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Inside Dental Technology
May 2018
Volume 9, Issue 5

New Materials Help Progressive Laboratory Push the Envelope

Composite material works well for complex immediate-load implant cases

VIVIDX dental laboratory has spent the past 5 years developing its immediate all-on-X guided offerings. Owners Brian Lindke, CDT, and Yuichi Ikenaga, RDT, have added hardware and software to help diagnose, plan treatment, and virtually plan implant placement along with the dentist and surgeon.

"We are a partner on the team for complex single- and dual-arch immediate-load implant cases," Lindke says. "We have been building that for the past 5 years, and we are at a point where we are extremely busy with it."

VIVIDX enters the process at the beginning now, working with the clinicians throughout the case, including in the surgical operatory.

"We used to handle full-arch implant-retained cases that already had integrated implants," Lindke says. "Being a more active part of the team and utilizing technology to develop new procedures and concepts has been rewarding not only for me personally but also for our business."

That wide range of new technologies and materials hitting the market makes the laboratory's role more critical than ever, Lindke says.

"We are fabricating new types of restorations with new materials and processes that even prosthodontists may not fully understand," he says. "Things are changing so quickly that clinical dentistry is having a difficult time keeping up with itself, let alone with the changes on the laboratory side. It is important that each team member has a strong grasp of their role and capabilities, so we can keep cases on track through communication and planning."

Lindke has worked directly with patients throughout his career, but usually it has been post-surgical interactions pertaining to the final restoration. Recently, he has found particular gratification participating in the diagnosis, treatment-planning, and surgical stages.

"It is really rewarding," he says, "and it also allows me to ensure that the laboratory has input at each stage so that when we fabricate the final prosthetic after the implants are integrated, there are no surprises or guesswork. It is a complete workflow."

Recent innovations have helped make it a quicker workflow, too. Lindke notes that the concept of teeth in an hour or a day is not new, but that it has not been done for final, definitive restorations.

"We are working on the concept of an immediate final restoration, and we are getting very close," Lindke says. "We have utilized Shofu HC Blocks & Disks to make the teeth on the restoration. Zirconia and lithium disilicate are not forgiving at the time of surgery because even though it is fully guided and very accurate, variables exist. It may be necessary to enlarge or move the screw access hole to accommodate the long axis and angulation of the implant. The restorations that we have designed are not temporary; they are a hybrid of a final restoration."

For example, Lindke says, composite can be added to a Shofu HC crown to correct the shape and the hole, and the result will be a definitive restoration.

"Many patients need this type of care and treatment," Lindke says. "It is a definitive restoration that will last for many years; it is better than a denture tooth hybrid restoration, which many patients end up using as final restorations."

Even for final dentures, Lindke says Shofu HC Block & Disc in conjunction with TRINIA is preferable to the standard titanium bar, denture tooth, and acrylic hybrid.

"Traditionally, teeth pop out of the acrylic, vertical dimension wears down quickly, and there is uneven wear and undue stress on the implants because of the wear," he says. "The titanium, acrylic, and denture teeth do not connect together well, but if we have a TRINIA milled base with the Shofu HC milled teeth on top of tooth preparations with pink composite, the composite-based chemistry in all three components provides a true adhesion that will be stronger and hold up because of the nature of the materials we are combining."

Lindke also uses Shofu HC Blocks & Disks to mill temporaries, including larger-span bridges, because the material is stronger than PMMA and more adjustable in the intraoral environment. He adds that Shofu Lite Art stains, specifically designed for composites, help further characterize the materials to accentuate the superb esthetics.

VIVIDX also is working on developing new processes and applications for Shofu HC Blocks & Disks that Lindke expects will be impactful.

"We are constantly innovating," he says, "because we want to be not just on the cutting edge but on the bleeding edge. In the future, these processes may be the standard for most laboratories, but for us, they already are part of what we do."

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