01. What was it you were hearing from the lab industry that led to the development of Evident software? 

Having worked with desktop software for many years, the 

 directors were ready to get into the cloud. Dental lab employees should not have to be computer technicians. With Evident, lab staff do not need to install, update or back up. Our technical support staff can see the lab software and data files, making problem solving infinitely easier. The other thing we wanted was paperless production management. With Evident, lab staff have access to everything they need, all of the time.

02. What have you seen in terms of adoption of the cloud model among dental labs?  

When we started out, we had to sell the cloud. Now people understand the benefit of letting us spend the money on big hardware so they don’t have to. They know they don’t have to worry about mixed computer hardware and operating systems, they enjoy access through tablets and smart phones, and they appreciate being able to access their system from absolutely anywhere there’s Internet. People used to worry about us being down but most now realize that a desktop system is down a lot more-we’re up better than 99.9 percent of the time.

03. What do you see as Evident’s greatest strength?

Evident is comprised of a group of people who are passionate about what they do. As a result, our code is rock solid, we get rave reviews for our customer support and we consistently provide the features customers need now and in the future. We’re a group of people who enjoy what we do and sincerely want to help.

04. Who is your target customer at Evident, and how do you feel you best meet their needs?

Evident is designed to centralize information. Our target is labs that want to use our features to automate as much as they can. We have the feature set large labs require, but we love to work with small- and mid-sized labs that embrace this concept.

05. Why should labs that aren’t currently using cloud-based software consider an option like Evident? 

To be competitive, labs need to focus their energy on their customers, their products, their staff and their business. By passing a lot of technical responsibility to us they can focus on their own operations. Our billing model is subscription-based with no contract. That means we have to keep labs happy to keep them as customers. Desktop systems require a big upfront investment before the lab really knows if they’ve made the right choice.

06. What differentiates Evident from other cloud-based offerings?

Three things stand out: 1. Evident is the fastest cloud-based system out there. Speed is surprisingly important-waiting for a second here or there may not seem like a big deal but over time, it adds up. 2. Billing is consistent, which makes budgeting easier. Evident bills a fixed amount each month-it is not based on the lab’s revenue. 3. Evident has the feature set big labs need-many of the small and mid-sized labs understand that those features can help them either now or in the future. Why not start with a system you can grow into?

07. What advice do you offer to labs in terms of making sure their data is secure?

Do your homework. The Evident servers have a three-tiered system that prevents loss of data and security. When moving to cloud-based systems, don’t be afraid to ask how the data is stored and what systems are used.

08. How is Evident helping labs of all sizes-from small, one- to two-person labs to much bigger labs?

For small labs, the challenge is maximizing time at the bench and reducing administrative tasks. Evident makes case tracking, billing and payments easy and documents are clear and professional. Large labs want to provide the quality and customer service of a boutique lab while managing many more people and much more information. Evident also has built-in compliance and legislation features that reassure all labs that they can handle whatever requirements arise.

09. What about labs that are nervous about not having their data or financial information “on-site”?

“On-site” data is the most easily stolen. In most labs, an employee takes a copy of the data file home every night to provide an off-site backup. That is about the least secure data imaginable. Theft, fire and computer hardware failure are all threats to on-site data. Many labs do not test their backups and when they do need to restore, find out that backups haven’t been working for months. Evident is redundant and always accessible to the lab. They can log-in to a backup any time they want to be assured it is working and accessible.

10. What can we expect from Evident in 2013 and beyond? 

Evident is known for its powerful features-our next step is to transform the interface to make it even easier to use. We love talking to our customers but strive to make setup easier and easier so we can spend more time talking to them about how to translate their management goals into reality. 

Articles

10 Questions: Evident lab management software [VIDEO]

As a dental laboratory, you seldom, if ever, are privy to patient telephone numbers, mailing or email addresses, birth dates, Social Security numbers, medical records or data directly identifying individuals’ relatives, employers or household members as part of your dealings with the dental office.

But what you do share in today’s digital age are the patient’s name, photos showing the patient’s full face, and perhaps even insurance numbers where you bill the patient’s plan directly for services rendered. All of these are private aspects and should be carefully protected under your patient confidentiality procedures. There is the real issue of protecting the confidentiality of any doctor-patient information, whether on a legal or moral basis. This is irrespective of whether HIPAA (or other regulations like the Health Information Technology for Economic and Clinical Health Act (HITECH) & HITECH Safe Harbor in the USA or the Personal Information Protection and Electronic Documents Act (PIPEDA) in Canada) apply directly.

Some aspects might be considered common sense-such as not including the patient’s name on case shipping labels going back and forth between practice and lab; and ensuring unauthorized individuals cannot view patient information on a computer monitor or have access to the patient record room. Others are perhaps more complex in today’s digital age. Let’s look at one example of how information is shared routinely every day, yet is perhaps more vulnerable than we all realize: email.

More than 50 years ago, dental collaboration meant all parties met in the same room to exchange information. As that information was shared verbally and through hard copy files, patient information was safeguarded. Over time, as new technology was introduced, like telephone, fax and the Internet, the exchange of information became less secure. The Internet has revolutionized dental communication as it offers a visual medium that enables collaboration across great distances. With digital high resolution imaging, collaboration was, for the first time since in-person meetings, available immediately to all collaborators. Yet, while that collaboration has enabled improvements in results, it often meant risking patient data by sending it through unsecure means like email or online storage sites.

Take a look around your laboratory. How many times each day are photos, impression files, etc. emailed back and forth with the patient’s name (and other details) shared as identifiers of that particular case? It won’t take long before you realize the extent of the information flow-and the potential liabilities that flow with it. Many popular tools like Outlook, Gmail, Dropbox, and other options that are commonly used for patient information sharing are NOT compliant with patient privacy laws.

Today, you should be ready to ensure, and document, that you are compliant with regulations. Consider the following:

: Who has access? How can you ensure it is limited to only those who need it and should see it?

: Is every transmission of patient information secure? To be compliant, data must be secure and encrypted during the sending and storage of the data.

: Can you prove your patients’ data is stored securely?

: Can you track each individual who was able to read, write and delete all patient information?

: Can you ensure sensitive data is disposed of safely when needed? Typical email systems hold and control the disposal of your private information. To be compliant, you must have procedures in place to address the final disposal of data.

Are you liable if this patient information is compromised? The answer to that question is beyond the scope of this article. What is clear is: Why take the chance? There are proven solutions available. At 

, to protect the confidentiality of the information we share with our clients.

Secure-Mail is a HIPAA-compliant messaging system designed to enable dentists, specialists and labs to easily and safely share private patient information. Secure-Mail works just like the email tools you are used to, with an important distinction-all your communications will meet compliance standards. And, you can securely send multiple high-resolution photos with every message (attach 500MB to every message).

When protecting the privacy of patient information, the choice is yours. Unfortunately, the long-term ramifications of not doing so properly may not be.

For more information on Secure-Mail, and to have your Patient Information Privacy questions answered by people that have an in-depth understanding and experience with the issue and its resolution, call Brightsquid at 800-238-6503 or visit 

. Photo credit: Photo: alengo / Getty Images

The most important privacy information you need to know

 began years ago at Boston University, and Dr. Russell Giordano was there from the beginning.

Here, he takes us behind the scenes of this product’s development and outlines the benefits of VITA Enamic, a new category of CAD/CAM material and the first hybrid dental ceramic with a dual-network structure that combines the best properties of ceramic and composite materials.

 It’s a completely new material with a combination of a ceramic sponge matrix with a small amount of polymer. That created a whole different set of challenges, to make sure we had the proper network with bonding materials that were stiff enough but not too stiff to be used for natural teeth.

One of the issues we wanted to avoid was the problems of composite resins. We also wanted to make sure the material wasn’t as stiff or as brittle as a conventional ceramic. It took a number of years to figure out the proper networks with wear properties, with machinability, materials that were stiff enough but not too stiff. There were a lot of properties that had to be examined and a lot of steps.

Q: What advantage does VITA Enamic offer over a conventional composite resin?

 A conventional composite resin has individual filler particles. With Enamic, we essentially have a ceramic backbone or a ceramic sponge network. All that ceramic is connected like a sponge and then the pores are filled with polymer. That type of interconnected network is unique. That small amount of polymer gives the material some flexibility, which improves the machinability and decreases milling time. You don’t go through as many burs when you are milling these blocks because they do not gum up the bur. A typical crown mills out in about four minutes; it is usually double for a conventional ceramic. You also don’t have the chipping you see with conventional ceramic materials.

 Figuring out the proper network so we would have the right connection between the ceramic and the amount of polymer in the final material. The whole processing step had never really been done before. You have to compensate for a number of different things that are going on during the curing process, and it took a lot of time to figure out how to do that properly.

So far all the news has been excellent. It has about 6 years worth of clinical trials. The edges are very sharp, so you don’t see all the chipping. The surface finish is smoother and you can get away with less tooth reduction, so you can use this material for a lot more cases. And the machining properties are well beyond what we ever imagined when we were making this material.

Q: How can labs best incorporate VITA Enamic?

It’s something they can jump into. In the area of single units, it’s pressing versus milling, which is more cost efficient. At this point, with the milling speed you can get with this material, it’s more cost efficient to mill things than to press them out. You don’t have to do any investment. You no longer wax up and you burn out. You just stick the block in, and  four  minutes later, you have your restoration. In the area of fabricating veneers, you can mill this to 3/10th of a mm and then finish it down to 2/10th in cases where you have minimal preps for veneers. So you also shift your fabrication procedures from conventional, whether it’s platinum foil or refractory or pressing, to milling for a veneer in only a few minutes. It is extremely quick and very easy to do.

Q: How do you see this product changing the industry?

The initial offering is really a small corner of all the possibilities for the different types of ceramics and polymer combinations. There are a lot of applications for this material, including implant abutments, crowns on top of implants, dentures and frameworks. A whole slew of materials can be made based on this structure by slightly changing some of the variables. There has been some independent testing on different Enamic variations that show you can go even thinner and start to approach 0.5 mm, the same minimum thickness some manufacturers claim for zirconia crowns. There is going to be a shift to materials that contain some sort of polymer because of the resilience and the improved machinability versus conventional ceramics or conventional composite resin.  

The initial research for Vident’s VITA Enamic began years ago at Boston University, and Dr. Russell Giordano was there from the beginning.

Inside Look: Vident's VITA Enamic [VIDEO]

More dentists are turning to social media to promote their practices, and it’s a great tool for labs as well. Tweet about specials your lab is offering.

Blog about successful cases you’ve completed and share links to your posts via Twitter, Facebook and Google+. Post pictures from successful cases on your Facebook page. Use these tools to showcase your work and attract dentists to your lab.

You’re always looking for ways to market your lab, and these days social media is a no-brainer. If you regularly update Twitter, Facebook and any other social media accounts connected with your lab, you have the ability to reach countless current and potential customers-especially if you’re posting content people want to share.

3. Social media offers a deeper connection

You can connect with dentists through traditional marketing methods, but nothing gives you the level of interaction that social media does. If you post a case on Facebook, chances are someone is going to ask you a question about or comment on that case, sparking a conversation. It gives you an opportunity to interact with clients, and even patients, on a different level.

One of the best things about social media is it’s free!

If you dive into social media, you need someone to manage it. This is a great opportunity for someone on your team to take ownership of the lab’s social media account as part of the lab’s marketing efforts. 

1. Your clients are into social media More dentists are turning to social media to promote their practices, and it’s a great tool for labs as well. Tweet about specials your lab is offering.

5 reasons you should get on social media

Over the years, most of the problems with any attachment are caused by poorly designed or fitting RPD (removable partial denture); specifically, frames without proper reciprocating arms.

For this reason, we would like to recommend the following technique: The fabrication of a precision attachment RPD with custom metal housing and lingual arms, as separate components. This provides many restorative benefits for the dental technician and dentist. This technique allows technicians to fabricate highly accurate and stress-free partial frames. When using the 

, as well as most other attachments, for fixed-removable combination cases, it is important to have an exact fitting reciprocating lingual arm and shoulder rest with an interlocking vertical groove. The main function of these is to divert occlusal loading forces away from the attachment and center them down the long axis of the tooth, also to avoid the partial slipping distally, especially on free-end saddle cases.  

Often times after cementing the crowns, the attachment may no longer fit passively; in that case, it is very simple to use a solder iron, heat up the bonded-in metal housing, and pull it out of the major connector. After creating the space in the acrylic, it can be reset in the patient’s mouth with quick cure acrylic.

The intent of this technique is to separate the making of the attachment section from the rest of the partial. As many RPD technicians probably are able to cast a chrome-cobalt partial with attachments and have a passive-fit across the arch, in my 40 years I have not been able to do this. For many years, I split the work process and created an absolute precise attachment casting with lingual arm and in the earlier years we soldered the attachment to the chrome cobalt partial. Even with that we found that after cementing the crowns, many times there was a slight rock or movement in the attachment section. At this point I started to bond instead of solder. Bonding makes later removal and subsequent resetting of the attachment section possible. This turned out to be very beneficial for myself and the dentist as it prevented me from remaking some of those cases. A further benefit of making the attachments separate is that I make the attachment section as soon as I finish the crowns, therefore if the dentist seats the crowns right away he can then pull the attachment sections in the final impression for the partial, which gives me a very precise relationship to the crowns.

In waxing the crowns, make sure the attachments are parallel and create a lingual parallel wall with a shoulder and a mesial groove.

 Finish the porcelain work in a traditional manner.

 Make sure your lingual arm recipient has no undercuts.  

 Place matrix on the attachment, snap on the castable housing.

 Model on the lingual arm using a quick-cure resin, eg PiKuPlast.

 Pull and cast the attachment section. Remove the matrix.

 After casting, fit the casting to the crown.

 The case should now go out to the dentist for a try-in.

 If the dentist decides to seat the crowns at this point, have the dentist pull the attachment sections in a new master impression. Otherwise, the dentist can pull the crowns in the master impression.

 After pouring the master model, the chrome cobalt partial is created in a traditional manner.

 The use of pink opaquer as shown in the pictures is optional.

 The attachment section and the chrome cobalt partials are now bonded together.

 Teeth are set up and the partial is finished in a traditional manner.     

This article originally appeared in the September 2013 issue of 

 magazine. For more great step-by-steps, 

Step-by-Step: Stress-free partials with the VKS-SG Attachment Systems [VIDEO]

Traditional dental implant restorations can be challenging for dentists and laboratories. Several factors must be considered to ensure predictable, successful placement and subsequent restoration.

When dental implants are cement-retained, inadequate clean-up of excess cement adjacent to implant margins could lead to peri-implantitis. When dental implants are screw-retained, screw access channels require careful management to create proper anatomy, esthetics and function.

To address these challenges, a simplified option has been developed. This has been accomplished with the creation of hybrid abutment solutions. IPS e.max Press Abutment Solutions from 

 allow for simple, accurate placement of dental implant restorations that demonstrate a natural emergence profile, shape and esthetic properties based on the individual clinical situation. Custom characterizations can be added to further enhance the life-like esthetics and seamless blending with natural dentition.

The use of lithium disilicate over a titanium base produces a restoration with a strength of 400 MPa and life-like optical properties. The 

 allows laboratories to create either one-piece hybrid abutment crowns attached to titanium bases, or hybrid abutments bonded to a titanium base onto which a crown can be cemented. Benefits of this fabrication technique include providing a laboratory a new product offering for dentists, cost savings compared to other customized abutments, faster turnaround and improved esthetics compared to traditional titanium or zirconia abutments.

[Editor's note: All case images in video above]

 An appropriate titanium base that corresponds to the implant being used is selected. The titanium base (Ti base) is placed on a model of the patient’s mouth, and a pin is inserted into the screw channel 

 Modeling resin is then used to design a coping around the Ti base and pin because the resin is more rigid than wax and will better withstand being slid on and off the Ti base 

 The emergence profile is created with resin 

, and the remainder of the coping is built up in wax 

 The dimensions are verified against a putty matrix 

. After removing the pin from the screw channel, attach a 2.5 mm sprue to a circular area, keeping the sprue parallel with the screw channel. Do not tilt the sprue 

 The wax-up is placed in an investment ring, and the investment is poured slowly, being sure to fill the screw channel 

 The investment is placed in the pressing furnace and preheated for 60 minutes. The appropriate press program is selected according to the ingot and ring size used.

 The restorations are removed from the ring, divested 

, and immersed in Invex Liquid to remove the reaction layer.

 The fit of the abutment is verified on the Ti base, and minor adjustments can be made with diamond-coated instruments 

 The sprues are cut with a separating disc, and the attachment points of the abutment and crown are smoothed. The emergence profile and fit of the abutment are verified on the model.

 Characterizations can be applied to the emergence profile of the abutment using IPS e.max Ceram shades and Essence stains 

, after which the abutment should be fired. Glaze is then applied and the abutment fired again.

 The Ti base is prepared for bonding by placing wax on the screw channel and emergence to protect them, while the boding area is carefully sandblasted with AI

 at low pressure (Fig. 11). Monobond Plus is applied to the bonding surface of the Ti base and allowed to react for 60 seconds 

 IPS Ceramic Etching Gel is then applied to the bonding surface of the IPS e.max Press abutment and left for 20 seconds, after which Monobond Plus is applied to the bonding surface of the abutment and left to react for 60 seconds 

 An opaque shade of cement is then applied directly to the bonding surfaces of the Ti base and the IPS e.max Press abutment, and the two components are seated together 

. Excess cement is easily cleaned away from the emergence and screw channel with a brush 

 Liquid Strip Glycerin Gel is then applied to the cement joint of the completed hybrid abutment complex to prevent the formation of an inhibition layer. The cement is allowed to set for about seven minutes 

. Rubber polishers can be used to smooth the cement joint 

 The abutment is placed in the patient’s mouth and torqued to equigingival margins 

. The screw access channel is then sealed with composite material (i.e., Tetric EvoCeram, Ivoclar Vivadent) and light cured. The IPS e.max Press crown is then cleaned and etched, and both the abutment and crown are treated with Monobond Plus for 60 seconds.

 An opaque shade of implant cement is used to bond the crown to the abutment. The finished restoration will blend seamlessly with adjacent teeth 

Using the technique outlined above will enable laboratory ceramists and technicians to produce implant supported restorations that demonstrate the proper emergence profiles, esthetics and function. The restorations also will be more predictable. IPS e.max Abutment Solutions simplify and increase predictability of a once challenging laboratory function. In addition to the ability to easily create custom hybrid abutment solutions, the technique also allows the creation of quickly fabricated hybrid implant crowns 

. Both of these options help to maintain a patient’s oral health, with minimal trauma to the gingival tissue 

In addition to an optimum design of the emergence profile, the individually fabricated, tooth-colored abutment features a long-lasting esthetic appearance, even in cases of gingiva recession. Given the fluorescence of the LS

 glass-ceramic in conjunction with individual characterizations, a lifelike appearance is achieved. The seating of hybrid abutments is facilitated as a result of their geometry, and excess cementation material can be easily removed.

About IPS e.max Press Abutment Solutions

: In addition to an optimum design of the emergence profile, the individually fabricated, tooth-colored abutment features a long-lasting esthetic appearance, even in cases of gingiva recession. Given the fluorescence of the LS

 glass-ceramic in conjunction with individual characterizations, a lifelike appearance is achieved. The seating of hybrid abutments is facilitated as a result of their geometry, and excess cementation material can be easily removed. For more information, contact Ivoclar Vivadent at 800-533-6825 or visit 

Step by Step: IPS e.max Press Abutment Solutions for Implant Restorations [VIDEO]

Fall marks a new beginning for the academic world. Fall has exciting academic opportunities for dental labs as well-dental lab techs never stop learning, so the availability of educational opportunities is important to the success of your laboratory.

Whether learning new techniques, refining current ones or discovering for yourself whether the newest trend, technique or equipment is a good match for you, your business, your current and potential clients, education is the key to your success.

Expos and trade shows provide a great opportunity to be introduced to the newest, most updated equipment and systems available; it takes a lot of information gathering to make certain your investment will do what you need it to do. Educational experiences run the gamut from informal discussions with peers, to discussions with manufacturer reps and formal education settings.

Local study clubs offer a great way to exchange ideas and learn with like-minded lab owners and technicians. State dental lab associations often provide seminars and programs. From a national prospective, the National Association of Dental Labs’ NADL University, held in September each year, allows participants to gain an advanced level of knowledge about the diverse aspects of management, including strategic thinking and planning in a competitive global environment. Many students return to their labs and grow their gross sales and net profit by implementing what they have learned.

Another option is Vision 21, NADL’s other business education meeting held each January. Bennett Napier, NADL’s Executive Director, says Vision 21 is a high level meeting that focuses on the business management side of the dental lab business. It does integrate/reference discussions on material and equipment trends and focuses more on how to pay for these trends, make money using them and work on culture shifts within the workforce to adapt.

Dental lab technicians might also want to investigate the Pankey Institute. Pankey Institute offers all its courses to dental lab technicians with the goal of creating excellence in techniques, enhancing a cooperative working relationship and developing a like-minded peer group in a true side-by-side learning environment. Ricki Braswell, Pankey’s President and Chief Executive Officer, cites the Implant Essentials course to be offered later this year as the perfect example. Presenters include restorative dentists, periodontists, certified dental technicians and a board-certified oral and maxillofacial radiologist to provide a well-rounded and practical understanding of how to provide the best care for the patient. Pankey courses are offered year round and technicians are always given generous discounts.

With the advent of the electronic age, online instruction has become popular and offers the opportunity to learn without leaving the work environment. The Internet also is a great resource for discovering educational opportunities that align with you and your goals. Taking advantage of these opportunities can seem expensive  and time-consuming at first; but the cost of not being educated can be so much more.

Click here to check out a calendar of meetings and events, put together by Carol Pilmer and DLP editor Ryan Hamm. 

Carol J. Pilmer graduated as a dental assistant from Elkhart University, Elkhart Ind., and spent the first 10 years in the clinical environment. She has been co-owner of R Dental Ceramics, Solana Beach, Calif., for 37 years and can be reached at rdental@sbcglobal.net.  

Easy tips to continue your education

In this video technique (taken from the pages of 

magazine), Robert Sarno, CDT and owner of Pinnacle Dental Lab, explains how he uses the anaxFORM system and Acryline acrylics (both from anaxdent) to create a versatile system that has increased laboratory production and eliminated waste. 

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In this video technique (taken from the pages of Dental Lab Products magazine), Robert Sarno, CDT and owner of Pinnacle Dental Lab, explains how he uses the anaxFORM

Dental Lab Products-2013-09-01