3D Printing: The Crown of Digital Dentistry
An explosive demand for 3D printing technologies is a direct result of its value-addition in terms of time savings, accuracy, affordability and multi-faceted nature over traditional methodologies. Specific to dentistry, wherein wax loss techniques or milling restorations demand skilled labour, lack flexibility and difficult to reproduce; 3D printing presents rapid production, high material utilization and simplified workflow, solving every such limitation. A major advantage is that three-dimensional objects can be designed and visualized on screen allowing almost unlimited variety of shapes and levels of complexity. Distinctly, the mechanical and aesthetic properties of the object to be printed can still be corrected during the 3D building process which is not possible with subtractive manufacturing.
Where ???? all it can be used to add value
From preparing study models and wax ups to printing surgical guides and restorations, 3D printing can be deployed in diversified aspects of dentistry including a variety of clinical applications in prosthodontics, maxillofacial surgery, oral implantology and orthodontics
1-Partial dentures and crown copings
Crown and bridge dentures can be fabricated using resin-based 3D printing technologies. Traditional methods highly relied on the skills of the operator and any empty spaces created during material mixing weakened the mechanical strength leading to fractures. Additionally, there are inherent limitations in machining tools and material properties. Whereas in 3D printing, the amount of material used is less, with almost no material loss. Further, it can print a variety of materials simultaneously favouring detailed reproducibility.
In the case of removable partial denture (RPD) frames, fabrication can be done using computer-aided design or computer-aided manufacturing process (CAD/CAM). First, either an intraoral or extraoral scanner is used to scan impressions and acquire a digital work file such as a standard tessellation file (STL). Second, STL files are transferred to CAD software for designing and finally to 3D printers to generate customized structures (Fig 1). These new digital workflows have more advantages than traditional workflows which cause wax pattern and cast distortions possibly leading to poor fit of castings. Utilizing 3D printing technologies to manufacture RPD enables the denture base to provide more uniform contact pressure thereby reducing the risk of bone breakage and reabsorption.
Increasing desire of patients for alternative “invisible” treatments has popularized 3D printed transparent aligners (Fig 3a). Rather than using error-prone plaster models that are laborious to handle, it is superior to use digital impressions and 3D print aligners for lesser cost, shorter lead time and greater accuracy. Treatment with clear aligners is also shorter in duration, highly comfortable and simple to use in contrast to conventional fixed braces and arch wires.
3D printing technology to create dental implants have been used by manufacturers widely as it has the ability to reproduce the minute details of the anatomical structure, which may not be produced by milling. The introduction of 3D printing allows the fabrication of precise and economical dental implants. The 3D model is constructed using intra-oral scanners and computer-aided design software and then changed into cross-sectional parts (slicing) to be sent to the 3D printer (Fig 2a). The printer deposits coating after coating of the selected material to yield accurate implants (Fig 3b).
4-Guides and Models
Surgical guides improve the accuracy and time efficiency in clinical treatment by reducing operation errors. Conventional surgical guides used radiation images which had lot of distortion and lack of clarity leading to inaccuracy and unreliability of the preoperative plan. However, the new surgical guides can be designed with intraoral scanning technology and easily produced using 3D printers (Fig 4).The drill guides indicate the insertion position, angles, and depth of the implant, which accurately transfers it to the patient, thereby simplifying the process of denture restorations, achieving good aesthetics and stabilizing the hard and soft tissues for a long time. Thus, 3D printed guides (Fig 5a) ensure for a less invasive, more predictable and safe operative procedures.
Owing to their high precision, shorter processing time, simple program and personalization, 3D printing can also produce custom trays (Fig 5b), which are increasingly desired. With CAD programs and 3D printers, almost all printing work in the production process of custom trays can be completed by the equipment. 3D printing technology simplifies the workflow of direct implant-supported dentures (Fig 5c) for patients completely lacking teeth as well. Additive methods thereby provide as a more economical and efficient method to control the space for the impression material or the extensions of the custom tray.
As an educational tool for students, they can also be used for treatment planning, record keeping, assessing potential management difficulties and to fabricate splints. Traditional plaster models do not replicate internal anatomical structures, accurately. While, 3D printed models reproduce the exact details of the anatomical structure and the data of the 3D model can be stored and exchanged electronically. Currently, the next stage of development for training models are multi-layer models. This multi-layering can refer to tooth structures as well as to layered structures of the entire jaw. Such models are extremely versatile to use; they may cover nature-identical simulation teeth (Fig 6a) for endodontic exercises to multi-layered models of the complete jaw for surgical simulations and trainings (Fig 6b).
What???? are the resources and features you need to look out for
It is absolutely crystal that 3D printing is indispensable for attaining better results and accuracy as we further progress towards digital dentistry. However, with an escalating list of available technologies and materials it is vital to understand the best fit for your practice or research based on functionality, costs, features and ease of operation to arrive at an informed decision.
In resin-based 3D printing, three main types of technologies including SLA (Stereolithography laser), DLP (Digital Light Processing) and LCD (Liquid Crystal Display) are predominant. All use liquid resin as 3D printing material, which becomes solid when activated by a specific light source. DLP printers are the more expensive, professional machines while LCD is seen as the most affordable of desktop printers.
An LCD printer with more pixels and greater size produces better print quality. By creating high-quality 4K prints, the Sonic 4K 2022 from Phrozen is an upgraded version of the Sonic 4K dental 3D printers with added features such as the new Phrozen Dental Synergy Slicer Software, equipped with internal heater and air purifier. The internal heater helps maintain constant temperature printing environment so that you can produce high-quality dental prints with 4K resolution, independent of the temperature outside and the brand-new air purifier system works to clear up resin fumes to enhance your entire 3D printing experience. Plus, another cool feature of the Sonic 4K 2022 is that it allows you to restart your print at any time and continue printing from where you left off; saving time and reducing print failures.
However, since the LCD 3D printers use an array of UV LEDs as a light source directly onto the build area the whole screen is lit up at once. Thereby, the light bleeds through the edges, yet fortunately, the light bleed is uniform which allows for an easy calibration via the slicer (Fig 2b).
Features (Resolution and Accuracy)
In terms of resolution, common knowledge suggests, a 4K projector is wildly expensive, especially if compared to a 4K monitor, which limits DLP usage. Additionally, several problems arise during scaling up with increased print areas, thus making LCD the go-to technology for large resin machines. Entry-level LCD 3D printers such as Phrozen often boast a 4K pixel resolution at a lower price. Research evaluating the accuracy of entry-level LCD printers compared to Laser-SLA printers found that the difference in accuracy between LCD printers and Laser-SLA printers is not clinically significant. Besides, SLA 3D printers prints out resin 3D prints with higher accuracy and precision through the use of a laser, however it prints very slowly and thus LCD outweighs both in terms of speed, accuracy and precision.
The Sonic Mighty 4K prints 3D models in 4K quality, offers extremely high-resolution printing at 52µm, and brings your most ambitious 3D printing ideas to life with insane amount of detail. Even large 3D printed parts can be printed with no wobbling whatsoever. It is also compatible with various resins made specifically for the dental industry, promising high precision in all professional dental applications.
On the other hand, 8K printers with massive build areas are also entering the LCD market that will likely lower the demand of DLP due to the high cost of projection technology. The Phrozen Mini 8K is one of the first 8K resin printers aim to make an expensive technology more accessible to the broader public. While, the Mega 8K breaks every single limitation for commercial 3D printers as both size and quality are delivered to you in one print with a stunning 8K resolution.
Not just the 3D printer, other hardware including print materials pose an important role in defining the final results. It’s also worthy to mention that certain high-resolution LCD and DLP printers will benefit from a high-resolution, purpose-made resin, like the Phrozen Castable Dental Resin (Green) specifically developed to rapidly produce highly accurate 3D printed dental models. Simply rinse with water to clean up your resin parts. Phrozen Castable Dental Resin has the perfects high’s and low’s you need. With low shrinkage rate to create the perfectly matched shapes, low viscosity to ease post-processing, low odour and high accuracy and precision.
Functionality (Speed and Productivity)
The main difference from the Laser-SLA printers is that LCD printers are faster. LCD printers are as fast as DLP printers, but LCD printers are more affordable because of the low-cost manufacturing materials that it is needed to build them up. This is the main reason for their growing popularity.
With the stronger ParaLED 3.0 UV lights, Sonic 4K 2022 series accelerates printing speed while maintaining outstanding accuracy. The monochrome LCD Screen prints up to 4 times faster than traditional 3D printers, taking only two seconds to print one layer. It boosts your 3D printing speed up to 400% faster with durable quality. Whereas, with a large-sized building plate, the Sonic XL 4K 2022 allows you to print enormous quantities of precise dental models in no time. This dental 3D printer comes with the dental 3D printing slicer software, Dental Synergy Slicer, which has simplified the dental workflow with its easy-to-use interface to enhance your entire 3D printing experience and reduce 3D printing failures. The Phrozen DS slicer also optimizes all 3D file editing processes, allowing for faster and easier treatments.
It is clear that LCD printers are the only true budget-friendly option at present (Fig 7), as DLP has barely broken into the consumer market. On the other hand, LCD printers has gained huge market share with lower price and appreciating quality. DLP 3D printers are also more expensive than LCD 3D printers as it requires the use of Digital Micromirror Device (DMD) which tends to be costly as well. Comparatively, SLA 3D printers are more costly than both DLP and LCD 3D printers as they include lasers which tend to be more expensive.
How ???we help ease your journey into digital dentistry
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