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RESEARCH AND EDUCATION

Mechanical properties, accuracy, and cytotoxicity of


UV-polymerized 3D printing resins composed of BisEMA,
UDMA, and TEGDMA
Chih-Hsin Lin, PhD,a Yuan-Min Lin, DDS, PhD,b Yu-Lin Lai, DDS, MS,c and Shyh-Yuan Lee, DDS, DScDd

Digital dentistry (intraoral image ABSTRACT


acquisition, data processing, and
Statement of problem. Three-dimensional printing has the potential for clinical applications, and
digital manufacturing) has additive manufacturing materials for dental use merit further investigation.
revolutionized dental practice.
Digital manufacturing includes Purpose. The purpose of this in vitro study was to evaluate the properties of materials formulated
with ethoxylated bisphenol A-dimethacrylate (BisEMA), urethane dimethacrylate (UDMA), and
subtractive manufacturing using
triethylene glycol dimethacrylate (TEGDMA) as 3D printing resins for ultraviolet digital light
computer-aided milling and processing (UV-DLP) 3D printers and to characterize the mechanical and biological properties
additive manufacturing using and accuracy of the printed objects.
3D printing. By cutting a
Material and methods. Ten different light-polymerized resins were formulated using BisEMA,
prefabricated block or disk,
UDMA, and TEGDMA. Their viscosities were measured, and only 7 resins with viscosities lower
milling technologies can create than 1500 centipoise (cP) were selected for 3D printing and further material characterization. The
prostheses which are compara- light-polymerized resins were printed into representative shapes using a custom-made 3D
ble with conventional prosthe- printer equipped with a 405-nm UV-DLP projector as the light source. The printed specimens
ses in terms of mechanical were subjected to biologic, mechanical, and accuracy tests, and the data were submitted to
performance, biological proper- 1-way ANOVA and Tukey post hoc comparisons (a=.05).
ties, and accuracy.1-3 Disadvan- Results. Photopolymerizable resins made of BisEMA, UDMA, and TEGDMA were successfully
tages of milling technologies are formulated for 3D printing to fabricate objects of various shapes and sizes. TEGDMA served as
that they are unable to shape the diluent to reduce the viscosity and increase the degree of conversion, while UDMA and
complex details such as un- BisEMA provided strength as demonstrated by the mechanical testing. All the printed objects
dercuts and intaglio geometry passed cytotoxicity testing. The flexural strengths of the printed specimens ranged between 60
MPa and 90 MPa; flexural modulus ranged between 1.7 GPa and 2.1 GPa; and surface hardness
and that only one unit can be ranged between 14.5 HV and 24.6 HV. These represent similar mechanical properties to those of
produced at a time. In contrast, currently used clinical resin materials. In the accuracy test, the resin mixture composed of 80%
additive manufacturing can BisEMA, 10% UDMA, and 10% TEGDMA had the highest accuracy, with a 0.051-mm deviation
build complex geometries and from the original design.
has the potential to be much Conclusions. BisEMA, UDMA, and TEGDMA are good candidates for the formulation of 3D printing
more productive.4 resins for dental use. The printed objects demonstrated favorable biological and mechanical
Digital light processing properties. Further, the accuracy of the printed specimens showed potential for clinical
(DLP) is one of the most application. (J Prosthet Dent 2019;-:---)

C.-H.L. and Y.-M.L. contributed equally to this article. This research is funded by the Ministry of Science and Technology, Taiwan (MOST106-3114-E-010-002).
a
Postdoctoral Researcher, Department of Dentistry, National Yang-Ming University, Taipei, Taiwan.
b
Associate Professor, Department of Dentistry, National Yang-Ming University, Taipei, Taiwan.
c
Chairperson, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan.
d
Professor, Department of Dentistry, National Yang-Ming University, Taipei, Taiwan; and Attending Doctor, Department of Stomatology, Taipei Veterans General Hospital,
Taipei, Taiwan; and Researcher, Department of Dentistry, Taipei City Hospital, Taipei, Taiwan.

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Table 1. Name, composition, and viscosity of formulated resins


Clinical Implications Specimen
Composition (wt%) Viscosity (cP)
Name BisEMA UDMA TEGDMA Mean SD
Three-dimensional printing resins made of BisEMA, 100 100 0 0 952 10
UDMA, and TEGDMA had properties that met 820 80 20 0 1217 13
clinical requirements. Because they were composed 640 60 40 0 1294 66
of components that are well established in 460 40 60 0 2219 61
dentistry, they can be accepted by dentists if 3D 280 20 80 0 3673 27
printers become more accessible. 010 0 100 0 7824 30
811 80 10 10 482 24
631 60 30 10 655 28

promising 3D printing technologies for dental applica- 451 40 50 10 815 17


271 20 70 10 1302 72
tions because of its high resolution, rapid processing
speed, and low cost.5 The light coming from a DLP BisEMA, ethoxylated bisphenol A-dimethacrylate; SD, standard deviation; TEGDMA,
triethylene glycol dimethacrylate; UDMA, urethane dimethacrylate.
projector in a 3D printer provides energy to polymerize
photosensitive materials layer by layer.6,7 Because the
choice of monomer is critical to the formulation of 3D
second and expressed in centipoise (cP). Only resins with
printing resins for dental use, a reasonable approach is to
viscosities lower than 1500 cP were selected for further
use monomers commonly found in the light-polymerized
experiments. The specimens were printed using a
dental composite resins, including bisphenol A-glycidyl
custom-made UV-DLP printer equipped with a projector
methacrylate (BisGMA) and urethane dimethacrylate
(Q2-B; Delta Electronics) below the transparent resin
(UDMA). However, these dimethacrylate monomers
tank.4 The tank was covered with 5 mm of poly-
have high molecular weights and high viscosities, which
dimethylsiloxane (PDMS). The DLP projector displayed a
could interfere with successful printing. Therefore, non-
series of images of the 3D model and focused on the
hydroxylated monomers, such as ethoxylated bisphenol
PDMS top surface to form specimens. The light intensity
A-dimethacrylate (BisEMA), with a lower viscosity are
was 4 mW at the resin tank bottom. The layer thickness
good candidates. Furthermore, triethylene glycol dime-
was 50 mm, and the exposure time was 4 seconds for each
thacrylate (TEGDMA) could be added as a diluent to
layer. The printed specimens were washed with iso-
decrease the viscosity of a formulated printable resin.8-10
propanol and subjected to 10 minutes of postprinting UV
The purpose of this study was to prefabricate potential
treatment using a custom-made 405 nm UV box.
printing resins for dental use. The research hypotheses
The degree of conversion (DC) of the 3D-printed
were that light-polymerized 3D printing resins could be
resin disks (n=5) were calculated by using a Fourier
formulated with BisEMA, UDMA, and TEGDMA and
transform infrared (FTIR) spectrometer (Nicolet iS5;
that the printed objects would have acceptable accuracy
Thermo Scientific). All spectrums were normalized to the
and mechanical and biological properties.
C=O peak at 1720 cm−1, and the DC of each specimen
was determined by comparing the intensity of the
MATERIAL AND METHODS
aliphatic C=C stretching vibration at 1640 cm−1 of the
Ten experimental composite resins were formulated us- polymerized resin and the negative control. The flexural
ing BisEMA (Double Bond Chemical), UDMA (Sigma strength and modulus of the printed rectangular beams
Aldrich), and TEGDMA (Double Bond Chemical) as base were tested using a universal testing machine (AGS-
materials (Table 1). For every resin, 3% of diphenyl 500G; Shimadzu Co). The cross-section of the rectan-
(2,4,6-trimethylbenzoyl) phosphine oxide (Sigma Al- gular beams (n=8) had a dimension of 2×2 mm, and the
drich) was added as a photoinitiator, initiated by 405 nm distance between 2 supports was 25 mm. Force was
of ultraviolet (UV) light. In addition, 0.5% of titanium applied at a crosshead speed of 2 mm/min until fracture.
dioxide with an average diameter of 25 nm (First The microhardness of the 3D-printed cubes (10×10×10
Chemical), 0.015% of iron oxide with an average diam- mm, n=8) was measured by using a microhardness tester
eter of 25 nm (First Chemical), and 0.5% of silicon di- (HMV-2; Shimadzu Co) equipped with a Vickers
oxide (First Chemical) with an average diameter of 4 mm indenter under a load of 0.98 N for 25 seconds. A total of
were added to each resin as fillers. 18 equidistant measurements covering different surface
The viscosities of each resin were measured using a areas of each specimen were performed.
cone-plate viscometer (DV3TRV Rheometer; AMETEK The accuracies of the printing were evaluated by
Brookfield) with a constant volume of 1 mL measured at comparing the 3D-printed models with the digital models.
10 rpm for 2 minutes at room temperature. The readings A typodont molar was prepared according to the crown
between 10% and 90% torque were recorded every preparation guidelines11 and scanned using an intraoral

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100 140 *

120
80 *
Degree of Conversion (%)

Flexural Strength (MPa)


100

60
80

60
40

40
20
20

0 0
100 820 640 811 631 451 271 100 820 640 811 631 451 271
Specimen Group Specimen Group
Figure 1. Mean and standard deviations of degree of conversion of Figure 2. Mean and standard deviations of flexural strength of
3D-printed cubes. *P<.05. 3D-printed beams. *P<.05.

scanner (TRIOS; 3Shape) as the master digital model. The The DC of the 3D-printed cubes is shown in Figure 1,
digital molar model was then printed out with the and the 271 specimen had the highest DC (49.03%). No
formulated resins. The printed molars were rescanned and statistically significant differences were found among the
compared with the master digital model using software DC of the other specimens. The flexural strengths of the
(Geomagic Control X; 3D Systems) to determine the printed resin beams ranged between 60 and 90 MPa
printing deviations from the master digital model. (Fig. 2). Specimen 271 had the highest strength and 820
The cytotoxicity of the printed resin cubes was had the lowest strength. In specimens containing 10%
evaluated in vitro according to the ISO 10993-5 TEGDMA, specimens that contained more UDMA
(elution test method).12 The fluid extracts of the prin- exhibited higher flexural strengths. The flexural moduli of
ted cubes (10×10×10 mm, n=3) were placed in phenol the printed resin beams were not statistically significantly
red-free Dulbecco’s modified Eagle’s medium (DMEM) different (Fig. 3). Specimen 811 had the highest flexural
containing 100 units/mL of penicillin, 100 mg/mL of modulus of 2.1 ±0.25 GPa, while specimen 100 had the
streptomycin, 2.5 mg/mL of fungizone, and 10% v/v of lowest flexural modulus of 1.7 ±0.14 GPa. The Vickers
fetal bovine serum at 37  C for 24 hours under hardness of the 3D-printed cubes showed that specimen
continuous stirring. Meanwhile, 50 000 cells/well of 640 had the highest value of 24.6 ±1.8 HV, while spec-
murine fibroblasts L929 were seeded into each well of imen 271 had the lowest surface hardness of 14.5 ±0.6
a 96-well plate and incubated in DMEM containing HV. In specimens containing 10% TEGDMA, specimens
antibiotics and 10% v/v of fetal bovine serum at 37  C containing more UDMA exhibited lower surface hard-
for 24 hours. The cell culture medium was then ness (Fig. 4).
replaced by the aforementioned fluid extracts and The accuracies of the 3D-printed models revealed that
incubated at 37  C. After 24 hours, cell morphology specimen 811 exhibited the lowest mean deviation value
and cell density were recorded, and MTT (3-(4,5- of 0.000 ±0.051 mm from the master digital model, and
dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bro- specimen 631 with a mean deviation value of 0.052
mide) assay was performed. ±0.101 mm was the second best. In contrast, specimen
Data for flexural strength, flexural modulus, DC, and 271 had the largest average deviation of 0.094 ±0.152 mm
cytotoxicity were analyzed with 1-way ANOVA and of all specimens. In specimens that contained 10% of
Tukey post hoc tests using statistical software (IBM SPSS TEGDMA, specimens containing more UDMA exhibited
Statistics, v20.0; IBM Corp) (a=.05). higher mean deviation (Fig. 5).
Figure 6 showed the MTT assays of L929 cells cultured
in the extracts of the 3D-printed cubes. The Y axis was
RESULTS
normalized to the negative control and labeled as
The viscosities of the formulated resins are shown in viability. Specimen 640 had the highest viability of 118.8
Table 1. Formulated resins with more UDMA had higher ±5.7%, while specimen 451 had the lowest viability of
viscosities, and adding 10% TEGDMA significantly 87.1 ±7.4%. Specimens containing no TEGDMA had
reduced the viscosity of the resin mixture; 7 of 10 resins higher viability than the specimens containing 10%
had viscosities lower than 1500 cP. TEGDMA. Nevertheless, all specimens were considered

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3.0

2.5
Flexural Modulus (GPa)

2.0

1.5

1.0

0.5

0.0
100 820 640 811 631 451 271
Specimen Group
Figure 3. Mean and standard deviations of flexural modulus of
3D-printed beams. No statistical difference among specimens found.

30 * *

*
25
Microhardness (HV)

20

15

10 Figure 5. Accuracies of 3D-printed models presented as color mapping


of 3D deviations from master digital model. SD, standard deviation.
5
methacrylate monomer in dental composite resins, its
0
high viscosity limits its application in 3D printing. In this
100 820 640 811 631 451 271 study, BisEMA, an analog of BisGMA, was therefore
Specimen Group chosen. The absence of the hydroxyl group in BisEMA
Figure 4. Mean and standard deviations of surface hardness of significantly decreases its viscosity and makes this
3D-printed cubes. *P<.05. monomer a good candidate for 3D printing.7,8 To create
the initial strength of the polymerized resin, UDMA was
selected as the second copolymer because UDMA has a
nontoxic according to the ISO 10993-5 standard12 as
maximum polymerization rate 3-fold higher than that of
their relative viabilities were all above 70%.
BisGMA.8 Furthermore, TEGDMA was incorporated to
adjust the viscosity of the formulated resins. Only 10% of
DISCUSSION
TEGDMA was proposed, as the diluent comonomer
The hypotheses that BisEMA, UDMA, and TEGDMA could adjust viscosity in logarithmic fashion13 and
could be successfully formulated to make light- excessive TEGDMA might adversely affect the properties
polymerized 3D printing resins and that the printed of the matrix by increasing its cytotoxicity and polymer-
objects demonstrated accuracy and mechanical and bio- ization shrinkage.14
logical properties that suggested their suitability for In the preliminary tests, resin mixtures with viscosity
dental use were accepted. Since 3D printing resins for exceeding 1500 cP led to voids or missing layers during
DLP printers must be precisely photopolymerized layer printing. Therefore, resin formulations that have viscos-
by layer to form the objects, they must have an adequate ities less than 1500 cP were further supplemented
flow (low viscosity) during the printing process. with a colorless UV-sensitive photoinitiator with an
Although BisGMA is the most commonly used absorption peak around 350 to 420 nm.15-17

THE JOURNAL OF PROSTHETIC DENTISTRY Lin et al


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140 * printing is not completely polymerized inside the tank;


therefore, intense postprinting UV exposure is indicated
120 to raise the DC and exhaust any residual photoinitiator.19
In this study, specimen 271 had the highest DC, and
Viability (% Control)

100
flexural strength had the lowest surface hardness of all
80 specimens (Figs. 2, 4). These findings could be explained
by the presence of TEGDMA and higher UDMA content
60 in the resin because the flexible ester bond located in
UDMA, compared with the rigid benzoic ring of BisEMA,
40 could significantly reduce the hardness. The flexural
strengths of the 3D-printed resins ranged from 60 MPa
20
to 90 MPa and are comparable with PMMA and bisacryl-
0 based interim restorative materials.30 Similarly, the flex-
ural moduli, ranging from 1.7 GPa to 2.1 GPa, were
1

1
0

nt ve

nt ve
81

63

45

27
10

82

64

co ti

co siti
Po l

l
ro

ro
ga
better than those of PMMA and only slightly lower than
Ne

those of bisacryl-based interim restorative materials.30


Specimen Group Accordingly, these formulated resins may be used to
Figure 6. Mean and standard deviations of MTT cytotoxicity tests of 3D- make interim restorations, denture bases, occlusal de-
printed cubes. *P<.05. MTT, 3-(4,5-dimethylthiazol-2-yl)-2,5- vices, custom trays, record bases, surgical guides, and
diphenyltetrazolium bromide assay. dental casts by 3D printing.5
The accuracy of the printed objects is correlated with
Although camphorquinone (CQ) is the most frequently the precise Z-axis displacements of the 3D printer and the
used photoinitiator in dental resins, its polymerization front polymerization kinetics of formulated resins.19 Resin
efficiency and yellowish color might limit its application matrixes are usually doped with TiO2 to limit the UV
in 3D printing.17,18 Another shortcoming is that CQ has penetration depth, which improves the resolution of
an absorption peak at 420 to 520 nm visible light, which printed objects in the Z-axis and results in better shape
induces deeper polymerization than with UV light.6,7,17 formation.31 In this study, only 0.5% of TiO2 was
Concerning the accuracy of the z-axis, a photoinitiator used since high TiO2 concentrations may cause agglom-
for UV light photoinitiation has been commonly cho- eration.31-33 Specimen 811 showed the best overall accu-
sen.19 Furthermore, UV absorbers have been supple- racy of 0.000 ±0.051 mm (Fig. 5). The 0.051-mm
mented in the resins to control the penetration depth of discrepancy might be excessive for definitive restorations.
light.20-22 In this study, metal oxides and silicon dioxide However, this is acceptable for interim crowns because the
fillers were used. discrepancy could easily be corrected at chairside if
BisEMA, UDMA, and TEGDMA are all bifunctional necessary. Furthermore, the mechanical and biological
monomers. A light-polymerized resin with DC smaller properties of specimen 811 were comparable with those of
than 50% would suggest that unreacted free monomers the interim restoration materials currently used, denoting
are present.23,24 The DC of the 3D-printed cubes ranged the potential of these resins for future clinical trials.
between 25% and 50% (Fig. 1), which likely denoted free Limitations of the current study include that only
monomers. Unreacted monomers could leach out and the accuracy of a single prepared tooth was examined.
cause cell death. These phenomena, however, were not The accuracy of the 3D-printed object is correlated with
observed for the printed specimens in the cytotoxicity the dimensions of the 3D designs, printing orientation
tests. One possible explanation was that after post- and layer thickness, light intensity and penetration
polymerization, the space between the polymer chains of depth, and postprinting UV treatment;5 therefore, future
the cube surfaces was small enough to prevent the research is required to calibrate and correct the distortion
monomers from leaching out. Another possible expla- in DLP printing.4,5,25 Additionally, as resin color setting
nation was that the maximum penetration depth of the might also affect the accuracy and mechanical and bio-
infrared beam from the spectrometer is only 10 mm, logical properties of the printed objects, the printing resin
which could only represent the absorption information of may need to be fine-tuned for clinical use.
the superficial layers of the resin cubes. It is suspected
that postprinting isopropanol wash and postprinting UV CONCLUSIONS
treatment might cause nonmonotonic spatial conversion
Based on the findings of this in vitro study, the following
of the resin matrix. Future studies to explore the 2D map
conclusions were drawn:
of DC on the 3D-printed objects are needed.19,25
The mechanical properties of the composite resins are 1. BisEMA, UDMA, and TEGDMA doped with various
related to the DC of resins.26-29 Frontal conversion in 3D fillers can be used to formulate 3D printing resins,

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and the 3D-printed objects showed properties 17. Schneider LF, Cavalcante LM, Prahl SA, Pfeifer CS, Ferracane JL. Curing
efficiency of dental resin composites formulated with camphorquinone
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Vinyl esters: low cytotoxicity monomers for the fabrication of biocompatible
3D scaffolds by lithography based additive manufacturing. J Polym Sci A
Polym Chem 2009;49:6941-54.
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