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Technology and Health Care -1 (2020) 1–8 1

DOI 10.3233/THC-191964
IOS Press

1 Marginal and internal fit of provisional

2 crowns fabricated using 3D printing
3 technology

Saurabh Chaturvedi∗ , Naseer M. Alqahtani, Mohammed Khalid Addas and

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5 Mohammed A. Alfarsi
Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia

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6

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7 Received 24 September 2019 fv
8 Accepted 7 January 2020

9 Abstract.
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10 BACKGROUND: Missing – please ask authors to provide this.

11 OBJECTIVE: The aim of the study was to evaluate the marginal and internal fit of provisional crowns fabricated using three-
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12 dimensional (3D) printing technology and to compare it with that of compression molding and milling methods.
13 METHODS: Ninety study models were fabricated by duplicating metal master models of the maxillary first premolar molar
14 with three different finish line chamfer, rounded shoulder and rounded shoulder with bevel. On each study model, provisional
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15 crowns were fabricated using compression molding (Mo. group, n = 30 – by over impression technique), milling (Mi. group,
16 n = 30 – by 5-axis dental milling machine), and 3D printing method (3D-P. group, n = 30 – by 3D printer). Marginal and
17 internal fit of the samples were evaluated by measuring gap using a scanning electron microscope with a magnification of 27
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18 ×, at 7 zones A–G on different finish line models. The data were statistically analysed using one-way analysis of variance
19 (ANOVA) at the 0.05 significance level. The p-values were calculated using Dunnett’s test.
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20 RESULTS: The marginal gap was minimal for the 3D-P. group for each finish line with lowest for rounded shoulder with bevel
21 at zone A 30.6 ± 5.3 and at zone G 32.8 ± 5.4. In axial area, i.e. zones B and F, the minimum gap was noticed for the Mo.
group and in Occlusal area (cusp and fossa), for zones C–E maximum gap was determined in Mi. group followed by Mo. and
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23 3D-P. groups.
24 CONCLUSIONS: 3D printed provisional crowns have better marginal and internal fit compared to milled and molded provi-
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25 sional crowns.

26 Keywords: Temporary crown, additive manufacturing, internal discrepancy, 3D printing, CAD-CAM

27 1. Introduction

28 The fit of the provisional restorations (PR) rely on the manner by which it is prepared, materials used
29 and geometry of prepared teeth. Along with conventional manner, PR can be fabricated using subtractive
30 method viz. milling method or additive method viz. three-dimensional (3D) printing. With these indirect
31 methods, the thermal and chemical risks to the tooth and mucosa are eliminated and the adaptation

∗
Corresponding author: Saurabh Chaturvedi, Department of Prosthetic Dentistry, College of Dentistry, King Khalid Univer-
sity, Abha, Saudi Arabia. Tel.: +966 580697248; E-mail: survedi@kku.edu.sa.

0928-7329/20/$35.00
c 2020 – IOS Press and the authors. All rights reserved
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2 S. Chaturvedi et al. / 3D printed provisional crowns

32 of the crown to the tooth is improved with an absolute marginal gap (AMG) of crowns to be in the
33 range from 10–110 mm with and internal gap at axial part was 23–154 mm and at occlusal part was
34 45–219 mm [1–7].
35 In milling method, pre-polymerized resin blocks are used with high degree of strength and accu-
36 racy [8–10] but with inherent limitation of machining tools and the material properties. The additive
37 method, such as 3D printing, consists of segmenting the 3D model data (CAD design) into multi-slice
38 images and by using simple layering technique usually 5 to 20 per millimeter of material in a layer to
39 produce definitive shape [11,12]. Moreover, the amount of material used in 3D printing technique is less
40 often compared to the milling method [13] and practically no loss of material and even unused material
41 can be processed in the future. Also, multiple materials can be printed at the same time with fine detail
42 reproduction [11].
43 In the literature we found very few studies [14–20] that have determined the marginal and/or internal
44 fit of provisional crowns fabricated using 3D printing techniques and to the best of our knowledge no

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45 study had compared the marginal gap and internal fit of provisional crowns fabricated by three different
46 techniques on different finish line configurations. Thus, the present study was planned with the aim to

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47 evaluate the marginal and internal fit of provisional crowns fabricated using 3D printing technology
and to compare it with that of compression molding and milling methods by using a scanning electron

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49 microscope (SEM) on three different commonly used finish line configurations. The null hypothesis
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50 assumed that the fit of provisional crowns fabricated using 3D printing would not differ from those
51 fabricated with the compression molding and milling methods.
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52 2. Methods

The present study was conducted at the King Khalid University in Abha, Saudi Arabia, at the Depart-
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54 ment of Prosthodontics, College of Dentistry and was approved by the institute’s ethical committee.
55 The study was conducted in pre-decided steps, as can be seen in the flowchart (Fig. 1). Three maxillary
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56 first premolar typodont teeth (#14) were mounted in three different typodont jaws along with adjacent
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57 teeth (#15, #13). Each #14 was prepared for full coverage crown with three different finish line chamfer
58 (C), rounded shoulder (RS), and rounded shoulder with bevel (RSB). Total occlusal reduction of 1.5 mm
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59 with convergence angle of six degrees was done. Each tooth model along with adjacent teeth was vir-
60 tually sectioned from typodont jaw to make a master model in metal (cobalt-chromium; Wirobond C;
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61 BEGO GmbH, Germany) after scanning and printing it with castable resin. The master dies (Fig. 2) pre-
62 pared were duplicated and study casts were poured with Type IV die stone (GC Fujirock EP; GC Europe,
63 Belgium). The 90 study models were divided into these three groups based on the method of fabrication
64 of provisional crowns compression molding (Mo. group), milling (Mi. group), and 3D printing (3D-P.
65 group), with 30 models each having 10 models of a particular type of finish line.
66 For Mo. group, the provisional crowns were fabricated using compression molding over-impression
67 technique [3], using bis-acrylic composite-based autopolymerizing resin, i.e., ProtempTM 4 (3M ESPE,
68 Seefeld, Germany). For Mi. and 3D-P. groups, the prepared models were scanned using a desktop scan-
69 ner (Ceramill Map 400; Amann Girrbach, Austria) and the data was exported as a standard tessellation
70 language (STL) format to a CAD software (Cerec inLab 4.2; Dentsply Sirona, USA), for the design and
71 the fabrication of full coverage restorations. The virtual crowns without any cementation space were
72 designed (Fig. 3). For Mi. group, the provisional crowns were fabricated using a 5-axis milling machine
73 (Ceramill Motion 2; Amann Girrbach, Austria) and poly(methyl methacrylate) and methacrylic acid
74 ester-based cross-linked resin blocks (Ceramill TEMP; Amann Girrbach, Austria) with a bur diameter
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Fig. 1. 1-a – Flowchart of the study design. 1-b – Scanned models of prepared typodont tooth #14 with finish line configuration.
A – chamfer, B – rounded shoulder, C – rounded shoulder with bevel, with virtual crown without any cementation space. 1-c –
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7 zones (A–G) on three selected surfaces marginal, axial and occlusal for measurements.
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Fig. 2. Representative SEM images at 27 × magnification showing a gap between the provisional crown surface and tooth
model surface at preidentified zones. A. Zones A and B; B. Zones C and D; C. Zones E–G.
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Fig. 3. Bi-comparisons of 3D-P., Mo. and Mi. groups for marginal and internal fit of provisional crowns for A- chamfer, B-
rounded shoulder, C- rounded shoulder with bevel finish lines.

75 of 1 and 3 mm following manufacturer’s recommendation. For 3D-P. group, the virtual crown files were
76 transferred to a 3D printer (Form 2 3D printer Formlabs Inc., USA), and provisional crowns were fabri-
77 cated by printing a biocompatible photopolymer (Formlabs Dental SG Resin) with a layering thickness
78 of 0.05 mm and a maximum laser speed of 5000 mm/s.
79 The provisional crowns prepared were cut from the centre in bucco-lingual direction, with the help
80 of precision cutting machine (Buehler, USA) and evaluated for the internal and marginal fit using SEM
81 at 27 × magnification. Three surfaces were selected, i.e. margin, axial and occlusal, for measurements
82 at seven zones (A–G) (Fig. ??). Absolute marginal discrepancy (AMD), the distance between the most
83 extended point of the restoration margin and the external marginal line of the prepared tooth, was used to
84 evaluate the discrepancy on the margin. For evaluating internal discrepancy, the perpendicular distances
85 from the internal surface of the crown to the external surface of the preparation were measured [21]. All
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Table 1
Intergroup comparison of 3D-P., Mo. and Mi. groups for marginal and internal fit of provisional crowns
for chamfer, rounded shoulder and rounded shoulder with bevel finish lines

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86 measurements were recorded and analysed using statistical analysis software (IBM SPSS Statistics for
87 Windows v22; IBM, USA).
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88 3. Results
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89 The mean internal and marginal gap were significantly influenced by fabrication method (P = 0.000)
90 and finish line design (P = 0.000). The intergroup comparison for various finish line designs showed
91 that the marginal gap was minimal for 3D-P. group for each finish line design and lowest for rounded
92 shoulder with bevel finish line at zone A 30.6 ± 5.3 and at zone G 32.8 ± 5.4. Overall internal fit was
93 also best for 3D-P. group. On performing Bi-comparison test using Dunnett’s test for calculating p-value,
94 significant differences were found between 3D-P. and Mo. groups in marginal and axial areas while in
95 the occlusal area the difference was significant for Mi. and 3D-P. groups (Table 1, Fig. ??a–c).

96 4. Discussion

97 The results of our study rejected the null hypothesis, as there was a better and more accurate fit
98 of provisional crowns fabricated by 3D printing method compared to molding and milling methods.
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99 But statistically there was no significant difference between 3D printing method and milling method in
100 marginal and axial areas.
101 The recommended thickness of cement starts from no gap [22] to 10 mm [23], to 15 mm with an
102 additional vertical space of 65 mm and a horizontal space of 50 mm [24], 30 mm [16,25], 50 mm [26],
103 60 mm [7] until 85 mm [27,28]. In our study, the design of samples were done without any gap to reduce
104 the chances inadequate seating, pseudo gap [1,24] and also to avoid any miscalculation of space under
105 microscope. Groten et al. [29] recommended at least 20 to 25 points of measurements per crown. In the
106 present study, 90 samples were made: 30 for each finish line and for assessing the fit, each sample was
107 studied in seven zones with three randomly selected points in each zone, yielding in 21 points in each
108 sample, thus total 630 points for each finish line type.
109 For evaluation of the fit of the restorations SEM had advantage in comparison to other methods,
110 such as the replica technique (difficulties in locating margins, tearing of silicone layer [1], presence
111 of defects in it [30] and errors in the sectioning planes [31]), triple scan method (requires the coating

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112 with contrasting agent [32]) and micro-CT technique (radiation artefacts [21]), as it was cost effective,
113 accurate and detailed measurement was possible.

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114 The results of our study showed that discrepancy in the marginal and internal fit of the provisional
115 crowns made from the molding method was maximal followed by milling and 3D printing method. This

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116 was in line with the studies by Pompa et al. [33] and Kelvin et al. [7] and may be attributed to the
properties of material used in molding method (volumetric shrinkage during polymerization [6]). Also,
117
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118 it was polymerized as a single piece resulting in higher discrepancies. While in the Mi. group the pre-
polymerized blocks were used resulting in less shrinkage, in 3D-P. group the polymerization of the resin
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120 was carried out in a cross-sectional manner layer-by-layer thus minimising volumetric shrinkage.
In our study the marginal discrepancy was minimal in rounded shoulder finish line with bevel irre-
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122 spective of the technique of fabrication and material used, followed by rounded shoulder and chamfer
123 finish line. This may be due to the fact that the more the restoration margin ends with an acute angle, the
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124 shorter the distance between the restoration margin and the tooth, as has also been described previously
125 by Schillinburg [34]. The results are also in line with the study by Euán et al. [35].
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126 Internal discrepancies varied among groups. Grajower et al. [36] found that the crowns were not
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127 completely seated when a thin cementation space was provided. Thus, a reduced internal discrepancy
128 in the axial region of the Mo. group may be closely related to the large mean marginal discrepancy in
that group. Meanwhile, in the occlusal region, the Mi. group showed significantly larger discrepancy
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130 than those of the other groups. However, the crowns in the 3D-P. group exhibited the most accuracy
in the occlusal region. This result may be attributed to a different inherent fabrication process. In the
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132 milling method, an object is fabricated in a subtractive manner by using cutting burs. Accordingly, the
133 bur size and cutting motion range are limiting factors in fabrication [37]. When sharp edges or a rugged
134 surface exist on an object, the object cannot be reproduced using the milling method. In such situations,
135 to facilitate the milling process, the shape of the object image should be modified.
136 The 3D printing method uses an additive pattern of applying materials layer-by-layer. Thus, this
137 method enables the fabrication of objects with complex structures, without the need for artificial modi-
138 fication of the design [38]. These findings suggest that a difference in the fabrication mechanism affects
139 the fit of restoration.

140 5. Conclusions

141 3D printing improved the fit of interim crowns in the proximal, marginal and internal regions, and its
142 effect was evident in the occlusal region.
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143 The accuracy of interim crowns fabricated using 3D printing was comparable with that of the milling
144 method. Thus, 3D printing could be an alternative approach to fabricate interim crowns.

145 Acknowledgments

146 This work was supported by the College of Dentistry, King Khalid University, Abha, Saudi Arabia,
147 under grant no. MRMC 01-019-004.

148 Conflict of interest

149 None to report.

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