Available online at www.sciencedirect.
com Current Opinion in
ScienceDirect
Application of metal additive manufacturing in oral
dentistry
Qirui Zhang1 and Yingchun Guan1,2
Abstract
With the progress of medical and health undertakings as well
as the continuous deepening of attention to dental health, the
dental implant has received extensive attention. It is an urgent
need to resolve the problems of original manufacturing
methods and processes in dental implant industry, such as
complex manufacturing process, high production cost, and low
biocompatibility. Recently, additive manufacturing has been
considered as a promising technology of medical implant
manufacturing with high efficiency, cost-effectiveness, wide
applicability, and high accuracy. This paper briefly describes
recent research and application progress of metal additive
manufacturing in dental implants, in order to provide a clue and
basis for maxillofacial joint, root, crown, etc.
Addresses
1
School of Mechanical Engineering & Automation, Beihang University,
Beijing 100083, China
2
National Engineering Laboratory of Additive Manufacturing for Large
Metallic Components, Beihang University, 37 Xueyuan Road, Beijing
100083, China
Corresponding author: Guan, Yingchun (guanyingchun@buaa.edu.
cn)
Current Opinion in Biomedical Engineering 2023, 25:100441
This review comes from a themed issue on Intelligent Biomaterials
2023
Edited by Seeram Ramakrishna, Ravin Narain, Himansu Sekhar
Nanda, Masoud Mozafari and Gulden Camci-Unal
For complete overview of the section, please refer the article collection
- Intelligent Biomaterials 2023
Received 14 August 2022, revised 10 November 2022, accepted 29
November 2022
https://doi.org/10.1016/j.cobme.2022.100441
2468-4511/© 2022 Elsevier Inc. All rights reserved.
Keywords
Additive manufacturing, Metal, Dental implant, Surface properties,
Surface enhancement.
Introduction
The main requirements of implant materials as dental
implants are as follows: high biocompatibility, proper
bone integration, and good mechanical properties [1].
Because of the aging of the population and the change of
modern lifestyles, tens of thousands of patients are
troubled by dental diseases. According to the latest
report of grand view research, the global dental implant
market is $3.6 billion in 2020. It is expected to expand at
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Biomedical Engineering
a compound annual growth rate (CAGR) of 11.0% from
2021 to 2028 and will reach $3.6 billion in 2028 [2].
Additive manufacturing (AM) has become an indis-
pensable part of modern product development due to its
high degree of design freedom [3]. For more than 20
years since AM technology was proposed, AM was
initially limited to manufacturing porous structures.
With the progress of technology, the density of samples
made of AM has been effectively improved. At present,
it has been widely used in the medical field and has
occupied the main market in the medical field [4]. The
traditional metal implants made by forging, investment
casting, hot rolling, and mechanical processing will have
stress shielding in the body, which will lead to mismatch
with the body organs. This led to a linear increase in
postoperative risk. Since AM can be used to manufac-
ture implants with controllable strength, hardness, and
Young’s modulus, it has more similar performance to
human bones, thus alleviating the problem of stress
shielding [5]. Compared with traditional lost wax cast-
ing, AM dental implants have higher precision and
processing efficiency, which reduces the technical re-
quirements of traditional lost wax casting for operators
and the processing errors caused by tedious steps of
traditional methods. Treatment time is shortened
through in-mouth scanning and AM techniques, and
comfort in the use of implants and fit with the human
body are improved [6]. Figure 1 shows a common
application scenario for AM metal dental implants.
Personalized medical implants with complex shapes and
suitable for personal conditions are manufactured by
AM, which provides a more economical and efficient
manufacturing method for implant manufacturing
(Figure 2).
In this review, we briefly summarized the main progress
of AM dental implants in the past five years and pro-
vided our views on future opportunities and challenges.
We discuss the influence of surface morphology on
implant performance by dividing this paper into
three parts, including common AM methods, surface
performance of AM parts, and surface enhancement
methods.
Additive manufacturing methods
AM is a rapid prototyping technology. The experi-
menters use computer-aided design (CAD) to design
CAD models and use AM equipment to prepare objects
with certain functions. The main preparation methods
Current Opinion in Biomedical Engineering 2023, 25:100441
2 Intelligent Biomaterials 2023
and materials used in the dental application of metal
implant are as follows: (1) selective laser melting
(SLM), (2) electron beam melting (EBM), and (3)
spark plasma sintering (SPS). Table 1 shows typical AM
methods for dental implants in recent years.
With the development of computer technology, re-
searchers begin to use intelligent manufacturing
methods to assist AM [21]. Through sensors, the AM
process can realize path optimization and parameter
adjustment of manufacturing process through online
detection feedback [22]. With regard to AM digital
ecosystem, the data area supply framework can identify
the process-structure-property (p-s-p) relationship and
get rid of the burden of trial and error [23]. Researchers
use data mining algorithms, machine learning, and AI
data-driven methods to explore the correlation between
AM inputs and outputs without physical interpretation.
Data-driven methods are preferred for fast prediction,
process optimization, and especially for real-time di-
agnostics with feedback control [24]. Majeed [25] pro-
posed a framework for large data analysis to reveal the
relationship between sustainable production perfor-
mance and processing parameters of AM. The process
parameters are optimized to improve product quality,
productivity, and reduce energy consumption. Tian [26]
proposed a data fusion method based on machine
Figure 1
Images of dental implants manufactured by AM technology [7–12].
Current Opinion in Biomedical Engineering 2023, 25:100441
learning, which used the measured pool heat prediction
to predict the porosity in AM parts. He correlated the
high-temperature image of the process with the strati-
fied porosity and developed a long-term recursive
convolution network (RCN) to correlate the continuous
thermal image from an infrared camera with the strati-
fied porosity.
Mechanical and corrosion properties
The method of obtaining dental seed plants through AM
is very suitable for producing dental plants with complex
shapes and accurately controlling the size of implants
[27]. Moreover, the accuracy of post-treatment grinding
of the implant obtained by AM on zirconia is also higher
than that of reduced material manufacturing. Besides,
AM is a digital method of storing inventory in digital
form, leading to the reduction of inventory cost [28].
With the popularization of AM technology, a large
number of efforts have been devoted to analyze the
potential of AM dental implants. Metal has good me-
chanical properties, corrosion resistance, wear resis-
tance, and biocompatibility compared with other metal
materials [29]. However, the high contrast of mechan-
ical properties between the periprosthetic bone tissue
and the implanted biomaterials may lead to bone
resorption, and it may lead to aseptic loosening and loss
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Figure 2
AM porous structure implant in vivo experiment (a) good fusion between implant screws with porous structure and host bone in rabbits [45]; (b) for
implants with porous structure, osteoblasts directly adhere to the metal surface and deposit minerals at the fourth week after implantation into the body
[31]; (c) porous implants achieve better bone integration and shorten the recovery time after surgery [46]; (d) porous dental implants have more cell
attachment at 72 h [47].
of bone density. As a result, the risk of periprosthetic
fracture is increased, and the revision surgery also
become more difficult [30]. In recent years, researchers
have applied the porous structure of metal to biomed-
icine. Studies have shown that implants with porous
surface structure have better bone integration and cell
proliferation ability, and metals have similar mechanical
properties to bone due to changes in surface structure
[31]. The results show that the porosity and pore
diameter of porous metal can affect the performance of
implants. In general, when the porosity is greater than
40%, the implants show better osteoblast differentia-
tion results than non-porous materials. When the
porosity is less than 70%, the differentiation effect of
osteoblasts will increase with the increase of porosity. In
addition, the implants will be accompanied by the
decrease of elastic modulus and compressive strength
and the increase of tensile strength [32]. The elastic
modulus of natural bone is 2.5 GPa, and metallic ma-
terials with a porosity of 66% exhibit similar properties
[33]. The diameter of the pore also obviously affects
the attachment and differentiation of cells. Generally,
considering the migration of bone cells, the diameter of
the pore is required to be greater than 100 mm [34]. In
order to realize that the total bone tissue of the implant
can grow inward, the diameter of the hole is often
controlled within 1200 mm [35]. The experiment
showed that with the increase of pore diameter, the
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Application of metal additive manufacturing Zhang and Guan 3
pore structure showed a better cell growth rate in the
early stage, and the larger pore structure showed a
better cell growth rate after 10 days. This is because the
pore structure with smaller diameter is conducive to
cell attachment, and the large pore is conducive to cell
growth and cell proliferation [36]. Implants with both
macroporous and small pore structures exhibit better
biocompatibility than implants with only macroporous
or small pore structures [37].
AM materials contain lower sediment content and are
uniformly distributed throughout the microstructures
compared to conventional casting methods for dental
implants. This makes it more difficult for materials
made by AM to form micro-cell structures than cast
alloys, so AM alloys tend to have better corrosion resis-
tance [38]. However, the specific surface area is an
important factor affecting the corrosion rate of metal
materials. Higher corrosion rates were observed in metal
porous supports due to the larger surface area in contact
with the corrosive media than the bulk. The corrosion
rate of the material increases with increasing porosity
[39]. However, the corrosion resistance of porous im-
plants is considered to be regulated by appropriate
surface modification due to the fact that the corrosion
resistance of materials is influenced by grain size,
passivation film produced by corrosion, and second
phase [40].
Current Opinion in Biomedical Engineering 2023, 25:100441
4 Intelligent Biomaterials 2023
Table 1
Typical AM methods for dental implants.
AM method References Application scenarios
SLM DDS Hu Chen [13] Removable partial denture bracket
Zena J. Wally [14] Dental implant
Mariana Lima da In vitro experiments
Costa Valente [15]
M Revilla-León [16] Complete-arch titanium frameworks
J Li [17] Tooth root
EBM R Yan [18] Mesh metal mandible prosthesis
bracket
W Zhang [19] In vitro experiments
SPS D Hao [20] In vitro experiments
The mechanical properties of porous materials have also
attracted wide attention. With the increase of porosity,
the compressive strength of materials will decrease [41].
Some scholars believe that the function of internal
porosity is similar to that of void defects. Closing of
these “void defects” during the compression test in-
creases the plastic deformation capacity and delays the
final fracture [42]. In addition, fatigue properties of
porous materials have attracted wide attention.
Research shows that the process of SLM often has faster
cooling rates than that of EBM, resulting in more ma-
terial produced. a0 the phase reduces the fatigue prop-
erties of the material [43]. Fatigue properties can also be
significantly improved by controlling and designing cell
shape, surface properties, post-treatment, and gradient
porosity [44].
Xiong [45] reported that by preparing porous implant,
teeth relieve the stress in the porous structure. These
factors contribute to the high normalized fatigue
strength (w0.5) and high effective fatigue strength
(w165.46 MPa) of dental implant. Chen [31] used
finite element analysis to calculate the 3D stress dis-
tribution around the implant teeth, and the results show
that the general stress distribution appeared to be fairly
similar for both the solid and porous implants. The fact
that the structures were porous seemed to have only a
minor impact on the stress distribution and the stress;
the stress distribution was determined mainly by the
length and diameter of the endosteal implant.
Current Opinion in Biomedical Engineering 2023, 25:100441
Performance
The adaptability of the Co–Cr–Mo frame
made with SLM is equivalent to that of the cast
frame
The Young’s modulus and yield strength were
adjusted by changing the manufacturing
structure of additive
The samples made by SLM are coarser and
have less wettability than those made by
traditional reduced material manufacturing.
There are no significant internal pores on the
material surface
The accuracy of samples manufactured by
additive has a large deviation in X and Y-
directions and a small deviation in Z-axis
Gradient printing can reduce the surface
roughness and make the distribution more
uniform
The EBM production process reduces the
production time, and the processed titanium
stent mesh has good biocompatibility
EBM samples showed lower wear rate than
SLM and forged samples
The Ti–40Nb made by SPS method have
elastic modulus and compressive
strength and have good biocompatibility
Surface properties enhancement
The surface roughness of the sample affects the me-
chanical properties of the implant and the degradation
rate. Most of the surface of the sample after material
increase is coated with powder particles, which increases
the risk of bacterial colonization and has a negative
impact on the biocompatibility of the sample [48].
In order to solve the problem of bacterial infection on
the surface of dental implants, researchers have
improved the antibacterial performance of the surface of
dental implants through various ways. The early
methods mainly include spraying drug-loaded coating
and adding heavy metal elements. However, these
methods will produce obvious cytotoxicity while
achieving the bacteriostatic purpose [49,50]. As shown
in Figure 3, it was found that the preparation of nano-
structures on the surface of materials would lead to the
change of the contact area of bacterial adhesion and the
deformation of the cell membrane in the adhesion area.
Compared with the flat surface without micro/nano-
structure, the micro/nanostructure will cause an reduce
in the bacterial adhesion area, resulting in an increase in
the tensile strain of the cell membrane. When the
drawing strain reaches a certain fixed value, the cells of
bacteria are dissolved [51]. In addition, bacteria are
more likely to form colonies or biofilms on hydrophilic
surfaces than on hydrophobic surfaces [52]. Therefore,
adjusting the surface wettability by adjusting the
microstructure of the material surface can also be used
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Figure 3
(a) Illustration of the bacteria on the surface of the original material; (b) illustration of bacteria on LIPSS structural surface. The contact points of the
bacteria on the surface are highlighted in red; (c) a diagram of the number of bacteria adhering to the surface of the original material; (d) figure of the
number of bacteria adhering to the LIPSS structural surface [59].
to prepare the material surface with antibacterial
function.
For the preparation of antibacterial functional surface,
the traditional physical method for post-treatment is
sandblasting to modify surface morphology and wetta-
bility, resulting in higher cell adhesion, cell prolifera-
tion, and osteoblast differentiation characteristics [53].
However, due to the uncontrollability of the sand-
blasting process, the roughness of the surface of the
material after sandblasting will be very uneven, leading
to obvious differences in the effect of bone bonding at
different positions. In past decades, many studies have
shown that laser-induced periodic surface structure
(LIPSS) is obtained by femtosecond laser preparation
of antibacterial metal alloy. This more uniform struc-
ture makes the material obtain excellent antibacterial
and bone integration effects. In addition, the material
surface treated by ultrafast laser strongly inhibits the
expression of adipose-related genes and regulates the
expression of bone-related genes [54]. In vitro experi-
ments showed that microstructures prepared by
femtosecond laser can enhance the adhesion of mouse
myoblast C2C12 and accelerate cell proliferation and
differentiation [55]. Orazi [56] conducted laser surface
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Application of metal additive manufacturing Zhang and Guan 5
texturing to fabricate LIPSS on dental implants with
complex geometries, leading to cell adhesion rate
increased from 82.1% to 98.3%. Joob-Fancsaly [57]
found that osseointegration was not strongly altered
when the structure size was in the range of 1e10 mm
compared to that of flat surfaces, while the surface
osseointegration effect would be significantly improved
when the size of the structure was enlarged to 20e
50 mm. Figure 4 shows the bacteriostatic performance
and biocompatibility improvement effect of different
treatment methods on the materials after implant
treatment, the increase rate of average optical density
(OD) value is used in ordinate as the criterion for cell
compatibility, while the increase rate of antimicrobial
activity is used in horizontal as the criterion for anti-
microbial performance. It is observed that the anti-
bacterial performance and biocompatibility of the
material surface after laser treatment are significantly
better than other treatment methods. In addition,
studies showed that the effective action time of anti-
biotics is short. When the release of antimicrobial
agents is most needed, the antimicrobial release coating
may be exhausted. Besides, the sustained low-level tail
release will help the development of antibiotic resis-
tance [58].
Current Opinion in Biomedical Engineering 2023, 25:100441
6 Intelligent Biomaterials 2023
Figure 4
Effect of modification methods on antimicrobial property and biocompatibility of implants [60–66].
Future prospects
In recent years, 4D material has been widely used in
biomedical field as a new intelligent material, and the
method of manufacturing 4D material by AM has
attracted much attentions by stimulating with temper-
ature, humidity, electricity, light, current, and magnetic
fields [67e70]. Malachowski [68] developed heat-
response multi-finger grippers to enable grasp tissues
at body temperature to sustainably release drugs.
Morrison [69] proposed a support structure for babies
with severe tracheobronchial softening to prevent airway
collapse during normal breathing using the stereo-
lithography (SL) device method. Bodaghi [70] used 4D
printed a metamaterial lattice consisting of flexible
beams with integrated fibers arranged in tubular shapes
to demonstrate one of their potential applications as
scaffolds. Correspondingly, we can change the network
spacing of materials by shrinking and expanding,
resulting in changes in the size or shape of the oral
implant. By providing complementary strategies for size
or shape control, 4D intelligent biomaterials will be
promising for oral care in coming future.
Summary
In this paper, the AM and surface modification of dental
implants are briefly reviewed. We describe the applica-
tion of intelligent manufacturing AM in dental plants
and the influence of optimization of AM methods on
material properties. The LIPSS can enhance the anti-
microbial property and biocompatibility of dental im-
plants, and it is a promising substitute to post-process
the dental implants. What is more, we have made
prospects for the application of intelligent materials in
dental plants.
Current Opinion in Biomedical Engineering 2023, 25:100441
Declaration of competing interest
The authors declare that they have no known competing
financial interests or personal relationships that could
have appeared to influence the work reported in this
paper
Data availability
The authors do not have permission to share data.
Acknowledgments
This work was funded by Beijing Natural Science Foundation (L202006).
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