3D Printing of Resin Material for Denture Artificial Teeth: Chipping and Indirect Tensile Fracture Resistance

In vitro evaluation of the mechanical and optical properties of 3D printed vs CAD/CAM milled denture teeth materials

This laboratory research aimed to assess the Flexural strength, fracture toughness, Volumetric wear and optical properties of various recent 3D-printed denture tooth materials and compare them to CAD/CAM milled materials. Four 3D-printed denture tooth materials (Lucitone Tooth, OnX, Flexcera Ultra +, and VarseoSmile Crown Plus) and one CAD/CAM milled denture teeth material (Ivotion Dent) were used to fabricate fifteen specimens for each material (with total no. of 300 specimens). Tests were conducted according to ISO standards to assess flexural strength, fracture toughness, color staining, and volumetric wear. All materials were printed, washed, cured, or milled following the manufacturer's instructions. Flexural strength and fracture toughness values were obtained by a universal testing machine. Volumetric wear was evaluated using a non-contact optical profilometer. Color stability outcomes were obtained via a spectrophotometer for determining L*a*b* values, with color change (ΔE2000) based on the CIEDE2000 formula. Data were analyzed using one-way ANOVA and Tukey post-hoc analysis (α = 0.05). All 3D-printed materials exhibited higher flexural strength values than the milled material (p < 0.05). For fracture toughness, two of the 3D-printed materials showed higher values than the milled material, while the other two had lower values. Insignificant variances in volumetric wear were detected between the materials (p > 0.05). Color staining results varied, with milled materials generally demonstrating better-staining resistance compared to the 3D-printed materials. 3D-printed denture tooth materials exhibit good mechanical and optical properties, presenting a cost-effective and efficient alternative to CAD/CAM milled materials for denture tooth fabrication.

Denture relining using digital replication method: A dental technique

The aim of this report was to digitize traditional denture relining using a digital duplication method, in addition to assessing the wear resistance of three-dimensional (3D) printed denture teeth. A complete denture was relined using light body impression. The denture with impression was scanned yielding a standard tessellation language file that was designed to print the denture base and teeth. The printed teeth were fitted into the sockets of the printed denture base and then bonded using auto-polymerized acrylic resins, followed by finishing and polishing. Dentures were inserted and fit and occlusion were adjusted as needed, and the patient was scheduled for follow-up appointments at one week, three months, and six months. At each follow-up visit, dentures were scanned using a 3Shape E3 desktop scanner and scans were superimposed. The occlusal wear was assessed in reference to the first scan after the denture insertion visit. The accuracy of the intaglio surface of dentures was within clinically acceptable limits. The clinical evaluation of inserted dentures in terms of retention, occlusion, esthetic, and patient satisfaction was encouraging. Using digital duplication, conventional dentures could be relined. The advantages of digital records include eliminating polymerization dimensional changes, and reducing cost and clinical time by minimizing the number of visits, which is particularly helpful with geriatric patients.

Mechanical properties of 3D-printed resin denture teeth: An in vitro study

PURPOSE

The purpose of this study was to compare the wear, fracture strength, and mode of failure of various brands of 3D-printed resin denture teeth with prefabricated acrylic resin. Additionally, the study aimed to analyze the different modes of failure exhibited by these teeth.

MATERIALS AND METHODS

The study utilized 90 3D-printed and 30 prefabricated, 3D-printed resin teeth from three brands: L = Optiprint Lumina, A = ASIGA DentaTooth, P = Power resins, along with prefabricated acrylic teeth from M = Major Super Lux. Each of the 30 samples per main group was divided into two subgroups: The first subgroup samples (M1, A1, L1, P1) were subjected to thermal cycling and mechanical loading; M2, A2, L2, and P2 were not aged and tested directly. A scan of a prefabricated acrylic tooth was taken using an intraoral scanner, and then the STL file was printed using an Asiga 3Dprinter. The specimens underwent aging to simulate 5 years of clinical use with 10,000 thermal cycles and 1,200,000 dynamic load cycles on a chewing simulator. Surface roughness parameters (Rz, Ra, Rq) were measured using a 3D Optical Profilometer, fracture resistance was assessed using a universal testing machine, and SEM analysis was performed to observe failure modes. Statistical analysis using T-test, one-way analysis, and two-way analysis processed by the Statistical Package for Social Sciences (SPSS) software version 23.0 (SPSS: Inc., Chicago, IL, USA) was done with a level of significance set at <0.05.

RESULTS

The results showed that the difference in surface roughness parameters (Rz, Ra, Rq) before and after aging for Group M, Group A, Group L, and Group P was statistically significant (p < 0.05). Two-way ANOVA for wear resistance between aging and groups on dependent variable Rz (p = 0.002), Ra (p = 0.001), Rq (p = 0.001) were significant. Multiple comparisons for surface roughness parameters showed Group A and Group L were lower than Group P and Group M (p < 0.05). For fracture strength, One-way ANOVA showed a significant difference between groups for fracture strength either without or after the aging procedure (p < 0.05). Multiple comparisons for fracture strength without aging showed no significant difference between Group M, Group A, and Group L (p > 0.05). After the aging procedure fracture strength for Group M was higher than Group A, Group L, and Group P (p < 0.05).

CONCLUSION

3D-printed resin teeth showed a greater and comparable wear resistance to prefabricated acrylic teeth. Fracture strength was comparable between prefabricated acrylic teeth and 3D-printed resin (Asiga and Lumina) before aging, but after aging 3D-printed resin teeth showed less fracture strength.

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.

Effects of aging on attachment of Candida albicans to conventional heat-polymerized, CAD-CAM milled, and CAD-CAM 3D-printed acrylic resin bases

PURPOSE

The aim of this study was to assess Candida albicans attachment on conventionally fabricated (polymethylmethacrylate, PMMA), CAD-CAM milled, and 3D-printed acrylic resin bases pre- and post-simulated thermal aging, along with examining material surface changes after aging.

MATERIALS AND METHODS

Forty-six samples (10 mm × 10 mm × 2 mm) for each of four material groups (conventional heat-polymerized PMMA, CAD-CAM milled acrylic resin base, CAD-CAM 3D-printed methacrylate resin base, CAD-CAM 3D-printed urethane methacrylate resin base) were subjected to 0, 1, or 2 years of simulated thermal aging. Microscopic images were taken before and after aging, and C. albicans attachment was quantified using cell proliferation assay (XTT). Statistical analysis employed analysis of variance (α = 0.05).

RESULTS

Two-way factorial analysis showed no significant differences based on acrylic resin type or thermal aging (p = 0.344 and p = 0.091 respectively). However, C. albicans attachment significantly differed between 0- and 2-year thermally aged groups (p = 0.004), mainly due to elevated initial attachments on CAD-CAM milled acrylic resin base and CAD-CAM 3D-printed urethane methacrylate resin base.

CONCLUSIONS

Regardless of the fabrication technique and material combination, no significant differences were found in C. albicans adhesion pre- or post- thermal aging. Milled and 3D-printed bases compared favorably with heat- polymerized PMMA in their affinity for C. albicans attachment and surface characteristics after aging. These findings indicate that the risk of patients developing denture stomatitis might not be linked to the type of acrylic resin or fabrication method used.

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.

Effects of various disinfectants on surface roughness and color stability of thermoset and 3D-printed acrylic resin

Denture cleansers are extensively utilized to inhibit the colonization of various Candida species. Currently, additive technology in denture fabrication has become more prevalent. This study aims to assess the impact of disinfectants on the surface roughness and color stability of distinct denture bases. Disc-shaped samples (N=66) were exposed to three different disinfectants: 0.5% sodium hypochlorite, 1% hydrogen peroxide, and 2% chlorhexidine. The samples underwent evaluation via spectrophotometry and profilometry, respectively. Data analysis was conducted utilizing analysis of variance (ANOVA) (p < 0.05). Within the heat-cured group, sodium hypochlorite resulted in the most notable change in surface roughness (0.2 μm), while chlorhexidine exhibited the least impact (0.001 μm), showing a significant difference (p <0.008). The color change (ΔE) for 3D-printed samples immersed in all disinfectants was higher compared to heat-cured samples. Among the heat-cured samples, chlorhexidine induced the highest ΔE (2.76), while sodium hypochlorite resulted in the lowest (ΔE = 1.44), and this difference was statistically significant (p <0.008). Chlorhexidine caused the most significant color alteration among the solutions, while sodium hypochlorite induced the most considerable changes in surface roughness.

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.

A comparison of the shear bond strength between denture teeth and denture base resins manufactured either conventionally or with a 3D printer

STATEMENT OF PROBLEM

Limited information is available on the shear bond strength (SBS) between denture teeth and denture base resins fabricated using a stereolithography (SLA) 3-dimensional (3D) printer.

PURPOSE

The purpose of this in vitro study was to evaluate the SBS between denture teeth and the denture base resins produced with the conventional method and with a 3D printer.

MATERIAL AND METHODS

Conventional or 3D printed denture teeth were included in the study. The denture base resins were manufactured either conventionally or with a 3D printer. Four subgroups were tested: conventional teeth-conventional base resin (CT-CB), conventional teeth-printed base resin (CT-PB), printed teeth-conventional base resin (PT-CB), and printed teeth-printed base resin (PT-PB). The maxillary molars were combined with Ø5×2.5-mm-cylindrical denture base resin. Shear bond testing was performed by applying a parallel force to the denture teeth-denture base resin interface by using a blade-edge chisel with a crosshead speed of 1 mm/min until failure occurred. SBS and elastic modulus (EM) were recorded. One-way ANOVA followed by the Dunnett T3 post hoc test was used for the statistical analysis (α=.05). The failure modes of the specimens were also analyzed.

RESULTS

A statistically significant difference (P<.05) was found between the evaluated groups for the SBS and EM values. PT-PB showed the highest SBS value (15.4 ±2.7 MPa), and CT-PB showed the lowest (0.9 ±0.7 MPa). The PT-CB group showed the highest EM value (62.74 ±20.80 GPa), and the CT-PB group showed the lowest (29.46 ±28.40 GPa). The CT-CB and CT-PB specimens showed mostly adhesive failure; none of the PT-PB specimens showed adhesive failure.

CONCLUSIONS

Three-dimensional printing led to a better bond between the denture teeth and the denture base resin compared with the conventional method. Although these findings need to be supported by clinical studies, the use of 3D printers is appropriate in the production of denture teeth and denture bases.

Effect of artificial aging on mechanical and physical properties of CAD-CAM PMMA resins for occlusal splints

PURPOSE

This study aimed to assess and compare the color stability, flexural strength (FS), and surface roughness of occlusal splints fabricated from heat-cured acrylic resin, milled polymethyl methacrylate (PMMA)-based resin, and 3D-printed (PMMA) based-resin.

MATERIALS AND METHODS

Samples of each type of resin were obtained, and baseline measurements of color and surface roughness were recorded. The specimens were divided into three groups (n = 10) and subjected to distinct aging protocols: thermomechanical cycling (TMC), simulated brushing (SB), and control (without aging). Final assessments of color and surface roughness and three-point bending test (ODM100; Odeme) were conducted, and data were statistically analyzed (2-way ANOVA, Tukey, P <.05).

RESULTS

Across all resin types, the most significant increase in surface roughness (Ra) was observed after TMC (P < .05), with the 3D-printed resin exhibiting the lowest Ra (P < .05). After brushing, milled resin displayed the highest Ra (P < .05) and greater color alteration (ΔE00) compared to 3D-printed resin. The most substantial ΔE00 was recorded after brushing for all resins, except for heat-cured resin subjected to TMC. Regardless of aging, milled resin exhibited the highest FS (P < .05), except when compared to 3D-printed resin subjected to TMC. Heat-cured resin exposed to TMC demonstrated the lowest FS, different (P < .05) from the control. Under control conditions, milled resin exhibited the highest FS, different (P < .05) from the brushed group. 3D-printed resin subjected to TMC displayed the highest FS (P < .05).

CONCLUSION

Among the tested resins, 3D-printed resin demonstrated superior longevity, characterized by minimal surface roughness and color alterations. Aging had a negligible impact on its mechanical properties.

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.

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.

Wear and Fracture Resistance of 3D-Printed Denture Teeth: An In Vitro Comparative Study

PURPOSE

The longevity of removable prostheses is mostly influenced by the properties of the used materials. The ability of the material to withstand high occlusal loads without deformation can enhance patient satisfaction and quality of life. This in vitro study aimed to investigate the wear and fracture resistance of three-dimensional (3D)-printed teeth compared with commercially available acrylic resin teeth.

MATERIALS AND METHODS

A total of 40 prefabricated acrylic teeth and 40 3D-printed teeth were prepared in two forms: anatomical for fracture resistance or flat for wear resistance (n = 10). For wear evaluation, specimens were scanned at baseline and then subjected to thermal cycling (10,000 cycles). This was followed by a chewing simulator (60,000 cycles) against either metal or natural tooth. Then, the specimens were scanned again. Wear analysis was performed by superimposing the standard tessellation language (STL) files from baseline and the final scans with the aid of GOM Inspect 2020 software. Fracture resistance was assessed with a universal testing machine at a crosshead speed of 0.5 mm/min before and after thermal cycling. Data were analyzed with two-independent t-test and two-way ANOVA (α = 0.05).

RESULTS

The 3D-printed teeth showed significantly lower wear resistance than the prefabricated ones with both antagonists (metal, p = 0.049; natural tooth, p = 0.021). The fracture resistance of the 3D-printed teeth was significantly higher than that of the prefabricated teeth before thermocycling (p = 0.042). After thermal cycling, the fracture resistance of both groups was decreased with no significant differences between them (p = 0.266).

CONCLUSIONS

The 3D-printed teeth showed lower wear resistance and higher fracture resistance than the prefabricated ones. Thermal cycling negatively affected the fracture resistance of 3D-printed teeth.

Efficacy of Denture Cleansers on Microbial Adherence and Surface Topography of Conventional and CAD/CAM-Processed Denture Base Resins

This study assessed the efficacy of five denture cleansers on the microbial adherence and surface topography of conventional and CAD/CAM denture base resins. Acrylic resin discs were fabricated using conventional, milling, and 3D printing methods (N = 180). The discs were contaminated with dual species of Candida albicans and Streptococcus mutans biofilm for 72 h and then disinfected with either of the denture cleansers (Fittydent cleansing tablets, 2% Chlorhexidine gluconate, 0.2% Chlorhexidine gluconate, 0.5% sodium hypochlorite, and 1% sodium hypochlorite (n = 10). Distilled water served as the control group. The colony-forming units of the microorganisms were calculated, followed by post-treatment surface roughness. Data were statistically analyzed using one-way ANOVA, paired t-test, and post hoc Tukey HSD test (α = 0.05). Among the denture cleansers, 2% Chlorhexidine gluconate, 0.5% sodium hypochlorite, and 1% sodium hypochlorite had the best cleansing effect on the resin discs and demonstrated zero growth of colonies for both the species. Comparing the material groups, the 3D-processed discs showed higher colony-forming units followed by the conventional and CAD/CAM milled group. The highest surface roughness was demonstrated by the 3D-printed discs (0.690 ± 0.08 μm), followed by the conventional (0.493 ± 0.11 μm) and the milled groups (0.301 ± 0.08 μm). The tested chemical denture cleansers affected the Candida albicans and Streptococcus mutans adhesion compared to control discs immersed in distilled water. The clinician may recommend to their patient to use 2% chlorhexidine gluconate for the disinfection of CAD/CAM PMMA denture base materials.

Fracture toughness of 3D printed denture teeth

BACKGROUND

Advances in digital dentistry lead to use of three-dimensional (3D) printed resin denture teeth. Fracture toughness of these teeth must be assessed.

OBJECTIVE

This study aimed to compare the chipping and indirect tensile fracture resistance of denture teeth fabricated by 3D printing technique with traditionally fabricated resin denture teeth.

METHOD

Four groups (Gr) were made (n= 50/group): Gr-1 3D printed denture teeth (denture teeth; Formlabs Inc., Somerville, MA, USA), Gr-2 SR-Orthosit-PE (Ivoclar Vivadent AG), Gr-3 Portrait IPN (Dentsply Sirona), Gr-4 Pala Premium 8 (Heraeus Kulzer GmbH). Stereolithography 3D printing was used to create the methacrylate-based photopolymerized resin teeth models and remaining group teeth were collected commercially. A 1 mm/min chipping and indirect tensile fracture speed tests were carried out till fracture occurred. The data so obtained were statistically analysed using one-way analysis of variance with Tukey's honestly significant difference multiple comparisons test (p< 0.05). At the end of the test, the fractured areas of the specimens were evaluated by the chief researcher to assess the fracture pattern of the teeth.

RESULTS

The indirect tensile fracture values of the 3D printed teeth were more than that of Pala Premium-8 and SR-Orthosit-PE but it was lower than that of Portrait IPN teeth. In chipping test, buccal chipping of the loaded cusp was seen in 3D printed resin without distortion and in indirect tensile test in 3D printed resin teeth, line of fracture emerges near the loading point propagates from the inner incline of both cusps and extends cervically, unlike in other groups where first deformation occurs then fracture.

CONCLUSION

Prosthetic teeth fabricated by the 3D printing technique using printable resin material provide adequate fracture resistance as denture teeth.

2D and 3D Wear Analysis of 3D Printed and Prefabricated Artificial Teeth

PURPOSE

This study aimed to assess the 3-body wear of prefabricated and 3D-printed artificial denture teeth.

MATERIALS AND METHODS

Four groups of artificial teeth were used; 3D-printed polymethylmethacrylate (PMMA) teeth (PR) and 3 prefabricated commercially available denture teeth: PMMA (Gnathostar, GN), PMMA (SR Orthotyp PE, SR), and Nanohybrid composite (SR Phonares NHC, PH). The 3-body wear test was performed using a steatite ceramic antagonist in a chewing simulator with 750,000 cycles, temperature 23 ± 2 ˚C, and force of 50 N. The abrasive medium was composed of ground millet seeds and white rice mixed with distilled water. The teeth were 3D-scanned before and after the wear test. The 3D images were assessed for teeth wear by measuring the volumetric (3D wear) and the vertical (2D wear) substance loss. The one-way analysis of variance followed by Tukey post hoc test was used to statistically obtain the data analysis.

RESULTS

Maximum 3D wear was observed in the PR (51.05 ± 4.53 mm³), followed by GN (20.22 ± 6.29 mm³) and SR (12.12 ± 6.29 mm³) artificial teeth. Minimum wear occurred in the PH teeth (6.24 ± 0.87 mm³). The analytical differences amongst the groups were statistically significant (P < .05) except between PH and SR teeth. For 2D wear measurement, the maximum was seen in the GN teeth (6.29 ± 1.64 mm), followed by PR (5.04 ± 0.83 mm) and then SR (4.53 ± 0.87 mm). The PH teeth (3.09 ± 0.68 mm) again showed minimum wear. Statistically, amongst the groups, the major observable differences (P < .05) were between PH and GN, PH and PR, and SR and GN.

CONCLUSIONS

Composite resin teeth had a greater wear resistance than acrylic resin teeth and 3D-printed resin teeth, both of which were comparable. Due to the advancement of digital workflows, manufacturers should devote effort to enhancing 3D-printed teeth.

Silver-loaded mesoporous silica nanoparticles enhanced the mechanical and antimicrobial properties of 3D printed denture base resin

The aim of this study is to develop a novel 3D printed denture base resin material modified with mesoporous silica nanocarrier loaded with silver (Ag/MSN) to enhance mechanical and antimicrobial properties. Acrylate resin-based was incorporated with various proportion of Ag/MSN (0.0-2.0 wt%). Specimens with different geometry were printed and characterized accordingly for the effect of modification on properties such as: mechanical and physical properties, chemical composition and degree of conversion, as well as biological response in term of biocompatibility and antimicrobial against oral fibroblast and candida biofilm (C. albicans), respectively. The consecutive addition of Ag/MSN improved significantly surface hardness and crack propagation resistance, while flexural strength remained similar to control; however, a negligible decrease was observed with higher concentrations ≥1 wt%. No significant difference was noticed with water sorption, while water solubility had a remarkable trend of reduction associated with filler content. The surface roughness significantly increased when concentration of Ag/MSN was ≥1.0 wt%. A significant reduction in C. albicans biofilm mass, as the inhibition proficiency was correlated with the proportion of the filler. With respect to the amount of Ag/MSN, the modification was compatible toward fibroblast cells. The sequential addition of Ag/MSN enhanced significantly the mechanical and antimicrobial properties of the 3D printed resin-based material without affecting adversely compatibility. The acrylic resin denture base material has susceptibility of microbial adhesion which limits its application. Silver loaded MSN showed a significant performance to enhance antimicrobial activity against C. albicans which is the main cause of denture stomatitis. The proposed invention is a promise technique for clinical application to provide an advanced prosthesis fabrication and serve as long-term drug delivery.

Colour Stability of 3D-Printed and Prefabricated Denture Teeth after Immersion in Different Colouring Agents-An In Vitro Study

This study investigated the colour stability of three dimensional (3D)-printed and conventional denture teeth after immersion in different colourants. A total of 60 artificial maxillary central incisors were selected from three types of materials: 3D-printed dental resin (NextDent, 3D Systems, Soesterberg, The Netherlands), prefabricated acrylic teeth in Ivostar Shade (Ivoclar Vivadent, Schaan, Liechtenstein), and SpofaDent Plus in shade A2 (SpofaDental, Jičín, Czechia). These were immersed in four types of colourants at room temperature (23 °C ± 1 °C), including artificial saliva (pH = 6.8) as a control group, coffee, red wine, and Coca-Cola (n = 5). The temperature and the pH of the colouring agents were maintained throughout all immersion periods. After 7 days (T1), 14 days (T2), and 21 days (T3), the ∆E values were measured with a SpectroShade Micro (SpectroShade, Oxnard, CA, USA) spectrophotometer. Their means were then calculated and compared by two-way ANOVA. The independent factors, immersion time and different staining solutions, as well as the interaction between these factors, significantly influenced ΔE. The highest and the lowest mean ∆Es were recorded for prefabricated teeth in red wine, and 3D-printed teeth in artificial saliva, respectively. All the specimens demonstrated an increased colour change at T1 compared to T3, and the difference in mean ∆E was statistically significant.

Evaluation of Shear Bond Strength Between Denture Teeth and 3D-Printed Denture Base Resin

PURPOSE

The aim of this study was to evaluate the bond strength between two types of artificial teeth with a 3D-printed denture base resin using different bonding agents.

MATERIALS & METHODS

Two types of artificial teeth were evaluated: 3D-printed (Cosmos TEMP) and prefabricated polymethylmethacrylate (Biotone) bonded to cylinders (2.5 mm in height and 5 mm in diameter) of 3D-printed denture bases (Cosmos Denture designing by Meshmixer and printed by Flashforge Hunter DLP Resin 3D Printer). Two combinations between denture base and artificial teeth were eveluated: Cosmos Denture - Biotone, n = 30, and Cosmos Denture - Cosmos TEMP, n = 30. For each combination, the specimens were randomly distributed according to the bonding agent: 1. autopolymerized acrylic resin-Duralay, n = 10; 2. 3D-printed resin Cosmos TEMP, n = 10; and 3. methylmethacrylate monomer (MMA) + 3D-printed resin Cosmos TEMP, n = 10, totaling 60 specimens. The application of MMA was done conditioning the tooth surface for 180 seconds; the other agents were applied on the same surface. The virtual design of the 3D-printed resin teeth was obtained by scanning the first maxillary molar of the prefabricated teeth as the same protocol of cylinders. The control group (n = 10) was a conventional heat-polymerized denture base resin (Lucitone 550) bonded to the prefabricated resin teeth (Biotone). The shear bond tests were performed by applying a perpendicular force to the artificial tooth - denture base resin, through a chisel at 1mm / min until failure. Two-way ANOVA and Bonferroni post hoc tests (α = 0.05) were used for multiple comparisons.

RESULTS

For the Biotone tooth, the bond strength was significantly higher using MMA + Cosmos TEMP (10.04 MPa), and similar to the control (11.84 MPa, p = 0.484). For the 3D-printed tooth (Cosmos TEMP), the bond strength using the agents Cosmos TEMP (9.57 MPa) and MMA + Cosmos TEMP (12.72 MPa) were similar to the control (11.84 MPa, p = 0.169 and p = 1, respectively), but different from each other (p = 0.016).

CONCLUSIONS

From the results, it is recommended to use: MMA + Cosmos TEMP bonding agent for the Biotone tooth; and Cosmos TEMP or MMA + Cosmos TEMP bonding agents for the Cosmos TEMP tooth, both attached to the 3D-printed denture resin Cosmos Denture. This article is protected by copyright. All rights reserved.

Noncovalent reversible binding-enabled facile fabrication of leak-free PDMS microfluidic devices without plasma treatment for convenient cell loading and retrieval

The conventional approach for fabricating polydimethylsiloxane (PDMS) microfluidic devices is a lengthy and inconvenient procedure and may require a clean-room microfabrication facility often not readily available. Furthermore, living cells can't survive the oxygen-plasma and high-temperature-baking treatments required for covalent bonding to assemble multiple PDMS parts into a leak-free device, and it is difficult to disassemble the devices because of the irreversible covalent bonding. As a result, seeding/loading cells into and retrieving cells from the devices are challenging. Here, we discovered that decreasing the curing agent for crosslinking the PDMS prepolymer increases the noncovalent binding energy of the resultant PDMS surfaces without plasma or any other treatment. This enables convenient fabrication of leak-free microfluidic devices by noncovalent binding for various biomedical applications that require high pressure/flow rates and/or long-term cell culture, by simply hand-pressing the PDMS parts without plasma or any other treatment to bind/assemble. With this method, multiple types of cells can be conveniently loaded into specific areas of the PDMS parts before assembly and due to the reversible nature of the noncovalent bonding, the assembled device can be easily disassembled by hand peeling for retrieving cells. Combining with 3D printers that are widely available for making masters to eliminate the need of photolithography, this facile yet rigorous fabrication approach is much faster and more convenient for making PDMS microfluidic devices than the conventional oxygen plasma-baking-based irreversible covalent bonding method.

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The stability of noncovalent PDMS-PDMS binding is dependent on the binding energy instead of the binding strength.

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The noncovalent binding of a special formulation of PDMS is sufficient for reversible assembly of leak-free microfluidic devices.

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The noncovalent binding method enables loading multiple types of cells into PDMS parts before assembling into the final device.

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The PDMS device can be easily dissembled due to the reversible nature of the noncovalent binding for retrieving cells.

Utilization of a 3D Printed Orthodontic Distalizer for Tooth-Borne Hybrid Treatment in Class II Unilateral Malocclusions

This paper introduces a novel method of 3D designing and 3D printing of a hybrid orthodontic tooth-borne personalized distalizer for treatment of unilateral Class II malocclusion. Research objectives were to clinically utilize 3D printed distalizers, appraise feasibility of this technique and compare two different biocompatible photopolymers (white and transparent). Frequency of distalizers’ debonding and patients’ aesthetical perception was evaluated on the set of 12 complete orthodontic treatments. The mean duration of treatment period with a bonded distalizer was 6.4 months. All cases were adults with unilateral Class II malocclusion managed with a hybrid approach as a part of Invisalign® comprehensive treatment. Results showed that such perspective practice is feasible for 3D design and in-office 3D printing of a personalized distalizer. Results also showed no clinically significant differences between both studied biopolymers. The paper discusses an evaluation of such personalized distalizer functionality with regard to the current state of the art and compares to conventional prefabricated alternatives like a Carriere® Distalizer™ appliance. Research showed a preference of patients towards transparent biocompatible photopolymer instead of the white A2 shade. The paper concludes that additive manufacturing from dental resins is a viable method in personalization and in-office 3D printing of orthodontic auxiliaries, particularly distalizers. New materials for orthodontic 3D printing endow enhanced individualization, thus more efficient treatment.

Mechanical Properties, Cytotoxicity, and Fluoride Ion Release Capacity of Bioactive Glass-Modified Methacrylate Resin Used in Three-Dimensional Printing Technology

Background: Clinically, three-dimensional (3D) printing technology is becoming a popular and efficient dental processing technology. Recently, there has been an increasing demand for dental materials that exhibit bioactive properties. The present study aimed to evaluate the mechanical properties, cytotoxicity, and fluoride ion release capacity of 3D-printed dental resins modified with bioactive glass. Materials and methods: The resin FotoDent splint used in the production of removable orthodontic splints, was modified by the addition of two types of bioactive glasses that are capable of releasing fluoride ions. The novel materials used for the production of dental splints were examined for their mechanical, physical, and biological properties (fracture resistance, sorption, solubility, elution of nonpolymeric substances, and release of fluoride ions over time) and cytotoxic effects on cell cultures. Results: Initially, the fracture toughness of the 3D-printed resin was found to be 55 MPa, but after modification with glass, the resistance was reduced to about 50 MPa. Sorption and solubility values of the materials (19.01 ÷ 21.23 µg/mm³ and 0.42 ÷ 1.12 µg/mm³, respectively) complied with the safety limits imposed by ISO standard. Modified resins were capable of releasing fluoride ions, and the maximum releasing effect was observed after 14 days of incubation. Both the modified resins, after four days of contact with human gingival fibroblasts, exhibited moderate cytotoxic properties. Conclusions: The experimental results showed that modification of methacrylate resin, used in 3D printing technology, with bioactive glasses produces novel dental materials that possess desirable bioactive properties. The findings of this study indicate the potential ability of modified polymethacrylate resins to release fluoride ions in the oral cavity environment. The modified materials are characterized with a moderate decrease in physical properties and mild cytotoxicity on direct contact with human fibroblasts.

Patient satisfaction with conventional dentures vs. digital dentures fabricated using 3D-printing: A randomized crossover trial

PURPOSE

Evidence regarding the performance of digital dentures (DDs) fabricated using 3D printing is insufficient. This study aimed to evaluate patient satisfaction with conventional dentures (CDs) and DDs fabricated using 3D printing.

METHODS

This randomized controlled trial was conducted between November 2017 and May 2020. In the CD-DD group, CDs were fabricated before DDs, while the protocol was reversed in the DD-CD group. The primary outcome was patient satisfaction, quantified using a 100-mm visual analog scale, which assessed chewing efficiency, pain, stability, retention, comfort, esthetics, ease of cleaning, phonetics, and general satisfaction. Secondary outcomes were quality of life (QOL), number of visits, time required for definitive denture fabrication, number of adjustment appointments, and time required for denture stabilization after denture delivery.

RESULTS

Patient satisfaction with CDs was superior in terms of phonetics, ease of cleaning, stability, comfort, and general satisfaction. Secondary outcomes such as social disability and the number of clinic visits were significantly lower in patients with DDs. However, the two groups showed no significant differences in the other outcomes. Although patient satisfaction with DDs was inferior to that with CDs, 20% of patients preferred and used DDs (12 patients preferred CDs, and three patients opted for DDs).

CONCLUSION

Although patient satisfaction or QOL with DDs may be somewhat inferior to that with CDs, 20% of patients preferred and used DDs daily. Thus, DDs fabricated using 3D printing may have comparable practicality and efficacy to CDs.

A Novel Low-Shrinkage Resin for 3D Printing

OBJECTIVE

To evaluate the shrinkage, accuracy, and mechanical properties of a newly developed photo-polymerizable resin material for 3D printing dental applications and compare it with three commercially available resins.

METHODS

An experimental novel proprietary resin material for 3D printing was formulated. This new resin, Die and Model Tan (SprintRay), Formlabs Grey (FormLabs), and LCD Grey (Roxel 3D) were evaluated and tested for volumetric shrinkage, accuracy, and flexural and tensile properties. Volumetric shrinkage was measured using the AcuVol video imaging method. The accuracy of the 3D printed objects through the DLP (digital light processing) printing system was determined by the 3D deviation between the scanned model and the original CAD digital model. Parallelepiped specimens (2 × 2 × 25 mm, n= 5) were printed for flexural strength, flexural modulus, and modulus of resilience and measured in accordance with ISO-4049. Dumbbell-shaped specimens (Type V, n = 5) were printed to investigate the tensile strength and tested according to ASTM-D638. Data were analyzed using one-way ANOVA and post-hoc Tukey tests (p≤0.05).

RESULTS

The experimental resin exhibited significantly lower volumetric shrinkage and significantly higher accuracy than the other commercially available resins (p < 0.001). The experimental resin showed flexural strength, flexural modulus, and tensile strength similar to Die and Model Tan resin (SprintRay) (p > 0.05), and these parameters were significantly higher than those of Formlabs Grey resin (Formlabs) and lower than those of LCD Gray resin (Roxel3D)(p <0.001).

CONCLUSION

The newly formulated 3D printing resin demonstrated lower volumetric shrinkage, high accuracy, and adequate mechanical properties compared to the commercially available resin materials.

CLINICAL SIGNIFICANCE

The new 3D printed objects exhibited higher accuracy, good stability over time, and adequate mechanical properties. The new 3D printing resin is a good candidate for modeling applications for restoration, orthodontics and implants.

Comparative Effect of Different Surface Treatments on the Shear Bond Strength of Two Types of Artificial Teeth Bonded To Two Types of Denture Base Resins

PURPOSE

This in vitro study aims to assess the impact of various surface treatments on the shear bond strength (SBS) of two types of artificial teeth and denture base resins (DBRs).

MATERIALS AND METHODS

Two types of DBRs (CAD/CAM-milled and heat-polymerized) and two types of denture teeth (acrylic and composite) were investigated. Teeth were cut into slices (5 × 5 × 2 mm) and divided according to surface treatment into four subgroups (n = 10): no treatment (control), air abrasion (Alumina-blasting; AB), bur roughening, and dichloromethane (DCM) subgroups. According to manufacturer recommendations, the treated tooth slices were bonded to the acrylic disk of DBRs. The SBS test was performed using a universal testing machine. ANOVA was used for results analysis followed by Tukey's post hoc tests (α = 0.05).

RESULTS

DCM and AB increased the SBS of acrylic teeth to heat-polymerized DBR compared with other groups (p < 0.001). All surface treatments showed no significant difference in CAD/CAM DBR with acrylic teeth (p = 0.059; AB, p = 0.319; bur roughening, p = 0.895; DCM), while there was a significant decrease in SBS with composite teeth (p ˂ 0.001). Between teeth, acrylic teeth showed a statistically significant increase in SBS compared to composite teeth (p < 0.001).

CONCLUSION

AB and DCM application improved the SBS for acrylic teeth with the heat-polymerized DBR when compared with the untreated group, but none of the surface treatment agents showed significant improvement with CAD/CAM DBR. All surface treatment agents reduced the SBS for composite teeth with CAD/CAM DBR while AB only increased the SBS with heat-polymerized DBR.

Color stability of 3D-printed denture resins: effect of aging, mechanical brushing and immersion in staining medium

PURPOSE

This in-vitro study evaluated and compared the color stability of 3D-printed and conventional heat-polymerized acrylic resins following aging, mechanical brushing, and immersion in staining medium.

MATERIALS AND METHODS

Forty disc-shaped specimens (10 mm in diameter and 3 mm thick) were prepared from two 3D-printed [DentaBASE (DB) and Denture 3D+ (D3D)] and one conventional polymethylmethacrylate (PMMA) denture materials. The specimens were thermo-cycled, subjected to mechanical brushing, and were immersed in either coffee, lemon juice, coke, or artificial saliva (AS) to simulate one and two years of oral use. Color measurements of the specimens were recorded by a spectrophotometer at baseline (T0), and after one (T1) and two years (T2) of simulation. The color changes (∆E) were determined and also quantified according to the National Bureau of Standards (NBS) units. Descriptive statistics, followed by factorial ANOVA and Bonferroni post-hoc test (α=.05), were applied for data analysis.

RESULTS

The independent factors, namely material, staining medium, and immersion time, and interaction among these factors significantly influenced ∆E (P<.009). Irrespective of the materials, treatments, and time, the highest and the lowest mean ∆Es were observed for PMMA in lemon juice (4.58 ± 1.30) and DB in AS (0.41 ± 0.18), respectively. Regarding the material type, PMMA demonstrated the highest mean ∆E (2.31 ± 1.37), followed by D3D (1.67 ± 0.66), and DB (0.85 ± 0.52), and the difference in ∆E between the materials were statistically significant (P<.001). All the specimens demonstrated a decreased color changes at T2 compared to T1, and this difference in mean ∆E was statistically significant (P<.001).

CONCLUSION

The color changes of 3D-printed denture resins were low compared to conventional heat polymerized PMMA. All the tested materials, irrespective of the staining medium used, demonstrated a significant decrease in ∆E values over time.

Digitally Fabricated Removable Complete Denture Clinical Workflows using Additive Manufacturing Techniques

The use of computer aided design and computer aided manufacturing in the fabrication of complete removable dentures has demonstrated that the prostheses produced are superior in many ways to removable dentures produced using analog techniques. A variety of clinical workflows that take advantage of digital technology have been shown to shorten the number of appointments required to produce high quality prostheses. This paper presents an overview of additive manufacturing in contemporary removable complete denture workflows and describes effective three appointment clinical techniques using additive manufacturing to produce a clinical trial denture and definitive prosthesis.

Printable PICN Composite Mechanically Compatible with Human Teeth

Polymer-infiltrated ceramic network (PICN) composites are mechanically compatible with human enamel, and are therefore promising dental restorative materials. Fabrication technology for PICN composites used in tooth restorative material has been established through computer-aided design/computer-aided manufacturing (CAD/CAM) milling, however, to date, has not been successfully developed using 3-dimensional (3D) printing. This study aimed to develop a 3D-printable PICN composite as a restorative material. The PICN composite was fabricated using a specific method based on 3D printing. A 3D-printable precursor slurry containing a high concentration of silica nanoparticles was produced and 3D-printed using stereolithography (SLA). The 3D-printed object was sintered to obtain a nano-porous object, and subsequently infiltrated and polymerized with resin monomer. Three different fabrication condition combinations were used to produce the 3D-printed PICN composites, which were characterized based on microstructure, mechanical properties, inorganic content, physicochemical properties, and overall shrinkage. The 3D-printed PICN composites were also compared to 2 commercially available CAD/CAM composite blocks, namely a PICN composite and a dispersed-filler composite. The 3D-printed PICN composites exhibited a nano-sized dual-network structure comprising a silica skeleton with infiltrated resin. The 3D-printed PICN composite exhibited a similar Vickers hardness to enamel, and a similar elastic modulus to dentin. The 3D-printed PICN composite exhibited comparable flexural strength (>100 MPa) to the CAD/CAM block, and acceptable water sorption and solubility for practical use. Further, the 3D-printed model-crown underwent isotropic shrinkage during sintering without fatal deformation. Overall, the potential of this 3D-printable PICN composite as a restorative material with similar mechanical properties to human teeth was successfully demonstrated.

Accuracy of 3D printing compared with milling - A multi-center analysis of try-in dentures

OBJECTIVES

In recent years, computer-aided design/computer-aided manufacturing (CAD/CAM) has been used to produce removable complete dentures. Most workflows include fabrication of milled or 3D-printed try-in prostheses. 3D-printing accuracy is affected by laboratory-specific and operator-dependent factors. This international five-center study sought to compare the accuracy of 3D-printed and milled try-in dentures.

METHODS

The construction file of a maxillary removable complete denture was selected as a reference. Eight try-in dentures were 3D printed at each of the five centers. Each center used their own printer (Objet260 Connex, Stratasys; MAX, Asiga; Anycubic Photon, Anycubic 3D; PRO2, Asiga and cara Print 4.0, Kulzer) along with their own material, printing settings, post-processing and light-curing parameters. At center 2, eight try-in dentures were milled to serve as a benchmark (PrograMill PM7, Ivoclar Vivadent). Dentures were scanned and aligned to the reference file using best-fit algorithms. Geometric accuracy was analyzed using the root mean square value (trueness) and standard deviation (precision) of the distributed absolute mesh deviations. Mean values of the five sets of printed dentures and the single set of milled dentures were compared.

RESULTS

Milled dentures showed a mean trueness of 65 ± 6 μm and a mean precision of 48 ± 5 μm. Thus, they were significantly more accurate than the 3D-printed dentures in four out of five centers. In mean absolute numbers, 3D printing was less true than milling by 17-89 μm and less precise by 8-66 μm.

CONCLUSIONS

Although milling remains the benchmark technique for accuracy, differences between milled and 3D-printed dentures were non-significant for one printing center. Furthermore, the overall performance of 3D printing at all centers was within a clinically acceptable range for try-in prostheses.

CLINICAL SIGNIFICANCE

The accuracy of 3D printing varies widely between and within laboratories but nonetheless lies within the range of accuracy of conventional manufacturing methods.

Comparison of shear bond strengths of different types of denture teeth to different denture base resins

PURPOSE

To determine the shear bond strengths of different denture base resins to different types of prefabricated teeth (acrylic, nanohybrid composite, and cross-linked) and denture teeth produced by computer-aided design/computer-aided manufacturing (CAD/CAM) technology.

MATERIALS AND METHODS

Prefabricated teeth and CAD/CAM (milled) denture teeth were divided into 10 groups and bonded to different denture base materials. Groups 1-3 comprised of different types of prefabricated teeth and cold-polymerized denture base resin; groups 4-6 comprised of different types of prefabricated teeth and heat-polymerized denture base resin; groups 7-9 comprised of different types of prefabricated teeth and CAD/CAM (milled) denture base resin; and group 10 comprised of milled denture teeth produced by CAD/CAM technology and CAD/CAM (milled) denture base resin. A universal testing machine was used to evaluate the shear bond strength for all specimens. One-way ANOVA and Tukey post-hoc test were used for analyzing the data (α=.05).

RESULTS

The shear bond strengths of different groups ranged from 3.37 ± 2.14 MPa to 18.10 ± 2.68 MPa. Statistical analysis showed significant differences among the tested groups (P<.0001). Among different polymerization methods, the lowest values were determined in cold-polymerized resin.There was no significant difference between the shear bond strength values of heat-polymerized and CAD/CAM (milled) denture base resins.

CONCLUSION

Different combinations of materials for removable denture base and denture teeth can affect their bond strength. Cold-polymerized resin should be avoided for attaching prefabricated teeth to a denture base. CAD/CAM (milled) and heat-polymerized denture base resins bonded to different types of prefabricated teeth show similar shear bond strength values.

A systematic review of digital removable partial dentures. Part II: CAD/CAM framework, artificial teeth, and denture base

PURPOSE

This study comprehensively reviewed the current status of the digital workflow of removable partial dentures (RPDs) and summarized information about the fabrication methods and material properties of the dental framework, artificial teeth, and denture base.

STUDY SELECTION

We performed a systematic review of the literature published in online databases from January 1980 to April 2020 regarding RPD fabrication and materials used in the related digital technology. We selected eligible articles, retrieved information regarding digital RPDs, and conducted qualitative/quantitative analyses. In this paper, the computer-aided design/computer-aided manufacturing (CAD/CAM) framework, artificial teeth, and denture base materials are reported.

RESULTS

A variety of materials, such as cobalt-chromium alloy, titanium, zirconia, and polyether ether ketone, are used for dental CAD/CAM frameworks. The mechanical strength of the metal materials used for the CAD/CAM framework was superior to that of the cast framework. However, the fitness and surface roughness of the framework and clasp fabricated using a selective laser melting (SLM) method were not superior to those obtained via cast fabrication. Most material properties and the surface roughness of poly methyl methacrylate (PMMA) discs used for digital RPDs were superior to those of heat-cured PMMA.

CONCLUSIONS

The use of a CAD/CAM framework and PMMA disc for digital RPDs offers numerous advantages over conventional RPDs. However, technical challenges regarding the accuracy and durability of adhesion between the framework and denture base remain to be solved. In digital fabrication, human technical factors influence the quality of the framework.

3D printing restorative materials using a stereolithographic technique: a systematic review

OBJECTIVE

To present through a systematic review a qualitative analysis of studies published on stereolithography-based 3D printing of restorative materials and their clinical applicability.

METHODS

The literature search was conducted based on the question: "What is the state-of-the-art of available restorative materials for 3D printing based on stereolithography?" Online search was conducted in three databases (MEDLINE/PubMed, Scopus and Web of Science) with no restriction for year of publication. Data are reported based on PRISMA, including publication details such as authors and their countries, year and journal of publication, and study design. The synthesis is focused on describing the dental restorative materials and properties evaluated, applied methods, 3D printers used and clinical applicability.

RESULTS

Studies that fit the inclusion criteria were performed in Asia (21), Europe (16) and USA (10), mostly using polymer-based restorative materials (38) for 3D printing constructs. Stereolithographic-printed ceramic-based restorative structures were evaluated by 9 studies. Many studies reported on dimensional accuracy (14), strength (11) and surface morphology (9) of the printed structures. Antibacterial response, cytotoxicity, internal and marginal fit, fracture and wear resistance, density, viscosity, elastic modulus, hardness, structural shrinkage and reliability, degree of conversion, layer cure depth, fatigue, and color were also evaluated by the included studies. Many of them (11) published a proof of concept as an attempt to demonstrate the clinical feasibility and applicability of the technology to print restorative materials, but only 5 studies actually applied the 3D printed restorative structures in patients, which highlights an increasing interest but limited early-stage translation.

SIGNIFICANCE

The fast expansion of stereolithographic-based 3D printing has been impressive and represents a great technological progress with significant disruptive potential. Dentistry has demonstrated an incredible willingness to adapt materials, methods and workflows to this promising digital technology. However, esthetic appearance, wear resistance, wet strength and dimensional accuracy are the main current clinical limitations restricting the progression to functional part production with 3D printing, which may explain the absence of clinical trials and reports on permanent/definitive dental restorative materials and structures.

Dental 3D-Printing: Transferring Art from the Laboratories to the Clinics

The rise of three-dimensional (3D) printing technology has changed the face of dentistry over the past decade. 3D printing is a versatile technique that allows the fabrication of fully automated, tailor-made treatment plans, thereby delivering personalized dental devices and aids to the patients. It is highly efficient, reproducible, and provides fast and accurate results in an affordable manner. With persistent efforts among dentists for refining their practice, dental clinics are now acclimatizing from conventional treatment methods to a fully digital workflow to treat their patients. Apart from its clinical success, 3D printing techniques are now employed in developing haptic simulators, precise models for dental education, including patient awareness. In this narrative review, we discuss the evolution and current trends in 3D printing applications among various areas of dentistry. We aim to focus on the process of the digital workflow used in the clinical diagnosis of different dental conditions and how they are transferred from laboratories to clinics. A brief outlook on the most recent manufacturing methods of 3D printed objects and their current and future implications are also discussed.

3D printed complete removable dental prostheses: a narrative review

Background

The purpose of this paper is to review the available literature on three-dimensionally printed complete dentures in terms of novel biomaterials, fabrication techniques and workflow, clinical performance and patient satisfaction.

Methods

The methodology included applying a search strategy, defining inclusion and exclusion criteria, selecting studies and forming tables to summarize the results. Searches of PubMed, Scopus, and Embase databases were performed independently by two reviewers to gather literature published between 2010 and 2020.

Results

A total of 126 titles were obtained from the electronic database, and the application of exclusion criteria resulted in the identification of 21 articles pertaining to printed technology for complete dentures. Current innovations and developments in digital dentistry have successfully led to the fabrication of removable dental prostheses using CAD/CAM technologies. Milled dentures have been studied more than 3D printed ones in the currently available literature. The limited number of clinical studies, mainly case reports, suggest current indications of 3D printing in denture fabrication process to be custom tray, record bases, trial, interim or immediate dentures but not definitive prostheses fabrication. Limitations include poor esthetics and retention, inability to balance occlusion and low printer resolution.

Conclusions

Initial studies on digital dentures have shown promising short-term clinical performance, positive patient-related results and reasonable cost-effectiveness. 3D printing has potential to modernize and streamline the denture fabrication techniques, materials and workflows. However, more research is required on the existing and developing materials and printers to allow for advancement and increase its application in removable prosthodontics.

A Novel Approach for Converting a Mandibular Complete Denture to a Fixed Interim, Screw-Retained Implant Prostheses: A Case Report

For most of the last century, conventional complete dentures have been the standard of care and the most common treatment for edentulous patients. Technological advancements in fabrication techniques may significantly reduce the number of office visits required to fabricate complete dentures. Immediate occlusal loading with mandibular full arch prostheses has been extensively researched and is now one of the standards of care for edentulous patients. A clinical technique for converting a mandibular immediate complete denture to an interim full arch, screw-retained fixed prosthesis with novel implant restorative components for immediate loading on four implants is described.

Comparison of material properties and biofilm formation in interim single crowns obtained by 3D printing and conventional methods

STATEMENT OF PROBLEM

Three-dimensionally printed interim restorations are among the recent technological advancements in dentistry. However, evidence of their performance is lacking.

PURPOSE

The purpose of this in vitro study was to compare the properties of interim restorations made by 3D printing with different technologies, laser stereolithography (SLA), technology and selective laser sintering (SLS) with those obtained by conventional techniques from acrylic resin and bis-acryl resin.

MATERIAL AND METHODS

Four different groups (acrylic resin, bis-acryl resin, SLS, SLA) were tested for flexural strength, Vickers microhardness, fatigue test, compressive strength, surface roughness before and after polishing, and biofilm formation. Specimens were made in the form of rectangular blocks, disks, and single crowns by following the manufacturing technique of each material. One-way ANOVA was used to test biofilm formation, Vickers microhardness, and the results of the 3-point bend flexural test, while the paired t test was used to assess differences in surface roughness between the materials (α=.05 for all tests).

RESULTS

The highest Vickers microhardness value was for acrylic resin interim crowns, while the elastic moduli were lower for both the 3D printed materials. Only the SLA resin fractured during the fatigue test. For surface roughness, a statistically significant difference was found among the studied materials (P<.001), with SLA resin and bis-acryl resin having the lowest values. No statistically significant differences were found for biofilm formation (P>.05).

CONCLUSIONS

SLS resin had favorable results for the Vickers microhardness, higher maximum flexural strength, and peak stress in load-to-fracture tests, the fatigue test, and biofilm formation compared with acrylic resin and bis-acryl resin, while SLA resin showed favorable results only for biofilm formation and surface roughness.

A Feasibility Study for 3D-printed Poly(methyl methacrylate)-resin Tracheostomy Tube Using a Hamster Cheek Pouch Model

BACKGROUND/AIM

A three-dimensional (3D) printed tracheostomy tube has potential application for patients who require a specialized tube. The aim of this study was to evaluate the characteristics of various 3D printing materials and determine their use in producing 3D-printed tracheostomy tube.

MATERIALS AND METHODS

Mechanical, chemical, and microbiological in vivo changes in the scaffolds were analyzed using a hamster cheek pouch (HCP) model.

RESULTS

The poly methyl methacylate (PMMA)-resin showed superior pre- and post-insertion mechanical properties and a relatively consistent lower biofilm formation compared with other scaffolds. PMMA-resin was successfully 3D-printed with dimensional accuracy without a support system. The use of a 3D-printed PMMA tracheostomy tube in a rabbit trachea showed no definite signs of infection, allergy or foreign body reaction.

CONCLUSION

PMMA-resin can be proposed as an alternative for a 3D-printed tracheostomy tube material. In addition, we suggest HCPs as an in vivo model for evaluating indwelling medical devices.

Bond Strength of Denture Teeth to Heat-Cured, CAD/CAM and 3D Printed Denture Acrylics

PURPOSE

To establish the fracture toughness (K_1C ) and flexural bond strength of commercially available denture teeth to heat cured, CAD/CAM and 3D printed denture-based resins (DBRs).

MATERIALS AND METHODS

Three types of DBRs (Heat cure, CAD-milled and 3D printed) and four different types of commercial denture teeth (Unfilled PMMA, double cross-linked PMMA, PMMA with nanofillers and 3D printed resin teeth) were investigated. DBR and epoxy embedded denture teeth (n = 30 per group) specimen beams (25 × 4 × 3 mm) were fabricated. The testing ends of all the specimens were surface treated, bonded and processed according to manufacturer's instructions. Twenty specimens were thermal cycled to simulate the effects of 6 and 12 months intraorally. A 4-point bend test, using the chevron-notched beam method was done and K_1C (MPa ·m^1/2 ) and flexure bond strength (MPa) were calculated. All specimens were analysed for the mode of failure under the light microscope and selected specimens under scanning electron microscope. Results were statistically analysed using ANOVA (SPSS Ver 24).

RESULTS

The mean K_1C was the highest for the teeth bonded to the heat-cured DBR group (1.09 ± 0.24), followed by CAD/CAM (0.43 ± 0.05) and 3D printed groups (0.17 ± 0.01). Differences were statistically significant (p < 0.01). Within each group, aging showed statistically significantly lower values but no statistical significance between the mean K_1C and flexural bond strength (p = 0.36). The dominant mode of failure was cohesive in the CAD/CAM groups and adhesive in the heat-cured and 3D printed groups.

CONCLUSION

Teeth bonded to heat-cured DBRs produced the highest K_1C .The bond strength decreased significantly with aging. Teeth bonded to CAD/CAM and 3D printed DBRs showed significantly lower bond strength, with no significant influence of aging.

Analysis of Stresses in a Tapered Roller Bearing Using Three-Dimensional Photoelasticity and Stereolithography

Digital photoelasticity is an important segment of optical metrology for stress analysis by digital photographic images. Advances in digital image processing, data acquisition, standard recognition and data storage allow the utilization of computer-aided techniques in the automation and improvement of the digital photoelastic technique. The objective of this study is to develop new techniques using 3D rapid prototyping with transparent resins in digital photoelasticity. Some innovations are proposed (e.g., a tapered roller bearing built with 3D rapid prototyping with transparent resin and the final assembly with the specimens prototyped separately). A metrology study is carried out with the new techniques developed.