3D-Printed Indirect Permanent Restoration

A clinical case by our Community member Dr Hüseyin Şimşek

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

Computer aided design-computer aided manufacturing (CAD-CAM) can be subtractive (milling) or additive (three-dimensional (3D) printing). Recently, dentists’ interest has been shifting to 3D printing, also known as rapid prototyping. Models, surgical guides, occlusal splints, complete dentures, clear aligners are produced with 3D printer in dental offices and dental laboratories. However, it is now possible to obtain permanent restorations, perhaps the most important item produced by dentists, with 3D printing. 3D printing system presented some advantages over milling as production of complex geometries, less waste material, lower cost, higher accuracy, and faster production.

styleitaliano style italiano initial situation

Fig.1
An 8-year-old patient came to the clinic complaining from sensitivity to cold. It can be clearly seen on the image that the carious lesion affected all the cusps.

styleitaliano style italiano Peri-apical x-ray

Fig.2
Peri-apical x-ray revealed an incomplete root formation with deep occlusal caries lesion.

styleitaliano style italiano Carious lesion

Fig.3
Extensive carious lesion under rubber-dam isolation.

styleitaliano style italiano Removal of unsupported occlusal enamel

Fig.4
Unsupported occlusal enamel was removed to better detect caries boundaries.

styleitaliano style italiano Removal of infected dentin

Fig.5
The infected dentin was removed, leaving only the affected dentin in the parts close to the pulp.

styleitaliano style italiano Etching

Fig.6
The enamel was etched with 37% phosphoric acid gel for 30 seconds.

styleitaliano style italiano Immediate dentin sealing

Fig.7
Immediate dentin sealing was performed with a universal adhesive (Clearfil S3 Bond, Kuraray) and a flowable composite (G-aenial Universal Injectable, GC).

styleitaliano style italiano Composite build-up

Fig.8
Composite build-up with packable composite before overlay preparation.

styleitaliano style italiano Overlay preparation

Fig.9
Overlay preparation.

styleitaliano style italiano Retraction cord placement

Fig.10
A retraction cord was used to retract the gingiva and to better identify the preparation margins in the digital impressions.

styleitaliano style italiano Final design

Fig.11
The final design of the indirect overlay (Exocad DentalCAD).

styleitaliano style italiano Slicing

Fig.12
Slicing was done using the application ChituBox.

styleitaliano style italiano Indirect overlay restoration

Fig.13
Indirect overlay restoration was produced with 3D printer (Phrozen Sonic Mini 8k) and 3D printing resin (Saremco Print Crowntec, SP).

styleitaliano style italiano After cementation

Fig.14
After cementation with self-adhesive dual-cure resin cement (Panavia SA Cement, Kuraray).

styleitaliano style italiano Staining and glazing of the restoration

Fig.15
The 3D-printed restoration was stained and glazed using the Optiglaze (GC America).

styleitaliano style italiano Post-cementation x-ray

Fig.16
Post-cementation x-ray was taken to evaluate the adaptation of the margins and the excess cement.

styleitaliano style italiano Final situation Indirect overlay restoration

Fig.17
Occlusal view (Immediate post-op).

styleitaliano style italiano Final situation Indirect overlay restoration

Fig.18
Natural occlusal anatomy (lateral view).

Conclusions

3D printing is constantly improving, and this technology is increasingly being used in dentistry. In the future of dentistry, a lot of 3D printing will be seen.

Bibliography

  1. Giannetti, L., Apponi, R., Mordini, L., Presti, S., Breschi, L., & Mintrone, F. (2022). The occlusal precision of milled versus printed provisional crowns. J Dent117, 103924.
  2. Donmez, M. B., & Okutan, Y. (2022). Marginal gap and fracture resistance of implant-supported 3D-printed definitive composite crowns: an in vitro study. J Dent124, 104216.
  3. Corbani, K., Hardan, L., Skienhe, H., Özcan, M., Alharbi, N., & Salameh, Z. (2020). Effect of material thickness on the fracture resistance and failure pattern of 3D-printed composite crowns. Int J Comput Dent23(3), 225-233.
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