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Inside Dentistry
September 2019
Volume 15, Issue 9

Fully Customized Dentistry

Realizing the benefits of cloud-based, digital manufacturing

Alfred C. Griffin, DMD, PhD, MMSc, and Lou Shuman, DMD, CAGS

The Fourth Industrial Revolution-or the exponential changes that we will experience due to the incorporation of new technologies that merge physical, digital, and biological elements-has been a hot topic ever since its introduction at the 2015 annual meeting of the World Economic Forum by founder and executive chairman, Klaus Schwab. Although the medical device industry is traditionally seen as the major usher of this revolution because of 3-dimensional printing and digital manufacturing, which have become buzzwords of innovation in medical device and health technology incubators, it is arguably the dental industry that is leading the charge regarding these newer technologies.

For example, in the dental industry, the 3D printing of a mass-produced device was seen as early as 1999 when Align Technology developed their clear aligner. This early application is even more impressive when one considers that 3D printing was still in its infancy in the late 90s and had otherwise rarely been applied to anything but prototyping, largely due to limitations related to materials, accuracy, and cost. In addition, 3D modeling software was also in its infancy, but these pioneering engineers were able to accomplish what the medical device space could not: to scale a mass-customized device using an early form of digital manufacturing. Obviously, these aligners were not true "end-use" parts but rather models that were indirectly used to make vacuum-formed molds.

On the medical device side, customized 3D printing has been applied to hearing aids, prosthetics, and knee and hip implants. One could even argue that there is a unique value to 3D printing in the fabrication of orthopedic ingrowth and ongrowth implants in reducing total implant weight while preserving strength through geometric lattices, which cannot be made via traditional manufacturing methods. In addition, custom surgical guides have almost become the standard of care for jaw and knee replacement surgeries, but this isn't terribly novel. The use of 3D printing for surgical guides has long been established in dental implant procedures as well as orthognathic surgeries.

So, why haven't there been more applications of 3D printing? In order to economically justify the initial capital expense of developing an application for 3D printing, there must be a high clinical value associated with customization and a big enough market to support it. Traditionally, it is assumed that 3D printed devices have less of an economy of scale due to their customized nature and that they require a higher price point when compared with devices that are made by bulk manufacturing processes. Although many potential medical applications have large enough markets, providers and payers from the industry are still determining the value of customization in these respective spaces, and many medical applications have yet to see the scale that the clear aligner has enjoyed.

Clear aligners have grown the adult orthodontic market and have evolved through the introduction of new materials and the refinement of attachments; however, traditional braces are still used for the vast majority of cases due to biomechanics and patient compliance. Despite this, brackets-by far our most common tooth-moving tool-have seen very little innovation. Today we still use a "one-size-fits-all" bracket prescription regardless of jaw relationship or tooth shape. And outside of good, old-fashioned wire bending and bracket repositioning, we only have a handful of partially-customized solutions, and they are expensive.

One company, LightForce Orthodontics, has now digitized bracket manufacturing and offers brackets that are 100% customized to the patient and an ideal occlusion determined by his or her treating orthodontist. This means that the bracket base fits perfectly with the surface of the tooth that it is bonded to, and the slot is properly angled in all directions to place the tooth in an ideal final position when the wire straightens.

The benefits of digital, cloud-based manufacturing are already being seen in improved manufacturing operations, traceability, reduced costs, and for patients, reduced treatment times and superior finishes. The current reality of the industry is that everything will be digitized, stock parts will be replaced by customized ones, and digital manufacturing will lead dentistry into the future.

About the AUTHORS

Alfred C. Griffin, DMD, PhD, MMSc, is the founder and chief executive officer of LightForce Orthodontics, and Lou Shuman, DMD, CAGS, is the founder and chief executive officer of the Cellerant Consulting Group and the cofounder of LightForce Orthodontics.

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