Mechanical properties of 3D-printed and milled composite resins for definitive restorations: An in vitro comparison of initial strength and fatigue behavior

Comparison of mechanical and surface properties of two 3D printed composite resins for definitive restoration

STATEMENT OF PROBLEM

Additive manufacturing (AM) technology is emerging as an innovative approach in the dental field. In recent years, manufacturers have introduced 3-dimensionally printed composite resins (3D-CRs) that are specifically designed for the AM of definitive prostheses; however, the mechanical and surface properties of these materials require investigation.

PURPOSE

The purpose of this in vitro study was to assess and compare the mechanical and surface properties of 2 commercially available 3D-CRs for definitive restoration after artificial aging.

MATERIAL AND METHODS

Saremco print Crowntec; Saremco Dental AG and Varseo Smile Crown Plus; Bego GmbH were printed with a layer thickness of 50 µm at a 90-degree angle. A total of 20 bar-shaped specimens (25×2×2 mm) were produced from each material to measure the flexural strength (σf) and elastic modulus (E) using a 3-point bend test, and 5 disk-shaped specimens (Ø15×3 mm) from each material were used to measure the surface microhardness using a microhardness test. Half of the specimens were tested under dry conditions, while the other half were immersed in distilled water for 30 days. Five disk-shaped specimens (Ø15×3 mm) from each material were used to evaluate surface roughness before and after undergoing toothbrushing simulations. Additionally, 5 disk-shaped specimens (Ø15×1 mm) were used to assess water sorption (wsp) and solubility (wsl) over 28 days. Statistical analyses were conducted using the Wilcoxon matched-pairs signed-rank test (1-tailed) with 90% power (α=.05).

RESULTS

The mean ±standard deviation flexural strength values were 123.4 ±8.7 MPa for Saremco print Crowntec and 109.9 ±15.8 MPa for Varseo Smile Crown Plus. After aging, these values were 97.5 ±15.2 MPa for Saremco print Crowntec and 94.2 ±11.7 MPa for Varseo Smile Crown Plus. The mean Vickers hardness values were 33.2 ±0.8 N/mm2 for Saremco print Crowntec and 31.5 ±0.6 N/mm2 for Varseo Smile Crown Plus. After aging, the mean values were 31.7 ±0.9 N/mm2 for Saremco print Crowntec and 29.6 ±1.0 N/mm2 for Varseo Smile Crown Plus. The mean modulus of elasticity was 4.2 ±0.3 GPa for Saremco print Crowntec and 3.82 ±0.2 GPa for Varseo Smile Crown Plus. After 21 days, the mean sorption values were 11.52 ±0.6 mg/mm3 for Saremco print Crowntec and 12.43 ±0.4 mg/mm3 for Varseo Smile Crown Plus. After 28 days, the mean solubility values were 1.36 ±0.4 mg/mm3 for Saremco print Crowntec and 0.98 ±0.3 mg/mm3 for Varseo Smile Crown Plus. Significant differences were found between the 2 3D-CRs in flexural strength in the dry state (P=.03), in Young modulus after 30 days of water immersion (P=.023), and in Vickers hardness in the dry state (P=.01) and after 30 days of water immersion (P=.018).

CONCLUSIONS

Both 3D-CRs provided good in vitro performance and the mechanical properties required for long-term clinical application. Artificial aging decreased the flexural strength of both 3D-CRs.

Comparison of Fracture Strength of Milled and 3D-Printed Crown Materials According to Occlusal Thickness

This study aimed to measure the fracture strengths and hardness of final restorative milled and 3D-printed materials and evaluate the appropriate crown thickness for their clinical use for permanent prosthesis. One type of milled material (group M) and two types of 3D-printed materials (groups P1 and P2) were used. Their crown thickness was set to 0.5, 1.0, and 1.5 mm for each group, and the fracture strength was measured. Vickers hardness was measured and analyzed to confirm the hardness of each material. Scanning electron microscopy was taken to observe the surface changes of the 3D-printed materials under loads of 900 and 1500 N. With increased thickness, the fracture strength significantly increased for group M but significantly decreased for group P1. For group P2, the fracture strengths for the thicknesses of 0.5 mm and 1.5 mm significantly differed, but that for 1.0 mm did not differ from those for other thicknesses. The hardness of group M was significantly higher than that of groups P1 and P2. For all thicknesses, the fracture strength was higher than the average occlusal force for all materials; however, an appropriate crown thickness is required depending on the material and component.

Effect of nanomodified 3D printed photopolymerizable resin on flexural strength, color, and antimicrobial efficacy: An in vitro study

STATEMENT OF PROBLEM

Three-dimensional (3D) printing has become popular in dentistry, but studies on the influence of incorporating organic and inorganic nanofillers on 3D printed materials are lacking.

PURPOSE

The purpose of this in vitro study was to assess the flexural strength, color, and antimicrobial efficacy of 3D printed photopolymerizable resin upon adding titanium dioxide nanoparticles (TiO2 NPs) and silanized chitosan nanoparticles (sCS NPs).

MATERIAL AND METHODS

A stereolithographic material (VarseoSmile Crown plus; Bego) was used as a control group (VSC resin), and 3 nanocomposite resin groups were prepared by adding nanoparticles as follow: titanium dioxide group (VSC resin + 0.4% wt. TiO2 NPs), chitosan group (VSC resin + 0.4% wt. sCS NPs), and hybrid group (VSC resin + 0.2% wt. TiO2 NPs + 0.2% wt. sCS NPs). A total of 132 specimens were designed by using a free computer-aided design software program, printed, postpolymerized, and divided into 4 groups. The nanocomposite resins were characterized using scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDX), and Fourier-transform infrared spectroscopy (FTIR). Bar shaped specimens (n=44) were tested for 3-point flexural strength using a universal testing machine followed by the color measurement of disk-shaped specimens (n=44) with a spectrophotometer. Antimicrobial capacity was measured with Streptococcus mutans, and absorbance was measured using a microplate reader (n=44). Statistical assessments were made with 1-way ANOVA followed by the Tukey post hoc test with Bonferroni adjustment (α=.05).

RESULTS

The hybrid group recorded the highest mean value of flexural strength 135.51 MPa, showing a significant difference compared with that of the control group (P=.022). Regarding color, the mean ∆E00 for titanium was 1.18, for chitosan was 4.26, and for the hybrid group was 3.23 (P<.001). The optical density of the chitosan (2.42) was significantly higher than that of the titanium 1.36 (P=.007) and that of the control 1.63 (P=.042).

CONCLUSIONS

The incorporation of nanofillers resulted in an increase in flexural strength, but it adversely affected the color of nanocomposite resins. Antimicrobial efficacy was improved by incorporating titanium nanofillers.

Effect of surface treatment strategies on bond strength of additively and subtractively manufactured hybrid materials for permanent crowns

OBJECTIVES

The purpose of this study is to evaluate the bond strength of different computer-aided design / computer-aided manufacturing (CAD/CAM) hybrid ceramic materials following different pretreatments.

METHODS

A total of 306 CAD/CAM hybrid material specimens were manufactured, n = 102 for each material (VarseoSmile Crownplus [VSCP] by 3D-printing; Vita Enamic [VE] and Grandio Blocs [GB] by milling). Each material was randomly divided into six groups regarding different pretreatment strategies: control, silane, sandblasting (50 μm aluminum oxide particles), sandblasting + silane, etching (9% hydrofluorics acid), etching + silane. Subsequently, surface roughness (Ra) values, surface free energy (SFE) were measured. Each specimen was bonded with a dual-cured adhesive composite. Half of the specimens were subjected to thermocycling (5000 cycles, 5-55 °C). The shear bond strength (SBS) test was performed. Data were analyzed by using a two-way analysis of variance, independent t-test, and Mann-Whitney-U-test (α = 0.05).

RESULTS

Material type (p = 0.001), pretreatment strategy (p < 0.001), and the interaction (p < 0.001) all had significant effects on Ra value. However, only etching on VSCP and VE surface increased SFE value significantly. Regarding SBS value, no significant difference was found among the three materials (p = 0.937), while the pretreatment strategy significantly influenced SBS (p < 0.05). Etching on VSCP specimens showed the lowest mean value among all groups, while sandblasting and silane result in higher SBS for all test materials.

CONCLUSIONS

The bond strength of CAD/CAM hybrid ceramic materials for milling and 3D-printing was comparable. Sandblasting and silane coupling were suitable for both millable and printable materials, while hydrofluoric etching should not be recommended for CAD/CAM hybrid ceramic materials.

CLINICAL RELEVANCE

Since comparable evidence between 3D-printable and millable CAD/CAM dental hybrid materials is scarce, the present study gives clear guidance for pretreatment planning on different materials.

Effect of coffee thermocycling on the color and translucency of milled and 3D printed definitive restoration materials

STATEMENT OF PROBLEM

Research on the color and translucency properties of 3-dimensionally (3D) printed definitive resins and the effect of coffee thermocycling on these properties is lacking.

PURPOSE

The purpose of this in vitro study was to investigate the effect of coffee thermocycling on the color and translucency parameters of the milled and 3D printed materials used for definitive restorations.

MATERIAL AND METHODS

Plate-shaped specimens (12×12×1 mm) of 3 milled (IPS e.max CAD (LDS), Vita Enamic (PICN), Cerasmart (RNC)) and two 3D printed (VarseoSmile Crownplus (VSP), Permanent Crown (PC)) were fabricated (n=12). The brightness (L*), red-green (a*), and yellow-blue (b*) parameters were measured with a spectrophotometer before and after 10 000 coffee thermocycles. The relative translucency parameters (RTP00) and color change were calculated using the CIEDE2000 formula. Stainability (ΔE00) and translucency differences (ΔRTP00) were evaluated. Data were analyzed with the Kruskal-Wallis, Mann-Whitney U, and Wilcoxon tests. The Spearman correlation test was used to analyze the ΔE00 and ΔRTP00 values (α=.05).

RESULTS

The type of material and coffee thermocycling significantly affected the evaluated parameters at both measurement periods (P=.001). Coffee thermocycling decreased the L* and RTP00 values while increasing the a* and b* values (P=.001). The highest ΔE00 values were found in VSP and PC, which were statistically similar (P=.291), while the highest | ΔRTP00 | values were observed for VSP (P=.001). The lowest ΔE00 and | ΔRTP00 | values were found in LDS (P=.001). A positive relationship was found between the ΔE00 and | ΔRTP00| values (R=.590, P=.01).

CONCLUSIONS

After coffee thermocycling, all tested materials exhibited a darkened, yellowish, and opaque appearance, although the alterations in color and translucency remained within clinically acceptable thresholds (AT00=1.81) for these materials.

The flexural strength of 3D-printed provisional restorations fabricated with different resins: a systematic review and meta-analysis

BACKGROUND

Three-dimensional (3D) printing technology has revolutionized dentistry, particularly in fabricating provisional restorations. This systematic review and meta-analysis aimed to thoroughly evaluate the flexural strength of provisional restorations produced using 3D printing while considering the impact of different resin materials.

METHODS

A systematic search was conducted across major databases (ScienceDirect, PubMed, Web of Sciences, Google Scholar, and Scopus) to identify relevant studies published to date. The inclusion criteria included studies evaluating the flexural strength of 3D-printed provisional restorations using different resins. Data extraction and quality assessment were performed using the CONSORT scale, and a meta-analysis was conducted using RevMan 5.4 to pool results.

RESULTS

Of the 1914 initially identified research articles, only 13, published between January 2016 and November 2023, were included after screening. Notably, Digital Light Processing (DLP) has emerged as the predominant 3D printing technique, while stereolithography (SLA), Fused Deposition Modeling (FDM), and mono-liquid crystal displays (LCD) have also been recognized. Various printed resins have been utilized in different techniques, including acrylic, composite resins, and methacrylate oligomer-based materials. Regarding flexural strength, polymerization played a pivotal role for resins used in 3D or conventional/milled resins, revealing significant variations in the study. For instance, SLA-3D and DLP Acrylate photopolymers displayed distinct strengths, along with DLP bisacrylic, milled PMMA, and conventional PMMA. The subsequent meta-analysis indicated a significant difference in flexure strength, with a pooled Mean Difference (MD) of - 1.25 (95% CI - 16.98 - 14.47; P < 0.00001) and a high I2 value of 99%, highlighting substantial heterogeneity among the studies.

CONCLUSIONS

This study provides a comprehensive overview of the flexural strength of 3D-printed provisional restorations fabricated using different resins. However, further research is recommended to explore additional factors influencing flexural strength and refine the recommendations for enhancing the performance of 3D-printed provisional restorations in clinical applications.