Ken Schnepf

Dr. Ron Kaminer, of Smiles By Design in Hewlett, N.Y.

Over the years, intraoral scanning has continued to develop and improve with the additions of more capabilities, such as improved software and hardware and the ability to handle a range of indications and provide digital impressions. Can you explain how you think 

 has taken on a role in developing these types of innovations?


	I think if you look across the board at all of the scanners on the market, 3Shape has paved the way for laboratories for years and now paves the way in the dental market. Now, on the dental side, it is the leader in image quality. Its products allow the dentist to see exactly what the laboratory is going to see. Using 3Shape Communicate and tools such as Team Viewer, we can consult and plan and discuss what we need to do.

One of the biggest issues a laboratory has is that the quality of standard impressions is just not good enough. Many laboratories receive a lot of substandard impressions. I think when a dentist sees something on a screen instead of in a standard impression, it makes it so both the dentist and lab technician can see the same thing. When I speak to people about scanning, believe it or not, their impression improves. There’s a certain mental impact a digital impression has that a regular impression doesn’t.

Related reading: 3Shape releases TRIOS® 3 digital impression solution

The clarity of the image on the screen is critical to the dentist. So you know you can receive a crown or restoration from the laboratory that is going to fit perfectly.
	I also love that I can take high-definition pictures so I can show them to my staff or attach to the lab order. Finally, there are a lot of features we can discuss-shade matching by simply pressing a button is one of them. We can get an exact shade to the restoration that we are looking for.

Can you briefly explain how 3Shape TRIOS® has enhanced intraoral scanning in the office?


	I think number one is the speed of the scanner. It’s the fastest on the market. And one of the biggest questions for dentists on the learning curve is, “How quick can I scan?” While accuracy across the board is good, TRIOS® is just outstanding, especially when compared to traditional impressions. It also is forgiving. We place the camera over the teeth, and it puts those images together.

It sounds like a minute detail, but the rapidity of the scan, regardless of hand movement, is extremely critical. While that may only be 10 or 15 seconds, that small amount of time may allow blood or saliva to get into your scan. It’s important to note how fast the TRIOS® recovers. It’s so quick in its functionality that it minimizes any distortions in the image.

What improvements in the 3Shape TRIOS® equipment have you seen over the years and found to be most valuable on a day-to-day basis and why?


	3Shape’s new camera, TRIOS® 3, is much smaller, which allows easier access to the back of the mouth.

It has incorporated implant-planning software so a dentist can take a scan of any edentulous area and run it through the 3Shape software, taking dentistry to the next level.
	One of the advantages of the 3Shape software is that it’s easy to learn and allows for flexibility. For instance, I scan a crown. I look at the image, and, if it’s not clear, I can erase just the area I don’t like. I don’t have to rescan the entire preparation. If I miss a contact, I can just go back and get to that area.

The ability of TRIOS® to be incorporated into a dental practice either in a handheld scanner attached to a PC or in a cart on wheels allows the dentist versatility depending on practice style and size.

So, for instance, if someone is in a larger practice, he or she might want the TRIOS® on a pod for maximum mobility to move room to room whereas the cart option could appeal to the smaller practice.

How has intraoral scanning impacted patient perception, and has that led to any impact upon patient care?


	I think many patients hate the “goo” involved in impression taking. They just don’t like impression material. They gag. It’s messy. It sticks to facial hair. A scanned impression eliminates all of that.

The TRIOS® is tech-savvy. When patients have a perception that something is technologically advanced, they feel like they are in the right place. It makes their dental experience smoother and better.


	TRIOS® 3 is a three-in-one digital impression solution featuring an intraoral scanner, integrated intraoral camera and automated shade measurement combined in one device. TRIOS® 3 is available in a pen grip design and handle grip version-both with autoclavable tips. Choose the configuration that suits the way you work-Cart, Pod or Chair Integration.

For even more information, view this video from 3Shape on the TRIOS 3:

Articles

 Dr. Ron Kaminer, of Smiles By Design in Hewlett, N.Y., discusses the TRIOS 3.

I Use That: “... patients feel like they are in the right place.”

Alloys are and will continue to be the gold standard when it comes to providing artistic, esthetically pleasing and lasting restorations to clinicians and their patients, according to a group of experts. While on the surface it may seem alloys have remained the same over time, new technology, engineering and blending of metals have brought about significant changes and improvements.

“There are different ways that alloys have evolved,” explained Paul Cascone, Senior Vice President of Research and Development at the 

, San Diego, where more than 600 different alloy compositions are produced. “The actual manufacturing process internally has changed over the years which has resulted in new and improved products. The manufacturing of alloys is a very intricate process.”

Cascone said over time, various innovations have been introduced to improve the performance of dental alloys. In the 1960s grain refiners were added allowing for the fabrication of PFMs. Specialized ceramic molds were developed in the 1970s enabling the fabrication of palladium based alloys. Next in the 1980s, continuous casting expanded the possibilities of alloy development, and in the 1990s exotic elements were added to yellow alloys to improve their strength and color. Most recently, in the 2000s powdered metals were employed for use with 

“There has been a history of innovation in dental materials which has accelerated over the last decade,” Cascone said. “Throughout the history of Argen alloy developments, we have responded to volatile commodity prices with lower intrinsic cost alloys that provide the same characteristics.”

Over the expanse of his career, Chuck Cook, CDT, owner of Cook Dental Studio, in Manchester, N.H., has seen and worked with those innovations. He worked as a lab technician at various facilities for many years before starting his own company 25 years ago. And he’s not just a technician, he’s a customer. Eleven of the crowns in his mouth, which were placed quite a while ago, are 74% gold.

“All ceramics are the future and we need to embrace it, but alloys will not go away for a long, long time,” Cook said. “For a molar, I choose all gold because it is indestructible.”

David Novak, president of Chain O’Lakes Dental Lab in Lake Villa, Ill., has a staff of 15 and over the past 30 years has been both a technician and lab owner. He’s also training one of his sons, Nick, 18, to be a lab technician.

 required development of lower gold content, lower cost alloys by dental alloy manufacturers,” Novak said. “Some of these alloys have high sliver contents. Many are palladium based. Some porcelains on the market are marginally compatible with the newer alloys. This situation necessitated changes in techniques by the technician, often resulting in more time consuming procedures.”

Younger dentists and students are more likely to be exposed to 

, so they tend to gravitate to those materials more than metal, said Donald Morris, owner of Eclipse Dental Laboratory in Mansfield, Ohio. He’s been in the industry for 17 years and has operated his lab for 12 years.

“That being said, dental laboratories can create an esthetic porcelain restoration with metal under it,” he explained. “In reality a porcelain fused to metal restoration is extremely esthetic, has the structural support of the metal and can be fabricated without the use of expensive equipment.”

, Fullerton, Calif., manufacturer of alloys since 1974, Cook, Morris and Novak regularly help other lab technicians better understand how to work with alloys.

For each case, the lab technician should consider the physical properties of the alloy before making a selection, Cascone advised. Strength, color and marginal elasticity are all important factors. Tissue response-how well the patient’s tissue will react to the material-is another important property.

“Elasticity determines how stiff the material is and how thin you can make the wall of the coping, providing more room for the porcelain,” he said. “Depending on the application you are using the alloy for, you have to weigh all the characteristics and consider the porcelain compatibility.”

Howard Hoffman, President of Aurident, Inc., explained that, “the coefficient of thermal expansion (CTE) of an alloy and porcelain is a major factor determining the compatibility of that metal/porcelain system. In general, the CTE of the alloy should be slightly higher than that of the porcelain in order to minimize interfacial stress that could induce porcelain cracking or spalling during the cool down period. But other factors also affect compatibility such as thermal conductivity and heat capacity of both materials as well as modulus of elasticity of the alloy.”

Alloys with low modulus of elasticity, typical of those with high gold content, may be compatible with a porcelain having a gross CTE mismatch. The only certain test of alloy/porcelain compatibility is a trial of the system in question, Hoffman added.

Being aware of the alloy’s properties is essential, Morris said. You need to know if the alloy is compatible with the type of porcelain being applied.

Coefficient of expansion between the porcelain and the alloy is critical, if they are not coordinated, fractures and delamination of the porcelain are possible. Burnout temperatures are just as key.

“Incomplete castings, short margins and rough appearance are just some of the symptoms of improper burnout temperatures,” he said.

Both over- and underheating when casting can have detrimental effects, Morris said.

“Technicians tend to be concerned with miscasts if the metal cools and solidifies too quickly so they try to make sure enough heat is applied,” he said. “But overheating can cause problems such as porosity and rough surfaces.”

Excessive temperatures will cause volatile elements in the alloy to vaporize and/or oxidize, changing its composition and properties. Palladium based alloys absorb hydrogen from propane or natural gas, so prolonged torch flame exposure can increase their hydrogen content, making it brittle and susceptible to cracking, Morris explained. To counter these effects, it’s always a good idea to add some new alloy to previously melted buttons and castings.

“You need to focus on the appearance of the alloy in the crucible. Leaving the flame of the torch on the alloy even a few seconds too long can cause it to overheat by 100º F or more,” he said. “Visually determining casting temperature requires some practice. If a gentle tap on the side of the casting machine arm causes ripples on the surface of the molten alloy, it is ready to cast.”

Cook prefers alloys that melt and are ready for casting in 45 seconds or less because the loss of volatile elements such as silver, indium, tin and gallium is minimized, assuring the physical and mechanical properties of the casting are essentially those reported by the alloy manufacturer.”

There are decades of experience behind producing today’s alloys and a variety of resources available for support.

“Always seek professional guidance before switching unilaterally between alloys,” Cascone recommended. “As we all know, the lab process is very intricate.

At the end of the day, you need to feel comfortable with the technical support offered by your alloy provider and confident that the support will be there when needed.”

Trust the manufacturers. They’ve been at it for quite a long time.

“They’ve been manufacturing ceramic alloys for over 50 years now,” Morris said. “If a technician has a problem with an alloy, it has been engineered to the ‘nth’ degree, so it’s highly improbable that anything is wrong with the alloy.

“Alloy manufacturers adhere to strict control standards that are governed by ISO13485 regulations. Slight but inadvertent variations in technique within a laboratory can result in a problem, particularly with technique sensitive materials. The manufacturer’s technical support staff can generally resolve any questions or issues you may encounter.”

Argenco Y+ delivers the beautiful gold hue laboratories desire at a price they can afford. With only 2% gold, the material brings all the qualities of a yellow alloy at 50%-70% less cost per ounce. Featuring stability, warm hue and economic pricing, it is said to be the fastest growing crown and bridge alloy on the market today. Argenco Y+ is a Type III Noble Yellow alloy with 2% gold, 34.9% palladium and 30% silver, suitable for full cast crowns and short span bridges.

What led you to choose Argenco Y+ for your lab?

I’ve been working with Argen for a number of years and have always been aware of Argenco Y+, but hadn’t used it in my lab until recently. I added it to my line-up of alloys when the price of gold shot up so high. I was pleasantly surprised with how great our restorations turn out. Argenco Y+ is a really beautiful color; at only 2% gold it‘s really amazing. It is a semi-precious but classified for a noble alloy.

What do you like about working with the alloy?

Argenco Y+ works like a high gold type III alloy. The polish comes up nicely to a sunshiny yellow luster, and the marginal integrity and cast is really nice. You would think it would be a harder alloy, but it’s very malleable and easy to work with. Y+ is saving us so much money, and this savings we also are able to then pass on to our dentists. It’s an economically priced gold alloy.

Would you recommend it as an option for other labs?

I recommend Argenco Y+ to a number of other labs because the quality and color of this alloy offer great restorations and an affordable price. This allows doctors the ability to prescribe gold with confidence. This alloy finishes beautifully and is very easy to work with, priced in a way that labs are able to keep the work in-house. Argenco Y+ gives labs an opportunity to offer the dentist and patient top quality, stable, warm hue material for excellent restorations.

Suitable for a broad range of indications, including implant superstructures, copper-free Callisto 75 Pd is a white, highly stable palladium-based alloy for the fabrication of PFM restorations involving the layering and press or Press-on-Metal technique. The Type 4 alloy has a low silver content and exhibits a high modulus of elasticity and 0.2% proof stress. Balanced mechanical properties provide for convenient handling, particularly during grinding with tungsten carbide burs.

Marotta Dental Studio Inc. - Farmingdale, N.Y.

How long have you been using Ivoclar alloys?

I have used Ivoclar alloys going back to the early 1980s when it was Williams Will-Ceram alloy and porcelain.

Ivoclar is the premier dental product manufacturer. They sponsor the most research and support their products with the research. We have participated in numerous studies for various products from crown and bridge to implant restorations with more than one university. The use of an Ivoclar product in these studies is overwhelming. 

Why would you recommend Ivoclar alloys to other lab owners?

Ivoclar alloy is the most reliable and consistent alloy for smooth clean castings and porcelain bond. The sales and customer service are second to none.

A proven performer, Eclipse is a high noble alloy with a silver-free formulation said to eliminate porcelain greening. The alloy reportedly provides strength, sag resistance and overall trouble-free performance. It is suitable for long span applications, implants or restorations subject to high stress.

Thayer Dental Laboratory Inc. - Mechanicsburg, Penn.

How long have you been using Eclipse alloy?

Thayer Dental Laboratory has been using Eclipse high-noble alloy from DENTSPLY Ceramco® for five years.

At Thayer Dental Laboratory, we pride ourselves on consistent, high quality restorations and outstanding service. Eclipse dental alloy meets our demanding material performance expectations. 

Our dentist customers who prescribe PFMs recognize that Eclipse offers a good value for a biocompatible, high-noble “white” alloy. 

Our technicians appreciate the ease-of-use in working with the alloy-from casting to finishing and polishing. In particular, Eclipse produces a minimal oxide layer that greatly reduces the time necessary to prepare the coping for the porcelain application. Thayer Dental Laboratory PFM restorations that are crafted with Eclipse alloy are finished with Ceramco® 3 porcelain, yielding a dependable bond, lifelike esthetics, strength and durability.

Would you recommend Eclipse alloy to other lab owners?

I would recommend the Eclipse alloy from DENTSPLY Ceramco to other labs for peace of mind. It’s silver-free and copper-free, so there’s no risk of discoloration. There’s no variation in what you receive. The quality is consistent from lot-to-lot, so you can be assured that the finished results will be reliable and of high quality. Because Eclipse alloy is available next day, your lab will not have to carry a large, expensive inventory. Finally, the responsive, knowledgeable service and support we receive from our sales representative is an important consideration in why we choose to award our white alloy business to DENTSPLY.

Alloys 360º – Alloys remain the gold standard

The top 5 reasons to buy NuSmile ZR zirconia crowns from NuSmile Pediatric Crowns.

These zirconia crowns are described as providing the 

 The metal-free crowns are made from monolithic zirconia and are said to be like 

ceramic steel and mimic anatomical contours

 of natural primary teeth to achieve a natural clinical outcome.

The anatomically contoured crowns deliver 

 to meet the demands of even the most challenging cases.
	
	

The high strength formula used to produce the crowns is reportedly 

to provide a superior result to composite strip crowns.
	
	

Available in 2 shades and numerous sizes, the crowns are 

. University surveys show, with 3 million smiles and counting, more pediatric dentists choose NuSmile.

NuSmile Pediatric Crowns' NuSmile ZR zirconia crowns achieve a natural, esthetic outcome [VIDEO]

What has oral care and whitening products, a grinding prevention appliance, a composite sculpting tool. try-in crowns for young patients, and an in-practice marketing system? This edition of the Weekly new dental products roundup of course. For more information on these products, read on, use the links to more details about each one and check out the roundup video.

The scope of the Venus White Line has been expanded to include four new oral care and whitening products.

The DAYGUARD appliance is designed for patients who grind during the day. 

Designed for the non-stick placement of composite materials, the Optrasculpt Pad is said to allow composite filling material to be placed and shaped with ease and efficiency. 

Described as an evolutionary step forward for pediatric dentistry, NuSmile Try-In Crowns are easy-to-use and ensure a successful restoration the first time.

Send a message in your reception area using Practice Vision which is used to emphasize the meaningful benefits of your practice. 

What has oral care and whitening products, a grinding prevention appliance, a composite sculpting tool. try-in crowns for young patients, and an in-practice marketing system? This edition of the Weekly new dental products roundup of course. For more information on these products, read on, use the links to more details about each one and check out the roundup video. 

Weekly new dental products roundup - March 29, 2013

This weeks roundup features a handful of items to help make your practice perfect. Check out the links to the complete articles on each one and the roundup video that follow.

 messaging system for dental professionals is said to be compliant with patient privacy legislation. 

 temporary cement is said to be engineered with precisely the right strength to ensure that temporary veneers will not fall off between appointments. 

 sensor bite blocks capture bite-wing images. A ratcheting mechanism adjusts to form a custom-fit around any size sensor and the bite-wing block slides into the mid-line position. 

Patient Activator mobile app             

 is said to provide the software’s most-used features. 

This weeks roundup features a handful of items to help make your practice perfect. Check out the links to the complete articles on each one and the roundup video that follow.  Secure-Mail  Brightsquid 

Weekly new dental products roundup

This week's roundup features everything from microbial testing strips and flavored prophy powder to disposable air/water syringe tips and fluoride-free natural whitening toothpaste and even an educational CD about accountability. Following are the links to the complete articles and the weekly roundup video.

Sporicidin Microbial Testing Strips are said to be fast, easy, and accurate tools for detecting potential microorganisms on many common interior surfaces. 

 Prophy Powder line. The powder is now available in strawberry, raspberry and lemon-lime. 

Offered in 8 assorted colors, SEAL-TIGHT® SPECTRUM disposable air/water syringe tips are said to deliver dry air on demand, reduce cross contamination and eliminate sterilization time. 

SLS-free and fluoride-free Tom’s of Maine Botanically Bright toothpaste reportedly whitens teeth with natural foaming action and great taste. 

The complimentary “Accountability = Energized Teams and Satisfied Patients” audio CD features Dr. Rhonda Savage, Chief Operating Officer of Miles Global, a practice management consulting firm serving dentists. 

This week's roundup features everything from microbial testing strips and flavored prophy powder to disposable air/water syringe tips and fluoride-free natural whitening toothpaste and even an educational CD about accountability. Following are the links to the complete articles and the weekly roundup video. Sporicidin Microbial Testing Strips Hager Worldwide

Weekly new dental Products roundup

This week's roundup features pure zirconia crowns, a denin substitute, face shields for young patients, composite and a solution for patients who suffer from dry mouth. The links to the complete articles and the roundup video follow.

 pure zirconia crown with no porcelain overlay for no porcelain fractures is said to cost less than half that of a gold crown. 

 is described as an all-in-one dentin replacement material that is bioactive and biocompatible. 

Cosmic Nee-Noggs Face Shields             

Said to be ideal for use when treating young, anxious patients, cute 

 from Practicon provide facial protection from chairside splash and airborne hazards.  

CLEARFIL™ MAJESTY ESTHETIC has been renamed 

 for dry mouth are all-natural oral adhering discs that time release 500mg of Xylitol and oral lubricant. 

This week's roundup features pure zirconia crowns, a denin substitute, face shields for young patients, composite and a solution for patients who suffer from dry mouth. The links to the complete articles and the roundup video follow. Zenostar Assured Dental Laboratory

Gadgets, apps and helpful accessories are all part of this edition of the Weekly new dental products roundup. Use the links that follow to read the complete information on each product and don't forget to give the video a look.

 includes a lightweight plastic HVE valve and 6 feet of tubing. 

 designed by a dentist to quickly and safely scrape hardened impression material from reusable trays. 

 is described as a durable, high-volume germicide tray designed for maximum use of chemicals to clean, disinfect, and sterilize instruments. 

Patients can see what they would look like when using a certain color of mouthguard when using the 

 available at no cost at the iTunes store. 

 spray is said to seal the tissue surfaces of a denture and other acrylic appliances from bacteria and plaque. 

Gadgets, apps and helpful accessories are all part of this edition of the Weekly new dental products roundup. Use the links that follow to read the complete information on each product and don't forget to give the video a look. Mr. Thirsty® Comfort Kit Zirc Co. 

Offered up in this edition of the Weekly new dental products roundup are ortho instruments, a handpiece coupler, a combination teether/toothbrush, CAD/CAM implant abutments and fluoride foam. Here's a summary of each with links to complete articles and the weekly video of the products that were posted throughout the week.

 that are said to feature optimal intraoral access, visibility for the clinician, enhanced comfort for the patient and more time savings per procedure. 

 is a combination teether and toothbrush. 

Titanium Base Abutments             

 serve as a connector between CAD/CAM individually fabricated crown/abutments and the implant. 

 are said to be effective, efficient and high quality while providing caries protection and prevention. 

Offered up in this edition of the Weekly new dental products roundup are ortho instruments, a handpiece coupler, a combination teether/toothbrush, CAD/CAM implant abutments and fluoride foam. Here's a summary of each with links to complete articles and the weekly video of the products that were posted throughout the week. Ortho Lingual Collection Hu-Friedy

 provides three distinctive treatment modes: surgery, whitening and pain therapy. The laser is controlled by a full-color touch-screen interface.

 With treatment options ranging from soft-tissue surgery to whitening to pain therapy for TMJ patients, it can address various clinical situations.

 The laser is FDA cleared for providing temporary relief of minor pain, meaning it can be used to treat TMJ and other musculoskeletal pain.

 Providing up to 10 Watts of peak power, the compact console also is fully portable.

 A ComfortPluse setting delivers precisely controlled micropulses of diode energy to the tissue followed by down time to allow tissue to positively respond

The EPIC™ diode laser provides three distinctive treatment modes: surgery, whitening and pain therapy. The laser is controlled by a full-color touch-screen interface.