RESEARCH ARTICLE


https://doi.org/10.5005/jp-journals-10063-0045
CODS Journal of Dentistry
Volume 11 | Issue 1 | Year 2019

Three-dimensional Printing of “VANPERIO” Model: A Novel Approach in Periodontics


Sakthidharan Aswin Prasad1, Kharidi Laxman Vandana2

1,2Department of Periodontics, College of Dental Sciences, Davangere, Karnataka, India

Corresponding Author: Kharidi Laxman Vandana, Department of Periodontics, College of Dental Sciences, Davangere, Karnataka, India, Phone: +91 9620227317, e-mail: draswinpgt@gmail.com

How to cite this article Prasad SA, Vandana KL. Three-dimensional Printing of “VANPERIO” Model: A Novel Approach in Periodontics. CODS J Dent 2019;11(1):7–10.

Source of support: Nil

Conflict of interest: None

ABSTRACT

Background: In the field of medicine and dentistry, cadavers and skeletons were the study models for students for the past decades; and in the gradually advancing and transforming world, the role of cadavers and skeletons is almost replaced by synthetic mannequins and three-dimensional (3D) models.

Aims and objectives: Implementing the novel idea of 3D printing in the field of periodontics, we created a 3D-0 printed model of lower jaw, which illustrates simple to complex concepts and methods. This will help teachers and clinicians in explaining and demonstrating to the students as well as patients, which in turn will help students in understanding the concepts in a better way and create better patient awareness.

Materials and methods: The 3D printing of the “VANPERIO” model which was custom-built by 3D data with the help of a software and a 3D printer using the desired material used to demonstrate various presurgical, surgical, and postsurgical clinical issues.

Review results: The utility of 3D model in demonstration of oral hygiene methods, periodontal osseous defects, and its management may prove to be a promising option due to its resemblance to natural anatomy and ease of use, compared with the existing models like plaster and stone models/casts.

Conclusion: The model, a combination of traditional and modern approach, is a promising novel technique useful in academic and clinical field to create awareness among patients and better understanding for the students than the traditional methods available. The benefits availed from the model will prove to overweigh its cost.

Clinical significance: The use in academic and clinical field to create awareness among patients and better understanding for the students by demonstration of various procedures.

Keywords: Activities, Bone defects, Demonstration, Dental model, Patient education, Suture holes, Three-dimensional printing.

INTRODUCTION

In the field of medicine and dentistry, cadavers and skeletons were the study models for students for the past decades; and in the gradually advancing and transforming world, the role of cadavers and skeletons is almost replaced by synthetic mannequins and three-dimensional (3D) models.

From defense, aerospace technology, art, jewellery, cloth designing to firearms, 3D printing, an exciting technology, is gaining attention of innovative minds. It has been hailed as “revolutionary” in field of medicine and surgery by changing the face of manufacturing products for applied human sciences1 including the bioprinting of tissues and organs.

The 3D printing helps dentists worldwide in fabricating:2 customized implants and prostheses (surgical guides, stents), custom 3D-printed dosage forms and drug delivery devices, replace or repair a damaged tooth, create an orthodontic model (for designing a treatment of braces or Invisalign, to design an orthodontic appliance and print the end result in-house), produce crowns, bridges, caps, dentures, construct surgical tools (3D print the drill guides, customized retractors, pliers).

In periodontics, the idea of creating 3D scaffolds customized for the patients using 3D volumetric data like cone beam computed tomography (CBCT) have already been tried out. A study discusses the scope of using 3D scaffolding technique in combination with either biologics or cell therapies to create bioactive scaffolding systems for tissue repair.3 The 3D printing for education purpose has been attempted and presented in the paper.

Inception of VANPERIO Model

For two decades, as early as 1995, the natural mandible (lower jaw) was utilized for demonstration of artificially created periodontal osseous defects by the author, a senior clinician, and academician in the field of periodontics (Dr Vandana, senior professor). This natural bone model is an inspiration and basis for creation of 3D printed VANPERIO model @ Vatsalya inventures (www.vinvent.in) who bring importance to those simple inventions occurring in Indian scene to the global front.

Vatsalya inventures is an enterprise with over 40 inventions, multiple national and international awards, armed with 15 patents, bringing brilliant ideas to life. Vinvent has created D-cleft prototypes that were used in subsequent trials for feeding cleft palate babies and found more ease in feeding cleft baby.1

VANPERIO illustrates simple to complex concepts in periodontics and provides a platform for better demonstration of normal to diseased depictions in mandible to the students. The patient education and motivation through demonstration of actual bone loss due to gum diseases promote them for better acceptance of surgical concepts.

Although there are books and atlases depicting various pictures, the 3D models speak better than the two-dimensional pictures. So implementing the novel idea of 3D printing in the field of periodontics, we created a 3D printed model of lower jaw for the first time, named as VANPERIO which provides a platform for better understanding of osseous defects by students.

A Brief Description of the 3D Printer (Fused Deposition Machine)

The 3D printing is a process of depositing fine layers of material and depends on adhesion of each consecutive layer to the previously deposited layer. The material for 3D printing may be available as fluid, powder, or filament. The fluid or powder type of material is stored in a tank provided in the machine and each layer is activated to fuse with previous layer by selective laser sintering. When provided as filament, the temperature rise in nozzle is used to melt the filament which is then deposited over previous layers which act as scaffold to support and fuse with consecutive layers.1

The 3D Printing Procedure

Object (natural mandible incorporated with osseous defects) was scanned in every possible view by rotation of stage and a scaffold type of design was obtained by the end of cycle. Cycle can be repeated for further refinement. The stage tilts during rotation for better angulation of object. This assists the scanner in increasing its field of acquisition.

Once completely scanned, the design was loaded in designing software for stitching top and bottom surface scaffolds and single model was made, and Slicer software prepared a 3D design file into a printable file. Slicer software prepares a 3D design file into a printable file.

In fused-deposition type of 3D printing machine, supports are required for providing a platform for elevated parts of design, which were removed after printing.

The downloaded STL files were attached; and using the 3D printing software slicer, the 3D printing of the files to the model was initiated. Further selection of preferences can be made based on requirement. Fill density can be reduced per requirement to reduce internal deposition of material.

About 1,000 layers were printed from base to completion. Fill density reduction provided us cancellous bone type of pattern inside the model. Finishing and polishing of the model was done using sand paper, repairing holes with XTC-3D and a coat of prime, paint, or varnish later on which removes the surface irregularities.

The model was 3D printed “by v-invent” using fused-filament type of 3D printer with polylactic acid material, which is a strong, biodegradable, ecofriendly material derived from corn starch, compatible for intraoral uses too.

The layer-by-layer deposition helped us to incorporate the cancellous bony pattern, marrow spaces, and even interdental spaces between the teeth in the jaw model to mimic the natural mandibular anatomy and structure while fabricating various periodontal osseous defects, implant models in a white colored robust unbreakable body.

The purposes of the VANPERIO model are as follows.

Patient Education and Motivation

  • Demonstration of brushing techniques.
  • Demonstration of interdental brushing (Fig. 1A).
  • Demonstration of flossing (through the interdental space which cannot be facilitated in stone and plaster models) (Fig. 1B).

Figs 1A and B: Demonstration of interdental brushing and flossing

Student Demonstration and Activities

  • Demonstration of scaling and root planning (using sticky wax to simulate calculus deposit).
  • Demonstration of splinting (Fig. 2).
  • Demonstration of surgical steps (after placement of gingiva using cotton cloth) (Fig. 3).
    • Local anesthesia administration.
    • Placement of incision.
    • Reflection of flap.
    • Access to osseous defect.
    • Debridement.
    • Placement of osseous graft.
    • Placement of guided tissue regeneration (GTR).
    • Suture placement and closure of flaps.

Figs 2: Demonstration of splinting

Figs 3: Demonstration of steps of periodontal regenerative surgery

Figs 4: Demonstration of grade III furcation

PERIODONTAL OSSEOUS DEFECTS4

Figs 5: Demonstration of interdental crater

Figs 6: Demonstration of suture holes

Additional features that are appreciable in VANPERIO model.

The model, a combination of traditional and modern approach tried first time in the field of periodontics, proves to be useful in academic and clinical field to create awareness among patients and better understanding for the students compared to the traditional methods available.

The clinical utility of this model is being trailed in various prestigious institutions of India by experienced periodontists. The 3D printing technology has made the teacher within the VANPERIO model to travel silently and reach different needs of periodontal clinical issues for the first time.

The various teaching models available in the market are expensive and do not incorporate all the purposes that are present in the unique VANPERIO model. The benefits availed from the model overweighed its cost, i.e., the model proved to be economical in terms of cost, considering its benefits. The demonstration of periodontal osseous defects in VANPERIO model is first of its kind that eases the students to better comprehend periodontal osseous defects. It is of lightweight and white in color and allows different parts of teeth and soft tissues to be painted if required for good learning. It is washable, not autoclavable and nonbreakable as long as there is no intention to break it.

CONCLUSION

Overall, VANPERIO model is recommended for better understanding of periodontal osseous defects, patient education motivation, and periodontal student activities. It is an additional tool in the periodontal academic armamentarium for the first time globally. It is recommended for best learning and teaching certain aspects of periodontics.

CLINICAL SIGNIFICANCE

The model, a combination of traditional and modern approach, tried first time in the field of periodontics, proves to be useful in academic and clinical field to create awareness among patients and better understanding for the students than the traditional methods available.

REFERENCES

1. Gupta R. 3D printing: the latest vogue in dentistry. 2018.Available: https://in.dental-tribune.com/clinical/3d-printing-the-latest-vogue-in-dentistry/.

2. Lee 2004.Available: http://www.evansondds.com/how-3d-printing-is-revolutionizing-dentistry/.

3. Lakkaraju RB. 3D printing - a new vista for periodontal regeneration. IOSR J Dent Med Sci 2018;17(3):19–23. DOI: 10.9790/0853-1703091923.

4. Vandana KL, Bharath Chandra GNR, Sadanand K. Periodontal osseous defects: an insight (paperback). Lambert Academic Publishing; 20171.

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