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3D Printing in Dentistry

Three-dimensional printing was once an extremely expensive and complex undertaking. Now, 3D printers are available for home and office use and dentists around the world are finding new and exciting ways to use this technology to improve patient outcomes.

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Scholarly Articles

♦ Bartkowiak, T., Walkowiak-Sliziuk, A.  2018.  3D printing technology in orthodontics- review of current applications.  Journal of Stomatology. 71 (4): 356-364. DOI: 10.5114/jos.2018.83410

Abstract: Additive manufacturing is a relatively new technology with rapidly growing range of applications in many fields of medicine and dentistry. The developments of available computer-aided design software and additive manufacturing hardware allowed integrating the technology in orthodontics, and revolutionizing the workflow in orthodontic practices and laboratories around the world. 3D printing is now easily accessible for orthodontists, being a reliable and cost-effective manufacturing method, which may be used in many aspects of orthodontic practice, and its potential is still growing. The article gives necessary insight into the history, development, and available technologies of additive manufacturing. Moreover, it summarizes and reviews current literature concerning all aspects of clinical use of 3D printing in orthodontics.  

 Brown MW, Koroluk L, Ko CC, Zhang K, Chen M, Nguyen T. 2015. Effectiveness and efficiency of a cad/cam orthodontic bracket system. Am J Orthod Dentofacial Orthop. 148(6):1067-1074. DOI:10.1016/j.ajodo.2015.07.029

Abstract: The first straight-wire appliance was introduced over 40 years ago to increase the consistency and efficiency of orthodontic treatment. More recently, computer-aided design and computer-aided manufacturing (CAD/CAM) technology has been used to create individualized orthodontic appliances. The purpose of this study was to investigate the clinical effectiveness and efficiency of CAD/CAM customized orthodontic appliances compared with direct and indirect bonded stock orthodontic brackets.This retrospective study included 3 treatment groups: group 1 patients were direct bonded with self-ligating appliances, group 2 patients were indirect bonded with self-ligating appliances, and group 3 patients were indirect bonded with CAD/CAM self-ligating appliances. Complete pretreatment and posttreatment records were obtained for all patients. The American Board of Orthodontics (ABO) Discrepancy Index was used to evaluate the pretreatment records, and the posttreatment outcomes were analyzed using the ABO Cast-Radiograph Evaluation. All data collection and analysis were completed by 1 evaluator.  There were no statistically significant differences in the ABO Discrepancy Index or the ABO Cast-Radiograph Evaluation among the groups. Treatment times for the 3 groups were significantly different; the CAD/CAM group was the shortest at 13.8 ± 3.4 months, compared with 21.9 ± 5.0 and 16.9 ± 4.1 months for the direct bonded and indirect bonded groups, respectively. The number of treatment appointments for the CAD/CAM group was significantly fewer than for the direct bonded group. The CAD/CAM orthodontic bracket system evaluated in this study was as effective in treatment outcome measures as were standard brackets bonded both directly and indirectly. The CAD/CAM appliance was more efficient in regard to treatment duration, although the decrease in total archwire appointments was minimal. Further investigation is needed to better quantify the clinical benefits of CAD/CAM orthodontic appliances.

♦ Jheon, A.H., Oberoi, S., Solem, R.C., Kapila, S. 2017.  Moving towards precision orthodontics: an evolving paradigm shift in the planning and delivery of customized orthodontic therapy.  Orthodontics and Craniofacial Research.  20: 106-113.  DOI: 10.1111/ocr.12171

"Advances in precision medicine portend similar progress in orthodontics and will be increasingly harnessed to achieve customized treatment approaches and enhance treatment efficiencies. Our goal is to provide a background on emerging advances in computer technologies and biomedicine and highlight their current and likely future applications to precision orthodontics.  A review of orthodontically relevant technologies and advances in pertinent biological research was undertaken. Innovations in computer hardware and software, and 3D imaging technologies offer the ability for customized treatment and biomechanical planning that will be more fully realized within the next few decades. These technologies combined with 3D printing are already being applied to customized appliance fabrication such as aligners and retainers. The future prospects for custom fabrication of orthodontic brackets of appropriate material properties and smart devices are highly desirable and compelling goals. Within biomedicine, the fundamental understanding of cartilage growth and bone biology is currently being tested in animal models to modify mandibular growth and modulate tooth movement, respectively. Some of these discoveries will ultimately have clinical applications in orthodontics including for growth modification, accelerating orthodontic tooth movement, and enhancing anchorage or retention of teeth. Additional genomic and proteomic information will add to further customization of orthodontic diagnosis and treatments. Over the coming decades, precision orthodontics will continue to benefit from advances in many fields and will require the integration of advances in technology, and biomedical and clinical research to deliver optimal, efficient, safe, and reproducible personalized orthodontic treatment."

♦ Krey KF, Darkazanly N, Kuhnert R, Ruge S. 2016. 3d-printed orthodontic brackets - proof of concept. Int J Comput Dent. 19(4):351-362. PMID: 28008431. (Full Text)

Abstract: Today, orthodontic treatment with fixed appliances is usually carried out using preprogrammed straight-wire brackets made of metal or ceramics. OBJECTIVE: The goal of this study was to determine the possibility of clinically implementing a fully digital workflow with individually designed and three-dimensionally printed (3D-printed) brackets. MATERIALS AND METHODS: Edgewise brackets were designed using computer-aided design (CAD) software for demonstration purposes. After segmentation of the malocclusion model generated based on intraoral scan data, the brackets were digitally positioned on the teeth and a target occlusion model created. The thus-defined tooth position was used to generate a template for an individualized arch form in the horizontal plane. The base contours of the brackets were modified to match the shape of the tooth surfaces, and a positioning guide (fabricated beforehand) was used to ensure that the brackets were bonded at the correct angle and position. The brackets, positioning guide, and retainer splint, digitally designed on the target occlusion model, were 3D printed using a Digital Light Processing (DLP) 3D printer. The archwires were individually pre-bent using the template. RESULTS: In the treatment sequence, it was shown for the first time that, in principle, it is possible to perform treatment with an individualized 3D-printed brackets system by using the proposed fully digital workflow. Technical aspects of the system, problems encountered in treatment, and possible future developments are discussed in this article.

♦ Nagib, R., Szuhanek, C., Moldoveanu, B., Negrutiu, M. L., Sinescu, C., Brad, S.  2017.  Custom designed orthodontic attachment manufactured using a biocompatible 3D printing material.  Materiale Plastice.  54(4): 757-758.  

Abstract: Treatment of impacted teeth often implies placing a bonded attachment and using orthodontic forces to move the tooth into occlusion. The aim of the paper is to describe a novel methodology of manufacturing orthodontic attachments for impacted teeth using the latest CAD software and 3D printing technology. A biocompatible acrylic based resin was used to print a custom made attachment designed based on the volumetric data aquired through cone bean computer tomography. Custom design of the attachment simplified clinical insertion and treatment planning and 3D printing made its manufacturing easier. Being a first trial, more reasearch is needed to improve the methodology and materials used.