In June 2013 I heard a segment on NPR about 3-D printed hands that were developed to help children born with amniotic band syndrome. My first thought was, this would be great in dentistry, I’m sure it already exists. I was envisioning a wave of 3-D printed crowns and bridges sweeping the industry- not to be confused with milling machines which some view as a 3-D printer. Milling machines are a subtractive process while 3-D printing is an additive process using a stereolithographic technique which adds layers upon layers of a photopolymer resin, light curing the layers together.
A year later I still didn’t see 3-D printers in the dental field. I did some research and came across a company called envisiontec. They manufacture 3-D printers which make night guards, models, surgical guides, and lo and behold… temporary crowns for about $0.17 a piece. If the printers had been reasonably priced, the potential to make inexpensive crowns was just around the corner. I contacted the company and discovered that a permanent biocompatible material had been developed and was in its clinical trial phase, waiting FDA approval. While the mat
erial itself is inexpensive, the printer and required components are not. There are 3 components needed to make a 3-D printed crown: the printer which runs between $25,000-$70,000, the digital impression scanner (desk top or wand) about $30,000, and the cad/cam software around $20,000. The cost of these components combined was more than what any clinic in the public sector would be willing to pay just to make a crown for an underserved patient. In the private sector the return on investment could be seen through dental assistants spending less time pouring up models, savings on impression material, cost of shipping models to the lab, and obviously seating the permanent crown the same day which eliminates subsequent appointments for crown delivery on the schedule. Of course this would come at a cost for the patient (which I believe patients would happily pay) but what I was envisioning was a less expensive crown for an underserved patient. I could see the potential for this to be used on mobile dental vans, health departments and third world countries. Often times patients will wear a temporary for much longer than the recommended 2-4 weeks, sometimes for several months and I have even seen cases where the patient has worn a temporary for several years! The resin based crown seemed like a good middle ground between a temporary and porcelain or porcelain fused to metal and something that might be more affordable, not to mention more accessible if it could be fabricated right on site which often times having underserved patients return for multiple appointments is a major struggle.
The digital impression scanner in its own right is amazing. There are several on the market, 3M, 3 shape, itero, sirona, etc. These scanners are able to scan the teeth in under 3 minutes creating a digital impression and some can do this in full color without requiring a contrast medium (powder). If the dentist doesn’t have a 3-D printer, he/she can still use the scanner. The dentist can scan a section being prepped for a crown or bridge, scan said section after prep, and with the touch of a button, send the file to the lab. The process is the same for night guards, surgical guides, etc. As we round the corner of the digital age, traditional alginate impressions will soon seem as antiquated as film radiography.
Is technology changing too quickly? Before envisiontec could get their permanent biocompatible material FDA approved, there was already a new printer, Rapidshape/Nextdent, on the market which makes 3D printed ceramic crowns using a process similar to sintering (3D printing metal). While these printers and their necessary components are still very expensive, I do believe that in the future we will see the same quality printers but for much less. The Formlabs 2 printer is a great example of a less expensive 3-D printer yet one that is unavailable in the medical industry simply because it is not an approved “medical device.” It uses the same stereolithographic process as the other printers and runs about $4,000. Prices like this could certainly make 3-D printed crowns available to the masses and as previously mentioned, as commonplace as the digital X-ray.
We are fast approaching a new era in the healthcare industry, technology is advancing daily where one innovative product is quickly superseded by the next. Its an interesting and exciting time for sure, in all industries not just healthcare. I mean, I think I heard we are about to go to Mars?