RESEARCH AND EDUCATION

Evaluation of the marginal and internal gaps of partially crystallized

versus fully crystallized zirconia-reinforced lithium silicate CAD-CAM
crowns: An in vitro comparison of the silicone replica technique,
direct view, and 3-dimensional superimposition analysis
Alaa El-Ashkar, BDS, MS,a Maha Taymour, BDS, PhD,b and Adel El-Tannir, BDS, MSDc

Zirconia-reinforced lithium ABSTRACT

silicate ceramics (ZLS) are Statement of problem. The crystallization process of lithium disilicate crowns has been reported to
innovative glass-ceramics with cause dimensional change, but whether the fit of chairside computer-aided design and computer-
zirconia additions (z10% by aided manufactured (CAD-CAM) zirconia-reinforced lithium silicate crowns is affected is unclear.
weight). The inclusion of zir- Purpose. The purpose of this in vitro study was to evaluate with a 3-dimensional superimposition
conia in an ultrafine micro- analysis technique the marginal and internal adaptation of fully crystallized versus partially
structure has been reported to crystallized zirconia-reinforced lithium silicate ceramic CAD-CAM fabricated crowns. Additionally,
provide higher edge stability the silicone replica technique and direct viewing of marginal gap values were compared with
during the milling process the 3-dimensional superimposition analysis technique.
than lithium disilicate.1-4 Material and methods. The marginal and internal adaptation of a fully crystallized zirconia-reinforced
Zirconia-reinforced lithium lithium silicate (CELTRA DUO) were compared with those of a partially crystallized zirconia-reinforced
silicate ceramic computer- lithium silicate (VITA SUPRINITY) after crystallization. Sixteen crowns (n=8) were fabricated with a
chairside CAD-CAM system. The crowns and die and crown assembly were scanned with an optical
aided design and computer- scanner for the 3-dimensional superimposition analysis. Four hundred sixty-eight measurements
aided manufactured (CAD- were made for each crown, 78 in each 2-dimensional section. Marginal discrepancy was measured
CAM) blocks have been by using the direct viewing technique. The internal adaptation of the shoulder area, axial space, and
developed as 2 products: VITA occlusal space was measured by using the silicone replica technique. Both gap values were
SUPRINITY, which requires compared with the 3-dimensional superimposition analysis results by using the independent t test.
crystallization to reach its The 2-way ANOVA was used to detect the effect of each variable (group and site) (a=.05).
maximum mechanical and Results. The VITA SUPRINITY crowns showed statistically higher marginal discrepancy values than the
optical properties, and CEL- CELTRA DUO crowns in both 3-dimensional superimposition analysis and the direct viewing method,
TRA DUO, which can be pol- and the lingual aspect recorded the highest marginal discrepancy mean value when compared with
other aspects. The 3-dimensional superimposition analysis and the direct viewing method were
ished or glazed before
statistically similar (P=.076). The VITA SUPRINTY crowns showed higher internal gap mean values than
cementation without a crys- the CELTRA DUO crowns in both 3-dimensional superimposition analysis and silicone replica
tallization cycle.1-4 techniques. The occlusal space recorded the highest mean value in both groups. Assessment by 3-
The lithium disilicate crys- dimensional superimposition analysis and silicone replica techniques showed statistical difference in
tallization process results in a internal gap values (P=.04).
0.2% densification of the ma- Conclusions. CELTRA DUO showed better precision fit values than VITA SUPRINITY. Three-
terial at 840  C.5,6 The mar- dimensional superimposition analysis is a reliable method of evaluating marginal and internal
ginal fit and adaptation affect adaptation. (J Prosthet Dent 2021;-:---)

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
a
Researcher, Faculty of Dentistry, Cairo University, Cairo, Egypt.
b
Assistant Professor, Fixed Prosthodontics Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.
c
Professor, Fixed Prosthodontics Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.

THE JOURNAL OF PROSTHETIC DENTISTRY 1

2 Volume - Issue -

determining the most appropriate cement space.

Clinical Implications A 3-dimensional triple-scan methodology pilot experi-
Clinical success and longevity rely on the best ment was carried out for the internal and vertical mar-
ginal gap measurements by using 1 crown from each ZLS
possible adaptation of the dental prosthesis.
type. For the 3DSA pilot testing, the method was
Accurate CAD-CAM restorations can be fabricated
compared with the silicone replica technique (SRT) and
from fully crystallized CELTRA DUO zirconia-
with the direct viewing of margins (DV) under a stereo-
reinforced lithium silicate blocks.
microscope, showing similar values. An additional pilot
study was carried out to evaluate the effect of the crys-
tallization process on both adaptation values with VITA
the survival rate of crowns, with poor marginal adapta-
SUPRINITY crowns (Fig. 1).
tion in affecting the longevity of fixed prostheses.5 The
The tested groups were according to the type of
marginal gap of lithium disilicate ceramics has been re-
material: group V, VITA SUPRINITY; and group C,
ported to be affected by crystallization.5 Majeed and Al-
CELTRA DUO. Considering that 468 measurements
Adel7 evaluated the marginal and internal adaptations of
would be made on each crown, the total of 16 crowns
lithium disilicate and VITA SUPRINITY, zirconia, and
was based on a power test calculation.5 The sample size
polymer-infiltrated ceramic network crowns, with VITA
(n=8) was sufficient to detect large effect sizes for main
SUPRINITY and lithium disilicate having the highest
effects and pair-wise comparisons, with a power of 80%
total gap values. Zimmermann et al8 tested the effect of
and a 95% confidence level.
postmilling glazing on the internal adaptation of CEL-
A typodont mandibular first molar (Frasaco) was
TRA DUO crowns and concluded that it had no effect on
prepared according to a conventional ceramic tooth
the internal adaptation values. However, information
preparation13 with a 1.2-mm circumferential rounded
regarding the effect of the crystallization process on the
shoulder finish line, an internal angle of 122 degrees, a 2-
fit of ZLS restorations is scarce.9
mm occlusal reduction, and a mean of 7.9 degrees of
In 2010, a measuring method was introduced by
convergence of the axial walls. The total convergence
Holst et al,10 who applied a triple scan protocol to
angle and the finish line angle were measured with a
evaluate the precision of fit of CAD-CAM implant su-
software program (AutoCAD 2017 Software; Autodesk
perstructures. In 2011, Holst et al11 reapplied the
Inc). The prepared typodont tooth was replicated in an
3-dimensional methodology to evaluate crown fit and
autopolymerizing resin (DuraLay; Reliance Dental
marginal adaptation to provide 3-dimensional informa-
Manufacturing LLC) master die, invested (BellaVest SH;
tion for the virtual registration of a digitized crown in
BEGO), and cast (Wiron Light, NiCr ingots; BEGO & Co)
relation to the abutment. The silicone replica technique
to form a Ni-Cr metal die. The metal die was finished,
has been commonly used because of its ability to mea-
polished, and examined for imperfections by the same
sure the internal adaptation of a dental prosthesis
investigator (A.T.) using magnifying loops (Designs for
without damaging the specimen tested.7,12 However, the
Vision, Inc).13,14
accuracy of measurements with the silicone replica
To enhance the precision of the optical scan, the
technique is unclear, and studies comparing the accuracy
master Ni-Cr metal die was sprayed (CEREC Optispray;
of the silicone replica technique with 2-dimensional
Dentsply Sirona) and scanned with a noncontact
sections of 3-dimensional superimposition analysis
extraoral scanner (3Shape D500 3D Scanner; 3Shape A/
(3DSA) are scarce.
S). A biogeneric crown design was generated by using a
The purpose of this in vitro study was to evaluate the
software program (inLab SW15.0; Dentsply Sirona) with
marginal and internal adaptation of CELTRA DUO
the cement space set at 50 mm for the axial and occlusal
versus VITA SUPRINITY zirconia-reinforced lithium sil-
aspects based on the pilot data.14,15 The crowns were
icate ceramic CAD-CAM crowns after crystallization by
milled with a 5-axis milling machine (inLab MC X5 five-
using the direct viewing method for vertical margin
axis milling unit; Dentsply Sirona).
assessment, the silicone replica technique for internal fit
The postmilling crystallization protocol of the VITA
assessment, and the 3-dimensional superimposition
SUPRINITY crowns (VITA Zahnfabrik) followed the
analysis technique. The null hypothesis was that the in-
manufacturer recommendations. The milled fully crys-
ternal and marginal gaps would not differ significantly
tallized CELTRA DUO (Dentsply Sirona) crowns were
between the materials or among the measurement
polished but did not receive a postmilling crystallization
methods.
or glazing cycle. All crowns were sealed in opaque en-
velopes that were then randomly numbered (www.
MATERIAL AND METHODS
random.org).
An appropriate methodology was developed after pilot For assessment of the vertical marginal gaps with
testing including with the 3DSA technique and for direct viewing, each crown was secured on the master

THE JOURNAL OF PROSTHETIC DENTISTRY El-Ashkar et al

- 2021 3

Figure 1. Vertical marginal gap values of VITA SUPRINITY. A, Before crystallization. B, After crystallization. Original magnification ×45.

Figure 2. Vertical marginal gap values. A, VITA SUPRINITY. B, CELTRA DUO.

Ni-Cr metal die by using a custom holding device. a noncontact optical scanner (3Shape D500 3D Scan-
Measurements were made with a stereomicroscope ner; 3Shape, A/S), and saved as “The Reference STL”
(Eclipse E600; Nikon Instruments Inc) at ×45 magnifi- files. The intaglio surfaces of the crowns were scanned
cation.16 Three equidistant landmarks were measured and saved according to their envelope number.10,11,18,19
along the cervical circumference of each of the mesial, The master Ni-Cr metal die scan was used as the third
buccal, distal, and lingual surfaces (Fig. 2).16 scan. The alignment transformation of the standard
The silicone replica technique method was used to tessellation language (STL) files was performed with a
measure the internal adaptation.16,17 The intaglio replicas 3D inspection software program (Solidworks premium
were made of light-body silicone impression material 2017; Dassault Systèmes SE). The alignment trans-
(Elite HD+, light body, fast set; Zhermack GmbH) and formation of the STL files was performed on the x, y,
heavy-body silicone (Elite HD+, heavy body, fast set; and z axis planes to be compared and stitched together
Zhermack GmbH). The replicas were sectioned into 4 to achieve a uniform merge of the 3 scans. Manual
equal segments in the mesiodistal and buccolingual di- alignment-transformation of the scan data was per-
rections on a custom-made device (Fig. 3). Five points in formed by selecting point-to-point or by using a
3 regions were measured on each section: shoulder area, manipulator.17,18 The auto-alignment function pro-
axial space, and occlusal space, yielding 13 internal duced malposition scans. The resultant combined 3D
measurements for each crown (Fig. 4).9,17 image was sectioned in 2 directions, buccolingual and
For the 3DSA method, the 16 crowns were seated on mesiodistal, to verify the accuracy alignment trans-
the master Ni-Cr metal die, scanned consecutively with formation procedure (Fig. 5).11,17

El-Ashkar et al THE JOURNAL OF PROSTHETIC DENTISTRY

4 Volume - Issue -

Figure 3. Silicone replica sectioned into 4 segments on custom-made device. Original magnification ×45.

The vertical gap between the external region of the

master Ni-Cr metal die scan and the internal region of
the crown was extracted from the 3D image and cut in
the buccolingual and mesiodistal directions by means
of the multiple section function. The cut sections were
reproducible, standardized, and equidistant at 2 mm
apart (Fig. 6). The extracted gap layer was converted into
a solid body 3D layer, and the marginal and internal gaps
were measured by applying the 2D section (Figs. 6, 7). An
average of 78 points were measured in each section, 468
measurements of each specimen. The average of all
measured points was used in the statistical analysis.
Descriptive statistics were used for the results of each
group. Two-way ANOVA was used to detect the effect of
each variable (group and site) with the average mea-
surement values used. An independent t test determined
whether the vertical marginal gap differed between the 2 Figure 4. Internal gap values measured from silicone replica. A, VITA
methods (3DSA and direct viewing technique). The t test SUPRINITY. B, CELTRA DUO. Original magnification ×45.
also evaluated the internal gap difference between the 2
methods (3DSA and silicone replica methods) (a=.05). (98.9 ±18.4 mm) and the direct viewing technique (98.7
±13.1 mm) were statistically similar (P=.076).
In the internal gap 3DSA evaluations, VITA SUPRIN-
RESULTS
ITY recorded a higher mean ±standard deviation internal
With 3DSA, VITA SUPRINITY recorded a higher mar- gap value (120.2 ±23.0 mm) than CELTRA DUO (95.8 ±9.1
ginal gap mean ±standard deviation value (110.6 ±3.7 mm) (P=.009) (Table 2, Fig. 8) (a=.05). With the silicone
mm) than CELTRA DUO (83.7 ±1.0 mm) (Fig. 8) (P<.001). replica technique, VITA SUPRINITY recorded a statistically
Similarly, with the direct viewing method, VITA SU- similar internal gap mean ±standard deviation value
PRINITY recorded a higher marginal gap mean ±stan- (133.8 ±35.8 mm) to CELTRA DUO (119.4 ±19.3 mm)
dard deviation value (99.5 ±6.7 mm) than CELTRA DUO (P=.241) (Table 2, Fig. 4). For the mean internal gap values
(85.9 ±3.8 mm) (P<.001) (Table 1, Fig. 2). The marginal between the 3DSA and the silicone replica technique, the t
gap mean ±standard deviation values between 3DSA test was statistically different (P=.042). The occlusal space

THE JOURNAL OF PROSTHETIC DENTISTRY El-Ashkar et al

- 2021 5

Figure 5. A, Buccolingual section showing alignment-transformation process. B, Gap layer extracted and converted into solid layer.

Figure 6. Three-dimensional gap model sectioned in 3 equidistant buccolingual sections and 3 mesiodistal sections with multiple section function. S, Q,
R: buccolingual cut sections with standard 2-mm distance between each. J, L, N: mesiodistal cut sections. J, first cut at 2-mm distance from surface; L, 4-
mm cut; N, 6-mm cut.

recorded the highest gap mean value in both methods, et al,21 and Mously et al.22 The finish line design used in
124.5 ±34.6 mm with the 3DSA and 140.8 ±33.6 mm with the present study was a circumferential rounded shoulder
the silicone replica technique. with an internal angle of 122 degrees, consistent with the
findings of Al-Zubaidi and Al-Shamma23 and Podhorsky
et al,24 who reported that a 120-degree shoulder
DISCUSSION
improved seating with a reduced vertical marginal gap.
The popularity of CAD-CAM fabricated restorations has The 122-degree shoulder finish line also facilitated
increased recently, and contemporary CAD-CAM detection by the scanning devices better than the 90-
ceramic crowns have marginal and internal adaptation degree shoulder finish line.
values within a clinically acceptable range.5,12 Studies on Despite its established reliability, studies that
the influence of the cement space and finish line compared the accuracy of 3DSA to that of other evalu-
configuration have been inconsistent. Rustum et al20 ation methods are sparse.10,25,26 The present research
reported that increasing the virtual cement space value used the 2D section of the 3DSA, consistent with the
improved marginal fit. In the present study, the axial and triple scan protocol described by Holst et al10,11 and
occlusal cement spaces were set at 50 mm based on the applied by Zimmermann et al,8 Boitelle et al,18 and
pilot study and on the work of Kale et al,15 Soliman Anadioti et al27 to evaluate the 2D and 3D marginal fit of

El-Ashkar et al THE JOURNAL OF PROSTHETIC DENTISTRY

6 Volume - Issue -

Figure 7. Internal and marginal gap measurements of 2-dimensional section.

Figure 8. Three-dimensional superimposition analysis of internal and marginal gap values. A, VITA SUPRINITY. B, CELTRA DUO.

pressed and CAD-CAM-fabricated lithium disilicate were consistent with those found by Kim et al,5 Azarbal
crowns, validating the 3DSA protocol for evaluating both et al,28 Yildirim et al,29 and Ural et al.30 The lingual
the marginal and internal fit of ceramic crowns. Nawafleh surface recorded the highest vertical marginal gap mean
et al16 recommended the direct view method as the most value in all specimens. The total surface values were not
frequently used one, a noninvasive method with repro- consistent with those reported by Asavapanumas and
ducible results for measuring the vertical marginal gap. Leevailoj,31 probably because different preparation de-
Unlike the cross-sectioning method, the silicone replica signs and marginal gap measuring methods were used.
technique replicates the complete cement space without Differences may have been associated with the brittle-
destroying the specimen.16,25 In the present study, the ness of the precrystallized state of VITA SUPRINITY and
silicone replica technique was preferred over the cross- its weak crystal structure, which may fracture during the
sectioning technique, as similar accuracy has been milling process.29-32
reported.7,26 The difference between the CELTRA DUO and VITA
In the present study, CELTRA DUO showed better SUPRINITY adaptation values might be linked to the
marginal and internal adaptations values than VITA crystallization shrinkage in the partially crystallized ZLS,
SUPRINITY in all the tested specimens and methods. as only the VITA SUPRINITY crowns received the crys-
Therefore, the null hypothesis was rejected. The values tallization cycle. Densification shrinkage has been

THE JOURNAL OF PROSTHETIC DENTISTRY El-Ashkar et al

- 2021 7

Table 1. Descriptive statistics of 3-dimensional superimposition analysis Table 2. Descriptive statistics of 3-dimensional superimposition analysis
marginal gap results and direct viewing method marginal gap results and silicone replica technique internal gap results (mean ±standard
(mean ±standard deviation) deviation)
95% CI 95% CI
Mean ±SD Mean ±SD
Variable (mm) Min. Max. Low High P Variable (mm) Min. Max. Low High P
3-Dimensional VITA 110.6 ±3.7 105.4 116.4 109.0 112.2 <.001 3-Dimensional VITA 120.2 ±23.0 91.4 184.3 93.8 146.6 .009
superimposition SUPRINITY superimposition SUPRINITY
analysis CELTRA DUO 83.7 ±1.0 81.2 88.0 82.9 84.6 analysis CELTRA DUO 95.8 ±9.1 69.7 123.9 83.5 108.2
Direct viewing VITA 99.5 ±6.7 90.7 111.3 92.6 105.1 <.001 Silicone replica VITA 133.8 ±35.8 107.6 210.8 103.8 163.8 .241
method SUPRINITY technique SUPRINITY
CELTRA DUO 85.9 ±3.8 79.1 95.8 82.3 90.1 CELTRA DUO 119.4 ±19.3 82.8 151.2 103.2 135.5

CI, confidence interval; Max, maximum; Min, minimum; SD, standard deviation. CI, confidence interval; Max, maximum; Min, minimum; SD, standard deviation.

correlated with the higher marginal discrepancies of the difficult to achieve and was a limitation of the present
partially crystallized ZLS group compared with the fully study. Further investigations are required to understand
crystallized ZLS group. Ritzberger et al33 stated that zir- the influence of the preparation design, digital design
conia acts as a nucleating agent, controls the internal settings, software program version, cement space, and
nucleation, and influences the crystallization by milling parameter variations on the accuracy of CAD-
hampering crystal growth. With increasing ZrO2 content, CAM restorations.
the lithium silicate and meta-silicate crystals become
smaller, and the densification increases with a reduction in
CONCLUSIONS
particle size for close packed arrangement.7,34-36 There-
fore, the densification shrinkage of ZLS is controlled and Based on the findings of this in vitro study, the following
has minimal effect because of its microstructure.37 conclusions were drawn:
Consistent with Yildirim et al,29 the adaptation of VITA
1. CELTRA DUO had better precision fit than VITA
was better than that of lithium disilicate because of zir-
SUPRINITY, with significant differences in marginal
conia particles in the microstructure. Similarly, Kim et al5
and internal discrepancies. All values were within a
reported variation in the marginal and internal fit of
clinically acceptable range.
lithium disilicate ceramic crowns before and after the
2. After their crystallization cycle, the effect of the
crystallization process in all the measured areas. Gold
crystallization process was evident in the VITA
et al6 and Azarbal et al28 suggested that the densification
SUPRINITY crowns. The densification shrinkage
shrinkage of the glass matrix ceramic during the crystal-
during the crystallization process affected the mar-
lization process might cause an increase in the gap size.
ginal and internal adaptation of the VITA
The occlusal region recorded the highest internal gap
SUPRINITY crowns.
value when measured by both the silicone replica and
3. The 3-dimensional superimposition methodology is
3DSA methods. The increased gap could have been
a reliable and valid method for assessing the
related to the scanner accuracy, the STL format conver-
adaptation values of dental restorations.
sion, or the application of powder. These errors were
minimized by standardizing the die scan: A single die
scan was used in both the crown fabrication and in the REFERENCES
3DSA, and powder was used to minimize the scanning
1. Babu PJ, Alla RK, Alluri VR, Datla SR, Konakanchi A. Dental ceramics: part I-
errors and eliminate variables. The obtained values were an overview of composition, structure and properties. Am J Mater Eng
consistent with those reported by Park et al,12 Technol 2015;3:13-8. .
2. Shen J. Advanced ceramics for dentistry. 1st ed. Waltham, MA: Butterworth-
Boitelle et al,18 Yildirim et al,29 and Anadioti et al.38 Heinemann/Elsevier; 2014. p. 257-77.
The 3DSA method showed lower values than the sili- 3. Deubener J, Höland W. Nucleation and crystallization of glasses and glass-
ceramics. Front Mater 2017;4:14-7.
cone replica technique, possibly because the light-body 4. Gracis S, Thompson VP, Ferencz JL, Silva NR, Bonfante EA. A new classi-
impression material might elevate the crown slightly fication system for ceramic and ceramic-like restorative materials. Int J
Prosthodont 2015;28:227-35.
and increase the internal gap values. With the 3DSA and 5. Kim JH, Oh S, Uhm SH. Effect of the crystallization process on the marginal
the direct viewing methods, the cement space was not and internal gaps of lithium disilicate CAD-CAM crowns. Biomed Res Int
2016;2016:1-6.
occupied. Also, with the silicone replica technique, 6. Gold SA, Ferracane JL, da Costa J. Effect of crystallization firing on marginal
selecting the same exact point in the 3D section and the gap of CAD-CAM fabricated lithium disilicate crowns. J Prosthodont 2018;27:
63-6.
equivalent point in the replica can be problematic.16 7. Majeed MA, Al-Adel SK. Evaluation of the marginal and internal fitness of
Thus, the comparison would have been more reliable full contour CAD-CAM crowns made from zirconia, lithium disilicate,
zirconia-reinforced lithium silicate and hybrid dental ceramic by silicone
if the measurements had been made at the same exact replica technique (a comparative in vitro study). J Genet Environ Resour
sites for each method. However, this was extremely Conserv 2016;4:10-20.

El-Ashkar et al THE JOURNAL OF PROSTHETIC DENTISTRY

8 Volume - Issue -

8. Zimmermann M, Valcanaia A, Neiva G, Mehl A, Fasbinder D. Digital eval- 25. Kuhn K, Ostertag S, Ostertag M, Walter MH, Luthardt RG, Rudolph H.
uation of the fit of zirconia-reinforced lithium silicate crowns with a new Comparison of an analog and digital quantitative and qualitative analysis for
three-dimensional approach. Quintessence Int 2018;49:9-15. the fit of dental copings. Comput Biol Med 2015;57:32-41.
9. Elsaka SE, Elnaghy AM. Mechanical properties of zirconia reinforced lithium 26. Schönberger J, Erdelt KJ, Bäumer D, Beuer F. Evaluation of two protocols to
silicate glass-ceramic. Dent Mater 2016;32:908-14. measure the accuracy of fixed dental prostheses: an in vitro study.
10. Holst S, Tawdrous RE, Karl M. Description of a novel technique for three- J Prosthodont 2019;28:599-603.
dimensional fit assessment of dental restorationsLim C.T., Goh J.C.H., edi- 27. Anadioti E, Aquilino S, Gratton D, Holloway J, Denry I, Thomas G, et al. 3D
tors. 6th World Congress of Biomechanics (WCB 2010). August 1-6, 2010 and 2D marginal fit of pressed and CAD/CAM lithium disilicate crowns made
Singapore. IFMBE proceedings. vol 31. Berlin, Heidelberg: Springer; 2010. p. from digital and conventional impressions. J Prosthodont 2014;23:610-7.
1479-82. 28. Azarbal A, Azarbal M, Engelmeier RL, Kunkel TC. Marginal fit comparison of
11. Holst S, Karl M, Wichmann M, Matta RET. A new triple-scan protocol for 3D CAD-CAM crowns milled from two different materials. J Prosthodont
fit assessment of dental restorations. Quintessence Int 2011;42:651-7. 2018;27:421-8.
12. Park JY, Bae SY, Lee JJ, Kim JH, Kim HY, Kim WC. Evaluation of the marginal 29. Yildirim G, Uzun IH, Keles A. Evaluation of marginal and internal adaptation
and internal gaps of three different dental prostheses: comparison of the of hybrid and nanoceramic systems with microcomputed tomography: an
silicone replica technique and three-dimensional superimposition analysis. in vitro study. J Prosthet Dent 2017;118:200-7.
J Adv Prosthodont 2017;9:159-69. 30. Ural Ç, Burgaz Y, Saraç D. In vitro evaluation of marginal adaptation in five
13. Hwang YC, Park YS, Kim HK, Hong YS, Ahn JS, Ryu JJ. The evaluation ceramic restoration fabricating techniques. Quintessence Int 2010;41:585-90.
of working casts prepared from digital impressions. Oper Dent 2013;38: 31. Asavapanumas C, Leevailoj C. The influence of finish line curvature on the
655-62. marginal gap width of ceramic copings. J Prosthet Dent 2013;109:227-33.
14. Kim JH, Cho BH, Lee JH, Kwon SJ, Yi YA, Shin Y, et al. Influence of prep- 32. Traini T, Sinjari B, Pascetta R, Serafini N, Perfetti G, Trisi P, et al. The
aration design on fit and ceramic thickness of CEREC 3 partial ceramic zirconia-reinforced lithium silicate ceramic: lights and shadows of a new
crowns after cementation. Acta Odontol Scand 2015;73:107-13. . material. Dent Mater J 2016;35:748-55.
15. Kale E, Seker E, Yilmaz B, Özcelik TB. Effect of cement space on the marginal 33. Ritzberger C, Schweiger M, Höland W. Principles of crystal phase formation
fit of CAD-CAM-fabricated monolithic zirconia crowns. J Prosthet Dent in Ivoclar Vivadent glass-ceramics for dental restorations. J Non Cryst Solids
2016;116:890-5. 2016;432:137-42.
16. Nawafleh NA, Mack F, Evans J, Mackay J, Hatamleh MM. Accuracy and 34. Kaur G. Clinical applications of biomaterials: state-of-the-art progress,
reliability of methods to measure marginal adaptation of crowns and FDPs: a trends, and novel approaches. Cham: Springer; 2017. p. 313-37.
literature review. J Prosthodont 2013;22:419-28. 35. Lien W, Roberts HW, Platt JA, Vandewalle KS, Hill TJ, Chu TMG. Micro-
17. Güngör MB, Do g an A, Bal BT, Nemli SK. Evaluation of marginal and internal structural evolution and physical behavior of a lithium disilicate glass-
adaptations of posterior all-ceramic crowns fabricated with chair-side CAD- ceramic. Dent Mater J 2015;31:928-40.
CAM system: an in vitro study. Acta Odontol Turc 2018;35:1-8. 36. Handal GP, Pathare P, Sonawane Y, Marathe A, Shinde G. Evaluation of
18. Boitelle P, Tapie L, Mawussi B, Fromentin O. 3D fitting accuracy evaluation of effects of porcelain firing on the marginal fit changes of porcelain-fused-to-
CAD-CAM copings-comparison with spacer design settings. Int J Comput metal crown fabricated utilizing two different margin designs and two
Dent 2016;19:27-43. commercially available base metal alloys. J Res Dent 2017;4:67-72.
19. Mostafa NZ, Ruse ND, Ford NL, Carvalho RM, Wyatt CC. Marginal fit 37. Lawson NC, Bansal R, Burgess JO. Wear, strength, modulus and hardness of
of lithium disilicate crowns fabricated using conventional and digital CAD-CAM restorative materials. Dent Mater 2016;32:275-83. .
methodology: a three-dimensional analysis. J Prosthodont 2018;27: 38. Anadioti E, Lee C, Schweitzer A. Fit of CAD-CAM tooth-supported single
145-52. crowns and fixed dental prostheses. Curr Oral Health Rep 2017;4:1-9.
20. Rustum M, Gonzalez MAG, Kasim A, Hayaty N, Abu Kassim NL,
Farook MS. Effect of operators’ experience and cement space on the marginal
fit of an in-office digitally produced monolithic ceramic crown system. Corresponding author:
Quintessence Int 2016;47:181-91. Dr Alaa El-Ashkar
21. Soliman MSM, Mohsen CA, El-Mahallawi O, Abu-Eittah MRH. Effect of Department of Fixed Prosthodontics
different cement spaces on the vertical marginal gap of full anatomical zir- Cairo University
conia bridges. J Am Sci 2015;11:145-52. 1 El-Saraya St, Cairo
22. Mously HA, Finkelman M, Zandparsa R, Hirayama H. Marginal and EGYPT.
internal adaptation of ceramic crown restorations fabricated with CAD- Email: alaas.elashkar@dentistry.cu.edu.eg
CAM technology and the heat-press technique. J Prosthet Dent 2014;112:
249-56. Acknowledgments
23. Al-Zubaidi ZAK, Al-Shamma AMW. The effect of different finishing lines on The authors thank Dr Omnia Nabil for her contribution in the 3D superimposition
the marginal fitness of full contour zirconia and glass ceramic CAD/CAM analysis method and for her assistance in this article.
crowns (an in-vitro study). J Dent Mater Tech 2015;4:127-36.
24. Podhorsky A, Rehmann P, Wöstmann B. Tooth preparation for full-coverage Copyright © 2021 by the Editorial Council for The Journal of Prosthetic Dentistry.
restorations-a literature review. Clin Oral Investig 2015;19:959-68. https://doi.org/10.1016/j.prosdent.2021.07.024

THE JOURNAL OF PROSTHETIC DENTISTRY El-Ashkar et al