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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Digital Esthetics. 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 the new year, labs can expect advances in technology, materials and the lab business itself.
The dental lab world is constantly changing, improving and evolving, and 2018 looks to be calling for even more growth and transformation. Labs can look forward to advances in both technology and materials, not to mention the lab business itself.
We talked to leaders in the lab field and asked them what they are looking forward to in the coming year.
1. Interdisciplinary digital workflow
Mark Ferguson, general manager at Vulcan Custom Dental, expects that cases will be improved because they will be even more digitally based and involve the entire team.
“You can do guided surgery with single units to full-arch, custom provisionals milled for time of surgery and long-term patient health,” Ferguson says. “In that scenario, there will be a guided surgery software and the doctor will plan exactly where they are going to place an implant. We are using 3Shape to do this already. We can take the plan out of 3Shape’s Implant Studio and bring it into the 3Shape lab software, and it has the implant position in the software, so we can do a screw-retained temporary, healing abutments, start the healing process a little bit sooner, and get a better outcome as the final restorations get placed in the patient’s mouth.”
2. A team approach to communication
That interdisciplinary approach is also improved through better communication between team members.
“The enhanced communication between a doctor and a lab to complete the case is fantastic,” Ferguson says. “It helps the lab to understand what the doctor has to go through, just in terms of maybe placing implant. On the lab side, we look at it and we’re like, ‘What was the doctor thinking about when he placed the implant at this angle?’ And the doctor, at times, is just thinking, ‘I have to find some bone to put this into.’ We can’t see bone on a stone model.
“As we start working together, more as a team - and it could be doctor and lab on a straight restorative basis or bringing in a surgeon and the periodontist - the more we understand interdisciplinary issues,” he continues. “For me, as a dental technician, the more that I learn about surgery for bone grafting or tissue grafting, it means understanding cases, how they got to that point. And bringing in a team approach is obviously going to help get the patient the best results in the end.”
3. 3D printing and dentures
Justin Marks, CDT, founder and CEO of 3D printing manufacturer Arfona, foresees big things happening for dentures in 2018.
“That 3D printing technology that we are already using, we are going to see it become a little bit more refined,” Marks says. “I think the materials are going to get better, especially for long-term appliances, so we are going to see more widespread adoption at that point.”
In terms of the materials used for those appliances, Marks says that advancement is going to be a combination of material formulation and government approvals.
“I think it’s going to be a combination of new materials as well as clearing some of the regulatory burden,” Marks says. “Some materials have been ready for a while, they’ve just been waiting for regulatory (approval).”
Up next: Advances in dentures and milling...
4. Dentures and milling
While 3D printing is gaining in prevalence, milling is still an important manufacturing method.
“I think we are going to see the release of some new mills that are specific for dentures,” Marks says. “They’ll be able to mill dentures faster and with specific tool paths for the pretty unique geometries of a denture.”
He expects improvement in milling software, too.
“Both for new mills that are coming on the market as well as for existing mills, I think we are going to see the new releases of software that will allow labs to mill dentures using various equipment,” he says.
And those improvements won’t just be specific to new equipment. Older equipment can also benefit from new software.
“Even just changing the software in an existing mill can radically improve the speed as well as the surface quality of a milled denture,” Marks explains. “I think you’re going to see the software developers really market that in 2018.”
5. Scanners and removables
Marks expects to see more use of intraoral scanners in the creation of removables.
“On the clinical side, I think we’re going to see more of the use of intraoral scanning for removable appliances,” he says. “Not necessarily full dentures, because that still requires some development and it’s still debatable whether or not it would yield a better appliance, but certainly for partial dentures and flippers and things like that. I think you’re going to see dentists who already have a scanner and want to maximize the utility of that, or new dentists that are investing in the scanner and want to use it for everything - they just don’t want to have to make any physical impressions, once they make that investment. That means that denture labs, whether they are digitally integrated or not, should be ready for that transition.”
6. Digital dentures and accessibility
Justin Zegar, product marketing manager, laboratory CAD/CAM and prosthetics at Dentsply Sirona, anticipates wider adoption of digital dentures.
“Who doesn’t love a product that makes life easier for everyone involved?” Zegar asks. “Patients benefit by having an improved experience with fewer visits that leads to a comfortable fitting, highly esthetic and durable denture. Lab owners have a new product offering, simplified process, faster turnaround time, lower remake rate and a permanent digital record. Dentists benefit from chair-time savings, simplified workflow, increased accuracy and minimal post insertion adjustments.”
The fact that the dentures are created digitally allows for easy replication, Zegar says.
“Here’s a quick example. A patient loses their denture - no problem. Utilizing the permanent digital record, a dentist can reorder the exact same denture from the laboratory. The laboratory can provide back the exact same denture and the patient doesn’t have to go through the entire process again. Digital dentures are truly a win-win for everyone involved,” he says.
Up next: Making removables a digital process...
7. Removables revolution
Continuing education is always important, and Zegar recommends attending Dentsply Sirona’s Removables Revolution event in Miami on Feb. 9 and 10 at the Kimpton Surfcomber Hotel.
“We live in a world where 23 million people are edentulous and about 15 percent of that population have dentures made each year,” he says. “Not to mention that 18.5 million - 6 percent of the U.S. adult population - wear partial dentures. The time for dentures and partial removables to go digital is upon us. We’ve put together a day-and-a-half event that will walk you through the entire digital removable process for partial frameworks and full dentures.”
8. Digital smile design
Jason Atwood, CDT, senior digital solutions advisor, Core3dcentres, expects digital smile design to become much more patient-involved.
“It’s going to become more consumer-driven, more patient-driven,” Atwood says. “The digital technology helps to involve the patient more.”
He compares the technology to apps that allow the user to look at how he or she would look with a new haircut or glasses. The same can now be done with smiles.
“It’s getting to the point where you can try a smile on,” Atwood explains. “You can open up an app, input a picture of yourself, and scroll through different smile designs and pick one that you like. It’s going to happen that way, which is kind of cool and kind of scary all at the same time. The demand is there and that is the way it’s going to go.”
9. Digital prep guides
Computers will now be able to guide the doctor’s hand based on parameters established by the lab.
“When you have a patient who needs some prepping done to their teeth, in order to accommodate that, it will now be possible to create a digital prep guide that will guide the doctor’s handpiece to prep the teeth to the required dimensions to accommodate the smile design,” Atwood says. “You won’t have to do it freehand anymore. You’ll have a guide that will specifically take measurements and say, ‘Okay, we need to reduce in this area by exactly 0.8 mm,’ and you’ll have a guide that will snap into place and work like a jig to guide the doctor’s hand to remove just enough in the proper area to accommodate the smile design.”
10. 3D printing materials
3D printing technology is gaining more and more popularity in dental labs. However, the materials have not been suitable for long-term restorations. That is expected to change in 2018.
“We are looking forward to some new materials this year that will help us expand what we can do with a 3D printer,” Atwood says.
The holdup has been a combination of material science and government regulations.
“We are seeing an uptick in what we are able to do with 3D printing, rather than milling temps, printing them and things like that,” Ferguson says. “As more and more companies get their materials improved, it kind of makes it easier for other companies to do the same because they can point to a material that it is like.”
“There are a lot of regulatory things that restrict what we can and can’t do with a 3D printer,” Atwood adds. “But there’s a lot of effort being put into materials that can be biocompatible and 3D printable, and that will really expand what we are able to do. The idea being, we will be able to scan the patient in the doctor’s office and then be able to send that smile design digitally to a 3D printer and print something rather rapidly that would be biocompatible that the patient would be able to take almost right away.”
Up next: 3D printing ceramics...
11. 3D printing ceramics
The materials used for 3D printing are expected to improve, in general, but Marks looks specifically to ceramics and how it might evolve the dental industry.
“We will start to see, although probably not marketable in dentistry, development on the side of ceramic 3D printing,” Marks says. “It’s already possible. There’s already one company called Xiet, and it will be very interesting to see where that goes and how it relates to our industry.”
12. Digital impressions
Over the past year, Shaun Keating, owner of Keating Dental Arts in Irvine, Calif., has seen an increase in doctors who submit digital impressions. He expects that number to get even bigger.
“We are averaging five to 10 doctors each month sending us digital impressions,” Keating says. “We’re just so excited about that because it is so accurate. We’re up to about 60, 70 doctors now and each week we’re just getting more and more. It’s just amazing how, in all my years, it’s been kind of slow - get a doctor here or there, maybe - but we’re getting so many that are just converting.”
Those digital impressions are leading to more wholly digital workflows.
“We’re getting a lot of stuff through email,” Keating says. “We are doing a lot of modeless stuff. We are making models for a lot of the doctors that are sending in their impression scans, but it seems more and more are going with the modeless routine. It’s really exciting.”
13. Industry growth
At the end of the day, the dental lab business is just that: a business. And in 2018, Keating looks forward to building off of one of his most successful years.
“We had almost our highest sales year ever,” Keating says. “I can’t wait for the new year, just to see what we can do it and keep growing.”
Thanks to an improved economy, doctors are seeing more patients. And, as a result, that equates to more work for labs.
“It seems like doctors have more patients seeing them,” Keating says. “It seems like the economy’s doing a little bit better. It seems like we’re busier and our doctors are all up percentage wise.”
With the new year comes the opportunity for new areas of growth. That is certainly the case for dental labs, who can look forward to seeing advances in technology, materials and the lab business itself.