Characterization of the mechanical properties of CAD/CAM polymers for interim fixed restorations

Impact of Nanoparticle Addition on the Surface and Color Properties of Three-Dimensional (3D) Printed Polymer-Based Provisional Restorations

This study aimed to evaluate and compare the impact of additives such as ZrO2 and SiO2 nanoparticles (ZrO2NP or SiO2NP) on the hardness, surface roughness, and color stability of 3D printed provisional restorations. Two hundred samples in total were printed using 3D printed resins (ASIGA, and NextDent). Each resin was modified with ZrO2NPs or SiO2NPs in two different concentrations (0.5 wt% and 1 wt%), while one group was kept unmodified (n = 10). Disc-shaped (15 × 2.5 mm) samples were designed and printed in accordance with the manufacturer's recommendation. Printed discs were evaluated for color changes through parameters CIELAB 2000 system (ΔE00), hardness using Vickers hardness test, and surface roughness (Ra) using a noncontact profilometer. After calculating the means and standard deviations, a three-way ANOVA and Tukey post hoc test were performed at α = 0.05. The addition of ZrO2NPs or SiO2NPs to ASIGA and NextDent resins significantly increased the hardness at a given level of concentration (0.5% or 1%) in comparison with pure (p < 0.001), with no significant difference between the two modified groups per resin type (p > 0.05). The highest hardness value was detected in 1% ZrO2NPs with 29.67 ± 2.3. The addition of ZrO2NPs or SiO2NPs had no effect on the Ra (p > 0.05), with 1% ZrO2NPs showing the highest value 0.36 ± 0.04 µm with NextDent resin. ZrO2NPs induced higher color changes (∆E00), ranging from 4.1 to 5.8, while SiO2NPs showed lower values, ranging from 1.01 to 1.85, and the highest mean ∆E00 was observed in the 1% ZrO2NPs group and NextDent resin. The incorporation of ZrO2NPs and SiO2NPs in 3D printed provisional resins increased the hardness without affecting the surface roughness. The optical parameters were significantly affected by ZrO2NPs and less adversely affected by SiO2NPs. Consequently, care must be taken to choose a concentration that will improve the materials' mechanical performance without detracting from their esthetic value.

Marginal Fit, Mechanical Properties, and Esthetic Outcomes of CAD/CAM Interim Fixed Dental Prostheses (FDPs): A Systematic Review

This systematic review aimed to study the outcomes of CAD-CAM (milled and 3D-printed) interim dental prostheses when compared to conventional ones. The focused question of "In natural teeth, what are the outcomes of CAD-CAM interim FDPs compared to the conventionally-manufactured ones regarding marginal fit, mechanical properties, esthetics, and color stability" was formulated. The systematic search was conducted electronically in the PubMed/MEDLINE, CENTRAL, EMBASE, Web of Science, New York Academy of Medicine Grey Literature Report, and Google Scholar databases by using the MeSH keywords and keywords associated with the focused question and limiting articles to those published between 2000 and 2022. A manual search was conducted in selected dental journals. The results were analyzed qualitatively and are presented in table format. Of the included studies, 18 studies were in vitro and 1 was a randomized clinical trial. Of the eight studies analyzing the mechanical properties, five studies favored the milled interim restorations, one study favored both 3D-printed and milled interim restorations, and two studies reported better mechanical properties in conventional interim restorations. Among four studies evaluating the marginal discrepancies, two studies favored the marginal fit in milled interim restorations, one study reported a better marginal fit in both milled and 3D-printed interim restorations, and one study found conventional interim restorations have a better marginal fit and smaller marginal discrepancy when compared to both milled and 3D-printed restorations. Among five studies that evaluated both the mechanical properties and marginal fit, 1 study favored 3D-printed interim restorations and four studies favored milled interim restorations over the conventional ones. Two studies analyzing the esthetics outcomes demonstrated better results with milled interim restorations compared to conventional and 3D-printed interim restorations in terms of their color stabilities. The risk of bias was low for all the studies reviewed. The high level of heterogeneity within the studies excluded meta-analysis. Most of the studies favored the milled interim restorations over the 3D-printed and conventional restorations. The results suggested that milled interim restorations offer a better marginal fit, higher mechanical properties, and better esthetic outcomes in terms of color stabilities.

Influence of CAD/CAM Milling and 3D-Printing Fabrication Methods on the Mechanical Properties of 3-Unit Interim Fixed Dental Prosthesis after Thermo-Mechanical Aging Process

This study assessed the influence of CAD/CAM milling and 3D-printing fabrication methods on mechanical properties of 3-unit interim fixed dental prosthesis (IFDPs) after thermo-mechanical aging. Forty 3-unit IFDPs were fabricated on a mandibular right second premolar and second molar of a typodont cast. Samples were fabricated from the following materials; auto-polymerized polymethyl methacrylate (conventional resin), CAD/CAM PMMA (milled resin) and two different CAD/CAM 3D-printed composite resins; digital light processing Asiga (DLP AS) and stereolithography NextDent (SLA ND). Mechanical properties were compared between the studied materials using Kruskal−Wallis test, followed by multiple pairwise comparisons using Bonferroni adjusted significance. There was a significant difference in flexural strength and microhardness between the studied materials (p < 0.001), with the highest mean ± SD reported in the milled IFDPs (174.42 ± 3.39, 27.13 ± 0.52), and the lowest in the conventional IFDPs (98.02 ± 6.1, 15.77 ± 0.32). Flexural strengths differed significantly between the conventional IFDPs and all materials except DLP AS. The highest elastic modulus was recorded in the milled group, and the lowest in the SLA ND group (p = 0.02). In conclusion, superior flexural strength, elastic modulus, and hardness were reported for milled IFDPs. SLA ND printed IFDPs showed comparable mechanical properties to milled ones except for the elastic modulus.

An Interdisciplinary Study Regarding the Characteristics of Dental Resins Used for Temporary Bridges

Background and Objectives: The surface condition of the materials that are used for temporary prostheses influences their microbial colonization, with a direct impact on the oral tissues. This study aims at a comparative analysis of three types of resins for temporary bridges using conventional and digital technologies. The attention was focused on the analysis of the surface characteristics and mechanical strength of these materials. Materials and Methods: The surface condition was assessed for three distinct materials both before and after polishing- heat-curing resin Superpont C + B (SpofaDental, Jicin, Czech Republic) used unconventional technology, Zotion dental milling polymethyl methacrylate (PMMA) block (Zotion, Chongqing, China) for provisional crowns/bridges used in digital subtractive technologies and Freeprint Temp (Detax GmbH & Co. KG, Ettlingen, Germany) resin for temporary crowns and bridges that are used in 3D printing technologies. The two-way ANOVA analysis indicated that polishing leads to a statistically significant increase in roughness coefficients for all the three resins that were tested (p < 0.001). While the highest roughness coefficients were displayed in the 3D cured sample, the largest decrease was reported by the milled sample Results: The results revealed that surface roughness was significantly influenced by both the type of resin that was used (p < 0.001) and the treatment that was induced by finishing and polishing (p < 0.001). Similar p-values were obtained for each of the three resins. Conclusions: The results demonstrated a significant optimization of the surfaces after finishing and polishing and statistically significant differences between the surface parameters and the mechanical properties of the samples. The low values of the roughness and the acceptable values of the mechanical resistance for the conventional samples indicate these materials for the long-term temporary bridge’s realization, allowing the correct restoration of the functions and the rehabilitation at the oral level.

Comparative evaluation of the effect of thermocycling on the mechanical properties of conventionally polymerized, CAD-CAM milled, and 3D-printed interim materials

STATEMENT OF PROBLEM

Studies on the energy absorption characteristics by means of elastic and plastic material deformation of interim materials are lacking.

PURPOSE

The purpose of this in vitro study was to compare the effect of different thermocycling periods on the flexural strength (σ_fs), resilience (U_r), and toughness (U_T) of conventionally polymerized, computer-aided design and computer-aided manufacturing (CAD-CAM) milled, and 3-dimensionally (3D) printed interim materials.

MATERIAL AND METHODS

Rectangular specimens (n=30 for each material) were fabricated from autopolymerized polymethyl methacrylate (PMMA), bis-acryl resin (Bis-acryl), CAD-CAM polymethyl methacrylate-based polymer (CAD-CAM/Milled), and 3D-printed composite resin (3D-Printed). Each material was divided into 3 groups (n=10) according to the applied thermocycling (5 °C to 55 °C) procedure: control (0 cycles), 2500, and 10 000 cycles. Parameters of the materials such as σ_fs, U_r, and U_T were tested in a 3-point bend test according to International Organization for Standardization (ISO) 10477. Data were statistically analyzed with the Shapiro-Wilk test followed by Kruskal-Wallis test, the Mann-Whitney U test, the Friedman test, and Wilcoxon signed-rank test (α=.05).

RESULTS

The tested material and thermocycling had a statistically significant influence on the σ_fs, U_r, and U_T values (P<.05). PMMA showed the lowest mean σ_fs, U_r, and U_T values (P<.05), and CAD-CAM/Milled showed σ_fs values similar to those of 3D-Printed at all thermocycling periods. CAD-CAM/Milled showed the highest U_r values at 10 000 cycles and the highest U_T values at all thermocycles. No significant differences were found in the mean change of σ_fs and U_r of CAD-CAM/Milled among different thermocycling periods.

CONCLUSIONS

The results suggested that digitally fabricated interim materials had better mechanical properties than conventionally polymerized materials and that milled materials had the highest stability in maintaining their initial capacity to absorb energy.

Influence of Conventional, CAD-CAM, and 3D Printing Fabrication Techniques on the Marginal Integrity and Surface Roughness and Wear of Interim Crowns

The aim is to assess the influence of fabrication techniques—conventional (CN), CAD-CAM (CC), and 3D printing (3D)—on the marginal fit, adaptation, surface roughness, and wear of interim restorations of crowns. Thirty interim crowns were fabricated using CN, CC, and 3D techniques. Sixty discs were fabricated to evaluate surface wear and surface roughness properties, with 10 disc samples in each group (n = 10). Internal adaptation and marginal integrity of interim crowns were analyzed with micro CT to detect microgaps at selected points. Average surface micro-roughness (Ra) was calculated in micrometers (μm) using an optical non-contact surface microscope under cyclic loading. Surface wear was evaluated by surface area measurements (mm3) using a micro CT. Analysis of variance (ANOVA) and Tukey’s post hoc comparison tests with Pearson correlation were performed for data analysis. The highest adaptation means were for CN (269.94 ± 64 μm), and the lowest mean value was observed for 3D (197.82 ± 11.72 μm) crowns. CN and CC specimens showed comparable adaptation (p > 0.05), which were significantly higher (p < 0.05) than 3D crowns. CN crowns showed significantly higher marginal misfit compared to 3D (p < 0.05) and CC (p < 0.05) crowns. The highest mean surface roughness was observed in the 3D crowns (5.61 ± 0.33 µm), whereas the lowest was found in CC crowns (3.28 ± 0.34 µm). Better restoration Ra was observed using the CC method followed by CN. CN had the highest wear (17.79 ± 2.78 mm3), and the lowest wear was observed in the 3D (10.81 ± 2.00 mm3) specimen. Low surface wear was observed using 3D printing, followed by CN and CC techniques. The printed specimen showed comparable outcomes to CAD-CAM restoration; however, they were better than CN restoration. A positive correlation between adaptation and surface roughness was observed, indicating an effect of the fabrication technique on material physical property.

Characterization of occlusal splint materials: CAD-CAM versus conventional resins

AIM

The aim of this in vitro study was to assess the mechanical properties of five commercially available subtractive computer-aided design and computer-aided manufacturing (CAD-CAM) milled splint materials, as well as to compare them with conventional heat-polymerized and autopolymerizing resins used in the construction of conventional splints.

MATERIAL AND METHODS

Five CAD-CAM milled (ProArt CAD Splint, Therapon Transpa, Temp Premium Flexible Transpa, Cast, and Aqua), one autopolymerizing (Palapress), and one heat-polymerized (Paladon 65) resin materials were evaluated. Flexural strength, E-modulus, Vickers hardness, fracture toughness, fracture work, water sorption, and water solubility were measured. Samples were evaluated after dry and water storage for 30 days at 37 °C. Data were collected and statistically analyzed.

RESULTS

Under both storage circumstances, the flexural strength values of Paladon 65, Therapon Transpa, Temp Premium Flexible Transpa, and Aqua were statistically non-significant (P=0.055). The polycarbonate-based CAD-CAM material Temp Premium Flexible Transpa had the highest statistically significant values of the fracture toughness and fracture work (P<0.001). Moreover, it exhibited the lowest percentages of water sorption and water solubility among the investigated materials (P<0.001). All of the CAD-CAM materials exhibited dry elastic moduli greater than Palapress and lower than Paladon 65. One of the CAD-CAM materials, Cast, had the highest dry Vickers hardness value, which was non-significant when compared to Therapon Transpa (P=0.762).

CONCLUSION

CAD-CAM polycarbonate-based splint materials exhibit higher fracture toughness and fracture work as well as lower water sorption and solubility than polymethyl methacrylate-based ones. The mechanical characteristics of the assessed CAD-CAM milled splint materials were not typically superior to those of the conventional heat-polymerized resin. However, some of them outperformed the autopolymerizing acrylic resin in terms of flexural strength, surface microhardness, water sorption, and water solubility.

Effect of specific retention biomaterials for ball attachment on the biomechanical response of single implant-supported overdenture: A finite element analysis

PURPOSE

The purpose of this finite element analysis (FEA) was to evaluate the effect of specific retention biomaterials with different elastic modulus on the biomechanical response to the axial and off-axial biting loads of a mandibular midline single implant-supported overdenture (SIO) model.

METHODS

Five 3-dimensional (3D) finite element models of an edentulous mandible with SIO were designed as follows: model M with a titanium retentive element for ball attachment, model P with a PEEK retentive element, model S with a silicone resilient liner retentive element, model T with a thermoplastic acrylic resin retentive element made from a CAD-CAM material, and model A with a polyacetal resin retentive element. Posterior bilateral vertical load (PV) at the 1st molar areas and anterior oblique load (AO) at the incisal edge of the mandibular central incisors at a 30-degree angle of 100 N were applied. Stress values were recorded.

RESULTS

Stress values were higher for all models under (AO) loading than under (PV) loading. Model M recorded the highest stress values on the implant, its components, cortical, and cancellous bone under both loading conditions. Under (AO) loading condition, the ball abutment von Mises stress value in model S was almost 7 times lower than that of model M (19 and 130 MPa respectively) and the other 3 models (P, T, and A) (119, 121, and 120 MPa respectively). However, model S recorded the highest value of denture base stress at the attachment area.

CONCLUSIONS

The elastic modulus of retention materials can affect stresses generated on the implant overdenture components and supporting structures.

In vitro comparison of the surface roughness of polymethyl methacrylate and bis-acrylic resins for interim restorations before and after polishing

STATEMENT OF PROBLEM

Polymethyl methacrylate and bis-acrylic based resins are widely used for interim restorations. Their initial surface roughness is important because it determines their aesthetic properties and the potential for biofilm adhesion.

PURPOSE

The purpose of this in vitro study was to assess the surface roughness and morphology of 6 bis-acrylic and 2 polymethyl methacrylate resins widely used for interim dental restorations, both before and after polishing.

MATERIAL AND METHODS

Specimens made of different bis-acrylic resins (Protemp 4, Luxatemp Star, Systemp, Telio, Structur Premium, Structur 3) or of polymethyl methacrylate (Unifast Trad, Unifast 3) were polished using a 2-step polishing system (Diatech). The average surface roughness before and after polishing (10 seconds at low speed in dry conditions) was measured by optical profilometry. Atomic force microscopy and scanning electron microscopy were used to analyze surface morphology. The Mann-Whitney and Kruskal-Wallis tests were used to evaluate the differences in roughness among specimens (α=.05), and the Pearson r correlation was computed to assess the relationship between fillers and average surface roughness.

RESULTS

In the 8 groups evaluated, the roughness significantly increased (P<.001) for Protemp 4 (from 0.12 to 0.50 μm), Luxatemp Star (0.17 to 1.19 μm), Unifast 3 (0.40 to 1.00 μm), Systemp (0.46 to 1.51 μm), Structur 3 (0.85 to 1.06 μm), Structur Premium (1.00 to 1.74 μm), and Telio (1.13 to 1.21 μm), except for Unifast Trad (9.20 to 2.59 μm). Pairwise multiple comparisons identified Protemp 4 as having the smoothest surface before and after polishing, while Unifast Trad was the roughest in both. Atomic force microscopy and scanning electron microscopy observations showed that the surface roughness of bis-acrylic resins was related to their surface morphology and average filler sizes. A positive relation between fillers and roughness was assessed (r=0.345, P<.001).

CONCLUSIONS

For the bis-acrylic interim resins, the surface roughness after polishing was correlated to the material used and its filler sizes. Nanofiller-based resins showed the smoothest surfaces. For the polymethyl methacrylate-based resins, the recently marketed Unifast 3 had the lowest overall roughness values.