Influence of Pre-Treatment and Artificial Aging on the Retention of 3D-Printed Permanent Composite Crowns

Effect of surface conditioning on the adhesive bond strength of 3D-printed resins used in permanent fixed dental prostheses

OBJECTIVES

Although pre-treatment parameters for subtractive computer-aided design/computer-aided manufacturing (CAD/CAM) materials have been thoroughly investigated, data regarding additive restorative materials designed for permanent use in the oral cavity are scarce. This study investigated the effects of abrasive materials and blasting pressure on the bond strength of 3D-printed resins used in permanent restorations.

METHODS

A total of n = 44 test specimens additively manufactured from Formlabs' `Permanent Crown Resin' were prepared. Three groups with n = 11 specimens were airborne-particle abraded with 50 µm aluminium oxide at 1 bar, 2 bar or 3 bar. The control group did not receive any further airborne-particle abrasion after post-processing with 50 µm glass beads. Cylindrical superstructures were bonded to the prepared surfaces using RelyX Unicem 2. The bonded specimens were then subjected to artificial ageing via thermocycling. Subsequently, shear bond strength (sbs) tests were conducted. Data were analysed with the Kruskal-Wallis test (α = 0.05).

RESULTS

After post-processing with glass beads, average shear bond strength values of 10.13 ± 7.62 MPa were achieved. When using aluminium oxide and 1 bar blasting pressure, significantly higher average sbs values of 25.57 ± 7.04 MPa were revealed (p = 0.009). The bond strength increased with higher blasting pressures (28.14 ± 6.35 MPa at 2 bar (p = 0.005); 30.15 ± 6.46 MPa at 3 bar (p < 0.001)). However, the shear tests revealed increased failure within the specimen base at higher blasting pressures.

CONCLUSION

Bond strength significantly improved when airborne-particle abrasion with aluminium oxide was applied. However, increased airborne-particle abrasion pressure led to more failures at the base plate level of the specimens.

CLINICAL SIGNIFICANCE

Aluminium oxide increases the adhesive strength of 3D-printed dental restorative materials. Although the adhesive bond increased slightly with increasing airborne-particle abrasion pressure, the 3D restorative materials also exhibited an increased failure rate within the restorative material in the shear bond strength test with increasing blasting pressure.

Bond strength of self-adhesive resin cement to definitive resin crown materials manufactured by additive and subtractive methods

The aim was to compare different surface pretreatments on definitive resin crown materials manufactured additively or subtractively in terms of shear bond strength (SBS) values. Seven subgroups (n=10) were formed from additively manufactured VarseoSmile Crown Plus (VS) and subtractively manufactured Cerasmart270 blocks (CS) according to different surface pretreatments applied; sandblasting (subgroup SB), hydrofluoric acid (subgroup HF), Multi Primer (subgroup MP), subgroup SB-HF, subgroup SB-MP, subgroup SB-HF-MP, and control subgroup. A 3-mm-diameter composite was cemented onto each sample by self-adhesive resin cement. SBS values were measured and failure modes were analyzed after thermocycling. Data were analyzed with two-way ANOVA and Tukey HSD tests. The mean SBS value of VS was found significantly higher than CS (p<0.001). Subgroups SB-HF-MP, HF, SB-MP, and MP of VS exhibited the highest SBS values (p<0.001). The VS exhibited mostly cohesive failure, while CS exhibited mostly adhesive failure.

Flexural Strength, Fatigue Behavior, and Microhardness of Three-Dimensional (3D)-Printed Resin Material for Indirect Restorations: A Systematic Review

The purpose of this systematic review was to evaluate three mechanical properties of 3D-printed resins for indirect restorations according to published scientific evidence. This systematic review was conducted according to the PRISMA statement (preferred reporting elements for systematic reviews and meta-analyses). The search was performed by two investigators, (DD) and (VB), and a third (AC) resolved disagreements. Articles were searched in four digital databases: PubMed, EBSCO, Lilacs, and Science Direct, starting on 18 February 2024. As 3D-printing technology has shown significant advances in the last 5 years, the review was conducted with a publication year range between 2019 and 2024, in English language and included in vitro articles on the mechanical properties of flexural strength, fatigue behavior, and microhardness of 3D-printed materials for temporary or definitive restorations. MeSH terms and free terms were used for the titles and abstracts of each article. Finally, the QUIN tool was used to assess the risk of bias. In the main search, 227 articles were found, of which 20 duplicates were excluded, leaving 207 articles; of these, titles and abstracts were read, and 181 that did not meet the eligibility criteria were eliminated; of the remaining 26 articles, 1 article was eliminated for not presenting quantitative results. Regarding publication bias, 6 of the 25 articles had a low risk of bias, 18 had a medium risk of bias, and 1 had a high risk of bias. It may be concluded that 3D-printed resins have lower flexural strength, fatigue behavior, and microhardness than other resin types used for the fabrication of temporary and permanent restorations. The type of 3D printer and polymerization time could be factors that significantly affect the flexural strength, fatigue behavior and microhardness of 3D-printed resins. Based on existing evidence, it should be considered that additive technology has promising future prospects for temporary and permanent dental restorations.

Effect of Air Particle Abrasion and Primers on Bond Strength to 3D-Printed Crown Materials

Two 3D-printed crown materials (Crown and Ceramic Crown) were examined to determine the best surface treatment and primers for bonding. Discs of the two materials were printed and mounted with their "intaglio" surfaces untouched. Half the specimens from each group were sandblasted with 50 µm alumina. Then, specimens were divided into four groups (n = 10): Gr1-no further treatment; Gr2-one coat of silane; Gr3-one coat of universal adhesive; Gr4-one coat of silane, then one coat of universal adhesive. Bond strength specimens were prepared with an Ultradent shear bond strength apparatus using Filtek Supreme composite. Specimens were stored for 8 weeks in 37 °C water. The specimens were debonded with a circular notched-edge blade applied at 1 mm/min, and the shear bond strength was calculated. The data were compared with a two-way ANOVA (factors: surface treatment and primer) and a Tukey post hoc analysis for both materials independently, with p < 0.01 considered meaningful. The filler content (burned ash) and resin content (FTIR) of the materials were determined. For both materials, factors surface treatment and primer were significant (p < 0.01), but their interaction was not (p = 0.43 for Crown and p = 0.34 for Ceramic Crown). Alumina air particle abrasion improved the bond strength for both materials. The Tukey post hoc analysis grouped primer treatments into the same statistically different groups for both materials: Gr1 and Gr2 < Gr3 and Gr4. The filler percentage of Crown was 32.7% and Ceramic Crown was 48.2%. Resin content was similar for both materials. The most effective method to bond to 3D-printed crowns (regardless of filler percentage) was to sandblast with 50 µm alumina and apply a layer of adhesive (with or without previous application of silane).

Comparison of trueness and margin quality of additively and subtractively manufactured definitive resin-based laminate veneers

STATEMENT OF PROBLEM

Currently available 3-dimensional (3D) additively manufactured (AM) resins used for definitive restorations have different chemical compositions and viscosities. The fabrication trueness and margin quality of laminate veneers additively manufactured with different resins have not been extensively studied.

PURPOSE

The purpose of this in vitro study was to evaluate the fabrication trueness and margin quality of AM and subtractively manufactured (SM) definitive resin-based laminate veneers.

MATERIAL AND METHODS

A laminate veneer restoration for a maxillary right central incisor with a 25-µm cement space was designed to generate a reference laminate veneer standard tessellation language (STL) file (RLV-STL). This RLV-STL was used to fabricate resin-based laminate veneers (N=60) for definitive use, either using AM (a low-viscosity, urethane acrylate-based resin (C&B Permanent, AM-LV), a high-viscosity, urethane acrylate-based resin (Tera Harz TC-80DP, AM-HV), and a glass-reinforced composite resin (Crowntec, AM-S) or SM (glass-filler reinforced composite resin blocks (Tetric CAD, SM) technologies. All laminate veneers were digitized with an intraoral scanner (CEREC Primescan SW 5.2) to generate their test STL files (TLV-STLs). RLV-STL and TLV-STLs were transferred into a 3D analysis software program (Geomagic Control X), and a trueness (external, intaglio, and marginal surface) analysis was performed by using the root mean square (RMS) method. The margin quality of laminate veneers was examined visually under a stereomicroscope and graded. The Kruskal-Wallis and Dunn tests were performed to analyze the data (α=.05).

RESULTS

External, intaglio, and marginal RMS values showed statistically significant differences among test groups (P<.001). The SM group had the highest RMS values for the external surface (P<.001), whereas the AM-LV group had the lowest RMS values. The AM-HV group had the highest RMS values for the intaglio surface (P<.001). No significant difference was found between the SM and AM-HV groups for marginal RMS values, which were higher than for the other groups (P=.830). All average values for the axial mesial, axial distal, and incisal edge margin quality of laminate veneers were found to be similar and Grade 3 (smooth edge) in all groups.

CONCLUSIONS

Regardless of the evaluated surface, the fabrication technique affected the trueness of laminate veneers. The low-viscosity AM laminate veneers and AM laminate veneers reinforced with glass fillers had higher trueness than the SM laminate veneers at all surfaces. The low-viscosity AM laminate veneers had the highest trueness on external and marginal surfaces among the test groups and had higher trueness than the high-viscosity AM laminate veneers.

Bond strength of recently introduced computer-aided design and computer-aided manufacturing resin-based crown materials to polyetheretherketone and titanium

STATEMENT OF PROBLEM

Several additively and subtractively manufactured resin-based materials indicated for interim and definitive fixed dental prostheses have been launched. However, knowledge of the bond strength of these materials to different implant abutment materials is limited.

PURPOSE

The purpose of this in vitro study was to evaluate the shear bond strength (SBS) of additively and subtractively manufactured resin-based materials to different implant abutment materials.

MATERIAL AND METHODS

One hundred and ten disk-shaped specimens (Ø3×3 mm) were fabricated either additively from 2 resins indicated for definitive use (Crowntec; AM_CT and VarseoSmile Crown Plus; AM_VS) and 1 resin indicated for interim use (FREEPRINT temp; AM_FP) or subtractively from a nanographene-reinforced polymethyl methacrylate (G-CAM; SM_GC) and a high-impact polymer composite (breCAM.HIPC; SM_BC). After allocating 2 specimens from each group for scanning electron microscope evaluation, the specimens were divided according to the abutment material (CopraPeek; polyetheretherketone, PEEK and Dentium Superline Pre-Milled Abutment; titanium, Ti) (n=10). All specimens were airborne-particle abraded with 50-µm aluminum oxide. After applying a resin primer (Visio.link) to PEEK and an adhesive primer (Clearfil Ceramic Primer Plus) to Ti specimens, a self-adhesive resin cement (PANAVIA SA Cement Universal) was used for cementation. All specimens were stored in distilled water (24 hours, 37 °C), and a universal testing device was used for the SBS test. SBS data were analyzed with 2-way analysis of variance and Tukey honestly significant difference tests, while the chi-squared test was used to evaluate the difference among the abutment-resin pairs in terms of failure modes (α=.05).

RESULTS

The interaction between the material type and the abutment type and the main factor of material type affected the SBS (P<.001). SM_BC-PEEK and SM_GC had the lowest SBS followed by SM_BC-Ti, whereas AM_VS-PEEK had the highest SBS (P≤.001). AM_CT-Ti had higher SBS than AM_FP-PEEK (P=.026). SM_GC had the lowest and AM_VS had the highest SBS, while AM_CT and AM_FP had higher SBS than SM_BC (P≤.004). The distribution of failure modes was significantly different among tested material-abutment pairs, and only for AM_CT among tested materials (P≤.025). Most of the material-abutment pairs had a minimum of 80% adhesive failures.

CONCLUSIONS

Regardless of the abutment material, additively manufactured specimens had higher bond strength and one of the subtractively manufactured materials (SM_GC) mostly had lower bond strength. The abutment material had a small effect on the bond strength. Adhesive failures were observed most frequently.

Digital analysis of fabrication accuracy and fit in additively and subtractively manufactured implant-supported fixed complete dentures

OBJECTIVES

To digitally evaluate the trueness and fit of additively and subtractively manufactured fixed complete dentures in materials intended for definitive use.

METHODS

An edentulous maxillary model with implants at the left first molar, left canine, right canine, and right first molar site was digitized and a fixed complete denture was designed. This design was used to fabricate fixed dentures in an additively manufactured resin for definitive use (AM), a high-impact polymer composite (SM-CR), and a strength gradient zirconia (SM-ZR) (n = 10). Each fixed denture was digitized and the surface (overall, occlusal, except occlusal, and abutments), linear, and interimplant distance deviations were analyzed. The fit was assessed with the triple-scan protocol. Data were analyzed with Welch analysis of variance and Games-Howell tests (α = 0.05).

RESULTS

SM-ZR led to lower overall deviations than AM, which had the highest occlusal and the lowest abutments deviations (P ≤ 0.007). SM-ZR had the lowest occlusal and SM-CR had the highest except occlusal deviations (P ≤ 0.002). AM mostly had higher linear and SM-CR mostly had higher interimplant distance deviations (P ≤ 0.043). AM led to the highest marginal gap at the left canine site, while SM-CR had the highest and SM-ZR had the lowest gaps at the right canine site (P ≤ 0.022).

CONCLUSIONS

SM-ZR dentures mostly had trueness and marginal fit similar to or better than the other groups. Tested fixed complete dentures were mostly smaller than the design file in terms of interimplant distances.

Bond strength of additively manufactured composite resins to dentin and titanium when bonded with dual-polymerizing resin cements

STATEMENT OF PROBLEM

Additively manufactured composite resins for definitive restorations have been recently introduced. The bond strength between these composite resins and different substrates has not been extensively studied.

PURPOSE

The purpose of this in vitro study was to measure the shear bond strength (SBS) between additively manufactured composite resins and dentin and titanium substrates and compare those with the SBS between subtractively manufactured polymer-infiltrated ceramic and the same substrates (dentin and titanium), when different dual-polymerizing resin cements were used.

MATERIAL AND METHODS

One hundred and eighty cylinder-shaped specimens (Ø5×5 mm) were prepared from 3 materials recommended for definitive restorations: an additively manufactured composite resin (Crowntec [CT]); an additively manufactured hybrid composite resin (VarseoSmile Crown Plus [VS]); and a subtractively manufactured polymer-infiltrated ceramic (Enamic [EN]) (n=60). Specimens were randomly divided into six subgroups to be cemented to the two substrates (dentin and titanium; n=30) with 1 of 3 resin cements (RelyX Universal, Panavia V5, and Variolink Esthetic DC) (n=10). The restoration surface to be bonded was treated according to the respective manufacturer's recommendations. Dentin surfaces were treated according to the resin cement (Scotchbond Universal Plus Adhesive for RelyX Universal, Panavia V5 Tooth Primer for Panavia V5, and Adhese Universal for Variolink Esthetic DC), while titanium surfaces were airborne-particle abraded, and only the specimens paired with Panavia V5 were treated with a ceramic primer (Clearfil Ceramic Primer Plus). SBS was measured in a universal testing machine at a crosshead speed of 1 mm/min. Failure modes were analyzed under a microscope at ×12 magnification. Data were analyzed by using 2-way analysis of variance and Tukey honestly significant difference tests (α=.05).

RESULTS

When SBS to dentin was considered, only restorative material, as a main factor, had a significant effect (P<.001); EN had the highest SBS (P<.001), while the difference in SBS values of CT and VS was not significant (P=.145). As for SBS to titanium, the factors restorative material and resin cement and their interaction had a significant effect (P<.001). Within each resin cement, EN had the highest SBS to titanium (P<.001), and within each restorative material, Variolink resulted in the lowest SBS (P≤.010). Overall, EN and RelyX were associated with the highest SBS to titanium (P≤.013). Mixed failures were predominant in most groups.

CONCLUSIONS

Regardless of the substrate or the resin cement used, the subtractively manufactured polymer-infiltrated ceramic had higher shear bond strength than the additively manufactured composite resins. The SBS of the additively manufactured composite resins, whether bonded to dentin or titanium, were not significantly different from each other. Regardless of the restorative material, Variolink DC resulted in the lowest SBS for titanium surfaces.

Surface roughness, wear, and abrasiveness of printed and milled occlusal veneers after thermomechanical aging

STATEMENT OF PROBLEM

Occlusal veneers are a conservative method of reestablishing vertical dimensions of occlusion (VDO) for worn teeth. A restorative material used for occlusal veneers should have a smooth surface, adequate wear resistance, and low abrasiveness to the antagonists, as total wear of occlusal veneers and their antagonists determines the stability of the reestablished VDO. Studies on roughness, wear, and abrasiveness of occlusal veneers are scarce.

PURPOSE

The purpose of this in vitro study was to assess the surface roughness, wear, and abrasiveness of printed and milled occlusal veneers after thermomechanical aging against natural cusps and restorative materials.

MATERIAL AND METHODS

Forty-eight extracted mandibular first molars were prepared for occlusal veneers and scanned with an intraoral scanner. The scans were exported to a computer-aided design program to design the occlusal veneers in 3 groups (n=16) according to the restorative material: group IP: milled lithium disilicate; group EN: milled hybrid ceramic (Vita Enamic), group VA: printed hybrid ceramic (Varseosmile Crown plus). The occlusal veneers in each group were bonded to their corresponding abutments and subjected to 250 000 mechanical cycles and a simultaneous 1000 thermal cycles in a mastication simulator. During thermomechanical aging, half of the specimens of each study group (n=8) were opposed by natural cusps (antagonist C) and the other half by antagonist cusps fabricated from the same restorative material as the occlusal veneers (antagonist R). The wear of the occlusal veneers and their antagonists was assessed with a 3-dimensional processing software program. The surface roughness of the veneers was assessed with a contact profilometer. The results were statistically analyzed with a 2-way ANOVA followed by the post hoc Tukey HSD test (α=.05).

RESULTS

The 2-way ANOVA indicated a significant effect for the material and the antagonist on surface roughness, wear, and abrasiveness (P<.05). When opposed by antagonist C, VA showed significantly higher surface roughness than IP and EN (P<.001). VA had significantly higher surface wear followed by EN and IP (P<.001). IP caused significantly higher wear to antagonist C than EN and VA (P<.001). In addition, IP had significantly higher total wear (combined wear of veneers and their antagonists) followed by VA and EN (P<.001). When opposed by antagonist R, no significant difference was found among the 3 materials for surface roughness (P=.08), material wear (P=.12), opposing wear (P=.11), or total wear (P=.11).

CONCLUSIONS

Both material and antagonist had a significant effect on surface roughness and occlusal stability when occlusal veneers were fabricated to restore VDO. VA had significantly more surface roughness and wear than EN and IP when opposed by natural cusps. IP abraded natural cusps significantly more than EN and VA. The 3 tested materials showed similar roughness, wear, and abrasiveness when opposed by the same material.

Evaluation of Wear on Primary Tooth Enamel and Fracture Resistance of Esthetic Pediatric Crowns Manufactured from Different Materials

Background and Objectives: Advances in dental materials and CAD-CAM technology have expanded crown options in primary teeth due to their improved appearance and mechanical properties. Thus, this study aimed to assess the enamel wear and fracture resistance of prefabricated, milled, and 3D-printed esthetic pediatric crowns. Materials and Methods: The study involved 60 extracted maxillary second primary molars and 60 3D-printed resin dies, divided into six groups based on different crown materials (n = 10): prefabricated zirconia, prefabricated composite, milled composite, milled resin matrix ceramic, milled PEEK, and 3D-printed resin. Prefabricated crowns were selected after the preparation of the typodont mandibular second primary molar tooth, while milled and 3D-printed crowns were custom produced. The specimens underwent mechanical loading of 50 N at 1.6 Hz for 250,000 cycles with simultaneous thermal cycling. The 3D and 2D wear amounts were evaluated by scanning the specimens before and after aging. Then, the fracture resistance and failure types of the restorations were recorded. Results: The results showed that the milled PEEK group had superior fracture resistance compared to the other groups, while prefabricated zirconia crown group had the lowest value. Milled resin matrix ceramic crown group displayed the lowest 3D wear volume, while 3D-printed crown group showed the highest 2D wear. Conclusions: The restorative material type did not have a significant effect on the wear of primary tooth enamel. The fracture resistance of the tested materials differed according to the material type. Although the milled PEEK group showed the highest fracture resistance, all tested materials can withstand chewing forces in children.

Comparison of wear and fracture resistance of additively and subtractively manufactured screw-retained, implant-supported crowns

STATEMENT OF PROBLEM

Additively manufactured resins indicated for fixed definitive prostheses have been recently marketed. However, knowledge on their wear and fracture resistance when fabricated as screw-retained, implant-supported crowns and subjected to artificial aging is limited.

PURPOSE

The purpose of this in vitro study was to evaluate the volume loss, maximum wear depth, and fracture resistance of screw-retained implant-supported crowns after thermomechanical aging when fabricated using additively and subtractively manufactured materials.

MATERIAL AND METHODS

Two additively manufactured composite resins (Crowntec [CT] and VarseoSmile Crown Plus [VS]) and 2 subtractively manufactured materials (1 reinforced composite resin, Brilliant Crios [BC] and 1 polymer-infiltrated ceramic network, Vita Enamic [EN]) were used to fabricate standardized screw-retained, implant-supported crowns. After fabrication, the crowns were cemented on titanium base abutments and then tightened to implants embedded in acrylic resin. A laser scanner with a triangular displacement sensor (LAS-20) was used to digitize the pre-aging state of the crowns. Then, all crowns were subjected to thermomechanical aging (1.2 million cycles under 50 N) and rescanned. A metrology-grade analysis software program (Geomagic Control X 2020.1) was used to superimpose post-aging scans over pre-aging scans to calculate the volume loss (mm3) and maximum wear depth (mm). Finally, all crowns were subjected to a fracture resistance test. Fracture resistance and volume loss were evaluated by using 1-way analysis of variance and Tukey Honestly significant difference (HSD) tests, whereas the Kruskal-Wallis and Dunn tests were used to analyze maximum wear depth. Chi-squared tests were used to evaluate the Weibull modulus and characteristic strength data (α=.05).

RESULTS

Material type affected the tested parameters (P<.001). CT and VS had higher volume loss and maximum wear depth than BC and EN (P<.001). EN had the highest fracture resistance among tested materials (P<.001), whereas BC had higher fracture resistance than CT (P=.011). The differences among tested materials were not significant when the Weibull modulus was considered (P=.199); however, VE had the highest characteristic strength (P<.001).

CONCLUSIONS

Additively manufactured screw-retained, implant-supported crowns had higher volume loss and maximum wear depth. All materials had fracture resistance values higher than the previously reported masticatory forces of the premolar region; however, the higher characteristic strength of the subtractively manufactured polymer-infiltrated ceramic network may indicate its resistance to mechanical complications.

Effect of surface treatment strategies on bond strength of additively and subtractively manufactured hybrid materials for permanent crowns

OBJECTIVES

The purpose of this study is to evaluate the bond strength of different computer-aided design / computer-aided manufacturing (CAD/CAM) hybrid ceramic materials following different pretreatments.

METHODS

A total of 306 CAD/CAM hybrid material specimens were manufactured, n = 102 for each material (VarseoSmile Crownplus [VSCP] by 3D-printing; Vita Enamic [VE] and Grandio Blocs [GB] by milling). Each material was randomly divided into six groups regarding different pretreatment strategies: control, silane, sandblasting (50 μm aluminum oxide particles), sandblasting + silane, etching (9% hydrofluorics acid), etching + silane. Subsequently, surface roughness (Ra) values, surface free energy (SFE) were measured. Each specimen was bonded with a dual-cured adhesive composite. Half of the specimens were subjected to thermocycling (5000 cycles, 5-55 °C). The shear bond strength (SBS) test was performed. Data were analyzed by using a two-way analysis of variance, independent t-test, and Mann-Whitney-U-test (α = 0.05).

RESULTS

Material type (p = 0.001), pretreatment strategy (p < 0.001), and the interaction (p < 0.001) all had significant effects on Ra value. However, only etching on VSCP and VE surface increased SFE value significantly. Regarding SBS value, no significant difference was found among the three materials (p = 0.937), while the pretreatment strategy significantly influenced SBS (p < 0.05). Etching on VSCP specimens showed the lowest mean value among all groups, while sandblasting and silane result in higher SBS for all test materials.

CONCLUSIONS

The bond strength of CAD/CAM hybrid ceramic materials for milling and 3D-printing was comparable. Sandblasting and silane coupling were suitable for both millable and printable materials, while hydrofluoric etching should not be recommended for CAD/CAM hybrid ceramic materials.

CLINICAL RELEVANCE

Since comparable evidence between 3D-printable and millable CAD/CAM dental hybrid materials is scarce, the present study gives clear guidance for pretreatment planning on different materials.

Influence of polishing technique and coffee thermal cycling on the surface roughness and color stability of additively and subtractively manufactured resins used for definitive restorations

PURPOSE

To evaluate how different polishing techniques and coffee thermal cycling affect the surface roughness and stainability of additively and subtractively manufactured resins used for definitive prostheses.

MATERIALS AND METHODS

Two additively manufactured composite resins (Crowntec, CT and VarseoSmile Crown Plus, VS) and a subtractively manufactured resin nanoceramic (Cerasmart, CS) were used to fabricate 90 rectangular-shaped specimens (14 × 12 × 1 mm) (n = 30). After baseline surface roughness (Ra) measurements, specimens were divided into three groups based on the polishing technique; conventional polishing with a 2-stage polishing kit (CP) and surface sealant application (Optiglaze, OG or Vita Akzent LC, VA) (n = 10). After polishing, specimens were subjected to 10,000 cycles of coffee thermal cycling. Ra and color coordinate measurements were performed after polishing and after coffee thermal cycling. Color difference (ΔE00) was calculated. Scanning electron microscope images were taken at each time interval. Kruskal-Wallis or 1-way analysis of variance (ANOVA) were used to evaluate Ra of materials within each polishing-time interval pair and different polishing techniques within each material-time interval pair, while Friedman or repeated measures ANOVA were used to evaluate Ra at different time intervals within each material-polishing pair. ΔE00 was assessed with 2-way ANOVA (α = 0.05).

RESULTS

Other than VA-after polishing (p = 0.055), tested materials had significantly different Ra within each polishing-time interval pair (p ≤ 0.038). When Ra differences among different polishing techniques within each material-time interval pair were considered, CS had differences after coffee thermal cycling, CT had differences before polishing and after coffee thermal cycling, and VS had differences within each time interval (p ≤ 0.038). When Ra differences among different time intervals within each material-polishing pair were considered, significant differences were observed among all pairs (p ≤ 0.016), except for CS-VA (p = 0.695) and VS-VA (p = 0.300). ΔE00 values were affected by material and polishing technique interaction (p = 0.007).

CONCLUSIONS

Ra of CS was similar to or lower than the Ra of other materials, regardless of the time interval or polishing technique. CP mostly led to lower Ra than other polishing techniques, whereas VA resulted in a high Ra regardless of the material-time interval pair. Polishing reduced the Ra, while coffee thermal cycling was found to have a small effect. Among tested material-polishing pairs, only CS-VA had moderately unacceptable color change when previously reported threshold values were considered.

Color stability of CAD-CAM hybrid ceramic materials following immersion in artificial saliva and wine

PURPOSE

To examine the color stability of 3D-printed and milled, interim, and definitive, restorative materials after immersion in artificial saliva and wine for 1, 3, and 6 months.

MATERIAL AND METHODS

The study used a 2 × 5 factorial design with 10 subgroups, including 2 immersion liquids (artificial saliva and wine) and 5 manufacturing technology and restorative material combinations (n = 10). Color measurements were taken using a contact-type digital spectrophotometer (CM-2600d Spectrophotometer; Konica Minolta Healthcare Americas Inc) before immersion and at 1 month (T1), 3 months (T3), and 6 months (T6) after immersion. The CIE2000 system was used to calculate quantitative measurements of color differences in ΔE00, and comparisons were made to the acceptability threshold (AT) and perceptibility threshold (PT). Repeated measures of ANOVA (α = 0.05) were used to compare differences in color changes between manufacturing technology/restorative material-immersion liquid combinations at T1, T3, and T6.

RESULTS

To compare the effect of immersion liquid and time on the manufacturing technology/restorative material groups, the ΔE00 values were compared to the PT of 0.8 and the AT of 1.8. Wine caused significant color changes in ΔE00 values beyond the PT and AT values in all groups at all time intervals, except for the AT value of milled definitive crowns (hybrid nano-ceramic material). Wine immersion caused significant ΔE00 for all manufacturing technology/restorative material groups at all time intervals (1 month, 3 months, and 6 months) when compared to artificial saliva immersion (all p < 0.001).

CONCLUSION

Upon exposure to artificial saliva, 80%-100% of samples from all groups remained within the acceptable and perceptible color change thresholds. The wine had significant chromogenic effects on all tested restorative materials, however, the milled definitive crowns (hybrid nano-ceramic material) showed the greatest color stability. For patients with heavy wine consumption, 3D-printed definitive crowns (hybrid ceramic-filled material) may show discoloration exceeding acceptable and perceptible color change limits.

Accuracy of the intaglio surface of 3D-printed hybrid resin-ceramic crowns, veneers and table-tops: An in vitro study

OBJECTIVES

The present study aims to examine the influence of the build angle on the accuracy (trueness and precision) of 3D printed crowns, table-tops and veneers with a hybrid resin-ceramic material.

METHODS

One crown, on table-top and one veneer were printed in five different build angles (0°, 30°, 45°, 60°, 90°) (n = 50) with the digital light processing (DLP) system (Varseo XS, Bego) using hybrid resin (Varseo Smile Crownplus A3, Bego). All printed restorations were scanned using the laboratory scanner (D2000, 3Shape) and matched onto the initial reference design in metrology software (Geomagic Control X, 3D Systems). The root mean square error (RMSE) was calculated between the scanned and reference data. The data was statistically analyzed using the Tukey multiple comparison test and Wilcoxon multiple comparison test.

RESULTS

The crown group showed higher trueness at 30° (0.021 ± 0.002) and 45° (0.020 ± 0.002), and table-tops at 0° (0.015 ± 0.001) and 30° (0.014 ± 0.001) (p < 0.0001). Veneers demonstrated higher trueness at 30° (0.016 ± 0.002) (p < 0.0001). All three restoration types demonstrated the lowest trueness at a 90° build angle and portrayed deviations along the z axis. The veneer and table-top groups showed the lowest precision at 90° (veneers: 0.021 ± 0.008; table-tops: 0.013 ± 0.003). The crown group portrayed the lowest precision at 45° (0.017 ± 0.005) (p < 0.0001).

CONCLUSION

The build angle of DLP-printed hybrid resin-ceramic restorations influences their accuracy.

CLINICAL SIGNIFICANCE

Considering the build angle is important to achieve a better accuracy of 3D-printed resin-ceramic hybrid restorations. This may help predict or avoid the interference points between a restoration and a die and minimize the clinical adjustments.

Bacterial adhesion to composite resins produced by additive and subtractive manufacturing

The aim of this study was to evaluate the surface roughness and contact angle of composite resins produced by CAD/CAM milling and three-dimensional (3D) printing for permanent restorations as well as the adhesion of S. mutans and S. sanguinis bacteria to these composites. Three CAD/CAM milling composite resins (Vita Enamic-VE, Cerasmart-CE, Lava Ultimate-LU) and three 3D printing resins (Varseo Smile Crown plus-VSC, Saremco print Crowntech-SPC, Formlabs 3B Permanent crown-FLP) were selected. Twenty samples were prepared for each group. Using a contact profilometer, the surface roughness was determined, and an optical goniometer was used to quantify the contact angle. To evaluate the bacterial adhesion, composite specimens were immersed in mucin containing artificial saliva. All samples were incubated for 24 h at 37°C in 5% CO2. CFUs were determined by counting colonies after the incubation period. Surface roughness values of test samples were the highest in the Group VSC [0.46 (0.14) µm], whereas the lowest values were found in the Group LU [0.23 (0.05) µm]. There was no statistically significant difference between the groups in contact angle values (p > 0.05). The S. mutans adhesion extent on the Group SPC was statistically higher compared to all other materials with p < 0.05. For S. sanguinis, the lowest bacterial adhesion value was recorded in Group CE (3.00 × 104 CFU/ml) and statistically significant differences were found with Group VE and VSC (p < 0.05). Different digital manufacturing techniques and material compositions can affect the surface roughnesses of composite resins. All composite resin samples have hydrophobic characteristics. Microbial adhesion of the tested composite resins may be varied depending on the bacterial species. S. mutans showed much more adhesion to these materials than S. sanguinis.

Impact of Auxiliary Features on Retention of Short Dental Crowns: An In-Vitro Analysis of Box and Groove Preparations

BACKGROUND Several auxiliary features have been proposed to achieve sustainable retention for short-prepared dental crowns; however, achieving retention is challenging. This study aimed to assess the impact of increased total occlusal convergence and auxiliary preparation factors like box and groove on the retention form of short tooth preparations. MATERIAL AND METHODS Eighty resin machine-milled dies with a height of 3 mm and a deep chamfer margin of 1 mm were prepared to mimic the short-prepared molar. Initially, 2 teeth were prepared following the guidelines, and the total occlusal convergence was kept at 10° and 20°, respectively. Auxiliary features such as the proximal box and buccal groove were prepared on separate 20° dies. Eighty dies were prepared with 10 samples each for 10°, 20°, 20° with proximal box and 20° with buccal groove for zirconia (n=40) and metal crowns (n=40). Cementation was done with glass ionomer luting cement, and a pull-off test was conducted. Data were analyzed using one-way analysis of variance and post hoc fisher least significant difference test (P<0.05). RESULTS The highest mean was observed in the proximal box group with the metal crown (14.59), and the lowest in the group with 20° zirconia crowns (9.12). Within groups, the highest retentive values were found for the 20° taper with proximal box preparation; the lowest was for the 20° taper group. CONCLUSIONS Within the study limitations, it could be concluded that incorporating a proximal box or buccal groove in short tooth preparations with an increased total occlusal convergence improved retentive values.

Evaluation of the Mechanical and Adhesion Characteristics of Indirect Restorations Manufactured with Three-Dimensional Printing

The aim of this study was to investigate the marginal fit and bond strength characteristics of onlay restorations manufactured by three-dimensional printing (Varseo XS, Bego GmbH, Bremen, Germany) and CAD/CAM (CAMcube, Montreal, QC, Canada) systems. Class II onlay cavities on sixty mandibular molars were prepared in cavities and restored in three separate groups using different fabrication methods. Digital and conventional impressions were taken to design the restorations in the CAD system (DWOS, Straumann GmbH, Freiburg, Germany). To evaluate the marginal fit and void volumes, all specimens were scanned with microcomputed tomography. A microshear test was performed to compare the bond strength of the restorations to the tooth surface. The marginal fit values measured for the 3D-printed and CAD/CAM onlay restorations were found to be at clinically acceptable levels (<120 µm), and no significant difference could be observed between the three different fabrication methods (p > 0.05). According to the microshear test results, the CAD/CAM group had the highest bond strength values before (34.82 MPa) and after (26.87 MPa) thermal cycling (p < 0.05), while the 3D-printed and conventionally produced onlays had similar results (p < 0.05). 3D printing technology is a promising option for indirect restorations; however, the post-production phase is as crucial as the printing and cementation phases.

Monomer release, cell adhesion, and cell viability of indirect restorative materials manufactured with additive, subtractive, and conventional methods

PURPOSE

The aim of this study was to measure residual monomer, cell adhesion, and cell viability of 3-dimensional printable permanent resin (PR), hybrid ceramic block (HCB), and indirect composite (IC) produced with additive, subtractive, and conventional techniques.

METHODS

Five 8 × 8 × 2 mm3 samples of each material were prepared for each experiment. In a 24-h period, monomer release was analyzed with high-performance liquid chromatography, and cell viability and adhesion were evaluated with the water-soluble tetrazolium salt test. Data were analyzed with IBM SPSS Statistics 26.0 statistical software, and results were regarded as significant at α = 0.05.

RESULTS

Monomer release (triethylene glycol dimethacrylate, urethane dimethacrylate, and Bisphenol A glycerolate dimethacrylate) was significantly higher in the IC group. Mean cell viability was significantly lower in the HCB group than in the IC group.

CONCLUSION

All monomers in the tested materials were released at rates that were below clinical significance. Cell adhesion rates in the groups were similar. Cytotoxic response was classified as minor in the HCB and PR groups and non-cytotoxic in the IC group.

Fabrication trueness and internal fit of hybrid abutment crowns fabricated by using additively and subtractively manufactured resins

OBJECTIVES

To evaluate the fabrication trueness and internal fit of hybrid abutment crowns fabricated by using additively and subtractively manufactured restorative materials.

METHODS

A maxillary first premolar crown with a screw access channel was designed onto a digitized master titanium base abutment. This file was used to fabricate 40 crowns additively (Crowntec (CT) and VarseoSmile Crown Plus (VS)) or subtractively (Brilliant Crios (BC) and Vita Enamic (EN)) (n = 10). Crowns were digitized with an intraoral scanner and root mean square method was used to evaluate fabrication trueness. Master abutment and the crowns when seated on the abutment were also digitized with the same intraoral scanner and triple scan method was used to evaluate internal fit. Data were analyzed either with 1-way ANOVA (surface deviations) or Kruskal-Wallis (internal fit) tests (α= 0.05).

RESULTS

CT had the highest overall, external, and marginal surface deviations (P≤.030), whereas BC had the lowest external (P≤.001) and VS and EN had the lowest marginal surface deviations (P≤.007). BC had the highest intaglio surface deviations (P<.001). BC and EN had higher average gap values CT and VS (P≤.006); however, the differences within additively and subtractively manufactured materials were nonsignificant (P≥.858).

CONCLUSIONS

One of the tested additively manufactured resins (CT) resulted in mostly lower trueness than that of other materials. However, deviations at the intaglio and marginal surfaces were generally small and the maximum mean difference among test groups when average gap was considered was 17.4 µm. Therefore, clinical fit of hybrid abutment crowns fabricated with tested materials may be similar.

Effect of number of supports and build angle on the fabrication and internal fit accuracy of additively manufactured definitive resin-ceramic hybrid crowns

OBJECTIVES

To evaluate the effect of number of supports and build angle on the fabrication and internal fit accuracy (trueness and precision) of additively manufactured resin-ceramic hybrid crowns.

METHODS

A mandibular first molar crown was designed and nested on the build platform of a printer either with a 30° angle between the occlusal surface and the build platform (BLS (less support) and BMS (more support)) or its occlusal surface parallel to the build platform (VLS (less support) and VMS (more support)) to fabricate additively manufactured resin-ceramic hybrid crowns (n=14). After fabrication, supports were removed by a blinded operator and all crowns were digitized with an intraoral scanner. Fabrication accuracy (overall, external, intaglio occlusal, occlusal, and marginal) was evaluated by using root mean square (RMS) method, while internal fit was evaluated with triple scan method. RMS, average gap, and precision of these data were analyzed (α= .05).

RESULTS

VLS had higher overall deviations than BLS and VMS (P≤.039). VMS had higher occlusal deviations than BLS (P=.033). While BMS and BLS had higher marginal deviations than VLS (P≤.006), BMS also had higher values than VMS (P=.012). BLS led to higher precision than VMS (intaglio occlusal and occlusal surfaces) and VLS (occlusal surface) (P≤.008). VLS led to higher precision than BMS (marginal surface) (P=.027). Average gap values were similar (P=.723); however, BLS resulted in higher precision than VLS (P=.018).

CONCLUSIONS

Considering their high marginal and occlusal surface trueness, and similar internal occlusal deviations and average gaps (trueness), clinical fit of resin-ceramic hybrid crowns fabricated with tested parameters may be similar. Reduced number of supports and angled orientation may lead to higher precision of fit.

CLINICAL SIGNIFICANCE

Tested resin-ceramic hybrid-printer pair may be used to fabricate crowns with reduced number of supports to maintain occlusal surface integrity without compromising the fabrication accuracy and fit.

The Effect of the Digital Manufacturing Technique, Preparation Taper, and Cement Type on the Retention of Aged Anterior Provisional Crowns: An In Vitro Study

A well-made provisional fixed prosthesis must present as a preview of the future prosthesis and may also augment the health of the abutments and periodontium. Provisional restorations have been prepared chairside with polymethyl methacrylate (PMMA) since time immemorial. CAD/CAM additive and subtractive technologies have revolutionized the fabrication of interim restorations in dental clinics. The current literature lacks substantial data about retention of provisional crowns manufactured using Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) additive and subtractive techniques with various temporary cements. This in vitro study aims to assess and compare the retention of temporary/provisional anterior crowns based on the combined effect of different digital manufacturing techniques, preparation tapers, and the temporary cements used for cementation. Two maxillary right central incisor typodont teeth were prepared to receive all-ceramic crowns, one with a 10-degree taper and the other with a 20-degree taper. Forty 3D-printed working models with the 10° taper and forty working models with the 20° taper were prepared to receive the temporary crowns. Forty temporary crowns were 3D-printed and forty crowns were milled (20 from each taper group). Kerr Temp-Bond NE conventional cement and Kerr Temp-Bond clear cement were used for cementation in the two groups. The number of samples per test group was 10. All samples were thermocycled and subjected to a universal testing machine to measure the pull-off force until retention loss (N) under tension with a crosshead speed of 5 mm/min. The pull-off force was highest for group 8, i.e., 3D-printed crowns with a 20° taper and cemented with Kerr Temp-Bond clear cement, followed by groups 6, 7, 4, 5, 3, and 2. Group 1, i.e., milled crowns with 10° taper cemented with Kerr Temp-Bond NE conventional cement, exhibited the lowest pull-off retentive force. The clinical selection of long-term provisional crowns fabricated using 3D-printing technology, prepared with 10° or 20° tapers, and cemented with clear cement, is the most favorable in terms of the retention of provisional crowns. 3D-printed provisional crowns can be used as an alternative to conventional and CAD/CAM-milled crowns for long-term provisionalization.