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training_ 3D-printed dental replicas I Fig. 5a Fig. 5b Fig. 6a Fig. 6b Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 dontic training, both in educational as well as board exam arenas. About two years ago, the president of a prominent board of dental examiners asked if we could model and print replicas that would authentically replace extracted teeth in their exams. Because 3D-printing allows fabrication of literally any organic or inorganic form that can be modeled on a graphics computer, it was obviously possible although many’s the slip be- tween cup and lip. In these cases I follow the advice of Richard Diebenkorn3 for any creative project. I begin by doing research to understand the context, the art, that has preceded my efforts. What I found was that existing endodontic models were not anatomically authentic — their canals were like soda straws in their oversimplified form, they were much softer than tooth structure when cut with high-speed handpiece burs, and, despite claims to the contrary, they did not work with apex locators. Over a period of two years our design and development process resulted in board exam testing replicas (Figs. 1-3) that had: 1. Coronal hardness very similar to natural teeth when cut by high-speed handpieces. 2. The exact anatomy found in human teeth. 3. Apex locator function that was as accurate as natural teeth. 4. Embedment in a rubber sleeve (with serial num- bers) that fit readily available typodonts. 5. Authentic radiopacity. That development process also inspired an inex- pensive version of these exam replicas that allowed our TrueTooth training replicas to be used in a better simulation than with individual replicas. While the examreplicasareexpensivewithmilledcomposite/ ceramic crowns, non-reusable sleeves and unique identification, the TrueTooth practice replicas now have reusable split sleeves that hold them in a ty- podont and perform perfectly with apex locators, allowing dental students to practice on replicas that cost less than $15 each (Figs. 4a,b). The other recent advance was what I call TrueJaw 2.0 — full-jaw replicas designed to train endodontic residents to do periradicular surgery, including inci- sion, ostectomy, apicoectomy, retrograde prepara- tions and fills, bone grafting and suturing. Each upper and lower jaw has five teeth with various periapical lesions, some perforating the cortical plate and some with root ends that need to be located through intact boney structures (Figs. 5a-12). Fig. 5a_CAD model of endodontic surgical training replica showing PA lesions associated with tooth #9 and tooth #12. Fig. 5b_3D-printed maxillary endodontic surgical training TrueJaw. Each jaw has five different Procedural dental education and testing will tooth replicas with periapical lesions, never be the same._ _References some perforating the cortical plate and others hidden behind intact bone surfaces. 1. Buchanan, LS, Control the Anatomy; Control Procedural from 3D Printed Training-New Teaching Paradigms Procedural Training Replicas, Roots, May 2014. Fig. 6a_Buccal view CT image of TrueJaw replica tooth #9 with PA lesion. Note the authentic 2. Buchanan, LS, Focus On: Endondotics, Interview with Damon Adams on the impact of 3D printing on procedural education, Dentistry Today, Pg 2, December 2015. appearance of tooth, PDL, medullary and cortical bone. 3. Diebenkorn, R, Notes to myself: Diebenkorn’s 10 rules for Fig. 6b_Sagital view CT image of TJ painting. Blog, Royal Academy of Arts, U.K., 3.13.15. replica #9. _about the author roots Fig. 7_Incision of rubber-like soft- tissue replication in preparation for L. Stephen Buchanan, DDS, FACD, FICD, is a diplomate of the American Board of Endodontics, a fellow of the American and International Colleges of Dentists and serves as part-time faculty to the UCLA and USC gradu- ate endodontic programs. He holds patents on the Endo- bender Plier (SybronEndo), System-B and Continuous Wave obturation tools and methods (SybronEndo), GT and GTX file systems (DENTSPLY Tulsa Dental Specialties), LA Axxess Burs (SybronEndo), and Buc ultrasonic tips (Spartan/ Obtura). Buchanan lives in Santa Barbara, Calif., where he enjoys a practice limited to conventional and microsurgical endodontics and dental implant surgery. He is the founder of Dental Education Laboratories, a hands-on training facility in Santa Barbara that he has directed for 28 years. endo surgical flap. Fig. 8_Flap replica reflected, revealing PA lesion perforating the cortical plate. Fig. 9_Osseous crypt developed, showing root end with canal. Fig. 10_Retrograde canal preparation with ultrasonic tip. Fig. 11_Retrograde filling in place. Fig. 12_Flap sutured. roots 1_ 2017 I 13