Marginal adaptation and fracture resistance of milled and 3D-printed CAD/CAM hybrid dental crown materials with various occlusal thicknesses

Accuracy, fit, and marginal quality of advanced additively manufactured and milled zirconia 3-unit fixed dental prostheses

STATEMENT OF PROBLEM

Advanced additive manufacturing (AM) of zirconia is an emerging technology that can explore the limitations of traditional computer-aided design and computer-aided manufacturing (CAD-CAM) milling techniques. However, a comprehensive evaluation of their differences in producing zirconia restorations, especially multi-unit restorations, is lacking.

PURPOSE

The purpose of this in vitro study was to compare the accuracy, fit, marginal quality, and surface roughness of zirconia 3-unit fixed dental prostheses (FDPs) by using advanced AM and 2 CAD-CAM milling materials.

MATERIAL AND METHODS

Based on the same CAD model, 30 3-unit posterior FDPs (n=10) were manufactured by using AM and 2 CAD-CAM milling materials (VT and UP). The accuracies of the total, intaglio, occlusal, axial, and marginal regions were calculated separately by comparing the scanned model with the design model by using 3-dimensional (3D) deviation analysis. The silicone layer was scanned to evaluate the marginal and intaglio fit in 3 dimensions. A 3D laser microscope was used for surface roughness detection, marginal quality assessment, and marginal defect measurement. The data were analyzed using ANOVA and the Tukey post hoc test (α=.05).

RESULTS

Compared with CAD-CAM milling, the AM group had higher accuracy and smaller positive deviations on the axial and intaglio regions (P<.001). Different manufacturing methods showed no statistically significant effect on the mean intaglio fit (P>.05), and all were within the clinically acceptable range (<100 µm). The intaglio gap was significantly higher than the target parameter in the occlusal regions. AM-fabricated FDPs had significantly higher surface roughness than milled ones, yet showed better margin quality with fewer marginal defects CONCLUSIONS: Compared with CAD-CAM milling, the advanced additively manufactured zirconia 3-unit FDPs provided better accuracy, improved margin quality, and clinically acceptable fit, but higher surface roughness, and may be a promising alternative for clinical applications.

Effects of print orientation and artificial aging on the flexural strength and flexural modulus of 3D printed restorative resin materials

STATEMENT OF PROBLEM

The integration of computer-aided design and computer-aided manufacture (CAD-CAM) technology has revolutionized restorative dentistry, offering both additive and subtractive manufacturing methods. Despite extensive research on 3-dimensionally (3D) printed materials, uncertainties remain regarding the impact of print orientation on their mechanical properties, especially for definitive resin materials, necessitating further investigation to ensure clinical efficacy.

PURPOSE

The purpose of this in vitro study was to investigate the influence of print orientation and artificial aging on the flexural strength (FS) and flexural modulus (FM) of 3D printed resin materials indicated for definitive and interim restorations.

MATERIAL AND METHODS

Specimens (2×2×25 mm) were additively manufactured in 3 orientations (0, 45, and 90 degrees) using five 3D printed resins: VarseoSmile Crownplus (VCP), Crowntec (CT), Nextdent C&B MFH (ND), Dima C&B temp (DT), and GC temp print (GC). A DLP 3D printer (ASIGA MAX UV) was used with postprocessing parameters as per the manufacturer recommendations. FS and FM were tested after storage in distilled water (DW) and artificial saliva (AS) for 24 hours, 1 month, and 3 months at 37 °C. Additional 2×2×16-mm specimens printed at 90 degrees were compared with the milled materials Lava Ultimate (LU) and Telio CAD (TC) after 24 hours of storage in AS at 37 °C (n=10). Measurements were conducted using a universal testing machine (Z020; Zwick/Roell) following the International Organization for Standardization (ISO) 4049 standard. Multiple way ANOVA, 1-way ANOVA, and Tukey HSD post hoc tests (α=.05) were used to analyze the data.

RESULTS

Print orientation significantly influenced the FS and FM of 3D printed resin materials, with the 90-degree orientation exhibiting superior mechanical properties (P<.05). Definitive resins (CT and VCP) exhibited higher FS and FM compared with interim resins (ND, DT, GC) at all time points (P<.001). LU had significantly higher FS and FM compared with other resins (P<.001), while TC had similar FS to definitive 3D printed resins. Aging time and media influenced FS and FM, with varying effects observed across different materials and time points. Strong positive correlations were found between filler weight and both FS (r=.83, P=.019) and FM. All materials met the minimum FS requirement of 80 MPa (ISO 4049) when printed at 90 degrees.

CONCLUSIONS

The 90-degree orientation produced specimens with higher FS than 0- and 45-degree orientations. CT recommended for definitive restorations displayed higher FS compared with VCP and those intended for interim use after 3 months of aging. LU exhibited higher FS and FM than 3D printed resins, while TC had similar FS and FM to the latter. Aging effects on 3D printed resins were minimal and were material specific.

Mechanical Properties of Additive-Manufactured Composite-Based Resins for Permanent Indirect Restorations: A Scoping Review

The introduction of 3D printing technology in dentistry has opened new treatment options. The ongoing development of different materials for these printing purposes has recently enabled the production of definitive indirect restorations via 3D printing. To identify relevant data, a systematic search was conducted in three databases, namely PubMed, Scopus, and Web of Science. Additionally, a manual search using individual search terms was performed. Only English, peer-reviewed articles that encompassed in vitro or in vivo research on the mechanical properties of 3D-printed composite materials were included, provided they met the predefined inclusion and exclusion criteria. After screening 1142 research articles, 14 primary studies were selected. The included studies mainly utilized digital light processing (DLP) technology, less commonly stereolithography (SLA), and once PolyJet printing technology. The material properties of various composite resins, such as VarseoSmile Crown Plus (VSC) and Crowntec (CT), were studied, including Vickers hardness, flexural strength, elastic modulus, compressive strength, tensile strength, fracture resistance, and wear. The studies aimed to compare the behavior of the tested additive composites to each other, conventional composites, and subtractive-manufactured materials. This scoping review examined the mechanical properties of composites used for 3D printing of definitive restorations. The aim was to provide a comprehensive overview of the current knowledge on this topic and identify any gaps for future research. The findings suggest that 3D-printed composites are not yet the first option for indirect restorations, due to their insufficient mechanical properties. Due to limited evidence, more research is needed in this area. Specifically, there is a need for clinical trials and long-term in vivo research.

Effects of Er,Cr:YSGG Laser Surface Treatments and Composites with Different Viscosities on the Repair Bond Strength of CAD/CAM Resin Nanoceramic

This study aims to evaluate the repair micro-shear bond strength of the CAD/CAM resin nanoceramic block treated using four different surface treatments and composite resins of different viscosities. For the current study, 96 samples with dimensions of 14 × 12 × 2 mm were obtained from a CAD/CAM resin nanoceramic block (Cerasmart) with a low-speed precision cutting saw under water cooling. The relevant samples were randomly divided into four groups according to the surface treatment processes: grinding with diamond bur, aluminum oxide airborne-particle abrasion, long-pulse laser, and short-pulse laser. Following silane application, universal adhesive was applied to all surface-treated samples and cured with an LED for 10 s. The samples prepared for the repair procedure were divided into two subgroups (microhybrid composite and injectable composite) according to the viscosity of the repair material to be used (n = 12). After the repair procedure, care was taken to keep the samples in distilled water in an incubator at 37 °C for 24 h. The repair micro-shear bond strength values (μSBSs) of CAD/CAM resin nanoceramic-composite resin complexes were tested. In addition, randomly selected samples from each group were examined with a scanning electron microscope to evaluate the surface topography after both surface treatments and the micro-shear bond strength test. Data were analyzed by two-way ANOVA and Bonferroni test. It was determined that the surface treatment preferred in the repair protocol significantly affected the μSBS value (p < 0.001). While the highest μSBS value was obtained with the short-pulse laser airradiation group, the lowest μSBS values were found in samples with long pulse laser irradiation. However, samples grinded with a bur and airborne-particle abrasion showed similar μSBS values (p > 0.05). The preferred composite viscosity in the repair procedure has a significant effect on the μSBS value (p < 0.001). However, the interaction between the surface treatment and the viscosity of the repair composite does not affect the μSBS values in a statistically significant way (p = 0.193). It may be recommended to clinicians to repair CAD/CAM resin nanoceramic restoration surfaces with injectable composites or after treatment with short-pulse lasers.

The influence of hygroscopic expansion of resin supporting dies on the fracture resistance of ceramic restorations during thermal cycling

OBJECTIVES

To evaluate the hygroscopic expansion characterization of resin composite dies during thermal cycling, and their influence on the fracture resistance of dental ceramic materials as well as the effect of pre-immersion on these measurements.

METHODS

Disc-shaped specimens (φ = 15.0 mm, h = 1.2 mm) and anatomical crown dies of four resin composites (epoxy, Z350, P60, G10) were fabricated. Disc-shaped samples were continuously soaked in distilled water and the volume expansion was measured at different time point by Archimedes method. Disc-shaped samples were pre-immersed for 0, 7, or 30 days, elastic modulus and hardness were measured using Nanoindentation test; thermal cycling (TC) test was performed (5 °C-55 °C, 104 cycles), and volume expansion during TC was measured. Four kinds of resin die with pre-immersion for 0, 7, or 30 days were cemented to 5Y-Z crown, or epoxy dies without pre-immersion were cemented to 5Y-Z, 3Y-Z and lithium disilicate glass (LDG) crowns, and load-to-failure testing was performed before and after TC. Finite element analysis (FEA) and fractography analysis were also conducted.

RESULTS

The hygroscopic expansion was in the order: epoxy > Z350 > P60 > G10. Except for G10, the other three resin composites exhibited different degrees of hygroscopic expansion during TC. Only the elastic modulus and hardness of epoxy decreased after water storage. However, only the fracture loads of 5Y-Z and LDG crowns supported by epoxy dies were significantly decreased after TC. FEA showed a stress concentration at the cervical region of the crown after volume expansion of the die, leading to the increase of the peak stress at the crown during loading.

SIGNIFICANCE

Only the hygroscopic expansion of epoxy dies caused by TC led to the decrease in the fracture resistance of the 5Y-Z and LDG crown, which may be related to the decrease in the elastic modulus of the epoxy die and the tensile stress caused by it.

Effect of thickness on the translucency of machinable and printable ceramic-glass polymer materials

OBJECTIVES

To assess the translucency of machinable and printable ceramic-glass polymer materials with different thicknesses.

METHODS

Five ceramic-glass polymer materials were tested: one 3D-printable material, Permanent Crown resin (3D), two machinable materials available at low translucency (LT) and high translucency (HT) levels, VITA Enamic (VE) HT/LT, and Cerasmart 270 (CS) HT/LT. A total of 100 specimens were produced across 10 subgroups (n = 10) with thicknesses of 1 mm and 1.5 mm. The colour coordinates of the specimens were measured against black and white backgrounds using a spectrophotometer. Translucency was quantified using the Relative Translucency Parameter (RTP), calculated via the CIEDE2000 formula. A two-way ANOVA followed by post-hoc tests with Bonferroni correction (α = 0.05) was used for statistical analysis.

RESULTS

The RTP for both thicknesses were ranked as follows: CSHT > VEHT > CSLT > 3D > VELT. The RTP of the 3D was lower than that of the HT machinable materials (CSHT and VEHT) for both thicknesses (p < 0.05). No significant difference was observed between the RTP of 3D and CSLT at 1.5 mm (p = 1.000); however, at 1 mm, the RTP of the 3D was lower than that of the CSLT (p < 0.05). Notably, the 3D showed the least translucency difference with a 0.5 mm increase in thickness.

CONCLUSIONS

Printable ceramic-glass polymer materials demonstrated lower translucency than HT machinable ceramic-glass polymer materials. Both the thickness and type significantly influenced the translucency of the LT machinable counterparts compared to the printable ceramic-glass polymer material.

CLINICAL SIGNIFICANCE

Printable ceramic-glass polymer resins may be a suitable option for minimally invasive procedures, especially when attempting to mask undesirable-coloured abutments. When selecting HT machinable ceramic-glass polymers, clinicians should pay greater attention to the abutment colour and thickness of the restorative material.

Surface roughness, wear, and abrasiveness of printed and milled occlusal veneers after thermomechanical aging

STATEMENT OF PROBLEM

Occlusal veneers are a conservative method of reestablishing vertical dimensions of occlusion (VDO) for worn teeth. A restorative material used for occlusal veneers should have a smooth surface, adequate wear resistance, and low abrasiveness to the antagonists, as total wear of occlusal veneers and their antagonists determines the stability of the reestablished VDO. Studies on roughness, wear, and abrasiveness of occlusal veneers are scarce.

PURPOSE

The purpose of this in vitro study was to assess the surface roughness, wear, and abrasiveness of printed and milled occlusal veneers after thermomechanical aging against natural cusps and restorative materials.

MATERIAL AND METHODS

Forty-eight extracted mandibular first molars were prepared for occlusal veneers and scanned with an intraoral scanner. The scans were exported to a computer-aided design program to design the occlusal veneers in 3 groups (n=16) according to the restorative material: group IP: milled lithium disilicate; group EN: milled hybrid ceramic (Vita Enamic), group VA: printed hybrid ceramic (Varseosmile Crown plus). The occlusal veneers in each group were bonded to their corresponding abutments and subjected to 250 000 mechanical cycles and a simultaneous 1000 thermal cycles in a mastication simulator. During thermomechanical aging, half of the specimens of each study group (n=8) were opposed by natural cusps (antagonist C) and the other half by antagonist cusps fabricated from the same restorative material as the occlusal veneers (antagonist R). The wear of the occlusal veneers and their antagonists was assessed with a 3-dimensional processing software program. The surface roughness of the veneers was assessed with a contact profilometer. The results were statistically analyzed with a 2-way ANOVA followed by the post hoc Tukey HSD test (α=.05).

RESULTS

The 2-way ANOVA indicated a significant effect for the material and the antagonist on surface roughness, wear, and abrasiveness (P<.05). When opposed by antagonist C, VA showed significantly higher surface roughness than IP and EN (P<.001). VA had significantly higher surface wear followed by EN and IP (P<.001). IP caused significantly higher wear to antagonist C than EN and VA (P<.001). In addition, IP had significantly higher total wear (combined wear of veneers and their antagonists) followed by VA and EN (P<.001). When opposed by antagonist R, no significant difference was found among the 3 materials for surface roughness (P=.08), material wear (P=.12), opposing wear (P=.11), or total wear (P=.11).

CONCLUSIONS

Both material and antagonist had a significant effect on surface roughness and occlusal stability when occlusal veneers were fabricated to restore VDO. VA had significantly more surface roughness and wear than EN and IP when opposed by natural cusps. IP abraded natural cusps significantly more than EN and VA. The 3 tested materials showed similar roughness, wear, and abrasiveness when opposed by the same material.

Fracture resistance of ultratranslucent multilayered zirconia veneers with different facial thicknesses

To assess the fracture resistance of computer-aided design and computer-aided manufacturing (CAD/CAM) ultratranslucent multilayered zirconia (5Y-YZP) veneers with varying facial thickness. Sixty translucent zirconia veneers were designed and milled using a chairside CAD/CAM system for maxillary central incisors. The butt joint incisal veneer tooth preparations consisted of 1.00 mm incisal reduction, 0.40 mm chamfer margin, and three different facial reductions; 0.50, 0.75, and 1 mm, respectively. The ceramic veneers were cemented to printed resin dies and subjected to thermal cycling. Subsequently, the restorations were loaded with compressive loading force, and fracture occurrences were recorded. Scanning electron microscope (SEM) images of the fractured specimens were captured. The fracture resistance varied among the veneers with different facial thicknesses. Ultratranslucent zirconia veneers with a facial thickness of 1.00 mm exhibited the highest fracture resistance values (742.15 N), followed by those with 0.75 mm facial thickness (673 N). Minimally invasive veneers with 0.50 mm thickness displayed similar fracture resistance as thicker veneers with 0.75 mm. However, veneers with 1.00 mm thickness displayed the highest values. SEM fracture patterns for 0.50 and 0.75 mm display similar and fewer crack lines than 1.00 mm veneers. RESEARCH HIGHLIGHTS: Minimally invasive zirconia veneers exhibit similar fracture resistance to thicker veneers.

Fracture resistance of additively or subtractively manufactured resin-based definitive crowns: Effect of restorative material, resin cement, and cyclic loading

OBJECTIVE

To evaluate how restorative material, resin cement, and cyclic loading affect the fracture resistance of resin-based crowns fabricated by using additive or subtractive manufacturing.

METHODS

A right first molar crown standard tessellation language (STL) file was used to fabricate 120 crowns from one subtractively manufactured polymer-infiltrated ceramic network (SM) and two additively manufactured resin composites (AM-B and AM-S) (N = 40). These crowns were randomly divided into 4 groups within each material according to the dual-polymerizing resin cement to be used (RX and PN) and the aging condition (n = 10). After cementation, the crowns without cyclic loading were subjected to fracture testing, while the others were first cyclically loaded (1.7 Hz, 1.2 million cycles, and 49-N load) and then subjected to fracture testing. Data were analyzed with generalized linear model analysis (α = .05).

RESULTS

Fracture resistance of the crowns was affected by material, resin cement, and cyclic loading (P ≤ .030). However, none of the interactions significantly affected fracture resistance of tested crowns (P ≥ .140). Among tested materials, SM had the highest fracture resistance, whereas AM-B had the lowest (P ≤ .025). RX led to higher fracture resistance, and cyclic loading decreased the fracture resistance (P ≤ .026).

SIGNIFICANCE

Tested materials can be considered reliable in terms of fracture resistance in short- or mid-term (5 years of intraoral simulation) when used for single molar crowns with 2 mm occlusal thickness. In the long term, polymer-infiltrated ceramic network crowns cemented with RelyX Universal may provide promising results and be less prone to complications considering higher fracture resistance values obtained.

Fracture Resistance of Posterior Milled Nanoceramic Crowns after Thermomechanical Aging

Fracture resistance is an important parameter used to predict the performance of indirect dental restorations. The purpose of this in vitro study was to assess the fracture load of posterior milled nanoceramic crowns, in comparison with the lithium disilicate crowns, after fatigue loading, for two different restoration occlusal thicknesses. Forty test metal dies were fabricated by duplicating a master metal model consisting of an anatomic abutment preparation of the maxillary first premolar for a single crown. The dies were divided into two groups of 20 each for the fabrication of nanoceramic (Lava Ultimate) and lithium disilicate (IPS e.max CAD) single crowns. Each material group was further divided into two sub-groups of 10 dies each, based on crown occlusal thickness, of 0.5-mm and 0.75-mm (n = 10). Dental Type V stone dies poured from polyvinyl siloxane impressions of the test metal dies were laboratory scanned in order to design and mill 40 ceramic crowns. The crowns were cemented on to the test metal dies with a self-adhesive resin luting cement. All crowns were thermocycled (2500 cycles) and mechanically loaded (250,000 cycles) in a chewing simulator followed by static loading until failure, and the values noted. The data were statistically analyzed by 2-way ANOVA and Tukey HSD post-hoc multiple comparison tests (α = 0.05). The mean fracture loads ranged from 1022 to 1322 N for nanoceramic crowns and from 1145 to 1441 N for the lithium disilicate crowns. Two-way ANOVA revealed insignificant differences between the nanoceramic and lithium disilicate crowns (p > 0.05) in terms of fracture load. Significant differences were noted in the fracture resistance of crowns based on occlusal thickness (303 N; p = 0.013) regardless of the material used. Multiple comparisons by Tukey HSD post-hoc test showed insignificant differences between the four material-occlusal thickness groups (p > 0.05). The nanoceramic crowns were found to be comparable with lithium disilicate crowns in terms of fracture load. The mean fracture loads of all of the tested crowns were within the normal physiological masticatory load limits. Based on the fracture-resistance results, nanoceramic crowns seem to be suitable for clinical use for the tested occlusal thicknesses.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL RELEVANCE

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

Effects of design software program and manufacturing method on the marginal and internal adaptation of esthetic crowns for primary teeth: A microcomputed tomography evaluation

STATEMENT OF PROBLEM

The adaptation of digitally produced crowns is affected by the design software program and manufacturing method. The effect of artificial intelligence (AI) software program design on the adaptation of the crowns is unclear and comparative evaluations should be documented.

PURPOSE

The purpose of this study was to assess the marginal and internal gaps, the absolute marginal discrepancies, and the 3-dimensional (3D) discrepancy volumes of the resin-based milled and 3D printed crowns for primary teeth designed with computer-aided design (CAD) and AI software programs by using microcomputed tomography (µCT).

MATERIAL AND METHODS

A total of 40 resin-based esthetic crowns were produced for a prepared typodont tooth (right mandibular primary second molar) according to the design software program (CAD and AI) and manufacturing method (milling and 3D printing) (n=10). Four experimental groups were generated as CAD-milled, CAD-3D printed, AI-milled, and AI-3D printed. The marginal, axial, and occlusal gap values, the absolute marginal discrepancies, and the 3D discrepancy volumes of the specimens were measured by using µCT. The data were analyzed by using 2-way ANOVA and the Tukey HSD tests (α=.05).

RESULTS

The lowest value for the marginal gap (54 ±43 µm) was observed in the CAD-milled group and the marginal gap value of the AI-3D printed group was significantly lower than the AI-milled group (P<.05). The lowest value for the axial gap (63 ±7 µm) was observed in the AI-3D printed group, and the highest value (145 ±58 µm) was observed in the CAD-milled group; the result for the occlusal gap value was opposite. The highest absolute marginal discrepancy value was observed in the CAD-milled group. The 3D discrepancy volumes increased in the order of the CAD-3D printed, AI-milled, CAD-milled, and AI-3D printed groups.

CONCLUSIONS

The marginal and internal gap values of the resin-based crowns were affected by the design software program and manufacturing method; however, tested groups showed clinically acceptable gap values.