RESEARCH AND EDUCATION

Influence of repeated firings on marginal, axial, axio-occlusal,

and occlusal fit of metal-ceramic restorations fabricated with
different techniques
Özay Önöral, DDS,a Mutahhar Ulusoy, DDS, PhD,b Emre Seker, DDS, PhD,c and _Ilker Etikan, PhDd

Metal-ceramic restorations are ABSTRACT

one of the most frequently used
prosthetic approaches in
contemporary dentistry.1-4 The
conventional casting technique
is still used to fabricate these
restorations,3,5-10 although
problems related to this chal-
lenging technique have been
reported.2,5,7,8 Recently, different
computer-aided design and
computer-aided manufacturing
(CAD-CAM) methods have
been developed to address these
problems.2,3,11-15 These include
fully sintered hard alloy milling
(FHAM), selective laser sintering
(SLS), and presintered soft alloy
milling (PSAM).3 The FHAM
method functions on the princi-
ple of subtractive manufacturing
and allows the fabrication of
metal frameworks by milling
nonporous hard alloy blocks.16,17
Milling the rigid sintered blocks,
however, is difficult, and the
milling tools rapidly abrade and
overheat because the milling process takes place after sin-
tering.2,3,11,13 However, the milled frameworks do not need
to be subjected to the sintering process again.13 The SLS
Statement of problem. Ill-fitting restorations can jeopardize dental, periodontal, and systemic
health. Repeated ceramic firing may influence the fitting accuracy of restorations, but scientific
information regarding this issue is lacking.
Purpose. The purpose of this in vitro study was to assess and compare the influence of repeated
firings on the marginal, axial, axio-occlusal, and occlusal fit of metal-ceramic 3-unit fixed partial
dentures (FPDs) manufactured with different framework methods, including casting, fully sintered
hard alloy milling (FHAM), presintered soft alloy milling (PSAM), and selective laser sintering (SLS).
Material and methods. A total of 60 Co-Cr metal frameworks for 3-unit FPDs were fabricated with 3
different computer-aided design and computer-aided manufacturing (CAD-CAM) techniques and
conventional casting for a typodont model. The discrepancy values for premolar and molar
abutments were measured by using the silicone replica technique after fabrication of the
framework, second firing, fourth firing, and seventh firing. The replicas were separated into
mesiodistal and buccolingual cross-sections, and digital images of the cross-sections were
obtained with a stereomicroscope at ×80 magnification. The measurement points were
examined to record the discrepancy values (mm) with in-built measuring software. The recorded
data were subjected to repeated-measures 4-way ANOVA and the Bonferroni post hoc test (a=.05).
Results. For all measurement periods, the marginal, axial, axio-occlusal, and occlusal discrepancy
values differed significantly among the manufacturing groups (P<.001). Moreover, the repeated
firings had a statistically significant influence on the discrepancy values of PSAM, FHAM, and SLS
groups (P<.05). The cast group was not significantly affected by repeated firings (P>.05). The
PSAM group revealed the lowest discrepancy values at all measurement periods (P<.05), except
after the second firing in the marginal and axial locations.
Conclusions. The PSAM-fabricated restorations demonstrated superior fitting accuracy. All
manufacturing groups were influenced by repeated firings, except the cast group. The marginal
discrepancy values of all manufacturing groups were within the range of clinical acceptability
(<120 mm). (J Prosthet Dent 2018;-:---)
additive manufacturing method, in which powder-based
materials can be used to fabricate metal frameworks,
allows the consolidation of particle precursors by using a

Supported by grant no. SAG-2-2016-010 from Near East University, Scientific Research Projects Coordination Unit, Nicosia, Mersin 10, Turkey.
a
Research Assistant and Dentist, Department of Prosthodontics, Faculty of Dentistry, Near East University, Nicosia, Mersin 10, Turkey.
b
Chief and Professor, Department of Prosthodontics, Faculty of Dentistry, Near East University, Nicosia, Mersin 10, Turkey.
c
Associate Professor, Department of Prosthodontics, Faculty of Dentistry, Eskişehir Osmangazi University, Eskisehir, Turkey.
d
Associate Professor, Department of Biostatistics, Faculty of Medicine, Near East University, Nicosia, Mersin 10, Turkey.

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Clinical Implications
The CAD-CAM techniques, soft alloy milling, hard
alloy milling, and laser sintering technologies can be
recommended as alternatives to the casting
technique. However, the repeated ceramic firings
affect the fitting accuracy of metal-ceramic
restorations fabricated with these technologies.

high-power laser.2,3,5 The newly developed subtractive

manufacturing PSAM method allows the production of
metal frameworks by milling porous soft alloy blocks. Figure 1. Three-dimensional design of framework.
The blocks used in this technology are in presintered
form. This enhances machinability, thereby allowing
master model was scanned (CEREC Omnicam;
a fast milling process.3,8,10,13,15 However, the milled
Dentsply Sirona), and the obtained digital data were
frameworks require sintering in an argon gas atmosphere to
transferred to CAD software (InLab SW 15; Dentsply
eliminate the porous structure and to obtain full den-
Sirona). A framework with a thickness of 0.5 mm and
sity.13,16,17 As this process results in 11% volumetric
an internal space of 50 mm was virtually designed, and
shrinkage,3,13 the accuracy of PSAM-fabricated restorations
the 3-dimensional (3D) design was saved as a standard
poses a challenge.
tessellation language (STL) file for the CAM devices
Problems with metal-ceramic restorations largely
(Fig. 1).
present with biological complications rather than the
For the casting group (n=15), wax patterns were
mechanical ones, principally because of poor marginal
fabricated from wax blocks (Alliance Wax; Turkuaz
or internal fit.7,18 Poor crown margins may lead to
Dental) in a 5-axis milling unit (inLab MC X5; Dentsply
cement dissolution and provide retention areas for
Sirona), sprued, and evaluated on the master model
dental plaque.19-23 Marginal and internal adaptation
with a stereomicroscope (Leica S8 APO; Leica Micro-
have been considered as the most important criteria
systems GmbH). The patterns were invested (Sherafina-
in the success and longevity of fixed
Rapid; Shera Werkstoff-Technologie GmbH & Co KG)
partial dentures (FPDs).5,6,24-26 Although a clinically
and the wax eliminated in an oven (MFX-1010; Mikro-
acceptable discrepancy value remains unclear, it should
tek Dental). The patterns were then cast in an electric
not exceed 120 mm.27
induction furnace (INF-2010; Mikrotek Dental) from a
Studies that evaluated the influence of repeated fir-
Co-Cr alloy (Wirobond easy; Bego GmbH) (Table 1).
ings on the adaptation of these newer metal-ceramic
The castings were devested by airborne-particle abrasion
systems are scarce. Therefore, the purpose of this
with 125-mm aluminum oxide and tungsten carbide burs
in vitro study was to assess and compare the influence of
at low speed. For the FHAM group (n=15), the STL file
repeated firings on the marginal, axial, axio-occlusal, and
was sent to a 5-axis milling device (inLab MC X5;
occlusal adaptation of metal-ceramic 3-unit FPDs fabri-
Dentsply Sirona), and the restorations were milled from
cated with different framework manufacturing methods.
fully sintered Co-Cr alloy blocks (CopraBond Co-Cr;
The null hypotheses were that no significant difference
Whitepeaks Dental Solutions GmbH & Co KG)
would be found in terms of the effect of repeated firings
(Table 1). For the PSAM group (n=15), the metal
on the marginal, axial, axio-occlusal, and occlusal fit be-
frameworks were milled from presintered Co-Cr alloy
tween the control group (C) and test groups (FHAM,
blocks (CopraSintec K; Whitepeaks Dental Solutions
SLS, and PSAM) and that no significant difference would
GmbH & Co. KG) (Table 1) and then sintered in an
be found in terms of marginal, axial, axio-occlusal, and
argon furnace (Calidia Sintec 770; Whitepeaks Dental
occlusal fit among the 4 groups.
Solutions GmbH & Co KG), according to the manu-
facturer’s recommendations. For the SLS group (n=15),
MATERIAL AND METHODS
the metal frameworks were sintered from Co-Cr-Mo
The maxillary left first molar was removed, and the super-alloy powder (EOS CobaltChrome SP2; EOS
maxillary left second premolar and maxillary left second GmbH) by using an SLS unit (EOSINT M 270; EOS
molar were prepared for FPD abutments in a typodont GmbH) (Table 1).
model (AG-3; Frasaco GmbH). A 360-degree, 1.0-mm All the frameworks were steam-cleaned and dried,
chamfer, an axial taper of 6 degrees, and an occlusal and measurements were made with the silicone replica
reduction of 1.5 to 2.0 mm were used. The prepared technique.28 Automixed (Applyfix 4; Kettenbach GmbH

THE JOURNAL OF PROSTHETIC DENTISTRY Önöral et al

- 2018
Table 1. Brand, manufacturer, and composition of alloys used
Manufacturing Technique
Cast
FHAM
PSAM
SLS
FHAM, fully sintered hard alloy milling; PSAM, presintered soft alloy milling; SLS, selective laser sintering.
M 5 7 D
4 6 8
3 9 c i
1 2 10 ab
11
Figure 2. Measurement points for discrepancy assessment in mesiodistal
and buccolingual cross-sections. B, buccal; D, distal; M, mesial; P, palatal.
& Co KG) light-body silicone (Elite HD + Light-Body
Fast Set; Zhermack) was applied to the framework to
mimic the cement space. The framework was then
positioned on the master model. An occlusal force of 50
N was applied to each abutment by using a specially
designed loading device. After a 5-minute polymeriza-
tion of the light-body silicone, the framework was
removed, and the cement replica was embedded in
heavy-body silicone (Elite HD + Putty Soft Fast Set;
Zhermack) and sectioned mesiodistally and buccolin-
gually. A total of 22 measurement points for each
abutment (Fig. 2) were measured with a stereomicro-
scope (Leica S8 APO; Leica Microsystems GmbH) at ×80
magnification, recording the discrepancy values (mm)
with in-built measuring software (LAS EZ 3.0; Leica
Microsystems GmbH) once digital images had been
obtained (Fig. 3).
After the prefiring measurements, the frameworks
were veneered with ceramic (IPS InLine; Ivoclar Vivadent
AG) with a firing protocol in a dental ceramic furnace
(Programat EP 5000/G2; Ivoclar Vivadent AG) (Table 2),
according to the manufacturer’s instructions. All speci-
mens were subjected to repeated firings during the
ceramic veneering, and all the measurements at 22 pre-
defined points on each abutment were repeated after the
second, fourth, and seventh firing. In total, 3840 mar-
ginal, 1920 axial, 1920 axio-occlusal, and 2880 occlusal
discrepancy values were recorded.
The supposition of normal distribution was confirmed
by the Kolmogorov-Smirnov test, and so parametric tests
were used to assess the differences among the 4 groups.
Data were subjected to repeated-measures 4-way
ANOVA and the Bonferroni post hoc test by using an
Önöral et al
Brand, Manufacturer
Wirobond easy, Bego GmbH
CopraBond Co-Cr, Whitepeaks
Dental Solutions GmbH & Co. KG
CopraSintec K, Whitepeaks
Dental Solutions GmbH & Co. KG
CobaltChrome SP2, EOS GmbH
e analysis program (IBM SPSS Statistics v23-Demo; IBM
B d g P
f h
j
k groups are depicted in Supplemental Table 1. A statisti-
3
Composition (wt%)
Co, 53.8; Cr, 25; W, 10.5; Fe, 7; Mo, 2.5; Other, 1.2
Co, 59-63; Cr, 27-29; W, 8-9; Mn, 0.15-0.35;
Fe, 0-0.5; Si, 1.5-1.8; C, 0-0.1
Co, balance; Cr, 26.5-30; Mo, 4.5-7; Si, 0-1; Mn, 0-1;
Fe, 0-1; C, 0-0.35; Other, <1
Co, 61.8-65.8; Cr, 23.7-25.7; Mo, 4.6-5.6; W, 4.9-5.9; Si,
maximum 0.8-1.2; Mn, maximum 0.50; Fe, maximum 0.1
Corp) (a=.05).
RESULTS
The mean marginal, axial, axio-occlusal, and occlusal
discrepancy values and standard deviations of the 4
cally significant interaction was detected among all var-
iances (P=.033) (Supplemental Table 1), and the mean
discrepancy values (for all locations) between the pre-
molar and molar abutments were significantly different
(P<.001). For this reason, the data obtained for premolar
and molar abutments were evaluated separately.
For both premolar and molar abutments, the mar-
ginal, axial, axio-occlusal, and occlusal discrepancy values
differed significantly among the manufacturing groups at
all measurement periods (P<.001). The cast group
showed higher marginal, axial, and axio-occlusal
discrepancy values than the other groups (P<.05). The
highest occlusal discrepancy value was recorded in the
FHAM group (P<.05). The PSAM group showed the
lowest discrepancy values at all measurement periods
(P<.05), except after the second firing in the marginal and
axial locations. The SLS group displayed the greatest
increase in the marginal discrepancy value during the
firing protocol (P<.05).
For the premolar abutment, a statistically significant
effect of repeated firings was observed on the marginal,
axial, and axio-occlusal discrepancy values of the SLS and
PSAM groups (P<.05), in contrast with the cast and
FHAM groups (P>.05). The cast and SLS groups were not
occlusally affected by repeated firings (P>.05), whereas
the PSAM and FHAM groups were (P<.05).
For the molar abutment, no statistically significant
effect of repeated firings was found on the marginal,
axio-occlusal, and occlusal discrepancy values of the cast
and FHAM groups (P>.05). However, a statistically sig-
nificant effect was detected (P<.05) on the axial
discrepancy values of the FHAM group. The marginal,
axial, and axio-occlusal discrepancy values of the SLS and
PSAM groups were significantly influenced by repeated
firings (P<.05). The PSAM group was affected by
repeated firings occlusally (P<.05), whereas the SLS
group was not. (P>.05).
THE JOURNAL OF PROSTHETIC DENTISTRY
4 Volume
Figure 3. Representative photomicrographs of marginal, axial,
axio-occlusal, and occlusal measurement points in mesiodistal
cross-section. Original magnification ×80. A, PSAM group, specimen no. 1,
molar abutment. B, PSAM group, specimen no. 2, molar abutment. C,
Cast group, specimen no. 1, premolar abutment. D, Cast group, specimen
no. 2, premolar abutment. E, SLS group, specimen no. 1, molar abutment.
PSAM, presintered soft alloy milling; SLS, selective laser sintering.
THE JOURNAL OF PROSTHETIC DENTISTRY
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DISCUSSION
In the present study, repeated firing cycles influenced the
fitting accuracy of FPDs produced by all techniques
except the cast technique, and 4 manufacturing tech-
niques presented considerable differences in all tested
locations. Therefore, the null hypotheses were rejected.
The cast group exhibited higher marginal, axial, and
axio-occlusal discrepancy values than did the other
groups. This is in accordance with other studies3,8,15 and
can be attributed to the cast technique being a complex,
sensitive technique requiring more steps than do the
others.15 Additionally, casting alloy is exposed to
compressive stresses (z450 MPa) during casting. These
residual stresses are released during the firing protocol
and cause distortion that can affect the discrepancy of a
cast restoration.29
In this study, rapid prototyping technology (CAD/RP)
was used to produce wax patterns for standardization.
However, Farjood et al24 and Vojdani et al25 reported that
the marginal and internal fit of the wax patterns produced
by hand was more accurate than the fit produced by CAD/
RP. The cast group presented better results than did the
SLS and FHAM groups in the occlusal location. This result
is also consistent with other studies.3,7 A possible expla-
nation for the inferiority of the SLS and FHAM groups is
tight marginal and axial fit. Overheating during milling,
the wear of milling burs, and vibrations in the CAM device
during machining could also have affected the discrepancy
values of the FHAM group.2,8,12,18 The findings of this
study also showed that PSAM technology provided better
adaptation than did the other techniques. This finding is in
accordance with the study by Kim et al8 and can be
attributed to the fact that the mechanical properties of the
blocks used in this technology are similar to those of wax
blocks.8,13,17 Therefore, the milling is easy, and the milling
tools are not exposed to rapid abrasion, overheating, or
intense stress.3,8,10,13,15
Various techniques for measuring the marginal and
internal fit have been reported.10,13,15,16,19,30 The silicone
replica technique was preferred in the present study as it
allowed the assessment of both the marginal and internal
adaptation of FPDs. Moreover, it is a noninvasive, cost-
effective technique that facilitates proper, repeatable
measurements at various points.8,11,13-17,19,22 It is also
preferred for in vivo evaluations of FPDs.8
Studies have emphasized that finish-line configura-
tion influenced the fitting accuracy of restorations.23,31-33
Shiratsuchi et al23 and Bottino et al31 examined the in-
fluence of 3 different finish-line configurations on the
fitting accuracy of metal-ceramic FPDs and found that
the chamfer finish line exhibited better cervical adapta-
tion. The chamfer finish line has been used for various
studies, including the present one, to evaluate the
adaptation of FPDs.3,8,13-15
Önöral et al
- 2018 5

Table 2. Firing chart for IPS InLine ceramic The present study has several limitations. Only 1 type
t[ H of alloy was used, a reliable 3D measurement technique
No. Firing Purpose T C B C S Min 
C/min min V1 C V2 C
was not used, the selective laser melting technique was
1 Initial oxide firing 980 403 4 80 1 450 979
2 First opaquer firing 930 403 6 100 2 450 929
not included, and only 3-unit FPDs were examined.
3 Second opaquer 930 403 6 100 2 450 929
Future studies should examine long-span FPDs.
firing
4 Margin firing 930 403 4 60 1 450 929
CONCLUSIONS
5 Dentin and 910 403 4 60 1 450 909
incisal firing
Within the limits of this comparative in vitro study, the
6 Correction 860 403 4 60 1 450 859
firing (add-on)
following conclusions were drawn:
7 Glaze firing 800 403 6 60 2 450 799 1. The marginal discrepancy values of all FPDs were
B, stand-by temperature; H, holding time; S, closing time in minutes; T, firing tempera- within clinical acceptability (<120 mm).
2. Repeated firings had no effect on the discrepancy
ture; t[, heating rate; V1, vacuum on temperature; V2, vacuum off temperature.

values of the cast group (P>.05). A statistically signif-

Co-Cr alloys are biocompatible and exhibit better
mechanical properties, including higher corrosion resis-
tance and less sag-related deflection when compared with
Ni-Cr alloys.3,4,7,11,13,15 Accordingly, Co-Cr alloys were
preferred over Ni-Cr alloys. Studies evaluating the influ-
ence of alloy type (Co-Cr or Ni-Cr) on the adaptation of
restorations fabricated with different techniques (cast and
SLS) have shown no significant difference between alloy
types.6,26 However, the authors are unaware of studies
concerning the influence of alloy type on the fit of resto-
rations fabricated with FHAM and PSAM technologies.
Metal frameworks are subjected to repeated firings at
high temperatures during ceramic veneering.29 This causes
transformation, also known as distortion, in the metallur-
gical structure of the alloy and adversely affects the fitting
accuracy of metal-ceramic FPDs.1,22,30 The alloy type,
shrinkage of the ceramic during firing, and thermal
expansion coefficient difference between the ceramic and
the metal contributes to this structural deforma-
tion.1,3,15,22,29 Other contributing factors are residual stress
on the frameworks originating from the stages before firing
and creep of the alloys at high temperatures.22 The influ-
ence of repeated firings on the discrepancy values of metal-
ceramic FPDs have been examined previously.1,6,15,22,29 Of
these, the studies by Quante et al,6 Kocaa g lu et al,15 and
g ao
Zeng et al have shown that repeated firings have no
22
significant effect on the fitting accuracy of metal-ceramic
FPDs. This finding is not consistent with the present
study, as the repeated firing cycles influenced the adapta-
tion of FPDs produced by all techniques except the C
technique. Conversely, Kaleli and Saraç2 reported that the
marginal discrepancy values increased after ceramic firing.
This is consistent with the present study.
The differences among studies may be due to the
differences in methodology, the research type (in vivo
versus in vitro), the use of different materials, and the use
of software, all of which can influence the fitting accuracy
of restorations. Other possible explanations of the dif-
ferences among studies may be the deformation of the
wax pattern, the precision of CAD-CAM systems, and
the shrinkage of the impression material.2,3,13,15
icant effect of repeated firings was found on the ad-
aptations of FHAM, PSAM, and SLS groups (P<.05).
3. The PSAM group demonstrated better fitting accu-
racy at all measurement periods (P<.05) except after
the second firing in the marginal and axial locations.
4. The cast group produced the poorest marginal, axial,
and axio-occlusal fit at all measurement periods
(P<.05).
5. The highest occlusal discrepancy value was recorded
in the FHAM group (P<.05).
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Corresponding author:
Dr Özay Önöral
Department of Prosthodontics
Faculty of Dentistry, Near East University
99138 Nicosia
Mersin 10, Turkey
Email: dtozayonoral@gmail.com
Copyright © 2017 by the Editorial Council for The Journal of Prosthetic Dentistry.
Önöral et al