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3D PRINTING: THE FUTURE TECHNOLOGY IN PROSTHODONTICS

Article · January 2015

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Journal of Dental & Oro-facial Research Vol 11, Issue 1. Jan-Jun 2015 JDOR

REVIEW

3D PRINTING: THE FUTURE TECHNOLOGY IN

PROSTHODONTICS

Dr.Sivaranjani Gali1*, Sharad Sirsi2.

*Corresponding Author Email: [email protected]

Contributors:
1 ABSTRACT: The connecting link of technologies and dentistry has often resulted
Reader,Department of
Prosthodontics,Faculty of Dental in innovations in manufacture of dental restorations right from Taggart’s lost wax
Sciences, M S Ramaiah University technique to the latest CAD CAM restorations. While there are rapid advances made
of Applied Sciences, Bengaluru, in technologies, its applications in the field of prosthodontics are not far behind. 3
Karnataka D printing has revolutionized the way things are manufactured and we may not
possibly imagine what future holds for us. This paper will give an insight on how
2. Assistant Professor,Faculty of 3D printing works, its application in 3D printing of dental restorations and its future
Arts and Design, M S Ramaiah directions
University of Applied Sciences,
Bengaluru, Karnataka

INTRODUCTION: material, to produce the restoration. The end result is chair

Technological developments have made significant impact side production of the restoration.1
and contributions to the field of dentistry. Right from Principles of subtractive manufacturing have been
adaptation of lost wax technique in jewellery fabrication in majorly used by both lost wax technique and CAD CAM
early 20th century for the fabrication of crowns and bridge technology. Subtractive technology is based on power
to the recent influence of computer aided design and driven machine tools such as saws, lathes and milling
machining (CAD CAM) technology on digitisation of machines that are used to mechanically cut a block of
restorations. material to a desired shape and geometry. This technology
Traditional fabrication of inlays, onlays and crowns uses a enabled reduction of production time and ease of fabricating
multistage process which involves an indirect technique of complex models. However, subtractive manufacturing
an impression followed by laboratory processing of the brings with it disadvantage of increased wastage with
restoration. This procedure involves several steps which removal of excess material and inability of mass production.
increases the possibility of errors in marginal accuracy, time ADDITIVE MANUFACTURING TECHNOLOGY
consumed by the patient as well as the doctor and the Additive manufacturing on the other hand opens up
treatment costs. As in many other industries, production new avenues for production of dental restorations. Additive
stages are increasingly becoming automated in dental manufacturing according to the American Society for
technology. Advances in computer technology now en- able Testing and Materials (ASTM) is the process of joining
cost-effective production of individual pieces. 1 materials to make objects from 3D model data, usually layer
CAD/CAM systems allow for the production of indirect upon layer, as opposed to subtractive manufacturing
restorations in a single visit. These systems use an optical methodologies.
camera to take a virtual impression by creating a three
dimensional image which is forwarded to a software The process of additive manufacturing works on the
program. This impression results in a virtual cast on which principle of taking a 3D computer file and creating a series
the restoration is designed. The software then controls a of cross sectional slices. Each slice is printed one on top of
milling process that uses prefabricated blocks of restorative the other to create the 3 dimensional object with an
material, either ceramic reinforced composite or all-ceramic advantage of minimal wastage. Today additive

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Journal of Dental & Oro-facial Research Vol 11, Issue 1. Jan-Jun 2015 JDOR

manufacturing can apply for product life cycle from Selective electron beam melting works by melting metal
prototyping to full scale manufacturing. Additive powder layer by layer with an electron beam in high vacuum
manufacture can be promising as it offers less time, more as shown in fig 3. Used for making porous dental implants
productive in terms of mass production thus overall reducing with an advantage of stress shielding & better ingrowth of
cost being used more in aerospace and automobile to bone, its roughness may not be suitable for crowns and
develop complex geometries. bridges fabrication.
Additive manufacturing technology has a range of Figure 3 Selective electron beam melting
applications such as stereo lithography, laser forming,
selective electron beam melting and inkjet printing. Stereo
lithography was introduced in 1980 by Charles Hull. It
works on the principle of making solid objects by
successively printing thin layers of UV curable
photopolymer on top of the each layer as shown in fig 1. The
ultra violet light draws the object and therefore cures it with
the input as digital CAD. SLA can be used for studying pre
operatively human models from CT (DICOM) data, for
preparation of customised surgical implant guides and also
as resin models for lost wax casting.
Figure 1 Stereolithography process In laser powder forming technology, laser beam hits the
powder and creates a melt pool and the powder particles fuse
together. The terminologies of Selective laser sintering or
selective laser melting may not be clear. Production of facial
prosthesis using polymers scaffolds (poly amide or poly
caprolactone), use of steel, titanium, cobalt chromium
porous mesh or dental implant with porous and dental
crowns and bridges partial denture frameworks have been
tried. Selective laser sintering works on the principle of
using a digital scanner (CAD) that scans the die model with
Fused Deposition Modelling developed by Schott Crump the CAD core design.
used mostly for modelling and prototyping applications. Inkjet printing ejects small ink drops of ink propelled with
This technology works on the principle of extruding a pressure, heat and vibration, towards a substrate as shown in
thermoplastic filament material through a heated nozzle and fig 4. Liquid droplets change phase on deposition on
the material hardens immediately after extrusion as shown substrate, dental models, surgical guides, try in veneers and
in fig 2. Materials such as acrylonitrile butyro styrene ABS, mouth guard can be fabricated. The ink could be a
polycarbonates and poly sulfones are used. Medical grade suspension of ceramic powders that is forced to pass through
ABS, polycarbonates have been tried out as surgical guides the nozzle. In comparison with traditional ceramic
however they are not 100 % dense and they do have a rough processing methods, ceramic inkjet printing has a number of
surface. Automated wax modelling process enables faster advantages. It requires minimum tooling and gives great
production of multiple wax patterns. Bio plotter uses a design and fabrication flexibility. 2
reservoir of material used in organ printing & scaffolds for
bone growth such as hydroxyapatite & tricalcium phosphate. Figure 4 Ink jet printing
Bioresorbable polymers such as poly carpolactone & poly
lactide microstructural patterns that enhance cell adhesion
proliferation.
Figure 2 Fused deposition modelling

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Journal of Dental & Oro-facial Research Vol 11, Issue 1. Jan-Jun 2015 JDOR

METHODS maxillofacial surgery as customised implants in the form of

A literature search using search engines such as Google porous scaffolds.
scholar and Pubmed with key words additive manufacturing STUDIES ON DIRECT INK JET PRINTING
/ three dimensional printing / rapid prototyping in dentistry, In direct ceramic ink jet printing, the ceramic particles pass
specifically stereo lithography/ selective laser melting/ ink through the printer nozzle and droplets of ceramic ink are
jet printing/fused deposition modelling in prosthodontics or propelled towards the substrate where they spread on impact
dentistry was done. All articles in English inclusive of case to produce a layer thickness less than 1 micron. After
reports, in vitro studies and systematic reviews were pyrolysis of the organic vehicle, the layer thickness is
considered. approximately equivalent to typical particle diameters of
sinter able ceramic powders.
STUDIES ON STEREOLITHOGRAPHY Application of direct ink jet printing for yttria stabilised
Stereo lithography is commonly used to make surgical zirconia ceramic powders for dental restorations was tried.
guides for dental implant insertion with advantages of high Ceramic ink suspensions were made; characterised and
mechanical strength and accuracy however, it has the flip specimens were fabricated and tested for fracture
side of being costly and requiring expensive equipment. toughness.13
Computer technology in guided implant surgery uses the Use of spherical powder offers special advantages for three
DICOM data conversion to CAD CAM technology to dimensional printing. They are known for producing low
produce surgical guides. Systematic review by Schneider et cohesive strength powder assemblies or powders with small
al show a survival rate of 96 % after a year of clinical internal friction for unusual good flow properties. Faceted or
observation in different clinical conditions with variable anisotropic powders tend to stick much more and are
levels of evidence with 4.6% of post-operative therefore, much more difficult to spread into thin layers. One
complications. But there is still no strong evidence to means for providing spherical particles which are highly
recommend computer assisted surgeries based on safety, flow able is to use the techniques of spray drying which
morbidity, efficiency or cost factors.3 Stereo lithography has result in spherical agglomerates consisting of small powder
been used in the field of maxillo facial prosthodontics as particles held together by a binding agent.14
obturators, surgical stents, duplication of prosthesis and burn Dental ceramic powders vary from feldspathic porcelains to
stents. A soft tissue model is constructed from CT scan into the doped zirconia powders. Yang et al performed
which a silicone is poured for the obturator. The obturator preliminary investigation for the feasibility of dental
can fit exactly on the patient requiring fewer adjustments restoration parts printing using the ExOne M‐Lab system
compared to the traditional impression techniques. with a commercialized dental porcelain powder. The
porcelain powders were characterized measuring pre‐
STUDIES ON SELECTIVE LASER SINTERING OR sintering temperature and flow agent to improve the process
MELTING ability of the original powder. 15 Direct ceramic inkjet
A number of studies on laser sintered nickel chrome and printing (DCIJP) uses ceramic powder in a carrier medium
cobalt chrome copings have been published. Bond strength which is deposited through a delivery system actuated by a
of the metal frameworks to porcelain, their marginal and piezoelectric device. Successful printing depends on the
internal fit were evaluated. Xu et al and Quante found preparation of suitable ceramic ink which is essentially a
improved and comparable marginal fit of laser sintered well-dispersed suspension of a fine powder. The dispersion
chrome cobalt crowns compared to traditional techniques4,5. must be stable and free from agglomerates.
While Eswaran et al found favourable results with direct Sinmazişik G et al compared the values of six commercial
metal laser sintered crowns compared to casting technique dentin porcelain powders (IPS Classic, IPS d.SIGN, IPS In
using 3D printed resin patterns and wax patterns. However, Line, Vita VMK 95, Vita Omega 900 and Ceram co III) for
studies by Ortopa, Kim, Akova, Park6,7,8,9 show increased the purpose of studying the microstructure characterisation.
marginal gap after porcelain firing compared to the Particle size distributions of porcelain powders were very
traditional casting technique. A permitted value of marginal similar, with particle sizes of all powders falling in a wide
gap of at least 120 um is required for clinical application. size range between 0.5 and 105 microns.16 Ponnambalam et
Direct laser sintering can be used to manufacture dental al prepared ceramic inks with alumina powder in ethyl
implants with a porous surface, its stiffness close to bone. A alcohol and zirconia powder in ethyl alcohol studying on
critical review 10 showed few case reports, case series , packing densities and viscosity of the ceramic ink
cohort studies and few histomorphometric and mechanical suspension.17 Utela et al determined the feasibility of
studies. The quality of methodology in human interventions producing structurally sound ceramic composites by 3DP
with laser sintered implants were medium, hence more process. Particle size analysis showed mean particle size of
evidence is required to prove their efficacy. 20.93 microns. Visual examination of the bulk powder and
spreading trials showed that the powder flowed well and
STUDIES ON ELECTRON BEAM MELTING created a smooth, even powder layer in the print bed of the
Mechanical properties, grind ability and corrosion of dental R-1 3DPrinter.18
implants manufactured by electron beam melting were found Particle analysis of the powders is necessary to determine
to be comparable to the precious and non-precious metal ceramic powder particle size and particle distribution is
alloys.11 Fatigue resistance was influenced by electron beam important to prevent agglomeration in the nozzles. Irregular
orientation and the crack propagation.12 This technology has particle size with a wide distribution of particles could
found more wide application in orthopaedics and oral possibly increase the chances of agglomeration.15

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 Journal of Dental & Oro-facial Research Vol 11, Issue 1. Jan-Jun 2015 JDOR

Based on results of particle analysis of various powders, 8. Akova T, Ucar Y, Tukay A, Balkaya MC, Brantley W a.
appropriate flow agents must be identified that can Comparison of the bond strength of laser-sintered and cast
potentially improve the flow ability of the ceramic ink base metal dental alloys to porcelain. Dent Mater.
suspension. Print head clogging, waste disposal, machine 2008;24(10):1400–4.
durability, cost and environmental factors influence the 9. Park J, Lee W, Kim H, Kim W, Kim J. Accuracy
selection of the binder or the flow agent. Green and sintered evaluation of metal copings fabricated by computer-aided
copings of both zirconia and alumina dental parts infiltrated milling and direct metal laser sintering systems. 2015;
with glass were successfully experimented, further studies Availablefrom:http://www.ncbi.nlm.nih.gov/pubmed/23680
are needed to prove their efficacy.18 302
STUDIES ON FUSED DEPOSITION MODELLING 10. Mangano F, Chambrone L, van Noort R, Miller C,
Ear prosthesis have been fabricated using semi-automated Hatton P, Mangano C. Direct metal laser sintering titanium
technology of CAD modelling and rapid prototyping. dental implants: a review of the current literature. Int J
Subtractive method of combining the mirror image of the Biomater [Internet]. Hindawi Publishing Corporation; 2014
contralateral ear with the scan of the defective side is used to Jan [cited 2015 Apr 27];2014:461534. Available from:
print the mold models with fused deposition modelling http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=
technique. The molds were finally then made in silicone 4267165&tool=pmcentrez&rendertype=abstract
fetching better accuracy and less time.19Integrated 11. Koike M, Martinez K, Guo L, Chahine G, Kovacevic R,
manufacturing systems with a laser digitising scanner, rapid Okabe T. Evaluation of titanium alloy fabricated using
prototyping and a vaccum casting machine were used to electron beam melting system for dental applications. J
fabricate a facial prosthesis.20 Mater Process Technol [Internet]. 2011 Aug;211(8):1400–8.
Availablefrom:http://linkinghub.elsevier.com/retrieve/pii/S
CONCLUSION: 0924013611000768
Developments in science and technology might look 12. Joshi G V., Duan Y, Neidigh J, Koike M, Chahine G,
fictional but it could impedingly disrupt our future. Though Kovacevic R, et al. Fatigue testing of electron beam-melted
the experiments are in a naïve phase, additive manufacturing Ti-6Al-4V ELI alloy for dental implants. J Biomed Mater
technology has potential in terms of cost, productivity and Res Part B Appl Biomater [Internet]. 2013
time. Mechanical testing and evidence of its efficacy are Jan;101B(1):12430.Availablefrom:http://doi.wiley.com/10.
more needed to explore for dental applications. 1002/jbm.b.32825
Note: Contents of this paper was presented by the first author 13. Özkol E, Ebert J, Uibel K, Wätjen a. M, Telle R.
at the 42nd Indian Prosthodontic Society held at Chandigarh Development of high solid content aqueous 3Y-TZP
on November 4-6th 2014. suspensions for direct inkjet printing using a thermal inkjet
printer. J Eur Ceram Soc [Internet]. 2009 Feb [cited 2015
REFERENCES Mar1];29(3):4039.Availablefrom:http://linkinghub.elsevier.
1. Beuer F, Schweiger J, Edelhoff D. Digital dentistry: an com/retrieve/pii/S095522190800335X
overview of recent developments for CAD/CAM generated 14. Micheal Cima. Three-dimensional printing techniques
restorations. Br Dent J. 2008;204(9):505–11. US5387380A.Availablefrom:https://www.google.com/pate
2. Song JH, Nur HM. Defects and prevention in ceramic nts/US5387380
components fabricated by inkjet printing. J Mater Process 15. Li Yanga, Shanshan Zhanga, Gustavo Oliveirab BS.
Technol. 2004;155-156(1-3):1286–92. Development of a 3D Printing Method for Production of
3. Schneider D, Marquardt P, Zwahlen M, Jung RE. A Dental Application Li Yang. 2011;346–53.
systematic review on the accuracy and the clinical outcome 16. Sinmazişik G, Öveçoǧlu ML. Physical properties and
of computer-guided template-based implant dentistry. Clin microstructural characterization of dental porcelains mixed
Oral Implants Res [Internet]. 2009 Sep;20:73–86. Available with distilled water and modeling liquid. Dent Mater.
from:http://doi.wiley.com/10.1111/j.1600- 2006;22(8):735–45.
0501.2009.01788.x 17. Ponnambalam P, Ramakrishnan N, Rajesh PK, Prakasan
4. Xu D, Xiang N, Wei B. The marginal fit of selective laser K. Rheological Behaviour of Ceramic Inks for Direct
melting–fabricated metal crowns: An in vitro study. J Ceramic Inkjet Printing. 2006;56(2):279–88.
Prosthet Dent [Internet]. 2014 Dec;112(6):1437–40. 18. Utela B, Anderson RL, Kuhn H. Advanced Ceramic
Availablfrom:http://linkinghub.elsevier.com/retrieve/pii/S0 Materials and Processes for Three-Dimensional Printing (
022391314002637 3DP ). Solid Free Fabr Symp. 2006;290–303.
5. Quante K, Ludwig K, Kern M. Marginal and internal fit 19. Subburaj K, Nair C, Rajesh S, Meshram SM, Ravi B.
of metal-ceramic crowns fabricated with a new laser melting Rapid development of auricular prosthesis using CAD and
technology. Dent Mater. 2008;24(10):1311–5. rapid prototyping technologies. Int J Oral Maxillofac Surg
6. Örtorp A, Jönsson D, Mouhsen A, Vult Von Steyern P. [Internet]. 2007 Oct;36(10):938–43. Available from:
The fit of cobalt-chromium three-unit fixed dental http://linkinghub.elsevier.com/retrieve/pii/S090150270700
prostheses fabricated with four different techniques: A 2603
comparative in vitro study. Dent Mater. 2011;27(4):356–63. 20. Chee Kai C, Siaw Meng C, Sin Ching L, Seng Teik L,
7. Kim J-W, Kim J-H, Janal MN, Zhang Y. Damage Maps Chit Aung S. Facial prosthetic model fabrication using rapid
of Veneered Zirconia under Simulated Mastication. J Dent prototyping tools. Integr Manuf Syst [Internet]. 2000
Res [Internet]. 2008 Dec 1 [cited 2015 Feb 8];87(12):1127– Feb;11(1):4253.Availablefrom:http://www.emeraldinsight.
32.Availablefrom:http://jdr.sagepub.com/cgi/doi/10.1177/1 com/doi/abs/10.1108/09576060010303668
54405910808701210

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