Inside Dental Technology
May 2014
Volume 5, Issue 5

Meeting Patient Expectations

New materials, software, and processes facilitate the creation of exceedingly true-to-life restorations

By Kate Hughes

When it comes to their dental procedures, today’s savvy patients have come to expect cosmetically superior outcomes. They demand esthetic, durable, and functional restorations that not only look like natural teeth, but also act like them. The demand for dental solutions that replicate nature has driven the dental team to use materials and technologies that promise the utmost in beauty, strength, and fit, and dental manufacturers have been hard at work developing those solutions.

According to a 2013 survey by the American Academy of Cosmetic Dentistry, patients are undergoing cosmetic procedures in ever-increasing numbers1; and, as dentistry moves ever closer to more naturalistic solutions, more and more patients will continue to demand and expect dentistry to improve their overall physical appearance and boost their self-esteem. Recognizing an opportunity, many manufacturers have been feeding this demand through education, creating consumer-based websites that play into patients’ desires for natural-looking teeth. As the patients become more educated, their esthetic requirements sway toward an undetectably natural outcome, and they are willing to pay a premium to ensure that those restorative solutions can pass as natural teeth.

Additionally, industry trends—such as the move toward digital technology and all-ceramic/zirconia materials—have expedited this process. Dental laboratories that specialize or offer cosmetic services have already started to incorporate these innovations into their workflow. Laboratory owners who have been able to adapt successfully to these trends have found their businesses primed for success in this segment of the dental industry.

A Collaborative Atmosphere

According to Peter Pizzi, CDT, MDT, FNGS, owner of Pizzi Dental Studio in Staten Island, NY, laboratories invested in meeting patients’ growing esthetic demands must be prepared to partner with their dentists in order to produce the high-end, natural, and functional restorations that the market currently expects. A passion for education and a solid footing in diagnostic planning is what sets high-end, cosmetically-focused laboratories apart from the competition. He believes that a common thread seen in some of the most successful dental laboratories offering cosmetic services is a desire on the part of the technician to play an active role in the patient’s treatment plan. “The laboratories that are doing well today seem to be the ones that have an open line of communication with their dentists and their patients. These laboratories are not only focused on how pretty a restoration looks, but have a diagnostic opinion to share with the clinician regarding prep-design, material choices, and the final esthetic results.” Pizzi asserts that how the technician approaches a case, and how he or she takes ownership of the final results, can make a huge difference in the appearance and functionality of the final outcome.

Jonathan Ferencz, DDS, echoes Pizzi’s sentiment. Ferencz, a prosthodontist with an esthetics-focused practice in New York City with an in-house laboratory, says that when working on cosmetic cases, he looks to the dental technician as a partner, and expects the technician to work with him collaboratively in order to achieve the best possible final results. “I would want to ensure that any laboratory I work with has the ability to analyze photographs and intra-oral scans in order to create the best final restoration for a patient,” he says. Ferencz also claims that laboratories looking to compete in the cosmetic market should aim to incorporate the latest innovations in materials and technologies into their workflow.

As cosmetic dental procedures become more complex, partnering with a knowledgeable laboratory can make or break cases that require superior beauty and function. By becoming educated about challenging procedures and cutting-edge material choices, laboratories can position themselves as a resource for their clients, making them an invaluable presence on the restorative team and helping them to take on more business. Eric Kibler, Marketing Manager of Removable Prosthetics at Ivoclar Vivadent, says the ultimate way for a laboratory to differentiate itself is to help clinicians with cases that set them apart from other dentists. “Being able to provide patients with solutions that cannot be duplicated by another dental team is the best way to ensure that business is always booming,” he explains.

CAD/CAM Cosmetics

Today, CAD/CAM technology plays a significant role in most aspects of dentistry. In terms of cosmetic cases, it allows laboratories to concentrate more on esthetics while achieving a superior fit and function in their prostheses. Pizzi does caution, however, that in cases where esthetics are of the utmost importance, technicians should not rely on CAD/CAM processes to save them a significant amount of time. “If a laboratory’s mantra is to make everything cheaper and faster, CAD/CAM can be an excellent tool for streamlining production processes. But ‘cheaper and faster’ should not be a mantra for laboratories working on cosmetic cases.”

Ferencz sees CAD/CAM affecting cosmetic dentistry differently than Pizzi, namely in how it drives material trends. “Because CAD/CAM is becoming the preferred method of fabrication for many laboratories, there is a huge uptick in the use of milled materials in cosmetic cases.” Ferencz cites this increased demand for milled restorations as the reason that many manufacturers have become increasingly focused on the production of highly esthetic millable materials.

Increasingly Esthetic Materials

One of the biggest trends seen on the materials side of the dental industry is a move toward all-ceramic restorations verses metal-based. Ferencz says that the reason the industry is taking this direction is that all-ceramic materials are not only more esthetic, but can also deliver very successful results. “Metal is being utilized less and less in cosmetic dentistry, and today the two hottest materials on the market are lithium disilicate and zirconia. Both of these materials are capable of high-end esthetics and can offer excellent strength and durability,” he describes. Ferencz adds that zirconia has also become a viable substitute for metal frameworks, one that his practice has preferred for some time.

“Many dentists think all zirconia products are the same but that’s not true,” says Ferencz. “The introduction of colored, highly translucent zirconia blocks allows laboratories to deliver a highly esthetic restoration.”

However, developing new highly esthetic materials and processes lies not only in the realm of fixed prosthetics. The projected future demand for esthetic, yet durable removable solutions has also motivated manufacturers to develop increasingly high-quality dental materials for the denture market. Kibler says that the demand for esthetics has pushed manufacturers to formulate increasingly superior materials to provide patients with more esthetic choices that surpass less-esthetic options both in durability and appearance. “In a down turned economy, technicians, clinicians, and patients alike are looking for the most durable, esthetic option at the best price,” he says. Kibler cites denture teeth as an example of a restorative component in which esthetics and durability go hand-in-hand. “Higher tier denture teeth are not only more esthetic than lower tier teeth, but they are also often made of stronger materials.”

Kibler also mentions that the development of new dental materials has given the industry more options, allowing the dental team to tailor their restorative approach to each individual patient’s needs, including financial. “When there are a number of financial options for patients looking to undergo cosmetic procedures, they are likely to find a manageable solution for their dental issues.”

Expanded Resources

Although new technologies and materials offer technicians and dentists with myriad answers to cosmetic demands, they are merely tools that rely on the skill and knowledge of the dental team to execute properly. Pizzi stresses that any new technology, materials, or procedures adopted in the laboratory should act as resources for the restorative team, not substitutes for their knowledge and skillset. He explains, “In the end, our job is to replicate nature. The goal is to utilize these new technologies and materials as tools to create a final restoration that achieves the highest form of esthetics, and provide our clients with life-like restorations.”


1. American Academy of Cosmetic Dentistry. State of the Cosmetic Dentistry Industry. Updated December 2013. Accessed April 8, 2014. https://www.aacd.com/proxy/files/Footer%20Nav/Media%20Room/AACD%20State%20of%20the%20Cosmetic%20Dentistry%20Industry%202013.pdf.

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