Long term Provisional, is printed or milled better?

[Contraluz]

As the title says, is printed composite or milled PMMA better for long term provisionals? I have been milling most of my provisionals in PMMA. But for certain cases, I recently started printing them in 'GC temp print'.

I your experience and knowledge, which material is more stable for long term use?

And what are you all using?

Thanks in advance,

M

 

[a3dl]

We print most now using the Flexcera smile ultra+. I don't have enough long term data but curios to see what others are doing.

 

[sidesh0wb0b]

As the title says, is printed composite or milled PMMA better for long term provisionals? I have been milling most of my provisionals in PMMA. But for certain cases, I recently started printing them in 'GC temp print'.

I your experience and knowledge, which material is more stable for long term use?

And what are you all using?

Thanks in advance,

M

i dont have data either way, though we mill ours.
what made you switch to printing them?

 

[Contraluz]

i dont have data either way, though we mill ours.
what made you switch to printing them?

I got curious...

I have not fully switched, yet. The thing is, you give up esthetics, due to the multi layered PMMA discs vs one shade printed composite product. On the other hand, there is almost no re-contouring with the printed provisionals, just smoothing out the 'printing layer lines'.

 

[sidesh0wb0b]

I got curious...

I have not fully switched, yet. The thing is, you give up esthetics, due to the multi layered PMMA discs vs one shade printed composite product. On the other hand, there is almost no re-contouring with the printed provisionals, just smoothing out the 'printing layer lines'.

ah yes, good ol curiosity! haha

 

[tuyere]

To be my usual pedantic self- In terms of product quality and longevity, what's better for the patient, milled is virtually always gonna be better, assuming competent fabrication and fitting- it's a reflection of each process and its limitations/constraints. SLM/DLP/LCD prints are flatly inferior, mechanically and structurally, to their subtractively-manufactured equivalents, there is no situation in which a porous, spongey composite only partially-composed of the desired restoration material is going to outperform a homogenous bulk sample, its properties carefully controlled at the point of blank manufacture, which is milled to final shape.
...now, which is better for the lab, that's a very different question with differently-weighted factors. High-performing, aesthetically-satisfactory printed materials have come a very long way in the past few years. Rodin Sculpture or Titan is fantastic stuff for any sort of temp or provisional, and you can't argue with the speed and ease of manufacture to a well-fitting, ready-to-wear standard. The fact that it lets labs do this kind of work with a $500 printer instead of a $35000 mill is probably the biggest bonus for small, shoestring-budget labs in particular.

Nothing I haven't said here before, across a half-dozen similar threads. If you can profitably mill temps and everybody's happy with them, keep on keepin' on. But the barrier to entry has basically collapsed, if you're willing to learn how to maintain your own hobbyist-tier printer and to print to a high standard with technically-challenging resins like Sculpture/Titan. Couple ways you can skin this satisfactorily, depending on your lab setup and your resources.

 

[tuyere]

...oh yeah, we do both, as it so happens, depending on the needs of the patient and what's a better fit on our production end. Sometimes we still mill stuff that would be cheaper/quicker to print, just because we don't want to tie one of our printers up for a few hours doing a single case, and we have the milling capacity to generally chuck another PMMA job on the heap and have it done by end of day. So- it really depends! Not the most useful answer, I know, but it is how things break down for us.

 

[TheLabGuy]

We let the puck decide...if it fits/loads, it gets milled...if not, then it gets printed.

 

[Contraluz]

...oh yeah, we do both, as it so happens, depending on the needs of the patient and what's a better fit on our production end. Sometimes we still mill stuff that would be cheaper/quicker to print, just because we don't want to tie one of our printers up for a few hours doing a single case, and we have the milling capacity to generally chuck another PMMA job on the heap and have it done by end of day. So- it really depends! Not the most useful answer, I know, but it is how things break down for us.

Thank you for your extensive response!

Besides cost, what my main question is, for this specific case, what is better for longevity. I realize, a milled puck is more homogenous, which would favor it. But what is about wear?

This begs the question, is there a difference in quality of the PMMA pucks, the different brands offered? Or are they all fabricated in the same facility and just rebranded?

I have been mostly using Harvest's PMMA. But they seem to have changed their 'ingredients' recently (with a decrease in cost/puck, fair enough), but it feels like the quality went down the drain, too. I liked the previous mixture much better.

 

[sidesh0wb0b]

Thank you for your extensive response!

Besides cost, what my main question is, for this specific case, what is better for longevity. I realize, a milled puck is more homogenous, which would favor it. But what is about wear?

This begs the question, is there a difference in quality of the PMMA pucks, the different brands offered? Or are they all fabricated in the same facility and just rebranded?

I have been mostly using Harvest's PMMA. But they seem to have changed their 'ingredients' recently (with a decrease in cost/puck, fair enough), but it feels like the quality went down the drain, too. I liked the previous mixture much better.

i agree with your assessment about harvest pmma. i ended up switching to whitepeaks for that reason (and some of the harvest shades were terrible!)

as far as longevity, i still believe mille would be best, but they do have some of those ceramic print resins that 'may' hold up better longer term. not sure if any big study groups have had enough time to run extensive trials on them both side by side. good questions!

 

[tuyere]

Thank you for your extensive response!

Besides cost, what my main question is, for this specific case, what is better for longevity. I realize, a milled puck is more homogenous, which would favor it. But what is about wear?

This begs the question, is there a difference in quality of the PMMA pucks, the different brands offered? Or are they all fabricated in the same facility and just rebranded?

I have been mostly using Harvest's PMMA. But they seem to have changed their 'ingredients' recently (with a decrease in cost/puck, fair enough), but it feels like the quality went down the drain, too. I liked the previous mixture much better.

For longevity and reliability, yeah, go with milled, definitely.
But yes, the material quality can vary considerably, a lot of stuff is rebadged generic material but it doesn't seem as common as that is with, say, zirconia. Quality and appearance can vary hugely between brands. We don't really use Harvest to begin with, we stock Aidite and Argen, with Vita and Esthetica available for premium cases, if i remember correctly.

as far as longevity, i still believe mille would be best, but they do have some of those ceramic print resins that 'may' hold up better longer term. not sure if any big study groups have had enough time to run extensive trials on them both side by side. good questions!

Yeah, this is my main reservation with these printed provisionals- they're new enough that we don't really have a good sense for the real-world longevity of printed nanoceramic parts.
The other thing is that it's much easier to manufacture these printed parts incorrectly, in a way that impacts longevity. Incorrect post-processing / curing, print defects that may be internal and invisible, etc- there are a lot of ways to print parts that are flawed and more likely to fail prematurely. This is much harder to do with milling- the material properties and structure are mostly locked in before you even buy the blank, you just have to cut away everything that isn't your provisional.

 

[tuyere]

An aside- we produce comparison samples of all the milled materials we work with (or are considering working with) so we can compare materials directly, usually for shade-matching. Here's a denture teeth sample set we're implementing:


Each tooth is mounted to its stick/holder with a pin that lets them rotate freely; I also engrave a unique code on each so they won't get mixed up. The aidite samples are currently being polished and prepped for assembly, we mill new samples of the less commonly-used materials as cases show up that call for them, eventually we'll populate most of this set. Lets them do quick and easy shade-matching across our entire PMMA library.

 

[Contraluz]

An aside- we produce comparison samples of all the milled materials we work with (or are considering working with) so we can compare materials directly, usually for shade-matching. Here's a denture teeth sample set we're implementing:

View attachment 45155
Each tooth is mounted to its stick/holder with a pin that lets them rotate freely; I also engrave a unique code on each so they won't get mixed up. The aidite samples are currently being polished and prepped for assembly, we mill new samples of the less commonly-used materials as cases show up that call for them, eventually we'll populate most of this set. Lets them do quick and easy shade-matching across our entire PMMA library.

I appreciate your extensive response and great content!

 

[sidesh0wb0b]

An aside- we produce comparison samples of all the milled materials we work with (or are considering working with) so we can compare materials directly, usually for shade-matching. Here's a denture teeth sample set we're implementing:

View attachment 45155
Each tooth is mounted to its stick/holder with a pin that lets them rotate freely; I also engrave a unique code on each so they won't get mixed up. The aidite samples are currently being polished and prepped for assembly, we mill new samples of the less commonly-used materials as cases show up that call for them, eventually we'll populate most of this set. Lets them do quick and easy shade-matching across our entire PMMA library.

very well thought out and great responses for sure!
silly question, how big is your lab that you stock 4 brands of PMMA?!?

 

[Contraluz]

very well thought out and great responses for sure!
silly question, how big is your lab that you stock 4 brands of PMMA?!?

I had the same thought...

 

[Contraluz]

we stock Aidite and Argen, with Vita and Esthetica

If I may, are you located in Europe? It seems the esthetica pmma is only available in Europe.

 

[RileyS]

I want to make printed holders. I’m guessing you printed the shade tab holders? They look way nice. Have an STL or quick tutorial?

 

[sidesh0wb0b]

I want to make printed holders. I’m guessing you printed the shade tab holders? They look way nice. Have an STL or quick tutorial?

he has everything.
a freaking wealth of cool gadgets to mess with

 

[tuyere]

very well thought out and great responses for sure!
silly question, how big is your lab that you stock 4 brands of PMMA?!?

We're pretty big, I think we've got 100ish lab staff all in. That's the only reason they can justify having a guy like me around who has no dental background and does very little actual production work.
We also don't actually stock all four in every shade, we stock almost all the Argen stuff (all the shades we normally mill teeth in), maybe 2/3 in Aidite (it's cheaper and still acceptable for many purposes), and Esthetica + Vita we don't maintain a stock of, per se, we just order those for the occasional ~premium job~ as needed, and very gradually build up a partial library of partially-used discs in those. I think I've got, like, 5 sample teeth prepped in Esthetica, all the most common shades.

I want to make printed holders. I’m guessing you printed the shade tab holders? They look way nice. Have an STL or quick tutorial?

Yep, designed and printed everything in-house to our denture supervisor's specifications. Some more deets-


Simple and straightforward, the holders have a countersunk pocket that accommodates the head of a little printed pin. The tooth samples have a flat section on the back, and a shallow, undersized hole in the middle of that flat. I manually ream the holes to final size and depth using a #52 drill bit chucked up in a pin vise because it gets much more consistent results than trying to do absolutely everything on the mill. For assembly I put the pin through the countersunk hole, transfer a little dot of glue to the end of the pin, and then press it into the socket on the tooth- with manual hole finishing I can generally press-fit the pin pretty securely, but that probably won't last because of how resin prints all exhibit creep under load, so the glue is insurance. If done correctly the glue never comes near the holder socket, so the teeth can rotate freely on the pin.




Detail of the markings- first letter indicates manufacturer, the rest is shade. The base of the pin looks weird and green because Dentamodel's filler material is actually green but you don't know it until you let a resin tray settle out for a couple days and then print without mixing it properly, as I have manifestly done here.
RE: models, I can't give this stuff out freely b/c it ain't mine to give, but I'm slowly working on something that I can distribute, so stay tuned I guess.

 

[CADGuy]

Milled PMMA has been the traditional go to with us, but recently have been doing more printed with Onyx Tough 2. Very durable and easy to characterize. Cost is also very favorable. Fantastic for All-on X. Worth trying out if you're interested.