Shakespearian Hamlet’s dilemma may be transliterated into what troubles the modern orthodontist.The shift to 3D orthodontics is accelerating and while the scanner is the first, obvious, purchase, many colleagues, including me, face the doubt if to buy or not a 3D printer.It seems that if you don’t have a 3D printer, you cannot really close the digital circle. It’s like being partially out of the game.

I am 35 and in the last 10 years I collected several appliances / pieces of technology that are now lying somewhere in a drawer. They have been enough to make me a less enthusiastic and naive buyer. That’s probably why I still do not have a 3D printer.Before evaluating the different options available on the market, I asked myself when and how much would I use a 3D printer?In a previous post, I described my global digital workflow with manufacturers from all over the world from Europe to Asia, passing from America. The production of aligners, braces, intraoral appliances is guaranteed through highly technological companies and products. They are pretty costly, but they guarantee a service that asks a moderate amount of my time (which I consider the most precious and costly entity). In fact, the only time that I have to invest is into approving the setup, for those company that need doctor approval (Insignia, Invisalign, etc.).

In fact, I do not need a 3D printer to run my practice

There is only a special scenario where I would enjoy having it: when I debond motion/carriere appliance and I take impression for a new set of aligners. In this specific case, I want to have an essix retainer to hold the position acquired by CLII/CLIII correction. At the moment, I take an alginate impression and my next-door technician deliver me the appliance for the next day.By having a small to mid-size office, I think it's really not worthy to invest a lot of money into a 3D printer at the moment. It’s not only a matter of money invested, but to me it’s more a matter of time.

The time of production, curing, cleaning of the printed models apparently varies a lot between the different brands and it’s somehow inversely proportional to the money that you invest into your 3D printer. Are 2-3 hours per model worthy a 4’000 to 5’000 USD printer? How much more would you invest to have something quicker? And what if your printer gets stuck? Do you need to have at least two printers for each office?Before to print you need to prepare the model for printing. Depending if you wish to use a free software or a yearly licensed one, this time may vary a lot. Whose time will be spent into preparing models? The technical skills needed to effectively manage a 3D software are in a way higher than those needed to pour stone models.What seem completely natural to new generations of orthodontist born in the 80’s and 90’s, may be not that intuitive and natural to our assistants, that are mainly women. I do not want to be sexist, but it was much more common for boys rather than for girls to spend plenty of hours playing video games while we were in our teens. This was an unconscious training to be ready to a digital world. I do not read any paper / intervention from our gentle sex colleagues regarding 3D printers. It’s like with LEGO, it’s universal but much more likely that boys get crazy about that, rather than girls.Why do I insist on this topic? As it won’t be you managing the complex digital workflow behind 3D printing, otherwise it's not such a money saving investment. If therefore, you are in need to hire a high-tech employee to manage all this stuff, well part of the money you save for in-home production is already gone. I do not think that this task ca be easily delegated to the average orthodontic assistant.Last but not least, to delegate you need to learn how to manage software & hardware. The last number of JCO (January 2018) was completely dedicated to 3D printing. That helps to get a rough idea of the topic thanks specially to Dr Christian Groth and Dr Neal Kravitz who are highly active on the web to educate pals on 3D printing, together with Dr Scott Frey on his Orthocosmos blog. By the way, at the moment you have to struggle to educate yourself to master an effective digital 3D printing workflow, and if you do not have a sound high tech base you are technically out of the games.It means a lot of effort and a lot of time (!!!) to be able to turn an enthusiastic purchase in something really useful for your practice. Unless you treat a lot of i7/lite equivalent case, so that the high volume of in-house aligners could represent a good return on investment.

I know when I’ll buy a 3D printer

It will be when we will have FDA/CE approved printable materials that will allow us to directly print appliances and aligners, without the need of printing a dental model. The classic dental technician will disappear to leave the field to the “appliance designer”, a new professional that do not even need to produce the appliance but just design them. He will conceive the digital design according to the orthodontist’s indications and he’ll send us a file ready to be printed or remotely launch the printing process from his office far far away.

Is this fiction? I hope not and I am looking forward for this moment to come.Hopefully much faster that what I think.