This study was supported by an American Academy of Fixed Prosthodontics Stanley D. Tylman grant.
a
Former Resident, Department of Prosthodontics, University of North Carolina at Chapel Hill School of Dentistry, Private practice,
Colorado Springs, Colo.
b
Director and Stallings Distinguished Professor, Graduate Prosthodontics, University of North Carolina at Chapel Hill School of Dentistry.
c
Clinical Assistant Professor, Department of Prosthodontics, University of North Carolina at Chapel Hill School of Dentistry.
d
Clinical Assistant Professor, Department of Prosthodontics, University of North Carolina at Chapel Hill School of Dentistry.
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771
Clinical Implications
Practitioners have multiple options for generating single-tooth
restorations with computer-aided design and computer-aided
manufacturing technology. Irrespective of available material choices,
a digital workow that involves intraoral scanning and digital design
may provide a clinically acceptable single-tooth restoration.
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Table I.
Modied United States Public Health Service criteria for crown evaluation
Marginal
Adaptation
Crown Contour
Shade
Ideal
Ideal
Ideal
S: Acceptable
T: Acceptable/modications
needed
Results
R: Excellent
V: Unacceptable
Remake
Additions or
reductions necessary
Remake
Occlusion
Ideal
Less than ideal but no
changes required/minimal
adjustments necessary
Adjustments necessary
Remake
Remake
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Table II.
Unacceptable
or Rejected
Acceptable with
Modications
Acceptable
Excellent
MC
12
Zr
10
Crown System
Total
Marginal adaptation
LD
10
Total
20
32
MC
12
Zr
10
LD
10
Total
23
32
12
Zr
10
LD
10
Total
18
32
Contour
Shade
MC
Occlusion
MC
12
Zr
10
LD
10
Total
16
13
32
For USPHS Shade, P.06; for USPHS Contour, P.16; for USPHS Margins, P.07; for USPHS Occlusion, P.0005.
USPHS, United States Public Health Service; MC, metal ceramic; Zr, zirconia; LD, lithium disilicate.
a
Denotes statistically signicant values assessed by Mantel Haenszel row mean score statistic.
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RESULTS
Six crowns (3 MC, 2 LD, 1 Zr) were
rejected for unacceptable marginal adaptation and were remade. Thus, the
remake rate because of clinically unacceptable marginal adaptation was
18.8%. These 6 crowns were among the
rst 12 fabricated, dening a learning
curve related to the software designation of margin location in design. Of
these six, 2 MC crowns were remade
with conventional impression and laboratory techniques, and were excluded
from the horizontal marginal discrepancy analyses. The remaining 4 crowns
that were remade were fabricated from
new intraoral scans and used the same
CAD/CAM processes for fabrication.
Three participants did not return for the
Table III.
DISCUSSION
Although the crown systems did not
differ with respect to shade, contour,
and marginal adaptation, Zr crowns
were superior in crown occlusion. Few Zr
Visita
Gingival Parameter
Crown
System
Pretreatmentb
1-mo
Postcementationc
MC
46.25 23.95
43.75 14.06
32.67 14.51
Zr
47.80 22.79
39.00 12.12
39.29 14.40
LD
32.00 9.56
44.13 24.51
43.33 19.10
MC
33.25 12.17
43.17 17.48
37.50 20.05
Zr
44.10 22.49
37.00 17.61
42.57 23.73
LD
39.40 16.77
56.88 23.74
39.83 15.72
MC
8/4 (67)
5/7 (42)
3/3 (50)
Zr
6/4 (60)
5/4 (56)
2/5 (29)
LD
5/5 (50)
2/6 (25)
2/4 (33)
6-mo
Postcementationd
MC, metal ceramic; SD, standard deviation; GCF, gingival crevicular uid; Zr, zirconia; LD, lithium disilicate.
a
MC (n12 [missing0] at visit 0, n12 [missing0] at visit 2, n6 [missing6] at visit 3); Zr (n10 [missing0] at visit 0, n9 [missing1] at visit 2,
n7 [missing3] at visit 3); LD (n10 [missing0] at visit 0, n8 [missing2] at visit 2, n6 [missing4] at visit 3).
b
Visit 0.
c
Visit 2.
d
Visit 3.
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Table IV.
Explanatory
Variable
Buccal
Surface
Lingual
Surface
Bleeding
on Probing
Crown system
.38
.71
.92
Time of measure
.49
.42
.25
Treated vs control
.47
.10
.17
Number of Crowns
10
Overextended
Underextended
8
6
4
2
0
PFM
LD
ZR
2 Sample micro
computed tomographic
image of buccal crown
margin of study lithium
disilicate crown.
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CONCLUSIONS
Table V.
Crown System
Range (mm)
LD
113.8 43.2
11.0-260.0
Zr
68.5 33.4
15.0-190.0
MC
92.4 20.6
23.0-210.0
SD, standard deviation; LD, lithium disilicate; Zr, zirconia; MC, metal ceramic.
Pairwise comparisons
among crown systems
Table VI.
Group 1 Group 2
df P
LD
Zr
8.07
.03
LD
MC
1.89
.54
Zr
MC
2.50
.38
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