3D Printing: The Future is Now...Sort Of

You're listening to the Phil Klein Dental Podcast. So why is the popularity of 3D printing growing so quickly among U.S. dentists? How does 3D printing differ from milling? Is 3D printing going to replace milling as a way to produce in-office restorations? What do you look for when buying a 3D printing system? To help us answer these questions and more is our guest, Dr. Anthony Mennito. He has been involved with digital workflow in the dental practice for almost 20 years. He is in private practice in South Carolina and is an adjunct faculty member at the Medical University of South Carolina. Dr. Mennito is also part of an excellent in-person CE program in Charleston, South Carolina. You can find more info on that at impresscourses.com, I-M-P-R-E-S, courses.com. We'll be introducing Dr. Mennito in a moment, but first... If you're looking for a state-of-the-art denture system, then you need to check out Ivotion from Ivoclar. The Ivotion denture system is a fast and predictable process that delivers a finished denture out of a single disc for increased efficiency with attractive aesthetics. Your impressions are quickly and easily digitized in the lab, and the intuitive software allows the denture to be individually designed and customized with high accuracy. And here's the amazing part. In only one uninterrupted milling cycle, without bonding, the Ivotion disc is transformed into a denture with both base and teeth material. And when the milling process is done, all you need to do is polish. The Ivotion denture system is truly a game changer in denture fabrication. The dream of finishing a denture out of one single disc with unparalleled efficiency and quality is now a reality. To learn more, visit ivachlor.com. Dr. Mennito, thanks for joining us on our show. It's great to be here, Phil. So to begin this episode, tell us why you think 3D printing has skyrocketed in the US in the last year or so. I think part of it has been, you know, social media and the people who are doing 3D printing are all over social media. And so we see that we see what they're able to do. with this technology. And I think it's just like anything else. We wonder, is this something that I could utilize in my practice to be more productive, to problem solve, things like that. So I think the social media, it's kind of out there, right? It's kind of in your face on social. And I think that's been part of it. The other thing is the cost of it. I mean, it's not that expensive. in relation to milling systems, right? So the cost of it is a very palatable entry point. And I think that's another reason why the popularity has increased. And I wouldn't say that it's necessarily skyrocketed at this point. There's still a relatively low adoption rate with this technology, but I think it's something that is maybe increasing as fast as any other dental technology. So yeah, maybe it is skyrocketing. Yeah. Can you talk about the evolution of 3D printing a little bit just to give our audience an idea of how it emerged into the dental profession? Yeah. So I think it first got utilized in dentistry when we started using intraoral scanners more. So think about this. If you have a patient who comes in and they want to do whitening in your office, right? Take home whitening where you're going to make them a tray. and you have an intraoral scanner how are you going to make that workflow work if you don't have stone and we don't we literally don't have stone in our office right so the 3d printer first came about to kind of as As the intraoral scanner gained popularity and you have a digital workflow, but sometimes you have to produce this physical model, right, to make a night guard, like you said, to make whitening trays. And so initially, most of what we were doing were just printing models. And honestly, that's still a big part of what I use my 3D printer for. The other thing that I initially used it for were surgical guides as guided implant surgery became. more and more popular, the cost of getting a guide from a laboratory or a company that provided them was quite high. And the cost of printing it yourself was incredibly low. So if you had the ability to design that yourself, you could really save a lot of money if you're doing guided implant surgery. But the main adoption, I think, was in a response to intraoral scanners becoming more and more popular. Yeah. And so now we're getting into an era where we're hearing that 3D printing is getting closer to milling. And the cost of printing restorations, indirect restorations versus milling them, obviously the setup costs and the footprint in the office is very different. So tell us what the difference is now and where we're going with that. Well, you hit on the cost. um that's a that's a major difference i mean a milling system right with the scanner and the milling machine and the design software you know is anywhere from a hundred thousand to say 160 000 depending on what you're purchasing I saw a bundled package the other day on Henry Schein's website of an intraoral scanner and a 3D printer for about $20,000. So that doesn't include the design software, but the design software is the small. you know, small piece of that. So you're talking maybe another three to $5,000. So the entry level for as far as cost is significantly lower, significantly lower. Now, that being said, the materials that are currently available for 3D printing, while they're rapidly evolving, are still... comparable to what we can produce out of a mill. So when you're talking about lithium disilicate, when you're talking about zirconia, you're not able to produce restorations of that quality with a 3D printer at this point. Think of it this way. 3D printers are able to print resin, okay? And the resin that they're able to print currently is only about 50 to 60% filler, right? that like glass particles that are not to get too nerdy in this, but the resins, even the chair side composites that we use have glass particles in them. Those chair side resins, the direct composites are filled 70, 80%, maybe even a little bit higher with filler. That filler is what gives them kind of strength and wear resistance. very important things uh that we're looking for uh in the oral cavity which is a pretty harsh place to to exist right and so these these resins that we're able to print are not as heavily filled therefore they're not as strong and not as wear resistant as our direct composites but that is getting better with each generation of material that is developed and they are rapidly developing. So we're kind of on in the very early stages of this. 3d printing kind of revolution um but with the with the rate that things are evolving it's not going to be long before we're really able to to print something that is uh of a very good quality and and i think at this point the marketing behind a lot of the materials has put the cart before the horse a little bit as like they're calling things definitive and permanent and things like that. And I don't think currently that those materials are quite there, but I think we're getting closer and closer with each iteration of new material. So being that you teach a lot of digital workflow and you obviously have done digital work, for many years you were probably one of the first dentists to get in there full scale right where do you think we are on the timeline where 3d printing will replace milling if it gets to be where it could print zirconia um i believe in europe they're already experimenting with some form of zirconia printing if i'm not yes that is correct right so so they're getting very close right now you know we're in a time where Things are moving much faster than they used to technology-wise in all aspects of technology, especially dentistry. If they could get close to what a milling machine produces, then why would a dentist want to buy a milling machine if we can get there? I mean, that's a good point. I think the other end of that is, are we still talking about single visit dentistry, right? You talked about printing zirconia and I don't know a lot about the printed zirconia, but say you can print zirconia, but then it has to center for nine hours. Right. So, you know, are we still talking about being able to do single visit dentistry? And I think that's on the on the printer side of things. That has been the biggest leap forward in printing in the last two years has been the time it takes to 3D print something. Because back when I started printing in 2017, it would take hours to print anything. Now I can print, if I had a patient who came into the office and they broke a tooth and I was going to print them a long-term provisional, it would print in about 12 minutes. So you're talking about much quicker workflows. And I think that's the piece that you can't undervalue because dentists want that. So yes, maybe we can print zirconia in three years or five years, but are we then, is it still going to be? within a timeframe that's going to allow us to do single visit dentistry. That I'm not smart enough to know at this point. I don't have any insider information on that. But I think that, you know, once again, we're able to print better and better resins. And I think within the next three years, we'll hopefully be able to print the same quality resin as we now can mill. And then from there, it may be that the 3D printers themselves have to evolve into a different type of a system in order for them to manage ceramic material. Once again, I'm not smart enough, Phil, to really know. Yeah. Well, you're pretty smart, Dr. Manino, but you may not have the inside information, as you mentioned, but you're pretty smart. But I think based on the way 3D printing is right now, it's a huge help to the GP, right? And to specialists. especially, of course, for implants. You talk about the surgical guides. Those are huge and important. But even for the GP that doesn't place surgical implants, night guards, trays, provisionals alone, if they just did provisionals alone, it seems to me they would be worth it. I think of 3D printing as the best problem solver I've ever had in my practice. So with my intraoral scanner, with my design software and my 3D printer, there is nothing that walks in that office that I can't fix. in a very timely manner. And so for sure, you talked about night guards. Night guards are an area that has really leapt forward in the past year. The quality of those materials is now very, very good. I think they're more comfortable, the night guards, than the printed ones, than the acrylic lab fabricated ones. So our patients actually really appreciate them or they wear them more than they did those other acrylic ones. The other thing about that is that maybe, you know, we're still on the front end of all these materials. So we don't know the quality and the durability, but it costs about $5 for me to print a night guard. So if a patient breaks one in a year, I don't have any, I already have that digital file. I don't have any problems reprinting them and maybe, you know, charging them. I don't know, 50 bucks for another night guard, or maybe not, you know, whatever, however you want to manage that in your practice, you know, is great. Maybe if they come to all their hygiene visits and they stay up, you know, up to date on everything, maybe you just print them that for free as a, as a good faith, you know, part of your practice. So there's all sorts of ways that you can manage this. I think the night guards and And models are where I always recommend that people start when they purchase a 3D printer because those are sort of the simplest things. With the night guards, you can start to get a return on your investment immediately because it's about, like I said, it's about $5, $7 worth of material that you're printing those night guards out of. So whatever you charge for a night guard, you do the math there. So yeah, it's a really fun technology that's constantly evolving and it's an exciting time to get in, to be honest. And what's the software that you like to use? that works with your 3D printer for designing? So I use ExoCAD. ExoCAD is a beautiful thing. And you have to be a little bit nerdy. You have to be invested. But even if you're not invested, you're like, I don't want to learn ExoCAD. There are laboratories. There are... artificial intelligence programs that will do the design for you. And the AI programs are, from what I understand, not so great yet, but obviously with artificial intelligence, you're talking about something that will improve greatly over time. And then, but, you know, you can get a night guard designed for 20, $25. And then you have your $5 cost of materials and all in for $30, you're producing night guard. So even if you're not interested in purchasing ExoCAD or 3Shape or any of these design softwares, there are many digital options or options for digital designing out there that are very affordable and will do that work for you. Yeah, I remember in dental school, we had to make our own on a stone model. and pour the acrylic in and lay the wires and bend the wires. I remember bending those wires and I knew that I would never be an orthodontist. And I ended up becoming an endodontist. Thank God there was something I can do. But orthodontics was not something that scared me away making those night cords when I was in dental school. Did they have you do that? You're a generation and a half younger than me. I don't have any recollection, but I remember waxing up, you know. Bridges. And I did a ton of my own lab work in dental school. And, you know, you would think it scared me away from laboratory work. But all it does is really make me appreciate doing digital lab work versus analog. Well, everybody had their own. experiences in dental school, the nightmare for me was bending wires because it was, you know, it's a three-dimensional thing and I would get it perfect in two dimensions and then I'd screw up the third dimension and then I'd fix that and then the first dimension would be destroyed. So it just went on and on and on. I was in an infinite loop of distress. Yeah. So what do you look for when buying a 3D printing system? We'll be getting back to our guest in a second, but first, are you looking for an air-driven handpiece that rivals the power and torque of electric? Well, I have good news. It's finally here. It's called the T-Mac Z and it's from NSK, a company we all know and trust as a world leader in dental handpieces. In addition to being lightweight and ergonomic, this revolutionary air-driven handpiece delivers unprecedented 44 watts of power, allowing it to cut through tough zirconia smoothly and quickly. In fact, the T-Mac Z reduces overall cutting time by 30%. That means less chair time, reducing the burden on you and your patient. Take a test drive of the TMAC-Z air-driven handpiece from NSK. For a free 10-day trial, go to NSK. mean, you know, cost is always something that you look at. But I think you have to understand that when you're 3D printing something, it's a system, right? So when that night guard or model comes out of the printer, it still requires some post-processing. So there's a wash unit that comes with most. printers that is basically an alcohol bath. What that alcohol bath does is it washes the excess resin off and then you have to post cure that night guard or model also. So when you buy a printer, it's not just the printer, it's the printer, it's the wash station, it's the cure unit. And it's really, you want all three of those items to be as user-friendly and as easy to use as possible. The other thing would be the footprint, right? How much space do we have in our office? My break room in our office right now, I talked about in one of our previous episodes how our milling unit is in the doctor's office. Well, our 3D printers are in the break room. So we are busting at the seams and having a smaller footprint is a really nice option. And so you can find some printers that are on the smaller side. And so that's what I would tell you. To have a workflow, something that's affordable, obviously, it fits into your budget. And printers nowadays are anywhere from really, I don't know, $5,000 to about $20,000 for the whole system. And you want something that's going to fit into your budget. You want something that's going to fit into your office. And you want something where the workflow is pretty streamlined and it makes sense. There's a couple of printers that are out there that I really like, but I'm not trying to sell anything here, so I'm not going to mention any names, but I love the printers that are on the smaller side. Now, that being said, it all depends on how much volume you're going to print too, because you can get some larger printers that have a larger build plate that allow you to print more at any given time. So it just depends on what you're going to use it for. I think for most of us, initially, a smaller printer is a good place to start. We're not going to be printing in any bulk right off the bat. And how fast are 3D printers evolving? I know the materials that they're printing are evolving, but the actual printer, if someone buys a 3D printer now, 2024, for instance, when would they be expected to replace that? Or could they keep that even though we advance in the materials that we're printing where they become closer and closer to what we're milling? Yeah, I think that the nice thing about really all the technology that we've talked about in this podcast, Phil, is that the hardware, you buy the hardware, right? But the companies are constantly evolving the software. And so your printer is going to stay relevant for, I don't know. two, three, four years just from software updates. And so I don't anticipate any giant leaps forward in printing technology in the next two or three years. And so, but the software updates can increase the speed. They can add additional materials. And that's another thing that I'd like to talk about real quick is the materials and the printers that go together. I mean, there is... Now that we're actually printing things that are going to, in some cases, be bonded. into patients' mouths, are going to live in patients' mouths, it's really important to have validated materials. And it's not even really the materials that are validated. So, you know, the Food and Drug Administration will do these validation testings. And what you're validating is not the material, it's the material in a certain workflow. So, you know, you have material X that is printed on printer A and then washed in a certain way and cured in a certain way. And they validated that workflow. to figure out that we're not placing incredibly cytotoxic materials in our patient's mouth. That's a really important point. Back when we were just doing models, it didn't matter, right? You could buy a $250 printer on Amazon if you're just printing models, that's fine. But now that we're actually putting things in patient's mouth, it's really important that we have somebody who's actually testing that workflow to make sure that the things that we're putting in there are safe. That's a very good point. Especially when you're near the pulp, cytotoxicity is a very big factor. Yeah. And before we wrap up this podcast, Dr. Menino, tell us about the CE courses that you're doing in person in South Carolina. I'd love to. So my partner, Amanda C. and I, we have another dentist who works with us, Adamo Noterantonio. And we have some guest lecturers who come in here in Charleston, give a series of courses in aesthetic dentistry. And I'm kind of the digital component to that. And it's called Impress, I-M-P-R-E-S. And the website is impresscourses.com. And we give, I don't know, six or seven courses each year here in Charleston, mostly focused on cosmetic, but we're also mixing in kind of the digital workflows and how those work. as well. So it's, I think they're great courses. If you, if you know Amanda C, if you know Adamo, they are two of the best cosmetic dentists that I've ever seen. They're really fantastic. Both fellows in the AACD and yeah, I highly recommend those courses. And so I do a ton of CE. I'm a CE junkie. And I've been to all those courses, obviously, and now I've gotten the opportunity to help out in them. They are truly exceptional courses. Excellent. And it gets our audience to visit Charleston, South Carolina, right? Charleston is beautiful. It's absolutely beautiful. That's what I hear. If you've never been, yeah, check it out for sure. Charleston, South Carolina. All right. Well, look up Dr. Mennito, M-E-N-N-I-T-O. Dr. Anthony Mennito. You can look him up online and find out more about what he teaches. Also, if you want to listen to Dr. Mennito’s webinars and podcasts on VivaLearning.com, just go to VivaLearning.com, enter his name in the search field, and you'll see everything he's done on VivaLearning.com. And of course, you can listen to this podcast on any of your favorite platforms, including Apple, Google, or Spotify, etc. So tell your friends about us, write us a review, and follow us on those platforms. Thank you so much. Dr. Mennito, thanks so much for joining us and really appreciate your time. Yeah, my pleasure, Phil. It's been fun.