H O S T E D BY Available online at www.sciencedirect.

com

ScienceDirect
Tanta Dental Journal 12 (2015) 81e88
www.elsevier.com/locate/tdj

Marginal adaptation of CAD/CAM zirconia-based crown during

fabrication steps
R.A. El-Dessouky a,*, M.M. Salama b, M.A. Shakal b, A.M. Korsel b
a
Fixed Prosthodontics Department, Faculty of Dentistry, Tanta University, Egypt
b
Conservative Dentistry, Faculty of Dentistry, Tanta University, Egypt
Received 20 April 2014; revised 22 December 2014; accepted 23 December 2014
Available online 23 May 2015

Abstract

Background: Excessive marginal discrepancy of crowns favors the rate of cement dissolution and microleakage that may cause
pulpal inflammation. Besides, it may increase plaque retention leading to the onset of periodontal disease. Therefore, this
research was carried out to study the effect of fabrication stages and artificial aging on the marginal adaptation of CAD/CAM
Zirconia-based crowns which have become increasingly popular among the patients due to their natural esthetics and excellent
strength.
Purpose: To evaluate the marginal adaptation of CAD/CAM Zirconia-based crowns on their respective prepared teeth during
different fabrication stages namely; framework, after veneering, after crown cementation and after thermo-mechanical
loading.
Materials and methods: A total of twenty zirconia frameworks were fabricated using (Cercon smart ceramics, DeguDent,
Germany) manufacturing system, conventionally veneered with (Cercon Ceram kiss, DENSPLY, Germany), cemented with
conventional glass ionomer to their corresponding prepared human teeth. The cemented crowns were finally aged through a
process of thermo-mechanical cyclic loading. The assessment of vertical marginal gap was performed on the prepared teeth
using an optical microscope with image-j software analysis system at 40
magnification for frameworks, for restorations
before and after cementation then, after thermo-mechanical loading. Differences between the vertical gap during fabrication
stages and the effect of artificial aging were statistically analyzed using a one-way analysis of variance ANOVA and
Independent-samples T test.
Results: In this study, the marginal gap increased after every tested stage. The vertical marginal gap recorded its smallest mean value
(41.08 ± 3.23 mm) during core stage. A significant increase in the measurement of vertical marginal gap was observed after firing the
veneering layer reaching (46.87 ± 3.94 mm). After cementation, the marginal gap was (46.87 ± 4.65 mm). Finally; thermo-mechanical
loading corresponding to one year of clinical use was found to cause a significant increase the vertical marginal gap to record its highest
value (56.73 ± 7.21 mm).

* Corresponding author. Tel.: þ20 1221795304 (mobile).

E-mail addresses: radwael_dessouky@yahoo.com, radwa.eldesouky@dent.tanta.edu.eg (R.A. El-Dessouky), mervat.salama@dent.tanta.edu.eg
(M.M. Salama), mahmoud.shakl@dent.tanta.edu.eg (M.A. Shakal), amany.ahmed@dent.tanta.edu.eg (A.M. Korsel).
Peer review under the responsibility of the Faculty of Dentistry, Tanta University.

http://dx.doi.org/10.1016/j.tdj.2014.12.002
1687-8574/© 2015, Hosting by Elsevier B.V. on behalf of the Faculty of Dentistry, Tanta University.
82 R.A. El-Dessouky et al. / Tanta Dental Journal 12 (2015) 81e88

Conclusion: Within the limitations of this study, it was found that every examined stage had a negative effect on the vertical
marginal adaptation of zirconia crowns.
© 2015, Hosting by Elsevier B.V. on behalf of the Faculty of Dentistry, Tanta University.

Keywords: Marginal fit; CAD/CAM; Zirconia crowns; Fabrication stages

1. Introduction Zirconia-based crowns at different fabrication steps, as

Accurate marginal adaptation is considered one of the
most important factors for the clinical success of dental
prosthesis. Excessive marginal discrepancy accelerates
the rate of cement dissolution and thus, micro-leakage
which may cause pulpitis. Furthermore, it increases pla-
que retention and changes the compositions of the sub-
gingival micro flora leading to periodontal diseases [1,2].
The development of all-ceramic crowns was satis-
factory for the demands of patients for maximal esthetics
and translucency. However, these crowns can be dis-
torted during their fabrication procedures particularly;
firing which can cause a negative effect on their marginal
adaptation [2,17]. The introduction of Zirconia high-
lighted a true advancement in development of ceramic
restorations because of its excellent unique combination
between high flexural strength and fracture toughness.
Besides, the absence of glass and dense polycrystalline
microstructure provides resistance to hydro-fatigue.
CAD/CAM technology which relies on exact
dimensional predictions has demonstrated improved
marginal adaptation [3,4]. The marginal discrepancy of
each crown system can be evaluated by comparing the
measurement values obtained at different steps of the
manufacturing process [5]. Moreover, the assessment of
mechanical and hydro-fatigue effect may provide in-
formation on the long-term stability of restor-
ations.6Therefore the purpose of this in vitro study was
to examine the marginal adaptation of CAD/CAM
well as after thermo-mechanical loading.
2. Materials & methods
Twenty extracted molars were selected, their roots
were covered with modeling wax1 and embedded verti-
cally in self-cure acrylic resin2 so that the resin was
extending 2 mm of the cement-enamel junction [7].
Before preparation, two silicone indices3 were made for
each specimen to aid in standardization of frameworks'
and veneering layers' thickness [6]. Following a stan-
dardized preparation protocol, the molars were prepared
using diamond tips4 under water cooling. The occlusal
surface was reduced to 1.5 mm and an axial reduction of
1.2 mm was made. A circumferential shoulder with
rounded angles was completed with the aid of modified
surveyor5 to standardize the degree of tapering at 6 for all
the specimens [Figs. 1 and 2].
Impressions6 of the prepared teeth were made and
dies7 were fabricated, then, scanned with the cercon
eye8 [8,9]. Designing the copings in the Cercon® art9
was carried out using a standard protocol, whereby
the settings were: 0.8 mm occlusal and axial wall
thickness, 30 mm for virtual cement layer and the
Spacer coverage was 90% spacer coverage corre-
sponding to approximately 0.5 mm off the finish line.
Once the design phase was completed, the Cercon
Brain10 proceeded with milling the selected Cercon
blank11 and the enlargement factor compensating for

1
BasePlate Wax, Cavex, Holland.
2
Cold cure acrylic resin, Acrostone, Egypt.
3
Stomaflex® Putty, SpofaDental; Markova, Czech Republic.
4
DENSPLY, Sharpcut round-ended tapered diamond tip, G37.ref 60674100.UnitedKingdom & JOTA rotary instrument 831 size 018.
5
Surveyor, Ramses, Egypt.
6
Elite® HD, Zhermack, Italy.
7
Sherahard-der klasse ROCK, Superhartgips IV; Germany.
8
Cercon eye, Degudent, Germany.
9
Cercon® art CAD, Degudent; Germany.
10
Cercon brain, Degudent; Germany.
11
Cercon base#47; DENSPLY, Germany.
 R.A. El-Dessouky et al. / Tanta Dental Journal 12 (2015) 81e88
sintering shrinkage (~18% linear) was calculated. The
frameworks were cut off the milled blank using fissure
bur12 mounted on a low speed hand piece. The
frameworks were placed on Cercon Heat furnace13 tray
and sintered at 1350  C for 6 h [10].
The veneering porcelain14 was built-up incremen-
tally to restore the final anatomical shape of the crown,
underwent two dentin firing cycles at 830  C then,
820  C under vacuum. Finally, The glaze15 was applied
and fired with the vacuum off at 810  C. The silicon
indices were used for checking the final crown thick-
ness [11] [Fig. 3].
Each crown was cemented with Glass Ionomer16 to
its corresponding tooth and held in place for 10 min
using universal testing machine17 that applies a five kg
static load [12]. All specimens were thermocycled af-
terwards, in a thermocycling apparatus18 for nearly 600
cycles from 5  C to 55  C with 30 s dwell time, 20 s
transfer time, corresponding to 1 year of clinical ser-
vice. The thermocycled specimens were subjected to a
maximum vertical load19 of five kg with cyclic fre-
quency of 1.7 Hz for 240.000 cycles which corre-
sponds to 1 year of clinical service [13,14]. At each
step (frameworks, veneering, cementation and artificial
aging) a Specimen Positioning Device (SPD)20 was
used to secure the samples on their corresponding
prepared teeth. Each specimen was photographed using
Digital optical microscope21 with a built-in camera
connected with an IBM compatible personal computer
using a fixed magnification of 40
. A digital image
analysis system22 was used to measure and qualita-
tively evaluate the discrepancy width. The collected
data were statistically analyzed using a one-way
(ANOVA) and Independent-samples T test.
3. Results
The vertical marginal discrepancy mean values in
different surfaces (buccal, distal, lingual and mesial) of
12
Dentsply Lab Carbide Burs, Faskut Carbide Cutter (Fine) # 216F.
13
Cercon heat, Degudent; Germany.
14
Cercon Ceram kiss dentin DB4, Ducera® liquid FORM, carving liquid, DENSPLY, Germany.
15
Cercon Ceram kiss, Glaze, Hanau, Germany and Ducera® Liquid Stain improved, Germany.
16
Medicem; PROMEDICA, Germany.
17
Model LRX-plus; Lloyd Instruments Ltd., Fareham, UK.
18
Custom-Made apparatus, conservative department; Tanta University.
19
Model LRX-plus; Lloyd Instruments Ltd., Fareham, UK.
20
Cutom-made stainless steel device.
21
Scope Capture Digital Microscope, Guangdong, China.
22
Image J 1.43U, National Institute of Health, USA.
83
all tested manufacturing stages were compared
together using (ANOVA) and there was no significant
difference between the different surfaces at the same
step where (P) values recorded >0.05 [Fig. 4].
Regarding the different studied steps, the core step
recorded the lowest marginal discrepancy mean value
(41.08 ± 3.23 mm) followed by veneered
(46.87 ± 3.94 mm) and cemented steps
(49.26 ± 4.65 mm) while the aged group recorded the
highest value (56.73 ± 7.21 mm). The difference be-
tween staged groups was statistically significant as
indicated by one way ANOVA test (P < 0.01).
Independent-samples T test was then employed to find
out the significant difference at each step during the
different studied groups and revealed that in all sur-
faces, there was a significant difference (p < 0.05)
between all tested steps except between cemented and
veneered steps where the difference was statistically
non-significant (p > 0.05).
4. Discussion
This in vitro study evaluated the vertical marginal
discrepancy of Cercon based crowns during their
fabrication steps; namely after CAD/CAM production
of frameworks, after their veneering, after cementation
and finally, artificial ageing was conducted for all
cemented crowns by means of thermocycling and
mechanical loading corresponding to one year of
clinical service in an attempt to simulate the chewing
motion, moisture and thermal changes in the oral
environment.
The assessment of the marginal adaptation was
performed on extracted human molars which have
been also used in previous studies [15,45] because their
modulus of elasticity, bonding characteristics, thermal
conductivity and strength are closer to the clinical
situation rather than those of metal, plastic and animal
teeth. The teeth were stored in thymol solution to
84 R.A. El-Dessouky et al. / Tanta Dental Journal 12 (2015) 81e88
Fig. 1. The prepared tooth.
prevent them from drying out and thereby becoming
brittle, and inhibit the microbial activity [6]. On the
other hand, natural teeth show a large variation because
of their age, individual structure and storage time, thus
causing difficulties in getting standardized prepara-
tions. With regard to a volumetrically standardized
preparation, some authors have used silicone indices to
control the amount of reduced tooth structure [6,12]. A
modified surveyor was used to ensure that the prepa-
rations' walls got the corresponding tapering of the
adjacent perpendicular bur as in several previous
studies [9,12,16].
SPD was used to secure copings and crowns on their
corresponding prepared teeth during measurements
preventing them from rotational movements as used by
several investigators with or without modifications
[17,18,34]. A variety of methods has been used to
evaluate the marginal adaptation of dental restorations
such as direct viewing, cross section view, impression
replica technique and clinical examination [7,19,44].
In the current study, direct viewing technique was
selected because it is a non-destructive, rapid, easy and
convenient method and has been most frequently used
to measure marginal discrepancy at various steps of
Fig. 2. The amount of axial reduction ¼ 1.2 mm.
Fig. 3. Checking the thickness of final crown using silicon index.
manufacturing [17,18,34,35]. Groten et al. [20],
determined minimum number of 20e25 measurements
per crown required for in-vitro testing. In this study,
the measurement points per crown were 20 distributed
as five fixed landmarks along the cervical circumfer-
ence for each surface of the crowns.
A controversy exists, regarding the clinically
acceptable marginal discrepancy. Theoretically, the
restoration needs a luting cement film of 20e40 mm
thickness [21]. McLean and Fraunhofer [22], stated
that a marginal discrepancy of 120 mm should be the
limit of clinical acceptability. A marginal discrepancy
that ranges from 17 mm to 161 mm has been reported
for all-ceramic restorations using different processing
techniques. However; the marginal discrepancy has
been seen to be influenced by the system used. The
mean marginal discrepancy for all-ceramic crowns
created by CAD/CAM was reported to range from 23
to 110.1 mm [6,16,22,23,35,36,44]. The demonstrated
marginal discrepancy values for machining of fully
Fig. 4. Column chart of vertical marginal gap regarding to teeth
surfaces at different stages.
 R.A. El-Dessouky et al. / Tanta Dental Journal 12 (2015) 81e88
sintered zirconia blocks are 60.4 and 110.1 mm [16,23]
while, machining of partially sintered zirconia was
found to achieve more accurate values for the marginal
discrepancies between 24.6 and 65 mm [6,23].
In this study, the mean of the marginal discrepancy
values at all measurement locations reflects the
magnitude of marginal discrepancy of the entire crown
at each step of fabrication. However, the marginal
adaptation of each crown may vary greatly at different
locations resulting in an increase in the standard de-
viation (SD) [24]. The anisotropic shrinkage of zirco-
nia frameworks and the non-uniform firing shrinkage
of the veneering porcelain also may contribute to this
fact [25]. The values of SDs reported in previous
studies ranged between 1.1 and 20 mm [2,4,25,26]. The
mean values of the present study in all studied stages
were accompanied by SDs between 3.23 and 7.21 mm
which are relatively small reflecting consistent results.
Since the coping mainly determines the overall
adaptation of final crown [7,34], the marginal adapta-
tion of copings in this study was measured firstly
without veneering and recorded a mean value smaller
than values obtained in previous studies [9,26]. This
difference can be attributed to the more complex
geometric form of FPDs in the other studies rather than
individual crowns tested in ours. Different axial
tapering, core thickness and different measurement
techniques also may contribute to this difference.
Moreover, higher values of marginal discrepancy were
reported by others [16,27], when used CAM only and
attributed this finding to the complicated fabrication
process required in the CAM only system (application
of die spacer and waxing) which can cause distortion at
the margin. However, the core marginal discrepancy in
this study was in the same range obtained by Beuer
et al. [12].
Additionally, significant increase in the marginal
discrepancy was observed after firing the veneering
porcelain agreeing with other studies [6,17,29,30,36]
due to melting of porcelain particles causing contrac-
tion of the veneering porcelain and thus, compressive
forces on the coping. This deformation spreads around
the whole marginal circumference. Although the
veneering porcelain was modulated by the manufac-
turer to have a coefficient of thermal expansion closer
in value to zirconia frameworks, but the remaining
difference between them can be another probable cause
of this finding. DeHoff et al. [31], suggested that a safe
thermal contraction mismatch (Da ¼ a core -a
veneering) lies in a range (0.61
106K1 to
þ1.02
106K1). In the present study, the CTE of
zirconia copings8 was 10.5
106K1 while that of
85
dentin veneering porcelain8 was 9.2
106K1 resulting
in (Da ¼ 1.3
106 K1) which is greater than the safe
range and may be the reason of this increased vertical
discrepancy. Another possible reason was previously
reported [30]: CAD/CAM machining of the pre-
sintered Y-TZP blocks induced microcracks at zirco-
nia surface which cannot be completely eliminated by
sintering. In the presence of water from the wet
veneering porcelain and high temperature during firing
cycles (around 800  C); these microcracks act as stress
concentration sites which grow further by migration of
water into zirconia lattice starting the tetragonal-to-
monoclinic phase transformation which is responsible
for 3e5% volume increase [31] and thus, creating
compressive stresses within the frameworks. These
stresses, together with those caused by (core-veneer)
CTEs mismatch, are thought to contribute to the mar-
ginal distortion developed during veneering of CAD/
CAM frameworks [33,41]. In the present study,
attributing the marginal distortion during veneering of
CAD/CAM zirconia frameworks to the [low tempera-
ture aging phenomenon together with the mismatch
between core and veneer coefficients of thermal
expansion] seems to be more reasonable rather than to
the contraction forces developed from firing shrinkage
of veneering porcelain because the high flexural
strength and fracture toughness of zirconia [3] can
resist its deformation under contraction forces.
Nevertheless, it must be noted that the marginal dis-
crepancies of these crowns after porcelain veneering
are still within the clinically acceptable standards and
that the amount of distortion does not affect the clinical
performance of the restoration.
On the other hand; other authors [34,35] found no
significant differences among the various steps of
crown fabrication. This difference between both results
and ours can be due to different laboratory procedures
as they examined different ceramic systems, different
thickness of veneering porcelain, and variation of the
manual skills of dental technician [6]. Besides, they
utilized acrylic dies instead of natural teeth and per-
formed only one dentin firing cycle rather than two
dentin firing cycles in our study. On contrary, other
authors observed a decrease in the marginal discrep-
ancy measurements after the addition of veneering
porcelain in Everest CAD/CAM system [36] and
relayed this decrease to the stresses initiated due to the
difference in CTEs between the core and veneering
porcelain which are directed toward the central axis of
the restoration. In the present study, no significant
difference in the vertical discrepancy measurements
was found between different teeth surfaces during
86 R.A. El-Dessouky et al. / Tanta Dental Journal 12 (2015) 81e88
porcelain firing distortion agreeing with previous
studies [36,37]. On contrary, other authors [17,34]
found significantly larger marginal discrepancies in
the facial and lingual surfaces rather than mesial and
distal ones and suggested the greater bulk of porcelain
at the facial and lingual surfaces and the tendency of
porcelain to shrink toward the greatest mass is a
probable reason for higher discrepancy in these sur-
faces. The difference between this finding and ours
may be due to the different coping configuration from
the maxillary central incisor used in other studies
[17,34] to the lower molar in the current study. Besides
the different material and fabrication technique of the
evaluated core, different thickness of the veneering
porcelain and location & number of measurements can
also contribute to this different finding.
In the current study, a slight increase in the mar-
ginal discrepancy value was observed agreeing with
previous studies [4,6]. However, others [7,26] recor-
ded a significant increase in the marginal discrepancy
after cementation. This difference between them and
ours can be explained by the fact that the pre-
determined internal space of 30 mm for the luting
agent seems to be enough to obtain an adequate space
for the cement and the result was a slight but not
significant increase in the vertical marginal discrep-
ancy. Nevertheless, as the internal adaptation was not
evaluated in this study, this assumption cannot be
verified. Another assumption is the different seating
force applied in this study instead of finger pressure
used by other authors [38].
Evaluation of the marginal discrepancies in this
study revealed significant increase after artificial aging
as the degradative effect of thermocycling in an
aqueous atmosphere on dental ceramics has been re-
ported [39]. Although the critical temperature of zir-
conia aging suggested [32]{above 100  C} is
extremely far from the temperature range applied in
the present study (5  Ce55  C), Perdig~ao et al. [40],
found that thermal fatigue in artificial saliva for 30,000
cycles accelerated the degradation of Lava zirconia
specimens, and confirmed by Kim et al. [41],who also
found that conducting 10 h of artificial aging for ven-
eered specimens of (IPS e-max ZirCAD, Ivoclar)
resulted in 55% T / M phase transformation. A more
reasonable explanation of this increase in marginal
discrepancy suggests that it is related to the luting
cement. Some portions of the cement film were washed
out during the aging procedures, resulting in a clearer
image under microscope and, thus, creating the pos-
sibility for increased measurements of the marginal
discrepancy [6] particularly, when using water-soluble
cements such as glass-ionomer which deteriorate over
time due to the deleterious effects of thermocycling
[42]. On contrary, found no significant effect on mar-
ginal discrepancy after aging was reported by others
[43]. This different finding can be due to the different
ceramic systems and luting agents being evaluated as
the insoluble resin cement they used decreased the
potential of interfacial failure of the luting agent during
thermocycling. However, Att et al. [6], also reported no
significant difference in the marginal discrepancy
although they used GIC and this can be due to different
parameters of mechanical loading.
5. Conclusion
Based on the results and within the limitation of this
study -including variation between teeth in age and
storage time and neglecting the internal adaptation
measurements-the following conclusions were made:
 The vertical marginal adaptation values observed
were all within the clinically acceptable range
(120 mm).
 The marginal discrepancy for zirconia cores
increased significantly after veneering.
 No significant difference in vertical discrepancy
measurements was found between the different
teeth surfaces during porcelain firing.
 Cementation did not significantly increase the ver-
tical marginal discrepancies of zirconia crowns
analyzed.
 Artificial Aging significantly increased the vertical
marginal discrepancy through thermo-mechanical
loading.
References
[1] Maritilo, Gjerdet NR, Tvinnereim HM. The firing procedure
influences properties of a zirconia core ceramic. Dent Mater
2008;24:471e5.
[2] Bindl A, Mormann WH. Clinical and SEM evaluation of all-
ceramic chair-side CAD/CAM generated partial crowns. Eur J
Oral Sci 2003;111:163e9.
[3] Goldin E, Boyd NW, Goldstein GR, Hittelman EL,
Thompson VP. Marginal fit of leuciteeglass pressable ceramic
restorations and ceramic pressed-to-metal restorations. J Pros-
thet Dent 2005;93:143e7.
[4] Gonzalo E, Surez MJ, Serrano B, Lozano JL. A comparison of
the marginal vertical discrepancies of zirconium and metal
ceramic posterior fixed dental prostheses before and after
cementation. J Prosthet Dent 2009;102:378e84.
[5] Komine F, Iwai T, Kobayashi K, Matsumura H. Marginal and
internal adaptation of zirconium dioxide ceramic copings and
 R.A. El-Dessouky et al. / Tanta Dental Journal 12 (2015) 81e88
crowns with different finish line designs. Dent Mater
2007;26:659e64.
[6] Att W, Komine F, Gerds T, Strub JR. Marginal adaptation of
three different zirconium dioxide three-unit fixed dental pros-
theses. J Prosthet Dent 2009;101:239e47.
[7] Beschnidt SM, Strub JR. Evaluation of the marginal accuracy of
different all-ceramic crown systems after simulation in the
artificial mouth. J Oral Rehabil 1999;26:582e93.
[8] Sundar V, Kennedy C, Ewoldsen N. Cercon® zirconia: con-
servative options in metal-free dentistry. Clin Man Degudent
Gmbh 2007.
[9] Beuer F, Korczynski N, Rezac A, Naumann M, Gernet W,
Sorensen AJ. Marginal and internal fit of zirconia based fixed
dental prostheses fabricated with different concepts. Clin Cosm
Invest Dent 2010;2:5e11.
[10] Cercon smart ceramics- The zirconia all-porcelain system.
Cercon art P 21. Instructions for use, degudent gmbh. 2006.
p. 8e34.
[11] Braunwarth J, Finke P, Fischer C, Linne M. Kiss e a better
veneering concept. 2006. p. 1e40. www.kiss-ceramics.com.
[12] Beuer F, Edelhoff D, Gernet W, Naumann M. Effect of prepara-
tion angles on the precision of zirconia crown copings fabricated
by CAD/CAM system. Dent Mater 2008;27(814):820.
[13] Sibel A, Jason W, Donald E. Surface protection for newly
erupting first molars. Compend Contin Educ Dent
2006;27:46e52.
[14] Krejci I, Lutz F, Reimer M. Marginal adaptation and fit of
adhesive ceramic inlays. Dent J 1993;21:39e46.
[15] García AJ, Santana FB, Szalay ER. Marginal adaptation and
microleakage comparison between two zirconia oxide systems
with the same cement. Rev Odontologica Mex 2011;15:101e6.
[16] Beuer F, Richer J, Gernet W. Influence of preparation angle on
marginal and internal fit of CAD/CAM e fabricated zirconia
crown copings. Quintessence Int J 2009;40:243e50.
[17] Balkaya MC, Cinar A, Pamuk S. Influence of firing cycles on
the margin distortion of 3 all-ceramic crown systems. J Prosthet
Dent 2005;93:346e55.
[18] Limkangwalmongkol P, Kee E, Chiche G, Blatz M. Comparison
of marginal fit between all-porcelain margin versus alumina-
supported margin on procera alumina crowns. J Prosthodont
ACP 2009;18:162e6.
[19] Rastogi A, Kamble V. Comparative analysis of the clinical
techniques used in evaluation of marginal accuracy of cast
restoration using stereomicroscopy as gold. J Adv Prosthodont
2011;3:69e75.
[20] Groten M, Axmann D, Probster L, Weber H. Determination of
the minimum number of marginal gap measurements required
for practical in-vitro testing. J Prosthet Dent 2000;83:40e9.
[21] Christensen GJ. Marginal fit of gold inlay castings. J Prosthet
Dent 1966;16:297e305. Quoted from Hilgert E, Neisser MP,
Bottino MA. Evaluation of the marginal adaptation of ceramic
copings in function of the cervical endings and treatment of the
internal surfaces. Clin Odontol Bras 2003; 6: 9e16.
[22] Mclean JW, Von Fraunhofer JA. The estimation of cement film
thickness by an in vivo technique. Br Dent J 1989;131:107e11.
[23] Karatas‚li O, Kursoglu P, Capa N, Kazazoglu E. Comparison of
the marginal fit of different coping materials and designs pro-
duced by computer aided manufacturing systems. Dent Mater
2011;30:97e102.
[24] Chan C, Haraszthy G, Gerstorfer JG, Weber H, Huettemann H.
Scanning electron microscopic studies of the marginal fit of
three esthetic crowns. Quintessence Int J 1989;20:189e93.
87
[25] Kuni J, Hotta Y, Tamaki Y, Ozawa A, Kobayashi Y,
Fujishima A, et al. Effect of sintering on the marginal and in-
ternal fit of CAD/CAM-fabricated zirconia frameworks. Dent
Mater 2007;26:820e6.
[26] Quintas AF, Oliveira F, Bottino MA. Vertical marginal
discrepancy of ceramic copings with different ceramic mate-
rials, finish lines, and luting agents: an in vitro evaluation. J
Prosthet Dent 2004;92:250e7.
[27] Baig MR, Tan KBC, Nicholls JI. Evaluation of the marginal fit
of a zirconia ceramic computer-aided machined (CAM) crown
system. J Prosthet Dent 2010;104:216e27.
[29] Farid, Hajimiragha, Jelodar R, Mostafavi, Nokhbatolfoghahaie.
In vitro evaluation of the effect of core thickness and fabrication
stages on the marginal accuracy of an all-ceramic system. Dent
J 2012;9:188e94.
[30] Kohorst P, Brinkmann H, Dittmer MP, Borchers L, Stiesch M.
Influence of the veneering process on the marginal fit of
zirconia fixed dental prostheses. J Oral Rehabil 2010;37:
283e91.
[31] Dehoff P, Barrettb A, Leeb R, Anusavice K. Thermal compat-
ibility of dental ceramic systems using cylindrical and spherical
geometries. Dent Mater 2008;24:744e52.
[32] Kim HT, Han JS, Yang JH, Lee JB, Kim SH. The effect of low
temperature aging on the mechanical property & phase stability
of Y-TZP ceramics. J Adv Prosthodont 2009;1:113e7.
[33] Elshazly ES, El-Hout SM, Ali ME. Yttria tetragonal zirconia
biomaterials: kinetic investigation. J Mater Sci Technol
2011;27:332e7.
[34] Sulaiman F, Chai H, Jameson LM, Wozniak WT. A comparison
of the marginal fit of in-ceram, IPS empress, and procera
crowns. Int J Prosthodont 1997;10:478e84.
[35] Vigolo P, Fonzi F. An in vitro evaluation of fit of zirconium-
Oxide-based ceramic four-unit fixed partial dentures, gener-
ated with three different CAD/CAM systems, before and after
porcelain firing cycles and after glaze cycles. J Prosthodont
ACP 2008;17:621e6.
[36] Dittmer M, Borchers L, Stiesch M, Kohorst P. Stresses and
distortions within zirconia-fixed dental prostheses due to the
veneering process. Acta Biomater J 2009;5:3231e9.
[37] Pilathadka S, Slezak R, Srinivasan V, Ivancakova R. Precision
of marginal adaptation of the incisor and molar Procera® all-
ceram crown copings. Prague Med Rep 2008;109:71e82.
[38] Bhowmik H, Parkhedkar R. A comparison of marginal fit of
glass infiltrated alumina copings fabricated using two different
techniques and the effect of firing cycles over them. J Adv
Prosthodont 2011;3:196e203.
[39] Blatz MB, Oppes S, Chiche G, Holst S, Blatz MB. Influence of
cementation technique on fracture strength and leakage of
alumina all-ceramic crowns after cyclic loading. Quintessence
Int J 2008;39:23e32.
[40] Perdig~ao J, Pinto AM, Monteiro RC, Braz FM, Laranjeira P,
Veiga JP. Degradation of dental Zro2-based materials after
hydrothermal fatigue. Part I: XRD, XRF, and FESEM analyses.
Dent Mater 2012;31:256e65.
[41] Kim JW, Covel NS, Guess PC, Rekow ED, Zhang Y. Concerns
of hydrothermal degradation in CAD/CAM zirconia. J Dent Res
2010;89:91e5.
[42] Albert FE, El-Mowafy OM. Marginal adaptation and micro-
leakage of procera all-ceram crowns with four cements. Int J
Prosthodont 2004;17:529e35.
[43] Stappert CF, Dai M, Chitmongkolsuk S, Gerds T, Strub JR.
Marginal adaptation of three-unit fixed partial dentures
88 R.A. El-Dessouky et al. / Tanta Dental Journal 12 (2015) 81e88

constructed from pressed ceramic systems. Br Dent J
2004;196:766e77.
[44] Kohorst P, Brinkmann H, Li J, Borchers L, Stiesch M. Marginal
accuracy of four-unit zirconia fixed dental prostheses fabricated
using different computer aided design/computer-aided
manufacturing systems. Eur J Oral Sci 2009;117:319e25.
[45] Rossetti PO, Valle AL, Carvalho RM, Goes MF, Egoraro LF.
Correlation between margin fit and microleakage in complete
crowns cemented with three luting agents. J Appl Oral Sci
2008;16:64e9.