For years, “print a crown while the patient waits” has been more aspiration than clinical routine. Milling has dominated same-day restorative dentistry, and resin-based 3D printing has largely been confined to models, surgical guides, and temporaries. That balance appears to be shifting in light of the latest news in dental 3D printing. Across the first half of 2026, a cluster of regulatory clearances, material launches, and academic results suggests that permanent, chairside-printed restorations are moving from novelty to a real clinical option. Why is this such a big deal? The current permanent crown workflow involves at least two office visits and a minimum of two weeks of waiting time for the crown to be ready for placement. During the weeks between visits, patients often have to wear a clunky, essentially nonfunctional temporary crown. With chairside permanent crown availability, patients can potentially receive same-day treatment, avoiding additional trips to the dentist and the inconveniences of a temporary crown. So it is a huge deal. However, after some investigation, there appear to be real caveats that any dentist or patient should understand before assuming printed crowns can simply replace milled or sintered ones.

The Headline Development: SprintRay’s FDA Clearance for Porcelain Crowns

The most consequential news is SprintRay’s FDA clearance to 3D print porcelain crowns. The company’s CEO, Amir Mansouri, has framed this as roughly 10 times the addressable market of its existing nightguard business, since SprintRay estimates that around 40 million crowns are produced annually in the United States, almost all of them currently routed through outside dental laboratories with a multi-week turnaround. SprintRay’s pitch is that its printers can now produce a crown chairside in 10 to 20minutes, collapsing weeks of lab logistics into a single appointment.

What makes this more interesting is the pricing strategy attached to it. SprintRay is evaluating subscription models to soften the roughly $15,000 upfronthardware cost, an approach explicitly aimed at making the technology accessible to general practices serving middle- and lower-income communities rather than only early-adopter specialty clinics. That’s a meaningful gesture when a company designs financing around volume practices instead of premium cosmetic clinics; it’s betting the technology is ready for the mainstream, not just the showcase.

SprintRay has also been expanding the surrounding ecosystem. Its Midas Digital Press platform uses a capsule-based “Digital Press Stereolithography” approach — resin cartridges that resemble single-use coffee pods — to print crowns in under ten minutes, and the company has previewed multi-unit production capabilities at the 2026 Chicago Midwinter Meeting, with enlarged build capsules intended to let practices fabricate several crowns, inlays, onlays, and veneers in one run rather than one unit at a time. A new “HT” (High Translucency) version of its Ceramic Crown resin specifically targets the chalky, flat appearance that has been a recurring criticism of earlier printed-resin restorations.

Why “Ceramic” Printed Crowns Aren’t Actually Ceramic Crowns

While there are several “permanent crown ceramic” resins out there, here are some details that might get lost in the enthusiasm: The materials industry leaders like SprintRay, Formlabs, Keystone Industries (RODIN), and Ceradirect use for printed crowns are not zirconia or lithium disilicate. They’re resin-matrix composites — biocompatible polymer bases loaded with 50 percent or more ceramic filler, typically silanized dental glass or barium aluminum silicate particles bonded into the resin and cured instantly under 405nm light. This is fundamentally different chemistry from pure ceramics, which rely on a glass matrix with crystalline phases like lithium disilicate or zirconia, an apolycrystalline metal oxide with no glass phase at all — sometimes nicknamed “ceramic steel.”

The practical consequence is strength. These reinforced-resin crowns test at roughly 112to 150 MPa of flexural strength. Lithium disilicate ceramics run 400 to 500 MPa. Zirconia exceeds 1,000 MPa, sometimes reaching 1,200. For context, normal human chewing generates roughly 100 to 150 MPa of force on the back molars, meaning printed resin crowns operate close to the edge of everyday biting forces rather than with the wide safety margin zirconia provides. Clinical forums and dental community feedback reflect this: dentists who’ve tried stretching the material beyond single units — attempting multi-unit bridges, for instance — report high failure and breakage rates, and the material demands a strict minimum wall thickness of 1.0 to 1.5 mm, meaning conservative tooth preparations with thinner margins carry a real fracture risk.

None of this makes the technology useless, but it does make it use-case-specific. The speed and cost advantage is dramatic: a printed resin crown can go from scan to seated restoration in 15 to 45 minutes for a few dollars in material cost, versus a 6-hour-plus mill-and-sinter cycle for zirconia or roughly 45 minutes of milling plus crystallization firing for lithium disilicate. That makes printed resin crowns well suited to single units with moderate bite forces, same-day veneers, and immediate temporaries, while zirconia remains the better choice for heavy grinders, molars under high occlusal load, and bridges, and lithium disilicate still holds the edge for anterior esthetics where light transmission matters most.

Ceramics Are Catching Up on Speed, Too

The clearance race isn’t confined to resin. Researchers at UT Dallas published work in Ceramics International demonstrating same-day chairside 3D-printed zirconia crowns, with debinding — the process of burning out organic binders before sintering — completed in under 30 minutes, rather than the 20-to-100-hour cycles typically required for printed ceramics. If that approach scales beyond the lab, it would narrow the speed gap that has kept true zirconia restorations out of single-visit dentistry, potentially combining zirconia’s mechanical strength with a turnaround time closer to that of resin.

Material jetting is advancing on the prosthetics side as well. 3D Systems secured full EUMDR certification for its NextDent Jetted Dentures workflow, clearing the way for a European launch in summer 2026, and reflecting a broader shift from milling toward additive manufacturing for full-arch removable prosthetics. Meanwhile, Axtra3D and Keystone Industries co-developed KeyModel Ultra Ivory, a non-chipping dental model resin validated specifically for Axtra3D’s Lumia X1 platform — part of a wider industry pattern in which resin and hardware are increasingly co-validated as matched pairs rather than sold as interchangeable, open components, which vendors argue improves clinical predictability but also tends to lock practices into single-vendor ecosystems.

So, Is It Real?

Chairside 3D printing of permanent restorations is real in the sense that FDA-cleared materials and hardware now exist, practices are adopting them, and the economics are increasingly built for general dentistry rather than boutique clinics. It is not yet a wholesale replacement for milled ceramics or sintered zirconia. Clinicians on the front lines remain measured in their enthusiasm. As Nabeel Cajee, DDS, of Advanced Dentistry of Newport Beach, puts it:

“I’m still hesitant to use printed resins for definitive restorations. Zirconia and traditional ceramics remain the gold standard for long-term reliability and aesthetic demand, and I’m not fully convinced the materials are quite there yet. That said, even if the physics never fully match zirconia or glass ceramics, the sheer speed and convenience of chairside fabrication may shift both dentist and patient preferences regardless — patients love same-day results, and that’s a powerful force. This is definitely technology to watch as it matures.”

The honest summary is that dentistry now has a genuine third option alongside milling and lab-based ceramics — fast, cheap, and adequate for the right indication, but not interchangeable with stronger, slower materials for cases that demand them. The technology to watch through the rest of 2026 is whether reinforced resins close the strength gap, whether zirconia closes the speed gap, or whether both simply settle into complementary roles based on where in the mouth — and how fast — a restoration is actually needed.

References:

https://www.voxelmatters.com/sprintray-gets-fda-clearance-to-3d-print-porcelain-dental-crowns

Single-step thermal debinding for ceramics vat photopolymerization in less than 30 minutes

https://www.3dsystems.com/press-releases/3d-systems-secures-class-iia-eu-mdr-certification-nextdentr-jetted-denture-solution

https://3dprintingindustry.com/news/axtra3d-launches-keymodel-ultra-ivory-for-lumia-x1-in-dental-materials-partnership-with-keystone-251592/

The post  Is Chairside 3D-Printed Crown Finally a Reality? appeared first on 3DHeals.

While the power of 3D printing lies far beyond the visual awe from the geometric lattices, unique mixtures of organic and synthetic curvatures, many of us were drawn to the technology often because of our visual experiences in our early encounters. Along with the amazing 3D objects that were made and designed entirely differently are stories that are inspirational and encouraging. For example, this box of 3D printed congenital pediatric heart pieces shown during RSNA, a radiology conference I went to almost a decade ago, was my earliest interaction with 3D printing.

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That’s why we decided that we should create and promote an Instagram account to increase the visibility of the creators in the healthcare community and showcase their work to as wide an audience as we could through our #3DHEALSPOST campaign as well as our Instagram Live events last year. We want to continue to be inspired and to inspire others. The result was phenomenal and we have met many inspiring individuals. Here we want to give a Kudo to the top Instagram posts we have reposted through 3DHEALS account. Make sure you give them a Kudo and follow their accounts.

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12. Point of Care with 3D Printed Cast (@3dxcast)

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11. The Power of Our Love and Heart (@esun3dprinting
@tehnalab)

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10. From Cosplay to Prosthetics #PrintedbyPrusa (@printedbyprusa
 @marsgizmo)

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9. Dave Makes Stuff! (@davemakesstuffbc)

What is even cooler is that Dave has made his designs available for download on Thingiverse!

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8. I want to grow up to be Dr. Johnny Uday (@udayjohnny)

Along with this post (cranial prosthetic design by Dr. Uday), there is a recent interview with him that is very worthwhile reading. Stay tuned for the upcoming podcast with Dr. Uday so we can all learn how to create magic like this in the near future.

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7. FRESH Bioprinting Technique (and Cellink) is Everywhere, and We Love them! (@sygnis_nt3d @cellink3d)

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6. Good 3D Printed Orthotic and Prosthetic Designs – Smart Latticing is the Key (@s_d_pro95)

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5. We love dogs…and their 3D Printed Prothesis (@divedesignco)

Check out our IG Live interview with Alex and Adam from Dive Design recently.

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4. Dental 3D Printing: Smooth 3D Workflow can be a piece of Art (@surfctcom @dr.anthonypallotto)

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3. Dave Makes Stuff Rock! (@davemakesstuffbc)

Another blockbuster anatomical design by Dave, also downloadable!

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2. We are making 3D printed implants for animals too! (@udayjohnny)

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1. Can generative design create better medical devices? (@genic_systems)

This is our number one post of the year. This post not only generated a massive number of likes and impressions but also many meaningful conversations among designers and 3D printing engineers, and clinicians. The creator of this post is Peter Domeracki, CEO of Genic Systems, and we hope to hear more from him in 2022.

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Related Articles:

Interview with Dr. Johnny Uday: 3D Printing for Animals

Product Design for Veterinary 3D Printed Prosthesis

IG Live: Tomi Kalpio: CEO of Brinter

Prof. Ali Khademhosseini: Academic Entrepreneur

Robert Pugliese: Design for Healthcare with 3DPrinting

No More Manual Work: Interview with Xkelet CEO and Co-founder Jordi Tura (Video)

3DHEALS Guides (Collective) – This is where we dive deep into subjects that you will find helpful for your projects and career.

3DEALS Expert Corner (Collective) – This is where we invite field experts to write their perspectives in a first-person narrative. To write for this column, please email: info@3dheals.com

3DHEALS From Academia (Collective) – This section features recent, relevant, close to commercialization academic publications in the space of healthcare 3D printing, 3D bioprinting, and related emerging technologies.

The post Twelve Viral Healthcare 3D Printing Instagram Posts in 2021 We Shared appeared first on 3DHeals.

A picture is worth a thousand words. This a recording of our recent IG live session. We had the pleasure to interview Dr. Mayra Vasques, founder of Innov3D. She is also an educator and a passionate technologist for the adoption of dental 3D printing. In this episode, we focused on an application that inspired her journey: a 3D-printed nightguard. This was also relevant to her Ph.D. thesis. We also answered live audience questions, including how the adoption of 3D printing differs between small and large dental labs. Dr. Vasques reveals some facts not commonly known to the public.

Guest Speaker Bio:

Dr. Mayra Vasques is the founder of iNNOV3D an EdTech company focused on supporting and training teachers and universities in Healthcare for the innovative and efficient use of 3D Technologies. The company was founded based on the belief that the best innovative solutions in healthcare will emerge from professionals that are raised familiar with technology and for this, the institutions must be prepared for these professionals.

She started in the additive manufacturing field in 2015, during her PhD Fellow at School of Dentistry at the University of Sao Paulo, where she led a project in additive manufacturing for the development of occlusal splints for patients with orofacial pain. Since then she has been involved in several AM research projects and as panelist in conferences.

She is deeply involved in creating a positive and more accessible local ecosystem in Brazil for digital technology and AM, working for local community building associated with international organizations such as ”Women in 3D Printing” and “3DHeals”.

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Host: Jenny Chen, M.D.

3DHEALS Founder/CEO

Jenny Chen, MD, is currently the Founder and CEO of 3DHEALS, a company focusing on education and industrial research in the space of bioprinting, regenerative medicine, healthcare applications using 3D printing. With a focus on emerging healthcare technology, Jenny invests in and mentors relevant startups, especially companies pitching through Pitch3D. She believes a more decentralized and personalized healthcare delivery system will better our future.

About 3DHEALS IG Live

Over the past 12 months, our IG account has grown significantly, both in content and functionalities. We aim to use this platform to give all innovators an equal playground. Good works will be discovered and highlighted continuously. In addition, we aim to make our IG a window for inspiration. We want people to be able to find futuristic art and design concepts as well as life-changing applications. Every 3DHEALS Instagram post is also directly reflected on our landing page. 

Every Thursday (SF, Pacific Time), we will host IG Live interviews with the Instagram influencers we admire to have formal and informal conversations.

We want to bring these amazing people behind the beautiful images into the spotlight. We will invite them to discuss their works/lives, and at the same time answer to our audiences directly. No filter. (If you have a relevant IG account and/or want to participate in IG Live interview, please email: info@3dheals.com)

Related Links:

3DHEALS IG Live: William Harley, Healthcare 3D Printing Ecosystem in Melbourne (Recording)

3DHEALS IG Live Recordings: 3D Printing in Veterinary Medicine with Richard Doerer

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Want to write a piece for 3DHEALS Expert Corner? Email us: info@3dheals.com

Based on the trends of the last few years, it can be stated that the digital revolution in dentistry has begun and seems to be irreversible. The question is no longer whether it should be introduced, but when, at what rate and to what extent. 

3D printing, and more specifically metal 3D printing, has a key role in this process.

According to forecasts, the world of dentistry will be profoundly transformed by digital dentistry technologies. Experts agree that in the coming years, changes will be driven and impacted the most by 3D printing (additive manufacturing).

3D printing has made a spectacular entry and given a new impetus to the spreading of digital dentistry. Two areas can be mentioned, where the technology is already widely applied and its impact has been significant: 1) the manufacture of invisible orthodontic aligners and 2) metal restorations. This article gives an overview of the latter, based primarily upon the experience gained in Central-Eastern Europe.

Nowadays, typically CoCr restorations are produced by 3D printing in dentistry. At the same time, titanium restorations gain also ground, the share of which is expected to grow by a significant rate in the coming years. 3D printed titanium restorations – owing to the advantageous features of titanium and 3D printing – offer a competitive alternative to restorations made of CoCr and zirconia, as well as restorations made by casting and milling technologies.

Casting is the longest used and most widely spread technology in dentistry. Both CoCr and titanium products can be fabricated by casting. As casting of titanium requires a higher level of technical competence and is also more expensive, with the exception of special works, the prosthetic restorations are typically made of CoCr.

The advantage of casting is its low investment cost, and in line with this the low price of the final product. However, some of the restorations produced by casting (about 10 to 20%), due to the features of the technology, contains inhomogeneity and inclusions. As these products are faulty, they must (should) be fabricated again.

The alternative to casting has been CNC milling for about two decades. CNC milling opened up the way to using new materials in addition to CoCr and titanium, too. A material frequently used for such prosthodontic restorations is zirconia. Zirconia restorations, for the time being, can only be produced with this technology. Moreover milling of zirconia requires a milling machine of lower capacity than that of CoCr or titanium.

One of the great advantages of the milling technology is that it produces a homogenous structure, reducing the ratio of the structurally faulty products practically to zero. An additional important advantage of the technology is that it results in a smooth surface, which is an indispensable requirement at the parts of the restorations fitting to the implants or implant interfaces (referring to as fitting parts later). A drawback of CNC milling is the high price of the product, which is resulted from the high investment costs and the high quantity of raw material (disk) to be used that finally turns into waste to a great extent.

As a result, CNC milling is used primarily for the production of zirconia, and to a smaller extent of CoCr and titanium restorations.

Metal 3D printing offers a new, viable option over casting and CNC milling. 3D printing is suitable for the production of both CoCr and titanium restorations. This latter, due to the explosive nature of titanium-oxide, requires a printer with a working chamber expressly engineered for this purpose, as well as greater technological competence and discipline. (It might be a reason of the current less extensive use of titanium vis-à-vis CoCr).

The product obtained by 3D printing, similarly to milling, has a homogeneous structure, therefore, the proportion of the faulty products is practically zero, too.

The surface of the product is rougher than that of the product made by milling, at the same time – with the exception of the fitting parts – this roughness is acceptable, since in case of veneering with ceramics it can be compensated, and in case of veneering with composites it is even advantageous.

Thanks to the recently developed processes combining 3D printing and milling (e.g. sint&mill), the fitting parts can also be produced in the required quality. Owing to this process, the smoothness of the fitting parts is equivalent to that obtained by CNC milling (as it is made by CNC milling), at the same time, the overall cost of production will be lower than in case of milling.

While the initial investment cost in case of 3D printing is also high, the significantly smaller amount of raw material (powder) required and the higher productivity result in lower specific fabrication costs and, consequently, a favourable product price when compared to milling.

In case of CoCr, the price of the 3D printed products is already competitive with that of the cast items, whereas their quality is higher. Due to the competitive price, 3D printing increasingly replaces casting and CNC milling in some Central-Eastern European countries. What is more, there are several dental labs in the region which produce restorations exclusively by 3D printing.

3D printing opened up new prospects for the fabrication and application of titanium restorations. The use of technology leads to higher quality compared to casting, a lower price compared to milling and greater conformity of the digital model and product compared to both. The advantage of 3D printing over milling is manifest particularly in the case of the various implants (e.g. circular, symmetric traditional or one-off platforms resting on the cortical bone surface) and traumatic platforms, as printing allows the production of such forms, which are practically impossible to make by milling.

Using titanium improves the sense of comfort, as well as extends the lifecycle of the restoration, with the patient being the ultimate winner. The weight of the restorations made of titanium is lower than those made of zirconia and particularly of CoCr (one half of this latter), and their tensile strength and elasticity features are much closer to those of the natural bone. An additional argument in favour of using titanium is its good osseointegration property, which is an important criterion in case of implants, whereas its biocompatibility is preferred in case of sensitivity to traditional metal restorations.

The increasing reputation of 3D printing generated by the positive experience gained so far, as well as the declining prices of 3D printers and raw materials are suggesting the more and more widespread application of 3D printed metal restorations. This is particularly true for titanium restorations, which can also be applied in cases when the use of CoCr is not recommended or not possible.

Those practitioners, who have not yet done so, should try the application of 3D printed metal restorations. To do so, it is not necessary to invest in an own 3D metal printer since there are several service providers and centre on the market which can print these restorations, and naturally we are also pleased to help in respect to both CoCr and titanium restorations.

I express my thanks to my colleague, Mr. Lajos Bozsányi, for this contribution to this article.

About the Author:

Zsolt is strongly engaged in the application of 3D printing in the healthcare sector. He is the Managing Director of Premet (www.premet.hu), a company focusing on the production of 3D printed products, including those made of CoCr, titanium and PEEK, for the dental and medical sectors. He is the leader of a3D Printing Training Centre that delivers a training on digital dentistry. Zsolt is founder and Vice-President of the Hungarian Additive Technology Association. He is the lead expert of a project aiming at facilitating transnational cooperation of Hungarian entities on the application of 3D printing in the health sector. He is very much interested in importing best practices to Hungary and in a broader sense to the Central and Eastern European region and export them from the Region. Zsolt is also the current 3DHEALS Budapest community manager.

Related Articles:

Where does power lie in the 3D printing medical industry? A rundown of Porter’s Five Forces

What Matters When Enabling Your Dental Practice with 3D Printing and 3D Scanning

3D Printing in Dentistry: From a Broken Tooth to Digital Revolution

The post Metal 3D Printing in Dentistry – Restoration appeared first on 3DHeals.

Want to write a piece for 3DHEALS Expert Corner? Email us: info@3dheals.com

Introduction

I commenced experimental research into the safety of 3D-printed devices at the time 3D Printing (3DP) was largely considered to be at a “proof of concept stage” in dentistry. I vividly remember how the technology was relatively unknown in my discipline when I arrived on the splendorous Gold Coast, 7 years ago to take up a lecturing position at Griffith University. It is against these backdrops that I would describe the recent hype and the desperate attempt by companies to diversify and innovate competitively as another milestone or perhaps a watershed in the dental specialism concerned with the design and manufacture of devices such as orthodontic splints (Fig.1), surgical guides, and dentures. While it is seemingly laudable that polymers and metals, which form the bulk of dental devices, can now be processed by 3DP, limited scientific evidence exists on their biological safety. It is, therefore, my intention to highlight some pertinent findings from my doctoral study that examined medically-approved photopolymers using the innovative zebrafish embryo model and analytical spectrometry.

Findings

1. All 3D-printed devices will display a varying degree of toxicity subject to physicochemical characteristics of the materials and postprocessing techniques that include disinfection protocols.
2. Resin formulations on the market are constantly evolving, and hence there is a need to independently verify their biological safety as per intended use.
3. New preclinical standards are required for 3D-printed devices bearing in mind the materials and additive processes differ considerably from traditional counterparts.

Recommendations

Since the different materials and additive processes make it nearly impracticable to achieve a consensus, it is recommended that users engaged in biomedically-related 3DP activities adopt the three-tiered approach that may together guarantee optimal results i.e., approved materials, apposite manufacturing parameters and postprocessing. Likewise, caution is required in the use of third-party materials in “open” 3DP systems without approved certifications. To guarantee patient safety, it is high time manufacturers are compelled by legislation to make available to the general public test results for scrutiny and academic reflection. While standards for preclinical testing are bound to lag behind evolving materials and emerging technologies, the gap can be narrowed considerably if urgent steps are taken to revise those in circulation to reflect the trends toward non-traditional medical devices. For instance, it will be preposterous to evaluate dental devices solely on ISO 20795 guidelines when evidence suggests that they may contain other potentially toxic acrylic esters apart from the recommended residual methyl methacrylate. In this regard, qualitative and quantitative analyses of the chemical composition of the printed devices will be more useful for predicting biological safety. Furthermore, dental devices that are likely to leach toxic substances could be scrutinized for acute toxicity using zebrafish, which has a high genetic similarity to humans, and offers economy and ease of quantifying multiple toxicity endpoints (Fig. 2).

Further Reading

Alifui-Segbaya, F. 2018. Toxicological assessment of photopolymers in additive manufacturing using the innovative zebrafish embryo model. PhD Doctorate, Griffith University.

Alifui-Segbaya, F., Bowman, J., White, A. R., Varma, S., Lieschke, G. J. & George, R. 2018. Toxicological assessment of additively manufactured methacrylates for medical devices in dentistry. Acta Biomaterialia, 78, 64-77.

Alifui-Segbaya, F. & George, R. 2018. Biocompatibility of 3D-Printed Methacrylate for Hearing Devices. Inventions, 3, 52.

Alifui-Segbaya, F., Varma, S., Lieschke, G. J. & George, R. 2017. Biocompatibility of Photopolymers in 3D Printing. 3D Printing and Additive Manufacturing, 4, 185-191.

Biographical Note

Dr Frank Alifui-Segbaya is a Lecturer at the School of Dentistry and Oral Health, Griffith University. He has since 2005 served in different capacities as an academic, a technologist and research scientist in Africa, Europe, and Australia. Frank has published widely on biomedical applications of additive manufacturing in high impact journals including “Additive Manufacturing”, “Acta Biomaterialia”, and “3D Printing and Additive Manufacturing”. He provides expert opinion in his area of expertise to the scientific community, and reviewer services to copious international journals. He is internationally recognised for his innovative research into preclinical assessment of medical devices in 3D Printing and the applications of zebrafish embryo model to toxicity screening of biomedical polymers. Frank is a member of the Academy of Dental Materials. His research interests are biomaterials, additive manufacturing, zebrafish genetics and toxicology, and the applications of digital manufacturing to dentistry. His learning and teaching interests are curriculum development, international benchmarking and external assessment.

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The post 3D Printing Has Come of Age But How Safe Are the Devices Going Into Our Mouth? appeared first on 3DHeals.

Want to write a piece for 3DHEALS Expert Corner? Email us: info@3dheals.com

(This is an expert post in both Chinese and English.)

3D打印骨科植入物在中国的应用概况以及商业转化中的挑战

3D打印技术在制造多孔结构、拓扑优化结构以及梯度材料领域具有技术上的优势，同时与传统制造技术相比，3D打印技术更易于实现植入物的批量定制化生产。这些优势为3D打印技术在骨科植入物制造中的应用发展带来了潜力，骨科植入物制造业是3D打印技术最早实现产业化应用的领域之一。

3D printing technology has technical advantages in the manufacture of porous structures, topologically optimized structures, and gradient materials. At the same time, compared with traditional manufacturing techniques, 3D printing technology is easier to achieve mass customization of implants. These advantages have brought potential to 3D printing technology in the manufacture of orthopedic implants. The orthopedic implant manufacturing industry is one of the earliest fields of industrial application of 3D printing technology.

截至2017年底获得FDA 医疗器械注册证的3D打印医疗器械已超过了100个，其中包括了多款由不同品牌制造的3D打印脊椎植入物和关节植入物。

More than 100 3D printing related medical devices have received FDA medical device registration certificates by the end of 2017, including a variety of 3D printed spinal implants and joint implants made by different brands.

相比之下，中国骨科医疗器械制造商在3D打印骨科植入物商业转化方面的进展较慢。截至2018年，中国有3个3D打印骨科植入物产品获得了医疗器械注册证，包括：

In contrast, Chinese orthopedic medical device manufacturers have made slow progress in the commercial conversion of 3D printed orthopedic implants. As of 2018, China has three 3D printed orthopedic implant products that have obtained medical device registration certificates, including:

• 2003年，上海交通大学医学院附属第九人民医院与上海晟实医疗器械科技有限公司合作获得个体化人工假体注册许可证（包括髋、膝、肩、踝、腕关节）。
• In 2003, Shanghai Ninth People’s Hospital cooperated with Sheng Shi Med to obtain individualized artificial prosthesis registration licenses (including hip, knee, shoulder, ankle, wrist).

• 2015-2016年，北京爱康宜诚医疗器材股份有限公司获得了三个金属3D打印植入物注册证：髋臼部件和椎体假体、椎间融合器。
• 2015-2016，AK Medical has three 3D printing products approved by CFDA.

• 2018年，西安科谷智能获得了个体化下颌骨重建假体注册证。其材料为Ti6Al4V铸造钛合金材料，通过与个体病患骨缺损形态匹配的铸造型壳（3D打印光敏树脂型消失型）铸造而成。
• In 2018, the personalized mandibular reconstruction prosthesis of Xi’an Kegu Intelligent Machine Co., Ltd was approved. The material used is a Ti6Al4V cast titanium alloy material, which is cast by a casting shell (3D printing photosensitive resin type disappearing type) matched with the shape of the individual patient’s bone defect.

与商业转化情况不同的是，3D打印骨科植入物在中国骨科临床治疗中的应用是处于国际先进水平的。中国部分三级甲等医院在临床中应用3D打印植入物已有多年历史，例如：上海交通大学附属第九人民医院在2014年就已将金属3D打印个性化假体用于骨盆肿瘤切除与重建手术。此后，上海第九人民医院在腕关节、踝关节、胸骨、髋关节等复杂骨科手术中又多次应用了3D打印的个性化金属植入物。除此之外，北京大学第三医院、空军军医大学唐都医院、广东省骨科医院等三级甲等医院（见图1）也陆续在复杂骨科疾病的治疗中应用了3D打印骨科植入物。

In contrast to the commercialization of 3D printed implants, the application of 3D printed orthopedic implants in the clinical treatment of orthopedics in China is considered at the advanced level internationally. Several lower-level hospitals in China have applied 3D printed implants in clinical practice for many years. For example, the Ninth People’s Hospital affiliated to Shanghai Jiaotong University has used metal 3D printed personalized prosthesis for pelvic tumor resection and bone reconstruction in 2014. Since then, the hospital has applied 3D printed personalized metal implants in complex orthopedic operations such as wrist joints, ankle joints, sternum, and hip joints. In addition, Peking University Third Hospital, Air Force Military Medical University Tangdu Hospital, Guangdong Provincial Orthopaedic Hospital, and other lower level hospitals (see Figure 1) have also applied 3D printed orthopedic implants in the treatment of complex orthopedic diseases.

Figure 1

可见，临床对于3D打印植入物存在多样化的需求，特别是在进行骨肿瘤治疗等复杂疾病修复治疗领域对于3D打印技术存在刚性需求。那么，在这种情况下，是什么原因导致3D打印植入物在中国的商业化进展缓慢呢？

影响3D打印骨科植入物商业转化的因素可以归纳为以下几点（见图2）：

Therefore, it is evident that there is a diversified demand for 3D printed implants in clinical practice, especially in the field of complex disease repair and treatment such as bone tumor treatment, which has a solid demand for 3D printing technology. So, in this case, what is the reason for the slow progress of commercialization of 3D printed implants in China?

Factors affecting commercialization of 3D printed orthopedic implants can be summarized as follows (see Figure 2):

• 技术因素 Technical factors
• 管理因素 Management factors
• 意识层面接受度 acceptance factors
• 法律法规的支持 Policy support
• 人才与教育 Talen & Education

Figure 2

结合中国的具体情况，在临床需求端，虽然3D打印骨科植入物在部分治疗中得到了应用，但3D打印技术并没有成为国内医生所普遍接受的技术，这是该技术商业化的其中一个挑战。

Combined with China’s specific situation, although 3D printed orthopedic implants have been applied in some treatments at the clinical demand side, 3D printing technology has not become a technology widely accepted by domestic doctors. This is one of the challenges for  commercialization.

从企业方来看，无论是增材制造技术的人才、医工结合的人才、打印材料、打印设备，还是后处理工艺，都没有做好植入物大规模制造的准备；另一方面是针对个性化植入物而言，在制造一些复杂个性化植入物时，对3D打印技术是刚性需求，但是由于这些个性化需求为企业带来的利润有限，这使得有实力的传统骨科医疗器械企业进入该领域的动力不足，而凭借3D打印技术生存的初创型医疗器械企业，也存在着实现盈利的挑战。

From the enterprise perspective, whether it is lack of talents in additive manufacturing, lack of talents with combined medical science and rehabilitation engineering backgrounds, lack of appropriate printing materials or equipment, or lack of post-processing technology, there is subsequently a lack of readiness for large-scale implant manufacturing. In terms of personalized implants, there is a definite need for 3D printing technology. However, because of the limited profit, the powerful traditional orthopedic medical devices manufacturers do not have enough motivation to enter this space, and medical device startups that survive with 3D printing technology also have the challenge of realizing profitability.

在医疗器械审批法律法规方面，国内法律法规的设置相对滞后，也是3D打印骨科植入物商业转化所面对的挑战之一。不过利好的一面是，相关法规、标准正在完善中，比如说CFDA已发布了“定制式增材制造医疗器械注册技术审查指导原则（征求意见稿）”。

In terms of medical device laws and regulations, the setting of the Chinese domestic laws and regulations is relatively lagging behind, and it is also one of the challenges faced by the commercialization of 3D printed orthopedic implants. However, the positive side is that relevant regulations and standards are being improved. For example, CFDA has issued the “Guidelines for the Review of Technical Registration for Customized Additive Manufacturing Medical Devices (Draft for Comment)”.

尽管存在着种种挑战，中国3D打印领域的先行者们仍在政策法规、行业标准的完善、临床应用、产品研发等领域推动着3D打印骨科植入物技术的发展。根据3D科学谷的市场观察，目前有一批新的3D打印定制化植入物正在进行商业转化，这些企业主要集中在中国华东、华中区域，预计2020年左右这些植入物将陆续获得医疗器械注册证。

Despite the challenges, the pioneers in China’s 3D printing industry are still driving the development of 3D printed orthopedic implant technology in areas such as policy and regulation, industry standards, clinical applications, and product development. According to the market observation of 3D Science Valley, a number of new 3D printed customized implants are currently undergoing commercialization. These enterprises are mainly concentrated in East China and Central China. It is expected that these implants will get registered around 2020.

About the Author:

Daisy Zhu is co-founder of 3D Science Valley , a commentary media platform focusing on additive manufacturing. She is responsibe for the publication of white paper of 3D printing in dental industry, orthopedic industry as well as rehabilitation appliances industry. She is one of the authors of the book ‘ 3D Printing in Automotive Inudstry Technology and Development Report’ and ‘3D Printing and Industrial Manufacturing’. She has been the keynote speaker at several medical forums , entrepreneurship salons and popular science activities. 

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Marta Kazmierowska graduated from Hunter College, the City University of New York, with a Bachelor’s degree in chemistry. After returning to Poland she pursued a Master’s degree in green chemistry at Gdansk University of Technology. During her second degree studies, she gained extensive practical knowledge about various 3DP technologies. She practiced at LITHOZ in Vienna where she worked with the lithography-based ceramic manufacturing (LCM), and in Pomeranian Science and Technology Park in Gdynia with selective laser sintering (SLS) and PolyJet technology. Right now she is a CAD/CAM supervisor and EOS M100 operator at a dental prosthesis laboratory. She is interested in all 3D printing technologies and their application in medical and non-medical fields. In her free time, she is building anatomical models from CT data.

Before I discovered 3D printing (3DP), I had several work experiences. In college, I worked as an assistant in a chemistry laboratory and in a pharmacy. I had also previously been a babysitter, a secretary and later on a teacher in an international school. Each of these jobs provided me with different and rich experiences that shaped my personality and way of thinking. However, for me, none of these experiences were truly fulfilling, truly absorbing, or my own… I felt that I was doing things that were already established by somebody else, sort of a template that I’d fill in. And I had an everlasting feeling that I need to do something innovative. I decided to quit the teaching position I had and enrolled on a master course at the Gdansk University of Technology. I quickly found a mentor and during one of our conversations she mentioned 3DP. I started researching the topic – I was mesmerized. That was it! There was one more thing that I knew right away, there is no time to waste! I need practice, practical knowledge, hands-on experience, not only dry facts from books. Through my professor, I contacted amazing people at LITHOZ in Vienna and left for a three-month practice. That experience was one in a lifetime, I gained knowledge, experience and I made true friends. When I came back to Poland, I saw that the 3DP Lab in the Pomeranian Science and Technology Park in Gdynia was opened, so I went there and asked if I could do some volunteering. I was lucky, again. The people were kind and open to share and exchange their knowledge.
The freedom, almost limitless possibilities of different 3DP techniques and the people from the field inspire and motivate me every day. I want to use and spread the power of 3DP to people’s advantage because many things can be done better, faster and generate less waste.
Therefore, I’m happy to be a CAD/CAM supervisor and EOS M100 operator working with CoCr at the dental prosthesis laboratory in Gdansk. I embarked on a mission to convince people from the dental and dental prosthesis field about advantages of the innovative CAD/CAM technologies with the focus on 3D printing.
Creation of precise, fully-functional and biocompatible metal crowns and bridges using conventional lost-wax casting methods is a laborious, multi-step, and time-consuming process, which may not always produce high-quality dental prosthesis parts. The errors can occur at early stages, during impression collection at the dentist, and build up during wax modeling, during metal casting, and during post-processing. The casting process by itself is difficult to control. As a result, the obtained part can have many irregularities, gaps, and air bubbles, which complicate and extend the post-processing step. Also, thick casting sprues, which are directly melted with the crowns, have to be cut away and the surface of a crown have to be polished.

Fig.1. 6-point bridge and one crown obtained with the conventional lost-wax casting technique. Irregular surface, air bubbles, thick and heavy sprues require laborious and time-consuming post-processing, which also generates a lot of waste.

A metal crown that is too tight, too loose or doesn’t fit on a model, is a nightmare that can happen to the most skilled and experienced dental prosthesis technician. Additionally, when producing big and multi-pontics bridges, there is a high chance that they will bend. Another disadvantage of the conventional metal casting is waste production.
Innovative CAD/CAM technologies allow to: collect precise digital impressions, and then design and produce very detailed metal crowns and bridges. The intraoral scanners are more comfortable for the patient since no goopy, short-lived impressions are needed. The entire scanning procedure happens in real-time at the dentist’s office. A doctor, in a split of a second, electronically sends obtained scans to a dental prosthesis CAD/CAM department, where specialized technicians make projects of metal crowns and bridges on the computers. The scans and projects can be stored and accessed at any time, eg. for retrospective studies, whereas most of the impressions can be only used once. The digital impressions can also be 3D printed in eg. digital light processing (DLP) technology. The 3DP models are more detailed than the gypsum models and almost no waste is generated during their production. If the dentist’s office doesn’t have an intraoral scanner, conventional impressions can be sent to our laboratory. In this case, we make our .stl projects by scanning gypsum models.
Obtained .stl project is then analyzed in additional programs, which check for errors in a digital net, orient the part and generate the support structures. Once the part and its support structures are ready, they are transferred to the EOS M100 printer which uses the direct metal laser sintering (DMLS) 3DP technology.

Fig.2. EOS M100 printer which uses the direct metal laser sintering (DMLS) 3DP technology.
M100 produces precise, high-quality, high-density metal crowns and bridges in a matter of few hours with no human interference. The parts are built in a layer-by-layer fashion, by application of a thin metal powder layer by the ceramic coater and exposition of layers by a high-intensity ytterbium laser.

Fig.3. Ytterbium laser tracing and melting the contours of support structures on a thin surface of the evenly distributed powder.
Fig.4. Metal crowns and bridges produced on an EOS M100 printer in the DMLS technology. The detail of the parts is precise due to scanners which replicate exact morphologies of patient’s teeth and due to 30µm printing layer thickness. The surface of parts is smooth and easy to finish. More than 80 metal points can be produced in a single cycle!
After the finished run, the printer is carefully cleaned. The biocompatible, medical-grade CoCr powder is screened on a sieve of a specific size and reused in next cycles. Therefore, almost no waste is produced because only the material that is needed for the part and its supports are used. The parts on a building platform are then sanded and placed in the oven. The thermal treatment in the inert Ar atmosphere gives parts final structural properties and reduces the tensions so the probability of twisting and bending is minimal. After the thermal cycle, the parts are detached from the building platform and undergo post-processing. The support structures have a form of small pins they do not go deep inside the part. Therefore, they can be easily removed with pliers by a squeezing and twisting motion. Once the supports are removed, the parts need surface polishing and quick sanding, since the surface of printed crowns and bridges is already smooth and regular.

Fig.5. A Precise, detailed and smooth surface of DMLS metal dental prosthesis parts together with tiny, easy to remove support structures.
Due to the exact and detailed image obtained with a scanner and thin printing layer (30 µm) the fitting of even the biggest 14-point bridge is almost perfect, so no laborious fitting on the model is needed. Such parts are ready to be used for eg. porcelain application. Due to the precise DMLS technology, the density of produced metal crowns and bridges reaches almost 100% so there is no gassing during the porcelain application process.

Fig.6. Building platform with CoCr crowns and bridges.
Thanks to the innovative CAD/CAM technologies we are able to produce in one cycle more than 80 metal points in a matter of few hours! And we are able to do more than four cycles a day! Therefore, this technique minimizes the errors, amount of work and waste, producing a large number of high-quality parts in less than a workday!
I speak with dentists and dental prosthesis technicians on a daily basis and try to convince them to these innovative approaches. I believe that big and small obstacles can be overcome because of a wide variety of options and solutions that are recently available on the market. Every day these solutions expand and right now are at a hand’s reach and they don’t have to be costly. Therefore, I’m motivated to speak to doctors and technicians and make small steps towards creating better future for them and their patients.

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“Many of the functions currently performed via 3D printing (surgical guides being one example) will be rendered obsolete once augmented reality for surgeries reaches a certain point.”

Dr. Madhavji graduated from the University of Manitoba in 2006 with an honours DMD and a concurrent B.Sc in Dentistry. He worked as a general dentist serving Northern Manitoban communities for a year before attending the oral and maxillofacial radiology specialty program at the University of Toronto until July 2010. He has exclusively practiced oral radiology at Canaray for the past 5 years and has reported over 30,000 CBCT scans. His current interests are CAD/CAM guided surgery and digital communication. He is a co-developer of the Accuplant guided surgeryinstrumentation system, which has been designed to enable all clinicians to utilize guided surgery with minimal instrumentation costs. Dr. Madhavji will be presenting at 3DHEALS2017.

Q: What is your vision on the intersection of 3D Printing and healthcare?

A: As an oral radiologist, I find that the most straightforward application of 3D printing is the translation of planning data from CBCT and other 3D modalities from the computer to the patient intra-operatively. 3D printing is really just one tool in the larger concept of moving to 3D computer-based planning of surgeries. Many of the functions currently performed via 3D printing (surgical guides being one example) will be rendered obsolete once augmented reality for surgeries reaches a certain point. 3D printing in the future would therefore be most likely applied to the manufacture of customized biological and biocompatible materials for surgical use.

Q: What do you specialize in? What is your passion?

A: I am a dentist that has specialized in oral radiology. My passion is tinkering with computer hardware and software to enable the repetitive tasks to be automated, which leaves more time available to pursue things that are more difficult or fun.

Q: What inspired you to do what you do?

A: I would say curiosity about how things work and a desire to try to communicate more effectively, along with the ability to not give up even when people think what I’m doing is a waste of time or seems trivial or silly at first glance.

Q: What is the biggest potential impact you see 3D printing having on the healthcare industry? Dentistry?

A: For dentistry, I feel that the biggest impact will be to encourage dentists to move from a 2D world of plain films and flat charts to a 3D world of planning and charting. 3D printing is what enables people to translate their ideas and plans from computers to the surgical suite in the most accessible and straightforward way at the moment, so it is a crucial component of the transition away from 2D planning.

Q: What challenges do you see arising in implementing 3D printing in healthcare sector in the next 5 years? Esp in dentistry?

A: The major challenge in dentistry specifically is metal artifacts in CBCT scans, which prevents effective segmentation of 3D data in the region we are interested in producing 3D printed objects, which means that we need to acquire other 3D data (digitize a stone model or take a digital impression of the dental arch) to compensate for the scatter. At the moment, digital impression systems that perform this task intraorally are the exception, not the norm, as they are between $15,000 and $35,000 per unit, but this should change over the next few years as the price of these units comes down.

The other challenge is the cost of introducing 3D printing into a workflow. Most dentists are used to dental implant surgeries costing a certain amount (whatever it is for each dentist). No matter what, the introduction of 3D printing into this implant workflow would increase the base fee by a few hundred dollars. For dentists in competitive markets, the increase in the fee makes some dentists feel that they would be at a competitive disadvantage, given that patients generally cannot tell the difference between a dentist that utilizes 3D planning from a dentist that utilizes 2D planning. Unless the patient and/or dentist understand the value of the 3D planning/printing process, and feel that it is worth it, the 3D workflow does not become the default technique.

Copyright Canaray.com

Q: What is the best business lesson you have learned?

A: Everything costs way more to implement than you are expecting. Also, as far as 3D printing and any other investment with an uncertain business model goes, only invest as much in it as you are willing to lose.

Q: What is the biggest business risk you have taken?

A: Becoming an oral radiologist back when it was considered a dead-end no-future specialty would be the biggest, at the time the decision was made (2006). Big risks are basically par for the course for me, because I am comfortable with the idea of “you win some, you lose some”. Most recently, I started a 3D printing-related offshoot in November 2016 that essentially promised to consume most of our future clinic revenue, and has also incurred a sizable debt for a business of our size, but the regret of not having tried when the opportunity arose would surely outweigh the potential loss of investment.

Q: What were the biggest challenges you had to overcome on your innovative journey?

A: Being able to ensure that my radiographic reporting duties are not neglected while trying to do programming. There is a shortage of Canadian oral radiologists, and the work is increasing in a linear fashion, so every month we have to come up with new innovations to save a few minutes here and there in order to keep up with the workload. I have really seen a huge nosedive in the amount of sleep I am getting lately, from reporting by day and programming at night, and it is unsustainable, but I can manage it in bursts for now.

The post Interview: Dr. Milan Madhavji appeared first on 3DHeals.

J: Hi! Chris, thanks for taking some time with the 3DHEALS audience for this interview. Can you tell us a little about yourself?
C: I am a dentist by trade with a few qualifications including a bachelor of Dental Science with honours and a bachelor of science in biochemistry and physiology from the University of Queensland as well as an M.Phil. by research in Biomedical Science from Cambridge University. I have been in clinical practice since 1998 and since then built a national network of dental clinics within Australia which I sold to private equity investors in 2013. In clinical practice I developed a special interest in craniofacial pain, reconstructive dentistry and sleep dentistry. In terms of the latter I am a severe apneic myself also suffering from Nasal Obstruction. Within my patient population I recognized that approximately half of my patients also suffered from increased nasal congestion as evidenced by them being obligate mouth breathers or oro-nasal breathers. I recognized that airway issues were a major issue for patients developmentally in terms of development of malocclusion and also in adults in terms of obstructive sleep apnea. I also recognized that a failure to address these issues in the patient population meant that the long term oral health of my patients and the success rates of the dentistry I was performing was at risk.
 
J: Have you always been a very creative/innovative person?
C: I think whenever I didn’t have an answer I would go looking for one and if one was not available I would always try to solve the problem with lateral thinking. A lot of innovation is common sense that is not contained by conventional thinking or dogma.
 
J: Tell us about the story behind the inception of Oventus?
C: Out of my own personal desperation, having failed CPAP treatment and having difficulty using oral appliances due to my nasal obstruction, I fashioned an airway out of some flexible saliva ejector tubes in an attempt to get air to the back of my throat unimpeded. This worked for me and was in fact the first O2Vent device. I then started making a similar device out of plastic for my patients which was working for them but was very labour intensive and resulted in a very bulky device with limited space available for the airway so while it was working reasonably well for patients it was not commercially viable as a treatment. The incorporation of CAD design and 3D printing in titanium was a game changer and addressed these issues with an airway that was five times bigger (the same as a healthy human nose in fact) much lighter weight (30 grams) and much smaller in size (60% smaller).

J: What are some of the tipping points of the Oventus story?
C: The first major tipping point was when I met the current CEO Neil Anderson and he then introduced the concept to the CSIRO (Australia’s peak research body) and kicked off a project to start designing the devices with CAD software and then 3D printing them in titanium. From then we developed a device that was on the market in about a year. This was the product development tipping point.
Shortly after that we reached another tipping point where as a result of one press release we had several thousand patients register on line for the device in a matter of weeks. We could only make about 1000 devices so this was the business tipping point and the catalyst to take in some investor funds to scale up manufacturing further develop the product pipeline.
 
J: Are the regulatory entities in Australia/US challenging to understand and comply with? What are you experiences with these areas?
C: They are both different but there are clear guidelines as to what is required to comply. In many ways the US system is easier to comply with as there is more structure. In both cases it has been very important to engage advisors that understand the landscape and how to navigate through it. For our first device the O2Vent Mono there were predicate devices for a 510K FDA application and for our second Device, the O2Vent T, we are able to use our own device as the predicate. This process was relatively straight forward and there are also existing reimbursement codes for oral appliance therapy for the treatment of OSA. As our clinical evidence builds, our unique technologies and resulting products could in the future lead to their own reimbursement codes. These could be as a result of the airway being used in the treatment of nasal obstructers or connecting the airway to CPAP machines for lower and more comfortable positive air pressure.
 
J: What/who inspired you to use 3D printing technology to prototype, and then to manufacture Oventus device?
C: The bulk of the handmade device and the cost and time to make these devices by hand meant that it was not commercially viable. The devices are also custom made bespoke for each patient and contains within it a complex hollow three-dimensional structure that could not be milled, cast or moulded so 3D printing was the only viable manufacturing process. The ability to custom design a large number of devices with complex hollow three dimensional airways and print them simultaneously made the device manufacture scalable and commercially viable.

J: What are the most significant differences between making your device with 3D printing and traditional manufacture?
C: Time, cost, weight, size, effectiveness, scalability and commercial viability. The handmade device took about 18 hours to make one, it was more than twice the size, three times the weight and the airway was only one fifth the size.
 
J: Why is 3D printing necessary, in creating the bilateral airway to the back of throat ?
C: Any time a complex hollow custom three-dimensional structure is required it can only be made by additive manufacturing. Doing this by hand is not viable so 3D printing is the only viable option.
 
J: What do you think can be improved in terms of 3D printing technology that would enable Oventus to continue to improve?
C: At the moment 3D printed titanium products need to be polished. We are finalising a mechanical polishing solution at the moment which will be a huge benefit but a finer quality finish on the printed surface would be a break through particularly when considering finishing internal surfaces. In terms of 3D printing of plastics there is a need for commercial size open-source machines to allow the opening up of development of new materials. Large companies that limit the use of materials to the ones they supply are inhibiting the growth of the 3D printing field. Across all types of 3D printing we need more speed at lower cost. I think it is similar to the early days of computing.
 
J: What are your biggest challenges in using 3D printing technology? How did you overcome these?
C: We were really pioneers in this field so there were many challenges, for example there was no scalable software to design our devices, we needed to validate the accuracy of the build as well, we needed to develop finishing techniques, we needed to test for adherence to different polymers for the tooth engagement, we needed to find out what the tolerances were in terms of wall thickness and build quality and many more. Some of these issues we solved internally with good old fashioned lateral thinking and problem solving but many of these challenges were solved through collaboration with other groups that had specialised skills in each of these areas and then managing those collaborations to a commercial end point.
 
J: What are your biggest challenges in making Oventus successful? How did you overcome these?
C: Oventus is a paradigm shift in the treatment of OSA. Like many new technologies the initial response to a new concept from the incumbents can be scepticism and doubt. Often the response can also be particularly aggressive. I think the Oventus technology is quite elegant in its simplicity and so we have certainly been the recipient of some aggressive actions taken by incumbents that failed to develop something similar. We take this as a compliment. Flowing from this the two most common questions we encounter are “How can it work if it is so simple?” and “Why didn’t someone else think of it?” We could take that as an insult but what it really means is that we have to communicate more clearly as to how it works and why it was developed. So the answer is continuing to build clinical evidence and the communication of this. As Oventus builds its product pipeline on the patented 3D printed airway platform it will become more apparent that this is a unique solution for which there is a clear indication, a massive unmet clinical need, a growing body of evidence and over time this will convert to an acceptance that it is a new paradigm and a standard of care for the treatment of OSA either on its own or incorporated into complimentary technology.
 
J: What makes 3D printing technology particularly interesting to you?
C: 3D printing is the only way to manufacture the Oventus devices so that is of particular interest. Over and above that it opens up a whole host of different opportunities the scale of which we are not yet grasping. The applications in the dental field alone are extraordinary. If I could work on a dozen businesses at once I might develop some more applications myself but I think I will need to leave that to others. It has massive benefits in terms of the provision of health care but the wider applications are just as exciting.
 
J: What do you think are the biggest barrier(s) in scaling 3D printing in dentistry? And in healthcare at large?
C: I think the biggest barriers are the regulatory and reimbursement hurdles, the cost of the equipment, print speed and quality of the surface finish. The technology related issues are either in the process of being solved for, or are on the cusp of a solution. We are certainly focussing on some of these ourselves. In terms of regulatory and reimbursement we are lucky at Oventus in that we are a class II device so the regulatory hurdles are not so profound (compared to say a class III implantable) and there are existing reimbursement codes for some of our technology. The early adopters will no doubt pave the way for others in terms of these issues. The cost of the equipment will undoubtedly come down over time. The printers are in effect big computers. The rate limiting step will likely be validation of the cheaper emerging technologies but this will only hold the tide back for a short while.
 
J: What is your forecast of the 3D printing industry in dentistry? And in general in healthcare?
C: The big opportunity will be in the manufacture of complex hollow three dimensional structures and serial customization combined with the fact that additive manufacturing is low cost in terms of input costs and can be considered green manufacturing in many ways. I think the applications are huge and we really don’t know right now how far that will go. In combination with 3D imagining technology, CAD design and the development of different media (e.g. cell scaffolds and tissue cloning etc.) I think anything is possible.
 
J: What would you tell the next generation of entrepreneurs in dental and healthcare 3D printing about being innovative and building companies?
C: Three things:

1. Think outside the box and back yourself.
2. If someone tells you something cannot be done it is not that “it” cannot be done but just that the person telling you that can’t do it.
3. Make sure you believe in what you are doing because when the going gets tough it is a lot easier to keep going if you believe in it.

 
J: What is your ultimate vision about Oventus? 3D printing in dentistry?
C: For Oventus I think we are just starting to scratch the surface of what 3D printing has allowed us to do. It has given us access to the oropharynx to allow unrestricted breathing, deliver oxygen and air pressure, to monitor efficacy and compliance and to gather information on what is happening in this part of the anatomy. The applications for this airway technology are not just in OSA but also in the fields of sports, orthodontics, anaesthetics, therapeutics and diagnostics. In terms of 3D printing in dentistry the applications certainly in terms of implant surgery and bone regeneration will be profound. There will also be a plethora of applications in prosthodontics, orthodontics and oral maxillofacial surgery to name a few.
 


As Clinical Director of Oventus, Dr Chris Hart is overseeing the launch of the O₂Vent to patients and through clinicians. Prior to establishing Oventus, Chris owned and managed a multi-site national dental practice, training institute and management consultancy which he recently sold to private equity investors. He now works full time as the Oventus Clinical Director and sits on the Oventus Board as founder and major shareholder.
Chris also acts as an adviser to various bodies within the dental industry as well as the health care sector more broadly on the commercial aspects of health care delivery.

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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.

Form 2, 3D printed night guard

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.

Interview: Dr. Nima Massoomi, Board Certified Oral and Maxillofacial Surgeon

The post 3D Printing in Dentistry: From a Broken Tooth to Digital Revolution appeared first on 3DHeals.