A novel CAD/CAM resin composite block with high mechanical properties

Mechanical properties, cytotoxicity, and protein adsorption of three-dimensionally printable hybrid resin containing zwitterionic polymer and silicate-based composites for dental restorations

OBJECTIVE

To evaluate the mechanical and biological properties of three-dimensionally (3D) printable resins filled with 2-methacryloyloxyethyl phosphorylcholine (MPC) and silicate-based composites and compare with those of a commercially available 3D-printable resin for definitive restorations.

METHODS

A group of 3D-printable hybrid resins (HRs) filled with 6 wt% MPC and three different compositions of silicate-based composites (barium silicate to zirconium silicate ratios: 1.50:1 for HR1, 0.67:1 for HR2, and 0.25:1 for HR3) were prepared. The HR groups were compared with the commercially available unfilled 3D-printable resin (CR) marketed for definitive restorations in terms of flexural strength and modulus, fracture toughness, surface roughness, Vickers hardness, light transmittance (all, n = 15), cytotoxicity, and protein adsorption (both, n = 3). All data were analyzed by using non-parametric Kruskal-Wallis and Dunn's tests (α=0.05).

RESULTS

The HR groups had significantly higher flexural strength, modulus, fracture toughness, and hardness values than the CR (P < 0.001). HR3 had the highest surface roughness and light transmittance among the groups (P ≤ 0.006). None of tested resins showed cytotoxicity. Both HR2 and HR3 showed significantly lower protein adsorption than the CR, with a difference of approximately 60% (P ≤ 0.026).

CONCLUSION

Both HR2 and HR3 exhibited superior mechanical properties (flexural strength, flexural modulus, fracture toughness, and Vickers hardness), light transmittance, and protein-repellent activity than the CR, with no impact on cytotoxicity.

CLINICAL SIGNIFICANCE

The MPC/silicate-based composite-filled resins may be a suitable alternative for definitive restorations, given their higher mechanical properties and promising biological properties to prevent microbial adhesion and subsequent biofilm formation, as well as their non-cytotoxic properties.

Bacterial adhesion to composite resins produced by additive and subtractive manufacturing

The aim of this study was to evaluate the surface roughness and contact angle of composite resins produced by CAD/CAM milling and three-dimensional (3D) printing for permanent restorations as well as the adhesion of S. mutans and S. sanguinis bacteria to these composites. Three CAD/CAM milling composite resins (Vita Enamic-VE, Cerasmart-CE, Lava Ultimate-LU) and three 3D printing resins (Varseo Smile Crown plus-VSC, Saremco print Crowntech-SPC, Formlabs 3B Permanent crown-FLP) were selected. Twenty samples were prepared for each group. Using a contact profilometer, the surface roughness was determined, and an optical goniometer was used to quantify the contact angle. To evaluate the bacterial adhesion, composite specimens were immersed in mucin containing artificial saliva. All samples were incubated for 24 h at 37°C in 5% CO2. CFUs were determined by counting colonies after the incubation period. Surface roughness values of test samples were the highest in the Group VSC [0.46 (0.14) µm], whereas the lowest values were found in the Group LU [0.23 (0.05) µm]. There was no statistically significant difference between the groups in contact angle values (p > 0.05). The S. mutans adhesion extent on the Group SPC was statistically higher compared to all other materials with p < 0.05. For S. sanguinis, the lowest bacterial adhesion value was recorded in Group CE (3.00 × 104 CFU/ml) and statistically significant differences were found with Group VE and VSC (p < 0.05). Different digital manufacturing techniques and material compositions can affect the surface roughnesses of composite resins. All composite resin samples have hydrophobic characteristics. Microbial adhesion of the tested composite resins may be varied depending on the bacterial species. S. mutans showed much more adhesion to these materials than S. sanguinis.

Hot isostatic pressing as an alternative thermo-mechanical treatment for metallic full-arch implant-supported frameworks obtained by additive and subtractive manufacturing technology: Vertical and horizontal fit, screw removal torque, and stress analysis

PURPOSE

To assess vertical and horizontal fit, screw removal torque, and stress analysis (considered biomechanical aspects) of full-arch implant frameworks manufactured in Ti-6Al-4V through milling, and additive manufacturing Direct Metal Laser Sintering (DMLS) and Electron Beam Melting (EBM), and the effect of the thermo-mechanical treatment Hot Isostatic Pressing (HIP) as a post-treatment after manufacturing.

MATERIAL AND METHODS

Maxillary full-arch implant frameworks were made by milling, DMLS, and EBM. The biomechanical assessments were screw removal torque, strain-gauge analyses, and vertical and horizontal marginal fits. The vertical fit was assessed by the single-screw test and with all screws tightened. All frameworks were submitted to a standardized HIP cycle (920°C, 1000 bar pressure, 2 h), and the tests were repeated (α = 0.05).

RESULTS

At the initial time, milled frameworks presented higher screw removal torque values, and DMLS and EBM frameworks presented lower levels of strain. Using the single-screw test, milled and DMLS frameworks presented higher vertical fit values, and with all screws tightened and horizontally, higher fit values were found for milled frameworks, followed by DMLS and EBM. After HIP, milling and EBM frameworks presented higher screw removal torque values; the lowest strain values were found for EBM. Using the single-screw test, milled and DMLS frameworks presented higher vertical fit values, and with all screws tightened and horizontally no differences were found.

CONCLUSIONS

DMLS and EBM full-arch frameworks presented adequate values of screw removal torque, strain, and marginal fit, although the worst values of marginal fit were found for EBM frameworks. The HIP cycle enhanced the screw removal torque of milled and EBM frameworks and reduced the strain values of milled frameworks. The HIP represents a reliable post-treatment for Ti-6Al-4V dental prostheses produced by milling and EBM technologies.

CAD-CAM resin composites: Effective components for further development

OBJECTIVE

This paper summarizes the effective components of computer-aided design and computer-aided manufacturing (CAD-CAM) resin composites that contribute to achieving greater mechanical properties and further development.

METHODS

In silico multi-scale analysis, in silico nonlinear dynamic finite element analysis (FEA), and artificial intelligence (AI) were used to explore the effective components of CAD-CAM resin composites. The effects of the filler diameter and silane coupling ratio on the mechanical properties of CAD-CAM resin composites have been clarified through multi-scale analysis. The effects of the filler contents, and filler and monomer compositions have been investigated by AI algorithms. The fracture behavior of CAD-CAM composite crown was analyzed using in silico non-linear dynamic FEA. The longevity of CAD-CAM composite crown was assessed through step-stress accelerating life testing (SSALT).

RESULTS

As the filler diameter decreases, there is an increase in elastic moduli and compressive strengths at the macroscale. At the nanoscale, a decrease in the filler diameter results in a decrease in the maximum value of the maximum principal strain. When the silane coupling ratio decreases, there is a decrease in the elastic modulus and compressive strength. According to the exhaustive search and feature importance analysis based on the AI algorithm, the combination of certain components was narrowed down to achieve a flexural strength of 269.5 MPa. The in silico non-linear FEA successfully detected the sign of the initial crack of the CAD-CAM composite molar crown. The SSALT revealed that CAD-CAM resin composite molar crowns containing nanofillers with a high fraction of resin matrix demonstrated great longevity.

SIGNIFICANCE

This paper summarized the effective components of CAD-CAM resin composites for their further development. The integration of in vitro and in silico approaches will expedite the advancement of CAD-CAM resin composites, offering benefits such as time efficiency and reduction of material waste for researchers and manufacturers.

Interblock and intrablock homogeneity of CAD-CAM composites mechanical properties

The purpose of this study was to characterize the homogeneity of the mechanical properties of commercial CAD-CAM composites between different blocks of the same material (interblock homogeneity) and within each block between the internal and external parts (intrablock homogeneity). Tetric CAD (TET); Katana Avencia (KAT); Cerasmart 270 (CER); Grandio (GRN) and Vita Enamic (ENA) were tested for flexural strength (σf), flexural modulus (Ef), flexural load energy (Ur) and hardness (HV). Results showed significant differences in interblock homogeneity of σf, Ef and Ur for TET, KAT, CER and ENA. In addition, significant differences in interblock homogeneity of HV for TET, CER and GRN were found. Moreover, significant differences in intrablock homogeneity of σf, Ef and Ur were found for KAT, CER, GRN and ENA, as well as for HV of all the tested materials except CER. Weibull modulus was highest for GRN, followed by ENA, KAT, TET then CER.

Comparison of the Surface Properties of 3D-printed Permanent Restorative Resins and Resin-based CAD/CAM Blocks

OBJECTIVE

This study aimed to investigate the surface roughness, microhardness, and color changes of resin-based computer-aided design/computer-aided manufacturing (CAD/CAM) blocks and 3D-printed permanent resins in different beverages.

METHODS AND MATERIALS

Resin-based CAD/CAM blocks (Cerasmart 270 and Grandio Blocs) and 3D-printed permanent restorative resins (Crowntec and Permanent Crown) were used in this study. A total of 96 specimens were prepared from CAD/CAM blocks and 3D-printed permanent resins. The initial surface roughness, microhardness, and shade value of the specimens were measured. Then, the specimens prepared from each material were divided into three subgroups (n=8) and immersed in tea, coffee, and distilled water for 30 days. After the specimens were immersed in the beverages, the surface roughness, microhardness, and tone values were measured again. The data were statistically analyzed using a two-way analysis of variance test (p<0.05).

RESULTS

No statistically significant difference was found in the surface roughness values of the resin-based CAD/CAM blocks and 3D-printed resins (p<0.05). Resin-based CAD/CAM blocks showed statistically significantly higher microhardness than 3D-printed permanent resins (p<0.05). Although the color changes in 3D-printed resins in tea and coffee were similar to those in resin-based CAD/CAM blocks on the first and seventh days, more color changes appeared in the 3D-printed resins after 30 days. The surface roughness and microhardness values of the specimens submerged in tea, coffee, and distilled water showed no statistically significant changes (p<0.05).

CONCLUSIONS

Although the surface roughness of 3D-printed permanent resins was similar to that of resin-based CAD/CAM blocks, they had a lower microhardness value. Moreover, 3D-printed permanent resins showed more color changes in tea and coffee.

Evaluation of Physical-Chemical Properties of Contemporary CAD/CAM Materials with Chromatic Transition "Multicolor"

The use of materials for computer-aided design/computer-aided manufacturing (CAD/CAM) has been rapidly increasing in daily practice. However, one of the main issues regarding modern CAD/CAM materials is their aging in the oral environment, which may lead to significant changes in their overall properties. The aim of this study was to compare the flexural strength, water sorption, cross-link density (softening ratio%), surface roughness, and SEM analysis of three modern CAD/CAM "multicolor" composites. Grandio (Grandio disc multicolor-VOCO GmbH, Cuxhaven, Germany), Shofu (Shofu Block HC-Shofu Inc., Kyoto, Japan), and Vita (Vita Enamic multiColor-Vita Zahnfabrik, Bad Sackingen, Germany) were tested in this study. They were prepared in stick-shaped specimens and submitted to different tests after several aging protocols, such as thermocycling and mechanical cycle loading challenge. Further disc-shaped specimens were also created and tested for water sorption, cross-link density, surface roughness, and SEM ultramorphology, before and after storage in an ethanol-based solution. For flexural strength and ultimate tensile strength, Grandio showed the greatest values both at baseline and after aging (p < 0.05). Grandio and Vita Enamic presented the highest modulus of elasticity and the lowest water sorption (p < 0.05). A significant reduction (p < 0.05) in microhardness after ethanol storage (softening ratio%) was observed especially in Shofu. Grandio had the lowest roughness parameters compared to the other tested CAD/CAM materials, while ethanol storage significantly increased the Ra and RSm values in Shofu (p < 0.05). Despite the comparable modulus of elasticity of Vita and Grandio, this latter showed greater flexural strength and ultimate tensile strength both at baseline and after aging. Hence, Grandio and Vita Enamic may be employed for the anterior teeth and for those restorations requiring load-bearing capacity. Conversely, aging seems to affect several properties of Shofu, so its use for permanent restorations should be well-pondered based on the clinical situation.

Micromechanical interlocking structure at the filler/resin interface for dental composites: a review

Dental resin composites (DRCs) are popular materials for repairing caries or dental defect, requiring excellent properties to cope with the complex oral environment. Filler/resin interface interaction has a significant impact on the physicochemical/biological properties and service life of DRCs. Various chemical and physical modification methods on filler/resin interface have been introduced and studied, and the physical micromechanical interlocking caused by the modification of fillers morphology and structure is a promising method. This paper firstly introduces the composition and development of DRCs, then reviews the chemical and physical modification methods of the filler/resin interface, mainly discusses the interface micromechanical interlocking structures and their enhancement mechanism for DRCs, finally give a summary on the existing problems and development potential.

The Influence of Polishing and Artificial Aging on BioMed Amber® Resin's Mechanical Properties

Currently, 3D print is becoming more common in all branches of medicine, including dentistry. Some novel resins, such as BioMed Amber (Formlabs), are used and incorporated to more advanced techniques. The aims of the study were to check whether or not polishing and/or artificial aging influences the properties of the 3D-printed resin. A total of 240 specimens of BioMed Resin were printed. Two shapes (rectangular and dumbbell) were prepared. Of each shape, 120 specimens were divided into four groups each (with no influence, after polishing only, after artificial aging only, and after both polishing and artificial aging). Artificial aging took place in water at the temperature of 37 °C for 90 days. For testing, the universal testing machine (Z10-X700, AML Instruments, Lincoln, UK) was used. The axial compression was performed with the speed of 1mm/min. The tensile modulus was measured with the constant speed of 5 mm/min. The highest resistance to compression and tensile test were observed in the specimens that were neither polished nor aged (0.88 ± 0.03 and 2.88 ± 0.26, respectively). The lowest resistance to compression was observed in the specimens that were not polished, but aged (0.70 ± 0.02). The lowest results of the tensile test were observed when specimens were both polished and aged (2.05 ± 0.28). Both polishing and artificial aging weakened the mechanical properties of the BioMed Amber resin. The compressive modulus changed much with or without polishing. The tensile modulus differed in specimens that were either polished or aged. The application of both did not change the properties when compared to the polished or aged probes only.

Antibacterial and physical properties of resin cements containing MgO nanoparticles

Cariogenic bacteria and dental plaque biofilm at prosthesis margins are considered a primary risk factor for failed restorations. Resin cement containing antibacterial agents can be beneficial in controlling bacteria and biofilm. This work aimed to evaluate the impact of incorporating magnesium oxide nanoparticles (MgONPs) as an antibacterial filler into dual-cure resin cement on bacteriostatic activity and physical properties, including mechanical, bonding, and physicochemical properties, as well as performance when subjected to a 5000-times thermocycling regimen. Experimental resin cements containing MgONPs of different mass fractions (0, 2.5%, 5%, 7.5% and 10%) were developed. Results suggested that the inclusion of MgONPs markedly improved the materials' bacteriostatic effect against Streptococcus mutans without compromising the physical properties when its addition reached 7.5 wt%. The mechanical properties of the specimens did not significantly decline after undergoing aging treatment, except for the flexural properties. In addition, the cements displayed good bonding performance and the material itself was not prone to cohesive fracture in the failure mode analysis. Furthermore, MgONPs possibly have played a role in decelerating material aging during thermocycling and enhancing bonding fastness in the early stage of cementation, which requires further investigation. Overall, developing MgONPs-doped resin cements can be a promising strategy to improve the material's performance in inhibiting cariogenic bacteria at restoration margins, in order to achieve a reduction in biofilm-associated secondary caries and a prolonged restoration lifespan.

Stress distribution in resin-based CAD-CAM implant-supported crowns

OBJECTIVE

This study aimed to evaluate the influence of new resin-based CAD-CAM implant-supported materials on posterior crown restoration stress and strain concentrations.

METHODS

A previous 3D implant model was edited to receive a cement-retained posterior crown manufactured with different CAD/CAM materials (Estelite P Block, Estelite Block II or Estelite Layered Block). Each solid model was exported to the computer-aided engineering software and submitted to the finite element analysis of stress and strain. Material properties were assigned to each solid with isotropic and homogeneous behavior according to the manufacturer information. A vertical load of 600 N was applied in the occlusal region of the crown, via a simulated food bolus, and stress was calculated in Von Misses (σVM) for the implant, abutment and screw, Maximum (σMAX) Principal Stresses for the crown and microstrain for the bone.

RESULTS

All simulated materials showed acceptable stresses levels with a similar stress pattern among the models. At the crown intaglio region and cement layer, however, differences were observed: Estelite P Block showed a lower tensile and shear stresses magnitude when compared to other resin-based materials with lower elastic modulus.

SIGNIFICANCE

The stress effect of different resin-based CAD-CAM implant-supported crowns is predominant in the crown and cement layer, with Estelite P Block showing 7.4 % versus 9.3 % and 9.2 % for Estelite Block II and Estelite Layered Block of crown failure risk.

Resin-Based Composites for Direct and Indirect Restorations: Clinical Applications, Recent Advances, and Future Trends

Continuous advancements in resin-based composites can make selection of the appropriate system a daunting task for the clinician. This review aims to simplify this process and clarify some new or controversial topics. Various types of composites for direct and indirect applications are discussed, including microfilled and microhybrid composites, nanocomposites, single shade, bulk fill, fiber-reinforced, high temperature/high pressure processed, CAD/CAM, and three-dimensional printable composites. Recent material advancements that lead to improved seal and toughness, degradation resistance, antimicrobial and self-healing capabilities are presented. Future directions are highlighted, such as the development of "smart" materials that are able to interact with the host environment.

Effect of Different Surface Treatments on Repair Bond Strength of CAD/CAM Resin-Matrix Ceramics

The purpose of this study was to investigate the influence of different surface treatment methods on the micro-tensile bond strength (μTBS) of resin-matrix ceramic (RMC) blocks repaired with resin composite. Three different prefabricated RMC blocks including Lava Ultimate (LU), Grandio Blocs (GB), and Shofu Block HC (HC) were thermo-cycled and divided into five surface treatment groups: Control (C), bur grinding (G), airborne particle abrasion (APA), Er,Cr:YSGG laser irritation (LI), and APA combined with LI (APA+LI). After surface treatments, topographic alterations were examined by scanning electron microscopy. Then, Universal Adhesive (Single Bond Universal) was applied and repair was simulated with nanohybrid composite (Grandio SO). Bonded specimens were cut into 1 mm2 sized beams (n = 16) and a μTBS test was conducted by using a universal test machine. Fracture types were evaluated by using a stereomicroscope. The bond- strength data was evaluated by two-way ANOVA and Tukey post-hoc test (α = 0.05). The μTBS values were significantly affected by the surface treatment variable and the interaction terms of the variables (p ≤ 0.001). However, no significant effect of RMC type was detected (p > 0.05). Among all materials, GBAPA+LI indicated the highest µTBS value. Except for the GBC, all surface treatments showed clinically acceptable bond-strength values. However, the surface treatments applied to GB and LU before the repair processes increased the repair bond-strength values while causing a negative effect for HC. In addition, LI and APA+LI can be applied as an alternative route compared to other procedures recommended by the manufacturer for surface preparation in intraoral RMC repair.

Printable and Machinable Dental Restorative Composites for CAD/CAM Application-Comparison of Mechanical Properties, Fractographic, Texture and Fractal Dimension Analysis

Thanks to the continuous development of light-curing resin composites it is now possible to print permanent single-tooth restorations. The purpose of this study was to compare resin composites for milling -Gandio Blocks (GR), Brilliant Crios (CR) and Enamic (EN) with resin composite for 3D printing-Varseo Smile Crown plus (VSC). Three-point bending was used to measure flexural strength (σ_f) and flexural modulus (E_f). The microhardness was measured using a Vickers method, while fractographic, microstructural, texture and fractal dimension (FD) analyses were performed using SEM, optical microscope and picture analysis methods. The values of σ_f ranged from 118.96 (±2.81) MPa for EN to 186.02 (±10.49) MPa for GR, and the values of E_f ranged from 4.37 (±0.8) GPa for VSC to 28.55 (±0.34) GPa for EN. HV01 ranged from 25.8 (±0.7) for VSC to 273.42 (±27.11) for EN. The filler content ranged from 19-24 vol. % for VSC to 70-80 vol. % for GR and EN. The observed fractures are typical for brittle materials. The correlation between FD of materials microstructure and E_f was observed. σ_f of the printed resin depends on layers orientation and is significantly lower than σ_f of GR and CR. E_f of the printed material is significantly lower than E_f of blocks for milling.