Assistant Professor and Assistant Program Director AEGD Residency, Comprehensive Dentistry Department, College of Dentistry, Texas A&M University, Dallas, Texas; Affiliate Faculty Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash; Researcher at Revilla Research Center, Madrid, Spain.
Associate Professor Department of Conservative Dentistry and Prosthodontics, School of Dentistry, Complutense University of Madrid, Madrid, Spain.
J Prosthet Dent. 2022 Oct;128(4):575-588. doi: 10.1016/j.prosdent.2021.01.001. Epub 2021 Jul 20.
Selective laser melting (SLM) additive manufacturing (AM) technologies provide an alternative to conventional casting and milling procedures in fabricating metal-ceramic dental prostheses. However, the quality of porcelain bond strength to the SLM AM cobalt-chromium (Co-Cr) metal framework of a dental restoration is unclear.
The purpose of this systematic review and meta-analysis was to identify in vitro studies that reported the porcelain bond strength to SLM AM Co-Cr dental metal alloys and compare the porcelain bond strength values to cast, milled, and additively manufactured Co-Cr dental alloys.
An electronic systematic review was performed in different databases: MEDLINE/PubMed, EMBASE, World of Science, Cochrane, and Scopus. A manual search was also conducted. Studies that reported the porcelain bond strength to SLM Co-Cr metal alloys and in the English language were included. Two investigators evaluated the quality assessment of the studies by applying the JBI critical appraisal checklist for quasi-experimental studies (nonrandomized experimental studies). A third investigator was consulted to resolve lack of consensus. Two subgroups were created based on the test used, 3-point bend and shear bond strength tests. The porcelain bond strength of cast, milled, and AM Co-Cr dental alloys were compared. The I2 statistic and its associated P value were used to assess the heterogeneity between studies. The Eger test was used for determining significance of the funnel pots.
A total of 216 studies were collected from the electronic and manual searches. After independently evaluating the titles and abstracts by the reviewers, 26 articles were identified. Three of these were excluded after full-text revision. The porcelain bond strength comparison between the cast and AM alloys for the 3-point bend subgroup revealed a significant result for overall effect (P<.001) favoring the SLM method with considerable heterogeneity (I2=83%, P<.001). Furthermore, the porcelain bond strength comparison between cast and milled alloys for the shear bond strength subgroup revealed a significant test for overall effect (P=.04) favoring milled procedures with a nonsignificant unimportant heterogeneity (I2= 0%, P<.47) and for the 3-point bend subgroup (P<.001) favoring milled specimens with a significant considerable heterogeneity (I2=79%, P<.001).
The metal manufacturing method had no effect on the porcelain bond strength to Co-Cr dental metal alloys.
选择性激光熔化（SLM）增材制造（AM）技术为金属陶瓷牙科修复体的传统铸造和铣削工艺提供了替代方法。然而，尚不清楚牙科修复体中 SLM AM 钴铬（Co-Cr）金属框架与瓷的结合强度。
本系统评价和荟萃分析的目的是确定报告 SLM AM Co-Cr 牙科金属合金与瓷结合强度的体外研究，并将瓷结合强度值与铸造、铣削和增材制造 Co-Cr 牙科合金进行比较。
在不同数据库中进行电子系统检索：MEDLINE/PubMed、EMBASE、World of Science、Cochrane 和 Scopus。还进行了手动搜索。纳入报告 SLM Co-Cr 金属合金与瓷结合强度且为英文的研究。两名研究人员应用 JBI 半实验研究（非随机实验研究）的批判性评估检查表评估研究的质量评估。第三名研究人员在共识缺失时进行咨询。根据使用的测试，创建了两个亚组，即 3 点弯曲和剪切结合强度测试。比较铸造、铣削和 AM Co-Cr 牙科合金的瓷结合强度。使用 I2 统计量及其相关 P 值评估研究之间的异质性。使用 Eger 检验确定漏斗图的显著性。
从电子和手动搜索中总共收集了 216 项研究。经过评审员独立评估标题和摘要，确定了 26 篇文章。在全文修订后，其中 3 篇被排除在外。3 点弯曲亚组中铸造和 AM 合金之间的瓷结合强度比较显示，整体效果具有显著意义（P<.001），支持 SLM 方法，具有相当大的异质性（I2=83%，P<.001）。此外，剪切结合强度亚组中铸造和铣削合金之间的瓷结合强度比较显示，整体效果具有显著意义（P=.04），支持铣削工艺，异质性不显著（I2=0%，P<.47），3 点弯曲亚组（P<.001）支持铣削标本，具有显著的重要异质性（I2=79%，P<.001）。
金属制造方法对 Co-Cr 牙科金属合金与瓷的结合强度没有影响。
