CAD/CAM versus 3D-printing/pressed lithium disilicate monolithic crowns: Adaptation and fatigue behavior

Objectives: this study aimed to evaluate the adaptation and fatigue behavior of lithium disilicate glass-ceramic (LD) monolithic crowns produced by press (combined with 3D-printing) and CAD/CAM milling (control) techniques. Methods: thirty abutment preparations with a chamfer finish line were produced with a dentin analogue material and scanned with extraoral scanner. Captured images were processed using CAD software to design a premolar. Blocks of LD were milled using CAD/CAM system. For the press technique, crowns were first 3D-printed using a polymeric material and the heat-pressing protocol was performed. Crowns were adhesively cemented to the abutments and scanned using micro-CT. Files were processed and cross-sectional images were analysed in five measuring points: marginal, axial angle, axial, occlusal angle and occlusal. Fatigue test was performed in a MTS universal testing machine (2 Hz, 37 degrees C distilled water) using an anatomic composite piston, following the stepstress method. Failures were detected with an acoustic system and confirmed by transillumination. A cumulative damage-Weibull distribution (95% CI) was used to analyze the fatigue data. Gap thickness data were analyzed using Kruskal-Wallis and Student-Newman-Keuls tests (alpha=0.05). Results: CAD/CAM milling resulted in larger gap thickness in the occlusal area and smaller gap thickness in the axial angle and axial area than press (p<0.05). The probability of failure was similar for crowns produced with CAD/CAM milling and press. The most frequent failure mode was radial crack. Conclusions: LD crowns produced using the combination of 3D-printing/press technique showed similar fatigue behavior than CAD/CAM milled control group, and resulted in smaller gap thickness at the occlusal region. Clinical significance: A more controlled process can be achieved by replacing conventional restoration waxing with 3D printing, which in combination with the press technique produces lithium disilicate glass-ceramic monolithic crowns with good adaptation and high fatigue survival.

Automated summary

This study evaluated the adaptation and fatigue behavior of lithium disilicate glass-ceramic (LD) monolithic crowns produced using 3D printing/press technique and CAD/CAM milling. The results showed that the fatigue behavior of crowns produced using 3D printing/press technique was similar to CAD/CAM milling, but had smaller gap thickness in the occlusal region.