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Comparison of the marginal gap of zirconia-fabricated copings generated by

CAD/CAM and Copy-Milling methods

Article  in  Dental Hypotheses · January 2015

DOI: 10.4103/2155-8213.150867

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Abdolhamid Alhavaz Ladan Jamshidy

Babol University of Medical Sciences Kermanshah University of Medical Sciences
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Original Research

Comparison of the marginal gap

of zirconia-fabricated copings generated
by CAD/CAM and Copy-Milling methods
Abdolhamid Alhavaz, Ladan Jamshidy1
Department of Prosthodontics, School of Dentistry, Babol University of Medical Sciences, Mazandaran, 1Kermanshah University of Medical
Sciences, Kermanshah, Iran.

A B S T R A C T

Introduction: This study was conducted to compare the marginal fit of single-tooth zirconia-based copings fabricated by CAD/
CAM process (Cercon; Degudent) and Copy Milling (Dentium). Materials and Methods: One in vitro prepared abutment from
one mandibular molar model served as a template for replication of 40 epoxy resin (highly filled) dies, which had been taken by
polyvinyl siloxane impression material. Copings were manufactured on epoxy replicas by two processes: the CAD/CAM (Cercon;
Degudent) (n = 20) and the Copy-Milling (Dentium) (n = 20) processes. Four measurements were performed for each surface
coping (Buccal, Lingual, Mesial, and Distal). Data were analyzed by SPSS 16 statistical software using independent t-test. Results:
There was a significant difference in the marginal gap values between CAD/CAM and Copy-Milling groups (P < 0.001). The mean
value of the marginal gap (SD) for CAD/CAM Copings (56.87 µm) was significantly less than that of Copy-Milling (136.12 µm) (P <
0.001). Conclusion: The marginal fit of CAD/CAM copings was better than that of Copy-Milling copings.

Key words: CAD/CAM, marginal gap, zirconia

Introduction periodontal disease, and endodontic inflammation is

Zirconia restorations have been widely used in the
past few decades. This may be due to the optimal
esthetic characteristics as well as the zirconia’s
bio-compatibility.[1,2]
Ceramic restorations have a long-term success, which
depends on the materials. The mechanical and bonding
characteristics[3] are also significantly influenced by
the marginal fit.[4-12] Inaccurate marginal fit causes
the plaque accumulation, micro-leakage, and cement
breakdown. Subsequently, the risk of carious lesions,
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DOI:
10.4103/2155-8213.150867
increased, and adverse consequences that affect the
underlying health of abutments may occur.[4-10]
Several studies have evaluated the maximal marginal
gap values.[13-20] McLean et al.[13,14] evaluated more than
1000 crowns in 5 years and concluded that a marginal
gap of less than 120 µm is clinically acceptable; however,
in vitro studies have reported values of 100 µm.[15-20]
To fabricate the zirconia-based copings, different
computer-aided design (CAD)/computer-aided
manufacturing (CAM) processes are commercially
available. The Cercon system is a CAD/CAM process
that can use one of two available coping design
methods. This coping is designed either virtually on
the scanned die or on a scanned wax pattern and a
scanned die (double-scan technique). By scanning,
all information about the die and wax is digitized and
the data are transmitted to a manufacturing center.
To compensate the shrinkage, the zirconia blank is

Corresponding Author: Dr. Ladan Jamshidy, Department of Prosthodontics, School of Dentistry, Kermanshah University of Medical Sciences,
Shariati St., Kermanshah - 67139 54658, Iran. E-mail: ladanjamshidy@yahoo.com

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Alhavaz, et al.: Marginal gap of zirconia-fabricated copings
milled on an enlarged replica. The internal and external
contour and the finishing line are all milled; the final
sintering is also performed in the manufacturing center.
The Copy-Milling system is a developed fabrication
technique in which the copings are fabricated using
an auto-polymerized acrylic resin (Rainbow, Dentium;
Korea) pattern previously adapted to the die. This
pattern is read by a technician-guided sensor, and
the copings are concurrently milled out of a partially
sintered zirconia blank and sintered in the laboratory
furnace, afterward.
The results of the two studies related to the Zeno
(Wieland-Imes, Eiterfeld, Germany) and Denzir
(Dentronic, Aarhus, Denmark) indicated the mean ± SD
marginal gaps of 13 ± 12 µm and 22-24 ± 25-36 µm,
respectively.[21,22] To evaluate the Cercon zirconia single-
crowns fit based on the studies, moderate absolute
marginal discrepancy (AMD; the distance from the
internal edge of the coping’s margin to the preparation
finishing line) varied from 17 µm to 83 µm.
The aim of the present study was to evaluate and compare
the zirconia single-crowns marginal fit manufactured
by a CAD/CAM process (Cercon, Deguden) and a Copy
Milling (Dentium).
Materials and Methods
A standard preparation was performed on the mandibular
molar model with the following characteristics (W&H
turbine, Allegra): 1.5 mm occlusal reduction and 1 mm
axial reduction with 6-8 convergence (3-4 for each side).[7]
Round shoulder finishing line with at least 1 mm width
was prepared on the lingual and facial surfaces, which
were reduced in two planes,[5,20] and all of the line angles
were rounded to reduce stress concentrations.
The prepared model served as a master die for
preparation of 40 other dies using a highly filled
epoxy resin (shoots dental Germany) of similar elastic
modulus as human dentin (12.9 GPa). To this end, 40
impressions were taken from the prepared model by
polyvinylsiloxane (Panacil, Kettenbach, Germany).
Then, these impressions were poured under the vacuum
with epoxy resin to reproduce void free dies.
Radiographic images (Eastman Kodak, America) were
taken to ensure void free dies.[7] Dies were randomly
divided to two groups (n = 20). In the first group, copings
were manufactured on epoxy replicas by Cercon CAD/
24 Dental Hypotheses
CAM machine (n = 20), and in the other group, Copy-
Milling machine was used (n = 20). Each of the dies
of group one was scanned and the obtained data were
transformed to the CAD data. The blanks of zirconia
ceramic (yttrium oxide tetragonal) were milled by the
CAM device to produce a coping with 1 mm thickness.
It should be noted that in this software, 30 µm virtual
thickness was intended under each coping (cement
space). Then, copings were sintered in the porcelain
furnace at 1350°C for 7 hours and 30 minutes. All of the
dies were covered with two layers of spacer (Vita Inceram
interspace varnish) with resultant thickness of 30 µm.
Care must be taken that the varnish is 0.5 mm short of
finish line.[11] After each application of varnish, 5 minutes
are required for drying and after the second layer, 20
minute time is required. Next, the autopolymerizing
acrylic resin (rain bow, dentium) was used to construct
acrylic resin copings. Thickness was assessed in different
areas (midbuccal, midlingual, midmesial and middistal)
by Iwanson gauge (Odontomed Establishment Medical
Equipments & Supplies, Al Ain, Emirates). Reduction
was performed in thick areas until the optimum thickness
of 1 mm was attained. Then, the patterns were put on the
dies and were read by a sensor guided by the technician,
and the copings were concurrently milled out of partially
sintered zirconia blanks. Copings were then sintered in
the furnace. To ensure fully seated copings on the dies,
fit checker (anti-spray, boush) was used on the intaglio
surface of copings and if any pressure points were
detected, the respective coping was excluded from the
study and a new one was made. A stereo microscope was
used for identification of marginal gap on four points of
buccal, lingual, mesial and distal surfaces, and mean
marginal gap of groups was compared and assessed.
Data were analyzed by SPSS software (SPSS Inc.
Released 2007. SPSS for Windows, Version 16.0.
Chicago, SPSS Inc) using independent t-test. P-value
less than 0.05 was considered significant.
Results
The mean marginal gap in the mesial-distal-facial-
lingual surfaces of copings manufactured by CAD/
CAM was 56.87 µm and for Copy-Milling system was
136.12  µm, which was statistically significant (P <
0.001). The mean marginal gap values for mesial,
distal, facial, lingual surfaces were calculated and
compared with each other. In the mesial surface, the
mean marginal gap in the CAD/CAM group was 57 µm,
and for Copy-Milling group was 149.5 µm. In the distal
surface, the mean marginal gap for CAD/CAM group
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Alhavaz, et al.: Marginal gap of zirconia-fabricated copings

was 54.5 µm and for Copy-Milling was 111 µm. In the The CAD/CAM system provides copings with a marginal
facial surface, the mean marginal gap in the CAD/CAM fit significantly better than the Copy-Milling system.
group was 69 µm and for Copy-Milling was 147 µm. In The results of the present study are in accordance
the lingual surface, the mean marginal gap for CAD/ with those of other authors that reported the Copy-
CAM group was 47 µm, and for Copy-Milling group the Milling method had less accuracy in comparison with
mean marginal gap was 137 µm, which was statistically other methods.[32] There are some influential factors:
significant (P < 0.001) [Table 1]. first, this difference may be from the spacer thickness
of the die and second, the reference for the coping
Discussion manufacturing. The coping manufacturing by the
Cercon system is based on the die, while it is based on
The null hypothesis, which stated manufacturing the epoxy resin patterns’ intaglio by the Copy-Milling
process does not influence the single-tooth zirconia system. Other factors that may influence the accuracy
copings marginal fit, was rejected. of the fit are related to the type of the zirconia used
and the management of the sintering process, because
In most in vitro studies similar to the present study, the in Cercon CAD/CAM system the rate of shrinkage after
prepared and standardized dies have been desirably sintering is calculated and intended for manufacturing
used to evaluate the accuracy of copings.[23] Then, the larger copings to compensate this shrinkage. This
prepared dies were generated using an impression study did not use dissection of the specimens that may
material. So, an accurate controlling was performed result in distortion of the copings and may reduce the
on the parameters such as the convergence rate of axial measurement accuracy by producing heating on the
walls and the finishing line. Therefore, the uniform size sectioning.
of these epoxy resin dies and consequently fabricated
One of the limitations of this study was not being
coping were resulted.
able to entirely reflect the final marginal fit of the
In some studies, the marginal gap and the AMD have restoration. In fact, the veneering influencing procedure
been compared.[23,24] These two measurements have was not evaluated. Finally, selecting the manufacturing
process depends on several factors. For example, the
been performed to compare the results of numerous
manufacturing process impacts the health of the
studies.[23,25,26] The accuracy of copings was measured
dentistry laboratory technician that must be considered
with no veneering, because the finished crown’s fit
as a main factor. The risk of technician who has to inhale
could be assessed by evaluating the copings.[27-31]
zirconia dust during the milling process is a concern
accompanied by this system.
In the present study, the mean marginal gap values for
CAD/CAM and Copy-Milling copings were 56.87 µm
and 136.12 µm, respectively. Based on 100 µm
Conclusion
criterion as the limit of the clinical acceptability, Marginal gap and AMD values for the Cercon CAD/CAM
the mean marginal gap of the CAD/CAM system was were smaller than those for the Copy-Milling. So, based
acceptable.[16-19] on the criterion of 100 µm as the limit of the clinical
acceptability, the mean marginal gap of the CAD/CAM
Table 1: Mean ± SD marginal gap of mesial-distal-facial- system was acceptable and preferred to fabricate the
lingual surfaces in CAD/CAM and Copy-Milling restoration.
Method Number Mean ± SD P-value
gap margin (µm) Acknowledgement
M CAD/CAM 20 57 ± 43.3 <0.001
Copy-Milling 20 149.5 ± 46.8
D CAD/CAM 20 54.5 ± 20.1 <0.001 This study has been approved by Babol University of
Copy-Milling 20 111 ± 42.3 Medical Sciences (No. 19T).
F CAD/CAM 20 69 ± 28.8 <0.001
Copy-Milling 20 147 ± 45.3
L CAD/CAM 20 47 ± 19.5 <0.001 References
Copy-Milling 20 137 ± 42.6
MDFL CAD/CAM 20 56.9 ± 15.6 <0.001 1. Manicone PF, Rossi Iommetti P, Raffaelli L, Paolantonio M, Rossi
Copy-Milling 20 136.12 ± 25.7 G, Berardi D, et al. Biological considerations on the use of zirconia
M: Mesial; D = Distal; F = Facial, L = Lingual; CAD = Computer-aided design; for dental devices. Int J Immunopathol Pharmacol 2007;20:9-12.
CAM = Computer-aided manufacturing 2. Koutayas SO, Vagkopoulou T, Pelekanos S, Koidis P,

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Alhavaz, et al.: Marginal gap of zirconia-fabricated copings
Strub JR. Zirconia in dentistry: Part 2. Evidence-based clinical
breakthrough. Eur J Esthet Dent 2009;4:348-80.
3. Sailer I, Pjetursson BE, Zwahlen M, Hammerle CH. A systematic
review of the survival and complication rates of all-ceramic and
metal-ceramic reconstructions after an observation period of at
least 3 years. Part II: Fixed dental prostheses. Clin Oral Implants
Res 2007;18:86-96.
4. Felton DA, Kanoy BE, Bayne SC, Wirthman GP. Effect of in vivo
crown margin discrepancies on periodontal health. J Prosthet
Dent 1991;65:357-64.
5. Jacobs MS, Windeler AS. An investigation of dental luting
cement solubility as a function of the marginal gap. J Prosthet
Dent 1991;65:436-42.
6. Lang NP, Kiel RA, Anderhalden K. Clinical and microbiological
effects of subgingival restorations with overhanging or clinically
perfect margins. J Clin Periodontol 1983;10:563-78.
7. Sailer I, Fehér A, Filser F, Gauckler LJ, Lüthy H, Hämmerle CH.
Five-year clinical results of zirconia frameworks for posterior
fixed partial dentures. Int J Prosthodont 2007;20:383-8.
8. Sorensen JA. A rationale for comparison of plaque-retaining
properties of crown systems. J Prosthet Dent 1989;62:264-9.
9. Hunter AJ, Hunter AR. Gingival margins for crowns: A review
and discussion. Part II: Discrepancies and configurations. J
Prosthet Dent 1990;64:636-42.
10. Sorensen JA. A standardized method for determination of
crown margin fidelity. J Prosthet Dent 1990;64:18-24.
11. Rekow ED, Harsono M, Janal M, Thompson VP, Zhang G.
Factorial analysis of variables influencing stress in all-ceramic
crowns. Dent Mater 2006;22:125-32.
12. Tuntiprawon M, Wilson PR. The effect of cement thickness
on the fracture strength of all-ceramic crowns. Aust Dent J
1995;40:17-21.
13. McLean JW. Polycarboxylate cements. Five years’ experience
in general practice. Br Dent J 1972;132:9-15.
14. McLean JW, von Fraunhofer JA. The estimation of cement film
thickness by an in vivo technique. Br Dent J 1971;131:107-11.
15. Hung SH, Hung KS, Eick JD, Chappell RP. Marginal fit of
porcelain-fused-to-metal and two types of ceramic crown. J
Prosthet Dent 1990;63:26-31.
16. Karlsson S. The fit of Procera titanium crowns. An in vitro and
clinical study. Acta Odontol Scand 1993;51:129-34.
17. Kashani HG, Khera SC, Gulker IA. The effects of bevel angulation
on marginal integrity. J Am Dent Assoc 1981;103:882-5.
18. May KB, Russell MM, Razzoog ME, Lang BR. Precision of fit:
The Procera AllCeram crown. J Prosthet Dent 1998;80:394-404.
19. Reich S, Gozdowski S, Trentzsch L, Frankenberger R,
Lohbauer U. Marginal fit of heat-pressed vs. CAD/CAM
26 Dental Hypotheses
View publication stats
processed all-ceramic onlays using a milling unit prototype.
Oper Dent 2008;33:644-50.
20. Weaver JD, Johnson GH, Bales DJ. Marginal adaptation of
castable ceramic crowns. J Prosthet Dent 1991;66:747-53.
21. Beuer F, Neumeier P, Naumann M. Marginal fit of 14-unit zirconia
fixed dental prosthesis retainers. J Oral Rehabil 2009;36:142-9.
22. Coli P, Karlsson S. Fit of a new pressure-sintered zirconium
dioxide coping. Int J Prosthodont 2004;17:59-64.
23. Tinschert J, Natt G, Mautsch W, Spiekermann H, Anusavice KJ.
Marginal fit of alumina-and zirconia-based fixed partial
dentures produced by a CAD/CAM system. Oper Dent
2001;26:367-74.
24. Lin MT, Sy-Muñoz J, Muñoz CA, Goodacre CJ, Naylor WP. The
effect of tooth preparation form on the fit of Procera copings.
Int J Prosthodont 1998;11:580-90.
25. Boening KW, Wolf BH, Schmidt AE, Kastner K, Walter MH.
Clinical fit of Procera AllCeram crowns. J Prosthet Dent
2000;84:419-24.
26. Kokubo Y, Ohkubo C, Tsumita M, Miyashita A, Vult von
Steyern P, Fukushima S. Clinical marginal and internal gaps of
Procera AllCeram crowns. J Oral Rehabil 2005;32:526-30.
27. Sulaiman F, Chai J, Jameson LM, Wozniak WT. A comparison of
the marginal fit of In-cream, IPS Empress, and Procera crowns.
Int J Prosthodont 1997;10:478-84.
28. Quintas AF, Oliveira F, Bottino MA. Vertical marginal
discrepancy of ceramic copings with different ceramic
materials, finish lines, and luting agents: An in vitro evaluation.
J Prosthet Dent 2004;92:250-7.
29. Beuer F, Naumann M, Gernet W, Sorensen JA. Precision of fit:
Zirconia three-unit fixed dental prostheses. Clin Oral Investig
2009;13:343-9.
30. Gonzalo E, Suárez MJ, Serrano B, Lozano JF. Marginal fit of
Zirconia posterior fixed partial dentures. Int J Prosthodont
2008;21:398-9.
31. Vigolo P, Fonzi F. An in vitro evaluation of fit of zirconium-
oxide-based ceramic four-unit fixed partial dentures, generated
with three different CAD/CAM systems, before and after
porcelain firing cycles and after glaze cycles. J Prosthodont
2008;17:621-6.
32. Yeo IS, Yang JH, Lee JB. In vitro marginal fit of three all-ceramic
crown systems. J Prosthet Dent 2003;90:459-64.
Cite this article as: Alhavaz A, Jamshidy L. Comparison of the marginal
gap of zirconia-fabricated copings generated by CAD/CAM and Copy-Milling
methods. Dent Hypotheses 2015;6:23-6.
Source of Support: Nil, Conflict of Interest: None declared.
Jan-Mar 2015 / Vol 6 | Issue 1