Titanium

[TheLabGuy]

Brother Charles...I hear ya man!!!

 

[biodentg]

Hi K2. What is the heat rate (min/C) on a PFT bridge you are using? thanks

 

[k2 Ceramic Studio]

Why use another alloy that will eventually leave a black line at the margins, and maybe even darker lines ?
Some doctors are switching to all ceramic to get away from future black margin and seeing opaque on day one.....and looking for cheaper fixed prices
So, my question is......Why go there with another pfm alloy on your menu.... unless your accounts are asking for titanium....

Why would you get a black margin if you have cut the metal back, also black areas around the neck are due to bio problems even high gold can have a tissue reaction but not with titanium it is the perfect metal for the patient, no tissue reaction no dark margins as long as you opaque it well. I really like Zr and emax but if a client wants a pfm crown why use high cost gold or nasty np when Ti is does the job and is far kinder to the patient!

 

[k2 Ceramic Studio]

Heat rate for Ti

Hi K2. What is the heat rate (min/C) on a PFT bridge you are using? thanks

Hi Biodentg

Just had a quick look at the furnace and this is the program that we use:

Low temp 400'c
Entry time 6min
Heat rate 45c/m
Top temp 810 (for large bridges) 800'c for singles
Hold 1min
Cool time 3min
Start vac @ 400'c
End vac @ 810'c

Never take over 820'c or you are going to have big problems!!!!!

All the best Pete

 

[CatamountRob]

What happens above 820?

 

[k2 Ceramic Studio]

All life as you know it ends, well yours does!!!! as you need to strip the lot and remake everything, Its a bit like emax veneers when you put them in on a pfm program, that look of oh no what have I done. You can get a shift from alpha to beta phase oxidisation that can lead to oxide delamination This should happen at 882'c but I was told the magic number not to cross was 820'c.

(In pure Titanium the alpha phase characterised by hexagonal close-packed crystaline structure is stable from room temperature to approximately 886'c)

 

[charles007]

Why would you get a black margin if you have cut the metal back, also black areas around the neck are due to bio problems even high gold can have a tissue reaction but not with titanium it is the perfect metal for the patient, no tissue reaction no dark margins as long as you opaque it well. I really like Zr and emax but if a client wants a pfm crown why use high cost gold or nasty np when Ti is does the job and is far kinder to the patient!

If I'm not mistaken, all alloys have oxides, and grow darker over time. If Ti is different, please correct me. Haven't used Ti yet ! but I would if my accounts asked for it.. Titanium has a very dark oxide, so my best guess, dark margins could appear just as easily as any other alloy, is not more so..

 

[k2 Ceramic Studio]

I know what you are saying, but It is a very strange metal, it does not oxidise like other metals its a bit like lead, it just goes dull, not black. you do get a jet black colour on your fist Ti bonder firing but that is what should happen and is not an oxidisation. The inside of the crown is the same colour after it has fired as it is when you first sandblast it, I have made hundreds of units using Ti and have never had a report of black/dark margins but I always do porcelain margins. The oxide is oxygen reactive and once it has it then that is it, it will only reoxidise if taken over that 820-880'c figure or if the oxide is damaged through being trimmed or sandblasted.

All the best Pete

 

[Mark Jackson]

The new insurance code puts the reimbursement of Titanium metal between noble and high noble PFM's. Milled Titanium should be the answer to everyone who hates base metals, doesn't want to use base metals, and is sick of putting crap metal in people's mouths.

Hmmm, considering I have a dental office with six dentists right here, I asked our billing department what the reimbursement is for PFT exactly.

Our computer does not even list PORCELIAN fused to titanium, but rather #2794 TITANIUM CROWN.

Our reimbursement is $585, vs $767 for porcelain to SP. Of course that number will vary from plan to plan, and we don't take the crappy ones here. I'm still not seeing the economics of this.

 

[Mark Jackson]

If I'm not mistaken, all alloys have oxides, and grow darker over time. If Ti is different, please correct me.

When titanium oxide first forms (at room temperature) the layer is only 1–2 nm thick but continues to slowly grow. Titanium is not like anything else. Of course these characteristics make it highly corrosion resistant, and help with biocompatibility, but the material is very reactive as temperatures rise.

Adding fluxes etc to lower firing temperatures only causes problems with solubility of the ceramic, and still does not address the formation, and continued development of alpha coat.

Call Glidewell and ask them when they will be adding Titanium to their line up.

 

[TheLabGuy]

I imagine it's not in the CDT book yet Mark, I know it was brand new and I'll look it up again. It was in one of the publications I read recently being released by the ADA, a Titanium PFM and the reimbursement was in between noble and high noble. I'll dig around and find it.

 

[JohnWilson]

Hmmm, considering I have a dental office with six dentists right here, I asked our billing department what the reimbursement is for PFT exactly.

Our computer does not even list PORCELIAN fused to titanium, but rather #2794 TITANIUM CROWN.

Our reimbursement is $585, vs $767 for porcelain to SP. Of course that number will vary from plan to plan, and we don't take the crappy ones here. I'm still not seeing the economics of this.

The reason is that there is no recognized code specifically for this "Exact" restoration. There are notations that state exactly how they classify the metal but no specific code for PFT.

The #2794 is for a full metal crown.

I have been very hesitant to even consider offering this product because of all the years of you bashing the hell out of it. I know you have a lot of experience trying to make CASTED material work but not sure how much milled experience you have had. With that being said, we have been working with the Nobels milled Ti with GC's porc on non real world cases to get a feel for the material, and I have to say the stuff has worked great. We will be rolling out this product as another cost effective "CLEAN" option compared to base metal this next month. Truthfully I don't see it being a very big product for us as EMAX and ZI keep growing.

 

[Mark Jackson]

I imagine it's not in the CDT book yet Mark, I know it was brand new and I'll look it up again. It was in one of the publications I read recently being released by the ADA, a Titanium PFM and the reimbursement was in between noble and high noble. I'll dig around and find it.

The ADA doesn't set fees. Their CDT publication means nothing. They are the NADL for dentists.

 

[TheLabGuy]

The ADA doesn't set fees. Their CDT publication means nothing. They are the NADL for dentists.

I realize that Mark, the insurance companies set the codes, but to do so they must have something to set to and that's where the CDT number comes into play. I'm not sure if this is where I read it but this is off B&D's website HERE

"Perfect Replacement for Noble or High-noble Metal
With gold price ever-increasing, Titanium can be a perfect replacement for noble or even hi-noble metal. The ADA Council on Scientific Affairs has recently classified titanium between noble and high-noble alloys. Because of this new classification, dentists may now charge insurance companies between noble and high-noble rates using ADA Code D2794."

Still looking around because I'm positive I read it somewhere else in a DDS journal recently.

 

[Mark Jackson]

I'm not sure if this is where I read it but this is off B&D's website HERE

Whenever I read something like this, I have to ask myself, "What does B&D have to gain from this?" I know those guys and I like them, but they are the ones selling it, so I do take that into consideration...



"Perfect Replacement for Noble or High-noble Metal
With gold price ever-increasing, Titanium can be a perfect replacement for noble or even hi-noble metal. The ADA Council on Scientific Affairs has recently classified titanium between noble and high-noble alloys. Because of this new classification, dentists may now charge insurance companies between noble and high-noble rates using ADA Code D2794."

Once again Rob, just because the ADA made up a new code, and put it in the line between noble and high noble, doesn't mean much. Hell, the dentist can charge the insurance company $100,000 for Porcelain Fused to Unobtainium, but it doesn't mean the insurance company will actually pay for it.....

And we ALL know how the insurance companies just love their patients and will always pay for the MORE for a better material.

.

 

[TheLabGuy]

Mark, we are not disagreeing here....
I know the ADA can come up with any code they want and it's up to the insurance company to reimburse or not too, they have the say one way or another. The thing here though is that now their is a code to point to. Now when the demand gets high enough (not saying it will) their is a code that everyone including the DDS's can point to for the insurance company to set some type of reimbursement for, whatever that may be, and I do believe some insurance companies (at least in my area) have already started setting the reimbursement value for this.

 

[Mark Jackson]

Mark, we are not disagreeing here....

I know that Rob. I'm just clarifying, or trying to clarify for those people who may not know what we are talking about. I get calls from lab owners all the time, and some people don't understand what the CDT's are, and what they do.

I know the ADA can come up with any code they want and it's up to the insurance company to reimburse or not too, they have the say one way or another. The thing here though is that now their is a code to point to.

"The code has been designated as the national standard for reporting dental services by the federal government"

Once any new material or procedure becomes accepted and standard, there has to be some accpeted way to communicate what is being done to the patient. We can't have every Tom, **** and Harry making up their own terminlogy, nor will the insurance companies tolerate a dentist call stuffing residual bone chips into a socket and billing for a graft.

I just see this claim that you can arbitrarily bill between noble and high noble as nonsense.

I've gotten way off topic on this. I'm sorry.

.

 

[TheLabGuy]

I never really thought about that but you're right, how can you say it's going to be between noble and high noble when most of the insurance companies haven't even discussed this...does make you wonder?

 

[Mark Jackson]

I have been very hesitant to even consider offering this product because of all the years of you bashing the hell out of it.

Actually, I LOVE the material. When I "bash" it, I'm really just objecting to the technicalities of the stuff. Maybe if i had a smaller lab, and I could manage all of these things, it would be a better fit for me, but the kind of lab I own, and the way I run my business is such that I don't like materials that are technique sensitive, and I don't like things I can't measure to see that they are working as planned.

I know you have a lot of experience trying to make CASTED material work but not sure how much milled experience you have had.

Casting the material was only part of the challenge back in the day. Getting reliable control of oxidation, and dealing with the reactivity of the metal was another. Titanium doesn't like high temperatures and until we make a light cured porcelain, I don't see any way to avoid heating it up.

How we got to the coping stage is immaterial to how it behaves once you raise the temperature.

With that being said, we have been working with the Nobels milled Ti with GC's porc on non real world cases to get a feel for the material, and I have to say the stuff has worked great. We will be rolling out this product as another cost effective "CLEAN" option compared to base metal this next month.

Good luck with that. I remember you saying you were going to "roll it out" last year, and I've heard the same thing from a lot of other people, but it just never seems to happen. One of the labs who is supposedly doing a "ton" of it, was here in November to look at my BruxZir mill and he said they've done less than 100 units.

Funny how stories grow as they get retold.


Truthfully I don't see it being a very big product for us as EMAX and ZI keep growing.

We have dropped several products this year, and Captek is currently on the examination table, and under consideration for the ax. I'm no longer adding any new products unless they are going to make a CONSIDERABLE contribution to sales or the bottom line (hopefully both) and we are scaling back our R&D activities.

I'm getting too old to sort out other peoples problems, and as long as there are alternatives that are proven and easy to work with, things like titanium just aren't going to make the cut here.

.

 

[Vazone]

Please tell me, if i have same price for Ti coping and Zr coping why i can choose Titanium? is there any benefits from Zirconia ?