Vat Photopolymerization 3D Printing in Dentistry: A Comprehensive Review of Actual Popular Technologies.

In this comprehensive review, the current state of the art and recent advances in 3D printing in dentistry are explored. This article provides an overview of the fundamental principles of 3D printing with a focus on vat photopolymerization (VP), the most commonly used technological principle in dental practice, which includes SLA, DLP, and LCD (or mSLA) technologies. The advantages, disadvantages, and shortcomings of these technologies are also discussed. This article delves into the key stages of the dental 3D printing process, from computer-aided design (CAD) to postprocessing, emphasizing the importance of postrinsing and postcuring to ensure the biocompatibility of custom-made medical devices. Legal considerations and regulatory obligations related to the production of custom medical devices through 3D printing are also addressed. This article serves as a valuable resource for dental practitioners, researchers, and health care professionals interested in applying this innovative technology in clinical practice.

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.

Comparison of the measurement error of optical impressions obtained with four intraoral and one extra-oral dental scanners of post and core preparations.

Statement of problem: Innovations in intraoral scanner (IOS) technology are opening up ever more indications for computer-aided design and manufacturing (CAD-CAM). The manufacturers claim that the latest generations of scanners allow the digitizing of root canal preparations. However, there is a lack of studies evaluating the quality of the optical impressions made for this type of treatment. Purpose: The purpose of this study was to evaluate the measurement error of 4 IOSs and a laboratory scanner used for the digitizing of root canal preparations and to highlight the effect of the presence or absence of adjacent teeth on the quality of the digital model. Material and methods: Two models: one presenting adjacent teeth, one without adjacent teeth, both presenting a 10 mm deep nominal conical pit mimicking a root canal preparation were fabricated. Each model was scanned 10 times with a laboratory scanner (E3) and 4 intraoral scanners (Primescan, Omnicam, TRIOS 4, and Medit i700). The digital models were then exported as standard tessellation language (STL) files and analyzed to evaluate the mean measurement error of the digitizing of the root preparation at three different depths: 0-3 mm, 3-6 mm, and 6-9 mm. Significant differences were assessed with a 1-way ANOVA test and the pairwise comparison between scanners was done by Tukey's multiple comparison test. Results: Statistical differences were found between scanners (P < 0.05). The mean measurement error ranged from 9.8 ± 0.5 µm with the Medit i700 to 28.2 ± 10 µm with the E3. The E3 and Omnicam scanners were in some cases incapable of digitizing the conical preparation in its entirety. The group Primescan, TRIOS 4, and Medit i700 showed minimally significant differences. The presence of adjacent teeth had a negative effect on the model quality for some scanners, mainly because of the obstruction of the IOS's head. Conclusions: Significant differences were found among the dental scanners used for digitizing root canal preparations. Optical impressions with modern intraoral scanners seem to be an adapted method of registration of root canal preparation for post-and-copings of post-and-cores fabrication.

Volumetric and dimensional accuracy assessment of CAD-CAM-manufactured dental prostheses from different materials.

STATEMENT OF PROBLEM: In computer-aided design and computer-aided manufacturing (CAD-CAM) dentistry, the CAD of the prosthesis represents the clinical prerequisite design to restore the treated tooth. However, how closely the CAM prosthesis shape matches the CAD, particularly in relation to different materials, is unclear. PURPOSE: The purpose of this in vitro study was to evaluate onlays designed and manufactured with the same CAD-CAM system but manufactured with different materials. MATERIAL AND METHODS: A single standard tessellation language (STL) model was used to produce 6 composite resin onlays, 6 leucite glass-ceramic onlays, and 6 lithium disilicate glass-ceramic onlays. The onlays were digitized by using an X-ray microtomographic protocol with a metrological calibration. The CAD model was then compared with the scans of the different onlays. An analysis by region of interest was then carried out to assess the accuracy and reliability of the dimensional accuracy. RESULTS: The composite resin and the lithium disilicate glass-ceramic had the best dimensional accuracy. The leucite glass-ceramic exhibited a lack of trueness linked to consistent overmilling. The composite resin had less peripheral chipping than the glass-ceramics. CONCLUSIONS: The composite resin and the lithium disilicate glass-ceramic material exhibited satisfactory dimensional accuracy. Milling the glass-ceramic before crystallization considerably improved dimensional accuracy.

Training for breech deliveries with the mother in an upright position: An innovative adaptation of a simulation model.

BACKGROUND: Delivery of a breech baby with the mother in an upright position or on all fours has gained a renewed interest. In these positions, the obstetrician or midwife needs to learn new landmarks and maneuvers. A realistic simulation model would be a valuable adjunct for breech on all fours teaching programs. MATERIAL AND METHODS: This article describes the simulation model and training program we have developed to train an interprofessional team to assist breech births when the mother is on all fours. A questionnaire was used to evaluate the realism of the adapted mannequin and the impact of training on the confidence level of the participants. RESULTS: On a Likert scale of 1 to 5, 92% of participants agreed or strongly agreed that the adapted mannequin used was realistic for training obstetric maneuvers for complicated breech births. After training, their confidence level supporting a breech birth in an upright position rose from an average of 2.5 to 5.7 on a scale of 1 to 10. CONCLUSION: Learning the skills for breech deliveries on all fours is made possible by targeted training with this adapted simulation model.

Accuracy of Complete-Arch Implant Digital Scans: Effect of Scanning Protocol, Number of Implants, and Scan Body Splinting.

PURPOSE: To determine the effect of scanning protocol, number of implants, and implant splinting on the accuracy of digital scanning in the edentulous arch. MATERIALS AND METHODS: A resin-based model of an edentulous mandible with six implants was scanned with a coordinate measurement machine as a reference and then with two intraoral scanner (IOS) systems (Trios 3 and Primescan). Ten scans were taken per IOS for three experiments, and each scan was compared to the reference data to evaluate trueness and precision. Analysis involved measurement of linear and angular discrepanices using engineering software. In experiment 1, three scanning protocols were compared (curvilinear, zigzag, and half-arch). In experiment 2, three clinical situations were simulated (6 implants, 4 implants-short arch, and 4 implants-long arch). In experiment 3, the effect of implant splinting with a suture thread was measured. Normal distribution of data was examined with Shapiro-Wilk test. Levene test was used for equality of variance (α = .05). Statistical differences in distance and angular deviations were analyzed using Student t test or ANOVA with post hoc Tukey test (α = .05). RESULTS: The best results in terms of trueness and precision were obtained with a linear scanning protocol and six implants. The results were as follows: Trios 3: trueness = 52 µm/0.42 degrees, precision = 40 µm/0.26 degrees; Primescan: trueness = 24 µm/0.28 degrees, precision = 18 µm/0.27 degrees. The scanning protocol did not significantly affect distance or angular deviation accuracy. Trueness and precision significantly decreased with four implants using Primescan and TRIOS 3. Splinting implants negatively affected accuracy with both IOS devices. CONCLUSION: Both IOS devices achieved clinically satisfying accuracy for distance (< 100 µm) and angular (< 0.5 degrees) deviations with six implants and a linear scanning protocol. With four implants, angular deviations sometimes differed between implants within the same group depending on the IOS and the clinical situation. Int J Prosthodont 2023;36:219-227. doi: 10.11607/ijp.7332.

Comparison of the acquisition accuracy and digitizing noise of 9 intraoral and extraoral scanners: An objective method.

STATEMENT OF PROBLEM: The quality of the digital cast obtained from an intraoral scanner is an important comparison parameter for computer-aided design and computer-aided manufacturing (CAD-CAM) restorations. However, data on cast quality are typically provided by manufacturers, and objective evaluation of these devices is lacking. PURPOSE: The purpose of this in vitro study was to build an evaluation protocol of 8 intraoral scanners by using an objective method for a small-scale model equivalent in size to a 4-tooth wide cast. In addition, a laboratory scanner was included to compare the performance of intraoral and extraoral devices. MATERIAL AND METHODS: An 8-mm-thick zirconia gauge block was scanned 10 times with a laboratory scanner (Iscan D104) and 8 intraoral scanners (Omnicam, Primescan, Itero element 5D, CS 3600, TRIOS 3, Emerald, Planscan, and Medit i500). The obtained digital casts were extracted as standard tessellation language (STL) files and analyzed to evaluate the digitizing noise, dimensional trueness, and dimensional precision of each scanner. After validation of the normal distribution of the digitizing noise, dimensional trueness, and precision test results for each scanner with the Shapiro-Wilk test (α=.05), differences were determined with a 1-way ANOVA test. RESULTS: Statistical differences were found between scanners (P<.05). The digitizing noise ranged from 3.2 ±0.6 µm with the Primescan to 15.5 ±2.5 µm with the Planscan. The dimensional trueness ranged from 19.1 ±11.5 µm for the CS3600 to 243.8 ±33.6 µm for the Planscan. The dimensional precision ranged from 7.7 ±2.4 µm for the Primescan to 53.7 ±3.4 µm for the Emerald. The group Iscan D104, Primescan, Itero 5D, CS3600, and TRIOS 3 showed minimally significant differences. CONCLUSIONS: Significant differences were found among the intraoral scanners for small-scale scans. The objective methodology of using a gauge block provided coherent and repeatable results.

3D-printed protected face shields for health care workers in Covid-19 pandemic.

The coronavirus pandemic resulted in a shortage of protective equipment. To meet the request of eye-protecting devices, an interdisciplinary consortium involving practitioners, researchers, engineers and technicians developed and manufactured thousands of inexpensive 3D-printed face shields, inside hospital setting. This action leads to the concept of "concurrent, agile, and rapid engineering".

Evaluation of the dimensional accuracy of a manufactured dental prosthesis in relation to its computer-aided model.

AIM: Currently, there is no reliable methodology to evaluate the dimensional conformity of dental prostheses manufactured through a digital shaping process. In the CAD/CAM method, the digital design of the prosthesis is considered as a reference, and it is crucial to reproduce it perfectly during the manufacturing process. Therefore, the aim of this study was to offer a comparison between a CAM prosthesis and its design model by superimposing the CAD model with the digitization of the manufactured prosthesis. MATERIALS AND METHODS: The metrological inspection developed in this study and presented in this article involved a comparison of the points cloud obtained by micro-computed tomography (micro-CT) and the CAD model of the prosthesis. First, an estimation of all inspection-method induced measurement errors was carried out, in which the measurement errors were assessed by proceeding to the dimensional inspection of a reference object of known dimensions. Then, the metrological inspection was extrapolated to a dental prosthesis. RESULTS: The estimation of measurement errors presented satisfying results compared with the usual metrological protocols developed by the dentistry research community. The dimensional deviation was estimated at 0.31% and the form deviation at 0.165 µm between the Gaussian sphere and the certified ball. The inspection of the manufactured surfaces revealed under-milled areas on the occlusal face, particularly on the anatomical fossae, and an irregular margin limit compared with its smooth design. CONCLUSION: A reliable micro-CT evaluation of the dimensional accuracy of a manufactured dental prosthesis compared with the CAD model demonstrated the performance level of CAD/CAM systems. The evaluation reliability was confirmed by the estimation of prior measurement errors. This estimation is essential for the metrological analysis.

Evaluation of the marginal fit of CAD-CAM zirconia copings: Comparison of 2D and 3D measurement methods.

PURPOSE: The purpose of this in vitro study was to compare the marginal fit of zirconia copings by using 2 different measurement methods: a triple optical scan method and a silicone replica method. MATERIAL AND METHODS: Sixty zirconia copings fabricated by computer-aided design and computer-aided manufacture (CAD-CAM) systems were studied for the marginal fit. For the replica method, the thickness of the light-body silicone layer of the discrepancy was assessed using light microscopy and image analysis software. The triple-scan optical method was performed to obtain a digital three-dimensional map of the marginal fit and analyzed marginal fit measurement values. For each method, the reliability of the measurement was tested, and a nonparametric analysis was then performed to compare the marginal fit values as measured by the 2 evaluation methods (α=.05). RESULTS: Intraclass correlation coefficients and repeatability coefficients revealed good repeatability for both of the evaluation methods. However, the triple-scan method produced a smaller marginal fit than the replica method (P<.001) for the entire group studied. CONCLUSIONS: Although both methods showed good repeatability, the triple-scan method was more reliable.

Understanding dental CAD/CAM for restorations--dental milling machines from a mechanical engineering viewpoint. Part B: labside milling machines.

Nowadays, dental numerical controlled (NC) milling machines are available for dental laboratories (labside solution) and dental production centers. This article provides a mechanical engineering approach to NC milling machines to help dental technicians understand the involvement of technology in digital dentistry practice. The technical and economic criteria are described for four labside and two production center dental NC milling machines available on the market. The technical criteria are focused on the capacities of the embedded technologies of milling machines to mill prosthetic materials and various restoration shapes. The economic criteria are focused on investment cost and interoperability with third-party software. The clinical relevance of the technology is discussed through the accuracy and integrity of the restoration. It can be asserted that dental production center milling machines offer a wider range of materials and types of restoration shapes than labside solutions, while labside solutions offer a wider range than chairside solutions. The accuracy and integrity of restorations may be improved as a function of the embedded technologies provided. However, the more complex the technical solutions available, the more skilled the user must be. Investment cost and interoperability with third-party software increase according to the quality of the embedded technologies implemented. Each private dental practice may decide which fabrication option to use depending on the scope of the practice.

3D fitting accuracy evaluation of CAD/CAM copings - comparison with spacer design settings.

OBJECTIVES: The accuracy of computer-aided design/computer- aided manufacturing (CAD/CAM) systems is linked to their technical characteristics and reliability for manufacturing the restoration designed. The aim of this study was to compare the accuracy of fit of zirconia copings manufactured with different CAD/CAM systems and their capacity to conform to pre-established spacer design settings. METHODS: Sixty zirconia copings were manufactured by three CAD/CAM systems, with their spacers set as recommended by their manufacturer on occlusal, axial, and marginal surfaces. The 3D triple-scan optical technique was used to obtain a fit mapping and to analyze the marginal and axial accuracy of fit. The reliability of the 3D measurement method was estimated using intraclass correlation and repeatability coefficients. The preparation coping interface width results were statistically analyzed using non-parametric analysis (Kruskal-Wallis, one-way ANOVA, and Wilcoxon signedrank tests) (P < 0.05). RESULTS: The repeatability coefficient was 6, 8, and 15 µm for axial, marginal, and occlusal interface width measurements, respectively. For the three systems tested, no differences were found in the marginal area of the copings studied, with a mean fitting accuracy ranging from 54.3 to 66.6 µm interface width. Statistically significant differences between groups were observed for the fitting accuracy measured in axial and occlusal areas. With the spacers set in the different areas, mean fit measurements of the zirconia copings were significantly larger, with an increased fit width ranging from 30 to 73 µm. SIGNIFICANCE: The three CAD/CAM systems evaluated allowed similar marginal accuracy but failed to reproduce the pre-established spacer parameters, with larger spacing showing throughout.

Understanding dental CAD/CAM for restorations - dental milling machines from a mechanical engineering viewpoint. Part A: chairside milling machines.

The dental milling machine is an important device in the dental CAD/CAM chain. Nowadays, dental numerical controlled (NC) milling machines are available for dental surgeries (chairside solution). This article provides a mechanical engineering approach to NC milling machines to help dentists understand the involvement of technology in digital dentistry practice. First, some technical concepts and definitions associated with NC milling machines are described from a mechanical engineering viewpoint. The technical and economic criteria of four chairside dental NC milling machines that are available on the market are then described. The technical criteria are focused on the capacities of the embedded technologies of these milling machines to mill both prosthetic materials and types of shape restorations. The economic criteria are focused on investment costs and interoperability with third-party software. The clinical relevance of the technology is assessed in terms of the accuracy and integrity of the restoration.

Influence of CAD/CAM tool and material on tool wear and roughness of dental prostheses after milling.

STATEMENT OF PROBLEM: Computer-aided design/computer-aided manufacturing (CAD/CAM) machining influences the surface roughness of dental restorations and tool wear. Roughness must be suitable to meet clinical requirements, and the tool must last as long as possible. PURPOSE: The purpose of this pilot study was to investigate the influence of the CAD/CAM tool-material couple on tool wear and surface roughness after milling. MATERIAL AND METHODS: Three tools (Lyra conical tool Ø1 mm; GACD SASU, Lyra conical tool Ø1.05 mm; GACD SASU, and Cerec cylinder pointed tool 12S; Sirona Dental Systems GmbH) and 3 CAD/CAM materials (Lava Ultimate; 3M ESPE, Mark II; VITA Zahnfabrik H. Rauter GmbH, and Enamic; VITA Zahnfabrik H. Rauter GmbH) were tested. The tool wear of 6 tool-material couples at a feed rate of 2 m/min was analyzed before and after 8 minutes of flank and climb milling with optical and scanning electron microscopy (SEM) observations and tool weighing. The surface roughness after milling was observed for 9 tool-material couples for flank and climb milling. Feed rates of 1, 2, 3, and 4.8 m/min were used for each couple. Ra, Rt, Rz, Sa, Sq, and Sz roughness criteria were measured. A paired comparison of tool-material couples was conducted with the Kruskal-Wallis test. RESULTS: The Mark II material led to more severe tool wear. Milling of Lava Ultimate resulted in chip deposits on the tool grit. The Cerec cylinder pointed tool 12S was less worn for each material tested. The Cerec cylinder pointed tool 12S and the Lyra conical tool Ø1.05 mm provided similar roughness measurements for the 3 materials tested. The Lyra conical tool Ø1.05 mm tool provided better roughness than the Lyra conical tool Ø1 mm tool for the Enamic material. CONCLUSION: Tool lifetime calculated by volume of milled material removed should be the measure provided by CAD/CAM manufacturers instead of a number of blocks. This tool lifetime should be provided for the milling conditions associated with the material milled. Material hardness and tool grit are key factors for achieving a given roughness.

Understanding dental CAD/CAM for restorations--accuracy from a mechanical engineering viewpoint.

As is the case in the field of medicine, as well as in most areas of daily life, digital technology is increasingly being introduced into dental practice. Computer-aided design/ computer-aided manufacturing (CAD/CAM) solutions are available not only for chairside practice but also for creating inlays, crowns, fixed partial dentures (FPDs), implant abutments, and other dental prostheses. CAD/CAM dental practice can be considered as the handling of devices and software processing for the almost automatic design and creation of dental restorations. However, dentists who want to use dental CAD/CAM systems often do not have enough information to understand the variations offered by such technology practice. Knowledge of the random and systematic errors in accuracy with CAD/CAM systems can help to achieve successful restorations with this technology, and help with the purchasing of a CAD/CAM system that meets the clinical needs of restoration. This article provides a mechanical engineering viewpoint of the accuracy of CAD/ CAM systems, to help dentists understand the impact of this technology on restoration accuracy.