Mechanical and biological properties of polymer materials for oral appliances produced with additive 3D printing and subtractive CAD-CAM techniques compared to conventional methods: a systematic review and meta-analysis

Abstract

Objectives: The aim of this review was to analyze mechanical and biological properties of resin materials used with subtractive or additive techniques for oral appliances fabrication and compare them to those conventionally manufactured.

Materials and methods: The protocol was registered online at Open Science Framework (OSF) registries ( https://osf.io/h5es3 ) and the study was based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). An electronic search was conducted on MEDLINE (via PubMed), Scopus, and Web of Science from 1 February 2022 to 1 May 2022.

Inclusion criteria: in vitro and in vivo studies published in the last 10 years, with CAD-CAM or 3D printed resins for occlusal splints. Data considered homogenous were subjected to meta-analysis (95% confidence interval [CI]; α = 0.05) with Stata17 statistical software. Since all variables were continuous, the Hedge g measure was calculated. A fixed-effects model was used for I² = 0%, while statistical analysis was conducted using a random-effects model with I² > 0%.

Results: 13 studies were included after full-text reading. The mechanical properties most studied were wear, flexural strength, surface hardness and surface roughness, while only 1 study investigated biological properties, performing the XTT viability assay. For the meta-analysis, only surface roughness, volume loss, and flexural strength were selected. Considering surface roughness, the subtractive specimen had a lower average value compared to traditional ones (Hedge's g with 95% CI = -1.25[ -1.84, - 0.66]). No significant difference was detected in terms of volume loss (P > 0.05) between the groups (Hedge's g with 95% CI = -0.01 [-2.71, - 2.68]). While flexural strength was higher in the control group (Hedge's g with 95% CI = 2.32 [0.10-4.53]).

Conclusion: 3D printed materials showed properties comparable to conventional resins, while milled splint materials have not shown better mechanical performance compared with conventional heat-cured acrylic resin. Polyetheretherketone (PEEK) have great potential and needs to be further investigated. Biological tests on oral cell populations are needed to confirm the long-term biocompatibility of these materials.

Clinical relevance: The use of "mixed splints" combining different materials needs to be improved and evaluated in future research to take full advantage of different characteristics and properties.

Keywords: Computer-aided design; Dental materials; Occlusal splint; Oral appliances; Printing, three-Dimensional; Resins, synthetic; Temporomandibular Joint disorders.