Additive manufacturing of dental polymers: An overview on processes, materials and applications

A Comparative In Vitro Study of Materials for Provisional Restorations Manufactured With Additive (3Dprinting), Subtractive (Milling), and Conventional Techniques

OBJECTIVE

To compare the mechanical, chemical, and surface properties of three materials used for provisional restorations, manufactured with additive (3D-printing), subtractive (milling), and conventional techniques.

MATERIALS AND METHODS

Three material groups were tested: (a) GC TempPRINT, (3D-printed/3DP), (b) VITA CAD-Temp, (milled/ML), and (c) Telio CS C&B, (conventional self-cured/CC). Each group consisted of 20 beam-shaped specimens (25 × 2 × 2 mm) used for a three-point flexural strength test and 5 discs (Ø:15 mm, h: 2 mm) used for surface roughness, gloss, degree of conversion, and hardness measurements. Data were analyzed using one-way ANOVA and Holm-Sidak multiple comparison tests (α = 0.05).

RESULTS

The ranking of the statistically significant differences (p < 0.05) was: 3DP >CC > ML (Sdr roughness parameter), ML >CC > 3DP (gloss) and ML > 3DP> CC (gloss, degree of conversion, hardness and flexural strength).

CLINICAL SIGNIFICANCE

The tested materials showed statistically significant differences in all tested properties. These differences may affect their clinical performance and should be taken into consideration for their clinical application.

Additively manufactured resin-based endocrowns: Effect of material type, margin configuration, and pulp chamber depth on fabrication trueness and fit

OBJECTIVE

To evaluate the effects of margin configuration and pulp chamber depth on the fabrication trueness and internal fit of resin-based endocrowns fabricated with additive (AM) and subtractive manufacturing (SM).

METHODS

Four mandibular first molar typodonts prepared with butt joint or 1 mm-wide shoulder margins and 2 mm or 4 mm pulp chamber depths were digitized to design reference endocrowns. These designs were used to fabricate endocrowns with AM (Crowntec [AM-CT], FREEPRINT Crown [AM-FP], Tera Harz TC80DP [AM-GR]) or SM (Tetric CAD [SM-TC]) (n = 7). Surface deviations (external, intaglio, and marginal root mean square, RMS) and triple scan protocol (average gap) were used for digital analyses. Data were analyzed with generalized linear models (α = 0.05).

RESULTS

Intaglio RMS was affected by the interaction of all main factors, while all surface deviations were affected by material type-margin configuration interaction. Material type-pulp chamber depth interaction affected intaglio RMS and average gaps, whereas margin configuration-pulp chamber depth interaction affected all outcomes, except intaglio RMS (P ≤ 0.001). AM-GR mostly led to lower intaglio and marginal RMS, while SM-TC mostly led to lower external RMS (P ≤ 0.022). SM-TC endocrowns with 4-mm depth had the highest and AM-GR endocrowns with 4-mm depth mostly had lower average gaps (P ≤ 0.024).

CONCLUSIONS

The interactions among the main factors affected the trueness of the tested endocrowns. However, no clear trend emerged that would highlight any subgroup as having the highest trueness. Most endocrowns demonstrated clinically acceptable internal gaps.

CLINICAL SIGNIFICANCE

Tested additively manufactured resin-based endocrowns had favorable internal adaptation. However, they may require more chairside adjustments on external surfaces compared to tested subtractively manufactured endocrowns.

Fully digital workflow for the fabrication of polycarbonate-based resin diagnostic and interim flexible removable partial dentures: A dental technique

This dental technique describes a fully digital workflow for the design and fabrication of interim removable partial dentures (RPDs) using a polycarbonate-based computer-aided design and computer-aided manufacture (CAD-CAM) material with custom-designed prosthetic teeth as an alternative to conventional interim RPDs with unesthetic metal clasps.

Aging and post-polymerization effects on conversion degree and properties of additive splint materials

The study objective was to analyze dimensional change, flexural strength, surface hardness, wear profile, and conversion degree of different additive splint materials under various post-polymerization conditions of time and artificial aging. Two additive manufacturing systems (Cara Print 4.0, Dima Print Ortho, Kulzer; SprintRay Pro, SprintRay Splint, SprintRay), and a thermally activated resin control (Clássico) were evaluated in artificial aging (deionized water or saliva; 28 or 84 days at 37°C), with recommended or doubled post-polymerization cycles. Dimensional change (surface metrology), flexural strength (ISO 20795-1:2013), fractography (SEM), Knoop hardness, two-body wear profilometry (150,000 cycles; 3mmØ; 20N; 2.1Hz), and conversion degree (FTIR spectroscopy) were assessed. Two-way ANOVA and post-hoc Tukey tests were used for parametric data, and Kruskal-Wallis and post-hoc Dunn tests, for non-parametric data (α = 0.05). Results indicated no statistically significant differences in dimensional change or flexural strength among the materials. Recommended post-polymerization cycles resulted in lower hardness for additive resins than the thermally activated control. Doubling post-polymerization time significantly increased flexural strength and hardness of Dima Print Ortho, but decreased flexural strength of SprintRay Splint, and did not affect wear resistance. Dima Print Ortho demonstrated the highest wear resistance. Artificial aging did not affect flexural strength, surface wear, or dimensional change, but negatively impacted the hardness of all materials except Dima Print Ortho. The conversion degree was unaffected by post-polymerization time, and no significant differences were found among the materials. Overall, additive materials exhibited mechanical and dimensional properties comparable to thermally activated resin, with doubling post-polymerization time positively influencing the properties.

Effect of changing the internal structure on the mechanical properties of three-dimensional-printed custom tray material: An in vitro study

The main challenges to the widespread clinical application of three-dimensional (3D)-printed customized trays include cost and time limitations. This study examined how changing the internal structure of 3D-printed materials used for customized trays affects flexural strength (FS), flexural modulus (FM), manufacturing time, and material weight. Specimens (64 × 10 × 3.3 mm) were printed using a light-sensitive liquid resin. The internal structures of control specimens were completely filled, whereas the internal structures of test groups comprised vertical bars spaced 1 mm (Test 1) or 2 mm (Test 2) apart. Specimens were weighed and then subjected to a three-point bending test to evaluate their FS and FM. Data were analyzed using one-way ANOVA and Tukey's test, with Weibull analysis applied to FS values. Control specimens had the highest FS (106 ± 4 MPa), while Test 2 specimens demonstrated the highest FM (6101 ± 1407 MPa). No significant differences were found between Test 1 and Test 2 specimens in FS or FM. Test 2 specimens had the lowest mean weight (1440 ± 42 mg). Manufacturing times were 80 min for control and Test 1 specimens and 60 min for Test 2 specimens. Including spaces in the internal structure of 3D-printed custom tray material saves material and manufacturing time while maintaining mechanical properties.

Exploring the Properties and Indications of Chairside CAD/CAM Materials in Restorative Dentistry

The present review provides an up-to-date overview of chairside CAD/CAM materials used in restorative dentistry, focusing on their classification, properties, and clinical applications. If CAD/CAM technology was only an aspiration in the past, a higher proportion of clinics are employing it nowadays. The market is overflowing with biomaterials, and these materials are constantly evolving, making it challenging for practitioners to choose the most appropriate one, especially in correlation with patients' medical diseases. The evolution of CAD/CAM technology has revolutionized dental practice, enabling the efficient fabrication of high-quality restorations in a single appointment. The main categories of chairside CAD/CAM materials include feldspathic ceramics, leucite-reinforced ceramics, lithium disilicate, zirconia, hybrid ceramics, and acrylic resins. The mechanical, physical, and aesthetic properties of these materials are discussed, along with their advantages and limitations for different clinical scenarios. Factors influencing material selection, such as strength, aesthetics, and ease of use, are also assessed. Ultimately, the guiding principle of dentistry is minimally invasive treatment following the particularity of the clinical case to obtain the envisioned result. Correlating all these factors, a simple, up-to-date classification is required to begin an individualized treatment. By synthesizing current evidence, this comprehensive review aims to guide clinicians in selecting appropriate chairside CAD/CAM materials to achieve optimal functional and aesthetic outcomes in restorative procedures. The integration of digital workflows and continued development of novel materials promise to further enhance the capabilities of chairside CAD/CAM systems in modern dental practice.

Mechanical properties of a polylactic 3D-printed interim crown after thermocycling

Polylactic acid (PLA) has garnered attention for use in interim dental restorations due to its biocompatibility, biodegradability, low cost, ease of fabrication, and moderate strength. However, its performance under intraoral conditions, particularly under heat and moisture, remains underexplored. This study evaluated the mechanical properties of PLA interim crowns compared with those of polymethylmethacrylate (PMMA) and bisphenol crowns under simulated intraoral conditions with thermocycling. Three CAD/CAM polymers-PMMA (milling), PLA (fused deposition), and bisphenol (stereolithography)-were tested for fracture resistance, hardness, and surface roughness. For fracture strength, 25 crowns from each group were cemented onto dies. The Shore D hardness and surface roughness were measured on round discs before and after 10,000 thermocycles (5°C/55°C). The surface topography was assessed via scanning electron microscopy. PMMA exhibited the highest fracture strength (2787.93 N), followed by bisphenol (2165.47 N) and PLA (2088.78 N), with no significant difference between the latter two. PMMA and bisphenol showed vertical fractures and cracks, whereas PLA showed crown tearing or die deformation. Bisphenol had the highest Shore D hardness, followed by PMMA and PLA, with no significant changes after thermocycling. The surface roughness (Ra) was lowest for bisphenol and similar between PMMA and PLA. The roughness (Rz) increased from bisphenol to PMMA to PLA. The roughness of the PMMA remained unchanged after thermocycling, whereas the Ra but not the Rz of the PLA increased. Bisphenol showed a significant increase in both Ra and Rz (p<0.0001). In conclusion, PLA interim crowns demonstrated mechanical properties comparable to those of conventional PMMA and bisphenol crowns after thermocycling.

Masking Ability of Subtractively and Additively Manufactured Dental Ceramic Restorations: A Systematic Review

OBJECTIVE

To conduct a systematic review on the masking ability of subtractively and additively manufactured dental ceramics.

MATERIALS AND METHODS

The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The electronic search was carried out through MEDLINE, Scopus, and Website of Science databases with a date restriction being from 2001 onwards. Publications in English, in vitro studies, and studies regarding the evaluation of the masking ability of crown materials that were subtractively and additively manufactured were included.

RESULTS

Out of 619 eligible articles, 13 were included. A thickness of 1.5 mm for lithium disilicate (LD) resulted in a dramatic decrease in ∆Eab/∆E00 across all substrates compared to a 1 mm thickness. Low-translucent LD appeared to have the best masking ability regardless of the shade of the try-in paste. Layering flowable composite over the substrates improved masking ability. Darker substrates were the hardest to mask no matter the type of restorative material, try-in paste used, and layering technique. Bilayered restorative materials proved to be superior to monolithic materials regarding masking ability.

CONCLUSION

Increasing the thickness of subtractively manufactured ceramics materials improves the masking ability. 1.5 mm thickness is found to provide the best masking ability for most ceramic materials. Darker substrates prove to be difficult to mask in comparison to lighter substrates and require either thicker materials and/or more opaque cements. Bilayered crowns are recommended for achieving optimal masking while preserving tooth structure. Despite the increasing demand, there is no study available on 3D-printed (additively manufactured) restoration's masking ability.

CLINICAL SIGNIFICANCE

This review provides a comparison of masking abilities of multiple subtractively manufactured ceramic materials and highlight the lack of current knowledge on additively manufactured crown materials. It also emphasizes the importance of having a universal approach to interpreting and communicating color changes between collaborative dental professionals to ensure the same shade predictions. In addition, when masking darker shades, clinicians should be aware that alternative material choice or clinical and technical procedures are essential.

Surface roughness, optical properties, and microhardness of additively and subtractively manufactured CAD-CAM materials after brushing and coffee thermal cycling

PURPOSE

To evaluate the surface roughness, optical properties, and microhardness of additively or subtractively manufactured CAD-CAM materials after simulated brushing and coffee thermal cycling.

MATERIAL AND METHODS

Two additively manufactured resins (Crowntec, CT and VarseoSmile Crown Plus, VS) and 3 subtractively manufactured materials (a reinforced composite (Brilliant Crios, BC), a polymer-infiltrated ceramic network (Enamic, VE), and a feldspathic ceramic (Mark II, VM)) were used to fabricate disk-shaped specimens (Ø10×1-mm) (n = 10). Surface roughness, Vickers microhardness, and color coordinates were measured after polishing, while surface roughness was also measured before polishing. Specimens were then subjected to 25000 cycles of brushing and 10000 cycles of coffee thermal cycling, and measurements were repeated after each time interval. Color difference (ΔE00) and relative translucency parameter (RTP) were calculated. Robust analysis of variance test was used to evaluate surface roughness, ΔE00, and RTP data, while generalized linear model analysis was used for microhardness data (α = 0.05).

RESULTS

Material type and time interval interaction affected tested parameters (p ≤ 0.002). In addition, material type affected all parameters (p < 0.001) other than surface roughness (p = 0.051), and time interval affected surface roughness and microhardness values (p < 0.001). Tested materials mostly had their highest surface roughness before polishing (p ≤ 0.026); however, there was no clear trend regarding the roughness of materials within different time intervals along with ΔE00 and RTP values within materials or time intervals. VS and CT had the lowest microhardness regardless of the time interval, while the remaining materials were listed as VM, VE, and BC in decreasing order (p < 0.001). Coffee thermal cycling only reduced the microhardness of VM (p < 0.001).

CONCLUSIONS

Tested additively manufactured resins can be considered more susceptible to simulated brushing and coffee thermal cycling than the other materials, given the fact that their surface roughness and ΔE00 values were higher than previously reported acceptability thresholds and because they had the lowest microhardness after all procedures were complete.

Revolutionizing Dental Polymers: The Versatility and Future Potential of Polyetheretherketone in Restorative Dentistry

Polyetheretherketone (PEEK) has emerged as a revolutionary material in modern dentistry because of its unique combination of mechanical strength, biocompatibility, and versatility. This literature review examines the current applications and future potential of PEEK in various dental disciplines. PEEK's favorable properties, including its low specific weight, high strength-to-weight ratio, and ability to be easily machined, have led to its adoption in prosthetics, implantology, and dental esthetic restorations. This material has shown promise for fabricating crowns, bridges, removable partial denture frameworks, and implant components. PEEK's radiolucency and bone-like elastic modulus make it particularly suitable for dental implants and abutments. Additionally, its resistance to degradation and compatibility with various surface treatments enhances its long-term performance in the oral environment. While challenges such as bonding to other dental materials and aesthetic limitations exist, ongoing research is addressing these issues through surface modifications and composite formulations. As the dental field continues to evolve, PEEK's adaptability and biocompatibility position it a key player in the development of next-generation dental materials and techniques, potentially transforming patient care and treatment outcomes in dentistry.

Polymeric Materials Used in 3DP in Dentistry-Biocompatibility Testing Challenges

In the latter part of the 20th century, remarkable developments in new dental materials and technologies were achieved. However, regarding the impact of dental resin-based materials 3D-printed on cellular responses, there have been a limited number of published studies recently. The biocompatibility of dental restorative materials is a controversial topic, especially when discussing modern manufacturing technologies. Three-dimensional printing generates the release of residual monomers due to incomplete polymerization of materials and involves the use of potentially toxic substances in post-printing processes that cannot be completely eliminated. Considering the issue of biocompatibility, this article aims to establish an overview of this aspect, summarizing the different types of biocompatibility tests performed on materials used in 3D printing in dentistry. In order to create this comprehensive review, articles dealing with the issue of 3D printing in dentistry were analysed by accessing the main specialized search engines using specific keywords. Relevant data referring to types of materials used in 3DP to manufacture various dental devices, polymerization methods, factors affecting monomer release, cytotoxicity of unreacted products or post-curing treatments, and methods for assessing biocompatibility were analysed. Although the introduction of new restorative materials used in dental treatments is subject to national and international regulations and standards, it is necessary to investigate them regarding biocompatibility in order to support or deny the manufacturers' statements regarding this aspect.

Internal and marginal fits of 3D-printed provisional prostheses: comparative effect of different printing parameters

Objectives

The influence of printing parameters on the marginal and internal fit of three-dimensional (3D) printed interim fixed partial dentures (IFPDs) has been understudied. This investigation sought to elucidate the impact of printing orientation and post-curing time on these critical factors.

Methods

A total of 260 3-Unit IFDPs were printed using two different resins (130/NextDent C&B MFH and 130/ASIGA DentaTOOTH). For each material, specimens were printed with three different angulations (0-, 45-, and 90-degree in relation to the z-axis). Each was further divided into 4 groups (n = 10) according to post-curing time (30-, 60-, 90-, and 120 min), while the green state (GS) group at 0-degree remained without post-curing as a control. Each specimen was scanned and then superimposed on the original CAD file. The marginal and internal fit of premolar and molar restorations were evaluated using the silicone replica technique. Digital scanning of the master die, both with and without a fit checker, was followed by data superimposition to compare the master die with the fit checker of each sample. 3D comparisons were conducted using initial and best-fit alignment methods, and the root mean square error (RMS) was calculated to quantify marginal and internal fit at each abutment and for the overall restoration. Statistical analysis was performed using JMP® software (JMP®, Version 16, SAS Institute Inc., Cary, NC, USA, 1989-2022) with a significance level 0.05 for all tests.

Results

For the ASIGA group, 0-degree orientation generally exhibited better fit than 45- and 90-degree orientations, with some variations based on post-cure time. For marginal fit, ASIGA crowns typically showed better results with 90-degree orientation, while NextDent crowns demonstrated consistent performance across orientations. Post-curing time also influenced marginal fit, with longer durations generally resulting in improved outcomes.

Conclusion

With different printing orientations and post-curing times, ASIGA and NextDent resins can produce IFDPs with acceptable internal and marginal fit. However, NextDent resin consistently outperformed ASIGA in terms of overall fit. Further research is needed to evaluate the long-term clinical performance of these materials.

Composite PCL Scaffold With 70% β-TCP as Suitable Structure for Bone Replacement

OBJECTIVES

The purpose of this work was to optimise printable polycaprolactone (PCL)/β-tricalcium phosphate (β-TCP) biomaterials with high percentages of β-TCP endowed with balanced mechanical characteristics to resemble human cancellous bone, presumably improving osteogenesis.

METHODS

PCL/β-TCP scaffolds were obtained from customised filaments for fused deposition modelling (FDM) 3D printing with increasing amounts of β-TCP. Samples mechanical features, surface topography and wettability were evaluated as well as cytocompatibility assays, cell adhesion and differentiation.

RESULTS

The parameters of the newly fabricated materila were optimal for PCL/β-TCP scaffold fabrication. Composite surfaces showed higher hydrophilicity compared with the controls, and their surface roughness sharply was higher, possibly due to the presence of β-TCP. The Young's modulus of the composites was significantly higher than that of pristine PCL, indicating that the intrinsic strength of β-TCP is beneficial for enhancing the elastic modulus of the composite biomaterials. All novel composite biomaterials supported greater cellular growth and stronger osteoblastic differentiation compared with the PCL control.

CONCLUSIONS

This project highlights the possibility to fabricat, through an FDM solvent-free approach, PCL/β-TCP scaffolds of up to 70 % concentrations of β-TCP. overcoming the current lmit of 60 % stated in the literature. The combination of 3D printing and customised biomaterials allowed production of highly personalised scaffolds with optimal mechanical and biological features resembling the natural structure and the composition of bone. This underlines the promise of such structures for innovative approaches for bone and periodontal regeneration.

Analysis of Mechanical Properties and Printing Orientation Influence of Composite Resin for 3D Printing Compared to Conventional Resin

This study aimed to compare the flexural strength, surface roughness, and microhardness of a resin for three-dimensional (3D) printing and a conventional composite resin and to evaluate whether the printing orientation influences these properties. To evaluate the flexural resistance, test specimens were produced and divided into four groups: three groups of resins for 3D printing with inclinations of 0°, 45°, and 90° and one group of conventional composite resin. Forty discs were produced and subjected to a sandpaper-polishing sequence, and the surface roughness was measured using a roughness meter. The Vickers microhardness (HV) test was performed at three different points, and the average was obtained. The results were subjected to ANOVA statistical analysis and Tukey's test. There were statistical differences in the flexural strength and microhardness between the conventional resin and the resin used for 3D printing. No statistical difference in surface roughness was observed. The resin for 3D printing exhibited lower flexural strength and microhardness than conventional composite resins. We concluded that the resin for 3D printing had lower flexural strength and HV than the conventional composite resin but similar surface roughness. The printing orientation did not affect the flexural strength, whereas the hardness increased as the printing angle increased.

A Review of the Biomimetic Structural Design of Sandwich Composite Materials

Sandwich composites are widely used in engineering due to their excellent mechanical properties. Accordingly, the problem of interface bonding between their panels and core layers has always been a hot research topic. The emergence of biomimetic technology has enabled the integration of the structure and function of biological materials from living organisms or nature into the design of sandwich composites, greatly improving the interface bonding and overall performance of heterogeneous materials. In this paper, we review the most commonly used biomimetic structures and the fusion design of multi-biomimetic structures in the engineering field. They are analyzed with respect to their mechanical properties, and several biomimetic structures derived from abstraction in plants and animals are highlighted. Their structural advantages are further discussed specifically. Regarding the optimization of different interface combinations of multilayer composites, this paper explores the optimization of simulations and the contributions of molecular dynamics, machine learning, and other techniques used for optimization. Additionally, the latest molding methods for sandwich composites based on biomimetic structural design are introduced, and the materials applicable to different processes, as well as their advantages and disadvantages, are briefly analyzed. Our research results can help improve the mechanical properties of sandwich composites and promote the application of biomimetic structures in engineering.

Effect of adding ytterbium trifluoride filler particles on the mechanical, physicochemical and biological properties of methacrylate-based experimental resins for 3D printing

OBJECTIVE

To formulate an experimental methacrylate-based photo-polymerizable resin for 3D printing with ytterbium trifluoride as filler and to evaluate the mechanical, physicochemical, and biological properties.

METHODS

Resin matrix was formulated with 60 wt% UDMA, 40 wt% TEGDMA, 1 wt% TPO, and 0.01 wt% BHT. Ytterbium Trifluoride was added in concentrations of 1 (G1 %), 2 (G2 %), 3 (G3 %), 4 (G4 %), and 5 (G5 %) wt%. One group remained without filler addition as control (GC). The samples were designed in 3D builder software and printed using a UV-DLP 3D printer. The samples were ultrasonicated with isopropanol and UV cured for 60 min. The resins were tested for degree of conversion (DC), flexural strength, Knoop microhardness, softening in solvent, radiopacity, colorimetric analysis, and cytotoxicity (MTT and SRB).

RESULTS

Post-polymerization increased the degree of conversion of all groups (p < 0.05). G2 % showed the highest DC after post-polymerization. G2 % showed no differences in flexural strength from the G1 % and GC (p > 0.05). All groups showed a hardness reduction after solvent immersion. No statistical difference was found in radiopacity, softening in solvent (ΔKHN%), colorimetric spectrophotometry, and cytotoxicity (MTT) (p > 0.05). G1 % showed reduced cell viability for SRB assay (p < 0.05).

SIGNIFICANCE

It was possible to produce an experimental photo-polymerizable 3D printable resin with the addition of 2 % ytterbium trifluoride as filler without compromising the mechanical, physicochemical, and biological properties, comparable to the current provisional materials.

A Comparison of the Shear Bond Strength between a Luting Composite Resin and Both Machinable and Printable Ceramic-Glass Polymer Materials

This study aims to compare the shear bond strength (SBS) and Weibull characteristics between a luting composite resin and both printable and two different machinable ceramic-glass polymer materials. A total of 36 substrates were prepared, with 12 in each group. Printable substrates (12 mm × 12 mm × 2 mm) were printed by using permanent crown resin (3D-PR). Machinable substrates were obtained from Cerasmart 270 (CS) and Vita Enamic (VE) blocks (2 mm in thickness). The bonding surfaces of substrates were polished and airborne abraded (50 µm Al2O3). A self-adhesive luting composite resin (RelyX U200, 3M ESPE, St. Paul, MN, USA, SLC) was applied on substrates with the help of a cylindrical (Ø3 × 3 mm) mold. The SBS test was conducted using a universal test machine. The SBSs of three materials were compared using a one-way analysis of variance (ANOVA) (α = 0.05). The Weibull modulus was calculated for each material. The Kruskal-Wallis and chi-square tests were carried out for the failure mode analysis. There was no significant difference between the SBSs of the three materials (p = 0.129). The Weibull modulus was 3.76 for the 3D-PR, 4.22 for the CS, and 6.52 for the VE group. Statistical analysis showed no significant difference between the failure modes of the groups (p = 0.986). Mixed-failure fractures were predominantly observed in all three groups. The results show that the SBS of the SLC to printable 3D-PR is comparable to that of CS and VE material. Failure modes of printable 3D-PR show similar results with two different machinable ceramic-glass polymers.

Factors affecting accuracy in the additive manufacturing of interim dental prostheses: A systematic review

STATEMENT OF PROBLEM

A systematic review of the effect of different factors on the accuracy of additively manufactured (AM) interim dental prostheses is lacking.

PURPOSE

The purpose of this systematic review was to identify potential factors that may affect the accuracy of AM interim dental prostheses.

MATERIAL AND METHODS

The review adhered to the guidelines outlined in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. The protocol was registered in the international prospective database of systematic reviews (PROSPERO) (CRD42024521564). The risk of bias in the included studies was assessed by using the Joanna Briggs Institute (JBI) checklist. Two reviewers performed an electronic search on the Web of Science, Scopus, PubMed, and Embase databases for articles published up to the end of 2023.

RESULTS

The electronic search resulted in 406 studies. After removing duplicates, 205 studies remained. Thirty-one studies (30 in vitro and 1 in vivo) were included and categorized into 6 types: AM material (type and composition), prosthetic factor (tooth type, restoration size, finish line, abutment taper), AM system (technique and printer), AM parameters (layer thickness, printing orientation), postprocessing (rinsing, postpolymerization), and aging.

CONCLUSIONS

The accuracy of AM interim dental prostheses is affected by factors that include the AM material, prosthetic factors, the AM system, the AM parameters, postprocessing, and aging.

Mechanical properties of 3D printed prosthetic materials compared with milled and conventional processing: A systematic review and meta-analysis of in vitro studies

STATEMENT OF PROBLEM

Three-dimensional (3D) additive manufacturing (AM) is an evolving technology in dentistry, proposed as an alternative to subtractive milling manufacture (MM) or conventional processing. However, a systematic review of the use of AM technology instead of milling or conventional processing is lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the mechanical properties of 3D printed prosthetic materials compared with MM and conventional techniques.

MATERIAL AND METHODS

An electronic search of the literature was conducted on the MEDLINE (via PubMed), Scopus, and Web of Science databases. The inclusion criteria were in vitro studies published in the last 5 years, in English or Italian, and with 3D AM printed dental prosthetic materials. Data extraction was focused on dental prosthetic materials (ceramics, polymers, and metals) and their mechanical properties: flexural strength, fracture load, hardness, roughness, removable partial denture (RPD) fit accuracy, trueness, marginal discrepancy, and internal fit. Data considered homogenous were subjected to meta-analysis using the Stata17 statistical software program (95% confidence interval [CI]; α=.05). Since all variables were continuous, the Hedge g measure was calculated. A fixed-effects model was used for I2=0%, while the statistical analysis was conducted using a random-effects model with I2>0%.

RESULTS

From a total of 3624 articles, 2855 studies were selected, and 76 studies included after full-text reading. The roughness of AM-printed ceramics generally increased compared with that of conventional processing while the marginal discrepancy was comparable both for ceramics and polymers. The flexural strength, hardness, and fracture load of AM-printed polymers were statistically lower than those of the conventional group (P<.05). No significant difference was detected in terms of hardness, roughness, marginal discrepancy, fracture load, trueness, or internal fit between the AM and MM techniques (P>.05). Milling techniques showed significantly higher values of flexural strength (Hedge g=-3.88; 95% CI, -7.20 to -0.58; P=.02), also after aging (Hedge g=-3.29; 95% CI, -6.41 to -0.17; P=.04), compared with AM printing.

CONCLUSIONS

AM is comparable with MM in terms of mechanical properties, in particular with polymeric materials. The flexural strength of AM-printed prostheses is lower than with conventional and MM techniques, as are the parameters of hardness and fracture load, while the marginal discrepancy is similar to that of MM and conventional techniques. AM prostheses are commonly used for interim crowns and fixed partial dentures, as their rigidity and fracture resistance cannot support mastication forces for extended periods. More comparative studies are needed.

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.

Polymers in 3D printing of external maxillofacial prostheses and in their retention systems

Maxillofacial defects, arising from trauma, oncological disease or congenital abnormalities, detrimentally affect daily life. Prosthetic repair offers the aesthetic and functional reconstruction with the help of materials mimicking natural tissues. 3D polymer printing enables the design of patient-specific prostheses with high structural complexity, as well as rapid and low-cost fabrication on-demand. However, 3D printing for prosthetics is still in the early stage of development and faces various challenges for widespread use. This is because the most suitable polymers for maxillofacial restoration are soft materials that do not have the required printability, mechanical strength of the printed parts, as well as functionality. This review focuses on the challenges and opportunities of 3D printing techniques for production of polymer maxillofacial prostheses using computer-aided design and modeling software. Review discusses the widely used polymers, as well as their blends and composites, which meet the most important assessment criteria, such as the physicochemical, biological, aesthetic properties and processability in 3D printing. In addition, strategies for improving the polymer properties, such as their printability, mechanical strength, and their ability to print multimaterial and architectural structures are highlighted. The current state of the prosthetic retention system is presented with a focus on actively used polymer adhesives and the recently implemented prosthesis-supporting osseointegrated implants, with an emphasis on their creation from 3D-printed polymers. The successful prosthetics is discussed in terms of the specificity of polymer materials at the restoration site. The approaches and technological prospects are also explored through the examples of the nasal, auricle and ocular prostheses, ranging from prototypes to end-use products.

The 3D-printed shell complete denture technique: Simplifying prosthodontic diagnosis prior to implant planning

Traditionally, artificial teeth arrangements or the definitive complete dentures are used to establish important prosthodontic parameters such as the occlusal plane orientation, vertical dimension, and the incisal edge position. The relationship of these elements with the underlying bony structures is commonly evaluated using advanced planning protocols such as the dual scan technique. This technique article presents an uncomplicated alternative approach to establish these parameters intraorally using a 3D-printed shell complete denture generated from a 3D scan of the patient's existing complete denture.

Effect of printing layer thickness on the trueness of 3-unit interim fixed partial dentures

STATEMENT OF PROBLEM

Three-dimensional printing has facilitated the fabrication processes in dentistry. However, knowledge on the effect of layer thickness on the trueness of 3D printed fixed partial dentures (FPDs) is lacking.

PURPOSE

The purpose of this in vitro study was to compare the effect of printing layer thickness on the trueness of 3-unit interim FPDs fabricated by using additive manufacturing with that of those fabricated by subtractive manufacturing.

MATERIAL AND METHODS

The right first premolar and first molar teeth of a dentate mandibular model were prepared for a 3-unit restoration and then digitized by using an intraoral scanner. A 3-unit interim FPD was designed to fabricate 40 restorations by using either the additive (NextDent C&B MFH) with layer thicknesses of 20 μm (n=10), 50 μm (n=10), and 100 μm (n=10) or subtractive manufacturing technique (Upcera) (milled, n=10). After fabrication, the interim FPDs were digitized by using the same intraoral scanner and were superimposed over the design data by using a 3D analysis software program. Root mean square (RMS) was used to analyze the trueness of the restorations at 4 different surfaces (external, intaglio, marginal area, and intaglio occlusal) and as a complete unit (overall). Data were analyzed with the Kruskal-Wallis and Wilcoxon tests with Bonferroni correction (α=.05).

RESULTS

The 100-μm-layer thickness interim FPDs showed the greatest overall (P≤.015), external (P≤.021), and intaglio occlusal (P≤.021) deviations, whereas the milled interim FPDs showed the lowest (P=.001). No significant differences were found among the test groups for marginal RMS (P≥.108). The differences between the 50-μm-layer thickness and 100-μm-layer thickness interim FPDs for the intaglio surface deviations (P=.064) and between the 20-μm-layer thickness and 50-μm-layer thickness interim FPDs for each surface tested were not statistically significant (P≥.108).

CONCLUSIONS

The printing layer thickness had a significant effect on the trueness of the additively manufactured interim FPDs. However, subtractively manufactured interim FPDs presented higher trueness than those additively manufactured, regardless of the printing layer thickness.

Comparison of wear and marginal fitness of 3D-printed deciduous molar crowns: An in vitro study

This study aimed to evaluate the wear resistance of primary tooth enamel and 3 kinds of 3D printing materials and to compare the marginal fitness and internal suitability of prefabricated all-ceramic crowns, computer-aided design/manufacturing (CAD/CAM) all-ceramic crowns, and three 3D-printed deciduous molar crowns. Multifunctional friction wear testing machine was used to image the wear surface of the sample and calculate the maximum wear depth and volume loss value of each sample. The internal fit evaluation used the silicon replica method, The four points were measured using scanning electron microscopy (SEM). The obtained data were statistically analyzed using ANOVA and Tukey HSD-test with a fully randomized design (p<0.05). The results showed the wear resistance of E-Dent400 was better than that of PEEK and three different 3D printed materials have good wear resistance compared with the primary tooth enamel. The measured values at M1 and M4 of E-Dent400 were both the smallest.

Experimental study on dimensional variations of 3D printed dental models based on printing orientation

This research investigates the trueness and precision of 3D printing technology in dental applications, specifically focusing on dimensional variations observed in models printed at different angles. The methodology involved importing a dental model into slicing software, adjusting its orientation, and implementing support structures for stability. Subsequently, the model underwent 3D printing five times for each orientation using appropriate equipment and underwent post-processing steps, including cleaning, washing, and UV-light post-curing. The printed models were then scanned using a specialized desktop scanner for further analysis. Accuracy assessment was carried out using dedicated software, employing an algorithm for precise alignment by comparing the scanned files. Color deviation maps were utilized to visually represent variations, aiming to evaluate how positioning during printing influences the trueness and precision of 3D-printed dental models. Trueness and precision analyses involved the Shapiro-Wilk test for normality and a one-way ANOVA to compare means of three independent groups, with statistical analyses conducted using IBM SPSS Statistics software. The color maps derived from 3D comparisons revealed positive and negative deviations, represented by distinct colors. Comparative results indicated that models positioned at 0° exhibited the least dimensional deviation, whereas those at 90° showed the highest. Regarding precision, models printed at 0° demonstrated the highest reproducibility, while those at 15° exhibited the lowest. Based on the desired level of precision, it is recommended that printed models be produced at an inclination angle of 0°.

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.

Zirconia Ceramics

Zirconia ceramics have become popular among other dental ceramics thanks to their biological, mechanical, optical, and aesthetic properties. CAD/CAM (computer-aided design/ computer-aided manufacturing) technology improvement has played a vital role in the increased popularity of zirconia ceramics; easy computer manipulation significantly expanded the possibility of using different types of restorations. Zirconia ceramics have a broad spectrum of indications in prosthetic dentistry, from simple restorations to complex structures supported by dental implants. A good orientation in the classification, features, and manipulation of zirconia ceramics is the main key to success.

Chairside 3-D printed impression trays: a new approach to increase the accuracy of conventional implant impression taking? An in vitro study

PURPOSE

A high transfer accuracy of the intraoral implant position to a model is required, to manufacture implant-supported restorations. However, clinically relevant deviations persist between the intraoral implant position and the model obtained, even for the benchmark conventional custom implant impressions with polyether. Thus, new approaches using 3-D printed impression trays may increase the transfer accuracy of implant impressions. The ability to adjust parameters such as the thickness of the layers and the influence of the openings in the impression tray could potentially affect accuracy.

METHODS

Four different types of impression trays (n = 10 for each group) for the conventional impression technique were investigated: conventional custom impression tray, customized foil tray, chairside 3-D printed impression tray with the SHERA system, and the Primeprint system using an implant master model with four implants in the posterior region and a reference cube. After plaster model casting, all models were measured using a coordinate measuring machine, and the deviation from the reference dataset was determined. A statistical ANOVA analysis was performed (p < 0.05).

RESULTS

Chairside 3-D printed impression trays showed the best results, followed by conventional custom impression trays. Implant impressions obtained using a customized foil tray exhibited the lowest accuracy. Statistically significant differences were observed between 3-D printed impression trays and conventional custom impression and customized foil trays (p < 0.05). Whereas, the implant position did not have any significant influence on accuracy (p > 0.05).

CONCLUSIONS

Chairside 3-D printed impression trays significantly increase the transfer accuracy for implant impression taking.

Evaluating the conversion degree of interim restorative materials produced by different 3-dimensional printer technologies

STATEMENT OF PROBLEM

Three-dimensional (3D) printers are a relatively new technology, but the degree of conversion (DC) of the resin specimens produced by using this method is currently unknown. However, the DC of resin interim restorative materials is critical for their biocompatibility and physical properties.

PURPOSE

The purpose of this in vitro study was to evaluate the DC of interim restorative materials produced by using different 3D printer technologies and compare them with conventionally manufactured polymethyl methacrylate.

MATERIAL AND METHODS

Stereolithography, digital light processing, and liquid crystal display 3D printers were used as experimental groups, and a conventional (C) method was used as the control. Five different 3D printers (DWS Systems, Formlabs [FL], Asiga, Mega, and Vega) were included. The 3D printed specimens were designed in a rectangular prism geometry (10×4×2.5 mm) by using a computer-aided design software program (Materialise 3-matic) and printed with a layer thickness of 50 µm in the horizontal direction (n=15). Fourier transform infrared spectroscopy (FT-IR) spectra were measured in 3 steps: the liquid state of the resins, after washing with 99% isopropanol, and after final polymerization. For the C method, FT-IR spectra were assessed in 2 steps: immediately after mixing the liquid and powder and after polymerization. Statistical analysis of the data was performed with 1-way ANOVA followed by the post hoc Tukey honestly significant difference (HSD) test (α=.05).

RESULTS

There was no statistically significant difference in DC values between the 3D printed groups (P>.05). There was a statistically significant difference only between FL and the C in terms of DC (P=.042).

CONCLUSIONS

Three-dimensionally printed interim resin materials found comparable results with those of the C group. The DC was not affected by different 3D printing technologies.

The Beating Heart of Untapped Business Opportunities for Additive Manufacturing

This article presents a case that joins user-driven innovation and additive manufacturing (AM) towards latent business opportunities in the preparation for life threatening operations. Surgeons, confronted with a patient with a delicate heart condition, collaborated with a prototyping facility to print a realistic 3D model of the patient's aortic aneurysm. The model allowed the surgeons to first study and then experiment to determine the most effective operation procedure before the actual operation, which shortened the surgery time by approximately 70%. Reducing surgery time creates two forms of value: improving patient outcomes and reducing costs. Shorter times under anesthetic and on cardiopulmonary bypass correlate with better surgical results. Reducing healthcare costs brings broad societal benefits in both publicly and privately funded healthcare systems. We outline a case for makerspaces to capture value by joining their expertise and manufacturing equipment with the needs of nearby healthcare systems for novel business developments.

Trueness and precision of skin surface reproduction in digital workflows for facial prosthesis fabrication

STATEMENT OF PROBLEM

How much skin surface details of facial prostheses can be transferred throughout the digital production chain has not been quantified.

PURPOSE

The purpose of this in vitro study was to quantify the amount of skin surface details transferred from the prosthesis virtual design through the prototype printing with various additive manufacturing (AM) methods to the definitive silicone prosthesis with an indirect mold-making approach.

MATERIAL AND METHODS

Twelve test blocks with embossed wrinkles of 0.05 to 0.8 mm and 12 test blocks with applied earlobe skin structures were printed with stereolithography (SLA), direct light processing (DLP), and PolyJet methods (n=4). DLP and SLA prototype specimens were duplicated in wax. All specimens were then transferred into medical-grade silicone. Rz values of the wrinkle test blocks and the root mean square error (RMSE) of the earlobe test blocks were evaluated by laser topography to determine the trueness and precision of each stage.

RESULTS

For the earlobe test blocks, the PolyJet method had superior trueness and precision of the final skin surface reproduction. The SLA method showed the poorest trueness, and the DLP method, the lowest precision. For the wrinkle test blocks, the PolyJet method had the best wrinkle profile reproduction level, followed by DLP and SLA.

CONCLUSIONS

The indirect mold-making approach of facial prostheses manufacturing may be associated with 7% of skin surface profile loss with SLA, up to 20% with DLP, and no detail loss with PolyJet.

Mechanical Properties of 3D-Printed Occlusal Splint Materials

Data regarding the mechanical properties of three-dimensionally (3D) printed materials for occlusal splint manufacturing are scarce. The aim of the present study was to evaluate the flexural strength and surface hardness of modern 3D-printed occlusal splint materials and compare them with two control groups, namely, milled and conventional cold-polymerized occlusal splint materials. A total of 140 rectangular specimens were manufactured for the present study. The specimens were prepared in accordance with the International Organization for Standardization standards (ISO 20795-1:2013). Five 3D-printed (NextDent Ortho Rigid, Dental LT Clear, Dentona Flexisplint, Cosmos Bite Splint, and ProArt Print Splint), one milled (ProArt CAD Splint), and one cold-polymerized (ProBase Cold) occlusal splint materials were used to determine flexural strength and surface hardness values. The three-point flexure test was used for the determination of flexural strength values, while Vickers hardness was measured to determine surface hardness. Ten specimens (n = 10) of each material were tested using these procedures. One-way ANOVA and Tukey's post-hoc test were used to analyze the obtained results (α = 0.05). The values of flexural strength ranged from 46.1 ± 8.2 MPa to 106 ± 8.3 MPa. The Vickers hardness values ranged from 4.9 ± 0.5 VHN to 20.6 ± 1.3 VHN. Significant differences were found among the tested materials (p < 0.0001). The milled and cold-polymerized materials yielded higher values for both flexural strength (only one 3D-printed resin had comparable results to cold-polymerized acrylics) and surface hardness. There are differences in the mechanical properties of the various tested occlusal splint materials. The flexural strength of most of the 3D-printed materials and their surface hardness values are still inferior when compared to the milled or cold-polymerized materials.

Influence of monolithic restorative materials on the implant-abutment interface of hybrid abutment crowns: An in vitro investigation

Purpose This in vitro study aimed to investigate the long-term performance, stability, and fracture mode of monolithic hybrid abutment crowns, and the effect of different materials on the implant-abutment interface (IAI).Methods Eighty monolithic hybrid abutment crowns luted on titanium bases were manufactured from 3Y-TZP zirconia (ZY3), "Gradient Technology" zirconia (ZY35), 5Y-TZP zirconia (ZY5), lithium disilicate ceramic (LDS), zirconia-reinforced lithium silicate ceramic (ZLS), polymer-infiltrated ceramic network (MHY), polymethylmethacrylate (PMA), and 3D-printed hybrid composite (PHC) (n = 10 for each material). Eighty implants (Camlog Progressive-Line, diameter: 3.8 mm) were embedded in accordance with ISO standard 14801, and crowns were mounted. After artificial aging (1.2 × 10⁶ cycles, 50 N, thermocycling), intact specimens were loaded 30° off-axis in a universal testing machine until failure.Results Seven specimens in the PHC group failed during artificial aging, and all the others survived. There were two subgroups based on the one-way analysis of variance and Dunnett's test (P < 0.05) of the mean fracture load values. The first comprised Z3Y, ZY35, Z5Y, and LDS, with mean fracture loads between 499.4 and 529.7 N, while the second included ZLS, MHY, and PMA, with values in the 346.2-416.0 N range. ZY3, ZY35, ZY5, and LDS exhibited irreversible, visible deformations of the implant shoulders with varying dimensions after load-to-fracture tests.Conclusions Crowns made of LDS, ZLS, MHY, and PMA may act as potential stress breakers, and prevent possible deformation at IAIs. Further clinical studies need to assess if these materials also withstand relevant loads in-vivo.

Access Cavity Preparation and Localization of Root Canals Using Guides in 3D-Printed Teeth with Calcified Root Canals: An In Vitro CBCT Study

Pulp canal obliteration (PCO) is a significant complication in endodontics that can occur due to various factors. Cone beam computed tomography (CBCT) is a useful diagnostic tool for identifying root canal anatomy and variations, and guided endodontics is emerging as an alternative treatment solution for teeth with partially or entirely obliterated pulpal canals. However, the accuracy of CBCT-guided 3D-printed guides on different materials and layer thicknesses is not well understood. Therefore, this study aimed to evaluate the accuracy of guides prepared using CBCT images on 3D-printed teeth with stereolithography (SLA) using three different materials and two different layer thicknesses. This study found that 3D-printed guides were accurate and reliable for accessing 3D-manufactured obliterated teeth and reaching the apical area. No significant differences in distance or angle measurements were found when different guide materials were used, suggesting that materials can be selected based on availability and cost. These findings contribute to the knowledge base regarding the effectiveness of 3D printing technology in guided endodontics and can help to identify the most suitable materials and techniques for this application.

Fabrication of color-graded feldspathic dental prosthetics for aesthetic and restorative dentistry

OBJECTIVE

Feasibility investigation of natural teeth shades replication on dental prosthetics fabricated via functionally graded additive manufacturing (FGAM) using combination of feldspathic porcelain (FP) and yttrium aluminum garnet cerium (Y₃Al₅O_12:Ce, YAG:Ce) as a promising esthetic restoration option.

METHODS

Color-graded feldspathic crown fabrication parameter through FGAM method was comprehensively examined from the slurry rheology, cure depth, debinding to sintering temperature. Effect of light absorbent also checked towards overcuring reaction during UV exposure by the shape comparison. Lastly, the flexural bending strength measured following ISO 6872:2015 to assure the applicability. Applying the studied parameter, natural teeth shades then imitated and investigated by alteration of FP and FP + 0.1 wt% YAG:Ce (Y-FP). Generated color across the structure captured through mobile camera, interpreted through the CIELAB coordinate and the gradation confirmed by the color differences (ΔE₀₀) calculated using CIEDE2000 formula.

RESULT

Parameter study indicated that 70 wt% of FP slurry with 3 wt% dispersant and 0.2 wt% light absorbent is favored. It produces excellent flowability in our FGAM system with less overcuring justified by edge margin reduction from 95.65° to 90.00° after UV exposure on rectangle shapes masking. The obtain structure also offers adequate flexural bending strength of 106.26 MPa (FP) and 101.36 MPa (Y-FP) after sintering at 780 °C. This validated the materials as class 2 dental prosthetics citing ISO 6872:2015. Color gradation was verified by the yellow b* value reduction (14.8 to -3.33) as it shifted from cervical to incisal area while ΔE₀₀ further affirmed the differences from each segment in comparison with the FP and Y-FP.

SIGNIFICANCE

Color gradation was successfully replicated by FP and YAG:Ce composition shift via FGAM technique. This result highlights the potential of FGAM as an alternative for fabricating dental prosthetics with high efficiency and improved esthetic appeal.

Effect of Different Vat Polymerization Techniques on Mechanical and Biological Properties of 3D-Printed Denture Base

Three-dimensional printing is increasingly applied in dentistry to fabricate denture bases. Several 3D-printing technologies and materials are available to fabricate denture bases, but there is data scarcity on the effect of printability, mechanical, and biological properties of the 3D-printed denture base upon fabricating with different vat polymerization techniques. In this study, the NextDent denture base resin was printed with the stereolithography (SLA), digital light processing (DLP), and light-crystal display (LCD) technique and underwent the same post-processing procedure. The mechanical and biological properties of the denture bases were characterized in terms of flexural strength and modulus, fracture toughness, water sorption and solubility, and fungal adhesion. One-way ANOVA and Tukey’s post hoc were used to statistically analyze the data. The results showed that the greatest flexural strength was exhibited by the SLA (150.8±7.93 MPa), followed by the DLP and LCD. Water sorption and solubility of the DLP are significantly higher than other groups (31.51±0.92 μgmm3) and 5.32±0.61 μgmm3, respectively. Subsequently, the most fungal adhesion was found in SLA (221.94±65.80 CFU/mL). This study confirmed that the NextDent denture base resin designed for DLP can be printed with different vat polymerization techniques. All of the tested groups met the ISO requirement aside from the water solubility, and the SLA exhibited the greatest mechanical strength.

Effect of computer-aided design and computer-aided manufacturing technique on the accuracy of fixed partial denture patterns used for casting or pressing

OBJECTIVES

To evaluate the effect of additive and subtractive manufacturing on the accuracy (trueness and precision) of fixed partial denture patterns (FPDPs) used for casting or pressing.

MATERIALS AND METHODS

A 3-unit complete coverage FPD on mandibular right first premolar and first molar teeth was virtually designed. Using the design data, FPD patterns were fabricated from an additively manufactured resin (PR, ProArt Print Wax) and 2 CAD-CAM wax discs (YW, ProArt CAD Wax Yellow and BW, ProArt CAD Wax Blue) (n = 10). Each pattern was then digitized with a scanner (CEREC Primescan) and evaluated for 3D surface deviation at 4 different surfaces (overall, external, marginal, and intaglio surfaces) by using a 3D analysis software (Medit Link). Root mean square (RMS) values were automatically calculated. Data were analyzed by using Kruskal-Wallis and Dunn's post hoc tests for trueness and precision (α= 0.05).

RESULTS

Significant differences were found among the RMS values for overall (P<.001) and each surface (P≤.040) evaluated. PR had the highest overall (P≤.011) and intaglio surface (P≤.01) deviations, while the difference between YW and BW was not significant (P≥.199). PR had the highest (P≤.027) and BW had the lowest (P≤.042) external surface mean RMS values. BW had higher mean marginal RMS value than YW (P=.047). For precision, significant differences were observed among test groups only for marginal RMS values (P=.002). PR had lower precision than BW (P=.002).

CONCLUSIONS

BW and YW FPDPs mostly had higher trueness compared with PR FPDPs. However, considering relatively smaller deviations at marginal and intaglio surfaces and the fact that patterns mostly had similar precision, clinical fit of FPDs fabricated by using tested patterns may be similar.

CLINICAL SIGNIFICANCE

Definitive 3-unit fixed partial dentures fabricated by using tested patterns may be similar. However, FPDs fabricated with tested additively manufactured resin patterns might result in more chairside adjustments than those fabricated with tested subtractively manufactured wax patterns.

3D Printing of CNT- and YSZ-Added Dental Resin-Based Composites by Digital Light Processing and Their Mechanical Properties

This study demonstrates the successful 3D printing of dental resin-based composites (DRCs) containing ceramic particles using the digital light processing (DLP) technique. The mechanical properties and oral rinsing stability of the printed composites were evaluated. DRCs have been extensively studied for restorative and prosthetic dentistry due to their clinical performance and aesthetic quality. They are often subjected to periodic environmental stress, and thus can easily undergo undesirable premature failure. Here, we investigated the effects of two different high-strength and biocompatible ceramic additives, carbon nanotube (CNT) and yttria-stabilized zirconia (YSZ), on the mechanical properties and oral rinsing stabilities of DRCs. Dental resin matrices containing different wt.% of CNT or YSZ were printed using the DLP technique after analyzing the rheological behavior of slurries. Mechanical properties such as Rockwell hardness and flexural strength, as well as the oral rinsing stability of the 3D-printed composites, were systematically investigated. The results indicated that a DRC with 0.5 wt.% YSZ exhibits the highest hardness of 19.8 ± 0.6 HRB and a flexural strength flexural strength of 50.6 ± 6 MPa, as well as reasonable oral rinsing steadiness. This study provides a fundamental perspective for designing advanced dental materials containing biocompatible ceramic particles.

Dental innovations which will influence the oral health care of baby boomers

From the widespread use of smartphones and tablets to the multitude of applications available, older adults are showing an interest in utilizing technology to maintain their independence and to improve their quality of life. As technology continues to advance and be incorporated into many day-to-day activities, the baby boom generation will see these changes affecting the way they access and utilize dental services. Innovative toothbrushes and chemotherapeutics are continuing to be developed and utilized by many older adults. Within the dental office, older adults are seeing greater application of technology in every day dental procedures. These include the use of teledentistry, artificial intelligence (AI), innovative restorative materials, digitization of fixed and removable prosthodontics, cone beam computed tomography (CBCT) scans to guide dental implant placement and endodontic procedures. There is also new technology to aid in cancer detection and shielding during cancer treatment. Improved communication between the medical and dental fields has become increasingly necessary to facilitate effective patient care and a few innovative healthcare systems have begun to consolidate these services. Overall, the baby boom generation will continue to see dental innovations that will change the way they experience everyday life and dental services.

Wear behavior of materials for additive manufacturing after simulated occlusion of deciduous dentition

OBJECTIVES

To evaluate wear characteristics of materials for additive manufacturing (AM) after a simulated occlusal test in primary teeth. Wear was simulated by means of impacting - sliding wear testing (ISWT) between specimens prepared from materials for AM against enamel derived from deciduous teeth.

METHODS

The prepared hemispherical upper specimens were subjected to impacting-sliding wear test (ISWT) machine against the flattened enamel of deciduous molars on lower specimens. The samples were subjected to 20,000 load cycles using a contact force of 30 N between the opposing surfaces under controlled conditions. In the upper specimens, five groups (n=9): four types of additively manufactured materials Dima, Zenith, Detax, Veltz and a deciduous enamel groups were tested in this study. The enamel-to-enamel group was used as the control. Wear characteristics comprised wear surface area, wear depth, wear volumetric loss, and surface roughness were measured with a confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Data obtained were statistically analyzed by Kruskal-Wallis test and Dunn's test with Bonferroni correction (p < 0.05).

RESULTS

Dima showed significantly higher worn surface area (p = 0.009, 0.001, and < 0.001 for Zenith, Detax, and control enamel, respectively), volumetric loss (p = 0.027, 0.007, and < 0.001 for Zenith, Detax, and control enamel, respectively), and damaged opposing enamel (p = 0.002, 0.001, and 0.01 for Detax, Veltz, and control enamel, respectively). There was no significant difference among the volumetric loss in Zenith and Detax. However, SEM revealed that Zenith showed rough worn surfaces and chipping, Detax showed rather a smooth circular worn surface. The worn area of Veltz was smaller than Detax and Zenith at 5,000 cycles, but higher at 15,000 and 20,000 cycles, and SEM showed detachment.

CONCLUSION

Wear behavior was different among different materials for AM. In the upper specimens, DM and VZ showed large wear. In the lower specimens, DM caused largest enamel wear and damage. In contrast, ZT and DX showed lower wear and caused less damage to the antagonistic primary enamel. SEM image of ZT showed large losses due to chipping, whereas DX showed the rather smooth. DX was confirmed to have lowest wear and caused least damage to the opposing deciduous enamel, which might be applicable as restorative treatments in deciduous dentition.

SIGNIFICANCE

Additive manufactured dental materials could be considered as a treatment modality in deciduous teeth.

Effect of dimensional variations on the manufacturing process and the 3D shrinkage ratio of stereolithographic dental alumina ceramics

The purpose of the present study was to evaluate the influence of height and length variations of alumina ceramics manufactured by stereolithography on deformations caused by the manufacturing process and on the 3D shrinkage ratio to control the final dimensions and improve the adaptation of stereolithographic ceramic dental prostheses. Two different U-shaped models were designed with variable heights or lengths. The specimens were manufactured by stereolithography and were scanned using a microtomographic device before and after the heat treatment. Dimensional variations were measured using inspection software. The number and surface of layers of alumina ceramic influenced the reliability of the stereolithography manufacturing but did not influence the 3D shrinkage ratio. The larger the layer surface, the larger the deformation of the ceramic. Dental ceramics manufactured by stereolithography with smallest layer surface are the most reliable. This helps in the selection of the build orientation.

Modular Digital and 3D-Printed Dental Models with Applicability in Dental Education

Background and Objectives: The ever more complex modern dental education requires permanent adaptation to expanding medical knowledge and new advancements in digital technologies as well as intensification of interdisciplinary collaboration. Our study presents a newly developed computerized method allowing virtual case simulation on modular digital dental models and 3D-printing of the obtained digital models; additionally, undergraduate dental students' opinion on the advanced method is investigated in this paper. Materials and Methods: Based on the digitalization of didactic dental models, the proposed method generates modular digital dental models that can be easily converted into different types of partial edentulism scenarios, thus allowing the development of a digital library. Three-dimensionally printed simulated dental models can subsequently be manufactured based on the previously obtained digital models. The opinion of a group of undergraduate dental students (n = 205) on the proposed method was assessed via a questionnaire, administered as a Google form, sent via email. Results: The modular digital models allow students to perform repeated virtual simulations of any possible partial edentulism cases, to project 3D virtual treatment plans and to observe the subtle differences between diverse teeth preparations; the resulting 3D-printed models could be used in students' practical training. The proposed method received positive feedback from the undergraduate students. Conclusions: The advanced method is adequate for dental students' training, enabling the gradual design of modular digital dental models with partial edentulism, from simple to complex cases, and the hands-on training on corresponding 3D-printed dental models.

Influence of digital implant analog design on the positional trueness of an analog in additively manufactured models: An in-vitro study

BACKGROUND

Limited evidence exists regarding the accuracy of implant analog position in printed models, particularly when implant analogs with varying designs are used.

PURPOSE

To evaluate the effect of digital implant analog (DIA) design on the trueness of their position in additively manufactured digital implant models (DIMs) and to compare with that of a conventional implant analog in a stone cast.

MATERIALS AND METHODS

A dentate maxillary model with a conventional implant analog (Nobel Biocare Implant Replica 4.3 mm CC RP) at left second premolar site was digitized by using a laboratory scanner (3Shape D2000) and a (SB) scan body to generate the master standard tessellation language (STL) file (M0). 12 custom trays were fabricated on M0 file and conventional polyvinylsiloxane impressions of the model were made. All impressions were poured after inserting conventional implant analogs (Nobel RP Implant Replica) (Group A). Model was then digitized with an intraoral scanner (TRIOS 3) and the same SB, and DIMs with three different DIA designs (Nobel Biocare [Group B], Elos [Group C], and NT-trading [Group D]) were generated (Dental System-Model Builder). 12 DIMs of each design were additively manufactured and corresponding DIAs were inserted. All models were digitized by using the same laboratory scanner and SB, and these STLs were transferred to a 3D analysis software (Geomagic Control X), where the STL files of the models were superimposed over M0. Linear and 3D deviations at three selected points on SB (implant-abutment connection, most cervical point on SB, and most coronal point on SB) as well as angular deviations on two planes (buccolingual and mesiodistal) were calculated. Analysis of variance (ANOVA) and Bonferroni corrected t-tests were used to analyze the trueness of implant analog positions (α = 0.05).

RESULTS

The interaction of main effects significantly affected linear (p < 0.001) and angular deviations (p = 0.020). At point 1, group D had higher deviations than groups A and B (p ≤ 0.015). In addition, groups A and D had higher deviations than group B at point 4 (p < 0.001). While group C had similar linear deviations to those of other groups at point 1 and point 4 (p ≥ 0.192), the differences among test groups at point 2 were nonsignificant (p ≥ 0.276). Group B had lower angular deviations than groups C (p = 0.039) and D (p = 0.006) on buccolingual plane.

CONCLUSIONS

Analog design affected the trueness of analog position as proprietary, pressure/friction fit DIA (group B) had higher linear trueness than screw-retained DIA (Group D) and conventional implant analog (group A). In addition, pressure/friction fit DIA had the highest angular trueness among tested DIAs.

An experimental investigation on the tensile properties of PEEK-PEI sandwich structures prepared via fused filament fabrication

High-temperature-resistant thermoplastics, e.g., Polyetheretherketone (PEEK) and Polyetherimide (PEI), exhibit much more superior material properties than conventional plastics. They are recently becoming favorable feedstock materials in Fused Filament Fabrication (FFF) 3D printing applications, which yields a low-cost and high-efficient approach providing complex parts and tooling. This paper fabricates the PEEK-PEI combined sandwich structures by properly alternating the fed material during FFF processes, aiming to combine the benefits of both materials. This is considered one of the first few attempts to prepare high-performance thermoplastics-based sandwich samples via the FFF method. The specimens are designed as three-layer and five-layer sandwiches (i.e., each “layer” contain a unique material). In addition, the printed samples are post-processed via a thermal annealing treatment. Experimental results show that the sandwich specimens exhibit higher surface quality than independently printed PEEK materials. The PEI material can be printed in 100% infill density in sandwich structures, while it can be rarely printed independently with infill densities exceeding 40%. Annealing may not enhance the mechanical properties of sandwich specimens while stabilizing their mechanical performances. Under the same PEEK/PEI volumetric ratio (i.e., 1:1), increasing the number of alternating stack layers improves the tensile strength of the sandwich specimens by up to 17%. The sandwich printing method is also cost-effective, such that the five-layer sandwich specimen provides competitive tensile performance as compared to the virgin PEEK material. At the same time, its cost is only ∼60% of all-PEEK specimens.

Additive Manufactured Polymers in Dentistry, Current State-of-the-Art and Future Perspectives-A Review

3D-printing application in dentistry not only enables the manufacture of patient-specific devices and tissue constructs, but also allows mass customization, as well as digital workflow, with predictable lower cost and rapid turnaround times. 4D printing also shows a good impact in dentistry, as it can produce dynamic and adaptable materials, which have proven effective in the oral environment, under its continuously changing thermal and humidity conditions. It is expected to further boost the research into producing a whole tooth, capable to harmoniously integrate with the surrounding periodontium, which represents the ultimate goal of tissue engineering in dentistry. Because of their high versatility associated with the wide variety of available materials, additive manufacturing in dentistry predominantly targets the production of polymeric constructs. The aim of this narrative review is to catch a glimpse of the current state-of-the-art of additive manufacturing in dentistry, and the future perspectives of this modern technology, focusing on the specific polymeric materials.

Color and optical properties of 3D printing restorative polymer-based materials: A scoping review

OBJECTIVE

Color and optical properties are particularly crucial to mimic natural tooth. This scoping review aimed to present an overview of the literature published on color and optical properties of 3D printing restorative polymer-based materials. The literature search was performed in MED-LINE/Pubmed, Scopus and Web of Science.

MATERIALS AND METHODS

The literature search was conducted in the three databases based on the question: "Are the optical properties and color adequately reported on polymer-based 3D printing dental restorative materials studies?" with no restriction on year of publication. Data were reported and synthesized following PRISMA-ScR statement.

RESULTS

Nine studies fit the inclusion criteria. Five studies focused on evaluating only color stability; three articles assessed the color stability along with mechanical and morphological properties and only one study compared color parameters of 3D printed to conventional polymers. Two studies evaluated translucency parameter and no study was found evaluating scattering, absorption, and transmittance.

CONCLUSIONS

Color and optical properties of 3D printed polymers that can be used in restorative dentistry are not adequately evaluated and characterized. Future studies on the influence of experimental printing conditions should include these physical properties to assist on improving esthetics.

CLINICAL SIGNIFICANCE

This review shows the scarce literature existing on color and optical properties of 3D printing restorative polymer-based materials. These properties and their study are of outmost importance to create materials that mimic natural tooth to allow clinicians to obtain esthetically pleasant restorations.

Additive or subtractive manufacturing of crown patterns used for pressing or casting: A trueness analysis

OBJECTIVES

To investigate the effect of subtractive and additive manufacturing techniques on the trueness of crown patterns used for pressing or casting.

MATERIAL AND METHODS

A complete-coverage mandibular right first molar crown was designed in standard tessellation language (STL) format. This STL served as the control (C-STL) and was used to fabricate 30 crown patterns in 3D-printed resin (PR, ProArt Print Wax), millable wax suitable for casting (BW, ProArt CAD Wax Blue), and millable wax suitable for pressing (YW, ProArt CAD Wax Yellow) (n = 10). Subtractively manufactured patterns were fabricated by using a 5-axis milling unit (PrograMill PM7), while 3D-printed patterns were fabricated by using a digital light processing-based 3D printer (PrograPrint PR5; Ivoclar Vivadent, Schaan, Liechtenstein). All fabricated patterns were digitized by using an intraoral scanner (CEREC Primescan SW 5.2) to generate test-STLs. C-STL and test-STLs were transferred into a 3D analysis software (Medit Link v 2.4.4). Trueness evaluation was performed at 4 different surfaces (external, intaglio with margin, marginal, and intaglio without margin) and for complete scan meshes (overall) by using the root mean square (RMS) method. Data were analyzed with Kruskal-Wallis and Mann-Whitney U tests (α = .05).

RESULTS

RMS values varied significantly at all surfaces (P < .001), except for marginal surface (P = .151). PR had the highest RMS values at external surface (P ≤ .007), intaglio surfaces (with (P ≤ .003) and without margin (P ≤ .005)), and overall (P ≤ .01). No significant differences were observed between YW and BW (P ≥ .223).

CONCLUSION

Patterns fabricated by using subtractive manufacturing exhibited high trueness. The deviation values, in general, were small, particularly at intaglio and marginal surfaces; thus, clinical difference in crown-fit may be negligible using additive or subtractive technique.

CLINICAL SIGNIFICANCE

The fit of definitive crowns may be similar when tested crown patterns are additively or subtractively manufactured. However, crowns fabricated by using tested 3D-printed resin patterns may require more chairside adjustments compared with those fabricated by using subtractively manufactured wax patterns.