While speakers in the main hall focused on minimally invasive procedures, it was standing room only in the parallel session as attention turned to the laboratory side of the dental world on the third day of the Nobel Biocare Global Symposium 2010. With everything from the accuracy of digital systems, to materials science, to in-depth porcelain layering techniques and even CAD/CAM-based business models up fro discussion, it made for a wide ranging session packed with information, opinions and tips.
Dr. Stefan Holst who presented on a similar topic the day before, gave the laboratory side of the systems attention as continued to speak about the myths and realities of CAD/CAM systems and digital aspects of dental laboratory work. While he again cautioned that scanner accuracy is not quite to the level he would like it to be, Dr. Holst asserted that industrial scale mill technology is capable of producing parts with more than enough accuracy for the needs of the dental and dental lab industries. With CAD/CAM production on the front end of the lab process, technicians can have more time available for the detailed veneering work that makes a finished zirconia crown amazing to behold. He also said that extra time in the process might allow lab technicians to communicate more and more effectively when working with clinicians on treatment planning.
Dr. Holst said he believes much more study is needed to determine and refine scanner accuracy, but the digital design process offers lab technicians a more accurate overall work environment and process. This is especially true with software systems are intelligent when it comes to the materials being used for a specific case and provide a warning if the design will not be functional when it is taken from digital concept to physical reality. Other advantages he sees to moving to digital design and computer-driven production is the lower cost of producing implant bars for retaining “fixed-removables” and the ability to produce custom implant abutments, which he said are as accurate as stock abutments.
Tasked with showing how zirconia crowns can be effectively used in the esthetic zone, Naoki Aiba, CDT offered up not only gorgeous images of crowns he has created, but a number of innovative and creative technical tips that can help with crown design and fabrication. Aiba began by saying he always does a bit of customization on the Procera zirconia copings he receives prior to layering his porcelain. He typically reduces the thickness by .2 mm to create greater translucency before using In-Nova powders to add character. After adding his first porcelain layer and designing the cutback, Aiba said he likes to use a coffee cup warmer to pre-dry the crowns before the first firing. After that first bake, he corrects his margins prior to adding a second build up. Aiba said he likes to polish his ceramics prior to glazing because this allows him to bake them at a slightly lower temperature.
Moving on to explain his process for communication with clinicians, Aiba said he like to work with digital images that he can manipulate in Adobe Photoshop. This part of his process comes in especially handy for shade matching because by cutting and pasting the shade tab images on top of the the temporaries in the image, he can determine the exact shade to match. To further assess the color, he uses the software’s color analysis to compare values between the shade tabs and the restorations.
Belgian brother Luc and Patrick Rutten were up next with a presentation on how they use CAD/CAM production to obtain esthetic results. Both expressed a strong belief that CAD/CAM production allows more cost effective production that, more importantly, is more precise than traditional casting techniques. The pair shared their techniques for firing porcelains on top of zirconia copings, saying they have learned over time that the material needs to be treated differently than metal substructures. They work hard to make sure they build in translucencies and florescences to make their restorations as close as possible to the natural dentition. When completing their cases, the brother Rutten said they deliver the final restoration seated on gypsum models so the contacts are perfect and the clinician can seat without adjustments.
“It’s better if we do it in the lab than if the clinician has to do it chairside,” Luc Rutten said.
Of course for that to work out, communication between lab and clinician must be solid and preparations and impressions or scans used to create models must be highly accurate. Understanding the issues clinicians deal with is a key component to making the communication and case planning process a smooth one, Luc Rutten added.
The final laboratory presenter was Australian lab owner Robert Hill who exhorted the audience to embrace the change hitting the industry and adapt CAD/CAM processes into their business models. Stating, “It’s time to move on,” he said waxing should not be needed any longer and digital production processes are a way to bring in new efficiencies to a lab. While he said he was not 100 percent pleased with every aspect of the Nobel Biocare system he uses, he selected it for his lab because he believes it will grow to add the features he wants to see and is ready to address all of the types of restorations he produces. The biggest advantage of CAD/CAM he’s seen is the ability to design milled implant bars that are more accurate, stronger and far faster to produce through a digital process.
“If you’re not doing implant bars—screw-retained fixed or removable—you’re wasting part of the market,” he said.
Hill continued on to outline his vision of a future lab with a completely digital workflow that cuts down on the mess and waste while increasing productivity. With outsourcing for fabrication on industrial mills, Hill said a lab could work with just a furnace, a scanner and a computer. In fact, he finished by showing his boat and calling it his second lab because he is already to take his laptop with him and remotely complete some case designs while out on the water.
For the weekend’s final session, a panel of speakers who presented throughout the weekend were brought back to review two cases, discuss the diagnosis and plan the treatment. The complex cases presented both clinical and financial challenges for the panel, and both the members of the panel and the clinicians remaining in the audience participated in the exercise.
The session provided a lively conclussion to the three day event and provided an opportunity to see the topics covered in the educational sessions put to use in actual clinical cases. After the panel put forward their proposed treatment, the actual clinical outcomes were revealed.
The weekend wrapped up with many good byes and trips to the airport as the international crowd of attendees and speakers left with new information on technolgies, techniques and treatments, and a solid overview of the implant and digital dentistry systems Nobel Biocare has available.
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