Dr. Wade Pilling is an implant and restorative dentist practicing in Boise, Idaho. His practice focuses on full-mouth implant and cosmetic dentistry. He is one of the most talented and technologically innovative dentists I know. I wanted to talk about digital workflows on those cases and how he uses 3D printing.
Joshua Austin: Dr. Pilling, I think you may be one of the few clinicians who is maxing out the effectiveness of 3D printing in your practice. When and how did your digital journey start with your practice?
Wade Pilling: Thank you. I think more and more clinicians are maxing out their 3D printers, so I'm not unique in this department. It is really exciting to see more ways of using this amazing technology. There really is no limit to what we’re learning and doing, and nothing has transformed dentistry this much in my career as 3D design and printing has.
I started my journey a long time ago when a few social posters started showing their 3D printers and how they could print simple models. At first I thought it was just an expensive tool for nerds that really had no ROI. I like technology, but I'm no nerd and won't invest simply for the excitement of having a new expensive toy, so I wasn't super interested at the time. If you're simply replacing alginate and stone models in your practice, 3D printing doesn't have a great ROI; it'll just take up space, and assistants won't use it much when traditional ways are faster and cheaper. But then I started seeing opportunities for surgical guides, for temporary crowns and bridges, for all-on-X temps, dentures, ortho aligners, night guards, etc. Once newer resins started being developed and I could see the digital world of design merging with the 3D printing fabrication world, my mind saw the potential. At that point I needed to be all in—not just for the fun of technology, but the ROI became huge at that point.
Also by Joshua Austin:
An interview with David Fitterling of DentalMonitoring
Talking CBCT with Dr. Justin Moody
With lab fees being costly on many things, the ROI and speed and time-saving became a no-brainer in terms of investing in 3D printers. I started out with small, cheap printers but quickly learned I needed more robust, faster printers, so I invested in higher-quality printers such as Sprintray.
So my journey started with me originally thinking this is a neat thing for nerds, and quickly morphed into thinking this is a game-changer—a real game-changer in revolutionizing what we can do in our practices for higher quality dentistry at lower overhead. I now have five different printers and likely will add more.
JA: You mentioned all-on-X and I want to ask you about that. I follow you on Instagram (@dr_wade_pilling), and your hybrid cases are stunning. Can you give us a quick overview of your workflows there and how you utilize 3D printing in the process?
WP: Thank you. I appreciate that. I try my best with these cases. My office is pretty much fully dedicated to full-arch implant or esthetic cases on teeth. 3D printing helps incredibly with both. As far as all-on-X cases go, I could not do them without the digital workflow. Traditional conversions are time consuming and can get sloppy and difficult to get perfect bite and contours. Plus they’re exhausting.
My workflow consists of preplanning the case digitally with scanners and software. Guides can then be printed. After implants are placed, the implant positions and soft tissue are captured digitally with a few different scanners. This digital data is then merged with our preplan design, much like a wax-up. Utilizing software, a full-arch implant hybrid or bridge is easily designed by a lab technician/designer. This connects directly to the implant multiunits or abutments. That design is then printed on our more accurate Sprintray printer utilizing new nano ceramic resins. These are super strong and beautiful and accurate. It takes less than 30 minutes to print.
Meanwhile I'm suturing up the patient. After the hybrid is printed and finished with some color, it is easily and quickly attached directly to the multiunits. The bite is often perfect as these are designed digitally. The patient now has a very accurate and strong prototype for the healing process.
This workflow has cut my chair time in half and my stress level even more. The frequency of fractures has almost been eliminated. In my opinion, this is the best way to do these all-on-X cases.
JA: You mention the bite, which is one place I wanted to go. Your Instagram posts always show videos of you attaching the hybrid to the implants and then immediately checking the bite—which is always perfect! I know you said the digital workflow resulted in this, but I think there’s more Wade Pilling magic at work here. I have far less experience with these cases than you do, but I have never had a perfect bite like your cases have almost immediately. Do you have any guidance on the best way to achieve that kind of accuracy and result with the occlusion?
WP: I really try to respect the bite, which all comes down to accurate data. From start to finish, if you can give the designer accurate data, then the design will be accurate. Any inaccuracies along the way will result in having to make adjustments that may be minor or huge.
I start by having a very accurate records visit prior to surgery. This involves detailed scans as well as an accurate centric relation bite at my desired vertical for function and esthetics—no different from a full-mouth rehab case. Unfortunately, for efficiency this appointment is delegated to an assistant who may not understand the dynamics of vertical dimension and centric relation (CR). Right from the start the records and bite will be inaccurate and the lab will be left to guess. With these accurate bite records, a design is created or a virtual wax-up.
From there, we now must have an accurate scan of the implant field to then merge with our predesign. If this is inaccurate or lacks good reference points, then it will not perfectly merge with our prescan data. There are some workflows we do to create a scan that can merge with our prescan data. If that scan is accurate, which is hard in a surgical field, then all the scans align and we now have an accurate 3D mounted model to build the hybrid. The more accurate this is, the closer the bite will be to perfect (as well as the esthetics). So for me it’s about making sure each step is accurately captured. In my "The workflow: full-arch digital implants" live patient course, I teach doctors how to have this stress-less workflow.
JA: That sounds like an amazing course. Where can our readers get more information?
WP: Either by contacting me on Facebook or going to ExcellenceInDentistryLive.com where all my courses are listed. They are small-group, live-patient courses so we can have more of a study club feel while experiencing the concepts live in the operatory. The courses consist of full-mouth implant cases as well as full-mouth cosmetic cases on teeth.
Utilizing 3D-printed temporaries on natural teeth is also a great way to utilize this technology. The temporaries hold up better for long-term staging cases, and the tissue response to the precise fit margins trump anything we can do with bis-acryl or other similar products. This technology has made everything I do more fun and profitable, and has led to better outcomes for patients.
Editor's note: This article appeared in the October 2022 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.
