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How new types of zirconia are enabling better esthetics and improved patient care.
Dental materials have gone through a drastic change in the last decade. Long gone are the days when porcelain-fused-to-metal restorations using gold were the standard. Instead, dentists and patients have begun to explore the world of digital materials, from single-unit offerings created chairside to more elaborate restorative solutions offered by digital dental laboratories.
One of the most recent innovations in digital dental materials has been the rise of new zirconia solutions that are extremely esthetic, formulated to mimic true tooth shade and dentition color. To find out how these materials are changing what practices can offer to patients, we spoke with Daxton Grubb, president of R-Dent Dental Laboratory in West Bartlett, Tennessee. He explained why dentists need to know about the changing dental materials world, what advantage new zirconias offer over past solutions and why his lab is excited about the digital future of dentistry.
Tell us a little bit about yourself and your lab.
My educational background is in business with a double major in finance and management. In 2003, Randy Grubb, my father and CEO of R-dent, asked me about coming aboard and helping him grow his declining family business. Within a year and a half, we added a removable department to a very dominant fixed-only dental laboratory. In 2006, R-dent had grown from seven to 22 employees. Today, R-Dent Dental Laboratory is the largest independently owned full-service lab servicing Tennessee, Mississippi and Arkansas, employing over 60 people.
Why should dentists care about the materials their labs are using? As long as it’s cheap, does it matter?
It absolutely matters. We are at a crossroads in the industry where zirconia prices are continuing to drop and with that so does the quality of the zirconia. At the end of the day, we want what’s best for the patient. The bottom line is, all zirconias aren’t equal, and the differences in how they are manufactured can present significant differences.
Could you give a brief rundown of the evolution of digital materials and, in particular, zirconia and super translucent zirconia?
When zirconia was first introduced to dentistry, the material was snow white and very opaque. At the time, 3M was the leader in this market, and they quickly developed acid-based coloring liquids for shading their materials before sintering.
Next came pre-shaded discs. With these, labs could eliminate acid-based liquids from the workflow and just mill the restoration from the correct pre-shaded disc. These monochromatic pre-shaded discs are still popular today.
In 2014, multi-shaded or multi-layered discs that mimic natural dentition with cervical, mid-body and enamel shades built into each disc were introduced and they were very well accepted by the industry. At that time, most zirconia materials had a 1100 MPa flexural strength and were more opaque (40% light transmission at 1 MM) than natural dentition.
The following year, a new generation of cubic zirconia was introduced. This new category of zirconia more closely matched the needed translucency of teeth (49% light transmission at 1 MM), but to reach that level the flexural strength was reduced to 600-700 MPa. At 600 MPa this new product was still 50 percent stronger than lithium disilicate (LO), and unlike LO, this zirconia had nearly zero strength degradation over time.
Next came multi-layered zirconia. These materials, such as [Zirlux Anterior Multi], are likely the highest quality, most esthetic materials available today. They are made from the cubic powder material and are multi-layered for what is the most lifelike monolithic ceramic restoration available. For all your zirconia single crowns and small bridges, these are the best materials offered in dentistry.
How long have you been using the original Zirlux and how long have you been using the latest product, Zirlux Anterior Multi?
We have been using Zirlux Zirconia in our lab since the original Zirlux FC came to market. We continued to adopt the next generations of Zirlux Zirconia into our production and are excited by offering Zirlux Anterior Multi. We’ve found that a multi-layer zirconia is a great restorative choice for the anterior and our doctors have been very happy with the esthetics.
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What is your favorite quality offered by Zirlux Anterior Multi?
This material is consistent. Time and time again I can achieve the esthetic results for a variety of indications without sacrificing strength. I know I’m delivering the patient the finest quality restoration.
What’s been the reaction from your dental clients who have received restorations using the material?
Because I can achieve consistent results with Zirlux Anterior Multi, my doctors trust that they’re getting consistent restorations and providing patients with the best quality product.
How have patient outcomes been?
Patients have more confidence with a natural looking smile knowing that their restoration will last.
What advantages do you think Zirlux Anterior Multi offers over other alternatives? Why have dentists and patients responded positively to the material?
Zirlux Anterior Multi offers more strength and range of indications than lithium disilicate. The discs have full gradient shading to match the incisal, dentin and gingiva of natural dentition, so they’re a fantastic solution for anterior restorations. This has been the most translucent of all the high-translucent lines of [full contour zirconia] we have tested, by far!
What do dentists need to know about CAD/CAM and the digital workflow, in your opinion? How has that changed what your lab can do?
CAD/CAM is the present and will continue to be the future. Adopting digital technology opens many doors to attracting more business and expanding your current offerings as well as giving your dentist office or lab a competitive advantage. Intraoral scanners ensure fewer remakes due to improved accuracy compared to traditional impressions that can warp. It allows us to isolate variables on both sides, which is key to consistently between any dentist and lab relationship.
In your opinion, how do today’s workflow and materials compare to restorative options of the past?
Traditional impressions can warp, providing an inaccurate fit and margin errors with restorations and lead to remakes-intraoral scanners provide a solution to this problem. Today, there are more indications available due to the variety of materials. Zirconia provides a stronger, more translucent product compared to past materials in a quicker amount of time.
Anything else you’d like to add?
No matter what lab you are using, be aware of what brand zirconia they are using, and unless you have the upmost trust for your lab already, do your homework on the brand of zirconia they are using. After all, these are YOUR patients, not the lab’s; you owe this to them.