The Technological Revolution in Implants and Aligners: How 3-D Printing and Planning Software Are Impacting Care

Drs. Brady Frank, Kevin Ison, Pete Stover, and Trent Anderson
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INTRODUCTION
Dental implant therapy and clear aligner therapy occupy polar opposite ends of the dentistry spectrum. After all, implants treat edentulism and failing dentitions, while clear aligners treat the healthiest of mouths. Yet the same technological advances are revolutionizing both of these fields—2 of the currently fastest-growing clinical segments of the dental market with great future potential. This article series will utilize clinical case examples in the fields of both implantology and clear aligners to help paint the picture of where each of these fields will be in 24 months and to open the discussion on new and exciting opportunities now available for clinicians.

Both fields are experiencing enormous growth with huge potential for continued development. In fact, a recent article in Forbes states, “…Align Technology estimates there are 10 million orthodontic cases each year…the Invisalign product is applicable to 6 million of those, [and] they have only 9% of those cases. That leaves plenty of room for growth—especially when you find out they are creating these aligners on a fleet of 3D printers.”1

The savvy clinician will anticipate where these fields are headed and position his or her services to reap success from the next revolution in clinical dentistry.

Current Clinical Climate of Implants and Aligners
Private equity, DSOs, and institutional investors have been increasingly focusing on both the implant and aligner markets in the last several years. Large implant centers have been adding more locations, and aligner therapy locations are going up by the dozens. Hundreds of millions of dollars have been spent to bring patient awareness in both the implant and aligner fields to all-time highs. At first glance, these developments may appear to be a negative to the private practitioner. Yet, incredible opportunity has been created for the private practitioner and the dentist-owned dental service organization (DDSO). This national marketing spend has created an unprecedented demand for both services, and this demand is at a level never before seen in the United States. Furthermore, add to this the reality that a patient would rather receive dental services in-house from his or her dentist of record. This means that patients are becoming aware of the benefits of implant and aligner therapy through mass marketing but, at least the majority of the time, are seeking those services with their home private dental practices. This trend is expected to continue, which opens a promising opportunity to put to use the clinical techniques explored in this series.

In-House 3-D Printing of Implant Guides and Aligner Models
Only a few years ago, it was not thought feasible for a clinician to efficiently and cost effectively print surgical implant guides and models for in-house aligner therapy. Clinicians who adopted in-house 3-D printing protocols early have positioned themselves to benefit the most from dentistry’s next big revolution. These clinicians are now producing guides and sets of aligners at a fraction of the retail cost of such appliances and have outsourced the majority of the workload to staff, creating very scalable growth. And, for clinicians yet to adopt these new technologies, there is still good news. Only recently have the printers and software for aligner therapy become efficient, user-friendly, and accurate enough to warrant the investment. At present, the minor investment to get into 3-D printing as a private practitioner creates multi-fold ROI possibilities. In fact, a recent article2 described in great detail how a college student used software to plan his own case and 3-D printed 12 models, procured clear aligner material from eBay, and successfully treated his own case. While this enterprising student had no dental training or experience and, as a result, put himself at great risk, the example still serves to demonstrate the relative simplicity of this technology, and, indirectly, it highlights the dawn of the 3-D printing revolution that can be beneficial for both doctor and patient when implemented professionally and with proper training.

The following cases will give clinical nuggets and offer analysis of the economic benefit to the clinician and, in turn, the patient.

CASE REPORTS
Case 1: In-House 3-D Printed Aligner

Let’s look at a typical case (Figures 1 to 3, courtesy of Kevin Ison, DDS) that could be routinely seen in any dental practice. The patient presented with a Class I bite relationship with minor tooth movements necessary to achieve an ideal aesthetic result. This type of case is an ideal situation for scanning, 3-D printing, and providing completely in-house aligner therapy at a fraction of the cost of sending the case out to a retail aligner lab.

Case 2: In-House 3-D
Printed Implant Guide

Figures 4 to 13 (courtesy of Peter Stover, DDS) demonstrate the modern workflow of guided implant dentistry.

Guided implant surgery has evolved much like the rest of digital dentistry. We began with complex systems that required custom impressions with radiographic markers and milled guides that were very expensive and sometimes inaccurate. Software and hardware improvements have improved the workflow and reliability of guided surgery, but nothing has opened the platform of guided surgery like the advent of 3-D printing. Three-dimensional printers are now affordable, accessible, and reliable.

CLOSING COMMENTS
From these case studies and from trends in the marketplace, it is clear that the 3-D printing revolution, as it relates to implants and aligners, is well underway. Prudent clinicians will prepare themselves and their own private practices, DSOs, or DDSOs for the bell curve of demand that is estimated to peak in the next 2 to 3 years. Allow the heavy marketing budgets of “big dental” to help fill your practice full of fee-for-service patients from the advantageous clinical fields of implant and aligner therapy.

In the next article in Dentistry Today related to these technology-related topics, we will describe more clinical techniques and share tips that will allow the clinician to take action as the innovations in the 3-D printing arena intensify. Five steps to building your implant or aligner 3-D printing ecosystem in the most cost-effective path possible will also be presented. Keeping in mind that minor investments in equipment and supplies are producing big dividends and a reduced overhead percentage for up-to-date practices around the country, the next article will also include a detailed low-, medium-, and high-cost breakdown for scanners and information on 3-D printers, printer resin, software, post-processing boxes, thermoformers, and labor and packaging ideas to help begin your 3-D printing journey.


References

  1. McCue TJ. 3D printing moves align technology toward $1.3 billion in sales. Forbes. September 14, 2017. https://www.forbes.com/sites/tjmccue/2017/09/14/3d-printing-moves-align-technology-toward-1-3-billion-in-sales/#224d62835378. Accessed December 1, 2019.
  2. MacDonald F. A college student has 3D-printed his own braces for less than $60. Science Alert. March 21, 2016. https://www.sciencealert.com/a-college-student-has-3d-printed-his-own-braces-for-less-than-60. Accessed December 1, 2019.

Dr. Frank is an international clinical and business lecturer, an inventor, and founder of multiple companies in the dental and real estate development spaces. Since graduating from Marquette University School of Dentistry in 2001, he has been the founder and co-owner of multiple private dentist-owned groups. He can be reached at bradyfrank74@gmail.com or at ddsolive.com and ddsostrategies.com.

Dr. Ison operates a multi-location DDSO in Ohio, Missouri, and Arizona. A board-certified orthodontist, Dr. Ison enjoys mentoring both his colleagues and partners in efficient clear aligner therapy and opening a 3-D printing center of their own. He is the clinical director of the DDS Aligner Institute with training locations throughout the nation. He can be reached via email at ison3@hotmail.com.

Dr. Stover is a 2002 graduate with honors of the University of Oklahoma College of Dentistry (OUCOD). He is a CEREC trainer for Patterson Dental and beta tester for Clear Correct digital workflow. He has lectured on topics around the CEREC Guide 2.0 implant protocol throughout the Midwest, conducted live webinar education series for Blue Sky Bio implant integration with Sirona, and lectured on 3-D printing for Patterson Dental. Additionally, he has hosted study clubs at OUCOD for printing surgical guides and restoring implants and beta tested products for Blue Sky Bio. Dr. Stover operates both pilotplusdental.com and premier3dlab.com with the goal of helping to simplify surgery with more predictable outcomes. He can be reached at petestoverdds@gmail.com.

Dr. Anderson, a graduate of the University of Minnesota School of Dentistry, is a general dentist in private practice in the Twin Cities. He is the owner of 5 independent offices. He thrives on mentoring associates and catapulting their experience, both clinically and from an owner’s perspective, thus creating excellent partners. He trains other dentists on the art of 3-D printing aligners. Dr. Anderson can be reached at drtmanderson@gmail.com or by calling (651) 353-6651.

Disclosure: The authors have a financial interest in some of the products mentioned but received no compensation for writing this article.

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