The Future of Dentistry

From basic restorative procedures to complex, double-arch reconstructions, three-dimensional (3D) printing can positively impact each step in a patient’s treatment and improve his or her overall experience. In my practice, every patient receives an intraoral scan to generate a digital impression. The standard tessellation language (.STL) file generated by the intraoral scanner is sent to the 3D printer to fabricate models that are used to demonstrate a patient’s clinical needs and workflow, while improving communication among my team. These scans can be merged with cone-beam computed tomography (CBCT) imaging for surgical planning of dental implants to make important clinical decisions related to the timing of surgery, implant position, and surgical approach. As a periodontist, the application of 3D printing in my practice focuses on periodontal and implant surgery. Following are several clinical areas where 3D printing may be impactful.

Periodontal Surgery. Similar to the preoperative checklist used in medicine, 3D printing helps clinicians avoid surgical errors. For example, 3D printed guides can improve intraoperative accuracy.¹ During esthetic crown lengthening procedures, 3D printed incision guides can be used to increase the precision of each incision.² These guides can also be used for tracing the ostectomy outline during lateral window sinus augmentation or to prepare the recipient site during tooth autotransplantation.^3,4 However, 3D printed guides never replace a dentist’s clinical judgment. A strong foundation in freehand techniques and practical experience is critical to success.

Image-Based Customized Scaffolding Technologies for Bone Tissue Engineering. In the era of personalized medicine, 3D printing enables the manufacturing of image-based scaffolding technologies customized to each patient for bone augmentation. For example, a 3D-printed titanium mesh can be fabricated based on a patient’s computer-aided manufacturing (CAD/​CAM) scan that accounts for specific bony defect morphology and surrounding anatomical structures.⁵ These scaffolds may allow for more predictable clinical outcomes and reduce surgical time, although clinical studies are currently in progress. With the development of new biomaterials and manufacturing technologies, such as 3D bioprinting, you can imagine a future where patient-specific tissue engineered constructs can be printed chairside to assist in the reconstruction and regeneration of complex defects.⁶

Implant Dentistry. The use of 3D printed surgical guides allows clinicians to perform dental implant surgery both accurately and efficiently. Prior to surgery, the guide is designed in a prosthetically driven manner, which facilitates communication between the entire team.¹ Intraoperatively, bone-reduction guides can be designed to enhance accuracy and osteotomy guides can be used to control implant position, reduce variability, and shorten the length of surgery. In addition, following implant placement, 3D printing enables the fabrication of provisional restorations, ranging from single crowns for a single immediate implant to replace a tooth in the esthetic region to a full-arch hybrid restoration for immediate loading.⁷ As a result, patients benefit from the efficiency and predictability that 3D printing provides.

Restorative Dentistry. The implementation of 3D printing provides streamlined production of temporary, permanent, fixed, and removable prostheses with enhanced adaptation and mechanical properties.⁸ For instance, 3D printing enables the fabrication of immediate dentures at the same visit as the extraction to provide patients with a temporary, natural, and esthetic smile.⁹ Additionally, the use of 3D printed crowns and bridges ensures restorative care can be completed in a single visit as well as optimal mechanical properties and esthetics.

Orthodontics. Patient-specific treatment planning and execution tools, such as 3D-printed clear aligners and 3D-printed brackets, are now available.¹⁰ With the integration of artificial intelligence to assist with treatment planning and improvement in biomaterial properties, 3D printing will continue to transform orthodontics.

Clinicians will only benefit from gaining familiarity with 3D printing’s clinical and technological implications.

References

1. Goodacre BJ. Digital workflow for 3D printed implant surgical guides. J Prosthet Dent. 2022;127:205.
2. Kim J, Lin YC, Danielak M, et al. Virtual planning and rapid 3d prototyping surgical guide for anterior crown lengthening surgery: a clinical case report. J Prosthodont Off J Am Coll Prosthodont. 2022;31:275-281.
3. Sun TC, Negreiros WM, Jamjoom F, Hamilton A, Gallucci GO, Rousson D. Application of 3D-printed implant-osseous-membrane guide for one-stage sinus floor elevation: a clinical report. Int J Oral Maxillofac Implants. 2020;35:1203-1208.
4. Cahuana-Bartra P, Cahuana-Cárdenas A, Brunet-Llobet L, Ayats-Soler M, Miranda-Rius J, Rivera-Baró A. The use of 3D additive manufacturing technology in autogenous dental transplantation. 3D Print Med. 2020;6:16.
5. De Santis D, Umberto L, Dario D, et al. Custom bone regeneration (cbr): an alternative method of bone augmentation-a case series study. J Clin Med. 2022;11:4739.
6. Wu DT, Pham HM, Tao O, Wu KY, Tran SD. Bioprinting applications in craniofacial regeneration. In: Chaudhari PK, Bhatia D, Sharan J, eds. 3D Printing in Oral Health Science: Applications and Future Directions. New York: Springer International Publishing; 2022:211-232.
7. Kihara H, Sugawara S, Yokota J, et al. Applications of three-dimensional printers in prosthetic dentistry. J Oral Sci. 2021;63:212-216.
8. Jain S, Sayed ME, Shetty M, et al. Physical and mechanical properties of 3d-printed provisional crowns and fixed dental prosthesis resins compared to cad/​cam milled and conventional provisional resins: a systematic review and meta-analysis. Polymers. 2022;14:2691.
9. Anadioti E, Musharbash L, Blatz MB, Papavasiliou G, Kamposiora P. 3D printed complete removable dental prostheses: a narrative review. BMC Oral Health. 2020;20:343.
10. Tartaglia GM, Mapelli A, Maspero C, et al. Direct 3D printing of clear orthodontic aligners: current state and future possibilities. Mater Basel Switz. 2021;14:1799.

From Decisions in Dentistry. April/May 2024; 10(3):46