Dr Pablo Ramirez with various products printed on his Formlab Dental 3D printer. Photo by Clínica Ramirez.
The Progress of 3D Printing in Dentistry: Insights of an Early Adopter
In a recent webinar with Formlabs Dental, DSD Founder Christian Coachman sat down with DSD Clinic owner Dr Pablo Ramirez to discuss his journey into digital dentistry and how 3D printing has become an indispensable part of his clinic workflows.
The Journey of an Early Adopter
A fourth-generation dentist based in Las Palmas, Canary Islands, Dr Ramirez became known over the years for his pioneering approach to digital dental technology. In 2013, he attended DSD Residency 1, a course that introduced him to Digital Smile Design (DSD). It was during this time that he saw the potential for 3D printing in dentistry, a moment in which he states “opened my mind and changed the way I thought, the way I communicate with my team, and with my lab. It completely changed my mentality”. After that course, Pablo became committed to implementing 3D printing in his clinic.
“I came back to the island and I said, wow, we need to look at what we’re doing. We have to transform this information into the 3D world. And at that time, the only way that we could manage was by using opacities, transforming this information, putting over the ClinCheck and having a little bit of extra information. But to be honest, it was not realistic. It was better than nothing, but it was not realistic at all. But it was the beginning of how most of the companies now are thinking or are implementing the digital ortho-restorative connection,” Pablo explained
A few years later, dental companies began to enter the digital world, opening up their systems for information to be exported and for dentists like Pablo to begin to create digital wax-ups. Without the know-how to design, he outsourced everything to the DSD Planning Center and 3D printed in his own clinic. It was at this point that he formally introduced Formlabs, the 3D printing company, to DSD. At the time, the company was exploring dental applications, and through collaboration between Pablo, Christian, and other digital dentists, in 2017 Formlabs Dental was founded, a company dedicated to 3D printing in dentistry.
Continuous Adoption Creates Sustainable Growth
Fast forward to 2023, and Pablo's journey remains in motion as he continues to pursue innovation for his practice. Since seeing the success of his early adoption of running an efficient digital clinic, many clinics are following his motivating example. Formlabs Dental has continued to innovate in many areas to make its products ideally suited to dental clinics. At the same time, dentists like him continue to research and implement; one particular area that he highlights is fast printing and materials innovations.
Since its inception, Formlabs Dental has aimed to reduce printing time by introducing fast-cure machines. This fast-cure unit has drastically reduced the curing time for provisionals to as little as six minutes, representing an astonishing 80% reduction in time. For Pablo this significant reduction in printing time has been the most notable benefit of 3D printing since the beginning, allowing him and his team to dedicate more time to patient assessment and care.
It's essential to acknowledge that advancements in 3D printing technology are not limited to machines alone; the evolution of resins plays a vital role. By utilizing high-quality materials, you can achieve faster and more efficient printing processes. As a result, you can now produce temporary restorations and provisionals in-house, saving both time and resources.
“In our practice, we utilize Formlabs resins for various purposes, including mockups, retainers, and bleaching trays. The speed at which we can create these mockups is remarkable, thanks to the continuous advancements in resin technology. In the beginning, I didn’t have the perfect recipe and I used to experience de-bonding. Now I, and other dentists, have seen a lot of success with flowable composites. It has become evident that both the machine and the evolving resins contribute to reduced printing times, opening up new possibilities for efficient workflows,” Pablo continued.
The advancements in resin technology have elevated the quality of provisionals to such an extent that some dentists have stopped referring to them as ‘provisionals’ altogether. These restorations can now remain in the mouth for extended periods due to their durability and biocompatibility.
“In the case of implants, we know that they work, we can see how the tissue is healing around these materials. We are leaving the provisionals in for three to four months and the biocompatibility is really amazing, we haven’t seen any inflammation. You can really restore the emergence and the submergence profile and the gingiva will enjoy the materials,” he added.
Time Management: Out-Source Design, Print In-House
By outsourcing cases to labs that dedicate their time to design, dentists can invest more time in the clinical part of the process, and more importantly, in 3D printing. While reversing this workflow is still quite common, the reality is that everything can be printed in-house with a 3D printer. Pablo explained that with time management taken into account, he and his team started outsourcing everything to the DSD Planning Center with the full awareness that they did not want to invest time and money into buying licenses for different design software, despite having the knowledge to do so.
“Outsource bigger cases to people who dedicate their time to design, so you can invest your time in the clinical part. You need to calculate the time to see which makes better sense for you in terms of outsourcing and doing things in-house. Everything can be printed in-house, it simply depends on the team understanding the software and how to use the machine. My advice for beginners - don’t try to do everything yourself and overwhelm the workflow, outsource the designs, and learn things one by one,” Pablo advised.
He compelled the webinar attendees to think beyond software proficiency, emphasizing that while numerous software enables printing, countless dentists depend on mastering these programs while still outsourcing to labs. Overall, understanding how to print and relaying that information to the team should be the priority for dentists getting started with 3D printing.
Smile Test Drives Made Easy
It is understandably challenging for patients to visualize their post-treatment outcome before commencing and expectation management remains a cornerstone of patient communication. This uncertainty can lead to multiple appointments and hand-made models, making the process time-consuming and costly. This advancement in chairside printing has been a remarkable advantage for Pablo, who now is able to provide immediate changes for his ortho patients.
Embracing chairside printing empowers him to offer efficient and personalized solutions for retaining the desired orthodontic position, which has enhanced both patient satisfaction and treatment outcomes in his clinic. In addition, he applauds the ability to 3D print mock-ups in-house as part of the “Smile Test Drive”, where patients get to wear their end result smile and approve it before treatment starts.
“The prototypes that you can provide during the test drives are something that is completely underutilized in dentistry and people jump from a very rough provisional to a very expensive final ceramics. We need to incorporate an intermediate step, the prototype smile test drive, that shows all the intricacies before the final restoration,” he explained.
Without a printer, as Pablo remembers, these decisions would have required additional appointments, outsourcing, and scheduling challenges.
“This is not only a fantastic opportunity for the dentist to take advantage of, but also an amazing experience for the patients. All of my patients love this,” Pablo added.
Promising Future
Pablo, with his vast experience and expertise as an early adopter, has laid the foundation for a future where dental professionals can harness the power of 3D printing to deliver exceptional care and remarkable results. What was once a groundbreaking concept has now become a reality for any dental clinic.
With faster machines and higher-quality resins, the dentist starting today has an easier learning curve, facilitating minimally invasive treatments and more accurate results.
Furthermore, Formlabs Dental continues to expand its offering, delivering extensive research to create materials that not only work but excel within the intricate environment of a patient's mouth, working alongside dentists such as Pablo to continually improve the technology, all of which signifies a promising future.
