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Dr Rooz Khosravi is a clinical assistant professor of orthodontics at the University of Washington School of Dentistry in Seattle in the US. He practices at PORTH, a digital driven orthodontic practice. His primary interests are implementation of digital technology in daily practice of orthodontics and clear aligner therapy, and he is a prolific author on the digital orthodontics and dental 3D printing. Dental Tribune International spoke with Dr Khosravi about an article he recently co-authored on cost-driven decision-making on in-office 3D-printing of appliances and his perspective on the evaluation process required in transitioning to providing in-house 3D printing.
Dr Khosravi, your article is a fantastic starting point for clinicians who want to evaluate the financial feasibility of producing appliances in-house. Could you give our readers some background on what led up to you to creating this useful guide?
The idea behind this publication came from various long discussions that I’ve had with my colleagues in orthodontics, Dr Bill Layman and Dr Pramod Sinha. I remember that I was on the phone with Dr Layman for 2 hours talking about whether it makes financial sense to fabricate aligners in-house. We both agreed that there is a threshold and after that you will lose money, period.
As part of a clinical advisory board, I have been involved in discussions on how additive manufacturing (3D printing) is going to impact the overhead in dentistry. I think that this issue has arisen in orthodontics and in-office aligner fabrication before other areas in dentistry because resins for 3D printing of dentures and crowns, for example, are fairly new on the market.
In the middle of all of this, I got a call from Dr Sinha about working with him as a co-guest-editor on a special issue on 3D printing in Seminars in Orthodontics. We picked a few topics, and I thought that we should talk about the cost of in-office 3D printing, so that is how we ended up with this publication.
In the article, you note that there has been a shift from the possibility of fabricating orthodontic appliances in-office to the cost-effectiveness of doing so and give an example of a printer that cost US$70,000 in 2005 and now costs US$500. Based on this trend, do you foresee a time when in-house fabrication might be the most cost-effective option for most clinicians, or is that never going to be reality?
The cost of acquiring a desktop 3D printer has been going down in the last five years. Many solutions to fabricate appliances are available and various aspects to consider in reflecting on whether practices will transition to in-office appliance fabrication. I think—and I believe that Drs Layman and Sinha agree with me on this—that decision-making on fabricating appliances in-office is more than whether it can be done. As we discussed in the article, cost, quality, speed of delivery, consistency and capacity are all important. Do I think that we’re going to fabricate everything in-house? No. Every practice has to think about all these factors and define a threshold and the type of appliances that they would like to make in-office. Hence, the goal of this article is to help dentists to make that decision. I personally believe that a happy balance is always the way to go.
In your cost breakdown, you also note costs such as labour and product quality that practice owners eager to try new technology might not consider. Do you have any advice for clinicians shopping around for 3D-printing solutions and who are bombarded with cost-saving promises?
In thinking about 3D-printing appliances in-office, one should cover all costs associated with this process. Like every other system, some costs are obvious, and others are less so. Examples of obvious costs are the cost of a 3D-printing resin and the printer. An example of a cost that one might not consider is the product quality, by which I mean whether the appliances manufactured in-office will do what they are supposed to do. For example, in the case of aligner treatment, if the in-office-fabricated aligners do not move the teeth the way that they should, then your overall cost of this approach is significantly more than had you outsourced these appliances, successfully delivered the care and achieved good patient satisfaction.
When it comes to purchasing a 3D printer, I would simplify the decision-making process based on the market changes I’ve seen in the last five years. There are four points to bear in mind to help narrow down your decision. First, there are two categories of printers to consider: printers that are designed for dentistry and printers that can be used in dentistry. Second, auxiliaries to the 3D printers are essential for smooth operation. These auxiliaries are the polymerisation and wash stations. Again, some of these auxiliaries are designed for a dental workflow and some have more general application.
I’ve have seen first-hand how Hossein Bassir, who is head of product design at SprintRay, goes about identifying the pain points of using a printer and then coming up with a solution for these. I think that’s why his design for a wash station is exactly what we needed in the clinical setting. It is about finding a solution that is specific to dentistry. I haven’t seen this at any other companies. I could be biased though, since I work with SprintRay closely, but I encourage everyone to look at what is out there through this lens.
The third point to consider is the resin. A library of resins specific to dentistry is the key. There used to be very few resins specific to dentistry, but now a lot of companies are fabricating resins that are specific to dentistry.
As dental 3D printing has continued to develop, it has become less about printers and more about the design of appliances and how quickly and easily you can load these designs to your printer. This is the fourth point to consider in decision-making.
Do you have any other advice or perspectives from your research that you would like to share with our readers?
I also like to pick a company that can offer me some sort of design service. In my decision-making process, I give a lot of weight to the smoothness of the workflow.
Is it a good time to get into 3D printing? We are in a sweet spot of 3D printing in dentistry. My advice is to start small and expand as far as you would like. Stay tuned on new protocols and digital frameworks, I have been building the Digital Orthodontics Hub, a resource for providers who want to learn more.
While the technology will get better, you have all you need to start. Don’t miss the boat and the opportunity to do better for your patients!
Drs. Khosravi, Layman and Sinha’s article, titled “Cost driven decision making on 3D printing appliances in-office, was published online on 17 October 2022 in Seminars in Orthodontics.
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