Applications Expanding for 3D Printing

Nate Farley, DDS, MS (NF): If it is done correctly, definitely. Entry-level applications such as implant surgical guides, wax-ups, and splints are relatively easy, and you can grow as much as you want from there, ultimately utilizing 3D printing for a wide variety of procedures. I started out with surgical guides and wax-ups. Surgical guides provide the restorative dentist with more control over the end result of surgeries. For wax-ups, I would print a model of the proposed treatment, make a putty model, fill that with temporary crown material, and place it in the patient's mouth to harden. It provided me with a powerful tool to help patients understand complex treatment plans. I wasn't doing splints at first because the software was expensive, but cheaper alternatives are available now, so that is a great entry-level application as well.

ID: What are some of the more advanced applications that can benefit practices?

NF: In our practice, almost everything that we do is digitally designed and then 3D printed or milled. We tend to still mill permanent crowns, dentures, and hybrid implant prostheses; however, 3D printing allows us to fabricate prototypes very quickly and affordably. In the past, milling a PMMA prototype was very expensive. If the patient was dissatisfied and required a second prototype, the case could quickly become unprofitable. Comparatively, the cost of 3D printing a second or even a third prototype is negligible. This permits the restorative team to be as discriminating as they want. We have the freedom to tell the patient, "Let's try something else."

ID: What are the most exciting recent developments in 3D printing technology?

NF: The developments that are exciting right now and those that are expected to be exciting in the future primarily involve materials. Not long ago, there was only one type of 3D printing material specifically developed for dentistry. I was printing denture try-ins with clear surgical guide resin because it was the only material that was approved for use in the mouth. However, in recent years, materials have become available for almost every application. The viability of new materials for permanent crowns and dentures is debatable, but there is no question that in the future, these materials will have improved enough that they will be widely accepted and utilized.

ID: With so many new materials coming to market, how important is doing your due diligence?

NF: That is a good question, and there is definitely some room for argument. As a dentist, technically, I can put something in my patient's mouth without the approval of the US Food and Drug Administration (FDA). Laboratories are required to use FDA-cleared materials, but I answer to the state dental board. Nonetheless, ethically, we should all be doing everything we can to use appropriate materials that have been properly printed and are safe for our patients. We need academics who have the time and resources to take on the project of deeply researching these materials and answering some of the questions that we still have or confirming or refuting what we believe about them.

ID: What are some of the considerations that someone new to 3D printing needs to be aware of?

NF: Some people might not realize that CAD is not easy for everyone; however, you can eliminate that barrier by using a third party for digital design. Others might not be prepared for the amount of postprocessing that can be necessary to get a printed product ready to go in the patient's mouth. Another aspect to be aware of is that 3D printing is messy. The resins that we use in dentistry are thick, sticky liquids. You need protocols in place to keep your 3D printing station from becoming a disaster area. The key is training your staff.

ID: You're a big proponent of networking as you navigate new technologies. How important is it to not go about attempting this alone?

NF: You might quit quickly if you do not have a support group. Like any technology, 3D printing does not always work. The more you do it, the more challenges you will encounter. You need support, and that can be acquired in a few different ways. The best support, which you should be seeking out when buying a 3D printer, is from the company that is selling you the machine. They are the ones who understand the technology the best, and they are motivated to figure out any new issues that arise because it is their product. Secondarily, having a personal friend or mentor who is experienced in 3D printing is helpful, but if you do not have that, Facebook can be a great resource.

Nate Farley, DDS, MS
Fellow
American College of Prosthodontists
Private Practice
Mesa, Arizona