RESEARCH AND EDUCATION

Evaluation of marginal and internal fit of ceramic and metallic

crown copings using x-ray microtomography (micro-CT)
technology
Manuel Antonio Pimenta, PhD,a Luis Carlos Frasca, PhD,b Ricardo Lopes, PhD,c and Elken Rivaldo, PhDd

Ceramic crowns fabricated by ABSTRACT

a variety of systems, whether Statement of problem. Prosthetic crown fit to the walls of the tooth preparation may vary
mechanized or manual, can depending on the material used for crown fabrication.
be used throughout the dental
Purpose. The purpose of this study was to compare the marginal and internal fit of crown copings
arch to obtain natural esthetics
fabricated from 3 different materials.
and biocompatibility.1 In add-
ition to esthetic and functional Material and methods. The selected materials were zirconia (ZirkonZahn system, group Y-TZP),
outcomes, longevity is another lithium disilicate (IPS e.max Press system, group LSZ), and nickel-chromium alloy (lost-wax casting,
group NiCr). Five specimens of each material were seated on standard dies. An x-ray
determinant of their success.
microtomography (micro-CT) device was used to obtain volumetric reconstructions of each
Longevity, whether from a specimen. Points for fit measurement were located in Adobe Photoshop, and measurements
mechanical or a biologic were obtained in the CTAn SkyScan software environment. Marginal fit was measured at 4
standpoint, is directly associ- points and internal fit at 9 points in each coping. Mean measurements from the 3 groups were
ated with the quality of mar- compared by analysis of variance (ANOVA) at the 5% significance level, and between-group
ginal and internal fit.2,3 differences were assessed with the Tukey range test.
In metal ceramic crowns, Results. The nickel-chromium alloy exhibited the best marginal fit overall, comparable with zirconia
widely studied and accepted and significantly different from lithium disilicate. Lithium disilicate exhibited the lowest mean values
for their longevity and clinical for internal fit, similar to zirconia and significantly different from the nickel-chrome alloy.
success rates, most instances Conclusions. The marginal and internal fit parameters of the 3 tested materials were within clin-
of failure are attributable to ically acceptable range. (J Prosthet Dent 2015;-:---)
secondary caries and only
rarely to structural failure.4,5 Inadequate marginal fit researchers seeking to assess marginal and internal fit. Of
(>120 mm)6 may lead to plaque buildup, dissolution of the various methods used to evaluate the fit of prosthetic
the cementing agent, caries, pulp inflammation, and restorations, x-ray microtomography (micro-CT)12-14 is
periodontal disease.7 Likewise, internal gaps greater than nondestructive and able to reproduce these measure-
122 mm at the axial walls may reduce the fracture ments repeatedly at the same sites or at different sites
strength of ceramic restorations.8-10 with micrometer-level precision.15-19
Despite its importance, the concept of restoration fit Of the systems currently used to fabricate ceramic
has been poorly defined, and the term has often been crowns, computer-aided design/computer-aided man-
used for different measurements and sites. Holmes et al11 ufacturing (CAD/CAM) is least dependent on the skills of
standardized the terminology and measurement sites for the laboratory technician,20 unlike the widely used

a
Professor, Department of Prosthodontics, Federal University of Santa Maria, Santa Maria, RS, Brazil.
b
Professor, Department of Prosthodontics, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
c
Professor, Department of Nuclear Engineering, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
d
Professor, Postgraduate Program in Dentistry, Lutheran University of Brazil, Canoas, RS, Brazil.

THE JOURNAL OF PROSTHETIC DENTISTRY 1

2 Volume
Clinical Implications
Crown fit to the walls of the tooth preparation must
be precise to ensure a thin cement line, thus
enhancing the mechanical and biologic perfor-
mance of the crown. The assessment of gap di-
mensions is essential to determine the different
techniques and materials available for crown
fabrication.
15,21
ceramic injection and lost-wax casting techniques.
The initial results of CAD/CAM systems provided poor
fit,22 and despite advances in this fabrication technique,
few comparisons are available between it and other
methods, in that most studies have compared different
CAD/CAM systems among themselves.16,23-31 Further
comparisons with other technologies are warranted.
The present study sought to compare the quality of
the marginal and internal fit of ceramic crown copings
fabricated from 3 different materials: zirconia (Zirkon-
Zahn system); lithium disilicate (IPS e.max Press sys-
tem); and a nickel-chromium alloy (lost-wax casting
technique).
MATERIAL AND METHODS
The specimen comprised the experimental groups and
materials described in Table 1. A heat-polymerized
acrylic resin model of a left maxillary canine was pre-
pared for a complete crown with the following charac-
teristics: facial, palatal, and proximal walls tapered 6
degrees; 2-mm incisal reduction; 1.2-mm facial reduc-
tion; rounded angles; and a 120-degree chamfer finish
line.32-34 The prepared tooth was scanned and repro-
duced in zirconia to create a master model.
To fabricate the specimen copings, 15 impressions of
the master model were made with polyether impression
material (Impregum Penta; 3M ESPE). After setting, 15
model dies were produced with a die stone (Fujirock; GC).
In group Y-TZP (zirconia, ZirkonZahn, CAD/CAM),
the stone model dies were scanned (ZirkonZahn S600
Scanner; VITA Zahnfabrik), and 5 copings were
designed in the ZirkonZahn software environment and
fabricated in a milling unit (M3, ZirkonZahn). The
copings were stored in a temperature-controlled envi-
ronment for 3.5 hours as a predrying procedure and
then sintered for 7 hours at 1600 C in a furnace (inFire
HTC Speed; Sirona). After cooling, airborne-particle
abrasion was performed with 125-mm aluminum oxide
(Basic Master; Renfert GmbH).
In group LSZ (lithium disilicate, IPS e.max Press,
ceramic injection molding), copings were fabricated
through the lost-wax investment casting technique, with
a thickness of 0.6 mm and by using Gilvest HS
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Table 1. Material, fabrication method, and composition of specimens
from each experimental group
Material/Fabrication Method Composition Group
Zirconia (ZirkonZahn CAD-CAM, Yttrium oxide partially stabilized Y-TZP
VITA Zahnfabrik) tetragonal zirconia polycrystal
Lithium disilicate (IPS e.max Press, Lithium disilicate LSZ
Ivoclar Vivadent), ceramic injection
Tilite, induction casting Nickel-chrome metal alloy NiCr
(Talladium Inc)
investment. After heating in a microprocessor-controlled
furnace (Kota Knebel) at 850 C, lithium disilicate ingots
were injected using a press furnace (Programat EP3000;
Ivoclar Vivadent), and the resulting copings underwent
airborne-particle abrasion (Basic Master; Renfert GmbH).
These copings were clear, in that they consisted of glass
ceramic containing lithium disilicate and lithium ortho-
phosphate crystals, with a crystal content of approxi-
mately 60% by volume.
In group NiCr (nickel-chromium alloy; Tilite), copings
were fabricated by induction casting through the lost-
wax technique to a final thickness of 0.6 mm. The
waxed dies were invested (Micro-Fine; Talladium Inc)
and fired in a furnace (Ney Vulcan 3-130; Dentsply Intl)
at a starting temperature of 400 C and a final tempera-
ture of 800 C. Induction casting was carried out in a
benchtop casting machine (Fornax T; Bego). After
cleaning, the copings were airborne-particle abraded
(Basic Master; Renfert GmbH). Correction or adjustment
of copings was not performed in any of the groups.15,25
Micro-CT measurements of marginal and internal fit
were performed by x-ray microtomography. The master
model was attached to an acrylic resin base, and the
specimens (copings) were seated individually and scan-
ned in a SkyScan 1173 micro-CT scanner (Bruker). Im-
ages were acquired using 130 kV maximum voltage, 61
mA current, and a 1-mm-thick aluminum filter with a
pixel size of 9.91 mm. A detector size of 2240×2240 pixels
was chosen. The specimens were scanned over 360 de-
grees (1 complete rotation) at 5 frames per rotation step
of 0.38 degree. The average scanning time of each
specimen was approximately 90 minutes.
After scanning, the images were reconstructed in
software (SkyScan NRecon 1.6.9.4 and InstaRecon
1.3.9.2), which uses a Feldkamp-based algorithm. This
reconstruction software enables preprocessing and the
selection of several parameters so as to generate a higher
quality image. The reconstruction settings used were
level 14 ring artifact correction, 40% beam hardening
artifact correction, and level 4 smoothing.
The SkyScan DataViewer 1.5.0 software can
generate 3 views: coronal (x-z plane), sagittal (y-z
plane), and transaxial (x-y plane). These views were
used to locate the mesiodistal and buccolingual posi-
tions of the crown.
Pimenta et al
- 2015 3

Table 2. Means and 95% confidence intervals of marginal fit on sagittal

and coronal micro-CT in each experimental group (mm)
Marginal Fit
Y-TZP LSZ NiCr P
Sagittal
Left 60.95A 113.80A 48.44A .111
95% CI 0-123 40.14-187.45 23.82-80.40
Right 44.01A 53.22A 64.03A .620
95% CI 35.57-53.71 0-110.38 21.66-102.76
Mean 52.48A 83.51A 56.24A .176
95% CI 26.86-82.87 50.35-119.43 30.01-72.42
Coronal
Left 20.55A 80.47B 2.08A .003
95% CI 0-63.28 31.92-129.03 0-7.88
Right 16.55A 57.26B 21.64A .010
Figure 1. Scanned tooth (image generated by SkyScan 1173 Micro-CT 95% CI 0-34.94 39.38-75.14 0-49.10
scanner; Bruker) showing sites of marginal fit (MF), chamfer area (CA), Mean 18.55A 68.86B 11.86A <.001
axial wall (AW), axio-occlusal angle (AOA), occlusal area (OA), and center 95% CI 0-42.43 50.41-87.32 0-27.88
(CE) measurement. Overall
Mean 35.5A 76.19B 34.05 A
.002
95% CI 10.85-60.18 52.71-99.66 24.65-43.45
Adobe Photoshop 12.0 was used to locate the desired 95% CI, 95% confidence interval.
measurement points. With the points thus identified Different superscript letters on the same row denote statistically significant differences.

(Fig. 1), measurements were made in SkyScan CTAn

1.13.5.1, at ×600 magnification.
After software processing of the dataset (TView 1.1;
SkyScan), the marginal fit (MF) of the specimens was
assessed and expressed by mean values in accordance
with the criteria set by Holmes et al,11 and the sites of
internal fit measurement were standardized as follows16:
chamfer area (CA), measured at 800 mm occlusal to the
margin of the die; axial wall (AW), measured at the
midpoint of the axial wall; axio-occlusal angle (AO);
occlusal area (OA), measured at 500 mm from the axio-
occlusal angle in the direction of the center of the
occlusal plateau; and center (CE), measured at the
midpoint between the right and left OA measurement
sites.
Each variable was analyzed descriptively as mean,
95% confidence interval, and range. One-way analysis of
variance (ANOVA) was used for comparison of means
from the three study groups at the 5% significance level.
Pairwise between-group differences were assessed with
the Tukey range test.
RESULTS
Tables 2 and 3 show the mean marginal and internal fit
values obtained from micro-CT measurements. As seen
in Table 2, regarding marginal fit, the smallest mean
values were found for the nickel-chromium alloy and
were statistically similar to those of the zirconia system.
Both were statistically different from the IPS e.max Press
lithium disilicate system.
Table 3 lists the measurements of internal fit at each
point. At CA, the smallest mean score was obtained with
the nickel-chromium alloy. This value was significantly
different from those of the other 2 systems, which, in
turn, were statistically similar to one another. At AW, the
nickel-chromium alloy was again associated with the
smallest mean value, but with no significant difference
from the other systems. At AOA, the lithium disilicate
system (IPS e.max Press) exhibited the smallest mean
value. Again, this value was significantly different from
those of the other 2 systems, which were statistically
similar to one another. At OA, lithium disilicate was
again associated with the smallest mean value, which
was statistically similar to the zirconia system; both were
significantly different from the nickel-chromium alloy. At
CE, the zirconia system exhibited the smallest mean
value, which was similar to that of the IPS e.max Press
lithium disilicate system and different from that of the
nickel-chromium alloy. Overall, the IPS e.max Press
lithium disilicate system exhibited the smallest mean
value. It was statistically similar to the ZirconZahn zir-
conia system and significantly different from the nickel-
chromium alloy. Figure 2 illustrates the means and
standard deviations of the MF, CA, AW, AOA, OA, and
CE measurements.
DISCUSSION
A clinical study of 1000 restorations carried out over a
5-year period showed that marginal gaps greater than
120 mm were clinically acceptable and those less than 50
mm were difficult to assess clinically.6 These values
became textbook references for marginal fit assessment.23
Mean marginal gap values for the nickel-chromium
alloy and zirconia groups in the present study were

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Table 3. Means and 95% confidence intervals of internal fit at each point of measurement in each experimental group (mm)
Internal Fit
Y-TZP LSZ NiCr P
Chamfer area
Left 95.10A 80.91A 29.79B .001
95% CI 60.09-130.10 49.82-112.00 14.38-45.19
Right 85.87A 99.93A 42.93B .018
95% CI 72.90-98.84 31.52-168.33 17.16-68.70
Axial wall
Left 89.94A 69.35A 75.64A .135
95% CI 55.49-124.38 35.84-102.86 26.63-198.51
Right 71.63A 77.61A 82.56A .871
95% CI 43.78-99.48 26.03-129.19 32.00-133.12
Axio-occlusal angle
Left 100.94A 49.20B 108.71A .015
95% CI 9.39-89.01 9.39-89.01 88.95-128.47
Right 80.20AB 38.04A 106.02B .019
95% CI 58.99-101.40 0-108.70 74.12-137.92
Occlusal area
Left 90.49A 77.61A 188.88B <.001
95% CI 30.74-150.24 65.09-90.13 163.78-213.97
Right 99.74A 87.52A 213.37B <.001
95% CI 72.63-126.85 65.43-109.61 188.04-238.71
Center
Mean 68.69A 80.09A 230.53B <.001
95% CI 31.17-106.21 27.29-132.88 189.07-271.98
Overall
Mean 86.95A 73.36A 117.88B .02
95% CI 71.88-102.03 54.69-92.03 112.85-122.91

95% CI, 95% confidence interval.

Different superscript letters on same row denote statistically significant differences.

much smaller than those described in the literature as
clinically acceptable.6 Studies of the marginal fit of metal
ceramic restorations in 3-unit partial fixed dental pros-
theses reported values in the range of 67 to 85 mm12,26
and 120 mm,27 far in excess of those reported here
(34.05 mm), which are closer to those described by Baig
et al28 (37.1 mm) and Colpani et al15 (12.8 mm). These
results suggest an advance in nickel-chromium alloy
casting, possibly due to improvements in the technique
itself and in the materials and instruments used.33
The results of groups Y-TZP and LSZ suggest
that ceramic crowns are comparable with metal ceramic
restorations in terms of marginal fit. This is a
major contribution, in that marginal fit is directly asso-
ciated with the success and longevity of prosthetic
restorations.2,3,13
Through the scanning process and by controlling the
milling and shrinkage of presintered blocks, CAD/CAM
fabrication achieved marginal gap values as small as 35.5
mm in the present study. These values approached those
reported by Borba et al,18 who also assessed CAD/CAM-
fabricated zirconia with the micro-CT modality, but used
different systems. Only 1 previous study27 assessed the
marginal fit of ZirkonZahn system restorations. The
investigators found a mean marginal gap value of 112.1
mm, larger than that measured in the present study,
although both values are clinically acceptable. These
differences may be attributed to different measurement
techniques and even to improvement of the system itself.
In the lithium disilicate group, the mean overall
marginal fitdalthough significantly different from that of
the other groupsdwas 76.19 mm, which is also within
clinically acceptable range and is close to the 63 mm and
62 mm values reported by Sulaiman et al31 and Beschnidt
and Strub,29 respectively. In a more recent study, Yuksel
and Zaimoglu9 found a mean marginal gap value of 92.6
mm, exceeding that found in the present study, but after
cementation. Cho et al14 reported mean values of 27.2
mm and 35.1 mm with chamfer and shoulder finish lines,
respectively, with no statistically significant differences
between the 2 finish line designs. These values were
smaller than those found in the present study, perhaps
due to a difference in measurement technique (light
microscopy).
Results from other studies suggest that restorations
fabricated with CAD/CAM techniques have fit values
similar to those obtained with nickel-chromium alloy15,26
and with ceramic injection techniques.27 Karatasli et al27

THE JOURNAL OF PROSTHETIC DENTISTRY Pimenta et al

- 2015
270.00
Y-TZP
LS2
240.00
NiCr
210.00
180.00
µm)
Measurement (µ
150.00
120.00
*
# *
90.00
60.00 * #
*
30.00
0.00
MF
Figure 2. Mean and standard deviation of overall mean of marginal fit (MF), chamfer area (CA), axial wall (AW), axio-occlusal angle (AOA), occlusal area
(OA), and center (CE). *, No significant difference; #, significant difference.
found that marginal fit was statistically similar in the
ZirkonZahn CAD-CAM system and in metal ceramic
restorations, which is consistent with the present
findings.
The best internal fit result was obtained with lithium
disilicate (73.36 mm), followed by zirconia (86.95 mm),
whereas the NiCr alloy specimens had a mean value of
117.88 mm. According to Tuntiprawon and Wilson,8
axial wall gaps greater than 122 mm may reduce the
fracture strength of crowns. Increasingly larger gaps are
being accepted with advancements in adhesive cement
technology,18 but some authors suggest that gaps
should not exceed 100 mm at the occlusal surface and
that in the 450- to 500-mm thickness range, the benefits
of bonding are lost because of polymerization shrinkage
stress.10
All measurements of internal fit were within clinically
acceptable levels, except for the OA and CE values in the
nickel-chromium alloy group. These values did not reach
the critical limit suggested by May et al,10 but could pose
a clinical issue in terms of occlusal fit if the space
required for the veneer is compromised.26 Furthermore,
according to May et al,23 a uniform internal thickness for
cementation is more critical for fully ceramic crowns
because of their brittle nature.
In restorations made with CAD/CAM technology, the
internal gaps described in the literature are due to gaps in
retention areas, angles, variations in the scanning pro-
cess, limitations of detail reproduction during the milling
Pimenta et al
5
#
#
*
*
* * *
*
* *
*
#
CA AW AOA OA CE
Mean Volume (µ
µm)
process,23,30 and successful control of contraction and
milling of presintered and postsintered materials.15,16
Therefore, the results of these prosthetics are far more
dependent on the ability of the system to fabricate objects
in accordance with operator input.17 In metal alloy
casting and in ceramic injection of lithium disilicate,
marginal and internal fit depend on the skill of the lab-
oratory technician and on the successful control of hy-
groscopic and thermal expansion to compensate for the
contraction of the cast metal or ceramic ingots during
fabrication.21
Regarding overall fit, all 3 groups exhibited best re-
sults for marginal fit, with values smaller than those
considered clinically acceptable. For internal fit, the zir-
conia and lithium disilicate groups had relatively stable
mean CA to CE values (optimal clinical situation),8,23
whereas in the nickel-chromium alloy group, these
values were increased, although within clinically accept-
able range.
Of the methods available for assessing marginal and
internal fit, micro-CT is able to reproduce specimens
with micrometer precision, both at different sites and
repeatedly, without damaging the specimen or the
model or die. This method has been used by Pelekanos
et al,17 Seo et al,34 and Della Bona and Kelly,19 among
others, and has been recommended by other in-
vestigators and in the systematic review of Contrepois
et al7 for assessing the marginal and internal fit of dental
restorations.
THE JOURNAL OF PROSTHETIC DENTISTRY
6 Volume
Further studies to address additional factors that may
influence marginal and internal fit, such as veneer firing,
cementation, functional loads, and thermal cycling, are
warranted.
CONCLUSIONS
Bearing in mind the limitations of the methods used for
this study and taking into account the mean of the
several measurements obtained, we concluded that the
cast metal alloy exhibited the best marginal fit and
lithium disilicate exhibited the best overall internal fit.
The overall assessment of the results showed that,
despite significant differences in fit, all tested materials
were within clinically acceptable range.
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Corresponding author:
Dr Elken Gomes Rivaldo
Rua Pedro de Oliveira Bittencourt, 207
Bairro Tristeza
91900-230 - Porto Alegre, RS
BRAZIL
Email: elkenrivaldo@gmail.com
Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.
Pimenta et al