Trueness and precision of skin surface reproduction in digital workflows for facial prosthesis fabrication.

STATEMENT OF PROBLEM: How much skin surface details of facial prostheses can be transferred throughout the digital production chain has not been quantified. PURPOSE: The purpose of this in vitro study was to quantify the amount of skin surface details transferred from the prosthesis virtual design through the prototype printing with various additive manufacturing (AM) methods to the definitive silicone prosthesis with an indirect mold-making approach. MATERIAL AND METHODS: Twelve test blocks with embossed wrinkles of 0.05 to 0.8 mm and 12 test blocks with applied earlobe skin structures were printed with stereolithography (SLA), direct light processing (DLP), and PolyJet methods (n=4). DLP and SLA prototype specimens were duplicated in wax. All specimens were then transferred into medical-grade silicone. Rz values of the wrinkle test blocks and the root mean square error (RMSE) of the earlobe test blocks were evaluated by laser topography to determine the trueness and precision of each stage. RESULTS: For the earlobe test blocks, the PolyJet method had superior trueness and precision of the final skin surface reproduction. The SLA method showed the poorest trueness, and the DLP method, the lowest precision. For the wrinkle test blocks, the PolyJet method had the best wrinkle profile reproduction level, followed by DLP and SLA. CONCLUSIONS: The indirect mold-making approach of facial prostheses manufacturing may be associated with 7% of skin surface profile loss with SLA, up to 20% with DLP, and no detail loss with PolyJet.

Long-term stability of an injection-molded zirconia bone-level implant: A testing protocol considering aging kinetics and dynamic fatigue.

OBJECTIVE: Separately addressing the fatigue resistance (ISO 14801, evaluation of final product) and aging behavior (ISO 13356, standardized sample) of oral implants made from yttria-stabilized zirconia proved to be insufficient in verifying their long-term stability, since (1) implant processing is known to significantly influence transformation kinetics and (2) aging, up from a certain level, is liable to decrease fatigue resistance. Therefore, the aim of this investigation was to apply a new testing protocol considering environmental conditions adequately inducing aging during dynamic fatigue. METHODS: Zirconia implants were dynamically loaded (107 cycles), hydrothermally aged (85°, 60 days) or subjected to both treatments simultaneously. Subsequent, monoclinic intensity ratios (Xm) were obtained by locally resolved X-ray microdiffraction (µ-XRD2). Transformation propagation was monitored at cross-sections by µ-Raman spectroscopy and scanning electron microscopy (SEM). Finally, implants were statically loaded to fracture. Linear regression models (fracture load) and mixed models (Xm) were used for statistical analyses. RESULTS: All treatments resulted in increased fracture load (p≤0.005), indicating the formation of transformation induced compressive stresses around surface defects during all treatment modalities. However, only hydrothermal and combinational treatment were found to increase Xm (p<0.001). No change in Xm was observed for solely dynamically loaded samples (p≥0.524). Depending on the variable observed, a monoclinic layer thickness of 1-2µm (SEM) or 6-8µm (Raman spectroscopy) was measured at surfaces exposed to water during treatments. SIGNIFICANCE: Hydrothermal aging was successfully induced during dynamic fatigue. Therefore, the presented setup might serve as reference protocol for ensuring pre-clinically long-term reliability of zirconia oral implants.