Prof. Francesco Mangano
• Associate Professor, Digital Dentistry, Sechenov First State Medical University, Moscow, Russian Federation; Lecturer, University of Hong Kong, China;
• Editor-in Chief, Digital Dentistry Section, Journal of Dentistry (Q1, Impact Factor 4.4; Citescore 7.0);
• Member of the Board of Directors (2022- 23) and President Elect (2024- 25), Digital Dentistry Society (DDS);
• Scientific Editor of DDS MAG and DentalTech (Infodent);
• Director of the Mangano Digital Academy (MDA);
• Author of 150 publications on international Pubmed indexed journals and high impact factor (Index: 54 Google Scholar – 39 Scopus);
• He works as a freelance in Gravedona (Como), devoting himself exclusively to Digital Dentistry.
introduction
introduction
Three month afoter the placement of an Anyridge® (Megagen, South Korea) single implant in position 36, the patient was ready for prosthetic rehabilitation.
The intraoral scan was performed with an iTeroTM Element 5D Plus (Align Technologies, USA), an intra- oral scanner with high trueness as demonstrated in a recent scientific study [1] and thus ideal for clinical application in not only orthodontics but also prosthetic dentistry (Fig. 1A–D).
In this case, an IPD® scanbody (IPD PRO CAM, Spain) was used.
The choice of a compatible scanbody was dictated by the quality of the implant libraries that IPD makes available to the dental technician in CAD. IPD PRO CAM offers a library with different solutions (or, rather, different enlargements of the same object), very useful in compensating for any errors or positional discrepancies due to the transition from mesh to library file [2], in the early stages of CAD modelling. The transfer of the correct position of the implant from the real to the virtual is thus granted, and modelling in CAD is possible without any error.
“The printing model with a double-fixation screw represents a valid solution for the precise transfer of the implant position from the virtual to the real.”
case study
case study
We opted for a crown cemented on a personalised abutment [3]: therefore, the dental technician modelled a monolithic crown to be cemented on an individual hybrid abutment (Fig. 2A–C). The model for 3D printing was also prepared in CAD (Fig. 3A– D). The printing model with a double-fixation screw represents a valid solution offered by IPD PRO CAM for the precise transfer of the implant position from the virtual to the real.
The monolithic crown was printed with additive technology using a modern 3D SLA printer, the DFAB® (DWS Systems, Italy), in the proprietary hybrid composite material Irix Max® (DWS Systems, Italy; Fig. 4A– E).
The DFAB printer, a small jewel of Italian technology, can print in 10–15 minutes up to five single crowns in a definitive material, in a colour gradient, thanks to the proprietary tilted stereolithography technology. Basically, the printer allows for obtaining restorations with three different colours because the operator can intuitively set the colour levels in the software (Fig. 5 A–D).
All the CAD/CAM is automated, which results in considerable time saving.
Besides the monolithic crown, the dental technician also modelled a customised abutment in CAD, printed with the same additive technology in hybrid material, in a chairside procedure (Fig. 6A–E).
As an alternative, the abutment could be milled in zirconia after nesting in CAM with Millbox® (Cimsystem, Italy), using a powerful five-axis milling machine (DWX-52D®; DGSHAPE, Japan). In the case of zirconia abut- ments, sintering in the Tabeo® furnace (Mihm Vogt, Germany) is required; if the full chairside additive procedure is instead opted for, both the monolithic hybrid composite crown and the abutment need to be polymerised in the proprietary DCURE® oven (DWS Systems, Italy; Fig. 7A–C).
The accuracy of the printing is very high, as demonstrated by the quality of the occlusal features and marginal closure of the restorations obtained with DFAB® (Fig. 8A, B).
The customised abutment was subse- quently adhesively cemented on an IPD® titanium bonding base (IPD PRO CAM, Spain). This individual hybrid abutment served as a support for the cementation of the final monolithic single crown, which could be further characterised.
conclusion
conclusion
The result was a certified crown for definitive use, aesthetically pleasing, with remarkable clinical precision [4] and ideal mechanical characteristics. Its function was guaranteed in the medium and long term [5].
The quality and accuracy of the restoration were verified on a model with a double-fixation screw (IPD PRO CAM, Spain) 3D printed on the XFAB 3500PD® desktop SLA printer (DWS Systems, Italy; Fig. 9A–D).
In a second session, the patient was recalled for delivery of the final restoration. Once the healing abutment was removed, the individual hybrid abutment was screwed into the cor- rect position dictated by the index (hexagon). Subsequently, once the screw hole of the individual abutment was closed with Teflon, the final crown in the hybrid composite material was cemented onto the abutment with TempBond® temporary cement (Kerr, USA; Fig. 10A–E).
SOURCES
1) Mangano FG, Admakin O, Bonacina M, Lerner H, Rutkunas V, Mangano C. Trueness of 12 intraoral scanners in the full-arch implant impression: a comparative in vitro study. BMC Oral Health. 2020 Sep 22;20(1):263. doi: 10.1186/s12903-020-01254-9.
2) Mangano F, Lerner H, Margiani B, Solop I, Latuta N, Admakin O. Congruence between Meshes and Library Files of Implant Scanbodies: An In Vitro Study Comparing Five Intraoral Scanners. J Clin Med. 2020 Jul 9;9(7):2174. doi: 10.3390/jcm9072174.
3) Lerner H, Mouhyi J, Admakin O, Mangano F. Artificial intelligence in fixed implant prosthodontics: a retrospective study of 106 implant- supported monolithic zirconia crowns inserted in the posterior jaws of 90 patients. BMC Oral Health. 2020 Mar 19;20(1):80. doi: 10.1186/s12903-020-1062-4.
4) Revilla-León M, Supaphakorn A, Barmak AB, Rutkunas V, Kois JC. Influence of print orientation on the intaglio surface accuracy (trueness and precision) of tilting stereolithography definitive resin-ceramic crowns. J Prosthet Dent. 2023 Apr 25:S0022-3913(23)00186-5. doi: 10.1016/j.prosdent.2023.03.020. Online ahead of print.
5) Corbani K, Hardan L, Eid R, Skienhe H, Alharbi N, Ozcan M, Salameh Z. Fracture Resistance of Three-unit Fixed Dental Prostheses Fabricated with Milled and 3D Printed Composite-based Materials. J Contemp Dent Pract. 2021 Sep 1;22(9):985-990.