3D PRINTING

TECHNIQUES

RAMESH A

FINAL YEAR POSTGRADUATE

 CONTENTS:

 INTRODUCTION

 HYPE VS REALITY

 STANDARDISING DENTAL CAD/CAM SYSTEMS

 ADDITIVE MANUFACTURING TECHNOLOGY

- STEREOLITHOGRAPHY

- FUSED DEPOS ITION MODELLING

- SELECTIVE ELECTRON BEAM MELTING:

- INKJET PR INTING

- POWDER BINDER PRINTER

 CONC LUS ION

:
INTRODUCTION:

Technological developments have made significant impact and

contributions to the field of dentistry. Right from adaptation of lost wax

technique in jewellery fabrication in earl y 20th century for the fabrication of

crowns and bridge to the recent influence of computer aided design and

machining (CAD CAM) technology on digitisation of restorations. Traditional

fabrication of inlays, onlays and crowns u ses a multistage process which

involves an indirect technique of an impression followed by laboratory

processing of the restoration. This procedure involves several steps which

increases the possibilit y of errors in marginal accuracy, time consumed by the

patient as well as the doctor and the treatment costs. As in many other

industries, production stages are increasingl y becoming automated in dental

technology. Advances in computer technology now en - able cost-effective

production of individual pieces. CAD /CAM systems allow for the production of

indirect restorations in a single visit. These systems use an optical camera to

take a virtual impression by creating a three dimensional image which is

forwarded to a software program. This impression results in a virtual cast on

which the restoration is designed. The software then controls a milling process

that uses prefabricated blocks of restorative material, either ceramic reinforced

composite or all-ceramic material, to produce the restoration. The end result is

chair side production of the restoration. Principles of subtractive manufacturing

have been majorl y used by both lost wax technique and CAD CAM technology.

Subtractive technology is based on power driven machine tools such as saws,

lathes and milling machines that are used to mechanically cut a block of

material to a desired shape and geometry. This technology enabled reduction of

production time and ease of fabricating complex models. However, subtractive

manufacturing brings with it disadvantage of inc reased wastage with removal of

excess material and inabilit y of mass production

3D printing is also known as additive manufacturin g (AM), rapid

protot yping, layered manufacturing or sol id free form fabrication. It is the

process in which multi ple layer s of material is added one by one under comput

er control to create three -dimensional object. The key id ea of this innovative

method is that the three dimension al model is sliced into many thin layers and

the manufac turing equipment uses this geometric data to build each layer

sequentiall y until final desired product is complete d. It all starts with creation

of a virtual design of the obj ect. Scanner may be used to scan buildings, rock

format ions, etc., to produce a 3D model. The 3D model is slice d a nd then it is

ready to feed into the 3D printer of comp atible brand and t ype. This can be

done via USB, SD or Wi -Fi. When a file is uploaded in a 3D printer, the obje ct

is ready to be 3D printed layer by layer. The 3D print er reads every slice (2D

image) and creates a three dime nsional object. Objects of any geometry can be

made by this technology. This is what we call slicing.

3D printing over CAD CAM technology

1. Subtractive methods such as CAD CAM has some limitations in relation with

3 D printing.
2. Large amount of raw material is wasted because of unused portions of the

mono-blocks which are discarded after milling and recycling of the excess

ceramic is also not feasible.

3. Milling tools are prone to heavy abrasion and wear which shortens thei r

cycling time.

4. Due to brittle nature of ceramic microscopic cracks can be introduced during

the process of machining

HYPE VS REALITY:

3D printing has grabbed widespread public attention, no doubt helped by

sensational news stories focused upon the ma nufacturing of firearms. This

amazing technology, however, has been in use for some time in dentistry, where

practical examples of digitised technology are making a real difference to

patient safet y and comfort. The benefits of employing computer -aided design

(CAD) and computer -aided manufacturing (CAM) methods have long been

established throughout the engineering industry. For example, the innovative

Renishaw LaserBridge system combines additive manufacturing (commonl y

known as 3D printing) of the surface features and structure of the bridge design,

with subtractive conventional machining of the implant interface features. This

is a product process being used in the real world of dentistry, embracing the

best elements of additive manufacturing and combining them with computerised

precision machining in order to obtain the ideal prosthetic solution. The finished

product is supplied with a mapping certificate showing the precise data -

matching outcomes when compared with the analogue data derived from the

implant positions. This particular aspect enables the laboratory to benchmark

the accuracy of the laboratory process control. The additive 3D printing process

brings large cost savings in material when compared with the traditional

subtractive milling process o f metal or ceramic billets. Another significant

advantage of this process is the unlimited design and manufacturing capabilit y

previousl y restricted in conventional CAM activit y by tool size and machine

axis movement. The digitised process control for clin ical data capture embraces

CAD where implant locations can be measured precisel y by using a high -

precision contact scanner. Wax -modelled designs can be rapidly digitised with

optical scanners and the data combined for use in the final manufacturing

process (CAM).

Standardising dental CAD/CAM systems :

While the use of CAD/CAM technology is commonplace within the

engineering industry, the applications being imported into the dental field lack

the important ingredient of standards that have been benchmarked by the dental

industry. Knott1 drew attention to the need to standardise dental processes by

employing benchmarked digital scanning technology to introduce consistency

and conformit y in the production of dental prostheses. Metrology (the science of

measurement) is the basic ingredient needed to calibrate our understanding of

the production methods for dental prostheses and measure the end results,

thereby eliminating errors. The piecemeal introduction of applied CAD/CAM

technology comes with a very real dan ger of replicating the errors that
accompany the analogue methods used in the production of dental prostheses.

We are at a stage of development whereby the manufacturing process can be

full y digitised but the clinical procedures have yet to be benchmarked by

clinical geometry data matching. Unfortunatel y, no accepted measure of

prosthodontic excellence presentl y exists and yet there should no barrier to

creating one. In September 2005 the International Organization for

Standardization’s Technical Committee for Dentistry (ISO/TC 106) met in Rome

to discuss the creation of a standard for dental CAD/CAM systems.2 At this

meeting a document was circulated entitled Validation of CADCAM systems,

which identified three areas of interest: i) The digitisation of dent al surfaces; ii)

electronic data management; and iii) devices for computerised manufacturing

purposes. Unfortunatel y the 28 ‘experts’ from 10 countries were unable to agree

and the minutes mention that ‘some participants strongl y emphasise the need for

scientific standards, as well as others who do not see a need at all’! It is clear

from this meeting that there was considerable controversy created by the

absence of any proper standard that could be applied to the calibration of optical

scanners, whereas co ntact scanners are currentl y calibrated to the ISO 10360 Pt.

4 standard. It is not difficult therefore to employ contact scanning technology to

calibrate the results obtained from an optical scanner and one wonders if, at the

time of the ISO/TC 106 meeting , there was the necessary technical expertise

readil y available from industry. Dentistry does have a tendency to insulate itself

from the outside world and we could be accused of parochialism in failing to

recognise that we should be applying some of the b asic principles used in

bioengineering.

ADDITIVE MANUFACTURING TECHNOLOGY

Additive manufacturing on the other hand opens up new avenues for

production of dental restorations. Additive manufacturing according to the

American Societ y for Testing and Materials (ASTM) is the process of joining

materials to make objects from 3D model data, usuall y layer upon layer, as

opposed to subtractive manufacturing methodologies. The process of additive

manufacturing works on the principle of taking a 3D computer file and creating

a series of cross sectional slices. Each slice is printed one on top of the other to

create the 3 dimensional object with an advantage of minimal wastage. Today

additive manufacturing can appl y for product life cycle from protot yping to full

scale manufacturing. Additive manufacture can be promising as it offers less

time, more productive in terms of mass production thus overall reducing cost

being used more in aerospace and automobile to develop complex geometries.

Additive manufacturing technology has a range of applications such as stereo

lithography, laser forming, s elective electron beam melting and inkjet printing.

Stereolithography

History of Stereo lithography dates back to 1980 an d was introduced by Charles

Hull. Principle of making solid objects involves successive printing of thin

layers o f UV curable photop ol ymer layer by layer. It is used to make implant

surgical guides because of high mechanical strength, obturators, surgical stents,

duplication of prosthesis and burn stents. The curing time and the thickness of

the layer pol ymerized is affected by the dy namics involved in the entire

procedure. The kinetics can be controlled by the power of the light source, the

scanning s peed and the chemistry and amount of the monomer and photo

initiators. In addition, UV absorbers can be added to the resin to control t he

depth of Pol ymerization. The main disadvantage of SLA is the scarcit y of

biocompatible resins with proper S LA processing properties. Additional

challenges are the use of photo initiators and radicals which may be cytotoxic

(with long processing time s), entrapment of unreacted monomer and residual

photo initiator, and inabilit y to create compositional gradient s along horizontal

planes. It works on the principle of making solid objects by successivel y

printing thin layers of UV curable photopol ymer on to p of the each layer as

shown in fig 1. The ultra violet light draws the object and therefore cures it with

the input as digital CAD. SLA can be used for studying pre operativel y human

models from CT (DICOM) data, for preparation of customised surgical impl ant

guides and also as resin models for lost wax casting.

FIG 1:STERIOLITHOGRAPHY
Fused Deposition Modelling:

Fused Deposition Modelling developed by Schott C rump. A thermoplastic

filament material is extruded thr ough a nozzle controlled by temperature and the

material hardens immediatel y (within .1 sec) after extrusion as shown in fig 2.

Materials such as acrylonitrile but yrost yrene ABS, pol ycarbonates and pol y

sulfones are used. Medical grade ABS, polycarbonates have been tried out as

surgical gui des however they are not 100 % dense and they do have a rough

surface. Automated wax modelling process enables faster production of multiple

wax patterns. Bio plotter uses a reservoir of material used in organ printing &

scaffolds for bone growth such as h ydroxyapatite & tricalcium phosphate.

Bioresorbable pol ym ers such as pol y carpolactone & pol y lactide

microstructural patterns that enhance cell adhesion proliferation.

 FIG2: Fused Deposition Modelling

Selective electron beam melt ing:

Selective electron beam melting works by melting metal powder layer by layer

with an electron beam in high vacuum as shown in fig 3. Used for making

porous dental implants with an advantage of stress shielding & better ingrowth

of bone, its roughness may not be suitable for crowns and bridges fabrication.
Selective Laser Sintering:

In laser powder forming technology, laser beam hits the powder and creates a

melt pool and the powder particles fuse together. The terminologies of Selective

laser sintering or selective laser melting may not be clear. Production of facial

prosthesis using pol ymers scaffolds (pol y amide or pol y caprolactone), use of

steel, titanium, cobalt chromium porous mesh or dental implant with porous and

dental crowns and bridges partial denture frameworks have been tried. Selective

laser sintering works on the principle of using a digital scanner (CAD) that

scans the die model with the CAD core design.

Inkjet printing :

Inkjet printing ejects small ink drop s of ink propelled with pressure, heat and

vibration, towards a substrate as shown in fig 4. Liquid droplets change phase

on deposition on substrate, dental models, surgical guides, try in veneers and

mouth guard can be fabricated. The ink could be a suspe nsion of ceramic

powders that is forced to pass through the nozzle. In comparison with traditional

ceramic processing methods, ceramic inkjet printing has a number of

advantages. It requires minimum tooling and gives great design and fabrication

flexibilit y.
Powder Binder Printer

This apparatus uses a modified inkjet head to print. Liquid droplets are

made to infiltrate a uniform and sing le layer of powder one after the other.

Powder bed drops incrementall y and a final model is ready which is built of

many layers and a new fine l ayer of powder is swept over the surface. The un -

infiltrated powder supports the model, and so no support material is essential. In

order to improve the strength and surface hardness in delicate printed model, a

cyanoacrylate or epoxy resin is infiltrated during post processing procedures.

Although models are fragile and its accuracy is limited but still models ar e

useful as study models or visual protot ypes. This technology proved to be an

efficient means of constructing a n object in full contour. Models are difficult to

sterilize which proves to be a major drawback from a surgical perspective.

Advantages are the machines and materials ar e lower cost, but still less

expensive. Lower cost materials and technology, can print in colour, Un -set

material provides support, process is relativel y fast and materials are safe to

use. Low resolution, messy powder, Low strength, difficult to heat sterilize are

major disadvantages of this process.

Conclusion

There is huge impact of 3D imaging and modelling, and C AD

technologies on all aspects of dentistry. With the help of digital data it is

possible to make accurate, p recise and complex geome trical forms in a variet y

of materials, locall y or in indus trial centers through 3 dimensi onal printing.

Although everything we make for our pati ents can be made by a 3D pr inter, but

still single technol ogy is not sufficient to fulfill all the needs of our patient .

Recent advances have an abilit y to produce lower stiff ness scaffolds with high

resolution features that allows its application in soft tissue engineering .The
technology is gaining importance also in the fields of orthodontics and

restorative dentistry w ith the increase in usage of in traoral scanning systems.

Different 3D prin ting techniques have become imp erative in maxillofacial an d

implant surgery, to assist th e complex treatment plan ning by constructing virtual

anatomical models. It is widel y acknowledged that surgery may be less invasive

and more predictable with the use of surgical guides printe d in resins

(commonl y) or autoc lavable nylon. With the ev olution of 3D printing it has

become possible to replicate desired geometry without an expensive mold and

tooling which were not feasible wi th conventional techniqu es. 3D printers are

becoming accessible and affordable but the cost of running, material s,

maintenance, and skill of operators must be taken into consideration. Health and

safet y protocols must be stric tl y followed.3Dprinting takes the efficiencies of

digital design to the production stage. The congruence of scanning,

visualization, CAD, milling and 3D printing, along with the professions inna te

curiosit y and creativit y mak es this an exceptionall y exciting time to be in

dentistry.
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