Abstract
CAD/CAM (computer-aided design and computer-aided manufacturing) technology has been widely applied in clinical dentistry, but the material safety remains a concern. To investigate the impacts of CAD/CAM metallic materials on trace metals and biocompatibilities, selective laser melted (SLM) cobalt-chromium (Co-Cr) alloys and computer numeric controlled milled (CNC milled) commercially pure titanium (CP-Ti) were placed on the maxilla of beagle dogs for 6 months. The trace metals in the oral mucosa, blood, liver, kidney, and hair were then determined by inductively coupled plasma mass spectrometry (ICP-MS). The histopathologic changes and biocompatibilities of tissues were examined by hematoxylin and eosin (H&E) staining, terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-digoxigenin nick end labeling (TUNEL) method, immunohistochemistry (IHC) assay, Western blot analysis, and liver and kidney function tests. Our results showed that trace metals released from these two CAD/CAM metallic materials accumulated transiently in the oral mucosa and whole blood. The trace metals released from SLM Co-Cr alloys could also transiently accumulate in the plasm and hair. In addition, these two CAD/CAM metallic materials both induced apoptosis and histopathologic changes in the oral mucosa, with SLM Co-Cr alloys inducing a higher level of apoptosis. In contrast, both materials did not exert autophagic effects on the oral mucosa or affect the trace metals, functions, or biocompatibilities of the liver and kidney. Therefore, this study suggests that CAD/CAM metallic materials should be selected carefully, especially in patients with metal- and apoptosis-related diseases, and CNC-milled CP-Ti can be recommended to patients on account of its better biocompatibility and safety.
Highlights
With the promotion and application of computer-aided design and computer-aided manufacturing (CAD/CAM) technology in dentistry, increased digital molding methods, such as selective laser melting (SLM) and computer numeric controlled (CNC) milling, have been used to fabricate metallic dental prostheses and implants
Metals Released From the CAD/CAM Metallic Materials Were Accumulated Transiently in Oral Mucosa, Blood, and Hair, but did Not Affect the Concentrations of Trace Metals in Liver and Kidney
Metal ions released from the SLM Co-Cr alloys and CNC-milled commercial pure titanium (CP-Ti) were found to accumulate transiently in the oral mucosa
Summary
With the promotion and application of computer-aided design and computer-aided manufacturing (CAD/CAM) technology in dentistry, increased digital molding methods, such as selective laser melting (SLM) and computer numeric controlled (CNC) milling, have been used to fabricate metallic dental prostheses and implants. There are many benefits associated with dental prostheses fabricated by CAD/CAM compared to traditional lost-wax casting techniques, including the access to better and almost defect-free pieces, an increase in quality, reproducibility, and efficiency, and an improvement in accuracy and precision (Patel, 2014; Bilgin et al, 2016; AhmED, 2018). These digitized molding methods mainly use cobalt-chromium (Co-Cr) alloy and commercial pure titanium (CP-Ti) as raw materials for dental prostheses because of their excellent mechanical properties and acceptable price. In this research, the SLM Co-Cr alloy and CNC-milled CP-Ti were used as the representatives of CAD/ CAM metallic materials
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