School of Dentistry

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Advanced biomaterials for periodontal tissue regeneration
(Wiley, 2022) Daghrery, Arwa; Bottino, Marco C.; Biomedical and Applied Sciences, School of Dentistry
The periodontium is a suitable target for regenerative intervention, since it does not functionally restore itself after disease. Importantly, the limited regeneration capacity of the periodontium could be improved with the development of novel biomaterials and therapeutic strategies. Of note, the regenerative potential of the periodontium depends not only on its tissue‐specific architecture and function, but also on its ability to reconstruct distinct tissues and tissue interfaces, suggesting that the advancement of tissue engineering approaches can ultimately offer new perspectives to promote the organized reconstruction of soft and hard periodontal tissues. Here, we discuss material‐based, biologically active cues, and the application of innovative biofabrication technologies to regenerate the multiple tissues that comprise the periodontium.
Advanced Scaffolds for Dental Pulp and Periodontal Regeneration
(Elsevier, 2017-10) Bottino, Marco C.; Pankajakshan, Divya; Nör, Jacques E.; Biomedical Sciences and Comprehensive Care, School of Dentistry
No current therapy promotes root canal disinfection and regeneration of the pulp-dentin complex in cases of pulp necrosis. Antibiotic pastes used to eradicate canal infection negatively affect stem cell survival. Three-dimensional easy-to-fit antibiotic-eluting nanofibers, combined with injectable scaffolds, enriched or not with stem cells and/or growth factors, may increase the likelihood of achieving predictable dental pulp regeneration. Periodontitis is an aggressive disease that impairs the integrity of tooth-supporting structures and may lead to tooth loss. The latest advances in membrane biomodification to endow needed functionalities and technologies to engineer patient-specific membranes/constructs to amplify periodontal regeneration are presented.
CAD-CAM Hollow Obturator Prosthesis: A Technical Report
(Wiley, 2022) Alfaraj, Amal; Su, Fang-Yu; Lin, Wei-Shao; Prosthodontics, School of Dentistry
An obturator with a hollow bulb can decrease the overall weight of the prosthesis, stress on the underlying tissues, and patient discomfort. Although many techniques and materials have been proposed in the literature for hollowing the obturator prosthesis, they are often time-consuming and technique sensitive. This proposed technique used an open-source software program to hollow digital design of solid obturator base from a commercially available software in one single convenient step. The hollowing process allowed precise control of prosthesis thickness at the hollow space area for desirable hermetic seal and prosthesis strength.
Color reproduction trueness of 3D-printed full-color dental casts with scans derived from an intraoral scanner
(Wiley, 2023) Alfaraj, Amal; Lin, Wei-Shao; Prosthodontics, School of Dentistry
Purpose To investigate the effects of shade tab color variations (tooth-colored vs. gingiva-colored) and surface treatment (application of mineral oil) on the trueness of color reproduction from dental shade tabs to 3D-printed full-color dental casts, using digital scans obtained from an intraoral scanner. Materials and Methods Pristine tooth-colored (with 16 shade tabs) and gingiva-colored (with five shade tabs) shade guides were digitally scanned using an intraoral scanner, and subsequently, 3D-printed replicas were created using a full-color material jetting 3D printer. Three color measurements using a contact type digital spectrophotometer were recorded, including actual shade tabs (R0), dried 3D-printed study samples (RP1), and study samples with mineral oil application (RP2), in this study to calculate color differences between the actual shade tabs and 3D-printed ones. The CIEDE2000 formula was used to calculate the color differences (color reproduction trueness) between reference shade tabs and 3D-printed full-color study samples—without and with mineral oil, ∆E00(RP1), and ∆E00(RP2). ∆E00(RP1) and ∆E00(RP2) were compared with a 50:50% accessibility threshold (AT) and a 50:50% perceptibility threshold (PT). A grading system, based on the relative ranges of AT and PT, was employed. The percentage of samples falling into each color-matching category was then recorded. The data collected were subjected to statistical analysis, utilizing a mixed model ANOVA to evaluate the effects of shade tab color and mineral oil application on color differences, α = 0.05. Results The application of mineral oil significantly affected the ∆E00 [F(1, 378) = 19.1, p = < 0.0001]. However, this effect was only significant for the gingiva-colored study samples; the mineral oil application significantly decreased color difference, showing ∆E00(RP1) of 8.71 ± 3.78 and ∆E00(RP2) of 6.55 ± 2.14 (p < 0.0001). For the tooth-colored groups, the mineral oil application did not yield any color difference, showing ∆E00(RP1) of 7.05 ± 2.35 and ∆E00(RP2) of 6.94 ± 2.35 (p = 0.497). In the absence of mineral oil, gingiva-colored samples revealed a significantly larger ∆E00(RP1) of 8.71 ± 3.78 compared to tooth-colored samples at 7.05 ± 2.35 (p = 0.017). Conversely, mineral oil application rendered comparable ∆E00(RP2) values between gingiva-colored (6.55 ± 2.14) and tooth-colored (6.94 ± 2.35) samples (p = 0.558). All 3D-printed full-color samples showed Grade 1 (extremely unacceptable mismatch) and Grade 2 (clearly unacceptable mismatch), regardless of the shades or the presence of mineral oil. Conclusions Utilizing an intraoral scanner to gather digital color data, along with an MJ 3D printer, offers the potential for producing 3D-printed full-color dental casts for prosthesis characterization in the dental laboratory. While mineral oil improves the color reproduction trueness of gingiva-colored objects, all 3D-printed full-color samples exhibited unacceptable mismatches when compared to their target objects. This underscores the need for future improvement in the digital color data acquisition process and color optimization protocols in 3D printing processes.
Duplicating Complete Dentures with Conventional and Digital Methods: Comparisons of Trueness and Efficiency
(MDPI, 2022) Chen, Li; Li, Deli; Zhou, Jianfeng; Lin, Wei-Shao; Tan, Jianguo; Prosthodontics, School of Dentistry
Background: A complete denture (CD) can be duplicated with a conventional or digital protocol. However, there are no comparative studies of these methods. This study aimed to compare the trueness and efficiency of conventional and digital CD duplication methods. Methods: A mandibular CD was digitized as the virtual reference model and duplicated using five methods (n = 10). The trueness (root mean square (RMS)) was calculated for the whole denture and across the dentition, cameo denture extension, and intaglio portions. The manual labor time spent during denture duplication was also recorded at different steps. The trueness and labor time comparisons were statistically analyzed among the five groups (α = 0.05). Results: The conventional group was the least true with the largest RMS (mean, 95% CI) in all of the comparisons. The four digital groups yielded similar trueness values across the dentition, cameo denture extension, and intaglio areas, yet they had a significant difference in the whole denture comparison between the Digital-CBCT-SLA printer (0.17, 0.15-0.19 mm) and Digital-Laboratory Scanner-SLA printer (0.13, 0.11-0.15 mm). The conventional protocol required longer trimming and finishing time (7.55 ± 1.02 min), as well as total labor time (27.64 ± 1.72 min) than the other four digital techniques. Conclusions: The conventional CD duplication method was less true and efficient than digital techniques.
The effects of additive manufacturing technologies and finish line designs on the trueness and dimensional stability of 3D-printed dies
(Wiley, 2023) Lai, Yi-Cheng; Yang, Chao-Chieh; Levon, John A.; Chu, Tien-Min G.; Morton, Dean; Lin, Wei-Shao; Prosthodontics, School of Dentistry
Purpose To evaluate the effects of 5 manufacturing technologies and 2 finish line designs on the trueness and dimensional stability of 3D-printed definitive dies at finish line regions under different storage conditions and time. Material and methods Preparation of light chamfer and round shoulder finish lines were adopted individually on two mandibular first molar typodont teeth and digitalized as standard tessellation language (STL) files. A total of 240 samples (192 AM definitive dies and 48 definitive conventional stone dies) in 20 groups (n = 12) were manufactured based on 2 finishing line designs (chamfer and shoulder), 5 manufacturing technologies (4 additively manufactured technologies and conventional stone die), and 2 storage conditions (light exposure and dark). The 4 additively manufactured (AM) technologies include a DLP 3D-printer, an economic LED 3D-printer, a CLIP 3D-printer, and an SLA 3D-printer. All the study samples were distributed into two storage conditions. Subsequently, samples were digitalized to STL files at 3 different time points (within 36 hours, 1-month, and 3-months). A surface matching software was used to superimpose the sample STL files onto the corresponding original STL files with the best-fit alignment function. The trueness of each printed and stone definitive dies and their dimensional stabilities were measured by the root mean square (RMS, in mm). A linear mixed-effects model was used to test the effects of the finish line design, manufacturing technology, storage condition, and storage time on RMS values (α = 0.05). Results While finish line designs had no significant effects [F(1, 220) = 0.85, p < 0.358], the manufacturing technologies [F(3, 220) = 33.02, p < 0.001], storage condition [F(1, 220) = 4.11, p = 0.044], and storage time F(2, 440) = 10.37, p < 0.001] affected the trueness and dimensional stability of 3D-printed dies at finish line regions. No significant interactions were found among the 4 factors. For the manufacturing technologies, Type IV stone groups and LCD 3D-printer groups had significantly higher RMS values than the other 3 printers (p < 0.001) with no significant differences between Type IV stone and LCD 3D-printer groups (p = 0.577). DLP 3D-printer groups had higher RMS values than both SLA 3D-printer groups and CLIP 3D-printer groups (p < 0.001). There were no significant differences between SLA 3D-printer groups and CLIP 3D-printer groups, p = 0.671. For the effects of storage conditions, RMS values were significantly higher in the groups stored with the direct light exposure than the ones stored in the dark, p = 0.044. In terms of the effects of storage time, the RMS values were significantly higher after 1-month storage, p = 0.002; and 3-month storage, p < 0.001, than the ones at the immediate postmanufacturing stage. However, the RMS values after 1-month and 3-month storage were not significantly different from each other (p = 0.169). Conclusions Manufacturing technologies, storage conditions, and storage time significantly affected the trueness and dimensional stability of 3D-printed dies at finish line regions, while finish line designs had no significant effects. Among the AM technologies tested, all have produced either comparable or truer 3D-printed dies than the Type IV dental stone dies, and the CLIP and SLA 3D-printers produced the best outcomes. 3D-printed dies showed significant distortion after 1-month and 3-months storage, especially under light exposure storage conditions. These findings may negate the clinical need to preserve 3D-printed dies, and digital data should be preserved instead.
Technical procedures for template-guided surgery for mandibular reconstruction based on digital design and manufacturing
(Springer Nature, 2014-05-23) Liu, Yun-feng; Xu, Liang-wei; Zhu, Hui-yong; Liu, Sean Shih-Yao; Orthodontics and Oral Facial Genetics, School of Dentistry
Background: The occurrence of mandibular defects caused by tumors has been continuously increasing in China in recent years. Conversely, results of the repair of mandibular defects affect the recovery of oral function and patient appearance, and the requirements for accuracy and high surgical quality must be more stringent. Digital techniques--including model reconstruction based on medical images, computer-aided design, and additive manufacturing--have been widely used in modern medicine to improve the accuracy and quality of diagnosis and surgery. However, some special software platforms and services from international companies are not always available for most of researchers and surgeons because they are expensive and time-consuming. Methods: Here, a new technical solution for guided surgery for the repair of mandibular defects is proposed, based on general popular tools in medical image processing, 3D (3 dimension) model reconstruction, digital design, and fabrication via 3D printing. First, CT (computerized tomography) images are processed to reconstruct the 3D model of the mandible and fibular bone. The defect area is then replaced by healthy contralateral bone to create the repair model. With the repair model as reference, the graft shape and cutline are designed on fibular bone, as is the guide for cutting and shaping. The physical model, fabricated via 3D printing, including surgical guide, the original model, and the repair model, can be used to preform a titanium locking plate, as well as to design and verify the surgical plan and guide. In clinics, surgeons can operate with the help of the surgical guide and preformed plate to realize the predesigned surgical plan. Results: With sufficient communication between engineers and surgeons, an optimal surgical plan can be designed via some common software platforms but needs to be translated to the clinic. Based on customized models and tools, including three surgical guides, preformed titanium plate for fixation, and physical models of the mandible, grafts for defect repair can be cut from fibular bone, shaped with high accuracy during surgery, and fixed with a well-fitting preformed locking plate, so that the predesigned plan can be performed in the clinic and the oral function and appearance of the patient are recovered. This method requires 20% less operating time compared with conventional surgery, and the advantages in cost and convenience are significant compared with those of existing commercial services in China. Conclusions: This comparison between two groups of cases illustrates that, with the proposed method, the accuracy of mandibular defect repair surgery is increased significantly and is less time-consuming, and patients are satisfied with both the recovery of oral function and their appearance. Until now, more than 15 cases have been treated with the proposed methods, so their feasibility and validity have been verified.
Three-Dimensional Printing of Clinical Scale and Personalized Calcium Phosphate Scaffolds for Alveolar Bone Reconstruction
(Elsevier, 2022) Anderson, Margaret; Dubey, Nileshkumar; Bogie, Kath; Cao, Chen; Li, Junying; Lerchbacker, Joseph; Mendonça, Gustavo; Kauffman, Frederic; Bottino, Marco C.; Kaigler, Darnell; Biomedical and Applied Sciences, School of Dentistry
Objective: Alveolar bone defects can be highly variable in their morphology and, as the defect size increases, they become more challenging to treat with currently available therapeutics and biomaterials. This investigation sought to devise a protocol for fabricating customized clinical scale and patient-specific, bioceramic scaffolds for reconstruction of large alveolar bone defects. Methods: Two types of calcium phosphate (CaP)-based bioceramic scaffolds (alginate/β-TCP and hydroxyapatite/α-TCP, hereafter referred to as hybrid CaP and Osteoink™, respectively) were designed, 3D printed, and their biocompatibility with alveolar bone marrow stem cells and mechanical properties were determined. Following scaffold optimization, a workflow was developed to use cone beam computed tomographic (CBCT) imaging to design and 3D print, defect-specific bioceramic scaffolds for clinical-scale bone defects. Results: Osteoink™ scaffolds had the highest compressive strength when compared to hybrid CaP with different infill orientation. In cell culture medium, hybrid CaP degradation resulted in decreased pH (6.3) and toxicity to stem cells; however, OsteoInk™ scaffolds maintained a stable pH (7.2) in culture and passed the ISO standard for cytotoxicity. Finally, a clinically feasible laboratory workflow was developed and evaluated using CBCT imaging to engineer customized and defect-specific CaP scaffolds using OsteoInk™. It was determined that printed scaffolds had a high degree of accuracy to fit the respective clinical defects for which they were designed (0.27 mm morphological deviation of printed scaffolds from digital design). Significance: From patient to patient, large alveolar bone defects are difficult to treat due to high variability in their complex morphologies and architecture. Our findings shows that Osteoink™ is a biocompatible material for 3D printing of clinically acceptable, patient-specific scaffolds with precision-fit for use in alveolar bone reconstructive procedures. Collectively, emerging digital technologies including CBCT imaging, 3D surgical planning, and (bio)printing can be integrated to address this unmet clinical challenge.
The Trueness of Obturator Prosthesis Base Manufactured by Conventional and 3D Printing Techniques
(Wiley, 2021) Alfaraj, Amal; Yang, Chao-Chieh; Levon, John A.; Chu, Tien-Min G.; Morton, Dean; Lin, Wei-Shao; Prosthodontics, School of Dentistry
Purpose : To compare the intaglio surface trueness of obturator prosthesis bases manufactured by traditional compression molding, injection molding, and 3D printing techniques. Materials and Methods : A complete edentulous master cast with Aramany Class I maxillary defect was selected for this in vitro study. Four study groups (n = 10/group) were included in this study, Group A: Compression Molding, Group B: Injection Molding, and Group C: Cara Print 3D DLP Printer, and Group D: Carbon 3D DLS Printer. All obturator prostheses' intaglio surfaces were scanned with a laboratory scanner (E4; 3Shape Inc, New Providence, NJ) and the dimensional differences between study samples and their corresponding casts were calculated as the root mean square (measured in mm, absolute value) using a surface matching software (Geomagic design X; 3D Systems, Rock Hill, SC). One-way Analysis of variance (ANOVA) and Fisher's least significant difference (LSD) test were used to compare groups differences in RMS (α = .05). Results There was a significant effect of manufacturing technique on the RMS values for the 4 conditions [F(3,36) = 5.743, p = .003]. Injection Molding (0.070 mm) and Compression Molding groups (0.076 mm) had a lower interquartile range, and the Cara Print 3D-Printer group (0.427 mm) and Carbon 3D-Printer (0.149 mm) groups had a higher interquartile range. The Injection Molding group showed the best and uniform surface matching with the most area in green in the color maps. The Injection Molding group (0.139 ±0.049 mm) had significantly lower RMS than all other groups (p<.001 for all comparisons). Compression Molding (0.269 ±0.057 mm), Cara Print 3D-Printer (0.409 ±0.270 mm), and Carbon 3D-Printer (0.291 ±0.082 mm) groups were not significantly different from each other (Compression Molding versus Carbon 3D-Printer, p = .59; Compression Molding versus Cara Print 3D-Printer, p = .25; Cara Print 3D-Printer versus Carbon 3D-Printer, p = .40). Conclusion : Obturator prosthesis bases manufactured with injection molding technique showed better intaglio surface trueness than ones made by the compression molding technique and 3D printers. Although obturator prosthesis bases manufactured from different 3D printers showed similar trueness, a DLP 3D printer produced less consistent outcome than a DLS 3D printer.

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