Essentially, 3D printing was a fringe technology that’s increasingly moving into the mainstream as it becomes more affordable and reliable. Early implementations of 3D printing in dentistry have primarily included diagnostic models and surgical guides—tools for dentists that require precision but not strength, and help guide treatment without actually replacing teeth. As the technology has improved, however, 3D printed dental crowns are now up for debate. Can we trust the technology that quickly prints guides and models to make teeth replacements up to the standard of, say, zirconia or eMax crowns made with CAD/CAM workflow?

And what exactly are 3D printed crowns made of? How strong are they, and how reliable can we trust them to be?

What are 3D dental crowns made of? How are 3D crowns made?

One absolute truth about the 3D printing process is that, up front, it’s easier on patients, dental staff, and dentists. Patients don’t have to sit through uncomfortable impressions, and practices don’t have to mail impressions away—similar to the seamless process of sending your digital impressions to Dandy. Once a 3D crown printing lab has the digital map of a patient’s mouth, they can (with the dentist) design a prosthetic, which is then fabricated by a 3D printer—digitizing each step of this process turns days and weeks into hours. After printing, a crown is “prepared,” meaning it is cleaned, inspected, and cured.

That said, most dentists are still using CAD/CAM and traditional milled crowns so that they can access the strength and durability of Zirconia, eMax, and even traditional ceramic crowns, because the truth of the matter is: 3D printed crowns are made from glorified composite resin.

One thing this translates to for the patient is cheaper, quicker crowns. Removing time-consuming milling from the process guarantees a quicker and more cost-efficient turnaround. And 3D printed crowns are definitionally accurate and precise. The process of intraoral scanning, digital impressions, and printed tooth replacements guarantees a level of precision slightly above milled or hand-fabricated prosthetics. But how strong are they? How long will they last?

How strong are 3D printed crowns?

We live in an age of restorative tooth abundance—there are many options from which clinicians and patients can select crowns. But all crowns are not created equal. 3D printed crowns are essentially a layered composite, and while 3D printed eMax may come in the future, it’s clear for now that 3D printed dental crowns are a solid temporary option that lack the strength and durability to be a reliable long-term restorative option in their current state.

Still, there are indications that the flexural strength of 3D printed crowns might be suitable for interim prosthetic crowns, and while the process compares favorably to conventional resins, we’re a significant wait from something that can compete with the strength and durability of milled zirconia and eMax crowns.

How aesthetic are 3D printed crowns?

As for the trade-off vis-a-vis that strength concession: turns out, the aesthetics aren’t probably worth it, either. While one of the great strengths of 3D printing is personalization, and the process enables near-perfect precision in shape and design, the limitations of the production medium keep clinicians also wanting more when it comes to aesthetics. Because only one shade can be printed at once, 3D printed restorations and temporary crowns must then be stained, leaving a tooth replacement that is opaque and monochromatic. 

Again, as a temporary, while waiting for a milled zirconia or even metal replacement, a 3D printed crown can get the job done. But for a longer (5+ years) restoration, you will find the aesthetic quality as lacking as the durability.

Should you look for a dental lab that 3D prints crowns? 

Clinicians and dental practices are happiest with outsourced lab work when the money they save is not at the cost of quality. Dental labs that mill zirconia, for example, can dependably offer durable, cost-effective crowns that typically last more than five years, according to studies.

And when things fail—whether because prematurely of fabrication issues and failure, or if the patient cracks the crown—a dentist doesn’t have the luxury of solving the problem in-house. Seek out a dental laboratory that works fast, creates high-quality fabrications, and has measures in place to make dealing with failure easy and stress-free. Don’t skimp on quality while 3D printing is so far behind, especially when Dandy offers a variety of superior alternatives and helps you set up digital, intraoral scanning to streamline best practices, save time, and improve patient outcomes with better, more reliable fabrications. 

Should you 3D print crowns in-house?

We’ve already given ample reason to eschew most 3D printed crowns from external labs. The technology is coming, but it’s not there, and the product is simply inferior to milled alternatives from external labs. 

If you want to 3D print other devices, like temporary crowns, aligners, and nightguards, you may join the many dentists mulling the decision to bring 3D printing and lab work in-house. If you have the scale, size, and appetite for problem-solving, you can add an in-house lab to a multi-office practice and achieve modest benefits. But to produce these benefits, you’ll need to hire part- or full-time team members solely to maintain and run your lab. Add a 3D printing system, and your lab expert will need additional training. Your practice will be purchasing and inventorying 3D printing materials, and the liability attached to poor-quality results will be yours alone. 

If you want a lab, you should build a lab, but it’s worth understanding the costs and benefits—not just of the lab itself, but of 3D printing—before taking on the substantial project of in-house lab work.

So, should your practice start offering 3D printed dental crowns?

Like so many modern advancements that feel almost magical in the benefits and ease they provide to industry, and any excitement over the tech is more than valid. If you’re passionate about 3D printing, you should continue to follow the development of the technology and wait for the right time to incorporate it into your practice. But truthfully, when it comes to 3D printing’s role in dentistry, it might not be the right time yet.  

3D printed crowns provide temporary quality at savings that don’t yet justify the expense, especially with solid, durable options like zirconia and eMax leading the way. And committing to 3D printing in-house is committing to all the costs and headaches of having your own lab: additional labor, training, inventory, process, and dedication of physical space to the lab equipment. There is a place for 3D printing in dentistry, but for crowns, today, we might still be waiting for the right alignment of tech and timing.

The post Should we trust 3D printed dental crowns? appeared first on Dandy.

Nascent but growing, 3D printing is used minimally, but effectively: only 16% of dentists use 3D printing in-office, but an equal amount plan to in the future. Of this group, 2/3 have added the tech in the last two years, and 3D printing is used in at least 25% of their cases—mainly for diagnostic models, but also splits, occlusal devices, and surgical guides. As with many new technologies, younger dentists are claiming the role of early adopter, but increasingly we’re also finding efficiencies in larger offices and especially labs like Dandy’s, where the 3D printing saves significant time at scale. As you explore 3D printing do consider leaving it to the experts at the lab, Doc, you have so many other duties on your plate—running a 3D printing operation further takes you away from your time with patients.

3D printing technology itself is almost 40 years old, and has been used to make everything from fuselages and boat hulls to chess pieces and action figures. For dentistry, it’s most often used to create diagnostic models. Digital dentistry can save a practice the cost and time sink of sending away physical molds to get models, and more sophisticated printers can even be used to fabricate aligners, 3D printed dentures, and crowns. With CAD/CAM technology and intraoral scanning, a level of precision is possible that can even help long-term results and fit. It’s also easier than ever to access 3D printing technology, especially with the help of platforms and services willing to take the heavy lift of digital dentistry off your plate. 

What is the process for 3D printing in dentistry?

To start, 3D printing requires a digital model of a patient’s mouth. This starts with an intraoral scan. Simple, faster, and less invasive than impressions, intraoral scans quickly take digital readings and measurements of a patient’s bite so that a dental lab can work off of a 3D model. And unlike with traditional dental impressions, digital files can be sent instantly, not requiring shipping and long wait times, or return visits from patients if something goes wrong. Once your lab receives your scan(s), they can move on to the CAD/CAM part, and model the implants and other parts that will be 3D printed.

What is dental 3D printing used for? 

Surgical Guides

More than half of the clinicians using this tech are currently 3D printing surgical guides. Surgical guides are exactly what they sound like—devices that help a dentist understand diagnosis and observe available to create safer and more predictable surgical procedures. Whether you’re an implant specialist or just a general dentist hoping to expand your offering, surgical guides improve clinical outcomes. Lab-printed surgical guides aid technicians with placing implants and lining up prosthetics with with the preferred, least invasive angles and chamfers, giving not just medically sound but aesthetically sound results. They also ensure that surgery is causing less damage and trauma to soft tissue and the surrounding mouth.

Digital dentures

Another popular 3D printed dental offering is minimal-appointment dentures (yes, with Dandy 2-Appointment Dentures are possible). Dentures can be challenging, complex and time-consuming to fit and finish, but with a full denture design team, CAD/CAM tech and 3D printing, you can see patients less and get to happy smiles sooner. 

The digital denture process for 3D printing involves an extraoral scan of existing appliance(s) and an intraoral scan of a patient’s it. Then—you guessed it—a lab of experts designs an appliance with the latest custom design libraries and sent to 3D printers to be fabricated with modern, state-of-the-art resins. 3D printed denture patients end up with the perfect, modern convergence of aesthetics and strength—not to mention long-lasting durability. The denture is fully milled and provides the most realistic gumline and is highly aesthetic.

Digital dental models 

Of course, the aforementioned prosthetics traditionally requires dentist to take physical PVS mold impressions. This mean mouthfuls of gagging, uncomfortable alginate that could potentially be flavored with grape or bubble gum, but never quite delivered a satisfying experience for the average patient. For decades this mold has helped capture tooth shape, spacing, and alignment. The mold then was the basis for dental workflow, allowing dentists and orthodontists to use this physical replica to model restorations, appliances, and prosthodontic treatments.

And of course these impressions were error-prone. They could contain human error and need to be retaken or recast. The process itself was laborious and time-consuming, and then physical models needed to be physically shipped to and from the various labs that service dental practices. Beyond this, the physical molds take up physical space, and so they need to be stored somewhere! Ask your dentist or dentist friends if they’ve ever had a storage unit…

Digital dental models were designed to help solve almost all of these problems. Intraoral scanners are fast, meaning less chair time for patients. They are precise, meaning fewer re-dos. In less than a minute, a dentist can get a full model of a patient’s mouth, and then in the time it takes to upload the perfect digital 3D impression, that crucial information and model are already at the dental lab. No mailing, no waiting.

By improving patient experience, you also can potentially attract new patients to your dental practice. There are few places people hate waiting like they dislike a wait at their doctor or dentist, and using modern technology to eliminate both discomfort in the chair and the discomfort of waiting is sure to improve many parts of your practice.

Night Guards

One last useful prosthetic device that is also on offer with the magic of 3D printing is the night guard. Designed to help alleviate the tooth and crown damage (as well as general discomfort) caused by bruxism during sleep, night guards can also help with TMD or sleep apnea, depending on the patient.

A good occlusal guard is an insurance policy against damaging your shiny new crowns and bridges, so 3D printing a night guard to match a digital scan of a mouth is simple, and a no-brainer.

Dandy’s 3D printed night guards are exceptionally strong and durable, because they’re made from one piece, opposed to traditional dual-laminate night guards.  Fit is next to perfect because of digital scanning, and customization is easy to arrange during the design process, always ensuring a flexible, comfortable fit—you’re wearing it while you’re trying to sleep, after all. It’s all one more easy way to increase your offerings with little lift, all because of the brilliance of CAD/CAM technology and its integration with practices ready to embrace the wider array of easy options and offering with 3D printing.

Dental 3D printing materials and in-office setup

Okay, so you’re convinced. 3D printing is the future of dentistry and you’re on board. Now what? What do you need, and what does your setup look like? 

Well, it’s easier to print, but you might not want to do it yourself, which is why letting a digital lab like Dandy take care of 3D printing for you is a solid option. You can get all the benefits of a digital lab without sacrificing counter space, having to train staff to use 3D printers, having to buy, store, and restock resin and other materials, install ventilation, and get new certifications. The all-in cost on a full suite of just the equipment you need to get started is in the neighborhood of $20,000. Recurring costs like resin can be as much as $500. 

Plus, all the time and labor saving you get by using a remote digital lab, you might not get if you do-it-yourself. For example, a standard process involves mixing resin (5 minutes), models designed (15 minutes for someone with experience, but with a steep learning curve), cleaning a resin tank (5-20 minutes), printing (10-30), followed by washing and curing. And then machines must receive maintenance. Oh, and you need to properly dispose of the waste. The time and effort savings you get are achieved by sending your models to labs, because the process outlined here only makes sense in large, multi-office practices with dedicated technicians. The good thing? Dandy’s ready to help you out.

Getting better patient outcomes using dental 3D printing

So once you’ve decided to go with a digital dental lab like Dandy or print yourself, how does this really help turnaround times?

With a digital lab relationship, you get all the results of intraoral scanning and 3D printing without sacrificing a second of your workforce’s time to attend to lab procedures. They scan, send, and move on to the next task. Your patients will be happier with less chair time and no modeling gunk in their mouths, but they also will receive care from much less overtaxed and overworked, multitasking staff, as the hard work of lab work will be done elsewhere, by your wonderful friends and compatriots at Dandy. Throwing in more accuracy and precision to the models themselves feels like a bonus on your bonus—but nevertheless, almost better in every way.

When is 3D printing used in dentistry?

Whether you’re investing in your own 3D printer or picking a dental lab to partner with for your practice, the benefits are clear: it’s easier, cheaper, less time consuming, more comfortable for patients, less taxing for staff, and provides better clinical, medical, and aesthetic results.

Being able to offer simply made, perfect-fitting 3D printed night guards as well as precise crowns, dentures, and bridges gives your practice a leg up that you’ll be proud you took. You’ll see happy patients with happier results, and a patient satisfaction that may very well lead to more business over time, in addition to a more streamlined workflow. Learn more about partnering with Dandy as your digital lab and reach out to us today!

The post 3D printing in dentistry appeared first on Dandy.

The good news: both cement- and screw-retained implants have low complication rates, and both methods are pervasive and ubiquitous enough such that there’s adequate experience, training, and common knowledge. Fixed dental restorations are always going to come with their benefits and limitations, the decision really boils down to a patient’s specific teeth, tooth, and case. Let’s compare factors like performance, durability, esthetics, and more to help you decide which implant retention method might be the best for your patients.

Screw-retained implant crowns and bridges

For a single implant crown restoration or an implant bridge, an impression or digital scan is necessary before a prosthetic implant is surgically inserted.  If you’re choosing a screw-retained implant, you will physically attach the implant abutment to jawbone, where after healing, it will provide a sturdy, rigid base for your crowns to–as the name implies—screw into.

Dentists who prefer screw-retained implants typically do for more than one reason, but a main benefit is retrievability. The technical complications that may happen when cementing a crown to an abutment are nonexistent, as application and installation is a cinch. But if something does happen, it is much easier than a cemented crown for removal, repair, cleaning, and even directly observing the soft tissue or implant underneath. It is all-around easier to diagnose and treat a complication. And, while wear and tear happens, it is easy enough to just retighten a screw, especially compared to removing and replacing cement.

With digital dentistry options like CAD/CAM and intraoral scanning, impressions are eliminated while the precision of screw-retained crowns continues to increase.

One negative (by comparison to cement-retained implants) of screw-retained implants is esthetics. Even when covered with composite, the hole for the screw can sometimes be visible or uneven, though precision design can allow you to avoid some of these visibility issues.

Cement-retained implant crowns and bridges

Many dentists opt for cement-retained implants. The more esthetic choice, cement retention is as described by the name: the abutment is attached to the jawbone, but instead of simply being screwed into the abutment, the implant crown is cemented.

As a standard crown always sits above the gumline, this method’s main benefit is the less-visible border. The crown blends in and sits below the gumline — which also increases the fixture’s durability, damaging a patient’s existing teeth less than regular crowns.

Cement-retained implants are, of course, not retrievable in the same way a screw-retained implant crown is. Cement is more permanent, and so if the abutment becomes loose, the final restoration becomes ruined, because it can’t be removed without damage. Another (albeit small) risk is what’s called late implant failure, which covers a variety of reasons an implant may fail in the first few years — infection, stress, grinding, shortage of bone. Late implant failure is more common in cement-retained than screw-retained implants because cement can act as a medium for bacteria to grow, damaging the ability of an abutment to osseointegrate (attach to bone). Implant failure can be painful and frustrating, not to mention costly.

That said, cement advancements are always on the horizon, and so the quality of cement-retained implants may, as a result, also improve. This won’t come without increased cost, but for situations where esthetic quality is a major concern, cement-retained have remained a quality, safe, and industry-standard approach to implant crowns.

Choosing your implant retention method

So: how should you choose between screw-retained implants and their counterpart, cement? It often comes down to dentist’s preference, your confidence with both prosthetic quality and their competency cementing. But both methods have the same level of safety and (low) failure rate, so the decision is the clinician’s.

Cementation is the more common method, because of its flexibility at installation. If an implant is ever-so-slightly misaligned or inclined, the malleability of the process allows for clean lines and better control of occlusion. It is also stronger. The advent of CAD/CAM technology also allows for the design and fabrication of more-precise prostheses, meaning that screw-retained are easy to install and increasingly as aligned as cemented. They also allow for mishaps to be more easily corrected, avoiding the miserable patient experience of implant failure. 

According to a study published by Dove Press: “No significant difference was found between the screw-retained and cemented-retained implant supported reconstructions. However, Screw-retained implant-supported reconstructions were found to pose less biological and technological complications. Retention of the tooth is more stable and functional when implantation is selected based on the efficiency of a treatment procedure.”

But given any variables, it comes down to the dentist. There will always be cases (and patients) that call for a specific process, but in general, the method a dentist is most comfortable performing (and teaching and training staff to do) is the procedure more likely to result in positive outcomes. Dental technology has advanced so sufficiently as to allow for more than one really-darn-good way of doing something. 

Dental implants with Dandy

Which brings us to us, Dandy. You can learn about how Dandy provides custom abutments with either method: screw-retained or cement-retained implants. The differences, advantages, and which is better all come down to preference. But for cement-retained, intraoral scanning gives you the option to secure your process against excess cement. And for screw-retained, the precision of Dandy’s CAD/CAM technology both for digital impressions and lab fabrication of prostheses means that patients will end up happy with the incline, occlusion, and alignment of the slightly more difficult-to-fabricate screw-retained implant. Whichever you decide, your patients’ smiles are in good hands when you’re working with a digital lab like Dandy.

The post Choosing between screw-retained implants vs cement-retained implants appeared first on Dandy.

Step 1: Use data to find your dental office overhead percentages

As any good clinician knows, creating an effective treatment plan begins with a detailed assessment. Similarly, the first step to lowering your dental practice’s overhead is finding out where you stand and how your numbers compare with industry benchmarks. Use key performance indicators (KPIs) to measure and manage your practice through reliable data.

In an article for Dental Economics, dental business advisor Mark J. Nadaud, CPA/ABV notes that “identification, analysis, and implementation” of KPIs is a critical-but-often-overlooked means of understanding the economic health of a practice. “The idea is to be able to identify, track, and analyze various metrics in order to make more informed and strategic business decisions,” Nadaud writes.

Nadaud recommends the use of supplemental reports to provide more detailed insights. “In addition to monthly or quarterly financial statements, I recommend that an owner obtain supplemental reports to allow him or her to track performance statistics to fully understand where the practice currently is, how it compares to prior periods, and whether it is in line with industry benchmarks.” This supplemental data could include production per day, active patient count, new patients per month, and treatment acceptance rate.

Step 2. Dig into the data and ask ‘Why?’

Once you gain insight into your current status, it’s important to dig into the data to understand what’s contributing to your numbers. Nadaud says the average dental practice overhead is 55%-65%. That aligns with a 2021 Dental Buyer Advocates study that found the median practice overhead for the year to be 61.9%.

Some of that overhead results from fixed costs that remain the same no matter how many patients walk through the door. In contrast, variable costs—such as those for dental supplies and dental laboratory services—are linked to production.  Lab fees don’t just include the price on your invoices, either. If you’re using a highly versatile digital lab, your staff won’t have to fill out paperwork for every order, and waste time processing and shipping physical molds and impressions. Not to mention the incredibly fluid (and often quite expensive) shipping costs you can’t control — unless you switch to a digital lab.

And when it comes to other, surprising laboratory expenses, important factors to consider include:

• Cost savings you may find by using a larger dental lab network or new technology
• The importance of clear communication to ensure a great relationship with your lab
• Use of photos to ensure quality lab work
• A focus on details to deliver clear requests
• The importance of feedback to help fine-tune your preferences

Other variable costs can also include factors that aren’t always obvious. That’s why it’s important to know the “true cost” of supplies by considering issues such as:

• Defective product returns
• Overstocked items held in inventory
• Shipping and handling charges
• Restocking fees
• Failure to maximize free offers
• Failure to receive credit for mistakes made by suppliers

Fixed vs. variable dental overhead costs

Each expense can be divided into status as a fixed or variable expense. Fixed expenses are those that cannot be easily changed, reversed, or reduced — this inflexibility can be the source of financial pressure on the rest of your practice. Especially since the dental industry often has high overheads. Still, the simple math works simply: every 1% you save on overhead is an additional 1% in profit.

Fixed expenses should comprise 4-7% of your production cost. These include rent, insurance, taxes, and utilities — the costs you can’t shop around for or negotiate lower.

Variable costs are where you can find those extra profit margins — like payroll, lab fees, and supplies.  Due to labor shortages and the Great Resignation, costs like hygienist salaries and wages have as much as doubled. But hiring and training a replacement can be even more costly.

Variable expenses will occupy 45-55% of your operating cost, and as you get more granular with how you record expenses—salaries, supplies, equipment, lab fees—you can get more information about how you might lower expense and improve margins.

Step 3. Determine your ideal overhead percentages

Since variable costs are related to production, it’s important to view them in relation to the income generated. Writing for Inside Dentistry, Richard P. Gangwisch, DDS underscores the importance of this relationship: “Dentists should be wary of cutting any costs that could ultimately affect their production. Sometimes you have to spend money to make money.”

Once you have a balanced view of expenses, consider industry benchmarks for overhead percentages and try to adjust so that your breakdown is similar.

Recommended dental practice overhead percentages

Gangwisch says that generally, your dental practice overhead breakdown should look something like this:

• Salary ratios: 20% to 24% overall
• Laboratory: 8% to 10%
• Dental supplies: 5% to 6%
• Facility: 4% to 6% for renters; 5% to 8% for owners
• General administrative: 6% to 10%
• Marketing: 2% to 5%
• Doctor salary: 20% to 25%
• Retirement, reinvestment, and capital expenditures: 20% to 25%

Step 4. Create and implement a plan to decrease dental practice overhead percentages

Once you understand your costs, you can focus on profit. How you manage your costs directly impacts profit, and though it seems obvious, it’s worth stating: only profitable practices stay in business. Prioritizing excess expenses and reducing overhead is the part of management that will keep you profitable.

Gangwisch says dental practices can reduce overhead by following a few concrete steps:

• Track the effectiveness of marketing expenses and cut those that underperform.
• Consider renegotiating your lease if you’re willing to make a longer-term commitment.
• Compare laboratory prices—always keeping quality your first priority.
• Get quotes from multiple insurance companies to see if you can save on your rates.
• Compare the costs of disposable vs non-disposable items that can be effectively autoclaved.
• Research the potential savings of using one vendor for all of your supplies.
• Use an inventory control system that ensures you always have what you need without having an excess.
• Pay bills on time to avoid finance charges that can add up quickly.
• Maintain steady cash flow with an effective collection policy and credit options for patients who struggle to pay.

Now, remember: it is more expensive, with marketing and outreach and business relationships, to acquire a new customer than retaining an existing. And since referrals are a huge driver of dental business, it’s crucial to make sure reducing costs doesn’t diminish patient experience.

High staff morale leads to patient satisfaction — try not to cut costs that make your employees’ work more difficult. If you can take shipping off someone’s hands, consider it. Take a hard look at your workflows and tools and decide: are there areas where you can make changes to improve efficiency? Also consider wait times. Only 37% of younger patients are satisfied with the wait at their current dentist. How can you keep these long-term patients happy and returning with digital dental tools that decrease chair time and simplify workflows? If you are already using digital tools like an intraoral scanner, is your lab fully optimized to use digital scans?

Step 5. Communicate the new plan to your team

When everyone in your office understands the Why behind your plan, they can provide better support. Hold team meetings on a regular basis to review progress, and ask for feedback from everyone on your team. They may identify weaknesses in your workflow, supply chain, or laboratory processes that you have missed. When you encourage everyone to speak up and be part of the effort to decrease overhead costs, you provide the leadership your team needs to help the business succeed.

Step 6. Approach all options with an open mind

Instead of resisting the learning curve that might come with new technology such as a digital dental scanner, embrace it with the knowledge that it will help you in the long run.

• Hire strong candidates who can multitask. Instead of focusing only on recruiting those with dental office experience—consider what other experiences and skills may benefit your office. For instance, if you have a receptionist position to fill, consider a candidate who has customer service experience, but might be able to help with social media marketing, too. Need an office manager who will keep your office humming? Consider someone with the experience you need, and also the computer skills to clean up your systems and train others when they get stuck.
• Embrace a DIY mindset. Your office is full of equipment vulnerable to the need for repair—and those service calls can add up. There may be simple repair and maintenance tasks for which equipment technicians can provide training.
• Make the most of technology. Digital dentistry is not what it was 20 years ago. Digital tools and workflows have advanced significantly. These tools help dental practices optimize both patient care and the bottom line. Instead of resisting the learning curve that might come with new technology, embrace it with the knowledge that it will help you in the long run. If it seems overwhelming, find a digital dental partner that offers in-depth training for you and your staff.

Decreasing dental office overhead

Your dental practice overhead breakdown is the key to reducing cost and improving profit—and as a result, the key to the long-term health of your practice. It’s not easy, managing cost and benefit of seemingly simple variables, but if you follow the above steps (using the percentages as KPIs) and focus on efficiency, your dental office’s overhead percentages can work for you.

Variable costs like supplies and hidden costs inside supplies—think about how expensive it is to ship lab materials for every patient—may guide you to cheaper and more efficient solutions. A solution like Dandy’s intraoral scanning could help your practice not just reduce wait times and improve patient comfort, but also increase employee happiness—a long tail that increases patient retention and reduces employee attrition. It can be done, and you can do it—just focus on variable costs that lead to efficiency and happiness, and profit will follow.

The post Dental office overhead percentages: Where does your practice land? appeared first on Dandy.

And they make sense—titanium dental implants are reliable, durable, and have basically become the industry standard, especially for patients who’ve lost teeth in accidents or who have significant tooth decay, infections, or periodontal disease. And titanium abutments are designed to be nearly permanent and are ultra-versatile, meaning that it’s unlikely another metal as cheap and reliable will unseat titanium as the industry-standard abutment material.  

However, recent advances in CAD/CAM Dentistry and the proliferation of zirconia as a popular crown material have led to zirconia’s adoption as a new alternative to the titanium post. So, which is best when it comes to zirconia vs. titanium implants? We’ll compare.

Zirconia implants

Zirconia is a translucent metallic oxide that mimics the look of natural teeth remarkably while also delivering unparalleled toughness and durability. It is one of the most durable materials available for tooth replacement, and when used in crowns, the ultra-strong material is typically milled with a machine, to specifications provided by digital scanning. 

Zirconia implant abutments are similarly produced from a monolithic block of zirconia and designed, using CAD/CAM technology, to the shape and specifications of a patient’s specific implant needs prior to milling.  Dandy custom-designs zirconia abutments over titanium-bases, for the specific cases where patients and clinicians prefer the material’s benefits, which include biocompatibility, aesthetics, and strength.

Zirconia implant biocompatibility & osseointegration

Bacteria has a hard time forming around zirconia implants, aiding better long-term oral health, and biocompatibility.  Additionally, zirconia has shown strong potential for osseointegration, the process by which existing (jaw) bone (and biological material) can successfully integrate or “interlock” with prosthetics and abutments, leading to longer-term strength and success for the implant. A popular in for the application of other medical prosthetics, zirconia’s ability to “fuse” with bone is promising.

Zirconia implant strength

Zirconia is one of the strongest technical ceramics available. In crowns, zirconia is often used for back teeth, where grinding and bite are more powerful forces. The fracture toughness and corrosion resistance are second to none in the landscape of ceramic materials for implants, although not as durable as titanium implants, so when weighing the benefits zirconia implants vs. titanium, it’s important to keep this in mind.

Zirconia implant aesthetics 

Zirconia shines in the smile zone. Of course, one of the primary benefits of zirconia abutments is a benefit they share with zirconia crowns: the material’s translucent, white color mimics natural teeth. This means that zirconia implants themselves are less noticeable, especially for patients with thin tissue where the implants might be visible at the gumline. It also, like titanium and metal implants, is radiopaque, meaning it shows up on X-rays and scans. 

Pros and cons of zirconia implants

As zirconia crowns have grown in popularity, so too have implants: they are are strong, esthetically great-looking, and biocompatible, which makes them a great choice for many implant candidates.  And the aesthetic benefits especially are great, and a driving factor in zirconia’s adoption by so many dental practices and labs. So what are the drawbacks, if any? First, zirconia is strong and can osseointegrate, but it is still not as strong as titanium. If you’re looking for the absolute most durable abutment on the market, metal is still the answer. And, for practical purposes—there are very few implant cases where abutment color and shade are an actual concern. As zirconia remains more expensive than its metal counterparts, it might make sense in most cases to go with the industry standard. As always, the best option is still the one that benefits a specific patient—the goal of dentistry is always going to be a patient-specific best solution.

Titanium implants

Whether screwed into the jawbone or cemented in place, custom titanium implants are durable bases for crowns of all materials, and with a digital workflow, the most popular replacement option for missing teeth or those with no roots. Titanium implants are designed after an impression or digital scan gives clinicians and labs the information they need to design a crown. The implant itself can be placed and configured with CAD/CAM technology to minimize invasiveness before the dentist or dental surgeon places the implant body in the gum.

After 3-6 months, the titanium implant will fuse with the bone, via the same osseointegration that is promising in zirconia fixtures. This fusion of bone and titanium helps your crown and jaw withstand tremendous biting pressures. Patients wear a “healing cap” during this period and before their crown is (easily and simply) attached to the titanium implant.

Titanium implant biocompatibility & osseointegration

As discussed, titanium implants are biocompatible for most patients. As an inert metal, titanium very rarely affects the surrounding gums and teeth, and the implants typically osseointegrate very well with jawbone, given enough recovery time. Titanium remains the most common abutment material because of the newness of zirconia as well as titanium’s ability to work with the body. Of course, as with any material (including zirconia), not every implant will be successful, but titanium implants have a very high success rate.  While there is no boilerplate, everything-solution for tooth replacement, for the most part titanium is the go-to.

Titanium implant strength

Titanium abutments and implants are tough. They resist fracture due to strong bites or use over time, but compared to ceramic implants like zirconia or zirconia blends, they also exhibit greater flexural strength — the bending or pushing that often causes fracture among more brittle replacement materials. Corrosion resistance and durability are so impressive that many patients have reported success over their entire lifetimes.

Titanium implant aesthetics  

How do they look? They look like metal posts. But it’s important to remember that a titanium implant doesn’t need to be as aesthetically pleasing as basically any other dental prosthetic. Abutments are capped and covered with crowns, so the aesthetic success of a replacement is mostly dependent on the crown and its fit and finish, not the implant.

Pros and cons of titanium implants

There’s a reason titanium is the industry standard for dental implants. Titanium alloys deliver osseointegration, cost, strength, and general biocompatibility that all align to most implant patients’ needs. Titanium implants provide full support for crowns, along the lines of teeth themselves, and are versatile for a complexity of crown cases and even some bridges. The material can even, when it fuses with jawbone, improve bone health and longevity. 

Custom abutments with Dandy: titanium and zirconia

Of course, all cases are contingent on the tooth, mouth, and patient, but whether your practice and cases are trending toward titanium or zirconia implants, Dandy’s got you covered. Our digital dental laboratory gives you the option to work with either material for custom abutments, helping your practice streamline and build efficiencies to deliver positive results through strong and aesthetic smiles.

The post Zirconia vs titanium implant abutments appeared first on Dandy.

One of the most dramatic transformations in the dental industry has been the embrace of modernized computer-aided design (CAD) and computer-aided manufacturing (CAM) dentistry. 

Today, innovative dental offices can leverage these advancements in dentistry technologies to make the tooth restoration process more efficient, cost-effective, and accurate—all of which can lead to better patient experiences and outcomes.

Of course, dentistry is a field steeped in tradition and often resistant to change — especially radical transformation. This also leads to many dentists and other professionals taking a little while to learn about easier, better ways to go about things. As Dental Economics notes: 

“The challenge of learning the technology was not so difficult. The bigger challenge was consistently implementing it to the point where it became the new, most frequently used behavior.”

But CAD/CAM dentistry is shaping up to be the real deal. This technology and its implementation is almost universally beneficial in a dental office, and can be applied to an array of reconstructive procedures, including inlays, onlays, veneers, dental crowns, and dentures. But what is CAD/CAM dentistry exactly, and how does it compare to traditional restorative dentistry? Let’s review.

What is the CAD/CAM workflow and how is it used in dentistry?

The adoption of digital workflows in dentistry is growing as more dentists learn the benefits CAD/CAM technology provides. Is it true that digital scanning is faster, more comfortable, and more precise? Let’s investigate the process of digital dental workflows and see.

Your workflow begins with an intraoral scan which is used to create a high-tech image and model. A dental laboratory like Dandy will then use this scan to either 3D print or mill a prosthetic or restoration. CAD/CAM workflows are replacing the classic impression mold and positive cast as the simplest, most precise way to model a patient’s mouth for the purpose of creating dental restorations

What is CAD/CAM technology used for?

CAD/CAM are digital technologies that utilize scanning, software, and 3D printing to digitally render, manipulate, and then fabricate an object. 

These technologies are not unique to dentistry. Professionals from a variety of fields—ranging from interior designers to aerospace engineers—use one or both of these programs as a part of their daily workflows.

The reason for a CAD/CAM system’s popularity is simple. It enables experts to render more precise design representations and make virtual alterations on the fly. It has largely replaced manual design, drafting, and crafting, with quicker, more accurate, and higher quality processes.   

What are the steps of the CAD/CAM process?

First, a dentist performs a digital scan. This can take as little as five-to-10 seconds. Compare to an analog impression, you’re already ahead of the old ways when it comes to speed and patient comfort.

Once your analog mold is ready, you can ship it to a lab to have a positive cast created. Or, if you use a digital dental process with intraoral scanners — you simply email or upload this scan to a lab like Dandy’s. Again, you are winning on speed and process simplicity, but you’re also saving shipping costs and potential mailing mishaps. (Did we mention that the digital scan is almost always more precise?)

Depending on the utility of your scans or impression, a lab will create a prosthesis, or replacement tooth (or teeth). If you are using a digital workflow, there’s a chance your prosthetics will be in the mail TO your practice in the same timeline it would take an analog impression to simply arrive at the same lab.

Once you receive a precision-made restoration, you’ll also find that dental workflow and adjustments are far less invasive and time-consuming when prosthetics are crafted with the precision of 3D imaging and CAD/CAM technology. Outside of initial setup cost, there is simply no procedural step where digital dentistry is not an improvement over long-established analog dental processes. If your conclusion is that CAD/CAM dentistry is better, you’re thinking like a modern dentist.

The Gradual Digitalization of Dentistry

Historically, CAD/CAM has been woefully underutilized within the dental industry. This is true for several reasons.

For one thing, dentistry is a field steeped in tradition and often resistant to change, especially radical transformation. For another, many dentists and other dental professionals just didn’t realize that there was a better, easier way to go about things. As Dental Economics notes: 

“The challenge of learning the technology was not so difficult. The bigger challenge was consistently implementing it to the point where it became the new, most frequently used behavior.”

Compare the traditional denture workflow with a CAD/CAM digital denture workflow, for example:      

Traditional Denture Process 

The traditional denture process can be lengthy, typically taking 6–8 weeks to complete, with several patient appointments over that period. This includes: 

1. Preparing and taking preliminary manual dental impressions
2. Preparing and taking definitive impressions
3. Establishing a VDO
4. Wax try-in
5. Adjustment and delivery   

During this process, there can be plenty of back and forth as the traditional impressions and models are shipped from the dentist’s office to the lab and vice versa, which increases the likelihood of an error occurring somewhere along the way. In addition, ensuring that the bite is accurate can require several different appointments for the patient’s fittings.

Dandy’s CAD/CAM Two-Appointment Denture Process 

CAD/CAM tech has completely revolutionized the denture workflow. What used to take 50+ days and 6 or more appointments can now be done in 10 days with just two or three appointments. 

For instance, with Dandy, the CAD/CAM dental process looks like this: 

• Appointment 1 (Scanning) – The dentist performs an intraoral scan, which renders a perfect digital dental model that’s turned into a 3D image. That 3D image is then sent to the lab’s design team to check for proper spacing and alignment before printing.  
• Appointment 2 (Fitting) – A week after the scan, the lab sends the final denture model. In the vast majority of cases, it will arrive as a perfect fit—but even if that’s not the case, it’s easy to make alterations.  

 The streamlining of the denture process can result in reduced patient time in the chair, easier planning and delivery of treatment, and less tedious manual work. Not to mention, patients receive a denture product that’s more precise and aesthetically pleasing. When it comes to the question of  what can increase productivity in a dental office, CAD/CAM dentistry can certainly help out.

The Benefits of applying CAD/CAM to dentistry

Dentures aren’t the only dental process that a CAD/CAM system can optimize. At Dandy, we make the entire process digital—from start to finish. We apply it to several procedures, such as crowns, bridges, partials, nightguards, implants, and aligners. 

Breaking the mold by going digital streamlines and simplifies traditional workflows. This, in turn, can create several tangible benefits for dental practices, including: 

• Improved patient experience – Patients receive their orders in a fraction of the time. The dental products they receive are more accurate, longer lasting, and look better. They spend less time in the chair, and even when they’re in the chair, they don’t have to suffer unpleasant processes like taking traditional impression molds.
• Less chair time – When it comes to how to grow your orthodontic practice, fewer and quicker appointments mean that dentists can take on more clients and devote more of their time toward procedures that actually require their expertise. Both benefits can bolster your bottom line.  
• Fewer remakes – The increased accuracy in scans and the reduced lab back and forth results in fewer errors and better end products. As a result, there’s a smaller likelihood that the dental product will need to be remade. 
• Reduced overhead costs – A practice using this new dental technology may spend less money on materials and outsourcing costs. With Dandy, you also enjoy operational efficiency by eliminating the need to use multiple labs for fulfillment.  

CAD/CAM software for digital dental restoration

Digital dental restoration is another new benefit of CAD/CAM technology. Basically, the days of handmade prosthetics, with all the instances and opportunities for human (and crafting) error have been improved upon. Computer-aided manufacturing is the process by which lab technicians actually design objects in the digital 3D space of a program.

In the instance of CAD/CAM dentistry, labs that use high-tech software are able to model restorations and craft for size, strength and fit — before ever modeling a prosthetic in the real world. This allows for a comparison of options and a focus on fit and comfort previously unavailable in analog lab work. In addition to crowns and bridges, software like Dandy’s can custom-mill abutments and posts, so that from scan to smile, you’re in control of every aspect of your patient’s restoration journey.

Adopt CAD/CAM tech with Dandy

CAD/CAM dentistry is shaking up the industry. By adopting this technology, a dental practice can completely modernize its traditional dental laboratory process and relationship.  

Dandy is a fully digital dental lab—the first of its kind. Our platform was designed to overhaul every one of your dental workflows by digitizing the entire process, whether it’s orthodontics, zirconia crown prep, or dentures. 

As a dental professional, if you’re looking for a forward-thinking partner who can transform your dental practice with CAD/CAM dental technology, get started with Dandy today and receive a free intraoral scanner.

Sources: 

NIH. The Use of CAD/CAM in Dentistry. https://pubmed.ncbi.nlm.nih.gov/21726690/

Dental Economics. CAD/CAM technology. https://www.dentaleconomics.com/money/article/16393531/cadcam-technology

The post Understanding the CAD/CAM workflow in dentistry appeared first on Dandy.

Firstly, both are reliable, modern, and beautiful in restorations. eMax is a lithium disilicate piece, and monolithic. This means it’s a single piece of ceramic that is filed and cut down to fit when replacing the missing and restored teeth. Zirconia is a metal oxide, meaning it, too, is ultra-durable (more so even), and often available as one big “monolithic” piece.

Both are good and can handle a great deal of wear and tear, especially compared to the porcelain of the past. So, when it’s time to fix decaying, cracked, or missing teeth, here’s the finer points on two of the most popular, durable, and aesthetically pleasing materials options on the market.

What are eMax crowns?

eMax is a name for a line of crowns made of ultra-, ultra-durable porcelain called a lithium disilicate. The material process makes eMax much stronger than traditional porcelain and nearly all ceramic competitors. Additionally, the material itself is great for bonding—it can attach to metal appliances and inserts as well as existing tooth structure. And the best part? In addition to uncompromised durability, eMax crowns look almost identical to the real deal. They are possibly the best visual tooth mimic on the market widely available.

Pros of eMax crowns

The major benefit of eMax is the look. eMax is more than an overall aesthetically pleasing option—it’s possibly the best. They are also less prone to chipping than other options, they don’t cause allergies, and they last for an extended period of time. These benefits—plus the look—makes them a terrific option for the anterior teeth that are most visible in smiles. 

Cons of eMax crowns

The main drawback when comparing eMax to zirconia and other materials? Cost. eMax crowns are expensive. For patients with a tighter budget (or more than one or two teeth to replace), the expense can be prohibitive.  But for single-tooth dental implants, eMax perhaps can’t be beat.

eMax & Zirconia crowns with Dandy

Dandy offers a variety of zirconia and eMax crowns for all uses. Explore all the crown and bridge materials offered by Dandy labs!

Explore crown and bridge lab

What are zirconia crowns?

Zirconia crowns are made of a translucent metallic oxide that, like eMax, does a great job approaching the look of natural teeth while still providing unbelievable toughness and durability.

Pros of zirconia crowns

Zirconia crowns are relatively cost-effective options, and much more durable and resilient than porcelain. They are biocompatible and won’t cause reactions, stand the test of time (relatively speaking), and do incredible work covering stained and off-color teeth. 

Cons of zirconia crowns

Similar to eMax and other modern, ultra-durable materials, zirconia can sometimes be too strong: those who have strong jaws and/or grind their teeth at night may find that a zirconia crown could do minor damage to other, opposing teeth. Otherwise, however, zirconia is a terrific option that is quickly helping make porcelain fused to metal crowns a thing of the past for posteriors.

Zirconia vs. eMax crowns

Both are major materials-science advances that are helping push modern dentistry forward, and have given hundreds of thousands of patients healthier, happier, and more resilient smiles. But really: which one’s the better choice: eMax or zirconia?

Durability — Zirconia

When it comes to material strength, Zirconia crowns are a bit more durable than eMax. Because of this, dentists often recommend zirconia crowns for back teeth — it is a good idea to replace the cracked, missing, and otherwise unhealthy molars of patients in need with zirconia. Of course, this is a relative comparison, as eMax crowns are still more durable than many traditional options, like porcelain.

Aesthetics / Appearance — eMax

Both zirconia crowns and eMax have a degree of translucency, and are better at tooth-matching than their predecessors by a pretty significant factor, however: eMax are often considered the best-looking crown material on the market. For matching shades of existing teeth, or providing a natural “gradient” look—with most labs*—you can’t beat eMax. *Dandy offers an Aesthetic Zirconia. The milling process used to make either material a customized tooth crown combines the benefits of digital, intraoral scanning with a CAD/CAM milling process that creates perfectly shaped teeth, as well. Zirconia is a great aesthetic option, but for anterior tooth replacement the matching of eMax are second to none.

Function — Case-dependent

The functionality of a tooth replacement depends entirely on the needs and variables related to the case and the patient. Because eMax crowns are a bit better at aesthetically matching real teeth, they’re typically a better choice for anterior teeth. And because eMax is pricier (and somewhat less durable) than zirconia, the case can also be made for zirconia being a better molar replacement, especially for patients who have strong bites and/or grind their teeth.

Cost — Quality per dollar: draw

And of course, when it comes to aesthetics, you get what you pay for. (Or, conversely: the best costs the most.) Between eMax and zirconia, neither is the cheapest option, but either of these materials on the case that suits them is worth every penny. There are very few occasions, other than paying out-of-pocket, where other materials would be preferred.

eMax vs. zirconia: which is the better crown material?

For every mouth, patient, and cracked or missing or unhealthy tooth, there will be dozens of options for treatment, from “old-fashioned” gold crowns to our more modern, versatile options like eMax and Zirconia. And it is not really an overcrowded marketplace of options, because every case has many avenues of treatment that end with happy smiles and healthy teeth. So the difference in the particular cases determines the better options. For single-tooth, otherwise healthy bites where the patient can afford eMax, the aesthetic matching to existing teeth (and customization precision like with Dandy’s digital dental lab) makes perfect sense. A single implant could last for awhile with near-perfect tooth-matching. If the patient needs a full bridge or posterior crowns you should probably opt for the durability of zirconia. The key takeaway should be: with digital dentistry advancements and do-it-all labs like Dandy, tooth replacement—and material selection—has never been both easier and more personalized. Add incredible advancements like milled eMax and Zirconia crowns, and you can have a patient experience that’s not just less intimidating, but also faster, better, and healthier. The real answer to which is better? “Yes.”

The post eMax vs. zirconia: What’s the difference? appeared first on Dandy.

Manufacturing these prosthetics took a significant amount of time and several visits by the patient to the dental office among other inconveniences that we, at the time, all considered normal. Then came the introduction of computer-aided design, manufacturing, and 3D printing of a denture base and teeth. Since the integration of modern technology into dentistry, there have been improvements in:

• Time in the chair time for the patient
• Time chairside for the dentist
• Number of appointments
• Quicker denture delivery
• Record-keeping
• No-appointment replacements
• Retention of fabricated prosthetics
• Clinical and patient-improved results and satisfaction

With the advent of intraoral scanners, computer-aided design, and the introduction of more modern technology into dentistry, chair time, delivery time, and even precision of prosthetics have been greatly increased. With a digital scan, the measurements of a patient’s mouth and dentures needs can be delivered instantaneously. With 3D printed dentures, the actual prostheses can be produced at a greater degree of accuracy, and then produced equally fast. It’s cheaper and faster, and many patients and clinicians prefer the results. But is it better? Let’s investigate.

Milled denture impression

Milled dentures were originally completely analog. Patients provided a bite impression at their dentists’ office, and then dentures were created based on a plaster mold made from that impression. The process was messy, with the patient enduring a first impression of the existing teeth using alginate or polyethers, polyvinyl siloxanes, and hybrids.

Choosing the right impression material is also a matter of personal preference. Most dentists use alginate, the go-to material in the dental world, due to cost, speed, and ease of use, but some prefer silicone impression material, which they say captures more detail, which is good for crowns, bridges, and restorations. 

Alginate distorts easily, so casting must be done quickly, meaning dental offices need to send their impressions and casts to the dental laboratory with expedience—especially compared to the more durable, longer-lasting silicon.

Of course, silicon also has its detractors. While the material picks up more grooves and spaces, it’s very thin, making it far more unpleasant for the patient—especially if it finds the back of their throats. Those with intense gag reflexes need not apply. Silicon also shrinks when curing, so it can’t be used for a full-mouth cast.

Dentists make two rounds of impressions. In the first, material is placed in stock trays that come in generic sizes. Of course, all mouths are different, so stock trays are only the first step. This round is done so that dentists can fabricate a custom-made impression tray for the second round.

These are referred to as “Wash Impressions” or “Border Molding.” During this phase, dentists will use a “Light Body” or “Heavy Body” Wash impression on the customer tray. This Wash is meant to capture patient muscle movement and the anatomy of their mouth. 

The second impression is intended to be more precise, because it’s the one sent to the lab to make dentures. But it doesn’t end here: the lab will typically use the Wash impression to fabricate something called Occlusal Wax Rims, and send these back to the dentist’s office for comparison to the patient. As you can see, this is a tedious, complicated process that involves multiple visits from a patient before a lab even begins to fabricate restorations.

And still, impression material capabilities do not always meet every patient’s needs. Some are not precise enough, because it’s hard to always take perfect molds. And when you go through multiple rounds of a process, you introduce more and more opportunities for human error. 

For almost fifty years, little changed. Many doctors and technicians are still going through the same process of heating metal spatulas, shaping wax by hand, converting that wax into acrylic, creating a plaster mold, boiling out that plaster mold, and packing the plaster mold again without a guarantee of complete accuracy. It is time-consuming and requires (expensive) manual labor. 

Patients want less time in the chair, and so does the dentist. Patients also want restorations and replacement teeth to fit. Imagine multiple, unending dentist visits for uncomfortable impressions, followed by receiving a prosthesis that makes your mouth and gums irritated or inflamed, or even injures existing jawbone — all because of fifty-plus year old manual technology. We haven’t even added teeth to these fitting, but you can already see why many dentists (and us at Dandy) are excited about the future of intraoral digital scanning.

Adding teeth to milled dentures

We have described the back-and-forth with the lab on the plaster molds and impressions, but we’ve yet to add teeth to these fittings.

The synthetic resin we’re using (a solid block disc of polymethyl methacrylate, aka PMMA) is durable and strong. It is found in denture bases and artificial teeth, but also in shatterproof windows, skylights, and aircraft canopies. Considering that the average human bite strength is 162 pounds per square inch (psi), with the second molars exerting a bite force between 1,100 and 1,300 Newtons, you can understand why patients may lose 70% of their bite force with traditional dentures, and why many dentists opt for something as strong as PMMA. With replacement teeth that are this strong, anatomy and fit matters.

So once the wax impression has been returned to the lab, it is prepared for the final process. Each manufacturer has its own methodology, but the standard process as prescribed by the Foundation for Oral-Facial Rehabilitation is that the dentures are removed from the articulator mountings and inspected for any damage. They are then placed in water and then positioned in a flask, which is then partially filled with stone. The positioning within the flask must land the cast and plaster at the same level as the edge of the flask. Then the wax is replaced with polymerized acrylic resin. 

Okay, now let’s add the teeth.

Modern milled dentures typically have two types of artificial teeth: carded or milled. They are chosen to be compatible with the patient’s structure of face, parfunction, previous dentures or partials, and jaw relationship. Carded teeth, named for the identification card they were originally placed on, are identified by mold, shape, and shade of the teeth (and described as versions A, D, C, E, and F). Most carded teeth consist of an anterior or posterior tooth selection guide with both upper and lower teeth. 

These teeth are manufactured in an extrusion molding process in a continuous strip. Manufacturers can also include a kit with a “facial meter,” which measures facial features for distance to correlate cards with a variety of different-sized upper teeth. This helps the dentist and patient evaluate and select teeth based on look and feel with the entire face. 

Some of the most commonly used are: Ivoclar DCL teeth, a highly durable nanohybrid composite version of acrylic resin, and Dentsply Portrait interpenetrating polymer network (IPN) teeth. Both are premium teeth known for long-lasting wear, and resistance to cracks and chips. And depending on budget and bite strength, versions of artificial teeth in a more economical porcelain are available.

When choosing between either acrylic or porcelain teeth for milled dentures, it comes down to durability, esthetics, and costs. And despite all these considerations, we’re still providing patients a replacement method with some risks. There can always be bonding issues if there are errors in the impression or manufacturing, and given that each tooth or group of teeth is fitted individually, there is always a greater chance of tooth loss than with something printed. Without proper fit or consistent wear of the complete denture, there can be bone loss, as the gums and jawbone end up not being stimulated to provide continued growth, and improper oral hygiene can lead to the deterioration of the dentures and staining of the prosthetic.

Enter tech-aided 3D printed dentures

In the 1980s that computer aided design and manufacturing (CAD/CAM) finally made its way to dentistry. Initially seen as a fad, it has now become a more accepted and useful part of many dentists’ workflow and dental lab work. 

Denture materials initially brought CAD/CAM in, like the Ivoclar Ivobase CAD milling system’s addition of fibered “veins” in the base for aesthetic enhancement. These denture materials looked great, but cost a lot more. When 3D printing found its way to the milling machine, dentistry moved more fully into the digital age.

Still, at the onset 3D printed dentures were honestly not superior. 3D construction had not reached the quality present in milled dentures, because manual care can be precise (and because the method had a 50+ year head start).

But the technology has caught up, and the second and third generations of teeth have improved massively, as the process has made CAD-milled bases and 3D printed dentures more commonplace. This digital milling saves time and expense, as rapid prototyping can remove weeks from the process of mailing and shipping impression bases back and forth to labs. Studies are also finding that intraoral scans of “periodontally compromised teeth bring a significant advantage for the treatment planning and delivery of outstanding complete dentures.” 

CAD/CAM is also passing comparison studies (like this one on PubMed) with flying colors, dismissing and demystifying claims of milled dentures maintaining superiority. When it comes to precisely fabricating teeth replacements, the machines are winning and 3D-printed dentures are becoming a new standard.

Denture printing and digital dentistry

Remember that once a tooth model has been made, the milled-denture patient still has a lengthy journey ahead. The first impression makes a cast, then a second impression, and more visits—usually a minimum of five in-chair visits with possible follow-up consultations for adjustments. 

With 3D printed dentures and advances in intraoral scanning, digital dentistry is winning the hearts, minds, mouths, and checkbooks of tooth-replacement patients. With an adept practitioner, and a quality scanner, a patient can be done in 2 visits. That’s 40% of the standard visit, for those keeping score. Add “no gagging” to the scorecard too, as the only thing to clean after visits is the scanner. Gone are the days of goo and hot spatulas. 

As technology advances with each iteration of scanners and software, the detail of the scans produces better images, and each can be saved and easily reproduced. (Not to mention: files can be stored on hard drives and the cloud instead of endless shelving or storage spaces). 

And we’re also at the advent of exploring new materials with 3D printed dentures and replacements. A study examining the dimensional accuracy and the surface topography of a custom-designed, 3D-printed zirconia dental implant found remarkable accuracy. These kinds of advancements in precision fabrication, combined with even more durable material, threaten to eliminate old headaches like the shrinkage of partials and removable complete dentures.

And as for partial dentures, it is a whole different game, but progress may get the industry to 3D-printed partials soon.

As we’ve outlined, however—it is not the printing of the digital dentures that is the miracle. Fine milled replacements have found their homes in happy smiles for more than a century, and milling works. The digital denture process, including digital scanning and CAD/CAM technology is the real advancement, eliminating time, money, postage, operator error, storage, and patient discomfort. That 3D printed dentures are as good or better than their milled counterparts is only part of an equation that includes constant improvements to partials, dentures, and implants relatively soon, but also to the industry at large — improving the trueness, structure, and flexural properties of dental prosthetics is only one (good) outcome.

There is better accuracy in design, meaning less time in the chair. This also leads to fewer repeat visits and refittings for dissatisfied patients. This brand-new patient experience leads to word-of-mouth marketing, and gives dentists competitive advantage. Scanning (and not dealing with molds, trays, and mail) improves dental office digital workflows and cuts down on chair time by about 15 to 20%. This allows dentists to increase their volume of patients without sacrificing quality of care. When you look at the practice, the patients, the employees, and process, the only question worth asking is not “is 3D printed better,” but instead “what about 3D printed dentures isn’t better?” 

The post Are printed or milled dentures superior for dental restoration cases? appeared first on Dandy.

Modern concerns require modern solutions. From improving the efficiency of a building’s energy systems and reducing patient visits, to moving on from physical molds and even using shipping and the mail less—technology gives dental practices many ways to practice more consciously. Building an ethical business is more than just ethically right—it’s also good business.

Dental molds

Let’s start with, first, physical impressions: dental impressions materials can account for 30% of solid waste in many dental practices. These negative models of a patient’s mouth and bite are used to cast models, and afterward are essentially useless. If made with materials known as irreversible hydrocolloids, such as alginate, they are biocompatible and can be added to decomposing material, like a community’s compost bin. If made with elastomers like silicones, these aren’t as biodegradable, dentists must find alternative ways of disposal. One Texan, umm, upcycled his old molds by filling potholes (the above image is from the ABC 13 broadcast) with them. Since much of dental waste ends up in landfills, it is probable that old plaster models will be sitting in the ground for decades, affecting soil and microbial life for untold generations.

Sustainable solution: There is another way, however, that is far more eco-friendly: digital dentistry. Other than there not needing to be material used and disposed of, the digital impression is sent electronically rather than physically shipped, greater lessening the carbon footprint.

Patient files

It’s the responsibility of a dental practice to keep records on file—sometimes for up to six years. Paying for and paying to maintain the space to keep these physical records is frustrating and feels wasteful when factoring in the cost of square footage. Yup, thin pieces of paper add up.

Sustainable solution: Review the HIPAA guidelines and go digital. The shelves upon shelves of manila folders now live in you computer and on a secure cloud. It will be much easier to find patient records, pull them up in every operatory room of your office, and the trees will also thank you.

Simple solutions

Moving your dental practice to digital setups also decreases the need to rely on film for all non-imaging photography. And there are even more every-day, cost-saving green tips that apply to any dental office: switching nonessential lighting to more efficient bulbs; using technology to eliminate paper billing and appointment reminders, and striving to recycle more. Kids, of course, should still get stickers, but you might also recommend patients use all-natural floss, avoiding disposable, plastic toothbrushes as gifts, and reminding patients to brush with the water off. Every drop counts.

Efficiency

And while small improvements like lightbulbs and water flossers are worth doing, the real driver of business success lies in efficiency. Which is why digital, intraoral scanning is more than just a green solution to plaster waste. The ease with which dentists can scan a patient for digital modeling results in (happier) patients who make fewer trips to the dentist. Technology’s improved precision leads to better crowns, bridges, and appliances, which—again—saves money but also saves time, visits, car trips, and all the waste that accompanies inefficiency. Going with efficiency is going green, and going green makes you money. For patients, dentists, staff, and even Mother Earth—our digital future builds more a sustainable world, and heightens the positive impact you have on your community.

Digital dentistry is sustainable

The post How to become a more sustainable dental practice appeared first on Dandy.

Communication is paramount when discussing treatment with your patient, colleagues, and lab, the intention of this dental glossary is to ensure we are all on the same (web)page. As dentistry modernizes, new methods, materials, and practices come into play requiring new words and language—many detailed below reflect the linguistics of digital dentistry. We have organized this digital dentistry glossary by category rather than alphabetically, if you have issues locating the term you are looking for, use the Find function in your browser (desktop: go to top of window, click Edit, click Find, click Find again and type).

Digital Dentistry Glossary

3D printed night guard

With advances like intraoral scanning and digital records, it’s never been easier to create, order, and deliver a 3D-printed nightguard, made with the precision of digital, not to mention the ease and relatively low cost for ordering replacements or backups.

Clear splint night guard

CLEARsplint is a proprietary night guard that’s made with slightly different materials, for patients with methyl methacrylate reactions. It’s a flexible, affordable, easily repairable splint that is molded to the patient’s existing bite.

Closed tray impression

When making an impression mold, dentists can opt for a closed tray impression, in which they leave the coping (see impression coping) on the implant, remaining after the impression has set. The coping is then removed from the implant, attached to the analogue, and transferred back into the impression. This is similar to conventional crown and bridge procedures, where impressions are taken of the existing tooth structure. It is easy, but some dentists find it slightly less accurate than making open-tray impressions—overall we, of course, recommend digital impressions.

Custom abutment

Some dentists may prepare custom abutments for more control and a smoother and more efficient final delivery and attachment of the prosthetic. These abutments can come in pure titanium, metal alloys, and zirconia, and are often fabricated in labs with CAD/CAM technology, to ensure precision.

Dental abutment

A dental abutment is the piece that connects a restoration to a dental implant. Also referred to as an implant abutment.

Dental implant parts

The main parts of a dental implant are: implant posts (or screws), abutment, and crowns (or dentures, or bridges).

Dental implant screw

The metal prosthetic rod (or screw) that is installed in a patient’s gum and jawbone for many dental implant procedures is often the shape and functionality of a small screw, into which the abutment and final restoration will screw directly. This rod is often referred to as the dental implant screw.

Digital dentures

Created with information gathered by intraoral scanning, designed and configured with CAD/CAM technology on computers, and 3D-printed — learn how digital dentures are increasing precision, reducing error, shrinking wait times, and improving both dentist and patient satisfaction.

Dual-laminate night guard

Dual-laminate nightguards combine the comfort of an inner rubber (soft) lining with the strength and durability of a hard acrylic base—the Keysplint is a popular proprietary model.

Flat plane occlusal guard

Your typical upper night guard accounts for the top teeth and the opposing bottom teeth, but a flat plane occlusal guard only molds to the top. The bottom teeth rest against a flat surface. This type of night guard is often used for patients with disclusion or malocclusion (bad bite).

Flexible partial denture

Flexible partial dentures are a standard prosthetic that allows tooth replacement without the investment and time of an implant procedure. Made of thermoplastic   materials like nylon, the flexibility of these dentures means that most patients find them FAR more comfortable than an implant procedure. Partials also don’t require metal clasps to attach, and the nylon looks realistic — meaning if a patient has good dental hygiene and no history of gum disease, flexible partials are a solid option that’s much cheaper than permanent implants.

Hader bar denture

Dentures can be attached many different ways, and one popular method is the installation of a Hader bar, a retainer implant installed in the gum that then is a single, narrow but durable attachment point for dentures. It is easy to attach, easy to service, and widely used.

Hard night guard

For night grinders and clenchers who need a sturdier option, hard night guards are made of durable acrylic, and commonly 3D-printed in modern dental offices. Less comfortable than its soft rubber counterpart, but much better for more severe cases of bruxism.

Hard soft night guard

For people who grind in their sleep, hard/soft night guards provide an easy, low-cost bite guard option to reduce grinding and TMJ effects like headache and shoulder/face/neck pain. A soft liner overlay sits on an added layer of hard acrylic, so that the night guard is contoured to replicate an arch but has the strength and durability of acrylic.

Hybrid denture

Hybrid dental implants (aka overdentures) are full dentures that have not just prosthetic teeth, but also lifelike gums that completely cover the jaw. They can be anchored to the jaw/jawbone with dental implants similar to permanent implants, which are much pricier.

Implant Abutment

An implant abutment is the (typically titanium, gold, or zirconia) screw piece that connects an artificial tooth root to dental prostheses like crowns and bridges. Implants (pure titanium, or an alloy) are inserted to connect to a patient’s jawbone. A dentist will likely either have installed an abutment at the same time (1-stage surgery), or depending on gum and oral health, choose to place a healing abutment atop the implant and, once healed, perform a second procedure to attach the implant abutment (2-stage).

Implant crown

A dental crown fits over an existing tooth structure, but for patients missing a tooth (or with underlying oral health that eliminates the possibility), dental implant crowns are a fitting option. Implant crowns require a metal insert placed in the jawbone with a surgical procedure, after which the crown is attached directly with an abutment (or screw), Standard crowns sit above the gumline, but implant crowns have the luxury of a more invisible border, blending in and sitting below the gumline, which also make for more durability. Implant crowns also damage your existing teeth much less than regular (zirconia or otherwise) crowns.

Implant overdenture

Traditional dentures replace all upper or lower teeth, and are removable — they are placed daily with strips or paste, but can move and cause difficulty eating and talking. The adhesive medium will also wear away the bone over time. Overdentures are dentures supported by implants, typically at least 2 and up to 6. Overdentures snap directly onto the permanent implants, which make the prosthesis more secure and promote bone growth/prevent loss.

Implant surgical guide

Dental implants can either be placed freehand or, more-accurately, with the aid of a surgical guide. Surgical guides are clear, retainer-like devices that help clinicians align and confirm the location of implants during procedures.

Implant systems

Dental implants are attached with surgery to allow the use of a variety of crown and denture fixtures. The entire implant system consists of the metal (or zirconia) implant body, plus an abutment, the crown (or denture/bridge) and, depending on the treatment, an optional abutment/fixation screw.  These systems are installed in the mouths of patients whose current tooth structure is missing: they’ve either damaged an entire tooth beyond repair (including the root) or for oral health considerations, need a tooth removed.

Impression coping and implant coping

Once you’ve installed a dental implant, you’re still going to need to situate and measure the implant in the mouth. While intraoral scanning (as offered by Dandy) is a growing method, taking impressions of the new implant is still popular. For impression coping or implant coping, a transfer cap is placed over the new fixture or implant, so that it can be transferred to a surgical guide for cleaner and easier crown installation.

Keysplint night guard

Keysplint is a proprietary 3D-printed nightguard made from a biocompatible, transparent, flexible, and stain-free resin that patients find comfortable and dentists find to be low-life, especially with advances in intraoral scanning over the last decade.

Maxillary complete denture

A maxillary complete denture simply refers to a full denture, which replaces all teeth in one jaw, and in the upper mouth (maxillary). These are removable, full-arch prostheses that many patients opt for when permanent fixtures aren’t on the table.

Metal partial denture

Metal partial dentures have acrylic or porcelain teeth attached to a metal base, often made of cobalt chrome. This option typically involves some sort of metal clasp, but some benefits include the added strength and durability of metal, combined with the ability to adjust the fixtures in the future, as they’re not permanent. Some patients experience irritation from acrylic or metal, but for the most part metal partial dentures represent an affordable and nonpermanent fix many patients appreciate.

Milled dentures

Milled dentures are historically made by hand from a solid block disc of polymethyl methacrylate, milled in a type of dental machine that has been used in the industry for almost 100 years. Learn more here.

NTI night guard

The NTI-tss, meaning Nonciceptive Trigeminal Inhibition Tension Suppression System, is a fancy way of saying that this resin- or acrylic-based hard night guard is only worn over the central incisors. This device suppresses the muscles used to clench teeth, and keeps your bit from clenching at all—meaning that not only is pain handled, but teeth are protected from continued wear and potential fractures.

Open tray impression

In an open tray impression method for aligning restorations to dental implants, the impression coping is allowed to be removed from the implant (and patient’s mouth) by the impression, then removed from the set impression once hard. The coping is then places back in the patient’s mouth, but anything made impression mold has absolute precision because it was molded around the coping. It is a little more accurate, but slightly riskier and more time-consuming, because you hav e to find and access the coping screw in order to remove the set impression from a patient’s mouth. For this reason, many dentists prefer closed tray technique, Dandy obviously prefers digital impressions.

Overdenture

See hybrid dentures.

Partial mandibular denture

Mandibular refers to the lower jaw—meaning dentures that replace several lower teeth.

Removable denture

Patients may not be able to afford implants for a permanent fixture, might not have the tooth base to attach a bridge, or might just not want dental surgery—there are many reasons to opt for removable dentures. But if you aren’t installing a permanent restoration, you must take care to advise patients not to sleep in their fixtures. They are removable for a reason, and gums need air and time to stay healthy and bacteria-free.

Resin-based partial denture

Many partial dentures are of the resin-based variety, meaning that the tooth material in the denture is made from acrylic resin — a strong plastic. This is one of the most common denture types, because the fit and shading is natural and often indistinguishable from real teeth. The only drawback? These need to be replaced every five to seven years, as they’re not as strong as their porcelain counterparts.

Scan body

Scan bodies are abutments that serve as guides in digital implant restorations. They are intraoral implant-positioning-transfer devices that aid in showing the precise position and height of an implant which is crucial in successfully designing and fabricating ideal fitting implant-supported restorations.

Screw retained implant crown

Depending on the restoration and its constraints, dentists may choose to adhere an implant crown to the dental implant with cement, or opt for a screw-retained implant crown, which is adhered to an implant directly with an abutment screw. These crowns can be made in a variety of materials, including monolithic zirconia or ceramic, and typically are chosen for fast lab turnaround and even faster, more streamlined installation.

Soft night guard

Made of pliable rubber, a soft night guard is the most flexible and (for many) the most comfortable night bite guard. For those who clench but don’t grind, this is a common option—those with more severe bruxism will need to opt for something sturdier.

Valplast dentures

More affordable than fixed restorations and not much more expensive than conventional dentures (with visible metal clasps), Valplast is a trademarked, proprietary thermoplastic resin that allows for fixtures to be made thin, durable, and flexible. If properly cared for, these fixtures can last up to 5 years; because of the way they’re made, they must be replaced if they break or stop fitting.

Valplast partial dentures

A Valplast partial denture fixture is exactly what it sounds like: a Valplast fixture (see above) designed to only replace some teeth, not an entire arch.

Wax rim denture

A bite rim, or wax rim is a ledge of wax that patients bit into to show dentists and labs how their teeth, jaws, and bites relate to each other, because a tooth or jaw on its own is an incomplete picture. A wax bite gives an accurate model of how much vertical occlusion is in a patient’s bite, so that dentists and labs can model dentures that won’t result in improper, misaligned bites.

Zirconia dentures

Zirconia dentures (aka Zirconia fixed bridges) combine the strength and durability of zirconia tooth replacement and zirconia crowns with the full-arch coverage of a fixed bridge, meaning patients get durable, permanent smiles that are extremely unlikely to crack, break, or stain

Crown and Bride glossary terms

Chamfer Crown prep

 A Horizontal Crown preparation similar to knife edge, but with a deeper cut, great for patients with weaker teeth, used with metal and cast-metal crowns

If you select a chamfer crown preparation, you’ll be creating a well-defined finishing line—a bit like a knife edge but with a deeper cut and greater angulation —meaning you can allow a marginal width of up to 0.3 mm. [note: Dandy prefers Shoulder prep for Crowns and Bridges in digital dentistry]

Many dentists prefer chamfer over other techniques because the marginal fit is adhered toward a larger tooth surface, making an angle that exhibits less stress on the tooth itself. This guard against fracture in patients with weaker teeth. 

Chamfer prep is historically only recommended for full cast-metal crowns like gold (and occasionally metal-ceramic), because even the thinnest cast-metal materials are quite resilient, and we’re already dealing with narrow finish margins. You need a strong, thin material for the crown.

When working on the existing tooth to create this margin, there is no hard and fast rule on which bur you should be using to shape, just know that it’s up to the dentist to create the right-shaped margin with whatever tip and bur you choose. To create a good chamfer, do not engage the whole shape of your bur. Ensure that half the diameter is outside the margins, because a chamfer prep width is only 0.3 mm.

Dental composite restoration (composite veneers)

Resin-based composites that are replacing classic metal fillings and can match tooth color

For those with metal allergies or reactions, gone are the days of silver fillings as the main restoration option when cavities or tooth injuries crop up. Composite restoration describes the process in which a composite resin is used to restore teeth that don’t need full crowns.

Made from a mixture of resin and natural materials, composite bonds to the tooth’s structure, not only “filling” the cavity and restoring the physical integrity, but strengthening it for the long haul. This also means less drilling and less tooth loss, because instead of covering, composite work is actually rebuilding and restoring the injured tooth. 

Composite veneers, like porcelain, only cover the front of the tooth, but when compared to porcelain veneers, have the added flexibility of being able to be removed later, if additional work needs to be done. The process bonds veneers but does not remove enamel, as in the case of traditional porcelain veneers.

But the real appeal in composite restoration is the color matching and finish. Metal fillings look like metal; resin-based composites are added in layers, cured, and hardened. This process is repeated until the tooth is completely restored. The finished product is then shaped, polished, and shaded to match the original tooth and teeth around it. 

The resin hardens in moments (with a special light) instead of days, can be easily repaired if damaged, and provides a restoration solution that doesn’t require the commitment and cost of a full crown restoration, for teeth that are still relatively healthy outside of cavity base or injury.

eMax Crowns and Bridges

A newer all-ceramic crown material, alongside zirconia, that offers tremendous esthetic benefit over traditional ceramic and metal

Ceramic mix (meaning, covering metal) crowns are often affordable and have been the standard for a long time, but this material also has long-known disadvantages. Some patients are allergic, many don’t love the appearance, and they are less comfortable than their ceramic (and more expensive) counterparts. eMax crowns and bridges, made from lithium desiccated ceramic, represents an all-ceramic alternative.

eMax Crowns and Bridges are translucent, durable, and known for incredible color matching and natural appearance. There is no metal band at the gumline as with metal-mix crowns, and they’re lighter and thinner, meaning less tooth has to be removed to fit.  Like zirconia, they also provide better, more comfortable fits than metal, and there aren’t the worries of allergic reaction when you’re dealing with ceramic restorations.

eMax crowns are a little more prone to cracking than metal, of course, but are substantially strong. eMax Bridges are often supported by more-durable zirconia.

The crowns themselves are designed in a lab on computers, aided by impressions or the much-simpler digital intraoral scan, and then milled from a block of ceramic using a super-fancy modern milling machine before being glazed and fired. The result is one of the best, most durable and esthetically pleasing restorations available. The only downside? The cost. 

The eMax bridge or crown is worth the money, but not everyone can justify the expense—which is understandable, since many other very solid options, like zirconia, exist in the field of modern dental restoration.

Feather Edge Crown prep

 A vertical Crown preparation without a defined finish line that preserves more tooth structure, and is great for all-ceramic crowns

When you’re preparing a tooth for a crown, you might pick a Feather Edge—this is a vertical finishing line, meaning there’s no defined finish line. This helps preserve tooth structure and can be ideal for marginal adaptation.

Feather edge (also known as a knife-edge chamfer) is so named because of the feather-thin margins. When you have a patient with fairly healthy tooth structure and want to keep as much of that as possible, this option presents as a flexible, fast, and sturdy crown preparation [note: Dandy prefers Shoulder prep for Crowns and Bridges in digital dentistry]. 

And there is nothing wrong with a conservative preparation (meaning saving tooth structure), and feather edge can be well-utilized for marginal adaptation, where we’re selecting the crown, trimming it to proper length, crimping its edges to proximate the prepared tooth, and then finishing. Feather Edge was originally primarily used with gold and metal, but is also now useful for newer zirconia crowns.

Dentists also love vertical preparations because the final line can be finished at various levels, and is often based on the patients’ gingival tissue information (gum health), letting clinicians make the call and modify emergence profiles, but ultimately also just perform simpler and faster preparations. The marginal width of your finish line will be less than 0.3mm, making this the narrowest when compared to Chamfer and Shoulder Preparation techniques. In instances of significant damage or tooth decay where you want to retain less tooth base, you might look to other preparation methods.

Gingival Retraction Cord

A cord that helps dentists pull the gum back to properly evaluate teeth for much dental work; digital scanning lessens the time you need to use them

During the preparation for crown and bridge procedures, dentists need to be able to get a clear working view of the tooth (or teeth) they’ll be preparing for work. Knowing what’s going on below the gumline is important, as many of our margins will end here, and X-rays can tell us some things, but not everything. So we need to displace gum tissue (the gingiva) before an impression or scanning. Enter the gingival retraction cord.

Gingival retraction cords are thin, flosslike “cords” that are wrapped around a tooth to “pull back” the gingiva and give dentists a clear view (and impression) of margins. These cords are often made of braided cotton of polyester fibers, and look like a flossing device (or string) connected to a stick.  And while some impression materials like silicon create a gingival gap large enough to make the retraction cord pointless, with digital intraoral scanning, some displacement is still necessary to get a full view of the tooth and gum. 

The good thing is, gingival retraction cords are safe. A good dentist will evaluate a patient’s dental health before using this device to reduce the potential for swelling and bleeding, and will also take care to quickly remove the cord to minimize gum irritation. With the advent of digital intraoral scanning, we’re able to spend less time retracting the gums than with traditional impressions, further reducing the sometimes-irritating side effects. We suggest the double cord retraction technique.

Layered Zirconia vs. Monolithic Zirconia

You may pick between solid zirconia and layered when preparing zirconia crowns—each has its advantages.

Monolithic zirconia refers to material that is formed of a single block. This material is super-sturdy, durable, and works for crowns, implants, and bridges up to 35mm in span. You will find it in situations where an all-metal crown may have previously been the recommendation.

Layered zirconia (also known as multilayer zirconia, or porcelain zirconia) is coated with a special ceramic where teeth are visible. You will find layered zirconia as the modern replacement for most PFM (porcelain-fused-metal) crowns. Layered is good for longer bridges (up to 48mm) compared with monolithic, as well as some inlays.

The differences between these options are mostly in durability. Solid is recommended for heavy bites (bruxism) and posterior teeth because of its near-invulnerability.

As the uses of each are different, the preparations will also be typically, similarly different: feather-edge preparations for posterior monolithic zirconia crowns, but chamfers for the more esthetically pleasing (and commonly anterior) layered zirconia crowns.

Both options are terrific advancements in restorative dentistry, helping clinicians replace teeth with a material that doesn’t get hot or cold, never produces allergic irritation, and lasts nearly as long as solid-metal. And because modern dentists are often moving away from impressions and toward intraoral digital scanning, the milling machines and labs that create zirconia crowns and bridges are able to deliver these restorations both faster and with more precision than once seemed possible.

Maryland Bridge dental / Maryland Bonded Bridges

For patients missing teeth but who aren’t suited to dental implants or traditional bridges, the Maryland bridge (aka a resin-bonded bridge or Maryland bonded bridge) is a conservative, cost-effective option.

The process involves two metal (or ceramic) wings on either side of the missing tooth, bonded with a special dental adhesive, onto which then the pontic (the replacement restoration) is attached. This creates a bridge where the tooth is missing, without requiring the adjacent teeth to be prepared or shaped for crowns. More natural tooth structure is preserved, less work is done, and a Maryland bridge can be removed, if the patient’s long-term needs or care changes over time.

Of course this procedure has a few drawbacks — you have to have healthy adjacent teeth for the bonding, Maryland bridges can cover up to 2-3 missing teeth, but Maryland bridges aren’t as long-lasting as some of their traditional, more invasive counterparts. It’s a cost-effective, fairly uninvasive option that many dentists prefer, especially for its flexibility in patient care.

PFM – Porcelain fused to metal crown

Porcelain covering a metal crown, which was the longtime preferred crown in dentistry

A longtime dental standard, porcelain-fused-to-metal crowns (PFM crowns) and bridges combine the strength and durability of a metal base with the esthetics of porcelain.

The are what they sound like. A metal base is covered with porcelain and fused with a process called baking, giving you almost all of the benefits of metal with the look of a tooth. They are affordable compared to all-porcelain, zirconia, or eMax restorations, metal bonds well to teeth, and so long as you don’t have irritation or allergic reaction, PFM work is built to last.

For people with night grinding, porcelain fused to metal bridges are one of the more common recommendations, and PFM bridges are good for any span. Another reason PFM crowns have been a popular choice for decades is a high rate of success. It’s one thing to say “they’re durable,” but the benefits of metal really are proven across the years.

And now, the disadvantages:

Despite the translucency of porcelain and excellent color-matching, one esthetic concern is that it’s impossible to cover the entire metal base, and most PFM crowns show a small gray line in patients’ smiles. Technology has given dentists the “porcelain butt joint margin,” which covers this line, but some gum recession is inevitable as we age.

PFM restorations will also require you to lose a lot of your tooth to fit the metal base. It is always better for long-term health to preserve as much tooth as possible, of course, even when restorations need to happen for the same dental-health reasons. 

Porcelain will wear out existing, opposing teeth in the long run (and occasionally chip), but as with some of these other disadvantages, the cost and benefit always tips toward getting a good restoration. Which brings us to cost.

The best way to improve your durability and long-term satisfaction with a PFM Bridge or PFM Crown is to go with precious metals. Gold is expensive, but it lasts a long time. From Gold on down through base metal alloys like silver or nickel, you can adjust work to a budget and still leave patients with a winning smile and work that’s built to last.

PFZ – Porcelain fused to zirconia crown

 A stronger composite restoration production gaining popularity

One of the main drawbacks to the (very sturdy) porcelain-fused-to-metal crown is the possibility of chipping the porcelain and revealing the less-esthetically pleasing metal beneath. Durability is not a major issue, but porcelain does fuse even better, making a stronger composite crown, to some ceramic materials — even more than it does with gold. This is to say that porcelain stands even less of a chance of pulling, peeling, or chipping away from its base with zirconia even than metal.

And so we have the porcelain-fused-to-zirconia crown and bridge. Zirconia can often be a good match to existing teeth, but translucency can be an issue. Add a porcelain coating, and you’ve got an even better match—rivaling even eMax.  

The biocompatibility of zirconia and its strength are hard to ignore, and many dentists are opting for the material even before porcelain finish.

Shoulder Crown prep

A horizontal crown preparation similar to knife edge, but with a deeper cut, preferred by Dandy for digital Crowns and Bridges

Shoulder crown preparation (also called a “butt” finishing line) is basically the least conservative crown finishing method, on the basis that it’s the method where you’re removing the most volume of tooth structure—which mightly helps in getting a clear scan.

To accommodate visibility and provide support for this bulk, we make a small shoulder around the tooth, onto which the crown fits. Axial walls, then, meet your finishing line at a right angle, with a marginal finish line above 0.3mm—wider than feather edge or chamfer crown preparation. Clinicians should take care to avoid undercuts where the shoulder meets the (tooth’s) axial wall, a common area for mistakes in fit and later failure.

Successful Shoulder Crown prep ends up producing remarkably natural restorations that last, as zirconia crowns create tremendous aesthetics when matched to existing tooth color. The easy, accurate edge closure attainable with shoulder prep also means that the crown also helps improve long-term dental hygiene as much as possible.

Yttria / Yttria-stabilized Zirconia

Yttria is the element number 39 on the periodic chart, a silvery-metallic transition metal that. When yttrium oxide is combined with zirconinum oxide, we get yttria-stabilized zirconia—a super-strong, super-durable ceramic that’s resistant to corrosion, oxidation, and high temperatures.

Yttria-stabilized zirconia is, due to these properties, a fast-growing top choice for crowns and bridges, because of this resistance to fracture and chipping. it also can blend (and be shaded) to match teeth. Zirconia restorations are already popular among contemporary dental work, and increased yttria content is making them even more durable. The more yttria in a zirconia crown, the more sturdy, but less aesthetic.

Zirconia Crowns and Bridges

Biocompatible zirconium oxide crowns, and a miraculous modern dental restoration material

Consider how much you bite, how often, and with how much force — our teeth are miracles, and approximating them with man made material is one of the great challenges in the history of dentistry. Zirconia crowns are a major leap forward in the direction of solving these challenges.

Made from Zirconium Oxide, Zirconia crowns and bridges are strong and durable, long-lasting, and available in shading to approximate dozens of tooth colors. One of the main reasons that traditional porcelain (or porcelain-fused-to-metal) crowns don’t last is because of fracture. Zirconia is so strong that clinicians don’t have to do as much preparation (and don’t have to sacrifice as much of your existing tooth to this preparation).

The crown and bridge material is biocompatible, and won’t trigger allergic reactions or irritation, and because the crowns are made on a milling machine often aided by CAD/CAM technology, the fit is next-to-perfect. So what’s the catch? There aren’t a ton. Zirconia crowns and bridges are becoming increasingly common and indicated for all types of procedures. Many dentists were initially afraid that the too-tough material would damage other teeth, but over the last decade studies have revealed zirconia to be, in many cases, as durable as metal but less-damaging than even some porcelain options.

Note: When you see the words “lava crown,” you’re seeing a zirconia crown, only the variety trademarked by the 3M company, which uses an also-trademarked porcelain (“Lava Ceram”) to finish and aid with translucency and look.

Zirconia Crown prep

The newest crown material on the block is popular, its preparation is similar to ceramic counterparts, and much-aided by modern technique

Zirconium oxide (zirconia) crowns are becoming increasingly popular for a few reasons, including their durability and color/aesthetic accuracy. They’re the newest player in dental restoration, and dentists everywhere have fallen in love with what is quite simply a top-quality, well-loved new crown.

Zirconia allows for a wider variety of shades, smoother edges leading to fewer fractures, and great fit. Their prep works similarly to other (metal and ceramic) preparations, and as zirconia is thicker than metal, it’s usually recommended to go with a shoulder preparation. Whether you’re working on anterior or posterior teeth, one of the best parts about going with modern materials is that you typically are accompanying them with modern techniques.

Intraoral scanning is rapidly replacing impressions to find shape, size, and fit. A digital scan sent to a lab can save days and weeks on crown preparation, and provide a level of measurement precision that allows for crowns with better fit. For a zirconia crown, you’ll pay attention to clearance and circumferential chamber as has been done on ceramic and metal restorations forever. Zirconia allows for stronger, prettier crowns that last longer and promote better dental health and hygiene. See Dandy’s Complete Zirconia Crown Prep Guide for more information on margins and chamfer recommendations.

Dandy’s digital dentistry glossary will be updated regularly.

The post Glossary of digital dentistry terms appeared first on Dandy.

Increasing practice efficiency, patient satisfaction and your bottom line can all benefit from doubling down on tidying up your storage and processes. So while office organization is an (often very frustrating) challenge, it is a crucial component of a successful dental practice,

Benefits of an organized dental office

The office is both the nerve center and the operational body of your practice. In a single visit, you can be responsible for storing everything related to the patient — files, impressions, data, records — as well as having the space and time to move them in and out, clean equipment and tools, and process their visits. You have to clean teeth and collect payment, and you have to store x-rays and schedule new appointments.

Improving organization improves all of the examples above, but it also can increase:

• Patient satisfaction – Patients are looking for seamless, efficient visits—and longer wait times (a common byproduct of poor organization) can impact patients’ experiences.

• Efficiency – The better your organization, the more efficiently you can operate. Even something as simple as moving your instruments chairside all at once can decrease your operational time per patient, freeing up time to help more people. 

• Profits – Satisfied patients become repeat customers. Efficient dental offices see more patients in a day. Organizing can facilitate both—double-boosting your bottom line. 

Plus, proper organization improves our positive perceptions of spaces. A 2016 study in the Journal of Environmental Psychology discovered that clutter has a negative impact on our comfort. In a climate where more than one-third of patients have a fear of dental treatment, practices must make every effort to make patients feel safe and at home. A nervous patient’s anxieties can often be at least partly alleviated by  the presence of a professional, clean, and seamless experience.

4 ideas to boost organization—and productivity

Equipment and tools have to be transported, cleaned, stored, and moved around the office for every patient. Keeping these well organized can keep your practice on the right track:

#1 Label everything

If you’re looking for peak efficiency, it’s time to dust off the labelmaker. Labeling instruments, materials, and bins can help everyone in your office quickly hunt down the tools they need. Consider labeling:

• Individual instruments – Tape that changes color after sterilization could help you easily separate clean tools.

• Shelves and cubbies – a labeled scaler is useless if it doesn’t find its way home. Consider adding labels to every tool’s corresponding storage areas. 

• Procedure “packs” – Creating dedicated, labeled, and pre-loaded bins with all the tools you need for any common dental procedure (for example: cleanings, fillings, or impressions) can speed up your preparation time between patients. Your hygienist or assistant can just grab their relevant kit and head in.

Making items quicker and easier to find can limit time spent sifting through the dental supply closet. Over the course of a day, tiny hiccups and delays add up. Conversely, the time saved through organization also adds up — dentists and their staff having an occasional moment to reset between patients and procedures can drastically improve the patient experience.

#2 Overhaul your storage

Everything in your office may have its place—but, does that place make sense?

If items overflow from their assigned locations every time you get a dental supply shipment, or multiple items have to live in the same cubbies, it might be time for a storage-area overhaul. 

Organize your supply room, procedure stations, treatment rooms, and sterilization room like you would organize your kitchen. Putting the mugs in the cabinet right above the coffee pot just makes sense—take the same approach as you find a home for your materials. 

• Group like items (or items commonly used in tandem) together
• Make sure that all of your stock can fit in one place (items shouldn’t overflow)
• “Decant” small materials from delivery boxes into smaller containers to save space

#3 Optimize your sterilization area

While your sterilization area is hopefully hygienic, it still may not be efficient. Consider separating your sterilizing space into a few distinct quadrants, one each for:

• Hygiene instruments
• Dental tools
• Patient products
• Lab cases

Make it as easy as possible to identify dirty and clean instruments—and streamline the sterilization process. Running tools through the autoclave multiple times because you aren’t sure if they’re clean can significantly slow down your workday and introduce unnecessary frustration.

#4 Take advantage of digital dentistry

Analog dentistry practices take time and leads to more clutter occupying your workspace or storage areas:

• Taking physical impressions is time-consuming (and uncomfortable for patients).
• Providers must wait for physical impressions to arrive at a dental lab.
• Lab technicians must turn the physical impressions into digital images in order to make implants and other products.

Numerous advancements in dentistry exist to shorten these turnaround times—particularly intraoral scanners, CAD/CAM dentistry technologies, and 3D printers. And all of these tools are available to today’s dentists. For both scheduling efficiency and reducing the amount of supplies kept on hand, digital dentistry is one of the most significant organization efforts dentists can undertake.

While you don’t have to jump into end-to-end digital dentistry right away, consider implementing one of Dandy’s digital tools above to speed up workflows, increase efficiency, and lower costs. 

Streamline operations with Dandy’s end-to-end digital dental solution

Dandy is all about efficiency—that’s why we’re helping dental practices shift into the digital age with our end-to-end dental lab solutions. We offer intraoral scanners, CAD/CAM software, 3D printing tools, and the training and support your dental office staff needs to use them effectively. 

We can basically make your office more efficient (and less cluttered) in short order with our user-friendly tools, tech, and customer service, which all combine to drive better outcomes for your practice. Learn more about going digital with Dandy today. 

Sources: 

Journal of Dental Hygiene. Do Waiting Times in Dental Offices Affect Patient Satisfaction and Evaluations of Patient-Provider Relationship? A Quasi-Experimental Study. https://pubmed.ncbi.nlm.nih.gov/27340187/ 

Journal of Environmental Psychology. The Dark Side of Home: Assessing Possession “Clutter” on Subjective Well-Being. https://www.sciencedirect.com/science/article/abs/pii/S0272494416300159?via%3Dihub 

Cleveland Clinic. Dentophobia. https://my.clevelandclinic.org/health/diseases/22594-dentophobia-fear-of-dentists 

The post 4 dental office organization ideas to improve productivity appeared first on Dandy.