Odontology (2010) 98:170–172
DOI 10.1007/s10266-010-0122-7
SHORT COMMUNICATION
Raquel C. Oyagüe · M. Isabel Sánchez-Jorge
Andrés Sánchez Turrión
Evaluation of fit of zirconia posterior bridge structures constructed with
different scanning methods and preparation angles
Received: September 4, 2009 / Accepted: January 25, 2010
Abstrac This study evaluated the influence of scanning
method, abutment position, and preparation angle on the
vertical seal of three-unit posterior zirconia structures. Sixty
differently angled metallic models were machined to receive
30 bridge frameworks. For each preparation type, half of the
structures were waxed-up and digitized, whereas the other
half were computer-designed after the abutments were
scanned. Once milled, the samples were cemented in stan-
dard fashion. Misfit was assessed by scanning electron
microscopy. Three-way analysis of variance showed signifi-
cant differences. Computer-designed structures achieved
the highest accuracy (P < 0.0001). No significant differences
were recorded concerning the abutment position and con-
vergence angle. All discrepancy values were within the clini-
cally acceptable range.
Key words CAD/CAM scanning method · Vertical discrep-
ancy · Occlusal convergence angle
Introduction
The physical, biocompatible, and aesthetic properties of zir-
conium oxide cores for all-ceramic fixed partial dentures
have been widely recognized.1–3 However, even though mar-
ginal discrepancies may lead to secondary caries, periodon-
tal diseases, debonding, or mechanical failure of cemented
restorations,4–6 few studies of posterior zirconia bridges
have been conducted.3,4,6–8
Vertical gaps may be introduced during either fabrica-
tion step, including during computer-aided design (CAD)/
computer-aided manufacturing (CAM) digitization.9 Hence,
since both the scanning technique7,9 and the preparation
R.C. Oyagüe (*) · M.I. Sánchez-Jorge · A. Sánchez Turrión
Department of Prosthodontics, Faculty of Dentistry, Complutense
University of Madrid, U.C.M. Pza. Ramón y Cajal s/n, 28040 Madrid,
Spain
Tel. +34-607367903; Fax +34-947506610
e-mail: raquel.castillo@odon.ucm.es
© The Society of The Nippon Dental University 2010
design10–12 may play an important role in the clinical success
of the denture, different preparation angles can be evalu-
ated to test the accuracy of different CAD/CAM systems.
The purpose of this research was to investigate the influ-
ence of scanning method (wax-up vs abutment digitization),
bridge retainer (mesial vs distal), and preparation conver-
gence angle (10°, 15°, or 20°) on the marginal adaptation of
three-unit posterior zirconia structures fabricated with
Cercon Smart Ceramics (Dentsply International, York, PA,
USA). The null hypothesis was that scanning method, abut-
ment position, and preparation angle had no effect on the
vertical fit of zirconia bridge frameworks.
Materials and methods
Sixty stainless-steel master dies were machined to simulate
tooth preparations for full crowns (cervical diameter, 6 mm;
height, 7 mm; finish line, chamfer of 1 mm). The abutments
were fitted in pairs into aluminum bases.
The pairs of dies were randomly assigned to three experi-
mental groups (n = 10), according to their preparation angle
(10°, 15°, or 20°). Half of the structures from each group
were waxed-up and digitized (Cercon Brain unit), and the
remaining frameworks were computer-designed after the
abutments were scanned (Cercon Eye optical laser). Once
milled and sintered, the structures were fixed with zinc
phosphate cement (Fortex, Faciden S.L., Girona, Spain)
under a constant axial load (15 N/cm2 for 4 min) using a
customized jig that fitted a dynamometric key (Defcon,
Impladent, Holliswood, NY, USA) (Fig. 1).
Vertical misfit was assessed by measuring the distance
parallel to the abutment axis from the structure margin to
the finish line using a JSM-6400 scanning electron micro-
scope (JEOL, Tokyo, Japan) at 500× magnification. The
abutment supports ensured repeatable projection angles.
Thus, the vertical gap was always perpendicular to the
optical axis of the microscope. Twenty measurements were
taken along the axial planes of every die (200 measurements
per experimental subgroup of bridge structures). Discrep-
 171

Fig. 1. Three-unit zirconia sample luted onto two master dies fitted in
their platform

A
Table 1. Mean misfit values of wax-up digitized and direct-scanned
zirconia structures in relation to the bridge retainer and the prepara-
tion convergence angle
Vertical misfit recorded in the experimental groups (μm)

Digitizing method W D

Convergence angle Bridge abutment Mean misfit (SD)

10° M 108 (7) a1 74 (8) b1

D 112 (12) a1 78 (7) b1
15° M 98 (11) a1 75 (6) b1
D 99 (10) a1 73 (7) b1
20° M 110 (9) a1 80 (7) b1
D 105 (11) a1 72 (8) b1
Different letters in the rows indicate statistically significant differences
(P < 0.05) Equal numbers in columns indicate no significant differences
(P > 0.05)
W, wax-up digitized; D, direct-scanned; M, mesial; D, distal
B

ancies were calculated with image-analysis software (INCA-

4.04, Oxford Instruments, Abingdon, UK) at marginal points
equally distributed to standardize the procedure and mini-
mize the operator bias.
Misfit data were initially analyzed by two-way analysis
of variance (ANOVA) with repeated measurements for the
abutment factor. Since no interaction involving scanning
method or preparation angle resulted in a significant intra-
group difference between paired abutments, three-way
ANOVA was performed, using the bridge retainer as an
additional independent variable.
Fig. 2A, B. Scanning electron microscope photomicrographs showing
the vertical misfit values of structures cemented onto 15°-tapered dies
(500× magnification, 20 kV; bar, 100 μm). A Direct-scanned and com-
puter-designed framework. B Structure obtained from wax-up digitiza-
tion, showing a higher misfit
Interaction among scanning method, abutment, and prepa-
ration angle was not significant (P = 0.950).

Results
The vertical discrepancy of waxed-up digitized structures
was significantly higher than that of the computer-designed
frameworks (P < 0.0001) (Table 1, Fig. 2). The abutment
position did not influence the vertical misfit (P = 0.717). The
preparation convergence angle did not significantly affect
the marginal seal (P = 0.086). No significant interactions
were recorded between scanning method and abutment
(P = 0.709), scanning method and preparation angle (P =
0.225), or abutment and convergence angle (P = 0.215).
Discussion
The development of new CAD/CAM technologies has
accelerated in recent years,1,7 but there are few scientific
data concerning their reliability for the fabrication of well-
fitted ceramic cores.7,9
In this study, the null hypothesis was partly rejected,
because computer-designed structures showed better mar-
ginal adaptation than wax-up digitized structures (Table 1,
Fig. 2). This result agrees with another result obtained under
similar experimental conditions,7 and is probably due to the
reduced number of steps when the abutments are scanned.7
172
However, consistent with previous research on zirconia
bridges,8 no differences in misfit between mesial and distal
bridge retainers were demonstrated (Table 1). Such accu-
racy can be explained by both the precision of the CAD/
CAM system8,9 and the specialized management of the
equipment.8
Nor were differences significant among preparation
angles (Table 1). Clinical convergences usually range from
12.2° to 20.1°.10 After an exhaustive literature review, Goo-
dacre et al.13 concluded that the ideal axial-wall inclination
should be from 10° to 20°. Lesser convergence angle prepa-
rations might not accommodate the optimal thickness of
zinc phosphate cement, resulting in greater vertical gaps.10
In this study, the absence of significant differences among
the convergence angles is probably because the axial-wall
inclinations tested were within the clinically recommended
range,10,13 and it can also be attributed to the standardization
of the cementation procedure.
Accordingly, Mou et al.5 detected only a slight difference
in misfit between 12° and 20° angled abutments, which they
attributed to scanning error. However, Zhao et al.11 regis-
tered the best marginal seal when the convergence angle of
the abutments was 20°. In this regard, Iwai et al.12 reported
better adaptation of zirconia cores when preparation angles
were increased from 6° to 20°. Disparities in study protocols
complicate data comparisons.7 Therefore, further research
is necessary, since clinically appropriate convergence angles
of the abutments should be determined not only in terms
of marginal adaptation but also in terms of retention and
fracture resistance.10,12
Nevertheless, within the limitations of this study, the fol-
lowing conclusions can be drawn: (1) the vertical fit of zir-
conia bridge structures depends on the digitizing method;
(2) abutment scanning is preferable to wax-up digitization,
although the marginal seal obtained with both techniques
was within the clinically acceptable range of 50–120 μm6,7,12
at all tested convergence angles of the tooth preparation.
Acknowledgments We are grateful to the technicians of the U.C.M.
Central Labs and to D. Rafael Briones of Prótesis S.A. Dental Labora-
tory (Madrid, Spain) for their support in this project.
References
1. Guazzato M, Albakry M, Ringer SP, Swain MV. Strength, fracture
toughness and microstructure of a selection of all ceramic materi-
als. Part II. Zirconia-based dental ceramics. Dent Mater 2004;20:
449−56.
2. Little DA, Graham L. Zirconia simplifying esthetic dentistry.
Compend Contin Educ Dent 2004;25:490−4.
3. Sailer I, Fehér A, Filser F, Lüthy H, Gauckler LJ, Shärer P,
Hämmerle CHF. Prospective clinical study of zirconia posterior
fixed partial dentures: 3-year follow-up. Quintessence Int 2006;37:
685−93.
4. 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.
5. Mou S, Chai T, Wang JS, Shiau YY. Influence of different conver-
gence angles and tooth preparation heights on the internal adapta-
tion of Cerec crowns. J Prosthet Dent 2002;87:248−55.
6. Att W, Komine F, Gerds T, Strub JR. Marginal adaptation of three
different zirconium dioxide three-unit fixed dental prostheses.
J Prosthet Dent 2009;101:239−47.
7. Oyagüe RC, Sánchez Jorge MI, Turrión AS, Toledano M, Monticelli
F, Osorio R. Influence of CAM vs. CAD/CAM scanning methods
and finish line of tooth preparation in the vertical misfit of zirconia
bridge structures. Am J Dent 2009;22:79−83.
8. Gonzalo E, Suárez MJ, Serrano B, Lozano JFL. Marginal fit of
zirconia posterior fixed partial dentures. Int J Prosthodont 2008;
21:398−9.
9. Persson A, Andersson M, Oden A, Sandborgh-Englund G. A three-
dimensional evaluation of a laser scanner and a touch-probe
scanner. J Prosthet Dent 2006;95:194−200.
10. Chan DCN, Wilson AH Jr, Barbe P, Cronin RJ Jr, Chung C, Chung
K. Effect of preparation convergence on retention and seating
discrepancy of complete veneer crowns. J Oral Rehabil 2005;32:
58−64.
11. Zhao YF, Wang HR, Li Y. The effect of tooth preparation design
on the CAD/CAM all-ceramic coping crown’s fitness. Zhonghua
Kou Qiang Yi Xue Za Zhi 2003;38:330−2.
12. Iwai T, Komine F, Kobayashi K, Saito A, Matsumura H. Influence
of convergence angle and cement space on adaptation of zirconium
dioxide ceramic coping. Acta Odontol Scand 2008;66:214−8.
13. Goodacre CJ, Campagni WV, Aquilino SA. Tooth preparations for
complete crowns: an art form based on scientific principles. J Pros-
thet Dent 2001;85:363−76.