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CC BY 4.0 · European Journal of General Dentistry
DOI: 10.1055/s-0044-1782183
Review Article

Quality Assessment and Comparison of 3D-Printed and Milled Zirconia Anterior Crowns and Veneers: In Vitro Pilot Study

Les Kalman 
1   Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
,
João Paulo Mendes Tribst 
2   Department of Reconstructive Oral Care, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
› Author Affiliations Funding This project was funded with a Schulich Dentistry IRG and in kind support from Lithoz.
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Abstract

The esthetic rehabilitation of a patient is a demanding yet rewarding procedure, improving the form, function, and well-being of a patient. Three-dimensional (3D) printed, or additive manufactured, zirconia has recently entered the dental space, but without a thorough assessment or comparison. This pilot study utilized digital impressions of two demonstration casts: Cast 1 prepared both central incisors for full ceramic crown coverage, while cast 2 had a lateral incisor (#22) prepared for a ceramic veneer. Both casts underwent digital scanning (Straumann CARES 3, Straumann, Basel, Switzerland) to create virtual STL models. Cast 1 had two full zirconia anterior crowns digitally designed, and Cast 2 had a zirconia veneer digitally designed, using Exocad GmbH software by a certified dental technician at Schulich Dentistry. The STL files were used for fabricating six milled zirconia crowns for central incisor (#21) and six 3D-printed zirconia crowns for the other central incisor (#11). Similarly, for Cast 2, milled and 3D-printed zirconia veneers were made for the prepared lateral incisor (#22). Statistical analysis employed Minitab 16.1.0 software to construct a 2 × 2 table for cross-tabulation and chi-squared analysis. This statistical approach assessed the relationship between restoration design and processing method. Cochran–Mantel–Haenszel test evaluated categorical variables considering different classification variables. Milled restorations showed minor variations, while 3D-printed units displayed consistency. Statistical tests found no significant associations. This in vitro study suggests 3D-printed zirconia for crowns and veneers meets precementation standards akin to conventionally milled restorations. Further research can assess its potential benefits for dentistry's efficiency, cost, and sustainability.

Keywords

3D-printing - additive manufacturing - zirconia - materials - dental materials - prosthodontics - restorative dentistry - sustainability


Publication History

Article published online:
02 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Haumschild MS, Haumschild RJ. The importance of oral health in long-term care. J Am Med Dir Assoc 2009; 10 (09) 667-671
    CrossrefPubMedGoogle Scholar
  • 2 Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005; 83 (09) 661-669
    PubMedGoogle Scholar
  • 3 Petersen PE, Ogawa H. Strengthening the prevention of periodontal disease: the WHO approach. J Periodontol 2005; 76 (12) 2187-2193
    CrossrefPubMedGoogle Scholar
  • 4 Tribst JP, Pereira GK, Kleverlaan CJ. Advancements in dental care: the evolving landscape of prosthetic dentistry. J Clin Med 2024; 13 (05) 1225
    CrossrefPubMedGoogle Scholar
  • 5 Guess PC, Schultheis S, Bonfante EA, Coelho PG, Ferencz JL, Silva NR. All-ceramic systems: laboratory and clinical performance. Dent Clin North Am 2011; 55 (02) 333-352 , ix
    CrossrefPubMedGoogle Scholar
  • 6 Chen YW, Moussi J, Drury JL, Wataha JC. Zirconia in biomedical applications. Expert Rev Med Devices 2016; 13 (10) 945-963
    CrossrefPubMedGoogle Scholar
  • 7 Tan PLB, Dunne Jr JT. An esthetic comparison of a metal ceramic crown and cast metal abutment with an all-ceramic crown and zirconia abutment: a clinical report. J Prosthet Dent 2004; 91 (03) 215-218
    CrossrefPubMedGoogle Scholar
  • 8 Conrad HJ, Seong W-J, Pesun IJ. Current ceramic materials and systems with clinical recommendations: a systematic review. J Prosthet Dent 2007; 98 (05) 389-404
    CrossrefPubMedGoogle Scholar
  • 9 Daou EE. The zirconia ceramic: strengths and weaknesses. Open Dent J 2014; 8: 33-42
    CrossrefPubMedGoogle Scholar
  • 10 Silva LHD, Lima E, Miranda RBP, Favero SS, Lohbauer U, Cesar PF. Dental ceramics: a review of new materials and processing methods. Braz Oral Res 2017; 31 (Suppl. 01) e58
    CrossrefPubMedGoogle Scholar
  • 11 Miyazaki T, Nakamura T, Matsumura H, Ban S, Kobayashi T. Current status of zirconia restoration. J Prosthodont Res 2013; 57 (04) 236-261
    CrossrefPubMedGoogle Scholar
  • 12 Shahmiri R, Standard OC, Hart JN, Sorrell CC. Optical properties of zirconia ceramics for esthetic dental restorations: a systematic review. J Prosthet Dent 2018; 119 (01) 36-46
    CrossrefPubMedGoogle Scholar
  • 13 Bidra AS, Rungruanganunt P, Gauthier M. Clinical outcomes of full arch fixed implant-supported zirconia prostheses: a systematic review. Eur J Oral Implantol 2017; 10 (Suppl. 01) 35-45
    PubMedGoogle Scholar
  • 14 Schmitter M, Mueller D, Rues S. In vitro chipping behaviour of all-ceramic crowns with a zirconia framework and feldspathic veneering: comparison of CAD/CAM-produced veneer with manually layered veneer. J Oral Rehabil 2013; 40 (07) 519-525
    CrossrefPubMedGoogle Scholar
  • 15 Rosentritt M, Steiger D, Behr M, Handel G, Kolbeck C. Influence of substructure design and spacer settings on the in vitro performance of molar zirconia crowns. J Dent 2009; 37 (12) 978-983
    CrossrefPubMedGoogle Scholar
  • 16 Rues S, Kröger E, Müller D, Schmitter M. Effect of firing protocols on cohesive failure of all-ceramic crowns. J Dent 2010; 38 (12) 987-994
    CrossrefPubMedGoogle Scholar
  • 17 Özkurt-Kayahan Z. Monolithic zirconia: a review of the literature. Biomed Res 2016; 27 (04) 1427-1436
    Google Scholar
  • 18 Osman RB, van der Veen AJ, Huiberts D, Wismeijer D, Alharbi N. 3D-printing zirconia implants; a dream or a reality? An in-vitro study evaluating the dimensional accuracy, surface topography and mechanical properties of printed zirconia implant and discs. J Mech Behav Biomed Mater 2017; 75: 521-528
    CrossrefPubMedGoogle Scholar
  • 19 Ebert J, Özkol E, Zeichner A. et al. Direct inkjet printing of dental prostheses made of zirconia. J Dent Res 2009; 88 (07) 673-676
    CrossrefPubMedGoogle Scholar
  • 20 Glidewell BruxZir® Esthetic Zirconia. [Internet]. Accessed January 28, 2024 at: https://glidewelldental.com/solutions/crown-and-bridge/zirconia/bruxzir-esthetic-solid-zirconia
    Google Scholar
  • 21 Lithoz LithaCon3Y 210 Zirconia. [Internet]. Accessed January 28, 2024 at: https://lithoz.com/en/materials/lithacon-3y-210/
    Google Scholar
  • 22 Krishna LSR, Srikanth PJ. Evaluation of environmental impact of additive and subtractive manufacturing processes for sustainable manufacturing. Mater Today Proc 2021; 45: 3054-3060
    CrossrefGoogle Scholar
  • 23 Schweiger J, Edelhoff D, Güth J-F. 3D printing in digital prosthetic dentistry: an overview of recent developments in additive manufacturing. J Clin Med 2021; 10 (09) 2010
    CrossrefPubMedGoogle Scholar
  • 24 Branco AC, Colaço R, Figueiredo-Pina CG, Serro AP. Recent advances on 3D-printed zirconia-based dental materials: a review. Materials (Basel) 2023; 16 (05) 1860
    CrossrefPubMedGoogle Scholar
  • 25 Lu Y, Wang L, Dal Piva AMO. et al. Influence of surface finishing and printing layer orientation on surface roughness and flexural strength of stereolithography-manufactured dental zirconia. J Mech Behav Biomed Mater 2023; 143: 105944
    CrossrefPubMedGoogle Scholar
  • 26 Grech J, Antunes E. Zirconia in dental prosthetics: a literature review. J Mater Res Technol 2019; 8: 4956-4964
    CrossrefGoogle Scholar
  • 27 Abualsaud R, Alalawi H. Fit, precision, and trueness of 3d-printed zirconia crowns compared to milled counterparts. Dent J 2022; 10 (11) 215
    CrossrefPubMedGoogle Scholar
  • 28 Buj-Corral I, Vidal D, Tejo-Otero A, Padilla JA, Xuriguera E, Fenollosa-Artés F. Characterization of 3D printed yttria-stabilized zirconia parts for use in prostheses. Nanomaterials (Basel) 2021; 11 (11) 2942
    CrossrefPubMedGoogle Scholar
  • 29 Ramos NC, Augusto MG, Alves LMM, Kleverlaan CJ, Piva AM. Wear of dental ceramics. Braz Dent Sci 2023; 26: e3638
    CrossrefGoogle Scholar
  • 30 Dal Piva AMO, Bottino MA, Anami LC. et al. Toothbrushing wear resistance of stained CAD/CAM ceramics. Coatings 2021; 11: 224
    CrossrefGoogle Scholar
  • 31 Arcila LVC, Ramos NC, Bottino MA, Tribst JPM. Indications, materials and properties of 3D printing in dentistry: a literature overview. Res Soc Dev 2020; 9: e80791110632
    CrossrefGoogle Scholar
  • 32 Kalman L. 3D Printing in Dentistry: Fundamentals, Workflows and Clinical Applications. In: Chaughule RS, Dashaputra R. eds. Advances in Dental Implantology using Nanomaterials and Allied Technology Applications. Springer, Cham; 2021. . Available at: https://doi.org/10.1007/978-3-030-52207-0_13
    Google Scholar
  • 33 Liu X, Aarts JM, Ma S, Choi JJE. The influence of polishing on the mechanical properties of zirconia—a systematic review. Oral 2023; 3 (01) 101-122
    CrossrefGoogle Scholar
  • 34 Pucci CR, Mafetano AP, Borges AL. et al. Substrate rigidity effect on CAD/CAM restorations at different thicknesses. Eur J Dent 2022
    PubMedGoogle Scholar
  • 35 Aly P, Mohsen C. Comparison of the accuracy of three-dimensional printed casts, digital, and conventional casts: an in vitro study. Eur J Dent 2020; 14 (02) 189-193
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Al-Halabi MN, Bshara N, Nassar JA, Comisi JC, Rizk CK. Clinical performance of two types of primary molar indirect crowns fabricated by 3D printer and CAD/CAM for rehabilitation of large carious primary molars. Eur J Dent 2021; 15 (03) 463-468
    Article in Thieme ConnectPubMedGoogle Scholar