Clinical outcomes of three different

crown systems with CAD/CAM

technology
Emily R. Batson, DDS, MS,a Lyndon F. Cooper, DDS, PhD,b
Ibrahim Duqum, DDS, MS,c and Gustavo Mendonça, DDS, PhDd
University of North Carolina at Chapel Hill School of Dentistry,
Chapel Hill, NC
Statement of problem. Computer-aided design and computer-aided manufacturing (CAD/CAM) generated restorations
are gaining popularity. However, limited clinical evidence is available for single-unit posterior CAD/CAM restorations
fabricated with established and newer crown materials.

Purpose. The purpose of this clinical study was to assess the restoration quality of and gingival response to CAD/CAM
fabricated posterior single-tooth restorations with different processing technologies.

Material and methods. Twenty-two individuals in need of posterior complete coverage crowns were recruited under an
institutional review board approved protocol. Teeth were randomized to 1 of 3 groups: metal ceramic, lithium disilicate, and
monolithic zirconia. An unprepared or minimally restored tooth on the contralateral side was chosen as a control tooth
for gingival measurements with each participant. Teeth were prepared and scanned intraorally by 1 of 3 experienced
practitioners. A total of 32 restorations were digitally designed and fabricated with either milling technology or
rapid-prototype printing and casting with conventional porcelain application. Restorations were evaluated with modified
United States Public Health Service criteria for contour, marginal adaptation, occlusion, and shade. Gingival crevicular fluid
volume and bleeding on probing were recorded preoperatively, at 1-month and 6-month postcementation visits. Polyvinyl
siloxane impressions were made of the buccal margin of cemented restorations and evaluated with microcomputed
tomography to assess marginal adaptation (horizontal discrepancy). The Mantel Haenszel row mean score was used to assess
whether the crown systems differed with respect to the modified United States Public Health Service criteria. Linear mixed
models were used to assess whether the average gingival volumes were affected by the explanatory variables (crown system,
tooth status [treated vs control], or visit). A generalized estimating equation approach was used to assess whether
bleeding on probing was affected by the explanatory variables. One-way ANOVA was used to assess marginal discrepancy
values among the crown systems (a¼.05 for all tests).

Results. Twelve metal ceramic, 10 lithium disilicate, and 10 zirconia restorations were fabricated for 22 participants. Zirconia
restorations were significantly different from the other 2 crown systems (P<.001) with respect to occlusion. No occlusal
adjustment was needed on 80% of the zirconia restorations. The average gingival crevicular fluid volumes did not differ among
crown systems, between treated and control groups, or over time. The average horizontal marginal discrepancy was
significantly different between lithium disilicate and zirconia crowns (P¼.027), with zirconia crowns having the least amount
of horizontal marginal discrepancy.

Conclusions. Given the small sample size and limitations of this study, CAD/CAM-generated restorations for posterior teeth
made from different materials had acceptable clinical results. (J Prosthet Dent 2014;112:770-777)

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.

The Journal of Prosthetic Dentistry Batson et al

October 2014
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 workflow that involves intraoral scanning and digital design
may provide a clinically acceptable single-tooth restoration.
Computer-aided design and computer-
aided manufacturing (CAD/CAM)
dentistry has evolved dramatically in
the past 30 years. Most recently,
numerous CAD/CAM systems with
broad capabilities that range from
implant restoration design and fabri-
cation to orthodontic appliance plan-
ning and manufacture have become
widely available for clinicians and
dental laboratories. In addition, de-
mand for esthetic materials has in-
creased1 in restorative dentistry, with
concurrent advances in materials sci-
ence that provide new monolithic
materials that synergize with CAD/
CAM technology. Two materials, lith-
ium disilicate (LD) and monolithic
zirconia (Zr), have become popular,
and both are fabricated with CAD/
CAM systems.2 A recent survey of
laboratory fabrication projections for
restorative materials estimates that, by
the year 2017, ceramic materials will
be used to fabricate approximately
42% of fixed dental restorations.1
The adoption of digital manufacture
for crowns involves the professional
assessment of all attributes of the res-
toration. Notably, attention has been
focused on the fit and marginal ad-
aptation of CAD/CAM restorations.3
As discussed in a recent review by
Miyazaki et al,4 crown margins can
be difficult to capture with intraoral
scanning, not only because of their
design, but their proximity to gingival
tissues, adjacent teeth, and sulcular
fluids. Other studies have concluded
no significant difference among intrao-
ral scanning, a scan of an impression,
or a gypsum cast.5,6 Güth et al7
examined the accuracy of digital
models with an in vitro experiment.
Batson et al
The direct intraoral capture of a pre-
pared abutment found more accuracy
than the scanned polyether impression
or gypsum cast. Average marginal dis-
crepancies of CAD/CAM restorations
have been reported, which ranged
from 35 to 71 mm, and clinical studies
with scanning electron microscopy
analysis have equivalent values.5,8-10
A clinical study by Brawek et al11 re-
ported a mean marginal discrepancy
value of 51 mm for veneered Zr crowns
fabricated with intraoral scanning
techniques and digital fabrication.
Even with studies that found com-
parable marginal adaptation with
standard metal ceramic restorations,
the longevity of ceramic materials are
of concern, especially those with
veneering methods for improved es-
thetics. A 94.8% 8-year survival rate
was reported by Gehrt et al12 for 94
single-unit fixed dental prostheses for
veneered LD restorations with a 5.5%
rate of chipping or fracturing of res-
torations. Fasbinder et al13 reported a
100% survival rate of 62 LD crown
restorations in 43 individuals over a
2-year recall period. No incidence of
crown fracture or chipping was re-
ported nor relatively high alpha scores
for color and marginal adaptation.
Higher chipping rates of 15% to 25%
have been reported for veneered Zr
restorations.14,15 A monolithic resto-
ration would appear to solve some of
the technical complications associated
with ceramic materials, despite limited
clinical data.
This prospective study compared
different CAD/CAM crown procedures.
The primary outcome measurement was
restoration quality assessed with modi-
fied United States Public Health Service
771
(USPHS) criteria. Secondary outcomes
included marginal adaptation measured
by micro–computed tomography (mi-
cro-CT) analysis and the gingival
response to CAD/CAM crown restora-
tions evaluated at the level of inflam-
mation with gingival crevicular fluid
(GCF) volume and bleeding on probing
(BOP). The null hypotheses were that no
difference would be found in crown
quality among metal ceramic (MC), LD,
and Zr crowns fabricated with CAD/
CAM technologies, no difference would
be found in gingival response among the
crown systems, and no difference would
be found in the marginal discrepancy
values between crown systems and
intraoral scanners.
MATERIAL AND METHODS
Patients of the University of North
Carolina (UNC) at Chapel Hill School
of Dentistry were screened and enrolled
in this study under institutional review
board approval (UNC institutional re-
view board 11-2099). Before treatment
began, radiographs, tooth shade, GCF
volume, and BOP measurements were
recorded for all treated teeth as well
as a minimally restored or unprepared
control tooth on the contralateral side.
Shade was matched to a Vita Classic
shade guide for treated teeth. GCF
volume was collected on the buccal and
lingual surfaces of selected and control
teeth with crevicular fluid strips (Perio-
paper; Oraflow) and a Periotron 8000
(Oraflow) according to the manufac-
turer’s instructions. BOP was measured
with a periodontal probe (UNC-15
Periodontal Probe; Hu-Friedy) on the
treated and control teeth. The crown
system was randomized to treated
772
teeth by using computerized software
(Random Allocation Software; http://
mahmoodsaghaei.tripod.com/Softwares/
randalloc.html). A total of 32 crowns
were fabricated for 22 participants.
Teeth that required a foundation
for appropriate resistance or retention
form were treated with either an
amalgam core (Sybralloy; Kerr Dental)
or composite resin core (Comp-Core;
Premier Dental). All the teeth were pre-
pared by 1 of 3 experienced practitioners
(E.B., L.C., I.D.) by using standard rec-
ommended preparation guidelines of
1.5 to 2.0 mm occlusal reduction, and
1.0 to 1.5-mm axial reduction with a
deep chamfer margin circumferentially.
Margin placement was designated at no
more than 0.5 mm subgingivally. After
preparation, the teeth were isolated
from the gingival tissues by placing
appropriately sized plain displacement
cord (Ultrapak; Ultradent Products Inc)
and were scanned according to the type
of restoration assigned; MC and Zr res-
torations were assigned to the iTero
scanner (Align Technology, Inc), and
LD crowns were assigned to the E4D
scanner (Planmeca-E4D) linked to the
E4D milling unit. All the teeth were
scanned by using the recommended se-
quences or patterns as determined by
each scanner. Scanned preparations
were reviewed chairside, and, if neces-
sary, adjustments were made and the
tooth rescanned. An intraocclusal re-
cord was made with an occlusal regis-
tration material for teeth assigned to the
LD group (Virtual CADbite; Ivoclar
Vivadent). MC and Zr crown intra-
occlusal scans were made as directed by
Table I. Modified United States Public Health Service criteria for crown evaluation
Marginal
Results Adaptation
R: Excellent Ideal
S: Acceptable Less than ideal
but acceptable
T: Acceptable/modifications Less than ideal,
needed adjust or remake
V: Unacceptable Remake
The Journal of Prosthetic Dentistry
the iTero scanner. Once scanning was
complete, an interim restoration was
fabricated from a bis-acryl material
(Integrity; Dentsply Caulk), polished,
and cemented with interim cement
(Temp-Bond NE; Kerr Dental).
Scans for MC and Zr crowns were
sent electronically to Align Technology
Inc. Preparation margins were marked
electronically by the clinician when sig-
nificant deviations were noted from the
default margin. Solid casts were ordered
for all MC and Zr restorations (Cadent
model; Align Technology Inc). One
dental laboratory fabricated all the MC
and Zr crowns. Both the MC and Zr
crowns were designed with digital design
software (3Shape software; 3Shape).
Die-space allowances were set within the
design software at 0.030 mm for Zr
crowns, and 0.040 mm for MC crowns
according to the type of material and the
manufacturer’s recommendations. MC
copings were produced by using rapid
prototype printing (3-dimensional
printing) technology and an appro-
priate polymer (Envisiontec Ultra 2 3-D
printer and EC 1000 Photopolymer;
EnvisionTEC). Printed copings were
invested and cast from a high noble alloy
followed by the application of porcelain
(Argedent Euro; The Argen Corporation
and IPS d.Sign, In-Line Porcelain;
Ivoclar-Vivadent). The Zr restorations
were fabricated by using milling tech-
nology (Wieland Mini-mill; Wieland
Dental). Intrinsically colored monolithic
Zr blocks (Zenostar; Wieland Dental)
were milled in the green state and then
sintered according to manufacturer
recommendations. If necessary, extrinsic
Crown Contour
Ideal
Less than ideal but minimal Less than ideal but no
or no changes required changes required
Additions or Staining or other shade
reductions necessary modifications required
Remake
Volume 112 Issue 4
stains were added for characterization
(Empress stains; Ivoclar Vivadent).
The LD crowns were fabricated
with the CAD software within the E4D
system. The restorations were sent
electronically to the E4D mill, and LD
blocks (eMax CAD; Ivoclar Vivadent)
were milled in the selected shade. The
E4D design software die spacing
settings of 0.10 mm were used. After
milling, sintering was completed ac-
cording to the manufacturer’s di-
rections. Characterization and glazing
were completed with appropriate stains
(IPS eMax Ceram; Ivoclar Vivadent).
One clinician (E. B.) recorded the
modified USPHS crown-quality criteria
as listed in Table I during the crown
delivery appointment. All crowns were
fitted by first verifying the interproximal
contacts and then verifying the fit with
addition silicone (black for ceramic,
white for MC; Fit-Checker; GC America
Inc) to disclose and verify the fit of
the intaglio surface. Necessary internal
adjustments were made for MC crowns
with a carbide bur (no. 4 round bur;
Hu-Friedy). For Zr and LD crowns, ad-
justments were made on the prepared
tooth surfaces when possible with
a water-cooled fine diamond rotary in-
strument (Two-Striper Diamond; Pre-
mier Dental). Marginal fit was verified
by explorer feel. Occlusion was evalu-
ated with occlusal indicating paper
(Accufilm; Parkell Dental), and any
necessary adjustments were made with
polishing wheels (Dialite polishers;
Brasseler Dental). If extensive adjust-
ment was necessary, the crown was
reglazed. Once seated, the shade of the
Shade Occlusion
Ideal Ideal
Less than ideal but no
changes required/minimal
adjustments necessary
Adjustments necessary
Remake Remake
Batson et al
October 2014
crown was verified with the patient. All
the crowns were cemented with glass
ionomer cement (Ketac Cem; 3M ESPE).
The participants were recalled 1
month after cementation for GCF
volume and BOP measurements.
Postcementation measurements and
impressions were recorded by 1 prac-
titioner (E. B.). After GCF volume and
BOP measurements, plain displace-
ment cord (Ultrapak; Ultradent Prod-
ucts Inc) was placed along the buccal
side of the restored tooth, and a poly-
vinyl siloxane (PVS) impression was
made of the cemented crown with light
and heavy viscosities (Imprint 3; 3M
ESPE) in a quadrant impression tray
with appropriate adhesive (COE brand
[GC America Inc] and VPS Tray Adhe-
sive [3M ESPE]). PVS impressions were
sectioned through the buccal and
occlusal surfaces of the impression to
display only the buccal section of the
treated tooth. The sectioned impres-
sions were scanned with a micro-CT
scanner (Scanco mCT 40 scanner;
Scanco Medical; Biomedical Research
Imaging Center at the UNC). Digital
Imaging and Communications in
Medicine (DICOM) files were created
with slices approximately 20 mm in
width and with approximately 6 mm
of resolution. Images were analyzed
with a DICOM viewer and linear
measuring tool (Image J software; U.S.
National Institutes of Health). Each
crown was measured at 6 locations 0.5
to 1.0 mm apart along the buccal
margin. Measurements were made
from the prepared crown margin of
the tooth to the closest horizontal
point of the crown restoration. Mea-
surements were recorded as absolute
values that represent overextended
or underextended crown margins. The
patients were recalled 6 months after
773
cementation for GCF volume and BOP
measurements.
Descriptive statistics were per-
formed with computerized software
(SAS v9.1; SAS). The Mantel Haenszel
row mean score statistic was used
to assess an association between the
crown system and the modified USPHS
criteria for acceptable; thus, the R, S,
and T values were combined for this
analysis. Linear mixed models were
used for buccal and lingual GCF vol-
umes separately, and a generalized
estimating equation approach was
used for BOP. The explanatory variables
of interest were the between-subject
factor (crown system) and the within-
subject factors (visit and tooth status,
treated vs control). Because both
tooth status and visit were correlated
within the crown system, a Kronecker
product formulation was used in the
linear mixed models for the covariance

Table II. Crown ratings by using modified USPHS criteria

Unacceptable Acceptable with
Crown System or Rejected Modifications Acceptable Excellent Total

Marginal adaptation
MC 3 0 8 1 12
Zr 1 0 5 4 10
LD 2 1 7 0 10
Total 6 1 20 5 32

Contour
MC 0 2 7 3 12
Zr 0 0 9 1 10
LD 0 3 7 0 10
Total 0 5 23 4 32

Shade
MC 0 2 6 4 12
Zr 0 6 3 1 10
LD 0 1 9 0 10
Total 0 9 18 5 32

Occlusion
MC 0 0 7 5 12
a
Zr 0 0 2 8 10
LD 0 3 7 0 10
Total 0 3 16 13 32

For USPHS Shade, P¼.06; for USPHS Contour, P¼.16; for USPHS Margins, P¼.07; for USPHS Occlusion, P¼.0005.
USPHS, United States Public Health Service; MC, metal ceramic; Zr, zirconia; LD, lithium disilicate.
a
Denotes statistically significant values assessed by Mantel Haenszel row mean score statistic.

Batson et al
774
structure and compound symmetry
in the generalized estimating equation
method. One-way ANOVA was used to
determine whether the average hori-
zontal marginal discrepancies differed
among the crown systems. For those
that were significant, pairwise compar-
isons were used between the crown
systems and scanners. The Bonferroni
method was used to obtain adjusted P
values (a¼.05).
RESULTS
Six crowns (3 MC, 2 LD, 1 Zr) were
rejected for unacceptable marginal ad-
aptation and were remade. Thus, the
remake rate because of clinically un-
acceptable marginal adaptation was
18.8%. These 6 crowns were among the
first 12 fabricated, defining a learning
curve related to the software designa-
tion of margin location in design. Of
these six, 2 MC crowns were remade
with conventional impression and lab-
oratory techniques, and were excluded
from the horizontal marginal discrep-
ancy 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. Descriptive statistics for gingival parameters and treated teeth (N¼32)
Gingival Parameter
Buccal surface GCF volume, mean (SD)
Lingual surface GCF volume, mean (SD)
Bleeding on probing, yes/no (% of yes)
MC, metal ceramic; SD, standard deviation; GCF, gingival crevicular fluid; Zr, zirconia; LD, lithium disilicate.
a
MC (n¼12 [missing¼0] at visit 0, n¼12 [missing¼0] at visit 2, n¼6 [missing¼6] at visit 3); Zr (n¼10 [missing¼0] at visit 0, n¼9 [missing¼1] at visit 2,
n¼7 [missing¼3] at visit 3); LD (n¼10 [missing¼0] at visit 0, n¼8 [missing¼2] at visit 2, n¼6 [missing¼4] at visit 3).
b
Visit 0.
c
Visit 2.
d
Visit 3.
The Journal of Prosthetic Dentistry
1-month recall visit, and 13 participants
did not return for the 6-month recall
visit. Twenty-nine crowns were evaluated
at the 1-month recall visit, and 19
crowns at the 6-month recall visit.
No statistically significant associa-
tion was found among crown types and
their marginal adaptation, shade, or
contour with the Mantel Haenszel row
mean score statistic. The majority
of restorations were scored in the
“acceptable” category with the USPHS
criteria. The distribution of crowns
graded within each USPHS criterion are
presented in Table II. Zr crowns were
statistically significantly different from
LD and MC crowns for occlusion
(P<.001). Eighty percent of Zr crowns
had an “excellent” rating and needed
no occlusal adjustment. Fifty-eight
percent of MC restorations and 100%
of LD restorations needed occlusal
adjustment before insertion. No statis-
tically significant differences were found
among the 3 crown systems for GCF
volumes or BOP. GCF volumes and
BOP were not significantly different
between the treated and the control
teeth or between visits. Descriptive sta-
tistics and P values for all explanatory
variables associated with the gingival
volumes and BOP are provided in
Crown
System Pretreatmentb
MC 46.25 23.95
Zr 47.80 22.79
LD 32.00 9.56
MC 33.25 12.17
Zr 44.10 22.49
LD 39.40 16.77
MC 8/4 (67)
Zr 6/4 (60)
LD 5/5 (50)
Volume 112 Issue 4
Tables III and IV. The P values for all
explanatory variables associated with
the gingival volumes and BOP are pro-
vided in Table IV.
The average horizontal marginal
discrepancy as determined by micro-CT
analysis was statistically significantly
different among the crown systems
(P¼.003). The number of crowns per
group and the type of horizontal
discrepancy as determined by micro-CT
analysis are displayed in Figure 1. A
study LD crown as seen by micro-CT
imaging is demonstrated in Figure 2.
Horizontal marginal discrepancy mea-
surements made with micro-CT imag-
ing are depicted in Figure 3. Pairwise
comparisons were used to determine
which systems differed. LD and Zr were
significantly different (P¼.027), with
LD crowns having larger values of hor-
izontal discrepancies. Descriptive sta-
tistics as well as pairwise comparisons
for horizontal discrepancy values are
given in Tables V and VI.
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
1-mo 6-mo
Postcementationc Postcementationd
43.75 14.06 32.67 14.51
39.00 12.12 39.29 14.40
44.13 24.51 43.33 19.10
43.17 17.48 37.50 20.05
37.00 17.61 42.57 23.73
56.88 23.74 39.83 15.72
5/7 (42) 3/3 (50)
5/4 (56) 2/5 (29)
2/6 (25) 2/4 (33)
Batson et al
October 2014 775
Table IV. P values from linear mixed and generalized estimating equation models and compare the manufactured quality
with 1 between-subject factor (crown system) and 2 within-subject factors (visit and of restorations with particular focus
tooth status) for gingival crevicular fluid volumes and bleeding on probing on marginal integrity and the responses
to this interface. During the 6-month
Explanatory Buccal Lingual Bleeding
period, no fractures or chipping of
Variable Surface Surface on Probing crowns was noted. Although other
studies14,15 indicate the chipping of Zr-
Crown system .38 .71 .92
coping–based crowns to be a limita-
Time of measure .49 .42 .25
tion, chipping complications were not
Treated vs control .47 .10 .17 revealed at the 6-month time point. In
this investigation, monolithic Zr and
monolithic LD crowns were used. Long-
10
term evaluations are needed to investi-
Overextended
Number of Crowns

8 gate their mechanical performance.

6 acceptance among all of the crowns,
4 izontal contours of fabricated restora-
2
0 crowns. Thus, the null hypothesis for
PFM
1 Number of crowns by group and type of horizontal
marginal discrepancy.
2 Sample micro–
computed tomographic
image of buccal crown
margin of study lithium
disilicate crown.
crowns required intraoral occlusal
adjustment, whereas 100% of LD
crowns required occlusal adjustments
compared with only 58% of MC resto-
rations. The Zr and MC restorations
were produced with the same intraoral
scanner, which underscores the poten-
tial accuracy of the intraoral scan, the
method of obtaining an intraocclusal
record, and the digital design and
fabrication of the Zr and MC
Batson et al
Underextended
LD ZR
restorations. Of note, LD crowns were
made without articulated casts to
permit laboratory adjustments. No sta-
tistical significance was found between
the MC and LD groups for occlusion.
The presence of a restoration near
or below the gingival margin may
induce localized inflammation and
lead to future periodontal complica-
tions.16,17 Although this study had a
small sample size of short duration, it
did not support those findings because
no statistically significant differences
were found among the crown systems
or between the treated and control
teeth for GCF volumes or BOP.
Although an overall slight increase in
GCF volume was noted for the lingual
surfaces of treated teeth, it was not
statistically significant. This could be
due to the small sample size. This
investigation may not contribute to
understanding the differences in tissue
responses to all ceramic versus MC
restorations. However, a recent study of
posterior 3-unit fixed dental prostheses
observed no difference in gingival pa-
rameters for Zr and MC prostheses.18
This initial investigation of short
duration was designed to investigate
Despite the similarity in clinical
measured differences in the overall hor-
tions were found between the 2 scanning
systems, specifically with LD and Zr
marginal discrepancy values was rejec-
ted. The use of a model that enables
contour refinement for MC and Zr
crowns is a possible explanation for this
difference. LD crowns were fabricated
purely by digital design and milling in the
clinical setting, and without a cast or
dental technician involved. Zr and
MC crowns were digitally designed
and milled in a laboratory, and finished
on a solid model to verify contours.
The milling technology itself may further
influence these restorations. In addition,
the type of preparation design deserves
mention because a deep chamfer margin
was chosen. Other published literature
has mentioned the use of a modified or
rounded shoulder as a better type of
margin design for ceramic restorations
that will be of a milled variety.10
This study evaluated the fit of
cemented restorations. Other recent
measurements have been reported
that used the indirect replica measure
of interposed PVS material before
cementation11 and may not be directly
compared with the present data.
When direct measurements of restor-
ative margins of ceramic systems have
been made, ranges of 7.5 to 161 mm
have been reported with both tradi-
tional and CAD/CAM fabrication
methods.3,19 When evaluated in
the laboratory, close marginal fit
776 Volume 112 Issue 4

A bleeding on probing measurements in-

B C
dicates greater inflammation for
restored teeth that have crowns with
larger marginal discrepancies. More
extensive clinical studies are needed to
assess the various parameters involved
with CAD/CAM fabricated restorations,
D specifically analyzing intraoral perfor-
mance as related to postcementation fit.

CONCLUSIONS

Within the limitations of this study,

the following conclusions can be drawn.
3 A, Delimitation of crown and tooth margins Posterior single-tooth restorations fabri-
to measure horizontal discrepancies. Example of cated from intraoral scans by using CAD/
(B) underextended margin, (C) overextended margin, CAM technology have acceptable results
(D) ideal margin. for shade, contour, marginal adaptation,
and occlusion. MC, LD, and monolithic
Zr had no differences in gingival response,
Table V. Descriptive statistics for horizontal marginal discrepancy
and Zr and LD crowns had differences in
Mean (SD) Horizontal horizontal discrepancy values.
Crown System Marginal Discrepancy (mm) Range (mm)
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Corresponding author:
Dr Emily R. Batson
9480 Briar Village Point Suite 300
Colorado Springs, CO 80920
E-mail: drbatson@pickledental.com
Acknowledgments
The authors thank Lee Culp, Jack Marrano, and
Eric Hill of Microdental DTI for their assistance in
crown fabrication, and Kevin Guley of Biomedical
Research Imaging Center, UNC at Chapel Hill for
assistance with micro-CT imaging.
Copyright ª 2014 by the Editorial Council for
The Journal of Prosthetic Dentistry.