Wear resistance and flexural properties of low force SLA- and DLP-printed splint materials in different printing orientations: An in vitro study

OBJECTIVES

To investigate the influence of material and printing orientation on wear resistance and flexural properties of one low force SLA- and two DLP-printed splint materials and to compare these 3D-printed splints to a subtractively manufactured splint material.

METHODS

Two DLP-printed (V-Print splint, LuxaPrint Ortho Plus) and one low force SLA-printed (Dental LT Clear) material, where specimens were printed in three printing orientations (0°, 45°, 90°), were investigated. In addition, one milled splint material (Zirlux Splint Transparent) was examined. A total of 160 specimens were produced for both test series. The two-body wear test was performed in a chewing simulator (80'000 cycles at 50 N with 5-55 °C thermocycling). Steatite balls were used as antagonists. The wear pattern was analyzed with a 3D digital microscope in terms of maximum vertical intrusion depth (mm) and total volume loss (mm³). The flexural properties were investigated by three-point bending in accordance with ISO 20795-1: 2013 (denture base polymers). The flexural strength (MPa) and the flexural modulus (MPa) were measured. Two-way ANOVA was performed to investigate the effects of the two independent variables material and printing orientation for the three 3D-printed materials. The comparison of the printing orientations within one material was carried out with one-way ANOVA with post-hoc Tukey tests.

RESULTS

Two-way ANOVA revealed that wear and flexural properties are highly dependent on the 3D-printed material (p < 0.001). Across groups, a significant effect was observed for wear depth (p = 0.031) and wear volume (p = 0.044) with regard to printing orientation but this was not found for flexural strength (p = 0.080) and flexural modulus (p = 0.136). One-way ANOVA showed that both DLP-printed groups showed no significant differences within the printing orientations in terms of wear and flexural properties. Dental LT Clear showed that 90° oriented specimens had higher flexural strength than 0° oriented ones (p < 0.001) and 45° oriented specimens also showed higher values than 0° ones (p = 0.038). No significant differences were observed within the printing orientations for flexural modulus and wear behaviour within this group. T-tests showed that the milled splints exhibited statistically higher wear resistance and flexural properties compared to all three 3D-printed splint materials (p < 0.001) and that highly significant differences were found between the 3D-printed splint materials for both test series.

CONCLUSION

Within the limitations of this in vitro study, it can be stated that wear behaviour and flexural properties are highly dependent on the 3D-printed material itself. Currently, milled splints exhibit higher wear resistance and flexural properties compared to 3D-printed splint materials. The printing orientation has a minor influence on the properties investigated. Nevertheless, two-way ANOVA also showed a significant influence of printing orientation in the wear test across groups and one-way ANOVA detected significant effects for SLA material in terms of flexural strength, with printing in 90° showing the highest flexural strength. Therefore, anisotropy was found in SLA material, but it can be limited with the employed printing parameters. Both DLP-printed materials showed no significant difference within the printing orientation.

Morphometrical analysis of main and accessory canals in apical root portion of frontal teeth

Reviewing radiographs may often lead to a wrong conclusion regarding root canal ending (apical constriction) and anatomical apex of the tooth root. Anthropological measurements may help clinicians to understand better root canal ending aberrations in a sense to decide whether to do a revision of the root canal filling or not. The object of this investigation was to examine the deviation frequency, the distance of the major apical foramen from the anatomical apex and occurrence and number of accessory canals in the apical third of the frontal teeth roots. A total of 156 randomly chosen upper and lower permanent incisors and canines, after extraction due to periodontal disease were prepared for the investigation. The access cavity was prepared and root canal therapy was initiated just to prepare endodontic space for methylene blue dye injection. Methylene blue clearly dyed all root canal exits and after that the teeth were cut and examined with a stereomicroscope and a sliding scale. Results indicate that deviation frequency was found in 60.25% of the cases and the mean distance between deviated major foramen and the anatomical root apex was 0.35 mm. Accessory canals were found in 33.33% of the cases in the apex third of the root. Data were statistically elaborated with the method of Chi-square test.

"C"-shaped canal configuration of mandibular second permanent molar

Roots of the second mandibular molar often fuse so the purpose of this investigation was to examine the appearance of "C"-shaped root canals and to classify different root canal types. A hundred and twelve randomly chosen second lower permanent molars-after extraction due to periodontal disease-were prepared and then analysed. Contrast liquid (methylene blue) was injected into prepared teeth. Each tooth was cut into slices to view the root canal morphology. Results of the analysis revealed fusion, either total or partial in 14 cases (12.5%). As a conclusion various appearances were classified into 5 types according to the fused canal shapes and the frequency of different types varied from 0.89%-6.25%.

Infectious discitis caused by Enterobacter cloacae

The case is reported of a patient who developed a vertebral osteomyelitis caused by Enterobacter cloacae. The organism was isolated in cultures of blood and vertebral puncture biopsy samples. The patient was satisfactorily treated with trimethroprim and sulphamethoxazole. Enterobacter cloacae, a Gram negative organism, has been confirmed as the cause of bacteremia in patients with burns, urinary infections, in adults with pneumonia, and in children with joint infections. Spondylodiscitis caused by Enterobacter cloacae has not previously been described.