Nicholas Hamm

	Gone are the days when labs and dental offices had to choose between esthetic or durable. New materials, processes and techniques mean that patients are being left with a great smile that they can actually use.

This isn’t some pipe dream - it’s happening in the real world. Sure, patients care a lot about esthetics, but as time goes on they’ll start to care a lot about the durability of a restoration too! Whether it fails the day after completion or two years after, a failed restoration means an unhappy and an unhealthy patient.

	New technologies and materials are becoming more and more affordable and accessible for the dental lab, which makes them more and more affordable for dental patients. Here are 6 techniques demonstrating what some of these advances can offer. The great thing is that even for patients with older failed restorations, new techniques can mean a great smile that actually lasts.

	This was a case that I worked on for a very special patient-my own sister. The patient had a complicated dental history and has worn a removable denture for a very long time. Thankfully, she has a dental professional in the family and came to learn that she now had options for a more stable, permanent and beautiful smile.

	The patient no longer wanted the partial denture that she had basically learned to live with for many years; she wanted a “fixed” solution. Teeth #s 3, 4, 8, 9 and 13 were to be prepped and were our only abutments

	How to create strong restorations with excellent esthetics

	Dentistry is fortunate enough to have access to a wide selection of chairside CAD/CAM monolithic blocks, ranging from the first feldspathic block introduced back in 1991 to more recent advances in zirconia chairside milling technologies.

	As dental professionals, we have witnessed a general increase in chairside monolithic block mPa strength over the years yet, many times, at the expense of esthetics. For example, we have an extremely strong material like zirconia but with less than desirable esthetics, or sometimes even more disappointing, an esthetically-pleasing restoration with low to moderate strength.

 to see how strength and esthetics can be combined.

	Our patient, a female in her 60s, had undergone a reconstructive dental process 15 years earlier with unfortunate issues involved with the work from the beginning. The porcelain popped off repeatedly, requiring frequent visits to the new dentist and numerous re-cementations.

	She was frustrated and unhappy with the overall case esthetics and the work which had been completed by the previous dentist. She approached the new doctor about re-doing her case and he agreed to undertake the process for her.

	Everything went well with the preparations and temporization process. She could not be happier with her improved bite, new shade and overall esthetics since her case was completed. We will discuss the streamlined process and the excellent outcome within our case discussion.

 about how improved technology means better results

	How guided implant surgery can deliver better patient care

	As dentistry has moved to a digital platform, more clinicians and labs have started taking advantage of enhanced communication tools in order to provide greater patient care.

	The accuracy currently achievable with digital dentistry is unparalleled. This accuracy, along with teamwork within the surgical and restorative team, is creating workflows where the final outcome can be visualized before a case is started.

	Implant dentistry is no different. Using 

 software (Implant Studio and Dental Designer), the entire restorative team (lab, restoring doctor and surgeon) can plan the surgery and restorative options based on the planned implant placement. Benchtop testing is showing fully guided implant surgery places the implant within .1 mm in all directions of planned placement. This certainly allows for the ability to place better temporary restorations or healing abutments than what has been used in the past.

	An alternative approach to long-term temporaries

	Our case study involves a female patient who was missing her lateral teeth, numbers 7 and 10. An implant had been placed on number 10 because the patient sought longevity in the treatment plan. She also wanted esthetically pleasing provisionals for cosmetic reasons since she would be wearing the restorations long-term-for six-to-nine months.

	Our purpose for this article is to demonstrate the best method for fabricating this type of excellent long-term temporization. This type of work is done through the fixed department and is cosmetic in nature.

 to read more about a long-term solution.

Articles

Esthetics and durability are no longer mutually exclusive, and these real-world examples prove it.

5 techniques showcasing long-lasting results

	Dental X-rays are the most common form of X-ray radiation most people receive. Though they are relatively common, they are a known carcinogen. To minimize exposure, X-rays are only to be given when clinically necessary. But what happens in a fee-for-service model, where more X-rays can turn into more profits?

	Researchers in the United Kingdom asked this question, and came to the conclusion that the promise of more money is a factor in the number of X-rays performed. Their 

 shows that “there are significant increases in X-rays when dentists receive fee-for-service rather than salary payments and when patients are made exempt from payment.”

Related article: Study finds office-based dental anesthesia is on the rise

	To find their answer, researchers examined data from the NHS in Scotland. In Scotland, dentists working in the public sector are either reimbursed in a fee-for-service model or are salaried, with income independent of services performed. Patients receiving care from public dentists are either exempt from charges or if non-exempt pay 80 percent of the treatment fee up to a certain amount.

Using claim data from 1998 to 2007 - about 1.2 million total claims covering over 200,000 patients and 3,144 dentists - the researchers discovered differences between the number of x-rays given by salaried dentists and fee-for-service dentists.

	During that long period, some of those dentists switched between salaried and fee-for-service payment models, giving an even clearer picture of the number of X-rays given under each model. Dentists who switched from salary to fee-for-service were 6.3 percent more likely to give an X-ray after the change. For patients making the change from non-exempt to exempt, the likelihood of receiving an X-ray increased by 3.4 percent.

	Overall, exempt patients receiving treatment from a fee-for-service dentist were 4.1 percent more likely to receive an X-ray than a non-exempt patient receiving treatment from a salaried dentist.

	Also of interest, older dentists were more likely to give x-rays, while older patients were less likely to receive an X-ray.

Related article: The risks and rewards of mail-order braces

	Co-author Martin Chalkley of the Centre for Health Economics at the University of York 

 that “Our study clearly shows that a potentially harmful treatment is being given in varying quantities according to how dentists are paid for it and we believe this is a genuine cause for concern. Dental X-rays deliver a very small dose of radiation, but there are no safe levels - every last bit of radiation is potentially harmful. Each dentist has to weigh up the risks versus the benefits before they take the decision to X-ray and our findings indicate that this calculation is being distorted by financial incentives.”

	“First do no harm – The impact of financial incentives on dental X-rays.” Published in the 

X-rays should be performed only when clinically appropriate, but a new study finds that dentists often take money into consideration.

Are dentists getting greedy over X-rays?

	There is a lot you can’t control in your practice. You can’t make customers walk in the door, you can’t keep your data absolutely safe, you can’t make everyone in your office the perfect employee.

You can’t do any of these things, but you can set up policies that help to influence them. You can create a great marketing plan to help advertise your practice, you can invest in the latest tech to keep your data as safe as possible. With employees, it’s the same thing. Invest in training that will help you be a better manager. Make your work environment the best it can be. Pay attention to how you and employees interact.

	It’s easier said than done though, so here are five tips to help you better manage what could be your dental practice’s greatest asset: employees. From front office staff to hygenists, a well-performing staff is vital. Do you have the tools to make that happen?

	When I see a persistent problem in the dental industry, I don’t search for solutions in the same place others ordinarily would. Why? Because others typically look for solutions where there is the least power. Most people look for solutions that are either more, better or different - but the same thing they’re already doing. Although they might spend plenty of time and money working on these solutions, rarely does the effort pay off.

	Some people are entrepreneurial and inventive enough to experiment with new solutions. Unfortunately, trying to create new solutions to chronic problems doesn’t have a great success rate.

	Why do these efforts fail or under-deliver? The answer is invariably the same: because the 

Click here to read more about why the way you view employees is vital

	How to create valuable partnerships between younger and older dentists

	The inexperienced dentist may see a wonderful opportunity with a mentor who has experience not just in the clinical side of the profession but also in the administrative part. Knowing management skills and having financial and business expertise is very much a part of the economics of dentistry.

	The partnership of the two age groups may be a wonderful relationship for each. The more mature and experienced dentist sees the energy of youth and the ability to work and learn so that the dental practice may grow and be respected by the community that it serves. It is also an excellent built-in exit strategy for the experienced and older dentist. With seminars and the recent state-of-the-art education of the younger dentist, the clinical piece of dentistry can be addressed and the patients should be happy. When the dentists speak to each other, they should certainly understand their professional language and work together to increase production and to learn from each other.

Click here to learn more about this important relationship

	How to succeed with millennial associates

	Like it or not, your company’s future performance, negotiable value and operational value are becoming more and more determined by millennials.

	The deeper understanding you have of millennials, the better your leadership, management and structures for working with them. The more you understand them, the better your communication and relationships will be with them. The better your communication and relationships are with millennials, the greater their levels of commitment and responsibilities will develop.

Click here to read more managing millennials

	When I work with dentist entrepreneurs in emerging or small group practices with three to 10 practices, they often began their journey envisioning themselves as the CEO of their future enterprise-away from the “chair,” sitting in a corporate wood-paneled office, meeting with a stellar executive team that is getting the job done in each department, with little or no oversight. They imagined themselves in a leather padded swivel chair, turning around as they look out through their floor to ceiling windows at the cityscape, all the while having a conversation on their headset. “Ah, it will be great,” they think.

	What they don’t realize is being a CEO isn't about having a C-level title, a corner office, or the power to make important company decisions. The best CEOs know that their success or failure depends on their ability to inspire and guide the people in their company.

Click here to find out more about leading your team

	You do your best to hire the right people. You know how important a strong team is to your success, after all. Sometimes, though, it just doesn’t work out and certain employees end up doing the practice more harm than good - which is a situation you can’t afford to ignore.  

	Team members who aren’t performing as they should can cause a lot of problems. They lead to extra stress, cost you money, hurt the practice image and jeopardize your marketing efforts. Trust me, patients can tell when team members are struggling with their role or just aren’t very motivated. It shows in how they interact with them and with other team members.

Click here to read more about letting an employee go

Employees can either be the best thing about your practice or your biggest liability - these tips can help you make them successful.

5 ways to be a better manager

	Part of being a successful practitioner means looking at available tools and methods and thinking, 

One tool you may not think about a lot is water jets. They’ve worked well and have worked for a long time, but researchers have found that a simple ingredient - bubbles - could take this technology from good to great.

 from Tohoku University and Showa University in Japan wanted to look at how traditional water jets could be improved. They were especially interested in patients with dental implants. Those patients have more areas with microgrooves, such as exposed screws, that make cleaning difficult.

	The team gathered four volunteers and grew a biofilm in their mouths over a period of three days. They then cleaned that biofilm using two methods: a traditional water jet and a cavitating jet.

	Cavitating jets work by introducing bubbles to a stream of water. These bubbles, though small, can greatly impact the force of the water hitting the tooth - the bubbles pop and create a high-pressure area, which greatly increases the impact force of the water stream. Traditional water jets exert a shear stress on the tooth, which can remove biofilm, but the force of the bubbles popping produces even more sheer stress.

More emerging research: Study finds link between oral bacteria and increased risk of esophageal cancer

	While the researchers saw little difference between the two methods when measured after 30 and 60 seconds of use, between 60 seconds and 180 seconds there was a significant difference After three minutes, the cavitating jet removed more than a third more plaque than the water jet - which left little plaque remaining at the end of the experiment. The cavitating jet was also able to remove plaque from the root section of the screws, and also - to a lesser extent - the harder-to-reach crest section.

	Because of this, the team concluded that the cavitating jet is superior to traditional water jets when cleaning irregular implants.

	Researcher Hitoshi Soyama from Tohoku University 

 that “Conventional methods cannot clean plaques on the surface of dental implants very well, so this new method could give dentists a new tool to better manage these fixtures which are becoming more common.”

, “Removal of Oral Biofilm on an Implant Fixture by a Cavitating Jet” was published in the journal Implant Dentistry, DOI: 10.1097/ID.0000000000000681.

They might be small, but bubbles can make your patients' teeth cleaner.

Bubbles are a dentist's best friend

	Dental implants are a huge part of every lab owner’s repertoire. But just like nearly everything else in the dental world, implants are quickly evolving.

And just like every other dental technology that’s evolving, it’s up to you to stay on top of the current trends. How is technology shaping the future of implants? What does the latest research say about implants? How are general dentists feeling about them? How are labs adding value to their clientele when it comes to implants? How are implants being used in the real world?

	All of these questions are important now, and they won’t become any less important in the future. In fact, the future is already here - the question is, will it leave you behind?

	How the digital revolution is making an impact on implant treatment

	It’s no secret that digital technologies are taking the dental and lab worlds by storm. The digital transition has led to more efficient workflows, easily accessible patient information and intuitive user interfaces, among other benefits.

	Digital Esthetics recently sat down with Dr. Pascal Kunz, vice president of product management digital dentistry at Nobel Biocare, to discuss the digital workflow and its impact on implant treatment.

Click here to see how the digital workflow is changing implants

Click here to see guided implant surgery in action

	Over half of the 500,000 dental implants placed in the U.S. every year are placed by general dentists-and that number is growing, according to the American Academy of Implant Dentistry. Thanks to the digital workflow, specifically CAD/CAM technology, more general dentists are gaining the tools and confidence needed to offer implants to their patients.

	“There are many dental professionals who, understandably, are wary of new ways of working and prefer to continue using the processes they were originally trained in,” says Dr. Pascal Kunz, vice president of product management for digital dentistry at Nobel Biocare. “The number of early adopters in dentistry remains relatively small, but those that embrace emerging technologies stand to benefit.”

	5 ways technology has changed the implant workflow

	The explosion of digital technology has drastically changed the dental landscape.

	With a larger percentage of clinicians starting to go digital, the workflow for all types of patient care is changing. No workflow has changed more than implant-based restorations.

	Here, I will discuss five ways in which digital workflow has changed the way in which implants are restored.

Click here to see five ways that technology is changing implants

	Research projects highlight increasing adoption of PEEK implants in clinical practice

	A wave of recent research projects presented at the latest International PEEK Meeting in Washington, D.C., highlighted the increasing adoption of PEEK implants in clinical practice as well as the material´s established position due to possible patient benefits. In particular, the potential of carbon fiber-reinforced PEEK (CFR-PEEK) plates for fracture fixation became increasingly compelling; moreover, additive manufacturing was revealed as making progress in the production of PEEK polymer-based implants.

	Topics ranging from dental, knee, spinal and trauma implants up to advances in additive manufacturing or medical PEEK performance in general demonstrated the broad scope of current research in PEEK technology and clinical applications. More than 40 abstracts were shared through podium and poster presentations along with invited talks focusing on medical implantable PEEK to attendees from the FDA, industry, academia and research hospitals - supporting the growing relevance and necessity for the International PEEK Meeting.

Implants are evolving - are you staying on top of the current trends?

5 things you need to know about implants

	You’ve been hearing it for years this point: “3D printing will revolutionize the industry,” “This technology is going to make this other product obsolete,” “Invest in 3D printing before it’s too late!”

3D printers aren't new, but they are continually being made cheaper, better and more accessible than ever. This means that not only do you have to track the 3D printing revolution as it relates dental industry - you also have to track the revolution being brought to 3D printers themselves. It’s a lot to take in, but we’re here to help.

	Here are 5 things you need to know about where 3D printing is now - what it’s being used for, how to best utilize it - and where 3D printing will be in the future. 3D printing shouldn’t be intimidating, so here’s how you can stay on top of the 3D printing revolution.

	Click through to see the 5 trends in 3D printing 

	Why the future looks bright for 3D printing

	The mass emerges slowly and steadily, still wet from the primordial ooze from which it originated. As it rises, its features are gradually revealed. With every passing moment, it becomes more definite, more apparent that something it is metamorphosing from, seemingly, nothing.

	No, this isn't a scene from the 1991 movie “Terminator 2” – it is the model of a lower arch being 3D printed on an M2 3D printer, made by manufacturer Carbon.

	While this technology is different from conventional 

, there are more improvements ahead. Currently, 3D printing at dental labs is only used for models and 

 for implant placements, but expect important changes in the next year or so - and expect even more Earth-shattering advancements in the years to come.

Click here to read more about the future of 3D printing

	7 ways 3D printing is changing everything

	CAD/CAM changed the face of dental laboratory work about 15 years ago, and you’d be hard-pressed to find a lab that hasn’t heard about CAD/CAM, isn’t considering CAD/CAM or doesn’t already own a CAD/CAM system. And while the basic system is revolutionary, it has continued to grow and evolve.

	One such advancement comes in the form of 3D printing. Labs can derive a lot of use from 3D printers and their prices are coming down, so now might be a good time to consider adding the technology to one’s CAD/CAM solution.   

	Digital technology is creating workflows never seen before in the dental industry. The pathways of sharing information and collaborating on cases are becoming more abundant and easier to use. As members of the restorative team strive for more accuracy in all aspects of the process, from implant placement, impression taking and prosthesis creation, one tool that is sure to get used more often is 3D printing. There are very few things that have advanced as quickly as 3D printing over the past few years. This advancement has come from the convergence of hardware and material development happening simultaneously. Along with this external development, the people using the 3D printers have also learned to optimize both the files they are printing and the machines they are using.  

	The amazing thing is that this could just be the tip of the iceberg as it relates to 

. As material manufacturers continue to strive for government approval for intraoral use, the printer and software companies, and the forward-thinking people operating the machines, continue to gain knowledge of the possibilities offered by additive manufacturing. This technology will grow exponentially.

Click here to see how 3D printing will grow

	How is dental technology REALLY being used?

	CAD/CAM and digital dentistry are major forces driving the industry, but to what extent? To find out, Digital Esthetics conducted a survey to determine how technology is driving dentistry. The survey asked respondents about how they utilize technology, what kinds of equipment they use and how they interact with their lab or doctor.

Click here to find out how 3D printing is really being used in the real world

	3D printing is changing-and disrupting-all kinds of dental workflows. Here are five dental processes that have been revolutionized by 3D printing possibilities:

	This is the most common use (so far) for 3D printing. Whereas models used to require time to mix stone and then careful set up, models can now be printed using the same CAD file used to create the restoration. It’s an easy way to naturally fit 3D printing into a digital workflow. Plus, it provides a great visual aid for dentists-and a bonus technological marvel for patients to take home!

3D printing isn't done revolutionizing the dental industry. Here's what you need to know to stay ahead.

5 things you need to know about 3D printing

	Medications can cause many oral health problems that dentists need to be aware of. The most common one is xerostomia, which affects 40 percent of seniors. But drugs causing xerostomia are not the only drugs dentists should be concerned with.

 has found that osteoporosis medication can cause significant problems with a patient’s implants. Researchers studied the effects of bisphosphonate (BP) use on mandibular bone quality. Implants are usually very predictable, but changes to bone structure can seriously affect the success of an implant. BPs are usually taken to treat osteoporosis or other diseases that cause bone-density loss, and help to prevent bone fractures and other complications.

The problem, researchers found, was that BPs also affect the landscape of the mandible. They examined 25 patients with osteoporosis who were at least 60 years old. The patients had all gone through implant surgery prior to the study. Of the 25 patients, 11 had been taking BPs for over one year, and the remaining 14 were not, instead taking a hormone therapy.
	The two groups were then monitored for changes to bone mineral density and cortical bone thickness.

Related article: Are you asking the right questions about your patient’s health history?

	In the BP group, 11 patients with a total of 25 implants had three (11.1 percent) of those implants fail in three (25 percent) different patients within one year. The 14-member non-BP group had 28 total implants, and every implant survived.

	So what caused these problems? Researchers found that the BP group patients had increased coricol bone thickness and a higher bone mineral density. Though the sample size was small, the researchers could still conclude that “These results indicate that BPs affect the quality and quantity of the cortical bone in the partially edentulous posterior mandible of patients with osteoporosis, which should be considered prior to treatment with dental implants in patients taking BPs.”

	“Influence of Bisphosphonates on Implant Failure Rates and Characteristics of Postmenopausal Woman Mandibular Jawbone,” DOI: 10.1563/aaid-joi-D-17-00015.

A new study has found that meds often taken for osteoporosis can affect dental implants.

Osteoporosis meds and implants are a bad combination

	The PrograMill One is reportedly the world’s smallest 5-axis milling machine. The machine is wireless and app-enabled, giving the user flexibility. It also reportedly offers a short processing time.

	The milling machine is indicated for a variety of options, including inlays, onlays, veneers, partial crowns, crowns and bridges up to 45 mm block length.

Ivoclar Vivadent’s 5-axis turn-milling technology means the block being processed moves around the tool. This reportedly keeps machining times short while reducing tool wear, and it results in outstanding surface quality and an excellent fit of restorations. Additionally, depending on the materials and indications, individual validated machining strategies are used, which is said to reduce rework to a minimum.

	A camera integrated within the mill automatically records all information on materials and tools. This reportedly makes using different materials easy and loading very convenient. In addition, material, shade and translucency are automatically read in by means of the Data Matrix Code, which is printed on the block. The OSD (Optical Status Display) visually informs the user about the current operating status.

	The mill is wireless and can be controlled from anywhere within the laboratory through an app. The app keeps the user informed of the machine’s status. It features order management, which allows the user to view the order list and current processing status, and it control the 5-axis block changer. The app also allows users to see the tool status and have control of the 8-position tool changer. Finally, the app gives the user an overview of machine data, the machine’s status and the filter unit’s status.

The PrograMill One is said to combine industrial manufacturing quality with a modern design.