1/1/1/ 3D printing 3D printing 3D printing international magazine of dental printing technology dental printing technology dental printing technology dental printing technology dental printing technology dental printing technology international magazine of international magazine of interview “Having a digital practice will be vital for practice growth” practice management Five key elements to get your dental team on board with in-house 3D printing case report 3D-printed maxillary premolar inlay restorations

editorial | Dr George Freedman Editor-in-chief 3D printing in dentistry: The need for standards 3D dental printing is in its formative stages; the ma- jor distinction between the comparable developments of dental cosmetics and implants is that printing is pro- gressing much more rapidly, much more internationally and in a far more open-source environment. The excit- ing expectation is that 3D printing promises to bring the functional and artistic control of the restorative process back to the chairside setting. The daunting concern is that the wide spread of research and multiple technical developmental lines will lead to mutually incompatible nomenclatures and technologies. The digital transformation of dentistry is firmly estab- lished. It promises to transform the practice and delivery of dentistry within a decade or two. It remains essential that dentists and the dental industry continue to develop a setting where communication is enabled by corresponding software platforms and technologies have both backward and forward flexibility, and most importantly, a research and development space where the terminology is stan- dardised and mutually comprehensible. Current 3D printers can manage the increasing demand for temporary, transitional, and permanent restorations and appliances. They can decrease delivery costs for these services, enhancing patient accessibility and dentist practice viability. To speed general practitioner acceptance worldwide, there must be a defined set of clinical standards that ensure treatment predictability and success, and a suitable lexicon of readily understood terms for this innovative area of dentistry. standards and guidelines. These paradigms should encompass most of the existing leadership of 3D printing at various levels, serving to delineate a basis for com- patibility, providing adequate space for flexibility and growth, that can reasonably accommodate foreseeable (and perhaps unforeseen) upcoming development. These foundational definitions will establish the future guide- lines for applications that are yet to be developed and will institute continuity between the present and the future. For the practising dentist, 3D dental printing is a wonderful addition to the clinical armamentarium. It is also something new, something different and something with its own vocabulary. The most important step to achieving univer- sal chairside acceptance of this technology is to make it easy to understand; every technology brings its own wordlist, and every new technology has many compet- ing wordlists that only serve to confuse the practitioner. It is impossible to explore innovative treatments without innovative words and meanings; we should attempt at the very least, however, to standardise these new terms and meanings to minimise the confusion as much as possible. This editorial is a call to create 3D dental printing stan- dards groups for defining: 1. a set of clinical, research, development and manu- facturing guidelines; and 2. standardised nomenclature. 3D printing is the future of dentistry. Let us begin by creating the proper foundations. At the level of researchers, developers and manufac- turers, this requires the establishment of a broadly rec- ognised and accepted framework of measurements, Dr George Freedman Editor-in-chief 3D printing 1 2022 03

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news | m o c . k c o t s r e t t u h S / I N R G O T O F © Researchers have found that most dental professionals use their 3D-printing device at least every two days and the vast majority use it at least once per week. devices were the most satisfied. Only three respondents said that they were dissatisfied with their device. experience can be created together, as the patient can follow the whole treatment via digital dental tools.” For CAD processes, the most commonly used soft- ware was made by exocad, followed by those made by Meshmixer and 3Shape. The respondents used intra-oral scanners almost as often as they used their 3D-printing devices, and the two technologies were often used together. Among the intra-oral scanners used by the sample group, those made by 3Shape were the most preferred, followed by those made by Medit, Dentsply Sirona, Align Technology and Planmeca. One of the surprise findings of the research was that only 51.7% of respondents had received training on how to use their 3D printer from the device manufacturer, and it was highlighted that most respondents had not been able to familiarise themselves with 3D printing during their dental education. Regarding becoming adept with the technology, the researchers noted that social media was a significant source of information, problem-solving and networking opportunities related to 3D printing in dentistry. They wrote: “Social media is essential. It is currently having a significant impact on the healthcare industry, and it is also an excellent tool for helping specialists exchange experience and knowledge. In addition, if one needs help, it seems to be a faster method for receiving it than the official support system.” It was found that newly graduated dentists and younger dentists were faced with fewer technical obstacles when adopting the technology. The researchers wrote: “They learn the critical steps of digital dental treatment during their education, including digital impression taking, intra-oral scanning, and additive manufacturing. This new generation of dentists has enormous potential to de- velop digital dentistry. The working process and patient The study identified environmental factors related to additive manufacturing as a concern within the dental community. They said that there was a lack of studies that investigated the full ecological footprint of digital dental workflows, including the complete life cycle of additive manufacturing processes, in comparison with more traditional dental technologies. “One of the surprise fi ndings of the research was that only 51.7% of respondents had received training on how to use their 3D printer from the device manufacturer.” The findings were based on an online survey that was conducted between 1 January 2020 and 1 January 2021 and completed by 120 dental professionals from 20 countries. This sample was comprised of 68 dentists, 29 dental technicians and 23 CAD/CAM specialists who were mainly based in Hungary (23.7%), the US (18.4%) and the UK (7.9%). Most of the respondents owned one 3D printer and the study participants, on average, had more than three and a half years of experience using the technology. Editorial note: The study, titled “User experience and sustainability of 3D printing in dentistry”, was published online on 9 February 2022 in the International Journal of Environmental Research and Public Health. 3D printing 1 2022 11

interview | proprietary Lubricant Sublayer Photo-curing (LSPc) technology. Could you please explain the system’s advantages in comparison with other digital light processing (DLP) and stereolithography (SLA) systems on the market? LSPc is a type of masked stereolithography (mSLA) technology, which cures resins by exposing them to ultraviolet light. Instead of tracing each layer with a laser beam, as in DLP, it uses a larger area ultraviolet light source that is masked with an LCD screen. This allows the patterned light to expose the resin consis- tently and simultaneously across the curing plane— think micro-patterned flood lamp, rather than tracing with a pencil-like beam. This makes mSLA much faster than conventional SLA. Additionally, with our patented ultraviolet light array, we are able to achieve complete light uniformity across the entire build area, ensuring part accuracy and consistency. What exactly can be printed and with which materials? NXD 200 is validated for use with all of the Keystone Industries’ dental resins—KeyTray, KeyModel Ultra, KeySplint Soft, KeyGuide and KeyOrtho IBT—as well as with Nexa3D’s xMODEL 2505 powered by BASF Forward AM. A few examples of what can be printed are patient-specific dental models, surgical guides, splints, trays and nightguards. Last year, Nexa3D announced the XiP, a desktop 3D printer suited for use in dental offices of all sizes and for delivering chairside prints. What are the distinctive features of XiP and when will it become available? XiP will be commercially available in the second quarter of 2022, and customers can place pre-orders simply by visiting our website. XiP is a simple-to-use desk- top unit with a fairly large build volume of 4.8 l and an integrated workflow. XiP is a solid machine, and its ease of use is going to be critical for a dental/ortho- dontic practice. Dental clinics are busy and having a simple-to-use 3D printer is important. The smart resin dispenser, quick connect build plate and stackable vat storage unit make it easy for anyone in the clinic to use. Don’t forget the price point of under US$6,000 (€5,450) makes it very affordable for a practice, whereas the desktop size makes it more accessible from a footprint perspective. At Formnext 2021, Nexa3D announced a new partner- ship with artificial intelligence-powered manufac- turing software start-up Oqton and a new dental software. Could you please explain how users of your 3D printers can benefit from this collaboration? Oqton software is an automated production system with artificial intelligence and a fully integrated applica- tion programming interface with the NXD 200. It is a cloud-based solution, so from a production standpoint Jim Zarzour, head of dental solutions at Nexa3D. it provides ease of use for the customer. It allows the setup of multiple print jobs at once. The user can order, prepare, schedule, monitor, analyse and track. More- over, it enables one-click data preparation in order to import, nest, label, and add supports, etc. This inte- gration is critical for large laboratories and manufac- turers, and we are excited to see this in action for our customers. Owing to growing demand for additively manufac- tured dental models, restorations and aligners, den- tal laboratories have been part of the digital revo- lution for some time already. Now, with new, more affordable and user-friendly 3D printer models on the market, dental offices are able to print devices at the practice too. What factors should practices consider when planning to purchase a 3D printer? Dental practices like the idea of being able to print in the office. It can help them showcase the fact that they are a digital practice, which is important these days for pa- tient experience and, in some cases, same-day dentistry. Allowing the patient to leave the office with his or her device can be important for the overall patient experi- ence. In addition, it can help from a profitability stand- point. Many practices have 3D printers in-house and do not use them for a number of reasons. For example, the workflow for the printer is not easy, and the practice does not have a staff member who is able to use it. Providing a simple and easy-to-use solution such as Nexa3D’s XiP could be critical to the success of a practice. 3D printing 1 2022 13

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practice management | of complexity of the workflows involved and know how much time the various steps require, which will help in training the team. Based on this knowledge, the next step is to look at the existing team and identify an organised, detail-oriented and open-minded candidate to be the digital specialist in the practice. Manufacturing in-house allows the production of several appliances simultaneously for multiple cases, thus trans- forming the practice into a small dental laboratory. There- fore, great organisation skills are crucial and there needs to be a system in place that allows effective tracking of all processes. Moreover, in-house production using 3D printing involves following specific instructions and 3D-printing protocols. A detail-oriented team member needs to be on top of the different steps. For example, he or she needs to learn how to orient parts to print in the 3D-printing space and to be able to follow the post-processing instructions thoroughly. Giving attention to detail and being organised are the key skills for this role. As long as the systems are easy to use, manufacturing can be done by anybody, including someone who does not have clinical experience. At Alvetro Orthodontics, Patricia started as a clinical assistant, but immediately transitioned into becoming the digital specialist at the clinic. Similarly, the clinician might find that the administrative staff have some downtime and thus can help out and will need to learn the nesting software and printer manipulation. After evaluating the existing team, the next step is to consider whom (and what skills) to bring on the team at a later stage. 2. Convincing the team about the advantages of the digital workflow To motivate the team, it is necessary to show them the advantages of using a digital workflow, how it is going to work and how it will impact their everyday work. The most evident advantage is that digital workflows are very patient-friendly. For example, patients do not always enjoy a traditional alginate impression being taken. However, a digital intra-oral scan being taken can be considered fun, as patients can see the scan being generated. This cre- ates the “wow” factor for patients and, in turn, motivates them. Similarly, having a 3D-printed model to show to the patient impresses him or her, and the team can say that they created it in their own 3D-printing laboratory, adding value to the patient experience. Many people are excited just by looking at our 3D-printing laboratory or Formlabs’ PreForm software. Some team members did not realise that 3D printing was an option in the dental world, especially those who did not have dental experience. The second advantage is that 3D printing in-house opens the door to new treatment possibilities not feasible via the traditional workflow. In our practice, we use Formlabs’ Form 3B printer for digital debonding cases, 3D printing 1 2022 21

practice management | 4. Educating the team on materials and applications There is a large variety of materials available for differ- ent indications, and this has expanded the services that can be offered to patients. Materials that have various characteristics, such as biocompatibility, precision, ac- curacy, durability and cost-effectiveness, are readily available, and the team needs to understand these characteristics and their applications. Formlabs provides excellent user guides for each material with step-by-step guidance, including on print parameters, print orienta- tion and post-processing protocols, to help manage each step successfully. Regarding 3D-printing applications, orthodontists often tend to focus on models, but 3D printing offers much greater utility. Years ago, we used to make occlusal splints, but the process was messy. It was time-intensive and complicated to create them in-house via the tradi- tional workflow. Today, the digital workflow allows scan- ning and even outsourcing the design and then printing the appliance in-house. It is an excellent service for our patients. It is much easier to produce and cost-effective, and there are biocompatible materials available for this specific purpose. The Form 3B printer can 3D-print models, including for the production of thermoformed retainers, and 3D-print indirect bonding trays and splints. Clinicians interested in dental restorative procedures can also print crowns and temporary restorations in different resins. The materials for model production and the biocompatible resins for end-use appliances guarantee that the printed part can safely come into contact with the patient’s tissue—which we consider a great advantage. If the team is trained and follows the instructions in the manufacturer’s guides, any one of the team members should be able to manufacture these indications. It is also vital to keep track of the time and costs needed to produce each appliance. PreForm software allows the team to track material consumption and evaluate the clinic’s return on investment per application, which becomes critical when deciding which procedures should be ad- opted in-house and which ones should continue to be outsourced to an external laboratory or design service. An indirect bonding tray requires only 7–8 ml of resin and splints just a bit more than that. When calculating the costs per part, it will become clear for which applications 3D-printing will be cost-effective. 5. Establishing a post-processing protocol chanical properties and biocompatibility standards are achieved by following specific washing and polymerising times and temperatures. To avoid any mistakes, it is im- portant to have defined steps and automated processes. In our orthodontic practice, we use Form Wash and Form Cure, which are highly effective and automated stations. In the past, we did the washing process manually using other systems, which involved pouring in propan-2-ol, swishing the models around and letting them sit in the isopropyl alcohol for a little. With Form Wash and Form Cure, the user can set the desired time and temperature at which the parts will be washed and polymerised. The machines will stop at those pre-established times, avoid- ing any risk of over-washing or over-polymerising, which would deteriorate parts. Automation combined with ease of use makes 3D printing a hassle-free and fun process. “Being involved in a digital team in the clinic creates a sense of pride and responsibility and makes team members feel valued.” Bonus: The team will become the experts Clinicians need to keep in mind that after learning these steps they will delegate these to the team, who will then become the experts. The 3D-printing process should be an advantage for clinicians but also, more importantly, for the dental team and patients. It is going to be exciting for them. In the beginning, it might take more of the den- tist’s time, but the team will eventually come up with new applications for 3D printing in the office. At our practice, Patricia is very knowledgeable and can train other team members on 3D-printing processes. Once the team be- comes expert, the clinician can be largely hands-off. 3D printing provides great advantages for clinical pro- cedures and patients and has a positive impact on the dental team. The learning process can be exciting for everyone involved when these five key elements are considered. We are certain that your team will be happy to jump on board and help your practice thrive. Once the part has been printed, it needs to be washed, dried, polymerised and sometimes polished. These stages should be implemented thoroughly, as the me- Dr Lisa Alvetro is an orthodontist and Patricia Mitchell is a digital specialist at Alvetro Orthodontics in Ohio in the US. about 3D printing 1 2022 23

trends & applications | “The print quality of the definitive restoration is dependent upon the quality of the provisional restoration.” and STL files of the restorations were created (Figs. 3 & 4). The STL files were digitally sent to ADEISS. The files were then imported into Fusion 360 software (Autodesk) and printed in cobalt–chromium (Figs. 5 & 6) with an AM 400 laser melting system (Renishaw). The printer used selective laser melting technology, melting and fusing layers of metallic powder (average diameter: 30–50 µm) using a 400 W laser. All restorations under- 5 6 Figs. 5 & 6: Additive manufactured onlay. Material and methods Three extracted and undamaged human molars were selected at random. A handheld tool was used to sup- port each molar. To impress each tooth, a sectional tray (TempTray, Clinician’s Choice Dental Products) and pro- visional material (Template, Clinician’s Choice Dental Products) were used. Preparation of the teeth was per- formed for a four-surface onlay, either mesial-occlusal- distal-lingual or mesial-occlusal-distal-buccal (Fig. 1). The provisional matrix was loaded with a bis-acrylic com- posite resin (Integrity, Dentsply Sirona) and was placed on the prepared tooth. A standard four-surface provi- sional restoration was fabricated, shaped and polished (Fig. 2). The provisional restorations were fixed with a Pic-n-Stic (PULPDENT) and sprayed with titanium dioxide (3M ESPE). The restorations were digitised (True Definition, 3M ESPE) 7 Figs. 7 & 8: Cemented onlay. 8 3D printing 1 2022 25

trends & applications | 12 Figs. 12 & 13: Zirconia onlay. 13 A novel workflow (Fig. 11) has been proposed that pro- vides a simple, efficient and inexpensive alternative to the traditional workflow. The new workflow circumvents the need for digital design, which would greatly reduce the time and cost, compared with the traditional work- flow. The approach may also provide a more sustainable treatment option. This study investigated cobalt–chromium indirect resto- rations, but other metal powders currently used in addi- tive manufacturing, including stainless steel and titanium, could be employed.7 In addition, the novel workflow could be applied to non-metal, aesthetic materials such as zirconia and lithium disilicate. The use of zirconia was also explored in this investigation with a single unit, using the same workflow, and achieved similar results but with milling rather than additive manufacturing (Figs. 12 & 13). This study had a small sample size and limited assess- ment, as the restorations were placed on stand-alone extracted teeth and only assessed through photographs, radiographs and a clinical post-cementation checklist. Further studies are required with larger sample sizes, ad- jacent teeth, antagonists, other materials, physical testing and clinical evaluation. Conclusion Digital dentistry will continue to evolve and expand while impacting clinical practice. The novel workflow presented for fabricating cobalt–chromium indirect restorations using additive manufacturing without the use of digital design provides an unconventional alternative. Its sim- plicity, efficiency and cost-saving seem to indicate that it offers a predictable and successful technique for cre- ating indirect restorations, offering hopes of improved accessibility and sustainability. Acknowledgements The author acknowledges the work of Dr Vishal Patel for the onlay preparations on the extracted teeth, Ashwin Baskaran and Megan Checora for their assistance with the polishing and Lyndsay Desimone for assistance with the manuscript. Special thanks go to ADEISS for the metal 3D printing and Alien Milling Technologies for the zirconia restoration. Funding Funding for the research was provided by the Schulich School of Medicine and Dentistry of the Western Uni- versity in London in Ontario in Canada (internal research grant). Editorial note: A list of references is available from the publisher. about Dr Les Kalman is an educator and medical device researcher focusing on additive manufacturing and software. He is a fellow of the Academy of Osseointegration, American College of Dentists and Academy for Dental Facial Esthetics and a diplomate of the International Congress of Oral Implantologists. He is the recipient of an Alumni of Distinction Award from the Schulich School of Medicine and Dentistry at the Western University in London in Ontario in Canada and a CES Innovation Awards honouree. 3D printing 1 2022 27

case report | 6 8 10 7 9 11 Fig. 1: Initial clinical situation. Fig. 2: Teeth after preparation. Fig. 3: Maxillary impression with tracings of the limits of the tooth preparations. Fig. 4: Black and white imprint control. Fig. 5: Dynamic occlusion recording (specific motion). Figs. 6–11: Inlay design. Case report A 58-year-old female patient with hypothyroidism under treatment consulted us for sensitivity to cold in the area of tooth #24. During the clinical examination, we identi- fied an occluso-distal fracture of the dental amalgam of the tooth 24 (Fig. 1). The restorations on teeth #25 and 26 had been carried out at the same time and appeared to have been infiltrated. After testing, we diagnosed revers- ible pulpitis of tooth #24. Teeth #25 and 26 did not exhibit any pulpal signs. The treatment plan consisted of the removal of the amal- gam restorations and the transition to a direct composite restoration on tooth #26 and indirect 3D-printed com- posite resin restorations (inlays) on teeth #24 and 25. The treatment would be carried out in two sessions: a prepa- ration session and a cementation session. Tooth #26 was filled using the direct composite resin technique. The shade of the indirect restorations was determined by the shade selected to fill the cavities in teeth #24, 25 and the filling of tooth #26. The composite filling protects against the risk of bacterial contamination and prevents possible pulpal sensitivity. The teeth were then prepared using calibrated burs for inlays (Fig. 2). After polishing, an intra-oral impression was taken using TRIOS 4 (3Shape), both statically and dynamically (Figs. 3 & 4). The patient’s mandibular move- ments were recorded to improve the accuracy of the occlusion (Fig. 5). The impression was sent to the prosthetic laboratory (Argoat Prothèses Dentaires) via the secure 3Shape Communicate web portal. The provisional res- torations were then fabricated from a flexible compos- ite (Luxatemp-Inlay, DMG Chemisch-Pharmazeutische Fabrik), which was selected for easy removal during the assembly session. The amalgam fillings were removed. In order to conceal the residual discolouration caused by the amalgam and to fill undercuts, the cavities were filled with composite. The restorations were modelled in the Dental System software (3Shape; Figs. 6–11). After the digital design had 3D printing 1 2022 29

case report | 20 22 21 23 Fig. 20: Cementation of the inlay on tooth #24. Fig. 21: Fitting view. Fig. 22: Polishing under surgical fi eld. Fig. 23: Final view after occlusion check and polishing. This allowed us to isolate the site from the moisture of the oral cavity and to improve visibility. The cavities were conditioned using a micro-sandblaster (27 μm alumina). The sandblasting reactivates the composite for bond- ing, cleaning the cavity of possible residues of temporary cementation agent and restoration (Fig. 16). We rinsed abundantly to remove alumina particles, which can de- crease the adhesion value. Phosphoric acid was applied for 30 seconds on the enamel and 15 seconds on the dentine (Fig. 17). The etching creates micromechanical keying and helps to finish cleaning the bonding surfaces (Fig. 18). For cementation, a dual-polymerising (chemical and light) universal cement agent (G-CEM LinkForce, GC) was used. The adjacent teeth were insulated with PTFE to avoid the adhesive and cementing agent reaching other surfaces. The adhesive was applied by actively rubbing it into the surfaces and applying the dry air blower to evaporate the solvents. The adhesive was ap- plied to the prosthetic restoration, which was then gently placed into the prepared cavity (Fig. 19). Excess cement- ing agent was carefully removed with a brush and then the restoration was photopolymerised for 20 seconds. The second inlay was then placed following the same protocol (Fig. 20). Here again, the excess was removed with a brush before photopolymerisation. The two inlays were then photopolymerised for 1 minute from all sides (Fig. 21). Initial polishing was carried out using silicone polishers (Footsie spiral, Komet; Fig. 22). The dental dam was then removed, the occlusion checked and the final polishing carried out (Fig. 23). The aesthetic integration was satisfactory. The patient would be seen again in six months for follow-up. Conclusion Permanent Crown Resin is an excellent alternative to composite blocks for inlay applications. 3D printing al- lows an economical solution with a satisfactory aesthetic result in terms of both morphology and colour. While a composite block can cost €10–€12 a piece, using 40 ml of 3D-printing material reduces costs signifi- cantly, to €4–€7 per inlay. The workflow proposed here in col laboration with the prosthetic laboratory can easily be done within the dental practice in a direct CAD/CAM framework. about Dr Edouard Lanoiselée is a general dental practitioner in a group practice in Nozay in France. He graduated in dentistry from what is now Nantes Université in France in 2008 and has received several certifi cates in prosthetics. He has maintained a link with the faculty since his graduation, whether for clinical supervision of students or for theoretical instruction at graduate level. He is a lecturer in the university diploma programme in aesthetic dentistry at the university, the master’s degree 1 programme in biology and health, and higher education certifi cates. Dr Lanoiselée was formerly a teaching hospital assistant lecturer at the care, research and teaching centre of the Faculty of Dentistry at Nantes Université. He has been a user of CAD/CAM systems since 2009 and regularly speaks on aesthetic dentistry and digital workfl ows at conferences. 3D printing 1 2022 31

case report | concerned, evolving from a predominantly manual into a predominantly digital task.4 The following case report describes the use of the CediTEC system (VOCO), which allows production of complete dentures in just a few appointments. Case description A 62-year-old female patient presented at our practice of her own volition, complaining of serious difficulties when chewing and speaking as a result of poorly fitting maxillary and mandibular dentures. From an aesthetic perspective, the patient also complained that her old dentures bothered her every day and confirmed that she was no longer happy with them at all. When asked about her medical history, she stated that she was undergoing treatment with bisphosphonates for diagnosed osteoporosis. Many years ago, the patient had also had five implants inserted into her lower jaw and two into her upper jaw, to which the existing removable dentures from her former dentist were attached. The patient’s request was for accurately fitting dentures again to improve both her appearance and her ability to chew and speak properly. Findings 5 Fig. 5: Digital maxillomandibular relationship registration and axiography. illary and mandibular dentures to be produced were designed using CAD/CAM technology. To do so, we decided for the sake of simplicity on the CediTEC system, in which all the necessary components are coordinated. The clinical, instrumental and radiographic findings re- vealed generalised horizontal and vertical bone loss in the edentulous regions. The mucous membranes did not appear to be irritated. The implant abutments, which had clearly been individualised multiple times, were inadequate for support of the removable dentures. All the implants displayed a degree of loosening and the peri-implant tissue appeared both slightly red and swollen. We found that the complete maxillary and mandibular dentures were inadequate and diagnosed peri-implantitis around all the implants. 6 Treatment planning The prognosis for the implants was not predictable at the time the findings were recorded, for which reason the implants were initially left as they were (Figs. 1 & 2). The treatment of the peri-implantitis would be initiated after production of the new complete maxillary and mandibular dentures. With special consideration of the patient’s existing condition and medication, replacement of the implants in the upper jaw with zygomatic and pterygoid implants at a later point in time might also have been conceivable. However, this will not be discussed in further detail at this point. 7 8 The patient requested that the functional impairments and aesthetic aspects be resolved as quickly as pos- sible. For cost and time reasons, the complete max- Fig. 6: Visualisation of digital maxillomandibular relationship registration. Figs. 7 & 8: Import into the exocad software after scanning of the individual impressions and dentures using the laboratory scanner. 3D printing 1 2022 33

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case report | 22 24 23 25 Fig. 22: Individualised, digitally produced complete maxillary and mandibular dentures in their finished state on the 3D-printed master models in the articulator (CediTEC). Fig. 23: Individualised, digitally produced complete maxillary and mandibular dentures in situ (CediTEC). Fig. 24: Individualised, digitally produced complete maxillary and mandibular dentures in situ, en face view, habitual bite (CediTEC). Fig. 25: Individualised, digitally produced complete maxillary and mandibular dentures in situ, smiling (CediTEC). bases. Using both additive and subtractive processes makes it possible to avoid dimensional changes resulting from polymerisation shrinkage. The reproducibility of the dentures for future replacements as mentioned is an- other advantage, as the digital data sets are available at all times and any location. The CediTEC system pre- sented here represents a consistent process for both dental practice and dental laboratory. CediTEC stands for CAD/CAM-enabled denture individual TEChnique. In this case, CediTEC DT (“DT” stands for “denture teeth”) was used in the scope of the milling technique for the computer-assisted production of the denture teeth. CediTEC DT is a special composite developed specifi- cally for CAD/CAM technology and available in four shades. In the case described here, the denture bases were produced using additive process technology with the aid of a 3D printer and the printing resin V-Print dentbase. The denture bases could alternatively have been manufactured subtractively, in which case they would have been milled from a PMMA disc (CediTEC DB). CediTEC DB is available in three different shades. Both CediTEC DB and CediTEC DT can be subsequently fur- ther customised in the scope of aesthetic dentistry with composite stains. Conclusion dentures so perfect in every way were possible in so few and such short appointments at that. In our opinion, nothing has changed in terms of the fundamental principles of the production of complete dentures, even when new and state-of-the-art CAD/CAM systems are utilised. Corresponding expertise in dentistry and dental technology remains the basis for time- and cost-effective treatment with digitally produced den- tures. Even in the future, handy software and hardware components will not be able to completely replace the expertise of dentists and dental technicians. Never- theless, applications in dental practices and dental laboratories will be joined by further new working steps in the interest of the digitalisation of clinical, patient-specific data and virtual planning of dentures. Editorial note: A list of references is available from the editor. contact Drs Francesco Zingari & Eleonora Carozzi Clinica Briantea Odontostomatologica Via Trento 41 20847 Albiate MB Italy The patient was very satisfied with both the aesthetic and the functional results. In addition, she was surprised that https://clinicabriantea.it/lo-studio 3D printing 1 2022 39

industry news | Dr Anderson explained how that same imaging em- powered his patients to ask more questions and better understand the nature of their individual procedures, thus improving their postoperative experience. Dr Hammer agreed. He explained: “Whether our patients have can- cer, trauma, or benign tumours, our goal is for patients to awaken from surgery with not only the pathology re- moved and a new craniofacial reconstruction, but to also have a full complement of implant-retained prosthetic teeth for immediate improvement of speech, swallowing, function, and overall quality of life.” Dr Beth Ripley, director of the VHA 3D Printing Network, explained in a video how, through the network’s partner- ship with Dr James Hoying, partner and chief scientist at Advanced Solutions Life Sciences, advances have been made with the BioAssemblyBot. “It’s a printer that can print anything that can come through a syringe. And that could be cells or collagen—the patient’s own cells,” said Dr Ripley. Dr Hoying clarified the process, saying: “We essentially take the basic components of bone. These are ground down into a powder and then recon- stituted with other elements in order to create what is almost like a bone paste.” In a VHA Talks series video, Dr Ripley referred to a type of surgery similar to the one performed on Murry and further outlined the goals for 3D printing within the military. She explained that in the future there would be faster surgeries without the need to harvest bone from other parts of the patient’s body, as is presently done in jaw reconstruction cases. “Well, now we have a bio-printer. We can take some [fat cells], we can take some bone cells, and remember we have the blueprint for your mandible. So, we know what the shape is, and we can start working on taking those cells, mixing them together and getting them to grow, with the idea that eventually we will be able to replace that piece of mandible with a living, growing bone that will be incorporated into your body and become part of you.” The main goal is for the military to be able to provide bio-tailored 3D-printed body parts for soldiers and vet- erans around the world, slashing development and build times and ensuring that the body parts are exactly what the patient needs, down to the cellular level. A statement from the VHA Innovation Ecosystem con- firmed this plan, highlighting the objective of using ad- vanced manufacturing technologies, including 3D printing, injection moulding, vacuum forming and laser machining, to help improve the supply and specialised use of med- ical devices. The organisation has three U.S. Food and Drug Administration-registered Advanced Manufacturing Hubs at present that are capable of printing products to match the needs of individual veterans. Marine Corps Lance Corporal Jaden Murry was the recipient of a new lower jaw and 3D printed teeth after having a dangerous tumour removed by surgeons with the Veterans Health Administration. (Image: © Mass Communication Specialist 3rd Class Jake Greenberg) 3D printing 1 2022 41

accurate reading when I need to consider interproximal contact points, occlusion and the anatomy of the tooth to be moved. The last step that needs to be considered be- fore I can even start moving teeth is each root placement. This will allow for the software to know how each tooth needs to move in relation to its root direction. Straightening of the patient’s teeth can then begin. Much of the knowledge I have gathered over the years regarding aligners has been from hands-on training by our orthodontists. They have taught me what the con- straints are per aligner, how to take into account contact points that are too great, when it is appropriate to have spaces to allow for better movement, and when and how you should place attachments. Whenever I am aligning a patient’s teeth, I always aim to overcorrect the problem area. What I have found over the years of working with aligners is that when you think it is perfect the final result will not be that way. Therefore, “Our workflow benefits from printing as many models as possible, as this saves time and costs.” an overcorrection will help ensure that ideal alignment will be achieved. The first thing I check are the contact points. There is no point in moving teeth if it will poorly affect the patient’s bite or if there is no room for the teeth to move. The interproximal contacts should be no greater than 0.5 mm. If the contacts are greater, interproximal reduction (IPR) will typically be done or the mouth will be expanded to reduce pressure from movement, allowing realignment. Virtually, I will go ahead and perform IPR if needed. When performing IPR, the most that should be removed is 0.15 mm per surface, so the most reduction done between two teeth should equate to 0.3 mm in total. You do not want to remove too much, as this will impair the integrity of the tooth. The same careful consideration needs to be given to the opposing teeth as well. I check the bite using the same feature I use to check the interproximal contact points. It is important to make sure that the movements done do not impact the opposing teeth too much. Personally, when working with the inci- sors, I do not want too much contact, so the most I allow is 0.1 mm. To avoid too much contact, I retract or intrude the teeth, or talk with the dentist regarding preparation of the teeth accordingly. When working with molars, the contact points are obviously higher. As I have become 3 Fig. 3: The MINISTAR S for vacuum forming. more comfortable with aligners, I have started moving premolars and molars. Regarding attachments and when and where to place them, what I have been taught is that if the tooth you are trying to align reaches a value greater than 10 mm, it is best to add an attachment. In most of the cases I have worked on, many issues that I was trying to resolve involved de-rotation. It is important to consider where the attachment needs to be placed based on what is needed. It is important that pressure is applied by the attachment to aid movement in the desired direction. Once I have realigned the teeth, I then specify the number of aligners required. The amount of movement allowed per aligner is 0.3–0.4 mm. It is at this stage that I send my ClinCheck treatment plan (Invisalign, Align Technology) to the dentist for approval before I can start the produc- tion of aligners. Once the treatment has been approved, we set up the 3D-printing process. This starts with load- ing the final models into the 3D-printing software, which provides automatic placement and positioning. Once all the models are in place, we transfer this data to the PRO 4K80 UV. Our workflow benefits from printing as many models as possible, as this saves time and costs. 4 Fig. 4: Polishing the aligner edges with a fine Scotch-Brite disc. 3D printing 1 2022 43

industry news | 4D-printed clear aligners found to show promise By Jeremy Booth, Dental Tribune International A study led by researchers at the University Hospital Bonn has found that 4D-printed orthodontic clear aligners can apply biocompatible orthodontic forces in order to move teeth. The technology of 4D printing is based on the 3D printing of shape memory materials. The 4D aligners are clear aligner trays that are 3D-printed using shape memory polymers (SMPs), and the implications of this novel material in clear alig-ner therapy could include re- ducing the cost of treatment and its burden on the en- vironment. Clear aligner trays are made of various types of polymers and are typically designed to move a tooth within the range of 0.2 to 0.3 mm—or to rotate it by 1 to 3°—before being replaced by successor trays. As the authors of the study point out, this stepwise treatment model requires more time and a higher cost for materials than treatment using fewer trays would. Naturally, for both patients and manufacturers, the use of successive plastic clear aligner trays also carries with it ethical con- cerns related to the environment. Various studies have examined applications for SMPs in medical materials, including for orthodontic applications. The researchers, however, sought to add to what they perceived was a lack of data in the literature concerning SMPs and tooth movement by measuring the forces generated by the 4D aligners and thereby their suitability in the treatment of malocclusion. The researchers, from dental faculties in Germany, Egypt and the UAE, used a biomechanical system in order to use forces to correct the malposition of a maxillary cen- tral incisor (tooth 21) in a custom-made typodont model using 4D-printed aligners. The generated forces were measured at different temperatures, and the clear aligner trays were made of ClearX v.1.1 material in the two thick- nesses 0.8 mm and 1.0 mm. The forces delivered were quantified using an orthodontic measurement and simu- lation system (OMSS). They found that the 4D-printed aligners were capable of achieving significant tooth movement within the range of 2.5 mm ± 0.5 mm, with little variation between the two thicknesses. In the OMSS simulations, it was found that the range of maximum forces delivered varied according to the different temperatures tested (37 °C, 45 °C, 55 °C) but that they were all within the range of acceptable phys- iological orthodontic forces, as reported by the literature. m o k.c c E v g eniyqw/Shuttersto © In contrast to other studies, the researchers found that using a thicker aligner had no effect on the generated force except at the higher temperature of 55 °C. The authors highlighted a number of limitations to the study, such as its focus on the isolated movement of a single tooth and not on a complex clinical case and the fact that it did not account for intra-oral conditions and factors such as humidity and salivation. They concluded, however, that the 4D aligner was capable of moving teeth using biocompatible orthodontic forces. They wrote: “Although orthodontic aligners have been studied in several aspects and great progress was done in ortho dontic treatment by aligners, practitioners still re- port some drawbacks to aligner use.” They explained that these drawbacks included the limited movement achieved by single aligner trays, which necessitated changing regimes. They concluded: “Therefore, we believe that if a method could be applied to decrease the number of the aligners per treatment, together with a method to accelerate the biological movement of the teeth, that would be a quantum leap in the field of orthodontics.” The study, titled “Potential application of 4D technology in fabrication of orthodontic aligners”, was published online on 28 January 2022 in Frontiers in Materials. 3D printing 45 1 2022 45

industry news | In Wuxi in the Jiangsu province in China, Angelalign has built the largest dental 3D-printing base in the country and deployed fourth-generation 3D printers which are among the most advanced in dental applications, ac- cording to a China Insights Consultancy report. With custom built-in parameters, Angelalign’s 3D printer can meet the needs of mass production, and the produc- tion speed is 25–50% faster than the industry average. Compared with Invisalign, Angelalign has a price advan- tage. The completion of the Wuxi base will continue to increase its production capacity and is expected to fur- ther expand its market share. Angelalign supplier Prismlab was founded in 2005 in Shanghai in China. Specialising in the research and de- velopment, manufacture, sales and service of 3D printers, the company is a high-tech enterprise that provides a complete set of invisible orthodontics solutions. Its sales volume has been growing steadily during the COVID-19 pandemic, attracting investment by global industrial giant BASF. Summary North America and China are the top two invisible ortho- dontics markets in the world. While advancements in and rapid adoption of dental technologies, including 3D print- ing, drive market growth in North America, China is still developing and has a huge population. Both have amaz- ing market potential. The Chinese market is expected to surpass that of European and American countries in the near future. However, its medical resources are lacking compared with North America. Overall, income level and awareness of oral hygiene and the acceptance of invisible orthodontics among Chinese people have gradually increased over the past decades. In addition, the pursuit of beauty and the development of digital invisible orthodontics are expected to boost the penetration rate of invisible orthodontics and to further intensify market competition in the future. about Rical Lee graduated from the Binzhou University in the Shandong province in China in 2014. He has a special interest in the 3D-printing industry and is engaged in market-related research. options are driving the invisible orthodontics market in North America. The Chinese invisible orthodontics market became the second largest market in the world in 2019 owing to the increasing demand for aesthetic dental treatments with clear aligners in developing economies. The market size increased from US$90 million in 2015 to US$300 million in 2020 and is expected to reach US$10 billion in 2030 at a CAGR of 390%. Key companies and market share insights The global market has been characterised by intense competition. One of the key factors driving competitive- ness among market players is the rapid adoption of advanced digital technology such as intra-oral scanners, 3D printers and CAD software. At the same time, these players are rapidly opting for strategic expansion and collaboration in order to expand their geographical presence and sales volume. In 1998, Align Technology’s Invisalign clear aligner system was approved by the U.S. Food and Drug Administra- tion and became the pioneer of invisible correction tech- nology. In 2001, Align’s successful initial public offering ushered in rapid development. By 2011, Invisalign had become the most important system in the global invisible orthodontics market. In August 2017, Straumann officially entered the field of digi- tal orthodontics. The company wholly acquired ClearCorrect, the world’s second largest invisible orthodontics brand, invested in a 38% stake in Spanish invisible orthodontics brand Geniova Technologies and increased its stake in den- tal digital solutions provider Dental Wings to full ownership. In the early 2000s, invisible orthodontics technology was introduced into China. After 20 years of development, the invisible orthodontics market in China includes Angelalign Technology, Align Technology and Shanghai Smartee Dental Technology. According to data from China Insights Consultancy, Angelalign and Align occupied 41.0% and 41.4%, respectively, of the market share in China in 2021, having obvious advantages over other brands. 3D printing 1 2022 47

industry news | Most printing jobs of dental models consist primarily of low-detail areas that can be quickly printed in 100 μm layers, such as the base of a model. The highest margin quality and detail are found in the remaining top portion of the dental model and should be printed much slower and in more detailed 50 μm layers. Users quickly adapted this innovation and found new and creative ways to implement multi-range printing. Multi-material printing was the next logical step. Instead of changing layer thickness from one range to another, multi-material printing switches the entire range’s exposure, lift and speed to match a completely different material configuration file. After loading a new material con- figuration INI file on the fly and defining a separate range, the user can create multi-material prints of a single object. The uses and benefits of this innovation are immediately obvious and include complete dentures that do not rely on bonding teeth to denture base sockets, dual hard and soft splints that offer patient comfort and increased wear resistance, and multi-material presentation and demon- stration models for patient education or the showcasing of work. The options are limitless. As new and exciting resins are constantly entering the market, it is crucial to select a printer brand with an open material system that guarantees compatibility and offers an open system that actively pairs these multi-materials in an innovative way. about Minh Tran is the founder and creative director of DentalTechTips, an online independent publication and blog that provides unbiased product reviews, offers tips, tricks and tutorials, and covers the latest and greatest in the dental laboratory industry. He is a second-generation dental technician from Windsor in Ontario in Canada and has been working in the dental industry since 2006. complexity and depth for the user to explore. Both multi- range and multi-material printing are only possible in Asiga printers. What is multi-range printing? A range is defined as a set of values in a data set. In 3D printing, a range refers to the starting and end point of a build. Essentially, every 3D-printing build is a ranged print. For example, a single-range, single-material print employs a material such as Asiga DentaMODEL and has only a single range, defined from 0 to 100% of the build volume. Conversely, a single-material, multi-range print could also employ Asiga DentaMODEL, but have 100 μm layers from 0 to 60% of the build and the remaining 40% could be printed in 50 μm layers. This feature was first imple- mented in Asiga’s PRO 4K to overcome speed challenges. 3D printing 1 2022 49

Formlabs: Form 3B+ Formlabs: Form 3BL Prismlab: Rapid-400 Prismlab: Rapid-600 40.5 cm (W) × 37.5 cm (D) × 53 cm (H) 77 cm (W) × 52 cm (D) × 74 cm (H) 840 cm (W) × 840 cm (D) × 1,750 cm (H) 930 cm (W) × 805 cm (D) × 2,300 cm (H) 14.5 cm (W) × 14.5 cm (D) × 18.5 cm (H) 33.5 cm (W) × 20 cm (D) × 30 cm (H) 384 cm (W) × 216 cm (D) × 340 cm (H) 576 cm (W) × 324 cm (D) × 100 cm (H)  SLA  LFS  PolyJet  DLP/DLS  SLS  DMLS  FDM  LCD 25 µm  SLA  LFS  PolyJet  DLP/DLS  SLS  DMLS  FDM  LCD 25 µm  SLA  LFS  PolyJet  DLP/DLS  SLS  DMLS  FDM  LCD 25 µm  SLA  LFS  PolyJet  DLP/DLS  SLS  DMLS  FDM  LCD 38 µm  Dental laboratory  Restorative dentistry  Orthodontics  Implantology and maxillofacial surgery  Endodontics  Bone replacement  Dentures (complete and/or partial)  Education (preclinical training models)  Custom trays  Study models  Diagnostic wax-up models  Models for fi nishing crowns and bridges  Castable wax patterns  Dental laboratory  Restorative dentistry  Orthodontics  Implantology and maxillofacial surgery  Endodontics  Bone replacement  Dentures (complete and/or partial)  Education (preclinical training models)  Custom trays  Study models  Diagnostic wax-up models  Models for fi nishing crowns and bridges  Castable wax patterns  Dental laboratory  Restorative dentistry  Orthodontics  Implantology and maxillofacial surgery  Endodontics  Bone replacement  Dentures (complete and/or partial)  Education (preclinical training models)  Custom trays  Study models  Diagnostic wax-up models  Models for fi nishing crowns and bridges  Castable wax patterns  Dental laboratory  Restorative dentistry  Orthodontics  Implantology and maxillofacial surgery  Endodontics  Bone replacement  Dentures (complete and/or partial)  Education (preclinical training models)  Custom trays  Study models  Diagnostic wax-up models  Models for fi nishing crowns and bridges  Castable wax patterns  Temporary prefabricated restorations (crowns, inlays, onlays, veneers and/or bridges)  Permanent (crowns, inlays, onlays, veneers and/or bridges)  Diagnostic wax-up models  Temporary prefabricated restorations (crowns, inlays, onlays, veneers and/or bridges)  Permanent (crowns, inlays, onlays, veneers and/or bridges)  Diagnostic wax-up models  Temporary prefabricated restorations (crowns, inlays, onlays, veneers and/or bridges)  Permanent (crowns, inlays, onlays, veneers and/or bridges)  Diagnostic wax-up models  Temporary prefabricated restorations (crowns, inlays, onlays, veneers and/or bridges)  Permanent (crowns, inlays, onlays, veneers and/or bridges)  Diagnostic wax-up models  Occlusal guards  Models for fabricating orthodontic aligners and retainers  Directly printed orthodontic aligners  Indirect bonding trays  Occlusal guards  Models for fabricating orthodontic aligners and retainers  Directly printed orthodontic aligners  Indirect bonding trays  Occlusal guards  Models for fabricating orthodontic aligners and retainers  Directly printed orthodontic aligners  Indirect bonding trays  Occlusal guards  Models for fabricating orthodontic aligners and retainers  Directly printed orthodontic aligners  Indirect bonding trays  Implant surgical guides  Endodontic surgical guides  Implant surgical guides  Endodontic surgical guides  Implant surgical guides  Endodontic surgical guides  Implant surgical guides  Endodontic surgical guides  Defi nitive complete dentures  Defi nitive partial dentures  Wax try-in of dentures, base plates and wax rims  Defi nitive complete dentures  Defi nitive partial dentures  Wax try-in of dentures, base plates and wax rims  Defi nitive complete dentures  Defi nitive partial dentures  Wax try-in of dentures, base plates and wax rims  Defi nitive complete dentures  Defi nitive partial dentures  Wax try-in of dentures, base plates and wax rims  Maxillofacial models  Other  Maxillofacial models  Other  Maxillofacial models  Other  Maxillofacial models  Other  Compatible with 3rd party resins  Compatible with manufacturer’s materials  Compatible with manufacturer’s materials and some selected 3rd party resins  Compatible with 3rd party resins  Compatible with manufacturer’s materials  Compatible with manufacturer’s materials and some selected 3rd party resins  Compatible with 3rd party resins  Compatible with manufacturer’s materials  Compatible with manufacturer’s materials and some selected 3rd party resins  Compatible with 3rd party resins  Compatible with manufacturer’s materials  Compatible with manufacturer’s materials and some selected 3rd party resins  Resin  Ceramic  Metal  Powder  Other  Resin  Ceramic  Metal  Powder  Other  Resin  Ceramic  Metal  Powder  Other  Resin  Ceramic  Metal  Powder  Other Models: .............................................................................. 8 Orthodontic models (horizontal): .......................................... 8 Orthodontic models (vertical): ............................................. 18 Surgical guides: .................................................................. 9 Permanent restorations: .................................................... 90 Dentures: ............................................................................ 8 Models: ............................................................................. 24 Orthodontic models (horizontal): .......................................... 24 Orthodontic models (vertical): ............................................. 52 Surgical guides: .................................................................. 32 Permanent restorations: ................................................... n.a. Dentures: ......................................................................... n.a. Models: ............................................................................. 30 Orthodontic models (horizontal): ......................................... 30 Orthodontic models (vertical): ........................................... n.a. Surgical guides: ................................................................. 65 Permanent restorations: ................................................... n.a. Dentures: .......................................................................... 60 Models: ............................................................................. 45 Orthodontic models (horizontal): ......................................... 30 Orthodontic models (vertical): .......................................... n.a. Surgical guides: ................................................................. 65 Permanent restorations: ................................................... n.a. Dentures: .......................................................................... 80 Models: .................................................................... 11.8 ml/h Single arch model at 100 microns (directly on build platform): ......................................... 11.8 ml/h Orthodontic single arch model at 100 microns (vertical): ......................................... 8.04 ml/h Two articulated quadrant restorative model at 100 microns: ........................................................ 19.6 ml/h Surgical guide at 100 microns: ................................... 4.6 ml/h Models: .................................................................... 11.8 ml/h Single arch model at 100 microns (directly on build platform): ....................................... 11.8 ml/h Orthodontic single arch model at 100 microns (vertical): ........................................... 7.3 ml/h Two articulated quadrant restorative model at 100 microns: ........................................................ 18.7 ml/h Surgical guide at 100 microns: ................................... 7.3 ml/h Models: ......................................................... up to 1,000 g/h Single arch model at 100 microns (directly on build platform): .............................................. n.a. Orthodontic single arch model at 100 microns (vertical): ................................................. n.a. Two articulated quadrant restorative model at 100 microns: ............................................................... n.a. Surgical guide at 100 microns: ......................................... n.a. Models: ......................................................... up to 1,500 g/h Single arch model at 100 microns (directly on build platform): .............................................. n.a. Orthodontic single arch model at 100 microns (vertical): ................................................. n.a. Two articulated quadrant restorative model at 100 microns: ............................................................... n.a. Surgical guide at 100 microns: ......................................... n.a.  Yes  No  STL  OBJ  Other  Live  Online  None  Yes  No  STL  OBJ  Other  Live  Online  None  Yes  No  STL  OBJ  Other  Live  Online  None  Yes  No  STL  OBJ  Other  Live  Online  None  Included with purchase  At additional fee  Included with purchase  At additional fee  Included with purchase  At additional fee  Included with purchase  At additional fee  Paid  Free  Yes  No  Yes  No  Wi-Fi  Ethernet  Both  Other 1–3 years €4,034–5,899  Paid  Free  Yes  No  Yes  No  Paid  Free  Yes  No  Yes  No  Wi-Fi  Ethernet  Both  Other ................................................................... USB 2.0  Wi-Fi  Ethernet  Both  Other 1–3 years €12,999 2 years €42,900  Paid  Free  Yes  No  Yes  No  Wi-Fi  Ethernet  Both  Other 2 years €71,500 The market overview does not claim to be complete. Status: May 2022. 3D printing 1 2022 53

Rapid Shape: D100+ Shining 3D: AccuFab-D1s Shining 3D: AccuFab-L4D VOCO: SolFlex 170HD 65 cm (W) × 108.0 cm (D) × 161.5 cm (H) 39.4 cm (W) × 40.6 cm (D) × 75.5 cm (H) 36 cm (W) × 36 cm (D) × 53 cm (H) 29.6 cm (W) × 31.8 cm (D) × 46.8 cm (H) 33.8 cm (W) × 19 cm (D) × 8 cm (H) 14.4 cm (W) × 8.1 cm (D) × 16 cm (H) 19.2 cm (W) × 12 cm (D) × 18 cm (H) 6.8 cm (W) × 12.1 cm (D) × 18.0 cm (H)  SLA  LFS  PolyJet  DLP/DLS  SLS  DMLS  FDM  LCD 44 µm  SLA  LFS  PolyJet  DLP/DLS  SLS  DMLS  FDM  LCD 35 µm  SLA  LFS  PolyJet  DLP/DLS  SLS  DMLS  FDM  LCD 50 µm  SLA  LFS  PolyJet  DLP/DLS  SLS  DMLS  FDM  LCD 63 µm  Dental laboratory  Restorative dentistry  Orthodontics  Implantology and maxillofacial surgery  Endodontics  Bone replacement  Dentures (complete and/or partial)  Education (preclinical training models)  Custom trays  Study models  Diagnostic wax-up models  Models for fi nishing crowns and bridges  Castable wax patterns  Dental laboratory  Restorative dentistry  Orthodontics  Implantology and maxillofacial surgery  Endodontics  Bone replacement  Dentures (complete and/or partial)  Education (preclinical training models)  Custom trays  Study models  Diagnostic wax-up models  Models for fi nishing crowns and bridges  Castable wax patterns  Dental laboratory  Restorative dentistry  Orthodontics  Implantology and maxillofacial surgery  Endodontics  Bone replacement  Dentures (complete and/or partial)  Education (preclinical training models)  Custom trays  Study models  Diagnostic wax-up models  Models for fi nishing crowns and bridges  Castable wax patterns  Dental laboratory  Restorative dentistry  Orthodontics  Implantology and maxillofacial surgery  Endodontics  Bone replacement  Dentures (complete and/or partial)  Education (preclinical training models)  Custom trays  Study models  Diagnostic wax-up models  Models for fi nishing crowns and bridges  Castable wax patterns  Temporary prefabricated restorations (crowns, inlays, onlays, veneers and/or bridges)  Permanent (crowns, inlays, onlays, veneers and/or bridges)  Diagnostic wax-up models  Temporary prefabricated restorations (crowns, inlays, onlays, veneers and/or bridges)  Permanent (crowns, inlays, onlays, veneers and/or bridges)  Diagnostic wax-up models  Temporary prefabricated restorations (crowns, inlays, onlays, veneers and/or bridges)  Permanent (crowns, inlays, onlays, veneers and/or bridges)  Diagnostic wax-up models  Temporary prefabricated restorations (crowns, inlays, onlays, veneers and/or bridges)  Permanent (crowns, inlays, onlays, veneers and/or bridges)  Diagnostic wax-up models  Occlusal guards  Models for fabricating orthodontic aligners and retainers  Directly printed orthodontic aligners  Indirect bonding trays  Occlusal guards  Models for fabricating orthodontic aligners and retainers  Directly printed orthodontic aligners  Indirect bonding trays  Occlusal guards  Models for fabricating orthodontic aligners and retainers  Directly printed orthodontic aligners  Indirect bonding trays  Occlusal guards  Models for fabricating orthodontic aligners and retainers  Directly printed orthodontic aligners  Indirect bonding trays  Implant surgical guides  Endodontic surgical guides  Implant surgical guides  Endodontic surgical guides  Implant surgical guides  Endodontic surgical guides  Implant surgical guides  Endodontic surgical guides  Defi nitive complete dentures  Defi nitive partial dentures  Wax try-in of dentures, base plates and wax rims  Defi nitive complete dentures  Defi nitive partial dentures  Wax try-in of dentures, base plates and wax rims  Defi nitive complete dentures  Defi nitive partial dentures  Wax try-in of dentures, base plates and wax rims  Defi nitive complete dentures  Defi nitive partial dentures  Wax try-in of dentures, base plates and wax rims  Maxillofacial models  Other  Maxillofacial models  Other  Maxillofacial models  Other  Maxillofacial models  Other  Compatible with 3rd party resins  Compatible with manufacturer’s materials  Compatible with manufacturer’s materials and some selected 3rd party resins  Compatible with 3rd party resins  Compatible with manufacturer’s materials  Compatible with manufacturer’s materials and some selected 3rd party resins  Compatible with 3rd party resins  Compatible with manufacturer’s materials  Compatible with manufacturer’s materials and some selected 3rd party resins  Compatible with 3rd party resins  Compatible with manufacturer’s materials  Compatible with manufacturer’s materials and some selected 3rd party resins  Resin  Ceramic  Metal  Powder  Other  Resin  Ceramic  Metal  Powder  Other  Resin  Ceramic  Metal  Powder  Other  Resin  Ceramic  Metal  Powder  Other Models: ............................................................................. 24 Orthodontic models (horizontal): ........................................ 24 Orthodontic models (vertical): ............................................ 52 Surgical guides: ............................................................... n.a. Permanent restorations: ................................................ > 200 Dentures: .......................................................................... 24 Models: .............................................................................. 2 Orthodontic models (horizontal): .......................................... 3 Orthodontic models (vertical): ............................................. 10 Surgical guides: .................................................................. 2 Permanent restorations: ..................................................... 10 Dentures: ............................................................................ 6 Models: .............................................................................. 5 Orthodontic models (horizontal): .......................................... 7 Orthodontic models (vertical): ............................................. 16 Surgical guides: .................................................................. 4 Permanent restorations: ..................................................... 18 Dentures: ........................................................................... 10 Models: .......................................................................... 3–6 Orthodontic models (horizontal): ..................................... 3–6 Orthodontic models (vertical): ............................................. 4 Surgical guides: ............................................................ 6–12 Permanent restorations: ............................... Depends on size Dentures: ............................................................................ 2 Models: ......................................................... up to 100 mm/h Single arch model at 100 microns (directly on build platform): ............................ up to 100 mm/h Orthodontic single arch model at 100 microns (vertical): ............................... up to 100 mm/h Two articulated quadrant restorative model at 100 microns: ............................................. up to 100 mm/h Surgical guide at 100 microns: ..................................... n.a. Models: .................................................................... 60 mm/h Single arch model at 100 microns (directly on build platform): ..................................... 60 mm/h Orthodontic single arch model at 100 microns (vertical): ........................................ 60 mm/h Two articulated quadrant restorative model at 100 microns: ....................................................... 60 mm/h Surgical guide at 100 microns: .................................. 60 mm/h Models: .................................................................... 35 mm/h Single arch model at 100 microns (directly on build platform): ..................................... 35 mm/h Orthodontic single arch model at 100 microns (vertical): ........................................ 35 mm/h Two articulated quadrant restorative model at 100 microns: ....................................................... 35 mm/h Surgical guide at 100 microns: .................................. 35 mm/h Models: .............................. 120 mm/h (depending on material) Single arch model at 100 microns (directly on build platform): ............................................. n.a. Orthodontic single arch model at 100 microns (vertical): ............................................... n.a. Two articulated quadrant restorative model at 100 microns: ............................................................. n.a. Surgical guide at 100 microns: ..................................... n.a.  Yes  No  STL  OBJ  Other  Live  Online  None  Yes  No  STL  OBJ  Other  Live  Online  None  Yes  No  STL  OBJ  Other  Live  Online  None  Yes  No  STL  OBJ  Other  Live  Online  None  Included with purchase  At additional fee  Included with purchase  At additional fee  Included with purchase  At additional fee  Included with purchase  At additional fee  Paid  Free  Yes  No  Yes  No  Wi-Fi  Ethernet  Both  Other ......................................................................... USB 1–5 years Price on request  Paid  Free  Yes  No  Yes  No  Wi-Fi  Ethernet  Both  Other 1 year  Paid  Free  Yes  No  Yes  No  Wi-Fi  Ethernet  Both  Other 1 year Price on request Price on request The market overview does not claim to be complete. Status: May 2022.  Paid  Free  Yes  No  Yes  No  Wi-Fi  Ethernet  Both  Other ......................................................................... USB 1 year Price on request 3D printing 1 2022 55

manufacturer news | 5100 came out as a clear winner. The standardised workfl ow, the speed and accuracy, and most importantly the company’s more than 80-year legacy of fabricating denture base materials made the decision relatively easy. During this fi rst step into digital dentistry with the 3Shape scanner and software, Michael did not see the need for a milling machine, and the laboratory focused mainly on removable work. The invest- ment and overhead of a milling machine were thus avoided. In this regard, Michael said: “I predict that more and more resins will become available for 3D printing of defi nitive fi xed restorations for patients.” The impact on Everdent going digital was huge. Traditional den- tures require a great deal of hands-on work, and the patient has to visit the clinic up to six times. The transformation from an analogue to a complete digital workfl ow enabled reduction of patient visits to the clinic to three in total on average. This, in combination with faster and more effi cient fabrication of dentures, doubled the number of cases per week within a year. Patient feedback to Everdent has been very encouraging. Patients have been pleased with the design, fi tting and most of all reduced chair time. To Michael’s surprise, very few dentures have needed a reline or reprint. Thanks to this overwhelmingly positive feedback, Everdent has continued to receive increasingly more requests from clinics, and the nearby dental hospital has started to refer patients who need dentures urgently to the laboratory. It is not about the money—it’s about the time saved! Going digital has worked wonders for Everdent. Michael is often asked how much he needed to invest and how much extra revenue he has made. He underlines that it is not about the money but about the time saved: “Yes, you must invest time and money to transform your workfl ow into a digital one, but when you have everything up and running, you will have so much more time to focus on your patients, the lab, the clinic, marketing. In short, going digital resulted in far more time to manage the lab and clinic. As a result, Everdent is growing in the number of patients, cases, staff and revenue.” https://everdentclinic.com.au/ Printed with NextDent Ortho Flex 3D printing 1 2022 57

manufacturer news | Designed and optimised for dental practices HeyGears launches UltraCraft ChairSide and ChairSide Pro dental production solutions HeyGears, a digital manufacturing company specialising in 3D printing, has recently launched two new products in its line of dental technology innovations: the UltraCraft ChairSide and UltraCraft ChairSide Pro 3D printers. As the demand for digital workfl ows in dental practices grows, so does the need for streamlined, easy-to-use production. With ChairSide and ChairSide Pro, in-offi ce 3D printing is no longer complicated. Users can easily complete the 3D-printing process for multiple dental applications with a minimal amount of training, providing dental practices and laboratories with the ability to fully optimise their 3D printing without requiring specialised staff or outsourcing of production. UltraCraft ChairSide UltraCraft ChairSide is an effi cient, autonomous solution with plug-and-play operation and a small physical footprint. The com- bination of UltraCraft ChairSide, the UltraCraft AirWash cleaner and dryer, and the UltraCraft AirCure polymerisation machine is a lightweight desktop 3D-printing system that provides effi ciency, speed and reliability. The solution has been specifi cally designed and optimised for dental practices and can go from scan to product within 30 minutes, depending on the application, providing effi cient use of time and a positive patient experience. After intra-oral data has been scanned and sent to HeyGears Cloud for design, the system begins printing operations. ChairSide handles the printing job using CapsulePrint, a 3D-printing solution that integrates the resin tank, resin liquid and material-adding mecha- nism in a single easy-to-use capsule. CapsulePrint is made from recycled plastic and is disposable, eliminating the hassle of resin tank cleaning and used resin storage. It makes shifting between applications fast and easy, having no need for calibration. UltraCraft AirWash completes the washing and drying process using the disposable platform as the base, preventing the need for contact with the liquid resin. There is also no need to clean the washing chamber when switching applications. AirWash can automatically detect the application in use and select the optimal washing solution for each output. UltraCraft AirCure performs the fi nal step in production, providing auto-calibrated fast polymerisation by identifying the application and the proper polymerisation strategy for each output. UltraCraft ChairSide Pro For increased output needs, UltraCraft ChairSide Pro incorporates the effi ciencies of ChairSide, but is an industrial-grade desktop 3D printer designed for clinics or laboratories with multiple dental application needs. ChairSide Pro offers the same quality but at a faster speed, making it perfect for small-batch production. HeyGears UltraCraft C Series ChairSide Pro utilises a matrix light source with an industrial- grade light engine for excellent resolution and a highly optimised separation strategy and offers a 40% increase in productivity compared with traditional digital light processing systems. Artifi cial intelligence-enabled pixel-grade imaging technology reduces the risk of optical distortion, ensuring high uniformity across print jobs. The adaptive printing process can dynamically adjust the printing parameters, including exposure time, layer thickness and separation strategy, according to the specifi c requirements of the application, striking a balance between speed and quality. Whether a dental practice or laboratory needs individual products or small-batch outputs, together these products provide the ability to increase production, fulfi lling the needs of patients faster and more effi ciently. www.heygears.com 3D printing 1 2022 59

manufacturer news | The D20+ from Rapid Shape for small laboratories The D20+ 3D printer is perfectly suited for small laboratories and dental practices. The device saves time without sacrifi cing quality, and its simple, fast and safe application makes chairside produc- tion extremely uncomplicated. Visitors to LMT LAB DAY found the many benefi ts of this printer convincing. Automation with the D50+ The D50+ 3D printer is the workhorse for dental laboratories, and Rapid Shape also had the opportunity to present this fast 3D printer for professional use in dental laboratories and practices at LMT LAB DAY. The printer can produce up to 11 models in one print cycle. As an all-rounder, the system, which has high 4K pre- cision, is suitable for a wide range of dental applications and enables a professional, validated workfl ow. All Rapid Shape 3D printers result from a winning combination of experience, expertise, ingenuity and passion for new technologies. The latest printer is the D50+, a modern and highly effi cient 3D laboratory printer catering for high demands. Having validated processes, the printer offers safety and is a must for dental labo- ratories. Series production in high volumes The RS inline is a fully automated and scalable series production line. The line was on display at the Rapid Shape booth in the form of the D100+. The production concept can be individually expanded to include up to fi ve machines in this model series. Additionally, if required, the RS inline can remain in operation around the clock. This means that it is possible to print 4,000 models per day. to be printed is supplied by using an automatic refi ll unit. Combined with the possibility of uninterrupted production, this allows for very low part costs. RS wash and RS cure Immediately after printing, the parts are cleaned and cured using the RS wash and RS cure post-processing units. This ensures an optimal and validated end result. The RS wash automatic cleaning system boasts a simple operation and process-controlled con- nection to the 3D printer for professional and validated post- processing of the printed parts. Thanks to the automatic selection of the appropriate cleaning program and cleaning medium, cleaning of the printed parts is not only process-safe and easy but also environmentally friendly. The process consists of two steps: pre-cleaning and fi nal cleaning. Rapid Shape has applied for a patent for this intelligent system. Using powerful LEDs, the RS cure automatic exposure system cures the printed parts homogeneously from all sides. Through the connection to the 3D printer, the device automatically selects the correct program. This ensures that the mechanical properties and the biocompatibility of the end product are always achieved. The presets are tested and validated in close cooperation with the material partners to ensure process reliability. Rapid Shape’s expert team was able to showcase the benefi ts and features of its 3D printers to the visitors to LMT LAB DAY. Next year, the company will certainly be back in Chicago and is already excited about the next developments. More information about the products can be found at: The open material system of Rapid Shape 3D printers allows selection from over 200 resins. The material required for the parts www.rapidshape.de/products/dental 3D printing 1 2022 61

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How to send us your work submission guidelines | m o c . k c o t s r e t t u h S / s l i e x p 2 3 © Please note that all the textual compo- nents of your submission must be com- bined into one MS Word document. Please do not submit multiple files for each of these items: · the complete article; · all the image (tables, charts, photo- · · graphs, etc.) captions; the complete list of sources consulted and the author or contact information (bi- ographical sketch, mailing address, e-mail address, etc.). In addition, images must not be embed- ded into the MS Word document. All im- ages must be submitted separately, and details about such submission follow be- low under image requirements. Text length Article lengths can vary greatly—from 1,500 to 5,500 words—depending on the subject matter. Our approach is that if you need more or fewer words to do the topic justice, then please make the article as long or as short as necessary. We can run an unusually long article in multiple parts, but this usually entails a topic for which each part can stand alone because it contains so much in- formation. In short, we do not want to limit you in terms of article length, so please use the word count above as a general guideline and if you have specific questions, please do not hesitate to contact us. Text formatting We also ask that you forego any special formatting beyond the use of italics and boldface. If you would like to emphasise certain words within the text, please only use italics (do not use underlining or a larger font size). Boldface is reserved for article headers. Please do not use un- derlining. Please use single spacing and make sure that the text is left justified. Please do not centre text on the page. Do not indent paragraphs, rather place a blank line be- tween paragraphs. Please do not add tab stops. Should you require a special layout, please let the word processing pro- gramme you are using help you do this formatting automatically. Similarly, should you need to make a list, or add footnotes or endnotes, please let the word process- ing programme do it for you automatically. There are menus in every programme that will enable you to do so. The fact is that no matter how carefully done, errors can creep in when you try to number footnotes yourself. Any formatting contrary to stated above will require us to remove such formatting before layout, which is very time-consum- ing. Please consider this when formatting your document. Larger image files are always better, and those approximately the size of 1 MB are best. Thus, do not size large image files down to meet our requirements but send us the largest files available. (The larger the starting image is in terms of bytes, the more leeway the designer has for resizing the image in order to fill up more space should there be room available.) Also, please remember that images must not be embedded into the body of the article submitted. Images must be submitted separately to the textual sub- mission. You may submit images via e-mail or share the files in our cloud storage (please contact us for the link). Please also send us a head shot of your- self that is in accordance with the re- quirements stated above so that it can be printed with your article. Image requirements Abstracts Please number images consecutively throughout the article by using a new number for each image. If it is imperative that certain images are grouped together, then use lowercase letters to designate these in a group (for example, 2a, 2b, 2c). Please place image references in your article wherever they are appropriate, whether in the middle or at the end of a sentence. If you do not directly refer to the image, place the reference at the end of the sentence to which it relates enclosed within brackets and before the period. In addition, please note: An abstract of your article is not re- quired. Author or contact information The author’s contact information and a head shot of the author are included at the end of every article. Please note the exact information you would like to ap- pear in this section and format it accord- ing to the requirements stated above. A short biographical sketch may precede the contact information if you provide us with the necessary information (60 words or less). · We require images in TIF or JPEG for- mat. · These images must be no smaller than Questions? 6 x 6 cm in size at 300 DPI. · These image files must be no smaller than 80 KB in size (or they will print the size of a postage stamp!). Magda Wojtkiewicz (Managing Editor) m.wojtkiewicz@dental-tribune.com 3D printing 1 2022 65

IMAGINE THE CADABILITIES exocad’s CAD software solutions for digital dentistry will make your dental dreams come true Whatever the requirements, indications or hardware, exocad offers you vast design options and seamless integration. Master simple or complex cases easily. For implant planning, cosmetic dentistry, highly esthetic and functional restoration design and more — we have got you covered. Our platform enables seamless workflows between clinicians, dental technicians and production centers. Imagine! exocad.com