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3D Printing in Dentistry: From a Broken Tooth to Digital Revolution
Nancy calls me at 1:30, “I just ate an olive pit and cracked my tooth. A big chunk of it is gone, it hurts and is really sharp against my tongue”. Nancy arrives at my office at 2 with half of her back molar has chipped off. Her teeth get scanned with an intraoral scanner and we design a digital crown. Next the design gets sent to a milling machine that precisely carves it out of a block of porcelain. At around 3:30 Nancy has a functional, permanent, esthetic new tooth in place of her chip and is back at work.
Nancy’s injury happens all the time in my office. Our digital workflow, computer assisted design and computer assisted milling (CAD/CAM) allows us to create strong and precise teeth restorations in under 2 hours. A few years ago this took two weeks.

Milling is a great way to make teeth but there are some limitations. The shapes we can mill are limited by the shape and size of the cutting instruments. In other words smooth round objects are easier to mill where as sharp or thin objects are difficulty. Teeth tend not to be smooth and round.
Color is another limitation of milling. It is very difficult to add different colors or translucencies to a milled crown. Currently the approximate color of a tooth is taken and a solid block of that color is milled into a crown. Teeth are not a single color but are actually made of multiple shades and opacities of enamel.

3D printing offers a solution to these limitations. By adding material we can make it almost any shape we want from a paper-thin veneer to a deep molar grove. It also has the potential to add different shades and translucencies to our restorations making them look more natural.
Currently we are using 3D printers in dentistry for surgical guides, temporary prosthetics and treatment panning. The big jump will be when we can throw away our milling machines and start printing veneers and crowns that can be placed permanently the same day of treatment.

Sirona the leading manufacture of digital crowns and milling machines suggests digital printers to still be several years away before they are ready for the dentists office.
One of the major limiting factors is that milling is really fast. It takes about 5 min to mill a block of porcelain into a crown then 15 min to bake it. 3D printing has a ways to go before it can catch up to those times.
As printing times get closer to milling I predict a fast adaptation of this technology. Printing opens up the possibility to produce a crown that can be color matched to adjacent teeth pixel by pixel. That will be a game changer is cosmetic dentistry.
About the Author: 


Dr. Russell Taylor received his Doctorate of Dental Medicine from McGill University in Montreal Canada. Subsequently, he went on to complete a residency in Advanced General Dentistry at the University of the Pacific in San Francisco. Currently, Dr. Taylor practice’s clinical dentistry in San Francisco and is an adjunct faculty member at the University of the Pacific Dugoni school of Dentistry. He also serves as a director for the San Francisco Dental Society. Dr. Taylor lectures throughout the United States on cosmetic dentistry as well as dental implants. He also volunteers within California in large-scale clinics that provide no cost dental service to the under served. Internationally, Dr. Taylor provides charity dental services in countries like Ecuador, Vietnam and the Fijian islands. He is focused on starting a residency program in Vietnam for new graduated dentists to help them better serve their community. Dr. Taylor’s is passionate about incorporating technology into in his dental practice to promote, maintain and restore oral health.

 

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