Evaluation of fit for 3D-printed retainers compared with thermoform retainers

A study on the compressive strength of three-dimensional direct printing aligner material for specific designing of clear aligners

BACKGROUND

The demand for orthodontic treatment using clear aligners has been gradually increasing because of their superior esthetics compared with conventional fixed orthodontic therapy. This study aimed to evaluate and compare the compressive strength of three-dimensional direct printing aligners (3DPA) with that of conventional thermo-forming aligners (TFA) to determine their clinical applicability. In the experimental group, the 3DPA material TC-85 (TC-85 full) was used to create angular protrusions called rectangular pressure areas (RPA). A protrusion akin to the power ridge typically employed in conventional TFAs was created using glycol-modified polyethylene terephthalate (PETG; Control 1). RPA was created using the same TC-85 without filling the protrusions (TC-85 blank; Control 2). Compression cycle tests were conducted on an LTM 3 h electrodynamic testing machine (Zwick Roell, Germany), with 500 cycles and compression depths of 100, 300, 500, and 700 µm. Twenty specimens were tested for PETG, 17 for the TC-85 blank, and 19 for the TC-85 full.

RESULTS

Changes in the compressive force were assessed based on the material and thickness. The results indicated significantly higher and broader ranges of compressive strength for specimens fabricated with the 3DPA material TC-85 compared with those fabricated using PETG. Among the TC-85 specimens, TC-85 full demonstrated the highest statistically significant compressive strength .

CONCLUSIONS

3DPA technology enables precise modifications in the shape and inner thickness at specific dental sites, including the creation of ridges in targeted areas, of aligners. These alterations enhance the biomechanical capability of aligners to exert selective forces necessary for desired tooth movement while reducing the number of attachments, thereby demonstrating the clinical potential of 3D-printed aligners in orthodontic treatment.

Comparison of physical, mechanical, and optical properties between thermoplastic materials and 3-dimensional printing resins for orthodontic clear retainers

INTRODUCTION

This study investigated the physical, mechanical, and optical properties of 3-dimensional (3D) printing resins compared with thermoplastic materials to evaluate their suitability for the fabrication of orthodontic clear retainers.

METHODS

Samples were prepared from thermoplastic sheets (Duran [Scheu-Dental GmbH, Iserlohn, Germany] and Zendura [Bay Materials LLC, Fremont, Calif]) and biocompatible 3D-printing resins (Dental LT Clear V2 [Formlabs Inc, Somerville, Mass] and OrthoFlex [Nextdent BV, Soesterberg, The Netherlands]) according to the manufacturer's instructions. The materials were characterized by Fourier transform infrared spectroscopy, differential scanning calorimetry, and water sorption tests. Mechanical properties were assessed by tensile tests and hardness under 3 different conditions: dry, wet (24-hour water immersion), and aged (thermocyled for 10,000 cycles). Surface characteristics were qualitatively and quantitatively evaluated by scanning electron microscopy and 3D confocal imaging, respectively. Optical properties were assessed by ultraviolet-visible spectroscopy and color stability tests by immersion into various staining solutions.

RESULTS

The mechanical properties of the 3D-printing resins were more markedly altered in different testing conditions (dry, wet, and aged) than in thermoplastic materials. The surface roughness, transparency, and color stability of 3D-printing resins are significantly inferior, especially NextDent OrthoFlex.

CONCLUSIONS

The evaluated 3D-printing resins are more brittle and less ductile compared with the thermoplastic materials. The 3D-printing resins also do not meet the clinical thresholds of surface roughness and optical properties for the fabrication of orthodontic clear retainers. Further postprocessing of the 3D-printing resins may be required to improve these properties.

Residual TPO Content of Photopolymerized Additively Manufactured Dental Occlusal Splint Materials

Background/Objectives: Diphenyl (2,4,6-trimethylbenzoyl) phosphine oxide (TPO) is widely used in the dental industry as a photoinitiator for resin-based materials, while its use may be further limited given its toxicological risks. The aim of this study was, therefore, to analyze the residual TPO content of 3D-printed resin-based dental splint materials. Methods: Six resin-based splint materials were analyzed: LuxaPrint Ortho Plus (DMG), FREEPRINT splint 2.0 (Detax), optiprint splint (Dentona), KeySplint Soft (KeyPrint), FREEPRINT ortho (Detax), V-Print splint comfort (Voco). Grid-shaped specimens were fabricated using the recommended workflow of each manufacturer (n = 18). TPO extraction was conducted using a maximum of eight extraction cycles of 72 h at a temperature of 37 °C until no more TPO eluates were detected by high-performance liquid chromatography (HPLC). The margin of safety (MoS) was calculated as the ratio between the Derived No-Effect Level (DNEL) and the estimated exposure based on the amount of TPO extracted. Results: The total amount of extracted TPO was the lowest for LuxaPrint Ortho Plus (Mean ± SD; 44.0 ± 17.1 ng/mL), followed by optiprint splint (80.6 ± 21.1 ng/mL), FREEPRINT splint 2.0 (127.4 ± 25.3 ng/mL), FREEPRINT ortho (2813.2 ± 348.0 ng/mL), V-Print splint comfort (33,424.6 ± 8357.9 ng/mL) and KeySplint Soft (42,083.5 ± 3175.2 ng/mL). For all tested materials, the calculated MoS was above the critical value of 1, demonstrating toxicological safety in the cured, clinically relevant state. Conclusions: Large differences in the residual TPO content were observed between the materials. Although the TPO content in the uncured state may exceed toxicological safety limits, appropriate curing of the investigated materials resulted in a significant reduction in TPO elution and, thus, in products with a very low toxicological risk for the patient.

Does curve of Spee affect the precision of 3D-printed curvature-adaptive splints?

OBJECTIVES

This study aimed to propose a standardized protocol for the fabrication of three-dimensionally (3D)-printed curvature-adaptive splints (CASs) and assess the precision of CASs on dentitions with different depths of the curve of Spee (COS).

METHODS

76 lower dental resin models, each exhibiting one of the four types of COS (0-, 2-, 4-, and 6-mm deep), were selected and digitally scanned. CASs were designed, 3D printed, and grouped into C0, C2, C4, and C6, corresponding to the four types of COS depths. To assess precision, the CASs occluded with the resin model were scanned as a whole and compared with the originally designed ones.

RESULTS

In terms of translational deviations observed in the CASs, the mean value of absolute sagittal deviation (0.136 mm) was significantly higher than those of vertical (0.091 mm) and transversal deviations (0.045 mm) (P < 0.01). Regarding rotational deviations of the CASs, the mean deviation in pitch (0.323°) was significantly higher than those in yaw (0.083°) and roll (0.110°) (P < 0.01). However, when comparing the accuracy of CASs across C0, C2, C4, and C6 groups, no statistically significant difference was found. Additionally, the translational deviations, rotational deviations, and RMSE of all groups were significantly lower than the clinically acceptable limits of 0.5 mm, 1°, and 0.25 mm, respectively (P < 0.01).

CONCLUSIONS

The depth of the COS has no significant impact on the precision of CASs, as evidenced by the absence of statistically significant differences in translational, rotational deviations, and RMSE among all groups (C0, C2, C4, and C6). Moreover, despite relatively high deviations in the sagittal dimension and pitch, all dimensional deviations and RMSE remained statistically significantly lower than the corresponding clinically acceptable limits (CALs) in all groups.

CLINICAL SIGNIFICANCE

This standardized protocol incorporating "curvature-adaptation" represents an optimized approach to fabricating diverse 3D-printed splints tailored to dentitions with different anatomical features in contemporary digital dentistry.

Prospects for 3D-printing of clear aligners—a narrative review

Clear aligner therapy is a rapidly developing orthodontic treatment. 3D-printing technology, which enables the creation of complex geometric structures with high precision, has been used in dentistry. This article aims to summarize the various aspects of 3D-printing clear aligners and give an outlook on their future development. The traditional thermoforming technology is introduced and the principle and application of 3D-printed clear aligners and materials are introduced, as well as the application prospects of 3D-printed clear aligners. According to PRISMA statement, the relevant literature of 3D-printing clear aligner was searched in PubMed, Web of Science, Embase and other databases. We searched the related words in the MESH database and then carried out advanced searches. We read systematic review and conference papers to find the articles related to the subject and manually added and excluded articles by reading the title and abstract. The production of clear aligners combines computer-aided 3D analysis, personalized design and digital molding technology. The thickness and edges of the 3D-printed clear aligner can be digitally controlled, which allows appliance more efficiently fitted. Presently, the array of clear resins suitable for 3D-printing include photo polymeric clear methacrylate-based resin (Dental LT) (Form Labs, Somerville, Mass), aliphatic vinyl ester-polyurethane polymer (Tera Harz TC-85) (Graphy, Seoul, South Korea). They all have good biocompatibility. But no such material is currently approved on the market. Developing biocompatible resins and further improving the material’s mechanical properties will be critical for the combination of 3D-printing and clear aligners. However, the literature on 3D-printed clear aligners is limited and lacks clinical application. Further in vivo and in vitro tests, as well as additional exploration in conjunction with corresponding cytological tests, are required for the research on available materials and machinery for 3D-printing clear aligners.

Virtual bracket removal: a comparative assessment of different software packages

BACKGROUND

High precision intra-oral scans, coupled with advanced software, enable virtual bracket removal (VBR) from digital models. VBR allows the delivery of retainers and clear aligners promptly following debonding, thus reducing the patients' appointments and minimizing the likelihood of tooth movement. The objective of this study was to compare the enamel surface before bonding and after VBR using three different Computer-aided design (CAD) software and to compare their accuracy.

METHODS

Maxillary scans of 20 participants starting orthodontic treatment were selected for inclusion in the study, who exhibited mild to moderate crowding and required bonding of brackets on the labial surface of permanent maxillary teeth (from the maxillary left first molar to the maxillary right first molar). Two intra-oral scans were conducted on the same day, before bonding and immediately after bonding using CEREC Omnicam (Sirona Dental Systems, Bensheim, Germany). The virtual removal of the brackets from the post-bonding models was performed using OrthoAnalyzer (3Shape, Copenhagen, Denmark), Meshmixer (Autodesk, San Rafael, Calif, USA), and EasyRx (LLC, Atlanta, GA, USA) software. The models that underwent VBR were superimposed on the pre-bonding models by Medit Link App (Medit, Seoul, South Korea) using surface-based registration. The changes in the enamel surface following VBR using the three software packages were quantified using the Medit Link App.

RESULTS

There was a significant difference among the 3Shape, Meshmixer, and EasyRx software in tooth surface change following VBR. Specifically, EasyRx exhibited lower levels of accuracy compared to the other two VBR software programs (p<.001, p<.001). A significant difference in enamel surface change was observed between tooth segments across all software groups, in both incisors and molars, with VBR of the molars exhibiting the lowest level of accuracy (3Shape p=.002, Meshmixer p<.001, EasyRx p<.001). Regarding the direction of tooth surface changes following VBR, it was observed that all three groups exhibited a significant increase in the percentage of inadequate bracket removal across all teeth segments.

CONCLUSIONS

3Shape and Meshmixer manual VBR software were found to be more accurate than EasyRx automated software, however, the differences were minimal and clinically insignificant.

Effects of offset design on the accuracy of bracket placement with a guided bonding device

BACKGROUND

This study aimed to evaluate the effects of offset design on the accuracy of bracket placement for computer-aided design and computer-aided manufacturing (CAD/CAM)-guided bonding devices (GBDs) in vitro.

METHODS

Eight dental models were selected. Seven types of GBDs were designed and three-dimensionally (3D) printed for each model, including one without any offset and the other six with translation offsets (TF) and expansion offsets (EF) of 0.05, 0.10, and 0.15 mm, respectively. After the brackets were bonded on the models using the different GBDs in vitro, linear and angular deviations of the bracket positions were evaluated.

RESULTS

In total, 56 GBDs were printed, and 784 brackets were bonded using the GBDs. No misfit between the dentitions and the devices was found during the bonding process. With increasing offset, more brackets were gingivally positioned with the frequencies ranging from 61.61 to 76.79% for the TF groups and from 58.93 to 78.57% for the EF groups. The vertical deviations of the brackets increased from 0.100 to 0.168 mm and from 0.117 to 0.150 mm in the TF and the EF group, respectively, as offset increased. No statistically significant difference was found in the vertical deviation between most of the TF and EF groups with the same offset value (p > 0.05). With respect to angulation, the mean absolute deviations were 0.881, 1.083, and 1.029° in the 0.05-mm, 0.10-mm, and 0.15-mm EF groups, respectively, which were greater than those in the corresponding TF groups (0.799, 0.847, and 0.806°). Similarly, with increasing offset, the mean absolute deviations for rotation in the EF groups (0.847, 0.998, and 1.138°) were greater than those in the TF groups (0.853, 0.946, and 0.896°). Compared with the 0.15-mm TF group, greater angulations (p < 0.05) and rotations (p < 0.01) were found in the 0.15-mm EF group.

CONCLUSIONS

Offset designs influenced the precision of vertical bracket placement with GBDs. Due to the smaller deviations in angulation and rotation of bracket placement, TF is preferred over EF for GBDs. Moreover, the differences between TF and EF also need to be considered in the design of other dental CAD/CAM devices.

An In Vivo Study to Compare the Clinical Effectiveness of Clear Retainer Made on a Conventional and a Digitally Fabricated Model Over a Six-Month Period After Debonding

Background With the advent of 3D printing, many more possibilities have arisen for treatment planning. 3D rapid prototyping has enabled us to see a whole other dimension that has helped us to give the best possible care for our patients. With more and more advancements being made in this subject, it becomes necessary to check the reliability of the equipment and its effectiveness in the management of the problem at hand. This original study was conducted with the aim of checking the accuracy, dimensional stability, and reliability of orthodontic retainers made on a conventional and digitally fabricated model over a six-month period after debonding. Material and methods The patients were selected from those who have completed fixed orthodontic mechanotherapy from the Department of Orthodontics and Dentofacial Orthopaedics, Sri Guru Ram Das Institute of Dental Sciences and Research, Sri Amritsar. Fifty patients received a clear retainer, which was fabricated for the upper and lower arch after removing the brackets. Patients were included in this study irrespective of their age groups. The manual method used a vacuum-forming machine to fabricate six retainers on stone models. In the digital method, new impressions were taken after three months, and digital models were obtained through 3D scanning and printing, followed by clear retainer fabrication. The data were gathered through a systematic process involving manual and digital methods for clear retainer fabrication and subsequent evaluation. The data obtained was computed for statistical evaluation and comparison. Results Mean and standard deviations of conventional (manual) and digital variables in the two groups were calculated. An ANOVA test was used to evaluate statistically significant differences for mesiodistal width and buccolingual width, and a post hoc Tuckey test was applied for multiple comparisons. The results indicated that most mesiodistal and buccolingual width measurements showed non-significant variations and exhibited a good correlation. Extraction space opening, assessed through an independent t-test for both the maxilla and mandible, also yielded non-significant and comparable results. Additionally, intra-operator and inter-operator measurements using a digital caliper demonstrated high agreement. Intra-class correlation (ICC) values exceeded 0.75, and inter-operator ICC results reflected a high level of agreement ranging from 0.8 to 0.99. Conclusion The primary objective of this study was to establish a correlation between the accuracy, dependability, and clinical efficacy of orthodontic retainers produced using both conventional and digitally created models. This investigation spanned a duration of six months following the removal of orthodontic brackets. The results showed that most of the statistically significant values were due to the inherent potential of the 3D printer for polymerization shrinkage, which, being a stereolithographic 3D printer, had a potential for a slight dimensional shift in the transverse dimension. However, the mean difference between all the models printed was slight and clinically insignificant.

Effect of wall thickness of 3D-printed models on resisting deformation from thermal forming in-office aligners

BACKGROUND

Fabricating clear aligners by thermoforming three-dimensional printed dental models requires a high degree of accuracy. It is unknown whether model thickness affects the accuracy when used to thermoform aligners.

PURPOSE

This research utilizes three-dimensional printed models made with differing wall thicknesses to determine its effect on their ability to withstand deformation during aligner fabrication.

METHODS

A total of 50 models of different wall thickness (10 each of 0.5, 1.0, 1.5, 2.0 mm, and solid) were printed using model resin (Model V2, Formlabs) on a low-force stereolithography printer (Form 3B, Formlabs). Aligners were then fabricated using a thermal pressure forming machine (Biostar V, Great Lakes Dental Technologies) utilizing 25 s cycles to adapt 0.030″ acrylic sheets (Invisacryl, Great Lakes Dental Technologies), then removed from the models and sprayed with a contrast powder (Optispray, Dentsply Sirona) to aid in scanning with an intraoral scanner (CEREC Primescan, Dentsply Sirona). Each aligner's data was then compared to the original file used for printing with 3D comparison software (Geomagic Control X, 3D Systems).

RESULTS

The results show model thickness greater than or equal to 2.0 mm produced clinically acceptable results within the margin of error (0.3 mm). A total of 0.5 mm thickness failed to withstand thermal forming in 4 of the 10 trials. A total of 0.5 mm produced 27.56% of results in tolerance, 1.0 mm produced 75.66% of results in tolerance, 1.5 mm had 80.38% of results in tolerance, 86.82% of 2 mm models were in tolerance, and solid had 96.45% of results in tolerance.

CONCLUSION

Hollow models of thicknesses 2.0 mm and solid models produced clinically acceptable aligners while utilizing less resin per unit compared to solid models, thus being more cost effective, time efficient and eco-friendly. Therefore, a recommendation can be made to print hollow models with a shell thickness of greater than 2.0 mm for aligner fabrication.

The effect of crowding on the accuracy of 3-dimensional printing

INTRODUCTION

The purpose of this study was to evaluate the accuracy of 3-dimensional (3D) printed aligners compared to conventional vacuum-formed thermoplastic aligners with varying levels of dental crowding.

METHODS

Digital intraoral scans of 10 cases were assigned to their respective groups (n = 10, each, 30 total) as follows: no crowding (control), moderate crowding, and severe crowding. Digital images of these models were created in standard tessellation language (STL) file format using 3Shape software and randomly 3D printed. The STL files of each case were also sent to a dental laboratory to fabricate vacuum-formed samples, the current technology used for manufacturing aligners. The intaglio surfaces of fabricated aligners in both groups were scanned using cone beam computed tomography to create STL files, which were then compared to the original STL files of the cases using Geomagic Control X software. Absolute deviations from the original file and root mean square values were recorded. A Kruskal-Wallis test was conducted to analyze the difference in average deviation, and a t-test was repeated for the RMS measure. The significance level was set at 0.05.

RESULTS

The crowding did not affect the trueness of aligners manufactured using 3D printing or conventional vacuum-forming techniques (P = 0.79). 3D-printed aligners showed less deviation than the vacuum-formed samples (0.1125 mm vs 0.1312 mm; P <0.01). Aligners manufactured with the vacuum-forming technique had significantly higher variation than those with the 3D printing process (P = 0.04).

CONCLUSIONS

3D aligners printed directly from an STL file exhibited better precision and trueness than those fabricated using the conventional vacuum-forming technique. Since accuracy is defined as a combination of precision and trueness, it is concluded that direct printing from an STL file can be used to manufacture aligners.

The Impact of Adding Chitosan Nanoparticles on Biofilm Formation, Cytotoxicity, and Certain Physical and Mechanical Aspects of Directly Printed Orthodontic Clear Aligners

Aligner treatment is associated with bacterial colonization, leading to enamel demineralization. Chitosan nanoparticles have been demonstrated to have antibacterial properties. This in vitro study aims to determine the effect of adding chitosan nanoparticles to directly 3D-printed clear aligner resin with regard to antibiofilm activity, cytotoxicity, degree of conversion, accuracy, deflection force, and tensile strength. Different concentrations (2%, 3%, and 5% w/w) of chitosan nanoparticles were mixed with the clear resin, and the samples were then 3D printed. Additionally, the thermoforming technique for aligner manufacturing was utilized. The obtained specimens were evaluated for antibiofilm activity against Streptococcus mutans bacteria and cytotoxicity against L929 and 3T3 cell lines. Additionally, Fourier transform infrared spectroscopy via attenuated total reflection analysis was used to assess the degree of conversion. Geomagic Control X software was utilized to analyze the accuracy. In addition, the deflection force and tensile strength were evaluated. The results indicated a notable reduction in bacterial colonies when the resin was incorporated with 3 and 5% chitosan nanoparticles. No significant changes in the cytotoxicity or accuracy were detected. In conclusion, integrating biocompatible chitosan nanoparticles into the resin can add an antibiofilm element to an aligner without compromising the material's certain biological, mechanical, and physical qualities at specific concentrations.

Expansion rebound deformation of clear aligners and its biomechanical influence: a three-dimensional morphologic analysis and finite element analysis study

OBJECTIVES

To determine the expansion rebound deformation (ERD) of clear aligners (CAs) and its biomechanical influence.

MATERIALS AND METHODS

A four-premolar extraction treatment plan was carried out for a patient with 2 CA companies. Thirty-six digitally scanned clear aligners with the corresponding 36 virtually constructed "ideal" aligners were constructed. The arch width and length between pairs of reference landmarks of the scanned CAs and corresponding dentition models were measured. Cone-beam computed tomography data and digital dental models were used for three-dimensional (3D) finite element analysis (FEA) modeling. Thirty-six scanned CA models with the corresponding 36 ideal CA models were constructed. One-way analysis of variance was used to determine the differences among deviation values at tooth level, and paired t-test was used to compare the displacements of teeth between the two group of CAs.

RESULTS

All CAs were wider and shorter than the digital model from which they were constructed. In the scanned CA model group, significant stress was observed in the buccolingual area of the periodontal ligament on posterior teeth, and the corresponding displacements of teeth were also noted. Significantly larger coronal displacements were noted for the lateral incisor, the canine, the second premolar, and the first molar in the scanned CA group (P < .05).

CONCLUSIONS

The general trend of ERD of thermoformed CAs was shown. This deformation may cause unforeseen tooth movements and negatively affect treatment outcomes.

Comparison of translucency, thickness, and gap width of thermoformed and 3D-printed clear aligners using micro-CT and spectrophotometer

The present study compared the thickness and gap width of thermoformed and 3D-printed clear aligners (CAs) using micro-computed tomography (micro-CT) and evaluated their translucency using spectrophotometer. Four groups of CAs were tested: thermoformed with polyethylene terephthalate glycol (TS) or copolyester-elastomer combination (TM), and 3D-printed TC-85 cleaned with alcohol (PA) or with centrifuge (PC). CIELab coordinates were measured (n = 10) to evaluate translucency. CAs (n = 10) were fitted onto respective models and micro-CT was performed to evaluate the thickness and gap width. Thickness and gap width were measured for different tooth type and location in sagittal sections on all sides. The PC group showed significantly higher translucency than the PA group, which was similar to the TS and TM groups (p < 0.01). After the manufacturing process, thickness reduction was observed in the thermoformed groups, whereas thickness increase was observed in the 3D printed-groups. The TM group showed the least gap width amongst the groups (p < 0.01). Thermoformed and 3D-printed CAs had significantly varied thicknesses and regions of best fit depending on the tooth type and location. Differences in the translucency and thickness of the 3D-printed CAs were observed depending on the cleaning methods.

Coffee Staining and Simulated Brushing Induced Color Changes and Surface Roughness of 3D-Printed Orthodontic Retainer Material

This in vitro study evaluated the influence of combined coffee staining and simulated brushing-induced color changes and surface roughness on 3D-printed orthodontic retainers. Specimens measuring 10 × 10 × 0.75 mm³ were obtained either by conventional vacuum forming or 3D printing at four print angulations (0°, 15°, 30°, and 45°) (n = 10). The prepared specimens were immersed in a coffee beverage and then mechanically brushed using a simulating device. The specimen's color difference (ΔE) and surface roughness (Ra) were quantified using a spectrophotometer and a non-contact profilometer, respectively. The highest and lowest mean ΔE values were recorded for the 3D-printed-45° (4.68 ± 2.07) and conventional (2.18 ± 0.87) groups, respectively. The overall mean comparison of ΔE between the conventional and 3D-printed groups was statistically significant (p < 0.01). After simulated brushing, all groups showed a statistically significant increase in the Ra values (p < 0.01). The highest Ra was in the 3D-printed-45° (1.009 ± 0.13 µm) and conventional (0.743 ± 0.12 µm) groups, respectively. The overall ΔE of 3D-printed orthodontic retainers was not comparable to conventional VFRs. Among the different angulations used to print the retainers, 15° angulations were the most efficient in terms of color changes and surface roughness and were comparable to conventional VFRs.

Comparison of mechanical properties of 3-dimensional printed and thermoformed orthodontic aligners

INTRODUCTION

Orthodontic treatment using clear aligners has experienced exponential growth since its introduction in the late 1990s. Three-dimensional (3D) printing has also grown in popularity among orthodontists, and companies have begun to produce resins to directly print clear aligners. This study aimed to examine the mechanical properties of commercially available thermoformed aligners and direct 3D-printed aligners under laboratory conditions and a simulated oral environment.

METHODS

Samples were prepared (approximately 2.5 × 20 mm) from 2 thermoformed materials, EX30 and LD30 (Align Technology Inc, San Jose, Calif), as well as 2 direct 3D-printing resins, Material X (Envisiontec, Inc; Dearborn, Mich) and OD-Clear TF (3DResyns, Barcelona, Spain). Wet samples were subjected to phosphate-buffered saline at 37°C for 7 days, whereas dry samples were stored at 25°C. Tensile and stress relaxation tests were carried out on an RSA3 Dynamic Mechanical Analyzer (Texas Instruments, Dallas, Tex) and Instron Universal Testing System (Instron, Norwood, Mass) to calculate elastic modulus, ultimate tensile strength, and stress relaxation.

RESULTS

The elastic modulus of dry and wet samples was 103.2 ± 17.3 MPa and 114.4 ± 17.9 MPa (EX30), 61.3 ± 9.18 MPa and 103.5 ± 11.4 MPa (LD30), 431.2 ± 16.0 MPa and 139.9 ± 34.6 MPa (Material X), and 38.4 ± 14.7 MPa and 38.3 ± 8.4 MPa (OD-Clear TF), respectively. The ultimate tensile strength of dry and wet samples was 64.41 ± 7.25 MPa and 61.43 ± 7.41MPa (EX30), 40.04 ± 5.00 MPa and 30.09 ± 1.50 MPa (LD30), 28.11 ± 3.75 MPa and 27.57 ± 4.09 MPa (Material X), and 9.34 ± 1.96 MPa and 8.27 ± 0.93 MPa (OD-Clear TF), respectively. Residual stress of wet samples at 2% strain for 2 hours was 59.99 ± 3.02% (EX30), 52.57 ± 12.28% (LD30), 6.98 ± 2.64% (Material X), and 4.39 ± 0.84% (OD-Clear TF).

CONCLUSIONS

There was a significant difference in elastic modulus, ultimate tensile strength, and stress relaxation among the samples tested. Moisture, specifically a simulated oral environment, appears to have a greater effect on the mechanical properties of direct 3D-printed aligners when compared with thermoformed aligners. This is likely to impact the ability of 3D-printed aligners to generate and maintain adequate force levels for tooth movement.

Three-dimensional (3D) printing in dental practice: Applications, areas of interest, and level of evidence

OBJECTIVES

The aim of this review to overview three-dimensional (3D) printing technologies available for different dental disciplines, considering the applicability of such technologies and materials development.

MATERIALS AND METHODS

Source Arksey and O'Malley's five stages framework using PubMed, EMBASE, and Scopus (Elsevier) databases managed this review. Papers focusing on 3D printing in dentistry and written in English were screened. Scientific productivity by the number of publications, areas of interest, and the focus of the investigations in each dental discipline were extracted.

RESULTS

Nine hundred thirty-four studies using 3D printing in dentistry were assessed. Limited clinical trials were observed, especially in Restorative, endodontics, and pediatric dentistry. Laboratory or animal studies are not reliable for clinical success, suggesting that clinical trials are a good approach to validate the new methods' outcomes and ensure that the benefits outweigh the risk. The most common application for 3D printing technologies is to facilitate conventional dental procedures.

CONCLUSIONS

The constantly improving quality of 3D printing applications has contributed to increasing the popularity of these technologies in dentistry; however, long-term clinical studies are necessary to assist in defining standards and endorsing the safe application of 3D printing in dental practice.

CLINICAL RELEVANCE

The recent progress in 3D materials has improved dental practice capabilities over the last decade. Understanding the current status of 3D printing in dentistry is essential to facilitate translating its applications from laboratory to the clinical setting.

Direct 3D-Printed Orthodontic Retainers. A Systematic Review

Three-dimensional (3D) printing technology has shed light on many fields in medicine and dentistry, including orthodontics. Direct 3D-printed prosthetics, implants or surgical devices are well-documented. The fabrication of orthodontic retainers using CAD technology and additive manufacturing is an emerging trend but the available data are scarce. The research approach of the present review included keywords in Medline, Scopus, Cochrane Library and Google Scholar up to December 2022. The searching process concluded with five studies eligible for our project. Three of them investigated directly 3D-printed clear retainers in vitro. The other two studies investigated directly 3D-printed fixed retainers. Among them, one study was in vitro and the second was a prospective clinical trial. Directly 3D-printed retainers can be evolved over time as a good alternative to all the conventional materials for retention. Devices that are 3D-printed are more time and cost efficient, offer more comfortable procedures for both practitioners and patients and the materials used in additive manufacturing can solve aesthetic problems, periodontal issues or problems with the interference of these materials with magnetic resonance imaging (MRI). More well-designed prospective clinical trials are necessary for more evaluable results.

Advances in orthodontic clear aligner materials

Rapid technological improvements in biomaterials, computer-aided design (CAD) and manufacturing (CAM) have endorsed clear aligner therapy (CAT) as a mainstay of orthodontic treatment, and the materials employed for aligner fabrication play an all-important role in determining the clinical performance of clear aligners. This narrative review has attempted to comprehensively encompass the entire gamut of materials currently used for the fabrication of clear aligners and elucidate their characteristics that are crucial in determining their performance in an oral environment. Historical developments and current protocols in aligner fabrication, features of contemporary bioactive materials, and emerging trends related to CAT are discussed. Advances in aligner material chemistry and engineering possess the potential to bring about radical transformations in the therapeutic applications of CAT; in the absence of which, clear aligners would continue to underperform clinically, due to their inherent biomechanical constraints. Finally, while innovations in aligner materials such as shape memory polymers, direct three-dimensional (3D) printed clear aligners and bioactive materials combined with clear aligner materials are essential to further advance the applications of CAT; increased awareness of environmental responsibilities among aligner manufacturers, aligner prescribing clinicians and aligner users is essential for better alignment of our climate change goals towards a sustainable planet.

Clinically Relevant Properties of 3D Printable Materials for Intraoral Use in Orthodontics: A Critical Review of the Literature

The review aimed at analyzing the evidence available on 3D printable materials and techniques used for the fabrication of orthodontic appliances, focusing on materials properties that are clinically relevant. MEDLINE/PubMed, Scopus, and Cochrane Library databases were searched. Starting from an initial retrieval of 669 citations, 47 articles were finally included in the qualitative review. Several articles presented proof-of-concept clinical cases describing the digital workflow to manufacture a variety of appliances. Clinical studies other than these case reports are not available. The fabrication of aligners is the most investigated application of 3D printing in orthodontics, and, among materials, Dental LT Clear Resin (Formlabs) has been tested in several studies, although Tera Harz TC-85 (Graphy) is currently the only material specifically marketed for direct printing of aligners. Tests of the mechanical properties of aligners materials lacked homogeneity in the protocols, while biocompatibility tests failed to assess the influence of intraoral conditions on eluents release. The aesthetic properties of 3D-printed appliances are largely unexplored. The evidence on 3D-printed metallic appliances is also limited. The scientific evidence on 3D printable orthodontic materials and techniques should be strengthened by defining international standards for laboratory testing and by starting the necessary clinical trials.

In-house three-dimensional printing within the digital orthodontic workflow

Intraoral scanning techniques, and the associated software, have revolutionized model acquisition, analysis, and virtual planning in orthodontics. Three-dimensional printing is the final aspect of this digital workflow, converting these virtual models and simulations of the tooth and occlusal movements into physical reality. This article provides an insight into how in-house three-dimensional printing is now a feasible and transformative reality for many orthodontic settings and how this empowers orthodontists to optimize their patient care.

The Effect of Scanning Strategy on Intraoral Scanner's Accuracy

The purpose of the present study was to examine the impact of scanning strategy on trueness and precision of the impression acquired from an intraoral scanner. Fifteen complete-arch, mandibular, post-orthodontic treatment casts were scanned with a laboratory scanner (Identica SE 3D, Medit) as the gold standard, and with an intraoral scanner (i500 Medit) following three different paths of the scanning head over the arch (scanning strategies A, B, and C). The hand scans were performed twice by one examiner and repeated by a second examiner, resulting in 180 triangular mesh surfaces (digital casts). The meshes were superimposed on the gold standards using the Viewbox 4 software. The closest distances between the meshes were computed and trueness and precision were evaluated using a General Linear Model. An interaction was found among the examiner and strategy. The accuracy of complete-arch impressions was affected by the scanning strategy; the manufacturer’s recommended strategy (A) was statistically significantly better (p < 0.05) than B and C, which were similar. An average accuracy below 50 μm, which is clinically acceptable in most orthodontic procedures, was achieved with all the examined scanning strategies.

A comparison of trueness and precision of 12 3D printers used in dentistry

Introduction

Judging the dimensional accuracy of the resulting printed part requires comparison and conformity between the 3D printed model and its virtual counterpart. The resolution and accuracy of 3D model samples are determined by a wide array of factors depending on the technology used and related factors such as the print head/laser spot size/screen resolution, build orientation, materials, geometric features, and their topology.

Aims

The aim of this manuscript is to present a literature review on 12 3D printers, namely the Ackuretta Sol, Anycubic Photon and Photon S, Asiga Max UV, Elegoo Mars, Envisiontec Vida HD, Envisiontec One, Envisiontec D4K Pro, Formlabs Form 2 and Form 3, Nextdent 5100, and Planmeca Creo, studying the accuracy of these printers that are of a wide variety of budgets.

Design

The present study involves some of the recently released 3D printers that have not yet been studied for their accuracy. Since these new printers will replace current models that may have been included in the previous studies in the literature, it is important to study whether they are statistically more or less accurate and to discuss whether these results are clinically relevant. For the purposes of this study, the use of a standardised printable object was used to measure the accuracy of these recent 3D printers.

Materials and methods

In total, 12 3D printers produced test blocks. All test blocks were printed using the same settings with 100 micron Z layer thickness and the print time set to standard where applicable. To measure the resulting blocks a digital measurement was taken using a Dentsply Sirona Ineos X5 lab scanner to measure the XYZ dimensions of each block produced on each printer using CloudCompare to measure the deviation compared to the Master STL. Each measurement was taken from the central axis of that dimension.

Results

When grouped into homogenous subsets, the cheapest 3D printers in the group, namely the Anycubic printers and the Elegoo Mars, are statistically not dissimilar to the higher priced Asiga Max UV or even the mid-priced Formlabs printers in the X and Z dimensions. However, the Envisiontec One and D4K Pro, Ackuretta Sol and Asiga Max UV were statistically superior in terms of consistently accurate Y dimension. Although these printers use different technologies to print, no specific type of printer technology is more accurate than the others.

Discussion

The null hypothesis was proved to be true, in that no significant differences were found among the various technologies of 3D printing regarding trueness and precision. The evolution of 3D printers that leads to budget printers being as statistically accurate, for at least two of the dimensions of data recorded, as expensive printers is remarkable. Whilst clear differences in the mean error between the printers were found, the performance of these printers is considered exceptional. Albeit, the Envision One, Envision D4K, Ackuretta Sol and Asiga Max UV printers performed the best with overall trueness under 35 μm.

Conclusion

This study shows that the current range of 3D printers can produce clinically acceptable levels of accuracy. The present study also shows that there is no statistical difference in the results of budget printers and more expensive printers for the X and Z dimensions but this was not the case for the measurements in the Y dimension. This study confirms that all of the 3D printers can produce a reliable, reproducible model.

Comparison of dimensional accuracy between direct-printed and thermoformed aligners

Objective

The purpose of this study was to evaluate and compare the dimensional accuracy between thermoformed and direct-printed aligners.

Methods

Three types of aligners were manufactured from the same reference standard tessellation language (STL) file thermoformed aligners were manufactured using Zendura FLX^TM (n = 12) and Essix ACE^TM (n = 12), and direct-printed aligners were printed using Tera Harz^TM TC-85DAP 3D Printer UV Resin (n = 12). The teeth were not manipulated with any tooth-moving software in this study. The samples were sprayed with an opaque scanning spray, scanned, imported to Geomagic^® Control X^TM metrology software, and superimposed on the reference STL file by using the best-fit alignment algorithm. Distances between the aligner meshes and the reference STL file were measured at nine anatomical landmarks.

Results

Mean absolute discrepancies in the Zendura FLX^TM aligners ranged from 0.076 ± 0.057 mm to 0.260 ± 0.089 mm and those in the Essix ACE^TM aligners ranged from 0.188 ± 0.271 mm to 0.457 ± 0.350 mm, while in the direct-printed aligners, they ranged from 0.079 ± 0.054 mm to 0.224 ± 0.041 mm. Root mean square values, representing the overall trueness, ranged from 0.209 ± 0.094 mm for Essix ACE^TM, 0.188 ± 0.074 mm for Zendura FLX^TM, and 0.140 ± 0.020 mm for the direct-printed aligners.

Conclusions

This study showed greater trueness and precision of direct-printed aligners than thermoformed aligners.

Thermo-mechanical properties of 3D printed photocurable shape memory resin for clear aligners

To overcome the limitations of the conventional vacuum thermoforming manufacturing method, direct 3D printing of clear aligners has been developed. The present study investigated the thermo-mechanical and viscoelastic properties of a photocurable resin TC-85, which is a new material for the direct 3D printed clear aligners, comparing to a conventional thermoplastic material polyethylene terephthalate glycol. Dynamic mechanical analysis was performed to analyse the mechanical behaviours of the two materials at 37 °C and 80 °C, respectively. Furthermore, the shape memory property of the two materials was evaluated using a U-shape bending test, and the shape recovery ratio for 60 min at 37 °C was calculated. The results indicate that TC-85 can constantly apply a light force to the teeth when used for the 3D printed clear aligners, owing to its flexibility and viscoelastic properties. In addition, it is expected that the force decay induced by repeated insertion of the clear aligners will be reduced and a constant orthodontic force will be maintained. Furthermore, its geometric stability at high temperatures and the shape memory properties provide advantages for the clinical application.

Comparison of 3-dimensional printing technologies on the precision, trueness, and accuracy of printed retainers

INTRODUCTION

This study aimed to evaluate the differences in the precision, trueness, and accuracy of 3-dimensional (3D) printed clear orthodontic retainers fabricated using printer systems with different printing technologies.

METHODS

Retainers (n = 15) were 3D printed using 4 different printers: stereolithography (SLA), digital light processing (DLP), continuous DLP, and polyjet photopolymer (PPP) printers. Printed retainers were transformed into a digital image through a cone-beam computed tomography scan and compared with the original image using 3D superimposition analysis software. At previously chosen landmarks (R6, L6, R3, L3, R1, and L1), intaglio surfaces of the retainers were compared to that of the reference model. The intercanine and the intermolar width measurements were also assessed. A discrepancy of up to 0.25 mm between the printed retainer and the reference retainer intaglio surfaces indicated accuracy and clinical acceptability. Precision and trueness were also determined. Root mean square and percent of points within the tolerance level were calculated for precision and trueness for each retainer. Statistical significance was set at P <0.05.

RESULTS

Interrater correlation coefficient indicated good agreement. Statistically significant differences were found between printer types among the 6 landmarks and the arch width measurements. When evaluating tolerance level and root mean square, statistically significant differences in median precision and trueness among each printer type were found.

CONCLUSION

Retainers fabricated by SLA, DLP, continuous DLP, and PPP technologies were shown to be clinically acceptable and accurate compared to the standard reference file. Based on both high precision and trueness, SLA and PPP printers yielded the most accurate retainers.

Effect of print angulation on the accuracy and precision of 3D-printed orthodontic retainers

INTRODUCTION

The study aimed to (1) compare the accuracy and precision of 3-dimensional (3D) printed retainers at various angulations and (2) evaluate the effect of angulation on printing time and the amount of resin consumed.

METHODS

Using a stereolithography 3D printer, 60 clear retainers were printed at 5 angulations (n = 12, each): 15°, 30°, 45°, 60°, and 90°. Samples for each group were randomly printed in a batch of 6 retainers at all print angulations as print 1 and print 2 cycles. Digital images of the original and printed samples were superimposed. Discrepancies on 8 landmarks were measured by 2 independent examiners, and 0.25 mm was set as the clinically acceptable threshold to determine the accuracy of the retainers.

RESULTS

Deviations ranged from 0.074 mm to 0.225 mm from the reference retainer at the cusp tips and incisal edges at all angulations, falling within the threshold of clinical acceptance. However, smooth surface measurements with deviations up to 0.480 mm were deemed clinically not acceptable. Three-dimensional printing at 15° was estimated to be the most time-efficient, whereas 3D printing at 45° was shown to be the most cost-effective setting.

CONCLUSIONS

Three-dimensional printed retainers, using a stereolithography printer, were found to be accurate within 0.25 mm at all print angulations at the cusp tips and incisal edges compared with the digital reference file. Smooth facial surfaces did not meet clinical acceptability. Print angulations were shown to affect the cost and amount of resin used.

Capabilities of Digital Software for Creating a 3D Printed Retainer

INTRODUCTION: The retention phase of orthodontic treatment is an important phase to prevent teeth returning to their initial position. An innovative solution for creating a retainer is through 3D printing by digital design. AIM: The purpose of this article is to demonstrate the capabilities of digital software in the creation of stabilization splint, type retainer, and after orthodontic treatment. MATERIAL AND METHODS: An intraoral scan of an orthodontically treated patient (18 years) was performed. A Trios Color scanner (3Shape) was used. 3Shape Dental system design – splint studio was used for file processing and design creation. The method of 3D printing was applied to make the retainer. With this method, the objects are created layer by layer from melted material with different nature. It was made by Dental LT Clear Resin (a biocompatible material) with Formlabs Form 2 printer. RESULTS: Depending on the selected thickness of the retainer and the position of the lower jaw, the software generates different distances between the dentitions. The digital design allows a change of 0.1 mm, which is impossible with a classic laboratory protocol. The resulting printed retainer fully meets our expectations – tooth adaptation, patient comfort, and aesthetics. CONCLUSION: Digital software and design provide many opportunities for modern orthodontics.

Evaluation of current additive manufacturing systems for orthodontic 3-dimensional printing

INTRODUCTION

The objective of this research was to evaluate and compare linear and surface accuracy of dental models fabricated using 3 different vat photopolymerization printing units: digital light synthesis (M2 Printer; Carbon, Redwood City, Calif), digital light processing (Juell 3D Flash OC; Park Dental Research, New York, NY), and stereolithography apparatus (Form 2; Formlabs Inc, Somerville, Mass), and a material jetting printing unit: PolyJet (Objet Eden 260VS; Stratasys, Eden Prairie, Minn).

METHODS

Maxillary and mandibular dental arches of 20 patients with the American Board of Orthodontics Discrepancy Index scores ranging between 10 and 30 were scanned using an intraoral scanner. Stereolithographic files of each patient were printed via the 3-dimensional (3D) printers and were digitized again using a 3D desktop scanner to enable comparisons with the original scan data. One-sample t test and linear regression analyses were performed. To further graphically examine the accuracy between the different methods, Bland-Altman plots were computed. The level of significance was set at P <0.05.

RESULTS

Bland-Altman analysis showed no fixed bias of one approach vs the other, and random errors were detected in all linear accuracy comparisons. When a 0.25 mm tolerance level was deemed acceptable for any positive or negative surface changes, only the models manufactured from digital light processing and PolyJet units showed more than 97% match with the original scans.

CONCLUSION

The surface area of 3D printed models did not yield an utterly identical match to the original scan data and was affected by the type of printer. The clinical relevance of the differences observed on the 3D printed dental model surfaces requires application-specific judgments.

Three-dimensional assessment of virtual bracket removal for orthodontic retainers: A prospective clinical study

INTRODUCTION

Computer-aided design and manufacturing of orthodontic retainers from digitally debonded models can be used to facilitate same-day delivery. The purpose of this prospective clinical study was to validate a novel technique for virtual bracket removal (VBR) in-office, comparing the accuracy with 2 orthodontic laboratories that use VBR for retainer fabrication in the digital workflow.

METHODS

The sample consisted of 40 intraoral scans of 20 patients. Four groups were compared. The scans without brackets were used as a control group. VBR was performed by 3 groups: In-office VBR (Software Meshmixer, version 3.5.474; Autodesk, San Rafael, Calif), Orthodent Laboratory (ODL; Buffalo, NY), and New England Orthodontic Laboratory (NEOLab; Andover, Mass). The virtually debonded models were superimposed onto the control models using surface-based registration. Regional 3-dimensional Euclidean distances between surface points of superimposed models were calculated for comparative analysis of surface changes after VBR using Vector Analysis Module (Canfield Scientific, Fairfield, NJ) software.

RESULTS

The accuracy of VBR using the Meshmixer did not differ significantly from the VBR protocols used by the 2 laboratories. However, there was a statistically significant difference between the 2 laboratories, with ODL showing lower accuracy than NEOLab. Although some differences were statistically significant, they were very small and not considered clinically relevant. There was also a statistically significant difference between the 3 tooth segments (incisors, canines/premolars, and first molars), with VBR of the first molars and second premolars showing the least accuracy.

CONCLUSIONS

The VBR techniques using the in-office Meshmixer, ODL, and NEOLab were considered accurate enough for the clinical use of orthodontic retainers fabricated from printed models.

Precision and trueness of maxillary crowded models produced by 2 vat photopolymerization 3-dimensional printing techniques

INTRODUCTION

This cross-sectional study aimed to analyze the precision and trueness of dental models produced using 2 rapid prototyping 3-dimensional printers.

METHODS

A digital crowded maxillary arch with a T-shaped base and 2 hemispheres of 2.5 mm radius was printed 10 times with a stereolithography apparatus (SLA) and digital light processing (DLP) in the highest precision and minimum layer thickness (z-resolution) mode. The copies were scanned using the D710 3Shape desktop scanner and assessed for precision and trueness via arch superimpositions and hemisphere measurements. Mann-Whitney U tests were used to compare trueness and precision among printers. Hemisphere radius was compared with the reference measurement and between 3-dimensional printers using 1 sample and independent Student t tests, respectively (α = 0.05).

RESULTS

The root mean square values of arch superimpositions showed statistically significant differences between the 2 techniques, both for precision (P = 0.011): SLA (46.8 μm ± 13.5); DLP (111.1 μm ± 71.9), and trueness (P = 0.015): SLA (61.1 μm ± 9.8); DLP (99.8 μm ± 47.2). The color map model analysis indicated greater distortion on premolar and molar surfaces, with a higher range of contraction on the SLA and both contraction and expansion on the DLP. Anterior and posterior hemisphere radius registered increased values with DLP (1.7% and 0.49%) and reduced values with SLA (0.6% and 0.7%); however, only the anterior SLA hemispheres revealed a significant decrease from the reference value (P = 0.037).

CONCLUSIONS

In this study, the SLA printer was significantly different from the DLS printer, with the highest precision and trueness.

Comparison of cooling methods on denture base adaptation of rapid heat-cured acrylic using a three-dimensional superimposition technique

Aim

To investigate the effect of different cooling methods on denture base adaptation of rapid heat-cured acrylic resin using 3D superimposition technique.

Setting and Design

In vitro - Comparative study.

Materials and Methods

Denture base adaptation of two different rapid heat-cured polymethyl methacrylate acrylic resins using five different cooling methods were compared. Forty maxillary edentulous stone cast were prepared to produce the denture bases with standardized thickness. The specimens were divided into five groups (n = 8) according to type of materials and cooling methods. The master stone cast and all forty denture bases were scanned with 3Shape E1 laboratory scanner. The scanned images of each of the denture bases were superimposed over the scanned image of the master cast using Materialize 3-matic software. Three dimensional differences between the two surfaces were calculated and color surface maps were generated for visual qualitative assessment.

Statistical Analysis Used

Generalized Linear Model Test, Bonferroni Post Hoc Analysis.

Results

All bench-cooled specimens showed wide green-colored area in the overall palatal surface, while the rapid cooled specimens presented with increased red color areas especially at the palate and post dam area. Generalized Linear Model test followed by Bonferroni post hoc analysis showed significant difference in the root mean square values among the specimen groups.

Conclusion

Samples that were bench cooled, demonstrated better overall accuracy compared to the rapid cooling groups. Regardless of need for shorter denture processing time, bench cooling of rapid heat-cured PMMA is essential for acceptable denture base adaptation.

Effects of Groove Sealing of the Posterior Occlusal Surface and Offset of the Internal Surface on the Internal Fit and Accuracy of Implant Placements Using 3D-Printed Surgical Guides: An In Vitro Study

This study evaluated the internal fit and the accuracy of the implant placement position in order to determine how the surface shape of the tooth and the offset influence the accuracy of the surgical guide. The acquired digital data were analyzed in three dimensions using 3D inspection software. The obtained results confirmed that the internal fit was better in the groove sealing (GS) group (164.45 ± 28.34 μm) than the original shape (OS) group (204.07 ± 44.60 μm) (p < 0.001), and for an offset of 100 μm (157.50 ± 17.26 μm) than for offsets of 30 μm (206.48 ± 39.12 μm) and 60 μm (188.82 ± 48.77 μm) (p < 0.001). The accuracy of implant placement was better in the GS than OS group in terms of the entry (OS, 0.229 ± 0.092 mm; GS, 0.169 ± 0.061 mm; p < 0.001), apex (OS, 0.324 ± 0.149 mm; GS, 0.230 ± 0.124 mm; p < 0.001), and depth (OS, 0.041 ± 0.027 mm; GS, 0.025 ± 0.022 mm; p < 0.001). In addition, the entries (30 μm, 0.215 ± 0.044 mm; 60 μm, 0.172 ± 0.049 mm; 100 μm, 0.119 ± 0.050 mm; p < 0.001) were only affected by the amount of offset. These findings indicate that the accuracy of a surgical guide can be improved by directly sealing the groove of the tooth before manufacturing the surgical guide or setting the offset during the design process.

Evaluation of the dimensional accuracy of thermoformed appliances taken from 3D printed models with varied shell thicknesses: An in vitro study

OBJECTIVE

Clinicians make numerous decisions when 3D printing models for fabrication of thermoformed appliances, including printing solid or hollow models. While hollow models can reduce resin use, models intended for thermoformed appliance fabrication must be printed with sufficient thickness to withstand thermoforming. The aim of the study was to determine for hollow 3D printed orthodontic models if there is an effect of shell thickness on the dimensional accuracy of retainers thermoformed upon them as compared with solid models and, if so, to identify the minimum shell thickness that ensures dimensional accuracy of the thermoformed retainer under the conditions investigated.

MATERIAL AND METHODS

Thermoformed appliances were fabricated on 3D printed models of six shell thicknesses: 1.0mm, 1.5mm, 2.0mm, 2.5mm, 3.0mm, and solid (n=10/group). The models were scanned before and after thermoforming. Thermoformed appliances were captured by two methods: scanning a polyvinylsiloxane casting of the appliance and scanning the appliance interior surface (intaglio surface). Each model-appliance pair was compared using superimposition software. A generalized linear model and post-hoc Tukey contrasts (α=0.05) were applied to compare each thickness.

RESULTS

Model thickness has a statistically significant effect on dimensional accuracy of thermoformed appliances. Appliances fabricated on 1.0mm and 1.5mm models displayed poor accuracy, with a statistically significantly lower percentage of data points within tolerance (±0.250mm) than appliances fabricated on models printed at 2.0mm thickness and greater.

CONCLUSIONS

3D printed model thickness affects the dimensional accuracy of a thermoformed retainer. To ensure minimal deformation and promote clinical utility of the thermoformed appliance, models should be printed with a minimum shell thickness of 2.0mm for the materials investigated.

Evaluation of the fused deposition modeling and the digital light processing techniques in terms of dimensional accuracy of printing dental models used for the fabrication of clear aligners

Objective

The objective of this study was to assess the accuracy of physical reproductions of plaster orthodontic study casts fabricated by two different rapid prototyping techniques: Fused Deposition Modeling (FDM) and Digital Light Processing (DLP).

Materials and methods

Twenty pairs of pretreatment plaster models were prepared from randomly selected patients at the Orthodontic Department, University of Damascus Dental School. Twenty‐one reference points were placed on plaster models, followed by scanning and printing of these models using FDM and DLP techniques. Forty measurements were made on these models using a digital caliper. Paired t tests were used to detect significant differences in the measurements between the 3D printed replicas and the original plaster models (Gold Standard). Alpha level was adjusted due to the multiplicity of the tests.

Results

The intraclass correlation coefficients for all the comparisons made between the 3D replicas and the gold standard models were greater than 0.80 with ICCs ranging from 0.802 to 0.990 and from 0.853 to 0.990 for the FDM and DLP techniques, respectively. This indicated an excellent agreement. No statistically significant differences could be detected between the 3D‐printed models and their corresponding plaster models. The overall mean difference was −0.11 mm and 0.00 ranging from −0.49 to 0.17 mm and from −0.42 to 0.50 mm, for the FDM and DLP techniques, respectively.

Conclusion

The accuracy of the 3D models produced by the DLP and FDM techniques was acceptable. However, for the fabrication of clear aligners, the optimum fit of the produced plates in the patients' mouths is not completely guaranteed.

Accuracy of different tooth surfaces on 3D printed dental models: orthodontic perspective

Background

Few studies have been reported regarding the accuracy of 3D-printed models for orthodontic applications. The aim of this study was to assess the accuracy of 3D-printed dental models of different tooth surfaces.

Methods

Thirty volunteers were recruited from the hospital, and then their dental models were produced by means of oral scanning and a stereolithography-based 3D printer. Each printed model was digitally scanned and compared with the oral-scanned STL file via superimposition analysis. A color map was used to assess the accuracy of different surfaces (occlusal, buccal, lingual) of anterior and posterior teeth. The Tukey test was used to evaluate the differences between the superimposition.

Results

Statistically significant differences were found in the average deviations of different tooth surfaces (P < 0.05). The mean average absolute deviations of the occlusal surfaces of posterior teeth were greater than those of other surfaces. Percentages of points beyond the upper and lower limits of different tooth surfaces displayed the same results (P < 0.05).

Conclusions

Occlusal surfaces, especially pits and fissures of posterior teeth on 3D printed maxillary dental models, showed greater distortions than those of other teeth and regions.

Analysis of the thickness of 3-dimensional-printed orthodontic aligners

INTRODUCTION

This study aimed to investigate the effect of digitally designed aligner thickness on the thickness of the corresponding 3-dimensional (3D)-printed aligner.

METHODS

Digitally designed aligners of 3 different thicknesses (0.500 mm, 0.750 mm, and 1.000 mm) were 3D printed in 2 different resins-Dental LT (n = 10 per group) and Grey V4 (n = 10 per group)-using a stereolithography format 3D printer. The Dental LT aligners were coated with a contrast spray and scanned with an optical scanner. The Grey V4 aligners were scanned before and after the application of the spray. Aligner scans were superimposed onto the corresponding digital design file. Average wall thickness across the aligner for each specimen was measured with metrology software.

RESULTS

Superimpositions showed that 3D-printed aligners were thicker overall than the corresponding design file. The Dental LT aligners had the largest thickness deviation, whereas the Grey V4 without spray had the smallest. For the 0.500-mm, 0.750-mm, and 1.000-mm groups, Dental LT average thickness deviation from the input file was 0.254 ± 0.061 mm, 0.267 ± 0.052 mm, and 0.274 ± 0.034 mm, respectively, and average thickness differences between the Grey V4 with and without spray was 0.076 ± 0.016 mm, 0.070 ± 0.036 mm, and 0.080 ± 0.017 mm, respectively. These results indicate that the excess thickness in the Dental LT groups could not be attributed to spray alone.

CONCLUSIONS

Fabrication of clear aligners directly by 3D printing with the workflow applied resulted in an increased thickness that may deleteriously affect the clinical utility of the aligners.

Assessment of Compatibility between Various Intraoral Scanners and 3D Printers through an Accuracy Analysis of 3D Printed Models

To assess the accuracy of various intraoral scanners (IOSs) and to investigate the existence of mutual compatibility that affects the accuracy between IOS and 3-dimensional (3D) printing using a scan quadrant model. For clinical implication, crown preparations and cavity design according to prosthetic diagnosis and treatment considerations must be acquired by a digital scanner. The selected typodont model was scanned using a reference scanner, from which reference (Ref) standard tessellation language (STL) data were created. Data obtained by scanning the typodont model with IOSs based on three different technologies were divided into three groups (CS3600, i500, and Trios3). Scanned data from the groups were divided into sub-groups of digital light processing (DLP), fused deposition modeling (FDM), and stereolithography apparatus (SLA), based on which 3D printed models (3DP) were fabricated. The 3DP dental models were scanned to obtain a total of 90 3DP STL datasets. The best-fit algorithm of 3D analysis software was used for teeth and arch measurements, while trueness was analyzed by calculating the average deviation among measured values based on superimposition of Ref and IOS and 3DP data. The differences between Ref and IOS (Ref-IOS), Ref and 3DP (Ref-IOS/3DP), and IOS and 3DP data (IOS-3DP) were compared and analyzed, while accuracy within each of the three main groups was assessed. For statistical analysis, the Kruskal–Wallis, Mann–Whitney U, and repeated measures ANOVA test were used (p < 0.05). The major finding is that the mutual relationships between IOSs and 3D printers vary depending on the combination. However, i500 intraoral scanner and DLP 3D printer was the combination that showed the best trueness value.

Introducing 3D printing in your orthodontic practice

Many orthodontists are aware of the potential applications of three-dimensional (3D) printing in orthodontics but are hesitant in introducing this technology into their clinical practice and workflow. Therefore, this article explains the hardware and software requirements, plus the workflow.

Intaglio Surface Dimension and Guide Tube Deviations of Implant Surgical Guides Influenced by Printing Layer Thickness and Angulation Setting

PURPOSE

To measure overall intaglio dimensional and tube deviations of implant guides printed at 50 and 100 µm layer thickness at 0°, 45°, and 90° angulation using a stereolithographic (SLA) printer.

MATERIALS AND METHODS

A surgical implant guide design from a subject missing a maxillary right central incisor, used as the original standard tessellation language (STL) were stereolithographically fabricated at each thickness and angulation, 50 and 100 µm layer thickness at 0°, 45°, and 90° angulation (n = 10 each group). The guide was then scanned using cone beam computed tomography. The digital imaging and communications in medicine (DICOM) scanned files were then converted to an STL format. The overall dimensional deviations of the intaglio surface and the positioning of the implant guide tube were then superimposed onto the original designed STL file using best-fitting alignment. A t-test and an F-test as well as ANOVA followed by a post hoc t-test were used to determine statistical significant differences (α = 0.05) for the intaglio surface and guide tube deviation, respectively.

RESULTS

The overall intaglio surface discrepancies (µm) printed at 0°, 45°, and 90° were 55.07 ± 1.36, 52.39 ± 2.09, and 61.02 ± 15.96 for 50 µm layer; and 98.38 ± 10.55, 84.47 ± 10.61, and 90.26 ± 5 for 100 µm layer with statistically significant differences for both t-test and F-test, p < 0.001. The maximal guide tube linear deviations (µm) printed at 0°, 45°, and 90° were 10.78 ± 3.84, 8.16 ± 3.68, and 12.57 ± 5.39 for 50 µm layer (ANOVA, p = 0.096); and 10.95 ± 5.23, 16.79 ± 4.97, and 22.63 ± 2.81 for 100 µm layer (ANOVA, p < 0.001). The maximal guide tube angular deviations (°) printed at 0°, 45°, and 90° were 1.29 ± 0.30, 0.64 ± 0.13, and 0.56 ± 0.21 for 50 µm layer (ANOVA, p < 0.001); and 1.57 ± 0.29, 0.86 ± 0.14, and 1.02 ± 0.31 for 100 µm layer (ANOVA, p = 0.034). There was a statistical difference in the deviations between 50 and 100 µm layer printing in all printed angulations except at 0° (t-test, p = 0.05, p = 0.03, and p = 0.001 for 0°, 45°, and 90°) and linear deviations (t-test, p < 0.001, p = 0.009, and p = 0.001 for 0°, 45°, and 90°).

CONCLUSION

Printing at 50 µm layer reduces dimensional intaglio deviations in general and reduces tube angular deviations with different angulations of printing. However, the deviations were only ∼60 to 100 µm for the intaglio dimension deviations; and ∼0.04 to 0.26 mm and ∼0.25° to ∼2° for tube deviations.

Accuracy and practicality of intraoral scanner in dentistry: A literature review

PURPOSE

The digitization of the dental field has been vigorously promoted in recent years. An impression using an intraoral scanner is considered to significantly change future dental treatment. The purpose of this review is to evaluate accuracy and practicality of various intraoral scanners and verification method of intraoral scanners.

STUDY SELECTION

This review was based on articles searched through the MEDLINE and PubMed databases. The main keywords that were employed during the search were "Oral Scanner, Intraoral Scanners, Desktop Scanner, and Digital Impression".

RESULT

It was reported that illuminance and color temperature affected trueness and precision of intraoral scanners. The repeatability of intraoral scanners indicated the possibility of producing fixed prostheses within the range of being partially edentulous. It is considered difficult to use intraoral scanners in fabricating cross-arch fixed prostheses. However, with intraoral scanners, it may be considered possible to fabricate mouth guards and dentures equivalent to those of desktop scanners. Current intraoral scanner scans are considered more comfortable than traditional impressions that use irreversible hydrocolloid and elastomeric impression materials.

CONCLUSION

Since the intraoral scanner is an evolving device, further improvement in accuracy is expected in the future. In addition, verification of the accuracy of intraoral scanners must be conducted accordingly.