Marginal fit and photoelastic stress analysis of CAD-CAM and overcast 3-unit implant-supported frameworks

Statement of problem. Several studies have shown the superiority of computer-assisted design and computer-assisted manufacturing (CAD-CAM) technology compared with conventional casting. However, an advanced technology exists for casting procedures (the overcasting technique), which may serve as an acceptable and affordable alternative to CAD-CAM technology for fabricating 3-unit implant-supported fixed dental prostheses (FDPs). Purpose. The purpose of this in vitro study was to evaluate, using quantitative photoelastic analysis, the effect of the prosthetic framework fabrication method (CAD-CAM and overcasting) on the marginal fit and stress transmitted to implants. The correlation between marginal fit and stress was also investigated. Material and methods. Three-unit implant-supported FDP frameworks were made using the CAD CAM (n=10) and overcasting (n=10) methods. The frameworks were waxed to simulate a mandibular first premolar (PM region) to first molar (M region) FDP using overcast mini abutment cylinders. The wax patterns were overcast (overcast experimental group) or scanned to obtain the frameworks (CAD-CAM control group). All frameworks were fabricated from cobalt chromium (CoCr) alloy. The marginal fit was analyzed according to the single-screw test protocol, obtaining an average value for each region (M and PM) and each framework. The frameworks were tightened for the photoelastic model with standardized 10-Ncm torque. Stress was measured by quantitative photoelastic analysis. The results were submitted to the Student t test, 2-way ANOVA, and Pearson correlation test (alpha=.05). Results. The framework fabrication method (FM) and evaluation site (ES; M and PM regions) did not affect the marginal fit values (P=.559 for FM and P=.065 for ES) and stress (P=.685 for FM and P=.468 for ES) in the implant-supported system. Positive correlations between marginal fit and stress were observed (CAD-CAM: r=0.922; P<.001; overcast: r=0.908; P<.001). Conclusions. CAD-CAM and overcasting methods present similar marginal fit and stress values for 3-unit FDP frameworks. The decreased marginal fit of frameworks induces greater stress in the implant-supported system.