- Case report
- Open Access
- Open Peer Review
Direct resin composite restoration of maxillary central incisors using a 3D-printed template: two clinical cases
- Juan Xia†1,
- Yinghua Li†1, 2,
- Dongping Cai1, 2,
- Xilin Shi1, 2,
- Shiyong Zhao1, 2,
- Qianzhou Jiang and
- Xuechao Yang1, 2Email author
© The Author(s). 2018
- Received: 19 April 2018
- Accepted: 9 September 2018
- Published: 20 September 2018
Three-dimensional (3D) printing technology is used widely in dentistry for applications including implant surgery, oral and maxillofacial surgery, orthognathic surgery, endodontics and prosthodontics. Using a 3D-printed template makes performing the repair procedure faster and more convenient. The aesthetic restoration of anterior teeth can recover facial beauty, enhance speaking and chewing functions and improve the quality of life of the patient.
This article describes two kinds of clinical cases including fractured teeth and dental caries. In both, a 3D-printed template was used for direct resin composite restoration of maxillary central incisors. A 3D-printed template was built using the following 3-step process: data acquisition was conducted via intra-oral scanning, virtual modeling was performed using an imaging process, and manufacturing was performed using a 3D printer. Aesthetically restoring the maxillary incisors with the assistance of the 3D-printed template achieved the anticipated results, and the patients were very satisfied with the effect.
The direct resin composite restoration of maxillary central incisors using a 3D-printed template represents a rapid, convenient, aesthetic and functional option for treating maxillary central incisors. A 3D-printed template is therefore an acceptable and reliable alternative to traditional direct composite restoration of maxillary central incisors including fractured teeth and dental caries.
- 3D printing technology
- Composite restoration
- Fractured tooth
- Dental caries
The anterior teeth play an important role in facial beauty, and fully recovering a fractured anterior tooth requires restoration of the color, dental anatomy, and translucency of the tooth in addition to the curvature of the smile line and harmony with the other teeth in the arc . The restored maxillary central incisors must also be well adapted, aesthetic, functional, and accepted by the patient.
Rapid prototyping technology, better known as 3-dimensional (3D) printing, is widely used for preoperative planning, procedure rehearsal and custom prosthetic design in clinical practice as well as an educational tool for teaching and to enhance communication between the patient and doctor [2, 3]. In dentistry, 3D printing technology is currently used in implant surgery [4, 5], oral and maxillofacial surgery [6, 7], orthognathic surgery [8, 9], prosthodontics [10, 11] and endodontics [12–14].
Digital dentistry can be broadly defined as any dental technology or device that incorporates digital or computer-controlled components, and it is changing the shape of the dental industry. The digital dentistry revolution has begun. In this study, the authors discussed the advantages and disadvantages of digital dentistry. The main advantages are as follows: first, digital dentistry is a powerful treatment planning tool that has improved the efficiency of diagnosis and treatment; second, it provides a high level of predictability in outcomes and enables good communication among dental team members while also improving accuracy over previous methods; and third, it promotes patient education and treatment acceptance. Its disadvantages include the following: first, the costs associated with equipment, maintenance and medical expenses and second, a lack of adequately trained clinicians and teams because it is a new dental technology . In conclusion, the digital revolution has opened interesting concepts and possibilities, but it also represents a challenge for dentists. Therefore, it is necessary to learn about new knowledge, including new devices, software and machines .
Because aesthetics are based on subjective and individual differences, it is important for a preoperative prediction of an aesthetic effect to reflect good communication between a doctor and patient. Moreover, such discussions are of great significance when deciding whether to proceed with a repair and when setting expectations to prevent future disputes. Currently, in clinical aesthetic restorations, diagnostic or temporary restoration methods are often used to predict the aesthetic effect . Diagnostic wax is commonly used in clinics, but its use is limited to simulating tooth size and shape, and it is therefore difficult to imagine the visual effect of the prosthesis in the mouth . In the present article, the aesthetic restoration of a fractured tooth was achieved by performing 3D scanning of the dentition and using a CAD system and 3D design software. CAD can be used to model the desired form and has the potential to further improve the quality of the patient’s smile. The young clinician can discuss the planning with a more experienced doctor at the computer before calling the patient for a second appointment. We believe that proper planning is key for success in all disciplines of dentistry. Although making a 3D-printed template requires more time for preparation and higher cost, this procedure could certainly be suitable for young and unexperienced doctors who have no experience in correctly reconstructing the form or shape of a central incisor; the reconstruction of the form and shape is key to aesthetics. However, making a 3D-printed template could be considered a waste of time for the experienced clinician, who can restore these teeth directly without any physical template, with regard to the time spent in the planning. Furthermore, digital dentistry is a powerful treatment planning tool; patients can intuitively feel the restored teeth, and patients may feel more comfortable and relaxed in the clinic. Currently, direct reconstructions performed using a silicone guide can be performed in cases involving crown fractures, inadequate fillings caries, closing diastema, or wear lesions. This type of restoration involves a minimally invasive therapy intervention, and a silicone build-up guide is frequently used during the aesthetic management of a tooth with direct composite. A 3D-printed template can perform all of the above functions. Digital technologies allow us to accurately analyze and evaluate occlusions to make an appropriate treatment plan. Compared to traditional direct composite restorations, direct resin composite restoration with the aid of a 3D-printed template necessitates a new machine and more time for preparation, but it saves time in the dentist’s chair. Although the cost is not lower, with the aid of a 3D-printed template, the doctor could improve the efficiency and aesthetic effects in the clinic, and the patient would feel more comfortable and have good communication with the doctor. In contrast to a silicone guide, a 3D-printed template does not require a silicone rubber impression of the patient to be made, and the patients will be more comfortable and have a more pleasant experience while sitting in the dentist’s chair. This is especially important for patients who are sensitive to silicone rubber. Additionally, a 3D-printed template does not require laboratory processing and can be generated in a dental clinic. Finally, using this technique does not require many of the traditional production processes that are currently performed during the repair process, including a dental impression, perfusion model, carving prosthesis wax type and the embedding casting process. This enables substantial savings with regard to resources and avoiding environmental pollution.
Techniques involving 3D printing have initiated a new age in dentistry. These techniques have already changed dentistry and will increasingly replace a number of traditional techniques involved in fabricating dental restorations. The limitations of 3D printing include its cost and complexity and the fact that it is time-consuming. Although 3D printers are becoming more affordable, the costs associated with operating a 3D machine, obtaining the required materials, maintaining the equipment, and training skilled operators must be carefully considered . Generally, medical applications involving 3D printing show promise for promoting specialized surgical planning and prosthetics applications .
In conclusion, the costs associated with equipment, maintenance and medical expenses should be considered. This new technology will take more time for preparation and more spending, and there is a lack of adequately trained clinicians and teams. Thus, it is necessary for clinicians to learn about new areas of knowledge, including new devices, software and machines.
The aim of this article is to describe an uncomplicated approach to using a 3D-printed template and resin composites to restore and enhance the aesthetic appearance of the anterior dentition. With the help of digital technology, the patient could feel more comfortable and relaxed in the clinic. Young and unexperienced doctors could improve their efficiency and quality in the clinic. The direct resin composite restoration of maxillary central incisors using a 3D-printed template represents a rapid, convenient, aesthetic and functional option for the direct resin composite restoration of maxillary central incisors. A 3D-printed template is therefore an acceptable and reliable alternative to traditional direct composite restoration of maxillary central incisors including fractured teeth and dental caries.
This work was supported by a grant from the International Cooperation from the Science and Technology Planning Project, Guangdong Province, China (No. 2017A050501054). The funding body aided us financially in designing and fabricating the template, purchasing materials used in the case and publishing this paper.
Availability of data and materials
The complete data and materials described in the case report are freely available from the corresponding author on reasonable request.
YXC come up with this idea. XJ and JQZ designed and manufactured the 3D printed template. XJ and LYH participated in the clinical operation of case 1. XJ and CDP participated in the clinical operation of case 2. SXL and ZSY were responsible for the literature search and wrote the paper. All authors read and approved the final manuscript.
Ethics approval and consent to participate
All the treatment protocols of the case report were approved by the Ethics Committee of Stomatology Hospital, Guangzhou Medical University, (KY-2017-012).
Consent for publication
Written informed consent was obtained from the patients for the publication of this case report and accompanying images. A copy of the written consent document is available for review by the journal.
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Pontons-Melo JC, Furuse AY, Mondelli J. A direct composite resin stratification technique for restoration of the smile. Quintessence Int. 2011;42(3):205–11.PubMedGoogle Scholar
- Hurson C, Tansey A, O’Donnchadha B, Nicholson P, Rice J, McElwain J. Rapid prototyping in the assessment, classification and preoperative planning of acetabular fractures. Injury. 2007;38(10):1158–62.View ArticleGoogle Scholar
- Ciocca L, De Crescenzio F, Fantini M, Scotti R. CAD/CAM and rapid prototyped scaffold construction for bone regenerative medicine and surgical transfer of virtual planning: a pilot study. Comput Med Imaging Graph. 2009;33(1):58–62.View ArticleGoogle Scholar
- Ozan O, Seker E, Kurtulmus-Yilmaz S, Ersoy AE. Clinical application of stereolithographic surgical guide with a handpiece guidance apparatus: a case report. J Oral Implantol. 2012;38(5):603–9.View ArticleGoogle Scholar
- Di Giacomo GA, Cury PR, de Araujo NS, Sendyk WR, Sendyk CL. Clinical application of stereolithographic surgical guides for implant placement: preliminary results. J Periodontol. 2005;76(4):503–7.View ArticleGoogle Scholar
- Sykes LM, Parrott AM, Owen CP, Snaddon DR. Applications of rapid prototyping technology in maxillofacial prosthetics. Int J Prosthodont. 2004;17(4):454–9.PubMedGoogle Scholar
- Jiang FF, Hou Y, Lu L, Ding XX, Li W, Yan AHl. Functional evaluation of a CAD/CAM prosthesis for immediate defect repair after total maxillectomy: acase series of 18 patients with maxillary sinus cancer.J Esthet Restor Dent 2015, 27 Suppl 1:S80–S89.View ArticleGoogle Scholar
- Shaheen E, Sun Y, Jacobs R, Politis C. Three-dimensional printed final occlusal splint for orthognathic surgery: design and validation. Int J Oral Maxillofac Surg. 2017;46(1):67–71.View ArticleGoogle Scholar
- Cousley RR, Turner MJ. Digital model planning and computerized fabrication of orthognathic surgery wafers. J Orthod. 2014;41(1):38–45.View ArticleGoogle Scholar
- Strong SM. 3D printing, polymethyl methacrylate acrylic, and fully milled zirconia for anterior implant restorations: the brave new world of prosthetic dentistry. Gen Dent. 2015;63(2):11–3.PubMedGoogle Scholar
- Sun J, Zhang FQ. The application of rapid prototyping in prosthodontics. J Prosthodont. 2012;21(8):641–4.View ArticleGoogle Scholar
- Byun C, Kim C, Cho S, Beak SK, Kim G, Kim SG, SY kIM. Endodontic treatment of an anomalous anterior tooth with the aid of a 3-dimensional printed physical tooth model. J Endod. 2015;41(6):961–5.View ArticleGoogle Scholar
- Krastl G, Zehnder MS, Connert T, Weiger R, Kühl S. Guided endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology. DentTraumatol. 2016;32(3):240–6.Google Scholar
- van der Meer WJ, Vissink A, Ng YL, Gulabivala K. 3D computer aided treatment planning in endodontics. J Dent. 2016;45:67–72.View ArticleGoogle Scholar
- Wong NK, Kassim AA, Foong KW. Analysis of esthetic smiles by using computer vision techniques. Am J Orthod Dentofac Orthop. 2005;128(3):404–11.View ArticleGoogle Scholar
- Rosati R, De Menezes M, Rossetti A, Sforza C, Ferrario VF. Digital dental cast placement in 3-dimensional, full-face reconstruction: a technical evaluation. Am J Orthod Dentofac Orthop. 2010;138(1):84–8.View ArticleGoogle Scholar
- Weinländer M, Lekovic V, Spadijer-Gostovic S, Milicic B, Krennmair G, Plenk H Jr. Gingivomorphometry– esthetic evaluation of the crown–mucogingival complex: a new method for collection and measurement of standardized and reproducible data in oral photography. Clin Oral Implants Res 2009, 20(5):526–530.View ArticleGoogle Scholar
- Paul L, Child JR. Digital dentistry: is this the future of dentistry? Dent Econ. 2011;101:108–14.Google Scholar
- Mangano Guest EditorF. Digital dentistry:the revolution has begun. Open Dent J. 2018;12:59–60.View ArticleGoogle Scholar
- Stylianou A, Liu PR, O'Neal SJ, Essig ME. Restoring congenitally missing maxillary lateral incisors using zirconia-based resin bonded prostheses. J Esthet Restor Dent. 2016;28(1):8–17.View ArticleGoogle Scholar
- Gouveia THN, Theobaldo JD, Vieira-Junior WF, Lima DANL, Aguiar FHB. Esthetic smile rehabilitation of anterior teeth by treatment with biomimetic restorative materials: a case report. Clin Cosmet Investig Dent. 2017;9:27–31.View ArticleGoogle Scholar
- Sakai VT, Anzai A, Silva SM, Santos CF, Machado MA. Predictable esthetic treatment of fractured anterior teeth: a clinical report. Dent Traumatol. 2007;23(6):371–5.View ArticleGoogle Scholar
- Rengier F, Mehndiratta A, von Tengg-Kobligk H, Zechmann CM, Unterhinninghofen R, Kauczor HU, Giesel FL. 3D printing based on imaging data: review of medical applications. Int J Comput Assist Radiol Surg. 2010;5(4):335–41.View ArticleGoogle Scholar