Microleakage of ceramic inlays luted

with different resin cements and dentin

adhesives
Bulent Uludag, DDS, PhD,a Ozge Ozturk, DDS, PhD,b and
A. Nilgun Ozturk, DDS, PhDc
Faculty of Dentistry, University of Ankara, Ankara, Turkey; Faculty
of Dentistry, University of Selcuk, Konya, Turkey
Statement of problem. Despite recent advances in adhesive dentistry, resin cement/dentin adhesive combinations
are not able to prevent microleakage in ceramic inlays. Marginal quality of tooth-colored restorations in large Class II
cavities is satisfactory in enamel margins, but microleakage in dentin margins remains a concern.

Purpose. The purpose of this study was to evaluate the microleakage of all-ceramic inlays luted with 2 dual-polymeriz-
ing resin cements or 1 autopolymerizing resin cement in combination with different dentin adhesives.

Material and methods. One hundred and twenty extracted human mandibular third molars were used in this study.
Teeth were prepared to receive Class II MOD inlays with enamel gingival margins on 1 proximal surface and dentin
gingival margins on the other surface. One hundred and twenty prepared teeth were divided into 3 groups of 40; 1
group for each resin cement: RelyX ARC, Variolink II, or Panavia 21. Each of the 3 groups were further divided into 4
dentin adhesive groups; Single Bond, ExciTE DSC, ED Primer, or Admira Bond. Each of the resin cements were used in
combination with the 4 dentin adhesives, and IPS Empress ceramic inlays were placed with 12 different cement/adhe-
sive combinations. After 1000 thermal cycles in a 5°-55°C water bath with a dwell time of 30 seconds, all specimens
were subjected to cyclic axial mechanical loading. Then the restored teeth were stored in 0.5% basic fuchsin solution
for 24 hours. The extent of dye penetration along the margins was measured with a stereomicroscope at x40 magnifi-
cation. The data were evaluated statistically using repeated-measures ANOVA and Duncan tests (α=.05).

Results. Microleakage at dentin margins was greater than that at enamel margins (P<.05) for all groups. Variolink II
and RelyX ARC resin cements showed significantly lower microleakage results than Panavia 21 with all dentin adhe-
sives in enamel margins. For dentin margins, Variolink II/Admira Bond combination showed the lowest microleakage
value in dentin (P<.05).

Conclusions. The overall microleakage at the enamel margins was significantly less than at the dentin margins (P<.05).
Panavia 21 showed higher microleakage values than Variolink II and RelyX ARC in enamel margins. (J Prosthet Dent
2009;102:235-241)

Clinical Implications
The results of this study suggest that there are no significant dif-
ferences in microleakage at dentin margins between dual-polym-
erizing resin cements and autopolymerizing resin cements with
the different cement/adhesive combinations evaluated.

Efficient adhesion between cav-
ity walls and restorative materials is
important for long-lasting restora-
tions.1,2 Microleakage of cariogenic
bacteria along the cavity walls of
restorations is reported to be a sig-
nificant cause of pulpal inflamma-
tion, pulp necrosis,3-7 and secondary
caries4-8 in restored teeth. The signs
of microleakage include immediate
postoperative sensitivity, chronic sen-
sitivity, and marginal discoloration.9-11
Microleakage at the enamel-resto-
ration interface has been minimized
since the introduction of acid etch-
ing by Buonocore in 1955,12 but seal-
ing dentin margins remains a chal-
lenge.2,7,13,14

a
Professor, Department of Prosthodontics, University of Ankara, Faculty of Dentistry.
b
Private practice, Istanbul, Turkey.
c
Associate Professor, Department of Prosthodontics, University of Selcuk, Faculty of Dentistry.
Uludug et al
236
Composite resin restorative ma-
terials undergo significant volumetric
shrinkage when polymerized. It has
been suggested that this property re-
sults in poor margin quality in com-
posite resin restorations.1 Different
composite resin restorative systems
and techniques have been developed,
and direct composite resin placement
is one of these techniques.15 However,
clinicians have difficulty establish-
ing proper anatomic form, proximal
contour, and contact in large, direct
placement composite resin restora-
tions. Indirect inlay systems have been
developed to overcome this limitation
of direct placement restorations.16
One of the advantages attrib-
uted to the ceramic inlay technique
is a thermal expansion coefficient of
the ceramic which is similar to that
of the tooth hard substance, as well
as the reduced volume of shrinking
composite resin (limited to the luting
resins), both of which are known to
have positive effects on marginal ad-
aptation.17-20
Clinical success with ceramic in-
lays/onlays has been assisted by the
development of a reliable bond be-
tween composite resin and dental tis-
sues.21,22 Generally, an adhesive resin
cement is recommended for luting
ceramic inlays,23 particularly because
of the excellent esthetic and mechani-
cal properties (flexural strength, com-
pressive strength) of adhesive resin
cements.20,24,25 Light-polymerized, du-
al-polymerized, and autopolymerized
luting composite resins have all been
used with ceramic inlays.26-28 Etched
enamel12 provides an ideal surface
for reliable bonding performance us-
ing adhesive resins.29,30 Success with
bonding to dentin, however, has been
less reliable due to the unique char-
acteristics of the dentin substrates,
including high organic content, tubu-
lar structure variations, and the pres-
ence of outward fluid movement.31-37
In an attempt to improve the bond
between dentin and composite resin,
a number of dentin adhesives have
been introduced. These react to form
chemical or micromechanical bonds
The Journal of Prosthetic Dentistry
between the tooth structure and the
restoration.38
There are 2 types of tooth sur-
face treatments. The total-etch tech-
nique involves conditioning enamel
and dentin with phosphoric acid in
a single step. To avoid overetching
the dentin, the phosphoric acid gel is
usually applied first to the enamel
margins and then to the dentin sur-
face.39 Self-etching adhesives, how-
ever, contain acidic monomers which
are copolymerized with adhesive
monomers after surface condition-
ing.39-41 An intrinsic problem of self-
etching systems is the acid-base re-
action of the acidic monomers with
the amines used in the initiator sys-
tems,39,42,43 such as the camphorqui-
none/amine system in light-polymer-
izing adhesives.
Many techniques involving dyes
have been used to assess microleak-
age both in vivo and in vitro. Dye pen-
etration is a technique to determine
the loss of adhesion. Other methods,
such as the silver nitrate staining tech-
nique, or penetration of radioactive
substances, are not commonly used
because they are time-consuming
and the handling of these materials
is difficult.44 Digital image analysis
allows quantitative measurement of
the length of dye penetration. This
method can assess the condition and
amount of microleakage of restora-
tions more accurately than the tradi-
tional scoring system that made mi-
croleakage studies more subjective.45
The purpose of this study was to
evaluate the microleakage of all-ce-
ramic inlays luted with 2 dual-polym-
erizing resin cements and 1 autopoly-
merizing resin cement in combination
with different dentin adhesives. The
null hypothesis was that the adhesive/
cement combinations have no effect
on microleakage.
MATERIAL AND METHODS
One hundred and twenty extract-
ed caries- and restoration-free hu-
man mandibular third molars were
used in this study. The teeth were
Volume 102 Issue 4
stored in 0.5% thymol (Merck KGaA,
Darmstadt, Germany) at room tem-
perature from the day of extraction.
The teeth were cleaned using scalers
and rotating brushes to completely
remove soft tissue remnants. Teeth
were embedded up to 2 mm apical to
the cemento-enamel junction in auto-
polymerizing resin (Palavit G; Heraeus
Kulzer GmbH, Wehrheim, Germany).
The teeth were prepared for Class
II MOD inlays. All preparations were
made according to the following cri-
teria using inlay diamond rotary cut-
ting instruments (Inlay Prep Kit 4261;
Komet Dental, London, UK): 10 de-
grees of axial wall convergence; flat
floor; 3-mm depth and 4-mm width
of the isthmus; 1 proximal box lim-
ited to enamel (1 mm coronal to the
cemento-enamel junction), and the
other extending 1 mm apical to the
cemento-enamel junction. Impres-
sions were then made with polyether
impression material (Impregum F;
3M ESPE, Seefeld, Germany) of all
specimens, and refractory dies were
prepared (Cergo Fit; Dentsply Degu-
Dent GmbH, Hanau, Germany).
To fabricate the IPS Empress in-
lays, restoration patterns were waxed
(Yeti Dentalprodukte GmbH, Engen,
Germany), sprued, and invested
with refractory material (AlphaDie
MF; Schütz-Dental GmbH, Rosbach,
Germany). The paper ring and sprue
former were removed after 1 hour.
The molds were then transferred to
a burn-out furnace (Vulcan 3-550,
Dentsply Ceramco, York, Pa), heated
from room temperature to 250°C at
a rate of 5°C/min, held at 250°C for
30 minutes, then further heated from
250° to 850°C at a rate of 5°C/min,
and finally held at 850°C for 60 min-
utes. After completion of the heating
cycles, the investment ring was imme-
diately removed from the heating fur-
nace, and the cold ingot was placed in
the investment ring. The investment
ring with the ingot and the alumina
plunger were transferred to the 700°C
preheated pressing furnace (EP 600;
Ivoclar Vivadent, Schaan, Lichten-
stein). For the IPS Empress ceramics,
Uludug et al
October 2009
the furnace was heated from 700° to
1180°C. The ingot was subjected to
a plunger pressure of 5 bar, as recom-
mended by the manufacturer. After
pressing, the ceramic inlays were di-
vested, finished with diamond rotary
cutting instruments (ND.0136.006;
Komet Gebr Brasseler GmbH, Lemgo,
Germany), and glazed.
One hundred and twenty prepared
teeth were divided into 3 groups of
40, 1 group for each of 3 resin ce-
ments: RelyX ARC, Variolink II, and
Panavia 21. Each of the 3 groups was
further divided into 4 dentin adhesive
groups: Single Bond, ExciTE DSC, ED
Primer, and Admira Bond. Each of the
resin cements was used in combina-
tion with the 4 dentin adhesives. The
resin cements and dentin adhesives
used in this study are described in
Table I.
All of the ceramic inlays were
etched with 9.6% hydrofluoric acid
(Porcelain Etch Gel; Pulpdent Corp,
Watertown, Mass) for 2 minutes. For
Panavia 21 resin cement, a layer of a
silane coupling agent mixture (Clearfil
Porcelain Bond Activator and Clearfil
SE Bond Primer; Kuraray Co Ltd, Osa-
ka, Japan) was applied to the ceramic
bonding (intaglio) surfaces for 5 sec-
onds, then air dried. For Variolink II
and RelyX ARC, a layer of silane cou-
pling agent (Silane Bond Enhancer;
Pulpdent Corp) was applied to the ce-
ramic bonding surfaces for 1 minute,
then air dried.
For the RelyX/Single Bond group,
35% phosphoric acid gel (Scotchbond
Etchant; 3M EPSE, St. Paul, Minn)
was applied to the enamel surface for
30 seconds and the dentin surface for
15 seconds, water rinsed for 10 sec-
onds, and then gently air dried for 5
seconds. Single Bond was applied to
237
the cavity surface, gently air dried for
5 seconds, and polymerized for 10
seconds with the light-polymerizing
unit (Hilux 200 Light Curing Unit;
Benlioglu Dental, Ankara, Turkey).
RelyX ARC was mixed for 10 sec-
onds and applied to both prepared
teeth and the bonding surface of the
ceramic restorations. A static load (1
kg) was used to stabilize the inlays
during the bonding procedure. Ex-
cessive cement was removed with an
explorer, and the cement was polym-
erized for 40 seconds with the light-
polymerizing unit at 350 mW/cm2
with a light tip-to-specimen distance
of 2 mm.
For the RelyX/ExciTE DSC group,
35% phosphoric acid gel (Scotch-
bond Etchant; 3M ESPE) was applied
to the enamel surface for 30 seconds
and the dentin surface for 15 sec-
onds, water rinsed for 10 seconds,

Table I. Resin cements and dentin adhesives used in this study

Resin Batch
Cement Manufacturer Number Composition

RelyX ARC 3M ESPE, St. Paul, Minn 20050524 Bis-GMA, TEGDMA, silica-zirconia glass

Variolink II Ivoclar Vivadent, G13371 Bis-GMA, UDMA, TEGDMA silicon dioxide,

Schaan, Liechtenstein autopolymerizing initiators, light-polymerizing
initiators, stabilizer, pigments

Panavia 21 Kuraray Co Ltd, 41235 Bis-GMA, MDP, quartz, benzoyl peroxide, initiators,
Osaka, Japan phosphate, monomer, amine, sulfine, stabilizer

Dentin Batch
Adhesive Manufacturer Number Composition

Single Bond 3M ESPE 7MH Bis-GMA, polyalkenoic acid co-polymer, dimethacrylate,

HEMA, photoinitiators, ethanol, water

ExciTE DSC Ivoclar Vivadent G11590 HEMA, dimethacrylate, phosphonic acid acrylate,
silicon dioxide, initiators, stabilizer, alcohol

ED Primer Kuraray Co Ltd 41154 HEMA, 5-MASA, MDP, water, catalyst

Admira Bond VOCO GmbH, 779921 Ormocer (organically modifed ceramic), bis-GMA,
Cuxhaven, Germany HEMA, organic acid, acetone

Bis-GMA: bisphenol-A glycidyl dimethacrylate; TEGDMA: tetraethyleneglycol dimethacrylate; UDMA: urethane dimethacrylate;
MDP: 10-methacryloyloxy-decyl dihydrogen phosphate; HEMA: 2-hydroxyethyl methacrylate; 5-MASA: methacryloyl-5-aminosalicylic acid

Uludug et al
238
and gently air dried for 5 seconds.
ExciTE DSC was applied to the cavity
surface, gently air dried for 3 seconds,
and polymerized for 10 seconds with
the light-polymerizing unit. RelyX
ARC was applied in the same man-
ner. For the RelyX/ED Primer group,
ED Primer was applied to the cavity
surface for 60 seconds and gently air
dried. RelyX ARC was applied as pre-
viously described.
For the RelyX/Admira Bond group,
35% phosphoric acid gel (Scotchbond
Etchant; 3M ESPE) was applied to the
enamel surface for 30 seconds and
the dentin surface for 15 seconds, wa-
ter rinsed for 10 seconds, and gently
air dried for 5 seconds. Admira Bond
was applied to the cavity surface for
30 seconds, gently air dried, and po-
lymerized for 10 seconds with the
light-polymerizing unit. RelyX ARC
was applied. Variolink II and Panavia
21 resin cements were used in combi-
nation with the 4 dentin adhesives in
the same manner.
After 24 hours of storage in wa-
ter at 37°C, all teeth were subjected
to 1000 thermal cycles (Thermal Cy-
cle; Nüve, Ankara, Turkey) between
5°and 55°C using a dwell time of
30 seconds. All specimens were sub-
jected to cyclic axial mechanical load-
ing (100,000 cycles, 1.6 Hz, constant
occlusal load of 50 N) using a 5-mm
steel ball. Specimens were coated with
nail polish (Del Laboratories, Inc,
Uniondale, NY) 1 mm short of the
restoration margins and immersed
in 0.5% basic fuchsin dye (SPI Sup-
plies Division, Structure Probe, Inc,
West Chester, Pa) for 24 hours. Fol-
lowing removal from the solution, the
teeth were rinsed under tap water and
embedded in autopolymerizing orth-
odontic acrylic resin (Orthocryl EQ;
Dentaurum, Ispringen, Germany).
Each tooth was vertically sectioned
twice mesial-distally, through the
restorations along the long axis, into
0.5-mm-wide sections, with a water-
cooled diamond disc (Mikrocut; Met-
kom, Bursa, Turkey). Four specimens
(0.5 x 10 x 15 mm) were made from
each tooth.
For each specimen, dye penetra-
tion along the cavity walls in dentin
and enamel on each of the 4 sec-
tioned surfaces was digitally photo-
graphed at x40 under a stereomicro-
Volume 102 Issue 4
scope (Carl Zeiss AG, Oberkochen,
Germany), and the data were trans-
ferred to a personal computer. For
each specimen, staining along the
cavity walls was measured using im-
age analysis software (KS 400 Image
for Windows; Carl Zeiss AG) and the
percentage of dye penetration was
calculated in relation to the entire
cavity length. The differences in the
amount of dye penetration along the
cavity walls were evaluated statistical-
ly using repeated-measures analysis of
variance (ANOVA) and Duncan tests
(α=.05).
RESULTS
Table II illustrates the mean per-
centage and SD for the microleakage
results obtained with the 2 resin ce-
ments in combination with the 4 den-
tin adhesives. The results of repeated-
measures ANOVA are summarized in
Table III and indicate that microleak-
age values vary according to the resin
cements and dentin adhesives (P<.05)
used. There were significant differ-
ences in microleakage between the
enamel and dentin margins (P<.05).

Table II. Percent mean values and SD for microleakage (n=10)

Enamel Dentin

Variolink II RelyX ARC Panavia 21 Variolink II RelyX ARC Panavia 21

Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD

ExciTE Ab Aa βb Aβ a βa Aa
β0.58 0.81 Aβ1.38 1.95 A2.69 2.77 β2.21 1.57 β2.91 2.45 A9.08 2.29
DSC

Single Ab Ab Ab Aa Aβ a Aa
β0.56 1.1 β0.23 0.32 A5.58 2.87 β3.52 2.21 β3.53 2.97 A10.93 2.50
Bond

ED Aa Ab Aβ a Aβ a Aa βa
β1.01 1.22 β0.54 0.90 A3.99 2.76 A1.90 1.98 A5.00 3.59 A5.44 2.83
Primer

Admira Aa Ab Aβ b βa Aβ a βa
β0.75 1.22 β1.39 1.59 A3.81 1.63 β0.93 1.28 A4.74 2.70 A6.66 1.73
Bond

Superscripted lowercase letters (a, b) indicate differences in cement/bonding agent combination (with respect to orientation);
right superscript characters (A, Aβ, and β) indicate differences in orientation/cement combination (with respect to bonding agent);
left subscript characters (β, Aβ, and A) indicate differences in orientation/bonding agent combination (with respect to cement).
Same characters on same sides (left or right) of values indicate no significant difference in results (P<.05).

The Journal of Prosthetic Dentistry Uludug et al

October 2009
Table III. Results of repeated-measures ANOVA
Source
Between Groups
Cement
Bonding agent
Cement x bonding agent
Within groups
Orientation
Orientation x cement
Orientation x bonding agent
Orientation x cement x bonding agent
Microleakage at the dentin mar-
gins was greater than that at the
enamel margins (P<.05) for all groups.
Variolink II and RelyX ARC resin ce-
ments showed the lowest microleak-
age results with all dentin adhesives in
enamel margins. Panavia 21 showed
higher microleakage values than
Variolink II and RelyX ARC. The low-
est microleakage value was obtained
with RelyX/Single Bond in enamel for
all resin cements (P<.05). With den-
tin margins, there were no significant
differences between RelyX ARC and
Variolink II combinations with Single
Bond and ExciTE DSC dentin adhe-
sives. However, the Variolink II/Ad-
mira Bond combination showed the
lowest microleakage value in dentin
(P<.05). Panavia 21 combined with
ED Primer showed the lowest micro-
leakage compared to the other Pana-
via 21/dentin adhesive combinations.
DISCUSSION
With regard to the influence of
the adhesive/cement combinations
on the dentin margins, the results of
this study do not support rejection
of the null hypothesis. This study is
in agreement with other studies35-37
in which enamel margins demon-
Uludug et al
Sum of Mean
Squares Square
928.0 464.0
46.0 15.3
132.8 22.1
491.0 491.0
69.9 35.0
30.1 10.0
89.5 15.0
strated a good seal, in contrast to the
dentin margins, because the smallest
degree of microleakage was observed
in enamel. It is also known that the
composition and other special char-
acteristics of luting agents, such as
the setting properties and the dentin
adhesives used, determine the degree
of leakage.7 Universal dentin adhe-
sives have been recommended for
bonding porcelain, composite resin,
and alloy to both dentin and enamel.
One reported benefit of these agents
is the ability to seal dentin, which re-
sults in a reduction of interfacial mi-
croleakage and pulpal sensitivity.29,30
For all-ceramic inlays, microleakage
is an important consideration for pre-
serving the marginal seal due to less
than ideal marginal adaptation of the
porcelain material.29
The total-etch technique involves
conditioning enamel and dentin with
phosphoric acid in a single step. Self-
etching adhesives, however, contain
acidic monomers which are copo-
lymerized with adhesive monomers
after surface conditioning.39,40 There-
fore, self-etching cementation sys-
tems require no rinsing step and are
therefore generally less technique
sensitive.40 Variolink II and RelyX ARC
resin cements showed the lowest mi-
239
df F P
2 77.9 <.001
3 2.57 .050
6 3.72 .002
1 138.1 <.001
2 9.83 <.001
3 2.82 .042
6 4.19 <.001
croleakage results with all dentin ad-
hesives in enamel margins. Panavia 21
combined with the self-etching adhe-
sive, ED Primer, showed significantly
higher microleakage values than
Variolink II and RelyX ARC in enamel
margins. This can be explained by the
2 different enamel bonding mecha-
nisms of the total-etch and the self-
etching techniques. The slow polym-
erization rate of Panavia 21 may allow
more water to diffuse from the vital
dentin into the hydrophilic interface
between the Panavia 21 primer and
dentin, due to its more hydrophibic
nature.39,41 The 2 phases seem to
weaken the interface.
With dentin margins, there were
no significant differences between
dual-polymerizing resin cements and
the autopolymerizing resin cement. In
a recent study in which ceramic inlays
cemented with a dual-polymerized or
autopolymerized composite resin lut-
ing agent were clinically evaluated,
Sjögren et al28 reported no signifi-
cant differences between the 2 luting
agents. These findings were confirmed
by van Dijken et al,27 who investigated
the use of a dual-polymerized and an
autopolymerized composite resin lut-
ing agent in restorations with exten-
sive dentin/enamel-bonded ceramic
240
coverage. An in vitro study of micro-
leakage found significantly worse re-
sults in dentin compared to enamel
margins for Variolink II/Excite and
Panavia F/ED Primer. However, there
were no significant differences be-
tween Variolink II/Excite and Panavia
F/ED Primer.26 These differences in
study results can be explained by the
differences in cavity widths and tooth
types.
The smallest degree of microleak-
age was achieved in enamel. Dentinal
adhesion has been shown to be less
predictable. Much of the difficulty in
bonding to dentin is the result of the
complex histological structure and
the variable composition of dentin.34
The results from the current study
compare favorably with other stud-
ies in which enamel margins demon-
strated a good seal, in contrast to the
dentin margins.35-37 Although lower
microleakage values were obtained
by using the manufacturer’s recom-
mended adhesive/composite resin
luting cement, similar microleakage
results were obtained by using differ-
ent adhesive system/composite resin
luting cement combinations. Signifi-
cant differences in microleakage val-
ues were specific to the proprietary
brand of the bonding agent.
The limitations of this study in-
clude that there was no evaluation
of the effect of nonaxial loading and
lateral movement. In vitro tests have
been used to study some properties
of materials to provide information
about their potential clinical perfor-
mance. However, in vitro tests cannot
adequately simulate clinical condi-
tions. Thus, the results of in vitro tests
should be applied with caution to the
clinical situation. The final evaluation
of a material, including resin cements,
should be performed in long-term
clinical studies.
CONCLUSIONS
Within the limitations of this in
vitro investigation, the following con-
clusions were drawn:
The Journal of Prosthetic Dentistry
1. Microleakage at enamel mar-
gins was significantly less than at den-
tin margins (P<.05).
2. The autopolymerizing resin ce-
ment Panavia 21 showed signficantly
higher microleakage values than Vari-
olink II and RelyX ARC in enamel mar-
gins, but no significant differences
were found in dentin margins for the
all-ceramic material evaluated.
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Corresponding author:
Dr Bulent Uludag
Ankara University
Department of Prosthodontics, Faculty of
Dentistry
06500 Besevler/Ankara
TURKEY
Fax: + 90 312 212 39 54
E-mail: bculudag@gmail.com
Copyright © 2009 by the Editorial Council for
The Journal of Prosthetic Dentistry.

Noteworthy Abstracts of the Current Literature

Marginal and internal fits of fixed dental prostheses zirconia retainers

Beuer F, Aggstaller H, Edelhoff D, Gernet W, Sorensen J.

Dent Mater 2009;25:94-102. Epub 2008 Jul 11.

Objectives: CAM (computer-aided manufacturing) and CAD (computer-aided design)/CAM systems facilitate the use
of zirconia substructure materials for all-ceramic fixed partial dentures. This in vitro study compared the precision of
fit of frameworks milled from semi-sintered zirconia blocks that were designed and machined with two CAD/CAM and
one CAM system.

Methods: Three-unit posterior fixed dental prostheses (FDP) (n=10) were fabricated for standardized dies by: a mill-
ing center CAD/CAM system (Etkon), a laboratory CAD/CAM system (Cerec InLab), and a laboratory CAM system
(Cercon). After adaptation by a dental technician, the FDP were cemented on definitive dies, embedded and sec-
tioned. The marginal and internal fits were measured under an optical microscope at 50x magnification. A one-way
analysis of variance (ANOVA) was used to compare data (α=0.05).

Results: The mean (S.D.) for the marginal fit and internal fit adaptation were: 29.1 μm (14.0) and 62.7 μm (18.9)
for the milling center system, 56.6 μm (19.6) and 73.5 μm (20.6) for the laboratory CAD/CAM system, and 81.4 μm
(20.3) and 119.2 μm (37.5) for the laboratory CAM system. One-way ANOVA showed significant differences between
systems for marginal fit (P<0.001) and internal fit (P<0.001).

Significance: All systems showed marginal gaps below 120 μm and were therefore considered clinically acceptable.
The CAD/CAM systems were more precise than the CAM system.

Reprinted with permission of the Academy of Dental Materials.

Uludug et al