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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Dental Lab Products. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.
In our most recent feature for Dental Lab Products, we talked a lot about esthetics. As part of that article, we asked the same experts we spoke with in the story what tips they'd give to lab technicians looking to increase the esthetics of their work in a modern context.
There were several suggestions that continued to come to the surface when talking about esthetics. So, with that in mind, here are 11 things every lab technician needs to know about maintaining esthetics in a changing dental landscape:
1. Give CAD/CAM a Chance
When seeking highly esthetic restorations, don’t be quick to dismiss CAD/CAM.
“CAD/CAM gives technicians access to a wider range of materials,” says Tais Clausen, CTO and cofounder of 3Shape. “CAD, in itself, did not change esthetics. CAD software is a tool-a tool that makes it easier and faster for the dental technician to create highly esthetic restorations. CAD supports esthetics by enabling better planning and flexible design options. CAD/CAM also provides design consistency.”
CAD/CAM provides such consistency that it removes some (but not all) of the human error that is present when making traditional restorations.
“The human factor is present, and the technician’s mood, health and level of focus at a given time can have an impact on the outcome of the restoration,” he adds.
2. Know Your Stuff
CAD/CAM is a very sophisticated tool, but it is just that: a tool. To get the best, most esthetic results, technicians still need to understand dental anatomy.
“The starting point is to really understand natural tooth anatomy,” says Dr. David Hornbrook, DDS, clinical director of education at Keating Dental Arts in Irvine, Calif. “The problem in today’s world, in a lot of the dental labs, is they bring someone into the CAD/CAM department that doesn’t have any experience in natural tooth anatomy or the function of teeth. They’ll come in, and they’re great with a mouse, they’re great with the computer, they can pull a tooth in from libraries that can be resized to fit the space. But unless you really know tooth anatomy, it’s difficult to make these CAD/CAM teeth function as well as they should or look as natural. Make sure you understand tooth anatomy-that we’re just not filling a space, but we’re actually trying to have as much function as we can with that tooth.”
3. Materials Matter
There are plenty of different materials for use in CAD/CAM solutions. Picking the right one for the right job will result in restorations with superior esthetics and performance.
“CAD/CAM may require a different family of materials as compared to analog manufacturing,” says Bob Cohen, CDT, president of Custom Automated Prosthetics in Stoneham, Mass. “Selecting the right disc can make a huge difference in the esthetic result. Unfortunately, so many lab owners are focused solely on the cost of the disc rather than the esthetic results. This business decision can stifle a laboratory’s ability to grow this product. What’s most interesting is this much more esthetic disc may cost only $1 or $2 more per unit. I believe a full-contour zirconia crown that has great form and is milled from a highly esthetic material can sell for 50 percent more than the market average and will enable a lab to grow the product and not be involved in, or contribute to, ‘the race to the bottom.’”
Once you find a quality material, it can be worked with to give the results that you want.
“There are pre-shaded discs; there are discs that are one shade,” says Alex Thomas, general manager of DAL DT Technologies in Davenport, Iowa. “There are A2 shaded discs that are used only for A2 cases, and then there are shading liquid systems that you can use if you’re just using a pure white zirconia. So really find a system that works and go with trusted products, especially in the zirconia makeup.”
4. Quality Matters
No one wants to spend more money than they have to on a case. However, it might be necessary to spend a little more to get the best results.
“Cheaper and faster is not always the best, which is something that we try to express to people,” says Lien Huynh, CAD/CAM specialist and lab manager at Zirkonzahn. “We always tell people, ‘If you want it done right, you have to take time doing it.’ It doesn’t matter if you’re doing it conventionally or with CAD/CAM. You still need that knowledge to apply to the case. Remember: There’s always a person attached to that tooth that you’re doing.
“At the Zirkonzahn Education Center, we have lots of people coming through,” she adds. “Some value quality, others just want things fast-‘How can I do this faster? How can I make more money?’”
Next page: Taking your lab to the next level-of efficiency ...
5. Use New Technology and Techniques
With so many new tools, materials and techniques available to the technician, there are many new ways to bring high esthetics to lab work.
“Advancements in materials are a key factor in enabling dentists and technicians to provide highly esthetic restorations,” Clausen says. “Lower material costs are also bringing esthetic solutions to a wider range of patients. More and more dentists and labs are becoming aware of new options to combine patient data such as CBCT, 2D photographs, face scans and intraoral scans to create a ‘digital patient’ and use all of these factors in planning esthetic solutions.”
6. Do It Again
The word that no one in a dental lab wants to hear is “remake.” And while no one wants to redo a case, the fact of the matter is that CAD/CAM takes some of the sting out when that has to happen.
“I’m producing as nice of esthetics that I ever have in my career, and I’m doing it more efficiently than I’ve ever been able to, and the really cool thing is if something goes sideways, I can press ‘remill’ and do it again or modify it and remill,” says Matt Roberts, CDT, owner of CMR Dental Lab in Twin Falls, Idaho. “We’ve all had cases that go out, and you make it out of the BL2 shade, and the patient says, “That’s too dingy. I want my teeth whiter than that.” It’s already three shades whiter than A1 or B1. If I were to have to sit down and hand wax that again, I’d cry before I got it done. Today, I can simply press the button on the milling machine. 50 percent of the labor is still there, but at least 50 percent is started. That’s nice. I love it.”
7. Go Lean
The efficiency of digital dentistry, in part, means that to remain competitive, those labs using traditional methods have to be more efficient. As such, it is necessary to work as resourcefully as possible.
“Take the initiative to operate your lab with lean manufacturing principles and workflows,” Cohen advises. “Go as lean as possible. Get an expert in to help if you can’t do this yourself. No one questions that traditional manufacturing requires much more labor. To compete long term with digital will become more difficult. As material science advances and offers better, more esthetic materials for digitally manufactured products, competing in the analog lab will require incredible efficiency.”
8. Realize Variety is the Spice of Lab Work
As with analog materials, different CAD/CAM materials have pros and cons for different applications. Make sure you understand which products are best for which applications.
“Branch out to understand the advantages and disadvantages of all the different materials,” Dr. Hornbrook says. “Materials are changing so much. Even a laboratory or a ceramist that didn’t embrace CAD/CAM is going to have to eventually. If [you] haven’t embraced CAD/CAM, really understand how at least the materials are changing. Because the materials are changing so fast, and we’re getting materials that two or three years ago, I would have said were absolutely ugly. [Now] we’re getting materials that are very esthetic. What I see in the clinician’s world, and I’ll use monolithic zirconia as an example, dentists will say, ‘It’s all opaque; it’s ugly; it’s lifeless.’ Well, that was the zirconia that we were using two and five and 10 years ago. Where we look at the materials now, where they’re actually multilayered, prior to them even being milled, we’re getting the advantages of previous generations, but now they look great.”
Next page: Getting better, all the time ...
9. Have Personnel with a varied skill set
CAD/CAM takes some of the detailed and time-consuming parts out of lab work. However, that is not the case where traditional methods and techniques are still employed. As such, successful labs require technicians with a different skill set.
“[Labs] need highly trained technicians, in all honesty,” Thomas says. “It’s an art form. Your employees are your biggest investment and especially your ceramists. They need to have experience and be well trained technicians that continue to educate themselves and are pushed to provide the highest quality possible.”
10. Find the Common Roots
Ultimately, both digital and traditional methods require the same foundations in dental knowledge.
“You use the same techniques [with digital work] that you would use doing it conventionally,” Roberts says. “In other words, good esthetics are never an accident. It’s always by following a good flowchart of getting things solved esthetically. First of all, identifying what is wrong, functionally and esthetically, with the patient and then identifying the ideal shape, form and position of dentition for the patient. Then reproducing that in the final restorative material and then delivering it without messing with that whole concept up.
“If I am doing something out of pressed ceramics,” he continues, “that means taking the impression of the temporaries and using a jewelry injector to transfer that to my final working model so that I know that I am in the same place as the temporaries, and then making modifications based on the photographs. If I’m working in the digital world, it involves scanning in a model of the temporaries and photos of the patient. I superimpose the model of the temporary into the patient’s facial features, and then I turn the temporary off and turn my restorations on so I’m seeing my teeth displayed within the patient’s lip structure and see that the size and proportions were appropriate for the patient’s smile.”
11. Find Room for Improvement
As good as CAD/CAM is for esthetics, as with any technology, it can always get better.
“[CAD/CAM technology has] come a long way, and it’s of an age that you don’t have to wait for it to get better to get in,” Roberts says. “Will it get better? Absolutely. Look at iPhones. Was the first iPhone the best that could be out there? How long do you plan on your current iPhone being relevant to leading-edge technology? How quickly will they replace it? Probably about 18 months. And that’s how I look at CAD/CAM. Anything I buy in the digital world for my lab I figure has about an 18-month shelf life of being leading-edge, another 18 months of being relevant and after that I won’t want to work with it so I better have a business plan in place to replace it.”
“I think there’s always room to improve,” Thomas adds. “Every dentist and every laboratory have shade guides. The VITA Shade Guides are the most common shade guides available in the industry. It’s the most well known and used. Anything zirconia, even e.max, you can always continue to push the bar to get to match those shade tabs exactly. You get as close as you can. Sometimes you’re spot on, but there are always improvements that can be made.”
While esthetics can mean different things to different techs, the materials, technology and techniques available today ensure labs have the best resources to deliver the best esthetics ever.
This article originally appeared in the June 2015 issue of Dental Lab Products. For more great articles, click here: http://bit.ly/18S8j4i
Top photo: Studio-Pro / Getty Images