Take a Look Around

Photo courtesy of Micron Dental.

Paul Feuerstein, DMD
Photo courtesy of Micron Dental.

The bottom line is, if you are considering a 3-D printer, know what you can actually make efficiently in your office and how much you will actually use it.

Last month, the annual meetings of the ADA and the FDI (World Dental Federation) were combined and held in San Francisco as the ADA FDI World Dental Congress 2019. For those not familiar, FDI represents more than a million dentists worldwide. As usual, many new products debuted in a large array of manufacturer displays. There were also 5 days full of continuing education with top presenters speaking on topics ranging from restorative dentistry to technology to wellness. It is a bit sad that many of you missed this opportunity. Although the ADA reported more than 30,000 attendees, there were only about 11,000 dentists and 4,000 assistants. Perhaps it was due to the fact that this was the week following Labor Day; I was told by many dentists that their families had commitments (eg, the first week of school), which might have been a deterrent.

Of course, my focus was on the new technology. All of the digital impression scanners presented improvements in functionality as well as new software. A few newcomers also graced the meeting. One of the new product introductions came from Carestream Dental, which launched its new CS 3700 scanner. Its increased speed, unique shade matching, and new intuitive software created a buzz.

I describe this space as an ongoing Kentucky Derby in dentistry. As I watch the products, changes come almost monthly, and honestly, as soon as one manufacturer introduces a new feature, the others follow rapidly. At this time, all the intraoral scanners create files for dental restorations and procedures. The elder statesmen (Dentsply Sirona, Planmeca, 3Shape, Align Technology, and Carestream Dental) have proven their accuracy with thousands of restorations as well as clinical studies. One of the most important aspects of this technology is the ability to create an accurate full-arch scan with precise cross-arch measurements from second molar to second molar. One of my early simple tests for this aspect was to create a full-arch scan and send it digitally to a laboratory and have them create a hard nightguard; then I would see if it “drops in” with no real pressure points. Although not scientific, it is an inexpensive test to perform before investing thousands of dollars. There are, of course, many new companies with units from all over the world being introduced at, in some cases, significant price differences. When I spend time at a show booth looking at the new products, creating a scan on a model often looks impressive. I cannot make a judgment at that time, though, as I really need to see legitimate studies and, if possible, create some restorations in my own practice. In earlier times, I rotated various systems on loan through my office and took a digital and a PVS impression to get a clinical sense of accuracy there—not in a sophisticated lab—just as any GP would do. I sometimes had the luxury of 2 scanners and could scan a crown prep twice and compare results. Margins, contacts, and centric occlusion were easy to check with explorers, floss, and articulating paper, and I continue to do this with newer products to report back to my readers and course attendees. The advice at this time is to at least get a demo in your office and do a case or 2. Look at the ease of use and the actual handling of the wand; examine the software; and, even at this early level, get a sense of the customer support. Also, find a laboratory that will do a totally digital workflow for you. Currently, the easiest product to receive is a full-contour zirconia crown with a model, for your testing. There is usually an additional charge for the model, but keep in mind, this is part of your investment in the ultimate end results for your patients. One of the first things that threw me in my earlier days was receiving a case from a lab with a little box that contained a crown and no model; I had to raise my right hand and say, “I believe.”

One of the other areas at the meeting that added to digital restoration confusion was focused on 3-D printers. There was an array of units ranging in cost from $3,500 to $20,000. There is a lot of talk by manufacturers on the methods used to print a product. SLA, DLP, DLS, etc, caused a lot of head scratching. To simplify, the questions should be how fast, how accurate, how many pieces at a time, and how large can they be and what materials are available. The latter will help determine what you will actually do with the printer. More important is the fact that you cannot just buy a printer and “attach” it to your scanner. There is software that is necessary to design the appliance, and you must consider who in the office will do this and how much time will it take. Then there is “post-processing.” The printer doesn’t just pop out a finished product; there are sprue-like pieces that have to be cut/grinded off. The printed piece has to go through one or 2 washes. Then many materials must be cured by light, and sometimes by heat in an oven. Finally, someone must polish it for delivery. A couple of companies, Micron Dental (microndental.com) for example, do not just sell you the printer: They also have all of the finishing components and are quite honest about all the steps needed and how much time and manpower is involved. One company, Structo (structo3d.com), showed the Velox, which has a little carousel inside the unit and automates all of the steps of printing, washing, and curing (but you still have to cut the sprues and polish). Those of you using guided surgery for implants will be able to print your own surgical guides, but make sure you understand the entire process—it is not a one-click solution (yet). There was a lot of talk about being able to print dentures right in your office at a cost of, perhaps, $25. Again, this requires designing, printing, and finishing, which takes time and manpower. And there are still limitations on what materials are FDA approved for long-term use in the mouth. The bottom line is, if you are considering a 3-D printer, know what you can actually make efficiently in your office and how much you will actually use it.

Of course, the understated point here is “Do your homework.” Take some courses either at workshops or online. The resources are out there for you to make an intelligent purchase decision.

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