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PURPOSE: This in vitro study analyzed the accuracy of a computer-assisted design (CAD)/computer-assisted manufacturing (CAM) guided implant surgery system by comparing linear, angular, and coronal deviations between the planned and final implant placement. METHODS: By using a fully guided surgery workflow, 32 dental implants were placed in 16 partially edentulous models. After virtual design of the restorations, radiological and CAD files were matched and implant positions were planned by using dedicated implant planning software (Galileo Implant version 1.9.2.). Templates were designed (Cerec Omnicam) and milled (Cerec MC XL) by using chairside workflow. Galileo Implant version 1.9.2. was used to evaluate accuracy. RESULTS: Mean horizontal and angular-coronal total deviation values were 0.2 mm (SD = 0.126) and 1.1º (SD = 0.834) respectively. Multivariate analysis of variance showed significant differences in horizontal and angular-coronal total deviation in the 32 implants (P = 0.0001). Multivariate analysis with one-factor interaction showed no statistical difference in implant position or implant type (P = 0.139) between eight maxilla models and eight jaw models. CONCLUSION: Horizontal and angular-coronal deviations of implants placed with chairside digital workflow were within the recommended safety margin for fully guided surgery.

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BACKGROUND: Temporary stage in crowns and bridgework plays an important role in the success and failure of the final restorations. Lack of marginal seal of the temporary restorations can lead to further complications. Recently, digital dentistry has been improved in terms of marginal integrity. AIMS: The aim of this study was to evaluate and compare the marginal leakage between CAD/CAM and conventionally made Polymethyl methacrylate (PMMA) interim crowns cemented with different temporary luting cements. MATERIALS AND METHODS: Sixty resin dies of a maxillary right first premolar were prepared according to the protocol of the tooth preparation for all-ceramic crown. Interim crowns were then fabricated and assigned to two main groups according to the fabrication technique (CAD/CAM technique and conventional technique). Furthermore, the samples were sub-grouped (n = 10) according to the type of the luting cements: Zinc oxide eugenol (RelyX temp E), Zinc oxide non-eugenol (RelyX temp NE), and Zinc polycarboxylate cement (pentron). The specimens were then subjected to thermocycling at 5°C and 55°CC for 30 sec and transfer time of 15 seconds for 1500 cycles. After that, the specimens were immersed in a 2% methylene blue solution for 24 hours. The cemented specimens were sectioned buccolingually and the amount of marginal leakage was evaluated under digital microscope at magnification 50x. The scores of dye penetration were recorded and analyzed using one-way ANOVA at P < 0.05 for all tests. RESULTS: For the fabrication technique, CAD/CAM-made interim crowns had significantly better performance in terms of lower microleakage in comparison to conventionally built interim crowns (P < 0.001). Overall, Zinc Oxide non-eugenol also showed significantly least microleakage as a luting cement then Zinc Oxide Eugenol and the most microleakage was found with Zinc Polycarboxylate regardless of the fabrication method. CONCLUSION: Interim crowns fabricated by CAD-CAM system are better suited for temporization. Zinc-oxide non-eugenol cements showed the least amount of microleakage in both types of crown.

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The purpose of this study was to assess the clinical fit provided by EZIS system, the newly commercialized chairside CAD/CAM system. Prostheses were fabricated with the chairside CAD/CAM system (CS) and labside CAD/CAM system (LS) and marginal, axial, and occlusal fit of the prostheses were compared and analyzed by using replica technique. CS group presented significantly lower fit in all the three fits compared to LS group. Differences in marginal fit, axial fit, and occlusal fit were 12.57 µm (P < 0.001), 3.32 µm (P < 0.05), and 17.20 µm (P < 0.05), respectively. Newly commercialized EZIS system yielded clinically feasible fit; however, further researches covering its biomechanical, physiological, stability aspects are required to promote active clinical use.

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In patients with fully edentulous jaw, treatment of complete dentures should be carried out in many stages when following the conventional methods. Therefore there were disadvantages such as multiple visits to dental clinic is inevitable. In addition, errors caused by polymerization shrinkage, which happens during the fabrication of denture, and difficulties in reproduction of damaged or lost denture were considered as disadvantages. But nowadays, computer-aided design and computer-aided manufacturing (CAD/CAM) system is widely used in dentistry and it has begun to expand its spectrum in manufacturing complete dentures. Using CAD/CAM system to fabricate complete dentures can reduce the number of patient's visit and clinical chair time, since taking impression, recording jaw relation, and selection of artificial teeth are performed at the same time during the first visit, and delivering of dentures during the second visit is possible. In addition, because 3D-Printing technology is used, errors by polymerization shrinkage can be reduced. Among the companies that fabricate complete dentures using CAD/CAM system, DENTCA CAD/CAM denture (DENTCA Inc., Los Angeles, CA, USA) is the most commercialized company. In this case, we treated patients of complete dentures using conventional complete denture method and DENTCA CAD/CAM denture system in the same patient. We would like to report this case because we have achieved good results not only in functional aspects of pronunciation, chewing, and swallowing but also in aesthetic aspects.

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A single-visit zirconia restoration can be easily achieved if direct milling of a fully sintered zirconia block can be performed without much effort. However, no studies have yet been reported regarding the evaluation of the trueness of crown fabricated from chairside-milling of a fully sintered zirconia block in the chairside computer-aided design and computer-aided manufacturing (CAD-CAM) system for single-visit dentistry. This in vitro study aimed to evaluate the trueness of crowns fabricated by milling a fully sintered zirconia block in the chairside CAD-CAM system and investigate the clinical implications for single-visit chairside restoration. Crowns were fabricated either by chairside-milling a fully sintered block of niobium oxide containing yttria-stabilized tetragonal zirconia polycrystals ((Y, Nb)-TZP) without the sintering process (n = 12) in a chairside single-visit dentistry system (Chairside group) or by laboratory-milling a partially sintered 3 mol% block of yttria-stabilized tetragonal zirconia polycrystals (3Y-TZP) followed by the sintering process (n = 12) in a conventional laboratory system (Labside group). Crown fabrication time, milling tool diameter and the trueness of each crown were evaluated. All trueness values of both groups were within the clinically acceptable range, although a significant difference between the Chairside (43.0 ± 3.67 µm) and Labside groups (37.4 ± 2.41 µm) was observed (P < 0.05). Mean fabrication time was 0.52 h and 1.42 h for Chairside and Labside groups, respectively. A decrease in the tool diameter was observed for the Chairside group.

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The purpose of this study comparatively analyzed the machinability of various dental hybrid blocks manufactured by using the CAD/CAM system. Three hybrid composite blocks (Vita enamic, Lava Ultimate, GC Cerasmart) were used for experimental groups and one conventional ceramic block (Vita Mark II) was used for control. The digital impression of the master model and abutment was taken by using a scanner, and then the CAD software program was used to design restorations. The four-axis milling machine (inLab MCXL; Sirona Dental Systems GmbH, Bensheim, Germany) was used four materials. The digitized data was superimposed with 3D inspection software to quantitatively obtain the machinability of a ceramic crown, and visual differences were confirmed with a color map. The root mean square (RMS) values of ceramic crown group were statistically analyzed with one-way ANOVA (α=0.05). While there was a significant difference in the machinability of the internal surface, among four groups, there was statistically significant difference between conventional (VM group) and hybrid ceramic (VE, LU, GC groups) (p<0.05). Consequently, the machinability of VM is lower than that of other hybrid ceramics, and the machinability of VE is better than that of LU and GC. For ceramics as final restorations, manufacturing of dental restorations using hybrid composite ceramic is recommended.

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Objective@#To investigate the clinical effect of restoration of posterior teeth with machinable CAD/CAM resin hybrid ceramic (VITA Enamic) onlays after root canal treatment. @* Methods @#136 posterior teeth restored after root canal treatment in our hospital were selected as the research subjects. The posterior teeth were restored chairside with CAD / CAM ceramic onlays to recover occlusion relation and protect residual dental tissues. With 68 teeth in each group, one group was restored with a machinable CAD / CAM resin hybrid ceramic (VITA Enamic) while the control group received zirconia-reinforced lithium silicate ceramic (VITA Suprinity). Before bonding, all the onlays were examined for good adjacency, fitness and occlusion, and then the adhesive surface was etched with hydrofluoric acids. After isolating the rubber dams in the mouths, the onlays were bonded with dual-cure resin cements. The patients were followed up for 24 months to compare the degree of prosthesis integrity, marginal fitness, gingival health, dental integrity, color matching and secondary caries. @* Results @#After restoration, all the onlays were in harmony with the surrounding teeth with good aesthetic effect and suitable marginal fit. Two years later, there were no significant differences in the marginal fitness, gingival health, dental integrity or secondary cavities between the two groups (P > 0.05). In terms of restoration integrity, the VITA Enamic onlays (100%) were intact and displayed good retention. The group that received VITA Suprinity had 6 onlay (9.23%) fractures and a success rate of 90.77%; however, the residual dental tissues did not break. The difference of prosthesis integrity between the two groups was statistically significant (χ2= 4.45, P < 0.05). @*Conclusion@#Chairside CAD/CAM resin hybrid ceramic (VITA Enamic) onlays can quickly restore posterior teeth after root canal therapy and better protect the residual dental tissue.

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PURPOSE: To compare and analyze trueness and precision of provisional crowns made using stereolithography apparatus and subtractive technology. MATERIALS AND METHODS: Digital impressions were made using a master model and an intraoral scanner and the crowns were designed with CAD software; in total, 22 crowns were produced. After superimposing CAD design data and scan data using a 3D program, quantitative and qualitative data were obtained for analysis of trueness and precision. Statistical analysis was performed using normality test combined with Levene test for equal variance analysis and independent sample t-test. Type 1 error was set at 0.05. RESULTS: Trueness for the outer and inner surfaces of the SLA crown (SLAC) were 49.6±9.3 µm and 22.5±5.1 µm, respectively, and those of the subtractive crown (SUBC) were 31.8±7.5 µm and 14.6±1.2 µm, respectively. Precision values for the outer and inner surfaces of the SLAC were 18.7±6.2 µm and 26.9±8.5 µm, and those of the SUBC were 25.4±3.1 µm and 13.8±0.6 µm, respectively. Trueness values for the outer and inner surfaces of the SLAC and SUBC showed statistically significant differences (P<.001). Precision for the inner surface showed significance (P<.03), whereas that for the outer surface showed no significance (P<.58). CONCLUSION: The study demonstrates that provisional crowns produced by subtractive technology are superior to crowns fabricated by stereolithography in terms of accuracy.

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Material structure-property relationship is strongly related to the employed process technology. Over the past years, laser processing of engineering materials has been proposed in many fields and different uses for diode lasers have been found in dentistry. In this contest, the potential of GaN- and InGaN-based laser diodes to cure dental materials was analysed. Two wavelengths of 405 nm and 445 nm were used as heat or light sources for warm condensation of gutta-percha, light transmission in dental posts and brackets or light curing of dental composites. Additive manufacturing approach was considered to fabricate 3D root analogues, suitable supports, positioning systems and moulds for optical measurements. A three-axis CAD/CAM system was implemented for positioning and aligning the laser beam. The ability of diode-pumped solid-state lasers to cure dental materials or to transmit light was compared to that of a traditional instrument. Temperature profile at the apex of an additive manufactured root canal sealed with gutta-percha, light transmission through translucent quartz fiber post or through aesthetic ceramic bracket, bending properties and morphological features of light cured dental composites (Gradia Direct - GC Corporation and Venus Diamond - Heraeus Kulzer) were measured. Results showed a very high potential of diode-pumped solid-state lasers to be used in endodontics, orthodontics and restorative dentistry.

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Facial symmetry, as well as function, remains the big challenge for surgeons who attempt mandibular reconstruction. Nowadays several studies recommend the use of computer aided surgery (CAS) and CAD/CAM technology to guide mandibular segmental osteotomies and reconstruction using free fibula flap. Although these systems have radically changed the way of doing mandibular reconstructive surgery, they are expensive and require extended periods of time for prototypation. This may be an important limitation in case of malignant neoplasms which require short-term treatment. The aim of our study is to investigate the reliability and efficiency of a protocol to obtain cutting guides produced in a "homemade" way. This study includes four consecutive patients who underwent a segmental mandibulectomy and fibula osteo-cutaneous free flap reconstruction for oral squamous cell carcinoma between January and September 2016. The CAD/CAM system algorithm proposed was based on the use of free open source software for digital planning and 3D layer plastic deposition printer. A cost of about 3 Euro for each case was estimated. An average mean distance between 3D preoperative and postoperative mesh points of 1.631 mm and a standard deviation of 5.496 mm has been demonstrated by 3D volume overlay analysis. Overlapping results with much shorter prototyping time was required with the in-house procedure described as compared to the available commercial system. In conclusion, we expect that this technique will reduce operative time and cost however further study and large series are needed to confirm our results and better define the applicability in everyday surgical practice.

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PURPOSE: To evaluate the accuracy of a model made using the computer-aided design/computer-aided manufacture (CAD/CAM) milling method and 3D printing method and to confirm its applicability as a work model for dental prosthesis production. MATERIALS AND METHODS: First, a natural tooth model (ANA-4, Frasaco, Germany) was scanned using an oral scanner. The obtained scan data were then used as a CAD reference model (CRM), to produce a total of 10 models each, either using the milling method or the 3D printing method. The 20 models were then scanned using a desktop scanner and the CAD test model was formed. The accuracy of the two groups was compared using dedicated software to calculate the root mean square (RMS) value after superimposing CRM and CAD test model (CTM). RESULTS: The RMS value (152±52 µm) of the model manufactured by the milling method was significantly higher than the RMS value (52±9 µm) of the model produced by the 3D printing method. CONCLUSION: The accuracy of the 3D printing method is superior to that of the milling method, but at present, both methods are limited in their application as a work model for prosthesis manufacture.

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PURPOSE: To evaluate the accuracy of a model made using the computer-aided design/computer-aided manufacture (CAD/CAM) milling method and 3D printing method and to confirm its applicability as a work model for dental prosthesis production. MATERIALS AND METHODS: First, a natural tooth model (ANA-4, Frasaco, Germany) was scanned using an oral scanner. The obtained scan data were then used as a CAD reference model (CRM), to produce a total of 10 models each, either using the milling method or the 3D printing method. The 20 models were then scanned using a desktop scanner and the CAD test model was formed. The accuracy of the two groups was compared using dedicated software to calculate the root mean square (RMS) value after superimposing CRM and CAD test model (CTM). RESULTS: The RMS value (152±52 µm) of the model manufactured by the milling method was significantly higher than the RMS value (52±9 µm) of the model produced by the 3D printing method. CONCLUSION: The accuracy of the 3D printing method is superior to that of the milling method, but at present, both methods are limited in their application as a work model for prosthesis manufacture.

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PURPOSE: To compare and analyze trueness and precision of provisional crowns made using stereolithography apparatus and subtractive technology. MATERIALS AND METHODS: Digital impressions were made using a master model and an intraoral scanner and the crowns were designed with CAD software; in total, 22 crowns were produced. After superimposing CAD design data and scan data using a 3D program, quantitative and qualitative data were obtained for analysis of trueness and precision. Statistical analysis was performed using normality test combined with Levene test for equal variance analysis and independent sample t-test. Type 1 error was set at 0.05. RESULTS: Trueness for the outer and inner surfaces of the SLA crown (SLAC) were 49.6±9.3 µm and 22.5±5.1 µm, respectively, and those of the subtractive crown (SUBC) were 31.8±7.5 µm and 14.6±1.2 µm, respectively. Precision values for the outer and inner surfaces of the SLAC were 18.7±6.2 µm and 26.9±8.5 µm, and those of the SUBC were 25.4±3.1 µm and 13.8±0.6 µm, respectively. Trueness values for the outer and inner surfaces of the SLAC and SUBC showed statistically significant differences (P < .001). Precision for the inner surface showed significance (P < .03), whereas that for the outer surface showed no significance (P < .58). CONCLUSION: The study demonstrates that provisional crowns produced by subtractive technology are superior to crowns fabricated by stereolithography in terms of accuracy.

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O desenho de uma estrutura Protética num computador seguido da sua confecção por uma máquina de fresagem geralmente é designado por CAD/CAM. Nos últimos 30 anos esta tecnologia tem trazido uma evolução muito grande na odontologia, com objetivo principal de otimizar a produção de trabalhos protéticos (CORREIA, 2006). Dos sistemas CAD/CAM para a odontologia, este estudo destaca o Zirkonzahn, CEREC, Procera, o Lava, Everest.(AU)

The design of a Prosthetic structure in a computer followed by its manufacture by a milling machine is generally referred to as CAD / CAM. In the last 30 years this technology has brought a great evolution in dentistry, with the main objective of optimizing the production of prosthetic works (CORREIA, 2006). Of the CAD / CAM systems for dentistry, this study highlights Zirkonzahn, CEREC, Procera, Lava, Everest.(AU)

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Introdução: através da introdução na odontologia do sistema CAD- -CAM simplificou-se o sistema de moldagem de próteses, que apresenta uma margem de erro por conter variáveis a serem controladas em relação aos materiais e sua manipulação. Objetivo: este artigo aborda o desenvolvimento do sistema CAD-CAM, como também a engenharia, os programas e as diretrizes de seu funcionamento na confecção de próteses dentárias. Materiais e métodos: o estudo caracterizou-se por uma pesquisa científica e bibliográfica nas plataformas indexadas nas bases de dados PubMED/Medline, Lilacs e Scielo, incluindo artigos originais e de revisão. Utilizou-se os seguintes descritores: Sistema CAD-CAM, CAD-CAM tecnologia no desenvolvimento de próteses, CAD-CAM system. Resultados: tecnologia CAD-CAM surgiu para facilitar o planejamento, o designer e a produção de vários projetos. Quando foi introduzida na odontologia trouxe um marco que revolucionou a forma de confeccionar restaurações, incluindo as protéticas. Sendo desenvolvido por várias empresas, está disponível em diferentes sistemas que, no entanto, se resumem no mesmo funcionamento: digitalização, designer e usinagem, no qual se obtém a imagem através de um escaneamento, manipula-se essa imagem em um software e finalmente converte-se essa imagem em um objeto real, como exemplo em: coroas, pontes, facetas, inlays, onlays e laminados. Conclusão: tendo em vista que essa tecnologia trouxe melhoria para a odontologia protética, na estética, resistência e durabilidade da restauração produzida, melhora a qualidade da saúde bucal oferecida para o paciente e facilita o trabalho do dentista.

Introduction: through the introduction of the CAD-CAM system, the prosthesis molding system has been simplified, which has a margin of error because it contains variables to be controlled in relation to materials and their manipulation. Objective: this article addresses the development of the CAD-CAM system, as well as the engineering, programs and guidelines of its operation in the manufacture of dental prostheses. Methods: this study was characterized by a scientific and bibliographic research in the platforms indexed in PubMED / Medline, Lilacs and Scielo databases, including original and review articles. The following descriptors were used: CAD-CAM system, CAD-CAM technology in prosthesis development, CAD-CAM system. Results: CAD-CAM technology has emerged to facilitate planning, design and production of various projects. When introduced to dentistry brought a landmark that revolutionized the way to make restorations, including prosthetics. Being developed by several companies, it is available in different systems which, however, are summarized in the same operation: digitization, designer and machining, in which the image is obtained through a scan, manipulate that image in a software and finally, this image in a real object, such as: crowns, bridges, facets, inlays, onlays and laminates. Conclusion: since this technology has brought improvement to the prosthetic dentistry, in the esthetics, resistance and durability of the restoration produced, improves the quality of oral health offered to the patient and facilities the work of the dentist.

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The purpose of this study was to compare the accuracy of zirconia FPDs fabricated by different laboratory CAD/CAM system. Thirty-six FPD zirconia frameworks were fabricated on corresponding epoxy resin models that were duplicated from a master model of mandibular second premolar and second molar mounted in an acrylic block to simulate missing first mandibular tooth. Frameworks were divided into groups (n = 12) of three laboratory CAD/CAM systems: Cercon, Amann Girrbach, and Zirkonzahn. For the two factors, system and abutment type, the absolute marginal discrepancy (AMD) was measured before cementation. Internal fit was also determined at three sites after cementation. The data were analyzed statistically (α = 0.05). The effects of system and tooth type were not significant for AMD (p ⟩ 0.05). Both factors showed influence on the internal fit of FPDs (p ⟨ 0.05). Molars showed larger gaps in axial and occlusal sites (p = 0.001 and p = 0.003), and Cercon led in better occlusal adaptation compared with Amann Girrbach (p = 0.013). The systems tested did not show differences in AMD, despite different incorporated components. However, internal fit was significantly different between tooth type and system.

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O presente estudo verificou a adaptação marginal entre a infraestrutura metálica para restauração metalocerâmica e o componente protético do tipo munhão anatômico para implante cone morse utilizando o sistema CEREC (Sirona Dental Company, Alemanha)...

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This study evaluated marginal adaptation before and after thermomechanical (TCML) loading, gap width and fracture strength of all-ceramic single crowns, as compared to porcelain-fused-to-metal (PFM). Thirty extracted premolars were prepared with a round shoulder of 1.0 mm depth. Specimens were restored with zirconia-ceramic (Group 1), lithium disilicate (Group 2) and metal-ceramic single crowns (Group 3). The replica of each sample was observed with a scanning electron microscope (SEM) to evaluate the crown-cement (c-c) and tooth-cement interface (t-c). After TCML, perfect margins decreased to 91.3% (c-c) and 93.9% (t-c) in Group 1, 94.6% (c-c) and 96.0% (t-c) in Group 2 and 73.5% (c-c) and 53.1% (t-c) in Group 3. The mean fracture strengths were 654.8 ± 98.1 N for Group 1, 551.3 ± 127 N for Group 2 and 501.43 ± 110.1 N for Group 3. All-ceramic systems could substitute for metal-ceramic crowns, but chipping of veneering ceramics, especially in zirconia-based crowns, should be investigated.

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PURPOSE: To assess the marginal and internal gaps of the copings fabricated by computer-aided milling and direct metal laser sintering (DMLS) systems in comparison to casting method. MATERIALS AND METHODS: Ten metal copings were fabricated by casting, computer-aided milling, and DMLS. Seven mesiodistal and labiolingual positions were then measured, and each of these were divided into the categories; marginal gap (MG), cervical gap (CG), axial wall at internal gap (AG), and incisal edge at internal gap (IG). Evaluation was performed by a silicone replica technique. A digital microscope was used for measurement of silicone layer. Statistical analyses included one-way and repeated measure ANOVA to test the difference between the fabrication methods and categories of measured points (α=.05), respectively. RESULTS: The mean gap differed significantly with fabrication methods (P<.001). Casting produced the narrowest gap in each of the four measured positions, whereas CG, AG, and IG proved narrower in computer-aided milling than in DMLS. Thus, with the exception of MG, all positions exhibited a significant difference between computer-aided milling and DMLS (P<.05). CONCLUSION: Although the gap was found to vary with fabrication methods, the marginal and internal gaps of the copings fabricated by computer-aided milling and DMLS fell within the range of clinical acceptance (<120 µm). However, the statistically significant difference to conventional casting indicates that the gaps in computer-aided milling and DMLS fabricated restorations still need to be further reduced.

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PURPOSE: To assess the marginal and internal gaps of the copings fabricated by computer-aided milling and direct metal laser sintering (DMLS) systems in comparison to casting method. MATERIALS AND METHODS: Ten metal copings were fabricated by casting, computer-aided milling, and DMLS. Seven mesiodistal and labiolingual positions were then measured, and each of these were divided into the categories; marginal gap (MG), cervical gap (CG), axial wall at internal gap (AG), and incisal edge at internal gap (IG). Evaluation was performed by a silicone replica technique. A digital microscope was used for measurement of silicone layer. Statistical analyses included one-way and repeated measure ANOVA to test the difference between the fabrication methods and categories of measured points (alpha=.05), respectively. RESULTS: The mean gap differed significantly with fabrication methods (P<.001). Casting produced the narrowest gap in each of the four measured positions, whereas CG, AG, and IG proved narrower in computer-aided milling than in DMLS. Thus, with the exception of MG, all positions exhibited a significant difference between computer-aided milling and DMLS (P<.05). CONCLUSION: Although the gap was found to vary with fabrication methods, the marginal and internal gaps of the copings fabricated by computer-aided milling and DMLS fell within the range of clinical acceptance (<120 microm). However, the statistically significant difference to conventional casting indicates that the gaps in computer-aided milling and DMLS fabricated restorations still need to be further reduced.

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