국소의치 구조물(framework)의 CAD-CAM 제조방식에 따른 정확도: 문헌고찰

이유승 大韓齒科補綴學會 2021 대한치과보철학회지 Vol.59 No.3

Purpose. The purpose of this study was to evaluate the currently published literatures investigating the accuracy of computer-aided design and computer-aided manufacturing removable partial denture (CAD-CAM RPD) framework with different manufacturing techniques and methods. Materials and methods. A comprehensive search for literatures was conducted in PubMed database using specific keywords with the patient, intervention, comparison, and outcome (PICO) question, “Is there a difference in accuracy of RPD frameworks manufactured using digital workflow according to the manufacturing process and methods?” Results. A total of 7 articles were selected. Two studies compared intraoral scanning and laboratory scanning for RPD frameworks and had heterogenous results. In the studies using different manufacturing process, RPD frameworks had clinically acceptable accuracy in both subtractive and additive manufacturing. Polyetheretherketone (PEEK)-milled RPD frameworks showed higher fit accuracy than traditionally casted or 3D printed RPDs. Direct milling method showed a higher accuracy than indirect milling method. However, in rapid prototyping, indirect method showed higher accuracy than direct method. Conclusion. The RPD frameworks fabricated using CAD-CAM technology showed a clinically acceptable level of accuracy regardless of manufacturing process or techniques. Consistent results have not been reported regarding the digital impression methods, which were intra oral scanning or laboratory scanning, and further studies are needed. 목적: 본 연구의 목적은 CAD-CAM 방식으로 제작한 RPD framework의 제조 과정 및 제작 방법에 따른 적합도를 문헌 고찰을 통해 평가하는 것이다. 재료 및 방법: 다음의 PICO(patient, intervention, comparison, and outcome) 질문과 관련한 특정 키워드를 이용하여 PubMed 데이터베이스 상에서 포괄적인 문헌 검색을 시행하였다: “제조 과정 및 제작 방식에 따라 디지털 RPD framework의 정확도에 차이가 있는가?” 결과: 총 7개의 문헌이 선택되었으며, 이 중 두 문헌에서 구강스캔과 모형스캔을 이용한 디지털 RPD framework의 정확도에 관하여 비교하였으나, 일관된 결과를 얻지 못하였다. 제작 방식에 따른 비교 문헌에서는 적층 가공 또는 절삭 가공을 통해 제작된 RPD framework 모두 임상적으로 허용가능한 수준의 정확도를 보였으며, PEEK (Polyetheretherketone) milling RPD framework가 전통적 주조방식으로 제작하거나 3D 프린팅으로 제작한 RPD framework보다 높은 적합도를 보였다. Milling RPD framework에서는 direct 방식으로 제작한 경우에 indirect 방식의 경우보다 우수한 적합도가 관찰되었으나, 3D 프린팅 RPD framework에서는 indirect 방식으로 제작한 경우에 더 높은 적합도를 보였다. 결론: CAD-CAM 기술을 이용하여 제작된 디지털 RPD framework는 제조 과정이나 방식에 관계없이 임상적으로 허용되는 수준의 정확도를 보였다. 구강스캔 또는 모형스캔의 디지털 인상 채득 방법에 따라서는 일관된 결과가 보고되지 않았으며, 추후 연구가 필요하다.

The effect of sandblasting duration on the bond durability of dual-cure adhesive cement to CAD/CAM resin restoratives

Neslihan Tekçe,Safa Tuncer,Mustafa Demirci 대한치과보철학회 2018 The Journal of Advanced Prosthodontics Vol.10 No.3

PURPOSE. To evaluate the effect of prolonged sandblasting on the bond durability of dual-cure adhesive resin cement to computer-aided design and computer-aided manufacturing (CAD/CAM) restoratives. MATERIALS AND METHODS. Nano-ceramic LAVA Ultimate and hybrid-ceramic VITA Enamic CAD/CAM blocks were used for this study. Each CAD/CAM block was sectioned into slabs of 4-mm thickness for the microtensile test (μTBS) test and 2-mm thickness for the surface roughness test. Three groups were created according to the sandblasting protocols; group 1: specimens were sandblasted for 15 seconds, group 2: specimens were sandblasted for 30 seconds, and group 3: specimens were sandblasted for 60 seconds. After sandblasting, all specimens were luted using RelyX Ultimate Clicker. Half the specimens were subjected to μTBS tests at 24 hours, and the other half were subjected to tests after 5000 thermocycles. Additionally, a total of 96 CAD/CAM block sections were prepared for surface roughness tests and scanning electron microscopy (SEM) evaluations. The Mann-Whitney U test, Kruskal-Wallis one-way analysis of variance, and Dunn’s post hoc test were used to compare continuous variables among the groups. RESULTS. At baseline, group 1, group 2, and group 3 exhibited statistically similar μTBS results for LAVA. However, group 3 had significantly lower μTBS values than groups 1 and 2 for VITA. After 5000 thermocycles, μTBS values significantly decreased for each block (P<.05). CONCLUSION. It is important to perform controlled sandblasting because it may affect bond strength results. Sixty seconds of sandblasting disturbs the initial μTBS values and the stability of adhesion of CAD/CAM restoratives to dual-cure adhesive resincement for VITA Enamic.

Evaluation of the repair capacities and color stabilities of a resin nanoceramic and hybrid CAD/CAM blocks

Bahadir, Hasibe Sevilay,Bayraktar, Yusuf The Korean Academy of Prosthodonitics 2020 The Journal of Advanced Prosthodontics Vol.12 No.3

PURPOSE. This study evaluated the color stabilities of two computer-aided design and computer-aided manufacturing (CAD/CAM) blocks and a nanofill composite resin and the microtensile bond strength (µTBS) between the materials. MATERIALS AND METHODS. Twelve specimens of 4 mm height were prepared for both Lava Ultimate (L) and Vita Enamic (E) CAD/CAM blocks. Half of the specimens were thermocycled (10,000 cycle, 5° to 55℃) for each material. Both thermocycled and non-thermocycled specimens were surface treated with one of the three different methods (Er,Cr:YSGG laser, bur, or control). For each surface treatment group, one of the thermocycled and one of non-thermocycled specimens were restored using silane (Ceramic Primer II), universal adhesive (Single Bond Universal), and nanofill composite resin of 4-mm height (Filtek Ultimate). The other specimens were restored with the same procedure without using silane. For each group, 1 × 1 × 8 mm bar specimens were prepared using a microcutting device. Bar specimens were thermocycled (10,000 cycle, 5° to 55℃) and microtensile tests were performed. Staining of the materials in coffee solution was also compared using a spectrophotometer. Data were analyzed using one-way ANOVA, t-test and post-hoc Scheffe tests. RESULTS. µTBS were found similar between the thermocycled and non-thermocycled groups (P>.05). The highest µTBS (20.818 MPa) was found in the non-thermocycled, bur-ground, silane-applied E group. Silane increased µTBS at some E groups (P<.05). Composite resin specimens showed more staining than CAD/CAM blocks (P<.05). CONCLUSION. CAD/CAM blocks can be repaired with composite resins after proper surface treatments. Using silane is recommended in repair process. Color differences may be shown between CAD/CAM blocks and the nanofill composite after a certain time period.

Biomechanical behavior of CAD/CAM cobalt-chromium and zirconia full-arch fixed prostheses

Barbin, Thais,Silva, Leticia Del Rio,Veloso, Daniele Valente,Borges, Guilherme Almeida,Presotto, Anna Gabriella Camacho,Barao, Valentim Adelino Ricardo,Groppo, Francisco Carlos,Mesquita, Marcelo Ferra The Korean Academy of Prosthodonitics 2020 The Journal of Advanced Prosthodontics Vol.12 No.6

PURPOSE. To verify the influence of computer-aided design/computer-aided manufacturing (CAD/CAM) implant-supported prostheses manufactured with cobalt-chromium (Co-Cr) and zirconia (Zr), and whether ceramic application, spark erosion, and simulation of masticatory cycles modify biomechanical parameters (marginal fit, screw-loosening torque, and strain) on the implant-supported system. MATERIALS AND METHODS. Ten full-arch fixed frameworks were manufactured by a CAD/CAM milling system with Co-Cr and Zr (n=5/group). The marginal fit between the abutment and frameworks was measured as stated by single-screw test. Screw-loosening torque evaluated screw stability, and strain analysis was explored on the implant-supported system. All analyses were performed at 3 distinct times: after framework manufacturing; after ceramic application in both materials' frameworks; and after the spark erosion in Co-Cr frameworks. Afterward, stability analysis was re-evaluated after 106 mechanical cycles (2 Hz/150-N) for both materials. Statistical analyses were performed by Kruskal-Wallis and Dunn tests (α=.05). RESULTS. No difference between the two materials was found for marginal fit, screwloosening torque, and strain after framework manufacturing (P>.05). Ceramic application did not affect the variables (P>.05). Spark erosion optimized marginal fit and strain medians for Co-Cr frameworks (P<.05). Screw-loosening torque was significantly reduced by masticatory simulation (P<.05) regardless of the framework materials. CONCLUSION. Co-Cr and Zr frameworks presented similar biomechanical behavior. Ceramic application had no effect on the biomechanical behavior of either material. Spark erosion was an effective technique to improve Co-Cr biomechanical behavior on the implant-supported system. Screw-loosening torque was reduced for both materials after masticatory simulation.

3D 프린팅 금관과 임플란트 보조 국소의치를 이용한 엇갈린 교합의 전악 수복 증례

이승훈,김성균,허성주,곽재영,박지만 대한치과보철학회 2023 대한치과보철학회지 Vol.61 No.4

최근 CAD-CAM (computer-aided design-computer-aided manufacturing) 기술 및 3D 프린팅 기술의 발전과 함께 다양한 디지털 기법들의 도입으로 top-down 방식의 최종 보철 수복의 정확성과 효율성이 증대되고 있다. 본 증례는 전후 엇갈린 교합을 가진 환자에서 총 9개의 상하악 구치부 임플란트 식립을 통해 안정적인 교합 지지를 얻으면서 잔존 치조골의 고도 흡수 경향을 보인 상악 전치부 무치악 부위는 케네디 4급 임플란트 보조 국소의치로 수복함으로써 연조직의 심미성을 회복하였다. 전산화단층촬영 가이드 수술로 계획된 위치에 임플란트를 식립하고, 이중 스캔 기법으로 임시 수복 단계에서 안정화된 교합을 최종 보철물에 반영하며, 코핑과 프레임워크를 금속 3D 프린팅으로 제작하여 효율적이며 예측 가능한 top-down 방식의 전악 구강 수복을 달성하였기에 이를 보고하고자 한다. With the recent development of computer-aided design-computer-aided manufacturing technology and 3D printing technology, and the introduction of various digital techniques, the accuracy and efficiency of top-down definitive prosthetic restoration are increasing. In this clinical case, stable occlusion support was obtained through the placement of a total of 9 maxillary and mandibular posterior implants in patient with anterior-posterior crossed occlusion. The edentulous area of the maxillary anterior teeth, which showed a tendency of high resorption of the residual alveolar bone, was restored with a Kennedy Class IV implant assisted removable partial denture to restore soft tissue esthetics. Computed tomography guided surgery was used to place implants in the planned position, double scan technique was used to reflect the stabilized occlusion in the interim restoration stage to the definitive prostheses, and metal 3D printing was used to manufacture the coping and framework. This clinical case reports that efficient and predictable top-down full mouth rehabilitation was achieved using various digital technologies and techniques.

Chairside computer-aided design/computer-aided manufacturing (CAD/CAM)-based restoration of anterior teeth with customized shade and surface characterization: a report of 2 cases

김현정,장지현,류길주,최경규,김덕수 대한턱관절교합학회 2020 구강회복응용과학지 Vol.36 No.2

Over the last 30 years, the use of chairside computer-aided design (CAD) and computer-aided manufacturing (CAM) systems has evolved and has become increasingly popular in dentistry. Although CAD/CAM restorations have been used in the anterior dentition, satisfying the esthetic requirements of clinicians and patients, where the restorations are limited to the chairside, remains a challenge. To reproduce multi-shades of CAD/CAM restorations in the clinic, a preliminary experiment to express several shades on A2 lithium disilicate (LS2) blocks using a staining kit was performed. After measurement of the CIE L*a*b* value of specimens, it was compared with that of the commercial shade guide. This report presents two cases with individual customization of shade and surface characterization of the CAD/CAM restorations using predictable methods based on the preliminary experimental data. The anatomical shape of restoration was obtained from ‘copy and paste technique’ and ‘mirror image acquisition technique’. All treatment procedures and fabrication of restorations performed in this report were executed in the clinic itself. (J Dent Rehabil Appl Sci 2020;36(2):128-37)

자동차용 루프 패널의 설계 및 해석에 관한 연구

이규배 ( Kyu-bae Lee ) 한국고등직업교육학회 2001 한국고등직업교육학회논문집 Vol.2 No.2

The development of computer hardware and software has made active research attempted in the motor field. From the design of motors to the manufacture of dies, it is attempted variously. Here, when we examine the computer applied example of dies manufacture. Specially, to evaluate formablity of stamping dies, simulation by computer is being made up. This is what we called “Virtual Manufacturing Method” by computer. Skilled shop workers can make a complete dies after spending much time and money. However, actual stamping process with virtual manufacturing method by computer can make the visualization of the result of simulation and verify strain conduct of the goods. Recently, at the advanced motor companies, the applicable of virtual manufacturing method to be moved up. This study is the area that must be researched at the point of time when is not reduced personnel and material expenses being consumed at the current manufacturing method. Positive attempt of the kind of technique is made up and have to be reduced the expense and time for manufacturing to the most.

3D 프린팅을 이용한 양악 총의치 제작 증례

이은수,박찬,윤귀덕,임현필,박상원 대한치과보철학회 2022 대한치과보철학회지 Vol.60 No.2

최근 디지털 치의학의 발달로, Computer-aided design-Computer-aided manufacturing (CAD-CAM)을 이용한 의치 제작이 증가하는 추세이다. CAD 소프트웨어를 통해 디자인된 의치를 제작하는 방식에는 밀링을 이용한 절삭가공방식과 3D 프린팅과 같은 적층가공방식이 있으며, 적층가공방식은 보다 복잡한 구조를 재현하는데 유리하게 사용될 수 있다. 본 증례는 뇌경색으로 인해 신체적 장애를 갖게 된 상·하악 완전무치악 환자에서 제작 기간과 내원 간격을 단축하기 위해 광경화 Stereolithography (SLA) 기반의 3D 프린팅을 이용한 디지털 제작 방식의 양악 총의치 수복 증례이다. 최종인상채득을 위해 기존 임시의치를 디지털 방식으로 복제 및 출력하여 개인트레이로 활용하였고, 부가중합형 실리콘 인상재로 채득한 최종인상체에는 수직고경과 중심위, 상악 전치부의 각도 및 길이에 대한 정보가 포함되었다. 또한 임시의치를 장착하고 촬영한 안면 스캔 데이터를 추가로 획득하여 기공작업 시 교합평면 결정이나 인공치 배열에 참고할 수 있도록 하였다. 인상체를 3차원 스캔 후 CAD 프로그램을 통해 인공치를 배열하였고, 연마면을 형성하여 의치 디자인을 완성하였다. 시적 의치 및 최종 의치는 FDA 승인을 받은 액체 광경화성 레진을 이용하여 SLA 기반 3D 프린터로 출력하였고, 최종 의치는 적절한 안정과 유지, 지지를 보였으며, 기능적, 심미적으로 만족스러운 결과를 얻을 수 있었다. 최종 의치의 전달까지 3회의 내원 횟수를 필요로 하였으며, 기공시간의 단축으로 내원 간격을 줄임으로써 환자의 만족도를 증진시켰다.

Comparison of the marginal fit of milled yttrium stabilized zirconium dioxide crowns obtained by scanning silicone impressions and by scanning stone replicas

Estefania Aranda Yus,Josep Maria Anglada Cantarell,Antonio Minarro Alonso 대한치과보철학회 2018 The Journal of Advanced Prosthodontics Vol.10 No.3

PURPOSE. To determine the discrepancy in monolithic zirconium dioxide crowns made with computer-aided design and computer-aided manufacturing (CAD/CAM) systems by comparing scans of silicone impressions and of master casts. MATERIALS AND METHODS. From a Cr-Co master die of a first upper left molar, 30 silicone impressions were taken. The 30 silicone impressions were scanned with the laboratory scanner, thus obtaining 30 milled monolithic yttrium stabilized zirconium dioxide (YSZD) crowns (the silicone group). They were poured and the working models were scanned, obtaining 30 milled monolithic yttrium stabilized zirconium dioxide (YSZD) crowns (the plaster group). Three predetermined points were analyzed in each side of the crown (Mesial, Distal ,Vestibular and Palatal), and the marginal fit was evaluated with SEM (×600). The response variable is the discrepancy from the master model. A repeated measures ANOVA with two within subject factors was performed to study significance of main factors and interaction. RESULTS. Mean marginal discrepancy was 22.42±35.65 μm in the silicone group and 8.94±14.69 μm in the plaster group. The statistical analysis showed significant differences between the two groups and also among the four aspects. Interaction was also significant (P=.02). CONCLUSION. The mean marginal fit values of the two groups were within the clinically acceptable values. Significant differences were found between the groups according to the aspects studied. Various factors influenced the accuracy of digitizing, such as the design, the geometry, and the preparation guidance, as well as the texture, roughness and the color of the scanned material.

Surface deterioration of monolithic CAD/CAM restorative materials after artificial abrasive toothbrushing

Nazmiye Şen,Betül Tuncelli,Gültekin Göller 대한치과보철학회 2018 The Journal of Advanced Prosthodontics Vol.10 No.4

PURPOSE. The purpose of this in vitro study was to evaluate the effect of abrasive toothbrushing on the surface properties of monolithic computer-assisted design and computer-assisted manufacturing (CAD/CAM) materials stored in food-simulating liquids (FSLs). MATERIALS AND METHODS. Fourty-eight disk-shaped test specimens of each material (Paradigm MZ100/PMZ, Lava Ultimate/LU, Vita Enamic/VE, and Vita Mark II/VMII) with a diameter of 10.0 mm and a thickness of 3.0 ± 0.05 mm were prepared. Specimens were divided into 4 subgroups (n=12) and stored in air, distilled water, 0.02 M citric acid, or 75% ethanol/water solution for 7 days at 36.5 ℃. Then, the specimens were brushed in a multi-station brushing machine under a vertical load of 2.0 N for 3 hours. Surface gloss (GU), roughness (Ra), and hardness (Vickers [VHN]) were measured after storage and brushing simulation. The data sets were statistically analyzed with 2 and 3-way ANOVAs followed by the Tukey's post-hoc comparisons (α=.05). RESULTS. Statistically significant difference was found among the materials concerning the results of surface properties. VMII showed the highest VHN, while PMZ produced the lowest. Storage in FSLs significantly affected the VHN of PMZ and LU. VMII showed the lowest Ra and highest GU irrespective of FSLs and of abrasive toothbrushing. VE, LU, and PMZ produced significant decrease in GU and increase in Ra after toothbrushing. CONCLUSION. Surface properties of monolithic CAD/CAM restorative materials were differently affected by the storage media and abrasive toothbrushing.