Skip to main content

3D printed zirconia used as dental materials: a critical review


In view of its high mechanical performance, outstanding aesthetic qualities, and biological stability, zirconia has been widely used in the fields of dentistry. Due to its potential to produce suitable advanced configurations and structures for a number of medical applications, especially personalized created devices, ceramic additive manufacturing (AM) has been attracting a great deal of attention in recent years. AM zirconia hews out infinite possibilities that are otherwise barely possible with traditional processes thanks to its freedom and efficiency. In the review, AM zirconia’s physical and adhesive characteristics, accuracy, biocompatibility, as well as their clinical applications have been reviewed. Here, we highlight the accuracy and biocompatibility of 3D printed zirconia. Also, current obstacles and a forecast of AM zirconia for its development and improvement have been covered. In summary, this review offers a description of the basic characteristics of AM zirconia materials intended for oral medicine. Furthermore, it provides a generally novel and fundamental basis for the utilization of 3D printed zirconia in dentistry.


Yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) is currently almost the most durable restorative ceramic available. Their exceptional mechanical qualities, along with their biocompatibility and corrosion resistance, are what draw individuals especially [1,2,3,4]. However, the means of manufacturing ceramics with required properties and complicated geometries is still with high cost and ineffectiveness [5]. Traditional zirconia processing methods are usually subtractive manufacturing (SM). SM zirconia materials still have drawbacks in their applications. CAD-CAM subtractive manufacturing results in a large amount of waste of raw materials leading to a reduction of production efficiency [6]. Moreover, the milling and postprocessing such as surface treatment steps may create microcracks to the material which has an adverse effect on mechanical properties of final products [7, 8]. Furthermore, it is noteworthy that SM is difficult to satisfy patients’ personalized needs with the popularization of bionics consciousness. These constraints have driven researchers to hunt for better-performing approaches of fabricating zirconia materials.

The first three-dimensional (3D) printer was patented by Charles W. Hull in 1986. From then on, 3D printing has expanded rapidly as an industrial technology over its near 40-year history [9, 10]. In 2000, ceramic parts were firstly made by stereolithography [11]. For dentistry, zirconia dental prostheses were first made by direct inkjet printing in 2009 [12]. The first metal mandible was produced in 2011 [13]. In 2012, root analogue implant was manufactured for immediate implant [14]. The LCM (Lithography-based Ceramic Manufacturing) process used by Lithoz (Vienna, Austria) offers a cutting-edge method dedicated for dental zirconia. Crowns for the mandibular molars were manufactured using Lithoz’s LCM technology [15] (Fig. 1). The additive manufacturing (AM) method has been applied in a wide range of domains, including dentistry and personalized medicine [16]. Fused deposition modeling, stereolithography (SLA), selective laser sintering, photopolymer jetting, inkjet printing, and powder binder printing are representatives of additive manufacturing technologies [17,18,19,20]. For additive manufacturing, a wide range of materials are employed, including composites, polymers, metal alloys, and ceramic [19,20,21,22]. Aiming towards more customized (multi-material, multi-shade/translucency) restorations, 3D printing is currently on the rise [23]. Nevertheless, 3D printed zirconia dental materials can be roughly regarded as still being in its infancy, and numerous researchers are working on the performance of 3D printing zirconia materials and comparing them with CAD/CAM ones. It is significant to consider whether they can be widely employed in oral medicine and clinical indications of different materials. Unfortunately, despite the fact that an increasing number of research has focused on the characteristics of AM dental zirconia materials, a thorough assessment of AM zirconia is still lacking.

Fig. 1
figure 1

The historical process related to 3D printing in dentistry

This review gives an overall summary of the current research progress on AM dental zirconia materials. Four aspects are elaborated here: the physical and adhesive properties, accuracy and biocompatibility of AM zirconia materials, their clinical applications, challenges and optimization methods of AM zirconia and its perspective. It aims to give guidance and fundamental support for upcoming research to create new material types. More importantly, it provides a basis for how clinicians choose different materials.

Properties of AM zirconia


As is known, the microstructure of a material determines its physical and chemical properties. On one hand, the toughness of a material depends on the microscopic phase composition. AM zirconia, like milled zirconia, consists of tetragonal phase only. Its constituent particles are evenly distributed and the grain size is about 0.6 μm. There is no significant difference of grain size, crystalline phase structure between digital light processing (DLP) zirconia and milled one [8].

For Y-TZP, the high-temperature phase (tetragonal phase) of zirconia may be maintained at normal temperature by adding yttrium oxide with Y-TZP. High strength is found in the tetragonal phase (t) and zirconia’s metastable tetragonal phase quickly changes into monoclinic phase (m) under specific stress. This transformation is followed by a 3–5% volume expansion namely transformation toughening. However, in humid settings, zirconia’s tetragonal (t) phase can change spontaneously into monoclinic (m). Intergranular microcracking is a side effect of what is known as aging, hydrothermal degradation, or low-temperature degradation (LTD), which causes the loss of mechanical characteristics [24]. LTD has no effect on surface roughness, but it affects the polarity and surface energy of the material, which will make a difference on biocompatibility [25, 26]. One recent study has shown that after aging (after both 5 and 10 h) the m-phase of DLP one was higher than that of SM one. That might because the composition of the two were different before aging. Besides, the t / m transformation rate of zirconia produced by SLA is significantly faster than that of traditional SM one [24]. What’s more, cubic grains contain a lot of yttrium, which might cause yttrium depletion in nearby tetragonal grains as they age. Additionally, cubic grains act as the nucleation sites for the phase transition from tetragonal to monoclinic phase [27]. Research reported that adding alumina could weaken the LTD effect of Y-TZP [28].

On the other hand, the surface roughness of dental zirconia ceramics is crucial for predicting its service reliability. High surface roughness of dental prosthesis means that plaque accumulates on the surface of prosthesis, which might cause secondary caries and periodontitis [29]. Roughness less than 0.58 µm is considered clinically acceptable [30]. However, a previous study showed the surface roughness did not meet the standard with the minimum value of 0.71 μm [31]. This may be explained by the stepping effect of 3D printing process.

Micropores and agglomerates might affect the mechanical properties of materials. The surface microstructure of AM zirconia was observed and it was found that there were micropores ranged from 196 nm to 3.3 µm [32]. Other research also noted the presence of pores on the surface of AM zirconia [33]. The presence of agglomerates affects the roughness and the aesthetics of the material. It is believed that the appearance of the pores is due to the weak bonding between the layers of the printed material and the uneven slurry. In principle, agglomerates are more likely to form when the slurry is thicker [34].

Mechanical properties

Numerous experiments have been conducted to evaluate the mechanical properties of 3D printed zirconia (Table 1). Vickers hardness characterizes the strength and toughness of materials, which means the durability of the material. The experimental results indicated that the Vickers hardness of 3D printed zirconia materials can be up to 13.4 ± 0.2 GPa. Researchers tested apparent hardness and true hardness using proportional specimen resistance (PSR) and modified proportional specimen resistance (MPSR) models. It came out that the hardness results were evidently load-dependent in terms of hardness. Both apparent and true hardness of 3D printed materials were lower than milled ones [35]. Vickers hardness was noted to be strongly dependent on pore size and porosity, and these factors were observed in the experiment [35].

Table 1 Mechanical properties of 3D printed zirconia applied in dental materials

Another most evaluated mechanical property is flexural strength. The average bending strength of AM ceramics meets the level 5 standard in ISO 6872 (> 800 MPa) [39]. Although the Weibull modulus of the zirconia produced by DLP is lower than that of CAD/CAM zirconia as indicated by uniaxial (three-point bending) and biaxial (ring on ring) tests, studies have found that the zirconia specimen acquired favorable flexural strength close to that of a conventional CAD/CAM one [8]. While higher flexural strength was acquired by 3D printing than CAD/CAM [36]. Milled zirconia blocks are more resistant to uniaxial compression than 3D printed blocks. However, the 3D printed samples without fracture show interesting characteristics, such as better elastic modulus and lower compression deformation tendency compared with the milled samples [40].

Awareness of the various ways that a prosthesis could malfunction is necessary for the investigation of dental ceramic optimization. Dental zirconia fails, like all ceramic materials, through brittle fracture that results from flaws that appear after treatment or during use. They are dispersed throughout the material and come in a variety of sizes and shapes, usually being very small [41]. A majority of studies found no significant variation in fracture toughness between 3D printed and CAD/CAM zirconia parts [28, 42]. While certain experimental findings indicated that 3D printed zirconia had poorer fracture toughness than CAD/CAM [34]. Studies showed that compared with zirconia alone, zirconia toughened with alumina has higher fracture toughness [28].

There are studies on the effect of aging on the mechanical properties of 3D printed zirconia materials. It turned out that the m-phase content for SLA and DLP increased with the aging time, whereas the mechanical properties did not significantly decrease, indicating the stability of both materials [24]. Another research was conducted in a chewing simulator with extra cyclic temperature fluctuations between 5 and 55 °C for 5 million cycles in water, and it turned out that there was no discernible difference in the bending moment after fatigue with regard to the long-term durability of AM implants. The implants exhibited a considerably larger fracture stress and bending moment during mechanical fatigue in water at 90 °C. When mechanical wear and tear in a chewing simulator with water at 90 °C was combined, 31 vol% t-ZrO2 at the surface experienced tetragonal-to-monoclinic phase change, including wear and tear and aging [43].

In general, solid amount, printing parameters, debinding and sintering procedures impact the performance of the final products prominently. Higher solid amount means better mechanical performance. Researchers observed significant differences in the indentation fracture resistance with different building orientations. In particular, the performance has been improved when the layer line orientations were 45° inclined to the indentation direction [42]. Poor temperature control during the sintering process leads to high porosity of the product [44].

Adhesion properties

Zirconia is an inert material. Durable resin-ceramic adhesion, which has been one of the difficult difficulties in dentistry, may affect the clinical outcome of ceramic restorations. Researchers observed the formation of dimples between the combination interfaces. They analyzed that this is due to the gradual cracking of the ceramic interface due to the absorption of external stress and hypothesized that dimples represent a strong bonding force between the two. This results in better bonding of 3D printing zirconia than the CAD/CAM one [45]. A Schwickerath adhesion test on DLP zirconia cope and it turned out that printed zirconia specimen exhibited a similar adhesive performance as CAD/CAM ones [46].


Accuracy is a key indicator for evaluating the performance of the final product by AM. For dental applications, accuracy enhancement of AM technology is still necessary. According to the International Organization for Standardization (ISO), ‘accuracy’ is the degree to which the measured value of an object and its real value agree (ISO/IEC GUIDE 99:2007 (E/F)). The term ‘accuracy’ is defined to include two parameters: “trueness”, which informs us of the divergence from the true value, and ‘precision’, which informs us of the consistency of repeated measurements [47]. It is well knowledge that improved fabrication precision results in better prosthetic fit. High accuracy means less clinical adjustment time. More importantly, less adjustment can reduce the damage caused by the operation and improve the mechanical quality of the products. As for implants, poor accuracy would lead to plaque accumulation, gingival inflammation and microleakage [48].

To evaluate the trueness of 3D printed crowns, researchers divided dental crowns into inner and outer surfaces, focusing on exploring the characteristics of the inner surface and the thickness and corresponding volume of the cement space. The crown was divided into three parts: marginal, axial and occlusal area in the axial orientation. They used visible-light scan and Micro-CT to obtain three-dimensional data and compare them with the original CAD design. As a result, volumetric evaluation of cement space, surface evaluation, manufacturing flaws and crown- prep adaptation were obtained (Fig. 2). The occlusal region of the intaglio can be expected to have the least optimal trueness and crown adaption for monolithic zirconia crowns for both SM and AM manufacturing techniques, according to a study [49]. Therefore, intaglio’s marginal area might be the determining factor recorded between 3D printing and milling. Researchers compared the two parties at the same time: milled ones and 3D printed ones (Table 2). While the intaglio occlusal surface, intaglio surface, and marginal area demonstrated the opposite outcome, the printing group’s accuracy in regard to the external surface of the crown outperformed that of the CAD/CAM group. None of these findings, however, revealed statistically distinct differences [45, 50, 51]. Nevertheless, opposite results have been reported: the accuracy of AM full-contour crown was lower than that of SM only in the marginal regions. Splint zirconia crown refers to two-piece crown, which has been evaluated for better mimicking the structure of enamel and dentin. It was shown that the trueness of CAD/CAM group and AM splint zirconia group were clinically accepted besides AM zirconia group [52, 53].

Fig. 2
figure 2

Schematic illustrating the different evaluation methodologies (four rounded squares) and the two study parameters TRUENESS, as determined in terms of the overcut (min), undercut (max) and trueness deviation (RMS) indices at the intaglio occlusal, axial and marginal areas, and the external surface area, and CEMENT-SPACE CHARACTERISTICS, as determined in terms of cement-space volume, thickness and thickness distribution at the occlusal, axial and marginal thirds in (a) and (b), with a color map representing trueness deviation in (c), a micro-CT cross-section in (d) and a 3D color map of cement-space thickness distribution in (e) [49]

Table 2 Trueness of 3D printed zirconia materials applied in dental materials

Understanding the precision of fabrication, its systematic and haphazard faults, as well as the constraints that could affect the proposed and accomplished restoration, is crucial. What’s more, printing technique and parameters make a difference. Studies found that reducing the layer height can increase the accuracy of the final product [56]. This may be explained by the surface stepping phenomenon of AM process [57]. Similar results were also detected in another four-unit bridge experiment. Researchers stressed that the accuracy of DLP was lower than SLA [58]. The accuracy is different under different porosity, which should be considered before manufacturing and adjusted by sintering [59]. Research showed that through some special process like using carefully designed porous polymer molds, 3D printed flexible products can be accurately shaped to a certain curvature [60]. Some models and methods can be adopted to predict the shrinkage of samples for better control [61]. Besides, both the tooth types and the angle of construction affect the accuracy of the products.


Implants and scaffolds require intricately interconnected cellular structures, which 3D printing technology can create. These structures can encourage the production of bone from the surrounding tissue [62]. Zr-based materials have shown promising outcomes with low ion release, low cytotoxicity, favorable biocompatibility, and good osseointegration capability [48]. 3D printed zirconia composite as implants and scaffolds has become a promising research direction (Table 3).

Table 3 Biocompatibility of 3D printing zirconia scaffolds

Various in vitro investigations have established the biocompatibility and osteogenic potential of 3D printed zirconia composite. Long-term attachment, osteoblast proliferation, and matrix mineralization are made achievable by fabricating direct implant shape with distinctive scattering geometries and surface topographies. These result in an elongated osteoblast morphology with uniform cell orientation. Fluorescence and scanning electron microscopy are used to analyze the cell distribution on the implant’s surface. It turns out that the groove structure on the surface of AM implants helps cells form slender shapes and uniform cell orientation. The osteoblasts are ‘contact-guided’ by the multilayer nature of AM implants. According to the concept of ‘contact guidance’, sticky signals from the extracellular matrix (ECM) or a biomaterial govern cell adhesion, which in turn determines cell shape and arrangement [72]. The tailored surface structure of AM implants appears to be advantageous for cell metabolism and proliferation. Compared to the control implant, the density of the AM implant covered by mineralized matrix is higher, demonstrating the favorability of matrix mineralization, or the matrix is more securely fixed on the AM implant than on the control implant (Fig. 3) [43]. Studies have shown that ZrO2-SiO2 (ZrO2:SiO2 = 1:1) had the best MG63 cell affinity among the ZrO2-SiO2 composite with other ratios [48]. The biocompatibility of the ZrO2-CS (calcium silicate) composite scaffold is excellent. Additionally, high CS concentration is better for MC3T3-E1 cell adhesion, proliferation, and differentiation, all of which are essential for the bone repair process [68].

Fig. 3
figure 3

Cell biological evaluation with primary human osteoblasts. a Analysis of cell adhesion and morphogenesis by fluorescence microscopy and SEM. b Data obtained in the metabolic alamarBlue assay and by DNA quantification; statistically significant differences are marked with bars above the corresponding columns. c Photographs and micrographs of the AlizarinRed staining. Cells on the negative controls were cultivated in standard culture medium, while the cells on the test samples in osteogenic medium [43]

Through the use of melt mixing, nano zirconia powder has been incorporated into polycaprolactone (PCL) material, and a regular grid scaffold is created via 3D printing. The embedding of nanometer-sized zirconia powder is demonstrated to improve the hydrophilicity and water absorption of the composite scaffold, which is favorable for the exchange of nutrients and promotes MC3T3 cell adhesion, proliferation, and growth [63]. According to studies on the differentiation of human mesenchymal stem cells (hMSCs) on BCP/ZrO2 scaffolds in static and dynamic culture conditions, the expression of bone morphogenic protein-2 (BMP-2) was higher on BCP/ZrO2 scaffolds than on BCP scaffolds [64]. An experiment using in vitro cell culture was performed to gauge the biocompatibility of the HAP/ZrO2. The results showed that the aggregation behavior of mBMSCs cells on the materials was more visible owing to the roughness of the surface of composite ceramics, and the growth morphology of mBMSCs cells became more elongated [68].

At the same time, in vitro experiments using dental pulp cells (DPCs) demonstrated that Zn-HA/glass composite-coated glass infiltrated zirconia scaffolds performed satisfactory biocompatibility, including the attachment, proliferation, and osteogenic differentiation of DPCs [68]. Using 3D printing technology, porous zirconia scaffolds are created and then coated in calcium silicate and hydroxyapatite. Test results revealed that coated scaffolds had good cytocompatibility and helped MC3T3-E1 cells proliferate and differentiate [69]. Low temperature 3D printing technology can effectively avoid interference from high-temperature environments on protein activity. Applying natural phospholipid modified protein technologies with low temperature printing technology to fabricate scaffold with Bone Morphogenetic Protein-2 and Human Beta Defensin-3 (BMP2 and HBD3) has been conducted. It turns out that this scaffold promotes osteogenic differentiation [73]. Producing biocompatible surface coatings for zirconia materials in this way could become a future research direction. There are in vivo experiments evaluating the biocompatibility of 3D printed zirconia. According to recent research, HE staining results indicate mild inflammatory response of ZrO2–ZnO ceramics with good biocompatibility [70]. What’s more, one 3D printed GBR barrier was fabricated showing good osteogenic response and biocompatibility by evaluating the expression of PDGFRs, osterix, osteopontin and osteocalcin [71]. However, in vivo experiments on 3D printed zirconia are still lacking.

Clinical applications

3D printed zirconia ceramic is a promising candidate material for a variety of applications because it provides great qualities similar to SM zirconia. In the past 10 years, 3D printing technology has become commonly employed in dentistry, including patient care and dental education. And the experiment fields of 3D printed zirconia include prosthodontics, oral implant and oral maxillofacial surgery. Examples include the ultra-thin occlusal veneer, cope, crown and bridge, implant, abutment, scaffold and so on. The most recent developments in the application of zirconia materials for 3D printing in dentistry will be specified here (Fig. 4).

Fig. 4
figure 4

Application of 3D printed zirconia materials in the field of dentistry

3D printed zirconia occlusal veneers

Ultra-thin occlusal veneer is a novel minimally invasive method that can minimize the removal of healthy tooth tissue. It is suitable for teeth that have been worn or eroded. Study showed that the load-bearing capacity of 3D printed zirconia was significantly higher than that of the CAD/CAM one when simulating the chewing environment [74]. A high degree of accuracy is also critical for printing zirconia veneers, which means that the veneers have an excellent fit to the dentin. The marginal adaptation (95 µm) and production accuracy (26 µm) of AM zirconia occlusal veneers generated via LCM (lithography-based ceramic manufacturing) are comparable to those derived from conventional methods [75]. Encouragingly, accuracy of occlusal veneer that is higher than milled ones has also been reported [76].

3D printed zirconia cope

The effectiveness of a zirconia cope using a pattern made by a 3D printer has been reported. Adhesion is quite essential for the application of PFZ (porcelain fused zirconia) especially for the anterior teeth, which is the key to the success of the restoration. Stable adhesion can improve the crushing resistance of the restoration. A Schwickerath adhesion test has been done on DLP zirconia cope and found that printed zirconia specimen exhibited a similar adhesive force as CAD/CAM ones [46]. Another study found that AM zirconia cope obtained higher bond strength than SM one because there were more dimples on the surface of AM one [45].

3D printed zirconia full-contour crown and bridges

Studies on mechanical properties and accuracy of zirconia full-contour crowns and bridges produced by 3D printers have been carried out by a number of researchers [8, 35,36,37,38]. As mentioned above, the mechanical properties and accuracy of 3D printed zirconia can meet clinical standards. Novel material composite, like PLA/ZrO2 synthetic resin as the material, glycerin and silane coupling agent as the binder to build dental crown samples has been conducted and obtains satisfactory results [77].

3D printed zirconia bridges have been fabricated and acquisitioned superior properties. The sintered part has an average hardness of 1224 HV, a density of 5.45 g/cm3, a flexural strength of 641.04 MPa and a clinically acceptable marginal gap. However, there are still shortcomings. Results showed that samples did not match the expected color, appearing purple. Besides, cracks were observed on the outer surface of the SLA samples [56].

3D printed zirconia implant and abutment

3D printed implants are one of the most promising applications of this technology in the sphere of dentistry, especially zirconia implant. The advantages of 3D printed zirconia implants can be analyzed from the following perspectives: first and foremost, the error can be narrowed by 3D printing ‘custom-made’ implants. A good fit of the implant to the bone tissue can greatly reduce the time required for recovery. By 3D printing, implant materials with specific porosity can be produced to finish the osseointegration process better. 3D printed zirconia porous materials are beneficial to the proliferation and adhesion of cells but have an inhibitory effect on differentiation. Second, compared to titanium implants, zirconia implants have the advantages of better aesthetic performance, which is especially noticeable in the anterior dental implants. Compared with titanium, zirconia has less bacterial adhesion and biofilm formation. Zirconia surfaces are less prone to infection [78]. Additionally, zirconia implants have several advantages over titanium implants, including no metal aura in situations when the buccal bone wall is inadequate and/or corrosion resistance, thin mucosal biotype and hypoallergenicity [79]. Traditional implants require surface treatment, such as phase transformation, chemical coating and laser treatment, which seem to be quite cumbersome. However, the significant advantage of 3D printed zirconia implants is to directly fabricate suitable porous structure to promote osseointegration for prolonged lifetime [43, 80].

A number of studies have been conducted to evaluate the clinical applicability of 3D printed zirconia implants. Research showed that the flexural strength and Weibull modulus of 3D printed implants were within clinically acceptable limits [32]. Compared to SM zirconia, AM zirconia has a smoother surface, resulting in a more random arrangement of cells on its surface [81]. AM zirconia is more affected by accelerated aging, namely greater phase transition rate (monoclinic phase increase). Furthermore, accelerated aging results in submicron changes in the surface morphology of both AM and SM zirconia [81]. These may be related to the low temperature aging (LTD) phenomenon of zirconia.

Smart implants are now visible to the general public. Sensing, actuation, and control capabilities are combined in smart implants to describe and analyze conditions and make judgments in a predictive or adaptive way to carry out intelligent activities. These implants need communication cavities, such as wires and antennas, sensors, and actuators. With the introduction of 3D printing, it has been possible to create implants that resemble the central nervous system of the human body by lining it with various materials. They have local surface areas with the ability to perceive and actuate, as well as an interior communication array of wires. Additionally, it is feasible to print sensorics/actuating regions, micro-antennas, or communication cavities on the implant’s surface. A microcavity was made on a ZrO2 substrate, according to a novel study, and silver powder was then added and sintered into it. Silver baselines of high quality and low resistance were produced using 3D printing techniques [82].

3D printed scaffolds for bone regeneration

Patients experiencing bone fractures from various reasons, such as tumors and automobile accidents, always need to have their bones replaced. For instance, motor vehicle accident (MVA) causes craniofacial bone fractures, with the most common damaged sites being the zygomatic, nasal bone, and orbital floor [83]. These moderate sized fracture regions are good candidates for 3D printing. Because they offer a setting for cell adhesion, proliferation, and differentiation, scaffolds are crucial [84]. Connectivity between pores of appropriate size is critical for the transport of nutrients/metabolites and the growth of bone tissue. However, because high porosity usually reduces the mechanical stability of the scaffold, there are conflicts between biological and mechanical requirements. Therefore, the proper balance between these two standards must be considered when designing maxillofacial surgery scaffolds [62, 85,86,87]. What’s more, optimized porous structure plays an important role in 3D printed porous bone scaffolds suitable for the human body. There have been myriad attempts to manufacture scaffolds for osseous surgery with the purpose of promoting alveolar bone regeneration [88]. A detailed review on biocompatibility has been provided in above. Here we put emphasis on the mechanical properties of scaffolds.

A large number of zirconia composites and new types of surface treatment methods have been proposed in order to improve their biocompatibility. Studies demonstrating the preparation of the porous ZrO2/CS composite scaffold using DLP technology revealed that as the CS content increased, the aggregated CS connected with one another and gradually formed a stable support structure, increasing the compressive strength of the composite scaffold [66]. The production of this material by hydrothermal method has been also studied [89]. The 3D printed support is coated with Zn-HA/glass composite coating on glass impregnated zirconia (ZC). The compressive strength of ZC supports is 20% higher than that of zirconia (Z) supports [68]. 10CeTZP-Al2O3 porous mechanical casting structure shows good mechanical properties and aesthetic properties, which can be employed for the fabrication of bone scaffolds [90]. Mechanical properties have been conducted on zirconia and β -TCP compounded with PA 12 composite. Due to the addition of PA 12, the hybrid ceramics’ tensile modulus and impact strength are enhanced. Additionally, the new composite materials’ cell viability has been dramatically improved [91]. As for the structure of the scaffold, research has shown that diamond lattice unit (DIA) is a good choice for vascular growth, nutrient transport, and bone formation [92].

However, the printing method without scaffolds has been proposed called Kenzan method. This biological printer can effectively pick up the sphere and transfer it to the printing stage of a single complete layer, reducing the printing time of large organizational structures. By accurately transferring the ball bead to the printing surface, it is easy to build customized tissue on the needle [93]. This method is likely to become the future development direction.

Maxillary segments have been stabilized using 3D printed zirconia ceramic miniplates and screws after a Le-Fort I advancement surgery [94]. Compared with titanium implants, it has superiorities such as excellent biocompatibility and tissue integration without producing artifacts in CT or MRI scans, but also has disadvantages of high fracture risk. In addition, the three-dome space-maintaining barrier can be one of the directions for future experiments. It is suitable as an experimental tool to evaluate the possibility of using the designed barriers in dentistry and orthopedics to promote the formation of new bone and determine their space and time dependent limitations [71].

Challenges of 3D printing in dental materials

The technologies of 3D printing zirconia have brought about progressive performance for complex and precise dental materials and structural design, which is unmatched by traditional subtractive methods. They have been explored in numerous territories of dentistry. Nevertheless, the slurry ratio of raw materials, porosity and agglomerates in the finished products, the connection between layers, as well as the unpredictable shrinkage rate, stand out as issues in the zirconia ceramic AM fabricating processes that still need to be resolved. Large-scale research efforts should be put on zirconia’s 3D printing technology.

Raw materials and slurry preparation

At present, the application technologies of 3D printing in dentistry are mainly based on slurry. Seeking for an appropriate ratio of powder and liquid is extremely critical for 3D printing. The high ratio of powder to liquid contributes to lower pores and agglomerates on the product. Nevertheless, if the ratio is too high, it will count against the flowability and rheology of slurry and make it easier to settle. Typically, solid loads below 50% result in ZrO2 parts with low density, significant shrinkage, and defective pieces [95,96,97]. On the other hand, the slurry ratio determines the curing qualities. The critical exposure energy, penetration depth, and dispersion coefficient are the key determinants of the slurry’s curing properties. The quantity of photo initiator allows for adjustment of the critical exposure energy. The physical characteristics of the ceramic powder and the pre-mixed resin itself are related to the penetration depth and scattering coefficient.

Porosity and agglomerates

The zirconia slurry used for printing dental products has a high viscosity. Air bubbles may consequently get entrapped during the printing process. If these air inclusions are located in the highly tensile stressed region of the specimens, they can spread across multiple layers and create worm-like pores, which eventually become fracture origins [34]. They can be distributed throughout various parts of the product, especially on the surface [8]. According to research, the porosities are classified into cavities for shrinkage and gas holes. Through experimental verification and theoretical analysis, it was shown that the air conveyed by powder spraying injection into the molten pool was the primary cause of the creation of pores [98]. Understanding the causes of pores is more helpful to reduce the generation of pores in the printing process. Porosity will also affect the accuracy of materials according to a recent study [59]. However, the porosity is still difficult to accurately be controlled during the fabrication of implants or scaffolds [43].

Agglomerates are remnants of the powder processing. These flaws can act as stress concentrators and lead to the failure of the specimens when loaded. However, differences were found in the fracture initiations of DLP and SM specimens, which were mainly reflected in the proportion, location, and size of fracture initiating pores [8]. More printing parameters and sintering programs related to porosity and agglomerates should become future research hotspots.

Inter-layer defects

In the process of 3D printing fabricating, layer-by-layer printing is always performed and bonding between layers occurs. In general, inter-layer bonding in 3D printed materials is weaker than intra-layer bonding from a mechanical standpoint. Thus, the inter-layer bond strength is considered as one of the key parameters to ensure stability of the structure [99]. Pores and agglomerates are more likely to appear at the joint of layers, which cause spaces between two layers always becoming the weak areas of the final products [34]. Therefore, it is necessary to optimize the printing parameters so as to make the interlink areas more inseparable.

Optimization of 3D printed zirconia materials

The application of 3D printing zirconia ceramics in dentistry has enormous potentials. The issues mentioned previously have been the subject of extensive research efforts. 3D printing technology essentially involves the combination of the disciplines of engineering and materials science. There are various of factors affecting the quality of printed samples: raw materials, printing parameters, debinding and sintering as well as the separating procedures. Next, possible optimization methods around these four aspects will be elaborated (Fig. 5).

Fig. 5
figure 5

Optimization methods of 3D printed zirconia materials

Raw materials

The formulation of ceramic suspension is the first step in slurry-based 3D printing techniques, and the selection of raw materials is crucial as they determine the final performance of the material. Generally, it is determined by multitude aspects: the powder ratio, dispersant and slurry components. Numerous studies have been carried out to investigate the ideal slurry ratio, the characteristics of dispersing agents, and innovative forms of zirconia composites. Herein, the review focus on the recent progress of raw materials applied in dental 3D printing.

Balanced ratio of slurry

It is significant to find a balance between a large enough solid load and good flowability. The consistency of the slurry produced for printing determines the mechanical properties of the final products. Slurry using large particles and high dry matter content can ensure good and reliable density, bending strength and Weibull modulus. On top of that, as zirconia has a high refractive index and scatters light strongly, photopolymerization typically results in significant incident light scattering. As a result, the photopolymer’s cure depth is constrained, and anisotropic contraction takes place [100]. According to a study, the solid loading needs to be at least 40% in order to prevent flaws following debinding and sintering [96].The viscosity will significantly increase when the solid content exceeds 60% [101]. Researchers conducted experiments using a slurry containing 58% zirconia and obtained satisfactory mechanical properties [8, 35].

Dispersing agent in 3D printing zirconia

Dispersants play an important role in improving homogeneity of the slurry and reducing agglomerates on the final product. The solubility, potency and decomposition temperature of dispersant greatly affect the structure quality after washing and degreasing [102, 103]. Addition of Triton X-100 can reduce the surface tension of suspension [104]. 5 wt% DISPERBYK can effectively modify the zirconia powder for the purpose of preparing a homogeneous slurry [105]. Disperbyk-111 and PEGDA 250 have been proved to be smart decisions. Due to the spatial stability produced on the ceramic particles, 5 wt% of this dispersant (Disperbyk) produced low viscosity slurries with no discernible sedimentation [106]. More research should concentrate on the combination of different dispersants and adjust their concentration for better performance.

Alumina toughened zirconia

Researches on the mechanical properties of alumina toughened zirconia (ATZ) have been carried out [107]. The AM alumina toughened zirconia crowns show similar fracture resistance to traditional ones when fixed on the implant supported abutment [108]. In addition, the strength of prep increases after long-term aging [109, 110]. Some researchers provided possible explanations for this phenomenon. They discovered that the alumina distributed in the 3Y-TZP matrix could slow down the transformation by decreasing the TZP grains’ surface area in contact. Al2O3 has a larger elastic modulus than ZrO2, which reinforces the matrix’s pulling effect on the tetragonal phase. Furthermore, by inhibiting the interaction between the hydroxyl groups, the alumina segregation is a crucial element in obstructing the spread of transformation [28]. It can be assumed that ATZ is a promising implant material because it is less affected by phase transformation. Besides, it is noteworthy that a notable advantage of ATZ material is its light weight, so it shows great prospects in fabricating more comfortable oral materials.

3D printed polymer-ceramic composites (PCCs)

Polymer infiltrated ceramics network (PICN) material is in progress for 3D printing to manufacture implants and scaffolds. By Combining polymer with zirconia, the mechanical strength of zirconia is closer to normal tooth tissue and bone tissue. Omitting the use of coating to achieve biocompatibility and better combining with bone tissue is the material goal. PICN samples have a larger capability to resist higher deformation than 50% infill ceramic scaffolds. Additionally, the presence of polymer helps to lessen the hardness for greater compatibility with natural teeth. The properties are desired for the use of zirconia material in the dentistry field. The polymer can be PA-12 and methacrylate [111, 112]. The mechanical qualities of the scaffold material are improved by the effective pentration of methacrylate copolymer. It has the strongest elongation resistance among similar materials. Moreover, it has the advantage of inhibiting bacterial reproduction [112]. Some additives are added like Si3N4 to avoid the problem of ultraviolet light scattering [113].

3D printed zirconia composite containing silicon and carbon fiber

Zirconia has little biological activity and it is hard to form chemical or biological combination with bone. SiO2 interacts with calcium and phosphate ions in biological fluids to produce strong cell and tissue affinity. The study demonstrated that ZrO2 and SiO2 could combine in the liquid phase to generate the combination of ZrO2-SiO2. These ZrO2-SiO2 compounds exhibit good biological characteristics and are suitable for medical applications due to the fact that they can release silicate ions and encourage osteoblast development and differentiation. The strength and hardness of the experimental group with silane coupling agent added in the suspension are improved compared with those without silane coupling agent [62, 114]. Carbon black has been introduced into the raw materials, and an implant base was successfully printed, which acted as printing support for any overhangs [104]. In composites, the addition of carbon fiber can increase the toughness, which is essential for abutments and implants [115].

Other 3D printed zirconia materials

3D printed two-photon lithography zirconia materials have been studied by researchers. They emphasized that, in comparison to the acrylate system, shrinkage caused by the loss of organic matter was significantly decreased, and that zirconia seeds enabled the formation of micro ceramic in the pure and stable cubic phase. Additionally, even without any thermal treatment, the inclusion of nanoparticles affords a significant enhancement in the optical characteristics of the microfabricated structures [116]. As the concept of energy conservation gradually popularizes, myriad researchers focus on 3D printing with recycled zirconia powders. There are a great number of zirconia residues in materials applied in 3D printing. The purpose of saving raw materials can be achieved by recycling the remaining raw materials for reuse. However, the agglomerates in the recovered powders increase and the mechanical properties decrease when using the recycled powders. Researchers suggested that the original powder could be used for the restoration of posterior teeth, while the recycled powder could only be used for the anterior teeth [117].

Printing parameters

Vat photopolymerization printers

Vat photopolymerization methods, such as SLA and DLP, are recommended for creating dense ceramic structures, as their applications have received the most attention [20]. For SLA and DLP, when the printing direction is horizontal, the dimensional accuracy and fracture toughness of the sample are obviously better than those of the vertical direction [38]. However, samples printed vertically have higher relative density, better semi-transparency, wettability and flexural strength. Besides, the printing direction influences the roughness of the surface of the final product at the same time [118]. To obtain the greatest mechanical properties, the best proportion of zirconia powder is different under different printing directions [118, 119].

Exposure energy and layer thickness also have a significant impact on product performance and final quality [120]. The quantity of photo initiators, particle size and shape, and exposure variables including wavelength, laser power, beam size and speed, exposure time and velocity are all factors that affect the resolution in the Z-direction, which is defined by the curing depth in each layer [121]. The Z-direction has the greatest variation [59]. Small layer heights make it easier to fully polymerize with each layer, which helps to avoid porosity and delamination problems at the layer borders. Defects in layer lines tend to lead to the DLP-printed zirconia’s failure. However, as the loading direction gets more favorable, the percentage of failures attributable to layer line faults diminishes [42]. It is necessary to further study the algorithm in which the ideal building angle is calculated before printing [57].

Material extrusion printers

The raw material used for material extrusion 3D printer needs sufficient liquidity. Moreover, printability enables sufficient strength to maintain stability of the printed structure immediately after deposition. Filament overlap ratio, printing speed and nozzle height affect the final performance of the material. Setting of appropriate overlap rate can effectively reduce printing defects, and thus improve the printing quality [122]. The layer height and printing speed have an impact on porosity. Low layer height and rapid printing yield the lowest surface roughness. The printing conditions affect the porosity and shrinkage percentage results. Low layer height and slow print speeds are correlated with the low porosity values [123]. The nozzle diameter affects the residual pore size on the surface of the material, thereby affecting the crack propagation resistance and the flexural strength of the material. The decrease in effective crack propagation resistance caused by the surface roughness of the curved surface and the large residual pore size on the fractured surface can be attributed to the excessive diameter of the extrusion nozzle, which leads to a loss of bending strength [124]. More studies should be conducted to find the standard nozzle diameter [124, 125].

Other printing techniques

Some novel printing methods have been developed to print zirconia dental materials. nanoparticle jetting (NPJ) is a unique technology that produces parts by spraying thousands of droplets. Products manufactured in this way have obtained satisfactory properties [126]. Wider application of 3D printing technology in clinical practice requires multidisciplinary cooperation. The optimal implant model with minimum fretting can be obtained by finite element simulation [127]. Combining two or more printing methods may become the future research directions [128]. The combination of two printing methods micro-stereolithography (PμSL) and direct ink write (DIW) has been used to print zirconia materials with specific porosity [129]. Ceramic injection molding (CIM) has low mechanical strength when used alone for manufacturing [130]. Free injection molding (FIM) is the product of combining CIM with 3D printing. The sample of this method has been studied, which showed that the problems of interlayer mixing defects and anisotropic shrinkage were avoided [131].

Debinding and sintering parameters

Efforts have been put for improving the controllability of debinding and sintering process. The scheme is exactly essential and can greatly reduce the defects of the products. After curing, the dispersant, solvent, and polymer network in the green body are eliminated by the debinding procedure. The ceramic microparticles are then densified by the particle surface energy at a high temperature to create a dense ceramic component. Compared with conventional CAD/CAM manufactured products, the post-processing steps for 3D printed products are complicated. Sintering affects porosity and surface roughness. A great number of research were conducted to optimize the debinding and sintering procedures. Sintering actually affects the asynchronous densification phenomenon [132]. Researchers proposed two-stage sintering or slow temperature gradient sintering [32]. Additionally, the secondary shaping process can be improved with the use of high-temperature porous polymer molds to precisely regulate the structural geometry [60]. Using cold isostatic pressing (CIP) technology can reduce the defects between layers [99]. After 3D printing, annealing of the workpiece is helpful to improve the mechanical properties of the material. Compared with the unannealed composite, the thermal and mechanical properties of the annealed composite are improved in terms of the heat resistance and compressive strength [77]. Study showed that the grain size of the material rose with the increase of sintering temperature [133]. Besides, for zirconia with different transmittance, the optimum sintering temperature is different [133].

Separation of sample from printing platform

The primary layer used in 3D printing, which must be removed once the body is constructed, fixes the green bodies to the building platform [134]. The green body deforms a tiny bit plastically upon removal. This results in the primary layer delamination at the margins closest to the construction platform, and this delamination persists even after sintering. But to a lesser level, delamination and edge damage also happen at the edges across from the building platform. One possibility of layering on this side is the formation of temperature gradients during sintering process [34]. In order to solve this problem, a novel method was proposed called Submersion-Light three-dimensional slurry printing method. The bottom-up methodology is the opposite of this one. The construction platform, which ordinarily goes up and down layer by layer, remains stabilized. In contrast, the light source, which ordinarily moves steadily up and down layer by layer is lowered into the vat rather than just relocated. What’ more, when printing products with complex shapes, the auxiliary supports may help regarding to this issue [31].

Conclusions and prospective

Zirconia is a crucial ceramic material in dentistry, and in recent years, academics have been more and more interested in the creation of zirconia items using additive manufacturing. Digital processing in the whole process of prosthodontics will prove to be the development trend in the future [135]. This review recapitulates recent developments in additive manufacturing of zirconia ceramic materials and related applications in the field of dental materials. More significantly, it offers an analysis on the challenges and optimization methods of AM dental materials.

A great effort has been devoted to evaluate the basic properties of AM zirconia materials. With regard to the microstructure, AM and SM products have almost the same phase composition. The mechanical properties of AM products are usually slightly inferior to SM ones but there are usually no significant differences between them. It is noteworthy that the accuracy of AM zirconia materials can reach the clinical standard. They have extraordinary biocompatibility, which make them promising in oral implant and scaffold fields. Dental prostheses, implants, and maxillofacial surgical components are the typical examples of AM-produced zirconia materials that have been demonstrated in this review.

Though tremendous progress has been made regarding AM zirconia materials, it is not as developed compared to the AM of metal and polymer materials. Raw materials, printing parameters, and improving the mechanical and accuracy qualities of AM-processed zirconia products are still major issues. Each AM technique offers benefits and drawbacks specific to the production of dental zirconia materials. Seeking out a practical and controllable AM process to create dental zirconia parts with outstanding characteristics remains a significant problem. Hence, future research should pay more attention to these challenges AM zirconia faced.

The content above also emphasizes a series of methods for improving 3D printing zirconia technology. The AM techniques used to fabricate zirconia dental materials include SLA, DIP, MEX, and ink-jet printing, for which SLA and DLP have been the mainstream. Additionally, attempts have been made to use binder jetting and 3D gel printing as AM processes. For the slurry, a balance of powder and liquid has been explored. Several new methods were brought about to improve the debinding, sintering and other post processing procedures. Combination of different AM methods or combination of AM and SM methods should be further searched. 3D printing function graded materials might be new research hotspot [136, 137]. As for implantology, the structure can exhibit transition from a dense inner zirconia to a bioactive and soft material in the outer region in order to improve the stress distribution of cortical bone, bone trabecula and soft tissue [138]. To make items with different colors conceivable, novel ceramic printing techniques and equipment need also be developed for better aesthetics and color matching [139,140,141,142]. By applying additional modeling and simulation techniques into the investigation of AM of zirconia ceramics, the best strategy to fabricate zirconia components with superior performance is anticipated to be derived.

On account of the review, it is noteworthy that significant progress has been made in terms of biocompatibility of AM zirconia dental materials. However, porosity and aggregates occur because there is no consensus over the ideal ratio of powder to liquid for raw materials. Furthermore, AM technology and manufacturing parameters are the source of interlayer faults. As a result, it seems hard for AM to create dental zirconia materials with superior mechanical qualities and accuracy better than SM ones. Wherein accuracy is the most imperative issue. The clinical application of AM zirconia will become feasible upon the resolution of the aforementioned difficulties. To accomplish the perfect target in dental materials, an efficient and manageable AM technique workflow should be further investigated. Additionally, more clinical researches on the accuracy and mechanical characteristics of AM zirconia materials should be conducted.

Availability of data and materials

All the data and materials supporting the conclusions were included in the main paper.



Additive manufacturing


Alumina toughened zirconia


Bone morphogenic protein-2


Computer aided design/computer aided manufacturing


Ceramic injection molding


Cold isostatic pressing


Calcium silicate


Direct ink write


Digital light processing


Dental pulp cells


Extracellular matrix


Free injection molding




Human beta defensin-3


Human mesenchymal stem cells


Organization for Standardization


Lithography-based ceramic manufacturing


Low temperature aging


Modified proportional specimen resistance


Nanoparticle jetting


Polymer-ceramic composites




Porcelain fused zirconia


Polymer infiltrated ceramics network


Polylactic acid


Proportional specimen resistance




Subtractive manufacturing


Yttria tetragonal zirconia polycrystal




  1. Zhang Y, Lawn BR. Evaluating dental zirconia. Dent Mater. 2019;35(1):15–23.

    Article  Google Scholar 

  2. Spitznagel FA, Balmer M, Wiedemeier DB, Jung RE, Gierthmuehlen PC. Clinical outcomes of all-ceramic single crowns and fixed dental prostheses supported by ceramic implants: a systematic review and meta-analyses. Clin Oral Implants Res. 2022;33(1):1–20.

    Article  Google Scholar 

  3. Sadowsky SJ. Has zirconia made a material difference in implant prosthodontics? A review. Dent Mater. 2020;36(1):1–8.

    Article  Google Scholar 

  4. Kelly JR, Denry I. Stabilized zirconia as a structural ceramic: an overview. Dent Mater. 2008;24(3):289–98.

    Article  Google Scholar 

  5. Schweiger J, Edelhoff D, Güth JF. 3D printing in digital prosthetic dentistry: an overview of recent developments in additive manufacturing. J Clin Med. 2021;10(9):2010.

    Article  Google Scholar 

  6. Strub JR, Rekow ED, Witkowski S. Computer-aided design and fabrication of dental restorations - current systems and future possibilities. J Am Dent Assoc. 2006;137(9):1289–96.

    Article  Google Scholar 

  7. Wang H, Aboushelib MN, Feilzer AJ. Strength influencing variables on CAD/CAM zirconia frameworks. Dent Mater. 2008;24(5):633–8.

    Article  Google Scholar 

  8. Lu YQ, Mei ZY, Zhang JJ, Gao SS, Yang XQ, Dong B, Yue L, Yu HY. Flexural strength and Weibull analysis of Y-TZP fabricated by stereolithographic additive manufacturing and subtractive manufacturing. J Eur Ceram Soc. 2020;40(3):826–34.

    Article  Google Scholar 

  9. Carlotti M, Mattoli V. Functional materials for two-photon polymerization in microfabrication. Small. 2019;15(40):e1902687.

    Article  Google Scholar 

  10. Della Bona A, Cantelli V, Britto VT, Collares KF, Stansbury JW. 3D printing restorative materials using a stereolithographic technique: a systematic review. Dent Mater. 2021;37(2):336–50.

    Article  Google Scholar 

  11. Doreau F, Chaput C, Chartier T. Stereolithography for manufacturing ceramic parts. Adv Eng Mater. 2000;2(8):493–6.

    Article  Google Scholar 

  12. Ebert J, Ozkol E, Zeichner A, Uibel K, Weiss O, Koops U, Telle R, Fischer H. Direct inkjet printing of dental prostheses made of zirconia. J Dent Res. 2009;88(7):673–6.

    Article  Google Scholar 

  13. Nickels L. World’s first patient-specific jaw implant. Met Powder Rep. 2012;67(2):12–4.

    Article  Google Scholar 

  14. Figliuzzi M, Mangano F, Mangano C. A novel root analogue dental implant using CT scan and CAD/CAM: selective laser melting technology. Int J Oral Maxillofac Surg. 2012;41(7):858–62.

    Article  Google Scholar 

  15. Schweiger J, Bomze D, Schwentenwein M. 3D printing of zirconia-what is the future? Curr Oral Health Rep. 2019;6(4):339–43.

    Article  Google Scholar 

  16. Khorsandi D, Fahimipour A, Abasian P, Saber SS, Seyedi M, Ghanavati S, Ahmad A, De Stephanis AA, Taghavinezhaddilami F, Leonova A, Mohammadinejad R, Shabani M, Mazzolai B, Mattoli V, Tay FR, Makvandi P. 3D and 4D printing in dentistry and maxillofacial surgery: printing techniques, materials, and applications. Acta Biomater. 2021;122:26–49.

    Article  Google Scholar 

  17. Buj-Corral I, Tejo-Otero A. 3D printing of bioinert oxide ceramics for medical applications. J Funct Biomater. 2022;13(3):155.

    Article  Google Scholar 

  18. Zhang XP, Wu X, Shi J. Additive manufacturing of zirconia ceramics: a state-of-the-art review. J Mater Res Technol. 2020;9(4):9029–48.

    Article  Google Scholar 

  19. Kihara H, Sugawara S, Yokota J, Takafuji K, Fukazawa S, Tamada A, Hatakeyama W, Kondo H. Applications of three-dimensional printers in prosthetic dentistry. J Oral Sci. 2021;63(3):212–6.

    Article  Google Scholar 

  20. Peng E, Zhang DW, Ding J. Ceramic robocasting: recent achievements, potential, and future developments. Adv Mater. 2018;30(47):1802404.

    Article  Google Scholar 

  21. Jang TS, Jung HD, Pan HM, Han WT, Chen S, Song J. 3D printing of hydrogel composite systems: recent advances in technology for tissue engineering. Int J Bioprint. 2018;4(1):126.

    Article  Google Scholar 

  22. Ferrage L, Bertrand G, Lenormand P, Grossin D, Ben-Nissan B. A review of the additive manufacturing (3DP) of bioceramics: alumina, zirconia (PSZ) and hydroxyapatite. J Aust Ceram Soc. 2017;53(1):11–20.

    Article  Google Scholar 

  23. Kirsch C, Ender A, Attin T, Mehl A. Trueness of four different milling procedures used in dental CAD/CAM systems. Clin Oral Investig. 2017;21(2):551–8.

    Article  Google Scholar 

  24. Zhai Z, Sun J. Research on the low-temperature degradation of dental zirconia ceramics fabricated by stereolithography. J Prosthet Dent. 2021;130(4):629–8.

  25. Yang H, Xu YL, Hong G, Yu H. Effects of low-temperature degradation on the surface roughness of yttria-stabilized tetragonal zirconia polycrystal ceramics: a systematic review and meta-analysis. J Prosthet Dent. 2021;125(2):222–30.

    Article  Google Scholar 

  26. Pandoleon P, Bakopoulou A, Papadopoulou L, Koidis P. Evaluation of the biological behaviour of various dental implant abutment materials on attachment and viability of human gingival fibroblasts. Dent Mater. 2019;35(7):1053–63.

    Article  Google Scholar 

  27. Chevalier J, Deville S, Munch E, Jullian R, Lair F. Critical effect of cubic phase on aging in 3 mol% yttria-stabilized zirconia ceramics for hip replacement prosthesis. Biomaterials. 2004;25(24):5539–45.

    Article  Google Scholar 

  28. Wu HD, Liu W, Lin LF, Li L, Li YH, Tian Z, Zhao Z, Ji XR, Xie ZP, Wu SH. Preparation of alumina-toughened zirconia via 3D printing and liquid precursor infiltration: manipulation of the microstructure, the mechanical properties and the low temperature aging behavior. J Mater Sci. 2019;54(10):7447–59.

    Article  Google Scholar 

  29. Hao Y, Huang X, Zhou X, Li M, Ren B, Peng X, Cheng L. Influence of dental prosthesis and restorative materials interface on oral biofilms. Int J Mol Sci. 2018;19(10):3157.

    Article  Google Scholar 

  30. Zhang M, Zhang Z, Ding N, Zheng D. Effect of airborne-particle abrasion of presintered zirconia on surface roughness and bacterial adhesion. J Prosthet Dent. 2015;113(5):448–52.

    Article  Google Scholar 

  31. Xiang D, Xu YX, Bai W, Lin H. Dental zirconia fabricated by stereolithography: accuracy, translucency and mechanical properties in different build orientations. Ceram Int. 2021;47(20):28837–47.

    Article  Google Scholar 

  32. Osman RB, van der Veen AJ, Huiberts D, Wismeijer D, Alharbi N. 3D-printing zirconia implants; a dream or a reality? An in-vitro study evaluating the dimensional accuracy, surface topography and mechanical properties of printed zirconia implant and discs. J Mec Behav Biomed Mater. 2017;75:521–8.

    Article  Google Scholar 

  33. Branco AC, Silva R, Santos T, Jorge H, Rodrigues AR, Fernandes R, Bandarra S, Barahona I, Matos APA, Lorenz K, Polido M, Colaco R, Serro AP, Figueiredo-Pina CG. Suitability of 3D printed pieces of nanocrystalline zirconia for dental applications. Dent Mater. 2020;36(3):442–55.

    Article  Google Scholar 

  34. Harrer W, Schwentenwein M, Lube T, Danzer R. Fractography of zirconia-specimens made using additive manufacturing (LCM) technology. J Eur Ceram Soc. 2017;37(14):4331–8.

    Article  Google Scholar 

  35. Mei Z, Lu Y, Lou Y, Yu P, Sun M, Tan X, Zhang J, Yue L, Yu H. Determination of hardness and fracture toughness of Y-TZP manufactured by digital light processing through the indentation technique. BioMed Res Int. 2021;2021:6612840.

    Google Scholar 

  36. Revilla-León M, Al-Haj Husain N, Barmak AB, Pérez-López J, Raigrodski AJ, Özcan M. Chemical composition and flexural strength discrepancies between milled and lithography-based additively manufactured zirconia. J Prosthodont. 2022;31(9):778–83.

    Article  Google Scholar 

  37. Yu TY, Zhang ZY, Liu QY, Kuliiev R, Orlovskaya N, Wu DZ. Extrusion-based additive manufacturing of yttria-partially-stabilized zirconia ceramics. Ceram Int. 2020;46(4):5020–7.

    Article  Google Scholar 

  38. Nakai H, Inokoshi M, Nozaki K, Komatsu K, Kamijo S, Liu H, Shimizubata M, Minakuchi S, Van Meerbeek B, Vleugels J, Zhang F. Additively manufactured zirconia for dental applications. Materials. 2021;14(13):3694.

    Article  Google Scholar 

  39. Li J, Craeghs W, Jing C, Gong S, Shan F. Microstructure and physical performance of laser-induction nanocrystals modified high-entropy alloy composites on titanium alloy. Mater Design. 2017;117:363–70.

    Article  Google Scholar 

  40. Gatto ML, Groppo R, Furlani M, Giuliani A, Mangano C, Mangano F. Lithography-based Ceramic Manufacturing (LCM) versus Milled Zirconia Blocks under uniaxial compressive loading: an in vitro comparative study. J Dent. 2022;116:103886.

    Article  Google Scholar 

  41. Turon-Vinas M, Anglada M. Strength and fracture toughness of zirconia dental ceramics. Dent Mater. 2018;34(3):365–75.

    Article  Google Scholar 

  42. Marsico C, Øilo M, Kutsch J, Kauf M, Arola D. Vat polymerization-printed partially stabilized zirconia: mechanical properties, reliability and structural defects. Addit Manuf. 2020;36:101450.

    Google Scholar 

  43. Zhang F, Spies BC, Willems E, Inokoshi M, Wesemann C, Cokic SM, Hache B, Kohal RJ, Altmann B, Vleugels J, Van Meerbeek B, Rabel K. 3D printed zirconia dental implants with integrated directional surface pores combine mechanical strength with favorable osteoblast response. Acta Biomater. 2022;150:427–41.

    Article  Google Scholar 

  44. Branco AC, Silva R, Jorge H, Santos T, Lorenz K, Polido M, Colaço R, Serro AP, Figueiredo-Pina CG. Tribological performance of the pair human teeth vs 3D printed zirconia: an in vitro chewing simulation study. J Mech Behav Biomed. 2020;110:103900.

    Article  Google Scholar 

  45. Moon JM, Jeong CS, Lee HJ, Bae JM, Choi EJ, Kim ST, Park YB, Oh SH. A comparative study of additive and subtractive manufacturing techniques for a zirconia dental product: an analysis of the manufacturing accuracy and the bond strength of porcelain to zirconia. Materials. 2022;15(15):5398.

    Article  Google Scholar 

  46. Lu Y, Mei Z, Lou Y, Yue L, Chen X, Sun J, Wan Z, Yu H. Schwickerath adhesion tests of porcelain veneer and stereolithographic additive-manufactured zirconia. Ceram Int. 2020;46(10):16572–7.

    Article  Google Scholar 

  47. Braian M, Jimbo R, Wennerberg A. Production tolerance of additive manufactured polymeric objects for clinical applications. Dent Mater. 2016;32(7):853–61.

    Article  Google Scholar 

  48. Chopra D, Jayasree A, Guo T, Gulati K, Ivanovski S. Advancing dental implants: bioactive and therapeutic modifications of zirconia. Bioact Mater. 2022;13:161–78.

    Google Scholar 

  49. Camargo B, Willems E, Jacobs W, Van Landuyt K, Peumans M, Zhang F, Vleugels J, Van Meerbeek B. 3D printing and milling accuracy influence full-contour zirconia crown adaptation. Dent Mater. 2022;38(12):1963–76.

    Article  Google Scholar 

  50. Wang W, Yu H, Liu Y, Jiang X, Gao B. Trueness analysis of zirconia crowns fabricated with 3-dimensional printing. J Prosthet Dent. 2019;121(2):285–91.

    Article  Google Scholar 

  51. Abualsaud R, Alalawi H. Fit, precision, and trueness of 3D-printed zirconia crowns compared to milled counterparts. Dent J. 2022;10(11):215.

    Article  Google Scholar 

  52. Revilla-León M, Methani MM, Morton D, Zandinejad A. Internal and marginal discrepancies associated with stereolithography (SLA) additively manufactured zirconia crowns. J Prosthet Dent. 2020;124(6):730–7.

    Article  Google Scholar 

  53. Lerner H, Nagy K, Pranno N, Zarone F, Admakin O, Mangano F. Trueness and precision of 3D-printed versus milled monolithic zirconia crowns: an in vitro study. J Dent. 2021;113:103792.

    Article  Google Scholar 

  54. Li R, Wang Y, Hu M, Wang Y, Xv Y, Liu Y, Sun Y. Strength and adaptation of stereolithography-fabricated zirconia dental crowns: an in vitro study. Int J Prosthodont. 2019;32(5):439–43.

    Article  Google Scholar 

  55. Anssari Moin D, Hassan B, Wismeijer D. A novel approach for custom three-dimensional printing of a zirconia root analogue implant by digital light processing. Clin Oral Implants Res. 2017;28(6):668–70.

    Article  Google Scholar 

  56. Li H, Song L, Sun J, Ma J, Shen Z. Dental ceramic prostheses by stereolithography-based additive manufacturing: potentials and challenges. Adv Appl Ceram. 2019;118(1–2):30–6.

    Article  Google Scholar 

  57. Kim YK, Han JS, Yoon HI. Evaluation of intaglio surface trueness, wear, and fracture resistance of zirconia crown under simulated mastication: a comparative analysis between subtractive and additive manufacturing. J Adv Prosthodont. 2022;14(2):122–32.

    Article  Google Scholar 

  58. Lüchtenborg J, Willems E, Zhang F, Wesemann C, Weiss F, Nold J, Sun J, Sandra F, Bai J, Reveron H, Chevalier J, Spies BC. Accuracy of additively manufactured zirconia four-unit fixed dental prostheses fabricated by stereolithography, digital light processing and material jetting compared with subtractive manufacturing. Dent Mater. 2022;38(9):1459–69.

    Article  Google Scholar 

  59. Revilla-León M, Mostafavi D, Methani MM, Zandinejad A. Manufacturing accuracy and volumetric changes of stereolithography additively manufactured zirconia with different porosities. J Prosthet Dent. 2022;128(2):211–5.

    Article  Google Scholar 

  60. Zhang DW, Peng E, Borayek R, Ding J. Controllable ceramic green-body configuration for complex ceramic architectures with fine features. Adv Funct Mater. 2019;29(12):1807082.

    Article  Google Scholar 

  61. Hsu HJ, Lee SY, Chang SL, Lo CH, Lin YM. Shrinkage prediction using finite element analysis and experimental validation using three-dimension slurry printing system. Int J Adv Manuf Tech. 2017;91(1–4):1289–96.

    Article  Google Scholar 

  62. Chang CH, Lin CY, Chang CH, Liu FH, Huang YT, Liao YS. Enhanced biomedical applicability of ZrO2-SiO2 ceramic composites in 3D printed bone scaffolds. Sci Rep. 2022;12(1):6845.

    Article  Google Scholar 

  63. Wang Q, Ma Z, Wang Y, Zhong L, Xie W. Fabrication and characterization of 3D printed biocomposite scaffolds based on PCL and zirconia nanoparticles. Bio-Des Manuf. 2021;4(1):60–71.

    Article  Google Scholar 

  64. Sa MW, Nguyen BNB, Moriarty RA, Kamalitdinov T, Fisher JP, Kim JY. Fabrication and evaluation of 3D printed BCP scaffolds reinforced with ZrO2 for bone tissue applications. Biotechnol Bioeng. 2018;115(4):989–99.

    Article  Google Scholar 

  65. Zhang JC, Huang D, Liu SF, Dong XM, Li YH, Zhang HW, Yang ZJ, Su QS, Huang WH, Zheng WX, Zhou WY. Zirconia toughened hydroxyapatite biocomposite formed by a DLP 3D printing process for potential bone tissue engineering. Mat Sci Eng C Mater. 2019;105:110054.

    Article  Google Scholar 

  66. He ZJ, Jiao C, Zhang HX, Xie DQ, Ge MX, Yang YW, Wu GF, Liang HX, Shen LD, Wang CJ. Fabrication of a zirconia/calcium silicate composite scaffold based on digital light processing. Ceram Int. 2022;48(18):25923–32.

    Article  Google Scholar 

  67. Shadianlou F, Foorginejad A, Yaghoubinezhad Y. Fabrication of zirconia/reduced graphene oxide/hydroxyapatite scaffold by rapid prototyping method and its mechanical and biocompatibility properties. Ceram Int. 2022;48(5):7031–44.

    Article  Google Scholar 

  68. Sakthiabirami K, Kang J-H, Jang J-G, Soundharrajan V, Lim H-P, Yun K-D, Park C, Lee B-N, Yang YP, Park S-W. Hybrid porous zirconia scaffolds fabricated using additive manufacturing for bone tissue engineering applications. Mat Sci Eng C-Mater. 2021;123:111950.

    Article  Google Scholar 

  69. Zhang HX, Jiao C, He ZJ, Ge MX, Tian ZJ, Wang CJ, Wei Z, Shen LD, Liang HX. Fabrication and properties of 3D printed zirconia scaffold coated with calcium silicate/hydroxyapatite. Ceram Int. 2021;47(19):27032–41.

    Article  Google Scholar 

  70. Zhu Y, Liu K, Deng J, Ye J, Ai F, Ouyang H, Wu T, Jia J, Cheng X, Wang X. 3D printed zirconia ceramic hip joint with precise structure and broad-spectrum antibacterial properties. Int J Nanomedicine. 2019;14:5977–87.

    Article  Google Scholar 

  71. Petre A, Balta C, Herman H, Gharbia S, Codreanu A, Onita-Mladin B, Anghel-Zurbau N, Hermenean AG, Ignat SR, Dinescu S, Urzica I, Drafta S, Oancea L, Hermenean A. A novel experimental approach to evaluate guided bone regeneration (GBR) in the rat femur using a 3D-printed CAD/CAM zirconia space-maintaining barrier. J Adv Res. 2021;28:221–9.

    Article  Google Scholar 

  72. Ramirez-San Juan GR, Oakes PW, Gardel ML. Contact guidance requires spatial control of leading-edge protrusion. Mol Biol Cell. 2017;28(8):1043–53.

    Article  Google Scholar 

  73. He W, Wei D, Zhang J, Huang X, He D, Liu B, Wang Q, Liu M, Liu L, Liu Y, Tian W. Novel bone repairing scaffold consisting of bone morphogenetic Protein-2 and human Beta Defensin-3. J Biol Eng. 2021;15(1):5.

    Article  Google Scholar 

  74. Ioannidis A, Bomze D, Hammerle CHF, Husler J, Birrer O, Muhlemanna S. Load-bearing capacity of CAD/CAM 3D-printed zirconia, CAD/CAM milled zirconia, and heat-pressed lithium disilicate ultra-thin occlusal veneers on molars. Dent Mater. 2020;36(4):E109–16.

    Article  Google Scholar 

  75. Ioannidis A, Park JM, Hüsler J, Bomze D, Mühlemann S, Özcan M. An in vitro comparison of the marginal and internal adaptation of ultrathin occlusal veneers made of 3D-printed zirconia, milled zirconia, and heat-pressed lithium disilicate. J Prosthet Dent. 2022;128(4):709–15.

    Article  Google Scholar 

  76. Abduo J, Ho G, Centorame A, Chohan S, Park C, Abdouni R, Le P. Marginal accuracy of monolithic and veneered zirconia crowns fabricated by conventional and digital workflows. J Prosthodont. 2023;32:706–13.

  77. Bennett C, Sojithamporn P, Thanakulwattana W, Wattanutchariya W, Leksakul K, Nakkiew W, Jantanasakulwong K, Rachtanapun P, Suhr J, Sawangrat C. Optimization of 3D printing technology for fabrication of dental crown prototype using plastic powder and zirconia materials. Materials. 2022;15(23):8618.

    Article  Google Scholar 

  78. Roehling S, Astasov-Frauenhoffer M, Hauser-Gerspach I, Braissant O, Woelfler H, Waltimo T, Kniha H, Gahlert M. In vitro biofilm formation on titanium and zirconia implant surfaces. J Periodontol. 2017;88(3):298–307.

    Article  Google Scholar 

  79. Mihatovic I, Golubovic V, Becker J, Schwarz F. Bone tissue response to experimental zirconia implants. Clin Oral Investig. 2017;21(2):523–32.

    Article  Google Scholar 

  80. Westover B. Three-dimensional custom-root replicate tooth dental implants. Oral Maxillofac Surg Clin North Am. 2019;31(3):489–96.

    Article  Google Scholar 

  81. Tan X, Zhao Y, Lu Y, Yu P, Mei Z, Yu H. Physical and biological implications of accelerated aging on stereolithographic additive-manufactured zirconia for dental implant abutment. J Prosthodont Res. 2022;66(4):600–9.

    Article  Google Scholar 

  82. Moura CG, Faria D, Carvalho O, Pereira RSF, Cerqueira MF, Nascimento RM, Silva FS. Laser printing of silver-based micro-wires in ZrO2 substrate for smart implant applications. Opt Laser Technol. 2020;131:106416.

    Article  Google Scholar 

  83. Roccia F, Iocca O, Sobrero F, Rae E, Laverick S, Carlaw K, Aquilina P, Bojino A, Romeo I, Duran-Valles F, Bescos C, Segura-Palleres I, Ramieri G, Ganasouli D, Zanakis SN, Gorla LFD, Pereira VA, Goetzinger M, Bottini GB, Gallafassi D, Faverani LP, Alalawy H, Kamel M, Samieirad S, Jaisani MR, Rahman SA, Rahman T, Aladelusi T, Hassanein AG. World Oral and Maxillofacial Trauma (WORMAT) project: a multicenter prospective analysis of epidemiology and patterns of maxillofacial trauma around the world. J Stomatol Oral Maxillofac Surg. 2022;123(6):E849–57.

    Article  Google Scholar 

  84. Chia HN, Wu BM. Recent advances in 3D printing of biomaterials. J Biol Eng. 2015;9:4.

    Article  Google Scholar 

  85. Shen MH, Qin W, Xing BH, Zhao WM, Gao SY, Sun Y, Jiao T, Zhao Z. Mechanical properties of 3D printed ceramic cellular materials with triply periodic minimal surface architectures. J Eur Ceram Soc. 2021;41(2):1481–9.

    Article  Google Scholar 

  86. Gaddam A, Brazete DS, Neto AS, Nan B, Fernandes HR, Ferreira JMF. Robocasting and surface functionalization with highly bioactive glass of ZrO2 scaffolds for load bearing applications. J Am Ceram Soc. 2022;105(3):1753–64.

    Article  Google Scholar 

  87. Abbasi N, Hamlet S, Love RM, Nguyen NT. Porous scaffolds for bone regeneration. J Sci-Adv Mater Dev. 2020;5(1):1–9.

    Google Scholar 

  88. Rodriguez-Salvador M, Ruiz-Cantu L. Revealing emerging science and technology research for dentistry applications of 3D bioprinting. Int J Bioprint. 2019;5(1):170.

    Article  Google Scholar 

  89. Shadianlou F, Foorginejad A, Yaghoubinezhad Y. Hydrothermal synthesis of zirconia-based nanocomposite powder reinforced by graphene and its application for bone scaffold with 3D printing. Adv Powder Technol. 2022;33(2):103406.

    Article  Google Scholar 

  90. Goyos-Ball L, Garcia-Tunon E, Fernandez-Garcia E, Diaz R, Fernandez A, Prado C, Saiz E, Torrecillas R. Mechanical and biological evaluation of 3D printed 10CeTZP-Al2O3 structures. J Eur Ceram Soc. 2017;37(9):3151–8.

    Article  Google Scholar 

  91. Abdullah AM, Rahim T, Hamad W, Mohamad D, Akil HM, Rajion ZA. Mechanical and cytotoxicity properties of hybrid ceramics filled polyamide 12 filament feedstock for craniofacial bone reconstruction via fused deposition modelling. Dent Mater. 2018;34(11):e309–16.

    Article  Google Scholar 

  92. Deng F, Liu L, Li Z, Liu J. 3D printed Ti6Al4V bone scaffolds with different pore structure effects on bone ingrowth. J Biol Eng. 2021;15(1):4.

    Article  Google Scholar 

  93. LaBarge W, Morales A, Pretorius D, Kahn-Krell AM, Kannappan R, Zhang J. Scaffold-free bioprinter utilizing layer-by-layer printing of cellular spheroids. Micromachines. 2019;10(9):570.

    Article  Google Scholar 

  94. Hingsammer L, Grillenberger M, Schagerl M, Malek M, Hunger S. Biomechanical testing of zirconium dioxide osteosynthesis system for Le Fort I advancement osteotomy fixation. J Mech Behav Biomed. 2018;77:34–9.

    Article  Google Scholar 

  95. Lian Q, Sui WQ, Wu XQ, Yang F, Yang SP. Additive manufacturing of ZrO2 ceramic dental bridges by stereolithography. Rapid Prototyp J. 2018;24(1):114–9.

    Article  Google Scholar 

  96. Sun JX, Binner J, Bai JM. Effect of surface treatment on the dispersion of nano zirconia particles in non-aqueous suspensions for stereolithography. J Eur Ceram Soc. 2019;39(4):1660–7.

    Article  Google Scholar 

  97. He RX, Liu W, Wu ZW, An D, Huang MP, Wu HD, Jiang QG, Ji XR, Wu SH, Xie ZP. Fabrication of complex-shaped zirconia ceramic parts via a DLP-stereolithography-based 3D printing method. Ceram Int. 2018;44(3):3412–6.

    Article  Google Scholar 

  98. Yan S, Huang Y, Zhao D, Niu F, Ma G, Wu D. 3D printing of nano-scale Al2O3-ZrO2 eutectic ceramic: principle analysis and process optimization of pores. Addit Manuf. 2019;28:120–6.

    Google Scholar 

  99. An D, Liu W, Xie ZP, Li HZ, Luo XD, Wu HD, Huang MP, Liang JW, Tian Z, He RX. A strategy for defects healing in 3D printed ceramic compact via cold isostatic pressing: sintering kinetic window and microstructure evolution. J Eur Ceram Soc. 2019;102(5):2263–71.

    Article  Google Scholar 

  100. Jang KJ, Kang JH, Fisher JG, Park SW. Effect of the volume fraction of zirconia suspensions on the microstructure and physical properties of products produced by additive manufacturing. Dent Mater. 2019;35(5):e97–106.

    Article  Google Scholar 

  101. Song X, Chen Y, Lee TW, Wu SH, Cheng LX. Ceramic fabrication using Mask-Image-Projection-based Stereolithography integrated with tape-casting. J Manuf Process. 2015;20:456–64.

    Article  Google Scholar 

  102. Kim J, Choi Y-J, Gal CW, Park H, Yoon S-Y, Yun H-S. Effect of dispersants on structural integrity of 3D printed ceramics. Int J Appl Ceram Technol. 2022;19(2):968–78.

    Article  Google Scholar 

  103. Kim I, Kim S, Andreu A, Kim J-H, Yoon Y-J. Influence of dispersant concentration toward enhancing printing precision and surface quality of vat photopolymerization 3D printed ceramics. Addit Manuf. 2022;52:102659.

    Google Scholar 

  104. Kriegseis S, Aretz L, Jennes M-E, Schmidt F, Tonnesen T, Schickle K. 3D printing of complex ceramic dental implant abutments by using Direct Inkjet Printing. Mater Lett. 2022;313:131789.

    Article  Google Scholar 

  105. Sun J, Binner J, Bai J. 3D printing of zirconia via digital light processing: optimization of slurry and debinding process. J Eur Ceram Soc. 2020;40(15):5837–44.

    Article  Google Scholar 

  106. de Camargo IL, Erbereli R, Taylor H, Fortulan CA. 3Y-TZP DLP additive manufacturing: solvent-free slurry development and characterization. Mater Res-Ibero-Am J. 2021;24(2).

  107. Wu Z, Liu W, Wu H, Huang R, He R, Jiang Q, Chen Y, Ji X, Tian Z, Wu S. Research into the mechanical properties, sintering mechanism and microstructure evolution of Al2O3-ZrO2 composites fabricated by a stereolithography-based 3D printing method. Mater Chem Phys. 2018;207:1–10.

    Article  Google Scholar 

  108. Zandinejad A, Methani MM, Schneiderman ED, Revilla-León M, Bds DM. Fracture resistance of additively manufactured zirconia crowns when cemented to implant supported zirconia abutments: an in vitro study. J Prosthodont. 2019;28(8):893–7.

    Article  Google Scholar 

  109. Kohorst P, Borchers L, Strempel J, Stiesch M, Hassel T, Bach FW, Hübsch C. Low-temperature degradation of different zirconia ceramics for dental applications. Acta Biomater. 2012;8(3):1213–20.

    Article  Google Scholar 

  110. Zheng T, Wang W, Sun J, Liu J, Bai J. Development and evaluation of Al2O3-ZrO2 composite processed by digital light 3D printing. Ceram Int. 2020;46(7):8682–8.

    Article  Google Scholar 

  111. Nakonieczny DS, Antonowicz M, SimhaMartynkova G, Kern F, Pazourkova L, Erfurt K, Hupsch M. PA-12-zirconia-alumina-cenospheres 3D printed composites: accelerated ageing and role of the sterilisation process for physicochemical properties. Polymers. 2022;14(15):3152.

    Article  Google Scholar 

  112. Hodasova LU, Sans J, Molina BG, Aleman C, Llanes L, Fargas G, Armelin E. Polymer infiltrated ceramic networks with biocompatible adhesive and 3D-printed highly porous scaffolds. Addit Manuf. 2021;39:101850.

    Google Scholar 

  113. Niu FR, Yang XL, Li YB, Guo JY, Peng L, Xie ZP, Yang XF. Fused deposition modeling of Si3N4 ceramics: a cost-effective 3D-printing route for dense and high performance non-oxide ceramic materials. J Eur Ceram Soc. 2022;42(15):7369–76.

    Article  Google Scholar 

  114. Huang S-J, Ye C-S, Zhao H-P, Fan Z-T. Parameters optimization of binder jetting process using modified silicate as a binder. Mater Manuf Process. 2020;35(2):214–20.

    Article  Google Scholar 

  115. Sun J, Yu S, Wade Zhu J, Chen X, Binnner J, Bai J. 3D printing of layered ceramic/carbon fiber composite with improved toughness. Addit Manuf. 2022;50:102543.

    Google Scholar 

  116. Desponds A, Banyasz A, Chateau D, Tellal A, Venier A, Meille S, Montagnac G, Chevalier J, Andraud C, Baldeck PL, Parola S. 3D printing and pyrolysis of optical ZrO2 nanostructures by two-photon lithography: reduced shrinkage and crystallization mediated by nanoparticles seeds. Small. 2021;17(42):e2102486.

    Article  Google Scholar 

  117. Su C-Y, Wang J-C, Chen D-S, Chuang C-C, Lin C-K. Additive manufacturing of dental prosthesis using pristine and recycled zirconia solvent-based slurry stereolithography. Ceram Int. 2020;46(18):28701–9.

    Article  Google Scholar 

  118. Miura S, Shinya A, Ishida Y, Fujisawa M. Mechanical and surface properties of additive manufactured zirconia under the different building directions. J Prosthodont Res. 2022;67(3):410–17.

  119. Hada T, Kanazawa M, Miyamoto N, Liu H, Iwaki M, Komagamine Y, Minakuchi S. Effect of different filler contents and printing directions on the mechanical properties for photopolymer resins. Int J Mol Sci. 2022;23(4):2296.

    Article  Google Scholar 

  120. Conti L, Bienenstein D, Borlaf M, Graule T. Effects of the layer height and exposure energy on the lateral resolution of zirconia parts printed by lithography-based additive manufacturing. Materials. 2020;13(6):1317.

    Article  Google Scholar 

  121. Stansbury JW, Idacavage MJ. 3D printing with polymers: challenges among expanding options and opportunities. Dent Mater. 2016;32(1):54–64.

    Article  Google Scholar 

  122. Zhang J, Zhou J, Cai J, Duan G. 3D printing of zirconia ceramic slurry: effect of overlapping rate on surface finish and mechanical properties. J Ceram Sci Technol. 2021;12(2).

  123. Buj-Corral I, Vidal D, Tejo-Otero A, Padilla JA, Xuriguera E, Fenollosa-Artes F. Characterization of 3D printed yttria-stabilized zirconia parts for use in prostheses. Nanomaterials. 2021;11(11):2942.

    Article  Google Scholar 

  124. Baltazar J, Alves M, Martins MA, Torres PMC, Santos C, Olhero S. Flexural strength of 3Y-TZP bioceramics obtained by direct write assembly as function of residual connected-porosity. J Mech Behav Biomed Mater. 2022;126:105035.

    Article  Google Scholar 

  125. Scheithauer U, Johne R, Weingarten S, Schwarzer E, Richter HJ, Moritz T, Michaelis A. Investigation of droplet deposition for suspensions usable for thermoplastic 3D printing (T3DP). J Mater Eng Perform. 2018;27(1):44–51.

    Article  Google Scholar 

  126. Li W, Liu M, Liu W, Zhou H, Li M, Chen Y, Xing Z. High-performance integrated manufacturing of a 3Y-TZP ceramic crown through viscoelastic paste-based vat photopolymerization with a conformal contactless support. Addit Manuf. 2022;59:103143.

    Google Scholar 

  127. Cheng YC, Lin DH, Jiang CP, Lin YM. Dental implant customization using numerical optimization design and 3-dimensional printing fabrication of zirconia ceramic. Int J Numer Methods Biomed Eng. 2017;33(5):e2820.

    Article  Google Scholar 

  128. Ahlhelm M, Guenther P, Scheithauer U, Schwarzer E, Guenther A, Slawik T, Moritz T, Michaelis A. Innovative and novel manufacturing methods of ceramics and metal-ceramic composites for biomedical applications. J Eur Ceram Soc. 2016;36(12):2883–8.

    Article  Google Scholar 

  129. Alshaikh AA, Khattar A, Almindil IA, Alsaif MH, Akhtar S, Khan SQ, Gad MM. 3D-printed nanocomposite denture-base resins: effect of ZrO2 nanoparticles on the mechanical and surface properties in vitro. Nanomaterials. 2022;12(14):2451.

    Article  Google Scholar 

  130. Hadian A, Fricke M, Liersch A, Clemens F. Material extrusion additive manufacturing of zirconia parts using powder injection molding feedstock compositions. Addit Manuf. 2022;57:102966.

    Google Scholar 

  131. Didilis K, Marani D, Bihlet UD, Haugen AB, Esposito V. Freeform injection molding of functional ceramics by hybrid additive manufacturing. Addit Manuf. 2022;60:103197.

    Google Scholar 

  132. Li HZ, Song L, Sun JL, Ma J, Shen ZJ. Asynchronous densification of zirconia ceramics formed by stereolithographic additive manufacturing. J Eur Ceram Soc. 2021;41(8):4666–70.

    Article  Google Scholar 

  133. Too TDC, Inokoshi M, Nozaki K, Shimizubata M, Nakai H, Liu H, Minakuchi S. Influence of sintering conditions on translucency, biaxial flexural strength, microstructure, and low-temperature degradation of highly translucent dental zirconia. Dent Mater J. 2021;40(6):1320–8.

    Article  Google Scholar 

  134. Lee JM, Sing SL, Yeong WY. Bioprinting of multimaterials with computer-aided design/computer-aided manufacturing. Int J Bioprint. 2020;6(1):245.

    Article  Google Scholar 

  135. Paolo S, Paolo S, Serena L, Gabriele C, Mario G. The digital integrated workflow in the aesthetic management of the smile: a case report. Prosthesis. 2020;2:196–210.

    Article  Google Scholar 

  136. Weingarten S, Scheithauer U, Johne R, Abel J, Schwarzer E, Moritz T, Michaelis A. Multi-material ceramic-based components - additive manufacturing of black-and-white zirconia components by thermoplastic 3D-printing (CerAM - T3DP). Jove-J Vis Exp. 2019(143).

  137. Guo WW, Jiang ZL, Zhong HH, Chen GP, Li XD, Yan HR, Zhang C, Zhao L. 3D printing of multifunctional gradient bone scaffolds with programmable component distribution and hierarchical pore structure. Compos Part A Appl Sci Manuf. 2023;166:107361.

    Article  Google Scholar 

  138. Choi AH, Matinlinna JP, Ben-Nissan B. Finite element stress analysis of Ti-6Al-4V and partially stabilized zirconia dental implant during clenching. Acta Odontol Scand. 2012;70(5):353–61.

    Article  Google Scholar 

  139. Pessanha-Andrade M, Sordi MB, Henriques B, Silva FS, Teughels W, Souza JCM. Custom-made root-analogue zirconia implants: a scoping review on mechanical and biological benefits. J Biomed Mater Res B Appl Biomater. 2018;106(8):2888–900.

    Article  Google Scholar 

  140. Kolakarnprasert N, Kaizer MR, Kim DK, Zhang Y. New multi-layered zirconias: composition, microstructure and translucency. Dent Mater. 2019;35(5):797–806.

    Article  Google Scholar 

  141. Al Hamad KQ, Al-Rashdan BA, Ayyad JQ, Al Omrani LM, Sharoh AM, Al Nimri AM, Al-Kaff FT. Additive manufacturing of dental ceramics: a systematic review and meta-analysis. J Prosthodont. 2022;31(8):e67–86.

    Article  Google Scholar 

  142. Chang J, Zou B, Wang X, Yu Y, Chen Q, Zhang G. Preparation, characterization and coloring mechanism of 3D printed colorful ZrO2 ceramics parts. Mater Today Commun. 2022;33:104935.

    Article  Google Scholar 

Download references


Not applicable.


This work was financially supported by the National Key R&D Program of China (2020YFA0710404), Applied Basic Research Program of Liaoning Province (2023JH2/101300035), and the Liaoning Medical-Engineering Joint Fund under grant number 2022-YGJC-01.

Author information

Authors and Affiliations



Qiang Wang designed the study. Guanyu Su drafted the manuscript. Yushi Zhang, Chunyu Jin, Qiyue Zhang, and Jiarui Lu prepared figures and tables. Qiang Wang and Zengqian Liu revised the manuscript. Xue Zhang and Jia Ma check the manuscript. All authors reviewed the manuscript. The authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Xue Zhang or Jia Ma.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

All authors have agreed to publish this manuscript. All materials and images are original except for Figs. 2 and 3 which have permissions. No consent needs to declare.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Su, G., Zhang, Y., Jin, C. et al. 3D printed zirconia used as dental materials: a critical review. J Biol Eng 17, 78 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: