Recent Advances in 3D Printing of Polymers for Application in Prosthodontics

Three-Dimensional-Printed Photopolymer Resin Materials: A Narrative Review on Their Production Techniques and Applications in Dentistry

Additive manufacturing (3D printing) has transformed dentistry by providing solutions with high precision and accuracy achieved through digital workflows, which facilitate the creation of intricate and personalized structures. Additionally, 3D printing promotes cost efficiency by reducing material waste and errors while enabling on-demand production, minimizing the need for extensive inventories. Recent advancements in 3D-printed resin materials have enhanced their clinical applications by improving mechanical strength, biocompatibility, esthetics, and durability. These innovations have facilitated the fabrication of complex and patient-specific structures, such as dental prostheses, surgical guides, and orthodontic appliances, while significantly reducing production time and material waste. Ongoing research and innovation are expected to strengthen resin properties, including strength, translucency, and durability, broadening their clinical applications. The ongoing evolution of 3D printing technology is poised to play a critical role in driving personalized treatments, streamlining clinical workflows, and shaping the future of dental care. This narrative review comprehensively examines the production techniques and clinical applications of 3D-printed photopolymer resins across various dental specialties, including prosthodontics, orthodontics, pediatric dentistry, maxillofacial surgery, periodontology, endodontics, and conservative dentistry. Additionally, the review provides insight into the transformative impact of these technologies on patient care, highlights existing challenges, and suggests future directions for advancing resin properties and their integration into routine dental practice.

Effect of different 3D-printing systems on the flexural strength of provisional fixed dental prostheses: a systematic review and network meta-analysis of in vitro studies

OBJECTIVES

The aim of this systematic review and network meta-analysis was to compare the flexural strength of provisional fixed dental prostheses (PFDPs) fabricated using different 3D printing technologies, including digital light processing (DLP), stereolithography (SLA), liquid crystal display (LCD), selective laser sintering (SLS), Digital Light Synthesis (DLS), and fused deposition modeling (FDM).

MATERIALS AND METHODS

A comprehensive literature search was conducted in databases including PubMed, Web of Science, Scopus, and Open Grey up to September 2024. Studies evaluating the flexural strength of PFDPs fabricated by 3D printing systems were included. A network meta-analysis was performed, using standardized mean differences (SMDs) and 95% confidence intervals (CIs) to assess the effects of each system on flexural strength.

RESULTS

A total of 11 in vitro studies were included, with 9 studies contributing to the network meta-analysis. SLS (77.70%) and SLA (63.82%) systems ranked the highest in terms of flexural strength, while DLP ranked the lowest (23.40%). Significant differences were observed between SLS and multiple other systems, including DLP (-14.58, CI: -22.67 to -6.48), LCD (-14.65, CI: -25.54 to -3.59), FDM (-12.87, CI: -23.30 to -2.52), SLA (-11.41, CI: -18.74 to -4.01), and DLS (-10.89, CI: -21.23 to -0.67). Direct comparisons were limited, with DLP vs. SLA having the most data. Other comparisons were predominantly indirect.

CONCLUSIONS

SLS and SLA systems exhibited superior flexural strength compared to other systems. However, the limited number of direct comparisons and reliance on indirect evidence suggest that further research is necessary to confirm these findings.

Artificial intelligence in dentistry and dental biomaterials

Artificial intelligence (AI) technology is being used in various fields and its use is increasingly expanding in dentistry. The key aspects of AI include machine learning (ML), deep learning (DL), and neural networks (NNs). The aim of this review is to present an overview of AI, its various aspects, and its application in biomedicine, dentistry, and dental biomaterials focusing on restorative dentistry and prosthodontics. AI-based systems can be a complementary tool in diagnosis and treatment planning, result prediction, and patient-centered care. AI software can be used to detect restorations, prosthetic crowns, periodontal bone loss, and root canal segmentation from the periapical radiographs. The integration of AI, digital imaging, and 3D printing can provide more precise, durable, and patient-oriented outcomes. AI can be also used for the automatic segmentation of panoramic radiographs showing normal anatomy of the oral and maxillofacial area. Recent advancement in AI in medical and dental sciences includes multimodal deep learning fusion, speech data detection, and neuromorphic computing. Hence, AI has helped dentists in diagnosis, planning, and aid in providing high-quality dental treatments in less time.

The Accuracy of 3D-Printed Fixed Dental Restorations

OBJECTIVE

The aim of this in vitro study was to evaluate the accuracy of resin-based fixed dental restorations, namely veneers, single crowns, and four-unit fixed partial dental prosthesis (FPDs), using two different 3D printing technologies and polymer-based materials.

MATERIALS AND METHODS

A standard maxillary polyurethane jaw model containing prepared teeth was scanned using an intraoral scanner. The generated STL data were used to design the restorations virtually using CAD software. Two 3D printers were utilized for the provisional digital light processing and stereolithography for the castable resin patterns. Each printer produced 10 specimens of each type of restoration, for a total of 80 restorations. The 3D-printed restorations were then 3D scanned using the same intraoral scanner and evaluated for external and internal dimensional accuracy in terms of trueness and precision. A one-way ANOVA and two-sample T-test were implemented to compute the precision (variability between groups) and trueness (with the designed CAD model). A level of statistical significance of p-value < 0.05 was set.

RESULTS

Statistical differences in the external dimensional analysis of the incisors, molars, and four-unit FPD with p-values < 0.001, 0.002, and 0.004, respectively. For the internal dimensional analysis, the overall mean values of trueness ranged between 17 and 52 μm, and the variability was significant.

CONCLUSION

The external and internal dimensional accuracy values of the 3D-printed fixed dental restorations in this in vitro study in terms of trueness can be clinically accepted after chairside modifications. However, significant variability between the 3D-printed restorations was observed. Further investigations are needed to improve the accuracy of the 3D-printed fixed dental restorations.

CLINICAL SIGNIFICANCE

In terms of clinical applications, 3D-printed fixed dental restorations produced by both 3D-printing technologies and polymer-based materials achieved acceptable levels of trueness, although some variability was observed. Significant deviations from the CAD model may require further chairside adjustments. Future integration of AI with 3D-printing may further improve the accuracy and efficiency of fixed dental restoration production.

Enhanced bacteriostasis and osseointegrative properties of SiRNA-modified polyetheretherketone surface for implant applications

Polyetheretherketone (PEEK), bearing an elastic modulus that effectively simulates the innate properties of natural bone, has come into the spotlight as a promising bone substitute material. Nonetheless, the biologically inert nature of PEEK, combined with its insubstantial osseointegration and sterilization capabilities, pose constraints on its clinical application in the realm of implants. RNA interference (RNAi), an effective technique used for gene expression regulation, has begun to be applied in implant surface modification. Herein, siCKIP-1 is securely affixed to the surface of PEEK implants, aided by an antibacterial polyphenol tannic acid (pTAN) coatings, enhancing physiologic osseointegration and inhibiting bacterial infection. This method breakthrough not merely facilitates the convenience, but also multifaceted PEEK implants' refinements. The modified PEEK implants have impressive biocompatibility coupled with a noteworthy degree of antibacterial properties. Meanwhile, modified PEEK implants improved osteogenic differentiation of rat bone mesenchymal stem cells (rBMSCs) and demonstrated excellent osteointegrative properties in rat femur implantation models. Therefore, identifying a new implant material with excellent biocompatibility and biomechanical properties is essential.

Comparative Study of the Fracture Resistance of 3D-Printed and Prefabricated Artificial Teeth for Removable Dentures

The integration of three-dimensional (3D) printed resin denture teeth represents a significant advancement in digital dentistry. This study aims to assess the ability of 3D-printed denture teeth to withstand chipping and indirect tensile fractures, comparing them with conventionally manufactured resin denture teeth. Four groups, each comprising 30 specimens, were examined: Group 1 featured 3D-printed denture teeth (NextDent, 3D Systems, Soesterberg, The Netherlands), while the others included commercially obtained Ivostar Shade, SpofaDent Plus, and Major Super Lux teeth. Stereolithography 3D printing was utilized to produce methacrylate-based photopolymerized resin teeth models for Group 1, while the remaining groups were commercially sourced. Chipping and indirect tensile fracture tests were performed at a rate of 0.8 mm/min until material failure, offering valuable insights into the mechanical properties of the tested denture teeth. Statistical analysis was carried out using one-way analysis of variance (ANOVA), coupled with Tukey's honestly significant difference test to compare multiple groups, with a significance threshold of p < 0.05. The findings showed that 3D-printed resin denture teeth exhibited greater indirect tensile fracture resistance than Major Super Lux and Ivostar Shade, though they were surpassed by SpofaDent Plus. In the chipping test, the 3D-printed teeth experienced buccal chipping without distortion, indicating their structural stability under localized force. Fractures during the indirect tensile test originated near the loading point and extended cervically along the inner slopes of both cusps, displaying consistent fracture patterns. These results demonstrate that 3D-printed denture teeth made from resin materials provide adequate fracture resistance for clinical use, although further refinement of materials could enhance their performance relative to conventional alternatives.

Effect of Addition of Metal Oxide Nanoparticles on the Strength of Heat-Cured Denture Base Resins: Protocol for Systematic Review and Meta-Analysis of In Vitro Studies

BACKGROUND

Metal oxide nanoparticle-reinforced polymethyl methacrylate (PMMA) has been shown to improve mechanical properties, such as strength. Different types of metal oxide nanoparticles have been used previously, but the comparative effect on the strength of heat-cured denture base resins remains unclear.

OBJECTIVE

This is a protocol for a systematic review and meta-analysis that will aim to pool evidence to compare and analyze the effects of the addition of different metal oxide nanoparticles, with varied sizes and concentrations, on the strength (flexural, impact, transverse, compressive tensile strength, and fracture toughness) of heat-cured PMMA. In addition, this review aims to analyze methodological factors, such as adherence to testing and sample-making guidelines, and the effects of surface treatments of the nanoparticles on the strength of heat-cured denture base resins.

METHODS

The protocol has been registered in the Open Science Framework. Search strategies to identify studies on the effect of metal oxide nanoparticles on the strength of heat-cured PMMA were developed by the subject matter expert in library science. Following this, a systematic search of 5 electronic databases (PubMed [NCBI], Scopus [Elsevier], Cochrane Library [Wiley], CINAHL Plus with Full Text [EBSCO], and Dimensions Free Web App) was conducted to retrieve in vitro studies published in English from January 2012 to October 2023. Along with this citation chasing, other online sources and gray literature were also searched. Furthermore, papers will be screened, and appropriate data elements will be extracted in a standardized manner. A risk-of-bias assessment will be performed using a modified Cochrane Risk of Bias Tool. A meta-analysis will be performed using a random-effects model.

RESULTS

Search in databases resulted in 1837 papers, of which 1752 were duplicates, leaving 85 records that were screened for titles and abstracts based on the eligibility criteria. A similar search run on other online sources identified 129 papers that will be further analyzed for inclusion. The study was initiated in November 2023 and research questions and search strategies were formulated. The proposed study is expected to be completed by December 2024.

CONCLUSIONS

This systematic review will comprehensively analyze the effects of the incorporation of metal oxide nanoparticles in heat-cured denture base resins on the strength of the material. We anticipate gaining a deeper understanding of the effects and method of use of metal oxide nanoparticles to improve the strength of PMMA denture base resins.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/59999.

The Applications of 3D-Printing Technology in Prosthodontics: A Review of the Current Literature

Prosthodontics has become increasingly popular because of its cosmetic attractiveness. 3D printing has revolutionized prosthodontics, enabling the creation of high-quality dental prostheses. It creates detailed restorations, such as crowns, bridges, implant-supported frameworks, surgical templates, dentures, and orthodontic models. In addition, it saves production time but faces challenges such as elevated expenses and the requirement for innovative materials and technologies. This review gives insights into the uses of 3D printing in prosthodontics, presenting how it has significantly changed clinical practices. This article discusses different materials and techniques. Additionally, it showcases the capacity of 3D printing to improve prosthodontic practice and proposes prospects for future investigation.

Efficient Digital Workflow to Replace a Missing Denture Tooth for Complete Denture Repair

Debonded denture teeth is a common complication on a fixed or removable dental prosthesis when denture teeth are fabricated separately from the denture base and bonded together. Missing denture teeth can alter a person's appearance, speech, or ability to eat. Traditionally, denture teeth repair can be a challenge for clinicians or dental laboratory technicians to find the identical tooth mould to meet esthetic and functional demands. This case report describes a digital workflow to scan, design, and mill a well-fitting and esthetic denture tooth to expedite treatment, improve patient satisfaction, and increase troop readiness when traditional methods may not be feasible.

Enhancing 3D-printed denture base resins: A review of material innovations

The limited physical and mechanical properties of polymethyl methacrylate (PMMA), the current gold standard, necessitates exploring improved denture base materials. While three-dimensional (3D) printing offers accuracy, efficiency, and patient comfort advantages, achieving superior mechanics in 3D-printed denture resins remains challenging despite good biocompatibility and esthetics. This review investigates the potential of innovative materials to address the limitations of 3D-printed denture base materials. Thus, this article is organized to provide a comprehensive overview of recent efforts to enhance 3D-printed denture base materials, highlighting advancements. It critically examines the impact of incorporating various nanoparticles (zirconia, titania, etc.) on these materials' physical and mechanical properties. Additionally, it delves into recent strategies for nanofiller surface treatment and biocompatibility evaluation and explores potential future directions for polymeric composites in denture applications. The review finds that adding nanoparticles significantly improves performance compared to unmodified resins, and properties can be extensively enhanced through specific modifications, particularly silanized nanoparticles. Optimizing 3D-printed denture acrylics requires a multifaceted approach, with future research prioritizing novel nanomaterials and surface modification techniques for a novel generation of superior performance, esthetically pleasing, and long-lasting dentures.

Bonding Efficiency between Artificial Teeth and Denture Base in CAD/CAM and Conventional Complete Removable Dentures

A common challenge encountered with both traditional and digitally produced dentures involves the extraction of artificial teeth from the denture base. This narrative review seeks to present an updated perspective on the adherence of synthetic teeth for denture base materials, employing diverse methods. Dental technicians often employ chemical approaches and mechanical techniques (including abrasion, laser treatment, and abrasive blasting) to augment the retention of denture teeth. However, the efficacy of these treatments remains uncertain. In certain instances, specific combinations of Denture Base Resin (DBR) materials and artificial teeth exhibit improved performance in conventional heat-cured dentures following these treatments. The primary reasons for failure are attributed to material incompatibility and inadequate copolymerization. As new denture fabrication techniques and materials continue to emerge, further research is imperative to identify optimal tooth-DBR combinations. Notably, 3D-printed tooth-DBR combinations have demonstrated reduced bond strength and less favorable failure patterns, while utilizing milled and traditional combinations appears to be a more prudent choice until advancements in additive manufacturing enhance the reliability of 3D-printing methods.

Assessment of CAD/CAM Fabrication Technologies for Post and Core Restorations-A Narrative Review

The primary objective of this study is to conduct a comprehensive review of the existing literature that discusses research on post and core restorations, covering aspects such as their composition, manufacturing methods, and clinical effectiveness. The methodology employed in this review encompasses the implementation of a well-defined search strategy, the establishment of criteria for inclusion and exclusion, and the selection of relevant studies to summarize their findings. To gather relevant literature published between 1993 and 2023, the research team conducted separate searches on PubMed, Web of Science, and Embase databases. In total, 168 titles were initially retrieved from these electronic databases. By applying the predefined exclusion criteria, the researchers identified 73 articles that specifically address the conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) technologies employed in post and core restorations. These treatments are commonly employed to restore teeth that have received endodontic therapy and subsequently experienced loss of dental structure. The development of computerized technology for the creation of customized posts and cores has emerged as a straightforward and efficient alternative to traditional methods. The review synthesizes papers discussing the techniques and materials involved in CAD/CAM-based construction of post and cores. It explores strategies for restoring endodontically treated teeth, highlighting both direct and indirect approaches. Commonly mentioned materials include zirconia, composite resin, and hybrid ceramics. Despite the limited literature on CAD/CAM post and core procedures, the review emphasizes the necessity of further research to assess long-term outcomes and efficacy. Additionally, it suggests including implications for future research and clinical recommendations to enhance the depth and practical relevance of the review.

A comparative study of the use of digital technology in the anterior smile experience

OBJECTIVES

this study aims to compare the clinical outcomes of traditional and digital crown extension guides in the aesthetic restoration of anterior teeth. Additionally, the study will analyze the differences in the results of various digital crown extension guides in anterior aesthetic restorations.

METHODS

Sixty-two patients who required aesthetic restoration of their anterior teeth were selected for this study. The patients had a total of 230 anterior teeth and were randomly divided into three groups: a control group of 22 cases who received diagnostic wax-up with pressure film, an experimental group 1 of 20 cases who received 3D printed digital models with pressure film, and an experimental group 2 of 20 patients who received digital dual-positioning guides. The control group had a total of 84 anterior teeth, experimental group 1 had 72 anterior teeth, and experimental group 2 had 74 anterior teeth. The study compared three methods for fabricating crown extension guides: the control group used the diagnostic wax-up plus compression film method, while experimental group 1 used compression film on 3D printed models and experimental group 2 used 3D printed digital dual-positioning crown extension guides. After the crown lengthening surgery, the control group patients wore DMG resin temporary crown material for gingival contouring, while the experimental group patients wore 3D printed resin temporary crowns for the same purpose. The patients were followed up in the outpatient clinic after wearing temporary crowns for 1 month, 3 months, and 6 months, respectively. The clinical results were evaluated in terms of marginal fit, red aesthetic index, and white aesthetic index.

RESULTS

Based on the statistical analysis, the experimental group required significantly fewer follow-up visits and less time for guide design and fabrication compared to the control group. Additionally, the surgical time for the experimental group was significantly shorter than that of the control group. During the postoperative period between the 1st and 3rd month, the PES index scores for the marginal gingival level, proximal, and distal mesiodistal gingival papillae of the experimental group showed a trend of superiority over those of the control group. By the 6th month, the marginal gingival level exhibited a significant difference between the experimental and control groups. The experimental group demonstrated superior results to the control group in terms of shape, contour, and volume of the teeth, color, surface texture, and transparency of the restorations, and features during the 1st and 3rd postoperative months. In the 6th month, the comparative results indicated that the experimental group continued to exhibit superior outcomes to the control group in terms of the shape, color, surface texture, and transparency of the restorations, as well as the characteristics of the teeth. Additionally, the experimental group demonstrated significantly fewer gingival alterations than the control group at 1 month, 3 months, and 6 months post-procedure, with this difference being statistically significant. Furthermore, the combination of 3D printing technology and restorative techniques was utilized, resulting in consistent patient satisfaction.

CONCLUSION

Digitalisation plays an important role in anterior aesthetic restorations. The use of digital technology to manage the entire process of anterior cosmetic restorations can improve restorative results, reduce the number of follow-up appointments, shorten consultation time, and achieve better patient satisfaction.

Characterization of Microstructure, Optical Properties, and Mechanical Behavior of a Temporary 3D Printing Resin: Impact of Post-Curing Time

The present study aimed to characterize the microstructure of a temporary 3D printing polymer-based composite material (Resilab Temp), evaluating its optical properties and mechanical behavior according to different post-curing times. For the analysis of the surface microstructure and establishment of the best printing pattern, samples in bar format following ISO 4049 (25 × 10 × 3 mm) were designed in CAD software (Rhinoceros 6.0), printed on a W3D printer (Wilcos), and light-cured in Anycubic Photon for different lengths of time (no post-curing, 16 min, 32 min, and 60 min). For the structural characterization, analyses were carried out using Fourier transform infrared spectroscopy (FT-IR) and scanning electron microscopy (SEM). The mechanical behavior of this polymer-based composite material was determined based on flexural strength tests and Knoop microhardness. Color and translucency analysis were performed using a spectrophotometer (VITA Easy Shade Advanced 4.0), which was then evaluated in CIELab, using gray, black, and white backgrounds. All analyses were performed immediately after making the samples and repeated after thermal aging over two thousand cycles (5-55 °C). The results obtained were statistically analyzed with a significance level of 5%. FT-IR analysis showed about a 46% degree of conversion on the surface and 37% in the center of the resin sample. The flexural strength was higher for the groups polymerized for 32 min and 1 h, while the Knoop microhardness did not show a statistical difference between the groups. Color and translucency analysis also did not show statistical differences between groups. According to all of the analyses carried out in this study, for the evaluated material, a post-polymerization time of 1 h should be suggested to improve the mechanical performance of 3D-printed devices.

Comparative Analysis of the Mechanical Properties and Biocompatibility between CAD/CAM and Conventional Polymers Applied in Prosthetic Dentistry

Modern media often portray CAD/CAM technology as widely utilized in the fabrication of dental prosthetics. This study presents a comparative analysis of the mechanical properties and biocompatibility of CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing) polymers and conventional polymers commonly utilized in prosthetic dentistry. With the increasing adoption of CAD/CAM technology in dental laboratories and practices, understanding the differences in material properties is crucial for informed decision-making in prosthodontic treatment planning. Through a narrative review of the literature and empirical data, this study evaluates the mechanical strength, durability, esthetics, and biocompatibility of CAD/CAM polymers in comparison to traditional polymers. Furthermore, it examines the implications of these findings on the clinical outcomes and long-term success of prosthetic restorations. The results provide valuable insights into the advantages and limitations of CAD/CAM polymers, informing clinicians and researchers about their suitability for various dental prosthetic applications. This study underscores the considerable advantages of CAD/CAM polymers over conventional ones in terms of mechanical properties, biocompatibility, and esthetics for prosthetic dentistry. CAD/CAM technology offers improved mechanical strength and durability, potentially enhancing the long-term performance of dental prosthetics, while the biocompatibility of these polymers makes them suitable for a broad patient demographic, reducing the risk of adverse reactions. The practical implications of these findings for dental technicians and dentists are significant, as understanding these material differences enables tailored treatment planning to meet individual patient needs and preferences. Integration of CAD/CAM technology into dental practices can lead to more predictable outcomes and heightened patient satisfaction with prosthetic restorations.

A 3D-simulation study of the deformation, tension, and stress of 3D-printed and conventional denture base materials after immersion in artificial saliva

INTRODUCTION

The worldwide application of digital technology has presented dentistry with transformative opportunities. The concept of digital dentures, incorporating computer-aided design (CAD) and computer-aided manufacturing (CAM) techniques, holds the promise of improved precision, customization, and overall patient satisfaction. However, the shift from traditional dentures to their digital counterparts should not be taken lightly, as the intricate interplay between oral physiology, patient comfort, and long-term durability requires thorough examination.