Noah Levine

DLP Tech Census 2011 | Image Credit: © Dmitry - stock.adobe.com

But just because things can be done in new ways with new tools, doesn’t mean people want or need to make those changes. With the 2011 Tech Census, Dental Lab Products took a look beyond what technologies are available for dental labs today to ask lab owners and technicians about which technologies they’re actually using and what they see as the most helpful to their business.

The results show an industry interested in the benefits technology can bring, but one moving slowly along the path toward greater automation and computer-driven production. The reasons for this are many, but the experts who shared their thoughts for this story all agreed that labs of all sizes get the most out of technology when they take a deliberate approach to integrating it into their workflows and business models. The high-tech dental lab that’s often talked and written about is still hanging out on the horizon, but based on the survey results, for most of the industry, it remains some distance away.

“Right now it’s like the wild west. It’s a shoot out with everyone throwing time money and energy at these new ideas,” said Dave Lesh, CDT, founder of Dale Dental. “But when you look at the proliferation, what’s actually making its way to the street and how people are using it, I think the reality falls short of what the expectations are.”

That same sentiment is shared by Lee Culp, CDT, Chief Technology Officer for DTI. He said the industry is “not even in the ballpark” of having shifted to technology-based manufacturing, and the slow pace of adoption was part of what led him to move from developing CAD/CAM systems for companies such as D4D Technologies to his current role implementing and managing technologies for a network of labs. 

While working for D4D he heard from one lab owner who was happy with his new system, but just using a fraction of its capacity and capabilities. When asked why he wasn’t using it more, Culp said the lab owner replied, “if I did any more my waxers wouldn’t have anything to do.” This showed him that while people want new technologies the commitment to them isn’t always there, and developing technologies that weren’t being used was less fun than putting those systems to work himself.

In his current position, Culp is able to help CAD/CAM and digital production technologies become more than just a department for DTI labs, but an integral part of how the labs work. He said for technology in the industry to ever take off in a big way labs must not only dip a toe into digital systems, but must actually make it a key part of everything they do.

“Are they using it? Have they fully integrated it into their laboratory? Is it a major part of what they do every day? Not even close,” he said.

The Tech Census bears this out. While CAD/CAM systems have made gains in the industry, they are far from being the norm. Just 39% of the survey respondents have invested in a 3D scanner and 28% have a mill for in-lab fabrication of the digital designs, (see “Technology in use”). Even more telling are the statistics showing 20% of labs have no interest in purchasing a scanner and more than a third of respondents said they don’t plan to purchase a mill.

For labs that have not only purchased these systems but successfully integrated them into their business, the investments have been worthwhile. As Lab Manager at Ziemek Aesthetic Dental Lab, which has handled more than 10,000 digital impression files from dentists using 3M ESPE’s Lava C.O.S., and other digital scanners on the market, Jamie Stover, CDT, said adopting and integrating the Lava system along with technologies from 3Shape, Sirona, Dental Wings, and other companies has been very good for his lab.

“Digital impression technology definitely works, and we utilize it in our lab every day. I feel we’ve only scratched the surface of that technology. It’s just going to get more accurate, more affordable, and faster,” he said.

This is a point on which Culp agrees. The technology currently available has the potential to change the industry because of the efficiencies it can bring. Both in his work at technology companies and in his work at DTI, Culp said he has seen a range of economic measurements that always show the benefits of CAD/CAM.

“There’s no question that going digital is a better business model for profitability, efficiency in production, turnaround time and everything you could possibly put a stick to and measure,” he said.

Still labs aren’t yet racing to snatch up systems, Lesh said. While the technology provides a better way to accomplish many tasks labs do every day, it doesn’t provide a better outcome in every single task. Labs evaluating new technologies must be careful to assess where, how and why the investment will benefit the bottom line, and figuring out not just what type of technology will provide the biggest benefit, but what exact system is the best fit for a particular lab. That can be a confusing and time consuming process.

Labs evaluating scanners and mills aren’t all that different than a consumer looking to buy a new smartphone or an iPad. The rate at which new and improved systems appear can make it difficult to feel good about making an investment, and once a lab does sign the check it has to be ready to stay on top of the system upgrades that will arrive sooner or later.

Lesh said it can be especially difficult for smaller labs to make sure the rewards of the technology will be greater than the financial risks of the purchase. With improvements happening so fast, a lab investing significant capital in something ideal for their business today, might soon find themselves behind the technology curve.

“You’re always chasing the flavor of the month. Now it just becomes a question of how much money you’re going to spend to chase it,” Lesh said. “I think it’s always going to be a problem.”

Waiting for the technology to reach a level where it will be a good fit for the lab is very important, Stover said. While Ziemek is a high-tech operation, the lab hasn’t yet invested in a wax printer or an in-lab model production solution because the available technologies in those areas cannot produce higher quality work, faster and at a lower cost than the technicians on his staff. Until he sees a system that can accomplish that, he’s happy with the way his lab operates today.

For it to be a successful investment, adding a new technology needs to involve more than just finding something that adds efficiencies, plugging it in and powering it up. It needs to be a commitment from the whole lab to doing things in a new way, and that involves business planning, training and a commitment to the transformation.

The new attitude required to succeed with technology needs to be in place before a new system, Culp said. At this point he doesn’t see the shift in mindset happening throughout the industry, and is thus not surprised that technological adoption hasn’t happened at a faster pace.

“We know the technology works, but the biggest changes are not technological. What it really takes is the cultural change and the people change and the philosophical change of moving the manufacturing platform and a full and total commitment of putting every model through that scanner,” he said. “As an industry, we have not made that cultural change.”

While the industry might not be ready to completely embrace every new technological solution today, there does seem to be plenty of interest in the high-tech options on the market. Just 13% of Tech Census respondents said they have little interest in adding new technologies to their labs, (see “Technology profiles”).

Instead most lab owners expressed interest, but a cautious approach to adopting new ways of producing restorations via technology. More than half of the respondents said they need to see a technology working for themselves along with other evidence of its capabilities before adopting a system. An additional 25% said they focus their attention on the potential for a new technology to improve their lab’s bottom line before making an investment.Those two approaches sound about right to Stover, who said Ziemek’s approach to evaluating new systems begins with an internal investigation of the lab’s current operations. Once logjams and inefficiencies have been identified, the lab sets out to see if there is a system available to address those issues. Stover said the people who work in the lab are always more important than the technology, so he’s looking for systems that make his technicians’ jobs easier so they can accomplish more.

“We evaluate what the technology is and exactly what it can do for us today as well as its future potential,” he said. “The technology is very good now but in most cases it can’t replace a technician at a high-quality lab.”

In fact, Stover said it is his technicians who help his lab stay up to date on all the high-tech options available in the industry. Keeping the lab on the cutting edge means technicians are encouraged to be proactive in looking at what’s available by reading industry publications, searching the Internet and talking with colleagues at other labs.  The technicians are proactive because they have seen first hand the benefits of using these technologies in the lab every day.

“Nobody is going to take you by the hand and show you all the new technology available, itemizing exactly what it can and can’t do in your lab. You have to go out and look for it,” he said.

Knowing what ‘s out there is important, but knowing why you want to invest in a technology and how you plan to use it is just as critical. While some Tech Census respondents said they invest in technology because it helps them compete with labs in their area or offshore labs, Stover said being able to meet the requests of your dentists should be the biggest motivation.

“Investing capital in technology for the sole purpose of competing with a lab across town is a risky strategy. Every lab has different technicians, different approaches to creating restorations, different profit margins,” he said. “A lot of labs that buy with this reason as their motivating factor won’t be happy with the ROI.”

Putting a system to use is very important, but trying to shoehorn every prescription through the scanner a lab invested in to make the payments on the system is not going to lead to the best results for the lab, the dentist and most importantly the patients. Listening to dentist requests and investing in the technologies they want their lab to be using, and at the same time informing them of the latest restorative materials available, can be important parts of retaining their business.

Stover said Ziemek not only asks dentists what types of restorations and materials they want to use, but why they want them. If a lab has a lot of accounts restoring implant cases with implants from Nobel Biocare or Straumann, it might make sense to invest in the CAD/CAM systems produced by those companies. This way, the lab is able to provide genuine parts to match those implant systems while having control of the design process.

“Some dentists are more particular about the parts they’re placing, if they have a Nobel (implant), they want to get a Nobel screw and a Nobel custom abutment,” Stover said. “If they have a Straumann implant then they feel more comfortable about getting Straumann genuine parts.”

Of course not every lab can afford to invest in a scanner from a specific company to offer parts from that company, and this is where outsourcing can be a valuable resource. Whether sending a case to a milling center, or to a manufacturer providing production services such as Nobel Biocare or DENTSPLY Prosthetics, labs have a range of options for producing restorations via materials, processes and technologies they cannot afford to work with completely in house.

Lesh’s Dale Dental was a pioneer in the outsourcing business model and he has made it his business to not only stay up to date on available production systems, materials and fabrication technologies, but also to form strategic partnerships with manufacturers including Straumann, Nobel Biocare, DENTSPLY Prosthetics and others that enable Dale to produce genuine parts that match their products.

Lesh described it as being akin to a pharmacy where dental labs can go to get whatever they need to fill the prescription sent in by the dentist. He wants to make it easy for labs with minimal investment technology to access the latest production methods and materials.

“Our commitment to our customers is always to have all the restorations that they need,” he said. “Ultimately, everyone will need a product that they can’t make.”

Even a lab chain such as DTI with its own industrial scale milling capabilities uses an outsourcing model for CAD/CAM production. When Culp began in his new position with the company, one of his first moves was to move the CAD/CAM technicians out of their own department so that the digital processes would be integrated into the overall workflow of the lab. However, this was just for the design of the restorations. The production technologies were moved to one department and now all DTI labs outsource to their in-network production facility that can operate with the efficiencies of working on a larger scale.

The majority of the people designing the cases sent to that in-network production center are not formally trained dental lab technicians, but designers who have learned the process starting with a computer design station. Culp said he stresses training to make sure his digital designers have a handle on the core dental knowledge required to produce a good restoration, but the technology can shorten the learning curve significantly.

“This digital does not take away education. It’s just something else to hold in your hand to make a tooth,” he said. “We’re just farther along so I don’t have to teach people basic tooth shape. Where you put that cusp tip, where the other cusp tip goes, how all the other teeth are going to relate to each other, the esthetics out of the mill, all those things are still extremely important.”

While Stover agreed that digital technology can make it easier to train people recently hired to work in a lab, he isn’t looking at the technology as a path to replacing his current staff. In fact training his staff to be experts on the new systems is a big part of the Ziemek business model, and getting buy in from the technicians working in the department most affected by the new systems is critical for it to be a successful addition to the lab.

Stover said he prefers for his technicians to become the lab’s experts on the systems automating the areas of production they’d worked in before the technology arrived, so their expertise can be leveraged into the efficiencies he hopes to achieve through the technology. As good as the systems become, he doesn’t know if they’ll  ever be able to create a high-quality crown by feeding in an impression and pushing a button. Because of this, designers trained just on CAD-and without a solid lab background-will only be able to do so much in the industry.

“It’s more difficult to take a CAD designer and turn them into a lab tech,” he said. “It’s easier to take a lab tech with a good lab skill set and understanding of form and function, and especially with the software these days, train them on CAD design.”

As much as his business is built on a foundation of technology, Lesh said he worries about its impact on the level of expertise to be found in the dental lab industry. People off the street might be able to use the software to design a crown, but without knowledge of form, function, occlusion and other principles at the heart of the work produced in dental labs, those people are completely at the mercy of the machines.

Lesh pointed out that when CAD technology moved into the architecture industry it didn’t lower the educational standards for architects, and the dental lab industry shouldn’t be any different. Putting someone who lacks training as a technician but is good with computers in charge of these systems may be the easier route for people to take when adopting new technologies, but that doesn’t make it right. Lesh said labs need to remember that their work ends up in the mouths of real people, and those people deserve a fully-functional prosthetic rather than a space-filler.

“You still need an architect who understands design and structure and support. You didn’t create an opportunity to replace them with somebody who has no skills, but knows how to work the keyboard,” he said. “CAD didn’t replace architects, why on earth would anyone think CAD would replace dental technicians, but yet people do it.”

This same mindset of taking the quickest path to producing restorations via technology also can lead labs down the wrong path when purchasing a system, Lesh added. New technologies can seem like a wonderful quick fix to boost efficiency in a lab, but spending the money to invest in technology requires a solid, long-term plan for how that system will increase a business’ bottom line.

Lesh said it’s important to start with examining the products the lab produces and those it wants to use technology to produce. However, factoring in the lifespan of the technology and how long it will be useful in manufacturing the restorations a lab’s dental clients are prescribing is an important step. Investing in a system that makes a restoration that happens to the flavor of the moment may seem great, but if the system isn’t adaptable, it could quickly be useless when the next big thing hits the industry.

It’s for this very reason that Stover is a big proponent of open-architecture technologies that allow a system to work with data from other systems, and to send designs for production on a range of mills and printers. Closed systems might work for a lab with business built around one niche product, but for most labs being able to handle a variety of materials and workflows is the only way for the product to fit into a realistic business model.

Coming up with that business model before the purchase is an absolute necessity. Stover said if a lab is profitable doing things the way it has been, it should have a solid plan for how the technology investment will increase those profits, or purchasing that system just doesn’t make any sense.
Currently there is no single system that can handle all materials and all restoration types for in-lab design and production. For this reason, Culp said small labs need to approach a big investment with caution. While certain products, such as full contour posterior crowns, lend themselves to CAD/CAM, a small lab that dedicates all its resources to one system needs to have a plan in place in case that system breaks down.

“It’s like a baby. You need to take care of that baby daily. If that baby gets sick you have a problem,” he said.

Large operations such as DTI are able to invest in extra production capacity so all is not lost if a mill goes down and needs repairs. However, if a lab cannot afford redundant technologies-and few small labs can-those that find digital production to be financially beneficial might be in even better shape by investing in just a scanner and a design station with outsourced production figured into the new costs of doing business.

Lesh founded his business on this outsource production model based on his strong belief that this is the best way for these new technologies to be implemented in the dental lab industry. Operations working on the scale of a Dale Dental can afford to make the large investments in expensive production technologies. This gives labs with or without in-lab scanning and design systems access to any product a dentist could request, and this means labs don’t need to go high-tech to provide restorations produced by the latest systems.

“I think it’s a good thing and I think that is the future,” Lesh said. “I still think labs are underestimating what’s involved with getting into scanning itself.”

But while technology might not be a great fit for every lab, many labs of all sizes are still finding that technology can lead to increased revenues. Labs looking to add new systems need to be committed to using the technology as much as possible, and Stover said arranging for a hands-on trial of a new system is a great way to get an idea of how realistic a plan actually is.

Many companies will allow a lab to spend some time using a new scanner or testing out new design software to see if it will work for that specific business. Stover said an in-lab trial period, “gives you a great idea of what you’re getting yourself into, and if the product lives up to the hype” and lets the staff members gain an understanding of how the new system might change the lab’s workflow and their individual responsibilities.

This also can provide a lab with a jumpstart on the training process, something else Stover said is key. Investing in new technology is about more than just purchasing a fancy new system, it’s also about investing in the technicians who will be using it, so getting them excited about being the expert on something new can go a long way toward successful integration.

“You need one person who is proficient with the particular technology, understands its benefits and limitations, and can then train others to be up to speed,” Stover said. “You need to put faith and trust into the technicians that you’re making that investment in, and then let them loose.”

Of course all the staff enthusiasm possible won’t help a lab be successful with a new system if that technology doesn’t either add new capabilities or improve on something the lab already does. If a lab doesn’t know how much it costs to pour a model by hand, there will be no way for the lab to know if adding a CAD/CAM model production technology will be a profitable move.

If a technology is going to be successfully integrated into a lab’s operations, the lab really needs to have a plan in place to use as much of that system’s capabilities as possible. Culp said labs should know how many years they expect a system to work and be confident the products that system produces will be in demand throughout that lifespan. Then it comes down to being dedicated to using that technology as much as possible.

“It’s a massive commitment and it has to be thought of that way,” he said. “Otherwise you’re just buying a toy.”

Despite all the words of caution, it seems clear to Lesh, Culp and Stover that technological and materials developments will continue to change the way restorations are created and alter the way labs do business.

At Ziemek Lab they are already producing some crowns without ever creating a physical model. For straightforward posterior cases that begin with a digital impression, this model-free workflow is proving to be an efficient solution for some dentists, but Stover said he doesn’t think this will become the process for all restorations, and models will still be a key component of complex cases.

While he hopes to someday have an open-architecture system capable of producing any type of restoration at his disposal, he knows change doesn’t happen in an instant and technology needs to produce a better end result, not just a faster one, before it will truly take over the industry.

“I’m a believer that PFMs will be around for a long, long time,” he said. “We do a ton of e.max and all-ceramic, but there are things you can do with a porcelain-fused-to-metal restoration that you still can’t get with an all-ceramic.”

Culp said he firmly believes in CAD/CAM, and he thinks the computerization of restoration design offers a range of benefits to labs of all sizes. However, he is less certain that the CAM part of the equation will look the same in even a few years.

Milling might be the state-of-the-art today, but as soon as there are additive processes for working with the materials labs use, those technologies will go by the wayside. Culp said printed zirconia is in the works and when it and other printable full-contour materials arrive, mills will no longer be in demand.

“Milling is not the best way to do things. It wastes time, it wastes materials, it’s not really efficient, it’s just what we have the ability to do now,” he said. “I know you’ll see more additive technologies in the future.”

Lesh also isn’t convinced the CAD/CAM of today will be around for the long haul. He noted that if an esthetic material came along that could be shaped by hand and hardened to a state where it functions beautifully in a patient’s mouth, scanners and mills wouldn’t be necessary. For this reason, labs need to be sure they stay abreast of what innovations are coming to the industry, so they don’t get caught behind the times when investing in a new way of doing things.

“It’s a materials game. It’s always been,” he said. “People go with CAD/CAM because of the efficiency, but at the end of the day CAD/CAM may not always be the best option in terms of the materials the customers are looking for.”

Whatever the next big thing may be, at their core, dental labs are businesses and it’s clear from both industry experts and the results of the DLP Tech Census that a measured approach to technology is warranted, but missing out on opportunities to improve the efficiencies of a lab’s operations can be just as harmful as not keeping up with the developments making their way through the industry. 

Articles

The potential for new design and production technologies to reshape the dental laboratory industry is certainly real. When combined with developments in materials, new technologies can be leveraged to increase capacity, achieve efficiencies and even increase the accuracy of the restorations fabricated by American dental laboratories.

Tech Census 2011

	There are numerous moving parts-sometimes literally-involved with creating a high quality dental restoration. Working with technologies, tools and materials that are designed to work together can make that process a little less complex.

	Sometimes this means using an entire line of products from one company with a systematic workflow. However, as new technologies and novel materials filter through the industry, more and more it seems that labs must find compatible options to allow their existing systems to work efficiently in new ways. For a lab to succeed it must keep its dentist customers happy, and that means being able to provide the restorations they are looking for at the level of quality and price point they demand.

	Zooming out from the benchtop to the boardroom, it’s easy to see some similarities. While many of the companies creating the products, materials and technologies used in dental labs on a daily basis strive to provide start-to-finish systems, technological and material innovations can come from different sources, and finding ways to stay compatible can be a key.

	In the past 18 months there has been a steady stream of press releases announcing mergers, acquisitions and formal partnerships between major dental companies. Technological developments are a key part of these moves, but they are motivated by profit margins as much as innovation. For the labs served by these companies, keeping track of who is aligned with who and understanding why these partnerships are being formed can be helpful when trying to figure out what the lab-level impact of these corporate actions might be.

	Corporate moves such as these are a normal part of doing business, and the recent wave of mergers, acquisitions and partnerships might be coincidentally timed, but Ernie Knight, a Harvard MBA who has worked as venture capital director for Nationwide Mutual Capital, said it is just as likely that these moves are a sign that companies in the dental industry see good things happening in the economy and they are setting themselves up for post-recession growth.

	“In the last few years with the financial armageddon of the Great Recession, companies have been hoarding cash. You can only hoard cash so long, and then you have to put it to use. The use is either giving dividends to your shareholders or making acquisitions that can drive value,” Knight said.

	This is especially true in the technology sectors of the economy, and in the dental industry many of the recent moves have come from technology-focused companies such as Straumann, Dental Wings, 3Shape and Align Technology. While tech companies were once newer business entities, Knight said they have now established their place in the larger economy and react to the same market forces that drive the overall, global economy.

	As the recession has eased, companies that have found themselves with cash reserves are now looking to branch out and put those resources to work. Growth through merger or acquisition is an established business strategy, and one that can be especially useful to a company looking for further investment via either public or private capital, Knight said.

	“They have to buy to grow. They couldn’t possibly maintain growth rates that would be attractive to investors just through organic internal driven growth and innovation,” he said. “They have to be acquisitive to compete and to create shareholder value.”

	While these corporate moves are a normal part of the ebb and flow of a business cycle, Knight said they can be seen as signs that the companies doing the purchasing see the Great Recession as something in their rear view mirrors. Acquiring another company involves a good deal of risk as well as financial outlay, so the increase in the frequency of these actions can be seen as a positive sign for the overall direction of the economy.

	“Any time you acquire, there’s a level of risk in that. There’s potentially product risk, there’s a risk you can lose focus. You tend to batten down the hatches in the tough parts of the cycle, and be more open and able to take on these growth risks when times are better,” Knight said.

	Another good sign about the moves being undertaken in the dental industry is that they make sense from a product standpoint. While some acquisitions are undertaken as a way to absorb a direct competitor, more often these moves allow a company to accelerate its growth by adding on a profitable enterprise that has synergies with the acquiring company’s core business. This is certainly the case with Argen Corp.’s purchase of Captek, Align’s move to buy Cadent and DENTSPLY International’s acquisition of Astra Tech.

	But not all of the recent moves have been outright purchases, as formal partnerships have also been something of a trend. The wave of partnerships kicked off in early 2010 as Nobel Biocare announced a Preferred Partner Program aligning with Ivoclar Vivadent, VITA and Noritake. More recent technology partnerships have been formed between Straumann, Dental Wings and 3M ESPE, as well as between Biomet 3i, 3Shape, Cadent and 3M ESPE. Earlier this year 3M ESPE also announced a partnership with Jensen Dental.

	These deals allow the companies to collaborate on product development to create materials and technologies that are designed and tested to work well together even when different parts of the system come with different brand names on the packaging.

	Knight said formal partnerships such as these have been more common in recent years. Sometimes they can be a prelude to a merger, as companies want to test the waters before formally combining corporate resources. Other times these partnerships are a way for both corporate entities to retain individual identities and cultures while adding new capabilities without the risk of full-scale investment.

	“Lots of firms are wanting to walk before they run. You’re seeing a little more of that than you would typically because people are still trying to find their way out of the Great Recession,” Knight said. “It’s a way to mitigate your risk by not jumping in full force.”

	Whether the move is an outright acquisition or a partnership deal, Knight said he thinks these moves are often good for the marketplace and can spur innovation.

	Acquisitions often involve a larger company buying a smaller outfit that has an innovative product or technology. The larger firm is in better position to leverage the technology and often can speed up the pace at which that technology can impact the industry as a whole. Partnerships can allow two successful companies to combine their offerings in an even more seamless way. When a hardware and a software company work together each company’s part of the system can be fine-tuned.

	These corporate changes are not often immediately noticeable at the customer level. Even after an acquisition, a new sales person or product manager may take over, but Knight said smart companies make those moves slowly and help ease customers through the transition. In fact a larger company might be ready to offer new resources to the customers of the smaller firm that was purchased.

	Still, Knight said it is important for a business’ customers to pay attention to the moves it is making at the corporate level because an acquisition or partnership deal may eventually lead to a significant change in a product a lab has come to rely on.

	This can be especially true in the technology sector. If your lab has an open-architecture scanner and software from one company, and the material or production provider you work with is partnering up with a different software firm, there’s a chance your system may not be compatible at some point in the future. Knight said these moves rarely happen in a flash, and most companies will work to help their customers transition with the change. However, it is important as a customer to pay attention to avoid a potentially costly surprise.

	“Clearly if they bury their heads in the sand and pay no attention to the trends and to what different partnerships are being developed, and to what type of things are being thought about with different vendors, it could come to pass that they wake up one day and there’s been a change and now they’re in crisis mode,” Knight said. “It’s something they should be able to plan for over time and not be caught off guard.”

 There are numerous moving parts-sometimes literally-involved with creating a high quality dental restoration. Working with technologies, tools and materials that are designed to work together can make that process a little less complex.

Connecting the dots

	The number of patients seeking therapy for snoring and sleep apnea has increased by 60% in the past decade, 

making sleep dentistry a profitable new practice driver for doctors

 and one of the fastest growing segments in dentistry today.
	
	According to the American Academy of Sleep Medicine, 

oral appliance therapy is first line treatment for snoring and mild to moderate sleep apnea

	Designed to improve mandibular advancement designs. 

The Moses™ adds a new dimension to oral appliance therapy

 with an anterior opening that allows the tongue to be positioned forward  and up in the roof of the mouth, encouraging nasal breathing.
	
	Custom fit and laboratory made, The Moses™ 

incorporates all three attributes of a successful anti-snore and sleep apnea appliance

: tongue management, mandibular advancement and patient compliance.
	
	With support from The Moses™ team and their preferred partners, 

dentists can effortlessly and seamlessly integrate sleep dentistry and The Moses™

 The number of patients seeking therapy for snoring and sleep apnea has increased by 60% in the past decade, making sleep dentistry a profitable new practice driver for doctors and one of the fastest growing segments in dentistry today.  According to the American Academy of Sleep Medicine, oral appliance therapy is first line treatment for snoring and mild to moderate sleep apnea.

Reasons to Buy: New practice driver

	The days of the AV cart are most certainly numbered. Like other sectors of the high-tech world, audio-video equipment continues to shrink at a brisk pace. Now, instead of rolling a bulky cart with a projector on top to wherever a presentation or movie will be shown, that projector can be carried in a pocket.

	These tiny projectors are known as Picos, and unfortunately, some devices in this class sacrifice projection power and image clarity in favor of their diminutive size. Thankfully, this is not the case for Optoma’s recently launched PK201 and PK301 projectors. With the capability to throw impressively large and crisp images on a screen or wall, this pair of Picos truly allow you to keep the big picture in your pocket.

	Powered by LED light sources that are estimated to last for more than 20,000 hours of use, both models throw WVGA widescreen images with 2000:1 contrast ratios. In plain English, this means their projected images are clearer than a standard-definition television, but not quite as sharp as an HD picture.

	Packing 20 lumens of brightness, the PK201 can show an image as large as 66 inches diagonal. Its more powerful cousin, the PK301, can put out up to 50 lumens, which allows it to project images up to a staggering 120 inches. To offer some perspective, that’s bigger than just about any TV currently on the market.

	The pictures may be large, but neither model will eat up much room regardless of how it is stored or transported.

	The PK201 is truly pocket sized, with measurements similar to a slightly thicker iPhone, and it weighs in at just 5.6 ounces. The PK301 might require slightly larger than normal pockets, but still comes in at an impressively small 4.7 x 1.2 x 2.7 inches and weighs just half a pound.

	Both are highly portable, but their small stature does have one drawback, and that comes in terms of battery life. Neither model’s rechargeable battery can run at full power for much more than 1 hour. Still, they each come with standard wall plugs and they’ll hum along just fine while connected to a power source.

	Putting either of these Picos to use is intuitively simple. They offer a range of ways to input images including Micro USB, Mini HDMI and 2.5-mm AV jack for composite video connections. Both models also feature 28-MB of internal memory and SD card slots that can add an additional 16-GB of data storage.

	They also boast built-in encoding software that plays videos or presentations directly from the internal memory, SD card or a USB drive. This makes it possible to leave the computer or DVD player at home if the presentation or movie can be saved externally.
	True, the 0.5W speaker in both models doesn’t always do the trick, but the audio output allows the projectors to connect to external speakers when a robust soundtrack is a necessity.

	When it comes to their primary task, projecting images large and clear, these Picos show enough power and versatility to outshine their minor drawbacks in terms of battery life and sound. Impressively small in size and big in picture, the PK201 and PK301 really make it possible to take high-quality projection just about anywhere.

 The days of the AV cart are most certainly numbered. Like other sectors of the high-tech world, audio-video equipment continues to shrink at a brisk pace. Now, instead of rolling a bulky cart with a projector on top to wherever a presentation or movie will be shown, that projector can be carried in a pocket.

Tech Smart: Big picture, small package

	Tablet PCs are nothing new. Besides popping up in science fiction movies for decades, the real things have existed in one form or another for quite some time. So why then was the entire tech world and much of the media so excitedly agog a few weeks back when Apple unveiled its first tablet, the iPad?

	Well, besides the fact that every Apple press event draws such a frenzy, the iPad is a big deal because with its launch next month, Apple is entering a new computer products market. This is not something to take lightly from a company with an impressive recent track record of not only being successful with new products, but in changing the status quo for the markets it enters. (iPods not only launched the concept of mp3 players, but also spurred on the digital music revolution that has changed how music is bought, sold and recorded. The iPhone shook up the mobile phone market and spurred every manufacturer to make the leap from pocket telephones to pocket computers.)

	With that in mind, it seems the launch of the iPad is the perfect time to give tablet computers a new look.

	Apple grabbed the biggest of the headlines, but they’re certainly not the only company looking to break into the tablet computer business. Just about every existing computer manufacturer has some sort of tablet on the shelves or in the works and the market for the machines is nearing tipping points in terms of price and functionality. In short, tablet computers are almost ready to start delivering on all that potential sci-fi writers have been predicting for so long.

	Prior to now, most tablet PCs were really laptop computers with an extra hinge, allowing the screen to be flipped and closed over the keyboard facing up. Sure they were often top-of-the-line laptops with all the memory and processing power available, but they were often bulky, overweight and input via the screen instead of the keyboard could be less than ideal.

	The new generation of tablet machines are dedicated to their tasks, with no keyboard, but far more reliable and advanced touchscreens in terms of both sensitivity and interface design. Touchscreens are everywhere these days from phones to car dashboards to kitchen appliances, and the quality of the screens keeps increasing all the while the costs are decreasing. Meanwhile flash memory is better, bigger and more affordable, as is processing power and battery life.

	This means it is now possible to not only make a tablet PC that is easy to use, reliable and responsive, but also to make them inexpensive. The iPad line starts at $499 and tops out at less than $1,000. With portability and convenience on their side, tablet PCs are ready to become a reasonable option for a number of uses. As personal media consumption devices they could be unparalleled, but they also show potential for some interesting educational and business applications.

	Built to be a machine to bridge the supposed gap between the funneled access of smart phones and full-sized/powered desktops and laptops, Apple’s iPad is fine-tuned to be a very good media delivery device. Besides having the company’s signature minimal design esthetic, it brings with it enough muscle to handle HD video, full Web access (minus everything Flash due to Apple’s ongoing dispute/boycott of Adobe’s Web video system), even some light versions of basic office software. Known for making machines that run well, it’s no surprise Apple gave the iPad touchscreen interface enough sensitivity to make typing without a physical keyboard a workable proposition.

	In designing iPad on an updated version of the company’s iPhone operating system (OS) rather than modifying their PC OS, Apple is betting tablets will be used differently (and less openly) than bigger, more powerful computers. Like the iPhone, the iPad’s App-based interface means it treats the Internet as a system of informative or entertaining tunnels with Apps for entrances, rather than as an interconnected Web of information and data.

	Of course just like in the smartphone marketplace, Apple grabs the headlines, but plenty of competition is lining up to compete with the iPad on both price and more importantly functionality. Computer makers, big and small, are all busy putting together their own visions of what the tablet computer can be.

	Some of the new entrants such as the JooJoo from upstart company Fusion Garage are trying to out pad the iPad, and that designed-from-the-ground-up machine looks to be a sleek media device that does the Web in full. However, other companies including HP, Dell, Verizon, MSI, ASUS and Archos are working on or have already released machines relying on existing software, with tablets pretty much evenly dividing between those running Microsoft’s Windows 7 and Google’s mobile Android OS.

	“It is now possible to not only make a tablet PC that is easy to use, reliable and responsive, but also to make them inexpensive.”

	The question of where and how tablet computers will be used has held the machines back for some time. Certain tasks, whether because of the processing and graphics power required or because of the interface requirements, will never be a good match for tablet computers. Still, many tasks including watching videos, consuming news and short bits of data entry are ideal for the quick, mobile convenience of a tablet.

	The App-based OS Apple decided on is perfect for those sort of tasks and the company imagines iPad to be something of a mobile TV, eReader, futuristic newsstand, digital picture frame and social media hub. Apps make those features accessible with the touch of a finger. Other tablet computers will be doing similar things whether they have the openness of a full-scale OS or the tunnel-vision approach of a mobile OS.

	So, as with any computer, the usefulness of tablets will really come down to the software that’s available. If someone creates the right program, tablet systems could have great application to the dental lab environment, and as capabilities continue to grow and prices continue to shrink, tablets are bound to get more accessible. On form alone, the single piece with no external moving parts or large openings is ideal for a manufacturing environment.

	Imagine having a simple slate that moves along with the progress of a case. On it and easily accessible is all of the data related to the case, including digital scans, case plans, a step-by-step fabrication check-list, digital sign off and more. It would also likely provide a way to instantly contact the dentist from benchside via e-mail, instant messaging, VOIP call or (if the tablet is Web cam enabled) video. Data from every step in the process could be wirelessly and automatically synched into the lab’s records. In a training environment, such a system could provide instant links to online information related to the techniques required to complete every step of fabrication.

	Or instead of having one tablet to travel throughout the lab, every bench station could inexpensively be equipped with a tablet that automatically detects a sensor in a case tray to provide all of the information possibly needed. Sure that software doesn’t yet exist, but tablets that could run it do, and there are plenty of other visions of how tablets could come into play for business as well as for fun.

	The tablet market is just starting to get going and like the first generation of any new technology, the first generation iPad leaves a lot to be desired. It could use a Web cam and multi-tasking capability among other things, but the kinks will be worked out eventually and a machine fitting between a smartphone and a desktop might be a nice fit for plenty of computer users.

	Noah Levine writes the monthly Tech Smart column on consumer electronics for Dental Lab Products. Contact him at 

 Tablet PCs are nothing new. Besides popping up in science fiction movies for decades, the real things have existed in one form or another for quite some time. So why then was the entire tech world and much of the media so excitedly agog a few weeks back when Apple unveiled its first tablet, the iPad?

In between machines

	As I enter my 25th year of general practice, I have been fortunate to be able to divide my time between clinical practice, lecturing, publishing and working with dental manufacturers in helping develop and evaluate the products that the dental profession ultimately uses. I have seen some products not last the test of time and others have become reliable staples in our profession.

What do you like most about FibreKleer 4X?


	The increased radiopacity is a major improvement to these fiber posts. In the past fiber posts could appear transparent on a radiograph. Improved identification on the radiograph ensures that anyone treating that patient will easily identify that a post is present, as well as eliminate any confusion with the insurance company evaluating a radiograph submitted for a post and core placement.

How long have you been using 4X or fiber posts?


	I have used fiber posts since the first fiber posts were introduced to market by Pentron almost 20 years ago. Since then, I have placed their’s and other brands’ extensively. I was fortunate to be included in beta testing FibreKleer 4X posts and have been using them for about a year in my practice.

What do you think is the greatest benefit to using this post system?


	The available shapes (tapered, parallel and serrated original design) combined with the sizes offered allow me to restore any endodontically treated tooth with confidence. I know I can provide a durable restoration that matches what Mother Nature initially provided the patient from a flexural strength standpoint without compromising esthetics.

Why would you encourage other clinicians to try FibreKleer 4X?


	The FibreKleer 4X post offers great radiopacity, but clinically it is translucent to disappear within the restoration and not cause an optically dead zone when all-ceramic restorations are placed to restore the tooth. Additionally, it offers physical properties mimicking dentin, providing greater resistance to root fracture than with metal posts.

	The options available for the FibreKleer 4X post system will allow the practitioner to restore the tooth conservatively, maximizing the amount of dentin remaining and therefore preserving the tooth longer. 

 As I enter my 25th year of general practice, I have been fortunate to be able to divide my time between clinical practice, lecturing, publishing and working with dental manufacturers in helping develop and evaluate the products that the dental profession ultimately uses. I have seen some products not last the test of time and others have become reliable staples in our profession.

Double Take: "I can provide a durable restoration that matches what Mother Nature Initially provided."

Load the platform with 30 dies, initiate the job and within 15 minutes, the automatic scan and design application produces final coping designs. Its 140 mm x 140 mm x 140 mm scan volume provides access for large fully articulated models. The 7Series is powered by DWOS®, Dental Wings open dentistry platform, that is recognized by major dental suppliers including 3M ESPE and Straumann as the platform of choice. The Crown & Bridge, Implant Custom Abutment, Virtual Model Builder, Partial Frameworks and Rapid-Prototyping & Manufacturing modules are included with the system. Customizable prosthesis material types, as well as anatomy and attachment libraries, allow the system to grow with the user’s design needs.

		Extensive scan applications: single to full arch preparations of positive models and silicon-based impressions (including lower anterior)

		Management of a wide range of restorations: copings and bridge frameworks, telescopic crowns, implants, full contour bridges, inlays/onlays/veneers, over-pressed crowns and bridges

		Automatic scan and design multi-die mode (up to 30 dies)

		Integration of numerous manufacturing equipment and processes

		Integrated communication between clinics, labs and production centers

Load the platform with 30 dies, initiate the job and within 15 minutes, the automatic scan and design application produces final coping designs. Its 140 mm x 140 mm x 140 mm scan volume provides access for large fully articulated models.

All-in-one scanner

	With laptops, notebooks, and netbooks, not to mention smartphones, tablets, and cloud computing, computer portability has never been more accessible.

	But just because there are many ways to make a computer portable, doesn’t mean managing this portability is simple. If, like many people, you have a powerful desktop at the heart of your computing set up, using a smaller machine while traveling can make data management a nightmare.

	With files, programs, and e-mails spread across however many machines are being used, keeping everything organized can bring to mind the classic George Carlin routine “A Place for My Stuff” where the comedian describes taking a vacation and dealing with ever smaller subsets of his “stuff” spread out across the country.

	Well that sort of data debris is no longer necessary with the launch of v.Clone™ software from portable hard drive maker Iomega®. The software makes a virtual copy of an entire PC, making the operating system, programs, files, and everything else on that computer usable on almost any machine where the drive is connected.

	Available as a download for many current Iomega drive owners and soon bundled with the company’s eGo portable hard drives, v.Clone makes it possible to create a virtual copy of a computer on the portable drive. Now, for all intents and purposes, any computer connected to the clone drive becomes the computer that was cloned.

	Managing data couldn’t be simpler. When the clone is reconnected to its home computer, any files updated on the clone drive are automatically backed up to the main computer.

	Working with sensitive files on a strange computer might seem like a frightening prospect, but v.Clone doesn’t ignore the importance of data security and protects information on the clone drive and the computer to which the clone is connected.

	Access to the clone is protected by a password, and for additional security several of Iomega’s hard drives include encryption that works with v.Clone. Clone users don’t need to worry about data being left behind either. Any data accessed on a clone drive stays in that virtual environment, and anything saved is saved only to that drive.

	Virtual clones come in handy for convenient data management between machines. They also can supercharge a netbook by essentially turning it into a fully functional PC.

	But the usefulness of v.Clone drives doesn’t end there. If enough space is available, multiple computers can be stored on the same clone drive, making it possible to travel with data from several machines on a single device that can fit in a pocket.

	At first, it might seem that a cloned computer is only useful to the road warriors out there, but virtual PC copies can be just as useful to people who rarely venture outside of one lab. With a virtual clone you can move files between computers with ease while keeping the software needed to work with and update the files accessible at all times. And while clones are not meant to replace proper data backup procedures, a clone drive could come in handy should a computer crash at a time when working on that machine is critical.

	Portability is key in the computer age, and v.Clone software is one of the easiest ways to make that happen. With a clone drive so easy to create and fit in a brief case or pocket, there’s no reason to go anywhere without your computer.

 With laptops, notebooks, and netbooks, not to mention smartphones, tablets, and cloud computing, computer portability has never been more accessible.  But just because there are many ways to make a computer portable, doesn’t mean managing this portability is simple. If, like many people, you have a powerful desktop at the heart of your computing set up, using a smaller machine while traveling can make data management a nightmare.

Tech Smart: Clone home

	Whether working with a milled bar or a cast bar knowing what will be built around it comes from experience. Different technicians and labs follow different protocols for working on these cases, but there are definite factors that must be taken into account when creating a denture that will be attached to a number of implants.

	Amos Harting, CDT, owner of Harting Dental Arts Lab in St. Louis said he likes to design a bar to attach the implants and then scan the bar design to allow digital production. The actual denture design will come from the patient’s anatomy and the implant placement. It will need to provide the function and esthetics based on any limitations created by those factors.

	“You build the foundation first and then put the house on top of it,” Harting said. “If you don’t design the foundation right, the top of the house is never going to be right, or the hybrid denture or crown and bridge case is never going to be right.”

	Another factor that must be considered is the bite forces involved with a restoration that is mounted to implants. Because they are screwed into bone without a periodontic ligament beneath it, implant supported prosthetics need to be able to withstand extreme bite forces, said Preat Corp. founder and CEO Tom Bormes. Still with the problem of retention solved by the implants, the design of these restorations can focus on how to esthetically replace the patient’s natural function.

	But even with that variable removed, Jim Collis, CDT, owner of Collis Prosthodontic Laboratory in Rolling Meadows, Ill., said the designs for these restorations require a lot of thought. The placement of the implants can determine how the occlusion should be set and what materials to choose. The fact that there will be a rigid bar behind the teeth and implants behind the bar means the denture teeth chosen for the restoration must be very strong, because if one breaks off, it will be difficult to retrieve the fixed dentures to replace the tooth.

	“You have to make sure you use the proper tooth,” Collis said. “You want to use a tooth that is consistent in its material make up.”

	Chuck Genco, CDT, General Manager of Van Hook Dental Studio in Tempe, Ariz., agreed saying the choice of teeth is important, and he likes to use Ivoclar Vivadent’s SR Phonares or Hereaus’ Premium teeth. There is a wide range of systems Genco feels comfortable working with, and he said the material options in terms of teeth and acrylics make it possible to find a solution to fit almost every case.

 Whether working with a milled bar or a cast bar knowing what will be built around it comes from experience. Different technicians and labs follow different protocols for working on these cases, but there are definite factors that must be taken into account when creating a denture that will be attached to a number of implants.

Tips for fixed removables

	Today Apple launched its latest generation of the iPhone, and as always seems to be the case when this company is launching something new, the media and general public are rapt in anticipation. However, this launch was the company’s first big move since founder and technology icon Steve Jobs stepped down from an active roll in running things and the press event seemed a bit lackluster without his smirking boasts about the wonderful things the company's latest can do.

	Sure this isn’t the first time Jobs has left his position with Apple. Back in the mid-’80s he was famously forced out from the company he helped create a decade earlier. But that led to the darkest era in Apple’s history and his return to the company in the mid-90s is considered the start of the company’s rise to its current position as the largest public company on the planet.

	Even with Jobs now out of the day-to-day work at Apple, the company seems set up to be a technology leader for years to come. But Jobs decision to turn over the CEO position to Tim Cook due to his own declining health certainly marks the end of an era for the company, and the perfect time to take a look back at the legacy he and his inventions have left on the technology landscape.

	It all started in the late ’70s as Apple released its first PC. While those hand-built machines are certainly left in the dust by the powerful computers in today’s phones, (even the not-smart variety) it was the precursor to the company’s computing portfolio and was quickly upgraded to become the Apple II. This open-architecture PC set a new standard with color graphics.

	The company’s biggest PC revolution came along a few years later with the graphical user interface that powered the ill-fated Apple Lisa and the now iconic Macintosh. It was Jobs who led the push to create graphics-based computer interfaces rather than the text commands used to operate computers previously. Both computers shipped with a mouse and offered users the chance to “point and click” for the first time.

	It was after these revolutions that infighting at Apple led to Jobs leaving the company. During his decade away Apple made some influential advancements such as the PowerBook laptop computers, but also failed with projects like the Newton PDA.

	When Jobs returned to the company he brought a new software basis for the company’s operating system and helped position Apple as a retailer of high-end computers preferred by artists and designers. That spirit permeated the products as well, with the 1998 launch of the iMac line of computers that got rid of the computer tower, combining the monitor and all the internal components in one box.

	All of these steps have led to the computers people see today, and while Apple’s design esthetic has continued to set trends followed by other manufacturers, it remains ahead of the pack in most cases. The ultrathin MacBook Air laptops have set new standards in portable computers while just about every computer maker now has an all-in-one computer that looks a lot like the latest generation of iMac.

	While once primarily a computer maker, Jobs’ vision has taken Apple into a range of other electronics arenas, and none has been more greatly changed by the company than the world of music. In 2001 the company began selling its first iPod digital music player. This marked the beginning of the end of the Compact Disc, which itself had only recently toppled the cassette tape.

	The iPod was a wonder in its early generations and sold well even before the company launched its iTunes online music store. That store is now among the biggest music retailers in the world and has changed the way most people acquire music.

	On top of changing the format on which people get their music, the iPod and digital music downloading also changed how artists interact with their audiences, making record labels and music stores less significant in the marketplace.

	Not satisfied with just changing people’s music habits, Jobs and Apple next revolutionized the way people interact with their computers, their phones and each other when they launched the iPhone in 2007. While it wasn’t the first phone to handle e-mail, it quickly set the standard for pocket computing.

	Intuitive to use and easy to customize with lots of software titles available, the iPhone was a runaway success. It combined the best of the company’s previous successes by presenting a user-friendly computer with high-quality graphics in a stylish, pocket-friendly package. Jokes about its poor phone service abounded, but millions of the phones have been sold and just about every smartphone since has had similarities to the iPhone in both form and function.

	The company’s most recent success is the iPad, which while certainly not the first tablet computer, is most definitely the first commercially successful one. Priced at a reasonable level and capable of doing a lot in small package, the iPad falls short of being a full computer, and instead settles in nicely as compact, affordable media machine.

	It works because it can do what most people who use computers these days need a computer to do. People raised on the Internet need a machine to visit websites, play audio and video, and other basic tasks. The iPad does all that in an attractive and portable package.

	Through his up and down years at the helm of Apple, Jobs’ career has been marked by several traits. He’s shown a willingness to take chances on his vision of what people will want next from their electronics, a dedication to creating products that set new standard in style and design, a determination to make sure they work as crisply as the look, and a ruthless approach to the business side of the industry.

 Today Apple launched its latest generation of the iPhone, and as always seems to be the case when this company is launching something new, the media and general public are rapt in anticipation. However, this launch was the company’s first big move since founder and technology icon Steve Jobs stepped down from an active roll in running things and the press event seemed a bit lackluster without his smirking boasts about the wonderful things the company's latest can do.