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Industry icon Jim Glidewell shares his perspective on the future of our industry, including restorative trends, the biggest challenges you’ll face and strategies to ensure your laboratory’s success.
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Fifty-five percent of our State of the Industry 2015 survey respondents have recently changed their business model to increase profitability, gain new clients and be more competitive. Five of our respondents share their stories.
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With today’s focus on highly cosmetic restorations and appliances, patients want functional, natural-looking removable partial dentures. Proper material selection is a key part of ensuring patient satisfaction.
The first part of LMT’s comprehensive, multi-issue State of the Industry 2015 coverage offers an in-depth look at the key trends impacting laboratory operators today.
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- November 2014
LMT taps into the expertise of 20 laboratory owners and managers from all size labs who’ve successfully incorporated digital technology into their operations, offering real-life experiences and tips on what we all wish we would have known before taking the plunge.
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- October 2014
After watching technicians drop one too many crowns and losing productivity, Ceramist Tom Greggs invented Stabiliner, which reduces the risk of slippage of milled restorations during contouring/finishing procedures.
LMT’s 2014 Fee Survey respondents offer a mixed picture of their sales and profitability. On one hand, laboratory sales seem to be slowly improving. Profits, though, seem to be lagging behind.
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A 2014 Fee Survey participant from the Midwest—who prefers to remain anonymous—offers a thoughtful take on how the rampant price competition on full contour zirconia restorations is negatively affecting the bottom line of many laboratories. Here’s what he had to say:
In the early 1980s, the price of gold skyrocketed and non-precious alloy showed up on the scene. Since it was a cheap metal, most labs didn’t even add the cost of the metal into the crown fee. However, they weren’t thinking about the revenue they had been making on gold alloys—or about the increase in labor because non-precious takes longer to finish—so their profitability suffered.
A similar trend is happening with FCZ. In many laboratories, FCZ is cannibalizing their PFM work and the labs are losing the alloy revenue. And, as the economy has declined, so has the price of FCZ: the $99 FCZ was born, quickly gained market penetration and the race to the bottom began. Many labs...
- March 2014
Since their introduction in the 1950s, PFM restorations have been the bread-and-butter of C&B and most full service laboratories. In fact, as recently as 2005, only 17% of C&B workloads were metal-free. However, with the proliferation of metal-free materials and technologies, we’re nearing the tipping point: 45% of C&B workloads are now comprised of metal-free restorations, according to LMT’s 2013 Porcelain Survey.
Foreign Dental Work Put to Test, an investigative report about lead found in restorations made in China was the talk of the industry when it aired in February 2008 on Ohio’s WBNS 10TV. The story covered an Ohio woman who had experienced pain and infection in her jaw after her dentist placed an ill-fitting, three-unit PFM bridge the previous year. After learning the bridge was made in China, she had the bridge removed and tested for hazardous materials, and lead (160ppm) was found in the restoration.
In addition, the TV station ordered eight PFM crowns from four labs in China and also had them tested; one of them tested positive for lead (210ppm).
The media coverage fueled objections to offshore outsourcing and even breathed new life into the debate about mandatory laboratory certification and registration. The ADA announced it would do its own independent testing and released its findings a year later: scientists analyzed 44 different porcelain powders and 102 finished PFM crowns...
- February 2014
Invented by Dr. Itzhak Shoher and Aharon Whiteman, CDT, first-generation Captek™ was introduced to the international dental community in 1993. The unique capillary technology took the PFM world by storm because it produced a high noble metal coping right on the refractory die without casting. Dentists and technicians alike were taken by its resulting thin, gold-colored copings and ability to maximize soft tissue health; Captek remains an ideal option for patients with any type of predisposition to caries or perio concerns.
In 2007, Captek Nano™—stronger and thinner than the original materials—was introduced. The technology was sold to Argen in 2011 and, soon after, the company introduced Digital Captek, a 3D-printing service.
Although PFMs were still considered by many to be the esthetic standard for clinical longevity, pressable ceramics—starting with IPS Empress and Optimal Pressable Glass (OPC)—began to drive the metal-free dentistry movement in the late 1980s. The improved esthetics and biocompatibility—coupled with soaring precious metal prices—quickly made the pressable technique a successful and cost-effective way to fabricate metal-free restorations. Later, the technique was adapted to create press-to-metal and press-to-zirconia restorations.
LMT took six impressions of the same prep and anonymously sent them to six different laboratories along with prescriptions for non-precious PFM crowns; one was made in the Philippines. In this ground-breaking experiment in 1985—with LMT Publisher Judy Fishman as the patient—we wanted to know: could a dentist tell the difference between the $35 crown and the $75 crown?
Among our panel of dentists, no one crown was rated head and shoulders above the rest. Although not uniform in their assessments, the dentists could not discern which was the most expensive and which was the least; in fact, several of them rated medium-priced crowns better than the higher-priced ones.
The Crown Experiment—an LMT tradition repeated three more times in our history—demonstrated that when dentists choose a laboratory, perception is as much a factor as the quality of the crown itself, proving the value of laboratory positioning and marketing.
In 2007, we kicked it up a notch and created...
- November 2013
Last year, Bob Iuliano, CDT, invested about $80,000 in CAD/CAM equipment—and he hasnât looked back since.
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DENTAL TEAM: Scott Atkin, Creative Dental Laboratory and Dr. Michael Foley, both in Scottsdale, AZ
RESTORATIVE PROBLEM: A 79-year-old male patient with an existing PFM full mouth rehab needed a classic A3 shade replacement bridge for teeth #11 through #15.
TREATMENT PLAN: A five-unit Crystal Diamond full contour bridge was prescribed. Crystal Diamond was chosen for its excellent translucency and strength, ideal for highly esthetic anterior and posterior metal-free restorations.
FABRICATION PROCESS: The case was scanned using a 3Shape D710 scanner and milled using Delcam software on a DentMill 4 milling machine from Digital Dental Lab. After milling, Atkin infiltrated the non-colored zirconia with a combination of Tanaka Zircolor and Zirkonzahn's Color Liquids Prettau® Aquarell shading liquids using green micro-brushes to ensure uniform application of the shading liquids. The technique, based on the instructional Shading Techniques DVD provided by Dental Laboratory Milling Supplies,...
DENTAL TEAM: Cindy Vuong and Dr. Michael DiTolla, both of Glidewell Laboratories, Newport Beach, CA
RESTORATIVE PROBLEM: The patient presented with a pre-existing discolored PFM restoration on tooth #8.
TREATMENT PLAN: Dr. DiTolla prescribed a full contour BruxZir® crown, and decided to take the opportunity to test the translucency of Glidewell Laboratories' new BruxZir™ Shaded material, which offers complete color penetration all the way through the restoration for greater shade consistency. The new material also prevents shade changes or white "show-through" after occlusal adjustment. BruxZir™ Shaded Milling Blanks are available in four base shades that can be stained to match all 16 shades in Vident's VITA Classical Shade Guide range.
FABRICATION PROCESS: The case was scanned on the 3Shape D700 and milled with the BruxZir™ Milling System using a BruxZir™ Shaded Milling Blank 200 to achieve the base shade of A2. The pre-shaded blocks were sintered and finished...
DENTAL TEAM: Dr. William Roddy and in-house technician Steve Coles, Flow Laboratory, Fort Worth, TX
RESTORATIVE PROBLEM: A 62-year-old female presented with implants on teeth #3, #4 and #5 and a PFM bridge placed by another dentist. The implants had been placed too far buccally and the patient was unhappy with the esthetics and thickness of the bridge. The patient's occlusal planes were also uneven, and she had another large-span anterior bridge on teeth #6 through #11 that was starting to show signs of decay at the margins.
TREATMENT PLAN: The team opted to remove both bridges and the remaining natural teeth in the arch. Additional implants were placed on teeth #6 and #11 through #14, and immediately loaded with a temporary bridge. After integration, the patient's final restoration would be a full contour, full arch, implant-supported bridge. KEROX ZircoStar zirconia in Extreme Translucent (ET) was chosen for its esthetics and ability to match natural teeth. Because of its small grain...
DENTAL TEAM: Sven Jesse, Jesse & Frichtel Dental Labs and Dr. Edward Narcisi, DMD, both of Pittsburgh, PA
RESTORATIVE PROBLEM: The patient—the wife of one of the laboratory owners--had an existing all-ceramic restoration on tooth #30 that cracked (she had previously had a PFM crown that also chipped).
TREATMENT PLAN: Since functionality and esthetics were a priority, a Zirlux FC2 full contour zirconia crown was chosen. The laboratory prefers to use Zirlux FC2 because of its flexural strength and low wear against opposing dentition. The Zirlux FC2 system consists of five pre-shaded zirconia discs, 10 stains, six modifier pastes and a universal glaze. The pre-shaded discs allow you to produce all 16 VITA A-D shades as well as bleach shades with no dipping.
FABRICATION PROCESS: A custom shade was taken in the laboratory and Jesse completed a shade-mapping diagram, indicating the varying shades and characteristics in the occlusal, incisal, body and neck areas of the tooth. The...
- September 2013
Thanks to the advent of digital technology, many laboratory owners and managers are discovering new business models and finding ways to reinvent their businesses and reinvigorate their careers. Here are the stories of three lab owners/managers who have done so using Sirona Dental, Inc.'s CEREC Acquistion Centers, Sirona Connect.
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- August 2013
Lately, Iâd noticed some pain when chewing, but I wasnât sure whether it was coming from that tooth or the opposing PFM crown. Though #19 had a root canal [the one from LMTâs second crown experiment, 1987], there was a chance that the tooth had cracked.
The following week, the prosthodontist confirmed that, indeed, the next step would be the crown lengthening procedure followed by six weeks of healing time before he would insert a post to further support the crown. And, as Bill Mrazek, CDT, recommended, the best restoration in this case, would be a PFM. He and his office are the cat's meow when it comes to professionalism and patient care and I'm fortunate to become their patient.
The periodontist he recommended was the same one I'd already called so that added to my feeling of being in the right hands. I've since had the crown lengthening procedure. The stitches are out and I'm on the mend.
I couldn't be any more impressed with the periodontist and his operation! He gave me arnica, with instructions to start taking these tiny natural remedy pills for quicker healing two days before the crown lengthening procedure. I love that he takes a holistic approach to his work and plan to have my dental cleanings there in the future.
- April 2013
All-ceramics, implants, profit erosion and other hot topics inspired dialogue during the biggest weekend of the year.
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Shofu demonstrated its next-generation ceramic, One Shot Unilayer Porcelain, that enables you to match all VITA shades and achieve the esthetics of a multi-powder buildup with a single powder. "They said it couldn't be done but we did it. One Shot powder is an incisal, body and dentin all in one bottle. It's an enormous time and money saver," said Lynne Calliott, Vice President of Marketing, Americas.
An extension to the Vintage MP and ZR product lines, One Shot's densely packed homogenous material yields reduced shrinking versus multiple firing-cycle techniques while allowing one powder to build to full contour. Two formulas are available: for PFMs and zirconia restorations.
For details, call 800-827-4638, ext. 222.
- March 2013
Restoring the smile of a dentistâs relative can be particularly challenging. Here, Luke Kahng shares how he transformed the smile of a clientâs mother-in-law with two PFM bridges and one PFM crown.
The growing popularity of all-ceramic restorations continues to erode the PFM market. The percentage of metal-free work being done—45%—is up 15% in just three years, and 20% since 2008.