Applications of additive manufacturing in dentistry: A review

Innovative PEEK in Dentistry of Enhanced Adhesion and Sustainability through AI-Driven Surface Treatments

This research investigates using Polyether ether ketone (PEEK) in dental prosthetics, focusing on enhancing the mechanical properties, adhesion capabilities, and environmental sustainability through AI-driven data analysis and advanced surface treatments. The objectives include improving PEEK's adhesion to dental types of cement, assessing its biocompatibility, and evaluating its environmental impact compared to traditional materials. The methodologies employed involve surface treatments such as plasma treatment and chemical etching, mechanical testing under ASTM standards, biocompatibility assessments, and lifecycle analysis. AI models predict and optimize mechanical properties based on extensive data. Significant findings indicate that surface-treated PEEK exhibits superior adhesion properties, maintaining robust mechanical integrity with no cytotoxic effects and supporting its use in direct contact with human tissues. Lifecycle analysis suggests PEEK offers a reduced environmental footprint due to lower energy-intensive production processes and recyclability. AI-driven analysis further enhances the material's performance prediction and optimization, ensuring better clinical outcomes. The study concludes that with improved surface treatments and AI optimization, PEEK is a promising alternative to conventional dental materials, combining enhanced performance with environmental sustainability, paving the way for broader acceptance in dental applications.

Effect of 3D printer, implant analog and angulation on the accuracy of analog position in implant casts

OBJECTIVES

To evaluate the accumulative effect of 3D printer, implant analog systems, and implant angulation on the accuracy of analog position in implant casts.

METHODS

A reference cast, presenting a case of a three-unit implant-supported prosthesis, was scanned with a coordinate measurement machine, producing the first reference data set (CMM, n = 1). The second reference data set (n = 10) was prepared using an intraoral scanner (IOS) (Trios4). Test quadrant casts were produced using three DLP type 3D printers, Max (MAX UV385), Pro (PRO 4K65 UV), and Nex (NextDent 5100), and three implant analog systems, El (Elos), Nt (Nt-trading), and St (Straumann) (n = 90). Stone casts were also produced via analog impressions (Stone, n = 10). After digitization, the accuracy of 3D distance, local angulation (angle between implants) and global angulation (angle between the implant center axis and an axis perpendicular to the global plane) was evaluated by comparing the reference (CMM, IOS), test (3D print), and control (Stone) groups using metrology software. Data were statistically analyzed using three-way ANOVA and Tukey`s tests (α = 0.05).

RESULTS

IOS was truer in 3D implant distance and more precise in capturing local angulation than Stone (p ≤ 0.05). Other measurements were similar between both groups (p > 0.05). The amount of error introduced in the workflow by IOS and 3D printing was mostly similar (p > 0.05). 3D printed casts had similar or even higher accuracy than Stone group (p > 0.05). In most cases, higher trueness was achieved when using PRO 4K65 UV 3D printer and Elos implant analog system (p ≤ 0.05).

CONCLUSION

3D printer, implant analog system, and implant angulation have a significant effect on the accuracy of analog position in implant casts. Limited-span implant-supported cases could be reproduced digitally with similar accuracy as conventional methods.

CLINICAL SIGNIFICANCE

A fully digital workflow with a carefully selected 3D printer and implant analog system can increase the accuracy of digitally produced implant casts with comparable accuracy to conventional workflow.

Mechanical Properties of Additive-Manufactured Composite-Based Resins for Permanent Indirect Restorations: A Scoping Review

The introduction of 3D printing technology in dentistry has opened new treatment options. The ongoing development of different materials for these printing purposes has recently enabled the production of definitive indirect restorations via 3D printing. To identify relevant data, a systematic search was conducted in three databases, namely PubMed, Scopus, and Web of Science. Additionally, a manual search using individual search terms was performed. Only English, peer-reviewed articles that encompassed in vitro or in vivo research on the mechanical properties of 3D-printed composite materials were included, provided they met the predefined inclusion and exclusion criteria. After screening 1142 research articles, 14 primary studies were selected. The included studies mainly utilized digital light processing (DLP) technology, less commonly stereolithography (SLA), and once PolyJet printing technology. The material properties of various composite resins, such as VarseoSmile Crown Plus (VSC) and Crowntec (CT), were studied, including Vickers hardness, flexural strength, elastic modulus, compressive strength, tensile strength, fracture resistance, and wear. The studies aimed to compare the behavior of the tested additive composites to each other, conventional composites, and subtractive-manufactured materials. This scoping review examined the mechanical properties of composites used for 3D printing of definitive restorations. The aim was to provide a comprehensive overview of the current knowledge on this topic and identify any gaps for future research. The findings suggest that 3D-printed composites are not yet the first option for indirect restorations, due to their insufficient mechanical properties. Due to limited evidence, more research is needed in this area. Specifically, there is a need for clinical trials and long-term in vivo research.

Fracture resistance, marginal and internal adaptation of innovative 3D-printed graded structure crown using a 3D jet printing technology

PURPOSE

This in vitro study aimed to create a graded structured dental crown using 3D printing technology and investigate the fracture resistance and the adaptation of this new design.

MATERIALS AND METHODS

A dental crown with a uniform thickness of 1.5 mm was designed, and the exported stereolithography file (STL) was used to manufacture 30 crowns in three groups (n = 10), solid (SC), bilayer (BL), and multilayer (ML) crowns using  3D jet printing technology. Marginal and internal gaps were measured using the silicone replica technique. Crowns were then luted to a resin die using a temporary luting agent and the fracture resistance was measured using a universal testing machine. One-way ANOVA and Tukey post hoc tests were used to compare the fracture resistance and the adaptation of crowns at a significance level of 0.05.

RESULTS

Mean marginal and internal gap of the ML group were 80 and 82 mm, respectively; which were significantly (p < 0.05) smaller than BL (203 and 183 mm) and SC (318 and 221 mm) groups. The SC group showed the highest mean load at fracture (2330 N) which was significantly (p < 0.05) higher than the BL (1716 N) and ML (1516 N) groups.

CONCLUSION

3D jet printing technology provides an opportunity to manufacture crowns in a graded structure with various mechanical properties. This study provided an example of graded structured crowns and presented their fracture resistance. SC group had the highest fracture resistance; however, ML had the best marginal and internal adaptation.

Trends and future perspectives of 3D printing in prosthodontics

The three-dimensional (3D) printing technology has led to transformative shift in prosthodontics. This review summarizes the evolution, processing techniques, materials, integration of digital plan, challenges, clinical applications and future directions of 3D printing in prosthodontics. It appraises from the launch of 3D printing to its current applications in prosthodontics. The convergence of printing technology with digital dentistry has facilitated the creation of accurate, customized prostheses, redefining treatment planning, design, and manufacturing processes. The progression of this technology is from generating models to prosthesis like-fixed dental prosthesis (FDP), implants, and splints. Additionally, it exhibits more wide capabilities. The exploration of materials for 3D printing provides various options like polymers, ceramics, metals, and hybrids, each with distinctive properties that are applicable to different clinical scenarios. The combination of 3D-printing technology and digital workflow simplifies the processes of data transfer, computer-aided design (CAD) design to fabrication, decreasing errors and chairside time. The clinical benefits include enhanced accuracy, comfort, conservative lab procedures, and economics. Challenges in the technology involve significant aspects like initial investment, material availability, and skill requirements. Future trends emphasize on research for improved materials, bioprinting integration, artificial intelligence (AI) application, regularization efforts to ensure safe and common use of the technology. 3D printing offers promise in prosthodontics, addressing challenges through research. The material improvements will promote its broader adoption and revolutionize the future of dental rehabilitation.

Effect of Post-Printing Conditions on the Mechanical and Optical Properties of 3D-Printed Dental Resin

This study aimed to evaluate the flexural strength (FS), surface wear, and optical properties of 3D-printed dental resins subjected to different post-printing conditions. A total of 240 specimens (2 × 2 × 25 mm³) were 3D-printed using resin materials for permanent (VaresoSmile Crown Plus) VSC and temporary (VaresoSmile Temp) VST restorations. Specimens underwent five post-printing conditions: no post-printing cure; post-cured in a Form Cure curing unit; Visio Beta Vacuum; Ivoclar Targis; or heat-cured (150 °C) for 30 min. Each group of specimens (n = 24) was tested either directly after post-curing, after 24 h of dry storage, or following hydrothermal accelerated aging in boiling water for 16 h. The three-point bending test was used to evaluate the FS. The two-body wear test was performed on 50 disc-shaped specimens (n = 5/group). Surface gloss and translucency were measured for permanent VSC specimens (n = 5/group). SEM/EDS and statistical analyses were performed. The Form Cure device yielded the highest FS and lowest wear depth (p < 0.05). Hydrothermal aging significantly reduced FS. There were no statistical differences in FS and wear values between materials subjected to same post-printing conditions. VSC groups exhibited similar optical properties across different post-printing treatments. Post-printing treatment conditions had a significant impact on the FS and wear of the 3D-printed resin, while optical properties remained unaffected.

Tribocorrosion of 3D printed dental implants: An overview

With the advancements in dental science and the growing need for improved dental health, it has become imperative to develop new implant materials which possess better geometrical, mechanical, and physical properties. The oral environment is a corrosive environment and the relative motion between the teeth also makes the environment more hostile. Therefore, the combined corrosion and tribology commonly known as tribocorrosion of implants needs to be studied. The complex shapes of the dental implants and the high-performance requirements of these implants make manufacturing difficult by conventional manufacturing processes. With the advent of additive manufacturing or 3D-printing, the development of implants has become easy. However, the various requirements such as surface roughness, mechanical strength, and corrosion resistance further make the manufacturing of implants difficult. The current paper reviews the various studies related to3D-printed implants. Also, the paper tries to highlight the role of 3D-Printing can play in the area of dental implants. Further studies both experimental and numerical are needed to devise optimized conditions for 3D-printing implants to develop implants with improved mechanical, corrosion, and biological properties.

Antimicrobial activity of cleanser tablets against S. mutans and C. Albicans on different denture base materials

BACKGROUND

In this study, the antimicrobial activity of three different cleanser tablets on S. mutans and C. albicans adhesion to PMMA, polyamide and 3D printed resin was investigated.

METHODS

40 samples were prepared for PMMA (SR Triplex Hot), polyamide (Deflex) and 3D printed resin (PowerResins Denture) materials and divided into four subgroups for cleansers (Aktident™, Protefix™, Corega™ tablets and distilled water) (n = 5). After the surface preparations were completed, the samples were immersed separately in tubes containing the prepared microorganism suspension and incubated at 37˚C for 24 h. After the incubation, the samples were kept in the cleanser solutions. The samples were then transferred to sterile saline tubes. All the tubes were vortexed and 10 µl was taken from each of them. Sheep blood agar was inoculated for colony counting. The inoculated plates were incubated for 48 h for S. mutans and 24 h for C. albicans. After incubation, colonies observed on all plates were counted. Statistical analyses were done with three-way ANOVA and Tukey's multiple comparison test.

RESULTS

Polyamide material registered the highest colony count of S. mutans, whereas PMMA registered the lowest. Significant differences in S. mutans adherence (p = 0.002) were found between the three denture base materials, but no such difference in C. albicans adherence (p = 0.221) was identified between the specimens. All three cleanser tablets eliminated 98% of S. mutans from all the material groups. In all these groups, as well, the antifungal effect of Corega™ on C. albicans was significantly higher than those of the other two cleanser tablets.

CONCLUSIONS

According to the study's results, it may be better to pay attention to surface smoothness when using polyamide material to prevent microorganism retention. Cleanser tablets are clinically recommended to help maintain hygiene in removable denture users, especially Corega tablets that are more effective on C. albicans.

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.

Adhesive strength of 3 long-term resilient liners to CAD-CAM denture base polymers and heat-polymerized polymethyl methacrylate with thermocycling

STATEMENT OF PROBLEM

Computer-aided design and computer-aided manufacturing (CAD-CAM) technologies have become popular for manufacturing complete dentures. However, the adhesive strength of resilient liners to the polymers used to fabricate CAD-CAM complete dentures is unclear.

PURPOSE

The purpose of this in vitro study was to determine the adhesive strength of 3 long-term resilient liners to CAD-CAM denture base polymers and heat-polymerized PMMA with thermocycling.

MATERIAL AND METHODS

A total of 90 specimens were fabricated, 30 per group of denture base material (Lucitone 199, Ivo Base CAD, Denture Base LP). For each denture base polymer, 10 specimens were relined with 1 of 3 resilient liners (Permasoft, Mucopren Soft, Molloplast-B). Five specimens of each group were thermocycled, and the other 5 specimens were stored in distilled water. Subsequently, the adhesive strength of the specimens was assessed by tensile testing. The resulting data were analyzed by using a 3-way analysis of variance (ANOVA) (α=.05).

RESULTS

After thermocycling, the adhesive strengths of all the resilient liners were found to be statistically different from each other for the same denture base polymer (P≤.012). Mucopren Soft displayed a high mean ±standard deviation adhesive strength to Lucitone 199 (1.78 ±0.32 MPa), followed by Molloplast-B (1.27 ±0.21 MPa) and Permasoft (0.66 ±0.06 MPa). For Ivo Base CAD, Molloplast-B exhibited a high mean ±standard deviation adhesive strength (1.70 ±0.36 MPa), followed by Mucopren Soft (1.11 ±0.16 MPa) and Permasoft (0.53 ±0.04 MPa). Molloplast-B displayed high mean ±standard deviation adhesive strength to Denture Base LP (1.37 ±0.08 MPa), followed by Mucopren Soft (0.68 ±0.20 MPa) and Permasoft (0.32 ±0.04 MPa). The adhesive strength of the majority of resilient liners not exposed to thermocycling was statistically different from each other for the same type of denture base polymer (P<.001). The only exception was the difference between the adhesive strength of Molloplast-B and Mucopren Soft to Lucitone 199 with mean ±standard deviation values of 1.42 ±0.18 and 1.66 ±0.40 MPa, respectively, (P=.067). Without thermocycling, the mean ±standard deviation adhesive strength to Lucitone 199 of Permasoft (0.57 ±0.02 MPa) was statistically different from that of Molloplast-B and Mucopren Soft (P<.001). Molloplast-B displayed a high mean ±standard deviation adhesive strength to Ivo Base CAD (1.83 ±0.25 MPa), followed by Mucopren Soft (1.26 ±0.19 MPa) and Permasoft (0.58 ±0.08 MPa). Molloplast-B displayed a high mean ±standard deviation adhesion to Denture Base LP (1.76 ±0.23 MPa), followed by Mucopren Soft (0.88 ±0.14 MPa) and Permasoft (0.25 ±0.06 MPa). Only Molloplast-B was significantly adversely affected by thermocycling (P=.009).

CONCLUSIONS

Molloplast-B displayed high adhesive strength to both CAD-CAM denture base polymers regardless of the storage conditions. Mucopren Soft displayed high adhesion to Lucitone 199. Permasoft presented moderate adhesion to PMMA-based denture bases and low adhesion to DBLP. Combining Permasoft with Denture Base LP should be considered carefully and limited to short-term use. Thermocycling had a detrimental effect on the adhesive strength of Molloplast-B.

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°.

Assessment of knowledge and practices of additive manufacturing in dentistry among university teaching faculty in Saudi Arabia

BACKGROUND

In recent era, digitalization in the dental sciences has been observed in wide ranges. This cross-sectional study aimed to assess knowledge and practice of additive manufacturing (AM) in dentistry among university teaching faculty in Saudi Arabia.

METHODS

A questionnaire was prepared and validated to distribute to the different dental colleges in Saudi Arabia. The questionnaire was divided into three parts: demographic information, knowledge and practices of AM among the dental teaching faculty. After receiving all the responses, descriptive statistics were used for the frequency distribution of all the responses.

RESULTS

A total of 367 responses were received from the different faculty members. Most of the participants were male (67.30%), holding assistant professor (52.50%) positions in the field of prosthodontics (23.40%). In terms of knowledge, even though most of the participants were aware of AM (64.30%); however, do not understand the AM techniques (33.50). Moreover, 71.90% of the participants had no experience working with AM and only 13.60% of participants used AM in their respective dental colleges.

CONCLUSION

AM techniques are not commonly used in the field of dentistry in Saudi Arabia; therefore, more platforms should have created to enhance the knowledge and practice of AM in the current population.

[Biomimetic approach to dental tissue restorations: Which biomaterials, which prospects?]

Les dents constituent un organe particulier. Elles permettent la fonction masticatrice, participent à la phonation et ont un rôle important dans les relations sociales. Elles doivent résister à des variations de température, comprises entre 5 °C et 55 °C, aux contraintes mécaniques de la mastication, et aux acides présents dans l’alimentation.

3D Printing of Ti-6Al-4V-Based Porous-Channel Dental Implants: Computational, Biomechanical, and Cytocompatibility Analyses

Objective: Loosening of dental implants due to resorption of the surrounding bone is one of the challenging clinical complications in prosthetic dentistry. Generally, stiffness mismatch between an implant and its surrounding bone is one of the major factors. In order to prevent such clinical consequences, it is essential to develop implants with customized stiffness. The present study investigates the computational and experimental biomechanical responses together with cytocompatibility studies of three-dimensional (3D)-printed Ti-6Al-4V-based porous dental implants with varied stiffness properties. Methods: Additive manufacturing (direct metal laser sintering, DMLS) was utilized to create Ti-6Al-4V implants having distinct porosities and pore sizes (650 and 1000 μm), along with a nonporous (solid) implant. To validate the compression testing of the constructed implants and to probe their biomechanical response, finite element models were employed. The cytocompatibility of the implants was assessed using MG-63 cells, in vitro. Results: Both X-ray microcomputed tomography (μ-CT) and scanning electron microscopy (SEM) studies illustrated the ability of DMLS to produce implants with the designed porosities. Biomechanical analysis results revealed that the porous implants had less stiffness and were suitable for providing the appropriate peri-implant bone strain. Although all of the manufactured implants demonstrated cell adhesion and proliferation, the porous implants in particular supported better bone cell growth and extracellular matrix deposition. Conclusions: 3D-printed porous implants showed tunable stiffness properties with clinical translational potential.

Tumor Shape-Specific Brachytherapy Implants by 3D-Printing, Precision Radioactivity Painting, and Biomedical Imaging

In brachytherapy (BT), or internal radiation therapy, cancer is treated by radioactive implants. For instance, episcleral plaques (EPs) for the treatment of uveal melanoma, are designed according to generic population approximations. However, more personalized implants can enhance treatment precision through better adjustment of dose profiles to the contours of cancerous tissues. An original approach integrating biomedical imaging, 3D printing, radioactivity painting, and biomedical imaging, is developed as a workflow for the development of tumor shape-specific BT implants. First, computer-aided design plans of EP are prepared according to guidelines prescribed by the Collaborative Ocular Melanoma Study protocol. Polyetheretherketone (PEEK), a high-performance polymer suitable for permanent implants, is used to 3D-print plaques and the geometrical accuracy of the printed design is evaluated by imaging. The possibility to modulate the dose distribution in a tridimensional manner is demonstrated by painting the inner surfaces of the EPs with radioactive 103Pd, followed by dose profile measurements. The possibility to modulate dose distributions generated by these 3D-printed plaques through radioactivity painting is therefore confirmed. Ex vivo surgical tests on human eyeballs are performed as an assessment of manipulation ease. Overall, this work provides a solution for the fabrication of tumor-specific radioactive implants requiring higher dose precision.

Holographic photopolymerization combined to microfluidics for the fabrication of lab-in-lab microdevices and complex 3D micro-objects

We show here brand-new possibilities of lab-in-lab fabrication while combining holographic photopolymerization and microfluidics. One shot real-time 3D-printing can produce 3D architectured microchannels, or free-standing complex micro-objects eventually in flow. The methodology is very versatile and can be applied to e.g., acrylate resins or hydrogels.

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.

The state of additive manufacturing in dental research - A systematic scoping review of 2012-2022

Background/purpose

Additive manufacturing (AM), also known as 3D printing, has the potential to transform the industry. While there have been advancements in using AM for dental restorations, there is still a need for further research to develop functional biomedical and dental materials. It's crucial to understand the current status of AM technology and research trends to advance dental research in this field. The aim of this study is to reveal the current status of international scientific publications in the field of dental research related to AM technologies.

Materials and methods

In this study, a systematic scoping review was conducted using appropriate keywords within the scope of international scientific publishing databases (PubMed and Web of Science). The review included related clinical and laboratory research, including both human and animal studies, case reports, review articles, and questionnaire studies. A total of 187 research studies were evaluated for quantitative synthesis in this review.

Results

The findings highlighted a rising trend in research numbers over the years (From 2012 to 2022). The most publications were produced in 2020 and 2021, with annual percentage increases of 25.7% and 26.2%, respectively. The majority of AM-related publications in dentistry research originate from Korea. The pioneer dental sub-fields with the ost publications in its category are prosthodontics and implantology, respectively.

Conclusion

The final review result clearly stated an expectation for the future that the research in dentistry would concentrate on AM technologies in order to increase the new product and process development in dental materials, tools, implants and new generation modelling strategy related to AM. The results of this work can be used as indicators of trends related to AM research in dentistry and/or as prospects for future publication expectations in this field.

Effects of Surface Preparation Methods on the Color Stability of 3D-Printed Dental Restorations

BACKGROUND

Color stability is a crucial performance parameter for dental restorations, and limited research exists on how surface preparation methods affect it. The purpose of this study was to test the color stability of three resins intended for 3D printing, which can be used to make dentures or crowns in A2 and A3 colors.

MATERIALS AND METHODS

Samples were prepared in the form of incisors; the first group was not subjected to any treatment after curing and washing with alcohol, the second was covered with light-curing varnish, and the third was polished in a standard way. Then, the samples were placed in solutions of coffee, red wine, and distilled water and stored in the laboratory. After 14, 30, and 60 days, color changes were measured (presented as Delta E) compared to material stored in the dark.

RESULTS

The greatest changes were observed for samples that were not polished, then were placed in red wine dilutions (ΔE = 18.19 ± 0.16). Regarding the samples covered with varnish, during storage, some parts detached, and the dyes penetrated inside.

CONCLUSIONS

3D-printed material should be polished as thoroughly as possible to limit the adhesion of dyes from food to their surface. Applying varnish may be a temporary solution.

Comparative Study of the Microstructure and Properties of Cast-Fabricated and 3D-Printed Laser-Sintered Co-Cr Alloys for Removable Partial Denture Frameworks

Since additive technologies in dentistry are gradually replacing metal casting technology, it is necessary to evaluate new dental constructions intended for the development of removable partial denture frameworks. The aim of this research was to evaluate the microstructure and mechanical properties of 3D-printed, laser-melted and -sintered Co-Cr alloys, and perform a comparative study with Co-Cr castings for the same dental purposes. The experiments were divided into two groups. The first group consisted of samples produced by conventional casting of the Co-Cr alloy. The second group consisted of 3D-printed, laser-melted and -sintered specimens produced from a Co-Cr alloy powder divided into three subgroups, depending on the technological parameters chosen for manufacturing (angle, location and heat treatment). Examination of the microstructure was carried out by classical metallographic sample preparation, using optical microscopy and scanning electron microscopy with energy dispersive X-ray spectroscopy (EDX) analysis. A structural phase analysis was also performed by XRD. The mechanical properties were determined using a standard tensile test. The microstructure observation showed a dendritic character in the case of castings, while in the case of 3D-printed, laser-melted and -sintered Co-Cr alloys, the microstructure was typical for additive technologies. The XRD phase analysis confirmed the presence of Co-Cr phases (ε and γ). The results of the tensile test showed remarkably higher yield and tensile strength values and slightly lower elongation of the 3D-printed, laser-melted and -sintered samples than those produced by conventional casting.

An assessment of the passivity of the fit of multiunit screw-retained implant frameworks manufactured by using additive and subtractive technologies

STATEMENT OF PROBLEM

The lack of passive fit in implant-supported restorations can lead to mechanical and biological complications and compromise the longevity of the prosthesis. The manufacturing technique and evaluation site are factors that may affect the passive fit of multiunit screw-retained implant frameworks. However, scientific information regarding this issue is lacking.

PURPOSE

The purpose of this in vitro study was to investigate the effect of manufacturing technique and evaluation site on the passive fit of multiunit screw-retained implant frameworks.

MATERIAL AND METHODS

Two multiunit implant analogs were placed into the right second premolar and second molar sites of a mandibular typodont model. A total of 50 3-unit Co-Cr frameworks were fabricated with 3 indirect (conventional technique, polymethyl methacrylate milling, stereolithography) and 2 direct techniques (selective laser melting and soft alloy milling). The patterns obtained by indirect techniques were subsequently cast. The Sheffield test was used for the assessment. Digital images of the sites were obtained by using a stereomicroscope at ×40 magnification, and the measurement points (n=10 for each site) were examined to record the vertical marginal discrepancy values (μm) with the aid of a measuring software program. The collected data were subjected to the 2-way ANOVA and Tukey honestly significant difference test (α=.05).

RESULTS

The influence of the manufacturing technique (variable 1) on the vertical marginal discrepancy values was statistically significant (P<.001). However, the evaluation site (variable 2) (P=.097) and the interaction of the variables (P=.960) were not statistically significant. The lowest misfit values were observed for selective laser melting (74.2 ±20.5 μm) followed by stereolithography (92.8 ±23.9 μm), soft alloy milling (108.4 ±12.0 μm), polymethyl methacrylate milling (116.7 ±17.0 μm), and conventional technique (137.5 ±18.9 μm). The vertical marginal discrepancy values of the selective laser melting group were significantly lower than those of all other groups (P<.05).

CONCLUSIONS

The manufacturing technique significantly affected the passive fit. selective laser melting-fabricated frameworks demonstrated superior fitting accuracy. Among the indirect techniques, stereolithography-fabricated frameworks revealed the lowest misfit values. The vertical marginal discrepancy values of all manufacturing groups were within the range of clinical acceptability (<150 μm).

Trueness of stereolithography ZrO2 crowns with different build directions

This study aims to measure the trueness of zirconia crowns with different build directions of materials fabricated using the stereolithography (SLA) method. The anatomic contour crown of prepped maxillary right first molar was designed using CAD software to obtain the standard tessellation language (STL) file. Two different build directions were set for the crowns using Materialize Magics software. One group was built with a margin base platform, while the other group was built in the direction opposite to the occlusal surface base platform. The 20 crown-shaped parts were printed. The STL files of scanned printing zirconia crowns were superimposed each segment by the 3D analysis software. The two groups were statistically analyzed using t-tests. Significant differences were found in the marginal and internal discrepancies between the groups. The build direction had a significant influence on the accuracy of the zirconia crown. The results indicate the most effective build direction for manufacturing SLA 3D-printed crowns.

Digital fabrication of a maxillary obturator prosthesis by using a 3-dimensionally-printed polyetheretherketone framework

The digital fabrication of a maxillary obturator with a 3D-printed polyetheretherketone (PEEK) framework is described. Digital oral data were scanned for the computer-aided design (CAD) of the framework and the 3D printing of a preliminary resin cast. The framework was accurately printed from a PEEK filament material. A secondary impression was made to fabricate the definitive cast. The PEEK framework exhibited precise fit, excellent retention, and reduced weight compared with a typical metal framework.

Biomechanical Testing of Two-Unit Bridges and a Comparison of Replacement Retention Depending on a Cementation Medium, Replacement Position, and Gap Size

Dental replacements are placed between the abutment teeth. The exceptions are two-unit bridges, as they are supported by a single tooth prepared only on one side of the missing tooth. The presented study deals with an analysis of a pressure force action on two-unit bridges placed in the frontal part (20 samples), where the pressure action is lower, and in the distal part (20 samples), where the pressure action is higher. A CAD program by 3Shape was used for digital designing with two different gap settings, 10 μm (20 samples) and 30 μm (20 samples). Two-unit bridges were attached to the prepared tooth using two types of dental cement (20/20 samples), which were selected for their physical and bioactive properties. All two-unit bridges (a total of 80 samples) were fabricated from CoCr alloys on Mlab cusing R by applying the Selective Laser Melting (SLM) technology. Mechanical testing was performed using the Inspekt5 table blue. The obtained data were used to verify the hypotheses-a difference between both types of cement (A ≠ B), a difference between the frontal and distal two-unit bridges (F ≠ D) and a difference between the gap sizes (10 ≠ 30). To confirm the given theories, data were statistically evaluated using the F-test and subsequent t-tests. The resulting p-value was compared with the level of significance (α = 0.05). A statistical evaluation revealed a significant difference between the compared groups; however, no explicit correlation between the individual groups of specimens was identified.

Custom-made additively manufactured subperiosteal implant

Subperiosteal implants were introduced in the last century. Poor clinical results led those implants to be progressively abandoned. Recently, several Authors suggested a revival of subperiosteal implants as an alternative to regenerative procedures. The purpose of this study was to describe the clinical application of custom-made additively manufactured subperiosteal implant for fixed prosthetic rehabilitation of edentulous maxilla. Plaster models of the upper and the lower arch were scanned, as well as the mock-up. Digital Imaging and Communications in Medicine data obtained from cone beam computed tomography were processed through the thresholding procedure. The design of the subperiosteal implant was drawn on the stereolithographic model and scanned. Once the digital project of the subperiosteal implant was completed, it was sent to additive manufacturing. After the surgery, the patient was strictly monitored for up to 2 years. The outcomes were assessed based on the incurrence of biological and mechanical complications, postoperative complications, and implant survival. The patient did not suffer from postoperative complications. Neither biological nor mechanical complications occurred during the follow-up period. At the end of the study, the implant was still in function. Custom-made subperiosteal implants could be considered as an alternative to regenerative procedures for the rehabilitation of severe bone atrophy. Further studies are needed in the future to confirm the positive outcome.

Advantages and disadvantages of the three-dimensional metal printed orthodontic appliances

Orthodontic digitalization has progressed steadily. Recently, three-dimensional metal printing has revolutionized the way appliances are designed and manufactured. The process offers several advantages over the conventional analog process for both the orthodontic team and the patients. This article aims to explore the process of three-dimensional metal printing and give an insight into the advantages as well as potential limitations and disadvantages of this new technology.

Influence of printing procedure and printing axis of dental alloys on dimensional accuracy, surface roughness, and porosity

Objectives:

This study aimed to evaluate the printing procedure and printing axis and its influence on the dimensional accuracy, surface roughness, porosity, and strength of 3D-printed dental alloys used in orthodontics prepared using binder jetting (BJ), electron beam melting (EBM), or selective laser melting (SLM).

Material and Methods:

Specimens with a dimension of 50 mm × 12 mm were produced using BJ, EBM, and SLM techniques of dental alloys and were printed either along the X-, Y-, or Z-axis (n = 8 per group). Specimen dimension was chosen according to the ISO standard 6892-1 for tensile strength test specimens. Surface roughness parameters Sa, Sz, Sq, and Ssk were obtained using a 3D laser microscope and porosities were visualized with scanning electron microscopy (SEM). The specimen surfaces were optically scanned and volumetric deviations from the original stereolithography files were calculated. Afterward, tensile strength was measured.

Results:

The printing method and printing axis significantly affected surface roughness parameters (P < 0.05). Overall, the lowest surface roughness Sa values were found for BJ (9.1 ± 3.4 µm) followed by SLM (39.8 ± 24.2 µm) and EBM (50.4 ± 6.4 µm). BJ showed the smallest dimensional deviation followed by EBM and SLM. SEM analysis revealed a porous structure of BJ while fewer pores were observed on EBM and SLM samples. The ultimate tensile strength was only determined for BJ (495 ± 6 MPa) and EBM (726 ± 50 MPa) as the strength of SLM superseded the strength of the holder of the universal testing machine.

Conclusion:

BJ printing provides the highest dimensional accuracy with the smoothest surfaces irrespective of the printing axis. However, the remaining porosities owed to this printing procedure may have decreased the strength of the material.

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.

Main Applications and Recent Research Progresses of Additive Manufacturing in Dentistry

In recent ten years, with the fast development of digital and engineering manufacturing technology, additive manufacturing has already been more and more widely used in the field of dentistry, from the first personalized surgical guides to the latest personalized restoration crowns and root implants. In particular, the bioprinting of teeth and tissue is of great potential to realize organ regeneration and finally improve the life quality. In this review paper, we firstly presented the workflow of additive manufacturing technology. Then, we summarized the main applications and recent research progresses of additive manufacturing in dentistry. Lastly, we sketched out some challenges and future directions of additive manufacturing technology in dentistry.

Surface Characteristics and Microbiological Analysis of a Vat-Photopolymerization Additive-Manufacturing Dental Resin

The wide application of additive manufacturing in dentistry implies the further investigation into oral micro-organism adhesion and biofilm formation on vat-photopolymerization (VP) dental resins. The surface characteristics and microbiological analysis of a VP dental resin, printed at resolutions of 50 μm (EG-50) and 100 μm (EG-100), were evaluated against an auto-polymerizing acrylic resin (CG). Samples were evaluated using a scanning electron microscope, a scanning white-light interferometer, and analyzed for Candida albicans (CA) and Streptococcus mutans (SM) biofilm, as well as antifungal and antimicrobial activity. EG-50 and EG-100 exhibited more irregular surfaces and statistically higher mean (Ra) and root-mean-square (rms) roughness (EG-50-Ra: 2.96 ± 0.32 µm; rms: 4.05 ± 0.43 µm/EG-100-Ra: 3.76 ± 0.58 µm; rms: 4.79 ± 0.74 µm) compared to the CG (Ra: 0.52 ± 0.36 µm; rms: 0.84 ± 0.54 µm) (p < 0.05). The biomass and extracellular matrix production by CA and SM and the metabolic activity of SM were significantly decreased in EG-50 and EG-100 compared to CG (p < 0.05). CA and SM growth was inhibited by the pure unpolymerized VP resin (48 h). EG-50 and EG-100 recorded a greater irregularity, higher surface roughness, and decreased CA and SM biofilm formation over the CG.

Properties of CAD/CAM 3D Printing Dental Materials and Their Clinical Applications in Orthodontics: Where Are We Now?

In the last years, both medicine and dentistry have come across a revolution represented by the introduction of more and more digital technologies for both diagnostic and therapeutic purposes. Additive manufacturing is a relatively new technology consisting of a computer-aided design and computer-aided manufacturing (CAD/CAM) workflow, which allows the substitution of many materials with digital data. This process requires three fundamental steps represented by the digitalization of an item through a scanner, the editing of the data acquired using a software, and the manufacturing technology to transform the digital data into a final product, respectively. This narrative review aims to discuss the recent introduction in dentistry of the abovementioned digital workflow. The main advantages and disadvantages of the process will be discussed, along with a brief description of the possible applications on orthodontics.

Three-dimensional printing in ophthalmology and eye care: current applications and future developments

Three-dimensional (3D) printing uses a process of adding material in a layer-by-layer fashion to form the end product. This technology is advancing rapidly and is being increasingly utilized in the medical field as it becomes more accessible and cost-effective. It has an increasingly important role in ophthalmology and eyecare as its current and potential applications are extensive and slowly evolving. Three-dimensional printing represents an important method of manufacturing customized products such as orbital implants, ocular prostheses, ophthalmic models, surgical instruments, spectacles and other gadgets. Surgical planning, simulation, training and teaching have all benefitted from this technology. Advances in bioprinting seem to be the future direction of 3D printing with possibilities of printing out viable ocular tissues such as corneas and retinas in the future. It is expected that more ophthalmologists and other clinicians will use this technology in the near future.

Effects of the Washing Time and Washing Solution on the Biocompatibility and Mechanical Properties of 3D Printed Dental Resin Materials

Three-dimensional (3D) printing technology is highly regarded in the field of dentistry. Three-dimensional printed resin restorations must undergo a washing process to remove residual resin on the surface after they have been manufactured. However, the effect of the use of different washing solutions and washing times on the biocompatibility of the resulting resin restorations is unclear. Therefore, we prepared 3D-printed denture teeth and crown and bridge resin, and then washed them with two washing solutions (isopropyl alcohol and tripropylene glycol monomethyl ether) using different time points (3, 5, 10, 15, 30, 60, and 90 min). After this, the cell viability, cytotoxicity, and status of human gingival fibroblasts were evaluated using confocal laser scanning. We also analyzed the flexural strength, flexural modulus, and surface SEM imaging. Increasing the washing time increased the cell viability and decreased the cytotoxicity (p < 0.001). Confocal laser scanning showed distinct differences in the morphology and number of fibroblasts. Increasing the washing time did not significantly affect the flexural strength and surface, but the flexural modulus of the 90 min washing group was 1.01 ± 0.21 GPa (mean ± standard deviation), which was lower than that of all the other groups and decreased as the washing time increased. This study confirmed that the washing time affected the biocompatibility and mechanical properties of 3D printed dental resins.

Analysis and Optimization of Dimensional Accuracy and Porosity of High Impact Polystyrene Material Printed by FDM Process: PSO, JAYA, Rao, and Bald Eagle Search Algorithms

High impact polystyrene (HIPS) material is widely used for low-strength structural applications. To ensure proper function, dimensional accuracy and porosity are at the forefront of industrial relevance. The dimensional accuracy cylindricity error (CE) and porosity of printed parts are influenced mainly by the control variables (layer thickness, shell thickness, infill density, print speed of the fused deposition modeling (FDM) process). In this study, a central composite design (CCD) matrix was used to perform experiments and analyze the complete insight information of the process (control variables influence on CE and porosity of FDM parts). Shell thickness for CE and infill density for porosity were identified as the most significant factors. Layer thickness interaction with shell thickness, infill density (except for CE), and print speed were found to be significant for both outputs. The interaction factors, i.e., shell thickness and infill density, were insignificant (negligible effect) for both outputs. The models developed produced a better fit for regression with an R² equal to 94.56% for CE, and 99.10% for porosity, respectively. Four algorithms (bald eagle search optimization (BES), particle swarm optimization (PSO), RAO-3, and JAYA) were applied to determine optimal FDM conditions while examining six case studies (sets of weights assigned for porosity and CE) focused on minimizing both CE and porosity. BES and RAO-3 algorithms determined optimal conditions (layer thickness: 0.22 mm; shell thickness: 2 mm; infill density: 100%; print speed: 30 mm/s) at a reduced computation time equal to 0.007 s, differing from JAYA and PSO, which resulted in an experimental CE of 0.1215 mm and 2.5% of porosity in printed parts. Consequently, BES and RAO-3 algorithms are efficient tools for the optimization of FDM parts.

Effect of post-curing time on the color stability and related properties of a tooth-colored 3D-printed resin material

This study investigated the effect of post-curing time on the color stability and related properties, such as degree of conversion (DC), surface roughness, water contact angle, water sorption (W_sp), and water solubility (W_sl) of 3D-printed resin for dental restorations. The 3D-printed specimens were divided into four groups according to the post-curing time (0, 5, 10, and 20 min). Color changes (ΔE₀₀) of the specimens immersed in aging media were measured using a spectrophotometer at different aging times. The DC of the resin was measured using a FTIR. The surface roughness (Ra) of the resin immersed in coffee was measured at different aging times. Water contact angle was evaluated using the sessile drop method, and W_sp and W_sl were tested according to the ISO 4049:2019. The ΔE₀₀ values of the specimens immersed in coffee and red wine decreased with increasing post-curing time. As the post-curing time increased up to 10 min, the DC increased and water contact angle decreased. The Ra value of the group without post-curing (0 min) increased gradually for 30 days, except between 7 and 15 days. However, when the post-curing time increased to greater than 10 min, no apparent change in Ra value was detected. The W_sp and W_sl of the group without post-curing were significantly lower and larger than that of the other groups, respectively. The longer the post-curing time of the tooth-colored 3D-printed resin, the better the color stability. The post-curing time of the 3D-printed resin affected the DC, surface roughness after aging in the staining media, water contact angle, water sorption, and water solubility.

Effect of additive manufacturing method and build angle on surface characteristics and Candida albicans adhesion to 3D printed denture base polymers

OBJECTIVES

To investigate the influence of additive manufacturing method and build angle on surface characteristics and Candida albicans (C. albicans) adhesion to 3D printed denture base polymers.

METHODS

Specimens of 3D printing denture base polymers were prepared by two printers, namely, stereolithography (SLA, Form 3B) and digital light processing technology (DLP, Solflex 350 plus). Three build angles were used: 0°, 45°, and 90°. Surface topography was examined by scanning electron microscopy. Also, arithmetical mean height (S_a) values were calculated. An adhesion test was performed to observe initial C. albicans adhesion to the specimens. The data were statistically analyzed using the two-way analysis of variance and Tukey's multiple comparison test.

RESULTS

The data of S_a values had statistically significant differences, which were mainly determined by the main factor of build angle (p < 0.05). Moreover, the quantitative results of C. albicans adhesion exhibited no significant differences: printing techniques (p = 0.7794) and build angle (p = 0.0589), respectively.

CONCLUSIONS

Surface roughness was significantly influenced by the build angle rather than by the AM method. Whereas, AM method (SLA and DLP) and build angle (0°, 45°, and 90º) had no impacts on the C. albicans adhesion to the 3D printed denture bases.

CLINICAL SIGNIFICANCE

Build angle dominates the surface roughness and topography of the 3D printed denture polymers. Our results indicate that C. albicans' adhesion might not be influenced by AM method and build angle.

Shaping ability of four single-file systems in the instrumentation of second mesiobuccal canals of three-dimensional printed maxillary first molars

Background

This study evaluated and compared the shaping ability of four advanced single-file nickel-titanium (NiTi) systems during the preparation of curved second mesiobuccal (MB2) canals in maxillary first molar replicas fabricated by three-dimensional (3D) printing via micro-computed tomography (Micro-CT) imaging.

Methods

A total of 60 3D-printed maxillary first molar replicas were constructed from one extracted tooth, with an angle of curvature ranging from 15° to 25°. The MB2 canals from these 60 replicas were divided into 4 groups of 15 replicas according to the canal instrumentation system used, namely, Waveone gold (WOG), Reciproc blue (RCB), XP-endo shaper (XPS) and M3-L. The specimens were scanned before and after preparation using Micro-CT. The pre- and post-instrumentation images of each specimen were superimposed, and the amount of resin removed, the change in surface area, the canal transportation, and centering ability were assessed using the Mimics software. Instrumentation time was also recorded. One-way analysis of variance and least significant difference (LSD) tests were used to statistically compare the groups. The significance level was set at 5%.

Results

Instrumentation time with M3-L was significantly longer than the other systems (P<0.05). The amount of resin removed and the change in surface area generated by the 4 systems were different at the apical, middle, and coronal thirds, and the total canal (P<0.05). Overall, WOG and XPS resulted in the less change than RCB and M3-L. There was no significant difference among the groups at the middle third regarding canal transportation and centering ability (P>0.05). However, a significant difference was found at the apical level (P<0.05), where RCB showed the poorest centering ability and the highest canal transportation (P<0.05). In addition, XPS resulted in the least canal transportation (P<0.05) at the coronal level, while there was no significant difference between the four groups in terms of centering ability.

Conclusions

The M3-L instrument required more time to prepare the curved MB2 canals compared with the other systems. Overall, WOG and XPS showed the least resin removal and surface area change. M3-L, XPS, and WOG instruments respected the original canal curvature better than RCB files.

Effects of Artificial Tooth Brushing and Hydrothermal Aging on the Mechanical Properties and Color Stability of Dental 3D Printed and CAD/CAM Materials

This study analyzed the surface roughness and waviness, Vickers hardness (VHN), and color changes of six types of 3D printed resins and computer-aided design/computer-aided manufacturing (CAD/CAM) materials after artificial toothbrushing. The average surface roughness height (Ra) change of Formlabs denture teeth A2 resin (FMLB) was not significant between after artificial toothbrushing (0.17 ± 0.02 μm and 0.17 ± 0.05 μm, respectively; mean ± standard deviation). However, the Ra value increased significantly in all remaining groups. Regarding waviness, polymethylmethacrylate (PMMA) had the largest increases in average waviness height (Wa) and maximum surface waviness height (Wz) between, before (0.43 ± 0.23 μm and 0.08 ± 0.02 μm), and after (8.67 ± 4.03 μm, 1.30 ± 0.58 μm) toothbrushing. There were no significant changes in Wa for Formlabs denture teeth A2 resin (FMLB) and NextDent C&B (NXT). After artificial toothbrushing, the dispersed-filler composite (DFC) group had the largest color difference (ΔE, of 2.4 ± 0.9), and the remaining materials had smaller changes than the clinical acceptance threshold of ΔE = 2.25. The VHN of FMLB and NXT were 9.1 ± 0.4 and 15.5 ± 0.4, respectively, and were not affected by artificial toothbrushing. The flexural strengths of the 3D printed materials were 139.4 ± 40.5 MPa and 163.9 ± 14.0 MPa for FMLB and NXT, respectively, which were similar to those of the polycarbonate and PMMA groups (155.2 ± 23.6 MPa and 108.0 ± 8.1 MPa, respectively). This study found that the evaluated 3D printed materials had mechanical and optical properties comparable to those of CAD/CAM materials and were stable even after artificial toothbrushing and hydrothermal aging.

Printable PICN Composite Mechanically Compatible with Human Teeth

Polymer-infiltrated ceramic network (PICN) composites are mechanically compatible with human enamel, and are therefore promising dental restorative materials. Fabrication technology for PICN composites used in tooth restorative material has been established through computer-aided design/computer-aided manufacturing (CAD/CAM) milling, however, to date, has not been successfully developed using 3-dimensional (3D) printing. This study aimed to develop a 3D-printable PICN composite as a restorative material. The PICN composite was fabricated using a specific method based on 3D printing. A 3D-printable precursor slurry containing a high concentration of silica nanoparticles was produced and 3D-printed using stereolithography (SLA). The 3D-printed object was sintered to obtain a nano-porous object, and subsequently infiltrated and polymerized with resin monomer. Three different fabrication condition combinations were used to produce the 3D-printed PICN composites, which were characterized based on microstructure, mechanical properties, inorganic content, physicochemical properties, and overall shrinkage. The 3D-printed PICN composites were also compared to 2 commercially available CAD/CAM composite blocks, namely a PICN composite and a dispersed-filler composite. The 3D-printed PICN composites exhibited a nano-sized dual-network structure comprising a silica skeleton with infiltrated resin. The 3D-printed PICN composite exhibited a similar Vickers hardness to enamel, and a similar elastic modulus to dentin. The 3D-printed PICN composite exhibited comparable flexural strength (>100 MPa) to the CAD/CAM block, and acceptable water sorption and solubility for practical use. Further, the 3D-printed model-crown underwent isotropic shrinkage during sintering without fatal deformation. Overall, the potential of this 3D-printable PICN composite as a restorative material with similar mechanical properties to human teeth was successfully demonstrated.

Influence of cleaning methods after 3D printing on two-body wear and fracture load of resin-based temporary crown and bridge material

OBJECTIVES

To investigate the impact of different cleaning methods on the fracture load and two-body wear of additively manufactured three-unit fixed dental prostheses (FDP) for long-term temporary use, compared to the respective outcomes of milled provisional PMMA FDPs.

MATERIALS AND METHODS

Shape congruent three-unit FDPs were 3D printed using three different resin-based materials [FPT, GCT, NMF] or milled [TEL] (N = 48, n = 16 per group). After printing, the FDPs were cleaned using: Isopropanol (ISO), Yellow Magic 7 (YEL), or centrifugal force (CEN). Chewing simulation was carried out with a vertical load of 50 N (480,000 × 5 °C/55 °C). Two-body wear and fracture load were measured. Data were analyzed using global univariate ANOVA with partial eta squared, Kruskal-Wallis H, Mann-Whitney U, and Spearman's rho test (p < 0.05).

RESULTS

TEL showed less wear resistance than FPT (p = 0.001) for all cleaning methods tested. Concerning vertical material loss, NMF and GCT were in the same range of value (p = 0.419-0.997), except within FDPs cleaned in ISO (p = 0.021). FPT showed no impact of cleaning method on wear resistance (p = 0.219-0.692). TEL (p < 0.001) showed the highest and FPT (p < 0.001) the lowest fracture load. Regarding the cleaning methods, specimens treated with ISO showed lower fracture load than specimens cleaned with CEN (p = 0.044) or YEL (p = 0.036).

CONCLUSIONS

The material selection and the cleaning method can have an impact on two-body wear and fracture load results.

CLINICAL RELEVANCE

Printed restorations showed superior two-body wear resistance compared to milled FDPs but lower fracture load values. Regarding cleaning methods, ISO showed a negative effect on fracture load compared to the other methods tested.

Comparison of artificial tooth position in dentures fabricated by heat curing and additive manufacturing

BACKGROUND

The purpose of this study was to compare the displacement of tooth arrangement in dentures fabricated by additive manufacturing (AM) and heat curing.

METHODS

Three-dimensional (3D) scanning was performed for edentulous jaw models. After the teeth were arranged, 3D scanning for the wax denture was performed. Heat-cured dentures were fabricated with heat-cure polymer resin. Based on data obtained by subtracting the model data from wax denture data, AM dentures were fabricated from ultraviolet-cured acrylic resin. Accuracy was verified by superimposing heat-cured and AM dentures on the tooth region data from the wax dentures and measuring displacement of the tooth arrangement.

RESULTS

In the maxillary dentures, the amount of tooth displacement for the heat-cured dentures and for the AM dentures ranged from -0.08 to +0.06 mm and from -0.25 to +0.06 mm respectively. A significant difference was observed between two dentures. In the mandibular dentures, the amount of tooth displacement for the heat-cured dentures and for the AM dentures ranged from -0.09 to +0.07 mm and from -0.03 to +0.07 mm respectively. No significant difference was observed between two dentures.

CONCLUSIONS

The artificial teeth of the maxillary dentures fabricated by AM showed a greater displacement compared to those by heat curing.

Impact of Layer Thickness and Storage Time on the Properties of 3D-Printed Dental Dies

The purpose of this study was to evaluate the effect of printing layer thickness on the repeatability and surface roughness of 3D-printed dies and detect the effect of layer thickness and storage time on the dimensional stability of 3D-printed dies. One stereolithography (STL) file of an upper molar prepared for a full ceramic crown was used to print three groups of dies: 25 µm, 50 µm, and 100 µm. Repeatability was evaluated by linear and area measurements with a digital caliper and a digital metrology microscope. Dimensional stability was analyzed at 3 weeks, 6 months, and 1 year of storage time. Surface roughness parameters were measured with a 3D confocal laser scanning microscope. Statistics were completed using one-way analysis of variance and Tukey’s post hoc tests, p < 0.05. Printing time decreased as layer thickness increased. All groups showed high repeatability and comparable surface roughness while showing differences in their linear dimensions and surface areas. At the 3 week storage interval, dimensional changes were observed in all groups. Within this experimental study’s constraints, it can be concluded that changing the 3D-printing layer thickness does not affect the repeatability or the surface roughness of the product; meanwhile, changes to the layer thickness and storage time influence the dimensional stability of 3D-printed dies.

The Effect of Build Orientation on the Dimensional Accuracy of 3D-Printed Mandibular Complete Dentures Manufactured with a Multijet 3D Printer

PURPOSE

To compare the dimensional accuracy of 3D-printed mandibular complete dentures with different build orientations.

MATERIAL AND METHODS

A mandibular complete denture was digitized as a virtual reference file. The reference file was 3D-printed at the 0°, 45°, and 90° build orientations with a MultiJet 3D printer (Projet MJP 3600 Dental, 3D systems, Rock Hill, SC). A total of 27 complete dentures were 3D-printed with 9 samples for each orientation. All printed dentures were digitized and separated into teeth, denture extension and intaglio test surfaces. The dimensional accuracy (in root mean square, RMS) was evaluated by comparing whole denture and 3 test surfaces with the reference file. One-way analysis of variance (ANOVA) and a Post-Hoc all pairs Bonferroni test were used to determine statistical differences (α = 0.05).

RESULTS

For the dimensional accuracy on whole denture, the 45° build orientation group showed the smallest RMS (0.170 ± 0.043 mm) than those of the 0° build orientation group (0.185 ± 0.060 mm, p < 0.001) and 90° build orientation group (0.183 ± 0.044 mm, p < 0.001). For the dimensional accuracy on the teeth, denture extension and intaglio test surfaces, the 45° build orientation group also show the smallest RMS values (0.140 ± 0.044 mm at teeth surface, 0.176 ± 0.058 mm at denture extension and 0.207 ± 0.006 mm at intaglio surface). The 0°and 90° build orientation groups had similar accuracy at the teeth (0.149 ± 0.056 mm versus 0.154 ± 0.056 mm, p = 0.164) and denture extension surfaces (0.200 ±0.025 mm vs 0.196 ± 0.013 mm, p = 1.000). However, 0° build orientation group (0.228 ± 0.010 mm) has significantly higher RMS values then those of 90° build orientation group (0.218 ± 0.057 mm) in the intaglio surface (p = 0.032). The teeth surfaces were most accurate in each build orientation groups, while the intaglio surfaces were least accurate.

CONCLUSIONS

The build orientation affected the dimensional accuracy of 3D-printed mandibular complete dentures, and the 45° build orientation resulted in the most accurate 3D-printed denture from a MultiJet 3D printer.

Enhanced Osseointegration by the Hierarchical Micro-Nano Topography on Selective Laser Melting Ti-6Al-4V Dental Implants

Currently, selective laser melting (SLM) has been thriving in implant dentistry for on-demand fabricating dental implants. Based on the coarse microtopography of SLM titanium surfaces, constructing nanostructure to form the hierarchical micro-nano topography is effective in enhancing osseointegration. Given that current nanomodification techniques of SLM implants, such as anodization and hydrothermal treatment, are facing the inadequacy in costly specific apparatus and reagents, there has been no recognized nanomodified SLM dental implants. The present study aimed to construct hierarchical micro-nano topography on self-made SLM dental implants by a simple and safe inorganic chemical oxidation, and to evaluate its contribution on osteoblastic cells bioactivity and osseointegration. The surface chemical and physical parameters were characterized by FE-SEM, EDS, profilometer, AFM, and contact angle meter. The alteration on bioactivity of MG-63 human osteoblastic cells were detected by qRT-PCR. Then the osseointegration was assessed by implanting implants on the femur condyle of New Zealand Rabbits. The hierarchical micro-nano topography was constituted by the microrough surface of SLM implants and nanoneedles (diameter: 20∼50 nm, height: 150∼250 nm), after nanomodifying SLM implants in 30% hydrogen peroxide and 30% hydrochloride acid (volume ratio 1:2.5) at room temperature for 36 h. Low chemical impurities content and high hydrophilicity were observed in the nanomodified group. Cell experiments on the nanomodified group showed higher expression of mitophagy related gene (PINK1, PARKIN, LC3B, and LAMP1) at 5 days and higher expression of osteogenesis related gene (Runx2 and OCN) at 14 days. In the early stage of bone formation, the nanomodified SLM implants demonstrated higher bone-to-implant contact. Intriguingly, the initial bone-to-implant contact of nanomodified SLM implants consisted of more mineralized bone with less immature osteoid. After the cessation of bone formation, the bone-to-implant contact of nanomodified SLM implants was equal to untreated SLM implants and marketable TixOs implants. The overall findings indicated that the inorganic chemical oxidized hierarchical micro-nano topography could enhance the bioactivity of osteoblastic cells, and consequently promote the peri-implant bone formation and mineralization of SLM dental implants. This study sheds some light on improvements in additive manufactured dental implants.

Additive Manufacturing Processes in Medical Applications

Additive manufacturing (AM, 3D printing) is used in many fields and different industries. In the medical and dental field, every patient is unique and, therefore, AM has significant potential in personalized and customized solutions. This review explores what additive manufacturing processes and materials are utilized in medical and dental applications, especially focusing on processes that are less commonly used. The processes are categorized in ISO/ASTM process classes: powder bed fusion, material extrusion, VAT photopolymerization, material jetting, binder jetting, sheet lamination and directed energy deposition combined with classification of medical applications of AM. Based on the findings, it seems that directed energy deposition is utilized rarely only in implants and sheet lamination rarely for medical models or phantoms. Powder bed fusion, material extrusion and VAT photopolymerization are utilized in all categories. Material jetting is not used for implants and biomanufacturing, and binder jetting is not utilized for tools, instruments and parts for medical devices. The most common materials are thermoplastics, photopolymers and metals such as titanium alloys. If standard terminology of AM would be followed, this would allow a more systematic review of the utilization of different AM processes. Current development in binder jetting would allow more possibilities in the future.