Optimizing the design of bio-inspired functionally graded material (FGM) layer in all-ceramic dental restorations

In Vitro Assessment of a New Block Design for Implant Crowns with Functional Gradient Fabricated with Resin Composite and Zirconia Insert

This study aims to evaluate and compare the mechanical resistance, fatigue behavior and fracture behavior of different CAD/CAM materials for implant crowns. Eighty-eight implant crowns cemented-screwed with four sample groups: two monolithic G1 Zirconia (control) and G3 composite and two bi-layered G2 customized zirconia/composite and G4 prefabricated zirconia/composite. All static and dynamic mechanical tests were conducted at 37 °C under wet conditions. The fractographic evaluation of deformed and/or fractured samples was evaluated via electron microscopy. Statistical analysis was conducted using Wallis tests, which were performed depending on the variables, with a confidence interval of 95%, (p < 0.05). The Maximum Fracture Strength values displayed by the four groups of samples showed no statistically significant differences. The crown-abutment material combination influenced the failure mode of the restoration, transitioning from a fatigue fracture type located at the abutment-analog connection for monolithic materials (G1 and G3) to a brittle fracture located in the crown for bi-layered materials (G2 and G4). The use of layered crown materials with functional gradients appears to protect the crown/abutment connection area by partially absorbing the applied mechanical loads. This prevents catastrophic mechanical failures, avoiding long chairside time to solve these kinds of complications.

Fracture resistance, marginal and internal adaptation of innovative 3D-printed graded structure crown using a 3D jet printing technology

PURPOSE

This in vitro study aimed to create a graded structured dental crown using 3D printing technology and investigate the fracture resistance and the adaptation of this new design.

MATERIALS AND METHODS

A dental crown with a uniform thickness of 1.5 mm was designed, and the exported stereolithography file (STL) was used to manufacture 30 crowns in three groups (n = 10), solid (SC), bilayer (BL), and multilayer (ML) crowns using  3D jet printing technology. Marginal and internal gaps were measured using the silicone replica technique. Crowns were then luted to a resin die using a temporary luting agent and the fracture resistance was measured using a universal testing machine. One-way ANOVA and Tukey post hoc tests were used to compare the fracture resistance and the adaptation of crowns at a significance level of 0.05.

RESULTS

Mean marginal and internal gap of the ML group were 80 and 82 mm, respectively; which were significantly (p < 0.05) smaller than BL (203 and 183 mm) and SC (318 and 221 mm) groups. The SC group showed the highest mean load at fracture (2330 N) which was significantly (p < 0.05) higher than the BL (1716 N) and ML (1516 N) groups.

CONCLUSION

3D jet printing technology provides an opportunity to manufacture crowns in a graded structure with various mechanical properties. This study provided an example of graded structured crowns and presented their fracture resistance. SC group had the highest fracture resistance; however, ML had the best marginal and internal adaptation.

Additive manufacturing of dental ceramics in prosthodontics: The status quo and the future

PURPOSE

This review aims to summarize the available technologies, material categories, and prosthodontic applications of additive manufacturing (AM) dental ceramics, evaluate the achievable accuracy and mechanical properties in comparison with current mainstream computer-aided design/computer-aided manufacturing (CAD/CAM) subtractive manufacturing (SM) methods, and discuss future prospects and directions.

STUDY SELECTION

This paper is based on the latest reviews, state-of-the-art research, and existing ISO standards on AM technologies and prosthodontic applications of dental ceramics. PubMed, Web of Science, and ScienceDirect were amongst the sources searched for narrative reviews.

RESULTS

Relatively few AM technologies are available and their applications are limited to crowns and fixed partial dentures. Although the accuracy and strength of AM dental ceramics are comparable to those of SM, they have the limitations of relatively inferior curved surface accuracy and low strength reliability. Furthermore, functionally graded additive manufacturing (FGAM), a potential direction for AM, enables the realization of biomimetic structures, such as natural teeth; however, specific studies are currently lacking.

CONCLUSIONS

AM dental ceramics are not sufficiently developed for large-scale clinical applications. However, with additional research, it may be possible for AM to replace SM as the mainstream manufacturing technology for ceramic restorations.

Methodological approaches in graded dental ceramics

BACKGROUND

Functionally graded materials (FGM) with indistinct boundaries potentially eliminate the damaging stresses occurring at the interfaces. FGM applications in dental ceramics have enhanced their fatigue resistance and interfacial toughness.

OBJECTIVES

This scoping review aims to map graded designs in dental ceramics, distinguish their methodological approaches with their material characteristics and properties, and understand the factors affecting the outcomes of each of the graded approaches.

METHODS

A systematic electronic search was performed with the databases MEDLINE (PubMed), Scopus, Cochrane Library, EBSCO, and Google Scholar along with a manual search.

RESULTS

About 2675 articles were initially found from all the searches with no date restriction till July 2023. After rejecting duplicates and based on exclusion criteria, about 52 articles were included.

SIGNIFICANCE

Methodological approaches in grading such as glass-infiltration and silica-infiltration have been investigated on pre-sintered zirconia. The type of infiltration and the method of infiltrate application significantly influenced the phase transformation of zirconia, its microstructure, surface hardness, fracture toughness, flexural strength, wear, and fatigue strength of graded dental zirconia. Interlayers were accommodated between metal-ceramic and veneer-core all-ceramic layers. Fractions of zirconia-porcelain and alumina-porcelain showed high bending strength and better stress distribution. The results of finite element analysis studies predicted that using 10-layered graded layers reduced the stresses at the crown-cement-dentin interface.

A parametrical finite element analysis for functionally graded material overlay restoration

The main cause of failure in bonded ceramic restorations is material fracture due to excessive stress concentration at the base of the prosthesis. The design of restorative functionally graded materials (FGM) could represent a major advance in dissipating mechanical stresses during occlusal contacts. The aim of this paper is to carry out a complete factorial design of finite element analyses to optimize a multilayer FGM introduced at the bottom of an overlay prosthesis. The number and thickness of layers vary within a spectrum compatible with ceramic shaping processes whereas Young's moduli variations are set in the range of dental tissues. For a 1.5-mm thick prosthesis, the optimal FGM configuration appears to be a 5 layers of 0.2 mm thickness with a linear distribution of Young's modulus from 30 to 70 GPa. This configuration was implemented in a 3D model of a restored tooth with realistic geometry to validate the proof-of-concept.

The Flexural Strength and Flexural Modulus of Stereolithography Additively Manufactured Zirconia with Different Porosities

PURPOSE

Additive manufacturing (AM) technologies are capable of fabricating complex geometries with different porosities. However, the effect of such porosities on mechanical properties of stereolithography (SLA) AM zirconia with different porosities is unclear. The purpose of this in vitro study was to investigate the mechanical properties namely flexural strength, and flexural modulus of AM zirconia with different porosities.

MATERIALS AND METHODS

A bar (25 × 4 × 3 mm) for flexural strength test (ISO standard 6872/2015) was designed by CAD software program and standard tessellation language (STL) file was obtained. The STL file was used to fabricate a total of 80 bars in four groups. Three experimental groups each containing 20 samples were manufactured using an SLA ceramic printer (CeraMaker 900; 3DCeram Co) and zirconia material (3DMix ZrO₂ paste; 3DCeram Co) with different sintering post processing to achieve different porosities including 0%-porosity (AMZ0), 20%-porosity (AMZ20), and 40%-porosity (AMZ40). The same STL file was used for subtractive manufacturing or milling of 20 zirconia bars as control group (CNCZ) with the same dimensions using a commercial zirconia. Three-point bending tests were performed for all groups following ISO standard 6872/2015 specification using a universal testing machine. Outcomes measured included load at fracture, mean flexural strength, and flexural modulus and they were compared across the experimental groups using a one-way ANOVA. Post hoc pair wise comparison between each pair of the groups were performed using Tukey test.

RESULTS

There was a significant difference between the four groups, in terms of fracture load, flexural strength and flexural modulus using one-way ANOVA. AM zirconia with 0% porosity (AMZ0) showed the highest value for fracture load (1132.7 ± 220.6 N), flexural strength (755.1 ± 147.1 MPa) and flexural modulus (41,273 ± 2193 MPa) and AM zirconia with 40% porosity (AMZ40) showed the lowest fracture load (72.13 ± 13.42 N), flexural strength (48.09 ± 8.95 MPa) and flexural modulus (7177 ± 506 MPa). Tukey's pairwise comparisons detected a significant difference between all the possible pairs for all variables except flexural modulus between AMZ0 and CNCZ. The Weibull moduli presented the lowest value for AMZ20 (4.4) followed by AMZ40 (6.1), AMZ0 (6.1), and the highest value was for CNCZ (8.1).

CONCLUSION

AM zirconia with 0% porosity showed significantly higher flexural strength and flexural modulus when compared to milled and AM zirconia with 20% and 40% porosities.

Additively Manufactured Dental Crown with Color Gradient and Graded Structure: A Technique Report

To assess the feasibility of manufacturing a dental crown with internal color gradient and graded structure design using additive manufacturing technology, a mandibular first molar was prepared and a monolayer dental crown with 1.5 mm uniform thickness was designed in a dental software (STL_C1 ). The monolayer crown design was sliced into multiple layers of 0.1 mm thickness and a design for a multilayer crown was obtained (STL_C2 ). A multilayer crown was manufactured with gradient color and graded structure using a material jetting printer. Different materials with different colors and properties were used and mixed in different ratios during manufacturing to achieve the prospected design. The feasibility of manufacturing such a crown was reported. This report confirms that multilayer dental crowns with internal gradient color and graded structure are possible when using a multimaterial jetting printer.

Two-layer additively manufactured crown: Proof of concept

OBJECTIVES

To assess the feasibility of additively manufacturing a crown with a 2-layer design.

METHODS

A mandibular first molar tooth preparation titanium die for a full coverage restoration was obtained. The die was used to design a monolayer (ML group) and 2-layer (2L group) anatomically contoured crown. In the ML group, the specimen was manufactured with a hard polymer (Rigur RGD450; Stratasys). In the 2L group, the crown was splinted into 2 parts: the intaglio that represented 25% of the total crown volume that was manufactured with a resilient polymer (Vero; Stratasys) and the exterior that represented the remaining crown volume that was manufactured with a hard polymer (Rigur RGD450; Stratasys). Specimens were manufactured using a material jetting printer (Connex3 Object260; Stratasys). The marginal and internal discrepancies of ML and 2L specimens were visually assessed.

RESULTS

The ML and 2L specimens were manufactured using a material jetting printer that obtained a visually acceptable marginal and internal discrepancy.

CONCLUSIONS

The 2-layer dental crown can be manufactured using a material jetting printer.

CLINICAL SIGNIFICANCE

Material jetting technology has the capability to fabricate a 2-layer dental crown design which can be fabricated using materials with different properties.

Tuning the mechanical properties of functionally graded nickel and aluminium alloy at the nanoscale

We revealed that the mechanical properties of Ni3Al (homogeneous alloy) could be modulated utilizing functional grading.

Functionally graded biomimetic biomaterials in dentistry: an evidence-based update

Design and development of novel therapeutic strategies to regenerate lost tissue structure and function is a serious clinical hurdle for researchers. Traditionally, much of the research is dedicated in optimising properties of scaffolds. Current synthetic biomaterials remain rudimentary in comparison to their natural counterparts. The ability to incorporate biologically inspired elements into the design of synthetic materials has advanced with time. Recent reports suggest that functionally graded material mimicking the natural tissue morphology can have a more exaggerated response on the targeted tissue. The aim of this review is to deliver an overview of the functionally graded concept with respect to applications in clinical dentistry. A comprehensive understanding of spatiotemporal arrangement in fields of restorative, prosthodontics, periodontics, orthodontics and oral surgery is presented. Different processing techniques have been adapted to achieve such gradients ranging from additive manufacturing (three dimensional printing/rapid prototyping) to conventional techniques of freeze gelation, freeze drying, electrospinning and particulate leaching. The scope of employing additive manufacturing technique as a reliable and predictable tool for the design and accurate reproduction of biomimetic templates is vast by any measure. Further research in the materials used and refinement of the synthesis techniques will continue to expand the frontiers of functionally graded membrane based biomaterials application in the clinical domain.