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Background/purpose: The adaptation and marginal integrity of computer-aided designed and computer-aided manufactured (CAD/CAM) crowns after exposure to thermal aging need to be investigated. The present in-vitro study was designed to investigate the marginal integrity of CAD/CAM fabricated crowns cemented on extracted teeth after thermocycling aging. Materials and methods: Twenty-six newly extracted human premolars were prepared for full-coverage CAD/CAM crowns and were divided into two groups (leucite-reinforced glass-ceramics and lithium disilicate glass-ceramics). Both crowns' groups were cemented using dual curing resin cement. All specimen margins were measured for marginal integrity using an imaging system 24 h post cementation; then after 1, 3, and 5 estimated clinical years (10,000, 30,000, and 50,000 thermocycles). Two-way ANOVA analysis were used to determine whether the mean value difference is significantly different (ɑ = 0.05). Results: The average margin gaps recorded for leucite-reinforced glass-ceramic crowns were: 82.61 µm initial, and 91.02 µm after 5 estimated clinical year). For the lithium disilicate glass-ceramic crowns, the average margin gaps recorded were: 100.01 µm initial, and 120.21 µm after 5 estimated clinical year. During all measuring intervals, the leucite-reinforced glass-ceramic crown group had a lower marginal discrepancy. No statistically significant difference between the two groups was recorded. Conclusion: After being subjected to thermocycling, both CAD/CAM ceramic crowns, exhibited an increase in their marginal discrepancy; the difference was within the accepted clinical range.

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BACKGROUND: Paediatric-preformed zirconia crowns have been associated with several issues, primarily their inability to be crimped and the need for extensive tooth preparation. Additionally, the capacity to adjust the size, shape, and fit of these crowns is very limited. AIM: To evaluate and compare the fracture strength of four different types of dental crowns intended for paediatric patients. DESIGN: The fracture resistance of four types of paediatric crowns was evaluated using the universal testing machine; freshly extracted primary molars received one of the following: preformed zirconia crowns, custom-made computer-aided design and computer-aided manufacturing (CAD-CAM) zirconia crowns, custom-made CAD-CAM ceramic crowns, and custom-made CAD-CAM hybrid composite crowns. Data were statistically compared using the Kruskal-Wallis test followed by the Bonferroni test, and the level of significance was set at 5%. RESULTS: Results showed that there was a statistically significant difference among the four groups (p < .001). The highest value of fracture force was observed for the milled zirconia crown and the lowest for the prefabricated zirconia. CONCLUSION: The implementation of the CAD-CAM digital crown fabrication technique has the potential to address issues associated with preformed crowns in paediatric patients, particularly in terms of fracture resistance.

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PURPOSE: To determine the fracture resistance of chairside computer-aided design and computer-aided manufacturing (CAD-CAM) zirconia surveyed crowns for a mandibular first molar without occlusal rest and with four different rest seat designs. MATERIALS AND METHODS: Seventy CAD-CAM zirconia 4Y-PSZ (IPS e.max ZirCAD MT for CEREC A1, C15, Ivoclar Vivadent) crowns (14 specimens/group) were designed and fabricated with a dental chairside CAD-CAM system (CEREC PrimeScan, and CEREC MCXL Dentsply Sirona). The restorations were divided into groups according to the following rest seat designs: (1) Surveyed crown without rest seat, (2) surveyed crowns with disto-occlusal rest seat, (3) surveyed crowns with disto-occlusal extended rest seat, (4) surveyed crowns with interproximal rest seat, and (5) continuous rest seat. Crowns were treated with a primer system (Monobond Plus, Ivoclar Vivadent) and cemented using resin luting cement (Multilink Automix, Ivoclar Vivadent) to resin-printed dies (Grey Resin V4, FormLabs). Subsequently, the crowns were subjected to 200,000 load cycles at 1 Hz with 20 N force and then loaded with a steel indenter until fracture. The test results were analyzed with one-way Analysis of Variance (ANOVA) and HSD Tukey post-Hoc test. RESULTS: The mean fracture resistance of surveyed crowns without and with different rest seats was significantly different from each other. Surveyed crowns with no rest seat displayed the highest resistance (4238 N) followed by crowns with continuous rest seat (3601 N), crowns with disto-occlusal extended rest seat (3283 N), and crowns with disto-occlusal rest seat (3257 N). Crowns with interproximal rest seat displayed the lowest fracture resistance (2723 N). CONCLUSIONS: Surveyed crowns without rest seats had a higher fracture resistance than crowns with rest seats Surveyed crowns with interproximal rest seats presented the lowest fracture resistance among all rest seat designs. Crowns with disto-occlusal rest seats, disto-occlusal extended rest seats, and continuous rest seats displayed similar fracture resistance.

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The objective of this study was to examine the effects of storage conditions on the flexural strengths of resin composite materials for CAD/CAM restorations. Seven commercially available resin composite CAD/CAM blanks were examined. Rectangular specimens (4.0×1.2×4.0 mm) of each material were trimmed from the blanks and subjected to thermal cycling between 5°C and 55°C in deionized water at 10,000 cycles or stored in 37°C deionized water for one week or air for one day (n=10 for each condition). The difference in storage condition between water immersion and thermal cycling did not affect the flexural strengths of resin composite materials for CAD/CAM examined in this study. The resin composite block CS300 made from Bis-MEPP and UDMA showed the greatest flexural strength under all storage conditions and less deterioration of strength by thermal cycling and water immersion among the resin composite blocks tested.

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PURPOSE: To evaluate the marginal fit of CAD/CAM copings milled from hybrid ceramic (Vita Enamic) blocks and lithium disilicate (IPS e.max CAD) blocks, and to evaluate the effect of crystallization firing on the marginal fit of lithium disilicate copings. MATERIALS AND METHODS: A standardized metal die with a 1-mm-wide shoulder finish line was imaged using the CEREC AC Bluecam. The coping was designed using CEREC 3 software. The design was used to fabricate 15 lithium disilicate and 15 hybrid ceramic copings. Design and milling were accomplished by one operator. The copings were seated on the metal die using a pressure clamp with a uniform pressure of 5.5 lbs. A Macroview Microscope (14×) was used for direct viewing of the marginal gap. Four areas were imaged on each coping (buccal, distal, lingual, mesial). Image analysis software was used to measure the marginal gaps in µm at 15 randomly selected points on each of the four surfaces. A total of 60 measurements were made per specimen. For lithium disilicate copings the measurements for marginal gap were made before and after crystallization firing. Data were analyzed using paired t-test and Kruskal-Wallis test. RESULTS: The overall mean difference in marginal gap between the hybrid ceramic and crystallized lithium disilicate copings was statistically significant (p < 0.01). Greater mean marginal gaps were measured for crystallized lithium disilicate copings. The overall mean difference in marginal gap before and after firing (precrystallized and crystallized lithium disilicate copings) showed an average of 62 µm increase in marginal gap after firing. This difference was also significant (p < 0.01). CONCLUSIONS: A significant difference exists in the marginal gap discrepancy when comparing hybrid ceramic and lithium disilicate CAD/CAM crowns. Also crystallization firing can result in a significant increase in the marginal gap of lithium disilicate CAD/CAM crowns.

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OBJECTIVE: To investigate fatigue fracture resistance and wear behavior of a polymer infiltrated ceramic network (PICN) material (ENAMIC, Vita Zahnfabrik). METHODS: Anatomically shaped ENAMIC monolithic crowns were milled using a CAD/CAM system. The crowns were cemented on aged dentin-like composite abutments (Z100, 3M ESPE) with resin-based cement (Vita DUO Cement, Vita). The specimens were subjected to 2 types of fatigue and wear tests: (1) accelerated sliding-contact mouth-motion step-stress fatigue test (n=24) in water; and (2) long-term sliding-contact mouth-motion fatigue/wear test using a clinically relevant load (P=200N, n=8) in water. Failure was designated as chip-off or bulk fracture. Optical and scanning electron microscopes were used to examine the occlusal surface and subsurface damage, as well as to reveal the material's microstructure. In addition, wear volume and depth were measured by X-ray micro-computed tomography. RESULTS: For accelerated mouth-motion step-stress fatigue testing, 3 out of the 24 ENAMIC crowns fractured following cyclic loading up to 1700N. Minor occlusal damage and contact-induced cone cracks were observed in all surviving specimens, but no flexural radial cracks were seen. For long-term mouth-motion fatigue/wear testing under a 200N load in water, a small wear scar without significant cracks was observed in all 8 tested ENAMIC crowns. SIGNIFICANCE: Monolithic CAD/CAM ENAMIC crowns showed superior resistance to sliding-contact fatigue fracture and wear.

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OBJECTIVE: To demonstrate the fatigue behavior of CAD/CAM resin composite molar crowns using a mouth-motion step-stress fatigue test. Monolithic leucite-reinforced glass-ceramic crowns were used as a reference. METHODS: Fully anatomically shaped monolithic resin composite molar crowns (Lava Ultimate, n=24) and leucite reinforced glass-ceramic crowns (IPS Empress CAD, n=24) were fabricated using CAD/CAM systems. Crowns were cemented on aged dentin-like resin composite tooth replicas (Filtek Z100) with resin-based cements (RelyX Ultimate for Lava Ultimate or Multilink Automix for IPS Empress). Three step-stress profiles (aggressive, moderate and mild) were employed for the accelerated sliding-contact mouth-motion fatigue test. Twenty one crowns from each group were randomly distributed among these three profiles (1:2:4). Failure was designated as chip-off or bulk fracture. Optical and electron microscopes were used to examine the occlusal surface and subsurface damages, as well as the material microstructures. RESULTS: The resin composite crowns showed only minor occlusal damage during mouth-motion step-stress fatigue loading up to 1700N. Cross-sectional views revealed contact-induced cone cracks in all specimens, and flexural radial cracks in 2 crowns. Both cone and radial cracks were relatively small compared to the crown thickness. Extending these cracks to the threshold for catastrophic failure would require much higher indentation loads or more loading cycles. In contrast, all of the glass-ceramic crowns fractured, starting at loads of approximately 450N. SIGNIFICANCE: Monolithic CAD/CAM resin composite crowns endure, with only superficial damage, fatigue loads 3-4 times higher than those causing catastrophic failure in glass-ceramic CAD crowns.

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INTRODUCTION: Marginal discrepancy severely affects the long term success of All ceramic complete veneer crowns. The precise role of resin luting agents influencing this phenomenon needs to be explored further. AIM: To estimate and compare the marginal discrepancy in CAD/CAM processed All ceramic complete veneer crowns prior and following luting with resin bonded luting agents. MATERIALS AND METHODS: Extracted human maxillary first premolars were randomly allocated into four groups of 27 samples each Viz., Group I-Resin Modified Glass Ionomer Cement (GIC) (RelyX), Group II-Bis-GMA based dual cure resin cement (Variolink II), Group III-PMMA based resin cement (Superbond), Group IV- Urethane Dimethacrylate resin cement (Calibra). Following tooth preparation, CAD/CAM All ceramic complete veneer crowns were fabricated and sectioned and marginal discrepancy was evaluated using a scanning electron microscope (TESCAN, Magnification power-1,00,000x) prior and after luting with the experimental resin cements. RESULTS: The vertical and horizontal discrepancy before and after cementation with Group I [270.08±103.10µm, 165.3±53.00µm and 270.86±102.70µm, 166.62±54.96µm respectively]; Group II [254.21±79.20µm, 117.75±24.29µm and 234.81±79µm, 116.89±18.22µm respectively]; Group III [272.47±86.25µm, 142.08±50.83µm and 251.82±62.69µm, 136.07±44.95µm respectively]; Group IV were [260.28±64.81µm, 116.98±17.71µm and 233.08±69.44µm, 116.58±21.13µm respectively]. ANOVA inferred a statistically significant difference between the four test specimen with regards to vertical and horizontal marginal discrepancy after cementation (F=9.092, p<0.001), (F=10.97, p<0.001). Tukey HSD Post-hoc test observed significant differences in vertical and horizontal marginal discrepancies between the resin modified glass ionomer and resin cements (p<0.05). CONCLUSION: Resin cements exhibited a greater reduction in the marginal discrepancy than the resin modified glass ionomer following luting in All ceramic complete veneer crowns. Hence resin cements are more preferable to GIC for luting All ceramic complete veneer crowns.