3D Printing Cuts its Teeth

- An in-depth look at additive manufacturing's effect on the dental industry in 2016

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It’s an accepted notion that nobody enjoys going to the dentist, even when you leave with that fresh, just cleaned, Colgate smile, it’s overshadowed by the perception of the dreaded dentist chair and all of the scary, shiny tools that come with it. While there may be no magic solution to cure a fear of the dentist, dental professionals are changing things up to take the pain out of other parts of the practice with the adoption of technologies that improve the experience for doctor and patient.

To manufacture a common appliance like a retainer, for years dentists have been using the tried and tested method of pressing a green paste onto a patient’s teeth which is then left to set for an uncomfortable amount of time to create an accurate mould that can be used to manufacture a patient-specific retainer. For anyone who has experienced the joy of braces, you will know this is not a tidy process, it’s unpleasant and messy but remains the most common way to create a dental impression. The good news is that intra-oral scanning and 3D printed moulds are taking the “goo” out of the process and replacing it with a clean digital method that implements both 3D scanning and 3D printing. As is the case with any new process in a traditional sector, adoption hasn’t happened over night but as accessibility and materials continue to improve, the uptake is ascending rapidly.

Currently 3D printers are more commonly found in larger dental labs rather than day-to-day dental practices but for a growing number of smaller businesses, particularly across the U.S., digital workflows are providing a competitive edge and a certain wow factor – for dentists, the buzz around 3D printing is definitely a positive, almost trendy coup that is attracting more patients to their businesses. The introduction of compact and affordable machines means that “mom and pop” style labs are able to bring advanced technologies in house that offer their patients faster and more efficient services allowing dentists to make their own appliance on site, such as patient-specific surgical guides or retainers.

“My vision for 3D printing within dentistry is to make our every day tasks simpler, potentially faster and equally more and more accurate so temporaries, surgical guides, bite guards, potentially even being able to print aligners for moving teeth,” Dr. Michael Scherer (DMD, MS, FACP), a practicing prosthodontics and dental implant surgeon in California told TCT. “If you were to ask me two or three years ago who was leading the dental market I would tell you it’s the dental laboratories but that's shifted. 3D printing is important in my every day workflow, I can’t do what I do now without my printer, it’s almost become dependent on everything but what I didn't realise at the time was that my patients and potential patients love the fact that I use 3D printing. They say “wow this dentist is really with it” who really wants to go to their dentist that still looks like their office is out of medieval times?”.

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Though we’re just starting to hear more about 3D printing being used in daily dentistry, 3D technologies are no novelty to the dental lab. For years dental professionals have been using intra-oral 3D scanners, a wand-like optical imaging tool that goes into a patient’s mouth to collect accurate oral data. Adoption of these devices is now growing so quickly that a recent study by 3Shape revealed that 39% of all practices are considering buying a digital impression system within the next three years.

On the fabrication side, 3D printing isn’t the only digital method of manufacture that dentists have at their disposal. Milling techniques have been in use for the last three decades whereby appliances such as crowns are cut away from a block of porcelain but like many 3D printers, these machines have been typically very expensive to purchase, pricing out smaller dental labs and practices. In the case of 3D printing, Formlabs’ dental expert, Gideon Balloch says adoption is currently much higher in dental labs than in dental practices due to the substantial investment a high-quality machine requires but with machine prices lowering, that investment is becoming a no-brainer.

“There is actually a lot of adoption of 3D technologies by dental labs whether that's by CNC milling, dental treatment software or 3D printing,” Gideon commented. “So it is having a day to day impact, some clinics might not know that 3D technology was used to make their stuff but now what we're seeing is the software itself is getting less expensive, companies like Formlabs are dropping the price of equipment whilst increasing quality to the point where not only is there adoption in dental labs but we're actually starting to see adoption in dental clinics which is really exciting.”

Take for example Dr. Scherer, after outsourcing all of his printing requirements to larger dental labs when starting out, he decided he wanted to bring it in house and set out to find a technology that would fit into his office without breaking the bank. He came across a Kickstarter campaign for the then little known startup Formlabs and its Form 1 3D printer, a compact desktop stereolithography system that would offer high level resolution for a fraction of the cost of comparative machines. It was a total experiment but one that has paid off both in Dr. Scherer’s practice and in the wider industry as this unexpected interest from early dental adopters caused Formlabs to take a closer look at this niche user base.

“Before January this year we hadn’t really taken a look at the dental industry, we hadn’t put a single tooth on the website and yet somehow we had hundreds of dental professionals buying Form 1s and doing some really amazing things.” Gideon commented. “Since we've launched it’s grown significantly and that's super exciting but I think we can be more than that over the next 12 months.”

Material Developments

3D printing has numerous applications in the dental space both directly and indirectly and one of the biggest benefits is in surgical planning. Dr. Scherer has been using 3D printing to create surgical guides, something he has been teaching to students at the University of Nevada School of Dental Medicine and in a series of workshops for dental professionals looking to take the digital plunge.

Earlier this year Formlabs released its first resin developed solely for 3D printing surgical guides. Developed with materials manufacturer Vertex Dental, Dental SG is its first biocompatible resin, a Class 1 material that allows dentists to directly print guides that can be put into the patient’s mouth to improve outcomes and make implant surgery faster and more precise.

“Dental SG for us is a couple of different things,” Gideon added. “It’s not just about the dental industry it’s more of a message that we're going into the dental industry and it's our first product that specialises in a specific dental application.”

This year EnvisionTEC also expanded its dental material selection with two new products, E-Guard for bite guards and E-Gum for flexible gingiva masks that are integrated into 3D models. E-Guard, a material used to produce night guards has just received FDA classification as a Class 1 device that can be worn in the mouth for as long as needed and is currently shipping in Europe. The material prints particularly well on EnvisionTEC’s Perfactory Vida DLP 3D printer which allows technicians to print around five appliances on the same build plate in just 30 minutes, saving dentists at least one hour per appliance. With over 15 years of experience in DLP technology, medical represents more than one-third of EnvisionTEC’s business and is its fastest growing category by far. Within that field, dental is number one with dental professionals and orthodontists both fans of its growing materials library and superior precision and surface finish.

“The dental industry has been one of the first industries to fully adapt to digital workflows whether that's scanning or 3D printing and now we're getting intricate enough and more advanced to where we can directly 3D print these appliances which is a really exciting step forward,” Chris Kabot, Dental Applications Specialist at EnvisionTEC commented.

The classification of these materials indicates a growing confidence from federations like the FDA in 3D printed products but it still remains a challenge to get these materials into day-to-day practice with different organisations across the globe requiring varying standards. However companies like EnvisionTEC are working with them to establish guidelines that can smooth out the process for future materials and appliances. Perhaps unsurprisingly, according to both companies, adoption is actually growing much faster in Europe under CE certification than in the U.S..

“The FDA has really just started to understand additive processes and one of the first things we're trying to do is establish some standards,” Chris added. “I think as we start to get more advanced with the technology and as we go into this next evolution of machines, standards around accuracy and resolution are going to be much more important for us as a 3D printing company and the same goes for the FDA, they care about how long this material is going to hold its shape, are any of the chemicals going to leak out and actually affect the patient?”

In-house or outsource?

Of course additive developments are happening elsewhere in the dental sector away from resin.

Metals is the AM industry’s fastest growing sector and dental is playing its part in that growth with companies like EOS, Sisma and Concept Laser targeting the industry with dental specific machines and certified materials. Global engineering firm, Renishaw is one company that has strengthened its emphasis on dental with the recent launch of its new Healthcare Centre of Excellence near Cardiff. In keeping with the mission of its Innovation Centre initiative launched last year, the aim is to provide a place for the manufacture of custom medical devices, including dental applications, along with education and training for the life sciences community.

Even for the biggest dental labs, investment in a current metal printing system is much higher than that of any resin based technology on the market and that results in most work being outsourced either before or in place of a machine purchase. Through these centres, Renishaw is providing a familiar environment for professionals to oversee the manufacture of custom devices on its metal AM systems for the likes of LaserAbutments or LaserPFM frameworks, and even practice using the latest technology before implementing it in their own labs. Renishaw provides a complete turnkey system, which comprises a range of scanners such as the blue light DS30 dental scanner and Renishaw Dental Studio software, along with dental frameworks and metal 3D printing. A recent example shared by Renishaw was of Bristol-based CBC, an award winning restorative laboratory, which has improved efficiency and freed up its staff for more profitable lab work since subcontracting its metal framework manufacture to the company. Though outsourced, these complete additive solutions which incorporate multiple forms of advanced equipment are just another way today’s dentists are able to implement 3D technologies into their day-to-day work.  

For an active dentist and someone who is passionate about teaching the next wave of dental professionals, Dr. Scherer believes we will see a surge in adoption in the near future and hopes that soon we will be able to directly manufacture fillings, restorations or even final crowns using 3D printing.

“Those going through school right now, every single one of them has expressed an interest in this technology,” Dr. Scherer added. “For dentists, any time you do something for the first time it’s going to be difficult but let them get it in their hands and I can assure you it’s going to be astronomical. The excitement level is palpable.”