Novel methodology for measuring intraoral wear in enamel and dental restorative materials

Josephine F Esquivel-Upshaw, Shu-Min Hsu, Ana C Bohórquez, Nader Abdulhameed, Gary W Scheiffele, Mijin Kim, Dan Neal, John Chai, Fan Ren, Josephine F Esquivel-Upshaw, Shu-Min Hsu, Ana C Bohórquez, Nader Abdulhameed, Gary W Scheiffele, Mijin Kim, Dan Neal, John Chai, Fan Ren

Abstract

Objectives: To test the hypotheses that (a) the chairside/handheld dental scanner combined with a metrology software will measure clinical wear in vivo in agreement with measurements from X-ray computed microtomography and; (b) polished monolithic zirconia does not cause accelerated wear of opposing enamel.

Materials and methods: Thirty single crowns were randomized to receive a monolithic zirconia or metal-ceramic crown. Two non-restored opposing teeth in the same quadrants were identified to serve as enamel controls. After cementation, quadrants were scanned using an intraoral dental scanner. Patients were recalled at 6-months and 1-year for re-scanning. Scanned images were compared using a metrology software to determine maximum vertical wear of teeth. The accuracy of the scanning measurements from this new method was compared with X-ray computed microtomography (micro-CT) measurements. Statistical analysis was performed using Mann-Whitney U test to determine significant differences between wear of enamel against zirconia, metal-ceramic or enamel. Linear regression analysis determined agreement between measurements obtained using intraoral scanning and micro-CT.

Results: Regression analysis demonstrated that there is a quantitative agreement between depth and volume measurements produced using intraoral scanning and the micro-CT methodologies. There was no significant difference between the wear of enamel against polished monolithic zirconia crowns and enamel against enamel.

Conclusions: Intraoral scanning combined with a matching software can accurately quantify clinical wear to verify that monolithic zirconia exhibited comparable wear of enamel compared with metal-ceramic crowns and control enamel. Agreement between the intraoral scanner and the micro-CT was 99.8%. Clinical Trials.gov NCT02289781.

Keywords: X-ray computed microtomography; monolithic zirconia; wear depth; wear of enamel; worn volume.

© 2020 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
(a) 3D volume reconstruction of a 30‐mm ceramic sphere scanned using the same CT scan position selected for scanning the Dentoform® samples; (b) Front view of a tomography image showing as a sphere radius r = 15 mm; (c) Representative 3D visualization for the initial worn Dentoform® tooth scanned; (d) Representative 3D visualization for the worn Dentoform® tooth scanned for validation purposes; (e) Front view of a tomography image showing a silicon‐nitride ceramic ball having roughly comparable size and density as the Dentoform® samples; (f) Merging two surfaces obtained for initial scanned worn Dentoform® and rescanned worn Dentoform®. All reconstruction and segmentation analysis were made using VGStudio Max 3.0. Scale bar 5 mm (white line)
FIGURE 2
FIGURE 2
Consort diagram showing enrollment, allocation, follow up and analysis of participants
FIGURE 3
FIGURE 3
Comparison of wear between metal‐ceramic (MC) and monolithic zirconia crowns at 6 months and 1 year using two different methods
FIGURE 4
FIGURE 4
Comparison of antagonist enamel wear between metal ceramic and monolithic zirconia crowns at 6 months and 1 year using two different methods
FIGURE 5
FIGURE 5
Comparison of enamel wear between crown antagonist enamel and control enamel. Negative values indicate greater control enamel wear while positive values indicate greater antagonist enamel wear
FIGURE 6
FIGURE 6
(a) Representative zirconia crown on mandibular left first molar, second molar was used as a control alongside scans using Geomagic® Control X™ software (3D Systems, Rock Hill, SC) where baseline scans are superimposed with either 6 months or 1‐year scans; (b) Opposing quadrant where maxillary first molar was used as the opposing enamel and the second molar was a control alongside intraoral scans. Scale indicate degrees of difference in microns between the two scans
FIGURE 7
FIGURE 7
Regression analysis showing intraoral Parity plot for depth (open squares) and volume (closed squares) of worn areas obtained from micro‐CT and intraoral scanning. Agreement for depth is 99.8% and 99.84 for volume
FIGURE 8
FIGURE 8
(a) Top view of superimposed baseline scan and worn scan from intraoral scanner using metrology software. Blue areas show areas of wear according to color scale on the right of the image; (b) Top view of a Dentoform model showing wear facets (red) obtained using micro‐CT measurements and representative wall thickness analysis obtained using VGStudio Max 3.0 for worn area A

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