Comparison of Mechanical Properties of 3D-Printed,

CAD/CAM, and Conventional Denture Base Materials

Vladimir Prpić, DMD ,1 Zdravko Schauperl, BSME,2 Amir Ćatić, DMD,3 Nikša Dulčić, DMD,4 &
Samir Čimić, DMD5
1
PhD Student, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
2
Full Professor, Department of Materials, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
3
Full Professor, Department of Prosthodontics, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
4
Associate Professor, Department of Prosthodontics, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
5
Assistant Professor, Department of Prosthodontics, School of Dental Medicine, University of Zagreb, Zagreb, Croatia

Keywords Abstract
Acrylic resin; denture base; flexural strength;
surface hardness.
Purpose: To evaluate and compare the mechanical properties (flexural strength and
surface hardness) of different materials and technologies for denture base fabrication.
Correspondence
The study emphasized the digital technologies of computer-aided design/computer-
Vladimir Prpić, PhD Student, School of Dental aided manufacturing (CAD/CAM) and three-dimensional (3D) printing.
Medicine, University of Zagreb, Gundulićeva Materials and Methods: A total of 160 rectangular specimens were fabricated from
5, 10000 Zagreb, Croatia. E-mail: three conventional heat-polymerized (ProBase Hot, Paladon 65, and Interacryl Hot),
[email protected] three CAD/CAM produced (IvoBase CAD, Interdent CC disc PMMA, and Polident
CAD/CAM disc), one 3D-printed (NextDent Base), and one polyamide material
Funding: Supported, in part, by the University (Vertex ThermoSens) for denture base fabrication. The flexural strength test was
of Zagreb scientific support “Diagnostic and the three-point flexure test, while hardness testing was conducted using the Brinell
therapy of craniomandibular dysfunctions.” method. The data were analyzed using descriptive and analytical statistics (α = 0.05).
Conflict of interest: none.
Results: During flexural testing, the IvoBase CAD and Vertex ThermoSens specimens
did not fracture during loading. The flexural strength values of the other groups ranged
Accepted March 04, 2020 from 71.7 ± 7.4 MPa to 111.9 ± 4.3 MPa. The surface hardness values ranged from
67.13 ± 10.64 MPa to 145.66 ± 2.22 MPa. There were significant differences between
the tested materials for both flexural strength and surface hardness. There were also
doi: 10.1111/jopr.13175 differences between some materials with the same polymerization type. CAD/CAM
and polyamide materials had the highest flexural strength values. Two groups of
CAD/CAM materials had the highest surface hardness values, while a third, along
with the polyamide material, had the lowest. The 3D-printed materials had the lowest
flexural strength values.
Conclusions: Generally, CAD/CAM materials show better mechanical properties
than heat-polymerized and 3D-printed acrylics do. Nevertheless, a material’s poly-
merization type is no guarantee of its optimal mechanical properties.

Complete dentures have been used for many years, and they various dental manufacturers and more CAD/CAM materials
are the gold standard for treating edentulism.1 Recent im- for denture base fabrication. While the mechanical properties
provements in science and technology have provided digital of conventionally polymerized denture base acrylics7-11 and
methods for denture base production, including computer-aided polyamide materials have been investigated and reported12-16 —
design/computer-aided manufacturing (CAD/CAM) and three- along with new data on mechanical properties of CAD/CAM
dimensional (3D) printing.2-5 Digital methods allow the pro- dentures, even if scarce17-19 —to our knowledge, no studies have
duction of a denture base in one block and provide the ability been published on the mechanical properties of denture bases
to attach prefabricated teeth with an appropriate adhesive. The produced from 3D-printed materials.
advantages of digital methods are faster denture fabrication Surface hardness testing and the three-point flexure test
and fewer phases in the work process,6 which can reduce the are regularly used for analyzing the mechanical properties
possibility of mistakes. With the further development of dig- of denture base materials.2,9,15 The aim of this study was to
ital technology, there are now new 3D-printed materials from employ such testing for examining the mechanical properties

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Table 1 Materials, types, manufacturers, and denture base fabrication techniques

Material Abbreviation Type Manufacturer Denture base fabrication technique

ProBase Hot PBH PMMA Ivoclar Vivadent AG Conventional; heat-polymerized

Paladon 65 PAL PMMA Kulzer GmbH Conventional; heat-polymerized
Interacryl Hot IAH PMMA Interdent d.o.o. Conventional; heat-polymerized
IvoBase CAD IBC PMMA Ivoclar Vivadent AG CAD/CAM
Interdent CC disc PMMA IDP PMMA Interdent d.o.o. CAD/CAM
Polident CAD/CAM disc basic PDD PMMA Polident d.o.o. CAD/CAM
NextDent Base NDB Monomer Nextdent B.V. 3D printing
based on
acrylic
esters
Vertex ThersmoSens VTS Polyamide Vertex-Dental B.V. Injection pressing

(flexural strength and surface hardness) of different materials the 3D printing was conducted using an appropriate 3D unit
for denture base fabrication, with an emphasis on digital (DentalFab, Microlay Dental 3D Printers, Madrid, Spain), with
technologies (CAD/CAM and 3D printing), and compare them subsequent light polymerization done in a suitable device (LC-
with heat-polymerized acrylics and thermoplastic material for 3DPrint Box, NextDent, Soesterberg, the Netherlands) follow-
the production of complete denture bases. The null hypothesis ing the manufacturers’ instructions.
was that different materials would have similar flexural CAD/CAM specimens were prepared from CAD/CAM
strength and surface hardness values. discs. First, the CAD/CAM discs were cut with a diamond
disc to obtain rectangular blocks. After rectangular heat-
polymerized, polyamide, 3D-printed, and CAD/CAM blocks
Materials and methods
were prepared, specimens to be used for flexural strength and
The following materials were selected for denture base fabrica- surface hardness testing were cut from the blocks on a water-
tion: three heat-polymerized acrylics, three types of CAD/CAM cutting machine (IsoMet 1000, Buehler, Lake Bluff, IL). All
materials, one type of resin for 3D printing, and one polyamide surfaces were ground using standard metallic grinding paper
material. A list of the materials, manufacturers, types, and den- (P500, P1000, and P1200) to smooth surfaces with the default
ture base fabrication techniques is given in Table 1. dimensions.
A total of 160 specimens were tested for flexural strength and The flexural strength was tested using a three-point flex-
surface hardness. The heat-polymerized acrylic blocks were ure test on a universal testing machine (10 specimens for
prepared using the compression molding technique. A rectan- each tested material, 64 × 10 × 3.3 ± 0.2 mm, ISO 20795-
gular template made of wax was invested with gypsum. A first 1:201320 ). Before testing, the specimens were immersed in a
layer of gypsum was poured in the lower half of the flask, water bath for 50 ±1 hour at 37°C. Immediately following
and a wax template was placed inside. After induration, the this, the specimens were removed from the water and placed
first gypsum layer was coated with separating medium (Sep- symmetrically on the base of a universal testing machine (VEB
arating Fluid, Ivoclar Vivadent, Schaan, Liechtenstein). The Werkstoffprüfmaschinen, Leipzig, Germany). The load force
second layer of gypsum was poured, and the flask was com- was increased evenly from 0, using a steady shift of 5 ± 1
pletely closed. After gypsum setting, the flask was opened, the mm/min until the specimen cracked. The flexural strength of
wax was completely removed, and the mold was coated with each specimen was measured according to the following for-
separating medium. The packing stage involved placement and mula: FS = 3FL/2bh2 , where FS is flexural strength (MPa), F is
adaptation of denture base resin within the mold cavity. Next, the maximum force applied to a specimen (N), L is the distance
the flasks were placed in a hydraulic press for 5 minutes under between the specimen carrier (mm), b is the specimen width
a 1250 kgf load and put in the appropriate polymerization unit (mm), and h is the specimen height (mm). Ten specimens of
(EWL Typ 5509, Kavo, Biberach, Germany) with the flask car- each material with the dimensions 64.0 × 10.0 × 3.3 ± 0.2
rier to maintain pressure. All three heat-polymerized acrylics mm were used for surface hardness testing (Brinell’s method,
were prepared according to the manufacturers’ instructions (ra- ISO 2039-1:200121 ). The surface hardness was determined us-
tio of polymer and monomer and polymerization method). After ing Brinell’s method according to the following formula: HB
polymerization, the flasks were left to cool at room temperature. = F/πDhk , where HB is the Brinell hardness (MPa), F is the
Finally, the rectangular acrylic blocks were carefully deflasked. force applied to the specimen (N), D is the ball diameter (mm),
Rectangular polyamide blocks were prepared in a similar way and h is the depth of penetration (mm). The 358 N force was
(injection pressing) following the manufacturer’s instructions. applied via a ball for 60 seconds (for one material, VTS, a
A rectangular block was designed (Netfabb Premium 2019, 196 N load was used because of the material’s lower hard-
Autodesk, San Rafael, CA) and saved as a standard tessella- ness). Brinell’s hardness was measured at five points on each
tion language (STL) file; the 3D-printed samples were pre- specimen, after which, the average hardness for each sample
pared according to the obtained STL file. Using the STL file, was determined. Testing was carried out on a Zwick apparatus

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groups could not be measured. The maximal and minimal flex-

ural strength values (MPa) of the rest of the tested groups were
119.1 and 103.7 for IDP, 116.4 and 97.0 for PDD, 110.6 and
84.1 for IAH, 100.7 and 71.8 for PBH, 88.5 and 62.2 for PAL,
and 84.5 and 60.0 for NDB. The maximal and minimal surface
hardness values (MPa) of the tested groups were 147.04 and
142.44 for IDP, 147.04 and 142.44 for PDD, 138.13 and 130.23
for PBH, 134.06 and 126.62 for IAH, 123.19 and 113.95 for
PAL,123.19 and 106.0 for NDB, 103.60 and 69.06 for IBC, and
80.50 and 51.99 for VTS.
For the inclusion of IBC and VTS in statistical analyses,
an arbitrarily high value was assigned (the maximum flexural
Figure 1 Means and standard deviations of flexural strength for the strength value determined in other groups plus 1). The median
groups. Matching uppercase letters denote no significant differences test determined the statistically significant (p < 0.001) differ-
between groups (Holm-Bonferroni post hoc test, p < 0.05). For better ences in flexural strength values between the tested groups.
visualization of results, groups without significant differences are marked Figure 1 shows the results of the Holm-Bonferroni post hoc
with the same color. For the IBC and VTS groups, neither specimen analysis. The median test determined the statistically signif-
fractured during loading within the end limits of possible movement icant between-group differences in surface hardness values
of the penetrant. For the inclusion of these two groups in statistical (p < 0.001). Figure 2 shows the differences in surface hardness
analysis, an arbitrarily high number was assigned (maximum flexural between the tested groups (Holm-Bonferroni correction).
strength value obtained in other groups plus 1).

Discussion
This in vitro study investigated the mechanical properties of
denture base materials made with different technologies, with
an emphasis on digital technologies (CAD/CAM and 3D print-
ing). The null hypotheses were rejected because statistical anal-
ysis showed differences between study groups for both flexural
strength and surface hardness.
Flexural strength, also known as modulus of rupture, bend
strength, or transverse rupture strength, is a material property
defined as the stress in a material just before it yields in a
flexure test. Since a denture base may fracture in real life for
Figure 2 Means and standard deviations of surface hardness for the various reasons, it is important that its material has high flexural
groups. Matching uppercase letters denote no significant differences strength. Findings related to the flexural strength of CAD/CAM
between groups (Holm-Bonferroni post hoc test, p < 0.05). For better materials for denture base vary.5,17-19 A study by Steinmassl et
visualization of results, groups without significant differences are marked al5 obtained mixed results where different CAD/CAM denture
with the same color. base resins showed similar, lower, or higher flexural strength
values than the control heat-polymerized group did. Ayman18
(Zwick Härteprüfgerät Modell 3106 No. 29542/1965, Zwick and Pacquet et al17 determined higher values of flexural strength
Roell Group, Kennesaw, GA). in heat-polymerized PMMA than in CAD/CAM denture base
Descriptive and analytical methods were used. The normality material. In contrast to the studies by Steinmassl et al,8
of distribution was tested with the Shapiro-Wilk test. Analysis Ayman,18 and Pacquet et al,17 the present study results (Fig 1)
of variance test and Tukey’s multiple comparison test were agree with those of Aguirre et al,19 where CAD/CAM materi-
used for comparing the obtained values between different types als showed higher flexural strength values than compression-
of material (normal distribution). If the data tested were not molded denture base materials did. Since CAD/CAM PMMA
normally distributed, the median test was used and a post hoc blocks are made under high heat and pressure conditions with
multiple comparison was made using Holm-Bonferroni correc- condensed acrylic resin and minimal shrinkage, porosity, or free
tion. The analysis was made using a statistical software package monomers,6 the higher flexural strength values of CAD/CAM
(SAS 8.2, SAS, Cary, NC) on the Windows platform. The sig- materials, confirmed by both the present study results (Fig 1)
nificance level was set at p < 0.05. and Aguirre et al,19 are expected. Still, it should be noted that
differences among the flexural strength values of CAD/CAM
Results and heat-polymerized denture base materials5,17-19 (Fig 1) may
be due to the use of different materials (manufacturers) in
Descriptive statistics for the flexural strength and surface hard- different studies. The only material that had higher flexural
ness values are presented in Figures 1 and 2. During flexure strength values than two of the CAD/CAM materials (IDP and
testing, no specimens in the IBC and VTS groups fractured PDD) in the present study was polyamide (Fig 1). Previous
during loading within the end limits of the penetrant’s possible studies confirmed that polyamide materials for denture bases
movement; thus, the values of flexural strength for these two have higher flexural strength than heat-polymerized PMMA

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In Vitro Study of Different Denture Base Materials Vladimir et al

does,12-14 which agrees with the present study results (Fig 1). to compare materials based on manufacture type (e.g., 3D
The 3D-printed material (NDB) had the lowest flexural strength printing, CAD/CAM, or heat polymerization), the mechanical
compared with the other study groups (Fig 1). Although the 3D- properties of the selected denture base material depend solely
printed material (monomer based on acrylic esters) had the low- on the material itself, and not how it was made. However,
est values (Fig 1), it met ISO requirements for flexural strength 3D-printed materials for denture base fabrication do have
(65 MPa).20 It is safe to conclude that 3D-printed materials for lower mechanical property values than most CAD/CAM and
denture bases are a new option for denture production, but for heat-polymerized acrylics do.
now, they have lower flexural strength values than most other The study had two major limitations. First, oral conditions
denture base materials. were absent in the present research, and second, different testing
Hardness is a measure of the resistance to localized plastic conditions (dry vs. wet) and different testing media (air or
deformation induced by either mechanical indentation or abra- water) were not included. Both may have affected the results.16
sion. Dentures made of a material with low surface hardness To obtain more comprehensive knowledge on new denture base
can be damaged by mechanical brushing, causing plaque reten- materials, future studies considering flexural modulus, bonding
tion and pigmentations, which can decrease the life of dentures. to synthetic polymer teeth, and residual monomer testing are
In the present study, two groups of CAD/CAM materials (IDP necessary.
and PDD, Fig 2) were determined to have the highest surface
hardness among the study groups. This finding is comparable
Conclusions
to that of Ayman,18 who reported higher hardness values for
CAD/CAM materials than for heat-polymerized ones (Fig 2). Based on the findings of this in vitro study, polyamide and
However, the third group of tested CAD/CAM materials (IBC) CAD/CAM materials exhibited higher flexural strength than
in the present study (Fig 2) had lower hardness values than heat-polymerized and 3D-printed acrylics. Materials with the
the other CAD/CAM materials, heat-polymerized PMMA, and same polymerization type can have different mechanical prop-
3D-printed materials. Given that significant between-group dif- erties and 3D-printed acrylics have lower mechanical properties
ferences were observed for groups using the identical polymer- than most other denture base materials.
ization process as that reported in similar studies,5 it can be
concluded that denture base materials cannot be studied solely
via the polymerization processing; in other words, the differ- Acknowledgments
ences in results cannot be attributed only to different polymer- The authors would like to thank Mr. Božidar Bušetinčan for his
ization technologies. Except for one CAD/CAM group (IBC), assistance with the mechanical testing.
3D-printed material had lower surface hardness values than
the other tested acrylics did (Fig 2). As in other studies,7,15
polyamide was found to be the material with the lowest hard- References
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