Dental Tribune America

Printing clear aligners in-house—how accessible is it?

By Jeremy Booth, DTI
February 19, 2020

SEATTLE, U.S.; Bellevue Orthodontics says that its patients can walk out of their first appointment with a set of fully customized clear aligners. Utilizing an all-digital workflow, Bellevue has joined the 3D-printing revolution that has seen private dental practices begin producing clear aligners in-house. The founders of the practice have also launched an educational community to help dentists and team members incorporate 3D-printing technology into their workflow. But what exactly is required and what advantages does in-house production offer?

The clear aligner market leader Invisalign is facing increased competition from smaller, localized manufacturers. Dentists wishing to offer clear aligner treatment have a number of options. Manufacturing and selling an in-house brand directly to patients is one option that a growing number of practices are choosing.

A dental practice requires an intraoral scanner, a suitable 3D printer and photopolymer dental resins for 3D-printing applications, a thermoforming machine for adapting the aligner material to printed models, and a digital workflow in order to bring it all together. Practice owners need to invest in material resources, but they also need to invest in education to help their team implement a 3D-printing workflow.

3D printing offers workflow control

Dr. Christopher Riolo founded Bellevue Orthodontics in 2019 after a decade of providing orthodontic treatment to patients in the Seattle area from his downtown Riolo Orthodontics clinic. In the clear aligner category, Bellevue offers its patients Invisalign but also its own in-house product.

According to the practice, the benefits offered by making its own aligners in-house include a lower treatment cost for patients owing to factors such as the ease of making 3D-printed retainers. A lifetime retainer policy is offered to patients, for example, which lowers the overall cost of treatment. The practice also points out that many patients nowadays are conscious of the impact of their treatment on the environment and that its in-house aligners result in a lower environmental impact because shipping and handling are not required. It says that having a better understanding of the materials used to make its own aligners means that staff can offer patients greater peace of mind.

Clinic Manager Cali Kaltschmidt told Dental Tribune International that the benefits of offering an in-house brand also include an expedited start to treatment, the possibility of same-day replacements and improved compatibility with fixed appliances for hybrid treatments. “The ability to provide aligners on the same day or even in the same week is huge. Our busy adult clientele love it,” Kaltschmidt explained. She said that integrating 3D printing is inevitable once a practice has begun using intraoral scanners and that doing so has allowed Bellevue to take control of its workflow.

“Orthodontists have the technology and clinical expertise to expedite care in ways that major corporations cannot deliver” - Dr. Christopher Riolo, Bellevue Orthodontics

“3D printing has allowed us to be in control of our own workflow, and with that, the possibilities are endless. We are able to provide esthetic treatment options for our patients and keep the cost down by not accruing large laboratory fees from third-party companies. This includes in-house clear aligners, lingual braces and hybrid treatment using a combination of both. 3D printing has truly changed the way we practice,” Kaltschmidt said.

“We’re so used to next-day delivery with Amazon and other services, why should straightening teeth be any different?” Riolo asked in a press note. “Orthodontists have the technology and clinical expertise to expedite care in ways that major corporations cannot deliver. This is why we decided to adopt these technologies early on.”

“The investment for orthodontists and dental professionals to get started [with a 3D printer] can be anywhere from $500 to $20,000 or more,” Kaltschmidt said. “Technology is advancing so quickly, and the cost of 3D printers will continue to come down. Our advice for those interested in getting started with 3D printing is to spend less on the printer and invest more time into refining your digital workflow. You will begin to notice the differences when you go from analog to digital.”

“Orthodontists can definitely brand their own aligners and they absolutely should,” Kaltschmidt continued. “The product you design and manufacture in your office as an orthodontist is a superior product in the end, and you should package and brand your aligners to reflect that. In-house aligners give the practitioner full control over workflow, time to delivery, trim line and choice of aligner materials.”

Last year, Riolo and Kaltschmidt founded the Tooth Movement 3D-printing educational community in order to share their expertise on using 3D-printing technology for orthodontic applications like clear aligner therapy. Kaltschmidt said that demand from within the dental community for the limited courses on offer has been significant and that she and Riolo have worked mostly with orthodontists, members of the treatment team and recent graduates. “Many residents do not have any exposure to 3D printing while in their schooling,” she pointed out.

Manufacturers are bullish on adoption of 3D printing in dentistry

Advancements in 3D-printing technology have seen the quality of desktop models for dentistry climb while costs have fallen.

According to Dr. Baron Grutter, who owns a dental practice in Kansas City, being able to offer clear aligner treatment at a lower cost has improved case acceptance at his practice for a product that is known for its high earning potential. Grutter was an early adopter of 3D-printing technology in the dental practice and has manufactured his own clear aligners in-house for some time. He told the manufacturer SprintRay in its Practice Insights series last year that a return on the investment of a 3D-printing workflow can be made by selling as few as three or four cases.

Growing demand for this technology from dentists is being met by companies manufacturing solutions that are tailored to a number of dental applications, including making clear aligners. Manufacturers predict that sales will climb this year and that integrated digital workflows will make the technology even more accessible.

Lee Kwang Min, vice president of the Korean 3D-printer manufacturer Carima, told the online trade journal 3D Printing Industry last year that “[2020] will be a full-scale digital dentistry year. The emergence of a variety of 3D scanning solutions with an affordable price range, which has been an obstacle to the spread of digital dentistry, will replace the milling machines in the market and, furthermore, [will accelerate] the rapid adoption of 3D printers.” Min said that he expects that a collaborative approach between individual manufacturers of 3D printers, software and scanners will act to increase the accessibility and adoption of the technology by dentists.

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