The future is here

It’s the new frontier in dentistry—3D printing, and it’s set to revolutionise the work of dentists, especially once the price comes down. By Andy Kollmorgen

Consider the current regimen for fitting a crown. First you have to make a physical mold of the tooth, then put in a temporary crown, then tell the patient you’ll see her again in a couple of weeks. The mold goes off to the lab and, with luck, a crown that fits comes back.

It’s a lot of steps, really.

Now imagine you can simply insert a digital camera into a patient’s mouth, fire up the software, and digitally design a custom-built crown on the spot.

In this perfect world, you can masterfully tap the keyboard and send the digital file to the CNC (computer numerical control) milling machine in the next room, where you and your patient can watch in wonder as a perfect-fitting crown is sculpted from a block of dental deposit.

Welcome to the new frontier of dentistry, where procedures take a fraction of the time they once took, leaving you with more hours in the day to see more patients and to generate more revenue. And what happy patients you will have, given their dental problems will be solved so quickly and easily.

Is there a catch? Well, yes. The technology that makes all this possible, a dental 3D printer and supporting software, doesn’t come cheap.

In February this year, the Singapore-based 3D printing firm Structo launched its latest dental 3D printer, the Structo DentaForm, at the Association of Orthodontists (Singapore) Congress. (Structo’s earlier model, the OrthoForm, was released last year.)

As dental 3D printers go, it was a big moment, especially if brisk efficiency is a priority for your practice.

According to the company, the DentaForm is capable of printing accurately within 50 micrometres—more than accurate enough for pinpoint dentistry.

It can print models for crowns, bridges, full arches and quadrants—30 models in an hour and a half, the company claims.

As Structo co-founder Huub van Esbroeck puts it, “We are revolutionising digital dentistry by breaking through the speed limits of 3D printers.”

Breakthroughs cost money, but the company declined to reveal the asking price of its latest product, saying, “As we are a solution-based company, pricing depends on the details of a tailored solution which is a case by case basis.” It’s fair to say that any full-scale 3D printer set-up is likely to run well into six figures.

CEREC machines, which also perform CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) procedures and have made their way into dental practices across Australia, aren’t cheap either.

But CEREC machines differ from 3D printers in that, with CEREC, you chip away at a piece of existing material instead of building a model from scratch. With a 3D printer, you can print a complete restoration without needing to, for instance, layer composite.

“We believe the market is going through a stage of consolidation. As more corporate dentistry groups emerge, they will need to start thinking like a lab in terms of managing their manufacturing processes.”—Jonathan Lim, marketing manager, Structo

Generally, the promise of 3D printing over CEREC technology is greater accuracy and efficiency.

For companies like Structo, whose 3D printers are available around the world, most of the business has come from dental labs and corporate dentistry groups, where printing volumes are high.

“However, we do have a few customers who own a chain of clinics who have insourced their manufacturing process and opted for 3D printing, and we are constantly getting inquiries from individual practices. Unlike in individual practices, 3D printing has been deployed in laboratories for various applications for some time now,” said Structo marketing manager Jonathan Lim.

The DentaForm is not the first 3D printer to hit the Australian market. Stratasys 3D printers have been available locally for a few years, and early adopters of the technology include Victoria-based tdl Precision Orthodontics.

Still, the proportion of dentists worldwide using digital tools such as 3D printing technology is only somewhere between five and 10 per cent. In Australia, 3D technology is largely confined to labs, though its uptake has been on the rise in recent years.

Lim sees that trend continuing. “We believe the market is going through a stage of consolidation.
As more corporate dentistry groups emerge, they will need to start thinking like a lab in terms of managing their manufacturing processes.”

It’s an evolution that will require access to capital, and not just for the printer. You will also need to consider which sort of software will best serve your practice’s needs, and where to find it.

Structo is not in the dental treatment planning software game, but CAD/CAM products such as 3Shape and Maestro3D have made a name for themselves. Harmonising your hardware, software and practice needs will likely require some tech support.

Not surprisingly, the 3D printer industry makes the case that the costs of the new technology will be recouped through greater practice efficiency and productivity. They may have a point.

Structo claims that the recent introduction of its 3D printers to Singapore’s FDC Dental Group comprising 21 clinics has cut the costs of clear aligners (an alternative to braces) to the practice by 50 per cent per patient and halved the time it takes to go from initial appointment to completed procedure. Previously, FDC Dental had outsourced its aligner manufacturing.

“With the growing volume in cases, we saw the opportunity to start managing the process ourselves in-house to better control the quality of the aligners and reduce manufacturing cost,” said CEO Dr Nural Aizat.

One sure sign that 3D printing is making significant inroads into Australian dentistry was the move by the Australian Dental Industry Association (ADIA) in January 2016, working with the ATO, to simplify arrangements for determining the lifespan of 3D printers and related depreciation calculations for tax purposes.

With technology continuously on the march these days, the ADIA recommended that the lifespan of these units for depreciation purposes be set at three years instead of four.

“ADIA received advice that the rapid advances in 3D printing technology are, in some circumstances, likely to render newly acquired units obsolete within a four-year period thus this timeframe was considered excessively long in duration,” the industry body said.

The question is whether dental practices will become obsolete if they don’t eventually upgrade to technologies like 3D printing or align themselves with labs that have such resources. That time may still be a way off, but it’s looking more certain that time will come.

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