3d-printing dentistry marketresearch product

Yankee Dental 2020

Metatooth went to Yankee Dental 2020 and here’s what we found.

3D Printing

Micron Dental was showing their P305 printer. This printer uses LCD technology as the light source. Micron claims less lens distortion issues with this technology over the SLA and DLP types. It is being sold as a bundle only, which includes a wash & cure station.

The P305 lacks the design flair of the Formlabs Form 3B  or SprintRay Pro. The exterior design would not effect performance, but it does limit access to the print plate, with a side door of just 18 inches. Compare this to the “hatch” approach provided by the other two vendors. Does this effect usability? Micron users please comment below!

Formlabs was present as well, showing the Form 3B. No new materials were shown. The hunt is still on for a printable clear aligner tray. Everyone seems happy to be selling model resin! Formlab’s PreForm software is free to download and use, which was news to Metatooth.

Finally, Great Lakes Dental Technologies showed an economy desktop LCD printer the UNIZ Slash Plus.

Dental CAD

Metatooth watched a demonstration of 3Shape‘s Bite Splint and Indirect Bonding modules. 3Shape’s design software is available stand-alone, at prices comparable to other stand-alone software. However, the yearly maintenance fees are required for the software to operate.

Look for 3Shape to support Polygon File Format (*.ply) in the near future. This will enable non-3Shape users of this data to receive the color information collected by TRIOS scanners. This would be a welcome addition to those supporting open standards and protocols in the dental industry.

Practice Management Software

There were a number of companies offering software products that worked with the leaders in practice management software. Hopefully more of these offerings will keep coming. Metatooth recommends software products that integrate using the vendor’s API, not via an understanding of the vendor’s database schema.

This market is quite regional, so for the Northeast, Metatooth considers these the market leaders.

  1. EagleSoft from Patterson Dental
  2. Dentrix from Henry Schein
  3. OpenDental

Relative newcomer carestack might be one to watch.


Artificial Intelligence vendors were centered around perio-charting assistance and some other voice-to-text tasks. BOLA.AI offered the most functionality. This area will continue to grow, especially as practice management systems (see above) move to the cloud and add API support.


Direct-to-consumer companies looking to add a clinical channel were present. quip was the most well known to Metatooth, but another toothbrush service — BURST — was also on the scene. Colgate, Oral-B, and the like had throngs at their booths. When does quip or BURST become an acquisition target?

There was also an anti-snoring device from Zyppah. This self-molding thermoform device is available directly from the company. A “dentist only” channel was being presented.

Metatooth had a great time at the vendor exhibition of Yankee Dental 2020. What did Metatooth miss? Tell us about it in the comments!

Yankee Dental 2020



friday links

Friday Links

Friday links to a collection of news items I’ve recently come across. Each is not enough for a full blog post, but maybe I can cobble one together! My own news at the bottom.

Here is another example of a 3d-printed implant this time for plastic surgery. It’s a 3d-printed breast implant which will start clinical trials in Germany by the end of year. It’s a resorbable structure that allows for the recipient’s own tissue to be used as the bio-mass, instead of silicon or polyurethane.

What’s the latest on SmileDirectClub? While anticipation of the initial public offering was high, it ended up being a big dud. The stock dropped again after their first earnings report. Note that the past quarter’s revenue was above expectations: $180MM vs $165MM. That seems like plenty of money!?  It’s definitely not if you spend $600MM. They remain on track to increase revenue 78% this year. SmileDirectClub (NASDAQ: SDC) has stumbled, but with the HP partnership and continuing consumer demand, it doesn’t seem like they are going away anytime soon.

Formlabs recently announced the Form 3B and are all in on dental with their dedicated business unit. The white case of the 3B is a nod to the desired clinical setting for these devices. This market needs advanced materials and Formlabs appears to be investing in their development, along with the creation of a support organization to differentiate themselves from other OEMs at this price point.

What’s the latest from Metatooth? The first printed night guards have been received!

Alien Milling is my manufacturing partner. There are still things for me to learn about digital workflows! Each participant has embraced digital platforms, but they don’t work together. A challenge and an opportunity.

Thanks for reading Friday links. What have you noticed in the news regarding dental, 3d-printing, and digital workflows? Tell me about it in the comments!



EforAll Lynn Winter 2020 Cohort

The EforAll Lynn Winter 2020 Cohort is coming together and Metatooth will be part of it! EforAll’s Lynn Community offers twice-a-year business accelerator programs and “pitch contests” focused on nurturing local entrepreneurs. Core values are Inclusivity, Empathy, Collaboration, Respect, Performance, and Drive. Entrepreneurship for All began in Lowell-Lawrence, MA as Merrimack Valley Sandbox in 2010.  It is the brainchild of Jaishree and Desh Deshpande, with initial funding through their Deshpande Foundation.  It has since expanded across communities in Massachusetts and has recently welcomed Longmont, CO to the fold.

It’s already been helpful to participate in the application and interview process. Interviewers and application reviewers have highlighted questions and prompted reflection on my motivation and goals. The core of the program is twice-a-week workshops over the next 12 weeks. Mentor matching happens at program start and mentors meet with entrepreneurs over the course of the following year. Participants are expected to leave the 12 week workshop period with a 9-month plan to grow their business.

There is a lot of moving parts in any operation. I’ve previously relied on SCORE and the Greater Lynn Chamber of Commerce for business questions and advice. I plan to go back to that well, too!

Thanks to the staff & volunteers of EforAll Lynn for their attention during the application process. How are you engaging with your local community to strengthen your business and achieve your goals? Tell me about it in the comments!

custom-night-guard development

Night Guard Design

Night guard design is done! Read about my scanning experience here.

I am using FullContour, LLC for design services. Super easy interfaces, works well with STL files. I use “design approval” but I am not sure I would make any changes. 2mm occlusal, 1mm buccal/lingual. Shallow trim. Can’t wait to evaluate the fit!

What’s your night guard design preference? Tell me about it in the comments!

dental-lab review


SHINING 3D’s AutoScan-DS-EX is an entry-level desktop dental scanner.  Their website describes it as cost-effective and at $5,000 it is. For that price, you get structured white light, two cameras, a swing arm & turntable, a collection of mounting jigs, calibration plate (more on that later), a USB drive with software, a USB dongle for licensing, and a package of Blu Tack.  You will need an Intel Core i7 processor, NVIDIA GTX 750 graphics card, and Windows 7 or later. Check out Metatooth’s setup!

I had two problems setting up. Each were quickly addressed by my supplier, Bayshore Dental Studio, and SHINING 3D Dental Support.

1. The software version on the thumb drive was not able to connect with the scanner.  I was sent a Google Drive link to download version 2931. It would have been nice to get this information ahead of setup, but it was quickly resolved. The customer service rep used Team Viewer to review my machine, this happened over night for me, given their location.

2. Take off the protective plastic cover before trying to scan the calibration plate!

The case entry form will be familiar to exocad users. I haven’t had reason to scan more than impressions. Additional scans were needed to fill holes; the default scan paths did not give complete coverage. Hopeful for a way to change the scan paths or possibly issue arm/turntable and capture commands to the scan server itself.

Any other AutoScan-DS-EX users out there? What has your experience been? Tell me about it in the comments!


NGINX Heroku WordPress

NGINX, Heroku, and WordPress combined. This website is powered by WordPress on Heroku. Details on configuration are here.

My next #DevOps task is to add NGINX in front of the WordPress application. In the future, this could be used as a load balancer. Until then, NGINX will reverse proxy the requests to the Heroku application instance.

To start, I spun up a virtual machine running Ubuntu on Amazon’s EC2. Check out how to install and configure NGINX here. Make sure to open your firewall to HTTP & HTTPS traffic!

I encountered two major issues:

  1. The request passed by NGINX through the reverse proxy was not being understood by Heroku’s application stack.
  2. Once the application stack properly handled the request, WordPress’s response triggered a redirect loop.

Reverse Proxy

Heroku’s stack uses the host of the request to route to the appropriate application instance. The originating Host value is (in my example) ‘’. Heroku shouldn’t respond to this. Turn off the app’s Custom Domain feature if it does. Update the reverse proxy to set a new Host header that Heroku will respond to.

server {

    location / {
        proxy_set_header Host;

    # configure SSL here

Redirect Loop

Setting the Host request header got Heroku’s attention, now WordPress responds to that request with a redirect loop. I encountered this problem while trying to configure an HTTPS-only WordPress installation. The way out of the redirect loop was to update two more request headers and then to use those headers in the WordPress configuration. Here’s the new section of wp-config.php

if ( $_SERVER['HTTP_X_FORWARDED_PROTO'] == 'https' )
        $_SERVER['HTTPS']       = 'on';
        $_SERVER['SERVER_PORT'] = '443';
        define('FORCE_SSL_ADMIN', true);

if ( isset($_SERVER['HTTP_X_FORWARDED_HOST']) ) {

That gets WordPress to not redirect to https on these proxied requests, but only if the request headers of X-Forwarded-Proto and X-Forwarded-Host are specified. The NGINX configuration now is:

server {

    location / {
        proxy_set_header Host;
        proxy_set_header X-Forwarded-Host $host;    
        proxy_set_header X-Forwarded-Proto $scheme;

    # configure SSL here

That’s how I got NGINX, Heroku, and WordPress to play well together. Next task is to use an upstream for the proxy_pass directives. What’s your infrastructure layout and what did you learn along the way? Tell me about it in the comments!


Docker Ubuntu 19.04

Docker on Ubuntu 19.04 is a cinch. “Dockerizing” an application is a great way to ensure you understand it’s dependencies. I always forget this last bit when setting up a new machine.

sudo usermod -aG docker username

Otherwise, I recommend this Medium post by Grigor Khachatryan.

It turns out that LAMP Ubuntu 19.04 is the most popular Metatooth blog post. Can’t argue with success. More #DevOps posts forthcoming! I’ll certainly keep posting about teeth and technology, too.

What other “crowdsourced” finding has surprised you recently? Tell me about it in the comments!



SmileDirectClub IPO

SmileDirectClub and it’s initial public offering is in the news. The numbers cited are astounding: revenue of $423.2 million in 2018; 700,000 customers since 2014; $945 million addressable market; $393 million in funding (Shen, 2019).

Legal and regulatory hurdles remain. SmileDirectClub is suing the state dental boards of Alabama and Georgia to remove the requirement that a licensed dentist be present for the 3D scan of the patient. Arkansas has a law, co-written by a state representative who is also a dentist, that requires in-person exams before a doctor can treat a patient remotely.  If the attorney general of that state takes action, expect a lobbying effort by SmileDirectClub (Mandelbaum, 2019).

The question remains: can you collect enough data to make a treatment decision (for example, start clear aligners or referral to a local orthodontist) remotely? If it’s really not possible, then more innovation is needed to make it so. Teledentistry provides a way to bring better oral health to under-served regions. The technology and infrastructure built to disrupt the orthodontic industry should have a side benefit.

Align Technology Inc.’s 17% stake is looking pretty good. What other disruptive startups have backing by industry leaders? Tell me about it in the comments!


Shen, Lucinda. Fortune (August, 16, 2019) Brace Yourself: SmileDirectClub Is the Latest Unicorn to File for an IPO Accessed August 23, 2019.

Mandelbaum, Robb. Bloomberg Businessweek (August, 22, 2019)  A Tooth-Straightening Startup Runs Into Resistance Accessed August 23, 2019.


Open Formats and Protocols in Dentistry

Open formats and protocols in dentistry first appeared in the 2000s. They grew from the need of dental laboratories to integrate equipment for digitizing study models, designing dental prosthesis,  and manufacturing those products. Many software systems are “walled gardens”, where everything inside the walls are manicured but there is no way to access other gardens.  Of course, outside the walls the landscape is *not* manicured, so a robust integration method is needed. The “gardens” in this case were the Dental CAD/CAM systems of the 1990s.

Dental laboratories pressed for open integrations so they could make effective outsourcing decisions about how to manufacture these products.  Dental CAD customers demanded ways to manufacture their products using the tools or partners they determined was best for their business. Performance tuning for specific equipment may still be needed, however the issue of connectivity between different vendor’s CAD and CAM is no longer an issue.

The same market forces that drove open formats and protocols between digital dentistry tools are now coming to bear on dental imaging and business software.  Some dentists are demanding it in the pages if Inside Dentistry:

Dentists should not be beholden to any company for the ability to access and use their data in the manner that they see fit. (Jablow, 2019)

Improving patient care while meeting the demands of the dental insurance industry will drive this move to open connectivity. For the patient that would be portability of dental records and image.   If market forces are expected to be efficient, then artificial barriers to patient choice need to be reduced.

The application of machine learning algorithms to dental imaging improve the accuracy of diagnosis, which could create demand for earlier interventions as well as reduce unnecessary ones [1].

Lastly, open formats and protocols will lower integration costs for the dentist [2]. Administrative costs are one of the largest drivers of dental (and overall healthcare) costs. In this way the dental industry will take a lead from dental lab owners in demanding  connectivity to improve patient outcomes.

How is open connectivity impacting your business? Tell me about it in the comments!


[1] Shah, Agam, AI Can Lead to Lower Dentist Bills, Wall Street Journal (July, 16, 2019) Accessed 2019-07-19

[2] Jablow, DMD, Martin, Digital Dentistry Data, Inside Dentistry (July 2019) Accessed 2019-07-19



dental-lab manufacturing

Terry Lorber mentioned on IDT Weekly

Metatooth’s Terry Lorber is mentioned in Episode 26 of IDT Weekly. IDT Weekly highlights articles in the peer-reviewed Inside Dental Technology publication. IDT is a resource and learning tool for dental laboratory owners and managers. This month’s issue (July 2019) includes a Continuing Education article entitled “Does it Scale?”, by Terry Lorber.

The article covers a range of topics, from the mundane (for example, network topology) to the more philosophical (for example, lean manufacturing). The aim is provide concrete examples on a number of ways to bring the latest business technology to the dental lab. For inspiration, the author looks to examples from his experience in dental startups, where the growth expected by investors must be supported by robust and reliable information systems.

Need help with integrating dental & business technologies? Contact us to find out more. Do you have examples of scaling information systems for dental manufacturing? Tell me about it in the comments!