RESEARCH AND EDUCATION

Effect of different CAD-CAM materials on the marginal

and internal adaptation of endocrown restorations:
An in vitro study
Wiam A. El Ghoul, DDS, DU,a Mutlu Özcan, DDS, PhD,b Hani Ounsi, DDS, PhD,c Hani Tohme, DDS, DES,d and
Ziad Salameh, DDS, MSc, PhDe

Advances in adhesive dentistry, ABSTRACT

computer-aided design and
Statement of problem. Recent resin-based and ceramic-based computer-aided design and
computer-aided manufacturing computer-aided manufacturing (CAD-CAM) materials have been used to restore endodontically
(CAD-CAM) technologies, and treated teeth. Adaptation of the restoration is important for clinical success, but studies
ceramic materials have resulted evaluating the effect of these materials on the adaptation of endocrowns are lacking.
in the introduction of new sys-
Purpose. The purpose of this in vitro study was to evaluate the effect of resin-based and
tems of dental restorations,1-3 ceramic-based materials on the marginal and internal adaptation of endocrowns.
including the endocrown resto-
ration, which reduces the risk of Material and methods. Forty mandibular molars were divided into 4 groups (n=10); each group
was restored with a different CAD-CAM material: group C: hybrid nanoceramic (Cerasmart; GC Corp),
failure during intracanal post
1,4
group T: fiber-composite material (Trilor; Bioloren Srl), group E: lithium disilicate glass-ceramic (IPS
preparation. An endocrown is e.max CAD; Ivoclar Vivadent AG), and group V: zirconia-reinforced lithium silicate glass-ceramic (Vita
a monobloc restoration that Suprinity; VITA Zahnfabrik GmbH). A digital scan was made with an intraoral digital scanner (TRIOS
combines the crown and the 3; 3Shape A/S), and endocrowns were milled with a 5-axis milling machine (Coritec 250i; imes-icore
core as a single unit.5,6 It covers GmbH). The replica technique and a stereomicroscope (×70) were used to measure the marginal
all cusps with a circular shoulder and internal adaptation of the endocrowns at 32 points. All data were statistically analyzed using
margin and extends toward the 1-way ANOVA and the Tukey honestly significant difference test (a=.05).
pulpal floor. Endocrowns use Results. Statistical tests showed significant differences among the tested groups (P<.001). The
the available surface provided resin-based groups displayed larger discrepancies than the ceramic-based groups. The resin-based
by the axial walls of the pulp groups showed a mean marginal gap larger than the mean internal gap C (P=.009), T (P<.001),
chamber as macromechanical whereas the ceramic-based groups showed similar gaps, V (P=.396), E (P=.936). The largest gap
was observed at the pulpal floor (P<.001).
retention, while the adhesive
resin cement acts as micro- Conclusions. All materials had clinically acceptable internal and marginal gaps (150 mm), except
mechanical retention.5,6 Endo- for the marginal gap of the Trilor group. (J Prosthet Dent 2019;-:---)
crowns have been reported to
be successful restorations for endodontically treated molars increases plaque accumulation, which could lead to sec-
with extensive loss of coronal structure.7,8 ondary caries, periodontal disease, and endodontic
Adaptation is one of the most important factors for inflammation.9 A thick cement layer increases polymer-
9
the success of any restoration. Poor marginal adaptation ization shrinkage and interfacial stresses, which in turn

The study was supported in part by GC, Dental Products Company. Prodent and CADent Dental Laboratory provided CAD-CAM supports.
a
Chief of clinical services, Department of Prosthodontics, School of Dentistry, Lebanese University, Beirut, Lebanon.
b
Professor, Department of Dental Materials, School of Dentistry, University of Zurich, Zurich, Switzerland.
c
Professor, Department of Endodontics, School of Dentistry, Lebanese University, Beirut, Lebanon.
d
Department of Prosthodontics, School of Dentistry, Saint Joseph University, Beirut, Lebanon.
e
Professor, Department of Research, Department of Prosthodontics, School of Dentistry, Lebanese University, Beirut, Lebanon.

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Clinical Implications
The marginal and internal discrepancies of CAD-CAM
endocrowns changed depending on the material
(ceramic based or resin based) used. Ceramic-based,
especially lithium disilicate glass-ceramic, showed
the smallest gap, which might improve the clinical
survival of the restored tooth.
can reduce the fracture resistance of ceramic restora-
tions.10 Holmes et al11 defined the internal gap as “the
perpendicular measurement from the internal surface of
the casting to the axial wall of the preparation” and the
marginal gap as the same measurement at the margin.
Another important measurement is the absolute mar-
ginal discrepancy (AMD), which has been defined as the
“angular combination of the marginal gap and the
extension error (overextension or underextension); AMD
is the combination of the vertical and horizontal marginal
discrepancies.”11
The marginal and internal adaptation is influenced by
variables such as the preparation design,12-14 fabrication
technique,15,16 methods of gap measurement,17-19 and the
materials used.20-22 CAD-CAM technology allows the use
of new restorative materials and chairside fabrication and
improves esthetics and fit.23 It also simplifies the process
as compared with conventional preparation methods.24,25
Different techniques for evaluating adaptation have been
described,26 including the replica technique (RT),27 which
is a nondestructive and reliable method for in vivo and
in vitro studies in which an impression of the cement space
is measured.28,29 Because the retention of endocrown
restoration relies mainly on bonding, materials which can
be acid etched and resin bonded to tooth tissue are
necessary.30 Various materials are available for endo-
crowns with different compositions and physical proper-
ties, including lithium disilicate glass-ceramics,1,7,31
hybrid nanoceramics,32-34 fiber-composites, and
zirconia-reinforced lithium silicate glass-ceramic.35
The effect of the intrapulpal extension of endocrowns
on marginal and internal adaptation has been evalu-
ated,12,13 but limited data are available on choosing the
best material for endocrown restorations. The authors are
unaware of studies on the influence of different materials
on the marginal and internal adaptation of endocrown
restorations.
The purpose of this in vitro study was to compare the
marginal and internal adaptation of endocrown restora-
tions fabricated from 4 different CAD-CAM materials:
hybrid nanoceramic, fiber-composite material, lithium
disilicate glass-ceramic, and zirconia-reinforced lithium
silicate glass-ceramic. The null hypotheses tested were
that no difference would be found between cervical, axial,
THE JOURNAL OF PROSTHETIC DENTISTRY
- Issue -
pulpal, and marginal fit within each group; and that no
difference would be found between internal fit (cervical,
axial, and pulpal) and marginal fit among the 4 groups.
MATERIAL AND METHODS
This research was approved by the ethical committee of
the Faculty of Dental Medicine, Lebanese University,
Beirut, Lebanon (CUMEB/D123/102018). Forty extracted
permanent mandibular molars were selected with nearly
similar size. Mesiodistal and buccolingual dimensions
were measured at the cemento-enamel junction (CEJ),
with a maximum deviation of 10%. The inclusion criteria
were absence of carious lesions or cracks and complete
root formation. The teeth were ultrasonically cleaned and
stored in 0.5% chloramineeT solution at 10  C. They were
then sectioned perpendicular to their long axis, 2 mm
above the CEJ, to open the pulp chamber. The pulp tissues
were removed, and the root canals were enlarged
with NiTi rotary instrumentation (ProTaper Universal;
Dentsply Sirona) and irrigated with NaOCl (5.25%). The
root canals were obturated using the warm vertical
condensation technique with system B (Sybron Endo;
Henry Schein, Inc), gutta percha (Calamus Dual; Dentsply
Sirona), and root canal sealer (AH 26; Dentsply Sirona).
Each tooth was fixed vertically in the metal holder of a
dental surveyor (Marathon-103; Saeyang) by injecting a
photopolymerizable gingival barrier (Laser protect; DMC
Dental) in the access opening and inserting the root in
autopolymerizing acrylic resin (Fastray; Harry J. Bosworth
Co) using cylindrical molds 2 mm below the CEJ to
simulate bone level. The gutta percha was removed from
the entrance of each root canal using a small tungsten
carbide rotary instrument, flowable composite resin
(Filtek Z350XT Flowable; 3M ESPE) was then used to fill
the canals, and the base of the pulp chamber was flat-
tened at a depth of 4 mm from the occlusal floor. All
teeth were prepared in a standardized manner under
water spray with the aid of a dental surveyor (Marathon-
103; Saeyang) and an 8-degree tapered diamond rotary
instrument (#856; Intensiv SA). The excessive retentive
areas were removed, the pulpal walls were aligned, and
internal angles were rounded. The preparations were
smoothed using fine polishing rotary instrument (#504;
Intensiv SA).
The teeth were divided into 4 groups (n=10) accord-
ing to the tested materials, each of which was adequate
for a statistical power of 80% (G*Power 3.1.9.2.)36,37:
group C, hybrid nanoceramic (Cerasmart; GC Corp);
group T, fiber-composite (Trilor; Bioloren Srl); group E,
lithium disilicate glass-ceramic (IPS e.max CAD; Ivoclar
Vivadent AG); and group V, zirconia-reinforced lithium
silicate glass-ceramic (Vita Suprinity; VITA Zahnfabrik
GmbH). The compositions and mechanical properties of
the tested materials32,35 are listed in Table 1.
El Ghoul et al
- 2019
Table 1. Type, manufacturer, composition, and mechanical properties of 4 tested materials
Material Code Manufacturer Ceramic Type
Cerasmart C GC Corp Hybrid nanoceramic
Trilor T Bioloren Srl Fiber-composite
IPS e.max CAD E Ivoclar Vivadent AG Lithium dissilicate glass-ceramic
Vita Suprinity V Vita Zahnfabrik GmbH Zirconia-reinforced lithium
silicate glass-ceramic
All prepared specimens were scanned with an
intraoral scanner (TRIOS 3; 3Shape A/S). The digital
scans were saved as 40 standard tessellation language
(STL) files for the 40 specimens. The appropriate design
software (2017; 3Shape Dental System) was used to
design the endocrowns on the virtual model. The oper-
ator determined design parameters as the thickness of
the spacer, which was set to be 10 mm on the marginal
discrepancy and 40 mm on the internal discrepancy; all
restorations were designed to have similar occlusal
anatomy and the same occlusogingival height. The
virtual endocrowns were converted to 40 STL files; they
were milled under wet processing with a 5-axis milling
machine (Coritec 250i; imes-icore GmbH) and CAD-
CAM materials: Cerasmart (block: A2 HT/14L), Trilor
(disk: diameter=98 mm, height=14 mm), IPS e.max CAD
(block: LT A2/C14), and Vita Suprinity (block T A2/LS14).
The milling rotary instruments were changed for each
group, and the size of the smallest was 0.6 mm.
Following the manufacturer instructions, specimens in
group E (IPS e.max CAD) and group V (Vita Suprinity)
were subjected to the crystallization process (Vita Vacu-
mat 6000 M; VITA Zahnfabrik GmbH), while specimens
in group C (Cerasmart) and group T (Trilor) did not need
any crystallization firing. All endocrowns were seated on
the corresponding teeth and evaluated with an explorer
and a silicone indicator paste (Fit Checker; GC Corp) for
adaptation. Some restorations, mainly in group T,
needed adjustments to enhance the fit.
The marginal and internal fit of the restorations in the 4
groups were assessed by a RT. Each endocrown was filled
with a pink light-body vinyl polyether silicone impression
material (EXA’lence; GC Corp) and seated along the long
axis of the corresponding tooth under a constant force of
50 N for 5 minutes.38 After 5 minutes (setting time of the
light-body material), the restoration was removed from
the corresponding tooth. The layer of the light body
adhered to the intaglio surface of the tooth. A green
heavy-bodied material (EXA’lence; GC Corp) was injected
into the tooth to adhere and stabilize the light-body
material. After polymerization, a sharp surgical blade
was used to cut each replica into 4 pieces from the center
in a buccolingual and mesiodistal direction. A slice of
El Ghoul et al
3
Modulus of Flexural Vickers
Composition Elasticity (GPa) Strength (MPa) Hardness (MPa)
Ceramic network: 71% 20 240 700
Resin matrix: 29%
Multidirectional fibers 26 380 1500
and resin matrix
Glass-ceramic 95 400 6000
ZrO2 z 10% 70 420 7000
SiO2 z 60%
Li2O z 18%
Pigmentsz 10%
2-mm-thick specimens was segmented from every piece
with parallel walls to obtain a vertical perpendicular view
on the stereomicroscope stage.
The discrepancy between the tooth and the endo-
crown was represented by the pink-colored light layer,
which was examined at ×70 magnification using a digital
trinocular stereomicroscope (AmScope 3.5; Irvine) with a
corresponding digital camera and software. For better
comparison, each slice was divided into 4 areas of in-
terest: marginal gap, cervical area, axial wall, and pulpal
floor according to previous publications.12,13,39 Eight
measurements were selected on each slice: 1 measure-
ment on the marginal gap, M1; 2 measurements on the
cervical area, C1 in the center and C2 on the cervico-axial
angle; 3 measurements on the axial wall, A1, A2, and A3
which divided the axial wall into 3 equal parts; and 2
measurements on the pulpal floor, P1 on the axiopulpal
angle and P2 in the center of the pulpal area of the
sectioned replica (Fig. 1). M1 was the AMD, that is, the
distance between the most extended point of the endo-
crown margin and the external marginal line of the
prepared tooth. C2 was the bisector of the angle between
the cervical area and the axial wall. P1 was the bisector of
the angle between the pulpal floor and the axial wall. C1,
A1, A2, A3, and P2 were the perpendicular distance from
the inner surface of the endocrown to the abutment
tooth. M1 represented the marginal fit, whereas C1, C2,
A1, A2, A3, P1, and P2 represented the internal fit of the
endocrown. Discrepancy thicknesses at marginal sites
and internal sites were analyzed. A total of 1280 mea-
surements were made for the 4 groups (8 measure-
ments×4 sections×10 endocrowns×4 groups). All data
were saved in a spreadsheet (Microsoft Excel 2007;
Microsoft Corp).
The Shapiro-Wilk test of normality confirmed that the
data were normally distributed (P>.05). Failure to meet
the assumptions required for a 2-way mixed ANOVA
necessitated separate testing of the effects of the
between-subjects factor (group) and of the within-
subjects factor (region), followed by Bonferroni correc-
tions for the multiple testing of 2 separate hypotheses.
One-way ANOVA tests were performed to assess dif-
ferences in marginal, cervical, axial, pulpal, and average
THE JOURNAL OF PROSTHETIC DENTISTRY
4 Volume
Figure 1. Schematic representation of measurement positions for
marginal and internal fit in cross-sectional cut of replica. Pink light layer
represents cement analog layer; M1: absolute marginal discrepancy. C1
and C2: cervical discrepancies. A1, A2, and A3: axial discrepancies. P1 and
P2: pulpal discrepancies.
internal gaps among the 4 groups, followed by the Tukey
post hoc test for multiple comparisons. The Welch
ANOVA and Games-Howell post hoc tests were applied
when the assumption of homogeneity of variances was
violated. Repeated measures ANOVA tests were then
carried out to test for differences among marginal, cer-
vical, axial, and pulpal gaps for each of the assessed
groups separately and were followed by post hoc pair-
wise comparisons with Bonferroni adjustment. Finally,
paired t tests were used to assess the differences between
marginal and internal gaps separately for each of the 4
tested groups.
All measurements were repeated twice at least 1
month after the initial assessment, and intraobserver
reliability was evaluated with the 2-way mixed effects
intraclass correlations for absolute agreement on single
measures. All data were processed using the statistical
software (IBM SPSS Statistics, v20; IBM Corp) (a=.05
except when assessing the outcomes of the ANOVA
tests, where a=.025 to account for the multiple testing of
2 separate hypotheses).
RESULTS
The intraclass correlations ranged between 0.904 and
0.998 for intrarater reliability, demonstrating very high
correspondence. All regions tested displayed statistically
significant differences in fit among the 4 assessed groups
(P<.001). Group T consistently displayed the largest
values among the groups for all tested regions, whereas
group E displayed the smallest gap for all regions except
for the axial region, where the smallest gap was observed
for group V (Table 2). When the adaptation was
compared across the regions, all the tested groups dis-
played statistically significant differences in fit (P<.001).
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The largest gap was consistently observed at the pulpal
floor for all tested groups, whereas the axial wall dis-
played the smallest mean gap in all groups except for
group E, where the cervical wall presented the smallest
gap (Table 3). Mean internal adaptation was statistically
similar to marginal adaptation in groups E (P=.936) and
V (P=.396). The mean internal gap was smaller than the
marginal gap in group C (116.1 ±14.3 mm compared with
143.0 ±21.7 mm; P=.009) and in group T (161.6 ±23.6 mm
compared with 196.7 ±33.7 mm; P<.001) (Table 4).
DISCUSSION
The results of this study led to the rejection of the 2 null
hypotheses tested: no difference would be found be-
tween cervical, axial, pulpal, and marginal fit of endo-
crown restorations within each group and no difference
would be found between internal fit (cervical, axial, and
pulpal) and marginal fit of endocrown restorations
among the 4 groups.
Several destructive and nondestructive methods have
been used to measure marginal and internal gaps, including
a dental explorer,17 visual examination,17 across section
technique after cementation,17 and an impression tech-
nique (RT).28 Recently, microcomputed tomography has
been introduced to provide 3D analysis of marginal and
internal discrepancies in dentistry.14 The RT has been
chosen by previous studies15,32,37,39 to evaluate marginal
and internal gaps and was also used in this study because it
is straight forward, accurate, reliable, less costly, noninva-
sive, and can be repeated quickly without loss of precision.
In addition, light-body vinyl polyether silicone impression
material was used in this study because it demonstrated
excellent dimensional stability.38 However, a disadvantage
of this technique is that it is a 2-dimensionalebased method.
In the present study, 4 segments with 32 landmarks per
abutment were measured, and this may not represent the
complete marginal and internal fit.18
To standardize the measurement and to provide high
clinical relevance despite using natural human teeth, all
the teeth chosen were of similar size, all preparations
were standardized using 1 type of diamond rotary in-
strument on a surveyor, a precise CAD-CAM scanner
and milling machine were used to eliminate manual
errors, and all replicas were sectioned in the same
position to observe the discrepancies from a directly
perpendicular perspective. Therefore, it was possible to
compare the marginal and the internal fit focused only on
the different tested materials.
Marginal and internal discrepancies are the main
concern of CAD-CAM endocrown restorations.12 A gap
between 75 and 160 mm has been considered acceptable
for internal and marginal adaptation.19,26 In this study,
the mean 2-dimensional internal gap of the 4 groups
(C, T, E, and V) was in the range of 105.3 to 161.6 mm,
El Ghoul et al
- 2019 5

Table 2. Mean values, standard deviations, and group comparison of gap thickness (values in micrometer) at various regions across 4 tested groups
(n=40)
Group Group Comparison
C (n=10) T (n=10) E (n=10) V (n=10) One-Way ANOVA Pa
Region Mean ±SD Mean ±SD Mean ±SD Mean ±SD F P C/T C/E C/V T/E T/V E/V
Marginal 143.0 ±21.7 196.7 ±33.7 104.8 ±14.1 114.7 ±21.5 23.239a <.001b .003b .001b .04 <.001b <.001b .631
Cervical 119.9 ±22.0 168.0 ±24.7 83.8 ±11.7 92.8 ±13.1 40.979 <.001b <.001b .001b .013b <.001b <.001b .013
Axial 83.9 ±15.4 92.0 ±18.8 90.5 ±18.9 60.7 ±7.8 8.314 <.001b .667 .792 .012b .996 .001b .001b
a b b b b
Pulpal 144.5 ±22.0 224.7 ±51.1 141.6 ±20.1 179.1 ±23.0 11.186 <.001 .003 .99 .014 .002 .096 .006b
a b b b b
Internal 116.1 ±14.3 161.6 ±23.6 105.3 ±14.9 110.9 ±12.4 13.805 <.001 .001 .374 .818 <.001 <.001 .8

C, Cerasmart; E, IPS e.max CAD; SD, standard deviation; T, Trilor; V, Vita Suprinity. aWelch ANOVA and Games-Howell post hoc P value reported when assumption of homogeneity of variances
violated. bStatistically significant at P<.025.

Table 3. Mean values, standard deviations, and region comparison of gap thickness (values in micrometer) within each of 4 groups across various
regions (n=40)
Region Region Comparison
Marginal (1) Cervical (2) Axial (3) Pulpal (4) Repeated-
(n=40) (n=40) (n=40) (n=40) Measures ANOVA Pairwise Comparison P
Group Mean ±SD Mean ±SD Mean ±SD Mean ±SD F P 1/2 1/3 1/4 2/3 2/4 3/4
C 143.0 ±21.7 119.9 ±22.0 83.9 ±15.4 144.5 ±22.0 22.122 <.001* .283 .002* 1 .002* .078 <.001*
T 196.7 ±33.7 168.0 ±24.7 92.0 ±18.8 224.7 ±51.1 46.209 <.001* .007* <.001* .085 <.001* .002* <.001*
E 104.8 ±14.1 83.8 ±11.7 90.5 ±18.9 141.6 ±20.1 40.695 <.001* .004* .594 .003* 1 <.001* <.001*
V 114.7 ±21.5 92.8 ±13.1 60.7 ±7.8 179.1 ±23.0 173.533 <.001* .001* <.001* <.001* <.001* <.001* <.001*

C, Cerasmart; E, IPS e.max CAD; SD, standard deviation; T, Trilor; V, Vita Suprinity. *Statistically significant at P<.025.

which was close to the clinically acceptable range of 75 Table 4. Differences in marginal and internal gap adaptation (values in
to 160 mm.19,26 The mean 2-dimensional marginal gap micrometer) within each of 4 groups (n=40)
of the 3 groups (C, E, and V) were in the range of 104.8 Marginal Internal Change
(n=40) (n=40) (T2-T0) Paired t Test
to 143.0 mm, which was in the clinically acceptable Group Mean ±SD Mean ±SD Mean ±SD Test Statistic P
range.19,26 But, the mean marginal gap of group T was C 143.0 ±21.7 116.1 ±14.3 26.9 ±25.7 3.317 .009*
196.7 mm, above the clinically acceptable range.19,26 T 196.7 ±33.7 161.6 ±23.6 35.2 ±17.2 6.478 <.001*
Group T displayed the largest gaps, followed by group E 104.8 ±14.1 105.3 ±14.9 -0.5 ±18.4 -0.083 .936
C and then group V, whereas group E displayed the V 114.7 ±21.5 110.9 ±12.4 3.8 ±13.4 0.891 .396
smallest gaps. Significant differences were observed C, Cerasmart; E, IPS e.max CAD; SD, standard deviation; T, Trilor; V, Vita Suprinity.
between the ceramic-based and resin-based blocks, *Statistically significant P<.05.

with a negative relationship between hardness and

adaptation. This result is consistent with previous
studies,20,32 relating mechanical properties and struc-
tural compositions with machinability. Conversely, other
studies21,22,37 have reported that resin materials had
better machinability and adaptation because of low
brittleness. They also reported that reproduction of
detail was difficult with milled ceramics compared with
resins because of the strength and friability of the
ceramic. This finding was not reproduced in the present
study, possibly because of the high modulus of elasticity
and flexural strength of the glass-ceramic materials,
which provides resistance to crack propagation and
chipping.
The mean internal gap was statistically similar to the
marginal gap in groups E and V, and the mean internal
gap was smaller than the marginal gap in groups C and
T. This finding may have been because the AMD (com-
bination of gap and extension errors) as described by
Holmes et al11 was used for measuring the marginal gap.
AMD provides accurate descriptions of marginal accuracy
but can provide larger values than actual marginal gap
measurements.37
The lack of standardization among different studies
may limit the comparison between results because the
adaptation depends on different factors. These include
the type of restoration (crowns, inlays, onlays, and
endocrowns), the different materials tested, the
method of fabrication, the precision of the scanning
and milling systems, the cement space, the size of the
milling rotary instrument, and the measurement tech-
niques used.
To analyze internal fit in greater detail, the mea-
surements of the internal gap in this study were divided
into 3 different areas of interest for better comparisons:
cervical (C), axial (A), and pulpal (P).12,13 The largest gap
was consistently observed at the pulpal floor for all tested
groups, especially in group T (224.7 ±51.1 mm). These
results were similar to those of the previous studies,12,13

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which can be influenced by the limited optical depth of
the scanner and a small convergence angle of the prep-
aration, resulting in a blurred image on the pulpal area.16
The axial wall (A) displayed the smallest mean gap in all
groups except for group E, where the cervical wall (C)
presented the smallest gap, so group E had the best
marginal and cervical adaptation, which are the 2 factors
closely related to cement dissolution, plaque retention,
recurrent carries, and periodontal disease.9
A limitation of this study was that it was an in vitro
study, which may differ from a clinical study, where the
scanning processing would be less precise because of
limitations such as saliva and limited access of the
scanner in the oral cavity. In addition, the gap di-
mensions were evaluated with a RT, and the preselected
measure points were restricted to the sectioned lines,
which might not represent the overall fit. Therefore,
in vivo studies with a larger sample size are recom-
mended for assessing the effect of different materials on
marginal and internal adaptation of endocrowns and the
use of intraoral digital scanning techniques.
CONCLUSIONS
Within the limitations of this in vitro study, the following
conclusions were drawn:
1. Marginal and internal discrepancies varied
depending on the different materials used. Ceramic-
based groups (E and V) showed smaller gaps than
resin-based groups (C and T).
2. All tested materials showed acceptable internal gap
sizes, and 3 (E, V, and C) of them showed accept-
able marginal gap sizes. The mean marginal gap of
the T material, however, was above the clinically
acceptable range.
3. The largest gap was observed at the pulpal floor for
all tested groups.
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36. Nejatidanesh F, Shakibamehr AH, Savabi O. Comparison of marginal Corresponding author:

and internal adaptation of CAD/CAM and conventional cement Dr Wiam A. El Ghoul
retained implant-supported single crowns. Implant Dent 2016;25: Department of Prosthodontics
103-8. Lebanese University, Beirut
37. Rippe MP, Monaco C, Volpe L, Bottino MA, Scotti R, Valandro LF. LEBANON
Different methods for inlay production: Effect on internal and marginal Email: drwiamelghoul@yahoo.com
adaptation, adjustment time, and contact point. Oper Dent 2017;42:
436-44. Acknowledgments
38. Nassar U, Chow AK. Surface detail reproduction and effect of disinfectant The authors thank Charles Khoury of the Prodent and CADent dental laboratory
and long-term storage on the dimensional stability of a novel vinyl polyether for the CAD-CAM support the authors thank GC dental product for their material
silicone impression material. J Prosthodont 2015;24:494-8. support.
39. Schonberger J, Erdelt KJ, Baumer D, Beuer F. Evaluation of two protocols to
measure the accuracy of fixed dental prostheses: An in vitro study. Copyright © 2018 by the Editorial Council for The Journal of Prosthetic Dentistry.
J Prosthodont 2 Feb 2017. doi: 10.1111/jopr.12583. [Epub ahead of print]. https://doi.org/10.1016/j.prosdent.2018.10.024

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