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
Distalisation
· 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
Software
· Appliance designer 3 shape
· Orthoapp Onyx Software
· Exocad – Aligntech
· Mexmixer – opensource
Material:
· 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
