Polishability and wear resistance of splint material for oral appliances produced with conventional, subtractive, and additive manufacturing

Mechanical performance of 3-dimensionally printed resins compared with conventional and milled resins for the manufacture of occlusal devices: A systematic review

STATEMENT OF PROBLEM

Digital methods for manufacturing occlusal devices provide advantages over conventional techniques, but information about the mechanical properties of 3-dimensionally (3D) printed resins is scarce.

PURPOSE

The purpose of this systematic review was to evaluate the literature to determine whether 3D-printed resins for occlusal devices present satisfactory mechanical performance when compared with milled and conventional heat polymerized and autopolymerized resins.

MATERIAL AND METHODS

This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and was registered in the Open Science Framework. The search strategy was applied without restriction of time and language to Embase, PubMed, Scopus, Science Direct, and Web of Science databases, and to the nonpeer-reviewed literature in ProQuest and Google Scholar. The selection process was conducted independently in 2 stages by 2 reviewers according to the eligibility criteria. The risk of bias was analyzed by using a checklist of important parameters to be considered. The systematic review considered the population, intervention, comparison, outcome, studies (PICOS) format, where population was resins for 3D printing of occlusal devices, intervention was inherent characteristics of the resin, comparison was conventional heat polymerized, autopolymerized, and milled resins, outcome was mechanical performance, and studies were in vitro experimental studies.

RESULTS

A total of 1430 articles were found with the search strategy. After removing 182 duplicates found in Rayyan, the title and abstract of 1248 articles were evaluated, of which 37 articles were screened from the databases, 23 were selected for full reading, and 6 met the eligibility criteria and were included in this review; 1 had a low risk of bias and 5 had a moderate risk. An additional search of the reference list of included articles did not result in the inclusion of any articles. A quantitative meta-analysis could not be performed because of the heterogeneity of the included studies regarding the type of resin used and the method for evaluating mechanical performance.

CONCLUSIONS

Resins for 3D printing had satisfactory mechanical performance for interocclusal devices when compared with conventional heat polymerized and autopolymerized resins, except for hardness. Milled resins were better than 3D-printed resins in hardness, wear resistance, flexural strength, flexural modulus, and fracture resistance when printing angle and thickness were not considered. Further development is needed in terms of printing techniques and chemical composition, as they are important for optimal mechanical properties and clinical performance.

Wear resistance of 3D printed occlusal device materials

STATEMENT OF PROBLEM

Three-dimensional (3D) printing offers an efficient method of producing occlusal devices; however, their wear resistance is poorly understood.

PURPOSE

The purpose of this in vitro study was to compare the wear resistance of flexible and rigid 3D printed occlusal device materials with milled and conventionally processed occlusal device materials.

MATERIAL AND METHODS

Blocks (n=8) of 3 flexible 3D printed materials (KeySplint Soft, NightGuard Flex 2, SmileGuard), 2 rigid 3D printed materials (KeySplint Hard, NightGuard Firm 2), 1 milled material (Ceramill A-Splint), 1 thermoform material (Erkoloc-Pro), 1 light-polymerized material (Eclipse Prosthetic Resin), 1 heat-polymerized material (Excel Formula Heat Cure Denture Base Material), and 1 autopolymerized material (Great Lakes Splint Resin Acrylic) were prepared and wet polished with 1200-grit SiC paper. The specimens were placed in a modified Alabama wear testing device with spherical zirconia antagonists. The devices applied a 20-N load and 2-mm horizontal slide for 400 000 cycles, and the test was run in a 33% glycerin solution. Following the wear test, the volumetric wear was measured with an optical profilometer. The Vickers microhardness of the materials was also measured (n=3). Volumetric wear and microhardness were compared with 1-way ANOVAs and Tukey post hoc analyses (α=.05).

RESULTS

Significant differences were found between the wear of the different occlusal device materials (P<.001). The rigid 3D printed materials experienced similar wear as the light-polymerized, heat-polymerized, and milled occlusal device materials. The autopolymerized and thermoformed occlusal device material experienced significantly more wear (P<.05). The flexible 3D printed materials had the significantly greatest wear (P<.05). A statistically significant, strong negative correlation between hardness and volumetric wear was found (r=-.93; P<.001).

CONCLUSIONS

Rigid 3D printed occlusal device materials exhibit a high degree of wear resistance; however, flexible 3D printed occlusal device materials exhibit relatively low wear resistance.

Comparative analysis of polishing protocols on microhardness and surface roughness of occlusal device materials fabricated using microwave-polymerized acrylic or 3D printed resins

STATEMENT OF PROBLEM

With advancements in digital technologies, the digital workflow has revolutionized the fabrication of occlusal devices through additive methods using 3-dimensional (3D) printing. However, an established protocol for polishing 3D printed occlusal devices is lacking, despite this step being crucial for minimizing surface porosity, material fatigue and preventing bacterial plaque accumulation, thereby contributing to device longevity.

PURPOSE

The purpose of this in vitro study was to evaluate the impact of polishing systems on the surface roughness and Vickers microhardness of heat-polymerizing acrylic resin and 3D printing resins used for occlusal devices.

MATERIAL AND METHODS

One hundred and twenty microwaved-polymerized acrylic resin and 3D printed resin specimens (40×40×3 mm) were divided into 12 groups (n=10) based on the type of resin and polishing protocol (Sealant, DhPro, Dhpro + Sealant, Trihawk, Trihawk + Sealant, and control). Surface roughness (Ra) and Vickers microhardness were tested. Additionally, 1 specimen per group underwent scanning electron microscopy before and after thermocycling (5000 cycles, 5 ºC and 55 ºC). Data analysis involved a 2-way ANOVA, 2-way repeated measured ANOVA, and Tukey's multiple comparison test (α=.05).

RESULTS

The Trihawk polishing protocol yielded significantly higher microhardness and lower surface roughness values for both resins. After thermocycling, the acrylic resin maintained its surface roughness for the Trihawk, Trihawk + Sealant, and unpolished groups, but all groups showed decreased microhardness. The 3D printing resin exhibited increased surface roughness and reduced microhardness after thermocycling across all groups.

CONCLUSIONS

The polishing protocol affects the surface microhardness and roughness of 3D printing resins and microwave acrylic resins for occlusal devices. Polishing using the Trihawk polishing protocol demonstrated significantly smoother and harder surfaces for both resins tested.

Influence of 3D printing system, postpolymerization and aging protocols on resin flexural strength and dimensional stability for printing occlusal splints, models and temporary restorations

OBJECTIVES

Investigate the effect of different postpolymerization protocols, aging, and 3D printing systems on the flexural strength (σ), dimensional stability, and roughness of resins used to fabricate occlusal splints, dental models, and temporary restorations.

MATERIAL AND METHODS

180 bars (25 × 2 x 2 mm-ISO 4049) of each type of resin (T-Temporary/Cosmos Temp, Yller; OS-Occlusal splint/Cosmos Splint, Yller; MO - Models/ Cosmos Model, Yller) were printed and divided into 12 groups (n = 15) according to the factors: "Postpolymerization" (Ctr - Control; UV - Ultraviolet oven and MW - Microwave); "Printer" (SLA- stereolithography (Forms 2/Formslab); LCD- liquid crystal display (FlashForge Foto 6.0/FlashForge)) and "Aging" (TC - 10,000 thermocycling cycles and Without). Each bar was measured with a digital caliper at 11 points before and after postpolymerization to evaluate dimensional stability. The samples were subjected to the σ test (100Kgf;1 mm/min). Data was evaluated using Three- and Two-way ANOVA, and Tukey's test (5%). Weibull analysis, Scanning Electron Microscopic and optical profilometry was performed.

RESULTS

LCD printing system and UV oven postpolymerization exhibited the highest σ (P < .05). The groups printed in SLA and post-polymerized in microwave ovens showed the greatest variations in their dimensions, for the occlusal splint resin, the OS-SLA-MW group (-4.29 ± 3.15)A showed a shrinkage of 40.2%. The resins for models (3.31 ± 0.66)A and temporary (-2.06 ± 1.52)A showed a shrinkage of 33% and 20.6%, respectively.

CONCLUSIONS

LCD printing with UV light postpolymerization was the most effective method for resins used in occlusal splints, dental models, and temporary restorations. SLA printing with UV postpolymerization showed the most significant dimensional changes, leading to shrinkage in occlusal splint resins, while model resins and temporary restorations expanded.

CLINICAL RELEVANCE

Resins for 3D printing should ideally be post-polymerized with UV light and printed using LCD technology, as this approach results in better mechanical properties and less dimensional change compared to microwave oven post-polymerization.

Effect of ethylene oxide unit number in bis-EMA on the physical properties of additive-manufactured occlusal splint material

PURPOSE

To investigate the effects of the number of ethylene oxide units in bis-EMA on the physical properties of additively manufactured occlusal splints.

METHODS

Seven experimental materials containing bis-EMAs with three and 10 ethylene oxide units (BE3 and BE10, respectively) were prepared at different BE10 content rates (BE10-0%, -20%, -30%, -40%, -50%, -60%, and -80%). Half the specimens of each material were aged in boiling water. Flexural strength (FS), flexural modulus (FM), fracture toughness (FT), microwear depth (MD), degree of conversion (DC), water sorption (WSP), water solubility (WSL), color difference between non-aged and aged series (ΔE), and translucency (TP) were evaluated. All the evaluated properties other than FS and MD were analyzed by 1-way ANOVA and Tukey's post hoc analysis, while FS and MD were analyzed by Kruskal-Wallis's test and Bonferroni correction (α=0.05).

RESULTS

BE10-80% revealed the lowest FS (P < 0.01 for BE10-0%, -20%, and -30%) and FM (P < 0.01, for all), while revealing the highest DC, WSP, WSL (P < 0.01 for all) and TP (P < 0.01 for all other than BE10-60%). BE10-50% showed the highest FT (P < 0.01 for all). BE10-50%, -60%, and -80% revealed significantly lower ΔE than others (P < 0.01) and lower MD than BE10-0% (P < 0.05). Regardless of the BE10 content, FS, FM, and FT decreased with aging.

CONCLUSIONS

The number of ethylene oxide units affects the physical properties of additively manufactured occlusal splints. The higher number of ethylene oxide units in bis-EMA enhanced the microwear resistance, DC, WSP, WSL, color stability, and translucency, whereas it deteriorated the FS and FM.

Cameo and intaglio surface stability and variability of additively, subtractively, and conventionally manufactured occlusal devices after long-term storage

STATEMENT OF PROBLEM

Additive and subtractive manufacturing have become alternative technologies for fabricating occlusal devices. However, knowledge of the long-term stability of occlusal devices fabricated using these recent technologies is limited.

PURPOSE

The purpose of this in vitro study was to evaluate the cameo and intaglio surface stability and variability of additively, subtractively, and conventionally manufactured occlusal devices after 18 months of storage.

MATERIAL AND METHODS

A standard tessellation language (STL) file of a dentate maxillary typodont was used to design a master occlusal device. The STL file of this design was used to fabricate occlusal devices additively either with a digital light processing (AM-1) or a continuous liquid interface production (AM-2) printer, subtractively with 2 different 5-axis milling units (SM-1 and SM-2), and conventionally (TM-HP) (n=10). STL files of each device's cameo and intaglio surfaces were generated using a laboratory scanner after fabrication and after 18 months of storage in a moist environment. These generated files were imported into an analysis software program (Geomagic Control X) to analyze the dimensional stability of tested devices by using the root mean square method. The average deviation values defined the variability of measured changes over time. Cameo and intaglio surface deviations were analyzed using the Kruskal-Wallis and Dunn tests, while the variability of measured deviations was analyzed with 1-way analysis of variance and the Tukey HSD tests (α=.05).

RESULTS

Significant differences were observed among tested devices when the intaglio surface deviations and the cameo surface variability were considered (P<.001). SM-2 had significantly higher intaglio surface deviations than AM-1, SM-1, and AM-2 (P≤.036). Among the test groups, AM-1 had the greatest cameo surface variability (P≤.004).

CONCLUSIONS

SM-2 resulted in lower intaglio surface stability than the additive and the other subtractive manufacturing technologies, while AM-1 led to the highest cameo surface variability among the test groups.

Mechanical and physical properties of splint materials for oral appliances produced by additive, subtractive and conventional manufacturing

OBJECTIVES

To investigate the flexural strength (FS), elastic modulus (E), Martens hardness (HM), water sorption (wsp), water solubility (wsl) and degree of conversion (DC) of 3D-printed, milled and injection molded splint materials.

METHODS

Specimens (N = 1140) were fabricated from five 3D-printed (GR-22 flex, GR-10 guide, ProArt Print Splint clear, V-Print Splint, V-Print Splint comfort), five milled (BioniCut, EldyPlus, ProArt CAD Splint clear, Temp Premium Flexible, Thermeo) and two injection molded (PalaXPress clear, Pro Base Cold) materials. FS, E, HM, wsp, wsl and DC were tested initially (24 h, 37 °C, H2O), after water storage (90 d, 37 °C, H2O) as well as after thermal cycling (5000 thermal cycles, 5/55 °C). Data were analyzed with Kolmogorov-Smirnov, Kruskal- Wallis, Mann-Whitney U test and Spearman's correlation (p < 0.05).

RESULTS

Initially, the mean flexural strength values ranged from 1.9 to 90.7 MPa for printed, 3.8 to 107 MPa for milled and 99.7 to 102 MPa for injection molded materials. The initial mean elastic modulus values were 0.0 to 2.4 GPa for printed, 0.1 to 2.7 GPa for milled and 2.8 GPa for injection molded materials. The initial mean Martens hardness values were 14.5 to 126 N/mm2 for printed, 50.2 to 171 N/mm2 for milled and 143 to 151 N/mm2 for injection molded materials. Initially, the mean water sorption values ranged from 23.1 to 41.2 μg/mm3 for printed, 4.5 to 23.5 μg/mm3 for milled and from 22.5 to 23.3 μg/ mm3 for injection molded materials. The initial mean water solubility values ranged from 2.2 to 7.1 μg/mm3 for printed, 0.0 to 0.5 μg/mm3 for milled and 0.1 to 0.3 μg/mm3 for injection molded materials. After water storage and thermal cycling most of the values decreased and some increased. The mean DC values ranged initially from 72.3 to 94.5 %, after water storage from 74.2 to 96.8 % and after thermal cycling from 75.6 to 95.4 % for the printed materials.

SIGNIFICANCE

The mechanical and physical properties of printed, milled and injection molded materials for occlusal devices vary and are influenced by aging processes. For clinical applications, materials need to be chosen according to the specific indications.

Effects of printing orientation and artificial ageing on martens hardness and indentation modulus of 3D printed restorative resin materials

BACKGROUND

Three-dimensional (3D) printing is increasingly used to fabricate dental restorations due to its enhanced precision, consistency and time and cost-saving advantages. The properties of 3D-printed resin materials can be influenced by the chosen printing orientation which can impact the mechanical characteristics of the final products.

PURPOSE

The objective of this study was to evaluate the influence of printing orientation and artificial ageing on the Martens hardness (HM) and indentation modulus (EIT) of 3D-printed definitive and temporary dental restorative resins.

METHODS

Disk specimens (20 mm diameter × 2 mm height) were additively manufactured in three printing orientations (0°, 45°, 90°) using five 3D-printable resins: VarseoSmile Crownplus (VCP), Crowntec (CT), Nextdent C&B MFH (ND), Dima C&B temp (DT), and GC temp print (GC). The specimens were printed using a DLP 3D-printer (ASIGA MAX UV), while LavaTM Ultimate (LU) and Telio CAD (TC) served as milled control materials. Martens hardness (HM) and indentation modulus (EIT) were tested both before and after storage in distilled water and artificial saliva for 1, 30, and 90 days at 37 °C.

RESULTS

90° printed specimens exhibited higher HM than the other orientations at certain time points, but no significant differences were observed in HM and EIT between orientations for all 3D-printed materials after 90 days of ageing in both aging media. LU milled control material exhibited the highest HM and EIT among the tested materials, while TC, the other milled control, showed similar values to the 3D printed resins. CT and VCP (definitive resins) and ND displayed higher Martens parameters compared to DT and GC (temporary resins). The hardness of the 3D-printed materials was significantly impacted by artificial ageing compared to the controls, with ND having the least hardness reduction percentage amongst all 3D-printed materials. The hardness reduction percentage in distilled water and artificial saliva was similar for all materials except for TC, where higher reduction was noted in artificial saliva.

SIGNIFICANCE

The used 3D printed resins cannot yet be considered viable alternatives to milled materials intended for definitive restorations but are preferable for use as temporary restorations.

Mechanical and biological properties of polymer materials for oral appliances produced with additive 3D printing and subtractive CAD-CAM techniques compared to conventional methods: a systematic review and meta-analysis

OBJECTIVES

The aim of this review was to analyze mechanical and biological properties of resin materials used with subtractive or additive techniques for oral appliances fabrication and compare them to those conventionally manufactured.

MATERIALS AND METHODS

The protocol was registered online at Open Science Framework (OSF) registries ( https://osf.io/h5es3 ) and the study was based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). An electronic search was conducted on MEDLINE (via PubMed), Scopus, and Web of Science from 1 February 2022 to 1 May 2022.

INCLUSION CRITERIA

in vitro and in vivo studies published in the last 10 years, with CAD-CAM or 3D printed resins for occlusal splints. Data considered homogenous were subjected to meta-analysis (95% confidence interval [CI]; α = 0.05) with Stata17 statistical software. Since all variables were continuous, the Hedge g measure was calculated. A fixed-effects model was used for I2 = 0%, while statistical analysis was conducted using a random-effects model with I2 > 0%.

RESULTS

13 studies were included after full-text reading. The mechanical properties most studied were wear, flexural strength, surface hardness and surface roughness, while only 1 study investigated biological properties, performing the XTT viability assay. For the meta-analysis, only surface roughness, volume loss, and flexural strength were selected. Considering surface roughness, the subtractive specimen had a lower average value compared to traditional ones (Hedge's g with 95% CI = -1.25[ -1.84, - 0.66]). No significant difference was detected in terms of volume loss (P > 0.05) between the groups (Hedge's g with 95% CI = -0.01 [-2.71, - 2.68]). While flexural strength was higher in the control group (Hedge's g with 95% CI = 2.32 [0.10-4.53]).

CONCLUSION

3D printed materials showed properties comparable to conventional resins, while milled splint materials have not shown better mechanical performance compared with conventional heat-cured acrylic resin. Polyetheretherketone (PEEK) have great potential and needs to be further investigated. Biological tests on oral cell populations are needed to confirm the long-term biocompatibility of these materials.

CLINICAL RELEVANCE

The use of "mixed splints" combining different materials needs to be improved and evaluated in future research to take full advantage of different characteristics and properties.

The Effect of Build Angle and Artificial Aging on the Accuracy of SLA- and DLP-Printed Occlusal Devices

The aim of this study is to investigate the influence of printing material, build angle, and artificial aging on the accuracy of SLA- and DLP-printed occlusal devices in comparison to each other and to subtractively manufactured devices. A total of 192 occlusal devices were manufactured by one SLA-printing and two DLP-printing methods in 5 different build angles as well as milling. The specimens were scanned and superimposed to their initial CAD data and each other to obtain trueness and precision data values. A second series of scans were performed after the specimens underwent an artificial aging simulation by thermocycling. Again, trueness and precision were investigated, and pre- and post-aging values were compared. A statistically significant influence was found for all main effects: manufacturing method, build angle, and thermocycling, confirmed by two-way ANOVA. Regarding trueness, overall tendency indicated that subtractively manufactured splints were more accurate than the 3D-printed, with mean deviation values around ±0.15 mm, followed by the DLP1 group, with ±0.25 mm at 0 degree build angle. Within the additive manufacturing methods, DLP splints had significantly higher trueness for all build angles compared to SLA, which had the highest mean deviation values, with ±0.32 mm being the truest to the original CAD file. Regarding precision, subtractive manufacturing showed better accuracy than additive manufacturing. The artificial aging demonstrated a significant influence on the dimensional accuracy of only SLA-printed splints.

Influence of print orientation and wet-dry storage time on the intaglio accuracy of additively manufactured occlusal devices

STATEMENT OF PROBLEM

Different factors can affect the manufacturing accuracy of additively manufactured dental devices; however, the influence of print orientation and wet-dry storage time on their intaglio accuracy remains uncertain.

PURPOSE

The purpose of this in vitro study was to assess the effect of print orientation (0, 45, 70, and 90 degrees) and wet-dry storage time (0, 30, 60, and 90 days) on the intaglio accuracy of additively manufactured occlusal devices.

MATERIAL AND METHODS

An occlusal device design was obtained in a standard tessellation language (STL) file format (control file) which was used to fabricate all the specimens by using a stereolithography printer (Form 3+) and a biocompatible resin material (Dental LT Clear Resin, V2). Four groups were created based on the print orientation used to manufacture the specimens: 0, 45, 70, and 90 degrees. Each group was divided into 4 subgroups depending on the time elapsed between manufacturing and accuracy evaluation: 0, 30, 60, and 90 days. For the subgroup 0, a desktop scanner (T710) was used to digitize all the specimens. The 30-day subgroup specimens were stored for 30 days with the following daily storage protocol: 16 hours inside a dry lightproof container, followed by 8 hours in artificial saliva (1700-0305 Artificial Saliva) inside the same lightproof container. The specimens were then digitized by following the same procedures used for subgroup 0. For the subgroups 60 and 90, the identical procedures described for subgroup 30 were completed but after 60 and 90 days of storage, respectively. The reference STL file was used to measure the intaglio discrepancy with the experimental scans obtained among the different subgroups by using the root mean square error calculation. Two-way ANOVA and post hoc Tukey pairwise comparison tests were used to analyze the data (α=.05).

RESULTS

Print orientation (P<.001) and usage time (P<.001) were significant predictors of the trueness value obtained. Additionally, the 0-degree print orientation at day 0 group demonstrated the best trueness value among all the groups tested (P<.05). No significant trueness discrepancies were found among the 45-, 70-, and 90-degree print orientation, or among the 30, 60, and 90 days of storage. A significant precision difference was found in the variance between print orientation groups across usage time subgroups.

CONCLUSIONS

The print orientation and wet-dry storage times tested influenced the trueness and precision of the intaglio surfaces of the occlusal devices manufactured with the 3D printer and material selected.

Effect of material and antagonist type on the wear of occlusal devices with different compositions fabricated by using conventional, additive, and subtractive manufacturing

STATEMENT OF PROBLEM

Additive (AM) and subtractive (SM) manufacturing have become popular for fabricating occlusal devices with materials of different chemical compositions. However, knowledge on the effect of material and antagonist type on the wear characteristics of occlusal devices fabricated by using different methods is limited.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of material and antagonist type on the wear of occlusal devices fabricated by using conventional manufacturing, AM, and SM.

MATERIAL AND METHODS

Two-hundred and forty Ø10×2-mm disk-shaped specimens were fabricated by using heat-polymerized polymethylmethacrylate (control, CM), AM clear device resin fabricated in 3 different orientations (horizontal [AMH], diagonal [AMD], and vertical [AMV]), SM polymethylmethacrylate (SMP), and SM ceramic-reinforced polyetheretherketone (SMB) (n=40). Specimens were then divided into 4 groups based on the antagonists: steatite ceramic (SC); multilayered zirconia (ZR); lithium disilicate (EX); and zirconia-reinforced lithium silicate (ZLS) used for thermomechanical aging (n=10). After aging, the volume loss (mm3) and maximum wear depth (μm) were digitally evaluated. Data were analyzed with 2-way analysis of variance and Tukey honestly significant difference tests (α=.05).

RESULTS

The interaction between the device material and the antagonist affected volume loss and maximum depth of wear (P<.001). AMH had volume loss and depth of wear that was either similar to or higher than those of other materials (P≤.044). When SC was used, CM had higher volume loss and depth of wear than AMV, and, when EX was used, AMD had higher volume loss and depth of wear than SMP (P≤.013). SC and ZR led to higher volume loss of CM and AMH than EX and led to the highest depth of wear for these materials, while ZR also led to the highest volume loss and depth of wear of AMD and AMV (P≤.019). EX led to the lowest volume loss and depth of wear of AMV and SMP and to the lowest depth of wear of AMH (P≤.021). Regardless of the antagonist, SMB had the lowest volume loss and depth of wear (P≤.005).

CONCLUSIONS

AMH mostly had higher volume loss and depth of wear, while SMB had the lowest volume loss, and its depth of wear was not affected by the tested antagonists. ZR mostly led to higher volume loss and maximum depth of wear, while EX mostly led to lower volume loss and maximum depth of wear of the tested occlusal device materials.

Evaluation of the clinical performance of different occlusal device materials

STATEMENT OF PROBLEM

Computer aided technologies have been used to fabricate occlusal devices. However, the clinical behavior of the newly developed materials developed for occlusal devices is unknown.

PURPOSE

The purpose of this prospective, double-blind study was to assess the clinical efficacy of recently introduced computer-aided design and computer-aided manufacturing (CAD-CAM) materials for the fabrication of occlusal devices.

MATERIAL AND METHODS

A total of 24 participants were divided randomly into 2 study groups; polyetheretherketone (PEEK) and polymethyl methacrylate (PMMA), and a control group (CG). Conventional impressions and gypsum casts were obtained from all participants. In the study groups, the casts were digitalized with an extraoral digital scanner, designed with a software program (Bite Occlusal Device Module; exocad GmbH) and milled from PEEK and PMMA blocks. Clear resin sheets were used for occlusal device fabrication in the CG. The baseline measurements were made during the initial appointments. After 6 months, the participants returned for follow-up evaluations. Clinical performance based on surface roughness, wear of the antagonist teeth, occlusal device fit and therapeutic effect, as well as participant satisfaction were compared using the 1-way ANOVA test between the main groups (α=.05). The post hoc and Kruskal Wallis-H tests were used to compare the nonparametric group.

RESULTS

The therapeutic effects of the occlusal devices did not differ. All participants showed improvement in palpation and mandibular movement scores, but no statistically significant differences were found among the groups (P>.05). PEEK and PMMA had statistically less surface wear than CG (P<.001) and led to less antagonist tooth wear. No significant participant satisfaction difference was seen among the groups (P>.05). The control group had the best fit (P<.001).

CONCLUSIONS

Recent CAD-CAM materials exhibit clinically acceptable outcomes, and their performance is comparable with that of traditional materials. CAD-CAM materials appear suitable in terms of accuracy, surface wear, and therapeutic efficacy.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Post-polymerization of three-dimensional printing resin using a dental light curing unit

Background/Purpose

In vat photopolymerization, post-polymerization of the three-dimensional (3D) printing resin is necessary to ensure the optimum physical properties of the printed objects. This study aimed to evaluate the potential use of a handheld polywave light-emitting diode (LED) dental light-curing unit (LCU) for post-polymerizing 3D printed resins by measuring the microhardness and biaxial flexural strength of the post-polymerized resin.

Material and methods

3D printed 1- and 2-mm-thick disks were irradiated with a dental LCU at 3200 mW/cm2. Post-polymerization was repeated either on one side from the top surface: two cycles (T2), four cycles (T4), and eight cycles (T8), or on both sides from the top and bottom surfaces: one cycle (T1B1), two cycles (T2B2), and four cycles (T4B4) for each side. The microhardness and biaxial strength of the disks were compared to those post-polymerized by a conventional desktop polymerizing unit (PC) and those without post-polymerization (NC).

Results

Microhardness of the disks varied between the top and bottom surfaces of the 1-mm and 2-mm-thick disks, depending on the post-polymerization methods. T8 and T4B4 produced comparable microhardness on the top surface to PC for both thicknesses. In contrast, PC, T2B2, and T4B4 exhibited the highest microhardness on the bottom surface. Except for NC, the 1-mm-thick disks had a higher biaxial flexural strength than the 2-mm-thick disks. T4B4 resulted in the highest biaxial flexural strength for both thicknesses, which was comparable to that of the desktop polymerizing unit.

Conclusion

The microhardness and biaxial flexural strengths of the post-polymerized 3D-printed disks increase with polymerization time. With sufficient polymerization from both sides, the polywave LCU has the potential to be a viable alternative to desktop polymerization units.

Fully digital workflow for the fabrication of occlusal stabilization splints based on individual mandibular movement

OBJECTIVE

This study was conducted to present a completely digital workflow for the fabrication of occlusal stabilization splints using CAD/CAM systems and a digital face bow based on optical sensor technology.

METHODS

Digital scans of the maxillary and mandibular arches of 20 volunteers were obtained using an intraoral scanner. Jaw relation and mandibular movements were recorded with a digital face bow via optical sensors. The virtual increase of the vertical dimension of occlusion (VDO) was then performed, after which computer-aided design (CAD) of the occlusal stabilization splints was carried out. The corresponding splints were then manufactured using digitally controlled technology.

RESULTS

A completely digital workflow for the manufacturing of occlusal stabilization splints was found to be clinically feasible. The corresponding data analysis revealed high congruence between virtual and physical occlusal contacts on the occlusal splint. Moreover, the appropriate guidance of the anterior teeth area was easily obtainable, and the time for adjusting the occlusion was less.

CONCLUSIONS

This study demonstrated that the fabrication of occlusal stabilization splints using a fully digital workflow is feasible. Compared to traditional impression-based manufacturing, several advantages of digital manufacturing include easy accessibility, time-efficient manufacturing, high-level accuracy in splint quality, and potential to manufacture duplicate splints.

CLINICAL SIGNIFICANCE

The proposed fully digital approach may help young dentists fabricating stable occlusal splints with beneficial curative effects. Meanwhile, it could also improve the production efficiency of stable occlusal splints, saving time for both doctors and patients while reducing labor costs.

Impact of effervescent denture cleaning tablets on color and surface characteristics of additively manufactured and hand-cast splint materials

OBJECTIVES

This study is to evaluate the color stability, surface roughness, and hardness of additively manufactured and hand-cast splint materials after a 6-month commercially available denture cleaning tablet immersion simulation.

MATERIALS AND METHODS

Disc-shaped additively manufactured and hand-cast auto polymerizing acrylic resin specimens were prepared (N = 40 each). All specimens were exposed to coffee solution totally 2 days. Thereafter, all specimens were immersed into three different effervescent solutions that simulated 6 months of clinical use. The total color change (ΔE*ab), surface roughness (Ra), and Vickers hardness (Vh) were measured at baseline and after immersion protocols. A two-way ANOVA and Bonferroni's post hoc test were used for color change. The dependent t-test and ANOVA were used for roughness and hardness evaluation.

RESULTS

Additively manufactured splint materials were more affected by coffee immersion. It was observed that all denture cleaning tablets induced a noticeable alteration in color of the specimens (p < 0.05). Roughness and hardness measurement changes after solution immersions were statistically significant for both splint groups (p < 0.05). On the other hand, distilled water and denture cleaning tablets created similar roughness and hardness measurements at baseline and after immersion.

CONCLUSIONS

After 6 months use of tested cleaning tables, the color stability, surface roughness, and hardness of both groups were affected. The evaluation of the surface properties of splint materials could be recommended to the dentists in periodic controls during splint treatments.

CLINICAL RELEVANCE

The use effervescent denture cleaning tablets altered the surface characteristics of tested splint materials over time with nonsignificant difference between each other. After 6 months, awareness should be raised about surface characteristics of splint materials.

Mechanical and chemical characterization of contemporary occlusal splint materials fabricated with different methods: a systematic review

OBJECTIVE

To systematically review studies on various occlusal splint materials and describe their mechanical and chemical properties.

METHODS

MEDLINE (PubMed), Scopus, and Web of Science searches were conducted for in vitro studies focusing on occlusal splint materials. Two reviewers performed an assessment of the identified studies and data abstraction independently, and this was complimented by an additional hand search. The articles were limited to those in the English language that were published between January 1st, 2012, and December 1st, 2022.

RESULTS

The initial search yielded 405 search results of which 274 were selected for full-text review following abstract evaluation. 250 articles that did not meet the inclusion criteria were excluded, and the remaining 25 articles (with 1 article identified from the reference lists of included articles) providing mechanical and chemical values were used in this review. Poly methyl methacrylate (PMMA) -based occlusal splint materials showed the highest values in terms of hardness, wear resistance, flexural strength, flexural modulus, e-modulus, and fracture toughness. The material group with the highest water sorption and water solubility was 3D printed (PR) splint materials. In addition, the lowest degree of double bond conversion was also observed in this group of materials.

CONCLUSIONS

The outcome of this review suggests that mechanically and chemically acceptable properties can be attained with PMMA-based occlusal splint materials using both conventional and digital production methods. PR splint materials should not be considered as the primary choice for long-term treatments due to their low mechanical and chemical properties.

CLINICAL RELEVANCE

This review provides clinical recommendations for selecting the appropriate material and fabrication method for occlusal splints while taking the patients' needs and the materials´ mechanical and chemical properties into account.

Comparative Analysis between Conventional Acrylic, CAD/CAM Milled, and 3D CAD/CAM Printed Occlusal Splints

The development of digital technologies has allowed for the fabrication of new materials; however, it makes it difficult to choose the best methods to obtain occlusal splints with optimal properties, so it is essential to evaluate the effectiveness of these materials. The aim of the study is to compare the fracture resistance of occlusal splints made of different materials after thermo-mechanical aging.

METHODS

A total of 32 samples were made from 4 materials (two 3D printed polymeric materials, a PMMA disc for CAD/CAM, and a conventional heat-cured acrylic resin); subsequently, the fracture test was performed using the load compression mode applied occlusally on the splint surface.

STATISTICAL ANALYSIS

Four statistical tests were used (Shapiro-Wilk, Levene's test, ANOVA, and Tukey's HSD test).

RESULTS

The following study showed that there are differences in fracture strength among the four materials investigated, where the highest strength was observed in the milled splint, with a mean of 3051.2 N (newton) compared to the strength of the flexible splint with 1943.4 N, the printed splint with 1489.9 N, and the conventional acrylic splint with 1303.9 N.

CONCLUSIONS

The milled splints were the most resistant to fracture. Of the printed splints, the splint made with flexural rigid resin withstood the applied forces in acceptable ranges, so its clinical indication may be viable. Although the results of this research indicated differences in the mechanical properties between the CAD/CAM and conventional fabrication methods, the selection may also be influenced by processing time and cost, since with a CAD/CAM system there is a significant reduction in the production time of the splint material.

Implementation of a Full Digital Workflow by 3D Printing Intraoral Splints Used in Dental Education: An Exploratory Observational Study with Respect to Students' Experiences

Fully digital workflows gained acceptance in dental practice and thereby are of interest for undergraduate education. An exploratory clinical observation was designed to track the implementation of such a workflow with novice digital users in order to describe its feasibility, time investment, and pitfalls.

METHODS

Students were invited to provide feedback for their experiences with a training module that consisted of the following: intraoral scanning, computer-aided design (CAD), manual finishing, and insertion of a 3D-printed bite splint for the lower jaw.

RESULTS

A total of 82 fourth-year students participated in the module. The average time required to perform an intraoral scan was 17 m 5 s, and all students were able to design a splint with an average time of 2 h 38 m. Students who indicated prior experience with CAD seem to outperform inexperienced students in both CAD task completion and intraoral scanning. The initial fit was reported as clinically acceptable by 68.5% of the participants, while 79% rated the workflow as very good to satisfactory and indicated that the training was helpful for dental practice.

CONCLUSIONS

The implementation of a digital workflow in undergraduate dental education is feasible and has acceptable clinical results. However, CAD is time-intensive, and the experience can be challenging.

Effect of Nitrogen Gas Post-Curing and Printer Type on the Mechanical Properties of 3D-Printed Hard Occlusal Splint Material

Although three-dimensional (3D) printing is clinically convenient to fabricate occlusal splints, it is still unclear how the post-curing method and the printer type can affect 3D-printed splints. This study aimed to evaluate the effect of stroboscopic post-curing at a nitrogen gas (N2) atmosphere versus post-curing in an air atmosphere, as well as the printer type (liquid crystal display (LCD) and digital light processing (DLP)) on the mechanical properties of a 3D-printed hard-type occlusal splint material. Flexural strength, flexural modulus, Vickers hardness number (VHN), fracture toughness, degree of double bond conversion (DC), 3D microlayer structure, water sorption, and water solubility were evaluated. The post-curing method significantly affected all evaluated properties except fracture toughness and 3D microlayer structure, while the printer type significantly affected all evaluated properties except flexural strength and flexural modulus. VHN and DC were significantly higher, and the smoother surface was noticeably obtained when printed by LCD printer and post-cured at an N2 atmosphere. The current results suggested that the post-curing method and the printer type would play a role in the mechanical properties of the evaluated material and that the combination of post-curing at an N2 atmosphere and LCD printer could enhance its mechanical properties and surface smoothness.

Effect of printing orientation and post-curing time on the flexural strength of 3D-printed resins

PURPOSE

To evaluate the effect of printing orientation combined with different post-curing times on the flexural strength of 3D-printed resins.

MATERIALS AND METHODS

A total of 480 rectangular specimens with the dimensions of 64×10×3.3 mm were designed and fabricated from two 3D printed acrylic resins and one heat-polymerized resin (HP). 3D-printed groups were divided into 3 groups according to printing orientations (0-, 45-, 90-degree); each group was subdivided into 4 groups according to post-curing time (30, 60, 90, 120 min.). All specimens were subjected to thermal cycling (10,000 cycles) before testing flexural strength. Fractured surfaces were examined under scanning electron microscope (SEM). ANOVA and Tukey's post hoc test were used for data analysis (α = 0.05).

RESULTS

The result of this study showed that the highest flexural strength values of 3D-printed resin (NextDent, and ASIGA) were in 0-degree groups. Also, the flexural strength values increased when post-curing time was increased regardless of the printing orientation and the highest flexural strength was recorded at 120 min post-curing time in all orientations. SEM analysis showed rougher surface with irregular lamellae which represented a ductile fracture confirming that high energy is required for crack propagation and these features markedly increased as post-curing time increased.

CONCLUSION

The results showed that the 0-degree orientation groups showed higher flexural strength compared to other groups. Similarly, with increased post-curing time, the flexural strength increased. This article is protected by copyright. All rights reserved.

Two-body wear of occlusal splint materials from subtractive computer-aided manufacturing and three-dimensional printing

OBJECTIVES

To investigate the two-body wear of occlusal splint materials fabricated from subtractive computer-aided manufacturing (CAM) compared to three-dimensional printing (3DP).

MATERIAL AND METHODS

Forty-eight substrates (n = 12/material) in the design of a mandibular first molar were fabricated using CAM (CAM-TD, Thermeo, pro3dure medical GmbH, Iserlohn, Germany; CAM-CL, CLEARsplint, Astron Dental Corporation, Lake Zurich, USA) and 3DP (3DP-GI, GR22 flex, pro3dure medical GmbH; 3DP-KY, KeySplint soft, Keystone Industries, Gibbstown, USA). The substrates were subjected to mastication simulation (120,000 cycles, 37 °C, 50 N, 1.3 Hz) opposed to enamel antagonists. The two-body wear was measured through matching of the scanned substrates before and after aging using Gaussian best-fit method. The damage patterns were categorized and evaluated based on microscopic examinations. Data was analyzed using Kolmogorov-Smirnov test followed by 1-way analysis of variance (ANOVA). Pearson correlation was calculated between vertical and volumetric material loss. The failure types were analyzed with Chi²-test and Ciba Geigy table.

RESULTS

No difference in two-body wear results between all materials was found (p = 0.102). Fatigue substrates showed a perforation for CAM and a fracture for 3DP. No abrasion losses on the antagonists were detected.

CONCLUSIONS

3DP substrates showed no differences in two-body wear compared to CAM ones but are more likely to show a fracture. None of the tested materials caused an abrasion on human teeth structure.

CLINICAL RELEVANCE

While therapies with occlusal splint materials are rising, 3DP offers a promising alternative to CAM in terms of production accuracy and therapeutic success at reduced costs.

Cytotoxicity of 3D‐printed, milled, and conventional oral splint resins to L929 cells and human gingival fibroblasts

Objectives

Evidence on the biocompatibility of three‐dimensional (3D)‐printed and milled resins for oral splints is limited. This in vitro study assessed the influence of the manufacturing method on the cytotoxicity of oral splint resins on L929 cells and human gingival fibroblasts (GF1).

Materials and Methods

Standardized specimens of four 3D‐printed, two‐milled, one‐thermoformed, and one‐pressed splint resin were incubated with L929 and GF1 cells for 24 h. Immunofluorescence and WST‐8 assay were performed to evaluate cytotoxic effects. One‐way analysis of variance and Tukey's multiple comparison test were applied with the variables “splint resin” and “manufacturing method” (p < .05).

Results

Immunofluorescence showed attachment of L929 and GF1 cells to the splint resins. Irrespective of the manufacturing method, the WST‐8 assay revealed significant differences between splint resins for the viability of L929 and GF1 cells. L929 cells generally showed lower viability rates than GF1 cells. The evaluation of cell viability by the manufacturing method showed no significant differences between 3D printing, milling, and conventional methods.

Conclusions

The cytotoxic effects of 3D‐printed, milled, and conventional oral splint resins were similar, indicating minor influence of the manufacturing method on biocompatibility. Cytotoxicity of the resins was below a critical threshold in GF1 cells. The chemical composition might be more crucial than the manufacturing method for the biocompatibility of splint resins.

CAD/CAM Diagnostic Esthetic Functional Splint (DEFS) as a Removable Prototype to Evaluate the Final Prosthetic Rehabilitation: A Narrative Review

The main objective of this narrative review was to provide an overview of DEFS (Diagnostic Esthetic Functional Splint), namely CAD/CAM manufactured, “snap-retained”, tooth-colored splints available by materials exhibiting a certain degree of elasticity (like polycarbonates or acetal resins) for restoring function, esthetics and occlusion in several clinical situations, before or as an intermediate alternative to undergoing the final treatment. The search strategy included all papers dealing with snap-retained prosthetic systems and was based on a literature review of papers available in electronic databases (Pubmed/Medline, Evidence-Based Dentistry, BMJ Evidence-Based Medicine, Dynamed, Embase, BMJ Clinical Evidence, Web of Science, Scientific reports); eligible papers were researched on Opengreyand a manual search was performed, as well. From the electronic databases emerged 13,199 records, many of which were duplicates. The grey literature and the manual research did not produce any eligible article. After duplicates removal, 7690 records were obtained. Titles, abstracts and keywords were analyzed. The studies concerning the topic of interest were examined by the reviewers and discussed. Although no evidence-based data were found in the literature, according to the authors’ clinical experience, the DEFS (Diagnostic Esthetic Functional Splint) is a very promising solution in multiple clinical situations, due to its diagnostic, therapeutical, functional and esthetic versatility.

Accuracy of 3D-Printed Occlusal Devices of Different Volumes Using a Digital Light Processing Printer

(1) Background: This in-vitro study was designed to investigate the accuracy of CAD/CAM fabricated occlusal devices with different heights and volumes. (2) Methods: Based on an intraoral scan, an occlusal device with a vertical bite elevation of 2.5 mm and 4.5 mm was digitally designed and 3D printed 10 times. The fabricated occlusal devices were digitized by an industrial structured light scanner (ILS) and provided in stl-format as test objects. The test objects were superimposed with the design dataset as reference to evaluate the accuracy of complete surfaces ([2.5_TOTAL] and [4.5_TOTAL]) with respect to their internal surfaces ([2.5_INTERNAL] and [4.5_INTERNAL]). The mean trueness and precision were calculated based on absolute mean deviation. Absolute and relative volume differences between reference and test were computed. Statistical significances were analyzed performing the Wilcoxon test (α = 0.05). (3) Results: As absolute mean deviation trueness values were obtained: 59 ± 5 µm for [2.5_INTERNAL], 98 ± 9 µm for [4.5_INTERNAL], 68 ± 1 µm for [2.5_TOTAL] and 90 ± 10 µm for [4.5_TOTAL]. The precision applying absolute mean deviation was 14 ± 8 µm for [2.5_INTERNAL], 22 ± 11 µm for [4.5_INTERNAL], 19 ± 10 µm for [2.5_TOTAL] and 26 ± 13 µm for [4.5_TOTAL]. The mean trueness and precision values differed significantly. Volume differences of 2.11% for [4.5_TOTAL] and of 2.35% for [2.5_TOTAL] in comparison to their reference file were evaluated. (4) Conclusions: Printed occlusal devices with minor height and volume were more accurate. Both types of devices exhibited results that were comparable to the literature.

In Vitro Time Efficiency, Fit, and Wear of Conventionally- versus Digitally-Fabricated Occlusal Splints

The purpose of the study was to compare conventional to digital workflows of occlusal splint production regarding time efficiency, overall fit, and wear. Fifteen Michigan splints were fabricated with a conventional and digital method. The duration for the dentist's and the dental technician's workload was recorded. Subsequently, the overall fit was examined with a four-level score (1-4). Paired t-tests were used to compare the time results for the conventional and digital workflows and the sign test to compare the overall fit. The mean time (16 min 58 s) for computerized optical impressions was longer than for conventional impressions (6 min 59 s; p = 0.0001). However, the dental technician needed significantly less mean time for the digital splint production (47 min 52 s) than for the conventional (163 min 32 s; p = 0.001). The overall fit of the digitally-fabricated splints was significantly better compared to the conventionally-fabricated splints (p = 0.002). There was no impact of the different materials used in the conventional and digital workflow on the wear (p = 0.26). The results suggest that the digital workflow for the production of occlusal splints is more time efficient and leads to a better fit than the conventional workflow.

Evaluation of wear behaviour of various occlusal splint materials and manufacturing processes

OBJECTIVES

To investigate the volumetric and vertical loss of occlusal splints manufactured by conventional (heat-cure), subtractive (CAD/CAM) and additive (3D-printing) methods.

METHODS

Six occlusal splint materials were investigated (n = 126), using three manufacturing methods: heat-cured, CAD/CAM and 3D-printed built-in three different printing angles (0°,45°and 90°). Block-on-ring wear testing was performed with extracted human molars as the antagonist. All samples were tested with an applied force of 49N at 1 Hz and 60RPM in artificial saliva at 37 °C for six and 12 months. Scanning electron microscopy images were analysed to evaluate the wear on the tooth enamel and in the splint material. Volumetric and vertical wear loss were statistically analysed.

RESULTS

The lowest volumetric and vertical loss was observed in CAD-CAM materials (6.44 ± 1.77 mm³ and 48.3 ± 7.14 μm) with no statistical significance to the heat-cured material (17.22 ± 9.23 mm³ and 148 ± 121.1 μm) after 12 months (p < 0.172). The mean volumetric loss of 3D printed materials ranged from 0.25 ± 0.15 mm³ to 0.29 ± 0.1 4mm³ with no statistical difference, whereas, the differences in vertical loss from 131.63 ± 44.1 μm to 493 ± 79.19 μm were statistically significant (p < 0.001). The highest vertical loss was observed in the KeySplint Soft 3D printed at 90° (385.35 ± 82.37 μm), whereas FreePrint Splint 2.0 with a build angle of 0° had the highest volumetric loss (204.59 ± 25.67 mm³).

CONCLUSION

CAD-CAM material had the highest wear resistance followed by heat-cured material.KeySplint Soft and FreePrint Splint 2.0 3D printed materials would be preferred for patients that do not have severe bruxing episodes. No significant wear of human enamel after six and 12 months was observed under SEM for any tested materials.

Characterization of occlusal splint materials: CAD-CAM versus conventional resins

AIM

The aim of this in vitro study was to assess the mechanical properties of five commercially available subtractive computer-aided design and computer-aided manufacturing (CAD-CAM) milled splint materials, as well as to compare them with conventional heat-polymerized and autopolymerizing resins used in the construction of conventional splints.

MATERIAL AND METHODS

Five CAD-CAM milled (ProArt CAD Splint, Therapon Transpa, Temp Premium Flexible Transpa, Cast, and Aqua), one autopolymerizing (Palapress), and one heat-polymerized (Paladon 65) resin materials were evaluated. Flexural strength, E-modulus, Vickers hardness, fracture toughness, fracture work, water sorption, and water solubility were measured. Samples were evaluated after dry and water storage for 30 days at 37 °C. Data were collected and statistically analyzed.

RESULTS

Under both storage circumstances, the flexural strength values of Paladon 65, Therapon Transpa, Temp Premium Flexible Transpa, and Aqua were statistically non-significant (P=0.055). The polycarbonate-based CAD-CAM material Temp Premium Flexible Transpa had the highest statistically significant values of the fracture toughness and fracture work (P<0.001). Moreover, it exhibited the lowest percentages of water sorption and water solubility among the investigated materials (P<0.001). All of the CAD-CAM materials exhibited dry elastic moduli greater than Palapress and lower than Paladon 65. One of the CAD-CAM materials, Cast, had the highest dry Vickers hardness value, which was non-significant when compared to Therapon Transpa (P=0.762).

CONCLUSION

CAD-CAM polycarbonate-based splint materials exhibit higher fracture toughness and fracture work as well as lower water sorption and solubility than polymethyl methacrylate-based ones. The mechanical characteristics of the assessed CAD-CAM milled splint materials were not typically superior to those of the conventional heat-polymerized resin. However, some of them outperformed the autopolymerizing acrylic resin in terms of flexural strength, surface microhardness, water sorption, and water solubility.

Wear Behavior of Occlusal Splint Materials Manufactured By Various Methods: A Systematic Review

PURPOSE

To systematically review studies on various materials and methods used for wear testing of occlusal devices and their antagonists in vitro and in vivo.

METHODS

An electronic search in OVID, Web of Science, PubMed and Scopus was conducted using the following terms (MeSH words) with any synonyms and closed terms: "Splint*" OR "occlusal splint*" OR "night guard" OR "occlusal device" OR "occlusal devices" OR "deprogrammer" OR "bite splint" OR "bite plane" OR "orthotic appliance*" OR "orthotic devices" AND "wear" OR "two-body wear" OR "three-body wear" OR "tooth wear" OR "wear measurement*" OR "wear behaviour" OR "wear behavior" OR "abrasion" AND "Polymethyl Methacrylate" OR "PMMA" OR "acrylic resin*" OR "dental material*" OR "dental enamel" OR "CAD" OR "CAM" OR "PEEK" OR "material* testing". Database search was limited to English-language publications and published between 2001 and 1st of September 2021. A further hand search was done to ensure all materials were captured.

RESULTS

After the removal of duplicates, 115 studies were identified, and 11 were chosen for review. Studies showed that the lowest volumetric loss was observed in PEEK occlusal device materials, whereas heat-cure, CAD-milled, and 3D printed occlusal device materials had no significant difference in wear. Vacuum-formed materials showed the highest wear among all groups. Testing parameters were found to be inconsistent across all studies.

CONCLUSION

There is a need for standardization of in vitro and in vivo wear measurement and testing protocols as this study revealed a wide variety of testing protocols which potentially could influence the outcome. Polishing procedures are required for the material. Limited studies are available on 3D printed occlusal device materials and would therefore require further investigation, especially on printing build angles and settings. Further clinical studies would be advantageous to provide guidance on the selection of the best occlusal device material that would last the longest without remake.

Strength and Surface Properties of a 3D-Printed Denture Base Polymer

PURPOSE

This in vitro study evaluated the flexural strength, impact strength, hardness, and surface roughness of 3D-printed denture base resin subjected to thermal cycling treatment.

MATERIALS AND METHODS

According to ISO 20795-1:2013 standards, 120 acrylic resin specimens (40/flexural strength test, 40/impact strength, and 40/surface roughness and hardness test, n = 10) were fabricated and distributed into two groups: heat-polymerized; (Major.Base.20) as control and 3D-printed (NextDent) as experimental group. Half of the specimens of each group were subjected to 10,000 thermal cycles of 5 to 55°C simulating 1 year of clinical use. Flexural strength (MPa), impact strength (KJ/m² ), hardness (VHN), and surface roughness (μm) were measured using universal testing machine, Charpy's impact tester, Vickers hardness tester, and profilometer, respectively. Data were analyzed by ANOVA and Tukey honestly significant difference (HSD) test (α = 0.05).

RESULTS

The values of flexural strength (MPa) were 86.63 ± 1.0 and 69.15 ± 0.88; impact strength (KJ/m² )-6.32 ± 0.50 and 2.44 ± 0.31; hardness (VHN)-41.63 ± 2.03 and 34.62 ± 2.1; and surface roughness (μm)-0.18 ± 0.01 and 0.12 ± 0.02 for heat-polymerized and 3D-printed denture base materials, respectively. Significant differences in all tested properties were recorded between heat-polymerized and 3D-printed denture base materials (P < 0.001). Thermal cycling significantly lowered the flexural strength (63.93 ± 1.54 MPa), impact strength (2.40 ± 0.35 KJ/m² ), and hardness (30.17 ± 1.38 VHN) of 3D-printed resin in comparison to thermal cycled heat-polymerized resin, but surface roughness showed non-significant difference (p = 0.262).

CONCLUSION

3D-printed resin had inferior flexural strength, impact strength, and hardness values than heat-polymerized resin, but showed superior surface roughness. Temperature changes (thermal cycling) significantly reduced the hardness and flexural strength and increased surface roughness, but did not affect the impact strength.

Effect of different fabrication methods of occlusal devices on periradicular stress distribution: A photoelastic analysis

STATEMENT OF PROBLEM

Investigations on the effectiveness of new methods for optimizing the fabrication of oral devices are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate stress distribution with photoelastic analysis in the periradicular area of teeth supporting occlusal devices fabricated by 5 different processes.

MATERIAL AND METHODS

The occlusal devices were fabricated by vacuum thermoforming, heat-polymerized acrylic resin, chemical polymerized acrylic resin, 3-dimensional printing, and milling (computer-aided manufacturing). The devices were evaluated regarding initial fit, number of adjustments for passive fit, and stress distribution under 100-N and 400-N loads in the periradicular locations of posterior teeth.

RESULTS

The 3-dimensional printing device did not require any adjustment for initial adaptation to the photoelastic model and presented a little friction with the model. The heat-polymerized acrylic resin device did not seat initially, requiring more sites of adjustment until passive adaptation. At 100-N and 400-N loads, the use of the computer-aided manufacturing occlusal device resulted in the lowest stresses in periradicular areas (0.744 and 1.583, respectively), and the 3-dimensional printing occlusal device produced the highest stresses with a 400-N load application (2.427). The lowest mean of fringe pattern was observed for the computer-aided manufacturing device, and the highest mean of fringe pattern was observed for the vacuum thermoforming device.

CONCLUSIONS

The computer-aided design and computer-aided manufacturing milled occlusal device presented the best initial adaptation and transferred lower stresses to the periradicular areas than the other evaluated devices.

Bonding Interface and Repairability of 3D-Printed Intraoral Splints: Shear Bond Strength to Current Polymers, with and without Ageing

This in-vitro study investigates the bonding interfaces reached by the conditioning of a splint material additively manufactured by digital light processing (AM base) as well as the shear bond strength (SBS) of resins bonded to these surfaces (repair material). Therefore, the AM base was either stored in dry for 12 h or wet environment for 14 days to simulate ageing by intraoral wear. The dry and wet group was bonded after physical and/or chemical conditioning to cylinders made from polymethylmethacrylate or four novel polymers allowing splint modifications. Blasted and methylmethacrylate (MMA)-conditioned Polymethylmethacrylate (PMMA) bonded to PMMA acted as the gold standard. The surface profiles revealed highest differences of Ra towards the gold standard in AM base conditioned with other than MMA after sandblasting. The adhesively bonded repair materials of the wet AM base were further aged in wet environment for 14 days. The SBS of the gold standard (25.2 MPa and 25.6 MPa) was only reached by PMMA bonded to blasted and MMA-conditioned AM base after dry (22.7 MPa) and non-conditioned after wet storage (23 MPa). Four repair materials failed to reach the threshold of 5 MPa after dry storage and three after wet storage, respectively. Non-conditioned AM base revealed the highest risk for adhesive fractures when using other resins than PMMA.

Effect of thermocycling on the surface properties of CAD-CAM denture base materials after different surface treatments

PURPOSE

To evaluate the effect of thermocycling on the water contact angle (WCA), surface roughness (SR), and microhardness (MH) of different CAD-CAM PMMA denture base materials after different surface treatments (conventional laboratory polishing, polishing kit, or surface sealant).

MATERIALS AND METHODS

Disk-shaped specimens (10 × 2 mm) of 3 different CAD-CAM PMMAs, AvaDent (AV); Merz M-PM (M-PM); Polident (Poli), and a conventional heat-polymerized PMMA (Vynacron) (CV) (n=21) were divided into 3 different surface treatment groups (n=7): conventional laboratory polishing (CLP), polishing with acrylic resin polisher kit (PK), and a surface sealant (Palaseal) (SSC). Stereomicroscopic images were taken both before and after thermocycling. WCA, SR, and MH of all specimens were measured before and after thermocycling and compared by using a 2-way ANOVA (α=0.05).

RESULTS

After thermocycling, WCA significantly increased for CLP- or PK -applied (P<.001) specimens of all materials and SSC-applied M-PM (P=.002), SR significantly increased for CLP-applied M-PM (P=.027) and PK-applied Poli (P=.041), and MH significantly decreased for CLP- or PK-applied AV (P = .001, P < .001, respectively), CV (P=.033, P=.023, respectively), and M-PM (P=.003, P=.001, respectively), SSC-applied M-PM (P<.001), and CLP-applied Poli (P<.001). Stereomicroscopic images revealed rougher surfaces for PK-applied specimens.

CONCLUSIONS

After thermocycling, surface treatment had a significant effect on water contact angle and surface roughness. CLP or PK application resulted in hydrophobic surfaces compared with before thermocycling. CLP or SSC application on CAD-CAM PMMAs resulted in smoother surfaces. Thermocycling lowered the microhardness of all PMMAs, and the decrease was significant in CLP- or PK-applied PMMAs, except for PK-applied Poli.

Influence of the Manufacturing Method on the Adhesion of Candida albicans and Streptococcus mutans to Oral Splint Resins

Microbial adhesion to oral splints may lead to oral diseases such as candidiasis, periodontitis or caries. The present in vitro study aimed to assess the effect of novel computer-aided design/computer-aided manufacturing (CAD/CAM) and conventional manufacturing on Candida albicans and Streptococcus mutans adhesion to oral splint resins. Standardized specimens of four 3D-printed, two milled, one thermoformed and one pressed splint resin were assessed for surface roughness by widefield confocal microscopy and for surface free energy by contact angle measurements. Specimens were incubated with C. albicans or S. mutans for two hours; a luminometric ATP assay was performed for the quantification of fungal and bacterial adhesion. Both one-way ANOVA with Tukey post hoc testing and Pearson correlation analysis were performed (p < 0.05) in order to relate manufacturing methods, surface roughness and surface free energy to microbial adhesion. Three-dimensional printing and milling were associated with increased adhesion of C. albicans compared to conventional thermoforming and pressing, while the S. mutans adhesion was not affected. Surface roughness and surface free energy showed no significant correlation with microbial adhesion. Increased fungal adhesion to oral splints manufactured by 3D printing or milling may be relevant for medically compromised patients with an enhanced risk for developing candidiasis.

The effect of time on mechanical properties of biocompatible photopolymer resins used for fabrication of clear dental aligners

Clear dental aligners are used for treating orthodontic anomalies (misaligned teeth, inappropriate contact between upper and lower teeth etc.), minor irregularities and bruxism. Using additive manufacturing technologies clear dental aligners are made of biocompatible photopolymer, using a vat photopolymerization technology. One of problems in application is the change of aligner material properties after production, including strength and elongation at failure. This can cause different sequence of tooth displacement which will not correspond to the planned therapy. In this paper three types of material testing are conducted i.e., tensile, compressive and three-point bending testing on specimens of 1 (24 h), 3 (72 h), 5 (120 h) and 7 (168 h) days old. Mechanical properties, such as tensile, compressive and flexural strength and strain at failure are monitored in order to show the effect of time on biocompatible photopolymer resin.

Comparison of hardness and polishability of various occlusal splint materials

OBJECTIVES

To measure polishability of occlusal splint materials manufactured by various methods.

METHODS

Seven occlusal splint materials manufactured by four different methods - Heat cured (Vertex Rapid simplified Clear), CAD-milled (Ceramill a-splint), Vacuum-formed (Proform splint) and 3D-printed (Freeprint Ortho, KeySplint Soft, DentaClear and FreePrint Splint 2.0) were tested for gloss, roughness, and surface hardness and elastic modulus. For all groups, the tests were repeated with the materials polished with three different polishing burs, pumice and high shine. All polishing procedures were standardised by applying the force of 1 N for 1 min at the set speed. 3D printed materials were further tested with additional specimens manufactured at different printing angles of 0°, 45° and 90°. Data was statistically analysed using ANOVA (SPSS Version 26) and MatLab (R2020a). Polished surfaces of each specimen were analysed under scanning electron microscope.

RESULTS

Vacuum-formed materials showed the highest polishability (80.61 ± 0.98 GU) with no statistical significance to heat-cured or CAD-milled (p = 1.00). Pumice and high shine polish significantly improved the gloss for all groups. The mean gloss and surface roughness for all 3D-printed materials ranged from 75.24 ± 25.05 GU to 0.18 ± 0.21 GU and 2.73 ± 3.18 μm to 0.06 ± 0.01 μm, which was significantly lower (p < 0.001) than heat-cured, CAD-milled and vacuum-formed materials. The highest hardness (0.40 ± 0.009 GPa), elastic modulus (6.06 ± 1.49 GPa) and gloss were found when materials were 3D-printed at 45°, with the lowest surface roughness.

CONCLUSION

Statistically significant differences in polishability were found among the different occlusal splint materials. The polishability and surface hardness of 3D-printed occlusal splint materials was influenced by the print angle. The 0° 3D-printed occlusal splint materials produced the highest gloss and the lowest surface roughness pre-polished, indicating that no polishing is required. While the 3D-printed occlusal splint materials at 45^oand 90° required polishing with burs, pumice and high shine to reduce the surface roughness, there were layering structures created during printing.

Evaluation of the mechanical properties and degree of conversion of 3D printed splint material

OBJECTIVE

To evaluate the effect of post-curing method, printing layer thickness, and water storage on the mechanical properties and degree of conversion of a light-curing methacrylate based resin material (IMPRIMO® LC Splint), used for the fabrication of 3D printed occlusal splints and surgical guides.

METHODS

96 bar-shaped specimens were 3D printed (Asiga MAX), half of them with a layer thickness of 100 μm (Group A), and half with 50 μm (Group B). Each group was divided in three subgroups based on the post-curing method used: post-curing with light emitting diode (LED) and nitrogen gas; post-curing with only LED; and non-post-curing. Half of the specimens from each subgroup were water-stored for 30 days while the other half was dry-stored (n = 8). Flexural strength and flexural modulus were evaluated. Additional specimens were prepared and divided in the same way for surface hardness (n = 96), fracture toughness, and work of fracture (n = 96). Five specimens were selected from each subgroup for evaluating the degree of conversion (DC). Data were collected and statistically analyzed with 1-way, 2-way ANOVA, and Tukey post-hoc analysis (α = 0.05).

RESULTS

The 2-way ANOVA showed that the post-curing method and water storage significantly affected the investigated mechanical properties (P < 0.001). The 1-way ANOVA revealed a statistically significant difference among the tested groups on the investigated properties (P < 0.001). After water storage, the 100 μm subgroup post-cured with only LED showed higher flexural strength (51 ± 9) than the 50 μm and 100 μm subgroups that were post-cured with LED in addition to nitrogen gas atmosphere (38 ± 5, 30 ± 3) (p < 0.05). The 50 μm subgroup post-cured with only LED showed the highest significant flexural modulus values (1.7 ± 0.08) (p < 0.05). However, the 50 μm subgroup post-cured with LED plus nitrogen showed significantly higher surface hardness values (p < 0.05) among the investigated groups. The non-post-cured subgroups showed the lowest values, which were significantly different from the other subgroups (p < 0.05).

CONCLUSION

The post-curing method, water storage, and printing layer thickness play a role in the mechanical properties of the investigated 3D Printed occlusal splints material. The combination of heat and light within the post-curing unit can enhance the mechanical properties and degree of conversion of 3D printed occlusal splints. Flexural strength and surface hardness can increase when decreasing printing layer thickness.

Polymers for conventional, subtractive, and additive manufacturing of occlusal devices differ in hardness and flexural properties but not in wear resistance

OBJECTIVES

To investigate the wear resistance of polymers for injection molding, subtractive and additive manufacturing of occlusal devices in comparison with enamel antagonist wear and material properties (i.e., hardness, flexural strength, and flexural modulus).

METHODS

Injection molding was compared with milling and the additive technologies stereolithography, low force stereolithography, and digital light processing. For each material, eight specimens were produced for wear measurements. Extracted human premolars served as indenters. All samples were subjected to two series of a 2-body wear test consisting of 200,000 circular loading cycles with an applied load of 1) 20 N and 2) 50 N in a thermocycling environment (5/55 °C, 30 s, 3860 cycles, H₂O). Wear resistance was characterized by means of maximum depth and volume of the resulting traces. In addition, enamel wear of the indenters and Vickers hardness, flexural strength, and flexural modulus of the polymers were determined. Wear was statistically analyzed with linear general models for repeated measures and material properties with one-way ANOVA with post-hoc Tukey-HSD tests.

RESULTS

Wear of the antagonists was not influenced by the material (P ≥ 0.343). Likewise, no differences in wear resistance were found between materials after cyclic loading with 20 N or 50 N (P ≥ 0.074). Material properties investigated revealed decreased values for the resins for the additive manufacturing with the exception of flexural strength of one material.

SIGNIFICANCE

Within the limitations of this in-vitro study, arylates for conventional, subtractive, and additive manufacturing of occlusal devices differ in material properties but not in wear resistance and antagonist wear.

Effects of Post-Curing Time on the Mechanical and Color Properties of Three-Dimensional Printed Crown and Bridge Materials

Three-dimensional (3D) printing is increasingly being utilized in the dental field. After fabricating a prosthesis using a 3D printed resin, a post-curing process is required to improve its mechanical properties, but there has been insufficient research on the optimal post-curing conditions. We used various 3D printed crown and bridge materials in this study, and evaluated the changes in their properties according to post-curing time by evaluating the flexural strength, Weibull modulus, Vickers hardness, color change, degree of conversion, and biocompatibility. The obtained results confirmed that the strength of the 3D printed resin increased when it was post-cured for 60–90 min. The Vickers hardness, the degree of conversion, and biocompatibility of the 3D printed resins increased significantly around the beginning of the post-curing time, and then increased more gradually as the post-curing time increased further. It was observed that the color tone also changed as the post-curing time increased, with some groups showing a ΔE₀₀ value of ≥ 2.25, which can be recognized clinically. This study has confirmed that, after the printing process of a 3D printed resin was completed, a sufficient post-curing time of at least 60 min is required to improve the overall clinical performance of the produced material.

A vat-polymerized 3-dimensionally printed dual-material occlusal device: A dental technique

A technique to additively manufacture an occlusal device by using a completely digital workflow is described. Using a computer-aided design program, information captured with an intraoral scanner was used to additively manufacture a dual-material occlusal device by using a vat-polymerization printer. This technique allows for the combination of 2 different materials, resulting in an occlusal device with a resilient intaglio and a hard resin exterior surface. Advantages of the resulting occlusal device compared with a single-material device include improved patient acceptance and comfort, better fit, and minimal adjustments to ensure fit.

Intelligent Occlusion Stabilization Splint with Stress-Sensor System for Bruxism Diagnosis and Treatment

Bruxism is a masticatory muscle activity characterized by high prevalence, widespread complications, and serious consequences but without specific guidelines for its diagnosis and treatment. Although occlusal force-based biofeedback therapy is proven to be safe, effective, and with few side effects in improving bruxism, its mechanism and key technologies remain unclear. The purpose of this study was to research a real-time, quantitative, intelligent, and precise force-based biofeedback detection device based on artificial intelligence (AI) algorithms for the diagnosis and treatment of bruxism. Stress sensors were integrated and embedded into a resin-based occlusion stabilization splint by using a layering technique (sandwich method). The sensor system mainly consisted of a pressure signal acquisition module, a main control module, and a server terminal. A machine learning algorithm was leveraged for occlusal force data processing and parameter configuration. This study implemented a sensor prototype system from scratch to fully evaluate each component of the intelligent splint. Experiment results showed reasonable parameter metrics for the sensors system and demonstrated the feasibility of the proposed scheme for bruxism treatment. The intelligent occlusion stabilization splint with a stress sensor system is a promising approach to bruxism diagnosis and treatment.

Surface roughness and wear behavior of occlusal splint materials made of contemporary and high-performance polymers

With the development of a digital technology of computer-assisted manufacturing (CAD/CAM) and new age materials, the use of new types of occlusal splint is to consider. The aim of the present study was to evaluate the surface roughness (Ra) and wear behavior of different CAD/CAM materials against enamel antagonist through a simulated chewing test. A total of 75 specimens made from ethylene vinyl acetate (EVA), polymethyl methacrylate (PMMA), polycarbonate (PC), polyetheretherketone (PEEK), and polyethyleneterephthalate (PETG) as a control were polished to evaluate the Ra before loading by optical profilometry and further analyzed by scanning electron microscopy (SEM). Specimens of each group were subjected to thermomechanical fatigue loading in a chewing simulator (60000 cycles at 49 N with 5-55 °C thermocycling). The wear volume loss and change in Ra of each specimen after the simulated chewing were analyzed. One-way ANOVA, paired samples t test, and Pearson correlation analysis were performed for statistical analyzes. The result showed that the volume loss and Ra varied among the materials tested. EVA exhibited the greatest amount of Ra and volume loss (p < 0.001), while PEEK had the lowest values for both (p < 0.001). In terms of volume loss, there was no significant difference between PC and PMMA (p > 0.05). SEM investigations revealed different wear behaviors, especially in EVA. As PEEK showed significantly more favorable results, PEEK splints should be considered as a new therapeutic option for occlusal splint.

Digital dentistry: The new state of the art - Is it disruptive or destructive?

OBJECTIVE

Summarizing the new state of the art of digital dentistry, opens exploration of the type and extent of innovations and technological advances that have impacted - and improved - dentistry. The objective is to describe advances and innovations, the breadth of their impact, disruptions and advantages they produce, and opportunities created for material scientists.

METHODS

On-line data bases, web searches, and discussions with industry experts, clinicians, and dental researchers informed the content. Emphasis for inclusion was on most recent publications along with innovations presented at trade shows, in press releases, and discovered through discussions leading to web searches for new products.

RESULTS

Digital dentistry has caused disruption on many fronts, bringing new techniques, systems, and interactions that have improved dentistry. Innovation has spurred opportunities for material scientists' future research.

SIGNIFICANCE

With disruptions intrinsic in digital dentistry's new state of the art, patient experience has improved. More restoration options are available delivering longer lifetimes, and better esthetics. Fresh approaches are bringing greater efficiency and accuracy, capitalizing on the interest, capabilities, and skills of those involved. New ways for effective and efficient inter-professional and clinician-patient interactions have evolved. Data can be more efficiently mined for forensic and epidemiological uses. Students have fresh ways of learning. New, often unexpected, partnerships have formed bringing further disruption - and novel advantages. Yes, digital dentistry has been disruptive, but the abundance of positive outcomes argues strongly that it has not been destructive.

Objects build orientation, positioning, and curing influence dimensional accuracy and flexural properties of stereolithographically printed resin

OBJECTIVE

To evaluate the influence of printing parameters on flexural properties and accuracy of SLA-printed standard objects.

METHODS

Thirty specimens were printed in 0°, 45° and 90° orientation. Fourth nine more specimens were printed evenly on the build platform. forty more specimens were printed and polymerized with three curing unit. Length, height and width was measured three times for each specimen and compared to the original dimensions. Afterwards all specimens underwent a three-point-bending test to assess their flexural properties. One way ANOVA and the Post-Hoc all pairs Tukey-Kramer HSD test were used for data evaluation.

RESULTS

The print orientation influences the printing accuracy. The parameters printed along the Z-axis are particularly prone to inaccuracies. Specimens with 45° orientation were found to be the most accurate. Object printed on the borders of build platform a rather prone to inaccuracies than those in the center. The 90° specimens with layer orientation parallel to the axial load showed the superior flexural strength and flexural modulus. The use of different curing unit is unlikely to affect the objects printing accuracy and flexural properties.

SIGNIFICANCE

The anisotropical behavior of printed specimens with regards to build orientation and positioning was revealed. The understanding of how the adjustable printing parameter influence the printing outcome is important for a precise fabrication of surgical guides. Inaccuracies up to 10% along the Z-axis, as revealed in the present study,may restrict an accurate implant placement.