3 D PRINTING & MICRO GUIDED ACCESS

• 3D PRINTING DEFINITION

• TYPES OF 3 D PRINTERS

• MATERIALS USED IN 3D PRINTING

• APPLICATIONS OF 3D PRINTING IN ENDODONTICS

• GUIDED ENDODONTICS

• GUIDED ENDO.SURGERY

• AUTOTRANPLANTATION

• TEACHING & LEARNING

• RECENT ADVANCES - 4 D PRINTING

• BIOPRINTING

• LIMITATIONS
CBCT - Accurate data & less radiation

Open sourcing software

Digital imaging & communication in medicine - DICOM

Capability to use DICOM files with CAD-CAM

Data converted to STL prior to CAD-CAM

STL file local / distant fabrication

(Endodontic application in 3 D printing-Julie Anderson)

 TYPES OF 3D PRINTING

• stereolithographic apparatus - S L A

• fused deposition modelling - F D M

• multijet printing - M J P

• polyjet color printing - C L P

• Digital light processing - D L P

• selective laser sintering ( S L S ) / selective laser melting ( S L M )

• Acquisition of images for 3 D printing - CBCT

• Medical images exported - modelling software

• Positive space models - actual hard-tissue anatomy

• Negative space models - intervening space next to +ve space

• Modelling software - Mimics, Amira, Rhino, Surgicare, ITK-Snap, InVesalius & 3D Slicer

• Printing software - 3D Systems, Solidworks & Alaris

• Charles Hull invented 3 D printing (1984)

• Stereolithography(SLS) - printing of materials on top each successive layers - 3 D object

• Hideo Kodama - rapid prototyping (1981)

• Fused deposition modeling(FDM) - extruder & plastic and layers deposited on a print bed
Materials used in 3D printing

• Fused deposition Modelling - thermoplastic polymers

• Polylactic acid - PLA

• Acrylonitrile butadiene styrene - ABS

• Polycarbonate - PC

• Polyether ether ketone - PEEK

 1. Stereolithography (SLA) - resins for photopolymerization, ceramic filled resins

2. Selective Laser sintering (SLS) - powders like polyamide, glass particle filled polyamide, rubber
like polyurethane

3. Polyjet printing - variety of photopolymers

4. Bioprinter - Cell loaded gels & inks based on collagen, photopolymer resins, alginate, hyaluronan,
chitosa

Bioprinting

• 3 D fabrication technique - prints complex tissue constructs using hydrogels loaded with cells & print

• Potential to generate transplantable soft tissues, bone, cartilage

• Complex structures - layer by layer addition of materials

• 4 D - materials change shape, colour, bioactive/ intend to perform function in response to external stimulus

• Tissue engineering - patient specific scaffolds

• Guidance cues printed - extent & rate of tissue regeneration

3D PRINTING IN ENDO

• GUIDED ENDODONTIC ACCESS

• SRUGICAL GUIDES

• AUTOTRANSPLANTATION

• EDUCATION MODELS (Teaching & learning)

• CLINICAL SIMULATION

• RESEARCH
GUIDED ENDODONTICS

A New approach for localizing & negotiating obliterated root canals

LIMITATIONS OF GUIDED ENDODONTICS

1. SUITABLE FOR ANTERIOR TEETH & STRAIGHT canals

2. SIZE OF THE BUR - HEAT GENERATION

3. CRACK FORMATION

4. CBCT - RADIATION & METAL ARTIFACTS

5. MOBILE TEETH
TECHNICAL DIFFICULTIES

Prohibitive cost

Substantial learning curve

Diverse product availability with little clinical testing

Accuracy of 3 D printing
39
 Computer Assisted Apicoectomy

• Navident dynamic navigation system

• System allowed precise localisation of the root & precise apicoectomy with minimally invasive cavity

• Non-experienced operator to precisely perform - minimally invasive osteotomy & root end resection

3D PRINTING IN RESEARCH

• Shaping ability of files (Orlando Zapata.et.al)

• Obturation techniques in C canal (Gok.et.al)

• E.Faecalis on SLA material ( Mohammed.et.al)

EDUCATION MODELS & CLINCIAL SIMULATION

• Tooth prototype - simulation exercises

• Extracanal invasive resorption ( Kim.et.al)

• Molar with 3 distal roots ( lee.et.al)

• Type III dens invaginatus (Kfier.et.al)

• Regenerative endodontic study models

3 D PRINTED MODEL FOR HANDS ON TRAINING IN DENTAL TRAUMATOLOGY

• Practical & inexpensive

• Highly realistic & useful instructive hands on training

• Difference between the groups significant

• New possibilities for training in treatment - difficult to simulate

3D BIOPRINTING

• Sequencing biological materials - cells, biomolecules -fabricating tissue like constructs

• Scaffold free cell aggregates, biomaterials laden with cells

• Biocompatible resin (NextDentSG,3D systems,Netherlands)

• 3D Printed scaffolds with MTA & Biodentin

• Enhanced differentiation of human dental pulp stem cells in favour of osteogenesis

• Anatomical Scaffolds (22 incisors, dorsum)

• Rat Incisor scaffold & human 3 Molar scaffold

• 80% Polycaprolactone +20% HA

• 3 D microstrands & interconnecting channels(200 microns)

• Cocktail of SDF1+BMP7(100ng/ml)

• Putative PDL & new bone - rat incisor(9 weeks)

• More endothelial cells & angiogenesis - scaffold

 CAR
T
A APICAL MICRO
SURGERY
A AUTOTRANSPLANTATION

A ANOMALOUS
TEETH
C CALCIFIED
CANALS
T TEACHING &
LEARNING
R RETREATMENT &
RESEARCH