Combining 3D-printed metal and resin for digitally fabricated dentures: A dental technique.

Most digitally fabricated removable dentures are currently available in resin only. To overcome this limitation, digitally fabricated dentures were designed by using a general purpose software program rather than a dental computer-aided design (CAD) software program. The functional cusps were made in metal and the denture base in resin with a 3-dimensional (3D) printer. The 2 outputs were combined to complete the metal-containing digitally fabricated dentures. The technique provides new possibilities for making a variety of digital dental prostheses.

Biocompatibility Evaluation of Feldspathic Porcelain with Nano-Sized Silver Ion Particles.

The major failure of dental restorations is caused by dental caries by S. mutans. This study evaluated the effect of nanosized silver ions in feldspathic porcelain on cytotoxicity and antimicrobial activity. The control group was feldspathic porcelain (Noritake EX-3, Kuraray Noritake Dental Inc., Japan) that did not contain Ag (silver). The experimental groups were feldspathic porcelain mixed with colloidal solutions of nanosized silver ions in mixtures of 5% 10%, 20%, 30%. Cell activity assays evaluated with osteoblast hFOB 1.19 cells (human Fetal Osteoblastic cell line, ATCC® CRL- 11372™) and antimicrobial activity test used the streptococcus mutans (S. mutans). According to the observations, the addition of Ag to feldspathic porcelain led to increased cell activity and showed excellent antibacterial performance. Especially, the feldspathic porcelain with 30% nanosized Ag ion appeared to have a significant antimicrobial effect, this allows for the possibility of various clinical applications for such material, including use in dental prosthesis and implants.

Novel ß-TCP Coated Titanium Nanofiber Surface for Enhanced Bone Growth.

In this study, we examined the effect of ß-tricalcium phosphate (ß-TCP) coating on alkali-treated CP Grade II titanium surface via RF magnetron sputtering on osteoblast like cell (MC3T3-E1) viability and bone formation in rat tibia. The specimens were divided into three groups; commercially pure titanium (control group), alkali-treated titanium with nanofiber structure (NF group) and ß-TCP coating on alkali-treated titanium with nanofiber structure (TNF group). The surface characteristics of specimens were observed under a field emission scanning electron microscope (FE-SEM), and contact angle was measured. The cell viability was assessed in vitro after 1 day, 3 days and 7 days. Implants of 2.0 mm diameter and 5.0 mm length were inserted into the tibia of rats. After 4 wks, the histomorphometric analysis was performed. Group NF and group TNF showed improved hydrophilicity of Ti. Group TNF showed significantly higher cell viability (P < 0.05) after 7 days. The bone to implant contact (BIC) ratio of the control group, NF group, and TNF group were 32.3%, 35.5%, and 63.9%, respectively. The study results suggested that ß-TCP coated alkali-treated titanium surface via RF magnetron sputtering might be effective in implant dentistry due to enhanced hydrophilicity, improved cell response, and better osseointegration.

Hydroxyapatite Coating on TiO2 Nanotube by Sol-Gel Method for Implant Applications.

The aim of this study was to determine the effect of hydroxyapatite (HA) coating on titanium dioxide (TiO2) nanotube by sol-gel process on viability of osteoblast like cell (MC3T3-E1) and bone formation in rat tibia. Specimens were divided into three groups including commercially pure titanium (control group), TiO2 nanotubes (group N), and HA coated TiO2 nanotubes (group HN). Surface characteristics were determined using field emission scanning electron microscope (FE-SEM; S-4700, Hitachi, Japan) and contact angles were measured. Cell viability was investigated in vitro after 1 day, 3 days, and 7 days of incubation. Implants (2.0 mm in diameter and 5.0 mm in length) were inserted into the tibia of rats. After 4 weeks, histomorphometric analysis was performed. Both N and HN groups showed enhanced hydrophilicity compared to control group. After 7 days of implantation, group HN showed higher cell viability with marginal significance (0.05 < P < 0.1). Bone to implant contact (BIC) ratio in the control group, group N, and group HN were 32.5%, 33.1%, and 43.8%, respectively. Results of this study showed that HA coated TiO2 nanotube using sol-gel process could be used to enhance hydrophilicity and improve osseointegration of dental implant surface.

Evaluation of the Fitness of Glass-Infiltrated Zirconia Core in Maxillary Central Incisor.

The purpose of this study was to evaluate the fitness of zirconia cores according to the amount and treated surface of glass infiltration. A maxillary right central incisor customized abutment was milled to have a 6° slope and a 1 mm deep chamfer margin and was manufactured in an intaglio mold using silicone impression material. Fifty-six stone dies were produced by injecting high strength dental stone into a mold and then zirconia cores were milled with CAD/CAM systems. The control group (Control) used non glass-infiltrated zirconia, and the experiment group was divided by one with the glass and distilled water ratio of 1:300 and the other with the ratio of 1:100. Each group was divided into subgroups by glasstreated surface: external surface infiltration, internal surface infiltration, and both surface infiltration. The zirconia cores sintered after glass infiltration were attached to the stone dies and then cut. Afterwards, the absolute marginal discrepancies and internal gaps of the buccal and lingual sides were measured. The buccal absolute marginal discrepancies and lingual internal gaps were influenced by the glass infiltration amount (p < 0.05); while fitness of zirconia core were not affected by the glasstreated surface (p > 0.05). As a result of the above experiments, the glass-infiltrated zirconia cores showed a clinically acceptable fitness, which is within 120 µm. This means that glass infiltration can be clinically used.

Effect on Adhesion of Porphyromonas gingivalis by Titanium Nitride Sputter Coating or Plasma Nitriding of Titanium.

Porphyromonas gingivalis (P. gingivalis) is one of main bacteria that adheres to the surface of dental implants and causes peri-implantitis. The purpose of this study was to observe the surface characteristics of titanium processed with either titanium nitride (TiN) sputter coating or plasma nitriding and to evaluate the subsequent adhesion of P. gingivalis. Specimens were divided into three groups: commercially pure (CP) titanium (control group), TiN sputter­coated titanium (group S), and plasma-nitrided titanium (group P). Surface characteristics such as roughness, morphology, and the formation of a thin TiN film or a nitriding layer were assessed. Adhesion of P. gingivalis in the three groups was determined by means of the crystal violet staining assay, and results were compared with one-way ANOVA, with post hoc comparison using Tukey's test (α = 0.05). Surface roughness values for the control group, group S, and group P were 0.08±0.02 µm, 0.19±0.04 µm, and 0.13±0.02 µm, respectively. In group S, the TiN layer was 1.36±0.1 µm thick, and nitrogen was detected on the surface of the specimens in group P, confirming formation of a nitrided layer. The level of adhesion in group P was significantly higher than that in the control group and in group S (p < 0.05), but there was no significant difference between the control group and group S. Within the limitations of this study, TiN sputter coating did not affect adhesion of P. gingivalis on the titanium surface, whereas adhesion was increased on the plasma-nitrided titanium surface.

Evaluation of Sandblasting on Mechanical Properties and Cell Response of Bioactive Glass Infiltrated Zirconia.

This study investigated the mechanical properties and initial cell response of bioactive glass infiltrated zirconia before and after sandblasting. One hundred zirconia specimens were divided into the following four groups: untreated zirconia (ZR), sandblasted zirconia (ZS), glass infiltrated zirconia (ZG), and sandblasted glass infiltrated zirconia (ZGS). Surface roughness, biaxial flexural strength, hardness and osteoblast cells proliferation were evaluated. ZGS group showed a slight decrease in hardness. However it has improvement in flexural strength (686.2 MPa). After sandblasting, the ZGS group had the highest surface roughness (R a = 1.24 µm) with enhanced osteoblast cells response. Our results indicated that sandblasting method can improve the mechanical properties of bioactive glass infiltrated zirconia with better osteoblast cell response. This new surface is promising for zirconia dental implant application in the future.

Surface Characteristics of Bioactive Glass-Infiltrated Zirconia with Different Hydrofluoric Acid Etching Conditions.

The purpose of this study was to examine the surface characteristics of bioactive glass-infiltrated zirconia specimens that underwent different hydrofluoric acid (HF) etching conditions. Specimens were classified into the following six groups: Zirconia, Zirliner, Porcelain, Bioactive glass A1, Bioactive glass A2, and Bioactive glass A3. Zirliner and porcelain were applied to fully sintered zirconia followed by heat treatment. Bioactive glass was infiltrated into presintered zirconia using a spin coating method followed by complete sintering. All the specimens were acid-etched with 10% or 20% HF, and surface roughness was measured using a profiler. The surface roughness of the zirconia group was not affected by the etching time or the concentration of the acid. The roughness of the three bioactive glass groups (A1, A2, and A3) was slightly increased up until 10 minutes of etching. After 1 hour of etching, the roughness was considerably increased. The infiltrated bioactive glass and acid etching did not affect the adhesion and proliferation of osteoblasts. This study confirmed that surface roughness was affected by the infiltration material, etching time, and acid concentration. For implant surfaces, it is expected that the use of etched bioactive glass-infiltrated zirconia with micro-topographies will be similar to that of machined or sand-blasted/acid-etched (SLA) titanium.

Effect of various polishing systems on the surface roughness and phase transformation of zirconia and the durability of the polishing systems.

STATEMENT OF PROBLEM: Although many systems are used to polish zirconia, a comparison of the performance of zirconia and feldspathic porcelain polishing systems is lacking. PURPOSE: The purpose of this in vitro study was to compare the effects of 3 polishing systems on surface roughness, zirconia phase transformation, and durability of the polishing systems when applied to zirconia and feldspathic porcelain. MATERIAL AND METHODS: Three polishing systems were evaluated: Z1, a zirconia polishing system; Z2, a zirconia polishing system, and F1, a feldspathic porcelain polishing system. Three ceramic systems were evaluated: PR and ZM zirconia specimens (diameter 15 mm, height 2 mm; 23 specimens each) and CB feldspathic porcelain specimens of the same size (15 specimens). A rough surface was created on the 3 types of specimens (15 specimens each) to model an occlusal adjustment under the same conditions. Polishing was carried out with the 3 polishing systems for 2 minutes each. Surface roughness was measured with a 3-dimensional (3D) optical profiler. The surface was also observed with a scanning electron microscopy. X-ray diffraction analysis was performed for 8 PR or ZM zirconia specimens polished by using the Z1 and Z2 systems for 8 minutes to evaluate the phase transformation of zirconia before, during, and after polishing. These specimens were compared and analyzed for phase transformation that might have occurred during the polishing of the specimens. After finishing the surface roughness experiment and the phase transformation experiment, the volumes of the polishers were measured with a 3D volume scanner and compared with those before the experiments to evaluate the durability of the polishing system. A statistical analysis of all data was performed using 2-way ANOVA and the Tukey honest significant difference test (α=.05). RESULTS: The 2 zirconia polishing systems (Z1, Z2) created a significantly (P<.001) smoother surface, regardless of the type of specimens used for polishing, than the feldspathic porcelain polishing system (F1). When polishing treatment was carried out on zirconia specimens for 8 minutes, the maximum percentages of monoclinic phase increased by 0.03% in the Z1 system and by 0.09% in the Z2 system. The volume change for the durability evaluation of the polishing system was 13.35 and 29.37% in the Z1 system, 2.05 and 5.92% in the Z2 system, and 3.60 and 4.95% in the F1 system, respectively. CONCLUSIONS: Zirconia polishing systems created a smoother surface on zirconia than the feldspathic porcelain polishing system. No significant changes in the phase transformation of zirconia were found before and after polishing. Each polishing system showed different levels of wear resistance.

Evaluation of Osteoblast-Like Cell Viability and Differentiation on the Gly-Arg-Gly-Asp-Ser Peptide Immobilized Titanium Dioxide Nanotube via Chemical Grafting.

This study examined the effect of the immobilization of the Gly-Arg-Gly-Asp-Ser (GRGDS) peptide on titanium dioxide (TiO2) nanotube via chemical grafting on osteoblast-like cell (MG-63) viability and differentiation. The specimens were divided into two groups; TiO2 nanotubes and GRGDS-immobilized TiO2 nanotubes. The surface characteristics of GRGDS-immobilized TiO2 nanotubes were observed by using X-ray photoelectron spectroscopy (XPS) and a field emission scanning electron microscope (FE-SEM). The morphology of cells on specimens was observed by FE-SEM after 2 hr and 24 hr. The level of cell viability was investigated via a tetrazolium (XTT) assay after 2 and 4 days. Alkaline phosphatase (ALP) activity was evaluated to measure the cell differentiation after 4 and 7 days. The presence of nitrogen up-regulation or C==O carbons con- firmed that TiO2 nanotubes were immobilized with GRGDS peptides. Cell adhesion was enhanced on the GRGDS-immobilized TiO2 nanotubes compared to TiO2 nanotubes. Furthermore, significantly increased cell spreading and proliferation were observed with the cells grown on GRGDS-immobilized TiO2 nanotubes (P < .05). However, there was no significant difference in ALP activity between GRGDS-immobilized TiO2 nanotubes and TiO2 nanotubes. These results suggest that the GRGDS-immobilized TiO2 nanotubes might be effective in improving the osseointegration of dental implants.

Complete-mouth rehabilitation using a 3D printing technique and the CAD/CAM double scanning method: A clinical report.

According to evolving computer-aided design/computer-aided manufacturing (CAD/CAM) technology, ceramic materials such as zirconia can be used to create fixed dental prostheses for partial removable dental prostheses. Since 3D printing technology was introduced a few years ago, dental applications of this technique have gradually increased. This clinical report presents a complete-mouth rehabilitation using 3D printing and the CAD/CAM double-scanning method.

Analysis of Removal Torque of Injection Molded Zirconia Implants; An Experimental Study on Beagles.

This study compared the removal torque between injection molded zirconia implants and titanium implants with resorbable blast media (RBM) surfaces in beagle humeri. Fifteen screw-shaped implants were classified into 3 groups; titanium implant with RBM surface (Group RT), injection molded zirconia implant (Group Zr) and injection molded zirconia implant with sand-blasted surface (Group ZrS). Implants were inserted into beagle humeri. After 12 weeks, removal torque values were measured. The Zr group has a slightly higher removal torque value than the RT and ZrS groups but there were no significant differences among groups. Zirconia implants shows a similar removal torque to RBM titanium implants. This in vivo study showed injection molded zirconia implants could be an alternative to RBM titanium implants in terms of removal torque.

Shear bond strength between resin cement and colored zirconia made with metal chlorides.

STATEMENT OF PROBLEM: Although the application of zirconia in esthetic prostheses has increased, the shear bond strength (SBS) between colored zirconia and resin cement has not been investigated. PURPOSE: The purpose of this study was to compare the SBS between resin cement and colored zirconia made with metal chlorides. MATERIAL AND METHODS: Sixty-four zirconia specimens were divided into 2 groups: one in which the specimens were bonded with resin cement, including 4-META (4-methacryloxyethyl trimellitic anhydride), and one in which the specimens were bonded with resin cement (SEcure, Sun Medical) after being processed with zirconia primer (Zirconia Liner), including 4-META. Each group was then divided into 4 subgroups depending on the coloring liquid. The subgroups were noncolored (control), commercial coloring liquid VITA In-Ceram 2000 YZ LL1, aqueous chromium chloride solution 0.1 wt%, and aqueous molybdenum chloride solution 0.1 wt%. Composite resin cylinders (Filtek Z250, 3M ESPE) were fabricated and bonded to the surface of the zirconia specimen with resin cement (SEcure). All specimens were stored in 37°C distilled water for 24 hours, and the SBS was measured with a universal testing machine. All data were analyzed statistically with 2-way ANOVA and tested post hoc with the Tukey test (α=.05). RESULTS: Significant differences were observed among the SBS values of the colored zirconia depending on the coloring liquid (P<.001) and whether they were processed with zirconia primer (P<.001). The SBS between colored zirconia and resin cement was significantly higher than that of noncolored zirconia and resin cement in groups processed with zirconia primer (P<.05). Colored zirconia immersed in aqueous molybdenum chloride solution showed a significantly higher SBS. CONCLUSIONS: Coloring liquid enhanced the SBS between resin cement and zirconia processed with zirconia primer. In particular, colored zirconia immersed in aqueous molybdenum chloride solution showed the highest SBS.

Hydroxyapatite coatings on nanotubular titanium dioxide thin films prepared by radio frequency magnetron sputtering.

In this study, hydroxyapatite (HA) was coated on anodized titanium (Ti) surfaces through radio frequency magnetron sputtering in order to improve biological response of the titanium surface. All the samples were blasted with resorbable blasting media (RBM). RBM-blasted Ti surface, anodized Ti surface, as-sputtered HA coating on the anodized Ti surface, and heat-treated HA coating on the anodized Ti surface were prepared. The samples were characterized using scanning electron microscopy and X-ray photoemission spectroscopy, and biologic responses were evaluated. The top of the TiO2 nanotubes was not closed by HA particles when the coating time is less than 15 minutes. It was demonstrated that the heat-treated HA was well-crystallized and this enhanced the cell attachment of the anodized Ti surface.

Effect of transition metal dopants on mechanical properties and biocompatibility of zirconia ceramics.

In this study, the effect of transition metal dopants, originally added as colouring agents, on the mechanical properties and biocompatibility of sintered zirconia was investigated. This study confirmed that transition metal dopants could have a slight detrimental effect on the mechanical properties of zirconia. The addition of metal dopants did not affect the adhesion and proliferation of gingival fibroblasts.

Fracture strength and microstructure of Y-TZP zirconia after different surface treatments.

STATEMENT OF PROBLEM: Airborne-particle abrasion of the inner and outer surfaces of an yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) core is used in an attempt to enhance the bond strength between the core and the veneering porcelain and to increase the surface area for cementation. However, airborne-particle abrasion introduces surface flaws that act as stress concentrators that may compromise the mechanical strength of the ceramic. PURPOSE: The purpose of this study was to investigate the effect of airborne-particle abrasion and heat treatment on the microstructure, biaxial flexural strength, and reliability of Y-TZP zirconia ceramics before veneering and cementation. MATERIAL AND METHODS: Forty-eight disks (15 mm in diameter, 0.5 mm in thickness) of Y-TZP were divided into 6 groups. Three treatments (untreated, airborne-particle abrasion, and heat treatment after airborne-particle abrasion) were applied to the upper surfaces, and 2 treatments (untreated and airborne-particle abrasion) were applied to the lower surfaces to mimic the preparation for veneering and cementation. For airborne-particle abrasion, 110 µm Al2O3 particles were used. The maximum load at fracture was calculated with a biaxial flexural strength test. The upper surfaces were facing the loading piston, and the lower surfaces were facing the supporting jig during testing. Results were analyzed with 2-way ANOVA (α=.05). The treated and fractured surfaces were observed with a scanning electron microscope. The relative content of the monoclinic phase was quantified with an x-ray diffraction analysis. RESULTS: The group with airborne-particle abraded lower surfaces showed significantly higher flexural strength than the untreated group (P<.001). The SEM images of the airborne-particle abraded zirconia specimens showed rough and irregular surfaces. The fracture initiated from the tension side, which was opposite to the applied load. CONCLUSIONS: Within the limits of this in vitro study, the results showed that airborne-particle abrasion of the lower surfaces increases the flexural strength of Y-TZP zirconia.

A leptin-loaded poly-ϵ-caprolactone 3D printing scaffold for odontoblastic differentiation in human dental pulp cells.

This study investigated the effects on odontoblast differentiation of a 3D-printed poly-ϵ-caprolactone (PCL) scaffold that incorporated leptin. Material extrusion-type 3D printing with a 43 000-molecular weight PCL material was used to fabricate a PCL scaffold with a 6 mm diameter, 1 mm height, and 270-340 µm pore size. The experimental groups were PCL scaffolds (control group), PCL scaffolds with aminated surfaces (group A), and PCL scaffolds with leptin on the aminated surface (group L). The aminated surface was treated with 1,6-hexanediamine and verified by ninhydrin analysis. Leptin loading was performed using Traut's reagent and 4-(N-Maleimidomethyl)cyclohexane-1-carboxylic acid 3-sulfo-N-hydroxysuccinimide ester sodium salt (Sulfo-SMCC). Groups A and L showed significantly higher surface wettability, pulp cell adhesion, and proliferation than the control group. Group L exhibited increased alkaline phosphatase, calcification deposits, and mRNA and protein expression of dentin sialophosphoprotein and dentin matrix acidic phosphoprotein 1 compared with the control group. In this study, a 3D-printed PCL scaffold containing leptin was enhanced odontoblast differentiation and dental pulp cells adhesion and proliferation.

Allergic contact stomatitis caused by a titanium nitride-coated implant abutment: a clinical report.

A patient developed contact mucositis after being treated with a titanium nitride implant abutment. Patch testing disclosed a positive reaction to titanium nitride. After removal of the titanium nitride-coated abutment and placement of an uncoated abutment, all signs and symptoms disappeared. This clinical report suggests that titanium nitride-coated abutments may be a potential allergen in some patients.

Fracture load of titanium crowns coated with gold or titanium nitride and bonded to low-fusing porcelain.

STATEMENT OF PROBLEM: It is difficult to achieve a reliable bond between the titanium copings and veneering porcelain of restorations. PURPOSE: The purpose of this study was to investigate the effect of various treatments on the fracture load of bonded titanium and porcelain components of crown restorations. MATERIAL AND METHODS: In this study, the surfaces of titanium copings (n=6) were either airborne-particle abraded with Al(2)O(3) particles, sputter coated with gold, or coated with TiN. Gold ceramic crowns served as the control group (n=6). The effects of these treatments on the fracture load of bonded titanium and low-fusing porcelain were investigated. A universal testing machine was used to determine the fracture load (N) of the crowns. All data were compared using 1-way ANOVA and the post hoc multiple range Tukey test (α=.05). In addition, the metal ceramic interfaces were examined by scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDS). RESULTS: The gold-coated titanium (1035 +/-41 N) and TiN-coated titanium (969 +/-93 N) had significantly higher fracture loads (P<.001) than the airborne-particle-abraded titanium ceramic crowns (865+/-44 N). The gold-coated and TiN-coated titanium specimens demonstrated fracture loads similar to that of gold ceramic crowns (1026 +/-50 N) [corrected]. SEM/EDS showed that after the crowns fractured, the gold control group and gold- and TiN-coated titanium specimens had more adherent porcelain on their surfaces than the uncoated titanium that was airborne-particle abraded with Al(2)O(3) particles. CONCLUSIONS: The in vitro fracture load of titanium crowns coated with gold or titanium nitride and bonded to low-fusing porcelain is comparable to that of gold ceramic crowns, and higher than loads observed with uncoated titanium airborne-particle abraded with Al(2)O(3) particles.

Three-Dimensional Zirconia-Based Scaffolds for Load-Bearing Bone-Regeneration Applications: Prospects and Challenges.

The design of zirconia-based scaffolds using conventional techniques for bone-regeneration applications has been studied extensively. Similar to dental applications, the use of three-dimensional (3D) zirconia-based ceramics for bone tissue engineering (BTE) has recently attracted considerable attention because of their high mechanical strength and biocompatibility. However, techniques to fabricate zirconia-based scaffolds for bone regeneration are in a stage of infancy. Hence, the biological activities of zirconia-based ceramics for bone-regeneration applications have not been fully investigated, in contrast to the well-established calcium phosphate-based ceramics for bone-regeneration applications. This paper outlines recent research developments and challenges concerning numerous three-dimensional (3D) zirconia-based scaffolds and reviews the associated fundamental fabrication techniques, key 3D fabrication developments and practical encounters to identify the optimal 3D fabrication technique for obtaining 3D zirconia-based scaffolds suitable for real-world applications. This review mainly summarized the articles that focused on in vitro and in vivo studies along with the fundamental mechanical characterizations on the 3D zirconia-based scaffolds.