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ROE Dental Lab is all in with 3D printing

Additive manufacturing has become a key process at an Ohio manufacturer of dental devices

ROE Dental Laboratory 3D-prints its removable products, such as dentures. Images: ROE

Dentures haven’t changed much in the past hundred years, according to the president of ROE Dental Laboratory, BJ Kowalski.

“In the 19th century, we had vulcanized dentures, and in the 20th century, acrylic was introduced and became the mainstay material,” he said during a webinar presented in April. “But now, in the 21st century, I firmly believe 3D-printed dentures will take the main stage and be the main method for producing dentures.”

Dentures aren’t the only devices ROE 3D-prints. The Independence, Ohio, company also additively manufactures replacement teeth, including full and partial arches; temporary crowns; interior models of patients’ mouths; prototypes for final screw-retained, full-arch prosthetics; surgical guides; splints, trays, and flippers; and, since the outbreak of the coronavirus pandemic, nasal swabs, face shields, and other PPE.

Milling is the primary process ROE uses to make dental products. Kowalski, in a post-webinar telephone interview, estimated that 35% of the company’s products are 3D-printed and the rest are milled. He added that 3D printing is used in the processing of 50% to 60% of products. Examples of this include printing temporary crowns and protoypes of prosthetics.

“In our industry, you’re either going to print it or you’re going to mill it,” said Company COO Joe Royer, a 28-year employee who joined ROE right out of high school.

The introduction of zirconia in the 2000s radically changed the dental industry, said Royer. “With zirconia, you didn’t have to hand-build a crown. You could digitally design it and mill it.” And, he noted, dental labs found that zirconia crowns were “super profitable, super strong, and were better restorations” than hand-built ones. “Everyone jumped on that train.”

And they’re still onboard. From a materials, time, and revenue standpoint, it still makes more sense to mill crowns than 3D-print them.

Removables Move Ahead

The use of additive manufacturing to build dentures and other removable devices is expected to continue growing in the coming years, thanks to material and equipment advancements.

Finding materials suitable for use in the human mouth—“a challenging, dynamic environment,” said Royer—has been a longtime problem for dental device manufacturers. “You couldn’t print a denture three years ago because the materials weren’t available.”

Dentsply Sirona changed that, according to Royer. The giant manufacturer of dental equipment and consumables teamed with Carbon to launch a digital denture workflow and material system optimized for Carbon’s M-series printer.

Additive manufacturing

ROE President BJ Kowalski believes that 3D printing will become the main method for making removable dental products.

“Dentsply cracked the code,” said Royer. “They developed a material that rivaled the strength of analog options.” Use of those options are time-consuming.

“Before, we had stone-setting time and we had acrylic-processing time—lots of things we had to wait for,” said Kowalski. “We don’t have to wait for too much anymore. We can print the teeth, print the base, and insert the teeth all at one time.” Dentures can be additively manufactured in a few hours.

Though it currently makes more economic sense to mill crowns, as was mentioned earlier, Royer thinks that if a substitute for zirconia is developed, 3D printers will begin to replace mills in dental labs in five to 10 years.

“It will happen because printing is way cheaper, and it’s more predictable,” he said. “If we print a bridge of teeth and we mill a bridge of teeth, there is less work to do on the printed teeth.”

AM also eliminates a lot of “dirty work,” like having to mix water and plaster together to make a model. “And you have the digital file forever,” said Royer. “If something happens to the model, the doctor doesn’t have to take a new impression. You just print a new model.”

Digital Evolution

ROE Dental Lab has been manufacturing dental products since 1926. Roe Miller founded the lab, which BJ Kowalski’s father, Bruce Kowalski, acquired in the 1970s. The younger Kowalski was named president in 1994.

In addition to the Independence headquarters, newly built in 2016, ROE operates facilities in Martins Ferry, Ohio, and Jamestown, N.Y. It currently employs more than 200 people.

Kowalski said the company has long focused on adopting cutting-edge technology. As an example, ROE was one of the first companies to use the Digital Imaging and Communications in Medicine (DICOM) standard, an international standard for sharing medical images.

“We would use DICOM data and CT scan data to [3D-print] surgical guides that would aid doctors in placing implants more accurately in a patient’s mouth,” he said.

The company bought its first 3D printer 15 years ago. Kowalski said the machine was “as big as a small Volkswagen” and that ROE used it to print wax copings for dental castings. The quality of the copings, unfortunately, was low. “If we made 50 copings, we could only use five and would have to throw the rest in the trash.”

digital manufacturing

ROE was an early adopter of digital dentistry. It first began experimenting with additive manufacturing 15 years ago.

ROE gained a lot of AM experience using the wax printers, which “kept us ahead of the curve” said Kowalski. And as better scanning equipment, printers, materials, and software became available, the quality of the copings improved dramatically. “We only threw away half of them, and instead of printers the size of Volkswagens, they now fit on a desktop.”

Today ROE operates 66 printers: 36 Formlabs Form 3Bs, 18 Form 2s, five Carbon M2s, two Stratasys Objet Eden 260Vs, and five Kulzer cara Print 4.0s.

“It’s been wild growth. Wild, wild growth since I’ve been here,” enthused ROE’s supervisor of CAM 3D printing, Denorris Turner, who joined the company four years ago.

Turner, who holds a mechanical engineering degree with a concentration in robotics, had no experience with AM before joining ROE. But he dove into the technology and learned quickly. He partially credits the era in which he grew up for easing his entrance into digital manufacturing.

The 27-year-old said that millennials like himself were raised with computers and possess an intuitive, foundational understanding of digital technologies such as AM. “It’s just something that we instantly understand.”

Turner’s background is not unique among ROE employees. Royer estimated that 70% of the “computer guys” involved with parts production had no dental experience before joining the company. He said two of his best designers are gamers. Their deep understanding of computers allows them to excel, despite having no dentistry knowledge prior to being hired.

“We’re finding it’s easier to teach somebody who knows about computers the dental side of the business than vice versa,” said Royer.

Newcomers to dentistry who ROE hires as designers spend a year or more learning about the morphology of the mouth, how to analogically set teeth, and other critical aspects of producing dental products.

Pivoting to NP Swabs

Many businesses were stopped cold by COVID-19, including ROE Dental. When the pandemic struck, the company had 193 employees working at its three plants.

“We went down to maybe 40 people because our work completely dried up,” said Kowalski.

Additive manufacturing

Denorris Turner (left) oversees ROE’s 3D printing department and Joe Royer is the company’s COO.

Around the time the pandemic started to close down businesses, ROE had an order in for 18 Form 3B printers from Formlabs, which was in the process of developing a nasopharyngeal test swab. The swab was designed to be produced on stereolithography-style printers like the Form 3B using Formlabs’ Surgical Guide Resin.

According to Formlabs, Somerville, Mass., a prototype of the swab quickly passed validation and clinical testing at USF Health, Tampa, Fla.; Northwell Health, New Hyde Park, N.Y.; and Tampa General Hospital.

Soon after, Formlabs and ROE partnered, and the Ohio company began gearing up to print swabs. Then an opportunity arose to 3D-print 1 million swabs for the state of Ohio. “We were fortunate to be able to work with the state of Ohio and Ohio State University to get the contract for the swabs,” said Kowalski. “We only had 30 days to arrange this, and even before we got the contract, I ordered another 18 printers” from Formlabs.

Asked about the challenges of transitioning from 3D-printing zero swabs a day to printing 15,000, Turner said, “We just dove in. BJ led the charge and we all followed suit.”

Turner’s job during the transition was to get the new printers up and running and making sure “we had the correct files loaded so we could fabricate the swabs in the most efficient way possible.”

He said there were a few bumps in the road, but “when it comes to a brand-new process and a relatively small window to get the process running, there’s always bumps.”

Besides swabs, ROE also prints face shields, mask holders, and other PPE.

The dental business began rebounding this past summer, and, according to Kowalski, the employees who were furloughed returned to work and additional personnel have been hired.

Some of the material in this report came from interviews conducted by Mateus Lima, a doctoral student at The Ohio State University’s Fisher College of Business.—Ed.

About the Author
FMA Communications Inc.

Don Nelson

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Don Nelson has reported on and been in the manufacturing industry for more than 25 years.