A look at the All on 4 Denture Procedure using 

Patients with dentures almost always will become tired of the re-lining process. It has to be done frequently, and gets to be a nuisance. The ever-increasingly popular alternative to dentures, known as the All on 4 Implant System, has alleviated this problem to a large extent for patients who have suffered with dentures. Some labs fabricate All on 4 dentures but some do not. It’s a very difficult restoration to outsource because it still has to be delivered to the doctor’s office for try-ins and adjustments quite a few times, depending on the fit. In my opinion, it is wise to learn how to fabricate these restorations because they are becoming more and more prevalent within the dental community.

This article illustrates the procedure for the All on 4 technique, involving the laboratory side. It also addresses using the new 

 Super Hi Impact, a denture based resin for the edentulous area. This product makes the technician’s job much easier because the product is strong, durable and esthetically beautiful, too.

 After taking off the healing caps, the mandibular 4-unit implant site was exposed before the impression was taken (Fig. 1). The doctor can use four temporary abutments and floss material to engage the implants together. The clinician used an open-tray technique to take this impression.

 The lab technician put the lab analogs into the impression tray and created the soft tissue and poured up the model (Fig. 2).

 The bite block was pre-made with the verification index (Fig. 3) from Primotec USA’s primopattern light-cured wax.

 After curing with the temporary abutment it was ready to send to the doctor for verification in the patient’s mouth. The doctor then sends back the bite block after verifying the patient’s bite. Then it is tried and verified on the model (Fig. 4).

If everything fits properly, the clinician sends it back as is. If for any reason it doesn’t fit properly, he must fix it by cutting and patching it with resin. If it is cut and patched because it does not fit, the lab will fix it on the model, then send it back to the doctor again for a wax try-in. The wax try-in is tried on the model (Fig. 5).

 The lab’s next step is to send the wax teeth to the doctor for a try-in in the patient’s mouth (Fig. 6) to re-check the bite.

 For the final teeth production, the lab used a GC Putty Guide material, based on the wax teeth (Fig. 7) to act as a template. At this stage, it is also necessary to look at the frame design for guidance with the final restoration. GC’s Nature-Cryl resin material (Fig. 8) is high impact and convenient to use. It requires two hours of heat curing and is available in seven different shades. The material is easy to finish and polish, and resists fracturing. I created some samples of the various colors available with Nature-Cryl, demonstrating how easy it is to create special characteristics and mimic the gum tissue aspect (Fig. 9).

Fig. 7 GC Putty material as a guide. (Figs. 1-6 above)

The colors in this image are: COE-LOR Moderate (#21) and COE-LOR Heavy (#22). In the next image (Fig. 10) there is another denture sample, from a true patient’s case, this time to demonstrate frame design and the mesh metal in a light color (#34). With the All on 6 denture pictured next (Fig. 11) the finished product is a light reddish pink in color (#35) and in the next (Fig. 12) we see a mandibular denture in the original color (#36).

 The flipper for the four missing mandibular teeth (Fig. 13) was completed in COE-LOR Moderate (#21).

 Finally, we see the All on 4 finished restoration with a hybrid bar as a two-piece detachable appliance (Fig. 14) or an All on 6 one piece restoration (Fig. 15).

Fig. 14 All on 4 finished product, 2 piece detachable

As a dental technician working primarily as a ceramist, I understand and create beautiful esthetics with my porcelain layering technique. However, things are changing rapidly in the dental industry and I began to realize it was important to expand my knowledge and keep up with the newer product offerings. To that end, it is always advantageous to experiment with new dental materials as they are offered.

We have all seen cases where the patient has an upper or lower denture only, but then find that he needs to have the opposite denture placed as well. The two should match in tooth color or the effect will be displeasing in appearance. For this reason and many others, technicians should learn how to fabricate All on 4 cases using denture or ceramic teeth. It is my hope that by sharing this knowledge we can expand our product bases and serve our clients better, too. There is a whole world of new creations out there for us to take advantage of. We should learn as much as we can!

Articles

A look at the All on 4 Denture Procedure using GC’s Nature-Cryl.

Take an in-depth look at this alternative to dentures

The introduction of SRPhonares® Nano Hybrid Composite denture teeth in 2010 represented true innovation in the dental market. Manufactured with Nano Hybrid Resin chemistry, this denture tooth line was designed to offer additional features over traditional resin teeth. The intent was to capture the virtues of composite resin esthetics and resistance to wear to meet today’s patients’ demands and expectations for high end removable prosthodontics (Fig. 1).

The success of the Phonares line of teeth combined with evolutionary enhancements of the composite chemistry have allowed for the introduction of SRPhonares II Expressive Denture Teeth. SRPhonares II sets new standards in removable prosthetics with optimized shape, shade and strength. The latest scientific knowledge has been implemented in the development and production of Phonares II to create a truly innovative tooth line (Fig. 2).

SRPhonares II builds on the successful mould selection of Phonares with the addition of two new mandibular anterior moulds, L54 and L55 (Fig. 3). Each mould uses the “set and fit” design to ensure a natural proximal contact is achieved (Fig. 4).

These new moulds provide greater setup options and deliver a more patient specific prosthesis. Additionally, they are particularly suited for partial and combination cases. The updated mould combination table available from Ivoclar Vivadent makes mould integration easy by suggesting the appropriate lower mandibular mould based on the maxillary anterior selection (Fig. 5).

SRPhonares II also uses advanced shading techniques in the manufacturing process to deliver a warmer, more vital look. This new shade protocol matches the A-D shade standard and provides for optimized shade matching for partial and combination cases (Fig. 6). Additionally two new shades have been added to the existing Phonares offering, BL1 and BL2. These two new bleach shades extend the range of existing bleach options, while satisfying patient demands for a more natural bleach appearance.

The most exciting addition of the new SRPhonares II tooth line is the evolutionary advancement of the composite chemistry. This new generation Nano Hybrid Composite provides improved strength or “toughness” without sacrificing the esthetics and wear characteristics of the original formulation (Fig. 7). Composite resin chemistry by its nature is harder and therefore less resistant to fracture when compared with the softer and more resilient traditional polymethylmethacrylate (PMMA) denture tooth materials, especially when the teeth are compromised by excessive grinding because of insufficient restorative space. SRPhonares II has improved properties that will help not only to sustain the teeth in challenging restorative conditions but to also make them more tolerant to laboratory handling procedures.

Several investigations on fracture behavior were carried out during the development of SRPhonares II denture teeth (Figs. 8, 9).

Based on the results in Figs. 9 and 10, it has been proven that SRPhonares II has similar fracture resiliency to that of the proven cross-linked PMMA material in terms of fracture behavior.

Additional testing was conducted on crack propagation. Test samples measuring 20 mm in diameter and 5 mm in height were loaded with a spherical metal indenter (5 mm diameter) at a speed of 5 mm/min in a universal testing machine (Zwick). The minimum load at which cracks were detected was recorded (Fig. 10).

The results show the SRPhonares II composite chemistry is considerably more resistant to crack formation than composite materials of earlier generations. The SRPhonares evolution is similar to other new innovations in dentistry including CAD/CAM technology that has had several generations of development.

Leading scientists have studied the adverse events of chipping and tooth fracture issues with composite resin denture tooth chemistry and have designed new experimental technologies to improve our understanding and prevention of these issues. Although there is not a bullet proof answer to many of the restorative challenges, we feel quite confident that SRPhonares II will provide a successful alternative that will have improved esthetics and improved resistance to wear over traditional PMMA based denture teeth, while having similar fracture and chipping resistance.

SRPhonares II truly represents innovation for the dental professional and the patient. The enhancements to shape, shade and strength deliver a tooth line that provides the best possible prosthetic outcome both functionally and esthetically.

The introduction of SRPhonares® Nano Hybrid Composite denture teeth in 2010 represented true innovation in the dental market. Manufactured with Nano Hybrid Resin chemistry, this denture tooth line was designed to offer additional features over traditional resin teeth.

How to spot quality in denture teeth

Designed specifically for dental labs, the 3Z™ LAB 3D wax printer is said to ease the transition to a total digital lab workflow by integrating with open architecture dental scanners and software while maintaining surface quality and precision. The printer features one-touch simplicity to easily produce wax-ups ready for casting and pressing with accurate marginal integrity, occlusion, contact and anatomy form. It will produce crowns, bridges and copings with exceptional margins for an optimal fit.
	 

New Product: 3Z LAB 3D Wax Printer

 is a unique corporation with a long history of industrial ceramic manufacturing success. This success has allowed them to transition into the dental industry with amazing results. The company’s specialty product is an advanced Zirconium Dioxide that exhibits superior optical qualities through 30% higher translucency indexes.

 is considered to be one of the leaders in its industry. Based on the company’s functional ceramic manufacturing experience, it expanded its business in recent years with the production of advanced dental materials.

The superior translucency that can be achieved at the incisal edge of an anterior full contour crown using the Zirkostar ET®, has provided dental practitioners worldwide the ability to place full contour crowns confidently. Now that Zirconia has crossed over to central and lateral incisor placement we are now experiencing a true paradigm shift.

 has a unique pressing and sintering experience and Total Quality Management, combining the most advanced qualifying methods with automatic inspection machinery, and demanding multi-stage quality control procedures including 100% inspection of parts.

 has approximately 250 customers in more than 40 countries worldwide, including those in Europe, Latin America, Asia, Australia, Africa and now in the U.S., Canada and Mexico. It provides superior customer service, reliable on-time delivery and competitive prices.

Bill Leo is a veteran in the field of restorative and implant dentistry. He just celebrated his 33rd year in the dental field on March 1, 2012. Bill has spent the last 30 years in various sales, marketing, and management positions for five different Blue Chip dental companies: DENTSPLY  International, Thompson Dental Company, Shofu Dental Corporation, Nobel Biocare USA and Zirkonzahn USA Inc.  His greatest joy in dentistry has been the relationships that he has made over the years with dental technicians, dental practitioners, surgeons and colleagues that have greatly enriched his work life.

Bill oversees all of North America to include the United States, Canada and Mexico. He will manage the Atlanta distribution center operations as well as the Sales and Marketing function to include field sales management.
	
	Kerox's wide product portfolio includes:

		Zirconia blanks and blocks for manual and CAD/CAM milling machines

		Extreme translucency blank (25-30% more light transmission)

		Custom shaded projects upon request
		 

Kerox Dental Ltd. is a unique corporation with a long history of industrial ceramic manufacturing success. This success has allowed them to transition into the dental industry with amazing results. The company’s specialty product is an advanced Zirconium Dioxide that exhibits superior optical qualities through 30% higher translucency indexes.

New Company Profile: Kerox Dental Ltd.

It’s January, and everyone knows what that means: New Year’s resolutions. To be sure, it’s a good time for lab owners to assess the status quo, evaluate both successes and failures and set specific objectives to work toward in the lab during the coming months. This time of year also presents an opportunity to recommit to those strategic goals that may have been pushed to the back burner as more pressing needs arose.

If you’ve given any thought to New Year’s resolutions for your lab, chances are marketing is somehow involved. Whether the primary goal for the lab is enhancing a particular skill set, increasing practice profitability or preparing for transition, 

 is certain to be an elemental part of the game plan.

Unfortunately, the dearth of business training, let alone specific marketing courses, is coupled with the proliferation of new and modern marketing methods-ranging from traditional mediums like yellow pages, magazines and direct mail to “new” online tactics including 

As a result, lab owners who are marketing novices are often overwhelmed by the wide scope of marketing mediums and vendors who call the practice ready with five-figure proposals. Confusion, information overload and paralysis by analysis have become a natural state of affairs when it comes to lab marketing. Some technicians may have tried a host of different marketing tactics over the years-at great expense- without any perceptible return on investment. Others may have great ideas, but can’t seem to find the time to put their plans into action.
	So where is the best place to start? The first step is to determine your lab’s annual marketing budget-nothing else can be done until you know how much money you have to allocate toward marketing efforts.

For a lab that has done little to no marketing in recent years, or if the lab’s website is more than three years old, a good rule of thumb would be to expect to spend closer to 6-8% of production. This is what is sometimes referred to as a “building year”-a time where the focus is on creating infrastructure. In a building year, the lab will have forward-looking expenditures that may not have a short-term payback, but in the long run will fuel the lab’s future success in attracting new customers and growing revenue.

If marketing is part of your professional New Year’s resolution, be sure to come back to this column each month. Over the course of the next 12 issues, I will provide professional insight and fresh ideas on the varied topics under the dental industry marketing umbrella.

The goal is to put dental marketing tactics, products and services under a microscope and provide a level of analysis that approaches that given to clinical products. We will discuss the full range of marketing mediums, evaluate which marketing opportunities are appropriate for a given lab based on its unique characteristics and share the means of measuring success. 

. It’s not just about having an attractive, professionally designed logo that is carried through all of the lab’s marketing materials; it’s also what differentiates one lab from the other one down the street, and accurately communicating the lab’s vision and philosophy to current and prospective customers.

. Who are your existing customers? What is the profile of your ideal target customer? What modes of communication will best reach your target?

. Do you have an updated, professionally designed website? Does it have all of the features and functionality available while providing maximum appeal to customers and prospective customers?

Search Engine Optimization and Online Marketing

. Is your lab easily found online? These “new” mediums have taken over as dentists and the patients they serve are increasingly turning to the Internet when making decisions.

. What are people saying about your lab on sites like Google+ Local and Yelp? What can you do to protect your online reputation and ensure the positive voices drown out any negative noise?

. Are you engaging with your community through social media? Labs that don’t have a robust social media presence are missing out on an almost limitless number of opportunities to reach new customers. Social Media uses the power of the Internet to magnify the most important marketing: word of mouth.

. A lab’s marketing plan cannot be effective without someone who can keep the ball in motion. Who is responsible for the day-to-day execution of individual tactics? Who sets goals, benchmarks, budgets and timelines? Who holds the lab owner accountable?

Check back for marketing advice that will help you grow your lab-in the New Year and beyond.

Naomi Cooper is President and Founder of Minoa Marketing and serves as Chief Marketing Consultant for Pride Institute. Naomi is a respected dental marketing consultant, author, speaker and industry opinion leader who co-teaches Pride’s groundbreaking marketing course, The New Rules of Dental Marketing. She also works with individual dentists and dental companies looking to develop a cohesive marketing approach and momentum for their marketing strategy. For information about Naomi’s upcoming course dates, call Pride Institute at 800-925-2600 or visit 

. Naomi also can be reached via email at 

. For regular updates from Naomi on social media and online marketing, follow her on 

or “Like” Minoa Marketing on Facebook at 

Dental Lab Products-2013-01-01

Take an in-depth look at this alternative to dentures

How to spot quality in denture teeth

New Product: 3Z LAB 3D Wax Printer

New Company Profile: Kerox Dental Ltd.

Your prescription for smarter lab marketing