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The Importance of Effective Communication Between the Dentist and Dental Lab

“Communication is the key to success in cosmetic dentistry/laboratory relations”5. To accurately fabricate dental restorations, effective communication needs to exist between the dental lab and the dentist to ultimately provide dental patients with the best dental care. The communication methods used by the dental lab to collaborate with the dentist is also a major factor that determines the success or failure of dental lab products.

 “Prosthodontics is a discipline that requires a synergy between the dentist and dental technician in order to fabricate intraoral prostheses with acceptable fit, function and aesthetics,” reported by Berry et al.. Although restorative dentistry is first about restoring the patient’s oral health, and next the esthetic appearance; the patient’s growing demand for realistic esthetics and long-lasting restorations is challenging the industry to properly manufacture dental lab products that exhibit both attributes. Recreating esthetic details that mimic the patient’s natural teeth is crucial when “subtle details in texture, anatomy, and contours keep the ceramic restoration from looking contrived and can provide the element of ‘prefect imperfection’ that natural teeth exhibit”3. Precise design parameters, shade matching, and available tooth structures should all be effectively communicated by the clinician to the dental lab to achieve a highly esthetic restoration that will match the patient’s natural tooth contours and shades3.

 The lab technician’s ability to match the exact shade to the patient’s teeth is a challenging aspect of communication; especially, when an increasing number of patients are demanding esthetically brilliant prostheses. Determining a precise shade (e.g., color, surface texture, shade characteristics) is first dependent on the clinician and must be effectively communicated to the lab technician. Exact shade communication is important because dental technicians are remotely located and usually never see the patient1. In consonances with a study on color matching, Seal et al. reported “precise color communication is integral to the development of esthetic harmony and overall restorative success.”  

 The communication methods used by the dental lab are major factors that influence the accuracy of dental lab products. With the development of software programs and web applications, dental labs can now use web content management systems (WCMS) to communicate to dental offices and manage laboratory cases at a faster and more accurate rate. As stated by Alshiddi, “Laboratory case management is a teamwork that should involve good communications between not only the dentist and the dental technician, but also other staff in the dental office (e.g., dental assistant and receptionist) and dental laboratory (e.g., laboratory owner, receptionist and delivery person)”5. When managing a high volume of dental lab cases, the lab must implement an effective content management system that will manage all of the dental cases coming from multiple forms of communication methods (e.g., hand-written lab authorization forms, telephone, email, electronic STL files, etc.). Equally important is the lab’s understanding of individual software requirements and design of the software that will essentially, if implicated correctly, improve communication and will ensure long term relationships between the dental office and dental laboratory5.

 The dental laboratory must provide great customer service for dentists and their dental office personnel so all parties can work proficiently together. Providing excellent dental lab services will lead to satisfied clinicians and comfortable professional relationships between the clinician and dental technician/laboratory5. Collaborative technical advice on routine and complex dental cases is a very important service that dental laboratories should exceed at every time. The dental lab must have an effective logistic team to make sure dental cases are fabricated in time for the patient’s scheduled appointment.

  Adequate skills of the dental laboratory and clinician along with collaborative teamwork through effective communication leads to high quality dental restorations. When problems arise from inaccurately fabricated prostheses, the patient will usually blame the dentist for the mishap. For this reason, it’s imperative dentists choose the best dental laboratory that can effectively communicate with their dental office to ensure satisfied patients every time and to ultimately provide better patient care.

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Common Errors that Occur During Digital Impression Procedures Using In-office CAD/CAM CEREC AC Systems

The intraoral scanner was invented to rectify quality deficiencies associated with manual production of traditional, hand-produced dental impressions and dental restorations1. Yet, a study by Kim et al. addresses common errors made with in-office CAD/CAM CEREC AC systems that affect the accuracy of dental restorations. Clinicians need to be aware that correct chairside procedures and operation of intraoral scanners are required to provide their dental lab optimal digital impression results.

 Kim et al. investigated five categories of errors arising from digital impressions that were created from an in-office CAD/CAM CEREC AC system. The most frequent errors they found were non-linear powder application, inappropriate oral cavity scanner positioning, and insufficient scanned data. Powder application is needed with CEREC Bluecam and requires both experience and skill from the clinician to apply it evenly. The study found that “if more or less than the ideal amount of powder is applied, the precision of the digital impression is compromised, and it is therefore difficult to expect an accurate reconstruction”1. In addition, uneven distribution of powder application may be an issue when salivary contamination and other obstacles such as the tongue and patient discomfort are unavoidable factors1.

 The second most common error found was inappropriate scanner positioning which results in the partial loss of the digital impression. The manufacturer states the scanner must be placed so that the teeth are present in the middle of the screen, at 3mm to 4mm distance and at a 10 degree angle with the direction of the ray parallel to the long axis of the teeth1. If the angle is too sharp, the ray will not reflect certain areas of the cavity walls and the clinician will lose part of the impression image.

 The third most common error found was insufficient scanned data which is similar to the frequency of inappropriate scanner positioning errors. According to Kim et al., adequate information regarding both the abutment and adjacent teeth is required to obtain a precise and ideal design1. When insufficient data is an issue in both of these regions, an incomplete reconstruction of the patient’s teeth will result in an ill-fitted dental restoration.

 Even though these errors common, it is worth noting the practitioner can immediately evaluate and eliminate preparation errors by modifying the images via the “repair” menu in CEREC system software. However, the clinician needs to be aware of these common errors so he or she may correct them immediately before sending the digital impression to their dental lab. Since dental restorations are manufactured based on the captured digital impression, dental labs rely on the clinician to send an accurate impression in order to fabricate a well-fitted prosthetic for their patients.

   About the organization Since 1991, Iverson Dental laboratories has provided their clinicians with higher quality dental lab products and exceptional dental lab solutions to guarantee their clinicians’ patients are fully content with their tailored restoration. Iverson dental labs strives to be a great dental resource for dentists by providing training on digital dentistry and new dental implant methods at their high-tech operatory and coaching facility. Iverson dental labs strongly believes in using high quality certified materials and authentic manufacturing elements to fabricate their dental restorations. Iverson also has a knowledgeable team of accredited dental technicians simply because clinical evidence has shown ample skills of the technician are critical for the prolonged success of a dental restoration.

  Resources:

 1.     Jae-Hong, K., Ki-Baek, K., Sa-Hak, K., Woong-Chul, K., Hae-Young, K., & Ji-Hwan, K. (2015). Quantitative evaluation of common errors in digital impression obtained by using an LED blue light in-office CAD/CAM system. Quintessence International, 1-7. Retrieved May 5, 2016, from http://www.ncbi.nlm.nih.gov/pubmed/25699295

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Should I Use Screw-Retained or Cement-Retained for Dental Implant Restorations?

Implant-supported restorations require either a screw-retained or cement-retained retention method to secure the restoration to the abutment. Even though there is still controversy over which method is best, Shadid and Sadaqa reports there are advantages and disadvantages of each method of retention from different aspects. These different aspects include, “ease of fabrication and cost, esthetics, access, occlusion, retention, incidence of loss of retention, retrievability, clinical prosthesis fit, restriction of implant position, effect on peri-implant tissue health, provisionalization, immediate loading, impression procedures, porcelain fracture, and clinical performance”1. The literature review also demonstrates there are certain clinical situations that prefer one method of retention over the other. The following will describe the different aspects that affect which method of retention is preferred over the other.

 Ease of fabrication and cost

 When it comes to cost, cement-retained restorations are usually the least expensive and easier to fabricate because of conventional laboratory and clinical prosthodontics techniques. Also, screw-retained restorations have extra components needed such as “plastic sleeves, laboratory fixation screws, and the fixation screws themselves”1. However, the cost of retrievability needs to be considered when factoring in potential costs of damaging the cemented restorations if biologic or technical complications occur.

 Esthetics

 There have been debates on whether screw-retained restorations should be placed in an esthetic area, but with pre-angled and custom abutments the screw access channel can be changed from facial access to lingual access. When the dental implant is placed in the optimal position, predictable esthetics can be achieved with either screw- or cement-retained restorations1.

 Access

 The authors argue cement-retained restorations rather than screw-retained offer easier access to the posterior of the mouth, but with new techniques it is now easier to place screw-retained restorations in the posterior of the mouth. Now with the angulated screw channel by Nobel Biocare, clinicians can easily retrieve posterior abutments with a low vertical clearance. With this angled ability, clinicians are able to change the direction of the esthetic outcome in an anterior tooth up to 25 degrees. This new technique means dental labs will be able to provide more restorative, esthetic options for clinicians.

 Occlusion

 Optimal and stable occlusal contacts can be found with cement-retained restorations because there are no occlusal screw access holes. Anterior guidance may be compromised when these screw access holes interfere with protrusive and lateral excursions1.

 Retention

 The most important factor affecting implant prostheses longevity is security of retention. Several factors affect the retention of cement-retained restorations such as “taper of abutment, surface area and height, surface roughness, and type of cement”1.

 For screw-retained restorations, retention is achieved by fastening a screw and loss of retention is described as screw loosening. Factors that will affect the amount of retention include “insufficient clamping force, screw settling, biomechnical overload, off-axis centric forces (forces that are not directed along the long axis of the implant), implant components and prothesis misfit, differences in screw material and design, and finally hex height and implant diameter”1.

 Retrievability

 Predictable retrievability can be achieved with screw-retained restorations without damaging the restoration—allowing for “prosthodontic components to be adjusted, screws to be refastened, and fractured components can be repaired with less time and at a lower cost than would be the case with cement-retained restorations”1.

 Clinical Prosthesis Fit

 Substantial stress within the prosthesis, the implant, and surrounding bone may be created when there is not a precise fit between the crown and abutment in a screw-retained restoration. Some leading factors that affect the restoration fit depends on “accuracy preformed in the fabrication process such as impression technique, master cast accuracy, component tolerance, casting tolerance, and skill of the technician, while the type of retention does not play a role in transferring or compensating for inaccuracies of prosthesis fabrication”1. However, screw-retained prostheses have been determined to produce tighter margins than cement-retained protheses.  

 According to the review, many authors believe cement-retained prostheses are more likely to achieve a passive fit than a screw-retained one. But the review points out this increased passivity of cement-retained restorations “rests on the assumption that the cement could act as a shock absorber and reduce stress to bone and implant-abutment structure”1. They also conclude cement-retained prostheses have the risk of bacteria colonization within the margins that may result in cement dissolution and gingival inflammation.

 Effects on the Health of Peri-implant Tissue

 Gingival inflammation was found to be an issue with cement-retained prosthesis because of the difficulty in removing the excess cement—especially when the prosthesis margin was greater than 3mm subgingivally. When excess cement is not removed completely, complications can arise such as peri-implant inflammation, soft tissue swelling, soreness, bleeding or exudation on probing, and resorption of peri-implant bone1. According to Shadid and Sadaqa, these clinical situations can be solved by using either screw-retained restorations or custom abutments for cement restorations. They also found the gingival response to be better when using screw-retained crowns since no cement was used.

 Provisionalization

When using provisional restorations, the review reports screw-retained provisional restorations are preferred over cement-retained restorations “because the screw can be used to seat the provisional restoration and to expand peri-implant mucosa”1. Furthermore, they can be screwed into the master impression to send additional information to the technician about the contours1. For cement-retained provisional restorations, the main disadvantage is the difficulty of removing excess cement and the risk of cement residues causing gingival inflammation.

 Immediate Loading

 Screw retention is the best choice for immediate loading because it eliminates the use of cement and the associated “difficulty in removing excess from the peri-implant area that may interfere with healing and implant integration”1. Interestingly, it has been found the interface of machined implant components are superior to any cement margin that can be developed1.

 Porcelain Fracture

 Porcelain fracture is most commonly seen in screw-retained restorations because the screw access hole disrupts the structural integrity of the porcelain.

 Clinical Perfomance

 Most of the studies reported that screw-retained restorations have more complications during follow-up periods, but the percentage of these complications was generally minimal and controllable1.

 Conclusions

 The review concluded that certain situations may call for either screw retention or cement retention because there are certain advantages and disadvantages to both methods. Based on the review, they have demonstrated that “one type of restoration is more appropriate than the other in some clinical situations”1.

 About the organization Since 1991, Iverson Dental laboratories has provided their clinicians with higher quality dental lab products and exceptional dental lab solutions to guarantee their clinicians' patients are fully content with their tailored restoration. Iverson dental labs strives to be a great dental resource for dentists by providing training on digital dentistry and new dental implant methods at their high-tech operatory and coaching facility. Iverson dental labs strongly believes in using high quality certified materials and authentic manufacturing elements to fabricate their dental restorations. Iverson also has a knowledgeable team of accredited dental technicians simply because clinical evidence has shown ample skills of the technician are critical for the prolonged success of a dental restoration.

 Resources

 1. Shadid, R., & Sadaqa, N. (2012). A Comparison Between Screw- and Cement-Retained Implant Prostheses. A Literature Review. Journal of Oral Implantology, 38(3), 298-307. doi:10.1563/aaid-joi-d-10-00146

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Top 5 Requirements to Expect When Seeking a Quality-Oriented Dental Lab

Although there are many dental laboratories in the U.S., not all can deliver the quality that many patients today would expect from their dentist. The dental lab that dental professionals choose may impact their business and quality of care they provide. Due to patients high expectations, it’s important to find a quality-oriented lab that can fabricate prosthetics with high esthetics and the proper mechanical properties needed for long-lasting restorations.

Finding a dental lab that cares about the quality they provide is essential for your practice to thrive and succeed throughout the years. Listed here are the top 5 requirements you and your dental team should anticipate when choosing a quality-oriented dental laboratory.

1.    Use genuine manufacturer parts and hardware for implant restorations

Using genuine implant manufacturing parts is important for the long-term success of implant restorations. The number of imitative implant manufacturers has increased greatly in recent years, and while some may make decent parts, others compromise quality for cheap, low-quality alternatives. According to Steve Pigliacelli, CDT, “It is not uncommon for labs to use plastic imitation components and pass them off as genuine…you must question how a lab can offer any implant restoration at such a low cost”. This can be a “serious offense,” he goes on to explain, “if you ask for a genuine Nobel Biocare™ bridge and the lab uses a knockoff.” Not only is this unethical but the manufacturer’s warranty is voided and if the implant fails, then the surgeon or periodontist will be responsible for replacing the implant.

Furthermore, using genuine implant components—screw, abutment and implant—from the same manufacturer minimizes complications such as implant or restoration fracture, screw loosening and fracturing; as well as minimizing biological complications such as bone loss or bacteria penetration. Pigliacelli recommends if you want to save money on parts, “get your own account, buy your own parts, and supply them to the lab to use.”

2.    Use ADA-approved materials for their dental lab products

It is recommended to be sure the dental materials that your lab uses are manufactured by reputable companies and are ADA-Approved1. The American Dental Association’s Approved products go through a stringent, scientific-based investigation that assesses the manufacturing standards that assure purity and uniformity in dental materials. Not only is using dental materials that are manufactured by reputable companies better for the oral health of the patient, but it is also a more ethical decision that you would expect from a quality-oriented dental lab. Some labs will pass off cheaper alternative materials for brand name ones. To ensure your getting quality ADA-approved materials, request manufacturer information from your lab. This is important to fabricating quality restorations that will give your patient the longevity and proper mechanical properties that they expect from your dental expertise.

3.    Provides reliable technical advising services

Technical Advising is one the most important services a dental lab should excel at. “Prosthodontics is a discipline that requires a synergy between the dentist and dental technician in order to fabricate intraoral prostheses with acceptable fit, function and aesthetics,” reported by Berry et al.. This “synergy” requires collaborative teamwork between the lab’s technical advisor and the restorative dentist to achieve the best outcome for restoring the patient’s oral health. Whether it be planning a case, dealing with a challenging patient, working with new materials, developing a digital workflow, or implementing CAD/CAM technologies within their practice—the clinician should be able to rely on their dental laboratory for knowledgeable solutions.

One of the more important aspects of technical advising is supporting the clinician with complex cases—relying on them for the right shades and knowledge of subtle nuances, teeth position, materials and restorative options. From treatment planning to placement of the prosthetic, reliable technical advising and collaborative teamwork between both parties achieves a better outcome for the patient. Some quality-oriented labs will send their CDT implant specialists to aid in surgery, further minimizing complications and showing the patient that the dentist has a team to create the smile that’s customized just for them.

4.    Lab should not send dental work offshore, use “gray-market” or counterfeit products

Outsourcing dental work to a foreign lab runs the risk of substandard quality and little (if any) governmental regulation of material safety and of the manufacturing processes. Some domestic labs will outsource their dental work to foreign labs and pass it off as their own, compromising the quality you would want from a domestic dental lab.

Dental material manufacturers sell their dental products either directly to the laboratory or through their authorized distributors. When the lab purchases products from a specific distributor, the source must be authorized by the manufacturer or they will run the risk of receiving gray-market and counterfeit products that may be passed down to you.

According to Dr. Christensen, gray-market products “include branded goods intended by the brand owner for one national market that instead are diverted and resold by unauthorized distributors to another market.” Counterfeit products pass off fake materials under a legitimate brand name. The main concerns for “gray-market” and counterfeit dental products are they may not comply with FDA regulation requirements, the quality and material safety may be compromised, and a false negative brand perception among clinicians3. Ordering only from “known, authorized retailers will ensure that the products are legitimate and from respected manufacturers”3. Therefore, when choosing a lab you can trust be sure to ask the lab where they purchase their products and if their vender is an authorized distributor.

5.    Lab facility should be clean, equipped with the latest dental technologies and dental materials

CAD/CAM technology has transformed and revolutionized the way dental laboratories design and manufacture restorations. CAD/CAM technology has streamlined the lab’s workflow, increasing productivity and predictability within their fabrication processes. The dental lab you choose should not only be up to clinical standards, but they also should be up-to-date with the latest dental technologies and materials to provide you with the best quality available on the market. As well as to stay competitive with other dental labs and industry pricing.  

Pigliacelli recommends taking a tour of the your prospective lab—meeting the lab owner, quality control manager, and technical advisors. He questions, “Is it clean?…Why would you accept a dirty, pumice-covered, disheveled mess of a dental lab instead of a professional-looking establishment?…Are the work desks neat?…Do the technicians take care of the equipment and respect their tools?” When a lab is well-organized and clean, its shows the company commits to high standards and holds their employees to those same standards.

To put briefly, it’s imperative to find a dental lab that you can trust because you as the dentist is reliant on your dental lab to consistently provide your patients with the best dental lab products available on the market. Quite often the patient sees a failed restoration as the clinician’s mistake and rarely blames the dental lab; so when clinicians choose a low-quality or offshore dental lab they run the risk of unhappy patients.

Dental professionals need to have strict requirements when choosing the best dental lab to fabricate their patients’ restorations. The lab’s mission should align with your mission: find the best solution for restoring the patient’s oral health.

About the company

Since 1991, Iverson Dental laboratories has provided their clinicians with high quality dental lab products and excellent dental lab services to ensure their clinicians’ patients are completely satisfied with their customized restoration. Iverson dental labs strives to be a great dental resource for dentists by offering training on digital dentistry and new dental implant techniques at their high-tech operatory and training facility. Iverson dental labs strongly believes in using high-quality certified materials and authentic manufacturing components to fabricate their dental restorations. Iverson also has a knowledgeable team of certified dental technicians because clinical evidence has shown adequate skills of the technician are important for the long-term success of a restoration.

Sources:

1. Pigliacelli, S. (n.d.). Top 5 questions you should ask a dental lab before you send them a case. Retrieved January 12, 2016, from http://www.perioimplantadvisory.com/articles/2011/4/top-5-questions-you-should-ask-a-dental-lab-before-you-send-them-a-case.html

2. Berry, J., Nesbit, M., Saberi, S., & Petridis, H. (2014). Communication methods and production techniques in fixed prosthesis fabrication: A UK based survey. Part 1: Communication methods. BDJ Br Dent J.

3. Christensen, G. J. (2010). Are You Using “Gray-Market” or Counterfeit Dental Products? The Journal of the American Dental Association, 141(6), 712-715.

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Trinia CAD/CAM Discs and Blocks - An Ultralight Alternative to Metal Substructures

Trinia, a CAD/CAM fiber-reinforced composite, was first introduced in 2010 and has achieved remarkable clinical success and acceptance among dental professionals worldwide. With the growing demand for alternatives to metal substructures in dentistry, Trinia CAD/CAM blocks and discs are the new advanced solution to CAD/CAM metal-free restorations.

 Trinia was designed with appropriate mechanical properties as well as proper esthetic characteristics to meet a broad range of clinical indications; resulting in a product with high flexural strength and compressive strength. This resilient and ultralight biocompatible resin material provides dentist and dental laboratories with a more efficient and cost-effective alternative to metal bars milled in titanium, or cast in semi-precious and precious metals.

 Benefits include:

•    Durable and resilient

•    Lightweight

•    Biocompatible

•    Adjustable

•    No firing required

•    High flexural strength

•    Cost-effective alternative to metal

•    Unique mechanical properties with high flexural and compressive attributes

 Indications of Clinical Use

 TRINIA can be utilized for the following indications: copings, substructures or frameworks for permanent and transitional anterior or posterior crowns, bridgework, and substructures that can be either cemented or uncemented restorations, such as telescopic prosthetics.

 Trinia CAD/CAM discs and blocks are composed of multi-directional interlacing fiberglass and resin within several layers. Trinia is available in 98mm circular discs, 89mm D-shaped discs, as well as 40mm and 55mm blocks. Following the proper milling procedures, Trinia can be milled on most leading wet and dry milling systems with extreme precision by nano-diamond burs.

 Trinia is durable with a flexural strength of 393MPa, compression strength of 374MPa (Parallel) and 339MPa (Perpendicular), and resilient with biocompatible material. Trinia makes their products in the United States, so dental professionals can be assured they are made from high quality materials and adequate manufacturing.  

 CAD/CAM Recommendations:

•    Eclipse design for bars

•    Minimum 0.7mm wall thickness

•    Minimum 7.0mm2 connector

•    Maximum 15mm cantilever

 About Iverson Dental Labs

 Iverson Dental Laboratories, a high-volume full-service dental lab, is an industry-leading provider of high-quality dental lab products and services to dental professionals nationwide. Established 1991 in Southern California by Corey Iverson, CEO, with a vision to be a reliable provider of quality dental restorations that exhibit strong mechanical properties and beautiful esthetics in the interest of patients' oral health.

With a modern and evidence-based approach, they continuously stay on the forefront of CAD/CAM technologies to increase productivity and consistency within their manufacturing processes to produce exceptional restorations.

Iverson aims to be the ultimate dental resource by offering continuing education seminars on digital workflows and on advanced implant procedures/techniques. Our purpose aligns with our clinicians, to restore oral health and confidence in every patient's smile.

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Advantages of CAD/CAM Custom Abutments in Implant Dentistry

The use of CAD/CAM (computer-aided design/computer-aided manufacturing) technology to design and manufacture custom implant abutments is a highly predictable and reliable fabrication process; demonstrating survival rates comparable to conventionally fabricated abutments2. The latest generation of CAD/CAM techniques allows the “clinician or technician to fully customize the abutment contour to match carefully the clinical situation after tissue customization with provisional restorations”1.

 Benefits of CAD/CAM Custom abutments

 ·         Precisely configures abutment for ideal anatomic contours1

·         Optimal design for esthetic emergence profile1

·         Highly predictable manufacturing process2

·         Availability of angulation correction1  

·         100% survival rates reported up to a 6-year period2

·         No technical complications reported up to a 6-year period2

·         Cheaper than gold cast abutments1

 Over the last 10 years, dental CAD/CAM digital systems have been gaining increased use in implant dentistry because of the accurate and calculable nature of CAD/CAM technology. For instances, some studies found the fit of “CAD/CAM implant frameworks to be statistically superior to that of conventional cast frameworks”1. It also has improved productivity and efficiency of prosthetic manufacturing processes within the dental lab. Continuous improvements to CAD/CAM technology have started to challenge the technique of fabricating dental implants and abutments using conventional methods.

 Implant abutments should be made from biocompatible materials with adequate mechanical properties to meet the functional, biological and esthetic demands1. Furthermore, they should “accurately and passively fit on their mating implants to prevent complications, such as screw loosening, bone loss and abutment fractures during function”1. To achieve optimal mucogingival esthetics, dental implant abutments require the appropriate emergence profile needed to support the surrounding soft tissue, especially for esthetically driven patients1.

 Implant abutments can be either stock, cast custom or CAD/CAM custom abutments. The main advantage of stock abutments is their lower initial cost, but a major disadvantage is the ideal anatomic contour and emergence profile cannot be achieved. Cast custom abutments have similar tough mechanical properties to CAD/CAM custom abutments; however, the complicated fabrication process of investing, casting and finishing could be prone to manufacturing errors1. Whereas, the use of CAD/CAM technology to design and manufacture custom abutments has been clinically proven to be extremely accurate due to the predictable nature of computer-aided manufacturing2.

 In a 2014 systematic review by Harvard School of Dental Medicine, researchers found CAD/CAM technology is able to provide results that are comparable to that of conventional techniques for implant survival, abutment survival, technical and biological complications2. In the study, a total of 101 patients were treated with a total of 138 CAD/CAM implant abutments with the same patient group seen at 12, 36, and 67 months. Three different major CAD/CAM systems were used to fabricate the dental implant abutments: Procera (Nobel Biocare), Straumann Cares, and Zirconzahn. Amazingly, they found the CAD/CAM abutment survival rate is 100% and no complications were reported, including screw loosening or fracturing of the abutment2.

 In sum, CAD/CAM custom abutments have demonstrated survival rates comparable to conventionally fabricated abutments and have several advantages over other fabrication methods, allowing the technique to be a viable option for manufacturing custom implant abutments.  

 About the Company

 Since 1991, Iverson Dental laboratory has provided dentists with high quality dental lab products and excellent dental lab services to ensure dental patients are completely satisfied with their restoration outcome. Iverson dental labs strongly believes in using high quality certified materials and authentic manufacturing components to fabricate their dental prosthetics given that material quality influences longevity of the restoration. Iverson Labs values their skilled team of certified dental technicians because clinical evidence has shown adequate skills of the technician are important for the long-term success of a restoration. Iverson dental labs strive to be a great dental resource for dental professionals by offering training on digital dentistry and new dental implant techniques at their cutting edge on-site operatory and training facility.

 To inquire more about CAD/CAM custom implant abutments, please visit http://www.iversondental-labs.com or call us at (800) 334-2057.

 Reference:

 1. Kim, E., & Shin, S. (n.d.). Influence of the implant abutment types and the dynamic loading on initial screw loosening. The Journal of Advanced Prosthodontics J Adv Prosthodont, 21-21.

 2. Kapos, T., & Evans, C. (n.d.). CAD/CAM Technology for Implant Abutments, Crowns, and Superstructures. The International Journal of Oral & Maxillofacial Implants Int J Oral Maxillofac Implants, 117-136.

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How Patients’ Decisions Influence Treatment Planning in Restorative Dentistry

As part of treatment planning, you as the dentist introduce options to your patients. After a relaxed conversation, a treatment plan is agreed upon between you and your dental patient. You use the best available research-based literature, clinical experience and patient opinions to guide your treatment decisions. As a dentist, you exercise substantial influence on which treatment method is chosen. Patients’ decisions can lead to less than ideal, though clinically adequate, treatment plans that give patient satisfaction over the long-term1. Patients’ decisions are most affected by their relationship with you as their dentist over factors such as time, access, and cost1. Health service providers may affect the decision-making process between you and your patient if specific treatments are favored or excluded on financial grounds. Kalsi and Hemmings recommends letters should be sent to patients explaining the “nature of all proposed options, including advantages and disadvantages, complications, success rates, biological and financial costs” and the consequences if no treatment is carried out1.

 Many psychological and social determinants influence patients’ values and decision-making when choosing a treatment plan in restorative dentistry. Frequently, a component of compromise between both parties in deemed acceptable even when clinical evidence indicates an alternative treatment to be more appropriate.

 The best possible treatments should be based on the best available literature; however, the majority of treatment plans are greatly impacted by patients’ desires and expectations, which may not be based on sound knowledge1. Patients’ wishes should be determined at the first treatment planning consultation to sort out whether they are realistic and possible within your own skill set, experience and knowledge1. It is widely known that no dentist should perform any treatment that could harm a patient.

 Time, number of appointments, use of anesthesia or sedative agents, pain and suffering are significant aspects to your patients’ decisions when selecting a treatment plan. You need to clarify biological and financial cost-benefit analyses to the patient1. Also identify clinical factors, such as age, medical history and economics.

 Patients seek dental treatment for three main reasons: comfort, aesthetics, and function. Patients are the real judge of whether their treatment is successful or not, so it is vital that they are pleased with their dental product1. Their subjective assessments of a proposed treatment do not always correspond with their acceptance of evidence-based suggestions from clinical research literature. This assessment is contingent on the value patients accredit to a treatment. Aesthetic awareness can push patients to ask for destructive, biologically invasive work in situations where appearances could easily and equally be improved with lower risks of morbidity. For example, bleaching and bonding with veneers may “improve aesthetics with the same effect as full coverage crowns, with less tooth destruction and risk of dental pulp death and pain”1.

 Factors that affect patients’ decisions when deliberating treatment options:

•  Availability and access to care

•  Real cost per treatment option

•  Perceived value for money

•  Past dental history: positive or negative attitudes

•  Dentist’s confidence and competence

•  Patient’s confidence in dentist’s competence

•  Patient’s confidence in the treatment plan

•  Time and number of appointments

•  Perceived impact to quality of life

•  Pain and inconvenience associated with treatment1

 Interestingly, patients place more emphasis on your recommendations rather than on objective, evidence-based literature1. If a dentist advocates a treatment, the patient is 2−21 times more likely to have it done1. Comparatively, Kalsi and Hemmings found the endorsements made by evidence-based literature made no difference to a patient when choosing to proceed with a treatment. Confidence in your advice establishes the foundation of a professional relationship with the patient.

 The significance of the dentist-patient relationship cannot be minimized, and a positive relationship is most likely to prompt a patient consenting for treatment. Patients put a lot of value on your recommendations. At the same time, patients want to play a collaborative role with you in the decision-making process. A treatment plan that is not evidence-based or approved with the patient runs the risk of losing a patient or, at worst, medico-legal action1. However, treatment plans with an “element of compromise can be acceptable if, following full discussion with the patient, and taking into account all relevant factors, the benefits outweigh the disadvantages. This is the basis of informed consent”1.

 About the Company

Since 1991, Iverson Dental laboratories have provided dentists with high quality dental lab products and excellent dental lab services to ensure dental patients are completely satisfied with their restoration outcome. Iverson dental labs strongly believes in using high quality certified materials and authentic manufacturing components to fabricate their dental prosthetics given that material quality influences longevity of the restoration. Iverson values their skilled team of certified dental technicians because clinical evidence has shown adequate skills of the technician are important for the long-term success of a restoration. Iverson labs strive to be a great dental resource for dental professionals, offering training on CAD/CAM technologies in digital dentistry and advanced dental implant techniques at their cutting edge on-site operatory and training facility.

To find more helpful resources about restorative dentistry or to inquire about our dental lab services, please visit http://www.iversondental-labs.com or call us at (800) 334-2057.

 References:

1. The influence of patients' decisions on treatment planning in restorative dentistry. (2013).

Dental Update,

40

, 698-710. 

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What Factors Influence Patient Satisfaction in Restorative Dentistry

According to “The Dental Practice-Based Research Network” (GPBRN), five general factors that influence dental patient satisfaction include:

 1.  Technical quality of care

2.  Interpersonal factors

3.  Convenience

4.  Financial issues

5.  Office environment

 Patient Satisfaction can influence a “patient’s likelihood of choosing a dentist, making and keeping appointments, and complying with dentists’ recommendations” [1]. Satisfaction can be considered a combination of the dissonance between the patients’ expectations and their experiences. Therefore, patient satisfaction is an important part of dental care that has the potential to impact restorative dentistry treatment outcomes [1].

 Higher ratings of patient satisfaction in restorative dentistry occurs in cases with more experienced dentists because of greater proficiency, when the defective restoration is repaired rather than replaced, when restorative materials are a natural tooth color material rather than amalgam, and when the tooth is a premolar or an anterior tooth.

 Effectively communicating the patient’s treatment plan and paying attention to concerns they may have are the most prominent components when patients are judging a dentist’s skill and quality of care. Whether the dentist recognizes their patient’s pain, talks over their fears, and aids in conquering their fears are very significant in terms of patient satisfaction. Patients deduce dental expertise from the dentist’s capacity to manage discomfort and provide a dental visit free from negative experiences.

 It is vital to include patients in treatment decisions on medications, restorative material options and dental prosthetic procedures. Dentist’s who educate and involve their patients in treatment decisions, provide adequate time to comprehend facts and have their questions satisfactorily answered are more likely to have higher rates of satisfaction among their patients. Patients who are given more preparatory information have much better control of postoperative discomfort because their dentist effectively communicated what they should expect in terms of pain and how to control the discomfort.

 Indeed, patients tend to use non-technical aspects of dental visits to appraise dentists’ technical capabilities. A dentist’s skills and quality of care are partially based on personal interactions with the dentist, the patient’s level of comfort, and post-treatment sensitivity. Steps can be taken to improve patient satisfaction by changing office policies or procedures, patient education and involvement, and/or the dentist’s interpersonal methods.

 Dental practitioners should remember that human and psychological aspects of care are essential factors in determining the quality of care provided.

 About the Company:

 Since 1991, Iverson Dental laboratory has provided dentists with high quality dental lab products and excellent dental lab services to ensure their dental patients are completely satisfied with the restoration outcome. Iverson dental labs strive to be a great dental resource for dentists by offering training on digital dentistry and new dental implant techniques at their high-tech on-site operatory and training facility. Iverson dental labs strongly believes in using high quality certified materials and authentic manufacturing components to fabricate their dental prosthetics. Iverson Labs also strongly believes in having a knowledgeable team of certified dental technicians because clinical evidence has shown the skills of the clinician and technician are important for the long-term success of a restoration.

 Reference:

  1. Riley, J., Gordan, V., Rindal, D., Fellows, J., Qvist, V., Patel, S., . . . Gilbert, G. (n.d.). Components of patient satisfaction with a dental restorative visit. The Journal of the American Dental Association, 1002-1010.

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The Importance of Finding a Dental Lab You Can Trust and Depend on for Quality Dental Lab Products and Services to Meet Patients’ High Expectations

In order to meet dental patients’ high expectations for long-lasting and highly esthetic dental restorations, its essential for dentists to find a dental laboratory they can trust and rely on for quality dental lab products to ultimately provide optimal patient care services. The long-term success of modern dental restorations depends on a number of factors that dentists must take into consideration when choosing the best dental laboratory to fabricate their patients’ dental prosthetics. Such factors include the lab’s ability to employ skilled dental lab technicians to adequately fabricate high quality dental lab products, and the lab’s ability to preserve the strength and esthetics of dental materials for restorations by executing proper lab techniques and procedures.

 The success or failure of a dental restoration is also determined by how effective the dental lab’s communication methods are, prompting dentists to find a dental lab they can depend on for effective communication. Finding a dental lab that a dentist can trust to consistently deliver first-rate dental lab products and dental lab services can be taxing, but the alternative can lead to unsatisfied patients and be damaging to a dentist’s reputation.

 Clinical evidence has shown the “skills of the clinician and technician are important for the long-term success of a restoration,” therefore dental laboratories must ensure their lab technicians have the skills and knowledge necessary to manufacture high quality prostheses on a consistent basis [1]. For instances, fabricating porcelain crowns and bridges is a highly sensitive technique and requires adequate skills of lab technicians because “minor laboratory faults may result in clinically unacceptable surface layers” [1]. One major fault is the formation of porosities that in turn may negatively affect the surface roughness, texture and shade of the restoration. Common reasons for the formation of porosities in dental porcelain as described by Rashid are “laboratory faults during condensation, in-appropriate powder/liquid mixing ratio and due to variations in firing time and temperature.”

 The long-term clinical success of modern dental restorations greatly depends on “the physical properties of the material, the laboratory fabrication process, the laboratory fabrication technique and clinical procedures that may damage these brittle [ceramic] materials” [1]. The surface roughness and microstructure of dental materials, particularly dental ceramics, are also factors that influence the strength and long-term success of a restoration. During laboratory processes—such as powder compaction, process of forming, firing and shaping—can cause flaws in dental ceramics when the procedure is not performed correctly. Rashid explains during lab processes, flaws may become inherited in the surface and/or microstructure of dental ceramics that can compromise the strength and esthetics of a restoration. Surface roughness will “lead to a non-uniform stress distribution and concentrate locally an applied stress due to the shape differences in the surface layer… developed cracks cannot propagate randomly but occur or propagate at points with higher stress,” causing fractures at these points of high stress [1]. In other words, laboratory processes can influence the existence of micro cracks and residual stresses that affects the longevity of the material, and therefore should be executed competently with the correct dental lab procedures and techniques by capable lab techs.

 Along with the ability to adequately manufacture ceramics and other dental materials with acceptable mechanical properties, the lab technician must also have the ability to recreate esthetic details that will match the patient’s natural tooth shape, texture and shade characteristics. Dr. Markus Blatz, restorative dentistry’s leading researcher at the University of Pennsylvania School of Dental Medicine, states the goal of restorative intervention is “to mimic nature as closely as possible” and the dental materials used should “depend on the patient’s needs” [6]. Recreating esthetic details that mimic the patient’s natural teeth is crucial when “subtle details in texture, anatomy, and contours keep the ceramic restoration from looking contrived and can provide the element of ‘prefect imperfection’ that natural teeth exhibit” [4]. In The Penn Dental Journal for the University of Pennylvania School of Dental Medicine, Dr. Blatz explains how he relies on the artistic skills of his dental technicians to first plan and design the substructures using CAD/CAM systems, and then build “the individual teeth by hand and applying the layers of ceramic on top of the copings and frameworks” [7]. He further adds, “Despite all technical advancements, machines are not able to recreate the intricate and subtle esthetic features of a natural tooth. That’s why [the lab technician’s] artistic expertise is so important" [7].

 Restorative dentistry also requires effective communication between the dental lab and dental practice to achieve the restorative goals set by the patient and dentist. With the development of software programs and effective web applications, dental labs can now use web content management systems (WCMS) to communicate to the dental office and manage laboratory cases at a faster and more accurate rate. As stated by Alshiddi, “Laboratory case management is a teamwork that should involve good communications between not only the dentist and the dental technician, but also other staff in the dental office (e.g., dental assistant and receptionist) and dental laboratory (e.g., laboratory owner, receptionist and delivery person)” [2]. When managing a large number of dental lab cases, the lab must implement an effective content management system that will manage all of the dental cases coming from multiple forms of communication methods (e.g., hand-written lab authorization forms, telephone, email, photographs, electronic STL files, etc.). Equally important is the lab’s understanding of individual software requirements and design of the software that will essentially, if implicated correctly, improve communication and will ensure long term relationships between the dental office and dental laboratory [2].

 Providing excellent dental lab services will lead to “well-designed prostheses, satisfied clinician and comfortable professional relationship between the clinician and dental technician/laboratory” [2]. The dental laboratory must provide great customer service for dentists and their dental office personnel, so all parties can work effectively together in the interest of the patient’s oral health. Collaborative technical advice on routine or complex dental cases is a very important service that dental laboratories should exceed at every time. The lab needs to have a strong management team to implement and oversee quality control processes on every dental case. They must also have an effective logistic team to ensure dental cases are fabricated and delivered in time for the patient’s scheduled appointment. Offering in-house custom shade appointments should be available for doctors and their patients, making sure the lab facility is up to professional standards in appearance and services they provide.  

 As stated in General Dental Council’s (GDC) policy document Principles of dental team working, “members of the dental team will work effectively together” and members have to “communicate clearly and effectively with other team members and colleagues in the interest of patients” [3]. Given these points, choose a dental lab that employs a knowledgeable team of certified dental technicians that can consistently fabricate high quality dental lab products. Also, finding a lab that can effectively communicate with the dentist and dental office personnel is essential for the overall success of a dental practice.

 About the Company

 Since 1991, Iverson Dental laboratories has provided dentists with high quality dental lab products and excellent dental lab services to ensure dental patients are completely satisfied with their restorative outcome. Iverson dental labs offer training on digital dentistry and new dental implant techniques at their high-tech operatory and training facility. Iverson dental labs strongly believes in using high quality certified materials and authentic manufacturing components to fabricate their dental restorations. Iverson also strongly believes in having a dedicated, knowledgeable team of certified dental technicians because clinical evidence has shown the skills of the lab technician are critical for the long-term success of a restoration. They serve dentists from all over North America with a strong following in Pennsylvania (PA), Texas (TX), and California (CA), where they are leading the way in providing professional dental lab services and products to ultimately improve patient care in restorative dentistry.

   Reference:

1. Rashid, H. (n.d.). The effect of surface roughness on ceramics used in dentistry: A review of literature. European Journal of Dentistry Eur J Dent, 571-571.

 2. Alshiddi, I. Communication Between Dental Office and Dental Laboratory: From Paper-based to Web-based. Pakistan Oral & Dental Journal, Vol. 34 Issue 3, p555.

 3. Berry, J., Nesbit, M., Saberi, S., & Petridis, H. (2014). Communication methods and production techniques in fixed prosthesis fabrication: A UK based survey. Part 1: Communication methods. BDJ Br Dent J.

 4. Weston, J., & Haupt, E. (n.d.). Creating Aesthetic Success Through Proper Clinician and Laboratory Technical Communication. Dental Clinics of North America, 371-382.

 5. Miyazaki, T., Nakamura, T., Matsumura, H., Ban, S., & Kobayashi, T. (n.d.). Current status of zirconia restoration. Journal of Prosthodontic Research, 236-261.

 6. Blatz, M. (2013, January 1). Prosthetic parameters and materials for anterior implant esthetics. Lecture. https://www.for.org/en/video-insights/markus-blatz-prosthetic-parameters-and-materials-anterior-implant-esthetics?rate=KDjDad61ETC0oRsYOyMxaye7jTkb3qvyTEpMruuj9qM

 7. Bonett, J. (2009). Bringing Da Vinci to Dentistry. Penn Dental Journal, 5(2), 2-5. Retrieved August 31, 2015, from http://www.dental.upenn.edu/pdf/penn-dental-journal/pdj_spring09.pdf

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The Importance of Effective Communication Between the Dental Lab and Dentist to Ultimately Provide Better Patient Care

“Communication is the key to success in cosmetic dentistry/laboratory relations” [3]. The importance of good communication has been highlighted by a number of studies [3]. Effective communication between the dentist and the dental laboratory is critical when fabricating well-designed, high quality dental restorations to ultimately provide patients with the best dental care. The effectiveness of the communication methods used by the dental lab to collaborate with the dental office is also a major factor that determines the success or failure of dental lab products.

 As reported by Berry et al., “prosthodontics is a discipline that requires a synergy between the dentist and dental technician in order to fabricate intraoral prostheses with acceptable fit, function and aesthetics.” Although restorative dentistry is first about restoring the teeth’s function and oral health of the patient, and next the esthetic appearance; the patient’s growing demand for realistic esthetics and long-lasting restorations is challenging the industry to meet these high expectations by producing dental products that exhibit both attributes. Recreating esthetic details that mimic the patient’s natural teeth is crucial when “subtle details in texture, anatomy, and contours keep the ceramic restoration from looking contrived and can provide the element of ‘prefect imperfection’ that natural teeth exhibit” [4]. Precise design parameters, shade matching, and available tooth structures should all be decided and effectively communicated by the clinician to the dental lab in order to successfully achieve a highly esthetic restoration that will match the patient’s natural tooth contours and shades [4].

 The lab technician’s ability to transfer exact shade matching, along with the ability of the clinician to communicate accurate tooth shades, is a challenging aspect of communication; especially, when an increasing number of patients are demanding esthetically brilliant prostheses. Determining a precise shade (e.g., color, surface texture, shade characteristics) is first dependent on the clinician and must be effectively communicated to the lab technician in order for the lab tech to achieve exact shade matching for the final restoration. Exact shade communication is important between the technician and dentist because dental techs are remotely located and usually never see the patient [1]. In consonances with a study on color matching, Seal et al. reported, “precise color communication is integral to the development of esthetic harmony and overall restorative success.”  

 The methods used by the dental lab to communicate with the dental practice are also major factors that influence the accuracy of dental lab products. With the development of software programs and effective web applications, dental labs can now use web content management systems (WCMS) to communicate to the dental office and manage laboratory cases at a faster and more accurate rate. As stated by Alshiddi, “Laboratory case management is a teamwork that should involve good communications between not only the dentist and the dental technician, but also other staff in the dental office (e.g., dental assistant and receptionist) and dental laboratory (e.g., laboratory owner, receptionist and delivery person)” [3]. When managing a large number of dental lab cases, the lab must implement an effective content management system that will manage all of the dental cases coming from multiple forms of communication methods (e.g., hand-written lab authorization forms, telephone, email, electronic STL files, etc.). Equally important is the lab’s understanding of individual software requirements and design of the software that will essentially, if implicated correctly, improve communication and will ensure long term relationships between the dental office and dental laboratory [3].

 The dental laboratory must provide great customer service for dentists and their dental office personnel so all parties can work together proficiently. Providing excellent dental lab services will lead to satisfied clinicians and comfortable professional relationships between the clinician and dental technician/laboratory [3]. Collaborative technical advice on routine and complex dental cases is a very important service that dental laboratories should exceed at every time. The dental lab must have an effective logistic team to make sure dental cases are fabricated in time for the patient’s scheduled appointment, also ensuring patients are satisfied with their dental care services.

 “By far my happiest [Dentists] with the happiest patients are the ones that communicate with the laboratory and view it as part of a team effort to achieve the right result for the patient,” stated one dental technician in a study on the communication methods used between the lab and dentist [1].

 Along with adequate skills of the dental laboratory and clinician, good teamwork through effective communication between the dentist and dental lab leads to high quality dental restorations with excellent fit, function and esthetics. When problems arise from inaccurately fabricated prostheses, the patient will usually blame the dentist/dental office for the mishap. For this reason, its imperative dentists choose the best dental laboratory that can effectively communicate with their dental office to ensure satisfied patients every time and to ultimately provide better patient care.

 About the Company:

 Since 1991, Iverson Dental laboratory has provided dentists with high quality dental lab products and excellent dental lab services to ensure their dental patients are completely satisfied with the restoration outcome. Iverson dental labs strives to be a great dental resource for dentists by offering training on digital dentistry and new dental implant techniques at their high-tech operatory and training facility. Iverson dental labs strongly believes in using high quality certified materials and authentic manufacturing components to fabricate their dental restorations. Iverson also strongly believes in having a knowledgeable team of certified dental technicians because clinical evidence has shown the “skills of the clinician and technician are important for the long-term success of a restoration” [1].

   Reference:

 1. Berry, J., Nesbit, M., Saberi, S., & Petridis, H. (2014). Communication methods and production techniques in fixed prosthesis fabrication: A UK based survey. Part 1: Communication methods. BDJ Br Dent J.

 2. Afsharzand, Z., Rashedi, B., & Petropoulos, V. (n.d.). Communication Between the Dental Laboratory Technician and Dentist: Work Authorization for Fixed Partial Dentures. J Prosthodontics Journal of Prosthodontics, 123-128.

 3. Weston, J., & Haupt, E. (n.d.). Creating Aesthetic Success Through Proper Clinician and Laboratory Technical Communication. Dental Clinics of North America, 371-382.

  4. Seal, M., Talukdar, P., Srivastav, V., & Pendharkar, K. (2014). Colour Matching: A Review of Conventional and Contemporary Dental Colour Matching Systems. International Journal of Oral Care and Research, 2(5), 47-53.

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The Importance of Finding a Quality Dental Lab to Adequately Fabricate Your Dental Lab Products

Although there are thousands of dental laboratories worldwide, not all of them communicate effectively and provide their dentists with high quality dental lab products that exhibit longevity and lifelike esthetics. The long-term success of modern dental restorations depends on a number of factors that dentists must take into account to ultimately provide their patients with the best dental care services available on the market. Such factors include adequate skills of laboratory technicians, proficient dental laboratory processes, and effective communication methods between the dental lab and dentist.  

 In order for a dental restoration to have a successful outcome, proper manufacturing procedures and techniques must be followed to ensure the patient’s high demand for durable and esthetically pleasing prostheses are met. According to Rashid, long-term clinical success of modern dental restorations greatly depends on “lab fabrication techniques and clinical procedures that may damage these brittle materials,” along with physical properties of the material and adequate skills of dental lab technicians. For instances, fabricating porcelain crowns and bridges is a highly sensitive technique and requires adequate skills of lab technicians because “minor laboratory faults may result in clinically unacceptable surface layers” [1]. One major fault is the formation of porosities that in turn may negatively affect the surface roughness, texture and shade of the restoration. Common reasons for the formation of porosities in dental porcelain as described by Rashid are “faults during condensation, in-appropriate powder/liquid mixing ratio and due to variations in firing tine and temperature.”

 As a matter of fact, major faults have been indentified when lab technicians do not adequately finish the surface of dental ceramics. For instances, if the surface of the dental material is rough it will “abrade the opposing dentition or restoration,” and Rashid highly recommends the lab technician finish and/or polish the surface appropriately [1]. Considering recent studies on wear of antagonist enamel, Miyazaki et al. confirmed that adequate surface finish of all-ceramic restoratives resulted in least wear of antagonist enamel and suggests that the “antagonist enamel wear is significantly affected by the degree of surface finish.” For that reason, it is very important lab technicians have adequate skills and tools required to achieve an extremely smooth surface for least wear of opposing enamel.

 Furthermore, the surface quality and composition of a dental restorative material determines the initial bacterial adhesion, and clinical studies have shown a rough surface will accumulate more plaque [1]. The oral cavity is “constantly contaminated by a complex diversity of microbial species that have a strong tendency to colonize surfaces” and if the “roughness were sub-gingival, the retention of the microorganisms would be more” [1]. Increased amounts of plaque on rough surfaces of ceramics and enamel is the major cause of dental caries and also a harmful influence on periodontal tissue [1].

 The surface roughness and microstructure of dental materials, particularly dental ceramics, is also a factor that influences the strength of a restoration. During laboratory processes—such as powder compaction, process of forming, firing and shaping—can cause flaws in dental ceramics when the procedure is not executed correctly. According to Rashid, during lab processes flaws may become inherited in the surface and/or microstructure of dental ceramics that can compromise the strength and esthetics of a restoration. Surface roughness will “lead to a non-uniform stress distribution and concentrate locally an applied stress due to the shape differences in the surface layer… developed cracks cannot propagate randomly but occur or propagate at points with higher stress” [1]. More simply put, laboratory processes can influence the existence of micro cracks and residual stresses, and therefore should be executed competently by lab technicians.

 Additionally, Rashid argues other lab processes are can be factors that influence the microstructure and thus the strength of the restoration. Specifically, damage to restorations can be “caused during grinding; pull-out caused during polishing, micro-porosity present on the subsurface and the introduction of large pores by technicians during restoration manufacture are common technical laboratory flaws “ [1]. Consequently, clinical success of a dental restoration is largely determined by the skills and knowledge of the dental lab and their technicians, along with effective communication between the dentist and dental lab to successfully collaborate on a dental case.

 Accordingly, restorative dentistry requires effective communication “between the dentist and dental technician in order to fabricate intraoral prostheses with acceptable fit, function and aesthetics” [3]. As stated in General Dental Council’s (GDC) policy document Principles of dental team working, “members of the dental team will work effectively together” and members have to “communicate clearly and effectively with other team members and colleagues in the interest of patients” [3]. Collaborative technical advice on routine and complex dental cases is an important service that dental laboratories should provide. Finding a dental laboratory that can effectively communicate with their dentist is essential to the clinical success of a dental restoration. Also, time is money. Dental Labs need to have an efficient logistics team to assure dental cases are fabricated in time for the patient’s scheduled appointment.

 Given these points, choose a dental lab that employs a knowledgeable team of certified dental technicians that can adequately fabricate high quality dental lab products. Also, finding a lab that can effectively communicate with the dentist on a consistent basis is essential for the overall success of a dental practice; ultimately to provide their dental patients with the best dental care services available on the market.

  About the Company:

Since 1991, Iverson Dental laboratory has provided dentists with high quality dental lab products and excellent dental lab services to ensure their dental patients are completely satisfied with the restoration outcome. Iverson dental labs strives to be a great dental resource for dentists by offering training on digital dentistry and new dental implant techniques at their high-tech operatory and training facility. Iverson dental labs strongly believe in using high quality certified materials and authentic manufacturing components to fabricate their dental restorations. Iverson also strongly believes in having a knowledgeable team of certified dental technicians because clinical evidence has shown the “skills of the clinician and technician are important for the long-term success of a restoration” [1].

Reference:

1. Rashid, H. (n.d.). The effect of surface roughness on ceramics used in dentistry: A review of literature. European Journal of Dentistry Eur J Dent, 571-571.

2. Miyazaki, T., Nakamura, T., Matsumura, H., Ban, S., & Kobayashi, T. (n.d.). Current status of zirconia restoration. Journal of Prosthodontic Research, 236-261.

3. Berry, J., Nesbit, M., Saberi, S., & Petridis, H. (2014). Communication methods and production techniques in fixed prosthesis fabrication: A UK based survey. Part 1: Communication methods. BDJ Br Dent J.

[awesomedentallaboratory-blog]

Pros and Cons of IPS e.max® Lithium Disilicate Glass-Ceramics for Dental Restorations

For more than a decade, clinical trials have recorded high chipping rates in porcelain fused to zirconia (PFZ) dental restorations because of the relatively weak bond between the porcelain veneer and strong zirconia core. Porcelain fused to metal (PFM) dental restorations experience veneer chipping as well, however, clinical evidence has shown they perform better than PFZ restorations [1]. The major problem with PFM restorations is the metal substructure does not provide the most appealing esthetics. Therefore, researchers and clinicians developed monolithic all-ceramic dental restorations in an attempt to resolve these issues. One such monolithic all-ceramic dental restoration was developed by Ivoclar-Vivadent called IPS e.max® lithium disilicate.

 When considering U.S. dental patient’s high demand for esthetically driven restorations, a dental professional must make informed decisions about the quality, longevity and esthetics of a dental restoration in order to have a high acceptance rate among their patients. Thus, the dental practice will be more successful by means of new and retained patients. This article will briefly analyze the pros and cons of lithium disilicate glass-ceramics.

 Microstructure of Lithium Disilicate (LS2)

 Dental ceramics can be classified by their microstructure (i.e., composition of glass-to-crystalline ratio) [2]. Lithium Disilicate (LS2) has a glass-based system (mainly silica) with crystalline fillers, formed by the controlled crystallisation of the glass material [2]. The crystalline filler particles are added to increase the strength of the glass-ceramic; cracks caused by stress are “arrested by the lithium disilicate crystals, providing a substantial increase in the flexural strength” [2].

 Pros

 One pro to lithium Disilicate glass-ceramic restorations is an observed low chipping and fracture rate [1]. Lithium disilicate has an unusual microstructure that contributes to its relatively high flexural strength of 360-400MPa. The spread of cracks is deflected, branched and blunted by lithium disilicate needle-like crystal structure – providing a substantial increase in the flexural strength [2]. In a 2015 study, Valenti evaluated the clinical performance of 110 lithium disilicate crowns over a 9-year period and found 2 crowns had core fractures and 1 crown chipped. They found the “overall survival probability was 96.1% up to 9 years, with a failure rate of 1.8%” [3].

 Six other clinical studies (Richter et al. 2009; Nathanson 2008; Reich et al. 2010; Fasbinder et al. 2010; Bind 2011; Sorensen et al. 2009b) showed 97.9% of 237 IPS e.max ® lithium d­­isilicate (CAD crowns) restorations survived after a mean observation period of 4 years. The 2.1% failure rate included 0.4% irreparable chipping, 0.4% secondary caries and 1.3% fractures. Glass-ceramics exhibit lower strength relative to Porcelain fused to zirconia but higher chip fracture resistance. High chip fracture resistance is due to an elongated grain structure that inhibits crack propagation and contributes to its toughness, while it limits the strength by “promoting crack initiation within a relatively coarse microstructure” [1].

 Another pro is lithium disilicate has superior esthetics compared to other ceramic materials. The monolithic structure and glass-ceramic system of lithium disilicate allows the material to take on translucent and light diffusing properties. Natural enamel has translucent qualities that transmits light rather than reflect or scatter it. The optical compatibility between the glassy matrix and the crystalline phase minimizes internal scattering of the light as it passes through the material—high translucency depends on the transmission of light through the core material [2]. Sravanthi et al. study argues that the “core translucency therefore becomes one of the primary factors in controlling aesthetics and is a critical consideration in selection of materials.” The study used a reflectance spectrophotometer (records the amount of light reflected) to compare the translucency of crowns fabricated with three different commercially available all-ceramic materials including alumina - CAD-CAM Procera, Lithium disilicate - Pressable IPS e.max Press, Zirconia - CAD-CAM Lava [4]. Out of all three ceramic materials, lithium disilicate was found to have the maximum translucency even when the coping was at a 0.8mm thickness.

 Lastly, glass-ceramics can be “readily etched and silanized at the intaglio surfaces, with attendant superior bonding to a support substrate” [1]. In other words, lithium disilicate has the ability to be easily etched or milled out of a homogenous material by computer-aided-design/computer-aided-manufacturing (CAD/CAM) digital systems. This technology assures acute accuracy of the fabrication of the designed restoration. The silanization of the restoration’s surface helps increase the hydrophobicity of the glass-ceramic.  

 Cons

 Although lithium disilicate crown applications have a high survival and success rate, they may be “less suitable for applications where stress concentrations can be high, e.g. FDP [fixed dental prosthesis] connectors” [1]. The 360-400MPa flexural strength of lithium disilicate is relatively weak compared to the 1,000MPa flexural strength of zirconia-based restorations. For this reason, FDPs with frameworks made of glass-ceramics require “larger connector areas to meet load-bearing requirements relative to their stronger zirconia counterparts” [1]. Whereas, lithium disilicate single crowns are supported by underlying dentin that exhibits greater strength and stability then lithium disilicate multiple-unit restorations. However, a 10-year study evaluated the long-term outcome of three-unit FDPs made from monolithic lithium disilicate ceramic (IPS e.max Press, Ivoclar Vivadent) and found that the survival and success rates were similar to those of conventional metal-ceramic FDPs [7].

 Next, one study analyzed the friction and wear behavior of human enamel that opposed lithium disilicate restorations and found evidence of abrasive wear behavior of the opposing enamel [5]. Lee et al. found the “enamel that opposed lithium disilicate glass ceramic exhibited cracks, plow furrows, and surface loss, which indicated abrasive wear as the prominent wear mechanism.” It’s worth noting that adequate surface finishing of dental ceramics influences wear on opposing enamel and requires competent skills of the dental laboratory to achieve an acceptable polished surface. A rough surface will abrade the opposing enamel of a restoration and “it is highly recommended that the surface is finished and polished appropriately” [6].  

 To conclude, the flexural strength of previous glass-ceramic materials was relatively weak until the development of highly esthetic and strong lithium disilicate glass-ceramics. The highly specialized monolithic structure of IPS e.max ® lithium d­­isilicate by Ivoclar Vivadent can achieve great structural integrity with superior translucent esthetics compared to other all-ceramic materials. For this reason, Lithium disilicate is a viable option for dental patients who are seeking longevity and beautiful esthetics for their dental restoration.

 About the Company:

 Since 1991, Iverson Dental laboratory has provided dentists with high quality dental lab products to ensure their patients are completely satisfied with the restoration outcome. Iverson’s highly knowledgeable team of certified dental technicians specialize in all-ceramic restorations, dental implants, cosmetic and digital dentistry. Iverson dental labs strongly believe in using high quality certified materials and authentic manufacturing components to fabricate their dental restorations.

 To inquire more about all-ceramic dental lab products, please visit http://www.iversondental-labs.com.

 Reference:

 1. Zhang Y, Chai H, Lee JJ, Lawn BR. Chipping resistance of graded zirconia ceramics for dental crowns. J Dent Res. 2012;91:311–5. [PMC free article] [PubMed]

2. Shenoy A, Shenoy N. Dental ceramics: An update. J Conserv Dent. 2010;13:195–203. [PMC free article] [PubMed]

3. Valenti M, Valenti A. Retrospective survival analysis of 110 lithium disilicate crowns with feather-edge marginal preparation. Int J Esthet Dent. 2015 Summer;10(2):246-57.

4. Sravanthi, Y., Ramani, Y. V., Rathod, A. M., Ram, S. M., & Turakhia, H. (2015). The Comparative Evaluation of the Translucency of Crowns Fabricated with Three Different All-Ceramic Materials: An in Vitro Study. Journal of Clinical and Diagnostic Research : JCDR, 9(2), ZC30–ZC34. doi:10.7860/JCDR/2015/12069.5559

5. Lee, A., Swain, M., He, L., & Lyons, K. (n.d.). Wear behavior of human enamel against lithium disilicate glass ceramic and type III gold. The Journal of Prosthetic Dentistry, 1399-1405.

6. Rashid, H. (n.d.). The effect of surface roughness on ceramics used in dentistry: A review of literature. European Journal of Dentistry Eur J Dent, 571-571.

  7. Kern, M., Sasse, M., & Wolfart, S. (n.d.). Ten-year outcome of three-unit fixed dental prostheses made from monolithic lithium disilicate ceramic.

The Journal of the American Dental Association,

234-240.

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Pros and Cons of Porcelain Fused to Zirconia (PFZ) Dental Restorations

In the last few decades, there has been an increasingly huge demand for highly esthetic dental restorations among U.S. dental patients. New developments and advances in all-ceramic dental materials have replaced metal-ceramic systems, such as porcelain-fused-to-metal (PFM) prostheses, with all-ceramic systems. Advancements in bonding techniques resulted in the development of porcelain fused to zirconia (PFZ) restorations, finding superior esthetics compared with PFM restorations.

 Metal-free all-ceramic restorations offer better esthetics and biocompatibility than porcelain fused to metal (PFM) prostheses [1]. Although PFZ prostheses offer better esthetics than metal ceramic systems, dentists must evaluate the pros and cons of PFZ prostheses in order to make an informed decision on providing the best dental lab products to their patients. This article will briefly analyze the cons and pros of porcelain fused to zirconia restorations.

 Microstructure of PFZ Restorations

 Dental ceramics can be classified by their microstructure (i.e., amount and type of crystalline phase and glass composition)[1]. Zirconia oxide (ZrO2) has a polycrystalline solid-based composition, formed by “directly sintering crystals together without any intervening matrix to from a dense, air-free, glass-free, polycrystalline structure”[1]. Solid-sintered zirconia-oxide ceramic is widely used as a framework material for dental implants, dental crowns, fixed-partial dentures, and other dental lab products.

 Conventional dental porcelain is a partially glassy material that contains high amounts of leucite crystals added to aluminum oxide. This pressed-glass ceramic undergoes “dispersion strengthening through the guided crystallization of leucite”[1]. Porcelain is widely used for veneer layering onto a zirconia core (PFZ) or a metal core (PFM).  

 Cons of PFZ Restorations

 To begin with, clinical research and practices have reported high occurrences of veneer chipping and fractures in all major brands of PFZ systems, especially in posterior prostheses [2]. The porcelain overlay can chip during mastication, most notably at the coping level were thickness is a factor that influences the survival and success of the restoration [3]. According to Agustin et al., porcelain veneer chipping most often occurs as an esthetic defect without affecting the survival of the restoration and is easily repaired by polishing or intraoral repair; it often goes unnoticed by the patient. For this reason, Agustin et al. five-year study reported the survival rates of zirconia-based fixed dental prostheses to be 97-99%.

 Although the survival rate is favorable, clinical studies have revealed a high rate of fractures for porcelain-veneered zirconia-based restorations that affect the success of the restoration—varying between 6% and 15% over a 3- to 5-year period. The success of the restoration is dependent on whether the restoration’s esthetics is compromised or not. Agustin et al. believes the reason for the high rate of fractures is uncertain but suspects the bond between the porcelain and the zirconia substructure failed. One likely reason could be the porcelain veneer has a weak flexural strength of 90MPa, contrasted to zirconia’s high flexural strength of 900–1200 MPa [2]. Another likely reason was found in a Baldassarri et al. 2012 clinical study, “the presence of a radial tensile stress in the overlay porcelain of zirconia-ceramic prostheses… may lead to the large clinical chips and fractures of these prostheses.”

 Another con to porcelain-veneered zirconia-based restorations is a reported high wear loss of antagonist enamel because porcelain consists of leucite crystal grains that act as an abrasive surface during mastication [4]. Porcelain also consists of feldspathic glass that disappears after wear, leaving large leucite grains to be exposed and act as abrasive materials on the opposing enamel [5]. In fact, Porcelain-veneered zirconia shows higher wear loss on opposing enamel than that of polished zirconia. Rashid reviewed an Odatsu et al. study that used carborundum points, silicone points and diamond polishing paste on zirconia and traditional feldpsathic porcelain to examine the materials surface roughness. They found the “feldspathic porcelain showed highest surface roughness values after finishing and polishing procedures” [7]. They concluded, “a rough surface will abrade the opposing dentition or restoration, and it is highly recommended that the adjusted surface is finished and polished appropriately��� [7].

 Pros of PFZ Restorations

 Despite the low flexural strength of the layered porcelain for PFZ restorations, superior fracture resistance of the zirconia ceramic core is a major pro. According to Miyazaki et al., in a study assessing zirconia-based restorations found the zirconia frameworks rarely got damaged and the complications that did occur were at the veneering ceramic level. In a 10-year clinical study, Sax et al. assessed the long-term survival rate of zirconia-based posterior fixed dental prostheses with zirconia frameworks and found the “zirconia frameworks exhibited very good long-term stability” [6].

 In 2012, Agustin et al. analyzed porcelain veneer behavior on zirconia ceramic cores using a scanning electron microscopy (SEM) and found 71.66% of the facture type for zirconia-core restorations were cohesive – meaning the facture only occurred at the surface level without affecting the ceramic-core interface. In another study with the same objective, Saito reported 88.8% of fracture types were cohesive. Since most of the fractures are cohesive in nature, the veneered porcelain can be easily repaired without much concern the ceramic core is fractured [7].

 Finally, PFZ restorations have the ability to mask discolored underlying tooth structures because zirconia has opaque characteristics that allow the prepared tooth to be concealed. Since the zirconia core is highly opaque, a porcelain overlay is needed to improve the esthetics of the zirconia core to appear more translucent, more similar to natural teeth. The dual layers of porcelain and zirconia from PFZ restorations allow the prosthetic to hide any discoloration and/or defects from the prepared tooth, making it a top option for patients who may have these issues.

 Some studies, particularly Agustin et al., have concluded the survival rate is not dependent on esthetic defects but on the functional survival of the restoration. But with an ever-growing society that demands perfection in esthetics for dental restorations, functionality is not the only characteristic desired for dental restorations by the majority. Although the 1,000 MPa zirconia substructure exhibits good long-term stability, the failure of the layering porcelain can be seen as ultimately a failure of the restoration. After much clinical research, it is safe to say the porcelain layer on PFZ restorations is not reliable for the long-term success of esthetics. Consequently, PFZ restorations are at the risk of failing as an acceptable restoration among U.S. dental patients.

 Resource Box:

Iverson Dental Laboratories is a cutting edge dental lab that utilizes advances in dental technology and procedures to fabricate high quality dental lab products. Their highly knowledgeable team of certified dental technicians specialize in all-ceramic restorations, dental implants, cosmetic and digital dentistry. Iverson strongly believes in using high quality certified materials and authentic manufacturing components to fabricate all their dental restorations. They proudly make 100% of their dental lab products at their Southern California dental labs, allowing them to have one of the fastest turnaround rates in the industry.

 To learn more about quality options for dental lab products, please visit http://www.iversondental-labs.com.

 References:

1. Shenoy A, Shenoy N. Dental ceramics: An update. J Conserv Dent. 2010;13:195–203. [PMC free article] [PubMed]

  2. Baldassarri M, Stappert CF, Wolff MS, Thompson VP, Zhang Y. Residual stresses in porcelain-veneered zirconia prostheses. Dent Mater. 2012;28:873–9. [PMC free article] [PubMed]

 3. Triwatana P, Nagaviroj N, Tulapornchai C. Clinical performance and failures of  zirconia-based fixed partial dentures: a review literature. J Adv Prosthodont. 2012;4:76–83. [PMC free article] [PubMed]

 4. Agustin-Panadero R, Román-Rodríguez JL, Ferreiroa A, Solá-Ruíz MF, Fons-Font A. Zirconia in fixed prosthesis. A literature review. J Clin Exp Dent. 2014;6:e66–73. [PMC free article] [PubMed]

 5. Miyazaki, T., Nakamura, T., Matsumura, H., Ban, S., & Kobayashi, T. (n.d.). Current status of zirconia restoration. Journal of Prosthodontic Research, 236-261.

  6. Sax C, Hammerle CH, Sailer I. 10-year clinical outcomes of fixed dental prostheses with zirconia frameworks. Int J Comput Dent. 2011;14:183–202. [PubMed]

7. Saito A, Komine F, Blatz M, Matsumura H. A comparison of bond strength of layered veneering porcelains to zirconia and metal. J Prosthet Dent. 2010;104:247–57. [PubMed]

  7. Rashid, H. (n.d.). The effect of surface roughness on ceramics used in dentistry: A review of literature.

European Journal of Dentistry Eur J Dent, 571-571.

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How Do Dental Implants Work?

Dental implants are considered to be the best long-term solution for missing teeth. Though dental bridges are a cheaper alternative, over time a dental implant is more cost-effective, as it can last decades. A patient can treat an implant as they would their real teeth, remembering that brushing and flossing is just as important! Dental implants look, feel and function like real teeth.

 A dental implant, usually made of titanium, takes the place of a missing tooth’s original root, connecting to the bone. They help to maintain the jaw bone’s shape and density. It can take two to six months for the bone to fuse around the implant. Once healing is complete, an abutment is attached to it. This is the device that joins the implant to a crown, which replaces the actual missing tooth.

 Crowns are custom-made at a dental laboratory, like Iverson, to match your existing teeth. The crown is cemented or screwed onto the abutment to permanently keep it in place. Once the dental implant procedure is complete, the crown should be indistinguishable from the rest of your teeth.

 For fixed multiple tooth replacement, custom-made crowns or bridgework can be attached to the abutments to replace missing teeth without disturbing the healthy teeth next to them, and while stopping bone loss in the jaw and maintaining facial features.

 If you are missing all of either your lower or upper teeth (or just all of your teeth), there’s also the option of getting a removable implant-supported tooth replacement. Two to six implants may be used to support a lower denture, depending on the design of the removable replacement. On the other hand, a minimum of four implants are required to support an upper denture. Removable dentures are usually used to replace extensive tooth, bone, and gum-tissue loss, providing support for the facial skeleton, lips, and cheeks. An advantage of a removable denture is making the cleaning of the dental implants significantly easier.

 Over time, dental implants have become much more efficient and affordable. They’re very widely used, as roughly 70% of adults in America are missing at least one tooth. If you think you may be a good candidate for dental implants, speak to an experienced dentist to review your options. If you don’t have enough existing bone in your jaw or you’ve had radiation to your jaw, possibly for treating cancer or something similar, dental implants may not be the best option for you. Also, if you’re a smoker, your dentist will probably ask you to quit, as smoking can increase infection and rejection risks for dental implants.

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The Pros and Cons of Computer-aided Dental Implant Surgical Planning

Although computer-aided dental implant surgery and the aid of surgical guides were originally developed to reduce the risks of standard implant procedures, dental professionals must still weigh the cons and pros of such procedures. Much research has been conducted to offer a clinical perspective on the accuracy of computer-aided oral implant surgery and computer-designed (SLA) surgical guides. Some findings have concluded computer-aided implant surgery, using three-dimensional (3D) virtual planning software and computer-aided surgical guides, is a reliable procedure to optimally position dental implants; however, some disadvantages have been reported as well.

 Combined technologies of computed tomography (CT) scans integrated with three-dimensional (3D) virtual planning software, and computer-aided design/computer-assisted manufacture (CAD/CAM) allows the “clinicians to virtually plan the location, angle, depth, and diameter of the virtual implants on the basis of the diagnostic casts and by using wax-ups as an exact replica of the final restoration” (Beretta, Poli, and Maiorana). Its worth mentioning more cutting edge dental laboratories are using 3D printers, such as Stratasys 3D printers, to print diagnostic casts or models at a faster rate with acute accuracy then previously manufactured.

 Intraoral digital scanners, such as iTero, create high-resolution 3D images of the surrounding oral cavity; allowing the dentist to check on the health of the tooth, their roots and bone surrounding them. Computer-aided implant surgical planning utilizes 3D imaging software from a CT system, such as Carestream, to customize surgical templates to help the dentist correctly drill and position the dental implant. With 3D imaging software, there are many possibilities to enhance the treatment planning process and improve patient care. Features range from implant placement planning to viewing in 3D high-resolution the sagittal, coronal, axial, obliques and panoramic angles for a more accurate diagnosis of dental treatment.

 In 2014, the Science Journal of Periodontal & Implant Science published a clinical study aimed at evaluating the accuracy of flapless, computer-aided implant placement by comparing the angular deviations of the planned and placed implant positions. They concluded that “computer-aided flapless implant surgery seemed to provide several advantages to the clinicians as compared to the standard procedure; however, linear and angular deviations are to be expected” (Beretta, Poli, and Maiorana). They found no complications and all implants achieved successful osseointegration. Their research also affirmed the development of “more accurate 3D planning programs for the CT scan analysis and virtual planning contributed to the progress of this type of surgery and implant rehabilitation with a one- or two-stage approach” (Beretta, Poli, and Maiorana).

 Here are several Pros of computer-aided oral implant surgery that Beretta’s study reported:

·         Flapless surgery with a consequent decrease in surgical time and patient morbidity.

·         Preservation of soft tissue structure and hard tissue volume in the surgical site.

·         Integration of the restorative determinants into the surgical planning, resulting in a more aesthetic, functional, and predictable prosthetic outcome.

·         Simplification of the technique-sensitive and operator-dependent surgical procedure (Beretta, Poli, and Maiorana).

 Beretta’s study reported some cons to computer-aided oral implant surgery as well:

·         The surgeon's inability to visualize anatomic structures.

·         The increased risk of axis and depth deviations during implant placement.

·         A decreased ability to contour the jawbone topography when needed for prosthetic purposes (Beretta, Poli, and Maiorana).

 Although this digital technique was originally developed to reduce the risks involved during standard implant procedures, providing greater control of the system, the problem of deviation between the planned and the placed implant positions still occurs. In a 2012 clinical study, researchers evaluated the accuracy of computer-designed (SLA) surgical guides for 116 implants inserted in both partially and completely edentulous patients. By comparing the three-dimensional positions of the planned and actual placement of the implants, they were able to report some deviations. However, “[the implants] do not appear to have resulted in important clinical complications. This suggests the necessity of always keeping a safety zone of at least 2 mm to avoid critical anatomical structures” (Cassetta et al).

 In Baretta’s study, they make suggestions on how to achieve an optimal accurate and stable position of the surgical guide for best outcomes in dental implant placement. In order to improve the stability of surgical guides, it is suggested the use of anchor pins inserted into the jawbone is necessary to prevent micromovements and “better results were obtained with the use of [such] stabilizing devices” (Beretta, Poli, and Maiorana). According to Cassetta et al., the use of three osteosynthesis screws in a tripod formation was the best option for the necessary stability of the surgical guide.

 Although there are some cons to computer-aided implant surgery and the use of surgical guides, if the procedures are implemented and executed correctly there can be major pros that out weigh the cons. The advent of technological advances in dental care provides clinicians with viable options to providing better patient care. Dental professionals should not only keep up-to-date with new techniques and procedures in order to make the best decisions for their patients, but also weigh the cons and pros for assured quality.

 About Iverson Dental Laboratories

 Iverson Dental Laboratories is a leading edge dental lab that utilizes advances in dental technology and procedures to fabricate high quality dental lab products and to provide excellent dental lab services. As a full service dental laboratory, they specialize in all-ceramic restorations, dental implants, cosmetic dentistry and digital dentistry. They have developed their own surgical guide, AccuGuideÒ, to maximize the use of available bone and provide greater accuracy for implant placement. They built an onsite operatory and training facility to train new and experienced dentists on new implant procedures and digital intraoral scanner systems to help enhance their practice. They proudly manufacture 100% of their dental lab products in-house at their Southern California lab, allowing them to have one of the fastest turnaround rates in the industry.

 To inquire more about computer-aided implant surgery and surgical guide products, please visit http://www.iversondental-labs.com.

 Sources:

1. Mario Beretta, Pier Paolo Poli, and Carlo Maiorana. "Accuracy of Computer-aided Template-guided Oral Implant Placement: A Prospective Clinical Study." J Periodontal Implant Sci Journal of Periodontal & Implant Science: 184. Web. 15 July 2015. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4148631/>.

 2. M. Cassetta, LV. Stefanelli, M. Giansanti, and S. Calasso. "Accuracy of Implant Placement with a Stereolithographic Surgical Template." Int J Oral Maxillofac Implants 27.3 (2012): 655-63. Pubmed.gov. Int J Oral Maxillofac Implants. Web. 15 July 2015. <http://www.ncbi.nlm.nih.gov/pubmed/22616060>.

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Find the Best Dental Lab to Provide High Quality and Safe Dental Lab Products

Although there are thousands of foreign and U.S. dental laboratories not all of them provide their dentists with high quality dental lab products and services. The infamous dental case, reported by the NADL, concerning an Ohio Woman in 2008 that after a chemical analysis of her 3-unit dental bridge found “unsafe levels of lead in the porcelain on the restoration” made from China is all to well known in the dental community, but still concerns many dental professionals today. The materials being used and quality of dental restorations from foreign and U.S. dental laboratories is still a major concern for the dental lab industry, dental professionals, and their patients.  

 Provided in this article is a brief overview of the concerns that the dental community and the United States Government have with low quality, and potentially unsafe imported and domestic dental lab products. Discussed next are considerations when choosing a dental laboratory, so new and experienced dentists can ensure their dental practice is an ongoing success and ultimately provide the best dental health care services to their patients.

 Imported dental restorations (and those fabricated domestically) are medical devices that must meet U.S. Food and Drug Administration requirements. Foreign laboratories, like U.S. Laboratories, are required to register their establishment, list medical devices, report medical device defects, and manufacturing in accordance with the quality system regulations. Although foreign and domestic dental labs are required to comply with these regulations, the FDA cannot regulate the contents of all imported and domestic dental lab products for assured safety. The FDA told NADL back in 2007, that it was concerned with safety management of the “increase in dental restorations coming in from foreign dental laboratories” and, more recently, the FDA revealed an all-time high of 38% of dental restorations being imported from foreign labs.

 U.S. States including Texas, Missouri, South Carolina, North Carolina, Kentucky, Illinois, Ohio, Pennsylvania, Virginia, Florida, Minnesota and Oklahoma are the only states that require some existing administrative or governmental laws regulating dental laboratories and/or technicians. Only 10 states require some regulations: material and point of origin disclosure, lab registration, at least one CDT for each lab or continuing education certification. Having only 10 out of 50 states that require regulations of dental labs and products, such as certification and material origin disclosure, is alarming when the public’s health is at risk. It should be a right for a patient to know what is being sold to them and where it is coming from, especially when it comes to medical devices that must be biocompatible with the oral cavity.

 Infection control and material safety in dental lab products are the main concerns when dental labs can go unregulated without the requirement of a license and/or certified dental technicians. In one such case in Springfield, Ohio, a man arrested over unrelated incidents at his home, police found an unsanitary dental lab in his basement. The “basement lab” was broadcasted by a local news station in Ohio, Local 12 News, and the man responsible for the alarmingly unsanitary dental lab told the news station that he learn dental work while he was in prison, taking a one year certificate course. In order to be a certified dental lab technician, a lab technician must have 5 years of experience along with certified courses; however, there are no laws in Ohio that required a dental lab and/or dental technician to be certified. Therefore the reported “basement lab” in Ohio, even though unacceptable, was not illegal because of the lack of laws and regulations. In over 40 states in the U.S., anyone can operate a “dental laboratory” without a required license.

 The National Association of Dental Laboratories (NADL) and American Dental Association (ADA) have supported material disclosure to dentists and their patients. They also support stricter FDA regulations for dental labs and dental products for all 50 states, not just for only 10 states.

 In 2007, the Food and Drug Administration and Federal Government officials collaborated with the National Association of Dental Laboratories (NADL) to address concerns about the regulation of imported dental lab products and the lack of FDA regulation for U.S. dental labs. FDA’s representatives told “NADL that there was concern about the government’s ability to adequately track the material safety of import dental restorations being used by U.S. consumers.” So the NADL concluded they would develop a framework of “best practices and guidelines for the dental laboratory industry” to help the FDA improve import safety for dental restorations to ultimately protect the dental health of U.S. dental patients. Since then very little has been done on the legislative side of all 50 states to improve regulation of dental products and labs, hence currently only 10 states are minimally regulated.

 In a 2008 ADA member survey, 45% of their dental patients requested material content information for a dental restoration or inquired about the materials that may comprise a restoration. Surprisingly, a 2009 ADA member survey showed that 65% of dentists believed that dental labs and technicians in their state are licensed.  

 "Such common-sense regulations are critical because in many cases, the dental technician--not the prescribing dentist--makes the selection of dental materials that will be used for a particular patient's restoration," said Bennett Napier, CAE co-executive director of the National Association of Dental Laboratories. "Without having some requirement for the person or manufacturer creating the device to have the appropriate knowledge and training, the issue of material selection and/or safety is left to chance."

 The bottom line is dentist’s need to be able to reassure their patients of the type of documentation they can provide about the origins of their dental restorations and what type of quality they are paying for. Furthermore, dental practices and dental patients need to be aware and educated about the differences and opportunities available when choosing dental restorations from a foreign or domestic dental lab.

 Low quality, or ill-fitted dental lab products can make your patient unsatisfied and bring the quality of services you provide to a damaging level, giving your patient a reason to find another dentist. When this happens the dentist is usually to blame by the patient so it’s imperative to know what level of quality you are getting to prevent any dissatisfaction. Dentists need to make decisions not based solely on price but also on quality, customer service, accessibility, remakes, and effective communication.

 When choosing the best dental lab for quality dental lab products, consider these tips to make the success of your dental practice and the public’s health a top priority:

 ·         Do they use certified materials and implant components?

·         What are the material origins used to make the restoration?

·         What are the origins of the restorations?

·         Do they outsource any of their dental work to foreign labs?

·         If they outsource to foreign labs, make sure you are provided with the FDA registration number and compliant with ANSI and ISO standards.

·         Are they a certified dental lab (CDL)?

·         Do they employ at least one certified dental technician (CDT)?

·         Physically visit and inspect the dental lab on a regular basis.

·         Build a relationship with your dental lab to ensure effective communication.

 About the company

Iverson Dental Laboratories is a cutting edge dental lab that utilizes advances in dental technology and procedures to fabricate high quality dental lab products and excellent dental lab services. As a certified dental laboratory, they specialize in all-ceramic restorations, dental implants, cosmetic and digital dentistry. They strongly believe in using certified materials and authentic manufacturing components to fabricate all their restorations. They proudly make 100% of their dental products in-house at their Southern California lab, allowing them to have one of the fastest turnaround rates in the industry. They also pride themselves on having the lowest remake and adjustment rate in the industry at 2.6%.

To inquire more about quality dental lab products and services, please visit http://www.iversondental-labs.com.

What to look for in a dental lab to ensure quality are also discussed to help new and experienced dentists ensure their dental practice is on going success and ultimately provide the best quality services to their patients.

[awesomedentallaboratory-blog]

Iverson Dental Labs Uses CAD/CAM Technology for Innovative Dental Lab Products & Services

Iverson Dental Labs has recently reported how they are able to provide innovative dental lab products and services with the growing popularity of CAD/CAM (computer-aided design/computer-aided manufacturing) technology in the dental industry. The expansion of CAD/CAM digital technologies in the past 10 years has greatly improved the techniques used to fabricate dental lab products, especially surgical guided implants and dental impressions.

 Continued improvements to CAD/CAM technologies has challenged and enhanced the techniques used to fabricate dental lab products, particularly implant-supported prosthesis and the use of surgical guides. With 3-Dimensional intra-oral scanning capabilities, the dentist and dental lab are able to easily view the upper and lower jawbone to plan for optimal implant placement. Implant-supported dental restorations are gaining huge popularity among dental patients who have one or more missing teeth because of the longevity and biocompatible nature associated with dental implant treatment.

 In a 2014 research study conducted by Dr. Kapos, DDS and Dr. Evans, BDSc Hons (QLD) at the Harvard School of Dental Medicine, researchers wanted to measure the failure and survival rates of CAD/CAM implant-supported restorations and abutments compared to conventionally fabricate dental implant prostheses. Although they found the survival rate from conventionally fabricated implants was comparable to CAD/CAM implant-supported prosthesis, they found color matching and durability was significantly better for all-ceramic dental crowns. The researchers found dental Implants aided by CAD/CAM technology to be highly reliable. They estimated the mean failure and survival rate of implants supporting CAD/CAM crowns was 98.85%. The failure and survival rate of implants supporting CAD/CAM abutments was an astonishing 99.85% with no reported technical complications.  

 Utilizing CAD/CAM technology to digitally plan and create surgical guides has made the procedure of implanting restorations more accurate and dependable then previous methods. Iverson Dental Labs utilizes CAD/CAM technology to virtually plan and design their surgical guides so the dentist can use them as a aid in surgery to correctly drill and position the implants. Iverson Dental Labs developed an innovative surgical guide, AccuGuideâ, to better address the need of highly accurate implant positioning to maximize the use of available bone. Iverson’s dental implant department assists their dentists with implant treatment and planning to provide the best experience for their dentists and ultimately to their patients.

 By not owning a digital intra-oral system does not exclude dentists from taking advantage of the cutting edge CAD/CAM technology because Iverson Dental Labs has made a Model Free dental crown/bridge option available for dentists. Iverson’s dentists deliver a physical impression to Iverson’s Lab and the lab scans the impression digitally, then designing the model on the computer for acute precision and cost efficiency. By utilizing CAD/CAM digital design software, Iverson’s certified dental technicians are able to save time by skipping tedious steps such as fabricating prosthetics and stone models by hand. With Stratasys 3-Dimensional printers, Iverson Dental Labs are able to save time and labor costs by printing dental lab products such as surgical guides, models, removable partial frameworks, diagnostic wax-ups and more.

 One of Iverson’s long-time clients, Ronald G. White DDS, sheds some light about the company stating, “Iverson Dental Laboratories has been meeting my laboratory needs for more than 14 years. Their quality and service has always been excellent. I would recommend them to anyone looking for a cutting edge full service dental laboratory.”

 About the company

 Iverson Dental labs is a full service dental lab based in Southern California that specializes in implants, cosmetic and digital dentistry. They make all of their high quality dental lab products in the USA, giving them one of the fastest in-lab turnaround times in the dental industry. They also provide dental lab services such as patient acquisition to assist dentists in increasing revenue, and educational seminars for digital intra-oral scanning systems, advanced dental implant techniques and procedures.

 Visit their website http://www.iversondental-labs.com/ for more info.