Education



This is typically a time of year when we start to look at our practice growth, getting back to continuing education (hopefully in person), and networking with our peers and colleagues. It is always exciting to see and hear what everyone is implementing to their practices. Whether it be an advancement in their skillset, or some new technology.
Because John often gets asked about Intra Oral Scanners, we have decided to dig right in there, and ask an expert.

Here’s a slightly dated image of an IOS party.

There have been HUGE advancements and upgrades over the years plus a few more popular considerations to invite.

From a Lab perspective, we can accept any file. Quality scans with accurate bites and pertinent additional information is always a must of course to get back quality work in a timely manner. You can find a previous article about effective Lab communication on our website.

Back to our expert.
We consulted one of our Dealer Reps Elise Poirier. She is the CAD/CAM Specialist from Henry Schein
and will help us break down the pros and cons of the 4
most common systems.

* We have not included iTero in our guide as they are proprietary to Invisalign. There are many other Aligner systems out there. But if this is the direction you are taking your practice, Align is your go-to for more information.

” My name is Elise Poirier and I am the BC CAD/CAM Specialist for Henry Schein. There are a lot of scanner options out there and you’ll find as you start to research them it’s easy to become overwhelmed and find yourself paralyzed in the decision making process as you sort through which scanner has which feature and which mythical unicorn scanner has ALLLL the features. Spoiler alert!  It doesn’t exist.

Features, they are what many believe is the most important consideration –  that and cost of course. The fact of the matter is all of the most popular scanners produce a quality image, some are just more accurate, easier to use or speak to a certain “niche”. The right scanner for you really depends on your expectation of what it can do for YOU specifically.  Are you interested in purchasing a scanner to enhance patient communication, digitally treatment plan, market your practice, support other technology or simply digitize your impressions? We offer four popular scanners at Henry Schein. I’ll do my best to concisely sum them up.”

3 Shape Trios comes in many configurations – wired, wireless, all-in-one “Move” cart.  There is also a couple of Basic options for smaller budgets and those that aren’t into all the bells and whistles this software giant prides themselves on continuously developing.  With software development naturally there are yearly fees however these fees have now become technically optional if the user decides to opt out of their “Trios Care”. 
Trios offers some great patient communication tools – Smile Design, Treatment Simulator and Patient Monitoring to compare scans to show change. 

The method of capture is picture-stitching and for the best ‘artificial intelligence’ you must follow the recommended scan strategy.  As far as practice marketing there are some really unique ways to highlight what a practice offers in the way of comprehensive treatment that can be used for those that have the know how and interest in social media and interactive website design. It can assist with shade-taking, capture an overlaid photo, “lock” scan data in areas you don’t want to over-scan and utilizes an app store interface and communication portal with separate phone/tablet app for lab to clinic communication.
3 Shape is the most commonly used lab software so connectivity to the lab is seamless from Trios to 3 Shape Dental System. 

Planmeca Emerald S scanner is a great bang for your buck scanner.  It is a portable scanner paired with laptop configuration but can also be integrated into the operatory computers for better ease of use if the specs meet the requirements.  The tips are self-heating and sterilizable and there are two sizes – regular and the “slim line” tip for smaller mouths.
The wand grip can be customized with 4 colour “boots” to choose from and the cradle detaches to create a holder for the wand in the chair delivery.  Planmeca offers “SOS” (support on site) and training both new user and remote by way of a dedicated clinical support team within SOS. My experience with their support is that it is both responsive and comprehensive.

Both the scanner and laptop are reasonably priced and include a 3 year bumper to bumper warranty followed by optional soft support and updates if needed.
There is a Smile Design and Implant Planning Wizard, Model Builder for 3D printing, Ortho Model analysis/compare scan tool and impression scanning mode. It is capable of assisting with shade selection, overlaying photos onto the scan and hands free navigation within the software. It produces all the most common file types (STL, PLY, 3 Shape and Exocad) that can be sent by Romexis Cloud software which has a Lab App that is free for your Lab.

 

Dentsply Sirona Primescan is an all in one cart configuration with back- up battery.  It’s medical grade touchscreen, touch pad and large wide screen is medical grade and wipeable with Cavicide. There are no scan fees, optional extended warranty past the (2 years come standard) and three scanner sleeve options – stainless steel with sapphire glass, disposable or combined sterilizable with disposable window. It boasts the largest field of view and depth of field (20mm versus 14-17mm with most other scanners).

This contributes to a fast continuous video scan albeit a heavier wand to maneuver initially.

There are 3 independent studies have demonstrated that it is the most accurate scanner on the market currently.

As far as speed and tissue capture, Dentsply Sirona has put forth a scanner that excels at both their flagship “same day crown” workflow and now really has addressed the need for an easy to use, fast, accurate scan and send solution as well.  As far as features there is a shade selection tool, ortho treatment simulator, ortho analysis and a really detailed prep analysis tool. It also takes a nice intraoral photo you can send for insurance pre-authorizations.  All scans are stored, easily backed up, moved and converted to other file types such as STL. One lab inbox license is included with purchase and scans can now be sent directly to 3 Shape labs.  Features to come include a new Smile Design and Compare scan feature.

The Kavo Medit X700 is the Medit backed by and paired with the powerful DTX imaging platform for those who are wanting a more integrative platform to house all of their Kavo Imaging and intraoral scan data.

The Medit includes features such as Model Builder/Editor, Smile Design, Ortho Treatment Simulator, Prep analysis, Impression Scanning, artificially intelligent scanbody matching and all features are housed within their App Store at no cost. The Cloud-Based Medit link portal is free for users as well as labs.  The scanner itself pairs with a laptop, directly connecting via detachable USB-C cable.  The tips are sterilizable, rotate 180 degrees and disinifected by UV-C technology during use.  Scanning is a little slower in comparison to some of the options but there is a lot of capability and features packed into this option.

Trueness of 12 intraoral scanners in the full-arch implant impression: a comparative in vitro study – PubMed (nih.gov)

If you have any further questions please feel free to contact Elise at
elise.poirier@henryschein.ca
Or of course your own Dealer Representative

Written by Roberta Bertram CDA
Reviewed by John Zahel RDT



So yes. This is a thing.
But why you ask ?

   First of all I want to mention that there isn’t any scientific data on this topic that I could find.
It seems this type of restoration came as a result of seasoned clinicians and technicians problem solving and engineering a creative solution.

Thank you Dr Anthony Mennito AKA @smileprofessor for the photo

I’m sure you know well, there are pro’s and cons of both cementable and screw retained implant prosthetics. As a lab we have no preference either.

However, sometimes we have to be creative together to provide the best outcome for the patient.  A Screwmentable option can be just the solution we need.

For example. It is less than ideal to have your access hole so near to a functional or esthetic part of the restoration.

This may be unavoidable depending on implant placement. Plus in an esthetic zone you would prefer a screw retained restoration.

So lets compare.

Screw retained restorations seem to be more common mainly because of cement associated peri-implantitis.
Some other pluses, are that they are accommodating in a situation where there is a shortage of vertical space and are easier to remove if the need arises. Another plus is they are less expensive to produce.

If you have to make adjustments to your proximal contacts, it can be cumbersome to keep screwing it on and off and then pray you didn’t take too much away once you’ve torqued it down.

Also, in the situation with splinted units or a bridge, draw and angulation can be a challenge for seating as well.

A custom abutment(s) and cemented prosthesis are certainly still a practice widely used. Customizing an abutment can make up for poor implant angulation especially when designing a multi unit or splinted restoration.

Having 2 parts will make for an easier path of insertion. Downside is, if you have to remove the restoration for some reason, you risk heating the implant while cutting off the crown.

Something to think about in a patient you for see transitioning into a multiple implant restorative situation.

” Always have future engineering in mind “

“What if I need angle correction with out the angulated channel and special driver. Then I need abutment and crown separately. But don’t want to worry about residual cement affecting the health of the implant ?I would like to plan for easy retrievability.”

With a Screwmentable option you simply integrate the two restorative concepts. 
There is no change in work flow for the doctor or the lab.
You can have the abutment margin slightly sub gingival since you are cementing the crown to the abutment extra orally. Very useful in an esthetic zone.

Always know that you can reach out to our implant specialists to discuss a case together. 

There probably isn’t much ‘Young ” Johnny here hasn’t seen or figured out.

Written by Roberta Bertram CDA

Reviewed by John Zahel RDT

                                                                                                                           


November 18, 2020

Gold and silver have always been the coveted investments in the precious metals markets until now.

Palladium has been trading higher than gold! So why?

What is driving dental alloy costs up so much?

For one, the auto industry demands a huge amount of Palladium for catalytic converters for reducing automobile emissions. Secondly, electronics.

Yup! Palladium is a major player in the electronics industry.

It is in all of our sought-after devices and keeping those supercomputer circuits running speedy. Hopefully, you have already got some of this precious stuff in your portfolio.

So, what do we do?
Yes, to Zirconia restorative options! They are strong, and the esthetic capabilities are ever evolving for us.
But …zirconia may not provide the best and long-lasting result in certain situations. There is still a need and demand for dental alloy in our industry.
The need for a conservative preparation with less tooth reduction, 360 gold margins, a subgingival margin or a gold occlusal on a 37/47 bridge abutment.
Heavy stuff, right?? (pun intended 😉)
You are always welcome to ask for a base metal dental alloy option for your case too.

OK, now how can we help?
Communication and being well informed is key.  Once our patient understands and accepts that the best treatment option is an alloy-based restoration, send off your case with a request for an estimate of the dental alloy cost.  That way you can pass the info along to the patient. No surprises!
Ballpark estimate: up to $200 per unit or more, depending on weight.
As a nice touch, if your cutting off a crown, offer it back to the patient to recycle. Might be worth a lunch out for them!

Another option we have is a dental alloy called Platinum Plus from Argen.              

This is a noble alloy that is palladium free.Platinum 20%

Ruthenium 5.7%

Cobalt 43.5 %

Chromium 29.3%

Argen.com for more product info

It is a little bit harder, white in color, has an excellent marginal fit and is an excellent option for implant restorations, ideal in fact being that there is an insignificant reaction with titanium.

This dental alloy meets our high-quality expectations and is a cost-effective alternative to pass along to your patients.

Always feel free to call the lab any time and discuss a case with John. There is a wealth of knowledge and experience there!

Written by Roberta Bertram CDA
Reviewed by John Zahel RDT

 

 

 


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February 18, 2021

And is it the actual photography that is changing ? Or is it the applications that are changing?

We really haven’t seen vast changes in the way we take photos with cameras. But we sure have seen changes in how we take photos with phones……

Wow. Who would have thought !!

 

Thankfully,  we have put the days of film and slides behind us and we now have everything in and instant!
This doesn’t change how our photos should look to be clinically useful, but it sure does impact the way we use our photos….in an instant. Those big flat screens and monitors in our clinics have been such a wise investment that our intra oral photography has become paramount in case acceptance and patient education.

 

In a far away land with the film and slides, resides the telephone books with the Yellow Pages section and advertising. Moving forward like a freight train, is digital marketing.
Digital marketing isn’t just limited to having a web page any more. It includes several different social media platforms and the STORYTELLING that goes along with it.
This is where the connections are  made. It’s sharing and showing and telling authentically with photos and a story.
Which is why it’s important to have good photos, consistently.
Perhaps why we have filters and effects for our photo sharing fun.

So what is the criteria for good clinical photos? 

Great retraction is key ! Dry teeth and soft tissue. Frenums pulled.

No images looking up noses or mustaches creeping into your shot. You can use contrasters to block out unwanted background and soft tissue. By doing this it demonstrates incisal translucency better. Very important communication with your lab 😉

This series is pretty basic. I would add a full face with big smile, nose to chin big smile as well. Lips framing the smile is important. Some clinicians add side view smiles and repose as well. Repose photo is  especially important for esthetic treatment planning in smile design software.

What is a good criteria for marketing photos ?
Consistency !! Whether it’s an esthetic or surgical case, your before and after photos need to have the same visual perspective.

Same field of view.
Same light.
Same angulation.
Same teeth in both photos.

Use backgrounds and /or contrastors.
Leverage your editing tools.
Play with angles rather than straight on shots.

If you plan to go beyond a beautiful image gallery for your webpage or a photo book for the office, might I suggest…

Make yourself a branding board. You can do this through Canva or similar apps for Social Media use.

Choose a  color scheme that co ordinates with your office decor.

Choose the same font and font color for your posts.

Embed your logo onto your photos.

Look at other well branded social media pages to see how they flow. How their grid layout is.

Delegate or hire someone to do this if needed, although I’m pretty sure someone in the office will be savvy at social Media if you are not.

Have fun with it !

Written by Roberta Bertram CDA
Reviewed by John Zahel RDT

 

 


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April 7, 2021

When you were in dental school what advice were you given for your esthetic Prosth cases ?

“Communicate with the lab ” or something like that ?

What exactly does that involve ?

Well, lots actually. Please read on !

This months topic came about after a connecting with the UBC Dental Undergrads. It is a very important question.

How should an esthetic case/esthetically demanding case be communicated with your Laboratory?

Because we feel we are all ALWAYS learning in our industry and in various stages of practice within our careers, as well as integrating many different aspects of the 

dental technologies currently available, this was worth sharing beyond just student body.

First the conversation has to happen. This could be during a new patient exam, a check up, they may bring it up with the hygienist or even receptionist. Perhaps you would just love to ask them !

I remember learning at course a good way to prompt your patient is by asking them if ,

” they had a magic wand and could change anything about their smile or teeth what would it be.”

There is your lead in.

Anyone in your team can ask this question,  and SHOULD ask it.

Now you get to have some fun! And of course this is always the most rewarding and impactful work we can do. That goes for the lab technicians too!


Smile design time

GOOD photos, impressions, mounted study casts, wax up, digital models, digital wax up, digital articulation, smile design software. So many great ways to go about this.

Make sure you set expectations with your patient early on about outcome and a timeline as well!

Something life changing can not be rushed.

 

This is a repeat statement, however it impresses how very important it is to review expectations and outcome before embarking on this journey with your patient. Not all cases are straightforward, there may be structural limitations, the need to accept things like pink porcelain in an esthetic zone, perhaps their budget limits the number of restorations leaving an unfilled buccal corridor. Some times there is no way to achieve perfection.

Discuss it all ! And once accepted, it might be wise to have the patient sign their estimate and agree formally to the proposed treatment options accepted AND declined.
( share these thoughts with your lab as well/keep them in the loop)

WARNING !

You may get that patient who comes to you with a photo in hand (likely on their phone) and want to look like …..
I feel this is where the new smile design software’s can be so impactful in the planning phase to demonstrate what works and might not work.

OR

If they are a mature patient and are looking for their youthful appearance back, and bring along a photo of them of them when they were younger….like a wedding picture. Pulls your heart strings for sure!

But that is certainly a more reasonable goal than a Julia Roberts smile.

Here is an example of a workflow outline that has been used by Doctors I have worked with over the years. Do it digitally, analog, a bit of both. Either way it’s about creating predictability.

  • do a mock up of your wax up or digital design in the mouth

  • use this template for an omnivac or lab fabricated temps

  • do your tooth preparation and provisionals

  • have the patient wear provisionals for several  weeks before having the lab start fabrication

  • confirm esthetics and phonetics – modify as needed, confirm

  • make a copy of the accepted provisionals for the lab

  • have the lab go ahead and make restorations

  • you could do a bisque bake try-in appointment ( using the phrase ‘try-in’ sets expectations that things may need to be modified or customized more)

  • have patient sign and accept final restorations and cement or bond them in place

  • Night Guard impressions/scans

  • after photos at Night Guard delivery, follow up with any adjustments or just celebrate the beautiful results !

  • review pre op and post op photos with the patient

  • ask for referrals !

Oh, and what a bonus if your office offers Botox and fillers ! I am going to also add that lipstick in an after photo looks so amazing, as do photo props for cool marketing pictures.

Written by Roberta Bertram CDA
Reviewed by John Zahel RDT


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June 30, 2021

A collaborative approach with your Dental Lab for accurate, consistent and swift results.

Regardless of where you are at with digital technology in the office, if you are placing implants, you are at at least getting a CT scan done most of the time.

So where do we fit in with regards to pre-planning and improving efficiency  ?

Our Lab uses 3Shape software and hardware for our digital workflows. 3Shape implant studio facilitates ‘ Prosthetic Driven Implant Planning ‘.

This image demonstrates the concept of meshing the surface scan and CT scan together and planning placement from the crown down. It gives us the ability to plan and review the case with you.
Once  a final design and placement is approved, we can provide a surgical guide, custom temporary abutment or custom provisional.

(Surgical guides can be tooth supported, mucosal or bone supported )

Now I just want to pause here and mention that we do understand that guided surgery is not for every case, patient scenario or doctor. However, some of the other aspects of the treatment plan post implant placement, like providing  custom provisionals may be useful. And perhaps none of this appeals to you. 
That’s ok.

A digital workflow does not require you to be fully digital in your office setting.
It is no problem to combine analog with digital.

  Therefore, you can rely on the lab software and hardware to assist by scanning a vinyl impression or stone model into the pre planning and design software.
This will work with a single unit restoration, to fully edentulous cases. Also, any file can be imported to 3Shape’s completely open digital communication, so you can even borrow your buddy’s scanner if you want to !

No matter what type of workflow works best for you or you are more comfortable with, neither produces a more superior result. Analog and digital are proving more and more similar end results.

From the lab’s perspective though, it is so much easier to make adjustments digitally than going back and forth with hard copies and couriers. It is also more efficient to be able to make any necessary changes along the way with a digital file.

A huge time and money saver for everyone involved. Especially the patient!

If you have any implant planning questions feel free to contact John at the lab.

Thank you to Justin Lee from 3Shape for your input.

Written by Roberta Bertram CDA
Reviewed by John Zahel RDT


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August 26, 2021

Just a little while ago, I was asked if our Lab did feldspathic restorations. I said yes of course, while thinking to myself, ” that seems like a kind of old school restorative approach.” However, clearly not lost or forgotten. Let’s go pick ole Johnny’s brain about this.

Now of course he didn’t just give up all the answers. I still had to do my homework and ask the questions.

Feldspath restorations are beautiful works of art. It takes a skilled ceramicist and doctor plus an ideal patient for a long term outcome of this type of restoration. Some pros.These can be done with little to no tooth preparation. They are highly esthetic and life like and have a super strong enamel bond.

But just like a tiny porcelain cup, they are very fragile. Strength only around 70 -90 mpa.

With out any prep retention, flexural tooth movements and oral habits can compromise integrity and adhesion.

 

Moving along with our desire for stronger, esthetic dentistry, we come onto pressable lithium disilicate.

This material checks the box of making a stronger restorations at  400 – 500 mpa. Excellent accuracy, and strong enough to be considered for posterior restorations.
(* when certain considerations are taken into account)
You can get away with more conservative tooth reduction as well.
It is quite a nice option for inlays, onlays, full or 3/4 coverage for the bicuspids or a first molar in a patient with a ‘kind’ occlusion.
These restorations do come out looking quite beautiful as is, but nice staining and glazing elevates their authentic appearance so much more! Not to mention, the lithium disilicate takes on feldspath layering very predictably. 
The Investing technique with pressable ceramics is easier and more predictable than building a restoration layer by layer with powder. A very finicky process for sure. But for some time now,  to improve on this even more, we have the option of milling lithium disilicate blocks.

The lessons I get from John always boil down to restoration strength, accuracy, esthetics and longevity.

Reproducible quality is of the utmost importance.

So after hearing stories of ‘back in the day”, because he is from ‘ back in the day’. We are on to how esthetic restorations have evolved to pressed ceramics and now to CAD/CAM.

Lets go CAD/CAM !

This is a modality in our profession that has made leaps and bounds in growth over the last 10 years. There is no going back. And why would we do that ?
Doesn’t matter if you are using an IOS or taking analog impressions in your office, in the Lab we are primarily scanning, milling and hand finishing. Yes with the custom, feldspatic layering on request.

Point of view.
The cost of alloys went way up a year or so ago. Patients are expecting metal free. And we all have our high demands and expectations as well. 

Zirconia and eMax are now our go to as a framework for all ceramic restorations. Lithium disilicate and zirconia come in blocks and pucks with  gradient translucency and shade. The lithium disilicate can even have zirconia reinforced in it.
They are highly esthetic, strong and precise down to single micron accuracy.

We have the ability to still achieve realistic tooth anatomy and morphology with milled restorations thanks to the design software available. If you have kids that are gamers or you watch a lot of action movies, you know just how creative computer software has become.
The image above is an example of a cut back milled framework in CAD. As much or as little morphology can be created leaving room for specific characteristics and translucency.

We can have the best of both worlds !

We have the benefit of combining science and technology
with art to create
beautiful authenticity.

Written by Roberta Bertram CDA
Reviewed by John Zahel RDT

 

 


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September 30, 2021

There are various reasons you may have to embark on a search for a Dental Lab. Typically you are going to reach out to your colleagues and see who they are using. You may even reach out to other practioners in a professional group or association.
Either way, it is important to find a fit that works for you and your practice.
I would like to note that this was a question I was asked by last years UBC Dental undergrad group. Most of them just went with who their instructor suggested. I hope this article is helpful to them in particular.

Access to your Technician

Good communication is key in any relationship.

   That includes the one between technician and Dentist.
   Our lab prescriptions shouldn’t have to be the only communication tool. Added info like photos and scans/models are important as well.
You should be able to call your lab and ask what they need from you to do the best job possible.

   A discussion about expectations early on can solve future issues and be a time/money saver for everyone.

Supportive in how you practice dentistry and your growth.

We are all life long learners in Dentistry, with a desire to practice more efficiently and learn new techniques, even expand on our technology. Having a Lab that can accommodate that growth and support for you is essential. It is also important that they are growing and evolving with all the new technology in the dental world as well.
Don’t be afraid to ask your lab what they are doing for continuing education, advancing their skills or potential growth for the future.

A collaborative approach and guidance working through complex cases.

This definitely ties into the previous points above. And it all starts with picking up the phone and having a meeting. Especially if you are embarking on something new, your lab can provide a lot of guidance and knowledge. Seek out a seasoned technician to help you along the way.This may be a situation where you are happy with your crown and bridge lab but need more service from another provider.

Consistency and quality.

A high level of consistency and quality!
That is Johnny’s moto.
Here’s a fun fact about him actually. He was once interested in buying a McDonalds franchise just  because he loved their business model so much!
( I knew I saved this photo for a reason )
But seriously, dental practice and dental lab are both businesses when it comes right down to it. Minimal errors and quick reconciliation help keep costs in     check.
Having that mutual respect and team approach makes us all successful and do wonderful things for our patients.

Written by Roberta Bertram CDA
Reviewed by John Zahel RDT


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