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Dental Students Compare Conventional and 3D Printed Surgical Training Models

There are few things I hate more than going to the dentist. That’s why I’m always glad to hear stories of dental students using 3D printed training models to learn on – if they have to work in my mouth, then I want them to know what they’re doing. A group of researchers from University Hospital Münster in Germany published a paper on this topic, relaying the results of their work using real patient data to create 3D printed surgical training models for root tip resection. Then, they compared them against a commercial typodont model, which is a common simulation model used at university dental clinics with replaceable gingiva masks and teeth that often “show idealized eugnathic situations, which are rarely encountered in everyday practice.”

“Furthermore, the ready-made standard models do not usually depict special pathological or anatomic situations,” they wrote.

A root tip resection, or apicoectomy, removes inflammation around the tip of the tooth’s root. The researchers explained that the typodont model at their university features teeth “in direct contact with the hard plastic that simulates the jawbone,” and simulates the inflammation (apical granuloma) with wax, though it’s missing a sensitive periodontal ligament.

“The teeth used are idealized stereotypes. Anatomical variations, such as extremely long or even curved roots, cannot be simulated with these industrially produced models. Therefore, we have developed a method to create more realistic, individualized training models,” the researchers explain.

The model they created is of a real patient’s upper jaw with three anterior root apices, periodontal ligament, and the apical granuloma, along with a gingival mask.

“We also present an evaluation of the model by dental students and compare it with their evaluation of the conventional typodont model,” the team wrote. “Our intention was to evaluate whether dental students accept the 3D-printed surgical training model just as well as the popular typodont model.”

L-R: Modified plaster cast, modified plaster cast with wax layer.

They used CAD/CAM technology to design the training model, which allowed them to add the simulated inflamed tissue, and took a conventional impression of the area in question in order to make a plaster cast. The gingiva was modeled with a 1 mm thick layer of wax, and an industrial 3D scanner was used to attain the shape of the modified cast with and without the wax gingival mask.

L-R: Scanned surface of the plaster cast without wax layer and meshes of the three teeth aligned to the upper jaw.

The cone beam computed tomography (CBCT) data of another patient was used to create 3D models/meshes of teeth 11, 12, and 21 in Materialise Mimics, and the 3D reconstruction was modified using Rhinoceros 5. To make a model of the periodontal ligament, which the typodont model doesn’t include, they deleted the upper parts of the teeth mesh and thickened the rest by 0.25 mm in Geomagic Wrap.

L-R: Meshes of the roots (rear faces of mesh in blue-green), extruded root surfaces representing periodontal ligament.

They constructed a 6 mm sphere around the root apex of tooth 11 to simulate an apical granuloma.

“The material used to represent the periodontal ligament and the apical granuloma is softer than the material used for the other parts of the model. This allows a more realistic representation than in the typodont model,” they explained.

Meshes of the granuloma on tooth 11 and the periodontal ligament on teeth 11, 12 and 21, 3D printed in soft support material (red).

The 3D printed model also includes a silicone gingival mask so students can practice the surgical incision. A 3D printed matrix technique was used to fabricate the mask directly onto the model, and the model was 3D printed out of liquid photopolymer on an Objet Eden 260V PolyJet 3D printer. The undercut areas and the cavities in the model that simulated apical granuloma and periodontal ligament were filled with a soft support material. It took roughly six hours to 3D print 12 models in a single build.

Silicone gingival mask.

“Dental students, about one year before their final examinations, acted as test persons and evaluated the simulation models on a visual analogue scale (VAS) with four questions (Q1–Q4),” the researchers wrote.

35 students evaluated the typodont model, while 33 students used the 3D printed simulation model. Participants watched a video of the root tip resection exercise, and then completed the procedure once. They were given a questionnaire about the simulation model and the difficulty of the exercise, rated on a visual analogue scale (VAS). There was also an optional free-text section if a participant wanted to express their opinion in their own words.

Surgical incision guidance on the 3D printed model in the phantom.

Osteotomy of the root tip.

Presentation of the root tip. Note: torn gingiva mask.

Resected root tip with demarcation to the bone.

Suture exercise on the gingiva mask.

54.5% of the Group 2 participants said in the free-text section that the gingiva mask in the 3D printed model tore during the procedure, while 20% in Group 1 said that it detached from the typodont model.

Questionnaire results; white dots denote the mean values.

“Shapiro–Wilk normality tests revealed that, with the exception of Q4, normality cannot be assumed,” they explained. “Wilcoxon rank sum tests were therefore carried out to identify differences in the assessments of the two model types. The alternative hypothesis for each test was “The rating for the typodont model is higher than that for the 3D printed”. As the p-values presented in Table 1 reveal, the alternative hypothesis has to be rejected in all cases.”

Table 1.

The researchers determined that their 3D printed training models were “not inferior to the industrially manufactured typodont models,” and that the approach is very flexible – the models can be easily redesigned and adapted for different learning scenarios, and it’s much faster to fix them when necessary. While the 3D printers weren’t cheap, the material costs for a 3D printed single-use model were only about €10, compared to €300 for the multi-use hypodont model.

“A shortcoming of our study is that the exercises were performed by students without surgical experience. As a result, there is a lack of professional evaluation of the models in terms of how well they reflect the reality. Thus, we were not able to check an important quality aspect of the models,” the researchers noted.

“Future studies with experienced surgeons could provide more information about the realism of the 3D-printed models.”

Other issues include the missing color difference between anatomical structures or cortical and cancellous bone structures, and the gingiva mask needs improvement, either through alternative technologies or materials.

“Individual 3D-printed surgical training models based on real patient data offer a realistic alternative to industrially manufactured typodont models. However, there is still room for improvement with respect to the gingiva mask for learning surgical incision and flap formation,” they concluded.

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AMS 2020: Panels on 3D Printing Materials and Applications for Dental Industry

At our recent Additive Manufacturing Strategies 2020 in Boston, co-hosted by SmarTech Analysis, many different topics were discussed in keynotes and panels, such as binder jetting, medical 3D printing, and different materials. Dental 3D printing was also a major topic of discussion at the event, and I attended three panels that focused on additive manufacturing for dental applications.

The first, “Into the dental and oral surgery office,” had three panelists: Dr.-Ing. Roland Mayerhofer, the Product Line Manager for Coherent/OR Laser; CEO Manager of Oral 3D Martina Ferracane; and Mayra Vasques, PhD, a dental prosthesis fellow at the University of São Paulo in Brazil.

Dr. Mayerhofer went first, and provided a quick overview of Coherent’s laser powder bed fusion (L-PBF) systems, and the dental applications for which they can be used.

The versatile CREATOR is the company’s open system, and can print with multiple materials, such as brass, cobalt chromium, steel, and Inconel.

“As long as it works, you can put any powder in you want,” Dr. Mayerhofer said about the 3D printer.

He explained said that the CREATOR setup is “typical but can be as big as a stand-up fridge, not the American double-size.”

You can take a look at the rest of the printer specs above, along with a few features that will be added to the new system that’s coming in 2021, such as two powder hoppers and a build platform.

“Then you can take them out, put fresh hoppers in, and keep going,” Dr. Mayerhofer said.

He stated that the dental field is likely one of the first major adopters of metal additive manufacturing, as the technology offers 100% personalization and can fabricate small, complex parts out of existing materials, like titanium alloys…all perfect features for the dental industry.

Dr. Mayerhofer then discussed Coherent’s digital dental workflow, which can get from scanning to a completed 3D printed part in 12 steps. Some of these steps include designing the CAD file and preparing it for 3D printing in the company’s APP software suite.

Later process steps are annealing, and then sandblasting, support removal, polishing, ceramic coating – added manually – and voila, you have a finished product.

The Dental Cockpit is Coherent’s latest addition. The CAM software makes it easy to load and print parts, which means that the digital dental workflow as a whole is much less complex. There’s one click to select the file, another to choose the materials and properties, and then a final click to generate the G-code.

Dr. Mayerhofer said that Coherent’s whole dental workflow, 3D printing on the CREATOR include, takes just one work day to fabricate a completed bridge in the dental lab.

After the cast skeleton is scanned, the dental lab begins preparing the CAD data at 8 am. Then the print job has to be prepared in Dental Cockpit, and 3D printing typically begins in the morning.

Once the parts are removed from the print bed, post processing is completed, and then a porcelain coating is added before the product is subjected to heat treatment and polishing. The completed bridge is then ready to go by 4 pm.

Dr. Mayerhofer noted that a dental lab’s ROI on the CREATOR 3D printing system is less than a year…typically about six months, in fact.

Then it was Ferracane’s turn to explain how her company, Oral 3D, makes 3D printing simple for dentists, even as it’s occurring at the industrial level.

“Our solution makes it extremely simple for dentists to bring 3D printing to their practice,” she said.

She presented a brief overview of the US dental market, noting that some of the major applications for 3D printing in the field include aligners, crowns, surgical guides, and soft tissue models, which dentists use to test procedures ahead of time.

“Usually today, the way most of these models are done is through intraoral scanning,” she explained.

Ferracane said that SLA technology makes it much easier to make these soft tissue models. But, even so, they can still only be used for testing purposes most of the time.

3D printed models of hard tissue – bone – are also fabricated, but she said that they’re not used often, as it’s difficult for dentists to come up with STL files of just the hard tissue.

She pulled up a slide that had the world “PROBLEM” across the top. The image appears to be scan data of bone, which looks pretty hard to read.

“It’s not easy for dentists to make this into something printable by cleaning up the images,” Ferracane explained. “So they can pay to outsource it to labs to clean it up. But our 3D printing software automatically does this. Just drag the CT scan, and we’ll take care of changing it from DICOM to STL. With one click, we can then convert STL to G-code.”

She said that while it’s obviously good to fabricate dental applications this way using Oral 3D’s printer, it will work with whatever system you’re already using.

These 3D printed models serve a variety of purposes – they can improve communication with patients, help in treatment planning, and even “broaden learning.” Ferracane mentioned that the company has partnerships with NYU and Harvard for this last.

Other applications include bone blocks, made-to-measure titanium membranes, and maxillofacial surgery. Additionally, she stated that Oral 3D recently began collaborating with dental surgeons, who use the company’s 3D printed dental models for planning and patient communication.

She finished by stating that the company believes FDM printing can “be a good value add for dentists.”

Vasques finished things by sharing her research into how things look, dental 3D printing-wise, from the point of view of clinicians.

“It’s common for most to be scared of using 3D printing,” she explained. “They think it’s plug and play, and it’s not.”

For her research, she divided users into two separate groups – high level experience (seniors), and innovation (early adopters and students).

“We are trying to figure out how these people understand the technology,” she said.

High level users expect accuracy, efficiency, high quality technology, and high-performance materials for the purposes of chairside 3D printing. Vasques said that these users “don’t want to wait 2-3 hours to make products by hand.”

“In university, we’re trying to establish protocols and research to help these people have the results they are expecting.

“We’re trying to solve problems, like mouthguards for sports.”

Vasques said that last year, she and her team published three articles about dental 3D printing topics, such as 3D printed occlusal devices and post-processing. She launched INNOV3D the same year, in order to help train professors in using dental 3D printing.

“We have an online training platform, educational materials, and 3D lab,” she stated.

Once she finished and sat back down, Davide Sher, the panel’s moderator, asked the other two panelists how they would address the challenges that Vasques listed, and how they would make dentists understand more about dental 3D printing.

Ferracane answered that most dentists aren’t buying 3D printers today, because they’re initially taught that the systems are really easy to use when they’re not. Once they run into issues with SLA technology, they get frustrated and just start outsourcing the work instead.

“Then they’re really dissatisfied, because they’re complicated and not just plug and play. We need to help them understand that they can bring the technology back to their office.”

Sher noted that dentists don’t really have the time to learn about the more advanced types, and so asked if the companies directed their technology to users in dental labs; Dr. Mayerhofer said yes.

After a short break, the next session, “Dental lab experiences with 3D printing,” began. While Les Kalman, an Assistant Professor for Restorative Dentistry at Western University’s Schulich School of Medicine, was unable to make AMS 2020, Arfona founder and CEO Justin Marks and Sam Wainwright, Dental Product Manager for Formlabs, were both ready to go.

Marks went first, explaining that Arfona, founded in 2017 by dental technicians and 3D printing enthusiasts on “the core belief that thermoplastic dental materials should not be substituted for inferior photopolymers,” has been working to “bring 3D printing into the world of dentistry.” The company’s flagship product is its 3D printed flexible nylon dentures.

He pulled up a slide that cited research stating that 36 million Americans are completely edentulous, meaning without teeth, and that 178 million are partially edentulous. But even so, Marks said that there’s an “astronomical” number of people who are still not wearing dentures.

“Most people don’t think about this until it happens to you or someone you know,” he said about missing a tooth. “It’s not always that easy or cheap to fix this with implants.”

According to a survey, only 8% of dentures are digitally fabricated, which means most are still made by hand using analog methods.

Marks said that even though 3D printing is “becoming more of a buzzword” in the dental industry, most of the materials “have largely stayed the same,” and based on the same technologies and principles. Extrusion-based AM is not used often in dentistry, and powder bed fusion (PBF) is mostly limited to metals, not polymers.

Marks went through a brief history of 3D printing in dentistry. Ubiquitous applications include impression trays, digital models, and resin patterns for casting, while digital dentures are currently happening and things like clear aligners, temporary and long-term crowns and bridges, and multimaterial printing are in development for use in the future.

He said that the ubiquitous ones have one thing in common – they’re used once and then thrown away.

“We’re still not doing much with crowns and bridges,” Marks said. “Clear aligners are the holy grail, and direct printing of the aligner is still a ways off, though all companies are probably working on it.”

Aronfa’s dental 3D printer is the r.Pod, which is a modified version of a Makerbot clone. The dual extrusion filament system is optimized for all of the company’s thermoplastic materials.

Then it was Wainwright’s turn to talk about dental 3D printing at Formlabs. He agreed with Marks that “FDM and thermoplastics have an incredible place” in the dental industry.

When the company was founded in 2012, its goal was to make professional-scale 3D printing accessible and affordable for everyone. Now Formlabs employs over 500 people at its multiple locations around the world, and has sold more than 50,000 3D printers.

Wainwright explained that the Form 3B desktop printer, optimized for biocompatible materials, has many dental-specific features, materials, and software, in addition to automated washing and post-curing systems “to help tie in end-to-end dental workflows.”

In addition, Formlabs offers dental materials, and launched its dental service plan (DSP) along with the Form 3B in 2019. Because there are high demands, the 3D printing process is complex, and the DSP offers support.

“We are committed to 3D printing for dental,” Wainwright stated. “We have over 20 people in the dental business unit. But we have the resources of a 500 person-plus company.”

While most are made overseas, Formlabs Dental is now developing photopolymers in my home state, since the company acquired its main material supplier, Ohio-based Spectra Photopolymers, last year. Formlabs’ biocompatible Surgical Guide Resin is the company’s first material made in an ISO-certified facility.

“It’s exciting to have intimate control over design aspects,” Wainwright said.

The image above is an example of the Surgical Guide material. Wainright explained that the light touch supports are very easy to remove, which means that there isn’t a lot of time wasted in post-processing.

He said that 36% of dental labs in the US use 3D printing technology, which makes them very “cutting edge.”

“There’s a ton of market opportunity for dental to go digital,” he said. “We have 30% of this market – we’re the biggest player in dental laboratories and will continue to grow, but compared to Invisalign, it’s not really that much.”

So far, Formlabs has 3D printed more than 10,000,000 parts for the dental industry. Wainwright predicts that in ten years or less, “everything in dental will be 3D printed.”

He reiterated to the room that Formlabs has “a whole host of materials” for dental applications, four of which are solely for fabricating models, which are “really critical to dentists.” As dental offices adopt intraoral scanning technology, it’s helpful to take the scan data and turn it into something physical. Wainwright mentioned that Formlabs’ Grey Resin can achieve fast, accurate prints, and that it’s good for thermoforming as well.

The company’s Draft material is “accurate enough to create models in less than 20 minutes,” which makes it perfect for creating retainers on the same day as a patient’s appointment. Model Resin is good for accurately restoring dental models, while the biocompatible Dental LT Clear Resin can be used to print occlusal splints in addition to models.

Formlabs’ Digital Dentures solution comes in multiple shades to match a patient’s teeth, and a full set can be 3D printed for less than $10, which Wainwright says is “really a game-changer.”

“We want to make treatments easier, better, and faster,” he said in conclusion.

“3D printing is still very early in dental, this is just the beginning. The materials will just keep getting better, it’s an exciting place to be.”

Then it was time to eat lunch and chat with other attendees…or, as I did, inhale food and then find a spot in the hallway near an outlet and get a little work done.

After the lunch break, I sat in on my last panel at AMS 2020, “3D materials for dental applications.” It was a panel of one – Gabi Janssen, Business Development Manager and Global Leader, Healthcare Segment Additive Manufacturing, for DSM Additive Manufacturing. She presented on digitalization in healthcare and dentistry.

She tried to play a short movie about what the company does, but due to technical difficulties there was no sound, so she narrated instead, explaining that DSM is “a material company” that also does a lot with nutrition – a brand behind the brands.

The company also has a biomedical department, which helps deliver advanced healing solutions for AM applications, including bioceramics, collagen, polyethylenes, polyurethanes, and hydrophilic coating.

“What we have on the market is filaments,” Janssen said, pulling up a list of the dental materials DSM offers.

Several of the company’s products are geared toward the healthcare market, such as Somos BioClear for dental guides and anatomical models.

“So how do we develop a new material?” Janssen asked. “We’ve discussed 510(k) clearance materials, and you have to work all together. We look at the application, and determine what we need – printer, software, material – to fit what the end user needs.”

She pulled up a slide of the major market drivers in 3D dental printing – performance, mass customization, and time-saving.

“What kind of applications do we have in dentistry?” she asked.

To answer her own question, she showed a brief history of digital dentistry, starting with the first 3D printed part in 1983, moving on to DSM’s 3D printing resin in 1988, the beginning of aligner manufacturing in 1997 and medical modeling in 2000, and DSM’s dental materials passing USP VI in 2008. For 2020 and beyond, hopefully we’ll see the availability of direct aligner materials.

“I think there’s still a lot of data needed to show it’s good,” Janssen said about where the industry currently stands. “Reimbursement is difficult, we need this data to back it up.”

The topic of FDA clearance obviously came up a lot at AMS 2020. Janssen said that DSM has a resin that’s certified for use in dental bite guards, and a general purpose resin that isn’t certified but can be used to make FDA-cleared aligners.

“The end device needs the clearance,” she reminded the room.

She brought up how Materialise was the first company to receive FDA clearance for software about 3D printing anatomical models for diagnostic use. Materialise Mimics inPrint translates the data for the model to the 3D printer. Then, combined with a specific printer and material, it’s possible to fabricate “the model they actually want within a certain safety margin.”

“But, if you want to print medical models, just for patient communication, it does not need to be cleared, because it’s not a medical device,” she explained.

The slide above explains what makes a medical device controlled, i.e. needs clearance, while the below slide lists some very useful definitions, including biocompatibility and risk.

Janssen then brought up the “sometimes confusing standards,” such as ISO standards.

“Depending on what we do with the material, and how long it goes in the mouth, there are different risk associations,” she explained.

In terms of product classification, Class I is the least risky. But, the higher you go up in class, the more research is required to show that the 3D printable material won’t harm patients.

She said that the regulatory industry is changing to have more focus on software, with higher regulations for that software, because it “needs to be validated in combination with the material and equipment.” Additionally, there is more of a focus these days on understanding and managing risks, as well as reducing animal testing…always good news!

When choosing the proper filaments for your workflow, you should start by working with the dentist on treatment planning. Then, once the patient’s mouth has been scanned, you can create the design in the software. Then the build has to be prepared, which takes some patience and precision – you need to enter the optimal print parameters, and add supports if they’re needed. Then, after the print is complete, it needs to be removed from the bed, supports (if there are any) need to be taken off, and there may even be grinding and painting involved before the final quality check.

“Many process variables can impact the safety of the final end product,” Janssen noted. “So you need to understand the effect the material can have on patients.”

Finally, there are also plenty of steps to follow to ensure material safety in development, so it’s important to follow the instructions your supplier gives you.

Then it was time for some questions. One attendee asked why dentists aren’t all adopting AM, since some products, like mouthguards, look pretty easy to make in the back office.

“This may look easy, but it’s actually not,” Janssen explained.

She went on to say that the product or device may not always “come out right the first time.” There are a lot of parameters to look at, and potentially tweak, in order to achieve the desired result. A lot of people can get frustrated if it doesn’t work right the first time.

“What we’re doing now – if you bring your design to us, we’ll do the tweaking for you, as our software has all of the maximum and minimum numbers needed for parameters,” she said.

3D printing thought leader and author John Hornick offered his take on the question, as he has some experience with the matter. He explained that most dental offices are private, though many dentists are consolidating their practices into larger ones, “and their appetite for spending money on these machines may go up.” But, SmarTech doesn’t think the average dentist will spend that much for larger, more expensive 3D printers. That’s why some companies, like Arfona, are working on simpler material extrusion systems.

Another attendee said that it seems like 3D printing companies are just throwing technology at various markets and praying that it sticks. Dentists want to be dentists, and not spend their time dealing with issues like print parameters and melted filament.

“We, as technology providers, need to raise our game and make this work for these people,” Janssen stated.

I think that’s a great note on which to end my AMS 2020 coverage – we, the AM technology providers, need to show the rest of the world how 3D printing can work for their industries.

We hope to see you next winter for Additive Manufacturing Strategies 2021!

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3D Printing News Briefs: September 2, 2019

In this edition of 3D Printing News Briefs, we’ve got stories to share about a new material, a case study, and an upcoming symposium. Liqcreate has released a new 3D printing material for dental professionals. FELIXprinters published a case study about its automotive 3D printing work with S-CAN. Finally, ASTM International will soon be hosting an AM symposium in Washington DC.

Liqcreate Releasing New Dental 3D Printing Resin

Manufacturer of professional-grade 3D printing materials Liqcreate has been hard at work on a new 3D printing resin to help dental professionals optimize their digital workflow and scale up their in-house manufacturing. The hard work has paid off, as the company is announcing the release of its newest material, Liqcreate Premium Model – an accurate, low shrinkage resin for fabricating dental and aligner models.

The opaque photopolymer is matte, and the color of skin. Parts 3D printed with Liqcreate Premium Model have low shrinkage and excellent dimensional stability, and its low odor makes it great for office use. Other benefits include high detail and accuracy, and temperature resistant for aligner production. The resin is compatible with the Anycubic Photon, Wanhao D7, and Kudo3D Bean 3D printers, in addition to all open source 385 – 420nm LCD and DLP systems. You can purchase Liqcreate Premium Model through the company’s distributor network starting September 2nd.

FELIXprinters Publishes Case Study

Dutch 3D printer manufacturer FELIXprinters published a case study about its work with reverse engineering and 3D scanning company S-CAN 3D Ltd, a UK customer which uses FELIX’s AM platforms to manufacture jigs, create casting molds and masters, and prototypes. Founded in 2012, S-CAN also uses FELIX technology to manufacture automotive parts, like the pictured engine block. FELIXprinters offers a range of systems for industrial prototyping and production applications, inlcuding its Pro 3 & Tec 4 series of AM platforms and its new, larger Pro L and XL models.

“We have found FELIXprinters AM platforms to be very easy to use. You can be up and running within a few minutes of getting them out of the box. We run all of our printers through Simplify3D software so you load the profile, pick a material and you are ready to go. In-house we now have the first machine we bought from FELIX back in 2015 (the Pro 1), and a Tec 4.1, a Pro 3 and the new Pro XL. Our first Pro printer has paid for itself 10 times over,” stated James Senior, MD of S-CAN 3D.

“Internally, S-CAN 3D use FELIX 3D printers for prototyping designs. We might do five or more different concept designs of a particular part or component, as it’s much easier to visualise a part when it’s in your hand. We are putting a lot of work through the newly purchased XL printer and it’s opening up things which we wouldn’t have been able to do before (at least to the same quality and size), so things are very encouraging. We have found FELIX machines to be very repeatable which is our most fundamental requirement for any application, and we also haven’t noticed any accuracy degradation over time.”

At the upcoming TCT Show in Birmingham, September 24-26, the two partnering companies will exhibit together at Stand E50 in Hall 3. Visitors will be able to view FELIXprinters’ Pro series of 3D printers, as well as its new advanced, customizable 3D bioprinting platform.

ASTM International’s AM Symposium

Speaking of industry events, ASTM International, which recently announced that it will be hosting its second Additive Manufacturing Center of Excellence Workshop in France, will also host a symposium in the Washington DC area. The Fourth ASTM Symposium on Structural Integrity of Additive Manufactured Materials and Parts, held by the ASTM International Additive Manufacturing Center of Excellence (AMCOE) from October 7-10 at the Gaylord National Resort and Convention Center, National Harbor, Maryland, is designed to give AM professionals a forum to exchange ideas about the structural integrity of 3D printed components and materials, focusing on quality and certification criteria and the lack of design principles and industry standards.

Paper topics for the symposium include the effect of anomalies, process optimization to improve performance, feedstock and its related effects on mechanical behavior and microstructure, and the applicability of existing test methods. Sessions will be organized by sector-specific applications, such as aviation, consumer, maritime, and spaceflight. Registration for the event will be open until October 2nd, 2019.

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Germany: Research Shows Good Response from Students Using 3D Printed Dental Traumatology Training

Authors M. Reymus , C. Fotiadou, R. Hickel, and C. Diegritz explore the uses of 3D printed models in dental traumatology training, with their findings outlined in the recently published ‘3D printed model for hands-on training in dental traumatology.’ For their study, they used an SLA printer to create a 3D printed model of a dental patient’s maxilla, mimicking several different traumatic dental injuries.

Being able to create accurate models exhibiting significant trauma offers a host of benefits to dental students who can take their time in a deliberate learning mode rather than waiting to rush in to see what could be a relatively small number of injured patients on-site. This also accentuates the enormous amount of learning gained from lectures. The hope is that more knowledge can be gained about dental traumatology, as the researchers point out that dental accidents are often treated by general dentists who may not have an adequate education or experience to deal with such cases overall.

The researchers wanted to make a model that was not only realistic but would allow for students to practice both diagnosis and treatment too. They also wanted to design a product that would translate from educational settings to dental clinics. With these hands-on tools available, the authors also created another level to their study regarding the use of dentaltraumaguide.org, offering the resource to only half of the students participating in the study—and comparing their knowledge.

The model was designed and 3D printed as follows to show dental trauma for a 16-year-old boy:

“The data generated were exported as single DICOM files and imported to Invesalius for Mac (Centre for Information Technology Renato Archer, Amarais, Brazil) to convert it into one .stl file. This file was subsequently imported to Meshmixer for Mac 11.0 (Autodesk, San Rafael, CA, USA) and trimmed to a region extending from the right first premolar to the left premolar. The right lateral incisor, the left first incisor as well as the left second incisor were cut out of the STL-mesh and exported as single STL-files.

Using the function ‘Boolean difference’, these teeth were cut out, leaving imitation tooth sockets in their original position. Additionally, the right lateral incisor was positioned at a 30° angle towards the palatal from its original position, and again, the function ‘Boolean difference’ was used to imitate a lateral luxation of the tooth perforating the buccal bone. The left lateral incisor was separated into two parts at its apical third imitating a horizontal root fracture. The extracted left incisor was not changed, imitating an avulsion. The mesial edge of the right incisor was removed, exposing the pulp chamber to imitate a complex crown fracture.”

Computer-aided designed model with empty tooth sockets, buccal perforation and complicated crown fracture.

The 32 undergraduate students were tasked to work on the case, even simulating a conversation with the mother of the injured boy as they practiced asking the correct questions about the accident, as well as advising on post-traumatic behavior. Upon examining the 3D printed model, they were given information about every tooth, and asked to offer the following:

  • Diagnosis
  • Treatment plan
  • Recall regime
  • Prognosis of each injured tooth

The assessment was considered in these areas:

  • Pre-treatment
  • Therapy
  • Post-treatment
  • Recall
  • Complications

“The presented workflow allowed the manufacturing of a radiopaque model that imitated a luxation injury, a complicated crown fracture, an avulsion, and a horizontal root fracture in a realistic way,” stated the authors.

Radiograph of the right lateral incisor with a luxation injury (left) and Radiograph of the empty tooth socket of the left incisor and the left lateral incisor with a horizontal root fracture (right).

And while their goal was for such a workflow to be easily transferred to another dental school, they would need to own a CBCT and a stereolithographic printer, along with software that could be offered free. The 32 students were asked to evaluate the model, with 57 percent reporting it to be ‘very realistic,’ and 43 percent choosing ‘rather realistic.’

“The diagnosis of the lateral luxation was evaluated to be the most difficult of all injuries, whereas the avulsion was the easiest injury to diagnose. Concerning treatment planning, the horizontal root fracture was rated as being the most difficult injury. When listing possible complications, the students had serious problems with the horizontal root fracture.

Students’ evaluations of difficulty in diagnosis, treatment planning, therapy and knowledge about complications for each injury.

“All participants reported to have gained new knowledge on dental traumatology, and 97 percent felt better prepared for treating traumatic dental injuries in the future.

“Students seem to focus especially on the diagnosis and treatment of traumatic injuries to teeth when dealing with dental traumatology. This is logical because these steps are of outmost importance for immediate care when confronted with a trauma case. Fortunately, both groups of students in the present study achieved their best results in these fields. The group without access to dentaltaumaguide.org, however, had only poor results when faced with developing a recall regime and knowing about possible complications,” concluded the researchers.

Many dentists and orthodontists rely on 3D printing today for digital dentistry, dentures, and even grafts for issues like alveolar augmentation. What do you think of this news? Let us know your thoughts! Join the discussion of this and other 3D printing topics at 3DPrintBoard.com.

Printed model with gingival mask.

[Source / Images: ‘3D-printed model for hands-on training in dental traumatology’

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3D Printing News Briefs: July 2nd, 2019

We’re talking partnerships and materials in today’s 3D Printing News Briefs. The Alfa Romeo F1 team and Additive Industries are strengthening their technology partnership, while Beam-IT and SLM Solutions are expanding their own cooperation. Metallum3D just opened a new beta testing program for its stainless steel filament, while Zortrax and CRP Technology are both introducing new materials.

Alfa Romeo F1 Team and Additive Industries Strengthen Partnership

At the recent Rapid.Tech-Fabcon industrial 3D printing conference in Germany, Additive Industries announced that its current technology partnership with the F1 team of Alfa Romeo Racing would be growing stronger. The Sauber Engineering company, on behalf of Alfa Romeo Racing, has ordered an additional: 4-laser, multi-module MetalFAB1 Productivity System, bringing the total up to four systems and making it Additive Industries’ largest customer with a high-productivity metal 3D printing capacity.

“Our installed base is growing fast, not only with new customers in our core markets like aerospace and the automotive industry but also through existing customers like Sauber Engineering, who are advancing to become one of the leading companies in industrial 3D printing in Europe, ramping up production,” stated Daan Kersten, the CEO of Additive Industries. “Although most users of metal additive manufacturing are still applying prototyping systems, we see an increasing number of companies concluding they need dedicated systems for series production. Our modular MetalFAB1 family is the only proven system on the market today designed for this use. We are grateful and proud to be technology partner to Sauber Engineering and the F1 team of Alfa Romeo Racing.”

Beam-IT and SLM Solutions Sign Expanded Agreement

M.Sc.Eng. Martina Riccio, AM Process Leader of Beam-IT and technical team

Italian 3D printing service bureau Beam-IT and metal 3D printing provider SLM Solutions have signed an agreement, which will expand their current long-term cooperation. Together in a joint venture project, the two will work to develop more material parameters – focusing on certain material properties – for the nickel-based alloys IN939 and IN718; this process will help create a less lengthy timeframe in terms of parameter testing. Additionally, Beam-IT has added two new SLM 3D printers to its product portfolio: an SLM 280 and an SLM 500.

 

 

 

“We are pleased to announce our cooperation agreement with SLM Solutions and the two additional machines,” said Michele Antolotti, the General Manager of Beam-IT. “We regularly produce high-quality parts for our customers using selective laser melting because the SLM ® technology works efficiently, quickly and, above all, safely. With the expanded capacity of our new multi-laser systems we can also increase our productivity and react to the increased interest in SLM ® technology from our customers.”

Metallum3D Opens Stainless Steel Filament Beta Testing Program

Virginia-based company Metallum3D announced that it has opened a beta test program for its stainless steel 316L 3D printing filament. This new program will support the company in its development of an affordable and accessible on-demand metal 3D platform for FFF 3D printers. The Filament Beta Test Program is open until July 31st, 2019, and a limited run of 150 0.5 kg spools of Metallum3D’s stainless steel 316L filament will be offered for a discounted price on a first come, first serve basis.

Nelson Zambrana, the CEO of Metallum3D, said, “Our 1.75mm Stainless Steel 316L filament material has a metal content of 91.7% by weight or 61.5% by volume, while maintaining enough flexibility for a minimum bend diameter of 95 mm (3.75 in.). The combination of high metal loading and filament flexibility was a tough material development challenge that took us over a year to solve.”

Zortrax Introducing Biocompatible Resins for Inkspire 3D Printer

Last year, Polish 3D printing solutions provider Zortrax developed the Inkspire, its first resin 3D printer. The Inkspire uses UV LCD technology to create small and precise models for the architecture, jewelry, and medical industries. With this in mind, the company is now introducing its specialized biocompatible resins that have been optimized for the Inkspire to make end use models in dentistry and prosthetics.

The new class IIa biocompatible Raydent Crown & Bridge resin is used for 3D printing temporary crowns and bridges, and is available in in an A2 shade (beige), with high abrasion resistance for permanent smooth surfaces. Class I biocompatible Raydent Surgical Guide resin for precise prosthetic surgical guides  is safe for transient contact with human tissue, and offers translucency and high dimensional accuracy. With these new materials, the Zortrax Inkspire can now be used by prosthetic laboratories for prototyping and final intraoral product fabrication.

CRP Technology Welcomes New Flame Retardant Material

Functional air conditioning piping made with LS technology and Windform FR1

In April, Italy-based CRP Technology introduced its Windform P-LINE material for for high-speed, production-grade 3D printing. Now, it’s officially welcoming another new material to its polyamide composite family – Windform FR1, the first carbon-filled flame-retardant laser sintering material to be rated V-0. The material is from the Windform TOP-LINE family, and passed the FAR 25.853 12-second vertical, the 15-second horizontal flammability tests, and the 45° Bunsen burner test. The lightweight, halogen-free material combines excellent stiffness with superior mechanical properties, and is a great choice for applications in aerospace, automotive, consumer goods, and electronics.

“Only a few days from the launch of a new range of Windform® materials, the P-LINE for HSS technology, I’m very proud to launch a new revolutionary composite material from the Windform® TOP-LINE family of materials for Laser Sintering technology,” said Franco Cevolini, VP and CTO at CRP Technology. “Our aim is to constantly produce technological breakthroughs. With Windform® FR1 we can steer you toward the proper solution for your projects.

“We will not stop here, we will continue our work on renewal and technological expansion in the field of Additive Manufacturing. Stay tuned!”

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