3D Printing in Restorative Dentistry

In restorative dentistry, one of the fundamental goals is to restore teeth using materials that replicate the chemical, biological, and mechanical properties of natural tissues.^1-3 Material options for provisional and definitive restorations include resin composites, ceramics, metals, and hybrid materials. Traditionally, restorations have been cast or milled; however, since the development of stereolithography (SLA) in the 1980s, 3D printing has gained traction in dentistry.⁴ In addition to SLA, several other additive manufacturing technologies are helping to drive this evolution, including digital light processing (DLP), material jetting (MJ), and selective laser sintering (SLS). This article provides an overview of the 3D printing technologies used in dentistry; examines some of the available materials, including their properties; and discusses the current clinical applications.

Overview of 3D Printing Technologies

SLA and DLP both rely on photopolymerization to cure resin in a tank layer by layer, but they differ in their light sources: SLA uses a focused laser beam, whereas DLP cures entire layers simultaneously using a projected image.⁵ Because DLP cures entire layers at once rather than tracing each point as SLA does, it generally results in faster fabrication times. MJ, which is similar to inkjet printing, dispenses light-sensitive droplets and cures them immediately after. Although MJ systems are typically large and expensive, their ability to print in multiple materials and colors makes them attractive for esthetic applications.⁶ SLS technology is different in that no light curing of resins is involved. These systems operate by using a laser to fuse powdered materials, such as metals and alloys; however, the cost, infrastructure requirements, and technical complexity of SLS limit its use in routine clinical practice. It should be noted that fused deposition modeling (FDM) technology was excluded from this discussion due to its limited accuracy and dimensional stability (Table 1).⁷

Although the use of 3D printed restorations is growing, milled restorations remain the clinical gold standard due to their extensively validated strength and long-term performance.^8,9 Nonetheless, additive manufacturing will continue to advance and become more integrated into dental workflows; therefore, clinicians should understand its advantages, limitations, and future potential.

3D Printing Materials and Their Properties

As 3D printing technologies have evolved, so have the materials available for clinical use. Common 3D printing materials include polymers, ceramics, and metals, each of which offer unique clinical strengths and limitations.

Polymers

Resins are the most widely used materials in dental 3D printing due to their affordability, ease of processing, and versatility. When compared with milled polymers, 3D printed resins may offer faster turnaround times and reduced material waste, especially for complex geometries. However, they generally exhibit lower flexural strength, hardness, and fracture resistance.^9,10 As a result, they are currently more appropriate for provisional restorations than definitive ones.

Recent advancements in the formulations of 3D printing resins, such as the development of ceramic-filled and nanofilled composites, aim to improve the mechanical properties of 3D printed restorations. Nevertheless, these materials still fall short of the durability and wear resistance demonstrated by milled ceramics.¹¹ Furthermore, although fully cured PMMA-based resins show acceptable cytocompatibility, partially cured resins may release residual monomers, such as HEMA and Bis-GMA, which can contribute to cytotoxicity and allergic reactions.^12,13

Ongoing innovations in polymer chemistry, including high-molecular-weight monomers, enhanced filler systems, and improved photoinitiators, are gradually narrowing the performance gap between 3D printed and milled materials.^14-16 These advances may eventually enable the broader clinical application of 3D printed polymers in long-term, patient-specific treatments.

Ceramics

Glass ceramics and zirconia are widely considered to be ideal restorative materials due to their esthetics, strength, and biocompatibility.¹⁷ Although the 3D printing of ceramics is technically feasible and has shown promise, it remains largely limited to research settings. Issues such as shrinkage during sintering, brittleness, and difficulty maintaining dimensional accuracy continue to hinder clinical adoption.¹⁸

Some materials marketed as 3D printed “ceramics” are actually resins that contain greater than 50% ceramic particle content.¹⁹ These materials do not meet the structural classification or esthetic standards of true ceramics; however, in controlled studies, certain ceramic-filled resins have demonstrated promising fatigue resistance and survival rates comparable to lithium disilicate materials.¹ When selecting materials, it is important for clinicians to understand the differences between true ceramics and ceramic-reinforced resins.

Metals

Technologies such as SLS and selective laser melting (SLM) facilitate the direct fabrication of cobalt-chromium and titanium frameworks, which offer excellent mechanical and biological performance.²⁰ These printed metals can rival or exceed the properties of conventionally cast alloys. However, certain post-processing steps, such as polishing and heat treatment, are often necessary to optimize their surface quality. SLS and SLM systems are costly and typically restricted to laboratory settings, and because long-term clinical data remain limited, further research is needed.²¹

Clinical Applications of 3D Printing

When combined with intraoral scanning and digital design, 3D printing enables efficient, customized fabrication of restorations and appliances and supports same-day delivery in selected cases.²² Studies suggest that 3D printed restorations can achieve a marginal and internal fit that is comparable to milled alternatives; however, such results are highly dependent on printer calibration and design parameters.^9,23 Unfortunately, 3D printed materials generally demonstrate lower flexural strength and wear resistance,^24,25 particularly under exposure to moisture, thermal cycling, and acidic conditions,^26,27 and their esthetic properties, such as color stability and translucency, also tend to be inferior, especially when used in the anterior region.²⁸

Given these limitations, 3D printing is currently best suited for the fabrication of temporary crowns, dentures, splints, and surgical guides.²⁹ Most printable resins approved by the US Food and Drug Administration (FDA) for clinical use are cleared only for temporary or extraoral applications. Few materials have FDA clearance for definitive intraoral use, and long-term clinical performance data are still being evaluated. Beyond fixed prosthodontics, 3D printing is increasingly being used in surgical guide fabrication, orthodontics, and endodontics.⁶

As material science and printer resolution improve, additive manufacturing may ultimately surpass subtractive methods for the fabrication of complex restorations requiring customized internal geometries.³⁰ However, successful clinical implementation requires proper training, workflow integration, equipment maintenance, and thorough knowledge of post-processing steps and bonding protocols.³¹ Moreover, proper handling of materials and adherence to manufacturer protocols is essential to achieving optimal results.

Conclusion

3D printing is a valuable tool for the fabrication of provisional restorations and surgical guides for digitally planned implants. However, advances in material chemistry and printer resolution are paving the way for it to be used to fabricate definitive restorations. Long-term clinical studies are necessary to validate biocompatibility, mechanical performance, and cost-effectiveness. 

Acknowledgment

The authors would like to thank the faculty of RSDM5511 at the Dental College of Georgia at Augusta University for their educational support.

About the Authors

David Shon
DMD Candidate
Dental College of Georgia
Augusta University
Augusta, Georgia

Kaitlyn Songer
DMD Candidate
Dental College of Georgia
Augusta University
Augusta, Georgia

Heather Burns
DMD Candidate
Dental College of Georgia
Augusta University
Augusta, Georgia

Rafael Rocha Pacheco, DDS, MSc, PhD
Associate Dean for Digital Technologies
Associate Professor
Department of Restorative Sciences
Dental College of Georgia
Augusta University
Augusta, Georgia

Steven John Hood, DMD
Assistant Professor
Department of Restorative Sciences
Dental College of Georgia
Augusta University
Augusta, Georgia

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