Jamie Stover, CDT

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In the current market, communication between the dental lab and dentist is more important than ever.

Dentists keeping a watchful eye on their overhead are faced with a lab bill every month that is reflective of the products and materials they are selecting for their patients. The case represented here demonstrates the importance of close communication between the lab and the dentist in regards to not only material science when selecting restorations, but in relation to different price points available from the lab for these products and materials.

A lab’s goal is to retain its clients, and a dentist who has to seek out and use multiple labs to obtain either higher quality work or lower priced restorations is not a viable path to this goal.

In this case, a 74-year-old female patient presented in excellent health, but with multiple missing and decayed teeth, severe wear fractures, and very dark discoloration 

. The dentist determined the need to open the patient’s bite to even out the plane of occlusion and provide room in the areas of super eruption for a mandibular RPD.

Much has been written about Ivoclar Vivadent’s e.max Press and its ability to provide reliable strength and beautiful lifelike restorations. Ivoclar’s Lithium Disilicate material can be waxed to full contour, pressed, stained and glazed, or be cut-back after pressing and porcelain layered on for increased translucency while providing a vast range of characterization and custom shade matching options.

The latter technique has become the standard when fabricating anterior restorations with e.max, but Ziemek Dental Lab has discovered that highly esthetic restorations can be produced without layering porcelain over e.max with the cut-back technique. Instead we are using a simpler stain and glaze process, and this is allowing dentists to successfully place monolithic e.max restorations in the anterior esthetic region more frequently, and at a lower cost.
	With adequate prep reduction and custom abutment design, the Low Translucency (LT) ingots can mask dark stumps and even titanium custom abutments while still providing natural, lifelike translucency along with 400 MPa strength.

Matching a single anterior restoration to existing natural dentition is among the most challenging tasks a lab undertakes, and this is unchanged when going monolithic. What does change is the workflow in the lab, and this change can allow a lab to potentially offer these restorations as a lower priced alternative to layered ceramics in the challenging anterior region. The strength of e.max Press, and the versatility provided by waxing and pressing it, allows a lab to design the restorations in virtually any style a PFM can be designed, incorporating features such as guide planes, rests and undercuts in conjunction with partial dentures, which was done in the case presented here.

Waxing, pressing and finishing anterior e.max Press monolithic restorations can be accomplished by lab technicians without porcelain layering experience, reducing the cost for the lab to produce them, and freeing up the more experienced technicians for the complicated custom ceramic layered cases, training other techs or other tasks.

Mid- and small-sized dental labs are under increasing pressure from a variety of sources to provide lower priced restorations, be it from overseas outsourcing or the large 1,000+ person labs here in the U.S. that are turning out lower priced products. To stay competitive with a lab across the state or across the sea, labs have to be proactive about seeking out materials and using technology along with techniques that allow them to stay profitable, while providing their dentists with a more varied price list and a myriad of restorative options. Fabricating e.max Press monolithic restorations for multiple unit anterior cases with straight forward shades can allow a lab to offer lower priced anterior esthetic options.

Although the case featured in this article is not a basic anterior case, the shade matching was similarly simple because all the existing teeth were restored. The final cost incurred by the dentist on this case was drastically lower than if the restorations chosen were e.max Press layered with ceramics, or if the dentist had chosen PFMs with the unpredictable price of alloy that has been very high in recent months.

The patient presented with extremely dark and worn dentition, along with existing PFMs of varying shades, and a large diastema between tooth Nos. 8 and 9. On the maxillary arch, the decision was made to restore the teeth and replace the existing crowns on tooth Nos. 3 through 13. On the mandibular arch she was missing all the teeth except tooth Nos. 22 through 27, and tooth No. 32 so it was decided the missing teeth would be replaced by an RPD.

The restorations chosen were e.max Press monolithic, which allowed the lab to mask the dark stumps adequately while still providing natural looking translucency. It allowed the lab to design the mandibular restorations in conjunction with the new RPD fabrication. And it allowed the lab to complete the entire case for about 25% less than if the same case was completed with layered e.max restorations, and about 40% less than PFMs. That is a substantial savings on a case of this size, without sacrificing strength, esthetic outcome or limiting the design.

 Pre-op impressions were provided by the dentist, the lab fabricated pre-op models 

, duplicated them, and fabricated diagnostic wax-ups 

, following the dentist’s prescription to open up the patient’s bite approximately 3 mm.

 The wax-ups were sent to the dentist for patient consultation and approval, and were used for the fabrication of the temporaries.

 The dentist prepped the maxillary arch, recorded the stump shades 

 After seeing the stump shades, the technician and dentist decided that LT ingots would be the best choice to mask the dark stumps while still creating a natural translucency without appearing opaque when finished. When using e.max Press monolithically, there is no incisal or effect porcelain layered on the buccal to provide this effect, and esthetics are achieved with only the e.max material and the e.max stain/glaze.

 At the lab, an impression was made of the diagnostic wax-up and a wax injector was used to quickly duplicate the crowns on the working model 

. This technique not only saves the lab the time and labor of waxing, but also provides accurately pressed crowns that require minimal time to finish.

 The wax-ups were invested and pressed with e.max LT A1 ingots (Fig. H), de-vested and finished on the model 

 The technician applied e.max stains 2 and 3 at the gingival to enhance the chroma, I1 on the line angles and to create a mammalon effect, and I2 as a basic translucent overlay 

. The stains were fired on the crowns, and then the e.max Glaze Paste was applied and fired on a separate cycle.

 The maxillary crowns were seated, the dentist prepped the mandibular teeth 

, and sent the impression to the lab, again fabricating the temporary crowns from the original diagnostic wax-up provided previously.

 The lab repeated the wax injection procedure to create the mandibular wax-ups, this time using a light colored wax as the dentist requested a wax try-in to check the patient’s occlusion, and aid in design of the mandibular RPD.

 Because the mandibular e.max restorations were to be designed for the fabrication of the new RPD, at this time the wax-ups were placed on the surveyor 

, guide planes were established on the distals of tooth Nos. 22 and 27, as well as the mesial of tooth Nos. 32, 22 and 27 were designed with lingual rests, as well as .01 undercuts on the buccal for I-bars 

. Tooth No. 32 was designed with a lingual shelf as well as a .01 undercut 

 The temporaries were removed and the wax-ups tried in 

, and any minor corrections for occlusion or esthetics were performed.

 The wax-ups were then sent back to the lab, invested and pressed (again, LT A1 ingots were used), and the same stain recipe used for the maxillary crowns was applied to the pressed mandibular restorations 

 The crowns were seated, and impressions were taken for fabrication of the RPD.

 The RPD was fabricated and tried in for fit, with only very minor adjustments required.
	The final result is considered by the authors and the patient as a great success and a very big improvement esthetically, and in the quality of life overall 

This case presentation illustrates how a dental lab can be proactive in research and development as well as communication with its dentist clients, informing them about products and materials that are priced lower, while still providing the dentist and patient strong and esthetically pleasing restorations with flexible design possibilities.

The authors would like to acknowledge and thank Sheryl Wolden, CDT, for her excellent work on the e.max Press restorations completed for this case.

Jamie Stover, CDT, is a member of the ACP Lab Alliance and Lab Manager at Ziemek Dental Lab, a high-quality fixed restorative lab located in Olympia, Wash., as well as Ziemek Innovative Digital Solutions and Ziemek Milling Center. His focus is using his experience at the bench as a technician along with new technology and materials to provide dentists with highly esthetic restorations, while keeping them on the cutting-edge of dental technology. He can be reached at Jamie@ziemekdentallab.com.

John C. Walker, DDS, graduated from the University of Washington dental school in 1983 and runs a full-time general and cosmetic dental practice in Olympia, Wash. He can be reached at john@smileolympia.com.

Cutting costs, keeping quality

	Many labs are involved in a digital workflow in one way or another. Those involved most likely agree that digital is undoubtedly the future of our industry. From hardware such as scanners and mills in our labs, to the digital acquisition of impressions from chairside scanners in dental practices, we are transitioning away from the old school and experiencing the advantages these technologies offer.

	What is fascinating to me, and an interesting challenge, is the marriage of this new technology to the hand craftsmanship that is still so necessary to achieve beautiful lifelike results, while maintaining fit, strength and consistency. Herein lies one of the most challenging aspects of this new era: How do labs integrate new technology and materials into their current workflow and with their current technicians without causing turmoil, killing their bottom line, or sacrificing strength and reliability? At Ziemek Dental Lab, we do this by keeping it simple. We implement systems and technology that improve our workflow without sacrificing quality, strength, fit or esthetics, and that allow us to offer dentists a variety of restorative options.

	The 3M™ ESPE™ Lava DVS Digital Veneering System is a great example of one such option, and is the best of both worlds. It’s a simple, effective way to take digital information and pair it with old school artisanship to deliver great looking, reliable crowns in less time, all while maintaining a healthy profit margin. This is primarily possible because the amount of hands on time required to finish Lava DVS restorations is minimal compared with a traditional hand stacked porcelain fused to zirconia crown, making it possible for technicians with little or no experience working with porcelain to get involved in the preliminary steps of fabrication, leaving more experienced techs with refining, stain/glaze and characterization.

	Lava DVS is a Lava™ Zirconia core and a full-contour Lava DVS “top” (milled from the Lava DVS glass ceramic material) that are bonded with the Lava DVS Fusion Porcelain. These materials look like a hand stacked crown because the Fusion Dentin acts as both a bonding agent and a true dentin porcelain. It provides a rich chroma from within, while the Lava DVS top is a translucent material that creates the enamel layer.

	This is not just marketing hype; the result truly is amazing. When you put a Lava DVS restoration next to a stacked crown and see how similar they appear in depth and translucence, it can be difficult to tell them apart. According to 3M ESPE’s research, its strength is equal to a restoration with porcelain layered over zirconia, while the bond strength of the veneering material to the zirconia core is excellent. Most labs have learned the importance of properly layering and firing porcelain on zirconia understructures to avoid chips, fractures and de-bonding. With Lava DVS this process is reduced to one main fusion cycle.

	Most of the Lava DVS crowns we produce originate from a 3M™ ESPE™ Lava™ Chairside Oral Scanner C.O.S. scan (Figs. B and C), however you also can create these restorations on stone models with many of the same benefits to your workflow.

 As soon as the Lava C.O.S/digital impression file is received, margin marked (Fig. D) and submitted for SLA model production, we split the file and simultaneously design both the Lava zirconia coping as well as the Lava DVS full contour “top” (Fig. E) and mill them both before the model arrives at our lab. The Lava DVS top mills in a “green state,” which allows you to do some contouring of the emergence profile and anatomy before you fuse it to the core, saving finishing time (Fig. F).

 Because the zirconia core is designed specifically to fit the top with the 3M™ ESPE™ Lava Design Software, final finishing of the core is minimal and amounts to finishing the margins precisely and checking the fit of the core and the top.

 Sandblast the Lava zirconia coping with 3M™ ESPE™ Rocatec™ Soft, a special material that delivers a mechanical and a chemical bond (Fig. G).

 The next step is the fusion process and a firing cycle that accomplishes two things: bonding the core and top while completing a sintering cycle for the top. These steps easily can be completed by a less experienced technician. In fact, in our lab these steps are completed by a tech with no porcelain experience at all.

 3M ESPE provides an easy to use chart that shows you exactly which Fusion Dentin to use for the requested shade. The Fusion Dentins and the Lava DVS tops are formulated to work together, along with the shade of the zirconia core to create the final desired shade/value. The key to this step is mixing the Fusion Dentin and the Fusion Liquid correctly, and getting the consistency of this porcelain perfect so you can evenly apply it inside the top and onto the core quickly and completely (Fig. H). Fuse multiple units of the same shade at the same time, making the most of the materials. This takes a few minutes, making it possible to fuse many Lava DVS crowns in a single shift.

 Fire them in a porcelain oven that you already have; no special furnace is required. Let them cool and it’s on to refining the contour (Fig. I), correcting any voids between the core and top, adjusting occlusion and anatomy, then staining and glazing (Fig. J). A really nice aspect of the Lava DVS system is the Correction Porcelain that is used to fix any contour issues, contacts or margins after fusion.

	That depends on whether your lab has the capability to mill the materials. Authorized Lava Milling Centers just need to purchase the Lava DVS blocks and the Lava DVS Porcelain kit. The Lava DVS tops can be milled in your current Lava mill as long as you clean it out before switching materials. If you are not an Authorized Lava Milling Center, you’ll need to decide if you will purchase the Lava zirconia cores and DVS tops un-fused and complete that step yourself, or pay a little more and purchase them already fused, leaving just the finishing steps to be completed in your lab. If you won’t be milling the materials in house, I recommend purchasing them already fused for a few reasons: fewer steps for you to learn and perfect; you can purchase just the Correction Porcelain instead of the full Lava DVS Porcelain Kit (which includes all the Fusion Powders/Liquids and Correction Powders available); and you won’t have to purchase the Rocatec Soft.

	At Ziemek Dental Lab, we only sell DVS to labs fused. When fused correctly, the finishing process is simple. For this case, I started the finishing steps a few hours before the seat appointment, took the pictures while working on the case, and delivered it on time. The result was a good match to the existing A3.5 gingival/A3-ish incisal range of the adjacent teeth.

	As you can see in Fig. L, the incisal third of No. 14 is lower in value than the A3 selected by the Dentist for No. 15, and although a custom shade would have allowed an exact match (the patient was not available for a shade appointment), the dentist did a good job selecting a close shade match.

	This seat appointment took 5 minutes with no adjustments, making me, the dentist and the patient very happy. This is a case that labs see daily, not a once or twice a year “showcase” mouth, and a practical example of how we use the Lava DVS system to improve our workflow and offer dentists alternatives.

	By combining the latest technology and old school craftsmanship we produce lifelike restorations that not only look beautiful, but also fit and function beautifully.

Jamie Stover is Manager of Ziemek Dental Lab, a high-quality fixed restorative lab located in Olympia, Wash. His focus is using his experience at the bench as a technician along with new technology and materials to provide dentists with highly esthetic restorations, while keeping them on the cutting-edge of dental technology. He can be reached by calling 360-943-6071 or by e-mailing i

 Many labs are involved in a digital workflow in one way or another. Those involved most likely agree that digital is undoubtedly the future of our industry. From hardware such as scanners and mills in our labs, to the digital acquisition of impressions from chairside scanners in dental practices, we are transitioning away from the old school and experiencing the advantages these technologies offer.

Step-By-Step: Lava DVS

As laboratory technicians, we are constantly made aware of new products and materials, and are subjected to much of the same marketing as dentists. However, we are in the unique position of having to fulfill our dentists’ requests to implement these new materials and discern what is hype and what works well. At the same time, now more than ever, we are under increasing pressure to keep costs down.

	Add to this the tumultuous gold market today, and it’s no wonder that we fear our bottom line shrinking. Offering a lower-cost noble alloy as an alternative to more expensive high-noble alloys for PFMs is an important option, but still leaves the alloy cost per crown inconsistent.

	Titanium is lightweight, extremely strong and very biocompatible. Although I wouldn’t categorize titanium as a “new material,” it is now more attainable and easier to use as a crown and bridge alloy. In the past, using titanium in PFMs was not an easy feat, as anyone who has ever tried to cast it will attest. Titanium gives you the ability to change the workflow in your lab by allowing the CAD/CAM fabrication of single copings and bridge frameworks as opposed to traditional waxing and casting.

	Additionally, it gives you a fixed alloy cost per unit, which allows you either to charge a fixed price for the alloy per crown or structure pricing to include the alloy in the price of the crown, regardless of its size. Labs choosing not to invest in a scanner and software can still use titanium and reap similar benefits by simply partnering with another lab and outsourcing the scan and design steps. Although with the speed that technology is transforming our industry, it’s becoming difficult to imagine any lab without some type of scanning ability.

	With titanium, you pay a fixed price per milled coping or pontic regardless of the size or weight. The actual price a lab pays per coping will differ depending on how you acquire your titanium frames, as labs that can scan/design their own understructures will most likely pay less per unit than the ones that choose to outsource these steps.

	As with zirconia, there are different grades of titanium available today of varying quality, making it important to seek out a reliable source. For this article, I will only discuss the materials I use to produce titanium PFMs at Ziemek Dental Lab. We use titanium alloy from Nobel Biocare, which is a high-quality Grade 5 titanium, and I stack them with GC Initial Ti porcelain from GC America. We have been extremely happy with both of these companies for their excellent products and outstanding support and customer service. Special thanks to Rick Sonntag of GC for all his help while I was getting off the ground with Ti.

	I hear quite a bit about how difficult it is to integrate titanium into a lab, and how tricky it can be to work with. Incidentally, I hear this mostly from labs that have never stacked a titanium crown, and I haven’t found this to be the case. There are a few basic rules that I follow when working with titanium.

	I always use a dedicated carbide bur for metal finishing to avoid cross contamination of our other alloys, which is no different in theory than working with non-precious alloys for Maryland Bridges, etc. I would recommend dedicating a work station exclusively for it; however, I haven’t needed to do this as of yet. I just keep my work area clean, use a dedicated bur, and don’t have any issues with cross contamination.

	Titanium builds an oxide layer by sitting at room temperature for about five minutes, so you don’t fire it in an oven to degas. This is a bonus in my opinion, as five minutes sitting at room temperature while I do something else is a quick, easy degas cycle.

	Before you opaque your coping, you’ll need to blast it with 125-micron aluminum oxide to really roughen up the surface texture and also apply a bonder layer; again, not a big deal. After firing the bonder, the alloy is a bit darker gray than our noble and high-noble alloys, so I use a bleach shade for my first opaque application. I also recommend that our dentists cut a porcelain margin prep to avoid any dark line at the gingival.

	Other than these differences, I stack it just like any other alloy we use and have been satisfied with the outcome. I would follow the instructions provided with the porcelain kit you choose to work with. I only use GC porcelain for our titanium PFMs, and subtle differences may exist.

 We use our NobelProcera scanner to scan the model (Fig. A) and design the copings (Fig. B).

 Two to three days after submitting the designed file, we receive the milled titanium coping from Nobel (Fig. C). Because the coping is milled, the thickness is set at 0.4 mm and requires minimal finishing.

 After the sprues are removed, the fit is checked and the margins are carefully finished (Fig. D).

 The sprues are finished down using a carbide bur, and contour is refined if needed. I go over the entire coping to create a more-retentive surface texture (Fig. E). Again, special care is taken to use a dedicated bur so there is no contamination amongst our different copings/alloys.

 The coping is blasted with 125-micron aluminum oxide at a 45° angle to prepare the surface for maximum adhesion (Fig. F).

 The coping is steam cleaned and allowed to sit at room temperature for five minutes to build an oxide layer.

 I apply a thin layer of the Initial Ti Bonder and fire it (Fig. G). After the bonder is fired, the coping is quite dark (Fig. H). I nullify this by applying a bleach white opaque shade for my first opaque layer, and do a porcelain margin whenever possible to avoid a gray line at the gingival.

 I apply my subsequent opaque and opaque modifiers in the desired shade (Figs. I and J).

 I do my buildups as usual with GC’s Initial Ti porcelain (Fig. K).

 I contour the crown (Fig. L), glaze and add stain for any desired characterization (Fig. M).

	The finished crown is ready to deliver (Fig. N).

	Many dentists and laboratory technicians alike are already very familiar and comfortable with titanium when used for custom implant abutments, bars, posts, etc. Time will tell if this alloy achieves the same popularity for crown and bridge applications. In the meantime, labs should experiment with it and decide if titanium can improve their workflow and be beneficial to the all important bottom line. I am here to say it can do both, and also is surprisingly easy to work with.

	Jamie Stover is Manager of Ziemek Dental Lab, a high-quality fixed restorative lab located in Olympia, Wash. His focus is using his experience at the bench as a technician along with new technology and materials to provide dentists with highly esthetic restorations, while keeping them on the cutting-edge of dental technology. He can be reached by calling 360-943-6071 or by e-mailing 

 Bench Mastery: Handling Titanium  As laboratory technicians, we are constantly made aware of new products and materials, and are subjected to much of the same marketing as dentists. However, we are in the unique position of having to fulfill our dentists’ requests to implement these new materials and discern what is hype and what works well. At the same time, now more than ever, we are under increasing pressure to keep costs down.

An alloy alternative

In the current market, communication between the 

 and dentist is more important than ever. Dentists keeping a watchful eye on their overhead are faced with a lab bill every month that’s reflective of the 

 and materials they’re selecting for their patients.

Close communication between the dentist and the lab about material science when selecting restorations is important, but it also can include discussion of different price points available from the lab for these products and materials.

A lab’s goal is to retain its clients, and a dentist who has to seek out and use multiple labs to obtain either higher quality work or lower priced restorations isn’t a viable path to this goal. Proper communication can lead to high quality restorations at an affordable price.

Much has been written about e.max Press from 

 and its ability to provide reliable strength and beautiful lifelike restorations. The lithium disilicate material can be waxed to full contour, pressed, stained and glazed, or be cut-back after pressing and porcelain layered on for increased translucency while providing a vast range of characterization and custom shade matching options.

The cut-back technique has become the standard when fabricating anterior restorations with e.max, but Ziemek Dental Lab has discovered that highly esthetic restorations can be produced with a simpler stain and glaze process. While still delivering esthetics, this technique allows dentists to place monolithic e.max restorations in the esthetic region at a lower cost.

With adequate prep reduction and custom abutment design, the Low Translucency (LT) ingots can mask dark stumps and even titanium custom abutments while still providing natural, lifelike translucency along with 400 MPa strength.

Matching a single anterior restoration to existing natural dentition is among the most challenging tasks a lab undertakes, and this is unchanged when going monolithic. What does change is the workflow in the lab, and this change can allow a lab to potentially offer these restorations as a lower priced alternative to layered ceramics in the challenging anterior region.

The strength of e.max Press, and the versatility provided by waxing and pressing it, allows a lab to design the restorations in virtually any style a PFM can be designed, such as guide planes, rests and undercuts in conjunction with Partial Dentures, which was done in the case presented here.

When using e.max Press monolithically, there is no incisal or effect porcelain layered on the buccal, and esthetics are achieved with only the e.max material and the e.max stain/glaze. Waxing, pressing and finishing anterior e.max Press monolithic restorations can be accomplished by lab technicians without porcelain layering experience, reducing the cost for the lab to produce them, and freeing up the more experienced technicians for cases requiring their specific skills and knowledge.

Fabricating e.max Press monolithic restorations for multiple unit anterior cases with straight-forward shades can allow labs of any size to offer lower priced anterior esthetic options on their menu.

Although the case featured in this article isn’t a basic anterior case, the shade matching was similarly simple because all the existing teeth were restored. The final cost incurred by the dentist on this case was drastically lower than if the restorations chosen were e.max Press layered with ceramics, or if the dentist had chosen PFMs with the price of gold what it is today.

A 74-year-old female patient presented in excellent health, but with multiple missing and decayed teeth, severe wear fractures and very dark discoloration, along with existing PFMs of varying shades, and a large diastema between tooth Nos. 8 and 9 

The dentist determined the need to open the patient’s bite to even out the plane of occlusion and provide room in the areas of super eruption for a mandibular removable prosthetic device (RPD). On the maxillary arch, the decision was made to restore the teeth and replace the existing crowns on tooth Nos. 3-13.

The restorations chosen were e.max Press monolithic, which accomplished a few important goals for the restorative team and the patient. It allowed the lab to mask the dark stumps adequately while still providing natural looking translucency, it allowed the lab to design the mandibular restorations in conjunction with the new RPD, and it allowed the lab to complete the entire case for about  25% less than if the same case was completed with layered e.max restorations, and about 40% less than PFMs. That’s a substantial savings on a case of this size, without sacrificing strength, esthetics or design options.

Pre-op impressions taken by the dentist were used to fabricate models and diagnostic wax-ups that followed the dentist’s prescription to open the bite approximately 3 mm. After the dentist and patient approved the wax-ups, they were used to fabricate temporaries, the teeth were prepped, stump shades recorded and the temporaries placed 

After seeing the stump shades, the technician and dentist decided LT (low translucency) ingots would be the best choice to mask the dark stumps while still creating a natural translucency. At the lab, an impression was made of the diagnostic wax-up and a wax injector was used to quickly duplicate the crowns on the working model 

. This technique not only saves the lab the time and labor of waxing, but also provides very accurately pressed crowns that require minimal time to finish.

The wax-ups were invested and pressed with e.max LT A1 ingots, de-vested, and finished on the model. e.max stains were applied at the gingival to enhance the chroma, on the line angles and to create a mammalon effect, as a basic translucent overlay, and the Empress Universal White for some highlights.

Next the maxillary crowns were seated, the dentist prepped the mandibular teeth 

, recorded the stump shades and sent the impression to the lab, again fabricating the temporary crowns from the original diagnostic wax-up. The lab repeated the wax injection procedure to create the mandibular wax-ups, this time using a light colored wax as the dentist requested a wax try-in to check the patient’s occlusion, and to aid the design of the mandibular RPD.

The temporaries were removed and the wax-ups tried in 

, and minor corrections for occlusion or esthetics were performed. The wax-ups were then sent back to the lab, invested and pressed (again, LT A1 ingots were used), and the same stain recipe used for the maxillary crowns was applied to the pressed mandibular restorations 

. The crowns were seated, and impressions were taken for fabrication of the RPD.

The RPD was fabricated and tried in for fit, with only very minor adjustments required. The authors and the patient agree the final result is a great success and a big improvement esthetically and in her overall quality of life 

This case presentation illustrates how a dental lab can be proactive in research and development as well as communication with its dentist clients, informing them about products and materials that are priced lower, while still providing the dentist and patient strong and esthetically pleasing restorations with flexible design possibilities. 

; John C. Walker, DDS, can be reached at: 

In the current market, communication between the dental lab and dentist is more important than ever. Dentists keeping a watchful eye on their overhead are faced with a lab bill every month that’s reflective of the new dental products and materials they’re selecting for their patients.