The Importance of Effective Communication Between the Dentist and Dental Lab

“Communication is the key to success in cosmetic dentistry/laboratory relations”⁵. To accurately fabricate dental restorations, effective communication needs to exist between the dental lab and the dentist to ultimately provide dental patients with the best dental care. The communication methods used by the dental lab to collaborate with the dentist is also a major factor that determines the success or failure of dental lab products.

“Prosthodontics is a discipline that requires a synergy between the dentist and dental technician in order to fabricate intraoral prostheses with acceptable fit, function and aesthetics,” reported by Berry et al.. Although restorative dentistry is first about restoring the patient’s oral health, and next the esthetic appearance; the patient’s growing demand for realistic esthetics and long-lasting restorations is challenging the industry to properly manufacture dental lab products that exhibit both attributes. Recreating esthetic details that mimic the patient’s natural teeth is crucial when “subtle details in texture, anatomy, and contours keep the ceramic restoration from looking contrived and can provide the element of ‘prefect imperfection’ that natural teeth exhibit”³. Precise design parameters, shade matching, and available tooth structures should all be effectively communicated by the clinician to the dental lab to achieve a highly esthetic restoration that will match the patient’s natural tooth contours and shades³.

The lab technician’s ability to match the exact shade to the patient’s teeth is a challenging aspect of communication; especially, when an increasing number of patients are demanding esthetically brilliant prostheses. Determining a precise shade (e.g., color, surface texture, shade characteristics) is first dependent on the clinician and must be effectively communicated to the lab technician. Exact shade communication is important because dental technicians are remotely located and usually never see the patient¹. In consonances with a study on color matching, Seal et al. reported “precise color communication is integral to the development of esthetic harmony and overall restorative success.” 

The communication methods used by the dental lab are major factors that influence the accuracy of dental lab products. With the development of software programs and web applications, dental labs can now use web content management systems (WCMS) to communicate to dental offices and manage laboratory cases at a faster and more accurate rate. As stated by Alshiddi, “Laboratory case management is a teamwork that should involve good communications between not only the dentist and the dental technician, but also other staff in the dental office (e.g., dental assistant and receptionist) and dental laboratory (e.g., laboratory owner, receptionist and delivery person)”⁵. When managing a high volume of dental lab cases, the lab must implement an effective content management system that will manage all of the dental cases coming from multiple forms of communication methods (e.g., hand-written lab authorization forms, telephone, email, electronic STL files, etc.). Equally important is the lab’s understanding of individual software requirements and design of the software that will essentially, if implicated correctly, improve communication and will ensure long term relationships between the dental office and dental laboratory⁵.

The dental laboratory must provide great customer service for dentists and their dental office personnel so all parties can work proficiently together. Providing excellent dental lab services will lead to satisfied clinicians and comfortable professional relationships between the clinician and dental technician/laboratory⁵. Collaborative technical advice on routine and complex dental cases is a very important service that dental laboratories should exceed at every time. The dental lab must have an effective logistic team to make sure dental cases are fabricated in time for the patient’s scheduled appointment.

Adequate skills of the dental laboratory and clinician along with collaborative teamwork through effective communication leads to high quality dental restorations. When problems arise from inaccurately fabricated prostheses, the patient will usually blame the dentist for the mishap. For this reason, it’s imperative dentists choose the best dental laboratory that can effectively communicate with their dental office to ensure satisfied patients every time and to ultimately provide better patient care. 

Common Errors that Occur During Digital Impression Procedures Using In-office CAD/CAM CEREC AC Systems

The intraoral scanner was invented to rectify quality deficiencies associated with manual production of traditional, hand-produced dental impressions and dental restorations¹. Yet, a study by Kim et al. addresses common errors made with in-office CAD/CAM CEREC AC systems that affect the accuracy of dental restorations. Clinicians need to be aware that correct chairside procedures and operation of intraoral scanners are required to provide their dental lab optimal digital impression results.

Kim et al. investigated five categories of errors arising from digital impressions that were created from an in-office CAD/CAM CEREC AC system. The most frequent errors they found were non-linear powder application, inappropriate oral cavity scanner positioning, and insufficient scanned data. Powder application is needed with CEREC Bluecam and requires both experience and skill from the clinician to apply it evenly. The study found that “if more or less than the ideal amount of powder is applied, the precision of the digital impression is compromised, and it is therefore difficult to expect an accurate reconstruction”¹. In addition, uneven distribution of powder application may be an issue when salivary contamination and other obstacles such as the tongue and patient discomfort are unavoidable factors¹.

The second most common error found was inappropriate scanner positioning which results in the partial loss of the digital impression. The manufacturer states the scanner must be placed so that the teeth are present in the middle of the screen, at 3mm to 4mm distance and at a 10 degree angle with the direction of the ray parallel to the long axis of the teeth¹. If the angle is too sharp, the ray will not reflect certain areas of the cavity walls and the clinician will lose part of the impression image.

The third most common error found was insufficient scanned data which is similar to the frequency of inappropriate scanner positioning errors. According to Kim et al., adequate information regarding both the abutment and adjacent teeth is required to obtain a precise and ideal design¹. When insufficient data is an issue in both of these regions, an incomplete reconstruction of the patient’s teeth will result in an ill-fitted dental restoration.

Even though these errors common, it is worth noting the practitioner can immediately evaluate and eliminate preparation errors by modifying the images via the “repair” menu in CEREC system software. However, the clinician needs to be aware of these common errors so he or she may correct them immediately before sending the digital impression to their dental lab. Since dental restorations are manufactured based on the captured digital impression, dental labs rely on the clinician to send an accurate impression in order to fabricate a well-fitted prosthetic for their patients.

  About the organization

Since 1991, Iverson Dental laboratories has provided their clinicians with higher quality dental lab products and exceptional dental lab solutions to guarantee their clinicians’ patients are fully content with their tailored restoration. Iverson dental labs strives to be a great dental resource for dentists by providing training on digital dentistry and new dental implant methods at their high-tech operatory and coaching facility. Iverson dental labs strongly believes in using high quality certified materials and authentic manufacturing elements to fabricate their dental restorations. Iverson also has a knowledgeable team of accredited dental technicians simply because clinical evidence has shown ample skills of the technician are critical for the prolonged success of a dental restoration.

Resources:

1.     Jae-Hong, K., Ki-Baek, K., Sa-Hak, K., Woong-Chul, K., Hae-Young, K., & Ji-Hwan, K. (2015). Quantitative evaluation of common errors in digital impression obtained by using an LED blue light in-office CAD/CAM system. Quintessence International, 1-7. Retrieved May 5, 2016, from http://www.ncbi.nlm.nih.gov/pubmed/25699295

Top 5 Requirements to Expect When Seeking a Quality-Oriented Dental Lab

Although there are many dental laboratories in the U.S., not all can deliver the quality that many patients today would expect from their dentist. The dental lab that dental professionals choose may impact their business and quality of care they provide. Due to patients high expectations, it’s important to find a quality-oriented lab that can fabricate prosthetics with high esthetics and the proper mechanical properties needed for long-lasting restorations.

Finding a dental lab that cares about the quality they provide is essential for your practice to thrive and succeed throughout the years. Listed here are the top 5 requirements you and your dental team should anticipate when choosing a quality-oriented dental laboratory.

1.    Use genuine manufacturer parts and hardware for implant restorations

Using genuine implant manufacturing parts is important for the long-term success of implant restorations. The number of imitative implant manufacturers has increased greatly in recent years, and while some may make decent parts, others compromise quality for cheap, low-quality alternatives. According to Steve Pigliacelli, CDT, “It is not uncommon for labs to use plastic imitation components and pass them off as genuine…you must question how a lab can offer any implant restoration at such a low cost”. This can be a “serious offense,” he goes on to explain, “if you ask for a genuine Nobel Biocare™ bridge and the lab uses a knockoff.” Not only is this unethical but the manufacturer’s warranty is voided and if the implant fails, then the surgeon or periodontist will be responsible for replacing the implant.

Furthermore, using genuine implant components—screw, abutment and implant—from the same manufacturer minimizes complications such as implant or restoration fracture, screw loosening and fracturing; as well as minimizing biological complications such as bone loss or bacteria penetration. Pigliacelli recommends if you want to save money on parts, “get your own account, buy your own parts, and supply them to the lab to use.”

2.    Use ADA-approved materials for their dental lab products

It is recommended to be sure the dental materials that your lab uses are manufactured by reputable companies and are ADA-Approved¹. The American Dental Association’s Approved products go through a stringent, scientific-based investigation that assesses the manufacturing standards that assure purity and uniformity in dental materials. Not only is using dental materials that are manufactured by reputable companies better for the oral health of the patient, but it is also a more ethical decision that you would expect from a quality-oriented dental lab. Some labs will pass off cheaper alternative materials for brand name ones. To ensure your getting quality ADA-approved materials, request manufacturer information from your lab. This is important to fabricating quality restorations that will give your patient the longevity and proper mechanical properties that they expect from your dental expertise.

3.    Provides reliable technical advising services

Technical Advising is one the most important services a dental lab should excel at. “Prosthodontics is a discipline that requires a synergy between the dentist and dental technician in order to fabricate intraoral prostheses with acceptable fit, function and aesthetics,” reported by Berry et al.. This “synergy” requires collaborative teamwork between the lab’s technical advisor and the restorative dentist to achieve the best outcome for restoring the patient’s oral health. Whether it be planning a case, dealing with a challenging patient, working with new materials, developing a digital workflow, or implementing CAD/CAM technologies within their practice—the clinician should be able to rely on their dental laboratory for knowledgeable solutions.

One of the more important aspects of technical advising is supporting the clinician with complex cases—relying on them for the right shades and knowledge of subtle nuances, teeth position, materials and restorative options. From treatment planning to placement of the prosthetic, reliable technical advising and collaborative teamwork between both parties achieves a better outcome for the patient. Some quality-oriented labs will send their CDT implant specialists to aid in surgery, further minimizing complications and showing the patient that the dentist has a team to create the smile that’s customized just for them.

4.    Lab should not send dental work offshore, use “gray-market” or counterfeit products

Outsourcing dental work to a foreign lab runs the risk of substandard quality and little (if any) governmental regulation of material safety and of the manufacturing processes. Some domestic labs will outsource their dental work to foreign labs and pass it off as their own, compromising the quality you would want from a domestic dental lab.

Dental material manufacturers sell their dental products either directly to the laboratory or through their authorized distributors. When the lab purchases products from a specific distributor, the source must be authorized by the manufacturer or they will run the risk of receiving gray-market and counterfeit products that may be passed down to you.

According to Dr. Christensen, gray-market products “include branded goods intended by the brand owner for one national market that instead are diverted and resold by unauthorized distributors to another market.” Counterfeit products pass off fake materials under a legitimate brand name. The main concerns for “gray-market” and counterfeit dental products are they may not comply with FDA regulation requirements, the quality and material safety may be compromised, and a false negative brand perception among clinicians³. Ordering only from “known, authorized retailers will ensure that the products are legitimate and from respected manufacturers”³. Therefore, when choosing a lab you can trust be sure to ask the lab where they purchase their products and if their vender is an authorized distributor.

5.    Lab facility should be clean, equipped with the latest dental technologies and dental materials

CAD/CAM technology has transformed and revolutionized the way dental laboratories design and manufacture restorations. CAD/CAM technology has streamlined the lab’s workflow, increasing productivity and predictability within their fabrication processes. The dental lab you choose should not only be up to clinical standards, but they also should be up-to-date with the latest dental technologies and materials to provide you with the best quality available on the market. As well as to stay competitive with other dental labs and industry pricing. 

Pigliacelli recommends taking a tour of the your prospective lab—meeting the lab owner, quality control manager, and technical advisors. He questions, “Is it clean?…Why would you accept a dirty, pumice-covered, disheveled mess of a dental lab instead of a professional-looking establishment?…Are the work desks neat?…Do the technicians take care of the equipment and respect their tools?” When a lab is well-organized and clean, its shows the company commits to high standards and holds their employees to those same standards.

To put briefly, it’s imperative to find a dental lab that you can trust because you as the dentist is reliant on your dental lab to consistently provide your patients with the best dental lab products available on the market. Quite often the patient sees a failed restoration as the clinician’s mistake and rarely blames the dental lab; so when clinicians choose a low-quality or offshore dental lab they run the risk of unhappy patients.

Dental professionals need to have strict requirements when choosing the best dental lab to fabricate their patients’ restorations. The lab’s mission should align with your mission: find the best solution for restoring the patient’s oral health.

About the company

Since 1991, Iverson Dental laboratories has provided their clinicians with high quality dental lab products and excellent dental lab services to ensure their clinicians’ patients are completely satisfied with their customized restoration. Iverson dental labs strives to be a great dental resource for dentists by offering training on digital dentistry and new dental implant techniques at their high-tech operatory and training facility. Iverson dental labs strongly believes in using high-quality certified materials and authentic manufacturing components to fabricate their dental restorations. Iverson also has a knowledgeable team of certified dental technicians because clinical evidence has shown adequate skills of the technician are important for the long-term success of a restoration.

Sources:

1. Pigliacelli, S. (n.d.). Top 5 questions you should ask a dental lab before you send them a case. Retrieved January 12, 2016, from http://www.perioimplantadvisory.com/articles/2011/4/top-5-questions-you-should-ask-a-dental-lab-before-you-send-them-a-case.html

2. Berry, J., Nesbit, M., Saberi, S., & Petridis, H. (2014). Communication methods and production techniques in fixed prosthesis fabrication: A UK based survey. Part 1: Communication methods. BDJ Br Dent J.

3. Christensen, G. J. (2010). Are You Using “Gray-Market” or Counterfeit Dental Products? The Journal of the American Dental Association, 141(6), 712-715.

Trinia CAD/CAM Discs and Blocks - An Ultralight Alternative to Metal Substructures

Trinia, a CAD/CAM fiber-reinforced composite, was first introduced in 2010 and has achieved remarkable clinical success and acceptance among dental professionals worldwide. With the growing demand for alternatives to metal substructures in dentistry, Trinia CAD/CAM blocks and discs are the new advanced solution to CAD/CAM metal-free restorations.

Trinia was designed with appropriate mechanical properties as well as proper esthetic characteristics to meet a broad range of clinical indications; resulting in a product with high flexural strength and compressive strength. This resilient and ultralight biocompatible resin material provides dentist and dental laboratories with a more efficient and cost-effective alternative to metal bars milled in titanium, or cast in semi-precious and precious metals.

Benefits include:

•    Durable and resilient

•    Lightweight

•    Biocompatible

•    Adjustable

•    No firing required

•    High flexural strength

•    Cost-effective alternative to metal

•    Unique mechanical properties with high flexural and compressive attributes

Indications of Clinical Use

TRINIA can be utilized for the following indications: copings, substructures or frameworks for permanent and transitional anterior or posterior crowns, bridgework, and substructures that can be either cemented or uncemented restorations, such as telescopic prosthetics.

Trinia CAD/CAM discs and blocks are composed of multi-directional interlacing fiberglass and resin within several layers. Trinia is available in 98mm circular discs, 89mm D-shaped discs, as well as 40mm and 55mm blocks. Following the proper milling procedures, Trinia can be milled on most leading wet and dry milling systems with extreme precision by nano-diamond burs.

Trinia is durable with a flexural strength of 393MPa, compression strength of 374MPa (Parallel) and 339MPa (Perpendicular), and resilient with biocompatible material. Trinia makes their products in the United States, so dental professionals can be assured they are made from high quality materials and adequate manufacturing. 

CAD/CAM Recommendations:

•    Eclipse design for bars

•    Minimum 0.7mm wall thickness

•    Minimum 7.0mm² connector

•    Maximum 15mm cantilever

About Iverson Dental Labs

Iverson Dental Laboratories, a high-volume full-service dental lab, is an industry-leading provider of high-quality dental lab products and services to dental professionals nationwide. Established 1991 in Southern California by Corey Iverson, CEO, with a vision to be a reliable provider of quality dental restorations that exhibit strong mechanical properties and beautiful esthetics in the interest of patients' oral health.

With a modern and evidence-based approach, they continuously stay on the forefront of CAD/CAM technologies to increase productivity and consistency within their manufacturing processes to produce exceptional restorations.

Iverson aims to be the ultimate dental resource by offering continuing education seminars on digital workflows and on advanced implant procedures/techniques. Our purpose aligns with our clinicians, to restore oral health and confidence in every patient's smile.

Advantages of CAD/CAM Custom Abutments in Implant Dentistry

The use of CAD/CAM (computer-aided design/computer-aided manufacturing) technology to design and manufacture custom implant abutments is a highly predictable and reliable fabrication process; demonstrating survival rates comparable to conventionally fabricated abutments². The latest generation of CAD/CAM techniques allows the “clinician or technician to fully customize the abutment contour to match carefully the clinical situation after tissue customization with provisional restorations”¹.

Benefits of CAD/CAM Custom abutments

·         Precisely configures abutment for ideal anatomic contours¹

·         Optimal design for esthetic emergence profile¹

·         Highly predictable manufacturing process²

·         Availability of angulation correction¹    

·         100% survival rates reported up to a 6-year period²

·         No technical complications reported up to a 6-year period²

·         Cheaper than gold cast abutments¹

Over the last 10 years, dental CAD/CAM digital systems have been gaining increased use in implant dentistry because of the accurate and calculable nature of CAD/CAM technology. For instances, some studies found the fit of “CAD/CAM implant frameworks to be statistically superior to that of conventional cast frameworks”¹. It also has improved productivity and efficiency of prosthetic manufacturing processes within the dental lab. Continuous improvements to CAD/CAM technology have started to challenge the technique of fabricating dental implants and abutments using conventional methods.

Implant abutments should be made from biocompatible materials with adequate mechanical properties to meet the functional, biological and esthetic demands¹. Furthermore, they should “accurately and passively fit on their mating implants to prevent complications, such as screw loosening, bone loss and abutment fractures during function”¹. To achieve optimal mucogingival esthetics, dental implant abutments require the appropriate emergence profile needed to support the surrounding soft tissue, especially for esthetically driven patients¹.

Implant abutments can be either stock, cast custom or CAD/CAM custom abutments. The main advantage of stock abutments is their lower initial cost, but a major disadvantage is the ideal anatomic contour and emergence profile cannot be achieved. Cast custom abutments have similar tough mechanical properties to CAD/CAM custom abutments; however, the complicated fabrication process of investing, casting and finishing could be prone to manufacturing errors¹. Whereas, the use of CAD/CAM technology to design and manufacture custom abutments has been clinically proven to be extremely accurate due to the predictable nature of computer-aided manufacturing².

In a 2014 systematic review by Harvard School of Dental Medicine, researchers found CAD/CAM technology is able to provide results that are comparable to that of conventional techniques for implant survival, abutment survival, technical and biological complications². In the study, a total of 101 patients were treated with a total of 138 CAD/CAM implant abutments with the same patient group seen at 12, 36, and 67 months. Three different major CAD/CAM systems were used to fabricate the dental implant abutments: Procera (Nobel Biocare), Straumann Cares, and Zirconzahn. Amazingly, they found the CAD/CAM abutment survival rate is 100% and no complications were reported, including screw loosening or fracturing of the abutment².

In sum, CAD/CAM custom abutments have demonstrated survival rates comparable to conventionally fabricated abutments and have several advantages over other fabrication methods, allowing the technique to be a viable option for manufacturing custom implant abutments.  

About the Company

Since 1991, Iverson Dental laboratory has provided dentists with high quality dental lab products and excellent dental lab services to ensure dental patients are completely satisfied with their restoration outcome. Iverson dental labs strongly believes in using high quality certified materials and authentic manufacturing components to fabricate their dental prosthetics given that material quality influences longevity of the restoration. Iverson Labs values their skilled team of certified dental technicians because clinical evidence has shown adequate skills of the technician are important for the long-term success of a restoration. Iverson dental labs strive to be a great dental resource for dental professionals by offering training on digital dentistry and new dental implant techniques at their cutting edge on-site operatory and training facility.

To inquire more about CAD/CAM custom implant abutments, please visit http://www.iversondental-labs.com or call us at (800) 334-2057.

Reference:

1. Kim, E., & Shin, S. (n.d.). Influence of the implant abutment types and the dynamic loading on initial screw loosening. The Journal of Advanced Prosthodontics J Adv Prosthodont, 21-21.

2. Kapos, T., & Evans, C. (n.d.). CAD/CAM Technology for Implant Abutments, Crowns, and Superstructures. The International Journal of Oral & Maxillofacial Implants Int J Oral Maxillofac Implants, 117-136.