How to Incorporate 3D Printing into Restorative Workflows

By JLO_FOTO / stock.adobe.com

3D printing technology has many capabilities for restorative dentistry regarding patient experience and practice growth. 3D printing also opens up many possibilities for same-day dentistry. We spoke to two of our dental technology experts to hear how you can incorporate 3D printing into your restorative workflows. Here's what they had to say. 

Fixing Teeth Faster and Easier

John Flucke, DDS and Technology Editor for DPR, uses his 3D printer in restorative workflows in many ways. For example, his private practice in Lee's Summit, MO, uses the 3D printer for temporaries, surgical guides, and virtual implant placement, among other capabilities. He says 3D printing ramps up what you can do in same-day dentistry for a patient with a missing tooth (or teeth) or mixed dentition that wants their teeth "fixed." With a cone-beam device and a 3D printer, you can treatment plan implant placement. He says you can put the implants in precisely the places you want them down to the tenth of a millimeter and 3d print the surgical guides.

"Somebody can walk in either completely edentulous, edentulous with an ill-fitting denture, or partially edentulous, and within 24 hours, they could have implant surgery and have the situation rectified," Dr Flucke says. "And that is something we have never been able to do before."

Moreover, the surgical guide provides such precision that you don't have to guess if you have the placement correct, he says. Dr Flucke says that hand skills in these cases are not as important as the skill in designing with the software.

"The actual drilling of the holes in the patient for the implant anybody could do because it's been so simplified," Dr Flucke says of the 3D printed surgical guides. "But you have to know what you are doing with the software."

Dr Flucke says you can print anything you can imagine, adding that on his desk, he has a butterfly he printed. You can print dentures, screw-retained temporary crowns that you place on the day of surgery, or occlusal guards, to name a few. Like the surgical guides, it is best to design the appliance in the 3D printer's software to optimize the fit and minimize adjustments. 

"In the computer, you can design a nightguard and then print it and it fits. You can line it up, just like everything else, so that when you put it in the patient’s mouth, you don't have to make adjustments," Dr Flucke says.

However, you can make adjustments to your restorations if necessary, he says, and they are easier and more efficient with 3D printers. For example, in a full-mouth reconstruction for a heavy bruxer who has worn down their teeth by several millimeters, you can make a prosthesis that is a few millimeters taller than the teeth are now to see how it feels in the jaw joint when the patient chews. If the prosthesis isn't tall enough, you add a couple of millimeters to the design and print a new one to see how that feels, Dr Flucke says. 

"Printing one of these in an hour is so nice," Dr Flucke says. "It used to be when people would do this, they literally would do it either with plastic crown and bridge temporary material or sometimes building the teeth out one by one with composite. You can imagine what that must have been like for both the doctor and the patient."

3D Printing is also great for when a patient loses a denture. The practice can print a new denture from the existing digital files, and the patient or caregiver can come to pick it up. It will fit because it is the same denture they had before.

"That is the great thing about all this digital stuff," Dr Flucke says.

Dr Flucke had a patient who called in because her dog ate her occlusal guard. It was simple for him to replace because the files were in the cloud. Like a Word document, he says, you can print as many copies of the files as you want.

"I said, 'okay, you want a new one? Let me just hit the print button, and in about 52 minutes, you can come by and pick it up,'" Dr. Flucke says.

Dental materials manufacturers release new 3D printed permanent materials so dental professionals can 3D print final crown restorations instead of milling them. Right now, there are at least three available, which are resin-based monomers. However, they are brand new, so there isn't much research on whether these materials can hold up long-term.

Dr Flucke says that he wouldn’t be worried about using these materials. Still, he would set proper patient expectations and only use the materials for a permanent restoration on a case-by-case basis at this point. For example, he would have concerns about using these materials with a placement where powerful occlusal forces exist or where the patient has broken crowns before. Furthermore, any restoration placed with these materials would need to have appropriate preps and margins before feeling comfortable. He says exercising caution with untested materials is paramount because you are "dancing on the edge" of innovation. 

"When you have something brand new, you want to make sure you are using it in the most judicious way possible," Dr Flucke says.

Dr Flucke says that you and the team must be comfortable working with the software for your 3D printer. He also recommends making it part of what the team members do in the office. It not only frees up the dentist's time for the hands-on work he or she needs to do, but it gives the team more job satisfaction to work with technology. They appreciate it.

"If you're compensating the team with a bonus based on production goals, then printing more occlusal guards in a month is good for everybody. It's not like the team members feel like, 'Oh great! One more thing I have to do,'" Dr Flucke says. "My team looks at it like it helps them get closer to hitting their production goals for the month. That rising tide floats everybody's paycheck."

High-Quality Care, But Faster

Jeff Rohde, MS, DDS, has a private practice in Santa Barbara, CA, and has been delivering same-day dentistry care for many years. He feels that same-day dentistry technology like his 3D printer allows him to provide the same high-quality care he always has, but faster.

"Same-day dentistry is not hurry-up, garbage dentistry," Dr Rohde says. "Same-day dentistry is a way to deliver high-quality care, just using new technologies."

Recently, his 3D printer allowed him to provide a temporary stent for an older adult in her 70s who had fallen and shattered her bridge, which extended from the back molar to the front tooth. Dr Rohde did a CEREC® scan, which he then sent to the lab for a 3D Digital wax-up. They sent the model as an STL file, which Dr Rohde printed in-house. A week later, the lab returned her permanent restoration. When Dr Rohde compared the final bridge with the temporary one he had printed a week earlier, he saw that the temporary was as good as her original bridge, which he credits to the design software and scaffolding with which he had to work. 

Another area where the 3D printer comes in handy is with long-term Provisionals. For example, Dr Rohde says, if a patient has knocked out teeth in the anterior and may or may not have an implant, you need to make a flipper. Dr Rohde and the team do a digital scan, print the model, which he says takes about thirty minutes to print, and then scan the model into the system. He then designs an Essix retainer with temporary tooth mills out of a material that he doesn't have to fire and then bonds into the retainer's edentulous space. The patient leaves with a perfectly-matched, clear aligner Essix retainer with a tooth on the same day. All of this takes an hour to fabricate, he says.

These are only two recent examples of how he uses the 3D printer. He says there are many ways to use it to deliver the care you want faster with the help of same-day dentistry technology. Moreover, that workflow is the future of dental care.

"That's where we are going," Dr Rohde says of the same-day dentistry workflow using 3D printing. "How can we do more rapid treatment to the final result without compromising?" 

Dr Rohde knows that some dentists are resistant to the idea of incorporating same-day dentistry and 3D printing technology into their workflows. He says he often has conversations with dentists that say they don't want to design their restorations. Dr Rohde explains that the software has improved to the point that it is not difficult to create restorations. 

However, Dr Rohde also says that the decision to move forward comes down to how the dentist wants to grow their practice. Same-day dentistry experiences are better for patients and provide quality care faster. You only have to numb patients once, and patients don't have to come back. While it's not the only way to provide quality care, Dr Rohde thinks using same-day dentistry technology like 3D printers is the better way to do so.

"We should be using the latest materials and technology that can give our patients a better experience," Dr. Rohde says. “What kind of practice do you want to have?”