Jack Marrano, CDT is the Director of Absolute Dental Services Signature Prosthetics Division in the Triangle region of North Carolina. Jack, a former Marine, started his ceramics career in 2002. He managed the Implant, All Ceramic and PFM Divisions of MicroDental DTI. He was director of technical artistry for Lee Culp at Sculpture Studios since 2014 before joining Absolute Dental Laboratory.

He has completed courses on advanced implant restorative dentistry with Dr Carl Misch and has received a Fellowship from the Misch Institute, as well as obtaining Fellowship and Mastership from the International Congress of Oral Implantologists. He is a member of the Academy of Osseointegration, the American College of Prosthodontists and the prestigious PEERS prosthodontic association. He was also named LMT magazine top 40 technicians in the U.S . under 40.

Jack has been an integral part in the research and development of top restorative materials. Today, he continues to work closely with restorative clinicians, prosthodontists, university graduate programs, and faculty practices from around the country. Jack can be contacted at 

Jack Marrano, CDT

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. 

Articles

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

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

Over the years we have witnessed and enjoyed the benefits of CAD/CAM technology and material advancements. These advancements are now being coupled with advancements in support products that pair perfectly with today’s modern materials. Harvest Dental’s Speed Polish is an example of an advanced support product.

Harvest Dental released Speed Polish at this year’s Chicago Mid-Winter Meeting. On the surface it appears similar to other polishes available today. It is not until the user experiences polishing a restoration with Speed Polish that its rewarding qualities shine.

Speed Polish is a proprietary combination of diamond and alumina which was developed for the efficient polishing of ZrO

 restorations. Harvest Dental’s products constantly not only meet, but exceed the demands of the most discerning technicians.

Speed Polish is a polishing compound crafted from a diamond/alumina base specially developed for polishing zirconium and lithium disilicate ceramics. Water soluble, it polishes in seconds, matches the esthetics of enamel, and reduces wear on opposing dentition.

Harvest Dental recommends using a #9 Robison short stiff brush, onto which the polish can be loaded slowly at a speed not greater than 5000 rpm. Once the brush is loaded, the technician can begin to polish the restoration using slow speed and high pressure 

During the review of Speed Polish, multiple benefits of the product stood out which make it quite different than other products currently available.

Speed Polish was designed for use with ZrO

 restorations which it polishes within seconds to a high luster, while not being so abrasive as to cause a loss of fine detail 

. The speed in which the polish performs stays true to its name. It was also noted that it performed equally well on layered ceramics 

Another tremendous benefit is the fact that Speed Polish is water soluble. This is a massive benefit and a great aid when cleaning off restorations. Comparable products that are not water-soluble lead to difficulty in removing remaining residue. With these products, a steamer is needed. This can be detrimental to ceramic restorations as the use of a steamer can introduce the possibility of thermal shock. The use of steam is completely avoided with Speed Polish, which is cleaned with water and a brush, or a simple cloth 

at a glance

The proprietary blend of Speed Polish incorporates a binder into its formula, allowing it to load exceptionally well to the brush, which results in minimal wasted material.

With technicians today concentrating on their health more than ever, and the fact that keeping a healthy laboratory environment has always been challenging, this binder is a key to the most remarkable quality of Speed Polish. While it maintains the ability to efficiently polish restorations, it is dust free due to the proprietary binder. According to Harvest Dental, this is by design and possibly the trait that breaks the mold, sets Speed Polish apart from other products, and places it in front of the pack.

Previous polishing products had a tendency to create fine particulate dust which would cover a work surface and even build up on a technician’s mask. Harvest Dental’s Speed Polish is a great supporting product that exhibits multiple advancements and benefits, and also aids the technician and laboratory in helping to create a healthier work environment.

Harvest Dental’s products constantly meet and exceed the demands of the most discerning technicians.This product is in line with all of Harvest’s other offerings, which not only perform as advertised, but surpass expectations with additional benefits. Speed Polish delivers and lives up to its motto: Time is Precious!

Polish efficiently with this paste ready to support the advanced materials you use.