Dental implant bars and bridges with additive manufacturing

Dr CKB Nair

Professor, Mechanical Engineering

Rajiv Gandhi Institute of Technology
Hebbal, RT Nagar Bangaluru- 560032
+919482048324 E-mail: [email protected]

ABSTRACT

Advances in bio manufacturing to integrate life science and engineering fundamentals

have produced bio-compatible products to improve quality of life. This rapidly evolving
cutting-edge technology of manufacturing sector has vast applications in implant dentistry.
Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM) technology
with scanners and Rapid Prototyping can be to generate surgical guides and prefabricated
prostheses. Additive manufacturing enables to realise complex, patient-specific design for
production of dental prostheses. Implant bars and bridges manufactured from additive
manufacturing achieve sufficient accuracy at the implant interface. This can integrate
complex surface textures and sealing edges. In this paper a clinical case based on 3D printing
carried out as part of interdisciplinary academic project in a dental research centre is
presented.

Design Research Forum (NDRF)

INTRODUCTION Bangalore were also used .

The orthodontic dentures Scanner and CAD/CAD systems

produced by traditional methods are were already successfully established for
mainly depending on the skill and dental applications with subtractive
[1,2,3,4,5]
experience of the technician. Its quality is manufacturing . In conventional
based on the accuracy of the technician’s systems, CAD/ CAM dental restorations
subjective judgment. Manual process are milled from solid blocks of ceramic
involves many steps that require long or composite resin to match the basic shade
time to complete. To overcome this, major of the restored tooth. Machining by
changes are taking place in dental material removal is not very competitive
laboratories with the help of new digital technology for mass production of parts ng
technologies. An interdisciplinary dental restorations like dentures and
[ 6, 7]
approach between engineering and dental crowns . Only one cutting tool can be
experts at academic level can evolve more used to machine one part at one time and
economical solutions for practitioners. In it cannot be concurrently used to machine
this paper an academic project undertaken another part. This constraint restricted the
in a dental research college in association application of material removal
with a PG research centre in an technology to lab side experiments in
engineering college with the support of dentistry. Rapid prototyping technologies
the required equipment manufacturers is can print physical models by adding
presented. Facilities available in National material based on computer-aided design
with 3 Dimensional (3D) printers [8,
1
9,10,11,12,13,14]
. A clinical case based on 3D dentist, and the fee is often double
printing technology[12,13,14] for manufacture comparing to conventional restorative
of dental implants is presented in this treatments using lab services.
paper. . Like other CAD/CAM fields,
CAD/CAM dentistry are using subtractive
SCANNER manufacturing processes like CNC milling.
In the present project , 3D printing, an
Abrasive computer tomography additive process, is used to produce
devices are used to scan denture image physical instances from 3D models. A file
and reconstruct. It enables to perform format named Stereo Lithography (STL)
digital manipulation of dental profile. is widely used for rapid proto-
Specific Scanners can be used to create typing and computer aided manufacturing
bridges, crowns, onlays, inlays, veneers, (CAM). STL files describe only the
mouth guards, partials, clear aligners, surface geometry of a three-dimensional
orthodontic appliances and models. With object without any representation of
internet enabled Scanner information texture, color, and other common CAD
system, digital impression files can be model attributes.
easily and securely send through a device
called Connection Center. To work directly An STL file describes a raw
with the digital scan data, Connection unstructured triangulated surface by
Center provides a secure location for easy the unit normal and vertices (ordered by
access to case files and prescription the right-hand rule) of the triangles using a
information.. The suitable material can be three-dimensional Cartesian coordinate
selected based on a knowledge base system.
available in the open system and which can Stereo lithography machines are 3D
be linked to the scanner data base. printers that can construct any volume
Appropriate design files can be shape as a series of slices. These machines
downloaded from the Connection Center require a series of closed 2D contours that
and sent to manufacturers of other are filled in, with solidified matter as the
orthodontic appliances who accept this layers are fused together. A file format for
industry-standard file format. such a machine would be a series of closed
polygons corresponding to different Z-
CAD/CAM values. However, since it's possible to vary
the layer thicknesses for a faster build, it
Computer-aided design and will be easier to define the model to be
computer-aided manufacturing (CAD/ built as a closed polyhedron that can be
CAM) are established fields sliced at the necessary horizontal levels.
of dentistry and prosthodontics to improve To properly form a 3D volume, the
the design and creation of  all types of surface represented by any STL file must
dental restorations. CAD/CAM has helped be closed and joined, where every edge is
to increase the speed of design and part of exactly two triangles, and not self-
creation, CAD/CAM simplifies design and intersecting. STL file format is simple and
increases the convenience of redesign and it is easy to output. Therefore,
insertion processes. Other goals include many computer-aided design systems can
reducing unit cost and making affordable output the STL file format. Many computer
restorations and appliances that otherwise aided manufacturing systems require
would have been prohibitively expensive. triangulated models. The format is
However, to date, chair side CAD/CAM commonly available, so the CAM system
often involves extra time on the part of the
2
will use it. In order to use the data, the In additive manufacturing the
CAM system may have to reconstruct the designed shape is realized by adding
connectivity. material layer by layer. A three-
dimensional printing machine is used for
mass-production of dental restorations for
SUBTRACTIVE MANUFACTURING denture teeth, all-ceramic and composite
crowns, inlays and onlays. Suitable
Subtractive manufacturing is based printing devices include both those with a
on the principle of material removal for continuous jet stream print head and a
realizing the designed shapes. In drop-on-demand stream print head. A high
CAD/CAM dentistry processes, a three- speed printer of continuous type is used
dimensional image of a stump of a tooth is which has a line printing bar containing
created along with the teeth surrounding approximately 1500 jets which can deliver
the stump in an effort to create a dental up to 60 million droplets per second
restoration which is to be placed over the continuously. Both raster and vector
stump. This picture is displayed on a apparatuses can be used. A raster apparatus
computer screen. Based on the adjacent is where the print head goes back and forth
teeth and stump the dental technician may across the bed with the jet turning on and
then select a tooth from a plurality of tooth off. Raster apparatus is likely to clog the
forms stored in the computer to best fit the jet upon settling. A vector apparatus is
stump. The chosen tooth is projected onto analogous to an x-y printer. This will be
the stump until an optimum positioning time-consuming but will have more
and dental restoration is fitted. The digital consistent finish.
data concerning the dental restoration thus
formed are supplied to a numerically Three-dimensional printing is used
controlled milling machine. The milling to create a dental restoration by ink-jet
machine cuts a blank of metal or porcelain printing a binder into selected areas of
material into the dental restoration design sequentially deposited layers of powder.
based on the data supplied Each layer is created by spreading a thin
layer of powder over the surface of a
powder bed. The powder bed is supported
The accuracy of restorations using by a piston which descends upon powder
CAD/CAM technology is not as consistent spreading and printing of each layer, or
as in other dental fabricating processes. conversely, the ink jets and spreader are
Crowns and bridges require an extremely raised after printing of each layer and the
precise fit on tooth stumps. Scanning and bed remains stationary. Instructions for
accurately calculating the stump surface each layer may be derived directly from a
topography by scanning and further milling CAD representation of the restoration. The
by CNC machines will have accuracy area to be printed is obtained by computing
restrictions. Fit accuracy varies according the area of intersection between the desired
to the CAD/CAD system and from user to plane and the CAD representation of the
user. Conventional CAD/CAM and hand- object. The individual sliced segments or
made dental processes can not consistently layers are joined to form the three
achieve required accuracy. dimensional structure. The three-
dimensional printing apparatus includes a
powder dispersion head which is driven
ADDITIVE MANUFACTURING reciprocally in a shuttle motion along the
length of the powder bed. A linear stepping
motor assembly is used to move the
3
powder distribution head and the binder While the layers become hardened
deposition head. The powder material is or at least partially hardened as each of the
dispensed in a confined region as the layers is laid down, once the desired final
dispensing head is moved in discrete steps shaped configuration is achieved and the
along the mold length to form a relatively layering process is complete, in some
loose layer having a typical thickness of applications it may be desirable that the
about 100 to about 200 microns. All the form and its contents be heated or cured at
layers required for an aesthetically sound a suitably selected temperature to further
restoration can be deposited concurrently promote binding of the powder particles. In
slice after slice and sintered/cured either case, whether or not further curing is
simultaneously. The amount of green body required, the loose, unbounded powder
oversize is equivalent to the amount of particles are removed using a suitable
shrinkage which occurs during sintering or technique, such as ultrasonic cleaning, to
curing. Although powder is used herein to leave a finished restoration.
identify the material, the material may
include particles of any shape including Powder particles are uniformly
fibers, rod-shaped particles, spherical deposited at a relatively high rate. Desired
particles, or any shape or form of material uniform depositions can be obtained by
used in the manufacture of dental knowledge of techniques of colloidal
restorations. An ink jet print head having a science and powder dispersion chemistry at
plurality of ink-jet dispensers is also driven the required rates and densities. Powders
by the stepping motor assembly in the can be dispensed either as dry powders or
same reciprocal manner so as to follow the in a liquid vehicle, such as in a colloidal
motion of the powder head and to dispersant or in an aqueous suspension. In
selectively produce jets of a liquid binder the dry state, the desired compaction of
material at selected regions thereby particles can be achieved using mechanical
causing the powdered material at such vibrating compaction techniques or by
regions to become bonded. The binder jets applying acoustic energy, with sonic or
are dispensed along a line of the print head ultrasonic vibrations, to the deposited
which is moved in substantially the same powder or by applying a piezoelectric
manner as the dispensing head. Typical scraper to the deposited powder.
binder droplet sizes are about 15 to about
50 microns. The powder/binder layer The ink-jet printing of the binder
forming process is repeated so as to build material should utilize droplets of materials
up the restoration, layer by layer. having shrinkage characteristics such that
the dimensional tolerances of the
restoration being made are maintained
upon hardening thereof. While the binder
solution must have a relatively high binder
content, the viscosity thereof should be low
enough so as to be able to flow through the
printing head for deposit into the powder
material. The binder material should be
selected to penetrate the layer and to
perform its binding action relatively
rapidly in each layer.

4
 Solid free-form (SFF)
fabrication of dental restorations are POLYJET, the most scalable
successfully used for net-shape technology in the Rapid Prototyping arena
manufacturing into small and complex is similar to the fast growing inkjet
shapes. Among solid free-form techniques, technology in 2D printing. 3D model is
dimensional printing and fused deposition printed layer- by- layer by injecting photo
modeling are preferred because both polymers and simultaneously cured using
ceramic and resin-based composite dental the Ultra-Violet rays. The model printed
restorations can be produced in solid for using Objet Polyjet Printers will be a fully
denture teeth or multilayered form for cured prototype straight from the printer.
crowns. Three-dimensional printing is Special Object 3D printers are available
most preferred for mass-production of for orthodontic Labs designed in smaller
dental restorations. with the facilities to digitize the workflow
from CAD file to model.

3D PRINTING Digital orthodontics is rapidly

becoming the standard practice in industry.
In Three Dimensional (3D) printing, This has power to slash delivery times and
designing and process planning is with to increase capacity. Bulky model storage
CAD/CAM the machining step is can be eliminated . Due to size and cost
substituted by computer assisted net- considerations, large labs were only able
shaping techniques of three-dimensional to use 3D printers.. Compact, affordable,
printing, selective area laser deposition or and easy to use 3 D printers will be
selective laser sintering (SLS), required for chair side clinical applications.
electrophoretic deposition, robocasting,
fused deposition modeling (FMD),
laminated object manufacturing (LOM),
stereo lithography and photo stereo
lithography. Most of these techniques were DENTAL APPLICATIONS
developed for net-shaped fabrication of
wax parts, such as three-dimensional Digital Dental Manufacturing
printing . Fused deposition modeling can (DDM) is a combination of digital
be used to build complex shapes from imaging, CAD/CAM and RP . DDM is
ceramic or metallic materials. A large very useful production process for dental
variety of ceramic, polymeric and elements such as crowns and fills . Chair
composite materials can be fabricated into side CAD/CAM restoration differs from
complex shapes using these techniques. conventional dentistry. Conventional
FDM, Polyjet, SLA and SLS are the main prosthesis, was using temporaries some
types of 3D printing processes. days to several weeks and the restorations
were produced in a dental laboratory or in
house dental lab.  The patient returns later
Fused Deposit Modeling ( FDM) is a to have the temporaries removed and the
technology that uses production grade laboratory-made crown cemented. An in-
thermoplastics for 3 D printing to have the house CAD/CAM system enables the
versatility to produce strong, durable and dentist to create a finished inlay in as little
accurate thermoplastic parts and as an hour in some cases. Bonded veneer
functionality of traditionally manufactured CAD/CAM restorations are more
parts without machining or tooling. conservative in their preparation of the
tooth. As bonding is more effective on
5
tooth enamel than the underlying dentin, Both ceramic and resin-based composite
care is taken not to remove the enamel dental restorations can be produced in solid
layer. Designed to provide a complete denture teeth or multilayered form of
digital workflow, chair side dental crowns.
CAD/CAM systems include a digital
impression system, 3D dental design Optical Scanner is commercially
software and a chair side mill that function available. The digital image of the optical
as a single system. Designed to provide a impression taken directly from the mouth
seamless workflow, these systems allow of the patient with a scanner is the input to
you to provide patients with crowns, CAD/CAM . CAD devices assure both
inlays, onlays and veneers in a single natural-like shape and proper function of
appointment. Though one-day service is a the restoration. The STL files were loaded
benefit that is typically claimed by dentists in a Stratasys Rapid Prototyping machine .
offering chair side CAD/CAM services, This facility is available in NRDF
the dentist's time is commonly doubled and Bangalore on hire for academic and
the fee is therefore doubled. research activities. The purpose of this
After decayed or broken areas of clinical report is to illustrate the use of 3D
the tooth are corrected by the dentist, an photography, CAD/CAM technology and
image (scan) is taken of the prepared tooth additive manufacturing to reduce the
and the surrounding teeth. This digital procedures currently used to create a
impression, draws the data into a prosthesis.
computer. A dedicated software then
creates a replacement part for the missing CONCLUSION
areas, creating a virtual restoration. This is
called reverse engineering. In the Metal alloys are milled currently
subtractive manufacturing the software dominated by subtractive machining
sends this virtual data to a milling machine technology. The additive processing routes
where the replacement part is carved out of of FDM, SLA, SLM and inkjet printing
a solid block of ceramic or composite are also being tried out. In principle this
resin. Stains and glazes are fired to the technology can be extended to all aspects
surfaces of the milled ceramic crown or of production of full dental construction,
bridge to correct the otherwise customized implants, and orthodontic
monochromatic appearance of the appliances for dental prostheses. With the
restoration. The restoration is then adjusted production of dental restorations such as
in the patient’s mouth and cemented or inlays, veneers, bridges and crowns using
bonded in place. dental CAD–CAM systems and new
improved systems appear more in the
market. The reducing cost of processing
PRESENT PROJECT power will ensure that these developments
will continue as exemplified by the recent
The present work is an academic introduction of a new range of digital intra-
project to demonstrate the feasibility of oral scanners.
realizing the prosthesis using a scanner
and CAD/CAM with Rapid Prototyping. Automation of the manufacture of
Solid free-form techniques are used to dental restorations can be conducive to
make dental restorations to denture teeth, mass production of restorations. This can
bridges and crowns. Dimensional printing be efficient and useful if applied to
and fused deposition modeling are used in variety of materials. Dental prostheses
the project with ABS plastic materials. manufacturing is experiencing a second
6
revolution with layered fabrication reduced cost for chair side use. With user
techniques reaching the point of being able friendly computer human interface the
to produce high quality dental prostheses. dentist can directly access the 3D model
Researchers can match the technology without relying on a CAD/CAM technician
with materials that are suitable for use in or denture technician. The related data
dentistry. In depth dental material research can be stored in a knowledge base which
can be undertaken for better solutions. can be retrieved as and when required to
speed up learning for professional
excellence of dental experts.
With more interdisciplinary
research, dental laboratories can have all
implants digitally manufactured with 3D
printing more consistently and at a

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