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Inside Dentistry

March 2013, Volume 9, Issue 3
Published by AEGIS Communications


Is Your Lab Ready to Help Dentists Navigate New Options for Indirect Treatments?

The introduction of a new material offers both opportunities and risks for laboratories—by applying your expertise and offering advice, you provide a value-added service to your customers

By Brad Slominski, CDT

The technology breakthroughs of recent years have brought dentists and laboratories many new options for indirect treatments. With the growing popularity of intraoral scanning, as well as faster and more accurate milling machines, CAD/CAM technologies are offering more capabilities than ever before. In addition, the continuing introduction of new milling materials has posed both challenges and opportunities for the dental and laboratory communities.

The trend toward improved esthetics has been a significant factor in the development of new materials, as both dentists and their laboratory partners seek solutions that will outperform porcelain-fused-to-metal restorations in looks and functionality. Monolithic restorations continue to grow in popularity among dentists and laboratory professionals due to their simplicity and efficiency, and recent CAD/CAM material introductions have been heavily concentrated in this category. As dentists often look to their laboratory as a trusted resource and counselor to choose the best material for a case, a profound understanding of all new materials on the market presents an ideal opportunity for laboratories to prove their worth. New materials that all laboratory technicians should know include monolithic zirconia, polymethyl-methacrylate (PMMA), and resin nano-ceramic.

New Materials, Different Purposes

Monolithic Zirconia

Zirconia is inherently more opaque in nature than other restorative materials, and manufacturers of monolithic zirconia crowns, including Zahn Dental (henryschein.com), One Source Dental (onesourcedental.com), and 3M ESPE (3mespe.com), are currently working on improvements to the translucency of their products. With greater translucency, monolithic restorations become a more esthetically appealing product. They are also very appealing from a durability standpoint, as there is no glass to fracture on these restorations. Laboratories should examine the productivity benefits of monolithic zirconia materials to determine whether adopting them makes sense for the business.

Polymethyl-Methacrylate

Unlike monolithic zirconia, PMMA is designed for temporary use. This material is made of acrylic and enables the laboratory to create a CAD/CAM temporary without having to prepare the model. Using CAD design software, the laboratory scans the case and then designs the CAD/CAM temporary with a virtual reduction. PMMA is a very accurate and cost-effective material to work with. It is monochromatic, but this is less of a long-term concern, given its use for temporaries.

Resin Nano-Ceramic

The third type of new block on the market is resin nano-ceramic, specifically LavaTM Ultimate Restorative (3M ESPE). This block is indicated for crowns, crowns over implants, inlays, onlays, and veneers, and it offers some new advantages in durability and function to dentists and laboratories. Formulated from a mixture of resin and ceramic, the material is not brittle and is fracture-resistant. The total nano-ceramic content by weight in this block is approximately 80%. The combination of resin and nanoparticles allows the material’s reinforced matrix to become much more resistant to wear than resin alone.

This block is available for milling to laboratories and to dentists with chairside milling systems. Because of its unique formulation, it does not require a final firing after milling, which helps streamline part of the manufacturing process (Figure 1). In addition to the elimination of the firing step, the blocks are also less abrasive on the burs in the milling machine.

The material has strong polish retention, similar to a glass ceramic, and its restorations have a chameleon-like property that allows them to blend naturally in the mouth (Figure 2 and Figure 3). In addition, they can be easily adjusted in the dentist’s office by either adding to the material with composite or subtracting from it. This makes it fairly easy for dentists to make changes such as occlusal adjustments without having to send the restoration back to the laboratory. In addition, if a crown is over-adjusted in the mouth, the dentist can simply repair it with composite. This serviceability also gives the dentist more flexibility down the road for cases such as implants; to access the implant and abutment, the dentist can simply cut a hole, then reseal it with composite and re-polish the restoration.

Embracing a New Material

The introduction of any new material presents both opportunities and risks for laboratories. The risks come with the fact that a new material will not have the track record of more established blocks. However, laboratories and dentists should take into account the manufacturer’s track record in the industry and the reputation from its other materials. They should also examine the research and testing that the manufacturer has performed prior to introducing the material. This can provide good insight into the accuracy of the material’s claims and the manufacturer’s expertise in the technology. A reliable manufacturer should be able to provide data on its internal testing that can serve as a guide until the material has been vetted independently.

Performing this research is increasingly important for laboratories as competition tightens and the need for differentiation grows. Laboratories that can provide their customers with insight and expertise on new materials can help strengthen their relationships and position themselves as important partners to dentists in the ongoing evolution of the industry. This is the opportunity that a new material gives to a laboratory—the chance to research and recommend products based on years of experience with many different classes of material. When the laboratory has the chance to apply its expertise and alert dentists to a material that saves time and money or one that has outstanding esthetics, it provides a value-added service that solidifies its standing as a trusted resource.

Communication with Dentists

With the introduction of any new material, a laboratory must look for avenues to get the word out to doctors. In the case of Lava Ultimate restorative, for example, laboratories must communicate to their customers that the block can be used in the same areas where monolithic zirconia would be used. They must also get out the message about the block’s resiliency and the ability to add or change the product with composite.

Recently, Dental Crafters (dentalcrafters.net) employed a unique approach to informing customers about this new material. After beta testing the block and confirming its utility, the laboratory began sending customers Lava Ultimate crowns in addition to the requested monolithic zirconia crowns. Along with the sample crown, the laboratory sent a survey that asked dentists for feedback regarding their preferences. This survey found that 65% of recipients preferred the Lava Ultimate crown to the monolithic zirconia based on esthetics alone. Dentists indicated they were very pleased with the material’s chameleon effect, as well as its marginal adaptation and overall fit. Since conducting this campaign, the laboratory has seen a marked increase in the number of requests for this restorative material.

Obviously, this is a high-investment tactic and cannot be used for every material introduction. However, it provides a good example of the type of robust campaign that a laboratory can undertake to introduce customers to a new material that the laboratory sees as promising. In any such campaign, the laboratory should communicate clearly with customers by providing support materials and research to help them decide which restorative material will best meet their patients’ needs.

The answer to that question will, of course, vary by case, and neither laboratories nor dentists should take a cookie-cutter approach. The shade of the preparation is one of the most important considerations when determining material choice, and the more discolored the preparation is, the more opaque the final restoration material will need to be. In addition, considerations such as bruxism should be taken into account. Given the number of restorative options on the market, many dentists send a case and ask for the laboratory’s recommendations. When a laboratory and the dentist can work as true partners, this is an ideal way to arrive at the best solution for the patient. The laboratory can apply its expertise on a case-by-case basis to help dentists make the best determinations that can ultimately help their patients.

About the Author

Brad Slominski, CDT
Dental Crafters Laboratory
Marshfield, Wisconsin


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Image Gallery

Figure 1 Restorations milled from Lava Ultimate Restorative, which requires no final firing.

Figure 1

Figure 2 Seated restorations before final polishing.

Figure 2

Figure 3 Final result.

Figure 3