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?
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 :)
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.
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).
Dry heaving would have been great. I would regularly vomit from impressions. My orthodontist would just prepare two sets if impression trays, cause the first one was going to go in the medical waste bin.
Impressions for invisilign (when I did it, about a million years ago) weren't so bad though. Unfortunately invisilign resulted in an open bite for my molars, which I really should go back to an orthodontist to address, but I'd rather not.
>The difficult part is not the manufacturing, but knowing how to do it properly so you don’t harm the patient.
And yet I read plenty of horror stories of bad orthodontic results. Ask me how I know.
Went to 3 different orthodontist to fix what a bad orthodontist did to me when I was a kid, and each gave me a completely different treatment plan. I feel like being an orthodontist is just eyeballing and patching your way as you go to an acceptable resolution.
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.
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!
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.
They have to have at least 2 different materials as well. The temporary trays were much softer and I had almost ground through them in my sleep by the time I had to switch to the next one but the final set is much more robust.
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.
If you keep them on soft food young, the jaw muscles don't get stimulated enough for the teeth that are coming out to sit properly. Misalignment and opportunity for decay ensues.
If you give them decently hard food early on in life you solve most problems.
After that it can still happen but there's less chance.
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?
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.
The 3D camera was really neat. A little faster, and I didn’t once dry heave.
I could watch the software and a 3D model slowly form of my mouth. Looked surprisingly user friendly. Missed areas were highlighted, for example.
Dry heaving would have been great. I would regularly vomit from impressions. My orthodontist would just prepare two sets if impression trays, cause the first one was going to go in the medical waste bin.
Impressions for invisilign (when I did it, about a million years ago) weren't so bad though. Unfortunately invisilign resulted in an open bite for my molars, which I really should go back to an orthodontist to address, but I'd rather not.
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.
The difficult part is not the manufacturing, but knowing how to do it properly so you don’t harm the patient.
And yet I read plenty of horror stories of bad orthodontic results. Ask me how I know.
Went to 3 different orthodontist to fix what a bad orthodontist did to me when I was a kid, and each gave me a completely different treatment plan. I feel like being an orthodontist is just eyeballing and patching your way as you go to an acceptable resolution.
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.
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.
If you keep them on soft food young, the jaw muscles don't get stimulated enough for the teeth that are coming out to sit properly. Misalignment and opportunity for decay ensues.
If you give them decently hard food early on in life you solve most problems.
After that it can still happen but there's less chance.