Mr Fraser, in dentistry, we have been experiencing a boom in 3D printers for a few years now. We understand that you use Primeprint Solution. Could you tell us how this printing system fits into your workflow?
I use it primarily for models and splints. I’ve done some other things with it as well of course, such as printing in castable resin for partial frameworks. But, by and large, it’s a workhorse for splints and models right now for me. The majority of cases that come through the laboratory require the printing of models. Clinicians also benefit from the printing of surgical guides, and sometimes they will want a custom tray for impressions for a variety of reasons. In the future, denturists will benefit because Primeprint will be able to create and print dentures entirely using Lucitone Digital Print.

Furthermore, it often seems that difficulty is associated with quality of execution. Specifically, if it is hard to achieve, we think it must therefore be good. However, life with Primeprint has challenged and defeated this old belief for me. Simplicity and high quality can, and do, coexist. With Primeprint, we find a collaborative but seamlessly integrated solution that was designed for dental applications from the ground up. Therefore, in concept and design, Primeprint differs vastly from other competitors in the dental landscape, as the technology is dentistry-specific and not the result of existing technology taken from different fields and reworked to serve a new purpose.

“With Primeprint, we find a collaborative but seamlessly integrated solution that was designed for dental applications from the ground up.”

In my opinion, one of the best things about the Primeprint workflow is the ease and joy of using the CAM software. With the CAM software, the user is treated to an intelligent process that aids him or her in expediting the positioning and support of the device while being easily customisable. The whole process is designed to work. That makes using it a delight for me, and it’s fun watching people whom I’ve trained, even the technicians in my own laboratory, when they get the idea behind it. The light of understanding quickly switches on as they grasp how helpful the software can be. It’s a time-saving device. It’s enjoyable to use. It’s predictable in its result. And beyond everything else, it’s the safest printer to use on the market. 

Compared with other 3D printers, how is Primeprint Solution different?
I started 3D printing in 2012 when the technology was still very new. Since then, I’ve gone through the various different evolutions of printers. At the laboratory, we have tried not only different printers but also different printing technologies, such as PolyJet and digital light processing.

Although we could use these other systems for dental purposes, they were not developed specifically for dentistry. We had to learn how to utilise printers that were developed for other industries for our own purposes. That left much to be desired. Another problem with these other printers is exposure to resins to the point where I actually developed an allergy. I appreciate that I can work with Primeprint all day long—and I do—without having any issues. Primeprint has become the broker of safety, protecting the user from the dangers of unpolymerised resins. The safety considerations found in this solution are not by happenstance but by design. Your health and that of your staff is important to Dentsply Sirona. The industry-leading technology found in the Primeprint line of products is direct evidence of that.

How much does speed matter for you?
Speed is really an indicator of efficiency, and that translates into time invested and ultimately cost. Though individual pieces of technology have price tags, the most expensive thing in any laboratory or practice is labour. At times, we fixate on the speed of a specific aspect of a workflow and ignore the other pieces. I have found in the dental industry that often one competitor will only mention a singular point and ignore the other 90% of the process in order to best argue for its product’s supremacy. To me, the only interesting or relevant way to compare workflows is through the entirety of the procedure—from beginning to end.

Devaughn Fraser has worked in the health industry for 20 years—17 specifically as a technician and as the director of Highland Dental Laboratory. (Image: Devaughn Fraser)

Furthermore, when we consider a comprehensive restorative process involving scanning, design, printing and milling, it is also of interest to note the element of efficiency, which is an important part of the Dentsply Sirona ecosystem. There is a level of dental intelligence in that the restorative process is simplified, there not being any redundant processes. By streamlining the process, time is maximised, frustration is diminished and enjoyment follows. Yes, making teeth is fun!

Dentsply Sirona can be characterised by something that “just works”. Much like with a symphony, the dental professional, like the conductor, can take these individual instruments and seamlessly blend the software (CEREC, inLab), hardware (Primeprint, Primescan, inLab MC X5 and MC XL) and materials (blocks like CEREC Tessera and CEREC MTL Zirconia as well as Cercon discs) into a masterpiece.

It is often said that “time is money”. In both the dental practice and the laboratory, this remains true. If we can expedite production, we are investing less labour in it and making every unit we produce less expensive as we achieve efficiency. The more pieces we scan, design, print, mill and finish, the faster we become and the cheaper it gets through specialisation. To take this even further, when we consider Primeprint Solution, it does not require the constant babysitting that other printing systems require. The processes of printing, multi-vat washing, drying and light polymerising only require the operator to return to the Primeprint Box once during the process, instead of the constant parade that is consistent with competing systems. This all-in-one approach frees the operator to perform other critical tasks while leaving the printer to do what it specialises in. Primeprint Solution enables us to maximise the use of labour.

With some of the other printers I’ve used, I’ve had to design in one type of software and then send the design to different CAM software that speaks to that particular printer. After printing, somebody has to clean off the excess material, remove the supports, put the product into an alcohol bath, clean it, put it into another ultrasonic bath, take it out and light-polymerise it. One has to figure out how many light flashes to use and to know whether the light used actually corresponds to the directions for use from the manufacturer. How do I know whether it’s completely polymerised? The user has to find these things out. Are different users doing all of these things consistently? All of these things take time, and a person with very specific knowledge has to be involved to do or check these steps.

“Primeprint has become the broker of safety, protecting the user from the dangers of unpolymerised resins.”

With Primeprint, we just press “start”, and when it’s finished printing, we remove the Primeprint Box, put it into the post-processing unit and press “start” again. Anybody can do this, which frees my technicians to do what they are really meant to do—highly technical steps in the finalisation of the production process. And that increases their job fulfilment. Primeprint is a great example of something complex that is executed with simplicity. This is how you want to do dentistry.

Finally, fewer and fewer dental professionals are true technology enthusiasts who delve deeply into a particular technology. People just want their machinery to work. That is one of the reasons that DS Core is so helpful. Working with a cloud-based solution, we don’t have to be technology experts anymore. Everything is updated automatically, and since it is an open system, you can collaborate easily with other clinics, specialists or laboratories.

One of the functions of DS Core is DS Core Create. One particular feature of DS Core Create allows a dentist to scan the patient and to send the scan data through DS Core for ordering the design of a model, surgical guide or whatever else is required. So, there is nothing needed for the dentist to do after scanning. Once the scan is finalised, it is automatically transmitted to DS Core’s order portal and awaits the clinician’s commission. From there, the dentist can expect to receive, according to the requested deadline, a highly sophisticated design from a technician with appropriate training and sophistication. This is DS Core Create.

Do you see limitations for 3D printers in dentistry?
The vast majority of what we do restoratively, whether in a clinic or in a laboratory, is done through milling or grinding, and there isn’t anything that can replace that yet. Most restorations that go into a patient’s mouth are made using a milling process because of the materials used, such as zirconia or a glass-ceramic like CEREC Tessera.

I have seen some people using 3D printing with what they refer to as permanent crown material; however, the shade remains inadequate. The materials that I would use to mill restorations, especially temporary crowns, like multilayer PMMA, are stronger and more pleasing to the eye than what is currently on the market for printing.

In my opinion, there is undoubtedly interest in this, whether for use as long-term temporary crowns, or as temporary crowns on implants that have to last five and six months. But currently, from a materials perspective, there is nothing in the printing realm comparable with milling in terms of ceramic crowns. Nothing looks like it. Nothing is as strong. Nothing prints or finishes as fast.

Additionally, a restoration can be milled quickly, whereas a 3D printer would take significantly more time when you include the processing and post-processing. I would much rather use my printer to do the things it does best.

Editorial note:

More information can be found at www.dentsplysirona.com/primeprint.