Few recent innovations have had the potential to transform dentistry as 3D printing. How widespread has it become so far, though? And is the boundless hype from its acolytes actually merited?
IN MARCH 2016, 23-year-old Amos Dudley, a student at the New Jersey Institute of Technology, made global headlines when he 3D-printed his own set of clear plastic orthodontic aligners for all of about $60. Using his school’s equipment, Dudley scanned and printed models of his teeth, determined how far they needed to move and then designed each alignment tray. His effort grabbed attention because it seemed a harbinger of what 3D printing might become—widely accessible, increasingly affordable and enormously useful.
Orthodontists probably don’t need to lose sleep over the idea that their customer base will decide to go DIY, of course; not everyone has access to high-tech university gear or the knowledge to use it competently. How soon might dental professionals themselves broadly adopt the technology, though? Industrial and medical uses of 3D printers have been hailed as the next great advance for some time, but it wasn’t until a few years ago that the dental market began to pick up in earnest. At EnvisionTEC, a popular manufacturer of 3D printers, dental-related sales increased 75 percent from 2015 to 2016. SmartTech Publishing forecasts the market will hit $3.7 billion by 2021, up from $1.2 billion in 2017.
“Most fields have already begun to embrace 3D printing more than dentistry—[but] not because dentists are not aware,” says Dr. John Kois, founder of the Kois Center in Seattle. “They’re waiting for the technology to not be first-generation, to go through the early adopters. But now we’re crossing that critical mass to move on to mainstream and begin mass production, which is going to be in the next year or two.”
Some dental companies—NextDent and Moonray are two leading examples—are catching on and beginning to market their own specialized 3D printers, making it easier for dentists to do procedures (such as implants) that have long been the domain of specialists. Wider adoption of the technology will also lead to lower costs for laboratories and patients alike, and much faster and easier in-house restoration work.
Some of the most popular current applications are for night guards and aligners, which take just a few hours to produce and are more customized and accurate given that they’re created from a precise scan of a patient’s teeth. Clinicians can also scan broken teeth and create crowns that fit perfectly. More intensive procedures are increasingly possible, too. “The most common use we have for [3D printing] is that we do a lot of implants, and the surgical guides to place the implants are 3D-printed,” says Dr. Steven Acker of Elite Dental on Staten Island, an early adopter of the technology.
TO BACKTRACK just a bit: Before 3D printing began to gain traction, most dentists worked with alginate impressions—sometimes wryly referred to as analog—and milling machines. Now that it’s possible to get accurate three-dimensional models of patients’ dentition, though, tailored solutions are better than ever. Which raises the question: Which printer is the right one? EnvisionTEC, Stratasys and Formlabs are three other industry leaders, and all of them are conducting research into the potential uses of printers to help dentists incorporate them into their practices.
Competition is boosting accessibility and lowering costs, too. Formlabs’ Form 2 printer and basic starter kit with service and support costs roughly $4,000. “It’s shaken up the industry quite a bit,” says Sam Wainwright, dental product manager at Somerville, Massachusetts–based Formlabs, which was started out of MIT (those technical universities again) in 2011. “A lot of 3D printing companies that had been selling to dental for years for $85,000 have had to adjust the way they approach the market.” Most current technology is based on stereolithography (SLA) and digital light processing (DLP), depending on the application. SLA creates products via laser photopolymerization of resin; DLP uses a projector. A clinician must use biocompatible materials approved by the Food & Drug Administration, such as Dental SG resin. (Amos Dudley told reporters he bought his dental plastic on eBay.)
PolyJet technology was the most widely used form of printing for many years. Much like an inkjet printer, PolyJet put down beads on resin, layer by layer, as it built a three-dimensional shape. “Before dentists even look at a printer, they have to have some idea what they want to do with it,” Kois says. “Is it to print out diagnostic models, or try to fabricate things that fit in the mouth? There’s a very big difference in just those two things.”
A printer’s ancillary components offer another big consideration. Having the right scanner and the right CAD/CAM software, and ensuring that they can talk to each other (and to the printer), has been a point of contention for years. Whereas initially industry leaders designed this trifecta so it could work only within its own ecosystem, the trend is clearly moving toward open-architecture products that are universally applicable. “You need to be able to interchange your scanner, 3D printer, milling machine and software,” says Elite Dental’s Dr. Acker. “That’s how you cut costs, and whenever things upgrade, you don’t have to replace the whole system.” It all starts with a 3D intraoral scanner, though, and being sure that it produces files in the open .STL format, which is becoming the default standard.
ALTHOUGH MORE AND MORE dental professionals are beginning to incorporate 3D printers in their practices, many still opt to outsource to labs that specialize in it, such as San Diego’s Argen Corporation, Irwin, Pennsylvania–based Albensi Laboratories or Bay View Dental Laboratory in Chesapeake, Virginia. Adopting a complex scanner, after all, doesn’t happen without some hiccups. “Regardless of how much you spend on a printer, none of them are completely plug-and-play,” Kois says. “Even in dentistry’s analog version, we’ve learned we have to work with many details, and it comes down to building systems and protocols, not just buying products.” The Kois Center recently introduced a course on “optimized digital integration in the dental practice” in the hope of bridging the new digital-equipment/workflow-efficiency gap.
Among the prominent dental companies making wide use of 3D printing are Align and Clear Caps, which use them to create aligners and night guards. The technology isn’t just making such services more affordable, customized and convenient; in some cases it’s helping contribute to companies’ local economies by bringing overseas manufacturing back home. “The most important change happening now in dental is the development of photopolymers and resins for these printers,” says Formlabs’ Wainwright. “The more things we can print in dental, the more widely they’ll be used and the more accessible dentistry is going to be for dentists, labs and patients.”
There’s talk that bio-printing will also soon be possible—an enormous leap forward that would lead to made-to-order gums and bone structures in tissue-like materials, making invasive dental surgery largely an unlamented procedure of the past. “If things are becoming easier to manufacture through 3D printing and the cost of materials is driven lower, that means laboratories, dentists and patients have access to care that maybe wasn’t possible before because it was unaffordable,” Wainwright adds. “There are dental needs around the world, and if we can reduce the costs of production, it’s going to be an incredible change for everyone’s oral health and well-being.”
The benefits of the proliferation of 3D printing, in other words, are coming, and soon. New standards of care will become the norm—and patients will perhaps no longer regard complicated dental procedures as akin to, well, pulling teeth. •
MELLANIE PEREZ is a journalist in Houston who writes frequently for Incisal Edge.