Distortion of CAD-CAM-fabricated implant-fixed titanium and zirconia complete dental prosthesis frameworks

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Statement of problem.

Computer-aided design and computer-aided manufacturing (CAD-CAM)-fabricated titanium and zirconia implant-supported fixed dental prostheses have become increasingly popular for restoring patients with complete edentulism. However, the distortion level of these frameworks is not well known.


The purpose of this in vitro study was to compare the 3-dimensional (3D) distortion of CAD-CAM zirconia and titanium implant-fixed screw-retained complete dental prostheses.

Material and methods.

A master edentulous model with 4 implants at the positions of the maxillary first molars and canines was used. Multiunit abutments (Nobel Biocare) secured to the model were digitally scanned using scan bodies and a laboratory scanner (S600 ARTI; Zirkonzahn). Titanium (n=5) and zirconia (n=5) frameworks were milled using a CAD-CAM system (Zirkonzahn M1; Zirkonzahn). All frameworks were scanned using an industrial computed tomography (CT) scanner (Nikon/X-Tek XT H 225kV MCT Micro-Focus). The direct CT scans were reconstructed to generate standard tessellation language (STL) files. To calculate the 3D distortion of the frameworks, STL files of the CT scans were aligned to the CAD model using a sum of the least squares best-fit algorithm. Surface comparison points were placed on the CAD model on the midfacial aspect of all teeth. The 3D distortion of each direct scan to the CAD model was calculated. In addition, color maps of the scan-to-CAD comparison were constructed using a ±0.500 mm color scale range.


Both materials exhibited distortion; however, no significant difference was found in the amount of distortion from the CAD model between the materials (P=.747). Absolute values of deviations from the CAD model were evident in the x and y plane and less so in the z direction.


Zirconia and titanium frameworks showed similar 3D distortion compared with the CAD model for the tested CAD-CAM and implant systems. The distortion was more pronounced in the horizontal and sagittal plane than in the vertical plane.

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