well good afternoon everyone thank you for everyone that's joined here in our faculty online Lou and thank you to everyone that's joining via Zoom we have wonderful presentations lined up for this afternoon so it is my pleasure to introduce our speakers I'll start with Dave deagle Dave is the business developer manager for 3D um cam by C America so today he's going to be presenting on 3D C and the process provider for EDI of manufacturing of Ceramics which is essential the future of the 3D print um material so followed by Dr Dr zandi and Dr Al rashan so I'll introduce our speakers as they are Tim up so we'll start with you da so if you're ready yeah so thank you to have you here again yeah thank you to the university and uh Dr zandi for coming in and um Dr aashan for all of your work uh and what I'll be talking about here is 3D ceram this is the ceramic 3D printer that we've used to make the parts for a lot of these studies recently um this printer is a laser SLA so we'll go through a little bit about the technology why we feel that this technology is best for administering and manufacturing of these dental implant components and then eventually what will be done in the future to make these in production in full scale production so again 3D saram cinto America um we manufacture the equipment the 3D printers that manufacture and actually print the components we also manufacture the software we make the different ceramic materials in this case the zonia is being made um for actually printing this material and then we provide services to those who own the printers or who are working on the development of the materials um so the premise here is that the 3D Workshop uh we have in France the 3D Workshop we have here in Michigan uh is available for universities like the University of Michigan and other universities uh to do your initial studies get your papers written do your Scholastics because from there feel that we will be able to do full FDA clearance within the next year for our process and then from that we will roll this out to dental Laboratories is where we feel this will be best used um so a little bit about the process so laser laa printing you you're basically using a laser as shown here to create a layer that layer is cured in a photo polymer and then layer after layer it gets built up layer after layer so we recat we cure a shape with the laser and then we recode again so what we're showing here is this is actual Parts being made one layer after another building up so unlike 3D printing using DLP we're printing with the laser top down onto the build plate and the laser draws a very precise line whereas DLP prints little pixels in the single layer with low powered light this is very high powerered laser so it can cure a very high density um high content zarconi in this case so this is what we're talking about the difference between DLP and Laser SLA so Digital Light processing are LP projects an image onto a mirror that then shines that up and into your curing bed or your vat it creates a series of pixels sort of like a computer monitor or TV screen little tiny squares are created and cured layer by layer and then the part uh the build platform drops down you cure onto that build platform and then it lifts it back up out of the resin over and over and over again until you create a part on ours the top down laser the laser is shooting from the top down onto the vat and onto the build platform creating a cured shape and then the the platform drops down 50 microns or 100 microns depending on the layer thickness you need um high resolution can be as low as 25 microns very thin layers are possible the other thing because we're printing it in this direction top down we don't need a series of supports to create the shape so you don't have little vestages or little connection points that then have to be ground off which you have on other 3D printing techniques so the advant the other advantage to laser printing you're drawing a continuous line with the laser um so the size of the laser spot is very consistent that laser spot draws a continuous line so you don't have pixelation or pixel accuracy where you have to try to align your shape on to that that pixel which is what we're showing here below um if the pixel is 25 by 25 micron which would be a high resolution DLP um so you can see here a round shape which is shown in the black and white that round shape is very hard to create with a pixel because you can't draw a circular line with a series of squares you end up with something that's shown like in the blue here on the bottom right where it looks like a series of steps which for Ceramics sharp Corners steps pixels like this create stress risers and we strongly encourage that we use a straight smooth shape whenever possible um you know there are curing and um ways of sort of blurring those pictures that the software is adding but you get a blurred line not a straight Crystal um this is what we're talking about support versus no support um so the DLP you're printing the part is rising up out of the platform when you're talking about a small ceramic part that's not a big deal you have just a few supports on it if you're talking about a full dental Arch which is where we're hoping to get to someday um that becomes pretty massive and you would need a lot of these support features that would then have to be ground off in some way um which are again grinding on the ceramic creates potential for problems with ours we're using gravity to help us so we can do minimal numbers of supports and we can actually just set the part on a shape and have contactless support so the slurry is so dense and so thick it's sort of like a melt shake and it's um actually able to sit and just rest on top of a supportless structure um so differ I'll just briefly talk about the printers we have three different sizes there's a C1 101 which is what we use for Dr alash Don s samples uh Dr zandi's samples mainly use the c101 lab or the C11 Fab this is something for the University level use occasional sampling the c1000 is what's used in sort of a dental lab it's what's currently used to make orthodontic brackets things of very high volume but every single part is unique and every single part can be customized so you could print in a month or a week you could print thousands of custom parts each print bed could have a thousand unique part numbers on it um so if you wanted to do unique custom abutments or copings or crowns and each one of them individual and patient specific you could make several patients 30 patients wor of individual teeth or individual abutments or individual crowns or maybe the entire package could all be printed in one print and so you can see how that would lead to an efficiency a feasible means of manufacturing in the future that would be on our c1000 size printer and then we have a c3600 size printer which is 600 by 600 by 300 so you could do an immense build platform for mass production so we do intend for this to be used at the University level learn let people learn how to use this equipment and then scale it up for mass production and that is the go mass production feasible means with just gradually growing the scale of the production so that's a little bit about what this technique is and how it's used our next presenter is Dr Sandy so it's my honor and pleasure to present you today h Dr zandi is a it's a very long CV so I'm gonna have to summarize it for everybody else's time so I'm very proud to read through this Dr zand is a full-time fanst at the Implant Dentistry associat of Arlington Texas he completed Dental training in 1996 and continues education by finishing multiple residency programs including operative AGD and prootics he served as a tener associate professor and director of the AGD program uh at the Texas ANM School of Dentistry till 2022 he's an author and or co-author of more than 80 scientific manuscripts and abstracts serve as revie for numerous scientific journals and holds multiple patterns on new prothetic design using three differencing technology he lectures nationally and internationally on new technologies 3D printing Ceramics implant and aesthetic danry so it's my honor to have him today to learn more about the updates in the 3D printing Ceramics and I know Dr zand is also on the speaker list for our upcoming annual American Cal cropic meeting so I'm also very happy to see him and listen to him over there too so Dr Zandy thank you for coming to Michigan thank you for your presentation so before that getting ready I wanted just to thank you University of Michigan Dr sag cross Department cross program and also CTO 3D serum for making that happen that's I'm really honored to be here so although I'm in a private practice full time since 2022 but I have been in academic for a long long time today when I walked to the building to be honest with you it was a very good feeling reminds me many old days that I used to be and teach my residents or being involved in the Pro PR residence for supervising them seeing patient with them and it was a very good environment not only to teach to learn as well to be honest with many things as a bright mind you bring up as a question that opens the door to a big research and I have been through that myself a lot so asking question and then I go ahead look for the answers and I see that okay haven't them been done so that opens the door for them for the good research so thank you so much again if the presentation is ready we can start [Music] yeah so a short movie quickly thank you you e that was my last affiliation now I'm in a fulltime private practice so my lecture is contains of few parts the first part is I'm going to talk about the zonia why zonia is important for us and why we putting too much attention to it to basically change even the fabrication technique so obviously because I'm lecturing to a group of clinician I added some clinical pictures as well you can interrupt me at any time we can discuss and answer the question as we go so the topic is 3D printing zonia and clinical D but why zonia it's a very it's a bi compatible material with a very good aesthetic I know that is sometimes look very Opa white but we can change it we can change the shape and most of you you know that as well and also it's mechanical properties is very very good mostly then we use the content of 3% utri however as you add more translucency by adding the content of your gum to the 5 or 8% the mechanical property drops but the still is comparable to your gasonics that's one example of it is lithium dilic right or emac it comes in a white powder and then they make it right now as a Pok for Ming but the new technology of 3D PR what is the application in clinical DS so we make a frame for fix partial dentures single crowns implant abutment implant supported crowns and even hybrid abutments so just a case I add for you that zonia today mostly if you basically use the translucent zonia can be very mimicked Optical properties of your enamel as and I just put a patient for you here that is almost a 10 unit zironia and it in the past we used to do the layering technique to get the translucency But now maybe with more translucent zonia with the staining technique you get a very good decent aesthetic from it either and we can extend it actually to implant as well if you recognize I know I'm not sure that you recognize which one is the implant Crown but number seven is the implant Crown as I go at the end of the presentation I explain that there is some criteria to get a really good restoration for Implant in athetic zone but to be honest with you there's many factors placed one of them is the soft tissue thickness and if you don't have enough soft tissue thickness without Zon abutments I don't think that you can get a nice pink Stelling because the light reflection under the tint soft tissue is not presenting a good shade if you don't have a ceramic under your tin sof is and we go over that so what I do and we can actually extend that application now to the full Arch cases and this is I do in daily basis now for the last past two years day in day out we do about 250 to 300 arches per year and zonia to be honest you has been a great help for because the patient acceptance is very hard very high my failure rate is very very low it doesn't need the maintenance that the hybrid model used to have it and aesthetic part is very good and more important very bi compatitive you may not believe that even when I have some not exactly a perfect flat surface even I have some concavity under it sometimes it happens because of the tissue CH shapes and still I get a beautiful soft tissue result which I have in pictures and another case that patient is completely ental and theonia Restorations is completely changes the life of a patient and the failure rate for that although is there is many factors that they have to consider but the fa the failure rate at least in our Center is less than 2% which is to me very very interesting and they have a longterm followup of some of the patient about five six years now so this is the the patients after providing that you can even use a layering technique to make the soft tissue very aesthetic as well and that was I was talking about that's a followup I think two years I remove the proste this is what you see Under The Prost soft tissue is really healthy and good I get it with the heartbe to be honest with you but not as good as ceramic ceramic is very bi compatible very easy to well what I said is not just my personal opinion you can look at the evidences there are there are good papers out there that talking about the longevity of that one I think that is what Abisha VRA published few years ago which shows that the failor rate success rate is very high and the one that normally is not then they follow up see that what the problem comes is a technical problem from the dental side dentist side or the lab side so if you follow those guidelines it really good get to a good substance now that was a brief introduction why zon and what we can do with zon how we fabricate the Z the only way to fabricate zonia right now the golden standard is Mill right so we use a HK or you use a block of zonia you have created the design STL file and that you can basically me the ab and like now I think so this is so what although this is the gold standard there is some limitation when we look at the the me one is the using excessive material so you you use a park and it depends on the park size you Nest it very well still you may not be able to use that bu anymore so the rest of that zon is bed also unusable bage that means that you cannot use it anymore it's gone limitation in producing detail and complexity and this is what I want to talk about so you what is the size of your mailing tools the smallest one you can get in the market about 0.5 which is 500 microns or3 mm is that right can't go less than so if your details is less than this you miss those details this is my personal opinion I could be wrong I think that even the prep guidelines when we move to the digital denistry should be changed if you're using the mealing because some of the sharp edges you're creating on your prep may not be able to duplicate it then you me the restoration mostly the inte and the other one is that complex geometri which I get to it so I have some pictures that's showing that how it's impossible to create that geometries with the Ming because you don't have any access to it and the final one is that the cutting instruments or cutting tool you're using you constantly have to change it otherwise if you don't do that you may cause some micro cracks during which later on will cause propagation and failure so constantly need to use a Milling tools and change them and that add to your cost so another technology for creating an object is a 3D print as David said it's a adding additive technology means that adding layer by layer and the thickness of that layers depends on the resolution of your printer on the z-axis okay so however if you use that high resolution you get control over every single layer you create on that 3D so the advantages of 3D printing I put them back here some of them are really got sorry so some of them are really I although I'm interested but more going to the cost effectivess of it and maybe lab part of it which is important but my interest normally come to the details and how that helps me CH side then I provide treatment for my patient so definitely is a mass production you can basically depends on the trace size you can print many many restoration at the same time sometimes added a little bit time but not that much reduction and Manufacturing time OB SE do you know that it's very interesting I just tell an example I was um I have a friend basically they have a mailing site north of Dallas where I live and I had a tour with them so they just bought invested a million dollar on a 3D printing mats and ask NY why you did that he showed me a frame to replace the mandible then you splin the mandible in fracture cases and it was nailed out of the big Park of titanium she asked me do you know how long that takes to meal I said no believe it or not more than 10 days conent and she said with a laser printer I can print it about 18 hours so that's saved lots of time and resources for you um obviously the material can be used again you use it in your clinic every day the resin as long as it's not dirty you can basically put it back to Res and use it my interesting facilitate the production of complex geometry so that SC back there has been printed by m cat can you really me that there's no way that the Milling can get to those details inside unless you make it layer by layer and then add them together however the printing system because it's layer add can do that not only the basically shape also the color as well and we have printers that they can they can use new colors right interestingly control the properties during that manufacturing if you use a printer which we having but J printer butes with different Reser if you use a different printers with a different reservo and color and and resins you can print different materials into it and hopefully that soon comes to Ceramics as well there are different um Technologies for the um additive manufacturing of of the theonia I just put a couple of them one that I use and I have been using 3D I use DP with the ls sometimes as well I'm very happy with the 3D the quality of that printer and the print that's what I have no financial interest I use the product because I think that is really good for all the Reon it's not at the app yet but I hope that it's coming very very soon so um I put couple of printers that there are in the market again I I my research everything that I basically presented today has been done with the 3D Sur here that's the printer I don't go over that we just did a literature review that's a publication goes over the different Technologies advantages and disadvantages David covered that part so I just bypass that go to the next so the accuracy of that 3D printing was very interesting for me uh this is the animation that how it it it works you basically feed back there the the ceramic it Pace comes down to the building platform they if you have any comments you can do that and then there's a com on your part and create the shape that you expect which can be a crown full orang and abman and ET it has a high accuracy high resolution and very smooth surface now as a clinician because just accept whatever comes to the market you know we are responsible for our patient I have to make sure that whatever I go back there place it it meets some criteria and that's why we have the check and balances FDA comes in ask you about bi compatibility also you about mechanical properties so because at the time that we started we didn't have that much information so some of those research has been done with our group so I go over that so we wanted to make sure that the mechanical properties are are there and Optical properties so we started with the mechanical properties of 3D printing zonia if you look at the the papers they published in 20176 you may see that the meeing was better than 3D printing as the newpapers comes out we see that actually additive manufacturing or 3D printing it's um better than however that can be a little bit debatable but for sure I can tell you that the mechanical properties are the same if not better for additive manufacturing and those are based on the publication that's based on the iso standard so ISO standard is good to start with but however we have to do some more um test as well I don't know if you're familiar with the fracture resistant test or not this is a mechanical test but it basically you putting in V right in the Ben studies so we did that study with a mil abund Theon abund on the stman implants and then we fabricated mil zonia milk lithium disilicate and also 3D printed zonia and also alumina reinfor zonia which has 20% alumina and 80% zonia and and interestingly it was M zon there were no significant differences between them and a study was published in 2018 however interesting point for me was all of them fracture at the abund level so I really could except one I think the one emx fracture as well if I have to do and redo that study definitely I will use a titanium to be able to make to see the differences between them but is it relevant maybe not the maximum forces we get back there how much is it maybe 600 to 900 Newton back there so it bypasses that is about we talking about 1,200 so it bypasses your glal forces however fracturing ceramic is not like that fracturing ceramic sometimes ceramic worked for three years and then you put 120 newton on it fractures because it had lots of crack on it and you needed one more push those crack propagate and Fracture so you need to be very careful about those numbers as well the clinical performance is very different just from the numbers so the properties of the 3D printing zonia so I talked about the the fracture resistance now go to the marginal and internal Integrity we did a study back there as well in 2018 to be honest we we see lots of marginal defects and Milling one was out performing the the printed one but the new CR that I just received is completely a game changer now I see that the marginal Integrity Integrity outperform if it is not the same definitely outperforming the mill now so based on what I said so far are you convinced really to use the 3 rather than mil be very honest tell me yes or let's let's review it quickly together the mechanical property was almost the same the marginal was not the same getting the same so what is the rational to use it at this point I'm not convinced however the second part of my presentation is different it is how creative we can be with the ad manufacturing I'm not using 3D printing zonia because it's a stronger than will to be honest with you and I'm not using 3D printing zonia or 3D printer because it gives me a better marginal Integrity I'm using it because it gives me a better properties and also I see lots of potential in the future with it it can do many things that 3D uh Milling cannot do that complex geometric and controlling the bi mechanics layer by layer let's look at it and see that what we can do it's just basically question what Ming or 3D printing so let's see what 3D printing can offer that I'm very very interested about that so one of the things that in New Modern Dentistry is coming is being able to be conservative you don't want to remove en and then I mean then I was training pfm was almost full the standard I mean your PR should be 2 mm right to get a nice beaut beautiful steady but right now you don't need that we know that it's a half MIM onl top table if you design it well bonded to superficial Ino you can get a very very good longevity out of it so bonding is is very important look at one case here that case is a is a extensive they call it what they call it um D basically when the crown and root are not in same angle so Oro couldn't do anything about that case however it does not interrupt the pollution so the only option was removing that to replacing with implants in a 17 years old young man I'm not going to do that I'm not sure that Honesty with implant deny after extracting I can have enough bone to provide a beautiful restriction so the other thing was a very conservative venir and that's on the left side done with now if we extend that treatment to use zonia or such a treatment definitely we need to make sure that the bonding is a strong strong and another case I think that research is about that the next research coming bonding the metal coping titanium copings to the zonum it's it it's one of the failures right we see that it gets debonded mostly if you don't use the protocol because B to Z although is approved I don't think that is is same as the glassic so Bing is is is very important for us and also sometimes it's really in a clinical Dentistry I think we talk about okay you have to do that b reduction implant has to be place here okay all of that then you do lots of cases you realize that it doesn't matter what you do some cases are go out of your hand in PL placement bone is not there angulation is wrong whoever did this why design is wrong you want to correct it you have to push the processes back now scre access come from the B we all see that when you practice a lot you will see some failes just if people will be smart if we try to minimize our failure I don't think that you can avoid faders and complication it always will be there so however good clinician should be able to manage them somehow so we basically saw that that case was designed outside came back to us when I corrected this SM design SC access was coming from the B so what we decided to do to put a vene bonded B to cover this grp so what I need now bonding again bonding to zon become very very important for me and that was what he did so in the Ed basically B to Z I think that is approved if you look at their literature and there is a protocol for that the zonia side should be sand blasted and clean right with the you have to control the pressure otherwise you cause the micro cracks so the pressure and um the particle size of alumin should be 50 Maron so it's important then you can actually use a primer like a z Prime has NDP or for me it which actually has Affinity to to bond to any metal oxide and zon is a metal oide zonum oide and then you use a dual C resin C to bond it together but do you really get a Best Bond maybe not because the texture is not there the roughness is not there The Edge pattern is not there and that's why you need to be cautious about so we did a study the first step is that proving that okay the 3D print zonia does have a bonding almost similar to the Milling yes without if you follow the same treatment I you don't see any differences the small difference you see it was not significant in my article if I remember it well the statistics however the question was that interestingly we did find something here and that was the roughness of the me one was more than the 3D printing one so that could explain a little bit B the strength but without any extra treatments or design they almost come at the same but what is fascinating is going back to that vision of T what we can do you can customize your surface that I was fascinated with that with that research that they did lots of roughness on it B started with porosity and my concept was that I need something like the edge enamel pattern or the edge denting pattern if I can as you can see that on the top right it's a denting clean denting side with the two B and down is a 3D that mix that so my concept was that if you do that you should be able to get a good bonding back by the tags you created so we started that with some resin 3D printing and then we did the camic 3D printing as well on that we actually could create different Pro size with different distances with with them still working on that on the how to really that texture needs to be to give us the best one for the impio of the restoration the preliminary study we did actually that hopefully comes up I don't know if it it's the same journal or not we submitted that too so we did a control on the control side we had air abrasion with 50 microns and the pressure application of a primer on it on the control and on on the 3D printed side we did not do any treatment to see that if do you know that why I didn't do any treatments then you apply sand blasting you may not realize it but in a long term you decreasing the longevity of your zonum because you're creating cracks on it and any cracks can absorb water and degrade the internal structure so we wanted to see that if we can bypass that no sand blasting just using the actually the result came out good we have three groups different design but in in a design of p200 without any treatment the bonding to the 3D printing zonum was more than m one with the S BL CR that's a lot and if you don't use the treatment on the control I I guarantee you that it goes much much less than is so that shows the value of the 3D printing how customized you can be and that's just get more and more to clinical Dentistry so this is the result of it too in this one we actually as you can see that it's control it and if this one shows that the one that p200 was more than the grp and this is the make on the left side side with the number can we go even further than this yes you can actually do the same thing on the restoration as well if you have a veneer you have onlet you can create any texture on that and then print it out as long as the resolution of your 3D printing is compatible with your design now any questions so far before I go to the implant the to see to show you and another application of that what was the study that showed longterm cracking will occur in sironia I don't have it in on top of my mind but I can get you because this is in my discussion my paper did a submitted I can there's few few studies I can I can show you yeah that they are basically um then you s as it it decreases the longevity I'd like to see those yes okay I have them in there in in my laptop so um implants in the aesthetic Zone this is one of the things that I love to do however sometimes it goes out of the control it doesn't matter what you do at least in my hand whatever I do I may not be able to get that aesthetic mostly the pink aesthetic that I like the soft isssue some so the key factors for success is definitely the first one is the ideal impact place an ideal implant placement is the depth and also in the aesthetic Zone you need 2 mm of restorative a space and 2 mm of the soft tissue and obviously to save that soft tissue you need a thickness of the bone I think that 2 mm to be able to keep that bone so you don't get any recessions and then IDE restora space is 2 mm soft tissue thickness is 2 mm if you have that anything works if not believe me or not always on the te isssue you will see that gra and that's a life reflection so if I see a cases that I don't have that softness only has a for optical property and the mechanical property Z and I all know that I mean z to the implant he was is [Music] implant was placed I use to my and I don't use if I go Blue enough thickness and restore space then I use the gold with cemented zonia on top so as I I talk about that the criteria for that I'm talking about to be honest with you s tissue more not you still sound is good still sound is good yeah so the pink aesthetic the soft issue aesthetic is more important because I believe that a good in a good hand of any technician if your technician understands camic they can match it the problem comes here if that soft tissue te is not 2 mm or more so I used to blame my surgeons sometime but sometimes nowadays when I look at the com c SC they don't have options they even do graph and then I still see that it's not there so they that implant may be placed a little bit more now as a restorative denses they have to be managed and if if mental appartments at least in my hand doesn't work in those cases that the soft tissue thickness is not there so the other on I wanted to mention here what is that attached do you one of the things around implants apartments that we see that and nowadays if you look at Dr Romano's work or other people coming they started to think talk talk about the pre implantitis and now because we didn't have it in the past now we have been able to see them in 10 15 20 years now we see that right one of them is a resin but there are different different reason behind it one could be a tight soft tissue connection to implant abing so nothing can migrate down do we have that around implants no soft tissue attachment around implants are not good we don't have connective a strong good connective tissue attachment so epitelial cell attached to a smooth polish surface but the fiber blast they don't they attach to rough surfaces and we don't have that because the concept of implants oh po about maybe the top part of it the more needs to be a little bit more rough I'm not saying that just randomly study needs to come out to tell you exactly that roughness which we start St but that gives you a good connective tissue attachment and not only that if you have a strong attachment it can support your epitelial attachment so maybe you get a better papillo or maybe those ruls from contact point to the B 4 mm papill feel it if less than this not may change because now we have a good connective tissue to support that so um just let's see the how it changes obviously if the soft tissue is not there the moment that I honestly change the ab to zonia that soft tissue looks good and pink and a study like by Marcus blot came many years ago about that light reflection penetrates inside come back from the soft tisue behind the soft tissue and create that pinkish color for you and that's why you get a good nice result number 10 is basically a implant PRS but I use the zon ABS because the soft tissue thickness was not there although I think that the Prototype is not a very thin maybe medium not thick as well but still I couldn't hide it goes in it's so we are taking some risk but it depends on the patient as long as I educate my patients about the risk and the benefits if they accept it I'll be very comfortable place and that's it the key be Z AB so as the 3D printing zonia I don't know the time still I have time right so as the 3D printing zonia coming out I have to make sure that the soft tissue attachment to them is the same so we did a study and we couldn't find any differences between the soft tissue attachment to the um 3D printed one and the m one now the other part comes in Innovative part okay they the same but can be improv it by controlling the surface texture to get better connective tissue attachment so look at this case for a second and tell me that which one is the Imp gr and which one is not you cut off the ginger but how do we tell this is the this is the answer it looks great the moment you remove it which one is theant eight and nine and this is the toughest case ever that you have two implants close to each other even though you you you're part three or more millimeters trust me soft tissue is not easy to get can I get rid of that black triangle absolutely I can make a long proximal contact is it the way to make it this is how your body is no your contact I am basically making or I can use pink for this is not my point I want to think a little bit out of the box is there any way I can get that soft issue back rather than just accept the fact it is what it is make the contact Point longer no let's see if it maybe yes if we change the texture on the abundance maybe we can change that and that's what I was trying to say so we with that concept that they all know that the epithelial cell attached to the polished smooth surface but fiberblast are different and that's the whole concept of that idea we have to be able to create an abundance that has a Polish surface for that pocket epio and then the rest will be rough however it needs to be studied come out exactly what is that roughness and then 3D printing can create that and then you may be able to get a f blast attachment to that so we are working on it we have some interesting preliminary data I can share with you so actually this is the abund that you guys printed for me we wanted to make sure that okay whatever we are talking about is practical it's not just based on in my mind it's not just you know fiction so we printed that and yes we could print the ABS zon ABS with the specific surface seure and then the next step was if we create that surface texture how the human fiop blast will react to that that was the next step so we printed with a different Pro size we looked at it to be honest with you at the when you start doing the research you realize that how many how much of those data that coming in it it can really sometimes be questioning so when we were studying the reading of those cells on the sample over the time are very different if you look at the 24 hours you see the Polish even on the fibr blast or B as the time goes by we see that the poorest one goes higher and also the shape of the fiber blast on the surface is very different if you see very rounded shaped cells that means that they are not very healthy the attachment is done if you see a stretch cells that's a very good sign means that it's still coming in so it needs to be follow up 96 hours or more to see that but definitely you see that the porous was going on and that's not the ideal porus I cannot expose it now because we are still under that we are looking to see that what would be the best porosities for that fiberblast attachment not epithelial if you want to do research go for fibroblast the epithelial cells we know that attached to this smooth surface and this is the concept that we working on it and I put it in animation and ab goes in with the Polish and the rough surface so the rough surface attract your fiberblast for a good connected tisue attachment and epithelia will be attached to the to the smooth and poly surface and this way you get a good attachment around implants hopefully that decreases the pr implantes and also give you a better firm connection maybe supporting your epithelial attachment with a better height of the fre ging margin right now can be extend it to something else all of that I'm showing you can't do that with me this is all 3D printing because that custom surface texure cannot be created with it's limitation so have you seen cases like that that's one of the cases come you start scratching your head right what what I have to do so basically in those cases you send it to to Sergeant they do multiple graph you know that block graphs and try to get it sometime they can sometime they don't but another idea is that can be really replace that missing bone we can you can't take com CTS scan the same way that you design it you can design that piece of phone with the shape of the missing one and extract the stl5 you can extract that stl5 use a material it's out in the market that has been approved by FDA as a device I think that they categorize it as as a they have a second device the one that you have to look at it they have a different FDA application for that and then you print that with a specific surface texture and that can be placed back there you don't need to remove it because material is biocompatible is it stays there and then soft tissue with the texture we talked about can grow on so if you know that you don't want to get epital attachment you make it polish and if you want to get some connective tissue attachment it has to have some texture on it and that most cases even when you have a bone have you seen your implants if you follow up your anterior implants they're coming after two years you see that you don't have that scalop for tissue anymore it's flat the bone is there soft tissue is there but it's not really very natural looking because you don't have that bone structure under them and that's what I we Tred to do as well so if you go back this animation shows that this is what and they have been printed that as well so that pie go has a separate texture on it IDE separate texture when the bone it's it's basically replac bone you never remove it and the soft isssue has Affinity to attach to it it covers that all again the technology so um we looked at the basically um fi blast proliferation on different 3D printing camic the bi compatible one actually there's a new one I can introduce as well to you this is the Silicon nitrate that is a very strong material it has a little bit of grayish coloring to it but it's a very good material for bi compatibility is very strong as well you can 3D print it and the soft tissue has a very good Affinity to it and if you look at the fiber blast cells over the Silicon Nitro de I think that if you in Implant Dentistry you will see that material coming soon for replacing many maybe titanium that's my assumption there's no evidences behind that but I can see that with the properties and all those papers coming with the titanium particles in different part of the body I can see that that could be the next generation of the implants material and this is the fiberblast attachment to it over the time so in basically conclusion 3D printed ceramic preliminary data are very promising mechanical properties are comparable or outperforming the Milling one accuracy of of Amic has been improved and clinically acceptable it is in the r of ISO standards Optical properties have not been investigated so that's a very nice research area to look at about the translucency and Optical properties of it data on BI compatibility are very very limited to be honest with you technology I think still needs to be improved I think that single material printing is not a way to go multimaterial printing is the future in any material we use and Bing to P is to be improved we did a study we published that for some reason 3D printing Ceramics does not Bond well to the post I think because of the remnants of the resin it needs to be clean completely before before you apply postland otherwise it it it works as a contamination may drop the work however with the new zonia coming out why5 by8 we may not need that because we go with this staining technique and the potential of this technology in my mind is really really unlimited so we published a a chapter you know the other author too is very good in digital Dentistry so it's in that book and we wrote the third chapter or fourth on the 3D so I know that my time is done I have another piece if I have time about the multi layer another concept of it's not there for ceramic yet but it is there for resin and we have done that if you think that the time is is fine I can go if not I can stop here sure how long I can possibly finish it in 1015 you okay with that so so let's let's talk about something else too very quickly so surval R why your enama lasts so long and my ceramic doesn't last long why you somebody gets the central in size of them they're six seven years old I see them they're 78 years old and it's still it's a little bit of achieving here and there but it still is there if the ceramic works for 20 years I will be more than happy why is that if you if I I think that you are going against the nature your enamel and den has properties that when you create a ceramic respiration you don't pay attention your enamel and denting is a graded structure did you know that right your Dentin have a low modules of elasticity low hardness fual strength is less to your enamal is hard is it that's it this is what most of the D material books talks about but that's not the fact it's more than this your enamel by itself is a great structure if you look at the papers the enam clu to dentino enam Junction the mechanical more close to your Den as you get to The Superficial enamel and that's why your bond is good with the superficial enamel not good with the dep deep enamel as you get to the layer to the surface enamel property changes dramatically and that change is not sudden it's a graded structure start with something very flexible goes on and that could be theck key not in over field but if you look at lots of engineering feed that great the structure concept is very very well established we don't use it in in in deny we're trying to find something the most strongest one can a metal Tire Works under your car no honestly can can you put a chain and drive with it which one wears out faster a plastic one or the metal chain metal chain is going to destroy in in less than 100 miles but you you work it 10,000 miles or maybe more on day real time so being a strong material it's good but not always and nature has an answer to it so your enam is a great when you started from here it's soft and it goes back it becomes very hard and it's a very sof so can be mimic that structure now and look for more longevity maybe yes so we looked at into it the firstep was actually we have a pattern again you know the other one as well Dr Lee and then Dr [ __ ] you know that so if you look at it the concept is that you have to have a different layers because that may work more under the pressure when you put pressure on it instead of cracking it it bounces back and forth not always good because it reduces your forces mastication forces like food denture on the soft tissue but it it it's basically stop the cracking let's let me tell you an example if you don't use any metal bar and if you use a fixed detachable fixed complete D over five six implants how long you think that it's going to surv why pure accur 6 months a year why your denture doesn't facture every six months because it's sitting on the gum which is flexible takes to absorb the forces the concept of fix rather than removal so that was the concept that with that idea and basically idea is saying that when you it back there right it absorb the shot and if it can create it in our stomic that may last longer as well mostly on the implant because the fracture of all stomic on the implant has a higher rate again rigidity there's no PD right that mean but the question is that can be created the first step is f i want to bypass it is just explaining about the Strat statuses with a different Reservoir but we have that technology for resin today I bypass it so we publish papers and you again know the other one too so um and we created that sdl we created sdl but on the thickness of 2 mm between layers and each layer is about 100 markers and we use different materials to print that this is how we print it when you have a jet printing you can mix and match so we put in one one reservoir the hard material like en Amo the other one soft material and then they started to print from the enti view the first layer pure denting the second layer 90% Dentin 10% inam you can do that with the 3D printing 8% Dentin 20% enam Then you get to the top surface the last 100 m pure enam so that's a greatest structure and the it took us two three years you may not believe that but yeah they finally created that structure I think that this was too another paper just came out two months ago that they actually measure the mechanical property as well and the internal feet of those crowns too so we created that crown with the same concept that I told you starting from completely zero enam full denting 100% enam on the top and that was the crown we created you can actually add color into it too each layer can be printed with the different colors and that was a crown on the D and um look at the crown I presented in Academy of cross I got lots of lots of fire back from Dr and Jack so you see it's hard you cannot but the moment that you take it out look at what I can do with that goes back because outside is work like very hard you can Cho but at the same time it doesn't crack because it has a great structure in we measure a couple of things on it and we measure the by layer graded and solid one we look at internal Gap so this is the start point of it I'm pretty sure that before that technology becomes available for clinical dentist need at least another 3 to five years but I mean we have to start from somewhere otherwise we would still do that pfx right and that was the the greated structure the mechanical property you can look at that paper that paper now is published now again we did that as well so we created a model to see that we can play with the mechanical properties yes we can we created different proes this is ceramic the ceramic with different mechanical with different prity as you change the prity inside the zon 5% 1% you can very easy play with the mechanical part so now statistically we know that for example how much prity we have to have in order to get that much of flex roar or hardness or modules of elasticity and that was it that concept I don't I'm not sure that that can be easy integrated to the ceramic but I'm pretty sure technology will get there very soon so thank you so much if you have any questions or the audien is in the zoom if they have any questions any questions we have sorry 3D ceramic printing is not available on right now am I correct it's in in the United State is not F approved now however I can basically tell you that there they're working on it it's not only 3D printing zonia I think the ioc CL will come very soon too they are going to print their lithium dilic H how long printing to be available on the market in the United States to be honest with you my my understanding is at anytime could be tomorrow morning could could be a month from now on very very soon we come become available this is this is yeah rfda clearance will be submitted in the next probably six months if not sooner and we're basing it on a predicate for using a printed zerconia for a veneer um that so it's fully biocompatible the material we're using we're just printing it for copings abutments and full Crown restoration and we should be able because we have the research and all of the data that Dr xandi has done the research that that uh Rama and Dr Aran has done um there's a lot of data that's been collected that we should be able to get FDF through real quickly the printers are available the printers can do mass production now um but they don't um I don't think you'd be able to do like a chair side level 3D printer would be able to do um the level of detail that we need to create some of these shapes and structures that that would be the Challenge on that and then with full ceramic after you print it you have to fully debinded burn off all the resin and then fully Center it into a solid monolithic ceramic or a varying verocity ceramic depending on your application um that technology or that skill set is left up to ceramicist and material scientists to be able to make that so that it can be done faster and more efficiently and controlled right now it takes about seven days to do from printing to final finish ceramic so um each batch would take approximately seven days from okay we're good to print we have a good scan speed that scan to the printer print it out and then finish it de clean it rebind it Center it takes about a week week to 10 days sorry I have a question you said that the hybrid printer so what is the ceramic you can basically past you can add to it if you don't mind if I ask about that wait I'm sorry what was that hybrid printer you said about that you have a har printer that can print ceramic no my question to you is as far as I know here we cannot print we can print hybrid restoration right now then you talk about heartbe you're talking about the ceramic reinforced resing or resin reinforced around okay I got it okay I got it yeah sorry I I thought that you were talking about printer so you're talking about hybrid material or high content ceramic resin something like that yeah and you're talking about pure the one that you you talking a Sprint R can do that yes so I have a Sprint right so my question is number one when do you see that happening here number two the printers are very different so the material that you are so they Market it and and I know very very well and I I know the people back they're they're really smart people back there and I work with them but the thing is that this is not really a definition of ceramic ceramic means density of the ceramic you don't need anything else in it what you we are talking it's a resin reinforced camic or ceramic however they change the name it's kind of hybd or they actually the first patent was rejected 15 years ago was from our group that be basically infiltrated resin inside the PO ceramic but that's not the definition of ceramic that's a hybrid material and that's in the market the ceramic printing is completely different and those printers may not be compatible with the tanic because and also the post process is very different you don't have that much post process you take it out cut the basicly supporting bars you you take the excess resal Cur is ready to go to the market Market however the ceramic one is very very different because you have to do two firing debinding fix all the resin out and then crystallization so completely two different printed two different concepts and that that's a seven day turn around for that probably so I think in a dental lab type setting like if you you guys are going to work in a full dental lab to build these Restorations and customize them for patient that dental lab setting would be the ideal setting for a full zconia or full silicon nitrite Dental um replacement uh implant uh to be manufactured probably be in a lab not in a office or chair sign type setting I think so to at least for now yes just because of that post process that debinding centering there's a skill set that needs to techn okay thank you wonderful presentation thank you so thank you again that present great presentation so last but not least our I'm very honored to and proud to present Dr Al rashan our very own Dr alashan she graduated from University of Georgia science of technology and then she just recently finished our Advanced education Pro program at the University of Michigan and was recruited immediately as a clinical instructor now doing wonders students so today Dr is gonna share her experience with her master's project ofd thank you H so hello to everyone who's still here and uh thank you for coming Dr zandi it was honestly very impressive uh really impressive and just very eyee opening now this uh presentation probably some or maybe yes some of you have already you know um you know seen this before I'm not I'm not going to go over the lit view because you both kind of covered it pretty much I'm just going to be talking mainly about the bonding of zeron over here now this project in specific was U was it I would say sponsored or it was uh supported by of course University of Michigan by the at Nobel biocare and by uh 3D saram stto so uh retention of mil versus 3D printed zerconia of three different Ino surfus characterization bonded to pre-treated uh Tha based abutments and it was an init study uh done here at University of Michigan um now to begin we want to start with okay so I'm just gonna say the um the presentation outline I'm going to talk briefly about zironia already covered that additional uh add manufacturing bonding Tonia we're we're going to talk a little bit more about that and then we're going to go to the aims objectives of that study materials and methods the results that we got and the conclusions um starting off with zerconia as we mentioned this is a metal oxide so it's zirconium oxide very biocompatible material um what's fascinating about it is that it is present in three different states uh depending on the pressure and the temperature so starting from monoc Clinic to tetragonal and cubic uh different temperatures we all know in dentistry we want to maintain this material in the tetragonal phase just because it has the best um mechanical properties over here um as you can see over here as it transitions between the monoclinic to the tetragonal there is kind of a three to five uh perc shrinkage and if that material cools down it tends to kind of expand back to the monoclinic and this causes a lot of problems in terms of uh craft propagation and formation of course and then with uh use it just propagates and then it really um limits the uh longevity so research have already given us some uh ways to actually stabilize that material in the tetragonal phase and that's by adding those oxides over here the most common is the utum oxide uh it really just stabilizes that material in the tetral phase preventing it from actually going drifting back to the monoclinic phase um so and that comes gives us the U you know the understanding of fracture toughening uh property of that material uh so if you see here that diagram with that tetragonal uh with that zerconia which has been stabilized already we have those white particles which has in tetragonal faith let's say um this material was uh subjected to some sort sort of force a long time with you know um let's say saliva as it's being used into inside the mouth at craft might actually form those utria particles they have enough stored energy to make the tetragonal uh zerconia undergo phase transformation to monoc clinic so as you can see closer to that craft is where that monoclinic uh transition happen and that monoc just holds that crack there and and prevents it from propagating um so just because it got the once it becomes monoclinic it kind of expands so it kind of acts like a pressure onto that crack and closes that crack so that's the whole concept of you know having a stabilized zerconia there now manufacturing zironia we've already already talked about that uh there's a subtractive manufacturing and if that could be a hard Mill or the soft Mill there are pros and cons for each uh soft Mill of course we do um the centering afterwards so there's a 20% shrinkage that happens over here and that should be accommodated to the design the hard Mill over here it's already pre-entered blocks and this really just wears our bursts really quick and also kind of introduces some also cracks there the other one is the additive manufacturing there's plenty of you know manufacturing techniques we're not really going to go deep into them like last time but um the probably the most advantage over here is we're really reducing that waste in the 3D printed in the sorry mil technique and we're um creating those very micro micro geometries that we cannot really achieve with that uh with the milk um um technique so additive manufacturing it's uh it's uh uh defined as the process of joining materials to create parts from 3D model data typically layer by layer in contrast to the subtracting manufacturing method um just in short how most of them work is we do have the 3D printing technique regardless of which technique we're using that goes layer by layer you can see there's a binder over there so we do have like an organic or in an organic an organic binder and then the actual powder which is that uh ceramic powder that we're looking for that binder it acts like U the scaffold that just holds the material together and then once that is printed and we call it it's printed in its scen state it goes under the debinding and that usually takes several days uh to uh get done and then at the end we go ahead and Center that just to get uh those um particles good together and just just solidify that material so this is how it usually goes from Green States after debinding and then once we get that final product uh after centy um as I said there's multiple um additive manufacturing techniques for uh Us in specific just because we use that in our project we're going to take you know talk about the SLA and I think they've already covered that for us it's basically having that build platform descending downwards each layer uh so you have the resin covering uh the lasers um solidifying whatever that fcl file has and then the platform kind of descends downwards Expos a new layer and that would be Sol solidified as well now as for bonding zironia can we actually Bond zironia so if we look at the material itself and compare it to Linex it it is a crystalline poly crystalline structure devoid of that glass material so bonding has been a challenge for zerconia multiple people have you know authors have demonstrated what could be possible uh you know uh surface treatments that we can do in order to enhance that bonding first was the hydro hydrochloric acid itching but that was really um advised against just because that acid does not really uh you know enhance the bonding efficiency it actually really changes the composition of the material so it we didn't really have good bonding strength with that material in specific Airborne particle abrasion and that's usually using aluminum particles now uh some actually advice against uh using this type of um of surface treatment for zironia in specific but because of the same U reason that was mentioned before is you are introducing those PRS if that pressure is not really controlled and the size is not controlled and even uh the duration sometimes and it's really hard to control this time so they they do advice against it although there are clinical uh scenarios where we do a abrasion to zironia but for the sake of here we wanted to actually eliminate that uh because there has been good research that supports it um versus last thing which is the MD containing resin cement and that's where we're heading over here is to have a a cement that contains this particle this particle in specific it has a very long name uh but you know I never read that name but anyhow this is how the particle looks in specific so if if we take a look at the uh the the groups that we have here we have the polymerization group the hydrophobic group and the hydrophilic the hydrophilic here contains the phosphate group that really links to that metal oxide and then from the other side which is the polymerization group it has the veny group that reacts with the uh resin itself which is the cement that we're going to be using and then you have that hydrophobic group that really separates those two together um and this diagram in specific shows how this mdp links to the metal oxide from one side and then to your resin C to the for uh from the other U through that phosphate group The ven group and El um so in terms of the bonding protocols if we want to like standardize the bonding protocol for zonia and specifically for this uh for this study uh it was recommended just to have the U zironia Crown to clean that inaco completely with alcohol make sure that it's completely dried use a an MTP containing R and cement and then maybe air abrasion for let's say for those titanium abues we're using titanium ABS here maybe do that air abrasion for that tit uh abutment instead of that zonian ground and that's what we uh we actually did but does this actually apply to edited manufactured zerconia that's where we wanted to actually see do we have that similar bond with the edited manufactured zerconia versus the uh the milk so what are the available literature on the bonding uh of the printed zerconia uh it is pretty much scattered between with and without we do have some um you know with that are with and some that are without um you know against um so the first category they did see satisfactory and adequate bond strength between 3D printed Zia and the veneering porcelain um and they compared favorably with the mil compartment versus the other one which we kind of talked about uh just briefly uh there were weaker bond strength uh of the additives there plenty of um of manufactured zonia when compare it to the forc veneers and composite rhym however the reason for that or the V for that variability it basically was attributed to the brand of porcelain U that was used and also the surface pre-treatments conducted before adhesion um so we couldn't really get um like a conclusion on that we wanted to test it ourselves as well and you know as just let you know this project did take some time so I was kind of viewing the literature before and you know throughout this project and right at the end of my project those two articles came out and they kind of Incorporated this surface textures that we were kind of talking about or there micro structures here they used hexagonal shape or the they call it the Frog I don't know the I forgot what it is but um so they did have that design and they did mention that it led uh for that bonding material to actually be more integrated into these zonia material and maybe that could be uh that could add or enhance into the uh Bond efficieny um so this takes us to the aim of our study here uh we kind of worked you know on what type of uh shapes we want to incorporate we kind of chose this specific design which is the inverted pyramid design having that Apex towards uh the the Apex towards the um the bul of the zonia material and then we have the base which is uh going to be directed towards the ti base itself now we wanted to incorporate that design and then if you can see here it's going to be zoom into uh it's not really showing here but it's going to show in the other slides um in this case we are we wanted to do the inverted a pyramid design for two reasons so um if we didn't have that so what if we don't have that Apex actually touching that TI based uh surface in order to prevent any you know micr you know probably those pointed edges are going to be you know upgraded or and we didn't want to do that just because it's going to create even more space between our tii base and the um and the other reason was exactly like Dr Zan mentioned which is we wanted to mimic this direct restoration bonding technique which is once we actually remove that smear layer with our um etch let's say we are exposing those dentinal tubules and we are having those composite actually integrating into our dentinal tubules so if we kind of mimic the same thing with our Restorations we might actually have a good chance of getting this robust bont so here it takes us to the objectives of the study which is uh we had two objectives uh first we wanted to investigate if there's a difference in retention of a retention stength between milled and printed monolithic uh zerconia copings that are bonding to TI based abundant that were uh previously um uh pre-treated with air abrasion and then our other objective is we wanted to see if there's an effect of any of those digitally designed micro structures in the intago surface of that printed uh am Sur or additive manufactured zonia um so materials and methods here we had Nobel body care implants Nobel parallel and we had 60 implants with 60 uh Universal TI bases we used uh 50 microns alumina oxide uh with a pressure of 0.25 megapascal and we uh kind of arated those um the fitting surface of the uh titanium we had zironia being milled by uh this brand over here up sah and then we had the additive manufactured um Z over here by 3dr uh we had 15 per group as you can see the additive manufacturing there's three groups uh one with no surface modification and that's going to be exactly the same as a subtractive because you can't really do any surface modification with just Mills um and then we incorporated those micro structures having 120 microns and then 240 microns um these are the composition of those two materials I mean you can look at them but maybe later uh so going back here um those U the MS they I just listed the equipments that were used over here for the uh milling and then the centering and then the same for uh the additive manufactured or the printed the printer the debinder and then the centering machine now the project workflow over here was very much interesting and very funny uh we wanted to amount those implants very much parallel so when we go ahead and do our pull-ups test our pull-ups test needs to be completely vertical and eliminating those lateral forces so we kind of did a design over here where uh we got a St seal uh ruler doesn't really Flex it was um with good thickness and we did those holes inside them that correspond to the impression copings that are going to um be screwed onto the implant so and we laid that very flat you can see those two platforms that we added those two platforms added we wanted to raise the platform of that implant so our resin would actually start 1 mm below the platform of that implant to kind of mimic the bone loss technique kind of situation now um we did this for every for all the copings over here and this is like a zoom in of you know the platform of the implant you can kind of see there almost 1 millimeter and we make sure that our mounting is completely parallel um or perpendicular to the floor uh so this is what we had over here we had all of them um we kind of report just for the sake of um we wanted good length over here then we attached our um our tie bases sand blasted those uh we kind of wanted to mimic these scw meable situations so we didn't work yet over here this uh TI base we used an an an in office uh scanner over here just to scan from that scan we can generate that FDL file and um I think we worked closely with Dave over here uh I I think it was solid works that we used um that's what I was told and then uh we did our design over here it took us some time just to get to that design but we finally made it this is the 3D uh uh you know sample that you know we made and this is how it looks on the inside as you can see those inverted pyramids it's really hard to see in real life I think you have to zoom in those are the printed samples over here I don't know if you're going to see I kind of scratched them with a pencils so you can see that there's like zigzag um uh figures and you can definitely see those uh Wings over here which correspond to our um wings that are already there on the universal TI base we went ahead and we cleaned those surfaces with alcohol no treatments we did not treat the zonia surface whatsoever for Mills and for printed um and we went ahead and used this um a multi-link hybrid ABM resin from iaar uh with the um a primer that contains the MVP and this is what we got we had everything cemented and ready to go um this is a zoom in we cleaned that excess cement we made sure that there's nothing you know cuz sometimes that interferes with our you know pull off it may give us some wrong readings so we make sure that it's completely uh clean there's no excess cement there and we let them uh for 24 hours to set before we go ahead and um uh do the pull off test at this point we made sure to torque these in just to simulate the screenable kind of um screenable situation then we went ahead and we um loaded those onto our uh instron machine we kind of ordered specific side screw action um uh grips for that this gave us a nightmare just to figure out what to do we ended up doing a customade jig that really is very precise to our uh coping over here as you can see that sloth is where that coping gets in that's why we kind of left also those 1 mm because it kind of slides in there and then when the pulloff test and I'm going to show you how it's mounted when we do our pulloff test we're kind of just loading those two extensions this is made out of iron and this is like 3 mm thickness uh of wherever the grip is holding so nothing is really flexing this is a very solid and rigid material we went ahead we did our testing and it was 0.25 mm No.5 mm per minute and uh we had a 5k Newton uh load cell over there and we did our full off test this is a zoom in of how it looks you can definitely see we're not really loading before loading that sample before doing the test there is like a very minimal space between that uh coping and um the platform that we have over here so our uh force is mainly centralized uh centralized to towards our um TI base uh specifically now the results are really interesting uh first uh we kind of did the QQ plot test to make sure that we have a normal uh Norm variation between the tests and we did a oneway Anova test over here and this is what we actually thought so we comparing all the groups together you can see that there wasn't really any statistical or difference between SM and am and here SM am is mailed and printed no surface alteration uh versus when we go to the 120 and 240 surface alteration that really significantly made a difference but One Way Anova with this because our samp size is quite limited and it's very small we went ahead and did T tests for each and every one of them and that was an interesting point so for uh the first one we wanted to compare the M with the PRP no service uh alteration and with that T Test we can actually see there is they're very very close but there is that significant difference between them not not so much but it's still there uh so for our question our object our first objective was there a difference in the tensile strength between M and printed and yes there was so we went ahead and we kind of rejected our first u n hypothesis going to the other groups of the uh um um what is a printed so we wanted to see okay we didn't have a you know a better bondage compared to the mil but if we do those circus stres are they going to really enhance that bonding yes they do enhance that greatly um we had numbers going up 1600s so it's uh it was amazing the numbers that we got H did it really differ between the 120 and 240 not really is it really necessary to go all the way to 240 debatable I don't know but just going back it did digitally design uh micro structures in the intaglio of the printed M of printed zironia influenced the bond strength and it did so we went ahead and rejected our second M hypothesis just for the fun of it we kind of did a te test for or we kind of did also testing between the uh the uh the mil and the am surface gestures so this is where it actually made a difference if we wanted to use additive manifacture zonia maybe it's not worth it to just do edited manufacturing without any surface uh texturization versus if we added some textures it actually surpassed the mil uh coas and that was the Breakthrough over here uh for us uh so for conclusions um within limitations of the study we want to conclude that first yes am zerconia or printed zironia did not perform as the M zerconia however once we added those micr structures it really influenced the bonding uh the bonding efficiency of the additive manufactured zerconia but it even also surpassed the uh mil Cates um which was very interesting now for the limitations of course it's an invidual study it's a preliminary study that involves static floting uh sem uh microscopic analysis is not was not performed although we will perform it uh future recommendations uh we want to see the effect of different surface treatments we want to see the effects of different cementation protocols and maybe long-term uh clinical investigations and that would conclude my presentation