Direct ink writing with dental composites: A paradigm shift toward sustainable chair-side production

To evaluate the dimensional accuracy of occlusal veneers printed using a novel direct ink writing (DIW) system and a clinically approved dental composite. A novel three-dimensional printer was developed based on the extrusion-based DIW principle. The printer, constructed primarily with open-source hardware, was calibrated to print with a flowable resin composite (Beautifil Flow Plus). The feasibility of this technology was assessed through an evaluation of the dimensional accuracy of 20 printed occlusal veneers using a laboratory confocal scanner. The precision was determined by pairwise superimposition of the 20 prints, resulting in a set of 190 deviation maps used to evaluate between-sample variations. Without material waste or residuals, the DIW system can print a solid occlusal veneer of a maxillary molar within a 20-minute timeframe. Across all the sampled surface points, the overall unsigned dimensional deviation was 30.1 ± 20.2 µm (mean ± standard deviation), with a median of 24.4 µm (interquartile range of 22.5 µm) and a root mean square value of 36.3 µm. The pairwise superimposition procedure revealed a mean between-sample dimensional deviation of 26.7 ± 4.5 µm (mean ± standard deviation; n = 190 pairs), indicating adequate precision. Visualization of the deviation together with the nonextrusion movements highlights the correlation between high-deviation regions and material stringing. This study underscores the potential of using the proposed DIW system to create indirect restorations utilizing clinically approved flowable resin composites. Future optimization holds promise for enhancing the printing accuracy and increasing the printing speed.