Additive Manufacturing of Dental Ceramics: A Systematic Review and Meta-Analysis

Taxonomic discordance of immersive realities in dentistry: A systematic scoping review

OBJECTIVES

This review aimed to map taxonomy frameworks, descriptions, and applications of immersive technologies in the dental literature.

DATA

The Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines was followed, and the protocol was registered at open science framework platform (https://doi.org/10.17605/OSF.IO/H6N8M).

SOURCES

Systematic search was conducted in MEDLINE (via PubMed), Scopus, and Cochrane Library databases, and complemented by manual search.

STUDY SELECTION

A total of 84 articles were included, with 81 % between 2019 and 2023. Most studies were experimental (62 %), including education (25 %), protocol feasibility (20 %), in vitro (11 %), and cadaver (6 %). Other study types included clinical report/technique article (24 %), clinical study (9 %), technical note/tip to reader (4 %), and randomized controlled trial (1 %). Three-quarters of the included studies were published in oral and maxillofacial surgery (38 %), dental education (26 %), and implant (12 %) disciplines. Methods of display included head mounted display device (HMD) (55 %), see through screen (32 %), 2D screen display (11 %), and projector display (2 %). Descriptions of immersive realities were fragmented and inconsistent with lack of clear taxonomy framework for the umbrella and the subset terms including virtual reality (VR), augmented reality (AR), mixed reality (MR), augmented virtuality (AV), extended reality, and X reality.

CONCLUSIONS

Immersive reality applications in dentistry are gaining popularity with a notable surge in the number of publications in the last 5 years. Ambiguities are apparent in the descriptions of immersive realities. A taxonomy framework based on method of display (full or partial) and reality class (VR, AR, or MR) is proposed.

CLINICAL SIGNIFICANCE

Understanding different reality classes can be perplexing due to their blurred boundaries and conceptual overlapping. Immersive technologies offer novel educational and clinical applications. This domain is fast developing. With the current fragmented and inconsistent terminologies, a comprehensive taxonomy framework is necessary.

Trueness and precision of digital light processing fabricated 3D printed monolithic zirconia crowns

OBJECTIVES

The present study aimed to evaluate the trueness and precision of monolithic zirconia crowns (MZCs) fabricated by 3D printing and milling techniques.

METHODS

A premolar crown was designed after scanning a prepared typodont. Twenty MZCs were fabricated using milling and 3D-printing techniques (n = 10). All the specimens were scanned with an industrial scanner, and the scanned data were analyzed using 3D measurement software to evaluate the trueness and precision of each group. Root mean square (RMS) deviations were measured and statistically analyzed (One-way ANOVA, Tukey's, p ≤ 0.05).

RESULTS

The trueness of the printed MZC group (140 ± 14 μm) showed a significantly higher RMS value compared to the milled MZCs (96 ± 27 μm,p < 0.001). At the same time, the precision of the milled MZCs (61 ± 17 μm) showed a significantly higher RMS value compared to that of the printed MZCs (31 ± 5 μm,p < 0.001).

CONCLUSIONS

The Fabrication techniques had a significant impact on the accuracy of the MZCs. Milled MZCs showed the highest trueness, while printed MZCs showed the highest precision. All the results were within the clinically acceptable error values.

CLINICAL SIGNIFICANCE

Although the trueness of the milled MZCs is higher, the manufacturing accuracy of the 3D-printed MZCs showed clinically acceptable results in terms of trueness and precision. However, additional clinical studies are recommended. Furthermore, the volumetric changes of the material should be considered.

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.

3D-printed versus conventionally milled zirconia for dental clinical applications: Trueness, precision, accuracy, biological and esthetic aspects

OBJECTIVES

This systematic review aimed to compare the clinical outcome, internal gap, trueness, precision, and biocompatibility of 3D-printed (AM) compared to milled (SM) zirconia restorations.

DATA SOURCE

A thorough search of Internet databases was conducted up to September 2023. The search retrieved studies compared AM zirconia to SM zirconia restorations regarding clinical outcome, fit, trueness, precision, and biocompatibility.

STUDY SELECTION

Of 1736 records, only 59 were screened for eligibility, and 22 records were included in this review. The quality of studies was assessed using the revised Cochrane risk-of-bias tool (ROB2), and the Modified Consort Statement. One clinical study exhibited a low risk of bias. All laboratory studies revealed some bias concerns. Short-term observation showed 100 % survival with no signs of periodontal complications. 3D-printed zirconia crowns showed statistically significant lower ΔE and a better match to adjacent teeth (p ≤ 0.5). The fit, trueness, and precision vary with the printing technique and the tooth surface.

CONCLUSIONS

3D-printed zirconia crowns provide better aesthetic color and contour match to adjacent natural teeth than milled crowns. Both 3D printing and milling result in crowns within the clinically acceptable internal and marginal fit. Except for nanoparticle jetting, the marginal gap of SM crowns was smaller than AM crowns, however, both were clinically acceptable. Laminate veneers might be more accurately produced by 3D printing. 3D-printed axial surface trueness was better than milled axial surfaces. Long-term RCTs are recommended to confirm the clinical applicability of 3D-printed restorations.

CLINICAL SIGNIFICANCE

Internal fit and gap, precision, and trueness are fundamental requirements for successful dental restorations. Both techniques produce restorations with clinically acceptable marginal and internal fit. Axial surfaces and narrow or constricted areas favored 3D-printed than conventionally milled zirconia.

Influence of 3D printed surface micro-structures on molding performance and dental bonding properties of zirconia

OBJECTIVES

To investigate the influence of the 3D printed micro-structured surfaces on the bond strength of zirconia to resin cement.

METHODS

Zirconia specimens were divided into five groups based on manufacturing technique and surface preparation: (1) milled zirconia (M group); (2) milled zirconia airborne abraded (MA group); (3) printed zirconia (M group); (4) printed zirconia airborne abraded (PA group); and (5) printed zirconia with micro-structured surface (PM group). The surface morphology, cross-sectional morphology, and elemental composition were observed using a scanning electron microscope (SEM). Surface roughness was measured using a laser scanning confocal microscope (SLCM). Shear bond strength (SBS) was measured using a universal testing machine after bonding resin cement (n = 10). The failure modes of the bonded fracture interfaces were observed and counted using a stereomicroscope and a SEM. In addition, boundary dimensional accuracy (n = 10) and micro-structural dimensional accuracy (n = 20) of printed zirconia specimens with micro-structured surfaces were measured using digital calipers and Fiji software. The crystalline phase changes before and after surface treatment were investigated using X-ray diffractometry. Data was analysed using one-way ANOVA and Tukey HSD post-hoc tests (α = 0.05).

RESULT

The surface micro-structures of the PM group had regular morphology and no obvious defects. The surface roughness results showed that the PM group had higher Sa (42.21±1.38 um) and Ra (21.25±1.80 um) values than the other four groups (p < 0.001). The SBS test showed that the bond strength of the PM group reached 11.23 ± 0.66 MPa, which was 55.97% (p < 0.001) higher than that of the P group (7.20 ± 1.14 MPa). The boundary dimensional accuracy of the PM group was proficient (diameter: 99.63 ± 0.31%, thickness: 98.05 ± 1.12%), and the actual fabrication dimensions of the hexagonal micro-structures reached 77.45%-80.01% of the original design. The micro-structured surface did not affect the crystalline phase of zirconia.

CONCLUSIONS

The current study illustrates that 3D-printed microstructured surfaces effectively improve the bond strength of zirconia to resin cements.

CLINICAL SIGNIFICANCE

With the advantage of 3D printing, this study provides a new idea for improving the bonding properties of zirconia.

Clinical outcomes of self-glazed zirconia veneers produced by 3D gel deposition: a retrospective study

BACKGROUND

Self-glazed zirconia (SZ) restorations are made by a novel additive three-dimensional gel deposition approach, which are suitable for a straightforward completely digital workflow. SZ has recently been used as minimally invasive veneer, but its clinical outcomes have not been clarified yet. This study aimed to evaluate the preliminary clinical outcomes of SZ veneers compared with the widely used lithium disilicate glass-ceramic veneers made by either pressing (PG) or milling (MG) process.

METHODS

Fifty-six patients treated with SZ, PG, and MG veneers by 2 specialists between June 2018 and October 2022 were identified. Patients were recalled for follow-up at least 1 year after restoration. Clinical outcomes were assessed by 2 independent evaluators according to the modified United States Public Health Service (USPHS) criteria. Overall patient satisfaction was assessed using visual analogue scale (VAS), and analyzed by one-way ANOVA. Chi-square test was applied to compare the difference in the success and survival rates among the 3 groups.

RESULTS

A total of 51 patients restored with 45 SZ, 40 PG, and 41 MG veneers completed the study, with a patient dropout rate of 8.9%. Mean and standard deviation of follow-up period was 35.0 ± 14.7 months. All restorations performed well at baseline, except for 2 SZ veneers with mismatched color (rated Bravo). During follow-up, marginal discrepancy (rated Bravo) was found in 4 MG veneers and 1 PG veneer, and partially fractured (rated Charlie) was found in another 2 PG veneers. The survival rate of SZ, PG, and MG veneers was 100%, 95%, and 100%, with a success rate of 95.56%, 92.50%, and 90.24%, respectively, none of which were significantly different (p = 0.099 and 0.628, respectively). The mean VAS score of SZ, PG, and MG was 95.00 ± 1.57, 93.93 ± 2.40, and 94.89 ± 2.00 respectively, without significant difference (p > 0.05).

CONCLUSION

SZ veneers exhibited comparable preliminary clinical outcomes to PG and MG veneers, which could be considered as a feasible option for minimally invasive restorative treatment.

Trueness of five different 3D printing systems including budget- and professional-grade printers: An In vitro study

Problem

Several types of 3D printers with different techniques and prices are available on the market. However, results in the literature are inconsistent, and there is no comprehensive agreement on the accuracy of 3D printers of different price categories for dental applications.

Aim

This study aimed to investigate the accuracy of five different 3D printing systems, including a comparison of budget- and higher-end 3D printing systems, according to a standardized production and evaluation protocol.

Material and methods

A maxillary reference model with prepared teeth was created using 16 half-ball markers with a diameter of 1 mm to facilitate measurements. A reference file was fabricated using five different 3D printers. The printed models were scanned and superimposed onto the original standard tesselation language (.stl) file, and digital measurements were performed to assess the 3-dimensional and linear deviations between the reference and test models.

Results

After examining the entire surface of the models, we found that 3D printers using Fused filament fabrication (FFF) technology -120.2 (20.3) μm create models with high trueness but high distortion. Distortions along the z-axis were found to be the highest with the stereolithography (SLA)-type 3D printer at -153.7 (38.7) μm. For the 4-unit FPD, we found 201.9 (41.8) μm deviation with the digital light processing (DLP) printer. The largest deviation (-265.1 (55.4) μm) between the second molars was observed for the DLP printer. Between the incisor and the second molar, the best results were produced by the FFF printer with -30.5 (76.7) μm.

Conclusion

Budget-friendly 3D printers are comparable to professional-grade printers in terms of precision. In general, the cost of a printing system is not a reliable indicator of its level of accuracy.

Dental implant placement with immersive technologies: A preliminary clinical report of augmented and mixed reality applications

A preliminary clinical report of implant placements with 2 immersive reality technologies is described: augmented reality with head mounted display and mixed reality with a tablet PC. Both immersive realities are promising and could facilitate innovative dental applications. However, mixed reality requires further development for clinical optimization.

Effect of firing time and wall thickness on the biaxial flexural strength of 3D-printed zirconia

OBJECTIVES

To evaluate the effect of accelerated firing on 3D-printed zirconia.

METHODS

To check if formulae provided by ISO 6872 can be extended to thin samples, finite element analyses were carried out in advance of fabricating 3-mol% yttria-stabilized tetragonal zirconia polycrystal discs by milling and by 3D-printing. Four groups (n = 38 each) of 3D-printed specimens were produced with two nominal thicknesses (0.6 mm and 1.2 mm) and two firing strategies (long: 51 h, accelerated: 14.5 h). In the milled group (thickness 1.2 mm, n = 30), a standard firing program (9.8 h) was selected. Biaxial flexural strength tests were applied and mean strength, characteristic strength, and Weibull modulus were calculated for each group. Differences were analyzed using Welch ANOVA and Dunnett-T3 post-hoc tests.

RESULTS

Maximum tensile stresses occurring during biaxial strength testing can be calculated according to ISO 6872 for thin samples with b > 0.3 mm. Variability of measured strengths values was smaller for milled zirconia compared with 3D-printed zirconia. The 1.2-mm-thick 3D-printed samples had significantly decreased strength after accelerated firing than after long firing. However, for the 0.6-mm-thick samples, comparable mean biaxial strength values of about 1000 MPa were measured for both firing protocols.

SIGNIFICANCE

At the moment, long fabrication time for zirconia restorations is a major drawback of 3D-printing when compared with milling technology. This investigation showed that the strength of 0.6-mm-thick zirconia discs fabricated by 3D-printing was not impaired by accelerated firing. Thus, overnight firing of thin-walled 3D-printed zirconia restorations could be possible.

Accuracy of zirconia crown manufactured using stereolithography and digital light processing

OBJECTIVES

The aim of this study is to evaluate the accuracy of zirconia crowns fabricated using stereolithography (SLA) and digital light processing (DLP) and to compare their accuracy with those fabricated using the subtractive manufacturing (SM) method.

METHODS

A typodont model with a prepared maxillary first molar was scanned, and the anatomical contour crown was designed using dental computer-aided-design (CAD) software. The designed file in standard tessellation language (STL) format was used to fabricate 10 crowns per group. The crowns were manufactured using a dental milling machine (Datron D5; MLC group), SLA (CERAMAKER 900; SLAC group), and DLP (ZIPRO; DLPC group) printers. The fabricated crowns were scanned using a dental laboratory scanner and saved in three parts: the external, intaglio, and marginal surfaces. For accuracy assessment, these parts were superimposed to the reference file. Root mean square (RMS) values were evaluated using three-dimensional analysis software (Geomagic Control X). Statistical significance was evaluated using a nonparametric Kruskal-Wallis test (α = 0.05) and a post-hoc Mann-Whitney U test with Bonferroni correction (α = 0.016).

RESULTS

Trueness evaluation revealed the lowest RMS value in all areas in the MLC group, followed by that in the DLPC group. The precision evaluation revealed the lowest RMS value in all areas in the MLC group. Statistically significant differences were observed among the groups in the external, intaglio, and marginal surface (P < 0.05).

CONCLUSIONS

Although the restorations fabricated using SM revealed higher accuracy, the crowns manufactured using SLA and DLP methods were considered clinically acceptable.

CLINICAL SIGNIFICANCE

In the production of zirconia crowns, subtractive manufacturing continues to demonstrate significantly higher accuracy compared to additive manufacturing. However, crowns fabricated using the additive manufacturing method also demonstrated high accuracy.

Mechanical characteristics of zirconia produced additively by 3D printing in dentistry - A systematic review with meta-analysis of novel reports

OBJECTIVES

This study was aimed at comparing the mechanical parameters of ceramics made using the addition and subtraction technique.

METHODS

A search was performed on four search engines on 5th April 2023. Quality assessment was performed using study type-specific scales. Where possible, a meta-analysis was performed.

SOURCES

Data were extracted from four search engines: PubMed, PubMed Central, Embase, Web of Science, Scopus.

STUDY SELECTION

The search strategy identified 686 potential articles. 19 papers were subject to qualitative analysis, and data from 11 papers were meta-analysed. The included studies were of high or medium quality. All included papers were in-vitro studies. No clinical trials were found in the literature.

SIGNIFICANCE

Ceramics made in the additive technology in terms of mechanical parameters can compete with ceramics made in the milling technology. There are no clinical studies yet that would indicate the use of this type of material for permanent restorations in patients. Studies presented in the literature vary greatly in terms of study design and reporting of results. The research did not receive external funding.

3D printed zirconia used as dental materials: a critical review

In view of its high mechanical performance, outstanding aesthetic qualities, and biological stability, zirconia has been widely used in the fields of dentistry. Due to its potential to produce suitable advanced configurations and structures for a number of medical applications, especially personalized created devices, ceramic additive manufacturing (AM) has been attracting a great deal of attention in recent years. AM zirconia hews out infinite possibilities that are otherwise barely possible with traditional processes thanks to its freedom and efficiency. In the review, AM zirconia's physical and adhesive characteristics, accuracy, biocompatibility, as well as their clinical applications have been reviewed. Here, we highlight the accuracy and biocompatibility of 3D printed zirconia. Also, current obstacles and a forecast of AM zirconia for its development and improvement have been covered. In summary, this review offers a description of the basic characteristics of AM zirconia materials intended for oral medicine. Furthermore, it provides a generally novel and fundamental basis for the utilization of 3D printed zirconia in dentistry.

The effect of surface treatment and low-temperature degradation on flexural strength of additive manufactured zirconia

This study aimed to assess the effect of low-temperature degradation (LTD) and surface treatment on the flexural strength of additive-manufactured (AM) zirconia by comparison to subtractive-manufactured (SM) zirconia. Disc-shaped zirconia specimens were fabricated using AM and SM technology, and each group was assigned to 3 subgroups according to the type of surface treatment: control, sandblasting (SB), and 9% hydrofluoric acid etching (HF). The groups were then further divided into 2 subgroups: unaged and aged. Biaxial flexural strength, crystal phase, surface topography, and surface roughness were measured to evaluate the mechanical properties. Statistical analyses were performed with 3-way ANOVA, followed by the comparison of means with Bonferroni post hoc analyses. The means and standard deviations of the biaxial flexural strength and Weibull parameters were calculated with descriptive statistics. All SM groups showed significantly greater flexural strength than the AM groups (p < .05), and LTD did not affect flexural strength except for the SMHF group (p < .05). After LTD, monoclinic phases (m-phase) were found in all groups, and SEM images showed grain pullout due to zirconia volume expansion in both control groups. Sandblasting significantly affected flexural strength (p < .05), whereas the HF group did not affect flexural strength except in the SMHF group after LTD (p < .05). No significant difference was observed in the surface roughness of AM compared to SM groups conditioned with the same surface treatment regardless of LTD. AM zirconia has comparable mechanical properties to SM zirconia, regardless of low-temperature degradation and surface treatment, which indicates the potential of the AM technique for clinical applications.

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.

Environmental sustainability related to dental materials and procedures in prosthodontics: A critical review

This article aims to review the status, challenges, and directions of environmentally sustainable oral healthcare by focusing on the dental materials and procedures used in prosthodontics. Sustainable development is a global priority and requires a systemic, integrative approach from all sectors of society. The oral healthcare sector is responsible for substantial greenhouse emissions throughout its value chain, including raw material extraction, industrial production, supply distribution, clinical practice, and management of waste. Of all dental specialties, prosthodontics has been one of the main generators of carbon emissions by fabricating a single product such as dentures or crowns in multiple steps. Dental prosthetic procedures involve chemicals and materials such as polymers, ceramics, metals, gypsum, and wax, which are often used in large quantities and for a single use. Thus, environmental risks and socioeconomic burdens can result from residuals and improper disposal, as well as waste and the embedded costs of unused materials retained by manufacturers, retail suppliers, dental laboratories, and dental clinics. To mitigate the environmental impact generated by conventional prosthodontics, we urge awareness and the adoption of sustainable good practices in the daily routine of dental clinics and laboratories. Capacity building and investment in a circular economy and digital technology can reduce the carbon footprint of prosthetic dentistry and improve the quality of life for present and future generations.

Additively and subtractively manufactured implant-supported fixed dental prostheses: A systematic review

AIM

To compare and report on the performance of implant-supported fixed dental prostheses (iFDPs) fabricated using additive (AM) or subtractive (SM) manufacturing.

METHODS

An electronic search was conducted (Medline, Embase, Cochrane Central, Epistemonikos, clinical trials registries) with a focused PICO question: In partially edentulous patients with missing single (or multiple) teeth undergoing dental implant therapy (P), do AM iFDPs (I) compared to SM iFDPs (C) result in improved clinical performance (O)? Included were studies comparing AM to SM iFDPs (randomized clinical trials, prospective/retrospective clinical studies, case series, in vitro studies).

RESULTS

Of 2'184 citations, no clinical study met the inclusion criteria, whereas six in vitro studies proved to be eligible. Due to the lack of clinical studies and considerable heterogeneity across the studies, no meta-analysis could be performed. AM iFDPs were made of zirconia and polymers. For SM iFDPs, zirconia, lithium disilicate, resin-modified ceramics and different types of polymer-based materials were used. Performance was evaluated by assessing marginal and internal discrepancies and mechanical properties (fracture loads, bending moments). Three of the included studies examined the marginal and internal discrepancies of interim or definitive iFDPs, while four examined mechanical properties. Based on marginal and internal discrepancies as well as the mechanical properties of AM and SM iFDPs, the studies revealed inconclusive results.

CONCLUSION

Despite the development of AM and the comprehensive search, there is very limited data available on the performance of AM iFDPs and their comparison to SM techniques. Therefore, the clinical performance of iFDPs by AM remains to be elucidated.

Influence of surface finishing and printing layer orientation on surface roughness and flexural strength of stereolithography-manufactured dental zirconia

OBJECTIVE

To evaluate the effect of surface finishing and printing layer orientation on the surface roughness and flexural strength of three-dimensionally (3D) printed 3 mol% yttria-stabilized zirconia manufactured by stereolithography (SLA).

METHODS

Ninety bar-shaped zirconia specimens (1 mm x 1 mm x 12 mm) were 3D-printed via SLA. After debinding and sintering, they were randomly divided according to the printing layer orientation: parallel (PR) or perpendicular (PD) to the tensile surface for bending test. Each group was submitted to a surface finishing protocol (n=15/group): unpolished (subgroup 0), with polished tensile surface (subgroup 1), and with polished lateral and tensile surfaces (subgroup 3). Roughness of tensile surface was determined using a contact sensor and surface morphology was analyzed under Scanning Electron Microscopy (SEM). Flexural strength, apparent elastic modulus, and Weibull parameters were assessed using a 3-point bending test. Fractured specimens were examined to identify failure origins. Finite element analysis was used to evaluate tensile stress peaks and failure risk.

RESULTS

PR orientation exhibited higher strength, higher apparent elastic modulus, higher maximum principal stress peaks, and lower failure risk. For both layer orientations, groups with polished lateral and tensile sides (PR3 and PD3) were the strongest. SEM revealed that polishing led to changes in defect type, location, and size.

SIGNIFICANCE

SLA zirconia shows different mechanical properties according to surface roughness and defects. Orienting the printed layers parallel to the tensile side improves its mechanical performance. Polishing can significantly improve its flexural strength. It is necessary to reduce the final product's surface roughness and large pores for its best performance.

Effect of 3D printing system and post-curing atmosphere on micro- and nano-wear of additive-manufactured occlusal splint materials

Although additive manufacturing has been widely applied for occlusal splint (OS) fabrication, it is still unclear whether 3D printing system and post-curing atmosphere would play a role in the wear resistance of additive-manufactured OS. Therefore, the aim of this study was to evaluate the effect of 3D printing system (liquid crystal display (LCD) and digital light processing (DLP)) and post-curing atmosphere (air and nitrogen gas (N₂)) on the wear resistance of hard and soft OS materials for additive-manufactured OSs (KeySplint® Hard and Soft). The evaluated properties were microwear (by two-body wear test) and nano-wear resistances (by nanoindentation wear test) as well as flexural strength and flexural modulus (by three-point bending test), surface microhardness (by Vickers hardness test), and nanoscale elastic modulus (reduced elastic modulus) and nano surface hardness (by nanoindentation test). For the hard material, the surface microhardness, microwear resistance, reduced elastic modulus, nano surface hardness, and nano-wear resistance were significantly affected by the printing system (p < 0.05), while all the evaluated properties except flexural modulus were significantly affected by the post-curing atmosphere (p < 0.05). Meanwhile, both the printing system and post-curing atmosphere significantly affected all the evaluated properties (p < 0.05). The specimens additive-manufactured by DLP printer tended to show higher wear resistance in the hard material groups and lower wear resistance in the soft material groups when compared to those by LCD printer. The post-curing at N₂ atmosphere significantly enhanced the microwear resistance of hard material groups additive-manufactured by the DLP printer (p < 0.05) and soft material groups additive-manufactured by the LCD printer (p < 0.01), while it significantly enhanced the nano-wear resistance of both hard and soft material groups regardless of the printing system (p < 0.01). It can be concluded that 3D printing system and post-curing atmosphere affect the micro- and nano-wear resistance of tested additively manufactured OS materials. In addition, it can be also concluded that the optical printing system providing higher wear resistance depends on the material type, and using nitrogen gas as a protection gas during post-curing enhances the wear resistance of tested materials.

Effect of maximum support attachment angle on intaglio surface trueness of anatomic contour monolithic prostheses manufactured by digital light processing and zirconia suspension

STATEMENT OF PROBLEM

Support structures are essential for the quality of resin-based prostheses made by the digital light processing (DLP), but few studies have evaluated the effect of support structure on the accuracy of zirconia-based anatomic contour prostheses.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of maximum support attachment angle (MSA) on the intaglio surface trueness of anatomic contour prostheses made by DLP and compare the trueness of 2-unit anatomic contour prostheses with that of those produced by milling.

MATERIAL AND METHODS

Anatomic contour single-unit prostheses were manufactured using DLP and a suspension with 3-mol% yttria-stabilized zirconia. Four different conditions of MSA values to the vertical axis of the object (50, 55, 60, and 65 degrees) were applied (n=10). After printing, postprocessing, and sintering, all successfully produced prostheses were evaluated for intaglio surface trueness by considering the root mean square (RMS). Using the MSA showing the highest trueness, the 2-unit prostheses made by DLP (DLP group) were compared with milled (MIL group) prostheses in terms of intaglio accuracy (n=10). One-way analysis of variance and a post hoc pairwise comparison or independent t test were used for trueness analysis (α=.05).

RESULTS

Three MSA groups (50, 55, and 60 degrees) were successfully produced with significant differences between the trueness of the single-unit prostheses for the groups with different MSA values (P<.05). The highest trueness was in the 50-degree MSA group. The 2-unit prostheses of the DLP group with 50-degree MSA showed significantly lower trueness than those of the MIL group (P<.05); however, the RMS values of both groups were lower than 50 μm.

CONCLUSIONS

The intaglio surface trueness of anatomic contour DLP-generated prostheses can be improved by changing the MSA. The 50-degree MSA was beneficial for the accuracy of both single-unit and 2-unit DLP-generated prostheses, produced within clinically acceptable limits.

Investigation of the esthetic perception of different canine parameters

OBJECTIVES

The aim of this study is to analyze the esthetic perception of selected canine features, namely crown length, shade, inclination, and angle of incisal edge tip.

MATERIALS AND METHODS

The anterior maxillary teeth of a Central European woman were photographed and digitally modified in order to investigate esthetic perceptions of the above four categories. Three groups of examiners with different levels of experience in the field of dentistry (laypersons/inexperienced dental students, advanced dental students, dentists) evaluated the photographs twice with the help of visual analogue scales.

RESULTS

The best-evaluated canines have approximately the same length as the central incisor, have the same shade as the other anterior teeth, are best embedded in a lighter overall tooth shade, are neutral to slightly palatal inclined, and have a right angled to rounded incisal edge (≥ 90°). The canines evaluated as least esthetic, however, are longer than the central incisors, darker, inclined labially, and have a tapered incisal edge. No significant differences could be found between the evaluations of the groups with regard to the four feature categories.

CONCLUSIONS

Laypersons, advanced dental students, and dentists generally evaluate according to the same esthetic standards. Gender does not have a significant influence on evaluation. Clear definitions of esthetically favored shades, incisal edge shapes, inclination, and lengths of the canines can be given.

CLINICAL RELEVANCE

Since the esthetics of the smile line play a critical role for patients, dentists, dental technicians, and their supplying industry, knowledge of the esthetically preferred morphology of canines is essential.

CLINICAL SIGNIFICANCE

The aim of this study is to give clear definitions of esthetically favored shades, incisal edge shapes, and lengths of the canines, as the esthetics of the smile line play a critical role for patients, dentists, dental technicians, and their supplying industry (e.g., denture tooth manufacturers). Precise knowledge of esthetic preferences is important in clinical practice for both dentists and dental technicians, for example, in order to adequately advise patients regarding esthetic corrections. Also, in the case of missing teeth, this knowledge is essential for optimal and satisfactory restorations. Thus, this study can contribute to the satisfaction of general practitioners and patients.