Noah Levine

	It’s not quite as light as the element from which it draws its name, but the latest iterations of Apple’s ultra-trim MacBook Air are getting mighty close.

	The duo of recently released laptops-available in 11- or 13-inch screen sizes-weigh in at less than 3 pounds each, and their distinctive tapered forms are less than 3/4 inch at its thickest and barely more than 1/10 inch at the thin edge. But just because these machines are slim doesn’t mean they’re not ready to handle a heavy computing workload.

	While being almost unbelievably thin, the new Airs are no pushovers. They sport the same aluminum unibody construction as larger MacBooks. This means the top and bottom enclosures are each milled from single pieces of aluminum for crisp looks and monolithic durability.

	The minimalist approach is carried throughout this laptop’s design with almost no moving parts besides the hinge. This means there is less that could be damaged when the Airs get moved around or jostled. This is accomplished because, like the first-generation MacBook Air, these machines have no optical CD drive. This time, things have been taken a step further, as the laptops have dropped traditional hard drives in favor of arrays of flash media storage.

	Using flash memory for data storage offers benefits in durability, but users will really notice its presence because flash memory is very appropriately named. Data can be accessed almost instantly, making working with files a snap, and the laptops can be brought out of sleep mode as fast as the lid can be flipped open.

	The lowest-end 11-inch Air sports 64 GBs of storage, which is relatively small by today’s standards, but the top of the Air line offers quadruple the storage space. Both models run speedy Intel Core Duo processors with 2 GB of RAM standard, which means the flash memory isn’t the only swift things about the new Airs.

	Of course, internal storage isn’t the only thing the Air is about, as these are machines optimized for working in a cloud computing environment. They feature all the standard WiFi connections and are equipped with a pair of USB ports, a webcam, mic and a Mini Display Port for connecting an external monitor or HD TV; the 13-inch model also includes an SD card reader.

	Getting data on the machines is quite easy, and working with it once it’s there is just as easy. Massive multi-touch capable trackpads handle the duties once done with a mouse, and the multi-touch gestures are both intuitive and incredibly time-saving if they’re really put to use.

	The new Airs are ready to offer plenty of time to play with all these systems. They may be small machines, but their batteries are the biggest internal components. This lets them boast 5 to 7 hours of unplugged work time, and an impressive 30 days of standby time on a single charge.

	Of course all this hardware is no good without software to back it up. Like all of Apple’s computers, the new Airs run the company’s OS X operating system with a lifestyle suite of image and video management programs included. Of course, many business titles are now easy to find for Apple’s computers, and as the company continues to gain more market share, ever more critical business applications are being made available for use on these machines.

	With an enviable look, sturdy construction and powerful components under the hood, the new MacBook Air laptops are enjoyable to use and up to just about any computing task that can be thrown their way. These machines beg to be taken everywhere, are ready to go and up to the task whenever they’re needed.

Articles

 November 2010 | Dental Lab Products  It’s not quite as light as the element from which it draws its name, but the latest iterations of Apple’s ultra-trim MacBook Air are getting mighty close.

Tech Smart: Air apparent

	With a balanced, lightweight and compact body designed to reduce hand fatigue, the LabPro™ handpiece provides optimum comfort and increased efficiency even on delicate pieces of work requiring extended periods of time.

	The handpiece features a brushless micromotor and a 180° vector control system to provide smooth rotation with minimal vibration or noise while still generating a powerful 8.7 Ncm maximum torque. A dust-proof mechanism is designed to prevent harmful material from infiltrating the handpiece bearings, which can extend the turbine life. The handpiece and control are easily incorporated into all NevinLabs workbenches, and the choice of a knee or foot control unit minimizes the required desk space.

		Ergonomically designed to meet the needs of dental laboratory professionals

		Easily incorporated into all NevinLabs™ workbenches

		Lightweight and compact for ease of use and reduced user fatigue

		Brushless micromotor improves handpiece balance for smooth performance

		180° vector control system provides smooth rotation

		Powerful and consistent torque at all speeds with minimal vibration

		dust-proof mechanism prevents infiltration of harmful material into the handpiece bearings

		Choice of knee or foot control provides increased desk space s

 Information provided by NevinLabs.  With a balanced, lightweight and compact body designed to reduce hand fatigue, the LabPro™ handpiece provides optimum comfort and increased efficiency even on delicate pieces of work requiring extended periods of time.

Quiet comfort

	The digital technology currently available to dental laboratories opens numerous new opportunities for collaboration and outsourcing, but there are plenty of options for labs looking to incorporate CAD/CAM production without relinquishing control of any part of the workflow.

	Complete CAD/CAM systems-comprised of a scanner, software/workstation and a mill, often designed and manufactured by one company-can provide an entry into CAD/CAM or a solid expansion choice for labs already scanning or designing digital restorations. These stand-alone CAD/CAM systems such as 

’s Incise, among others, provide labs with a digital workflow that takes a case from a physical or digital impression to completed prosthetic quickly and accurately without any part of the process being completed outside of the lab.

	Working with a complete CAD/CAM system where every component comes from the same company offers labs a number of advantages, not the least of which is efficiency. Because the scanner, software and mill were all designed together, the workflow between parts of the system is seamless and training on the technology is simplified because technicians only need to learn one interface, rather than having to understand how to transfer data from one company’s software to hardware from another company, Amann Girrbach America President Todd Larson said.

	Having one source for the technology is advantageous whenever a lab using the system is looking to improve their work. When there are any questions about how some part of the process is supposed to be completed, a lab with a complete CAD/CAM system knows exactly where to turn for troubleshooting assistance. DENTSPLY Prosthetics Product Manager Erica Henny said labs using Cercon will notice this cohesiveness and support from the moment they adopt the system.

	“The Cercon CAD/CAM system was developed to work as a cohesive unit,” she said. “When a lab purchases the Cercon eye scanner, Cercon art software and Cercon brain expert mill from DENTSPLY, an installation technician is sent to the lab to install and then a training expert is sent to educate the lab on how to use the software.”

	While these systems might be designed and supported by one company, they are not always designed to work in isolation. Larson said a big advantage to the Ceramill system is that it is a complete system, but with open architecture software capable of working with data from scanners and software made by other companies. This means the system can be a good expansion choice for labs already into CAD/CAM production in one way or another.

	“Every dental laboratory technology we develop and introduce to the market focuses on LEAN manufacturing principles-Faster, Better, Cheaper,” Larson said. “The Ceramill CAD/CAM system is a ‘complete’ open architecture system that seamlessly provides the dental laboratory with the latest advanced technology and ability to grow and expand their business.”

	Larson said it is not difficult to show labs how adding such a system can provide solid return on investment because in-house CAD/CAM production is both efficient and cost effective, especially because most of these systems do not charge a per-unit clock or dongle fee. With complete control of the production process, labs with a system such as Ceramill can complete cases more rapidly while maximizing the use of milled materials. This can add up to large savings for labs currently sending a large amount of work to a milling center.

	“A laboratory does not have to relinquish models or have their production affected by weather or shipping issues to and from a milling center,” Larson said. “You can scan and mill a single unit or up to 24-26 units on one blank in a variety of materials. The fully landed cost per unit is around $10 out of the Ceramill system. This represents a substantial savings versus the cost per unit from a milling center.”

	Having the ability to complete every step of the process in-house can speed up a lab’s production, and Henny said a big advantage of Cercon is that it is among the least expensive complete systems on the market, but still offers labs a range of options. Those options include not only in-lab milling of zirconia and base cast resin, but also the ability to outsource to the company’s Compartis

 manufacturing facility for greater material options and implant bar fabrication.

	“The biggest advantage a lab gains by adding a CAD/CAM system with an in-lab milling machine, like the Cercon

 brain expert, is flexibility,” she said. 

	And like all technology, the improvement process is never ending. Purchasing a complete system makes it easier for a company to update the software in ways that enhance the capabilities of the related hardware. Henny said forthcoming updates to the Cercon art software will provide for the design of custom implant abutments as well as full-contour zirconia crowns.

	With the ability to mill zirconia and acrylic materials, the Ceramill Motion provides a launching point for in-house production, and the Ceramill Mind software features a virtual articulator and the ability to import data directly from intraoral scanners, which means labs looking to work completely digital can skip model fabrication when they choose to. Larson said the system is designed to give labs a hub from which to control just about any digital production workflow they choose to work with. 

	“We can import data from intraoral scanners, third party scanners and export data to milling centers, wax printers, whatever the end user desires,” he said. “You only need one system to communicate with the world.”

	While the footprint of these systems is small compared with the industrial scale mills used at large production centers, Larson said labs investing in his company’s tabletop mill are not sacrificing accuracy or quality in the finishing restorations. He said he often demonstrates how well-designed the Ceramill Motion is by putting the mill to work while it is set up on a card table, “to show the lack of vibration our mill produces without any loss of accuracy in the final product.”

	Determining if a complete CAD/CAM system is a good fit for an individual lab requires some inward analysis. It’s not just about the size of a lab taking advantage of the scalability of digital workflows. Larson said the Ceramill system is currently the top system in European dental laboratories and is in use in labs ranging from single technician operations to businesses with 500 employees.

	The common factor linking those labs is the desire to increase their efficiency in certain areas of production by controlling the pace of the work and reducing per unit manufacturing costs. The system has proven to be especially beneficial to labs looking to reduce sizable monthly outsource expenses, he said.

	“Labs with large outsource bills who have brought the Ceramill system in-house have commented to us their immediate and positive ROI, reduction in production costs, faster turnaround to their customers and exceptional quality product,” Larson said.

	Henny said many mid-sized dental labs benefit greatly from adding the in-lab CAD/CAM capabilities of the Cercon system, and those benefits can be realized quickly because of the system’s ease of use. Still, the system really fits with any lab looking to invest in growing its business by reducing the time it takes to complete a case and return it to the dental practice.

	“An in-lab milling system is perfect for dental labs that base their business around quick delivery,” she said.

 The digital technology currently available to dental laboratories opens numerous new opportunities for collaboration and outsourcing, but there are plenty of options for labs looking to incorporate CAD/CAM production without relinquishing control of any part of the workflow.

Start-to-finish systems

 line of cleaning products provides the same cleaning power as the company’s biodegradable and phosphate-free Enzymax cleaning products, while reducing bioaccumulation potential and using enzyme stabilizers that are safer for the environment.

 The enzymes used are more rapidly biodegradable, with lower inherent toxicity and fewer toxic byproducts.

 Featuring 2.5W of power, three customizable presets and the ability to use disposable tips or strippable fiber, the lightweight laser is designed for dentists and hygienists just beginning to add laser services to the operatory.

 With no harsh chemicals or volatile organic compounds, the cleaning products do not pollute indoor air and are safer for the staff doing the cleaning.

 The cleaning products are available in a concentrated liquid form or in single-use PAX® packets that mix with one gallon of water.

 The Enzymax Earth line of cleaning products provides the same cleaning power as the company’s biodegradable and phosphate-free Enzymax cleaning products, while reducing bioaccumulation potential and using enzyme stabilizers that are safer for the environment.  Earth friendly: The enzymes used are more rapidly biodegradable, with lower inherent toxicity and fewer toxic byproducts.

Tech Brief: Applying Enzymax® Earth in your practice

surround your patients-whether seated or reclined-with digital media

, the Flexview HD media delivery system gives your practice a “wow” effect patients are sure to remember.

	2. Designed to make the most of your intraoral cameras, digital x-ray systems and software, the 

 shows patients-in high definition-everything you want them to see.

	3. Patients love the distraction of video entertainment, and 

when you reduce anxiety and discomfort, patients are easier to work with

	4. Allowing complete rotation around and over the dental chair within a tight footprint, the Flexview HD is a 

compatible with nearly all lighting systems

, Flexview offers expert consultation and design services according to the needs of your office.

 1. With its ability to surround your patients-whether seated or reclined-with digital media, the Flexview HD media delivery system gives your practice a “wow” effect patients are sure to remember.  2. Designed to make the most of your intraoral cameras, digital x-ray systems and software, the crystal-clear Samsung monitor shows patients-in high definition-everything you want them to see.

In-op flexibility

	Unless you live TV free, by now you’ve likely been exposed to the seemingly endless advertising battle between Verizon and AT&T over their respective 3G networks. The wireless providers pull no punches as they take shots at each other’s service networks, but they never really stop to explain just what 3G means.

	If you weren’t already aware-just like with many technologies and materials-that 3G stands for 3rd Generation. And while they compare them as if they were the same thing, AT&T and Verizon actually use very different platforms for the third step in the evolution of their respective wireless communication networks.

	But all that fighting will soon be a thing of the past as the next generation of network technology, (yup, you guessed it, 4G) is already here­-at least in most major markets. The first provider of this latest generation of mobile data service isn’t one of the big cell companies, but Clearwire, a company that, through its WiMax technology, can offer mobile download and upload speeds two to three times as fast as the top 3G network. It’s not quite cable-modem fast, but using a device connected to Clearwire’s 4G network gets to websites, videos and other online information almost as quickly.

	While just a handful of smartphones are currently capable of accessing the highspeed 4G network, there are other ways to get on. Clearwire’s CLEAR Spot 4G mobile hotspot lets any device capable of connecting to a Wi-Fi network jump into the 4G fun.

	The battery-powered, pocket-sized device creates a portable Wi-Fi network anywhere it can get a 4G signal. With a capacity for up to eight users simultaneously, it creates a spot for laptops, netbooks, 3G smartphones, iPads and other devices to cruise at 4G speeds. The hotspot handles the 4G transmissions, and because they are connected via the Spot’s temporary Wi-Fi network, they get to operate at 4G speeds without having to be 4G-compatible themselves.

	While the CLEAR Spot 4G is only applicable in areas covered by Clearwire’s 4G network, CLEAR Spot 4G+ provides nationwide mobile Wi-Fi access by connecting to Sprint’s 3G network anywhere it can’t get a 4G signal.

	Just as compact as its non-plussed cousin, 4G+ does make a few minor sacrifices for the more flexible connectivity. Namely its battery life is around three hours of continuous use rather than the 4G’s four hours, and it only allows five connections at a time.

	Both CLEAR Spot mobile hotspot devices provide network security in the same formats familiar to anyone using a home Wi-Fi router. This means only users with the proper password can access the network.

	One thing users don’t need to do is stand next to the hotspot to soak in the 4G Internet. Both hotspot devices work at a range of up to 150 feet so people connected to the portable network have some room to roam.

	Actually the entire network can roam. As long as the CLEAR Spot has a signal, the network is active. If a signal is available, it’s possible to have multi-user 4G Wi-Fi access from a moving car or train (or even on a plane if the airline allowed it).

	With a strong signal, (and like wireless networks from the other providers, Clearwire’s continues to expand and improve) there’s no need to seek out somewhere with free Wi-Fi while on the road or just out of the office. With the CLEAR Spot 4G and 4G+ it’s now not only possible, but quite simple to take the Internet-and the speeds we’ve all come to take for granted-almost anywhere.

 Unless you live TV free, by now you’ve likely been exposed to the seemingly endless advertising battle between Verizon and AT&T over their respective 3G networks. The wireless providers pull no punches as they take shots at each other’s service networks, but they never really stop to explain just what 3G means.

Mark your own spot

	December 14, 2010  | dentalproductsreport.com

	In an evolutionary sense, humans have little in common with the tuatara.

	The ancient lizard species, native to New Zealand, is the last in a genetic line that flourished some 200 million years ago. It features a number of properties that are rare or found nowhere else in nature today and thus is a prized specimen for evolutionary biologists to study.

	Among those features is the way tuatara teeth are fused directly to their jaws. The lizards lack the periodontal nerve that helps many other species gauge bite forces during chewing, and a recent study published in the Journal of Biomechanics shed some light on how tuataras use the muscle groups that control their jaw movements to manage bite forces and prevent damage to the jaws during mastication.

	While the study was designed to examine how the lizards are able to maintain optimal jaw function throughout their more than 60-year lifespan, the results might also provide a good starting point for people looking to study how humans with dental implants adapt to their new teeth.

	“The finding that the jaw joints could be important in maintaining some degree of normal feeding function when the teeth are lost could lead to future studies,” said Dr. Neil Curtis, a postdoctoral fellow at the University of Hull in England. “For example how well humans with replaced teeth control bite forces, or how the muscle activities vary between those with normal teeth and those without.”

	Because dental implants are attached directly to the bone with no periodontal ligament to provide a cushion, implant crowns, bridges and implant-retained dentures are likely to behave much more like a tuatara’s teeth than the teeth they are replacing. Thus, humans with implants wind up with something in common with ancient lizards.

	Dr. Curtis said his study’s results do not provide any viable information that can be translated to humans, but the computer modeling techniques he and his fellow researchers used in their study of tuatara skulls could be adapted to study how human jaws function and control bite forces when it comes to dental implants.

	“This means analyses into the function of the human masticatory system can certainly be carried out,” he said.

	In Dr. Curtis’ study the tuatara skulls were scanned using computed tomography to create 3D virtual models. These models were imported into a software application designed for performing multi-body dynamic analysis for bite force simulations. The software allowed the creation of virtual muscle strands connecting the jaw and the skull and allowing the moving pieces to interact, with accurate measurements of the forces affecting the muscles, bones and joints during chewing of materials with different densities.

	The study determined that tuataras are able to manage the bite forces and prevent damage to their jaws while biting hard substances by various muscle groups on opposite sides of the jaw working in conjunction. Dr. Curtis said he believes humans with implants would be able to manage bite forces in a similar manner.

	“All animals have groups of muscles that open the jaw and groups that close the jaw,” he said. “While the positions and some characteristics of these groups will differ, their ultimate function will be similar. I therefore believe that muscles of mammals could function in the same way as the tuatara.”

	Of course translating his research data directly to human jaws is not possible. However, similar research on humans with dental implants might be beneficial to understanding how humans adapt their jaw function when implants are placed, how to best care for implants after they are placed and possibly even how to improve implant design for optimal jaw function.

	“We have only modeled the situation virtually, but in vivo, the effect of modification to normal jaw function could have a major long-term effect,” Dr. Curtis said. “If we know more, such as forces in the jaw joints are too high when the teeth are lost, then perhaps better post-implantation advice could be given. For example eating certain foods that will not cause high bite/joint forces, or perhaps more sophisticated implants that damped peak bite forces somehow to help protect the teeth and jaw joints against these sudden high forces.”

	The current research may not offer applicable information, but looking at the ancient teeth of the tuatara may help humans take a bite out of understanding how humans with dental implants manage biting.

 December 14, 2010  | dentalproductsreport.com  In an evolutionary sense, humans have little in common with the tuatara.  The ancient lizard species, native to New Zealand, is the last in a genetic line that flourished some 200 million years ago. It features a number of properties that are rare or found nowhere else in nature today and thus is a prized specimen for evolutionary biologists to study.

What we can learn from lizards

	When considering the digital technology that exists today, it’s not hard to imagine a dental lab looking a lot more like a cubicle in a typical office with just a computer and a scanner as the only tools occupying the desktop.

	Such a lab would take in cases either via digital impression or by scanning a traditional impression, design the restorations in a completely digital environment and then outsource production of the digitally planned restorations. Sure, the lab technician as digital designer would most likely do some finishing work on the restorations that come back from his or her production partner, but the majority of the effort could be handled virtually with greatly reduced overhead costs in terms of supplies, equipment and office space.

	“Do I ever see a day when laboratories can survive with just scanning technology sitting in an office environment? You could conceivably do that today,” said Dave Nakanishi, owner of Nakanishi Dental Lab in Bellevue, Wash. “You could sit in a very sterile business office, take in those input scans, design copings or whatever you’re doing and then send them off for casting, producing and machining. It’s really not a heavy financial burden. It does take a change in the thought process in terms of workflow, in terms of how a laboratory wishes to create their product.”

	A self-described early adopter, Nakanishi’s lab uses a number of digital workflows and CAD/CAM systems including SensAble Technologies’ SensAble Dental Lab System and scanners from Nobel Biocare, Straumann and Biomet 3i. He said the software advancements and intuitive interfaces such as SensAble’s haptic system have advanced to the point where, “technology is actually allowing technicians to be able to better utilize their skills.”

	It’s a similar thought that led Tom Nieting, CDT, and Norbert Ulmer, MBA, to create DENTATRUST, their vision of an all-digital workflow built around Sirona’s CEREC Connect network, which they helped launch. Ulmer said the digital processes save time and labor in a number of ways.

	By taking in cases via digital file direct from chairside, DENTATRUST is able to greatly reduce the costs to pick up cases, which saves money even when those cases are coming from nearby dentists. This also speeds up the start of work, and because they outsource model fabrication to Sirona, the lab is able to begin working on designing the restoration immediately.

	“While Sirona is fabricating these models, we usually already start fabricating the restorations, especially when it needs zirconium oxide or some substructure materials,” he said.

	Another benefit of the system is the way it helps the lab stay close to dentists, Ulmer said. By being able to review and respond to the case immediately, DENTATRUST is often able to make sure everything is in order with the digital scan and the prep while the patient is still in the dentist’s office.

	It’s this relationship that Eddie Corrales, owner of Downtown Dental Designs in San Diego, believes is a real key to succeeding in a digital dental landscape. Also built around the CEREC inLab system and CEREC Connect, his five-technician operation works so closely with its dentists that the techs hope to be considered almost part the staff.

	“If we are on speakerphone with the doctor or live on Skype-we actually like Skype better-we actually help them with the scanning,” he said. “We kind of drive his hand directing him more lingual or buccal before he takes the next image.”

	He sees himself as a resource for the dentists and hopes they view him and his lab as an extension of their chairside scanning technology. Corrales has also found a way to remain a part of their chairside milling technology because designing restorations virtually means they can be involved in cases that never leave the dentist’s office.

	“We try to do everything digital where we offer designing directly on the doctor’s machine directly through remote desktop,” he said. “We can run their computers from our lab or from an iPad.”

	While the CEREC system is celebrating its 25th anniversary this year, it is still a minority of dentists who have adopted either the chairside CAD/CAM or digital impression technology. However, Corrales said he believes chairside digital impressions and CAD/CAM will eventually grow to become the norm in dentistry.

	This means dentists might eventually be doing most posterior inlays, onlays and crowns chairside and labs will need to adapt to the changes. Corrales said there will always be value placed on their knowledge and skills, but dental technicians will need to adjust to using them in new ways.

	“If I was to start my business today, I would probably just have a big computer screen and maybe my own scanner and outsource my wax patterns,” he said. “That’s where we’re going as technicians, where we don’t need to have all the equipment anymore. As technicians we have to accept the reality and be the technicians we need to be, which is the cutting edge digital technician.”

	Ulmer said being on the ground floor of the digital workflow between clinicians and labs is a good place to be. Even as more dentists begin using the CEREC system and take on more of their own production, they will always need a lab partner for the cases their chairside system is not capable of handling. Ulmer believes CAD/CAM will continue to grow in dentistry and by being a resource for dentists as they are learning their CAD/CAM system, DENTATRUST plans to become their trusted outsource resource for those cases still outsourced.

	“Our industry is moving that way, and it is a strategic question, do you want to be involved in the future or not? And then to what degree do you want to be involved?”

	Nakanishi said there are a number of different ways labs can get involved in a digital workflow and finding the right system to match the lab’s needs is really the key. He added just SensAble’s design system to his partial department because it is his smallest department and the company allows labs to buy into different system components separately.

	His partials department uses just the scan and design capabilities of the system and outsources all of the printing. Regardless of which SensAble printing center they’ve used, Nakanishi said the results have been consistent and impressive. In fact, he said the high quality work coming from all his digital systems has been better than ever.

	The thing that excites him most is seeing the rise of a more open architecture environment because as the various digital systems begin to work together, he can simplify his lab with one system capable of accepting a wide range of cases from a variety of sources. With so many ways to add digital capabilities to a lab today, Nakanishi said there are systems that should fit into any lab’s workflow.

	“It’s really hard to avoid getting involved in at least scanning technology. There’s so many sources out there today to be able to print, to be able to mill, to be able to fabricate that small laboratories can get involved,” he said. “It’s not just a big laboratory game today.”

	In fact, Ulmer said finding the right digital business model could be the key to smaller labs remaining viable as digital dentistry grows. The greatly reduced costs and increased production speed from a digital workflow can help smaller operations remain profitable in the changing landscape, but Ulmer said he doesn’t think the majority of labs see this yet.

	“My vision is that the digital production, the CAD/CAM equipment basically offers the smaller sized labs to continue to have a place in this economic environment,” he said. “Right now what I see is that the majority of small sized labs are trying to avoid technology rather than embrace it.”

	Corrales said he views the industry as several bubbles. The far larger bubble is the dentists who are not using CEREC and CAD/CAM technology, while he’s setting up shop and securing his place in the smaller CAD/CAM bubble because he sees that as the future.

	“My bubble’s getting larger every day,” he said. “It’s certainly going to take a few years before it’s larger than the other bubble, but we are going to be taken over by these machines, so we have to find our niche.”

	Dental Lab Products Senior Editor Noah Levine can be reached at 

 When considering the digital technology that exists today, it’s not hard to imagine a dental lab looking a lot more like a cubicle in a typical office with just a computer and a scanner as the only tools occupying the desktop.

A desktop future for the dental lab

	The global dental implant market is currently worth $3.2 billion and expected to be worth an additional billion dollars in the next 5 years, with 31 percent of the revenue in North America, according to a report¹ recently released by market research firm Markets and Markets (marketsandmarkets.com).

	The report cites the functional and esthetic efficacy of implants, along with growing patient awareness and the continuing growth of CAD/CAM in the implant arena as key factors spurring the growth. And while the expected additional revenues will be spread throughout the dental industry, many laboratories and dental manufacturers are lining up behind CAD/CAM as a way to capture as much of that growing revenue as possible.

	As the owner of Precision Craft Dental Laboratory in Smithfield, R.I., Richard Napolitano, CDT, has seen the growth of the implant market for the past 30 years, and said in just the last 10 years he’s seen his implant business jump by about 30 percent. It’s a trend he expects to continue due to both the factors cited in the M & M report and the fact that recent dental school grads are receiving more training in implants than previous generations of dental students, leading to an influx of clinicians interested in providing implants.

	But whatever the cause of the growth in the implant marketplace, Napolitano believes the efficiencies of CAD/CAM production will be the key to Precision Craft capturing its share of that new business.

	At his lab, the CAD/CAM solution comes by working in partnership with BIOMET 3i and the company’s CAD software and third-party collaborations. Using the technology has allowed him to offer implant restorations with custom-designed abutments at about two-thirds of the cost of using more traditional fabrication techniques for the same restoration. Additionally, he can offer zirconia copings and frameworks for both implant abutment and natural tooth restorations with the 

	“We’re finding that there’s a decrease in price and time. That’s really sparking the interest in a lot of dentists,” he said. “Everything’s being driven down by these CAM designs. You still have control over the design, but you’re not spending the man hours or the money on the materials that will inflate the price.”

	These same efficiencies are being embraced by many parts of the industry, with a variety of companies continuing to expand and refine their CAD/CAM offerings and how their systems work with products from other companies.

	For Straumann USA this means bringing all of the company’s digital offerings under the new CARES® (Computer Aided REstorative Solutions) brand, which includes new software, a new scanner, a partnership with Cadent for accepting intraoral scan data from its iTero system and expanded uses of the system including lab-fabricated stents for guided surgery procedures. Straumann USA CEO Martin Dymek said the expanding technologies will help make implants an even more common dental option because they lead to better patient outcomes.

	“Technology continues to enhance the predictability and expand the range that implants can be used in,” he said. “In many cases, we’re actually looking at a far more precise, more accurate restoration, which certainly saves time for the patient.”

	This expansion of CAD/CAM in the implant realm is also something being embraced by 3M ESPE, where the company continues to expand the capabilities of its selectively open Lava™ Network with abutment design and milling capabilities. Lava Design System Brand Manager Roger Dawson, CDT, said he expects to see only more and more use of digital production techniques, and he believes the bulk of the dental lab industry will take advantage of the technology as it continues to prove itself in the marketplace.

	“The technician, I think, is always looking for ways to get better, always looking for ways to be on top, and always looking for ways that they can streamline their processes,” he said.

	“The problem we’ve got in laboratories is that we always look at everything that comes along with a little bit of a squinted eye. We love to try new technologies that work, but we’ve been burned by a lot of technologies that didn’t work. We always look at it with a little bit of doubt because we’re concerned that it could be a failure. And we don’t have time for failures.”

	But while Dawson said he respects the level of skepticism many in the industry bring to new products and new techniques, CAD/CAM and digital workflows should no longer be viewed as something new, but rather as something standard. By adopting the digital workflow, technicians can realize a range of efficiencies in costs and labor, but doing so involves trusting the new techniques and being ready to work in a different way.

	Dawson said a major advantage in the latest generation of 

 is the capability to scan an interface from virtually any implant system and design a custom abutment that can be milled out of Lava Zirconia to fit that implant.

	When combined with the company’s Lava DVS (Digital Veneering System), which creates a zirconia coping with a glass ceramic outer layer from the same digital design, Dawson said the system is capable of creating a complete implant solution while skipping a number of labor-intensive steps from more traditional workflows.

	“With a virtual design in our system, now I don’t have to wax up, I don’t have to do anything other than scan the interface and then virtually design an abutment top,” he said. “Now it is possible to create an abutment, a coping and DVS top without even having a model. The reports I get from my technicians is they feel it makes them more efficient, and it gives them more design ability and design control.”

	Control is the operative word for Napolitano and his lab. Part of the decision to implement the 3i incise system was the ability to bring zirconia production in-house via the Renishaw Dental Milling Machine. Thus far, the results have been impressive to him and the clinicians he works with as they’re seeing improved frictional retention and marginal adaptation from the in-house-produced zirconia copings.

	“Predictability is very important to us as far as consistency in the products. If I have variable fits or variable margins, I’m going to be in trouble with my doctors,” he said. “We’re finding our clinicians are accepting it whole-heartedly. They’re seeing a major difference in the fit of our copings.”

	Precision Craft COO Ryan Napolitano attributes the improved fit from the 3i incise system to a handful of factors including the ability to set a customized cement gap during the digital design and software options for designing copings for use with implant abutments, which tend to have a parallelism not found in crown preps for non-implant cases. These design efficiencies are bolstered by the milling fabrication that takes advantage of both computer-guided precision and the inherent strength of creating restorations from a monolithic block of material.

	“The technicians are very excited over this, because they’re able to apply what they’re trained for without the casting and manufacturing inaccuracies that we’ve had in the past. With the CAD/CAM designed structures, there’s the predictability and consistency,” he said. “It’s in the labs’ best interest to try to utilize CAD/CAM to automate as many processes as they can, and thereby get a consistent result at a more cost-effective price.”

	In the world of implants, this really comes into play with the growing options for creating patient-specific abutments that take advantage of the patient’s individual anatomy at the implant site to enhance the esthetics of the final restoration.

	Richard Napolitano said he’s experienced an increase in requests for custom abutments for his implant cases, but he also tries to push dentists to go in that direction because of the benefits custom abutments offer to the lab, the dentist and especially the patient.

	“We’re finding that the results of custom abutments allow us to do a more esthetic and functional case for a considerably cheaper price,” he said.

	Ryan Napolitano said he believes that just like the steady move toward increased CAD/CAM use, the industry also  will shift to the point where milled custom abutments are the norm for implant cases because they offer better results for the patient and lower costs for labs that do not need to stock as many materials or supplies because of the more efficient digital workflow.

) and BIOMET 3i’s Encode® custom abutment services have made CAD/CAM-produced abutments available to labs with all levels of digital integration. The model of smaller labs working with outsource partners and milling centers for part or all of the digital workflow certainly seems like it will be a viable option for smaller labs looking to add CAD/CAM services to their product offerings.

	While Dawson said he doesn’t believe stock abutments will completely disappear, he believes the enhanced esthetics and improved function that can be realized through the use of custom abutments will drive the increase in demand for them from dentists. Having local control of design and production, such as that offered through 3M ESPE’s Lava Network, offers dental labs a huge advantage when providing dentists with custom abutments for their implant cases, he added.

	“With what we’ve got now, the technician has to send nothing out and has complete control of design and doesn’t have to change abutment construction when it gets back to them,” Dawson said. “They have complete control of when they get their abutments back and when they can create their crowns and their full contour tops.”

	Dymek and Straumann also are strong believers in the benefits of custom abutments and the CARES system provides a workflow for efficient design and fabrication. That workflow puts the lab technician’s focus on the digital design process with Straumann serving as a partner for the fabrication.

	When cases begin from an iTero intraoral scan, they allow the lab technician to begin the design the instant the data file is received. And with the final production handled by Straumann’s industrial scale milling center, that technician can move on to working on another case while that process is underway.

	“We’ve engineered this from start to finish. This is an entire seamless connectivity within one workflow. This has all been designed to work well together,” Dymek said. “We feel the best way to ensure a robust restoration as well as for maximum accuracy is a ­central milling model where industrial strength mills and processes can be utilized.”

	But while centralized, industrial-scale milling is Straumann’s model for implant parts and abutments, Dymek said the

system sets up local labs for closer connections to their dentist partners by giving labs the capability of designing and fabricating surgical stents for use in Straumann’s guided surgery workflow.

	This brings the lab into the case from the very beginning of the treatment planning, but Dymek said if labs are not engaged at that point of the case, the CARES system provides a new access point by allowing surgeons with iTero units to send intraoral scans of the implant site immediately after surgery, giving the technician a chance to get a jumpstart on designing the restoration. This is designed to improve communication between everyone involved with the case and maximizes use of digital patient information.

	“Once the [physical] impression is sent to the lab, the surgeon has no way of evaluating the quality of the impression. Whereas once we have that digitized the opportunity exists for the surgeon, the restoring dentist and the lab have the ability to look at that data together,” Dymek said. “This creates a unique digital relationship between a surgeon and a laboratory, which is certainly not a relationship that exists with great frequency today. They certainly can streamline the ordering and treatment planning of that site, by being engaged at the time of surgery.”

	Being engaged with an implant case prior to surgery is often a major benefit to everyone, Ryan Napolitano said while noting that sometimes it can be a challenge to convince dentists of these benefits. Still, a skilled technician working on a case-whether digitally or via more traditional techniques-prior to surgery is able to apply his or her knowledge of dental mechanics and skill at anatomical design to help the case have the best chance for exceptional function and esthetics.

	In all aspects of the implant cases, Ryan Napolitano said Precision Craft is benefiting from adopting the BIOMET 3i Encode® and 3i incise CAD/CAM system. Bringing more of the production processes in-house has proved to bring in not only a greater degree of control but also a decrease in production time and a reduction of costs per unit to the lab. This has allowed them to provide dentists with higher-quality work in less time and at a lower price.

	“We like the fact that we can control the flow of work much more accurately,” he said. “You’re turning out a quality product faster, and it’s able to be delivered in a shorter period of time.”

	Dawson also strongly believes there is no turning back from the digital technology making ever-deeper inroads in the dental lab industry. It is a competitive business, and anything that makes a lab more efficient needs to be considered, especially if it simultaneously improves quality.

	With 35 years of experience as a ceramist in his background, Dawson said he understands the way lab technicians and owners approach new developments and next big things cautiously. However, he believes the jury is no longer out on CAD/CAM technologies, and when it comes to complex implant cases CAD/CAM offers immense benefits to lab owners and technicians as well as efficiencies and improvements that can help them stay ahead.

	“As a lab owner I want my work to look better than the guy’s down the street with the same amount of effort or less. I want it to look better without having to work harder to get it. That gets me more work,” Dawson said. “I don’t have to hide my head in the sand. What I need to do is grab a hold of this technology and ride with it.” 
	
	

Editors note: Richard and Ryan Napolitano are paid consultants for BIOMET 3i.

	1. “MarketsandMarkets: Global Dental Implants Market worth US$4.2 Billion by 2015” http://www.marketsandmarkets.com/PressReleases/Dental-Implants.asp. Accessed Oct. 5, 2010.

 The global dental implant market is currently worth $3.2 billion and expected to be worth an additional billion dollars in the next 5 years, with 31 percent of the revenue in North America, according to a report¹ recently released by market research firm Markets and Markets (marketsandmarkets.com).

Making it your own

	It’s always a showstopper when there’s a demonstration of a 3D printing system taking place in the exhibit hall of a trade show. Watching digitally designed copings, frameworks, crowns or models rise up and take shape on the print platform can be almost mesmerizing.

	But these high-tech printers are more than just attractive novelties. With the ability to rapidly produce high-precision parts that fit a variety of production workflows quickly and cost effectively, a 3D printer can become a critical part of a dental lab’s CAD/CAM operation.

	“Superior accuracy, fine details, high resolution and low cost per case; these should be the key factors for dental labs considering the move to digital dentistry and 3D printing,” said Avi Cohen, Head of Medical Solutions for 

, which produces the Eden260V 3D printer. “With a 3D printing solution doing the detailed work, dental labs can eliminate the bottleneck of manual modeling and allow the business to expand and stay ahead of the competition.”

	Consistency and efficiency are big benefits of an investment in a 3D printing system, said Ron Snyder, CDT, Dental Application Manager for 

, which makes the ProJet™ line of 3D printers along with a range of other additive production technologies. Whether the technology is being used to produce in-house models based on digital or scanned impressions, or making digital designs into wax forms for casting, Snyder said 3D printers provide speed and precision.

	“It’s faster than using a dip pot and just dipping a die in,” he said. “What you get is more consistency. If the computer says it’s a 3/10 of a mm coping, it’s really going to be a 3/10 of a mm coping.”

	Digital design software saves time on the front end by automatically blocking out undercuts, the wax forms don’t need to be fine tuned prior to casting, and once cast the end results require 50% less finishing time, Snyder said, adding that these efficiencies lead to material savings that can reduce a lab’s alloy consumption by 10-30%.

	Grant Day, CDT, Manager, Technical Support for 

 said the EnvisionTEC line of 3D printers available through Zahn are adaptable and upgradable systems with sizes ranging from desktop units to industrial scale systems.

	A variety of materials are currently available that allow EnvisionTEC printers to produce lost wax casting patterns for fixed restorations, and there also is an FDA registered resin for long-term temporaries. Objet’s printers can be used to produce stone models, orthodontic appliances, implant surgical guides and veneer try-ins, and Cohen said parts produced with the company’s 3D Printing system are classified and approved for use as medical devices. Materials available for the various 3D Systems printers can produce casting patterns, models, partial frameworks and just about anything that can be digitally designed.

	These systems are designed to make existing lab technicians more efficient by automating time consuming tasks, freeing up time for other steps in the production process. Cohen said Objet’s printer can reduce fabrication times by 60%, and if that time is well spent, technician output can increase by an even wider margin. The benefits of 3D printing grow even more evident when the technology is paired with chairside digital impressioning.

	“The moment you have an oral scan impression on your computer, the 3D printer gets to work producing exactly what you see on screen, without deviations or faults,” he said.

	Digital designs that can be exported in the STL format can be sent for production on any of the companies’ systems, and the ProJet printers also can be set up to print designs from CEREC and Lava users. Very little needs to be done to print a design, and Snyder said his company’s software stands out by automatically generating the supports and arranging the designs on the print platform for efficient production.

	“You’re not sitting around looking at a computer screen and fiddling around with the jobs. You’re just sending the jobs and walking away,” Snyder said.

	3D printing systems can be employed in a number of ways to fit in with labs of various sizes and specializations. The only prerequisite for adding any of these systems to a lab is scan and design capabilities.

	Finding the printer that fits your lab’s size and business is really the key, Day said. Of course investing in efficient technology is also about growing that business, and Cohen said a 3D printer can help a lab scale up its production capabilities without adding staff to the payroll.

	Snyder said ProJet printers are currently in use from labs as small as two-person operations to large scale production centers with 2,000 employees. Regardless of size, every lab investing in the system is set up to fill in unused capacity by taking on outsource work, and 3D Systems promotes the outsource capabilities of labs with its printers online at 

	For labs with scan and design systems in place, adding and being trained on a printer is a relatively simple process. Day, Snyder and Cohen all said training is a simple process and depending on the lab’s CAD/CAM acumen, it could be printing in 3D in as little as one day.

	Day and Cohen said Zahn and Objet both provide onsite installation and training with ongoing customer support available for labs with questions after the training is completed. 3D Systems sells printers through reseller partners such as CadBlu and Sensable Dental. Snyder said ProJet labs contact their printer source for support, but if those companies need further assistance, 3D Systems is there to provide the answers.

	Of course setting up and learning to properly use and care for the printer is only one part of the equation. It is far more important for a lab to know how the 3D printing system will fit into the lab’s processes if it expects to achieve the best business returns possible, Snyder said. That needs to happen prior to purchase so the lab has a plan in place when the printer arrives.

	“It’s one thing to learn how to use a piece of equipment. It’s something else entirely to learn how to integrate it into your business,” Snyder said. “Some of it is ancillary management that has nothing to do with operating the equipment. It’s operating the business.”

 It’s always a showstopper when there’s a demonstration of a 3D printing system taking place in the exhibit hall of a trade show. Watching digitally designed copings, frameworks, crowns or models rise up and take shape on the print platform can be almost mesmerizing.  But these high-tech printers are more than just attractive novelties. With the ability to rapidly produce high-precision parts that fit a variety of production workflows quickly and cost effectively, a 3D printer can become a critical part of a dental lab’s CAD/CAM operation.