Cutting teeth on 3D printing

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Tom Eddershaw reports on the growing use of additive manufacturing in medical and dental practices

Munich will be playing host to a range of additive manufacturing (AM) companies during the Laser World of Photonics trade fair, which will take place from 22 to 25 June. In the medical industry, additive manufacturing is being used to create tailored implants and prosthetics, as well as moulds and impressions in dental laboratories.

In a less direct fashion, AM’s ability to speed up the time-to-market of a product is allowing more companies to get medical products into hospitals, reducing development costs and letting products that might not otherwise have been made reach the patients and doctors that need to use them. The fluid design and new opportunities opened up by the layer-by-layer construction process also mean better designs that are more ergonomic can be implemented, making products easier to use.

Andy Middleton, president of Stratasys EMEA, a 3D printing company, commented: ‘In some cases, surgeons are now able to “practice” surgery ahead of the operation using 3D printed models, enabling them to perfect the treatment and reduce the amount of time patients spend on the operating table.’

Stratasys’ Fused Deposition Modelling (FDM) technology works with production-grade materials, including high-performance thermoplastics, to produce strong, high-performance parts that function like the intended product. ‘For medical device manufacturers, the ability to print tough, durable parts enables them to test prototypes for fit, form and function in their intended environment – bringing products to market quicker than ever before,’ Middleton added.

He said: ‘I predict that 3D printing will become an integral part of the healthcare industry as more dental labs and hospitals realise the potential of this technology. As the benefits of 3D printing become more commonplace within treatment, we will see its adoption grow, but I still believe traditional manufacturing has its place, especially for mass production.’

When asked what the driving factor is behind 3D printing’s uptake in the healthcare industry, Middleton said: ‘The healthcare industry by its very nature is a fast-paced industry that requires fast turnaround. When a human life is directly affected by a technology, users will always look for innovations that can reduce time and improve quality. By bringing 3D printing in-house, doctors and dentists may be able to reduce the time it takes to make a diagnosis.’

Tackling teeth

Dental procedures often have to be personalised to the patient in order to provide the best result. With this being one of the main selling points for AM, companies demonstrated what they could offer at the International Dental Show, held earlier this year in Cologne, Germany. EOS presented partial dentures created using Direct Metal Laser Sintering (DMLS) techniques, Concept Laser provided a selection of entry-level, small build envelope products for dental laboratories, and Stratasys demonstrated its range of 3D printers aimed at the dental market. 

Avi Cohen, director of global dental for Stratasys, said that the cost of laboratory work is becoming a major factor in dental restoration planning and therapy. Because of this, Stratasys is noticing an increase in digital dentistry within dental labs because of the improved efficiencies and the ability to provide a higher level of patient care. 

He said: ‘With an increased range of superior intraoral scanners and associated software now available on the market, more and more dental labs of all sizes are exploring and installing the level of 3D printing technology that suits their company’s size and budget.

‘Most notably, this year we have seen an explosion of devices dedicated to digital imaging, impressioning and CAD/CAM fabrication of restorations – both chair-side and in the lab. With the roll out of new 3D printing systems, materials, and capabilities over the coming year, many believe that more dentists will begin to see the technology as a viable alternative for their practices.’

According to EOS, the dental industry has now accepted additive manufacturing as a useable process for products, with nearly 100 of the company’s systems installed worldwide, as of March. EOS said five million units are produced each year which includes partial dentures, dental crowns and dental models.

EOS described the benefits of using AM compared to more established techniques. Conventionally a dental prosthesis is produced using a wax model based on a cast model to create the part, which can be time consuming. But EOS said that with AM the part can be produced quickly ‘with just a few clicks using the flexibility of design offered by the modelling software. This leads to high strength, rigid and at the same time filigree geometries, while casting errors are eliminated.’

Concept Laser has also noticed huge growth, with dental technology turnover in 2014 improving by 75 per cent when compared to the previous year. Oliver Edelmann, vice president of global sales and marketing at Concept Laser, said: ‘Although dental technology is not the greatest mainstay of turnover, it is a technically very sophisticated segment that is continuously growing and also has extensive potential worldwide.’

Concept Laser’s most relevant model for dental technology is its small Mlab Cusing series. The company said a key feature of the Mlab Cusing R is the drawer principle with a handling station for the safe handling of material. The drawer allows material to be changed quickly without any risk of contaminating powder materials.

Edelmann said: ‘The 200W laser is of particular interest to dental technology. It makes very sophisticated components possible, which are ideal for multi-unit bridge structures. Extremely high surface quality is the result. A new feature is the multi-laser technology with two 200W lasers, which can, of course, also process reactive materials, such as titanium.’

However, manufacturers still need to proceed with caution. Stratasys’ Cohen said: ‘With any new technology, there may be obstacles that delay adoption. With digital dentistry some may argue that the initial cost of buying a 3D printer and the materials may cause further considerations. Although, with the cost of laboratory work – a major factor in dental restoration planning and therapy – a growing number of forward-thinking dental labs are adopting digital dentistry as a viable option over plaster moulds, since 3D printing significantly reduces the cost per model.’

Also, dentists may need to be re-trained to use 3D printing as a complementary technology in order to improve the uptake of in-house systems. This being said, dentists-in-training could be taught to use the technology without too much difficulty. Cohen said: ‘The new generation of dentists joining the industry are armed with training in CAD and 3D printing, and we are seeing this new generation driving digital dentistry.’ 

Cohen concluded: ‘We might look back at this year as the moment that dental laboratories passed the point of no return from a traditional manual workflow toward an all-digital design and manufacturing process. In many respects, digital dentistry is already here, with a growing number of laboratory owners incorporating it in some form into their strategic business models.

‘For many dental professionals, this evolution has been a long-awaited and welcome transition to a more rapid and labour-saving process that improves quality and precision while keeping businesses competitive.’

Printing Prosthetics

There are an increasing number of stories appearing in the mainstream media about prosthetics being printed. As in the dental industry, a scan is taken of the surviving bone structure and tissue surrounding the affected area. This is then used to design a replacement prosthetic that fits perfectly to the patient with all of the support structures in place. One example took place at Morriston Hospital in Swansea, Wales, where a motorcycle crash victim had part of their skull reconstructed using 3D printed plates. 

But it’s not just the customisation made possible by AM that offers promise in the medical field. The reduced cost of a tailored prosthetics has allowed an American charity called E-Nable to create 3D printed prosthetics for children and adults who have wrists but no fingers, or elbows with no wrists or hands. E-Nable works with another charity called Limbitless Solutions.

E-Nable notes that its prosthetics provide simple grasping motions, but are not designed for supporting a child’s weight. However, a simple gripping motion gives a child a degree of freedom before receiving a more advanced prosthetic. 

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