http://dx.doi.org/10.5272/jimab.2015214.974
Journal of IMAB
ISSN: 1312-773X
http://www.journal-imab-bg.org
Journal of IMAB - Annual Proceeding (Scientific Papers) 2015, vol. 21, issue 4
MODERN TRENDS IN THE DEVELOPMENT OF THE
TECHNOLOGIES FOR PRODUCTION OF DENTAL
CONSTRUCTIONS
Tsanka Dikova1, Dzhendo Dzhendov2, Maksim Simov3, Iveta Katreva-Bozukova2,
Svetlana Angelova3, Diana Pavlova3, Metodi Abadzhiev2, Tsvetan Tonchev4
1) Department of Medical and Biological Sciences, Faculty of Dental Medicine,
Medical University of Varna, Bulgaria
2) Department of Prosthetic Dentistry and Orthodontics, Faculty of Dental
Medicine, Medical University of Varna, Bulgaria
3) Medical College, Medical University of Varna, Bulgaria
4) Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine,
Medical University of Varna, Bulgaria
ABSTRACT
The aim of the present paper is to make a review of
the modern trends in the development of the technologies
for production of dental constructions. Three are the main
trends in production technologies in dentistry last 30 years:
digitalization, simulation and implementation of additive
technologies. The simulation occurred first and due to the
computers development it underwent fast progress from the
mathematical calculations and analytical analysis to the 3D
modeling and visualization. Thus Computer Aided Engineering (CAE) was developed, allowing dental constructions
with optimal design to be produced by optimal technological regimes.
The first Computer Aided Design (CAD) – Computer Aided Manufacturing (CAM) systems were created in
1970s as a result of the digitalization. In this mode of operation at first virtual 3D model is generated by CAD, which
then is used for production of the real construction by CAM.
The CAD-CAM systems allow fabrication of dental restorations which is difficult or impossible to be manufactured
by conventional technologies. The development of CAD
unit runs from indirect scanning of the plaster model for
obtaining data for the 3D model to direct scanning of the
prosthesis area. While the development of CAM unit leads
to direct manufacturing of the real dental construction using subtractive or additive technologies. The future development of the CAD-CAM systems as a whole characterizes
with transition from closed to open access systems, which
make them more flexible.
In the late 1980sthe new approach to the production
of constructions appeared – by addition of material layer
by layer. The additive technologies were developed. They
characterize with building of one layer at a time from a powder or liquid that is bonded by means of melting, fusing or
polymerization. Stereo lithography, fused deposition
modeling, selective electron beam melting, laser powder
forming and inkjet printing are the methods, mostly used
in dentistry. Due to the great variety of the additive manufacturing processes various materials can be used for production of different dental constructions for application in
974
many fields of dentistry.
The simulation, digitalization and implementation of
additive technologies in dentistry led to fast development
of the technologies for production of dental constructions
last decade. As a result many of manual operations were
eliminated, the constructions’ accuracy increased and the
production time and costs decreased.
Key words: dental constructions, simulation, digitalization, CAD-CAE-CAM, additive technologies, dentistry.
INTRODUCTION
The technologies for production of dental constructions undergo fast development last 30 years. This process
characterizes with three main trends: digitalization, simulation and implementation of additive technologies. Historically, the simulation occurs first. Computers, facilitating the
mathematical calculations, led to the Computer Aided Engineering (CAE), which is intended to simulate the performance of the construction in order to improve its design. As
a result of the digitalization the first Computer Aided Design (CAD) – Computer Aided Manufacturing (CAM) systems were created in 1970s. Implementation of CAD-CAM
systems in dentistry led to elimination of many manual operations, increase of the constructions’ accuracy and decrease of the production time. In the late 1980sthe new approach to the production of constructions appeared – by addition of material layer by layer. The additive technologies
were developed as alternative of subtractive ones. Their
main advantages are: production of complex objects by different materials – polymers, composites, metals and alloys;
manufacturing of parts with dense structure and predetermined surface roughness; controllable, easy and relatively
quick process.
The aim of the present paper is to make a review of
the main modern trends in the development of the technologies for production of dental constructions.
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1. Simulation
The first simulations occurred in aviation, military
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and automotive industry in the beginning of the last century. The military was a major impetus in the transfer of
modeling and simulation technology to medicine. The definition of medical simulation as “an imitation of some real
thing, state of affairs, or process” describes its historical
roots [1]. Physical models of anatomy and disease were constructed long before the advent of modern plastic or computers. But the computers facilitated the mathematical description of the human physiology and pharmacology, the
worldwide communication, and the design of virtual worlds
[2]. Nowadays mathematical modeling and 3D visualization
are used in learning of dental anatomy, morphology of the
teeth and analysis of the state of the teeth and the surrounding tissues in different impacts [3-6]. 3D digital models of
selected anatomy are intended to support activities such as
proper diagnosis, preoperative planning, orthodontic and
surgical simulations, leading to successful treatment, risk
reduction and increased patient safety [3, 7-9].
The simulation is very often used in manufacturing
of dental constructions, because it gives fast and standardized results on the prognosis of prosthetic restorations in
comparison with the clinical trials [10, 11]. Laboratory
simulation is used in two ways: 1) for investigation the
biomechanical behavior of dental constructions to understand the failure behavior of complex structures [12, 13];
2) to optimize the experiments through the mathematical
simulation and selection of the best design to perform the
test and the manufacturing process [11, 14]. The complex
process of simulation is called Computer Aided Engineering (CAE). It consists of three stages: simulation, validation and optimization.
The simulation stage, when simplified specimens like
disks and micro-bars are used, is fast, but with low accuracy because the influence of the restoration geometry on
the stress distribution is not taken into account. When the
models are with the shape of the crown and bridges, the
mechanical behavior is closer to the clinical situation, but
the evaluation of the stress distribution within complex
geometries is limited [11]. In this case the Finite Element
Analysis (FEA) - fast and a relatively low cost method is
used. In the FEA, a large structure is divided into a number
of small simple shaped elements, for which individual deformation (strain and stress) can be more easily calculated
than for the whole undivided large structure [15]. During
FEA the model should be created, material properties and
software limitations should be input, the mesh and convergence analysis should be done, loading and boundary conditions should be applied. The computer software solves a
set of simultaneous equations with thousands of variables
to achieve the desired results. Finally, the graphical presentation of results, including qualitative and numerical results, is given [11, 12, 15]. Using FEA biomechanical
behavior of different dental constructions such as crown,
bridges, implants, implant-bone interfaces etc., made of different materials or combination of materials – metal alloys,
porcelain, metal-ceramic, composites and polymers can be
investigated. The main advantage of FEAis the virtual simulation of real structures that are difficult to be clinically
evaluated which makes it a low cost alternative in compari-
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son to the other in vitro methods. But there are some limitations of the FEA models concerning mainly to the specific patient anatomy, the wet environment and the damage
accumulation under repetitive loading [12].
For investigation of complex structures by FEA usually 2D or 3D models are used depending on the complexity of the geometry, the type of analyses required, expectations of accuracy as well as the general applicability of the
results. The main limitation of the 2D models is the lower
accuracy and reliability comparing to the 3D ones. In contrast, a 3D model has acceptable accuracy/reliability while
properly capturing the geometry of complex structures.
However, the higher the complexity of 3D models the higher
the difficulty in generating appropriate mesh refinement for
simulation [11,12]. The 3D models can be generated by two
ways depending on the structure of interest and the purpose
of study. The first one is manually by using the appropriate software such as AutoCad, SolidWorks, Pro/Engineer or
Rhino 3D. The second is the imaging approach which involves transformation of available medical imaging files
from computed tomography (CT) scans, magnetic resonance
images (MRI), ultrasound, and laser digitizers into wire
frame models that are then converted into FE models [11,
12, 13].
Validation is the second stage of CAE which means
comparing the behavior of the model with data of the analytical and experimental in vitro or in vivo investigations.
In vitro validation allows the loads and boundary conditions
to be carefully controlled in order to assess the validity of
the model’s geometry and elastic properties [12]. A combination of in vitro and in vivo experimentation potentially
offers the best validation which leads to the third stage of
CAE process – optimization. As a result dental constructions with optimal design can be produced with optimal
technological regimes.
The digitalization and the computers development
played leading role in the CAE implementation into the
biomechanical investigation of dental constructions. CAE
let to make the engineering calculations and analysis without manufacturing of physical model, resulting in optimal
design of dental constructions produced with optimal technological regimes in considerably reduced time and costs.
2. Digitalization
As a result of the digitalization the first CAD–CAM
systems for application in dentistry were created in 1970s
[16, 17]. In the first CAD stage the geometry of the parts,
which should be produced, is defined. While during the second, CAM stage, the information for the production is
merged and mostly the control of the production machines
is made [18]. So, the all CAD-CAM systems have three
functional components: 1) a digitalization tool (scanner) that
transforms geometry into digital data that can be processed
by a computer; 2) software which processes scanned data
and produces a data set readable by a fabrication machine;
3) a manufacturing technology that takes the data set and
transforms it into the desired product by fabricating the restoration [17, 19].
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a)
e)
c)
g)
f)
d)
b)
Fig. 1. First stage of the CAD-CAM systems development. Plaster model – a), scanning of the plaster model –
b), virtual 3D model – c), 3Dprinter and stereo lithography process – d); 3D polymer model – e), casting wax up – f), as
casted dental bridge – g).
On the first stage of the CAD development the data
for the 3D model are obtained by indirect scanning of the
plaster model (Fig.1). In this case the first operations for
manufacturing of a dental construction are manually done
by the dentist (taking an impression) and the dental technician (pouring the plaster model). After that the plaster model
is scanned by contact [13, 15] or the more modern contact
less scanning methods [11, 12]. Using scanned data the virtual 3D model is generated with specialized software which
is then transferred to the CAM unit for manufacturing. Thus,
the real dental construction can be made of porcelain by
milling, or the polymer casting model - by stereo lithography (3D printing) [17].
On the next stage of the CAD development the data
are obtained by direct scanning of the prosthesis area in the
a)
patient’s mouth (Fig.2). This stage is a result of the recent
introduction of the intra-oral scanners. Thus the process of
generating the 3D model is shortened several times as well
as the accuracy of dental restoration arises, because the first
manual operations are eliminated. Now there are many software packages available for the design of dental crowns,
bridges and partial denture frameworks, as some of them
can survey, design and wax a partial denture framework in
less than 20 min [17].
The development of CAM unit leads to direct manufacturing of the real dental construction (Fig.2). It can be
done by milling of sintered porcelain and metal alloys with
ultrasonic machine which ensures very smooth surfaces and
high accuracy, or by selective laser melting machine, guaranteeing predetermined surface roughness.
b)
c)
d)
Fig. 2. Second stage of CAD-CAM development: direct scan with intraoral scanner – a), virtual 3Dmodel – b),
selective laser melting machine – d); dental bridge made of Co-Cr alloy by SLM process – e).
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The further development ofthe CAD-CAM systems
as a whole is the transition from the closed to open access
systems, which means that the componentparts of a CADCAM system can be purchased separately. As a consequence
the following advantages can be ensured: 1) the data can
be obtained from different sources; 2) appropriate design
software can be used for 3D modeling of different dental
constructions;3) the mostappropriate manufacturing techniques can be selected for wide range of materials [17].
Due to the digitalization and exponential development of computers the CAD-CAM systems were implemented in dentistry. Their development from closed to open
access gives opportunities for fast production of dental restorations from direct scan of the prostheses field, generating of 3D model and direct manufacturing of the real construction. This approachleads to more flexibility ofCADCAM systems, elimination of manual operations, increase
of the constructions’ accuracy and decrease of their production time and cost.
3. Subtractive/additive technologies
The first CAD-CAM systems in dentistry are based
on the process of subtractive manufacturing in which the
restoration is produced from a prefabricated block with
guaranteed properties by cutting or milling with bursor diamond disks on conventional numerical controlled milling
machine [17, 19, 20]. Subtractive processes characterize
with carefully planned tool movements to cut the material.
This technology is used in dentistry for manufacturing of
metallic and ceramic crowns. The main advantage of the
subtractive fabrication is that the complexshapeswhich are
difficult or impossible to make by the conventional dental
processes can be effectively created in reduced time. Nowadays new highly sophisticated technologies are developed:
electrical discharge machining, electrochemical machining,
electron beam machining, photochemical machining, ultrasonic machining and so called laser “milling” (material removal by laser ablation) [17, 21, 22].
But there are still some limitations, concerning to:
1) the precision fit of the inside contour of the restoration
which depends on thesize of the smallest usable tool; 2) the
waste of considerable amount of raw material, as in some
cases approximately 90 percent of the initial bock could be
removed [17]; 3) abrasion wear of the milling tool and its
short running cycles; 4) microscopic cracks on the ceramic
surfaces due to machining of the brittle material [19].
They can be overcome by using of Additive Manufacturing (AM). American Society for Testing and Materials (ASTM) defined additive manufacturing as: „the process of joining materials to make objects from 3Dmodel data,
usually layer upon layer, as opposed to subtractive manufacturing methodologies” [17, 23].
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AM technologies produce parts by polymerisation,
fusing or sintering of materials in predetermined layers
without need of tools, thus enable production of geometries
that arealmost impossible to produce using other machining or moulding processes and nearly with no waste. The
layers of all AM parts are created by slicing CAD data with
specialized software. Each sliceis then printed one on top
of the other to create the 3D object – the so called “3 Dimensional printing” process [17, 24]. These processes are
also known as “layered manufacturing”, “freeform fabrication”, “rapid prototyping”, “rapid manufacturing” [23, 25].
Additive manufacturing processes started to beused
in the 1980s when Hull invented stereo lithography (SLA)
- the first 3D printing technology [26]. The earliest applications of these technologies were mainly for manufacturing of prototypes, models and casting patterns. That is why
this process was called “Rapid Prototyping”(RP). But today the additive manufacturing technologies are used
throughout the whole product cycle: from pre-production,
i.e. rapid prototyping, to full scale production, known as
Rapid Manufacturing (RM) [17, 23, 24, 27].
The ASTM International committee, dedicated to the
specification of standards for AM, formed in 2009 (known
as ASTM F42) created a categorization of all 3D printing
technologies into seven major groups [25]. According to it
the 3D printing technologies with application in
biomaterials are as follows: 3D plotting/direct ink writing,
laser-assisted bioprinting, selective laser sintering, stereo lithography, fused deposition modeling, robotic assisted
deposition/robocasting.
The additive manufacturing processes mostly used in
dentistry include: stereo lithography, Fused Deposition
Modeling (FDM), Selective Electron Beam Melting
(SEBM), laser powder forming (selective laser sintering,
selective laser melting), inkjet printing [17,19, 28].
During the stereo lithography process (Fig.3) a concentrated beam of UV light is focused onto thesurface of a
tank filled with liquid photopolymer and, as the light beam
draws the object onto the surface of the liquid,each time a
layer of resin is polymerized or cross linked. Thedetail is
built up layer by layer, to give a solid object [17, 19, 24,
28]. At first SLA was used in medicine and dentistry for
production of physical models of the human anatomy,for
planningof surgical procedures and as a means of constructing customized implants such as cranioplasties, orbital
floors andonlays. Nowadays the application of SLA processes is extended to manufacturing of surgical guides for
placement ofdental implants, temporary crowns and bridges
as well as resin models for loss wax casting [17, 19].
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A
B
C
Fig. 3. 3D printer and stereo lithography process – a) and various dental constructions manufactured by it – b)
and c).
The process of fused deposition modeling characterizes with extruding of the thermoplastic materials
through heated nozzle or the material is fed from a reservoir through a syringe. Depending on the strength and thermal properties several types of polymers are used: acrylonitrile butadiene styrene (ABS) polymer, polycarbonates,
polycaprolactone, polyphenylsulfonesand waxes. During
manufacturing process a water-soluble material is used for
temporary supports. This technology is mostly used for
production of wax patterns for subsequent casting [19, 29].
By selective electron beam meltingnear net shape
metal parts can be produced. Theparts are manufactured
by melting of metal powder layerper layer with an electron beam in a high vacuum [17]. This technology permits
production of porous structures from biocompatible metals and alloys such as commercially pure Ti, Ti-6Al-4V alloy and Co-Cr alloys. But the accuracy of SEBM is in the
range of 0,3–0,4 mmand the surface finish tends to be
rough with an Ra value in therange of 25 µm. So, this technology is applied mainly in production of customized implants for orthopedics and maxillofacial surgery and is not
good enough for crown and bridges frameworks [17].
Laser powder forming technique consists of two
978
processes - Selective Laser Sintering (SLS) and Selective
Laser Melting (SLM). In this technology layers of particular powder material are fused into a 3D model by adopting
a computer-directed laser [19]. When processing polymers
and ceramic the term of“selective laser sintering” is used,
whereas the processes for manufacturing of metals and
metal alloys are known as “selective laser melting” (Fig.4)
or “Direct Metal Laser Sintering”(DMLS) [17, 24].This
technology is very attractive for dentistry, particularly for
prosthodontics, because a large variety of materials can be
used as building materials – thermoplastic polymers, investment casting wax, metallic materials (Ti and its alloys, CoCr alloys, stainless steel), ceramics and thermoplastic composites. When using polymers and composites, facial prosthesis, functionally graded scaffolds and customized scaffolds for tissue engineering can be produced by SLS. While
using of metals and alloys, orthopedic and dental implants
even with porous surface [17, 30], dental crowns and
bridges as well as partial denture frameworks can be manufactured by SLM [31-34]. During production process many
constructions can be packed in one powder bad (Fig.4), thus
ensuring high productivity of the laser powder forming technique.
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A
B
Fig. 4. Possibilities of the SLM technology: dental constructions made of Co-Cr alloy – a) and skull with porous
structure made of Ti – b).
In inkjet printing technology an extremely small ink
droplet is ejected towards the substrate. Different substances
can be used as ink -aqueous solution of coloring agents and
binders to a ceramic suspension, such as used in some studies to produce zirconiadental restorations [17, 19, 35]. Another variant of the inkjet printing technology is thatbuilds
up layer by layer by depositing droplets of a polymer and
each formed layer is cured by UV light [17].This technology found wide range of dental applications for reproduction of dental models, orthodontic bracketguides, surgical
guides for implant placement, mouth guards and sleep apnea
appliances.
Additive manufacturing technologies offer a number
of advantages over subtractive technologies and traditional
methods of production: 1) the objects with complex geometry can be produced, without need of any complex machinery setup; 2) the method of production is a controllable, easy
and relatively quick process; 3) the objects can be made of
the same or different materials and depending on the technological regimes the desired properties can be obtained;
4) due to the great variety of the additive manufacturing
processes various materials can be used for production of
different dental constructions for application in many fields
of dentistry. The undoubted advantages of the additive technologies led to their exponential development and wide application in dentistry last decade.
CONCLUSION
Three are the main trends in the development of the
technologies for production of dental constructions last 30
years - digitalization, simulation and implementation of the
additive technologies.
As a result of the digitalization the first CAD–CAM
systems were created in 1970s. In this mode of operation
at first virtual 3D model is generated by CAD, which then
is used for production of the real construction by CAM. On
the first stage of development the data for the 3D model are
obtained by indirect scanning of the plaster model. On the
next stage the data are in result of direct scanning of the
prosthesis area in the patient’s mouth. Implementation of
CAD-CAM systems in dentistry led to elimination of many
manual operations, increase of the constructions’ accuracy
and decrease of the production time and costs.
Computer aided engineering is an intermediate unit
in the CAD-CAM system, which is intended to simulate the
performance of the construction in order to improve its design. It consists of three processes: simulation, validation
and optimization. Using the CAE helps dentists and dental
technicians to create the optimal construction concerning to
mechanical properties and accuracy and to manufacture it
by the optimal process.
In the late 1980sthe new approach to the production
of constructions appeared - by addition of material layer by
layer. The additive technologies were developed, which
characterize with building of one layer at a time from a powder or liquid that is bonded by means of melting, fusing or
polymerization. Stereo lithography, fused deposition
modeling, selective electron beam melting, laser powder
forming and inkjet printing are the methods, mostly used
in dentistry. Their advantages include: production of complex objects of various materials - polymers, composites,
porcelains, metals and metal alloys; manufacturing of parts
with dense structure and predetermined surface roughness;
controllable, easy and relatively quick process. Due to the
great variety of the additive manufacturing processes and
the various materials used, different dental constructions can
be produced for application in many fields of dentistry.
Acknowledgements
The present study is supported by the project with contract B02/19, 12 Dec 2014, of the Fund for Scientific Investigations, Ministry of Education and Science.
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979
Abbreviations:
AM - Additive Manufacturing
ASTM - American Society forTesting and Materials
CAD - Computer Aided Design
CAE - Computer Aided Engineering
CAM – Computer Aided Manufacturing
CT- Computed Tomography
DMLS - Direct Metal Laser Sintering
FDM - Fused Deposition Modeling
FEA - Finite Element Analysis
MRI - Magnetic Resonance Images
SEBM - Selective Electron Beam Melting
SLA – Stereolithography
SLM - Selective Laser Melting
SLS - Selective Laser Sintering
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Please cite this article as: Dikova T, Dzhendov D, Simov M, Katreva-Bozukova I, Angelova S, Pavlova D, Abadzhiev M,
Tonchev T. MODERN TRENDS IN THE DEVELOPMENT OF THE TECHNOLOGIES FOR PRODUCTION OF DENTAL CONSTRUCTIONS. J of IMAB. 2015 Oct-Dec;21(4):974-981. DOI: http://dx.doi.org/10.5272/jimab.2015214.974
Received: 12/09/2015; Published online: 03/12/2015
Address for correspondence:
Assoc. Prof. Dr. Tsanka Dikova,
Vice Dean, Faculty of Dental Medicine, Medical University - Varna
55, Marin Drinov Str., Varna 9000, Bulgaria
mob. tel.: +359 899 883 125
E-mail: tsanka_dikova@abv.bg
/ J of IMAB. 2015, vol. 21, issue 4/
http://www.journal-imab-bg.org
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