Information provided by Dentsply Sirona

	When Dr. Scott Dickinson, DMD was beta testing the Dentsply Sirona’s new Resurge Ultrasonic Cleaner, he kept asking his staff if they were using it. He couldn’t hear it. They assured him they were. It was just that much quieter than the ultrasonic unit they had been using previously. He was surprised-and impressed. He called it his first aha! moment with the new equipment.   

	“Ultrasonics tend to be that thing that when you turn it on, everyone in the office knows it’s on. It’s like a squeaky wheel,” Dr. Dickinson says. “When the Resurge runs, you don’t know it’s on.”  

	His second “aha! moment” was when his instruments came back squeaky clean from their first run through the ultrasonic unit. No composite or bonding agent remained that tends to accumulate over time, build up that Dr. Dickinson admitted had probably been there a while. He asked his assistants if they had scrubbed them before putting them in the new unit. They hadn’t. The Resurge had blasted everything off. 

	“I said, ‘I’ll take it! At that point, I knew I wanted one,” he said. A week later, his rep delivered Dr. Dickinson’s new Resurge unit to his busy practice. 

Related reading: Applying the Resurge Ultrasonic Bath in your practice

	Ultrasonics get plenty of use, running in some practices at least a dozen times a day. It’s a part of the daily routine that most dental professionals don’t think about very much. Everyone throws their instruments in the ultrasonic after they use them. Dr. Dickinson admitted that after practicing 19 years, he never paid attention to the ultrasonic unit. It was only after he agreed to try the new one that the ultrasonic was on his radar at all.

	“It’s like the dishwasher,” Dr. Dickinson explains. “All of a sudden you get a new dishwasher and you are like, ‘Whoa! My dishes have never been clean like that before. What’s going on?’ That’s the way it was when I got to use the unit. It looked cool, and it was significantly better than the ultrasonic I had used prior to it.”

	The quiet operation and the powerful clean are not the only benefits that Dr. Dickinson experienced. He also appreciates the digital self-timer that he can run for different things. “Most ultrasonics have those old kitchen timers, where you spin the dial, and they count down,” he says. “They go ‘ding,’ and then they turn off. Sometimes they get stuck. This one is different. It’s just nice. It’s clean. You can set it for any time you want.”

	He also appreciates the size of the unit. Dr. Dickinson estimates he sees a patient an hour. His hygienist does, too. Then they have overflow patients as well. That means the practice goes through many instruments in a day. “I run a busy office, but this ultrasonic is big enough that I only run it every two hours versus some of the smaller ones that I would run constantly,” he notes. 

Trending article: Dentsply Sirona Endodontics introduces new software and advanced technologies

	Dr. Dickinson cleans his instruments in cassettes and can get six cassettes in there per cycle. “It accommodates a busy office,” he says about the 2.0-gallon unit he purchased.

	Dr. Dickinson thinks the little things can make a big difference in the patients’ perception of the practice, including the appearance of the sterilization bay. After all, patients walk by it and look in there. It makes an impression. “Your sterilization bay needs to look sterile, clean, and modern. He compared the appearance of other ultrasonic units to props from “Lost in Space,” the 60s Sci-Fi televisions show. 

	“‘Danger, Will Robinson!’” he says, laughing, “They are 1950s technology. We can do better. This is the first time I have ever seen anybody put effort into making something like this look nice. The Resurgence Ultrasonic is very modern; it’s streamlined; it’s digital. It has a LED light read out.”

	Dr. Dickinson is also a fan of Dentsply Sirona. A sometimes lecturer for the company, he often tells other doctors something he admires about Dentsply Sirona is that they always have a beautiful product, and it’s always high-end. “I’m a guy, so everything is cars, right?” he says. “When I am training, and I say the nice thing about Dentsply is that whatever they decide to do, it’s a Lexus. You might pay a little bit more for it, but it’s so worth it. “

	Dr. Dickinson appreciates that Dentsply Sirona kept to that standard, even when they work with these small instruments. “They did a bang-up job of it,” he says. “They could have made a lousy ultrasonic unit and sold it by default because they are who they are, but this is an excellent unit. It’s encouraging to me. If I want something, I will go to them first. They always do it right.”

	People sometimes react poorly to change. It’s no different in the dental practice. Doctors and staff are used to what they have and don’t always consider what could be if they were to switch equipment. Dr. Dickinson remembers when digital X-rays first came on the market. “Dentists were resistant to that at first but now if you walk into an office that doesn’t have digital X-ray you think it’s a dinosaur,” he says. 

More about the Resurge Ultrasonic Cleaner

	For nearly two decades, Dr. Dickinson has not worked in an analog office. He loves how digital dentistry has improved the science. “I was using digital coming out of residency and I didn’t look back,” he says. The difference with this change is that if an office buys a better ultrasonic unit than it is currently using, there isn’t the same degree of disruption to the status quo that adopting digital radiography might have had on a practice. 

	The Resurge Ultrasonic unit is also simple to use. As far as the set up went, Dr. Dickinson says they took it out of the box, plugged it in and filled it with water. “It doesn’t get any easier,” he says. 

	Not only that, unlike digital radiography and other technology outlays, the ultrasonic unit isn’t a high-ticket item, making the decision to upgrade equipment an easier one. “It’s not one of the things you have to dwell on whether you want to make the investment. This one is a no-brainer,” he says. 

	For those clinicians that sometimes resist adopting new technology, Dr. Dickinson would advise them to embrace the improvements that come along with the change. “We are gadget guys, and we are reluctant to change. We worry, ‘Oh. It doesn’t look like the old one.’ It’s OK. Cars don’t look the same either!” he says, laughing. “Things are getting better. This ultrasonic is significantly better than the other one. In 10 years, there might be one even better; you just have to go with it.”  

Articles

DPR interviews Dr. Scott Dickinson about his experience using the Resurge Ultrasonic Cleaner from Dentsply Sirona.

I Use That: Resurge Ultrasonic Cleaner

How using Dentsply Sirona's Aquasil Ultra+ helps this clinician in hydrophilicity, tear strength and speed/delivery options.

How to get the best results from your impression material

	Are we, as dentists, sometimes passing on new and worthy ideas for the sake of deep-seated traditions and established habits? Indeed, I believe that sometimes we are. Take for instance the problem of capturing a final impression for fabrication of indirect restorations. Trends toward the use of retraction pastes as alternatives to cord do not usually result in adequate sulcus retraction. In addition, lower cost materials with potentially inferior physical properties to overcome such conditions have created confusion for the clinician as they justify or are told that “all PVS is the same.”

	The difference in PVS materials is truly in the details. The recently introduced 

 Smart Wetting Impression Material (Dentsply Sirona Restorative) is an upgrade in the well-established Aquasil line and has been specifically designed to help clinicians in three key areas: hydrophilicity, tear strength and speed/delivery options. 

	Impressions used intraorally (i.e. the real world) need to work in the rigors of the oral cavity, which can include presence of fluids including blood and saliva. With this in mind, Aquasil Ultra+ was designed with a low-contact angle as tested on uncured samples of impression materials at high relative humidity to better represent the clinical situation. The resulting performance translates to improved handling intraorally which translates to improved impressioning results. In turn, the clinician may notice improved accuracy and potentially better fitting restorations that require less chairside adjustments. This improvement is beneficial because as most dentists know, rarely if ever do we work under ideal conditions in a crown and bridge procedure. Enhanced intraoral hydrophilicity means less stress and more confidence in achieving the desired results.

Related article: 10 of the CRAZIEST impressions you've ever seen

	In addition to increased hydrophilicity, Aquasil Ultra+ has unmatched tear strength. Impression materials injected into paste-retracted sulci often result in thin cross sections of material. When adequate gingival retraction is not present, the importance of the tear strength of the material being used is compounded. To prevent tearing at the margin and loss of detail, Aquasil Ultra+ was designed to feature market-leading tear strength at both mouth removal time and after 24 hours of setting. This benefit should provide confidence to the clinician that the material placed into the mouth will be completely retrieved and no critical margin information was lost due to tear mishaps. Furthermore, this feature allows lab technicians the opportunity to create extremely accurate working models that duplicate what was captured in the mouth.

Related Article: 10 ways to make a great impression

	Aquasil Ultra+ Smart Wetting Impression Material complements its clinical performance with both material selection and precision delivery options. With a variety of viscosities to meet the clinical need, situation and goal of treatment, the clinician, not the manufacturer, can choose the best parameters to operate within. Additionally, the ease and ergonomic advantages of the digit Targeted Delivery System gets the clinician closer to the prepared tooth for better control and accuracy.

	The following case example demonstrates the features and benefits of Aquasil Ultra+ to both clinician and lab technician. Patient DR presented with the need for a new crown on tooth #14. A 0.8mm circumferential chamfer margin design was used and mesial and distal secondary retention slots were included to increase resistance form. A quadrant-sized metal triple tray impression was utilized. Aquasil Ultra+ XLV wash was syringed using digit for enhanced control of delivery while Aquasil Ultra+ Heavy body viscosity was used for the tray material.

	Both tray and wash materials were fast set speeds with an intra-oral working time of 35” and a mouth removal time of 2’30”. Digital electronic timers were used to ensure proper observance of working and setting times per manufacturer instructions (Fig. 1).

	Upon pour up, one can note exceptional margin capture and detail (Figs. 2-4). 

	A full contour zirconia crown was prescribed and careful consideration was taken to provide the lab with the necessary prep-reduction requirements indicated for fabrication (Figs. 5-7).

	The patient returned in two weeks for the crowns seat visit. The tooth was cleaned with a 2% chlorhexidine pumice slurry and the crowns were tried in and checked for marginal fit using a cowhorn explorer, at which time no detectable catches or gaps were present due to seamless transition between crown and tooth surface. In addition, proximal contacts were checked and flossed and the occlusion was marked to ensure proper centric stops.

	The zirconia intaglio surface was cleaned by air abrasion with aluminum oxide and the crown was conventionally cemented (Figs. 8-10).

	Everyone likes days filled with high productivity and low stress. Often we are lured by products that overpromise to meet that desire and usually under-deliver. We have the power and the choice to see beyond price and promises and look to what matters: results. Tiny tweaks can and do make big differences. Aquasil Ultra+, with all its wonderworking effects, translates to better, smarter and faster dentistry. And that is worth giving up the good enough to go for the great. 

 is a full-service lab in Charlotte, N.C., specializing in highly esthetic results for a variety of clients who request a variety of solutions. The lab is small with seven full-time technicians, an office manager and a delivery person on staff.

Sikes Dental Studios serves as a beta lab for 

, enabling them to have access to cutting-edge technology, like the newest in inLab system innovations and workflow solutions like Sirona Connect.

 enables inLab labs to receive digital files from their dentists, making communication and case collaboration with clinicians easier than ever. The inLab system provides an in-house solution for labs to create a variety of restorative options that they can offer to clinicians at a cost-effective price and with a quick turnaround time. With Sirona Connect and the inLab system, dentists and labs can quickly work together and realize the potential of a fully digital workflow.

Lindy Sikes, CDT and owner of Sikes Dental Studios, has been a dental technician for nearly 40 years. As the lab market has gone increasingly digital, he found himself at a crossroads. “Being a third-generation CDT, I grew up watching my grandfather and father run the dental laboratory, and I gradually developed a real interest in it,” Sikes explains. “My connection to Sirona began about 10 years ago. Using an old inLab LED cam, I began seeing the advantages of digital technology. At that particular time, we were sending our zirconia patterns to be processed by an outside source. As we kept working, we noticed our outsourced work was vastly increasing, to about $4,000 a month. Realizing that purchasing my own system would only cost me $2,000, I bought one and produced everything in-house.”

Becoming an inLab lab with full access to Sirona Connect has helped him take that workflow to the next level. Using Sirona Connect’s capability to manage cases and communicate with his clinician clients, Sikes is able to complete work with a faster turnaround time and with less communication breakdowns that can so often make restorative cases tricky. “Probably in 97 percent of my business, I use Sirona Connect in one step or another for digital impression-taking,” Sikes says. “Using Sirona Connect has changed my entire business model. Crowns that once took two weeks to turn around now can be completed in just three-to-five days, along with an overall reduction in costs.

“Sikes Dental Studios is a small laboratory, but we manage the volume of a 15-lab territory because of our digital capabilities,” he continues. “Using digital technology makes us much quicker. We can accept more cases with fewer technicians, complete cases faster and actually reduce our overall costs.”

Next page: The time-and-money ROI of going digital.

Sikes Dental Studios generally uses Sirona Connect to produce restorations taken from Sirona intraoral scanners and then work with the doctor’s instructions to design the solution. They then send it to Sirona’s central production service, 

, to produce the final restoration. “About 25 percent of our work comes in digitally through Sirona Connect,” Sikes notes. “Of that 25 percent, at least 75 percent of those cases require a model to work on. We take the digital file that the doctor sends us and then we send it to infiniDent to print the model. infiniDent can produce full-contour crowns or bridge frameworks with a wide range of materials including ceramic, wax or metal.

News update: Learn about the latest CEREC software update.

“We [also] use Sirona Connect to design gold crowns and porcelain-fused-to-metal copings. Before digital technology, we had to hand-wax copings at a cost of between $5-$20 each. Now that cost is $3.95 per coping. It requires less of the technician’s time handling the product and the accuracy is far greater than what can be done by hand. It saves on cost and we produce a more consistent product.”

Of course, the cost savings provided to Sikes Dental Studio by Sirona Connect isn’t just because of a reduction in coping prices. Sirona Connect also improves turnaround time, which has a dramatic effect on Sike’s bottom line. “The benefit to producing a crown faster is that it saves the doctor anywhere between $60 and $80 per minute,” Sikes explains. “Five years ago, it would usually take a week to get a crown processed. In two weeks, the patient had a temporary made out of plastic with the permanent crown delivered in three weeks. The plastic began to break down and the spaces naturally began to close. The microns of closure require grinding the permanent crown down to fit properly. That equates to an additional 10-30 minutes, and in some cases up to an hour, to place the crown at the doctor’s office.

“It’s not because the lab is bad, but because of the production time involved in producing a quality product,” Sikes goes on. “If the case can be finished quicker, there’s less time for the temporary to break or start wearing down. Using digital impression-taking, we can actually deliver a crown in a day and chairside time is minimal.” That time savings for the lab can then be passed to the doctor and then to the patient, ensuring a rapid workflow that is both better for the budget and better for the final customer: the patient.

The List: Top 5 reasons you shouldn't be scared of chairside CAD/CAM

Sikes firmly believes any lab ought to take the leap into a fully digital workflow and should begin to invest in technologies that will help them receive 

 files easily from clinicians, along with providing a way to rapidly produce restorations (either in-house or with a partner like Sirona). “Any lab that accepts digital cases is positioned well for the future,” he says. “For those lab technicians who don’t have digital capabilities right now, it’s hard for them to understand that integrating a digital platform would expand their capabilities and open a whole new communication platform between dentists’ offices and clients. We’ve milled more than 2,000 inLab units and will continue to mill many more using Sirona Connect and the inLab System.”  

 The Lab: Sikes Dental Studios is a full-service lab in Charlotte, N.C., specializing in highly esthetic results for a variety of clients who request a variety of solutions. The lab is small with seven full-time technicians, an office manager and a delivery person on staff.

Increase esthetics and ROI with Sirona inLab and Sirona Connect [VIDEO]

Dentists are busy people-and adding the time to get a fully esthetic anterior crown to their list of job responsibilities just isn’t realistic for many of them. “There will always be a need for a quality crown,” explains Tra Chambers of 

. “Chairside crowns done in 90-minute appointments will never have the same esthetics or quality as a crown created by a professional ceramist over a 40-hour timeframe.”

Chairside esthetics aren’t lab esthetics

For some cases, chairside restorations might be just fine. But as Doug Frye of 

 explains, sometimes they won’t cut it. “There are very few dentists who have the experience, capabilities or training to fabricate, create and finalize top-tier esthetics, which can only be obtained by layered ceramics,” Frye notes. 

Many labs worry about the milling part of CAD/CAM, but remember that the CAD component to the equation can actually help a lab’s workflow. “Chairside milling is not for everyone, but digital impressions are,” Chambers says. “As doctors get more exposure to digital dentistry, they will want a laboratory to support them.”

“It creates new opportunities such as the opportunity to work WITH the doctor, not necessarily FOR the doctor in a like-minded way through technology such as 

. “Furthermore, it provides the opportunity to grow your lab in directions never before available.”

If a clinician uses a chairside CAD/CAM system to take care of simple restorations, that takes those off the lab’s plate and opens you up to be the specialized creative you are. When you’re not spending time creating posterior crowns that will never be seen, you’ll become the go-to for anterior solutions that the dentist just can’t do on his or her own.

This article originally appeared in the May 2014 issue of Dental Lab Products. For more great articles about products in action, click here to subscribe to DLP's newsletter: 

The dentist doesn’t have time. Dentists are busy people-and adding the time to get a fully esthetic anterior crown to their list of job responsibilities just isn’t realistic for many of them. “There will always be a need for a quality crown,” explains Tra Chambers of Express Dental Laboratory. “Chairside crowns done in 90-minute appointments will never have the same esthetics or quality as a crown created by a professional ceramist over a 40-hour timeframe.”  

The List: Top 5 reasons you shouldn't be afraid of chairside CAD/CAM

Hailed as the most significant and sophisticated release since the launch of CEREC 3D almost a decade ago, CEREC®  Software 4.0 brings out the full potential of the CEREC AC Acquisition unit and its Bluecam imaging technology.

: Users can work on multiple restoration designs at the same time. Restorations also can be designed in different modes for greater flexibility.

: Design tools now are executed directly on the tooth for adding or removing material, rotating or positioning the restoration and expanding or reducing tooth size.

: Intuitive workflow lets operators know exactly where they are in the design process and what steps come next, enabling jumping from one step to the next without linear limitations.

: Streamlined design at the bottom of the CEREC Software 4.0 design window shows each step clearly defined along with the prior and next steps in the design process. 

Hailed as the most significant and sophisticated release since the launch of CEREC 3D almost a decade ago, CEREC®  Software 4.0 brings out the full potential of the CEREC AC Acquisition unit and its Bluecam imaging technology. Multitasking: Users can work on multiple restoration designs at the same time. Restorations also can be designed in different modes for greater flexibility.