Valplast enters the CAD/CAM market. 3M ESPE delves into a new material category. Three more manufacturers enter the milling center arena. These are just a few of the highlights from the DLOAC's CAD/CAM Technology Symposium & Expo in November in Pasadena, CA.
While digital technology has been a boon to the C&B market in the past decade, its application to removable labs has been much more limited. One of the latest developments* in the removable arena is Valplast International Corp.'s Precise-Fit™, a system for producing a digitally designed trial baseplate which is used to fabricate a Valplast Flexible Partial.
Here's how the process works: the laboratory sends a model or conventional or digital impression to Valplast where its technicians use a 3Shape scanner and software to create a 3D model. They then digitally survey the image to optimize the path of insertion and block out undercuts, and design the denture, taking into account all clasps, major connectors, facial extensions and denture base thickness.
The trial baseplate is printed with an Objet 3D printer in a proprietary flexible resin that has similar flexural properties to the final appliance and returned to the laboratory. The lab sets the denture teeth onto the baseplate and sends it to the dentist who can modify it to the patient's satisfaction. The laboratory uses that baseplate to fabricate the Valplast Flexible Partial in the conventional manner.
"This process saves the dental team significant time and labor. There is no need to strip the teeth off the baseplate after patient approval; it eliminates the potential for overwaxing as well as the need for a duplicate model; and, using the digital data, it's easy to make a duplicate denture for the patient," explained Justin Marks, Business Development Manager at Valplast, during his presentation at the meeting.
The Materials Market
Monolithic materials continue to proliferate, driving the growth of the all-ceramic market. For example, Dentsply's Cercon HT zirconia was introduced last month and 3MTM ESPETM's monolithic zirconia, Lava™ Plus, is being launched this month. Glidewell is developing a lithium disilicate that will be marketed under the name Obsidian.
Delving into a new material category, 3M ESPE has introduced Lava Ultimate Restorative, a millable resin nano ceramic block. "It acts like a glass ceramic in terms of polishability and esthetics but is easy to adjust like a composite. Indicated for crowns, including implant-supported crowns, onlays, inlays and veneers, it doesn't require firing, doesn't absorb moisture and offers a long-lasting polish," said Jim Buchanan, Director, National Accounts. Currently, Lava Ultimate restorative is used for chairside milling with the CEREC® and E4D®; Straumann—one of 3M's partners—provides a Lava Ultimate crown for use over implants. However, the material will be available to Lava Milling Centers early this year.
The sentiment that not all zirconia materials are created equal was a common theme among DLOAC speakers. "The quality of raw materials, processing method, how the binders are eliminated and pre-sintering technique are key factors in determining the long-term success of zirconia," said Don Cornell, Vice President, Jensen Industries.
To ensure you're buying a quality zirconia, research the manufacturer advises Cornell. "You want a company that has experience processing zirconia, with roots in the dental materials business, and research and development capabilities to back it up."
The debate about full contour zirconia restorations' wear on opposing dentition continues. "The jury is out on its wear kindness. However, most people agree that grinding to adjust a full contour restoration in the mouth is not a good idea," said Dr. Russell Giordano, Associate Professor and Director of Biomaterials at Boston University.
Throughout the manufacturer presentations** and the exhibit hall featuring more than 50 manufacturers, suppliers and laboratories, several trends dominated:
More manufacturers are offering milling services to their laboratory customers. New players include Talladium's TMC, which has been operational for about six months. It accepts files from Dental Wings and 3Shape and mills zirconia, Tilite alloy, wax and PMMA. Aurident, Inc. just launched its Aurident Delta Milling Center offering single units, bridges, full contour restorations and implant abutments made from Delta yttria-stabilized zirconia. Zimmer Dental has partnered with Zfx GmbH and, this summer, will start milling crown and bridge components, bars, and titanium and zirconia abutments at its new Zfx milling center; it will also be distributing Zfx open-platform laboratory scanners, CAD software and an intraoral scanner.
Manufacturer partnerships continue to increase. In the past five years, more and more manufacturers have partnered to create compatibility among their systems and expand their services. The latest example: Jensen Dental is now the exclusive U.S. supplier of 3M ESPE Lava-branded materials, equipment and software, including the new Lava Design 7 software (see text below for more details).
Smaller milling systems are becoming increasingly available, giving users a compact, affordable milling option that fits on a benchtop. For instance, CADBlu's new exMILL is available in two models, a four- and five-axis mill; can mill zirconia units in under 10 minutes; and is capable of producing 16-unit restorations. Another example is Digital Dental Lab's new, compact four-axis model of its Dental Mill that is for both wet and dry applications, so it can mill zirconia, titanium, glass, PMMA and/or wax on the same machine. The new unit features a Jaeger 100,000-rpm spindle and harmonic gearing.
Systems continue to be enhanced; for example: Delcam previewed its new white light scanner, DentSCAN, that's lighter and smaller than its iMetric scanner. In addition, scan adaptors compatible with major implant systems are now available and a virtual articulation feature has been added to the company's DentCAD 2012 R2 software that will be released in the summer.
3Shape's Dental System™ 2012 was released last month. Key new features include 3Shape Communicate™ software that allows labs and dentists to easily share files and discuss 3D designs via the internet; Model Builder™ for designing models directly from intraoral scans, physical impression scans and gypsum scans; a 2D-Image Overlay tool for superimposing a patient's actual smile in the design process; and virtual preparation and virtual articulation software.
Astratech's latest offering is the Atlantis™ abutment core file, which is ordered at the same time as the abutment and used to design the coping before receipt of the final abutment. The core file represents the outer surface of the manufactured Atlantis abutment without the screw hole and includes all corresponding scanned data, reducing the turnaround time.
Competing in the Digital Future
With industry analysts predicting that 50% of the C&B market will be all ceramic by 2015, what will dentists be looking for from their laboratory customers in the future? "Laboratories shouldn't be threatened by chairside CAD/CAM; there has only been an 8% market penetration in 25 years. What doctors want to do is prep and cement; that's it," said keynote speaker Dr. Ed McLaren, Director of the UCLA Center for Esthetic Dentistry and UCLA Master Dental Ceramist residency program.
McLaren advises laboratories to use digital technology and capitalize on offering same-day service. "Dentists want to send a scan in the morning and deliver the lab's bonded mockup several hours later; this is a great sales tool for dentists," he explained. "Offering same-day service is a smart business model, and one that can't be offshored."
- Two new digital fabrication services for complete dentures have been introduced to the marketplace: AvaDent™ Digital Dentures from Global Dental Science in Scottsdale, AZ; and Onedenture in Los Angeles. Both systems use CAD/CAM technology to fabricate the dentures, reduce the number of patient visits to two and are being marketed directly to dentists.
** The following companies gave presentations: 3Shape; B&D Dental Corp.; Biomet 3i; CadBlu; Cadent; CIMsystem s.r.l.; Delcam USA; Dental Wings; Dentsply; Glidewell Laboratories; Jensen Dental; Nobel Biocare; Objet Geometries, Inc.; ShenZhen Upcera; Sirona; Straumann USA; Valplast; Wieland Systems; Zahn Dental; and Zirkonzahn.
Jensen Dental/3MTM ESPETM Expand Partnership
In April 2011, Jensen Dental became a 3M ESPE Certified Lab Channel Partner responsible for selling 3M ESPE Lava™ materials in the U.S. Last month, the companies announced a further expansion of their partnership, making Jensen the exclusive U.S. supplier in the laboratory segment of all 3M ESPE Lava-branded materials, equipment and software, including the new Lava Design 7 software.
3M ESPE will concentrate its efforts on driving clinical demand for Lava products while Jensen will focus on the laboratory market. In addition to Lava Zirconia and DVS (Digital Veneering System), Jensen will sell and support all future Lava products in the lab segment; for 2012, these include the Lava Ultimate, a millable resin nano ceramic block, and Lava Plus, a highly translucent, full contour zirconia solution.
In addition, Jensen is launching a "small-medium lab" digital solution including a scanner, desktop mill, sintering furnace and consumables. A Jensen-branded framework and full contour zirconia material and wax will be available this year to all Authorized Lava Milling and Design Centers and Jensen's digital customers. These materials can be processed using established Lava and new Jensen equipment in the existing frame configuration.
Until further notice, all technical support and equipment service needs will be managed through the existing 3M ESPE channels.