The world of dentistry is transitioning from a hybrid analog/digital workflow to fully digital, spurred on by the reduced cost and increased reliability of 3-D printing. This fully digital workflow includes the capturing of patient anatomy with a digital scanner, the manipulation of that 3-D model in CAD/CAM software, and the in-office fabrication of the required dental appliances. 3-D planning and printing have and will continue to change endodontics and general dental treatments, especially in the in-office fabrication of surgical guides for dental implants, access guides, apical surgery guides, nightguards, and aligners.
The Real-World Side of Digital
The standard workflow for patients who needed orthodontics, a crown, or even an implant has always involved taking a negative impression of the patient’s dentition using myriad waxes, pastes, and polymers. This impression would then be sent to a lab, where the necessary dental appliance would be fabricated with a mixture of computer-aided milling and skilled labor. After completion, the appliance would be mailed back to the clinic, where it would be utilized as needed.
But the increased adoption of 3-D printing by dental professionals is shifting the paradigm away from remote fabrication and toward the in-office creation of dental appliances. At Kelliny Endodontics in southern California, 3-D printing has become the last step in the fully digital workflow. The quick turnaround time for a 3-D printed dental appliance on a printer such as our SprintRay MoonRay 3-D printer means that the outputting of a physical device from a 3-D design no longer needs to be outsourced. The production can happen inside the treatment clinic.
Improved Accuracy in Dental Work
Digital imaging is much more accurate and less physically invasive than traditional impression methods. If a component of a patient’s dentition fails to scan digitally, a technician can easily re-scan that part of a patient’s mouth. If a wax or silicone impression fails, the entire process must be repeated. With 3-D imaging, mistakes are immediately apparent and easy to correct. With traditional impression methods, it isn’t always immediately apparent when a mistake is made, which means that sometimes an entire appliance can be fabricated with the wrong dimensions and the mistake isn’t caught until it is placed in the patient’s mouth weeks later.
Constantly seeking to improve the accuracy of our implants and the experience of our patients, we leapt at the opportunities presented by 3-D printing, adopting the technology into our practice since its inception. We currently use a high-resolution 3-D printer from SprintRay that has enabled us to innovate in the creation of surgical guides for root canals and apical surgeries.
After a handful of test cases, we found that surgical accuracy improved to nearly 100%. We are so confident in our surgical guide root canals that, after drilling through the guide, no second look is required. 3-D printing also lets us pioneer methods to reduce endodontic surgery times from 1.5 hours down to between 5 and 10 minutes.
Unmatched Convenience, Improved Care
3-D printing can reduce the inconvenience of dentistry to patients through increased speed and improved care options. Guided surgery, once a prohibitively expensive procedure, is becoming more widely available due to the decreased costs of fabricating guides. Historically, treatment might be put off for weeks after an issue was identified while a surgical guide was developed offsite. With the advent of 3-D printing, our patients have gone from waiting weeks for treatment to getting the same-day printing of the required surgical guides for their treatment.
Not only does 3-D printing make the development of surgical guides much quicker, it also reduces surgery time. 3-D printing can enable more dentists to provide care formerly limited to specialists, which lowers treatment cost. The printer itself also offers significant cost savings to the practice. We estimate a yearly savings of 30% to 40%. In fact, our 3-D printer paid for itself in producing just eight guides.
Conclusion
Even as an early adopter, our practice has seen this reduced discomfort lead to fewer post-operative visits, leading to less total time spent in the chair. We see the benefits of 3-D planning and printing reaching far beyond just endodontics and dental science. Orthodontics, prosthodontics, and general dentistry can all benefit from the production of in-office applications.
Broadly conceived, digital dentistry has been an open system consisting of digital scanning and the manipulation of captured 3-D images through CAD/CAM software. The proliferation of inexpensive desktop 3-D printing is leading us toward a new standard of care that will close the system of digital dentistry to create fully digital, highly flexible workflows for clinicians and patients. The output of dental appliances in-office at a fraction of lab costs will bring about positive change in the industry.
Dr. Kelliny earned his BDS from Cairo University in 1992. He graduated with a DDS from the University of Southern California (USC) in 1998 and earned a Certificate in Endodontics also from USC in 2001. He is currently a part-time clinical assistant professor with the Herman Ostrow School of Dentistry of USC postgraduate endodontic program and has been teaching at USC since 2002, where he is involved in teaching and lecturing residents on various aspects of endodontics with a specific emphasis on surgical endodontics, 3-D endodontics, and dental Implants. Heis a member of the ADA, California Dental Association, Western Los Angeles Dental Society, American Association of Endodontists, American Dental Society Anesthesiology, and International Congress of Implantologists. He can be reached at dkelliny@gmail.com.
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