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      Comparison the Marginal and Internal Fit of Metal Copings Cast from Wax Patterns Fabricated by CAD/CAM and Conventional Wax up Techniques

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          Abstract

          Statement of Problem: Metal-ceramic crowns are most commonly used as the complete coverage restorations in clinical daily use. Disadvantages of conventional hand-made wax-patterns introduce some alternative ways by means of CAD/CAM technologies.

          Purpose: This study compares the marginal and internal fit of copings cast from CAD/CAM and conventional fabricated wax-patterns.

          Materials and Method: Twenty-four standardized brass dies were prepared and randomly divided into 2 groups according to the wax-patterns fabrication method (CAD/CAM technique and conventional method) (n=12). All the wax-patterns were fabricated in a standard fashion by means of contour, thickness and internal relief (M1-M12: representative of CAD/CAM group, C1-C12: representative of conventional group). CAD/CAM milling machine (Cori TEC 340i; imes-icore GmbH, Eiterfeld, Germany) was used to fabricate the CAD/CAM group wax-patterns. The copings cast from 24 wax-patterns were cemented to the corresponding dies. For all the coping-die assemblies cross-sectional technique was used to evaluate the marginal and internal fit at 15 points. The Student’s t - test was used for statistical analysis (α=0.05).

          Results: The overall mean (SD) for absolute marginal discrepancy (AMD) was 254.46 (25.10) um for CAD/CAM group and 88.08(10.67) um for conventional group (control). The overall mean of internal gap total (IGT) was 110.77(5.92) um for CAD/CAM group and 76.90 (10.17) um for conventional group. The Student’s t-test revealed significant differences between 2 groups. Marginal and internal gaps were found to be significantly higher at all measured areas in CAD/CAM group than conventional group ( p< 0.001).

          Conclusion: Within limitations of this study, conventional method of wax-pattern fabrication produced copings with significantly better marginal and internal fit than CAD/CAM (machine-milled) technique. All the factors for 2 groups were standardized except wax pattern fabrication technique, therefore, only the conventional group results in copings with clinically acceptable margins of less than 120um.

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          Considerations in measurement of marginal fit.

          The terminology describing "fit" and the techniques used for measuring fit vary considerably in the literature. Although fit can be most easily defined in terms of "misfit," there are many different locations between a tooth and a restoration where the measurements can be made. In this work, the measurements of misfit at different locations are geometrically related to each other and defined as internal gap, marginal gap, vertical marginal discrepancy, horizontal marginal discrepancy, overextended margin, underextended margin, absolute marginal discrepancy, and seating discrepancy. The significance and difference in magnitude of different locations are presented. The best alternative is perhaps the absolute marginal discrepancy, which would always be the largest measurement of error at the margin and would reflect the total misfit at that point.
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            Effect of in vivo crown margin discrepancies on periodontal health.

            Numerous reports have suggested a relationship between marginal adaptation of dental castings and periodontal tissue health, and this study examined this relationship quantitatively. Forty-two crown restorations in 29 randomly selected patients were selected for this study using three criteria. (1) The crowns were placed at the University of North Carolina School of Dentistry; (2) the crowns were in service for a minimum of 4 years; and (3) the crown margins were within the intracrevicular crevice (subgingival). Replica impressions of the facial margins of specific crowns were made with a vinyl polysiloxane impression material, and poured casts were prepared for scanning electron micrograph evaluation. Marginal discrepancy measurements were identified on each micrograph at 10 equally spaced locations along the margin and averaged for each specimen. Periodontal indices of pocket depths, crevicular fluid volume, and gingival index were accumulated for clinical measurements. Pearson correlation and Bonferroni adjusted probability tests were performed, but no significant correlation was found between marginal discrepancy (0.16 +/- 0.13 mm) and pocket depth (2.4 +/- 0.9 mm). However, a strong correlation (p less than 0.001) existed between marginal discrepancy and gingival index (2 +/- 0.8) and between marginal discrepancies and crevicular fluid volume (49.9 +/- 31.1). These results established that a significant quantitative relationship existed between the marginal discrepancy and periodontal tissue inflammation for subgingivally located crown margins.
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              Clinical fit of all-ceramic three-unit fixed partial dentures, generated with three different CAD/CAM systems.

              In this study, the hypothesis was tested that the marginal and internal fit of CAD/CAM fabricated all-ceramic three-unit fixed partial dentures (FPDs) can be as good as in metal-ceramic FPDs. Twenty-four all-ceramic FPDs were fabricated and randomly subdivided into three equally sized groups. Eight frameworks were fabricated using the Digident CAD/CAM system (DIGI), another eight frameworks using the Cerec Inlab system (INLA). Vita Inceram Zirkonia blanks were used for both groups. In a third group frameworks were milled from yttrium-stabilized Zirconium blanks using the Lava system (LAVA). All frameworks were layered with ceramic veneering material. In addition, six three-unit metal-ceramic FPDs served as control group. All FPDs were evaluated using a replica technique with a light body silicone stabilized with a heavy body material. The replica samples were examined under microscope. The medians of marginal gaps were 75 microm for DIGI, 65 microm for LAVA and INLA and 54 microm for the conventional FPDs. Only the DIGI data differed significantly from those of the conventional FPDs. Within the limits of this study, the results suggest that the accuracy of CAD/CAM generated three-unit FPDs is satisfactory for clinical use.
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                Author and article information

                Journal
                J Dent (Shiraz)
                J Dent (Shiraz)
                JDS
                Journal of Dentistry
                Shiraz University of Medical Sciences (Shiraz, Iran )
                2345-6485
                2345-6418
                September 2013
                : 14
                : 3
                : 118-129
                Affiliations
                [a ]Dept. of Prosthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
                [b ]Postgraduate Student, Dept. of Prosthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
                Author notes
                Corresponding Author: Torabi K., Dept. of Prosthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran. Tel: +98-9171113044 , Email: torabik@ 123456yahoo.com
                Article
                jds-14-118
                3927676
                24724133
                f0d11d1b-566f-4def-a624-d9514ed8f7ab
                © 2013: Journal of dentistry (Shiraz, Iran)

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : February 2013
                : March 2013
                : April 2013
                Categories
                Original Article

                marginal fit,internal fit,wax patterns,metal-ceramic crowns,cad/cam

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