Digital Prosthodontics With 3D Printing: How Dr. Cacioppo Builds a Reliable 3D Printing Environment

Dr. Antonino Cacioppo is a digital dentistry expert who’s been 3D printing for almost a decade, and practicing digital dentistry since 2005. A dentist, private practitioner, and prosthodontist in Palermo, Italy, Dr. Cacioppo started out with a Form 2 3D printer, and currently uses 23 3D printers from different manufacturers, including all of Formlabs’ Form Series 3D printers for dental applications.

Each of Dr. Cacioppo’s printers is dedicated to a specific application based on his requirements for those applications and the parameters of the printers. The precision, accuracy, and reliability of Formlabs printers paired with the expansive material library have led Dr. Cacioppo to reserve Formlabs printers for biocompatible applications where high levels of precision and accuracy are needed. Printing surgical guides, occlusal splints, and both temporary and permanent restorations, Dr. Cacioppo is a 3D printing expert at the cutting edge of digital prosthodontics.

Dr. Cacioppo is a Formlabs beta-tester and KOL who started designing dental appliances for 3D printing in 2007. As an early adopter of 3D printing, Dr. Cacioppo has first-hand experience with the history of 3D printers and resins for dental applications. In 2015, he brought printing in-house with Form 2, saying, “Previously, 3D printers were not accessible, both due to their dimensions and costs. I started with a few models and with surgical guides.”

Models are the easiest application to print, but while surgical guides are also a good first application to bring in-house, they require highly precise printing to ensure the fastest, most successful procedures and outcomes for the patient. Most recently, Dr. Cacioppo has been printing on Form 4B with Surgical Guide Resin, a combination he says is “maybe the best I’ve ever used.”

Using Surgical Guide Resin on Form 4B, Dr. Cacioppo noted that he could not see the layers,  and that the transparency and hardness were even more noticeable compared to parts printed on Form 3B+. The sleeves, too, fit perfectly on the first try.

Not needing to finish prints saves valuable workflow time, translating to less labor, cost-savings, and the difference between multiple appointments and same-day procedures. The benefits go beyond these savings, making for less chairtime, more precise surgery, and a better patient experience. 

“Time-saving is absolutely important,” says Dr. Cacioppo. In his office, where multiple printers are working every day and all staff are involved in 3D printing, streamlined, efficient workflows are key. 

Unreliability in dental 3D printing means repeat prints, wasting time and costs. Tricky workflows take more time and are more likely to result in errors. Inaccuracies mean remakes, wasting time, material, and potentially lengthening treatment timelines. This is why having a printer, settings, materials, workflows, and support you can rely on is key.

But it’s not just about workflows: the final dental appliance must meet the exacting standards of dental professionals. When evaluating a new printer, Dr. Cacioppo puts it through a thorough testing regime to check accuracy, reliability, precision, and material quality.

Form 4 Series printers print with 95% of the surface within 50 μm of the CAD model, and 99% of the surface within 100 μm of the CAD model, for sleeves that fit in surgical guides, restorations with titanium bases, and appliances that fit every time.

The requirements of MDR in Europe mean 3D printing biocompatible parts is carefully regulated, and Dr. Cacioppo prints all of his biocompatible resins in one room — all on Formlabs printers: his original Form 2, three Form 3B 3D printers, one Form 3B+, and one Form 4B. He uses these Formlabs printers for surgical guides, temporary restorations, long-term or permanent crowns, bridges, and occlusal splints. 

Of these printers, two are for occlusal splints: one prints Dental LT Clear Resin (V2) for rigid splints, and one Dental LT Comfort, for flexible splints. Another printer is dedicated to printing surgical guides with Surgical Guide Resin, and Form 4B prints restorations with Premium Teeth Resin and BEGO™ VarseoSmile^Ⓡ TriniQ^Ⓡ Resin. 

Formlabs resins for biocompatible dental applications are manufactured at our FDA-registered facility in Ohio. These materials are designed and manufactured within our robust Quality Management System that is ISO 13485 and EU MDR certified. A dedicated team of operators and quality assurance professionals make the resins inside a certified ISO Class 8 clean room. All of our Medical Device Resins are appropriately registered with the FDA and CE-marked according to the EU MDR. 

These strict quality standards are important for Dr. Cacioppo, even more so since Formlabs’ resins are validated on Formlabs printers, giving him peace of mind, and making it easy to press print knowing the printer settings don’t require any troubleshooting or adjustment.

Premium Teeth Resin is a nano-ceramic filled biocompatible material for 3D printing of denture teeth, temporary full-arch implant-supported restorations (All-on-X appliances), temporary single units (crowns, inlays, onlays, and veneers), and up to seven-unit bridges. Dr. Cacioppo compares the appliances printed with Premium Teeth Resin as “More similar to the milled PMMA that I ever saw in my entire life. And trust me, the milling machine PMMA material is one of my favorite materials of all time — and, like me, maybe 99% of prosthodontists.”

The similarities of flexural strength and aesthetics between Premium Teeth Resin and PMMA make Premium Teeth Resin a “game changer” when printed on Form 4B. Unlike a milling machine, which can only manufacture one crown at a time, Form 4B can print an entire build platform of restorations in the same amount of time, and the speed of 3D printing only continues to improve. 

Dr. Cacioppo adds that “The supports are very, very easy to cut. They are smaller and I can choose five or six supports for each crown and everything else is clean.” This cuts down on post-processing time which, Dr. Cacioppo says, is “absolutely related to time management. All the procedures after 3D printing are related to your work, or an assistant, and time saving is absolutely important.”

Though Dr. Cacioppo has a fleet of 3D printers, he doesn’t produce all appliances in-house; the dental lab is still an important partner. Occlusal splints, surgical guides, and temporary restorations are all produced in-house, but about 40% of permanent restorations are still produced in a dental lab. Restorations made from zirconia, which requires advanced skills to mill, and final ceramic structures, which Dr. Cacioppo calls a dental art, are sent to the dental lab, to be manufactured by specialists. 

Dr. Cacioppo sees prosthodontists being more and more involved in 3D printing, managing all design and production of temporary restorations in-house, with highly specialized final restorations being produced by the dental lab. This gives prosthodontists full control and quicker turnaround on temporary restorations, for faster delivery which impacts patient care, while letting the dental lab specialists produce high-quality permanent restorations. 

With new dental materials becoming available indicated for permanent and temporary restorations, clinicians are slowly starting to 3D print these parts in-house for some of their cases. Dr. Cacioppo has been printing crowns, onlays, anterior bridges, and posterior three-unit bridges with BEGO™ VarseoSmile^Ⓡ TriniQ^Ⓡ Resin. Based on his use thus far, Dr. Cacioppo says it’s, “perfect for posterior implant crowns, for inlays, onlays, and overlays, and very good for long-lasting provisionals.” Additionally, he found the interaction with the cement agent to be advantageous.

“3D printing in the dental office, it's not possible if you own just one 3D printer,” says Dr. Cacioppo. While it’s easy to do material changeovers on Formlabs 3D printers, offices that are printing multiple applications a day will find it easier to have dedicated printers for each resin. 

“It's not related to the printer,” says Dr. Cacioppo. “But when, every day, you’re printing occlusal splints, temporaries, models, and surgical guides, your dental office needs more than one printer.”

Dr. Cacioppo relies on Dashboard to monitor and manage printers. “I love Dashboard because my secretary and my assistant know the printing time and if everything is okay. Lots of times I am out of my office for courses or congresses. If I want to print something, I can print even if I’m outside of my office.” Everyone on staff can track prints, get notifications about print status, and start jobs from anywhere. Dashboard also tracks material usage for seamless reordering.

The technology powering Formlabs Dental 3D printers makes printing easy and intuitive while empowering the production of a full range of appliances and restorations. 

Explore Form 4B to learn more or talk to a dental specialist to see how Formlabs Dental can help you produce quality dental appliances and restorations.