Scanning electron microscope evaluation of the marginal gap and internal fit of additive versus subtractive fabrication techniques for posterior lithium disilicate crowns

Statement of the problem: The wide use of digital dentistry in fixed prosthodontics using 3D printers and CAD/CAM in fabricating crowns and partial fixed dental prosthesis created a need for more information about their marginal gap and internal fit.
Purpose: This study aimed to evaluate the effect of fabrication technique using CAD/CAM manufactured and heat pressed lithium dislicate crowns made from milled wax and 3D printed resin patterns on their marginal gap and internal fit.
Material & Methods: A total of 50 prepared mandibular first molar resin models were used and divided into two main groups according to their fabrication phase: Patterns group and fully fabricated crowns group. Patterns group was subdivided into milled wax patterns (W) (n=10) and 3D printed resin patterns (P) (n=10). Fully fabricated crowns group was subdivided according to fabrication technique of lithium disilicate crowns into: Machinable ceramics (M), using IPS e-max CAD blocks (n=10), Pressable ceramics (Pw), using IPS e-max press ingots following wax milling (n=10) and Pressable ceramics (Pp), using IPS e-max press ingots following 3D resin printing (n=10). All patterns and ceramic crowns were cemented with Rely-X self-adhesive resin cement. Marginal and internal adaptations were measured using SEM at 300 × magnification. Kruskal-Wallis and Wilcoxon signed-rank tests were applied to compare between the groups. Data were presented as median and range values. The significance level was set at P ≤ 0.05.
Results: P group showed a significant higher median total marginal gap of 111.4 μm
(80.8-139.7) than W group of 51.3 μm (45.1-57.8) before heat pressing. While M group showed the significant highest median marginal gap of 138.4 μm (83.4-191.8) and no significant difference between heat pressed groups (Pw and Pp) (P ≤ .05). Regarding changes after heat pressing, Pw group showed no significant decrease, while Pp group showed a significant decrease in median total marginal gap. For internal fit, there was no significant difference between the pattern groups (W and P) before heat pressing (P ≤ .05). After heat pressing, Pp group showed the significantly highest median gap of 195 μm (138.9-441.5) with no significant difference between M and Pw groups (P ≤ .05). Pw group showed a significant decrease in median gap, and Pp group showed no significant decrease after pressing (P ≤ .05).
Conclusions: Heat pressed lithium disilicate glass ceramic crowns produced from CAD/CAM waxing or resin 3D printing techniques resulted in better marginal and fit accuracy than CAD/CAM. 3D printed resin patterns yielded internal fit values higher than other groups, but with promising clinical acceptability.
Clinical implications: Both the additive and subtractive production for patterning phase before heat pressing allow clinical acceptability in terms of marginal and internal adaptation when a single unit posterior ceramic lithium disilicate crown is fabricated.