3D-printed hybrid composite restoration

Dr Francesco Mangano

Thu. 29. January 2026

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In recent years, 3D-printed polymer-infiltrated ceramic resins, also defined as hybrid composites, have emerged as a promising option for definitive dental restorations. These innovative materials combine the advantages of resin composites and ceramic fillers, offering improved strength, aesthetics and biocompatibility compared with traditional provisional resins.^1–4 Unlike conventional composites, hybrid formulations are specifically designed for long-term use. They exhibit superior wear resistance and optical integration. This makes them highly suitable for daily prosthodontic applications.^1–4 Moreover, hybrid composites offer better stress absorption, intra-oral reparability, ease of polishing and reduced wear of the opposing teeth than zirconia and lithium disilicate.^1–4

To date, most studies on these 3D-printed hybrid composites have been in vitro analyses. These analyses have shown that restorations printed with these materials have high marginal accuracy, comparable to that of milled restorations. However, they also have lower mechanical properties than restorations fabricated by conventional milling.^5–10 The only available in vivo clinical studies have shown differing results, depending on the material used.^11–13

In a prospective study with a follow-up period of up to three years, Hobbi et al. evaluated the clinical performance of 3D-printed resin composite fixed dental prostheses for posterior restorations.¹¹ In that study, 49 patients were treated with 68 three-unit 3D-printed resin composite posterior fixed bridges (els even stronger, SAREMCO Dental) which were then evaluated for a mean observation period of 22 months.¹¹ At the final recall, only 24 of the 64 restorations remained in clinical service without complications. This indicates limited long-term success owing to a high incidence of fractures, mainly in the connector regions.¹¹ The authors concluded that 3D-printed resin composite fixed dental prostheses offer certain advantages, but should be considered as long-term provisional restorations, because of the high incidence of mechanical failures within three years.¹¹

In contrast, another retrospective analysis examined 145 patients who received 185 short-span implant-supported fixed hybrid composite restorations (Irix Max, DWS Systems) which were fabricated using tilted stereolithography (TSLA). This study reported far more favourable outcomes.¹³ In this analysis, all the restorations were manufactured using a fully digital, model-free workflow that combined intra-oral scanning, CAD and TSLA printing with the novel Dfab printer (DWS Systems). Of the restorations, 95 had a 24-month follow-up and 90 had a 12-month follow-up.¹³ Marginal adaptation and occlusal and interproximal contacts were consistently excellent, aesthetics were satisfactory and every restoration remained functional. Complications were uncommon (3.7% prosthetic complications), and no fractures were reported. This yielded an overall success rate of 95.1%.¹³ The authors concluded that TSLA-fabricated short-span implant-supported hybrid composite restorations can provide high clinical accuracy and have a low complication rate over two years.¹³

This article presents a simple case of single-implant prosthetic rehabilitation in the posterior mandible. The rehabilitation was carried out through a fully digital workflow that included intra-oral scanning, designing a custom abutment and definitive restoration with CAD software, and fabricating and delivering a definitive 3D-printed hybrid composite restoration (Irix Max; Figs. 1a-f). This case study illustrates how Irix Max 3D-printed hybrid composite restorations can be successfully integrated into a complete digital workflow for implant prosthodontics.

Figs. 1a–f: Overview of the digital workflow for fabrication of a 3D-printed hybrid composite restoration. Intra-oral scan with iTero Lumina (Align Technology; a). CAD modelling with DentalCAD (exocad), producing an STL file of the design for the definitive restoration (b & c). High-precision 3D printing of the restoration with Dfab using Irix Max (d & e), followed by post-polymerisation, polishing and delivery of the restoration to the patient (f).

Case presentation

The process begins with an intra-oral scan performed with the iTero Lumina scanner (Align Technology; Figs. 2a-c & 3a-c). The innovative iTero Multi-Direct Capture technology offers a threefold larger field of view and maximum capture distance of 25 mm, designed to scan twice as fast and simplify the capture of challenging anatomy encountered in denture, edentulous and other complex cases. This step eliminates the need for conventional impressions, improving accuracy and patient comfort. The accuracy of the intra-oral scanner is essential to the efficiency of the digital chairside prosthetic workflow. High-precision intra-oral scans minimise the need for adjustments and remakes as well as streamline the design and fabrication process. This shortens clinical and laboratory time and improves the reliability of same-day restorative procedures. A recent study showed that this scanner ensures high scanning accuracy and enables immediate integration with the laboratory by transmitting the scan directly via a cloud-based system.¹⁴

Fig. 2a–c: The intra-oral scanning with iTero Lumina scanner (a) begins with the antagonist quadrant (b) and then with the master model (c) after removal of the healing abutment, followed by the occlusal registration. In this case, the scan was captured immediately after implant placement, while the sutures were still in position.

Fig. 3a–c: Intra-oral scanning with iTero Lumina scanner (a) proceeded with the capture of the implant’s spatial position on the master model after the implant scan body had been screwed in: occlusal (b) and buccal (c) view.

The data is then transferred to DentalCAD 3.2 Elefsina software (exocad) for the CAD of the restoration. This software enables the dental technician to design individual abutments and definitive crowns with functional occlusal surfaces, excellent interproximal contact points and optimal emergence profiles (Figs. 4–6).

Figs. 4a & b: CAD modelling in DentalCAD of the definitive restoration and of the custom abutment, which was to be milled from titanium, to support the restoration (a & b).

Figs. 5a & b: CAD modelling in DentalCAD of the definitive restoration. Photorealistic rendering (a). Aligned master and antagonist models (b).

Fig. 6: STL file of the CAD of the definitive restoration.

Once the design has been finalised, the restoration is fabricated using Dfab (Figs. 7–9). This advanced additive manufacturing technology enables the fabrication of hybrid composite restorations with high accuracy—in less than 20 minutes. The Irix Max resin cartridge provides the hybrid composite material used to fabricate restorations with both high mechanical durability and natural aesthetics. Thanks to the Photoshade system, the material is available in multiple shades, ensuring seamless aesthetic blending. The Photoshade system allows for the customisation of aesthetic parameters, such as shade layering, which is essential for natural integration with adjacent teeth.

Figs. 7a–d: Steps in 3D printing of the definitive restoration with the Dfab printer. The operator opens the Dfab door, secures the grey disposable printing plate, supplied with the cartridge, on to its black carrier (printing block; a) and inserts the assembly into the corresponding upper slot of the printer (b). The operator then inserts the Irix Max cartridge (c) and locks it into the corresponding lower slot (d). The operator can then close the printer.

Figs. 8a–e: The operator connects the Dfab printer (a) to the laptop via USB and launches the Nauta Photoshade software, into which he or she imports the STL file of the CAD for the crown (b & c). The software automatically positions the crown and generates the supports and build base (d). The operator only needs to configure the different colour layers (e) within the software to achieve ideal aesthetics and chromatic adaptation in the patient’s mouth.

Figs. 9a–d: In just 15 minutes, the Irix Max crown is printed (a). Before removing the crown from the printing plate and detaching the supports (b), the operator rinses the restoration in ethanol for a few minutes using a dedicated tool (c). After removing the liquid resin, the operator detaches the restoration (d) and places it in the polymerisation unit.

After printing and washing, the restoration is light-polymerised in the Dcure unit (DWS Systems) to ensure complete polymerisation and optimal physical properties. The OptraGloss polishing system (Ivoclar) is then used for polishing and finishing to enhance surface smoothness and gloss (Figs. 10a-d). These steps are essential for achieving long-term colour stability, resistance to plaque accumulation and comfortable occlusal contact for the patient.

Final delivery involves adhesive cementation with Variolink Esthetic resin cement (Ivoclar), which provides secure bonding to the abutment and long-term stability under functional load. Using modern adhesive cements contributes to the retention and marginal seal of the restoration (Figs. 11a-f). For screw-retained restorations, a direct chairside approach is possible. At the six-month follow-up, the 3D-printed Irix Max hybrid composite crown exhibited favourable aesthetics, stable occlusion and harmonious gingival integration, demonstrating the material’s clinical reliability (Figs. 12a & b).

Figs. 10a–d: Polymerisation is completed in a few minutes inside the Dcure polymerisation unit (a–c). At this point, the operator polishes the restoration with the OptraGloss system (d), and the crown can undergo further characterisation. While this final step is useful for optimising the aesthetic outcome, it is optional, since the printer already produces a restoration with a natural colour gradient.

Figs. 11a–f: Delivery of the definitive 3D-printed hybrid composite restoration, cemented on to the individual titanium hybrid abutment. Intra-oral scans illustrating the prepared site, neighbouring dentition and emergence profile (a–c). Buccal view of the titanium hybrid abutment in situ (d). Buccal view of the definitive 3D-printed restoration after cementation (e). Variolink Esthetic DC resin cement used for luting (f).

Figs. 12a & b: Six-month follow-up of the 3D-printed hybrid composite restoration, showing the restoration’s aesthetic integration and healthy, stable tissue, occlusal view (a) and buccal view (b).

In conclusion, hybrid composites like Irix Max are a significant advancement in restorative dentistry. When combined with a complete digital workflow—scan, plan, print and deliver—they enable the efficient, precise and aesthetic production of implant-supported restorations. This synergy between materials science and digital technology is redefining contemporary prosthodontic practice. The accuracy of both the intra-oral scanner and the 3D printer is essential for achieving predictable clinical outcomes, and the integration of chairside workflows enhances cost- and time-efficiency, ultimately enabling clinicians to deliver durable, minimally invasive and aesthetic restorations in a streamlined manner.

Editorial note:

This article was published in CAD/CAM—international magazine of dental laoboratories vol. 16, issue 2/2025. The list of references can be found here.