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AlAzzam NF, Bajunaid SO, Mitwalli HA, Baras BH, Weir MD, Xu HHK. The Effect of Incorporating Dimethylaminohexadecyl Methacrylate and/or 2-Methacryloyloxyethyl Phosphorylcholine on Flexural Strength and Surface Hardness of Heat Polymerized and 3D-Printed Denture Base Materials. MATERIALS (BASEL, SWITZERLAND) 2024; 17:4625. [PMID: 39336366 PMCID: PMC11433138 DOI: 10.3390/ma17184625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 09/11/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND A major disadvantage of polymethyl methacrylate (PMMA) acrylic resins is susceptibility to biofilm accumulation. The incorporation of antimicrobial agents is a reliable prevention technique. The purpose of this study is to investigate the effect of incorporating dimethylaminohexadecyl methacrylate (DMAHDM) and/or 2-methacryloyloxyethyl phosphorylcholine (MPC) into heat-polymerized (HP) and 3D-printed (3DP) denture base materials on the flexural strength, modulus of elasticity, and surface hardness. METHODS DMAHDM and/or MPC were mixed with the acrylic resin liquid of a heat-polymerized (ProBase Hot) and a 3D printed (NextDent Denture 3D) material at mass fractions of 1.5% and 3% and a combination of 3% MPC and 1.5% DMAHDM. RESULTS Significant differences in mechanical properties between the control and experimental groups have been detected (p-value < 0.0001). In HP materials, the addition of DMAHDM and/or MPC generally decreased the flexural strength, from (151.18 MPa) in G1 down to (62.67 MPa) in G5, and surface hardness, from (18.05 N/mm2) down to (10.07 N/mm2) in G5. Conversely, in 3DP materials, flexural strength was slightly enhanced, from (58.22 MPa) in G1 up to (62.76 MPa) in G6, although surface hardness was consistently reduced, from (13.57 N/mm2) down to (5.29 N/mm2) in G5. CONCLUSION It is recommended to carefully optimize the concentrations of DMAHDM and/or MPC to maintain mechanical integrity.
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Affiliation(s)
- Njood F AlAzzam
- Department of Prosthetic Sciences, College of Dentistry, King Saud University, Riyadh 60169-15, Saudi Arabia
| | - Salwa O Bajunaid
- Department of Prosthetic Sciences, College of Dentistry, King Saud University, Riyadh 60169-15, Saudi Arabia
| | - Heba A Mitwalli
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh 60169-15, Saudi Arabia
| | - Bashayer H Baras
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh 60169-15, Saudi Arabia
| | - Michael D Weir
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Hockin H K Xu
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
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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; 132:604.e1-604.e7. [PMID: 38955603 DOI: 10.1016/j.prosdent.2024.06.008] [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: 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, Biruni 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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Maleki T, Meinen J, Coldea A, Reymus M, Edelhoff D, Stawarczyk B. Mechanical and physical properties of splint materials for oral appliances produced by additive, subtractive and conventional manufacturing. Dent Mater 2024; 40:1171-1183. [PMID: 38851965 DOI: 10.1016/j.dental.2024.05.030] [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: 09/25/2023] [Revised: 03/15/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
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.
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Affiliation(s)
- Tina Maleki
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany.
| | - John Meinen
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Andrea Coldea
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Marcel Reymus
- Department of Conservative Dentistry and Peridontology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Edelhoff
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Bogna Stawarczyk
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
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Hampe T, Liersch J, Wiechens B, Bürgers R, Krohn S. Bisphenol A release from CAD/CAM splint materials. Eur J Oral Sci 2024; 132:e12993. [PMID: 38778467 DOI: 10.1111/eos.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/26/2024] [Indexed: 05/25/2024]
Abstract
This study aimed to investigate the bisphenol A (BPA) release from four CAD/CAM splint materials: three polycarbonate-based (DD BioSplint C, Splint Plus Biostar, Temp Premium Flexible) and one polymethylmethacrylate-based (Temp Basic) material. From each material, ten cylindrical samples (n = 40) were immersed in high-performance liquid chromatography (HPLC) grade water following ISO 10993-12 and incubated for 24 h in an incubation shaker at 37°C and 112 rpm. Following BPA derivatization, analysis was performed by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). After 24 h of incubation, all investigated materials released significant amounts of BPA compared to water blanks. The material-dependent elution increased in the following order: DD BioSplint C < Splint Plus Biostar < Temp Basic < Temp Premium Flexible. Subtracting extraneous BPA, the concentrations ranged between 2.27 ng/mL and 12.65 ng/mL. After extrapolating the concentrations in relation to the average surface area of occlusal splints, the amount of BPA per mL exceeded the Tolerable Daily Intake (TDI) set by the European Union for a person weighing 70 kg by 1.32-6.16 times. Contrary to the release from previously investigated materials, BPA elution from CAD/CAM splint materials was highly elevated. Considering the increasing adaptation of CAD/CAM techniques, elution from them may represent a relevant BPA source in daily dental practice.
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Affiliation(s)
- Tristan Hampe
- Department of Prosthodontics, University Medical Center Göttingen, Göttingen, Germany
| | - Julia Liersch
- Department of Prosthodontics, University Medical Center Göttingen, Göttingen, Germany
| | - Bernhard Wiechens
- Department of Prosthodontics, University Medical Center Göttingen, Göttingen, Germany
- Department of Orthodontics, University Medical Center Göttingen, Göttingen, Germany
| | - Ralf Bürgers
- Department of Prosthodontics, University Medical Center Göttingen, Göttingen, Germany
| | - Sebastian Krohn
- Department of Prosthodontics, University Medical Center Göttingen, Göttingen, Germany
- Department of Orthodontics, University Hospital Regensburg, Regensburg, Germany
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Valenti C, Federici MI, Coniglio M, Betti P, Pancrazi GP, Tulli O, Masciotti F, Nanussi A, Pagano S. 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. Clin Oral Investig 2024; 28:396. [PMID: 38916682 DOI: 10.1007/s00784-024-05772-6] [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: 02/03/2024] [Accepted: 06/11/2024] [Indexed: 06/26/2024]
Abstract
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.
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Affiliation(s)
- Chiara Valenti
- CISAS "Giuseppe Colombo", University of Padua, Via Venezia, 15, Padua, 35131, Italy
- Department of Medicine and Surgery, Faculty of Dentistry, University of Perugia, S. Andrea delle Fratte, Perugia, 06156, Italy
| | - Maria Isabella Federici
- Department of Medicine and Surgery, Faculty of Dentistry, University of Perugia, S. Andrea delle Fratte, Perugia, 06156, Italy
| | - Maddalena Coniglio
- Department of Medicine and Surgery, Faculty of Dentistry, University of Perugia, S. Andrea delle Fratte, Perugia, 06156, Italy.
- Strada vicinale Via delle Corse, S. Andrea delle Fratte, Perugia, 06132, Italy.
| | - Paolo Betti
- Department of Medicine and Surgery, Faculty of Dentistry, University of Perugia, S. Andrea delle Fratte, Perugia, 06156, Italy
| | - Gian Piero Pancrazi
- Department of Medicine and Surgery, Faculty of Dentistry, University of Perugia, S. Andrea delle Fratte, Perugia, 06156, Italy
| | - Ornella Tulli
- Department of Medicine and Surgery, Faculty of Dentistry, University of Perugia, S. Andrea delle Fratte, Perugia, 06156, Italy
| | - Francesca Masciotti
- Department of Medicine and Surgery, Faculty of Dentistry, University of Perugia, S. Andrea delle Fratte, Perugia, 06156, Italy
| | | | - Stefano Pagano
- Department of Medicine and Surgery, Faculty of Dentistry, University of Perugia, S. Andrea delle Fratte, Perugia, 06156, Italy
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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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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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Benli M, Al-Haj Husain N, Ozcan M. Mechanical and chemical characterization of contemporary occlusal splint materials fabricated with different methods: a systematic review. Clin Oral Investig 2023; 27:7115-7141. [PMID: 37910242 DOI: 10.1007/s00784-023-05360-0] [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: 03/25/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
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.
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Affiliation(s)
- Merve Benli
- James B. Edwards College of Dental Medicine, Department of Oral Rehabilitation, Division of Removable Prosthodontics, MUSC, Charleston, USA.
- Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey.
| | - Nadin Al-Haj Husain
- Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, 8032, Zurich, Switzerland
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, 3010, Bern, Switzerland
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, 8032, Zurich, Switzerland
| | - Mutlu Ozcan
- Division of Dental Biomaterials, Center for Dental Medicine, Clinic for Reconstructive Dentistry, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
- Clinic for Chewing Function Disturbances, Center for Dental Medicine, Clinic for Reconstructive Dentistry, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
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Blasi A, Henarejos-Domingo V, Palacios-Bañuelos R, Vidal-Ponsoda C, Aparicio C, Roig M. CAD-CAM and analog occlusal splints comparison based on the amount of occlusal adjustments. 3D analysis of the volumetric changes: A pilot study. J ESTHET RESTOR DENT 2023; 35:1271-1278. [PMID: 37395327 DOI: 10.1111/jerd.13080] [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: 05/11/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To evaluate the volumetric changes on occlusal surface of computer-aided design and computer-aided manufacturing (CAD-CAM) occlusal devices fabricated following a fully digital workflow after occlusal adjustment, compared to those fabricated with an analog workflow. MATERIALS AND METHODS Eight participants were included in this clinical pilot study, receiving two different occlusal devices fabricated with two different workflows, fully analog and fully digital. Every occlusal device was scanned before and after the occlusal adjustments to compare the volumetric changes using a reverse engineering software program. Moreover, three independent evaluators assessed a semi-quantitative and qualitative comparison using visual analog scale and dichotomous evaluation. The Shapiro-Wilk test was performed to validate normal distribution assumption, and a dependent t-Student test for paired variables was used to determine statistically significant differences (p-value < 0.05). RESULTS The root mean square value was extracted from the 3-Dimensional (3D) analysis of the occlusal devices. The average values of the root mean square were higher for the analogic technique (0.23 ± 0.10 mm) than the digital technique (0.14 ± 0.07 mm) but the differences were not statistically significant (paired t-Student test; p = 0.106) between the two fabrication techniques. The semiquantitative visual analog scale values between the impression for the digital (5.08 ± 2.4 cm) and analog (3.80 ± 3.3 cm) technique were significant (p < 0.001), and statistically significant differences values were assessed for evaluator 3 compared to the other evaluators (p < 0.05). However, the three evaluators agreed on the qualitative dichotomous evaluation in 62% of the cases, and at least two evaluators agreed in 100% of the evaluations. CONCLUSIONS Occlusal devices fabricated following a fully digital workflow resulted in fewer occlusal adjustments, as they could be a valid alternative to those fabricated following an analog workflow. CLINICAL SIGNIFICANCE Fabricated occlusal devices following a fully digital workflow could have some advantages over analog workflow such reduce occlusal adjustments at delivery appointment, which can result in reduced chair time and therefore increased comfort for the patient and clinician.
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Affiliation(s)
- Alvaro Blasi
- Faculty of Dentistry, Department of Restorative Dentistry, International University of Catalunya, Barcelona, Spain
- Department of Restorative Sciences, Dental College of Georgia at Augusta University, Augusta, Georgia
| | - Víctor Henarejos-Domingo
- Faculty of Dentistry, Department of Restorative Dentistry, International University of Catalunya, Barcelona, Spain
| | - Ricardo Palacios-Bañuelos
- Faculty of Dentistry, Department of Restorative Dentistry, International University of Catalunya, Barcelona, Spain
| | - Carla Vidal-Ponsoda
- Faculty of Dentistry, Department of Restorative Dentistry, International University of Catalunya, Barcelona, Spain
| | - Conrado Aparicio
- Faculty of Dentistry, International University of Catalunya, Barcelona, Spain
| | - Miguel Roig
- Faculty of Dentistry, Department of Restorative Dentistry, International University of Catalunya, Barcelona, Spain
- Faculty of Dentistry, International University of Catalunya, Barcelona, Spain
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Nassif M, Haddad C, Habli L, Zoghby A. Materials and manufacturing techniques for occlusal splints: A literature review. J Oral Rehabil 2023; 50:1348-1354. [PMID: 37392157 DOI: 10.1111/joor.13550] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/11/2023] [Accepted: 06/22/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To review the materials and fabrications methods of occlusal splints with their advantages and shortcomings and to clarify the indications for each. BACKGROUND Temporomandibular joint disorders (TMDs) encompass a range of conditions affecting the masticatory system. Occlusal splints are currently recognised as a viable option for the management of TMDs when they are adopted in conjunction with additional approaches varying from conservative procedures (counselling, biofeedback, physical therapy, pharmacotherapy) to irreversible and less conservative ones (occlusal adjustments, orthodontics, arthroscopy and surgery). These splints can vary in design, function and material. The components used to fabricate the splints must withstand occlusal forces, be aesthetically pleasing, comfortable and minimally interfering with function and phonetics. Traditional methods for fabricating splints include sprinkle-on, thermoforming and lost wax techniques. However, with the advancement of CAD/CAM technology, additive (3D printing) and subtractive (milling) manufacturing methods expand the range of possibilities by introducing novel solutions for elaborating splints. METHODS An electronic search was conducted on PubMed using the following keywords: "occlusal splint", "guard and "materials", and "manufacturing." Thirteen in vitro publications were screened and they consisted of four clinical studies, nine reviews (three of them were systematic reviews), and five case reports. CONCLUSION The choice of material is crucial for the success of splint therapy. Factors such as biocompatibility, ease of fabrication, adjustability, cost and patient preference should be considered. Newer materials and techniques are emerging because of advancements in material science and manufacturing techniques. However, it should be noted that most of the evidence is based on in vitro studies with different methodologies, limiting their validity in daily practice.
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Affiliation(s)
- Maryse Nassif
- Department of Prosthodontics and Occlusion, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Camille Haddad
- Department of Prosthodontics and Occlusion, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Lara Habli
- Department of Prosthodontics and Occlusion, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Amine Zoghby
- Department of Prosthodontics and Occlusion, Saint Joseph University of Beirut, Beirut, Lebanon
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Raffaini JC, Soares EJ, Oliveira RFDL, Vivanco RG, Amorim AA, Pereira ALC, Pires-de-Souza FCP. Effect of artificial aging on mechanical and physical properties of CAD-CAM PMMA resins for occlusal splints. J Adv Prosthodont 2023; 15:227-237. [PMID: 37936836 PMCID: PMC10625884 DOI: 10.4047/jap.2023.15.5.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/11/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023] Open
Abstract
PURPOSE This study aimed to assess and compare the color stability, flexural strength (FS), and surface roughness of occlusal splints fabricated from heat-cured acrylic resin, milled polymethyl methacrylate (PMMA)-based resin, and 3D-printed (PMMA) based-resin. MATERIALS AND METHODS Samples of each type of resin were obtained, and baseline measurements of color and surface roughness were recorded. The specimens were divided into three groups (n = 10) and subjected to distinct aging protocols: thermomechanical cycling (TMC), simulated brushing (SB), and control (without aging). Final assessments of color and surface roughness and three-point bending test (ODM100; Odeme) were conducted, and data were statistically analyzed (2-way ANOVA, Tukey, P <.05). RESULTS Across all resin types, the most significant increase in surface roughness (Ra) was observed after TMC (P < .05), with the 3D-printed resin exhibiting the lowest Ra (P < .05). After brushing, milled resin displayed the highest Ra (P < .05) and greater color alteration (ΔE00) compared to 3D-printed resin. The most substantial ΔE00 was recorded after brushing for all resins, except for heat-cured resin subjected to TMC. Regardless of aging, milled resin exhibited the highest FS (P < .05), except when compared to 3D-printed resin subjected to TMC. Heat-cured resin exposed to TMC demonstrated the lowest FS, different (P < .05) from the control. Under control conditions, milled resin exhibited the highest FS, different (P < .05) from the brushed group. 3D-printed resin subjected to TMC displayed the highest FS (P < .05). CONCLUSION Among the tested resins, 3D-printed resin demonstrated superior longevity, characterized by minimal surface roughness and color alterations. Aging had a negligible impact on its mechanical properties.
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Affiliation(s)
- Júlia Correa Raffaini
- Department of Dental Materials and Prosthodontics, Ribeirão Preto School of Dentistry - University of Sao Paulo, Ribeirão Preto, SP, Brazil
| | - Eduardo Jose Soares
- Department of Pediatric Dentistry, Ribeirão Preto School of Dentistry - University of Sao Paulo, Ribeirão Preto, SP, Brazil
| | - Rebeca Franco de Lima Oliveira
- Department of Dental Materials and Prosthodontics, Ribeirão Preto School of Dentistry - University of Sao Paulo, Ribeirão Preto, SP, Brazil
| | - Rocio Geng Vivanco
- Department of Dental Materials and Prosthodontics, Ribeirão Preto School of Dentistry - University of Sao Paulo, Ribeirão Preto, SP, Brazil
| | - Ayodele Alves Amorim
- Department of Dental Materials and Prosthodontics, Ribeirão Preto School of Dentistry - University of Sao Paulo, Ribeirão Preto, SP, Brazil
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12
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Orgev A, Levon JA, Chu TMG, Morton D, Lin WS. The effects of manufacturing technologies on the surface accuracy of CAD-CAM occlusal splints. J Prosthodont 2023; 32:697-705. [PMID: 36227731 DOI: 10.1111/jopr.13610] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/01/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate the effects of the manufacturing technologies on the surface (cameo and intaglio) accuracy (trueness and precision) of computer-aided design and computer-aided manufacturing (CAD-CAM) occlusal splints. MATERIALS AND METHODS The digital design of the master occlusal splint was designed in a CAD software program. Six groups (n = 10) were tested in this study, including Group 1 - Milling (Wax), Group 2 - Heat-polymerizing, Group 3 - Milling (M series), Group 4 - Milling (DWX-51/52D), Group 5 - 3D-printing (Cares P30), and Group 6 - 3D-printing (M2). The study samples were placed in a scanning jig fabricated from putty silicone and Type III dental stone. The study samples were then scanned with a laboratory scanner at the intaglio and cameo surfaces, and the scanned files were exported in standard tessellation language (STL) file format. The master occlusal splint STL file, was used as a reference to compare with all scanned samples at the intaglio and cameo surfaces in a surface matching software program. Root mean square (RMS, measured in mm, absolute value) values were calculated by the software for accuracy comparisons. Group means were used as the representation of trueness, and the standard deviation for each group was calculated as a measure of precision. Color maps were recorded to visualize the areas of deviation between study samples and the master occlusal splint file. The data were normalized and transformed to rank scores, and one-way ANOVA was used to test for the differences between the groups. Pairwise comparisons were made between different groups. Fishers least square differences were used to account for the family-wise error rate. A 5% significance level was used for all the tests. RESULTS The null hypotheses were rejected. The manufacturing technologies significantly affected the trueness of occlusal splints at both intaglio and cameo surfaces (p < 0.001). At the cameo surfaces, Group 1 - Milling (Wax) (0.03 ± 0.02 mm), Group 3 - Milling (M series) (0.04 ± 0.01 mm), and Group 4 - Milling (DWX-51/52D) (0.04 ± 0.01 mm) had the smallest mean RMS values and highest trueness. Group 3 had the smallest standard deviation and highest precision among all groups (p < 0.001, except p = 0.005 when compared with Group 2). Group 5 had the largest standard deviation and lowest precision among all groups (p < 0.001). At the intaglio surfaces, Group 1 - Milling (Wax) (0.06 ± 0.01 mm) had the smallest RMS values and highest trueness among all groups (p < 0.001), and Group 2 - Heat-polymerizing (0.20 ± 0.03 mm) and Group 5 - 3D-printing (Cares P30) (0.15 ± 0.05 mm) had significantly larger mean RMS and standard deviation values than all other groups (p < 0.001), with lowest trueness and precision. In the color maps, Group 2 - Heat-polymerizing and Group 5 - 3D-printing (Cares P30) showed the most discrepancies with yellow and red (positive discrepancies) in most areas, and Group 1 - Milling (Wax) showed the best and most uniform surface matching with the most area in green. CONCLUSION The manufacturing technologies significantly affected the trueness and precision of occlusal splints at both intaglio and cameo surfaces. The 5-axis milling units and industrial-level CLIP 3D-printer could be considered to achieve surface accuracy of occlusal splints.
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Affiliation(s)
- Ahmet Orgev
- Department of Restorative Dentistry, University at Buffalo School of Dental Medicine, Buffalo, New York
| | - John A Levon
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Indiana
| | - Tien-Min G Chu
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, Indiana
| | - Dean Morton
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Indiana
| | - Wei-Shao Lin
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Indiana
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13
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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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Bhargava D, Chávez Farías C, Ardizone García I, Mercuri LG, Bergman S, Anthony Pogrel M, Sidebottom AJ, Srouji S, Şentürk MF, Elavenil P, Moturi K, Anantanarayanan P, Bhargava PG, Singh VD. Recommendations on the Use of Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders: Current Evidence and Clinical Practice. J Maxillofac Oral Surg 2023; 22:579-589. [PMID: 37534353 PMCID: PMC10390439 DOI: 10.1007/s12663-023-01939-y] [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: 09/27/2022] [Accepted: 05/20/2023] [Indexed: 08/04/2023] Open
Abstract
Background 'Temporomandibular joint disorders (TMDs)' denote an umbrella term that includes arthritic, musculoskeletal and neuromuscular conditions involving the temporomandibular joint, the masticatory muscles, and the associated tissues. Occlusal devices are one of the common treatment modalities utilized in the conservative management of TMDs. The indications for the available 'oral splints' or 'oral orthotic occlusal devices' remain ambiguous. Methods A joint international consortium was formulated involving the subject experts at TMJ Foundation, to resolve the current ambiguity regarding the use of oral orthotic occlusal appliance therapy for the temporomandibular joint disorders based on the current scientific and clinical evidence. Results The recommendations and the conclusion of the clinical experts of the joint international consort has been summarized for understanding the indications of the various available oral orthotic occlusal appliances and to aid in the future research on oral occlusal orthotics. Conclusion The use of the oral orthotic occlusal appliances should be based on the current available scientific evidence, rather than the archaic protocols.
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Affiliation(s)
- Darpan Bhargava
- Joint International Consortium on Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders, TMJ Foundation, TMJ Consultancy Services, Bhopal, Madhya Pradesh India
- Oral and Maxillofacial Surgery, People’s University, Bhopal, Madhya Pradesh India
- DAMER India, Bhopal, India
| | - Camilo Chávez Farías
- Joint International Consortium on Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders, TMJ Foundation, TMJ Consultancy Services, Bhopal, Madhya Pradesh India
- Department of Temporomandibular Joint Disorders, Orofacial Pain and Dental Sleep Medicine, Complutense University of Madrid, Madrid, Spain
| | - Ignacio Ardizone García
- Department of Temporomandibular Joint Disorders, Orofacial Pain and Dental Sleep Medicine, Complutense University of Madrid, Madrid, Spain
| | - Louis G. Mercuri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, USA
- Department of Bioengineering, University of Illinois, Chicago, USA
- Stryker/TMJ Concepts, Ventura, CA USA
| | - Suzie Bergman
- Joint International Consortium on Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders, TMJ Foundation, TMJ Consultancy Services, Bhopal, Madhya Pradesh India
- Division for Temporomandibular Joint Disorders and Orthodontics, Dentistry On Officers Row, McGann Postgraduate School of Dentistry, Progressive Orthodontic Seminars, Vancouver, WA USA
| | - M. Anthony Pogrel
- Department of Oral and Maxillofacial Surgery, UCSF School of Dentistry, UCSF Dental Center, San Francisco, CA USA
| | - Andrew J. Sidebottom
- Oral and Maxillofacial Surgery & Temporomandibular Joint Related Surgery, Nottingham, UK
| | - Samer Srouji
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Naharia, Israel
| | - Mehmet Fatih Şentürk
- Department of Oral and Maxillofacial Surgery, Dentistry Faculty, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - P. Elavenil
- Department of Oral & Maxillofacial Surgery, SRM Dental College, Ramapuram, Chennai, India
| | - Kishore Moturi
- Joint International Consortium on Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders, TMJ Foundation, TMJ Consultancy Services, Bhopal, Madhya Pradesh India
- Department of Oral and Maxillofacial Surgery, Vishnu Dental College, Bhimavaram, India
| | - P. Anantanarayanan
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu India
| | - Preeti G. Bhargava
- Joint International Consortium on Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders, TMJ Foundation, TMJ Consultancy Services, Bhopal, Madhya Pradesh India
- Department of Oral & Maxillofacial Surgery, TMJ Consultancy Services, Bhopal, Madhya Pradesh India
| | - Vankudoth Dal Singh
- Joint International Consortium on Oral Orthotic Occlusal Appliance Therapy for Temporomandibular Joint Disorders, TMJ Foundation, TMJ Consultancy Services, Bhopal, Madhya Pradesh India
- Department of Oral and Maxillofacial Surgery, Lenora Institute of Dental Sciences, Rajahmundry, India
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Wada J, Wada K, Garoushi S, Shinya A, Wakabayashi N, Iwamoto T, Vallittu PK, Lassila L. Effect of 3D printing system and post-curing atmosphere on micro- and nano-wear of additive-manufactured occlusal splint materials. J Mech Behav Biomed Mater 2023; 142:105799. [PMID: 37028121 DOI: 10.1016/j.jmbbm.2023.105799] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 04/07/2023]
Abstract
Although additive manufacturing has been widely applied for occlusal splint (OS) fabrication, it is still unclear whether 3D printing system and post-curing atmosphere would play a role in the wear resistance of additive-manufactured OS. Therefore, the aim of this study was to evaluate the effect of 3D printing system (liquid crystal display (LCD) and digital light processing (DLP)) and post-curing atmosphere (air and nitrogen gas (N2)) on the wear resistance of hard and soft OS materials for additive-manufactured OSs (KeySplint® Hard and Soft). The evaluated properties were microwear (by two-body wear test) and nano-wear resistances (by nanoindentation wear test) as well as flexural strength and flexural modulus (by three-point bending test), surface microhardness (by Vickers hardness test), and nanoscale elastic modulus (reduced elastic modulus) and nano surface hardness (by nanoindentation test). For the hard material, the surface microhardness, microwear resistance, reduced elastic modulus, nano surface hardness, and nano-wear resistance were significantly affected by the printing system (p < 0.05), while all the evaluated properties except flexural modulus were significantly affected by the post-curing atmosphere (p < 0.05). Meanwhile, both the printing system and post-curing atmosphere significantly affected all the evaluated properties (p < 0.05). The specimens additive-manufactured by DLP printer tended to show higher wear resistance in the hard material groups and lower wear resistance in the soft material groups when compared to those by LCD printer. The post-curing at N2 atmosphere significantly enhanced the microwear resistance of hard material groups additive-manufactured by the DLP printer (p < 0.05) and soft material groups additive-manufactured by the LCD printer (p < 0.01), while it significantly enhanced the nano-wear resistance of both hard and soft material groups regardless of the printing system (p < 0.01). It can be concluded that 3D printing system and post-curing atmosphere affect the micro- and nano-wear resistance of tested additively manufactured OS materials. In addition, it can be also concluded that the optical printing system providing higher wear resistance depends on the material type, and using nitrogen gas as a protection gas during post-curing enhances the wear resistance of tested materials.
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Wada J, Wada K, Gibreel M, Wakabayashi N, Iwamoto T, Vallittu PK, Lassila L. Effect of Surface Polishing on Physical Properties of an Occlusal Splint Material for Additive Manufacturing under Protection Gas Post-Curing Condition. Polymers (Basel) 2023; 15:polym15030625. [PMID: 36771926 PMCID: PMC9919341 DOI: 10.3390/polym15030625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/19/2023] [Indexed: 01/27/2023] Open
Abstract
The aim of this study was to evaluate the effect of surface polishing as well as the post-curing atmospheres (air and nitrogen gas) on the physical properties of an occlusal splint material for additive manufacturing. Flexural strength, flexural modulus, Vickers hardness number (VHN), degree of carbon double bond conversion (DC), water sorption (WSP), and water solubility (WSL) were evaluated. Surface polishing significantly affected the evaluated properties. Regardless of the post-curing atmosphere, flexural strength, flexural modulus, VHN, and DC showed significantly higher values for the polished specimens when compared with the unpolished ones, while WSP and WSL were significantly lower for the polished specimens. Unpolished specimens post-cured at nitrogen gas showed significantly higher VHN and DC values. However, the effect of the post-curing at a nitrogen gas atmosphere was non-significant in polished specimens. The current results suggested that surface polishing plays a role in the physical properties of the evaluated occlusal splint material and can enhance all the evaluated properties regardless of the post-curing atmosphere. Meanwhile, the post-curing at a nitrogen gas atmosphere can enhance the VHN and DC but its effect is confined only to the surface layers, which can be removed during surface polishing.
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Affiliation(s)
- Junichiro Wada
- Department of Biomaterials Science, Turku Clinical Biomaterials Centre–TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B, 20520 Turku, Finland
- Department of Advanced Prosthodontics, Tokyo Medical and Dental University–TMDU, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113–8510, Japan
- Correspondence: (J.W.); (L.L.); Tel.: +81-358035515 (J.W.)
| | - Kanae Wada
- Department of Biomaterials Science, Turku Clinical Biomaterials Centre–TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B, 20520 Turku, Finland
- Department of Pediatric Dentistry/Special Needs Dentistry, Tokyo Medical and Dental University–TMDU, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113–8510, Japan
| | - Mona Gibreel
- Department of Biomaterials Science, Turku Clinical Biomaterials Centre–TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B, 20520 Turku, Finland
| | - Noriyuki Wakabayashi
- Department of Advanced Prosthodontics, Tokyo Medical and Dental University–TMDU, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113–8510, Japan
| | - Tsutomu Iwamoto
- Department of Pediatric Dentistry/Special Needs Dentistry, Tokyo Medical and Dental University–TMDU, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113–8510, Japan
| | - Pekka K. Vallittu
- Department of Biomaterials Science, Turku Clinical Biomaterials Centre–TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B, 20520 Turku, Finland
- Wellbeing Services County of South-West Finland, Lemminkäisenkatu 23, 20520 Turku, Finland
| | - Lippo Lassila
- Department of Biomaterials Science, Turku Clinical Biomaterials Centre–TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B, 20520 Turku, Finland
- Correspondence: (J.W.); (L.L.); Tel.: +81-358035515 (J.W.)
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Albagieh H, Alomran I, Binakresh A, Alhatarisha N, Almeteb M, Khalaf Y, Alqublan A, Alqahatany M. Occlusal splints-types and effectiveness in temporomandibular disorder management. Saudi Dent J 2023; 35:70-79. [PMID: 36817028 PMCID: PMC9931504 DOI: 10.1016/j.sdentj.2022.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
Background Occlusal splints are routinely used in dental offices to diagnose and treat abnormalities of the masticatory system. There are different occlusal splints, each of which can address various conditions. They may treat individuals with temporomandibular disorders (TMDs) and bruxism or be used for occlusal stabilization and dentition wear reduction. Methods The literature in the National Library of Medicine's Medline Database was reviewed using the Mesh terms 'occlusal splints' AND 'Temporomandibular Disorders. Conclusion Occlusal splints can treat a wide variety of TMDs. They can treat bruxism, headaches, postural imbalances related to TMDs, and decreased vertical dimension of occlusion (VDO). However, there is no clear evidence that occlusal splints are superior to physiotherapy in treating TMDs. In the long-term follow-up, they were equally effective as other therapies.
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Affiliation(s)
- Hamad Albagieh
- Oral Medicine and Diagnostic Sciences Department, College of Dentistry, King Saud University, Riyadh, Saudi Arabia,Corresponding author at: College of Dentistry, Building 23, 2nd Floor, Office# 2B 19, Saudi Arabia.
| | - Ibrahim Alomran
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Meteb Almeteb
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Yousef Khalaf
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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18
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Effect of 3D Printer Type and Use of Protection Gas during Post-Curing on Some Physical Properties of Soft Occlusal Splint Material. Polymers (Basel) 2022; 14:polym14214618. [PMID: 36365611 PMCID: PMC9658356 DOI: 10.3390/polym14214618] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Despite the fact that three-dimensional (3D) printing is frequently used in the manufacturing of occlusal splints, the effects of the 3D printer type and post-curing methods are still unclear. The aim of this study was to investigate the effect of the printer type (digital light processing: DLP; and liquid crystal display: LCD) as well as the post-curing method with two different atmospheric conditions (air and nitrogen gas (N2)) on the mechanical and surface properties of 3D-printed soft-type occlusal splint material. The evaluated properties were flexural strength, flexural modulus, Vickers hardness (VHN), fracture toughness, degree of double bond conversion (DC%), water sorption, water solubility, and 3D microlayer structure. The printer type significantly affected all the evaluated properties. Flexural strength, flexural modulus, and fracture toughness were significantly higher when specimens were printed by a DLP printer, while VHN and DC% were significantly higher, and a smoother surface was noticeably obtained when printed by an LCD printer. The post-curing at an N2 atmosphere significantly enhanced all of the evaluated properties except water sorption, 3D microlayer structure, and fracture toughness. The current results suggested that the printer type and the post-curing methods would have an impact on the mechanical and surface properties of the evaluated material.
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19
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Effect of Nitrogen Gas Post-Curing and Printer Type on the Mechanical Properties of 3D-Printed Hard Occlusal Splint Material. Polymers (Basel) 2022; 14:polym14193971. [PMID: 36235919 PMCID: PMC9571503 DOI: 10.3390/polym14193971] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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20
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GIBREEL M, PEREA-LOWERY L, VALLITTU PK, GAROUSHI S, LASSILA L. Two-body wear and surface hardness of occlusal splint materials. Dent Mater J 2022; 41:916-922. [DOI: 10.4012/dmj.2022-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mona GIBREEL
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku
| | - Leila PEREA-LOWERY
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku
| | | | - Sufyan GAROUSHI
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku
| | - Lippo LASSILA
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku
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