Saylors Dental Laboratory

New site goes live on Monday, August 3rd!

2009-07-31T08:23:00.002-04:00

As mentioned previously, I wanted to update the appearance of the blogsite, and add a little bit of functionality to it to make it more useful for our clients...

First, we went to a white background. Teresa Duncan had advised me that the white type on black background was a little hard on the eyes, so...

Next, we added a toolbar that will allow for the viewing and downloading of our Fee Schedule and Rx Form, plus a Web Special button. The idea behind the Web Special is to incentivize more clients to return to the blog more often. We'll see...

We also added a Contacts button that provides easy access to our address, phone numbers as well as email addresses of key people at the lab, plus a special email address to be used to send case information and photos.

On the sidebar, we chose to display only the last three posts - the Archives and Categories widgets were made to operate as drop down menus giving the format a cleaner, simpler appearance without sacrificing function.

We eliminated the Google Words ads between the posts, instead choosing to display advertisements from select companies - businesses which we think will be of interest to our clientele, and have excellent reputations for customer support. Please feel free to click on the ads to go directly to the websites of our sponsors. Just don't forget to come back!

Below the ads, you'll see a widget that tracks the daily price of gold and other precious metals - just a simple reminder that alloy ain't cheap, and there are alternatives available.

Lastly, if you scroll all the way to the bottom of the blog, we've added a Google Maps widget displaying our location. If you click on the pin, you can access driving directions from your location to ours - an excellent tool to help you and your patients who may need visit our facility.

I hope you like the changes. As always, we are open to suggestions, so please feel free to leave your comments.

PS - We changed the name of the blog to saylorsdentallab.com. The current site will remain up, but you will be redirected to the new site come Monday.

Off-Brand Zirconia - Worth the Risk?

2009-07-30T07:00:00.004-04:00

Late yesterday, I received a call from a small lab in Georgia. The woman on the phone asked if we outsource our zirconia copings/frameworks, or did we mill them in-house? When I replied that we outsourced the millings, she asked what type of scanner we were using. I told her we did primarily Lava, but that we also used 3Shape forWhipMix's Vericore and NobelProcera.

She then offered a price on the Lava millings, which was competitive with what we are now paying our current Authorized Lava Milling Center. After I expressed my disinterest, she then offered an off-brand Zirconia - Crystal - for $15 less per unit than the price we are currently paying for Lava. Having never heard of Crystal before, I told her that I was more than a little suspicious of off-brand zirconias. She went on to assure me that my clients would never be able to tell the difference. She brought up an example of one lab that had switched and was saving themselves in excess of $5,000 per month!

The whole conversation made me a little queasy.

First, do you think for a second that the lab experiencing the savings has told its clients that its now using a potentially inferior zirconia?

Secondly, suppose the clients knew and were happy to use Crystal because of a slightly reduced lab fee? Assume that the lab passed the entire savings on to the dentist - is $15 per unit really worth risking your reputation?

We at SDL take great pride in our workmanship, and that includes tightly controlling the quality of the materials we use. That's why participate in the Identalloy program, and offer only branded restorative options like Lava, Empress Esthetic, eMax, etc... And, we invite our clients to visit our facility at any time to verify our protocols.

Peace of mind. Just another reason to work with us...

For more information

Contact Mike Malone

at mikem@saylorsdentallab.com

or 800.678.7354

Celera Denture Technique Update

2009-07-29T05:00:00.001-04:00

On Monday, I shared with you that our own Mike Malone and Al Rodriguez had attended last Saturday's co-sponsored (3M ESPE / Imtec) continuing education event featuring mini-implants and the Celera Denture Duplicating Technique. Here's Mike's take on the Celera portion of the program -

"The Celera method uses a patient's existing denture as a reference, eliminating preliminary impressions, custom trays and wax rims. A wax pattern of the existing denture is easily produced creating a highly predictable 3D blueprint of the patient's new denture.

It cuts the treatment time in half!

When looking at ways to save time, and therefore money, we think this system will become a common practice for clients."

We believe in the system so we purchased both starter refill kits for your ordering convenience. If you would like to learn more please contact Mike at 703-361-4176 or mikem@saylorsdentallab.com

Cadent iTero Cases - Follow-up...

2009-07-28T08:32:00.007-04:00

We just completed our first four Cadent cases. My overall impression of the models is just as I expected. I like working on the models better than the Lava COS models because they feel more like a conventional stone cast, and the dies are easier to remove from the model base. However, I prefer the Lava COS protocol that delivers both a working model and a solid model for refinement of the proximal contacts.

The Cadent model serves both as a working and solid cast - a situation that can cause extra work in the lab as it is difficult to seat mesial and distal contacts simultaneously - one or the other always seems to open up right at the end of the seating process making a small porcelain addition necessary.

One of my blog readers made a comment that it is possible to order the Cadent model with removable dies adjacent to the prep dies. I need to look into this, but I wonder if that adjustment in the model fabrication method would result in overly tight contacts as the dies adjacent to the preps might be prone to micro-movements. I will talk with our Cadent rep, and let you know what I find out.

In the meantime, here are some photos of two of the finished cases -

1. Occlusal view of a 3-unit bridge.

2. Buccal view of 3-unit bridge. One interesting item of note - The Cadent dies feature what I would describe as a "dual ditch". The margins are delineated from the die stump by a flat area, approximately 0.5 mm in width, below the actual margin. The actual ditch of the margin is located cervical to the flat area. This was a little confusing at first as every die looks as if the margin type was a shoulder with bevel. I personally would prefer a small ditch directly under the margin to minimize the opportunity for errors during waxing and finishing.

3. This is a view of the 3-unit bridge on Cadent's full arch articulator. The red mark on the opposing cast indicates where we trimmed the model to provide adequate space for a PFM restoration. The articulator was easy to work with, but I think Cadent should look into providing some type of pin to prevent overclosure during seating of the occlusion. This particular case had no posterior stops, so we had to be very diligent to create an open occlusion on the molar abutment. It is Cadent's contention that we could disk off the "strut" that is used to attach the models to the Cadent articulator, and remount the case in the lab on a conventional articulator; or they have jigs available that allow for the models to be mounted on a Denar instrument. I'm sure we will gain experience with both of these methods in the future, but we were operating under time constraints, so we proceeded with the cases as provided.

4. Just an occlusal view of an upper first molar crown. The only reason I'm shown this is to note the remnants of the red articulating paper present on the adjacent teeth. This is the appearance of the model after several minutes of attempting to steam clean the model - does not make for an attractive presentation, but I guess I'll have to live with it...

As the prescribing dentist resides in Alaska, I hope to get his feedback as to the fit and occlusion some time next week. Will update you with his comments.

Imtec Mini Implant Seminar Update

2009-07-27T12:07:00.002-04:00

This past Saturday, our own Mike Malone and Al Rodriguez attended an all-day seminar we co-sponsored with 3M ESPE / Imtec. Topics covered included the placement and restoration of mini-implants, as well the Celera Denture Duplicating Technique. In the interest of time, Mike has written the following, short review of the mini-implant portion of the course. His summary of the Celera portion of the course will be provided later this week -

"Interesting seminar this weekend on the Imtec MDI "mini implants". The speaker was Prosthodontist Paul Mullaseril DDS MS, who currently teaches at Eastern Washington University, and previously at the University of Oklahoma College of Dentistry for 11 years. Dr. Mullaseril has trained over 2000 dentists - half of whom were trained specifically on this technique.

Because of limited space, I will spare you all the details of what we learned. However, we came away with a greater knowledge and appreciation of this technique and can absolutely see the benefits it will bring those who incorporate "mini implants" into their practice.

Some of the highlights of the system are:

*A growing market - $14 million in 2005 to an estimated $55 million in 2010.

*A rapidly growing target market - baby boomers

*Cost effective alternative for your patient

*New profit center for the doctor

*Minimally invasive, easy and relatively quick technique with 90%+ success rate.

I think the highlight of the day was Dr. Mullaseril's video of an MDI implant surgery from which the patient walked away with his new implant-retained denture in under 2 hours.

SDL sees the use of this technique much like we see other restorative decisions - There will be patients who do and do not fall within the parameters set forth by the doctor. While "mini implants" will never fully replace the traditional implant, we do believe their use will increase exponentially because of increased acceptance by industry leaders and an increasing potential patient base..."

If you would like more information, including an Imtec MDI technique video, please call Mike Malone at 703-508-1245.

Cadent Responds...

2009-07-24T05:00:00.003-04:00

Here is the response I received from my Cadent representative regarding the issue discussed in my previous post (I have edited out the names of individuals)

" 1) The doc should have been able to see up close and in person that the teeth were not parallel. If he looked from the buccal and used the “Graphing Tool” in the software it would have been apparent to the doc that further prep was needed._________ the local rep will follow-up with the doc, review the tool and provide additional support/education.

2) We rely on our lab “partners” to pick up variances such as parallel. I recommend you think of our “external” processes very much like your model and die room. It is not until the case is poured and pinned that such discoveries are made normally in the lab. In this case, whatever remedy you have made conventionally in the past applies to the milled model. Meaning if you created a reduction coping, modified the die or communicated with the doc on the next step then the same applies to the “external” lab process.

3) Tools are available to “partner” labs similar to those of Lava COS to modify and correct the digital file. This requires additional investment however it is not necessary normally to achieve good outcomes. Since you and the doc are learning the system, I would place this in the “getting to know you” category. As the doc does several more cases and become more fluid with the system, I expect issues like this to not happen again.

4) I recommend we provide the doc additional education and work with him on how to “read” the digital impression during the case. This should take probably a few more cases. One dramatic difference between our system and others is the short learning curve. Reading the digital file is important for all systems. Thankfully learning to read on iTero is very quick and straight forward.

In the end, I apologize for not cluing you into this as a possible scenario. Since I don’t have a crystal ball it would have been impossible to see such an issue coming forward. ____took your feedback and will work internally to add additional value to external lab processes."

I call that an acceptable answer and appreciate that the company seems to be interested in taking a proactive stance. I should be posting pictures of the finished cases this weekend...

Cadent iTero Update

2009-07-23T02:26:00.000-04:00

One of the topics of discussion from yesterday was about a marginal undercut present in a Cadent-fabricated model that we received last week. As stated, the undercut was clearly visible on the digital files that we received from Cadent - as shown through our 3Shape CAD/CAM software. The milled model also clearly demonstrated an undercut on the molar abutment of the three-unit bridge in question.

So, why was the model milled as if everything was hunky-dory?

The answer lies in Cadent's business model vis-a-vis dental laboratories. They offer three tiers of participation. The top level includes full access to the actual digital impression data including the ability to mark margins and download said data into the CAD/CAM package of choice. The second level enables the lab to view the digital files after Cadent has processed the data and marked the margins - the lab does not have the ability to mark the margins at this level - as well as access the data inside the lab's own CAD/Cam software. In effect, this allows the lab to quality control the data before the model is created. The third tier - the one on which we currently reside - simply provides the model work to the laboratory of the referring dentist's choosing.

At this final level, Cadent processes the data, marks the margins, and creates the model - without input from the dentist or lab, unless their team of technicians decides the problem makes a particular case "unworkable".

Well, somebody at Cadent saw the scanned image of our bridge, and decided he could get the model milled if he programmed a dual path of insertion. He didn't inform the dentist that there was a potential problem; nor did he ask me for my opinion. He simply made a unilateral decision. The problem is that while he could create a dual path of insertion for his milling machine to create a ditched die, I can't do the same in the laboratory because I have to deal with adjacent teeth that will not allow for a path of draw once a full-contour restoration is fabricated.

I spoke with an engineer from Cadent and told him that this decision was basically setting me up for failure and a potentially costly remake for both the dentist and myself. He assured me that he would make my concerns known to Cadent's Operations Group.

I suppose I will have to consider making the investment to upgrade our involvement with Cadent to augment our position with Lava COS. Prudence dictates I may wait a bit before pulling the trigger on that move...

A Veritable HodgePodge...

2009-07-22T06:52:00.004-04:00

Just a few quick updates -

1. We are set for our NobelProcera training to begin the first week of August. The first component of the training will be done in-house and encompass copings and abutments. That will be followed by a trip to Mahwah, NJ, August 14/15, for advanced training using the BioCad software for implant overdenture bars and hybrid frameworks. I will be attending, as will the latest addition to our Removables staff, Mr. Al Rodriguez. Updates to follow.

2. I know I promised pics of the Cadent iTero cases that are currently being processed. We hit a little bit of a snag when downloading the digital impression data into our 3Shape scanner. It seems the 3-unit bridge image contained a pretty severe undercut in the preparation of the molar abutment. I have a call into Cadent (for 2 days now) and have yet to get a response to my question as to why the model was processed with this undercut. It seems to me that either the chairside scanner software should have picked this up, or, if not at the time of the impression then during pre-modelling processing at Cadent?

3. As a brief aside to a previous post about technology in development to "print" ceramic crowns using an ink jet-like process, I recently received an email from an industry leader mentioning that he had been informed that Envisiontec has developed a zirconia that could be printed using their current wax printer. I checked with "my guy" who said that there are plenty of people working on similar ideas, however - 1. Envisiontec has developed a reputation as a company that generates a lot of hype, but sometimes fails to deliver. My Guy thinks it may be as long as three years before we see such technology, and 2. There are evidently easier ceramics to print than zirconia.

I honestly have no relationship with Envisiontec, and can't comment on the first assertion. The second assertion leads to many questions, such as What materials? How strong are these materials? Will these materials come in different shades, or be "shadeable" post-printing like zirconia is after milling? Will there be issues derived from the sintering process of such materials?

I know one thing - in lieu of the potential development of such materials, I would have to seriously question the value of investing in any in-house zirconia milling solution. The best course of action for small to medium-sized labs will continue to be outsourcing the milling - and, eventually printing - of the zirconia substructures. Technology is simply changing too fast to put all your eggs in one basket...

The Holy Grail of CAD/CAM - Ink Jet Ceramics???

2009-07-20T15:47:00.002-04:00

I just finished reading an article in "dental lab products" about what may be the ultimate in CAD/CAM technologies for the dental industry. The article describes a research project currently underway at the Georgia Institute of Technology in which a team of scientists are developing the ability to use ink jet printing technology to deposit microscopic layers of shaded ceramic material on either metal or ceramic substructures.

The chief researcher, David Rosen PhD, claims to be less than 6 months away from having a viable, working prototype that would enable the three-dimensional printing of ceramic restorations, pursuant to the necessary funding. He goes on to describe how the next step in the process would be to link digital imagery to the ink jet process. The digital image capture units would determine the shading and characterizations of the patient's adjacent teeth to drive the ceramic deposition process ensuring an exact color match.

Scary stuff if you've spent your whole life learning the "art" of dental ceramics. Sometimes I feel like the buggy whip maker just before Henry Ford arrived on the scene...

Cadent iTero and 3Shape - A Digital Revolution.

2009-07-17T06:00:00.001-04:00

Earlier this week, I wrote a post about our having received our first batch of Cadent iTero models fabricated from a digital impression. Being cautious, we decided to process the cases in a traditional manner which for us involved scanning the models in our 3Shape scanner and then using affiliated CAD software to design and print the wax-ups for the metal substructures - two copings and one three-unit bridge.

To ascertain the feasibility of investing more heavily in in the Cadent system, I had the company send me the digital files of the impression for the bridge to see if we could download the file directly into the CAD software without having to physically scan the model. This would eliminate the need for us to scan the model, and enable us to begin working on the case even before the models actually arrived in our facility.

I have to say, the process worked beautifully.

This opens a whole host of possibilities as the 3Shape software is extremely versatile enabling for the design of everything from simple copings and frameworks to full contour patterns and pressables - even implant abutments. We can even design and have milled our Vericore zirconia substructures using the digital impression data.

Pretty exciting. Check the blog on Tuesday for a complete update - with photos! In the meantime, if your interested in any of the digital impression systems, please call Mike Malone to arrange an informal lunch-and-learn for your office (800.678.7354)

Lava COS Margin Marking - We've ARRIVED!!!

2009-07-16T05:00:00.000-04:00

Just talked with our 3M ESPE Lava COS Specialist, Mark Senkowski, who informed me we are now cleared to use our COS Margin Marking software for other laboratories. This is great news as we are now one of only three labs in the country eligible to provide this service.

We recognize that we can't be all things to all people. The average dentist uses 3-5 laboratories, so it would be naive to think that our clients don't send the occasional case to another facility. Now, the fact that a client would want to remit a case to another lab doesn't imply an impediment to using Lava COS' digital impression technology to fabricate the model work - for any laboratory of your choice.

The fee for this service will be $8 per preparation. If you have any questions, please call me @ 800.678.7354 or email @ rjsaylors@gmail.com

Changes on the way...

2009-07-15T07:10:00.003-04:00

I started this blog roughly three months ago using Google's Blogger online software. I went that way to minimize costs and to insure that I was willing and able to put in the effort to provide meaningful content on a regular basis. I am now satisfied - because of comments made by the readers - that the blog offers useful information for our clients, and that many industry players come here for my opinions regarding new technologies.

With that in mind, I have engaged a local firm to help update the appearance and functionality of the blog site. In addition to posts, you will also be able access PDF files of our Rx form and our Fee Schedule - including special fees available only to those folks who visit the site. We will also be adding a Contacts List which will make it easier for clients to communicate directly with myself and other key employees.

In effect, the blog site will function more like a "living" website as opposed to a static representation of the laboratory's products and services in hopes that you will continue to visit us as the content changes.

We will also be changing the address of the blog site to SaylorsDentalLab.com, but should you use the current address, the software has been set up to simply redirect you to the new site.

Thank you for your continued patronage of our site. I hope you find the changes we are making useful, and please feel free to make suggestions.

Great Learning Opportunity from 3M ESPE for Lava COS

2009-07-14T12:30:00.004-04:00

One of the key pieces of information most doctors want before purchasing
new technology is discussion with another doctor who has already made the
commitment. 3M ESPE has created a way to accomplish this by hosting live
Webinars. These on-line forums, which can be experienced from office or
home, include a digital impression case presentation and on-line discussion
led by an experienced Lava COS user (over 150 cases submitted).

There is no charge for this Webinar, but you must pre-register to reserve
your spot. Your seat is paid for by 3M ESPE, a proud supporter of CE for
the dental professional. The first 100 registrants will be able to
participate in the live Webinar, and will have the opportunity to e-mail
questions directly to Dr. Smith during the Webinar.

Presenter: Richard N. Smith, DDS
Topic: Lava™ Chairside Oral Scanner C.O.S. — Better Dentistry with
Digital Impressions
Date: Tuesday, July 28, 2009
Time: 7:00 - 8:00 PM Central

Second, Lava 2.0 software update for the Chairside Oral Scanner is now
being installed on user systems. Version 2.0 is AWESOME! The enhancements
will not change the way dentists currently scan. It will improve scanning
and the process of assessing scans. These enhancements will increase user
confidence in the accuracy and completeness of their scans and the
resulting models. And, there will be less scanning chair time for users
and their patients.

Cadent Models Arrive - Pretty Impressive...

2009-07-13T10:16:00.008-04:00

I've mentioned in past posts that we have a client in Alaska who was in the process of selecting a digital impression system. After test driving the three major players on the market - 3M Lava COS, Cadent iTero, and Cerec - he chose the Cadent system for ease of use. He specifically liked the absence of any powder in the process, as well as the ability to rest the camera on the teeth rather than hovering over the teeth to maintain the proper the focal distance. I'm not commenting on the superiority of one system over another - just reporting his personal preferences.

This morning, we received our first three case from our Alaskan friend - through Cadent - and I thought I would provide you with my initial gut reaction to the quality of the models versus those we've been receiving from our Lava COS clients.

First, the Cadent models look more like conventional stone models. Not sure this is a big deal one way or the other, but that feature may provide some comfort to the more traditional among us. There is a major difference in the way the models are manufactured. Where Lava COS models are "built" using stereolithographic technology, the Cadent models are milled using a buff-colored polyurethane. My observation here is the Cadent models are smoother - the Lava COS models exhibit a striated appearance under magnification which I assume occurs as the polymer resin is incrementally cured. I will say that these striations don't seem to be clinically significant as we have had nothing but glowing reviews for the fit of our COS restorations.

Second, the Cadent models are interesting in that one model serves both as a working model and a solid, contact model. The "pinning" technique may remind some of you of models that were fabricated using the old copper tube impression technique. I think this may provide for some difficulties when margins are placed even slightly subgingival. Also, most ceramist I know prefer to seat one contact at a time on the working model and then make the minor adjustments necessary to fit the contact model. I can see trying to fit two contacts simultaneously as being a little bit of an issue, but not an insurmountable one. The more traditional approach of the Lava COS protocol providing a working model and a separate solid model appeals to me, however the "pinning" of the LAVA COS models leaves a lot to be desired as the individual dies are excessively difficult to remove from the articulator.

Lastly, Lava COS models arrive at the lab with each case mounted on its own articulator, which is then returned to the doctor with the final case. Conversely, each Cadent case arrives with just the working model and opposing, pre-drilled to be mounted on a Cadent articulator - either a quadrant or full arch articulator depending upon the doctor's scan. The Cadent business model has three different levels of participation for labs, each providing a higher level of accessibility to the scan data as well as a higher number of articulators. As we have only one Cadent client at this time, we went with the minimum investment which provides only two articulators. This is already an issue, as we received three cases today, so we will have to do some logistical juggling to make the system work. However, I can say with confidence that should we get good feedback regarding fit and function of our Cadent restorations, we will be upgrading our position.

Lastly - yes, I know I've already written that once - I do like that Cadent requires the doctor to "mark" his or her margins. I've had a few problems with the Lava COS margin marking software where fluid has provided for potential misreading of the margins. In these instances, the folks at 3M have had to step in using a software fix to provide a clearer view of the tooth structure. I felt the process took an inordinate amount of my time, and all I kept thinking was if the doctor had to mark his own margins, he would have noticed the problem right away and simply rescanned.

Call me a dreamer...

I will make further comments as the Cadent cases work their way through the laboratory.

NobelProcera - Blown Away!

2009-07-09T16:17:00.002-04:00

Steve Gilbert - our local Nobel Biocare Rep - came in this morning and did a 45 minute presentation on the capabilities of the new NobelProcera Scanner and software. I knew the software was loaded with functionality, but to see the programs in action was simply too cool.

The Copings module is definitely more user-friendly with the ability to design in full contour and then have the software do an automatic cutback for the veneering porcelain, thus insuring optimal ceramic support. And, I was glad to see that the software engineers kept the Profile View for margin marking as this feature makes it possible to really nail the fit of your restorations.

The Bridges Module has been completely revamped with a much more intuitive user interface, and gives us the ability to fabricate frameworks up to 14 unitsin length, in 4 different shades of zirconia, as well as titanium and chrome cobalt alloys. Again, the design platform encourages working in full contour mode and using the auto cutback feature to insure proper design. The on-screen connectors even change color to warn you of potential errors in your "wax-up".

The above modules, together with the Procera Implant Bridge module, would be enough to make the system worth the cost. However, Nobel Biocare included two other Modules which make me anxious to get my hands on our system (End of July delivery - Training in mid-August).

First, the Abutments Module features true CAD processing, enabling us to scan your implant model and design your custom abutments on-screen using either our own diagnostic wax-ups, or an auto-generated diagnostic image ensuring proper placement and angulation. The abutments themselves are fully-customizable including emergence profiles and collar heights relative to tissue position. There's even a Grouping Function which will automatically parallel abutments should you prescribe a splinted final prosthesis. Of course, all of Nobel Biocare's platforms will be supported, as well as Biomet 3i, Straumann and eventually Zimmer, and all will be available in titanium as well as shaded zirconia.

Last, but certainly not least, is the BioCad Module. This one just blew me away. With this program, we can custom design just about any titanium implant bar for overdenture or hybrid applications. The software stores a virtual cornucopia of bar styles and attachments which can be placed and manipulated to your exact specifications using a transparent image of the "final" prosthesis as a guide. A jpeg image of the design can even be emailed to you for approval.

All-in-all, I think this Nobel Biocare package is going to be a game changer giving serious competition to a few systems that currently dominate the market.

NobelProcera Training set for August

2009-07-07T12:48:00.006-04:00

I've mentioned in past posts that we have purchased Nobel Biocare's new NobelProcera Scanner -one of the first 60 labs in the country to do so - and I've just learned that we should be up and running by the end of August.

The scanner is currently in transit, and once it arrives we will receive in-house training on the first two modules - Copings and Implant Abutments. After successful completion of that session, we are slated for a weekend in beautiful Mahwah, NJ for an intense two-day meeting featuring additional modules on Bridges, Procera Implant Bridges and BioCad applications.

Additional modules - including the capacity to scan impressions and output physical models - are in the works for later in 2009. I will keep you posted as we move through the various processes.

Nothing Dental Today - Let's talk Solar Energy....

2009-07-03T06:56:00.003-04:00

I had an experience this week that I thought many of you might find amusing - or disturbing - depending upon your political bent.

With all the talk recently of alternative energy sources and the potential for a Cap-and-Trade system which many believe will drive up the cost of power - at least in the short term - for American businesses and households, I thought it would be a good time to investigate my options. For those of you who don't know, the laboratory facility is an 8000 sq.ft. building with a flat roof and virtually no shade, so a solar array seemed like a viable choice.

Did my homework, and contacted a a regional company which specializes in solar installation to come and do a cost/benefit analysis.

Let's say there was a whole lot more "cost" than "benefit".

Keeping it simple, a $58,ooo investment ($70k minus an immediate federal subsidy of $12k) would provide me with a 900 sq.ft. array consisting of 60 3'x5' solar panels that would deliver enough juice to offset my annual electricity expenses by a whopping $1440/yr. At that rate, it would take over 40 years to recoup my investment - and that's counting the federal subsidy!

A more expensive, larger configuration would generate three times the power of the smaller grid, and would reduce the time to recoup the expense to only 14 years.

I was told that the reason the cost-to-benefit ratio was so bad was that Virginia power is derived mainly from coal-fired plants (My cost per kilowatt hour is only $.12 versus Maryland and DC's cost of roughly $.18) that are the main targets of the administration due to the carbon emissions.

So the question becomes just how much is the Cap-and-Trade policy going to add to our power costs? And, if solar energy becomes more cost competitive, will the cost of the panels themselves go down due to economies of scale? Or does someone figure a way to burn coal cleanly?

I don't have the answers, and I'm not spending $58K and waiting 40 years based on a hunch.

Just something to think on...

Have a great Fourth of July!!!

WhipMix announces 31 Flavors of Shaded Zirconia Abutments!!!

2009-07-01T14:00:00.009-04:00

Yeah, I know - lame attempt at humor. (You write a blog for a couple of months and see what happens to you).

Anyway...

Just heard from Stuart Steinbock of WhipMix that they have received final FDA approval for fabrication and sale of their Vericore Shaded Zirconia Abutments for 31 different implant platforms. (To see the full story on Vericore Abutments, click here).

The complete list of available platforms is as follows -

Please take advantage of our special introductory Vericore Implant Package fees!

Tissue Model / Vericore Abutment / Crown (Vericore / Lava / e.Max): $599

(Allow 6 working days for processing of the your Vericore Abutments and an additional 6 days to fabricate your crown of choice).

Should you have any questions, please contact Jeff Saylors s @ 800.678.7354

Feedback on Rx Design...

2009-06-30T06:05:00.002-04:00

With all the new technologies that have hit the market in the last year, we think its time to design an Rx pad that reflects the changing times. And, rather than simply update the old look and feel of our past prescription pads, we're rethinking the whole dynamic of this basic tool of communication.

To that end, we're asking our readers for ideas and opinions on what they would like to see in an Rx. Please post your comments to the site, and we'll do our best to incorporate any information provided into the design.

Thanks, Jeff

eMax HT - Maryland Bridge Application?

2009-06-29T05:00:00.000-04:00

Quite often in the laboratory business, we are asked to do something that is - how should I put this -a compromise?

Last week saw just such an occasion when one of our clients presented us with a case involving a young patient with a congenitally missing lateral. Given the age of the patient, an implant was not considered a viable treatment option, although that would probably be the restorative therapy of choice in the future. Our client also was wary of using a traditional Maryland Bridge because the patient's teeth were exceptionally translucent and it was feared that the metallic wings would cause an extreme shade shift in the abutment teeth. Lastly, the patient did not want a removable solution, nor were the abutment teeth to be prepared.

As my magic wand has been on the fritz lately, I had to come up with a less preternatural approach.

Thank goodness for Ivoclar's e.Max HT material.

As you can see from the picture below, we were able to wax and press an all-ceramic Maryland Bridge with full lingual retainers measuring less than .4mm in thickness on the abutment teeth that could be etched and bonded into place using Ivoclar's Variolink luting composite.

Even though the material exhibits a flexural strength of 400 mPa, I am still crossing my fingers given the patient's age and growth potential. We will continue to monitor the case to let you know if anything untoward occurs....

Procera Zirconia Abutments - The Rebirth of the Screw-Retained Implant Restoration?

2009-06-24T19:37:00.004-04:00

In Poker, you have to play the hand your dealt.

The same principle holds true for implant restorations.

When we began restoring implants back in 1987, most of the single-tooth restorations were screw-retained crowns. In our efforts to maximize esthetics, we routinely built the ceramic around the screw-access hole. The restoring dentist would screw the crown/abutment complex into place; carefully adjust the occlusion; and cover the screw hole with direct composite. Quite often, even after everyone's best efforts, the unsupported porcelain surrounding the screw hole would chip, ultimately leading to the failure of the restoration.

Thus was born the crown-over-custom-abutment concept.

At first, we waxed and cast the abutments. Now, we design them in various CAD programs. And, we are no longer restricted to metal abutments. Zirconia has proven itself to be a more than adequate alternative for cases where esthetics is critical.

Back to Poker...

In the case pictured below, we faced some long odds. First, the implant was placed to the lingual. If we had completed the case with, say a Lava crown over a zirconia abutment, we most likely would have ended up with an unnaturally contoured incisal edge for a mandibular incisor. Also, due to the limited mesial-distal width, there was little chance of squeezing an abutment and crown into the available space.

So, we went with a Procera Zirconia Abutment (Nobel Active platform) directly veneered with Creation Zi-F Ceramic.

I think the esthetics turned out really well, and we were able to achieve a nice emergence profile and natural contour - no overcontoured incisal edge to detract from the final result...

kinda like hitting a gutshot straight draw on the river!

SDL Ceramists get Advanced Training @ IDEA

2009-06-24T09:59:00.004-04:00

We are always trying to stay one step ahead with regards to the quality of our restorations, and one of the tools at our disposal is to provide our technicians with advanced, hands-on continuing education opportunities. With that in mind, I'm pleased to announce our participation in two, upcoming seminars with two of the world's most creative ceramists at the Interdisciplinary Dental Education Academy (IDEA) in Foster City, CA -

On August 20/21, the newest addition to our staff, Mr. Dusty Cooper, will be working along side Mr. Oliver Brix, MDT on The Foundations of Color. Mr. Brix is internationally renowned for his skills and will be teaching his advanced principles of esthetics including color management, translucency vs. opacity, light dynamics and a systematic build-up technique - including the placement of internal effects - to achieve truly life-like results.

Then, on November 20/21, I will be attending Mr. Otto Prandter, MDT course on Replicating Nature with Implants. Mr. Prandter's course will focus on optimizing emergence profiles; the creation of site specific custom abutments; achieving a match between implant-supported and tooth-supported restorations; and the fabrication of surgical stents.

Follow our blog for upcoming posts where we will display photos of our course work...

Celera Denture Technique

2009-06-23T10:56:00.002-04:00

It happens every day - a patient presents to your office with an old, worn denture and you tell him or her that it may be time to replace the existing appliance. The patient demonstrates a certain reluctance because "my old denture is comfortable - can't we just "fix" it?" You both know that a new denture is (more than likely) going to require a certain period of adjustment which no one is going to enjoy.

So, what do you do?

Now, using Imtec's Celera Denture Technique, you can confidently treat your existing denture patients using their current denture as a reference while eliminating the need for preliminary impressions, custom trays and wax rims. The user-friendly Celera Arch Refill Kit - complete with all the materials and easy-to-follow video instructions - will enable you to predictably deliver a high-quality denture in three visits.

You can also use the Celera technique to create a clear surgical stent and open tray to assist in the planning of implant-retained dentures. And, the same technique is easily modified for use with guided implant surgical treatment plans.

For more information, contact Al Rodriguez, or to order your Celera Kit contact Mike Malone @ (800) 678-7354.

Live Lava COS Webinar - June 23, 2009 (8:00pm-9:00pm)

2009-06-22T10:16:00.003-04:00

3M ESPE is hosting a live Lava COS webinar tomorrow night (6/23/2009) for the first 100 participants to sign up. The presenter is Dr. John F. Weston of La Jolla, CA. He will offer insight into his experience with COS digital impressions and the positive effects the technology has had on his practice and patients. (CE Credits - 1 hour)

To sign up:

Click: http://espertiseinteractivelearning.com/

Once at the site:

1. Click "Register" to open a free account to earn CE credit.

2. Create your free training account.

3. Reserve your seat for this live, online presentation! The webinar will be available on a

first-come, first-served basis.

Happy Father's Day!

2009-06-21T06:03:00.003-04:00

Lava COS Margin Marking Update!!!

2009-06-18T14:18:00.003-04:00

The folks at Brontes recently updated the margin marking process for the Lava COS Laboratory software, and - as far as I'm concerned - they hit the ball out of the park!

Prior to this latest iteration of the software, the user was required to identify points on the margin fully-circumferentially which was a tedious and pain-staking task in some instances. Now, the user only has to identify the first three points on the margin, then drag the cursor inside the margin line for the remaining portion of the margin and the software automatically identifies what it thinks is the most likely margin. It even provides different colored markers depending upon how sure the software is of its own decision - talk about artificial intelligence!

Of course, its still recommended that the user verify each point along the margin line using the profile and 3D views, but the margin marking assist feature makes a huge difference in the time it takes to complete the task.

Kudos for a job well done...

Atlantis Zirconia Abutment now available for Straumann Bone Level Implant

2009-06-17T17:06:00.002-04:00

Short post.

Not much I can add to the title - just wanted to let you know...

Atlantis Abutments now compatible with Straumann Standard/Standard Plus NN (Narrow Neck) Platform

2009-06-16T06:35:00.003-04:00

We just received a new FLO insert (scannable position marker) for use with our Lava Scanner that now enables us to offer Atlantis Abutment solutions for the Straumann Standard/Standard Plus NN (Narrow Neck) implant. Currently, only Atlantis Titanium and Gold-Shaded Titanium Abutments are available - no zirconia.

Keep in mind, on cases involving single implants, you can take advantage of our ability to remit your orders through the Lava Remote Scan process which saves you both time and money - your case arrives in Atlantis the day after you send it to us and the only shipping fees incurred are for the return trip to our facility from Atlantis.

SDL to accept Cadent iTero cases

2009-06-15T12:45:00.002-04:00

We have a client in Alaska who recently pulled the trigger on the purchase of a Cadent iTero digital impression device. In order for him to be able to have the SLA models shipped to our facility, we needed to become an affiliate iTero laboratory. For a small investment, we receive a couple of articulators on which to mount the SLA models. There are two, additional levels of participation for laboratories, which we will explore once we have a little more experience with the process.

Incidentally, our client did some hands-on research with both the Lava COS and the Cadent systems, and settled on the iTero unit because he was able to rest the image capture device on the teeth to capture the necessary images. This is in contrast to the Lava COS modality which requires the user to "hover" a video wand over the teeth within a prescribed focal length.

I will offer my views on the laboratory process for both systems in upcoming posts.

Lava COS Testimonial

2009-06-11T21:21:00.004-04:00

Had a great meeting today with Drs. Ron Rosenberg and Larry Goldbaum of Rockville, MD. These two gentlemen were our first two clients using 3M ESPE's Lava COS Digital Impression System. As stated before in previous posts, we've completed about 15 cases to date, and last time I reported on a couple of our misfires.

This time I'd like to share with you our success stories - and, just like the old cliche, a picture is worth a thousand words...

What you're looking at is a radiograph of a Lava crown placed on the patient's upper second bicuspid. According to Dr. Rosenberg, this is the typical fit of his COS restorations - nothing short of perfect. (I'd also like to point out how the Lava substructure has been modified for proper support of the veneering ceramic - a critical factor in the success of any zirconia restoration.) Dr. Rosenberg went on to mention the virtual elimination of any proximal contact or occlusal adjustments during his seating appointments, which dovetails nicely with 3M's own statistics stating that COS users are seeing a 41% decrease in seating time of their restorations fabricated from digital impressions.

Dr. Rosenberg and I discussed doing a video demonstration of the complete process of fabricating a Lava COS 3-unit bridge so we could share the ins and outs of his impression technique - He was very honest in his assertion that there is a small learning curve, but the results have been well worth the effort - and, I could provide a more in-depth look at what happens in the lab once the impression data is captured. I will be sure to post an update as soon as we "go to print".

Thanks to both Drs. Rosenberg and Goldbaum for their continued support and enthusiasm!

Pressable Ceramics

2009-06-10T06:00:00.010-04:00

It seems like we've been doing pressable ceramics since I was wearing short pants - not quite, but the process has been around a long time since Ivoclar introduced Empress roughly 16 years ago. Currently, the combination of Empress Esthetic for veneers and full crowns in the anterior region, and either e.Max LT or HT for crowns/inlays/onlays/veneers anywhere in the mouth provides our clients with a suitable armamentarium for practicing dentistry virtually "metal-free".

Here's a couple of samples of our work that went out of the laboratory just yesterday -

e.Max HT - This lateral didn't require anything fancy, so we just waxed it full contour, pressed, and applied the shading medium. Incidentally, e.Max restorations can be cut back and layered for your more esthetically-demanding patients. And, don't forget - e.Max can be bonded or conventionally cemented (See past post on our e.Max/Multilink promotion).

Empress Esthetic - Personally, I would have gone with e.Max HT here. The fracture resistance is almost 3 times that of Empress Esthetic - a useful distinction in the posterior - but I wasn't calling the shots in this case...

Empress Esthetic - 6 veneers. Again, these restorations were pressed full contour and shaded. The prep design wouldn't allow for a suitable cutback - I need at least 1mm off the incisal edge to perform the cutback technique adequately, but still a pretty nice result...

Thanks to Ceramist Sue Kim for her excellent work in shading and glazing all the restorations pictured!

Crown in a Day? Bring your Checkbook...

2009-06-08T20:00:00.009-04:00

On Thursday of last week, I received a phone call from a long-time client asking if we could get him out of jam by doing a rush crown - overnight! We would receive the case via FedEx on Monday, and we would need to deliver the case to his office in Northwest Washington on Tuesday. Even though we had such a bad experience with our recent Cerec training, I came to the conclusion the only way to accomplish the mission - without staying up all night - was to mill an e.Max CAD crown, and pray.

The shipment arrived in our office about 9:30am. We completed our usual disinfection process and then fabricated the model and die. We made a bite registration over the prepared tooth using Ivoclar's Virtual CADBite, and then proceeded to scan/design/mill the proverbial "Blue Block" e.Max CAD Material.

Needless to say, the result was pretty poor. I will say that the contacts and occlusion were pretty good, but the morphology was suspect and the margins were borderline ridiculous. However, being "up against it," I decided to see if I could make it work.

I needed to correct the contour through porcelain addition which necessitated a wash firing prior to adding a layer of enamel ceramic. After two firings, the crown looked reasonable enough, so I went to glaze. Lastly, I relined the margins using a low-firing add-on dentin powder. This took an additional two firings, and a small amount of adjustment using a fine finishing diamond and polishing wheels.

Here's the result -

My final assessment would be that the whole procedure can be done, and probably even as a "same day" service. However, its more work than it needs to be due to the lack of precision of the Cerec InLab milling machine. If I had to do it again, the fee would have to be in the $375-425 range (not including shipping or courier fees), and pre-scheduling would be a must.

If you're interested, please call me to make your reservation...

Lava COS / Vericore Abutments / 3Shape

2009-06-05T09:39:00.006-04:00

The Lava COS presentation in Gaithersburg, MD went really well last night. Mark Senkowski, our local COS Specialist, gave a great argument for any office to purchase the 3M digital impression system based on new information gathered from early adopters.

For instance, Lava COS users have experienced an average 41% reduction in the seating time of their restorations due to the accuracy of the scanning device and the elimination of material expansion/contraction inherent to conventional impressions and stone models.

In addition, many users have experienced a rise in productivity by allowing their assistants to scan the opposing arch and bite relation - not to mention the elimination of time and material expense associated with the occasional "retake" due to air bubbles, pulls, tray show-through, etc...

Mark also pointed out that these early adopters are seeing an increase in patient referrals due to the comfort patients experience during restorative procedures. When you added it all up, it was a compelling argument to jump on the digital bandwagon.

Of course, getting to GBurg from Manassas is never a picnic, but I managed to use the time to talk with a couple of folks to get updates on a couple of upcoming developments...

First, Stuart Steinbock of WhipMix related to me that he heard from the FDA regarding the final approval of the remaining platforms for Vericore Abutments. It looks like everything is good to go for a late summer rollout. As you may recall, the four Noble Replace Select platforms are already available. Stuart assured me that they are ready to go with the other 27 implant types as soon as the government gives the go-ahead. (If you haven't heard of the Vericore Abutment, you can review all related posts by clicking on "Vericore" in the "Covered Topics" section on the main blog page.)

Next, I received an update from Rich Motto of CadBlu on the latest 3Shape software update which is in beta testing right now. Rich thinks the update, which will include inlay/onlay and veneer applications; a more robust coping/overpress pattern feature with improved tooth morphology, and an Implant CAD mode, is going to be truly special. I'm really looking forward to taking advantage of the improved coping/overpress application. I think if we can get this to work using Vericore substructures pressed with either CZR Press or Vita PM9, we could offer our clients a vastly superior restoration at a great value!

You'll know as soon as I do...

Lava COS Seminar - 2Nite in GBurg...

2009-06-04T05:55:00.003-04:00

I will be attending a 3M ESPE Lava COS Intro Seminar @ the Gaithersburg Marriott tonight from 6:00-8:30 pm. There are 30+ dentists registered. I hope to be able share our experience with the system to date.

So far, we've had two "hiccups", but the issue was the same in both cases, and I would chalk it up to working with a new client rather than anything wrong with system. Each case was a gold onlay for which the doctor cut a shoulder with bevel margin in the proximal box. As I marked the margin on the screen - using the 3D Vision Technology - I just missed the bevel. All the other margins fit perfectly. This is something that could very well happen on a stone model, as well, when the technician is unaware that the dentist has used that particular style of margination.

And, lest you think I'm an idiot for doing the same thing twice - I was unaware of the first remake until after the second onlay had been fabricated. Now, if I do it again....

Cerec Connect

2009-06-02T12:21:00.003-04:00

As a result of my rant on the Cerec Inlab system yesterday, I heard from a Sirona executive who was very apologetic regarding my training experience. As you might guess, he stood firmly behind his product, and offered to have one of Sirona's own trainers visit our laboratory sometime in the future to see if he could persuade me to change my opinion. It was a pleasant conversation, and I promised to keep an open mind.

We did discuss what I feel is the major shortcoming in the system - the seeming lack of robustness of the InLab milling machine. I inquired if it would be possible to continue to use the scanner and design software and have the restorations milled by an outsource partner like Diadem Digital Solutions, which uses a Roders industrial-capacity milling machine. I was told that while I was certainly free to pursue a relationship with Diadem, I would have to own an Inlab MC XL milling machine as a prerequisite to our participation in the Cerec Connect program.

So, at this point I will have to remove the little "For Sale" sign from my MC XL. I am going to contact Diadem and do a few e.Max CAD restorations using their process. I'll update you on the results in the near future.

Cerec? Not for me...

2009-06-01T09:00:00.003-04:00

Yup.

I know.

I'm going to make some folks mad with this post, but I can't, in good conscience, sit idly by without expressing my opinion...

I would never allow a dentist to place a Cerec restoration in my mouth.

I spent my entire Friday last week with a highly recommended "Cerec expert" who purported to be able to provide me with a "recipe for success" for achieving outstanding results with our Cerec InLab System. In retrospect, I should have known the day was going to be a waste when the "expert" began by denigrating the expected results before we even scanned the first case -(paraphrasing) "I did this course for a large lab in California, and they were not happy with the marginal integrity of the restorations. They examined the crowns under 8x magnification. I told them that their ceramists might be required to do a little work on the margins, but..."

Uh-oh.

So... the morning began with our instructor calibrating our milling machine and scanning device, and setting the software parameters to insure our equipment was "set for success". We then followed the procedures for scanning and milling a variety of restorations from single e.Max crowns to an Empress CAD inlay to a 3-unit zirconia framework. All-in-all, we produced eight different millings.

The results? Not one usable restoration.

That's right - not a single restoration without significant marginal issues (and, don't even get me started on the tooth morphology). Honestly, if I tried to send out the calibre of work that the Cerec machine produced, I am confident I would be out of business in less than two weeks.

Please don't write this off as the rantings of a bitter, old technician who's upset that Cerec is eating into his business. I was looking to openly embrace this technology as part of our commitment to working with digital impressions, which I see as the future of dentistry. I still feel that way, but my personal observations lead me to believe that the Cerec milling machines are simply not sophisticated enough to mill clinically acceptable restorations in a repeatable fashion. Are there guys and gals out there who can "make this thing sing"? Maybe. However, after my day with the expert, I have to believe there's an awful lot of "let the resin fill that marginal gap" going on out there.

So, at the end of the day, I'm still looking forward to working with Cerec Connect. However, I think our involvement will be limited to accepting the SLA models produced from the chairside scans, and then working with physical models. We will cast or press your restorations to insure an uncompromising fit - Heck, we may even scan the Cerec SLA dies on our Lava scanner and see what kind of fits we get from a "big boy" milling machine.

But, we won't be making any restorations with our Cerec milling machine. If you know anyone who would like to purchase a very slightly-used InLab unit, have 'em call me @ 800.678.7354

Confusion leads to a Retraction??? Lava COS vs. Cerec

2009-05-28T10:29:00.004-04:00

It has been pointed out to me that I may have misspoken in a previous post regarding the processing fees charged to doctors who purchase either a Lava COS or Cerec Bluecam digital impression device.

It was related to me that Cerec users would not be charged a fee to take a digital impression and remit it to a Cerec InLab user. That statement is true only for those dentists who currently own a Cerec 3 Unit complete with an in-office milling machine.

For new purchasers of Cerec's stand-alone Bluecam digital impression device, there are two options available: First - a dongle, or licensing fee, may be purchased that will allow the user to submit impression files at a cost of approximately $25/impression. That fee will vary depending upon the volume of dongles purchased. The second option is to pony up $25,000-28,000 (I was told two different amounts by two different reps - methinks this amount might be negotiable) for a "lifetime dongle" which entitles the purchaser to unlimited usage with no additional charges incurred per impression.

In summary, if you're contemplating the purchase of one of these devices - there is no free lunch. Both Lava COS and Cerec Bluecam business models provide for a usage fee, in addition to a separate fee if an SLA model is produced (this fee is borne by the laboratory).

My apologies to all, and especially my friends at 3M, for providing you with misinformation. I was simply going on what I had been told, not realizing I had been told only half the story.

I will always endeavor to provide my readers with facts. And, I invite anyone to question or comment on anything I write. Its my aim to provide my customers with information regarding the latest news in dental technology, and my opinions on such. If I think something's good or bad, you're going to hear it. My relationship with our vendors is important to our success, but please understand that my loyalty lies first with my clients.

One more Atlantis Abutment Platform...

2009-05-27T05:35:00.003-04:00

Yesterday, we received the necessary components to begin processing Atlantis Titanium and Gold-Shaded Titanium abutments for the Straumann Bone Level interfaces (3.3 / 4.1 / 4.8). There was an accompanying letter which stated that an additional platform - the Straumann Standard/Standard Plus Narrow Neck implant 3.3 - should also be available in the next few weeks.

Look here for news concerning the release of this interface...

Vericore Abutments

2009-05-26T05:00:00.000-04:00

On my way out of town last Friday, I had a brief conversation with Stuart Steinbock of the WhipMix Corporation to get an update on the availability of their line of Vericore Zirconia/Titanium Shaded Implant Custom Abutments (How about we go with "VCA" from here on out?).

As you may remember, VCAs are currently available for all four of Nobel Biocare's Replace Select platforms. Stuart advised me that - FDA willing - he hopes to have 27 more platforms available later this summer. That's great news for your patients being treated with implants in the "Esthetic Zone".

Let me provide you with a brief pictorial on the VCA process -

1. We begin with an implant soft tissue model. Depending upon the circumstances (and, always with your permission) we may slightly alter the silicone "tissue" to achieve proper emergence profile of the restoration. A waxing jig, duplicating the interface of the selected platform, is attached to the model, and the final dimensions of the coronal portion of the VCA are modelled.

2. The wax-up is then removed from the model and attached to a custom scanning platform which is then placed in our 3Shape Scanner for digitization.

3. Once the file is created, and the shade of the abutment is selected, the data is sent via internet to the Vericore Milling Center in Louisville, KY. These milling machines are some of the most sophisticated devices currently being used in the dental laboratory industry. Each weighs in excess of 3 tons and is capable of milling tolerances of 5 microns.

4. The coronal portion of the VCA is milled from industry-standard Metoxit zirconia. The milled unit is then shaded and sintered, and then press-fit to a titanium interface. A seating screw is supplied with the abutment and should be torqued to the guidelines set forth by the implant manufacturer. (The screw seat is specifically engineered to hold the individual zirconia and titanium components together without the need for a luting resin.)

5. When we receive the VCA in the laboratory, we can do a variety of restorations including a Vericore Crown, Lava, or e.Max. In this case, we chose to use the e.Max HT material. The abutment was placed on the model and scanned. Using the 3Shape software, we modelled the final contours of the restoration and then applied an automatic cut-back algorithm.

6. The result was pressed and characterized with some subtle gingival and incisal effects. The e.Max veneering porcelain was then applied, fired, contoured and glazed.

I think the result speaks for itself. There is no "greying" of the restoration that so often happens with metallic custom abutments. The pressed fit of the e.Max material is spot-on, and the translucency of the new HT material is phenomenal. I have to say that given the results, this combination of restorative solutions would be my go-to option for anterior implant cases.

If you have any questions or comments, please don't hesitate to contact me.

Straumann Bone-Level Platform now available through Atlantis Abutments

2009-05-22T08:25:00.004-04:00

Received this in an email this morning -

"We are pleased to announce the availability of Atlantis™ abutments for Straumann Bone Level 3.3, 4.1, and 4.8 diameter implants. Material options for these new interfaces include titanium and gold-shaded titanium (Atlantis GoldHue™ abutment) for the more esthetically challenging situations."

I've been told that a zirconia option will be added in the not-too-distant future...

Going to take a few days off from posting. Please enjoy a safe and happy Memorial Day Weekend!!!

SDL to be one of first labs in region with NobelProcera!!!

2009-05-21T13:27:00.003-04:00

We were just approved for the purchase of Nobel Biocare's new NobelProcera impression/model scanner featuring conoscopic holigraphic technology for unparalled accuracy. This will greatly expand our Procera offerings given Nobel Biocare's recent acquistion of BioCad - the leading software developer for the design and milling of implant overdenture bars and hybrid frameworks.

We expect to travel to Nobel Biocare's facility in Mahwah, NJ for training sometime in the next 6-8 weeks, and will have a follow-up post at that time.

Duracetal Nesbits

2009-05-19T18:05:00.004-04:00

Nesbit RPDs aren't for everyone, but that doesn't mean they don't have their place. With our new CDM Duracetal thermoplastic resin, we can offer you a modern twist on this old stand-by that may just come in handy one day...

A quick, economic posterior restoration that could serve well as temporary over an implant site-

or, a more permanent solution with an acrylic saddle that can be relined.

Pretty cool. If you have questions, please contact Al Rodriguez @ 800.678.7354

Encode Abutments & 3Shape - Questionable Value...

2009-05-18T05:00:00.002-04:00

I had a meeting with the area representatives for Biomet 3i last week. A portion of the meeting touched on something I wrote about several weeks ago - the partnership Biomet 3i and 3Shape have entered into allowing laboratories to use the 3Shape scanning technology to scan Encode Abutment cases and remit them over the internet for milling. It appears the technology is ready, and we are evaluating our level of involvement.

However, there is one big hole in the process as currently available.

For those of you not familiar with Encode Abutments, the idea was developed by 3i to eliminate the need for an implant-level impression. The key to the process is the placement, by the oral surgeon, of the specially engineered Encode Healing Abutment (EHA) - rather than a conventional healing abutment - at the time the implant is uncovered. The coronal portion of each EHA is configured in such a way as to impart information related to the type, diameter and relative position of the underlying implant. The restoring dentist takes a simple C&B impression of the EHA with an elastomeric impression material, and a stone model is made using conventional methods. The model is then mounted on a Stratos 100 Articulator and sent to Biomet 3i.

The 3i technicians then use proprietary software to scan the model containing the stone replica of the EHA. Once the implant information is ascertained, a custom Encode Abutment is designed and milled from a titanium blank. Finally - using a process called Robocast - the original stone cast is milled in the site of the EHA and an implant analog is placed, thus providing the laboratory with a model on which to work. One could choose not use the Robocast technology, but that would necessitate an abutment try-in and second impression of the Encode Abutment in place.

Whew...

Back to the 3Shape process -

Now, a laboratory equipped with a 3Shape scanner can scan/design the EHA and send the files over the internet to Biomet 3i for the milling of the titanium Encode Abutment. However, the model still has to be sent to 3i for the Robocast process!

The question begs - "If I still have to send the model to 3i, what the heck am I saving?"

Sure, Biomet 3i is providing participating laboratories with a fair discount off the regular fee for a conventionally-processed Encode Abutment, but I have to invest a not-s0-inconsequential sum in the scanner and software, plus the time taken to scan and design the abutment. And, I still have the cost/time of shipping the model back and forth.

The solution would be for 3i to partner with a manufacturer providing milled or stereolithographic models, and use a Robocast-like technology to "build" an implant replica directly into the model using the scan data. My guess is its only a matter of time before such a development comes to the market. Maybe I'll just wait...

Imtec MDI Implants - Washington, DC Training July 25th!!!

2009-05-15T14:24:00.007-04:00

I'm willing to wager that you have at least a few patients in your practice wearing full lower dentures with little to no retention due to resorption of the mandible. Until a few years ago, the accepted methodology was to send these patients to have implants placed, and then restored with some type of implant-retained overdenture. To many people, the cost of implant surgery was prohibitive, and they simply continued to suffer through the pain and humiliation.

Now, you can do something for these patients using FDA-approved Imtec MDI "mini" implants and a simple surgical technique that can easily be accomplished by any general dentist - without a major investment in training or equipment - at a fee structure that most patients will find affordable.

The November 2007 issue of the CRA Newsletter concluded that "long-term use of small diameter implants is moving from a relatively experimental mode to mainstream practice...& that their use will (sic) expand otherwise unavailable service for patients."

I am pleased to announce that Saylors Dental Laboratory is an Affiliate Imtec MDI Laboratory, and as such will be co-sponsoring a training seminar in the Washington, DC area on July 25th. For more registration information, please contact Kerry Ross @ kross@mmm.com or 800-879-9799 ext 164.

eMAX - Join the Revolution!!!

2009-05-14T08:52:00.014-04:00

e.Max is HOT!!!

In April, Ivoclar introduced the latest iteration of their revolutionary lithium disilicate e.Max material - e.Max HT (High Translucency) - and opened a whole new set of applications. In addition to conventional full contour crowns and anterior bridges, the new HT material is perfect for minimally invasive restorations like inlays, onlays and no-prep veneers.

At Saylors, we work primarily with e.Max Press, as opposed to e.Max CAD. We do this because we are in the unique position of having the 3Shape design software and the 3D Systems ProJet to output highly accurate and detailed resin patterns that can then be modified and pressed similar toEmpress. And, by using e.Max Press, we provide our clients with a restoration that is fully 10% stronger in terms of flexural strength than e.Max CAD (400MPa vs. 360MPa)

Here's a brief overview of the process:

First, we scan the model -

Next, we design the wax-up and complete the incisal cutback automatically using customizable parameters within the software -

The resin pattern is printed and seated to the physical model -

The framework is then pressed; the sprues removed; and the incisal highlights are refined and characterized -

Then the incisal ceramic is layered; final contour is achieved; and a fluorescent glaze applied -

Cerec InLab Training

2009-05-12T13:49:00.003-04:00

I'm pleased to announce we have contracted with Mr. Kris Cukar - a recognized expert with Sirona's Cerec InLab system - to come to our facility on May 29th for a private all-day training session.

With Kris' help, we plan to "dial in" our scanning and milling processes, enabling us to provide exceptional results with a variety of materials including Vita's InVizion zirconia and Ivoclar's eMax CAD. We will also be learning how to more fully incorporate Sirona's Cerec Connect and InfiniDent applications into our daily operations.

I recognize that we have several Cerec users as clients - please feel free to contact me with any questions you may have for Kris.

The Key to Success? Adapt to your Customer's needs....

2009-05-09T11:45:00.003-04:00

A few weeks ago we started a promotion featuring eMax Press restorations and MultiLink Automix - Ivoclar's new universal self-etching luting composite for fast, reliable adhesive luting of indirect restorations of all types. Our original idea was to offer a pre-paid package of 5 eMax restorations and a full MultiLink Kit for the special introductory fee of $750 - a savings of over $300!

Given these difficult economic times, we found that even though most clients liked the idea, they were uncomfortable paying for the entire package upfront. As a result, we've modified the offer to the following:

Order your next eMax Press restoration and ask for the MultiLink Kit Special. We'll bill the eMax restoration at our regular fee and send you the MultiLink Kit for $200 - an instant savings of 17% off retail.

But, wait there's more - I feel like Bob Barker - To sweeten the pot, if you complete four (4) more eMax restorations before the end of 2009, we will rebate the entire $200 cost of the kit!

This is a great opportunity to sample two great products. eMax Press offers a combination of great esthetics, excellent fit and strength (400 MPa). MultiLink is simply the easiest, most advanced luting composite on the market. To learn more, call Mike Malone @ 800.678.7354

Why Lava?

2009-05-08T11:45:00.003-04:00

We were a little slow in coming to the Lava party, primarily because we had invested in other systems that we felt duplicated what the 3M ESPE system had to offer. That opinion quickly changed with the introduction of the Lava ST Scanner and the decision to embrace an open architecture business model.

With regards to the accuracy of the scanning and milling processes, Lava leads the way with an average marginal gap of 3-unit bridges hovering around the 20 micron mark*. Compare that with Cerec InLab (appx. 60 microns) and Cercon (appx. 80 microns), and you begin to understand the Lava advantage. This superiority is due in part to the Lava ST Scanner which delivers greater data density than other systems because of its unique design - more data equals more accuracy. The other part of the equation is the milling process. Just the sheer size of the Lava Mill as compared to the relatively small dimensions of the other systems' milling units means less vibration during milling, hence greater accuracy.

In addition, the open architecture allows us to use the Lava Scan for other types of restorations - Both Atlantis and Lava Custom Abutments; as well as to output resin patterns that can be cast as copings, frameworks, and press-to patterns on our 3D Systems Pro-Jet.

And, the future holds even more possibilities with the Lava Digital Veneering System (DVS) enabling us to design and mill a zirconia coping and a glass ceramic final contour pattern - from a single scan! Or design laser-sintered copings and frameworks for alloy-based restorations.

In the near future, I hope to have some images depicting some of these applications. Please feel free to contact me if there is a particular aspect of the Lava System that interest you.

Lava COS Software Update

2009-05-06T05:52:00.003-04:00

Just heard from Bill Slocum of 3M ESPE's Brontes Division with good news regarding an upgrade to the Lava COS software which will now enable us to use the digital impression data to "CAD/CAM" resin copings and frameworks.

Previously, after Brontes had processed the data sent to them from the Lava COS dentist, we were supplied with a "Lava Packet" containing the files used to digitally construct the models and dies. That information was then downloaded into our Lava Design software, but we were restricted to fabricating only Lava substructures.

Now, we are able to select an option which allows us to design the copings and frameworks, and rather than routing the designs to the Lava Milling Center, we can instead route them to our 3D Systems Pro-Jet Printer to output a resin pattern which can then be cast using the traditional lost-wax technique.

This is important because it enables us to begin working on your case before your SLA models arrive, and takes advantage of the digital accuracy of the Lava COS and Lava Design software.

Lava COS Seminar - Harrisonburg, VA - May 6, 2009

2009-05-04T05:18:00.003-04:00

I will be traveling to Harrisonburg, VA to participate in a 3M ESPE presentation of its Lava Chairside Oral Scanner Technology. Mr. Mark Senkowski - Lava COS Specialist - will be hosting the event which features a combination slide/video lecture and hands-on demonstration of the scanner. The presentation will run from 6:30-8:30pm, and will close with a question and answer period during which I will be available to discuss our experiences as a Lava COS Laboratory.

If you're interested in attending, please contact Mr. Senkowski (msenkowski@mmm.com) to inquire if space is still available. Click on the link below for information on the lecture site -

Marriott Courtyard

Flexible RPDS, etc....

2009-05-03T07:00:00.001-04:00

I am pleased to announce the addition of CDM's family of flexible, thermoplastic Removables solutions including Duracetal and DuraFlex RPDs and VisiClear Esthetic Clasps.

Duracetal is a dense thermoplastic that can be used to fabricate metal-free RPDs with tooth-colored clasps, as well as temporaries and Nesbits. The non-porous, monomer-free material is bacteria and stain resistant and will not retain odors.

DuraFlex RPDS feature a great combination of esthetics (Both tissue-shaded and clear materials are available to make your patients' appliance less noticeable); comfort due to the materials flexibility and relatively light weight; and reliability.

Both Duracetal and DuraFlex are virtually unbreakable providing for years of service.

Finally, VisiClear Esthetic Clasps are fabricated using a clear, strong flexible material that can be added to almost any removable appliance in lieu of traditional metal clasping.

All materials are completely bio-compatiable and FDA-approved. For more information, contact Mike Malone @ 800.678.7354

Zirconia Facts courtesy of Ed McLaren, DDS

2009-05-01T07:00:00.001-04:00

Had the opportunity to attend a "webinar" hosted by 3M ESPE featuring Dr. Ed McLaren of the UCLA School of Dentistry. Dr. McLaren's presentation centered on zirconia restorations from the raw materials used to fabricate the milling blocks to laboratory processing tips that can enhance your long-term success.

Highlights include -

All zirconia is not created equally which means you could be playing with fire by using an off-brand zirconia product. He cited 3M ESPE Lava and Vita's Invizion as being the two best zirconias in terms of flexural strength. Dr. McLaren credited the difference between these other brands as stemming from better manufacturing processes during the fabrication of the milling blocks resulting in higher particle density.
Dr. McLaren also took issue with a recent study done by Dr. Rella Christensen which calls into question the long-term efficacy of zirconia restorations - particularly Dr. Christensen's observations regarding the frequency of chipping of the veneering ceramic. If I understood Dr. McLaren correctly, Dr. Christensen seems to believe this porcelain fracturing is a result of the materials in use, while Dr. McLaren (Note: Dr. McLaren is not only a faculty member at UCLA, but widely regarded in the dental laboratory industry as a world-class ceramist) believes it is the handling of the materials that may lead to failures.
Dr. McLaren's key point in his analysis is his observation of zirconia's thermal diffusivity vis-a-vis the veneering ceramic. In other words, zirconia copings and frameworks take longer to heat up during the ceramic firing, and cool at a slower rate than does the veneering ceramic. It is his contention that if the firing programs each lab uses do not take this thermal diffusivity into account, that the overlaying ceramic material may have pre-stresses built up in the material which may lead to chipping of the ceramic.
Dr. McLaren also visited the controversy regarding whether or not zirconia should be sandblasted prior to porcelain application. There has been some chatter that this process could weaken the zirconia substructure. However, his studies have concluded that there is no discernible effect on the strength of the zirconia, and sandblasting the outer surface of the substructure actually helps with wetting of the surface of the veneering ceramic, thereby improving the bond at the interface.
Dr. McLaren also offered one final tip regarding cases involving preparations characterized by a dark stumpf shade. In these case, he routinely prepares the facial surface slightly more aggressively so he can use a zirconia core measuring .6mm in thickness (normally he uses .3mm), and requests that the zirconia core shade be one shade brighter than usually prescribed for the given desired shade of the final restoration.

As stated in one of my earlier posts, Saylors Dental Laboratory has an excellent track record with zirconia restorations dating back 8 years with a failure rate <0.5%>

Proximal Contact Issues? First a Little Detective Work...

2009-04-30T07:01:00.001-04:00

If you've been a dentist for any length of time, you've experienced some type of difficulty with the proximal contacts of your restorations. And, as tempting as it is to fault your laboratory, don't be so quick to judge without first applying a little deductive reasoning.

Don't get me wrong - We're not perfect. We take every precaution we can to provide our clients with consistently firm, anatomically-correct proximal contacts - from using a computer-controlled dispenser to maintain the correct water/powder ratios in our model stone to final seating of the crowns on a solid model under 20x magnification. And, we still have the occasional complaint from a crown requiring significant adjustment to another with an open contact. Obviously its not a consistent issue, but if it ever becomes one we need to work together to address the situation logically.

I would suggest you always verify the proximal contacts on the solid model before you even seat the patient. If the contacts are light or non-existent, or if the crown doesn't seat all the way down to margins on the solid, we haven't done our job and the crown should be returned to the lab - (any such adjustment will be done for next day delivery).

If the crown looks good on the solid model, but is light or tight in the mouth, there's a simple way to ascertain where the problem lies - Remove the cement from your temporary restoration and seat it on the solid model. Do the crown and temporary have the same spatial relationship when seated on the solid cast? If not, then you need to look at your temporization technique.

If your contacts are consistently light, then its possible your temporaries are too tight, virtually driving a wedge between the adjacent teeth. This is frequently an issue with restorations with no tooth distal to the preparation. The contact on the temporary is made extra firm, driving the preparation distally. Then the crown shows up for delivery and has no contact. This scenario is exactly why we don't use solid models on such cases. We want these contacts firm - Our thought is its better that you take a little time to adjust the crown than have to return the crown for an addition.

Conversely, if the temporary contacts are open on the solid model than its likely that the adjacent teeth have tipped toward the preparation thus creating tight contacts on the final restoration. Sure, you'll be able to deliver crown, but you'll be cursing me under your breath the entire time you spend grinding those contacts just so.

By examining your temporaries we can logically determine where the problem lies, and then develop a game plan. The answer may be that we need to adjust our procedures to accomodate your individual preferences, but those adjustments should be grounded in observation and logic.

Sherlock would be proud.

Breaking News - Veneers are now an Approved Application for Lava COS

2009-04-29T16:49:00.002-04:00

I just received an email from 3M ESPE regarding this exciting new application for Lava COS owners. Be advised there is a strict protocol to follow during a veneer scan. Click here to view a PDF file of the protocol.

Straumann Bone Level Implants & Atlantis Abutments

2009-04-29T07:00:00.000-04:00

As of Monday, April 27th you can have an Atlantis titanium abutment fabricated for your Straumann Bone Level Implant case. This is great news for our many doctors who have been using this particular platform as it should lower your overall costs and improve your results.

In addition, on or around May 11th, AstraTech will make available the FLO components necessary for us (as an Authorized Lava Design Center) to scan your cases in-house saving you the time and expense of shipping your models to Atlantis for processing.

Furthermore, our representative tells us that the Atlantis zirconia abutments should be available for the Straumann Bone Level Implant interface sometime in the next 6-8 weeks. We will provide updates, as warranted.

Your Lab's "Dirty Little Secret"

2009-04-28T07:00:00.001-04:00

We've invested a fair amount of capital in CAD/CAM systems including Lava, Vericore, Cerec InLab, and Procera. Each of the systems has its unique applications, but there is a fair amount of overlap, i.e. each system can be used to fabricate zirconia copings and frameworks. So, why do we make it a point to have the different scanner technologies in-house?

The answer is design control.

Just as with porcelain fused-to-metal restorations, proper zirconia coping/framework design is critical to long-term success - unsupported ceramic is a leading cause of failure.

That's why we do all our own scanning and design of any restoration we fabricate, and our designers always have your complete model work in hand during the process. They can easily identify areas in your preparations that require build-up of the zirconia, such as broken cusps. As a result of our diligence we have a ceramic failure rate on our zirconia-based restorations of less than one-half of one percent (<0.5%)

Incidentally, we also serve as an outsource for many smaller labs who can't or won't invest in each system, so they send us their cases for scanning and designing. However, all too often these laboratories - in an attempt to save money on shipping - will provide us with just a simple die. We have no model with the opposing or adjacent teeth. In these cases, all we can do is make a simple coping without regard for proper framework support for the ceramic.

As we aren't given the other lab's client or patient data, its impossible for us to track failures. That being said, I would suggest if you experience a higher-than-normal incidence of ceramic failure with your zirconia restorations, you owe it to yourself to investigate your lab's protocol.

A few dollars saved on shipping charges may be costing you hundreds in wasted time with unnecessary remakes...

Cerec Connect

2009-04-27T06:00:00.003-04:00

I had a meeting late Thursday afternoon with our local Patterson rep and the rep from Sirona to talk about the May 1 rollout of the new Cerec Connect service. I must say the conversation was very interesting and I can't wait to take advantage of some of the application's unique features.

Similar to the Lava COS, Cerec Connect allows Cerec users to send digital impression files directly to their Cerec InLab for processing of various restorative options including eMax CAD, Empress CAD, and a variety of zirconias. In addition, because any design file can be sent to Sirona's Infinident 3D resin printer, the laboratory can even use the system to manufacture porcelain fused-to-metal copings and frameworks, as well as full contour patterns that can be cast or pressed.

In reality, this aspect of the system was already available as the digital files could be remitted to a Cerec InLab using simple email files. What's new is the ability to have your digital impression data used to create a physical model using Stereolithography (SLA) technology. Prior to this advance, it was impossible for the lab to do anything other than provide clients with monolithic materials milled to final contour. In other words, the absence of a model denied us the capability of milling a coping and then stacking ceramic because we lacked facsimiles of the surrounding hard and soft tissues.

As I won't have any experience with the system until after May 1, I can only report on what I've seen to date:

1. The Cerec SLA models appear to be smoother in composition than the Lava COS models. Our experience to date with the COS cases leads me to believe this isn't an issue, just an observation.

2. The Cerec models are not mounted on an articulator as are the COS models. Instead, the laboratory is supplied with a number of articulators on which the individual elements of each set of models can placed. I think this is a good idea as it helps reduce costs, but it also means that your case models will be returned "in pieces", and I assume you will then puzzle them together on your own articulator.

3. The difference in the scan technology - Lava COS' video capture versus Cerec's point-and-click option is probably going to come down to personal preference. However, it is my understanding the Cerec business model does not require a processing fee unless a model is manufactured. This is a huge deal as the Lava COS business model requires the dentist to pay a processing fee, and the laboratory to purchase the SLA models. If this is true, 3M ESPE's going to have to go some to demonstrate why a practitioner would pay 10% more for the scanner upfront, plus an additional fee per scan.

4. I believe there is a difference in the quality of the output on the laboratory side. With regards to milled restorations, let's face it - the Cerec InLab MC XL is a nice unit, but its small compared with the Lava milling unit and therefore prone to a higher degree of vibration, thus less accurate millings. Also, I still have yet to see an eMax CAD unit that has anywhere near the marginal accuracy of an eMax Press restoration - not to mention the Press unit has a 10% higher flexural strength (400Mpa for the Press material versus 360 Mpa for the CAD).

That's off the top of my head. I suggest you visit the Cerec Connect site. There is a nice video of the entire process which provides a great overview, although I can't say the final result is something I would write home about...

Amazon Kindle 2

2009-04-25T08:00:00.001-04:00

Okay, this has nothing to do with dentistry, but...

The Amazon Kindle 2 is a very cool product.

For those of you who haven't heard about this gadget, it is a wireless reading device. It is very compact, easy on your eyes (not like reading a computer screen), and can hold practically your entire library in one easy-to-access repository.

I suggest you click on the embedded link to get the full details, but let me just tell you why I love this product.

1. The "Always-on" wireless 3G connection allows me to shop for books, magazines, newspapers and even blogs wherever I am, and you only pay for what you download to your Kindle.

2. Not only is the screen easy on your eyes, but you can adjust the type size on the screen to suit your individual preferences - I ditched my reading glasses the day I received the Kindle.

3. Easy, one-handed reading. You can toggle to the next page or the previous page using just your thumb. I like to read while I'm at lunch, and now I don't have to put my fork down to turn the page (maybe not such a good feature, after all).

4. An easily accessible dictionary that works within your selected reading material. Come across a word you're not sure of? Simply move the cursor to the beginning of the word and the word's short definition pops up at the bottom of the screen. Need more depth? Click the return key and the full-blown dictionary entry is displayed from which you can return to your reading material with one click.

5. I travel a fair amount and I'm used to reading the Washington Post (what can I say?). With the Kindle, I can have the day's issue wirelessly downloaded for the same price as at the newsstand. No more having to read the St.Paul Daily Register, or whatever it is.

6. I tend to read several books at a time. The Kindle holds them all in one place, and I can go from one to another with virtually no effort. I wish - every time I get the bill for my daughter's books - that the Kindle was standard issue in our colleges and universities....

Check it out. Yes, its a little pricey, however when you consider the downloaded books top out at $9.99 for new titles, you're saving quite a bit per book if you normally purchase hard covers.

NewDocs.com

2009-04-24T08:00:00.001-04:00

Stumbled across this site while searching for something else on the internet, and thought I would pass it along.

NewDocs.com is a Facebook-type site aimed at dentists. It has a certain element of social networking, but for me the best feature is the Forums where you can post a question or comment and get replies from dentists all over the world. The topics range from Practice Management to Technology to CE Course Reviews - and its free to sign up.

I like free.

Lava COS & Accurate Bites

2009-04-23T06:40:00.005-04:00

This post was prompted by a phone call I received late yesterday.

The doctor in question has been a client for over 20 years; is a very good practitioner and I believe we have a great deal of mutual respect for one another. That said, he called to apprise me of a case he had just spent an hour grinding the occlusion in on two Lava restorations #s18 & 19 - I hate telling stories like this, but I think the example will help to make a point regarding Lava COS, so...

Anyway, he had done everything right - clearly defined margins, plenty of tooth reduction,full arch impressions - except furnish a bite record. Ordinarily, with full arch models featuring plenty of occlusal stops you would think hand articulation would be adequate. However, for whatever reason the articulation was errant - maybe there was a distortion in the opposing model; maybe we failed to adequately equilibrate the models, or maybe the hand articulation wasn't quite as clear-cut as it seemed.

Whatever the reason, I advised the doctor that furnishing a bite to us would have made it possible for us to identify the error in the articulation immediately. Even if we hand articulated the mounting, we could have used the bite for a simple check before proceeding.

And, then I started thinking about our experience with the Lava COS cases we have completed.

Every set of SLA models we have had fabricated from a digital impression has been perfect with respect to the occlusal relation between the working and opposing casts!

First, the casts are completely free of the types of distortions usually associated with current impression materials due to improper mixing or handling. Second, the casts are free of bubbles or voids in the stone that sometimes occur during the model fabrication process. Third, and most importantly though, is the fact that the dentist "takes the bite" with the patient in full interdigitation with no intervening material present.

This is vitally important, as is the doctor's ability to verify the bite relation right on the chairside display - EVEN FROM THE LINGUAL VIEW!!! - before submitting the case to the lab for processing. Think about it - this lingual view has been impossible to achieve until the impressions are poured and models mounted on an articulator. Not only can you check the bite from the lingual, but you can also verify the amount of tooth reduction.

This feature alone might just be worth the price of admission...

Quick Update - Vericore Shaded Zirconia Custom Abutments

2009-04-22T11:09:00.006-04:00

I had a brief conversation with the folks from WhipMix yesterday during which I was informed that all four of Nobel Biocare's Replace Select platform jigs are now available. This is great news for those of you who prefer the Replace Select implant because you now have a relatively low-cost alternative to the Procera Zirconia Abutments - and you have 7 Vericore shades versus only 3 from Procera.

You don't need to do anything different on your part to take advantage of this new technology. Once we have fabricated your tissue model, we wax up the coronal portion of the custom abutment on the supplied titanium implant interface, and simply scan the entire complex on our 3Shape scanner and transmit the data to WhipMix for milling.

The zirconia element is the fitted to the titanium interface and screwed into place with the supplied screw at the implant manufacturer's recommended torque. You can then place a Vericore, Lava or eMax crown using your preferred method of cementation.

I was told during my conversation with WhipMix that now that the FDA has approved the Replace Select platforms, it should be less than 90 days before approval of the other 27 implant platforms in the pipeline for use with Vericore. This is a very exciting alternative to both Procera and 3M ESPE Lava Custom Abutments.

Encode Abutments Simplified?

2009-04-21T07:19:00.002-04:00

Biomet 3i and 3Shape are teaming to offer an expedited Encode Abutment service through labs operating a 3Shape Scanner. With a simple software addition, Saylors Dental Laboratory should soon be able to scan models poured from you Encode Abutment impressions and remit the digital data directly Biomet 3i.

This new process eliminates the need to physically ship the orders to Biomet 3i, and should reduce in-house processing time (I hope so - at last check the Biomet 3i turnaround time was running at 15 days!) In addition, the Encode Lab-designed Abutment will be sold at a discounted price.

We are currently working on obtaining the necessary software package. More information to come...

Surgeon-supplied Implant Components - Why? (Part II)

2009-04-20T16:25:00.002-04:00

First of all, please forgive me for not including the heretofore promised spreadsheet. After several failed attempts to capture my point using simple mathematics, I gave up and went for the words...

Scenario #1

Patient presents to the general dentist's office and a single tooth, implant-supported restoration is prescribed (For the sake of my argument, any costs associated with the placement of the implant, i.e. stents, bone grafts, tissue augmentation, etc..., as well as the cost of final restoration, are deemed to be the same across both scenarios and therefore inconsequential). The surgeon places the implant and manages the case until such time as the healing period is completed, and the patient is advised to return to the general dentist - healing abutment in place - ready for impressions.

The surgeon has traditionally forwarded to the general dentist a package of components including an impression coping, an implant replica and a UCLA-type cast-to abutment (For simplicity I will assume that the patient has modest esthetic expectations, and that a cast custom abutment and porcelain fused-to-metal restoration will be fabricated. If the case were more esthetically challenging - requiring a zirconia abutment of some type - the furnished UCLA-type abutment is rendered useless. Which begs the question, "Who gets saddled with the cost of the zirconia abutment - the surgeon who already charged the patient for the components, or the general dentist who has quoted a fee based on the components being provided by the surgeon?"

I digress.

Our patient is cooperative and a nice pick-up impression is taken which is then forward to the lab with the analog and UCLA-type abutment. The laboratory fabricates a tissue model, and then hand-waxes, sprues, invests, casts, divests, finishes, and polishes a very nice custom cast abutment made of 2.5 dwts. of 52% AU High Noble White Ceramic Alloy. The associated charges are as follows: Tissue Model - $50; Custom Abutment Labor - $125; Alloy- $115 (assuming $900/oz. spot gold price) for a total of $290.

If you were to include the cost of the UCLA-type cast-to abutment - generally regarded as being around $185 (This is the purchase price - if you factor in a 33% mark-up to cover the surgeon's cost of maintaining the inventory and employing the Implant Coordinator - the true cost to the patient is closer to $270) the "cost" of the cast custom abutment is quickly approaching $600.

Scenario #2

Same as above, except that the general dentist quarterbacks the process. The surgeon is asked to place the implant just as before, however the only components forwarded to the general dentist is the impression coping. The surgical fee is reduced by an appropriate amount - let's say $270 - to reflect the fact the UCLA-type component is not required.

Instead, the lab fabricates a titanium Atlantis Abutment (as a 3M ESPE Lava ALDC- Saylors Dental Laboratory can scan your model and submit the the digital files directly to Atlantis thus saving time and shipping charges) for a total cost of $350 - including tissue model and implant analog. Or, a Lava Custom Abutment could be manufactured using a titanium temporary abutment for a total cost of $340 - again including tissue model and analog.

Not only is the patient saved a fair amount of money (approximately $250 per abutment), but the milled custom abutment has been demonstrated to be superior to a cast abutment with regards to fit at the implant interface. This has led to some speculation that a milled surface could reduce the amount of screw-loosening due to the less accurately fitting interfaces of the cast abutments. And, the computer design capabilities that allow for the subgingival contouring of the abutment collar to each practicioner's preferences cannot be discounted.

In summary, it is my contention that the only person not benefitting from the surgeon supplying the restorative components is the patient. With the advent of computer designed and milled custom abutments, the use of cast-to componentry is an inferior and unnecessarily expensive treatment modality.

Surgeon-supplied Implant Components - Why?

2009-04-19T09:28:00.002-04:00

We've had lots of discussion with the folks from AstraTech (Atlantis Abutments) and 3M about a local phenomenon - the high-percentage of cases we receive for which the implant surgeon has supplied - at no cost - a cast-to UCLA type component to the general practitioner prescribing the final restoration.

If I remember correctly, this practice was started several years ago by a well-known surgeon in the area as a way to promote his practice to potential referring general dentists. The idea was for the surgical practice to employ an "Implant Coordinator" that would maintain an inventory of components - impression copings, implant replicas, and an assortment of stock and cast-to custom abutments - and dole the correct parts out to the referring dentist at the appropriate time.

It seemed like a great idea at the time - the general dentist was not only relieved of the time-consuming responsibility of ordering parts or maintaining an inventory, but he was provided these parts free of charge to provide the laboratory for use in the fabrication of the custom abutment or final restoration should a screw-down option be chosen.

My question is - Who really benefits from this practice? It is my understanding that the costs of the components are incorporated into the surgical fee charged to the patient, often at a mark-up. The increased fee helps to offset the costs of the surgical practice maintaining an inventory and employing the Implant Coordinator (in smaller surgical practices this function becomes the responsibility of another member of the team, but the costs associated with employing that person must still be taken into account). And, it is my contention that this marked-up fee has become a source of profit for the surgical practice, although to what degree I can't pretend to know.

The consequences of the practice are that the surgeon rather than the restoring dentist drives the process, practically dictating how the final case will be restored. Now, with the advent of Atlantis Abutments (which require no cast-to components) and the 3M Lava Custom Abutment (requiring a much less expensive titanium temporary abutment), this local custom is not only outdated, but I would contend inflates the final costs of implant therapy for the majority of patients.

In my next post I will provide a cost analysis that will prove my point...

belleGlass NG - Start 2 Finish

2009-04-18T17:35:00.012-04:00

This is a little slideshow I put together of a case we recently completed using belleGlass NG - our material of choice for indirect composite restorations.

To view the images in full screen mode, click on the Picasa logo in the lower righthand corner of the screen. Then click the album name - belleGlassNG. This will take you to my Picasa web album. Once there, just click the Slideshow tab in the upper left corner - the whole presentation should take less than 90 seconds.

Impress Trays - Great for pick-up implant impressions!!!

2009-04-16T12:02:00.004-04:00

We recently held a morning seminar in conjunction with AstraTech and a local Periodontics practice to discuss the efficacy of using Atlantis Abutments. The AstraTech representative took it upon herself to also invite a gentleman from CbiteDDS who gave out free samples of what could be a very useful product for use in taking pick-up implant impressions.

I won't bore you with all the specifics - simply said this tray offers a very easy-to-use, very economical alternative to custom implant trays or the needless destruction of good quality stock trays - highly recommended.

Lava Custom Implant Abutments

2009-04-14T17:51:00.007-04:00

We do a large number of custom abutments using several different processes - waxing and casting to UCLA-type components; scanning and designing Atlantis Abutments using our Lava Design Software; and combining pre-fabricated titanium temporary abutments with a custom milled, shaded Lava zirconia coronal element.

Each method has its advantages and disadvantages.

Custom cast abutments are great because we have complete control over the design of the abutment from marginal placement to angulation. However, the components are expensive; the cast-to process requires the use of expensive high-noble alloys; and the esthetic value of a cast abutment can be a hindrance in some cases.

Atlantis Abutments are available in three different materials - titanium; GoldHue titanium coated with a titanium nitride providing a warm golden surface to enhance esthetics; and a solid, white zirconia. In most cases, the position of the implant is scanned and submitted to an Atlantis designer through our Lava software. The design is accomplished by an Atlantis technician using criteria stipulated by us during the order process. Once modeled, the abutment can be viewed in a 3D application, and once approved by us is precision milled to insure optimal fit.

I personally think the Atlantis titanium abutments are better than the cast-to custom abutments fabricated in the lab - Atlantis abutments provide cost certainty regardless of the platform and I believe the milled interface is superior to a milled interface that has been exposed to the casting process.

However, I think when it comes to zirconia abutments, Lava is the choice for two reasons. First, Lava abutments are available in 7 shades matching the core shade of the crown that will be subsequently placed providing an esthetic safeguard against future gingival recession . Second, because the zirconia is luted to the titanium temporary abutment, the screw forces are on the metal screw seat - not on the zirconia. Until proven otherwise, I think this arrangement is safer than exposing an all-zirconia abutment to the forces created during the torquing of the seating screws.

There are two other shaded zirconia custom abutment products just now coming on to the market - Procera and Vericore - but each is restricted by limited platform availability. More to follow...

eMax HT / Multilink Promotion

2009-04-13T14:24:00.005-04:00

Great news from the folks at Ivoclar / Vivodent. The next iteration of the revolutionary eMax lithium disilicate material is on its way! The new HT (High Translucency) material provides us with a complete armentarium to handle just about any case including thin veneers (And, I mean actual .3mm veneers - not the .8mm veneers a large national lab advertises as .3mm)

To help promote this addition to our product line, we are teaming with Ivoclar/Vivodent to offer you a great value on a package deal consisting of 5 eMax Press shaded restorations with a complete MultiLink Cementation Kit - all for $750 - an incredible savings of $292 over retail!

Our eMax Press crowns, veneers, inlays and onlays are modeled to exacting tolerances with life-like tooth morphology, and pressed in the shade of your choice. The resulting restoration exhibits a natural translucency and an amazing flexural strength of 400 mPa, and can be either bonded or conventionally cemented.

Multilink is a universal, self-etching luting composite system for the fast and reliable adhesive luting of indirect restorations made of all types of material. The purely self-curing Multilink is mixed by hand.

Advantages

Quick setting reaction, easy removal of excess material
Broad spectrum of indications
Self-curing material
Three shades: Yellow, transparent, opaque
No total-etch technique
High-strength bonding values and stability

Indications

Cementation of indirect restorations (inlays, onlays, crowns, bridges, posts) made of:

Metal and metal-ceramics (PFM)
All-ceramics (silicate)
Strengthened core ceramics (zirconium and aluminium oxide)
Composites

Take advantage of this great offer to experience first hand the esthetics and reliablity of eMax and the ease of use of MultiLink. Call Mike Malone @ 800.678.7354 to purchase your eMax/MultiLink while supplies last.

LAVA COS Purchase Assistance Program

2009-04-13T08:29:00.004-04:00

We're very excited about the Lava COS Technology, and we want to do everything we can to help any "early adopters" get on board. To do so, Saylors Dental Laboratory is offering $500 to any dentist purchasing a Lava COS that lists SDL as the referring laboratory, with the purchase being completed prior to June 30, 2009.

Its really quite simple. We purchased the margin-marking software with the understanding that we would be able to recapture some of our investment each time a dentist we referred to 3M purchased a system. All we're doing is sharing this referral fee with you- once we receive the payment from 3M, we will forward you a check.

This offer is limited to the first five (5) dentists, so hurry!!!

If you have any questions, please call me @ 800.678.7354

Lava COS / Lava Design Software Issues

2009-04-12T10:07:00.002-04:00

Following up on the previous post which described an issue related to the quality of a chairside scan, let me now discuss another issue that arises once a case's margins have been marked and the case has been submitted to Brontes for processing and the creation of a Lava Packet.

A Lava Packet is simply the digital data/images that can be downloaded into the Lava Design software and used for the design of the coping/framework. The packet is accessed and downloaded through the Lava Case Manager software. Once downloaded, the file is "run" which allows it to be opened inside the Lava Design software.

However, rather than opening the file directly in the order entry page, the process leaps directly to the margin detection portion of the program. The problem with this is the technician running the Lava Design software has no chance to edit the order entry. This presents the technician with a number of problems -

All Lava Packets are automatically designated for fabrication of a Lava zirconia framework even if the desired final restoration is a PFM or Full Cast restoration. As an Authorized Lava Design Center, and the owner of a 3D Resin Printer, Saylors Dental Laboratory has the ability to output the design files as either Lava zirconia, or a resin pattern that can then be cast in the alloy of choice. If we perform a scan of an actual physical model/die complex, we have the opportunity to choose the output - Lava or Other Materials. COS cases are automatically assumed by Brontes technicians creating the Lava packets to be Lava zirconia restorations. There have been several instances when a Lava packet with an Other Materials designation has been requested in the notes section of the submitted cases, and the request has been either missed or ignored. We have been told that we need to notify Brontes via a separate email should we want to change a case to an Other Materials designation, which seems rather silly and laborious. A simpler solution would be to unlock the order entry page for COS cases so we could simply choose the desired output.

This would be preferable because we have also had cases where the doctor has not filled out the digital RX completely, and the Lava Packet arrives with missing information. In one case, the missing info was the shade, and that was easily dealt with by writing the shade in the comments section of the Order Entry Page (only accessible at the end of the process prior to sending the case to be milled).

The other case was a two-unit splint for which two separate Lava Packets were created as if we were making two separate crowns. In this case Brontes had to be contacted and a new Lava Packet had to be created - the doctor correctly filled out the digital Rx, but the info was ignored during processing.

These may seem like minor issues as presented. However, the time that has been wasted to date to correct these problems has been substantial in that the Brontes customer service apparatus is multi-layered, and it usually takes some time to get in touch with the appropriate person(s). We have been informed that Brontes is taking steps to rectify the situation, and will report on developments has they occur.

Lava COS / Lava Design Software Issues

2009-04-11T17:30:00.003-04:00

We are currently working with a single office owned and operated by two dentists. We have completed eight cases to date with very positive results. However, there have been a few issues.

One of the first cases that was submitted to our laboratory was an upper first molar. If you are not familiar with the Lava COS process, you should know that the dental office scans the preparation, adjacent teeth, and opposing dentition, as well as a buccal view of the teeth in full inter-digitation which serves as "bite". The digital information is then transmitted to 3M Brontes for processing, and then made available to the laboratory.

Upon receipt of the files through the Lava Case Manager software, the lab manipulates the images of the working and opposing "models" to position them for articulation, and selects the articulator type which will be used during the model fabrication process (quadrant or full arch).

ing model is then "sectioned" very similarly as one would do the same operation on an actual stone model in the laboratory. Care must be taken to place the "cuts" so as to avoid damaging the margin of the preparation, as well as the adjacent teeth. All images up to this point are two-dimensional computer-generated graphic representations of the three-dimensional tooth structure and tissue. Once satisfied with the placement of the "cuts", the technician running the software proceeds to the next step which is the actual marking of the margin(s).

At this point, the technician has three distinct views of the preparation die - 1) a computer-generated "mesh" image similar to the images in the previous step; 2) a black and white, photo-like image composited from the video images captured during the chairside scanning process which can be viewed as a 3-D image; and 3) a simple line graphic providing a lateral profile view of the prepared tooth.

The mesh image can be enlarged and freely rotated in all directions. The "photo" image can be enlarged to a small degree, but cannot otherwise be manipulated. To see other "photo" images, the technician can scroll through roughly 30 images that are composited from the digital video data. The profile line graphic is static except that it will move in response to the technician's manipulation of the other images.

Marking the margins involves using the mouse and clicking on the provided images. We usually do a very quick and rough outline of the margin on the mesh image, and then use the 3-D image and profile view to fine-tune our initial proposal.

In this particular case, the mesh image had two rather large "voids", or areas where the software had failed to extrapolate missing data. One area was on the mesial-occlusal line angle of the preparation, however it appeared that the occlusal surface was in tact, so the missing data could have been treated similarly to blocking out an undercut. The more troublesome void was in the lingual margin, and appeared to be the result of inadequate moisture control.

3M will tell you that a small amount of moisture will not affect the outcome of your scans. This is the only case to date that we have witnessed this issue, so that may in fact be true. In any event, this one case makes the point that digital impressions are not a substitute for poor tissue management (not saying this case was handled poorly - it was one of the first cases this particular doctor had processed so we were all learning).

The voids were noted and both the doctor and 3M were notified of the potential problem. A computer technician at Brontes attempted to "repair" the image, and did so to a degree that we were able to complete the margin-marking process, and submit the case to have a model manufactured and a Lava coping milled.

Upon receipt of the model and the coping, the case was returned to the doctor for try-in before we completed porcelain application. The case has not been returned to date. We will report on this case as soon as we know the results.

Another future post will describe some blatant "holes" in the Lava COS as it relates to using the digital data inside the Lava Design Software.

Saylors Dental Lab - Lava COS

2009-04-11T16:50:00.000-04:00

Saylors Dental Laboratory in Manassas, VA is a third-generation family-owned business which prides itself on being a leader in the field of dental technology. As such, we have recently invested in the margin-marking software for 3M ESPE's Lava Chairside Oral Scanner (COS) - the first laboratory in Virginia, and one of only a handful of labs nationwide to do so.

It is our intention to use this blog as a running commentary on our day-to-day experiences with the Lava COS digital impression technology.

8669 Phoenix Drive

Manassas, VA 20110

800.678.7354