Orthoprint, or How I Open-Sourced My Face

March 15, 2016 7:42 AM

What is to stop someone, who has access to a 3D printer, from making their own orthodontic aligners? "So what does one need to do this themselves? Knowledge of orthodontic movement, a 3D scanner, a mold of the teeth, CAD software, a hi-res 3D printer, retainer material, and a vacuum forming machine. "
posted by xingcat (27 comments total)

Metafilter: Nothing to stop you except for an instinct for self-preservation.

(ok, this is pretty neat, admittedly. Though as he notes, and you can see in before/after, the printed braces can only correct certain things)
posted by k5.user at 7:51 AM on March 15, 2016 [1 favorite]

This has already hit the Dentaltown forums, and I'm very interested in seeing their responses.

I'm assuming that if he ever wanted to package this in a bundle and sell it, he'd quickly be shut down for practicing dentistry without a license. That said, I see no reason why some Zenni equivalent couldn't set up shop in another country and do the same thing.
posted by leotrotsky at 7:58 AM on March 15, 2016 [2 favorites]

That said, I see no reason why some Zenni equivalent couldn't set up shop in another country and do the same thing.

It's been done. The Invisalign company (Align Technology) is embroiled against a patent suit against a company called ClearCorrect that figured out a bit of a loophole in the patent system:

1. A dentist in the US makes a mold of the patient's teeth and gives it to a US company, which scans the mold and sends the resulting file to another company overseas.

2. The foreign company uses the digital mold to create a series of CAD files for aligners, then sends those files back to the US-based company.

3. The aligners are printed in the US and given to the patient.

Et voila: no patent infringement, since key steps were performed outside of the US, and the Federal Circuit recently held that the files themselves aren't "articles" for purposes of International Trade Commission jurisdiction. There is likely to be either an en banc rehearing or a Supreme Court appeal, so the case is probably not over, but so far the Zenni-equivalent is winning.

Whether it's an overall good thing to allow such a loophole for 3D printable (or CNC-machinable) objects is another question, but that's the state of things at the moment.
posted by jedicus at 8:05 AM on March 15, 2016 [15 favorites]

Fortunately for dentists, they are one of the few professions you can't really outsource. They've got to be physically there in your mouth cleaning or repairing your teeth. There are also laws in many states that prohibit a dentist from being employed by anyone but another dentist. The real risk for dentists are the DSOs (dental service organizations), also known as corporate dentistry (like Aspen, Heartland, Great Expressions, etc.) which end run around those laws by providing just the 'business' side of practices. They are generally not a good deal for dentists, and there's been some pushback on them from the profession (though arguably not enough).
posted by leotrotsky at 8:05 AM on March 15, 2016 [2 favorites]

Neat.

I am a tooth grinder and my dentist has repeatedly suggested I buy one of their $500 night mouth guards but I could never bring myself to shell out that kind of money. So I bought a $40 guard from Amazon that you heat up and shape to your mouth (which as far as I can tell is just Instamorph) and now my morning mouth pain and headaches are a thing of the past.

Maybe it's going to screw up my teeth long term or something, I dunno, but I can't imagine a $500.00 device would work any better.

I think the Internet and 3D printers are really going to shed light on the ridiculous markups the dental and optical industries have been scamming us with for years.
posted by bondcliff at 8:10 AM on March 15, 2016 [7 favorites]

Like 3D printed guns, I think this kind of thing is important but not in a large-scale commercial way. I doubt people will generally want to do this themselves and as the writer indicates, he has access to some pretty high-end equipment. But it's pretty amazing how accessible it all is given a few hundred thousand dollars of generic equipment.
posted by GuyZero at 8:11 AM on March 15, 2016

the ridiculous markups the dental and optical industries have been scamming us with for years.

So I am of two minds - on one hand, yeah, glasses are a scam. On the other, design is a thing and having spent probably hundreds of hours in my life trying to find just the right new frames, clearly good frame designers deserve to be compensated for their work. Because ugly glasses are goddamn terrible.
posted by GuyZero at 8:12 AM on March 15, 2016 [2 favorites]

Just don't do what this person did.
posted by fiercecupcake at 8:13 AM on March 15, 2016 [1 favorite]

Oh is that all I need? Well sign me up! None of that stuff sounds more expensive than actual orthodontic treatment.
posted by Brocktoon at 8:18 AM on March 15, 2016 [4 favorites]

When I think of DIY medical devices, this for some reason comes to mind.
posted by Cash4Lead at 8:19 AM on March 15, 2016 [1 favorite]

I am a tooth grinder

and my dentist has repeatedly suggested I buy one of their $500 night mouth guards

When I read the first part, I thought it was some kind of weird dentist slang for their own profession
posted by clockzero at 8:31 AM on March 15, 2016 [26 favorites]

GuyZero: You don't need to go bottom-of-the-barrel to still save a ton of money on glasses.

I keep reading that in commercial-voice-over-voice.
posted by GuyZero at 8:32 AM on March 15, 2016 [3 favorites]

Fortunately for dentists, they are one of the few professions you can't really outsource. They've got to be physically there in your mouth cleaning or repairing your teeth.

For now. A tiny robot crew could probably see better and clean/repair more effectively (and with less wedging your mouth open with painful plastic doohickeys). Might not happen for a long time, but I wouldn't count on the long term. I'd personally be up for trying it because I'm tired of dentists stretching my mouth out like a cheap kid's balloon so they can wedge their giant clumsy hands in there and gouge at my teeth.
posted by emjaybee at 9:41 AM on March 15, 2016 [6 favorites]

For now. A tiny robot crew could probably see better and clean/repair more effectively (and with less wedging your mouth open with painful plastic doohickeys). Might not happen for a long time, but I wouldn't count on the long term. I'd personally be up for trying it because I'm tired of dentists stretching my mouth out like a cheap kid's balloon so they can wedge their giant clumsy hands in there and gouge at my teeth.

One time, my regular dentist was out sick so I had to see this older dentist whose name -- I swear to God -- was "Scambologne" (a clue I foolishly ignored). This guy was the worst medical professional I ever had to deal with in the US, and, I assume, not actually a dentist but rather a con man with a weird sense of humor. He was so clumsy and thoughtless, it was unbelievable. First he rested one of his hands on my eye, then he literally leaned on (!!) my face with one hand until I said "Uh, get the fuck off of my face," and then he acted like I was being rude for swearing at him. A female hygienist who seemed far more competent finished up for me, and when I thanked her for not leaning on my face she laughed and then sighed deeply.

So yeah, tiny robot crews sound alright to me.
posted by clockzero at 9:54 AM on March 15, 2016 [7 favorites]

Well in the other thread, they've been talking about cybernetic cockroaches, very effective for getting into small spaces.
posted by RobotHero at 10:00 AM on March 15, 2016

I'm on my last tray of Invisilign (barring any refinements), and I'd recommend finding a dentist that is just getting into the process, because they can do it for 1/10th the price for the first couple of customers.

I have no doubt that in 20 years this stuff will cost $20/month and everyone will do it.
posted by blue_beetle at 10:12 AM on March 15, 2016

Maybe it's going to screw up my teeth long term or something, I dunno, but I can't imagine a $500.00 device would work any better.

I'm not sure if it'll screw up your teeth, but my dentist made guard was way more comfortable at night, noticeably less jaw tension during day, and lasted forever. I also have a screwed up bite (my teeth didn't settle the way the orthodontist thought they would after my braces) and TMJ, so it may be that it makes a bigger difference for me than it would for someone with just grinding?

I'd love to have a tiny robot crew clean my teeth. No more judgemental looks about by inconsistent flossing.
posted by ghost phoneme at 11:04 AM on March 15, 2016

Tiny robot tooth-cleaners are a slippery slope that ends in the GOP-backed Woomba.
posted by a halcyon day at 11:28 AM on March 15, 2016 [1 favorite]

Tiny robot tooth-cleaners are a slippery slope that ends in the GOP-backed Woomba.

No, not those teeth, but I can see how Republicans could get confused since they know so much about women's bodies
posted by clockzero at 11:45 AM on March 15, 2016 [9 favorites]

I did think of naming it "The ToothOMBA" but it just didn't work.
posted by emjaybee at 11:55 AM on March 15, 2016 [2 favorites]

I have had a number of bite guards over the years. The hard one cost $500 and it took the dentist a year of appointments to get it right. It made my troubles worse, for months, and I was in agony. I have a decades-long relationship with this dentist, he does good work for fillings and crowns, but frankly I think he sucks at making bite guards and I should have just quit. But once it was finally right, it worked pretty well for a couple years. (Until I left it next to a hotel sink and only remembered when I was getting on the plane. And I called the hotel and they refused to ship it to me, they said dental stuff is unhygenic and their policy is to throw it away when people leave it behind. Grrrr.)

Anyways, it was such a nightmare getting that thing fitted, I didn't get another. My tooth grinding seemed to abate for a while, but periodically it flares up. The dentist likes to pressure me to do more about it and has made me four or five of the soft bite guards with the melty plastic. I use them for a while sometimes, but they get nasty fast; they are only a temporary thing. I usually end up carving on them a bit to improve the comfort, and I'm quite successful at it. The trick is to cut away some of the extra bulk, with scissors or a sharp knife, then use a candle to melt the sharp edges and smooth them out.

Sometimes when it flares up between dental appointments, I buy the DIY ones. I get them at Target; they cost around $20. I think they solve the problem just fine. Mine are a little looser but I don't think it matters very much; that is actually a little more comfortable. I wear them for a couple weeks until the flare-up passes, and then pitch them.

Anytime I put in an old one, I can tell my teeth have moved. It's uncomfortable. New ones are better.

Also, the instruction for the DIY ones, tell you to do the top teeth, but I find it easier to breathe while wearing them on the bottom teeth, so I ignore that part of the instruction.
posted by elizilla at 12:15 PM on March 15, 2016

It's been done. The Invisalign company (Align Technology) is embroiled against a patent suit against a company called ClearCorrect

I called this as soon as i saw an actual invisalign tray in person. As far as i can tell the process has one extra step from what you listed just like the one in the article, in that a positive is printed(like those fake teeth/jaw sets you get from the ortho anyways sometimes) and then the actual trays are vacuformed or something over them.

Why do i think this? Because the inside of the trays have stepping from 3d printing or relatively low accuracy/cheap/fast/CNC on whatever they're molded over, and the outsides are smooth without seeming like they were buffed.

The secret sauce seems to be placement of the "attachments" that get glued to your teeth. I have invisalign, and a couple of them busted off fairly quickly and one was poorly chosen size/shape wise and doesn't "catch" well so that tooth isn't coming in to position as fast as the others. This seems like something you could probably cheat with good enough software, but that is easiest/works best when done by someone who has experience and can just shoot from the hip.

Basically, tl;dr, i think that this is never going to be an at-home thing but that it will become a $200-ish zenni optical type product if you're willing to do the whole process with no checkups or something. Sure your local maker space or whatever might have all the gear, but unless someone writes an utterly godly piece of software to place the nubs then... ehh.

To me, at least, besides pork the most expensive cost wise portion of the process is actual seat time with an ortho. The appointments spread out throughout the process with invisalign, but there's still a whole bunch. You can cut out basically all the cost of the actual trays and molding process but you'll probably need to sacrifice almost all of that to get the cost down.

What this really needs is dirt cheap 3d scanners that can make a rough scan of your teeth and give you an estimate. Simple fixes where you only get a few attachments could probably just be an appointment to put the nubs on and take them off, but that's not everyone... or even most people.

You would quickly hit a wall that most of the "sharing economy" services have smashed through, or at least tried to in unethical ways. Mainly, how little can you pay for the labor portion? Orthos and dentists have as little motivation to work with this as bike shops do with assembling cheap internet bikes. I'm not sure how awesome this plan will actually work.
posted by emptythought at 1:34 PM on March 15, 2016 [1 favorite]

emptythought, a version of what you're describing exists now: SmileCareClub ('straightens your teeth completely from home'). They advertise through GroupOn, LivingSocial, and the Sharper Image catalog.
posted by furtive_jackanapes at 2:14 PM on March 15, 2016

Just don't do what this person did.

That cannot be real...can it??
posted by Greg_Ace at 3:05 PM on March 15, 2016

I did the make a mold yourself then ship it to the dental company in California to be made into a chomping guard for way cheaper than a dentist managed equalivant thing.

It has worked great for over a year now and I honestly think that outsourcing to this specialist shop, who may also be making the one your dentist 'made' for you, is an all around win for us as consumers that are tired of being straight up fucked by pricing models and insurance runaround.
posted by RolandOfEld at 3:34 PM on March 15, 2016

Thank you so much for posting this! While I don't expect I'll be going the route that the writer of this piece did, his experience is fascinating and encouraging. And I had not heard about ClearConnect or SmileCareClub, or the lawsuit that was mentioned in this thread.

It's exciting to me to think that affordable alternatives to Invisalign exist now. My dentist quoted me $5000 (in 2010) for the Invisalign orthodontic treatment I need, and there is no way I can afford that (I'm self-employed, and my income is below the Federal Poverty Level), so I simply haven't gotten it done, and have become progressively more bothered by my overbite. It gives me hope to think that at some point in the not-too-distant future, I may be able to find something I can manage financially.
posted by velvet winter at 12:49 PM on March 16, 2016

I guess with the horrible braces gone wrong picture, they bent a wire or something and attached it, and then the wire exerted pressure while trying to spring back into shape.

The thermoplastic used here at least shouldn't be in danger of that particular error. It's heated when shaped, rather than just bent, and any material that sprang back after this process I think people would have learned not to use it as a thermoplastic.

I guess the part about "tipping / rotational forces" "Begg’s tipping principle" and what movements are possible for the device to cause, that's where it would most help to get a real orthodontist to sign off on it.
posted by RobotHero at 11:03 AM on March 17, 2016