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article imageQ&A: Digital dentistry becomes the new standard Special

By Tim Sandle     Sep 22, 2018 in Technology
As digital dentistry becomes the new standard, dental practitioners are rushing to adopt 3D printing technologies and transition away from traditional dentistry. Gideon Balloch, Dental Product Lead at Formlabs explains more.
Dentistry has embraced the digital age with a number of innovations emerging. For example, dentists can start to say goodbye, gooey dental impressions; and hello to digital scans and overnight 3D printed models. One company leading the way is Formlabs, which is now a $1 billion 3D printing company based out of Massachusetts. Digital dentistry is one of the company's fastest growing subdivisions.
To explain more about innovations in digital dentistry, Digital Journal spoke with Gideon Balloch, who is the Dental Product Lead at Formlabs.
Digital Journal: How has the dental industry changed in the past ten years?
Gideon Balloch: To get a sense of scale, it’s safe to say that more has changed in dental in the last 10 years than the previous 50. The industry has undergone an incredibly fast change in the way that dental products are manufactured. If you took a technician from an average dental lab from 2008, and walked them through the lab of 2018, they almost wouldn’t recognize the workflows being employed.
There’s also been a lot of consolidation in the industry, and the business landscape facing dental labs and dental practices continues to get more competitive. This is the overwhelming thing that we hear from our dental customers and partners: businesses have to figure out how to change, or face the potential that they might not be around indefinitely. For an industry that is full of sole proprietorships, this can be really difficult.
X-ray of teeth  at the Wellcome Collection in London.
X-ray of teeth, at the Wellcome Collection in London.
DJ: To what extent has digital technology driven these changes?
Balloch: A shift towards digital technology has been the primary driver for change, ranging from scanning hardware, to treatment design software, to manufacturing tools and materials.
If you rewind to 2008, the only proven example of digital dentistry was Invisalign. Brontes and 3M had just started pushing the first digital intraoral scanner as a method just for making models. All ceramic restorations were just being introduced to the market, while metal and porcelain-fused-to-metal were still dominant. CNC milling and 3D printing were used by only a handful of the largest milling centers in the world, and the technology was expensive and unreliable.
Today, there is a highly competitive intraoral scanning market, and a lot of new entrants into the dental CAD software space. Monolithic all ceramic restorations are used for the majority of prosthetics. The majority of dental labs have brought milling machines in-house, and there’s been a growing wave of adoption of 3D printers. Therefore I think it’s fair to say that the broad majority of change in dental has been due to innovations in digital manufacturing techniques.
DJ: What can 3D printing deliver for dentistry?
Balloch:At Formlabs we strongly believe that we need to offer manufacturing solutions that satisfy three customer needs: (i) cost-effectiveness, (ii) reliability, (iii) quality. 3D printing is a really exciting technology, especially for dental, but we only want to deliver solutions to customers that just make sense.
Modern dentistry in practice  taken at the Wellcome Collection in London.
Modern dentistry in practice, taken at the Wellcome Collection in London.
With that in mind, 3D printing can offer a more repeatable, more cost effective and efficient ways to produce dental appliances. It is the technology of choice for a variety of dental applications, including printing models, surgical guides, and occlusal guards. As we continue to develop new materials and workflows, this will continue to grow. Soon we will be releasing our materials for dentures for example, where the 3D printing workflow literally saves hours of time over the traditional techniques.
DJ: How does Formlabs stand-out from others in the field?
Balloch:The key reason Formlabs technology is causing 3D printing to succeed in widespread dental adoption, where for two decades other manufacturers failed, is because our Form 2 3D printer is reliable, affordable, and easy to use. This means it’s a technology that can make business sense for a dental company of any size, one that’s quick to learn, and most importantly that can be depended on day in and day out.
This is empowering dental labs of all sizes to undertake the kind of technological change that in the past only giant companies could stomach. In the United Kingdom, for example, Ashford Orthodontics is a lab that is managing a transition towards digital, powered by a bank Formlabs printers. Previously they had a set of expensive, industrial printers, but they just couldn’t make the economics of the digital portion of their business viable, because of the high cost and complexity of operating the large-scale 3D printers. Now they’ve scaled up to over 10 Form 2 3D printers, they do around 15% of their work digitally, and it’s the fastest growing portion of their business.
Until the mid-2000’s the only dental company that underwent this kind of technological transition successfully was Invisalign; over the subsequent few years a handful of the largest milling centers in the world followed suit. Ashford Orthodontics has essentially undertaken that same task, at a much lower cost and a much faster timescale.
Models of teeth  at the Wellcome Exhibition in London.
Models of teeth, at the Wellcome Exhibition in London.
Moreover, this isn’t an isolated case. At Formlabs we’ve enabled thousands of dental business to do the same over just the last two years. Through this kind of work with our partners, 3D printing has gone from a technology with promising potential to an honest, approachable business choice.
DJ: What types of 3D printed dentistry products are produced?
Balloch:Currently the Form 2 offers workflows for crown & bridge models, clear aligner models, surgical guides, splints, occlusal guards. This fall we’ll be starting to publicly ship materials for dentures, which we’ve been actively testing with partner labs, as well as a material for casting and pressing crowns, bridges, and RPD’s. At the end of the day this is really driven by materials capabilities, and with the amount of research and development happening at Formlabs and elsewhere, the applicability of the technology will continue to grow.
DJ: Is this a sign of personalized dentistry?
Balloch:To be fair, dentistry has always been personalized -- everyone’s dentition and treatment needs have always been different. Technicians and clinicians have therefore been delivering customized treatments and prosthetics for as long as the profession has existed. In fact, in learning about dental I’ve honestly been impressed by the artisanship which has been employed in this craft. It’s truly impressive what technicians have been doing by hand -- really an artform.
Modern equipment at a dental surgery  on display at the Wellcome Collection in London.
Modern equipment at a dental surgery, on display at the Wellcome Collection in London.
3D printing is just the next in a long history of different manufacturing techniques and tools that have enabled technicians and doctors to deliver personalized treatments and prosthetics. And it’s exciting because of the potential the drive better precision, quality, and outcomes, and the potential the make dental treatments more accessible.
DJ: What are the advantages for patients?
Balloch:For some indications, 3D printing offers patients the potential for higher quality care, by making more precise, repeatable treatments easier for doctors to carry out, and more affordable for them to provide. For instance, for implant surgeries the large majority of dentists carry out the procedure freehand, reserving guided surgery only for the most difficult cases. This leads to a wide range of clinical outcomes in terms of implant placement. With 3D printing, guided surgery becomes so low cost -- literally less than $10 / guide -- and so easy that for doctors who have adopted it, it doesn’t make sense to even think about whether to do it.
DJ: What has the interest from dentists been like?
Balloch:The response and level of adoption from dentists and dental practices has probably been the single most surprising since launching into the dental vertical in 2016. We knew that 3D printing technology would eventually make its way directly into the dental practice, but we thought that was at best a 5-10 year outlook.
Modern dental setup with modern digital technology. Taken at the Wellcome Collection  London  July 2...
Modern dental setup with modern digital technology. Taken at the Wellcome Collection, London, July 2018.
Instead what we’ve seen is that, for a small set of the easiest digital workflows, thousands of dental practices have now brought 3D printing in house. They still work with their labs for the vast majority of their work, of course, but they print in house when it makes the most sense. We’ve even seen some labs adapt to this change, offer digital-only design services for the practice to then print. This means that we need to try to serve both our lab and practice customers effectively for their different needs, and we’re excited to see how it will continue to evolve.
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