Dr. Raymond Wong graduated with a Bachelor of Dental Surgery from the University of Malaya. While there, he won the University Entrance Scholarship and won the Book Prize for Excellence for the First, Second and Final Professional Examinations (Part 1). He then pursued his specialist training in Oral and Maxillofacial Surgery (OMFS) at the National University of Singapore under the Association of Southeast Asian Nations (ASEAN) Post Graduate Scholarship, graduating with a Master of Dental Surgery (OMFS). He subsequently went on to work as a Specialist Registrar at the Sunderland Royal Hospital and a Clinical Fellow at Morriston Hospital, Swansea, Wales in the United Kingdom while on a Health Manpower Development Program under the Ministry of Health Singapore. He obtained a Ph.D. in Medical Sciences from the Radboud University of Nijmegen, the Netherlands. He is a Senior Consultant and Assistant Professor in OMFS at the National University Centre for Oral Health and the National University of Singapore. At the University Level, he is the co-thrust lead for Dentistry, AM.NUS. Dr. Wong was a Past President, Association of Oral and Maxillofacial Surgeons Singapore, sits on the Specialist Training Committee, OMFS, represents Singapore as Country Councilor on the Asian Association of Oral and Maxillofacial Surgeons as well as holds a Councilor at Large post on the Executive Council of the Asian Association of OMFS and the International Association of OMFS as Singapore Councilor. He serves as a Regional Faculty, Association for the Study of Internal Fixation (AO) Craniomaxillofacial Surgery (AOCMF) at the Asia Pacific region. AOCMF is a nonprofit educational organization dedicated to the teaching of head and neck surgery to surgeons from all specialties. He is also currently the Organizing Chairman, Asian Conference on Oral and Maxillofacial Surgery, 2020 in Singapore. Dr. Wong will be speaking in our upcoming August 28th, 2019 3DHEALS Singapore Annual Event.

Jenny: When was the first encounter you had with 3D printing? What was that experience like?

Dr. Wong: I first tried 3D printing in 2008 when I had a case that needed a surgical cutting guide to be fabricated. At that time the place where I worked had bought the Z-Corp printer which essentially had powder base bound by an inkjet and then needed strengthening with cyanoacrylic glue. It didn’t find much use because there was no allocation for a technician and no one knew how to use it. So it became a white elephant and the powder kept on having to be discarded as it had expired. I found the process interesting but quite painful and realized that we needed trained personnel to do this. It was very difficult for busy clinicians to learn how to perform segmentation of the radiologic images, exporting in STL format and deciding on how to position the print on the platform. Essentially I did it by trial and error in between patients and after work with little guidance. That took me the better part of 2 weeks. The computer where we installed the segmentation software kept on hanging and running out of memory and had to be re-booted repeatedly. The first model I printed crumbled and I had to print it again taking 8 hours. The second model I managed to remove from the build chamber but part of it crumbled when I used an air-jet to remove excess powder as recommended by the manufacturer. Another 8 hours later, I managed to use the cyanoacrylic strengthener but my glove got stuck to the model and I managed to peel most of it out individually with a scalpel.

Jenny: What inspired you to start your journey in 3D printing ?

Dr. Wong: The recognition that we already had technological advances at hand but there was little implementation because, for many surgeons, it felt too difficult to learn or little impetus to change since the old methods worked. My argument against that is that there are always better ways to do things and the use of these technologies is not just fancy toys but you actually reduce the incidence of bad complications and improve the frequency of good outcomes.

Jenny: Who inspired you the most along this journey in 3D printing ?

Dr. Wong: The late Emeritus Professor Henk Tideman, University of Hong Kong, who was my Ph.D. supervisor-he made me realize that you need to keep up to date on the latest advances-he was much older than me but more in tune with technology than me. The second person who comes to mind is Prof Adrian Sugar of Morriston Hospital, Wales. He was, again, older than me but in the forefront of advanced digital technology for head and neck surgery.

Jenny: What motivates you the most for your work?

Dr. Wong: I am never content to accept the current way we do something is the best way. There are always ways to improve things.

Jenny: What do you think are the biggest challenge(s) in 3D Printing/bio-printing? What do you think the potential solution(s) is (are)?

Dr. Wong:

Challenges:

Lack of trained personnel

Lack of funding for equipment, training and employing such personnel

Solutions:

Having a centralized centre like that available in NUS (AM.NUS) is a possible way forward for institutions.

Jenny: What were/was the best investment you made in 3D printing? 

Dr. Wong: Spending the time to learn how to clean radiologic images, performing segmentation, learning how to design with a CAD program and doing my own printing. It gave me a deep understanding of the nuances and intricacies involved.

Jenny: What was/is the biggest risk you took in your career?

Dr. Wong:  Using 3D planning for surgery and printing surgical guides exclusively without any backup (in case the printed guides didn’t fit or work). I did the first orthognathic jaw surgery case in Singapore planned using computer virtual planning and then fabricate 3D printed guides in 2011. Prior to that, I had done a difficult post-traumatic deformity case in 2010 using a combination of 3D planning and 3D printed cutting and positioning guides for facial surgery.

Jenny: What is your favorite quote? Why?

Dr. Wong: I like this quote from Prof Ryan Bell- Everyone can have a bad day in the office. For surgeons, a bad day in the office implies a poor outcome for a patient with its own cost and morbidity. The use of digital technology improves good outcomes and increases the frequency of good outcomes. 

This phrase means a lot because as surgeons, things that we do can impact a patient negatively. Not using the best tools at our disposal for treatment and even training is difficult to defend especially when such technologies are not exactly that new.

Related Articles:

Maxillofacial Surgery and 3D printing: Past and Present

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

Interview: Renata Vano, 3D Printing in Prosthodontics, Brazil

Interview: Dr. Pedro Martinez Seijas, Oral and Maxillofacial Surgeon at Donostia University Hospital

The post Influencer Interview: Dr. Raymond Wong, Singapore appeared first on 3DHeals.

By Eric Barnes, AuntMinnie.com staff writer

This article was originally published on March 22nd, 2017 on AuntMinnie.com.

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3DHEALS2017 Recap, April 20th, 2017

3D printing is revolutionizing medicine — and radiology with it. But what’s the best way to learn about this emerging discipline? The 3DHeals International Conference, being held in San Francisco on April 20, will explore 3D printing in healthcare with an eye on virtual reality, augmented reality, and artificial intelligence.
The meeting at the University of California, San Francisco (UCSF) Mission Bay campus will feature hands-on workshops on 3D printing and talks on everything from 3D-printed organs to prosthetics to building surgical and educational models, according to organizers.

Neuroradiologist Dr. Jenny Chen.

Featuring experts from across the U.S., the meeting is aimed at anyone interested in 3D printing, but it will be especially relevant for radiologists, radiologic technologists, and surgeons who deal with the problems 3D printing addresses every day, according to 3DHeals founder and CEO Dr. Jenny Chen, a neuroradiologist and adjunct clinical instructor of radiology at Stanford University.
Radiology as prime beneficiary
3D printing is a natural adaptation for radiologists, according to Chen.
“On a daily basis, radiologists scan patients from the physical world into the digital world, review the digital data, and then give some kind of cognitive information to take care of them in the physical world,” she told AuntMinnie.com. “Now with 3D printing we can finally convert the physical data into a 3D object that surgeons can hold in their hand.”
For applications such as pediatric congenital heart disease, surgeons can plan their interventions holding the heart in their hand — something with enormous implications for patient care that wasn’t possible before 3D printing, she said.
“All of that cognitive information is now embedded in that physical object … and there is increasing evidence that having that data available for planning is reducing operating time,” improving outcomes, saving money, and wielding enormous effects on patients’ lives, she said.
3D printing a surgical guide is another application with enormous potential for radiology to cut costs and improve outcomes, Chen said. Exactly what and how the new technologies will reshape healthcare is the subject of many clinical trials, both currently underway and to come.
https://vimeo.com/168270199
Experience in a hurry
One key dynamic in medicine today is that older, more experienced surgeons benefit from a wealth of insight and experience they can use to, for example, “freehand the perfect incision and do the perfect surgical procedure,” Chen said. But with 3D-printed surgical guides, younger doctors with less experience who are still perfecting their art or have lower baseline skill levels can now perform better, helping to satisfy market demand.
“We’re an aging population,” she said. Without 3D printing, “we can’t meet the demand.”
And of course, it’s not just radiology that benefits from 3D printing. Specialties from orthopedics to cardiology are using computers and medical imaging to advance their fields.
“One of the benefits of this conference is that we combined all of the specialties in healthcare together to have a cross-pollination effect,” she said.
For example, radiology has lessons to learn from dentistry, which has a wealth of experience in 3D models and will have its own track at the conference.
In all, there will be 50 speakers at 3DHeals, including the following:

• Dr. Sanjay Prabhu, co-director of the SimPeds 3D printing service at Boston Children’s Hospital, will lead a medical hands-on workshop. Prabhu has a wealth of experience in 3D simulation, and his facility has a wide range of 3D printers for metal, plastic, and robotic and laboratory applications, Chen said.
• Justin Ryan, PhD, from Phoenix Children’s Hospital is part of a nationwide study of congenital pediatric heart disease.
• Dr. Lisa Lattanza, professor and chief of the division of hand, elbow, and upper extremity surgery at UCSF, is one of three prominent orthopedic surgeons speaking at the meeting. Using 3D printing, Lattanza performed successful elbow surgery on a patient who lacked usable arms on both sides and now has the use of one arm thanks to the life-transforming surgery, Chen said.
• Keith Murphy, chairman and CEO of Organovo, is among the pioneers of bioprinting 3D organs and one of several bioprinting leaders attending the event. “Research is ongoing” in bioprinting and “the regulatory burden is extremely high,” Chen said. “But all the science fiction will be coming true. We are innovating at an exponential rate.”

The multidisciplinary nature of the conference is aimed at eliminating the silos to which technology researchers are often confined, according to Chen. The best innovation doesn’t confine itself to a specific field, but rather approaches research from a problem-solving focus, endeavoring across disciplines to solve one critical small problem at a time.
“There’s no way the tech people can solve it without practicing medicine themselves, and on the other hand, clinicians aren’t well-educated on what’s happening in the tech world,” she said.
Innovating across specialties and combining clinical issues with technologies such as virtual reality, augmented reality, and artificial intelligence (AI) is what drives progress, Chen said. AI in particular will be key to making 3D printing and stereolithography (STL) files easier to produce.
For radiologists looking to keep their skills relevant in a highly automated future, 3D printing is a great place to start, Chen added.
“Everyone is responsible for their own future,” she said.
Registration fees for the meeting have been intentionally minimized for medical students ($50) and residents ($150), and they are reasonable for physicians ($450) as well, Chen said. For more information or to register, click here.

The post 3DHeals conference explores 3D printing and more appeared first on 3DHeals.

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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

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