Conrad J. Rensburg is CEO and head of the dental implant division at Absolute Dental Services in North Carolina. He graduated with a 4-year Baccalaureate degree from Pretoria Tech in 1992. He is certified with an ND in technology and specialized with an NHD in fixed prosthetics.

He is a member of the prestigious PEERS association, the Academy of Osseointegration, the American College of Prosthodontists, and registered with the NADL, NCDLA, and certified by the SADTC. He has specialized in fixed and removable dental prosthetics with an emphasis on dental implants since the early 1990s. As a CE-accredited speaker since 2002, he has presented at hundreds of events across the U.S., including the Academy of Osseointegration, Global and U.S. symposiums, World Summit Tours, and a multitude of study club events. Conrad’s emphasis as a speaker, is keeping today’s clinicians abreast with the latest advancements in restorative protocols and digital workflows related to removable as well as fixed prosthetics. Conrad can be contacted at absolutedentallab.com or conrad@absolutedentalservices.com

Conrad Rensburg, N.D. & N.H.D.

Material Trends: Why Additive Removable Workflows Are the Next Frontier Figures

Material Trends: Why Additive Removable Workflows Are the Next Frontier

Voices from the Industry

Business Trends: Digital Technology Is Key to Overcoming Industry Demographic Challenges 

Glidewell images

The Future: The Cost of Progress: A Look at the Future of Dental Laboratories 

Dental Lab Products 2023 Innovation Guide

Articles

Dental lab industry leaders share what they see ahead for the industry in the coming year.

Available as Flexcera Smile and Flexcera Base

Its long-chain chemistry provides ceramiclike strength

Said to be about 3 times more resistant to fracture and 2 times more resistant to moisture

Flexcera Base is a light-curable resin for the fabrication of high-impact and removable denture bases.

Flexcera Smile is a light-curable resin for the fabrication of high-impact artificial teeth with variable translucency for dentures.

Formulated exclusively for use with EnvisionTEC 3D printers

The digital denture concept is not new and was introduced to the dental industry in 2011. Early on, digital systems required convoluted workflows with what some would say were lackluster esthetics and strength. Over the years different manufacturers developed and released their versions into the market with not much fanfare. The development of technologies coupled with materials has moved at an exponential pace in recent years, with manufacturers seeing a need in the market for simple digital workflows coupled with high-strength, high-esthetic materials.

More recently, advancements in printing technology and materials have led the way forward on a new path and breathed life into the digital denture market, making them more of a reality today than ever before. With these advancements came simple, easy-to-use workflows for both clinicians and technicians.

While this gave the industry capability to realize the fullest extent of the technology, there was a drawback when it came to the teeth themselves. Although new additions to the market have proven esthetic and strong, there have been some downsides, such as initial startup costs and the use of proprietary carded teeth.

In 2021, Desktop Health released Flexcera Base and Flexcera Smile 

. These printable materials were developed and validated for Desktop Health’s line of EnvisionTEC printers 

. This provided another great entry into the digital denture market. This release meets the industry demand for strength and esthetics with leading performance, while maintaining a cost-effective option for entry into the system.

This cost-effective entry has given more laboratories the ability to offer digital dentures. There are many benefits to a printable tooth solution, such as the ability to choose from a multitude of libraries, as well as scalability to meet production demands. By providing a printable tooth solution, this has given technicians the ability to customize the occlusion with ease. A fully customizable denture gives way to the ability to meet clinicians and demands in a rapidly growing area of the industry. These 2 materials were developed to work together in a system to be able to achieve the desired goal of any case.

Carded teeth in some cases can hinder the designer, as the library cannot be adjusted 

. Therefore, in many instances difficulties arise in the successful designing of a case due to the inability of the designer to adjust and customize the occlusion. For example, when designing a duplicate denture from an existing denture, it becomes more difficult to exactly match existing denture teeth within a preset library.

Flexcera 3D Resins

Flexcera has shown to be 3 times more resistant to fracture, with total work fracture numbers exceeding 3600J/m2. This ceramic-like material also exhibits a water absorption rate of 1.96%. This very low rate provides great resistance to moisture which aids in the ability to prevent staining or discoloration from liquids. Flexcera Smile produces a natural esthetic and exhibits ceramic-like translucency. When manufacturing teeth with Flexcera Smile, technicians gain the added benefit of being designed as a mono-track 1-piece design that is more resistant to tooth pop. The 1-piece design can be placed and luted into the base in a very efficient manner.

Flexcera Base was introduced in 5 shades—light pink, medium pink, original pink, dark pink, and dark meharry (

). Flexera Smile is available in these popular shades: Bleach, A1, A2, A3, A3.5, and B1 (

. The multitude of base and tooth shades gives the laboratory the ability to produce dentures in the most popular and requested shade combinations. Also, Flexcera Base does have the ability to accept conventional carded teeth if desired. Postprocessing of the materials follows typical laboratory procedures associated with 3D printing 

Although not indicated for use, the material can also be used to fabricate additional products within the dental laboratory such as high-strength esthetic hybrid provisionals.

These provisionals aid in the predictability of large complex cases and provide much value to the restorative team. The ability to print these provisionals efficiently is a great benefit to the dental laboratory today 

Laboratories that adopt this system will also gain capabilities that go with digital dentures that offer great advantages as compared to a traditionally processed denture, including the ability to archive the design data. This may be one of the greatest advantages to a dental laboratory and clinician. Having the ability to remanufacture a denture proves to be an incredible time save in an instance of a lost or broken denture.

As we move forward, we will continue to see product offerings and innovation from companies such as Desktop Health. These innovations will give the modern dental laboratory a competitive edge in the market and aid the laboratory in meeting production demands when dealing with a shrinking workforce. 

The Flexcera™ Systems from Desktop Health offers an entry point to digital systems with great strength and esthetics. 

How to Gain a Competitive Edge with Digital Dentures

Advances in materials and technologies have dramatically changed the way dental laboratories operate. Milling machines, scanners, 3D printers, and the realm of materials used with them, are offering new approaches to familiar challenges, and new levels of accuracy and efficiency for everyday processes.

With these new systems and materials comes a whole new way of doing things in terms of workflows and capabilities that totally reshape what a dental lab can look like. One way to put these innovations in the spotlight is to take a look at what they replaced. It’s easy to get used to a comfortable and effective daily workflow, and sometimes it may even seem there’s no need for change. But once something new is brought to the lab world designed to save time, enhance results, or otherwise make things better, it’s easy to move forward from the way things were.

This article (and its online components at dentalproductsreport.com) puts some of those former favorites front and center a final time, as dental laboratory professionals share stories of things they once used day in and day out but no longer need due to innovations that make practicing dentistry better for everyone.

Today, the shift to monolithic zirconia solutions is complete. The latest advancements in zirconia production are now combining strength and esthetics.

Alloy to Zirconia … the Products We Left Behind!  

The author's choice for the new product that will help transcend the dental lab  industry is the Ivotion system by Ivoclar Vivadent.

Ivotion, the Preferred Digital Denture System


Metal free restorative materials and digital dentures have changed the way dental labs work with clinicians and has opened up a whole new set of workflows.


The Dental Lab Products We’ve Left Behind (and What’s Replaced Them)

Over the past decade, our industry has witnessed a definite advancement in technology-driven prosthetic solutions. Initially, many of these computer-aided design technologies were classified as “nice to haves,” but because technicians had no predictable way to bring the digital design into an analog world, the validity of many technologies was questioned.

Fortunately for the dental industry, the past few years spawned multiple new and very innovative materials to support these digital processes. This merging of materials and digital design has definitively answered the question: “Should I go digital?”

Prototyping offers the modern-day dental laboratory the ability to accurately transfer a digitally produced diagnostic wax-up to the patient’s mouth for evaluation and approval. This transitional step, along with the ability to process the final prosthesis in a full digital workflow, has greatly reduced the delivery stresses and, more importantly, postdelivery failures.

Currently, 2 technologies are available to transfer the digital design: additive and subtractive. The older, and therefore also the more established technology, is a milling solution. This technology had a head start on additive solutions, so the materials available for these milling units are more advanced. Unfortunately, reducing any material creates friction and friction leads to wear, which ultimately speeds up failure. A reductive technology is not only slower than an additive solution but also requires more maintenance and inherently has a slower production rate. Ultimately, most dental laboratories would rather produce products with printing technology because of its accuracy and scalability. At the time this article was written, our industry lacked esthetic printing materials appropriate for long-term intraoral use.

A prototyping workflow allows the patient a test-drive of the virtual final prosthesis and in return, gives a clinician the ability to make final adjustments. These fine-tune adjustments, while sometimes frustrating, were traditionally done at the final delivery.

Adjusting on a polymer or resin material versus a sintered zirconia structure is not only better for the longevity of the final material but also positively influences patient confidence and the clinician’s profitability.

Jack Marrano and his Advanced Restorative Team at Absolute Dental Services in North Carolina offer a prototype try-in appointment as a part of all complex cases. This “trial” device is part of Absolute’s suggested clinical workflow and is supplied with every complex case.

This device serves as a final bite check, model verification, and final esthetic try-in. Currently, Absolute offers 2 options—a disposable printed, and a dual-use milled prototype.

 is included with the regular workflow and offered to the clinician at no additional charge. The advantage of a printed try-in is that intraoral adjustments (either by adding composite or reducing with a bur) are easily done to the prototype itself. These adjustments allow for immediate feedback from the patient. The main disadvantage is that this printed try-in is a functional representation of the final and that esthetic results are not represented by this device. Furthermore, depending on the type of printed resin used, the prototype device can be worn by the patient for a short to medium term.

; formlabs.com) is a biocompatible photopolymer resin that works great for this application. This material is categorized as a class 2 biocompatible resin and supports printing resolutions to 50 microns. The material displays flexural resistance capabilities of greater than 50 MPa and a density of 1.15 g/cm3 < X < 1.25 g/cm3.1

It is important to note that a printed structure’s material properties will greatly vary depending on several factors, including type of printer, print orientation settings, and temperature. Therefore, it is difficult to accurately determine and control mechanical properties like water sorption and solubility. These properties can greatly influence the longevity of a prosthesis as it relates to discoloration and material breakdown.

At A Glance

 is considered an Absolute Signature product and serves as a try-in and a long-term emergency hybrid. This transitional prototype gives a patient the ability to try-in an exact copy of what the final prosthetic proposal will be. This device is delivered to the patient with the final prosthesis and can be used as a long-term emergency hybrid.

The advantage of working in this fully digital workflow when restoring a dual-arch rehabilitation is that the approved prototype will be fully interchangeable with the final prosthesis 

. This device, being an exact functional and esthetic copy of the final, gives the restorative team the ability to achieve a guaranteed patient approval before proceeding to the final restoration. Absolute Dental Services utilizes 3Shape design software (3shape.com) for the diagnostic, prototype, and final design 

. This software allows maintenance of all the progressive files—from preop to final—in one digitally interchangeable folder.

These prototypes are milled from double cross-linked polymethyl methacrylate–type materials 

. Absolute uses Harvest Dental’s Temp Esthetic. This double cross-linked polymer material is supplied in 98.5 and 95 mm millable pucks and is available in 12 popular Vita and bleach shades. The material is a multilayer composite allowing for very esthetic, long-term provisional results.

Temp Esthetic is Food and Drug Administration (FDA) 510(k) cleared for medium- to long-term use as a provisional material. Per data filed with the FDA, the device can remain in place for up to 5 years. Temp Esthetic displayed a flexural strength of greater than 100 MPa and water sorption under ISO 10477 of less than 20 µg/mm3, making this an exceptionally resilient intraoral material.2

Digital processes are key to efficiency and profitability. The question as to whether laboratories should process in digital has been answered. Material development is the next frontier.

1. Materials data sheet. Formlabs. September 18, 2018. Accessed November 5, 2020. 

https://archive-media.formlabs.com/upload/XL-DataSheet.pdf

2. Harvest Temp Esthetic. Package insert. Harvest Dental Laboratory Products LLC. Accessed October 2020. 

https://static1.squarespace.com/static/579bb6cf725e25911c5e632d/t/5e5ef0a942e056080e830a63/1583280297769/FRM-IFU-09+Rev5+-+DFU+Temp_Esthetic3.pdf

Prototyping offers dental labs accuracy and reduced postdelivery failures.


 How to use prototyping for profitability through predictability

trained in the 1990s and before, fully understand the design freedom that a wax-knife, a Bunsen burner, and a block of wax offered. This was a world where a talented artist—with a firm understanding of function, anatomy, esthetics, and a willingness to work long hours—easily ruled the universe.

Unfortunately, this “analog freedom” of creating almost anything imaginable was rather short-lived and was quickly replaced by a digital mouse and a computer screen. This digital evolution was ultimately for the better, and through this process, a new breed of super-efficient technicians was spawned. This 21st-century technician can create amazing prosthetics with this technology while preserving the most valuable asset off all—artistic hands.

Over the last decade we have seen the creation, and subsequent development of many digital design programs, such as 3Shape dental system (

At first, most of these softwares focused on fixed restorative processes required to support the multitude of new milling systems and innovative zirconia products on the market. With the introduction of printable and millable denture bases, these software companies quickly stepped up to also supply the industry with a workable denture and partial design module.

3Shape, under the leadership of visionaries such as Rune Fisker, offered a denture module for laboratories as early as 2010. This was long before the industry had the analog ability to produce a functional and esthetic digitally processed denture that was comparable with a hand processed prosthesis.

As laboratory owners and technicians wanting to compete in this ever-changing digital landscape, it is crucial to not only stay abreast of these technologies but more importantly, understand what mastering its capabilities offers.

In the past, layering glass ceramics, casting alloy substructures, and grasping other hand processes defined a laboratory. Going forward, the ability to manipulate and control the STL file will be the differentiator.

Artistry will never be replaced by machines, but hand processes remain the biggest potential enemy of consistency. A marriage between digital design and human artistry is ultimately the future of this industry.

Up to this point in our evolution, labs have had no choice but to be prosthetic producers guided by manufacturers. A technician’s responsibility in the past was mastering the processing of materials driven by suppliers. STL is now allowing technicians to be leaders and innovators, using these materials to support their innovations and through this, differentiate their laboratories from the competition.

Many dental laboratories established in the 1990s and before were founded as specialized businesses focusing on either fixed or removable prosthetics. With the introduction of the all-on-four™ concept by Nobel Biocare, the once clearly defined lines differentiating fixed from removable laboratories became blurred. As this concept grew in popularity, many fixed labs found themselves in a situation where a traditional denture wax set-up was required to initiate the process of restoring a fixed hybrid prosthesis.

Absolute Dental Lab faced this same conundrum. Ultimately, the decision, albeit hesitantly, was made to morph into a full services lab.

For almost a decade the Absolute removable division was seen purely as a support department for the fixed aspect, and therefore was never promoted, advertised, or ever considered as a profitable business opportunity.

All the above drastically changed when Dentsply Sirona, in partnership with Carbon 3D printing, launched the new Lucitone 3D Print™ material. This material/technology combination greatly increased production efficiency and yielded high-end esthetics combined with material strength never achievable in a printable prosthesis 

. This material advancement greatly improved profitability and breathed a breath of fresh air into this once almost forgotten department.

Unfortunately, the corporate Lucitone message was that the technology could only be used for full dentures and offered no initial application for removable partials. As more clinicians became aware of the incomparable strength of this material, the lab received calls on a constant basis requesting a Lucitone 3D printed partial.

Create a partial in a full digital workflow 

, print the base with Lucitone 3D Print on a Carbon M2 printer and lute/fuse the IPN 3D™ Portrait teeth using Dentsply Sirona’s proprietary Lucitone Digital Fuse. Creating this partial, with a custom milled tooth structure in the design software, is as simple as point and click. The goal with this project was to process only with available Dentsply approved components found inside the Lucitone 3D print family. Unfortunately, using the proprietary prefabricated IPN 3D teeth posed a real digital challenge.

At a Glance

No proprietary Dentsply Sirona supported partial design workflow exists in the 3Shape RPD design module. At the time of this publication, the 3Shape RPD module did not have premanufactured tooth libraries available. Even though the IPN 3D DME library exists in the 3Shape denture module the RPD design module relies on traditional custom crown and bridge tooth designs that can be exported for milling of the tooth overlays.

The 3Shape RPD module offers a customizable tooth library option through the “scan it library” function. This allows a laboratory the ability to create their own custom tooth library in lieu of using the 3Shape default libraries for their crown design.

This option gave the Absolute team the ability to create an RPD workaround by physically scanning the IPN 3D teeth on a 3Shape E2 benchtop scanner 

. This effectively created an IPN 3D DME library 

Although initially necessary to scan every mold in the IPN 3D range to build the library, this arduous task is only required once. Furthermore, it is only necessary to scan one quadrant of each tooth card. The “scan it” function has a “mirror current tooth” option which offers the ability to automatically set the contralateral tooth from the DME file.

It is important to note that if interproximal or clearance adjustments are needed, the value of using prefabricated teeth in lieu of a custom designed and milled option becomes questionable.

Because of the aforementioned, 3Shape had no practical reason to offer prefabricated tooth libraries in the RPD module and this should therefore not be seen as a deficiency in the software.

The flexibility of the RPD design module does, however, allow the designer to infringe in the interproximal contact areas if an optimal DME tooth is not available 

. In this case, those infringements caused over-designed contact areas which had to be adjusted in analog on the printed model.

The advantage that milling a tooth structure offers over printing a base, for luting prefabricated teeth, is the fact that the tooth structures can be customized in the digital design. Those custom designs are milled on spec in the analog fabrication process. The flip side is that milling a tooth structure and denture base, even utilizing the most advanced milling equipment compared to printing the denture base, is simply not efficient or cost-effective in a modern-day production laboratory setting.

To complete an encompassing workflow available for use in all clinical scenarios, the Lucitone Digital print product family requires the addition of millable tooth puck. This addition would also allow the use of this superb product when a custom designed tooth is a requirement.

Even though a Lucitone printed partial base is 3 times stronger (3000+ J/m2) than the minimum required ISO impact standard (900 J/m2) and more than twice as strong as the well-proven traditional Lucitone 199 (1380 J/m2), the demand for permanent acrylic partials have all but disappeared.

This digital revolution in the dental industry is only now starting to gather steam, and over the next decade, these technologies will grow exponentially in both functionality as well as demand.

The rationale behind this article was not to revitalize interest in acrylic flippers.

Laboratory owners and technicians need to realize that times have already changed. Digital design is the future. Understanding the hidden ability of this new “wax knife” will lead to innovation and innovation will ultimately lead to relevancy.

The author would like to recognize Dries van Aarde, Kate Johnson, and Steve Lombardi for their thorough understanding and ability to manipulate the 3Shape design software. Also, ART team members Jack Marrano and Chris Love for their amazing artistry.

Slideshows

As digital design has advanced, it’s become clear that the future of the industry lies somewhere between digital design and human artistry.