How to Move from Analog to Digital Dentistry

No two dental cases are the same. Patient anatomy is unique, and each treatment is tailored, enabled by a long history of custom, human-centric craftsmanship. But, as with any trade, quality is dependent on the skills of a given dentist, orthodontist, assistant, or technician, and achieving consistent, high-quality, affordable dental products with so many potential sources of error is incredibly difficult.

Digital dentistry reduces the number of steps and, therefore, the risks and uncertainties introduced by human factors, providing higher consistency, accuracy, efficiency, and precision at every stage of the workflow. 3D intraoral scanning removes many of the variables associated with taking a traditional impression, giving dental technicians more accurate data to design from.

Dental and orthodontic CAD software tools provide visual interfaces similar to traditional workflows, with the added benefit of being able to automate certain steps, as well as easily identify and fix mistakes. 

Digital manufacturing equipment such as 3D printers or milling machines deliver a range of high-quality custom products, prosthetics, and appliances with superior fit and repeatable results for fewer errors, lower costs, and increased clinical performance.

One of the most significant benefits of digital technologies is improved patient experience and comfort. A satisfied patient is more likely to follow treatment plans, return to a clinic, and recommend it to others, contributing to the long-term success of a practice.

Digital technologies improve the workflow from diagnosis to planning to treatment. Intraoral scanning is faster and substantially more comfortable than regular impressions, while Cone Beam Computed Tomography (CBCT) scanning adds a new dataset to assist in planning for implant surgery or further diagnosis in orthodontic treatments. Virtual treatment planning and appliance design enable less invasive treatments and better-fitting prosthetics. Digital tools also simplify communication between the dentist and patient, and the practice and lab, allowing for immediate data transmission and worldwide reachability.

3D printers can create temporary or permanent prosthetics chairside, so there’s no need to wait when presented with an urgent case. If replacement aligners or occlusal splints are needed, patients can quickly be presented with the appliances they need, removing potential gaps in treatment plans. Same-day and chairside delivery of appliances became possible thanks to digital production methods and technical developments. As a result, digital dentistry makes for reduced chair time, faster treatments, and higher acceptance rates, all with scientifically proven, superior clinical outcomes.

The dental industry is going through rapid change. Practices and labs that delay adopting new technologies risk falling behind their competition and leave money on the table by over-reliance milling centers and outsourced providers.

According to a 2022 survey by the Journal of the American Dental Association (JADA) 17% of respondents currently use a 3D printer, 67% of whom have been using it for two years or less. Adoption of 3D printers by practices is rapidly increasing as dental professionals look to control workflows, improve efficiency, and reduce costs and lead times. 

Labs have an even higher adoption rate. A survey of more than 215 dental labs in the US by Key Group inc in 2022 found that 57% (up from 45% in 2020) of dental laboratories in the United States have 3D printing technology and 66% are planning to purchase or lease a 3D printer in the next 12 months. The technology adoption is partly driven by the need to cater to dentists. 

In a transnational study published in the International Dental Journal in 2023, more than 78% of respondents, all dental clinicians, utilize an intraoral scanner to take impressions. This represents significant opportunities for dental labs. Accepting digital impressions cuts out the lengthy shipping time for physical impressions, which can be distorted during the trip. As a result, digital labs can service clients in a wider geographical area or specialize in certain products.

Like traditional dental and orthodontic product fabrication, digital production starts with the patient’s individual anatomy. 3D intraoral scanners can be used in the dental or orthodontic practice to capture fast and accurate digital impressions from the patient, replacing manual impressions. Alternatively, desktop optical scanners in dental labs can be used to scan traditional impressions or plaster models. For treatments and applications that require patient osteotomy, such as surgical guides for implant placement, an additional dataset needs to be collected using CBCT scanners.

For complex rehabilitation cases, extraoral and intraoral photography and facial scanning provide further data to create highly accurate digital patient files. 

Recommended tools: 

• For a dental practice: 3D intraoral scanner, CBCT scanner (optional), facial scanner (optional)
• For an orthodontic practice: 3D intraoral scanner
• For a dental lab: desktop optical scanner

After scanning, patient anatomical data is imported into dental or orthodontic CAD software for planning treatments and designing prosthetic or restorative appliances, mock-ups, and models. For simple diagnostic models, you can also convert intraoral 3D scan files directly into printable dental models using Scan to Model in PreForm Dental, Formlabs’ print-preparation software. 

Most software packages use design processes very similar to traditional methods, employing highly visual interfaces with features like virtual articulators that are familiar to dental technicians. Digital design results in easier, more precise treatments and simplified communication. After the treatments are designed, models can be exported for printing. If a remake is needed, the same digital design can be reprinted.

Dental and orthodontic digital design services have also proliferated in recent years, empowering any dental business to get started easily without design knowledge.

Recommended tools:

• Dental or orthodontic CAD software, or design service
• PreForm Dental (free)

To manufacture an appliance, 3D models are uploaded to the CAM or print-preparation software and then sent to a 3D printer or a milling machine. 3D printers are common in both dental labs and practices and can produce appliances for a variety of indications.

3D printers work by solidifying parts (via photopolymerization) layer by layer to form the shape of the appliances and models. To create orthodontic appliances like clear aligners or retainers, thermoforming or other techniques are applied to the 3D printed models. 

Milling machines are more common in dental labs, but also have some limited applicability to the dental practice as well. These are typically used to create final restorations and dentures by using burs to subtract material from a solid block of material, such as PMMA or zirconia. 

Recommended tools: 

• For a dental practice: 3D printer
• For an orthodontic practice: 3D printer
• For a dental lab: 3D printer, milling machine

With a traditional workflow, a dental practice takes a physical impression of the patient and ships it to a dental lab that creates the required models, restorations, or other indication(s). The lab then ships the final parts or appliances back to the practice for treatment. If there are mistakes in the physical impression or the fabricated appliance, additional time must be added to the process, including adding additional patient appointments. 

In digital workflows, the individual steps can alternate easily between the dental lab and practice depending on the complexity of the case, the indication, the tools available at a practice, and other conditions. 

For example, a dental practice can take a digital intraoral impression and instantaneously send it to a lab, or send a manual impression for scanning at the lab. Alternatively, a dental practice can use a digital impression to design the models, restorations, and other indications in-house in CAD software or outsource design to a lab or design service. A practice can then manufacture simple parts such as models, surgical guides, occlusal splints, or models for thermoforming in-house and rely on a lab for complex parts such as all-ceramic restorations. Labs can manufacture parts in-house with 3D printing or milling or offer design as a service and send the design files to their customer for 3D printing in the dental practice. 

Overall, digital technologies simplify the workflow between the dental practice and lab, offering unlimited freedom to optimize for speed, ease of use, or cost, depending on the case.

Transitioning to digital dentistry and orthodontics doesn’t need to happen all at once. Start with the easiest 3D printing workflows first, build your team’s expertise, and gradually add new applications to avoid unnecessary risks.

The best place to start is with diagnostic models. These are the easiest parts to 3D print because they don’t require third-party design software to prepare a digital impression for printing. Formlabs Dental 3D printer customers can use the Scan to Model feature in the free PreForm Dental software to turn their digital impressions into physical models for free. These models can be used as diagnostic models or as a mold for thermoforming retainers or bleaching trays in-house. Additionally, the ability to 3D print models means you can store files, rather than physical models, freeing up valuable office space. 

If you want to start with something other than simple models, choose an application that is currently inefficient, unreliable, expensive, or in high demand. Splints are one such appliance and can be directly printed with biocompatible resins and post-processed for same-day delivery – all with minimal polishing.

Surgical guides or clear aligners also have simple, quickly learned workflows. Design can be executed in-house with design software, or you can outsource this step to a design service like Evident, Full Contour, or Digital Smile Design, and still do the appliance manufacturing in-house. Whatever you choose, start with a single use case and extend to multiple applications, while continuing to rely on labs for complex cases and final restorations for maximum efficiency and accuracy. 

For dental labs, 3D printers offer a variety of digital workflows. Professional 3D printers are incredibly versatile: it’s possible to manufacture a wide range of products on the same machine, just by switching materials. Explore the complete dental resin library and dental application guides to learn more about the versatility of 3D printing.

When you have a specific application in mind, piece together the complete step-by-step digital workflow for that application to make sure you understand all the pieces needed for scanning, design, and manufacturing, and how to time this for your practice or lab. 

Educational resources, including step-by-step workflows, are available online to help ease the process of learning new indications. Formlabs offers an extensive resource library and the Formlabs Dental Academy, a hub of free courses for learning and building digital dentistry skills. 

In a dental practice, consider whether it makes sense to invest in an intraoral scanner or you will be sending stone models or physical impressions to your lab for scanning. If you’re running a dental lab, consider whether you’ll only receive digital impressions from dentists or if you’ll need a desktop optical scanner to scan stone models or physical impressions.

If you’re planning to design parts in-house, make sure to get a demonstration of the workflow of any design software to understand the step-by-step process before adopting it. Then, select a dental software package compatible with the scanning and manufacturing equipment of your choice. The easiest way to do this is to stick with software that allows open importing of scan files, and open .STL file export, which ensures compatibility with all 3D printing solutions.

When considering manufacturing equipment such as milling machines or 3D printers, always source samples before buying equipment. Technical data and marketing specs can be misleading and hard to decipher. Instead of comparing sales brochures, compare actual parts — don’t hesitate to ask for a physical sample of the indication you’re looking to produce. There’s no better way to compare quality between two machines than holding the final product in your hand.

Once you’re ready to start, trial the workflow for a few weeks before moving to full production, leaving time to learn each step and iron out any wrinkles. As you get comfortable with the results, switch the workflow fully to digital, and start scaling up.

In digital workflows, scaling up can include adding scanning, design, or production capacity or expanding to more complex applications. Desktop 3D printers offer more production flexibility than ever before, with access to a library of resins – including biocompatible ones – that can easily be changed out for an agile production process.

When scaling up, adding printers can bring added benefits. A significant advantage of affordable desktop printers over larger, more expensive systems, is the ability to add additional printers for redundancy. Printers can also be devoted to specific materials. For example, one printer can print denture bases while another prints denture teeth, for even more efficient production. 

Offering a new product or service doesn’t have to be a difficult decision with a long-term return on investment. With digital dentistry, you can start small, see faster returns on investment, and scale up over time.