Repair strength of 3D-printed denture base resins: Effect of surface treatment and repair material type.

PURPOSE: The aim of the study was to investigate the effect of surface treatment and repair materials on the flexural strength of repaired 3D-printed denture base resins after thermal aging. MATERIALS AND METHODS: Bar-shape specimens (64 × 10 × 3.3 mm) were designed as intact (control) specimens while repair specimens were printed in sections with 2.5 mm space for repair material. Printing was performed with either ASIGA or NextDent denture base material. In each material, one group received no surface treatment, while other repair groups were subjected to one of three surface treatments: (1) monomer application, (2) aluminium oxide particles-abrasion, or (3) both methods (aluminum oxide particles-abrasion and monomer application). Pairs were fixed in a customized mold then repaired with either autopolymerizing acrylic resin or flowable composite (n = 9). Repaired specimens were incubated for 48 h at 37°C in distilled water and then subjected to thermal cycling (5000 cycles). A 3-point bending test was used to evaluate the flexural strength using a universal testing machine, and mode of failure determined followed by fractured surface analysis using scanning electron microscope. Data were analyzed using ANOVA and post hoc Tukey test (α = 0.05). RESULTS: Both resin materials showed a significant decrease in the flexural strength of repaired specimens when compared to control ones (p < 0.001). Groups with no surface treatment had significantly lower flexural strength than those with surface treatment (p < 0.001). Groups treated with monomer application, and with aluminum oxide particles abrasion plus monomer application had similar flexural strength values (p > 0.05), which were higher than those treated with aluminum oxide particles abrasion alone (p < 0.001). Specimens repaired with composite resin showed higher flexural strength than those repaired with auto-polymerized resin (p < 0.05) however, specimens treated with aluminum oxide particles abrasion alone had similar values for both repair materials (p = 0.95). Adhesive failure was dominant in all repaired groups with auto-polymerized while cohesive and mixed were dominant with composite repair groups. CONCLUSION: Surface treatment improved the repair strength of 3D-printed denture base resins. Using composite resin for repair shows better strength with dominant cohesive and mixed failure suggesting that surface treatment and composite repair are suitable procedures for 3D-printed denture base repair.

SEQUEL: Prevalence of dental caries in Saudi Arabia: A systematic review and Meta-analysis.

This meta-analysis investigated the prevalence of dental caries throughout the Kingdom of Saudi Arabia (KSA) between 2011 and 2023 as a follow-up to a previously published review in 2013 by Khan et al. and aimed to provide an update on the current status of caries prevalence in the KSA. A literature search was conducted, and thirty-three articles were included in the final analysis. To determine the prevalence of caries in primary teeth, the 2- to 12-year-old Saudi population was included in the search, and an age range of 6-18 years was used for permanent teeth. The prevalence of caries in the primary and permanent dentition was analyzed separately. As the included studies for the primary and permanent teeth had insignificant heterogeneity, fixed-effect models and forest plots were used to evaluate caries prevalence in both dentitions. In the primary dentition, the mean decayed-missing-filled teeth (dmft) index was 4.14 (95 % confidence interval (CI): 3.11-5.18), with an average prevalence of 75.43 %. For the permanent teeth, the mean DMFT (uppercase used for permanent dentition) was 1.28 (95 % CI: 0.93-1.64), with an average prevalence of 67.7 %. The average dmft/DMFT scores decreased in both primary and permanent teeth compared to the previous meta-analysis by Khan et al., suggesting a beneficial effect of preventative measures on caries prevalence. Continuing these measures is necessary to maintain the downward trend of caries prevalence in the KSA.

Effect of Dietary Simulating Solvents on the CAD-CAM Provisional Restorative Materials' Microhardness and Color Stability Properties: An in vitro Study.

Purpose: This in vitro study investigated the effects of dietary solvents on the microhardness and color stability of CAD/CAM provisional restorations compared to conventional materials. Methods: Disc-shaped specimens (n=200) were fabricated from self-cured acrylic resin, two 3D-printing resins (FormLabs, NextDent), and a milled material (TelioCAD). Randomization assigned specimens (n=10/group) to immersion solutions: artificial saliva, citric acid, heptane, coffee, and tea. Microhardness and color stability were evaluated. One-way and three-way ANOVA with Tukey's post hoc test analyzed the data. Results: Dietary solvents significantly reduced the surface microhardness of all tested materials (p<0.05). Unpolished surfaces exhibited greater color changes compared to polished ones (p<0.05) across all materials. Coffee and tea induced the most substantial reductions in hardness and the most significant color alterations (p<0.05), whereas saliva and citric acid had minimal effects. Conclusion: Milled provisional restorations exhibited superior hardness and color stability. Dietary solvents significantly affected material properties over time, highlighting the importance of material selection for clinical applications.

Influence of different printing orientations and post-polymerization time on the translucency of three-dimensional (3D) printed denture base resins.

PURPOSE: To evaluate the effect of different printing orientations and post-polymerization time with thermal cycling on the translucency of 3D-printed denture base resins. METHODS: Heat-polymerized (HP) acrylic resin specimens were fabricated and 3D-printed denture base materials (NextDent, ASIGA, FormLabs) were printed with different printing orientations (0, 45, 90 degrees) and subjected to different post-polymerization times (15-, 30-, 60-, and 90-min). All specimens were polished and immersed in distilled water for 1 day at 37°C. CIEDE2000 was used to measure the translucency parameters (TP00) before and after thermal cycling (5000 cycles) recording the color parameters (L*, a*, b*) against a black and white background using a spectrophotometer. k-factors ANOVA followed by post hoc Tukey's test (α = .05) was performed for statistical analysis. RESULTS: The k-factors ANOVA test showed a significant effect of resin material, post-polymerization time, and printing orientation on translucency (p < 0.001). In comparison to HP, all 3D-printed resins showed lower translucency with all post-polymerization times and printing orientation (p < 0.001) except FormLabs resin (p > 0.05). For all 3D-printed resins, the translucency increased, with increasing the post-polymerization time (p < 0.001) and 60- and 90-min showed the highest translucency. For printing orientation, 90 and 45 degrees significantly showed high translucency in comparison to 0 degrees (p < 0.001). FormLabs showed significantly higher translucency when compared with NextDent and ASIGA per respective printing orientation and post-polymerization time. The translucency significantly decreased after thermal cycling for all tested resins (p < 0.001). CONCLUSION: The findings of this study demonstrated that the translucency of 3D-printed resins is influenced by the printing orientation, post-polymerization time, and resin type. As a result, choosing a resin type, and printing orientation, with a longer post-polymerization time should be considered since it may improve the esthetic appearance of the 3D-printed resins.

Nanoparticle-Modified 3D-Printed Denture Base Resins: Influence of Denture Cleansers on the Color Stability and Surface Roughness In Vitro.

This study aimed to evaluate the influence of denture cleansers on the color, stability, and surface roughness of three-dimensional (3D)-printed denture base resins modified with zirconium dioxide nanoparticles (nano-ZrO2). A total of 440 specimens were fabricated using one heat-polymerized resin, and two 3D-printed resins (NextDent and ASIGA). According to the nano-ZrO2 content, the specimens for each resin were divided into five groups (0%, 0.5%wt, 1%wt, 3%wt, and 5%wt). Each concentration was divided into four subgroups (n = 10) based on the immersion solution (distilled water, sodium hypochlorite, Corega, and Fittydent) and immersion duration (360 and 720 days). The color changes (∆E00) and surface roughness (Ra, µm) of each specimen were measured at different time intervals (base line, 360 days, 720 days) using a spectrophotometer and a non-contact profilometer, respectively. The results were statistically analyzed using ANOVA and a post hoc Tukey's test (α = 0.05). Sodium hypochlorite showed the highest significant color change of all the denture base resins (p < 0.001). The average value of ΔE00 for sodium hypochlorite was significantly higher than the values for the other solutions (Fittydent, Corega, and water) (p < 0.001). Color stability was significantly affected by immersion time for all types of solutions except Corega (p < 0.001). All of the tested immersion solutions (distilled water, sodium hypochlorite, Corega, and Fittydent) showed a significant increase in the surface roughness of all the denture base resins (p < 0.05). Surface roughness was substantially increased by immersion time for all types of solution except Fittydent (p < 0.001). Denture cleansers can result in substantial color change and affect the surface roughness of unmodified and nanoparticle-modified denture base resins. Therefore, the selection of denture cleanser and appropriate types of material is critical for denture longevity.

Psychiatric implications of anti-seizure medications in epileptic population.

BACKGROUND AND OBJECTIVE: Epilepsy is a prevalent neurological disorder that affects a significant number of individuals globally. This condition is associated with a high occurrence of psychiatric comorbidities, which can significantly affect the quality of life of individuals affected. The aim of this study was to investigate the association between antiseizure therapies and the likelihood of psychiatric comorbidities in individuals with epilepsy. METHODOLOGY: Data for this study was gathered from the Neurology referral center in Islamabad, Pakistan. A standardized questionnaire was utilized to gather data from 120 individuals diagnosed with epilepsy. The survey consisted of inquiries regarding the management of seizures, the utilization of anti-seizure medications, and the presence of psychiatric comorbidities. The data was analyzed using the Statistical Package for the Social Sciences (SPSS). RESULTS: The findings indicated that individuals who were using multiple antiseizure medications had a notably higher likelihood of having psychiatric comorbidities in comparison to those who were on mono therapy (p = 0.010). suggests that patients with unsuccessful seizure control are more probable to have psychiatric comorbidities as compared to those with good seizure control (p = 0.029). CONCLUSION: To conclude poor seizure control and poly therapy are associated with increased risk of psychiatric comorbidities.

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.

Flexural strength of 3D-printed nanocomposite provisional resins: Impact of SiO2 and ZrO2 nanoparticles and printing orientations in vitro.

PURPOSE: The aim of this study was to investigate and compare the influence of zirconium dioxide nanoparticles (ZrO2 NPs) and silicon dioxide nanoparticles (SiO2 NPs) addition and printing orientation on the flexural strength (FS) of provisional three-dimensional (3D) printing resins undergoing thermal cycling (TC). METHODS: Three dimensional-printed resin (NextDent C&B MFH) was used to fabricate 300 bar-shaped specimens (25 × 2 × 2 mm3 ). The ZrO2 NPs and SiO2 NPs specimens were divided into two groups, then subdivided into three groups, based on the nanoparticle concentration (i.e., 0 wt% (original group), 0.5 wt%, and 1 wt%). Each concentration was printed in three printing orientations (0°, 45°, and 90°). The printed specimens were exposed to 5000 cycles of TC, followed by a three-point bending test to assess the FS. Fracture surface analysis was conducted by using a scanning electron microscope (SEM). For data analysis, ANOVA and Tukey's post hoc were utilized (α = 0.05). RESULTS: Compared to the original material, the addition of ZrO2 NPs and SiO2 NPs had a significantly positive impact on the FS, (P > 0.001). After TC, the FS of the original group decreased significantly and had the lowest value. The highest FS value was observed in 1% ZrO2 NPs at 0°. Regardless of the nanoparticle concentration, the 0° orientation consistently showed a higher FS, compared to the 45° and 90° orientations. At all orientations (i.e., 0°, 45°, and 90°), the FS significantly increased with the addition of NPs, compared with that of the original material (P > 0.001). TC had a significantly negative effect on the FS of the unmodified groups. However, no significant differences existed in FS among the modified groups after TC. CONCLUSION: The addition of SiO2 NPs and ZrO2 NPs increased the FS of the 3D-printed provisional resin. Regardless of the nanoparticle concentration, the 0° orientation had the higher FS. TC had an effect on the original resin, whereas it had no significant effect on the nanoparticle-modified resins. In clinical practice, 3D-printed provisional nanocomposite resins printed at the 0° orientation could be recommended for long-term dental provisional restorations.

Comparative Evaluation of TiO2 Nanoparticle Addition and Postcuring Time on the Flexural Properties and Hardness of Additively Fabricated Denture Base Resins.

Three-dimensionally (3D)-printed fabricated denture bases have shown inferior strength to conventional and subtractively fabricated ones. Several factors could significantly improve the strength of 3D-printed denture base resin, including the addition of nanoparticles and post-curing factors. This study evaluated the effect of TiO2 nanoparticle (TNP) addition and the post-curing time (PCT) on the flexural properties and hardness of three-dimensionally (3D)-printed denture base resins. A total of 360 specimens were fabricated, with 180 specimens from each type of resin. For evaluating the flexural properties, bar-shaped specimens measuring 64 × 10 × 3.3 mm were used, while, for the hardness testing, disc-shaped specimens measuring 15 × 2 mm were employed. The two 3D-printed resins utilized in this study were Asiga (DentaBASE) and NextDent (Vertex Dental B.V). Each resin was modified by adding TNPs at 1% and 2% concentrations, forming two groups and an additional unmodified group. Each group was divided into three subgroups according to the PCT (15, 60, and 90 min). All the specimens were subjected to artificial aging (5000 cycles), followed by testing of the flexural strength and elastic modulus using a universal testing machine, and the hardness using the Vickers hardness test. A three-way ANOVA was used for the data analysis, and a post hoc Tukey's test was used for the pairwise comparisons (α = 0.05). Scanning electron microscopy (SEM) was used for the fracture surface analysis. The addition of the TNPs increased the flexural strength in comparison to the unmodified groups (p < 0.001), while there was no significant difference in the elastic modulus and hardness with the 1% TNP concentration. Among the TNP groups, the 2% TNP concentration significantly decreased the elastic modulus and hardness (p < 0.001). The SEM showed a homogenous distribution of the TNPs, and the more irregular fracture surface displayed ductile fractures. The PCT significantly increased the flexural strength, elastic modulus, and hardness (p < 0.001), and this increase was time-dependent. The three-way ANOVA results revealed a significant difference between the material types, TNP concentrations, and PCT interactions (p < 0.001). Both concentrations of the TNPs increased the flexural strength, while the 2% TNP concentration decreased the elastic modulus and hardness of the 3D-printed nanocomposites. The flexural strength and hardness increased as the PCT increased. The material type, TNP concentration, and PCT are important factors that affect the strength of 3D-printed nanocomposites and could improve their mechanical performance.

Impact of international collaboration on dentistry related papers published in Kingdom of Saudi Arabia.

Objective: This bibliographic analysis was designed to review all dental publications in the Kingdom of Saudi Arabia (KSA) and evaluate the effect of international collaboration on the impact of published articles. Methods: The Web of Science (WOS) database was used to extract all related published articles in the KSA from 1982 to 2021. The keywords were connected using Boolean Operators to download related articles. Downloaded articles were screened according to the following inclusion criteria: collaboration journal category, journal discipline, number of citations, number of authors, and impact factor. After applying the inclusion criteria and excluding single-author articles, 5,689 documents were included in the final analysis. The chi-square test and two-independent samples t-test were used to determine the statistical significance between the variables. Results: A significantly higher proportion of articles with international collaboration (51.4%) were published in dental journals than those published nationally (43.3%) or within the institutional level (41.8%) (P < 0.0001). In addition, the average number of citations (9.28 ± 23.8) ranged from 0 to 749, received by an article and the impact factor of the journal in which the article was published, significantly higher in the case of internationally collaborative work compared with national or within institutional collaboration (P < 0.0001). Conclusion: International collaboration positively affected the impact factor, number of citations, and quartile rank of published articles. Moreover, the number of co-authors in different countries contributes to the international collaboration effect.

Effect of Denture Disinfectants on the Mechanical Performance of 3D-Printed Denture Base Materials.

Denture care and maintenance are necessary for both denture longevity and underlying tissue health. However, the effects of disinfectants on the strength of 3D-printed denture base resins are unclear. Herein, distilled water (DW), effervescent tablet, and sodium hypochlorite (NaOCl) immersion solutions were used to investigate the flexural properties and hardness of two 3D-printed resins (NextDent and FormLabs) compared with a heat-polymerized resin. The flexural strength and elastic modulus were investigated using the three-point bending test and Vickers hardness test before (baseline) immersion and 180 days after immersion. The data were analyzed using ANOVA and Tukey's post hoc test (α = 0.05), and further verified by using electron microscopy and infrared spectroscopy. The flexural strength of all the materials decreased after solution immersion (p < 0.001). The effervescent tablet and NaOCl immersion reduced the flexural strength (p < 0.001), with the lowest values recorded with the NaOCl immersion. The elastic modulus did not significantly differ between the baseline and after the DW immersion (p > 0.05), but significantly decreased after the effervescent tablet and NaOCl immersion (p < 0.001). The hardness significantly decreased after immersion in all the solutions (p < 0.001). The immersion of the heat-polymerized and 3D-printed resins in the DW and disinfectant solutions decreased the flexural properties and hardness.

Assessment of Modality and Accuracy of Single Root Canal Treatment Performed by Undergraduate Students in Saudi Arabia: A Retrospective Study.

Aim To assess the radiographic quality of root canal treatment (RCT) performed on single-rooted anterior teeth by undergraduate dental students of Imam Abdulrahman Bin Faisal University (IAU). Moreover, the study also aimed to assess the types of procedural errors encountered during root canal treatment and to compare the results between male and female students. Methodology The record of patients who visited the endodontic clinics at IAU between the years 2018 and 2021 was obtained from the medical records department. The inclusion criteria for the study involved: i) RCT performed on anterior teeth with a single root; ii) RCT performed by fourth, fifth, and sixth-year undergraduate dental students; and iii) availability of pre-operative and post-operative peri-apical radiographs. After the inclusion criteria, a total of 278 records were selected. The radiographs were accessed by two calibrated examiners for the length of the obturation, homogeneity, and taper. In addition, procedural errors such as the presence of a ledge, perforation, or fractured instruments were also observed. Analysis was done using the Chi-square test. Results A total of 139 teeth (50%) were found to have an adequate quality root canal treatment. Regarding the length of the obturation, 85.6% were considered acceptable, while 65.1% of the obturations had acceptable radiographic homogeneity. The acceptable taper was found in 71.9% of the obturations. Dental students who participated in this study demonstrated a low rate of procedural errors, with 4.7% ledge formation and 1% perforation. A statistically significant difference was found in the quality of root canal obturation (P = <0.001) performed by fourth, fifth, and sixth-year students. Moreover, a significant difference was also observed between maxillary and mandibular teeth (P= 0.032). Conclusion The quality of RCT performed by undergraduate dental students demonstrated that improvements are required. The teaching methods used in the endodontic courses need to be developed and improved to ensure the best possible learning and treatment outcomes.

Antibiofilm Activity of 3D-Printed Nanocomposite Resin: Impact of ZrO2 Nanoparticles.

Poly(methyl methacrylate) (PMMA) is a commonly used material, as it is biocompatible and relatively cheap. However, its mechanical properties and weak antibiofilm activity are major concerns. With the development of new technology, 3D-printed resins are emerging as replacements for PMMA. Few studies have investigated the antibiofilm activity of 3D-printed resins. Therefore, this study aimed to investigate the antibiofilm activity and surface roughness of a 3D-printed denture base resin modified with different concentrations of zirconium dioxide nanoparticles (ZrO2 NPs). A total of 60 resin disc specimens (15 × 2 mm) were fabricated and divided into six groups (n = 10). The groups comprised a heat-polymerized resin (PMMA) group, an unmodified 3D-printed resin (NextDent) group, and four 3D-printed resin groups that were modified with ZrO2 NPs at various concentrations (0.5 wt%, 1 wt%, 3 wt%, and 5 wt%). All specimens were polished using a conventional method and then placed in a thermocycler machine for 5000 cycles. Surface roughness (Ra, µm) was measured using a non-contact profilometer. The adhesion of Candida albicans (C. albicans) was measured using a fungal adhesion assay that consisted of a colony forming unit assay and a cell proliferation assay. The data were analyzed using Shapiro-Wilk and Kruskal-Wallis tests. A Mann-Whitney U test was used for pairwise comparison, and p-values of less than 0.05 were considered statistically significant. The lowest Ra value (0.88 ± 0.087 µm) was recorded for the PMMA group. In comparison to the PMMA group, the 3% ZrO2 NPs 3D-printed group showed a significant increase in Ra (p < 0.025). For the 3D-printed resins, significant differences were found between the groups with 0% vs. 3% ZrO2 NPs and 3% vs. 5% ZrO2 NPs (p < 0.025). The highest Ra value (0.96 ± 0.06 µm) was recorded for the 3% ZrO2 NPs group, and the lowest Ra values (0.91 ± 0.03 µm) were recorded for the 0.5% and 5% ZrO2 NPs groups. In terms of antifungal activity, the cell proliferation assay showed a significant decrease in the C. albicans count for the 0.5% ZrO2 NPs group when compared with PMMA and all other groups of 3D-printed resins. The group with the lowest concentration of ZrO2 NPs (0.5%) showed the lowest level of C. albicans adhesion of all the tested groups and showed the lowest Candida count (0.29 ± 0.03). The addition of ZrO2 NPs in low concentrations did not affect the surface roughness of the 3D-printed resins. These 3D-printed resins with low concentrations of nanocomposites could be used as possible materials for the prevention and treatment of denture stomatitis, due to their antibiofilm activities.

Flexural Properties and Hardness of CAD-CAM Denture Base Materials.

PURPOSE: To compare flexural strength, elastic modulus, and surface hardness of computer aided design and computer aided manufacturing CAD-CAM milled, 3D-printed, and heat-polymerized denture base resins. MATERIALS AND METHODS: A total of 120 specimens were fabricated from heat-polymerized acrylic resin (HP), milled resin (Avadent and IvoCad), and 3D-printed resin (ASIGA, FormLabs, and NextDent). The specimens were divided into 6 groups according to the type of denture base material (n = 20/material) (10/flexural properties and 10/hardness). Flexural strength and elastic modulus of the specimens were evaluated by 3-point bending test and surface hardness by Vickers hardness test. To test flexural properties, the specimens were fabricated according to ISO 20795-1:2013 standards (64 × 10 × 3.3 ± 0.2 mm). The dimensions for hardness test were 15 × 10 × 2.5 ± 0.2 mm. Scanning electron microscope was used to evaluate the surface morphology of the fractured specimens. The means and standard deviations were calculated, followed by one-way ANOVA and Tukey post-hoc test (α = 0.05). RESULTS: Milled resins showed significantly higher values for flexural strength, elastic modulus, and surface hardness, followed by HP and then 3D-printed resins (p < 0.001). Within milled groups, flexural strength of AvaDent was significantly higher than IvoCad (p < 0.001), while elastic modulus and hardness didn't show significant difference. Within 3D-printed resins, ASIGA showed the highest flexural strength and elastic modulus, insignificantly with FormLabs (p = 0.595) and significantly with NextDent (p = 0.008). ASIGA also showed significantly the highest hardness among the 3D-printed groups. No significant difference was found between FormLabs and NextDent in flexural strength (p = 0.357), elastic modulus (p = 1.00), or surface hardness (p = 0.987). CONCLUSION: CAD-CAM milled resins had greater flexural properties and hardness compared to heat-polymerized acrylic resin and 3D-printed resins. Although 3D-printed samples showed the lowest values of tested properties, the flexural strength and modulus were above clinically acceptable values.

Wear and Fracture Resistance of 3D-Printed Denture Teeth: An In Vitro Comparative Study.

PURPOSE: The longevity of removable prostheses is mostly influenced by the properties of the used materials. The ability of the material to withstand high occlusal loads without deformation can enhance patient satisfaction and quality of life. This in vitro study aimed to investigate the wear and fracture resistance of three-dimensional (3D)-printed teeth compared with commercially available acrylic resin teeth. MATERIALS AND METHODS: A total of 40 prefabricated acrylic teeth and 40 3D-printed teeth were prepared in two forms: anatomical for fracture resistance or flat for wear resistance (n = 10). For wear evaluation, specimens were scanned at baseline and then subjected to thermal cycling (10,000 cycles). This was followed by a chewing simulator (60,000 cycles) against either metal or natural tooth. Then, the specimens were scanned again. Wear analysis was performed by superimposing the standard tessellation language (STL) files from baseline and the final scans with the aid of GOM Inspect 2020 software. Fracture resistance was assessed with a universal testing machine at a crosshead speed of 0.5 mm/min before and after thermal cycling. Data were analyzed with two-independent t-test and two-way ANOVA (α = 0.05). RESULTS: The 3D-printed teeth showed significantly lower wear resistance than the prefabricated ones with both antagonists (metal, p = 0.049; natural tooth, p = 0.021). The fracture resistance of the 3D-printed teeth was significantly higher than that of the prefabricated teeth before thermocycling (p = 0.042). After thermal cycling, the fracture resistance of both groups was decreased with no significant differences between them (p = 0.266). CONCLUSIONS: The 3D-printed teeth showed lower wear resistance and higher fracture resistance than the prefabricated ones. Thermal cycling negatively affected the fracture resistance of 3D-printed teeth.

Polymethylmethacrylate Denture Base Layering as a New Approach for the Addition of Antifungal Agents.

PURPOSE: To introduce a new technique, denture base layering, for the addition of titanium dioxide nanoparticles (TiO2 NPs) to polymethylmethacrylate (PMMA) and to investigate the effects of the layering technique on Candida albicans (C. albicans) adhesion and on surface roughness, hardness, translucency, and flexural strength. MATERIALS AND METHODS: In total, 210 heat-polymerized acrylic resin specimens were prepared as discs (15 × 2 mm) for testing C. albicans adhesion (n = 70) and surface roughness, hardness, and translucency (n = 70); and as acrylic plates (65 × 10 × 2.5 mm) for testing flexural strength (n = 70). Specimens were divided into 4 groups: control (n = 30), one-layer (n = 60), double-layer (n = 60), and dotted-layer (n = 60) according to the packing and layering technique. Each group was divided according to the concentration of TiO2 NPs 1% and 2.5% (n = 10). The control group comprised one layer of unmodified resin. The one-layer group comprised one layer of a mixture of PMMA/TiO2 NPs packed conventionally. The double-layer group consisted of two different layers packed in two steps, as follows: unmodified resin first, followed by a continuous thin layer of the PMMA/TiO2 NPs mixture. Similarly, the dotted-layer group consisted of two different layers packed in two steps, as follows: unmodified resin first, followed by a thin layer of the PMMA/TiO2 NPs. However, the second mixture was added in a dotted manner. The direct culture method for C. albicans adhesion before and after ultraviolet light activation, and surface roughness, hardness, translucency, and flexural strength were measured. An analysis of variance and Tukey's post hoc test were used for data analysis (α = 0.05). RESULTS: The addition of TiO2 NPs reduced C. albicans adhesion (p < 0.001). However, no significant difference was found between both concentrations within the same group before and after ultraviolet light activation (p > 0.05), except in the 1% dotted-layer (p = 0.022). Surface roughness and hardness were not affected by the additions of different concentrations of TiO2 NPs (p = 0.905) and (p = 0.059), respectively. Translucency was significantly reduced in all the groups (p < 0.001) except in the 1% dotted-layer (p = 0.332). Flexural strength decreased as the TiO2 NPs concentration increased, with the greatest reduction in strength observed in the one-layer group (p < 0.001). CONCLUSIONS: The double and dotted layering techniques were effective in reducing C. albicans adhesion, without affecting surface roughness, hardness, or flexural strength. However, translucency was reduced in all the groups, except the 1% dotted-layer group.

Effect of Printing Orientation and Postcuring Time on the Flexural Strength of 3D-Printed Resins.

PURPOSE: To evaluate the effect of printing orientation combined with different postcuring times on the flexural strength of 3D-printed resins. MATERIALS AND METHODS: A total of 480 rectangular specimens with the dimensions of 64×10×3.3 mm were designed and fabricated from two 3D-printed acrylic resins and one heat-polymerized resin (HP). 3D-printed groups were divided into 3 groups according to printing orientations (0-, 45-, 90-degree); each group was subdivided into 4 groups according to postcuring time (30, 60, 90, 120 min.). All specimens were subjected to thermal cycling (10,000 cycles) before testing flexural strength. Fractured surfaces were examined under a scanning electron microscope (SEM). ANOVA and Tukey's post hoc tests were used for data analysis (α = 0.05). RESULTS: The result of this study showed that the highest flexural strength values of 3D-printed resin (NextDent, and ASIGA) were in 0-degree groups. Also, the flexural strength values increased when postcuring time was increased, regardless of the printing orientation; the highest flexural strength was recorded at 120 minutes postcuring time in all orientations. SEM analysis showed a rougher surface with irregular lamellae which represented a ductile fracture confirming that high energy is required for crack propagation and these features markedly increased as postcuring time increased. CONCLUSION: The results showed that the 0-degree orientation groups showed higher flexural strength compared to other groups. Similarly, with increased postcuring time, the flexural strength increased.

Effect of Occlusal Splint Therapy on Condylar Movements Recorded Using an Electronic Pantograph: A Prospective Clinical Study.

Aims and Objective: The effect of occlusal splint therapy on the muscle activity has been addressed in the literature. However, its effect on condylar movements in subjects with normal and abnormal occlusions has not yet been investigated. This prospective clinical study addressed the effect of occlusal splint therapy on condylar movements in subjects with normal and abnormal occlusions using an electronic pantograph. Materials and Methods: Two groups of subjects were included in this study. The first group included subjects with normal occlusion, whereas the subjects in the other group were diagnosed with abnormal occlusion. The occlusal splint was fabricated, adjusted clinically, and delivered for each subject. Condylar movements were recorded using a Cadiax Compact II electronic pantograph at baseline, 2-, 4-, and 6-month follow-up periods to assess sagittal condylar inclination (SCI), immediate mandibular lateral translation (IMLT), and progressive mandibular lateral translation (PMLT). The t-test, one-way analysis of variance (ANOVA), and two-way ANOVA were used to compare the parameters between the groups and to assess the time effect on these parameters (α = 0.05). Results: Twenty subjects were recruited for this study (n = 10). Among them, 12 were women and eight were men, with a mean age of 34 years. In each group, insignificant differences were reported for each tested parameter at baseline and during the follow-up periods (P > 0.05). However, when comparing the two groups, the only significant difference was found in the SCI during the 6-month follow-up period (P = 0.014). Conclusions: Occlusal splints had an insignificant effect on the parameters SCI, IMLT, and PMLT up to 6 months of follow-up for subjects with normal or abnormal occlusion. SCI increased substantially in normal occlusion subjects compared with abnormal occlusion subjects during the 6-month follow-up period.

Evaluation of the effectiveness of bioactive glass fillers against Candida albicans adhesion to PMMA denture base materials: An in vitro study.

Background: Dentures with antimicrobial properties are desirable for preventing Candida albicans adhesion. This study was to assess the effectiveness of bioactive glass (BAG) on C. albicans adhesion, surface roughness, and hardness of denture base materials. Methods: Heat-polymerized (HP) and autopolymerized (AP) acrylic resins were used to fabricate 240 disk specimens (120/material, 60/C. albicans, 60/surface roughness and hardness). Specimens were divided into five groups (n = 10) based on the BAG concentration: 0.5, 1.5, 3, 5, and 7.5 wt% of the acrylic powder, with a control group comprised of unmodified specimens. Direct culture method was used to assess C. albicans adhesion. A profilometer and Vickers hardness test were used to measure surface roughness and hardness respectively. Analysis of variance (ANOVA) and post hoc Tukey's test were used for data analysis (α = 0.05). Results: BAG addition significantly decreased the C. albicans count when compared with the control group (P < 0.001) for both HP and AP. Regarding surface roughness, there was no change in the HP acrylic resins (P > 0.05), while the AP acrylic resins exhibited significantly higher surface roughness with BAG addition (P < 0.001). The hardness of the HP and AP acrylic resins were significantly higher with the addition of BAG (P < 0.001). Conclusions: The addition of BAG to HP and AP acrylic resins effectively decreases C. albicans adhesion. The roughness of AP acrylic resins increases with the addition of BAG, while the hardness of both HP and AP acrylic resins increase with the addition of BAG.

Repair Bond Strength of Conventionally and Digitally Fabricated Denture Base Resins to Auto-Polymerized Acrylic Resin: Surface Treatment Effects In Vitro.

Denture base fracture is one of the most annoying problems for both prosthodontists and patients. Denture repair is considered to be an appropriate solution rather than fabricating a new denture. Digital denture fabrication is widely spreading nowadays. However, the repair strength of CAD-CAM milled and 3D-printed resins is lacking. This study aimed to evaluate the effect of surface treatment on the shear bond strength (SBS) of conventionally and digitally fabricated denture base resins. One l heat-polymerized (Major base20), two milled (IvoCad, AvaDent), and three 3D-printed (ASIGA, NextDent, FormLabs) denture base resins were used to fabricate 10 × 10 × 3.3 acrylic specimens (N = 180, 30/resin, n = 10). Specimens were divided into three groups according to surface treatment; no treatment (control), monomer application (MMA), or sandblasting (SB) surface treatments were performed. Repair resin was bonded to the resin surface followed by thermocycling (5000 cycles). SBS was tested using a universal testing machine where a load was applied at the resin interface (0.5 mm/min). Data were collected and analyzed using ANOVA and a post hoc Tukey test (α = 0.05). SEM was used for failure type and topography of fractured surfaces analysis. The heat-polymerized and CAD-CAM milled groups showed close SBS values without significance (p > 0.05), while the 3D-printed resin groups showed a significant decrease in SBS (p < 0.0001). SBS increased significantly with monomer application (p < 0.0001) except for the ASIGA and NextDent groups, which showed no significant difference compared to the control groups (p > 0.05). All materials with SB surface treatment showed a significant increase in SBS when compared with the controls and MMA application (p < 0.0001). Adhesive failure type was observed in the control groups, which dramatically changed to cohesive or mixed in groups with surface treatment. The SBS of 3D-printed resin was decreased when compared with the conventional and CAD-CAM milled resin. Regardless of the material type, SB and MMA applications increased the SBS of the repaired resin and SB showed high performance.