Two 3D-printed [DB (DentaBase, LOT # MO/07875, Asiga, Alexandria, NSW, Australia) and D3D (Denture 3D+, LOT # WY032N01, NextDent, AV, Soesterberg, The Netherlands)] and one conventional (QC-20 heat-polymerize, LOT # D64015111, DeguDent GmbH, Hanau, Germany) denture base acrylic resin were evaluated.
The sample size was calculated using G
*Power v. 3.1.9.3 freeware (Heinrich-Heine-Universität Düsseldorf, Germany). The effect size of 0.6, power of 0.8, α = .05 and estimated SD of 0.32 required a minimum of eight samples in each group. However, the samples were increased to 10 to accommodate any specimen loss during the experiment.
Forty disk shaped specimens (10 mm diameter and 3 mm thickness) were fabricated from each material. For DB and D3D materials, the digital specimen file (.STL)(
Fig. 1A) was imported into a operational standard slicing software (Chitubox All-in-one SLA/DLP/LCD Slicer, Guangdong, China) equipped with the 3D-printer (ST-1600 3D-Printer, Satori Ltd., London, UK). The 3D-printing resin was poured into the printer, and the specimen was printed layer by layer at a thickness of 50 µm at 0° in a pre-determined dimension by Mask Stereolithography (MSLA) technique.24 The obtained specimens were cleaned with isopropanol and post-print cured by immersion in glycerin for an additional 40 min using a post-curing oven (Zirlux, Zahn Dental Labs, Henry Schein, Waltham, MA, USA) to ensure the reaction of remaining monomers.14 For the conventional heat polymerized acrylic resin specimens, the lost wax technique was followed. The prepared wax pattern was processed to PMMA using the flask-press-pack method.7 (
link) Following deflasking, the redundant resin from all the specimen surface was trimmed using a tungsten carbide bur.
For the purpose of standardization, the specimens were handled by a single investigator for finishing and polishing. The specimens were finished with sequential use of silicon carbide paper (Dentaurum, Ispringen, Germany) at 300 rpm under water cooling. Polishing was accomplished using water and pumice slurry in a polishing unit (Derotor, London, England) for 90 s. The specimens' dimensions to the nearest ± 0.05 mm were confirmed using a digital caliper (Digimatic Micrometer, Mitutoyo, Kanagawa, Japan). The specimens were cleaned ultrasonically in distilled water for 5 min and dried with tissue paper before baseline color measurements (T0).
Following T0, the specimens were thermocycled (TC), subjected to mechanical brushing and later immersed in staining medium corresponding to one year of oral use. The specimens were TC for 10,000 cycles at 5℃ – 55℃, with 30 s dwell time and 10 s transfer time in a thermocycler (Huber 1100, SD Mechatronik GmbH, Feldkirchen-Westerham, Germany) to represent one year of oral use.25 (
link) After TC, the specimens were cleaned under running water and stored in distilled water before mechanical brushing simulation.
A simulator device (ZM 3, SD Mechatronik GMBH, Feldkirchen Westerham, Germany) was used to simulate brushing. The specimens were fixed onto the customized plexiglass inside the brushing device's containers using a drop of acrylic monomer. The device was equipped with 12 separate slots to which 12 soft toothbrushes (Colgate® 360®, Colgate-Palmolive Company, Riyadh, Saudi Arabia) were attached. A slurry was then prepared using commercially available dentifrice (Colgate® Regular, Colgate-Palmolive Company, Riyadh, Saudi Arabia) and deionized water at a ratio of 1:1 (by weight) and mixed in a plaster vacuum mixer. All 12 containers were filled with the slurry to cover the specimens (approx. 12 ml/container). Mechanical brushing was accomplished at 356 rpm, under a vertical load of 200 g and a stroke path of 3.8 cm, brushing 12 specimens simultaneously. The total brushing time was 50 min (17,800 cycles) that equalled to one year of tooth brushing.26 (
link) The slurry was refilled, and toothbrushes were replaced every 4,500 cycles. The toothbrushes were replaced in accordance with the American Dental Association (ADA) recommendations, which states that brushes be replaced 3 – 4 months or earlier if the toothbrush bristles wear away.27 (
link) The specimens were then stored in distilled water for 24 hours before immersion procedure according to the ISO/TR 11405:1994 recommendation.7 (
link)
After identification with a bur (
Fig. 1B), the specimens were randomly allocated into four groups (n = 10) according to the staining medium used (coffee, lemon juice, coke, and artificial saliva). Coffee (Nescafe Classic, Nestle, Riyadh, Saudi Arabia) and artificial saliva (AS) was prepared fresh. In contrast, lemon juice (Florid's natural lemonade juice, Lake Wales, FL, USA) and coke (The Coca-Cola Company, Riyadh, Saudi Arabia) were used as received from the manufacturer. The coffee beverage was prepared by adding 15 g of coffee powder into 250 mL of boiling water and continuously stirred for 10 min. Once the prepared solution was cooled down to room temperature, it was filtered using a filter paper to remove the residue.28 (
link) The AS was prepared by a pharmacist per the description from a previous study.29 (
link) The pH of beverages and AS was determined using a benchtop pH meter (pH 2700, OAKTON Instruments, Vernon Hills, IL, USA).
The specimens were then individually immersed in vials containing 20 mL of either of the beverages. Each specimen was suspended inside the vial using dental floss to ensure equal exposure of both surfaces to the beverages. The specimens were immersed in their respective beverages for 288 hours, and the beverages were changed every 24 hours. The immersion time used in this study was equal to one year of oral exposure.30 (
link)
The specimens were later removed from the vials, cleaned under running water, and further stored in distilled water for 24 hours. The second color measurements (T1) were recorded, and the specimens were again subjected to the whole procedure (TC + mechanical brushing + immersion) as detailed above to simulate another year of oral use, followed by final color measurements (T2).
Before each color measurement, the specimens were dried well with a disposable paper towel. The color of the specimens were recorded in the 3-dimensional Commission Internationale de l'Eclairege L
*a
*b
* (CIELab) color space using an UV light visible spectrophotometer (LabScan® XE, Hunter Associates Laboratory Inc., Reston, VA, USA). The CIE L
*a
*b
* system is a chromatic value color space measuring both value and chroma on L
*a
*b
* coordinates: L
* measures the lightness of the color (a value of 100 corresponds to perfect white and 0 to black); a
* measures color in the red (a
* > 0) and green (a
* < 0) dimension; and b
* measures color in the yellow (b
* > 0) and blue (b
* < 0) dimension.31 (
link) The CIE L
*a
*b
* mean reading was repeated three times and the average was calculated for each specimen. The total color alteration (ΔE
*) for each specimen at T1 and T2 was calculated using the equation (1) and (2), respectively:
According to the ISO/TR-28642:2016 norm, the CIELAB 50:50% perceptibility threshold (PT) ΔE values is ≤ 1.2, whereas 50:50% acceptability threshold (AT) ΔE value is between 1.2 and 2.7. Any ΔE values above the AT limit is not clinically acceptable.32 Furthermore, in relating the color difference to a clinical situation, the ΔE values were converted to National Bureau of Standards (NBS) units using the equation 3.33 (
link)
Data analyses were performed using Statistical Package for Social Sciences v.20.0 (SPSS) (IBM SPSS Inc., Chicago, IL, USA). Shapiro-Wilk test revealed the presence of a normal distribution. Descriptive statistics (mean and SD) were used to describe the quantitative color difference (ΔE). Factorial ANOVA was used to quantify the effect of material type, staining medium, and immersion time on ΔE values. Bonferroni post-hoc test was used for multiple comparisons between independent factors (Materials/staining medium/Time) (α = .05).
Alfouzan A.F., Alotiabi H.M., Labban N., Al-Otaibi H.N., Al Taweel S.M, & AlShehri H.A. (2021). Color stability of 3D-printed denture resins: effect of aging, mechanical brushing and immersion in staining medium. The Journal of Advanced Prosthodontics, 13(3), 160-171.