Can lithium disilicate ceramic crowns be fabricated on the basis of CBCT data?

  • Ana Elisa Colle Kauling
  • Christine Keul
  • Kurt Erdelt
  • Jan Kühnisch
  • Jan-Frederik GüthEmail author
Original Article



Evaluating the fit of CAD/CAM lithium disilicate ceramic crowns fabricated on basis of direct and indirect digitalization of impressions by CBCT or of dental casts.

Material and methods

A metal model with a molar chamfer preparation was digitized (n = 12 per group) in four ways: IOS—direct digitalization using an Intra-Oral scanner (CS3600), cone-beam computed tomography scan (CBCT 1)—indirect digitalization of impression (CBCT-CS9300), CBCT 2—indirect digitalization of impression (CBCT-CS8100), and Extra-Oral scanner (EOS)—indirect digitalization of gypsum-cast (CeramillMap400). Accuracy of 3D datasets was evaluated in relation to a reference dataset by best-fit superimposition. Marginal fit of lithium disilicate crowns after grinding was evaluated by replica technique. Significant differences were detected for 3D accuracy by Mann–Whitney U and for fit of crowns by One-way ANOVA followed by Scheffe’s post hoc (p = 0.05).


3D analysis revealed mean positive and negative deviations for the groups IOS (− 0.011 ± 0.007 mm/0.010 ± 0.003 mm), CBCT 1 (− 0.046 ± 0.008 mm/0.093 ± 0.004 mm), CBCT 2 (− 0.049 ± 0.030 mm/0.072 ± 0.015 mm), and EOS (− 0.023 ± 0.007 mm/0.028 ± 0.007 mm). Marginal fit presented the results IOS (0.056 ± 0.022 mm), CBCT 1 (0.096 ± 0.034 mm), CBCT 2 (0.068 ± 0,026 mm), and EOS (0.051 ± 0.017 mm).


The marginal fit of EOS and IOS, IOS and CBCT 2, and CBCT 2 and CBCT 1 showed statistical differences. The marginal fit of CBCT 1 and CBCT 2 is within the range of clinical acceptance; however, it is significant inferior to EOS and IOS.

Clinical relevance

The use of a CBCT enables clinicians to digitize conventional impressions. Despite presenting results within clinical acceptable levels, the CBCT base method seems to be inferior to Intra-Oral scans or to scanning gypsum models regarding the resulting accuracy and fit.


Cone-beam computed tomography Digital impression Direct digitalization Fit Indirect restorations 



The authors would like to thank CARESTREAM for the support of the study.


The first author was financial supported by the Brazilian National Council for Scientific and Technological Development (grant, no. 290087/2014–7). This study was financially supported by CARESTREAM.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.

Informed consent

For this type of study formal, consent is not required.


  1. 1.
    Zimmerman M, Valcanaia A, Neiva G, Mehl A, Fasbinder D (2017) Digital evaluation of the fit of zirconia-reinforced lithium silicate crowns with a new three-dimensional approach. Quintessence Int 30:9–15. Google Scholar
  2. 2.
    Hamza TA, Ezzat HA, El-Hossary MM, Katamish HA, Shokry TE, Rosenstiel SF (2013) Accuracy of ceramic restorations made with two CAD/CAM systems. J Prosthet Dent 109(2):83–87. CrossRefGoogle Scholar
  3. 3.
    Simeone P, Gracis S (2015) Eleven-year retrospective survival study of 275 veneered lithium disilicate single crowns. Int J Periodontics Restorative Dent 35(5):685–694. CrossRefGoogle Scholar
  4. 4.
    Pieger S, Salman A, Bidra AS (2014) Clinical outcomes of lithium disilicate single crowns and partial fixed dental prostheses: a systematic review. J Prosthet Dent 112(1):22–30. CrossRefGoogle Scholar
  5. 5.
    Ng J, Ruse D, Wyatt CA (2014) Comparison of the marginal fit of crowns fabricated with digital and conventional methods. J Prosthet Dent 112(3):555–560. CrossRefGoogle Scholar
  6. 6.
    Abdel-Azim T, Rogers K, Elathamna E, Zandinejad A, Metz M, Morton D (2015) Comparison of the marginal fit of lithium disilicate crowns fabricated with CAD/CAM technology by using conventional impressions and two intraoral digital scanners. J Prosthet Dent 114(4):554–559. CrossRefGoogle Scholar
  7. 7.
    Kim JH, Jeong JH, Lee JH, Cho HW (2016) Fit of lithium disilicate crowns fabricated from conventional and digital impressions assessed with micro-CT. J Prosthet Dent 116(4):551–557. CrossRefGoogle Scholar
  8. 8.
    McLean JW, von Fraunhofer JA (1971) The estimation of cement film thickness by an in vivo technique. Br Dent J 131:107–111CrossRefGoogle Scholar
  9. 9.
    Janenko C, Smales RJ (1979) Anterior crowns and gingival health. Aust Dent J 24:225–230CrossRefGoogle Scholar
  10. 10.
    Belser UC, MacEntee MI, Richter WA (1985) Fit of three porcelain-fused-to-metal marginal designs in vivo: a scanning electron microscope study. J Prosthet Dent 53:24–29CrossRefGoogle Scholar
  11. 11.
    Sulaiman F, Chai J, Jameson LM, Wozniak WT (1997) A comparison of the marginal fit of In-Ceram, IPS Empress and Procera crowns. Int J Prosthodont 10:478–484Google Scholar
  12. 12.
    Beschnidt SM, Strub JR (1999) Evaluation of the marginal accuracy of different all-ceramic crown systems after simulation in the artificial mouth. J Oral Rehabil 26:582–593CrossRefGoogle Scholar
  13. 13.
    Hunter AJ, Hunter AR (1990) Gingival crown margin configurations: a review and discussion. Part I: terminology and widths. J Prosthet Dent 64(5):548–552CrossRefGoogle Scholar
  14. 14.
    Contrepois M, Soenen A, Bartala M, Laviole O (2013) Marginal adaptation of ceramic crowns: a systematic review. J Prosthet Dent 110(6):447–454. CrossRefGoogle Scholar
  15. 15.
    Almeida e Silva JS, Erdelt K, Edelhoff D, Araújo É, Stimmelmayr M, Vieira LC, Güth JF (2014) Marginal and internal fit of four-unit zirconia fixed dental prostheses based on digital and conventional impression techniques. Clin Oral Investig 18(2):515–523. CrossRefGoogle Scholar
  16. 16.
    Keul C, Stawarczyk B, Erdelt KJ, Beuer F, Edelhoff D, Güth JF (2014) Fit of 4-unit FDPs made of zirconia and CoCr-alloy after chairside and labside digitalization—a laboratory study. Dent Mater 30(4):400–407. CrossRefGoogle Scholar
  17. 17.
    Ender A, Zimmermann M, Attin T, Mehl A (2016) In vivo precision of conventional and digital methods for obtaining quadrant dental impressions. Clin Oral Investig 20(7):1495–1504. CrossRefGoogle Scholar
  18. 18.
    Güth JF, Runkel C, Beuer F, Stimmelmayr M, Edelhoff D, Keul C (2017) Accuracy of five intraoral scanners compared to indirect digitalization. Clin Oral Investig 21(5):1445–1455. CrossRefGoogle Scholar
  19. 19.
    Ender A, Mehl A (2013) Influence of scanning strategies on the accuracy of digital intraoral scanning systems. Int J Comput Dent 16(1):11–21Google Scholar
  20. 20.
    Ender A, Attin T, Mehl A (2016) In vivo precision of conventional and digital methods of obtaining complete-arch dental impressions. J Prosthet Dent 115(3):313–320. CrossRefGoogle Scholar
  21. 21.
    Güth JF, Edelhoff D, Schweiger J, Keul C (2016) A new method for the evaluation of the accuracy of full-arch digital impressions in vitro. Clin Oral Investig 20(7):1487–1494. CrossRefGoogle Scholar
  22. 22.
    Kim SR, Kim CM, Jeong ID, Kim WC, Kim HY, Kim JH (2017) Evaluation of accuracy and repeatability using CBCT and a dental scanner by means of 3D software. Int J Comput Dent 20(1):65–73Google Scholar
  23. 23.
    Robben J, Muallah J, Wesemann C, Nowak R, Mah J, Pospiech P, Bumann A (2017) Suitability and accuracy of CBCT model scan: an in vitro study. Int J Comput Dent 20(4):363–375Google Scholar
  24. 24.
    Şeker E, Ozcelik TB, Rathi N, Yilmaz B (2016) Evaluation of marginal fit of CAD/CAM restorations fabricated through cone beam computerized tomography and laboratory scanner data. J Prosthet Dent 115(1):47–51. CrossRefGoogle Scholar
  25. 25.
    Molin M, Karlsson S (1993) The fit of gold inlays and three ceramic inlay systems. A clinical and in vitro study. Acta Odontol Scand 51:201–206CrossRefGoogle Scholar
  26. 26.
    Boening KW, Wolf BH, Schmidt AE, Kästner K, Walter MH (2000) Clinical fit of Procera all-ceramic crowns. J Prosthet Dent 84:419–124CrossRefGoogle Scholar
  27. 27.
    Güth JF, Kauling AEC, Schweiger J, Kühnisch J, Stimmelmayr M (2017) Virtual simulation of periodontal surgery including presurgical CAD/CAM fabrication of tooth-colored removable splints on the basis of CBCT data: a case report. Int J Periodontics Restorative Dent 37(6):e310–e320. CrossRefGoogle Scholar
  28. 28.
    Hwang HS, Choe SY, Hwang JS, Moon DN, Hou Y, Lee WJ, Wilkinson C (2015) Reproducibility of facial soft tissue thickness measurements using cone-beam CT images according to the measurement methods. J Forensic Sci 60(4):957–965. CrossRefGoogle Scholar
  29. 29.
    Pauwels R, Araki K, Siewerdsen JH, Thongvigitmanee SS (2015) Technical aspects of dental CBCT: state of the art. Dentomaxillofac Radiol 44(1):20140224. CrossRefGoogle Scholar
  30. 30.
    Pauwels R, Beinsberger J, Stamatakis H, Tsiklakis K, Walker A, Bosmans H, Bogaerts R, Jacobs R, Horner K (2012) Comparison of spatial and contrast resolution for cone-beam computed tomography scanners. Oral Surg Oral Med Oral Pathol Oral Radiol 114(1):127–135CrossRefGoogle Scholar
  31. 31.
    Brüllmann D, Schulze RK (2015) Spatial resolution in CBCT machines for dental/maxillofacial applications-what do we know today? Dentomaxillofac Radiol 44(1):20140204. CrossRefGoogle Scholar
  32. 32.
    Flügge T, Derksen W, Te Poel J, Hassan B, Nelson K, Wismeijer D (2017) Registration of cone beam computed tomography data and intraoral surface scans—a prerequisite for guided implant surgery with CAD/CAM drilling guides. Clin Oral Implants Res 28(9):1113–1118. CrossRefGoogle Scholar
  33. 33.
    Boldt J, Rottner K, Schmitter M, Hopfgartner A, Jakob P, Richter EJ, Tymofiyeva O (2018) High-resolution MR imaging for dental impressions: a feasibility study. Clin Oral Investig 22:1209–1213. CrossRefGoogle Scholar
  34. 34.
    Huotilainen E, Jaanimets R, Valášek J, Marcián P, Salmi M, Tuomi J, Mäkitie A, Wolff J (2014) Inaccuracies in additive manufactured medical skull models caused by the DICOM to STL conversion process. J Craniomaxillofac Surg 42(5):e259–e265. CrossRefGoogle Scholar
  35. 35.
    Lee CH, Ryu JH, Lee YH, Yoon KH (2015) Reduction of radiation exposure by lead curtain shielding in dedicated extremity cone beam CT. Br J Radiol 88(1050):20140866. CrossRefGoogle Scholar
  36. 36.
    Kang SR, Lee WJ, Woo SY, Kim DS, Yi WJ (2014) Radiation dose reduction in CBCT imaging using K-edge filtering and energy weighting. Conf Proc IEEE Eng Med Biol Soc 2014:5137–5140. Google Scholar
  37. 37.
    Flügge T, Hövener JB, Ludwig U, Eisenbeiss AK, Spittau B, Hennig J, Schmelzeisen R, Nelson K (2016) Magnetic resonance imaging of intraoral hard and soft tissues using an intraoral coil and FLASH sequences. Eur Radiol 26:4616–4623CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ana Elisa Colle Kauling
    • 1
  • Christine Keul
    • 1
  • Kurt Erdelt
    • 1
  • Jan Kühnisch
    • 2
  • Jan-Frederik Güth
    • 1
    • 3
    Email author
  1. 1.Department of ProsthodonticsUniversity HospitalMunichGermany
  2. 2.Department of Operative Dentistry and PeriodontologyUniversity HospitalMunichGermany
  3. 3.Department of ProsthodonticsUniversity HospitalMunichGermany

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