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A recent study found that printing dental prostheses for fibula and implant reconstructions in-house eliminates the additional waiting period before surgery, making the treatment suitable for patients with malignant disease. (Image: Miriam Doerr Martin Frommherz/Shutterstock)

Study highlights benefits of in-house 3D printing for immediate dental implant placement

By Iveta Ramonaite, Dental Tribune International
September 04, 2020

FORT WORTH, Texas, U.S.: Owing to the growing popularity of point-of-care 3D printing and the subsequent creation of 3D-printing laboratories, a recent study aimed to compare the benefits of printing dental prostheses for fibula and implant reconstructions in-house with those of using traditional techniques that involve outsourcing to dental laboratories. The researchers found that in-house printing offers considerable benefits, such as reducing the waiting period before surgery, but that it requires an initial investment in 3D-printing equipment.

3D printing has recently helped to save the lives of many health care professionals fighting on the front line against COVID-19. It was seemingly impossible to comply with the updated recommended infection control practices in light of the shortage of proper personal protective equipment, and 3D-printed masks and face shields were produced to assist in this situation. Dental Tribune International (DTI) has also previously reported on the advantages of using a fully digital workflow and printing clear aligners in-house. The benefits of 3D printing are manifold, and so are its applications for medical use.

The present study included 12 patients who underwent free fibula reconstruction of the mandible or maxilla with immediate implants and immediate restoration. The restorations were created before surgery, and the first five patients each received a prosthesis that was fabricated by a dental laboratory after virtual surgical planning. The remaining patients each received a prosthesis that was designed by a surgeon and 3D-printed via the in-house laboratory.

“Creating a 3D-printed dental prosthesis in-house allows more control for the surgeon to create the occlusal scheme”
— Dr. Fayette C. Williams, John Peter Smith Health Network

The researchers fabricated a dental prosthesis using point-of-care 3D printing within 24 hours of the virtual surgical planning session. The time required to generate the in-house 3D-printed prostheses was significantly shorter when compared with dental laboratory-fabricated prostheses, which typically take weeks. Additionally, the procedure was more cost-effective. Whereas the prostheses created by an off-site dental laboratory averaged $617.00 (€523.00), each in-house 3D-printed prosthesis cost an average of $8.34 (€7.00) for resin, and the researchers noted that a full-arch prosthesis 3D-printed in NextDent Micro Filled Hybrid costs under $50.00 (€42.00). The price includes the costs for the resin and the export fee for Blue Sky Plan, a 3D-printing software.

“The study describes a digital workflow to design and 3D-print an immediate provisional dental prosthesis to be placed during jaw reconstruction when using a fibular free flap. This surgery has been called ‘Jaw in a Day.’ Previous methods involved third-party dental laboratories which require additional time, laboratory expertise and are more expensive. Our technique allows surgeon-guided virtual planning, just like we do with the jaw and fibula,” Dr. Fayette C. Williams, fellowship director in the Division of Maxillofacial Oncology and Reconstructive Surgery at John Peter Smith Health Network, told DTI.

“Creating a 3D-printed dental prosthesis in-house allows more control for the surgeon to create the occlusal scheme. It is also much quicker. I can generate this prosthesis in one day, whereas dental laboratories can take two or more weeks,” he added.

According to the researchers, outsourcing dental prostheses to a dental laboratory has previously created a delay in the treatment, which has limited its usefulness to benign conditions. In the present study, the digital workflow used allowed for immediate dental restoration for patients with malignant disease. “This time is significant for a patient with cancer waiting to get their surgery to remove their jaw and tumor,” Williams explained.

Despite its clear advantages, the researchers believe that the digital workflow presented in the study is most suitable for patients with teeth in place preoperatively that will be removed with their tumor. For more complex cases, it is necessary to familiarize oneself with image manipulation and prosthesis planning. Additionally, the researchers calculated that the total initial cost of a 3D printer and post-processing supplies can reach around $3,000 (€2,541), plus additional costs associated with using the software.

The study, titled “Immediate teeth in fibulas: Planning and digital workflow with point-of-care 3D printing,” was published on Aug. 1, 2020, in the Journal of Oral and Maxillofacial Surgery.

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