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Orgev A, Donmez MB, Almogbel L, Cakmak G, Marques VR, Kahveci C, Yilmaz B. Cameo and intaglio surface stability and variability of additively, subtractively, and conventionally manufactured occlusal devices after long-term storage. J Prosthet Dent 2024:S0022-3913(24)00427-X. [PMID: 38955603 DOI: 10.1016/j.prosdent.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024]
Abstract
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.
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Affiliation(s)
- Ahmet Orgev
- Clinical Associate Professor, Department of Restorative Dentistry, School of Dental Medicine, University at Buffalo, Buffalo, NY.
| | - Mustafa Borga Donmez
- Associate Professor, Department of Prosthodontics, Faculty of Dentistry, Istinye University, Istanbul, Turkey; and ITI Scholar, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Lolowh Almogbel
- Fellow, Advanced Education Program in Implant Dentistry, Loma Linda University School of Dentistry, Loma Linda, Calif.; Restorative and Prosthetic Dental Sciences Department, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Gulce Cakmak
- Senior Research Associate, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Vinicius Rizzo Marques
- Digital Implant Fellow, Department of Restorative Dentistry, School of Dental Medicine, University at Buffalo, Buffalo, NY
| | - Cigdem Kahveci
- Assistant Professor, Department of Prosthodontics, Giresun University Faculty of Dentistry, Giresun, Turkey
| | - Burak Yilmaz
- Associate Professor, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; Associate Professor, Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland; and Adjunct Professor, Division of Restorative and Prosthetic Dentistry, The Ohio State University, Columbus, Ohio
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Saadat Sarmadi B, Schmidt F, Beuer F, Metin DS, Simeon P, Nicic R, Unkovskiy A. The Effect of Build Angle and Artificial Aging on the Accuracy of SLA- and DLP-Printed Occlusal Devices. Polymers (Basel) 2024; 16:1714. [PMID: 38932064 PMCID: PMC11207952 DOI: 10.3390/polym16121714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/22/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
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.
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Affiliation(s)
- Bardia Saadat Sarmadi
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, Aßmannshauser Street 4-6, 14197 Berlin, Germany; (B.S.S.); (F.S.); (F.B.); (D.S.M.); (P.S.); (R.N.)
| | - Franziska Schmidt
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, Aßmannshauser Street 4-6, 14197 Berlin, Germany; (B.S.S.); (F.S.); (F.B.); (D.S.M.); (P.S.); (R.N.)
| | - Florian Beuer
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, Aßmannshauser Street 4-6, 14197 Berlin, Germany; (B.S.S.); (F.S.); (F.B.); (D.S.M.); (P.S.); (R.N.)
| | - Dilan Seda Metin
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, Aßmannshauser Street 4-6, 14197 Berlin, Germany; (B.S.S.); (F.S.); (F.B.); (D.S.M.); (P.S.); (R.N.)
| | - Philipp Simeon
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, Aßmannshauser Street 4-6, 14197 Berlin, Germany; (B.S.S.); (F.S.); (F.B.); (D.S.M.); (P.S.); (R.N.)
| | - Robert Nicic
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, Aßmannshauser Street 4-6, 14197 Berlin, Germany; (B.S.S.); (F.S.); (F.B.); (D.S.M.); (P.S.); (R.N.)
| | - Alexey Unkovskiy
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, Aßmannshauser Street 4-6, 14197 Berlin, Germany; (B.S.S.); (F.S.); (F.B.); (D.S.M.); (P.S.); (R.N.)
- Department of Dental Surgery, Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya Street, 19c1, Moscow 119146, Russia
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Ateş G, Demirel M, Donmez MB, Dayan SÇ, Sülün T. Effect of material and antagonist type on the wear of occlusal devices with different compositions fabricated by using conventional, additive, and subtractive manufacturing. J Prosthet Dent 2024; 131:1235.e1-1235.e8. [PMID: 38594086 DOI: 10.1016/j.prosdent.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
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.
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Affiliation(s)
- Gökçen Ateş
- Postdoctoral Research Associate, Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey; and ITI Scholar, Department of Prosthodontics, University of São Paulo (USP), São Paulo, Brazil
| | - Münir Demirel
- Assistant Professor, Department of Prosthodontics, Faculty of Dentistry, Biruni University, Istanbul, Turkey
| | - Mustafa Borga Donmez
- Associate Professor, Department of Prosthodontics, Faculty of Dentistry, Istinye Univeristy, İstanbul, Turkey; and ITI Scholar, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - Süleyman Çağatay Dayan
- Associate Professor, Program of Dental Technicians, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tonguç Sülün
- Professor, Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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Pecenek D, Gokcen-Rohlig B, Ongul D, Ayvalioglu DC. Evaluation of the clinical performance of different occlusal device materials. J Prosthet Dent 2024:S0022-3913(24)00295-6. [PMID: 38806342 DOI: 10.1016/j.prosdent.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/30/2024]
Abstract
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.
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Affiliation(s)
- Duygucan Pecenek
- Graduate student, Department of Prosthodontics, Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Turkey
| | - Bilge Gokcen-Rohlig
- Professor, Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Deger Ongul
- Associate Professor, Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey.
| | - Demet Cagıl Ayvalioglu
- Assistant Professor, Department of Prosthodontics, Faculty of Dentistry, Altınbas University, Istanbul, Turkey
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Sun X, Feng Y, Jiao Y, Liu W. Fully digital workflow for the fabrication of occlusal stabilization splints based on individual mandibular movement. J Dent 2024; 141:104826. [PMID: 38157975 DOI: 10.1016/j.jdent.2023.104826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/07/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024] Open
Abstract
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.
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Affiliation(s)
- Xinrong Sun
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Department of Prosthodontics, Stomatological Hospital and Dental School of Tongji University, 399, Yanchang Middle Rd, Jing'an District, Shanghai 200072, China
| | - Yue Feng
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Department of Prosthodontics, Stomatological Hospital and Dental School of Tongji University, 399, Yanchang Middle Rd, Jing'an District, Shanghai 200072, China
| | - Yi Jiao
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Department of Prosthodontics, Stomatological Hospital and Dental School of Tongji University, 399, Yanchang Middle Rd, Jing'an District, Shanghai 200072, China
| | - Weicai Liu
- Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Department of Prosthodontics, Stomatological Hospital and Dental School of Tongji University, 399, Yanchang Middle Rd, Jing'an District, Shanghai 200072, China.
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Cameron AB, Tong K, Tadakamadla S, Evans JL, Abuzar M. Effect of build orientation on the trueness of occlusal splints fabricated by three-dimensional printing. J Oral Sci 2023; 65:261-264. [PMID: 37690838 DOI: 10.2334/josnusd.23-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
PURPOSE Scientific evidence pertaining to the evaluation of trueness of occlusal splints fabricated using different three-dimensional (3D) printers and build orientations compared to subtractive technologies is lacking. METHODS Overall, one hundred and ten occlusal splints were manufactured using two different 3D printers and a dental mill. Five groups of ten were fabricated using the 3D printers at different build orientations (0, 30, 45, 60, and 90 degrees). In addition, a comparison group of ten occlusal splints was subtractively manufactured using a five-axis dental mill. All occlusal splints were scanned and exported as a standard tessellation language file. Analysis was conducted with metrology software with root mean square estimate average positive deviation and average negative deviation used as the measured outcome. RESULTS The 0 degree printing orientation was the most accurate for printer one with the root mean square value of 0.05 ± 0.01 mm, and 60 degree printing orientation was most accurate for printer two with the RMS value of 0.11 ± 0.01 mm. Subtractively manufactured occlusal splint had significantly higher trueness with the lowest RMS value of 0.03 ± 0.05 mm. CONCLUSION Build orientations influence the trueness of additively manufactured occlusal splints while occlusal splints produced by subtractive manufacturing were statistically significantly more accurate.
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Affiliation(s)
| | - Keith Tong
- School of Medicine and Dentistry, Griffith University
| | - Santosh Tadakamadla
- Dentistry and Oral Health, Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University
| | - Jane L Evans
- School of Medicine and Dentistry, Griffith University
| | - Menaka Abuzar
- School of Medicine and Dentistry, Griffith University
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Abad-Coronel C, Ruano Espinosa C, Ordóñez Palacios S, Paltán CA, Fajardo JI. Comparative Analysis between Conventional Acrylic, CAD/CAM Milled, and 3D CAD/CAM Printed Occlusal Splints. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6269. [PMID: 37763547 PMCID: PMC10532716 DOI: 10.3390/ma16186269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023]
Abstract
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.
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Affiliation(s)
- Cristian Abad-Coronel
- CAD/CAM Materials and Digital Dentistry Research Group, Faculty of Dentistry, Universidad de Cuenca, Cuenca 010204, Ecuador
| | | | | | - César A. Paltán
- New Materials and Transformation Processes Research Group GiMaT, Universidad Politécnica Salesiana, Cuenca 010105, Ecuador; (C.A.P.); (J.I.F.)
| | - Jorge I. Fajardo
- New Materials and Transformation Processes Research Group GiMaT, Universidad Politécnica Salesiana, Cuenca 010105, Ecuador; (C.A.P.); (J.I.F.)
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Christopher H, Kykal J, Rues S, Schwindling FS, Rammelsberg P, Eberhard L. Thermo-flexible resin for the 3D printing of occlusal splints: a randomized pilot trial. J Dent 2023; 133:104514. [PMID: 37031885 DOI: 10.1016/j.jdent.2023.104514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/11/2023] Open
Abstract
OBJECTIVES To compare the clinical performance of occlusal splints printed from thermo-flexible resin with milled splints. METHODS A parallel two-arm pilot trial was initiated. Forty-seven patients (n women=38) were recruited from a tertiary care center and randomized using an online tool (sealed envelope). Inclusion criterion was an indication for treatment with a centric relation occlusal splint due to bruxism or any form of painful temporomandibular disorder. Patients were excluded if they were younger than 18 years, unable to attend follow-up appointments, or required another type of splint therapy. Patients received either, a 3D-printed (intervention group, V-print splint comfort, VOCO) or a milled splint (control group, ProArt CAD splint, Ivoclar). Construction software Ceramill M-splint (AmannGirrbach), 3D-printer MAX UV 385 (Asiga) and milling unit PrograMill PM7 (Ivoclar) were used. Follow-up assessments were conducted after 2 weeks and 3 months. Outcome measures were survival, adherence, technical complications, patient satisfaction on a 10-point Likert scale, and maximum wear using superimposition of optical scans. RESULTS After 3 months, 20/23 intervention group and 18/24 control group participants were assessed. All splints survived. Minor complications were small crack formations on 6 printed and 4 milled splints. Mean patient satisfaction was 8 (SD 1.7) for printed, and 8.1 (SD 2.3) for milled splints (r= .1, p=.52). Median maximum wear was highly dispersed with 153 (IQR 140) in posterior and 195 (IQR 537) in frontal segments of printed, and 96 (IQR 78) respectively 123 (IQR 155) of milled splints, (both: r= .31, p=.084). CONCLUSIONS Within the limitations of a pilot trial, 3D-printed and milled splints performed similarly in terms of patient satisfaction, complication rates and wear behavior. CLINICAL SIGNIFICANCE Thermo-flexible material was proposed for 3D printing of occlusal splints to overcome mechanical weaknesses of previously available resins. This randomized pilot study provides evidence that this material is a viable alternative to milled splints for at least three months of clinical use. Further evidence on long-term use should be obtained.
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Affiliation(s)
- Herpel Christopher
- Heidelberg University Hospital, Department of Prosthodontics, Heidelberg, Germany.
| | - Jana Kykal
- Heidelberg University Hospital, Department of Prosthodontics, Heidelberg, Germany
| | - Stefan Rues
- Heidelberg University Hospital, Department of Prosthodontics, Heidelberg, Germany
| | | | - Peter Rammelsberg
- Heidelberg University Hospital, Department of Prosthodontics, Heidelberg, Germany
| | - Lydia Eberhard
- Heidelberg University Hospital, Department of Prosthodontics, Heidelberg, Germany
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Accuracy of 3D-Printed Occlusal Devices of Different Volumes Using a Digital Light Processing Printer. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
(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.
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Patzelt SBM, Krügel M, Wesemann C, Pieralli S, Nold J, Spies BC, Vach K, Kohal RJ. In Vitro Time Efficiency, Fit, and Wear of Conventionally- versus Digitally-Fabricated Occlusal Splints. MATERIALS 2022; 15:ma15031085. [PMID: 35161032 PMCID: PMC8837971 DOI: 10.3390/ma15031085] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/20/2022] [Accepted: 01/28/2022] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Sebastian Berthold Maximilian Patzelt
- Private Dental Clinic, Am Dorfplatz 3, 78658 Zimmern ob Rottweil, Germany
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (M.K.); (C.W.); (S.P.); (J.N.); (B.C.S.); (R.-J.K.)
- Correspondence: ; Tel.: +49-741-32103; Fax: +49-741-31400
| | - Marei Krügel
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (M.K.); (C.W.); (S.P.); (J.N.); (B.C.S.); (R.-J.K.)
| | - Christian Wesemann
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (M.K.); (C.W.); (S.P.); (J.N.); (B.C.S.); (R.-J.K.)
| | - Stefano Pieralli
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (M.K.); (C.W.); (S.P.); (J.N.); (B.C.S.); (R.-J.K.)
| | - Julian Nold
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (M.K.); (C.W.); (S.P.); (J.N.); (B.C.S.); (R.-J.K.)
| | - Benedikt Christopher Spies
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (M.K.); (C.W.); (S.P.); (J.N.); (B.C.S.); (R.-J.K.)
| | - Kirstin Vach
- Medical Center—University of Freiburg, Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104 Freiburg, Germany;
| | - Ralf-Joachim Kohal
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (M.K.); (C.W.); (S.P.); (J.N.); (B.C.S.); (R.-J.K.)
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Grymak A, Waddell JN, Aarts JM, Ma S, Choi JJE. Evaluation of wear behaviour of various occlusal splint materials and manufacturing processes. J Mech Behav Biomed Mater 2022; 126:105053. [PMID: 34998068 DOI: 10.1016/j.jmbbm.2021.105053] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Anastasiia Grymak
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, New Zealand
| | - John Neil Waddell
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, New Zealand
| | - John M Aarts
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, New Zealand
| | - Sunyoung Ma
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, New Zealand
| | - Joanne Jung Eun Choi
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, New Zealand.
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12
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Grymak A, Aarts JM, Ma S, Waddell JN, Choi JJE. Wear Behavior of Occlusal Splint Materials Manufactured By Various Methods: A Systematic Review. J Prosthodont 2021; 31:472-487. [PMID: 34516696 DOI: 10.1111/jopr.13432] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 01/17/2023] Open
Abstract
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.
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Affiliation(s)
- Anastasiia Grymak
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - John M Aarts
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Sunyoung Ma
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - J Neil Waddell
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Joanne Jung Eun Choi
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Gülcan O, Günaydın K, Tamer A. The State of the Art of Material Jetting-A Critical Review. Polymers (Basel) 2021; 13:2829. [PMID: 34451366 PMCID: PMC8399222 DOI: 10.3390/polym13162829] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 01/20/2023] Open
Abstract
Material jetting (MJ) technology is an additive manufacturing method that selectively cures liquid photopolymer to build functional parts. The use of MJ technology has increased in popularity and been adapted by different industries, ranging from biomedicine and dentistry to manufacturing and aviation, thanks to its advantages in printing parts with high dimensional accuracy and low surface roughness. To better understand the MJ technology, it is essential to address the capabilities, applications and the usage areas of MJ. Additionally, the comparison of MJ with alternative methods and its limitations need to be explained. Moreover, the parameters influencing the dimensional accuracy and mechanical properties of MJ printed parts should be stated. This paper aims to review these critical aspects of MJ manufacturing altogether to provide an overall insight into the state of the art of MJ.
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Affiliation(s)
- Orhan Gülcan
- General Electric Aviation, Gebze 41400, Kocaeli, Turkey
| | | | - Aykut Tamer
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK;
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