2) For 5k (Cdn) - I get 42 moulds, a method used to scan and submit my progress for each mould duration, feedback and advice from a dentist, a scan test to see who they fit
3) Considering the cost of braces and the flexibility these allow (as long as you are disciplined in wearing them) it's well worth it
4) My teeth were really misaligned. At 42 I just decided to do it so I could smile more in pics. Not confidence issue, just sometimes in life you have to do things for yourself
5) You can see the 3d printing lines and its pretty detailed given how lightweight and accurate the shape is for each tooth
6) There are little mounts they install on your teeth for the moulds to latch on to as well, so its not just a fit on the teeth but the mounts as well
7) Each individual mould has a unique number on the package in comes in as well as on the mould. Each package has my name, the dentist and the mould number out of 42.
8) I could see changes starting with mould 6
9) If look even close to mould 42, I will be extactic
10) it also comes with an attachment for your phone that alows you to submit self exams each mould. Its really cool. its very impressive
Just be prepared near the end for refinements. When I did mine, I had to do another 6 months of refinements near the end to help get the locking of my bite grip to be where it needs to be. I was otherwise expecting that day to be when I’d be done, and later learned refinements are a fairly common occurrence when going through Invisalign.
As the sibling comment, it’s definitely worth it. Best of luck!
This isn’t the case with 3D printed bracket systems. Studies have shown that the 3D personalized bracket system from LightForce will cut down treatment time over 40%. The refinement phase is also spot on and finishes much faster, and recent studies have shown further improvements. Also, the more complex the case, the larger the delta on the performance. Not all orthos are practicing this way but this is where the future is going whether it is LightForce or another company. The physics just works out better than the best plastics.
Disclaimer: I’m a health nerd and was an employee a couple years ago.
LightForce still requires a lot of visits to the doctor. Nice source of revenue for orthos. Aligners may become more accessible to patients, because that tech is more scalable by design.
Ivan worked at Align and was CTO of European DTC competitor. I agree with Ivan that both technologies have their sweet spot. I disagree with the scale piece and the frequency of visits as there are practices doing both those things differently using the placement and remote monitoring technology.
For younger patients that haven’t had braces before which is the majority of historical patient populations and future ones, 3D printed personalized braces systems are better as the tooth movement needed is more clinically substantial at tougher angles. Many younger patients forget and lose their plastic aligners.
That said: what is chosen should be what for the whole person at multiple levels.
This sounds like AI-written comment, at least in the first part. What I do not get is why are you dismissing the argument about number of visits. 3D printed braces are still braces. They require manual adjustment for each treatment stage. Aligners do not need that - they may need a check-up in the middle of the treatment, maybe one or two mid-course corrections, maybe an appointment for installation of attachments, but that's it. You change aligners at home without visiting doctor.
>Many younger patients forget and lose their plastic aligners.
My SO is now using it. I’m waiting for her impressions to decide if I want to do so.
The dentist told me I’d only need it for like 3-4 months, minor corrections. But it seems like such a hassle. Always having to remove it before eating anywhere, no coffee, and gotta make sure I’d always travel with the next set of aligners etc.
Because it’s annoying to remove and clean for eating each time, it will get to a point where coffee or the odd snack is not worth the hassle. Maybe once in the year process did I find it worth it to remove it to eat fourth time in a day. It’s a weird reorienting. Like jumping into a new energy level that is more taxing, but is in a minima such that you want to stay to 3 meals a day.
I am nearing the end, depending on the refinements. The first two weeks I was regretting it, but adjusted quickly. Honestly for me the issue was more that I did not like the way my teeth feel with the trays out (and the rough field of the aligners on the teeth). The eating was not that big of a deal. I have a travel toothbrush and case I keep with me. It has been pretty easy.
Still looking forward to getting the stuff off my teeth.
Just do what I did: ignore your orthodontist and wear them only at night, smashing them into your mouth like some kind of idiotic brute. 4 years later, great teeth!
You teeth are literally being pushed to a new position. So if you dont use the braces for the "minimum" duration, you teeth may not be in a place where they need to be for the second set of braces to start working. So your 2nd braces are going to be pushing more and that might cause damage to your teeth/gums. Think of it like trying to do splits. If you have never done them ever before and you try to do them on your first try, then you gonna break whatever you have down there. But if you keep at it then day by day you will notice progress. The braces are like that. Each one eases you into the next stage if that makes sense.
Wouldn't be such a big deal if we didn't keep all our teeth, but we do now. The migration forward as we age, plus wisdom teeth are evolutionary holdovers.
Fun fact, I have one fully grown in wisdom tooth. The rest are still there, but never moved. My dentist is always after me to get all of them removed, telling me that they won't fill a cavity on the grown in one
Do you know what type of plastic they use? I have a 3D printer and I wouldn't want to put 3D printed stuff on my mouth. It's way too easy to end up with microplastics
The article says the braces are 2 layers. The inner one is polyester and the outer one is polyurethane. They also don't currently 3d print the braces themselves but instead thermo form them on top of 3d printed molds.
I had really bad teeth as a kid, so had braces. Periodically I'd have to go in to get them tightened, and remember the worst whole head pain for a day. Just curious is switching Invisalign molds is a similar process?
Tangential, but I have sleep apnea. Fortunately I have it mild enough to get away with a mouthpiece instead of a CPAP (which is good anyway because I also have bruxism).
The mouthpiece works great and I would recommend everyone get tested for sleep apnea if your insurance covers it, but I have to admit that paying for it bothered me. Even with insurance covering some of it, it cost me about $600.
I know that there's a deceptively high amount of engineering required for these kinds of things, but it was very hard to wrap my head around paying $600 for what amounted to a couple pieces of clear plastic. I actually got them to send me the STL of the scan of my teeth, and some back of napkin math indicated that it would have cost me about fifteen cents of resin to print it out myself. Instead I'm paying about 4000x that price.
Obviously this is not apples to apples, I'm sure they're using different and/or better resin that what I have, and as I said there's probably engineering and fine-tuning for this, but even still it was not fun to pay for.
All the same, I sleep like 10x better, so I suppose that considering that $600 is a cheap price to pay.
I think your comment would have been more insightful if you had at least pretended to try to account for labor before saying "They charged me 4000x the cost of goods!".
To be clear I'm not even asking for you to account for the cost of your printer, the 3d scanner, and software licenses in your math. Let's assume that all those are free. How many hours of specialized human time was spent on consultations, scans, design, reviews, to produce working guards for you?
The next question is then, of course, how much do they charge for subsequent guards now that the scan has been done and validated? Is it still 4000x the cost of raw resin?
Even if the actual specialist labor had been minimal, there's also the amount of time and effort it takes to accumulate enough knowledge to become a specialist. It's like the joke about spending $200 for a repair guy to come kick your printer in just the right spot to fix a print jam--you pay him $50 for kicking it, and $150 for knowing where to kick it :)
Yes, they will charge a similar amount for producing another guard from an existing scan - I’ve had that done. It was also completely unnecessary in my case, it’s clearly an easy money grab for some offices.
With sleep apnea, I highly recommend you look into myofunctional therapy, which is like airway physical therapy. (full disclosure, my mom is a myofunctional therapist). It worked for several friends; They still use their cpap but they get much better sleep after committing to a routine. Not advertising but spreading the word, find someone local!
If it doesn’t, you can try and find some free resources online. If you’re in NYC, my mom’s business is HappyMyo and you can tell her her son sent you from HN. Good luck and I hope it helps you, it sounded really hippie and lame when I heard the name but I’m a believer now.
I do live in NYC and I actually did see that practice when I was searching. I might check it out though apparently my insurance will not cover it. I'll dig a bit further.
So shouldn't this really be something that could be opened sourced. I think I've seen a few write ups of people that did their own, but seems like a highly functional implementation could be democratized.
It is definitely not that simple for a number of reasons.
Yes, aligners and retainers in theory may be printed on some commercially available hardware. At your own risk, because you will be printing a medical device and you will need:
1. A treatment plan: simulated movement of teeth at every step, taking into account all forces. That’s specialized software or external lab service.
2. Precision. You put too much pressure at the wrong angle and you will need a surgery to fix the damage, because the tooth root moved in wrong direction.
3. Plastic. You cannot use ordinary 3D printer ink. You need a plastic that can survive the chemical environment in your mouth, maintain the pressure, and you probably want it to look good (no discoloration etc).
4. Finish: Align Tech, Straumann etc do not stop after 3D printing, there are few other steps involved to make sure there’s no sharp edges etc.
5. Maybe you will need attachments (to focus pressure in the right direction on certain teeth) or wires.
Align Tech is Apple of clear aligners, but now competition exists, producing aligners at scale is commercially more efficient, considering all the risks and required qualifications, and of course the best materials for aligners are patented and not sold OTC to everyone.
Disclosure: I worked at Align 10 years ago and later was CTO of European DTC competitor.
How many of these risks and problems are exaggerated in scope and potential due to both a desire for a regulatory moat and a general fear of litigation in the medical space?
That is to say, how good is “good enough” when done at small-scale in developing nations or medically underserved communities?
1. There‘s always a reason or two for the treatment. The problems with bite may affect your health in various ways. There’s aesthetic component in it, sometimes even cultural preferences for how your teeth should look like. But let’s say patient cannot afford to care about final position when signing up for the treatment. They just trust the doctor saying they need it. Failure mode: patient is unhappy with outcome and will ruin your business from marketing perspective.
2. Let‘s say the practice does it in old way, with impressions - no intraoral scanner. The scanner of impressions still needed, but it can be cheaper. Someone needs to build it and achieve required accuracy (let’s say, 50 μm). Who? Why? Failure mode: bad scan leads to aligners not fitting your teeth from day 1. Oops.
3. Let‘s say someone builds a good OSS alternative to OrthoCAD (Who? Why?), so that orthodontist on site could build a treatment plan and export it into series of 3D models for printers. Failure mode: good treatment plans are rarely possible or output is garbage (aligners do not fit, cause pain etc)
4. Maybe some company develops good plastic or patent expires, so that it is possible to produce it in India, China or other inexpensive location with strong industrial base. That would be cool, otherwise: non-compliant plastic breaks in patient’s mouth, decomposes with patient ingesting some toxic chemicals or is simply not strong enough to move teeth in desired position, so you have problem with 2nd aligner.
5. Maybe you get to this point, but you still need a printer that can maintain the same precision in printing. And you need a good cutting and finishing process. Someone needs to build such device. Failure modes are similar to the mentioned above.
6. The ortho supervision sounds easy, but how many patients in developing countries do even have a possibility to see orthodontist? They are definitely not in position to treat themselves.
So, in this process, what is good enough exactly? Who and why would drive the costs down while building an on-site solution?
These kinds of things can slowly move your bone structure over time. After all, that is their entire point. You don't want to accidentally mess up your teeth and jaw even more.
This would be what I'd worry about. How many of us do any metrology on our printed artefacts? It's really easy to get a subtly warped print and without having some sort of calibration of the process I wouldn't want to make any accuracy claims whatsoever.
IIRC, yes. It’s been some time ago, I don’t know how manufacturing looks now. It’s different process compared to 3D printing at home. It doesn’t mean it should be different, it just has to maintain certain properties. I’m not chemical or bioengineer to go into detail of it :)
Yes just the safe to be in the mouth and for it to handle significant pressure from teeth biting changes this from simple 3D filliment to something much more involved during the design and regulatory processes.
I did Invisalign a few years ago. Manufacturing the retainers is surely only a small part of the puzzle.
They used a specialized sort of 3D camera on a stick to get an incredibly accurate model of my mouth, any open source solution would need an equivalent. And you’d also need open source code from somewhere to work out which teeth need to move where and at what stage in the treatment.
While both were originally companies based in Israel, the technology behind the Kinect is different.
iTero scanners (owned by Align Technology) use parallel confocal imaging via red light lasers. Their newer models also use Multi-Direct Capture techniques.
Kinect used a Light Coding technique, an infrared projector and camera. It was developed by a company called PrimeSense, which was later purchased by Apple.
They also use this camera system when creating implants. After the implant post was installed, they scan your mouth to determine the optimum shape for your crown (that goes on the post).
Certainly it's not impossible to DIY, but it's more difficult than just popping some aligners on your 3d printer.
Manufacturing them requires a resin printer and a vacuforming setup, but that's still the easy part. It's a whole system with a dental 3D scanner, software for rearranging your mouth, and attachment points that have to be epoxied onto (and later removed from) your teeth by a dentist.
A point I didn’t see sibling comments make is that the dentist often has to file between teeth for them to sit and align correctly. They did so several times in my case. I would not want to do that to myself!
It’s been tried, with some success. Pretty sure I’ve seen a post here on HN from someone that DIy’d it end to end.
But it’s also something that’s not responsible to shortcut. Shifting teeth around too fast can result in permanent root damage and even loss of teeth. There was a whole cottage industry in the US for a while focused on under cutting Invisalign with a reverse-engineered product, but they often moved on accelerated treatment timelines that caused a not-insignificant amount of harm to patients, and cut corners on intake (DIY at home mold kits) that also contributed to problems. Pretty sure all of the companies doing this are basically dead now.
Need expensive printers and you need CAD software that can correctly move the teeth. Also not all it can be done by software, sometimes you need to blank out certain teeth that dentist will make the call.
My 2 kids had those and it is amazing compared to traditional way, pulling healthy teeth, wearing braces which are brutal to your teeth.
It should be illegal to pull kids teeth when this tech exists. Dentists were angry about this but it is superior in every way. I think costs will come down, but they are already cheaper then alternatives.
I am happy my wife researched and discovered Invisalign.
One required much more alignment, I don't remember but it was 20+ weeks, other was done in 16 weeks. Now they have retainers and that is it.
129 comments
2) For 5k (Cdn) - I get 42 moulds, a method used to scan and submit my progress for each mould duration, feedback and advice from a dentist, a scan test to see who they fit
3) Considering the cost of braces and the flexibility these allow (as long as you are disciplined in wearing them) it's well worth it
4) My teeth were really misaligned. At 42 I just decided to do it so I could smile more in pics. Not confidence issue, just sometimes in life you have to do things for yourself
5) You can see the 3d printing lines and its pretty detailed given how lightweight and accurate the shape is for each tooth
6) There are little mounts they install on your teeth for the moulds to latch on to as well, so its not just a fit on the teeth but the mounts as well
7) Each individual mould has a unique number on the package in comes in as well as on the mould. Each package has my name, the dentist and the mould number out of 42.
8) I could see changes starting with mould 6
9) If look even close to mould 42, I will be extactic
10) it also comes with an attachment for your phone that alows you to submit self exams each mould. Its really cool. its very impressive
As the sibling comment, it’s definitely worth it. Best of luck!
Disclaimer: I’m a health nerd and was an employee a couple years ago.
For younger patients that haven’t had braces before which is the majority of historical patient populations and future ones, 3D printed personalized braces systems are better as the tooth movement needed is more clinically substantial at tougher angles. Many younger patients forget and lose their plastic aligners.
That said: what is chosen should be what for the whole person at multiple levels.
>Many younger patients forget and lose their plastic aligners.
They can get a new one easily by post.
The dentist told me I’d only need it for like 3-4 months, minor corrections. But it seems like such a hassle. Always having to remove it before eating anywhere, no coffee, and gotta make sure I’d always travel with the next set of aligners etc.
Glad it worked well for you though!
Still looking forward to getting the stuff off my teeth.
I needed 15 trays so just 30 weeks. Not that bad.
Lo and behold I read that as we age the jaws shrink which makes the teeth crowd together.
I'm going for a free mouth scan in a couple weeks.
Fun fact, I have one fully grown in wisdom tooth. The rest are still there, but never moved. My dentist is always after me to get all of them removed, telling me that they won't fill a cavity on the grown in one
I haven't done any similar treatment and I'm considering it at 35. Worried about the length since I heard it takes far longer for adults.
As you probably know you're going to have to wear retainers at night for the rest of your life if you want your teeth to stay where they landed.
The mouthpiece works great and I would recommend everyone get tested for sleep apnea if your insurance covers it, but I have to admit that paying for it bothered me. Even with insurance covering some of it, it cost me about $600.
I know that there's a deceptively high amount of engineering required for these kinds of things, but it was very hard to wrap my head around paying $600 for what amounted to a couple pieces of clear plastic. I actually got them to send me the STL of the scan of my teeth, and some back of napkin math indicated that it would have cost me about fifteen cents of resin to print it out myself. Instead I'm paying about 4000x that price.
Obviously this is not apples to apples, I'm sure they're using different and/or better resin that what I have, and as I said there's probably engineering and fine-tuning for this, but even still it was not fun to pay for.
All the same, I sleep like 10x better, so I suppose that considering that $600 is a cheap price to pay.
To be clear I'm not even asking for you to account for the cost of your printer, the 3d scanner, and software licenses in your math. Let's assume that all those are free. How many hours of specialized human time was spent on consultations, scans, design, reviews, to produce working guards for you?
The next question is then, of course, how much do they charge for subsequent guards now that the scan has been done and validated? Is it still 4000x the cost of raw resin?
I'm sure labor is involved, and maybe it's a lot, but it still seems like an awful lot of money for a piece of plastic.
https://pmc.ncbi.nlm.nih.gov/articles/PMC1360393/
1. A treatment plan: simulated movement of teeth at every step, taking into account all forces. That’s specialized software or external lab service.
2. Precision. You put too much pressure at the wrong angle and you will need a surgery to fix the damage, because the tooth root moved in wrong direction.
3. Plastic. You cannot use ordinary 3D printer ink. You need a plastic that can survive the chemical environment in your mouth, maintain the pressure, and you probably want it to look good (no discoloration etc).
4. Finish: Align Tech, Straumann etc do not stop after 3D printing, there are few other steps involved to make sure there’s no sharp edges etc.
5. Maybe you will need attachments (to focus pressure in the right direction on certain teeth) or wires.
Align Tech is Apple of clear aligners, but now competition exists, producing aligners at scale is commercially more efficient, considering all the risks and required qualifications, and of course the best materials for aligners are patented and not sold OTC to everyone.
Disclosure: I worked at Align 10 years ago and later was CTO of European DTC competitor.
That is to say, how good is “good enough” when done at small-scale in developing nations or medically underserved communities?
2. Let‘s say the practice does it in old way, with impressions - no intraoral scanner. The scanner of impressions still needed, but it can be cheaper. Someone needs to build it and achieve required accuracy (let’s say, 50 μm). Who? Why? Failure mode: bad scan leads to aligners not fitting your teeth from day 1. Oops.
3. Let‘s say someone builds a good OSS alternative to OrthoCAD (Who? Why?), so that orthodontist on site could build a treatment plan and export it into series of 3D models for printers. Failure mode: good treatment plans are rarely possible or output is garbage (aligners do not fit, cause pain etc)
4. Maybe some company develops good plastic or patent expires, so that it is possible to produce it in India, China or other inexpensive location with strong industrial base. That would be cool, otherwise: non-compliant plastic breaks in patient’s mouth, decomposes with patient ingesting some toxic chemicals or is simply not strong enough to move teeth in desired position, so you have problem with 2nd aligner.
5. Maybe you get to this point, but you still need a printer that can maintain the same precision in printing. And you need a good cutting and finishing process. Someone needs to build such device. Failure modes are similar to the mentioned above.
6. The ortho supervision sounds easy, but how many patients in developing countries do even have a possibility to see orthodontist? They are definitely not in position to treat themselves.
So, in this process, what is good enough exactly? Who and why would drive the costs down while building an on-site solution?
They were a company theoretically doing the same thing with still more resources than an average individual has, and ruined people's bites and teeth.
I don't think there's a good enough here
They used a specialized sort of 3D camera on a stick to get an incredibly accurate model of my mouth, any open source solution would need an equivalent. And you’d also need open source code from somewhere to work out which teeth need to move where and at what stage in the treatment.
AFAIK Align's 3D scanning system is more or less branched from the same Israeli tech that went into the Xbox 360 kinect camera and the iPhone face-ID.
iTero scanners (owned by Align Technology) use parallel confocal imaging via red light lasers. Their newer models also use Multi-Direct Capture techniques.
Kinect used a Light Coding technique, an infrared projector and camera. It was developed by a company called PrimeSense, which was later purchased by Apple.
The difficult part is not the manufacturing, but knowing how to do it properly so you don’t harm the patient.
Manufacturing them requires a resin printer and a vacuforming setup, but that's still the easy part. It's a whole system with a dental 3D scanner, software for rearranging your mouth, and attachment points that have to be epoxied onto (and later removed from) your teeth by a dentist.
But it’s also something that’s not responsible to shortcut. Shifting teeth around too fast can result in permanent root damage and even loss of teeth. There was a whole cottage industry in the US for a while focused on under cutting Invisalign with a reverse-engineered product, but they often moved on accelerated treatment timelines that caused a not-insignificant amount of harm to patients, and cut corners on intake (DIY at home mold kits) that also contributed to problems. Pretty sure all of the companies doing this are basically dead now.
It should be illegal to pull kids teeth when this tech exists. Dentists were angry about this but it is superior in every way. I think costs will come down, but they are already cheaper then alternatives.
I am happy my wife researched and discovered Invisalign.
One required much more alignment, I don't remember but it was 20+ weeks, other was done in 16 weeks. Now they have retainers and that is it.
For some reason now it’s assumed these were some kind of injection molding, but it makes perfect sense that it’s 3-D printed.