CLINICAL
3D Printing in the dental field Benjamin Huberson, France
T
he first 3D printers were born in the 1980s with the help of Charles HULL. They were normally reserved for prototypes but gradually extended their field of application to aeronautics, medicine, or dentistry. This technology has a particular affinity with dentistry, and advances in medical imaging and modeling such as CBCT and intraoral scanners, and the use of CAD-CAM which is becoming more important. The evolution of this method pushes us, as dentists, to evolve towards a digital area. The choice between printing and milling depends mainly on the material used. For metals, ceramics and zirconia milling seems more suitable while 3D printing is preferred for resins. These 3D printers adapted to the dental field allow the creation of physical models for orthodontics, surgery, and prosthodontics, the manufacture of dental and craniomaxillofacial implants, occlusal splints, or even orthodontic aligners.
1. Printing technologies
There are several printing technologies, each of which has its advantages and disadvantages. Unfortunately, the common feature is that the equipment comes at a high cost, both for materials and for machine maintenance and repairs. In the 90s, the FDM technique (Fused Deposition Modeling) was born. It creates a three-dimensional part by adding molten material, layer by layer. These are generally plastics (ABS, Nylon, or PLA). The resin wire passes through a nozzle heated to high temperature and a molten filament comes out. It is deposited and comes to stick by fusion on what was deposited before. This printing technique is the most affordable, but its accuracy is average. This technique is useful in manufacturing models because the materials are not approved for intraoral dental use, but also because of the fact that manufacturing layers are visible in the final product.
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The SLA or Stereolithography Apparatus uses a scanning laser to build parts layer by layer. In this technique, the part is photopolymerized by a laser, point by point, which shoots into the surface of a photopolymerizable resin vat. Once the layer is finished, a new layer of liquid resin is applied, and the process is repeated. This method requires a post-treatment step. At the end of printing, the parts must be cleaned to remove unpolymerized resin residues, then must be photopolymerized to ensure their stability. There are many compatible resins, some of which are developed specifically for dental applications. Thus, there are resins to print the models, for surgical guides, others for splints and still others for making denture bases or temporary crowns. The DLP technique (Digital Light Projection) is actually an improvement on the SLA technique. Rather than “drawing” the part to be printed, we project the image of each layer in one go, using a projector. Since each layer is “flashed” all at once, the printing speed is improved compared to the stereolithography method. Today, the majority of 3D printers offered for the dental sector operate on the principle of DLP. They allow to achieve a model or a surgical guide in less than 30
minutes!
2. Applications
The easiest way to use a 3D printer in the office is to make models. Once you have an intraoral scanner for taking an impression, it is very easy to retrieve the files generated in. stl format (STL stands for Stereolithography) and open them in the 3D printing software. These models, once printed, allow us a precise study of the patient’s dental condition and facilitate the choice of the treatment plan. In orthodontics, treatment is planned, and devices are manufactured. The processing can be computerized using data from intraoral cameras and / or CBCT. There is the Invisalign® system which allows to digitally realign the patient’s teeth, and to make an aligner. It gradually repositions the teeth over several months or years. The aligner can be created from a 3D printer and a specific resin. An increasingly important application of 3D printing is manufacturing the drilling guides. Drilling guides are plastics forms that are individually produced for the patient. It fits the teeth perfectly. The place of future implant contains a hole with a stainless-steel sleeve to
