The aim of this study was to assess the effect of printing orientation and water ageing on the flexural strength and flexural modulus of 3D printed resins for occlusal splints. Bar-shaped specimens were designed with dimensions of 64 × 10 × 3.3 mm according to ISO 20795-2:2013. Specimens were 3D printed with the Form 3B printer (Formlabs), using Dental LT Clear Resin (CL) or Comfort Resin (CO) (Formlabs), and 3 different printing orientations: as per manufacturer's recommendation (40° N = 20), parallel (0° N = 20), or perpendicular to the build platform (90° N = 20). To simulate intraoral ageing, half of the specimens per material and printing orientation (N = 10) were stored in distilled water at 37 °C for 30 days prior to testing. Specimens were tested in a three-point bending apparatus using a universal testing machine equipped with a 50 N load cell moving at a crosshead speed of 5 mm/min. Flexural strength (MPa) and flexural modulus (GPa) data were collected and statistically processed with separate analyses for unaged and aged specimens (Two-Way or One-Way ANOVA; Tukey test; p < 0.05). As for unaged specimens, both resin materials exhibited the highest flexural strength and modulus in the 90° orientation and the lowest values in the 40° orientation group. After water aging, all groups showed reduced flexural strength and modulus, with CO displaying up to 52% loss in flexural strength and values falling below ISO thresholds. CO consistently exhibited significantly lower flexural strength and modulus than CL, irrespective of aging.

Orthodontic aligners 3D-printed in resin currently provide a viable alternative to thermoformed ones. However, concerns have been raised regarding their biocompatibility. This review addressed the available scientific evidence on the biological properties of marketed resins for 3D printing of orthodontic aligners, encompassing cytotoxicity, estrogenicity, biofilm formation, and oral soft tissues reactions. A comprehensive literature search of several databases was conducted and PRISMA guidelines were followed to summarize the retrieval. Eleven studies were included in the review. They provided information on only three marketed resins: Tera Harz TC-85 DAC and Tera Harz TA-28 (Graphy) and Clear-A (Senertek). For the last two materials, only one investigation has been performed. Despite the large variability in experimental protocols, the lack of cytotoxicity of Tera Harz TC-85 DAC was a consistent finding. Also, no estrogenic effect was detected for this resin, in line with the lack of any bis-phenol A precursor in its chemical composition. In two clinical studies, oral soft tissue reactions were reported as rare and non-serious occurrences. Biofilm adhesion was regarded as critical for the clinical safety of 3D-printed aligners. Standardization of in vitro protocols, also including more clinically relevant settings, chemical characterization of the resins' eluates, and collection of additional in vivo data are advised to improve the quality of the evidence.

Background: 3D-printed (3DP) resins for permanent restorations are increasing in availability and gaining popularity. Aesthetic stability is an issue of dental resins that may compromise the long-term success of restorations. A staining test has been performed to evaluate gloss, roughness, and color staining of a permanent 3DP resin, and the effects of repolishing. Methods: Squared specimens of one 3DP permanent resin (Crown permanent, Formlabs) have been CAD-designed and 3D-printed. After the roughness, gloss, and color measurements, they were immersed in a coffee staining bath at 44 °C for 24 h and then measured again. Subsequently, they were repolished with three different systems: prophy cup and Nupro prophy paste, HiLuster Plus 2-step, and Opti1Step Polisher 1-step polishing systems. Results: Gloss and Roughness were not significantly affected by the staining procedure. No significant changes were observed for gloss after repolishing, while one of the tested systems (prophy cup and paste) produced a worsening effect on roughness. Color was affected by the staining procedure. After repolishing, b* changes were almost completely recovered, while L* changes were recovered only partially. Conclusions: Color stability still represents a challenge, and 3DP resins for permanent use are affected. Repolishing systems should be further developed and tested.

BACKGROUND: This prospective two-center case series feasibility study aimed to investigate the potential of a novel maxillary protraction facemask customized to the patients' anatomy recorded with 3D face scanning and then produced by digital design and additive manufacturing. METHODS: Ten subjects (5 females and 5 males, average age 7.7 +/- 1.0 years) with Class III malocclusion were treated with a rapid maxillary expander (RME) and a Petit-type facemask (FM), whose components were digitally designed on a 3D scan of the patient's face. Subjects' face scans were obtained either with a tablet or with face scanner. FM components were modelled with a 3D software. The pads were 3D printed in biocompatible resin, and the bar was printed in stainless steel. A questionnaire investigating the patients' experience was filled in after the first week of treatment and after 3, 6, and 9 months. RESULTS: The customized FM showed an excellent adaptation to the anatomy of the face. No severe complications were reported during the 9 months of appliance wearing. Some reversible episodes of skin irritation were reported below the pads, mainly in the chin area. The reported time wearing ranged between 8.2 +/- 2.3 and 9.5 +/- 1.2 hours per day, mainly at night. Reported pain was overall low (maximum after 1 week with an average value of 1.9 +/- 1.7 on a visual analog scale [VAS] 0-10) and patients' satisfaction was adequate at the end of the facemask wear after 9 months (8.7 +/- 1.4 on a VAS 0-10). CONCLUSIONS: The customized FM was overall well accepted by the patients and represents a valid alternative to conventional ones.

To evaluate the effect of printing orientation on flexural strength and modulus of 3D-printed resins used for occlusal splints. Bar-shaped specimens for 3-point bending tests were designed according to ISO 20795-2: 2013 specifications (64 × 10 × 3.3 mm). Specimens were fabricated using a Form 3B printer with two resins: Dental LT Clear Resin (CL, N=10) and Comfort Resin (CO, N=10). Each material was printed in 3 orientations: 0°, 90°, and 40°. Mechanical testing was performed using a universal testing machine equipped with a 50 N load cell operating at 5 mm/min crosshead speed. Testing ceased at 15 mm deflection. Flexural strength (MPa) and modulus (GPa) were calculated from the recorded load (N). Statistical analysis employed two-way ANOVA and Tukey’s post-hoc tests, with significance at p<0.05. Printing orientation significantly affected flexural strength, whereas material type did not. The highest strength was observed for 0° specimens, while 40° specimens exhibited the lowest values and these differences were significant. The between-factor interaction was significant: among all groups the highest strength was reached by CO specimens printed at 0°. Flexural modulus was influenced by material type and print orientation. CO exhibited a significantly lower modulus than CL. Modulus increased as print orientation shifted from 0° to 90°. The between-factor interaction was statistically significant: among all groups the highest strength was reached by CO specimens printed at 0°. All specimens exceeded the ISO threshold for flexural strength, but flexural modulus, particularly for CO, was below the ISO requirement. CO demonstrated the highest flexural strength combined with the lowest modulus, aligning with the manufacturer's claims of greater elasticity. This result may enhance splint adaptation and patient comfort without compromising strength. However, the low modulus raises concerns about resistance to deformation under intense parafunctional loads.

The study aims to assess the effect of printing orientation on surface roughness and gloss of resins for 3D printing of aligners. Squared specimens (14 × 14 × 4 mm) were printed using Dental LT Clear (Formlabs, Somerville, MA, USA; LT) or Tera Harz TC-85 DAC (Graphy, Seoul, Republic of Korea; TC) with different orientations: 0° (horizontal), 90° (vertical), and as per the manufacturer’s recommendation (40° for LT, 60° for TC). A profilometer was used to measure roughness (Ra) in µm, while gloss was recorded in gloss units (GU) with a glossmeter. The collected data were statistically analyzed. Material type did not significantly influence roughness, while print orientation was an influential factor, with the orientation recommended by the manufacturer yielding the roughest specimens. Vertical printing resulted in significantly higher roughness than horizontal. Material type was a significant factor for gloss, with TC exhibiting significantly higher gloss than LT. Print direction significantly influenced gloss, with vertical printing resulting in the highest gloss. The finding of higher roughness for vertical prints can be explained by the presence of a greater number of layers. The superior gloss exhibited by TC regardless of print angulation could be related to the effective cleaning of uncured resin by centrifugation and to the high degree of monomer conversion in nitrogen atmosphere.

Class III malocclusions, a dentofacial deformity requiring early intervention, pose significant challenges due to the need for prolonged use of facemasks by young patients. The SuperPowerMe project aims to improve compliance with the orthodontic treatment by integrating personalised, sensor-equipped facemasks with gamification. Through a design thinking process, the facemasks were custom-fitted using 3D facial scanning and 3D-printed with biocompatible materials to ensure comfort and ergonomic fit. Sensors embedded in the mask monitored wear time, and data collected were used to engage children in a video game allowing children to progress through game challenges as they complied with the treatment. Observational studies were conducted, evaluating patients’ adherence and comfort levels. The results indicated a substantial increase in daily wear time and patient satisfaction, with self-reported compliance closely matching sensor data. The personalised design and gamified elements fostered higher patient autonomy over the treatment period, although minor technical issues with the facemasks were noted. In conclusion, the results suggest that gamification paired with custom devices holds promise as a strategy for improving adherence to long-term orthodontic treatments in children. Further refinement of the system and broader trials are promoted to fully validate the efficacy of therapy gamification.

To evaluate whether there are differences among orthodontists in the clinical management of facemask treatment for early treatment of Class III malocclusion, a survey consisting of 16 questions was conducted among members of the Italian Society of Orthodontics (SIDO). Sixty percent of the respondents were Specialists in Orthodontics (S) whereas 40% were General Dentists practicing Orthodontics (GD). Descriptive statistics were calculated to summarize the collected data. Differences in answers between S and GD were assessed with the Fisher's exact test for dichotomous variables, chi-square test for qualitative variables, and Mann-Whitney test for ordinal variables. A total of 151 clinicians participated in this survey. As for treatment timing, about 80% of the participants reported treating Class III patients with RPE and facemask between 5 and 8 years of age. Most of the participants requested the patients to wear the facemask in the afternoon and at night for a period of 9 or 12 months with recommended forces of 500 g per side. Comparisons between S and GD showed that S preferred the Petit facemask whereas GD favored the Delaire's type facemask (Fisher's Exact test, p = 0.0005). S and GD also differed significantly in their judgment of the most critical time of treatment, which for the majority of GD was the initial period but for the S was the final period (Chi-square test p = 0.0188). This survey showed that the facemask is not well received by the patients who, along with their parents, express concerns regarding its tolerability.

PURPOSE:To evaluate interfacial three-dimensional adaptation and internal voids of different flowable materials before and after cyclic fatigue in a simulated deep-margin elevation scenario. METHODS:Eighty (n &#61; 80) extracted premolars were selected and two Class II cavities were prepared. The mesial one with cervical margin 1 mm above the cementum-enamel junction (CEJ) and the distal one with cervical margin 1 mm below the CEJ. After performing adhesive procedures, specimens were divided into four groups according to the employed materials for 2 mm horizontal deep-margin relocation: nanohybrid composite (Clearfil ES2, Kuraray); conventional viscosity flowable composite (Tetric Flow, Ivoclar); medium viscosity flowable composite (Majesty ES2 Low Flow, Kuraray); high viscosity flowable composite (Majesty ES2 Super Low Flow, Kuraray). All restorations were finalized by oblique layering with nanohybrid composite (Clearfil ES2, Kuraray). To reveal interfacial and internal gap progression, specimens were scanned with a micro-CT (SkyScan 1172), before and after 500,000 cycles of mechanical chewing simulation (50 N, 1 Hz). Data were imported into Mimics software after smoothing and region growing. Only the 2 mm margin relocation volumes were considered. Obtained masks were analyzed for noise removal and volume calculation. At baseline, interfacial gap progression and internal voids, expressed in mm3, were collected and statistically analyzed with two-way ANOVA (α 0.05) for the variables substrate and restorative materials followed by Tukey post-hoc test. An additional two-way ANOVA test, followed by Tukey post-hoc test, was performed to evaluate variation in interfacial gap progression after mechanical aging. RESULTS:At baseline, the ANOVA test showed a significant difference for the variable restorative materials (p &#61; 0.01). More specifically, the Tukey post-hoc test revealed that the highly filled medium viscosity composite performed better than the conventional viscosity composite at baseline for the interfacial gap. The internal voids ANOVA test at baseline reported no significant differences for the variable tested. Analysis of variance for internal gap progression after thermocycling showed no differences for both substrate and restorative material employed. CONCLUSIONS:Highly filled medium viscosity composite performed significantly better than the conventional viscosity flowable composite for what concern baseline interfacial gaps. Artificial aging with a chewing simulator and thermocycling did not affect interfacial gap progression on enamel and dentin. The tested restorative materials performed equally after aging.

The objective of this study was to review the scientific evidence currently available on 3D printable materials and 3D printing technologies used for the fabrication of permanent restorations, focusing on material properties that are clinically relevant. A literature search was performed on four databases (MEDLINE/PubMed, Scopus, Cochrane Library, Web of Science) for articles published from January 2013 until November 2023, using a combination of free words: (restorative dentistry OR prosthetic dentistry) AND (3D printing OR additive manufacturing OR rapid prototyping) AND materials. Two reviewers screened titles and/or abstracts of 2.468 unique studies. In total, 83 studies were selected for full-text reading, from which 36 were included in the review. The assessed variables were mechanical properties, reporting in most of the cases positive results, dimensional accuracy and fit, reporting conflicting results with a predominance of positive, aesthetic properties, with positive reports but scarcely addressed, and biological properties, almost unexplored in independent studies. Despite numerous studies with positive results in favor, papers with negative outcomes were also retrieved. Aesthetic and biological properties are conversely still mostly unexplored. There remains a lack of conclusive evidence for viable 3D printable restorative and prosthodontic materials for permanent restorations. Research should be strengthened by defining international standards for laboratory testing and, where pre-clinical data are promising, conducting clinical trials.

The use of lubricants during restorative procedures is a clinically common practice to alleviate the stickiness of resin-based composite (RBCs) materials and to improve its handling. This study evaluated the effects of three modeling liquids (ML) and one universal adhesive (UA) used as lubricants during composite layering on the color stability and translucency of RBCs. Methods. The following materials were applied between every 1 mm RBC layer (total restoration height of 4 mm): GC modeling liquid (GCML, GC Corporation, Tokyo, Japan), composite wetting resin (UPWR, Ultradent Products, South Jordan, UT, USA), Bisco modeling resin (BSMR, Bisco Inc., Schaumburg, IL, USA) as an ML and Clearfil Universal Bond Quick (KUBQ, Kuraray Noritake Dental, Tokyo, Japan) as a UA. Lubricant-free specimens were used as the control. Color coordinates (L*, a* and b*) were recorded at baseline and after a simulation of 1 month of coffee consumption. Data were analyzed using ANOVA and a post hoc Tukey test (p < 0.05). Results. All lubricants induced a color change higher than the perceptibility threshold (ΔE00 > 0.81). GCML showed the highest color stability. The use of KUBQ resulted in significantly higher a* values (p = 0.001) at baseline and after staining. KUBQ and UPWR significantly influenced the color stability (ΔE00, p = 0.0001) after staining, overcoming the clinical acceptability threshold (ΔE00 > 1.77). Conclusions. The use of lubricants may affect color stability at baseline and after simulation of staining. Translucency was not affected at baseline nor after staining. Clinical Significance. Clinicians should be aware that some lubricants may affect color stability, even at baseline.

Nasopharyngeal swab sample collection is the first-line testing method for diagnosing COVID-19 infection and other respiratory infections. Current information on how to properly perform nasopharyngeal swabbing in children is largely defective. This study aimed at collecting nostril to nasopharynx distance measurements on lateral skull radiographs of children and adolescents to design a nasopharyngeal swab meant to standardize and facilitate the sample collection procedure. A total of 323 cephalograms of 152 male and 171 female children aged 4–14 years taken for orthodontic reasons were selected. On each cephalogram, the shortest distance between the most anterosuperior point of the nostril contour and the nasopharynx outline was measured in mm parallel to the palatal plane. Descriptive statistics of the measurements were calculated for each age group. The lower limit of the 95% confidence intervals of the measurements was taken as a reference to design a swab shaft with marks that, at each age, delimitate a safety boundary for swab progression up to the posterior nasopharyngeal wall. The simplification of the procedure enabled by the newly designed nasopharyngeal swab is valuable to help healthcare providers perform specimen collection on children in a safe and effective way, perhaps under the less-than-ideal conditions possibly occurring in ‘point-of-need’ contexts.

The review aimed at analyzing the evidence available on 3D printable materials and techniques used for the fabrication of orthodontic appliances, focusing on materials properties that are clinically relevant. MEDLINE/PubMed, Scopus, and Cochrane Library databases were searched. Starting from an initial retrieval of 669 citations, 47 articles were finally included in the qualitative review. Several articles presented proof-of-concept clinical cases describing the digital workflow to manufacture a variety of appliances. Clinical studies other than these case reports are not available. The fabrication of aligners is the most investigated application of 3D printing in orthodontics, and, among materials, Dental LT Clear Resin (Formlabs) has been tested in several studies, although Tera Harz TC-85 (Graphy) is currently the only material specifically marketed for direct printing of aligners. Tests of the mechanical properties of aligners materials lacked homogeneity in the protocols, while biocompatibility tests failed to assess the influence of intraoral conditions on eluents release. The aesthetic properties of 3D-printed appliances are largely unexplored. The evidence on 3D-printed metallic appliances is also limited. The scientific evidence on 3D printable orthodontic materials and techniques should be strengthened by defining international standards for laboratory testing and by starting the necessary clinical trials.

Objectives: To conduct a systematic review assessing quantitative enamel loss occurring after orthodontic debonding and clean-up procedures. Materials and Methods: A systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed on different databases (Embase, Medline, Scopus, Web of Science) for papers investigating volumetric enamel loss due to bracket and clear aligner attachment debonding and/or clean-up procedures. Studies investigating in vivo and in vitro articles published in the English language until 16 July 2022 were included. The study selection was then performed by two authors who screened the abstracts independently. Results: Of 421 screened abstracts, 41 articles were selected for full-text analysis. Finally, nine studies were included in this review. No in vivo papers were retrieved. In vitro papers investigated volumetric loss caused by the removal of metal brackets (n = 7), ceramic brackets (n = 1), and both (n = 1). The clean-up procedure varied among all investigations. Impressions at baseline and after debonding/clean-up were superimposed, and the volumes were subtracted using different 3D digital analysis software. Among all included studies, the volumetric loss of enamel ranged from 0.02 ± 0.01 mm3 to 0.61 ± 0.51 mm3 per tooth. Conclusions: Debonding and clean-up procedures produce enamel loss. The debonding/clean-up procedure that is able to cause the least enamel volume loss has yet to be identified.

Introduction The purpose of the present study was to evaluate the long-term variations in maxillary second molar position in untreated subjects with normal occlusion. Setting and sample population A sample of 39 subjects (18 females and 21 males) selected from the University of Michigan Growth Study (UMGS) was followed longitudinally with digital dental casts at 3 observation times: T1, when the maxillary permanent second molars were fully erupted, T2, last observation available in the longitudinal series (38 subjects), and T3, at least 20 years after T2 (12 subjects). Materials and methods Digital measurements were recorded with an open-source software. Outcome variables were sagittal and transverse inclinations of the upper second molars. Two mixed-effect models were performed. Results The maxillary second molars had a distolingual inclination at T1, T2 and T3. Sagittal and transverse inclination showed progressive significant uprighting from T1 through T3 (P < .001). From T1 to T2, the adjusted difference in sagittal crown inclination was 8.0 degrees (95% CI from 6.5 degrees to 9.6 degrees; P < .001). From T2 to T3, the adjusted difference was 5.5 degrees (95% CI from 3.0 degrees to 8.1 degrees; P < .001). From T1 to T2, the adjusted difference in transverse crown inclination was 1.9 degrees (95% CI from 0.4 degrees to 3.5 degrees; P = .011). From T2 to T3, the adjusted difference was 6.0 degrees (95% CI from 3.4 degrees to 8.5 degrees; P < .001). Conclusions Along with age, maxillary second molars showed a progressive significant uprighting with a decrease in the distal and lingual inclinations.

OBJECTIVEThe objective of this study was to review the experimental staining procedures performed in in-vitro studies for evaluating color stability of resin-based composites used for direct restorations.OVERVIEWA review was performed with the purpose to identify in vitro procedures carried out to establish staining and color stability of resin-based composites used for direct restorations. A literature search was performed on four online databases (PubMed, Scopus, Embase and Web of Science) for articles published from January 1st 2001 till March 20th 2021, using a combination of free words and Medical Subject Headings (MESH) terms: "Composite Resins" AND "Color Stability" OR "Staining." Two reviewers screened titles and/or abstracts of 1728 unique studies. In total, 208 studies were selected for full-text reading, from which 178 were included in the review. The assessed variables were specimen dimensions, shape, and surface finishing; time before immersion; staining media type, dwell time, temperature and renewal interval; type of composite; color and translucency assessment parameters and measuring system. One hundred and seventy-eight articles analyzed color stability with staining liquids. Coffee was the most used staining medium (n = 102), followed by tea (n = 61), and red wine (n = 55). A disc-shaped specimen was used in most studies (n = 170) with a 2 mm thickness (n = 116). Spectrophotometers were the most used color assessment devices (n = 154), followed by colorimeters (n = 17). Color differences were quantified with ΔE (n = 154), ΔE00 (n = 23). Acceptability and or perceptibility thresholds were also taken into consideration (n = 126).CONCLUSIONSThe large variety of staining procedure suggests the need for standardization.CLINICAL SIGNIFICANCEAesthetic failure due to discoloration is a relevant clinical problem. Evaluating benefits and drawbacks of resin based composites artificial staining procedures will improve to predict materials clinical performances.

The need for bracket bonding to ceramic restorations is increasing. The aim of this study was to evaluate the effect of universal adhesives on bracket adhesion to polished or glazed lithium disilicate (LDS) and monolithic zirconia (MZ) surfaces. One hundred and twenty brackets (N = 10) were bonded to either polished or glazed LDS (e.max CAD B32, Ivoclar Vivadent, Schaan, Liechtenstein) and MZ (In-Ceram® YZ, VITA, Bad Sackingen, Germany) blocks using three different adhesives combined with Transbond™ XT Paste (3M Unitek, Monrovia, CA, USA). Tested universal adhesives were Scotchbond™ Universal Adhesive (SU, 3M St. Paul, MN, USA) and Assure Plus (AP, Reliance, Itasca, IL, USA). Transbond™ XT Primer (XTP, 3M Unitek, Monrovia, CA, USA) served as a control adhesive. Bracket bond strength was measured in shear mode (SBS). Failure type was determined by the Modified Adhesive Remnant Index (ARI). Data were statistically analyzed. On polished LDS, SU yielded bracket SBS significantly superior to those of AP and XTP. On polished MZ, the use of SU and AP significantly enhanced bracket retention as compared with XTP. Low SBS values, below the threshold of clinical acceptability, were reached by all tested adhesives on glazed LDS and MZ specimens. SBS measurements corresponded with failure type observations. Universal adhesives SU and AP could be considered for use on polished LDS and MZ surfaces.

COVID-19 has deeply impacted clinical strategies in dentistry and the use of surgical masks and respirators has become critical. They should adapt to the person’s facial anatomy, but this is not always easy to achieve. Bellus3D Company proposed to apply their face scan software, used with selected smartphones and tablets, to design and 3D-print a bespoke “Mask Fitter” to improve the sealing of surgical masks and respirators. Twenty dental staff participants were face scanned and a Mask Fitter for FFP2 respirators was designed and 3D-printed. Participants were asked to wear their Mask Fitter over one week and then completed a survey. Questions were asked about wearing comfort, sealing confidence, glasses or loupes fogging, both with and without the Mask Fitter. Dental staff gave positive feedback, with levels of comfort during daily use reported as similar with and without the Mask Fitter; and a higher confidence in achieving a proper seal, ranging from a 10% confidence rating of a proper seal without the Mask Fitter to 75% with the Mask Fitter. Moreover, fogging problems decreased considerably. The tested Mask Fitter device could represent an easy and low-cost procedure to improve the facial adaptation of the FFP2 respirator.