Biomechanical In Vitro Study on the Stability of Patient-Specific CAD/CAM Mandibular Reconstruction Plates: A Comparison Between Selective Laser Melted, Milled, and Hand-Bent Plates

2020 ◽  
pp. 194338752095268
Author(s):  
Robin Kasper ◽  
Karsten Winter ◽  
Sebastian Pietzka ◽  
Alexander Schramm ◽  
Frank Wilde

Study Design: An experimental in vitro study. Objective: Plate fractures are a recurrent problem in alloplastic mandibular reconstruction. Hypothetically it can be assumed that computer-aided design (CAD)/computer-aided manufacturing (CAM) reconstruction plates have a higher stability than conventional hand-bent plates. The aim of the study was to compare additive and subtractive fabricated CAD/CAM mandibular reconstruction plates as well as conventional plates with regard to their biomechanical properties. Methods: In a chewing simulator, plates of 2 conventional locking plate systems and 2 CAD/CAM-fabricated plate systems were compared. The plates were loaded in a fatigue test. The maximum number of cycles until plate fracture and the plate stiffness were compared. Results: While all conventional plates fractured at a maximum load between 150 and 210 N (Newton) after a number of cycles between 40 000 and 643 000, none of the CAD/CAM plates broke despite a nearly doubled load of 330 N and 2 million cycles. Both CAD/CAM systems proved to be significantly superior to the hand-bent plates. There was no difference between the 2 CAD/CAM systems. Conclusions: Concerning the risk of plate fracture, patient-specific CAD/CAM reconstruction plates appear to have a significant advantage over conventional hand-bent plates in alloplastic mandibular reconstruction.

2021 ◽  
Vol 11 (2) ◽  
pp. 857
Author(s):  
Keunbada Son ◽  
Kyu-Bok Lee

The purpose of this in vitro study was to evaluate marginal and internal fits of ceramic crowns fabricated with chairside computer-aided design and manufacturing (CAD/CAM) systems. An experimental model based on ISO 12836:2015 was digitally scanned with different intraoral scanners (Omnicam (CEREC), EZIS PO (DDS), and CS3500 (Carestream)). Ceramic crowns were fabricated using the CAD/CAM process recommended by each system (CEREC, EZIS, and Carestream systems; N = 15). The 3-dimensional (3D) marginal and internal fit of each ceramic crown was measured using a 3D inspection software (Geomagic control X). Differences among the systems and various measurements were evaluated using the Kruskal–Wallis test. Statistically significant differences were validated using pairwise comparisons (α = 0.05). Occlusal gaps in the CEREC, EZIS, and Carestream groups were 113.0, 161.3, and 438.2 µm, respectively (p < 0.001). The axial gaps were 83.4, 78.0, and 107.9 µm, respectively. The marginal gaps were 77.8, 99.3, and 60.6 µm, respectively, and the whole gaps were 85.9, 107.3, and 214.0 µm, respectively. Significant differences were observed with the EZIS system compared with the other two systems in terms of the marginal gap sizes. The CEREC system showed no significant differences among the four measured regions. However, the EZIS and Carestream systems did show a statistically significant difference (p < 0.05). All three systems were judged to be capable of fabricating clinically acceptable prostheses, because the marginal gap, which is the most important factor in the marginal fit of prostheses, was recorded to be below 100 µm in all three systems.


2019 ◽  
Vol 18 (4) ◽  
pp. 764-772
Author(s):  
Asa Yazdani Fard ◽  
Zuryati Ab Ghani ◽  
Zaihan Ariffin ◽  
Dasmawati Mohamad

Background: Studies on microleakage of Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) crowns are abundant. However many of them are inconclusive, especially those using self adhesive cements. Aims: To compare the microleakage between CAD/CAM crowns milled out of feldspathic ceramic and resin nano ceramics, cemented with three resin cements. Materials and Methods: Crown preparation was made on 54 extracted human premolars. Impressions were captured optically using CEREC 3D machine intraoral camera, and crowns were milled from feldspathic ceramic (CEREC® Blocs PC, VITA) and resin nano ceramic (Lava™ Ultimate CAD/CAM Restorative, 3M ESPE) blocks. The crowns were then cemented with three cements (n = 9); RelyX™ U200 Self-Adhesive Resin Cement (3M ESPE); NX3 Nexus ® cement with two-step etch-and-rinse adhesive (Kerr Corporation) or three/multistep etch-and-rinse resin cement, Variolink® II/Syntac Classic (Ivoclar Vivadent). The specimens were kept in water for 24 hours, thermocycled, and then soaked in methylene blue dye for 24 hours, before being sectioned mesiodistally. Microleakage was assessed using a fivepoint scale using stereomicroscope. Statistical analysis of the data was carried out using ONEWay ANOVA. Results: CEREC® Blocs PC crowns showed significantly less microleakage (p< 0.001) compared to Lava™ Ultimate. RelyX™ U200 showed significantly lower microleakage (p< 0.001) compared to other cements. Combination of Lava™ Ultimate crown cemented with RelyX™ U200 showed the least microleakage (p< 0.001). Conclusions: The microleakage scores were affected by the types of crown and cements. Bangladesh Journal of Medical Science Vol.18(4) 2019 p.764-772


2014 ◽  
Vol 7 (2) ◽  
pp. 158-166 ◽  
Author(s):  
Frank Wilde ◽  
Carl-Peter Cornelius ◽  
Alexander Schramm

We investigated the workflow of computer-assisted mandibular reconstruction that was performed with a patient-specific mandibular reconstruction plate fabricated with computer-aided design and computer-aided manufacturing (CAD/CAM) techniques and a fibula flap. We assessed the feasibility of this technique from virtual planning to the completion of surgery. Computed tomography (CT) scans of a cadaveric skull and fibula were obtained for the virtual simulation of mandibular resection and reconstruction using ProPlan CMF software (Materialise®/DePuy Synthes®). The virtual model of the reconstructed mandible provided the basis for the computer-aided design of a patient-specific reconstruction plate that was milled from titanium using a five-axis milling machine and CAM techniques. CAD/CAM techniques were used for producing resection guides for mandibular resection and cutting guides for harvesting a fibula flap. Mandibular reconstruction was simulated in a cadaveric wet laboratory. No problems were encountered during the procedure. The plate was fixed accurately to the residual bone without difficulty. The fibula segments were attached to the plate rapidly and reliably. The fusion of preoperative and postoperative CT datasets demonstrated high reconstruction precision. Computer-assisted mandibular reconstruction with CAD/CAM-fabricated patient-specific reconstruction plates appears to be a promising approach for mandibular reconstruction. Clinical trials are required to determine whether these promising results can be translated into successful practice and what further developments are needed.


2017 ◽  
Vol 61 (2) ◽  
pp. 177-184 ◽  
Author(s):  
Bálint Vecsei ◽  
Gellért Joós-Kovács ◽  
Judit Borbély ◽  
Péter Hermann

2015 ◽  
Vol 15 (2) ◽  
pp. 173 ◽  
Author(s):  
Srinivasan Jayaraman ◽  
BalajiN Rajan ◽  
Baburajan Kandhasamy ◽  
Ilangkumaran Rajakumaran

Materials ◽  
2020 ◽  
Vol 13 (19) ◽  
pp. 4239
Author(s):  
Roxana-Diana Vasiliu ◽  
Sorin Daniel Porojan ◽  
Liliana Porojan

The accuracy of newly developed ceramic materials is still being studied. Marginal and internal adaptation are known factors that have an essential impact on the long term success of dental restorations. The aim of this in vitro study was to evaluate the marginal and internal fit of heat-pressed and milled monolithic glass-ceramic restorations based on their ceramic type, processing technique, and in vitro thermocycling. Thirty-two crowns were studied and divided into four groups (n = 8), according to the ceramic material (feldspathic glass-ceramic (F) and zirconia reinforced lithium silicate glass-ceramic (ZLS)) and to their technological obtaining processes (milling (M) and heat-pressing (P)). A typodont preparation was scanned with a D2000 3D scanner to obtain identical 32 resin 3D-printed abutment teeth. Marginal and internal gaps were measured using the silicone replica technique under 40× magnification. The crowns were further cemented and thermally aged for 10,000 cycles After cementation and thermocycling of the samples, marginal and internal gaps were assessed using micro-CT (micro-computed tomography)) analysis. Data were statistically analyzed using statistical tests. Significant differences were found before and after cementation and thermocycling among the tested materials (p < 0.05). Related to technological processing, significant differences were seen in the marginal area between FP and FM (p < 0.05) Significant differences were also found in the axial and occlusal areas between the ZLSP and ZLSM. Thermocycling and cementation did not have a significant effect on the tested materials (p < 0.05). The technological processes influenced the marginal and internal fit of the crowns in favor of the CAD/CAM (computer aided design/computer aided manufacturing)technologies. Thermal aging had little effect on marginal adaptability; it increased the values for all the tested samples in a small way, but the values remained in their clinically acceptable range for all of the crowns.


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