• The Journal of Advanced Prosthodontics
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• 제15권1호
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• pp.44-54
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• 2023

PURPOSE. To assess the clinical performance of monolithic CAD-CAM lithium disilicate glass-ceramic (LDGC) crowns and metal-ceramic (MC) crowns provided by predoctoral students. This study also assessed the effects of patient and provider-related factors on their clinical performance as well as patient preference for these types of crowns. MATERIALS AND METHODS. Twenty-five patients who received 50 crowns (25 LDGC CAD-CAM and 25 MC) provided by predoctoral students were retrospectively examined. LDGC CAD-CAM crowns were milled in-house using the CEREC Bluecam system and cemented with either RelyX Unicem or Calibra Esthetic resin cements. MC crowns were cemented with RelyX Unicem cement. Clinical assessment of the crowns and the supporting periodontal structures were performed following the modified California Dental Association (CDA) criteria. Patients' preference was recorded using a visual analog scale (VAS). The results were statistically analyzed using log-rank test, Pearson Chi-squared test and Kaplan-Meier survival analysis. RESULTS. Twelve complications were observed in the MC crown group (9-esthetic, 2-technical and 1-biological). In comparison, 2 complications in the LDGC CAD-CAM crown group were observed (1-technical and 1-esthetic). The 6-year cumulative survival rates for MC crowns and LDGC CAD-CAM were 90.8% and 96%, respectively, whereas the success rates were 83.4% and 96%, respectively. Overall, patients preferred the esthetic outcomes of LDGC CAD-CAM crowns over MC crowns. CONCLUSION. The high survival and success rates, low number of complications, and the high level of patients' acceptance of monolithic LDGC CAD-CAM crowns lend them well as predictable and viable alternatives to the "gold standard" MC crowns.

• The Journal of Advanced Prosthodontics
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• 제13권1호
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• pp.36-45
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• 2021

Purpose. To investigate the fracture resistance of monolithic CAD-CAM all-ceramic surveyed crowns with two different occlusal rest seat designs. Materials and Methods. Two maxillary first premolar were prepared for all-ceramic surveyed crowns with wide (2/3rd of buccolingual width of an unprepared tooth) or narrow (1/3rd of buccolingual width of an unprepared tooth) disto-occlusal rest seat (ORS) designs. Eighty monolithic CAD-CAM all-ceramic surveyed crowns were prepared and divided into 4 groups - Group CR, Composite resin material as a control; Group LDS, Lithium disilicate based material; Group ZIPS, zirconia-material (IPS ZirCAD); and Group ZLHT, zirconia- material (CeramillZolidht+). Crowns were cemented on an epoxy resin die with adhesive resin cement. The fracture resistance of crowns was tested with the universal machine. Univariate regression analysis was used. Results. The mean ± standard deviation of maximum failure force values varied from 3476.10 ± 285.97 N for the narrow ORS subgroup of group ZIPS to 687.89 ± 167.63 N for the wide ORS subgroup of group CR. The mean ± standard deviation of maximum force was 1075 ± 77.0 N for group CR, 1309.3 ± 283.9 N for group LDS, 3476.1 ± 285.97 N for group ZIPS, and 2666.7 ± 228.21 N for group ZLHT, with narrow occlusal rest seat design. The results of the intergroup comparison showed significant differences in fracture strength with various material groups and occlusal rest seat designs (P<.001). Conclusion. The zirconia-based all-ceramic surveyed crowns fractured at more than double the load of Lithium disilicate based crowns. The crowns with narrow base occlusal rest seat design had statistically significantly higher fracture resistance than surveyed crowns with wide occlusal rest seat design. The use of narrow occlusal rest seat design in CAD-CAM all ceramic surveyed crowns provides higher fracture resistance, and therefore narrow occlusal rest design can be used for providing esthetics with high strength.

• The Journal of Advanced Prosthodontics
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• 제10권3호
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• pp.236-244
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• 2018

PURPOSE. To determine the discrepancy in monolithic zirconium dioxide crowns made with computer-aided design and computer-aided manufacturing (CAD/CAM) systems by comparing scans of silicone impressions and of master casts. MATERIALS AND METHODS. From a Cr-Co master die of a first upper left molar, 30 silicone impressions were taken. The 30 silicone impressions were scanned with the laboratory scanner, thus obtaining 30 milled monolithic yttrium stabilized zirconium dioxide (YSZD) crowns (the silicone group). They were poured and the working models were scanned, obtaining 30 milled monolithic yttrium stabilized zirconium dioxide (YSZD) crowns (the plaster group). Three predetermined points were analyzed in each side of the crown (Mesial, Distal, Vestibular and Palatal), and the marginal fit was evaluated with SEM (${\times}600$). The response variable is the discrepancy from the master model. A repeated measures ANOVA with two within subject factors was performed to study significance of main factors and interaction. RESULTS. Mean marginal discrepancy was $22.42{\pm}35.65{\mu}m$ in the silicone group and $8.94{\pm}14.69{\mu}m$ in the plaster group. The statistical analysis showed significant differences between the two groups and also among the four aspects. Interaction was also significant (P=.02). CONCLUSION. The mean marginal fit values of the two groups were within the clinically acceptable values. Significant differences were found between the groups according to the aspects studied. Various factors influenced the accuracy of digitizing, such as the design, the geometry, and the preparation guidance, as well as the texture, roughness and the color of the scanned material.

• 대한심미치과학회지
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• 제25권2호
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• pp.109-126
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• 2016

CAD/CAM의 발전으로 기존의 많은 보철물이 지르코니아로 대체되고 있다. 하지만 많은 치과기공사가 지르코니아 색조재현에 많은 어려움을 겪고 있다. 시행착오를 겪으며 이에대한 해결을 위해 많이 노력하였고 이에 이 논문에서는 Ko's coloring 기법에 대해 설명하고자 한다.

• The Journal of Advanced Prosthodontics
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• 제16권1호
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• pp.12-24
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• 2024

PURPOSE. This study aimed to evaluate the maximum vertical wear, volume wear, and surface characteristic of antagonist enamel, opposing monolithic zirconia or lithium disilicate crowns. MATERIALS AND METHODS. The study comprised 24 participants (n = 12), who were randomly allocated to receive either a 5 mol% Y-TZP or a lithium disilicate crown in positions which would oppose the natural first molar tooth. The contralateral first molar along with its antagonist was considered as the enamel opposing natural enamel control. Data collection was performed using an intraoral scanner and polyvinylsiloxane impression. The means of the maximum vertical loss and the volume loss at the occlusal contact areas of the crowns and the various natural antagonists were measured by 3D comparison software. A scanning electron microscope was subsequently used to assess the wear characteristics. RESULTS. The one-year results from 22 participants (n = 11) indicated no significant differences when comparing the zirconia crown's antagonist enamel (40.28 ± 9.11 ㎛, 0.04 ± 0.02 mm³) and the natural enamel wear (38.91 ± 7.09 ㎛, 0.04 ± 0.02 mm³) (P > .05). Also, there is no significant differences between lithium disilicate crown's antagonist enamel (47.81 ± 9.41 ㎛, 0.04 ± 0.02 mm³) and the natural enamel wear (39.11 ± 7.90 ㎛, 0.04 ± 0.02 mm³) (P > .05). CONCLUSION. While some studies suggested that monolithic zirconia caused less wear on opposing enamel than lithium disilicate, this study found similar wear levels to enamel for both materials compared to natural teeth.

• The Journal of Advanced Prosthodontics
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• 제8권3호
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• pp.194-200
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• 2016

PURPOSE. The prospective follow-up aimed to assess the performance of lithium disilicate crowns and clinical reasons of adverse events compromising survival and quality. MATERIALS AND METHODS. 58 patients were treated with 375 heat-pressed monolithic crowns, which were bonded with resin cement. Annual recalls up to five years included a complete dental examination as well as quality assessment using CDA-criteria. Any need for clinical intervention led to higher complication rate and any failure compromised the survival rate. Kaplan-Meier-method was applied to all crowns and a dataset containing one randomly selected crown from each patient. RESULTS. Due to drop-outs, 45 patients (31 females, 14 males) with the average age of 43 years (range = 17-73) who had 327 crowns (176 anterior, 151 posterior; 203 upper jaw, 124 lower jaw) were observed and evaluated for between 4 and 51 months (median = 28). Observation revealed 4 chippings, 3 losses of retention, 3 fractures, 3 secondary caries, 1 endodontic problem, and 1 tooth fracture. Four crowns had to be removed. Survival and complication rate was estimated 98.2% and 5.4% at 24 months, and 96.8% and 7.1% at 48 months. The complication rate was significantly higher for root canal treated teeth (12%, P<.01) at 24 months. At the last observation, over 90% of all crowns showed excellent ratings (CDA-rating Alfa) for color, marginal fit, and caries. CONCLUSION. Heat pressed lithium disilicate crowns showed an excellent performance. Besides a careful luting, dentists should be aware of patients' biological prerequisites (grade of caries, oral hygiene) to reach full success with these crowns.

• 대한치과의사협회지
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• 제56권7호
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• pp.366-374
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• 2018

Purpose : The purpose of this study was to compare the marginal fit of monolithic zirconia restorations fabricated form the conventional and the digital impression technique. Materials and methods : Ten patients were restored with monolithic zirconia restorations fabricated from the digital and the conventional impression technique. Before definitive insertion, silicone replicas were produced from all twenty crowns. The silicone replicas were cut in three sections; each section was evaluated at two points. The measurement was carried out by using a measuring microscope (Olympus BX 51) and I-Solution. Data from the silicone replica scores were analyzed by Shapiro-Wilk test for normal distribution and the t-test for equality of two population's mean. All tests were performed with ${\alpha}-level$ of 0.05. Results : The average marginal gaps of monolithic zirconia restorations were $133.81{\pm}36.46{\mu}m$ for the conventional impression technique, $90.07{\pm}9.47{\mu}m$ for the digital impression technique. No statistical differences were found between the two impression techniques Conclusion : Both prostheses presented clinically acceptable results with comparing the marginal fit.

• 대한치과기공학회지
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• 제38권3호
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• pp.119-125
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• 2016

Purpose: The purpose of this study is to evaluate the marginal gap of all-ceramic crowns fabricated by CEREC$^{(R)}$ in-office CAD/CAM system. Methods: The mandibular first molar was selected as the abutment for the experiments. Thirty working models were prepared. VITA Mark II(VM) and VITA Enamic(VE), LAVA Ultimate(LU) blocks were milled using CEREC MCXL with CEREC 3D system to construct 10 crowns for each groups. To measure marginal gap, milled restorations were examined under digital microscope with scale under 160x magnifications. The results were statistically analyzed using the one-way ANOVA and Tukey's HSD test(${\alpha}=0.05$). Results: There was no significant difference in the marginal gap regarding to ceramic materials(p>0.05). Conclusion: Single crowns fabricated using CEREC in-office CAD/CAM system provided clinically acceptable marginal gap. This confirmed that the type of ceramic material used does not determine the precision of fit of a prosthesis.

• The Journal of Advanced Prosthodontics
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• 제8권6호
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• pp.439-448
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• 2016

PURPOSE. The purposes of this study are to evaluate the internal and marginal adaptation of two widely used CAD/CAM systems and to study the effect of porcelain press veneering process on the prosthesis adaptation. MATERIALS AND METHODS. Molar of a lower jaw typodont resin model was prepared by adjusting a 1.0 mm circumferential chamfer, an occlusal reduction of 2.0 mm, and a $5^{\circ}$ convergence angle and was duplicated as an abrasion-resistant master die. The monolithic crowns and copings were fabricated with two different CAD/CAM system-Ceramil and Zirkonzahn systems. Two kinds of non-destructive analysis methods are used in this study. First, weight technique was used to determine the overall fitting accuracy. And, to evaluate internal and marginal fit of specific part, replica technique procedures were performed. RESULTS. The silicone weight for the cement space of monolithic crowns and copings manufactured with Ceramil system was significantly higher than that from Zirkonzahn system. This gap might cause the differences in the silicone weight because the prostheses were manufactured according to the recommendation of each system. Marginal discrepancies of copings made with Ceramil system were between 106 and $117{\mu}m$ and those from Zirkonzahn system were between 111 and $115{\mu}m$. Marginal discrepancies of copings made with Ceramil system were between 101 and $131{\mu}m$ and those from Zirkonzahn system were between 116 and $131{\mu}m$. CONCLUSION. Marginal discrepancy was relatively lower in Ceramil system and internal gap was smaller in Zirkonzahn system. There were significant differences in the internal gap of monolithic crown and coping among the 2 CAD/CAM systems. Marginal discrepancy produced from the 2 CAD/CAM systems were within a reported clinically acceptable range of marginal discrepancy.

• The Journal of Advanced Prosthodontics
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• 제13권4호
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• pp.216-225
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• 2021

PURPOSE. The aim of this study is to evaluate the effects of canine guidance occlusion and group function occlusion on the degree of stress to the bone, implants, abutments, and crowns using finite element analysis (FEA). MATERIALS AND METHODS. This study included the implant-prosthesis system of a three-unit bridge made of monolithic zirconia and hybrid abutments. Three-dimensional (3D) models of a bone-level implant system and a titanium base abutment were created using the original implant components. Two titanium implants, measuring 4 × 11 mm each, were selected. The loads were applied in two oblique directions of 15° and 30° under two occlusal movement conditions. In the canine guidance condition, loads (100 N) were applied to the canine crown only. In the group function condition, loads were applied to all three teeth. In this loading, a force of 100 N was applied to the canine, and 200-N forces were applied to each premolar. The stress distribution among all the components of the implant-bridge system was assessed using ANSYS SpaceClaim 2020 R2 software and finite element analysis. RESULTS. Maximum stress was found in the group function occlusion. The maximum stress increased with an increase in the angle of occlusal force. CONCLUSION. The canine guidance occlusion with monolithic zirconia crown materials is promising for implant-supported prostheses in the canine and premolar areas.