Effect of cement space on 3D-printed fixed prostheses: an in vitro evaluation of accuracy and tensile strength

Efeito do alívio interno em próteses fixas impressas: uma avaliação in vitro de acurácia e força tênsil

ABSTRACT

Objective:  This in vitro study evaluated the internal adaptation and the influence of different internal cement space parameters on dimensional accuracy and tensile retention strength of 3D-printed provisional crowns.

Methods:  Three internal cement spaces (40 μm, 80 μm, and 120 μm) were digitally designed using MeshMixer software for a cylindrical abutment compatible with an implant-supported cementation post. Twenty specimens were printed per group. After standardized post-processing, specimens were internally scanned and STL files were analyzed using CloudCompare software to assess internal accuracy. Specimens were cemented onto abutment analogs and divided into two subgroups (n=10): storage in saline solution for seven days or thermocycling for 3,000 cycles between 5°C and 55°C. Tensile bond strength testing was performed to evaluate cementation stability.

Results:  The 120 μm group showed significantly greater internal distortion in total surface area and cervical third compared with the 40 μm and 80 μm groups (p<0.001). All crowns demonstrated clinically acceptable accuracy. Increased cement space significantly reduced tensile retention, with the 80 μm group exhibiting the highest bond strength. Thermocycling significantly reduced tensile strength in all groups.

Conclusion:  The 80 μm internal spacing showed superior accuracy, while thermocycling negatively affected the tensile strength of all 3D-printed provisional crowns, with the 120 μm group exhibiting the lowest tensile resistance.

Indexing terms
Dental cementation; Computer-aided design; Three-dimensional printing

RESUMO

Objetivos:  Este estudo in vitro avaliou a adaptação interna e a influência de diferentes parâmetros de espaço interno para cimento na acurácia dimensional e na resistência de retenção à tração de coroas provisórias impressas em 3D.

Métodos:  Três espaçamentos internos (40 μm, 80 μm e 120 μm) foram planejados digitalmente no software MeshMixer para um pilar cilíndrico compatível com um munhão de cimentação sobre implante. Vinte espécimes foram impressos por grupo. Após pós-processamento padronizado, os espécimes foram escaneados internamente e os arquivos STL analisados no software CloudCompare para avaliação da acurácia interna. Os espécimes foram cimentados sobre análogos de pilares e divididos em dois subgrupos (n=10): armazenamento em solução salina por sete dias ou termociclagem com 3.000 ciclos entre 5°C e 55°C. A resistência de união à tração foi avaliada.

Resultados:  O grupo de 120 μm apresentou distorção interna significativamente maior na área total e no terço cervical em comparação aos grupos de 40 μm e 80 μm (p<0,001). Todas as coroas apresentaram acurácia clinicamente aceitável. O aumento do espaço interno reduziu significativamente a retenção, sendo o grupo de 80 μm o de maior resistência. A termociclagem reduziu significativamente a resistência à tração.

Conclusão:  O alívio de 80 μm apresentou maior acurácia. A termociclagem afetou negativamente a resistência à tração de todas as coroas provisórias impressas, sendo o grupo de 120 μm o que apresentou a menor resistência.

Termos de indexação
Cimentação dentária; Retenção de prótese dentária; Impressão tridimensional

INTRODUCTION

Provisional prostheses play a crucial role in implant-supported rehabilitations, offering several benefits for both patients and clinicians. In addition to protecting the surgical site and promoting tissue healing, provisional restorations maintain masticatory function during the osseointegration period, thereby improving patients’ quality of life. They also assist in preserving the prosthetic space and emergence profile, preventing soft tissue displacement and facilitating the fabrication of the definitive prosthesis. Although acrylic resin is traditionally used for the fabrication of provisional restorations, processed using conventional techniques such as chemical polymerization, the advent of 3D-printing resins specifically formulated for Digital Light Processing (DLP) and Liquid Crystal Display (LCD) technologies has introduced new possibilities for prosthesis manufacturing [¹-³].

Nowadays, digital dentistry has transformed the way dental restorations are planned and fabricated, driving the demand for increasingly precise and personalized solutions. Among these innovations, 3D printing has emerged as a fundamental tool, enabling the production of prostheses with high aesthetic and functional quality [⁴-⁶]. Although conventional and 3D-printing resins share similar aesthetic and biocompatible properties, printing materials offer greater accuracy and control over microstructural characteristics, enabling more customized and predictable outcomes [⁷-⁸]. Among the various available 3D-printing technologies, DLP and LCD systems stand out due to their high accuracy and resolution, making them widely adopted in dentistry. These systems rely on the photopolymerization of light-sensitive resins using ultraviolet light projection, allowing the fabrication of complex components with high detail. The choice between DLP and LCD depends on factors such as desired resolution, printing speed, and cost [⁹].

The stability of the cementation of 3D-printed provisional fixed prostheses is a critical factor for the success of prosthetic treatment [¹⁰-¹²]. Internal spacing – an intentional space created between the restoration and the abutment to facilitate cement flow – plays a significant role in prosthesis retention and longevity. However, the influence of internal adjustment dimensions on accuracy and cementation stability of 3D-printed restorations remains underexplored in the literature [¹³-¹⁵].

Therefore, the present study aimed to evaluate the effect of different internal adjustment dimensions on the accuracy and retention of 3D-printed provisional crowns fabricated using DLP technology. This investigation sought to determine which spacing dimension provides optimal retention and prosthetic stability, contributing to the refinement of clinical protocols and the long-term success of prosthetic treatments.

METHODS

A universal Morse taper abutment (4.5 × 4.0 mm) (Neodent, Curitiba, Brazil) served as the reference structure and was digitized using an intraoral scanner (Trios 3, 3Shape). Based on this dataset, three specimen designs were generated, incorporating cement space values of 40 µm, 80 µm, and 120 µm. Each specimen measured 10 mm in height and 6 mm in diameter and included a perpendicular hole positioned 2 mm above the abutment’s occlusal surface to facilitate tensile testing. All models were created using MeshMixer software. A P 20+ printer (Straumann, Basel, Switzerland), a closed-system DLP device known for high manufacturing reproducibility, was selected for fabrication. Slicing was performed in Netfabb (Autodesk Inc.) according to the manufacturer’s parameters for the P Pro resin (Straumann, Basel, Switzerland)), chosen for its mechanical suitability, esthetic properties, and full compatibility with the printer. A power analysis conducted in G*Power, combined with comparison to sample sizes reported in similar studies, resulted in a total of 60 specimens allocated into six experimental groups (table 1).

Table 1
Experimental groups.

Group	Internal Spacing (µm)	Cycling	N
1	40	No	10
2	80	No	10
3	120	No	10
4	40	Yes	10
5	80	Yes	10
6	120	Yes	10

All specimens were produced on the same day under controlled environmental conditions (28°C) to minimize processing variability. Following fabrication, printed specimens were washed in a Getech Wash GCW01 unit using two 7-minute cycles with isopropyl alcohol. Internal cleaning was refined manually using a size-0 brush. All samples then underwent post-curing for 10 minutes. All printed specimens were subsequently digitized using the same intraoral scanner (Trios 3), and the resulting STL files were compared with the original reference design in CloudCompare (open-source). Best-fit alignment (minimum deviation setting) was used to perform surface deviation analysis. Quantitative data were collected from four regions: internal occlusal surface, internal middle third, marginal area, and total surface area. Accuracy was assessed using the Root Mean Square (RMS) deviation, calculated as the square root of the mean point-to-point distance between the reference and test meshes. Qualitative assessment was performed using color-coded deviation maps combined with Gaussian distribution curves. Each printed crown was cemented onto a Morse taper analog (4.5 × 4.0 mm) (Neodent, Curitiba, Brazil) using a noneugenol provisional cement (TempBond, Kerr Corporation, USA).

Cementation was standardized using a surveyor under a constant 4-kg load for 5 minutes to ensure axial seating and uniform pressure across all specimens. Specimen groups 1, 2, and 3 were stored in saline solution in a bacteriological incubator (Quimis, model Q317M4) at 37°C for 7 days. Groups 4, 5, and 6 were stored under identical conditions for 24 hours and then subjected to thermocycling (Ética, model 521-T0), completing 3000 cycles between 5°C and 55°C. All groups were subsequently subjected to tensile testing in a universal testing machine (Instron 5565) at a crosshead speed of 0.5 mm/min, and failure loads were recorded in Newtons.

As for the quantitative analysis, different statistical approaches were adopted according to the experimental design. For accuracy analysis, multiple groups (40, 80, and 120 µm) and crown regions were compared simultaneously, requiring multifactorial analysis (ANOVA or Kruskal-Wallis) followed by post hoc tests to identify specific differences. For tensile strength, independent samples t-tests were used when assumptions of normality were met, and Mann-Whitney tests were applied when assumptions were violated. When three internal spacing groups were compared simultaneously, ANOVA with Tukey’s post hoc test was employed. A significance level of α = 0.05 was adopted for all analyses.

RESULTS

Data analysis was performed using Jamovi statistical software. Accuracy evaluation Descriptive data for internal spacing values (40, 80, and 120 µm), including the means and Standard Deviation (SD) for each crown region (cervical, medium, occlusal, and total), are presented in table 2.

Table 2
Descriptive statistics of obtained accuracy.

Statistics	Internal Spacing (µm)	Cervical	Medium	Occlusal	Total
Mean	40	0.0438	0.0277	0.0386	0.0392
	80	0.0409	0.0258	0.0310	0.0399
	120	0.0745	0.0317	0.0360	0.0615
Median	40	0.0407	0.0273	0.0344	0.0372
	80	0.0375	0.0281	0.0340	0.0375
	120	0.0647	0.0262	0.0335	0.0614
Standard deviation	40	0.0188	0.0087	0.0180	0.0122
	80	0.0113	0.0065	0.00848	0.0080
	120	0.0270	0.0202	0.0100	0.0120
Shapiro Wilk W / p	40	0.877/0.016	0.824/0.002	0.643/<0.001	0.655/<0.001
	80	0850/0.005	0.913/0.073	0870/0.012	0.914/0.077
	120	0.864/0.009	0.652/<0.001	0.935/0.189	0.848/0.005

For the cervical region, mean ± SD values were 0.0452 ± 0.0189 µm (40 µm), 0.0321 ± 0.0113 µm (80 µm), and 0.0709 ± 0.0270 µm (120 µm). For the total fit, mean ± SD values were 0.0392 ± 0.0122 µm (40 µm), 0.0399 ± 0.0080 µm (80 µm), and 0.0615 ± 0.0112 µm (120 µm).

The one-way ANOVA indicated significant differences for the total fit (F = 28.48, df = 2,57, p<0.001) and cervical region (F = 19.33, df = 2,57, p<0.001). No significant differences were observed for the medium (p=0.373) or occlusal regions (p=0.171). The Kruskal-Wallis test confirmed differences for the total (c² = 28.62, p<0.001) and cervical regions (c²= 26.66, p<0.001).

Post hoc comparisons (Dwass-Steel-Critchlow-Fligner and Dunn’s tests in tables 3 and 4) of the same regions (cervical and total) showed that crowns with 120 µm spacing had significantly greater misfit to the original file values compared to both 40 µm and 80 µm groups (p<0.001), while no differences were found between 40 µm and 80 µm (p>0.05).

Table 3
Dwass-steel-critchlow-fligner for total surface area.

Multiple Comparisons	W	p
40-80	0.650	0.890
40-120	6.274	<0.001
80-120	6.771	<0.001

Table 4
Dwass-steel-critchlow-fligner for cervical third.

Multiple Comparisons	W	p
40-80	-3.06	0.078
40-120	4.78	0.002
80-120	6.89	<.001

Tensile strength evaluation Descriptive data for tensile strength with and without thermal cycling are presented in table 5. Without cycling, mean values were 69.66 ± 10.89 N (40 µm), 64.3 ± 22.30 N (80 µm), and 44.0 ± 11.98 N (120 µm). With cycling, mean values were 37.0 ± 8.66 N (40 µm), 40.7 ± 16.20 N (80 µm), and 23.33 ± 16.0 N (120 µm) finding that thermal cycling reduced retention values across groups (p<0.001) and between 80 µm and 120 µm (t = -7.03, df = 38, p<0.001). No significant difference was observed between 40 µm and 80 µm (p=0.835). ANOVA followed by Tukey’s post hoc test confirmed that crowns with 120 µm spacing presented significantly lower tensile strength compared to both 40 µm and 80 µm groups (p<0.001).

Table 5
Descriptive statistics of the tensile test.

Group	Internal Spacing (µm)	Aging Condition	Mean	SD	p
1	40	Control	69.6	10.89	0.63
2		Cycling	37.0	8.66	0.19
3	80	Control	64.3	22.30	0.30
4		Cycling	40.7	16.20	0.95
5	120	Control	44.0	11.98	0.91
6		Cycling	23.3	16.00	0.54

DISCUSSION

The primary objective of this in vitro investigation was to evaluate the influence of varying internal cement spaces (40 µm, 80 µm, and 120 µm) on the internal adaptation accuracy and tensile retention strength of 3D-printed provisional crowns, simulating aging conditions relevant to the oral environment. Based on the significant differences observed across the test groups, the null hypothesis that no statistically significant differences would be observed was rejected. The management of internal cement space is a critical factor for the long-term success of prosthetic rehabilitation, a concept studied in dentistry since the development of full metal crowns [¹⁵,¹⁶]. Consistent with literature, a larger cement space is generally expected to facilitate seating and potentially improve marginal adaptation by reducing resistance [¹⁷]. However, the present study’s accuracy evaluation revealed a contrasting result: specimens printed with the largest internal spacing (120 µm) demonstrated significantly greater distortion in total surface area and the cervical region compared to the smaller 40 µm and 80 µm groups. Despite this statistical increase in distortion for the 120 µm group, all tested crowns maintained internal adaptation accuracy within a clinically acceptable limit of 100 µm, as evidenced by the color-coded deviation maps and Gaussian distribution curves.

These findings align with the broader consensus in current literature, which suggests that although statistically discernible differences may exist, if used the proper parameters such as printing angle and layer thickness [¹⁸,¹⁹], the overall accuracy of 3D printing remains as clinically applicable as the subtractive manufacturing (milling) methods [⁴,¹²,²⁰]. The maximum standard deviation of only 0.02 µm observed in the 120 µm group further supports the conclusion that the provisional crowns fabricated in this study were well within clinically acceptable limits [²¹]. Achieving high levels of accuracy in additive manufacturing is highly dependent on rigorous control over the numerous process variables. Strict adherence to parameters such as ambient and resin temperature, resin manipulation, proper printer selection and configuration (DLP technology was used in this study), post-processing, and storage are all essential for ensuring the precision and stability of the final prosthetic restoration [³,⁸,¹¹].

Accurate and stable provisional restorations are, in turn, vital clinical tools that guide diagnosis and allow clinicians to assess proposed functional and aesthetic changes before final restoration. Regarding cementation stability, the internal cement space demonstrated a significant inverse relationship with tensile retention strength. The 120 µm cement space resulted in significantly lower tensile strength compared to both the 80 µm and 40 µm groups. Notably, the 80 µm internal spacing provided the highest tensile retention with cycling (40.7 N), suggesting that this intermediate value may represent the optimal balance for ensuring prosthesis stability and retention among the parameters tested. The reduction in strength for the 120 µm group is potentially related to a thinning of the crown walls, which increases their susceptibility to fracture under tensile load.

The present results diverge from those of Hassan et al. [¹⁵], who found no significant differences in tensile strength when evaluating narrower cement spaces (70 µm, 90 µm, and 110 µm). This discrepancy is likely attributable to two key differences in study design: (1) the relatively narrow range of spacing values investigated by Hassan et al. may have precluded measurable differences, and (2) the use of definitive cement in their study, as opposed to the provisional cement (TempBond) utilized in the present investigation. Furthermore, thermocycling significantly reduced the tensile strength across all experimental groups, supporting the established notion that aqueous environments and functional stress contribute to the degradation of provisional cements over time. This observation is consistent with literature indicating that the mechanical stability of provisional cements is compromised by time, even without humidity [²²].

In the present study, the cervical region was intentionally designed without internal spacing and, therefore, was expected to achieve precise adaptation with the abutment surface. Statistically significant differences in tensile retention strength were observed between the 40 µm and 80 µm groups when compared to the 120 µm group, suggesting that the increased cervical gap associated with the largest cement space may have facilitated fluid penetration during thermal cycling, leading to degradation of the cement film and, consequently, a reduction in tensile resistance.

These results reinforce the importance of controlled cement space design, especially at the cervical region, where improper adaptation may compromise both mechanical stability and the clinical performance of provisional restorations. It is important to acknowledge the limitations of this study, which include the use of a single acrylic resin and a limited thermocycling duration (3,000 cycles). These factors may restrict the generalizability of the findings. Future research utilizing different provisional materials, extended thermocycling protocols, and alternative experimental designs are warranted to confirm these results and establish more comprehensive clinical guidelines.

CONCLUSION

Based on the results obtained and the objectives of this laboratory investigation, the following conclusions can be drawn:

1. The 80 μm internal spacing demonstrated superior accuracy, with all evaluated parameters remaining within clinically acceptable limits.

2. The 120 μm internal spacing specimens exhibited lower tensile strength resistance; moreover, thermocycling negatively affected the tensile strength of all 3D-printed provisional crowns.

• How to cite this article
  de Souza FCA, Noronha CP, Gomes RD, Marcos BDN, da Silva ED, Tamaki R, Mukai MK. Effect of cement space on 3D-printed fixed prostheses: an in vitro evaluation of accuracy and tensile strength. RGO, Rev Gaúch Odontol. 2026;74:e20260023. http://dx.doi.org/10.1590/1981-86372026002320260032

Data Availability

The research data are available in the body of the document.

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Edited by

• Assistant editor
  Luciana Butini Oliveira

Publication Dates

• Publication in this collection
  17 Aug 2026
• Date of issue
  2026

History

• Received
  30 Mar 2026
• Accepted
  01 May 2026