Does everyone make digital dentures now?

Flippercentral

Flippercentral

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I was wondering, because to read the lab magazines you would think everyone makes them now. I don't plan to go digital, should I just end my career right now?
 
JMN

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I'm not.

We got no ansswers from digital denture people in tue how many a day thread. So I'm guessing not that many. Keep in mid, if the trade publications and their ads were right Dental Wings would be top dog.
 
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bigj1972

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No...been a removable lab for 24 years. Technology is not there yet to replace current standard or ROI. Drs are eager because they think they will get stuff faster and cheaper, and also think it will come about with a wand. That's not gonna happen. 3D printing is promising. Ivoclar's milling system looks the most promising if I was going to pick one now, but I think the real level of change will be the next generation of 3D printing and approved materials.
Right now its all a marketing blast toward Docs and labs. They just see new toys to play with. Can they make dentures? Yes. But are you gonna spend $25-50K to make a base plate? Is the Dr? The Dr won't make a wax rim in the office to save $40. With digital, the Dr (assistants) will have to take good impressions, bites, and measurements/facebowish. I can barely get a midline marked on a wax rim.

Here's a question. How do you print a cast metal partial?
Sure you can print a pattern to cast, even go for laser sintering. But how do you get the saddles & teeth on? If it has to see a flask (pour/pack),then what was the reason to spend all the money.
If milling becomes the standard, you gonna need a room full like Glidewell if you believe the others here that boast they do 10 dentures a day.

3D printing does make nice Surgical guides though. That's the value to Drs who have invested inhouse for wand and Formlabs.
Sure Formlabs prints a 6 pack of denture bases, but they look ugly, and I have seen no protocol for repair/reline, and you know how that time frame works. And are you gonna print a whole new denture for replacement, for free(repair cost)?
 
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Flippercentral

Flippercentral

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I agree, I think it's mostly hype right now, but that's all you see in the lab publications and meetings now, there's a tremendous effort to push this through. Tom M, rest his soul, used to argue that digital could do away with relines and repairs because the denture would be on file and we could just print a new one for less cost than the repair or reline.I'm sure the dentists will have one in their offices at some point (they never pass up a new toy at the conventions, lol),however they will be in for a real surprise when they find out dentures aren't the same as full mouth crown and bridge , lol.
 
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bigj1972

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I agree, I think it's mostly hype right now, but that's all you see in the lab publications and meetings now, there's a tremendous effort to push this through. Tom M, rest his soul, used to argue that digital could do away with relines and repairs because the denture would be on file and we could just print a new one for less cost than the repair or reline.I'm sure the dentists will have one in their offices at some point (they never pass up a new toy at the conventions, lol),however they will be in for a real surprise when they find out dentures aren't the same as full mouth crown and bridge , lol.
Exactly....just look at all the Cerecs on E-Bay. The business model is to promise Star Trek technology, sell expensive equipment that need subscriptions, and now your committed and on your own after the free day of training. Thats where the money is made in the industry. And by the time you can use it, there's a new one, just like PCs and digital cameras.

Can you make a digital denture?...yes. Can Cerec make a crown?...yes. Beauty is in the eye of the beholder.

Its success will be determined by what becomes the new accepted standard of product. Many dentists are happy with their Cerec crowns, although it wouldn't have been previously acceptable from their C&B guy.
 
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Doris A

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Most of my docs want a natural set up, with that being said, they'll heat up a wax spatula and move a tooth or two and get the pts approval in one appointment. You can't do that with digital, so, no we're not going digital.
 
CoolHandLuke

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you absolutely can do that Doris, theres a company in eastern USA called Evolve that will sell you this.
 
Jason D

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Its a very small minority today, but it will change rapidly over the next 2 years, there are one or two behavioral things to fix and 2 technical obstacles going from analog to digital in the lab workflow.

the real problem is compliance from the dentists. also they all want to do it with IOS ....which is not possible of course....

and the hype you see is just that - hype. they are trying to make you think you are behind if you are not already doing digital dentures, and the fact is the workflow and costs are not there yet, so you would be R&D not a manufacturer (as we always are, but you don't make money that way, and many labs don't have a lot of extra time and cash to spare).

The Ivoclar method? It may be further along than some of the others BUT if you think milling is the way to go with removables I think you do not know much about milling....subtractive manufacturing is going to die as fast as materials and processes get in line with additive manufacturing, its just way too efficient. Nope Ivoclar is promoting digital milling of dentures to get you to buy their new line of mills and pucks because their cash cow of emax is dying so fast.
 
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Flippercentral

Flippercentral

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Its a very small minority today, but it will change rapidly over the next 2 years, there are one or two behavioral things to fix and 2 technical obstacles going from analog to digital in the lab workflow.

the real problem is compliance from the dentists. also they all want to do it with IOS ....which is not possible of course....
I'm giving it 5 years, and still until the next generation of dentists graduate that use this kind of equipment in dental school it won't be used so much. If I was just starting out, I would be excited over the possibilities for the future, however, I'm not going to invest in the equipment I'll just ride it out as long as I can.
 
Jason D

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The printers to look at right now are Kulzer and Carbon. Kulzer is further along with their materials than anyone, (and the Cara Printer is fantastic at its price point. In some ways it outperforms our eden 260 at less than 1/5 the price!) and carbon is moving very fast, though their business model is very pricey, (they just created an 'entry level' lower monthly cost - down from 4k to 2500 - if you can live with a smaller build area.)
 
Flippercentral

Flippercentral

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The printers to look at right now are Kulzer and Carbon. Kulzer is further along with their materials than anyone, (and the Cara Printer is fantastic at its price point. In some ways it outperforms our eden 260 at less than 1/5 the price!) and carbon is moving very fast, though their business model is very pricey, (they just created an 'entry level' lower monthly cost - down from 4k to 2500 - if you can live with a smaller build area.)
I'm fairly ignorant on digital dentures, I thought most were milled, the ones you suggest are printed?
 
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bigj1972

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The Ivoclar method? It may be further along than some of the others BUT if you think milling is the way to go with removables I think you do not know much about milling....subtractive manufacturing is going to die as fast as materials and processes get in line with additive manufacturing, its just way too efficient. Nope Ivoclar is promoting digital milling of dentures to get you to buy their new line of mills and pucks because their cash cow of emax is dying so fast.
As stated, if I had to choose now, as in where we are with todays standard. A high impact acrylic base with a single/sectioned PMMA arch (Ivoclar tooth libraries) glued together. Serviceable with current techniques. I was not promoting Ivoclar or any milled removable system.
Agreed...3D printing (additive) is the future, but its not there yet. By today's standard.

Standard being the Dr or patient doesn't notice any visual difference between your analog/digital appliance. Anything printed now is obvious. And the resins are not there yet or maybe never will be.
 
Jason D

Jason D

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I'm fairly ignorant on digital dentures, I thought most were milled, the ones you suggest are printed?
Milling is pretty wasteful as a denture option, there are a few exceptions but for the bulk of work printing will be what wins.

i understand the objection that "it doesn't look like the old dentures"

BUT there are 2 important things to consider:
1 - dentures dont look like teeth, so who cares if they look like 'dentures have looked for a while now"
2 - we all said this about zirconia 15 years ago...now it would be almost impossible to keep a fixed lab open without it, and the material improvement reached 'acceptable' to the vast majority of clients very quickly

(please note I am not opening a debate on whether mopnolithic zirconia is pretty enough etc, I am saying the market has spoken, and zirconia won vs pfm)
 
Jason D

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To be fair… I think if you showed your customer a picture of the denture fresh out of a flask without any finishing trimming polishing etc. they wouldn’t approve of that either… You can’t take a denture out of a printer and deliver it to a patient unless the aesthetic standards are extremely low. There is postprocessing to be done and characterization ... I have seen printed dentures That match some very high-end characterized dentures with custom tinting oh and texturing. However, that all takes work and right now that process costs too much in the current workflow. But that will change soon… Everything does.

Many crown and bridge labs posted pictures of their beautiful PFM’s 15 years ago and said that their customers would never except digital crowns made of solid zirconia. And 5000 of those labs don’t exist today
 
Flippercentral

Flippercentral

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The denture in the pics above any seasoned denture person would smile at. Personally I do all my work in wax before I process. There is minor border trimming and then straight to polish. The denture above almost looks like a thin flexible denture with an attempt to add some tint. Maybe I'm missing something.
 
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bigj1972

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The denture in the pics above any seasoned denture person would smile at. Personally I do all my work in wax before I process. There is minor border trimming and then straight to polish. The denture above almost looks like a thin flexible denture with an attempt to add some tint. Maybe I'm missing something.
Seriously though a much better job could have been done. Contouring and such. Apparently the translucent pink or white you have to "paint" to look more natural.
 
Jason D

Jason D

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Again, it helps to understand what you are looking at. These are not complete products, this is one stage in the process, these “dentures” are nothing more that a printed base and a printed arch of teeth which have been placed together. Depending upon the system and process there can be several steps after this which are similar to glazing a crown, if you are familiar with fixed work this would be analogous to a bisque bake or even a framework for porcelain application.

There are subsequent steps of glazing and/or layering of translucent characterized composites to finalize the restoration.

It is in your best interest to learn about these methods now, even though they are not yet practical for daily production, because sooner or later they will be - and if you have had your head in the sand or insisted “my doctors would never except this junk” then you’re going to lose your doctors when someone else gets it right… Digital is here to stay folks if you expect to stay in this industry more than a couple years you owe it to yourself to learn about it. It’s really too late for crown and bridge people to “go digital“ but removable labs are at the beginning of that journey, take advantage of the writing on the wall that you see in the crown and bridge world already.
 
Flippercentral

Flippercentral

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Again, it helps to understand what you are looking at. These are not complete products, this is one stage in the process, these “dentures” are nothing more that a printed base and a printed arch of teeth which have been placed together. Depending upon the system and process there can be several steps after this which are similar to glazing a crown, if you are familiar with fixed work this would be analogous to a bisque bake or even a framework for porcelain application.

There are subsequent steps of glazing and/or layering of translucent characterized composites to finalize the restoration.

It is in your best interest to learn about these methods now, even though they are not yet practical for daily production, because sooner or later they will be - and if you have had your head in the sand or insisted “my doctors would never except this junk” then you’re going to lose your doctors when someone else gets it right… Digital is here to stay folks if you expect to stay in this industry more than a couple years you owe it to yourself to learn about it. It’s really too late for crown and bridge people to “go digital“ but removable labs are at the beginning of that journey, take advantage of the writing on the wall that you see in the crown and bridge world already.
It may not matter what I'm about to say, however, I've been in dentistry since 1987 and dentures was not a weeks long journey, it took decades. Sure you can make a denture after a few courses, however there is so much more to them that you can't put in a machine. The ones here who have done this awhile know what I'm talking about, like it's a duty to stay in the business because once this knowledge is gone (aged out) and if it isn't passed along then the public will suffer. I suspect dentures will end up like watchmaking, there are plenty of digital watches out there, but horologists are very much in demand to make watches despite talk of the end of their craft.. Like I said earlier, I will do this until there is no more need, but I'm not buying the digital.
 
Jason D

Jason D

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It may not matter what I'm about to say, however, I've been in dentistry since 1987 and dentures was not a weeks long journey, it took decades. Sure you can make a denture after a few courses, however there is so much more to them that you can't put in a machine. The ones here who have done this awhile know what I'm talking about, like it's a duty to stay in the business because once this knowledge is gone (aged out) and if it isn't passed along then the public will suffer. I suspect dentures will end up like watchmaking, there are plenty of digital watches out there, but horologists are very much in demand to make watches despite talk of the end of their craft.. Like I said earlier, I will do this until there is no more need, but I'm not buying the digital.
I understand and agree about the journey.
I also have been doing dentures since the 80’s and the biggest problems with the digital approach are that they are not understanding the principles that all good removable techs have to employ.
In fact, it is this lack of knowledge that has caused the current offering of digital options to be so second rate. I literally just had a two hour conversation This week with some of the people from carbon about the gaps in the methodology. I was bringing up things that I thought would be patently obvious if they have talked with Denture technicians about how to implement this technology… They acted like they had never heard any of it before… It was discouraging and encouraging at the same time because they were thoroughly interested in learning about some of these gaps but apparently they’ve never been told… It’s crazy!
 
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