Staying competitive in the current economy has increased the need for an alternative to gold-based restorations. I am constantly thinking of ways to use my 

 system to streamline and improve productivity while maintaining and ensuring quality.

The recent development of Crystal Diamond Zirconia has made milling full-contour zirconia restorations more appealing. This presentation focuses on a technique that combines traditional waxing, full-contour milling, and custom acid-based pre-sinter infiltrating. This process is an 

 way to produce a high-quality restoration consistently.

The patient presented with a gold crown that was in need of replacement. Options were discussed and a 

 zirconia crown was agreed upon for the following reasons: lifetime guarantee, natural tooth color, and cost-effectiveness compared with that of a gold crown.

A digital impression was taken chairside with the Cadent iTero intraoral digitizer and CAM milled models produced by Cadent received by the laboratory.

A waxup is produced using a Gnathoflex Premium Silicone (XPdent) occlusal form (

). Note: This technique is extremely fast and consistent. The contact and axial walls are completed in wax. It is not necessary to perfect the margin area as the scan of the die is responsible for the intimacy of the fit and margins.

, the waxup on the die is first scanned (

), then the waxup is removed and the die scanned. Note: It is critical that when removing the waxup the die is not moved.

 Full-contour zirconia crowns are milled out of a Crystal Diamond milling blank using Turning Solutions’ Dental Mill CAM milling unit (

). A five-tool routine is used to achieve the detailed anatomy. Note: Crystal Diamond is more translucent than conventional zirconia used for copings and bridges and this maximizes the esthetic result.

, the green-state crown is removed from the milling blank by cutting the sprues with a highspeed carbide (

). Milling dust is then removed using a compressed gas duster.

 Using a plastic microbrush, Prettau liquids (ZirkonZahn) are applied to the crown in a systematic way to enhance esthetics (

). Note: Do not use a conventional brush with a metal ferrule as this will contaminate the liquid and the crown.

The crown is sintered and seated on the model to refine the margins using a ceramic polisher.

 The contacts and occlusion are checked and any necessary adjustments made. The model is mounted on Denar articulators using the Denar iTero Mounting System (Whip Mix).

 The surface of the crown is lightly sandblasted to accept the glaze. Once glazed, the crown is fired to stabilize it at 1025°C for 2 minutes. Note the variation in color from the custom infiltration liquids.

 Conventional stains are used to highlight and adjust value and chroma if necessary.

 A slight tabac stain is placed in deepest fossae. White or cream is placed on ridges, then a light blue/violet stain is washed around the circumference of the occlusion. The stain is then fired and set at 900°C. Glaze is applied in the same fashion as a conventional ceramic crown and fired at 900°C.

The completed crown on the model. Note the natural appearance without the additional labor of layering porcelain.
	 
	 
	 
	 
	 
	
	 

Articles

Staying competitive in the current economy has increased the need for an alternative to gold-based restorations. I am constantly thinking of ways to use my CAD/CAM system to streamline and improve productivity while maintaining and ensuring quality.

Full-Contour Productivity

Ceramic layering is still the most critical aspect of an esthetic restoration regardless of the ceramic material used or the substructure makeup. Whether the base structure for our ceramic was fabricated by hand, CAD/CAM milled, or pressed, our ability to understand the layering process is still the key to success.

As I’ve said in previous articles, understanding the materials we choose and the purpose behind those choices is key to 

 case outcome. Limiting ourselves to simple builds, using only dentin and enamel, yields a certain commonplace esthetic look that will not help move our businesses forward, especially in challenging times.

Business success today is dependent on what separates us from our competition, not by following the same old protocols. It is mandatory that we continue to educate ourselves to improve what we do every day. This is what will move our price levels and market share forward and upward. That’s not to say technology can’t help us, because it definitely can play a role. However, it is our depth of knowledge that can set us apart in today’s business environment.

 use, enamel and transparent selection seems to be an area often overlooked. The enamels/translucents can be one of the more energetic parts of a ceramic kit. These materials allow us to filter the underlying dentin layers and/or allow light transmission to reveal the dentin structure, controlling value and light transmission to improve the general overall appearance of the restoration.

Evaluating the manufacturer’s shade tabs can give you a jump on the process, but obviously firing your own shade tabs is the best scenario. Still, challenges arise when using these 

 as a guide because we often lose sight of how they work with and without other layers. The best way to understand the effects of other layers is to use small amounts of different enamels or translucencies with everyday cases and evaluate the results.

For the purpose of this article, I have taken two very different dentin 

, specifically without any enamels, and duplicated them with refractory dies. Now I can fabricate enamel or translucent 

 on the dies, devest them, and put them back on the original dentin buildup to evaluate the influence these materials have on the underlying layer.

The first die was fabricated with a fairly normal dentin buildup, transitioning to more translucency as the incisal edge was approached. Mammelon materials were used in the middle third to the incisal edge to create some structure and effect and then fired (

The second die was created with a more translucent transition as commonly seen in much younger teeth. With this build, I also used some mammelon materials to mask some of the translucency and create the mammelon-type effects. Again, I fired the veneer without enamel over the dentin build (

At this point, it is important to realize that at least 0.5 mm is required at the incisal edge so our translucency maintains the 

. Too much enamel will cause our restorations to appear low in value, while too little can cause a loss in depth. Overall, we need to stick to about 0.5 mm at the incisal edge and about 0.2 or 0.3 cervically.

For experimental purposes, I fabricated three veneers, one for each of the three dentin builds. Each changes the esthetic look of the underlying dentin layer and helps us understand the filtration process. A glazing medium used between the veneer and dentin allowed a union of the materials. Veneer No. 1 was created using straight 57 enamel (whitish high-value enamel); Veneer No. 2 using a 60 enamel (more translucent, more toward the grayer scale); and Veneer No. 3 with a mix of enamels and translucents.

Evaluation of each of the three veneering materials gives us some insight into how we can filter the underlying dentin layer either through masking or allowing light to penetrate the areas of our choice. As with any addition to our 

, understanding a material’s ability is the key to artistic growth.

Pizzi on fixed: Enamel filtration

	Do you have employees who work from home? Or employees such as sales reps working on the road with no set home base? Or how about employees working in an established location but being managed by an off-site manager such as in a satellite lab?.

	If you do, you know managing off-site employees in each of these scenarios has its rewards and challenges. If you are considering a remote management situation or are being challenged by an existing situation, keep the following key points in mind.

	Not everyone can work remotely. Remote workers must be able to set priorities, keep on task, and to a large degree, be self-motivated and self-managed.

	Employees who require a large degree of direct supervision will not be successful working in a remote environment. If you have the luxury of hiring the employees who will be working remotely, look for these qualities in your candidates.

	However, many of us “inherit” remote workers. It is up to us then, as managers, to groom them into successful employees or replace them. Honesty is the most important quality to look for in off-site workers. You need to trust that they are working, that they are productive, and that they are doing what they are supposed to be doing.

	Even if you have the utmost trust in your remote employees, they still need to have goals and to know the priority of each of those goals. The goals should be mutually agreed upon, committed to writing, and must directly support the overall goal of that department and/or the organization.

	Clearly defined and mutually agreed-upon goals and priorities help the remote worker know exactly what is expected, and the motivation to reach these goals is then internalized.

	The old-fashioned report is the tool of choice. Sales reps submit daily, weekly, and monthly reports of their sales activities. Remote customer service employees complete a daily call log, tracking all incoming calls, the reason for the call, and the outcome.

	Satellite technicians log in cases, and then bill them out when they are done. Remote managers run production reports and sales reports to measure the performance of their employees.

	The reports compare the mutually agreed-upon goals with the actual outcome and will reveal success or a need for improvement. The output measured by these reports will confirm the remote arrangement is, or is not, working, or if priorities need to be adjusted.

	E-mail, instant messaging, phone and conference calls, Web and video-conferencing, and face-to-face meetings are great tools to keep off-site employees in close communication with managers and other employees.

	Not everyone communicates successfully using the same method, so while many employees like using e-mail as their primary communication method, others will prefer picking up the phone. The downside of e-mail messages is they do not accurately convey the author’s tone and can often be misinterpreted. Long e-mail exchanges should be avoided, instead opting for a phone conversation. But nothing can replace the face-to-face meeting. Most of our remote managers are advocates of monthly meetings, with an absolute minimum of annual visits.

	Make sure remote employees have everything they need to be successful. Having the proper communication equipment such as cell phones, PDAs, laptop computers and fax machines is vital to a successful remote arrangement.

	The authority to make decisions is as important as the equipment. Employees working remotely will face many instances during the normal work day when they need to take immediate action. If they must stop and call their remote manager each time, then work stops until they get a reply. Giving the remote employee a clearly defined authority level will eliminate this often overlooked and underappreciated contentious issue.

	The remote workplace is becoming a business trend of the future. It dramatically cuts overhead costs and actually can make a company more agile in responding to shifts in the industry. Before you enter into a remote arrangement, be sure to weigh the pros and cons and be ready to make changes when necessary.

 Do you have employees who work from home? Or employees such as sales reps working on the road with no set home base? Or how about employees working in an established location but being managed by an off-site manager such as in a satellite lab?.  If you do, you know managing off-site employees in each of these scenarios has its rewards and challenges. If you are considering a remote management situation or are being challenged by an existing situation, keep the following key points in mind.  Choose the right people

Managing remotely

	A corporate vision sets the overall goals of an organization. It is a forward-thinking statement that defines who the company is and serves as a beacon for corporate direction, providing a road map for the future.

	But the realization of any corporate vision requires a leader, men and women whose passion and commitment keep the company’s mission sharply in focus, employees inspired, and the message to customers clear.

	You all know the companies spotlighted here; they are major players in our industry. Turn these pages and meet the men and women whose inspiration and vision are changing our industry and the new innovations they are bringing to the marketplace.

 Champions of the vision  A corporate vision sets the overall goals of an organization. It is a forward-thinking statement that defines who the company is and serves as a beacon for corporate direction, providing a road map for the future.  But the realization of any corporate vision requires a leader, men and women whose passion and commitment keep the company’s mission sharply in focus, employees inspired, and the message to customers clear.

Champions of the vision

	The current economy has forced many labs to add new clients to fill the void of work no longer coming in. To do so, some have curbed advertising and marketing, while others have stepped it up. One thing is certain: You have to get in front of your existing and prospective customers for some face time. But what can you do to make your sales calls more effective?

	A common mistake is to just go out and make calls without any preparation. You need to do some homework and develop questions to ask that will give you some answers on what your customer or prospect might need in his or her practice.

	Look at your customers first. The goal is to gather the proper information to help you be more effective during your visit.

	Who are your customers? What type of work do they send? By analyzing which department they fall into, you can determine which area has the greatest opportunity for growth based on experience.

	Performing an account analysis will provide you with a wealth of information. An account analysis is a ranking by each account and the type of work they send to your laboratory based on dollar volume. It should guide your sales efforts to the areas that will give you the greatest return. You might discover there are customers not giving you work in certain areas, and that is an opportunity. You’ll also discover who your most important customers are. These are the accounts you need to make sure are taken care of properly. But you already knew that, right?

	An account analysis also should give a profile of customers who give you the bulk of your business. You’ll probably find the 80/20 rule applies (80% of your volume comes from 20% of your customers). Similar attributes such as age, dental school, location of practice, study group interest, and how you obtained the account are useful pieces of information to know as you plan your call on new prospects.

	There are different applications to use with existing clients versus prospective customers, so just be aware that you need to rely on your existing client account analysis for help in developing your questions. This also applies to calling on new prospects.

	There are three rules to consider when growing any business:

 If the 80/20 rule applies, then it is critical you know who they are and take care of them. How many new customers would you need if you ever lost one? By concentrating on keeping the business you have, you can reduce account attrition.

 Your laboratory already has a relationship with the practice, so why not leverage this relationship to increase business and not simply maintain it. A good program of up-selling and cross-selling to your existing customers also keeps you in constant communication.

 Once you have a system in place to handle existing customers, work on adding new ones.

	Sales is a difficult profession and calls for someone who can take rejection, has patience, and is determined to get the job done correctly. But gathering information and developing a sound sales-call process will make getting up-close and personal more enjoyable and financially rewarding. Developing a strategy that appeals to your existing customers’ needs and wants also will appeal to potential customers. 

	When making in-person sales calls on current or potential customers…
	

		Ask how much time you might spend with him or her during the visit

		Ask open-ended questions that cannot be answered with a yes or no

		Ask about what they are experiencing and how you might help them

		Listen for areas of specific need or shortcomings with existing labs

		Ask what they like about their current laboratory partner

		Ask about personal likes, hobbies, etc.

		Get back with answers to questions you could not answer

		Listen, take notes, and show a true interest in their practice

		Assume you know what the client or prospect wants

 The current economy has forced many labs to add new clients to fill the void of work no longer coming in. To do so, some have curbed advertising and marketing, while others have stepped it up. One thing is certain: You have to get in front of your existing and prospective customers for some face time. But what can you do to make your sales calls more effective?  Be Prepared

Dental Lab Products-2010-04-01

Full-Contour Productivity

Pizzi on fixed: Enamel filtration

Managing remotely

Champions of the vision

Up-close & personal