Teeth Being Restored and Jobs Being Reshored
May 10, 2017 by Kevin Ayers - Consulting Editor
One of the early applications for 3D printing/additive manufacturing (AM) was in the medical industry. As the machines and materials have improved, the use of these technologies expanded into almost every application. In medical, there are unique challenges as patient safety is paramount and government regulation and insurance issues structure what can and will be done. But medical and especially the dental industry is a perfect use of AM. Why? Because although AM has improved in capability and cost, it is still the most beneficial when used in customized products and short production runs.
Traditionally, dentistry has made good use of mainstream manufacturing methods. Many of the low-volume molding technologies, for instance, have been applied for years. That led to small labs cropping up everywhere so that at one point they numbered around 14,000 facilities across the country. In the last 20 years, small CNC machines have been employed in these labs and later in some dentist offices. Software for the manufacturing technologies used in dentistry evolved. Serious business enterprises developed.
There is money in dentistry and it is for the most part a recession-proof industry. However, times change for good or bad and the US-based dental manufacturing industry suffered setbacks.
What happened to the manufacturing in the US dental industry was in parallel with what impacted US manufacturing overall—overseas competition. The Chinese began to make serious inroads in the US dental market, making products cheaper and, in this case, better. The dental labs in the US went from 14,000 down to where there are only some 6500 today, with three labs closing daily.
But something changed within the last two years—technology. In this case, 3D printing has arrived. Now new labs have started to spring up and older institutions have not only been revived but are flourishing. Case in point is what has happened to Albensi Laboratories (Irwin, PA).
Dental building platform is a demonstration piece made by EOS to show AM’s versatility
in making custom components en masse.
Albensi is typical. Started in a basement in 1973, Albensi began making crowns and other dental pieces. The business prospered quickly, growing out of the basement to a new facility with 25 on staff and revenues reaching $25 million a year. Emphasizing customer service and a quick turnaround, Albensi developed a loyal clientele. However, in 2002, Albensi began losing business to China. The company was impressed with the pieces coming out of China and in 2003 changed its business model. Albensi began outsourcing much of its work to China but this was only a temporary fix. In order to survive, Albensi would have to make products faster, cheaper, and better than the competition.
In 2009, Albensi began pursuing what we call the modern dentistry digital lab. It added a small CNC machine and began teaching its staff in the use of CAD/CAM. It gambled by putting its profits in digital capability. It then added a 3D scanner and a 3D Systems additive manufacturing machine. Albensi soon found out that it could now compete with its Chinese counterparts both in price and quality.
The result is that not only has Albensi survived but prospered. It has outgrown two facilities in that time and currently has 160 employees. It has added six AM machines from EnvisionTEC and Stratasys as well as 14 CNC machines. Additionally, Albensi has discovered what many in the AM world have also found to be a big plus, namely that AM gives you many value-added benefits.
Counting the Blessings
One of these is time. Dental pieces can now be delivered in a few days and possibly the same day under the right conditions. A new offering by FedEx has helped. Replacement pieces can be regenerated on demand just by running a new job from the digital file. New materials have been made that meet the industry standards and there are more coming as the industry grows. Furthermore, AM produces parts without the restraints of manufacturabilty from geometry concerns. And finally, there is much more customer satisfaction in having your dental lab closer to home especially when there is an emergency or other problems.
The first stab at a dental application was made by the early general purpose AM machines in the 1980s. Now the AM OEMs are making custom machines just for dental applications. AM takes the efficiencies of digital design to the production stage. By combining oral scanning, CAD/CAM design and 3D printing, dental labs can accurately and rapidly produce crowns, bridges, stone models and a range of orthodontic appliances. With a 3D printer doing the hard work, dental labs eliminate the bottleneck of manual modeling and let the business grow.
For those eager for the day when everything from scheduling to finished restoration can be achieved digitally and automatically, the future is here. For those interested, check out some of major OEM websites like EnvisonTec, Stratasys, and 3D Systems for equipment and materials.
A key to continued AM growth in the dental field will come down not just to machines but to material development. Take EnvisionTEC (Dearborn, MI). The company essentially has two printer lines for the dental industry: the 3SP line, which is aimed at dental labs like Albensi’s that are focused on quality production, and the Vida line for dentists and orthodontists, which offers the ultimate in-office flexibility in terms of the variety of products that can be printed. EnvisionTEC is spending just as much R&D money on materials as on its printers. In addition to its clear E-Guard material for 3D printing mouthguards and E-Dent for direct 3D printing of crowns, bridges and roundhouses restorations, it is working on a new material, called E-IDB, for 3D printing indirect bonding trays for the orthodontic industry, an all-new application that reduces the time to install brackets from about two hours to one.
Continued innovations like this are key to AM’s longterm growth. Thus EnvisonTEC has a wide range of offerings, including machines, approved materials for surgical drill guides, orthodontic appliances, denture bases, models with removable dies, night guards, and bite splints. In total they make 11 different models tailor-made for the dental application.
Stratasys 3D printers can accurately print surgical guides, veneer try-ins, crown & bridge models, models for clear aligners, implant models including the gingival mask, and a wide range of various orthodontic appliances using 3D data directly from intraoral scans and CAD designs through the most popular CAD softwares in the industry, such as 3Shape and Dental Wings.
The modularity of Stratasys 3D printers, from small desktop printers to large production printers, allows for the seamless integration into laboratories of all sizes, from the one-employee lab to a 4000-plus employee laboratory. Multiple printer offerings provide tailored solutions specific to the focus and specialty of the laboratory, whether that be crown & bridge, removables, orthodontics or full-service labs.
Depending on the needs of the laboratory for services offered, Stratasys 3D printers have the capabilities to jet multiple materials from one printer, such as VeroDentPlus (MED690) and VeroGlaze (MED620), perfect for strong, accurate and durable models, as well as a Clear Bio-compatible (MED610) and transparent material, medically approved for temporary in-mouth placement. Additionally, printing solutions from Stratasys bring triple-jetting technology to dental and orthodontics, for printing multiple materials at one time or implant models that mimic real gum-like textures for accurate evaluation. This impressive feature provides users the ability to create gum-like softness and color with complete control.
“3D printing is bringing the dental industry a range of new benefits—better care for patients, more efficiency for clinicians and reshoring of dental work for labs,” said Al Siblani, CEO of EnvisionTEC. “This is the kind of winning disruption that 3D printing offers to a wide range of industries, and while the adoption of these new technologies may come in waves, we see no signs of it slowing down long-term.”
Breakthrough in Dental Bioprinting
The bioprinting of real teeth may be not too far away. In bioprinting, the 3D printer builds a matrix or scaffold out of a biocompatible material. Human cells then are added to each part of the scaffold which multiply to fill the matrix. The scaffolds are designed to help the body with its own healing, tissue building capabilities. The tissue that connects the root of a tooth to the mouth or jawbone is not one type of tissue. It’s a mix of soft tissue and calcified (similar to bone) tissue.
Research was conducted outside the body (de novo) in a bioreactor to see if the combination of a biocompatible polymer scaffold embedded with biocompatible spheres with growth factors and bone proteins would cause regeneration of the complex connective tissue for teeth. The initial results are promising, suggesting that some gum and root issues might be treated with this approach. The next step would be to conduct some in vivo (in the body experiments) to see if the tissues can be regenerated within the body. Typically, this would be done with animals before humans. While promising for a whole new area for dental, it’s not quite ready for use with dental patients. Understanding the regeneration of connective tissue could also open the door to finding ways to regenerate other dental structures. See more in https://envisiontec.com/3d-bioplotter-research-papers/index.php?id=168