3D Printing of Metals in

Dentistry

Under supervision of

Prof/ Yasser Fathi Hussien

Head of Biomaterials Department
Dean of faculty of dentistry, Minia University

&
Dr/ Hanaa Farouk
Lecturer in Biomaterials Department

Seminar submitted to Dental Biomaterial Department in partial

fullfiment of the requirements of PhD in Dental Biomaterial
Department (first semester)

Prepared by /
Hager Abdullah Abdulhamid
2024
 Introduction
The application of computer-aided design (CAD) and computer-aided
manufacturing (CAM) in dentistry has progressed strongly over the past few
decades. It has led to the development of new classes of materials and to the
digitization and automation of various work processes.

Until recently, in dentistry, the CAM process was compatible with the
subtractive manufacturing process. In this process, an object is created out of a
blank by milling, grinding, drilling, turning, or polishing using specific tools. From
a procedural and ecological point of view, subtractive production has the
disadvantage in that the surface resolution is limited by the smallest tool radius.
The material loss by computer numeric controlled milling can reach 90%.

In addition, the subtractive technique also has a limitation with regard to the
number of objects it can produce per machining operation, and it is not capable of
reproducing more complex geometries. Furthermore, the tools used show signs of
wear after repeated use, which can lead to cracks in the objects produced.
Alternative ways of producing CAD files are the additive manufacturing processes.

All additive manufacturing processes (AM) have in common that on the

basis of 3D design data, the physical object is built up by the sequential application
of thin layers of material. With the development of the first CAD programs, the
first experiments in the 3D printing sector were carried out from 1980. The
inventor of the 3D printer, Chuck Hull, took his place in history in 1986 with his
patent application for stereolithographic printing. Shortly thereafter, a number of
alternative processes were developed.

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 In contrast to subtractive methods, additive processes can save material and
produce more complex geometries. As a result, this manufacturing method is a
suitable solution in the dental field. From a process engineering point of view, the
additive process has the potential to overcome the disadvantages of the subtractive
production method.

The Additive Manufacturing technology can be classified in seven main

categories: Stereolithography (SLA), Material Jetting (MJ), Material Extrusion
(ME), Binder Jetting (BJ), Powder Based Fusion (PBF), Sheet Lamination (SL)
and Direct Energy Deposition (DEP).

Powder-Based Fusion Technologies (PBF)

Powder-based fusion (PBF) is the most commonly used technology for

three-dimensional (3D) metal printing in dentistry. The PBF process begins with
the creation of a 3D CAD model, which is numerically 'sliced' into several discrete
layers. For each layer, a heat source scan path is calculated which defines both the
boundary contour and some form of fill sequence, often a raster pattern since the
heat source is typically an energy beam (e.g. a laser).

Each layer is then sequentially bonded on top of each other. PBF processes
spread powdered material over the previously joined layer, ready for processing of
the next layer hence the manufacturing is discrete rather than continuous (though
each layer is fully consolidated to adjacent layers).

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 Fig.1: Schematic diagram showing PBF technology

A hopper supplies the powdered material which is then spread uniformly

over the powder bed build platform area via a roller or blade. The optimal
thickness of each layer of spread powder is dependent on the processing conditions
and material used, but values of 25 to 100µm are common.

Currently, three types of PBF technologies are available, namely Selective

Laser Sintering (SLS), Selective Laser Melting (SLM) and Electro Beam Melting
(EBM).

a. Selective Laser Sintering (SLS)

Selective laser sintering technology is based on application of high powered

laser (Na:YAG laser) beam focused onto a bed of powdered metal where thin solid
layers (20–100 μm) are fused until the 3D object is built. The entire fabrication
chamber is sealed and maintained at a temperature just below the melting point that
the metal powder sinters.

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 Object parts made by partial melting are characterized by high porosity with
initially achieving only point contacts between the particles. During laser heating,
various sintering and rearrangement mechanisms induce the powder binding and
densification. Unfortunately, with partial melting and sintering mechanism,
porosities could not be completely eliminated as generally possible repulsion
forces arise between particles at a high fraction of the binding liquid component.

Fig.2: Schematic diagram showing SLS technology

b. Selective Laser Melting (SLM)

With the introduction of powerful high-quality lasers, the partial melting

achieved by SLS technology has been taken over by complete melting, giving rise
to a new development of metal laser sintering.

Although the superficial finish is considered very well, the components may
have high internal stresses caused by thermal gradients induced during processing

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and therefore require additional heat treatment. The most common fibre laser used
on the SLM technology is the CO2 laser for processing metal powders and the
building plate can be preheated up to 200 °C.

Fig.3: Schematic diagram showing SLM technology

c. Electron Beam Melting (EBM)

Instead of using a laser beam to melt or sinter the powder, with the EBM
technologies, a focused electron beam is used to selectively melt layers of powder
(100 μm) in an inert environment such as purified argon. Also, while building the
part, an elevated temperature of about 700 °C is maintained in the chamber to
reduce the residual stresses.

Initially, a tungsten filament is heated over 3000 °C, which causes electrons to
be emitted, and subsequently, potential difference between a cathode and an anode
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causes the electrons to accelerate. The electrons are focused and detected using
magnetic coils to form a narrow high-energy beam that attacks the surface of the
powder. Eventually, the kinetic energy transferred through friction creates the heat
that is necessary to melt the metal powder.

Fig.4: Schematic diagram showing EBM technology

Differences between three types

The differences between SLM and SLS come down to the fundamentals of the
particle bonding process: SLM uses metal powders with a single melting
temperature and fully melts the particles, while in SLS the powder is composed of

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materials with variable melting points that fuse on a molecular level at elevated
temperatures.

Essentially, SLM produces parts from a single metal, while SLS produces parts
from metal alloys.

The main differences between the PBF technologies are the operational
parameters such as melting temperature, energy source, energy power, laser beam
absorption/reflections coefficients, thermal conductivity, chamber conditions,
temperature reached, along with other parameters such layer thickness, build
orientation and grain size. All these parameters have to be adjusted depending on
the metal type.

How does this works?

The basic fabrication process is similar for both SLM and SLS. Here's how it
works:

• The build chamber is first filled with inert gas (as argon) to minimize the
oxidation of the metal powder and then it is heated to the optimal build
temperature.

• A thin layer of metal powder is spread over the build platform and a high-
power laser scans the cross-section of the component, melting (or fusing) the
metal particles together and creating the next layer. The entire area of the
model is scanned, so the part is built fully solid.

• When the scanning process is complete, the build platform moves

downwards by one layer thickness and the recoater spreads another thin
layer of metal powder. The process is repeated until the whole part is
complete.

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 When the build process is finished, the parts are fully encapsulated in the metal
powder. The parts are attached to the build platform through support structures.
Support in metal 3D printing is built using the same material as the part and is
always required to mitigate the warping and distortion that may occur due to the
high processing temperatures.

When the bin cools to room temperature, the excess powder is manually
removed and the parts are typically heat treated while still attached to the build
platform to relieve any residual stresses. Then the components are detached from
the build plate via cutting or machining and are ready for use or further post-
processing.

Metals Used in Additive Manufacturing in Dentistry

For 3D metal printing in dental applications, currently cobaltchrome (Co-Cr)

and titanium (Ti) are the most commonly used alloys. The metal powder of Co-Cr
also contains molybdenum, tungsten, silicon, cerium, iron, manganese and carbon,
while nickel and beryllium are not present in the composition anymore.

The metal powders used in conjunction with AM technologies are a mixture of

particles with sizes ranging between 3 and 14 μm.

Depending on the manufacturers of the AM technologies, composition and

mechanical properties of Co-Cr may show differences between products.

Typical titanium alloys used in dentistry and medicine such as Ti6Al4V show
slight differences in composition and physical and mechanical properties
depending on the AM system (i.e. SLM vs. EBM).

Difference in mechanical properties of cast, milled amd SLM manufactured

CoCr dental alloys
• Hardness and microstructural characterization
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 When comparing CoCr dental alloys manufactured using casting, milling or
SLM techniques, significant differences were noted in hardness values being the
highest for SLM, followed by the cast and milled procedures. The manufacturing
process showed also a significant effect on the alloy microstructure where Xray
radiography revealed the presence of porosity only in the cast group.

It has to be noted that, although effort was made to use one type of CoCr alloy
for all procedures, for SLM manufacturing another type of CoCr alloy had to be
used which has slightly higher Co/Cr ratio than those of cast and milled ones.

• The objects made of CoCr through the SLS or SLM technologies

present thermal stresses in the body of the object due to rapid heating and cooling
during the fabrication process. Such internal residual stress could generate high
strain and thereby affects the accuracy.

The solution is the employment of heat treatment after printing the metal
that could at the same time change the microstructure. The reduction in porosity in
CoCr alloys fabricated through AM technologies has a positive effect on the
mechanical properties of the printed object through which higher yield and tensile
strength of the cast alloys could be obtained.

• Corrosion resistance of CoCr SLM specimens on the other hand appears to

remain similar to that of the conventional casting processing.

About Ti dental alloys

Ti6Al4V is a two-phase material, consisting of the hexagonal close packed
phase and the body centre cubic phase. The transition temperature between the two
phases for Ti6Al4V is 995 °C.

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 The mechanical properties of the two-phase Ti6Al4V alloy are dependent on
the microstructure and the distribution of the two phases throughout the material.
The SLM technology is more commonly used to manufacture Ti6Al4V fixed
dental prostheses (FDPs) than EBM.

SLM produces more rapid cooling, resulting in transformation to

α′martensite phase in various proportions that significantly affects the corrosion
potential and be detrimental for dental applications.

However, when low oxygen-containing powder is used in EBM fabrication,

mechanical properties could be improved. Mechanical properties of the Ti6Al4V
alloy fabricated using EBM versus casting was reported to deliver strength (1.18
GPa) and elongation (16 to 25%) with microindentation hardness ranging from 3.6
to 3.9 GPa, comparable to the very best wrought Ti6Al4V alloy (4 GPa).

Comparing Marginal and Internal Gap

Marginal and internal gap of CoCr 3-unit FDPs manufactured with
conventional lost wax, milling or DMLS fabrication methods indicated the best fit
with DMLS group, followed by the lost wax and milled group. However, only
vertical gaps were measured and no measurements were performed in horizontal
planes. In another study, where internal gaps of pre-sintered milled, cast and SLS
manufactured CoCr metal frameworks indicated the lowest gap formation with the
milled one, followed by SLS and casting.

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About Physical properties

CoCr alloy samples made by traditional casting and SLM methods, before
and after firing with ceramics. It has been established that SLM samples have a
more homogeneous structure and retain it after firing with ceramics.

Moreover, using X-ray photoelectron spectroscopy and studying the pH of

the solution, it was proven that the samples obtained by different methods have
good, similar corrosion resistance.

The chemical composition, surface roughness and adhesion force to

ceramics of metal disks manufactured by milling and on 4 different SLM printers.

The resulting samples of all 4 groups, prepared by the SLM method, differed
from the control and differed from each other in weight and atomic percentage
chemical elements.

The surface of all four types of samples produced on 3D printers turned out
to be 2-3 times rougher than the surface of milled samples.

However, the adhesion strength to ceramics for all samples was about the
same.

Application of metal 3D printing technology for the production of individual

implants maxillofacial area

In 2017, they have developed a customized 3D SLM printed titanium

temporomandibular joint and ramus implant design, called the Melbourne implant,
which is modified according to each patient's anatomy.

Subsequently, the authors increased the length and thickness of the articular
process. When simulating each individual implant using the finite element method,
it was found that such changes improve the load resistance of the implant.
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Application of metal 3D printing technology for the production of dental
implants

• DMLS technology is used for the production of experimental one-piece

(together with an abutment for cemented crown fixation) dental individual
intraosseous and subperiosteal titanium implants.
• Using a 3D printer, it is possible to produce porous implants with a pore size
from 200 to 400 microns and mechanical properties (flexural strength,
elastic modulus), corresponding properties of bone tissue.
• A performed a study on the surface roughness and wettability and surface
energy of dental implants manufactured individually using SLM technology
and compared obtained parameters with data from scientific sources
literature for dental implants manufactured in a standard way.
• It has been established that after 3D printing Dental implants are
significantly superior to standard implants in terms of roughness and
wettability surface, and the surface energy of printed implants is 10 to 19%
lower than that of standard implants.
• The authors concluded that dental implants, printed on a 3D printer using
SLM technology, do not require additional surface treatment.

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Service life of fixed dentures manufactured 3D printing method

They studied the in vivo service life of three-unit metal-ceramic bridges in the
lateral jaw with a frame made of cobalt-chrome alloy using DMLS technology.

During the observation period, not a single fracture of the connection between
the parts of the bridge was recorded. Two complications were discovered in the
form of periapical changes and caries on adjacent teeth; service life for 5 years was
95.5%.

3D Printing in manufacturing Removable Partial Denture Frameworks

First, either an intraoral or extraoral scanner is used to scan impressions or

conventional casts to acquire a digital work file such as a standard tessellation file
(STL). Second, STL files are transferred to CAD software for designing and finally
to 3D printers to generate customized structures.

These new digital workflows have more advantages than traditional

workflows. The traditional process of waxing and investing causes wax pattern and
refractory cast distortions possibly leading to poor fit of castings compared with
new digital workflows.

Most importantly, pressure-induced mucosal lesions and residual ridge

resorption are the main sources of clinical complications. The use of 3D printing
technologies to manufacture RPD enables the denture base to provide more
uniform contact pressure and then reducing the risk of long-term bone resorption.
Recently, SLM has been shown to produce clinically acceptable RPD frameworks.

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3D Printing in manufacturing Occlusal Splints

The occlusal splint is an intraoral device with reversible therapeutic

properties. It mainly treats temporomandibular joint disorders by adjusting the
occlusal relationship between the upper and lower dental arches.

The traditional process flow for the production of occlusal splints includes
interocclusal wax occlusal registration for the upper and lower dentition of the
working models and alginate impressions.

This method is costly, and errors may occur in the impression process or
casting manufacturing process. Manufacturing the occlusal splints by milling not
only is time-consuming but also wastes a lot of materials.

The shape of the occlusal splints prevents them from fitting well in a round
resin blank. One blank can only mill up to two occlusal splints, which causes
considerable waste. Additionally, this method has serious wear on the milling tools,
particularly hard materials.

However, in 3D printing, only the supporting structure must be removed

when the occlusal splint is manufactured. Moreover, several splints can be
manufactured simultaneously, which greatly improves the manufacturing
efficiency and saves time and cost.

However, the antistress and antiaging abilities of 3D printing materials are

not as good as those of traditional or milling resin materials, which will adversely
affect their long-term use.

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 3D Printing in manufacturing Surgical Guides

Surgical guides can significantly improve the accuracy and time efficiency
in clinical treatment, reduce operation errors, make the treatment results more
predictable for dentists, and allow patients to better understand the implant
prosthodontic treatment.

The surgical guidance systems include dynamic and static systems. Dynamic
guides use mechanical or optical systems to transfer virtual plans to the surgical
area and display the process on screen in real time.

Static surgery guides are fabricated in the laboratory by 3D printing, called

SLA guides made by perforations on the jaw models. The static surgery guide
differs from the dynamic surgical guide as the former does not move during the
operatio.

Traditional surgical guides are based on panoramic radiation images.

However, the enlargement, distortion, and lack of clarity of the radiation image
restrict the creation of the surgical guides, which leads to the inaccuracy and
unreliability of the preoperative plan.

However, the new surgical guide combined with CBCT, intraoral scanning
technology, CAD, and virtual planning environment can be created by combining
the digital files obtained.

Once the treatment planning is completed by using the application

preoperative planning software, the surgical guides can be produced by SLA. The
drill guides indicate the insertion position, angles, and depth of the implant, which
accurately transfers it to the patient through the simulated plan, establishing a link
between the planned and the actual operation while in use.

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 Owing to the advantages of simpler operation and lower investment cost,
static techniques are widely adopted as the preferred method to guide the surgery.
Currently, most of the major implant brands are based on the same basic principles
and have their SLA-guided surgery system. Therefore, compared with a dynamic
system, a static system is more frequently used. Briefly, compared with dynamic
guides or traditional guides, the SLA guidelines have significant advantages.

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