Prof. Francesco Mangano
DDS, PhD
• Associate Professor, Digital Dentistry, Sechenov First State Medical University, Moscow, Russian Federation; Lecturer, University of Hong Kong, China; University of Lyon, France; University of Fez, Morocco;
• Editor-in Chief, Digital Dentistry Section, Journal of Dentistry (Q1, Impact Factor 4.8; Citescore 7.3);
• President (2024- 25), Digital Dentistry Society (DDS); Scientific Editor, DDS MAG, DentalTech, Infodent;
• Director of the Mangano Digital Academy (MDA);
• Author of 145 publications on international Pubmed indexed journals and high impact factor;
• H index 56 (Google Scholar), 41 (Scopus);
• He works as a freelance in Gravedona (Como), devoting himself exclusively to Digital Dentistry.
introduction
introduction
Today, implant-supported prostheses have changed thanks to the advent of 3D printing, which allows the manufacture of certified definitive restorations in hybrid composites filled with ceramic, even chairside.
Here, we present a rehabilitation case of a patient with two single implants, one in the maxilla (#26) and the other in the mandible (#46), managed through a fully digital and model-free workflow and finalised with two hybrid composite crowns (filled with 42% ceramic particles). The first step was intraoral scanning of the implants (Anyridge®; Megagen, South Korea; Figs. 1–4).
the case
the case
The scan was captured with a powerful intraoral scanner (iTERO Element 5D Plus®; Align, USA) according to a consolidated protocol, which included:
- Scanning of the master model after removing the healing abutment;
- Scanning the opposing arch;
- Scanning of the bite on the left and right;
- High-resolution scanning of the scan body (IPD Pro CAM®; Matarò, Spain) and adjacent teeth for the best definition of the contact points;
- Scanning the master model with the scan body in position.
The intraoral scanner choice was motivated by the high accuracy of the iTERO Element 5D Plus®, as unequivocally demonstrated in the scientific literature [1]. We opted for IPD Pro CAM® compatible scan bodies since this is one of the very few companies able to provide incremental libraries (i.e. equipped with multiple files of the same scan body at different magnifications), which helps to compensate for the possible (and probable, given that it is an optical scan) mesh growth during scanning.
This library allows the dental technician to significantly improve the quality of the superimposition of the library file on the scan body mesh, minimising all errors. It eliminates the risk of shifting the implant platform from real to virtual.
After receiving the scan file in the cloud, the dental technician modelled an individual abutment for each implant, to be fabricated by milling in zirconia, and a single crown, to be 3D printed in hybrid composite loaded with ceramic particles (Galway®; exocad, Germany; Figs. 5–8).
“Having received the scan file in the cloud, the dental technician modeled for each implant an individual abutment and a single crown.”
The files were reshared with me, and I put them into production. The individual abutments were milled in zirconia with a powerful five-axis milling machine (DGSHAPE DWX-52D®; Roland Company, Japan), sintered in a dedicated oven and adhesively cemented onto TiBase IPD ProCam®, appropriately sectioned to identify the best possible height, through a specific cutting template.
The prosthetic crowns were instead 3D-printed using a tilted stereolithography technique with a Dfab® printer (DWS Systems, Italy) in hybrid composite material (filled with 42% ceramic particles) Irix Max® (DWS Systems; Thiene, Italy; Figs. 9–12).
“The prosthetic crowns were instead printed using a tilted stereolithography technique.”
The workflow involved loading the STL file of the restorations into the proprietary Nauta Photoshade® software (DWS Systems, Italy), which automatically generates the
supports and print bases. The operator must only set the colour levels because the printer can print restorations with a colour gradient (three different colours) for a better aesthetic adaptation, all completed in under 15 minutes. After printing, the restorations were further characterised and cured for five minutes in a dedicated unit (Dcure®; DWS Systems, Italy) before delivery.
The definitive hybrid-composite restorations were delivered at the second appointment. The healing abutments were unscrewed, the individual hybrid abutments were screwed, and the monolithic crowns in hybrid composite loaded with ceramic were cemented on top of the (Figs. 13–14).
conclusion
conclusion
The precision of these crowns, obtained by 3D printing, is relatively high, as demonstrated in a recent in vitro study [2]. From a clinical perspective, these restorations proved reliable in a recent retrospective study involving 85 patients rehabilitated with 95 restorations (70 single crowns and 25 bridges with up to three elements) [3].
SOURCES
(1) Mangano FG, Admakin O, Bonacina M, Lerner H, Rutkunas V, Mangano C. Trueness of 12 intraoral scanners in the full-arch implant impression: a comparative in vitro study. BMC Oral Health. 2020 Sep 22;20(1):263
(2) Mangano FG, Cianci D, Pranno N, Lerner H, Zarone F, Admakin O. Trueness, precision, time-efficiency and cost analysis of chairside additive and subtractive versus lab-based workflows for manufacturing single crowns: An in vitro study. J Dent. 2024 Feb;141:104792.
(3) Mangano FG, Yang KR, Lerner H, Porrà T, Khachatryan LG, Gordienko ID, Admakin O. 3D-printed Shortspan Hybrid Composite Implant-supported Restorations Fabricated Through Tilting Stereolithography: A Retrospective Clinical Study on 85 Patients with 1 Year of Follow-up. J Dent. 2024 May 22:105095.