We have three laboratory options from which to choose for these types of cases:

No metal zirconia block-the newest and most sophisticated technique 

The material choice we as technicians make depends on the dentist’s prescription and the patient’s desires. Before we fabricate the final case, we will send a try-in provisional to the dentist for him to test it in the patient’s mouth. We are always looking to confirm our guidelines for: horizontal lines, occlusion and mid-line, size of teeth, shape, shade, color and most importantly, occlusion contact. 

In our case study, the patient and the dentist demanded a metal-free hybrid bridge, which we will discuss in this article.

 Six Straumann tissue-level implants were placed (

) and, after being poured up, shown here on the model. An acrylic denture placed over the model shows the open anterior bite (

 Contact was added in order to close the bite and create a centric stop. It was duplicated with acrylic in order to copy the scan. After milling, it is too late for this stage. It must be done properly or the bite will be off (

 The side view image shows the occlusion contact after the inside has been filled in (

). An in-lab exocad scanning and processing machine (

) was used in our case. In the computer, we can see the scan and the processing using special software (

 Full contour arch design is next ready for the technician to cut back facially (

). After milling, the metal, 16 mm in size, had this appearance (

 An internal color of sand was utilized in the fabrication of the restoration (

). Facially, the restoration was cut back 8/10 mm during the scan and before milling. 

 After milling, the shape was ground facially before sintering (

 shows a photograph of the appearance after the first bake. 

). During try-in, adaptation to the model was decided (

) and then the porcelain evaluated on the cast model-translucency gingival color was achieved all the way to the incisal (

 Note the molar to central side view on the model (

This is a complicated procedure and, for it to be successful, we have to understand occlusion and how to evaluate it properly. The laboratory’s Removable Department has to be involved in order to give direction as to how to scan, design and mill the restoration. Without vast knowledge regarding occlusion contact and Curves of Spee and Wilson, the technician will not produce a final restoration that has proper alignment because the patient is edentulous. There is no guidance, which can lead to cracking, slanting and fracturing in the final prosthesis. For this reason it’s always best to provide a temporary flipper for evaluation of the fit. It also helps if we can fabricate both arches at the same time-but if not, we should always try to provide a treatment plan for the future. 

The ultimate goal is to have the patient be comfortable in the mastication process. The cosmetic side of the case is uncomplicated in comparison to the construction side. This requires intense study and planning and then strict adherence to procedure in order to provide the patient with the best possible long-term results.

Articles

Technology keeps moving and changing with noticeably different and better results. In the author’s career, he has been fortunate enough to be involved with several full-mouth restoration cases.

Step-by-step: A full-arch, metal free zirconia restoration

’s zirconia bar is designed with innovation in mind.

Featuring screwed attachments, labs can request a “wrap-around” or a “milled” shape, or lab technicians can request a zirconia bar of their own design. All zirconia bars are fitted with titanium screw bases, and there are two ionized finish choices: gold and pink. Additionally, the bar itself now comes in three shades of pink in addition to traditional white.

Learn about Panthera Dental's U.S. leadership change

This new solution from Panthera is engineered to combine the advantages provided by zirconia with the technology of a screw-attached bar. Panthera Dental also offers a new material called PEEK to create a 

 with its zirconia bar, which demonstrates a light weight and high level of biocompatibility and corrosion resistance. Together with the zirconia bar from Panthera Dental, this material can create an ideal base for stunning restorative options.

Zirconia bar with the PEEK material to create a double structure.

		Combines the strength and esthetics of zirconia with the features of a bar

		Features increased biocompatiblity thanks to zirconia

		Titanium screw bases available in two ionized finishes

		Zirconia bar available with screwed attachments, a first for the market 

		When combined with new PEEK material, reportedly creates excellent double structures

Fore more information, contact Panthera Dental at 

A milled zirconia bar to provide a tooth-shaped substructure.

 Panthera Dental’s zirconia bar is designed with innovation in mind.

Panthera Dental's zirconia bar offers new solutions for labs

Vident has long been a name well-known to dental labs. But recently, Vident changed their name to make their relationship with VITA more apparent: the company is now called VITA North America.

We recently spoke with VITA North America Fred Ketcho about his company's recent changes, what they mean for the lab market and what VITA has planned in the coming year.

1. You’ve recently changed your name to VITA North America. What was the impetus behind that change?

Since 1984, our core business has been focused on the distribution of VITA products to dental laboratories and clinicians across North America. In the past, we have supplemented our VITA offerings with accessories and ancillary products. However, these add-on products served to dilute our efforts. We have been refocusing for several years now and decided it was time to go “all in” and change the company name to VITA North America. The name change is our most visible way of renewing our promise to the dental industry that VITA products and top-notch technical support are now, and always will be, what we do best.

2. What does more closely tying yourself to the VITA name do for the company?

The brand awareness and equity of the VITA name is exceptionally high. Saying “VITA” to virtually any dentist or technician in the world elicits instant recognition. VITA is 90 years old now, and all this time the name has represented quality and esthetics in dentistry. To not recognize that brand and consolidate our future behind it would be a big mistake.

3. How does this name change mirror the business strategy Vident has always had?

We focus on technical proficiency and education combined with excellent customer support. We also add value through exceptional service and programs for large labs, small labs and clinicians. It seems simple, but it can be very hard, particularly in an industry where sometimes the cheapest product gets the most attention. Aligning ourselves with VITA through this name change reinforces our strategy of continuing to provide superior customer and technical support.

4. What kind of changes or innovations will this enable VITA North America to make that might not have been as possible before?

The change removes the confusion we’ve propagated in the marketplace for some time. Dentists know us as “VITA” and labs know us as “Vident.” Can you imagine setting up a trade show or designing a magazine ad and having to determine which logo to use? We’ve had to do this for 30 years. Is that customer-centric? Of course not. When I joined the company, I brought a more customer-centric attitude, and this change will present a unified vision to our internal team that will then translate into more effort and time spent on customer-facing efforts.

5. You’re also moving your headquarters. What is the driving force behind that change?

In November, we’re moving our Orange County, Cali., corporate office from Brea to Yorba Linda, the city immediately to the east. The new office is in a med tech complex which more closely aligns us with our industry and offers a much better business environment. The building features state-of-the-art renovations across the board and a more modern clinical look. We’re designing the inside to foster a collaborative and productive work environment for both our colleagues and our customers; the building will also include a new, high-tech CAD/CAM lab.

6. What does the move do for VITA North America as a company?

It will allow us to present a more modern facility to course participants and have a more clinically professional appearance. The layout and flow of the facility also promotes a more collaborative and productive work environment.

7. With all of this change, what can customers expect from you?

I anticipate shorter hold times as a result of a new phone system, a better classroom environment with upgraded benches and faster technical support from our lab team. We always strive for fast, professional customer service, and although our research shows we rank high in this regard with our customers, I believe there will be an even higher rate of satisfaction after the name change and move to our new office.

8. How do these changes better equip VITA North America to serve labs all over the country?

We are rolling out an initiative to help our lab partners successfully grow in the CAD/CAM arena, centered around VITA Enamic. The program is focused on a business proposition that will help labs differentiate themselves in the marketplace with materials that most mimic natural dentition. Our new dedicated CAD/CAM lab will support the certification program. We will also have a milling room that allows for expansion as new systems come to market, allowing us to remain on the cutting edge.

9. What product is VITA North America most excited about for 2014 and heading into 2015?

Our VITA Enamic hybrid ceramic material has proven exceptionally popular with CEREC dentists, and we intend to launch it to dental labs. We will also be introducing universal mandrel CAD/CAM blocks and disk materials that will allow Enamic and our Mark II feldspathic material to be milled in most systems.

10. What else can we expect from VITA North America in the coming months? 

We are also in the process of putting the finishing touches on a CAD/CAM certification program that will allow us to present a milling material solution to labs that combines our products with excellent training, service and support.

 Vident has long been a name well-known to dental labs. But recently, Vident changed their name to make their relationship with VITA more apparent: the company is now called VITA North America.

How Vident's change to VITA North America benefits labs

	The word’s out! Digital dentistry is no longer a dream. It isn’t about the future. It is here and now. It is here to stay. Unfortunately, as with any fast-evolving methodology, doctors have an abundance of choices to handle their digital requirements.

As is usually the case, it is now up to the lab to have a solution that allows them to handle all these different digital file formats. What complicates the situation is that most technicians are under the misguided notion that any open laboratory CAD system can read all open STL files. Unfortunately, that is certainly not the case. At Core3dcentres, as we have gained experience with the STL files created by different systems, we have found that they are anything but the same. This begs the question: What is a lab to do?

As with all aspects of the relationship between clinician and laboratory, the key to success is extensive communication. For a lab to be ready to accept digital cases, it certainly helps to know what system the files are going to be originating from-and well before the cases start coming in! The optimal situation is to be able to guide the doctor to a system in which the laboratory has confidence. Unfortunately, this is not always possible. Labs are often left to gather information about the system and files when the clock is already ticking on a case. This process includes what we might consider basic information on case options. Does the case need a model? How will the restoration be manufactured? What material is requested or required on the case?

For typical crown and bridge, the answers to these questions can be simplified. Monolithic restorations can be fabricated without a model-end of story. The question I am asked most often is “can a lab guarantee fit of a restoration without a model?” The easy answer is yes. However, this can require a bit of a leap of faith. Labs have fabricated restorations without models, but had trouble fitting them to the model they then receive for the case. What happened?

Through a series of tests, we have determined the cause of this is more likely inaccuracies in the model, not in the restorations. Depending on fabrication of these models, different types of inaccuracies can occur. The thing to remember here is that the digital data collected from the intraoral scanner is the most accurate data to work from. With proper parameters in the design software, a lab should have the utmost confidence that modeless restorations can be counted on to fit. This goes back to communication between the lab and doctor as to how the restorations are working in the mouth.

That being said, when these cases start to involve implants, the workflow gets a little harder to decipher. The start of the data collection process here should be “where the doctor purchased the scan body.” Once that information is verified, the next step is to follow up with the scan body manufacturer.

Scan bodies are connected to implant libraries-and are not able to be used without their particular library if you want to achieve an accurate result. Depending on the implant library, it may, or may not, be possible to fabricate a model. There are also different types of models that can be created. Some libraries have the ability to print a model with a socket for a lab analog to embed in, while others only have the ability to print the model with a replica of the designed implant abutment. The best place to determine this, and the rest of the workflow, would be the manufacturer of the implant library.

The “unspoken factor” in digital workflow is always the scanner the doctor uses. With the variety of scanners on the market, doctors have many choices and many different reasons for making their decisions. Some doctors wish to also take on in-house manufacturing; this does not mean they won’t still send some work to their labs. The ability to work with these cases often requires additional software for the lab. Some of the scan-only intraoral scanners also require that the data runs through additional software before it becomes usable in particular laboratory CAD design software. The key point? Differences in scanners represent, for the most part, differences in workflow. 

Core3dcentres has the in-depth experience and ability to work with scan data from all the major intraoral scanners, and the additional software to make that data usable for laboratories. We also have an implant library that has the versatility to make models with embedded implant replicas, allowing labs to retain their current workflow. Perhaps most important of all, we also provide training through our Core3daCADemy™ and the on-demand technical assistance that helps labs help themselves.

Photos: Top photo-a-r-t-i-s-t / Getty Images (top). Workflow image courtesy of Core3dcentres.

 The word’s out! Digital dentistry is no longer a dream. It isn’t about the future. It is here and now. It is here to stay. Unfortunately, as with any fast-evolving methodology, doctors have an abundance of choices to handle their digital requirements.

How to handle digital files from your dental clients

	Choosing a CAD system can be a daunting task. Here are the most important things to consider before you take the plunge.

How to transition your lab from traditional to all-digital

Before making a decision on a CAD system, you need to know how it will work with your other equipment and with the equipment owned by your dentist clients. While both options have their advantages (open systems can handle files from a variety of sources and can work with numerous CAM systems and mills, while closed systems often provide a reliable, start-to-finish workflow with no question of compatibility), this can affect what files you can accept from dentists and what you can produce.

This might seem like an obvious question, but your needs will determine what kind of system you should buy. If you’re mostly doing crown and bridge work, you might not care if a system has a detailed implant add-on. But if your business specializes in more intensive solutions, be sure your scanner and design software will support what you want to make.

Make sure purchasing a scanner will actually pay for itself. If you’re not sure you’ll have the volume needed to justify the expense (and, if applicable, ongoing licensing fees), consider working with an outsourcing center to handle your CAD cases until you’re sure you’re ready to hit that next level.

Beyond the initial purchase, what kind of training and support are available to you as a customer? Being sure you’ll be able to take advantage of the system is a key to getting your money’s worth.

What pricing structure works for your lab?

There are multiple pricing models when considering a CAD system. You can pay an upfront fee for the software and a scanner that you’ll later need to pay to upgrade. Or, you can pay a monthly fee that includes all future updates. Decide ahead of time what will be best for your lab’s bottom line.

One investment to save time, money and stress

This article originally appeared in the October 2014 issue of Dental Lab Products. For more great articles about products in action, click here to subscribe to 

 Choosing a CAD system can be a daunting task. Here are the most important things to consider before you take the plunge.

Top 5 questions to ask before choosing a CAD system

	Dentistry is advancing into the digital era faster than most had anticipated. Not many people can doubt that these digital trends will only accelerate. We believe the age of the Full Digital Lab is almost upon us. Here are nine things we see:

New scanners make plaster models extinct 


	Recent scanning technology advancements, especially in terms of speed and accuracy, have made the use of intraoral scanners increasingly attractive for dentists, and we expect that application of digital impression-taking in clinics will truly boom. Labs that are directly connected to dental clinics that have such solutions will be able to receive digital impressions immediately, and start designing right away without casting a model. Naturally, the use of physical impressions will continue in some clinics or in specific situations that merit it. However, even with such cases, rather than using the impression to cast a model, labs will employ sophisticated impression scanners that can accurately scan the physical impression directly.

Read part 1 in this series: How to increase your business by going digital


	Digital model-making is surging forward rapidly as better digital impression systems, new CAD software and improved manufacturing technologies provide model-making solutions at lower costs with higher accuracy and increased efficiency. More and more models will be created directly from digital impressions using CAD model design software and CAM model-making machines.


	More and more labs will produce crowns and simple cases without models because accurate virtual articulators in the CAD software let them validate and adjust dynamic articulation using the intraoral scan or impression scan as input. Currently, most model-free crown production focuses on single crowns. However, in some cases, model-free workflows have already spread to more complex restorations such as bridges, and more advanced restoration types.

Must read: 5 ways to go digital the RIGHT way


	Several years ago, market observers started speaking about full digital crowns; many listeners were skeptical. Today, we can already see this concept has advanced much faster than expected-largely driven by new materials such as full zircronia and IPS e.max. We expect this trend will only widen as new monolithic materials emerge. Full digital products will no longer be limited to copings. The combination of new materials and digital processing enhances accuracy, and enables labs to design full digital crowns for manufacturing in one or two materials without the time-consuming hand-veneering step.

Customized abutments will replace stock abutments


	Generally, we will see an increased market penetration of implant cases, largely due to lower costs of implants and restorative components, and an increased use of CAD/CAM technologies. Naturally, in terms of optimal treatment, customized abutments represent the best choice for almost all abutment cases. Customized abutments allow for better fits, perfect emergence profiles and generally represent a better clinical solution for the customer. As digital design processes improve, the price of customized abutments will eventually become comparable to, and perhaps even lower, than those of stock abutments--a development that is already emerging in some markets. Labs with CAD/CAM are today saving costs, space and logistics by removing the need to store stock abutments. For technicians already engaged in a CAD workflow, adding the steps for customizing the abutment to the specific case follows easily. Industry experts predict that stock abutments will eventually disappear from the market.

Read part 2 in this series: How to take your lab from traditional to all-digital

There will be a complete lab software package


	In the future, the leading CAD software systems will provide digital workflows covering the total spectrum of lab work. Software potentially can be developed to design any indication, and even combinations of indications, all in one go! Software is not the obstacle. The challenge is to manufacture all software-produced CAD designs in the right materials in terms of sufficient quality, lower costs and acceptable milling/printing times. We already see more and more manufacturing methods, cheaper manufacturing machines and new materials--such as monolithic ceramics and affordable 

 that directly support production of CAD designs. Driven by such developments and industry needs, the introductions of complete laboratory design software are not far away.


	Digital technologies help simplify case communication and provide tools for accomplishing complete case planning that is faster and more accurate than through traditional methods. Some CAD systems allow labs to design digital diagnostic wax-ups that are easily sent online to the dentist for 3D viewing in the clinic and, potentially, for discussion with the patient. Furthermore, CAD systems can bring together implant planning, prosthetics and production of surgical guides, enabling labs to provide full restorative packages before surgery.

Next page: Learn about a complete digital workflow ...


	More and more areas of dentistry are being touched by digital technologies, and we expect that soon all workflows will be integrated digitally, starting at the clinic, through the lab, on to manufacturing and ending with final treatment. Today, open intraoral scanning solutions kick off the 

 by enabling dentists to take digital impressions and send all digital case data directly to the lab using digital order forms. 

Administration systems for both practice management and lab management are being integrated

, thereby improving communication, logistics and workflows between all parties.


	The future technician will spend more time at the computer than at the workbench. But they will still need their technical and artistic skills. CAD software, no matter how intelligent, must be guided by a professional human touch when creating optimally esthetic and functional restorations. CAD software is a toolbox containing a wide range of methods that help improve quality and workflows. The efficiency and productivity this toolbox brings to labs will allow the digital dental technician more room to focus on providing services to dentists rather than restoration production alone.

Editor’s note: This article is the third in a four-part series. Make sure you check out upcoming issues of Dental Lab Products to find out even more about how your lab can go digital the RIGHT way. Don’t miss it!

Tais Clausen is the CTO and co-founder of 

. Since the founding of 3Shape, Clausen has been a 

key visionary driver in the company’s technology development

. His close, almost daily involvement with dental labs and clinics using 3Shape worldwide is the integral factor underlying his recognized expertise when it comes to the current and future needs of modern dental businesses.