Digitalization and additive manufacturing at the forefront of dentistry
Dentalklinik Dr. Tóka dental practice has been providing outstanding service to its patients since its inception. Thecompany, located in Sopron, now has one of the most advanced dental technology labs in the country, which is also equipped with a Stratasys DentaJet 3D printer .Weimportance ofthe andtheintegration of technologies into dentistryto Tamás Egresits.
Pleasea, introduce your business and what you do
The company was started in 1987 in a small one-chair clinic by Dr. József Tóka. During the change of regime, many people opened private practices, but few have grown as much as this clinic. We currently have 96 employees, of which 54 are strictly patient-oriented, while the others perform dental technician and administrative tasks. Currently, we have nearly 20 clinics providing continuous patient care. We have 6 dental technician-framing colleagues, who deal with the design of metal frameworks and monolithic zirconia restorations, which are later covered by ceramics and painting. 4 ceramic colleagues customize and paint the finished restorations, there are also 3 prosthetic colleagues who deal with classic, removable dentures, a laboratory manager, and 2 engineer colleagues – including me – who are solely responsible for production. Our task is to search for new technologies and manage the production process.
When werefirstdigitaltechnologiesthe company?
The company has always had an innovative approach, we liked to try out the latest technologies, with all their positive and negative effects. We had the first dental milling machine available, which was a 3+1-axis CNC. We milled metal frames with it – as we just managed, since it was difficult to use – but fortunately this technology has developed significantly. There are few places in Hungary where patient care is provided under one roof at such a level and with such modernization, and of course, a dental laboratory of a similar level can be found next to it, with a high-tech production line and machines. We constantly visit world exhibitions, we look at all the new things. Since the doctor is very innovative, he always makes such investments if he sees an opportunity in it, and such investments usually have a positive outcome.
From what perspectiveisdifficultsuch an investment?
It is always difficult to be the first. When a new machine or software is released, even the dealer or manufacturer does not know exactly how dentistry will use it. These are usually solutions that trickle down from the industry and are sold to dental technicians, thinking that they will definitely work there too. We have been down this road a few times. For example, we had industrial milling machines that we used to machine titanium. The three 5-axis machines were converted for us to meet the needs of dental technicians. Programming was also in its infancy, and we used industrial software for that too. Over time, these solutions became simpler, and countless users now use dental CNCs. Nowadays, this is no longer as unique as it used to be. After a while, metal cutting was replaced by 3D printing, so we replaced 4 milling machines with a single metal printer, and although it took us half a year to learn how to use it, it has worked perfectly ever since.
How common is it in the country for a dental laboratoryto have such a well-equipped facility?
Similar technologies are used in several parts of its units, but larger labs typically have at least one CNC. There are milling centers that operate with a larger number of machines, even ours, but I don't know of any other dentistry in Hungary that is as complex and advanced as this, which provides patient care in such a high quality and with such a technological background. I think we are unique in that we implement the two areas together, in-house, at such a high level.
:The application of this kind of technology requiresin industry, even. How can this be transferred to the medical sector for this to be foundthe human capitalneeded?
Dr. Tóka was always forward-thinking, not only thinking about dental technicians, but also about designers. He hired me, who came from an industrial background, 8 years ago. I knew how to design in 3D, I understood CNC, but I didn't even know what dentistry was. That's when the dental technicians working here, sometimes with 30 years of experience, came into the picture, and they taught me this profession, so to speak, combining engineering and dentistry.
Aren't there similarhybrid knowledgeprovidecoursestraining?
Basically, we don't find people with such a school education, dental technology training is very limited to even classical technology. Now universities are also starting digital dental technology courses, but recently there has also been a trend where people coming from the industrial side are starting to infiltrate dental technology, because we need to help each other. It's teamwork in that sense, which I think works well. Young people are already interested in the matter, we also have younger colleagues who no longer want to work with wax because they see the potential in the digital world, but the older ones need a little help, they have a harder time getting used to it, so the generation gap is very noticeable.
What technologiesdo you use every day at work?
We have 6 zirconium CNC mills, three DLP 3D printers, one PolyJet printer, and one metal sintering machine. Speaking of digital manufacturing, it is important to note that we also have 7 digital CAD/CAM design stations, as well as 5 3D scanners, which we use to scan classic plaster impressions. In addition, we already have 7 digital oral scanners, which have actually replaced the classic process and have made us completely digital. As far as I know, we have taken the most digital impressions in the country so far.
What does a treatment process look like, say, in the case of dental restorations, and how does additive technology help with this?
The digital process at our clinic consists of scanning the patient's teeth with an oral scanner during their first visit and archiving them. If the patient needs an implant, we plan the implant positions based on their CT scan and digital impression and print an implant drilling template in 3D for the surgery. Since we already know the position of the implants in advance, we can also make a temporary denture, of course with a 3D printer. The patient can leave with teeth immediately after implantation. If the teeth need to be polished, a digital impression is made after polishing. For this reason, there is no need to bother with taking a plaster sample, because the 3D model is already visible in the software. The colleague designs the denture, which we can immediately print in a short time with a 3D printer. The Stratasys printer makes one model, the other a plastic denture, and the patient leaves in the afternoon with a so-called trial bridge, which he can try on for a week phonetically, aesthetically, can see the shapes and how much he likes it. He can eat with it, talk to it, and then when he comes back, there is the possibility of making changes during the consultation. In this case, another trial bridge is made and when everything is perfect, we make the final denture out of zirconium or metal. The fact that we have switched to digital impression taking in 80-90% made it necessary to purchase a high-performance 3D printer. Our DLP machines basically print very quickly, but to service them, a person practically had to stand next to the machines constantly, to perform the removal, replacement, and start-up. That is why we were looking for a large-format printer that met our expectations. That is how we found the Stratasys DentaJet machine, which we are very satisfied with.
Whyyou chooseVarinex andthe Stratasysmachinedid?
We already knew them and of course György Falk. We have been in contact with them for a long time, and now we have managed to get this investment under way. In the case of the DentaJet machine, they were chosen because it can be manufactured cost-effectively and has an extremely large production capacity, and for us these were the two key factors that made this machine win over the others.
How does the technology work?
DentaJet , machines Stratasys' PolyJet the printed objects pass under a UV lamp, which solidifies the material layer by layer, thus obtaining the desired bodies. The advantage of this is that there is no solid support material that needs to be broken, for example, in the case of a DLP printer. PolyJet uses a support that can be easily removed with a high-pressure washer. Another advantage is that we can print any surface or cavity, even one that bends into itself, since the support material completely surrounds the object. It also does not require post-treatment, which cannot be said of DLP, which also requires alcohol washing and solidification. Compared to DLP, however, PolyJet is slower in speed. This was not a negative factor for us because quantity and independence were more important to us. It does not require constant supervision, so it can operate at night, thereby replacing the work of a person.
How durable are printed objects?
Temporary dentures are typically in the patient's mouth for a week, so I can't comment on their durability for longer than that. In addition to this, we also print trial dentures, which we use in the office during the so-called smile design. This way, in addition to the digitally designed images, the patient can also see in their own mouth what the final result will look like. Currently, Stratasys for so-called Try-in works, which can be in the patient's mouth continuously for two days. The so-called TrueDent material, which is currently unique on the market and is suitable for printing personalized, colored gum and denture models, which can remain in the patient's mouth without restrictions. This material has recently been approved in Europe, so we don't have it yet, but it could be the next big step towards almost instantly ready dentures.
CNC: Howlong has the machine been in use?trainHow long did it take to install and?
We have had the machine for about 10 months. Anyone who has used similar additive technologies can learn how to use it in an afternoon at most, as it is extremely user-friendly. The machine was chosen mainly for its productivity, as we saw the volume of digitalization in this sector, which DLP technology could not serve to a lesser extent. Initially, we started the machine with only half a tray, but now even one tray is not enough, which also shows that we are developing at an extraordinary pace in this field.
What are yourfuture plans and directionsdevelopmentfield?
Our current goal is to utilize artificial intelligence. We are testing software that helps with manufacturing and CAM design, print orientation, support material placement, trajectory optimization, using artificial intelligence. We are also trying to utilize AI at the design level, and there are already programs for this that are developing at breakneck speed. Some software can design complete crowns, correct the patient's incorrect bite, and can digitally find the superposition of the jaws that is correct in reality. Based on the natural wear of the teeth, it simulates chewing movement, which movement we can take into account when designing the denture. So we want to develop in this direction from the software side, and from the hardware side, the goal is to acquire a full face scanner, which will allow us to connect the digital mouth scan with the digital smile design using the CAD program. This will make it easier for the patient to see the final result.
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The article was prepared by CNCMédia Kft. and originally published on cnc.hu.
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