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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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Simeon P, Unkovskiy A, Saadat Sarmadi B, Nicic R, Koch PJ, Beuer F, Schmidt F. Wear resistance and flexural properties of low force SLA- and DLP-printed splint materials in different printing orientations: An in vitro study. J Mech Behav Biomed Mater 2024; 152:106458. [PMID: 38364445 DOI: 10.1016/j.jmbbm.2024.106458] [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: 12/21/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To investigate the influence of material and printing orientation on wear resistance and flexural properties of one low force SLA- and two DLP-printed splint materials and to compare these 3D-printed splints to a subtractively manufactured splint material. METHODS Two DLP-printed (V-Print splint, LuxaPrint Ortho Plus) and one low force SLA-printed (Dental LT Clear) material, where specimens were printed in three printing orientations (0°, 45°, 90°), were investigated. In addition, one milled splint material (Zirlux Splint Transparent) was examined. A total of 160 specimens were produced for both test series. The two-body wear test was performed in a chewing simulator (80'000 cycles at 50 N with 5-55 °C thermocycling). Steatite balls were used as antagonists. The wear pattern was analyzed with a 3D digital microscope in terms of maximum vertical intrusion depth (mm) and total volume loss (mm³). The flexural properties were investigated by three-point bending in accordance with ISO 20795-1: 2013 (denture base polymers). The flexural strength (MPa) and the flexural modulus (MPa) were measured. Two-way ANOVA was performed to investigate the effects of the two independent variables material and printing orientation for the three 3D-printed materials. The comparison of the printing orientations within one material was carried out with one-way ANOVA with post-hoc Tukey tests. RESULTS Two-way ANOVA revealed that wear and flexural properties are highly dependent on the 3D-printed material (p < 0.001). Across groups, a significant effect was observed for wear depth (p = 0.031) and wear volume (p = 0.044) with regard to printing orientation but this was not found for flexural strength (p = 0.080) and flexural modulus (p = 0.136). One-way ANOVA showed that both DLP-printed groups showed no significant differences within the printing orientations in terms of wear and flexural properties. Dental LT Clear showed that 90° oriented specimens had higher flexural strength than 0° oriented ones (p < 0.001) and 45° oriented specimens also showed higher values than 0° ones (p = 0.038). No significant differences were observed within the printing orientations for flexural modulus and wear behaviour within this group. T-tests showed that the milled splints exhibited statistically higher wear resistance and flexural properties compared to all three 3D-printed splint materials (p < 0.001) and that highly significant differences were found between the 3D-printed splint materials for both test series. CONCLUSION Within the limitations of this in vitro study, it can be stated that wear behaviour and flexural properties are highly dependent on the 3D-printed material itself. Currently, milled splints exhibit higher wear resistance and flexural properties compared to 3D-printed splint materials. The printing orientation has a minor influence on the properties investigated. Nevertheless, two-way ANOVA also showed a significant influence of printing orientation in the wear test across groups and one-way ANOVA detected significant effects for SLA material in terms of flexural strength, with printing in 90° showing the highest flexural strength. Therefore, anisotropy was found in SLA material, but it can be limited with the employed printing parameters. Both DLP-printed materials showed no significant difference within the printing orientation.
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Affiliation(s)
- Philipp Simeon
- Charité - Universitätsmedizin Berlin, Center for Oral Health Sciences CC3, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Alexey Unkovskiy
- Charité - Universitätsmedizin Berlin, Center for Oral Health Sciences CC3, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197, Berlin, Germany; Department of Dental Surgery, Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya Street, 19с1, Moscow, 119146, Russia
| | - Bardia Saadat Sarmadi
- Charité - Universitätsmedizin Berlin, Center for Oral Health Sciences CC3, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Robert Nicic
- Charité - Universitätsmedizin Berlin, Center for Oral Health Sciences CC3, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Petra Julia Koch
- Charité - Universitätsmedizin Berlin, Center for Oral Health Sciences CC3, Department of Orthodontics and Orthofacial Orthopedics, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Florian Beuer
- Charité - Universitätsmedizin Berlin, Center for Oral Health Sciences CC3, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Franziska Schmidt
- Charité - Universitätsmedizin Berlin, Center for Oral Health Sciences CC3, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
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Danko M, Chromy L, Ferencik N, Sestakova M, Kolembusova P, Balint T, Durica J, Zivcak J. Literature Review of an Anterior Deprogrammer to Determine the Centric Relation and Presentation of Cases. Bioengineering (Basel) 2023; 10:1379. [PMID: 38135970 PMCID: PMC10740564 DOI: 10.3390/bioengineering10121379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
The increasing demand for dental aesthetics, articulation corrections, and solutions for pain and frequent bruxism demands quick and effective restorative dental management. The biomedical research aimed to create a beneficial, ecological, and readily available anterior deprogrammer to determine the centric relation (CR) of cases. This medical device is additively manufactured from a biocompatible material. Size is customizable based on the width of the patient's anterior central incisors. This is a pilot study with two subjects. The task was to develop a complete data protocol for the production process, computer-aided design (CAD), and three-dimensional (3D) printing of the anterior deprogrammers. The research focused on creating simple and practically applicable tools for the dentist's prescription (anterior deprogrammer in three sizes), and secondly for the communication between the dentist and the patient (computer application). The tested hypothesis was whether, according to these novel tools, it is possible to produce functional occlusal splints, which could be manufactured using current technologies. This study compared a traditional splint with a digitally designed and 3D-printed one. The tested hypothesis was whether manufactured occlusal splints differ in patients' subjective perception of comfort. Each conservative treatment was monitored for ten weeks. Initial results are promising; no statistically significant difference was found between the productive technologies.
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Affiliation(s)
- Maria Danko
- Department of Biomedical Engineering and Measurement, Faculty of Mechanical Engineering, Technical University of Kosice, 04200 Kosice, Slovakia; (L.C.); (N.F.); (P.K.); (T.B.); (J.Z.)
| | - Lubos Chromy
- Department of Biomedical Engineering and Measurement, Faculty of Mechanical Engineering, Technical University of Kosice, 04200 Kosice, Slovakia; (L.C.); (N.F.); (P.K.); (T.B.); (J.Z.)
| | - Norbert Ferencik
- Department of Biomedical Engineering and Measurement, Faculty of Mechanical Engineering, Technical University of Kosice, 04200 Kosice, Slovakia; (L.C.); (N.F.); (P.K.); (T.B.); (J.Z.)
| | - Marcela Sestakova
- 1st Department of Stomatology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, 04154 Kosice, Slovakia; (M.S.); (J.D.)
| | - Petra Kolembusova
- Department of Biomedical Engineering and Measurement, Faculty of Mechanical Engineering, Technical University of Kosice, 04200 Kosice, Slovakia; (L.C.); (N.F.); (P.K.); (T.B.); (J.Z.)
| | - Tomas Balint
- Department of Biomedical Engineering and Measurement, Faculty of Mechanical Engineering, Technical University of Kosice, 04200 Kosice, Slovakia; (L.C.); (N.F.); (P.K.); (T.B.); (J.Z.)
| | - Jaroslav Durica
- 1st Department of Stomatology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, 04154 Kosice, Slovakia; (M.S.); (J.D.)
| | - Jozef Zivcak
- Department of Biomedical Engineering and Measurement, Faculty of Mechanical Engineering, Technical University of Kosice, 04200 Kosice, Slovakia; (L.C.); (N.F.); (P.K.); (T.B.); (J.Z.)
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