New Era Dental Arts, based in Sylvania, Ohio, staffs six technicians and works with more than 20 dental practices. Jeff Wayton, a technician with more than 30 years experience, and Mark Nightingale run the crown and bridge lab, which also provides some ortho services.

BruxZir® Solid Zirconia is a monolithic zirconia crown or bridge restoration with no porcelain overlay. While it is considered a strong option, the Glidewell Laboratories’ product also is known for delivering optimal esthetics when prescribed instead of metal occlusal PFMs and cast gold restorations. Described as virtually chip proof, it is an ideal restoration for bruxers and grinders.

BruxZir Solid Zirconia crowns and bridges are made from the highest quality zirconia that is uniquely colloidal processed without mechanical pressing or contaminate organic binders for enhanced esthetics (patents pending).

Designed and milled using CAD/CAM technology, these crowns and  bridges are sintered for 6.5 hours at 1,530° C. The final BruxZir crown or bridge then emerges nearly “bulletproof” and is glazed to a smooth surface.    

Wayton’s lab has only been producing BruxZir restorations for a few months, but the results for both New Era Dental Arts and its dentist customers have been great.

Initially, other companies started coming out with versions of zirconia crowns. Wayton and his staff  tried out some of these other blocks, but after talking to Glidewell and trying out BruxZir, the lab thought it was a superior product to the others.

“It had better translucency and was nicer all the way around,” Wayton said. “It wasn’t so dead looking as some of the others.”

Rising gold prices also helped make the switch a wise choice.

“With the gold prices going up so high it’s a good alternative to the gold in the posterior region,” he said. “I mean, yeah, you lose some of the esthetics as far as a PFM, but it’s more esthetic than a gold crown. Really, we’re getting them to the point where they’re looking real nice. I’ve had guys even use them up in the bicuspid region.”

The dentists like them so much they’re asking for BruxZir more and more, he said.

“They’re very happy with it. Matter of fact, in the last year our CAD went from about 18 percent to 30 percent of our output from the lab. It’s changed from PFMs to some sort of CAD product,” Wayton said. “Now, the BruxZir is up to 6 or 7 percent of our business. So we’re doing quite a few of them.”

New Era Dental Arts has had an onslaught of BruxZir crown requests, and Wayton said once doctors hear about them and try them out, they really seem to like them.

“They’re strong and they’re esthetic. They don’t want to have the chances of the porcelain chipping down the road, if you’ve got minimal room. So they’re going to these.”

Including the stints with some other products, Wayton has been doing the full zirconia for about a year. He’s glad they made the switch to BruxZir.

“We just felt  you always try to better your product, and from what we tried, the BruxZir really worked out. It looked the best and it was very strong. You know, hey, if you can make it look better, you’re going to use that product,” he said.

Learning to produce the restorations with CEREC inLab came easily to the staff at New Era Dental Arts.

“It was a smooth transition,” Wayton said. “As far as one block to the other, there were only a few little changes you had to make. The CAD tech doesn’t have a problem with it. It was a very simple changeover; a simpler process.”

When the BruxZir blocks first became available for use with inLab, the lab made a few crowns and started  showing them off to potential customers .

“We made a couple samples and took them around and showed them. They thought they saw a market for them and as we started doing them (our clients)   liked them so we started getting more and more orders for them,” Wayton said. “We’ve been very happy with them. We’re very excited.”

Producing these restorations has helped the lab’s efficiency and therefore its bottom line. There’s less labor cost, and because you don’t have to put ceramics on it, there is no fee for a ceramist to build it up.

“It’s all pretty much computer generated. The only thing you really have to do is once they’re sintered you do shade them and sinter them-you just have to stain and glaze them,” Wayton explained. “So the process is shorter, they look  nice and they’re strong. It cuts down the labor costs on them, too.”

And not only is New Era Dental Arts seeing a nice return on its investment when compared with other types of crowns, but it’s also drumming up some outsource business from labs requesting they handle the BruxZir milling for them.

“We’re seeing a nice return on it. It’s less expensive than our porcelain-to-zirconia crowns because once again you’ve got zirconia there but you also have got to build porcelain on it so it takes longer; you’ve got more labor involved and supplies,” he said. “So this is actually a cheaper alternative to even a PFM, porcelain-fused-to-metal crown. And obviously much cheaper than a gold crown, because with the gold prices, we’re billing some gold crowns for $300 to $400. The dentists obviously don’t like that so here’s your alternative.

“And if a lab wants these made we can make them. We do some work for some labs, too, so they’ll send us their models and we scan off them and make them for them and send them back unglazed and then they can stain and glaze them. So we do some sub-contract work that way and that’s increased. That helps us increase (revenues).”
	In a short period of time this lab has already seen great results from offering BruxZir restorations.

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The Lab New Era Dental Arts, based in Sylvania, Ohio, staffs six technicians and works with more than 20 dental practices. Jeff Wayton, a technician with more than 30 years experience, and Mark Nightingale run the crown and bridge lab, which also provides some ortho services. The Product

Real-Time ROI: Glidewell Laboratories' BruxZir

	When our patients look to make changes in their smiles, it does not always need to be a full mouth rehab. In certain cases, depending on the lip dynamics, four to six teeth may be ideal for a major change in a patient’s appearance. The key to making a change is always about tooth position, shape and color. And each one of these plays a different role in the makeover process.

	If color is the main concern, we may need to consider a larger amount of restorative work, again depending on the patient’s lip dynamic. But almost always, the starting point needs to be at least 8 to 10 restorations.

	When tooth position is the challenge, it is first recommended to use orthodontic opportunities rather than restorative solutions, with the second option being a combination of orthodontic and restorative. The last option when dealing with tooth position is restorative solutions on their own. This option is undertaken with the realization that we will need to make the movements by tooth reduction and replacement material selection.


	In a case such as this one, the patient is unhappy with his smile (Fig. A). As we examine the lip dynamics we can see that even with a large smile our focus becomes the anterior four only (Fig. B). So in this scenario, just the positional change of the anterior four will complete the change.

	As always in a case like this, orthodontic treatment was suggested, but it was not accepted by the patient. For us to proceed without orthodontics, we need to be certain the patient understands more tooth reduction will be required to complete the change.

	We need to clearly explain that with an orthodontic treatment this could possibly be only a two- to four-unit veneer case, which would mean much less reduction of the natural tooth and much more opportunity for current success and future ability to revisit this with more options in future years.

	Let’s be clear, our job is as much about saving tooth structure as it is restoring it. This again needs to be clearly understood by patients, and when it is, it usually convinces them that orthodontically they will have a much better long-term result.

	Still with all of this explained, the patient’s decision is for just restorative treatment. With that information in hand, it helps us and our partner clinician to choose the best material options to complete the esthetic tooth position. In this case, because of the reduction necessary, porcelain fused to metal will give us the safest option. The thought process here is that while all ceramic seems to be an optimal restoration in the anterior zone, the amount of reduction and repositioning of the teeth will give us very little support.

	In this case, with ceramic to metal, we can and should design the metal substructure to be supportive of the final restoration (Fig. C). As with all esthetic/functional cases, a diagnostic wax up and possible intraoral mock up is a good starting point (Fig. D). This allows us to evaluate our tooth position concept and to adjust our first plan if necessary (Fig. E). Once all this preliminary work is complete, this becomes a simple smile makeover and our focus now shifts to the esthetics.

	With the understanding of the amount of reduction needed to be done and our choice of porcelain to metal for support, the case control now switches to the technician’s understanding of contour and color matching (Fig. F). Ceramic margins are used as always when trying to achieve optimal esthetics, and our case is built on a solid tissue cast to help guide the esthetic contours (Fig. G). Our ceramic is built with a standard layering system as read with the photographic information and fitted back to the tissue cast for esthetic evaluation (Figs. H, I). It is useful and interesting at this point to evaluate the light transmission of the porcelain to metal to verify the ceramics’ ability to blend in the oral environment (Figs. J, K).

	When and if possible, a try in at this stage is useful, but not always necessary depending on the previous control system. The “Bisque Bake” concept seems silly to me as the previous guideline has not been set. From the technician’s point of view, this try in is about fine tuning and not any major change, especially to the incisal position where our translucencies and effects have already been applied. A major adjustment would basically mean the diagnostics have not been accomplished.

	The ceramic restorations are tried in and evaluated for contour and color (Figs. L, M). With this photographic information, we can evaluate and make any slight changes necessary. At this point the final glaze and polish is completed and verified back on the solid cast (Figs. N, O). The final restorations are cemented with a translucent adhesive to allow the ceramic marginal materials to bring light into the supporting root, and our simple smile makeover is complete. Obviously, there is no such thing as a simple restorative case, but with a diagnostic approach and communication, we can simplify to provide a successful esthetic result (Figs. P, Q, R).

 When our patients look to make changes in their smiles, it does not always need to be a full mouth rehab. In certain cases, depending on the lip dynamics, four to six teeth may be ideal for a major change in a patient’s appearance. The key to making a change is always about tooth position, shape and color. And each one of these plays a different role in the makeover process.

Dental Lab Products-2011-02-01

Real-Time ROI: Glidewell Laboratories' BruxZir

The simple smile makeover