Research Spotlight

Revilla-León, M., Z. Smith, M. M. Methani, A. Zandinejad and M. Özcan (2020). “Influence of scan body design on accuracy of the implant position as transferred to a virtual definitive implant cast.” J Prosthet Dent May 31;S0022-3913(20)30237-7. [Epub ahead of print.].

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STATEMENT OF PROBLEM: Previous studies have analyzed factors influencing intraoral scanner accuracy; however, how the intraoral scan body design affects the implant position on the virtual definitive cast is unclear. PURPOSE: The purpose of this in vitro study was to measure the discrepancies of the implant replica positions of the virtual definitive implant cast obtained by using 3 different scan body designs when performing a digital scan. MATERIAL AND METHODS: A partially edentulous typodont with 3 implant replicas (Implant Replica RP Branemark system; Nobel Biocare Services AG) was prepared. Three groups were determined based on the scan body system evaluated: SB-1 (Elos Accurate Nobel Biocare), SB-2 (NT Digital Implant Technology), and SB-3 (Dynamic Abutment). Each scan body was positioned on each implant replica of the typodont, and was digitized by using an intraoral scanner (iTero Element; Cadent) as per the manufacturer’s scanning protocol at 1000 lux illuminance. A standard tessellation language (STL) file was obtained. Before the scan bodies were removed from the typodont, a coordinate measuring machine (CMM Contura G2 10/16/06 RDS; Carl Zeiss Industrielle Messtechnik GmbH) was used to measure the scan body positions on the x-, y-, and z-axis. The linear and angular discrepancies between the position of the scan bodies on the typodont and STL file were calculated by using the best fit technique with a specific program (Calypso; Carl Zeiss Industrielle Messtechnik GmbH). The procedure was repeated until 10 STL files were obtained per group. The Shapiro-Wilk test revealed that the data were not normally distributed. The data were analyzed by using the Mann-Whitney U test (α=.05). RESULTS: The coordinate measuring machine was unable to measure the scan body positions of the magnetically retained SB-3 group because of its mobility when palpating at the smallest pressure possible. Therefore, this group was excluded. No significant differences were found in the linear discrepancies between the SB-1 and SB-2 groups (P>.05). The most accurate scan body position was obtained on the z-axis. However, the SB-1 group revealed a significantly higher XZ angular discrepancy than the SB-2 group (P<.001). CONCLUSIONS: The scan body systems tested (SB-1 and SB-2 groups) accurately transferred the linear implant positions to the virtual definitive implant cast. However, significant differences were observed in the XZ angular implant positions between the scan body systems analyzed.

Revilla-León, M., J. L. Sánchez-Rubio, J. Pérez-López, J. Rubenstein and M. Özcan (2020). “Discrepancy at the implant abutment-prosthesis interface of complete-arch cobalt-chromium implant frameworks fabricated by additive and subtractive technologies before and after ceramic veneering.” J Prosthet Dent May 24;S0022-3913(20)30236-5. [Epub ahead of print.].

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STATEMENT OF PROBLEM: Selective laser melting additive manufacturing (AM) technologies can be used to fabricate complete-arch cobalt-chromium (Co-Cr) implant-supported prostheses. However, the discrepancy at the implant-prosthesis interface with these fabrication techniques and after ceramic veneering remains unclear. PURPOSE: The purpose of the present in vitro investigation was to measure the discrepancy at the implant abutment-prosthesis interface before and after the ceramic veneering of frameworks fabricated by using subtractive and selective laser melting AM technologies. MATERIAL AND METHODS: A completely edentulous cast with 6 implant abutment replicas (Multi-unit Abutment RP Replicas; Nobel Biocare Services AG) was prepared. A total of 20 Co-Cr frameworks were fabricated using subtractive or computer numerical control milling (CNC group) and additive (AM group) technologies (n=10). A coordinate measurement machine was used to measure the linear and angular discrepancy at the implant abutment-prosthesis interface. Subsequently, a ceramic veneer was applied to each framework following the same standardized protocol. A bonding layer (Chromium-Cobalt Bonding; Bredent), 2 opaquer layers (Powder opaque and liquid UF; Creation CC), a layer of dentin ceramic (Dentine A3; Creation CC), a layer of enamel ceramic (Enamel S-59; Creation CC), and a glaze layer (Glaze paste and Liquid GL; Creation CC) were applied following the manufacturer’s firing protocol. Coordinate measurement machine assessment was repeated to measure the linear and angular discrepancies after ceramic veneering procedures. Data were analyzed by using the Wilcoxon signedrank and Mann-Whitney U tests (α=.05). RESULTS: No statistically significant differences (P>.05) were demonstrated in assessing the discrepancies at the implant abutment-prosthesis interface between the groups except for the XZ angle of the CNC group (P<.05). Ceramic techniques produced significantly higher linear and angular discrepancies in both groups (P<.001) with a mean ±standard deviation increase in the 3-dimensional gap of 36.9 ±15.6 μm in the CNC group and 38.9 ±16.6 μm in the AM group. The AM group presented significantly higher discrepancy in the x-axis than the CNC group (P<.001). CONCLUSIONS: Manufacturing procedures did not significantly influence the discrepancy at the implant abutment-prosthesis interface, which was significantly increased after ceramic veneering, except for the XZ angle of the CNC group. The differences between the discrepancies at the implant abutment-prosthesis interface before and after ceramic application revealed no significant discrepancies among the groups, except in the AM group that presented a significantly higher discrepancy on the x-axis compared with the CNC group.

Revilla-Leon, M., D. Jordan, M. M. Methani, W. Piedra-Cascon, M. Ozcan and A. Zandinejad (2020). “Influence of printing angulation on the surface roughness of additive manufactured clear silicone indices: An in vitro study.” J Prosthet Dent Apr 22;S0022-3913(20)30143-8. [Epub ahead of print].

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STATEMENT OF PROBLEM: Vat-polymerization additive manufacturing (AM) technologies can be used to fabricate clear silicone indices for diagnostic trial restorations, interim restorations, and direct composite resin restorations. Different support parameters, including print orientation of the virtual design of the silicone index, need to be determined when a dental device is fabricated with AM. However, the optimal printing angulation for minimal surface texture remains unclear. PURPOSE: The purpose of this in vitro study was to measure the surface roughness of the AM clear silicone indices manufactured by using a vat-polymerization 3D printer with different print orientations. MATERIAL AND METHODS: A virtual design of a facial silicone index was obtained, and the standard tessellation language file was exported and used to manufacture all the specimens using a vat-polymerization 3D printer. All the specimens were placed on the build platform with the same parameters, except for the print orientation which was selected as the only manufacturing variable. Therefore, the 5 different groups were 0, 25, 45, 75, and 90 degrees. To minimize variation in the procedure, all the specimens (N=50) were manufactured at the same time in the selected printer at a constant room temperature of 23 degrees C. The printer had been previously calibrated following the manufacturer’s recommendations. Surface roughness was measured in the intaglio of the left central maxillary incisor using an optical profilometer with a magnification of x20 and an array size of 640×480. Three measurements per specimen were recorded. The Shapiro-Wilk test revealed that the data were normally distributed, and the data were analyzed by using 1-way ANOVA, followed by the post hoc Sidak test (alpha=.05). RESULTS: The 0-degree angulation printing group reported the least mean +/-standard deviation surface roughness (0.9 +/-0.3 mum), followed by the 90-degree group (3.0 +/-0.6 mum), the 75-degree group (12.4 +/-1.0 mum), the 25-degree group (13.1 +/-0.9 mum), and the 45-degree group (13.5 +/-1.0 mum). However, no statistically significant difference was found in the surface roughness between the 25-degree and 45-degree print orientation groups (P=.296). CONCLUSIONS: Print orientation significantly influenced the surface roughness measured on the intaglio of the facial AM silicone indices tested.

Revilla-León, M., N. A. Husain, M. M. Methani and M. Özcan (2020). “Chemical composition, surface roughness, and ceramic bond strength of additively manufactured cobalt-chromium dental alloys.” J Prosthet Dent May 25;S0022-3913(20)30227-4. [Epub ahead of print.].

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STATEMENT OF PROBLEM: Selective laser melting (SLM) additive manufacturing (AM) technology is a current option to fabricate cobalt-chromium (Co-Cr) metal frameworks for dental prostheses. However, the Co-Cr alloy composition, surface roughness, and ceramic bond strength values that SLM metals can obtain are not well-defined. PURPOSE: The purpose of this in vitro study was to compare the chemical composition, surface roughness, and ceramic shear bond strength of the milled and SLM Co-Cr dental alloys. MATERIAL AND METHODS: A total of 50 disks of 5 mm in diameter and 1 mm in thickness were fabricated by using subtractive (control group) and AM with each of following SLM providers: SLM-1 (EOS), SLM-2 (3D systems), and SLM-3 (Concept Laser). The milled disks were airborne-particle abraded with 100-μm aluminum oxide particles. All the specimens were cleaned before surface roughness (Ra), weight (Wt%), and atomic (At%) percentages were analyzed. Three-dimensional profilometry was used to analyze the topographical properties of the surface parameters Ra (mean surface roughness). The chemical composition of Co-Cr alloy specimens was determined by using energy dispersive X-ray (EDAX) elemental analysis in a scanning electron microscope (SEM). Thereafter, the specimens were bonded to a ceramic (Dentine A3 and Enamel S-59; Creation CC) interface. Specimens were stored for 24 hours at 23 °C. The bond strength of the SLM-ceramic interface was measured by using the macroshear test (SBT) method (n=10). Adhesion tests were performed in a universal testing machine (1 mm/min). The Shapiro-Wilk test revealed that the chemical composition data were not normally distributed. Therefore, the atomic (At%) and weight percentages (Wt%) were analyzed by using the Kruskal-Wallis test, followed by pairwise Mann-Whitney U tests between the control and AM groups (AM-1 to AM-4). However, the Shapiro-Wilk test revealed that the surface roughness (Ra) and ceramic bond strength data were normally distributed. Therefore, data were analyzed by using 1-way ANOVA, followed by the post hoc Sidak test (α=.05). RESULTS: Significant differences were obtained in Wt%, At%, and Ra values among the Co-Cr alloys evaluated (P<.05). Furthermore, the control group revealed significantly lower mean ±standard deviation Ra values (0.79 ±0.11 μm), followed by AM-3 (1.57 ±0.15 μm), AM-2 (1.80 ±0.43 μm), AM-1 (2.43 ±0.34 μm), and AM-4 (2.84 ±0.27 μm). However, no significant differences were obtained in the metal-ceramic shear bond strength among the different groups evaluated, ranging from mean ±standard deviation 75.77 ±11.92 MPa to 83.65 ±12.21 MPa. CONCLUSIONS: Co-Cr dental alloys demonstrated a significant difference in their chemical compositions. Subtractive and additive manufacturing procedures demonstrated a significant influence on the surface roughness of the Co-Cr alloy specimens. However, the metal-ceramic shear bond strength of Co-Cr alloys was found to be independent of the manufacturing process.

Revilla-León, M., W. Att, M. Özcan and J. Rubenstein (2020). “Comparison of conventional, photogrammetry, and intraoral scanning accuracy of complete-arch implant impression procedures evaluated with a coordinate measuring machine.” J Prosthet Dent May 6;S0022-3913(20)30220-1. [Epub ahead of print.].

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STATEMENT OF PROBLEM: Conventional implant impressions by using elastomeric impression material have been reported as a more reliable technique for a complete-arch implant record compared with intraoral scanner procedures. Photogrammetry technology may provide a reliable alternative to digital scanning or a conventional impression; however, its accuracy remains unclear. PURPOSE: The purpose of this in vitro study was to measure and compare the implant abutment replica positions of the definitive cast with the implant abutment replica positions obtained by the conventional technique, photogrammetry, and 2 intraoral scanners. MATERIAL AND METHODS: An edentulous maxillary cast with 6 implant abutment replicas (RC analog for screw-retained abutment straight) was prepared. Three impression techniques were performed: the conventional impression technique (CNV group) by using a custom tray elastomeric impression procedure after splinting the impression copings at room temperature (23°C), photogrammetry (PG group) technology (Icam4D), digital scans by using 2 different IOSs following the manufacturer’s recommended scanning protocol, namely IOS-1 (iTero Element) and IOS-2 (TRIOS 3) groups (n=10). A coordinate measuring machine (CMM Contura G2 10/16/06 RDS) was used to measure the implant abutment replica positions of the definitive casts and to compare the linear discrepancies at the x-, y-, and z-axes and the angular distortion of each implant abutment replica position by using a computer aided-design software program (Geomagic) and the best fit technique. The 3D linear gap discrepancy was calculated. Measurements were repeated 3 times. The Shapiro-Wilk test revealed that the data were not normally distributed; therefore, the Kruskal-Wallis test was used to analyze the data, followed by pairwise Mann-Whitney U tests (α=.05). RESULTS: Significant y-axis linear and XY and YZ angular discrepancies were found among the CNV, PG, IOS-1, and IOS-2 groups (P<.05). The PG group obtained a significantly higher distortion on the y-axis and 3D gap compared with all the remaining groups (P=.004). The 3D discrepancy of the CNV group was 11.7 μm, of the IOS-1 group was 18.4 μm, of the IOS-2 was 21.1 μm, and of the PG group was 77.6 μm. In all groups, the interquartile range was higher than the median errors from the discrepancies measured from the definitive cast, indicating that the relative precision was low. CONCLUSIONS: The conventional technique reported the lowest 3D discrepancy for the implant abutment position translation capabilities of all the implant techniques evaluated. The intraoral scanners tested provided no significant differences in linear distortion compared with the conventional method. However, the photogrammetry system tested provided the least accurate values, with the highest 3D discrepancy for the implant abutment positions among all the groups.