Done by

Hiba Abdil karim Salman

PhD student
University of Baghdad
Conservative department

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1. Introduction
Over the past 30 years, 3D printing and prototyping has gained popularity
with- in the profession and among patients alike. It has provided comfort and
better quality of restoration to dentists.
Moreover, dental restorations, which are being produced through rapid
prototyping, are more adaptive and faster in production compared to the
restorations created by dental technicians.
Three-dimensional (3D) printing is an additive manufacturing method in
which a 3D item is formed by laying down successive layers of material.
3D printers are machines that produce representations of objects either
planned with a CAD program or scanned with a 3D scanner.
Printing is a method for replicating text and pictures, typically with ink on
paper. We can print different dental pieces using different methods such as
selective laser sintering (SLS), stereo- lithography, fused deposition
modeling, and laminated object manufacturing.
The materials are certified for printing individual impression trays,
orthodontic models, gingiva mask, and different prosthetic objects.
The material can reach a flexural strength of more than 80 MPa. 3D printing
takes the effectiveness of digital projects to the production phase.
Dental laboratories are able to produce crowns, bridges, stone models, and
various orthodontic appliances by methods that combine oral scanning,
3D printing, and CAD/CAM design. Modern 3D printing has been used for
the development of prototypes for several years, and it has begun to find its
use in the world of manufacturing. ) Cristian et.al.,2017)

2. HISTORY OF 3D PRINTING

3D printing has been used increasingly since the 1980s.

In 1983, Charles Hull printed, for the first time, a three-dimensional object.
He created the first 3D printer that used the technique of stereolithography,

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as well as the first program for virtualization. They received increased
attention in fields such as architecture due to the increased potential in the
direct construction of parts,
Their use in areas that require millimetric precision, has drawn the attention
of specialists in general medicine, who started to implement it since the
1990s.) Cristian et.al.,2017)
Throughout the 1990s oral and maxillofacial surgery increasingly used
Computed Tomography (CT) files to 3D print surgical planning models for
identification of anatomic structures, decreasing surgical risk and shortening
treatment time (Erickson et al. 1999, Anderson et al., 2018)
The US Food and Drug Administration (FDA) approved the first CBCT for
dental use in the United States in 2000 (Danforth 2003, Anderson et al.,
2018).
In contrast to the medical CT voxel, where axial height is determined by
slice thickness, the CBCT voxel is cubic, allowing for higher resolution and
more accurate measurements in multiple planes.
CBCT is a more accurate source of data for 3D printing applications and has
the added benefits of reducing radiation exposure, scan time and cost
(Cotton et al. 2007, Anderson et al., 2018)
In the early days, the cost of printing was expensive and so the consumer
Market & interested industries were limited. With developments in
technology, the cost has drastically decreased and has become increasingly
available for the general market. Printers that used to cost more than $20,000
USD in 2010 can now be found for less than $1,000 .(Matt,2014,
Holly,2015)
The classification of 3DP as a creative disruption to traditional man-
ufacturing and prototyping methods is supported by the decreasing cost and
increasing consumer use availability, improving materials and processes
(increased resolution, faster build time), the feature of adaptability/hyper-
customization, and lastly, the expanding opportunity set (Fig. 1). (Holly,
2015)

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 Fig.1: 3d printer revenues by end market,repsorted as %of industry
revenues.( Rob Wile and Goldman Sachs,2013)

The key verticals of the 3DP market are shown to include aerospace,
automotive, health care, and consumer industries. (Holly, 2015)
CAD software is commonplace in industrial design, engineering, and
manufacturing environments, and is also common in the dental laboratory; it
is even becoming a feature of many dental surgeries.
The new techniques of making prosthetic restorations largely eliminate the
help given by dental laboratories. (Yadroitsev et al., 2007; Cristian et al.,
2017).

3. 3D printing over CAD CAM technology

1. Subtractive methods such as CAD CAM has some limitations in relation
with 3 D printing.
2. Large amount of raw material is wasted because of unused portions of the
mono-blocks which are discarded after milling and recycling of the excess
ceramic is also not feasible.
3. Milling tools are prone to heavy abrasion and wear which shortens their
cycling time.

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4. Due to brittle nature of ceramic microscopic cracks can be introduced
during the process of machining. (Reeta et al, 2016).

4. The process of 3DP

The 3D model, creating using CAD and saved as an STL file, must be
processed by a ’slicer’ program before it can be printed (Fig. 2).

Fig.2: The process of manufacturing a 3dp produced restoration. (Brian Evans, 2012).

The ’slicer’ converts the model into virtual horizontal cross sections in the
form of a G-code instructions file.
Following the G-code instructions, the 3D printer builds the successive
layers that are joined or automatically fused to create the final shape. (Brian,
2012).
Higher resolution objects can be achieved by printing an oversized version
and removing the excess via a subtractive process with resolution greater
than the printer resolution (described by layer thickness). (Holly, 2015)

5. The types of 3D printing technologies

For 3DP, there is more than one method to realize the object and the
difference between these lies in the way in which layers are deposited, the
way in which materials are used and the type of materials that can be used.
These can be categorized into:
5.1. Light Polymerization 3D Printing
5.1.1- Stereolithography (SLA):

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 SLA employs a vat of liquid ultraviolet-sensitive photopolymer resin and an
ultraviolet laser. For each layer, the laser beam traces a pattern, curing and
solidifying the photopolymer (Fig.3). (Holly, 2015)

Fig.3: Stereolithography (SLA)

Advantages:
1. Rapid fabrication.
2. Able to create complex shapes with high feature resolution.(Andrew
et al.,2015)
3. strength of produced objects (strong enough to be machined)
(Holly,2015)
4. Lower cost materials if used in bulk.

Disadvantages:
1. Only available with light curable liquid polymers.
2. Support materials must be removed.
3. Resin is messy and can cause skin sensitization, and may be irritant by
contact and inhalation.
4. Limited shelf life and vat life.
5. Cannot be heat sterilized.
6. High cost technology.
(Andrew et al., 2015)

5.1.2.Photojet - Light sensitive polymer (Photopolymer Jetting):

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 Photojet - Light sensitive polymer is jetted onto a build platform from an
inkjet type print- head, and cured layer by layer on an incrementally
descending platform. (Andrew et al., 2015)
A wide range of resins and waxes for casting, as well as some silicone-like
rubber materials can be printed.
This technology gives the resolution of apprx.16 microns and gives the easy
access for making complex and fine detailed objects. (Andrew et al., 2015)
3D Jet printers may have a single print head like a computer printer, or they
may have multiple heads to cover the width of the working platform. Either
the print head moves across the working platform, or the platform moves
back and forth under stationary print head(s) (Fig. 4).
They are useful for:
 Printing dental or anatomical study models.
 Implant drill guides may be quickly and cheaply produced with this
technology as they are less bulky. (Reeta et al, 2016)

Fig.4: Photojet - Light sensitive polymer

Advantages:
1. Relatively fast.
2. High-resolution,

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 3. high-quality finish possible.
4. Multiple materials available various colours and physical properties
including elastic materials.
5. Lower cost technology.
Disadvantages
1. Tenacious support material can be difficult to remove completely.
2. Support material may cause skin irritation.
3. Cannot be heat sterilized.
4. High cost materials.
(Andrew et al., 2015)

One of the studies was compared between two types of 3dp technique
(Stereolithography and Polyjet technique) about the accuracy of printed
model from intra oral scan with different design of model bases, it was
concluded that printed models with a horseshoe shaped base made with the
Stereolithography printer had a statistically significant reduction in the
transversal dimension that was not found in the models printed with the
polyjet technique. (Leonardo et al., 2017)

5.1.3. Digital light processing (DLP).

DLP 3D printing is a new form of SLA printing, in which the process and
theory is almost identical, but Instead of a using a laser to cure the
photopolymer resin, this form uses a DLP projector.
This projector technology gives DLP 3D printing a huge advantage over
standard SLA, as DLP 3D printing can print and cure a single layer across
the total build plate in just a couple seconds, making it significantly faster.
Another advantage that DLP has over SLA, and most other forms of 3d
printing, is that it wastes very little material, which helps keep the cost per
print to bare minimum (Fig.5).
DLP printing is currently being utilized in the dental industry for creating
 Models from digital impressions,
 castable restorations,
 surgical guides,
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  Splints, and even short-term temporaries.

Due to the speed and accuracy of DLP printing, this form of 3D

printing will continue to grow in the dental industry. (Bernie et al.,
2017)

Fig.5: Digital light processing (DLP)

Advantages:
1. Good accuracy,
2. smooth surfaces,
3. Relatively fast.
4. Lower cost technology.
Disadvantages
Light curable liquid polymers and wax-like materials for casting. Support
materials must be removed. Resin is messy and can cause skin sensitization,
and may be irritant by contact Limited shelf life and vat life. Cannot be heat
sterilized. Higher cost materials. (Andrew et al., 2015)
5.2. Powder binder
Plaster or cementaceous material set by drops of (coloured) water from
'inkjet' print head. Object built layer by layer in a powder bed, on an
incrementaly descending platform (Fig. 6). (Andrew et al., 2015)

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Advantages:
Lower cost materials and technology. Can print in colour. Un-set material
provides support relatively fast process. Safe materials.
Disadvantages
Low resolution. Messy powder. Low strength. Cannot be soaked or heat
sterilized. (Andrew et al., 2015)
In order to improve the strength and surface hardness in delicate printed
model, a cyanoacrylate or epoxy resin is infiltrated during post processing
procedures. (Helena and Benjamin, 2015; Reeta et al, 2016)

Fig.6: powder binder printer

5.3 Sintered powder or granular

5.3.1. Selective laser sintering
Selective laser sintering for polymers (SLS).
This technology has been brought into usage since mid-1980s and was
developed by university of Texas.
Object built layer by layer in powder bed. Heated build chamber raises
temperature of material to just below melting point. Scanning laser then

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sinters powder layer by layer in a descending bed (Fig.7). (Andrew et al.,
2015)
Selective laser sintering is used in fabrication of anatomical study models,
cutting and drilling guides, dental models, and also for engineering/design
prototypes. (Chen et al., 2014)
Advantages:
1. Range of polymeric materials including nylon, elastomers, and
composites.
2. Strong and accurate parts.
A high (60μm) level of resolution may be obtained.
3. No support material is required as the structures that are printed are
supported by the surrounding powder. (Pattanayak et al., 2011).
4. Production of facial prosthesis makes use of polymers scaffolds (poly
amide or poly Caprolactone).
5. Polymeric materials – commonly nylon may be autoclaved.
6. Printed object may have full mechanical functionality.
5. Lower cost materials if used in large volume.
(Andrew et al., 2015)
Disadvantages
1. Significant infrastructure required, eg. Compressed air, climate
control.
2. Messy powders.
3. Inhalation risk.
4. High cost technology.
5. Rough surface.
(Andrew et al., 2015)

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 Fig.7: Selective laser sintering

5.3.2. Selective laser sintering for metals and metal alloys.

Also described as selective laser melting (SLM) or direct metal laser
sintering (DMLS).
Scanning laser sinters metal powder layer by layer in a cold build chamber
as the build platform descends. Support structure used to tether objects to
build platform.
Advantages:
1. High strength objects,
2. Can control porosity.
3. Variety of materials including titanium, titanium alloys, cobalt
chrome, stainless steel. Metal alloy may be recycled.
4. Fine detail possible.
Disadvantages
1. Elaborate infrastructure requirements.
2. Extremely costly technology moderately costly materials.
3. Dust and nanoparticle condensate may be hazardous to health.
4. Explosive risk. Rough surface.
5. Elaborate post-processing is required: Heat treatment to relieve
internal stresses in printed objects.
6. Hard to remove support materials.
7. Relatively slow process.

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5.3.3 Electron beam melting (EBM, Arcam).
Heated build chamber. Powder sintered layer by layer by scanning electron
beam on descending build platform.
Advantages
1. High temperature process, so no support or heat treatment needed
afterwards.
2. High speed.
3. Dense parts with controllled porosity.
Disadvantages
1. Extremely costly technology moderately costly materials.
2. Dust may be hazardous to health.
3. Explosive risk.
4. Rough surface.
5. Lower resolution.
(Andrew et al., 2015)
5.3.4. Commonly used materials in SLS 3d printer (Seyed et al.,
2016).
Polymers.
There are a number of studies on using natural and synthesized polymers in
SLS. For example, cellulose, the most abundant natural polymer ,has been
used to fabricate SLS scaffolds.
An important synthetic biodegradable polymer material is polycaprolactone
(PCL) This material is semi-crystalline with high thermal stability and a
degradation period of approximately two years.
Due to the good biocompatibility, bioresorbability, and processability of
PCL, this polymer is used for tissue engineering and cartilage repair .
Ceramics.
SLS of ceramic materials can be either direct or indirect.
Direct SLS of ceramics can be powder based or slurry based.

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In the powder-based method, the packing density of the powder layers is
low, leading to a lower sintered density and also leading to cracks due to
thermal stresses in the parts.
Efforts have been made to develop direct SLS to produce fully dense
ceramic composites. In this method high laser energy is applied to a
preheated powder bed, causing the powder to melt and avoiding thermal
stress cracking.
On the other hand, slurry-based direct SLS takes advantage of more
homogeneous and much more densely packed powder layers obtained from
the slurry process.
The concern is that this method produces parts with lower strength due to
thermal cracks and microstructural inhomogeneities.
Agglomeration of powders is a concern with using slurry-based SLS. An
effective way to avoid agglomeration during laser sintering may be to
process at a lower scanning speed or to employ a surfactant in a very low
concentration.
Using a surfactant helps obtain a homogeneous green part which can
demonstrate better mechanical properties.
This method is appropriate when the purpose is the fabrication of ceramic
scaffolds with bioactive ceramics such as calcium silicate and
hydroxyapatite
The indirect method uses polymers as a binder with ceramic powders as the
main matrix and involves the melting of sacrificial organic polymer to obtain
a green part. The green parts are subsequently sintered to produce the final
porous ceramic parts.
Bioactive glass materials have numerous advantages over other bioactive
ceramics like sintered hydroxyapatite. For example, it has been shown that
dissolution products from bioactive glasses upregulate the expression of
genes that control osteogenesis, which explains the high rate of bone
formation.

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Metals.
Porous metallic scaffolds such as titanium (Ti) and tantalum (Ta) and
biocompatible alloys such as CoCr and nitinol have been proposed as bone
replacement materials, but unlike bioactive ceramics or biocompatible
polymeric scaffolds, biomolecules cannot be integrated into metallic
scaffolds.
The lack of degradability of metallic implants restricts the use of these kinds
of scaffolds. The main concern with embedding metallic scaffolds is metal
ion release into body fluid, leading to sarcoma.
Coating the surface of metallic scaffolds with bioactive ceramics such as HA
or CS or using surface finishing methods is highly recommended to improve
the biological properties of metallic scaffolds.
Different CoCrMo alloys meeting the requirements for tissue applications
have been investigated to observe the effect of the laser melting process on
corrosion and metal release in biologically relevant fluids.
Dental implants have been fabricated from stainless steel and Ti6Al4V and
CrCo alloys by the SLM method.
The alloys fabricated by SLM are functionalized with a pharmaceutically
relevant biomolecule (paracetamol) using phosphonic acid–based self-
assembled monolayers (SAMs) to be used as a biocompatible coating layer
for drug and protein delivery.
Composites.
Polymers are elastic and have low stiffness, whereas ceramics are rigid and
brittle. By mixing ceramics and polymers into composites, the mechanical
properties are significantly improved because the problem of brittleness and
the difficulty of shaping hard ceramics can be overcome
The main issue for ceramic/polymer composites is the agglomeration of
ceramic powders into the polymer matrix. Using SLS for sintering, a mixture
of ceramic and polymer powders can solve this problem due to the uniform
distribution of ceramic into the matrix.
5.4. Thermoplastic or extrusion
Fused Deposition Modelling (FDM)
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Fused Deposition Modelling developed by Schott Crump. (Reeta et al,
2016).
Fused deposition modelling (FDM) First 3DP technology, most used in
'home' printers.
Thermoplastic material extruded through nozzle onto build platform.
Controlled by temperature and the material hardens immediately (within .1
sec) after extrusion (Fig.8). (Andrew et al., 2015)
Materials such as acrylo nitrile butyro styrene ABS, polycarbonates and poly
sulfones are used. Building complex geometries usually necessitates the
usage of a second extruder – for example, might extrude a water soluble
support material. (Zein et al., 2002)

Advantages
1. High porosity.
2. Variable mechanical strength.
3. Low - to mid-range cost materials and equipment.
4. Low accuracy in low costequipment.
5. Some materials may be heat sterilized.
Disadvantages
1. Low cost but limited materials - only thermoplastics.
2. Limited shape complexity for biological materials.
3. Support material must be removed. (Andrew et al.,2015)

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 Fig.8: fused deposition modelling
The 3 widely adopted 3DP technologies are FDM, SLS and SLA (Holly,
2015)

6. APPLICATIONS OF 3D PRINTING IN DENTISTRY

6.1. medical modelling
the production of drilling or cutting guides using 3D printed technology or
conventional laboratory technology, can lead to expedited, less invasive, and
more predictable surgery (Fig. 9). (Sanna et al., 2007; Tardieu et al., 2007;
Andrew et al., 2015)

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 Fig. 9 Models and drill guides printed in resin for simultaneous full lower arch
implant rehabilitation and mandibular reconstruction. (a) Implant drill guide over the
3DP model. (b) Bending the osteosynthesis plate on the sterilised medical model. (c)
Plate in place.

6.2 Drilling and cutting guides

These ‘engineering’ tools need to be robust and precise, as well as being
capable of sterilisation or disinfection as used in a surgical environment.
For example. The use of drill guides and cutting guides allows a virtual 3D
plan, created on-screen in software to be transferred to the operative site,
(Fig.10).(Chen et al.,2014)

Fig. 10: Example of a drilling template from 3D printing (Varseo, BEGO)

6.3. Digital orthodontics in orthodontics,

Treatment may be planned and appliances created, or wires bent robotically
based upon a digital workflow using intra oral or laboratory optical scanning
or even CBCT to capture patient data. (Andrew et al., 2015)

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6.4 Dental implants
Manufacturers have used 3D printing technology to create novel dental
implants with a porous or rough surface.
There is also the opportunity to create implants which have complex
geometry, although ultimately inserting a dental implant using a screw type
form seems like a well proven approach. (Andrew et al., 2015)

6.5 Bone regeneration

3D printers can print bone tissue tailored to the requirements of the patient,
and can act as biomimetic scaffolds for bone cell enhancement and tissular
growth and differentiation. (Heoa et al., 2017; Cristian et al., 2017)
In bone regeneration procedures, novel 3D printed alginate-peptide hybrid
scaffolds can also be used. Studies indicate that the alginate-based scaf-
folds provide a stable environment for the growth of stem cells. (Zhou et al.,
2014; Cristian et al., 2017)
We can create composite powders that can be printed into scaffolds.
Calcium phosphate (CaP) powders can be mixed with a 3D printing (3DP)
powder based on calcium sulphate (CaSO4), and the scaffolds can also be
used as bone augmentation material. (Sykes et al., 2004; Cristian et al.,
2017)

6.6. BioPrinting
Bioprinting, as described in the International Conference of Bioprinting and
Biofabrication in Bordeaux, is ”the use of computer-aided transfer processes
for patterning and assembling living and non- living materials with a
prescribed 2D or 3D organization in order to produce bio-engineered
structures serving in regenerative medicine, pharmacokinetic and basic cell
biology studies” .(Guillemot et al.,2010; Athanasios et al., 2013)
For bioprinting purposes, cell printers utilizing similar techniques to FDM
were developed. These printers give us the ability to place cells in areas that
mimic their respective coordinates in organs.

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The capability to drop cells on previously printed successive layers provides
an opportunity for three dimensional organ printing. (Boland et al., 2003;
Athanasios et al., 2013)
Such breakthrough of bioprinting technology in three dimensions draws
from the use of thermo-reversible gels. Gels are fluid at 20oC and above
32oC and therefore similar to conventional printing methods can be applied,
so as tissue structures can be printed with cells representing biological ink.
According to the above, successive layers could be produced just by
dropping another layer of gel onto an already printed surface.
This technology allows us to print 3D complex organs with accurate and
precise assignment of various cell types to the gel. Feasibility of this
technology can be shown, if we take into consideration that human cells are
placed close enough in sequential layers of 3d gels, which can be fused and
create fully functional organs and cultured in vitro. The process is illustrated
in (Fig.11 and 12).

Fig. 11: The Mathematical model of cell aggregate behavior when implanted in a 3D
model gel

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 Fig. 12: Tissue self-assembly after the careful placement of cells in the original
geometrical positions.

This principle of cell self-assembly into fully vascularized tissues is similar

to the way embryonic like-issues sort and fuse into functional forms dictated
by the rules of developmental biology (Athanasios et al., 2013).
Researchers at Wake Forest University in North Carolina say they have
created a 3D printer that can produce organs, tissues, and bones that could
theoretically be implanted into living humans.
Using some of the same methods we are using to print today these
researchers are laying down layers of human cells. They have printed out an
ear-shaped piece of cartilage, a muscle, and a piece of a jawbone.
BioPrinting is truly ground breaking.
We may be a few years from printing the final restoration and even farther
than that from printing a replacement jaw, but as the above research suggests
we may be there sooner than we think. (Bernie et al., 2017).
6.7. ceramic
For ceramic materials, 5 generative manufacturing techniques are of special
interest:
(i) stereo-lithography .
(ii) 3D-P, i.e., printing of a polymeric or inorganic binder into a ceramic
powder bed .

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(iii) Selective laser sintering .
(iv) Selective laser melting (Hollander et al., 2003); and
(v) Direct inkjet printing
Only porous structures, however, can be created by the first 4 technologies
(i-iv) mentioned above.
In contrast, direct inkjet printing of a ceramic suspension provides the
possibility of generating dense green bodies at a high resolution and
complex shape (Ebert et al., 2008; Özkol et al., 2009).
The most popular powders used for ceramic 3D printing are made from
aluminet and cermet. (Martin, 2013)
6.7.1. Titanium Ceramic Composite Material
Z3Dlab is a French metal printing company that is currently working on a
SLM machine that will print a titanium zirconia combination. The new
material called ZTi-Powder is the world’s first titanium/ceramic composite
material in 3D printing
Full Contour Layered High Strength Ceramics Quite a few universities,
companies and independent research facilities have been working with high
strength ceramic materials to develop a printing process that will print the
final restoration which will include internal coloration and shading to
simulate the appearance and esthetics of natural dentition. (Bernie et al.,
2017)

6.7.2. Full Contour Layered High Strength Ceramics

Quite a few universities, companies and independent research facilities have
been working with high strength ceramic materials to develop a printing
process that will print the final restoration which will include internal
coloration and shading to simulate the appearance and esthetics of natural
dentition. (Bernie et al., 2017)
6.7.3. Ceramic pigment.
Pigments such as cobalt aluminate (CoAl2O4) are composite oxide and
agents with ceramic characteristics.

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It is a highly stable with excellent resistance to light and weather.
Therefore, it has found a widespread use and widely employed as a blue
pigments.
Nano-pigment are typically fabricated onto ceramic substrates by various
methods such as stereo-lithography, selective laser sintering, laminated
object manufacturing, 3-D printing, dip coating, and ink-jet printing.
In ceramic ink-jet printing, ceramic ink, which contains well dispersed
ceramic pigments in a liquid carrier, passes through the printer nozzles
(40–100 µm in diameter) at high speeds. Droplets of the ceramic ink are
sprayed on the substrate where they spread on impact to produce a layer of
less than 1 mm thickness. (Masood et al., 2014).

6.8. 3D printing in restorative dentistry

6.8.1. Crown copings and partial denture frameworks
In fixed and removable prosthodontics, treatment may be planned and
restorations designed in CAD software.
This scan data and CAD design may be used to mill or print crown or bridge
copings, implant abutments, and bridge structures.
3D printing may be harnessed for the fabrication of metal structures either
indirectly by printing in burn-out resins or waxes for a lost-wax process, or
directly in metals or metal alloys. (Venkatesh and Nandini, 2013)
The advantage of printing in resin/wax and then using a traditional casting
approach is that there is much less post-processing involved than in the
direct 3D printing of metals.( Kasparova et al.,2013).
Casting alloys and facilities are also familiar and widely available. Printing
directly in metals requires the use of more costly technologies which have
their own very specific health and safety requirements, and demand a great
deal of post-processing before components may be ready for use (Fig. 13).

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 Fig. 13:3D manufacture of metal crown copings. (a) Selective laser sintering in
progress. (b) Printed copings in cobalt chrome alloy tethered to build platform by
support structue.

6.8.2. Dental models for restorative dentistry

The trend towards the use of intraoral scanners means that dentists need 3D
printing in order to make a physical model of the scanned jaw. Although
today, it is not always strictly necessary to print a master model at all,
The 3D printed master model (Fig.14) may be used for conventional aspects
of the fabrication of a restoration, such as adding a veneering material, and
we are accustomed to seeing restorations displayed on a model – even if they
have been directly fabricated digitally.
Patient model data may be digitally archived, and only printed when needed,
easing storage requirements. (Andrew et al., 2015)

Fig. 14: SLS printed prepared teeth, printed from data from an intra-oral scanner

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6.8.3. Antimicrobial Plastic
Dutch researchers at the University of Groningen are working on the
creation of a 3D printed tooth made of an antimicrobial plastic that kills the
bacteria responsible for tooth decay on contact. Imagine a restoration that
kills more than 99% of all bacteria. (Bernie et al., 2017)

6.8.4 Bioprinting technology

Tissue engineering of the tooth crown, root, and periodontium was already
Investigated in 2006 by Hu et al. and researchers have started to look into
3D dental bioprinting technology using human dental pulp cells mixture as a
Bioink. (Holly, 2015; Xue et al., 2013)

6.8.5. Endodontic applications of 3D printing

The endodontic literature for 3D printing is limited to case reports and pre-
clinical studies. Endodontic applications for stent-guided EMS, rapid
prototyping of anomalous teeth, autotransplantation and educational
modelling are documented within the literature. (Anderson et al., 2018)
7. Understanding 3D Printer Resolution
When comparing printers, most specifications will only show the Z (vertical)
resolution and state it as representing the “accuracy” of the printer.
For example, the photo below (Fig.15) shows the same model twice, but the
model on the left was printed in 100 micron layers and the model on the
right was printed in 50 micron layers.

Fig.15: show the Z (vertical) resolution and state it as representing the “accuracy” of the
printe the model on the left was printed in 100 micron layers and the model on the right was
printed in 25
50 micron layers.
This is misleading as the proper resolution/accuracy of the printer is not
determined by the Z axis, but rather the XY axis.
Defining the XY accuracy of a 3D printer will depend on the type of 3D
printing technology that you are using.
Example: DLP 3D printer, which is the most common form of desktop 3D
printing being used in the dental industry. The accuracy of a DLP 3D printer
is defined by the size of the pixel being projected.
The easiest way to understand how the pixel-size defines the accuracy is to
compare it to a HD television screen. If you look closely at your TV screen
you will notice thousands of small “squares”, or pixels (Fig.15).

Fig.15: 3D printer with an XY accuracy

A DLP 3D printer with an XY accuracy and pixel size of 75 microns will be

able to print objects as thin as 75 microns.
This would produce a highly detailed object. Since DLP 3D printers have a
high resolution, they are able to be used for all applications in dentistry
including Crown and Bridge models, restorations, RPD frameworks, surgical
guides, splints, custom impression trays, orthodontic models and even
temporaries.
Stereolithography (SLA) Laser printers define their resolution by the
diameter of the laser. The most common desktop SLA printer has a laser
resolution of 140 microns. At this resolution the smallest printable feature

26
size would be 140 microns making it 2-3 times less precise than a DLP 3D
printer.
SLA Laser printers work fine for areas where high precision, detail, and
accuracy is not needed, such as custom impression trays, splints and surgical
guides. (Bernie et al., 2017)

8. Open vs. Closed 3D Printers

With a closed 3D printer system, you can only use the printer manufacturer's
resins.
Open material 3D printers allow you to print any suitable material from any
supplier. (Bernie et al., 2017)

9. Advantages and disadvantages of 3D Printing

9.1. The advantages
If we compare the advantages of 3D printed restorations with
conventional or CAD/CAM restorations, 3D printing restorations will
surely be placed on top.
1. They provide the possibility of high quality restorations with
quick and easy fabrication.
2. The quality of these restorations has been demonstrated by
several studies, although cost is still a major issue.

9.2. The disadvantage:

1. stereolithography and digital light processing is that they are
available only with light- curable liquid polymers and the
support materials must be removed.
2. Resin is messy and can cause skin irritation, and it could also
cause inflammation by contact and inhalation.
3. they present a limited shelf
4. Can- not be heat-sterilized, while being a high-cost technology.

27
 5. The disadvantage of selective laser melting is that it is an
extremely costly technology and a slow process. .) Cristian
et.al.,2017)
10. Conclusion
Dental applications of 3D printing adopt one or more of the following
common technical type classifications:
stereolithography apparatus (SLA), fused deposition modelling (FDM),
MultiJet printing (MJP), PolyJet printing, ColorJet printing (CJP), digital
light processing (DLP) and selective laser sintering (SLS) also known as
selective laser melting (SLM) (Kim et al. 2016;Anderson et al., 2018) .
SLA systems direct the exposure path of a UV laser onto the surface of a vat
of photosensitive resin. During a sequential curing process layers bind
together to form a solid mass, beginning from the bottom of the object and
building upward (Kim et al. 2016).
SLA was the earliest and is the most commonly used technology employed
in dentistry (Kim et al. 2016). Its inventor (3D Systems, Rock Hill, SC,
USA) also developed the STL or stereolithography CAD/CAM file format In
addition to being utilized to describe SLA systems, the term
stereolithography has been used to describe 3D printing in general.
With FDM printing, layers of molten material are deposited from a
filamentous nozzle and then solidify within 0.1 s (Kim et al. 2016).
FDM is generally less accurate and less expensive than other 3D printing
methods (Kim et al. 2016).
MJP and PolyJet printing are characterized by the jetting of photopolymer
material in ultra-thin layers, curing each layer after deposition onto a build
tray; they differ only in their support structures and post-processing
requirements (Kim et al. 2016).
In CJP, a print head selectively disperses binder onto layers of powder and
like PolyJet printing, the build platform lowers with each subsequent layer
(Kim et al. 2016).
There is extensive documentation of dental applications of CJP, PolyJet and
MJP. DLP printers have a projector that exposes a vat of photosensitive resin

28
to a two-dimensional image; printing occurs sequentially in layers as the
supporting platform is manipulated to incrementally produce the object.
The resin is cured from the bottom, and as a platform moves up, more resin
is exposed (Kim et al. 2016).
SLS and SLM printers use a computer-directed laser and roller to distribute
layers of powdered material on top of a preceding layer; a solid object takes
shape as each new layer is sintered (SLS) or melted (SLM) (Kim et al.
2016; Buican et al. 2017).
SLS printing is used to fabricate metal objects through direct metal laser
sintering (DMLS) (Kim et al. 2016).
CEREC products are an example of a closed system in which acquisition,
design and manufacturing phases require proprietary Sirona technology
(Dentsply Sirona, York, PA, USA) (van Noort 2012; Anderson et al.,
2018).
A key innovation in the rise of 3D printing in dentistry occurred with the
advent of ‘open sourcing systems’ that allow for a variety of acquisition
sources to be used with several design and manufacturing technologies on a
personal computer (van Noort 2012;Alghazzawi 2016).
The capability to use Digital Imaging and Communication in Medicine
(DICOM) files with a variety of CAD/CAM systems is a major advantage of
open sourcing.
In these open systems, data are converted to a STL file prior to CAD and
CAM. STL files can be used in local fabrication or for printing at distant
laboratories. (Alghazzawi 2016).
Although 3D printers are becoming more affordable, the cost of running,
materials, maintenance, and the need for skilled operators must also be
carefully considered, as well as the need for post-processing and adherence
to strict health and safety protocols. Despite these concerns it is clear that 3D
printing will have an increasingly important role to play in dentistry. (
Andrew et al.,2015)

29
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