Dental furnaces round-up

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A round-up of dental laboratory furnaces.

Precision and Reliability are the Keys to a Dental Furnace 

A dental technician at Guided Dental Ceramics, LLC in Naples, Florida, Jason Dunbar specializes in Chrome Guided Surgery for all-on-4 treatment. When working on a surgical prosthesis for intraoral conversions, Dunbar’s material of choice is the TriLor Arch from Harvest Dental. The material is 3.5 mm and is already in an arch form, which are just two of the features that drew Dunbar to the TriLor, he says.

“The nice thing about is it comes in a 3.5 mm thickness. And you cannot get a puck for a mill that thin, that’s not a possibility. So, the fact that it’s an arch-form shape already and it’s already as thin as 3.5 mm, that’s attractive because then you can go in and manually add it to your prosthetics,” Dunbar says. “Something like that would be hard to integrate into the digital workflow. It’s actually one step that takes me out of a digital workflow because it is a manual task. That’s attractive because it’s easy to implement.”

What he usually does is mill a nano-ceramic surgical provisional 2 to 3 mm short on the intaglio surface of the provisional, then he can replace that 2 to 3 mm void with the TriLor Arch. The outcome is a surgical provisional that has 2 to 3 mm of cradle support on the provisional, something that he believes would be difficult within a digital workflow and be cost-effective, Dunbar explains.

“I make a prosthesis that’s a few millimeters short, and I basically slide in 3 mm of TriLor under it. And I don’t see how that would ever work in a digital world. I mean, you can get a digital workflow, but it wouldn’t be as far as actual milling because there’s no such thing as a 3.5 mm puck. Whereas, as far as the TriLor Arch form, that’s been a 3.5 mm,” he says. “And what I mean by cradle, is that it’s supporting the whole underside of the prosthetic.”

The size of the material is an advantage, but the real benefit lies in TriLor’s strength, he says.

“The real value is the end-product. I attach TriLor to an already very strong milled nano-ceramic provisional,” Dunbar says. “By the time that I’m adding those two together, what we end up with is a very long-term provisional that’s almost as strong as the final prosthetic.”

The TriLor Arch is so strong, Dunbar believes it lasts about 5 times longer than traditional metal bars.

“Instead of using TriLor, some [techs] will use a metal bar, and you integrate that into the provisional and that is the support for your long-term provisional. But, I would still limit that to a year, year and a half. Whereas this one here, I almost feel comfortable saying and it will last five years,” he says.

Dunbar actually has a dentist client who is offering a five-year guarantee with the provisional due to the TriLor support, he says.

“That’s kind of a standout right there because if there’s a [dentist] that will put his practice and his career on the line and say, ‘I get a five-year guarantee on this,’ that speaks volumes because there’s nobody doing that,” Dunbar says. “With the TriLor support, there’s no doubt in my mind it’s a good five-year provisional. I would say that this is a long-term provisional that is the closest you can get to an actual final prosthetic strength.”

In addition to its strength, Dunbar finds the TriLor to be very easy to work with, something he was skeptical about in the beginning.

“From a laboratory standpoint, the material is just extremely strong,” Dunbar says. “But, it’s not that hard to work with. It’s kind of user-friendly at the bench. So, despite its strength, it still grinds nicely with our typical standard carbide burs and diamond burs. The first time I started looking into it, I had no idea what the material would grind like. The one thing I found nice is that it’s very strong, but it’s still pretty easy to grind on.”

Another aspect of the TriLor Arch that Dunbar enjoys is its cost-effectiveness, he says.

“It’s very cost-effective, and you can turn around and charge a good premium for adding it to your provisionals. So, for under $100 an arch, we can add the TriLor. And we can easily get an upgrade of, say, another $400. That’s a good markup, and it doesn’t take that long—it probably takes an hour and a half to do,” Dunbar says. “I think, the advantages of the TriLors are one, cost-effective to integrate it into the workflow, and two, you end up with a very strong long-term provisional.”

You can follow Dunbar’s work on Instagram @Chromeguidedsurgery.

Articles

This lab technician finds the TriLor® Arch from Harvest Dental to offer flexibility without compromising on strength.

A high-tech prosthesis material that offers strength

It can be difficult to figure out where to begin with 3D printing

With so many systems available, finding an easy-to-use system that offers a wide range of options in materials and applications is challenging.

Provides high resolution output across multiple applications and material options

Ideal for those new and experienced with 3D printing

Easy-to-use software with automatic support creations simplifies print set up as well as post processing

A large print volume and print speeds of up to 40 mm/hour allow it to produce up to 120 wax-up crowns in 45 minutes or 4 arch models in an hour

Applications include dental models, wax-ups, surgical guides, custom impression trays, bracket transfer trays, and more

Supports both SHINING 3D print resins and compatible 3rd party print resins

No annual software fees—software updates are included with the purchase of the unit

With SHINING 3D’s AccuFab-D1 Dental 3D Printer available via Aurident, dental labs can quickly and easily add a range of additive workflows.


Solve My Problem: A Benchtop Printer Ready for a Range of Tasks

trained in the 1990s and before, fully understand the design freedom that a wax-knife, a Bunsen burner, and a block of wax offered. This was a world where a talented artist—with a firm understanding of function, anatomy, esthetics, and a willingness to work long hours—easily ruled the universe.

Unfortunately, this “analog freedom” of creating almost anything imaginable was rather short-lived and was quickly replaced by a digital mouse and a computer screen. This digital evolution was ultimately for the better, and through this process, a new breed of super-efficient technicians was spawned. This 21st-century technician can create amazing prosthetics with this technology while preserving the most valuable asset off all—artistic hands.

Over the last decade we have seen the creation, and subsequent development of many digital design programs, such as 3Shape dental system (

At first, most of these softwares focused on fixed restorative processes required to support the multitude of new milling systems and innovative zirconia products on the market. With the introduction of printable and millable denture bases, these software companies quickly stepped up to also supply the industry with a workable denture and partial design module.

3Shape, under the leadership of visionaries such as Rune Fisker, offered a denture module for laboratories as early as 2010. This was long before the industry had the analog ability to produce a functional and esthetic digitally processed denture that was comparable with a hand processed prosthesis.

As laboratory owners and technicians wanting to compete in this ever-changing digital landscape, it is crucial to not only stay abreast of these technologies but more importantly, understand what mastering its capabilities offers.

In the past, layering glass ceramics, casting alloy substructures, and grasping other hand processes defined a laboratory. Going forward, the ability to manipulate and control the STL file will be the differentiator.

Artistry will never be replaced by machines, but hand processes remain the biggest potential enemy of consistency. A marriage between digital design and human artistry is ultimately the future of this industry.

Up to this point in our evolution, labs have had no choice but to be prosthetic producers guided by manufacturers. A technician’s responsibility in the past was mastering the processing of materials driven by suppliers. STL is now allowing technicians to be leaders and innovators, using these materials to support their innovations and through this, differentiate their laboratories from the competition.

Many dental laboratories established in the 1990s and before were founded as specialized businesses focusing on either fixed or removable prosthetics. With the introduction of the all-on-four™ concept by Nobel Biocare, the once clearly defined lines differentiating fixed from removable laboratories became blurred. As this concept grew in popularity, many fixed labs found themselves in a situation where a traditional denture wax set-up was required to initiate the process of restoring a fixed hybrid prosthesis.

Absolute Dental Lab faced this same conundrum. Ultimately, the decision, albeit hesitantly, was made to morph into a full services lab.

For almost a decade the Absolute removable division was seen purely as a support department for the fixed aspect, and therefore was never promoted, advertised, or ever considered as a profitable business opportunity.

All the above drastically changed when Dentsply Sirona, in partnership with Carbon 3D printing, launched the new Lucitone 3D Print™ material. This material/technology combination greatly increased production efficiency and yielded high-end esthetics combined with material strength never achievable in a printable prosthesis 

. This material advancement greatly improved profitability and breathed a breath of fresh air into this once almost forgotten department.

Unfortunately, the corporate Lucitone message was that the technology could only be used for full dentures and offered no initial application for removable partials. As more clinicians became aware of the incomparable strength of this material, the lab received calls on a constant basis requesting a Lucitone 3D printed partial.

Create a partial in a full digital workflow 

, print the base with Lucitone 3D Print on a Carbon M2 printer and lute/fuse the IPN 3D™ Portrait teeth using Dentsply Sirona’s proprietary Lucitone Digital Fuse. Creating this partial, with a custom milled tooth structure in the design software, is as simple as point and click. The goal with this project was to process only with available Dentsply approved components found inside the Lucitone 3D print family. Unfortunately, using the proprietary prefabricated IPN 3D teeth posed a real digital challenge.

At a Glance

No proprietary Dentsply Sirona supported partial design workflow exists in the 3Shape RPD design module. At the time of this publication, the 3Shape RPD module did not have premanufactured tooth libraries available. Even though the IPN 3D DME library exists in the 3Shape denture module the RPD design module relies on traditional custom crown and bridge tooth designs that can be exported for milling of the tooth overlays.

The 3Shape RPD module offers a customizable tooth library option through the “scan it library” function. This allows a laboratory the ability to create their own custom tooth library in lieu of using the 3Shape default libraries for their crown design.

This option gave the Absolute team the ability to create an RPD workaround by physically scanning the IPN 3D teeth on a 3Shape E2 benchtop scanner 

. This effectively created an IPN 3D DME library 

Although initially necessary to scan every mold in the IPN 3D range to build the library, this arduous task is only required once. Furthermore, it is only necessary to scan one quadrant of each tooth card. The “scan it” function has a “mirror current tooth” option which offers the ability to automatically set the contralateral tooth from the DME file.

It is important to note that if interproximal or clearance adjustments are needed, the value of using prefabricated teeth in lieu of a custom designed and milled option becomes questionable.

Because of the aforementioned, 3Shape had no practical reason to offer prefabricated tooth libraries in the RPD module and this should therefore not be seen as a deficiency in the software.

The flexibility of the RPD design module does, however, allow the designer to infringe in the interproximal contact areas if an optimal DME tooth is not available 

. In this case, those infringements caused over-designed contact areas which had to be adjusted in analog on the printed model.

The advantage that milling a tooth structure offers over printing a base, for luting prefabricated teeth, is the fact that the tooth structures can be customized in the digital design. Those custom designs are milled on spec in the analog fabrication process. The flip side is that milling a tooth structure and denture base, even utilizing the most advanced milling equipment compared to printing the denture base, is simply not efficient or cost-effective in a modern-day production laboratory setting.

To complete an encompassing workflow available for use in all clinical scenarios, the Lucitone Digital print product family requires the addition of millable tooth puck. This addition would also allow the use of this superb product when a custom designed tooth is a requirement.

Even though a Lucitone printed partial base is 3 times stronger (3000+ J/m2) than the minimum required ISO impact standard (900 J/m2) and more than twice as strong as the well-proven traditional Lucitone 199 (1380 J/m2), the demand for permanent acrylic partials have all but disappeared.

This digital revolution in the dental industry is only now starting to gather steam, and over the next decade, these technologies will grow exponentially in both functionality as well as demand.

The rationale behind this article was not to revitalize interest in acrylic flippers.

Laboratory owners and technicians need to realize that times have already changed. Digital design is the future. Understanding the hidden ability of this new “wax knife” will lead to innovation and innovation will ultimately lead to relevancy.

The author would like to recognize Dries van Aarde, Kate Johnson, and Steve Lombardi for their thorough understanding and ability to manipulate the 3Shape design software. Also, ART team members Jack Marrano and Chris Love for their amazing artistry.

As digital design has advanced, it’s become clear that the future of the industry lies somewhere between digital design and human artistry.

How to balance digital and analog design

Pressing and casting workflows require smooth and precise waxups, and some millable wax pucks don’t produce smooth surface or sharp margins

Additionally, millable waxes can produce residue which can build up and clog burs, slowing production and adding to the time it takes to clean the mill.

Formulated from a highly homogenous material to mill with optimal precision, smooth surfaces, and well-defined margins

Technically an acrylic material rather than a wax, it burns out without leaving a residue, making the material ideal for all-ceramic restorations

During milling the wax is shaved off in small chips that do not stick to the bur or the wax puck

Specifically designed for use with CAD/Cast and CAD/Press workflows

Distinct blue color for increased visibility

With a highly homogenous formulation, Renfert’s EASY Blank Wax is designed to produce accurate CAD/Cast and CAD/Press restorations.

Solve My Problem: Smoothing Out Hybrid CAD Workflows

ince the late 18th century, London’s Savile Row has been home to the world’s most exclusive bespoke tailors. A single custom-fit, hand-stitched suit can cost thousands of dollars, taking up to 12 weeks to deliver. Conversely, an individual can go to a department store and get something off the rack for a couple of hundred dollars. It’s a lot of money to spend on a suit, but buying something that’s handcrafted rather than mass-produced adds a certain element of attention to detail and élan.

A similar comparison exists between traditional, handmade restorations and CAD/CAM restorations that are gaining in popularity and prevalence. That is not to suggest, however, that one type of restoration is better than the other. Each has its merits and benefits, but for all the attention that CAD/CAM receives, labs shouldn’t forget the distinctions of analog restorations.

Like Savile Row’s suits, analog restorations are delivered thanks to the skilled eyes and hands of craftspeople. “For me it’s signature,” says Sasha Der Avanessian, founder and CEO of Harvest Dental Products in Berea, California. “People are going to differentiate themselves with their signature and [by spending] more time on esthetics, more time on the things that actually separate you, the things that move you into a different light. I’m a big believer in allowing yourself to spend more time on things that actually separate you in your work.”

Analog restorations also give technicians the opportunity to demonstrate their knowledge of form and function, Der Avanessian says. “From a theory standpoint, analog is important because it teaches us the theories of function and occlusion,” he notes. “And from a training standpoint, there still needs to be a real focus on analog for that knowledge of form and function.”

The human eye, with its attention to detail, can ferret out the subtleties that a computer might miss. “I see a situation, and I can go back to the doctor,” says Tom Zaleske, owner of Matrix Dental Laboratory and Consulting in Crown Point, Indiana. “I alert them to that situation. I can help steer the case. In other words, dental technicians with a knowledge base can provide oversight. We’re the technical resource for the doctor. What can and can’t we do? What do I see once I get the impression poured up? It could be a dozen different questions.”

Technicians training with a mouse or a stylus on a CAD/CAM design system, for instance, might not know what to look for, Zaleske says. They’re trained to move the mouse to a certain position based on a ridge, whereas hand-skilled technicians see what others miss, he adds.

Because CAD/CAM is so efficient and reproducible, practices expect more output from technicians with the required skill set. As a result, CAD/CAM technicians simply don’t have the resources to spend with each case. Zaleske observes, “If a guy is sitting at a machine and he’s running the mouse or pen and designing stuff, he hasn’t got time. He’s got to get them out the door. It turns into a widget. It becomes commoditized. So, with commoditization, like the guy at the coat hanger factory, he isn’t saying, ‘Hey, that loop doesn’t look right,’ because there are about 10,000 of those cranked out every hour.”

Human interaction, however, provides a layer of quality control that the computer can’t achieve. The analog technique allows technicians to add a finishing touch to the shape, says Richard Wills, owner of Duece Dental in Wichita Falls, Texas.

“I can sit there and tweak it a little bit,” Wills says. “I can look at the computer screen and get shapes figured out, but you’ve still got to put your hands on it and give it just a little finishing touch…a little bit of tweaking to get the shape that you just couldn’t see in that picture.”

Not every restoration requires grueling attention to detail. However, those that do, benefit from the human eye, especially when esthetics are critical. A hands-on approach adds a refinement that is hard to achieve digitally, Wills says. “The ones that look really nice, that’s where the analog comes in—putting your hands on it to give it that finesse. And I’m sure there are people out there who say they can get that done digitally, but I’m sure they still put their hands on it before they send it out the door,” he adds.

One of CAD/CAM’s pros is also one of its cons. Its comprehensive tooth design library files, though they provide the tooth shapes that labs need, end up lacking personality. The result is technicians use the same files to print similar-looking crowns, Zaleske says. “It’s going to be the same way with dentures. Everybody’s going to use the same files; everything’s going to start looking the same,” he notes.

This also poses a business quandary for the lab: If all patients’ restorations look the same, how does the lab differentiate itself?

“How do you stand apart?” Zaleske asks. “Will you stand apart from everybody else because you have to charge less? I’ve heard all the stories: ‘Oh yeah, you’ve got to service the account.’ OK, get past servicing the account, get past everything else. It comes down to price then, because there is no individuality. They all look the same.”

Most of the form and function benefits that the analog workflow afford are, quite simply, due to the training and skill of the lab technician. For instance, training and proficiency pay off when it comes to lighting, according to Dane Barlow, owner of Smiles by Dane in Boise, Idaho.

“I’ve had designers send me cases, and they couldn’t see that the light source was causing a certain shadowing, making them think that it was pointing a certain way,” Barlow says. This is similar to a dentist sitting on one side of the patient, with the teeth all facing in one direction, he adds. The teeth are parallel across the mouth and lean toward the side that the dentist is working on.

“As a technician, we have to understand these things,” Barlow continues. “And how many years did analog technicians sit in a corner with a light coming through a window on one side and carve their wax incorrectly? I’ve had technicians do that, and I had to move them to a different part of the room. ‘OK, here’s your new station. This is where you’re going to work from now on because the lighting is directly overhead or directly from the window.’ So, they would be able to see an equal shadow on each side. That same problem exists in software. And if they don’t know to look for it, if my world has been arches from the beginning and not single tooth, they don’t understand the cosmetics and the balance of it.”

Spartan Dental Lab in Lansing, Michigan, has been part of David Turpin’s family for four generations, more than 60 years. Digital wasn’t an immediate adoption for the lab, but when it was added, it underscored the place of analog workflows. That is, digital works for some things, but analog still delivers, especially when a technician’s skilled eye and hand are needed.

“My dad and I, we butted heads for a little while about whether it’s more efficient, and it is more efficient because we can cut out steps,” Turpin says. “But analog has its benefits because it’s a little easier to put the art back into it. Digital kind of commoditizes the industry a bit. People liked my grandfather, who took over from his father, and they came to him because of his artistry. Now it’s a little more commoditized. With digital, we’re losing that touch a little bit.”

A deeper connection exists between technicians in the analog world, who are craftspeople at heart, and their creations, Der Avanessian says. For analog technicians, the digitized process is less intimate and pulls them away from the creativity they bring to a traditional technique, he notes.

“It’s self-actualization of the dental technician,” Der Avanessian says. “The areas of creativity and esthetics and art—those were the areas that dental technicians really took a lot of pride in. You never really heard a lot about, ‘Look at how good this substructure was made.’ You need to have the function of a substructure. It needs to be designed with integrity, with minimum thicknesses…But at the end of the day, I think that opportunities to connect dental technicians back to loving what they do [center on] the touch, feel, and, sculpt elements of dental technology.”

Regrettably, sometimes that lack of skill or attention to detail is lost on patients and dentists. Patients have never experienced the difference, and dentists with limited educational or practice exposure have preconceived notions about prosthetics, Zaleske says. For him, crafting dental prosthetics is a necessity, and they are not analogous to handmade suits.

“This isn’t an elective thing that we do,” Zaleske says. “Suits are an elective thing. If you decide that you want a better suit, something that looks nicer, that fits better, you have to decide whether to buy it off the rack or pay thousands of dollars to have one custom-made. But at its core, we make a custom dental prosthetic for somebody who has lost their teeth to disease or an accident. It’s just like somebody who would make a facial prosthetic.”

In any business, costs matter, and whether analog or digital is more expensive depends on the lab and how it works. “Some processes, like the digital dentures, don’t cost less,” Turpin says. “I think it’s more of a wash in the cost of materials, but the machines are very expensive. So, I think that even on the material costs, it’s more the amount of labor that you save doing it.”

Materials for digital cost less compared with analog, but the equipment that uses the material is not cheap, Wills adds. He spends more on labor for analog than for digital, so his lab is saving on the number of individuals it needs to hire, he says. “With analog, you don’t have the equipment expense; you’ve just got manpower,” he observes.

CAD/CAM machines are just that—machines. They can be expensive and eventually become obsolete. Zaleske compares this to the music industry, which has moved from records to 8-tracks to cassettes to CDs and now, digital downloads. Eventually, one technology is phased out in favor of something shiny and new.

“[When] you buy a piece of equipment like that, you have an investment,” Zaleske says. “It’s a capital equipment investment, and it has a certain shelf life. It’s like everything. Well, that equipment has a shelf life. It’s only going to manufacture for you for so long before the next latest and greatest thing comes along because that’s the 

 of manufacturing. You trickle it out. You get a bunch of people invested in the technology, and then you milk them along. After 3 years, if the machine hasn’t paid for itself, you’re looking for a lease on a new machine.”

Labs should not base their value entirely on price but also on behaviors that make them more valuable than what they do, Der Avanessian suggests. He recommends innovating behavior to make a lab unique. At the end of the day, competition only exists where a lab’s value does not, he says.

“We hear about the race to the bottom a lot,” Der Avanessian says. “And to me, the race to the bottom is a territory. And the people who engage in that race are people who have not created a value proposition more valuable than their crown, which then makes price their only differentiator. I believe that you can be a profitable laboratory, whether you are milling your crown or not. The hard truth is that the market does not need another crown; it needs you. Your thumbprint tells you that you have no competitor. Act on that.”

It may seem counterintuitive, but in some cases, doing the work by hand can be faster than following a digital process. That is often the case when using a new design system. Digital tends to be a very slow process when a technician is getting started, Barlow says, and the transition isn’t necessarily easy.

For example, if a lab spends $3,000 on a computer that’s well designed for nesting, it would absolutely perform calculations faster. However, if the computer calculates through 80 or 90 percent when trying to set arches and it fails, a redesign may be necessary, Barlow says. And it can fail multiple times before the technician understands whether the issue lies with the nesting software or the design software.

“On the back end, once you start to understand what it’s doing wrong, you avoid that early on in your design completely,” Barlow says. “That’s something not every designer understands either. You have [one] person [doing] the nesting and [another] doing design. And if they’re not in great communication, the designer doesn’t know what he’s supposed to do to help the nesting software, and the guy who is providing the nesting has a hand in getting those designs to work. So, it does take a lot of communication and active learning to actually get the results that you want, which is efficiency and how things move correctly.”

Labs can regularly update CAD systems’ software with new functions and features, which is a plus. However, this can also become an unexpected obstacle for designers as options are changed out and don’t function as planned, Barlow says. Even if the technician and lab are producing digital products, they need a foundation in the functionality of the analog world.

“Everything we do digitally, if you have not done analog, you have no business doing it digitally,” Barlow says. “I just added a technician, walked up, and looked at the screen and said, ‘OK, well, how did you determine your orientation on a screen?’ ‘Well, I just said OK to that.’ ‘So that means you looked at the model work that’s on-screen and just arbitrarily determined that the face looks a certain way?’ ‘If you were doing this analog and had articulated it in the articulator, what would you do?’ [The tech said] ‘I would print out the photo of the patient with a grid or a retracted view. I would then orient what I’m looking at in the articulator.’ I said, ‘Great, so why haven’t you done that digitally, set a new custom view? Why did you just arbitrarily make it look like the stone arch is perfect?’”

Quality control for digital cases necessitates a need for a knowledge of function, the kind of knowledge that comes from having worked in the analog world. Even if a technician does send out a wrong case, the ceramist would ideally catch the mistake, usually by using analog and verifying with a photograph to make sure it’s articulated correctly, Barlow says.

“It really does require that people are following analog procedures, even in a digital space. There are lot of fun things to look at in software, but if they’re not working correctly yet, then it’s best to avoid them and not suffer the consequences or additional loss. It takes great technicians who understand analog to still teach and do their job in a digital workspace,” Barlow says.

Although the appeal of digital includes speed, efficiency, and consistency, some would argue that an understanding of anatomy and of function gets lost in the workflow. It’s the sort of foundation learned in a formal setting. However, dental labs are struggling to find new technicians, according to Turpin.

“I know from talking to a lot of other labs that the problem with not going digital is the lack of technicians out there,” Turpin says. “It takes quite a bit of time to train them. Either you can find a great analog technician who is not very good with computers, or you can find someone who’s really great with computers, but they’re not a technician. There are only 13 schools in the country and, according to the NADL [National Association of Dental Laboratories] at a meeting I was at a few months ago, there were about 300 graduates in 2018. There are just shy of 6,000 dental labs in the United States, so not a lot are finding technicians. It’s harder to scale from a business aspect.”

As cases get more complex, the need for that education becomes even more apparent. There is a lack of formal education in the field, Zaleske says. Compounding that problem are individuals outsourcing and using offshore products from countries such as China, he explains.

“Because of that reason, labs had to find a way to compete. First off, owners, if you have a larger laboratory, you’ve got to find technicians,” Zaleske says. “Well, if there are no technicians around, you have to either create them in-house or look outside for another source to do that. It’s very distasteful for many people to use outsourcing. They’d like to keep it domestic. Labs have to look at how we can compete with China basically. What happened was that some of our larger laboratory groups and independent laboratories looked around and said, ‘Well, we don’t have enough people. We’re competing against China. We’ve got to bring in some sort of automation. We’ve got to find a way to fill those positions that would ordinarily be filled with human beings.’”

But that doesn’t mean that labs need to pick sides; a place exists for both analog and digital workflows. No lab can survive in a digital-only space or an analog-only space; labs need both to get by, and Der Avanessian believes the industry needs to define a middle ground.

“I think there’s really an opportunity for growth in both areas,” Der Avanessian says. “But I think we’ve kind of drawn a line right down the middle of our industry, and we’ve pushed digital to the left and analog to the right. My question is: What do we call the middle? Because the middle is actually where we live.”

As for form and function, digital allows technicians to automate the areas that they don’t compete on, so they can spend more time on the things that make them unique, Der Avanessian says. “It comes back to that idea of signature—your signature esthetic and, most of all, the exclusive behavior you possess and deploy at every human touchpoint where your dentist interacts with your lab. This is ultimately what’s going to separate you,” he explains.

That signature is a source of pride for the analog craftsperson, Wills adds, because technicians put a lot of pride into their work. This is the biggest difference between analog and digital, he notes.

“I’m sure there are lots of people out there who will argue against me on that. But if you put your heart and soul into working with your hands and making something look beautiful, that goes a long way,” Wills says. “I think that the digital method is just out there. [It’s] the cash cow because you can crank out a lot of work and make a lot of money without really knowing more than how a crown should look on the computer and stain and glaze it.”

From a functional standpoint, the suits fashioned in Savile Row are, by and large, no different from the ones found on a department store rack. The same can be said of restorations crafted by hand or created digitally. However, each method has its own advantages. Handmade restorations offer an element of personalization, the same element of care and craftsmanship that goes into those bespoke suits.

Images courtesy of Matrix Dental Laboratory and Consulting.

Dental labs can still succeed with traditional techniques and approaches.

Where CAD/CAM cannot compete


Innovation is defined as the introduction of something new, a new idea, method, or device. For Ivoclar Vivadent, to further qualify a product as innovative, it must also be easy and very efficient, require fewer clinical appointments, fewer manual working steps, appealing esthetics, individual and functional dentures, ability to shape and morph the teeth, highly efficient manufacturing, and high-quality optimal results for the patient.

“Disruption” is a word you tend to hear quite a lot these days, especially in the digital economy. Contrary to the word’s negative connotations, when disruption leads to improvement, it’s actually a positive.

Disruption is a process in which existing ways of doing business (products, technologies, services) are replaced and sometimes driven out of use by new technologies. Two examples of disruptive innovations are Uber, which changed the conventional taxi industry, and Netflix, which has rendered traditional video stores virtually obsolete.

The Digital Denture Process is an excellent example of disruptive innovation to digital dentistry and as a whole has evolved over the past five years with more than 1,000,000 cases designed in 3Shape Dental Systems. This is no longer a concept, but a ground breaking reality.

Conversely, only 1% of the removable prosthetics manufactured globally are digital. In 2019, 3Shape saw a 250% growth in the number of digital dentures designed. That statistic bears repeating: 250%!

What does all this mean? Earlier I spoke about morphing: so what happens when a company like Ivoclar Vivadent meets innovation? The result: Ivotion. One disc. One milling process. One denture.

Combining proven high-quality tooth and denture base materials in a single bi-color disc, Ivotion provides digital dental laboratories with an efficient, predictable, monolithic milling solution that offers change in the world of digital dentistry, the kind of change that will most certainly be noted in the history books of prosthetics as a pivotal turning point.

The driving factor behind this innovation was to make the production of digital dentures as efficient as possible for a laboratory. And what could be easier than to get a finished denture out of one single disc?

The Ivotion monolithic milling disc features unique Shell Geometry, a data-based three-dimensional tooth and dental arch structure suitable for the rapid digital fabrication of removable upper and lower dentures. It is based on the data of time-tested complete dentures to create this geometry. Shell Geometry defines the transition between the tooth and the denture base sections of the disc.

Integrated exclusively into 3Shape Dental System 2020 CAD software, the digital denture system allows patient-specific customization with the Ivotion tooth library and the coordinated Shell Geometry. Efficient design strategies offer the freedom to customize and morph the shape of individual teeth for optimal retention, stability, function, phonetics, and esthetics.

What makes this process a true innovation is the elimination of the denture tooth bonding process. Dentures are milled in the PrograMill milling unit in one uninterrupted milling process and only need application of surface texture, separation, and polishing prior to delivery—true to the motto that Ivoclar Vivadent has declared: Design. Mill. Finish. Ivotion is the answer to optimal efficiency, as customized monolithic complete dentures are fabricated in a seamless workflow with fewer manual working steps.

Regardless of your clinical record process, the Ivotion Digital Denture Process is designed to provide you with exceptional quality, and a clean, esthetic result that can be digitally preserved indefinitely. Throughout this article I will demonstrate a unique 3-appointment clinical process as well as the laboratory design, mill, and finish process.

Clinical and laboratory prodeures

Clinical Record options for centric relation records can include occlusal rims, existing denture impressions (reference dentures), Gothic arch tracing with functional final impressions, as well as a unique workflow, that includes two impressions and a centric tray which will be shown in greater detail in the article below 

Preliminary Records utilizing Accudent XD, UTS CAD Fixated to Centric Tray to determine Bi-Pupillary Line & Campers Plane 

The scanning of the Centric Tray with the 3shape Impression Fixture is shown in 

. Scanning of the Centric Tray and Maxillary and Mandibular Impressions are illustrated in 

. Maxillary and Mandibular impression scans are then aligned to the Centric Tray Scans 

Maxillary and Mandibular mounted casts with Centric Tray Registration and the UTS CAD in the 3Shape software 

Model Analysis, denture base outline, and Initial Proposal of Ivotion (Ivoclar Vivadent) follows, and the arch proposes based on the occlusal plane established by the UTS CAD. The Arches can be arranged with either a Soft or Bold Tooth Mould Utilizing the Phonares II Moulds B and S 70 Series from Ivoclar Vivadent. This mould features slightly abraded incisal edges and a reduced facial curvature but can be morphed and individualized to meet esthetic specifications 

The laboratory does an evaluation of the Ivotion Full arch arrangement proposal, an evaluation of Shell Geometry and final Gingiva proposal 

 shows the milling of the Try-in Pro Art CAD Try-in. The intraoral assessment of the Pro Art CAD Try-in 

Note that the polymerization process occurs while the material is still in its “wet swelling state creating a true monolithic disc due to the unique polymerization process” 

The Ivotion Disc demonstrates one monolithic Disc, while the CAM V.4.1 illustrates seamless integration of the CAM5 Ivotion file into the CAM software. This nests the Ivotion Denture directly into the Ivotion disc aligned with the Shell Geometry.

The PrograMill PM7 performs the first milling steps of milling pink and white with 5 mm flattening tool (

 demonstrates the monolithic disc being milled where the tooth arch begins to be defined, leading to the final results directly after milling (

Ivotion Digital Denture Innovation helps you produce optimal results. The finalization steps include separation, individualization vertical and horizontal surface textures 

Next, polish surface texture and interproximals with Universal polishing base. Polish the denture base with Resilience Pumice and 3 brushes for optimal smooth and polished surfaces, and finalize with Universal Polishing Paste leading to the desired appealing esthetics, individual and functional dentures and high-quality optimal results for the patient 

With Ivotion, customized monolithic complete dentures are fabricated in a seamless workflow with fewer manual working steps. The workflow makes it easy for clinicians to implement and to get great results.

Regardless of your clinical record process, the Ivotion Digital Denture Process is designed to provide you with exceptional quality, and a clean esthetic result that can be digitally preserved indefinitely (

Ivoclar Vivadent’s Ivotion Digital Denture Innovation works with 3Shape to allow patient-specific customization and great results. 

How to perfect a complete digital manufacturing process to create top-quality removable dentures

Dental Lab Products New Products - August 2020

A look at some of the recently announced products for dental laboratories.

 laboratory steps in the fabrication of removable prosthetics is the transference of clinical information to the laboratory so they can provide an accurate, translatable form to an articulator for setting clinically prescribed tooth positions. As we know, this information is supplied with an occlusal rim.

A clinical checklist taught in dental and technical schools consists of basic information which enables the laboratory to accurately articulate and set the teeth based on specified markings and trimmed dimensions of the rim. This article will address how my laboratory uses and maintains an easy, tractable, guided way to stay within the parameters of the trimmed rim during set-up and how I illustrate to my clinical partners the importance of taking time to rim trim.

In order to maintain and translate the rim dimensions to a repeatable position, this author has relied heavily on fixed occlusal platforms 

 in conjunction with several articulator systems. These articulators offer the fixed platform as a purchasable feature. Over the years I have realized this feature allows me to: 1) use a rim tracing to keep tooth positions within the horizontal width boundaries, 2) maintain a parallel plane anteriorly and posteriorly established by clinical rim trim to the Campers line as a baseline for tooth arranging 

, and 3) A documentation tool to communicate prescription fulfillment.

Because many clients rely on laboratories to use non-adjustable articulators which don’t have the platform feature or can be expensive, I had to establish a way to accessorize my non-adjustable articulators with an interchangeable fixed platform feature which I will illustrate 

Step by step

Consistent with either manufacturer supplied or handmade platform is the need to center, mount, and rim trace the maxillary arch. I cover the platform with painters’ tape for easy tracing and removal at case conclusion. I have recently found the yellow version works even better 

. I also use landmark extension lines to allow for centering on platform.

Once the maxillary arch is mounted the mandibular arch is affixed and mounted, you have a photo documentable depiction of the rim mounted on the platform and an outline of the rim that guides the set up. Because the platform is fixed, a baseline to begin a Curve of Spee or lengthen anterior teeth, you never lose angle orientation of the plane 

 Take a polystyrene sheet, trace a mounting platform shape of your choice, and cut out using a Komet H219 cutter. Finish edges with preferred smooth cut carbide 

 Select the mounting plate for the articulator system you prefer. Box the base with painters’ tape to contain plaster within the plate boundary. Fill base to a level that coincides nearly with the vertical sweet spot on the articulator 

 While it’s setting up, place an interlocking construction toy piece modified with a ball of pattern resin on top along with a small bubble level to establish a plane parallel to the floor during the setting of plaster. It helps to use a stiff mix of plaster to avoid pieces from sinking 

 Once set, interlock a secondary piece and apply hot glue on top. Immediately center and place occlusal plate along with small bubble level on top of cooling glue. Use the level to adjust plate with a centered bubble. Glue is pliable while cooling so move quickly. Once cool remove plate and inspect 

 You now have a removable plate with a base that has been constructed for that particular articulator. You can work on several cases on the same articulator if desired by making several plates as described using the same base 

Again, when it comes to the fabrication of removable prosthetics, it’s very important for the laboratory to take the necessary steps in the transference of clinical information to the laboratory so they can provide an accurate, translatable form to an articulator for setting clinically prescribed tooth positions.

Here, the author addresses how his laboratory uses and maintains an easy, tractable, guided way to stay within the parameters of the trimmed rim during set-up, as well as how he illustrates to clinical partners the importance of taking time to rim trim. 

How one laboratory technician uses consistent communication steps to equate to consistent results in the fabrication of removable prosthetics.

How to perfect the plane truth process 

There seems to be something special about those who get really excited about producing great dentures. Not everyone can deliver truly great dentures and not everyone seems to even have the desire to do so.

But for those who really do want the best and have the passion, the end results can be outstanding, both in terms of esthetics as well as function.

Jeremiah Naas from Inverness Dental Arts in Maine runs a high end removable laboratory with his wife, and he is one of those who just so happens to want the dentures he produces to be the very best. Naas has been in the dental laboratory business for over 20 years, but moved from Florida to Waterville, Maine last year to become a denturist.

“If you have passion for esthetics, it’s exciting times [to work with dentures],” he says. “I feel that a lot of other people just find it to be frustrating, but it’s not really if you really stick to your protocols and you do some education.”

With this in mind, Inverness Dental Arts has been exclusively using the REF-LINE denture teeth from Primotec. These teeth are made from a new composite acrylic material that is composed of pre-cross-linked polymer and the matrix is reinforced by inorganic nano- and micro-fillers.

According to Primotec, when compared to conventional acrylic, the REF-LINE material offers improved resistance to the mechanical wear, good resistance to plaque adhesion, color stability, higher hardness, excellent polishing properties, and good adhesion to denture base materials.

Having worked with his father’s high-production laboratory before starting his own business, Naas has seen and worked with many denture teeth lines. But the more cases he worked on, the more passion he had for making great dentures, not just good ones.

“I started to really scrutinize my denture teeth to the point where I would hold them up to the light and really try to see into the tooth,” he says. “I found by doing that, by really paying attention, that some companies would have manufacturing errors in their teeth.

“A lot of people don’t recognize it, take the time to see it, or they simply accept it being there. But I was always one of those people that just never was willing to accept that.”

Then a friend and respected lab technician, Arian Deutsch, CDT, told Naas about the great esthetics he was getting from REF-LINE.

“That’s how I first got introduced to the teeth, through photos and talking about cases with Arian, and I tried them out,” he says. “I quickly just fell in love with them. They’re very strong teeth, and they have a unique, very natural look to them.”

Naas has continued using the REF-LINE moulds simply because he likes what he sees in his patients’ mouths.

“Because my patients and prosthodontists are very heavily sharing photos, we get to see it even on a laboratory side, and we get to see our end result quite often,” he says. “I have yet to find any complaints from people at all.”

He loves to hear doctors tell him how happy they are with the end result and wonder how long it took his lab to create and deliver such great dentures.

“I’ve actually had a couple doctors tell me, ‘Wow you did it. You did an amazing job with this and you must have been working on it forever’,” says Naas, who adds that using REF-LINE is helping set his laboratory apart from others.

REF-LINE is designed to provide great anatomy for restorations, and both patients and dentists have noticed. The teeth are well-suited for both implant cases and traditional dentures and are said to deliver esthetics similar to porcelain crowns.

“They’re definitely not the only high-quality line of teeth out there so I don’t want to make that claim,” Naas says.“But I do find that, as a laboratory that is trying to set themselves apart from other labs, that these teeth were not as commonly used. And when clients start seeing these teeth…there’s something different about them. It’s been a great thing just to have a little bit more of a unique tooth to use.”

Naas also likes the way the mould guide has been set up by Primotec, making it easy to use and understand.

“It’s the little details at the end of the day,” he says. “There are so many small things that are above and beyond.”

One dental laboratory has stopped looking for denture teeth options after going with Primotec’s REF-LINE.

Dental Lab Products August 2020