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Inside Dentistry
October 2019
Volume 15, Issue 10

In-Office 3D Printing

Recommendations for effective and safe implementation

Valerie McMillan, DDS, MS

Dentists love technology, novelty, innovation, and the tools that can bring those things into their practices. A 3-dimensional printer is high on the list of wanted items for many dentists. If well implemented, a 3D printer is more than just a "toy" for a doctor to waste his or her evening and weekend time on before losing interest; it is a valuable addition to the dental team. When purchasing a 3D printer, there are two main roles and responsibilities to consider. First, the dentist serves as the overseer regarding printer setup, decision-making, and quality control. And second, the dental team manages the day-to-day operations of printing, ensuring that the dentist doesn't need to sacrifice his or her daily time. When this happens, the printer becomes like a robotic assistant for the office, providing an advanced service and changing the way that the practice helps its patients. Printing is fun, and there is something very satisfying about watching a part emerge from the printer, transformed into a patient-specific device. Of course, any journey into printing can have problems, so it is important to have a complete understanding of the process and be prepared with solutions.

Basic Considerations

The dentist's role in printing is as an educated overseer of the process. To optimize this, he or she should consider taking a course in 3D printing, paying for professional training as part of a printer purchase, and joining social media groups that are dedicated to users of 3D printers. Deciding which printer to buy can be a difficult decision. At the top of the list of important factors should be what items you intend to print, the volume of printing, and the cost of the machine. General rules such as, "You get what you pay for," tend to apply, and in general, lower-cost printers will take longer to print and experience more problems than higher-cost machines. Purchasing a printer and resins from the manufacturer or approved resellers is always advised. This protects you from inadvertently using materials that are not approved for your printer or your location. One of the most common questions asked by dentists is, "What are 3D printing resins approved to fabricate?" The answer is quite complicated, but the safest recommendation is to only use them for purposes that are marketed by their manufacturers. Dentists can rely on the manufacturer's recommendations to ensure that any parts that are printed in their offices are biocompatible, strong, and of high quality. Many online resources exist to help educate dentists about how to generate a print, create proper supports, and troubleshoot issues. Another concern for the dentist when deciding whether or not to print a device is to consider the standard of care. How would other dentists compare the quality and efficacy of a printed device to a conventionally made one?

Getting Started

After sorting out all of the decisions and readying yourself to jump into 3D printing, you will need to start with a design. Designing parts and printing them can be a monumental task for someone who is just beginning. I recommend undertaking one of these processes at a time. If you want to print, let someone else design the parts. Many laboratory technicians are happy to create the file for you and charge a lower fee because you will be doing the manufacturing. The reverse is true as well. If you want to play with design but need to outsource the manufacturing, a social media request will likely generate several laboratories and technicians who are willing to help. It is important to note that having a backup for both design and manufacturing is critical to keep your practice running smoothly. If your printer is down, you will need a manufacturer; if your time is short, you will need a designer. Even though the dentist is the ultimate decision-maker and overseer of the process, being able to delegate some aspects of 3D printing is crucial to success.

Delegation and Training

Another important delegation involves the day-to-day operations of the printing process, which can be performed entirely by the dental team. The printing process isn't any more difficult than other tasks performed by assistants, and it only requires a bit of technical knowledge that can easily be learned. My recommendations for teaching the step-by-step details are simple. First, the dentist must learn how to correctly perform all of the steps. Next, he or she performs the entire printing process while taking a photograph of each step with a smartphone camera, showing each click of the mouse button. These photographs can be printed and annotated with any necessary clarifications to create a training manual for staff members. Once created, calibrate your training manual. Have an assistant follow it while you watch and take notes regarding any further clarification that may be needed. Last, place a sign-off sheet in the back of the manual for staff to sign when they have completed the training. Assistants should also be responsible for performing the printer's maintenance procedures as well as tracking replaceable parts, such as cassettes and trays or platforms. Your existing equipment maintenance protocols can easily be amended to add those steps.

One unforeseen problem that I encountered when I started printing involved timely scheduling. Print cases are laboratory cases, except there is no laboratory to make sure that the printing gets done. We discovered that we needed a system to help us remember to print devices. Our solution to this problem was to develop a "laboratory cases" checklist-a sheet of laminated paper on which we used a dry erase marker to write the patient's name and each step that would be involved (eg, send for design, print models, vacuum forming, etc). At the end of each day, if a case did not get completed, we placed the patient's name on the checklist during our end-of-day chart review and only erased elements of the checklist when they were completed. Keeping the list as empty as possible was the goal of every dental assistant. This approach to incorporating new production into your office procedures is a good training method and ensures that your time is being well spent.

Safety Concerns

Introducing a 3D printer into your practice is an exciting advancement, but it also requires careful consideration of safety. Printing resins are biocompatible when they are fully cured; however, uncured resins have been known to cause contact dermatitis and allergic reactions. Printing is a messy process, so wearing proper personal protective equipment (PPE) and protecting surfaces is important. Printers heat uncured resins, which can disperse them into the air and potentially create air quality concerns. Solvents may also create air quality concerns. When selecting a printer, look for air filtration or other systems to mitigate this risk. In addition, uncured resins and solvents are considered hazardous waste. Although approved disposal methods vary by location, a simple online search can help source an appropriate local waste management company. Solvents are flammable, require labeling, and may be governed by other regulations. Sections of your training manual can also include photographs of proper PPE, as well as the part washing, postcuring, and disposal processes, to ensure that your staff is adequately trained to follow proper protocols.

Conclusion

With the safe and effective implementation of 3D printing, you can usher your practice into a new age of manufacturing. The delegation of tasks, use of new or improved systems, and adoption of checklists can help you make it work. When a patient calls and says that the dog ate his or her nightguard, you will be prepared to help like never before. When a patient is in the hospital and his or her denture is lost, you can say, "Don't worry." And when you want to try out the design for a complicated fixed bridge prior to having it finalized and start realizing all of the other things you can do, you are going to have a lot of fun.

About the Author

Valerie McMillan, DDS, MS, maintains a private practice in Dayton, Ohio.

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