3-D Printing

Mike Gow: Thanks for speaking with me about 3-D printing in dentistry Raj. Can you give us a quick introduction to 3-D printing and how widely they are currently used in various applications?

Raj Nath: Three-dimensional printing is getting more and more popular and 3-D printers are getting more and more affordable. Schools have them, artists have them, sculptors have them, designers have them and in many other disciplines 3-D printing and rapid prototyping is used on a daily basis. Medical 3-D printing has been in use in mainstream medicine and surgery for years. Prosthetic limbs are 3-D printed. There is even a crowdfunding prosthetic limb project where people with home 3-D printers are printing parts for the limbs.

Mike Gow: What are the main 3-D printing technologies?

Raj Nath: The most common 3-D printing technologies available are

1) FDM – Fused Deposition Modelling

2) SLA- Stereolithography

3) SLS – Selective Laser Sintering

There are other technologies available but to go into them is not within the scope of this article.

Mike Gow: Is 3-D printing expensive?

Raj Nath: You can get a 3-D printer with reasonable resolution for less than £500 which can do most daily tasks in a dental practice like study models, patient demonstration models, etc.

Mike Gow: Is it time-consuming?

Raj Nath: In my experience, you can actually train your nurses and support personnel. They will be delighted to be trained in and use this technology. Also, most 3-D printing is automated meaning that you can set it and go do your daily work and it will be finished by the time you come back.

Mike Gow: What could our readers actually use a 3-D printer for in their dental practice?

Raj Nath: Some of you are actually already using 3-D printing technology in your daily practice possibly without even being aware of it! Many of the parts of your dental chair are rapidly prototyped before mass manufacture. Some might be using implant surgical guides to aid the planning and placement of implants in tricky cases.

An experienced implant surgeon might question whether guides are always needed? After all s/he may have been placing implants without any guides for 20 years. However what about the less experienced surgeons? If there is an aid available in allowing them to predictably and accurately place implants safely in a patient should they not use it? The surgical guide planned using CBCT data and digital diagnostic wax ups or analogue wax ups allows highly accurate surgical guides and templates to be produced which allows safer placement of implants. Nowadays you can do this in-house very cheaply with open source software to the maximum cost of £30 or it can be outsourced to a lab which will cost you more. This is not a difficult skill to master, especially if you can place implants!

Three-dimensionally printed models are quicker and comparable in accuracy to classic stone models with less mess. In countries like Germany this is mainstream in dentistry and the technology has penetrated to a significant percentage of dentists (not just specialists!)

One of the most common daily tasks that the dentist undertakes is patient education leading to consent and treatment planning. We all know visual learning is ingrained from infancy, so using visual aids helps in conveying the idea across. Many of us use demonstration models but they are generic. Customised demonstration models are more informative and the planning-consent to case acceptance may be be swifter. There are many other uses, a full digital work flow is possible to be integrated into daily dentistry.

Mike Gow: What’s the most advanced or impressive thing that 3-D printing has done in dentistry in your opinion?

Raj Nath: The first 3-D printed titanium full mandible was implanted on an 83 year old who lost her mandible due to disease back in 2011 in a joint effort from researchers and surgeons in Belgium and the Netherlands (Figs. 1–3).

This is a much more advanced use than the average 3-D printing enthusiast can reach and is certainly one of the most impressive uses of the technology that I have encountered.

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  Figure 1

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  Figure 2

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  Figure 3

Mike Gow: Can you give us a few examples of how you use 3-D printing yourself in practice?

Raj Nath: Of course!

Example 1: Endodontic microsurgery—not an easy procedure at the best of times!

Using the printed model, I can demonstrate the defect to the patient, plan surgery, calculate graft volume, plan flap and it serves as a medical record, too! Printed in 21 minutes at a cost of print £2!

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  Example 1

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Example 2: Wisdom teeth surgery—again, not a procedure that the average dentist might want to do, all the warnings about the possible injury to the nerve might put people off!

The lingual bone plate was digitally removed to demonstrate the position of the tooth printed in 15 min at low resolution of 300 micrometers and cost of print £2.

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  Example 2

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Example 3: Most dentists do endodontic therapy. Imagine if there was a way to do it easier, quicker and that would allow you to do a practice run before even touching the patient!

The tooth is digitally dissected out of the DICOM data and 3-D printed reproducing internal anatomy.

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  Example 3

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Example 4: One of my patients has thick fingers and doesn’t like the commercially available interdental aids. As we all know one can try maybe two or three solutions before giving up. We know how difficult it is sometimes to get our patients to use interdental cleaning aids. How about we help a little and customise a cleaning aid for the patient?

The handle and width of the floss holder can be customised to the patient, printed in 7 minutes cost of print £0.25. Do you think we scored some brownie points with the patient?

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  Example 4

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Mike Gow: Thank you for your time, Raj. That has been really interesting. If any of the DentaltownUK readers are interested in learning more—are you aware of any upcoming events that you would recommend?

Raj Nath: Yes, if anyone would like to learn these techniques (and more), professor Jonathan Abenaim from NYU is coming on May 22–23 to the LONDEC training centre in London. He is running a course: ‘Dentistry of the Future Now’ —full digital integration work flow for daily dentistry—not just implants! I’d highly recommend this event.