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d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 320–326

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Marginal and internal fit of pressed lithium disilicate partial
crowns in vitro: A three-dimensional analysis of accuracy
and reproducibility
Oliver Schaefer a,∗ , David C. Watts b , Bernd W. Sigusch c ,
Harald Kuepper a , Arndt Guentsch c
a
b
c

Jena University Hospital – Friedrich Schiller University Jena, Policlinic of Prosthetic Dentistry and Material Science, Jena, Germany
University of Manchester, School of Dentistry, Biomaterials Research Group, Manchester, United Kingdom
Jena University Hospital – Friedrich Schiller University Jena, Policlinic of Conservative Dentistry, Jena, Germany

a r t i c l e

i n f o

a b s t r a c t

Article history:

Objectives. The objective of this in vitro study was to visualize and to quantify the marginal

Received 18 November 2011

and internal fit of heat-pressed ceramic restorations by a novel three-dimensional proce-

Received in revised form

dure. Accuracy and reproducibility of the employed measuring method were determined.

15 December 2011

Methods. An acrylic model of a lower left first molar was prepared to receive a partial crown

Accepted 16 December 2011

and duplicated by single step dual viscosity impressions. Corresponding working casts were
formed from Type IV die stone and indirect restorations were fabricated from heat-pressable
lithium disilicate ceramics (IPS e.max Press, Ivoclar Vivadent AG, Schaan, Liechtenstein).

Keywords:

The acrylic tooth model and the ceramic partial crowns were digitized by a structure light

Marginal fit

scanner with a measurement-uncertainty of 4 ␮m and subjected to computer-aided quality

Internal fit

inspection. Visual discrepancies in marginal and internal fit were displayed with colors. For

Dental ceramics

quantitative analysis, mean quadratic deviations (RMS) were computed and analyzed by

Three-dimensional analysis

Student’s t-test (n = 5, ˛ = 0.05).

CAD/CAM

Results. Mean RMS-values for accuracy (reproducibility) ranged from 34 (14) ␮m for internal
areas to 78 (23) ␮m for marginal surfaces. Differences in accuracy (p = 0.003) and reproducibility (p < 0.001) were statistically significant. In general, areas with sharp internal line angles
such as occlusal ridges and the preparation finish line exhibited oversized dimensions,
whereas areas with rounded and soft internal line angles were undersized.
Significance. The viability of a computer-aided and three-dimensional approach for assessing
marginal and internal fit of indirect restorations was demonstrated. Thereby, the obtained
results track complex form changes as they occur during laboratory processing.
© 2011 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

1.

Introduction

A plethora of ceramic materials suitable for different indications such as inlays, onlays, crowns or fixed partial dentures

are commercially available [1]. The clinical success of these
restorations is closely connected to their mechanical properties, adequate cementation and bonding, accurate adaption
and reasonable esthetics [2]. Thereby, marginal and internal fit to the underlying tooth structure are essential criteria

Corresponding author at: An der Alten Post 4, 07740 Jena, Germany. Tel.: +49 3641 934471; fax: +49 3641 934472.
E-mail address: oliver.schaefer@med.uni-jena.de (O. Schaefer).
0109-5641/$ – see front matter © 2011 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.dental.2011.12.008

Bindl and Mörmann Stappert et al. 2.20]. KaVo Dental GmbH. Yuksel and Zaimoglu 2003 2003 2004 2004 2005 2005 2008 2008 2008 2008 2010 2011 2011 Optical microscopy/in vitro Optical microscopy/in vitro Optical microscopy/in vitro Optical microscopy/in vitro Scanning electron microscopy/in vitro Optical microscopy/in vitro Scanning electron microscopy/in vitro Scanning electron microscopy/in situ Optical microscopy/in vitro Optical microscopy/in vitro Optical microscopy/in vitro Optical microscopy/in vitro Optical microscopy/in vitro 147 (45)–167 (30) 46 (16) 68 (47) 65 (15)–89 (14) 44 (23) 51 (4) 166–246 (n/a) 56 (31) 54 (4)–61 (4) 85 (18) 35 (36) 56 (18) 93 (10) 206 (60) – – – 105 (53) – – – – 118 (23) – 17 (5) – which predetermine the longevity of a ceramic restoration [3]. Accuracy and reproducibility of the employed measuring method were determined. Brasseler GmbH. 2. filled with heavy-bodied impression material.5]. Materials and methods 2. Reich Stappert et al. along with ISO 4823:2000 [23] viscosity designations. Also. Tettnang. Thus. Al-Rabab’ah et al.2.1. Light-bodied impression material was injected on and around the prepared tooth and dispersed with syringe air for approximately 3 s. Germany) was prepared to receive a partial crown restoration. Keshvad et al. a variety of clinical trials and in vitro studies have been conducted to examine marginal and internal gap sizes (Table 1). Acceptable fit-discrepancies have been reported to range from 50 to 150 ␮m [3–15]. Schaan. IPS Empress 2. The primary null hypothesis was that differences between marginal and internal fit of heat-pressed ceramics were not statistically significant. The resulting layer may be digitized by optical systems. precise information on marginal and internal adaption are prerequisite towards long-term clinical success. was gently lowered into the seating position without applying any additional force. frameworks can be veneered with fluoroapatite porcelain to provide natural semi-translucent esthetics [21]. Additionally. A minimum . dissolution of cement. thereby providing improved mechanical stability [18]. a 1 mm rounded shoulder finish line of the buccal wall and a 1 mm deep occlusal box. Since poor adaption might lead to marginal discoloration.max Press. microleakage. the impressions were allowed to set three times longer than recommended by the manufacturer [24]. with 2–150 different measuring locations. The objective of this in vitro study was to visualize and to quantify the marginal and internal fit of pressed lithium disilicate partial crowns by a novel three-dimensional procedure. Germany) based on a hybrid chemical formulation of silicone and polyether structures (Vinylsiloxanether). Further details are listed in Table 2. Author Year Measuring method/study type Marginal gap (SD) in ␮m Internal gap (SD) in ␮m Addi et al. As enlarged internal incongruities might lead to incomplete bonding interfaces. and IPS e. The 3 mm deep approximal grooves were finished with oscillating diamond tips (SONICflex prep ceram. Biberach. Tooth preparation An acrylic model of a lower left first molar (AG-3 ZE 36. Liechtenstein). Quintas et al. Romao et al. Dimensional differences were examined spatially for the entire surface of a prepared molar. Common sample sizes range from 5 to 10 specimens per group. Germany) was used to achieve controlled tooth-substance removal. Although indirect ceramic restorations undergo complex three-dimensional form changes during their laboratory fabrication process [13]. selected in a systematic or random manner. a light-bodied vinylpolysiloxane can be injected between the restoration and the underlying die to replicate the cement space. evaluated photometrically. Frankenberger et al.max Press (both Ivoclar Vivadent AG. Baig et al. exposure of luting resin. that can compromise the integrity of ceramic restorations [11]. marginal and internal discrepancies have generally been evaluated in a one. To ensure adequate polymerization at room temperature.321 d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 320–326 Table 1 – Selected peer-reviewed studies on marginal and internal fit of the heat-pressable ceramics IPS Empress. In particular. Kettenbach GmbH. Yeo et al. increased plaque retention and secondary decay [4. using an elastomeric impression material (Identium.or two-dimensional context. Germany) in order to achieve 90◦ margins as well as rounded and soft internal line angles. contemporary lithium disilicate based ceramic cores may be used for replacing a single second premolar as a pontic in posterior fixed partial dentures [19. Eschenburg. Frasaco GmbH) and duplicated by single step dual viscosity impressions. The jaw model was mounted on a rectangular base containing three conical guidance pins to allow for standardized tray positioning.5 mm occlusal height reduction. Frasaco GmbH. Heat-pressable ceramics were developed to decrease inhomogeneities and porosities that usually occurred during conventional sintering [16]. A standard set of diamond burs suitable for ceramic preparations (Set 4562. specimens are sectioned to evaluate internal and marginal gap sizes by either optical or scanning electron microscopy. Impression taking and cast fabrication The prepared tooth was fastened to a typodont (AG-3. lithium disilicate crystals embedded into a glassy matrix prevent the propagation of microcracks [17]. or analyzed regarding its density and weight [22]. An individualized tray. With the introduction of the IPS Empress 2 material and its successor IPS e. The preparation featured a 1. All impressions were made at room temperature by a single investigator. Lemgo.

interferences on internal aspects were marked (Fit Checker II. Syringe air was used to remove excess surfactant and gently dry the impression surfaces. RMS can serve as a measure of how far deviations between two different datasets vary from zero. Levene’s test was used to determine equality of variances.max Press Invex Liquid.6.28]. Bad Homburg. Ivoclar Vivadent AG) using a combination of the lost-wax and heat-press techniques. mean marginal and internal gap values (RMS) and their standard deviations (SD) were calculated. featuring a measurement-uncertainty of 4 ␮m and a homogenous measuring-point-distance of 5 ␮m (data according to manufacturer). Jena. Internal surfaces were sandblasted with 100 ␮m aluminum oxide at 2 bar pressure. 2. Chicago).i − x2. SPSS Inc. Germany) and saved in a STL format (Surface Tessellation Language.26].3. Germany). Afterwards. Dimensional differences between the ceramic partial crowns and the prepared reference tooth were computed for every data point captured during digitalization. 1c).5. Three data points were combined to form triangles. A Student ttest was conducted to detect significant differences among RMS-values for accuracy and reproducibility (n = 5. starMed GbR. To compare congruent areas [22]. Thereafter. surface normals of the virtual preparation were inverted. x2. Digitalization The prepared tooth and the fabricated ceramics were digitized with a structure light scanner originally developed by the Frauenhofer Institute for Applied Optics and Precision Engineering (Flex 3A. Single light bands were projected onto the resin and ceramic surfaces and simultaneously recorded with three high-resolution camera lenses mounted fixed at predefined angles (triangulation angles). OR. 1b) [29]. Triangulation routines allowed the calculation of data points from the captured images that could be displayed in a common coordinate system. After removal. while the RMS between one and another of the crowns measures the reproducibility of the method [30]. After a holding time of 25 min the pressed crowns were divested. Almore International Inc. Glass ceramic ingots (HO 2. 2. .7× magnification (starVision SV1. and n is the total number of measuring points. corresponding gypsum casts were formed with Type IV die stone (Tewerock. approximately 0.. STL records of the preparation and restorations were superimposed one on the other by computing all possible orientations and selecting the one with the best object-to-object penetration (so called Best-Fit-Method. the restorations were fitted to their corresponding gypsum dies.max Press. All restorations were manufactured under supervision by the same dental technician at a commercial laboratory (Böhme Zahntechnik. The recommended ratio of 20 mL of distilled water to 100 g of powder was vacuum mixed (Wamix-Classic. Ivoclar Vivadent AG) for 10 min. Preciseness and repeatability measurements were performed with emphasis on the preparation finish line (marginal fit) and the entire inner surface of the reference tooth (internal fit). Datasets for each restoration and the reference tooth were computed (Qualify 12. Ivoclar Vivadent AG). Germany) and systematically removed by watercooled diamond burs. GC Germany GmbH. Partial crown fabrication Five partial crowns were fabricated from lithium disilicate glass ceramics (IPS e. Fig. low RMS-scores indicate high three-dimensional congruency of the superimposed records. Germany). Hamburg. ˛ = 0. The mean quadratic deviation (root mean square. A consistent amount of surfactant (three spray bursts. Ivoclar Vivadent AG.. leading to highly accurate virtual representations of the digitalized objects. Fit evaluation Color-coded difference images were used to examine the congruency of preparation and restorations qualitatively (Fig. Ivoclar Vivadent AG) into an investment mold (IPS PressVEST Speed. 2. separated and cleaned by applying 1% hydrofluoric acid (IPS e. USA) to reduce surface tension and improve the quality of the resulting cast [27. In the present study.i is the measuring point i on duplicate. Otto Vision Technology GmbH.5 mL) was dispersed into the impression negatives and remained there for 30 s. Stuttgart.4. Therefore. The RMS of the virtual preparation compared to the partial crowns accounts for general accuracy. 2. Germany). Prior to die formation.i is the measuring point i on reference. Kettenbach GmbH). RMS) was calculated by the following formula:  RMS = n (x i=1 1. Finally. all impressions were inspected for defects by using 2. Germany). Statistical analysis Using statistical software (SPSS Statistics 19. Material Identium Light Identium Heavy Mixing ratio 1:1 5:1 Mixing technique Automatic Automatic ISO 4823 type [23] Working time in s Setting time in s Hardness in shore A Batch number 3 1 120 120 330 330 46 60 100051 90761 material thickness of 3 mm around the prepared tooth minimized distortion once the impression was separated [25.i ) 2 n where x1. Munich. Jena.05). Wassermann Dental-Maschinen GmbH. then slowly vibrated (KV-16. LOT P30472) were plasticized at 930 ◦ C and vacuum pressed (EP 500 press furnace. standard for CAD/CAM data exchange). Portland. Wassermann Dental-Maschinen GmbH) into the impressions and allowed to set for 45 min before removal and final inspection. Geomagic GmbH. the impressions were treated with a surfactant (Debubblizer Surfactant.322 d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 320–326 Table 2 – Selected characteristics of the Vinylsiloxanether impression material used in the present study.

(For interpretation of the references to color in this figure legend. Results Table 3 shows the results for accuracy and reproducibility measurements of marginal and internal surfaces. Occlusal boxes (4/5) and outer approximal grooves (3/5) were partially enlarged. Therefore.693. This hypothesis was rejected.) Discussion The primary null hypothesis of this in vitro study was that differences between marginal and internal fit of heat-pressed ceramics were not statistically significant. Lowest potential stress concentrations were recorded at the occluso-approximal isthmus (2/5). Optical digitalization allows for very precise detection and virtual reproduction of dental surface structures. Statistically significant differences between marginal and internal fit emerged for both accuracy (p = 0. inner approximal grooves) showed decreased dimensions (5/5). comparison to previously conducted research is difficult.05. However. Variances were equally distributed (p > 0.323 d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 320–326 Table 3 – Mean (SD) RMS-values in ␮m for marginal and internal fit discrepancies. since different measurement methods were employed. the reader is referred to the web version of this article. Color-coded difference images (Fig. Traditionally.or two-dimensional approaches. By contrast. without data loss due to specimen sectioning or destruction.g. marginal and internal fit may be evaluated simultaneously by direct data acquisition. 3.31] remained. Furthermore. Nevertheless. restorations were digitized with a mean number of 1.256 data points per specimen to allow for precise and complete analyses. Luthardt et al. For this study. 2) allowed qualitative congruency analyses. Discrepancies are calculated and displayed with colors (c).or scanning electron microscopy has been used to evaluate marginal and internal adaption. a novel three-dimensional procedure was introduced in the present study that may generate more clinically relevant information than the previously used one.13] or indirect data acquisition [22. 4. Areas with sharp internal line angles such as occlusal ridges (5/5 specimens) and the preparation finish line (5/5) exhibited oversized dimensions. In particular. [31] described a three-dimensional “replica technique” for analysis of internal discrepancies. optical.05). areas with rounded and soft internal line angles (e. Blue shades indicate negative deviations (smaller partial crown) whereas yellow to red shades indicate positive deviations (larger partial crown). Accuracy (preparation versus restoration) Marginal discrepancy Internal discrepancy 78 (18)a 34 (14)b Reproducibility (restorations among one another) 23 (3)a 14 (2)b Different superscript letters within each column indicate statistically significant differences at p < 0. 1 – Experimental procedure for marginal and internal fit analysis. The obtained results imply high accuracy and precision of the presented method and accord with reported values of in vitro and in situ studies (Table 1). thereby surpassing the . since statistically significant differences emerged. difficulties with specimen sectioning [3–5. Fig.003) and reproducibility measures (p < 0. Virtual reference tooth (a) and ceramic partial crown are aligned one to another (b).001). preparation finish lines were continuously evaluated.

the reader is referred to the web version of this article. (For interpretation of the references to color in this figure legend.324 d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 320–326 Fig. Different lowerscript letters indicate different specimens fabricated in the current study. 2 – Color-coded difference images for qualitative deviation analysis of internal (left column) and marginal surfaces (right column).) .

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