Optical and mechanical properties of conventional, milled and 3D-printed denture teeth

Efficient Digital Workflow to Replace a Missing Denture Tooth for Complete Denture Repair

Debonded denture teeth is a common complication on a fixed or removable dental prosthesis when denture teeth are fabricated separately from the denture base and bonded together. Missing denture teeth can alter a person's appearance, speech, or ability to eat. Traditionally, denture teeth repair can be a challenge for clinicians or dental laboratory technicians to find the identical tooth mould to meet esthetic and functional demands. This case report describes a digital workflow to scan, design, and mill a well-fitting and esthetic denture tooth to expedite treatment, improve patient satisfaction, and increase troop readiness when traditional methods may not be feasible.

Transfer accuracy of 3D printed versus CAD/CAM milled surgical guides for temporary orthodontic implants: A preclinical micro CT study

OBJECTIVES

Temporary anchorage devices (TADs) have become an integral part of comprehensive orthodontic treatments. This study evaluated the transfer accuracy of three-dimensional (3D) printed and computer-aided design/computer-aided manufacturing (CAD/CAM) milled surgical guides for orthodontic TADs using micro-computed tomography (CT) imaging in a preclinical trial.

METHODS

Overall, 30 surgical guides were used to place TADs into typodonts; 3D printing and CAD/CAM milling were used to produce the guides. The virtual target positions of the TADs were compared to the real positions in terms of spatial and angular deviations using digital superimposition. Micro-CT imaging was used to detect the positions. To evaluate reliability, two investigators collected the measurements twice. Intra-rater and inter-rater correlations were tested.

RESULTS

In total, 60 palatal TADs were evaluated. The mean coronal deviations in the print group ranged from 0.15 ± 0.20 mm to 0.71 ± 0.22 mm, whereas in the mill group, they ranged from 0.09 ± 0.15 mm to 0.83 ± 0.23 mm. At the apical tip, the overall deviations in the print group ranged from 0.14 ± 0.56 mm to 1.27 ± 0.66 mm, whereas in the mill group, they ranged from 0.15 ± 0.57 mm to 1.09 ± 0.44 mm. The mean intra-class and inter-class correlation coefficients ranged from 0.904 to 0.987. No statistically significant differences were found between the groups.

CONCLUSIONS

CAD/CAM milled guides yielded spatial and angular accuracies comparable to those of 3D printed guides with notable deviations in the vertical positioning of TADs.

CLINICAL SIGNIFICANCE

Digital planning of orthodontic temporary implants combines clinical predictability and the safety of surrounding tissue. Therefore, the transfer accuracy of the guides is crucial. This preclinical study was the first to evaluate CAD/CAM milling for orthodontic guides and found its accuracy comparable to that of the current "gold standard".

Surface hardness and wear resistance of prefabricated and CAD-CAM milled artificial teeth: A cross-over clinical study

PURPOSE

To clinically evaluate the surface roughness and wear resistance of prefabricated and CAD-CAM milled acrylic resin teeth for complete dentures.

MATERIALS AND METHODS

In a cross-over study design, 10 completely edentulous patients were randomly included in this study and given two complete dentures. The first complete denture was made using prefabricated teeth, while the second was constructed using CAD-CAM milled teeth. Following insertion (T0), 3 months (T3), and 6 months (T6), the complete dentures were scanned. Utilizing 3D surface super-imposition techniques, the vertical (2D wear), and volumetric (3D wear) material loss were measured. The hardness of the teeth was evaluated at the time of denture insertion (T0) and then after 6 months (T6) of denture insertion by digital Vickers hardness tester. Statistical analysis was done using SPSS software. Paired groups were compared by paired t-test. Also, a repeated measure test was used. The significant difference was considered if p ≤ 0.05.

RESULTS

The time of denture function was linearly correlated with the wear of the prefabricated and CAD-CAM milled denture tooth. Prefabricated acrylic teeth had significantly more vertical and volumetric wear after 3 and 6 months, compared to CAD-CAM milled denture teeth where p-values were 0.01, 0.009, 0.003, and 0.024, respectively. Additionally, CAD-CAM milled teeth displayed significantly higher hardness values than prefabricated teeth both before and after 6 months of use where p-values were 0.001. After 6 months, all studied teeth showed a decrease in their hardness.

CONCLUSIONS

In terms of wear resistance and surface hardness, CAD-CAM milled acrylic resin teeth were superior to prefabricated acrylic resin artificial teeth once the complete denture functions.

The Effect of Aging on Artificial Saliva at Different pH Values on the Color Stability of New Generation Denture Base Materials

STATEMENT OF PROBLEM

New-generation denture base materials are used successfully in denture fabrication; however, the effect of saliva pH change on the color stability of materials is unknown.

PURPOSE

The purpose of this in vitro study is to evaluate the color stability of new-generation denture base materials after immersion in artificial saliva with different pH values (3,7,14).

MATERIAL AND METHODS

Disc-shaped samples (Ø 10 mm x 2 mm) were prepared from three different denture base materials (1 pre-polymerized polymethylmethacrylate [PMMA], 1 graphene-reinforced PMMA, and heat-cure polymethyl methacrylate resin) (n=10). After polishing, color coordinates were measured using a PCE-CSM 5 colorimeter programmed in the CIE system (L* a* b*). The samples were kept in artificial saliva at different pH values and 37°C for 21 days. At the end of 21 days, color coordinates were measured again. The suitability of the measurements for a normal distribution was examined with the Kolmogro-Smirnov test. Whether color measurements obtained at different pH levels differed according to groups was examined with the Kruskal-Wallis test. The correlation between the CIEDE2000 and CIELab color difference formulas was examined by correlation analysis.

RESULTS

The highest color difference occurred in heat-cure samples at pH 3 (p<0.001). The color difference at different pH values was least observed in pre-polymerized PMMA samples. Significant color differences occurred in the graphene-reinforced pre-polymerized PMMA group at pH 7 (p<0.001).

CONCLUSIONS

It was observed that color differences occurred in all groups. Dentures made of new-generation CAD/CAM PMMA, which are less exposed to color differences, can be recommended for elderly patients with systemic diseases who are frequently exposed to pH changes in the oral cavity.

CLINICAL IMPLICATIONS

Color differences on denture surfaces over time negatively affect aesthetics. Since pH changes cause changes on the prosthesis surface, it may be recommended for these patients to fabricate dentures from new-generation CAD/CAM PMMA resins, which are less deformable.

Comparison of mechanical properties, surface roughness, and color stability of 3D-printed and conventional heat-polymerizing denture base materials

STATEMENT OF PROBLEM

Studies on the mechanical, optical, and surface properties of 3-dimensionally (3D) printed denture base materials are scarce, and those available have reported conflicting results.

PURPOSE

The purpose of this in vitro study was to compare the mechanical properties, surface roughness, and color stability of 3D-printed and conventional heat-polymerizing denture base materials.

MATERIAL AND METHODS

A total of 34 rectangular specimens (64×10×3.3 mm) were fabricated from each of the conventional (SR Triplex Hot; Ivoclar AG) and 3D-printed (Denta base; Asiga) denture base materials. All specimens underwent coffee thermocycling for 5000 cycles, and half in each group (n=17) were evaluated in terms of color parameters, color change (ΔE00), and surface roughness (Ra) before and after coffee thermocycling. The specimens then underwent a 3-point bend test. The remaining specimens in each group (n=17) underwent impact strength and Vickers hardness testing. Data were analyzed by the paired samples, independent samples, and Wilcoxon signed rank tests (α=.05).

RESULTS

The color change caused by coffee thermocycling in the 3D-printed group was higher than that in the conventional group (P<.001). Surface roughness significantly increased in both groups after coffee thermocycling (P<.001). The conventional group had higher surface roughness before coffee thermocycling, while the 3D-printed group had higher surface roughness after coffee thermocycling (P<.001). The flexural strength, flexural modulus, and surface hardness in the conventional group were significantly higher than those in the 3D-printed group (P<.001). However, the impact strength of the conventional group was lower than that of the 3D-printed group (P<.001).

CONCLUSIONS

The 3D-printed denture base material showed higher impact strength and surface roughness than the conventional heat-polymerizing acrylic resin. However, flexural strength and modulus, surface hardness, and color stability were lower in the 3D-printed group.

Development of predictive algorithms for the wear resistance of denture teeth materials

OBJECTIVES

To investigate the wear resistance of conventional, CAD-milled and 3D-printed denture teeth in vitro with simulated aging. To use the collected data to train single time series sample model LSTM and provide proof of concept.

METHODS

Six denture teeth materials (Three Conventional; Double-cross linked PMMA (G1), Nanohybrid composite (G2), PMMA with microfillers (G3), CAD-milled (G4), two 3D-printed teeth (G5, G6) (Total n = 60) underwent simulation for 24 and 48 months of linear reciprocating wear using a universal testing machine (UFW200, NeoPlus) under 49 N load, 1 Hz and linear stroke of 2 mm in an artificial saliva medium. Single samples were parsed through Long Short-Term Memory (LSTM) neural network model using Python. To determine minimal simulation times, multiple data splits for training were trialled (10/20/30/40%). Scanning electron microscopy (SEM) was performed for material surface evaluation.

RESULTS

3D printed tooth material (G5) had the lowest wear resistance (59 ± 35.71 μm) whereas conventional PMMA with microfillers (G3) shown the highest wear rate (303 ± 0.06 μm) after 48 months of simulation. The LSTM model successfully predicted up to 48 months wear using 30% of the collected data. Compared with the actual data, the model had a root-mean-square error range between 6.23 and 88.56 μm, mean-absolute-percentage-error 12.43-23.02% and mean-absolute-error 7.47-70.71 μm. SEM images revealed additional plastic deformations and chipping of materials, that may have introduced data artifacts.

CONCLUSIONS

3D printed denture teeth materials showed the lowest wear out of all studied for 48 months simulation. LSTM model was successfully developed to predict wear of various denture teeth. The developed LSTM model has the potential to reduce simulation duration and specimen number for wear testing of various dental materials, while potentially improving the accuracy and reliability of wear testing predictions. This work paves the way for generalized multi-sample models enhanced with empirical information.

Mechanical properties of 3D-printed prosthetic materials compared with milled and conventional processing: A systematic review and meta-analysis of in vitro studies

STATEMENT OF PROBLEM

Three-dimensional (3D) additive manufacturing (AM) is an evolving technology in dentistry, proposed as an alternative to subtractive milling manufacture (MM) or conventional processing. However, a systematic review of the use of AM technology instead of milling or conventional processing is lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the mechanical properties of 3D-printed prosthetic materials compared with MM and conventional techniques.

MATERIAL AND METHODS

An electronic search of the literature was conducted on the MEDLINE (via PubMed), Scopus, and Web of Science databases. The inclusion criteria were in vitro studies published in the last 5 years, in English or Italian, and with 3D AM printed dental prosthetic materials. Data extraction was focused on dental prosthetic materials (ceramics, polymers, and metals) and their mechanical properties: flexural strength, fracture load, hardness, roughness, removable partial denture (RPD) fit accuracy, trueness, marginal discrepancy, and internal fit. Data considered homogenous were subjected to meta-analysis using the Stata17 statistical software program (95% confidence interval [CI]; α=.05). Since all variables were continuous, the Hedge g measure was calculated. A fixed-effects model was used for I2=0%, while the statistical analysis was conducted using a random-effects model with I2>0%.

RESULTS

From a total of 3624 articles, 2855 studies were selected, and 76 studies included after full-text reading. The roughness of AM-printed ceramics generally increased compared with that of conventional processing while the marginal discrepancy was comparable both for ceramics and polymers. The flexural strength, hardness, and fracture load of AM-printed polymers were statistically lower than those of the conventional group (P<.05). No significant difference was detected in terms of hardness, roughness, marginal discrepancy, fracture load, trueness, or internal fit between the AM and MM techniques (P>.05). Milling techniques showed significantly higher values of flexural strength (Hedge g=-3.88; 95% CI, -7.20 to -0.58; P=.02), also after aging (Hedge g=-3.29; 95% CI, -6.41 to -0.17; P=.04), compared with AM printing.

CONCLUSIONS

AM is comparable with MM in terms of mechanical properties, in particular with polymeric materials. The flexural strength of AM-printed prostheses is lower than with conventional and MM techniques, as are the parameters of hardness and fracture load, while the marginal discrepancy is similar to that of MM and conventional techniques. AM prostheses are commonly used for interim crowns and fixed partial dentures, as their rigidity and fracture resistance cannot support mastication forces for extended periods. More comparative studies are needed.