Noah Levine

Dental ceramics have been the focus for Rafael Santrich, CDT, throughout his career, which stretches back to the 1990s. Santrich has used numerous ceramic systems and materials and developed esthetic techniques and workflows such as the Scoop Technique. In the early 2000s, he founded VM Lab Technologies in Aventura, Florida, which now has 9 employees as well as a small teaching center.

“I’ve been doing esthetics, always, always,” he says. “This is my main focus esthetic cases, custom cases, and we do a lot of hybrids.”

A technician who is comfortable pioneering new workflows and employing new technologies such as photogrammetry imaging of implant cases, Santrich says he was skeptical about 3D printers when they began to be employed in dental laboratories. He only started using the technology at his laboratory 2 or 3 years ago.

“At the beginning, I didn’t believe in 3D printing technology because I always heard the materials are not stable. So I never got involved 100% with it,” he says.

The first printer he purchased for his lab didn’t always meet his expectations. Santrich says solid models were fine, but when it came to printing models for implant cases requiring as much precision as possible, he’d find the analogs would not seat completely. He would have to adjust the printed models, which made work more complex and time-consuming. Santrich eventually found better results outsourcing model printing to a larger lab with a large-scale printer. He was happy with the results of the handful of models he’d outsource each month, but he still preferred analog impressions and models.

Designed to provide a start-to-finish 3D printing solution, the PrograPrint system from Ivoclar Vivadent includes the PrograPrint PR5 3D Printer, PrograPrint Clean, PrograPrint Cure, and ProArt™ line of print materials. The PrograPrint PR5 is a self-calibrating DLP printer featuring a 4-million-pixel resolution, 49-µm pixel size, and 50- to 100-µm layer thickness. The system produces models, splints, surgical guides, as well as wax for pressing or casting. Self-contained material cartridges increase efficiency and reduce waste.

Earlier this year, he added Ivoclar Vivadent’s PrograPrint 3D printer to his lab. Santrich says he is trying a variety of applications for the printer, and it is producing results he’s happy to use. Models produced with his previous printer didn’t meet expectations, but the PrograPrint models provide a good fit for implant analogues and deliver when it comes to resolution.

“The quality is really nice, allowing me to see very good details,” he says. “There is no need to make adjustments and accuracy of fit is right on.”

Santrich also is using the PrograPrint to produce wax-ups for pressing IPS e.max restorations. He likes having the freedom to allow the software to attach the sprues or to choose the contact points himself. Although the printed wax material does shrink a bit, the workflow for printing, cleaning, and then pressing with the wax parts helps eliminate any negative impact. Santrich likes that the wax remains stable until it is cleaned and cured, and as long as it is pressed within the next 2 hours he’s able to get the printed accuracy in the pressed ceramic.

“Once we press, it’s really good,” he said. “It prints thin margins, which is really important today with noninvasive dentistry, and that is something that some mills can’t produce, so that level of precision is really important.”

The print-and-press workflow Santrich is employing with the PrograPrint is a growing part of his workload. The self-described “really, really picky” technician says the PrograPrint’s production quality is meeting his expectations. Santrich says the printer adds efficiencies to his lab, but no matter how good the technology gets, an experienced technician is always the most important part in meeting each case’s unique challenges.

“I think it’s a device that helps us to be more predictable and faster, but [the technology won’t] replace us,” he says.

With the PrograPrint in his lab, he is able to speed up veneer and similar cases by digitally designing and printing the wax-ups and then having his waxing department check for quality and invest the ring, which saves a significant amount of time. His workflow takes into account the 2-hour window of time post curing, so they print the cases overnight in order to clean, cure, and press the next morning.

For Santrich, the PrograPrint is a printer with the accuracy he demands. He’s continuing to develop and refine his workflows and finding ways to use the printer instead of his mills.

“I was skeptical about having a big machine [such as] that in the lab, but now it’s worth it,” he says. “We are experiencing the advantages. Right now we’re super busy.”

Articles

How the PrograPrint 3D Printer from Ivoclar Vivadent is meeting the requirements to work in Rafael Santrich’s lab.

A 3D Printer Providing the Precision Labs Require

Today’s dental practice very likely looks different from how it did a year ago. In response to the coronavirus disease 2019 (COVID-19) pandemic, dental practices changed schedules, modified clinical and operational workflows, and adopted new strategies and products to prevent infection.

These steps clearly made a difference: Although dental professionals work in one of the riskiest environments for the spread of infectious diseases, COVID-19 was not widely transmitted in dental settings. With multiple approved vaccines, the pandemic might be a less pressing concern later this year, but some of the changes in dental practices likely will be permanent industry shifts.

With this in mind, here’s a look back at 6 ways dentistry changed in the wake of the AIDS pandemic in the 1980s and ’90s.


This is one of the most noticeable changes that arose in the 1980s. Due to the risks of transmission of HIV and hepatitis B, dentists were encouraged and then required to wear gloves, masks, and other PPE. Today, the idea of working in a patient’s mouth barehanded seems outrageous.


Prior to the AIDS pandemic, dental handpieces were generally cleaned after use but rarely sterilized. This was due to both design and a lack of sterilization requirement. When the requirement changed, handpiece design followed; today, like all other nondisposable instruments in the practice, these vital pieces of operatory equipment get sterilized.


The processing of instruments also changed as hand cleaning and cold sterilization were determined to be less effective than heat sterilization at preventing the spread of disease. An increased awareness of how to prevent the spread of blood-borne pathogens led to a decline in hand washing of instruments, especially those with sharp points and edges. This made way for ultrasonic cleaners and instrument washers to enter the industry to improve the safety and efficacy of instrument processing.


With the risks of the spread of deadly diseases such as HIV more widely understood, dental practices began implementing more stringent processes for cleaning waterlines, wiping down surfaces between appointments, and using protective barriers on surfaces and instruments that cannot be sterilized or sanitized.


In 1986, the Centers for Disease Control and Prevention issued formal infection control guidelines for health care settings, standardizing how dental practices are expected to operate regarding sterilization, sanitization, staff training, and general protocols for keeping patients and practitioners safe.

Dental professionals have long known about the risks of transmitting disease in health care settings, but with the spread of both HIV and hepatitis B in the 1980s, the risks from viruses that are transmitted by blood and other body fluids became far more present, and training in how to mitigate those risks became standard.

These are some of the most noticeable ways the dental industry adapted to meet the challenges of the AIDS pandemic in the 1980s and early ’90s. Not every change adopted during the COVID-19 pandemic will stick around, but some will. For example, the industry’s new focus on aerosol risks and mitigation strategies is likely here to stay. Although change can be difficult, clinicians and patients are better off with every step practices take to make things safer.

The full impact of the current pandemic might not come into focus for several years, but here's a look at some of the key changes to the industry following the AIDS pandemic of the 1908s and 1990s.

6 Ways the Previous Pandemic Changed Dentistry

It’s safe to say that over the course of the past decade 3D printing has advanced to the point where the technology is not only a vital part of many modern dental laboratories but a foundation for the future of the industry.

Perhaps the ideal technology for meeting the needs of dental labs, 3D printers allow for rapid production of small, customized parts with a high degree of detail and accuracy. With different printing systems capable of printing in wax, polymers, ceramics, and metals, the technology is already able to meet most of the needs of dental labs when it comes to the production of dental prosthetics and the various parts and pieces needed to fabricate them.

But a 3D printer is one of the most versatile technologies in the dental laboratory industry. These systems are limited only by their build volumes and material options, and even with those limitations, there are numerous other applications for 3D printers that might be of interest to dental lab professionals. Here are 5 other things you can print on your lab’s 3D printer.

5 Other Things to Produce With Your Dental 3D Printer

A 3D printer is one of the most versatile technologies around, and these systems can do a lot more than produce dental models and restorations.

Through his work at his Boston dental practice, his role as a dental educator at a local university, and his extensive experience testing new dental materials, Gerard Kugel, DMD, PhD, MS, feels confident he knows what to look for in a composite system.

Throughout his more than 3 decades of clinical experience, Dr Kugel has worked with and tested many generations of direct restoratives. He believes clinicians today have more great material options to choose from than ever, and is excited by some of the newest dental composites that take shade matching to a new level with the ability to match almost any tooth shade with a single composite shade.

“It’s the translucency and refractive index,” he says. “It picks up the color of the [surrounding] teeth, almost mirroring the color.”

Among the materials he’s used, Dr Kugel sees Ivoclar Vivadent’s Tetric Prime as a standout. He first encountered the material while conducting research with composites offering a single-shade chameleon effect.

“Other conventional composites didn’t work as well,” Dr Kugel says. “We were impressed with Tetric Prime. I’ve used it in practice as well. It has a very streamlined shading system in general. They have universal enamel shades, which are great, but you could theoretically complete a lot of restorations with just the translucent shade.”

Tetric Prime is a universal composite system featuring prime handling and a simplified shade system. Tetric Prime is said to provide the creamy handling necessary to use in the anterior and the adaptability and nonslumping characteristics needed for posterior efficiency. Tetric Prime’s T shade is 15% translucent and contains refractive index technology to match the optics of natural teeth, offering a single shade option for Class I and II restorations.

The material’s composition includes a monomer matrix and filler materials with a matching refractive index to allow light to transmit through the composite in order to produce natural-looking shade blending.

Dr Kugel says the T shade can get the job done on its own for many Class I and II and some Class V restorations, but Tetric Prime offers 11 additional shades with differing levels of translucency to allow more conventional shade matching and customization.

This versatility sets Tetric Prime apart from other composite materials, according to Dr Kugel. He says the translucent shade allows clinicians to work with Tetric Prime the same way they would with other single-shade composites. This means a simplified clinical protocol and less material in inventory. But with Tetric Prime, clinicians gain the benefits of a more traditional composite system as well.

“Ivoclar knows they’ve got a product that’s good for a lot of restorations with the translucent shade, but they’re still giving you the option, which is probably smart,” Dr Kugel says.

The 2 dentin shades are useful for cases in which opacity is critical, he adds, noting that Tetric Prime can be a go-to option for many practices. Still, Tetric Prime brings more than simplified shade matching, Dr Kugel says.

“Most of the new composites that come out are pretty decent,” he adds. “What really makes a difference for dentists with new composites is handling. [Tetric Prime is] creamy, I can sculpt it well and it’s got great handling characteristics. The other thing I found in my study is that it polishes really well.”

As impressed as he is with the material, Dr Kugel says there are still capabilities he hopes to see in restorative materials of the future. While Tetric Prime checks the boxes forsimplified shade matching, reduced inventory, and smooth handling, Dr Kugel says he’d love to have a material that adds self-adhesive to that list of capabilities.

“To me in a perfect world, the ideal composite would be a universal shaded, self-adhesive, bulk fill material that handles well and polishes well,” he says. “We’ve come very far, but we still could make it even better.”

Dr Kugel says there are numerous high-quality restorative materials available today that make it simpler for clinicians to get the results they and their patients expect. Tetric Prime is among the new materials to impress Dr Kugel, and he thinks it makes a great single-shade solution while maintaining the flexibility for use in complex situations.

“Having a product that can answer your questions, meet your needs, and not take up 800 shelves in your storage room is a good thing,” he says.

Gerard Kugel, DMD, PhD, MS, shares his experiences working with and testing Tetric Prime, a versatile universal composite from Ivoclar Vivadent.