Monolithic Madness

[JeffT]

Hey all, down here in Oz the Monolithic train is starting to build up steam, particularly with the release of Lava plus and ultimate, bruxzir, core opalite and everyone else who has a material that is suitable for full contour. Emax started it all and we do heaps of it. I guess maybe the future will be monolithic for 90% of our day to day work with the rest being good old fashioned layering. (will the next gen of techs even learn how to layer or will it be a specialty skill aquired if desired but not necessary?). Anyway, with the Monolithic train well underway in the States /Europe, I was wondering what you guys thought of it all, particulary in regards to FCZ and how well it has been recieved into the industry and also if products like Lava Ultimate will have a place as a permanent restoration. Our lab is planning a big promotion on all things monolithic but I do not want to go crazy if these materials are not really continuing to perform in North America / Europe now that the hype has settled.

Penny for your thoughts
Jeff

 

[sidesh0wb0b]

EMax isnt going anywhere anytime soon. Ivoclar has lots of stuff in the pipeline and just the past 3-4 mo at the lab im at now we have seen a MAJOR shift to EMax......talking from 50/50 EMax/PFM to 85/15 EMax/PFM

 

[charles007]

Emax isn't going anywhere any time soon.... are you kidding..Wait til you see the stats on emax for this year compared to last year in labs across the country.. .

I totally agree with 90%+ of our work being done in mono, I'm there now.. .. Sometime soon we will see fcz used on anterior as zirconia improves, and its being done now. At his time its fairly easy to make the facial or buccal surface look very nice with products like GC Lustre on FCZ, its the occlusals that are practically impossible to make them look as good as a well made pfm.
Last year I thought emax would peak at the begining of this year, I was so wrong,, it appears that more labs like me started doing more emax and the bottom fell out with pfms because of the skyrocketing rage of the FCZ RocketTrain..
I see a growing number of doctors wanting to buy cheap tickets on the Mono Train compared to higher priced tickets on the PFM Limo, that leaves black tire marks in patients mouths.
The older doctors are always seeing chipped porcelain on older pfms they seated years ago. Patient are now asking about the black line they see at the gum line of their crowns. More and more patients are asking for white crowns.. Now we have monolithic crowns like emax that looks better than the average pfm and zirconia that will not break, and both can be facially or buccaly layered that looks just as good if not better than pfms. We have young doctors learnng about cad/cam in dental school and ready to jump in with years playing computer games.. Now ask yourself, if you were a young dentist and had a choice of paying less for a mono crown for most of your bread and butter cases, which ticket would you want to buy,,the Mono Train, or Pfm Limo that breaks down much more often as it ages.

Monolithic crowns are growing at a faster rate than any product in the past 40 years I worked in the lab. Nothing compares at any level..
For the younger techs with a -15+ years in the lab that spent $$ on courses to layer porcelain, you haven't wasted a dime, but you can't slow down the cad/cam mono train..These same techs will end up making better looking mono crowns and keep prices from hitting bottom,.... when they see the light of all ceramics.
This out of control wreckless cheap tickets Mono Train is not slowing down for any brush licking pfm tech.. I have 40 years at the bench and I very clearly see the future of this business and where its going...Love it or hate it, Mono is here to stay, and FCZ is the hotest ticket in town on posteriors..
Just wait till Lava Ultimate takes off, its going help alone with emax-fcz put a head stone on pfms in many labs.. lol

 

[ed 3]

there will be room for any kind of material. If economy recovering very slow but steady like right now we going to see pick up of demand for ether emax , pfm or full zirconium. The only one thing will be no doubt- the shortage of qualified tech's many of whom changed their careers for the past 10 years.

 

[cheadlemick]

As a tech of 40 years i'm amazed at how some of us look at our profession! Monolithic crowns look **** compared to E-Max, let's be honest how many preps do you get to give enough room for monolithic to look even halfway natural. !'m lucky i will retire soon and the saddest part is no one seems to have pride in their skills any more! How many of you on here do their own plumbing or plastering or car maintenance? The general public hardly know what we do never mind what is involved, give a bloke in the street a manual on how to pour an imp they wouldnt get past page one! I hope none of you techs out their are hoping to get your family involved in this job because it wont be around too much longer!

 

[ed 3]

let's be honest how many preps do you get to give enough room for monolithic to look even halfway natural. !'m lucky i will retire soon and the saddest part is no one seems to have pride in their skills any more! How many of you on here do their own plumbing or plastering or car maintenance?

Hi cheadlemick, you are right! The devil is in details isn't it? I personally have a multiple skills- plummer,welder,craftsman, contraction manager,dental tech. But I love what I am doing now,how long I will be as a dental tech. I try not to think so much, but trying to do my BEST,that is all!
In MHO non of the NEW STUFF better and softer for opposing than layered ,pfm's or full pressed Emax crowns., but it is just me and I don't care what many of our community think.

I am taking one day after another as a God given. What will be tomorrow none can predict, except this humble forum.

p.s. as a contraction person I would add-up , how many of you seen buildings without metal supported concrete??? Exactly! PFM's do not go away anytime soon unless found new material from another planet LOL

 

[JeffT]

I am a newbie to the digital world having just added a scanner to our lab, and we are using it more and more every week now. We still wax and press our emax which gives me a bigger buzz now more than ever because it's like a little treat for me, and today I layered a custom emax for a single central which I took a little longer to do because I was bonding with my hard learnt skills (or did I just have more time freed up because of the scanner). So as long as we can still do a little of each in between scanning and designing I think we can still have a fullfilling career.

Just a side note to this, Here in Australia we are seeing more and more crown and bridge labs close as techs go over to become clinical prosthetists which I figure should provide more opputunity for us, while they slowly over populate their trade

thanks all
jeff

 

[SiKBOY]

Hey Jeff, you are right wih more c&b techs doing the pros course. I to thought that the massive influx of Techs doing Pros course will flood the denture
Making market but then one of my mates that just started the pros course told me that the amount of sugar in everyone's diet today is more than ever.

I just started my own lab and I believe that I have entered the market at the worst time possible but I have different goals and am aiming at a different market. Hopefully my gamble wil pay off

 

[SiKBOY]

As a tech of 40 years i'm amazed at how some of us look at our profession! Monolithic crowns look **** compared to E-Max, let's be honest how many preps do you get to give enough room for monolithic to look even halfway natural. !'m lucky i will retire soon and the saddest part is no one seems to have pride in their skills any more! How many of you on here do their own plumbing or plastering or car maintenance? The general public hardly know what we do never mind what is involved, give a bloke in the street a manual on how to pour an imp they wouldnt get past page one! I hope none of you techs out their are hoping to get your family involved in this job because it wont be around too much longer!

I have steered EVERYONE away who has even had an inkling about being a tech. The hours that I have done (14 to 16hr days 7 days a week) is not a life to me.

I just made up my own lab and did everything myself with my dad helping out. From plumbing, wiring new lights, running air lines, electrics, cabinet making etc. It was fun and I really enjoyed it. Now if something goes wrong I have more of a chance to know where the fault is and I don't have to call in someone to fix it costing me downtime and money.

I love working with my hands and the reason why I got into this job is because I didn't want to be stuck in front of a computer all day.

 

[NicelyMKV]

I think the popularity of full contour work, even among highly skilled technicians, is purely time savings. How many of you guys are sick and tired of constant nights and weekends? I know I am.... I'm also tired of dealing with unskilled labor. Tired of investing a year or more in someone only to have them decide that the pay isn't good enough fast enough, or the work is too difficult, or they just flat out didn't continue to progress. As far as training in house, ceramists? Really? That's years of knowledge. I have about 100 units sitting piled up at my ceramics bench. I don't have years to train someone and hope that they are capable? I think that's the draw to the cad/ milling/ full contour craze? Maybe?

 

[CoolHandLuke]

you's are all thinking behind the curve. too many of you just want to get the existing products done. you arent willing or are incapable of thinking ahead; the way we process crowns and dentures is shifting. like an airplane, it is beginning the stage of lifting off the ground and into a new age.

the 3d systems exist but so few have the capability to understand how to use it, even less have the capacity to use it well. much in parallel with your unskilled labour; so few tech seem capable. fewer still seem proficient.

as mastery of the system progresses the systems in turn change. we're shifting now from a simple scanner into a system designed to be cleaner, faster, and streamlined. a process change; now from impressions to final insertion we've gone hands-off.

is that not the way so many trades have gone? geology now is using Lasers instead of pickaxes; construction is now using printing instead of bricklaying.

this is the way it should be. ignoring it or discounting it will not solve the problems faced by the day-to-day lab.

ingenuity was at first solving the problem of expensive materials by replacing porcelain with zirconia; much more profitable - but the cost of switching means a new tool to use, and potentially disastrously use.

the ingenuity from here is to solve the un-useablity of the tools. make them capable of thinking on their own; make them able to parametrically go about the process without input. to make the software able to recognize problems and solve them.

not an easy task, indeed, but one that is being tackled by almost every major brand of CAD out there.

as far as monolithic crowns being something of a current novelty, well that will change. one day a new material will spring up, easier to work with, faster to design, perhaps even enamel coloured.

with doctors now growing replacement teeth from stem cells, it is highly possible we will not ever need to design monolithic structures in lieu of designing stem cell capsules.

 

[paulg100]

well lets see what happens when it gets automated enough. im sure 3m, nobel, straumann, dentsply etc will be ready to step in and bypass the labs as soon as the times right.

another reason to get a backup plan like Clinical Dental Tech qualification.

some think the departure of techs from the trade will be good for them. Personally i think this will be one of the driving forces to make the big guys step into the space, with their automated commodity crowns.

 

[JeffT]

Cool hand luke, I agree but how long will all these advancements take to be relized. We can only work with what is available now. I am sure there is a "holy grail" material out there but who knows when and if. Imagine designing a crown or stem cell capsule with 3D holographic software, where the software is so intuitive that it does it all. (do we even have to turn on the computer). This will come i'am sure but it will evolve slowly I think.
Windows 3.2 to Win 7 now, It has been evolving for years but I still have to tap a keyboard and move a mouse.

"blade runner, Bicentennial man " not yet

 

[PCDL]

well lets see what happens when it gets automated enough. im sure 3m, nobel, straumann, dentsply etc will be ready to step in and bypass the labs as soon as the times right.

I wouldn't think that this will be a problem for a long time. These companies, by and large, are too industrial for them to service a dentist fully. They work on mass production of items, not "custom fabbing" one off parts. It's just too far outside of their core competency to make it profitable. What you have to do is stay ahead of the curve, and be proactive, not reactive. That will keep you busy, and keep your kids busy (Im a second Gen guy). Im as busy as ever, and I think the next 5 years are going to be awesome!

 

[JeffT]

" one of my mates that just started the pros course told me that the amount of sugar in everyone's diet today is more than ever."



Sik Boy, I have stopped putting sugar in my cofee and tea so I should be fine, just got to curve my cola intake when I have a Macca attack

 

[subrisi]

I still don't get the whole full contour ZI thing. Every single one of my customers don't want to deal with them and they all say the same. "Why does it has to be sooo strong?" ( if something has to break, it better be the crown and not the tooth) and "It would take me 3 burrs to cut that s*** off if I have to." So why not keeping it in emax? I strongly believe that the monolithic Zi is pushed so hard just to utilize the milling machines. Those monsters are just too expensive to sit around. There had to be something invented to keep them running. But is this really in the interest of the patient? I do believe milling is something that will continue to grow as a part of industrializing our work and will never go away, but I think the material choice is something to be reviewed and to be improved.

 

[JeffT]

I still don't get the whole full contour ZI thing. Every single one of my customers don't want to deal with them and they all say the same. "Why does it has to be sooo strong?" ( if something has to break, it better be the crown and not the tooth) and "It would take me 3 burrs to cut that s*** off if I have to." So why not keeping it in emax? I strongly believe that the monolithic Zi is pushed so hard just to utilize the milling machines. Those monsters are just too expensive to sit around. There had to be something invented to keep them running. But is this really in the interest of the patient? I do believe milling is something that will continue to grow as a part of industrializing our work and will never go away, but I think the material choice is something to be reviewed and to be improved.

Maybe this is where the Lava Ultimate will come into it's own.

 

[NicelyMKV]

My doctors draw to FCZ was the fact they didn't want to reduce as they should. Knife edge margins and 4 tenths occlusions don't play well with Emax and are an esthetic nightmare with PFMs. Yes, FCZ are not the most esthetic thing either, but they can handle some of the bad situations I get 50% of the time. I do not agree with the reason but can't argue with the clinicians asking for it directly.

I can do pretty much whatever I need to with cad. No lack of understanding the technology etc. you still can't compare a monolithic crown to an artfully layered restoration. I don't care how talented of a cad operator you are or what technology you are using to fabricate your design. That may change one day but not anytime soon.

I've been thinking a lot about standards. Who sets them? What is considered success? Is working 12 hour days and weekends considered a standard because some people are willing to do it? Free remakes? Cheaper prices?
Most look at the guy with the most money as being the most successful. Is that all success is? What about the guy producing the most clinically sound and natural looking restoration? Is he not considered successful because he can't purchase a muti million dollar yacht? Just wondering......

I am constantly fighting justification in our industry and within myself.

 

[rkm rdt]

When I attend a local lecture and notice that I have less grey hair than everyone else and I don't reek of cigarettes then I know I am successful.

 

[JohnWilson]

Give it another few years and you can be completely jaded like the rest of us

All kidding aside you are so correct, who's bar are we trying to measure up to? Successful/competent to some is poverty/inept to others.

Be happy, live longer, work smarter, charge more! is my motto.