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Monday

Dentists: Choosing the Right Materials in Restorative, Implants, Cosmetic Dentistry

AFTER • IPS e.max crowns #6-#11*

As dentistry and dentists continue to shift in the direction of metal free restorations, it is imperative for both the dental clinician and technician to understand differences in materials as each one has the ability to achieve different things.

If we consider ourselves a team working towards the same goal, Renstrom (lab) and dentists should be on the same page at all stages of the dental treatment plan. When the doctor office provides the necessary information as well as the objectives of the dental patient, it makes it easier for the laboratory technician to choose a material that will deliver the best outcome.

*VIEW Renstrom laboratory, patient smile cases here.

Trying to associate each dental material with its unique brand name can be confusing, especially now when there are so many. Dental lab technicians receive a lot of training and education on products at the lab, but at times it can be overwhelming for our doctors.

Although Renstrom generally does make suggestions based on the circumstances of the case, it is beneficial for doctors to be familiar with the different options. The easiest way to differentiate dental products is to understand the technique or technology that each employs.

At Renstrom lab, usually breaks this up in to roughly four different categories, and also look at some general guidelines.

1.) Feldspathic (smile veneers on refractory die): Oldest system in metal free technology. Used when there is a conservative dentist prep design in order to preserve the natural tooth structure. Indicated primarily in the anterior region for teeth with good underlying dentition.

2.) Pressable Ceramics (i.e. Empress, Authentic): After waxed, sprued, and pressed to ingot, cut-back and layering technique is used to achieve desired smile, tooth aesthetics. Doesn’t have the masking ability that zirconia would if the tooth is darker.

3.) Zirconia (i.e. Lava, Procera, InVizion): Copings are designed and fabricated by dental CAD/CAM milling machines. The coping is designed with the required thickness needed for unsupported porcelain to maximize the longevity of the restoration. This is the strongest of the layered all-ceramics. Can be used for crowns, bridges, and dental implant abutments.

4.) Lithium Disilicate (e.Max): This universal dentistry material is either pressed or milled from a variety of translucent blocks/ingots. Applications include full dental crowns, smile makeover veneers, implant abutments, and three unit anterior bridges. Can be pressed as thin as .3 mm but must consider the stumpf shade of the prepared tooth.

The incisal cut back is done on anterior tooth restorations for added porcelain effects. A Shoulder/chamfer margin is needed for full contour crowns and sharp angles should always be eliminated. The full contour tooth structures are stained and glazed, which eliminates the possibilities for porcelain chipping, and therefore increases the strength and durability of the tooth restoration.

When selecting the best dental material choice, dentists should consider the following factors; stumpf shade, occlusion, single unit/bridge, and also cementation preferences. You should also consider the possibility of any future needs of the patient so that similar materials can be used for optimal esthetic matching.

It is always good to keep accurate records of the specific type of crown or bridge, product, and the shade of the patient. This way if something needs adjusting or future work is needed, a more predictable result can be expected.

To ensure the success of the dental material chosen, check all requirements of the product at hand. Proper tooth prep design is a must when it comes to all ceramics as sharp angles and feather edged margins can lead to early failures. Also, the required thickness of each product can vary and so the specific guidelines should always be followed.

If you are a dentist with questions regarding materials or a particular case, we encourage you to give Renstrom Dental Studio (laboratory) call so we can discuss the best treatment plan for your patient!

CONTACT

Renstrom Dental Studio, Inc
Renstrom.com
Vadnais Heights/St. Paul MN

651-407-0491

Original Minnesota Dental Lab Materials Article posted here.

Renstrom Dental Studio (MN Lab) is also a Northern Dental Alliance member.

Reposted by
Dick Chwalek
NicheDental.com

Dick is also a Northern Dental Alliance member.

Thursday

ADA Identalloy Certificates: Vital Areas for Dentists to Keep in Mind

Evidently, things just aren’t the same as they were two or three years ago. Aside from the recent recession, technology has also been a contributor to the continuous changes taking place in dentistry.

Laboratories have had to invest in new systems and materials in order to offer their dentist clients the latest products. This has come as a challenge for smaller laboratories who struggle with having the production levels of a large corporate lab.

Some of these small local labs have opted to join alliances with one another at a national level in order to remain competitive. The concern then is that the level of personal attention and service may differ from that of a smaller lab.

Big or small lab, it really boils down to what is most important to the dentist. Although there may be advantages and disadvantages to both, a few questions should be asked regardless the size of the laboratory.

1) Are the materials used genuine and ADA approved?

Everyone is trying to cut costs these days, which is even more reason to verify the authentication of the materials your lab is providing. This includes all components, especially implant parts.

A dentist might question how their competitor down the road can charge a third of what they are but they should also question how a lab can offer an implant restoration at such a low cost. This stands true for gold and PFM restorations as well.

With gold at an all time high, it’s hard to believe how labs can offer high noble/noble crowns at incredibly low prices. To assure you’re not receiving any substitute metals or a lesser alloy than prescribed, check for an Identalloy certificate with each case.

Make sure you are actually receiving what it is you are paying for. Any reputable lab would be happy to provide an authentication sticker for their products.

2) Is any of the work sent offshore?

Some labs send their work overseas to countries with low labor and production costs. This information may be disclosed to their dentist clients but many times it’s not.

Is there anything wrong with this?

Perhaps not, if they can prove that the materials are in compliance with the FDA and ADA laws like U.S. labs now do. Lead contamination has already been an issue with crowns, putting both dentist and patient’s health at risk.

An overseas' crown might cost a Lab $25, which they can then turn around and sell at a price less than their competitors, still making a nice profit. A crown made with quality craftsmanship and ADA materials is tough to find for under $200.

Once again, just be sure to ask where the work is being done at.

3) What is the quality control process with each case?

Quality is the differentiator between a good laboratory and a great laboratory. The number one reason dentists switch labs is due to inconsistent quality. Every lab should have a structured quality control checklist.

Of course a three-day turnaround time is wonderful, but when and how is the work thoroughly being checked? Although technology today has improved efficiency in labs, quality control still takes time at each stage in the fabrication process.

An entire day should be set aside for final checkout so that adjustments can be made if needed. Does the lab have a consistent team of technicians or do they employ subcontractors that come in at all hours of the day?

Every doctor’s expectations are different and every technician should be fully aware of what they are. Labs should have a system in place to track the feedback of each case. This way if a problem is occurring, it can be taken care of immediately.

A structured quality control system is beneficial for all sizes of laboratories.

4) Can I come and take a look at your lab?

If your lab is as top quality as they claim to be, they will gladly invite you in for a lab tour. Take a look at the cleanliness and professionalism of the establishment.

If you send patients to the lab for custom shade consults, keep in mind that their impression of the facility and how they are cared for while there is a direct reflection upon you. Look around at the neatness of the workbenches and case pans.

Is there stone all over the articulators and models? Are there empty pans sitting around on shelves, and if so where is the work being sent out to?

You can usually tell when a lab is certified and has certified technicians working for them because their achievements would be displayed just as most are in a dental office.

It is never a bad idea to know exactly who and what you’ll be working with.

5) Are there open lines of communication?

When it comes to dental restorations, It takes a team to provide patients with the best possible outcome. Although the lab work is done behind the scenes, they are still a big part of this team.

Communication is crucial when it comes to case success. It helps to have a good relationship with those working on your cases so that you fully understand each other’s expectations.

Do you have the ability to treatment plan cases with your technician or lab owners? Can you rely on your lab as a resource?

It’s difficult to stay abreast of the rapid changes in dentistry and can be nice to look to your lab for advice. Does your lab make sure you’re aware of the newest materials and latest advancements in technology?

Some labs offer so much more than just the fabrication of a crown, and most of the time the so much more has a lot to do with communication.

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