Journal of Dentistry 131 (2023) 104438

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Journal of Dentistry
journal homepage: www.elsevier.com/locate/jdent

CAD-CAM complete denture resins: Effect of relining on the shear

bond strength
Dilvin Mert a, *, Porawit Kamnoedboon a, Nadin Al-Haj Husain b, Mutlu Özcan b,
Murali Srinivasan a
a
Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
b
Division of Dental Biomaterials, Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland

A R T I C L E I N F O A B S T R A C T

Keywords: Objectives: The aim of this study was to compare the shear bond strength of relined CAD-CAM complete
Adhesion removable dental prosthesis (CRDP) resins with conventional heat-polymerized polymethylmethacrylate
Dental materials (PMMA) resin.
Removable complete dentures
Methods: A total of 96 resin specimens in identical dimensions of 10 mm × 10 mm × 11 mm were fabricated for
CAD-CAM
four study groups [#1- Conventional heat-polymerized group: n=24 (ProBase); #2- Milled#1: n=24 (Ivobase);
Residual monomer content
CAD-CAM milling #3- Milled#2: n=24 (Ivotion); #4- 3D-printed: n=24, (NextDent Denture 3D+)]. Twelve specimens in each
3D-printing group were sectioned in the middle to produce a 3 mm defect and then were relined using a conventional denture
Geriatric dentistry relining material. All specimens underwent thermocycling (5-55◦ C) for 10,000 cycles. The shear bond tests were
Prosthetic dentistry carried out in a universal testing machine. One-way ANOVA and Tukey’s test were used for statistical analysis
(p<0.05). The two-parameter Weibull distribution values were calculated.
Results: Relined 3D-printed specimens had a significantly lower shear bond strength when compared with con-
ventional (p=0.0003) and milled groups (Milled#1: p=0.0004; Milled#2: p<0.0001). There were no differences
in the shear bond strengths between the milled and conventional groups. Weibull distribution presented the
highest shape value for the non-relined Milled#1 (22.83) group and the lowest values for the 3D-printed relined
group (4.001).
Conclusion: The findings of this study conclude that the shear bond strength of the conventionally-relined 3D-
printed resins used for fabricating CRDPs was inferior to the shear bond strength of conventionally-relined
resins employed for manufacturing CRDPs using CAD-CAM milling and conventional heat-polymerization
techniques.
Clinical significance: When considering 3D-printing for the fabrication of CRDPs, it is recommended to employ it
in clinical situations where a frequent need for denture relining is not expected.

1. Introduction post polymerization phase, linear deformation of (approx. 0.45 – 0.9%)

The conventional methods for fabrication of complete removable
dental prostheses (CRDPs) still follow the preferred protocols that were
developed almost a century before [1]. The success of conventional
CRDPs predominantly depends on its retention [2]. In order to achieve
good retention, the close adaptation between the denture base and un-
derlying tissues is very important [3]. Even today, the material of choice
to fabricate CRDPs is the heat-polymerized polymethylmethacrylate
(PMMA) as this material has numerous benefits including excellent tis-
sue compatibility [4–6]. However, during the polymerization cycle and
may occur due to polymerization shrinkage [1] and subsequently, the fit
and retention may be affected [1]. This may affect the patient satisfac-
tion and the Oral Health-Related Quality of Life (OHRQoL) [1,7–9].
Over the last three decades, computer aided design and computer
aided-manufacturing (CAD-CAM) techniques have gained considerable
popularity in clinical dentistry and extensively in the dental laboratory
[10,11]. The two principal CAD-CAM techniques employed in the
manufacturing of CRDPs, include subtractive [computerized numeric
control milling (CNC milling)] and additive (3D-printing)
manufacturing techniques [11,12]. CRDPs manufactured using

* Corresponding author.
E-mail address: dilvin.mert@hotmail.com (D. Mert).

https://doi.org/10.1016/j.jdent.2023.104438
Received 12 July 2022; Received in revised form 20 December 2022; Accepted 26 January 2023
Available online 28 January 2023
0300-5712/© 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
D. Mert et al.
CAD-CAM milled manufacturing methods offer better retention [13],
trueness [3], improved mechanical properties [6,14], and eliminate the
complications due to effect polymerization [1] when compared to con-
ventional CRDPs. Furthermore, CAD-CAM (additively and subtractively)
manufactured CRDPs offer numerous patient benefits including reduc-
tion in the number of patient clinical visits, a decrease in the
manufacturing time and costs, and an overall reduction in the treatment
costs for the patient [15]. Although both techniques are successful for
the fabrication of CRDPs, the vast majority are milled [16,17].
In general, when using CRDPS, an important aspect to consider in
edentulous patients is the residual alveolar ridge resorption (RRR)
[17–20]. This hampers the denture retention and its stability over time
[20]. A need for denture relining is warranted to improve the fit of the
CRDP, which has been impaired by the RRR [21]. Denture relining is a
routine procedure performed to improve denture retention and coun-
teract the ill-effect of RRR [19]. In denture relining, the intaglio surface
is renewed with a coat of resin that adapts to the remodelled underlying
tissue [9]. This helps re-establishment of the fit and retention, and
thereby restoring function and subsequently the OHRQoL [16,22,23].
Denture relining is an procedure in CRDP therapy especially when it
comes to immediate dentures, where remodelling is necessary more
frequently in the first-year post-extraction [24]. With conventional
CRDPs, relining may not need to be addressed as an aspect to consider,
as the resins employed in the original CRDPs and for the relining pro-
cedure are similar/identical in most aspects, including their chemical
nature and polymerization procedures. Most importantly, since the
bonding between the CRDP and the relining resin will not be an issue
and similarly the strength as well as the material properties of the
relined CRDPs would not be much affected/different. Bond strength
between the CRDP and the relining material has been frequently
investigated in numerous studies [25–27]. Different relining materials
have been tested with conventional CRDPs and their material properties
as well as bond strengths have been evaluated [20,25–27]. Evidence
suggests that relining is not complicated in the case of conventional
CRDPs and is a routine procedure with successful outcomes [28].
However, information about outcomes with relined CAD-CAM CRDPs is
missing or less abundant in the current literature. There is not much
scientific evidence in current literature that have assessed the outcomes
of relining in CAD-CAM CRDPs with regard to resin compatibility, me-
chanical properties, or bond strength. Whether it is actually possible to
reline 3D-printed CRDPs successfully is questionable [11]. Given the
chemical nature of the milled CRDP resins, it can be assumed that the
conventional relining procedure are possible. However, evidence is
lacking in literature evaluating the bond strength and mechanical
properties of these relined milled CRDPs. This is an important point,
since heavy occlusal forces or accidental damages, faulty design, fabri-
cation and material choice causes the fracture of acrylic maxillary
complete dentures, which is a frequently seen problem in the clinic use
[29,30].
Hence, the aim of this in vitro study was to evaluate the shear bond
strengths of conventionally relined milled and 3D-printed CRDP resin
samples and compare it with conventionally relined conventional heat-
polymerized CRDPs resin samples. Therefore, based on the aim, the
Table 1
Resin groups with their corresponding subgroups along with sample sizes and product information.
Resin groups Subgroups Sample size (n)
Conventional heat-polymerized PMMA resin Not relined 12
Relined 12
CAD/CAM milled (Ivobase) Not relined 12
Relined 12
CAM/CAM milled (Ivotion) Not relined 12
Relined 12
CAM/CAM 3D-printed Not relined 12
Relined 12
n: number; PMMA: polymethylmethacrylate
2
Journal of Dentistry 131 (2023) 104438
primary null hypothesis set for this in vitro experiment was that there
would be no differences in the shear bond strength of conventional heat-
polymerized PMMA and CAD-CAM (milled and 3D-printed) resins after
conventional relining procedures. A secondary hypothesis set for this
study was that there would be no difference in the maximal force
required to de-bond before and after relining.
2. Materials and methods
2.1. Experimental groups
A total of 96 resin specimens were fabricated for this study using
three different manufacturing techniques [#1- Conventional PMMA:
n=24, conventional heat-polymerized PMMA resin (ProBase Hot, Ivo-
clar Vivadent, Schaan, Liechtenstein); #2- Milled Ivobase: n=24 (Ivo-
Base CAD for Zenotec, Wieland Dental, Pforzheim, Germany); #3-
Milled Ivotion: n=24 (Ivotion A2/Pink V Denture Disc, Ivoclar Vivadent,
Schaan, Liechtenstein); #4- 3D-printed group: n=24 (NextDent Denture
3D+, NextDent B.V., Soesterberg, The Netherlands)] as shown in
Table 1. The Ivotion disk is a disk with the tooth shades incorporated
within the base disk based on a data-based shell geometry design and is
composed of a highly cross-linked PMMA tooth coloured material with a
premium denture base material similar to the Ivobase CAD. All resin
specimens were manufactured with the same dimensional specifications
(10 mm x 10 mm x 11 mm). Each resin group had a subgroup (n=12)
which served as a control group which did not undergo relining. The
manufactured specimens were checked for defects or other problems in
quality.
2.2. Sample size
The sample size for the current bench-study was calculated using the
significant results from a previously published study with similar
outcome parameters [31]. The effect size (d = 1.7141) was calculated
from this study and based on the calculated effect size, to achieve a
power of 95%, the required sample size was calculated as 10 samples per
group [d = 1.7141, ⍺ err prob = 0.05; Power (1-β err prob) = 0.95;
Two-tailed T-tests; Critical t = 2.1009; Sample size per group=10; Total
Sample size = 20; Actual power = 0.9517]. For the rapid-prototyping
groups the significant results were used from the same
above-mentioned previous study [31]. An effect size d=6.2830 was
calculated and for a power of 95%, the required sample size per group
was calculated as 3 per group [d = 6.2830, ⍺ err prob=0.05; Power
(1-βerr prob) =0.95; Two-tailed T-tests; Critical t = 2.7764; Sample size
per group=3; Total sample size=6; Actual power=0.9997]. A 20%
damage and sample loss were estimated and therefore the final sample
size fixed for the groups were calculated to be 12 per milled and con-
ventional groups. It was also decided in consensus that the sample size
for the 3D-printed group will also be 12 instead of 6. Therefore, a total of
96 specimens were made, with 24 in each study group and within each
group 12 specimens were to be used as control (non-relined). The sample
size calculation was done using a freeware (G*power, version 3.1.96,
Dusseldorf, Germany) [32].
Product (manufacturer)
ProBase Hot (Ivoclar Vivadent, Schaan, Liechtenstein)
IvoBase CAD for Zenotec (Wieland Dental, Pforzheim, Germany)
Ivotion A2/Pink V Denture Disc (Ivoclar Vivadent, Schaan, Liechtenstein)
NextDent Denture 3D+ (NextDent B.V., Soesterberg, The Netherlands)
D. Mert et al.
2.3. Relining procedures, thermocycling, and storage of specimens
The specimens were manually sliced approximately in the centre in
order to create a defect of 3 mm, resulting in two approximate halves of
4 mm. The sliced specimens were relined conventionally in the labora-
tory using a conventional relining PMMA resin (ProBase Cold, Ivoclar
Vivadent, Schaan, Liechtenstein). The relining was performed according
to the manufacturer’s instructions, which included coating of the resin
surface with the corresponding monomer of the reliner (ProBase Cold
Fig. 1. Shear bond strength (MPa) of the specimen groups after relining.
3
Journal of Dentistry 131 (2023) 104438
Monomer, Ivoclar Vivadent, Schaan, Liechtenstein). All relined speci-
mens underwent a quality check and were finished and polished by a
single investigator (D. M.) before undergoing thermocycling.
All specimens (relined and non-relined) underwent thermocycling
for 10’000 cycles in distilled water in order to imitate an approximate
clinical use of one year. The thermocycling temperature was set between
5◦ C and 55◦ C. After thermocycling, the specimens were stored in 37-
39◦ C prior to testing.
D. Mert et al. Journal of Dentistry 131 (2023) 104438

Table 2 Maximum likelihood estimation without a correction factor was used for
Resin groups and their shear bond strength with the intergroup comparisons. 2-parameter Weibull distribution, including the Weibull modulus, scale
Groups Shear bond strength (m) and shape (0), to interpret the shear bond values (Minitab Software
(mean ± SD) V.16, State College, PA, USA).
1 - conventional heat-polymerized 36.680 ± 7.306
2 - CAD/CAM milled Ivobase 36.575 ± 5.030 3. Results
3 - CAD/CAM milled Ivotion 40.315 ± 6.512
4 - CAD/CAM 3D-printed 25.897 ± 6.758 Shapiro-Wilk’s test confirmed a normal distribution of the data
P-Value (ANOVA) < 0.001
(shear bond strength: p=0.486; Tmax: p=0.568). ANOVA models
Inter-group comparisons P-value (Tukey’s test) revealed that the relined 3D-printed specimens had a significantly lower
conventional heat-polymerized vs: shear bond strength when compared with the conventional (p=0.0003)
CAD-CAM milled Ivobase 1.000 and the milled groups (vs Milled-Ivobase: p=0.0004; vs Milled-Ivotion:
CAD-CAM milled Ivotion 0.770
p<0.0001) (Fig. 1, Table 2). There were no differences in the shear bond
CAD-CAM 3D-printed
strength between the milled and the conventional groups.
<0.001
CAD-CAM milled Ivobase vs:
CAD-CAM milled Ivotion 0.744 All the experimental groups demonstrated a significantly lower
CAD-CAM 3D-printed <0.001 maximum load for debonding after relining (p<0.001; Table 3, Fig. 2).
CAD-CAM milled Ivotion vs: Intra-group analysis revealed that the Milled-Ivobase group had the
CAD-CAM 3D-printed
lowest difference for the maximum fracture load between its control and
<0.001
SD: standard deviation; CAD-CAM: computer aided designing and computer aided
manufacturing relined specimen (Table 3, Fig. 2). Weibull distribution presented the
highest shape value for the non-relined Milled#1 (Ivobase; 22.83) and
the lowest values for the 3D-printed relined group (4.001) (Fig. 3).
The fracture mode analysis revealed that all specimens from all study
2.4. Shear bond strength testing
groups demonstrated a category IV (100%) failure as shown in Table 4
(Fig. 4a-d).
The shear bond tests were carried out using a Universal Testing
Machine (Z010, ZwickRoell, Ulm, Germany), where the specimen was
4. Discussion
mounted in a metal holder. A metal blade was positioned parallel to the
material interface to apply a progressing compressive load at a cross-
In this study, the shear bond strength of conventional heat-poly-
head speed of 1.0 mm/min until debonding. The testing was carried out
merized, CAD-CAM milled and CAD-CAM 3D-printed resins were
in room temperature conditions (23.0 ± 2.0◦ C). The shear bond strength
examined with and without relining. The primary null hypothesis set for
(S) was calculated using the formula, = AT , where ‘T’ is the maximum this in vitro experiment was that there would be no differences in the
tension applied to debond the specimen and ‘A’ is the surface area of shear bond strength of conventional heat-polymerized PMMA and CAD-
adhesion. CAM (milled and 3D-printed) resins after conventional relining pro-
cedures. The results indicated no differences in terms of the shear bond
2.5. Failure modes evaluation strength between the relined conventional heat-polymerized resins and
the relined CAD-CAM milled resins, also when not relined in terms of the
The failure modes were classified into four groups after evaluation maximum fracture load. The relined printed resins showed significantly
the types of failures: lower values than the relined conventional heat-polymerized resins and
the relined CAD-CAM milled resins, therefore the null hypothesis is
1 Cohesive failure in the relined zone: failure appeared totally in the partially rejected.
relining material These results relating to the conventional heat-polymerized denture
2 Cohesive failure in non-relined zone: failure located entirely on the resins and the CAM/CAM milled denture resins stay in partially contrast
non-relined surface to the results of a recently published study from Taghva et al. (2022)
3 Adhesive failure: failure at the interface (no trace of reline material [33]. In that study two different relining materials were used, namely
on the specimen) heat-polymerized reline and auto-polymerized reline resins, to reline
4 Mixed failure: a combination of all of the above CAD-CAM and conventional heat-polymerized acrylic resin denture
bases [33]. In terms of shear bond strength, when relined with heat--
2.6. Statistical analysis polymerized resins, there was no statistically significant difference
similar to this study. However, when relined with a self-curing resin, the
Means and standard deviations were calculated for the data collected shear bond strength values were significant higher for the milled resins.
and were verified for a normal distribution using the Shapiro-Wilk’s test Moreover, in comparison of the relining material, the heat-polymerized
for normality. resins showed significantly better results than the self-cured reline resins
One-way ANOVA model was applied for comparing the differences [33]. The partially different outcome may be due to the use of different
between the study groups with the level of significance set to α=0.05. relining materials and to the different pre-treatment with sandblasting
Post hoc Tukey’s HSD test was used for evaluating the intra-group dif- [33]. It has been shown in this study that the shear bond strength of
ferences. All statistical analyses were performed using the SPSS® soft- CAD-CAM milled resins had no significant differences than the
ware package (version 28.0.1 IBM® Corporation, Armonk, NY, USA).

Table 3
Differences in the TMax (N) for each resin group against their non-relined controls (p-value: Tukey’s HSD test).
Specimen groups Conventional heat-polymerized CAD-CAM milled Ivobase CAD-CAM milled Ivotion CAD-CAM 3D-printed
(mean ± SD) (mean ± SD) (mean ± SD) (mean ± SD)

Control 4263.488 ± 742.700 4182.478 ± 195.364 5135.572 ± 377.721 3440.070 ± 362.451

Relined 3128.598 ± 626.523 3409.598 ± 480.758 3714.292 ± 589.370 2363.926 ± 632.721
P-value 0.013 <0.001 <0.001 <0.001
SD: standard deviation

4
D. Mert et al.
Fig. 2. Intra-group analysis showing the differences in the maximum tensile load (TMax) required for fracturing the non-relined and relined specimens.
conventional heat-polymerized resins. Noting other mechanical out-
comes, as seen in the study from Prpić et al. (2020), the CAD-CAM
materials showed generally better mechanical outcomes in terms of
flexural strength and surface hardness than heat-polymerized and
3D-printed acrylic resins [14].
Furthermore, comparisons in terms of shear bond strength for relined
3D-printed denture resins and relined heat-polymerized denture resins
made by Cho et al. (2021) revealed similar outcomes as in this study
[34]. They used a few different relining materials, and the results for the
shear bond strength with all relining materials were significantly lower
in the 3D-printed group compared to the relined heat-polymerized resin
group [34]. An important aspect to be considered is that the resin used
for 3D-printing in this study is primarily composed of bisphenol-A
dimethacrylate and therefore the conventional cross-linking of methyl
methacrylate that occurs between PMMA interfaces may not be occur-
ring in this group. This is an important factor that might have affected
the low shear bond strength. Nevertheless, this point was known even
before the start of the experiment and still no extra measures were taken
to improve the bonding because in real life, when a denture needs to be
relined or repaired, the information on the resin type is not always
known. Situations may arise that the dentist/laboratory which originally
manufactured the CRDP may not be the ones who might reline or repair
the CRDP because the patient has migrated or is unable to access his/her
original dental professional. Therefore, it is important to understand the
5
Journal of Dentistry 131 (2023) 104438
reline capabilities when such a situation arises. More so, it is now
evident that in a clinical context it is important to deliver the informa-
tion about the resin employed for fabrication along with the denture
itself, so that the patient can convey this information to the treating
dentist or the laboratory for any required emergency repair or relines.
The results of this current study indicate that 3D-printed samples
demonstrated the lowest shear bond strength, and also the lowest flex-
ural strength values, as observed in previously published studies [35].
There are a lot of surface treatments for relining the resins [17,29,
36]. The surface treatment in this current study was applying monomer
on the specimens before relining was done. Relining the denture base
with soft liners shows that a pre-treatment with a monomer improved
the bonding between the denture base and the liner [36]. It is also
known that the surface treatment with methyl formate-methyl acetate
on heat-polymerized acrylic resin denture base improved the shear bond
strength [37]. The same surface treatment could be applied on the
milled and 3D-printed resins and tested on shear bond strength again
with the same conditions. Much more pre-treatments, such as laser
treatment, oxygen plasma pre-treatment, and immersion in acetone or
IBMA resulted in improved bonding when relining the denture base
resins with soft liners [36]. And also regardless of the material, the shear
bond strength was increased after sandblasting [38].
Thermocycling is also something to consider which may affect the
shear bond strength. Denture prostheses are exposed to various thermal
D. Mert et al.
Fig. 3. Two-parameter Weibull modulus distribution for all groups tested.
Table 4
Failure analysis of the resin samples.
Groups (n) Category I Category II
conventional heat-polymerized (12) 0 0
CAD/CAM milled Ivobase (12) 0 0
CAD/CAM milled Ivotion (12) 0 0
CAD/CAM 3D-printed (12) 0 0
n: number; Category I: cohesive failure in the relined zone; Category II: cohesive failure in the non-relined zone; Category III: adhesive failure; Category IV: mixed
situations in the oral cavity due to the intake of cold and hot drinks and
food. In a wet environment, thermal cycling causes a degradation of the
denture polymers, and the water sorption may be raised because of the
extension of the distance between the polymer chains due to heat stress
[39]. The water absorption is thus directly related with the dimensional
stability of the dental material [40]. Absorbed water can reduce the
mechanical properties of the denture, because it can act as a plasticizer,
soften the denture, and enhance the elasticity [33,39,40]. This results in
decreasing the bond strength [33]. Otherwise, further polymerization
reactions can be enhanced due to heating the acrylic resins which im-
proves the mechanical properties [39]. So, it can be assumed that the
thermal cycling has an effect on the mechanical properties of the acrylic
resins, which may influence the performance of the relined removable
prostheses [39]. Studies with soft reliners show that thermocycling can
improve or impair the shear bond strength, but it mostly resulted in a
significant reduction of the shear bond strength [36,41,42].
The chemical composition of the different resins used may have an
impact on thermocycling. However, the CAD-CAM milled PMMA-based
denture resins show lower porosities and voids and have a stronger cross
linkage between polymer chains. This reduces water absorption [33]. A
Journal of Dentistry 131 (2023) 104438
Category III Category IV
0 12
0 12
0 12
0 12
previous published study showed that thermocycling lowered the
microhardness of three different CAD-CAM denture base materials [43],
which led to a reduced shear bond strength. However, this effect may
have occurred in the 3D-printed resin group, as its chemical composition
is different from the CAD-CAM milled and the conventional PMMA resin
groups. Furthermore, different thermal expansion coefficients (CTE) of
materials, as the possible differences in CTE between the denture base
resin and the reline material, lead to different degrees of shrinkage and
expansion. This results in a cyclic stress at the interface and enhances the
fatigue of bond during thermocycling [33,44].
A limitation of this study was that no special pre-treatment or
bonding procedures were applied to the 3D-resin group samples.
Therefore, this could have affected the shear bond strength of the
samples from this group, since the chemical composition is different
from that of the CAD-CAM milled PMMA and the conventional PMMA. It
is therefore evident that conventional relining procedures should not be
employed for relining/repairing 3D-printed dentures, unless employed
with special surface pre-treatment of the resins or with a special bonding
technique that will enhance the bonding of the 3D-printed resin with
conventional relining/repairing resins. This aspect was not tested in the
6
D. Mert et al.
Fig. 4. Typical category IV fracture observed in the various specimens, a: conventional heat-polymerized PMMA group; b: CAD-CAM milled Ivobase group; c: CAD-
CAM milled Ivotion group; d: 3D-printed group.
current study as it was beyond the scope of this study. It is recommended
that this factor should be addressed in a future purpose-built study with
this aim as a primary objective.
5. Conclusions
The findings of this study conclude that the shear bond strength of
the conventionally-relined 3D-printed resins used for fabricating CRDPs
was inferior to those of conventionally-relined resins employed for
manufacturing CRDPs using CAD-CAM milling and conventional heat-
polymerization techniques. This finding was also supported by the
Weibull distribution presented by the highest shape value for the milled
group. This study provides important information to the clinician in the
decision-making process of selecting the appropriate CAD-CAM method
for fabricating CRDPs. 3D-printing for the fabrication of CRDPs can only
be recommended in clinical situations where a frequent need for denture
relining is not expected.
Source of funding
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
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Journal of Dentistry 131 (2023) 104438
CRediT authorship contribution statement
Dilvin Mert: Methodology, Validation, Formal analysis, Data cura-
tion, Writing – original draft, Writing – review & editing, Visualization,
Project administration. Porawit Kamnoedboon: Validation, Formal
analysis, Writing – review & editing. Nadin Al-Haj Husain: Validation,
Formal analysis, Writing – review & editing. Mutlu Özcan: Methodol-
ogy, Validation, Formal analysis, Data curation, Writing – original draft,
Writing – review & editing, Visualization, Supervision, Project admin-
istration, Resources. Murali Srinivasan: Conceptualization, Methodol-
ogy, Validation, Formal analysis, Data curation, Writing – original draft,
Writing – review & editing, Visualization, Supervision, Project admin-
istration, Resources.
Declaration of Competing Interest
The authors did not have any commercial interest in any of the
materials used in this study.
Acknowledgments
The authors would like to acknowledge and thank Mrs. Ilona Sadiku
(DT), Clinical of General-, Special Care and Geriatric Dentistry, Center of
Dental Medicine, University of Zurich, for manufacturing the conven-
tional heat-polymerized resin samples. The authors also would like to
D. Mert et al.
thank Mr. Kiren Jan Mätzener, dental technician, Center of Dental
Medicine, University of Zurich, for his help with manufacturing the
CAD-CAM samples. Further thanks are due to Mr. Christian Lüscher
(Technician) from technical services, for his help with the
manufacturing of the samples and Mr. Marcus Zimmermann, laboratory
technician, Center of Dental Medicine, University of Zurich, for his help
with the Universal Testing Machine.
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