• The Journal of Korean Academy of Prosthodontics
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• v.52 no.3
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• pp.246-251
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• 2014

In case of prosthesis fabrication by CAD/CAM, location, area and contour of occlusal contacts can be adjusted so more functional occlusion can be acquired. Also, errors in a manufacturing process is reduced compared to cast metal prostheses and porcelain fused metal prostheses fabricated by conventional methods such as casting and porcelain build up. Therefore, prostheses by CAD/CAM show superior occlusion accuracy. Recently, virtual articulator function has been introduced to CAD/CAM system, which reproduces mandibular movement against maxilla. Thus, it is possible to consider occlusal interference in anterior/lateral movement as well as closing movement. There have been many studies on the marginal and internal fit of prostheses using zirconia but the occlusal fit of zirconia crown fabricated by CAD/CAM has not been researched as much. In this case report, 7 zirconia crowns were designed and fabricated by CAD/CAM for total 5 patients. The models of zirconia crowns before and after occlusal adjustment during intraoral try-in were scanned for occlusal contacts, which were compared to evaluate accuracy of prostheses and understand patterns of occlusal adjustment. Most of the occlusal adjustments were done on functional cusps and slopes of zirconia crown, and the magnitude of occlusal adjustment ranged from $15{\mu}m$ to $60{\mu}m$. In the zirconia crown fabricated with CAD/CAM systems, the occlusal adjustment is a necessary procedure, so additional procedures will be needed for compensating reduced mechanical properties.

• The Journal of Korean Academy of Prosthodontics
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• v.54 no.3
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• pp.273-279
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• 2016

Severe tooth wear may lead to pathological changes of pulp, imbalance in occlusion as well as functional and esthetic problems. In this case, 34-year-old male came to the hospital because of generally worn dentition due to attrition and erosion. After evaluation, a full mouth restoration with elevation of the vertical dimension of occlusion was planned. After occlusion was stabilized by an occlusal stabilization appliance, centric relation position was recorded and subsequent provisional restorations were fabricated. After evaluation, a CAD-CAM (computer aided design-computer aided manufacturing) prosthetic restoration was carried out using monolithic zirconia. After 12 months of follow up observation, the patient was satisfied with function and esthetic appearance.

• The Journal of Korean Academy of Prosthodontics
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• v.56 no.4
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• pp.360-367
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• 2018

Extensive dental erosion and wear will cause serious loss of function and aesthetics in the mouth. In order to recover this condition, careful analysis of the patient's bite relationship is required. In particular, a treatment plan should be established considering the possibility of reproduction of the vertical dimension and centric relation, and appropriateness of the occlusal plane and anterior guidance. Also, the choice of prosthetic materials is an important consideration in patients with severe wear. In this case, patients with overall wear and erosion on tooth was established anterior guidance by orthodontic treatment and fully restored with monolithic zirconia, without increasing vertical dimension.

• Journal of Dental Rehabilitation and Applied Science
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• v.34 no.3
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• pp.196-207
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• 2018

An accurate implant placement with ideal location is significant for long-term success of the implant. An exact evaluation of nearby anatomic structures such as quality of residual bone, an inferior alveolar bone and a maxillary sinus is required. For a prosthetic-driven treatment, planned surgery, precise prosthesis and communication with the patient are significant requisites especially for full-mouth rehabilitation. In this case, the patient with severe alveolar bone resorption had a CT guided surgery supported by CT data and the data from scanning diagnostic wax-up. Afterward, edentulous area was restored by full mouth implant-supported prosthesis by using monolithic zirconia and CAD/CAM technique. This paper reports the outcome of the procedure which was remarkable both esthetically and functionally.

• The Journal of Advanced Prosthodontics
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• v.11 no.1
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• pp.23-31
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• 2019

PURPOSE. To investigate and compare the surface roughness (SR), weight and height of monolithic zirconia (MZ), ceramometal (CM), lithium disilicate glass ceramic (LD), composite resin (CR), and their antagonistic human teeth enamel. MATERIALS AND METHODS. 32 disc shaped specimens for the four test materials (n=8) and 32 premolars were prepared and randomly divided. SR, weight and height of the materials and the antagonist enamel were recorded before and after subjecting the specimens to 240,000 wear-cycles ($49N/0.8Hz/5^{\circ}C/50^{\circ}C$). SR, height, weight, and digital microscopic qualitative evaluation were measured. RESULTS. CM ($0.23+0.08{\mu}m$) and LD ($0.68+0.16{\mu}m$) exhibited the least and highest mean difference in the SR, respectively. ANOVA revealed significance (P=.001) between the materials for the SR. Paired T-Test showed significance (P<.05) for the pre- and post- SR for all the materials. For the antagonistic enamel, no significance (P=.987) was found between the groups. However, the pre- and post- SR values of all the enamel groups were significant (P<.05). Wear cycles had significant effect on enamel weight loss against all the materials (P<.05). CR and MZ showed the lowest and highest height loss of 0.14 mm and 0.46 mm, respectively. CONCLUSION. MZ and CM are more resistant to SR against the enamel than LD and CR. Enamel worn against test materials showed similar SR. Significant variations in SR values for the tested materials (MZ, LD, CM, and CR) against the enamel were found. Wear simulation significantly affected the enamel weight loss against all the materials, and enamel antagonist against MZ and CM showed more height loss.

• The Journal of Korean Academy of Prosthodontics
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• v.60 no.2
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• pp.135-142
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• 2022

Purpose. This study aims to evaluate the combined effect of reduced thickness in different regions on the fracture resistance of monolithic zirconia crowns. Materials and methods. Seven nickel-chromium dies were generated from a 3D model of mandibular first molar using the digital scanner with the following geometries: 1.5 mm occlusal reduction, 1.0 mm deep chamfer. Based on the abutment model, Zirconia blocks (Luxen Zirconia) were selected to fabricate Sixty-three zirconia crowns with occlusal thicknesses of 0.3 mm, 0.5 mm, and 1.5 mm, and different axial thicknesses of 0.3 mm, 0.5 mm, and 1.0 mm. All crowns were cemented by resin cement. Next, the crowns were subjected to load-to-fracture test until fracture using an electronic universal testing machine. In addition, fracture patterns were observed with a scanning electron microscope (SEM). Two-way ANOVA and the Tuckey HSD test for post hoc analysis were used for statistical analysis (P < .05). Results. The mean values of fracture resistancerecorded was higher than the average biting force in the posterior region. The two-way ANOVA showed that the occlusal and axial thickness affected the fracture resistance significantly (P < .05). However, the effect of axial thickness on fracture resistance did not show a statistical difference when thicker than 0.5 mm. The observed failure modes were partial or complete fracture depending on the severity of crack propagation. Conclusion. Within the limitations of the present study, the CAD-CAM monolithic zirconia crown with extremely reduced thickness showed adequate fracture resistance to withstand occlusal load in molar regions. In addition, both occlusal and axial thickness affected the fracture resistance of the zirconia crown and showed different results as combined.

• The Journal of Advanced Prosthodontics
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• v.10 no.2
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• pp.79-84
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• 2018

PURPOSE. All-ceramic restorations required extensive tooth preparation. The purpose of this in vitro study was to investigate a minimally invasive preparation and thickness of monolithic zirconia crowns, which would provide sufficient mechanical endurance and strength. MATERIALS AND METHODS. Crowns with thickness of 0.2 mm (group 0.2, n=32) or of 0.5 mm (group 0.5, n=32) were milled from zirconia and fixed with resin-based adhesives (groups 0.2A, 0.5A) or zinc phosphate cements (groups 0.2C, 0.5C). Half of the samples in each subgroup (n=8) underwent thermal cycling and mechanical loading (TCML)(TC: $5^{\circ}C$ and $55^{\circ}C$, $2{\times}3,000cycles$, 2 min/cycle; ML: 50 N, $1.2{\times}10^6cycles$), while the other samples were stored in water ($37^{\circ}C/24h$). Survival rates were compared (Kaplan-Maier). The specimens surviving TCML were loaded to fracture and the maximal fracture force was determined (ANOVA; Bonferroni; ${\alpha}=.05$). The fracture mode was analyzed. RESULTS. In both 0.5 groups, all crowns survived TCML, and the comparison of fracture strength among crowns with and without TCML showed no significant difference (P=.628). Four crowns in group 0.2A and all of the crowns in group 0.2C failed during TCML. The fracture strength after 24 hours of the cemented 0.2 mm-thick crowns was significantly lower than that of adhesive bonded crowns. All cemented crowns provided fracture in the crown, while about 80% of the adhesively bonded crowns fractured through crown and die. CONCLUSION. 0.5 mm thick monolithic crowns possessed sufficient strength to endure physiologic performance, regardless of the type of cementation. Fracture strength of the 0.2 mm cemented crowns was too low for clinical application.

• The Journal of Advanced Prosthodontics
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• v.9 no.6
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• pp.423-431
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• 2017

PURPOSE. The goal of this study was to evaluate the fracture resistances of various monolithic crowns fabricated by computer-aided design and computer-aided manufacturing (CAD/CAM) with different thickness. MATERIALS AND METHODS. Test dies were fabricated as mandibular molar forms with occlusal reductions using CAD/CAM. With different occlusal thickness (1.0 or 1.5 mm), a polymer-infiltrated ceramic network (Enamic, EN), and zirconia-reinforced lithium silicate (Suprinity, SU and Celtra-Duo, CD) were used to fabricate molar crowns. Lithium disilicate (e.max CAD, EM) crowns (occlusal: 1.5 mm) were fabricated as control. Seventy crowns (n=10 per group) were bonded to abutments and stored in water for 24 hours. A universal testing machine was used to apply load to crown until fracture. The fractured specimens were examined with a scanning electron microscopy. RESULTS. The type of ceramics and the occlusal thickness showed a significant interaction. With a recommended thickness (1.5 mm), the SU revealed the mean load similar to the EM, higher compared with those of the EN and CD. The fracture loads in a reduced thickness (1.0 mm) were similar among the SU, CD, and EN. The mean fracture load of the SU and CD enhanced significantly when the occlusal thickness increased, whereas that of the EN did not. CONCLUSION. The fracture loads of monolithic crowns were differently influenced by the changes in occlusal thickness, depending on the type of ceramics. Within the limitations of this study, all the tested crowns withstood the physiological masticatory loads both at the recommended and reduced occlusal thickness.

• The Journal of Advanced Prosthodontics
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• v.6 no.6
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• pp.456-461
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• 2014

PURPOSE. Translucency and colour stability are two most important aspects for an aesthetic dental restoration. Glass ceramic restorations are popular amongst clinicians because of their superior aesthetic properties. In the last decade, zirconia has generated tremendous interest due to its favorable mechanical and biological properties. However, zirconia lacks the translucency that lithium disilicate materials possess and therefore has limitations in its use, especially in esthetically demanding situations. There has been a great thrust in research towards developing translucent zirconia materials for dental restorations. The objective of the study was to evaluate and compare the transmittance of a translucent variant of zirconia to lithium disilicate. MATERIALS AND METHODS. Two commercially available zirconia materials (conventional and high translucency) and 2 lithium disilicate materials (conventional and high translucency) with standardized dimensions were fabricated. Transmittance values were measured for all samples followed by a microstructural analysis using a finite element scanning electron microscope. One way analysis of variance combined with a Tukey-post hoc test was used to analyze the data obtained (P=.05). RESULTS. High translucency lithium disilicate showed highest transmittance of all materials studied, followed by conventional lithium disilicate, high translucency zirconia and conventional zirconia. The difference between all groups of materials was statistically significant. The transmittance of the different materials correlated to their microstructure analysis. CONCLUSION. Despite manufacturers' efforts to make zirconia significantly more translucent, the transmittance values of these materials still do not match conventional lithium disilicate. More research is required on zirconia towards making the material more translucent for its potential use as esthetic monolithic restoration.

• Journal of Dental Rehabilitation and Applied Science
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• v.40 no.2
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• pp.72-81
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• 2024

Purpose: This study aimed to assess the marginal and internal fit of 3-unit monolithic zirconia fixed partial dentures (FPDs) fabricated via computer-aided design and computer-aided manufacturing (CAD/CAM) from solid working casts and removable die system. Materials and Methods: The tooth preparation protocol for a zirconia crown was executed on the mandibular right first premolar and mandibular right first molar, with the creation of a reference cast featuring an absent mandibular right second premolar. The reference cast was duplicated using polyvinyl siloxane impression, from which 20 working casts were fabricated following typical dental laboratory procedures. For comparative analysis, 10 FPDs were produced from a removable die system (RD group) and the remaining 10 FPDs from the solid working casts (S group). The casts were digitized using a dental desktop scanner to establish virtual casts and design the FPDs using CAD. The definitive 3-unit monolithic zirconia FPDs were fabricated via a CAM milling process. The seated FPDs on the reference cast underwent digital evaluation for marginal and internal fit. The Mann-Whitney U test was applied for statistical comparison between the two groups (α = 0.05). Results: The RD group showed significantly higher discrepancies in fit for both premolars and molars compared to the S group (P < 0.05), particularly in terms of marginal and occlusal gaps. Color mapping also highlighted more significant deviations in the RD group, especially in the marginal and occlusal regions. Conclusion: The study found that the discrepancies in marginal and occlusal fits of 3-unit monolithic zirconia FPDs were primarily associated with those fabricated using the removable die system. This indicates the significant impact of the fabrication method on the accuracy of FPDs.