Nicholas Hamm

	Finding the perfect new equipment for your lab can be a challenge.

There’s a lot to consider: what price point are you comfortable at? What features are a must have? What features can you do without? What materials do you mill most often? What applications are you looking for?

	To help narrow down your search, we’ve gathered several of the most cutting-edge milling machines available today. From big to small and everything in between, chances are one of these mills will be just what you and your lab are looking for.

	The Ceramill Motion 2 is a benchmark in terms of the range of indications and materials in-house. The 5-axis milling unit combines wet and dry processing in one unit and enables the value-creation chain to be kept virtually completely in-house in the laboratory.

	The Ceramill Motion 2 can be used either as a purely dry or wet unit or in combined operation for a reportedly unlimited range of materials and indications.

	Equipped with the innovative control technology and robust machine concept from Amann Girrbach, the Ceramill 2 is guaranteed to be future-proof, economic and precise.

	The Versamill 5X400 from Axsys Dental Solutions is reportedly the most capable mill in its class. It offers double the machining capability of the top-selling competitive brand for almost half the price. Constructed with the technology in “full-frame” CNC industrial machines, the 5X400 is designed to perform reliably with high precision for the long term.

	This open source 5-axis mill can accept input from any popular design program and process virtually any dental milling material (even titanium) with superior surface finishes, faster cycle times and greater tool life. Single-unit zirconia and glass ceramic crowns in 14 minutes. 

	The M10Pro Next is a German-engineered, high-speed milling machine featuring the new DATRON next control system. DATRON next, for DATRON high-speed milling machines, provides an intuitive touch-screen machine control that functions much like a Smartphone – allowing the operator to tap into robust machining functionality. Unlike other numbers-based controls, DATRON next is image-based and swiftly leads the user through the steps required to start milling. Recognizable images replace numerical input for selecting tools, projects, and more.

	The inLab MC X5 is the only five-axis milling and grinding unit that switches seamlessly between wet and dry functions and processes a wide range of materials. With the inLab MC X5, laboratory technicians have complete control throughout the entire production process while creating esthetically pleasing restorations.

	It also accommodates any 98mm standard disc as well as milling blocks, enabling the production of fixed restorations, implant abutments and screw-retained implant bridges with multi-unit abutments from nt-trading and Medentika.

	Moreover, Dentsply Sirona’s recent launch of inLab SW 18 now allows users the ability to mill Digital Dentures right in-house using the inLab MC X5. The inLab MC X5 is an open system that can be used in combination with inLab software, open STL-design file import, or any other laboratory CAD-software. 

	The new CORiTEC one machine system is said to be suited perfectly for processing any common CAD/CAM blocks up to a size of 65mm x 40mm x 20mm (maxi blocks). Offering the new and extremely robust axis kinematics, the machine is also able to machine premilled abutments. The cast aluminum construction facilitates high stability while maintaining the smallest of footprints. Machine operation is user-friendly via the large touchscreen display with its integrated high-performance PC, no additional computer system required. The 3-fold block holder and 6 tool positions with sister (twin) tool function make economic, safe and fast processing possible.

	The PrograMill One milling machine is a compact, 5-axis milling machine designed to mill beautiful, esthetic IPS e.max restorations. PrograMill One is wireless, which enables it to be positioned anywhere within the practice. It can be controlled using the mill’s corresponding app on a tablet or smartphone. An LED light ring visually informs the user about the current processing status. An innovative rotary grinding process, 5XT, reportedly produces shorter duration of the milling process and minimal tool wear. A camera integrated within the mill automatically records all data on material and tool use. Material management is said to be more expedient than ever with PrograMill One.

	The New Planmeca PlanMill 30 S has been designed for optimal precision without compromising quality, expectations or budget.

		4-axis high-speed single spindle: Capable of reaching maximum speeds of 100,000 RPMs, ideal for single visit restorations and everyday milling of inlays, onlays, crowns or bridges.

		SMART software: Streamlines the user experience with updates on 

ool status to notify you when the mill needs attention.

		Broad Range of Milling Materials: To provide the best treatment option for the patient. Milling blocks include ZirCAD, IPS e.mas, IPS Empress, Lava Ultimate and VITA.

	The DWX-52DCi features an Automatic Disc Changer (ADC) that reportedly optimizes productivity by storing up to six discs of different materials and enabling discs to be replaced automatically during milling. In addition, the DWX-52DCi supports new DWINDEX performance visualization software that provides reporting on operation time, materials used and other deliverables. It also features include an Automatic Tool Changer (ATC) for fully automated 5-axis milling of a wide range of materials, such as zirconia, PMMA, PEEK, CoCr Sinter Metal, fiber-reinforced resins, composites, and all other standard milling materials. Typical applications range from crown and bridge to surgical guides, denture bases and more. Both models feature rigid frame construction, automatic calibration, and other advanced features that ensure optimum performance, reliability and convenience.

	The updated K5+ features DirectDisc TechnoloÂ­gy for fixing discs. Thanks to this tool-free blank clamping system, the machine can reportedly be loaded with material quickly and easily. A built-in ionizer neutralizes the static charge of acrylic particles. Improved air circulation in the working area is said to significantly reduce cleaning time.

	The dry milling machine now includes a built-in camera for simplified supÂ­port and an Ethernet port, which increases stability and flexibility of the connection. The extremely stable design with a solid cast body guarantees first-rate machining results. An automatic changer with space for 16 tools rounds out the machine’s many versatile features.

Articles

A roundup of some of the latest dental mills that could be just what your lab is looking for.

Finding the perfect mill for your lab

If your patients think dental offices are scary now, show them what their ancestors had to endure.

7 horrifying procedures dentists used to do

	Chances are, if it oozes or bleeds or causes pain, you’ve dealt with it in your practice. The stuff of horror films wouldn’t even faze most healthcare professionals.

But that’s because you’re used to treating those things. You know how to relieve the pain of caries, how to staunch bleeding and use antibacterial agents. For much of dental history, however, that hasn’t really been the case. In fact, it almost seems like dentists of old caused more pain and more bleeding than they stopped.

, just remind them that it could be a lot worse. You 

 be putting poison in their mouth, or using dental tools with the unfortunate side effect of accidentally breaking entire jaws, or drilling into their mouth with sharp rocks. The whine of the dental drill isn't exactly a pleasant sound, but it's certainly much easier to handle with copious amounts of anesthetic.

	To help celebrate just how far dentistry has come, from the earliest evidences of dentistry around 14,000 years ago to the hi-tech landscape of today, and to celebrate the scarier side of this time of year, we rounded up some of the most horrifying things dentists have ever done.  

	The Middle Ages and Renaissance in Europe created the ultimate jack-of-all-healthcare-trades with the curiously-named “barber-surgeon.” These healthcare workers could perform a range of tasks, from cutting hair to bloodletting to 

 to amputating limbs to, you guessed it, dentistry.

	These barber-surgeons are ones responsible for the quintessential Middle Age dental technique - large tongs grabbing a tooth and wrenching it free.

	But tongs weren’t the only tools available to these early dentists. One tool, known as the “

” because it resembles a pelican’s beak, dates back to the 1300s. The device operated using a fulcrum system, where a curved metal bit was placed under the tooth and then a lever removed the tooth. The system was painful and probably caused a fair amount to damage.

	It didn’t get much better after the Middle Ages. From the late 1700s on, the 

 tool used for tooth pulling was the dreaded “dental key.” The dental key, also known as a tooth key, was modeled after a door key. It was inserted horizontally, then clamped over the tooth ready to be pulled. The dentist would then rotate the key, loosening the tooth. This sometimes caused horrific injuries 

 during extraction. Dental keys remained in vogue until the early 20

 century, when modern forceps were finally invented.

Photo credit: Tooth Key, The Ohio State University Libraries.

	While the common perception of the Medieval dentist is gruesome, are they really so different from the dentists of today? After all, tooth pulling still happens with some degree of frequency (though at least with much more anesthesia and cleaner instruments)?

	Even more impressively, dentists of the time were also involved with cosmetic procedures. Specifically, some barber surgeons were in the business of teeth whitening. Perhaps they weren’t so different from dentists today!

	That would be true, except that the teeth whitening agents of the 16

, barber surgeons applied the very innocent-sounding 

 (strong water) using a stick. This was done, of course, after a thorough cleaning using toothpicks and bits of cloth. All of this sounds very similar to today, except when you realize that 

 is actually just a solution of nitric acid. While it certainly did whiten teeth, it also had the unfortunate effect of ruining the enamel beyond repair.

	Arsenic has a long and storied history in the dental field.

 in China about 3000 years ago. At the time, China had what were probably the most advanced dental care techniques in the world. They were already using fillings, practicing restorations with artificial teeth and treating periodontitis using teeth-cleaning techniques. So while putting an extremely toxic substance into the oral cavity may not have been the best idea, there were plenty of other techniques that were likely much more successful (and less deadly).

	Arsenic in dentistry, however, was by no means limited to China. Around 700 AD, dentists in Europe and the Middle East 

 to treat dental fistula and tooth pain, and for root canals. They also mixed it with opium as a pain-reliever.

	The practice was still going strong over a 1000 years later - in fact, the practice was still going strong in dentistry circles through the 1800s. An October 8, 1879 

 describes “the horrible death of Mr. George Arthur Gardiner, caused by arsenical poison placed by a dentist in one of his teeth to kill an aching nerve.”

	Today, the practice is generally frowned upon - though some homeopaths 

 arsenic as a way to relieve tooth pain and there are still arsenic poisoning cases reported because of it.

	Depending on who you ask, this one might not even be so bad.

 century, surgeons would sometimes use a device they referred to as a “

” as an anesthetic. It was used by patients as a deterrent the excruciating pain they might have otherwise undergone. Doesn’t sound so bad, right?

	The only problem was the ingredient list for the sponge. The recipe begins with a sea sponge, which is then soaked in a solution of ingredients like opium, hyoscyamine (an overdose of which can cause hallucinations and short-term memory loss), hemlock and mandrake. The sponge was then supposed to completely dry out in the sun, and then would be dunked in water again just before surgery.

	Some accounts say that surgeons would lift the sponge to patient’s nostrils, but other say the sponge water would be drunk. Whatever the method, the patient would fall asleep or hallucinate. This doesn’t mean they weren’t in pain, however - even if they couldn’t remember it, they would still flinch and move about in reaction to pain.

	While some early dentists used less-than-savory chemicals and salves to treat dental pain, some resorted to more strange devices.

 century would roam through villages and towns, advertising their shows in town squares and other public places. They were known simply as “tooth drawers,” and made a spectacle out of their craft. They were known for one type of dental surgery: pulling teeth.

	Tooth drawers would set up a lavishly-decorated stage and hire musicians to draw in spectators (definitely a 

). They would then invite patients suffering from toothaches up on the stage, promising that they were expert surgeons who could perform the operation painlessly. Not surprisingly, most of them were not very skilled.

	But crafty tooth drawers could use tricks to lure more innocent patients to their stage. The musicians 

 to the stage, but they drowned out the patient’s screaming on stage.

 in the audience. That actor would then come on stage, where the surgeon would mimic pulling a tooth - but would instead place a blood-soaked tooth in the actor’s mouth. At the end what looked like a very quick and pain-free experience, the plant would then spit out the tooth for the amazed crowd.

Photo credit: The tooth puller (arracheur de dents), Jean Duplessis-Bertaux. Prints and Photographs Collection, History of Medicine Division, National Library of Medicine.

	You might think of ancient humans as all having rotted out, decaying teeth. After all, they all went way longer than six months without a cleaning!

	But in reality, only a very small number of them actually had problems. In fact, 

 a caries frequency rate of just 1 to 5 percent. With no refined sugar to speak of in their diets, our ancient ancestors were much healthier (at least in terms of caries) than us.

	Still, not even those unlucky few had to suffer with rotten teeth for their entire lives. Researchers recently 

 of dental care in humans as far back as 14,000 years ago - painful, painful dentistry. Researchers discovered carious lesions on a molar found at a site in Northern Italy. Remarkably, those lesions showed evidence of scratches from pointed flint tools, sort of an early proto-drilling. If your patients ever complain about the whine of a drill, remind them that you could be using a hammer and chisel without the use of anesthetic.

	The second-oldest evidence of dentistry ever found was even more advanced than that. Researchers 

 dating back to around 13,000 years ago. The teeth were again drilled, but also had a much more modern touch - fillings made of bitumen (a kind of naturally-occurring tar) and human hair. The filling may have been used as a kind of antiseptic, but that doesn’t negate the fact that the poor patient had to endure primitive stone tools scraping away tissue only to have tar shoved into the wound.

 (a gourd-like vine native to the Mediterranean region) is used in a variety of 

, but it’s been banned by the FDA since 1991. It 

 severe irritation of the stomach and bloody diarrhea, kidney damage and even death.

 from shoving it into teeth in an attempt to heal teeth. The process for treating a septic tooth, or what they called “a tooth that gnaws into an opening in the flesh,” was a salve containing cumin, frankincense and colocynth.

	This salve would most certainly have smelled good and probably even tasted good - not to mention the antibacterial and pain-relieving properties 

 to frankincense. But all of those good antibacterial properties would be wasted if the patient’s kidneys failed.

	Much of the work dental labs do is meant to last as long as possible-after all, no patient wants to go back to their dentist every three weeks for the rest of their life.

That’s why labs use the best materials and techniques to get the best product possible.

	But temporaries require a different sort of focus. Sure, they need to be esthetic and they need to be functional, but they are still what their name implies: temporary.

	So how should labs approach this kind of work? How do you provide a good fit and excellent esthetics and still turn something around quickly (and cheaply)? These five techniques demonstrate how lab technicians solved the problem and created satisfied patients.

An alternative approach to long-term temporaries

	Our case study involves a female patient who was missing her lateral teeth, numbers 7 and 10. An implant had been placed on number 10 because the patient sought longevity in the treatment plan. She also wanted esthetically pleasing provisionals for cosmetic reasons since she would be wearing the restorations long-term-for six to nine months.

	Our purpose for this article is to demonstrate the best method for fabricating this type of excellent long-term temporization. This type of work is done through the fixed department and is cosmetic in nature.

Step-by-step: Fabricating temporaries with PMMA material

	We used to fabricate our temporaries with acrylic by hand, and, for higher end long-term bridges, we would often use composite. This particular case study will explain what PMMA (defined by webopedia.com as “short for polymethylmethacrylate or, more correctly, Poly (methyl methacrylate), PMMA is a clear plastic acrylic material that can be used as a replacement for glass”) is and how we can successfully use the material in the dental world.

	We can utilize technology, especially for implants, to create long-term temporaries through the use of a CAD/CAM machine. A good example of what we can use the material for is with a full-mouth implant case scanned and then copy scanned with a wax try-in already set up.

Providing immediate esthetics for implant cases

	By Chris Halke CAD/CAM Supervisor Albensi Dental Laboratory and Dr. Michael Pikus Director of Clinical Education Albensi Dental Laboratory

	Today, immediate implant placement after extraction and immediate temporization is becoming an increasingly popular option for many clinicians.

	Implants have revolutionized dentistry and are allowing patients whose only hope 40 years ago would have been to get complete dentures to now be able to have an esthetic and functional fixed prosthetic. Initially, dental implants were placed by oral surgeons, and their restorations were almost entirely undertaken by a prosthodontist. As implant science improved with different surface treatments and an increased scientific body of knowledge about the process of osseointegration, more clinicians started to delve into implant placement and prosthetics.

	How to place an anterior implant using a digital workflow

	The patient, a 48-year-old female, is in good general health with no known diseases and not taking any medication. She is a non-smoker with no allergies.

	The patient is suffering from the continuous decimation of her crown on the central incisor. Once the crown is removed, we can see that the remaining stump has subgingival margins and the typical appearance of having suffered continued leaks.

	How to simplify temporaries with Tuff-Temp Plus

	A prosthetic reconstruction for oral rehabilitation requires a number of clinical and laboratory treatment stages. An interim restoration is necessary and this has a crucial influence on the patient’s well-being, the quality of the final restoration and the long-term success of the treatment.

	Essential factors for success in fabrication of fixed restorations include making anatomically correct and hygienic temporaries. Temporary fixed restorations serve to protect the underlying tooth preparation while the final restoration is being fabricated in the laboratory.

Temporaries are an important part of any lab’s technical skill profile. These five techniques will help you improve those skills.

Top 5 temporaries techniques

	The cause of tooth decay has long been known - two kinds of bacteria (

) create a biofilm and acid that damages teeth.

 by researchers in a group simply called mutans streptococci, since they both work together to form dental caries. However, much more is known about 

 is more prevalent than its caries-causing twin and is more stable, making it much easier to study.

	Until recently, very little was known about 

. That changed when a group at the University of Illinois Bioengineering department 

More emerging research: Are elderly patients with caries at risk of developing respiratory problems?

, an assistant professor at the university, the reason 

is so little studied is that it is difficult to work with in the lab and it isn’t present in all people. However, it was known that 

 produces acid more quickly and is associated with the poorest clinical outcomes, especially among children,” 

, you’re at risk for rampant tooth decay, which means there's some level of communication or synergy between the two that we don't understand yet."

Armed with this new knowledge about the 

s genome, Jensen and his team are now building models that will allow them to study the relationship between the two bacteria and how they can be neutralized most effectively. The work is funded with a $218,000 grant from the National Institute of Dental and Craniofacial Research (

	For instance, the researchers have already noted that the 

, an ability many bacteria have that allows them to sense and react to other nearby bacteria. 

 has this ability in the form of peptides that reach out sense other 

bacteria. Then, once a certain threshold is reached, the bacteria attack. Jensen and his team are trying to figure out why this isn’t the case for 

	“This is groundbreaking work because the field was plagued by a lack of information," says Jensen. "In 2018, it is surprising that we had a whole species [of bacteria] that causes disease and no complete genome of it.”

 that his team is working on a genomic-scale model, which will allow them to run virtually any experiment they want. With this model, he says, they could simulate what would happen if certain genes were deleted or if the bacteria were fed different sugars. Armed with this knowledge, his team will then make recommendations of drug targets for further experimentation. These therapies could eventually be used to lessen the destructive power of the bacteria.

Related article: Study finds link between oral bacteria and increased risk of esophageal cancer

	“A lot of scientists are interested in 

 and they want to see what we find out,” says Jensen. “Using computation is allowing us to rationally demonstrate that this is the way to study 

 even though other lab-based experiments failed in the past.”

	The team’s research on genome sequencing 

How new research on some of the worst dental bacteria could lead to exciting discoveries.

Have scientists finally solved tooth decay?

	As an expert on dental prostheses and restorations, you might take it for granted that you do excellent work.

	But there is an entire corner of the internet that says, “I don’t need an expert for that, I can do it myself.” Here is what happens when non-experts try to get into the dental game.

You’ve spent years training to use the best materials and techniques to create the best product that is esthetic, safe and (most importantly) functional. The following groups of people spent a few hours using household objects and YouTube guides to make or fix their dentures.

	After seeing some of the worst denture tips and “hacks” from across the internet, you’ll agree that the phrase “leave it to the experts” has never been truer.

	Not only will these tips not create something long-lasting or beautiful, they may just be the worst thing a patient could put in their mouth. They might be cheaper in the short run, but these could end up costing patients a lot more in wasted materials or health problems.

	It should go without saying that no one should ever get health tips from ebay. But at least 140 people didn’t realize that. Instead, they turned to Ebay user 

 (100% positive feedback rating!) for a “

very easy dvd kit for makeing [sic] your own dentures at home

	This kit isn’t being auctioned off, instead it’s available to buy now for the low price of $35. Very reasonable! That $35 includes: two dvds, a printout of the additional materials you will need to purchase, another printout on how to order teeth, yet another printout with a materials checklist and finally a bottle of free liquid tin foil.

	The additional materials will cost around $25 (at least according to garry704), meaning that an entire set of dentures will only run about $60. While certainly cheaper than most any other options, this kit will almost undoubtedly create further problems.

	For example, while the description might claim all materials are only $25, the actual printout tells a different story. It suggests a 

, which run at least $50. There’s also a 

 ($10) and a generic order for “cutting tools,” which will probably cost a reasonable amount of money. The printout also suggests a 25lb bag of 

, which runs $17 and seems like an excessive amount of material.

	According to the cover of the DVD, after a few attempts you will be able to complete 3 full denture sets in the 3.5 hours it takes to watch the instruction dvd - so perhaps it all comes down to a matter of quantity over quality.

	But let’s say that you have all of those materials just sitting in your garage and that you also happen to be an amazingly talented craftsperson without any sort of formal training. There’s still the problem the problem of sanitation and safety. What if one of these dentures breaks while chewing? What if one of the teeth pops out and you swallow it? Can you make sure that the “duck tape” from Walmart meets safety standards?

 promises to help you make $12 dentures in less than an hour. If that sounds too cheap to be good, you’re probably right.

	This method only requires one material, polymorph pellets, a plastic bead sold in many craft stores (some are even cheaper than $12). To make the bridge, first melt the beads in a microwave. Then, while still warm, apply the melted plastic mass around the teeth to make a form. Once the form is completed, remove the plastic and use a butter knife heated in water to slowly shape the plastic into a tooth-like form. This will create very white teeth that can then be dyed using coffee or (as one commenter suggests) yellow food coloring.

	The finished product does admittedly seem to work well in the video and the cost saving is certainly admirable - except for one potentially huge problem. During the forming process, the creator, “bigcatfishin,” stresses that you don’t want to let the plastic harden. Any procedure that could result in accidentally sealing a huge glob of plastic in your mouth seems inherently dangerous and could result in serious damage - not to mention the thousands of dollars it would take to repair that damage.

	Most labs probably don’t have a drawer full of crayons - for good reason. But the website 

 sees no problem with using children’s craft supplies for something that goes into your mouth.

	These dentures claim to be the cheapest of all - just five dollars! They’re also quick, taking only around 30 minutes from start to finish.

	The base material, while not exactly ideal for this application, is at least made to be put into the mouth. The process starts with dental wax, the kind used to protect the mouth from braces that can be obtained from any pharmacy. Something you will not find in most drugstores, however, are this site’s instructions to first melt that wax in a spoon held over a candle.

	That’s when it starts to go downhill quickly. The next step is to melt the wax of a white candle and add that to the dental wax. This is help firm up the dental wax enough to hold its shape - the site recommends about 10-15 percent candle wax in the mixture.

	The next step goes even further. The wax is too white, so to color the teeth the site recommends melting crayons into the mixture. And not just one type of crayon - white, brown and yellow crayons should all come into play. Somehow, these colors will eventually match tooth color.

	Next, shape the wax into a roughly tooth like shape and allow it to cool slightly. Place it into the mouth for a final fitting and then continue to shape it.

	The website warns that this should only be used a temporary solution, but even that seems too long. Even the dental wax, the actually FDA-approved portion of this mixture, isn’t recommended for long term use -it’s listing says to remove it after a couple of days, because it “

, but it’s generally not recommended to eat them. Same with wax candles - though depending on the candle, those might have all sorts of strange chemicals (or bacteria) in them.

	Improving appearance and self-confidence are certainly a key part of modern dentistry, but as 

 demonstrate, that’s not enough. Structure and usability also matter a lot!

	The Perfect Smile Veneer is made of a “special, non-toxic polymer,” so at least there’s no candle wax this time. And, while the $14.99 veneer isn’t exactly the world’s most esthetic option (the teeth are too white, the wax bulges outward, the color of the gums is off), it does at least provide a cheap option for covering up teeth. For those who can’t afford dental care, this might be the best cosmetic option.

	The problem, however, is directly in the commercial (and featured prominently on the bottom of their website). “This product is only intended to enhance your appearance, and isn't a denture or a dental device.” While this product might make you look a little better, it really isn’t much of help at all.

 presents an even bleaker picture: “Do not wear Perfect Smile when eating; although it is possible to drink while wearing it.” There is also the danger that during fitting the impression material can cling to the roof of the mouth, impeding speech. The veneer also only comes in one size, claiming to be a one-size-fits-all approach - but what about patients with smaller or larger mouths? What about patients who struggle to mold the veneer? $15 might seems like a steal, but it’s no substitute for a custom-fitted denture.

	Angie Barlow, a 48-year-old British woman, 

 for her dental work. Barlow was afraid of the dentist and hadn’t been in years. However, she had severe dental problems - her teeth were falling out due to a heavy smoking habit.

	Her solution? Super glue. When a tooth would fall out, she would apply a small amount of glue to the top and then stick it back in to avoid a gap. Over time, this resulted in a kind of super glue denture because of the amount of glue in her mouth. The super glue fix weakened her bones and remaining teeth, to the point where she had to have 11 teeth extracted and replaced with implants.

	Barlow’s case probably isn’t an isolated one. There are 

 for fixing dentures out there on the internet (though helpfully, 

 warning against the practice). Some claim that the glue is only toxic in liquid form, others dismiss claims that super glue should not be used in damp environments, others ignore the probable long-term damage to their dentures. As with most things on the internet, it’s too good and too cheap to be true.

For every good idea on the web, there are thousands of bad ones. These are some of the worst fixes out there.

The 5 craziest denture tips on the internet

For every good idea on the web, there are thousands of bad ones. These are some of the worst pieces of denture advice we've ever seen. 

The 5 Craziest Denture Tips on the Internet

	Dental labs, like so many other parts of the dental world, are rapidly going through changes.

	From cutting-edge digital design to the growing accessibility of chairside fabrication, the lines between lab and office are quickly becoming blurred. But one thing is still clear: Technicians will always be the experts when it comes to dental fabrication.

	As labs and offices move closer together - and as both become increasingly complex - many clinicians and technicians have realized that the key to success is to draw closer together. For some, this looks like increased collaboration through the process of digital impressions and case design, commenting and tweaking cases well before fabrication.

Related article: The state of dental technology in 2018

	For a small - but growing - number of technicians and clinicians, the easiest way to collaborate is to join forces in a single office. These in-office technicians work side-by-side with dentists, allowing for seamless collaboration all the way from patient to fabrication.

	Michael T. Morris, CDT, FAACD, is an in-office dental lab technician in Lexington, Kentucky-based 

. He sums up his experiences working in an office this way: “better than I could have imagined.” For Morris and many others, in-office work offers a variety of benefits and optimizations not found elsewhere.

	According to the National Association of Dental Laboratories (

), the number of technicians moving into dental offices has slowly increased over the last few years.

	In 2016, five percent of the technicians NADL surveyed worked in a dental office. In 2017, that number increased to 6.2 percent, while in 2018 it jumped up to 6.7 percent of technicians. Additionally, nearly one in ten (9.3 percent) small labs (those with between one and nine employees), were located in a dental office in 2018. This is up from 7.8 percent in 2017 and 5.6 percent, indicating that small labs are making the move to the dental office.

	Obviously, those numbers represent are relatively small when compared to the overall number of technicians. However, the data indicate that more and more technicians and practice owners see this as a mutually beneficial relationship.

At the same time, the number of dental lab technicians in the country has been shrinking for years. In 2015, according to the 

 (BLS), there were 37,520 technicians. In 2017, the most recent year available, that number dropped to 35,630. The growing number of in-office technicians may just be a simple reflection of the need for lab technicians to define their value in an increasingly competitive market - but that doesn’t mean there aren’t a number of benefits to the arrangement.

	One big reason technicians might be moving to offices is perhaps the most obvious: money. On average, technicians in offices make nearly $1,000 more per year than the average dental lab technician. In 2017, according to the BLS, technicians working in offices earned $43,000 compared to dental technicians as a whole, who earned $41,990 (Fig. 1). While only an increase of about 2.5 percent, the lure of bigger paycheck could be an attractive option for technicians struggling with low wages.

	Money is certainly one reason why technicians might consider moving, but technicians can benefit in other ways as well.

	Perhaps the most unique part of operating in-office is the ability for technicians to work directly with patients. “Working closely with patients and getting to see results firsthand is my favorite aspect of working in house. I see patients all through their treatment process,” says Morris. He appreciates the ability to meet with patients during pre-treatment record appointments, where he can then share his perspective the patient - a process he says is much more personal than if he were off-site.

Trending article: 6 materials lab techs need to know about

	In-office technicians also have greater access to doctors than they would working offsite. Rather than having to rely on email or having to send cases back and forth for corrections, technicians can work directly with the doctor to get it right quickly and more accurately. After all, nearly 

65 percent of all impressions sent to labs are faulty

 - working directly with the doctor can take some of the technician’s guess work out of the picture.

	“I think I add the most value to the patient and Doctor,” says Morris, “by seeing the patients during the placement of their restorations, where I'm able to make changes and adjustments at the request of the Doctor and the patient.” Those finishing touches, he adds, “make all the difference for success.”

	Steven Goldstein, DDS, a dentist based in Scottsdale, Arizona, says that working as a dentist-technician team benefits everyone involved: doctor, technician and patient. The best part of working with an in-office technician, he says, is the ability to work with the technician “daily to make critical decisions regarding case design, esthetics, materials, etc.”

	The move to offices is also a practical one. The march of new innovations added into dental offices is meant to remove the lab middleman, but may actually be leading to an increased reliance on the technician’s expertise.

	“I think the move for more in house technicians in recent years can be attributed to the digital movement in dentistry.” says Morris, “Dental offices are becoming their own laboratory through purchasing current digital equipment and are realizing the need to employ the skill of dental technicians to manage their in-house lab and digital equipment for all restorations to be completed onsite.”

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	In-house labs are not, however, free from problems. Morris says that his biggest challenge is handling workload and managing a consistent workflow for his in-house work while also doing outside work. Scheduling and communicating about deadlines, he says, is a must. But even then, when it gets tough he has no choice but to work more hours to get everything done.

	Dentists also feel some constraints with the setup. Goldstein’s office, as of 2014, no longer has a full-time technician. The biggest issue he had with an in-house technician was the lack of opportunity to consult other experts for specific cases.

An in-office dental lab technician benefits everyone in the dental practice, from patient to doctor to the technician.