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Build Angle: Does It Influence the Accuracy of

3D-Printed Dental Restorations Using


Digital Light-Processing Technology?
Reham B. Osman, BDS, MSc, PhD1/Nawal Alharbi, BDS, MSc2/Daniel Wismeijer, DDS, PhD3

Purpose: The aim of this study was to evaluate the effect of the build orientation/build angle
on the dimensional accuracy of full-coverage dental restorations manufactured using digital
light-processing technology (DLP-AM). Materials and Methods: A full dental crown was
digitally designed and 3D-printed using DLP-AM. Nine build angles were used: 90, 120, 135,
150, 180, 210, 225, 240, and 270 degrees. The specimens were digitally scanned using a high-
resolution optical surface scanner (IScan D104i, Imetric). Dimensional accuracy was evaluated
using the digital subtraction technique. The 3D digital files of the scanned printed crowns (test
model) were exported in standard tessellation language (STL) format and superimposed on the
STL file of the designed crown [reference model] using Geomagic Studio 2014 (3D Systems).
The root mean square estimate (RMSE) values were evaluated, and the deviation patterns on
the color maps were further assessed. Results: The build angle influenced the dimensional
accuracy of 3D-printed restorations. The lowest RMSE was recorded for the 135-degree
and 210-degree build angles. However, the overall deviation pattern on the color map was
more favorable with the 135-degree build angle in contrast with the 210-degree build angle
where the deviation was observed around the critical marginal area. Conclusions: Within
the limitations of this study, the recommended build angle using the current DLP system was
135 degrees. Among the selected build angles, it offers the highest dimensional accuracy
and the most favorable deviation pattern. It also offers a self-supporting crown geometry
throughout the building process. Int J Prosthodont 2017;30:182–188 . doi: 10.11607/ijp.5117

R ecently there has been a burgeoning increase in


the implementation of digital tools in the field of
restorative dentistry. Digital fabrication technologies
AM has a unique advantage over conventional mill-
ing production methods: it produces practically no
waste material, there is no restriction in geometric
involve computer-aided design/computer-assisted shape of the products, and tolerance of milled parts is
manufacture (CAD/CAM) techniques through either no longer an issue.1,2 This allows AM technologies to
subtractive (milling) or additive (3D printing) manu- be a key component in the mass production of parts
facturing (AM). with special geometric requirements.2 The fabrication
of fixed dental crown and bridge restorations with their
unique buccal, lingual, mesial, and distal contours and
1Lecturer, Removable Prosthodontics Department, Faculty of Dentistry, sophisticated occlusal outlines is an example.
Cairo University, Giza, Egypt; Research Associate, Department of Oral
Among the various AM techniques, digital light pro-
Implantology and Prosthetic Dentistry, Academic Centre for Dentistry
Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit,
cessing (DLP) is gaining increased popularity in the
Amsterdam, The Netherlands. production of dental parts.3–5 In a DLP build process,
2PhD Candidate, Oral Implantology and Prosthetic Dentistry, a highly complex structure is fabricated on a layer-by-
Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van layer basis directly from 3D data, whereby consecutive
Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands;
liquid photoactivated monomer layers are exposed to
Lecturer, Prosthetic Dental Science Department, College of Dentistry,
King Saud University. Riyadh, Saudi Arabia.
UV light and cured based on the final shape of the
3Professor of Oral Implantology and Prosthetic Dentistry and Head of the required product. The DLP process involves a digital
Department of Oral Implantology and Prosthetic Dentistry, Academic micromirror device (DMD) that is used to dynamically
Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and define a mask image that is projected on the resin
Vrije Universiteit, Amsterdam, The Netherlands.
surface.6–9 DMDs consist of hundreds of thousands
Correspondence to: Dr Nawal Murshed Alharbi, Department of of individually moving micromirrors that control the
Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry reflection path of light. Each pixel of the image corre-
Amsterdam (ACTA), Gustav Mahlerlaan 3004, 1081 LA Amsterdam,
sponds to an individual micromirror, the orientation of
The Netherlands. Email: nawalmurshed@gmail.com
which can be switched among several degrees based
©2017 by Quintessence Publishing Co Inc. on the geometry of the part to be printed.9,10

182 The International Journal of Prosthodontics


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Osman et al

Fig 1 (right)  STL model of the designed restoration (the occlusal


and fitting surface). Antirotation feature (a); flat occlusal surface (b);
tapered axial wall with 6-degree angle (c).

Fig 2 (below)  3D-printed specimens using different build angles. a

Buccal Lingual

90 120 135 150 180 210 225 240 270


Build angle (degrees)

Direct capture of the geometric features of the ob- Materials and Methods
ject during the build process is limited by the spe-
cific machine design and the fact that photoactivated Printing of Specimens
monomers often do not change optical characteristics
in the polymerization process.9 Customization of build A virtual full-coverage crown restoration was designed
angle/orientation during the build process is one of on a virtual die simulating an actual tooth preparation
the factors that can improve the geometrical accu- using the 3-Shape Dental System TM CAD solution.
racy as well as the structural properties of the final The crown design is shown in Fig 1. Crown design and
3D-printed part by using the full capabilities of the model preparation have been previously described in
light source.11 detail.12
In the same context, a study by Alharbi et al12 The digital data of the crown restoration were ex-
evaluated influence of build angle and support con- ported in standard tessellation language (STL) format,
figuration (thick vs thin) on the dimensional accura- which was used for the 3D printing of dental crowns
cy of full-coverage dental restorations printed using using DLP technology. The crowns were fabricated
stereolithography (SLA) technology. The findings of using nine different build angles; 90, 120, 135, 150,
the study revealed that both factors influence the di- 180, 210, 225, 240, and 270 degrees (Fig 2). Initially,
mensional accuracy of the printed parts. The optimal the crown was rotated 90 degrees where the support
build angle should provide self-supported geometry structure was located on the lingual surface, and this
and thus require minimal support structure during the was considered the start build angle. Subsequently,
build process.12 However, similar studies in the dental the object was rotated at nine different build angles
literature investigating the influence of various techni- until the support was located on the buccal surface of
cal factors involved in DLP technique on the accuracy the crown. The support structure was generated semi-
of printed dental restorations are lacking. automatically; the software automatically configured
Therefore, the aim of the current study was to evalu- any surface that needed support within each build an-
ate the effect of the build orientation/build angle on the gle. Any support structure automatically generated at
dimensional accuracy of full-coverage dental restora- the fitting surface of the crown was manually removed.
tions manufactured using DLP-AM technology. The location of support was generated based on the

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Influence of Build Angle on Accuracy of 3D-Printed Dental Restorations

90 120 135 150 180 210 225 240 270


Build angle (degrees)

Fig 3   Red areas represent crown surfaces where support structure was generated in different build angles.

Z-axis

Build platform

Printed object Y-axis X-axis

Resin vat

Motor

Lens
30° LED light source

DMD
Build platform

Fig 4  Red arrows represent surfaces with < 30 Fig 5   DLP printing technique.
degrees that must be supported.

Table 1   M
 aterial Properties of NextDent C&B wavelength of 390–420 nm) and 10.0 W/m2
Property Model Value energy output. The build platform size was
Brookfield viscosity at 23 degrees 0.9–1.4 Pa ASTM D2162
110 × 62 mm and the resolution was 1,080
× 1,920 pixels. The pixel size was 0.058 mm,
Flexural strength 85–100 MPa ISO 10477:2003 and the layer thickness was 50 µm. The x-y
Flexural modulus 2.300–2.500 MPa ISO 10477:2003 accuracy of this DLP system as reported by
Charpy impact strength unnotched 12–15 kJ/mm2
the manufacturer is ± 29 µm.13 Fig 5 pres-
ISO 179: 2010
ents a schematic drawing describing the
Water sorption < 30 μg/mm2 ISO 10477:2004 mechanism of the DLP process.
Water solubility < 5 μg/mm2 ISO 10477:2004 All crowns were printed using NextDent
C&B material (Shade A2, NextDent) with
Hardness shore (D) 80–90 ISO 868:2003
similar printer settings. The material prop-
erties as reported by the manufacturer are
presented in Table 1.
angle between the building platform and the long axis of the ob-
ject; any horizontal surface forming an angle of < 30 degrees with Specimen Preparation for Analysis
the long axis was supported as shown in Figs 3 and 4.
The crowns were printed using RapidShape D30 DLP printer After printing, all specimens were cleaned
(Rapid Shape) with each crown fabricated at the center of the with 96% alcohol for 5 minutes and post-
build platform. The DLP printer uses an LED light source, a DMD cured for 30 minutes using ultraviolet
device/chip, a lens, a resin vat, and a build platform moving along curing unit LC 3DPrint Box (NextDent)
the z-axis (Fig 5). The DMD device is composed of several mi- following the manufacturer’s instruc-
cromirrors that dynamically reflect the light either toward (on) or tions.14 The specimens were stored in a
away from the vat (off) to create light or dark pixels, respectively. lightproof box and tested within 10 days of
The LED light used had a wavelength of 405 nm (narrow spectrum fabrication.

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Osman et al

0.08
0.07
0.06
0.05
RMSE (mm)
0.04
0.03
0.02
0.01
0
90 120 135 150 1800 210 225 240 270
Build angle (degrees)

Fig 6   RMSE values in all build angles.

Table 2   D
 eviations of all Build Angles
Build angle RMSE Maximum deviation Maximum deviation Average deviation Average deviation SD
(degrees) (mm) (+) (mm) (−) (mm) (+) (mm) (−) (mm) (mm)
 90 0.072 0.209 −0.549 0.033 −0.058 0.066
120 0.056 0.341 −0.449 0.022 −0.050 0.048
135 0.049 0.547 −0.408 0.026 −0.043 0.044
150 0.055 0.515 −0.343 0.034 −0.045 0.049
180 0.064 0.547 −0.543 0.044 −0.054 0.053
210 0.049 0.542 −0.549 0.025 −0.040 0.042
225 0.050 0.320 −0.444 0.034 −0.039 0.048
240 0.051 0.325 −0.504 0.022 −0.041 0.046
270 0.061 0.301 −0.550 0.033 −0.047 0.060

Analysis Statistical Analysis

All specimens were digitally scanned using a high-res- Intraobserver reliability was assessed using intraclass
olution optical surface scanner (IScan D104i, Imetric). correlation coefficient. To assess the observer bias,
Prior to scanning, the scanner was calibrated accord- measurements of all build angles were taken twice by
ing to the manufacturer’s instructions. The specimens one observer with an interval of 15 days between the
were examined for any manufacturing defects and two measurements. Furthermore, possible errors from
sprayed with a thin layer of antireflective powder (3D optical scanning were excluded by assessing the re-
Scan Spray, Helling). peatability of the measurements six times in one ran-
The accuracy of the printed crowns was then evalu- domly selected build angle.
ated using a digital subtraction technique. The STL
files of the scanned printed crowns (test model) and Results
that of the designed crown (reference model) were
exported in Geomagic Studio (3D Systems). The ex- The intraclass correlation coefficient was 0.99, which
ported files were aligned to have the same coordinate reflects high reliability of the measurements and elim-
systems. The alignment was further refined using inates any possible observer bias. The repeatability
automatic best-fit alignment based on the closest of the measurements was high as is evident from the
point algorithm (ICP) system. Prior to the alignment RMSE values of the six repeated measurements of the
process, the support structure was virtually removed randomly selected build angle (120 degrees).
to eliminate any potential error during the procedure. RMSE values of all the build angles are shown in
The accuracy was then evaluated through root mean Table 2 and Fig 6. Maximum deviation was observed
square estimate values (RMSE) and deviation pat- with the 90-degree build angle followed by 180- and
terns on color maps. All specimens were scanned and 270-degree angles where the RMSE values were
analyzed by one trained operator. 0.072 mm, 0.064 mm, and 0.061 mm, respectively. The

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Influence of Build Angle on Accuracy of 3D-Printed Dental Restorations

90 120 135 150 180 210 225 240 270


Buccal

Lingual

Fig 7   Deviation pattern on the color-map. Deviation within 0.030 mm marked in green, ≥ 0.100 mm marked in red,
≤ −0.100 mm marked in dark blue.

Positive deviation of fitting surface at


close vicinity to support structure and on Attachment of
opposing wall to support support structure
Buccal Buccal Buccal

Lingual Lingual Lingual


90 degrees 180 degrees 270 degrees
Attachment of Support structure located
support structure on the occlusal surface

Fig 8   Fitting surface view of build angles 90, 180, and 270 degrees.

An average deviation of 100 µm decrease of the


crown margins relative to the reference crown was
observed on the color maps for all the build angles
Test Test (Fig 7). Furthermore, an increase in the positive de-
model model
viation was observed on the fitting surfaces of printed
Reference
crowns in areas in close vicinity to the support struc-
Reference model ture and on the opposing wall as denoted by the red
model areas on the color maps as observed with build angles
90, 180, and 270 degrees (Fig 8). In other words, the
wall of the printed crowns in the previously described
areas will be thicker in comparison to the reference
model, thus the expected tighter fit (Fig 9).

Discussion

The aim of this study was to evaluate the effect of the


support/build angle on the dimensional accuracy of
Fig 9  Greater wall thickness of printed restoration relative to the full-coverage dental restorations fabricated using the
reference model.
DLP-AM technique.
Nine full-coverage dental crowns were 3D printed
using nine different build angles. To minimize and/or
minimum RMSE values were recorded for 135- and eliminate all potential handling and processing errors,
210-degree build angles (0.049 mm). However, scru- several measures were taken. Each crown was printed
tiny of the deviation patterns of both angles on the individually in the center of the build platform. One
color map reveals that the 135-degree build angle trained practitioner performed the fabrication and
exhibits a more favorable deviation pattern that is lo- postcuring process. The restoration was designed
cated further away from the critical marginal area. on a customized virtual die to eliminate any error

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Osman et al

encountered from digital impression of a real tooth A previous study that evaluated the geomet-
preparation.15,16 Further, the virtual die allowed for a ric accuracy of the printed crown fabricated using
simple flat design of fitting surfaces of the printed SLA technique reported a maximum RMSE value of
crowns and thus enhanced the digital superimposi- 0.042 mm, which is still less than the minimal devia-
tion process. The antirotational feature in the fitting tion reported in this study (0.049 mm). This can be
surface of the crown prevented any rotational move- attributed to the difference between the two manu-
ment during the scanning and analysis procedures.12 facturing techniques. The precision of DLP printing
The results were interpreted taking into consider- is further influenced by the optical specifications
ation the RMSE values and the deviation pattern on integrated in the system; DMD device, lens quality,
the color maps. Maximum, minimum, and average pixel size, and platform resolution.7,9 Furthermore,
deviation values were not considered when the accu- these results are in line with various reports in the
racy was evaluated. The deviation values can be either literature stating SLA technique to be one of the most
positive or negative, which when averaged to provide accurate techniques amongst additive manufacturing
the arithmetic mean can preclude any existing actual technologies.18,19 However, it would be wise to con-
difference.17 clude that no single 3D-printing technique is superior
In this study, the minimum RMSE value was 0.049 to another, but that a properly selected technique fits
mm for both 135- and 210-degree build angles, the intended use.5,20
whereas the maximum value was 0.072 mm for the The results of this study revealed that a build an-
90-degree build angle. This can be explained by gle of 135 degrees offers the lowest deviation and
the fact that angulation of the crown with 135- and the most favorable deviation pattern. However, the
210-degree build angles offered the most self-sup- results of this study should be carefully interpreted
porting geometry in comparison to other build angles. when using different DLP systems, other printing
This assumption can be confirmed by observing the materials, and different designs of the printed parts.
increase and decrease pattern of the RMSE values re- Nevertheless, the selected build angle for any system
lated to the difference in supported and unsupported must ensure high accuracy, self-supported geometry,
surfaces of the printed crowns. The highest RMSE minimal support structure, and minimal fabrication
values were observed with build angles 90, 180, and time. In this study, one aspect of DLP technology was
270 degrees, where most of the fitting surfaces were explored. Factors to be evaluated in the future could
unsupported, whereas lower values were observed for include the depth of cure/light intensity and the posi-
the angles in between with the increase in the self- tion of the part within the build platform. Future de-
supported geometry of the printed crowns (Fig 6). velopments in materials applied and in the different
Though the RMSE value for both 135- and 210-degree technical aspects of DLP systems, such as the quality
build angles was the same, the pattern of deviation on of the lens and DMD device and the light source, are
the color map was different. The deviation pattern in ongoing and mandatory. This will guarantee a leading
the 135-degree build angle was more favorable and place for DLP technology among other 3D-printing
located farther from the critical margin area. techniques in the dental field.
Further analysis of the color map revealed positive Limitations of this study are acknowledged and in-
deviation on the fitting surfaces close to the support clude limited generalizability of the result due to dif-
structure and on the opposing wall. This finding can ferent printers specifications and materials, but the
be attributed to the upward movement of the building general concept explaining the findings remains un-
platform during the fabrication process and sagging of changed. Further drawbacks involve inherited errors
the material under its own weight. On the other hand, associated with any digital subtraction procedure and
the positive deviation on the wall opposing the sup- potential scanning and slicing errors. However, the
port structure can be explained by the curing pattern knowledge added to this field outweighs any potential
of the DLP technique. In the DLP system, the whole limitation and presents a stepping stone for further
layer is illuminated at once, and those walls may be studies in this field.
exposed to overcuring during processing of the sub-
sequent layers. This precuring is expected consider- Conclusions
ing the geometry of the fitting surface of the crown
featuring a hollow cylinder. Within the limitations of this study, the recommended
The recorded RMSE values for all the build angles build angle using the current DLP system was 135
other than 90, 180, and 270 degrees were smaller degrees. Among the selected build angles, it offers
than the pixel size of the build platform. Therefore, the the highest dimensional accuracy and the most favor-
cause of deviation may be inherited from the nature of able deviation pattern. It also offers a self-supporting
the DLP system.9 crown geometry throughout the building process.

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Influence of Build Angle on Accuracy of 3D-Printed Dental Restorations

Acknowledgments 10. Lee MP, Cooper GJ, Hinkley T, Gibson GM, Padgett MJ, Cronin
L. Development of a 3D printer using scanning projection
stereo­lithography. Sci Rep 2015;5:9875.
The authors would like to thank Imetric 3D SA for providing the
11. Oropallo W, Piegl LA. Ten challenges in 3D printing. Eng
digital scanner used for the study. In addition, they would like to
Comput 2016;32:135–148.
thank Koen Brongers from TTL Zutphen laboratory for his help in
12. Alharbi N, Osman RB, Wismeijer D. Factors influencing the di-
designing the restoration. This project is supported by a scholar-
mensional accuracy of 3D-printed full-coverage dental resto-
ship grant number 2/302626 from King Saud University, Riyadh,
rations using stereolithography technology. Int J Prosthodont
Kingdom of Saudi Arabia. The authors reported no conflicts of in-
2016:29:503–510.
terest related to this study.
13. Welcome to the future of 3D dental manufacturing.
Germany: Rapidshape, 2015. http://panadent.co.uk/wp-
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Literature Abstract

Association of Endodontic Lesions with Coronary Artery Disease

Much attention has been given to the association between periodontitis and coronary artery disease (CAD), and this study examines
the link with endodontic lesions (ELs). A sample of 508 adults who underwent coronary artery angiography were dentally, clinically,
and radiographically examined. They were assigned to one of four groups: no significant CAD, stable CAD, acute coronary syndrome
(ACS), and ACS-like but no CAD. The presence of periapical widened spaces and apical rarefactions were determined from panoramic
radiographs. Subgingival bacterial samples were taken, and blood samples were drawn. The incidence of ≥ 1 widened periapical spaces
was 50.4% and ≥ 1 apical rarefaction was 22.8%. In total, 51.2% of all teeth with apical rarefactions had been root treated. The results
indicated an association between ELs and cardiologic outcomes, especially ACS, which was more evident in untreated ELs. ELs were
associated with subgingival P endodontalis and serum IgG levels, indicating a systemic immune response, which may be the potential
mechanism of induction of systemic inflammation and endotoxemia. The high prevalence of both diseases warrants further study.

Liljestrand J M, Mäntylä P, Paju S, et al. J Dent Res 2016;95:1358–1365. References: 40. Reprints: sagepub.com/journalsPermissions.nav doi:
10.1177/0022034516660509 jdr.sagepub.com. Email: johnliljestrand@helsinki.fi —Steven Soo, Singapore

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