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A Comparison of the Surface and Mechanical Properties of 3D Printable

Denture‐Base Resin Material and Conventional Polymethylmethacrylate
(PMMA)

Article in Journal of Prosthodontics · February 2022

DOI: 10.1111/jopr.13491

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A Comparison of the Surface and Mechanical Properties of
3D Printable Denture-Base Resin Material and Conventional
Polymethylmethacrylate (PMMA)
Ziad N. Al-Dwairi, BDS, PhD(QUB), MFDSRCS (England), MFDSRCPS (Glasg), MFDSRCS (Ed), FICCDE,
FACD, FCGDent ,1 Abdulkareem A. Al Haj Ebrahim, BDS,MClinDent,1 & Nadim Z. Baba, DMD, MSD,
FACP 2
1
Department of Prosthodontics, Faculty of Dentistry, Jordan University of Science and Technology (JUST), Irbid, Jordan
2
Advanced Specialty Education Program in Prosthodontics, Loma Linda University, School of Dentistry, CA

Keywords Abstract
Complete denture; CAD-CAM; digital denture;
PMMA; polymethylmethacrylate; 3D printed
Purpose: To study the surface and mechanical properties of 3D printed
resin. denture-base resin materials and compare them with conventional heat-cured
polymethylmethacrylate (PMMA).
Correspondence Materials and methods: Three brands of 3D printed denture-base resin materi-
Dr. Ziad N. Al-Dwairi, Department of als and one conventional heat-cured PMMA were tested in this study: NextDent 3D
Prosthodontics, Faculty of Dentistry, Jordan printed resin, Dentona 3D printed resin, ASIGA 3D printed resin, and Meliodent
University of Science and Technology (JUST), conventional PMMA. Sixty specimens (25 × 25 × 3 mm) were fabricated (n=15
P.O. Box 3030 code 22110, Irbid, Jordan. per group) to perform the following tests: wettability, surface roughness, and micro-
E-mail: [email protected] hardness. One hundred twenty specimens (65 × 10 × 3 mm) were fabricated (n=30
per group) and stored in distilled water at (37 ±1°C) for 7 days. Specimens (N =
Conflict of interest statement: 15) in each group were subjected to the three-point bending test and impact strength
Authors declare no conflicts of interest. test, employing the Charpy configuration on un-notched specimens. The morphology
Funding:
of the fractured specimens was studied under scanning electron microscope (SEM).
Support for this research from the Jordan Statistical analysis was performed using one-way ANOVA and Tukey-pairwise mul-
University of Science and Technology (Grant # tiple comparisons with 95% confidence interval. P-values of ≤0.05 were considered
20200473). significant.
Results: The conventional heat-cured specimens demonstrated the highest means of
Received: October 18, 2021 surface roughness (0.23 ± 0.07 µm), Vickers hardness number (18.11 ±0.65) and
Accepted January 26, 2022 flexural strength (92.44 ±7.91 MPa), and the lowest mean of contact angle (66.71°
±3.38°). ASIGA group showed the highest mean of contact angle (73.44° ±2.74°)
doi: 10.1111/jopr.13491 and the lowest mean of surface roughness (0.19 ±0.03 µm). The highest mean of
impact strength was recorded in the Dentona group (17.98 ±1.76 kg/m2 ). NextDent
specimens showed the lowest means of Vickers hardness number (16.20 ±0.93), flex-
ural strength (74.89 ±8.44 MPa), impact strength (15.20 ±0.69 kg/m2 ), and recorded
the highest mean of bending modulus (2,115.80 ±178.95 MPa).
Conclusions: 3D printed resin exhibited noticeable differences in surface and me-
chanical properties between different brands and with conventional heat-polymerized
PMMA.

The incidence of edentulism has decreased in recent years, ing and rapid prototyping.3–6 3D stereoscopic images are used
however, the number of edentulous patients is rising as life for both the subtractive and the additive methods in restoration
expectancy increases.1 Complete dentures have been used to manufacturing.4 The stereoscopic images from a scanner are
rehabilitate patients with complete edentulism for decades.2 used to virtually design the planned prosthesis. When the de-
Computer-aided design and computer-aided manufacture sign is completed, the data is converted to standard tessellation
(CAD-CAM) technology is currently being used to fabricate language (STL) files and transmitted to each device. The ac-
removable prostheses, including subtractive methods (com- quired data is then used to fabricate the definitive prosthesis.3,4
puter numerical control [CNC] machining; milling) and addi- Blocks of ceramics, wax, resin, or metal can be milled by
tive methods, commonly known as 3-dimensional (3D) print- subtractive manufacturing to obtain the desired prosthesis.3,4

Journal of Prosthodontics 0 (2022) 1–9 © 2022 by the American College of Prosthodontists 1

Comparison of Surface and Mechanical Properties Al-Dwairi et al

One major disadvantage of the subtractive technique is the gen gas with two times 2000 flashes with a 5 min break in
production of excessive leftover material following the milling between.
of the desired prosthesis.4,5 Furthermore, the milling machines The printed specimens were finished using silicon carbide
could have difficulty milling severe undercuts areas during the papers (mega-Schmirgelleinen; megadental, Büdingen, Ger-
machining process.5 many) followed by rubber acrylic burs (Edenta AG, St. Gallen,
3D printing is a modern technology with different appli- Switzerland), pumice (Shera, Lemförde, Germany) and rouge
cations in the field of prosthetic dentistry that has grown (Dialux Rouge; Dialux, Paris, France). Only one surface of
rapidly over the past few years as it saves time, manpower, and each specimen was polished while the other surface was left
ensures perfect marginal fit for the produced construction.7 A intact to mimic the intaglio surface of the denture that is never
significant advantage of 3D printing technologies is the ability polished. All the specimens were prepared by the same oper-
to print objects from different materials such as composites, ator who also measured the dimensions of all the specimens
polymers, metals, and alloys with a dense structure and prede- measuring 65 ×10 × 3 mm using a digital caliper (ABS Digi-
fined surface roughness.7 Moreover, polymerization is carried matic Caliper; Mitutoyo Corp., Kawasaki, Japan) to insure
out in 3D printing by selectively concentrating a laser beam standardization. All the specimens were then stored in distilled
on the selected part of the material, so unnecessary materials water at (37 ±1°C) for 7 days to mimic the plasticizing effect
are not consumed by this process; only the necessary portion exerted by water molecules in saliva.19 The remaining speci-
of the product is obtained.4 With the advancement of digital mens measuring 25 × 25 × 3 mm were stored in distilled water
technology, different dental manufacturers are producing more for 48 hours for residual monomers elimination.
3D printed and CAD-CAM-milled materials.2,8 The surface To prepare the conventionally processed specimens, extra 3D
and mechanical properties of conventionally polymerized printed resin specimens measuring (25 × 25 × 3 mm) and
denture-base acrylics and polyamide,9–15 as well as new data (65 × 10 × 3 mm) were flasked in a two-part mold using
on milled CAD-CAM materials16–21 have been investigated. a Hanau Varsity Flask (Hanau Flask Press No.2; Hanau En-
However, to the authors’ knowledge, there are few published gineering Co., Buffalo, New York). Following the setting of
reports that have investigated the surface and the mechan- the stone, the flasks were opened, and the printed patterns re-
ical properties of 3D printed denture-base resin material. moved. Two coats of stone sealants (Cold Mold Seal; PSP,
Therefore, the aim of this study was to evaluate and com- Kent, United Kingdom) were applied to the stone and heat-
pare surface wettability, surface roughness, surface hardness, polymerized acrylic resin (Meliodent; Heraeus Kulzer, Hanau,
flexural strength, flexural modulus, and impact strength of Germany) mixed following the manufacturer recommendation,
three 3D printed denture-base resin materials to conventional then packed under pressure. The flasks were then placed in
heat-polymerized PMMA. The null hypothesis was that there a thermostatically controlled water bath (Type 5518; KaVo
would be no differences between the surface and mechanical EWL, Biberach, Germany) and cured using a short curing
properties of 3D printed denture-base resin materials and cycle.
conventional heat-polymerized PMMA nor between different Following curing, the flasks were opened, the specimens col-
brands of 3D printed denture-base resin materials. lected, and excess acrylic was trimmed with the use of a tung-
sten carbide acrylic burs (Edenta AG, St. Gallen, Switzerland).
The specimens were then finished and polished exactly as done
Material and methods for the 3D printed resin specimens. Specimen dimensions were
verified using a digital caliper (ABS Digimatic Caliper; Mitu-
Printed resin specimen fabrication
toyo Corp., Kawasaki, Japan). The specimens measuring 65 ×
Two parallel rectangular specimens measuring (25 × 25 × 3 10 × 3 mm were stored in distilled water at (37 ±1°C) for 7
mm) and (65 × 10 × 3 mm) were designed virtually in Auto- days, while specimens measuring 25 × 25 × 3 mm were stored
CAD software (Autodesk AutoCAD 2016 Design software). in distilled water for 48 hours to minimize residual monomer.
The STL file of the virtual design was exported into the ASIGA Each study group of 15 specimens measuring 25 × 25 × 3
Composer software (ASIGA Composer v 1.1.7). The support- mm were used to perform the following surface tests (Fig 1).
ing structure was applied, and the specimens oriented 45° to
the printing table.22,23 Three brands of 3D printed denture-base
Surface wettability
resin materials were used in this study: NextDent Denture 3D+
(NextDent Denture 3D+; Nextdent B.V., Soesterberg, Nether- The angle formed by a drop of distilled water placed on the
lands), Dentona Optiprint Denture 3D Printer resin (Dentona specimen surface was measured using the Sessile drop method.
Optiprint Denture 3D Printer resin; Dentona AG., Dort- A 20 µl drop of distilled water was delivered from a mi-
mund, Germany) and ASIGA DentaBase (ASIGA DentaBase; cropipette (Transferpette S; Sigma Aldrich, St. Louis, MI) on
ASIGA, Sydney, Australia). 500 mL of liquid resin was the polished surface of a horizontally placed specimen on a
needed from each brand to print the specimens. An ASIGA previously tested horizontal bench.9,17 The water drop was left
Max 3D printer (Asiga MAXTM ; ASIGA, Sydney, Australia) to spread for 20 seconds; an image was captured with the use
was used to print the specimens at 50 µm layer thickness. of a Nikon camera (Type D7200; Nikon. Tokyo, Japan) sta-
The specimens were stored for two minutes in an ultrasonic bilized on a tripod and equipped with a 105 mm microlens
bath containing isopropanol (99%). The specimens were poly- (Nikon AF-S VR Micro-NIKKOR 105mm f/2.8G IF-ED Lens;
merized in the light curing unit (Otoflash Post Curing Light Nikon, Tokyo, Japan). The image was then imported and ana-
Pulsing Unit; Envision TEC, Dearborn, Michigan) with nitro- lyzed using AutoCAD 2017 software. The angle (ø) between

2 Journal of Prosthodontics 0 (2022) 1–9 © 2022 by the American College of Prosthodontists

Al-Dwairi et al Comparison of Surface and Mechanical Properties

Figure 1 Specimens 25 × 25 × 3 mm. Figure 2 Specimens 65 × 10 × 3 mm.

the solid line of the specimen and the tangent to the water drop is the load or force at which fracture occurred (N), L is the
was measured on the right and the left side and the average was span of specimen between the supports (50 mm), b is the width
recorded. (10 mm), and d is the thickness of the specimen (3 mm).16,24
The bending modulus was measured from the load-deflection
Surface roughness curve using the formula: E= FL3 / 4Ybd3 . E is the flexural mod-
ulus (MPa), Y is the recorded deflection corresponding to a
Four readings of surface roughness (Ra) were measured on dif-
certain load (f) for a point on a straight-line segment on the
ferent areas of each polished specimen with the use of a digital
load-deflection curve, L is the span of specimen between the
contact profilometer (RT-10; SM S.R.L, Bologna, Italy) which
supports (50 mm), b is the width (10 mm), and d is the thick-
has an accuracy of 0.001 µm and a total measurement length
ness of the specimen (3 mm).14,16
of 0.8 mm. An average of the four readings was calculated and
recorded.
Impact strength
Surface hardness The Charpy impact test was performed on un-notched spec-
imens as described in the International Organization for
Vickers hardness number (VHN) was recorded immediately
Standardization (ISO) standard and the American Society
after removal of the specimens from distilled water with the
for Testing Materials (ASTM) D4812 standard. Corrected
use of a micro hardness tester (Model MHT-1, No.8621; Mat-
absorbed energy (Ec) was recorded and the impact strength
suzawa Seiki Co. LTD., Tokyo, Japan) under a load of 300 g at
of each specimen was calculated according to the formula: I
15 seconds dwell time. Three indentations were conducted on
= Ec/ WT where I is the calculated impact strength kJ/m2 W
each specimen and the pyramids created by the square-based
is the specimen width (m), and T is the thickness (m). The
pyramid indenter were evaluated, and the resulting diagonals
morphology of the fractured surface was evaluated on six
measured. An average of the three VHNs readings was calcu-
randomly selected fractured specimens. Under water cooling,
lated and recorded.
a 5 to 10 mm cut was made away from the fracture line and
the specimens were coated with palladium and the surface
Mechanical tests
morphology of the fractured specimens was examined using a
Each study group of 15 specimens measuring 65 × 10 × 3 scanning electron microscope (SEM) (Quanta 600 FEG; FEI,
mm was used to perform the three-point bending and impact Hillsboro, Oregon) at 1000×.
strength tests (Fig 2).
Statistical analysis
Flexural properties (three-point bending test)
Individual contact angle, surface roughness, VHN, flexural
The flexural strength and the bending modulus were measured strength, flexural modulus, and impact strength values were
with the use of a 3-point bending test on a computer control calculated and tabulated. Mean and standard deviations for
electromechanical universal testing machine (WDW-20; Jinan each test were calculated with the use of an R statistical com-
Testing Equipment, Jinan, China). A 50 mm distance was es- puting software (version 3.14). One-way ANOVA was used
tablished between the two centers of support and a load cell ap- to determine whether significant differences existed among
plied at the midpoint of the specimen with a crosshead speed the study groups (i.e., ASIGA, Dentona, NextDent and con-
of 5 mm/min until fracture (Fig 3). The flexural strength of ventional heat-polymerized PMMA) followed by Tukey Pair-
each specimen was calculated according to the following for- wise multiple comparisons at 95% confidence interval, which
mula: FS = 3FL/ (2bd2 ). FS is the flexural strength (MPa), F were performed to determine which resin group significantly

Journal of Prosthodontics 0 (2022) 1–9 © 2022 by the American College of Prosthodontists 3

Comparison of Surface and Mechanical Properties Al-Dwairi et al

Figure 3 The maximum deflection of specimens immediately before fracture.

differed from the others. p-Values ≤ 0.05 were considered sig-

nificant.

Results
ASIGA group demonstrated the highest mean of contact an-
gle (73.44 ±2.74°), followed by NextDent (72.73 ±2.10°),
Dentona (70.20 ±2.43°). The conventional heat-polymerized
group showed the lowest mean of contact angle (66.71
±3.38°). The difference in mean angles between the conven-
tional heat-polymerized group and 3D printed resin groups
was statistically significant (p ≤ 0.05). Dentona group showed
a significant difference in mean contact angles with ASIGA
group (p ≤ 0.05) while nonsignificant difference was found
with NextDent group (p > 0.05). Also, nonsignificant differ-
ence in mean contact angles was found between NextDent and
ASIGA groups (p > 0.05) (Table 1).
Conventional heat-polymerized showed the highest mean of Figure 4 Load-deflection curves of the four groups together: con-
surface roughness (0.23 ±0.07 µm), followed by NextDent ventional heat-cured in blue, Dentona in orange, ASIGA in gray, and
(0.22 ±0.07 µm) and Dentona (0.21 ±0.06). ASIGA group NextDent in yellow.
showed the lowest mean of surface roughness (0.19 µm
±0.03). The means of the surface roughness between the group and other tested groups was statistically significant
four tested groups were statistically nonsignificant (p > 0.05) (p ≤ 0.05), while the means of the surface microhardness be-
(Table 1). tween the 3D printed resin groups were statistically nonsignif-
The highest mean of VHN was recorded for conventional icant (p > 0.05) (Table 1).
heat-polymerized (18.11 ±0.65) followed by Dentona (16.41 Load-deflection curves were recorded (Fig 4). Conven-
±0.96), ASIGA (16.24 ±0.79), and NextDent (16.20 ±0.93). tional heat-polymerized group showed the highest mean of
The results revealed that the difference in the mean of surface flexural strength (92.44 ±7.91 MPa), followed by Den-
microhardness between the conventional heat-polymerized tona (81.33 ±5.88 MPa) and ASIGA (79.33 ±6.07 MPa).

4 Journal of Prosthodontics 0 (2022) 1–9 © 2022 by the American College of Prosthodontists

Al-Dwairi et al Comparison of Surface and Mechanical Properties

Table 1 P-values and t-values for the performed tests

Conventional Conventional Conventional

Dentona and NextDent and heat-cured and NextDent and heat-cured and heat-cured and
ASIGA ASIGA ASIGA Dentona Dentona NextDent

t-value p-Value t-value p-Value t-value p-Value t-value p-Value t-value p-Value t-value p-Value

Contact angle –3.42 0.010 –0.80 0.890 –5.99 0.000 3.05 0.062 3.25 0.004 5.86 0.000
Surface 1.26 0.750 1.83 0.358 2.09 0.206 0.62 0.914 0.90 0.760 0.28 0.987
roughness
Surface 0.55 0.940 –0.12 0.999 7.09 0.000 –0.62 0.899 –5.69 0.000 –6.55 0.000
hardness
Flexural 0.92 0.870 –1.66 0.334 5.09 0.000 –2.43 0.077 –4.36 0.000 –5.88 0.000
strength
Flexural –1.90 0.268 4.84 0.000 4.35 0.000 7.00 0.000 –6.48 0.000 0.47 0.962
modulus
Impact strength 1.91 0.143 –3.21 0.037 –0.18 0.997 –5.69 0.000 2.12 0.094 –3.07 0.060

The NextDent group showed the lowest mean of flexural diate fractures. NextDent specimens showed a lower number of
strength (74.89 ±8.44 MPa). The statistical analysis showed intermediate fractures, while Dentona specimens exhibited the
significantly higher flexural strengths for the conventional highest number of intermediate fractures.
heat-polymerized group in comparison to 3D printed resin
groups (p ≤ 0.05). Whereas the difference in means among Discussion
3D printed resin groups was not statistically significant
(p > 0.05) (Table 1). This study compared the mechanical and surface properties
The highest mean of flexural modulus was recorded in the of different brands of 3D printed denture-base resin materi-
NextDent group (2,115.80 ±178.95 MPa). Coming next was als and compared them with conventional heat-polymerized
the conventional heat-polymerized group (2,084.99 ±180.33 PMMA. The null hypotheses of this study, which assumed that
MPa) and the ASIGA group (1,801.40 ±176.86 MPa), no differences would be found between the surface or me-
while the Dentona group showed the lowest mean of bend- chanical properties of 3D printed denture-base resin material
ing modulus (1,685.09 ±157.14 MPa). The difference in and conventional heat polymerized PMMA nor between dif-
flexural modulus means between the NextDent group and ferent brands of 3D printed denture-base resin material, was
the conventional heat-polymerized group was not statisti- partially rejected. Statistical differences were found between
cally significant (p > 0.05), while flexural modulus means study groups in surface wettability, surface hardness, flexural
of both groups were statistically significant from the other properties, and impact strength, whereas no significant differ-
tested groups (p ≤ 0.05). However, the difference between ences in surface roughness among study groups were detected
ASIGA and Dentona groups was statistically nonsignificant (p > 0.05).
(p > 0.05) (Table 1). The calculated mean of contact angles of the conventional
The Dentona group demonstrated the highest mean of im- heat-polymerized samples in this study (66.71° ±3.38°) was
pact strength (17.98 ±1.76 kg/m2 ). Followed by the ASIGA lower than the range of contact angles of 3D printed sam-
and the conventional heat-polymerized groups, which they ex- ples (70.20° ±2.43° to 73.44° ±2.74°). Al-Dwairi et al17 re-
hibited close means of impact strength (16.76 ±1.75 and 16.64 ported that the mean of contact angles for the conventional
±1.69 kg/m2 ) respectively. The NextDent group showed the heat-polymerized specimens (65.97° ± 4.67°) was close to the
lowest mean of impact strength (15.20 ±0.69 kg/m2 ). Statisti- mean angles obtained by this study for the conventional group.
cal analysis revealed that the difference in the means of impact While milled PMMA materials showed higher means of con-
strength between the conventional heat-polymerized group and tact angles ranging from (69.53° ±3.87° to 72.87° ±4.83°).17
3D printed resin groups was not statistically significant (p > The results of the contact angles obtained in this study were in
0.05), while the means of impact strength between NextDent accordance with the results obtain on the previously mentioned
group and both ASIGA and Dentona groups were statisti- study. The increased contact angles among the 3D printed and
cally significant (p ≤ 0.05). However, the difference between milled PMMA could be due to inherent characteristic features
ASIGA and Dentona groups was not statistically significant (p of their surfaces. Surface energy can be influenced by chem-
> 0.05) (Table 1). ical composition, topography, and salivary pellicle, as well as
Brittle fractures reveal well-defined, organized, compact, and charge.19 Increased hydrophobicity of 3D printed denture-base
flat surface fractures.11 Intermediate fractures reveal irregular, resin material could have an effect on the 3D printed denture
disorganized surfaces11 (Figs 5 to 8). Specimens of all groups material to retain stains, plaque and microorganisms, as well as
demonstrated a higher number of brittle fractures than interme- water sorption.17

Journal of Prosthodontics 0 (2022) 1–9 © 2022 by the American College of Prosthodontists 5

Comparison of Surface and Mechanical Properties Al-Dwairi et al

Figure 5 SEM scanning at 1000× showing the fracture morphology of ASIGA specimens. (a) Brittle fracture mode (i.e., smooth and compact surface)
and (b) an intermediate form of fracture (i.e., jagged and rough appearance).

Figure 6 SEM scanning at 1000× showing the fracture morphology of Dentona specimens. (a) Brittle fracture mode (i.e., smooth and compact surface)
and (b) an intermediate form of fracture (i.e., jagged and rough appearance).

Smooth denture surfaces help reduce the retention of plaque tributed to the differences in polishing techniques and instru-
and microorganism, as microbial adhesion and colonization ments used.
typically occur on nonshedding surfaces.12,13 Studies have Hardness is a measure of how resistant a material is to
shown that a surface roughness (Ra) of 0.2 um is a clini- localized plastic deformation caused by mechanical indenta-
cally acceptable value.24,25 Therefore, finishing and polishing tion or abrasion.8,17 Dentures made of low-surface-hardness
of dental prostheses are mandatory to reduce surface rough- materials can be damaged by mechanical brushing, resulting
ness. In the present study, the mean surface roughness be- in plaque retention and pigmentation, which can reduce den-
tween the four tested groups, ranging from (0.19 ±0.03 to 0.23 ture life.8,26 3D printed denture-base resin groups exhibited
±0.07 µm) were not statistically significant (p > 0.05). This lower surface hardness in comparison to the conventionally
finding is comparable to that of Fernandez et al,23 who in- heat-polymerized group which might be associated to the
vestigated the polishability of 3D printed and milled denture level of residual monomers as residual monomer content was
materials in comparison to conventionally heat polymerized found to adversely affect the surface hardness.17,26 Farina et
PMMA. They reported no statistically significant differences in al27 reported that homogenous heating of PMMA produced
the intermediate-polished specimens among the groups, while higher monomer conversion, less plasticizing effect of residual
lower Ra values were observed for high gloss-polished 3D monomers, and hence an increased surface hardness. A study
printed and milled specimens compared to conventionally pro- by Prpić et al8 found that the surface hardness of milled
cessed PMMA. However, Alp et al,20 Al-Dwairi et al,17 and and heat-polymerized PMMA was higher when compared
Srinivasan et al21 reported greater Ra values after the final pol- to 3D-printed materials. Ayman compared milled to heat-
ishing of milled PMMA dentures from various manufacturers. polymerized PMMA and found that milled PMMA had higher
These differences in Ra values between the studies may be at- hardness values.18

6 Journal of Prosthodontics 0 (2022) 1–9 © 2022 by the American College of Prosthodontists

Al-Dwairi et al Comparison of Surface and Mechanical Properties

Figure 7 SEM scanning at 1000× showing the fracture morphology of NextDent specimens. (a) Brittle fracture mode (i.e., smooth and compact
surface) and (b) an intermediate form of fracture (i.e., jagged and rough appearance).

Figure 8 SEM scanning at 1000× showing the fracture morphology of conventional heat-cured specimens. (a) Brittle fracture mode (i.e., smooth and
compact surface) and (b) an intermediate form of fracture (i.e., jagged and rough appearance).

Flexural strength is a collective measurement of compres- lower double-bond conversion, which can affect the mechan-
sive, tensile, and shear stresses of different materials. The flex- ical properties.8 In contrast, with milled PMMA, high pres-
ural strength of milled PMMA varies among studies.8,18,28,29 sure contributes to the development of longer polymer chains
When comparing the flexural strength of heat-polymerized to and can lead to a higher degree of monomer conversion. Fur-
milled denture-base resins, Steinmassl et al28 obtained simi- thermore, inorganic fillers, as well as high temperature used
lar, lower, or higher flexural strength values than the control during the manufacturing process of the milled PMMA puck
group did. Ayman18 and Pacquet et al29 found higher flexural improves the mechanical properties of the PMMA, including
strength values of heat-polymerized PMMA when compared flexural strength.23 Although, the 3D-printed groups had lower
to milled denture-base material. On the other hand, Prpić et flexural strength values when compared to milled and heat-
al8 found that milled PMMA showed higher flexural strength polymerized PMMA, they still met the ISO requirements for
than heat-polymerized and 3D-printed resins. They also found flexural strength (65 MPa).8 In spite of their lower flexural
that 3D-printed material (NextDent) had the lowest flexural strength values when compared to other materials used for den-
strength when compared to milled PMMA, polyamide and ture fabrication, 3D-printed materials are an alternative option
conventionally heat-polymerized groups.8 The results of this for denture fabrication.
study agree with those of Prpić et al,8 where conventional Flexural modulus reflects the material’s stiffness and
heat-polymerized material showed higher flexural strength val- rigidity.10,16 Higher flexural modulus is often advantageous in
ues than 3D printed denture-base resin materials. The flexural clinical settings. Bending modulus values of NextDent and
strength values obtained in this study can be explained accord- conventional groups obtained the recommendation of the ISO
ing to the inner structures of the materials. 3D printed acrylic 20795−1, which states that the flexural modulus of the pro-
resins used for the printing of removable denture-bases have a cessed modulus shall not be lower than 2 GPa.14 On the other

Journal of Prosthodontics 0 (2022) 1–9 © 2022 by the American College of Prosthodontists 7

Comparison of Surface and Mechanical Properties Al-Dwairi et al

hand, Dentona and ASIGA groups did not fulfill this prereq- and mechanical properties before recommending 3D printing
uisite. Both of these materials exhibited considerable bending as a standard manufacturing technique for the fabrication of
before fracture (Fig 3). complete dentures are required.
Impact strength is considered a critical mechanical param-
eter because it is a reflection of denture fracture vulnerabil-
ity, particularly upon accidental dropping.16,30 In this study the
difference in the means of impact strength between the conven-
tional heat-polymerized group and 3D printed resin groups was References
not statistically significant (p > 0.05). A study by Al-Dwairi 1. Slade GD, Akinkugbe AA, Sanders AE: Projections of U.S.
et al16 used research samples and the method of conducting edentulism prevalence following 5 decades of decline. J Dent
the impact test similar to this study to compare the impact Res 2014;93:959-965.
strength of milled PMMA with conventional heat-polymerized 2. Anadioti E, Musharbash L, Blatz MB, et al: 3D printed
PMMA. The results showed that the milled material had higher complete removable dental prostheses: a narrative review. BMC
Oral Health 2020;20:343.
impact strength values (24.56 ±2.63 to 29.56 ±6.94 kJ/m2 )
3. Alghazzawi TF: Advancements in CAD/CAM technology.
in comparison to the conventional heat-polymerized acrylic Options for practical implementation. J Prosthodont Res
(14.76 ±2.11 kJ/m2 ). The present study results showed im- 2016;60:72-84.
pact strength values for 3D printed resins ranging from (15.20 4. Bae EJ, Jeong ID, Kim WC, et al: A comparative study of
±0.69 to 17.98 ±1.76 kJ/m2 ) and (16.64 ±1.69) for conven- additive and subtractive manufacturing for dental restorations. J
tional heat-polymerized samples. The superiority of impact Prosthet Dent 2017;118:187-193.
strength in the milled materials in comparison to 3D printed 5. Kalberer N, Mehl A, Schimmel M, et al: CAD-CAM milled
resin and conventional heat polymerized acrylic might be re- versus rapidly prototyped (3D-printed) complete dentures: an in
lated to the unique manufacturing process of these materi- vitro evaluation of trueness. J Prosthet Dent 2019;121:637-643.
als since they are milled from prepolymerized PMMA pucks 6. Bidra AS, Taylor TD, Agar JR: Computer-aided technology for
fabricating complete dentures: systematic review of historical
which are polymerized under high temperatures and pressure
background, current status, and future perspectives. J Prosthet
values.8,23 Dent 2013;109:361-366.
SEM was used to study the fractographic appearance of all 7. Katreva IP, Dikova T, Abadzhiev M, et al: 3D-printing in
specimens. Similarly, to previously published studies,11,16 the contemporary prosthodontic treatment. Scripta Scientifica
specimens of all the groups in this study demonstrated a higher Medicinae Dentalis 2016;2:7-11.
number of brittle fractures than that of intermediate fractures. https://doi.org/10.14748/ssmd.v1i1.1446
NextDent specimens showed a lower number of intermediate 8. Prpić V, Schauperl Z, Ćatić A, et al: Comparison of mechanical
fractures. One possible explanation is that perhaps this resin properties of 3D-printed, CAD/CAM, and conventional denture
suffers little plastic deformation, and absorbs less energy dur- base materials. J Prosthodont 2020;29:524-528.
ing the impact strength test.11 Dentona specimens exhibited the 9. Al-Dwairi ZN, Al-Quraan FA, OY AL-O: The effect of
antifungal agents on surface properties of poly (methyl
highest number of intermediate fractures. Therefore, it can be
methacrylate) and its relation to adherence of Candida albicans.
concluded that increased impact strength results in increased J Prosthodont Res 2012;56:272-280.
intermediate fractures.15 10. Meng TR, Latta MA: Physical properties of four acrylic denture
Although it may seem rational to compare materials based on base resins. J Contemp Dent Pract 2005;6:93-100.
how they were manufactured (e.g., 3D printing, CAD-CAM, 11. Faot F, Costa MA, Cury AA, et al: Impact strength and fracture
or heat polymerized), the surface and mechanical features of morphology of denture acrylic resins. J Prosthet Dent
the chosen denture base material are purely determined by the 2006;96:367-373.
material itself. However, when compared to other conventional 12. Al-Fouzan AF, Al-mejrad LA, Albarrag AM: Adherence of
methods, creating dentures using 3D printers is simple, rapid, Candida to complete denture surfaces in vitro: a comparison of
and inexpensive; as a result, it is predicted that 3D printing will conventional and CAD/CAM complete dentures. J Adv
Prosthodont 2017;9:402-408.
become more widespread in the future. Although this study
13. Choi JJ, Uy CE, Raman RS, et al: Evaluation of surface
involved in vitro evaluation of some surface and mechanical roughness, hardness and elastic modulus of nanoparticle
properties of three brands of 3D printed resin and conventional containing light-polymerized denture glaze materials. J Mech
heat-polymerized PMMA, it is still predictive of clinical situ- Behav Biomed Mater 2020;103:103601.
ations. Other properties such as porosity, candida adherence, 14. Ucar Y, Akova T, Aysan I: Mechanical properties of polyamide
water sorption, fracture toughness, residual monomer levels, versus different PMMA denture base materials. J Prosthodont
material and color stability, material compatibility with con- 2012;21:173-176.
ventional relines, and biocompatibility may be fields of future 15. Praveen B, Babaji HV, Prasanna BG, et al: Comparison of
investigations. impact strength and fracture morphology of different heat cure
denture acrylic resins: an in vitro study. J Int Oral Health
2014;6:12-16.
Conclusions 16. Al-Dwairi ZN, Tahboub KY, Baba NZ, et al: A comparison of
the flexural and impact strengths and flexural modulus of
Based on the findings of this in vitro study, differences in CAD/CAM and conventional heat-cured polymethyl
surface and mechanical properties were found within differ- methacrylate (PMMA). J Prosthodont 2020;29:341-349.
ent brands of 3D printed resin and with conventional heat- 17. Al-Dwairi ZN, Tahboub KY, Baba NZ, et al: A comparison of
polymerized PMMA. Further studies to evaluate other surface the surface properties of CAD/CAM and conventional

8 Journal of Prosthodontics 0 (2022) 1–9 © 2022 by the American College of Prosthodontists

 Al-Dwairi et al Comparison of Surface and Mechanical Properties

polymethylmethacrylate (PMMA). J Prosthodont methacrylate) denture base material reinforced with different
2019;28:452-457. fillers. J Prosthet Dent 2016;116:803-810.
18. Ayman AD: The residual monomer content and mechanical 25. Bourlidi S, Qureshi J, Soo S, et al: Effect of different initial
properties of CAD/CAM resins used in the fabrication of finishes and Parylene coating thickness on the surface properties
complete dentures as compared to heat cured resins. Electron of coated PMMA. J Prosthet Dent 2016;115:363-
Physician 2017;9:4766-4772. 370.
19. Foggi CC, Machado AL, Zamperini CA et al: Effect of surface 26. Ajay R, Suma K, Rakshagan V, et al: Effect of novel
roughness on the hydrophobicity of a denture-base acrylic resin cycloaliphatic comonomer on surface roughness and surface
and Candida albicans colonization. J Investig Clin Dent hardness of heat-cure denture base resin. J Pharm Bioallied Sci
2016;7:141-148. 2020;12:67-72.
20. Alp G, Johnston WM, Yilmaz B: Optical properties and surface 27. Farina AP, Cecchin D, Soares RG, et al: Evaluation of Vickers
roughness of prepolymerized poly(methyl methacrylate) denture hardness of different types of acrylic denture base resins with
base materials. J Prosthet Dent 2019;121:347-352. and without glass fibre reinforcement. Gerodontology
21. Srinivasan M, Gjengedal H, Cattani-Lorente M, et al: 2012;29:155-160.
CAD/CAM milled complete removable dental prostheses: an in 28. Steinmassl O, Offermanns V, Stöckl W, et al: In vitro analysis
vitro evaluation of biocompatibility, mechanical properties, and of the fracture resistance of CAD/CAM denture base resins.
surface roughness. Dent Mater J 2018;37:526-533. Materials (Basel) 2018;11:401.
22. Hada T, Kanazawa M, Iwaki M, et al: Effect of printing https://doi.org/10.3390/ma11030401
direction on the accuracy of 3D-printed dentures using 29. Pacquet W, Benoit A, Hatège-Kimana C, et al: Mechanical
stereolithography technology. Materials (Basel) 2020;13:3405. properties of CAD/CAM denture base resins. Int J Prosthodont
23. Fernandez P, Unkovskiy A, Benkendor V, et al: Surface 2019;32:104-106
characteristics of milled and 3D printed denture base materials 30. Dikbas I, Gurbuz O, Unalan F, et al: Impact strength of denture
following polishing and coating: an in-vitro study. Materials polymethyl methacrylate reinforced with different forms of
(Basel) 2020;13:3305. E-glass fibers. Acta Odontol Scand 2013;71:727-
24. Kul E, Aladağ LI, Yesildal R: Evaluation of thermal 732.
conductivity and flexural strength properties of poly (methyl

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