journal article·2025-08-07Open access

Analysis of 3D-Printed Zirconia Implant Overdenture Bars

Les Kalman, João Paulo Mendes Tribst

Applied Sciences· Volume 15· Issue 15

Abstract

Dental implant components are typically fabricated using subtractive manufacturing, often involving metal materials that can be costly, inefficient, and time-consuming. This study explores the use of additive manufacturing (AM) with zirconia for dental implant overdenture bars, focusing on mechanical performance, stress distribution, and fit. Solid and lattice-structured bars were designed in Fusion 360 and produced using LithaCon 210 3Y-TZP zirconia (Lithoz GmbH, Vienna, Austria) on a CeraFab 8500 printer. Post-processing included cleaning, debinding, and sintering. A 3D-printed denture was also fabricated to evaluate fit. Thermography and optical imaging were used to assess adaptation. Custom fixtures were developed for flexural testing, and fracture loads were recorded to calculate stress distribution using finite element analysis (ANSYS R2025). The FEA model assumed isotropic, homogeneous, linear-elastic material behavior. Bars were torqued to 15 Ncm on implant analogs. The average fracture loads were 1.2240 kN (solid, n = 12) and 1.1132 kN (lattice, n = 5), with corresponding stress values of 147 MPa and 143 MPa, respectively. No statistically significant difference was observed (p = 0.578; α = 0.05). The fracture occurred near high-stress regions at fixture support points. All bars demonstrated a clinically acceptable fit on the model; however, further validation and clinical evaluation are still needed. Additively manufactured zirconia bars, including lattice structures, show promise as alternatives to conventional superstructures, potentially offering reduced material use and faster production without compromising mechanical performance.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Dental Implant Techniques and Outcomes · Dental materials and restorations · Bone Tissue Engineering Materials

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St., London, ON N6A 3K7, Canada

Department of Reconstructive Oral Care, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands

Funding

American Academy of Implant Dentistry Foundation

References (46)

Show source-provided references
1. Emami, E., De Souza, R.F., Kabawat, M., and Feine, J.S. (2013). The impact of edentulism on oral and general health. Int. J. Dent., 2013.10.1155/2013/498305 ↗
2. Restoration of unfavourably positioned implants for a partially edentulous patient by using an overdenture retained with a milled bar and attachments: A clinical report10.1016/j.prosdent.2003.09.009 ↗
3. Rationale for dental implants10.1038/sj.bdj.4813718 ↗
4. The implant-supported milled-bar mandibular overdenture10.1111/j.1532-849X.2001.00046.x ↗
5. Implant-supported mandibular bone resorption in edentulous patients: Results of a long-term radiologic evaluation10.11607/jomi.4009 ↗
6. Effect of implants on maximum bite force in edentulous patients10.1563/1548-1336-35.4.196 ↗
7. Comparison of three-implant supported fixed dentures and two-implant-retained overdentures in the edentulous mandible: A pilot study of treatment efficacy and patient satisfaction
8. A clinical trial of patient satisfaction and prosthodontic needs with ball and bar attachments for implant-retained complete overdentures: Three-year results10.1016/j.prosdent.2004.10.013 ↗
9. Implant-supported removable partial denture improves the quality of life of patients with extreme tooth loss10.1590/0103-6440201300097 ↗
10. Tissue-supported dental implant prosthesis (overdenture): The search for the ideal protocol. A literature review
11. Implant position record and implant position cast: Minimizing errors, procedures and patient visits in the fabrication of the milled-bar prosthesis10.1016/S0022-3913(00)70095-3 ↗
12. Implant supported milled bar overdenture
13. Bueno Samper, A., Hernández Aliaga, M., and Calvo Guirado, J.L. (2010). The implant-supported milled bar overdenture: A literature review. Med. Oral Patol. Oral Cir. Bucal, 15.10.4317/medoral.15.e375 ↗
14. Stanley, M., Paz, A., and Miguel, I. (2018). Fully digital workflow, integrating dental scan, smile design and CAD-CAM: Case report. BMC Oral Health, 18.10.1186/s12903-018-0597-0 ↗
15. Downs, J. (2019, January 18). The Real Cost of In-Office Milling. Available online: https://adentmag.com/the-real-cost-of-in-office-milling/.
16. 3D printing in dentistry10.1038/sj.bdj.2015.914 ↗
17. Quality Assessment and Comparison of 3D-Printed and Milled Zirconia Anterior Crowns and Veneers: In Vitro Pilot Study10.1055/s-0044-1782183 ↗
18. Nabil, M.S., Mahanna, F.F., and Said, M.M. (2024). Evaluation of Masticatory Performance and Patient Satisfaction for Conventional and 3D-Printed Implant Overdentures: A Randomized Crossover Study. BMC Oral Health, 24.10.1186/s12903-024-04389-1 ↗
19. Marginal Fit of Selective Laser Melting Cobalt-Chromium Bar Versus Cast Bar on Mandibular Edentulous Casts with Two Implants Supported Over Denture: An In Vitro Study10.21608/acdj.2025.349756.1031 ↗
20. Kalman, L. (2022). 3D Fabrication Workflow: Solid & Lattice-Structured Titanium Alloy Dental Implant Overdenture Bars. Oral Health, 112, Available online: https://www.oralhealthgroup.com/features/3d-fabrication-workflow-solid-lattice-structured-titanium-alloy-dental-implant-overdenture-bars/.
21. Kalman, L. (2022). Development of a Novel Dental Thermal Imaging Application. Med. Res. Innov., 6.10.15761/MRI.1000184 ↗
22. (2017). Standard Test Method for Flexural Properties of Unreinforced and Reinforced Plastics and Electrical Insulating Materials by Four-Point Bending (Standard No. ASTM D6272-17e1).
23. (2021). Standard Practice for Conditioning Plastics for Testing (Standard No. ASTM D618-21).
24. Marginal and Internal Fit of Zirconia Based Fixed Dental Prostheses Fabricated with Different Concepts10.2147/CCIDE.S6691 ↗
25. Tribst, J.P.M., Dal Piva, A.M.D.O., Borges, A.L.S., Rodrigues, V.A., Bottino, M.A., and Kleverlaan, C.J. (2020). Does the Prosthesis Weight Matter? 3D Finite Element Analysis of a Fixed Implant-Supported Prosthesis at Different Weights and Implant Numbers. J. Adv. Prosthodont., 12.10.4047/jap.2020.12.2.67 ↗
26. Heboyan, A., Lo Giudice, R., Kalman, L., Zafar, M.S., and Tribst, J.P.M. (2022). Stress Distribution Pattern in Zygomatic Implants Supporting Different Superstructure Materials. Materials, 15.10.3390/ma15144953 ↗
27. Romanos, G.E., Fischer, G.A., and Delgado-Ruiz, R. (2021). Titanium wear of dental implants from placement, under loading and maintenance protocols. Int. J. Mol. Sci., 22.10.3390/ijms22031067 ↗
28. Delgado-Ruiz, R., and Romanos, G. (2018). Potential causes of titanium particle and ion release in implant dentistry: A systematic review. Int. J. Mol. Sci., 19.10.3390/ijms19113585 ↗
29. Sheikh, Z.D., Patel, A., and Eraldo, B. (2025, June 18). Dental Implant Failure and the Association with Proton Pump Inhibitors (PPIs) and Selective Serotonin Reuptake Inhibitors (SSRIs). Available online: https://www.oralhealthgroup.com/features/dental-implant-failure-and-the-association-with-proton-pump-inhibitors-ppis-and-selective-serotonin-reuptake-inhibitors-ssris/.
30. Siverino, C., Freitag, L., Arens, D., Styger, U., Richards, R.G., Moriarty, T.F., Stadelmann, V.A., and Thompson, K. (2021). Titanium Wear Particles Exacerbate S. epidermidis-Induced Implant-Related Osteolysis and Decrease Efficact of Antibiotic Therapy. Microorganisms, 9.10.3390/microorganisms9091945 ↗
31. Metal-backed patellar component failure in total knee arthroplasty: A possible risk for late infection
32. Ceramic-onpolyethylene hip arthroplasty reduces the risk of postoperative periprosthetic joint infection10.1002/jor.25230 ↗
33. Delayed-type hypersensitivity to metals in connective tissue decreases and fibromyalgia10.1016/j.envres.2017.12.004 ↗
34. Metal-on-metal total hip arthroplasty: Risk factors for pseudotumours and clinical systematic evaluation10.1007/s00264-016-3305-1 ↗
35. Histological Features of Pseudotumor-like Tissues From Metal-on-Metal Hips10.1007/s11999-010-1372-y ↗
36. Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties10.3109/17453670903473016 ↗
37. Characterization of metal-wear nanoparticles in pseudotumor following metal-on-metal hip resurfacing10.1016/j.nano.2011.08.002 ↗
38. Rainey, J.P., Gililland, J.M., Peters, C.L., Archibeck, M.J., Anderson, L.A., and Pelt, C.E. (2023). Metallosis and Corrosion Associated With Revision Total Knee Arthroplasties with Metaphyseal Sleeves. Arthroplast. Today, 22.10.1016/j.artd.2023.101167 ↗
39. Insight into corrosion of dental implants: From biochemical mechanisms to designing corrosion-resistant materials10.1007/s40496-022-00306-z ↗
40. Swaroop, A.K. (2025, June 18). Can titanium material for dental implants cause allergy?. iCliniq, Available online: https://www.icliniq.com/articles/dental-oral-health/allergy-and-titanium-dental-implants.
41. Lu, Y., van Steenoven, A., Dal Piva, A.M.D.O., Tribst, J.P.M., Wang, L., Kleverlaan, C.J., and Feilzer, A.J. (2025). Additive-Manufactured Ceramics for Dental Restorations: A Systematic Review on Mechanical Perspective. Front. Dent. Med., 6.10.3389/fdmed.2025.1512887 ↗
42. From Human to Artificial Mouth, from Basics to Results10.1016/j.snb.2009.11.030 ↗
43. Low Temperature Degradation-Aging-of Zirconia: A Critical Review of the Relevant Aspects in Dentistry10.1016/j.dental.2010.04.006 ↗
44. Cobos, S.F., Norley, C.J., Pollmann, S.I., and Holdsworth, D.W. (2022). Cost-Effective Micro-CT System for Non-Destructive Testing of Titanium 3D Printed Medical Components. PLoS ONE, 17.10.1371/journal.pone.0275732 ↗
45. Bakhsh, T.A., Alfaifi, A., Alghamdi, Y., Nassar, M., and Abuljadyel, R.A. (2023). Thermal Sensing of Photo-Activated Dental Resin Composites Using Infrared Thermography. Polymers, 15.10.3390/polym15204117 ↗
46. Dimensional Changes from the Sintering Process and Fit of Y-TZP Copings: Micro-CT Analysis10.1016/j.dental.2017.08.191 ↗