RESEARCH AND EDUCATION

In vitro study on the influence of postpolymerization and

aging on the Martens parameters of 3D-printed
occlusal devices
Marcel Reymus, Dr med denta and Bogna Stawarczyk, Prof Dr Dipl-Ing (FH), MScb

Occlusal devices are used in ABSTRACT

dentistry to protect the teeth of
Statement of problem. Additive manufacturing has been proposed for the fabrication of occlusal
patients with habits including devices. However, information about the mechanical properties of additively manufactured devices
bruxism or tooth grinding from is lacking.
excessive occlusal wear and
Purpose. The purpose of this in vitro study was to evaluate the influence of the postpolymerization
forces1 and have been advo-
unit and artificial aging on the Martens hardness (HM) and indentation modulus (EIT) of different
cated for alleviating the 3D-printed materials in comparison with a conventionally milled material.
symptoms of temporoman-
dibular disorder.2 Additionally, Material and methods. Thirty disks (20 mm in diameter and 5 mm in thickness) were additively
manufactured (D20 II, Rapidshape & Form 2) for each 3D-printed material (NextDent Splint,
they can be used to test a new
Formlabs Dental LT Clear, and Freeprint Splint). As a control, 10 disks of the same thickness were
occlusal dimension in patients cut from a conventionally milled material (Temp Premium). Each specimen was measured for HM
requiring extensive prosthetic and EIT (ZHU 0,2) after fabrication. The specimens were stored in water at 37
C and measured
treatment.3 Traditionally, again after 2 and 4 weeks. The data were analyzed statistically by using the Kruskal-Wallis,
occlusal devices have been Mann-Whitney U, and Wilcoxon tests (adjusted by Bonferroni correction a=.05/27=.002).
manufactured by either vac- Results. The highest influence on HM parameters was shown by artificial aging (partial eta squared:
uum thermoforming, sprin- HM: hP2=0.840, EIT: hP2=0.855, P<.001), followed by the material (HM: hP2=0.690 EIT: hP2=0.845,
4
kling acrylic resin, or a P<.001) and the postpolymerization unit (HM: hP2=0.649, EIT: hP2=0.778, P<.001). Initial HM values
5 ,6 ranged from 147 ±8.11 N/mm2 for Formlabs postpolymerized in Otoflash to 89.5 ±8.55 N/mm2
combination of both. With
the advent of computer-aided for Detax postpolymerized in the Labolight unit. EIT values ranged from 3.92 ±0.061 kN/mm2 for
design and computer-aided Formlabs postpolymerized in Otoflash to 2.48 ±0.212 kN/mm2 for Detax postpolymerized in the
Labolight unit. In general, HM and EIT values decreased after water storage, whereas the values
manufacturing in dentistry,7 a remained unchanged for the control group.
digital approach to fabricating
occlusal devices has been Conclusions. HM parameters of additively manufactured occlusal devices depend on
postpolymerization strategy. Otoflash and Printbox result in higher HM and EIT values. The 3D-
introduced with a 3-step work-
printed materials are more prone to artificial aging than the control group, which brings into
flow: data acquisition, data question their long-term service. (J Prosthet Dent 2020;-:---)
processing, and manufacturing.
The patient’s data can either be acquired with an intraoral of the occlusal device8,9 and enables straightforward
scanner or indirectly with a conventional impression, later reprocessing of the file if the device needs replacement.
digitalized by using a laboratory scanner. Based on these The computer-aided manufacturing process can
data, the occlusal device can be digitally designed. This either be subtractive by using milling procedures or ad-
allows a more precise and efficient manufacturing process ditive by using 3D printing technology. The subtractive

a
Resident, Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany.
b
Professor, Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany.

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Clinical Implications
A correct postpolymerization strategy of additively
manufactured occlusal devices is mandatory to
achieve adequate mechanical properties. However,
such fabricated devices might show inferior clinical
performance in terms of service time than milled
ones.
method uses a blank of prefabricated material out of
which the desired object is milled. This process wastes
material,10 which is especially true for occlusal devices.
Additive manufacturing (AM) builds up the object layer
by layer. Only the support structure, which stabilizes the
object during the manufacturing process, is discarded.
AM is relatively new to dentistry and consists of different
technologies,11 including resin processing devices and
metal and ceramic sintering devices. The use of AM to
produce an occlusal device was first described in 201312
and used stereolithography (SLA). SLA or digital light
processing (DLP) are currently the most popular tech-
nologies for the manufacture of occlusal devices. Both
technologies work with liquid resin that is either poly-
merized immediately with a laser (SLA) or on a large area
with a beam (DLP).13 Postpolymerization of the objects is
essential because the photosensitive resin is not
completely polymerized during the printing process.14
However, manufacturers make their own recommenda-
tions for a polymerization unit, making it difficult to re-
view the advantages and disadvantages of the different
technologies.
Regardless of the manufacturing process, the material
used for an occlusal device must meet the mechanical re-
quirements that enable its clinical use. Occlusal devices
must resist occlusal forces of up to 770 N15 and the impact
of tooth grinding and clenching.16 Hardness is one mea-
sure of evaluating the material’s ability to withstand such
stress and resist scratching. Indentation measurements are
efficient in investigating surface properties which, in turn,
can be directly correlated with their morphology and
deformation behavior.17 Traditionally, Knoop or Vickers
hardness has been used, but they have disadvantages
including a dependence on test load, dwell times, and the
operator.18 Martens hardness (HM) has been proposed as
an improved test for dental materials.19 It is especially
suitable for determining the elastic-plastic mechanical
properties of one material.20 Such behavior is important for
occlusal devices; this is why Martens parameters were
investigated in the present study. One recent study also
used hardness measurements to compare different mate-
rials for the manufacturing of occlusal devices.21
Polymer networks react strongly in a wet environ-
ment22; therefore, for clinically relevant testing, the
THE JOURNAL OF PROSTHETIC DENTISTRY
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material’s behavior must be investigated after artificial
aging.23,24 In general, the hardness values of resin-based
materials is reduced after artificial aging,25,26 which is
mostly explained by water uptake. However, one study
investigating direct restorative materials reported a rise in
hardness values after aging.27 Indentation tests
contribute to the understanding of a material’s defor-
mation28 and have been used to characterize mechanical
properties.29,30 The indentation modulus (EIT) is compa-
rable with the Young modulus and can be determined
simultaneously in a single measurement.17 Occlusal de-
vices must possess some elastic behavior. If too brittle,
they will be susceptible to fracture during function. A
previous study reported a decrease in flexural strength
and flexural modulus after 14 days of water storage.31
The purpose of this in vitro study was to investigate
the impact of the postpolymerization unit and artificial
aging on the HM and EIT of different 3D-printed mate-
rials. The null hypothesis was that no differences would
be found among the different materials, the different
postpolymerization units, or the aging levels regarding
HM and EIT.
MATERIAL AND METHODS
The 3D-printed materials tested and the milled control
(TP; Temp Premium, Zirkonzahn) are presented in
Table 1. Thirty disks (20 mm in diameter and 5 mm in
thickness) of each of the 3D-printed materials were
additively manufactured by using a DLP printer (D20II;
Rapidshape) for NextDent Ortho (ND) and Freeprint
Splint (DX) and an SLA printer (Form 2; Formlabs) for
Formlabs Dental LT Clear (FL). For the control group, 10
disks (N=120) of the same thickness were cut from pre-
fabricated blanks. The 3D-printed specimens were
cleaned for 5 minutes in 96% ethanol (Otto Fischar
GmbH) in an ultrasonic bath (Sonorex Super RK1022;
Bandelin) and subsequently postpolymerized. The post-
polymerization units tested are presented in Table 2. For
each 3D-print material, 10 specimens were each post-
polymerized in the 3 different units; no specimen was left
unpolymerized. Subsequently, the specimens were
embedded in autopolymerizing acrylic resin (Scandi
Quick A and B; ScanDia) and semiautomatically polished
(Tegramin-20; Struers) with consecutive silicon carbide
papers up to P2000 under water cooling.
The HM and EIT of all specimens was measured
immediately after fabrication. Subsequently, all speci-
mens were stored in distilled water at 37
C in an incu-
bator (HeraCell 150; Heraeus) and measured again after
14 and after 28 days. For each measurement, every
specimen was tested at 3 different locations (N=1080
measurements). The parameters of HM were determined
by using a universal testing machine (ZHU 0,2; Zwick).
For this purpose, the specimens were loaded with a
Reymus and Stawarczyk
- 2020 3

Table 1. Summary of materials, composition, manufacturers, and lot numbers

Materials Brands 3D Printer Composition Manufacturer Lot No.
3D-printed materials NextDent Ortho Clear [ND] D20II, Rapidshape Methacrylates NextDent XK044N01
Formlabs Dental LT Clear [FL] Form 2, Formlabs Methacrylates Formlabs FLDLCL01
Freeprint Splint [DX] D20II Rapidshape Methacrylates Detax 03709
Control Group Temp Premium [TP] Polymethylmethacrylates Zirkonzahn 9223

Table 2. Summary of postpolymerization units with corresponding technology, duration, wavelength, and manufacturers
Brands Technology Duration Wavelength Manufacturers
LC-3DPrint Box Ultraviolet light 30 min Range 315-550 nm, peaks at approximately 360 and 435 nm NextDent
Otoflash G171 Flashlight, nitrogen 2 processes of 2000 flashes Range 300-700 nm, peaks at approximately 480 and 530 nm NK Optik
atmosphere
Labolight DUO Light-emitting diode 2 processes of 3 min Range 380-510 nm, peaks at approximately 395 and 475 nm GC Europe

Vickers diamond indenter (a=136 degrees) with a force of Table 3. Mean and standard deviation of Martens hardness (HM in
9.8 N for 10 seconds. The minimum indenter depth was N/mm2) for materials for fabrication of occlusal devices, measured
always greater than 5 mm. HM and EIT were calculated directly after fabrication and after water storage in days (d)
Postpolymerization
with software (testX-pert V12.3 Master; Zwick) according Units ND FL DX TP
to the ISO specification32: Printbox
Initial 142 ±6.21c,ii 130 ±7.22b,ii 97.0 ±8.21a,ii 114 ±6.7
F
HM = ; 14 d 78.0 ±12.6a,iii 77.4 ±10.7a,ii 73.7 ±8.18a,iii 111 ±6.76
As ðhÞ
28 d 75.9 ±13.6b,i 64.8 ±8.92a,ii 74.6 ±4.64b,iii 112 ±6.34
Otoflash
where HM is in N/mm2, F (test force) in N, As (h)
Initial 140 ±4.30b,ii 147 ±8.11c,iii 99.5 ±2.41a,ii d
(surface area of the indenter at distance h from the tip) in
14 d 73.5 ±9.13b,ii 95.6 ±4.10c,iii 58.5 ±4.32a,ii d
mm2, h (indentation depth under applied test force) in
28 d 112.7 ±11.8b,ii 119 ±1.50c,iii 51.5 ±3.56a,ii d
mm, and Labolight

−1 pffiffiffiffi Initial 109 ±4.66b,i 120 ±6.96c,i 89.5 ±8.55a,i

 1 1−v 2i p
d
EIT = 1 − v s ×
2
− with Er = pffiffiffiffiffiffi ;
a,i b,i
14 d 39.4 ±4.00 50.7 ±8.07 61.3 ±7.69c,i d
Er Ei 2C Ap 28 d 74.6 ±4.64b,i 81.4 ±10.9c,i 38.1 ±5.89a,i d

where EIT (elastic modulus of the indenter) is in N/mm2,
C (compliance of the contact), vs (Poisson ratio of the test
piece), and vi (Poisson ratio of the indenter) with vs=0.433
and vi=0.3.
For each measurement, the corresponding load-
displacement curve was recorded.
The data were analyzed descriptively and globally by
using univariate analysis, and the Kolmogorov-Smirnov
test was used to test the normal distribution. The sta-
tistical differences among the test groups were calculated
by using nonparametric tests, including the Kruskal-
Wallis, Mann-Whitney U, and Wilcoxon tests by using
statistical software (IBM SPSS Statistics, v25; IBM Corp)
(adjusted by Bonferroni correction, a=.05/27=.002).
RESULTS
Descriptive statistics are represented in Tables 3 and 4
and in Figures 1 and 2. According to the univariate an-
alyses, the highest influence on HM parameters was
shown by artificial aging (partial eta squared: HM:
hP2=0.840, EIT: hP2=0.855, P<.001), followed by material
(HM: hP2=0.690 EIT: hP2=0.845, P<.001) and post-
polymerization unit (HM: hP2=0.649, EIT: hP2=0.778,
P<.001). The interaction effect of the trinary
DX, Freeprint Splint; FL, Formlabs Dental LT Clear; ND, NextDent Ortho Clear; TP, Temp
Premium. a,b,c describe significant differences between materials within one aging level
and one polymerization unit. i,ii,iii describe significant differences between polymerization
units within one aging level and one material.
combinations of the 3 independent parameters (aging,
material, and postpolymerization unit) was also signifi-
cant (P<.001, HM: hP2=0.473; EIT: hP2=0.402). Therefore,
the data were analyzed separately according to the test
hypothesis.
In specimens postpolymerized by using Printbox, ND
reported the highest initial Martens parameters, followed
by FL (P<.001). The lowest values were observed for DX
(P<.001). After 28 days of water storage, however, DX
presented the highest values with ND, whereas FL re-
ported the lowest (P<.001). For specimens post-
polymerized by using Otoflash, FL reported the highest
Martens parameters, regardless of the aging level, fol-
lowed by ND (P<.001) and DX (P<.001).
In specimens postpolymerized by using Labolight, FL
reported the highest initial Martens parameters (P<.001),
followed by ND, whereas DX presented the lowest values
(P<.001). After 14 days of water storage, however, DX
reported higher HM values than FL (P<.001) and ND
(P<.001).

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Table 4. Mean and standard deviation of indentation modulus (EIT in
kN/mm2) for materials for fabrication of occlusal devices, measured
directly after fabrication and after water storage in days (d)
Postpolymerization
Units ND FL DX
Printbox
Initial 3.90 ±0.111c,iii 3.58 ±0.008b,ii 2.70 ±0.151a,ii
14 d 2.66 ±0.228c,iii 2.50 ±0.232b,ii 2.01 ±0.195a,iii 2.90 ±0.001
28 d 2.49 ±0.293b,ii 2.15 ±0.210a,ii 2.19 ±0.096a,iii 2.90 ±0.046
Otoflash
Initial 3.82 ±0.089b,ii 3.92 ±0.061c,iii 2.78 ±0.041a,ii
14 d 2.53 ±0.167b,ii 2.94 ±0.081c,iii 1.77 ±0.103a,ii
28 d 3.21 ±0.354b,iii 3.47 ±0.319c,iii 1.54 ±0.093a,ii
Labolight
Initial 3.23 ±0.092b,i 3.27 ±0.079c,i 2.48 ±0.212a,i
b,i b,i
14 d 1.60 ±0.079 1.64 ±0.138 1.56 ±0.199a,i
28 d 2.19 ±0.096b,i 2.20 ±0.213b,i 0.950 ±0.146a,i
DX, Freeprint Splint; FL, Formlabs Dental LT Clear; ND, NextDent Ortho Clear; TP, Temp
Premium. a,b,c describe significant differences between materials within one aging level
and one polymerization unit. i,ii,iii describe significant differences between polymerization
units within one aging level and one material.
ND (P=.071) and DX (P=.160) reported no impact of
postpolymerization unit on the initial HM values. The
lowest values were observed for the specimens post-
polymerized by Labolight (P<.001).
With respect to aging level, the initial measurements
reported the highest values, regardless of the 3D-printed
material and postpolymerization unit (P<.001). In gen-
eral, the values decreased with the increase in storage
days. The exceptions were ND and FL, which were
postpolymerized by using Otoflash or Labolight. In these
groups, the specimens reported higher values after 28
days of water storage than after 14 days of storage
(P<.001). The control group reported no differences
compared with 3D-printed specimens, and no impact of
aging level was observed.
DISCUSSION
This study demonstrated the impact of postpolymeriza-
tion and water storage on the HM and EIT of different
3D-printed materials for the fabrication of occlusal de-
vices. Consequently, the null hypothesis was rejected.
All tested materials exhibited elastic-plastic behavior.
Their corresponding load-displacement curves revealed
different characteristics, which seem to be influenced by
the material itself, the postpolymerization unit, and
artificial aging (Fig. 3). The curve peak plateau indicated
the materials’ creep characteristic under indentation load.
The plateau of the control group’s curve tended to be
narrower than those of the 3D print materials, which
illustrated a lower creep characteristic (Fig. 3). Regarding
the creep properties of the 3D-printed materials, ND and
FL seemed to behave similarly, whereas DX displayed a
longer plateau and thus a higher creep tendency.
Consequently, TP was less prone to deformation from
THE JOURNAL OF PROSTHETIC DENTISTRY
- Issue -
long-term mechanical stress such as tooth clenching. In
contrast, additively manufactured occlusal devices might
lose some precision of the functionally adjusted occlusal
TP
surface over time.
The area between the loading and uploading curve
3.0 ±0.050 illustrates the permanent damage (Wp=1-hIT) that seems
to be dependent on the postpolymerization unit (Fig. 4).
After 2 weeks of water storage, TP revealed the lowest
permanent damage and thus the highest elastic capacity.
d DX postpolymerized in LC-3DPrint Box or Otoflash
d G171 reported a similar property of permanent damage,
d whereas after postpolymerization in Labolight DUO
(LL), it seemed to be the highest. Therefore, the choice of
d postpolymerization unit affects the desired viscoelastic
d
behavior of the material and thus the deformation of the
d
occlusal devices in long-term use. Regarding artificial
aging, for the 3D-printed materials, creep as well as
permanent damage seemed to increase after prolonged
storage time (Fig. 5). In contrast, the influence of artificial
aging seemed to be negligible for the control group, TP.
From a clinical point of view, this result favors milled
splints for long-term use.
Regarding the different 3D-printed materials, in gen-
eral, the highest HM values were recorded for ND and FL,
followed by DX. The hardness of a material depends on
its composition. For example, a higher filler content may
lead to higher hardness. Because the manufacturers do
not release the composition of the materials, it is difficult
to draw further conclusions from these results. In terms of
patient safety and the potential for allergic reactions and
for further research projects, it would be desirable to
determine the composition of the different 3D-printed
materials. The milling material TP is promoted by the
manufacturer as a material for the fabrication of trans-
parent occlusal devices or for long-term tooth colored
interim fixed dental protheses. This indication might
explain why TP reported higher HM and EIT values than
other milling materials, which are solely formulated for
occlusal devices. Studies on the mechanical properties of
3D-printed materials are scarce. To the authors’ knowl-
edge only the Prpic et al21 study is comparable with the
present investigation. They investigated the hardness and
flexural strength of conventional, 3D-printed, and milled
materials for the fabrication of occlusal devices. Hardness
was measured after water storage of 50 hours by using the
Brinell method. The highest hardness was recorded for 1
milled material and 2 conventional materials, followed by
1 3D-printed material. The recorded values of the CSP
and ORR range are consistent with the corresponding
materials in the present study.
Devices manufactured by SLA require an appropriate
posttreatment procedure to produce the mechanical
properties suitable for service in the oral cavity. Post-
polymerization of 3D-printed occlusal devices is essential
because the materials are resin based. The influence of
Reymus and Stawarczyk
- 2020 5

Material
ND FL DX

150
125

Printbox
100
75
50
25

150

Polymerization
125

Otoflash
100
HM

75
50
25

150
125

Labolight
100
75
50
25
Initial 14 d 28 d Initial 14 d 28 d Initial 14 d 28 d
Storage
Figure 1. Box plots of HM values (N/mm2) for different 3D-printed materials and different aging levels. FL, Formlabs Dental LT Clear; ND, NextDent
Ortho Clear; DX, Freeprint Splint; HM, Martens hardness.

the postpolymerization unit on hardness was apparent in
the present study. In general, specimens post-
polymerized in the Printbox or the Otoflash unit had
higher HM values than those postpolymerized in the
Labolight unit. This was true for each material and each
storage time. That fact might be explained by the light
source of the postpolymerization Labolight unit (light-
emitting diode) and the correlation between hardness
and degree of conversion. It seems likely that LL pro-
duced a lower degree of conversion than the other units.
A possible explanation might be that the emitting energy
or the wavelength of LL’s light source was not well
adapted to the 3D-printed materials.
During their service time, occlusal devices are exposed
to 100% humidity. The artificial aging protocol in this
study aimed to simulate the condition in the oral cavity
and to investigate its impact on the properties of the
materials. In general, a drop in HM values was recorded
with prolonged storage time for 3D-printed materials.
This result is consistent with those of studies of resin-
based materials19,20 and might be explained by water
uptake. The control group, TP, however, seems to have
been unaffected by the selected aging protocol, possibly
because its industrial fabrication under high temperature
and pressure made its polymer network more resistant
against degeneration in an aqueous solution. The HM
values for ND and FL increased between the aging levels
of 14 days and 28 days but solely after postpolymeriza-
tion in the Otoflash or the Labolight unit. A possible
explanation might be that continued polymerization
occurred during the artificial aging in heated water after
the initial water uptake. Such behavior has been reported
for direct composite resin materials.21 The post-
polymerization time in the Printbox was the longest for
all the units (30 minutes). After such a long post-
polymerization period, it might be that there were no
more residual C=C double links within the specimens for
later polymerization to occur. The missing occurrence of
the phenomenon for DX might be explained by the
material’s composition and chemistry, which, again, is
not stated by the manufacturer.
In contrast with milled materials, which are industri-
ally prefabricated, additively manufactured objects can be
adversely affected by a range of parameters, including
their position on the printer platform, the postprocessing
method, and the postpolymerization strategy. This might
explain why an abnormal distribution of the data was
recorded.

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Material
ND FL DX
5

Printbox
3

Polymerization
4

Otoflash
3
Eit

Labolight
3

0
Initial 14 d 28 d Initial 14 d 28 d Initial 14 d 28 d
Storage
Figure 2. Box plots of EIT values (in kN/mm2) for different 3D-printed materials and different aging levels. FL, Formlabs Dental LT Clear; ND, NextDent
Ortho Clear; DX, Freeprint Splint. EIT, indentation modulus.

12 12

a b c d a b c d
10 10

8 8
Force [N]

Force [N]

6 6

4 4

2 2

0 0
0 20 40 60 0 20 40 60 80 100
µm]
Indentation [µ µm]
Indentation [µ
Figure 3. Load displacement curves of FL (a), ND (b), TP (c), and DX (d), Figure 4. Load displacement curves of TP (a), ND postpolymerized in
all 3D print materials postpolymerized in Otoflash. FL, Formlabs Dental Printbox (b), ND postpolymerized in Otoflash (c), and ND
LT Clear; ND, NextDent Ortho Clear; TP, Temp Premium; DX, Freeprint postpolymerized in Labolight (d) after 2 weeks of water storage.
Splint. TP, Temp Premium; ND, NextDent Ortho Clear.

In general, the EIT values behaved similarly to the HM result is consistent with that of a previous study25 and
values; that is, the elastic properties of the 3D-printed limits the long-term use of additively manufactured
materials decreased with prolonged water storage. This occlusal devices. They seem to become brittle over time

THE JOURNAL OF PROSTHETIC DENTISTRY Reymus and Stawarczyk

- 2020
12
a-c d e f
10
8 additive manufacturing of occlusal splints: a clinical pilot study. J R Soc
Force [N]
6 Oper Dent 2020;45:30-40.
4 15. Nishigawa K, Bando E, Nakano M. Quantitative study of bite force during
2 bite force values for healthy young adults. Eur J Oral Sci 1993;101:171-5.
0 mol Symp 2012;315:44-51.
0 20 40 60 80
µm]
Indentation [µ
Figure 5. Load displacement curves of TP initially (a), after 2 weeks water
storage (b), after 4 weeks (c), and DX initially (d), after 2 weeks (e) and
after 4 weeks (f). TP, Temp Premium; DX, Freeprint Splint.
and thus be more susceptible to fracture than milled
devices after equal service time.
CONCLUSIONS
Based on the findings of this in vitro study, the following
conclusions were drawn:
1. ND and FL reported higher HM and EIT values than
those of DX.
2. Postpolymerization in Otoflash G171 and LC-
3DPrint Box resulted in a higher hardness and
EIT than postpolymerization in LL.
3. The 3D-printed materials were more susceptible to
artificial aging than the milled control group TP,
which brings into question the long-term service of
additively manufactured occlusal devices.
REFERENCES
1. Leib AM. The occlusal bite splint - a noninvasive therapy for occlusal habits and
temporomandibular disorders. Compend Contin Educ Dent 1996;17:1081-4.
2. Türp J, Komine F, Hugger A. Efficacy of stabilization splints for the man-
agement of patients with masticatory muscle pain: a qualitative systematic
review. Clin Oral Investig 2004;8:179-95.
3. Edelhoff D, Schweiger J, Prandtner O, Trimpl J, Stimmelmayr M, Güth J-F.
CAD/CAM splints for the functional and esthetic evaluation of newly defined
occlusal dimensions. Quintessence Int 2017;48:181-91.
4. Kass CA, Tregaskes JN. Occlusal splint fabrication. J Prosthet Dent 1978;40:
461-3.
5. Becker CM, Kaiser DA, Lemm RB. A simplified technique for fabrication of
night guards. J Prosthet Dent 1974;32:582-9.
6. Bohnenkamp DM. Dimensional stability of occlusal splints. J Prosthet Dent
1996;75:262-8.
7. Beuer F, Schweiger J, Edelhoff D. Digital dentistry: an overview of recent de-
velopments for CAD/CAM generated restorations. Br Dent J 2008;204:505-11.
8. Gateno J, Xia J, Teichgraeber J, Rosen A, Hultgren B, Vadnais T. The precision
of computer-generated surgical splints. J Oral Maxillofac Surg 2003;61:814-7.
9. Lauren M, McIntyre F. A new computer-assisted method for design and
fabrication of occlusal splints. Am J Orthod Dentofacial Orthop 2008;133:
130-5.
Reymus and Stawarczyk
7
10. Strub JR, Rekow ED, Witkowski S. Computer-aided design and fabrication of
dental restorations: current systems and future possibilities. J Am Dent Assoc
2006;137:1289-96.
11. Dawood A, Marti BM, Sauret-Jackson V, Darwood A. 3D printing in
dentistry. Br Dent J 2015;219:521-9.
12. Salmi M, Paloheimo K-S, Tuomi J, Ingman T, Mäkitie A. A digital process for
Interface 2013;10:2013-24.
13. Kessler A, Hickel R, Reymus M. 3D printing in dentistrydstate of the art.
14. Stansbury J, Idacavage M. 3D printing with polymers: challenges among
expanding options and opportunities. Dent Mater 2016;32:54-64.
sleep associated bruxism. J Oral Rehabil 2001;28:485-91.
16. Waltimo A, Könönen M. A novel bite force recorder and maximal isometric
17. Bhandari NL, Lach R, Grellmann W, Adhikari R. Depth-dependent inden-
tation microhardness studies of different polymer nanocomposites. Macro-
18. Ilie N, Hilton T, Heintze S, Hickel R, Watts D, Silikas N, et al. Academy of
dental materials guidancedresin composites: Part Idmechanical properties.
Dent Mater 2017;33:880-94.
19. Shahdad SA, McCabe JF, Bull S, Rusby S, Wassell RW. Hardness measured
with traditional Vickers and Martens hardness methods. Dent Mater 2007;23:
1079-85.
20. Chicot D, Tricoteaux A. In: Wunderlich W, editor. Mechanical properties of
ceramic by indentation: principle and applications, ceramic materials. Lon-
don, UK: IntechOpen Limited; 2010. p. 115-53.
21. Prpic V, Slacanin I, Schauperl Z, Catic A, Dulcic N, Cimic S. A study of the
flexural strength and surface hardness of different materials and technologies
for occlusal device fabrication. J Prosthet Dent 2019;121:955-9.
22. Münchow EA, Ferreira ACA, Machado RM, Ramos TS, Rodrigues-Junior SA,
Zanchi CH. Effect of acidic solutions on the surface degradation of a micro-
hybrid composite resin. Braz Dent J 2014;25:321-6.
23. Lohbauer U, Belli R, Ferracane JL. Factors involved in mechanical fatigue
degradation of dental resin composites. J Dent Res 2013;92:584-91.
24. Wendler M, Belli R, Valladares D, Petschelt A, Lohbauer U. Chairside CAD/
CAM materials. Part 3: cyclic fatigue parameters and lifetime predictions.
Dent Mater 2018;34:910-21.
25. Hampe R, Lümkemann N, Sener B, Stawarczyk B. The effect of artificial aging
on Martens hardness and indentation modulus of different dental CAD/CAM
restorative materials. J Mech Behav Biomed Mater 2018;86:191-8.
26. Liebermann A, Wimmer T, Schmidlin PR, Scherer H, Löffler P, Roos M, et al.
Physicomechanical characterization of polyetheretherketone and current
esthetic dental CAD/CAM polymers after aging in different storage media.
J Prosthet Dent 2016;115:321-8.
27. Hahnel S, Henrich A, Bürgers R, Handel G, Rosentritt M. Investigation of
mechanical properties of modern dental composites after artificial aging for
one year. Oper Dent 2010;35:412-9.
28. Xu HH, Smith DT, Schumacher GE, Eichmiller F, Antonucci JM. Indentation
modulus and hardness of whisker-reinforced heat-cured dental resin com-
posites. Dent Mater 2000;16:248-54.
29. Wassell R, McCabe J, Walls A. Subsurface deformation associated with
hardness measurements of composites. Dent Mater 1992;8:218-23.
30. White S. Mechanical fatigue of a feldspathic dental porcelain. Dent Mater
1993;9:260-4.
31. Väyrynen VO, Tanner J, Vallittu PK. The anisotropicity of the flexural prop-
erties of an occlusal device material processed by stereolithography.
J Prosthet Dent 2016;116:811-7.
32. International Organization for Standardization. ISO 14577-1. Metallic ma-
terials -instrumented indentation test for hardness and materials parameters
- Part 1: test method. Geneva: International Organization for Standardiza-
tion; 2015.
33. Greaves GN, Greer A, Lakes RS, Rouxel T. Poisson’s ratio and modern
materials. Nat Mater 2011;10:823.
Corresponding author:
Dr Marcel Reymus
Department of Conservative Dentistry and Periodontology
University Hospital, LMU Munich
Goethestrasse 70, Munich 80336
GERMANY
Email: mreymus@dent.med.uni-muenchen.de
Copyright © 2020 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2019.12.026
THE JOURNAL OF PROSTHETIC DENTISTRY