Background and Overview Although the use of computer-aided design/computer-aided manufacturing (CAD/CAM) seems to be a recent addition to the dental restorative armamentarium, this concept was first investigated more than 35 years ago. CEREC (Sirona Dental Systems GmbH, Bensheim, Germany) was the first and is the only available chairside system, and it has more than 20 years of use in the dental office. The initial concept had three tenets: esthetic ceramic reconstruction, a single patient visit and minimal tooth reduction (inlays and onlays instead of crowns). The author reviews the materials used for CAD/CAM–fabricated restorations. The structure, properties and clinical success of the materials for full-contour chairside restorations, as well as laboratory-based high-strength all-ceramic restorations are presented. Results CAD/CAM restorations have demonstrated clinical success owing to a combination of improvements in materials with advances in CAD/CAM systems. Full-contour ceramic restorations fabricated chair-side may reinforce the tooth, providing good long-term clinical success. High-strength milled restorations allow for the use of all-ceramic restorations for multiple-unit posterior and anterior bridges. Clinical Implications Examination of the structure, properties and clinical results of CAD/CAM materials supports their use in routine dental practice.

Materials for chairside CAD/CAM–produced restorations

There are 7 categories of additive manufacturing (AM) technologies, and a wide variety of materials can be used to build a CAD 3D object. The present article reviews the main AM processes for polymers for dental applications: stereolithography (SLA), digital light processing (DLP), material jetting (MJ), and material extrusion (ME). The manufacturing process, accuracy, and precision of these methods will be reviewed, as well as their prosthodontic applications.

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Additive Manufacturing Technologies Used for Processing Polymers: Current Status and Potential Application in Prosthetic Dentistry.

This paper reviews acrylic denture base resin enhancement during the past few decades Specific attention is given to the effect of fiber, filler, and nanofiller addition on poly(methyl methacrylate) (PMMA) properties The review is based on scientific reviews, papers, and abstracts, as well as studies concerning the effect of additives, fibers, fillers, and reinforcement materials on PMMA, published between 1974 and 2016 Many studies have reported improvement of PMMA denture base material with the addition of fillers, fibers, nanofiller, and hybrid reinforcement However, most of the studies were limited to in vitro investigations without bioactivity and clinical implications Considering the findings of the review, there is no ideal denture base material, but the properties of PMMA could be improved with some modifications, especially with silanized nanoparticle addition and a hybrid reinforcement system

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PMMA denture base material enhancement: a review of fiber, filler, and nanofiller addition.

A wide range of polymers are commonly used for various applications in prosthodontics. Polymethyl methacrylate (PMMA) is commonly used for prosthetic dental applications, including the fabrication of artificial teeth, denture bases, dentures, obturators, orthodontic retainers, temporary or provisional crowns, and for the repair of dental prostheses. Additional dental applications of PMMA include occlusal splints, printed or milled casts, dies for treatment planning, and the embedding of tooth specimens for research purposes. The unique properties of PMMA, such as its low density, aesthetics, cost-effectiveness, ease of manipulation, and tailorable physical and mechanical properties, make it a suitable and popular biomaterial for these dental applications. To further improve the properties (thermal properties, water sorption, solubility, impact strength, flexural strength) of PMMA, several chemical modifications and mechanical reinforcement techniques using various types of fibers, nanoparticles, and nanotubes have been reported recently. The present article comprehensively reviews various aspects and properties of PMMA biomaterials, mainly for prosthodontic applications. In addition, recent updates and modifications to enhance the physical and mechanical properties of PMMA are also discussed.

Prosthodontic Applications of Polymethyl Methacrylate (PMMA): An Update.

https://eprints.ncl.ac.uk/file_store/production/239754/57B3E38D-BFFD-4E7B-BA8F-AD4BF445C497.pdf

Multifunctional bioactive glass and glass-ceramic biomaterials with antibacterial properties for repair and regeneration of bone tissue

The fracture resistance of polymethyl methacrylate (PMMA) the most popular denture base materials, is not satisfactory. The aim of this study is to improve the mechanical properties of PMMA by adding filler particles. Different inorganic filler particles including micronised glass flakes, acryl silane micronised, glass flakes 350nm, TiO2 and ZrO2 with different ratios by weight were incorporated into heat-cure plain PMMA and processed with optimal condition [2.5:1 Powder/ monomer ratio, conventional packing method and water bath curing for 2 hours at 95°C] to produce 12mm diameter and 2mm thick discs. Plain PMMA without additives was prepared as a test control. Three types of mechanical tests, biaxial flexure, microindentation fracture toughness and Vickers hardness were carried out on the samples. It was found that incorporating the particles did not improve the biaxial flexural strength of the resin. However, TiO2, ZrO2 and micronised glass flakes increased the fracture toughness of the resin. The hardness of PMMA was improved by the incorporation of all the particles.

Reinforcement of Denture Base Resin

The response to implantation of novel apatite glass–ceramics was evaluated using a weight bearing in vivo bone implant model. Five novel glasses with varying calcium to phosphate ratios were cast as short rods and heat-treated to crystallize principally apatite. One glass ceramic had an apatite stoichiometry (Ca : P=1.67); three were phosphate-rich and one calcium-rich. One of the phosphate-rich glasses was also tested in its glassy state to determine the effect of crystallization on the biological response. Rods were implanted into the midshaft of rat femurs and left for 28 days. The femurs were then harvested and processed for scanning electron microscopy, energy dispersive X-ray microanalysis and conventional histology as ground and polished sections. Four of the materials exhibited evidence of osseointegration and osteoconduction. However, there was a marked inflammatory response to one of the phosphate-rich glass–ceramics, and to the non-crystallized glass. Crystallization of the latter significantly improved the bone tissue response. The glass–ceramic with an apatite stoichiometry elicited the most favorable response and merited further study as an osteoconductive bone substitute in maxillofacial and orthopedic surgery.

Crystallization modifies osteoconductivity in an apatite–mullite glass–ceramic

The aim of this study was to determine the average freeway space of dentate subjects and relate this to recommended ranges for edentulous patients, also to see if any differences were observed between two different methods of measuring freeway space. The freeway space of 72 dentate subjects was measured, first using a Willis gauge, and secondly using a pair of sprung dividers. The intra- and interoperator variability was evaluated as was the reproducibility of the accuracy of both techniques. The mean freeway space using the Willis gauge was 3.3 mm, for both intra and inter operator variability, and with the sprung dividers 3.1 and 2.9 mm, respectively, with no significant difference being seen between any combination of results (P > 0.05). Individual measurements within the two measuring methods being assessed showed significant differences (P < 0.05). The mean measurements of freeway space in dentate subjects found in this study were within the recommended 2-4 mm range, however, 15% of the subjects in the study had freeway space measurements outside this range. This study would suggest that the range for freeway space measurement could more realistically be 2-7 mm.

The determination of freeway space using two different methods

The aim of this study was to compare the marginal and internal fit accuracy of crowns constructed using three different wax production methods; conventional, milled, and 3D printed and utilizing three different cement gap thicknesses.15 identical stone dies were made for each method. Wax patterns were produced and then cast into metal crowns, which were assessed for differences in accuracy of both marginal and internal fit. Measurement points were 4 points per crown; occlusal, axial, marginal gap, and marginal discrepancy points. A silicone impression technique and conventional cementation technique were employed to facilitate the measurements.There was no significant difference (p > 0.05) in accuracy between the digitally and manually produced crowns, with the 3D printed crowns being slightly more accurate. Whereas, statistically significant differences were noticed between the conventional versus printed groups, in occlusal and marginal gap points (p < 0.05).The marginal and internal fit of 3D printed wax patterns is more accurate than the other two production methods. The milling of wax crowns is as accurate as the conventional hand carved production in terms of internal and marginal fit. The manufacturer recommended offset/die-spacer of 30 μm produced the most accurate internal and marginal fits.

Anthony Johnson

Papers

Reinforcement of Denture Base Resin

Crystallization modifies osteoconductivity in an apatite–mullite glass–ceramic

The determination of freeway space using two different methods

The Accuracy of Fit of Crowns Made From Wax Patterns Produced Conventionally (Hand Formed) and Via CAD/CAM Technology.

Determination of Polyetheretherketone (PEEK) mechanical properties as a denture material.