Dr. Byung Chan Kim
DDS
• Dr. Byung Chan Kim graduated in Dentistry from the University of Foggia in 2020 and has taught seminars in the Prosthodontics department at the same institution.
• He is an active member of the Digital Dentistry Society (DDS).
• He is the President of the local Foggia chapter of the Italian Association of Dentists (AIO).
• He practices at Studio Lepidi & Suriano in Andria, Italy.
Luca Lepidi
introduction
introduction
Digital dentistry continues to reshape everyday clinical practice by providing faster, more predictable, and patient-centered restorative solutions. Three-dimensional (3D) printing has emerged as a practical alternative to conventional subtractive manufacturing, particularly for chairside and time-sensitive procedures. Meanwhile, additive manufacturing is increasingly integrated into single-visit restorative protocols, allowing efficient material use, streamlined workflows, and rapid production.
Recent advances in dental 3D printing—such as systems capable of chairside fabrication of definitive restorations—have expanded the clinical potential of in-office workflows. 3D-printed hybrid composite materials exhibit reliable fit, adequate strength, and favorable esthetic outcomes, supporting their use in routine restorative and prosthetic applications.
While implant-supported restorations are often the preferred option for single-tooth replacement, patients may decline implant therapy for reasons of personal preference, treatment duration, surgical concerns, or cost. In such cases, a conventional fixed dental bridge remains a predictable alternative. When combined with a fully digital workflow, these restorations can be delivered efficiently, with reduced chair time and minimal laboratory involvement.
This case report presents a fully digital, chairside workflow for the replacement of a single missing mandibular molar in a patient who declined implant therapy, using a 3D-printed three-unit fixed dental bridge. The workflow encompasses digital diagnosis, intraoral scanning, computer-aided design (CAD)-based prosthetic design, and in-office additive manufacturing, all completed in a single appointment.
Case report
Case report
A patient presented with the absence of the mandibular right first molar (tooth 46), but expressed reluctance to undergo implant therapy. Considering the stability of the adjacent teeth and the presence of compromised restorations, a conventional three-unit fixed dental bridge was planned to restore the missing tooth and reinforce the adjacent teeth.
Following endodontic treatment and prosthetic preparation of teeth 45 and 47 (Figs. 1, 2), an intraoral scan was performed to obtain optical impressions for digital prosthetic planning. The scanned data were imported into CAD software (exocad DentalCAD, Darmstadt, Germany; Figs. 3–7), which was used to design the restoration using standard digital prosthetic protocols. This included defining finish lines, virtual positioning of the prosthetic elements, optimizing the interproximal and occlusal contacts, and configuring the bridge connectors. The final CAD design was approved before proceeding to additive manufacturing.
“The scanned data were imported into CAD software, where the restoration was designed using standard digital prosthetic protocols.”
The restoration was fabricated using a chairside 3D printer (Dfab, RD Printing, Thiene, Italy; Fig. 8) with tilted stereolithography, a technology designed to enhance printing efficiency and material distribution. STL files were uploaded and the restoration and generated supporting structures were automatically positioned by the Photoshade software (Figs. 9–12). A hybrid composite material containing 42% ceramic filler (Irix Max, RD Printing, Thiene, Italy; Fig. 13) was used for the bridge. Integrated software enabled chromatic gradient customization to improve esthetic integration. Printing was completed in approximately 20 minutes, without complications.
“3D printing has emerged as a practical alternative to subtractive manufacturing, particularly for chairside procedures.”
After printing, the bridge was cleaned in 95% ethanol (Fig. 14) and air-dried. It was inspected for a uniform matte appearance with no shiny areas (Fig. 15), which would indicate residual liquid resin. Any remaining resin was removed by gentle brushing.
The restoration was easily detached from the build platform—thanks to the patented easy-break configuration of the supports (Fig. 16)—and post-cured in a dedicated unit combining heat and UV light (Dcure, RD Printing, Thiene, Italy) to optimize polymer conversion (Fig. 17).
The bridge was then finished, and, following sandblasting of areas of interest (Fig. 18), extrinsic characterization was performed using a staining system (IPS Empress Direct, Ivoclar, Schaan, Liechtenstein; Figs. 19–22) to match the patient’s natural dentition. Final polishing was conducted with a sequential diamond-impregnated system (Optra Gloss, Ivoclar, Schaan, Liechtenstein) followed by a goat hair wheel to achieve a high-gloss surface.
The bridge was evaluated for shade, fit, and occlusion; no further adjustments were necessary. Adhesive cementation was performed following standard protocols. The intaglio surfaces of the bridge were sandblasted with 50 micron aluminum oxide, cleaned, and treated with a universal adhesive system (Adhese Universal, Ivoclar, Schaan, Liechtenstein). Prepared teeth were cleaned, etched, and conditioned before applying the adhesive. The restoration was seated using a light-curable luting composite (Variolink Esthetic DC, Ivoclar, Schaan, Liechtenstein). Excess cement was removed, and margins were polymerized under controlled light conditions. Occlusion and functional movements were verified, and final finishing of the cement lines was performed (Optra Gloss intraoral, Ivoclar, Schaan, Liechtenstein) (Fig. 23).
Discussion
Discussion
This case demonstrates the feasibility of a fully digital chairside workflow for single-appointment, 3D-printed fixed dental bridges. The approach offers predictable fit, efficient fabrication, and superior esthetic outcomes while reducing patient visits and reliance on laboratory processing. Hybrid composite materials allow chairside polymerization, characterization, and polishing, producing restorations suitable for definitive clinical use.
While implant therapy remains the standard for single-tooth replacement, digital workflows enable conventional fixed bridges to be delivered efficiently for patients who decline surgical interventions. Proper material handling, post-curing, and adhesive protocols are critical to ensure the long-term success of 3D-printed restorations.
“With careful attention to material selection, 3D-printed hybrid composite restorations can be incorporated effectively into routine clinical practice.”
CONCLUSION
CONCLUSION
Fully digital, chairside fabrication of a 3D-printed three-unit fixed dental bridge is a viable option for single-tooth replacement in patients who decline implants. This workflow provides predictable fit, esthetic integration, and functional outcomes within a single appointment. With careful attention to material selection, post-processing, and adhesive cementation, 3D-printed hybrid composite restorations can be incorporated effectively into routine clinical practice.
References
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