RESEARCH AND EDUCATION

Trueness of milled prostheses according to number of

ball-end mill burs
Chong-Myeong Kim, MSc, PhD,a So-Ri Kim, MSc, PhD,b Ji-Hwan Kim, MPH, PhD,c
Hae-Young Kim, DDS, PhD,d and Woong-Chul Kim, MPH, PhDe

Recently, computer-aided design/ ABSTRACT

computer-aided manufacturing Statement of problem. Making a computer-aided design/computer-aided manufacturing (CAD/
(CAD/CAM) systems have been CAM) prosthesis with a milling machine often requires 2 (2- and 1-mm diameter) or 3 (2-, 1-, and
used in a variety of industries. 0.6-mm diameter) burs; however, using 3 burs can reduce time effectiveness and increase cost.
CAD/CAM systems that were Studies evaluating the trueness of prostheses made with 2 and 3 burs are lacking.
primarily used in the machine Purpose. The purpose of this in vitro study was to evaluate the 3-dimensional trueness of crown
tool industry to process complex prostheses made using 2 and 3 ball-end mill burs in the milling process.
shapes have recently been
Material and methods. The abutment die of the maxillary right first molar for ceramic crowns was
introduced to the field of
designed with computer-aided design software. After the crown prosthesis design was completed,
dentistry for the production of a polyurethane blocks were milled using 2 and 3 burs with a 5-axis milling machine. The outer and
variety of prostheses.1-5 Dental inner surfaces of the milled crown prostheses were scanned with a dental scanner. The inner part
CAD/CAM systems include a was separated into a marginal part and an internal part using 3-dimensional evaluation software.
scanner, CAD software, CAM The 3-dimensional trueness of the prostheses milled with 2 or 3 burs was compared.
software, and a milling ma- Results. No significant differences in trueness were found for the inner or internal parts of the
chine.4 These dental CAD/CAM prosthesis (P>.05). However, the outer and marginal parts of the prosthesis did show significant
systems help simplify the differences in trueness (P<.05).
prosthesis-manufacturing pro- Conclusions. Milling the marginal part of the inner prosthesis was better with 2 burs, whereas
cess. The lost-wax technique is a milling the outer part was better with 3 burs. (J Prosthet Dent 2015;-:---)
method of fabricating prosthe-
ses involving wax carving, wax elimination, and casting.6 The ball-end mill bur has been the one most widely
However, this technique is prone to errors and depends used in milling with CAD/CAM systems,12,13 with 2-, 1-,
heavily on the skill of the operator.7,8 Dental CAD/CAM and 0.6-mmediameter ball-end mill burs preferred for
systems combine the scan after the fabrication of the dental milling. However, 2 or 3 ball-end mill burs may be
working model, the CAD design of the prosthesis, and the selected depending on the required result and the tem-
tool path generation to create the numeric control (NC) data plate. Typically, when 3 burs are used, their diameters are
file, which is then exported to the milling machine. This 2, 1, and 0.6 mm; when 2 are used, their diameters are 2
series of processes can be controlled by a single computer and 1 mm. Although the use of 3 ball-end mill burs re-
and is not affected by operator skill.8-11 quires a longer processing time than that of 2 burs, the

Supported by South Korea Ministry of Trade, Industry, Energy (20133110002881).

a
Doctoral student, Department of Dental Laboratory Science and Engineering, College of Health Science, Korea University, Seoul, South Korea.
b
Doctoral student, Department of Dental Laboratory Science and Engineering, College of Health Science, Korea University, Seoul, South Korea.
c
Professor, Department of Dental Laboratory Science and Engineering, College of Health Science, Korea University, Seoul, South Korea.
d
Associate Professor, Department of Dental Laboratory Science and Engineering, College of Health Science and Department of Public Health Sciences,
Graduate School and BK21+ Program in Public Health Sciences, Korea University, Seoul, South Korea.
e
Professor, Department of Dental Laboratory Science and Engineering, College of Health Science, Korea University, Seoul, South Korea.

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Clinical Implications
When manufacturing a prosthesis with a
milling machine, the diameter of the bur affects
the trueness of the prosthesis. Small-diameter burs
are able to create finer details but are also
disadvantageous in terms of time- and cost
effectiveness.
former reproduce fine details better. Thus far, studies
regarding the precise reproducibility of milled parts are
lacking.
Recently, the reproducibility of the milled area has
been evaluated by using trueness.14,15 Determining the
trueness of a milled prosthesis requires 3-dimensional
(3D) rather than 2-dimensional (2D) evaluation,16 as
3D evaluation can analyze the generated errors from
various perspectives. Furthermore, 3D evaluation can be
used to identify the error site between the CAD design
and the milled prosthesis11,17-20 and can be used for
nondestructive experiments, since the resulting value is
represented numerically, making it possible to detect
differences more accurately.
The purpose of this study was to evaluate the 3D
trueness of dental prostheses prepared with 2 or 3 ball-
end mill burs in the milling process. The null hypothe-
sis was that no difference would be found in the trueness
of the crown prosthesis according to the number and
diameter of the ball-end mill burs used.
MATERIAL AND METHODS
A maxillary right first molar (AG-3 ZPVK; Frasaco
GmbH) was prepared for a ceramic crown, and an
impression (Aquasil Ultra; Dentsply Intl) was made,
poured in Type 4 dental stone (GC Fujirock EP; GC
Corp), and scanned with a dental blue light scanner
(Identica Blue; Medit). The scanned 3D file was imported
using dental CAD software (DentCAD; Delcam plc), and
a maxillary right first molar was designed, saved in the
stereolithography file format, and imported with CAM
software (GO2dental; GO2cam International).
For the milling operation, a template was selected, and
the tool path was generated and saved in an NC file.
Templates for manufacturing the prosthesis with 2 or 3
burs were selected, thus generating the tool path of each
template. The templates that used 2 burs and 3 burs were
named 2 bur and 3 bur, respectively. Each generated tool
path was saved in the NC file and exported to the 5-axis
milling machine (DWX-50; Roland DG Corp); 14 speci-
mens of each crown were milled. Specifications of the
ball-end mill burs used in the milling process are shown in
Figure 1 and Table 1. Crowns were milled from a poly-
urethane block (innoBlanc model: innoBlanc GmbH). This
THE JOURNAL OF PROSTHETIC DENTISTRY
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OL
EL
ShD
D
Figure 1. Schematic of bur used. D, diameter of ball nose; EL, effective
length; OL, overall length; ShD, shank diameter.
Table 1. Specifications of burs used (mm)
D EL OL ShD
2 20.5 50 4
1 16.5 50 4
0.6 12.5 50 4
D, diameter of ball nose; EL, effective length; OL, overall length; ShD, shank diameter.
block can be milled to the same size as the design shape,
thus minimizing problems of expansion and contraction
during milling.
After milling, the outer part of the completed pros-
thesis was scanned with the dental blue light scanner.
Unnecessary portions of the scanned surface (parts other
than the crown) were removed using 3D evaluation
software (Geomagic Verify 2015; Geomagic GmbH). The
intaglio was similarly scanned and unnecessary portions
removed. Portions from the margin to 1 mm above the
margin were removed from the scan data of the intaglio,
designated as the internal part; these removed regions
were designated as the marginal part.21,22 The part of the
margin above 1 mm was designated as the boundary of
the marginal and the internal parts to allow the part to be
selected in the CAD design program on the basis of the
margin part. After acquiring the necessary data, each part
(outer part, inner part, marginal part, and internal part)
was evaluated for trueness by superimposing the corre-
sponding data on the reference CAD data (n=14 for each
part) (Fig. 2).
For the superimposed data, the CAD data and each
part were first auto-aligned. The align/best fit command
was then applied for precise arrangement. The proba-
bility of success of the align/best fit command was
increased by setting the sampling ratio to 100%. Then,
through the whole deviation shown in the color-map,
the calculation data sampling ratio was set to 100%,
and the upper and the lower tolerance limits were set to
50 mm. The resulting color-difference maps were used
to compare the reference CAD data with the scan data
of the milled crown restorations. Root mean square
(RMS) ±standard deviation (SD) values were also
calculated.
Kim et al
- 2015 3

Nominal data Superimpose

=Reference data
Reference
Acrylic Replica Data
CAD Tool Path Post Definitive
Resin Gypsum Scan
Design Generate Processor Prosthesis
Model Cast
Scan Data

2 BUR (n=14) Outer

Blue light scan
Inner
3 BUR (n=14)
Marginal

Internal
(n=14, each part)
Figure 2. Experiment flow.

RMS was used to determine the average of the pos- Table 2. Trueness of prostheses milled using 2 burs and 3 burs
itive and negative value coexistence according to the 2 Bur (mm) 3 Bur (mm)

following formula17,23: Area RMS ±SD 95% CI RMS ±SD 95% CI

qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi Outer 64 ±17 52.5e69.9 50 ±10* 43.1e57.1

Pn  2 Inner 28 ±8 24.1e33.5 31 ±7 26.6e35.6
i=1 X 1;i −X2;i
RMS= pffiffiffi ; Marginal 67 ±21* 55.1e80.1 98 ±37 76.5e120.2
n Internal 20 ±7 15.7e24.7 16 ±3 14.4e18.3

where n is the total number of specimens, X1;i is the CI, confidence interval; RMS, root mean square; SD, standard deviation.
Values are root-mean square ±standard deviation (mm).
measuring point of the reference scan data, and X2;i is the *Significant differences (P<.05).

measuring point of the milled crown prosthesis scan

data. In this study, RMS was used to evaluate error.
According to the International Organization Standard
12836, a low RMS value indicates excellent trueness.15
Statistical software (IBM Statistics for Windows,
v22.0; IBM Corp) was used to calculate the RMS and SD
of the outer, inner, marginal, and internal parts. The t test
was used to determine significant differences between
the reference CAD data and the prosthesis scan data. The
Levene test was used for analysis of variance (a=.05).
RESULTS
RMS data for the tested prostheses are given in Table 2.
In the outer part of the prosthesis, the RMS value for 3
bur was significantly lower than that for 2 bur (P<.05),
indicating higher trueness for 3 bur. In the inner part of
the inner prosthesis, the RMS value for 3 bur was higher
than that for 2 bur, but the difference was not significant
(P=.455). For the marginal part of the inner prosthesis,
the RMS value for 3 bur was significantly higher than
that for 2 bur (P<.05), indicating lower trueness. For the
internal part of the inner prosthesis, the RMS value for 3
bur was lower than that for 2 bur, but the difference was
not significant (P=.100). Qualitative analysis was pre-
sented as a color-difference map with red and yellow
indicating negative values and blue and sky blue indi-
cating positive values (Figs. 3, 4).
Scan data for the outer and inner parts of 2 bur
are given in Figure 3A, B. Figure 3A shows an overall
positive value in the color-difference map for the outer
part, with a particularly strong positive value in the side
groove. Figure 3B shows a normal overall value in the
color-difference map for the inner part; however, the
edge shows a positive value. The scan data for the outer
and inner parts of 3 bur are given in Figure 3C, D.
Figure 3C shows an overall positive value in the color-
difference map for the outer part, with the exception of
the occlusal surface. Figure 3D shows a normal overall
value in the color-difference map for the inner part.
Scan data for the marginal and internal parts of 2
bur are given in Figure 4A, B. In Figure 4A, the color-
difference map shows an overall negative value in the
margin. Figure 4B, however, shows an overall normal
value in the color-difference map of the internal part,
but a positive value at the line angle of the occlusal
surface. The scan data for the marginal and internal
parts of 3 bur are given in Figure 4C, D. Figure 4C
shows an overall positive value in the color-difference
map of the marginal part, whereas Figure 4D shows
an overall normal value in the color-difference map of
the internal part.
DISCUSSION
The present study investigated the trueness of prostheses
milled with ball-end mill burs of 2 or 3 different di-
ameters. The null hypothesis was rejected for the outer
and marginal parts of milled crown prostheses, as

Kim et al THE JOURNAL OF PROSTHETIC DENTISTRY

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Figure 3. Color difference map for outer and inner parts of 2 bur and 3 bur. (A) Outer part of 2 bur. (B) Inner part of 2 bur. (C) Outer part of 3 bur.
(D) Inner part of 3 bur.
trueness was significantly different between prostheses
made with 2 or 3 burs (P<.05). However, the null hy-
pothesis was accepted for the inner and internal parts, for
which trueness was not significantly different between 2
bur and 3 bur (P>.05).
The trueness of 3 bur was higher than that of 2 bur
in the outer part, mostly because of the side groove
(Fig. 3A, C). The formation of larger grooves is more
difficult for 2 bur, in which the smallest bur is 1 mm in
diameter, than for 3 bur, in which the smallest bur is 0.6
mm in diameter (Fig. 3A). In addition, it was confirmed
that the occlusal surface of 3 bur showed an overall
positive RMS value (Fig. 3C). Performing the final fin-
ishing of the milling process using the 0.6-mm diameter
bur could reduce this value.5,11,18,23 For the marginal
part, the trueness of 3 bur was lower than that of 2 bur
(Fig. 4A, C). Rigidity may have been reduced when the
diameter of the smallest bur was fixed in a cantilever
state to the holder parts, causing unstable milling.12,3
However, when using 3 burs, the addition of the 0.6-
mmediameter bur can improve the formation of the
groove or line angle part (Figs. 3, 4). Therefore, in
restorations with complex shapes and many thin, deep
groove regions, the use of 3 burs for prosthesis milling
THE JOURNAL OF PROSTHETIC DENTISTRY
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is recommended. However, for a prosthesis with a
coping and a simple shape, 2 burs can be used to save
both time and money.
The maxillary right first molar abutment used in this
study had many grooves and a broad, round shape and is
thus often used as an object for milling evaluation. Many
studies have evaluated prosthesis accuracy by using the
scan accuracy and CAD/CAM data from the maxillary
right first molar.24-28 However, studies investigating the
trueness between reference CAD data and scan data
from milled crown prostheses are lacking. The present
evaluation of the trueness of milled crown prostheses
according to the number of ball-end mill burs used
during milling is thus significant. In addition, the 5-axis
milling machine used in this study is suitable for pro-
cessing complex shapes and undercuts. The machine was
calibrated at the processing stage for each group of
prostheses in order to improve reliability.
In this study, the crown prostheses were milled from a
polyurethane block. Polyurethane is an appropriate ma-
terial for testing milling machines and creating trial res-
torations, because the prosthesis can be processed from a
block of the same size as the design shape. This offers an
advantage in that it minimizes the problems associated
Kim et al
- 2015
Figure 4. Color difference map of marginal and internal parts of 2 bur and 3 bur. A, Marginal part of 2 bur. B, Internal part of 2 bur. C, Marginal part
of 3 bur. D, Internal part of 3 bur.
with expansion or contraction during the milling process.
Polyurethane also offers excellent surface roughness and
shape stability for low thermal-expansion coefficients, is
the ideal color for scanning, and is suitable for 3D
evaluation.4
This study has a few limitations. First, the abutment
used is a standard die and thus cannot represent the
clinical condition. Moreover, the polyurethane block used
in this study is not well suited for definitive patient use.
Future studies should evaluate trueness using abutments
that more closely reflect clinical conditions.
CONCLUSIONS
No significant differences were found in the trueness of
the inner and internal parts of crown prostheses milled
using ball-end mill burs of 2 or 3 different diameters.
However, the outer and marginal parts of the prostheses
showed excellent trueness with 3 bur and 2 bur,
respectively.
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Corresponding author:
Dr Woong-Chul Kim
Department of Dental Laboratory Science and Engineering
College of Health Science
Korea University
145 Anam-ro, Seongbuk-gu, Seoul 136-713
SOUTH KOREA
Email: kuc2842@korea.ac.kr
Acknowledgments
The authors thank the representatives and staff of Medit Inc. and Delcam PLC,
Korea, for providing access to their scanners and inspection software, respectively.
Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.
Kim et al