d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) 336–350

Available online at www.sciencedirect.com

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journal homepage: www.intl.elsevierhealth.com/journals/dema

3D printing restorative materials using a

stereolithographic technique: a systematic review

Alvaro Della Bona a,∗ , Viviane Cantelli a , Vitor T Britto a , Kaue F Collares a ,
Jeffrey W Stansbury b
a Postgraduate Program in Dentistry, Dental School, University of Passo Fundo, Campus I, BR285, Passo Fundo, RS,
99052-900, Brazil
b Department of Craniofacial Biology, School of Dental Medicine, University of Colorado Anschutz Medical Campus,

Aurora, CO, USA

a r t i c l e i n f o a b s t r a c t

Keywords: Objective. To present through a systematic review a qualitative analysis of studies pub-
3D printing lished on stereolithography-based 3D printing of restorative materials and their clinical
Dentistry applicability.
Dental materials Methods. The literature search was conducted based on the question: “What is the state-of-
the-art of available restorative materials for 3D printing based on stereolithography?Önline
search was conducted in three databases (MEDLINE/PubMed, Scopus and Web of Science)
with no restriction for year of publication. Data are reported based on PRISMA, including
publication details such as authors and their countries, year and journal of publication, and
study design. The synthesis is focused on describing the dental restorative materials and
properties evaluated, applied methods, 3D printers used and clinical applicability.
Results. Studies that fit the inclusion criteria were performed in Asia (21), Europe (16)
and USA (10), mostly using polymer-based restorative materials (38) for 3D printing con-
structs. Stereolithographic-printed ceramic-based restorative structures were evaluated by
9 studies. Many studies reported on dimensional accuracy (14), strength (11) and surface
morphology (9) of the printed structures. Antibacterial response, cytotoxicity, internal and
marginal fit, fracture and wear resistance, density, viscosity, elastic modulus, hardness,
structural shrinkage and reliability, degree of conversion, layer cure depth, fatigue, and color
were also evaluated by the included studies. Many of them (11) published a proof of con-
cept as an attempt to demonstrate the clinical feasibility and applicability of the technology
to print restorative materials, but only 5 studies actually applied the 3D printed restora-
tive structures in patients, which highlights an increasing interest but limited early-stage
translation.
Significance. The fast expansion of stereolithographic-based 3D printing has been impressive
and represents a great technological progress with significant disruptive potential. Dentistry
has demonstrated an incredible willingness to adapt materials, methods and workflows
to this promising digital technology. However, esthetic appearance, wear resistance, wet
strength and dimensional accuracy are the main current clinical limitations restricting the

∗
Corresponding author.
E-mail address: dbona@upf.br (A. Della Bona).
https://doi.org/10.1016/j.dental.2020.11.030
0109-5641/© 2020 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.
 d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) 336–350 337

progression to functional part production with 3D printing, which may explain the absence
of clinical trials and reports on permanent/definitive dental restorative materials and struc-
tures.
© 2020 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
2. Materials and methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .337
2.1. Protocol and registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
2.2. Eligibility criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
2.3. Information sources and search strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
2.4. Selection of sources of evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
2.5. Data charting process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
2.6. Synthesis of results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348

rials, there are still problems in both these areas that limit
1. Introduction 3D printing from advancing and reaching the full potential of
what can be done in dentistry and more broadly in the printing
Computer-aided design (CAD) and computer-aided manufac- of fully functional parts as opposed to temporary restorations,
turing (CAM) technologies have led to major improvements in models and prototypes [10,15,16]. Nevertheless, the rapid and
dentistry [1]. CAD-CAM subtractive methods produce reliable dynamic progress of recent digital manufacturing technolo-
restorations with accurate dimensions, reducing manufactur- gies is a global sprint becoming an additional challenge to
ing time and labor compared to other fabrication techniques follow up its state of the art [17]. A systematic review is a
[2–8]. However, subtractive manufacturing wastes unpro- way to map and present the existing literature on a topic
cessed material and milling tools, and generates surface and using rigorous and transparent methods to broadly identify,
sub-surface machining defects that are structural stress con- select and critically appraise relevant literature pertaining to a
centrators [9]. With the advances in computer-aided design research question [18–20]. Therefore, this comprehensive nar-
(CAD) technology, additive manufacturing (AM), rapid proto- rative work based on a systematic review aimed to present a
typing or simply 3D-printing, is emerging in Dentistry as a qualitative analysis of studies published on stereolithography-
promising technique to fabricate dental restorative and other based 3D printing of restorative materials and their clinical
appliance structures. Complex structures can be produced applicability.
with 3D printing, which does not waste material in the process
and it is more economical than subtractive manufacturing
techniques in terms of hardware investment and overall pro- 2. Materials and methods
duction costs [1,10]. Among the various AM techniques [11],
stereolithography (SL) is the most popular for dental appli- This review was conducted based on the following question:
cations, offering the greatest accuracy and resolution, fine “What is the state-of-the-art of available restorative materials
building details and smooth surface finish [1,12,13]. In the SL for 3D printing based on stereolithography?"
technique an object is built through deposition of consecutive
layers of photosensitive material that is readily polymerized. 2.1. Protocol and registration
The thickness and orientation of the printed layer, and the
depth and degree of polymerization along with any post-cure The protocol of this review was based on PRISMA-P for sys-
process are some of the factors influencing the mechanical tematic review protocols [21] and is available at the following
and physical properties of the printed structure [14]. link: DOI 10.17605/OSF.IO/9W4M2.
While stereolithography-based 3D printing (e.g. SLA- stere-
olithography apparatus, DLP- digital light processing, and 2.2. Eligibility criteria
LCM- lithography-based ceramic manufacturing) is widely rec-
ognized as producing to date the best spatial resolution and The present review included published studies in English lan-
most isotropic mechanical properties among printable mate- guage that used stereolithography-based 3D printers to print
338 d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) 336–350
materials for use or potential use for restorative dentistry. In
contrast, studies on materials and structures not applied to
restorative dentistry, literature reviews, manufacturer reports,
comments and conference abstracts were excluded from this
review.
2.3. Information sources and search strategy
Electronic search was conducted in three different databases
(MEDLINE/PubMed, Scopus and Web of Science) with no
restriction for year of publication, and the last search was per-
formed on June 12th 2020. The search strategy was outlined
based on PubMed MeSH terms and adapted for each database.
-MEDLINE/PubMed: D̈entistry, Operative¨[Mesh] OR
Öperative Dentistry¨[title/abstract] OR D̈ental Materi-
als¨[Mesh] OR M̈aterials, DentalÖR D̈ental MaterialÖR
M̈aterial, DentalÖR B̈iomedical and Dental Materials¨[Mesh]
OR P̈rosthodontics¨[Mesh] or D̈entistry, ProstheticÖR P̈rosthetic
DentistryÖR D̈entistry¨[Mesh] AND ((3D print* [title/abstract])
OR (additive manufact* [title/abstract]) OR “RP Technolo-
gies” [title/abstract] OR “Rapid Prototyping” [title/abstract]
OR “rapidly prototyped” [title/abstract] OR “3D digital den-
tistry” [title/abstract] OR “three-dimensional printing”
[title/abstract] OR “stereolithographic” [title/abstract] OR
“stereolithographically printed” [title/abstract])
2.4. Selection of sources of evidence
The search was initially conducted using Mendeley program.
Two researchers (V.C. and V.T.B) independently identified arti-
cles analyzing titles and abstracts for relevance and presence
of eligibility criteria. Retrieved records were classified as
“include”, “exclude”, or “uncertain”. The full-text articles of
the “include” and “uncertain” records were selected for further
eligibility screening by the same researchers (acting inde-
pendently). Discrepancies in screening of titles/abstracts and
full-text articles were resolved through discussion. In case
of disagreement, the opinion of a third reviewer (A.D.B.) was
obtained. In case of missing information or data, the corre-
sponding author from such papers was contacted up to three
times by e-mail.
2.5. Data charting process
The articles meeting the inclusion criteria were subjected to
critical appraisal, which was carried out by two reviewers (V.C.
and V.T.B) independently. Standardized data extraction form
was created on Excel software (Microsoft Corporation, Red-
mond, WA, EUA) to collect the following data:
- Publication details: authors, Country where the work was
executed (based on the Institution location of the corre-
sponding author), year and journal of publication.
- Study characteristics: in-vitro studies and clinical studies.
- Materials characteristics: polymers, metals and ceramics.
- Methods characteristics: evaluated parameters, properties
and concepts, and 3D printers used.
- Clinical applicability: clinical evaluation of the printed
structures.
2.6. Synthesis of results
This study focused on describing the dental restorative
materials evaluated, applied methods and 3D printers
used. A descriptive analysis was performed considering the
study design, the characteristics of materials, methods and
stereolithography-based 3D printing devices, which were pre-
sented in Figures and Table.
3. Results
Fig. 1 presents the flow chart for the study selection. The
search initially yielded 3876 potentially relevant citations
(PubMed: n = 2630; Scopus: n = 623; Web of Science: n = 623).
After removing duplicates (764) and irrelevant articles (3035)
that did not meet the inclusion criteria, 77 citations met the
eligibility criteria based on title and abstract. These papers
were obtained and full-text screened, resulting in 47 studies
that were included in the analysis (qualitative synthesis).
The first study on stereolithography-based 3D printing of
restorative materials was published in 2015. Such recent devel-
opment gained increasing interest with four publications in
2016, six in 2017, twelve in 2018, twelve in 2019, and twelve
publications on the subject up to the search date (June 12th)
in 2020. The majority of the studies (37) were published in den-
tal journals, mostly in the Journal of Prosthetic Dentistry (13)
and in Dental Materials (6). Eight papers were published in
materials science and engineering journals and two articles
were published by medical journals. Most studies (21) were
performed in Asia, mostly from South Korea (11), but also
from China (7), Turkey (2) and India (1). Sixteen studies were
performed in Europe with four studies from the Netherlands,
three studies each from Switzerland and Germany, two from
Bulgaria, and one study from each of the following countries:
France, Austria, Romania and Spain. Ten studies were per-
formed in the USA (Fig. 2).
From the 47 studies included in this review, 9 printed
ceramic structures, 38 printed polymer-based constructs and
one of them also printed the metallic cusps of the 3D-
printed set of teeth [22] (Fig. 2). The majority of them
(36) 3D printed dental restorative structures and eleven
printed test specimens from restorative materials. Most of
the restorative structures (28 out of 36) were printed out of
polymer-based materials, resulting in removable prosthesis-
related constructs [22–34], provisional restorations [35–47], or
inlays [48,49]. Nine studies printed ceramic-based restorative
structures and they were zirconia-based constructs [50–56],
glass-ceramic crowns [57] or alumina-based crowns [16]. Yet,
only 5 studies (gray-shaded in Table 1) included in this
review actually applied the 3D printed restorative structures
in patients, reporting the clinical cases [29,33,34,36,41].
Regarding the materials parameters and proper-
ties evaluated, a great number of studies reported on
dimensional accuracy [30,31,35,38,40,48–50,53,57–61],
strength [16,26,43,50,52,55,59–63] and surface morphology
[25,26,31,40,48,49,51,60,64]. In addition, antibacterial effect
[25,26,43,60,64], cytotoxicity [26,43,64], internal and marginal
fit [37,39,45,46,52], fracture resistance [27,44,47,54–56], wear
resistance [32,65,66], elastic modulus [52,58,59,61], density
 d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) 336–350 339

Fig. 1 – PRISMA flow diagram showing the flow of information through the different phases of the present systematic
review.

Fig. 2 – Chart showing the Country where the work was executed and materials used for the included studies on
stereolithography-based 3D printing of restorative materials.
340
Table 1 – Studies in chronological and alphabetical order, reporting 3D printing of restorative materials using a
stereolithography-based (SL) printer. Gray shaded studies clinically applied the printed structure(s).
Study
Bilgin et al., 2015 [23]
Alharbi et al., 2016 [62]
Alharbi et al., 2016 [35]
Digholkar et al., 2016 [63]
Joo et al., 2016 [36]
Bae et al., 2017 [48]
Dehurtevent et al., 2017 [16]
Lee et al., 2017 [37]
d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) 336–350
Objective
To fabricate dentures
using CAD-CAM and RP,
combining with
conventional laboratory
techniques.
To evaluate the effect of
build direction (layer
orientation) on the
mechanical properties
of a novel restorative
material.
To evaluate the
influence of build
(support) angle and
configuration on
dimensional accuracy of
3D-printed crowns.
To evaluate and
compare properties of
provisional restorative
materials fabricated by
RP, CAD-CAM, and
conventional methods.
To perform a complete
mouth rehabilitation
using 3D printing and
CAD/CAM
double-scanning
method.
To evaluate the accuracy
of inlay restorations
fabricated by AM
comparing to
subtractive methods.
To compare material’s
properties of
SL-manufactured
alumina ceramics of
different composition to
those of subtractive-
manufactured ceramics
and to produce dental
crown frameworks.
To evaluate the internal
and marginal fit of
provisional crowns
manufactured by
CAD/CAM milling and
3D printing methods.
SL material,
printed structure
(N; NS; n); 3D
printer
Light-cured resin
(E-Dent 100;
EnvisionTEC) denture
teeth set (n = 1);
Perfactory® 4 DDP Mini
(EnvisionTEC)
Hybrid composite resin
(Temporis, DWS)
cylinders (NS = 40; n =
20); DW028D 3D-printer
(DWS)
Hybrid composite resin
(Temporis DD-1000,
DWS) dental crowns (NS
= 18; n = 1); DW028D
3D-printer (DWS)
Light-cured resin
(E-Dent 100, Envision
TEC) bar-shaped
specimens (N = 60; NS =
20; n = 20); Perfactory® 4
Standard (EnvisionTEC)
Light-cured resin
(E-Dent, Envision TEC)
provisional crowns (NS
= 17; n = 1); DDP
(EnvisionTEC)
Polymer (VisiJet FTX
Green, 3D Systems)
distal-occlusal inlays (N
= 40; NS = 10; n = 10);
ProJet 1200 (3D Systems)
Experimental alumina
slurries for testing bars
(NS = 90; n = 15) and
crown framework (n =
1); CryoCeram
(CryoBeryl)
Polymer (ZMD-1000B,
Dentis) provisional
crowns (N = 30; NS = 10;
n = 10); Zenith (Dentis)
Evaluated Main conclusion
parameter(s)
Feasibility and Denture teeth sets
applicability of a fabricated by CAD/CAM
technology (proof of and RP can be
concept) accomplished with
reduced chair time,
self-designed esthetics
and occlusion.
Printing layer Composite material
orientation and printed with the layers
compressive strength oriented perpendicular
to load direction have
greater compressive
strength than material
printed horizontally.
Dimensional accuracy (9 The 120◦ build angle
build angles and 2 should offer the crown
support types) the highest dimensional
accuracy and
self-supported
geometry with the least
necessary support
surface area.
Flexural strength and All materials showed
microhardness flexural strength higher
than minimal
acceptable for
provisional restorations.
RP specimens showed
the highest hardness
values.
Feasibility and 3D printed resin-based
applicability of a provisional crowns
technology (proof of showed adequate fitting
concept) and fractures during
interim service.
Dimensional accuracy The accuracy of inlays
and surface morphology fabricated by AM is
higher than that of
subtractive methods.
Viscosity, density, Viscosity of the alumina
flexural strength, slurry influenced the
structural shrinkage, SL-manufacturing
and Weibull structural process. High particle
reliability size (d50≈ 1.6 ␮m) and
volume fraction (80
wt%) resulted in reliable
anisotropic shrinkage,
high density, flexural
strength, and Weibull
characteristics suitable
for SL manufacturing.
Internal and marginal fit SL-manufactured
crowns showed similar
or better marginal and
internal fit than
CAD-CAM milled
crowns.
 d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) 336–350
– Table 1 (Continued)
Study Objective
Lin et al., 2017 [24] To duplicate a complete
removable dental
prosthesis (CRDP) using
SL technology.
Osman et al., 2017 [38] To evaluate the effect of
the build
orientation/build angle
on the dimensional
accuracy of
full-coverage dental
restorations
manufactured by DLP.
Totu et al., 2017 [25] To obtain a PMMA-TiO2
material with improved
antibacterial
characteristics, suitable
for manufacturing 3D
printed dental
prosthesis.
Alharbi et al., 2018 [39] To evaluate the
influence of fabrication
method (CAD-CAM and
SL) and four finish line
design on marginal and
internal fit of
provisional crowns.
Bae et al., 2018 [49] To compare subtractive
(CAD-CAM) and additive
(SL) manufacturing
methods to investigate
if the CAD data of the
proposed inlay shape is
correctly machined.
Chen et al., 2018 [64] To synthesized a
bioactive
nanocomposite for
enhanced antibacterial
and biocompatibility
characteristics suitable
for 3D printing dental
prosthesis.
Chen et al., 2018 [26] To develop a composite
of nanocrystalline
cellulose-silver
(CNCs-Ag) introduced
into the PMMA matrix
with enhanced
mechanical properties,
high antibacterial
activities and excellent
biocompatibilities.
SL material,
printed structure
(N; NS; n); 3D
printer
Polymer (Standard Clear
Resin, Formlabs) CRDP
(n = 1); Form 2
(Formlabs)
Resin (Next Dent C&B)
provisional crowns (NS
= 9; n = 1); D30 (Rapid
Shape GmbH)
Resin (E-Dent 100,
Envision TEC) + TiO2
nanoparticles
specimens (NI) and
denture (n = 1);
Perfactory®
(EnvisionTEC)
Hybrid composite resin
(Temporis A2, DWS)
crowns (N = 80; NS = 40;
n = 10); DW028D
3D-printer (DWS)
Polymer (VisiJet FTX
Green, 3D Systems)
mesial-occlusal inlays
(N = 40; NS = 10; n = 10);
ProJet 1200 (3D Systems)
Experimental
PMMA-based
nanocomposite (n = 1).
Printer not mentioned.
PMMA-CNCs-Ag
composite resin
(NextDent Denture 3+)
for bar-shaped
specimens (n = 6) and
denture base (n = 1); DLP
Vida (Envision Tech)
341
Evaluated Main conclusion
parameter(s)
Proof of concept It is feasible to duplicate
a CRDP using SL
technology.
Dimensional accuracy (9 The angle of 135◦
build angles) offered the highest
dimensional accuracy
and the most favorable
deviation pattern, with
a self-supporting crown
geometry throughout
the building process.
Microstructure and Significant
surface morphology, improvements in
antibacterial effect; polymer characteristics
proof of concept and nice dispersion of
the TiO2 nanoparticles
were noticed for 0.4
wt%, which was used
for stereolitographic
complete denture
prototyping.
Marginal and internal fit The fabrication
methods influenced
more on the fit than the
finish-line design.
SL-printed crowns
showed lower marginal
and internal gap than
milled restorations, but
both techniques showed
adequate values.
Dimensional accuracy SL showed the best
and surface morphology accuracy but both
additive and subtractive
methods can be used
clinically
Surface morphology, The nanocomposite
antibacterial efficacy, showed excellent
cytocompatibility antibacterial efficacy
and favorable
compatibility with
dental pulp cells, being
efficaciously employed
for denture
manufacturing using SL.
Flexural strength, The composite showed
Surface morphology, high antibacterial
antibacterial efficacy, activity with no
cytotoxicity significant cytotoxic
effect. It showed great
potential and it is
recommended as a
functional dental
restoration material.
342 d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) 336–350
– Table 1 (Continued)
Study Objective
Chung et al., 2018 [27] To evaluate chipping
and fracture resistance
of 3D printing resin
material compared with
resin denture teeth.
Dikova et al., 2018 [40] To compare the
dimensional accuracy
and surface roughness
of polymeric dental
bridges produced by
different 3D printers.
Katreva et al., 2018 [41] A case report to
demonstrate that 3D
printing is a precise
alternative to fabricate
dental restorations.
Li et al., 2018 [42] To use a SL-based
technology to 3D print
provisional dental
crown and bridge
Lin et al., 2018 [28] To propose a digital
workflow for fabricating
a mandibular interim
complete removable
dental prosthesis
(CRDP) with an in-office
DLP 3D printer.
Park et al., 2018 [66] To evaluate the wear
resistance of 3D
printing resin material
compared with milling
and conventional resin
materials.
Tahayeri et al., 2018 [58] To optimize the 3D
printing of a dental
material for provisional
restorations using a
low-cost SL 3D printer,
and compare its
mechanical properties
against two
conventionally cured
provisional dental
materials.
SL material,
printed structure
(N; NS; n); 3D
printer
Methacrylate-based
resin (Dentca) denture
teeth (N = 50; NS = 10; n
= 10); Zenith (Dentis)
Methacrylate-based
resins (NextDent C + B
and Formlabs) 4-unit
dental bridges (N = 9; NS
= 6; n = 3); Form 1+
(Formlabs) and D30
(Rapid Shape GmbH)
Resin (Next Dent C&B)
provisional crown (n =
1); D30 (Rapid Shape
GmbH)
Commercially available
high viscosity polymers
(Unifast LC; Revotek LC;
and Ervotek LC) for
temporary restorations
(NS = 3; n = 1); custom
made 3D printer
Soft-tissue colored
(NextDent Base) and
A2-shade (Freeprint
temp UV; DETAX
Ettlingen) resins for
CRDP (n = 1); MAX
(Asiga)
Resin (Next Dent C&B)
specimens (N = 60; NS =
20; n = 20); D1−150
(Veltz3D)
Resin (NextDent C&B)
bar-shaped samples (N
= 36; NS = 24; n = 6);
Form 1+ (Formlabs)
Evaluated Main conclusion
parameter(s)
Chipping and fracture Fracture resistance of
resistance 3D printed resin teeth
was comparable to
prefabricated denture
teeth.
Dimensional accuracy Printing settings,
and surface roughness polymer properties,
sample position and
building direction
influence geometric
characteristics and
surface roughness. SL
can be successfully used
to fabricate 4-unit
dental bridges.
Clinical applicability 3D printing offers time
saving, precise accuracy
and fitting of the
constructions, no risk of
distortions and
laboratory mistakes,
production of complex
shapes with no need of
special tools and almost
no waste material.
Proof of concept The temperature
controlled SL-based
method can 3D print
high viscous crown
material with fast speed
and high resolution.
Proof of concept Further studies are need
to investigate the design
parameters in different
CAD software programs
and printing strategies
in different 3D printers
to achieve optimal
clinical outcome.
Wear resistance Wear resistance of the
(volume loss and 3D printed resin
maximal depth loss of material was in a range
wear) comparable to milled or
conventionally
fabricated resin
materials.
Printing accuracy, 3D printable provisional
degree of conversion, restorative material
elastic modulus and allows for sufficient
peak stress. mechanical properties
for intraoral use, despite
the limited 3D printing
accuracy of the printing
system of choice.

– Table 1 (Continued)
Study
Unkovskiy et al., 2018 [59]
Clark et al., 2019 [29]
Jang et al., 2019 [50]
Kalberer et al., 2019 [30]
Kessler et al., 2019 [65]
Lee et al., 2019 [31]
d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) 336–350
Objective
To evaluate the
influence of printing
parameters on flexural
properties and accuracy
of SL-printed standard
objects.
To propose a digitally
replicated denture
technique (DRDT)
demonstrating a
predictable workflow for
fabricating complete
dentures for patients
with existing dentures.
To analyze suspensions
with various zirconia
(Zr) volume fractions
(Vv) and their influence
on microstructural and
physical properties of
products produced by
DLP-AM and sintering
processes.
To compare the
differences in trueness
between the CAD-CAM
milled and 3D-printed
complete dentures.
To investigate the three
body wear resistance of
3D printed resin
materials in comparison
to one milled PMMA
and one direct
composite materials.
To evaluate the accuracy
and surface resolution
of denture bases
fabricated by three
methods: injection
molding, milling, and
DLP RP using surface
matching software.
SL material,
printed structure
(N; NS; n); 3D
printer
Dental SG resin
(Formlabs) bar-shaped
samples (NS = 30; n = 10
for 3 orientations; NS =
49; n = 49 for
positioning; NS = 40; n =
10 for post-curing);
Form 2 (Formlabs)
Resin (NI) for replicated
and trial dentures (n =
2); Form 2 (Formlabs)
Six (48–58 vol% in Vv)
experimental Zr-based
suspensions for bars (NS
= 60; n = 10), discs (NS =
60; n = 10) and crowns
(NI); Octave Light R1
(Octave Light Ltd.).
Resin (NextDent
Denture 3+) for
complete denture (N =
20; NS = 10; n = 10);
RapidShape D30 (Rapid
Shape)
Resins (3Delta temp;
NextDent C&B;
Freeprint temp)
specimens (N = 40; NS =
24; n = 8); D20II (Rapid
Shape)
Resin (NextDent Base)
for denture base (N = 30;
NS = 10; n = 10); Bio3D
W1 (Bio3D Inc.)
343
Evaluated Main conclusion
parameter(s)
Printing orientation, 45◦ printing orientation
positioning and showed the best
accuracy, flexural accuracy and 90◦
strength and flexural specimens with layer
modulus orientation parallel to
the axial load showed
superior flexural
strength and flexural
modulus. Objects
printed on the borders
of build platform are
rather prone to
inaccuracies than those
in the center.
Proof of concept The clinical case
showed that DRDT
using rapid prototyping
can streamline the
process of complete
denture fabrication for
patients with existing
dentures.
Viscosity, depth of cure As Zr Vv increased in
(DC), geometrical the suspensions, the
overgrowth, thermal viscosity increased and
behavior, sintering DC decreased.
shrinkage, density, and Distortion due to
flexural strength geometrical overgrowth
was observed after
polymerization.
Maximum strength was
675 MPa for a Vv of 58
vol%.
Trueness (accuracy of fit CAD-CAM milled
to a master model) complete dentures were
considering 8 regions superior to 3D-printed
complete dentures in
terms of trueness of the
intaglio surfaces.
Three-body wear 3D printed temporary
resistance resins showed
comparative wear
resistance to
established materials
for temporary use.
Differences between
materials were more
pronounced than
between manufacturing
techniques.
Dimensional accuracy Overall accuracy of
and surface resolution denture base is higher
in milling and RP
methods than the
injection molding
method. Surface
resolution is higher in
the injection molding
method than the
milling or RP methods.
344
– Table 1 (Continued)
Study
Li et al., 2019 [51]
Li et al., 2019 [52]
Sa et al., 2019 [43]
Uçar et al., 2019 [55]
Wang et al., 2019 [53]
Zandinejad et al., 2019 [54]
Zimmermann et al., 2019 [44]
d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) 336–350
Objective
To use AM to fabricate
dental bridges and
implants made of
zirconia.
To evaluate the physical
and mechanical
properties of
SL-manufactured
zirconia dental crowns
and analyze their
internal and marginal
adaptation.
To evaluate the
antibacterial properties
and mechanical
behavior of an
experimental resin for
3D printing restorations.
To compare mechanical
and microstructural
properties of a ceramics
from lithography-based
ceramic manufacturing
(LCM) with pressing and
CAD/CAM methods.
To evaluate the trueness
of zirconia crowns
fabricated by 3D
printing in comparison
with crowns fabricated
by CAD-CAM milling as
a control.
To compare the fracture
resistance of milled
zirconia (MZr), milled
lithium disilicate (MLD),
and AM zirconia (AMZr)
crowns when cemented
to MZr implant
abutment.
To evaluate the fracture
behavior of different
CAD/CAM ceramics and
composites and one
3D-printed composite as
a function of different
crown thicknesses (0.5,
1 and 1.5 mm).
SL material,
printed structure
(N; NS; n); 3D
printer
Custom made
resin-based zirconia
slurry for dental bridges
and implants (n = NI);
DLP 3D printer (brand
NI)
Custom made
resin-based zirconia (45
vol%) slurry for
experimental samples
(n = 22) and molar
crowns (n = 5); CSL 150
(Porimy)
Experimental resin for
crowns and bridges (n =
1) and testing samples
(n = NI); DLP printing
system
High-purity alumina
(LithaLox HP 500, Lithoz)
for disc-shaped
specimens (N = 30; NS =
10; n = 10); CeraFab 7500
(Lithoz)
Photosensitive resin
mixed with zirconia
paste (3DMix ZrO2 L,
3DCeram Co.) for
crowns (N = 20; NS = 10;
n = 10); Ceramaker 900
(3DCeram Co.)
Zirconia paste (3DMix
ZrO2 , 3DCeram Co.) for
crowns (N = 30; NS = 10;
n = 10); Ceramaker 900
(3DCeram Co.)
Composite (els-3D Harz,
Saremco Dental AG) for
crowns (N = 180; NS =
30; n = 10); DLP Freeform
Pro 2 (ASIGA)
Evaluated Main conclusion
parameter(s)
Structural and Several technical
morphological barriers have to be
characterization overcome to apply 3D
printed all-ceramic
prostheses to clinical
practice.
Density, sintering The strength of
shrinkage, flexural SL-manufactured
strength, Weibull zirconia was adequate
parameters, internal- to fabricate dental
marginal adaptation. crowns, which showed
less than ideal internal
and marginal
adaptation for clinical
application.
Flexural strength and The 3D printable
modulus, antibacterial composite material
activity and cytotoxicity with Ag-HNT/SLR
showed high strength,
sustaining antibacterial
activity and
non-toxicity.
Biaxial flexural strength, LCM can be used to
hardness, fracture produce ceramic parts.
toughness, structural Mechanical properties
reliability and manufacturing of
LCM ceramics seem to
be promising but need
improvements, mainly
to reduce porosity.
Trueness (dimensional Zirconia crowns
accuracy considering 4 produced by 3D printing
crown locations) met the trueness
requirements, and 3D
printing may be suitable
for fabricating zirconia
crowns.
Fracture resistance and AMZr crowns showed
mode of failure comparable fracture
resistance to milled
restorations. AM
appears to be a
promising technology
for the fabrication of all
ceramic restorations.
Fatigue and fracture As none of the 0.5-mm
load ceramic crowns
survived fatigue testing
and all 0.5-mm
composite crowns did,
composites may have
advantageous material
characteristics
compared to ceramic
CAD/CAM materials for
minimal restoration
thicknesses.

– Table 1 (Continued)
Study
Cha et al., 2020 [32]
Ioannidis et al., 2020 [56]
Jurado et al., 2020 [34]
Lin et al., 2020 [61]
Park et al., 2020 [22]
Peng et al., 2020 [45]
Peng et al., 2020 [46]
d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) 336–350
Objective
To compare the wear
resistance of 3D-printed
denture teeth with that
of conventionally
prefabricated denture
teeth.
To test the load-bearing
capacity of ultra-thin
molar occlusal veneers
fabricated with
3D-printed zirconia,
CAD-CAM milled
zirconia, and pressed
glass-ceramic.
Using case reports to
compare subtractive
and additive
technologies for the
manufacture of
immediate complete
dentures.
To evaluate materials
based on Bis-EMA,
UDMA, and TEGDMA as
3D printing resins and
to characterize the
mechanical and
biological properties
and accuracy of the
3D-printed objects.
To 3D print resin
(PMMA) dentures with
metal cusps.
To evaluate the internal
fit and marginal
discrepancy of interim
crowns made by
different manufacturing
methods.
To compare the internal
fit and marginal
discrepancy of interim
crowns fabricated by
different manufacturing
methods.
SL material,
printed structure
(N; NS; n); 3D
printer
Dentca PMMA-based
resin (Dentca Inc.) for
denture teeth (N = 80;
NS = 12; n = 12); Zenith
D (Dentis)
Zirconia slurry
(LithaCon 3Y 610 white,
Lithoz) for occlusal
veneers (N = 60; NS = 20;
n = 20); CeraFab 7500
(Lithoz)
Dentca PMMA-based
resin (Dentca Inc.) for
denture teeth (N = 2; NS
= 1; n = 1); M2 SpeedCell
(Carbon)
Experimental resins
based on Bis-EMA,
UDMA, and TEGDMA for
disc-, cube-, and
bar-shaped
specimens(NS = 168; n =
8, 5, and 3);
custom-made UV-DLP
printer (NI)
Ti6 Al4 V alloy (LaserForm
Ti Grade 23) for cusps
printed with ProX 100
DMP (3D systems); a
photopolymer
(NextDent C&B) for
denture base and teeth
printed with Bio3D-L12
(Bio3D)
Resin (NextDent C&B
MFH) for crowns (N = 48;
NS = 16; n = 16); DLP
MiiCraft 125 (Young
Optics)
Resin (NextDent C&B
MFH) for crowns (N = 36;
NS = 12; n = 12); DLP
MiiCraft 125 (Young
Optics)
345
Evaluated Main conclusion
parameter(s)
Wear resistance The wear behavior of
3D-printed denture
tooth resin was
comparable to that of
prefabricated denture
teeth.
Load-bearing capacity Despite significant
(dynamic aging by cyclic differences between
fatigue and temperature restorative materials, all
variation) load-bearing capacities
exceeded the clinically
expected normal bite
forces.
Case report Both approaches
resulted in well-fitted
immediate complete
dentures. Printing
technology does not
provide anatomical
details and needs to
improve the bonding
between teeth set and
baseplate.
Viscosity, dimensional The experimental resins
accuracy, flexural are good candidates for
strength and modulus, 3D printing dental parts,
depth of cure (DC), and which showed favorable
hardness biological and
mechanical properties.
The accuracy of the
printed specimens
showed potential for
clinical application.
Proof of concept Metal and PMMA resin
were designed
separately and
combined by using
general purpose
software to produce
digitally fabricated
dentures,
demonstrating digital
prosthesis designs with
improved functionality.
Internal fit and Digitally fabricated
marginal discrepancy crowns (CAD-CAM and
3D-printed) had better
internal fit and smaller
marginal discrepancy
than manually
constructed crowns.
Internal fit and Digitally fabricated
marginal discrepancy interim crowns
(CAD-CAM and
3D-printed) had better
internal fit and smaller
marginal discrepancy
than manually
fabricated interim
crowns
346
– Table 1 (Continued)
Study
Revilla-León et al., 2020 [67]
Reymus et al., 2020 [47]
Schönherr et al., 2020 [57]
Shim et al., 2020 [60]
Takeda et al., 2020 [33]
AM- additive manufacturing; RP- rapid prototyping; SLA- stereolithography apparatus; DLP- digital light processing; LCM- lithography-based
ceramic manufacturing; CAD-CAM- computer-aided design and computer-aided manufacturing; PMMA- Poly(methylmethacrylate); Bis-EMA-
ethoxylated bisphenol A-dimethacrylate; UDMA- urethane dimethacrylate; TEGDMA- triethylene glycol dimethacrylate; N- total number of
structures/samples in the study, and/or NS- total number of SL structures/samples in the study; n- SL sample size (per experimental group);
NI- not informed.
d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) 336–350
Objective
To measure and
compare color
dimensions of five
different AM and two
conventional interim
restorative materials.
To investigate the
impact of 3D print
material, build
direction, post-curing,
and artificial aging on
fracture load of interim
3-unit fixed dental
prostheses (FDPs).
To optimize the
precision of glass
ceramic additively
manufactured parts,
especially dental molar
crowns.
To evaluate the effect of
3 printing orientations
(0◦ , 45◦ and 90◦ ) on the
printing accuracy,
flexural strength,
surface characteristics,
and microbial response
of 3D-printed denture
base resin.
To fabricate 3D-printed
replication dentures
using digital workflow.
SL material,
printed structure
(N; NS; n); 3D
printer
Resins (*Detax FreePrint
temp; †Envisiontec
E-Dent 400; *NextDent
C&B; *NextDent C&B
MFH; Stratasys Med620
VEROGlaze) disks (N =
420; NS = 300; n = 60);
*D30 (Rapid Shape),
†VIDA (EnvisionTEC),
and Eden 260VS
(Stratasys)
Resins (EXP-
experimental; CB-
NextDent C&B; FT-
DetaxFreePrint temp;
DT- Deltamed 3Delta
temp) for FDPs (N = 405;
NS = 360; n = 15); D20II
(Rapidshape)
Experimental lithium
disilicate-based ceramic
filled photosensitive
resin slurries for crowns
(NI); DLP printer (NI).
PMMA for denture base
(NextDent Base)
specimens (NS = 30; n =
10); Form 2 (Formlabs)
Photopolymerizing resin
(Formlabs Dental SG V1)
replication dentures (NS
= 2); Form 2 (Formlabs)
Evaluated Main conclusion
parameter(s)
Color differences None of the additively
manufactured interim
materials tested
matched the
conventional interim
materials in all 3 CIELab
color dimensions.
Fracture load Interim 3D-printed FDPs
might offer an
alternative to milled
and conventionally
fabricated ones.
Adequate post-curing is
crucial for 3D-printed
materials to ensure
sufficient mechanical
properties, but they are
more prone to artificial
aging than milled
PMMA, questioning
their long-term use.
Dimensional accuracy The best precision of
of 3D-printed the final part was
glass-ceramic crowns obtained from micro
computed tomography
(CT) scanning. It
resulted in an optimized
process allowing for
possible production of
high precision molar
crowns with
dimensional accuracy
and high reproducibility.
Printing accuracy, Printing orientation
flexural strength, influenced printing
surface roughness, accuracy, flexural
hydrophilicity, surface strength, roughness,
energy, and microbial and response to C.
response to Candida albicans. Thus, printing
albicans orientation should be
carefully decided to
fabricate products with
appropriate properties.
Proof of concept Digital replication of
dentures allows for
necessary repairs and
changes to be made
while also maintaining
the desirable features of
the existing dentures.
 d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) 336–350
[16,50,52], structural shrinkage [16,50,52] and reliability
[16,35,55], viscosity [16,50,61], hardness [55,61,63], print-
ing orientation [59,62], degree of conversion [58], layer
cure depth [50,61], fatigue [44], and color [67] were eval-
uated. Eleven papers published a proof of concept as an
attempt to demonstrate the clinical feasibility and appli-
cability of the technology to print restorative materials
[22–25,28,29,33,34,36,41,42].
Considering the 3D printers based on stereolithography (SL)
technology, 26 studies used digital light processing (DLP), 19
used stereolithography apparatus (SLA), and two studies used
lithography-based ceramic manufacturing (LCM). The most
frequent manufacturer for DLP was Rapid Shape and for SLA
was FormLabs.
4. Discussion
A technology undergoing rapid progress often brings faster
benefits to the society, but it can also generate some tur-
moil involving clear communication and, as a result, not the
best possible use of such technology. Additive manufacturing
(AM), or simply 3D printing, fits well on this rationale. Despite
standardization efforts to attempt to reduce confusion that
hampers communication and potentially wider application of
AM, there is a clear mismatch between the literature and the
standard description of this technology [11]. The standard is
intended to provide a basic understanding of the fundamental
principles for AM offering definitions for terms and nomencla-
ture associated with it, facilitating adequate communication
worldwide. It was actually a rare joint effort from the two main
international organization for standardization, ISO and ASTM,
putting together a standard. The final version of the standard
[11] was published in the same year of the earliest report [23]
that fit the inclusion criteria of the present review, offering the
opportunity to minimize terminology mismatches that were
observed in the literature. Nevertheless, it may be time for
new effort to update the standard terms and definitions on
this very dynamic development that applies to the hardware,
software and materials in order to prevent near-term future
disparities.
As this review aimed to present a qualitative analysis
of studies published on stereolithography-based 3D printing
of restorative materials and their clinical applicability, focus
was on a specific AM process (SL- stereolithography) with
application to restorative dentistry. SL-based 3D printing (e.g.
SLA, DLP, and LCM) is one of the most used AM processes
in Dentistry, offering the greatest accuracy and resolution,
fine building details and smooth surface finish among print-
ing technologies [1,10,12,13,17]. An SL-printed construct is
built through deposition of consecutive layers of a photosen-
sitive material, which is readily polymerized. This may be
the reason for the earliest studies to investigate the influ-
ence of thickness and orientation of the printed layer on
dimensional accuracy of the constructs [35,62]. Yet, this has
been the research concern from many authors in this topic
[30,31,35,38,40,48–50,53,57–61]. It has been shown that print-
ing orientation, build angle and position influence not only
printing accuracy but other properties, such as strength, sur-
face morphology, and bacterial response [40,60]. In addition,
347
the print orientation can affect other aspects such as print
efficiency (print time and packing density accommodated on
the build plate) as well as the amount of material consumed
as sacrificial structural supports. Considering polymer-based
structures, bar-shaped specimens printed with 45◦ orientation
showed the best accuracy, but the 90◦ specimens with layer
orientation parallel to the axial load showed superior flex-
ural strength and modulus [59]. For dental restorations, e.g.
crowns, build angles of 120◦ [35] and 135◦ [38] have offered
the highest dimensional accuracy and self-supported geome-
try throughout the building process. Objects printed on the
borders of the build platform are rather prone to inaccu-
racies as compared to those positioned in the center [59].
When considering printing accuracy of polymer-based struc-
tures, which may be influenced by the tuning between the
material, the printer and the process parameters used, some
authors showed adequate accuracy [48,49] and others reported
inferior accuracy [30,31,58] compared to other manufacturing
processes. Printing accuracy of ceramic constructs has been
associated with the crystalline volume fraction (Vv) [50]. As
zirconia Vv increases, the flowability of a Zr-based suspension
decreases, which makes it more difficult to reliably 3D print.
The viscosity of zirconia suspensions sharply increased from
a volume fraction (Vv) of ≥ 54 vol%, therefore, the maximum
Vv of Zr in suspensions possible for printing was 58 vol% (or 89
wt%), which also produced the higher mean flexural strength
(675 MPa). The cure depth of zirconia suspensions decreased
as the Vv increased, yet it was greater than 100 ␮m after pho-
tocuring any of the suspensions for 15 s [50]. As zirconia has
a strong light scattering effect, with a refractive index 20-27%
higher than other ceramic materials such as silica and alu-
mina [7,68], it can cause significant scattering of the incident
light during polymerization of a photopolymer, limiting its
depth of cure [69–71]. Further, all ceramic constructs showed
some distortion after polymerization [50]. Nevertheless, AM of
ceramic crowns is very promising [53].
Inherent to material science and as noticed above, material
properties and structural behavior are associated. Therefore,
strength [16,26,43,50,52,55,59–63] and surface morphology
[25,26,31,40,48,49,51,60,64] were also significantly examined
in the included studies. Despite of the heterogeneity of
experimental methods and material composition, all printed
polymer-based structures showed strength higher than mini-
mal acceptable for provisional restorations [26,43,59,60,62,63].
As mentioned above, the strength of printed alumina- and
zirconia-based constructs is strongly associated with the crys-
talline content, with high particle size (d50 ≈ 1.6 ␮m) and
Vv (≈80 wt%) resulting in reliable anisotropic shrinkage and
high strength [16,50]. However, the resulting ceramic struc-
tures need improvements, mainly to reduce defects (e.g. cracks
and porosity) and enhance internal and marginal adapta-
tion (dimensional accuracy) for clinical application [52,55].
Although surface morphology is an important clinical param-
eter, polymer-based restorations are not difficult to polish
and it is a routine dental practice [72]. This parameter is
mostly related to printing settings, post-cure processing and
polymer properties [40,60], directly influencing on surface
roughness, color [67] and bacterial response and adherence
[25,26,43,60,64].
348 d e n t a l m a t e r i a l s 3 7 ( 2 0 2 1 ) 336–350
The main goal of the present review was to present the
most recent developments and clinical evaluation of SL-
printed structures. The clinical applicability of 3D-printed
structures was, somehow, present in the majority of stud-
ies included in this review. Most of them reported a proof of
concept as an attempt to demonstrate the clinical feasibility
and applicability of the technology to print restorative mate-
rials [22–25,28,29,33,34,36,41,42]. However, only five studies
(gray-shaded in Table 1) placed the printed temporary/interim
restorative structures in service, reporting the clinical cases
[29,33,34,36,41]. Up to date there is no clinical trial on
stereolithography-based 3D printed restorative constructs.
5. Conclusion
The fast expansion in photopolymerized-based AM using
stereolithographic processes has been notable and represents
great technological progress. The ability to rapidly produce
customized objects and functional parts is expected to dig-
itally transformed many practices. This review showed that
Dentistry has demonstrated an incredible ability to adapt
materials, methods and workflows to this promising digital
technology. However, full realization of the potential promise
of 3D printing is reliant on sustained improvement in ade-
quate dental materials and processes. Esthetic appearance,
wear resistance, and dimensional accuracy are the main cur-
rent clinical limitations that restrict progression to functional
part production with 3D printing, which may explain the
absence of clinical trials and reports on permanent/definitive
dental restorative materials and structures.
Acknowledgements
This study was partially supported by CNPq do Brasil grant
302587/2017-9; CAPES do Brasil PVEX 88881.337090/2019-01;
and NIH/NIDCR R21 grant DE028444.
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