Strength and Surface Properties of a 3D-Printed Denture Base Polymer

Development of 3-dimensionally printed denture base material utilizing hybrid polymer: A preliminary investigation

STATEMENT OF PROBLEM

Current 3-dimensionally (3D) printed denture bases have inadequate strength and durability for long-term use, and milled denture bases generate excessive waste. Addressing these limitations is crucial to advancing prosthetic dentistry, ensuring improved patient outcomes and promoting environmental responsibility.

PURPOSE

The purpose of this in vitro study was to incorporate microparticles into a commercially available 3D printed denture base resin and compare its mechanical and biological properties with the conventional polymethyl methacrylate (PMMA) denture base material.

MATERIAL AND METHODS

Microparticles were collected from milled zirconia blanks and were blended with a 3D printing denture base resin (NextDent Denture 3D+). The optimal zirconia microparticle content (2%) for blending and printed was determined by using a liquid-crystal display (LCD) 3D printer. The printed specimens were then postrinsed and postpolymerized based on the manufacturer's instructions. Mechanical and biological characterization were carried out in terms of flexural strength, fracture toughness, and fungal adhesion. One-way ANOVA was carried out to analyze the results statistically.

RESULTS

The incorporation of microparticles in the 3D printed denture demonstrated higher mechanical strength (104.77 ±7.60 MPa) compared with conventional heat-polymerized denture base resin (75.15 ±24.41 MPa) (P<.001), but the mechanical strength deteriorated when compared with the unmodified 3D printing resin (122.17 ±11.58 MPa) (P<.001). However, the modified 3D printed denture showed greater antibacterial activity (1184.00 ±243.25 CFU/mL) than the unmodified resin (1486.50 ±103.94 CFU/mL) (P=.045).

CONCLUSIONS

The incorporation of microparticles into the 3D printed denture base resin demonstrated the potential to enhance the mechanical and biological properties of the denture base when compared with conventional techniques. However, when compared with the unmodified 3D printed denture base resin, the mechanical properties deteriorated while the biological properties improved.

Evaluation of microhardness, degree of conversion, and abrasion resistance of nanoglass and multiwalled carbon nanotubes reinforced three-dimensionally printed denture base resins

PURPOSE

To assess the effect of nanoglass (NG) particles and multiwalled carbon nanotubes' (MWCNTs) addition on Vickers hardness (VH), degree of conversion (DC), and abrasion resistance of 3D-printed denture base resin.

MATERIALS AND METHODS

3D-printed denture base resin was reinforced using silanized NG and MWCNTs to obtain four groups: Control, 0.25 wt% NG reinforced resin, 0.25 wt% MWCNTs reinforced resin, and a combination group of 0.25 wt% of both fillers. All specimens (N = 176) were tested before and after thermal aging (600 cycles) for VH (n = 22), DC, and abrasion resistance (n = 22). Abrasion resistance specimens were subjected to 60,000 brushing strokes, and then assessed for surface roughness (Ra) and weight loss. Specimens were then scanned with a benchtop scanner before and after abrasion to produce a color map of topographical changes from superimposed images. Data were analyzed using ANOVA tests followed by Tukey post hoc test. Kruskal-Wallis test was used to compare percent change among groups, followed by Dunn post hoc test (α = 0.05).

RESULTS

The interaction between nanofiller content and thermal cycling displayed a significant effect on VH and DC. The 0.25% NG expressed the highest VH before aging but revealed the highest percent decrease after aging. Nanofiller content, thermal aging, and brushing displayed a significant interaction impact on the Ra values.

CONCLUSIONS

The addition of nanofillers resulted in an overall improvement in resin microhardness and abrasion resistance. The 0.25% MWCNTs group revealed the lowest Ra with the least percent change in VH and DC, while the combination one displayed the least change in weight.

Tissue surface adaptation and retention of digital obturator after one year of use

BACKGROUND

Effect of aging on tissue adaptability and retention of digital obturator is still under investigation.

METHODS

A maxillary Armany (class I) epoxy reference model was scanned to fabricate digital obturator fabricated from milled Co-Cr framework and 3D printed bulb. A color map of the scanned reference and digital obturator was made using Geomagic software to evaluate the accuracy of fit before and after cyclic loading using ROBOTA chewing simulator at 37,500, 75,000 and 150,000 cycles to simulate clinically 3-, 6- and 12-months chewing condition. Insertion-removal condition simulating the placement and removal of the obturator was done using repeated 360, 720 and 1440 cycles and retention was evaluated before and after the repeated cycles. Data were collected, tabulated and statistically analyzed using Statistical Package for Social Sciences (IBM SPSS Statistics 26). Student t-test and multi variable ANOVA test were used to detect significance. P-value < 0.05 was considered significant difference.

RESULTS

For retention test: There was a significant difference between baseline and 3, 6 and12 months. For the tissue surface adaptation test: There was significant difference at all measured areas (P-value < 0.05) before and after application of load.

CONCLUSION

digitally designed and fabricated obturator was highly retentive and has excellent tissue surface adaptation upon fabrication, After application of load; reduction of retention and lack of tissue adaptation were resulted. THE CLINICAL IMPLICATION: of this manuscript is that digital obturator can be used successfully with the shortcomings of loosening retention and adaptation afterwhile. So, clinical trials should investigate the clinical acceptance of these shortcomings.

Mechanical and physical properties of splint materials for oral appliances produced by additive, subtractive and conventional manufacturing

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.

Post-processing of a 3D-printed denture base polymer: Impact of a centrifugation method on the surface characteristics, flexural properties, and cytotoxicity

OBJECTIVES

To investigate the impact of a centrifugation method on the surface characteristics, flexural properties, and cytotoxicity of an additively manufactured denture base polymer.

METHODS

The tested specimens were prepared by digital light processing (DLP). A centrifugation method (CENT) was used to remove the residual uncured resin. In addition, the specimens were post-processed with different post-rinsing solutions: isopropanol (IPA), ethanol (EtOH), and tripropylene glycol monomethyl ether (TPM), respectively. A commercial heat-polymerized polymethyl methacrylate was used as a reference (REF). First, the values of surface topography, arithmetical mean height (Sa), and root mean square height (Sq) were measured. Next, flexural strength (FS) and modulus were evaluated. Finally, cytotoxicity was assessed using an extract test. The data were statistically analyzed using a one-way analysis of variance, followed by Tukey's multiple comparison test for post-hoc analysis.

RESULTS

The Sa value in the CENT group was lower than in the IPA, EtOH, TPM, and REF groups (p < 0.001). Moreover, the CENT group had lower Sq values than other groups (p < 0.001). The centrifugation method showed a higher FS value (80.92 ± 8.65 MPa) than the EtOH (61.71 ± 12.25 MPa, p < 0.001) and TPM (67.01 ± 9.751 MPa, p = 0.027), while affecting IPA (72.26 ± 8.80 MPa, p = 0.268) and REF (71.39 ± 10.44 MPa, p = 0.231). Also, the centrifugation method showed no evident cytotoxic effects.

CONCLUSIONS

The surfaces treated with a centrifugation method were relatively smooth. Simultaneously, the flexural strength of denture base polymers was enhanced through centrifugation. Finally, no evident cytotoxic effects could be observed from different post-processing procedures.

CLINICAL SIGNIFICANCE

The centrifugation method could optimize surface quality and flexural strength of DLP-printed denture base polymers without compromising cytocompatibility, offering an alternative to conventional rinsing post-processing.

3D printed, subtractive, and conventional acrylic resins: Evaluation of monotonic versus fatigue behavior and surface characteristics

This study assessed the mechanical properties and surface characteristics of dental prosthetic acrylic resin fabricated by 3D printing, comparing it with subtractive, pressing, and molding techniques. Bar-shaped specimens (N= 90; 65 × 10 × 3.3 mm; ISO:207951) were prepared and assigned into six groups: PRINT (3D printing vis stereolithography with PriZma 3D Bio Denture, Makertech Labs); SUB (subtractive manufacturing with Vipiblock Trilux, Vipi); PRESS Base (pressing using muffle with Thermo Vipi Wave, Vipi for base); PRESS Tooth (pressing with Onda-cryl, Clássico for tooth); MOLD Base (molding using addition silicone with Vipi Flash, Vipi for base); and MOLD Tooth (molding with Dencor, Clássico for tooth). Monotonic flexural strength (FS) and elastic modulus (E) were measured using a three-point bending approach (n= 5) on a universal testing machine at a crosshead speed of 5 mm/min. Fatigue testing (n= 10) followed similar geometry and settings, with a frequency of 2 Hz, initial stress level at 20 MPa, and stress increments of 5 MPa every 2,500 cycles. Surface roughness (n= 10) was assessed through profilometry, and fractographic and topographic analyses were conducted. Statistical analyses included One-Way ANOVA for monotonic FS, roughness, and E, along with Kaplan-Meier with Mantel-Cox post-hoc and Weibull analysis for fatigue strength. PRINT showed lower monotonic FS than the SUB and PRESS Tooth but comparable fatigue strength to these groups and superior to PRESS Base and MOLD (Base and Tooth) groups. All groups had similar Weibull moduli. Surface roughness of the PRINT group was comparable to most techniques but higher than the PRESS Tooth group. Fractographic analysis revealed fractures originating from surface defects under tensile stress, with SEM showing scratch patterns in all groups except PRINT, which had a more uniform surface. Despite its lower monotonic strength, 3D printed resin demonstrated comparable fatigue strength to subtractive and pressing methods and similar surface roughness to most methods, indicating its potential as a viable option for dental prosthesis.

Enhancing 3D-printed denture base resins: A review of material innovations

The limited physical and mechanical properties of polymethyl methacrylate (PMMA), the current gold standard, necessitates exploring improved denture base materials. While three-dimensional (3D) printing offers accuracy, efficiency, and patient comfort advantages, achieving superior mechanics in 3D-printed denture resins remains challenging despite good biocompatibility and esthetics. This review investigates the potential of innovative materials to address the limitations of 3D-printed denture base materials. Thus, this article is organized to provide a comprehensive overview of recent efforts to enhance 3D-printed denture base materials, highlighting advancements. It critically examines the impact of incorporating various nanoparticles (zirconia, titania, etc.) on these materials' physical and mechanical properties. Additionally, it delves into recent strategies for nanofiller surface treatment and biocompatibility evaluation and explores potential future directions for polymeric composites in denture applications. The review finds that adding nanoparticles significantly improves performance compared to unmodified resins, and properties can be extensively enhanced through specific modifications, particularly silanized nanoparticles. Optimizing 3D-printed denture acrylics requires a multifaceted approach, with future research prioritizing novel nanomaterials and surface modification techniques for a novel generation of superior performance, esthetically pleasing, and long-lasting dentures.

The effect of various surface treatments on the repair bond strength of denture bases produced by digital and conventional methods

There is limited information on the repairability of prostheses produced with digital technology. This study aims to evaluate various surface treatments on flexural bond strength of repaired dentured base resins produced by digital and conventional methods. A total of 360 samples were prepared from one heat-polymerized, one CAD/CAM milled and one 3D printed denture base materials. All of the test samples were subjected to thermocycling (5-55 °C, 5000 cycles) before and after repair with auto-polymerizing acrylic resin. The test samples were divided into five subgroups according to the surface treatment: grinding with silicon carbide (SC), sandblasting with Al2O3 (SB), Er:YAG laser (L), plasma (P) and negative control (NC) group (no treatment). In addition, the positive control (PC) group consisted of intact samples for the flexural strength test. Surface roughness measurements were performed with a profilometer. After repairing the test samples, a universal test device determined the flexural strength values. Both the surface topography and the fractured surfaces of samples were examined by SEM analysis. The elemental composition of the tested samples was analyzed by EDS. Kruskal-Wallis and Mann-Whitney U tests were performed for statistical analysis of data. SB and L surface treatments statistically significantly increased the surface roughness values of all three materials compared to NC subgroups (p < 0.001). The flexural strength values of the PC groups in all three test materials were significantly higher than those of the other groups (p < 0.001). The repair flexural strength values were statistically different between the SC-SB, L-SB, and NC-SB subgroups for the CAD/CAM groups, and the L-SC and L-NC subgroups for the 3D groups (p < 0.001). The surface treatments applied to the CAD/CAM and heat-polymerized groups did not result in a statistically significant difference in the repair flexural strength values compared to the NC groups (p > 0.05). Laser surface treatment has been the most powerful repair method for 3D printing technique. Surface treatments led to similar repair flexural strengths to untreated groups for CAD/CAM milled and heat-polymerized test samples.

Bonding Efficiency between Artificial Teeth and Denture Base in CAD/CAM and Conventional Complete Removable Dentures

A common challenge encountered with both traditional and digitally produced dentures involves the extraction of artificial teeth from the denture base. This narrative review seeks to present an updated perspective on the adherence of synthetic teeth for denture base materials, employing diverse methods. Dental technicians often employ chemical approaches and mechanical techniques (including abrasion, laser treatment, and abrasive blasting) to augment the retention of denture teeth. However, the efficacy of these treatments remains uncertain. In certain instances, specific combinations of Denture Base Resin (DBR) materials and artificial teeth exhibit improved performance in conventional heat-cured dentures following these treatments. The primary reasons for failure are attributed to material incompatibility and inadequate copolymerization. As new denture fabrication techniques and materials continue to emerge, further research is imperative to identify optimal tooth-DBR combinations. Notably, 3D-printed tooth-DBR combinations have demonstrated reduced bond strength and less favorable failure patterns, while utilizing milled and traditional combinations appears to be a more prudent choice until advancements in additive manufacturing enhance the reliability of 3D-printing methods.

Impact of Artificial Aging on the Physical and Mechanical Characteristics of Denture Base Materials Fabricated via 3D Printing

Three-dimensional (3D) printing is becoming more prevalent in the dental sector due to its potential to save time for dental practitioners, streamline fabrication processes, enhance precision and consistency in fabricating prosthetic models, and offer cost-effective solutions. However, the effect of aging in artificial saliva of this type of material has not been explored. To assess the physical and mechanical properties of the two types of 3D-printed materials before and after being subjected to artificial saliva, a total of 219 acrylic resin specimens were produced. These specimens were made with two types of 3D-printed materials, namely, NextDent (ND) and Formlabs (FLs), and a Schottlander heat-cured (HC) resin material that was used as a control. Water sorption and solubility specimens (n = 5) were tested after three months of storage in artificial saliva. Moreover, the Vickers hardness, Martens hardness, flexural strength/modulus, and impact strength were evaluated both under dry conditions and after three months of storage in artificial saliva. The degree of conversion (DC), elemental analysis, and filler content were also investigated. The ANOVA showed that 3D-printed resins had significantly greater sorption than the control group (p < 0.05). However, the flexural strength values of the 3D-printed materials were significantly greater (p < 0.05) than those of the heat-cured material. The DC of the 3D-printed resins was lower than that of the control group, but the difference was not significant (p > 0.05). The 3D-printed materials contained significantly more filler than the control (p < 0.05). Moreover, the artificial saliva had a significant effect on the Vickers hardness for all tested groups and on the Martens hardness for the control group only (p < 0.05). Compared with conventional heat-cured materials, 3D-printed denture base materials demonstrated relatively poorer performance in terms of sorption, solubility, and DC but exhibited either comparable or superior mechanical properties. The aging process also influenced the Vickers and Martens' hardness. The strength of the 3D-printed materials was in compliance with ISO recommendations, and the materials could be used alongside conventional heat-cured materials.

Impact of adding zirconium oxide nanoparticles to the 3D printable acrylic resin base material for implant-retained overdentures: A clinical comparative parallel study

STATEMENT OF PROBLEM

Three-dimensionally (3D) printed acrylic resin base materials have been adopted in prosthetic dentistry. However, their mechanical and biological properties require improvement.

PURPOSE

The purpose of this clinical study was to evaluate the effect of adding zirconium oxide nanoparticles to a 3D printable acrylic resin base material for a 2-implant-retained complete mandibular overdenture in terms of peri-implant tissue health, surface roughness, and biofilm formation.

MATERIAL AND METHODS

Twenty edentulous patients were enrolled in this clinical parallel study. All patients received maxillary complete dentures opposing a 2-implant-retained mandibular overdenture. The participants were randomly divided into 2 equal groups according to the mandibular overdenture base material, nonmodified 3D printable acrylic resin (control group) or 3D printable acrylic resin base material modified with 3.0 wt% zirconium oxide nanoparticles (study group). Peri-implant tissue health and surface roughness were measured immediately at the insertion of the mandibular overdenture (T0), after 3 months (T1), and after 6 months (T2). Microbiological assessment of the denture base was done after 1 week, 1 month, 3 months, and 6 months of overdenture use. The data were analyzed using a statistical software program. The Wilcoxon signed-rank test, paired t test, and Fisher exact test were used to compare distributed data. The Mann Whitney U test and repeated measures ANOVA test were used to compare distributed data at different times (α=.05).

RESULTS

The gingival index (GI), plaque index (PI), probing depth (PD), and surface roughness values at the baseline, 3 months, and 6 months were statistically higher with the nonmodified compared with the modified group (P=.001). Regarding the microbiological analysis, the nonmodified group also had a statistically higher mean bacterial and Candida albicans count than the modified group (P<.05). No significant increase in the bacteria was found in the nonmodified group with time (P=.252), but, for the modified group, a statistically significant decrease in bacteria count was found with time (P<.001).

CONCLUSIONS

Adding zirconium oxide nanoparticles to a 3D printable acrylic resin base material was found to be promising. This addition improved the peri-implant tissue health and decreased surface roughness and biofilm formation.

Nanoparticle-Modified 3D-Printed Denture Base Resins: Influence of Denture Cleansers on the Color Stability and Surface Roughness In Vitro

This study aimed to evaluate the influence of denture cleansers on the color, stability, and surface roughness of three-dimensional (3D)-printed denture base resins modified with zirconium dioxide nanoparticles (nano-ZrO2). A total of 440 specimens were fabricated using one heat-polymerized resin, and two 3D-printed resins (NextDent and ASIGA). According to the nano-ZrO2 content, the specimens for each resin were divided into five groups (0%, 0.5%wt, 1%wt, 3%wt, and 5%wt). Each concentration was divided into four subgroups (n = 10) based on the immersion solution (distilled water, sodium hypochlorite, Corega, and Fittydent) and immersion duration (360 and 720 days). The color changes (∆E00) and surface roughness (Ra, µm) of each specimen were measured at different time intervals (base line, 360 days, 720 days) using a spectrophotometer and a non-contact profilometer, respectively. The results were statistically analyzed using ANOVA and a post hoc Tukey's test (α = 0.05). Sodium hypochlorite showed the highest significant color change of all the denture base resins (p < 0.001). The average value of ΔE00 for sodium hypochlorite was significantly higher than the values for the other solutions (Fittydent, Corega, and water) (p < 0.001). Color stability was significantly affected by immersion time for all types of solutions except Corega (p < 0.001). All of the tested immersion solutions (distilled water, sodium hypochlorite, Corega, and Fittydent) showed a significant increase in the surface roughness of all the denture base resins (p < 0.05). Surface roughness was substantially increased by immersion time for all types of solution except Fittydent (p < 0.001). Denture cleansers can result in substantial color change and affect the surface roughness of unmodified and nanoparticle-modified denture base resins. Therefore, the selection of denture cleanser and appropriate types of material is critical for denture longevity.

Do 3D-printed and milled tooth-supported complete monolithic zirconia crowns differ in accuracy and fit? A systematic review and meta-analysis of in vitro studies

STATEMENT OF PROBLEM

Additive (3-dimensional printing) and subtractive (milling) methods are digital approaches to fabricating zirconia restorations. Comparisons of their resultant fabrication accuracy and restoration fit are lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the accuracy and fit of monolithic zirconia crowns fabricated by 3-dimensional printing and milling.

MATERIAL AND METHODS

The PubMed (Medline), Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar databases were searched up to August 2023. Eligible records were included, and the standardized mean difference (SMD) analyzed 4 outcomes: marginal fit, intaglio fit, trueness, and precision. Publication bias was analyzed with Trim-and-fill, the Egger regression test, and Begg funnel plot. Methodological quality was rated using the QUIN tool.

RESULTS

A total of 15 publications were found eligible out of the initial 6539 records. The 3-dimensional printing group demonstrated a lower marginal fit (SMD=1.46, 95% CI=[0.67, 2.26], P<.001; I2=83%, P<.001) and trueness (SMD=0.69, 95% CI=[0.20, 1.18], P=.006; I2=88%, P<.001) and a significantly higher precision (SMD=-2.19, 95% CI=[-2.90, -1.48], P<.001; I2=56%, P=.045). The intaglio fit did not differ significantly across the study groups (SMD=0.77, 95% CI=[-0.22, 1.77], P=.127; I2=87%, P<.001).

CONCLUSIONS

Given the high degree of heterogeneity, it can be cautiously concluded that while 3-dimensional printing led to greater precision, the outcomes of the 2 accuracy and adaptation parameters most crucial to the longevity of the restorations-trueness and marginal fit-showed the superiority of the milling technique.

In Vitro Evaluation of Candida albicans Adhesion and Related Surface Properties of CAD/CAM Denture Base Resins

OBJECTIVE

 The aim of this study was to evaluate the surface roughness, contact angle, and adhesion of Candida albicans to computer-aided designing/computer-aided manufacturing (CAD/CAM) and heat-polymerized (HP) denture base materials.

MATERIALS AND METHODS

 Specimens were allocated to six groups based on the composition of studied denture base materials, HP acrylic resin, milled resins (AvaDent and IvoCad), and 3D-printed resins (ASIGA, FormLabs, and NextDent). Ten specimens per group were used for each test (n = 10/test). Surface roughness and contact angles were analyzed using profilometer and goniometer, respectively. Adhesion of C. albicans was counted using colony-forming unit (CFU/mL). Means and standard deviations were calculated, and then one-way analysis of variance (ANOVA), followed by Tukey's post hoc test. Correlation of Candida adhesion and surface parameters was determined by using Pearson's correlation analysis.

RESULTS

 No statistically significant difference was noted in surface roughness between HP, milled, and 3D-printed denture base resins except NextDent, which showed significantly higher roughness in comparison to all other resins (p = 0.001). In terms of contact angle, milled resins had the lowest value, followed by HP, ASIGA, and FormLabs, whereas NextDent showed the highest contact angle (p = 0.001). C. albicans adhesion showed no significant difference between all denture base resins. A positive and significant correlation was found between C. albicans adhesion and contact angle (p = 0.003), while no correlation was reported between C. albicans adhesion and surface roughness (p = 0.523).

CONCLUSION

 Adhesion of C. albicans was similar in all tested specimens. Surface roughness showed no significant difference between all groups except NextDent, which had the highest value. Milled denture base resins had the lowest contact angle among all groups.

Accuracy of Artificial Intelligence Models in Dental Implant Fixture Identification and Classification from Radiographs: A Systematic Review

Background and Objectives: The availability of multiple dental implant systems makes it difficult for the treating dentist to identify and classify the implant in case of inaccessibility or loss of previous records. Artificial intelligence (AI) is reported to have a high success rate in medical image classification and is effectively used in this area. Studies have reported improved implant classification and identification accuracy when AI is used with trained dental professionals. This systematic review aims to analyze various studies discussing the accuracy of AI tools in implant identification and classification. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study was registered with the International Prospective Register of Systematic Reviews (PROSPERO). The focused PICO question for the current study was "What is the accuracy (outcome) of artificial intelligence tools (Intervention) in detecting and/or classifying the type of dental implant (Participant/population) using X-ray images?" Web of Science, Scopus, MEDLINE-PubMed, and Cochrane were searched systematically to collect the relevant published literature. The search strings were based on the formulated PICO question. The article search was conducted in January 2024 using the Boolean operators and truncation. The search was limited to articles published in English in the last 15 years (January 2008 to December 2023). The quality of all the selected articles was critically analyzed using the Quality Assessment and Diagnostic Accuracy Tool (QUADAS-2). Results: Twenty-one articles were selected for qualitative analysis based on predetermined selection criteria. Study characteristics were tabulated in a self-designed table. Out of the 21 studies evaluated, 14 were found to be at risk of bias, with high or unclear risk in one or more domains. The remaining seven studies, however, had a low risk of bias. The overall accuracy of AI models in implant detection and identification ranged from a low of 67% to as high as 98.5%. Most included studies reported mean accuracy levels above 90%. Conclusions: The articles in the present review provide considerable evidence to validate that AI tools have high accuracy in identifying and classifying dental implant systems using 2-dimensional X-ray images. These outcomes are vital for clinical diagnosis and treatment planning by trained dental professionals to enhance patient treatment outcomes.

Comparing the accuracy of occlusal vertical dimension transfer in CAD-CAM dentures

PURPOSE

There are different methods to transfer occlusal vertical dimension (OVD) when fabricating complete dentures, but it is not clear which method yields the most accurate transfer. This study investigated the accuracy of transferring the OVD of the maxillary/mandibular relationship when designing and fabricating digital dentures by evaluating two commonly used workflows: duplicate dentures (DDs) and occlusion rims (ORs).

MATERIALS AND METHODS

Mounted edentulous casts were used to simulate a completely edentulous patient. These casts were used in two workflows: (1) DD workflow where complete dentures were fabricated and relined (n = 15), and (2) OR where final impressions and ORs were constructed (n = 15). Relined dentures and ORs with fiduciary markers were then scanned and virtually articulated, then exported as STL files. A scan of the articulated casts (simulated patients) with fiduciary markers embedded was also exported as an STL file and used as a control. STL files for each workflow were superimposed over the control and analyzed in 3D inspection software (Geomagic Control X, 3D Systems, NC) for deviations (mm) at three different locations. Average 3D deviations were compared among the groups using a two-way ANOVA (α-0.05).

RESULTS

The average deviation for OR was significantly larger than DD at all locations of measurement [F = 46.00, p < 0.0001]. The majority of the measurements (98.9%) had a positive deviation value, indicating increased OVD. The overall deviation for the OR group from the control was 0.72 ± 0.13 mm versus 0.45 ± 0.23 mm for the DD group. There was no difference in deviation between the points of measurement and no interaction between the location and method [F = 0.02, p < 0.98].

CONCLUSIONS

The DD workflow exhibited less deviation in the transfer of OVD than the OR workflow. However, the deviation was small and may not be clinically significant.

Effect of coffee thermocycling on the surface roughness and stainability of denture base materials with different chemical compositions manufactured with additive and subtractive technologies

OBJECTIVE

To evaluate the effect of coffee thermocycling (CTC) on the surface roughness (Ra ) and stainability of denture base materials with different chemical compositions fabricated by using additive and subtractive manufacturing.

MATERIALS AND METHODS

Disk-shaped specimens were additively (FREEPRINT denture, AM) or subtractively (G-CAM, GSM and M-PM, SM) fabricated from three pink denture base materials in different chemical compositions (n = 10). Ra was measured before and after polishing, while color coordinates were measured after polishing. Specimens were subjected to CTC (5000 cycles) and measurements were repeated. Color differences (ΔE00 ) after CTC were calculated. Ra among different time intervals within materials was evaluated by using repeated measures analysis of variance (ANOVA), while 1-way ANOVA was used to evaluate the Ra of different materials within each time interval and the ΔE00 values. Color coordinates within each material were compared by using paired samples t-tests (α = 0.05).

RESULTS

Ra before polishing was the highest for all materials (p < 0.001), while SM had its lowest Ra after CTC and AM had its lowest Ra after polishing (p ≤ 0.008). Before polishing, AM had the highest Ra among the materials (p < 0.001). After polishing, SM had higher Ra than AM (p < 0.001). After CTC, GSM had the lowest Ra (p ≤ 0.048). SM had the lowest (p ≤ 0.031) and AM had the highest (p < 0.001) ΔE00 . CTC decreased the a* and b* values of SM and AM (p ≤ 0.017), and increased the L* values of AM (p < 0.001).

CONCLUSIONS

Polishing significantly reduced the surface roughness of all materials. CTC did not increase the surface roughness of materials above the clinically acceptable threshold. Only AM had perceptible color change when previously reported threshold values for denture base materials were considered.

CLINICAL SIGNIFICANCE

Tested denture base materials may have similar surface stability after coffee thermocycling. However, subtractively manufactured denture base materials may have improved color stability when subjected to long-term coffee consumption.

A 3D-simulation study of the deformation, tension, and stress of 3D-printed and conventional denture base materials after immersion in artificial saliva

INTRODUCTION

The worldwide application of digital technology has presented dentistry with transformative opportunities. The concept of digital dentures, incorporating computer-aided design (CAD) and computer-aided manufacturing (CAM) techniques, holds the promise of improved precision, customization, and overall patient satisfaction. However, the shift from traditional dentures to their digital counterparts should not be taken lightly, as the intricate interplay between oral physiology, patient comfort, and long-term durability requires thorough examination.

The Influence of Contemporary Denture Base Fabrication Methods on Residual Monomer Content, Flexural Strength and Microhardness

(1) Background: Digital technologies are available for denture base fabrication, but there is a lack of scientific data on the mechanical and chemical properties of the materials produced in this way. Therefore, the aim of this study was to investigate the residual monomer content, flexural strength and microhardness of denture base materials as well as correlations between investigated parameters. (2) Methods: Seven denture base materials were used: one conventional heat cured polymethyl methacrylate, one polyamide, three subtractive manufactured materials and two additive manufactured materials. High-performance liquid chromatography was used to determine residual monomer content and the test was carried out in accordance with the specification ISO No. 20795-1:2013. Flexural strength was also determined according to the specification ISO No. 20795-1:2013. The Vickers method was used to investigate microhardness. A one-way ANOVA with a Bonferroni post-hoc test was used for the statistical analysis. The Pearson correlation test was used for the correlation analysis. (3) Results: There was a statistically significant difference between the values of residual monomer content of the different denture base materials (p < 0.05). Anaxdent pink blank showed the highest value of 3.2% mass fraction, while Polident pink CAD-CAM showed the lowest value of 0.05% mass fraction. The difference between the flexural strength values of the different denture base materials was statistically significant (p < 0.05), with values ranging from 62.57 megapascals (MPa) to 103.33 MPa. The difference between the microhardness values for the different denture base materials was statistically significant (p < 0.05), and the values obtained ranged from 10.61 to 22.86 Vickers hardness number (VHN). A correlation was found between some results for the material properties investigated (p < 0.05). (4) Conclusions: The selection of contemporary digital denture base manufacturing techniques may affect residual monomer content, flexural strength and microhardness but is not the only criterion for achieving favourable properties.

Effect of thermocycling on surface topography and fracture toughness of milled and additively manufactured denture base materials: an in-vitro study

BACKGROUND

Studies investigating thermocycling effect on surface topography and fracture toughness of resins used in digitally manufactured denture bases are few. The study aimed to assess the impact of thermocycling on surface topography and fracture toughness of materials used for digitally manufactured denture bases.

METHODS

Water sorption, solubility, hardness, surface roughness, and fracture toughness of both three-dimensional (3D)-printed and computer-aided design, computer-aided manufacturing (CAD-CAM) milled specimens (n = 50) were assessed both prior to and following 2000 thermocycles, simulating 2 years of clinical aging. Surface hardness (n = 10) was measured using a Vickers hardness testing machine, surface roughness (n = 10) was determined by a contact profilometer, and fracture toughness (n = 20) was measured using the 3-point bend test, then studying the fractured surfaces was done via a scanning electron microscope (SEM). Prior to and following thermocycling, water sorption and solubility (n = 10) were assessed. Normally distributed data was tested using two-way repeated ANOVA and two-way ANOVA, while Mann Whitney U test and the Wilcoxon signed ranks test were used to analyze data that was not normally distributed (α < 0.05).

RESULTS

Following thermocycling, Vickers hardness and fracture toughness of both groups declined, with a significant reduction in values of the 3D-printed resin (P < .001). The 3D-printed denture base resins had a rougher surface following thermocycling with a significant difference (P < .001). The sorption and solubility of water of both materials were not affected by thermocycling.

CONCLUSIONS

Before and after thermocycling, milled specimens had lower surface roughness and a greater degree of hardness and fracture toughness than 3D-printed specimens. Thermocycling lowered hardness and fracture toughness, and increased surface roughness in both groups, but had no effect on water sorption and solubility.

Biofilm removal effect of diatom complex on 3D printed denture base resin

For patients who have difficulty in mechanical cleaning of dental appliances, a denture cleaner that can remove biofilm with dense extracellular polymeric substances is needed. The purpose of this study is to evaluate the efficacy of diatom complex with active micro-locomotion for removing biofilms from 3D printed dentures. The diatom complex, which is made by doping MnO2 nanosheets on diatom biosilica, is mixed with H2O2 to generate fine air bubbles continuously. Denture base resin specimens were 3D printed in a roof shape, and Pseudomonas aeruginosa (107 CFU/mL) was cultured on those for biofilm formation. Cleaning solutions of phosphate-buffered saline (negative control, NC), 3% H2O2 with peracetic acid (positive control, PC), denture cleanser tablet (DCT), 3% H2O2 with 2 mg/mL diatom complex M (Melosira, DM), 3% H2O2 with 2 mg/mL diatom complex A (Aulacoseira, DA), and DCT with 2 mg/mL DM were prepared and applied. To assess the efficacy of biofilm removal quantitatively, absorbance after cleaning was measured. To evaluate the stability of long-term use, surface roughness, ΔE, surface micro-hardness, and flexural strength of the 3D printed dentures were measured before and after cleaning. Cytotoxicity was evaluated using Cell Counting Kit-8. All statistical analyses were conducted using SPSS for Windows with one-way ANOVA, followed by Scheffe's test as a post hoc (p < 0.05). The group treated with 3% H2O2 with DA demonstrated the lowest absorbance value, followed by the groups treated with 3% H2O2 with DM, PC, DCT, DCT + DM, and finally NC. As a result of Scheffe's test to evaluate the significance of difference between the mean values of each group, statistically significant differences were shown in all groups based on the NC group. The DA and DM groups showed the largest mean difference though there was no significant difference between the two groups. Regarding the evaluation of physical and mechanical properties of the denture base resin, no statistically significant differences were observed before and after cleaning. In the cytotoxicity test, the relative cell count was over 70%, reflecting an absence of cytotoxicity. The diatom complex utilizing active micro-locomotion has effective biofilm removal ability and has a minimal effect in physical and mechanical properties of the substrate with no cytotoxicity.

Evaluation of the Influence of Build Orientation on the Surface Roughness and Flexural Strength of 3D-Printed Denture Base Resin and Its Comparison with CAD-CAM Milled Denture Base Resin

OBJECTIVES

 The purpose of this study was to determine the surface roughness and flexural strength of a three-dimensional (3D)-printed denture base resin printed with two different build plate orientations and to compare them with a computer-aided design-computer-aided manufacture (CAD-CAM) milled denture base resin.

MATERIALS AND METHODS

 Sixty-six specimens (n = 22/group) were prepared by 3D printing and CAD-CAM technology. The group A and B specimens were 3D-printed bar-shaped denture base specimens printed at 120-degree and 135-degree build orientation, respectively, whereas group C specimens were milled using a CAD-CAM technology. The surface roughness was assessed using a noncontact profilometer with a 0.01 mm resolution and the flexural strength was determined using a three-point bend test. The maximum load in Newtons (N) at fracture, the flexural stress (MPa), and strain (mm/mm) was also measured.

STATISTICAL ANALYSIS

 Data were analyzed by a statistical software package. One-way analysis of variance test was applied to determine whether significant differences existed among the study groups, followed by Bonferroni post-hoc test to determine which resin group significantly differed from the others in terms of flexural strength and surface roughness (p ≤ 0.05).

RESULTS

 The flexural stress (MPa) of group C was 200% of group A and 166% of group B. The flexural modulus was 192% of group A and 161% of group B. In contrast, group A had the lowest mean value among the three groups for all the parameters. No significant difference was seen between group A and group B. The mean roughness values of the CAD-CAM denture base resin specimens (group C) were the least (127356 nm) among all the three groups. The mean surface roughness of the 3D-printed denture base specimens (group A) was 1,34,234 nm and that of group B was (1,45,931 nm); however, it was statistically nonsignificant (p > 0.05) CONCLUSIONS:  The CAD-CAM resin displayed superior surface and mechanical properties compared to the 3D-printed resin. The two different build plate angles did not have any significant effect on the surface roughness of the 3D-printed denture base resin.

Effect of repair and surface treatments on the strength of digitally fabricated resin-based dental prostheses: A systematic review of in vitro studies

OBJECTIVE

This review investigated the current literature pertaining to the repairability of computer-aided design-computer-aided manufacturing (CAD-CAM) milled and three-dimensional (3D) printed resin-based dental prostheses (RBDPs) as well as the appropriate surface treatment for each repair material that will produce adequate repair bond strength.

DATA/SOURCES

PubMed, Web of Science, and Scopus databases were searched for published articles involving repair of CAD-CAM RBDPs between January 2010 and June 2023. Data were collected and analyzed to reveal the surface treatment effects, suggested repair materials, and strength of repaired RBDPs.

STUDY SELECTION

Out of 164 retrieved titles, 11 studies were included, of which five investigated the repair of 3D-printed RBDPs, three investigated the repair of CAD-CAM milled resins, and three investigated both materials. Additionally, of the included studies, seven investigated denture base resins, three studied provisional restoration resins, and one evaluated 3D-printed intraoral splints. Various surface treatments were suggested, with air-abrasive methods being the most commonly used. Different materials for resin repair were proposed and used, including auto-polymerized, reline, and composite resins. For 3D-printed resins, repair with Bis-acrylic/Bis-GMA composites improved repair strength.

CONCLUSION

Surface treatments positively affected the repair strength of conventional and milled RBDPs. However, challenges remain relevant to the repair of 3D-printed resins owing to composition mismatches and fabrication techniques. Therefore, further investigation is required to develop new 3D-printed resins.

CLINICAL SIGNIFICANCE

CAD-CAM milled resins have satisfactory repair strength, which increases with surface treatment. The repair of 3D-printed resins has proven challenging even with surface treatments. However, composite resins are the materials of choice.

Artificial teeth obtained by additive manufacturing: Wear resistance aspects. A systematic review of in vitro studies

Wear resistance is one of the properties that must be considered for maintaining the long-term functionality of artificial teeth in dental prostheses. This property can be altered by the method of tooth fabrication, the material, the chewing force, and the relationship to the antagonist tooth. This systematic review evaluated the wear resistance of artificial teeth obtained by the additive manufacturing method and aims to answer the question, "Do artificial teeth for dental prostheses obtained by additive manufacturing show wear resistance similar to prefabricated ones?" The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist guidelines were followed with a customized search in Scopus, PubMed/Medline, Embase, Science Direct, and Google Scholar databases on August 30, 2023. The inclusion criteria were artificial teeth for dental prostheses in acrylic resin by additive manufacturing and comparing the wear resistance with conventional prefabricated teeth, in vitro and English studies, without time restriction. And excluded if 1) do not make artificial teeth by additive manufacturing or that were metal or ceramic teeth; 2) clinical trials, animal studies, review articles, case reports, letters to the editor, short communication, book chapters; 3) another language that is not English. The selection was in two steps, reading the titles and abstracts, followed by reading the selected studies in full. The risk of bias analysis was performed with the adaptation of the quasi-experimental studies tool by Joanna Briggs Institute. Four hundred and twelve articles were found in the databases, after the selection steps and application of eligibility criteria, 6 articles were included for qualitative data analysis and presented low risk of bias. For teeth obtained by additive manufacturing, 2 studies reported lower wear resistance, 2 studies had higher resistance, and 2 similar compared to prefabricated ones. Additive manufactured teeth compared to prefabricated teeth show influences on wear resistance due to differences in material composition, relationship to the antagonist's tooth, applied force, chewing cycles, and processing methods.

Comparison of cytotoxicity between 3D printable resins and heat-cure PMMA

Aim

The aim of this study was to evaluate and compare the cytotoxicity of polyurethane and polyoxymethylene printable resins with conventional heat cure polymethyl methacrylate denture base resins.

Methods

The study followed ISO-10993-5 guidelines. It comprised of three groups. Fifteen cuboidal samples measuring 10x10 × 10mm dimension were prepared for each group. The polymethylmethacrylate samples were fabricated using conventional denture processing techniques, while the polyoxymethylene samples were printed using fused deposition modeling and the polyurethane samples using stereolithography technique. Post fabrication the samples were evaluated for cytotoxicity using the MTT assay with the VERO cell line. The percentage of cell viability was calculated to determine the cytotoxic effects.

Results

Statistical analysis revealed a significant difference in the cell viability of the experimental groups (p ≤ 0.0001). The polyoxymethylene group showed the highest % cell viability (62.78 %), followed by the polymethylmethacrylate group (52.43 %), and the least was observed in the polyurethane-based resin group (46.47 %). The findings indicate polyoxymethylene group displayed least cytotoxicity, followed by polymethylmethacrylate, and polyurethane-based resin.

Conclusion

Polyoxymethylene resin exhibited the minimum cytotoxic properties among the tested materials, followed by polymethylmethacrylate and polyurethane resin.

Effects of disinfection with a vinegar-hydrogen peroxide mixture on the surface characteristics of denture acrylic resins

OBJECTIVE

This study aimed to investigate changes in the surface characteristics of two denture resins when disinfected with a vinegar-hydrogen peroxide (VHP) mixture.

MATERIALS AND METHODS

Microwave-polymerized or 3D printed acrylic resin disks were immersed for 900 min (simulating 90 daily uses) in the following solutions (N = 10): water; 0.5% sodium hypochlorite; hydrogen peroxide and water dilution (1:1 ratio); vinegar and water dilution (1:1 ratio); and VHP mixture. Surface roughness, Knoop microhardness, surface free energy, and scanning electron microscopic images were assessed before and after the immersions. Results were compared using the 2-way ANOVA for repeated measures and Tukey test, at 5% significance.

RESULTS

Surface roughness and microhardness did not differ (P > .05) among the solutions and times. Surface free energy and its dispersive component increased (P < .05) for all solutions. All solutions, except for water and VHP mixture, degraded microtopography.

CONCLUSIONS

The VHP mixture was not deleterious to conventional and 3D-printed resin surfaces.

CLINICAL RELEVANCE

Conventional and 3D printed resin dentures can be disinfected with a VHP mixture in a 1:1 ratio because this mixture does not substantially affect the surface characteristics after 90 daily immersions. On the contrary, sodium hypochlorite, hydrogen peroxide, and vinegar solutions, even in low concentrations, should be used with caution for denture disinfection because they may alter the resin microtopography over time.

Microbiological evaluation of conjunctival anopthalmic flora after using digital 3D-printed ocular prosthesis compared to conventional one: a randomized clinical trial

BACKGROUND

This study aims to assess the influence of using 3D-printed acrylic resin versus conventional Poly-methyl methacrylate (PMMA) for fabricating ocular prostheses on the biofilm and microbial flora of anophthalmic socket.

METHODS

A randomized controlled trial was designed as a parallel group study. Participants were allocated randomly into two groups: the control group, which received conventionally fabricated ocular prostheses (CG, n = 11), and the test group, which received digitally 3D-printed ocular prostheses (DG, n = 11). Microbiological analysis was conducted before prosthesis insertion and three months after using the ocular prosthesis. Swab samples were inoculated on blood agar, MacConkey's agar, and Sabouraud's dextrose agar (SDA) for isolating Gram-positive, Gram-negative, and fungal organisms, respectively. Subsequently, the plates were incubated at 37 degrees Celsius for 48 h. Additionally, a validated questionnaire was used for subjective clinical evaluation, including parameters such as comfort level, socket discharge, lacrimation, and frequency of lubrication for each ocular prosthesis patient in both groups.

RESULTS

Test group (DG, n = 11) exhibited a positive, though statistically insignificant, difference (p > 0.001) in microbial growth when compared to the control group (CG, n = 11). A statistically significant difference was observed in comfort levels between the two groups, with more comfort level within group II (test group) patients. While parameters such as discharge amount, discharge location, lacrimation and lubrication frequency displayed statistically insignificant differences between the two groups, all parameters showed improved results after three months of prosthesis use.

CONCLUSIONS

The choice of ocular prosthesis fabrication technique did not yield a statistically significant difference in anophthalmic flora. However, the 3D-printed acrylic resin, as an artificial eye material, displayed potential advantages in reducing the colonization of opportunistic pathogens. All subjective clinical evaluation parameters exhibited enhanced outcomes after three months of prosthesis use, emphasizing the need for an adaptation period during which patients complains are alleviated. In comparison with PMMA, 3D-printed acrylic resin showcased a certain degree of anti-colonization ability against pathogenic bacteria, along with a significant level of patient comfort, suggesting its potential as a promising material for ocular prostheses.

TRIAL REGISTRATION

This parallel double-blinded RCT has been registered at ClinicalTrials.gov with identification number: NCT05584865, 18/10/2022.

3D printed denture base material: The effect of incorporating TiO2 nanoparticles and artificial ageing on the physical and mechanical properties

OBJECTIVES

To evaluate the physical and mechanical properties of three-dimensional (3D) printed denture base resin incorporating TiO2 nanoparticles (NPs), subjected to a physical ageing process.

METHODS

Acrylic denture base samples were prepared by a Stereolithography (SLA) 3D printing technique reinforced with different concentrations (0.10, 0.25, 0.50, and 0.75) of silanated TiO2 NPs. The resulting nanocomposite materials were characterized in terms of degree of conversion (DC), and sorption/solubility flexural strength, impact strength, Vickers hardness and Martens hardness and compared with unmodified resin and conventional heat-cured (HC) material. The nanocomposites were reassessed after subjecting them to ageing in artificial saliva. A fractured surface was studied under a scanning electron microscope (SEM).

RESULTS

The addition of TiO2 NPs into 3D-printed resin significantly improved flexural strength/modulus, impact strength, Vickers hardness, and DC, while also slightly enhancing Martens hardness compared to the unmodified resin. Sorption values did not show any improvements, while solubility was reduced significantly. The addition of 0.10 wt% NPs provided the highest performance amongst the other concentrations, and 0.75 wt% NPs showed the lowest. Although ageing degraded the materials' performance to a certain extent, the trends remained the same. SEM images showed a homogenous distribution of the NPs at lower concentrations (0.10 and 0.25 wt%) but revealed agglomeration of the NPs with the higher concentrations (0.50 and 0.75 wt%).

SIGNIFICANCE

The outcomes of this study suggested that the incorporation of TiO2 NPs (0.10 wt%) into 3D-printed denture base material showed superior performance compared to the unmodified 3D-printed resin even after ageing in artificial saliva. The nanocomposite has the potential to extend service life of denture bases in future clinical use.

Effect of Hygiene Protocols on the Mechanical and Physical Properties of Two 3D-Printed Denture Resins Characterized by Extrinsic Pigmentation as Well as the Mixed Biofilm Formed on the Surface

To assess the effect of hygiene protocols and time on the physical-mechanical properties and colony-forming units (CFU) of Candida albicans, Staphylococcus aureus, and Streptococcus mutans on 3D-printed denture resins (SmartPrint and Yller) with extrinsic pigmentation compared to conventional resin (CR). The protocols were evaluated: brushing (B), brushing and immersion in water (W), 0.25% sodium hypochlorite (SH), and 0.15% triclosan (T), simulating 0, 1, 3, and 5 years. The data were analyzed by ANOVA with repeated measurements, ANOVA (Three-way) and Tukey's post-test, generalized linear model with Bonferroni adjustment, and ANOVA (Two-way) and Tukey's post-test (α = 0.05). The protocols influenced color (p = 0.036) and Knoop hardness (p < 0.001). Surface roughness was influenced by protocols/resin (p < 0.001) and time/resin (p = 0.001), and flexural strength by time/protocols (p = 0.014). C. albicans showed interactions with all factors (p = 0.033). Staphylococcus aureus was affected by protocols (p < 0.001). Streptococcus mutans exhibited no count for SH and T (p < 0.001). Yller resin showed more color changes. The 3D-printed resins displayed lower microhardness, increased roughness, and decreased flexural strength compared to CR with all protocols in a simulated period of 5 years. The indication of printed resins should be restricted to less than 3 years.

Effect of coffee thermal cycling on the surface properties and stainability of additively manufactured denture base resins in different layer thicknesses

PURPOSE

To compare the effect of coffee thermal cycling on surface roughness (Ra), Vickers microhardness (MH), and stainability of denture base resins additively manufactured in different layer thicknesses with those of subtractively manufactured denture base materials.

MATERIALS AND METHODS

Eighty disk-shaped specimens (Ø10×2 mm) were fabricated from two subtractively (Merz M-PM [SM-M] and G-CAM [SM-G]) and three additively (NextDent 3D+ [50 µm, AM-N-50; 100 µm, AM-N-100], FREEPRINT Denture [50 µm, AM-F-50; 100 µm, AM-F-100], and Denturetec [50 µm, AM-S-50; 100 µm, AM-S-100]) manufactured denture base materials (n = 10). Ra measurements were performed before and after polishing by using a non-contact optical profilometer, while MH values and color coordinates were measured after polishing. Specimens were then subjected to 5000 cycles of coffee thermal cycling, all measurements were repeated, and color differences (ΔE00) were calculated. A linear mixed effect model was used to analyze Ra and MH data, while one-way analysis of variance was used to analyze ΔE00 data (α = 0.05). Ra values were further evaluated according to a clinically acceptable threshold of 0.2 µm, while ΔE00 values were evaluated according to perceptibility (1.72 units) and acceptability (4.08 units) thresholds. The interaction between the material type and the time interval affected both Ra and MH (p ≤ 0.001). Tested materials had their highest Ra before polishing (p ≤ 0.029). Before polishing, AM-F-100 had the highest, and SM-M and SM-G had the lowest Ra (p < 0.001). After polishing and after coffee thermal cycling, SM-G mostly had lower Ra than those of other materials (p ≤ 0.036). SM-G mostly had higher MH than that of other materials before and after coffee thermal cycling (p ≤ 0.025). Coffee thermal cycling reduced the MH of SM-M and increased that of AM-S-100 (p ≤ 0.024). AM-N-100 had higher ΔE00 than AM-F, AM-S-100, and SM-G (p ≤ 0.009), while AM-F and SM-G had lower ΔE00 than AM-S-50 and AM-N-50 (p ≤ 0.024).

CONCLUSIONS

Polishing reduced the surface roughness of all materials, whereas the effect of coffee thermal cycling was nonsignificant. Most of the tested materials had acceptable surface roughness after polishing and after coffee thermal cycling according to the reported threshold. Layer thickness only affected the microhardness of tested additively manufactured resins, which was material-dependent. Subtractively manufactured specimens mostly had high microhardness and that of nonreinforced subtractively manufactured resin decreased after coffee thermal cycling. When reported color thresholds are considered, all materials had acceptable color stability.

Influence of denture brushing on the surface properties and color stability of CAD-CAM, thermoformed, and conventionally fabricated denture base resins

PURPOSE

To assess the influence of denture brushing on the surface roughness, hardness, and color stability of conventional, thermoformed, and CAD-CAM denture base materials.

MATERIALS AND METHODS

Seven different denture base materials were included in this study; conventional heat-polymerized acrylic resin (PMMA) served as control, polyamide, acetal, two categories of milled acrylic discs (AvaDent and IvoCad), and two categories of 3D-printed resins (NextDent and FormLabs). The specimens were constructed according to manufacturers' instructions and then subjected to simulated brushing (20,000 cycles). According to the brushing method, the specimens were split into three groups, no brushing, brushing with water, and brushing with toothpaste. Surface roughness, hardness, and color change were evaluated before and after brushing. Collected data were analyzed using ANOVA, and post-hoc Tukey's tests (α = 0.05).

RESULTS

A significant difference was noted between the surface roughness of the tested materials before and after denture brushing (p < 0.05), and milled resin showed the least Ra values. Denture brushing with water significantly increased the Ra of PMMA (p = 0.004) and IvoCad (p = 0.032), while brushing using toothpaste did not show a significant increase. The brushing protocols did not alter the hardness of tested materials except that of PMMA (p = 0.001). The color stability of the tested materials showed comparable results with both brushing protocols.

CONCLUSION

The tested properties showed variations between the types of denture base resins. Hardness and color stability of CAD-CAM and thermoformed denture base resins were not altered by denture brushing and showed comparable results with both brushing methods. Surface roughness was the only property that showed alteration after denture brushing.

Ranking Technologies of Additive Manufacturing of Removable Complete Dentures by the Results of Their Mechanical Testing

In this study, a methodology was developed for ranking manufacturing technologies of removable complete dentures (RCDs) according to the results of their full-scale mechanical tests. The actuality of the study is motivated by establishing the advantages and drawbacks of 3D-printed RCDs in contrast with ones manufactured via an analog protocol. The RCDs were fabricated via four technological routes that included various combinations of subtractive technologies (hot polymerization/HP and CAD/CAM milling) and additive manufacturing (digital light processing/DLP) ones and the installation of commercially available cosmetic denture teeth (DT). In the mechanical tests, different blocks of teeth (incisors, canines, premolars and molars) were loaded. To solve the ranking problem, it was proposed to interpret the results of the mechanical tests in terms of the reliability, durability and compliance/stiffness criteria. For this purpose, the combined AHP-VIKOR method was applied. In addition, a computer simulation of the mechanical loading conditions and the response of the RCDs was performed based on the finite element method (FEM). As the key conclusion, it was stated that additive manufacturing (AM) methods are competitive and cost-effective techniques for the fabrication of RCDs.

Comparison of surface characteristics of denture base resin materials with two surface treatment protocols and simulated brushing

PURPOSE

To investigate the effects of 4 denture base materials, 2 surface treatment protocols, and simulated brushing (SB) on the surface hardness, surface roughness, surface gloss, and the surface loss of denture base materials.

MATERIALS AND METHODS

Four denture base resin material groups (compression-molded, injection-molded, 3D-printed, and milled) with two different surface treatment protocols (polished and glazed) were utilized in this study. A total of 80 samples (n = 10) were evaluated for surface hardness (Vickers) before SB. SB was performed for each sample (custom-built V8 cross brushing machine, 50,000 reciprocal strokes). Surface roughness (Ra) was measured before and after SB with a non-contact optical profilometer. Surface gloss was performed using a glossmeter to determine changes in surface reflectivity of the specimens before and after SB. Surface loss (wear resistance) was measured after SB using optical profilometry. The effects of material, surface treatment, and SB on all surface characteristics were examined with two-way and three-way analysis of variance models (ANOVA) (α = 0.05).

RESULTS

The polished compression-molded group had significantly higher surface hardness than all other groups. The protective glaze coating significantly increased the surface hardness for all groups (P < 0.001). SB increased the surface roughness of all groups regardless of surface treatments (P < 0.001). The increase in surface roughness after SB was significantly higher with polished surface treatment than with a glazed surface treatment in all groups (P < 0.001). Surface gloss was significantly higher with the glazed surface treatment than with the polished surface treatment for all denture base materials (P < 0.001). After SB, milled denture base material showed the highest, and 3D-printed material showed the second highest surface gloss compared to the other groups (P < 0.001), regardless of surface treatment. In all materials tested, surface glaze significantly decreased surface loss (P < 0.001). With the glaze surface treatment, compression-molded denture base material had significantly less surface loss (more surface gain) than other materials, while with the polished surface treatment, 3D-printed denture base material had the least surface loss when compared with other groups.

CONCLUSIONS

A single layer of nano-filled, light-polymerizing protective glaze coating has displayed potential for enhancing the longevity of denture base materials, as evidenced by increased hardness and wear resistance. Following simulated brushing, the milled denture material exhibited the highest surface gloss and lowest surface roughness among all groups, regardless of the surface treatment protocol. This indicates that milled denture base material possesses favorable surface properties and may serve as a viable alternative to traditional denture base materials.

Three-dimensionally printed denture base resins modified by nanoglass particles and carbon nanotubes

STATEMENT OF PROBLEM

Three-dimensionally (3D) printed denture base resins exhibit inferior mechanical properties compared with conventional and milled ones, a problem affecting their long-term clinical use. Improved 3D printed resins are required.

PURPOSE

The purpose of this in vitro study was to determine whether a 3D printed denture base resin with nanoglass particles and multiwalled carbon nanotubes (MWCNTs) would exhibit enhanced mechanical properties.

MATERIAL AND METHODS

The nanoglass particles and MWCNTs were silane coated and added to the resin to obtain the following groups: Control, resin modified with nanoglass particles with 2 percentages, 0.25 wt%, and 0.5 wt%; resin modified with MWCNTs with 2 percentages, 0.25 wt%, and 0.5 wt%; and a combination group with 0.25 wt% of each filler type. The printed specimens (N=330) were tested before and after thermocycling (600 cycles) for flexural strength (FS) and elastic modulus (n=22) by using a universal testing machine and for impact strength (IS) (n=22) by using a Charpy impact tester. The fractured impact specimens were then evaluated by using scanning electron microscopy (SEM). The surface roughness (Ra) (n=11) was assessed by using a profilometer. For data analysis, the 2-way ANOVA test was used for the analysis of FS, elastic modulus, and IS, and the 3-way ANOVA test was used for Ra with a subsequent Tukey post hoc test. Percentage change was compared among groups by using the Kruskal-Wallis test, followed by the Dunn post hoc test with Bonferroni correction (α=.05).

RESULTS

The filler content and thermocycling revealed a significant main interaction effect (P<.001) on FS, elastic modulus, and IS, with the 0.5% nanoglass group displaying the highest percentage decrease after thermocycling. The SEM images of fractured impact specimens revealed a brittle failure in the control and nanoglass groups. In contrast, the groups containing MWCNTs and the combination group displayed intermediate to ductile failure. Moreover, a significant inclusive interaction effect (P<.001) was found between the filler content, thermocycling, and polishing on surface roughness, with the 0.5% nanoglass group revealing the highest percentage increase in Ra of the polished surface after aging.

CONCLUSIONS

The addition of nanoglass and MWCNTs led to a significant improvement in the FS, elastic modulus, and IS of the 3D printed resin. The combination group displayed the least percentage change among all groups regarding the FS and IS, displaying intermediate to ductile failure. The control revealed the least percentage change in elastic modulus after thermocycling but with lower peak values compared with all other groups.

Effect of denture cleansers on the physical and mechanical properties of CAD-CAM milled and 3D printed denture base materials: An in vitro study

STATEMENT OF PROBLEM

Studies on the impact of denture cleansers on the physical and mechanical properties of denture bases designed and constructed by using computer software programs are lacking.

PURPOSE

The purpose of this in vitro study was to test the effect of a peroxide denture cleanser on the hardness, fracture toughness, water sorption, and solubility of denture base materials manufactured by 3D printing and computer-aided design and computer-aided manufacturing (CAD-CAM) milling.

MATERIAL AND METHODS

The hardness, fracture toughness, water solubility, and sorption of CAD-CAM milled and 3D printed groups (n=40) were evaluated before and after exposure to a denture cleanser. Hardness (n=10) was analyzed with a Vickers hardness testing machine, and fracture toughness (n=20) with the 3-point bend test. After the fracture of specimens, a scanning electron microscope at ×300 was used for fractographic analysis. Water sorption and solubility (n=10) were evaluated before and after immersion in denture cleanser for 6 days to simulate 180 days of immersion. Two-way repeated ANOVA and 2-way ANOVA were used to test normally distributed data, whereas the Mann Whitney U test and Wilcoxon signed ranks test were used for data that were not normally distributed (α<.05).

RESULTS

The Vickers hardness and fracture toughness of both materials decreased after immersion in denture cleansers, with a higher decrease in values for the 3D printed group (P<.001). The denture cleanser had no effect on the water sorption and solubility of either group.

CONCLUSIONS

Milled specimens had higher hardness values and fracture toughness before and after immersion in the denture cleanser. Denture cleansers resulted in the reduced hardness and fracture toughness of both groups, but the percentage change in the milled group was lower. Denture cleansers had no effect on water sorption or solubility.

3D-printed nanocomposite denture base resin: The effect of incorporating TiO2 nanoparticles on the growth of Candida albicans

PURPOSE

To develop a biocompatible denture base resin/TiO2 nanocomposite material with antifungal characteristics that is suitable for 3D-printing denture bases.

MATERIALS AND METHODS

TiO2 nanoparticles (NPs) with a 0.10, 0.25, 0.50, and 0.75 weight percent (wt.%) were incorporated into a commercially available 3D-printed resin material. The resulting nanocomposite material was analyzed using Lactate dehydrogenase (LDH) and AlamarBlue (AB) assays for biocompatibility testing with human gingival fibroblasts (HGF). The composite material was also tested for its antifungal efficacy against Candida albicans. Fourier transform infrared (FTIR) and Energy Dispersive X-ray Spectroscopy (EDX) mapping were conducted to assess the surface coating and the dispersion of the NPs.

RESULTS

LDH and AB assays confirmed the biocompatibility of the material showing cell proliferation at a rate of nearly 100% at day 10, with a cytotoxicity of less than 13% of the cells at day 10. The concentrations of 0.10, 0.25, and 0.50 wt.% caused a significant reduction (p < 0.05) in the number of candida cells attached to the surface of the specimens (p < 0.05), while 0.75 wt.% did not show any significant difference compared to the control (no TiO2 NPs) (p > 0.05). FTIR and EDX analysis confirmed the presence of TiO2 NPs within the nanocomposite material with a homogenous dispersion for 0.10 and 0.25 wt.% groups and an aggregation of the NPs within the material at higher concentrations.

CONCLUSION

The addition of TiO2 NPs into 3D-printed denture base resin proved to have an antifungal effect against Candida albicans. The resultant nanocomposite material was a biocompatible material with HGFs and was successfully used for 3D printing.

Microbial adhesion and biofilm formation by Candida albicans on 3D-printed denture base resins

This study evaluated surface properties and adhesion/biofilm formation by Candida albicans on 3D printed denture base resins used in 3D printing. Disc-shaped specimens (15 mm x 3 mm) of two 3D-printed resins (NextDent Denture 3D+, NE, n = 64; and Cosmos Denture, CO, n = 64) and a heat-polymerized resin (Lucitone 550, LU, control, n = 64) were analyzed for surface roughness (Ra μm) and surface free energy (erg cm-2). Microbiologic assays (90-min adhesion and 48-h biofilm formation by C. albicans) were performed five times in triplicate, with the evaluation of the specimens' surface for: (i) colony forming units count (CFU/mL), (ii) cellular metabolism (XTT assay), and (iii) fluorescence and thickness of biofilm layers (confocal laser scanning microscopy). Data were analyzed using parametric and nonparametric tests (α = 0.05). LU presented higher surface roughness Ra (0.329±0.076 μm) than NE (0.295±0.056 μm) (p = 0.024), but both were similar to CO (0.315±0.058 μm) (p = 1.000 and p = 0.129, respectively). LU showed lower surface free energy (47.47±2.01 erg cm-2) than CO (49.61±1.88 erg cm-2) and NE (49.23±2.16 erg cm-2) (p<0.001 for both). The CO and NE resins showed greater cellular metabolism (p<0.001) and CO only, showed greater colonization (p = 0.015) by C. albicans than LU in the 90-min and 48-hour periods. It can be concluded that both 3D-printed denture base resins are more prone to colonization by C. albicans, and that their surface free energy may be more likely associated with that colonization than their surface roughness.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2022 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertise in their subject areas that include (in order of the appearance in this report): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence the daily dental treatment decisions of the reader with an emphasis on innovations, new materials and processes, and future trends in dentistry. With the tremendous volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope that readers find this work helpful in managing patients.

Effect of build angle, resin layer thickness and viscosity on the surface properties and microbial adhesion of denture bases manufactured using digital light processing

OBJECTIVES

To investigate differences in the surface properties and microbial adhesion of denture base resins for digital light processing (DLP) with varying resin layer thicknesses (LT), build angles (BA), and resin viscosities.

METHODS

Two denture base resins for DLP with different viscosities (high and low) were used to prepare disk specimens applying two manufacturing parameters: 1) LT (50 or 100 μm) and 2) BA (0-, 45-, and 90-degree). Surface roughness and contact angle values were measured on the test surfaces (n=10 per group). Streptococcus oralis and Candida albicans absorbance was measured to assess microorganism attachment (n=6 per group). A three-way analysis of variance (ANOVA) was conducted, considering the main effects and their interactions (viscosity, LT, and BA). Post-hoc multiple pairwise comparisons were performed. All data were analyzed at a level of significance (P) of 0.05.

RESULTS

LT and BA significantly affected the surface roughness and contact angle of the specimens, depending on resin viscosity (P<.001). Absorbance measurement showed no significant interaction between the three factors (P>.05). However, significant interactions were observed between viscosity and BA (P<.05) and between LT and BA (P<.05).

CONCLUSIONS

Regardless of the viscosity and LT, discs with a 0-degree BA showed the least roughness. High-viscosity specimens fabricated with a 0-degree BA had the lowest contact angle. Regardless of the LT and viscosity, discs with a 0-degree BA showed the lowest S. oralis attachment. Attachment of C. albicans was the least on the disk with 50 μm LT, irrespective of the viscosity.

CLINICAL SIGNIFICANCE

Clinicians should consider the effects of LT and BA on surface roughness, contact angle, and microbial adhesion of DLP-generated dentures, which can differ depending on resin viscosity. A 50 μm LT and 0-degree BA can be used with a high-viscosity resin to fabricate denture bases with less microbial adhesion.

Effect of denture cleansers on color stability and surface roughness of denture bases fabricated from three different techniques: Conventional heat-polymerizing, CAD/CAM additive, and CAD/CAM subtractive manufacturing

PURPOSE

Denture base materials are commonly exposed to different denture cleansers which can affect their essential properties. This study aimed to assess the effect of denture cleansers on color stability and surface roughness of poly methyl methacrylate (PMMA) denture bases fabricated from different techniques: Conventional heat-polymerizing, CAD/CAM additive and CAD/CAM subtractive.

MATERIALS AND METHODS

In this in vitro study, 24 disc-shaped specimens were fabricated by the mentioned methods for each group. The initial color and surface roughness of specimens were recorded. The specimens were randomly divided into three subgroups (n = 8): a control subgroup (distilled water), and two experimental subgroups of bioactive oxygen tablet (Corega) and 1% sodium hypochlorite solution. Then they were immersed in the solutions simulating 180 days of clinical use. Color change (∆E) was measured by a spectrophotometer according to the CIE L*a*b* color space and the American National Bureau of Standards (NBS = 0.92 × ∆E). Final surface roughness was recorded by a profilometer and its change was calculated. The Kruskal-Wallis test followed by the Wilcoxon signed rank test were used for statistical analyses (α = .05).

RESULTS

The conventional and CAD/CAM subtractive groups showed an increase in surface roughness following immersion in hypochlorite solution (p < .05). After immersion in the solutions, the highest surface roughness was noted in the conventional group, and the lowest in the CAD/CAM additive group. The CAD/CAM additive group experienced a significant color change in hypochlorite solution (p < .05) and showed the highest color change while the CAD/CAM subtractive group showed the lowest color change in all denture cleanser solutions.

CONCLUSION

Although the CAD/CAM additive denture base resins had the lowest surface roughness after exposure to denture cleanser solutions, they showed significant color change, which should be taken into account. Using hypochlorite as a denture cleanser should be cautioned due to its negative effects on the surface roughness and color stability of denture base materials.

Strength and Wear Behavior of Three-Dimensional Printed and Prefabricated Denture Teeth: An In Vitro Comparative Analysis

OBJECTIVES

 With advanced technology for complete denture fabrication, there is a lack of knowledge on the mechanical behavior of three-dimensional (3D) printed teeth despite the development of complete denture fabrication technologies. This study aimed to compare different types of 3D-printed teeth in terms of wear and fracture resistance in comparison to control prefabricated denture teeth.

MATERIALS AND METHODS

 One prefabricated tooth was selected and fixed in a resin holder and half of the tooth remained in anatomic form, while the other half was flattened for the wear test. One from each type was scanned and then printed with different resins; Asiga (DentaTOOTH, Asiga, Alexandria 2015,NSW, Australia), FormLabs (Denture Base LP, FormLabs, Berlin, Germany), and NextDent (NextDent C&B MFH, NextDent B.V., Soesterberg, the Netherlands) according to manufacturer recommendations. A total of 60 specimens (20/resin, n = 10) were thermo cycled (5,000 cycles) and wear test samples were further subjected to cyclic loading (1,70,000 cycles) in a chewing simulator machine CS-4.2 (SD Mechatronik GmbH, Germany). The fracture strength of anatomic teeth was measured using a universal testing machine (Instron model 5965, Massachusetts, United States), while Geomagic Control X software was used to assess the amount of wear of flattened teeth. Statistical analyses were performed with one-way analysis of variance with Tukey's post hoc test at significance level of α = 0.05.

RESULTS

 NextDent specimens showed the greatest volume loss, whereas FormLabs specimens showed the least volume loss. Comparing NextDent specimens to FromLabs specimens, FromLabs showed statistically significantly less volume loss (p < 0.001). No other group pairs differed significantly from one another in terms of volume loss (p > 0.06).

CONCLUSION

 3D-printed denture teeth showed comparable strength and wear resistance with the prefabricated denture teeth and were suitable for long-term clinical usage except for NextDent that significantly showed the lowest fracture resistance.

Mechanical Properties of 3D-Printed Occlusal Splint Materials

Data regarding the mechanical properties of three-dimensionally (3D) printed materials for occlusal splint manufacturing are scarce. The aim of the present study was to evaluate the flexural strength and surface hardness of modern 3D-printed occlusal splint materials and compare them with two control groups, namely, milled and conventional cold-polymerized occlusal splint materials. A total of 140 rectangular specimens were manufactured for the present study. The specimens were prepared in accordance with the International Organization for Standardization standards (ISO 20795-1:2013). Five 3D-printed (NextDent Ortho Rigid, Dental LT Clear, Dentona Flexisplint, Cosmos Bite Splint, and ProArt Print Splint), one milled (ProArt CAD Splint), and one cold-polymerized (ProBase Cold) occlusal splint materials were used to determine flexural strength and surface hardness values. The three-point flexure test was used for the determination of flexural strength values, while Vickers hardness was measured to determine surface hardness. Ten specimens (n = 10) of each material were tested using these procedures. One-way ANOVA and Tukey's post-hoc test were used to analyze the obtained results (α = 0.05). The values of flexural strength ranged from 46.1 ± 8.2 MPa to 106 ± 8.3 MPa. The Vickers hardness values ranged from 4.9 ± 0.5 VHN to 20.6 ± 1.3 VHN. Significant differences were found among the tested materials (p < 0.0001). The milled and cold-polymerized materials yielded higher values for both flexural strength (only one 3D-printed resin had comparable results to cold-polymerized acrylics) and surface hardness. There are differences in the mechanical properties of the various tested occlusal splint materials. The flexural strength of most of the 3D-printed materials and their surface hardness values are still inferior when compared to the milled or cold-polymerized materials.

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.

Effectiveness of disinfectant solutions associated or not with brushing on the biofilm control of a 3D printed-denture base resin

BACKGROUND

The formation of biofilm on denture bases is a recurrent clinical problem that favors the development of denture stomatitis. The effectiveness of a hygiene protocol in a 3D-printed denture base resin is still uncertain.

OBJECTIVE

To evaluate of the effectiveness of immersion, associated or not with brushing in a soap solution, on the biofilm control of a 3D-printed denture base resin.

METHODOLOGY

Specimens of denture base resins [Cosmos Denture (COS) and Classico (CLA/control)] were contaminated in vitro with Candida albicans and immersed in sodium hypochlorite 0.25% (SH, alkaline peroxide) AP, chlorhexidine digluconate 2% (CD or PBS-Control), associated or not with brushing with 0.78% Lifebuoy soap. Roughness was evaluated before and after brushing and immersion. The effectiveness of the protocols was assessed by CFU/mL, cellular metabolism (XTT), scanning electron microscopy (SEM), and confocal scanning laser microscopy. Data were analyzed by T student, ANOVA/Welch, and Tukey/Gomes-Howell pos-hoc tests (α = 0.05).

RESULTS

CLA showed greater roughness than COS. CFU/mL and XTT were higher in COS resin with a higher hyphae formation. Immersion in SH and CD eliminated CFU/mL and reduced XTT for both resins, associated or not with brushing. AP reduced CFU/mL only when associated with brushing.

CONCLUSIONS

The biofilm on the 3D-printed resin was thicker and presumably more pathogenic, regardless of its smoother surface. Immersions in SH 0.25% and CD 2% are effective hygiene protocols for both resins, associated or not with brushing. AP should be recommended when associated with brushing with a Lifebuoy 0.78% solution.

Material extrusion of thermoplastic acrylic for intraoral devices: Technical feasibility and evaluation

With global demand for 3D printed medical devices on the rise, the search for safer, inexpensive, and sustainable methods is timely. Herein, we assessed the practicality of the material extrusion process for acrylic denture bases of which successful outcomes can be extended to implant surgical guides, orthodontic splints, impression trays, record bases and obturators for cleft palates or other maxillary defects. Representative materials comprising denture prototypes and test samples were designed and built with in-house polymethylmethacrylate filaments using varying print directions (PDs), layer heights (LHs) and reinforcements (RFs) with short glass fiber. The study undertook a comprehensive evaluation of the materials to determine their flexural, fracture, and thermal properties. Additional analyses for tensile and compressive properties, chemical composition, residual monomer, and surface roughness (Ra) were completed for parts with optimum parameters. Micrographic analysis of the acrylic composites revealed adequate fiber-matrix compatibility and predictably, their mechanical properties improved simultaneously with RFs and decreased LHs. Fiber reinforcement also improved the overall thermal conductivity of the materials. Ra, on the other hand, improved visibly with decreased RFs and LHs and the prototypes were effortlessly polished and characterized with veneering composites to mimic gingival tissues. In terms of chemical stability, the residual methyl methacrylate monomer contents are well below standards threshold for biological reactions. Notably, 5 vol% acrylic composites built with 0.05 mm LH in 0° on z-axis produced optimum properties that are superior to those of conventional acrylic, milled acrylic and 3D printed photopolymers. Finite element modeling successfully replicated the tensile properties of the prototypes. It may well be argued that the material extrusion process is cost-effective; however, the speed of manufacturing could be longer than that of established methods. Although the mean Ra is within an acceptable range, mandatory manual finishing and aesthetic pigmentation are required for long-term intraoral use. At a proof-of-concept level, it is evident that the material extrusion process can be applied to build inexpensive, safe, and robust thermoplastic acrylic devices. The broad outcomes of this novel study are equally worthy of academic reflection, and further translation to the clinic.

Evaluation of the Effects of Different Polishing Protocols on the Surface Characterizations of 3D-Printed Acrylic Denture Base Resins: An In Vitro Study

Chairside polishing kits are an alternative to laboratory polishing techniques. The effects of using a chairside polishing kit on a three-dimensional (3D)-printed acrylic denture base (ADB) have not been reported previously. Thus, this study aimed to evaluate the effects of different chairside polishing techniques on the surface characterizations of ABD, including surface roughness average (Ra), average maximum profile height (Rz), and scanning electron microscopy (SEM) representations. One hundred and twenty disc-shaped specimens were fabricated from one conventional heat-polymerized (HP) ADB resin and two 3D-printed (Asiga (AS) and NextDent (ND)) ADB resins (n = 40 per material). Each group was further divided based on the polishing protocol (n = 10) as follows: conventional polishing protocol (C), microdont chairside polishing kit (M), shofu chairside polishing kit (S), and an unpolished group (U). The Ra and Rz values were measured using an optical profilometer. Two-way ANOVA and post hoc tests were used for data analysis (α = 0.05) at significant levels. In unpolished groups, there was a statistically significant difference between HP-U vs. AS-U and ND-U groups (p < 0.0001). For Ra, the lowest values were observed in HP-C, AS-S, and ND-C. While the highest values were shown in all unpolished groups. Within the material, there were statistically significant differences between the three polishing protocols (C, M, and S) vs. unpolished (p < 0.0001), while there was no significant between C, M, and S groups (p = 0.05). The Rz values had the same pattern as the Ra values. The two chairside polishing kits were comparable to conventional polishing techniques, and they can be recommended for clinical application.

Tensile Bond Strength between Different Denture Base Materials and Soft Denture Liners

(1) Background: Various materials are available for CAD-CAM denture base fabrication, for both additive and subtractive manufacturing. However, little has been reported on bond strength to soft denture liners. Therefore, the aim of this study was to investigate tensile bond strength, comparing between different denture base materials and soft denture liners. (2) Methods: Seven different materials were used for denture base fabrication: one heat-polymerized polymethyl methacrylate, three materials for subtractive manufacturing, two materials for additive manufacturing and one polyamide. Two materials were used for soft denture lining: one silicone-based and one acrylate-based. The study was conducted according to the specification ISO No. 10139-2:2016, and the type of failure was determined. The Kruskal-Wallis test with Dunn's post hoc test was used to analyse the values of tensile bond strength, and Fisher's exact test was used to analyse the type of failure. p Values < 0.05 were considered statistically significant. (3) Results: The tensile bond strength values were not statistically significantly different combining all the materials used for denture base fabrication with the acrylate-based soft denture liner (p > 0.05), and the average values ranged between 0.19 and 0.25 Mpa. The tensile bond strength values of the different denture base materials and silicone-based denture liner were statistically significantly different (p < 0.05), and the average values ranged between 1.49 and 3.07 Mpa. The type of failure was predominantly adhesive between polyamide and both additive-manufactured denture base materials in combination with the acrylate-based soft liner (p < 0.05). (4) Conclusions: The use of digital technologies in denture base fabrication can have an influence on different tensile bond strength values for soft denture liners, with different types of failure when compared with heat-cured PMMA. Similar tensile bond strength values were found between the acrylate-based soft denture liner and denture base materials. Significant differences in tensile bond strength values were found between the silicone-based soft denture liner and denture base materials, where the additive-manufactured and polyamide denture base materials showed lower values than heat-cured PMMA and subtractive-manufactured denture base materials.

Adhesion of Conventional, 3D-Printed and Milled Artificial Teeth to Resin Substrates for Complete Dentures: A Narrative Review

BACKGROUND

One type of failure in complete or partial dentures is the detachment of resin teeth from denture base resin (DBR). This common complication is also observed in the new generation of digitally fabricated dentures. The purpose of this review was to provide an update on the adhesion of artificial teeth to denture resin substrates fabricated by conventional and digital methods.

METHODS

A search strategy was applied to retrieve relevant studies in PubMed and Scopus.

RESULTS

Chemical (monomers, ethyl acetone, conditioning liquids, adhesive agents, etc.) and mechanical (grinding, laser, sandblasting, etc.) treatments are commonly used by technicians to improve denture teeth retention with controversial benefits. Better performance in conventional dentures is realized for certain combinations of DBR materials and denture teeth after mechanical or chemical treatment.

CONCLUSIONS

The incompatibility of certain materials and lack of copolymerization are the main reasons for failure. Due to the emerging field of new techniques for denture fabrication, different materials have been developed, and further research is needed to elaborate the best combination of teeth and DBRs. Lower bond strength and suboptimal failure modes have been related to 3D-printed combinations of teeth and DBRs, while milled and conventional combinations seem to be a safer choice until further improvements in printing technologies are developed.

Adhesion of biofilm, surface characteristics, and mechanical properties of antimicrobial denture base resin

PURPOSE

This study incorporated the nanomaterial, nanostructured silver vanadate decorated with silver nanoparticles (AgVO₃), into heat-cured resin (HT) at concentrations of 2.5%, 5%, and 10% and compared the adhesion of multispecies biofilms, surface characteristics, and mechanical properties with conventional heat-cured (HT 0%) and printed resins.

MATERIALS AND METHODS

AgVO₃ was incorporated in mass into HT powder. A denture base resin was used to obtain printed samples. Adhesion of a multispecies biofilm of Candida albicans, Candida glabrata, and Streptococcus mutans was evaluated by colony-forming units per milliliter (CFU/mL) and metabolic activity. Wettability, roughness, and scanning electron microscopy (SEM) were used to assess the physical characteristics of the surface. The mechanical properties of flexural strength and elastic modulus were tested.

RESULTS

HT 10%-AgVO₃ showed efficacy against S. mutans; however, it favored C. albicans CFU/mL (P < .05). The printed resin showed a higher metabolically active biofilm than HT 0% (P < .05). There was no difference in wettability or roughness between groups (P > .05). Irregularities on the printed resin surface and pores in HT 5%-AgVO₃ were observed by SEM. HT 0% showed the highest flexural strength, and the resins incorporated with AgVO₃ had the highest elastic modulus (P < .05).

CONCLUSION

The incorporation of 10% AgVO₃ into heat-cured resin provided antimicrobial activity against S. mutans in a multispecies biofilm did not affect the roughness or wettability but reduced flexural strength and increased elastic modulus. Printed resin showed higher irregularity, an active biofilm, and lower flexural strength and elastic modulus than heat-cured resin.

Effect of Different Vat Polymerization Techniques on Mechanical and Biological Properties of 3D-Printed Denture Base

Three-dimensional printing is increasingly applied in dentistry to fabricate denture bases. Several 3D-printing technologies and materials are available to fabricate denture bases, but there is data scarcity on the effect of printability, mechanical, and biological properties of the 3D-printed denture base upon fabricating with different vat polymerization techniques. In this study, the NextDent denture base resin was printed with the stereolithography (SLA), digital light processing (DLP), and light-crystal display (LCD) technique and underwent the same post-processing procedure. The mechanical and biological properties of the denture bases were characterized in terms of flexural strength and modulus, fracture toughness, water sorption and solubility, and fungal adhesion. One-way ANOVA and Tukey’s post hoc were used to statistically analyze the data. The results showed that the greatest flexural strength was exhibited by the SLA (150.8±7.93 MPa), followed by the DLP and LCD. Water sorption and solubility of the DLP are significantly higher than other groups (31.51±0.92 μgmm3) and 5.32±0.61 μgmm3, respectively. Subsequently, the most fungal adhesion was found in SLA (221.94±65.80 CFU/mL). This study confirmed that the NextDent denture base resin designed for DLP can be printed with different vat polymerization techniques. All of the tested groups met the ISO requirement aside from the water solubility, and the SLA exhibited the greatest mechanical strength.