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Several materials for 3D printing of fixed dental prostheses (FDP) have been recently introduced. This study aims to evaluate the initial biocompatibility of novel printable resins for manufacturing temporary and permanent FDP.Specimens of five printable resins (VarseoSmile Crown plus, NextDent CB MFH, VarseoSmile Temp, Temp PRINT, P Pro CrownBridge), two types of resins for subtractive manufacturing (Tetric CAD, Telio CAD) and two types of resins with conventional curing processes (Tetric EvoCeram, Protemp 4) were produced and finished. Post-processing was strictly performed according to the manufacturer's protocol. Biocompatibility was evaluated by eluting specimens with cell culture medium and treating human gingival fibroblast cells with the eluates. A 72-hour continuous read cell viability assay measuring the reducing potential of the cells was performed. The cellular inflammatory response in terms of IL-6 and PGETetric CAD and Telio CAD were slightly toxic. All other resins were moderately to severely cytotoxic. VarseoSmile Crown plus and P Pro CrownBridge significantly enhanced PGEFurther post-processing steps such as additional curing and washing may improve the biocompatibility of printable materials.

The aim of the study was to compare incidences and types of injury incurred between e-scooter crashes and bicycle crashes. This retrospective study included all victims of e-scooter crashes who were treated in the department of oral and maxillofacial surgery during a 12-months interval.A comparison was made with a cohort of patients who underwent bicycle crashes. Study parameters included type of fracture, soft tissue and dental affection, necessity of inpatient or outpatient treatment, the use of helmets, and the time of admission. In total, 400 patients were included. Of these 40 had suffered a crash on an e-scooter and 360 on a bicycle. Descriptive statistics showed a low helmet-wearing rate among cyclists (16.1% of recorded cases), with no helmet wearing recorded among e-scooter users. E-scooter-related crashes showed a higher rate of facial soft-tissue injuries (77.5%, p = 0.049) than among cyclists (61.7%), as well as a higher rate of dental injuries (27.5%, p = 0.017) compared with the bicycle cohort (13.3%). Facial fractures were also more common in the e-scooter cohort (45% vs 25.8%, p = 0.010). Admission was typically at the weekend - in the afternoon for the bicycle cohort and in the evening and at night for the e-scooter cohort. As a consequence of the fact that e-scooter riders seem to have an increased risk of facial injuries, it seems that an awareness campaign might be necessary to encourage helmet usage and to persuade intoxicated persons to use public transportation instead.

Previous studies have shown that particles can be released from dental titanium (Ti)- and zirconia (ZrOCyto- and genotoxicity of TiOParticle size measurements revealed that 99% of the TiOTi usually develops an oxide layer (TiO

Objectives To investigate the initial bacterial adhesion on 3D-printed splint materials in relation to their surface properties. Materials and methods Specimens of five printable splint resins (SHERAprint-ortho plus UV, NextDent Ortho Rigid, LuxaPrint Ortho Plus, V-Print Splint, KeySplint Soft), one polymethylmethacrylate (PMMA) block for subtractive manufacturing (Astron CLEARsplint Disc), two conventional powder/liquid PMMA materials (FuturaGen, Astron CLEARsplint), and one polyethylene terephthalate glycol (PETG) thermoplastic sheet for vacuum forming (Erkodur Thermoforming Foil) were produced and finished. Surface roughness Ra was determined via contact profilometry. Surface morphology was examined under a scanning electron microscope. Multi-species bacterial biofilms were grown on entire splints. Total biofilm mass and viable bacterial counts (CFU/ml) within the biofilms were determined. Statistical analyses were performed with a one-way ANOVA, Tukey’s post hoc test, and Pearson’s test (p Results Astron CLEARsplint and KeySplint Soft specimens showed the highest surface roughness. The mean total biofilm mass on KeySplint Soft splints was higher compared to all other materials (p Ra, biofilm mass, and CFU/ml. A positive correlation was found between Ra and CFU/ml (r = 0.69, p = 0.04). Conclusions The 3D-printed splints showed overall favorable results regarding surface roughness and bacterial adhesion. Thermoplastic materials seem to display a higher surface roughness, making them more susceptible to microbial adhesion. Clinical relevance The development of caries and gingivitis in patients with oral appliances may be affected by the type of material.

Objective The elution of unpolymerized (co-)monomers and additives from methacrylic resin-based materials like polymethyl methacrylate (PMMA) can cause adverse side effects, such as mutagenicity, teratogenicity, genotoxicity, cytotoxicity and estrogenic activity. The aim of this study was to quantify the release and the cytotoxicity of residual (co-)monomers and additives from PMMA-based splint materials under consideration of real splint sizes. Three different materials used for additive (3D printing), subtractive (milling) and conventional (powder and liquid) manufacturing were examined. Methods The splint materials SHERAprint-ortho plus (additive), SHERAeco-disc PM20 (subtractive) and SHERAORTHOMER (conventional) were analysed. 16 (n = 4) sample discs of each material (6 mm diameter and 2 mm height) were polished on the circular and one cross-section area and then eluted in both distilled water and methanol. The discs were incubated at 37 °C for 24 h or 72 h and subsequently analysed by gas chromatography/mass spectrometry (GC/MS) for specifying and quantifying released compounds. XTT-based cell viability assays with human gingival fibroblasts (HGFs) were performed for Tetrahydrofurfuryl methacrylate (THFMA), 1,4-Butylene glycol dimethacrylate (BDDMA) and Tripropylenglycol diacrylate (TPGDA). In order to project the disc size to actual splint sizes in a worst-case scenario, lower and upper jaw occlusal splints were designed and volumes and surfaces were measured. Results For SHERAeco-disc PM20 and for SHERAORTHOMER no elution was determined in water. SHERAprint-ortho plus eluted the highest THFMA concentration of 7.47 μmol/l ±2,77 μmol/l after 72 h in water. Six (co-)monomers and five additives were detected in the methanol eluates of all three materials tested. The XTT-based cell viability assays resulted in a EC50 of 3006 ± 408 μmol/l for THFMA, 2569.5 ± 308 μmol/l for BDDMA and 596.7 ± 88 μmol/l for TPGDA. Significance With the solvent methanol, released components from the investigated splint materials exceeded cytotoxic concentrations in HGFs calculated for a worst-case scenario in splint size. In the water eluates only the methacrylate THFMA could be determined from SHERAprint-ortho plus in concentrations below cytotoxic levels in HGFs.

The aim of this study was to evaluate the anti-biofilm effect of polyhexanide mouth rinses against oral pathogens in vitro.Biofilms of Candida albicans, Streptococcus mutans, Actinomyces naeslundii...

Objectives To evaluate the biological and physicochemical features of bioactive root canal sealers. Materials and methods Human periodontal ligament fibroblasts (hPDLF) and human osteoblasts (hOB) were exposed to eluates of three bioactive root canal sealers, GuttaFlow® bioseal (GF), BioRoot™ RCS (BR), and TotalFill® BC Sealer (TF), and the epoxy resin–based sealer AH plus® (AH). Cytotoxicity and cellular inflammatory response were evaluated. The osteogenic potential was examined using human mesenchymal stem cells (hMSC). Film thickness, flowability, and pH were assessed. Root canal treatment was performed on human extracted teeth to evaluate the sealers’ tightness towards bacterial penetration. The antibacterial activity against common pathogens in primary root canal infections was tested. Results AH was severely cytotoxic to hPDLF and hOB (p p p 2 production in hPDLF and hOB (p p p Conclusions This study revealed favorable in vitro results regarding the biocompatibility of the bioactive root canal sealers. Clinical relevance Bioactive root canal sealers may be a useful alternative to epoxy resin–based sealers.

Antimicrobial peptides are receiving increasing attention as potential therapeutic agents for treating biofilm-related infections of the oral cavity. Many bacteria residing in biofilms exhibit an enhanced antibiotic tolerance, which grants intrinsically susceptible microorganisms to survive lethal concentrations of antibiotics. In this study, we examined the effects of two endogenous human antimicrobial peptides, LL-37 and human Lactoferricin, on the antibiotic drug efficacy of amoxicillin, clindamycin and metronidazole in two types of polymicrobial biofilms, which aimed to represent frequent oral diseases: (1) facultative anaerobic (Streptococcus mutans, Streptococcus sanguinis, Actinomyces naeslundii) and (2) obligate anaerobic biofilms (Veillonella parvula, Parvimonas micra, Fusobacterium nucleatum). LL-37 and Lactoferricin enhanced the anti-biofilm effect of amoxicillin and clindamycin in facultative anaerobic biofilms. Metronidazole alone was ineffective against facultative anaerobic biofilms, but the presence of LL-37 and Lactoferricin led to a greater biofilm reduction. Obligate anaerobic biofilms showed an increased drug tolerance to amoxicillin and clindamycin, presumably due to metabolic downshifts of the bacteria residing within the biofilm. However, when combined with LL-37 or Lactoferricin, the reduction of obligate anaerobic biofilms was markedly enhanced for all antibiotics, even for amoxicillin and clindamycin. Furthermore, our results suggest that antimicrobial peptides enhance the dispersion of matured biofilms, which may be one of their mechanisms for targeting biofilms. In summary, our study proves that antimicrobial peptides can serve as an auxiliary treatment strategy for combatting enhanced antibiotic tolerance in bacterial biofilms.

The transfer of 3D implant position planning to the clinical site is challenging. The aim of this study was to compare in vitro this transfer accuracy by using dynamic real-time navigation or static surgical guides.Deviations between planned and actual pilot drill positions were calculated (Denacam and NobelGuide; each n = 90), matching pre- and postoperative CBCT images: entry point, angle, tip (each 3D); depth, mesiodistal/bucco-oral entry points, and angles (each 1D). The influence of the maxilla and mandible, implant region (anterior/posterior), and marker position (ipsilateral/contralateral, Denacam only) was investigated (Mann-Whitney U test).No significant differences occurred regarding entry point (3D), mesiodistal/bucco-oral entry points (1D) or mesiodistal angle (1D) (P0.05). The angular and tip deviations (3D) were significantly smaller using Denacam (2.16 ± 0.59 degrees, 0.80 ± 0.55 mm; NobelGuide 2.54 ± 1.19 degrees, 1.09 ± 0.56 mm; P = 0.024, P0.0001). The deviations in depth and bucco-oral angle (1D) were significantly smaller using NobelGuide (1.05 ± 0.50 mm, 1.02 ± 1.16 degrees; Denacam 1.50 ± 0.64 mm, 1.51 ± 0.82 degrees; P0.0001). Significantly smaller deviations occurred within the mandible (Denacam, 5/8 parameters). Region and marker position showed no influence. No distinct influences were found with the use of NobelGuide.Denacam might possibly be a promising alternative to static surgical guides.

The aim of this study was to assess near-infrared transillumination with high dynamic range imaging (NIRT-HDRI) for occlusal caries detection in vitro and to compare it with visual inspection using the International Caries Detection and Assessment System II (ICDAS) and digital bitewing radiography (BWR). Sixty-one extracted permanent molars with sound or occlusal carious surfaces without severe cavitation were visually assembled. Two examiners assessed twice these surfaces independently using ICDAS, BWR and NIRT-HDRI. The latter was performed with a prototype consisting of two laser sources (780 nm), a CCD sensor and subsequent processing with image analysis software. Thresholds for carious surfaces, enamel and dentin lesions were defined for all methods. Micro-computed tomography served as the reference standard. Linear weighted Kappa analysis of the methods versus the reference at the threshold carious surface, enamel and dentin lesion revealed 0.59/0.08/0.12 for ICDAS, 0.37/− 0.06/0.58 for BWR and 0.33/− 0.01/0.51 for NIRT-HDRI. Sensitivity values at the three thresholds were 0.85/0.78/0.13 for ICDAS, 0.59/0.00/0.69 for BWR and 0.98/0.33/0.78 for NIRT. Specificity values at the three thresholds were 0.70/0.40/1.00 for ICDAS, 0.9./0.96/0.90 for BWR and 0.30/0.65/0.72 for NIRT-HDRI. Reliability analysis revealed substantial agreement for BWR and NIRT and almost perfect agreement for ICDAS. NIRT exhibited a strong ability to identify occlusal dental decay in general; however, it revealed a tendency towards overestimation. Its strength was the detection of dentin caries lesions compared with ICDAS and BWR. NIRT-HDRI seems to be a suitable method to detect hidden dentin caries as a supplement to visual examination.

Antimicrobial peptides (AMPs) represent important facets of the immune system controlling infectious diseases. However, pathogens show varying susceptibilities to AMPs. This study investigates the susceptibilities of strains of Streptococcus mutans (SM), Actinomyces naeslundii (AN), and Lactobacillus spp. (LB) towards AMPs and if there are correlations between the appearance of such high-risk strains and clinical caries status. Plaque samples were collected from patients along with clinical examinations. Bacterial strains were identified via selective media, matrix-assisted laser desorption/ionization analysis-time of flight (MALDI-TOF), and arbitrary-primed-PCR (AP-PCR). Each strain was tested for susceptibility to LL-37, HBD-2, HNP-1, and HNP-3 or phosphate-buffered saline as negative control in a biofilm model on hydroxylapatite discs. Survival rates and resulting risk classification for each strain were determined. Correlations were calculated between the number of high-risk strains (all/S. mutans) appearing in patients and their clinical caries status. Forty-seven patients were included with mean DMFT values of 11.4 ± 8.7. A total of 8 different SM, 30 LB, and 47 AN strains were detected. One-way ANOVA indicated that type/concentration of AMPs had major influence on reductions of Lactobacilli and Actinomyces. Seventeen strains of AN, 2 of SM, and 6 of LB had low susceptibilities to AMPs. The number of such strains in patients showed significant positive correlations to the DMFT values (all p = 0.001; r = 0.452; S. mutans p

Modern teaching formats have not been considered necessary during the COVID-19 pandemic with uncertain acceptance by students. The study’s aim was to describe and evaluate all measures undertaken for theoretical and practical knowledge/skill transfer, which included objective structured practical examinations (OSPEs) covering a communication skills training. The students’ performance in the OSPE as well as the theoretical knowledge level were assessed, of which the latter was compared with previous terms. In conservative dentistry and periodontology (4th and 5th year courses), theoretical teaching formats were provided online and completed by a multiple-choice test. Practical education continued without patients in small groups using the phantom-head, 3D printed teeth, and objective structured practical examinations (OSPEs) including communication skills training. Formats were evaluated by a questionnaire. The organization was rated as very good/good (88.6%), besides poor Internet connection (22.8%) and Zoom® (14.2%) causing problems. Lectures with audio were best approved (1.48), followed by practical videos (1.54), live stream lectures (1.81), treatment checklists (1.81), and virtual problem-based learning (2.1). Lectures such as .pdf files without audio, articles, or scripts were rated worse (2.15–2.30). Phantom-heads were considered the best substitute for patient treatment (59.5%), while additional methodical efforts for more realistic settings led to increased appraisal. However, students performed significantly worse in the multiple-choice test compared to the previous terms (p &lt, 0.0001) and the OSPEs revealed deficits in the students’ communication skills. In the future, permanent available lectures with audio and efforts toward realistic treatment settings in the case of suspended patient treatment will be pursued.

Aesthetic alternatives to stainless-steel crowns for restoring primary molars attain growing interest. We studied the mechanical properties of prefabricated zirconia crowns and conventional crowns. Three brands of prefabricated zirconia crowns were compared with computer-aided design/computer-aided manufacturing (CAD/CAM) zirconia crowns, preveneered stainless-steel crowns, and conventional stainless-steel crowns regarding: (i) fracture load under each of three conditions [no pretreatment, artificial aging in saliva for 12 wk, and after chewing simulation/thermocycling (1.68 × 106 cycles/5-55°C)]; and (ii) survival rate during chewing simulation, considering decementation, fracture, chipping, fatigue cracks, and occlusal holes. Without pretreatment, the prefabricated zirconia crowns showed mean fracture load values between 893 N and 1,582 N, while the corresponding values for CAD/CAM zirconia crowns and preveneered stainless-steel crowns were 2,444 N and 6,251 N. Preveneered stainless-steel crowns showed significantly lower fracture loads after artificial aging (5,348 N after saliva aging; 3,778 N after chewing simulation) than without artificial aging, whereas the fracture load of zirconia crowns was not influenced negatively. The survival rate of the different groups of zirconia crowns and preveneered stainless-steel crowns during chewing simulation was 100%, but only 41.7% for the stainless-steel crowns. These in-vitro data suggest that prefabricated zirconia crowns are aesthetically and durable alternatives to stainless-steel crowns for primary molars.

In this single-blinded, prospective, randomized, controlled clinical trial, the effectiveness of an ozone gas or NaOCl/CHX disinfection protocol was compared within the root canal treatment of apical periodontitis. Sixty permanent teeth were randomly allocated to one technique. The clinical/radiographic assessment criteria included clinical symptoms, periapical index (PAI), and size of the apical lesion. In both groups, the root canal was mechanically cleaned and irrigated with NaCl and EDTA. Ozone gas (32 g m−3) or NaOCl (3 %) was applied followed by a 1-week inter-appointment dressing (Ca(OH)2). As final disinfection, ozone gas (ozone group) or CHX 2 % (NaOCl group) was applied. Microbial samples were taken after preparing the access cavity, after chemo-mechanical treatment and after inter-appointment dressing by sterile paper points. Microbial identification was performed by mass spectroscopy (MALDI-TOF-MS) and 16S-rRNA gene sequencing. The treated teeth were blindly re-evaluated after 6/12 months. Success rates, the decrease in PAI, the size of apical lesions and bacterial reduction were compared between groups (Fischer’s exact test, Mann-Whitney U test). There were no significant differences between the success rates (ozone group: 96.2/95.5 % after 6/12 months; NaOCl group: 95.5/95.2 % after 6/12 months). The differences in the decreases in PAI values and apical lesion sizes were also insignificant after 6 and 12 months. The bacterial reduction showed no significant differences between groups after chemo-mechanical treatment and after inter-appointment dressing. The most commonly found bacterial genera were Streptococcus spp., Parvimonas spp. and Prevotella spp. The here used ozone gas and NaOCl/CHX protocols showed no difference in bacterial reduction in the sampled areas of the root canals. Within the limitations of the study, ozone gas seems to be a possible alternative disinfection agent within the root canal treatment of apical periodontitis.

Introduction: Assessment of practical skills in undergraduate dental education has difficulties, including a lack of transparency/objectivity in student evaluations. This prospective study investigated whether agreement between student- and faculty-based assessments increased when students were trained to use the assessment criteria. Materials and methods: Assessment criteria were available for 6 tasks in the Phantom course of Conservative Dentistry: Class II cavity preparation, composite restoration, gold and ceramic partial crown preparation, trepanation and access cavity preparation, and root canal filling. Forty-two students were allocated to three different assessment training groups. Students' self-assessments of practical tests were compared with instructors' assessments, depending on training intensity and task type (Pearson's rho, ANOVA, Tukey's post hoc test, Kruskal-Wallis test). Students/instructors were questioned regarding benefits/drawbacks of the criteria. Results: Student self-assessments showed either consent (24.2%), overestimation (31%) or underestimation (44.8%). Gender differences were negligible. Regarding pass-ing/failing grades, more intensive training yielded significantly increased agreement only for preparation of gold partial crowns (rho = +0.313, P = 0.044). Ratings exhibited significant differences amongst tasks ( P = 0.002), for example, trepanation assessment had significantly lower differences than gold or ceramic preparation assessments. These discrepancies decreased with increased training. Students consistently reported benefitting most from learning the criteria for gold preparations, followed by composite and ceramic preparations. They also reported that learning the criteria was beneficial for knowledge transfer/feedback. Instructors rated the criteria as helpful for task evaluation and feedback efficiency. Conclusions: Pre-defined assessment criteria may increase consistency between student self-assessment and instructor assessment depending on the task, improving transparency and feedback in dental education.

To evaluate differences in physical characteristics and sealing ability of root-end-fillings made with these materials compared to the gold standard (ProRoot MTA).The physical characteristics of ProRoot MTA, Medcem MTA and Biodentine were evaluated regarding setting time, flow, film thickness, solubility and radiopacity according to the German Institute for Standardization (EN-ISO 6878). To investigate their sealing ability as root-end-fillings, a glucose penetration model was used. 60 human extracted single-rooted teeth were endodontically treated, root-end resections performed and divided in three groups of 20 teeth, using either ProRoot MTA, Medcem MTA or Biodentine as root-end-filling material. After 30 days, glucose concentrations were determined photometrically, followed by statistical analysis (Kruskal-Wallis test, Mann-Whitney U-test).Biodentine showed the fastest setting time (12 minutes) and lowest film thickness (0.11± 0.01 mm), whereas Medcem MTA showed the best values regarding solubility (0.1%) and flow (9.5± 0.02 mm). ProRoot MTA revealed the highest radiopacity (7.58± 0.1 mm aluminum equivalent). The glucose leakage in the Medcem MTA group was significantly lower than in the ProRoot MTA group (P= 0.011). Biodentine showed lower leakage than ProRoot MTA (P= 0.031).As Medcem MTA showed significantly lower leakage than the other materials tested, it may be an alternative for root-end-fillings with comparable physical characteristics to the current gold standard. With the exception of the high solubility, Biodentine performed well regarding leakage and setting time.

There are many ways to produce all-ceramic crowns. Computer-aided design and computer-aided manufacturing (CAD/CAM) procedures compete against conventional fabricated restorations. As different methods of production may produce variable results, this study aims to compare chairside and laboratory-based CAD/CAM systems to conventional crowns regarding their similarity to original tooth morphology, number of occlusal contacts, occlusal adjustment time, and subjective aesthetic perception. Impressions of caries-free jaws were taken, and the resulting gypsum casts were scanned with a laboratory scanner. Preparations for all-ceramic full crowns were performed on first molars, and three different restorations were made: CEREC restorations (CER), laboratory-produced CAD/CAM crowns (LABCAD), and conventional waxed-up/pressed ceramic crowns (CONV). Time for occlusal adaptation and the number of occlusal contacts were noted. Two dentists performed aesthetic gradings of restorations. Statistical analysis included one-way ANOVA with least significant difference (LSD) post hoc test, t test, and Kruskal-Wallis test. Metrical deviations of the re-scanned crowns to the original, unprepared tooth surface were 220.55 ± 54.31 μm for CER, 265.94 ± 61.39 for LABCAD, and 252.44 ± 68.77 μm for CONV group. One-way ANOVA showed significant lower deviations for the CER group. LABCAD crowns showed significantly more occlusal contacts, whereas CONV crowns required the least time for occlusal adaptation and showed excellent aesthetic gradings. All three methods had pros and cons regarding different parameters. Further improvements of CAD/CAM software shall lead to restorations comparable to conventional restorations in all aspects, especially in aesthetics. All tested methods of production for all-ceramic crowns produced clinically acceptable results. Thus, in an individual case, the method chosen can be determined by the dentist’s preference.

To evaluate the anti-microbial effect of gaseous and aqueous ozone on biofilms of caries pathogen microorganisms with regard to concentration and time dependency.Biofilm cultures of Actinomyces naeslundii, Streptococcus mutans and Lactobacillus paracasei were grown on nitro-cellulose-membranes for 48 hours. The membranes were cut into equal-sized pieces and exposed to chlorhexidine digluconate (CHX) (positive control; 0.1-20%), gaseous (1-64 g m3) and aqueous ozone (1.25-20 microg ml(-1)) for 60 seconds. The influence of exposure time (30-120 seconds) was tested for exemplary concentrations of the three agents. Colony forming units of bacteria were counted. The bacteria survival rate was given as percentage of the negative control (PBS for CHX/aqueous ozone, ambient air for gaseous ozone).There was no difference in bacterial reduction of different species with general reduction close to zero for high concentrations of all agents. Univariate ANOVA with partial eta-squared (Eta2) statistics showed major effects for concentration/contact time of the agent on bacteria survival. High concentrated gaseous and aqueous ozone seem to be potential alternatives to CHX with equivalent antimicrobial activity.

Recently, it has become possible to reconstruct complete occlusal surfaces using the biogeneric tooth model. This study aimed to mathematically assess and compare the morphologic agreement between original morphology and CAD-reconstructed, waxed-up and CAM partial crowns.Thirty-nine intact first permanent molars (39 participants) were included. Impressions, bite registrations and three gypsum replicas were made. Preparations for CAD/CAM partial crowns were performed and scanned. The restorations were biogenerically reconstructed (CEREC® v3.80) and milled. Wax-ups of these preparations were scanned as well as the milled restorations and original teeth. Discrepancies were evaluated by matching the scans with the original morphologies (Match3D, output: volume/area, z difference) and by contact patterns. The discrepancies were compared between CAD-reconstructions and either wax-ups or milled restorations (paired t test, α = 0.025 for two multiple tests).The mean differences between natural tooth morphology (triangular stabilisation 71.8%) and biogeneric reconstructions, wax-ups and milled restorations (triangular stabilisation 87.2%) were: 184 ± 36 μm (volume/area), 187 ± 41 μm (z difference); 263 ± 40 μm (volume/area), 269 ± 45 μm (z difference) and 182 ± 40 μm (volume/area), 184 ± 41 μm (z difference). Differences associated with biogeneric reconstructions were significantly less than those of wax-ups (volume/area and z difference, p 0.0001), but not significantly different than those of milled restorations (p = 0.423 (volume/area), p = 0.110 (z difference)).CAD software enables a closer reconstruction of teeth than do wax-ups, even when no cusps remain. The milling device is precise enough to transfer CAD into the final restoration.This study shows that state of the art CAD/CAM can effectively produce natural tooth morphology and may be ideal for fixed partial dentures.