 is a new material option available from 

, such as strength and a long-term success rate, with a stated significant increase in translucency (49 percent translucency).

This combination is engineered to make the material ideal for anterior and posterior applications, including  up to three-unit bridgework in all tooth positions.

Reportedly highly biocompatible and requiring only a feather-edge prep, 

 is said to be the ideal restorative material for today’s dentistry, offering the translucency of a 

 while retaining the strength of zirconia (720 MPas). The material is formulated for technicians who no longer want to choose between traditional zirconia and lithium disilicate; cubeX

		Suitable for a variety of indications, including single crowns and three-unit bridgework in all tooth positions 

		Available in 10, 12, 14, 16 and 18 mm discs

		Engineered to provide the strength of zirconia and the esthetics/translucency of lithium disilicate

For more information, contact DT Technologies, a division of Dental Arts Laboratories, Inc. at 

Articles

 cubeX2 cubic zirconia is a new material option available from Dental Arts Laboratories. The cubeX2 material combines the positive properties of zirconia, such as strength and a long-term success rate, with a stated significant increase in translucency (49 percent translucency).

This new zirconia is engineered to blow your mind

Impressions can make or break a case. If it comes to you with problems, you're never going to be able to produce something great, no matter how hard you try.

But if it comes in spotless, your work can make the doctor's (and patient's) day! Here are three tools (including at least one you already use every day!) that can make dealing with impressions a lot easier:

For time immemorial, one of the biggest headaches faced by dental technicians is receiving an impression from a dentist, only to discover something totally unusable. Whether it’s a poor bite registry, a botched impression thanks to careless hands (or a patient who can’t quite sit still), poor impressions make it impossible to deliver what the dentist and patient want-no matter what the dentist screams into the phone at the lab technician! But things are beginning to shift. More and more manufacturers are beginning to introduce 

intraoral and benchtop scanners specifically geared to the dental office

Products in practice: An intraoral scanner in use

And these scanners have made it through the growing pains phase-no longer should you receive half-scans that are essentially useless. Instead, you should be able to receive excellent digital scans you can plug right into your CAD software and get to work. Gone are the days of goopy, smeared impressions; now you can receive a 3D impression you can pour your artistry into. Just make sure you’re ready to receive your dentists’ scans and you’re all set.

You might think this is a joke, but the lowly telephone is actually one of your best friends when it comes to getting great impression results. The fact is, your dentist and his or her team want to get you impressions that will lead to an excellent restoration and a happy patient. Sending you a poor impression that leads to another in-chair appointment or a terrible fit just isn’t in the best interest (or bottom line) for the practitioner. So if you see a bad impression come in from your dentist: Call him! And if it’s a pattern you’re noticing, offer to come in and show the whole team what you need in an impression to deliver great results. Your clients will be impressed with your diligence-and that you took the time to work through a problem with them rather than delivering something they can’t use.

What your dental clients REALLY want you to know

You know how important the right materials are when making a crown or a removable. Why should impression materials be any different? While you have every right to hope that your dental clients will do the research to pick the best material for their impressions, you can also benefit from doing a little digging on the current leaders in the impressions market.

Who are the manufacturers that understand what dentists-and labs-need from impressions? Find out what the leading options are in both traditional materials, and in scanning materials. You can make yourself an invaluable resource to your dental clients, and that’s a role that can continue long beyond any impression issues.

 Impressions can make or break a case. If it comes to you with problems, you're never going to be able to produce something great, no matter how hard you try.

3 products that can help your clients make better impressions

	Throughout the course of several articles last year, we explored the future of digital dentistry and how it could help your lab counter business threats, grow and help you do highly esthetic work in a more cost-effective and efficient way. But what comes after digitization?

Mass-digitization of the dental lab industry

 is already underway, and, in my previous articles, I argued labs need to get on the digital bandwagon as soon as possible to stay competitive. But what happens after all labs are digitized-and being digital is no longer the deciding differentiator that keeps a lab’s business ahead of its competitors?

First, I foresee a future in which non-digital labs will have closed down, except for those few that manage to hang on to some of their customers due to long-term relationships. Some non-digital labs may survive by positioning themselves in niche areas. But the main industry drivers will be large, mid-sized and even smaller digital labs with efficient 


	With all contenders in the ring being digital, many labs will have similar offerings, and labs, at least those with top-of-the-market CAD/CAM systems, will basically be working with comparative possibilities in terms of production speed, available materials, quality and the range of indications they can offer. Inevitably, the dental lab market will lean more and more towards becoming a buyer’s market where dentists can easily shop around and switch providers without suffering major consequences. Therefore, digital labs will need to develop new differentiators-business models that are strong enough to maintain customer loyalty, win new clients and take the lead in their local markets.


	Many labs today are looked upon as production centers, delivering orders of dental restorations to their client base of dentists. Embracing CAD/CAM surely adds production speed, improved quality and more indications. But in a massively digital market, these improvements, although significant, will not by themselves change the perception of the lab’s role as yet another efficient production center among many others. Labs need to move from being production-only labs to become service-provider labs-while taking advantage of their digital technologies to get there. To put it shortly, labs that want to stand out need to shift focus, redefine their function for dentists and create a new place for themselves in the value chain.

Related reading: How to transition your lab from traditional to all-digital


	Labs will require tools that make possible new service opportunities as supplements to restoration production. The best CAD/CAM providers will target their innovation and solutions to provide such tools to labs. Already today, advancements in technology and digital precision are bringing highly reliable tools to the market, and I expect that labs will take advantage of these to intensify the application of treatment planning in a larger number of cases. Additionally, 3D technology and Internet communication tools make it easy to provide clinics with pre-treatment visualizations so dentists can evaluate restoration designs and discuss cases with the patient.


	A typical dental lab is a warehouse of knowledge. The combination of technician skills, wide-ranging case experience, materials expertise and CAD/CAM technology know-how represents a business asset that is both unique and valuable. Digital labs can easily position themselves as dental specialists and offer formal consultancy services-mainly to dentists but also to other labs, milling centers and practically anyone involved in the industry. Such activity is not only a potential revenue-bringing business model, but it also strengthens relationships with dentists and eventually brings in more work.

Enhancing the “service provider” image


	As a dental lab’s service portfolio grows increasingly versatile, it becomes more and more important to promote its offerings and uniqueness in the market. As with any business, good marketing will help labs establish a strong image, reach more customers and beat competition. There are plenty of marketing channels available to labs-channels that do not require the clout of a whole marketing department. An active and communicative website, direct mail campaigns, social media and digital newsletters are just a few examples.


	Digitization of the lab industry opens a realm of opportunity as well as new business challenges. More than ever, it will become imperative to strengthen customer relationships by shifting focus and business models from production to services for dentists. As a first step, those labs which have not yet embraced CAD/CAM should do so soon-because a lab’s CAD/CAM maturity will become a key competitive advantage when all the other labs discover they had better go digital as well.

Labs that have already fully integrated CAD/CAM into their workflows and business models, while building up technology expertise, will simply have a head-start in relation to many of the competition-winning factors, and a bright outlook to their future.

 Throughout the course of several articles last year, we explored the future of digital dentistry and how it could help your lab counter business threats, grow and help you do highly esthetic work in a more cost-effective and efficient way. But what comes after digitization?

Meeting the challenges of digitization

	It should come as no surprise that the dental lab industry has-and continues to-grow and evolve. From George Washington’s ivory dentures (despite what you heard on the elementary school playground, they were not wooden) to porcelain-fused to metal crowns to today’s all-digital, full-arch cases, the way we do things has constantly grown. Even within the modern 


	While current, modern systems seem to be the peak of technological advancement, CAD/CAM systems are still developing and will continue to do so.

“CAD/CAM is in its infancy right now,” says 

Mark Ferguson, assistant manager at Core3dcentres

 in Las Vegas. “Ten years ago, we thought, ‘We have to do these manual processes before we get to be able to do the next part.’ Now, it’s all digital, and we can change paths midway through a case. Manually, if I’m waxing a case, and now they say they want 

, and I change my coping wax up to a full contour, that’s been a problem. In CAD/CAM, you might have to restart the case. That’s not the situation anymore. Now you can change paths midstream.”

It isn’t just the design software that is changing. Hardware must also keep pace with advancements.

“The bigger part of it is not just the software; it’s also that the hardware of the computers is able to handle all the data,” Ferguson says. “When you look at the shape of a tooth versus the shape of a house, there are a lot of straight lines-doors and stairs, whatever. It doesn’t have the intricacies and the detail that you have when you’re designing a tooth. The tooth takes more processing power of the CAD station even than designing a house, even though the house is obviously much bigger. Hardware is catching up and becoming more and more affordable. Software’s pushing the limits of that at all times.”

Related reading: Untangling the confusing world of CAD/CAM


	The equipment, products and materials of dental labs are improving but not all at once and not evenly.

“If you break down the evolution of the industry, I think it breaks down into advances in scanning technology and then advances in design technology and then advances in fabrication technology,” observes Larry Bodony, president of 

Each of the three is dependent on the others for success, and it all starts with scanning.

“Without a decent scan, the rest of it doesn’t make any difference,” Bodony says. “What we’re seeing, especially in the last two years, is the rapid evolution of so-called white light scanners, which look like they’re the leading dental lab scanner type right now. These replaced the old laser scanners. They’re faster and they have generally better accuracy.”

One of the key areas in which scanning technology has improved is its speed.

"The algorithms and the computers got faster enough to make some really sophisticated processing happen in real-time,” Bodony says. “The time to scan something has gone down dramatically in the last two or three years to the point now where high-volume labs can basically put junior people on scanning and crank out more than 100 cases a day.”

Once the scan moves to the design stage, technicians can do much more now than they could even a couple of years ago.

From the CAD standpoint, what’s expanded has primarily been the breadth of restorations that you can design,” Bodony says. “Pretty much everyone started out with single crowns, inlays, onlays and things like that. Recently, what we’re seeing is an advance in other types of restorations-from bite splints to bars. Now, full-denture design systems are starting to make their appearance.”


	And when it’s time to make the physical product, innovation in materials and equipment are responsible for better restorations.

“It’s been in increasing material innovations and machining innovations that have led to all kinds of interesting breakthroughs, like being able to mill pre-sintered zirconia-even though the milling was fast, the sintering took forever,” Bodony says. “It’s all about
	getting productivity and good value on the restoration and good biological characteristics. On the fabrication side, now you hear a lot of innovation happening with 

. Mills are pretty well understood, but, still, there are 

 every day that can mill harder substances and do it faster and more accurately.”

Rob Nazzal, CEO of Custom Automated Prosthetics

 in Stoneham, Mass., compares one of the earliest CAM mills, which was the size of a refrigerator and cost a quarter of a million dollars, to a present-day table holding five desktop printer-sized mills.

“These five machines don’t even add up to a quarter million dollars, and these machines can run circles around that old mill,” Nazzal says. “These things can do much more than that big refrigerator could do.”

Related reading: How a stand-alone mill can help your lab take complete control of finalized productions

While some of the advancement comes by sheer virtue of technological advancements, Nazzal attributes some of that advancement to older machines having to perform manufacturing tasks for a broad range of industries. Manufacturers are making the machines specifically for dental applications.

"Now that zirconia has taken off and manufacturers recognized dental as a market, they are making purpose-built mills for dental,” Nazzal says. “That’s why you see things that are the right size, have the right features and are just right for dental, and that’s why the price got to be into the right range.”

Labs need and want different things from their machines, so there can’t be a one-size-fits-all mindset guiding their development.

“We have very open machines with very often software feeding the machines,” Ferguson says. “Not every machine is great for everything, so we have certain machines we dedicate for wet milling of glass ceramic and then we have another one for metal and then we have other machines that don’t wet mill at all for where we mill our zirconia or our PMMA.”

No matter where labs are now-or where the equipment progresses-it will never be in its final form.

“I think it will always be evolving and changing, because what’s perfect for one person is not going to be perfect for another,” Ferguson says. “I can say, ‘Is there a perfect-looking woman?’ And you can get a group of 100 different guys, and they’re going to have 10,000 different women that they think would be perfect, and they won’t look alike.”

Bench mastery: Esthetic and efficient monolithic zirconia crowns


	Advancements in the realm of manufacturing are not just limited to the machines. Materials have evolved and continue to be more useful within the world of CAD/CAM.

“Ten years ago, when we first started milling zirconia for example, at that time it was just white zirconia,” says Ryan Faufau, director of CAD/CAM rvesources at 

 was a pre-shaded zirconia. They were actually one of the first pre-shaded materials on the market, but the translucency, the lifelike look of the actual material itself wasn’t there. Back then, I wouldn’t have done a full contour with the material composition of the time.”

The improvement of materials makes CAD/CAM a more complete solution.

“With more translucent zirconia today, with multilayer products where it actually has that transitional blend from the gingival to the incisal, really kind of simplifies the process. The materials are really driving this digital era that we’re encountering,” Faufau says.

That growth in materials has changed the applications for which materials are used.

“We had the substructure first, then we got the full-contour zirconia and now are branching out into some of these more advanced things,” Nazzal says. “There are all kinds of materials on the market, like implant components, and all kinds of things that you can do in-house now.”

“The biggest change has been the availability of materials,” Ferguson adds. “That’s helped the dental labs, but it’s also hurt the dental labs. When we started milling in our dental lab, we had a couple different zirconias that we could choose from, maybe mill some wax or some PMMA, but now with all the glass ceramics and new materials coming out, whether they be 

 to compete with e.max, the material manufacturers are really working to make the materials themselves more processable, where you can click a button and let the machine do some work and you don’t have to sit there babysitting a burn out oven. It’s more about letting machines do the work while saving labor time so you can get more work through the lab.”

Materials are better for end results but also in terms of the demands on lab technicians.

A lot of the newer materials are more user-friendly material in its milled version than in its pressed version,” Ferguson says. “One of the things we started to do in our lab pretty quickly was stop pressing e.max and start milling it. It’s simply made it easier on the ceramists.”

Video: KATANA multilayered zirconia now available in new shades


	When dental CAD/CAM systems first came to market, they were closed, proprietary systems, meaning that the scan, design and milling components were all made and sold by the same manufacturer. Over time, the industry has moved toward so-called “open standards,”-specifically the 

-which allows work to be performed on any machine, no matter who manufactured it, as long as the machine can work with open standard files.

“It has to do with not creating proprietary, closed standards,” Bodony says. “The reason [companies make closed systems] is pretty obvious. They want to sell everything as possible in the food chain. The benefit is that it tends to be better-engineered because they control the source and destination of every piece of data. The difficulty for the purchaser is that once you commit to one piece of that puzzle, maybe it’s intraoral scanning for the design, you can only get things from that system and send things to that system because it’s closed.”

CAD/CAM was available in other industries before it came to dental, and the appeal of open systems was first evident in those applications.

While the STL format is utilitarian enough in its capabilities, dental still requires a better standard.

“The piece that’s missing in our standards today is a layer of metadata, which is data about the data,” Nazzal says. “That has to do with things like if you needed to pass on information about where the margin line is on the design file. Or, ‘What is the insertion direction of this STL file?’ Or, ‘What is the patient information for this file?’ There’s no sort of envelope for information that’s included to tell us anything meaningful about that data. There’s no real standard for that right now.”

For that standard to become a reality, it will necessitate a body to make those definitions.

“At some point, they’ll get forced to interoperate,” Nazzal observes. “The market is going to demand that it goes open and that these standards make it even easier to transfer information between these systems. There’s not a lot of motivation between the players to make it happen yet. As more cases become digital and more systems require interoperability, we’re going to see more of these standards evolve.”

Related reading: How an all digital workflow can save your lab time and money


	Labs considering the move from analog to digital (or at least adding digital to their offerings) must be aware that there is a different workflow involved.

"Changing is very difficult,” Faufau says. “I’ve consulted with a lot of laboratories about how they’re going to integrate the new process of doing production from the conventional methods. It gets to the point where I think that most laboratories are under the belief that you can hire a gamer or somebody that’s good with the computer and end up with the same result. I haven’t found that to be true. What you see on the screen is different than what you physically see in your hand.”

Faufau gives new designers a hands-on demonstration of the difference between reality and virtuality.

“One of the things that I do when I have a new designer on staff is let them design, and then I go ahead and we mill the design out of wax,” Faufau says. “Then we actually place that on a model and let the technician look at the difference between what they’ve actually designed physically and what’s on the screen. It’s a good tool because it allows them to see, physically what they’ve done virtually.”

Nazzal favors a teamwork approach, pairing those who are technologically inclined with those who are dentally inclined.

“See if you can find someone in your group; don’t just take your best ceramist and put them on the computer,” Nazzal advises. “They may not be interested in doing these things. It can be very frustrating for them. See who gravitates toward the computer. You might have somebody who always fixes your front desk computer or somebody who is interested in doing the next cool thing in the company and will work to help make that happen. They just need to be sitting next to somebody with dental knowledge.”

Free white paper: Understanding the new digital dental workflow

Using a computer to make dental restorations has certainly made the process easier, but there is still something to be said for the knowledge and skill required making restorations by hand.

"In a lot of ways, becoming a good manual technician is harder than becoming a good digital technician,” Bodony says. “Not only do you have to have good conceptual knowledge of what you’re trying to do, but you also have to be mechanically very adept at waxing and cutting and grinding and polishing and all the things that techs traditionally had to do.”

While the field used to call for special people with the unique ability to work in both fields, those workers are becoming less and less rare.

“The idea is you had to create your unicorns,” Nazzal notes. “There are more unicorns out there though. A lot of these unicorns have been grown because there’s so much digital out there in our industry, and it’s not as much of the unicorn as it was because there are thousands of scanners and there are thousands of mills out there now. A lot of technicians have touched these.”


	There is still a place for labs that do everything by hand, but those days may be coming to a close.

"It’s a little like the fish in the pond, and that is drying up,” Bodony observes. “It’s not going to happen all at once. You can have a couple of good dentists who are happy to send you restorations and happy to get the thing back. You can ignore it for a while, but the number of them is going to go down. There’s no question about it. Between the advances in intraoral scanning, CT scanning, implants, planning and all of that, the number of cases that are going to come in analog is going to decrease over time. When the exact point is when more cases are done digitally than analog is anyone’s guess because it’s impossible to gather the data. Everyone seems to agree that it’s happening, and it’s happening rather rapidly right now. The dentists I know who are using intraoral scanners are very happy with them, and they’re getting the results they want. They certainly don’t mind saving all the money in impression material and getting more reliable results.”

Related reading: How to integrate dental digital imaging with paperless workflow

Dentists are becoming more comfortable with CAD/CAM systems so the workflow is changing right from the earliest stages of restoration making.

If you’re going to stay relevant to the industry, you have to adapt to technology,” Faufau says. “I’m seeing more and more younger clinicians-doctors being trained in utilizing chairside scanning at universities. One of the first things they want to do is continue to use that technology once they graduate and open up their own practice. In order to work with these doctors, you’re going to have to have a way to accept data from them. I think technology is definitely the driver of the industry at this point, and if you haven’t adapted to it and you may be left behind.”

Many older labs may stick with traditional methods simply because they specialize and might be near retirement, but those labs would be wise to consider their exit strategy.

“I think there are always going to be processes that will be done by hand, at least for the foreseeable future,” Ferguson says. “But I know some labs that are small, boutique labs that are one- or two-man labs. They charge whatever they want to charge. They are at the absolute highest end. They will probably be able to make it through to retirement. I think there will always be a place for that. It also matters what they want to do with their lab when they’re ready to retire. When I look at a small lab that has CAD/CAM in its facility already, that’s something that you can sell. But when I look at a lab with one ultra high-end ceramist who wants to retire, that lab has nothing to sell at the end. As a business plan, I think what CAD/CAM does is it allows you to maintain the same quality more predictively, more streamlined, more efficiently and more quickly. Smaller labs mostly have older technicians thinking of an exit strategy. If you have a five-man lab that’s doing everything by hand, your exit strategy is to sell off your accounts and maybe some equipment, but it’s not really as much as when you bring in CAD/CAM.”


	Deciding to embrace digital technology is the first step. But once that decision is made, the move shouldn’t be made carelessly or without solid planning.

“The biggest problem that I see is the up-front investment that you have with technology, and then obviously not knowing if that return on investment is going to come back at a fast rate and what the laboratory is expecting when they integrated,” Faufau notes.

Webinar: Dr. Flucke talks about "how digital dentistry works"

CAD/CAM systems require more than a passing bit of education.

“Most laboratories can’t just go to a seminar to learn it,” Faufau says. “They need chairtime. You need time with the 

. You have to get familiar with the tools that the software offers, and a lot of that you just need to put in the time to learn it.”

Ferguson advises not just looking at the price tag on a new machine but also knowing about the company supporting it.

“The biggest thing is to research the support that you’re getting with whatever system you choose,” Ferguson says. “There are a few major systems out there, and may be bought from any number of different people. Use 

, for example. It’s the same system shipping from 3Shape, but how was the company you bought it from supporting you? That makes more of a difference than a thousand dollars on the purchase of a scanner. You can easily lose five to ten times that amount in trying to figure out that the system didn’t come with the proper support and training. It doesn’t matter the system: 3Shape, 

, exocad, whatever. Especially for technicians who haven’t dipped their foot into CAD/CAM, that training and support is going to be their lifeblood in how they incorporate their manual workflow digitally.”

The industry is firmly on the track to embrace digital, and it’s something labs that aren’t incorporating it should.

“If you look through the vendors who are involved with some of these [trade]shows today, the focus is digital,” Faufau says. “If you’re not digital today, I don’t know what you’re going to the show for.”

Nazzal recommends making sure you’re not going to digital just for the sake of going to digital. There needs to be some justification for it.

“For instance, zirconia is the fastest-growing restoration, and it’s best made using digital processes,” he says. “If you’re getting lots of orders for zirconia and you’re outsourcing those orders, it might make sense to bring that technology in-house. But there are certain times when you shouldn’t do it. If you’re only doing two or two or three zirconia units a day, it might not make sense to bring some of the stuff in house.”

There has been a lot of evolution in dental lab technologies, and that growth hasn’t ended yet. Make sure you’re prepared to make the leap to the future, and you’re doing so in ways that will make your lab last into the future.

Related reading: The top 5 dental lab trends of 2014

 It should come as no surprise that the dental lab industry has-and continues to-grow and evolve. From George Washington’s ivory dentures (despite what you heard on the elementary school playground, they were not wooden) to porcelain-fused to metal crowns to today’s all-digital, full-arch cases, the way we do things has constantly grown. Even within the modern CAD/CAM systems, progress continues.

From traditional to now: Taking your lab from the past into the future

	While the technology surrounding dental impressions has come a long way, you may still have some problems with them. This month's list focuses on the top 3 products that can help your dental clients take better impressions.


	For time immemorial, one of the biggest headaches faced by dental technicians is receiving an impression from a dentist, only to discover something totally unusable. Whether it’s a poor bite registry or a botched impression thanks to careless hands (or a patient who can’t quite sit still), 

 make it impossible to deliver what the dentist and patient want-no matter what the dentist screams into the phone at the lab technician! But things are beginning to shift. More and more manufacturers are beginning to introduce 

 specifically geared to the dental office. And these scanners have made it through the growing pains phase-no longer should you receive half-scans that are essentially useless. Instead, you should be able to receive excellent digital scans you can plug right into your CAD software and get to work. Gone are the days of goopy, smeared impressions; now you can receive a 3D impression you can pour your artistry into. Just make sure you’re ready to receive your dentists’ scans

The List: Top 5 ways to help your clients go digital


	You might think this is a joke, but the lowly telephone is actually one of your best friends when it comes to getting great impression results. The fact is, your dentist and his or her team want to get you impressions that will lead to an excellent restoration and a happy patient. Sending you a poor impression that leads to another in-chair appointment or a terrible fit just isn’t in the best interest (or bottom line) for the practitioner. So if you see a bad impression come in from your dentist: Call him! And if it’s a pattern you’re noticing, offer to come in and show the whole team what you need in an impression to deliver great results. Your clients will be impressed with your diligence-and that you took the time to work through a problem with them rather than delivering something they can’t use.


	You know how important the right materials are when making a crown or a removable. Why should impression materials be any different? While you have every right to hope that your dental clients will do the research to pick the best material for their impressions, you can also benefit from doing a little digging on the current leaders in the impressions market. Who are the manufacturers that understand what dentists-and labs-need from impressions? Find out what the leading options are in both traditional materials, and in scanning materials. You can make yourself an invaluable resource to your dental clients, and that’s a role that can continue long beyond any impression issues.  

 While the technology surrounding dental impressions has come a long way, you may still have some problems with them. This month's list focuses on the top 3 products that can help your dental clients take better impressions.

Dental Lab Products March 2015

This new zirconia is engineered to blow your mind

3 products that can help your clients make better impressions

Meeting the challenges of digitization

From traditional to now: Taking your lab from the past into the future

The List: Top 3 products that can help your dental clients take better impressions