Noah Levine

With the economy skittering along on the edge of recession it’s no surprise many dental labs took a cautious approach to major purchases during 2011. The year may have started with hints of optimism in a rebound just around the corner, but as the months dragged on and that rebound refused to solidify, it makes sense that many labs are ready to tread lightly as 2012 arrives.

For the Dental Lab Products 2012 Buyer’s Guide Survey we asked lab owners, managers and technicians about their purchasing in 2011, their plans for 2012 and their approach to purchasing and investment in general. We found that while just 15% of respondents regretted a purchase in 2011, only 35% said they planned to invest in new equipment next year.

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2012 Buyers Guide Survey: Holding off and holding on

A Web-based dental laboratory and supply-chain management software, SoundTrack is a suite of innovative tools designed to help labs drive revenue growth, decrease costs and strengthen customer loyalty. Designed to blend seamlessly with emerging dental technologies, labs can manage hundreds of concurrent cases online from anywhere there’s an Internet connection. Dentists are provided with secure online access to all case, shipping and billing information, which helps labs increase sales with improved on-time deliveries and customer service. Detailed reporting on all aspects of the lab’s operations increases efficiency and improves profit margins.

		Web-based software-users only need a computer and an Internet connection

		Private, encrypted client portal allows dentists to submit cases, track shipments, access invoices and more

		Configure and customize all workflows to match your labs’

		Confidential login screens for multiple labs and outsource partners

		Simple fee structure, with no additional user fees, login fees or license fees

		Easy to navigate with uncluttered, technology-forward design

		Software enhancements released every month with no user installation required

A Web-based dental laboratory and supply-chain management software, SoundTrack is a suite of innovative tools designed to help labs drive revenue growth, decrease costs and strengthen customer loyalty. Designed to blend seamlessly with emerging dental technologies, labs can manage hundreds of concurrent cases online from anywhere there’s an Internet connection.

Take it to the cloud

I have always been drawn to new technology. When analyzing the WaveOne file, it is clear that a lot of science went into its development. The concept and design behind the file system is built around a conservative shaping approach. The file system allows me to establish deep shape in the apical third of the root canal system while maintaining a conservative preparation in the middle and coronal third.

What sets the files apart from other endo files you’ve used?


	The main distinguishing feature that separates WaveOne technology from other engine driven instruments is reciprocation. While it is not a new concept-engine driven reciprocation was first introduced in 1969-the unique feature to WaveOne is its asymmetric envelope of motion that mimics the “Balanced Forces” hand shaping technique, which has been shown to minimize canal transportation during shaping due to its ability to keep the instrument more centered in the canal. The WaveOne system is the first engine driven system that accurately reproduces the Balanced Forces concept.


	WaveOne files are suited for any and all cases. I have used these files on single canal anterior teeth as well as complex, curved, multi-rooted molars. I find these files to perform very efficiently while providing great shapes regardless of tooth or canal type.

Has using the files changed your technique for shaping canals?


	No. I have a very regimented canal shaping technique that is anchored by orifice opening, glide path establishment and glide path maintenance. The advantage of the WaveOne system is that I don’t have to change my technique.


	The biggest benefit of WaveOne in my hands lies with the Primary file in smaller canals (a size 25 progressive 8% (.08) tapered file). My personal philosophy, based on my interpretation of the literature, dictates that the final shape of any canal should be prepared to no less than ISO size 25 with a minimum taper of 6% (.06) (exceptions will occur). The rationale behind this philosophy is based solely upon the ability to deliver the irrigant to within 1 mm of the working length.

The progressive shape of the WaveOne Primary file allows me to introduce all irrigation products to the exact length needed to establish the most predictable outcome while maintaining a conservative preparation and keeping the apical foramen as small as reasonably allowable.
	 

Double Take: "...the first engine driven system that accurately reproduces the Balanced Forces concept."

	Flip through the pages of an issue of Dental Lab Products or walk a tradeshow floor, and you’re likely to cross paths with at least one new material. Keeping up with the stream of new options for your lab can be almost dizzying.

	Some new materials are breakthroughs requiring new categories and opening new technical approaches, others are simply expanded shade options for an established line. But whether it’s a new ceramic system, alloy or millable block, watching these developments and correctly assessing which ones can improve processes and outcomes at your lab is an important part of staying successful.

	Tracking all these developments can almost seem like a full-time job. But it’s a job that pays off when your lab knows just the right time to begin offering restorations made from the latest materials that produce higher quality and more efficient results.

	“I think more and more now with the technology advancements, it’s not like a new thing comes out once a year and it’s small. Now, we regularly have major innovations,” said Gary Iocco, President of Dimension Dental Design in Hastings, Minn.

	As he evaluates the new developments on the materials market, Iocco is looking for options that offer higher-quality outcomes, but many other factors come into play before something piques his interest. A quality material option may be too much trouble if incorporating it calls for entirely new workflows or expensive equipment investments. Then again, he said there are times when the benefits of new innovations can be substantial enough to make such investments worthwhile.

	Strength and esthetics are the first qualities to be assessed when Bob Ziemek, owner of Ziemek Aesthetic Dental Lab in Olympia, Wash., is looking at new product and material options. His lab tries to stay on the leading edge of the industry, but he still looks carefully at new materials and prefers options that don’t require his dentists to drastically change the way they prep and seat restorations. When it comes down to it, Ziemek said he always approaches new materials asking the question, “Is it going to last a long time?”

	Staying in front of the industry curve is imperative for the business model of Precision Ceramics Dental Laboratory in Montclair, Calif. Co-Owner/Vice President Mark Jackson, RDT, is always on the lookout for something that will not only improve on the existing options his lab can produce but also will be attractive to both existing and new dental accounts.

	Dentists need to trust and be comfortable with a new material, and many big successes are simple, but significant improvements on another popular material. Jackson said a perfect example of this is 

’ BruxZir full-contour zirconia, which as a monolithic material eliminates the problems of veneering porcelains chipping off zirconia substructures.

	“I look at this as being a product that is perfectly placed to be successful because it addressed all of the shortcomings of other popular products on the market at the time,” he said.

	It’s also a new material Iocco cited as a great fit and a big winner for his lab, but for him the attractiveness of BruxZir was as much about the company behind the material as it is about the material’s qualities. Iocco said his lab places a lot of faith in a company’s track record of launching quality products. He also appreciates when companies provide marketing support, because his lab doesn’t have a large marketing budget. In fact, he said when companies such as Glidewell or 

 aggressively and successfully market their latest offering to both the clinical and lab sides of the industry it creates momentum that makes it difficult to avoid implementing their latest material developments.

	“If our doctors see things, and if it will work better for them, we want to be able to provide that. If we don’t do it, someone else will,” Iocco said.

	But evaluating new material options is certainly about much more than just hopping onto the bandwagon of a successful mass-marketing effort. Jackson said materials development really is about the science underlying the material’s physical properties. The more novel the material, the more of that research and success in pre-clinical trials he wants to see before being ready to take it and run.

	Both Ziemek and Iocco agree that seeing published research is a key factor when evaluating a new material. Seeing long-term studies showing success in patients’ mouths can be powerful evidence in favor of something new. Still, Ziemek said finding time for this is a difficult necessity.

	“Things are changing so rapidly that you almost have to have people involved in researching these developments,” he said. “For a small lab, it’s tough.”

	For Jackson, watching the latest developments in materials science is both a passion and a key part of his role at Precision Ceramics. At CE events, Jackson spends all his time in the materials science sessions rather than the technique-focused courses. He also reads journals and stays involved with online forums for the dental technology industry, but also for the engineering and medical device industries, because Jackson believes that much like with zirconia and titanium, the next wave of materials to shake up the dental world are already being developed and used in other industries.

	“This is a cottage industry, and we get trickle-down technology,” he said. “I can tell you with a high degree of confidence that the next generations of materials are going to be resins, and some of that technology is going to be coming from medical and defense industries.”

	All of this research is crucial because Jackson wants to keep himself and his lab from being caught by surprise when new developments arrive. Still, even if he is familiar with their uses in other industries, when materials are launched for dental use, Jackson approaches with caution because he can recall a number of times he jumped into something new only to get caught up in unexpected failures.

	Failures of new materials usually are not because of problems with the material’s physical properties, as much as how those properties get adapted to dental purposes. This is why Jackson’s evaluation process takes more than just the material itself into account. For him to be sold on something new, the entire system of working with it from the lab’s processes to the way it will be seated in the patient’s mouth needs to be backed by sound evidence.

	“When I evaluate something new, I look at what other materials are going to be used with it to see if this is going to be some sort of cohesive system,” he said. “I keep up with this stuff because I have to. I’ve still got another 25 years in this industry. I have to constantly stay a step ahead and keep my eyes on the horizon.”

Designed for efficiency with just one porcelain and one ingot, DENTSPLY Ceramco’s Ceramco iC system can be used for a range of restorations and combination cases.
					Photos courtesy of DENTSPLY Ceramco

	Staying on top of the latest research and development news is an important part of the process, but knowing your lab internally is just as important. It is that knowledge that will tell you when a material is not just a fit for the industry, but a winning addition to your lab. Jackson said having a clear vision for his lab is really the first step of evaluating new materials.

	“In choosing new products and materials, I can never lose site of the direction we’re headed and take little side trips,” he said. “I need to look at the long term objective and make sure every new product and everything we do is headed in that direction.”

	For Precision Ceramics that direction is all-digital design without a physical model and automated production out of monolithic materials. When a product fits into this workflow and comes with an easy-to-identify client base, Jackson gets excited.

	“If those two things come together and match up, then that tells me, yeah, ding-ding-ding, this product is a winner,” he said.

	For Iocco and Dimension, figuring out when a new product is a match for his lab involves assessing the general dental lab marketplace. When new options match up with his existing technology and workflows, the transition is easier, but he’s always trying to proceed with caution to be sure he doesn’t go full speed with something that doesn’t pan out six months later.

	It’s a balancing act because waiting too long to launch a product can mean losing accounts to other labs providing it earlier. Iocco said he likes to at least have things in an internal testing phase so he can be ready to launch when he sees indications the market is ready.

	“We’ve been burned on a couple products over the last 20 years, so I don’t like to be the first lab to have a product. But you don’t want to be the last guy on the bus because by then the bus is already full,” he said. “When we hear a couple of our doctors ask us about something, we know it’s time to introduce it.”

	Being ready to go with that new material can be fairly simple, or it can require an overhaul of the lab’s production process. When he added Ivoclar Vivadent’s e.max lithium disilicate it was simple because it fit with his lab’s milling and pressing workflows, but Iocco said regardless of how smooth the transition will be, he still needs to have his technicians on board with the change early in the process. He starts building staff buy-in as soon as he identifies a potential new product for the lab.

	“If it’s something that’s going to give us a better product, save us time and make us more profitable, then we’ll bring a rep in and have the rep talk to our staff,” Iocco said.

	Being in regular contact and having a good relationship with the material manufacturers helps Ziemek when he is adding the new products as well. Having a level of trust in that relationship means you are confident that when a company tells you something will work, it will work, and when they train technicians on proper use of the new product, the lab will be ready to work with it correctly.

	Manufacturer training followed by first-hand experience is extremely important to evaluating a new material. But that hands-on experience working with the new material has to be about mastering the steps taught by the manufacturer and figuring out if those processes work for you.

	Ziemek said the companies producing the materials have really done the R&D homework and when there are problems with the end result, it is usually because the lab was not following instructions. Iocco added that working with trusted manufacturers helps inspire confidence and speed up the process of moving from one generation of materials to the latest development.

	“You always hear of some dental technicians who shortcut things. You can’t do that. What makes us think that we can shortcut it and still have the material react the same way?” Iocco said. “If you use the manufacturer’s recommendation, it usually works out fine. Then it’s just fine tuning it for our esthetics and how we work it into our workflow at our lab.”

	Jackson also comes down firmly against deviating from the manufacturer’s recommended processes and protocols. He said it is important to work with one entire product system because that manufacturer has done its research and trials with those components working together. His view is that mixing elements from one company’s system with those from another for use on a case to be seated in a patient’s mouth is an experiment with that patient as an unknowing subject. Jackson and his lab are not willing to go that far to get satisfactory results.

	“There’s no room for gut instinct any more. What we do is evidence-based,” Jackson said. “If we find a product, I don’t care if it’s really popular and everybody does it, if it doesn’t work for us without being bastardized or adulterated, then it’s just not a good fit for my lab. When I’m working on actual cases to go in a human’s mouth, I’m not going to find any new tricky techniques because I’m not trying to.”

	He does participate in beta tests, and those are the times he tests different firing protocols or looks for ways to achieve greater efficiencies and higher-quality outcomes. However, when a case is destined for a patient’s mouth, everything is done by the book. Jackson said using a company’s material puts a lab into a partnership of sorts with that company and links their professional reputations to the restoration’s success.

					Photo courtesy of Glidewell Laboratories

	Of course in today’s dental landscape, those partnerships forged over materials go beyond just the ties between labs and the companies developing the materials the labs use. Outsourcing production of copings, bars, frameworks and entire restorations is now common, and smaller labs are able to take advantage of these opportunities to expand the material options they can offer their dentists.

	Iocco said the ability to tap into milling centers and outsource labs is a way for smaller labs to build business around a new material without investing in new equipment. His lab only made the investment in their own mill after generating a steady flow of porcelain fused to zirconia crowns. With the business in place, his investment in a mill was offset by being able to cut his monthly outsource bill.

	Moving to in-house zirconia production went smoothly for Iocco because his technicians already knew how to finish the milled copings. There still was a learning curve as his technicians mastered running the mill, but Iocco said this was no different than working out the kinks of any new product.

	Using a new material is the only way to overcome this learning curve. When Ziemek’s lab is mastering a new material he doesn’t like to put a set timeframe on the process. Doing that could mean sacrificing in quality, which is not fair to the dentist or patient receiving the restoration.

	Confidence that the new product will offer some advantage over what the lab currently works with is necessary to making the internal testing process worthwhile, Iocco said. Confidence also comes into play when figuring out exactly when demand exists and it’s time to launch the new product.

	“That’s the gut part of materials,” Iocco said. “That end of it-when we put it out there-you don’t want to be too soon, and we want to make sure we know what we’re doing here.”

	Jackson knows when his lab is ready to green light something new because the lab follows good manufacturing practices (GMPs) with detailed quality control programs that allow him to track every step of every restoration making its way through the lab, identify problems and trace their sources, whether it’s a bad batch from a manufacturer or a flaw in the workflow.

	He has assurances of the training of his staff, the calibration of his equipment and that all of the procedures are documented. As long as things are done properly, anomalies are easy to spot, as are new products that aren’t performing as expected. Jackson said he was spurred to enact such rigorous recordkeeping after experiencing product failures in the past. While they now help him spot new products that aren’t going to work for his lab, they also taught him the importance of the manufacturer-recommended protocols.

	“Our GMPs here give me a lot more confidence when launching new products,” he said. “Once I had good manufacturing practices in place, all of my product failures and product problems basically went away, which tells me a lot of them originated right here in my lab.”

	Once a lab has worked out the kinks and built up confidence in efficiently achieving quality with a new material, it still needs dentists interested in prescribing those restorations. Lower-cost options are always a good selling point, Ziemek said, but the best way to effectively launch something new comes from working closely with the dentists sending cases to his lab.

	While testing a new material, Ziemek reaches out to a handful of dentists to find cases that can be completed and seated before the lab is ready to offer the new material to everyone. Working with dentists this way builds trust on both sides and allows his lab to train the dentists a bit when new materials require specific preparations to work effectively.

	Iocco works with dentists in a similar way and offers different dentists early access to different products so everyone working with his lab feels valued and has a chance to get in early on his next big thing. Still before bringing dentists into the equation, Iocco needs to have complete confidence in his new products so he is not sending out a case he considers to be a test.

	“Our doctors rely on us, and they trust us. We have to be very careful not to abuse their trust,” he said.

	Not every new product works as well as he would like, but Iocco said the materials being developed are exciting, and he plans to continue putting his lab in a position to work with the best options available.

	“Our industry has changed so much in the last 10 years,” he said. “I can’t wait to see what happens in the next 10 years.”

 Flip through the pages of an issue of Dental Lab Products or walk a tradeshow floor, and you’re likely to cross paths with at least one new material. Keeping up with the stream of new options for your lab can be almost dizzying.

Materials: Science Vs. Gut

	Someday chairside digital impressioning may be standard operating procedure and cases will go directly from the operatory to a lab’s computer, but until then, lab scanners will be the main gateway to digital workflows.

	Last month the SCCAN series focused on network connected scanners that link a lab with the scanner manufacturer for both the benchtop technology and production of the digitally designed restorations. This month the focus shifts to open-architecture scanners designed to give a lab options in both digital design and physical production.

	Open scanners such as systems produced by 

 allow labs to send digital restoration design production on any number of mills, 3D printers and other CAM systems. This means open scanners can bring digital efficiencies to just about any workflow for any type of restoration a lab produces, and users have their choice of production partners, materials and just about every other detail.

	“This provides the users flexibility in choice of manufacturers, allowing for freedom and competition,” 3Shape International Product Manager Sven Nonboe said.

	Adding digital processes to a lab is really about leveraging technology to increase efficiency. Working from scanned data for digital case design can allow the lab to automate some of the more labor intensive steps in the fabrication process, and an open system lets the lab choose which parts of the process are to be done digitally and which will still be hand crafted.

	Nonboe said 3Shape’s system is designed around that type of flexibility with a full-range of indications available through the company’s DentalSystem™ software, which can be used for everything from basic coping design, to full-contour crowns, implant bars and removable partials. The “user-friendly yet flexible” system guides the user through the scan and design steps allowing people to get to work quickly and at a quick pace.

	“With 3Shape’s CAD/CAM, a technician can design a coping in under two minutes,” he said. “Even complex restorations such as removable partials can be designed in less than 12 minutes, reducing production time in relation to the conventional manual process by 70-80 percent.”

	Those efficiencies are of great benefit to a busy lab, but the scanners also should let lab technicians make use of the skills, knowledge and techniques they already possess within the digital environment. One way 3Shape is trying to accomplish this is through the high-quality scans captured by the 5 megapixel cameras of the company’s new D800 scanner, which is capable of detecting hand-drawn markings on models being scanned, whether they’re removable design sketches or margin lines. The software then picks up on these lines and automatically incorporates them into the digital design. Nonboe said synergies between the scan and the design technologies are designed to be efficient so labs can achieve optimal outcomes via digital production steps. And these synergies go both ways between the scanner and the software.

	“For example, if the user selects a certain indication and teeth in the order form, the software can relay the information to the scanner to ensure optimal scanning for the specific order,” he said.  

	Getting into scanning via an open-architecture scanner does leave the lab with many decisions to make. What products will be produced based on digital designs? Will all or just part of the case be done digitally? Will production be done via a mill or printer in-house? If outsourcing the production, who will the cases be sent to?

	With open systems, labs face these choices, but they’re also not locked into that decision once the choice has been made. If an outsource production partner isn’t delivering the expected quality, the lab can look for another place to send cases, or even another material or fabrication technique to test out.

	Labs also are not left on their own when approaching these decisions. Dental Wings scanners are sold through Zahn Dental while 3Shape scanners are available through a range of resellers. Labs can look to theses sources for both training and production recommendations.

	“3Shape resellers will assist users setting this up, so sending a case is as easy as sending an e-mail,” Nonboe said.

	Open scanner systems allow labs flexibility to change and expand how they work. If digital business grows, a second workstation can be added to the system so the same scanner can be sending cases for design by two technicians. If a lab starts off sending designs out for production they are not locked into using the same system or materials when deciding to bring some of that business back in-house.

	Just as they’re designed to be flexible in how they can be used, open-architecture scanner systems are just as flexible when it comes to being a good fit for a lab. Nonboe said 3Shape now has an entry level D500 scanner for smaller labs, and the technology can be put to use in both specialized labs and full-service operations.

	While milled restorations seem to be the first thing people think of doing with digital workflows, Nonboe said with 3D printing and other production technologies available via outsource and in-house systems that can be connected to the 3Shape scanner and software, labs can go digital for some processes without becoming strictly CAD/CAM operations.

	“CAD/CAM is obviously a prerequisite for some materials, such as zirconia, but the use of 3Shape is by no means limited to that-you can use it for milled ceramics, PFM, implant bars, abutments, removable partials,” he said.

	That freedom is the biggest advantage to open systems. Labs going this route are setting themselves up with digital options. The lab can make a digital transition at its own pace and if that plan isn’t working, it can be changed. 3Shape is committed to improving its software and hardware to provide labs of all sizes with more opportunities and options via digital production.”

 Someday chairside digital impressioning may be standard operating procedure and cases will go directly from the operatory to a lab’s computer, but until then, lab scanners will be the main gateway to digital workflows.

Open to the possibilities

	The opportunity to do some professional concert photography came about as a surprise bonus from the freelance writing I’d been doing for a number of music publications. I was offered an assignment covering Lollapalooza as long as I could provide them with both the copy and accompanying images, and even though I hadn’t done much serious photography since taking a handful of classes back in college, I wasn’t about to turn this opportunity down.

	This unexpected gig more than five years ago has lead to a fun sideline to my career at DLP. In that time I’ve shot thousands of photos of hundreds of performers, and I’ve done almost all of this with a now five-year-old Canon PowerShot S3 IS that is quite often the smallest, oldest and least powerful digital camera in the hands of anyone with photography credentials for the event.

	At the time I purchased this sub-DSLR shooter, it was the best option for my budget because it offered me full control of all the camera settings and an impressive for the time 12X optical zoom. The 6 megapixel digital sensor seemed pretty powerful back then too, but today there are smartphones with twice the megapixels.

	These days the gadget you just purchased is probably out of date by the time you finish unboxing it, yet I’m still using my woefully out of date camera in a professional capacity and I’m not looking to upgrade any time soon. I know exactly how to coax the shots I need from this camera, how to change the settings to match light conditions, when and how to employ the flash, and the best angles from which to approach a shot to capture the image I want.

	When I’m shooting at these events I find myself surrounded by other photographers holding $20,000 camera bodies with equally pricy lenses attached. My camera cost me less than $400 brand new. Still, the results I achieve not only meet the requirements of my assignments, they often impress my photographer colleagues when we compare our work online after the show.

	Of course the camera has its limitations. A larger lens would make low-light situations easier to shoot. A more powerful sensor with three times the megapixels would allow me to print larger sized images. But I know these limitations going in. In my years of shooting with this camera I’ve learned just how far I can push it in any situation, and I make the most of what it can do.

	Besides, upgrading would come with a cost, and not just the dollar signs on the pricetag. Upgrading to even the latest generation of equivalent camera from Canon would certainly be a quantum leap in capabilities. It would also mean a learning curve, as I would need to master the nuances and figure out how to best employ new features. It’s something I’ll certainly do eventually, but for now the gear I have on hand is up to the tasks it’s asked to accomplish.

	My camera remains fully functional, has never required any maintenance and keeps on capturing the images I ask it to. As long as it continues to meet those requirements I have no need to grab the current best thing available. I’ve gotten a similar lifespan out of my MacBook laptop-albeit with some maintenance along the way. In the case of both of these devices, they continue to be fully capable of handling all the jobs I need them to and they’re reliable in doing this.

	With both of these devices I did my homework before making my purchase to make sure they not only did what I needed them to do the day I brought them home, but that they had a bit of headroom in the capabilities so they could meet expanded needs in the future. Sure my old camera has long bumped up against its full capabilities, but until my photo needs grow beyond what it can do, I’m happy to keep using it.

	I read reviews prior to making my purchases and for the computer, I also sought out reviews of people running the software applications I planned to use on that specific system. I even sent an email to the author of one review with a question, and the response I got helped me make my decision.

	Once my purchases were complete, I made sure I learned as much as I could about how both devices work, what they can do and how to get at all of their controls. This is a good practice with any technology investment, whether it’s for personal or professional use. When I get something new, I not only read the manual completely, but I keep it around in case I need to double-check something in the future. Of course actually playing with the gadget, pushing every one of its buttons and watching the results is a good learning tool as well.

	Of course nothing is expected to last forever, so it’s always a good idea to go into a purchase with an idea of how long you hope to have something around. Sure sometimes machines break down ahead of schedule, but for the most part if the capabilities meet your requirements and you care for the device it should reach your planned lifespan.

	By pushing it to those limits, the eventual upgrades become amazing leaps forward and make a technology you’ve grown familiar with exciting and new once again. The timing of those upgrades is easy to see as well. When the device is no longer able to do what it was purchased for, it’s time for it to be replaced.

	That’s when the homework starts and it’s time to look at the newest in whatever technology category you’re looking at. There’s no sense in buying last year’s model to save a bit of money if you’ve planned for your new device to stick around for a while.

	Today’s technologies are so powerful they often are more than up to the task at hand, and getting something that will reliably do its job for a long time should not be difficult. Sure something with a few more features will come along next week, but if one of those features was mission critical to your investment, you should have waited that extra week in the first place.

	There’s always going to be something new on the store shelves and something even newer on the horizon, but that doesn’t mean technology should be disposable. These gadgets that are becoming more and more integral to our work and our lives can last for years. It comes down to making sure it’s the right technology from the start, it’s properly cared for and the full range of its capabilities are put to use.

 The opportunity to do some professional concert photography came about as a surprise bonus from the freelance writing I’d been doing for a number of music publications. I was offered an assignment covering Lollapalooza as long as I could provide them with both the copy and accompanying images, and even though I hadn’t done much serious photography since taking a handful of classes back in college, I wasn’t about to turn this opportunity down.

Tech Smart: Maximum use

	Available in three models to meet every dentist’s needs and budget, the LightWalker line of lasers includes a single Er:YAG and two dual Er:YAG/Nd:YAG wavelength models designed for hard- and soft-tissue applications.

	All three models feature the Er:YAG wavelength and are >designed to perform fast cavity preps rarely requiring anesthetic, along with soft-tissue surgeries, and other minimally invasive procedures including the proprietary PIPS™ endodontic protocol

	With the dual wavelength 8-watt DT model, users gain Nd:YAG wavelength capabilities and can perform expanded soft tissue options including the proprietary WPT™ periodontic protocol. 
	
	The dual wavelength 20-watt AT model can be upgraded for esthetic treatments such as wrinkle removal, permanent hair removal, and skin resurfacing.  

	The company offers a comprehensive training continuum with courses for beginner and advanced laser users.

 Information available at laresdental.com  Available in three models to meet every dentist’s needs and budget, the LightWalker line of lasers includes a single Er:YAG and two dual Er:YAG/Nd:YAG wavelength models designed for hard- and soft-tissue applications.

Making the cut

	1. With a life of 30,000-plus hours-10 times longer than halogen-the everLight eliminates the need to replace light bulbs.

	2. Using 70% less electricity than halogen-based systems the everLight’s use of less than 35W of energy is said to help lower energy bills.
	
	3. The 100% true direct LED lighting remains at a consistent, cool temperature, eliminating the need for noisy fans or reflectors.
	
	4. Equipped with nine color temperature/intensity settings, everLight is ready to meet a variety of operative needs including focused, shadow-free, color-corrected lighting.

	5. The everLight’s natural daylight illumination provides clearer oral cavity visibility and precise color matching, and the composite setting will not cause pre-maturing on composite materials.

		A delivery unit for patient comfort and clinician convenience: Group Simplicity from DentalEZ

		Comfortable operatory seating: Generation Stool from DentalEZ

	Magnification can help you take advantage of what the light illuminates, and companies such as Orascoptic (

) offer a range of loupes to fit just about any clinical need.

 1. With a life of 30,000-plus hours-10 times longer than halogen-the everLight eliminates the need to replace light bulbs.

Lasting brightness

	Dr. Matthew Young’s West Hendersonville, N.C., practice is free of many things that can be commonly found in many dental offices. He practices without fluoride, without the use of any latex products and does not place any mercury amalgam fillings.

	As a practitioner of “biological dentistry” Dr. Young regularly questions conventional dental wisdom and is always looking for new science to demonstrate whether or not the materials and techniques he employs are biocompatible with his patients and safe for both them and his dental team. As a member of the International Academy of Oral Medicine and Toxicology (IAOMT) he helps fund research into the toxicology of dental materials and works to promote high standards of both care and safety.

	“We’re not dogmatic in that we insist everybody fall into that pigeon hole, but we try to be a little bit broad minded with our diagnosis and the way we treat patients,” he said.

	Formed more than 25 years ago, IAOMT works to “bring scientific evidence into the issues facing dentistry,” said Dr. David Kennedy, fluoride information officer and past president of IAOMT. He believes dentists generally do not pay enough attention to recent scientific findings and stay too rooted in the way they were taught to do things in dental school. He said the industry would be very different if the latest science was more of a guide to the way people practice.

	“It would fundamentally change the profession because they obviously would choose to use many different materials in their care and a totally different approach to treatment of gum disease and the prevention of tooth decay,” Dr. Kennedy said.

	Due to the toxicity of elemental mercury, protecting the safety of both patients and clinicians by eliminating the use of mercury amalgam is at the heart of the biological dental movement, and one of the issues IAOMT advocates on with the most vigor. While some dentists and even the American Dental Association continue to proclaim that the mercury in dental amalgam is safe for patients and clinicians, Dr. Young cites a 1996 report by Health Canada among the many studies showing that the mercury content of amalgam does not stay confined to the restorations and poses a health risk for both patients and clinicians. Dr. Kennedy adds that according to the Environmental Protection Agency, there is no safe level of exposure to mercury.

	Safety is at the heart of Dr. Young’s argument against amalgam, and he is quick to point out that OSHA’s Permissible Exposure Limits (PELs) on mercury are easily exceeded during common dental procedures such as autoclaving tools used in amalgam placement or removal. Noting that a horse liniment and mercury amalgam fillings are the only two medical-related products that still contain elemental mercury, he questions why dentists do not follow the same OSHA protocols as manufacturers of batteries or fluorescent light who use mercury in their businesses.

	“They all have to follow the same PEL guidelines set by OSHA, but for some reason dentists and dental employees are exempt,” he said. “We’re trying to get into the 21st century as far as workplace safety goes, and to make the dental office a safe place to work.”

	While his practice is among the many that no longer place amalgam fillings, Dr. Young still deals with patients who have had the fillings placed by previous dental providers. To keep his employees and patients as safe as possible, he monitors the air quality in his practice to make sure it is well below the mercury PEL. When removing amalgams from patients, he follows a set procedure that includes independent air for his patients to breath, and HAZMAT style masks for himself and his assistants.

	“Our protective gear and our protective technique that we use helps to make it safer for everybody,” he said.

	But while the ADA still promotes the safety of amalgam and Medicaid supports its use by basing reimbursement levels for dental fillings on the cost of amalgam, Dr. Young thinks the industry is ready to move away from the material, albeit slowly. While he wishes dentists were better educated on this issue, Dr. Kennedy said patient pressure is currently driving the move away from amalgam use. Dr. Young hopes that trend continues so he can practice in a world where amalgam becomes something from dentistry’s past rather than a standard of care.

	“The patients are demanding a more natural looking and compatible material,” he added.

	The compatibility, or as he puts it “biocompatibility” of dental materials is another key to the way Dr. Young practices. With new products constantly on the market he and the IAOMT regularly test new materials to see if they emit harmful chemicals or pose any other risks. But beyond that, it often comes down to what material works best for an individual patient.

	“We’re going to probably be looking at things a little differently,” Dr. Young said “Some patients are chemically sensitive to certain materials. We tend to go as metal free as possible, and we try to use materials that don’t give off any chemicals.”

	Dr. Kennedy said IAOMT bases material recommendations on standard risk assessment models and published peer-reviewed research. The academy also hires specialists to evaluate the safety and biocompatibility of dental materials.

	Sometimes it’s a patient-by-patient thing where different people react differently to different materials, and other times patients arrive in Dr. Young’s office seeking help because a restoration placed by another dentist seems to be causing issues, such as an allergy to nickel reacting badly to a PFM crown and irritating the gingiva.

	While he is always trying to stay on top of new material options that might work better, Dr. Young said he has great success with 3M ESPE’s Filtek Supreme composite, likes to use Flexite for dentures because it is non-acrylic and doesn’t outgas monomers, and is a big proponent of the all-ceramic crowns he can produce with Sirona’s CEREC system.

	“The patient gets it in one visit so there’s no temporary or impression material that you have to use,” he said of CEREC restorations.

	In describing how the concept of biological dentistry fits into his practice, Dr. Young said there is more than just promoting patient and employee safety, eliminating amalgam and using biocompatible materials with his patients. Those are just some of the principles that guide how he provides care. Guided by the connection between oral and overall health, Dr. Young promotes good nutrition and hygiene for his patients. He is also a strong believer in patient education and informed consent.

	Before treating a patient, Dr. Young tries to make sure the patient understands not just the end goals of what he is going to do, but everything involved in the process. He likes to explain the details of the materials he will be using and the possible impacts the procedure might have. It is a very patient-specific process and his recommended treatment is never based on a one-plan-for-all-situations model.

	“We don’t necessarily say that everyone who walks into the office with amalgam has to have it out right away,” he said. “There’s a big spectrum of differences in the way a patient reacts to a non-compatible material.”

	For now the biological dentistry movement remains a small part of the American dental landscape. One of just a handful of biological dentistry organizations, IAOMT has about 700 members. Still, Dr. Young remains optimistic that the way he practices will become more common in this country.

	While he is aware that change comes slowly to the standards that govern how care is delivered, he is encouraged by the trend moving away from the use of amalgam. He would welcome more emphasis on OSHA regulations and workplace safety in dental schools, but for now would be satisfied to see dentists embrace a more environmentally friendly approach through expanded use of mercury separators in all offices.

	“The main thing would be to educate the general dental community on how to think outside the box, how to improve their employee safety and their patient safety,” he said. “We’d like to use the environmental aspect as a way to improve the standard of care, and at least get everybody on board with safer handling of the materials that we already use.”

	Noah Levine is a senior editor for DPR. Contact him at 

 Dr. Matthew Young’s West Hendersonville, N.C., practice is free of many things that can be commonly found in many dental offices. He practices without fluoride, without the use of any latex products and does not place any mercury amalgam fillings.

The biological approach

	Improving on existing functions and adding expanded capabilities, 3Shape’s Dental System™ 2012 software is designed to provide CAD/CAM solutions for new indications, help dental labs increase productivity and help dental labs help their dentists.

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		Dynamic Virtual Articulation allows automatic and manual jaw movement

		Implant abutment and bar design compatible with most major implant systems

		Rapid removable partial design for fabrication of both metal and flexible restorationss

 Information provided by 3Shape.  Improving on existing functions and adding expanded capabilities, 3Shape’s Dental System™ 2012 software is designed to provide CAD/CAM solutions for new indications, help dental labs increase productivity and help dental labs help their dentists.