July 9, 2021
by Florin Lazarescu, DDS, MSc, MSc
When I discovered CAD/CAM technology more than 10 years ago, I was amazed at the technological world that I was entering. It was novel and it was creative; but it was also rather daunting. My student years had provided some abstract images of various scanners and milling machines that were available at that time, but no actual cases employing these technologies. Once I graduated, the systems were far too expensive for the small office where I was practicing initially.
After I made the decision to purchase a complete in-office system, I discovered an exciting new world, one that I could not have imagined previously. As suggested, I allowed myself a comfortable learning curve at the beginning, starting with easy cases, gradually gaining experience and familiarity with the process, until I was confident enough to push for more. CAD/CAM systems have evolved rapidly, and during the past 10 years I have been witness to an accelerated evolution of three generations of scanners and milling machines. Today, I would not even consider opening a new office without, at the very least, a scanner, and preferably, a complete in-office CAD/CAM system.
I remember that when I explained the benefits of CAD/CAM technology to my patients a decade ago, I could not help wondering what lay ahead for dentists, and where the future of the profession would lead us.
As I look at the rapidly developing field of 3D printing, I get the same game-changing feeling that I had when I first discovered CAD/CAM technology. The mainstream dental 3D printing boom began in 2015, following important technological milestones such as the first dental 3D printing in 2000, digital impressions for an analog world in 2005, and the introduction of all-ceramic restorations and desktop scanners in 2010.
There are 3 distinguishable types of 3D printing that can be categorized from a technological perspective:1
LFS 3D–Form 3B printer (Courtesy of Formlabs Dental).
Various companies utilize differing photopolymerization technology categories:
However, the underlying principle is the same: a polymerizing light hardens the resin to a solid-state layer by layer. DLP or LED techniques offer faster results, while SLA and LFS modes provide smoother and finer details, but the process is significantly slower.
There are numerous dental applications for 3D printing.2 In fact, there are many applications that are not possible without 3D printing (aligner thermoforming models, indirect bonding trays). 3D printing can enhance traditional techniques such as surgical guides, custom impression trays, diagnostic models, splints, restorative models, and provisionals. And there are novel 3D printing opportunities such as full dentures and permanent indirect and direct restorations. (Figs. 2-4)
Provisional crowns–Temporary CB resin(Courtesy of Formlabs Dental).
Surgical guide (Courtesy of Formlabs Dental).
Permanent single unit restorations (Courtesy of Formlabs Dental).
In my daily practice I find many situations where 3D printing allows me to offer existing services more predictably and rapidly. Currently available options include: provisional crown and bridge restorations, inlays, onlays and veneers.
The ability to print splints represents a tremendous advantage; a reliable in-house splint can be completed in a single appointment whereas sending the case to a dental laboratory is far less efficient and much more expensive. The routine use of rapidly printed surgical guides improves the patient’s perception of surgical procedures, speeds treatment, and assists in predictable results for every case. 3D in-house printing reduces the waiting time before surgeries.3
In the past, it was extremely difficult to treat totally edentulous patients with significant bone loss. Ultimately, the limitations of dentist-technician communications made the process long and tedious, and results were often less than satisfactory. It was also frustrating that during this time-consuming ordeal the patient had no access to provisional dentures. 3D printed full dentures, available the same day, offer a practical solution to both patient and dentist. Scanner, 3D printer and an in-house technician are the ideal.
As with any new technology, 3D printing has a learning curve. It is highly recommended that the practitioner begin with simpler procedures, and then tackle more complex ones as experience and confidence are accumulated. 3D printing technology is a game changer in the dental industry that will greatly influence and modify patient treatment in the years to come.
3D printing, taken together with CAD/CAM and CBCT, creates a comprehensive shift to digital dentistry, a trend that is rapidly redefining the dental profession.
Oral Health welcomes this original article.
About the Author
Dr. Florin Lazarescu is President of the European Society of Cosmetic Dentistry (ESCD) and founder and corporate director of the Society of Esthetic Dentistry in Romania (SSER), and Editor-in-Chief, DTI Romania. Dr. Lazarescu is author of Immersion in Esthetic Dentistry and Comprehensive Esthetic Dentistry (Quintessence) and numerous articles. His esthetic practice in Bucharest focuses on all-ceramic and implant restorative procedures.
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