Australian Dental Journal

The official journal of the Australian Dental Association

Australian Dental Journal 2021; 0: 1–6

doi: 10.1111/adj.12817

Comparison of artificial tooth position in dentures

fabricated by heat curing and additive manufacturing
A Tasaka,*,† H Okano,* K Odaka,†,‡ S Matsunaga,†,§ T K. Goto,‡ S Abe,§ S Yamashita*
*Department of Removable Partial Prosthodontics, Tokyo Dental College, Tokyo, Japan.
†Oral Health Science Center, Tokyo Dental College, Tokyo, Japan.
‡Department of Oral and Maxillofacial Radiology, Tokyo Dental College, Tokyo, Japan.
§Department of Anatomy, Tokyo Dental College, Tokyo, Japan.

ABSTRACT
Background: The purpose of this study was to compare the displacement of tooth arrangement in dentures fabricated by
additive manufacturing (AM) and heat curing.
Methods: Three-dimensional (3D) scanning was performed for edentulous jaw models. After the teeth were arranged, 3D
scanning for the wax denture was performed. Heat-cured dentures were fabricated with heat-cure polymer resin. Based
on data obtained by subtracting the model data from wax denture data, AM dentures were fabricated from ultraviolet-
cured acrylic resin. Accuracy was verified by superimposing heat-cured and AM dentures on the tooth region data from
the wax dentures and measuring displacement of the tooth arrangement.
Results: In the maxillary dentures, the amount of tooth displacement for the heat-cured dentures and for the AM den-
tures ranged from 0.08 to +0.06 mm and from 0.25 to +0.06 mm respectively. A significant difference was observed
between two dentures. In the mandibular dentures, the amount of tooth displacement for the heat-cured dentures and
for the AM dentures ranged from 0.09 to +0.07 mm and from 0.03 to +0.07 mm respectively. No significant differ-
ence was observed between two dentures.
Conclusions: The artificial teeth of the maxillary dentures fabricated by AM showed a greater displacement compared to
those by heat curing.
Keywords: 3D printer, additive manufacturing, CAD/CAM, heat curing, tooth arrangement.
Abbreviations and acronyms: 3D = Three-dimensional; AM = additive manufacturing; CAD/CAM = computer-aided design and com-
puter-aided manufacturing; MJ = material jetting; UV = ultraviolet.
(Accepted for publication 4 January 2021.)

relationship damages the anatomy of the occlusal sur-

INTRODUCTION
The most commonly used denture base material is
acrylic resin. During the fabrication process, wax den-
ture investment into a flask followed by resin packing
and curing are performed after artificial tooth
arrangement and festoon. Problems with this method
include material distortion—specifically, wax shrink-
age, investment material expansion and resin shrink-
age—as well as release of residual stress on
deflasking, leading to denture base distortion and
tooth displacement.1-3 Acrylic resin volumetric and
linear shrinkages of approximately 7% and 1%,
respectively, have been showed.4 These shrinkages
result in tooth displacement, causing articulator inci-
sal pin opening on denture remount. Mahler showed
that a 1-mm opening of the incisal pin affects vertical
dimension.5 Grinding to recover the occlusal
© 2021 Australian Dental Association
face of the teeth.6
Computer-aided design and computer-aided manu-
facturing (CAD/CAM) systems to fabricate complete
dentures continue to be developed.7 The three main
fabrication methods comprise (i) fitting and bonding
prefabricated teeth into a denture base milled from a
resin block; (ii) fitting and bonding prefabricated teeth
into an additive-manufactured (AM) denture base;
and (iii) monolithic computer numerical control
milling of the denture base and teeth from a resin
block. The first two methods are prone to deviation
of the positional relationship between the denture
base and teeth during bonding8 and attempts to adjust
offsets values or the design of the basal surface of the
teeth have yet to successfully mitigate this issue.9
Comparing tooth displacement with CAD/CAM fabri-
cation and conventional flasking, Goodacre found the
1
A Tasaka et al.
least tooth displacement with monolithic fabrication
of the denture base and teeth.10 However, this tech-
nique also presents issues such as limitations to the
size of the dentures that can be milled from the block,
constraints on tooth arrangement and generation of
material waste through cutting.
Considerable advances in AM techniques made in
recent years allow a variety of materials and colours
to be used in maxillofacial surgery.11-13 However,
tooth displacement with AM of complete dentures has
yet to be sufficiently investigated.
The present study aimed to compare displacement
of the tooth arrangement in dentures fabricated by
AM and by conventional heat curing in order to
investigate the clinical application of AM fabrication
methods for complete dentures, including the teeth.
MATERIALS AND METHODS
Fabrication of experimental denture
The procedures for fabricating the experimental den-
tures are shown in Fig. 1. Three-dimensional (3D)
scanning of an edentulous maxillary-mandibular plas-
ter jaw model (NC-N4; Nissin, Tokyo, Japan) was
performed using a dental laboratory scanner (Dental
System D700-3SP; 3shape, Copenhagen, Denmark).
The teeth were arranged after mounting the maxillary
Fig. 1 Flowchart of experimental denture production.
2 © 2021 Australian Dental Association
and mandibular working casts on the articulator via
an occlusion rim. Veracia SA (Shofu, Kyoto, Japan)
anterior (maxillary, A3 and O-5; mandibular, A3 and
MA-5) and posterior (maxillary, A3 and M-30;
mandibular, A3 and M-30) teeth were used. After
tooth arrangement and festoon, the finished wax den-
tures were coated with titanium oxide, and 3D scan-
ning was performed. Wax dentures were then invested
and heat-cured experimental dentures (heat-cured den-
tures) were fabricated with heat-cure polymer resin
(SR Ivocap; Ivoclar Vivadent, Schaan, Liechtenstein)
using the Ivocap injection system (Ivoclar Vivadent).
Based on data obtained by subtracting the working
cast data from wax denture data, AM experimental
dentures (AM dentures) were fabricated from ultravio-
let (UV)-cured acrylic resin (Vero Clear RGD835;
Stratasys, Eden Prairie, MN, USA) using a 3D printer
(Objet260 Connex; Stratasys). Five of each type of
experimental denture were fabricated.
Verification of accuracy
Both types of experimental denture were coated in
titanium oxide, and 3D scanning was performed using
an optical scanner (ATOS Core80; GOM, Braun-
schweig, Germany). Accuracy was verified by super-
imposing the tooth region data from the heat-cured
and AM dentures on the tooth region data from the

wax dentures using best fit algorithm of 3D data
inspection software (GOM Inspect, GOM) and mea-
suring the displacement of the tooth arrangement. In
addition, colour maps were created using the 3D com-
parison function to visually display the direction and
amount of tooth displacement.
Fig. 2 shows the measurement points on the maxillary
and mandibular dentures. Using the inspection software,
a total of 48 measurement points were established for all
dentures. Twenty-four measurement points were defined
on the anterior teeth: at the cusp tip or centre of the inci-
sal edge; at the mesio- and disto-incisal angles; and at
the centre of the lingual face of each tooth. Similarly, 24
measurement points were defined on the posterior teeth
at the cusp tips of each tooth.
The average value of the five dentures was calcu-
lated for each of the 48 measurement points, and this
was used as the representative value of the measure-
ment point. Next, statistical analysis was performed
using the median of 48 measurement points to com-
pare the tooth displacement between the heat-cured
and the AM dentures, and the median of 24 measure-
ment points to compare the displacement between the
anterior and molar teeth region. The Mann–Whitney
U test was used for the statistical analysis (SPSS 14.0J
for Windows; SPSS, Chicago, IL, USA). Significance
was set at a = 0.05.
RESULTS
Fig. 3 show typical colour maps of differences in
tooth displacement when design data and fabrication
data are superimposed.
Fig. 2 Measuring points of artificial tooth displacement.Anterior teeth—Incisor teeth: (i) Centre of cutting edge: 4 points; (ii) Mesio-incisal angle:
4 points; (iii) Disto-incisal angle: 4 points; (iv) Centre of lingual side: 4 points. Canine teeth: (i) Cusp tip: 2 points; (ii) Mesio-incisal angle: 2 points;
(iii) Disto-incisal angle: 2 points; (iv) Centre of lingual side: 2 points.Posterior teeth—Premolar teeth: (i) Cusp tip: 8 points. Molar teeth: (i) Cusp tip:
16 points.
© 2021 Australian Dental Association
Compare artificial tooth position in denture
In the maxillary dentures, the amount of tooth dis-
placement for the heat-cured and AM dentures ranged
from 0.08 to +0.06 mm (median: 0.01 mm) and
from 0.25 to +0.06 mm (median: 0.07 mm)
respectively. A significant difference was observed
between the two dentures (Fig. 4). In the mandibular
dentures, the amount of tooth displacement for the
heat-cured and AM dentures ranged from 0.09 to
+0.07 mm (median: 0.02 mm) and from 0.03 to
+0.07 mm (median: 0.01 mm) respectively. No signifi-
cant difference was observed between the two den-
tures (Fig. 5).
In the maxillary heat-cured dentures, the amount of
tooth displacement for the anterior and posterior
tooth regions ranged from 0.06 to +0.02 mm (me-
dian: 0.02 mm) and from 0.08 to +0.06 mm (me-
dian: 0.02 mm) respectively. A significant difference
was observed between the two regions (Fig. 6). In the
maxillary AM dentures, the amount of tooth displace-
ment for the anterior and posterior tooth regions ran-
ged from 0.25 to +0.06 mm (median: 0.06 mm)
and from 0.20 to 0.03 mm (median: 0.07 mm)
respectively. No significant difference was observed
between the two regions (Fig. 7).
In the mandibular heat-cured dentures, the amount
of tooth displacement for the anterior and posterior
tooth regions ranged from 0.10 to +0.05 mm (me-
dian: 0.01 mm) and from 0.06 to +0.07 mm (me-
dian: 0.02 mm) respectively. No significant difference
was observed between the two regions (Fig. 8). In the
mandibular AM dentures, the amount of tooth dis-
placement for the anterior and posterior tooth regions
ranged from 0.03 to +0.07 mm (median: 0.01 mm)
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A Tasaka et al.
Fig. 3 Colour map of artificial tooth displacement.
Fig. 4 Comparison of artificial tooth displacement between experimental
maxillary denture fabricated using heat curing and additive
manufacturing.
Fig. 5 Comparison of artificial tooth displacement between experimental
mandibular denture fabricated using heat curing and additive manufacturing.
and from 0.02 to +0.04 mm (median: 0.02 mm)
respectively. No significant difference was observed
between the two regions (Fig. 9).
4 © 2021 Australian Dental Association
Fig. 6 Comparison of artificial tooth displacement between anterior and
posterior teeth on experimental maxillary denture fabricated using heat
curing.
Fig. 7 Comparison of artificial tooth displacement between anterior and
posterior teeth on experimental maxillary denture fabricated using addi-
tive manufacturing.
DISCUSSION
Pack-and-press, fluid resin and injection moulding are
among the various techniques that exist for denture
curing by conventional flasking. The present study uti-
lized injection moulding due to comparatively little
associated incisal pin opening.14-16 Additive manufac-
turing options include stereolithography (SLA), digital
light processing (DLP), material jetting (MJ) and fused
deposition modelling (FDM).17 The MJ process
selected for the present study is characterized by selec-
tive extrusion of the liquid resin followed by UV cur-
ing. The ability to use multiple print nozzles enables
the selection of various materials and colours and
potentially even the selection of separate materials for
the denture base and teeth. It is expected that with
the development of technology and materials in the
future, it is possible to manufacture a denture in
which the denture base and the artificial tooth are
integrated by the MJ process.

Fig. 8 Comparison of artificial tooth displacement between anterior and
posterior teeth on experimental mandibular denture fabricated using heat
curing.
Fig. 9 Comparison of artificial tooth displacement between anterior and
posterior teeth on experimental mandibular denture fabricated using addi-
tive manufacturing.
In the present study, wax and experimental denture
data were superimposed in three dimensions, thus
allowing evaluation of the direction of displacement.
The measurement error of the 3D data evaluation
software used in the present study was 0.012 mm
when measuring between points and 0.015 mm when
measuring surfaces. Dentures fabricated using heat
curing are associated with mean incisal pin opening
on remount of 0.5 to 1.0 mm while a tooth displace-
ment of 0.25 mm produces an opening of 1.0 mm.5
The mean and maximum amounts of tooth displace-
ment measured in the present heat-cured dentures
were 0.01 and 0.06 mm in the maxillary and 0.01
and 0.07 mm in the mandibular dentures. The injec-
tion moulding selected for the present study was
expected to minimize incisal pin opening. Conversely,
the mean and maximum amounts of tooth displace-
ment in the AM dentures were 0.07 and 0.25 mm
in the maxillary and 0.01 and 0.07 mm in the
mandibular dentures, demonstrating a significant
© 2021 Australian Dental Association
Compare artificial tooth position in denture
difference between the types with regard to maxillary
dentures. This finding might be due to the tendency
for a high number of outliers to be generated with the
AM dentures. However, no significant difference
between denture types was observed for the mandibu-
lar dentures and the interquartile range for the
amount of tooth displacement in the AM dentures
was smaller than that observed in the heat-cured den-
tures, suggesting high fabrication reproducibility.
Comparisons of the anterior and posterior tooth
regions showed significantly greater tooth displace-
ment in the posterior than the anterior tooth region in
the maxillary heat-cured denture. Furthermore, the
interquartile range also tended to be greater in the
posterior compared to the anterior tooth region. Con-
versely, no significant differences were observed
between the anterior and posterior tooth regions in
the mandibular heat-cured denture. As the maxillary
denture has a base in the palatal region, these findings
might be attributable to concentration of tooth dis-
placement in the centre of the palate,18 palate mor-
phology19 or thickness of the denture base in the
palatal region.20,21 The present study used an edentu-
lous jaw model comparable to the American College
of Prosthodontists22 Type A model; thus, the well-
formed residual ridge and deep palate might also have
had an effect. In the maxillary AM denture, no signifi-
cant differences were observed between the anterior
and posterior tooth regions; however, a high number
of outliers tended to be generated in the anterior
tooth region, evidencing susceptibility to error. In the
present study, the AM dentures were printed such that
the platform and occlusal plane were positioned in
parallel; therefore, the axial inclination of the crown
was greater for the anterior compared to the posterior
teeth, amplifying any effects on printing accuracy.
Conversely, smaller inclination of the anterior teeth in
the mandibular dentures would likely have minimized
effects on printing accuracy.
Tooth displacement in the maxillary AM dentures
was in a negative direction to the wax denture at
many measurement points, likely due to warping
caused by shrinkage of the AM material.23 Such
shrinkage lowers the position of the tooth arrange-
ment and might cause decreased vertical dimension of
the finished denture. This phenomenon is also
observed with fabrication methods that involve
milling the resin block to form a denture base into
which the basal surface of the teeth will fit and bond-
ing prefabricated teeth and those involving monolithic
milling of the resin block to form the denture base
and teeth.10 The present findings indicate that ade-
quate care must be taken regarding the possibility of
decreased vertical dimension in the finished dentures
when using CAD/CAM systems for denture fabrica-
tion.
5
A Tasaka et al.
The conventional flasking process for denture fabri-
cation involves many manual procedures, including
investment, wax elimination, packing, curing and
deflasking, with the possibility for error present at
each stage.24 Furthermore, accuracy is reliant on the
skill of the dental technician. With AM denture fabri-
cation, as long as the printing settings are appropriate,
it should be possible to fabricate dentures with a high
degree of reproducibility, as showed in the present
mandibular AM dentures. Further investigation is nec-
essary with regard to the effects of printing settings
on tooth displacement, such as placement and volume
of support material and printing angle, pitch and
speed.
CONCLUSIONS
Artificial teeth of the maxillary dentures fabricated by
AM showed greater displacement compared to those
by heat curing with injection moulding. However,
superior fabrication accuracy and reproducibility were
achieved with AM for mandibular dentures.
ACKNOWLEDGEMENT
The authors are grateful to Prof. Kaoru Sakurai, Dr.
Masahiro Ryu and Dr. Chiaki Unno for helping with
the manufacture of the experimental denture base and
with the measurement procedures.
CONFLICT OF INTEREST
There is no conflict of interest with regard to this
study.
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Address for correspondence
Akinori Tasaka
Department of Removable Partial Prosthodontics,
Tokyo Dental College
2-9-18 Kandamisakicho Chiyoda-ku
Tokyo 101-0061
Japan
Email: atasaka@tdc.ac.jp