Dom o arrigato, Mr. Roboto!

Paul Feuerstein, DMD

Will Spacely Sprockets take over your dental lab? Procera made a big splash by building computer cores out of ceramic, reducing the aesthetic problems of metals. Because this specialized equipment was so expensive, labs had to send models to one of two Procera labs.

Now computers have arrived in labs. Several companies have now entered into the CAD market, offering labs equipment that they can use in-house. Last year, DENTSPLY introduced CERCON, while Sirona took the CEREC technology and developed an In-Lab system. 3M has recently introduced LAVA. These systems now claim to be useful for multiple units. Should the wax and cast department start looking for new jobs?

Several dental schools are investigating these systems, and many labs have jumped right in. In most situations, the computers are building the cores based on a model that has come from the dentist. Usually, the computer scans the models and then designs the copings. Then, the ceramic artist can skillfully build the teeth into beauty and function.

Several other companies also are in this arena. KaVo, for example, has the Everest system, which not only will create ceramic substructures, but can also mill out of titanium! This system allows technicians to do their own wax-up and design. Cynovad has a product called WaxPro that produces complete wax-ups ready for casting at an amazing rate. Austenal Lab has been using a system called DCS Smart Fit, which they claim can do long span bridges. Ivoclar, Degussa, and a few other European companies have similar systems. What they have in common is that the copings, according to Austenal, are "milled — not cast from solid blocks for greater strength and material integrity with absolutely no shrinkage or casting imperfections." It is also notable that some of these systems will also mill metal substructures if desired.

I surveyed a few dental labs and dentists who have used these systems. Mark Jackson of Precision Ceramics in Calif. states that he has had great success with the newest ceramic bridge substructures. He points out that although today's technicians can get lifelike results from metal, these new restorations are certainly the future.

Larry Borman, of Tetra Dynamics Lab in New York, states that "labs will have to venture beyond three-unit bridges to define the limits of the materials." He also notes that dentists will have to change prep designs and some ideology before these are universally accepted. Long-term results are not yet available. However, Jackson and Borman are monitoring current studies, and they both report excellent results with cases to date.

Of course, clinicians now have to review connector designs, forces, bond strengths, etc. All manufacturers have excellent resources available to the dentists and have support personnel who have been quite skillful in answering my questions. All have contact information through their company Web sites, which are too numerous to list here.

These systems should not be confused with the excellent CEREC system where the entire restoration is built by the computer. Sirona has just introduced new 3-D software that makes the in-office CEREC a simpler, more intuitive system. In fact, if you have not seen CEREC this year, you are in for a great surprise. Most of the difficult outlining and designing has been eliminated. Plus, you can visualize the prep and the proposed restoration in real-time 3-D. If you have been on the fence, you just fell over.

In order to fully assess this new lab technology, you must do some homework. The investigation has to go beyond the technology arena, because we are now discussing clinical treatment.

Talk to labs as well as other practitioners, and study the short and long-term clinical information. You will have to blend your high-tech, clinical, and intuitive dental minds. Since I do have a general practice (in between my time on the Internet), I hope to have a more extensive report on these systems first hand in the future.