Move over CAD/CAM, here comes 3-D Printing…

On a recent episode of the Big Bang Theory, Raj and Howard, disappointed with their purchase of expensive action figures of themselves ...

by Audrey Sim, DDS

On a recent episode of the Big Bang Theory, Raj and Howard, disappointed with their purchase of expensive action figures of themselves, decide to get a 3-D printer to make their own action figures. Of course the printer they buy ends up costing quite a bit more than they originally spent, but if you're a fan of the show, you know they'll do anything for nerdom.

The show hadn't yet ended and my mind was racing. This technology would be incredible for dentistry. Being a lover of technology, a user of CAD/CAM for 10 years, a user of CEREC, and now E4D, I wish every year I had a connection to get into the International Consumer Electronics Show (CES). Why hadn't I heard of 3-D printing? There had to be dental applications for this technology. As soon as Big Bang Theory ended, I immediately began to Google, and indeed 3-D printing has already made an entrance into our profession.

My first stop was YouTube. If you have never seen a 3-D printer in action, I highly recommend "the wrench video." ZCorp prints a working wrench complete with color and moving parts from a digital scan of a wrench. It will blow your mind. Last month for a Cub Scout visit to my office, after giving everyone their oral hygiene lesson, an intraoral camera exam, and showing them the E4D, I talked about how 3-D printing is being used in dentistry, and ended the tour with the wrench video. They were amazed and delighted, except for one mother who said her husband had been bugging her to buy one and now her son would be too!

My next stop was Wikipedia to find out how the process works. 3-D printing is the opposite of CAD/CAM, which is a subtractive process of removing layers of material from a solid block of material. 3-D printing is an additive process of making a 3-D object of virtually any shape from a digital image using a multitude of mediums, complete with color and moving parts. Laying down the materials in successive layers, the object is created from the inside out. Artists are now experimenting with this technology because it allows us to create objects that cannot be made by any other method. 3-D printing has been used for years for rapid prototyping in manufacturing. It allows designers to create prototypes without investing in expensive tool and die. 3-D printing provides custom-part, single-unit production with high accuracy to the degree of microns making it ideal for use in dentistry.

Current materials for 3-D printing are:

  1. Thermoplastics
  2. Electronically conductive plastics
  3. Titanium alloys
  4. Metal alloys and foil
  5. Paper
  6. Photopolymers
  7. Liquid resins
  8. Full color sandstone
  9. Rubber-like materials
  10. Glass
  11. Foods (chocolate!)
  12. Medication
  13. Bio-ink make of cells and stem cells for tissue generation
  14. Human skin
  15. Nylon (In March 2013, a fully-articulated nylon, 3-D printed gown was unveiled by designers Francis Bitoni and Michael Schmidt. The dress had 3,000 joints, allowing the dress to seductively flow with the woman who wore it.)

Presently, 3-D printing is being used in dental laboratories around the world. Orthodontic labs are using it to make models and aligners, and restorative labs are using it to make patterns for fixed prosthodontics, surgical guides, and complete removable dentures. According to iData Research, the U.S. prosthetics market reached over $11 billion in 2010, and will grow another $5 billion over the next five years due mainly to digital technologies. The leader of the pack in printers is the Stratasys' Object Eden260V, which won the 2013 Product Award - Top Innovative Equipment from The Dental Advisor magazine in January, and the Reader's Choice Award from Dental Lab Products in 2011 for its high accuracy (down to 6 microns), outstanding surface detail, and easy management and maintenance.

Home 3-D printers are becoming smaller and more affordable as well. Cubify by 3DSystems™ has models available for purchase on their website that are under $3,999. The Cube®, which sells for $1,999, is wireless and weighs just under 10 pounds (about the size of a coffee machine). It uses strong recyclable ABS, acrylonitrile butadiene styrene, and compostable polylactic acid. The materials come in 16 colors, including metallic silver and glow-in-the-dark. The downside is that its current accuracy is about 0.5 mm, according to user reports. The Cube's big brother, the CubeX, drew big crowds at this years CES and was voted a CES 2013 People's Voice Award and a CES 2013 Best Emerging Tech Award.

3-D printing services are also available through the iPhone, iTouch, or iPad. Scuplteo offers a free app on which you can design objects that Scuplteo will 3-D print and ship to you within a few days. You can even take an image of yourself to incorporate in your designs, and then share your designs via FaceBook and Twitter.

After investigating this technology and looking at how far digital technology has come, it will surely only be a matter of time before we bridge the gap between the expensive and highly accurate 3-D printers and the inexpensive, inaccurate home-use printers. If I could print composite restorations, this could be a wonderful solution to the effort of layering composite and those pesky contact problems of direct placement of Class IIs. Perhaps with one or two scans of the tooth with a wand connected via Wi-Fi to my iPhone, I could design a composite and print it chairside. Maybe one day I will be able to print my models in my office rather than take alginates and pour them up in stone, which with every step allows for error. If I can't find exactly what I want to wear in my closet, I will print a new dress by purchasing the latest fashion from my favorite designer, all while printing my breakfast.

Perhaps that Star Trek food replicator isn't as far in the future as we thought.

Audrey Sim, DDS, has practiced general dentistry in Algonquin, Ill., for 20 years. She co-founded a group practice that was nationally awarded Dental Economics "Dental Practice of the Year" in 1998 and now practices solo providing general, cosmetic and same-day dentistry. She can be contacted at www.draudrey.com.

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