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Clin Implant Dent Relat Res. 2013 Aug 22. doi: 10.1111/cid.12133. [Epub ahead of print]
1. Microstructure of Titanium-Cement-Lithium Disilicate Interface in CAD-
CAM Dental Implant Crowns: A Three-Dimensional Profilometric Analysis.

Cresti S, Itri A, Rebaudi A, Diaspro A, Salerno M.
University of Genova, Genova, Italy.
Abstract
BACKGROUND: Peri-implantitis is an infection of the implant surface caused by adhesion of
bacteria that generate bone resorption and sometimes even consequent implant loss. Both
screw-retained and cemented fixed implants are affected.
PURPOSE: The purpose of this study is to investigate the morphological defects at the
cemented interface between titanium abutment and ceramic crown, comparing different
adhesive cements used to fill the marginal gap.
MATERIALS AND METHODS: Twelve computer-aided design-computer-aided manufacturing
dental crowns were cemented to titanium abutments using three different resin composite
cements. Sealed margins were polished using grommets with descending diamond particle
size. Three groups of four crowns each were made according to the cement used, namely
RelyX Unicem (3M ESPE), Panavia F 2.0 (Kuraray), and NX3 (Nexus Kerr). Samples were
analyzed using optical inspection, three-dimensional profilometry, and image analysis,
including analysis of variance.
RESULTS: Although RelyX showed significantly lower root mean square surface roughness
(4.41.5m) than that of NX3 (7.02.9m), it showed no significant difference with Panavia
(3.71.5m). The marginal gap was significantly wider in Panavia (149108m) as
compared with NX3 (7145m) and Relyx (6434m). For all groups, homogeneous
heights of both metal-cement and ceramic-cement gaps were observed. Moreover, all samples
showed homogeneity of the margins and absence of instrumental bias, thus validating both
procedure and materials.
CONCLUSIONS: When using the chosen polishing method, RelyX Unicem showed both low
roughness and marginal width, and thus the smoothest and more continuous abutment-crown
interlayer, promising a low probability of occurrence of peri-implantitis.
2013 Wiley Periodicals, Inc.
http://www.ncbi.nlm.nih.gov/pubmed
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KEYWORDS: CAD-CAM, CEREC, dental implants, marginal gap, stylus profilometer, surface roughness
PMID: 23968260 [PubMed - as supplied by publisher]
J Oral Implantol. 2013 Aug;39(4):417-24. doi: 10.1563/AAID-JOI-D-11-00103.
2. Marginal fit of implant-supported all-ceramic zirconia frameworks.

Zaghloul HH, Younis JF.
Conservative Dentistry Department, Faculty of Oral and Dental Medicine, Misr International University, Cairo, Egypt.
hh_zaghloul@hotmail.com
Abstract
This study evaluated the effect of fabrication techniques and cyclic loading on the vertical
marginal fit of implant-supported fixed partial denture (FPD) frameworks. Thirty implantsupported 3-unit FPD frameworks were fabricated on a model system, divided into 3 equal
groups (n = 10). The first group (control) was constructed from base metal alloy; the other 2
test groups were constructed from all-ceramic zirconia using a computer-aided
design/computer-aided manufacturing (CAD/CAM) Cerec 3 system and a copy milling
(Zirkonzahn) system. A cyclic load of 200 N was applied to each framework for up to 50,000
cycles. Linear measurements were made in micrometers of the vertical gap between the
framework and the implant-supported abutment at 16 predetermined points before and after
cyclic loading. The frameworks were viewed using scanning electron microscopy to inspect
any fractographic features. One-way analysis of variance was performed to compare the
marginal discrepancy values of the control and the 2 test groups and for each group; a t test
was applied to determine whether significant changes in the fit were observed after cyclic
loading ( = 0.05). The CAD/CAM group showed significantly higher marginal gap mean
values (80.58 m) than the Zirkonzahn and control groups (50.33 m and 42.27 m,
respectively) with no significant difference. After cyclic loading, the CAD/CAM group recorded
the highest marginal gap mean value (91.50 4.260 m) followed by control group (72.00
2.795 m); the Zirkonzahn group recorded the lowest marginal gap (65.37 6.138 m). Cyclic
loading significantly increased the marginal gap mean values in the control group only. A
marginal chip was observed in one of the CAD/CAM ceramic frameworks. Within the
limitations of this study, the fabrication technique influenced the marginal fit of the implantsupported 3-unit FPD frameworks. Cyclic loading failed to change the fit of all-ceramic zirconia
frameworks, whereas significant changes were found in the metal frameworks.
PMID: 23964776 [PubMed - in process]
Int J Comput Dent. 2013;16(2):173-81.
3. New CAD/CAM materials and blocks for chairside procedures.

[Article in English, German]
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Zimmermann M, Mehl A, Reich S.

Department of Restorative Dentistry and Periodontology, Ludwig Maximilians University, Munich, Germany.
mzimmer@dent.med.uni-muenchen.de
PMID: 23930578 [PubMed - indexed for MEDLINE]
MeSH Terms, Substances

Int J Comput Dent. 2013;16(2):109-18.
4. CAD/CAM single retainer zirconia-ceramic resin-bonded fixed dental
prostheses: clinical outcome after 5 years.

Sasse M, Kern M.
Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts

University at Kiel, Germany. msasse@proth.uni-kiel.de
Abstract
PURPOSE: This study evaluated the clinical outcome of CAD/CAM zirconia-ceramic resinbonded fixed dental prostheses (RBFDPs) with a cantilevered single-retainer design.
MATERIALS AND METHODS: Thirty anterior zirconia-ceramic RBFDPs fabricated with the
Cerec CAD/CAM system were inserted using either a phosphate monomer containing resin
(Panavia 21 TC; N = 16) or an adhesive bonding system with a phosphoric acid acrylate
primer (Multilink-Automix with Metal/Zirconia primer; N = 14).
RESULTS: During a mean observation time of 64.2 months, one debonding occurred in each
group. Both RBFDPs could be rebonded successfully resulting in a five-year survival rate of
100%.
CONCLUSION: Independent of the bonding system, cantilevered zirconia-ceramic RBFDPs
showed promising results during the first five years. (ClinicalTrials.gov Identifier:
NCT01411592).
CLINICAL SIGNIFICANCE: Single-retainer zirconia ceramic RBFDPs present an alternative
treatment option offering good esthetics, a minimally invasive preparation, a high
biocompatibility and can even be used to treat juvenile patients who do not yet come into
consideration for implant placement. No significant influence of the bonding system used has
been detected so far.
Publication Types, MeSH Terms, Substances, Secondary Source ID

J Am Dent Assoc. 2013 Aug;144(8):914-20.
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5. Assessing the feasibility and accuracy of digitizing edentulous jaws.

Patzelt SB, Vonau S, Stampf S, Att W.
Dr. Patzelt is a visiting scholar, Department of Periodontics, School of Dentistry, University of Maryland, Baltimore,
and an assistant professor and a scientific associate, Department of Prosthodontics, School of Dentistry, University
Hospital Freiburg, Freiburg, Germany. Address reprint requests to Dr. Patzelt, Department of Periodontics, School of
Dentistry, University of Maryland, 650 W. Baltimore St., Baltimore, Md. 21201, spatzelt@umaryland.edu.
Abstract
BACKGROUND: Despite the accuracy of intraoral scanners (IOSs) in producing single-unit
scans and the possibility of generating complete dentures digitally, little is known about their
feasibility and accuracy in digitizing edentulous jaws. The purpose of this in vitro investigation
was to evaluate the feasibility and accuracy of digitizing edentulous jaw models with IOSs.
METHODS: The authors used an industrial laser scanner (reference scanner) and four IOSs to
digitize two representative edentulous jaw models. They loaded the data sets obtained into
three-dimensional evaluation software, superimposed the data sets and compared them for
accuracy. The authors used a one-way analysis of variance to compute differences within
groups (precision), as well as to compare values with those of the reference scanner
(trueness) (statistical significance, P < .05).
RESULTS: Mean trueness values ranged from 44.1 to 591.8 micrometers. Data analysis
yielded statistically significant differences in trueness between all scanners (P < .05). Mean
precision values ranged from 21.6 to 698.0 m. The study results showed statistically
significant differences in precision between all scanners (P < .05), except for the CEREC AC
Bluecam (Sirona, Bensheim, Germany) and the Zfx IntraScan (manufactured by MHT Italy,
Negrar, Italy/ MHT Optic Research, Niederhasli, Switzerland; distributed by Zfx, Dachau,
Germany) (P > .05).
CONCLUSIONS: Digitizing edentulous jaw models with the use of IOSs appears to be
feasible, although the accuracy of the scanners differs significantly. The results of this study
showed that only one scanner was sufficiently accurate to warrant further intraoral
investigations. Further enhancements are necessary to recommend these IOSs for this
particular indication. Practical Implications. On the basis of the results of this study, the authors
cannot recommend these four IOSs for digitization of edentulous jaws in vivo.
KEYWORDS: Intraoral scanner, accuracy, digital impression, edentulous jaws, precision, trueness
Clin Oral Investig. 2013 Aug 1. [Epub ahead of print]
6. In vitro fracture load of monolithic lithium disilicate ceramic molar crowns
with different wall thicknesses.
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Seydler B, Rues S, Mller D, Schmitter M.

Department of Prosthodontics, Section for Biomaterial Research, University Hospital Heidelberg, Im Neuenheimer
Feld 400, 69120, Heidelberg, Germany.
Abstract
OBJECTIVES: The objective of this in vitro study was to assess the effect of wall thickness on
the fracture loads of monolithic lithium disilicate molar crowns.
MATERIAL AND METHODS: Forty-eight extracted molars were prepared by use of a
standardized preparation design. Lithium disilicate crowns (e.max CAD, Ivoclar/Vivadent,
Schaan, Liechtenstein) of different wall thicknesses (d=0.5, 1.0, and 1.5 mm; n=16 for each
series) were then constructed and milled (Cerec MC-XL, Sirona, Bensheim, Germany). After
placement of the teeth in acrylic blocks (Technovit, Heraeus Kulzer, Hanau, Germany), the
crowns were adhesively luted (Multilink, Ivoclar Vivadent). In each series, eight crowns were
loaded without artificial aging whereas another eight crowns underwent thermocycling
(10,000 cycles, THE-1100, SD Mechatronik) and chewing simulation (1.2 million cycles,
Willytec CS3, SD Mechatronik, F max=108 N). All specimens were loaded until fracture on one
cusp with a tilt of 30 to the tooth axis in a universal testing machine (Z005, Zwick/Roell).
Statistical assessment was performed by use of SPSS 19.0.
RESULTS: Crowns with d=1.0 and 1.5 mm wall thickness did not crack during artificial aging
whereas two of the crowns with d=0.5 mm wall thickness did. The loads to failure (F u) of the
crowns without aging (with aging) were 470.280.3 N (369.2117.8 N) for d=0.5 mm, 801.4
123.1 N (889.1154.6 N) for d=1.0 mm, and 1107.6131.3 N (980.8115.3 N) for d=
1.5 mm. For aged crowns with d=0.5 mm wall thickness, load to failure was significantly lower
than for the others. However, differences between crowns with d=1.0 mm and d=1.5 mm wall
thickness were not significant.
CONCLUSIONS: Fracture loads for posterior lithium disilicate crowns with 0.5 mm wall
thickness were too low (F u<500 N) to guarantee a low complication rate in vivo, whereas all
crowns with 1.0 and 1.5 mm wall thicknesses showed appropriate fracture resistances F u>
600 N.
CLINICAL RELEVANCE: The wall thickness of posterior lithium disilicate crowns might be
reduced to 1 mm, thus reducing the invasiveness of the preparation, which is essential for
young patients.
J Dent Res Dent Clin Dent Prospects. 2013;7(2):112-8. doi: 10.5681/joddd.2013.020. Epub 2013 May 30.
7. Simultaneous Replacement of Maxillary Central Incisors with CEREC
Biogeneric Reference Technique: A Case Report.

Akgungor G, Sen D, Bal E, Ozcan M.
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Professor, University of Istanbul, Faculty of Dentistry, Department of Prosthodontics, Istanbul, Turkey.
Abstract
Biogeneric Reference Technique (BRT) of the CEREC 3D v.3.8 software is an effective
technique for single anterior ceramic crowns because it provides computer-controlled match of
the tooth form to the contralateral tooth. BRT also enables the fabrication of two or more
anterior all-ceramic crowns simultaneously. This clinical report demonstrates the clinical
application of BRT for designing and milling two central incisors in one appointment using a
single optical impression. After completing the virtual design of the first central incisor, it was
copied and a mirror image was created. The second central incisor was designed using this
replicated image and therefore a computer-controlled symmetry was obtained. The crowns
were milled from monolithic feldspathic ceramic blocks and adhesively luted with dual-cured
resin cement following dentin conditioning. At the two-year follow-up appointment, the
restorations were intact, no adverse effects were noted, and the resultant appearance was
highly satisfactory for the patient. A step-by-step protocol is described from design to
cementation of these restorations.
KEYWORDS: CAD-CAM, CEREC, crowns, dental porcelain, resin cements
PMID: 23875091 [PubMed] PMCID: PMC3713860
Free PMC Article
Quintessence Int. 2013 Jun 6. doi: 10.3290/j.qi.a29750. [Epub ahead of print]
8. Enamel wear opposing different surface conditions of different CAD/CAM
ceramics.
Passos SP, de Freitas AP, Iorgovan G, Rizkalla AS, Santos MJ, Santos Jnior GC.
Abstract
Objective: The aim of this study was to evaluate bovine enamel wear opposed to four different
ceramic substrates (CEREC) in the glazed and polished conditions. Method and Materials:
Sixty-three ceramic (IPS Empress CAD, Paradigm C, Vitablocs Mark II) and fourteen
composite resin (MZ100) styli were prepared. Ceramics were subdivided into three surface
conditions (n = 7), unpolished, polished, and glazed, and the composite resin (n = 7) into
unpolished and polished. All styli were used as wear antagonists opposing bovine enamel
blocks (8 mm 9 mm) in an oral wear simulator. Wear tests were conducted at 30 N abrasion
and 70 N attrition forces applied at 1.7 Hz for 5,000 simulated mastication cycles. Abrasion
and attrition wear were evaluated using an automatic profilometer. Statistical analyses were
conducted using Tukey's B rank order test, P = .05. Results: For bovine enamel opposing
glazed Vitablocs, abrasion and attrition wear showed a volume loss significantly higher than
bovine enamel opposing polished Vitablocs (P < .05). For attrition wear, bovine enamel
opposing glazed Vitablocs and untreated Paradigm C showed a volume loss higher than
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bovine enamel opposing the other ceramic conditions. Conclusion: Abrasion and attrition wear
of bovine enamel opposing antagonist ceramic was affected according to the ceramic surface
condition and the ceramic material. Antagonistic wear against the studied ceramic materials
and conditions exhibited wear rates within the range of normal enamel. In addition, the glaze
layer presented as a protection, exhibiting fewer cracks and less loss of material on the
ceramic surface.
Tex Dent J. 2013 Mar;130(3):238-44.
9. Evolution of chairside CAD/CAM dentistry.

Harsono M, Simon JF, Stein JM, Kugel G.
Department of Prosthodontics and Operative Dentistry, Tufts University School of Dental Medicine, Boston,
Massachusetts, USA.
Publication Types, MeSH Terms, Substances

J Oral Rehabil. 2013 Jul;40(7):519-25. doi: 10.1111/joor.12061. Epub 2013 May 11.
10. In vitro chipping behaviour of all-ceramic crowns with a zirconia
framework and feldspathic veneering: comparison of CAD/CAM-produced

veneer with manually layered veneer.
Schmitter M, Mueller D, Rues S.
Section for Biomaterial Research, Department of Prosthodontics, University of Heidelberg, Heidelberg, Germany.
Abstract
The purpose of this in vitro study was to assess the breaking load of zirconia-based crowns
veneered with either CAD/CAM-produced or manually layered feldspathic ceramic. Thirty-two
identical zirconia frameworks (Sirona inCoris ZI, mono L F1), 06 mm thick with an
anatomically shaped occlusal area, were constructed (Sirona inLab 3.80). Sixteen of the
crowns were then veneered by the use of CAD/CAM-fabricated feldspathic ceramic (CEREC
Bloc, Sirona) and 16 by the use of hand-layered ceramic. The CAD/CAM-manufactured veneer
was attached to the frameworks by the use of Panavia 2.0 (Kuraray). Half of the specimens
were loaded until failure without artificial ageing; the other half of the specimens underwent
thermal cycling and cyclic loading (12 million chewing cycles, force magnitude F(max) = 108
N) before the assessment of the ultimate load. To investigate the new technique further, finite
element (FE) computations were conducted on the basis of the original geometry. Statistical
assessment was made by the use of non-parametric tests. Initial breaking load was
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significantly higher in the hand-layered group than in the CAD/CAM group (mean: 116586 N
versus 39545 N). During chewing simulation, however, 875% (7/8) of the crowns in the handlayered group failed, whereas no crown in the CAD/CAM group failed. The CAD/CAMproduced veneer was significantly less sensitive to ageing than the hand-layered veneer.
2013 John Wiley & Sons Ltd.
Int J Comput Dent. 2013;16(1):59-67.
11. Cerec omnicam and the virtual articulator--a case report.

Fritzsche G.
info@drfritzsche.com
Abstract
This case report demonstrates how two opposing teeth were restored with full crowns using
Cerec software version 4.2 (pre-release version). In addition, an anterior tooth was provided
with a veneer. The situation was scanned with the Cerec Omnicam. The new virtual articulator
was used for the design to obtain correct dynamic contacts. The Cerec Omnicam can scan the
entire situation prior to preparation without the help of an assistant, as no surface pretreatment
is necessary. The locations of the occlusal contacts can be marked with articulating paper and
are indicated on the virtual models. Selective deletion of individual areas allows the prepared
teeth to be rescanned, considerably speeding up the workflow. A video demonstration is
available of the acquisition and design procedure.

Int J Comput Dent. 2013;16(1):11-21.
12. Influence of scanning strategies on the accuracy of digital intraoral
scanning systems.

Ender A, Mehl A.
Division for Computerized Restorative Dentistry, Center of Dental Medicine, University of Zurich, Switzerland.
andreas.ender@zzm.uzh.ch
Abstract
The digital intraoral impression is a central part in today's CAD/CAM dentistry. With its
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possibilities, new treatment options for the patient is provided and the prosthetic workflow is
accelerated. Nowadays, the major issue with intraoral scanning systems is to gain more
accuracy especially for larger scan areas and to simplify clinical handling for the dentist. The
aim of this study was to investigate different scanning strategies regardingtheir accuracy with
full arch scans in an in-vitro study design. A reference master model was used for the digital
impressions with the Lava COS, the Cerec Bluecam and a powderfree intraoral scanning
system, Cadent iTero. The trueness and precision of each scanning protocol was measured.
Lava COS provides the a trueness of 45.8 microm with the scanning protocol recommended
from the manufacturer. A different scanning protocol shows significantly lower accuracy
(trueness +/- 90.2 microm). Cerec Bluecam also benefits from an optimal scanning protocol
with a trueness of +/- 23.3 microm compared to +/- 52.5 microm with a standard protocol. The
powderfree impression system Cadent iTero shows also a high accurate full-arch scan with a
trueness of +/- 35.0 microm and a precision of +/- 30.9 microm. With the current intraoral
scanning systems, full arch dental impressions are possible with a high accuracy, if adequate
scan strategies are used. The powderfree scanning system provides the same level of
accuracy compared to scanning systems with surface pretreatment.
Publication Types, MeSH Terms

Clin Oral Investig. 2013 May 1. [Epub ahead of print]
13. Marginal adaptation of ceramic and composite inlays in minimally
invasive mod cavities.
Zaruba M, Kasper R, Kazama R, Wegehaupt FJ, Ender A, Attin T, Mehl A.

Clinic for Preventive Dentistry, Periodontology and Cariology, University of Zurich, Plattenstrasse 11, CH-8032,
Zurich, Switzerland, markus.zaruba@zzm.uzh.ch.
Abstract
OBJECTIVES: This study aims to evaluate the effect of a minimally invasive mesial-occlusaldistal (mod) preparation on the marginal adaptation of ceramic and composite inlays with the
aim of saving sound dental substance.
MATERIALS AND METHODS: Class II mod cavities were prepared in 50 extracted human
molars and randomly allocated to five groups (n=10). In all groups, the mesial-proximal box
margins were located in the dentin, 1 mm below the cementoenamel junction (CEJ), while the
distal box margins were 1 mm above the CEJ. In groups A and B, conventional standard
preparations with a divergent angle of =6 were prepared. In groups C, D, and E, minimally
invasive standard preparations with a convergent angle of =10 were prepared. In groups A
and D, composite inlays and, in groups B and C, ceramic inlays were fabricated (chairside
economical restoration of esthetic ceramics (CEREC)) and adhesively inserted. In group E, a
direct composite filling using the incremental technique was placed. Replicas were taken
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before and after thermomechanical loading (1,200,000 cycles, 50/5 C, max. load 49 N).
Marginal integrity (tooth-luting composite, luting composite-inlay) was evaluated by scanning
electron microscopy (200). The percentage of continuous margins in the different locations
was compared between and within groups before and after cycling, using ANOVA and Scheff
post hoc test.
RESULTS: After the thermomechanical loading, no significant differences were observed
between the different groups with respect to the interface of luting composite-inlay. At the
interface of tooth-luting composite for preparations involving the dentin, groups A and B
behaved significantly better compared to the control group E, which in turn were not different
to groups C and D.
CONCLUSION: Composite and ceramic inlays inserted in minimally invasive prepared mod
cavities result in margins not different from those of inlays placed in conventional mod
preparations. Direct composite filling margins, however, were inferior to those attained by
conventional indirect restorations.
CLINICAL RELEVANCE: Minimally invasive preparations for mod inlays with undercuts show
marginal adaptation equal to that of conventional inlay preparation design.
Dent Mater. 2013 Jun;29(6):e70-7. doi: 10.1016/j.dental.2013.03.019. Epub 2013 Apr 22.
14. Fracture strength of minimally prepared all-ceramic CEREC crowns after
simulating 5 years of service.
Skouridou N, Pollington S, Rosentritt M, Tsitrou E.

Academic Unit of Restorative Dentistry, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
Abstract
OBJECTIVES: To examine the strength and mode of fracture of traditionally and minimally
prepared all-ceramic resin bonded CAD/CAM crowns after fatigue loading.
METHODS: Thirty human maxillary molars were used and divided in three groups namely;
traditional crown preparation group (I), minimal crown preparation group (II) and occlusal
veneer preparation group (III). A leucite reinforced glass ceramic (IPS Empress CAD) was
used for fabricating the crowns. The CEREC InEOS system (v3.10) was used for scanning,
designing and milling. Five years of clinical service were simulated and the fracture strength of
the crowns was measured. One-way ANOVA and Kruskal-Wallis test were used for data
analysis (=0.05).
RESULTS: The mean fracture strength and SD in Group I was 1070N (181) and in Group II
1110N (222). One-way ANOVA analysis showed no statistically significant difference
between the two groups (p>0.05). In Group III all restorations developed cracks during TCML
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and were not subjected to fracture loading. Three of the traditionally designed crowns (Group
I) and 4 of the minimally designed crowns (Group II) developed surface cracks during TCML.
SIGNIFICANCE: Minimal all-ceramic resin-bonded crowns can potentially form a viable
restorative option as they demonstrated comparable strength to traditional all-ceramic crowns.
However, this should be interpreted with caution as a number of crowns showed cracks after 5
years of simulated service. All the occlusal veneers developed cracks during simulation and
further investigation is needed for this to be considered a viable option.
Copyright 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
Oper Dent. 2013 Apr 9. [Epub ahead of print]
15. Composite vs Ceramic Computer-aided Design/Computer-assisted
Manufacturing Crowns in Endodontically Treated Teeth: Analysis of

Marginal Adaptation.
Ramrez-Sebasti A, Bortolotto T, Roig M, Krejci I.
Abstract
SUMMARY Objectives : To compare the marginal adaptation between ceramic and composite
CEREC crowns in endodontically treated teeth restored with endocrowns or with a short or a
long post. Methodology : Forty-eight intact maxillary incisors were used. After endodontic
treatment, the crowns were sectioned 2 mm coronally to the cemento-enamel junction, which
provided a ferrule of 2 mm. The prepared teeth were divided randomly into six groups (n=8).
Group 1 was restored with a large fiberglass post, composite core, and ceramic full-coverage
computer-aided design/computer-assisted manufacturing (CAD-CAM) crown. Group 2 was
restored with a short fiberglass post, composite core, and ceramic full-coverage CAD-CAM
crown. Group 3 was restored with a large fiberglass post, composite core, and composite fullcoverage CAD-CAM crown (LPCpr). Group 4 was restored with a short fiberglass post,
composite core, and composite full-coverage CAD-CAM crown (SPCpr). Groups 5 and 6 were
restored with ceramic and composite CEREC machined endocrowns, respectively (EndoCer
and EndoCpr). The restored teeth were loaded thermomechanically in a computer-controlled
chewing machine. Impressions of each restoration were made in a polyvinylsiloxane material
before and after loading. Gold-coated epoxy replicas were prepared for scanning electron
microscopy examination at 200 magnification. Results : Loading had a statistically significant
effect (p<0.05) on the percentage of "continuous margin" in all groups. The LPCpr, SPCpr, and
EndoCpr groups showed the highest percentage of continuous margin initially and after
loading. The effect of the different post lengths on marginal adaptation was not significant
(p>0.05). Conclusion : CAD-CAM crowns fabricated from millable composite resin blocks
(Paradigm MZ100) offer a superior option to all-ceramic crowns (IPS Empress CAD).
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Int J Prosthodont. 2013 Mar-Apr;26(2):111-24. doi: 10.11607/ijp.3202.
16. A systematic review and meta-analysis of the survival of non-feldspathic
porcelain veneers over 5 and 10 years.

Layton DM, Clarke M.
laytonpros@dipros.com.au
Abstract
PURPOSE: This systematic review aimed to report and explore the survival of dental veneers
constructed from non-feldspathic porcelain over 5 and 10 years.
MATERIALS AND METHODS: A total of 4,294 articles were identified through a systematic
search involving all databases in the Cochrane Library, MEDLINE (OVID), EMBASE, Web of
Knowledge, specific journals (hand-search), conference proceedings, clinical trials registers,
and collegiate contacts. Articles, abstracts, and gray literature were sought by two independent
researchers. There were no language limitations. One hundred sixteen studies were identified
for full-text assessment, with 10 included in the analysis (5 qualitative, 5 quantitative). Study
characteristics and survival (Kaplan-Meier estimated cumulative survival and 95% confidence
interval [CI]) were extracted or recalculated. A failed veneer was one which required an
intervention that disrupted the original marginal integrity, had been partially or completely lost,
or had lost retention more than twice. A meta-analysis and sensitivity analysis of Empress
veneers was completed, with an assessment of statistical heterogeneity and publication bias.
Clinical heterogeneity was explored for results of all veneering materials from included studies.
RESULTS: Within the 10 studies, veneers were fabricated with IPS Empress, IPS Empress 2,
Cerinate, and Cerec computer-aided design/computer-assisted manufacture (CAD/CAM)
materials VITA Mark I, VITA Mark II, Ivoclar ProCad. The meta-analysis showed the pooled
estimate for Empress veneers to be 92.4% (95% CI: 89.8% to 95.0%) for 5-year survival and
66% to 94% (95% CI: 55% to 99%) for 10 years. Data regarding other non-feldspathic
porcelain materials were lacking, with only a single study each reporting outcomes for
Empress 2, Cerinate, and various Cerec porcelains over 5 years. The sensitivity analysis
showed data from one study had an influencing and stabilizing effect on the 5-year pooled
estimate.
CONCLUSION: The long-term outcome (> 5 years) of non-feldspathic porcelain veneers is
sparsely reported in the literature. This systematic review indicates that the 5-year cumulative
estimated survival for etchable non-feldspathic porcelain veneers is over 90%. Outcomes may
prove clinically acceptable with time, but evidence remains lacking and the use of these
materials for veneers remains experimental.
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J Prosthet Dent. 2013 Feb;109(2):83-7. doi: 10.1016/S0022-3913(13)60020-7.
17. Accuracy of ceramic restorations made with two CAD/CAM systems.

Hamza TA, Ezzat HA, El-Hossary MM, Katamish HA, Shokry TE, Rosenstiel SF.
Crown and Fixed Prosthodontics Department, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt.
drtamerhamza@hotmail.com
Abstract
STATEMENT OF PROBLEM: Different types of CAD/CAM systems are currently available,
but information regarding which system produces the best marginal fit is lacking.
PURPOSE: The purpose of this study was to evaluate the effect of 2 different CAD/CAM
systems (Cerec inLab, Kavo Everest) on the marginal fit of 2 types of zirconia-based and
lithium disilicate crowns.
MATERIAL AND METHODS: Forty zirconia-based and lithium disilicate crowns, 20 each,
were fabricated with the Cerec inLab and Everest CAD/CAM systems on a specially designed
stainless steel die to ensure the standardization of specimen shape and dimensions. The
vertical marginal fit for all tested crowns was evaluated by using a digital microscope at 100
magnification, and the data were tabulated and statistically analyzed with 2-way ANOVA,
followed by the Tukey honestly significant difference (HSD) test with a confidence level of .05
to determine the mean differences.
RESULTS: The results showed that the CAD/CAM technique, ceramic type, and their
interaction had a statistically significant effect on the mean marginal fit of both ceramic types
tested.
CONCLUSIONS: Better marginal fit values were exhibited by the Everest CAD/CAM technique
for both ceramic types tested.
Copyright 2013 The Editorial Council of the Journal of Prosthetic Dentistry. Published by
Mosby, Inc. All rights reserved.

Clin Oral Investig. 2013 Jan 31. [Epub ahead of print]
18. The clinical accuracy of single crowns exclusively fabricated by digital
workflow-the comparison of two systems.

Brawek PK, Wolfart S, Endres L, Kirsten A, Reich S.
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Department of Prosthodontics, Implantology and Biomaterials, Medical Faculty, RWTH Aachen University,
Pauwelsstr. 30, 52074, Aachen, Germany.
Abstract
OBJECTIVES: The purpose of the study was to compare the accuracy of crowns exclusively
fabricated by the digital workflow of two systems. The null hypothesis stated was: Both
systems do not differ with respect to marginal and internal accuracy.
MATERIALS AND METHODS: In 14 patients, 13 molars and 1 premolar were prepared. Each
preparation was scanned intraorally with two different digital impression systems, Lava COS
and Cerec AC. On the basis of these data, Lava DVS crowns [DVS] and Vita Rapid Layering
Technique crowns [RLT] were fabricated, respectively. Both systems contained of a zirconia
framework and a digitally fabricated silicate ceramic veneering. The marginal and internal fit of
the crowns was documented by a replica technique. The replicas were examined under
microscope with a magnification of 200. The Wilcoxon signed rank test was applied in order
to test if the values of the two systems showed significant differences at p0.05.
RESULTS: The results were as follows in micrometers (standard deviation): at the marginal
gap, 51 (38) for [DVS] and 83 (51) for [RLT]; mid-axial, 130 (56) for [DVS] and 128 (66)
for [RLT]; axio-occlusal, 178 (55) for [DVS] and 230 (71) for [RLT]; and centro-occlusal, 181
(41) for [DVS] and 297 (76) for [RLT]. According to the Wilcoxon signed rank test, the
results differed significantly at the marginal, axio-occlusal, and centro-occlusal gaps.
CONCLUSIONS: The null hypothesis had to be rejected.
CLINICAL RELEVANCE: The exclusively digital workflow on the basis of intraoral digital
impressions delivered clinically satisfying results for single crowns with both systems.
Gen Dent. 2013 Jan-Feb;61(1):36-40; quiz 41.
19. Overview of CEREC CAD/CAM chairside system.

Santos GC Jr, Santos MJ Jr, Rizkalla AS, Madani DA, El-Mowafy O.
Abstract
This article describes CAD/CAM technology used in dentistry and different restorative
materials used in conjunction with adhesive cementation with particular attention given to the
evolution of the CEREC system, as well as various ceramics developed for this system.
Advantages and limitations of materials and technique are also discussed.
Implant Dent. 2013 Feb;22(1):66-70. doi: 10.1097/ID.0b013e318278a576.
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20. Fracture load of monolithic CAD/CAM lithium disilicate ceramic crowns
and veneered zirconia crowns as a posterior implant restoration.
Kim JH, Lee SJ, Park JS, Ryu JJ.

Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Korea.
Abstract
PURPOSE: To compare the fracture load and failure mode of the monolithic lithium disilicate
crown (e.max group) and 2 types of veneered zirconia crowns, hand layer (ZV group) and heat
pressed (ZP group), as a posterior implant-supported restoration.
METHODS: A total of 24 all-ceramic crowns for molar tooth were fabricated using the
computer-aided design/computer-assisted manufacture (CAD/CAM) system. The e.max group
crowns and zirconia copings for ZV and ZP groups were fabricated using a Cerec milling unit.
The ZV group was fabricated using a hand-layer veneering method, and the ZP group using a
heat-pressing method. All crowns were luted to the abutments, which were connected to
implant fixtures, using resin cement. Fracture load was measured using the universal testing
machine, and the fracture surface was evaluated by scanning electron microscopy.
RESULTS: The ZP group showed significantly higher fracture load (5229.3 N) compared with
the e.max group (3852.1 N) and ZV group (3100.3 N). All fractures in the ZV group occurred in
the veneered layer.
CONCLUSION: Monolithic CAD/CAM lithium disilicate crowns are applicable to posterior
implant-supported restorations because the fracture load was higher than the average occlusal
force.
Dent Mater. 2013 Mar;29(3):324-31. doi: 10.1016/j.dental.2012.11.013. Epub 2013 Jan 1.
21. Fatigue resistance and crack propensity of large MOD composite resin
restorations: direct versus CAD/CAM inlays.

Batalha-Silva S, de Andrada MA, Maia HP, Magne P.
Department of Operative Dentistry, Federal University of Santa Catarina, Florianpolis, Brazil.
Abstract
OBJECTIVES: To assess the influence of material/technique selection (direct vs. CAD/CAM
inlays) for large MOD composite adhesive restorations and its effect on the crack propensity
and in vitro accelerated fatigue resistance.
METHODS: A standardized MOD slot-type tooth preparation was applied to 32 extracted
maxillary molars (5mm depth and 5mm bucco-palatal width) including immediately sealed
dentin for the inlay group. Fifteen teeth were restored with direct composite resin restoration
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(Miris2) and 17 teeth received milled inlays using Paradigm MZ100 block in the CEREC
machine. All inlays were adhesively luted with a light curing composite resin (Filtek Z100).
Enamel shrinkage-induced cracks were tracked with photography and transillumination. Cyclic
isometric chewing (5 Hz) was simulated, starting with a load of 200 N (5000 cycles), followed
by stages of 400, 600, 800, 1000, 1200 and 1400 N at a maximum of 30,000 cycles each.
Samples were loaded until fracture or to a maximum of 185,000 cycles.
RESULTS: Teeth restored with the direct technique fractured at an average load of 1213 N
and two of them withstood all loading cycles (survival=13%); with inlays, the survival rate was
100%. Most failures with Miris2 occurred above the CEJ and were re-restorable (67%), but
generated more shrinkage-induced cracks (47% of the specimen vs. 7% for inlays).
SIGNIFICANCE: CAD/CAM MZ100 inlays increased the accelerated fatigue resistance and
decreased the crack propensity of large MOD restorations when compared to direct
restorations. While both restorative techniques yielded excellent fatigue results at physiological
masticatory loads, CAD/CAM inlays seem more indicated for high-load patients.
Publication Types
Int J Comput Dent. 2012;15(3):237-49.
22. CAD/CAM generated all-ceramic primary telescopic prostheses.

Kurbad A, Ganz S, Kurbad S.
University Witten-Herdecke, Witten, Germany. info@cerec.de
Abstract
Computer-aided design and manufacturing (CAD/CAM) systems have proven effective not
only for the manufacture of crown and bridge frameworks, inlays, onlays and veneers, but also
for the generation of all-ceramic primary telescopic prostheses in more than 10 years of use in
dental technology. The new InLab 4.0 software generation makes it possible to design and mill
primary telescopic prostheses with CAD/CAM technology. The computer-generated raw
crowns for these restorations require very little manual adaptation. The secondary crowns are
manufactured by electroforming and bonded onto the tertiary structure or framework.

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Int J Comput Dent. 2012;15(3):207-25.
23. Examples of model-free implant restorations using Cerec inLab 4.0
software.

Reich S, Schley J, Kern T, Fiedler K, Wolfart S.
Department of Prosthodontics, Implantology and Biomaterials, Faculty of Medicine, RWTH University Hospital,
Aachen, Germany. sreich@ukaachen.de
Abstract
This case report demonstrates two ways to fabricate model-free implant restorations with the
Cerec inLab 4.0 software. Because the patient, a woman with a history of periodontal disease,
did not wish to have a removable partial denture, implant therapy was planned for the
restoration of her edentulous areas 14/15 and 24/25. In addition, the restoration was to provide
functional relief of the natural maxillary anterior teeth. The two implants for the first quadrant
were planned as single-tooth restorations. Each was designed as a full contour implant suprastructure using the Cerec Biogeneric abutment design technique. After completing the design
phase, each restoration proposal was split into two parts: a zirconia abutment and a lithium
disilicate crown. For the restoration of the second quadrant, custom 20-degree-angled
abutments were individualized and acquired with the Cerec camera. A block crown was then
designed, milled in burn-out acrylic resin, and fabricated from a lithium disilicate glass-ceramic
ingot according to the press ceramic technique. Additionally methods of provisional
restorations are discussed.

Int J Comput Dent. 2012;15(3):199-205.
24. Cerec Omnicam - Intraoralscan 2.0.

Wiedhahn K, Schenk O, Fritzsche G.
wiedhahn@quintessenz.de

Int J Comput Dent. 2012;15(3):185-97.
25. Reliability of nonretentive all-ceramic CAD/CAM overlays.

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Arnetzl GV, Arnetzl G.

Austrian Society of Computerized Dentistry (OEGCZ). vincent@arnetzl.at
Abstract
Intracoronal restorations have a variable risk of cusp fracture depending on the amount of
tooth structure remaining. All-ceramic restorations with acusp-supporting design could be a
long-lasting alternative. The aim of this study was to verify the clinical reliability of occlusal
veneers. A total of 286 occlusal veneers made of Vita Mark II ceramic that were fabricated and
inserted in 244 patients from 2003 to 2004 using the Cerec method with an optimized ceramic
design were periodically re-assessed over the following years. Based on the fracture rate
observed over 93 months of follow-up, the probability of survival was 99.3%, demonstrating
the excellent practical suitability of the method. In light of this, it is worth reconsidering the
question of treatment with intracoronal restorations versus occlusal veneers in the posterior
region.

J Craniofac Surg. 2012 Nov;23(6):e575-9. doi: 10.1097/SCS.0b013e31826b8043.
26. Optical impression systems for CAD-CAM restorations.

Galhano G, Pellizzer EP, Mazaro JV.
Department of Dental Materials and Prosthodontics, UNESP-Aracatuba, Aracatuba, So Paulo, Brazil.
grazielagalhano@yahoo.com.br
Abstract
Computer-aided design/computer-aided manufacturing images can be taken through either
direct or indirect imaging. For the indirect systems, the digitalization is obtained from the
impression material or cast, and for the direct ones the image is taken directly from the mouth
using intraoral scanners.The direct acquisition systems have been constantly improved
because these are less invasive, quicker, and more precise than the conventional method.
Besides, the digital images can be easily stored for a long time. Therefore, the aim of this
paper was to describe and discuss based on the literature the main direct image acquisition
systems available on the market: CEREC Bluecam (Sirona), Lava C.O.S. System (3M ESPE),
iTero System (Cadent/Straumann), and E4D System (D4D Technologies).
Oper Dent. 2013 May-Jun;38(3):309-15. doi: 10.2341/12-233-L. Epub 2012 Oct 23.
27. Dimensional accuracy of optical bite registration in single and multiple

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unit restorations.
Iwaki Y, Wakabayashi N, Igarashi Y.
Tokyo Medical and Dental University, Prosthodontics, Tokyo, Japan.
Abstract
The dimensional accuracy of optical bite registration in the CEREC system was compared to
that of the conventional physical method in vitro using a bite registration material. Maxillary
and mandibular full-arch dentate epoxy models mounted on an articulator were used to
measure the interarch distance and the angles created by the occlusal planes. The
preparations for a single restoration on the maxillary first molar or for multiple restorations on
the maxillary posterior quadrant were made on the model. Optical impression and bite
registration data were collected to construct virtual models using computer-aided design
software. A silicone material was used for the physical method, and the dimensional accuracy
was measured by means of the coordinate measuring machine. The discrepancy relative to
the baseline before preparation was analyzed in each registration record. For the single
restoration, the optical method created a mean discrepancy of 243.2 m relative to baseline at
the prepared tooth, which was insignificantly but slightly lower than the mean discrepancy of
311.1 m obtained with the physical method. The mean rotational deviation in the horizontal
plane was significantly lower for the optical method. For the multiple preparations, the optical
method showed significantly larger discrepancy on the right molar and on the left premolar and
molar sites. In the frontal view, the optical method created significantly larger rotational
deviation than the physical method. The result indicates that the optical bite registration was
effective in terms of dimensional accuracy for single posterior restorations.
Clin Oral Investig. 2013 Sep;17(7):1759-64. doi: 10.1007/s00784-012-0864-4. Epub 2012 Oct 21.
28. Accuracy of digital and conventional impression techniques and
workflow.
Seelbach P, Brueckel C, Wstmann B.

Department of Prosthodontics, Justus-Liebig-University, Schlangenzahl 14, 35392, Giessen, Germany,
paul.seelbach@dentist.med.uni-giessen.de.
Abstract
OBJECTIVES: Digital impression techniques are advertised as an alternative to conventional
impressioning. The purpose of this in vitro study was to compare the accuracy of full ceramic
crowns obtained from intraoral scans with Lava C.O.S. (3M ESPE), CEREC (Sirona), and
iTero (Straumann) with conventional impression techniques.
MATERIALS AND METHODS: A model of a simplified molar was fabricated. Ten 2-step and
10 single-step putty-wash impressions were taken using silicone impression material and
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poured with type IV plaster. For both techniques 10 crowns were made of two materials (Lava
zirconia, Cera E cast crowns). Then, 10 digital impressions (Lava C.O.S.) were taken and
Lava zirconia crowns manufactured, 10 full ceramic crowns were fabricated with CEREC
(Empress CAD) and 10 full ceramic crowns were made with iTero (Copran Zr-i). The
accessible marginal inaccuracy (AMI) and the internal fit (IF) were measured.
RESULTS: For AMI, the following results were obtained (meanSD): overall groups, 44
26 m; single-step putty-wash impression (Lava zirconia), 3319 m; single-step putty-wash
impression (Cera-E), 3825 m; two-step putty-wash impression (Lava zirconia), 6030 m;
two-step putty-wash impression (Cera-E), 6829 m; Lava C.O.S., 4825 m; CEREC, 30
17 m; and iTero, 4116 m. With regard to IF, errors were assessed as follows (meanSD):
overall groups, 4925 m; single-step putty-wash impression (Lava zirconia), 365 m;
single-step putty-wash impression (Cera-E), 4422 m; two-step putty-wash impression (Lava
zirconia), 357 m; two-step putty-wash impression (Cera-E), 5636 m; Lava C.O.S., 29
7 m; CEREC, 8820 m; and iTero, 502 m.
CONCLUSIONS: Within the limitations of this in vitro study, it can be stated that digital
impression systems allow the fabrication of fixed prosthetic restorations with similar accuracy
as conventional impression methods.
CLINICAL RELEVANCE: Digital impression techniques can be regarded as a clinical
alternative to conventional impressions for fixed dental restorations.
Acta Odontol Scand. 2013 Mar;71(2):317-24. doi: 10.3109/00016357.2012.680905. Epub 2012 Sep 25.
29. Influence of a proximal margin elevation technique on marginal
adaptation of ceramic inlays.
Zaruba M, Ghring TN, Wegehaupt FJ, Attin T.

Clinic for Preventive Dentistry, Periodontology and Cariology, University of Zrich, Zrich, Switzerland.
markus.zaruba@zzm.uzh.ch
Abstract
PURPOSE: Evaluating the effect of a proximal margin elevation technique on marginal
adaptation of ceramic inlays.
METHODS: Class II MOD-cavities were prepared in 40 human molars and randomly
distributed to four groups (n = 10). In group EN (positive control) proximal margins were
located in enamel, 1 mm above the cementoenamel junction, while 2 mm below in groups DE1In, DE-2In and DE. The groups DE-1In, DE-2In and DE simulated subgingival location of the
cervical margin. In group DE-1In one 3 mm and in group DE-2In two 1.5 mm composite layers
(Tetric) were placed for margin elevation of the proximal cavities using Syntac classic as an
adhesive. The proximal cavities of group DE remained untreated and served as a negative
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control. In all groups, ceramic inlays (Cerec 3D) were adhesively inserted. Replicas were
taken before and after thermomechanical loading (1.200.000 cycles, 50/5C, max. load 49 N).
Marginal integrity (tooth-composite, composite-inlay) was evaluated with scanning electron
microscopy (200). Percentage of continuous margin (% of total proximal margin length) was
compared between groups before and after cycling using ANOVA and Scheff post-hoc test.
RESULTS: After thermomechanical loading, no significant differences were observed between
the different groups with respect to the interface composite-inlay and tooth-composite with
margins in dentin. The interface tooth-composite in enamel of group EN was significantly
better compared to group DE-2In, which was not different to the negative control group DE and
DE-1In.
CONCLUSION: Margin elevation technique by placement of a composite filling in the proximal
box before insertion of a ceramic inlay results in marginal integrities not different from margins
of ceramic inlays placed in dentin.

Clin Oral Investig. 2013 Jun;17(5):1407-13. doi: 10.1007/s00784-012-0830-1. Epub 2012 Sep 22.
30. Monolithic and bi-layer CAD/CAM lithium-disilicate versus metal-ceramic
fixed dental prostheses: comparison of fracture loads and failure modes

after fatigue.
Schultheis S, Strub JR, Gerds TA, Guess PC.
Department of Prosthodontics, School of Dentistry, Albert-Ludwigs-University Freiburg, Hugstetter Strasse 55,
Freiburg, Germany.
Abstract
OBJECTIVES: The authors analyzed the effect of fatigue on the survival rate and fracture load
of monolithic and bi-layer CAD/CAM lithium-disilicate posterior three-unit fixed dental
prostheses (FDPs) in comparison to the metal-ceramic gold standard.
MATERIALS AND METHODS: The authors divided 96 human premolars and molars into
three equal groups. Lithium-disilicate ceramic (IPS-e.max-CAD) was milled with the CEREC-3system in full-anatomic FDP dimensions (monolithic: M-LiCAD) or as framework (Bi-layer: BLLiCAD) with subsequent hand-layer veneering. Metal-ceramic FDPs (MC) served as control.
Single-load-to-failure tests were performed before and after mouth-motion fatigue.
RESULTS: No fracture failures occurred during fatigue. Median fracture loads in [N], before
and after fatigue were, respectively, as follows: M-LiCAD, 1,298/1,900; BL-LiCAD, 817/699;
MC, 1,966/1,818. M-LiCAD and MC FPDs revealed comparable fracture loads and were both
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significantly higher than BL-LiCAD. M-LiCAD and BL-LiCAD both failed from core/veneer bulk
fracture within the connector area. MC failures were limited to ceramic veneer fractures
exposing the metal core. Fatigue had no significant effect on any group.
CONCLUSIONS: Posterior monolithic CAD/CAM fabricated lithium-disilicate FPDs were
shown to be fracture resistant with failure load results comparable to the metal-ceramic gold
standard. Clinical investigations are needed to confirm these promising laboratory results.
CLINICAL RELEVANCE: Monolithic CAD/CAM fabricated lithium-disilicate FDPs appeared to
be a reliable treatment alternative for the posterior load-bearing area, whereas FDPs in bilayer configuration were susceptible to low load fracture failure.
Publication Types
PLoS One. 2012;7(8):e43312. doi: 10.1371/journal.pone.0043312. Epub 2012 Aug 22.
31. Application of intra-oral dental scanners in the digital workflow of
implantology.
van der Meer WJ, Andriessen FS, Wismeijer D, Ren Y.

Department of Orthodontics, University Medical Centre Groningen, University of Groningen, Groningen, The
Netherlands. w.j.van.der.meer@umcg.nl
Abstract
Intra-oral scanners will play a central role in digital dentistry in the near future. In this study the
accuracy of three intra-oral scanners was compared. Materials and methods: A master model
made of stone was fitted with three high precision manufactured PEEK cylinders and scanned
with three intra-oral scanners: the CEREC (Sirona), the iTero (Cadent) and the Lava COS
(3M). In software the digital files were imported and the distance between the centres of the
cylinders and the angulation between the cylinders was assessed. These values were
compared to the measurements made on a high accuracy 3D scan of the master model.
Results: The distance errors were the smallest and most consistent for the Lava COS. The
distance errors for the Cerec were the largest and least consistent. All the angulation errors
were small.
CONCLUSIONS: The Lava COS in combination with a high accuracy scanning protocol
resulted in the smallest and most consistent errors of all three scanners tested when
considering mean distance errors in full arch impressions both in absolute values and in
consistency for both measured distances. For the mean angulation errors, the Lava COS had
the smallest errors between cylinders 1-2 and the largest errors between cylinders 1-3,
although the absolute difference with the smallest mean value (iTero) was very small
(0,0529). An expected increase in distance and/or angular errors over the length of the arch
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due to an accumulation of registration errors of the patched 3D surfaces could be observed in

this study design, but the effects were statistically not significant.
CLINICAL RELEVANCE: For making impressions of implant cases for digital workflows, the
most accurate scanner with the scanning protocol that will ensure the most accurate digital
impression should be used. In our study model that was the Lava COS with the high accuracy
scanning protocol.
PMID: 22937030 [PubMed - indexed for MEDLINE] PMCID: PMC3425565
Free PMC Article

Int J Comput Dent. 2012;15(1):55-66.
32. Cerec reconstruction of a hemisected mandibular molar: method and
case report.

Ronay V, Sahrmann P, Ender A, Bindl A, Schmidlin PR.
Clinic for Preventive Dentistry, Periodontology and Cariology, Center for Dental and Oral Medicine and MaxilloFacial Surgery, University of Zurich, Switzerland.
Abstract
Hemisection of mandibular molars is a viable method of preserving periodontally or
endodontically compromised teeth or roots. This paper describes a simple chairside CAD/CAM
method of fabricating a cantilever crown for a hemisected molar. The technique is illustrated by
a clinical case, which was treated according to this protocol and was followed-up over 2.5
years. Given careful patient selection and strict recall intervals, the introduced method
represents a conservative and cost-effective treatment modality for high-quality ceramic
reconstructions of root-resected teeth. In addition, other treatment options such as
implantation or prosthesis, which would represent therapeutic and prosthetic endpoints, can be
postponed.

Int J Comput Dent. 2012;15(1):45-54.
33. Cerec Guide: rapid and streamlined manufacture of surgical guides in
dental practice.

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Bindl A, Ritter L, Mehl A.

Computer Assisted Restorative Dentistry Unit, Department of Preventive Dentistry, Periodontology and Cariology,
Dental, Oral and Maxillofacial Medicine Center, University of Zurich, Switzerland. andreas.bindl@zzm.uzh.ch

Int J Comput Dent. 2012;15(1):23-31.
34. InLab and Cerec Connect: virtual contacts in maximum intercuspation
compared with original contacts--an in vitro study.

Nemli SK, Wolfart S, Reich S.
Department of Prosthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey.
Abstract
PURPOSE: The aim of this in-vitro study was to evaluate the accuracy of inLab and Cerec
Connect software in simulating the maximum intercuspal contacts in comparison to the real
situation on the respective gypsum casts.
MATERIALS AND METHODS: Ten pairs of maxillary and mandibular casts were mounted in
articulators in maximum intercuspal position. The contacts of the gypsum casts were marked
and digital photographs of the mandibular casts were taken. Digital impressions of arches
were made using two different software packages; inLab (Version 3.83) and Cerec Connect
(Version 3.83) using the Cerec Acquisition Center. The intercuspal position of the teeth was
captured by buccal images. Screenshots of the virtual casts showing the occlusal contacts
were saved. The digital photographs of the contacts of the cast and the screenshots of the
occlusal contacts were superimposed using an image processing program. The number of
contacts of the virtual mandibular models that were identical with the contacts of the gypsum
casts were determined and calculated as percentages in relation to the gypsum cast contacts,
which were set as 100%. The null hypothesis tested was that the Cerec connect software
delivers contacts that are closer to the real situation than contacts created with the inLab
software.
RESULTS: Cerec Connect showed a median percentage of 41.6% and Inlab a median
percentage of 31.9%. The Wilcoxon test revealed statistically significant differences between
the inLab software and Cerec Connect. Especially at the contra-lateral side of that side where
the virtual buccal registration was done, the contacts showed the greatest deviations from the
original.
CONCLUSION: Cerec Connect more precisely virtually simulated the real contacts than did
inLab when scanning full-arch dentitions.
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Compend Contin Educ Dent. 2012 Jul-Aug;33(7):546.
35. Clinicians and patients both win with Sirona's CEREC system.
[No authors listed]
MeSH Terms
Int J Comput Dent. 2012;15(2):149-58.
36. Bite registration in Cerec and in lab.

Frank E, Frank S.
info@drfrank.de
MeSH Terms
Int J Comput Dent. 2012;15(2):137-48.
37. Cerec 4.0: articulation and more.

Reiss B.
Breiss@t-online.de

Int J Comput Dent. 2012;15(2):125-36.
38. Fracture strength and mode of anterior single-retained all-ceramic resin-
bonded bridges using a CAD/CAM system.

Tsitrou E, Tsangari KN.
Academic Unit of Restorative Dentistry, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
e.tsitrou@sheffield.ac.uk
Abstract
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PURPOSE: To examine the performance of CAD/CAM all-ceramic resin-bonded bridges

(RBBs) fabricated from a glass ceramic material, and determine the influence of two different
preparation designs on the fracture strength of these prostheses.
MATERIALS AND METHODS: Twenty human central incisors were used, placed into two
groups. A clinical situation where a lateral incisor was missing was simulated. A minimal
preparation design (palatal veneer preparation) and one that extended into the proximal area
were applied in each group. The Cerec InEos and the Cerec 3D software were used to scan,
design, and mill the restorations. A lithium disilicate glass ceramic material was used for the
fabrication of the bridges (IPS e.max CAD). Twenty bridges were milled which were adhesively
bonded on their abutments (Variolink II). A universal testing machine was used to evaluate the
fracture strength and the mode of failure of the bridges.
RESULTS: The mean fracture strength for the minimal design group was 774 N (+/- 341) and
for the extended preparation group 814 N (+/- 474). No statistically significant difference was
found between the two designs (p > 0.05). The mode of failure was fracture at the connector
area between the pontic and the retainer wing.
CONCLUSION: The fracture strength of the RBBs fabricated with IPS e.max CAD was in a
clinically acceptable range. The two preparation designs did not have a significant influence on
the fracture strength of the RBBs.

J Tenn Dent Assoc. 2012 Spring;92(1):19-21; quiz 21-2.
39. Integrating the CEREC technology at UT College of Dentistry.

Dehghan M, Simon JF, Harrison J.
Department of Restorative Dentistry, Collge of Dentistry, University of Tennessee Health Center, USA.
mdehghan@uthsc.edu
Abstract
The computer-aided design/computer-aided manufacturing (CAD/CAM) has evolved during the
past 25 years, and this evolution has improved the speed and precision in which dentists can
deliver high quality esthetic restorations. CEREC is an acronym for "ceramic reconstruction"
and is one of the CAD/CAM systems available to dentists in private practice. The University of
Tennessee College of Dentistry was one of the first dental schools in the United States to
embrace this technology and integrate it into the four-year curriculum. In a dental school
setting, this technology can prove to be an educational tool for the dental students, cost
effective for the University and provide exceptional service for the patients.
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Zhonghua Yi Xue Za Zhi. 2012 Mar 27;92(12):845-7.
40. [Esthetic evaluation of Cerec 3D anterior crowns].

[Article in Chinese]
Yang J, Feng HL, Wei XX, Xing YX, Jia L, Zhou YS.
Department of Prosthodontics, Peking University, School of Stomatology, Beijing 100081, China.
Abstract
OBJECTIVE: To observe the short-term effect of clinical application of Cerec 3D anterior
crowns.
METHODS: A total of 16 patients were restored with 31 Cerec 3D anterior crowns. All
restorations were stained before cementation. The evaluation started 1 week after luting. The
restorations were examined in accordance with the modified US Public Health Service
(USPHS) criteria at baseline and every 6 - 12 months.
RESULTS: The observation period of 31 Cerec 3D anterior crowns varied from 8 to 33
months. The mean observation period was 22 months. All restorations scored A or B by
modified USPHS standard. And 22 out of 31 restorations scored A for all criteria while 8
restorations scored B in color matching. Slight differences of translucency and chroma could
be observed. Between baseline and follow-up examinations, insignificant shift from A-to Brating occurred.
CONCLUSION: Cerec 3D anterior crowns may achieve favorable short-term esthetic effects.

Eur J Prosthodont Restor Dent. 2011 Sep;19(3):111-6.
41. In vitro failure of crowns produced by two CAD/CAM systems.

Donnelly TJ, Burke FJ.
Primary Dental Care Research Group, University of Birmingham, School of Dentistry, College of Medical and Dental
Sciences, UK.
Abstract
Previous laboratory studies have demonstrated satisfactory fracture resistance of all-ceramic
crowns placed using a resin-composite luting material and a dentine bonding system. This
study investigated the fracture resistance of teeth restored using CAD/CAM technology,
namely, Zirconia Based crowns and Cerec produced feldspathic porcelain crowns, both luted
with a self adhesive resin luting material (RelyX Unicem Clicker 3M ESPE). Standardized
preparations were carried out on two groups often sound, unrestored, maxillary premolar teeth.
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Ceramic crowns were constructed to have a thickness of 2mm at their midline fissure.
Compressive fracture resistance was determined for each group using a Universal Testing
Machine. The failure modes were also examined visually and interpreted according to a
chosen scale. Mean Compressive fracture resistance of 746 (147)N and 1630 (175)N were
recorded for the Cerec and Lava groups respectively; differences were statistically significant
(p < 0.001). The fracture resistance of teeth restored with Lava crowns is significantly greater
than a similar group of teeth restored with Cerec crowns.

Gerodontology. 2012 Jun;29(2):e1176-9. doi: 10.1111/j.1741-2358.2011.00521.x.
42. CAD/CAM treatment for the elderly--a case report.

Van Zeghbroeck L.
Department of Prosthetic Dentistry, University Hospital of Ghent, Ghent, Belgium. lieve.vanzeghbroeck@ugent.be
Abstract
BACKGROUND: When elderly develop signs and symptoms of Alzheimer's disease they lose
their independence and neglect dental hygiene. Dentists are increasingly confronted by
seniors who are in need but who have limited access to dental care. Caretakers and family are
also often confronted with behaviour problems besides the dental problems.
OBJECTIVE: To report the importance of shorter and lower impact treatment for seniors when
caretakers and family are confronted with a behavioural problem in addition to the dental
problem.
MATERIALS AND METHODS: In this case report, the oral management of a patient with
Alzheimer's disease was described using chairside computer-aided design/computer-aided
manufacturing (CAD/CAM) technology while constructing a bonded bridge.
DISCUSSION: The case report emphasises the importance of interaction with the patient and
added a treatment method for patients with limited cognitive skills who become easily agitated
or aggressive.
CONCLUSION: The fabrication of a full ceramic bonded bridge utilising the Cerec 3D
chairside CAD/CAM technology in an Alzheimer patient has been shown to be a feasible,
precise, aesthetic and durable solution. It added a technique for intervening with patients with
limited tolerance for dental procedures, which improves the quality of life of both patient and
family.
2011 The Gerodontology Society and John Wiley & Sons A/S.
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Clin Oral Investig. 2013 Apr;17(3):851-7. doi: 10.1007/s00784-012-0749-6. Epub 2012 May 13.
43. Comparison of biogenerically reconstructed and waxed-up complete
occlusal surfaces with respect to the original tooth morphology.

Kollmuss M, Jakob FM, Kirchner HG, Ilie N, Hickel R, Huth KC.
Department of Restorative Dentistry, Periodontology and Paedodontics, Ludwig-Maximilians-University, Munich,

Germany.
Abstract
OBJECTIVES: Recently, it has become possible to reconstruct complete occlusal surfaces
using the biogeneric tooth model. This study aimed to mathematically assess and compare the
morphologic agreement between original morphology and CAD-reconstructed, waxed-up and
CAM partial crowns.
MATERIALS AND METHODS: Thirty-nine intact first permanent molars (39 participants) were
included. Impressions, bite registrations and three gypsum replicas were made. Preparations
for CAD/CAM partial crowns were performed and scanned. The restorations were
biogenerically reconstructed (CEREC v3.80) and milled. Wax-ups of these preparations were
scanned as well as the milled restorations and original teeth. Discrepancies were evaluated by
matching the scans with the original morphologies (Match3D, output: volume/area, z
difference) and by contact patterns. The discrepancies were compared between CADreconstructions and either wax-ups or milled restorations (paired t test, =0.025 for two
multiple tests).
RESULTS: The mean differences between natural tooth morphology (triangular stabilisation
71.8%) and biogeneric reconstructions, wax-ups and milled restorations (triangular
stabilisation 87.2%) were: 18436 m (volume/area), 18741 m (z difference); 26340 m
(volume/area), 26945 m (z difference) and 18240 m (volume/area), 18441 m (z
difference). Differences associated with biogeneric reconstructions were significantly less than
those of wax-ups (volume/area and z difference, p<0.0001), but not significantly different than
those of milled restorations (p=0.423 (volume/area), p=0.110 (z difference)).
CONCLUSIONS: CAD software enables a closer reconstruction of teeth than do wax-ups,
even when no cusps remain. The milling device is precise enough to transfer CAD into the
final restoration.
CLINICAL RELEVANCE: This study shows that state of the art CAD/CAM can effectively
produce natural tooth morphology and may be ideal for fixed partial dentures.
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J Dent. 2012 Aug;40(8):670-7. doi: 10.1016/j.jdent.2012.04.019. Epub 2012 Apr 27.
44. Internal adaptation, marginal accuracy and microleakage of a pressable
versus a machinable ceramic laminate veneers.

Aboushelib MN, Elmahy WA, Ghazy MH.
Dental Biomaterials Department, Faculty of Dentistry, Alexandria University, Egypt.
Abstract
OBJECTIVES: The aim of this study was to evaluate the internal adaptation and marginal
properties of ceramic laminate veneers fabricated using pressable and machinable CAD/CAM
techniques.
MATERIALS AND METHODS: 40 ceramic laminate veneers were fabricated by either milling
ceramic blocks using a CAD/CAM system (group 1 n=20) or press-on veneering using lost wax
technique (group 2 n=20). The veneers were acid etched using hydrofluoric acid, silanated,
and cemented on their corresponding prepared teeth. All specimens were stored under water
(37 C) for 60 days, then received thermocycling (15,000 cycles between 5 and 55 C and
dwell time of 90 s) followed by cyclic loading (100,000 cycles between 50 and 100 N) before
immersion in basic fuchsine dye for 24 h. Half of the specimens in each group were sectioned
in labio-lingual direction and the rest were horizontally sectioned using precision cutting
machine (n=10). Dye penetration, internal cement film thickness, and vertical and horizontal
marginal gaps at the incisal and cervical regions were measured (=0.05).
RESULTS: Pressable ceramic veneers demonstrated significantly lower (F=8.916, P<0.005)
vertical and horizontal marginal gaps at the cervical and incisal margins and lower cement film
thickness (F=50.921, P<0.001) compared to machinable ceramic veneers. The inferior
marginal properties of machinable ceramic veneers were associated with significantly higher
microleakage values.
CONCLUSIONS: Pressable ceramic laminate veneers produced higher marginal adaptation,
homogenous and thinner cement film thickness, and improved resistance to microleakage
compared to machinable ceramic veneers.
CLINICAL SIGNIFICANCE: The manufacturing process influences internal and marginal fit of
ceramic veneers. Therefore, dentist and laboratory technicians should choose a manufacturing
process with careful consideration.
Copyright 2012 Elsevier Ltd. All rights reserved.

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Quintessence Int. 2012 Jun;43(6):e67-72.
45. Influence of three scan spray systems on human gingival fibroblasts.

Willershausen I, Lehmann KM, Ro A, Ghanaati S, Willershausen B.
Department of Operative Dentistry, University Medical Center of Johannes Gutenberg University, Mainz, Germany.
ines.willershausen@unimedizin-mainz.de
Abstract
OBJECTIVE: CAD/CAM is based on optical or mechanical scanning of tooth surfaces. The
aim of this in vitro study was to investigate the influence of three different scan sprays on the
proliferation, viability, and adenylate kinase (ADK) release of human fibroblasts.
METHOD AND MATERIALS: Three different scan sprays (ScanDry, ScanSpray Luer Classic,
and CEREC Optispray) were tested in vitro to determine their effects on proliferation, viability,
and ADK release of human periodontal fibroblasts. A defined amount of the test material was
sprayed into 96 multiwell plates, dried, and incubated with fibroblasts. The LIVE/DEAD Viability
Assay, a two-color fluorescence-based method, was used to determine the cytotoxic potential
(the AlamarBlue Assay for the proliferation rate and the ToxiLight BioAssay for the release of
ADK).
RESULTS: There were differences between the scan sprays concerning inhibition of the
proliferation and viability of fibroblasts. All materials inhibited the fibroblast proliferation and
viability compared with the control group (P < .001), and there were also significant differences
among the scan spray groups. The scan sprays led to a greater release of ADK, but a
significant difference could be found only between ScanSpray Luer Classic and CEREC
Optispray (P < .009).
CONCLUSION: The results of this study proved that the scan sprays do not induce a
significantly higher ADK release than the control group. The inhibiting effect on the fibroblast
proliferation can be attributed to a material-independent phenomenon. Further experiments are
necessary to validate the present data.

Beijing Da Xue Xue Bao. 2012 Apr 18;44(2):299-302.
46. [Effect of cementation on fracture toughness of chair-side CAD/CAM
ceramic].
Dong YT, Wang XY, Gao XJ.
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Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing 100081,
China.
Abstract
OBJECTIVE: Chair-side CAD/CAM ceramic restorations are esthetic with a time-saving
procedure. However, ceramic restorations often failed due to fracture. This study was to
investigate the effect of cement thickness on fracture toughness and hardness of CAD/CAM
ceramic.
METHODS: Machinable ceramic blocks for CAD/CAM (Sirona CEREC Blocs) were cut into 9
slices (12 mm14 mm2 mm) using a diamond saw (Leica SP 1600) and polished carefully
with sandpaper / diamond pastes to yield a mirror-like surface. LIGHT-CORE(TM) was used to
prepare resin slices with dimension of 12 mm14 mm2 mm. The polished ceramic slices
were then randomly divided into 3 groups and cemented to resin slices using Multilink
Automix: Group 1, no cement; Group 2, the thickness of cement was 50 m; Group 3, the
thickness of cement was 100 m. Hardness (H) was determined by Vickers indentation
technique using micro-hardness tester (HMV-2T Shimadzu) with a load of 19.6 N for 15 s. The
fracture toughness (K(IC)) was calculated by K(IC) = 0.016 (E/H)(0.5)(P/c(1.5)), where
P=applied load, c=crack length, E=elastic modulus, H= (0.47 P/a(2)), a=half diagonal of the
indentation.
RESULTS: The fracture toughness for Group 1 (no cement) was (1.020.11) MN/m(3/2), for
Group 2 and Group 3 was (0.990.10) MN/m(3/2) and (0.970.14) MN/m(3/2). Group 3
showed lower fracture toughness than group 1 (P<0.05). The Weibull parameter m of group 2
was the highest and K(0) of three groups were 1.08 MN/m(3/2), 1.04 MN/m(3/2) and 1.03
MN/m(3/2) respectively. The hardness for Group 1 was (6.680.73) GPa, group 2 [(6.850.64)
GPa], group 3 [(6.810.98) GPa]. There was no significant deference in hardness among the 3
groups (P>0.05).
CONCLUSION: Thickness of cementation may affect fracture toughness of machinable
ceramic, therefore, a thinner film of cementation is recommended for Chair-side CAD/CAM
ceramic restorations.
Free full text

J Prosthodont. 2012 Oct;21(7):523-8. doi: 10.1111/j.1532-849X.2012.00847.x. Epub 2012 Apr 1.
47. Retention of CAD/CAM all-ceramic crowns on prefabricated implant
abutments: an in vitro comparative study of luting agents and abutment

surface area.
Carnaggio TV, Conrad R, Engelmeier RL, Gerngross P, Paravina R, Perezous L, Powers JM.
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Department of Prosthodontics, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA.
thomasvcarnaggio@gmail.com
Abstract
PURPOSE: Previous studies considering retention of cast metal restorations to implant
abutments incorporated some degree of frictional fit due to internal surface nodules and
roughness of the restoration. In comparison, CAD/CAM restorations have minimal surface
irregularities, possibly impacting retention. There is insufficient knowledge of retentive force of
CAD/CAM restorations to titanium abutments, and therefore the topic warrants further
investigation. This in vitro study investigated the retention of all-ceramic CAD/CAM
restorations to three different prefabricated implant abutments using five different cements.
MATERIALS AND METHODS: A total of 150 Astra Tech dental implant abutments were used,
with each group of 50 being subdivided into five groups of 10. An optical impression of each
size of abutment was made with the CEREC 3D intraoral camera. A full-coverage restoration
was designed and milled with an enlarged, conical-shaped occlusal surface, which served to
secure the restoration into a brass jig used with a universal testing machine. Five different
cements were used with three different-sized abutments. Following cementation, the
implant/abutment/restoration assemblies were stored for 24 hours at 37C in 100% humidity. A
pull-out test using a universal testing machine, set at a 0.5 mm/min crosshead speed, was
used to evaluate retention of the individual restorations. The load required to remove each allceramic restoration was recorded. Retention values were analyzed using ANOVA and Fisher's
PLSD multiple comparisons test at the 0.05 level of significance.
RESULTS: Peak loads for two provisional cements and a resin-modified glass ionomer cement
ranged from 56 N to 127 N. Peak loads for two resin cements ranged from 184 N to 318 N.
Two-way ANOVA showed significant effects upon retentive forces for both the cement and
abutment design. Post hoc Fisher's PLSD multiple comparisons test found significant
differences in retention for 7 of the 10 pairings of cements at a 0.05 level of significance. In
addition, Fisher's PLSD multiple comparisons test found significant differences between Astra
Tech Direct Abutments 4 and Astra Tech Direct Abutments 5 as well as Astra Tech Direct
Abutments 4 and Astra Tech Direct Abutments 6 at a 0.05 level of significance. No significant
difference was found between Astra Tech Direct Abutments 5 and Astra Tech Direct
Abutments 6.
CONCLUSIONS: Of the five cements tested, the most retrievable CAD/CAM restorations were
luted with Temp Bond NE and Improv Temporary Cement. Resin-modified glass ionomer
retentive forces were closer to those of the "temporary cements" than those of the permanent
adhesive-resin cements. The abutment surface area became less important when using
adhesive-resin cements. Retention of CAD/CAM all-ceramic restorations to prefabricated
abutments has not been reported in the literature. This in vitro study demonstrated clinically
significant variation among the selected cements used to retain all-ceramic CAD/CAM
restorations to implant abutments. In addition, abutment size influenced the retention of allceramic CAD/CAM restorations.
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2012 by the American College of Prosthodontists.

Clin Oral Investig. 2013 Mar;17(2):491-6. doi: 10.1007/s00784-012-0714-4. Epub 2012 Mar 27.
48. Fully automatic CAD design of the occlusal morphology of partial crowns
compared to dental technicians' design.
Litzenburger AP, Hickel R, Richter MJ, Mehl AC, Probst FA.

Department of Restorative Dentistry, University of Munich (LMU), Munich, Germany.
Abstract
OBJECTIVES: The aim of this study was to compare the occlusal morphology of partial crown
reconstructions made by dental technicians with reconstructions made by a fully automatic
software process (biogeneric tooth model) in relation to the original natural tooth shape.
MATERIAL AND METHODS: Stone replicas of natural teeth were measured threedimensionally before preparing inlay and onlay cavities for ceramic restorations (n = 5). For
each preparation, five reconstructions (in total n = 25) were made by five dental technicians.
Additionally, reconstructions were calculated automatically by a software based on the
biogeneric tooth model (Cerec 3D). In order to compare the two different kinds of
reconstruction, an objective metrical similarity measure (shape similarity value, SSV) based on
calculated volumes between compared datasets was used.
RESULTS: In 22 of 25 cases, the reconstructions made by the CAD software were closer to
the original situation than the reconstructions made by the technicians. Mean average SSV of
reconstructions made by the technicians (310.2 78.8 m) was significantly higher (p < 0.05)
than mean SSV of CAD reconstructions (biogeneric model) (222.0 47.7 m).
CONCLUSIONS: In the design of naturally shaped occlusal inlay/onlay surfaces, a fully
automatic CAD system can be at least as good as conventional wax-ups by dental technicians.
CLINICAL RELEVANCE: The adjustment of a dental restoration to fit the morphology of
surrounding tooth structures, still presents challenges for the dentist.
J Oral Implantol. 2012 Mar 1. [Epub ahead of print]
49. Marginal Fit of Implant-supported All-Ceramic Zirconia Frameworks.

Zaghloul HH, Younis JF.
a Misr International University, Ass. Professor, Fixed Prosthodontics, Misr International University.
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Abstract
Abstract Objective: This study evaluated the effect of fabrication techniques and cyclic loading
on the vertical marginal fit of implant-supported FPD frameworks. Methods: Thirty implant
supported 3-unit FPD frameworks were fabricated on a model system, divided into three equal
groups (n=10). The first group (control) was constructed from base metal alloy and the other
two test groups were constructed from All-ceramic Zirconia using CAD/CAM Cerec III system
and copy milling (Zirconzahn) system. A cyclic load of 200 N was applied to each framework
for up to 50,000 cycles. Linear measurements were made in micrometers (m) of the vertical
gap between the framework and implant-supported abutment at 16 predetermined points
before and after cyclic loading. The frameworks were viewed using SEM to inspect any
fractographic features. One way analysis of variance (ANOVA) was performed to compare the
marginal discrepancy values of the control and the two test groups and for each group; T-test
was applied to determine whether significant changes in the fit were observed after cyclic
loading. (=0.05). Results: CAD/CAM group showed significantly higher marginal gap mean
values (80.58 m) than Zirkonzahn and control groups (50.33 m and 42.27 m respectively)
with no significant difference while, after cyclic loading, CAD/CAM group recorded the highest
marginal gap mean value (91.50 4.260 m) followed by control group (72.00 2.795 m)
while Zirconzahn group recorded the lowest marginal gap (65.37 6.138 m). Cyclic loading
significantly increased the marginal gap mean values in the control group only. Marginal chip
was observed in one of the CAD/CAM ceramic frameworks. Conclusions: Within the limitations
of this study, the fabrication technique influenced the marginal fit of the implant supported 3unit FPD frameworks. Cyclic loading failed to change the fit of all-ceramic Zirconia frameworks
while; significant changes were found in the metal frameworks.
Int J Comput Dent. 2011;14(4):353-6.
50. 12th international ISCD Certified Cerec Trainers Course in Vancouver.

Schenk O.

Int J Comput Dent. 2011;14(4):309-19.
51. Tensile bond strength of ceramic crowns to dentin using resin cements.
Simon JF, de Rijk WG, Hill J, Hill N.
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Department of Restorative Dentistry, University of Tennessee College of Dentistry, Memphis, 38163,USA.

jsimon2@uthsc.edu
Abstract
PURPOSE: This study measured the bond strength of the self-adhesive resin cements and a
bonded resin cement for crowns bonded to extracted teeth with preparations having a total
taper greater than 30 degrees. A crown pull-off test was used with direction of pull along the
path of insertion. The CAD/CAM system Cerec was used to create crowns with the pull-off
loop as an integral part of the crown structure.
MATERIALS AND METHODS: One hundred extracted human molars were prepared for allceramic crowns with a 1.5-mm shoulder, greater than 30-degree axial wall convergence, a flat
occlusal surface and 3 to 5 mm occlusal/ gingival height. All-ceramic crowns were cemented
with five different self-adhesive cements (Rely X Unicem, Maxcem Elite, BisCem, SmartCem
2, and G-Cem) and one bonded resin cement (Multilink). Forfour cements (excluding GCem
and Multilink) there were 2 groups, one with HF etching and one without ceramic surface
treatment. The crowns were then subject to tensile stress until either the crown fractured or the
crown was lifted off from the tooth.
RESULTS: For several cements, the bond strength exceeded the tensile strength of the allceramic crown; thus, the crown fractured, leaving the cemented part of the crown on the tooth.
The effect of ceramic surface etching was not statistically significant at p = 0.05; however, for
each cement, the treated crowns showed a lower coefficient of variance (COV). For this study,
the COV ranged from 24.9 % to 97.9 %. Loads ranged from 41.3 to 190.3 N.
CONCLUSION: Some of the new self-etching resin cements can create bonds to non-retentive
crown preparations that are stronger than the strength of a ceramic crown; however, these
high bond strengths may not be able to be achieved consistently.

Int J Comput Dent. 2012;15(4):315-26.
52. Accuracy of CAD/CAM crown fit with infrared and LED cameras.
Cook KT, Fasbinder DJ.
Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann
Arbor, Michigan 48109-1078, USA. ktcook@umich.edu
Abstract
PURPOSE: The intraoral recording of digital images is a critical component of fabricating
accurate Cerec restorations. This study evaluated the marginal fit and internal adaptation of
Cerec ceramic crowns fabricated using different cameras, alternative powdering materials,
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and multiple image capture sequences.

MATERIALS AND METHODS: A master epoxy resin model was fabricated using a
polyvinylsiloxane (PVS) impression of a typodont with an all-ceramic crown preparation on
tooth 14. A titanium dioxide powder/mechanical sprayer and an aerosol contrast spray were
used to create a uniformly reflective surface. An infrared laser Cerec 3/RedCam unit and LED
Cerec AC/BlueCam unit were used to record images for crown fabrication. Three different
image capture sequences were performed to record the data. Crowns were made for each test
group using a Cerec AC unit with V3.80 software. The crowns were milled from blocks of IPS
EmpressCAD. Marginal fit and internal adaptation of the crowns to the master model of the
preparation was assessed with a measuring microscope at 20X. The data was analyzed using
a two-way ANOVA.
RESULTS: No significant differences were found in the marginal fit, axial wall adaptation, or
occlusal wall adaptation between any of the test groups (p < 0.05).
CONCLUSION: Within the confines of this in vitro study, there were no significant differences
between the marginal fit and internal adaptation of Cerec CAD/CAM ceramic crowns
fabricated with: 1) the infrared laser camera (RedCam) and the LED camera (BlueCam), 2)
titanium dioxide powder or aerosol contrast spray, or 3) multiple imaging sequences for
recording the preparation and adjacent teeth.

J Dent. 2012 Mar;40(3):202-9. doi: 10.1016/j.jdent.2011.12.008. Epub 2011 Dec 14.
53. Fracture resistance and marginal discrepancy of porcelain laminate
veneers influenced by preparation design and restorative material in vitro.

Lin TM, Liu PR, Ramp LC, Essig ME, Givan DA, Pan YH.
Department of General Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan.
Abstract
OBJECTIVES: The purpose of this investigation is to evaluate marginal discrepancy and
fracture resistance of two veneering materials using two preparation designs.
METHODS: Two veneer preparation designs (full and traditional) were restored with leucitereinforced ceramic (ProCAD, Ivoclar Vivadent, Amherst, NY) milled by CAD/CAM (Cerec 3D
milling system, Serona Dental Systems), and conventional sintered feldspathic porcelain
(Noritake Super Porcelain EX3, Noritake Dental Supply Co). Forty-eight specimens were
analysed with a sample size of n=12 per group. The thickness of each veneer was measured
on four specific surfaces. Marginal discrepancy was evaluated with a replica technique and
cross-sectional view using a digital microscope. The fracture resistance of veneers cemented
on standardised composite resin dies was evaluated using a universal testing machine.
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Results were analysed with ANOVA, Tukey-Kramer post hoc testing, and linear regression.
RESULTS: The results of this investigation revealed no correlation between the thickness and
marginal discrepancy of the veneers. The full preparation design with ProCAD and the
traditional preparation design with feldspathic porcelain manifested smaller gap. Fracture
resistance was decreased for the full preparation design with feldspathic porcelain.
CONCLUSIONS: In terms of marginal discrepancy and fracture resistance, the most
favourable combination was a traditional veneer preparation design with conventional sintered
feldspathic porcelain. For the full veneer preparation, a stronger ceramic material such as
ProCAD is suggested.
Published by Elsevier Ltd.

J Hepatol. 2012 Apr;56(4):877-85. doi: 10.1016/j.jhep.2011.10.022. Epub 2011 Dec 13.
54. Whole genome RNA expression profiling of endoscopic biliary brushings
provides data suitable for biomarker discovery in cholangiocarcinoma.

Chapman MH, Tidswell R, Dooley JS, Sandanayake NS, Cerec V, Deheragoda M, Lee AJ, Swanton C,
Andreola F, Pereira SP.
UCL Institute of Hepatology, Royal Free Campus, University College London, United Kingdom.
Abstract
BACKGROUND & AIMS: Molecular analyses of biliary brushings using microarray and qPCR
have the potential to provide valuable information on the biology of biliary diseases. Microarray
analysis of biliary strictures has rarely been applied to endoscopic biliary brushings.
METHODS: Biliary brushings were obtained from patients with benign and malignant biliary
disease at the time of ERCP. Microarray analysis of mRNA isolated using brushings from 10
patients was validated for a selection of genes by qPCR using the same source mRNA and a
second fresh set of nine biliary brushings as well as surgical resection tissue. Cultured
cholangiocytes were used to assess the impact of bile or X-ray contrast solution on RNA
quality.
RESULTS: RNA was of variable quantity (100-1500 ng) and poor quality (Agilent RNA Integrity
Number (RIN)<5, estimated to be fragments 100 to 600 base pairs long). Reliable qPCR
results required primer pairs designed to produce amplicons <130 bp. Differential gene
expression by microarray analysis identified 1140 up-regulated genes and 1001 downregulated genes between benign and malignant biliary strictures. The trends in a selection of
45 up-regulated genes, including various HOX genes, collagens, PVT1, MUC4, MUC5AC, and
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LEF1, were validated by qPCR using RNA from biliary strictures with a moderate to strong
correlation coefficient between microarray and qPCR (r=0.41 to r=0.57).
Immunohistochemistry of surgical resection tissues (n=23) showed elevated CD9, SERPINA3,
and PNMA2 protein expression in cancer samples.
CONCLUSIONS: RNA isolated from biliary brushings is suitable for molecular analysis of
biliary diseases using qPCR and microarray.
Copyright 2011 European Association for the Study of the Liver. Published by Elsevier B.V.
All rights reserved.
Free PMC Article
Publication Types, MeSH Terms, Substances, Grant Support

Clin Oral Investig. 2012 Oct;16(5):1413-24. doi: 10.1007/s00784-011-0642-8. Epub 2011 Dec 7.
55. Seven-year clinical performance of CEREC-2 all-ceramic CAD/CAM
restorations placed within deeply destroyed teeth.
Roggendorf MJ, Kunzi B, Ebert J, Roggendorf HC, Frankenberger R, Reich SM.

Department of Operative Dentistry and Endodontology, Medical Center for Dentistry, University Medical Center
Giessen and Marburg, Marburg, Germany. matthias.roggendorf@staff.uni-marburg.de
Abstract
OBJECTIVES: Adhesively luted all-ceramic restorations represent a promising way to
preserve and stabilize weakened tooth substance, but little information is published about the
clinical performance of extensive all-ceramic restorations.
MATERIALS AND METHODS: A total of 78 large CEREC 2 single-tooth all-ceramic
restorations had been placed in 35 patients. After 7 years, 59 teeth in 25 patients were
reevaluated according to USPHS or modified USPHS criteria regarding aesthetic properties,
e.g., "anatomic form," "color match," and "marginal discoloration"; functional properties, e.g.,
"marginal integrity," wear expressed by the criteria "proximal contact" and "static/dynamic
occlusal relationship"; and biological properties, e.g., "tooth vitality" and "secondary caries".
Additionally, the "proportion of margin below/above cemento-enamel junction" was included.
RESULTS: Two restorations had failed prior to the 7-year recall, one due to a bulk fracture of
the restoration and one due to poor marginal integrity (rated "Charlie") after 4 years. Other six
restorations were rated as failure at the 7-year evaluation (three restorations revealed
secondary caries, one was bulk fracture of the Cerec 2 restoration, and two failures were
related to endodontic problems resulting in extraction or amputation of one root, respectively),
resulting in a failure rate of 13.1% after 7 years. A total of 96.4% of the restorations revealed
sufficient ratings for esthetic properties "anatomic form," "color match," "marginal
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discoloration," and "marginal integrity".

CONCLUSIONS: The survival rate of 86.9% at the 7-year recall demonstrates that adhesively
luted all-ceramic CAD/CAM-generated restorations are suitable for restoration of extended
coronal defects.
CLINICAL RELEVANCE: CAD/CAM-generated all-ceramic restorations facilitate the
reconstruction of deeply destroyed teeth irrespectively of the location of the cavity margins.
Clin Oral Implants Res. 2012 Dec;23(12):1360-8. doi: 10.1111/j.1600-0501.2011.02360.x. Epub 2011 Nov 25.
56. Fatigue resistance and failure mode of adhesively restored custom
implant zirconia abutments.
Oderich E, Boff LL, Cardoso AC, Magne P.

Department of Restorative Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los
Angeles, CA 90089-7792, USA.
Abstract
OBJECTIVES: This study assessed the fatigue resistance and failure mode of porcelain and
composite resin crowns and onlays bonded to premolar custom zirconia implant abutments.
MATERIALS AND METHODS: Sixty standardized zirconia implant abutments were milled
(NeoShape) according to two different restoration designs (onlay or crown). Using Cerec 3,
the corresponding onlays and crowns were fabricated either in ceramic (Paradigm C) or
composite resin (Paradigm MZ100), resulting in four experimental groups (n = 15). The fitting
surfaces of the abutments were airborne-particle abraded and cleaned. The intaglio surfaces
of the restorations were HF-etched and silanated (Paradigm C) or airborne-particle abraded
and silanated (Paradigm MZ100). Following insertion of the abutments into a Morse taper
implant (Titamax CM), all restorations were bonded with a zirconia primer (Z-Prime Plus),
adhesive resin (Optibond FL), and a preheated light curing composite resin (Filtek Z100).
Cyclic isometric chewing (5 Hz) was simulated, starting with a load of 50N (5000), followed by
stages of 200N, 400N, 600N, 800N, 1000N, 1200N, and 1400N (25,000 each). Samples
were loaded until fracture or to a maximum of 180,000 cycles. The four groups were compared
using the life table survival analysis (Logrank test at P = 0.05).
RESULTS: All composite resin onlays and crowns survived (100% survival rate), while ceramic
ones fractured at an average load of 1347N and 1280N, respectively, (survival rate of 46.7%
and 20%) with a significant difference in survival probability (P < 0.0001). Fractures consisted
in partial or total failure of the restoration only (no abutment failure, no screw loosening).
CONCLUSIONS: Composite resin onlays and crowns bonded to custom zirconia implant
abutments presented a significant higher survival rate when compared to ceramic onlays and
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crowns.
2011 John Wiley & Sons A/S.
Publication Types
J Prosthodont. 2012 Jan;21(1):28-32. doi: 10.1111/j.1532-849X.2011.00773.x. Epub 2011 Oct 18.
57. Fatigue resistance and microleakage of CAD/CAM ceramic and composite
molar crowns.
Kassem AS, Atta O, El-Mowafy O.

Crown and Bridge Department, Suez Canal University, Ismailia, Egypt.
Abstract
PURPOSE: The aim of this study was to determine effect of compressive cyclic loading on
fatigue resistance and microleakage of monolithic CAD/CAM molar ceramic and composite
crowns.
MATERIALS AND METHODS: Thirty-two extracted molars were prepared to receive CEREC
crowns according to manufacturer's guidelines using a special paralleling device (Parallel-APrep). Sixteen feldspathic ceramic crowns (VITABLOCS Mark II) (VMII) and 16 resincomposite crowns (Paradigm-MZ100 blocks) (PMZ) were milled using a CEREC-3D machine.
Eight crowns of each group were cemented to their respective teeth using self-etching resin
cement (Panavia-F-2.0) (PAN), and eight were cemented using self-adhesive resin cement
(RelyX-Unicem-Clicker) (RXU). Following storage for 1 week in water, specimens were
subjected to uniaxial compressive cyclic loading in an Instron testing machine at 12 Hz for
1,000,000 cycles. Load was applied at the central fossa, and the cycle range was 60-600 N.
Specimens were then subjected to microleakage testing. Data were statistically analyzed using
factorial ANOVA and Post Hoc (Tukey HSD) tests.
RESULTS: All composite crowns survived compressive cyclic loading without fracture, while
three ceramic crowns from the subgroup cemented with RXU developed surface cracks at the
center of occlusal surfaces, extending laterally. Microleakage scores of ceramic crowns
cemented with PAN were significantly lower than those of the other three subgroups (p <
0.05).
CONCLUSIONS: After 1,000,000 cycles of compressive cyclic loading, PMZ composite molar
crowns were more fatigue-resistant than VMII ceramic crowns. Cement type had a significant
effect on fatigue resistance of the ceramic crowns but not the composite ones. Microleakage
scores of ceramic crowns cemented with PAN were significantly lower than those of the other
subgroups (p < 0.05).
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2011 by The American College of Prosthodontists.


Clin Oral Implants Res. 2011 Nov;22(11):1275-81. doi: 10.1111/j.1600-0501.2010.02103.x. Epub 2011 Feb 24.
58. Fatigue resistance and failure mode of CAD/CAM composite resin implant
abutments restored with type III composite resin and porcelain veneers.
Magne P, Oderich E, Boff LL, Cardoso AC, Belser UC.
The Don & Sybil Harrington Foundation Chair of Esthetic Dentistry, Division of Restorative Sciences, The Herman
Ostrow School of Dentistry, University of Southern California Los Angeles, CA 90089-7792, USA. magne@usc.edu
Abstract
OBJECTIVES: This study assessed the fatigue resistance and failure mode of type III
porcelain and composite resin veneers bonded to custom composite resin implant abutments.
MATERIAL AND METHODS: Using the CEREC 3 machine, 28 composite resin implant
abutments (Paradigm MZ100) were fabricated along with non-retentive type III veneers, milled
either in ceramic Paradigm C (n=14) or in composite resin Paradigm MZ100 (n=14). The
intaglio surfaces of the veneers were hydrofluoric acid etched and silanated (Paradigm C) or
airborne-particle abraded and silanated (MZ100). The fitting surface of the abutments was
airborne-particle abraded, cleaned, silanated and inserted into a bone level implant (10 mm,
BLI RC). All veneers were luted with adhesive resin (Optibond FL) and a preheated light curing
composite resin (Filtek Z100). Cyclic isometric chewing (5 Hz, 30 angle) was simulated,
starting with a load of 40 N, followed by stages of 80, 120, 160, 200, 240 and 280 N (20,000
cycles each). Samples were loaded until fracture or to a maximum of 140,000 cycles. Groups
were compared using the life table survival analysis (Log rank test at P=0.05). Previously
published data using same-design zirconia abutments were included for comparison.
RESULTS: Paradigm C and MZ100 specimens fractured at an average load of 243 and 206 N
(survival rate of 21% and 0%), respectively, with a significant difference in survival probability
(P=0.02). Fractured specimens presented mixed failure modes and solely adhesive failures
were not observed. The survival of composite resin abutments was similar to that of identical
zirconia abutments from a previous study (P=0.76).
CONCLUSIONS: Non-retentive porcelain veneers bonded to custom composite resin implant
abutments presented a higher survival rate when compared with composite resin veneers.
Survival of composite resin abutment did not differ from zirconia ones.
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Dent Today. 2011 Sep;30(9):66, 68, 70-3.
59. Fixed prosthodontics: time to change the status quo?

Christensen GJ, Child PL Jr.
American Board of Prosthodontics, USA. info@pccdental.com
Abstract
The majority of indirect restorations placed in the United States are currently made by
conventional procedures in 2 or more appointments, including standard impressions using
VPS or polyether, use of dental laboratory technicians to make the restorations, and
conventional cementation procedures. The likelihood of rapid change to digital impressions
and/or in-office milling is not predicted. However, some dentists have changed to making
digital impressions and sending the information to specific dental laboratories to have the
crowns fabricated. In general, they are satisfied with the concept and the restorations thus
produced. It is anticipated that digital impressions will slowly continue to grow until the concept
eventually dominates the market. In-office milling of restorations by CEREC or E4D is now a
reliable clinical process in spite of an arduous and long period of development. It is anticipated
that this concept will continue to grow. At this time, any of the 3 concepts discussed in this
article--conventional procedures, digital impressions sent to a laboratory, or digital impressions
followed by in-office milling--are acceptable depending on the preferences of practitioners.

Dent Mater. 2011 Nov;27(11):1119-26. doi: 10.1016/j.dental.2011.08.004. Epub 2011 Sep 13.
60. Adaptation of all-ceramic fixed partial dentures.

Borba M, Cesar PF, Griggs JA, Della Bona .
Post-Graduation Program in Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil.
Abstract
OBJECTIVES: To measure the marginal and internal fit of three-unit fixed partial dentures
(FPDs) using the micro-CT technique, testing the null hypothesis that there is no difference in
the adaptation between the ceramic systems studied.
METHODS: Stainless steel models of prepared abutments were fabricated to design the
FPDs. Ten FPDs were produced from each framework ceramic (YZ - Vita In-Ceram YZ and IZ
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- Vita In-Ceram Zirconia) using CEREC inLab according to the manufacturer instructions. All
FPDs were veneered using the recommended porcelain. Each FPD was seated on the original
model and scanned using micro-CT. Files were processed using NRecon and CTAn software.
Adobe Photoshop and Image J software were used to analyze the cross-sections images. Five
measuring locations were used as follows: MG - marginal gap; CA - chamfer area; AW - axial
wall; AOT - axio-occlusal transition area; OA - occlusal area. The horizontal marginal
discrepancy (HMD) was evaluated in another set of images. Results were statistically analyzed
using ANOVA and Tukey tests (=0.05).
RESULTS: The mean values for MG, CA, AW, OA and HMD were significantly different for all
tested groups (p<0.05). IZ exhibited greater mean values than YZ for all measuring locations
except for AW and AOT. OA showed the greatest mean gap values for both ceramic systems.
MG and AW mean gap values were low for both systems.
SIGNIFICANCE: The ceramic systems evaluated showed different levels of marginal and
internal fit, rejecting the study hypothesis. Yet, both ceramic systems showed clinically
acceptable marginal and internal fit.
Free PMC Article
Publication Types, MeSH Terms, Substances, Grant Support

Implant Dent. 2011 Oct;20(5):374-8. doi: 10.1097/ID.0b013e3182310e61.
61. Fatigue resistance of 2 different CAD/CAM glass-ceramic materials used
for single-tooth implant crowns.

avuolu Y, Sahin E, Grbz R, Aka K.
Faculty of Dentistry, Hacettepe University, Ankara, Turkey.
Abstract
PURPOSE: To evaluate the fatigue resistance of 2 different CAD/CAM in-office monoceramic
materials with single-tooth implant-supported crowns in functional area.
MATERIALS AND METHODS: A metal experimental model with a dental implant was
designed to receive in-office CAD/CAM-generated monoceramic crowns. Laterally positioned
axial dynamic loading of 300 N at 2 Hz was applied to implant-supported crowns machined
from 2 different glass materials for 100,000 cycle. Failures in terms of fracture, crack
formation, and chipping were macroscopically recorded and microscopically evaluated.
RESULTS: Four of 10 aluminasilicate glass-ceramic crowns fractured at early loading cycles,
the rest completed loading with a visible crack formation. Crack formation was recorded for 2
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of 10 leucite glass-ceramic crowns. Others completed test without visible damage but fractured
upon removal.
DISCUSSION: Lack in chemical adhesion between titanium abutment and dental cement likely
reduces the fatigue resistance of machinable glass-ceramic materials. However, relatively
better fractural strength of leucite glass-ceramics could be taken into consideration.
Accordingly, progress on developmental changes in filler composition of glass-ceramics may
be promising.
CONCLUSION: Machinable glass-ceramics do not possess sufficient fatigue resistance for
single-tooth implant crowns in functional area.

Int J Comput Dent. 2011;14(2):139-46.
62. Impression-free implant restorations with Cerec InLab.

Rauscher O.
Praxis@Dr-Otmar-Rauscher.de
Abstract
The Cerec InLab software 3.80 allows for the fabrication of implant abutments and crowns
without taking impressions. The intraoral optical impression is taken with the help of what is
termed "scanbodies". The custom-made zirconia abutments are bonded to a titanium base and
can thus be fastened with high torques without creating tensile stress.

J Prosthodont. 2011 Oct;20(7):535-40. doi: 10.1111/j.1532-849X.2011.00745.x. Epub 2011 Aug 1.
63. Marginal gap, internal fit, and fracture load of leucite-reinforced ceramic
inlays fabricated by CEREC inLab and hot-pressed techniques.

Keshvad A, Hooshmand T, Asefzadeh F, Khalilinejad F, Alihemmati M, Van Noort R.
Department of Prosthodontics, School of Dentistry, Shahed University, Tehran, Iran.
Abstract
PURPOSE: This in vitro study was designed to evaluate and compare the marginal gap,
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internal fit, and fracture load of resin-bonded, leucite-reinforced glass ceramic mesio-occlusaldistal (MOD) inlays fabricated by computer-aided design/manufacturing (CAD/CAM) or hot
pressing.
MATERIALS AND METHODS: Fifty caries-free extracted human molars were prepared for
standardized MOD inlays. Impressions of each specimen were made and poured using type IV
dental stone. Dies were randomly divided into two equal groups. Twenty-five ceramic inlays
were fabricated by the hot-pressed technique using IPS Empress leucite-reinforced glass
ceramics, and the other 25 ceramic inlays were produced by CAD/CAM technology using
ProCAD leucite-reinforced ceramic blocks and CEREC inLab facilities. Inlays were bonded to
the teeth using a dual-cured resin cement. The specimens were stored in distilled water at
37C for 24 hours and then thermocycled for 5000 cycles. The marginal gap measurements
were taken with a stereomicroscope. Specimens in each group of inlay systems were
randomly divided into two subgroups of 10 and 15 specimens each. Ten specimens in each
subgroup were sectioned mesiodistally for evaluation of the internal fit. The fracture load of
specimens in the second subgroup (n = 15) of the two inlay systems was determined under
compressive load in a universal testing machine. Data were analyzed using Student's t-test at
a significance level of p < 0.05. Results: The mean marginal and internal gap size in both IPS
Empress and ProCAD inlays were less than 100 m; however, the marginal gap for the IPS
Empress restorations was significantly higher than that of ProCAD restorations (p < 0.05).
There was no significant difference in the mean internal fit or the fracture load between the two
glass ceramic inlays (p > 0.05).
CONCLUSIONS: The leucite-reinforced glass ceramic inlay restorations fabricated by CEREC
inLab (CAD/CAM) and the hot-pressed technique provided clinically acceptable marginal and
internal fit with comparable fracture loads after luting.

Drug Metab Dispos. 2011 Oct;39(10):1987-96. doi: 10.1124/dmd.110.036848. Epub 2011 Jul 21.
64. CYP4F3B expression is associated with differentiation of HepaRG human
hepatocytes and unaffected by fatty acid overload.
Madec S, Cerec V, Ple-Gautier E, Antoun J, Glaise D, Salaun JP, Guguen-Guillouzo C, Corlu A.

Centre National de la Recherche Scientifique, UMR 7139, Station Biologique, Roscoff, France.
Abstract
Fatty acid microsomal -oxidation involves cytochrome P450 enzymes. Some of them
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belonging to the CYP4F3 family are mainly expressed in the liver, making this organ a major
player in energy homeostasis and lipid metabolism. To study this important regulation
pathway, we used HepaRG cells, which gradually undergo a complete differentiation process.
Even at the early stage of the differentiation process, CYP4F3B generated by alternative
splicing of the CYP4F3 gene represented the prevalent isoform in HepaRG cells as in the liver.
Its increasing expression associated with hepatocyte differentiation status suggested a
hepatic-specific control of this isoform. As in liver microsomes, the catalytic hydroxylation of
the CYP4F3B substrate [1-C]Z9(10)-epoxystearic acid led to major production of 18-hydroxy9(10)-epoxystearic acid. When treated with saturated, monounsaturated, or polyunsaturated
fatty acids, CYP4F3B and CYP4A11 expression remained unchanged whereas CYP4F2 and
CYP4F12 expression was transiently up-regulated. A 24-h exposure of differentiated HepaRG
cells to various polyunsaturated fatty acids and derivatives induced microvesicular steatosis;
down-regulation of lipid metabolism gene regulators such as sterol regulatory element-binding
protein-1c, fatty acid synthase, peroxisome proliferator-activated receptor (PPAR), PPAR,
and decreased expression of glucose-dependent metabolism genes, which could limit de novo
lipogenesis. Docosahexaenoic acid seemed to be the most effective compound. These results
suggest that a PPAR-independent pathway could participate to limit lipogenesis and
emphasize the role of hepatocytes in the fatty acid -hydroxylation pathway. They also give
insights on the use of HepaRG hepatocytes to open new avenues of investigations on factors
mediating the lipid metabolic pathway and finding new hypolipidemic molecules.
Free full text

Eur J Dent. 2011 Jul;5(3):281-90.
65. Nanoleakage for Self-Adhesive Resin Cements used in Bonding CAD/CAD
Ceramic Material to Dentin.
El-Badrawy W, Hafez RM, El Naga AI, Ahmed DR.

Department of Clinical Sciences, Restorative Discipline, Faculty of Dentistry, University of Toronto, Toronto, Canada.
Abstract
OBJECTIVES: To determine nanoleakage of CAD/CAM ceramic blocks bonded to dentin with
self-adhesive resin cement.
METHODS: Eighteen sound extracted human molars were sterilized and sectioned into 3 mmthick dentin sections. Trilux Cerec Vitablocks (Vita) were also sectioned into 3 mm sections,
surface-treated using 5% hydrofluoric acid-etchant, and then coated with silane primer (Vita).
Trilux and dentin sections were cemented together by means of three resin cements: Rely-X
Unicem (3M/ESPE), BisCem (Bisco), and Calibra (Dentsply), according to manufacturers'
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recommendations. Calibra was used in conjunction with Prime/Bond-NT adhesive (Dentsply),

while the other two are self-adhesive. The bonded specimens were stored for 24h in distilled
water at 37C. Specimens were vertically sectioned into 1 mm-thick slabs, yielding up to six
per specimen. Two central slabs were randomly chosen from each specimen making up the
cement groups (n=12). Each group was subdivided into two subgroups (n=6), a control and a
thermocycled subgroup (5-55C) for 500 cycles. Slabs were coated with nail polish up to 1 mm
from the interface, immersed in a 50% silver nitrate solution for 24h, and tested for
nanoleakage using Quanta Environmental SEM and EDAX. Data were statistically analyzed
using two-way ANOVA and Tukey's post-hoc tests.
RESULTS: Rely-X Unicem and Calibra groups demonstrated no significant difference in the
percentage of silver penetration, while the BisCem group revealed a significantly higher
percentage (P.05). Thermocycling (500 cycles) did not have a statistically significant effect on
the percentage of silver penetration (P>.05).
CONCLUSIONS: One self-adhesive-resin cement demonstrated a similar sealing ability when
compared with a standard resin cement. Thermo-cycling did not significantly increase dye
penetration under the test conditions.
KEYWORDS: Bonding, CAD/CAM, Ceramic blocks, Nanoleakage, Self-adhesive
PMID: 21769269 [PubMed] PMCID: PMC3137441
Free PMC Article
Dent Mater. 2011 Sep;27(9):942-7. doi: 10.1016/j.dental.2011.05.011. Epub 2011 Jun 30.
66. Risk of onlay fracture during pre-cementation functional occlusal tapping.

Magne P, Schlichting LH, Paranhos MP.
Department of Restorative Sciences, Herman Ostrow School of Dentistry of USC, University of Southern California,
Oral Health Center, Los Angeles, CA 90089-7792, USA.
Abstract
OBJECTIVE: To evaluate in vitro the pre-cementation resistance of CAD/CAM onlays
subjected to functional occlusal tapping.
METHODS: An extracted tooth model (molar and premolar) with simulated bone and
periodontal ligament was used to make a mesio-occlusal onlay preparation (two mesial cusps
covered). Immediate dentin sealing was applied to the prepared tooth. The corresponding
onlays were fabricated with Cerec either using composite resin (Paradigm MZ100) or ceramic
(e.max CAD and Mark II) (n=14). An elevated marginal ridge was designed with the intention
of generating hyper-occlusion. Pre-cementation occlusal tapping was simulated using closedloop servo-hydraulics at 2 Hz, starting with a load of 40 N, followed by 80, 120, 160, 200, 240
and 280 N (10 cycles each). All samples were loaded until fracture or to a maximum of 70
cycles. Groups were compared using the life table survival analysis (p=.016, Bonferroni
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method).
RESULTS: Survival probability was MZ100>e.max CAD>Mark II. The restorations made from
e.max CAD and Mark II failed at an average load of 157 N and 123 N, respectively with no
specimen withstanding all 70 load cycles (survival 0%); with MZ100 the survival rate was 36%.
SIGNIFICANCE: Material selection has a significant effect on the risk of CAD/CAM onlay
fracture during pre-cementation functional occlusal tapping with composite resin onlays
showing the minimum risk compared to ceramic ones.

Quintessence Int. 2011 Jul-Aug;42(7):533-7.
67. Esthetic restoration of maxillary incisors using CAD/CAM chairside
technology--a case report.

Seydler B, Schmitter M.
Department of Prosthodonctics, University of Heidelberg, Heidelberg, Germany.
Abstract
High-quality esthetic veneers can be produced in a single treatment session only by means of
chairside CAD/CAM technology. With efficient therapy, the duration of the relatively long
treatment cycle can be optimized: planning casts and a diagnostic wax-up are steps that
simplify therapy decisions, the same as with veneers produced by laboratories. After
production of a mock-up and preparation of the teeth, removable composite veneers can be
prepared and gradually replaced by ceramic veneers. Modern, three-dimensional presentation
by use of the Cerec 3D system facilitates construction of veneers seen in relation to the other
teeth. A very helpful aspect is that the mock-ups can be adjusted to patients' needs during the
complete production process. After individualization by a dental ceramic technician, there is no
recognizable esthetic difference from veneers produced by a laboratory.

Int J Prosthodont. 2011 Jul-Aug;24(4):376-8.
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68. Combined effects of thermocycling and load-cycling on microleakage of
computer-aided design/computer-assisted manufacture molar crowns.
Abstract
This study evaluated the combined effects of thermocycling and compressive load-cycling on
microleakage of computer-aided design/computer-assisted manufacture molar crowns. Sixteen
ceramic (Vita Mark-II) and 16 composite resin (Paradigm MZ-100) crowns were milled using
the CEREC 3D system. Eight crowns of each group were cemented to prepared molars using
Panavia F 2.0, and 8 were cemented using RelyX Unicem Clicker. Specimens were
thermocycled for 500 cycles and subjected to load-cycling for 1,000,000 cycles (60 to 600 N).
Specimens were then tested for microleakage. Data were analyzed statistically using the
Tukey post hoc test. All composite resin crowns survived load and thermal fatigue, while 6
ceramic crowns developed cracks. There were no statistically significant differences among
groups regarding microleakage scores. Paradigm MZ-100 crowns were more crack-resistant to
combined load and thermal fatigue than those composed to Vita Mark-II. However,
microleakage scores of both types of crowns were similar. Int J Prosthodont 2011;24:376-378.
Dent Mater. 2011 Sep;27(9):892-8. doi: 10.1016/j.dental.2011.05.007. Epub 2011 Jun 25.
69. Chairside vs. labside ceramic inlays: effect of temporary restoration and
adhesive luting on enamel cracks and marginal integrity.

Frankenberger R, Krmer N, Appelt A, Lohbauer U, Naumann M, Roggendorf MJ.
Department of Operative Dentistry and Endodontics, Medical Center for Dentistry, University Medical Center
Giessen and Marburg, Georg-Voigt-Str. 3, D-35039 Marburg, Germany. frankbg@med.uni-marburg.de
Abstract
OBJECTIVES: To assess the influence of different temporary restorations and luting
techniques of labside and chairside ceramic inlays on enamel defects and marginal integrity.
METHODS: 120 extracted human third molars received MOD preparations with one proximal
box each limited in either enamel or dentin. 64 Cerec 2 inlays and 56 IPS Empress I inlays
were randomly assigned to the following groups (fabrication mode: chairside (CS)=no
temporary restoration (TR), labside (LS)=TR with Luxatemp (L) inserted with TempBond NE,
or Systemp.inlay (SI) without temporary cement), luting technique: SV=Syntac/Variolink II,
RX=RelyX Unicem: A: Cerec inlays were luted with (1) CS/SV. (2) CS/SV/Heliobond
separately light-cured. (3) CS/RX. (4) LS/L/SV. (5) LS/L/RX. (6) LS/SI/SV. (7) LS/SI/RX. (8)
LS/SI/RX with selective enamel etching. B: Empress. (9) L/SV. (10) L/SV/Heliobond separately
light-cured. (11) L/RX. (12) SI/SV. (13) SI/SV, Heliobond separately lightcured. (14) SI/RX.
(15) SI/RX after selective enamel etching. Before and after thermomechanical loading (TML:
loading time of TR 100050N+25 thermocycles (TC) between +5C and +55C; clinical
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simulation: 100,00050N+2500 TC) luting gaps, enamel cracks, and marginal adaptation to
enamel and dentin were determined under an SEM microscope (200) using replicas.
RESULTS: Loading time of temporary restorations negatively affected enamel integrity and
enamel chipping (p<0.05). Luxatemp resulted in less enamel cracks than Systemp.inlay
(p<0.05). Syntac/Variolink achieved better marginal enamel quality than RelyX Unicem in all
groups (p<0.05). Marginal quality in dentin revealed no differences when no temporary cement
was used (p>0.05). Temporary cement negatively affected dentin margins when RelyX Unicem
was used (p<0.05).
SIGNIFICANCE: Chairside-fabricated Cerec inlays reduce the risk of enamel cracks and
marginal enamel chipping due to omitted temporary restorations. Syntac/Variolink revealed a
significantly better performance than RelyX Unicem.

Minerva Stomatol. 2011 Jun;60(6):311-9.
70. Biaxial flexural strength of CAD/CAM ceramics.

Buso L, Oliveira-Jnior OB, Hiroshi Fujiy F, Leo Lombardo GH, Ramalho Sarmento H, Campos F,
Assuno Souza RO.
So Paulo State University, So Jos dos Campos, Brazil.
Abstract
AIM: Aim of the study was to evaluate the biaxial flexural strength of ceramics processed using
the Cerec inLab system. The hypothesis was that the flexural strength would be influenced by
the type of ceramic.
METHODS: Ten samples (ISO 6872) of each ceramic (N.=50/n.=10) were made using Cerec
inLab (software Cerec 3D) (:15 mm, thickness: 1.2 mm). Three silica-based ceramics (Vita
Mark II [VM], ProCad [PC] and e-max CAD ECAD]) and two yttria-stabilized tetragonalzirconia-polycrystalline ceramics (Y-TZP) (e-max ZirCad [ZrCAD] and Vita In-Ceram 2000 YZ
Cubes [VYZ]) were tested. The samples were finished with wet silicone carbide papers up to 1
200-grit and polished in a polishing machine with diamond paste (3 m). The samples were
then submitted to biaxial flexural strength testing in a universal testing machine (EMIC), 1
mm/min. The data (MPa) were analyzed using the Kruskal-Wallis and Dunn (5%) tests.
Scanning electronic microscopy (SEM) was performed on a representative sample from each
group.
RESULTS: The values (median, meansd) obtained for the experimental groups were: VM
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(101.7, 102.113.65 MPa), PC (165.2, 16034.7 MPa), ECAD (437.2, 416.150.1 MPa),
ZrCAD (804.2, 800.864.47 MPa) and VYZ (792.7, 807100.7 MPa). The type of ceramic
influenced the flexural strength values (P=0.0001). The ceramics ECADa, e-max ZrCADa and
VYZa presented similar flexural strength values which were significantly higher than the other
groups (PCb and VM IIb), which were similar statistically between them (Dunn's test). The
hypothesis was accepted.
CONCLUSION: The polycrystalline ceramics (Y-TZP) should be material chosen for make
FPDs because of their higher flexural strength values.

Int Endod J. 2011 Oct;44(10):926-37. doi: 10.1111/j.1365-2591.2011.01901.x. Epub 2011 Jun 10.
71. Failure analysis and survival rate of post and core restorations under
cyclic loading.
Balkenhol M, Rupf S, Laufersweiler I, Huber K, Hannig M.

Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University Hospital, Homburg Saar,
Germany. markus.balkenhol@uks.eu
Abstract
AIM: To investigate in a laboratory setting the influence of (i) post material (ii) preparation
design and (iii) luting agent on the survival probability of root filled teeth, restored with allceramic restorations.
METHODOLOGY: The crowns of 80 extracted single-rooted human teeth were removed, and
root canal treatment was performed including canal filling with Gutta-percha without sealer
(crown-down-pressureless technique). The root fillings were removed and the root canal
enlarged with a reamer up to size 110. Prefabricated zirconia (CeraPost) or glass-fibrereinforced posts (DentinPost) were luted using either Ketac Cem or Panavia F 2.0. A core
build-up was applied (Clearfil Photocore), and the teeth were prepared with or without a 2-mm
ferrule design (n=10 per experimental group). The prepared teeth were scanned (Cerec 3D)
and crowns fabricated. After luting of the crowns (Ketac Cem), teeth were subjected to
thermocycling (4000, 5-55 C) and cyclic loading (1.5 million cycles, 90 N). After load cycling,
the teeth were immersed in methyleneblue solution for 24 h and subsequently sectioned in
three segments for a dye penetration test. Kaplan-Meyer analysis was performed to assess
the survival probability followed by a Cox regression analysis (=5%).
RESULTS: Teeth prepared using the ferrule design as well as the teeth with DentinPosts
exhibited a significantly higher survival probability (P<0.05). The luting agent was of minor
importance (P>0.05). Most common failure was debonding of posts (CeraPost) and post
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fracture (DentinPost). The majority of the teeth showed dye penetration after cyclic loading.
CONCLUSIONS: Post material and ferrule design were of paramount importance regarding
the survival probability of the post and core restorations using pre-fabricated posts.
DentinPosts showed superior results versus CeraPosts.
2011 International Endodontic Journal.

Int J Comput Dent. 2011;14(1):33-45.
72. The impression-free Cerec multilayer bridge with the CAD-on method.
Wiedhahn K.
Abstract
Two new developments extend the spectrum of the Cerec applications: Cerec-Connect: The
entire mandible and maxilla can be scanned, as well as their relationship to one another, with
the intraoral scanner. Multilayer technique for up to four-unit fixed dental prostheses (FDPs):
the CAD-on technique from Ivoclar is the latest procedure in which a zirconium oxide
framework and a veneer structure of e.max-CAD are bonded together by ceramic. Intraoral
data acquisition with Cerec-Connect, design with Cerec-inLab and fabrication of the three-unit
FDP are described and illustrated with a clinical case, and further developments are
suggested.

Int J Comput Dent. 2011;14(1):11-21.
73. Full arch scans: conventional versus digital impressions--an in-vitro
study.

Ender A, Mehl A.
Department of Computerized Dentistry, Center for Dental Medicine, University of Zurich, Switzerland.
andreas.ender@zzmk.uzh.ch
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Abstract
The digital intraoral impression has become a central part of the CAD/CAM technique. The
objective of the present study was to compare the accuracy (trueness and precision) of digital
impressions of the full arch with that of conventional impressions on the in-vitro model. For this
purpose, a master model was acquired with a new reference scanning process, the measuring
trueness of which was +/- 4.1 microm and the precision +/- 2.5 microm. On the one hand,
conventional impressions and then plaster models (n = 5) were produced from this master
model, and on the other hand, digital impressions were made with the Cerec AC Bluecam and
the Lava COS system (each n = 5). The plaster models were also scanned with the reference
scanner. The available data records were superimposed and the differences determined. The
deviation from the master model defines the trueness of the impression method. The
deviations of the models among one another demonstrate the precision of the method. The
trueness of the impressions was 55 +/- 21.8 microm in the conventional impression group, for
digital impressions with Cerec Bluecam it was 49 +/- 14.2 microm and for digital impressions
with Lava COS 40.3 +/- 14.1 microm. The precision was 61.3 +/- 17.9 microm for conventional
impression with Impregum, 30.9 +/- 7.1 microm for digital impression with the Cerec Bluecam
and 60.1 +/- 31.3 microm for digital impression with Lava COS. These in-vitro results show that
accuracy of the digital impression is similar to that of the conventional impression. These
results will have to be confirmed in further clinical studies.

Int J Comput Dent. 2010;13(4):351-65.
74. Three-dimensionally layered ceramic blocks.

Kurbad A.
info@cerec.de
Erratum in
Int J Comput Dent. 2011;14(1):54.
Abstract
With the aid of an innovatively structured ceramic block, it is possible to achieve results at a
high esthetic level with relatively simple means. In the three-dimensionally structured Vitablocs
RealLife, translucent enamel ceramic is arranged around a conically structured, opaque dentin
core. The virtual restoration can be positioned freely in all three dimensions with the aid of the
Cerec/inLab software. The restorations are milled fully anatomically and only minimally glazed
or characterized with stains. Results that otherwise can be achieved only with much more
complex layering processes are possible.
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Int J Comput Dent. 2010;13(4):331-40.
75. Color correspondence of different batches of TriLuxe CAD/CAM ceramic
blocks.

Vichi A, Carrabba M, Louca C, Corciolani G, Ferrari M.
Department of Dental Materials, School of Dentistry, University of Siena, Siena, Italy. vichialessandro@virgilio.it
Abstract
TriLuxe ceramic blocks for chairside CAD/CAM procedures are color layered to allow natural
esthetics, and only require subsequent glazing. The purpose of this study was to compare
color repeatability of different batches of TriLuxe blocks. The three commercially available
shades (1M2C, 2M2C, 3M2C) of TriLuxe blocks for the Cerec CAD/CAM system were
examined. For each of the three colors, three different batches were tested, 5 blocks each.
The measurements were made using a spectrophotometer equipped with an integrating
sphere using the CIELab* colorimetric system. One-way ANOVA showed that the factor
"Production Batch" was not statistically significant. Regarding deltaE, none of the 315 color
comparisons (neither within the same shade, nor between specimens of the same batch, nor
between specimens from different batches) exceeded the proposed deltaE = 3.3 threshold for
clinical acceptability. All the different batches of the different shades of VITA TriLuxe blocks for
the Cerec system showed the high degree of color correspondence necessary in industrially
prefabricated CAD/CAM blocks.

Int J Comput Dent. 2010;13(4):303-16.
76. Accuracy of occlusal contacts for crowns with chairside CAD/CAM
techniques.

Fasbinder DJ, Poticny DJ.
University of Michigan School of Dentistry, Ann Arbor, Michigan 48109-1078, USA. djfas@umich.edu
Abstract
Information from the opposing dentition is used to design and fabricate occlusal contacts with
a reasonable level of accuracy for a given restoration. The dental database with the antagonist
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design process utilizes a bite registration to propose the construction of a virtual opposing
model. The Articulation design technique utilizes a functionally generated bite registration to
control both the maximum intercuspation and excursive contacts on the restoration.
Correlation design technique offers the opportunity to copy the established occlusal anatomy
to the preparation. Although these techniques offer a workflow to establish occlusal contacts
with the Cerec system, there is a lack of quantitative data as to the accuracy achieved.
Alternative techniques to control the occlusal contacts have been suggested which rely on
"user customized design techniques" that recommend altered program settings, manual
override of automated features in the software, or modification of the established software
design programs. The purpose of this study was to measure the occlusal vertical discrepancy
for various design techniques. Full crowns made using dental database with the antagonist
design technique had a significantly smaller occlusal vertical discrepancy than those made
with correlation. Dental Database with the Antagonist had a significantly smaller occlusal
vertical discrepancy than all suggested alternative design techniques. Use of the Dental
Database with Antagonist design technique provides the most accurate technique for
establishing occlusal contacts with the Cerec 3D system.

Acta Odontol Scand. 2011 May;69(3):182-92. doi: 10.3109/00016357.2010.549504. Epub 2011 Jan 13.
77. Effect of resin coating and occlusal loading on microleakage of Class II
computer-aided design/computer-aided manufacturing fabricated ceramic

restorations: a confocal microscopic study.
Kitayama S, Nasser NA, Pilecki P, Wilson RF, Nikaido T, Tagami J, Watson TF, Foxton RM.
Cariology and Operative Dentistry, Department of Restorative Science, Graduate School, Tokyo Medical and Dental
University, Tokyo, Japan. nuevo_centro@yahoo.co.jp
Abstract
OBJECTIVE: To evaluate the effect of resin coating and occlusal loading on microleakage of
class II computer-aided design/computer-aided manufacturing (CAD/CAM) ceramic
restorations.
MATERIAL AND METHODS: Molars were prepared for an mesio-occlusal-distal (MOD) inlay
and were divided into two groups: non-coated (controls); and resin-coated, in which the cavity
was coated with a combination of a dentin bonding system (Clearfil Protect Bond) and a
flowable resin composite (Clearfil Majesty Flow). Ceramic inlays were fabricated using the
CAD/CAM technique (CEREC 3) and cemented with resin cement (Clearfil Esthetic Cement).
After 24 h of water storage, the restored teeth in each group were divided into two subgroups:
unloaded or loaded with an axial force of 80 N at a rate of 2.5 cycles/s for 250,000 cycles while
stored in water. After immersion in 0.25% Rhodamine B solution, the teeth were sectioned
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bucco-lingually at the mesial and distal boxes. Tandem scanning confocal microscopy (TSM)
was used for evaluation of microleakage. The locations of the measurements were assigned to
the cavity walls and floor.
RESULTS: Loading did not have a significant effect on microleakage in either the resin-coated
or non-coated group. Resin coating significantly reduced microleakage regardless of loading.
The cavity floor exhibited greater microleakage compared to the cavity wall. TSM observation
also revealed that microleakage at the enamel surface was minimal regardless of resin
coating. In contrast, non-coated dentin showed extensive leakage, whereas resin-coated
dentin showed decreased leakage.
CONCLUSIONS: Resin coating with a combination of a dentin-bonding system and a flowable
resin composite may be indicated prior to impression-taking when restoring teeth with
CAD/CAM ceramic inlays in order to reduce microleakage at the tooth-resin interface.

Dent Mater. 2011 May;27(5):431-8. doi: 10.1016/j.dental.2010.10.026. Epub 2011 Jan 12.
78. Evaluation of failure risks in ceramic restorations for endodontically
treated premolar with MOD preparation.

Lin CL, Chang YH, Pai CA.
Department of Biomedical Engineering, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112,
Taiwan. cllin2@ym.edu.tw
Abstract
OBJECTIVES: This study evaluated the risk of failure for an endodontically treated premolar
with MOD preparation and three CEREC ceramic restoration configurations.
METHODS: Simulations were performed based on three 3D finite element (FE) models
designed with CEREC ceramic inlay, endocrown and conventional crown restorations. Longterm failure probability in relation to varying load conditions was calculated by incorporating the
Weibull function in FE analysis. Additionally, the final fracture strength and corresponding load
value of the first acoustic emission (AE) activity in each specimen was recorded by performing
in vitro AE analysis in CEREC restored teeth compressive testing.
RESULTS: Simulation results indicated that the stress values on the enamel, dentin and luting
cement for endocrown restorations were the lowest ones among the corresponding values for
inlay and conventional crown restorations. Weibull analysis indicated that failure probability
was 95%, 2% and 2% for the inlay, endocrown and conventional crown restorations,
respectively, for normal biting. AE analysis revealed that, although the significantly least load
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was required for the first AE activity for inlay configuration, the endocrown and conventional
crowns did not significantly differ from each other.
SIGNIFICANCE: This in vitro study, i.e. numerical and AE analyses, suggest that endocrown
and conventional crown restorations for endodontically treated premolars with MOD
preparation present a similar longevity.

Am J Dent. 2010 Oct;23(5):240-6.
79. Controlled, prospective, randomized, clinical evaluation of partial ceramic
crowns inserted with RelyX Unicem with or without selective enamel

etching. 1-year results.
Schenke F, Federlin M, Hiller KA, Moder D, Schmalz G.
Department of Operative Dentistry and Periodontology, University Medical Center Regensburg, Dental School,
University of Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
Frederike.Schenke@klinik.uni-regensberg.de
Abstract
PURPOSE: To compare the performance of partial ceramic crowns (PCCs) inserted with
RelyX Unicem (RXU) either with (RXU+E) or without (RXU) selective enamel etching.
METHODS: 34 patients (15 male, 19 female) participated in the investigation, with a total of 68
PCC restorations. In each patient, one PCC was randomly assigned to insertion with RXU, the
second PCC was assigned to insertion with RXU+E. The PCCs were CAD/CAM fabricated
using the Cerec 3 system. RXU: 25 PCCs were placed in molars, nine in premolars. RXU+E:
26 PCCs were placed in molars, eight in premolars. The restorations were clinically rated
using modified United States Public Health Service (USPHS) criteria at baseline, 6 and 12
months after placement. The median patient age was 41 years (24-59 years). The median (2575%) PBI was 6% (3-9%).
RESULTS: All patients were available for the three recall appointments. One PCC (RXU)
debonded after 11 months in situ, one PCC (RXU+E) fractured after 12 months in situ. Both
restorations had to be replaced. At the 12 months recall, 66 of 68 controlled restorations were
functional without need of replacement. The evaluation using USHPS criteria revealed a
significant decrease of alfa ratings over time with respect to criteria marginal adaptation and
marginal discoloration. No statistically significant differences between the two luting
techniques, RXU and RXU+E, we reobserved during the observation period of 1 year. Within
the limitations of the present study, adhesive luting with RXU with or without selective enamel
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etching can be recommended.


Vojnosanit Pregl. 2010 Oct;67(10):812-8.
80. [Accuracy of optical scanning methods of the Cerec 3D system in the
process of making ceramic inlays].

[Article in Serbian]
Trifkovi B, Todorovi A, Lazi V, Draganjac M, Mirkovi N, Joki B.

Stomatoloski fakultet, Klinika za stomatolosku protetiku, Beograd, Srbija. brankatr@yahoo.com
Abstract
BACKGROUND/AIM: One of the results of many years of Cerec 3D CAD/CAM system
technological development is implementation of one intraoral and two extraoral optical
scanning methods which, depending on the current indications, are applied in making fixed
restorations. The aim of this study was to determine the degree of precision of optical scanning
methods by the use of the Cerec 3D CAD/CAM system in the process of making ceramic
inlays.
METHODS: The study was conducted in three experimental groups of inlays prepared using
the procedure of three methods of scanning Cerec 3D system. Ceramic inlays made by
conventional methodology were the control group. The accuracy of optical scanning methods
of the Cerec 3D system computer aided design-computer aided manufacturing (CAD/CAM)
was indirectly examined by measuring a marginal gap size between inlays and demarcation
preparation by scanning electron microscope (SEM).
RESULTS: The results of the study showed a difference in the accuracy of the existing
methods of scanning dental CAD/CAM systems. The highest level of accuracy was achieved
by the extraoral optical superficial scanning technique. The value of marginal gap size inlays
made with the technique of extraoral optical superficial scanning was 32.97 +/- 13.17 mus.
Techniques of intraoral optical superficial and extraoral point laser scanning showed a lower
level of accuracy (40.29 +/- 21.46 mus for inlays of intraoral optical superficial scanning and
99.67 +/- 37.25 mus for inlays of extraoral point laser scanning).
CONCLUSION: Optical scanning methods in dental CAM/CAM technologies are precise
methods of digitizing the spatial models; application of extraoral optical scanning methods
provides the highest precision.

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Clin Oral Implants Res. 2011 Feb;22(2):195-200. doi: 10.1111/j.1600-0501.2010.02012.x. Epub 2010 Oct 6.
81. Fatigue resistance and failure mode of novel-design anterior single-tooth
implant restorations: influence of material selection for type III veneers

bonded to zirconia abutments.
Magne P, Paranhos MP, Burnett LH Jr, Magne M, Belser UC.
Division of Restorative Sciences, School of Dentistry, University of Southern California, 3151 S. Hoover St., Los
Angeles, CA 90089-7792, USA. magne@usc.edu
Abstract
OBJECTIVES: This study assessed the fatigue resistance and failure mode of type III
porcelain and composite resin veneers bonded to custom zirconia implant abutments.
MATERIAL AND METHODS: Twenty-four standardized zirconia implant abutments were
fabricated. Using the CEREC 3 machine, type III veneers of standardized shape were milled in
ceramic Vita Mark II or in composite resin Paradigm MZ100. The intaglio surfaces of the
restorations were hydrofluoric acid etched and silanated (Mark II) or airborne-particle abraded
and silanated (MZ100). The fitting surface of the abutments was airborne-particle abraded,
cleaned, and inserted into a bone level implant (BLI RC SLActive 10 mm). All veneers (n=24)
were adhesively luted with a zirconia primer (Z-Prime Plus), adhesive resin (Optibond FL) and
a pre-heated light-curing composite resin (Filtek Z100). Cyclic isometric chewing (5 Hz) was
simulated, starting with a load of 40 N, followed by stages of 80, 120, 160, 200, 240, and 280
N (20,000 cycles each). Samples were loaded until fracture or to a maximum of 140,000
cycles. Groups were compared using the life table survival analysis (Logrank test at P=.05).
RESULTS: Mark II and MZ100 specimens fractured at an average load of 216 N and 229 N
(survival rate of 17% and 8%), respectively, with no difference in survival probability (P=.18).
Among the fractured samples, 40% of the failures were at the abutment level for Mark II and
27% were at the abutment level for MZ100. No exclusive adhesive failures were observed.
CONCLUSIONS: Type III Mark II and Paradigm MZ100 veneers showed similar fatigue
resistance when bonded to custom non-retentive zirconia implant abutments. The bond was
strong enough to induce abutment fractures. MZ100 presented a higher percentage of
"friendly" failures, i.e. maintaining the restoration-abutment adhesive interface and the
abutment itself intact.

J Prosthet Dent. 2010 Nov;104(5):301-5. doi: 10.1016/S0022-3913(10)60144-8.
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82. Sensitivity of transillumination for detecting microcracks in feldspathic
and zirconia ceramic materials.
Beck N, Graef F, Gerstbrein O, Karl M.

Department of Prosthodontics, University of Erlangen-Nuremberg, Erlangen, Germany.
Abstract
STATEMENT OF PROBLEM: Despite good clinical success rates of ceramic restorations,
fractures of substructures made from high-strength dental ceramics remain an issue.
Transillumination of ceramic restorations has been proposed as a means of quality assurance.
PURPOSE: The purpose of this study was to compare the sensitivity of transillumination and
the fluorescent penetrant method (FPM) in detecting microcracks in zirconia and feldspathic
ceramic materials.
MATERIAL AND METHODS: Two groups (n=20) of standardized plates were fabricated from
zirconia ceramic (Cercon) and feldspathic ceramic (VITABLOCS Mark II for CEREC) materials,
and central holes were created to induce microcracks. The plates were microscopically
analyzed at 20 magnification by means of transillumination and FPM. Based on whether the
criterion crack was recognized or not recognized, contingency tables were developed. Fisher's
exact test for count data was used to compare frequency distributions (=.05).
RESULTS: Minimum crack length as detected by FPM was 18 m in zirconia ceramic and 17
m in feldspathic ceramic. For transillumination, minimum detectable crack length was 54 m
in zirconia ceramic and 33 m in feldspathic ceramic. Thirty-seven percent of cracks in
feldspathic ceramic plates and 64% of cracks in zirconia ceramic plates could not be detected
by means of transillumination. The conditional probabilities for a crack being detected by
transillumination, although it was detected by FPM, were significantly lower than 1 for both
materials (P<.001). Although transillumination was less sensitive than FPM on a relative scale,
it was not possible to demonstrate a general difference between the 2 analyzing techniques by
using statistical methods.
CONCLUSIONS: Using FPM as a relative reference system, transillumination appears to be
less sensitive in detecting microcracks in ceramic components.

Dent Mater. 2011 Feb;27(2):109-13. doi: 10.1016/j.dental.2010.09.002. Epub 2010 Oct 8.
83. Influence of material selection on the risk of inlay fracture during prehttp://www.ncbi.nlm.nih.gov/pubmed
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cementation functional occlusal tapping.

Magne P, Paranhos MP, Schlichting LH.
Department of Restorative Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los
Angeles 90089-7792, USA. magne@usc.edu
Abstract
OBJECTIVE: To evaluate in vitro the pre-cementation resistance of CAD/CAM inlays
subjected to functional occlusal tapping.
METHODS: An extracted tooth model (molar and premolar) with simulated bone and
periodontal ligament was used to make a medium-size mesio-occlusal inlay preparation
(molar). Immediate dentin sealing was applied to the prepared tooth. The corresponding inlays
were fabricated with Cerec either using composite resin (Paradigm MZ100) or ceramic (e.max
CAD and Mark II) blocks (n=14). A high marginal ridge was designed in order to generate
hyper-occlusion. Pre-cementation occlusal tapping was simulated using closed-loop servohydraulics at 2 Hz, starting with a load of 40 N, followed by 80, 120, 160, 200, 240, and 280 N
(10 cycles each). All samples were loaded until fracture or to a maximum of 70 cycles. Groups
were compared using the life table survival analysis (p=0.016, Bonferroni method).
RESULTS: Survival probability was e.max CAD>MZ100>Mark II. None of the specimens
survived the 70 cycles except for two e.max CAD inlays (survival: 14%).
SIGNIFICANCE: Material selection has a significant effect on the risk of Cerec inlay fracture
during pre-cementation functional occlusal tapping.
Copyright 2010 Academy of Dental Materials. Published by Elsevier Ltd. All rights
reserved.

J Med Chem. 2010 Nov 11;53(21):7647-63. doi: 10.1021/jm1007648.
84. Targeting the polyamine transport system with benzazepine- and azepine-
polyamine conjugates.
Tomasi S, Renault J, Martin B, Duhieu S, Cerec V, Le Roch M, Uriac P, Delcros JG.

Produits Naturels-Synthses-Chimie Mdicinale, Sciences Chimiques de Rennes, CNRS UMR 6226, Facult de
Pharmacie, Universit Rennes 1, Universit Europenne de Bretagne, Rennes Cedex, France.
Abstract
The polyamine transport system (PTS) whose activity is up-regulated in cancer cells is an
attractive target for drug design. Two heterocyclic (azepine and benzazepine) systems were
conjugated to various polyamine moieties through an amidine bound to afford 18 compounds
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which were evaluated for their affinity for the PTS and their ability to use the PTS for cell
delivery. Structure-activity relationship studies and lead optimization afforded two attractive
PTS targeting compounds. The azepine-spermidine conjugate 14 is a very selective substrate
of the PTS that may serve as a vector for radioelements used for diagnoses or therapeutics in
nuclear medicine. The nitrobenzazepine-spermine conjugate 28 is a very powerful PTS
inhibitor with very low intrinsic cytotoxicity, able to prevent the growth of polyamine depleted
cells in presence of exogenous polyamines.

Int J Comput Dent. 2010;13(3):275-81.
85. Efficient quadrant restoration with the new Cerec software.

Fritzsche G.
German Society of Computerized Dentistry info@drfritzsche.com
Abstract
Quadrant restoration has been an integral part of the software since the Cerec 3-D program
was introduced. In the new 3.80 version, the program also offers the option of scanning the
opposite jaw and correlating it with the prepared jaw by a buccal scan. This innovation is
especially appropriate when several teeth in a quadrant are being restored. The procedure is
described in detail in this article.

Int J Comput Dent. 2010;13(3):265-73.
86. Registration of occlusion by buccal scan in Cerec software version 3.80.

Mller HC.
dr-hans-mueller@gmx.de
Abstract
With the software version 3.80, the Sirona company also delivers the Buccal Scan feature,
among other features. This opens up a completely new way of high-precision registration of
the occlusion. The new method can be used easily and universally.
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MeSH Terms
Int J Comput Dent. 2010;13(3):221-31.
87. Digital 3-D implant planning: Cerec meets Galileos.

Bindl A, Ritter L, Mehl A.
Computer Restoration Station, Department of Preventive Dentistry, Periodontology and Cariology, Center of Dental,
Oral and Maxillofacial Medicine, University of Zurich, Switzerland. andreas.bindl@zzmk.uzh.ch
Abstract
Prosthetically based implant planning is necessary so that implants are set expediently and
correctly during surgery. A clinical case is presented to describe how this can be performed
today purely digitally. Prosthetic planning was undertaken with the Cerec CAD/CAM system.
The data record created was transferred and superimposed on a CBCT 3-D radiograph. The
position of the implant was planned taking the prosthetic planning into account.

J Prosthet Dent. 2010 Sep;104(3):149-57. doi: 10.1016/S0022-3913(10)60111-4.
88. In vitro fatigue resistance of CAD/CAM composite resin and ceramic
posterior occlusal veneers.
Magne P, Schlichting LH, Maia HP, Baratieri LN.

University of Southern California, Herman Ostrow School of Dentistry of USC, Los Angeles, Calif, USA.
magne@usc.edu
Abstract
STATEMENT OF PROBLEM: Thin, bonded, posterior occlusal veneers constitute a
conservative alternative to traditional complete coverage crowns. Information regarding
selection of the appropriate material and its influence on fatigue resistance, which may affect
the longevity of the restoration, is missing.
PURPOSE: The purpose of this study was to assess and compare the fatigue resistance of
composite resin and ceramic posterior occlusal veneers.
MATERIAL AND METHODS: Thirty extracted molars received a standardized nonretentive
tooth preparation (simulating advanced occlusal erosion), including removal of occlusal
enamel, exposure of dentin, and immediate dentin sealing (Optibond FL). All teeth were
restored with a 1.2-mm-thick occlusal veneer (Cerec 3 chairside CAD/CAM system). The
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restorations (n=10) were milled from leucite-reinforced and lithium disilicate ceramics (IPS
Empress CAD and IPS e.max CAD, respectively) and a composite resin (Paradigm MZ100).
The intaglio surfaces of the ceramic restorations were conditioned by hydrofluoric acid etching
and silane. Airborne-particle abrasion and silane were used to condition the composite resin
restorations. Preparations were airborne-particle abraded and etched. All restorations were
bonded with preheated luting material and submitted to cyclic isometric loading at 5 Hz,
starting with a load of 200 N (x5000 cycles), followed by stepwise loading of 400, 600, 800,
1000, 1200, and 1400 N at a maximum of 30,000 cycles each. The number of cycles at initial
failure (first cracks) was recorded. Specimens were loaded for a maximum of 185,000 cycles.
Groups were compared using the life table survival analysis (alpha=.016, Bonferroni method).
RESULTS: IPS Empress CAD failed at an average load of 900 N, with no specimen
withstanding all 185,000 load cycles (survival 0%), while IPS e.max CAD and Paradigm
MZ100 demonstrated survival rates of 30% and 100%, respectively. None of the specimens
exhibited catastrophic failure, but only cracks limited to the restorative material.
CONCLUSIONS: Posterior occlusal veneers made of composite resin (Paradigm MZ100) had
significantly higher fatigue resistance (P<.002) compared to IPS Empress CAD and IPS e.max
CAD.

J Dent. 2010 Dec;38(12):980-6. doi: 10.1016/j.jdent.2010.08.011. Epub 2010 Aug 22.
89. Evaluation of the marginal integrity of ceramic copings with different
marginal angles using two different CAD/CAM systems.

Giannetopoulos S, van Noort R, Tsitrou E.
Academic Unit of Restorative Dentistry, School of Clinical Dentistry, University of Sheffield, Claremont Crescent, S10
2TA, Sheffield, UK.
Abstract
OBJECTIVES: To investigate and compare the marginal integrity of ceramic copings
constructed with the CEREC3 and the EVEREST system employing three different margin
angle designs and explore to what extent these CAD/CAM machines can produce acute
marginal angles creating restorations with acceptable margins.
MATERIALS AND METHODS: Three brass models were prepared with a different marginal
finish line, namely a 0 bevel (or 90 shoulder), a 30 bevel and a 60 bevel. Ten restorations
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were produced for each finishing line and CAD/CAM system, respectively. The copings were
milled from lithium disilicate glass ceramic blocks (IPS e.max() CAD). An impression was
taken for each model to fabricate a series of 10 replica dies for each marginal design.
Quantitative analysis of the margins of each coping was performed using digital photography
and image analysis software. The marginal integrity of the restorations was evaluated by
detecting and measuring any signs of marginal chipping and the Chipping Factor (CF) was
calculated. Statistical analysis was performed using Univariate Analysis of Variance and
multiple comparisons (Tukey HSD).
RESULTS: The average Chipping Factor (CF) of the CEREC copings was: 2.8% for the 0
bevel angle, 3.5% for the 30 bevel angle and 10% for the 60 bevel angle. For the EVEREST
copings the average CF was: 0.6% for the 0 bevel angle, 3.2% for the 30 bevel angle and
2.0% for the 60 bevel angle. Univariate Analysis of Variance and multiple comparisons
showed that there was a statistically significant difference in the quality of margins between the
two systems for the 0 and 60 bevel finishing line.
CONCLUSIONS: The results of this study indicated that the introduction of a marginal angle of
the restoration increases the potential for marginal chipping. Different CAD/CAM systems
which employ different milling processes produce restorations with different amount of
marginal chipping, although this only became apparent for a marginal angle of a 60.
Copyright 2010 Elsevier Ltd. All rights reserved.

J Prosthodont. 2010 Oct;19(7):523-30. doi: 10.1111/j.1532-849X.2010.00637.x. Epub 2010 Aug 16.
90. Microleakage of porcelain and composite machined crowns cemented
with self-adhesive or conventional resin cement.

Ghazy M, El-Mowafy O, Roperto R.
Department of Conservative Dentistry and Fixed Prosthodontics, Faculty of Dentistry, University of Mansoura,
Mansoura, Egypt. mghazy@mans.edu.eg
Abstract
PURPOSE: Resistance of machined crowns to microleakage when cemented with new selfadhesive cements has not been fully investigated. This study evaluated microleakage of
machined crowns milled from porcelain and composite blocks and bonded to teeth with selfadhesive and conventional resin cement.
MATERIALS AND METHODS: Thirty-two freshly extracted premolars of similar shape and
size were sterilized and mounted in resin blocks. Teeth received standard crown preparations
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with 1-mm circumferential shoulder finish line, flat occlusal surface reduced by 2 mm, and ideal
angle of convergence. Prepared teeth were divided into two equal groups and assigned to
either porcelain (Vita Mark II, Vident) or composite (Paradigm MZ100, 3M ESPE) blocks for
crown fabrication. Optical impressions were captured for each tooth with the intraoral camera
of a CEREC 3D machine. Crowns were designed and milled from both materials. Each group
was then subdivided into two subgroups (n = 8) according to cement used (self-adhesive resin
cement, RelyX Unicem, 3M ESPE or resin cement with self-etching adhesive, Panavia F 2.0,
Kuraray). Following seating, a 5-kg weight was applied on the occlusal surface of the crown for
5 minutes. Specimens were then stored in water at 37C for 24 hours. Specimens were
thermocycled for 3000 cycles between 5C and 55C, then coated with nail varnish and
immersed in a 2.0% basic red fuchsine dye solution for 24 hours. Teeth were then rinsed and
sectioned mesiodistally and assessed under magnification for microleakage. A five-point scale
was used to score degree of microleakage. Data were statistically analyzed with 2-way
ANOVA and Kruskal-Wallis nonparametric test.
RESULTS: Crown material had no significant effect on microleakage (p= 0.67); however,
cement type had a significant effect (p < 0.0001), with Panavia F 2.0 resulting in lower
microleakage scores than RelyX Unicem.
CONCLUSIONS: Compared to the self-adhesive cement, the resin cement with separate
primer/bonding agent resulted in significantly lower microleakage scores, irrespective of crown
material.

J Prosthodont. 2010 Dec;19(8):606-13. doi: 10.1111/j.1532-849X.2010.00640.x. Epub 2010 Aug 16.
91. Influence of preliminary damage on the load-bearing capacity of zirconia
fixed dental prostheses.
Kohorst P, Butzheinen LO, Dittmer MP, Heuer W, Borchers L, Stiesch M.

Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Germany.
Kohorst.Philipp@mh-hannover.de
Abstract
PURPOSE: The objective of this investigation was to evaluate the influence of differently
shaped preliminary cuts in combination with artificial aging on the load-bearing capacity of
four-unit zirconia fixed dental prostheses (FDPs).
MATERIALS AND METHODS: Forty frameworks were fabricated from white-stage zirconia
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blanks (InCeram YZ, Vita) by means of a computer-aided design/computer-aided

manufacturing system (Cerec inLab, Sirona). Frameworks were divided into four
homogeneous groups with ten specimens each. Prior to veneering, frameworks of two groups
were "damaged" by defined saw cuts of different dimensions, to simulate accidental flaws
generated during shape cutting. After the veneering process, FDPs, with the exception of a
control group without preliminary damage, were subjected to thermal and mechanical cycling
(TMC) during 200 days storage in distilled water at 36C. Following the aging procedure, all
specimens were loaded until fracture, and forces at fracture were recorded. The statistical
analysis of force at fracture data was performed using two-way ANOVA, with the level of
significance chosen at 0.05.
RESULTS: Neither type of preliminary mechanical damage significantly affected the loadbearing capacity of FDPs. In contrast, artificial aging by TMC proved to have a significant
influence on the load-bearing capacity of both the undamaged and the predamaged zirconia
restorations (p < 0.001); however, even though load-bearing capacity decreased by about 20%
due to simulated aging, the FDPs still showed mean load-bearing capacities of about 1600 N.
CONCLUSIONS: The results of this study reveal that zirconia restorations have a high
tolerance regarding mechanical damages. Irrespective of these findings, damage to zirconia
ceramics during production or finishing should be avoided, as this may nevertheless lead to
subcritical crack growth and, eventually, catastrophic failure. Furthermore, to ensure long-term
clinical success, the design of zirconia restorations has to accommodate the decrease in loadbearing capacity due to TMC in the oral environment.

Am J Dent. 2010 Jun;23(3):161-7.
92. Controlled, prospective clinical split-mouth study of cast gold vs. ceramic
partial crowns: 5.5 year results.

Federlin M, Hiller KA, Schmalz G.
Department of Operative Dentistry and Periodontology, Dental School, University of Regensburg, Franz-JosefStrauss-Allee 11, 93042 Regensburg, Germany. marianne.federlin@klinik.uni-regensburg.de
Abstract
PURPOSE: To investigate the long-term clinical performance of cast gold partial crowns
(CGPCs) as compared to partial ceramic crowns (PCCs). The null hypothesis tested was that
CGPCs and PCCs would show similar clinical outcomes. In the present evaluation, the 5.5
year results are reported.
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This
was a controlled, prospective, clinical split-mouth study. In each patient, one CGPC
METHODS:
(Degulor C) and one PCC (Vita Mark II ceramic/Cerec 3) had been inserted at
baseline. After 5.5 years, 22 CGPC and 22 PCC restorations in 22 subjects attending the
recall visit were clinically assessed using modified United States Public Health Service
(USPHS) criteria. Kaplan-Meier survival rates were calculated for CGPCs and PCCs of the 29
subjects who had been originally enrolled in the study.
RESULTS: 22 subjects (8 male, 14 female) participated in the 5.5-year recall with a total of 44
restorations. 22 CGPCs and 11 PCCs were placed in molars; 11 PCCs were placed in
premolars. The median patient age was 37 years (32-44 years). All subjects revealed a papilla
bleeding index (PBI) of < 20% (median: 7%). After 5.5 years, PCCs revealed a statistically
significant, time dependant decrease of Alfa ratings for criteria anatomic form, marginal
adaptation and marginal discoloration. Furthermore, PCCs as compared to CGPCs showed a
statistically significant material-related decrease of Alfa ratings for criteria anatomic form and
marginal discoloration. Kaplan-Meier survival analysis revealed a 93.3% cumulative survival
rate for CGPCs and an 88.8% cumulative survival rate for PCCs after 5.5 years. Survival
functions did not differ significantly across groups. At 5.5 years, CGPCs and PCCs exhibited
satisfactory clinical outcomes. For PCCs, Bravo ratings increased significantly over time,
however this did not compromise clinical survival of the restorations as compared to CGPCs.

Int J Comput Dent. 2010;13(2):155-67.
93. The computer-aided overpress (CAO) technique--principles and a case
example.

Ellerbrock C.
c.ellerbrock@t-online.de
Abstract
It is possible for the first time with the computer-aided overpress technique to produce allceramic fixed dental prostheses (FDP) largely by CAD/CAM methods. The advantage of the
technology is that a workflow is created in which already acquired data are used to the
maximum within the Cerec software, and thus the manufacturing depth can be increased. This
happens both by production of a crown or FDP framework, and by the additional design of the
crown or FDP surface. Also, no joint seam is created between the framework ceramic and the
sleeve ceramic by overpressing, since the two different ceramics do not have to be bonded
with one another. In addition, subsequent changes can be made to the finished workpiece
without having to take any bonding materials into account.
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Int J Comput Dent. 2010;13(2):141-54.
94. Cerec3D endocrowns--two-year clinical examination of CAD/CAM crowns
for restoring endodontically treated molars.

Bernhart J, Bruning A, Altenburger MJ, Wrbas KT.
Department of Dental Prosthetics, University Clinic for Dental Oral and Craniomandibular Sciences, Clinic of the
Albert Ludwigs University Freiburg, Germany. jasmin.bernhart@uniklinik-freiburg.de
Abstract
The present clinical study evaluates the clinical prognosis of Cerec3D endocrowns over an
observation period of two years. Twenty Cerec endocrowns (VITABLOCS Mark II, Vita
Zahnfabirk, Bad Sckingen, Germany) were placed with PanaviaTM F 2.0, a dual-curing
bonding composite. The control examinations took place semi-annually and the restorations
were evaluated based on modified US Public Health Service criteria (USPHS). The two-year
survival rate of the Cerec endocrowns was 90%. Two out of 20 endocrowns were assessed as
failure because of fractures. The first fracture was observed after 12 months and the second
fracture after 18 months. No recurrent caries was diagnosed during the entire examination
period. Slight percussion symptoms were found on three restorations in the first weeks after
placement. The results of the present study show that good esthetic and functional results
similar to those of other restoration types can be achieved with endocrowns and that
CAD/CAM-fabricated crowns represent a very promising treatment alternative for
endodontically treated molars.

Eur J Radiol. 2011 Nov;80(2):432-40. doi: 10.1016/j.ejrad.2010.06.012. Epub 2010 Jul 7.
95. Fire victim identification by post-mortem dental CT: radiologic evaluation
of restorative materials after exposure to high temperatures.

Woisetschlger M, Lussi A, Persson A, Jackowski C.
Center for Medical Image Science and Visualisation (CMIV), University Hospital Linkping, Linkping University,
58185 Linkping, Sweden. Mischa.woisetschlager@lio.se
Abstract
OBJECTIVES: The aim of this study was to evaluate the use of high resolution CT to
radiologically define teeth filling material properties in terms of Hounsfield units after high
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temperature exposure.
METHODS: 122 human molars with 10 different filling materials at defined filling diameters
were examined. The teeth were CT scanned both before and after the exposure to different
temperatures. After image reconstruction, the teeth and filling materials were analyzed
regarding their morphology and Hounsfield units (HU) using an extended HU scale.
RESULTS: The majority of filling materials diminished in size at temperatures400 C. HU
values were stable for all materials up till 200 C, and only slightly changed up to 600 C.
Cerec, Dyract and dentin showed only minor changes in HU at all temperatures. The other
materials, inclusive enamel, showed specific patterns, either increasing or decreasing in HU
with increasing temperatures over 600 C.
CONCLUSIONS: Over 600 C the filling materials show specific patterns that can be used to
discriminate filling materials. Ultra high resolution CT may improve the identification processes
in fire victims. Existing 3D visualization presets for the dentition can be used until 600 C and
have to be optimized for bodies exposed to higher temperatures.
Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Quintessence Int. 2010 Jul-Aug;41(7):585-90.
96. In vitro evaluation of marginal adaptation in five ceramic restoration
fabricating techniques.
Ural C, Burgaz Y, Sara D.
Department of Prosthodontics, Faculty of Dentistry, University of Ondokuz Mayis, Samsun, Turkey.

cagriural@omu.edu.tr
Abstract
OBJECTIVE: To compare in vitro the marginal adaptation of crowns manufactured using
ceramic restoration fabricating techniques.
METHOD AND MATERIALS: Fifty standardized master steel dies simulating molars were
produced and divided into five groups, each containing 10 specimens. Test specimens were
fabricated with CAD/CAM, heat-press, glass-infiltration, and conventional lost-wax techniques
according to manufacturer instructions. Marginal adaptation of the test specimens was
measured vertically before and after cementation using SEM. Data were statistically analyzed
by one-way ANOVA with Tukey HSD tests (a = .05).
RESULTS: Marginal adaptation of ceramic crowns was affected by fabrication technique and
cementation process (P < .001). The lowest marginal opening values were obtained with
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Cerec-3 crowns before and after cementation (P < .001). The highest marginal discrepancy
values were obtained with PFM crowns before and after cementation.
CONCLUSION: Marginal adaptation values obtained in the compared systems were within
clinically acceptable limits. Cementation causes a significant increase in the vertical marginal
discrepancies of the test specimens.

J Calif Dent Assoc. 2010 May;38(5):323-30.
97. Dentistry a la carte: in-office CAD/CAM technology.

Kachalia PR, Geissberger MJ.
Department of Restorative Dentistry, Arthur A. Dugoni School of Dentistry, San Francisco, Calif. 94115, USA.
Abstract
This article examines the differences among four in-office computer-aided design/computeraided manufacturing restorative technologies. Two acquisition media systems, 3M ESPE's
Lava COS and Cadent's iTero, are compared and contrasted. Additionally, two acquisition and
manufacturing media, Sirona's CEREC AC and D4D's E4D, are examined. Image acquisition
techniques and cast fabrication methodologies are compared between Lava COS and iTero. In
addition, image acquisition, cast fabrication, and restoration fabrication methodologies are
discussed as related to CEREC AC and E4D. Strategies for computer-aided design/computeraided manufacturing incorporation into practice are explored.
MeSH Terms
Oper Dent. 2010 May-Jun;35(3):324-9. doi: 10.2341/09-178-L.
98. Evaluation of different methods of optical impression making on the
marginal gap of onlays created with CEREC 3D.

da Costa JB, Pelogia F, Hagedorn B, Ferracane JL.
Oregon Health & Science University, Portland, OR, USA. dacostaj@ohsu.edu
Abstract
OBJECTIVES: This study evaluated the marginal gaps on several surfaces of onlays created
with the Cerec 3D system using one intraoral and two extraoral optical impression methods.
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METHODS: A human molar (#19) was mounted with its adjacent teeth on a typodont
(Frasaco) and prepared for a MODL onlay. The typodont was assembled in the mannequin
head in order to simulate clinical conditions. The same operator took 36 individual optical
impressions using a CEREC 3D camera. For group 1 (IP), a thin layer of titanium dioxide
powder (CEREC powder-VITA) was applied directly onto the surface of the preparation for
imaging (n = 12). For group 2 (EP), a sectional impression was taken with hydrocolloid Identic
Syringable (Dux Dental), a die made with polyvinylsiloxane KwikkModel Scan (R-dental
Dentalerzeugnisse GmbH) and powdered with titanium dioxide for imaging (n = 12). For group
3 (ES), a sectional impression was taken with PVS and a sectional stock tray, a die fabricated
in stone (Diamond die- HI-TEC Dental Products) and the die being imaged without powdering
(n = 12). One operator designed and machined the onlays in VitaBlocks Mark II for Cerec
(VITA) using a CEREC 3D. The marginal gaps (microm) were measured with an optical
microscope (50x) at 12 points, three on each surface of the MODL. The results were analyzed
by two-way ANOVA/ Tukey's (p = 0.05).
RESULTS: The overall mean marginal gaps (microm) for the three methods were: IP = 111.6
(+/- 34.0); EP = 161.4 (+/- 37.6) and ES = 116.8 (+/- 42.3). IP and ES were equal, but both
were significantly less than EP. The pooled mean marginal gaps (microm) for the occlusal =
110.5 (+/- 39) and lingual = 111.5 (+/- 30.5) surfaces were equivalent and significantly less
than the distal = 136.5 (+/- 42.5) and mesial = 161.1 (+/- 43.3).
CONCLUSION: The marginal gap of CEREC 3D onlay restorations was not different when the
optical impression was taken intraorally vs extraorally using a stone cast that does not require
powdering. The lingual and occlusal surfaces showed the lowest gaps.

J Am Dent Assoc. 2010 Jun;141 Suppl 2:20S-4S.
99. Integrating three-dimensional digital technologies for comprehensive
implant dentistry.
Patel N.
Infinite Smiles, 7500 Sawmill Parkway, Powell, Ohio 43065, USA. Drpatel@infinitesmiles.com
Abstract
BACKGROUND: The increase in the popularity of and the demand for the use of dental
implants to replace teeth has encouraged advancement in clinical technology and materials to
improve patients' acceptance and clinical outcomes. Recent advances such as threedimensional dental radiography with cone-beam computed tomography (CBCT), precision
dental implant planning software and clinical execution with guided surgery all play a role in
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the success of implant dentistry.

METHODS: The author illustrates the technique of comprehensive implant dentistry planning
through integration of computer-aided design/computer-aided manufacturing (CAD/CAM) and
CBCT data. The technique includes clinical treatment with guided surgery, including the
creation of a final restoration with a high-strength ceramic (IPS e.max CAD, Ivoclar Vivadent,
Amherst, N.Y.). The author also introduces a technique involving CAD/CAM for fabricating
custom implant abutments.
RESULTS: The release of software integrating CEREC Acquisition Center with Bluecam
(Sirona Dental Systems, Charlotte, N.C.) chairside CAD/CAM and Galileos CBCT imaging
(Sirona Dental Systems) allows dentists to plan implant placement, perform implant dentistry
with increased precision and provide predictable restorative results by using chairside IPS
e.max CAD.
CONCLUSIONS: The precision of clinical treatment provided by the integration of CAD/CAM
and CBCT allows dentists to plan for ideal surgical placement and the appropriate thickness of
restorative modalities before placing implants.

100. A clinical evaluation of chairside lithium disilicate CAD/CAM crowns: a
two-year report.
Fasbinder DJ, Dennison JB, Heys D, Neiva G.

Cariology, Restorative Sciences,and Endodontics, School of Dentistry, University of Michigan, 1011 N. University,
Ann Arbor, MI 48109-1078, USA. djfas@umich.edu
Abstract
BACKGROUND: Developments in ceramic material science have led to improvements in the
physical properties of modern ceramics, leading to a substantial increase in the clinical use of
all-ceramic restorations. The authors evaluated the clinical performance of lithium disilicate
(IPS e.max CAD, Ivoclar Vivadent, Amherst, N.Y.) all-ceramic crowns.
METHODS: The authors fabricated 62 lithium disilicate crowns with a chairside computeraided design/computer-aided manufacturing (CAD/CAM) system (CEREC 3, Sirona Dental
Systems, Charlotte, N.C.) and cemented them with two types of adhesive resin cements. Two
examiners used modified U.S. Public Health Service criteria to evaluate the crowns at
baseline, six months, one year and two years.
RESULTS: There were no clinically identified cases of crown fracture or surface chipping.
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There was no reported sensitivity at one or two years with either cement. For margin
discoloration, the percentage Alfa score was 86.9 percent for crowns cemented with a selfetching, dual-curing cement. All other percentage Alfa scores were greater than 92.0 percent,
indicating no appreciable change in the crowns during the two-year study.
CONCLUSIONS: The results show that lithium disilicate crowns performed well after two years
of clinical service.
CLINICAL IMPLICATIONS: Early results indicate that monolithic lithium disilicate CAD/CAM
crowns may be an effective option for all-ceramic crowns.

101. CAD/CAM in-office technology: innovations after 25 years for
predictable, esthetic outcomes.

Poticny DJ, Klim J.
Grand Prairie, TX, USA. djpoticny@earthlink.net
Abstract
BACKGROUND: The in-office application of computer-aided design/computer-aided
manufacturing (CAD/CAM) has evolved continually across 25 years, and material
enhancements made in conjunction with this evolution have improved the speed and precision
with which dentists can place high-quality, esthetic restorations for almost every dental
application.
METHODS: The authors present an overview of the CEREC Acquisition Center (AC) with
Bluecam system (Sirona Dental Systems, Charlotte, N.C.) and available materials.
RESULTS: On the basis of the growth of CAD/CAM, the manufacturer has made substantial
improvements to all aspects of the CEREC AC system-including hardware, software and
materials-during the past 25 years.
CONCLUSION: Dentists can create laboratory-grade restorations in their offices with little
disturbance to work-flow patterns. This is possible, because of innovations to the system that
make CAD/CAM feasible for most dental practices.
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102. The CEREC system: 25 years of chairside CAD/CAM dentistry.

Fasbinder DJ.
Cariology, Restorative Sciences,and Endodontics, School of Dentistry, University of Michigan, 1011 N. University,
Ann Arbor, MI 48109-1078, USA. djfas@umich.edu

Am J Dent. 2010 Feb;23(1):53-6.
103. The occlusal precision of laboratory versus CAD/CAM processed all-
ceramic crowns.
Reich S, Brungsberg B, Teschner H, Frankenberger R.

Department of Prosthodontics and Dental Materials, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30,
D-52074 Aachen, Germany. sreich@ukaachen.de
Abstract
PURPOSE: The null hypothesis was tested: There is no difference between two all-ceramic
crown systems, the Cerec method (CHAIR) and the IPS Empress method (LAB), with respect
to occlusal precision and time expenditure for the dentist.
METHODS: 20 casts representing clinical situations were mounted in semi-adjustable
articulators to serve as simulation models. The left lower first molars were prepared to receive
feldspathic ceramic crowns. The minimum number of three (Min3) occlusal contacts and their
desired location was defined on each crown before preparation. Two crowns were produced
on each die: (CHAIR) was applied in order to simulate a chair-side treatment and [LAB] was
applied to simulate the laboratory/clinical mode of production. Additionally the time required to
perform the occlusal adjustment was measured. For occlusal analysis, the (Min3) were divided
by the contacts that were "actually achieved" (ACT). Mean quotients for (LAB) and (CHAIR)
were calculated (n = 20 each). The Wilcoxon signed rank test at P < or = 0.05 was applied to
determine statistical significance.
RESULTS: The mean quotients MEAN QU (Min3)/(ACT) of 0.87 for (CHAIR) and 0.94 for
(LAB) and the time expenditure for simulating intraoral occlusal adjustment of 3.44 minutes for
(CHAIR) and 3.79 minutes for (LAB) did not differ significantly.
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J Calif Dent Assoc. 2010 Mar;38(3):170-3, 176-7.
104. Immediate placement and provisionalization of a dental implant utilizing
the CEREC 3 CAD/CAM Protocol: a clinical case report.

Gougaloff R, Stalley FC.
Redondo Beach Dental Group, Redondo Beach, Calif 90278, USA.
Abstract
Dental implant placement with immediate provisionalization is a well-established protocol with
excellent success rates. Immediate provisionalization after dental implant placement is a very
convenient treatment modality for the patient, especially in the esthetic zone, since removable
provisionalization modalities can be avoided and the gingival architecture can also be reestablished more predictably. This case report describes the use of CAD/CAM technology to
facilitate the manufacture of an immediate provisional for a dental implant.

Hua Xi Kou Qiang Yi Xue Za Zhi. 2010 Feb;28(1):29-33.
105. [An experimental study on the effect of different optical impression
methods on marginal and internal fit of all-ceramic crowns].

Tan FB, Wang L, Fu G, Wu SH, Jin P.
Dept. of Prosthodontics, The Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing 400015,
China.
Abstract
OBJECTIVE: To study the effect of different optical impression methods in Cerec 3D/Inlab MC
XL system on marginal and internal fit of all-ceramic crowns.
METHODS: A right mandibular first molar in the standard model was used to prepare full
crown and replicated into thirty-two plaster casts. Sixteen of them were selected randomly for
bonding crown and the others were used for taking optical impression, in half of which the
direct optical impression taking method were used and the others were used for the indirect
method, and then eight Cerec Blocs all-ceramic crowns were manufactured respectively. The
fit of all-ceramic crowns were evaluated by modified United States Public Health Service
(USPHS) criteria and scanning electron microscope (SEM) imaging, and the data were
statistically analyzed with SAS 9.1 software.
RESULTS: The clinically acceptable rate for all marginal measurement sites was 87.5%
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according to USPHS criteria. There was no statistically significant difference in marginal fit
between direct and indirect method group (P > 0.05). With SEM imaging, all marginal
measurement sites were less than 120 microm and no statistically significant difference was
found between direct and indirect method group in terms of marginal or internal fit (P > 0.05).
But the direct method group showed better fit than indirect method group in terms of mesial
surface, lingual surface, buccal surface and occlusal surface (P < 0.05). The distal surface's fit
was worse and the obvious difference was observed between mesial surface and distal
surface in direct method group (P < 0.01).
CONCLUSION: Under the conditions of this study, the optical impression method had no
significant effect on marginal fit of Cerec Blocs crowns, but it had certain effect on internal fit.
Overall all-ceramic crowns appeared to have clinically acceptable marginal fit.
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Publication Types
Int J Prosthodont. 2010 Jan-Feb;23(1):60-2.
106. Survival rates of porcelain molar crowns-an update.

Department of Fixed Prosthodontics, Faculty of Dentistry, Suez Canal University , Ismailia, Egypt.
Abstract
The aim of this study was to identify recent studies that dealt with the clinical performance of
porcelain molar crowns and to explore the possibility of grouping the findings from similar
studies together to draw overall conclusions. A MEDLINE literature search was conducted in
early 2009 covering the preceding 12 years. Seventeen studies were indentified. However,
only seven met the specific inclusion criteria and were analyzed. Among seven studies, five
European countries were covered. Five studies reported on Procera AllCeram molar crowns
while one reported on In-Ceram Alumina and Spinell crowns and another on CEREC crowns.
For comparison, one additional study that reported on premolar crowns was included. In the
five Procera AllCeram studies, 235 molar crowns were evaluated for 5 or more years, of which
24 failed. When the results of the five studies on the performance of Procera AllCeram molar
crowns were considered collectively, an overall failure rate of 10.2% was found at 5 or more
years. Int J Prosthodont 2010;23:60-62.

J Adhes Dent. 2010 Jun;12(3):189-96. doi: 10.3290/j.jad.a17650.
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107. Influence of different curing approaches on marginal adaptation of
ceramic inlays.
Rechenberg DK, Ghring TN, Attin T.

Clinic for Preventive Dentistry, Periodontology and Cariology, University of Zrich, Zrich, Switzerland.
dan.rechenberg@zzmk.uzh.ch
Abstract
PURPOSE: To evaluate the effect of different curing protocols on marginal adaptation of
ceramic inlays after thermomechanical loading (TML).
MATERIALS AND METHODS: Forty-eight human molars were randomly divided into 6 groups
(n = 8). After Class II cavity preparation (mod), ceramic inlays (Cerec) were fabricated. In
groups I to IV, the cavities were conditioned with XP Bond mixed with Self Cure Activator
(SCA) and the inlays were placed with the luting composite (LC) Calibra Mix (dual curing). The
teeth in groups V and VI were conditioned with XP Bond without SCA and the inlays were
placed with Calibra base (only light curing). In groups III, IV and V the adhesive was separately
light cured prior to, and in groups II, IV, V and VI, after the inlay insertion. Before and after
TML, marginal adaptation was measured using scanning electron microscopy (200X).
Continuous margins (% of the total) were compared between groups using analysis of
variance (ANOVA). A Bonferroni correction was applied to correct for multiple testing (alpha <
0.005).
RESULTS: Light curing after inlay insertion improved marginal adaptation on the occlusal
interface between LC and enamel significantly, regardless of the LC's curing mode. Separate
light polymerization of XP Bond did not result in superior marginal quality. Investigation of the
interface between LC and proximal dentin margins showed improved adaptation by dual curing
the adhesive and LC, irrespective of light application.
CONCLUSION: Light curing after inlay insertion showed improved marginal adaptation. Using
dual-curing adhesive and LC, advantages in marginal adaptation between LC and dentin were
observed.

Eur J Oral Sci. 2010 Feb;118(1):87-93. doi: 10.1111/j.1600-0722.2009.00704.x.
108. Finite element and Weibull analyses to estimate failure risks in the
ceramic endocrown and classical crown for endodontically treated

maxillary premolar.
Lin CL, Chang YH, Chang CY, Pai CA, Huang SF.
Department of Mechanical Engineering, Chang Gung University, Tao-yuan, Taiwan.
Abstract
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The present study evaluated the failure risks of an endodontically treated premolar with
severely damaged coronal hard tissue and restored with either a computer-aided
design/computer-aided manufacturing (CAD/CAM) ceramic endocrown or a classical crown
configuration. Two, three-dimensional finite element maxillary premolar models were designed
with endodontic treatment and restored with either a chairside economic reconstruction of
esthetic ceramic (CEREC) ceramic endocrown or a classical crown. The Weibull function was
incorporated with finite element analysis to calculate the long-term failure probability relative to
different load conditions. Additionally, an in vitro fatigue-load fracture experiment was
performed to validate the numerical simulation results. The results indicated that the stress
values on the dentin and luting cement for the endocrown restoration were lower than those for
the crown configuration. Weibull analysis revealed that the individual failure probability in the
endocrown dentin and luting cement diminished more than those for the crown restoration.
While the overall failure probabilities for the endocrown and the classical crown were similar,
fatigue fracture testing revealed that the endocrown restoration had higher fracture resistance
than the classical crown configuration (1,446 vs. 1,163 MPa). This investigation implies that
the endocrown can be considered as a conservative, aesthetic, and clinically feasible
restorative approach for endodontically treated maxillary premolars.

Clin Oral Investig. 2011 Apr;15(2):283-9. doi: 10.1007/s00784-010-0384-z. Epub 2010 Feb 9.
109. Efficiency of a mathematical model in generating CAD/CAM-partial
crowns with natural tooth morphology.

Ender A, Mrmann WH, Mehl A.
Division of Computer Restorations, Department of Preventive Dentistry, Cariology, and Periodontology, Center for
Dental and Oral Medicine, University of Zrich, Zrich, Switzerland. andreas.ender@zzmk.uzh.ch
Abstract
The "biogeneric tooth model" can be used for computer-aided design (CAD) of the occlusal
surface of dental restorations. From digital 3D-data, it automatically retrieves a morphology
matching the natural surface left after preparation. This study evaluates the potential of this
method for generating well-matched and well-adjusted CAD/computer-aided manufacturing
(CAM) fabricated partial crowns. Twelve models with partial crown preparations were mounted
into an articulator. Partial crowns were designed with the Cerec 3D CAD software based on
the biogeneric tooth model (Biog.CAD) and, for control, with a conventional data-based Cerec
3D CAD software (Conv.CAD). The design time was measured, and the naturalness of the
morphology was visually assessed. The restorations were milled, cemented on the models,
and the vertical discrepancy and the time for final occlusal adjustment were measured. The
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Biog.CAD software offered a significantly higher naturalness (up to 225 to 11 scores) and was
significantly faster by 251 ( 78)s in designing partial crowns (p < 0.01) compared to
Conv.CAD software. Vertical discrepancy, 0.52 ( 0.28) mm for Conv.CAD and 0.46 (
0.19)mm for Biog.CAD, and occlusal adjustment time, 118 ( 132)s for Conv.CAD and 102 (
77)s for Biog.CAD, did not differ significantly. In conclusion, the biogeneric tooth model is able
to generate occlusal morphology of partial crowns in a fully automated process with higher
naturalness compared to conventional interactive CAD software.

Int J Prosthodont. 2009 Sep-Oct;22(5):466-71.
110. A systematic review of the clinical performance of CAD/CAM single-tooth
restorations.
Wittneben JG, Wright RF, Weber HP, Gallucci GO.

Advanced Graduate Prosthodontics Program, Department of Restorative Dentistry and Biomaterials Sciences,
Harvard School of Dental Medicine (HSDM), Boston, Massachusetts, USA. julia.wittneben@zmk.unibe.ch
Abstract
PURPOSE: This systematic review sought to determine the long-term clinical survival rates of
single-tooth restorations fabricated with computer-aided design/computer-assisted
manufacture (CAD/CAM) technology, as well as the frequency of failures depending on the
CAD/CAM system, the type of restoration, the selected material, and the luting agent.
MATERIALS AND METHODS: An electronic search from 1985 to 2007 was performed using
two databases: Medline/PubMed and Embase. Selected keywords and well-defined inclusion
and exclusion criteria guided the search. All articles were first reviewed by title, then by
abstract, and subsequently by a full text reading. Data were assessed and extracted by two
independent examiners. The pooled results were statistically analyzed and the overall failure
rate was calculated by assuming a Poisson-distributed number of events. In addition, reported
failures were analyzed by CAD/CAM system, type of restoration, restorative material, and
luting agent.
RESULTS: From a total of 1,957 single-tooth restorations with a mean exposure time of 7.9
years and 170 failures, the failure rate was 1.75% per year, estimated per 100 restoration
years (95% CI: 1.22% to 2.52%). The estimated total survival rate after 5 years of 91.6% (95%
CI: 88.2% to 94.1%) was based on random-effects Poisson regression analysis.
CONCLUSIONS: Long-term survival rates for CAD/CAM single-tooth Cerec 1, Cerec 2, and
Celay restorations appear to be similar to conventional ones. No clinical studies or randomized
clinical trials reporting on other CAD/CAM systems currently used in clinical practice and with
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follow-up reports of 3 or more years were found at the time of the search.
Comment in
Survival rate for single tooth CAD/CAM restorations is similar to conventional dental
restorations (UT CAT#2191). [Tex Dent J. 2013]

Quintessence Int. 2009 Oct;40(9):729-37.
111. Influence of overlay restorative materials and load cusps on the fatigue
resistance of endodontically treated molars.

Magne P, Knezevic A.
Don & Sybil Harrington Foundation Chair of Esthetic Dentistry, Division of Primary Oral Health Care, School of
Dentistry, University of Southern California, Los Angeles, Californa 90089-7792, USA. magne@usc.edu
Abstract
OBJECTIVES: To assess the influence of restorative materials and load cusps on the fatigue
resistance of endodontically treated molars.
METHOD AND MATERIALS: Thirty extracted molars received root canal treatment followed
by a standardized tooth preparation (3-mm cuspal reduction and immediate dentin sealing).
Twenty Cerec 3 overlays (Sirona Dental Systems) were milled in the ceramic Vita MKII block
(Vident; groups MKIIGL and MKIIGL-Z, oven-glazed), and 10 restorations were duplicated with
a composite resin (Miris 2, Coltane/Whaledent; group M2). The fitting surfaces of the
restorations were hydrofluoric acid etched (porcelain only) and silanated. Preparations were
airborne-particle abraded and etched. All restorations were luted with preheated Filtek Z100
(3M ESPE) and subjected to cyclic isometric chewing (5 Hz) starting at 200 N (5,000 cycles),
followed by stages of 400, 600, 800, 1,000, 1,200, and 1,400 N at a maximum of 30,000 cycles
each. A stainless steel load sphere was used for groups MKIIGL and M2, while a composite
resin load sphere was used in group MKIIGL-Z. All samples were loaded until fracture or to a
maximum of 185,000 cycles. Groups were compared using the Kaplan-Meier survival curves
(P = .05).
RESULTS: None of the molars restored with porcelain withstood all 185,000 loading cycles
(survival = 0%). The mean fracture load for MKIIGL was 1,060 N and for MKIIGL-Z, 1,280 N. In
group M2, the survival rate was 50%. The rate of fracture below the CEJ was 40%, 30%, and
20% for MKIIGL, MKIIGL-Z, and M2, respectively.
CONCLUSION: Miris 2 overlays showed higher fatigue resistance than MKII porcelain (P =
.01) when loaded with a stainless steel antagonist.
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Oper Dent. 2009 Sep-Oct;34(5):537-43. doi: 10.2341/08-030-L.
112. Fracture strength of minimally prepared resin bonded CEREC inlays.

Tsitrou E, Helvatjoglou-Antoniades M, Pahinis K, van Noort R.
Adult Dental Care, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom.
e.tsitrou@gmail.com
Abstract
PURPOSE: This study compared the structural integrity and fracture mode of teeth restored
with traditionally and minimally prepared resin-bonded CAD/CAM inlays fabricated from the
same material.
METHODS: Forty intact maxillary premolars were used and divided into four groups. Two
groups were prepared according to a traditional inlay preparation design (2.0 mm occlusal
reduction, a 1.5 mm wide proximal box and divergent walls) and two groups were prepared
according to a newly proposed minimal preparation design (round shaped cavity with 1.0 mm
occlusal reduction, a U-shaped proximal box 1.0 mm wide and parallel walls). Two restorative
systems were tested: a composite system comprised of Paradigm MZ100 (3M ESPE) blocks
and RelyX Unicem (3M ESPE) resin cement and a ceramic system comprised of ProCAD
blocks (Ivoclar-Vivadent) and Variolink II (Ivoclar-Vivadent) resin cement. The inlays were
cemented according to the manufacturers' instructions. Each specimen was loaded axially to
its occlusal surface at a crosshead speed of 0.5 mm/minute in a universal testing machine until
fracture. The fracture load data were analyzed using ANOVA, comparing inlays of the same
restorative material. Also, the mode of fracture of the inlays was recorded and analyzed using
a non-parametric test (Kruskal-Wallis).
RESULTS: In the composite system case, the mean fracture load and SD were 1322 N (+/445) for the traditional inlays and 1511 N (+/- 395) for the minimal inlays, while in the ceramic
system case, those values were 1135N (+/- 450) for the traditional inlays and 1761 N (+/- 494)
for the minimal inlays. Statistical analysis of the results showed that there was no statistically
significant difference between the two designs for the composite system, while for the ceramic
system, the minimally prepared teeth showed higher mean fracture strength. Non-parametric
analysis (Kruskal-Wallis) of the mode of fracture showed that there was no statistically
significant difference between traditionally and minimally prepared inlays for both systems (p >
.05).
CONCLUSIONS: Under the conditions of this experimental study, only the ceramic inlays,
when prepared with a minimal preparation design, demonstrated a higher fracture strength as
compared to the traditionally prepared teeth. Use of the proposed minimal preparation design
did not compromise the immediate post-operative structural integrity of teeth restored either
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with resin composite or ceramic inlays.


Int J Comput Dent. 2009;12(3):279-89.
113. A comparison of the fabrication times of all-ceramic partial crowns:
Cerec 3D vs IPS Empress.

Gozdowski S, Reich S.
Department of Prosthodontics and Dental Material Science of the University of Leipzig, Leipzig, Germany.
Stephan.Gozdowski@medizin.uni-leipzig.de
Abstract
Apart from precision, the time factor plays a decisive role in the fabrication of all-ceramic
dental restorations. Therefore, the aim of this study was to compare two all-ceramic systems
with regard to the time required for the fabrication of partial crowns [MODB]. The null
hypothesis tested was that the fabrication times of CAD/CAM generated partial crowns are
shorter than the fabrication times of partial crowns manufactured in the laboratory.
MATERIALS AND METHODS: In sixteen model pairs mounted in the articulator, which
corresponded to different clinical situations, tooth 36 was prepared for an all-ceramic partial
crown [MODB]. With the Cerec3D method [CHAIR], the fabrication of the restoration was
simulated directly on the "phantom patient". The IPS Empress system [LAB] was used forthe
indirectfabrication method via an impression of the phantom patient. Both methods were used
for each preparation. The adhesive luting procedure was not simulated and, therefore, not
measured.
RESULTS: The mean processing times [hh:mm:ss] were 00:35:05 (SD +/- 03:27 min) for the
Cerec method and 04:17:54 (SD +/- 26:01 min) for the Empress method. The mean time on
the phantom patient for process-induced activities was 11:47 minutes (SD +/- 02:08 min) for
the Cerec method and 03:58 minutes (SD +/- 02:50 min) for the Empress method.
DISCUSSION: Time expenditure for fabrication is only one aspect in order to assess the
suitability of a restoration system. Both methods enable the dentist to provide high quality all
ceramic restorations. Although the Empress method showed a time advantage of 65% during
the fitting phase and occlusal grinding-in on the phantom patient in comparison to the Cerec
method, the time spent during the laboratory phase has to be considered as well.
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Int J Comput Dent. 2009;12(3):265-77.
114. Evaluation of the clinical success of Cerec 3D inlays.

Bernhart J, Schulze D, Wrbas KT.
Department of Dental Prosthetics, University Clinic for Oral and Maxillofacial Medicine, Albert Ludwigs University,
Freiburg, Germany. jasmin.bernhart@uniklinik-freiburg.de
Abstract
The objective of the present study was to determine the clinical success of Cerec 3D inlays
over a period of three years. Within the scope of the restorative dentistry course II, 62 Cerec
ceramic inlays were inserted with Dual Cement (Ivoclar Vivadent) in combination with the
Syntac Classic system (Ivoclar Vivadent). Regular follow-up examinations and assessments
were performed by reference to modified US Public Health Service (USPHS) criteria. The
baseline examination was performed one week after insertion and further follow-up
examinations were performed at 6-month intervals. The survival rate of the Cerec 3D inlays
was 95% after three years. Three inlays were assessed as failures because of loss of
sensitivity, restoration fracture, and marginal gap formation. Six patients initially suffered from
postoperative hypersensitivity, which vanished by the first follow-up examination. The results
of this study show that dentists with little experience are able to achieve good clinical results
and long-term success after short theoretical as well as practical training and an introductory
course in the Cerec method.

Eur J Esthet Dent. 2009 Autumn;4(3):278-92.
115. Micro-CT evaluation of the marginal fit of different In-Ceram alumina
copings.
Pelekanos S, Koumanou M, Koutayas SO, Zinelis S, Eliades G.

Department of Prosthodontics, School of Dentistry, National and Kapodistrian University, Athens, Greece.
pelekan@otenet.gr
Abstract
The aim of the study was to evaluate the marginal fit of different In-Ceram alumina ceramic
cores manufactured by four different techniques. Four groups of four In-Ceram alumina core
specimens (Vita), each 0.6 mm in thickness, were fabricated from a master die using four
different techniques: Group SL, the slip-cast technique (In-Ceram system); Group CL, the
copy-milling technique (Celay system); Group CR, a CAD/CAM system (Cerec inLab system)
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and Group WO, the electro-deposition dipping technique (Wol-Ceram). After the core
specimens were fitted on the master die, they were scanned with the use of a
microtomography device (1072 micro-CT, Sky- Scan). Datasets were processed by software
(TView v1.1, SkyScan) and 10 vertical sections from each core were generated. On these
microtomographic cross-sections the marginal gap (MG) and the absolute marginal
discrepancy (MD) were measured in microscale (microm). The slip-cast and the electrodeposition dipping techniques presented the best results of MG with 22 microm and 35
microm, respectively (alpha<5%). The CAD/CAM system presented an MG of 55 microm. In
addition, the slip-cast and the electro-deposition dipping techniques presented the best results
of MD with 50 microm and 60 microm, respectively (alpha<5%). The slip-cast technique and
the Wol-Ceram system presented the best marginal fit, followed by Cerec inLab, which
presented clinically acceptable results. Microtomography analysis seemed to be a reliable
method of evaluating the marginal fit of dental restorations.

Schweiz Monatsschr Zahnmed. 2009;119(7):717-29.
116. [Use of the CEREC system in dental practices. Esthetic reconstruction of
the anterior teeth--a case report].

[Article in French, German]
Di Rocco D.
Klinik fr Zahnerhaltung, Prventiv- und Kinderzahnmedizin, Zahnmedizinische Kliniken, Universitt Bern,

Freiburgstrasse 7, 3010 Bern. domenico.dirocco@zmk.unibe.ch
Abstract
The replacement of a metal-ceramic crown utilizing CAD/CAM technology is described in this
case report. A healthy, 42-year-old patient complained about aesthetic appearances after the
reconstruction of tooth 11 with a metal-ceramic crown. Depending on the production process
CEREC crowns are divided in direct and indirect CEREC reconstructions. In this case the
indirect way was elected, where the CEREC crown is customized by the technicians. After the
final tooth preparation and the immediate dentin sealing the impression and bite registration
was taken conventionally. Then the crown was manufactured with the CEREC 3-D-system and
the technicians reduced the labial aspect of the CEREC crown and completed the
reconstruction by veneering. Success ist closely linked with the quality of the laboratory work
and the precision employed by the dentist regarding the preparation and integration technique.
The replacement of a metal-ceramic crown on a vital tooth utilizing the CEREC 3-D-technology
can lead to aesthetically pleasing, functional outcomes with great patient and clinician
satisfaction.
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J Dent. 2010 Jan;38(1):16-22. doi: 10.1016/j.jdent.2009.07.003.
117. A preliminary evaluation of the structural integrity and fracture mode of
minimally prepared resin bonded CAD/CAM crowns.

Tsitrou EA, Helvatjoglu-Antoniades M, van Noort R.
Department of Adult Dental Care, School of Clinical Dentistry, University of Sheffield, Claremont Crescent, S10 2TA,
Sheffield, UK. e.tsitrou@gmail.com
Abstract
PURPOSE: This study was a preliminary evaluation of two minimal preparation designs
proposed for ceramic and composite resin bonded CAD/CAM crowns. It compared the
structural integrity and fracture mode of teeth restored with traditionally and minimally prepared
resin bonded CAD/CAM crowns fabricated from the same material hypothesizing that teeth
restored with minimal resin bonded crowns would demonstrate the same fracture strength to
teeth restored with traditional resin bonded crowns.
MATERIALS AND METHODS: Forty intact maxillary molar teeth were used and divided in four
groups. Two groups were prepared according to a traditional crown preparation design and
two groups were prepared according to minimal preparation designs. A resin composite
(Paradigm MZ100, 3M ESPE) and a leucite glass-ceramic (ProCAD, Ivoclar Vivadent) were
used for the fabrication of the crowns using CEREC Scan. Crowns of ceramic were cemented
using Variolink II (Ivoclar Vivadent) and crowns of composite with Rely X Unicem Aplicap (3M
ESPE) and loaded until fracture. Load data was analysed using ANOVA comparing crowns of
the same restorative material. The mode of fracture was also recorded and analysed (KruskalWallis).
RESULTS: For the composite system the mean fracture load and SD was 1682N (+/-315) for
the traditional and 1751N (+/-338) for the minimal crowns. For the ceramic system the mean
fracture load and SD was 1512N (+/-373) for the traditional and 1837 (+/-356) for the minimal
crowns. No statistically significant difference was found between the two designs for each
system. Nonparametric analysis (Kruskal-Wallis) of the fracture mode showed no statistical
significant difference between designs for either material (p>.05).
CONCLUSION: Within the limitations of this experimental design, it was found that minimally
prepared resin bonded CEREC crowns demonstrated equal fracture resistance and mode of
fracture to that of crowns bonded to traditionally prepared teeth.

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Eur J Prosthodont Restor Dent. 2009 Jun;17(2):73-7.
118. The reproducibility and accuracy of internal fit of Cerec 3D CAD/CAM all
ceramic crowns.
D'Arcy BL, Omer OE, Byrne DA, Quinn F.

Dublin Dental School and Hospital, Dublin 2, Ireland.
Abstract
The objective of this study was to evaluate the reproducibility and accuracy of internal fit using
Cerec 3D CAD/CAM (computer aided design/computer aided manufacturing) all-ceramic
crowns and to investigate the proximal contact point areas between the crowns and
neighbouring teeth, in terms of location and the presence or absence of contact. A total of 48
crowns were milled and divided into two groups of twenty-four each. One group consisted of
testing a Control die and the other group consisted of testing single Replica stone die
duplicates of the Control die. The Internal Marginal Gap, Axio-Occlusal Transition Gap and
Occlusal Gap were measured on each crown in both groups. No significant differences were
identified between the mean thickness of the Marginal Gap, the Axio-Occlusal Transition Gap
and the Occlusal Gap of the Control die when compared with the Replica dies indicating
uniformity and consistency of the accuracy of fit and therefore die replication.

Eur J Oral Sci. 2009 Aug;117(4):454-62. doi: 10.1111/j.1600-0722.2009.00653.x.
119. Effect of resin coating on adhesion and microleakage of computer-aided
design/computer-aided manufacturing fabricated all-ceramic crowns after

occlusal loading: a laboratory study.
Kitayama S, Pilecki P, Nasser NA, Bravis T, Wilson RF, Nikaido T, Tagami J, Watson TF, Foxton RM.
Cariology and Operative Dentistry, Department of Restorative Science, Graduate School, Tokyo Medical and Dental
University, Bunkyo-ku, Tokyo, Japan. nuevo_centro@yahoo.co.jp
Abstract
This study investigated the effect of resin coating and occlusal loading on adhesion and
microleakage of all-ceramic crowns. Molars were prepared for an all-ceramic crown and were
divided into two groups: non-coated (control) and resin-coated with Clearfil Tri-S Bond. Crowns
were fabricated using CEREC 3 and cemented using Clearfil Esthetic Cement. After 24 h of
storage in water, the restored teeth in each group were divided into two subgroups: unloaded,
or loaded while stored in water. Mechanical loading was achieved with an axial force of 80 N at
2.5 cycles s(-1) for 250,000 cycles. After immersion in Rhodamine B, the specimens were
sectioned and processed for microleakage evaluation by confocal microscopy, which was
followed by further sectioning for microtensile bond testing. Loading had no significant effect
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on microleakage in either the resin-coated or non-resin-coated groups. Resin coating did not
reduce the microleakage at the dentine interface but increased the microleakage at the enamel
interface. All the beams fractured during slicing when non-coated and loaded. The bond
strengths of non-coated and unloaded, resin-coated and unloaded, and resin-coated and
loaded groups were 15.82 +/- 4.22, 15.17 +/- 5.24, and 12.97 +/- 5.82 MPa, respectively.
Resin coating with Clearfil Tri-S Bond improved the bonding of resin cement to dentine for
loaded specimens. However, it was not effective in reducing the microleakage, regardless of
whether it was loaded or unloaded.

J Dent. 2009 Aug;37(8):627-37. doi: 10.1016/j.jdent.2009.04.006. Epub 2009 May 3.
120. All-ceramic partial coverage restorations--midterm results of a 5-year
prospective clinical splitmouth study.
Guess PC, Strub JR, Steinhart N, Wolkewitz M, Stappert CF.

Department of Prosthodontics, Albert-Ludwigs-University, Freiburg, Germany. petra.guess@uniklinik-freiburg.de
Abstract
OBJECTIVES: Midterm-evaluation of a 5-year prospective clinical splitmouth-investigation on
survival rate and long-term behavior of all-ceramic partial coverage restorations (PCRs) on
molars. Pressed ceramic and CAD/CAM fabricated PCRs were compared.
METHODS: 80 vital molars of 25 patients were restored with all-ceramic PCRs (40 IPS e.max
Press*[IP] and 40 ProCAD*[PC]). IP-PCRs were heat pressed following the lost-wax method.
PC-PCRs were fabricated with Cerec 3** and Cerec InLab** CAD/CAM system (**Sirona
Dental Systems, Bensheim, Germany). All PCRs were adhesively luted with a lightpolymerizing composite (Syntac*/Tetric*) (*Ivoclar Vivadent, Schaan, Liechtenstein). Clinical
reevaluations were performed at baseline and 13, 25, and 36 months after insertion of the
PCRs according to the modified United States Public Health Services (USPHS) criteria.
Absolute failures were demonstrated by Kaplan-Meier survival rate.
RESULTS: After an observation time up to 3 years, survival rate of IP-PCRs was 100% and
97% for PC-PCRs due to one severe fracture. The PC-PCR had to be replaced after 9 months.
Secondary caries and endodontic complications did not occur. Increased clinical service time
resulted in significant decrease of marginal adaptation (p=0.031) and enhanced marginal
discoloration (p<0.0001). Both PCR ceramic materials demonstrated significant deteriorations
in color match (p<0.0001) and surface roughness (p<0.0001), IP-PCRs were significantly more
affected (p< or =0.005). Regarding anatomic form IP-PCRs performed significantly better
(p=0.0012).
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CONCLUSION: Pressed ceramic and CAD/CAM fabricated partial coverage restorations

exhibited a reliable treatment option to restore larger defects in posterior teeth. Marginal
degradation of the resin cement and deterioration of the all-ceramic materials during clinical
function determine the clinical long-term performance of partial coverage restorations.

Int J Comput Dent. 2009;12(2):171-85.
121. A method for the easy fabrication of all-ceramic bridges with the Cerec
system.

Kurbad A, Schnock HA.
info@cerec.de
Abstract
Both pressing technology and CAD/CAM methods have proven themselves clinically for the
fabrication of all-ceramic restorations. The advantages of the Cerec technology for the
economic fabrication of all-ceramic bridges can be exploited by the use of burn-out blanks of
polymer material. The milling process of very hard ceramics in the milling unit, which has some
disadvantages, is replaced by the pressing process and makes the IPS e.max press material
accessible to CAD/CAM users, primarily for extending the range of indications to splinted
crowns and small all-ceramic bridges.

J Prosthet Dent. 2009 Apr;101(4):239-47. doi: 10.1016/S0022-3913(09)60047-0.
122. Marginal adaptation of three different zirconium dioxide three-unit fixed
dental prostheses.
Att W, Komine F, Gerds T, Strub JR.

Department of Prosthodontics, School of Dentistry, Albert-Ludwigs University, Freiburg, Germany.
wael.att@uniklinik-freiburg.de
Abstract
STATEMENT OF PROBLEM: Marginal adaptation is important for the long-term success of
dental restorations. Data on the marginal discrepancy of zirconia-based fixed dental
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prostheses made with different computer-aided design/computer-aided manufacturing

technology is needed.
PURPOSE: The purpose of this study was to evaluate the marginal adaptation of different
zirconia 3-unit fixed dental prostheses at different fabrication stages and after artificial aging.
MATERIAL AND METHODS: Twenty-four zirconia 3-unit fixed dental prostheses (DCS,
Procera, and VITA YZ-Cerec; n=8) were fabricated using different manufacturing systems and
conventionally cemented with glass ionomer cement on human teeth. Each group was aged in
a masticatory simulator with thermal cycling. The marginal gaps were examined on epoxy
replicas for frameworks and for restorations before and after cementation, and after
masticatory simulation, at x 250 magnification. Marginal adaptation was assessed using
geometric means of the marginal gap values with 95% confidence intervals. Differences
between the manufacturing systems and the effect of artificial aging were tested using
repeated-measures ANOVA and post hoc paired and unpaired t tests with Bonferroni-Holm
correction (alpha=.05).
RESULTS: The geometric mean (95% confidence limits) marginal gap values (mum) for
frameworks and for restorations before cementation, after cementation, and after masticatory
simulation were, respectively: DCS: 86 (80-93), 86 (83-90), 86 (78-94), and 84 (79-90);
Procera: 82 (74-89), 89 (81-97), 89 (84-95), and 88 (82-94); and VITA YZ-Cerec: 64 (57-72),
67 (61-77), 76 (71-82), and 78 (76-80). The repeated-measures ANOVA showed significant
group and stage effects (P<.05). Group VITA YZ-Cerec showed significantly smaller marginal
gap values than groups DCS and Procera at framework (P<.05) and before-cementation
(P<.05) stages. The VITA YZ-Cerec group showed significantly smaller marginal gap values
than the Procera group after cementation (P<.05). The marginal gap values between different
stages were not significantly different for all groups (P>.05).
CONCLUSIONS: The marginal accuracy of zirconia fixed dental prostheses is influenced by
manufacturing technique.

Int J Comput Dent. 2009;12(1):87-93.
123. . . . You have Cerec Connect for everything else.

Haselbauer J.
Sirona Dental Systems GmbH, Bensheim, Germany. joerg.haselbauer@sirona.com
Abstract
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Cerec users today produce chairside inlays, onlays, veneers and crowns on the basis of a
digital impression. Cerec Connect, Sirona's Internet portal, through which Cerec users can
send digital models to the laboratory for production of the restorations, is now available for
many further indications.
MeSH Terms
Int J Comput Dent. 2009;12(1):79-85.
124. The Cerec bridge.

Wiedhahn K.

Int J Comput Dent. 2009;12(1):71-7.
125. The new Cerec AC Bluecam recording unit: a case report.

Steinbrenner H.
dr.steinbrenner@gmx.de

Int J Comput Dent. 2009;12(1):59-70.
126. The perfect companion: Cerec 3D software upgrade V3.40.

Gedosev M.
Sirona Dental Systems GmbH, Bensheim, Germany. milos.gedosev@sirona.com
Abstract
The new software for the Cerec system is a perfect companion for the Cerec Bluecam and the
Cerec 3 camera. It has a completely new and redesigned 3D preview. Taking optical
impressions for new users is now easier than ever and has all the features that the
experienced user requires. The software indication spectrum includes: inlays, onlays, anterior
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crowns, posterior crowns, veneers and now also long-term provisional chairside bridges. The
new milling preview shows precisely where the restoration in the selected block will be placed
and how it will be milled.
MeSH Terms
Int J Comput Dent. 2009;12(1):47-52.
127. Digital impressions--easier than ever.

Pieper R.
Dipl.-Ing., Produkt Management Cerec, Sirona Dental Systems GmbH, Bensheim, Germany.
reinhard.pieper@sirona.com
Abstract
The technical features of the new Cerec Bluecam greatly simplify the optical impression-taking
process and allow the dentist to concentrate on the patient and on the clinical aspects of the
procedure. The level of precision attained with the Cerec Bluecam compares very well with the
results achieved with laboratory scanners. With Cerec Bluecam, digital impressions become a
clinical reality even for laboratory-made indirect restorations.
MeSH Terms
Int J Comput Dent. 2009;12(1):41-6.
128. The new acquisition unit Cerec AC.

Schenk O.
schenk@quintessenz.de
Abstract
Cerec AC presents itself as a modern acquisition unit with all features that are necessary for
the digital optical impression. Apart from that, many user demands have been realized to
improve different aspects, most importantly, of course, the much easier imaging process. But
also the uninterrupted power supply--even though only an option--will soon be in every unit. A
work of art.
Pagina 93 di 97
19/09/13 13:24
MeSH Terms
Int J Comput Dent. 2009;12(1):11-28.
129. Accuracy testing of a new intraoral 3D camera.

Mehl A, Ender A, Mrmann W, Attin T.
Divison of Computerized Dentistry, Center for Dental and Oral Medicine and Cranio-Maxillofacial Surgery, University
of Zurich. Albert.Mehl@zzmk.uzh.ch
Abstract
Surveying intraoral structures by optical means has reached the stage where it is being
discussed as a serious clinical alternative to conventional impression taking. Ease of handling
and, more importantly, accuracy are important criteria for the clinical suitability of these
systems. This article presents a new intraoral camera for the Cerec procedure. It reports on a
study investigating the accuracy of this camera and its potential clinical indications. Singletooth and quadrant images were taken with the camera and the results compared to those
obtained with a reference scanner and with the previous 3D camera model. Differences were
analyzed by superimposing the data records. Accuracy was higher with the new camera than
with the previous model, reaching up to 19 microm in single-tooth images. Quadrant images
can also be taken with sufficient accuracy (ca 35 microm) and are simple to perform in clinical
practice, thanks to built-in shake detection in automatic capture mode.

Quintessence Int. 2009 Feb;40(2):125-33.
130. Simulated fatigue resistance of composite resin versus porcelain
CAD/CAM overlay restorations on endodontically treated molars.

Magne P, Knezevic A.
School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA. magne@usc.edu
Abstract
OBJECTIVE: To assess the influence of material selection (porcelain versus composite resin)
for overlay-type restoration of endodontically treated molars and its effect on the in vitro fatigue
resistance and failure mode.
METHOD AND MATERIALS: A standardized tooth preparation was applied to 30 extracted
molars, including root canal treatment, 3-mm coverage of all cusps, a mesial box 1.5 mm
below the cementoenamel junction (CEJ), a distal box in enamel, a glass-ionomer base, and
immediately sealed dentin. Using the Cerec machine (Sirona), all teeth were restored with an
Pagina 94 di 97
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overlay of standardized thickness and occlusal anatomy. Fifteen restorations were milled in the
ceramic Vita MKII block (Vident) and the other 15 using the composite resin Paradigm MZ100
block (3M ESPE). The intaglio surfaces of the ceramic restorations were etched and silanated.
The intaglio surfaces of the composite resin overlays were airborne-particle abraded and
silanated. Preparations were airborne-particle abraded and etched before restoration insertion.
All restorations were adhesively luted with an adhesive resin (Optibond FL, Kerr) and a lightcuring composite resin (Filtek Z100, 3M ESPE). Cyclic isometric chewing (5 Hz) was
simulated, starting with a load of 200 N (5,000 cycles), followed by stages of 400, 600, 800,
1,000, 1,200, and 1,400 N at a maximum of 30,000 cycles each. Samples were loaded until
fracture or to a maximum of 185,000 cycles.
RESULTS: MKII overlays fractured at a mean load of 1,147 N, and none of them withstood all
185,000 loading cycles (survival = 0%); with MZ100, the survival rate was 73%. With MKII,
40% of the fractures ended below the CEJ; with MZ100, only 25% did.
CONCLUSIONS: Composite resin MZ100 increased the fatigue resistance of overlay-type
restorations in endodontically treated molars when compared to porcelain MKII. The efficiency
of the bond strategy (immediate dentin sealing) was demonstrated by the absence of adhesive
failures.

Oper Dent. 2008 Nov-Dec;33(6):644-50. doi: 10.2341/07-162.
131. Marginal fit of heat-pressed vs. CAD/CAM processed all-ceramic onlays
using a milling unit prototype.
Reich S, Gozdowski S, Trentzsch L, Frankenberger R, Lohbauer U.

University of Leipzig, Department of Prosthodontics and Material Sciences, Leipzig, Germany.
sven.reich@medizin.uni-leipzig.de
Abstract
The composite luting gap between ceramic and dental hard tissue can be termed an "Achilles
heel". Therefore, one major goal of luting ceramics focuses on minimizing the inter-marginal
gap area. This study evaluated the marginal accuracy of two all-ceramic systems. The null
hypothesis was that there is no statistical difference between the marginal accuracy of the IPS
Empress and Cerec 3D all-ceramic systems. On 16 casts, representing different clinical
situations, the left first mandibular molar was prepared to receive large onlays (MOD and
replacement of the distobuccal and distal cusps). For each cavity, one laboratory heat-pressed
(IPS Empress) and one chairside CAD/CAM restoration (Cerec 3D) were manufactured. A
newly developed milling unit was used for CAM processing. The restorations were placed in
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their respective cavities and die replicas were taken and examined under SEM for quantitative
gap measurement. The gap width was measured at 11 defined landmarks by two different
examiners. An overall gap width of 56 microm (+/- 31 microm) was measured for IPS Empress,
compared to the significantly increased value of 70 pm (+/- 32 microm) for Cerec 3D. From a
clinical viewpoint, the statistically significant difference between the two systems is not
relevant, since both systems still exhibit a clinically acceptable gap width of less than 100
microm.

Oper Dent. 2008 Nov-Dec;33(6):629-35. doi: 10.2341/07-158.
132. Effects of total and selective bonding on marginal adaptation and
microleakage of Class I resin composite restorations in vitro.

Schmidlin PR, Huber T, Ghring TN, Attin T, Bindl A.
Department of Preventive Dentistry, Periodontology and Cariology, Center for Dental Medicine, University of Zrich,
Zrich, Switzerland. patrick.schmidlin@zzmk.uzh.ch
Abstract
This study assessed the marginal integrity and microleakage of standardized Class I resin
composite restorations when placed with either "total" or "selective bonding" techniques. Sixty
standardized Class I cavities comprising the main fissure system were prepared (9 mm length
and 7 mm width). Cavity depth was set at 2.5 mm. In cavities where a glass ionomer liner was
placed, the cavity was deepened by an additional 0.5 mm. In "total bonding" specimens,
enamel and dentin were conditioned using a four-step adhesive system (Syntac Classic). In
teeth with "selective bonding," a chemical curing conventional glass ionomer cement (GIC;
Ketac Fil) and light-curing resin-modified glass ionomer liner (RMGI; Vitrebond) or three-step
adhesive bonding liner (Syntac) were applied. The cavity margins of the latter specimens were
finished with water-spray, acid-etched and a bonding agent was applied. All restorations were
placed in two oblique increments. Totally bonded ceramic inlays (Cerec) served as the control.
All specimens were subjected to thermo-mechanical loading (1.2 Mio cycles) and marginal
quality and microleakage were assessed. The highest percentage of margins rated as
"perfect" was found in selective bonding samples with glass ionomer liners and totally bonded
inlay restorations. All the other groups showed significantly decreased marginal quality (p <
0.05). The same results were found for the microleakage assessment. The authors of the
current study concluded that the application of a GIC liner significantly improved the overall
marginal adaptation of direct Class I restorations. The use of an adhesive bonding agent for
cavity sealing as currently used is not recommended.
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Dent Mater. 2009 Jan;25(1):94-102. doi: 10.1016/j.dental.2008.04.018. Epub 2008 Jul 11.
133. Marginal and internal fits of fixed dental prostheses zirconia retainers.
Beuer F, Aggstaller H, Edelhoff D, Gernet W, Sorensen J.
Department of Prosthodontics, Ludwig-Maximilians-University, Munich, Germany.
Abstract
OBJECTIVES: CAM (computer-aided manufacturing) and CAD (computer-aided design)/CAM
systems facilitate the use of zirconia substructure materials for all-ceramic fixed partial
dentures. This in vitro study compared the precision of fit of frameworks milled from semisintered zirconia blocks that were designed and machined with two CAD/CAM and one CAM
system.
METHODS: Three-unit posterior fixed dental prostheses (FDP) (n=10) were fabricated for
standardized dies by: a milling center CAD/CAM system (Etkon), a laboratory CAD/CAM
system (Cerec InLab), and a laboratory CAM system (Cercon). After adaptation by a dental
technician, the FDP were cemented on definitive dies, embedded and sectioned. The marginal
and internal fits were measured under an optical microscope at 50x magnification. A one-way
analysis of variance (ANOVA) was used to compare data (alpha=0.05).
RESULTS: The mean (S.D.) for the marginal fit and internal fit adaptation were: 29.1 microm
(14.0) and 62.7 microm (18.9) for the milling center system, 56.6 microm (19.6) and 73.5
microm (20.6) for the laboratory CAD/CAM system, and 81.4 microm (20.3) and 119.2 microm
(37.5) for the laboratory CAM system. One-way ANOVA showed significant differences
between systems for marginal fit (P<0.001) and internal fit (P<0.001).
SIGNIFICANCE: All systems showed marginal gaps below 120 microm and were therefore
considered clinically acceptable. The CAD/CAM systems were more precise than the CAM
system.
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