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Factors Affecting the Marginal Fit of CAD-CAM Restorations and Concepts to Improve Outcomes

  • Alan AtlasEmail author
  • Wael Isleem
  • Michael Bergler
  • Howard P. Fraiman
  • Ricardo Walter
  • Nathaniel D. Lawson
Modern Production Laboratory Advances in Dental Technology (M Bergler and E Steger, Section Editors)
  • 11 Downloads
Part of the following topical collections:
  1. Topical Collection on Modern Production Laboratory Advances in Dental Technology

Abstract

Purpose of Review

With the advent of CAD-CAM technology, it is essential to examine factors that affect outcomes of restorations fabricated by the new methodologies.

Recent Findings

This report assesses and compares ceramic crown fabrication systems to determine what factors affect marginal fit and provide solutions for better outcomes.

Summary

The review revealed key scientific evidence about what factors influence the marginal fit of CAD-CAM ceramic restorations. Solutions were recommended to help the clinician achieve greater long-term success when providing this treatment to their patients. The dental microscope enables the dental practitioner to achieve improved clinical outcomes in all phases of restorative dentistry, especially CAD-CAM restorations.

Keywords

CAD-CAM Marginal fit Marginal Gap Ceramic restoration Dental Microscope 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • Boitelle P, Mawussi B, Tapie L, Fromentin O. A systematic review of CAD/CAM fit restoration evaluations. J Oral Rehabil. 2014;41:853–74.  https://doi.org/10.1111/joor.12205This review emphasized deficiency in the number of clinical studies on accuracy of CAD-CAM restorations and inconsistency in protocols preclude solid evidenced based conclusions.CrossRefGoogle Scholar
  2. 2.
    • Papadiochou S, Pissiotis AL. Marginal adaptation and CAD-CAM technology: A systematic review of restorative material and fabrication techniques. J Prosthet Dent. 2018;119(4):545–51.  https://doi.org/10.1016/j.prosdent.2017.07.001This review concluded there is lack of evidence to conclude CAD-CAM restorations have superior marginal adaptation.CrossRefGoogle Scholar
  3. 3.
    Hamza TA, Sherif RM. In vitro evaluation of marginal discrepancy of monolithic zirconia restorations fabricated with different CAD-CAM systems. J Prosthet Dent. 2017;117(6):762–6.  https://doi.org/10.1016/j.prosdent.2016.09.011.CrossRefPubMedGoogle Scholar
  4. 4.
    •• Schestatsky R, Zucuni CP, Venturini AB, de Lima Burgo TA, Bacchi A, Valandro LF, et al. CAD-CAM milled versus pressed lithium-disilicate monolithic crowns adhesively cemented after distinct surface treatments: fatigue performance and ceramic surface characteristics. J Mech Behav Biomed Mater. 2019;94:144–54.  https://doi.org/10.1016/j.jmbbm.2019.03.005This study compared CAD/CAM’s different classes of materials possessing various levels of machinability compared to pressed manufacturing.CrossRefPubMedGoogle Scholar
  5. 5.
    Contrepois M, Soenen A, Bartala M, Laviole O. Marginal adaptation of ceramic crowns: a systematic review. J Prosthet Dent. 2013;110(6):447–454.e10.  https://doi.org/10.1016/j.prosdent.2013.08.003.CrossRefPubMedGoogle Scholar
  6. 6.
    • Holmes JR, Bayne SC, Holland GA, Sulik WD. Considerations in measurement of marginal fit. J Prosthet Dent. 1989;62:405–8.  https://doi.org/10.1016/0022-3913(89)90170-4This paper is considered the gold standard for evaluative criteria for marginal fit.CrossRefGoogle Scholar
  7. 7.
    Demir N, Ozturk AN, Malkoc MA. Evaluation of the marginal fit of full ceramic crowns by the microcomputed tomography (micro-CT) technique. Eur J Dent. 2014;8:437–44.  https://doi.org/10.4103/1305-7456.143612.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Sorensen JA. A rationale for comparison of plaque-retaining properties of crown systems. J Prosthet Dent. 1989;62:264–9.  https://doi.org/10.1016/0022-3913(89)90329-6.CrossRefPubMedGoogle Scholar
  9. 9.
    McLean JW, von Fraunhofer JA. The estimation of cement film thickness by an vivo technique. Br Dent J. 131(1971):107–11.  https://doi.org/10.1038/sj.bdj.4802708.CrossRefGoogle Scholar
  10. 10.
    Akbar JH, Petrie CS, Walker MP, Williams K, Eick JD. Marginal adaptation of Cerec 3 CAD/CAM composite crowns using two different finish line preparation designs. J Prosthodont. 2006;15:155–63.  https://doi.org/10.1111/j.1532-849x.2006.00095.x.CrossRefPubMedGoogle Scholar
  11. 11.
    Abduo J, Lyons K, Swain M. Fit of zirconia fixed partial denture: a systematic review. J Oral Rehabil. 2010 Nov;37(11):866–76.  https://doi.org/10.1111/j.1365-2842.2010.02113.x.CrossRefPubMedGoogle Scholar
  12. 12.
    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.  https://doi.org/10.1016/S0022-3913(09)60047-0.CrossRefPubMedGoogle Scholar
  13. 13.
    Ural C, Burgaz Y, Saraç D. In vitro evaluation of marginal adaptation in five ceramic restoration fabricating techniques. Quintessence Int. 2010;41:585–90. PMID: 20614046Google Scholar
  14. 14.
    Bourbia M, Ma D, Cvitkovitch DG, Santerre JP, Finer Y. Cariogenic bacteria degrade dental resin composites and adhesives. J Dent Res. 2013;92(11):989–94.  https://doi.org/10.1177/0022034513504436.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Nedeljkovic I, De Munck J, Ungureanu A-A, Slomka V, Bartic C, Vananroye A, et al. Biofilm-induced changes to the composite surface. J Dent. 2017 Aug;63:36–43.  https://doi.org/10.1016/j.jdent.2017.05.015.CrossRefPubMedGoogle Scholar
  16. 16.
    •• Kusuma Yulianto HD, Rinastiti M, Cune MS, de Haan-Visser W, Atema-Smit J, Busscher HJ, et al. Biofilm composition and composite degradation during intra-oral wear. Dent Mater. 2019;35(5):740–50.  https://doi.org/10.1016/j.dental.2019.02.024This study examined the effect of cariogenic bacteria on the tooth-restoration interface.CrossRefPubMedGoogle Scholar
  17. 17.
    Montagner AF, Opdam NJ, Ruben JL, Bronkhorst EM, Cenci MS, Huysmans MC. Behavior of failed bonded interfaces under in vitro cariogenic challenge. Dent Mater. 2016;32(5):668–75.  https://doi.org/10.1016/j.dental.2016.02.005.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kuper NK, Opdam NJM, Ruben JL, de Soet JJ, Cenci MS, Bronkhorst EM, et al. Gap size and wall lesion development next to composite. J Dent Res. 2014;93(7 Suppl):108S–13S.  https://doi.org/10.1177/0022034514534262.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    • Maske TT, Hollanders ACC, Kuper NK, Bronkhorst EM, Cenci MS, Huysmans MCDNJM. A threshold gap size for in situ secondary caries lesion development. J Dent. 2019;80:36–40.  https://doi.org/10.1016/j.jdent.2018.10.014This in-vitro study demonstrated the marginal gap is minimal for secondary caries development.CrossRefGoogle Scholar
  20. 20.
    Denry I. How and when does fabrication damage adversely affect the clinical performance of ceramic restorations? Dent Mater. 2013;29(1):85–96.  https://doi.org/10.1016/j.dental.2012.07.001.CrossRefPubMedGoogle Scholar
  21. 21.
    Fraga S, Amaral M, Bottino MA, Valandro LF, Kleverlaan CJ, May LG. Impact of machining on the flexural fatigue strength of glass and polycrystalline CAD/CAM ceramics. Dent Mater. 2017;33(11):1286–97.  https://doi.org/10.1016/j.dental.2017.07.019.CrossRefPubMedGoogle Scholar
  22. 22.
    Romanyk DL, Martinez YT, Veldhuis S, Rae N, Guo Y, Sirovica S, et al. Strength-limiting damage in lithium silicate glass-ceramics associated with CAD-CAM. Dent Mater. 2019;35(1):98–104.  https://doi.org/10.1016/j.dental.2018.11.004.CrossRefPubMedGoogle Scholar
  23. 23.
    Gold SA, Ferracane JL, da Costa J. Effect of crystallization firing on marginal gap of CAD/CAM fabricated lithium disilicate crowns. J Prosthodont. 2018;27(1):63–6.  https://doi.org/10.1111/jopr.12638.CrossRefPubMedGoogle Scholar
  24. 24.
    Azarbal A, Azarbal M, Engelmeier RL, Kunkel TC. Marginal fit comparison of CAD/CAM crowns milled from two different materials. J Prosthodont. 2018;27(5):421–8.  https://doi.org/10.1111/jopr.12683.CrossRefPubMedGoogle Scholar
  25. 25.
    Furtado de Mendonca A, Shahmoradi M, Gouvêa CVD, De Souza GM, Ellakwa A. Microstructural and mechanical characterization of CAD/CAM materials for monolithic dental restorations. J Prosthodont. 2019;28(2):e587–94.  https://doi.org/10.1111/jopr.12964.CrossRefPubMedGoogle Scholar
  26. 26.
    Mounajjed R, M Layton D, Azar B. The marginal fit of E.max Press and E.max CAD lithium disilicate restorations: A critical review. Dent Mater J. 2016;35(6):835–44.  https://doi.org/10.4012/dmj.2016-008.CrossRefPubMedGoogle Scholar
  27. 27.
    Azar B, Eckert S, Kunkela J, Ingr T, Mounajjed R. The marginal fit of lithium disilicate crowns: Press vs. CAD/CAM. Braz Oral Res. 2018;32:e001.  https://doi.org/10.1590/1807-3107/2018.vol32.0001.CrossRefPubMedGoogle Scholar
  28. 28.
    Shim JS, Lee JS, Lee JY, Choi YJ, Shin SW, Ryu JJ. Effect of software version and parameter settings on the marginal and internal adaptation of crowns fabricated with the CAD/CAM system. J Appl Oral Sci. 2015;23:515–22.  https://doi.org/10.1590/1678-775720150081.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Hamza TA, Ezzat HA, MMK EL-H, HAEM K, Shokry TE, Rosenstiel SF. Accuracy of ceramic restorations made with two CAD/CAM systems. J Prosthet Dent. 2013;109:83–7.  https://doi.org/10.1016/S0022-3913(13)60020-7.CrossRefPubMedGoogle Scholar
  30. 30.
    Kirsch C, Ender A, Attin T, Mehl A. Trueness of four different milling procedures used in dental CAD/CAM systems. Clin Oral Investig. 2017;21(2):551–8.  https://doi.org/10.1007/s00784-016-1916-y.CrossRefPubMedGoogle Scholar
  31. 31.
    Okutan M, Heydecke G, Butz F, Strub JR. Fracture load and marginal fit of shrinkage- free ZrSiO4 all-ceramic crowns after chewing simulation. J Oral Rehabil. 2006;33:827–32.  https://doi.org/10.1111/j.1365-2842.2006.01637.x.CrossRefPubMedGoogle Scholar
  32. 32.
    Kale E, Yilmaz B, Seker E, Özcelik TB. Effect of fabrication stages and cementation on the marginal fit of CAD-CAM monolithic zirconia crowns. J Prosthet Dent. 2017;118(6):736–41.  https://doi.org/10.1016/j.prosdent.2017.01.004.CrossRefPubMedGoogle Scholar
  33. 33.
    Albert FE, El-Mowafy OM. Marginal adaptation and microleakage of Procera AllCeram crowns with four cements. Int J Prosthodont. 2004;17:529–35.PubMedGoogle Scholar
  34. 34.
    •• Yu H, Chen YH, Cheng H, Sawase T. Finish-line designs for ceramic crowns: a systematic review and meta-analysis. J Prosthet Dent. 2019;122(1):22–30.  https://doi.org/10.1016/j.prosdent.2018.10.002This review examined the effect of diamond shape during tooth preparation on marginal gap development.CrossRefPubMedGoogle Scholar
  35. 35.
    Skjold A, Schriwer C, Øilo M. Effect of margin design on fracture load of zirconia crowns. Eur J Oral Sci. 2019;127(1):89–96.  https://doi.org/10.1111/eos.12593.CrossRefPubMedGoogle Scholar
  36. 36.
    Lehmensiek M, Askar H, Brouwer F, Blunck U, Paris S, Schwendicke F. Restoration integrity, but not material or cementation strategy determined secondary caries lesions next to indirect restorations in vitro. Dent Mater. 2018;34(12):e317–23.  https://doi.org/10.1016/j.dental.2018.09.004.CrossRefPubMedGoogle Scholar
  37. 37.
    Winkelmeyer C, Wolfart S, Marotti J. Analysis of tooth preparations for zirconia-based crowns and fixed dental prostheses using stereolithography data sets. J Prosthet Dent. 2016;116(5):783–9.  https://doi.org/10.1016/j.prosdent.2016.03.019.CrossRefPubMedGoogle Scholar
  38. 38.
    Renne W, McGill ST, Forshee KV, DeFee MR, Mennito AS. Predicting marginal fit of CAD/CAM crowns based on the presence or absence of common preparation errors. J Prosthet Dent. 2012;108(5):310–5.  https://doi.org/10.1016/S0022-3913(12)60183-8.CrossRefPubMedGoogle Scholar
  39. 39.
    • Renne W, Wolf B, Kessler R, McPherson K, Mennito AS. Evaluation of the marginal fit of CAD/CAM crowns fabricated using two different chairside CAD/CAM systems on preparations of varying quality. J Esthet Restor Dent. 2015;27(4):194–202.  https://doi.org/10.1111/jerd.12148This study demonstrated the importance of preparation over scanning and milling systems utilized.CrossRefGoogle Scholar
  40. 40.
    Rosenstiel SF, Land MF, Fujimoto J. Con- temporary fixed prosthodontics. 4th ed. St Louis: Mosby Elsevier; 2006. p. 325–7.Google Scholar
  41. 41.
    Shillingburg HT, Hobo S, Whitsett LD, Ja-Cobi R, Brackett SE. Fundamentals of fixed prosthodontics. 3rd ed. Chicago: Quintessence Publishing; 1997. p. 437.Google Scholar
  42. 42.
    Hmaidouch R, Neumann P, Mueller WD. Influence of preparation form, luting space setting and cement type on the marginal and internal fit of CAD/ CAM crown copings. Int J Comput Dent. 2011;14:219–26.PubMedGoogle Scholar
  43. 43.
    Euán R, Figueras-Álvarez O, Cabratosa-Termes J, Brufau-de Barberà M, Gomes-Azevedo S. Comparison of the marginal adaptation of zirconium dioxide crowns in preparations with two different finish lines. J Prosthodont. 2012;21(4):291–5.  https://doi.org/10.1111/j.1532-849X.2011.00831.x.CrossRefPubMedGoogle Scholar
  44. 44.
    Ferreira A, Oliveira F, Bottino MA. Vertical marginal discrepancy of ceramic copings with different ceramic materials, finish lines, and luting agents: an in vitro evaluation. J Prosthet Dent. 2004;92:250–7.  https://doi.org/10.1016/j.prosdent.2004.06.023.CrossRefGoogle Scholar
  45. 45.
    Cho L, Choi J, Yi YJ, Park CJ. Effect of finish line variants on marginal accuracy and fracture strength of ceramic optimized polymer/fiber-reinforced composite crowns. J Prosthet Dent. 2004;91:554–60.  https://doi.org/10.1016/j.prosdent.2004.03.004.CrossRefPubMedGoogle Scholar
  46. 46.
    Keeling A, Wu J, Ferrari M. Confounding factors affecting the marginal quality of an intra-oral scan. J Dent. 2017;59:33–40.  https://doi.org/10.1016/j.jdent.2017.02.003.CrossRefGoogle Scholar
  47. 47.
    •• Abduo J, Elseyoufi M. Accuracy of intraoral scanners: a systematic review of influencing factors. Eur J Prosthodont Restor Dent. 2018;26(3):101–21.  https://doi.org/10.1922/EJPRD_01752Abduo21This review examined important elements when considering intra-oral scanning over conventional impression techniques.CrossRefPubMedGoogle Scholar
  48. 48.
    Mangano F, Gandolfi A, Luongo G, Logozzo S. Intraoral scanners in dentistry: a review of the current literature. BMC Oral Health. 2017;17(1):149.  https://doi.org/10.1186/s12903-017-0442-x.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    • Nedelcu R, Olsson P, Nyström I, Thor A. Finish line distinctness and accuracy in 7 intraoral scanners versus conventional impression: an in vitro descriptive comparison. BMC Oral Health. 2018;18(1):27.  https://doi.org/10.1186/s12903-018-0489-3This study demonstrated the potential issues scanners have compared to conventional impressions.
  50. 50.
    Li YQ, Wang H, Wang YJ, Chen JH. Effect of different grit sizes of diamond rotary instruments for tooth preparation on the retention and adaptation of complete coverage restorations. J Prosthet Dent. 2012;107(2):86–93.  https://doi.org/10.1016/S0022-3913(12)60029-8.CrossRefPubMedGoogle Scholar
  51. 51.
    Geminiani A, Abdel-Azim T, Ercoli C, Feng C, Meirelles L, Massironi D. Influence of oscillating and rotary cutting instruments with electric and turbine handpieces on tooth preparation surfaces. J Prosthet Dent. 2014;112(1):51–8.  https://doi.org/10.1016/j.prosdent.2014.02.007.CrossRefPubMedGoogle Scholar
  52. 52.
    Solá-Ruiz MF, Faus-Matoses I, Del Rio HJ, Fons-Font A. Study of surface topography, roughness, and microleakage after dental preparation with different instrumentation. Int J Prosthodont. 2014;27(6):530–3.  https://doi.org/10.11607/ijp.3932.CrossRefPubMedGoogle Scholar
  53. 53.
    Faus-Matoses I, Solá-Ruiz F. Dental preparation with sonic vs high-speed finishing: analysis of microleakage in bonded veneer restorations. J Adhes Dent. 2014;16(1):29–34.  https://doi.org/10.3290/j.jad.a30754.CrossRefPubMedGoogle Scholar
  54. 54.
    • Ellis R, Bennani V, Purton D, Chandler N, Lowe B. The effect of ultrasonic instruments on the quality of preparation margins and bonding to dentin. J Esthet Restor Dent. 2012;24(4):278–85.  https://doi.org/10.1111/j.1708-8240.2011.00495.xThis study demonstrated sonic handpieces have a positive effect on finish line margins and bonding.CrossRefGoogle Scholar
  55. 55.
    Bowers DJ, Glickman GN, Solomon ES, He J. Magnification’s effect on endodontic fine motor skills. J Endod. 2010;36:1135–8.  https://doi.org/10.1016/j.joen.2010.03.003.CrossRefPubMedGoogle Scholar
  56. 56.
    Ferreira R, Prado M, de Jesus Soares A, Zaia AA, de Souza-Filho FJ. Influence of using clinical microscope as auxiliary to perform mechanical cleaning of post space: a bond strength analysis. J Endod\. 2015;41(8):1311–6.  https://doi.org/10.1016/j.joen.2015.05.003.CrossRefPubMedGoogle Scholar
  57. 57.
    Setzer FC, Shah S, Kohli M, Karabucak B, Kim S. Outcome of endodontic surgery: a meta-analysis of the literature - part 1: comparison of traditional root- end surgery and endodontic microsurgery. J Endod\. 2010;36:1757–65.  https://doi.org/10.1016/j.joen.2010.08.007.CrossRefPubMedGoogle Scholar
  58. 58.
    Setzer FC, Kohli M, Shah S, Karabucak B, Kim S. Outcome of endodontic surgery: a meta-analysis of the literature - part 2: comparison of endodontic microsurgical techniques with and without the use of higher magnification. J Endod\. 2012;38:1–10.  https://doi.org/10.1016/j.joen.2011.09.021.CrossRefPubMedGoogle Scholar
  59. 59.
    Tsesis I, Rosen E, Taschieri S, Telishevsky Strauss Y, Ceresoli V, Del Fabbro M. Outcomes of surgical endodontic treatment performed by a modern technique: an updated meta-analysis of the literature. J Endod\. 2013;39:332–9.  https://doi.org/10.1016/j.joen.2012.11.044.CrossRefPubMedGoogle Scholar
  60. 60.
    Friedman MJ, Landesman HM. Microscope-assisted precision (MAP) dentistry. A challenge for new knowledge. J Calif Dent Assoc. 1998;26(12):900–5.PubMedGoogle Scholar
  61. 61.
    Musikant BL, Cohen BI, Deutsch AS. The surgical microscope, not just for the specialist. N Y State Dent J. 1996;62(8):33–5.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alan Atlas
    • 1
    • 2
    • 3
    Email author
  • Wael Isleem
    • 4
  • Michael Bergler
    • 5
  • Howard P. Fraiman
    • 2
    • 4
  • Ricardo Walter
    • 6
  • Nathaniel D. Lawson
    • 7
  1. 1.Department of EndodonticsUniversity of Pennsylvania School of Dental MedicinePhiladelphiaUSA
  2. 2.Department of Preventive and Restorative SciencesUniversity of Pennsylvania School of Dental MedicinePhiladelphiaUSA
  3. 3.PhiladelphiaUSA
  4. 4.Periodontal Prosthesis Program, Department of PeriodonticsPhiladelphiaUSA
  5. 5.CAD-CAM Ceramic CenterUniversity of Pennsylvania School of Dental MedicinePhiladelphiaUSA
  6. 6.Department of Comprehensive Oral HealthUniversity of North Carolina Adams School of DentistryChapel HillUSA
  7. 7.Department of Clinical and Community Sciences, School of DentistryUniversity of Alabama at BirminghamBirminghamUSA

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