Interview: Game Changer with 3D Printed Dental Implants (Video)

Apr 08, 2020

An Interview with Dr. Rui Coelho, Founder of BoneEasy

Dr. Rui Coelho

“I’ve started as a DDS, jumping almost immediately to maxillofacial surgery, I’ve taught dental implantology at the University from 1993 to 1998, a post-graduate program. From 2011 I’ve dedicated to the Industry as a project manager for some projects including “Digital stratification of dental crowns”. The project was developing a 5-axes 3D printer to make stratification of dental crowns with composites by 3D printing.

In 2013 I’ve found two companies “Tailoredimplant” and “Boneeasy”, the first was to develop 3D software for surgeons designing bone grafts and the second one a bioprinting company that prints implantable medical devices.”

Dr. Coelho will be speaking on the dental panel at 3DHEALS2020.

There are those who shoot for incremental change and then there are those who shoot to change the game. Dr. Rui Coelho and his team at Bone Easy based in Portugal aim to rewrite the rules of oral implantology with 3D printed patient-specific dental implants and their related components. The team designs implants using the patients’ 3D X-ray data then print them. Beyond the ‘cool’ factor of their work, the benefits are numerous including a less invasive and quicker surgical process and a more streamlined prosthetic phase to rehabilitate the patient. The customized implants are currently available in Portugal, Saudi Arabia, ……… Dr. Rui and his time hope to make them available in ….. in the near future.

I decided to ask Dr. Coelho how he got into customized implants and what he envisions for the future. Read the following conversation below.

Dr. Coelho and Dr. Cajee

What do you specialize in? What is your passion?

Dr. Coelho: I specialize in Patient-Specific Implants in the Maxillofacial area, utilizing CT scans to make 3D reconstructions of the face. Along with the surgeon & sometimes with the collaboration of patients, we design reconstruction volumes or implants. My passion is to develop solutions that can help oral and maxillofacial surgeons. More than tools we aim to give them solutions to reduce errors in planning and intraoperative tasks. I think patients can benefit a lot from pre-design solutions that allow less invasive surgeries and much less operative time, but to achieve this goal we need collaboration from the surgeons on developing new designs and giving intensive feedback to improve this kind of solution.

BoneEasy Mesh

How did you get into developing individualized bone grafts, meshes, and craniofacial implants?

Rui: My background is oral surgery focused on bone regeneration. I discovered the difficulties of many clinicians I instructed to reproduce geometries of the bone loss during bone regeneration procedures. The idea of  making bone regeneration techniques a more democratic procedure made me first develop a 3D modelling software named Tailoredimplant, and I manufactured the individualized bone blocks by a milling process of synthetic  (TCP/HA) blocks. Our company is guided by surgeons’ needs, many ask us for a pre-designed product of a 50/50 mix of autologous bone chips and bone substitutes. After customizing bone blocks we chose to focus our efforts on customized metal meshes to support the stability of bone grafts. From our research, we decided to make it by SLM (Selective Laser Melting) printing of titanium, which allows us to make devices that integrate the planning of the fixation points, guide implant placement and create small appendices to fix the collagen membrane. The biggest difficulty that we’ve found with this technology is the surface roughness that allows bacteria colonization, so we developed new systems of polishing and now we deliver it polished, and the outcome very promising. After we acquired the SLM printer we decide to push the envelope and produce individualized implants, where regeneration was not biologically possible. This is a much more complex process, which implies more complex geometries, it has to be combined with milling processes to create connections for screwing abutments, and surgical guides for bone preparations.

Peek Membrane (BoneEasy)

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

Dr. Coelho: I have no doubt that the future of medical devices is going to be marked by bioprinting. Every day the additive manufacturing industry is bringing new solutions. For example, we are testing HA grafts and we are we are doing it by mixing UV castable resin with Calcium phosphate to allow print a bone graft in a DLP/SLA printer. Then we burn the castable resin allowing to sinterise the block to achieve a TCP/HA bone block with porosities and interconnectivity never achieved by standard procedures.

Personalized Dental Implants (BoneEasy)

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

Dr. Coelho: The next step is to make 3D printed devices more biologically compatible. I hope that we can involve tissues from a patient’s own cell cultures to achieve a quicker integration. We manage very well with current metal 3D printing systems, now is the time to go further and develop biologically active implant devices.

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

Dr. Coelho: Bioprinting is a medical procedure in which engineering is a very powerful tool. However, the best lesson that I’ve learned is that we are not in an engineering business, we are in a people business. It is crucial we collaborate with our surgeons. We need to put all our skills and knowledge together to create our personalized devices. We cannot start to design a device  without knowing the surgical plan of the surgeon. We also need to educate all health professionals about our methods and techniques so they see they benefits and potential for patients who are in need of the devices we manufacture.

Personalized Implant (BoneEasy)

Q: What crucial skill should people aiming to work in this industry acquire?

Dr. Coelho: To be humble and listen. When we see that we can manufacturer almost everything, we tend to act like God. It is true is that we have a powerful tool but in the case of bioprinting the rules of biology must be understood — and that is provided by the surgeons that know best the patient’s situation and needs.

About the Author:

Dr. Nabeel Cajee is the Dental Ambassador for 3D Heals, a healthcare 3D Printing innovation platform, and has served as adjunct faculty at the University of the Pacific. He graduated from the University of the Pacific Dugoni School of Dentistry in San Francisco and completed an Advanced Education in General Dentistry Residency at Oakland’s Highland Hospital. He is recognized as a Master of the International Congress of Oral Implantologists and Fellow of the American Academy of Implant Prosthodontics. He maintains implant dentistry focused private practice in Manteca, California. He will be a speaker and moderator at 3DHEALS2020.

European Regulatory Issues with Custom Made Medical Devices

Interview: Richard McFarland, Chief Regulatory Officer, ARMI

3D Printing Has Come of Age But How Safe Are the Devices Going Into Our Mouth?

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

3D Bioprinting and Biologics: A Look at Patent and FDA Market Exclusivity Strategies