Clinical outcomes of milled, 3D-printed, and conventional complete dentures in edentulous patients: A systematic review and meta-analysis.

PURPOSE: This systematic review aims to compare clinical outcomes of digital dentures with conventional dentures. MATERIALS AND METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in Prospero. The formulated population, intervention, comparison, outcome (PICO) question was "What is the clinical outcome of digital versus conventional complete dentures (CDs) in edentulous patients?". The search strategy used three main electronic databases and an additional manual search was completed in August 2023 by following an established search strategy. Initial inclusion was based on titles and abstracts, followed by a detailed review of selected studies, and clinical studies that evaluated the clinical outcome of digital (milled or 3D-printed) versus conventional CDs were included. A qualitative analysis for clinical studies was used to assess the risk of bias. The certainty of the evidence was assessed according to the grading of recommendations, assessment, development, and evaluations (GRADE) system. In addition, a single-arm meta-analysis was performed to evaluate the retention between digital versus conventional CDs. RESULTS: The initial search yielded a total of 947 articles, out of which 19 were selected for a comprehensive review, and six met the eligibility criteria to be included in this systematic review. The computer-aided design and computer-aided manufacturing (CAD-CAM) CDs showed increased retention, no relevant differences in oral health-related quality of life (OHRQoL), and shorter working time compared to conventional dentures. Two studies were eligible for meta-analysis; retention was significantly better among CAD-CAM fabricated dentures (standardized mean difference [SMD] 0.501) than conventional dentures. The heterogeneity between studies was high (95% CI: 0.049-0.952). CONCLUSIONS: Clinically, both the milled and the 3D-printed CD fared better than conventional dentures in terms of retention, reduction in the number of appointments, improved patient comfort, and improved predictable maintenance of the denture. Patients' perceptions and satisfaction were independent of the digital and conventional fabricated dentures.

Effect of a new support design on the marginal and internal gap of additively manufactured interim crowns using direct light deposition technology.

PURPOSE: To investigate the design and location of supporting structures on the marginal and internal gap of interim restorations. MATERIALS AND METHODS: A mandibular right first molar resin tooth was prepared for a full coverage crown and scanned using a laboratory scanner (3Shape D900). The scanned data were converted into standard tessellation language (STL) format and an indirect prosthesis was designed using computer-aided design (CAD) software (exocad DentalCAD). The STL file was used to fabricate a total of 60 crowns with a 3D printer (EnvisionTEC Vida HD). The crowns were printed using E-Dent C&B MH resin and divided into 4 groups based on four different support structure designs, including supports on the occlusal (0° group), buccal and occlusal (45° group), buccal (90° group), and a new design consisting of horizontal bars placed on all surfaces and line angles (Bar) (n = 15). The silicone replica technique was used to determine the gap discrepancy. Fifty measurements were obtained for each specimen to examine the marginal and internal gaps by using a digital microscope (Olympus SZX16) at ×70 magnification. Additionally, the marginal discrepancy at different locations of the tested crowns, including buccal (B), lingual (L), mesial (M), and distal (D), as well as the maximum and minimum marginal gap intervals among groups, were analyzed. The collected data were analyzed using factorial ANOVA, followed by the Tukey HSD test for multiple comparisons (a = 0.05). RESULTS: There was a significant difference in marginal and internal gaps among the groups (p < 0.001). The buccal placement supports (90° group) had the least marginal and internal discrepancies (p < 0.001). The new design group showed the highest marginal and internal gap. The marginal discrepancy in different locations of the tested crowns (B, L, M, D) was found to be significantly different among the groups (p < 0.001). The mesial margin of the Bar group had the largest marginal gap, whereas the buccal margin of the 90° group had the lowest marginal gap. The new design had a significantly smaller difference between the maximum and minimum marginal gap intervals than other groups (p < 0.001). CONCLUSION: The location and design of the supporting structures affected the marginal and internal gaps of an interim crown. The buccal placement of supporting bars (90° printing orientation) showed the smallest mean internal and marginal discrepancies.

Comparative evaluation of gingival fibroblast growth on 3D-printed and milled zirconia: An in vitro study.

PURPOSE: The purpose of this study was to analyze the fibroblast growth and proliferation on 3D-printed zirconia in presence and absence of porosities. MATERIAL AND METHODS: A total of 40 bars (8 × 4 × 3) were included in this study. Thirty 3D-printed and 10 milled zirconia samples were prepared. The 3D-printed samples had different porosities, 0% (PZ0), 20% (PZ20), and 40% (PZ40) with 10 specimens in each group. Milled zirconia samples were used as the control (MZ). Rat gingival fibroblasts were cultured for 48 h, and the proliferation of fibroblasts on each sample in each group (n = 10) was determined by MTT assays. The differences among the four groups were compared by one-way ANOVA. To test the significance of the observed differences between two groups, an unpaired Student's t-test was applied. The significance level was set at p < 0.05. Qualitative analysis for the cell culture was performed using scanning electron microscopy. RESULTS: One-way ANOVA showed that the numbers of the fibroblasts among the four groups had a statistical difference. Post hoc Bonferroni test revealed that there was no significant difference between PZ0 and MZ; however, all other groups and among groups were significantly different. CONCLUSIONS: Fibroblasts had a better affinity toward the MZ and PZ0 in a short period of cell culture time.

Exploring the impact of the extent of the partially edentulous area on the accuracy of two intraoral scanners.

STATEMENT OF PROBLEM: The accuracy of intraoral scans, particularly in edentulous areas, remains a concern despite the increasing use of digital technology, especially intraoral scanners. PURPOSE: The purpose of this in vitro study was to assess the impact of the extent of an edentulous area on the accuracy (trueness and precision) of intraoral scans from 2 intraoral scanners. MATERIAL AND METHODS: A KaVo dentoform with epoxy resin teeth was used to generate 9 groups with different numbers of teeth removed. A laboratory scanner served as the reference dataset, and 2 intraoral scanners (TRIOS 3 and Primescan AC) were evaluated. A single operator performed all scans following standardized protocols and calibration. Trueness and precision were assessed by using root mean square (RMS) values. Analysis of variance was used to compare trueness and precision values obtained from the 2 scanners and different partially edentulous conditions (α=.05). RESULTS: A significant difference was found in the trueness of intraoral scans of the 2 scanners and under different partially edentulous extensions. Primescan AC exhibited significantly lower trueness than TRIOS 3 (P<.001). For the individual edentulous conditions, Primescan had a significantly higher RMS mean than TRIOS 3 for G0, G3, G4, G6, G7, and G8 (P<.001) and a significantly lower RMS mean than TRIOS 3 for G1 and G4 (P<.001), while no significant difference in RMS mean was found between the 2 scanners for G2 (P=.999). For precision, no significant difference was found between the 2 scanners or different edentulous conditions [(F 8, 90)=1.82, P=.085]. CONCLUSIONS: The accuracy of intraoral scans was influenced by the length of edentulous areas and the scanner used. Primescan AC demonstrated lower trueness than TRIOS 3 for most partially edentulous conditions, while the scanners were similar in precision. These findings highlight the need for careful scanner selection in specific clinical situations, as scanning accuracy may vary depending on the scanner and edentulous condition.

Color Stability of Resin Hybrid Ceramic Materials in Comparison to Zirconia-Reinforced Lithium Silicate Ceramic.

Objectives: This in vitro study aimed to compare the effect of external staining agents (black tea and grape juice) on the color change of three hybrid ceramics including a new material in comparison to zirconia-reinforced lithium silicate. Materials and Methods: Ten samples of two hybrid dental ceramics including Vita Enamic (Vita Zahnfabrik) and Crystal Ultra (Digital Dental) in addition to a resin nanoceramic, Lava Ultimate (3M ESPE); and a zirconia-reinforced lithium silicate glass ceramic, Vita Suprinity (Vita Zahnfabrik) were prepared and immersed in black tea or grape juice for 30 days. A spectrophotometer was used to evaluate color change. All samples were carefully chosen in A3 shades or their equivalent. Two-way ANOVA and Bonferroni tests were used to analyze the color differences (ΔE00) among the materials and the staining solutions at a significant level of 0.05. Results: Significant color changes were observed in Vita Enamic and Lava Ultimate groups after immersion in both solutions (P<0.001). The least color changes (ΔE00) belonged to the Vita Suprinity (1.34) and Crystal Ultra (1.92) groups, respectively. Conclusion: The color changes of Vita Enamic and Lava Ultimate materials were beyond clinical acceptability. However, the mean color changes of Vita Suprinity and Crystal Ultra groups were clinically acceptable.

Influence of Polymerization Postprocessing Procedures on the Accuracy of Additively Manufactured Dental Model Material.

PURPOSE: To measure the influence of postpolymerization condition (dry and water-submerged) and time (2, 10, 20, and 40 minutes) on the accuracy of additively manufactured model material. MATERIALS AND METHODS: A bar standard tessellation language (STL) file was used to manufacture all the resin specimens using a 3D printer. Two groups (n = 80 each) were created based on postpolymerization condition: dry (D group) and water-submerged (W group). Each group was then divided into four subgroups (D1 to D4 and W1 to W4; n = 20 each), which were each assigned a postpolymerizing time (2, 10, 20, and 40 minutes). The specimens' dimensions were measured using a low-force digital caliper. The volume was calculated as follows: V = l × w × h. Shapiro-Wilk test revealed that the data were not normally distributed. Data were analyzed using Kruskal-Wallis and pairwise Mann-Whitney U tests (α = .05). RESULTS: Significant differences in length, width, height, and volume were found among the subgroups (P < .0018). In all groups, the width dimension (x-axis) presented less accuracy compared to height (z-axis) and length (y-axis) (P < .0018). The D2 and D4 subgroups obtained the closest dimensions to the virtual design, and there were no significant differences between these subgroups (P < .0018). The dry condition showed higher manufacturing accuracy than the water-submerged condition. In the water-submerged subgroups, the highest accuracy was obtained in the W2 and W4 subgroups (P < .0018). CONCLUSIONS: Postpolymerization condition and time influenced the accuracy of the material tested. The dry postpolymerization condition with times of 10 and 40 minutes obtained the highest accuracy.

Marginal and internal discrepancies associated with carbon digital light synthesis additively manufactured interim crowns.

STATEMENT OF PROBLEM: The carbon digital light synthesis (DLS) or continuous liquid interface production (CLIP) technology is an innovative additive manufacturing technology using oxygen-inhibited photopolymerization to create a continuous liquid interface of unpolymerized resin between the growing component and the exposure window. This interface eliminates the need for an incremental layer-by-layer approach, allowing for continuous creation and increased printing speed. However, the internal and marginal discrepancies associated with this new technology remain unclear. PURPOSE: The purpose of this in vitro study was to evaluate the marginal and internal discrepancies by using the silicone replica technique of interim crowns fabricated by 3 different manufacturing technologies: direct light processing (DLP), DLS, and milling. MATERIAL AND METHODS: A mandibular first molar was prepared, and a crown was designed with a computer-aided design (CAD) software program. The standard tessellation language (STL) file was used to create 30 crowns from the DLP, DLS, milling technologies (n=10). The gap discrepancy was determined using the silicone replica approach, with 50 measurements made with a ×70 microscope for each specimen for the marginal and internal gaps. The data were analyzed using 1-way ANOVA, followed by the Tukey HSD post hoc test (α=.05). RESULTS: The DLS group had the least marginal discrepancy compared with the DLP and milling groups (P<.001). The DLP group showed the highest internal discrepancy followed by the DLS and milling groups (P=.038). No significant difference was found between DLS and milling in terms of internal discrepancy (P>.05). CONCLUSIONS: The manufacturing technique had a significant effect on both internal and marginal discrepancies. The DLS technology showed the smallest marginal discrepancies.

Shear bond strength of porcelain to milled and stereolithography additively manufactured zirconia with and without surface treatment: An in vitro study.

STATEMENT OF PROBLEM: Delamination of veneering ceramic is one of the most common challenges relating to veneered zirconia restorations. Additive manufacturing (AM) is a fast-expanding technology that has gained widespread acceptance in dentistry and is increasingly being used to produce dental restorations. However, information about bonding of porcelain to AM zirconia is lacking. PURPOSE: The purpose of this in vitro study was to investigate the shear bond strength (SBS) of porcelain to milled and additively manufactured zirconia, and the effect of surface treatment on bond strength. MATERIAL AND METHODS: A Ø12×5-mm disk was designed virtually to fabricate all specimens, which were divided into 2 groups according to the manufacturing technique: additively manufactured or milled zirconia. The effect of airborne-particle abrasion and a zirconia liner before porcelain application was investigated in both groups. Veneering porcelain was fired into an alumina ring mold on the zirconia surface. SBS was measured by using a universal testing machine at a crosshead speed of 1 mm/min before and after aging (n=10). SBS data were analyzed with 3-way ANOVA (α=.05) RESULTS: A significant difference was found between milled and AM zirconia. The SBS of porcelain to milled zirconia was significantly higher (1.38 MPa) than to AM zirconia (0.68 MPa) (P<.001). The surface treatment of zirconia had no significant effect on porcelain SBS in either group (P=.254), whereas thermocycling significantly reduced the SBS of porcelain to zirconia in both milled and AM groups (P=.001). CONCLUSIONS: Porcelain bonding to milled zirconia was better than to AM zirconia. Pretreating the zirconia substrate before porcelain application did not improve the porcelain bond.

Biaxial flexural strength and Weibull characteristics of a resin ceramic material after thermal-cycling.

PURPOSE: The purpose of this in vitro study was to compare the flexural strength and Weibull characteristics of 3 different resin-ceramic materials with a zirconia-reinforced lithium silicate material after thermal-cycling. MATERIAL AND METHODS: Four different computer-aided design and computer-aided manufacturing restorative materials (Vita Enamic, Lava Ultimate, Crystal Ultra, and Vita Suprinity) were tested. A total of 40 Ø12×1.2-mm disks were prepared and divided into 4 groups (n = 10). Their flexural strength was evaluated after 5000 thermal-cycles with a 4-point biaxial flexure test using a universal testing machine. The Weibull modulus and probability of failure were also determined from the biaxial flexural strength data. Data were analyzed with one-way ANOVA and the Tukey pairwise comparison test (α = 0.05). RESULTS: Significant differences were found among the materials in terms of biaxial flexural strength (p < 0.05). Vita Suprinity had the highest mean ±standard deviation flexural strength (289.1 ± 15.1 MPa), and Vita Enamic had the lowest (100.0 ± 3.2 MPa). The highest Weibull modulus was calculated for Crystal Ultra, followed by Vita Enamic, Lava Ultimate, and Vita Suprinity. CONCLUSION: Vita Suprinity had the highest flexural strength when compared with the other materials tested. Crystal Ultra had the highest flexural strength among the resin-ceramic materials. The highest Weibull modulus was calculated for Crystal Ultra and the lowest for Vita Suprinity.

Surface roughness and shear bond strength to composite resin of additively manufactured interim restorative material with different printing orientations.

STATEMENT OF PROBLEM: Additive manufacturing (AM) is a technology that has been recently introduced into dentistry for fabricating dental devices, including interim restorations. Printing orientation is one of the important and influential factors in AM that affects the accuracy, surface roughness, and mechanical characteristics of printed objects. However, the optimal print orientation for best bond strength to 3D-printed interim restorations remains unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effect of printing orientation on the surface roughness, topography, and shear bond strength of AM interim restorations to composite resin. MATERIAL AND METHODS: Disk-shaped specimens (Ø20×10 mm) were designed by a computer-aided design software program (Geomagic freeform), and a standard tessellation language (STL) file was obtained. The STL file was used for the AM of 60 disks in 3 different printing orientations (0, 45, and 90 degrees) by using E-Dent 400 C&B material. An autopolymerizing interim material (Protemp 4) was used as a control group (CNT), and specimens were fabricated by using the injecting mold technique (n=20). Surface roughness (Sa, Sz parameters) was measured by using a 3D-laser scanning confocal microscope (CLSM) at ×20 magnification. For shear bond testing, the specimens were embedded in polymethylmethacrylate autopolymerized resin (n=20). A flowable composite resin was bonded by using an adhesive system. The specimens were stored in distilled water at 37 °C for 1 day and thermocycled 5000 times. The shear bond strength (SBS) was measured at a crosshead speed of 1 mm/min. The data were analyzed by 1-way ANOVA, followed by the Tukey HSD test (α=.05). RESULTS: The 45-degree angulation printing group reported the highest Sa, followed by the CNT and the 90-degree and 0-degree angulations with significant difference between them (P<.001). The CNT showed the highest Sz, followed by the 45-degree, 90-degree, and 0-degree angulations. The mean ±standard deviation SBS was 28.73 ±5.82 MPa for the 90-degree, 28.21 ±10.69 MPa for the 45-degree, 26.21 ±11.19 MPa for the 0-degree angulations and 25.39 ±4.67 MPa for the CNT. However, no statistically significant difference was found in the SBS among the groups (P=.475). CONCLUSIONS: Printing orientation significantly impacted the surface roughness of 3D-printed resin for interim restorations. However, printing orientation did not significantly affect the bond strength with composite resin.

Influence of base design on the manufacturing accuracy of vat-polymerized diagnostic casts: An in vitro study.

STATEMENT OF PROBLEM: Vat-polymerized casts can be designed with different bases, but the influence of the base design on the accuracy of the casts remains unclear. PURPOSE: The purpose of the present in vitro study was to evaluate the influence of various base designs (solid, honeycombed, and hollow) with 2 different wall thicknesses (1 mm and 2 mm) on the accuracy of vat-polymerized diagnostic casts. MATERIAL AND METHODS: A virtual maxillary cast was obtained and used to create 3 different base designs: solid (S group), honeycombed (HC group), and hollow (H group). The HC and H groups were further divided into 2 subgroups based on the wall thickness of the cast designed: 1 mm (HC-1 and H-1) and 2 mm (HC-2 and H-2) (N=50, n=10). All the specimens were manufactured with a vat-polymerized printer (Nexdent 5100) and a resin material (Nexdent Model Ortho). The linear and 3D discrepancies between the virtual cast and each specimen were measured with a coordinate measuring machine. Trueness was defined as the mean of the average absolute dimensional discrepancy between the virtual cast and the AM specimens and precision as the standard deviation of the dimensional discrepancies between the virtual cast and the AM specimens. The Kolmogorov-Smirnov and Shapiro-Wilk tests revealed that the data were not normally distributed. The data were analyzed with Kruskal-Wallis and Mann-Whitney U pairwise comparison tests (α=.05). RESULTS: The trueness ranged from 63.73 µm to 77.17 µm, and the precision ranged from 44.00 µm to 54.24 µm. The Kruskal-Wallis test revealed significant differences on the x- (P<.001), y- (P=.006), and z-axes (P<.001) and on the 3D discrepancy (P<.001). On the x-axis, the Mann-Whitney test revealed significant differences between the S and H-1 groups (P<.001), S and H-2 groups (P<.001), HC-1 and H-1 groups (P<.001), HC-1 and H-2 groups (P<.001), HC-2 and H-1 groups (P<.001), and HC-2 and H-2 groups (P<.001); on the y-axis, between the S and H-1 groups (P<.001), HC-1 and H-1 groups (P=.001), HC-1 and H-2 groups (P=.02), HC-2 and H-1 groups (P<.001), HC-2 and H-2 groups (P=.003); and on the z-axis, between the S and H-1 groups (P=.003). For the 3D discrepancy analysis, significant differences were found between the S and H-1 groups (P<.001), S and H-2 groups (P=.004), HC-1 and H-1 groups (P=.04), and HC-2 and H-1 groups (P=.002). CONCLUSIONS: The base designs tested influenced the manufacturing accuracy of the diagnostic casts fabricated with a vat-polymerization printer, with the solid and honeycombed bases providing the greatest accuracy. However, all the specimens were clinically acceptable.

Best-Fit Algorithm Influences on Virtual Casts' Alignment Discrepancies.

PURPOSE: To measure the influence of best-fit (BF) algorithms (entire dataset, 3 or 6 points landmark-based, or section-based BF) on virtual casts and their alignment discrepancies. MATERIAL AND METHODS: A mandibular typodont was obtained and digitized by using an industrial scanner (GOM Atos Q 3D 12M). A control mesh was acquired. The typodont was digitized by using an intraoral scanner (TRIOS 4). Based on the alignment procedures, four groups were created: BF of the entire dataset (BF group), landmark-based BF using 3 reference points (LBF-3 group), or 6 reference points (LBF-6 group), and section-based BF (SBF group). The root mean square (RMS) error was calculated. One-way ANOVA and post hoc pairwise multi-comparison Tukey were used to analyze the data (α = 0.05). RESULTS: Significant RMS error mean value differences were found across the groups (p < 0.001). Tukey test revealed significant RMS error mean value differences between the BF and LBF-3 groups (p = 0.022), BF and LBF-6 groups (p < 0.001), LB-3 and LB-6 groups (p < 0.001), LBF-3 and SBF groups (p < 0.001), and LBF-6 and SBF groups (p < 0.001). The LBF-6 group had the lowest trueness, while SBF and BF groups obtained the highest trueness values. Furthermore, significant SD differences were revealed across the groups tested (p < 0.001). Tukey test revealed significant SD differences between the BF and LBF-6 groups (p < 0.001), LBF-3 and LB-6 groups (p < 0.001), LBF-3 and SBF groups (p = 0.004), and LBF-6 and SBF groups (p < 0.001). The BF and SBF groups showed equal and highest precision, while the LBF-6 group had the lowest precision. CONCLUSIONS: The best-fit algorithms tested influenced the virtual casts' alignment discrepancy. Entire dataset or section-based best-fit algorithms obtained the highest virtual casts' alignment trueness and precision compared with the landmark-based method.

A complete digital approach for facially generated full arch diagnostic wax up, guided surgery, and implant-supported interim prosthesis by integrating 3D facial scanning, intraoral scan and CBCT.

Continuous innovation in digital dental technology offers new prospects for creating a complete virtual environment. The technique described adds a facial approach to the conventional digital workflow by incorporating 3D face scans to cone beam computed tomography and intraoral scans. Using this workflow, clinicians can obtain a complete virtual patient for facially generated diagnostic wax up and plan and implement a predictable implant placement and interim prosthesis. This technique provides a full digital workflow for restoratively-driven computer-aided implant planning, guided surgery, and 3D printing of an interim complete-arch fixed implant-supported prosthesis.

Computer-aided design and additively manufactured resin-bonded framework to retain an existing ceramic crown as the interim restoration after extraction: A dental technique.

A novel way to use the patient's existing ceramic crown from a nonrestorable maxillary anterior tooth as part of the interim restoration after extraction is described. The crown was fixed intraorally with a digitally designed and 3D-printed resin-bonded fixed dental prosthesis framework in its pre-extraction position. The procedure maintained esthetics, optimized soft-tissue management, and provided a fixed prosthesis before implant placement in the esthetic zone.

Surface Roughness and Bond Strength of Resin Composite to Additively Manufactured Zirconia with Different Porosities.

PURPOSE: To investigate the bond strength of resin cement to additively manufactured (AM) zirconia with different porosities when compared to milled zirconia. MATERIALS AND METHODS: A 12 × 5 mm disk virtual design file was used to fabricate a total of 48 disks divided into 4 groups: 3 groups were AM with different porosities including 0%-porosity (AMZ0 group), 20%-porosity (AMZ20 group), and 40%-porosity (AMZ40 group), and 1 milled zirconia (control or CNCZ group). The dimensions of all specimens were measured using a digital caliper. A 3D- confocal laser scanner was used to analyze surface morphology and measure the surface roughness (Sa), followed by SEM analysis. Tensile bond strength of composite resin cement to specimens was measured before and after aging procedures using a universal testing machine (n = 10). Failure modes were evaluated under a light microscope. Volumetric change data was analyzed using one-way ANOVA, and two-way ANOVA was used to compare bond strength values (α = 0.05). RESULTS: There was a significant difference in volumetric changes among the groups. The CNCZ group showed the least changes in diameter 0.027 ± 0.029 mm and thickness 0.030 ± 0.012 mm and AM zirconia with 40% porosity showed the most volumetric changes in diameter 5.237 ± 0.023 mm. ANOVA test indicated an overall significant difference in surface roughness across all groups (F = 242.6, p < 0.001). The CNCZ group showed the highest mean Sa of 1.649 ± 0.240 µm, followed by AMZ40 group with Sa of 0.830 ± 0.063 µm, AMZ20 group with Sa of 0.780 ± 0.070 µm, and the AMZ0 group with Sa of 0.612 ± 0.063 µm. Two-way ANOVA showed significant difference in bond strength between the CNCZ group 12.109 ± 3.223 MPa and the AMZ0 group 8.629 ± 0.914 MPa, with significant pretest failures in specimens with porosities. Thermal cycling methods reduced the bond strength non-significantly in CNCZ group with no effect in the AMZ0 group. CONCLUSION: Milled zirconia had a higher surface roughness and bond strength to composite resin cement than AM zirconia, and porosities in AM zirconia decreased the bond strength with significant pretest failures.

Manufacturing accuracy and volumetric changes of stereolithography additively manufactured zirconia with different porosities.

STATEMENT OF PROBLEM: When compared with subtractive fabricating methods, additive manufacturing (AM) technologies are capable of fabricating complex geometries with different material porosities. However, the manufacturing accuracy and shrinkage of the stereolithography (SLA) AM zirconia with different porosities are unclear. PURPOSE: The purpose of this in vitro study was to measure the manufacturing accuracy and volumetric changes of AM zirconia specimens with porosities of 0%, 20%, and 40%. MATERIAL AND METHODS: A digital design of a bar (25×4×3 mm) was obtained by using an open-source software program (Blender, version 2.77a; The Blender Foundation). The standard tessellation language (STL) file was exported. Three groups were created based on the material porosity: 0% porosity (0% group), 20% porosity (20% group), and 40% porosity (40% group). The STL was used to manufacture all the specimens by using an SLA ceramic printer (CeraMaker 900; 3DCeram Co) and zirconia material (3DMix ZrO2 paste; 3DCeram Co) (n=20). After manufacturing, the specimens were cleaned of the green parts by using a semiautomated cleaning station. Subsequently, debinding procedures was completed in a furnace at 600 °C. The sintering procedures varied among the groups to achieve different porosities. For the 0% group, the ZrO2 was sintered in a furnace at 1450 °C, and for the 20% and 40% groups, the sintering temperature varied between 1450 °C and 1225 °C. The specimen dimensions (length, width, and height) were measured 3 times with digital calipers, and the mean value was determined. The manufacturing volume shrinkage (%) was calculated by using the digital design of the bar and the achieved AM dimensions of the specimens. The Shapiro-Wilk test revealed that the data were not normally distributed. Therefore, the data were analyzed by using the Kruskal-Wallis followed by pairwise Mann-Whitney U tests (α=.05). RESULTS: The Kruskal-Wallis test demonstrated significant differences among the groups in length, width, and height (P<.001). The Mann-Whitney U test indicated significant differences in pairwise comparisons of length, width, and height among the 3 groups (P<.001). The 0% group obtained a median ±interquartile range values of 20.92 ±0.14 mm in length, 3.43 ±0.07 mm in width, and 2.39 ±0.03 mm in height; the 20% group obtained 22.81 ±0.29 mm in length, 3.74 ±0.07 mm in width, and 2.62 ±0.05 mm in height; and the 40% group presented 25.11 ±0.13 mm in length, 4.14 ±0.08 mm in width, and 2.96 ±0.02 mm in height. Significant differences in manufacturing volumetric changes were encountered among the 3 groups (P<.001). In all groups, volumetric changes in the length, width, and height were not uniform, being higher in the z-axis direction compared with the x- and y-axis. The manufacturing volumetric changes varied from -20.33 ±1.00% to +3.5 ±2.00%. CONCLUSIONS: The 40%-porosity group obtained the highest manufacturing accuracy and the lowest manufacturing volume change, followed by the 20%-porosity and the 0%-porosity groups. An uneven manufacturing volume change in the x-, y-, and z-axis was observed. However, none of the groups tested were able to perfectly match the virtual design of the specimens.

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.

Accuracy of a patient 3-dimensional virtual representation obtained from the superimposition of facial and intraoral scans guided by extraoral and intraoral scan body systems.

STATEMENT OF PROBLEM: A patient 3-dimensional virtual representation aims to facilitate the integration of facial references into treatment planning or prosthesis design procedures, but the accuracy of the virtual patient representation remains unclear. PURPOSE: The purpose of the present observational clinical study was to determine and compare the accuracy (trueness and precision) of a virtual patient obtained from the superimposition procedures of facial and intraoral digital scans guided by 2 scan body systems. MATERIAL AND METHODS: Ten participants were recruited. An intraoral digital scan was completed (TRIOS 4). Four fiduciary markers were placed in the glabella (Gb), left (IOL) and right infraorbital canal (IOR), and tip of the nose (TN). Two digitizing procedures were completed: cone beam computed tomography (CBCT) (i-CAT FLX V-Series) and facial scans (Face Camera Pro Bellus) with 2 different scan body systems: AFT (ScanBodyFace) and Sat 3D (Sat 3D). For the AFT system, a reference facial scan was obtained, followed by a facial scan with the participant in the same position as when capturing the CBCT scan. For the Sat 3D system, a reference facial scan was recorded, followed by a facial scan with the patient in the same position as when capturing the CBCT scan. The patient 3-dimensional representation for each scan body system was obtained by using a computer program (Matera 2.4). A total of 14 interlandmark distances were measured in the CBCT scan and both 3-dimensional patient representations. The discrepancies between the CBCT scan (considered the standard) and each 3-dimensional representation of each patient were used to analyze the data. The Kolmogorov-Smirnov test revealed that trueness and precision values were not normally distributed (P<.05). A log10 transformation was performed with 1-way repeated-measures MANOVA (α=.05). RESULTS: The accuracy of the virtual 3-dimensional patient representations obtained by using AFT and Sat 3D systems showed a trueness ranging from 0.50 to 1.64 mm and a precision ranging from 0.04 to 0.14 mm. The Wilks lambda detected an overall significant difference in the accuracy values between the AFT and Sat 3D systems (F=3628.041, df=14, P<.001). A significant difference was found in 12 of the 14 interlandmark measurements (P<.05). The AFT system presented significantly higher discrepancy values in Gb-IOL, TN-IOR, IOL-IOR, and TN-6 (P<.05) than in the Sat 3D system. The Sat 3D system had a significantly higher discrepancy in Gb-TN, TN-IOL, IOL-3, IOL-6, TN-8, TN-9, TN-11, IOR-11, and IOR-14 (P<.05) than in the AFT system. The Wilcoxon signed-rank test did not detect any significant difference in the precision values between the AFT and Sat 3D systems (Z=-0.838, P=.402). CONCLUSIONS: The accuracy of the patient 3-dimensional virtual representations obtained using AFT and Sat 3D systems showed trueness values ranging from 0.50 to 1.64 mm and precision values ranging from 0.04 to 0.14 mm. The AFT system obtained higher trueness than the Sat 3D system, but both systems showed similar precision values.

Fabrication of a complete-arch implant-supported fixed interim prosthesis by using a cone beam computed tomography digital scan for a patient with primordial dwarfism: A dental technique.

A complete-arch implant-supported interim prosthesis was fabricated from a cone beam computed tomography digital scan of the implant abutments for a patient with primordial dwarfism. The patient presented with limited mouth opening, which hindered the use of a conventional impression technique. The described technique provided an alternative digital procedure to obtain a virtual implant definitive cast.