RESEARCH AND EDUCATION

Comparison of material properties and biofilm formation in

interim single crowns obtained by 3D printing and
conventional methods
Débora Meincke Simoneti, DDS, MSc, PhD,a Tatiana Pereira-Cenci, DDS, MSc, PhD,b and
Mateus Bertolini Fernandes dos Santos, DDS, MSc, PhDc

Digital technology has revolu- ABSTRACT

tionized prosthodontics, as the
Statement of problem. Three-dimensionally printed interim restorations are among the recent
planning and manufacturing technological advancements in dentistry. However, evidence of their performance is lacking.
of single crowns, removable
partial dentures, fixed partial Purpose. The purpose of this in vitro study was to compare the properties of interim restorations
made by 3D printing with different technologies, laser stereolithography (SLA), technology and
dentures, and implant-
selective laser sintering (SLS) with those obtained by conventional techniques from acrylic resin
supported prostheses can now and bis-acryl resin.
be made with the aid of dental
scanners, digital articulators, Material and methods. Four different groups (acrylic resin, bis-acryl resin, SLS, SLA) were tested for
flexural strength, Vickers microhardness, fatigue test, compressive strength, surface roughness
computer-aided design and
before and after polishing, and biofilm formation. Specimens were made in the form of
computer-aided manufacturing rectangular blocks, disks, and single crowns by following the manufacturing technique of each
(CAD-CAM), and most material. One-way ANOVA was used to test biofilm formation, Vickers microhardness, and the
recently 3D printing through results of the 3-point bend flexural test, while the paired t test was used to assess differences in
additive manufacturing pro- surface roughness between the materials (a=.05 for all tests).
cesses.1-4 Although once Results. The highest Vickers microhardness value was for acrylic resin interim crowns, while the
considered expensive and fu- elastic moduli were lower for both the 3D printed materials. Only the SLA resin fractured during
turistic with limited applica- the fatigue test. For surface roughness, a statistically significant difference was found among the
tions,5 the ease of printing, studied materials (P<.001), with SLA resin and bis-acryl resin having the lowest values. No
obtainment of high-resolution statistically significant differences were found for biofilm formation (P>.05).
printed casts, as well as Conclusions. SLS resin had favorable results for the Vickers microhardness, higher maximum
adequate surface finish for flexural strength, and peak stress in load-to-fracture tests, the fatigue test, and biofilm formation
interim restorations,6 and the compared with acrylic resin and bis-acryl resin, while SLA resin showed favorable results only for
lower prices of 3D printers have biofilm formation and surface roughness. (J Prosthet Dent 2022;127:168-72)
made this technology an important tool in dentistry.2,3,7-9 printer polymerizes a liquid resin, and with SLS, a
Three-dimensional printers are available with powdered resin is selectively fused by the laser
different technologies,10-12 including laser stereo- beam.2,7,8,10
lithography (SLA) and selective laser sintering (SLS) Conventional materials for interim restorations
producing casts and prototypes by light-polymerizing include acrylic and bis-acryl resins, providing good es-
layers of material.13 With SLA, the laser of the thetics, biocompatibility, and stability in the oral

Supported in part by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brasil (CAPES), Finance Code 001.
a
Graduate student, Graduate Program Prosthodontics, School of Dentistry, Universidade Federal de Pelotas, (UFPel), Pelotas, RS, Brazil.
b
Associate Professor, Graduate Program Prosthodontics, School of Dentistry, Universidade Federal de Pelotas, (UFPel), Pelotas, RS, Brazil.
c
Assistant Professor, Graduate Program Prosthodontics, School of Dentistry, Universidade Federal de Pelotas, (UFPel), Pelotas, RS, Brazil.

168 THE JOURNAL OF PROSTHETIC DENTISTRY

January 2022 169

Table 1. Studied materials

Clinical Implications Material Manufacture Mode Composition
Product
Information
The properties of stereolithography and SLS 3D Acrylic Direct technique e Polymethylmethacrylate, Dencor; Artigos
printing materials appear to be suitable for interim resin Matrix assisted with Benzoyl Peroxide, Odontológicos
elastomeric Biocompatible Pigments Clássico Ltda.
single crowns. However, caution is recommended impression
as some properties such as biocompatibility, color Bis-acryl Direct technique e Dimethacrylates, Yprov Bisacryl;
resin Matrix assisted with nanoparticles, catalysts, Yller
changes, and wear resistance were not assessed. elastomeric pigments, inhibitor Biomaterials
impression
Stratasys SLS Nylon 12 PA2201 PA2201;
SLS resin Stratasys Direct
environment.14,15 Although these materials are also Manufacturing
inexpensive, fabricating interim restorations is time Gray SLA Oligomers methacrylates, Gray Resin;
consuming and their quality is dependent on the den- Formlabs methacrylate monomers, Formlabs Inc
SLA resin Photoinhibitors, Pigments,
tist’s or dental assistant’s skill.16,17 Three-dimensional Special additives
printing may become an important tool for producing SLA, stereolithography; SLS, selective laser sintering.
interim crowns without the presence of the patient,
making the process more efficient and minimizing
chairside time.6,18
The purpose of this in vitro study was to compare the
properties and mechanical performance of interim
restoration materials made by 3D printing techniques
with different technologies (SLA or SLS) with those
obtained by conventional techniques (acrylic resin or bis-
acryl resin). The null hypothesis of this study was that the
studied groups would be similar.

MATERIAL AND METHODS

Two 3D-printed interim restorative materials (SLA and
SLS) and 2 conventional materials (acrylic resin and bis-
acryl resin) were assessed for fracture resistance (3-point
bend flexural test), surface roughness, Vickers micro-
hardness, fatigue, and biofilm formation. Specimens
were obtained for the physical and mechanical tests as
per Table 1.
Interim single crowns (n=40; 10 per group) were
made through the digital planning of a mandibular molar
tooth preparation pattern corresponding to a mandibular
right molar (Fig. 1), which was scanned and then digitally
designed (Zirkonzahn; Zirkonzahn GmbH). After
obtaining a digital standard tessellation language
(STL) file of the single crown, it was 3D printed to serve
as a matrix for the techniques with the conventional
materials (acrylic resin and bis-acryl resin).
In addition to the crowns, specimens with different
configurations were made in 4×2×10-mm rectangular
blocks (n=10 per group) and disks (n=10 per group)
(Ø10×2 mm) as per the specifications of the tests (Fig. 2).
The SLA specimens were processed after printing as per
the manufacturer’s recommendations to strengthen and
stabilize the specimens. The specimens were polymerized
for 30 minutes at 60  C with the same light-emitting
diode (LED) used for printing. The SLS specimens were
not processed after printing, following the recommen-
dations of the manufacturer.
Figure 1. Mandibular molar tooth preparation.
To evaluate surface roughness, all specimens of the
different groups (n=10) were evaluated with a contact
profiler (SJ-201; Mitutoyo Inc) by using the amplitude
parameter Ra with the following test conditions: cutoff
length 0.8 mm, resolution 0.0001 mm (8 mm range), speed
0.5 mm/s, and total length 4 mm. Three readings were
made for each specimen, and the mean and median
roughness values (Ra, mm) were determined from the
arithmetic mean of these 3 measurements.19 The speci-
mens were first measured before polishing and after
polishing with a felt disk (Diamond Master; FGM Dental
Products Inc) with high-luster polishing paste (Opal L
No. 520-0001; Renfert GmbH) for 1 minute, simulating
clinical polishing.
To evaluate biofilm formation on the specimens
(n=6), an in vitro biofilm assay was performed in a
microcosm model. Saliva from a healthy donor was
collected and placed on the specimens from each group,
which were positioned on cell culture plates for 1 hour for
acquired film formation. The saliva was then aspirated
and inserted in a defined medium mucin (DMM) (saliva-
like culture medium) and incubated under anaerobic

Simoneti et al THE JOURNAL OF PROSTHETIC DENTISTRY

170
Figure 2. Specimens and materials used. A, Acrylic resin, B, SLA, C, SLS, D, Bis-acryl resin. SLA, stereolithography; SLS, selective laser sintering.
conditions for a period of 24 hours. After this period, the
specimens were removed, washed in saline solution, and
sonicated (3 pulses of 10 seconds, 10 W). The biofilm was
serially diluted and plated on blood agar plates. The
plates were incubated at 37  C under anaerobic condi-
tions for 72 hours, and the microorganisms were coun-
ted. This experiment was performed in duplicate at 3
different times.
To evaluate the Vickers microhardness, specimens
(n=5) were evaluated by means of a previously calibrated
microdurometer (FM-700; Future-Tech Corp). Five in-
dentations were made in different regions of the speci-
mens. The applied load was 490 N for 15 seconds. The
Vickers microhardness number (kgf/mm2) of the
analyzed surfaces of each specimen was acquired as per
the average of 5 readings. The test was performed by a
single operator (D.M.S.).
For the 3-point bend flexural test, a universal testing
machine (DL500; EMIC Inc) was used with a 1000-N load
cell at a speed of 0.5 mm/minute, applying a slowly
increasing load in the center of the test piece (n=10) until
rupture. Through this test, the values of the moduli of
elasticity, maximum stress, and maximum strength sup-
ported by the tested materials were obtained.
Each crown model group (n=10) was submitted to
mechanical fatigue testing performed by using a piston
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 127 Issue 1
(Ø2.5 mm) in a pneumatic mastication simulator (Bio-
cycle V2; Biopdi Inc).20 The specimens were placed on a
metal base and positioned at a 90-degree angle to the
long axis of the tooth. The piston touched the internal
inclines of the buccal and lingual cusps, and each load
cycle consisted of the indenter coming into contact with
the specimens, loading 2 bars, holding for 0.125 seconds,
and completely unloading for 0.125 seconds, with a fre-
quency of 4 Hz. A total of 120 000 cycles were performed
to simulate 6 months of clinical use.20
The results were analyzed by 1-way ANOVA followed
by the Tukey honestly significant difference (HSD) test for
each of the tests: biofilm formation, Vickers microhard-
ness, and 3-point bend flexural test. The paired t test was
also used to compare the surface roughness before and
after polishing and the intergroup comparison by 1-way
ANOVA. The fatigue resistance was chosen to present
the data in a qualitative way because only one 3D-printing
group fractured after the mechanical cycling (a=.05 for all
tests).
RESULTS
A statistically significant difference was found among the
Vickers microhardness of the assessed groups (P<.001),
with the acrylic resin specimens having higher values
Simoneti et al
January 2022 171

Table 2. Vickers microhardness, elastic moduli, maximum flexural Table 3. Surface roughness data before and after polishing (mm) and
strength, peak stress, and fracture resistance of tested materials biofilm formation
Maximum Fracture of the Before Polishing Surface After Polishing Surface Biofilm
Vickers Elastic Flexural Peak Material After Material Roughness (mm) Roughness (mm) Count (× 109)
Microhardness Moduli Strength Stress Fatigue Acrylic 4.8 ±0.6b 0.9 ±0.2b 3.6 ±2.5a
2
Material (Kgf/mm ) (MPa) (MPa) (N) Simulation* resin
Acrylic 14.2 ±2.6d 859.4 69.2 ±8.8bc 114.6 . SLA 1.5 ±0.4a 0.7 ±0.1a 6.1 ±7.2a
resin ±46.3c ±14.6b resin
SLA 8.4 ±0.2ab 513.3 48.9 ±1.2ac 58.7 4 SLS resin 6.2 ±0.6c 1.2 ±0.3c 5.5 ±4.6a
resin ±29.7b ±2.2a
Bis-acryl 1.5 ±0.3a 0.7 ±0.1ba 5.1 ±6.1a
SLS resin 10.3 ±1.0bc 452.4 77.3 ±3.1d 133.7 . resin
±35.8ab ±4.4d
Bis-acryl 10.7 ±2.2ac 997.3 75.0 ±8.2c 131.1 . SLA, stereolithography; SLS, selective laser sintering. Different letters represent
resin ±108.5d ±2.2ac statistically significant differences between materials for each of tests (ANOVA and Tukey
test, P<.05). Regarding comparison of polishing (before versus after), differences in all
SLA, stereolithography; SLS, selective laser sintering. Different letters represent materials (P<.001, paired t test)
statistically significant differences between materials for each of tests (ANOVA and Tukey
test, P<.05). *After fatigue simulation: 4 material fractured

Physical and mechanical properties are important

parameters to be considered when deciding which ma-
than the other materials. The SLA resin were statistically
terial to use for an interim restoration. Three-dimen-
similar (P>.05) to those of the bis-acryl resin group.
sionally printed interim restorations are a current option,
Similarly, a statistically significant difference was
but the available information on the chemical composi-
found between the maximum flexural strength and peak
tion and mechanical properties of such materials is still
stress among the studied groups, with the SLA resin
limited.2,10 In addition, the emerging number of 3D
having the lowest values, followed by acrylic resin, bis-
printing methods and commercially available products
acryl resin, and SLS resin (P<.001). However, when
makes the classification and comparison of these mate-
considering the elastic moduli of the different materials,
rials difficult.2
the lowest values were observed for both 3D printing
The digital workflow is gaining acceptance in all areas,
materials (SLA and SLS), which were almost half the
and additive manufacturing (3D printing) is being
values in the acrylic resin and bis-acryl resin groups
increasingly applied in dentistry. The marginal and in-
(P<.001).
ternal adaptation of copings fabricated by conventional
In the fatigue, mechanical cycling test, the 4 SLA resin
wax pattern, 3D printing, and laser sintering techniques
specimens did not resist the compression to which they
has been assessed, and the precision of the 3D printing
were submitted. The fractures occurred after 22 000,
technique has been reported to be within an acceptable
33 700, 45 000, and 113 800 cycles. No fracture was
range.6,18
observed in the other tested groups (Table 2).
The surface of an interim restoration should be as
Biofilm formation was not significantly different on
smooth as possible, for esthetics and also periodontal
the materials (P=.949). The surface roughness was
health because lower surface roughness has been asso-
significantly different in all materials before and after
ciated with lower biofilm formation.14 The surface
polishing (P<.001). SLA resin showed the lowest values
roughness values in the present study were consistent
of surface roughness, similar to those of bis-acryl resin.
with those of previous studies,1,15 and both SLA (0.7 ±0.1
The conventional materials (acrylic resin and bis-acryl
mm) and SLS (1.2 ±0.3 mm) had mean roughness values
resin) presented similar values for surface roughness,
similar to those of conventional materials, although sta-
while SLS resin showed the highest values of surface
tistically significant differences were not observed for
roughness, statistically different from the other groups
biofilm formation.
(Table 3).
SLS resin had the highest values for maximum flex-
ural strength and peak stress in load-to-fracture, being
DISCUSSION
statistically higher than those of the other groups. This
The null hypothesis that no difference would be found finding is consistent with a previous study which re-
among conventional and 3D-printed interim restorations ported that 3D printing technology using resin materials
was partially accepted because differences were observed provided adequate fracture resistance for denture teeth.18
among the materials for some of the tested parameters. Conversely, the SLA resin presented lower Vickers
Previous studies that assessed mechanical properties of microhardness values compared with those of the other
3D printing materials and compared them with con- materials, which might lead to increased fracture; in the
ventional materials (acrylic resin and bis-acryl resin) used present study, the SLA resin was the only material that
for interim crowns are sparse.11,12 In addition, the au- failed during the fatigue test.
thors are unaware of a previous study that assessed Limitations of the present study include that new 3D
biofilm formation on such materials. printing resins are being developed and marketed

Simoneti et al THE JOURNAL OF PROSTHETIC DENTISTRY

172
rapidly; thus, resins with different compositions and
polymerization times could produce interim restorations
with different properties. The present study assessed the
mechanical properties of the materials printed only in
horizontal layers. Printing in different orientations could
lead to different properties.2,13 In addition, the study
assessed only 1 protocol of layer thickness and support
structures, and the formed biofilm was evaluated only
initially and its composition could change over time.
The range of available shades is not yet adequate and
color changes in the oral environment and wear resis-
tance are important aspects that were not addressed in
this study. Further studies are needed to address these
limitations.
CONCLUSIONS
Based on the findings of this in vitro study, the following
conclusions were drawn:
1. SLA and SLS resins presented similar values of
Vickers microhardness to those of bis-acryl resin.
2. SLS resin presented higher maximum flexural
strength and peak stress values in the load-to-
fracture test than conventional materials, while
SLA performed worst compared with all assessed
materials.
3. The elastic moduli of both SLA and SLS were lower
than for acrylic resin and bis-acryl resin.
4. The SLA resin specimens did not survive the fatigue
test.
5. The SLA resin presented the lowest values for sur-
face roughness, which were similar to those of the
bis-acryl resin group, while the SLS resin showed
the highest values than all other groups.
6. Biofilm formation was not affected by the assessed
material.
REFERENCES
1. Arnold C, Monsees D, Hey J, Schweyen R. Surface quality of 3D-printed
models as a function of various printing parameters. Materials (Basel)
2019;12:E1970.
2. Tahayeri A, Morgan M, Fugolin AP, Bompolaki D, Athirasala A, Pfeifer CS,
et al. 3D printed versus conventionally cured provisional crown and bridge
dental materials. Dent Mater 2018;34:192-200.
3. Joo HS, Park SW, Yun KD, Lim HP. Complete-mouth rehabilitation using a
3D printing technique and the CAD/CAM double scanning method: A
clinical report. J Prosthet Dent 2016;116:3-7.
4. Chaturvedi S, Alqahtani NM, Addas MK, Alfarsi MA. Marginal and internal
fit of provisional crowns fabricated using 3D printing technology. Technol
Health Care 2020;28:635-42.
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 127 Issue 1
5. Mulford JS, Babazadeh S, Mackay N. Three-dimensional printing in ortho-
paedic surgery: review of current and future applications. ANZ J Surg
2016;86:648-53.
6. Molinero-Mourelle P, Canals S, Gomez-Polo M, Sola-Ruiz MF, Del Rio
Highsmith J, Vinuela AC. Polylactic acid as a material for three-dimensional
printing of provisional restorations. Int J Prosthodont 2018;31:349-50.
7. Kasparova M, Grafova L, Dvorak P, Dostalova T, Prochazka A, Eliasova H,
et al. Possibility of reconstruction of dental plaster cast from 3D digital study
models. Biomed Eng Online 2013;12:12-49.
8. Chung P, Heller JA, Etemadi M, Ottoson PE, Liu JA, Rand L, et al. Rapid and
low-cost prototyping of medical devices using 3D printed molds for liquid
injection molding. J Vis Exp 2014;27:e51745.
9. Obregon F, Vaquette C, Ivanovski S, Hutmacher DW, Bertassoni LE. Three-
dimensional bioprinting for regenerative dentistry and craniofacial tissue
engineering. J Dent Res 2015;94:143S-52S.
10. Revilla-Leon M, Meyers MJ, Zandinejad A, Ozcan M. A review on chemical
composition, mechanical properties, and manufacturing work flow of addi-
tively manufactured current polymers for interim dental restorations. J Esthet
Restor Dent 2019;31:51-7.
11. Revilla-Leon M, Ozcan M. Additive manufacturing technologies used for
processing polymers: current status and potential application in prosthetic
dentistry. J Prosthodont 2019;28:146-58.
12. Revilla-Leon M, Sadeghpour M, Ozcan M. An update on applications of 3D
printing technologies used for processing polymers used in implant dentistry.
Odontology 2020;108:331-8.
13. Kulkarni P, Marsan A, Dutta D. A review of process planning techniques in
layered manufacturing. Rapid Prototyping Journal 2000;6:18-35.
14. Mickeviciute E, Ivanauskiene E, Noreikiene V. In vitro color and roughness
stability of different temporary restorative materials. Stomatologija 2016;18:66-72.
15. Young HM, Smith CT, Morton D. Comparative in vitro evaluation of two
provisional restorative materials. J Prosthet Dent 2001;8:129-32.
16. Arora A, Yadav A, Upadhyaya V, Jain P, Verma M. Comparison of marginal
and internal adaptation of copings fabricated from three different fabrication
techniques: An in vitro study. J Indian Prosthodont Soc 2018;18:102-7.
17. Holmer L, Othman A, Luhrs AK, von See C. Comparison of the shear bond
strength of 3D printed temporary bridges materials, on different types of
resin cements and surface treatment. J Clin Exp Dent 2019;11:e367-72.
18. Chung YJ, Park JM, Kim TH, Ahn JS, Cha HS, Lee JH. 3D printing of resin
material for denture artificial teeth: chipping and indirect tensile fracture
resistance. Materials (Basel) 2018;11:1798.
19. Valente LL, Peralta SL, Ogliari FA, Cavalcante LM, Moraes RR. Comparative
evaluation of dental resin composites based on micron- and submicron-sized
monomodal glass filler particles. Dent Mater 2013;29:1182-7.
20. Sedrez-Porto JA, Munchow EA, Valente LL, Cenci MS, Pereira-Cenci T. New
material perspective for endocrown restorations: effects on mechanical per-
formance and fracture behavior. Braz Oral Res 2019;33:e012.
Corresponding author:
Dr Tatiana Pereira-Cenci
School of Dentistry
Federal University of Pelotas (UFPel)
457 Gonçalves Chaves St, Room 508
Pelotas, RS, 96015-560
BRAZIL
Email: tatiana.dds@gmail.com
CRediT authorship contribution statement
Débora Meincke Simoneti: Conceptualization, Methodology, Funding acquisi-
tion, Formal analysis, Data curation, contributed during the article elaboration
process and final approval of the version to be published. Tatiana Pereira-Cenci:
Conceptualization, Methodology, Funding acquisition, Formal analysis, Data
curation, contributed during the article elaboration process and final approval of
the version to be published. Mateus Bertolini Fernandes dos Santos:
Conceptualization, Methodology, Funding acquisition, Formal analysis, Data
curation, contributed during the article elaboration process and final approval of
the version to be published.
Copyright © 2020 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2020.06.026
Simoneti et al