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Journal of Prosthetic Dentistry

Mechanical performance of 3-dimensionally printed resins compared with conventional and milled resins for the manufacture of occlusal devices: A systematic review

      Abstract

      Statement of problem

      Digital methods for manufacturing occlusal devices provide advantages over conventional techniques, but information about the mechanical properties of 3-dimensionally (3D) printed resins is scarce.

      Purpose

      The purpose of this systematic review was to evaluate the literature to determine whether 3D-printed resins for occlusal devices present satisfactory mechanical performance when compared with milled and conventional heat polymerized and autopolymerized resins.

      Material and methods

      This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and was registered in the Open Science Framework. The search strategy was applied without restriction of time and language to Embase, PubMed, Scopus, Science Direct, and Web of Science databases, and to the nonpeer-reviewed literature in ProQuest and Google Scholar. The selection process was conducted independently in 2 stages by 2 reviewers according to the eligibility criteria. The risk of bias was analyzed by using a checklist of important parameters to be considered. The systematic review considered the population, intervention, comparison, outcome, studies (PICOS) format, where population was resins for 3D printing of occlusal devices, intervention was inherent characteristics of the resin, comparison was conventional heat polymerized, autopolymerized, and milled resins, outcome was mechanical performance, and studies were in vitro experimental studies.

      Results

      A total of 1430 articles were found with the search strategy. After removing 182 duplicates found in Rayyan, the title and abstract of 1248 articles were evaluated, of which 37 articles were screened from the databases, 23 were selected for full reading, and 6 met the eligibility criteria and were included in this review; 1 had a low risk of bias and 5 had a moderate risk. An additional search of the reference list of included articles did not result in the inclusion of any articles. A quantitative meta-analysis could not be performed because of the heterogeneity of the included studies regarding the type of resin used and the method for evaluating mechanical performance.

      Conclusions

      Resins for 3D printing had satisfactory mechanical performance for interocclusal devices when compared with conventional heat polymerized and autopolymerized resins, except for hardness. Milled resins were better than 3D-printed resins in hardness, wear resistance, flexural strength, flexural modulus, and fracture resistance when printing angle and thickness were not considered. Further development is needed in terms of printing techniques and chemical composition, as they are important for optimal mechanical properties and clinical performance.
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      References

        • Berli C.
        • Thieringer F.M.
        • Sharma N.
        • et al.
        Comparing the mechanical properties of pressed, milled, and 3D-printed resins for occlusal devices.
        J Prosthet Dent. 2020; 124: 780-786
        • Grymak A.
        • Aarts J.M.
        • Ma S.
        • Waddell J.N.
        • Choi J.J.E.
        Comparison of hardness and polishability of various occlusal splint materials.
        J Mech Behav Biomed Mater. 2021; 115: 104270
        • Lutz A.M.
        • Hampe R.
        • Roos M.
        • Lümkemann N.
        • Eichberger M.
        • Stawarczyk B.
        Fracture resistance and 2-body wear of 3-dimensional-printed occlusal devices.
        J Prosthet Dent. 2019; 121: 166-172
        • Fernandes M.P.
        • Vidal C.L.
        • de Oliveira T.T.
        • Botelho A.L.
        • Valente M.L.D.C.
        • Dos Reis A.C.
        Effects of photobiomodulation on auriculotherapy points for sleep disorders, anxiety, and temporomandibular dysfunctions.
        Cranio. 7 December 2020; ([Epub ahead of print.])https://doi.org/10.1080/08869634.2020.1853896
        • Dutra Dias H.
        • Botelho A.L.
        • Bortoloti R.
        • Dos Reis A.C.
        Neuroscience contributes to the understanding of the neurobiology of temporomandibular disorders associated with stress and anxiety.
        Cranio. 13 September 2021; ([Epub ahead of print.] 1–6)https://doi.org/10.1080/08869634.2021.1977901
        • Prpic V.
        • Slacanin I.
        • Schauperl Z.
        • Catic A.
        • Dulcic N.
        • Cimic S.
        A study of the flexural strength and surface hardness of different materials and technologies for occlusal device fabrication.
        J Prosthet Dent. 2019; 121: 955-959
        • Kuzmanovic Pficer J.
        • Dodic S.
        • Lazic V.
        • Trajkovic G.
        • Milic N.
        • Milicic B.
        Occlusal stabilization splint for patients with temporomandibular disorders: meta-analysis of short and long term effects.
        PLoS One. 2017; 12e0171296
        • Dos Reis A.C.
        • Vidal C.L.
        • de Souza Caetano K.A.
        • Dias H.D.
        Use of recorded poetic audios to manage levels of anxiety and sleep disorders.
        J Relig Health. 2020; 59: 1626-1634
        • Berntsen C.
        • Kleven M.
        • Heian M.
        • Hjortsjö C.
        Clinical comparison of conventional and additive manufactured stabilization splints.
        Acta Biomater Odontol Scand. 2018; 4 (Published 2018 Aug 13): 81-89
        • Väyrynen V.O.
        • Tanner J.
        • Vallittu P.K.
        The anisotropicity of the flexural properties of an occlusal device material processed by stereolithography.
        J Prosthet Dent. 2016; 116: 811-817
        • Unkovskiy A.
        • Bui P.H.
        • Schille C.
        • Geis-Gerstorfer J.
        • Huettig F.
        • Spintzyk S.
        Objects build orientation, positioning, and curing influence dimensional accuracy and flexural properties of stereolithographically printed resin.
        Dent Mater. 2018; 34: e324-e333
        • Chockalingam K.
        • Jawahar N.
        • Chandrasekhar U.
        "Influence of layer thickness on mechanical properties in stereolithography".
        Rapid Prototyp J. 2006; 12: 106-113
        • Ide Y.
        • Nayar S.
        • Logan H.
        • et al.
        The effect of the angle of acuteness of additive manufactured models and the direction of printing on the dimensional fidelity: clinical implications.
        Odontology. 2017; 105: 108-115
        • Wesemann C.
        • Spies B.C.
        • Sterzenbach G.
        • et al.
        Polymers for conventional, subtractive, and additive manufacturing of occlusal devices differ in hardness and flexural properties but not in wear resistance.
        Dent Mater. 2021; 37: 432-442
        • Hada T.
        • Kanazawa M.
        • Iwaki M.
        • Arakida T.
        • Minakuchi S.
        Effect of printing direction on stress distortion of three-dimensional printed dentures using stereolithography technology.
        J Mech Behav Biomed Mater. 2020; 110: 103949
        • Huettig F.
        • Kustermann A.
        • Kuscu E.
        • Geis-Gerstorfer J.
        • Spintzyk S.
        Polishability and wear resistance of splint material for oral appliances produced with conventional, subtractive, and additive manufacturing.
        J Mech Behav Biomed Mater. 2017; 75: 175-179
        • Anderson J.
        • Wealleans J.
        • Ray J.
        Endodontic applications of 3D printing.
        Int Endod J. 2018; 51: 1005-1018
        • Reymus M.
        • Fabritius R.
        • Keßler A.
        • Hickel R.
        • Edelhoff D.
        • Stawarczyk B.
        Fracture load of 3D-printed fixed dental prostheses compared with milled and conventionally fabricated ones: the impact of resin material, build direction, post-curing, and artificial aging-an in vitro study.
        Clin Oral Investig. 2020; 24: 701-710
        • Amin A.
        • Meshramkar R.
        • Lekha K.
        Comparative evaluation of clinical performance of different kind of occlusal splint in management of myofascial pain.
        J Indian Prosthodont Soc. 2016; 16: 176-181
        • al-Quran F.A.
        • Lyons M.F.
        The immediate effect of hard and soft splints on the EMG activity of the masseter and temporalis muscles.
        J Oral Rehabil. 1999; 26: 559-563
        • Ayaz E.A.
        • Bağış B.
        • Turgut S.
        Effects of thermal cycling on surface roughness, hardness and flexural strength of polymethylmethacrylate and polyamide denture base resins.
        J Appl Biomater Funct Mater. 2015; 13 (Published 2015 Oct 16): e280-e286
        • Perea-Lowery L.
        • Gibreel M.
        • Vallittu P.K.
        • Lassila L.
        Evaluation of the mechanical properties and degree of conversion of 3D printed splint material.
        J Mech Behav Biomed Mater. 2021; 115: 104254
        • Gao S.
        • Gao S.
        • Xu B.
        • Yu H.
        Effects of different pH-values on the nanomechanical surface properties of PEEK and CFR-PEEK compared to dental resin-based materials.
        Materials. 2015; 8: 4751-4767
        • Shim J.S.
        • Kim J.E.
        • Jeong S.H.
        • Choi Y.J.
        • Ryu J.J.
        Printing accuracy, mechanical properties, surface characteristics, and microbial adhesion of 3D-printed resins with various printing orientations.
        J Prosthet Dent. 2020; 124: 468-475
        • Totu E.E.
        • Nechifor A.C.
        • Nechifor G.
        • Aboul-Enein H.Y.
        • Cristache C.M.
        Polymethyl methacrylate with TiO2 nanoparticles inclusion for stereolitographic complete denture manufacturing - the fututre in dental care for elderly edentulous patients? [published correction appears in J Dent 2021 Sep;112:103739].
        J Dent. 2017; 59: 68-77
        • de Castro D.T.
        • Valente M.L.
        • Agnelli J.A.
        • et al.
        In vitro study of the antibacterial properties and impact strength of dental acrylic resins modified with a nanomaterial.
        J Prosthet Dent. 2016; 115: 238-246
        • Abuzar M.A.
        • Bellur S.
        • Duong N.
        • et al.
        Evaluating surface roughness of a polyamide denture base material in comparison with poly methyl methacrylate.
        J Oral Sci. 2010; 52: 577-581
        • Jiménez M.
        • Romero L.
        • Domínguez M.
        • Espinosa M.M.
        "Rapid prototyping model for the manufacturing by thermoforming of occlusal splints".
        Rapid Prototy J. 2015; 21: 56-69
        • Rayyan M.M.
        • Aboushelib M.
        • Sayed N.M.
        • Ibrahim A.
        • Jimbo R.
        Comparison of interim restorations fabricated by CAD-CAM with those fabricated manually.
        J Prosthet Dent. 2015; 114: 414-419
        • Lebon N.
        • Tapie L.
        • Vennat E.
        • Mawussi B.
        Influence of CAD-CAM tool and material on tool wear and roughness of dental prostheses after milling.
        J Prosthet Dent. 2015; 114: 236-247
        • Wu T.
        • Hu W.
        • Guo L.
        • et al.
        Development of a new model system to study microbial colonization on dentures.
        J Prosthodont. 2013; 22: 344-350
        • Campbell R.I.
        • Martorelli M.
        • Lee H.S.
        “Surface roughness visualisation for rapid prototyping models.”.
        CAD Computer Aided Design. 2002; 34: 717-725
        • Reymus M.
        • Stawarczyk B.
        In vitro study on the influence of postpolymerization and aging on the martens parameters of 3D-printed occlusal devices.
        J Prosthet Dent. 2021; 125: 817-823
        • Prpić V.
        • Schauperl Z.
        • Ćatić A.
        • Dulčić N.
        • Čimić S.
        Comparison of mechanical properties of 3D-Printed, CAD-CAM, and conventional denture base materials.
        J Prosthodont. 2020; 29: 524-528
        • Cruz-Reyes R.A.
        • Martínez-Aragón I.
        • Guerrero-Arias R.E.
        • García-Zura D.A.
        • González-Sánchez L.E.
        Influence of occlusal stabilization splints and soft occlusal splints on the electromyographic pattern, in basal state and at the end of six weeks treatment in patients with bruxism.
        Acta Odontol Latinoam. 2011; 24: 66-74
        • Casey J.
        • Dunn W.J.
        • Wright E.
        In vitro wear of various orthotic device materials.
        J Prosthet Dent. 2003; 90: 498-502
        • Stansbury J.W.
        • Idacavage M.J.
        3D printing with polymers: challenges among expanding options and opportunities.
        Dent Mater. 2016; 32: 54-64
        • Murakami N.
        • Wakabayashi N.
        • Matsushima R.
        • Kishida A.
        • Igarashi Y.
        Effect of high-pressure polymerization on mechanical properties of PMMA denture base resin.
        J Mech Behav Biomed Mater. 2013; 20: 98-104
        • Ayman A.D.
        The residual monomer content and mechanical properties of CAD-CAM resins used in the fabrication of complete dentures as compared to heat cured resins.
        Electron Physician. 2017; 9 (Published 2017 Jul 25): 4766-4772
        • Zafar M.S.
        Prosthodontic applications of polymethyl methacrylate PMMA: an update.
        Polymers. 2020; 12 (Published 2020 Oct 8): 2299
        • Chen S.G.
        • Yang J.
        • Jia Y.G.
        • Lu B.
        • Ren L.
        TiO2 and PEEK reinforced 3D printing PMMA composite resin for dental denture base applications.
        Nanomaterials. 2019; 9 (Published 2019 Jul 22): 1049
        • Page M.J.
        • Moher D.
        • Bossuyt P.M.
        • et al.
        PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews.
        BMJ. 2021; 372: n160
        • Sarkis-Onofre R.
        • Skupien J.A.
        • Cenci M.S.
        • Moraes R.R.
        • Pereira-Cenci T.
        The role of resin cement on bond strength of glass-fiber posts luted into root canals: a systematic review and meta-analysis of in vitro studies.
        Oper Dent. 2014; 39: E31-E44
        • International Organization for Standardization
        ISO 20795-1. Dentistry base polymers. Part 1: Denture base polymers.
        International Organization for Standardization, Geneva2013 (ISO Store Order: OP-6218182001. Available at:)