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Pecenek D, Gokcen-Rohlig B, Ongul D, Ayvalioglu DC. Evaluation of the clinical performance of different occlusal device materials. J Prosthet Dent 2024:S0022-3913(24)00295-6. [PMID: 38806342 DOI: 10.1016/j.prosdent.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/30/2024]
Abstract
STATEMENT OF PROBLEM Computer aided technologies have been used to fabricate occlusal devices. However, the clinical behavior of the newly developed materials developed for occlusal devices is unknown. PURPOSE The purpose of this prospective, double-blind study was to assess the clinical efficacy of recently introduced computer-aided design and computer-aided manufacturing (CAD-CAM) materials for the fabrication of occlusal devices. MATERIAL AND METHODS A total of 24 participants were divided randomly into 2 study groups; polyetheretherketone (PEEK) and polymethyl methacrylate (PMMA), and a control group (CG). Conventional impressions and gypsum casts were obtained from all participants. In the study groups, the casts were digitalized with an extraoral digital scanner, designed with a software program (Bite Occlusal Device Module; exocad GmbH) and milled from PEEK and PMMA blocks. Clear resin sheets were used for occlusal device fabrication in the CG. The baseline measurements were made during the initial appointments. After 6 months, the participants returned for follow-up evaluations. Clinical performance based on surface roughness, wear of the antagonist teeth, occlusal device fit and therapeutic effect, as well as participant satisfaction were compared using the 1-way ANOVA test between the main groups (α=.05). The post hoc and Kruskal Wallis-H tests were used to compare the nonparametric group. RESULTS The therapeutic effects of the occlusal devices did not differ. All participants showed improvement in palpation and mandibular movement scores, but no statistically significant differences were found among the groups (P>.05). PEEK and PMMA had statistically less surface wear than CG (P<.001) and led to less antagonist tooth wear. No significant participant satisfaction difference was seen among the groups (P>.05). The control group had the best fit (P<.001). CONCLUSIONS Recent CAD-CAM materials exhibit clinically acceptable outcomes, and their performance is comparable with that of traditional materials. CAD-CAM materials appear suitable in terms of accuracy, surface wear, and therapeutic efficacy.
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Affiliation(s)
- Duygucan Pecenek
- Graduate student, Department of Prosthodontics, Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Turkey
| | - Bilge Gokcen-Rohlig
- Professor, Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Deger Ongul
- Associate Professor, Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey.
| | - Demet Cagıl Ayvalioglu
- Assistant Professor, Department of Prosthodontics, Faculty of Dentistry, Altınbas University, Istanbul, Turkey
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Türksayar AAD, Diker B. Effect of layer thickness and polishing on wear resistance of additively manufactured occlusal splints. J Dent 2024:105101. [PMID: 38801940 DOI: 10.1016/j.jdent.2024.105101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE To evaluate the effect of polishing and layering thickness on the wear resistance of 3D-printed occlusal splint materials. METHODS Specimens with 3 different layer thicknesses (50,75,100 µm) were produced in the form of a disc 3 mm thick using V-Print splint resin on a 3D-printer with digital light processing technology. (n=16 for each thickness) All specimens were washed and cured according to the manufacturer's instructions. Half of the specimens of each layer thickness were polished with silicon carbide papers. All specimens were subjected to 120,000 cycles of a chewing simulator for 2-body wear tests. Before and after the wear test, the specimens were scanned with a laser scanner, and the images were overlaid using a 3D analysis program and the volume loss was calculated. The wear patterns of the specimens were examined under a scanning electron microscope. Statistical evaluation was performed using a Shapiro-Wilk test, 2-way ANOVA, 1-way ANOVA, and Tukey post hoc test (α=0.05). RESULTS While polishing had a significant effect (p=0.003) on the wear volume of the occlusal splints, layer thickness (p=0.105) and their interaction between polishing and layer thickness (p=0.620) did not significantly affect the wear volume. Regardless of the polishing, the lowest mean wear was observed for D50 (0.064 mm3), followed by D75 (0.078 mm3), and D100 (0.096 mm3). However, a significant difference was observed only between polished D50 and unpolished D100. CONCLUSION The polished 3D-printed occlusal splint resin showed higher wear resistance than the unpolished one, regardless of the layer thickness. CLINICAL SIGNIFICANCE Since different layer thicknesses of 50 µm and greater had no effect on the wear resistance of the material, a layer thickness of 100 µm may be preferred for faster printing. However, polishing occlusal splints may reduce the amount of wear and improve clinical performance.
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Affiliation(s)
| | - Burcu Diker
- Department of Prosthodontics, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey
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Ateş G, Demirel M, Donmez MB, Dayan SÇ, Sülün T. Effect of material and antagonist type on the wear of occlusal devices with different compositions fabricated by using conventional, additive, and subtractive manufacturing. J Prosthet Dent 2024:S0022-3913(24)00218-X. [PMID: 38594086 DOI: 10.1016/j.prosdent.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
STATEMENT OF PROBLEM Additive (AM) and subtractive (SM) manufacturing have become popular for fabricating occlusal devices with materials of different chemical compositions. However, knowledge on the effect of material and antagonist type on the wear characteristics of occlusal devices fabricated by using different methods is limited. PURPOSE The purpose of this in vitro study was to evaluate the effect of material and antagonist type on the wear of occlusal devices fabricated by using conventional manufacturing, AM, and SM. MATERIAL AND METHODS Two-hundred and forty Ø10×2-mm disk-shaped specimens were fabricated by using heat-polymerized polymethylmethacrylate (control, CM), AM clear device resin fabricated in 3 different orientations (horizontal [AMH], diagonal [AMD], and vertical [AMV]), SM polymethylmethacrylate (SMP), and SM ceramic-reinforced polyetheretherketone (SMB) (n=40). Specimens were then divided into 4 groups based on the antagonists: steatite ceramic (SC); multilayered zirconia (ZR); lithium disilicate (EX); and zirconia-reinforced lithium silicate (ZLS) used for thermomechanical aging (n=10). After aging, the volume loss (mm3) and maximum wear depth (μm) were digitally evaluated. Data were analyzed with 2-way analysis of variance and Tukey honestly significant difference tests (α=.05). RESULTS The interaction between the device material and the antagonist affected volume loss and maximum depth of wear (P<.001). AMH had volume loss and depth of wear that was either similar to or higher than those of other materials (P≤.044). When SC was used, CM had higher volume loss and depth of wear than AMV, and, when EX was used, AMD had higher volume loss and depth of wear than SMP (P≤.013). SC and ZR led to higher volume loss of CM and AMH than EX and led to the highest depth of wear for these materials, while ZR also led to the highest volume loss and depth of wear of AMD and AMV (P≤.019). EX led to the lowest volume loss and depth of wear of AMV and SMP and to the lowest depth of wear of AMH (P≤.021). Regardless of the antagonist, SMB had the lowest volume loss and depth of wear (P≤.005). CONCLUSIONS AMH mostly had higher volume loss and depth of wear, while SMB had the lowest volume loss, and its depth of wear was not affected by the tested antagonists. ZR mostly led to higher volume loss and maximum depth of wear, while EX mostly led to lower volume loss and maximum depth of wear of the tested occlusal device materials.
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Affiliation(s)
- Gökçen Ateş
- Postdoctoral Research Associate, Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey; and ITI Scholar, Department of Prosthodontics, University of São Paulo (USP), São Paulo, Brazil
| | - Münir Demirel
- Assistant Professor, Department of Prosthodontics, Faculty of Dentistry, Biruni University, Istanbul, Turkey
| | - Mustafa Borga Donmez
- Associate Professor, Department of Prosthodontics, Faculty of Dentistry, Istinye Univeristy, İstanbul, Turkey; and ITI Scholar, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - Süleyman Çağatay Dayan
- Associate Professor, Program of Dental Technicians, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tonguç Sülün
- Professor, Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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Rosello Jimenez JR, Fuchs F, Schmohl L, Schulz-Siegmund M, Koenig A. Aging Processes and Their Influence on the Mechanical Properties of Printable Occlusal Splint Materials. Polymers (Basel) 2023; 15:4574. [PMID: 38232021 PMCID: PMC10707959 DOI: 10.3390/polym15234574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 01/19/2024] Open
Abstract
Three-dimensional (3D)-printed occlusal splints are becoming more prevalent in the treatment of tooth substance loss due to their fast and cost-effective production. The purpose of this in vitro study was to investigate whether the mechanical properties (tensile strength-TS, modulus of elasticity in tension-ME, and Vickers hardness-HV) vary between the materials (printed dimethacrylate-based resins: Keyprint KeySplint soft-KEY, Luxaprint Ortho Plus-LUX, V-Print splint-VPR, printed methacrylate-based resins Freeprint splint 2.0-FRE, and milled methacrylate-based material, CLEAR splint-CLE), and the influence of aging processes (extraoral storage conditions and nightly or daily use) was examined. The printed methacrylate-based resins (FRE, LUX, and VPR) had much higher TS (43.7-48.5 MPa compared to 12.3-13.3 MPa), higher ME (2.01-2.37 GPa compared to 0.43-0.72 GPa), and higher HV (11.8-15.0 HV compared to 3.3-3.5 HV) than both of the methacrylate-based resins (KEY and CLE) after the production process. Although the TS, ME, and HV of the printed dimethacrylate resins (FRE, LUX, and VPR) decreased significantly under humid conditions with possibly elevated temperatures (thermocycling as well as 37 °C), these mechanical properties were significantly higher than both methacrylate-based resins (KEY and CLE). Therefore, printed dimethacrylate resins should be used rather than methacrylate-based resins for high expected masticatory forces, low wall thicknesses, or very long wearing times (≥6 months).
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Affiliation(s)
- Jan Raffael Rosello Jimenez
- Department of Prosthodontics and Material Sciences, Leipzig University, 04103 Leipzig, Germany
- Private Practice, Zahnarztpraxis Jan Rosello, 04654 Frohburg, Germany
| | - Florian Fuchs
- Department of Prosthodontics and Material Sciences, Leipzig University, 04103 Leipzig, Germany
| | - Leonie Schmohl
- Department of Prosthodontics and Material Sciences, Leipzig University, 04103 Leipzig, Germany
| | | | - Andreas Koenig
- Department of Prosthodontics and Material Sciences, Leipzig University, 04103 Leipzig, Germany
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Borg H, Azer SS, El Hadary A, Helaly O, Shoeib A, Hassan M. Evaluation of enamel wear by 3 occlusal splint materials: An in vitro study. J Prosthet Dent 2023; 130:743.e1-743.e6. [PMID: 37743141 DOI: 10.1016/j.prosdent.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/26/2023]
Abstract
STATEMENT OF PROBLEM Occlusal devices used to manage bruxism have been commonly fabricated from polymethyl methacrylate with the powder-liquid technique. More recently, Vertex ThermoSens (VTS) and the biocompatible high-performance polymer (BioHPP), an optimized material having polyetheretherketone (PEEK) as its basis, have been used, but little is known about the wear of these materials on human enamel. PURPOSE The purpose of this in vitro study was to assess via a mastication simulation test how 3 occlusal device materials affected the wear and roughness of enamel antagonists. MATERIAL AND METHODS A noncontact 3D optical profilometer was used to measure the enamel surface roughness (Ra) against 3 occlusal device materials: vertex regular, VTS, and PEEK high-performance polymer (BioHPP). A dual-axis mastication simulator was used to perform a 2-body wear test on specimens from each group. The test consisted of 10 000 cycles with a 70-N force and 5 to 55 °C thermocycling. Following simulated mastication, the weight of each specimen and the Ra change were compared with the Kolmogorov-Smirnov test, paired specimens t test, Wilcoxon signed-rank test, and 1-way analysis of variance (α=.05). RESULTS The polyamide group caused the lowest amount of enamel wear (P<.05), while the heat-polymerized acrylic resin group induced the largest amount of enamel wear (P<.05). For polyamide and PEEK, the change in enamel surface roughness exhibited a smooth texture, whereas it found a rougher surface for the heat-polymerized acrylic resin. CONCLUSIONS According to this study, surface roughness and wear on human enamel were not correlated. PEEK is a promising material for the fabrication of occlusal devices.
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Affiliation(s)
- Hisham Borg
- Assistant Professor of Removable Prosthodontics, Depatrment of Removable Prosthodontics, Faculty of Oral and Dental Medicine, Alsalam University, Tanta, Egypt
| | - Shereen S Azer
- Associate Professor and Chair, Division of Restorative and Prosthetic Dentistry, College of Dentistry, The Ohio State University, Columbus, Ohio.
| | - Amany El Hadary
- Professor, Removable Prosthodontics, Depatrment of Removable Prosthodontics, Faculty of Oral and Dental Medicine, Future University in Egypt, Cairo, Egypt; Adjunct Professor of Prosthodontics, Depatrment of Removable Prosthodontics, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Osama Helaly
- Lecturer of Removable Prosthodontics, Depatrment of Removable Prosthodontics, Faculty of Dentistry, Al-Azhar University, Cairo, Egypt
| | - Ahmad Shoeib
- Lecturer of Removable Prosthodontics, Depatrment of Removable Prosthodontics, Faculty of Dentistry, Al-Azhar University, Cairo, Egypt
| | - Mohammed Hassan
- Lecturer of Prosthodontics, Depatrment of Removable Prosthodontics, Faculty of Dental Medicine, King Salman International University, South Sinai, Egypt
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Nassif M, Haddad C, Habli L, Zoghby A. Materials and manufacturing techniques for occlusal splints: A literature review. J Oral Rehabil 2023; 50:1348-1354. [PMID: 37392157 DOI: 10.1111/joor.13550] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/11/2023] [Accepted: 06/22/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To review the materials and fabrications methods of occlusal splints with their advantages and shortcomings and to clarify the indications for each. BACKGROUND Temporomandibular joint disorders (TMDs) encompass a range of conditions affecting the masticatory system. Occlusal splints are currently recognised as a viable option for the management of TMDs when they are adopted in conjunction with additional approaches varying from conservative procedures (counselling, biofeedback, physical therapy, pharmacotherapy) to irreversible and less conservative ones (occlusal adjustments, orthodontics, arthroscopy and surgery). These splints can vary in design, function and material. The components used to fabricate the splints must withstand occlusal forces, be aesthetically pleasing, comfortable and minimally interfering with function and phonetics. Traditional methods for fabricating splints include sprinkle-on, thermoforming and lost wax techniques. However, with the advancement of CAD/CAM technology, additive (3D printing) and subtractive (milling) manufacturing methods expand the range of possibilities by introducing novel solutions for elaborating splints. METHODS An electronic search was conducted on PubMed using the following keywords: "occlusal splint", "guard and "materials", and "manufacturing." Thirteen in vitro publications were screened and they consisted of four clinical studies, nine reviews (three of them were systematic reviews), and five case reports. CONCLUSION The choice of material is crucial for the success of splint therapy. Factors such as biocompatibility, ease of fabrication, adjustability, cost and patient preference should be considered. Newer materials and techniques are emerging because of advancements in material science and manufacturing techniques. However, it should be noted that most of the evidence is based on in vitro studies with different methodologies, limiting their validity in daily practice.
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Affiliation(s)
- Maryse Nassif
- Department of Prosthodontics and Occlusion, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Camille Haddad
- Department of Prosthodontics and Occlusion, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Lara Habli
- Department of Prosthodontics and Occlusion, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Amine Zoghby
- Department of Prosthodontics and Occlusion, Saint Joseph University of Beirut, Beirut, Lebanon
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Wuersching SN, Westphal D, Stawarczyk B, Edelhoff D, Kollmuss M. Surface properties and initial bacterial biofilm growth on 3D-printed oral appliances: a comparative in vitro study. Clin Oral Investig 2023; 27:2667-2677. [PMID: 36576565 PMCID: PMC10264496 DOI: 10.1007/s00784-022-04838-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
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 < 0.05). 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 < 0.05). Colony-forming unit per milliliter on FuturaGen, Astron CLEARsplint, and KeySplint Soft splints was one log scale higher compared to all other materials. The other four printable resins displayed overall lower 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.
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Affiliation(s)
- Sabina Noreen Wuersching
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336, Munich, Germany.
| | - David Westphal
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336, Munich, Germany
| | - Bogna Stawarczyk
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Goethestrasse 70, 80336, Munich, Germany
| | - Daniel Edelhoff
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Goethestrasse 70, 80336, Munich, Germany
| | - Maximilian Kollmuss
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336, Munich, Germany
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Revilla-León M, Cascos-Sánchez R, Zeitler JM, Barmak AB, Kois JC, Gómez-Polo M. Influence of print orientation and wet-dry storage time on the intaglio accuracy of additively manufactured occlusal devices. J Prosthet Dent 2023:S0022-3913(22)00765-X. [PMID: 36635137 DOI: 10.1016/j.prosdent.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023]
Abstract
STATEMENT OF PROBLEM Different factors can affect the manufacturing accuracy of additively manufactured dental devices; however, the influence of print orientation and wet-dry storage time on their intaglio accuracy remains uncertain. PURPOSE The purpose of this in vitro study was to assess the effect of print orientation (0, 45, 70, and 90 degrees) and wet-dry storage time (0, 30, 60, and 90 days) on the intaglio accuracy of additively manufactured occlusal devices. MATERIAL AND METHODS An occlusal device design was obtained in a standard tessellation language (STL) file format (control file) which was used to fabricate all the specimens by using a stereolithography printer (Form 3+) and a biocompatible resin material (Dental LT Clear Resin, V2). Four groups were created based on the print orientation used to manufacture the specimens: 0, 45, 70, and 90 degrees. Each group was divided into 4 subgroups depending on the time elapsed between manufacturing and accuracy evaluation: 0, 30, 60, and 90 days. For the subgroup 0, a desktop scanner (T710) was used to digitize all the specimens. The 30-day subgroup specimens were stored for 30 days with the following daily storage protocol: 16 hours inside a dry lightproof container, followed by 8 hours in artificial saliva (1700-0305 Artificial Saliva) inside the same lightproof container. The specimens were then digitized by following the same procedures used for subgroup 0. For the subgroups 60 and 90, the identical procedures described for subgroup 30 were completed but after 60 and 90 days of storage, respectively. The reference STL file was used to measure the intaglio discrepancy with the experimental scans obtained among the different subgroups by using the root mean square error calculation. Two-way ANOVA and post hoc Tukey pairwise comparison tests were used to analyze the data (α=.05). RESULTS Print orientation (P<.001) and usage time (P<.001) were significant predictors of the trueness value obtained. Additionally, the 0-degree print orientation at day 0 group demonstrated the best trueness value among all the groups tested (P<.05). No significant trueness discrepancies were found among the 45-, 70-, and 90-degree print orientation, or among the 30, 60, and 90 days of storage. A significant precision difference was found in the variance between print orientation groups across usage time subgroups. CONCLUSIONS The print orientation and wet-dry storage times tested influenced the trueness and precision of the intaglio surfaces of the occlusal devices manufactured with the 3D printer and material selected.
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Affiliation(s)
- Marta Revilla-León
- Affiliate Professor, Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash; Faculty and Director of Research and Digital Dentistry, Kois Center, Seattle, Wash; Affiliate Professor, Graduate Prosthodontics, Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Mass
| | - Rocío Cascos-Sánchez
- Postgraduate Advanced in Implant-Prosthodontics, Department of Conservative Dentistry and Prosthodontics, School of Dentistry, Complutense University of Madrid, Madrid, Spain
| | | | - Abdul B Barmak
- Assistant Professor Clinical Research and Biostatistics, Eastman Institute of Oral Health, University of Rochester Medical Center, Rochester, NY
| | - John C Kois
- Founder and Director, Kois Center, Seattle, Wash; Affiliate Professor, Graduate Prosthodontics, Department of Restorative Dentistry, University of Washington, Seattle, Wash; Private Practice, Seattle, Wash
| | - Miguel Gómez-Polo
- Associate Professor, Department of Conservative Dentistry and Prosthodontics, Director of postgraduate program of Advanced in Implant-Prosthodontics, School of Dentistry, Complutense University of Madrid, Madrid, Spain.
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Liu Y, Fang M, Zhao R, Liu H, Li K, Tian M, Niu L, Xie R, Bai S. Clinical Applications of Polyetheretherketone in Removable Dental Prostheses: Accuracy, Characteristics, and Performance. Polymers (Basel) 2022; 14:polym14214615. [PMID: 36365609 PMCID: PMC9654455 DOI: 10.3390/polym14214615] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
The high-performance thermoplastic polyetheretherketone (PEEK) has excellent mechanical properties, biocompatibility, chemical stability, and radiolucency. The present article comprehensively reviews various applications of PEEK in removable dental prostheses, including in removable partial dentures (RPDs) (frameworks and clasps), double-crown RPDs, and obturators. The clinical performance of PEEK in removable dental prostheses is shown to be satisfactory and promising based on the short-term clinical evidence and technical complications are scarce. Moreover, the accuracy of RPDs is a vital factor for their long-term success rate. PEEK in removable dental prostheses is fabricated using the conventional lost-wax technique and CAD/CAM milling, which produces a good fit. Furthermore, fused deposition modeling is considered to be one of the most practical additive techniques. PEEK in removable prostheses produced by this technique exhibits good results in terms of the framework fit. However, in light of the paucity of evidence regarding other additive techniques, these manufacturers cannot yet be endorsed. Surface roughness, bacterial retention, color stability, and wear resistance should also be considered when attempting to increase the survival rates of PEEK removable prostheses. In addition, pastes represent an effective method for PEEK polishing to obtain a reduced surface roughness, which facilitates lower bacterial retention. As compared to other composite materials, PEEK is less likely to become discolored or deteriorate due to wear abrasion.
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Affiliation(s)
- Yuchen Liu
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
| | - Ming Fang
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Correspondence: (M.F.); (S.B.)
| | - Ruifeng Zhao
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
| | - Hengyan Liu
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
| | - Kangjie Li
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
| | - Min Tian
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
| | - Lina Niu
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
| | - Rui Xie
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
| | - Shizhu Bai
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Correspondence: (M.F.); (S.B.)
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Two-body wear of occlusal splint materials from subtractive computer-aided manufacturing and three-dimensional printing. Clin Oral Investig 2022; 26:5857-5866. [PMID: 35612645 PMCID: PMC9474371 DOI: 10.1007/s00784-022-04543-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/06/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate the two-body wear of occlusal splint materials fabricated from subtractive computer-aided manufacturing (CAM) compared to three-dimensional printing (3DP). MATERIAL AND METHODS Forty-eight substrates (n = 12/material) in the design of a mandibular first molar were fabricated using CAM (CAM-TD, Thermeo, pro3dure medical GmbH, Iserlohn, Germany; CAM-CL, CLEARsplint, Astron Dental Corporation, Lake Zurich, USA) and 3DP (3DP-GI, GR22 flex, pro3dure medical GmbH; 3DP-KY, KeySplint soft, Keystone Industries, Gibbstown, USA). The substrates were subjected to mastication simulation (120,000 cycles, 37 °C, 50 N, 1.3 Hz) opposed to enamel antagonists. The two-body wear was measured through matching of the scanned substrates before and after aging using Gaussian best-fit method. The damage patterns were categorized and evaluated based on microscopic examinations. Data was analyzed using Kolmogorov-Smirnov test followed by 1-way analysis of variance (ANOVA). Pearson correlation was calculated between vertical and volumetric material loss. The failure types were analyzed with Chi2-test and Ciba Geigy table. RESULTS No difference in two-body wear results between all materials was found (p = 0.102). Fatigue substrates showed a perforation for CAM and a fracture for 3DP. No abrasion losses on the antagonists were detected. CONCLUSIONS 3DP substrates showed no differences in two-body wear compared to CAM ones but are more likely to show a fracture. None of the tested materials caused an abrasion on human teeth structure. CLINICAL RELEVANCE While therapies with occlusal splint materials are rising, 3DP offers a promising alternative to CAM in terms of production accuracy and therapeutic success at reduced costs.
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Accuracy of 3D-Printed Occlusal Devices of Different Volumes Using a Digital Light Processing Printer. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
(1) Background: This in-vitro study was designed to investigate the accuracy of CAD/CAM fabricated occlusal devices with different heights and volumes. (2) Methods: Based on an intraoral scan, an occlusal device with a vertical bite elevation of 2.5 mm and 4.5 mm was digitally designed and 3D printed 10 times. The fabricated occlusal devices were digitized by an industrial structured light scanner (ILS) and provided in stl-format as test objects. The test objects were superimposed with the design dataset as reference to evaluate the accuracy of complete surfaces ([2.5_TOTAL] and [4.5_TOTAL]) with respect to their internal surfaces ([2.5_INTERNAL] and [4.5_INTERNAL]). The mean trueness and precision were calculated based on absolute mean deviation. Absolute and relative volume differences between reference and test were computed. Statistical significances were analyzed performing the Wilcoxon test (α = 0.05). (3) Results: As absolute mean deviation trueness values were obtained: 59 ± 5 µm for [2.5_INTERNAL], 98 ± 9 µm for [4.5_INTERNAL], 68 ± 1 µm for [2.5_TOTAL] and 90 ± 10 µm for [4.5_TOTAL]. The precision applying absolute mean deviation was 14 ± 8 µm for [2.5_INTERNAL], 22 ± 11 µm for [4.5_INTERNAL], 19 ± 10 µm for [2.5_TOTAL] and 26 ± 13 µm for [4.5_TOTAL]. The mean trueness and precision values differed significantly. Volume differences of 2.11% for [4.5_TOTAL] and of 2.35% for [2.5_TOTAL] in comparison to their reference file were evaluated. (4) Conclusions: Printed occlusal devices with minor height and volume were more accurate. Both types of devices exhibited results that were comparable to the literature.
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Grymak A, Waddell JN, Aarts JM, Ma S, Choi JJE. Evaluation of wear behaviour of various occlusal splint materials and manufacturing processes. J Mech Behav Biomed Mater 2022; 126:105053. [PMID: 34998068 DOI: 10.1016/j.jmbbm.2021.105053] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the volumetric and vertical loss of occlusal splints manufactured by conventional (heat-cure), subtractive (CAD/CAM) and additive (3D-printing) methods. METHODS Six occlusal splint materials were investigated (n = 126), using three manufacturing methods: heat-cured, CAD/CAM and 3D-printed built-in three different printing angles (0°,45°and 90°). Block-on-ring wear testing was performed with extracted human molars as the antagonist. All samples were tested with an applied force of 49N at 1 Hz and 60RPM in artificial saliva at 37 °C for six and 12 months. Scanning electron microscopy images were analysed to evaluate the wear on the tooth enamel and in the splint material. Volumetric and vertical wear loss were statistically analysed. RESULTS The lowest volumetric and vertical loss was observed in CAD-CAM materials (6.44 ± 1.77 mm3 and 48.3 ± 7.14 μm) with no statistical significance to the heat-cured material (17.22 ± 9.23 mm3 and 148 ± 121.1 μm) after 12 months (p < 0.172). The mean volumetric loss of 3D printed materials ranged from 0.25 ± 0.15 mm3 to 0.29 ± 0.1 4mm3 with no statistical difference, whereas, the differences in vertical loss from 131.63 ± 44.1 μm to 493 ± 79.19 μm were statistically significant (p < 0.001). The highest vertical loss was observed in the KeySplint Soft 3D printed at 90° (385.35 ± 82.37 μm), whereas FreePrint Splint 2.0 with a build angle of 0° had the highest volumetric loss (204.59 ± 25.67 mm3). CONCLUSION CAD-CAM material had the highest wear resistance followed by heat-cured material.KeySplint Soft and FreePrint Splint 2.0 3D printed materials would be preferred for patients that do not have severe bruxing episodes. No significant wear of human enamel after six and 12 months was observed under SEM for any tested materials.
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Affiliation(s)
- Anastasiia Grymak
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, New Zealand
| | - John Neil Waddell
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, New Zealand
| | - John M Aarts
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, New Zealand
| | - Sunyoung Ma
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, New Zealand
| | - Joanne Jung Eun Choi
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, New Zealand.
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