3D Metal-printed Bone Borne Appliances Simon Graf. AAO June 2021. Episode 94

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Hosted by
Farooq Ahmed

3D Metal-printed Bone Borne Appliances Simon Graf



Virtual planning

·      2 step

o   1/ TADs inserted

o   2/ Impressions taken lab design

·      1 step

o   Place TADs with positioning splint and appliance


Simon Graf usually uses 2 step process, less overbearing for patients




Scanning TADs in the palate – scan issues as they struggle due to undercuts not captured, causing a distortion of scan of implant, if the scanner cannot recognise the border = scanner will delete the TAD

·      Solutions

o   Powderspray in undercut to the TAD – smooth to scan

o   Lab use digital analogue = superimpose


Hyrax appliance

·      Custom made bands

o   Tip – bonding is very good, create thin point to aid cutting and removal

o   Hyrax screw: digital file to design

o   Implant connection = ring around the TAD




·      C shaped bands on 6s

·      Plan distalisation

·      Can plan for intrusion as well


Distalizer Vs distal-slider

·      Distal slider = negative effect of buccal tipping

·      Simon prefers distaliser 1 direction of movement




·      Appliance designer 3 shape

·      Orthoapp Onyx Software

·      Exocad – Aligntech

·      Mexmixer – opensource



·      Denaurum

·      Co-Cr

·      Very stiff, cannot bend


Machine Conceptlaser

·      Not efficient for in house, currently sending to lab


Additive manufacturing

·      Selective laser melting

o   Simon uses

o   Small metal particles are joined, no space inbetween

·      Selective laser sintering

o   Metal particles not touching, only close together

o   Sintering results in shrinking and eliminates the gaps

o   Source of error , software can plan shrinkage

·      Binder-jetting

o   Particles are not in contact, glue is used and removed

o   Can cause shrinkage

o   Easier to manufacture than Selective lasering


Supportive sticks – reduce manufacturing error, place on non-fitting surfaces


Electrochemical polishing recommended, not hand polishing takes a long time!

Graf 2018 AJODO CadCam design and TADs


Graf 2017 AJODO


Distalisation rate

·      2 x per week 0.2mm per turn

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