Dental 3D Printing – The Ultimate Guide

The best way to consider 3D printing in any discipline is to ask the question famous author Clayton Christensen wrote in many of his books, “Will this new technology (workflow, idea, etc.) do the job my customers or patients are looking to do?” This is no exception for dental 3D printing. Our job at 3DHEALS is not to simply “evangelize” the clinical application of 3D printing, but to figure out which “job” is worthwhile to adopt 3D printing to make healthcare more effective, more affordable, and more accessible to hopefully everyone. The adoption of 3D printing in dentistry, which has already undergone a digital revolution in the last few decades, is not accidental. This guide serves both as a summary and an update on the current status, trends, and future trends in this industry.  We wrote this guide based on a number of events we hosted focusing on this subject, as well as industry reports and PubMed research. We aim to regularly update the content of this 3DHEALS Guide. Here is the outline of this guide: 

Background, Statistics, the Why

What are the major technical advantages of 3D printing in dentistry? 

What are the current major industry trends in dental 3D printing? 

What jobs are being done in dentistry with 3D printing?

What 3D printing hardware, software, and materials can dental professionals use? A beginner’s guide

Which companies are in the dental 3D printing space?

Conclusion

Background, Statistics, the Why

Dental service to most people, including those in the wealthiest nations, is a luxury item. While people are well aware of the disability and health risks dental disease pose, many often opt not to get or delay dental service because it is less life-threatening, very extensive, and physically and emotionally painful. Based on the CDC website, in 2015, in the United States, 29% of all population and 62% of older adults do not have dental insurance. Additionally, traditional Medicare does not cover routine dental care, and Medicaid programs are not required to provide dental benefits to enrollees. Fifteen states have no coverage or only emergency coverage. Even for those with insurance, reimbursements for dental care are on the decline. According to the Americal Association of Endodontists, there was about a 6% reimbursement decline between 2013-2017 across the board. Of seventeen percent of U.S. adults older than 65, only fifteen percent of the population have dentures. Additionally, the population who are edentulous often overlaps with populations with lower socioeconomic status and poor overall health. 

Therefore, while the call for “equity” is louder, the disparity in oral health is doomed to increase with an aging population and increasing costs. 

The impact of untreated dental disease negatively impacts the quality of life and productivity, which translated into “over $45 billion is lost in productivity in the United States each year because of untreated oral disease.” 

 However, even for those who are lucky enough to receive dental care, how many can truly be excited about root canals, dental crowns, dentures, and implants? I don’t see anyone raising their hands.

Currently, a majority of dental practices still need weeks to deliver dental crowns and up to a year for dental implants. Many are only at an early stage in considering earlier digital tools like intraoral 3D scanners and milling machines (Cerec). 

As such, if we really would like everyone to enjoy dental health as long as they live, new solutions are needed, and 3D printing appears to provide some new options. 

What are the major technological advantages of adopting 3D Printing in dentistry?

While some of these benefits are repeated often in our guide, it is helpful to first mention these again in the context of digital dentistry. 

Mass Customization

One of the archetypes of mass customization using 3D printing in healthcare is perhaps the dental aligner industry. Align Technology is the company that brings this concept to life with “unicorn” commercial success. Each day, according to one of our speakers Lee Dockster, more than a million dental aligners can be manufactured using a process that leverages 3D printing. Each one of these aligners is a unique device catered to a personalized treatment plan. The aligner industry is well and alive today with more and more competing companies offering cheaper, faster, and simpler solutions to the consumers. However, this is impossible without the fundamental benefit of being able to simultaneously 3D print many unique geometries without large upfront capital expenditures.

More importantly, competing against many traditional manufacturing processes, injection mold, and digital subtractive manufacturing processes in dentistry, 3D printing offers consistent accurate efficient cheaper, and often more superior alternatives. In the case of being superior, such as in the case of aligner manufacturing, 3D printing is taking over other processes while transforming the profession on a larger scale. 

For example, Align Tech first marketed its products primarily to orthodontists, collectively a monopoly on putting braces on people the mouths. According to Lee Dockster, AlignTech then decided to change its business model and marketed its product to general dentistry creating a win-win situation for patients (cheaper and more accessible) as well as dental professionals (more revenue streams, more value proposition to patients).

Complexity for “Free”

When it comes to this concept of “complexity for free”, many immediately draw their memory of a 3D printed gyroid lattice, which is nearly impossibly to be produced without a significant cost and impossible to be mass produced. Since we are all unique creatures, this feature is extremely valuable in healthcare because personalization is often desired. The unmet need to be able to massively create customized medical devices at no added cost is obvious to many. This is no exception to dentistry since everyone’s dental anatomy is unique. 

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Example of 3D printed lattice structures

However, another way to look at this concept is that 3D printing can greatly simplify the current manufacturing workflow by being about to reduce subcomponents needed to assemble a final product. This is because instead of having to fasten or screw components together, 3D printing can create intricate internal structures obviating the need for assembling.

A consequence of not needing these subcomponents also simplifies supply chain logistics, which is an ever more important subject during this pandemic era. Fewer components, less negotiation time, less supply chain headaches. 

 While the latter may not necessarily apply to the dental industry, the ever simpler dental aligner solutions to the consumers are evident with intraoral scanners digitalizing the treatment plan, and fewer orthodontic visits. The technology is enabling general dentists to provide what used to be a very complex procedure to a bigger and less affluent population. 

Design Freedom

This benefit is related to the “complexity for free” concept. Because of AM’s ability to produce a larger portfolio of complex geometries, the designers of medical and dental devices naturally can be more creative. This resonates with many healthcare providers who often face patients’ unique problems but with no readily available solutions. During one of our virtual events, Dr. Sergio Gianvechio demonstrated several creative workflows using OrtogBlender, a Blender plugin software that was created by Cicero Moraes primarily to empower dentists with orthognathic surgical planning, but also to create an indirect orthodontic bonding guide in a resource-poor country like Brazil where people do not have access to more advanced healthcare. This kind of end user and need-driven 3D printing solution that adds a “designer” hat to healthcare providers is what will shorten the medical device innovation cycle. 

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Dr. Sergio Gianvechio demonstrated several creative workflows using OrtogBlender a Blender plugin software that was created by Cicero Moraes primarily to empower dentists with orthognathic surgical planning

With new tools, new solutions will be created in geographies and patient populations that were previously not specifically addressed due to socio-economic or simply technical barriers. Some of these innovations will be equivalent to existing solutions, but more will be adopted because it is better than an existing solution. Such revolutions have been observed in the aligner and hearing aid industries for decades, where the 3D printing process replaced old manufacturing techniques and made a world of difference in patients’ lives. 

New design techniques, including topology optimization and generative design that require 3D printing to produce final products, are also slowly taking center stage in the future of product design.

Decentralized Manufacturing At Point of Care Equals More Patient Satisfaction

At the end of the day, dentists just want to make their patients healthy and happy. 

Satisfied patients will come back for more, allowing us to build a more sustainable business. 

However, anyone who had the experience of getting a dental crown or dental implant never wishes to have another. These procedures not only themselves are uncomfortable, the protracted treatment timing, lasting weeks to months, is something we all hate. This is not to mention the uncomfortable PVS impressions, repeat x-rays, and logistic complications to schedule multiple appointments with multiple subspecialists. 

In the past decade, 3D printing is more integrated into the digital dentistry workflow. In-office intra-oral 3D scanners and milling machines (Cerec) are now must-haves for a modern dental office.

I personally “fired” my old dentist for not having a 3D scanner, because why would you use an abacus when you have access to a computer? Granted, these tools currently carry a five-figure cost, but when a practitioner doesn’t have something that will significantly improve patient experiences, it is a warning sign to me that they are under-investing in their practices in general. A warning sign that the dental office may be either too short-term profit-driven or its practitioner is too out of date to practice. The trend to convert an “art-based” practice to a “science-based” and “evidence-based” practice is definitive. I prefer my dentist mostly a scientist, and perhaps a little artistic. 

With 3D printing at the point of care, dental practitioners are now able to diagnose, plan treatment, and even deliver crowns, and implants with a much-shortened timeline. There is less need to send the treatment plan to a dental lab. In fact, according to our speaker Ron Ellenbogen from Stratasys, more and more dental labs are merging with dental providers. This trend is a clear indication that the patients (and dentists) prefer manufacturing at the point of care. This preference has become a clear industry economic drive for both dental and medical 3D printing.  

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Ron Ellenbogen from Stratasys presented polyjet technology for dental 3D printing.

In addition to crowns, and temporaries, a variety of point-of-care dental devices are also made faster and cheaper, which include but are not limited to dental surgical guides (along with other virtual planning tools), aligners, and even implants. We will expand on specific applications in the later part of this guide. 

Material innovation

Having a dental brace is sometimes no better than having crooked teeth. It is almost a rite of passage for many to adulthood. The problem, is, of course, adults need braces too well into their 30s and 40s. The invention of clear aligners represents not just what 3D printing can do to make things, but what kind of material and design innovations come with it. Using existing or inventing new clear thermoplastics that have the aesthetics, biocompatibilities, and mechanical properties, the dental aligner industry showed the world how 3D printing and the design thinking behind it can create a massive new market that benefits millions who previously did not consider having braces. 

Material innovation has been a major limitation for many innovators in the dental 3D printing space, but new materials are surfacing at an accelerating pace ranging from ceramics, polymer, and dental space to enable more new products to be created. 

Dental professionals upskilling

In addition to the disruptive nature of the clear aligner industry to orthodontists, 3D printing and digital dentistry are disrupting the traditional dental professional subspecialties by equipping general dentists with tools that can produce equal and even superior end results for patients. This is no different than empowering less experienced surgeons with more pre-surgical planning tools so that they are more prepared before surgery. Even though they do not have previous experience or training, because of these new tools, they also rely less on intuition or artful skills to perform procedures.

One such example is dental implantology. More and more general dentists can now perform this procedure with the help of digital tools including 3D printing surgical guides. This increases access to care for the patients, generating new revenue for general dentists, and decreasing the pricing of similar procedures.

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Dr. Nabeel Cajee demonstrated how 3D printed surgical guide improved patient care and work efficiency.

What are some of the major trends in Dental 3D Printing?

Some of the major dental 3D printing trends are also general trends for dentistry and additive manufacturing industries in general. What is interesting and intuitive is that every 3DHEALS dental panelist is motivated by eventually enabling more accessible, better, affordable dental care for a larger population using 3D technologies. However, the overshadowing trend is that we are moving away from that end goal due to an aging population, increasing life span, decreasing workforce (especially in the dental technician front), and increasing overall wealth.  The gap will only increase if we don’t have better solutions.

We have mentioned these major trends throughout this guide, but to summarize, these trends are: 

  • 3D Printing for rapid prototyping to end-user parts, volume production via distributed manufacturing.
  • Decreasing reimbursement for dental care.
  • Increasing supply/demand gap for dental care.
  • Dental care is more expensive in general, with added economic pressure directly and indirectly from the pandemic.

3D printing adoption in dentistry is shifting dental lab businesses to dental clinics. According to our speaker Ron Ellenbogen from Stratasys, more than 60% of dental labs’ business is taken away by the clinic’s work. 

Several new business models are emerging as more 3D printing adoption occurs:

More clinics and labs are merging into one entity.

Some of the driving forces include new technologies enabling point-of-care delivery (see previous sections), a shrinking dental lab technician workforce, cost pressure, and a more consumer-driven market. 

Democratization of clear aligner business.

Whenever I hear the word “democratization”, it makes me cringe as an investor. Because the opposite of democratization is a monopoly, which is often the key to a long-lasting business moat and long-term success for a business. However, this is ultimately great news for patients and consumers. And I firmly believe the strongest driving force in this market is the consumer, and perhaps other areas in dental markets as well. Streamlined digital workflow for clear dental with a 3D scanner, CAD/CAM, and 3D printing is on its way to taking over 90% of the market where you can get it at local CVS, leaving more complex cases to dental offices and traditional metal-wired braces. In fact, 3D printing is even being used in newer metal braces. For example, a Boston-based startup Lightforce Orthodontics 3D prints ceramic polycrystalline alumina dental brace brackets for wire braces, leveraging similar digital workflow as clear aligners. 

Point of Care Manufacturing.

While the medical community is still debating on if a hospital can act as a manufacturer, dental clinics already rolled up their sleeves and jumped into producing in-office dental devices. Dr. Rick Ferguson leads such a dental clinic and also teaches other dentists how to set up a workflow that is friendly to private practices.

Robotic labs. AI/ML.

The shrinking workforce of lab technicians is not due to a lack of market demand, according to our speakers. While no research is done to figure out the cause of such change, it is presumed that this is because traditional dental technicians are lowly paid, less equipped with CAD/CAM knowledge, and lack respect in the industry. Regardless, the shortage is real. However, Justin Marks, who used to be a dental technician himself, showed us how he created a partial denture “robot farm” using FDM printers and built a business behind it. Needless to say, a major driving force behind it will be the development of artificial intelligence and machine learning strategies at every step along the digital workflow. 

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Justin Marks, who used to be a dental technician himself, showed us how he created a partial denture “robot farm” using FDM printers and built a business behind it.

Digital Outsourcing.

While many are thinking about how to bring design and manufacturing in-house, new outsourcing options are also making a business case. For example, Dr. Rick Ferguson mentioned in his presentation that it is now an option to outsource the design process for dental offices that want to keep manufacturing in-house. It is likely that similar to medical 3D printing, a hybrid of in-house and outsourced design and 3D printing customized for each practice is needed to optimize the solution in the end. 

What jobs are being done with 3D printing in dentistry? 

While the success of aligners is the most visible application, there are many existing and new applications in oral health. One of the better ways to organize one’s understanding of the industry is to categorize these by dental subspecialties, which include general dentistry, oral surgery, endodontics, prosthodontist, periodontics, and orthodontics. Craniofacial maxillary (CMF) surgery is also a closely related field. A good review article by Anderson. et al summarizes the main applications throughout the history of dental 3D printing.  Of these, surgical-based subspecialties like dental implantology, dental surgery, and orthodontics are taking a lead in both research and commercialization of dental 3D printing services and products. (Figure 1)

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Figure 1. Pubmed publication number by dental subspecialties vs. Year

As early as the1990s, oral and maxillofacial surgery already started to use CT files to 3D print surgical planning models, aiming to reduce operative time. In 2000, the FDA approved the first CBCT for dental use in the United States. [1] The widespread use of handheld Intraoral 3D scanners is another enabling imaging technology. The combination of CBCT and 3D scanning allows dentists to accurately reproduce both the bony and soft tissue anatomy of a patient. The technical and economic breakthroughs of CBCT and 3D scanning contributed greatly to an increased application of 3D printing in dentistry.

We have mentioned quite a few of these applications already, but here is a summary of some of the more popular applications. We have also indicated the typical materials used in the commercial setting, but please keep in mind that, with increasing new and hybrid 3D printable materials coming to the market, the line between polymer-based and metal-based applications is getting blurred. For example, both polymer materials and metal have been used for dental crown manufacturing. This will ultimately be decided by the care providers and patients based on a combination of availability, mechanical properties, functionality, aesthetic requirements, and costs. The biomaterials landscape is ever-changing and exciting. For those who are interested in biomaterials topic, we have hosted quite a few webinars. Also, subscribe to read our upcoming Definitive Guide on Biomaterials that will soon be published.

Clear Aligner Dental Models

We have discussed this application extensively in this article. A related application is to create an indirect bonding guide to attach dental brace brackets onto the surface of the teeth. Hawley Retainers is also a similar application, where a 3D printed model helps with the creation of a wire/resin-based retainer. 

Materials used: Polymer

Dental brackets

A closely related application is the manufacturing of dental brackets used for more conventional wire-based dental braces. 

Materials used: Polymer, metal, ceramic

Dental Crown and Bridge

Materials used: Metal, Polymer, Ceramic

Surgical Guides 

Almost all dental surgical subspecialties are using 3D printed surgical guides.

CAD/CAM fabrication of surgical implant guides has been used extensively for targeting implant osteotomy drills. Oral surgery uses 3D models for surgical planning and treatment for post-traumatic reconstruction, removal of pathological tissue, autotransplantation, and obturator prosthesis fabrication in patients with maxillectomy. (Note: A removable maxillary obturator prosthesis is a device that separates the oral cavity from the nasal and/or antral cavities and is used to close a congenital or acquired defect in the maxilla.)

Dr. Sergio Gianvenchio demonstrated how OrtogOnBlender, a Blender plugin, can be used to plan for orthognathic surgery. The software can demonstrate the relationship between bones, soft tissues, and bite movements virtually but also can be used to generate 3D models and surgical guides. Dr. Nabeel Cajee, a general dentist but also an implantologist, demonstrated how he can create surgical guides in the office for dental implants.

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Dr. Nabeel Cajee presented his dental implant works using 3D printing as a presurgical planning tool.

Even when it comes to root canals, 3D printed surgical guides provide immense help in accuracy and efficiency in endodontists’ work. Drill guides to access root canals allow accurate translation of virtual planning information from CBCT/3D scan to the physical world with more precision. Interested readers can learn more about applications of 3D printing in endodontics from recent Dr. Gordon Lai’s presentation.

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Dr. Gordon Lai presented his personal endodontic 3D printing workflow.

Materials used: Mostly polymer

Splints/Occlusal Guards

Materials used: Polymer

Patterns for Casting and Pressing

Materials used: Polymer

Complete dentures or partial dentures

This is perhaps one of the earliest applications in dental 3D printing. 50 million dentures are produced a year globally, and this number is growing. However, many dental labs struggle to find the talents to make dentures in a conventional way. In one of our 2018 Summit speakers Dr. Valerie Cooper‘s own words, “When making dentures conventionally, the typical process takes possibly five or six appointments, with a high lab fee, with many tedious steps that cannot be easily corrected.” 

It is also evident that newer generations of dentists and dental technicians are using 3D printing to change that reality. Dr. Valerie Cooper (also nicknamed “Denture Queen”) is a prosthodontist who has a passion to make beautiful digital dentures for her community (sometimes free) that many others can also easily learn to make. Justin Marks, previously a dental technician himself, now CEO and co-founder of Arfona believes that 3D-printed complete dentures and partial dentures are the fastest growing AM-based applications.

A good article focusing on partial denture framework using metal additive technology can be found here

Materials used: Polymer, Metal

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Partial denture by Arfona during founder Justin Mark’s presentation.

Dental implant

Materials used: Metal, Ceramic

CMF implant

Materials used: Metal, Ceramic

We have several fantastic past Expert Blogs focusing on metal 3D printing CMF implants and dental devices:

From Esthetic to Functionality – Perspectives of Anodized 3D Printed Titanium Dental Restorations

3D Printing Implants for Atrophic Jaws

What 3D printing technologies, hardware, software, and materials can dentists use?

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Dr. Sergio Gianvechio presented some necessary tools for his daily dental 3D printing workflow.

Imaging Acquisition: 

As we have mentioned in the previous section, there are two main imaging acquisition modalities in dentistry: CBCT and 3D Scanning. 3D scanning, a completely noninvasive modality with no radiation, is also heavily utilized in the 3D printing orthotics and prosthetics industry.  A typical intraoral 3D scanner costs 10-20 K. While less widely used, an external 3D Scanner can also be used to scan dental articulators, triple-tray impressions, and texture scanning. For example, Shining3D manufactures such scanners. 

CBCT

Cone beam computed tomography (CBCT) is a radiographic imaging method that allows accurate, three-dimensional (3D) imaging of hard tissue structures. “This imaging modality is capable of providing sub-millimeter resolution (2 line pair/mm) images of higher diagnostic quality, with shorter scanning times (~60 s). Radiation exposure dose from CBCT is 10 times less than from conventional CT scans during maxillofacial exposure (68 µSv compared with 600 µSv of conventional CT)1 and also it has got great dimensional accuracy (only about 2% magnification).” [2]. “In contrast to the medical CT voxel, where axial height is determined by slice thickness, the CBCT voxel is cubic, allowing for higher resolution and more accurate measurements in multiple planes.” [1] As a result, CBCT is a more accurate source of data for additive manufacturing applications with less radiation exposure, scan time, and cost [1].

A typical CBCT machine costs around 50-100K. [4]

Intra-oral 3D Scanner – Medit, Itero (now part of Align Tech, Carestream, 3Shape, Sirona, Shining3D (also external 3D scanner)

Intraoral dental 3D scanners are small handheld scanners that go directly into the patient’s mouth to examine the inside as well as to scan the teeth directly. They are significantly faster and less messy than impressions as the scans can be processed immediately, meaning they can be used to skip the impression stage. Additionally, the images can be stored to be reused in case a device is distorted or lost. Nearly 50% of American dentists are now equipped with an intraoral scanner according to ADA in a 2021 article[3]. A typical intraoral scanner typically costs 10-20K. 

“Among respondents who use an intraoral scanner, 70% cited improving clinical efficiency as their main reason for introducing it into their practice, and 58% said they began using a scanner less than four years ago. The most common use of intraoral scanners is for single tooth-supported crowns, with 90% reporting they use a scanner for this treatment.” [3]

The two imaging modalities is complementary in many procedures providing both superficial soft tissue and intra-oral anatomy, and deeper facial maxillary bony anatomy. 

Computer-Aided Design Software:

Based on our past webinars, the more popular free software selections include Meshmixer, Blue Sky Bio, and 3D Slicer, but the true list is extensive as an indication that no current software truly satisfies a dental provider’s need to implement dental 3D printing. There are a lot of mashed-up solutions that have a steep learning curve and require true dedication to acquiring the skills. That said, more automated dental 3D printing software is coming into the market. For example, Belgium-based startup Relu is such an example. The company sells B2B API that would enable automatic segmentation of CBCT data and combine facial anatomy from CBCT and intraoral scans.  

Meshmixer (Autodesk)

Invesalius

Blue Sky Bio

Exocad

Orthoanalyzer (3Shape)

OrtogOnBlender, and a more expensive solution is Dolphin

(For those who are interested in learning this free plugin, here is an English version tutorial.)

Nemocast

Archform

3D Slicer

Chitubox

PrusaSlicer

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3D Printers

What is a good 3D printer for my dental practice? This is perhaps the most commonly asked question during our virtual events. 

That depends.

The answer for individual dentists or small practices will be different for larger-scale dental labs and larger dental practice chains with central manufacturing and distribution capabilities. But for simplicity’s sake, given a majority of the 3DHEALS audience belong to the former group, we will focus our discussion that way. We will leave the discussion of metal 3D printing to a separate future guide. 

Stereolithography (SLA), digital light processing (DLP), and material jetting are the most commonly used dental 3D printer. Each technology can deliver the precision and accuracy needed for dental applications, but quality can vary among different machines and systems. We have talked about various kinds of 3D printing processes before, but here are more descriptions focusing on dental applications:

1. Fused Deposition Modeling (FDM) – This is perhaps the most popular 3D printing process for beginners to learn 3D printing due to its ease to understand and affordability. Ultimately, however,  SLA or DLP-type 3D printers are the workhorses of a dental practice. The FDM process depends on the controlled extrusion of molten thermoplastics onto the build plate, layer by layer. This has been used to create dentures, surgical guides, and dental models. However, there are quite a few drawbacks of using FDM printers, including poor surface finish, slow speed, layer shift, resolution limitation, poor mechanical property (sometimes this can be improved with better design), and limited biomaterial portfolio, which collectively translates into a limited range of applications. 

2. Stereolithography (SLA) – liquid photopolymer resin is selectively exposed to a laser beam across the build plate, solidifying resin in specific areas. Stereolithography is highly accurate and has the best surface finish of the three technologies. SLA printers offer large build volumes and a wide range of materials for various applications. Some of the most well-known SLA printer companies include Formlabs and 3D Systems

2. Digital Light Processing (DLP) – Digital light processing operates with the same chemical process as SLA but uses a digital projector as a light source to solidify the resin, rather than a laser. Currently, consumer-level SLA and DLP printer prices are indistinguishable. DLP parts also tend to show voxel lines layers formed by small rectangular bricks due to digital screens and have a generally lower quality surface finish. One well-known DLP company is Carbon. However, Stratasys has recently acquired Origin, adding DLP to its dental portfolio.

4. Material Jetting (MJP) – Material jetting (PolyJet and MultiJet Modeling) 3D printers work similarly to inkjet printing, but instead of jetting drops of ink onto paper, they jet layers of liquid resin onto a build tray and cure them instantly using light. Material jetting technologies were the most common in the dental industry a few years ago, but expansion was limited by their high cost and the large size of the machines. They require extensive post-processing and the surface finish of parts produced with this technology is generally inferior to SLA or DLP. Material jetting systems have high throughput but can only be used for a limited range of applications due to the costly, proprietary materials. Some of the commonly known companies for this type of printer is HP and Stratasys

Regardless of printer type, the hardware space is extremely competitive (“red ocean“), which benefits end-users.

Here are some characteristics you should be looking for when deciding on a “3D printer”:

1. Technology:

Find the technology that matches your end application requirements in terms of accuracy, precision, ease of use, and reliability. Other considerations include throughput and scalability of the printer, which heavily depends on particular dental practices/labs. Finally, like any other electronics, warranty, customer support, ease of replacement and upgrades should also be added into your purchase consideration. 

One thing you need to remember is that the job is still incomplete after a 3D print is done.

Post – processing is an extremely important step to ensure quality, which we will discuss in another blog. Many of the technologies above also require extensive post-processing ranging from curing (for SLA and DLP), to polishing (MJP and FDM). 

2.  Pricing:

The obvious answer without this guide is the cost of an individual printer. That is well defined and you can use Amazon search. Nothing fancy. However, this is not where your homework ends. While we have not done a thorough analysis of ROI in investing in 3D printing, it is helpful to simulate the financial outcomes of in-house, outsourced, and hybrid 3D printing workflow similar to medical 3D printing.

A more expensive printer upfront may translate into shorter breakeven time, fewer future upgrades needed more potential applications (i.e. more future revenue), superior customer support, etc. 

3. 3D Printing Materials portfolio (Equals application portfolio):

There are more and more biocompatible materials available for dental 3D printing. Many printer manufacturers actually generate significant revenue from their material offerings than from selling 3D printers. Therefore, it is important to purchase a printer that is capable of work working with a variety of existing dental materials for a variety of applications. One such example is Asiga 3D printers. Alternatively, a printer that comes with a solid portfolio that meets a majority of your office needs would also work. One such example is Formlabs. Stay tuned for future guides on biomaterials for 3D printing. 

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Cory Lamberston from Asiga, an Australian 3D printing and material company, presents its machine vision-based printer technology.

4. Training and support:

3D printing is still hard. 

And each printer is different.

With a paucity of training programs focusing on dental 3D printing and the persistent gap between technology and healthcare end-user, finding equipment manufacturers with excellent customer support and training program is essential. One company that has done well is consumer-facing Formlabs, which has a very informative blog and tutorials for dental users. SprintRay and Kulzer also offer a comprehensive approach and promise a smooth integration between dental printing software, printers, accessories, materials, and support.

More importantly, since many dental offices now leverage dental assistants in the 3D printing process, does the printer company offer training to your staff in an affordable and easy manner will become more and more important. 

Who are the commercial players in dental 3D printing? Newborns, Warriors, Unicorns, Winners:

We like to classify a particular ecosystem into four categories based on valuation and business maturity. The following definition is a modified version of our earlier version in 2020:

Newborns: These are early-stage Pitch 3D startups (pre-seed or Seed stage companies).

Warriors: These are Pitch 3D startups that have successfully completed fundraising at Series B.

Unicorns: These are companies that have a new private market valuation of more than 1 billion dollars in the past three years.

Winners: Public companies that have a strong track record in the past decade and/or are considered industry leaders.

Since 3D printing is an emerging field, most of the companies in the space are early-stage startups. Many 3D printing companies are in the “Winners” category with a strong dental portfolio but are still small-cap companies despite decades-long industry track records. These companies include 3D Systems and Stratasys.

One “winner” in the space is Align Technology (ALGN, market cap: 21 billion), which we have referenced numerous times in this article. The technology, history, and stories surrounding this amazing company are worth studying for those interested in innovation in dental 3D printing. 

The “unicorn” category includes Carbon, and Desktop Metal (which has lately been building up its dental portfolio after acquiring EnvisionTech). 

The early-stage startup examples include: 

Upcoming clear aligner competitors: Candid, Lightforce Orthodontics(Series C at the time of this article)

Oral appliances: Oventus Medical

Digital dental lab reimagined: Dandy, Aforna

Drill free dental implant: i-Dentical implant

Automation: Relu

Biomaterials: Cerhum

For a full complete regularly updated list, please check out our Company Directory. 

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Conclusion:

In conclusion, 3D printing is poised to increase its footprint in the dental space. However, like the old Chinese saying, it requires the perfect alchemy of “timing, geography, and people”. It is necessary to ask the question of why Align Technology is the only “winner” so far in the space. Some may argue first mover advantage or an unfavorable patent landscape set up by various incumbent 3D printing companies. However, the IP/patent portfolio in the end is a defensive move, not an offensive one. First movers also have plenty of risks and disadvantages. What is stopping the next Align technology from being born? I am excited to see newcomers to the space and carve out a new market (and new solutions for the patients).

Reference: 

1. Endodontic applications of 3D printingJ. Anderson,J. Wealleans,J. Ray First published: 27 February 2018. https://doi.org/10.1111/iej.12917

2. Cone Beam Computed Tomography – Know its Secrets. J Int Oral Health. 2015 Feb; 7(2): 64–68.

3. ACE Panel report finds about half of dentists use intraoral scanners. 

4. CBCT Purchasing Guide: How to Choose the Perfect Machine

Dental 3D Printing: Pioneers and Rulebreakers (On Demand, August 11th, 2022)

Dental 3D Printing: Latest in Digital Dentistry (On Demand, October 21, 2021)

Interview with Rick Ferguson: Teaching Dental 3D Printing

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

From Esthetic to Functionality – Perspectives of Anodized 3D Printed Titanium Dental Restorations

Interview with CEO of Arfona Printing, Justin Marks

3D Printing Implants for Atrophic Jaws

Dr. Gordon Lai: 3D Printing in Endodontics

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