Suitable for friction bars and removable partial dentures.

Made from a high-performance polymer, Dentivera milling discs are said to be a clinically proven product and specifically designed to meet the critical performance requirements for removable partial denture frames. The discs are biocompatible and bond well with polymethyl methacrylate. Frames made from the Dentivera milling disc are digitally designed and milled to result in a superior fit.

Dentivera is reportedly the only milling disc made from Ultaire® AKP, an aryl ketone polymer engineered to provide a biocompatible, lightweight, and nonirritating alternative to metal. The disc is formulated to be rigid and supportive, yet has enough flexibility to protect the abutment teeth and preserve gum tissue. Ultaire AKP frames are digitally designed for an accurate fit and hold their shape, so they require fewer adjustments, saving dentists and patients time and money.

Articles

These milling discs are manufactured with a high-performance polymer that is a biocompatible alternative to metal.

5Ws* Dentivera Milling Discs

The successful prosthetic tooth performs a delicate act of balancing bond strength, wear resistance, esthetics, and occlusion with natural teeth. Dental laboratories seek highly wear-resistant, highly esthetic teeth for implant and premium cases. Historically, this wasn’t always the case, as material options were severely limited.

The first denture teeth can be traced to 700 BC when the Etruscans fabricated the first false teeth from animal teeth.1 This standard did not change much until the 18th century, when hippopotamus, walrus, and elephant ivory became common.

In the 1770s, French dentists turned to porcelain, which was handpainted to give the appearance of natural teeth.1 Unfortunately, these dentures lacked esthetics and were too brittle.

While porcelain denture teeth aimed to offer a more durable material, human teeth were still widely used during this period. So-called Waterloo teeth were dentures fabricated from the teeth of dead soldiers left on the battlefield.

 This was common in the early 19th century but was still practiced through the 1860s, during the Civil War.

Dental laboratory technicians today have a variety of teeth sizes, shapes, and shades to choose from. Here, we present 15 of the industry’s denture teeth offerings.

Elsenpeter R. The fascinating history of dentures. 

®. October 16, 2018. Accessed May 25, 2021. https://www.dentalproductsreport.com/view/fascinating-history-dentures

Waterloo teeth. The British Dental Association. Accessed May 25, 2021. https://bda.org/museum/collections/teeth-and-dentures/waterloo-teeth

DLP June 2021 Roundup

Lifelike in Form and Function

A look at some of the recently announced products from the dental laboratory industry.

DLP June 2021 New Products

Dental labs and the technicians working there must become experts with the materials they use. A technician needs to understand the specific nuances of a material relative to the techniques for shaping and processing the material as well as the techniques for finishing the restoration. An understanding of a material’s physical properties is key because restorations must be engineered to meet functional demands as exacting as the esthetic expectations of patients and clinicians. With this in mind, we asked what materials technicians are most likely to recommend for different restoration types, as well as what factors are most important when selecting a new material to use.

When it comes to choosing materials to recommend for different clinical situations, it should be no surprise that the response depends on the type and location of the restoration. While zirconia is proving to be the Swiss Army knife of indirect materials and was the most popular choice for use in the posterior, glass ceramics and layered ceramics were other popular options for single anterior units. When it comes to the posterior for crowns or bridges, porcelain-fused-to-metal (PFM) or porcelain-fused-to-zirconia (PFZ) options remain common recommendations. The opinions were most divided on the best option for anterior bridges, where zirconia, PFM, and layered ceramic restorations were all popular choices.

When it comes to removable partials, the recommendations are all across the board. Cobalt-chrome (CoCr) frames were the most popular choice, but titanium alloys were close behind, and newer polymer options received strong support from the lab providing removable partial services. From this variety of recommendations, it’s clear there are many workable options for designing removable partial frameworks.

It’s likely no surprise that the factors rated most important when considering a new material are enhanced durability followed closely by enhanced esthetics. Those factors were rated as “very important” by more than half of the survey respondents, and when the “important” votes are added to that total, both factors were cited by more than 9 in 10 survey respondents. Every factor in the survey was rated as “very important” or “important” by more than half the respondents, so it’s clear that lab technicians are evaluating every aspect of a new material before bringing it into a lab.

The Dental Lab Products® 2021 Materials Survey provides a look at what materials are most often recommended in various clinical situations, as well as the most important properties for a dental material.

The 2021 DLP Materials Survey: An Open Approach to Find the Best Materials

The evidence of humans replacing damaged and missing teeth goes back centuries. Based on the archeological and anthropological records, it appears these restorations were undertaken for both functional and esthetic reasons. Although dentistry was likely quite painful for patients back then, especially in the earliest days before the dawn of the concept of anesthesia, some of these ancient techniques and the materials used can be easily connected to modern dental restorations. Gold, for example, is among the earliest materials used to fix and replace damaged teeth.

Although the use of gold is less common than it was in the mid-20th century, gold is still a part of the dental industry today. However, other materials have been left to the pages of history books, and this was a smart move, as some of these indirect dental restoration choices sound far less than optimal. Here’s a look at a quintet of abandoned restorative materials from throughout history.

Animals come in a variety of shapes and sizes, and so do their teeth. Animal teeth were used in many ways for dental restorations. Some evidence shows that animal teeth were used as direct replacements for missing teeth in humans. More commonly, the large teeth of animals, such as the hippopotamus, were carved to create sets of dentures that were likely not very comfortable but durable enough for long-term use.


Wood is plentiful. It’s durable, and it’s fairly easy to shape. For this reason, it shouldn’t be too surprising that wood, specifically bamboo, has been used for dental purposes dating as far back as 4000 years ago. Human remains were found with carved bamboo pegs pounded into the jaw, creating an effective but likely extremely painful replacement for a missing tooth.

Used both for decorative and potentially functional purposes, stones as dental restorations date back more than a millennium, with evidence that the Mayan civilization would drill holes in teeth and fill them with precious stones. But stones have also been used to replace missing teeth, with some archeological evidence showing that rocks had been specifically carved to fit in place of a missing dentition.

Although the esthetics and functionality of seashells as dental restorations remain something of a mystery, the archeological record does demonstrate this material might have been one of the more successful attempts at replacing a missing tooth. Once again, the Mayans are behind this dental innovation. In 1931, investigators discovered remains dating back to the seventh century, when seashells had replaced several missing teeth. Most significantly, evidence of bone growth around the shells indicates these restorations were placed while the patient was alive. This is ome of the earliest known evidence of osseointegration.

Much like with animal teeth, this option seems pretty straightforward. Someone is missing a tooth, and the dead person isn’t using it anymore. However, implanting a cadaver tooth in place of a missing tooth can lead to infection, rejection, and a range of other complications, and this doesn’t even account for the fact that many of the teeth sold to dentists were sourced from unwitting donors by grave robbers. As gruesome as the practice of using cadaver teeth must have been, it still doesn’t compare with the brutal practice of slave owners replacing their teeth with dentition taken from living slaves.

A look at some materials used to replace missing teeth from the times before organized dentistry.

5 Historical Indirect Restorative Materials Unlikely to Be Used Again

Any dental lab with a 3D scanner or the ability to accept digital impression scans from practices.

Whenever a case comes into the lab, because DentalCAD 3.0 Galway features powerful tools for designing fixed and removable restorations.

This single software platform is designed to make restoration design simple and features enhancements, including instant anatomic morphing where proposed tooth anatomy automatically adjusts when the crown proposal is moved on screen. A new interface makes the software easier to use and more intuitive and tool updates make it easier to plan restoration insertion angles and bridge connectors. Updates to the implant module allow easier implant connection switches as well as easier implant positioning adjustments.

 Automation allowing this software platform to accomplish more in less time is a focus of the enhancements in this latest version of DentalCAD. Beyond the automated anatomical morphing, the latest update also adds artificial intelligence–driven smile design that can aid in both treatment planning and patient communication. The model creator module is designed for efficiency and can be used with any 3D printer. For removables, the software includes preset tooth setups and the ability to save custom setups from completed cases.

With more than 90 new features and an updated user interface, this impressive CAD application is even more powerful than previous generations of exocad’s flagship software.

5Ws* DentalCAD 3.0 Galway

Implant cases with screw retained restorations where either or both esthetics and access are priorities.

During case design and at delivery of the case so the implant screw channel can be hidden or positioned for easier access during placement of the abutment and final restoration.

The SMARTbase abutments are designed to improve both esthetics and accessibility with a screw access channel that can be redirected from 0º to 25º, allowing for easier hiding of the screw channel in anterior restorations and easier access to the screw channel in posterior restorations. The abutments are designed with dual hue anodization to seamlessly blend with surrounding dentition to provide a natural look. The versatile abutment solution is compatible with both screw-retained and cement restorations. With a variety of cuff heights and widths available, the abutments can be used with a range of situations.

 The off-axis screw channel allows cases to be designed with lingual screw access as well as other configurations for enhanced access. Specialized off-axis implant drivers are used to attach the screw, and the abutments are designed with grooves that are said to enhance cement retention when the abutments are used with cement-retained restorations. The dual-hued abutments feature gold color at the top to naturally blend with the restoration, and a pink hue in the lower section to better match the gingival tissue. Additionally, the abutments are designed with a concave profile that is said to enable subcrestal placement without the need for major tissue manipulation.

With its angulated screw access channel, this implant abutment system from Implant Direct aims to make implant cases simpler and more esthetic.

5Ws* SMARTbase from Implant Direct

Dentures are a big part of his practice, so Miles Cone, DMD, CDT, FACP, has spent countless hours working on denture relines and doing his best to remove the excess reline material as efficiently as possible.

Dr Cone also admittedly hoards instruments he has used over the years and has a drawer full of worn-out burs that could handle only so many tough cases. So when he first got his hands on a line of ceramic cutters from Komet USA, he expected them to be solid because of his experience working with many Komet products, but he also expected them to have limitations in terms of their cutting ability on tough materials and in terms of lasting long.

Much to his surprise—and happiness—these instruments have withstood everything he has thrown at them. They not only speed up his workflow, but seem as if they may last forever. “Maine has one of the oldest demographics in the country, which means we do a ton of dentures,” explains Dr Cone, a prosthodontist in Portland, Maine.

Although he loves the reline materials he works with—namely, a “tenacious material from GC America”—it can be difficult and time-consuming when it comes to removing them.

“I struggled for years, and I’ve tried every bur that’s out there from every company,” he says. “I’m a hoarder and keep things around, so I’ve got a drawer full of burned-out burs and carbides and sandpaper.”

When Komet first sent him a kit of ceramic cutters, he wasn’t sure what to expect. “I was thinking, ‘This thing’s going to break. It’s going to chip,’ ” says Dr Cone. “But what is awesome about these burs is [that] they don’t generate heat the same way that carbides do. It’s an absolute lifesaver when slogging away at the bench with tough denture material.”

He learned that the ceramic cutters dissipate the heat well and don’t clog and get gummed up as is typical with carbide burs. He now confidently reaches for a number of instruments in his Komet denture repair kit, with some specifically designed as part of a flexible partial contouring system.

“These cutters are so good at hogging out just globs of denture reline material, and they get it out quickly and efficiently,” he says. “Normally, by the end of this, you’d be sore and feel like you have carpal tunnel syndrome. But that is no longer the case.”

Komet offers a variety of instruments that can help laboratories, specialists, and general practitioners alike.

“These burs are not just for high-end laboratories,” he says. “[For] every lab doing dentures, and for the doctors who have bulk patients, [such as] the community dental center—these [will] make your life so much easier.

“Imagine using a carbide on days where I’ll have 2 or 3 denture patients,” he adds. “I couldn’t possibly do it. My hands and joints wouldn’t be able to tolerate it.”

Dr Cone loves the different coarses and shapes in the denture repair kit.

“These ceramic burs have been an absolute game changer just for what I do day-to-day in the trenches,” says Dr Cone, whose office consists of himself, his wife as office manager, and an assistant. “I like having beautiful things in my hands, and these instruments are kind of like having a MacBook Air or an iPhone. There’s a certain level of cool factor for my lab bench and they work so well.”

Another benefit of these instruments, according to Dr Cone, is that dentures and denture reline work are not going away anytime soon, even as many labs shift from analog to more modern, automated methods of work. “I tell people all the time that where we currently stand right now, doing denture relines is going to be a thing for a long time. You can make a digital denture, but when that patient has a sore spot or their tissue starts to break down, you still need to have those [reline] skills,” he says. “As long as we’re doing relines, people are going to need to remove those.”

That is why he suggests colleagues give Komet ceramic cutters a try: “I think this is something that the denture technicians and the clinicians that are doing the same procedures that I’m doing really need to invest in. You’ll want anything to make your life easier.”

The Komet kits also assist in the finishing and polishing of flexible partials despite the difficulty of dealing with some resins when using some carbide burs. “These ceramic cutters go through and leave such a clean finish to it. They have multiple applications. They’re not just for dentures,” he adds.

For this CDT/prosthodontist, Komet USA’s durable instruments make benchwork and denture relines much easier.

Workhorse Burs Improve Denture Case Efficiency

When Benny and Gail Johnson of Perfect Impressions dental laboratory in Carrollton, Texas, were looking for a way to reward their regular doctors for using their services and increase payment efficiency, they found tfg Loyalty, a program offered through tfg Payment Solutions.

Relationships with practices and doctors are important to the Johnsons.

“Before Gail goes in and takes on an account, we will visit the doctor, visit the practice, get to meet everyone, and make sure that we understand what the doctor’s expectations are and what their preferences are. So we go in and build that relationship from the beginning,” Benny Johnson says. “We don’t take on just any practice—we want to make sure that it’s the right practice for us and that we’re the right lab for them. That’s all about communication.”

As a part of that key communication, the Johnsons use the tfg Loyalty program to promote retention and reward practices for their business.

“With that, we also decided that we wanted to provide a program that would say, ‘Your business means a lot to us. We appreciate your loyalty and this is our way of saying thanks,’” Benny Johnson says. “Most of our doctors have been with us for 5, 6 years, so our retention is pretty good. It’s all based on communication and how Gail and the team work with the practice.”

Practices in the loyalty program are rewarded for consistent payment with merchandise, gifts, travel, and more. The program also can be used by practitioners to treat their employees, assistants, and technicians with things such as lunches and gift cards.

The payment process works through a payment card industry (PCI)-compliant, secure, online platform. Practices can schedule payments with a credit card, check, or Automated Clearing House (ACH) electronic payment.

“It allows us, as the lab, to get paid sooner because if they pay us by the 15th of every month, whether it be a credit card or a check or an ACH, they get points and dollars toward the rewards. It really helps both parties,” Benny Johnson says.

The platform allows clinicians and practices to keep track of payments, pay faster and more efficiently, and track rewards they may have accrued from on-time payments.

“A lot of them like that. They will take that and they’ll go out and maybe get a Starbucks card or they’ll treat the team to a lunch one day,” Benny Johnson says. “It’s just a way for them to also give back to their employees or assistants and technicians.”

The company is also working on QuickBooks integration, which will boost efficiency by incorporating and sharing important information from software to software.

“That’s going to be a huge, huge help for me as far as a timesaver. With the integration and how it’s all coming together, it’s going to allow me to do it in a period of 30 minutes, versus an hour and a half, which it’s taking me to do it today,” he says. “So, they’re doing the right things by integrating the software. As a matter of fact, the next step is to link to my lab production software to transfer invoices saving even more time. After all, time is money.”

Since the Johnsons started using tfg’s Loyalty program in January 2021, about 10 doctors have set up their accounts in the loyalty and payment portals. It allows doctors who may otherwise find it difficult to remember to set payments up automatically.

“We give them opportunity to...go on a secure portal and make a payment without having to call me and give me a credit card or having to write a check and put it in the mail,” Benny Johnson says. “That’s just going to save them time, too.”

Laboratories save time and money while rewarding practices and doctors. 

Loyalty Program, Payment Portal Boost Relationships Between Practices and Lab

When Anthony K. Senegal Sr, cofounder, president, and operations director of Partners Elite Dental Laboratory Services (PEDLS), decided he needed to streamline his lab’s workflow for monolithic removable dentures, he wasn’t sure where to turn. He wanted a system that simplified design while reliably producing quality dentures with little need for extra manual work. After searching, he found his solution through Ivoclar Vivadent.

The Ivotion Denture System offers a complete digital manufacturing process for the fabrication of removable monolithic dentures. The digital system comprises an integrated workflow of digital laboratory fabrication methods, simplifying the creation of dentures and reducing opportunities for human mistakes.

“It’s an extreme benefit when you are talking about reducing mistakes,” Senegal says. “There’s less human error that can take place when you’re dealing with the milling of Ivotion.”

The Ivotion Denture System workflow uses materials from Ivoclar, software and scanning technologies from 3Shape, and milling machines and manufacturing strategies from PrograMill. These combine into a seamless workflow. Senegal integrated Ivotion into his workflow at PEDLS in November 2020 and was impressed with the accuracy and quality of the system. He has found that the fast manufacturing time, quality materials, and predictable results have been a great benefit to his lab.

“If you ever want to make a technician go from a smile to a frown, just say the word 

,” Senegal says, laughing. “That’ll make them frown really quickly. But we haven’t had a single remake since we started using Ivotion. You’re guaranteed you’ll get a quality denture, with few to no mistakes.”

With the slogan “1 disc, 1 milling process, 1 denture,” Ivotion has an uninterrupted milling process that machines monolithic complete or individual complete dentures, immediate complete dentures, and overdentures on 2 attachments from 1 disc, reducing the need for manual work. Although he has had a few patients with larger arches who required the 2-step method, for most patients, 1 puck fits the bill.

He has found that Ivotion’s Shell Geometry technology has been beneficial for design quality and esthetics, streamlining the process more. Located within the Ivotion disc, the Shell Geometry is a 3D tooth and dental-arch structure designed for the fabrication of mandibular and maxillary dentures and allows technicians to mill accurate complete dentures—which rarely require more than polishing after production—in 1 operation.

“You design it, then you send it to manufacturing, and the machine does the work for you,” Senegal says. “So you’re guaranteed to get a quality denture with no mistakes. And that’s a huge benefit, to the lab, the clinician, and patient satisfaction.”

Although Senegal says the initial investment in Ivotion can be high, he has found his investment has paid off. Between the high-quality polymethyl methacrylate tooth and denture base materials and reduced manual steps due to milling accuracy, he has cut down on case time and been able to increase his case load.

“If you get the fit right, there are fewer patient visits after you deliver that denture,” Senegal says. “The likelihood of a patient coming back is minimal. That’s huge when you think about the time you spend on a particular case, when you could be focused on another one. You can save time to do other things and work on other accounts—and still be able to deliver a quality denture.”

Senegal has deemed the investment so worthwhile that he and his business partner, Richard “Al” Wilson, DDS, cofounder and chief clinical consultant and director at PEDLS, are in construction to build a full-service digital commercial lab and are planning to add 3 more PrograMill units, or, as they call them, Ivotion machines.

“When we first looked into this milling system, I quickly said, ‘That’s it, we’re all in, we need to offer this accuracy of milling to our patients,’” Senegal says. “That’s how much we believe in this system and how much benefit we feel that we can get.”

This system offers a total digital manufacturing process to simplify the creation of dentures.

Ivotion Denture System Streamlines Workflow

Stratasys J5 DentaJet™ , the only multimaterial 3D dental printer

Suitable for any dental lab that wants to reduce costs, maximize efficiency, and create more dental parts with less handling.

The J5 DentaJet enables technicians to load mixed trays of dental parts and can produce at least 5 times more dental parts on a single mixed tray than competitive 3D printers, giving dental labs 3D printing efficiency paired with realism and precision.

Typically when dental implant cases require multiple materials, separate 3D printers are needed for each individual material. The J5 DentaJet can handle up to 5 different materials, including support materials, by utilizing mixed trays of dental parts. The single mixed tray can hold a full array of opaque, clear, flexible, and color resins, creating dental implant cases and denture applications faster and more accurately.

This new system scales 3D model printing efficiency for dental labs. 

5Ws* Stratasys J5 DentaJet

A million and a half years ago, Grog the Caveman watched with envy as his neighbor, Atouk, learned how to harness fire. Of course, fire stopped being a novelty long ago and became a necessity.In 1886, Carl Benz patented the first automobile.

 Like Atouk’s fire, no one at the time needed one. Now, it’s hard to imagine life without it. And, 29 years ago, the smartphone started with little fanfare, but now most of us do, indeed, need one.

Any technological advance seems to start as a novelty, something that people simply want. But, over time, that piece of technology can become a need. Dental lab advances are no different. Some labs rely on CAD/CAM. A popular technology augmenting those workflows is 3D printing. But, it begs the question, does every lab need a 3D printer?


The answer to that question, is that it depends on who you ask.

Jesse Flor, CDT, owner of Great Smiles Dental Services, Inc., is no stranger to 3D printing, and he’s still not ready to make the blanket statement that everyone needs a printer.

“Honestly, no,” Flor says. “And I say this having had at least 10 to 15 printers in the 10 years that I’ve been doing digital dentistry.”

Tom Zaleske, owner of Matrix Dental Laboratory and Consulting, has made custom removable prosthetics for more than 35 years. He stands by the quality he achieves in the analog workflow.

“There are a ton of things that a 3D printer can do, but you can still do in your laboratory without a 3D printer,” Zaleske says. “It really boils down to labor—how trained the technicians are in the laboratory; how entrenched the clinical side, your customers, are with the technology. It really comes down to, they say, ‘Well, we can duplicate such and such a thing with a printer.’ I can duplicate things using products here, and I can do them rather quickly, and I can do them very accurately.”

Andrew Kissin, Director of Marketing, Zahn Dental, observes that such choice depends on the lab’s business position.

“I think that’s a decision each lab needs to make on their own based on their business goals and plans,” he says. “Of course, in my opinion digital dentistry is right for every lab and is a tool to assist in optimizing a lab’s workflow. First things first though, start with a scanner and see where your digital journey goes from there. Do you have the right technicians on site to use a 3D printer, what applications would you print today and what might you print tomorrow? All good considerations.”

Jamie Stover, CDT, Senior Manager of Dental Lab Applications at Carbon, Inc., says that the times are changing and 3D printing is becoming more of a necessity.

“If you would’ve asked me this question a few years ago, I would’ve most likely said, ‘No’,” he observes. “Because, in those days, the applications available for labs to print were really limited and 3D-printing models in-house for cases received from intraoral scanners was how the majority of labs substantiated the investment in a 3D printer. But, since then, the global additive manufacturing landscape has dramatically changed and we have seen many industries making the shift to additive manufacturing. Material development has rapidly expanded the number of applications that can be fabricated with the 3D printers in the dental industry, and increased the number of labs for which a 3D printer now makes sense.”

Deciding whether or not a lab needs a printer is going to depend on a number of variables, including how entrenched they are in the digital workflow.

“Labs are about to have a very heavy digital presence,” Flor says. “Because, if you look at it, the numbers may be only 15 to 20 percent of the dental workforce has visual imagers. Those labs definitely have to have an investment. Almost 90 percent of my work is all-digital. No stone models, really, come in, and even if any do, we digitize those as quickly as possible. Where 3D printing comes in is I can present a 3D-printed denture. I can do a partial. I can do teeth.”

“It’s not an intuitive answer,” Stover adds. “You would think that the answer, right off the bat, would be, ‘Yes, in order to be successful with a 3D printer, a lab needs to have CAD/CAM workflows firmly established and have very experienced digital technicians.’ But, honestly, the answer to that question really depends on how we’re measuring success. In other words, if we’re measuring success by the speed at which a lab gets up and running with the 3D printed workflow, or how efficiently they transition their technicians from the bench to the printed production? Or, perhaps it is measured on how well they market and educate their clients on the printed products to drive prescriptions. The reality is when you’re moving these products and fabrication from an analog process to a printer, there is education and communication with your dental clients required for them to understand the benefits for their workflow and the benefits for the patient so they are incentivized and motivated to prescribe them.

“In my experience, a lab needs to do all three of these things very effectively to be successful with the 3D printer,” he continues. “And I measure 3D printing success by how much profitability a printer yields, both from reducing the amount of hands-on labor required to fabricate the restorations and how much a lab can grow their business by increasing the number of restorations they fabricate, as well as the efficiency it provides our dental clients and the benefits of the printed restorations for patients. Every lab has to start somewhere with a transition into the digital workflow, and years ago milling was where they had to start. Today, because of the number of available 3D printed applications on the market even smaller labs without years of digital experience can incorporate printing right out of the gate and experience success.”

Another consideration is whether or not their client doctors are willing to be part of that workflow.

“I see big contenders, like Asiga, the little cheap ANYCUBIC Photons,” Flor says. “I see a lot of doctors buying those for their own offices, just because it’s affordable and also allows them to work through the challenges of dialing in the settings. But once they do, they have a 3D printer in their office that doesn’t break the bank. And then I see big, huge corporations, or even bigger labs, they’re getting like Carbon. So, I think in mass-produced dentures, it’s almost like niche operations going with 3D printers. It’s a neat tool to use, and you see big corporations going for the full-scale product for the ability and volume production models. But, in other ways, not everyone is in that mentality.”

One of the knocks against digital dentistry is that while 3D lab output is faster, more reliable, and more reproducible, an element of personalization is lost. 3D printing doesn’t really do anything to change that.

“This isn’t a widget – it’s not like a coat hanger where everything’s the same,” Zaleske observes. “Every patient has their own nuances and challenges. And that’s what makes it such a great profession, because we’re doing one-off dentistry. If you don’t understand dentistry, if you don’t understand how anatomy, function, phonetics all coordinate toward a successful conclusion, then there is a whole lot to not get right.”

It’s not just technicians, he observes, that have less knowledge about how to achieve successful removable treatment, but is a sign of the times.

“You’ve got dentists coming out of school with less removable technical education, less emphasis on hand skills like impressions and bite registrations,” Zaleske says. “Then, the battle cry that I always hear out there is, ‘Well, that’s what the patient wanted.’ You know, that’s kind of like an excuse now.”

Even though he hasn’t, personally, seen much demand for digital dentistry, Zaleske

anticipates that to change—both because of trends in labs and clinics.

“Unless there’s a huge surge in formally trained dental technicians and better trained dentists, I don’t see that train stopping,” Zaleske says. “I really don’t. I just see more and more people adopting it, only because—and remember this is not a slam to dental technology—but by-and-large, dental technicians are reactive, not proactive. So, if a doctor asks for something, they get it. Even if they do or do not agree with it, they get it because somebody is asking them to do it.”


Like any technological advancement, with 3D printers, the entry point tends to be initially very expensive. But, as time goes on, costs come down and become more accessible to the masses.

“If you look at it from a 1,000-foot view, you can see that, as with most technology in our lives, the cost is coming down,” Stover says. “We know that many years ago a Lava mill for Zirconia crowns cost around $300,000, and now, for around $20,000, you can purchase a mill that is far superior as a result of technology improving. Affordability and price are really a conversation about your ROI and about the perception of what ownership actually means. The majority of dental labs purchase more expensive hardware with capital equipment loans—they don’t pay cash, and that means that they are making monthly payments on this equipment for 3 to 5 years. Making payments on these machines is not ownership, the lender owns the machines until the loan is paid off. The reality is that the majority of this hardware is depreciating on day one and on a road to obsolescence in 2 to 3 years, either by the parts wearing out or it not being compatible with the new materials that are developed. By the time a lab pays off the loan, they need a new printer, and the cycle just continues. Also, labs need to factor in the amount of hidden costs associated with most 3D printers, such as the unplanned downtime when they break down and the disruption it causes in workflow, the technician time to calibrate, tinker and repair the printers when they go down, the annual service fees and often, high resin prices.”

Stover says that Carbon ameliorates this with its subscription model.

“Our subscription model replaces the monthly loan payments with a model of comprehensive support, including proactive monitoring of all the printer’s components to virtually eliminate unplanned downtime. Our printers are smart hardware, and the performance continuously improves over time with automatic software updates,” he says. “So, a Carbon printer installed today will actually perform better a year later. You eliminate that race to get your ROI before the printer’s performance depreciates and the technology becomes obsolete.”

Labs, and clinicians, can find even more affordable options to dip their toes into the 3D printing waters.

“It’s definitely going well,” Flor says. “My first Stratasys was $160,000. This year I bought a ANYCUBIC Photon for around $350. You can get a really good chairside printer, like a SprintRay. They’re a little finicky. They still need some dialing in, but they’re getting better, but that’s about $6,000. You could also send this on like a FormLabs 3B, which is specifically for dental. And those are maybe $3,500. Those things are reliable workhorses. They just really very rarely go down. So anyone can really use them. You see all these different price lines. It just depends on what you want. If you want speed, you’re definitely going to have to buy one of the more Lamborghini-type printers. If you just want reliability or versatility, you can go with these affordable, slower printers and it still works pretty good.”

“Today, labs can get into 3D printing for a few thousand dollars, assuming they already have a scanner,” Kissin adds. “Of course each lab should do their due diligence on the printer specs and ultimately what they are going to use it for. Just because you buy a 3D printer doesn’t mean you’re going to be able to churn out 50 models a print or you’re printing with the most accuracy. Every lab should look at what their main indications will be to start and select what’s right for their budget and workflow.”

But it isn’t just the cost of the printer that labs must consider. The printer needs other components or work.

“There’s a substantial investment,” Zaleske says. “They’ll say, ‘It’s not that much,’ but it is. You have a substantial investment in a printer, but you also have to have a scanner to go along with the printer. You can’t just buy a printer and say, ‘I’m printing’. There’s ancillary education that goes along with that. You have to learn how to use it. You have to be able to implement it. There are a lot of different things that go into that mix besides just buying the equipment. And then you have to look at your clientele base.”

He hasn’t seen a lot of demand from his client doctors, but it is out there.

“I had one person who asked to do that. It wasn’t a deal killer with my business,” Zaleske says. “They were more curious about it and wanted to get involved in it. It’s this funny thing. Before you pick up the shiny objects, you ought to investigate the ones with fingerprints over them. Everybody wants to jump forward with this stuff super quick, and it seems like an, ‘If you’ve got a hammer, everything looks like a nail,’ kind of thing. Well, if you got a printer, everything looks like it’s going to print. Everything looks like we should be doing it with that, and that’s not necessarily always true.”


In order for 3D printing to be a critical component in the dental lab, some prerequisites must first be met.

“A lab that already has adopted a scanner is obviously in the right place to add to their workflow,” Kissin says. “Over the past few years, we’ve seen major advancements in the software and technology so it isn’t just for crown and bridge labs anymore. We are seeing more and more removable labs start to add to their digital ecosystem as opportunities for both additive and subtractive workflows evolve they are able to replace very manual and labor-intensive processes with digital.”

The materials used for 3-D printing continue to evolve and are, somewhat, the technology’s Holy Grail. The field is improving, but not there, quite yet.

“On the materials side, we’ve come a long way very quickly,” Stover says. “When looking at the number of applications a lab can now produce on a printer, they have dramatically increased. Lucitone Digital Print dentures and KeySplint Soft Clear night guards are examples of game-changing products that have become available just in the last couple of years. There will, no doubt, be other really impactful applications that are going to become available to print as the focus on material development continues for the dental industry.”

Cost isn’t the only barrier to entry—3D printers must also be easy to use.

“Those cheap little printers are cheap, because it’s just the basic technology has been put in,” Flor says. “You have to really know how to dial it in and work in a collaborative group to get the settings right. The company doesn’t do that for you. Products like Asiga, they make it a big deal where they kind of validate workflows for you. If you print out dentures, they really kind of do the backing into it. And then they provide you with that information. It makes it easier to integrate. But honestly, the biggest limitation, is printed materials. BEGO has their resin print material that allows doctors to print out a supposedly permanent crown for about $2 in resin materials. But the problem is, we still don’t know long-term durability and versatility. Can it really handle the chewing cycles of what people put it through? What we’re all looking for with toughness and materials and resistance to impact that we use, which is like 90 percent of what we have to do in any type of dental products.”


3D-printing is an output device for a CAD/CAM solution, one currently widely filled by milling. But, is 3D-printing poised to replace milling, or is there a place for both?

“I think at some point yes, 3D printing will reign supreme,” Kissin says. “By default when you manufacture with additive technologies you aren’t wasting materials. While dental techs have already become masters at nesting entire discs, there is always some residue. With 3D printing this should eliminate any leftover. I believe there will be a place for both in most every dental lab, however. Ultimately it’s going to depend on what each business decides is right for their workflow and products they offer their accounts. Not to mention, I don’t think anyone is printing zirconia but I’m sure that’s on the horizon.”

“They still have their place, but yes, within 5 years there definitely will be a supplantation of printing,” Flor adds. “The problem is when we first started with zirconia crowns, they were not very esthetic. They were very ungainly to look at. It’s going to be the same type of induction curve that’s going to come in, and you’re going to have early adopters really testing it out, seeing if the proof’s in them and then providing that feedback. And then resins and materials would catch up in translucency, durability, and affordability, in terms of systems. And then more and more adoption will kind of speed that along. But there will always be cases, just like today. There are some cases you cannot do in pure zirconia—you might have to do a PFM base and layer porcelain, just because the patient can’t handle that setup.”

“I think in the future there will be a 3D printer in every lab,” Stover adds. “And, eventually, the possibility exists that 3D printing will replace milling, but I think, for quite a while, they’re going to coexist. Milling and 3D printing are both very viable production methods for labs, and it really comes down to the material development for printing and the applications they make available, because there really isn’t an argument about which production method is more or less efficient. When we’re talking about milling, it’s reductive technology and it’s inherently wasteful, because you’re starting with a large mass of material, cutting out just the pieces that you need, and the rest is thrown away or perhaps a portion of it recycled. This being said, milling is, currently, the most efficient production method for restorations such as zirconia crowns and bridges. It’s also a very efficient way to fabricate products from alloy, such as milled implant custom abutments, implant bars, and even full gold crowns and frameworks for PFM bridges. But, for other types of restorations, especially what we’re seeing with the digital evolution of the removable segment of the industry for dentures and night guards, it’s much more efficient to print than to mill them, or to fabricate them by hand at the bench with traditional methods. I believe that milling and 3D printing are going to continue to coexist in the labs for some time to come, with mills handling the majority of the fixed digital workflow and printers producing the digital removable prostheses. We don’t yet have a printable material for final restorations. When that day arrives I think printing will become the way the majority of restorations are fabricated. I say, ‘Hold on tight, the evolution of our industry is going to happen faster than it has up to this point!’”

If 3D printing does become a necessity for dental labs, it certainly won’t take another million and a half years, a century, or even 3 decades. 3D printing is accessible right now, and it’s not too hard—or expensive—to get started.

“The biggest thing for anyone is that it’s better to get in and at least get your feet wet,” Flor says. “And, thankfully, there are a lot more affordable options that can teach you what 3D printing can and can’t do for your process. And, honestly, it’s better to at least know what’s coming down the road than to try to ignore what doesn’t exist.”

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SimpleTexting;History and Evolution of Smartphones; 

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3D printing is playing a bigger and bigger role in digital dental workflows, and lower costs and higher capabilities mean the technology will only grow in popularity.

Dental Lab Products June 2021