An in vitro comparison of the marginal and internal adaptation of ultrathin occlusal veneers made of 3D-printed zirconia, milled zirconia, and heat-pressed lithium disilicate

Abstract

Statement of problem: Whether additively produced zirconia could overcome problems with conventional computer-aided design and computer-aided manufacture (CAD-CAM) such as milling inaccuracies and provide accurate occlusal veneers is unclear.

Purpose: The purpose of this in vitro study was to compare the marginal and internal fit of 3D-printed zirconia occlusal veneers with CAD-CAM-fabricated zirconia or heat-pressed lithium disilicate ceramic (LS2) restorations on molars.

Material and methods: The occlusal enamel in 60 extracted human molars was removed, with the preparation extending into dentin. Occlusal veneers at a thickness of 0.5 mm were designed and manufactured according to their group allocation: 3DP, 3D-printed zirconia; CAM, milled zirconia; and HPR, heat-pressed LS2. The prepared teeth and restorations were scanned and superimposed, and the marginal and internal adaptation were measured 2- and 3-dimensionally; the production accuracy (trueness) was also measured. The comparisons of the group medians were performed with nonparametric methods and a pairwise group comparison (α=.05).

Results: Three-dimensionally printed zirconia revealed median outcomes of 95 μm (margin), 252 μm (cusp), 305 μm (fossa), and 184 μm (3D internal adaptation). CAM showed median values of 65 μm (margin), 128 μm (cusp), 203 μm (fossa), and 120 μm (3D internal adaptation). The respective values for the group HPR were 118 μm (margin), 251 μm (cusp), 409 μm (fossa), and 180 μm (3D internal adaptation). Significant differences (P<.001) between CAM and 3DP (cusp, fossa, 3D internal adaptation) and between CAM and HPR (all regions) were found, with the former group showing higher accuracies. The trueness showed median discrepancies of 26 μm (3DP), 13 μm (CAM), and 29 μm (HPR) with significant differences (P<.001) for the comparisons 3DP-CAM and CAM-HPR.

Conclusions: Three-dimensionally printed zirconia occlusal veneers produced by means of lithography-based ceramic manufacturing exhibit a marginal adaptation (95 μm) and a production accuracy (26 μm) similar to those of conventional methods.