Full Contour Anterior's & Bridges/Micro ?

[charles007]

Lets have a discussion on what I think will be/Is a fast growing market... full contour anteriors and bridges in zirconia, and the same can be said about FC Emax with the new multi-layered ingot and the $$$$$$ of how will we price these new restorations ?
Zirconia is improving with higher translucency and there are many doctors and labs looking for unbreakable, chip free restorations. We now have a choice of using full contour or Micro layering with totally protected porcelain as new options. Are we going to be smart business owners knowing this ? Higher priced layered restorations in metal ceramics and metal free is disappearing..
After months of wondering when I would pickup my first full contour anterior's & full contour anterior bridge I finally did my first bridge this week, 6x8 9x11. Several months ago over several weeks I picked up 3 sets of 8,9 full contour. Apparently full contour zirconia is more than acceptable now.
What have I learned in these select few cases ?
1. They are much harder to design than the hardest posterior single or bridge.
2. If the shading is off your screwed, and Micro layering is your lifeline for shade correction which may prevent another remill/remake.....Hope to hear more opinions from labs who are producing these everyday unlike me. Some labs I know are up to 80% Full Contour ! so I hope to hear other opinions and helpful tips and tricks

One of the reasons I wrote this is because I strongly believe we should charge more for full contour anteriors and bridges. I know the simple unit single FCZ posterior are the bread & butter in our labs and it can be hard to sell these at premium prices in certain regions, and depending on our perceived competition...the $99.00 FCZ... is it ok to say BruxZir lol
Three plus years ago I started designing zir anteriors with protected incisal edges so no porcelain was in occlusion and the same on posteriors when shading was more critical. Now that we have more translucent zirconia's like Imagine, multi-blended zirconia's, and higher strength zir like XT that's more translucent, I'm sure FC restorations will be the growing go-to crown for many of us, and even more so for lower priced labs. You may not agree but I think Micro layering will be a growing technique for discriminating doctors and labs who want the best of both worlds of monolithic and glass ceramics....
If we're heading towards a Monolithic world of restorations, and I know we are, and with extended Cad anatomy libraries, will the $99.00 restoration be the Norm as materials continue to improve and improve.
I say stand up to the low pricing norm and up your prices if using these new materials and techniques.

 

[rkm rdt]

I'm tired of being under cut by every one else.

 

[2thm8kr]

I'm tired of being under cut by every one else.

Block them out.

 

[AGV]

"1. They are much harder to design than the hardest posterior single or bridge"

Yes, besides, 3D designs on the screen are not always what you expected to get when it's milled/pressed. 70% of cases must be "slighty to severe" redone (because of 2D-on-screen to 3D-real-object mistakes),in order to get what you know your Dr. wants for a restoration.
That's because i mill ant. cases in wax, then "redo", reduce incisal to layer and press in LT or MT ingots. Better result than FCZ HT. Even in third position is Multi Layer emax ingots, which i think doesn't worth my time/money.
Anyway there's one thing i'm realizing: The Big Masters of this Universe (Vita, Ivoclar...) are introducing more and more high tech pmma like Enamic. Easy to mill, no ovens, just an adjustment and fly to the clinic. No waste of energy with 1450ºC ovens for hours. The bad is if your Dr. decides to do it in his gabinet. The good is redirecting to the first sentence: "It's really hard to design a good quality resto. even with the be$t equipment..."

 

[JohnWilson]

We charge a bunch more as the unit count increases because of the complexity .

Sent from my iPhone using Tapatalk

 

[BobCDT]

We have been charging more, a lot more for all anterior restoration than posteriors. We moved to this in 2008 when the economy went south and most docs were out looking for a deal. Unfortunately, we didn't go up on anterior, we went down on posteriors. Keep in mind, the price reduction was all at a loss of profitability. Any reduction in existing crown fees (unless you change your process and or cost of goods) always comes off the bottom line. And, the only way to get that profit back is to do more work

I find the difficulty with anteriors with CAD and zirconia is more related to the shrinkage, hardness and having all the needed info in the CAD. Respectfully, I don't think the 2D design is a big problem. When designing anteriors. It's more related to not having adequate info.

I like to have a matrix of the final position of the maxillary incisal edges made from a good study model attached to the lower cast when scanned. When making the matrix, the study cast is mounted to the lower model. I don't sink the incisal edge into the puddy. I make the matrix so it is flush with the labial contour of the teeth and angles as smooth transition so the labial aspect of the teeth and puddy are in the same plane. This helps in duplicating the incisal edge position and incisal embrasure locations and the contour of the buccal plane as related to the study model. Keep in mind this is only as good as the study cast so before making the matrix you may want to spend a few minutes adding wax to make the study cast ideal.
When finishing green state, this is where the shrinkage issue come in and we can't put the units on a cast. for contouring. I lay the 6 units on the bench, lined up and try to idealize each unit with rotaries. This is when I try to do everything, including surface texture. I think getting this right the first time is mostly about technique. Both digital and analog.
If designing in 3Shape, make sure you "adjust to opposing" as early in the design process as possible. The software will recognize the matrix as part of the lower occlusion and cut the design to it. If you are careful when making the matrix and have the puddy fill the gap between the overbite and overjet it is like having a custom incisal guide table. The CAD will recognise the matrix material as part of the opposing. Thus when cutting to opposing all interferences with the matrix as well as the lower teeth are removed. This essentially results in a duplication of form of the functional aspect of the lingual contours. Or, a lingual duplication from the centric stops to the incisal edge. In addition, if you try this make sure your setting for reduction to opposing are set to zero.
Kind of difficult to explained. I'll try to post some pics or a video this week.

 

[charles007]

Thanks Bob, you just demonstrated in great detail reasons for charging a lot more for full contour anteriors/ ant. bridges, and Layered restorations for that matter. Almost all anterior cases I receive sometimes come with poorly shaped temps pre-op models. I scan the pre-op models and use as a guide for the midline, length, width, occlusion, and overjet. Sometimes I re-contour/grind on the pre-op models, and sometimes I wax over to improve to have an improved pre-op model to scan. Even scanning pre-op models as a guide takes a lot of experience to achieve nice shapes and practically ideal occlusion. Labs that are able to produce really nice anteriors separates ourselves from the typical $99.00 FCZ labs, so why not charge a lot more for all the extra work and precision needed on cases like this in full contour or layered.

 

[rkm rdt]

We're running out of people who will pay more for quality.
It's not that they don't want to , but they are tapped out!

There's too many franchise labs and too many group practices out there these days to go back to the way it should be.

 

[BobCDT]

Thanks Bob, so why not charge a lot more for all the extra work and precision needed on cases like this in full contour or layered.

That's the point. If you can do esthetic cases esthetically there are a lot of docs willing to pay good lab fees for nice work. Final contour and function are key elements to chagring higher fees. In addition, the described protocol above really doesn't take much more time and helps insure you get it right so it doesn't come back.

 

[BobCDT]

Hi John,
Im curious about your sintering block. At fist sight it seems as though it could bend or distort during sintering. There must be a reason you are spending extra mill time to hollowed out the middle. Care to share you thoughts on the design?
Thanks

 

[JohnWilson]

Hi Bob my goal is to have similar mass between the pattern and the brace if you look at my pattern it also has 3 drops to lay the pattern down (horizontally) to maintain the pattern in the heat zone while sintering. We get extremely even firing and never once have had a big case like this warp.

 

[JohnWilson]

Here is a better photo, you can see the drops on the molars and the central

 

[BobCDT]

Thanks John, makes sense. Are the tops of the "drops" at the same level as the top of sintering block so the block is also contacting the tray when firing? Do you fire this on a disc or beads?
BTW, the glass look really nice.
Thanks again.

 

[rkm rdt]

Where are the screw access holes?

 

[BobCDT]

looks like a cement on case.

 

[rkm rdt]

I don't think I've seen that before.

 

[Al.]

That's the point. If you can do esthetic cases esthetically there are a lot of docs willing to pay good lab fees for nice work.

Ditto X 100

IMO the word "quality" has little meaning any more because everybody claims they do quality work and then bitch that Drs wont pay for their version of quality any more.

Presentation of your work is so important.

 

[JohnWilson]

Thanks John, makes sense. Are the tops of the "drops" at the same level as the top of sintering block so the block is also contacting the tray when firing? Do you fire this on a disc or beads?
BTW, the glass look really nice.
Thanks again.

Yes bob the brace and the drops are at the same level as the brace. We sinter on a polished disk of alumina, (we also go back and shine this from time to time to maintain the slick surface.(reduce drag)

While the brace alone will support the pattern properly in most circumstances the drops add one more level of security as well. I have had some cases where the tech was a bit rough cutting out the pattern from the disk and the brace fractured from the piece. The drops allow to have some security to try and save the milling when necessary.

 

[JKraver]

I wouldn't say we are running out of people who will pay a more, I think they are being replaced by people who don't know you can get better for more.

 

[rkm rdt]

I wouldn't say we are running out of people who will pay a more, I think they are being replaced by people who don't know you can get better for more.

That's a perfect segway into a thread I have been thinking about starting.

Uber has shaken up the taxi industry.
Netflix has shaken up the cable industry,

What would it take to shake up the dental industry?