Are scanners worth it? Or PVS impressions? For crowns/bridges.

[Mauricio45]

Just curious what your thoughts on. Pros and cons?

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[PerioDont]

just my personal preference...I like them much more.

you can use them for scanning for models as well for NG, surgical guides, invisalign etc.

Is it necessarily worth the cost? not always. depends how much C&B you are doing etc...

as a millenial and tech user, I just enjoy using them.

 

[TanMan]

Just curious what your thoughts on. Pros and cons?

IOS is definitely superior to PVS impressions, but it has to be the right IOS. Not all the scanners are the same, and each one has it's own strengths and weaknesses. In most of your cases, I think the CEREC system is superior to all other systems, due to the integration and seamlessness of scanning, milling, and baking/sintering. I'll go over each one of the ones I personally own:

Primescan:
Pros: Fast, mirror doesn't fog w/ built in heater, can do full arches more efficiently, easy/idiot-proof software. Can capture deep subgingival margins
Cons: Price (although I think it's totally worth it), bigger head than the Omnicam - can be harder to scan 2nd molars, closed system unless you're running a separate software suite, yearly subscription cost (but this is for however many scanners/mills you have onsite, we have 6 cerec scanners + 7 mills and it's sitll the same subscription cost of 1 set)
Current Use: Most everything that requires a CEREC crown/3 unit bridge

Omnicam:
Pros: Smaller head, shared software with primescan (easy to use), can be used to send full arch scans to invisalign (but painfully slow)
Cons: Awful for full arch scans, slower than primescan, no built-in heater so heating pad gives you limited time to prevent fogging, yearly subscription cost. Not great for deep sub-G margins
Current Use: 2nd molar limited opening crown patients

Trios 3:
Pros: Probably the best scanner for full arches in terms of speed, accuracy. Export PLY files (color scans) so you can see the margin real clearly. Very accurate shade measurement (I don't have to do shade tabs anymore) and cross arch accuracy and can capture deep sub-G margins
Cons: Price (but the price has gone down significantly), yearly subscription per scanner (I have to pay 2 yearly subscriptions for 2 scanners).
Current Use: Sending out scans to the lab. Fast scans, fast processing, easy shade taking makes it ideal for lab cases.

Carestream CS3700:
Pros: Small head, different tip for different purposes.
Cons: Small head, but huge handle. Not very ergonomic. Painfully slow scanning AND processing. Sending cases to the lab is a PITA. Upgrading hardware does little to speed up the scans (I tried an RTX 3090 and Quadro 6000 w/ an i9-11900 to no avail).
Current Use: Nothing, as a back up in case my trios and all my cerec scanners catch on fire.

Trios Element 2:
Pros: Invisalign + Outcome simulator
Cons: Massive head, like putting a brick in someone's mouth, slow, proprietary, poor integration with milling systems. Single use sleeves that you gotta keep buying.
Current Use: None - Not doing invisalign at this time.

Maybe I'll make a video running over the last two scanners with a tank. Hopefully this helps in your buying decision. I'd recommend just getting two primescans, two primemills/one MCXL, and two speedfires, and maybe a trios 3 if you send a lot of lab cases out. Best investment you'll ever make. If not, you can always sell your cerecs to me, 😆... jk, I have enough scanners/mills for now.

 

[nobeldds]

You can get a lab to provide you with a scanner in exchange for using their services. This way you can see if you like it. Dandy labs will gibe you the trios 3shape to use

 

[PerioDont]

IOS is definitely superior to PVS impressions, but it has to be the right IOS. Not all the scanners are the same, and each one has it's own strengths and weaknesses. In most of your cases, I think the CEREC system is superior to all other systems, due to the integration and seamlessness of scanning, milling, and baking/sintering. I'll go over each one of the ones I personally own:

Primescan:
Pros: Fast, mirror doesn't fog w/ built in heater, can do full arches more efficiently, easy/idiot-proof software. Can capture deep subgingival margins
Cons: Price (although I think it's totally worth it), bigger head than the Omnicam - can be harder to scan 2nd molars, closed system unless you're running a separate software suite, yearly subscription cost (but this is for however many scanners/mills you have onsite, we have 6 cerec scanners + 7 mills and it's sitll the same subscription cost of 1 set)
Current Use: Most everything that requires a CEREC crown/3 unit bridge

Omnicam:
Pros: Smaller head, shared software with primescan (easy to use), can be used to send full arch scans to invisalign (but painfully slow)
Cons: Awful for full arch scans, slower than primescan, no built-in heater so heating pad gives you limited time to prevent fogging, yearly subscription cost. Not great for deep sub-G margins
Current Use: 2nd molar limited opening crown patients

Trios 3:
Pros: Probably the best scanner for full arches in terms of speed, accuracy. Export PLY files (color scans) so you can see the margin real clearly. Very accurate shade measurement (I don't have to do shade tabs anymore) and cross arch accuracy and can capture deep sub-G margins
Cons: Price (but the price has gone down significantly), yearly subscription per scanner (I have to pay 2 yearly subscriptions for 2 scanners).
Current Use: Sending out scans to the lab. Fast scans, fast processing, easy shade taking makes it ideal for lab cases.

Carestream CS3700:
Pros: Small head, different tip for different purposes.
Cons: Small head, but huge handle. Not very ergonomic. Painfully slow scanning AND processing. Sending cases to the lab is a PITA. Upgrading hardware does little to speed up the scans (I tried an RTX 3090 and Quadro 6000 w/ an i9-11900 to no avail).
Current Use: Nothing, as a back up in case my trios and all my cerec scanners catch on fire.

Trios Element 2:
Pros: Invisalign + Outcome simulator
Cons: Massive head, like putting a brick in someone's mouth, slow, proprietary, poor integration with milling systems. Single use sleeves that you gotta keep buying.
Current Use: None - Not doing invisalign at this time.

Maybe I'll make a video running over the last two scanners with a tank. Hopefully this helps in your buying decision. I'd recommend just getting two primescans, two primemills/one MCXL, and two speedfires, and maybe a trios 3 if you send a lot of lab cases out. Best investment you'll ever make. If not, you can always sell your cerecs to me, 😆... jk, I have enough scanners/mills for now.

Are you guy actually using 6 scan/milling machines at one time for a single doc office?

 

[DrJeff]

Love my Trios.

Had it in the office for a little over 3 years now, and frankly have had ZERO thoughts about going back to PVS.

Worth every penny in my mind

 

[Saddleshoes]

It's all based on the type of practice you are running...

If you cut 15 crowns a month maybe a scanner is not such a good idea.
If you cut 30 crowns a month you might consider investing in one of those gadgets.
If you cut over 60 crowns a month you likely already have a scanner in the office.

 

[DrJeff]

It's all based on the type of practice you are running...

If you cut 15 crowns a month maybe a scanner is not such a good idea.
If you cut 30 crowns a month you might consider investing in one of those gadgets.
If you cut over 60 crowns a month you likely already have a scanner in the office.

Just based on my personal experience, with improved fit from the lab, less adjustments at seating time, the ability to get a REALLY good look at your preps once scanned, etc, I would make the point that the improved final product that a scanner allows most any clinician to deliver their patients, makes the cost of a scanner more than worth it for just about any practice that is doing most any procedures where a lab fabricated item is part of a treatment plan, and that includes removeable units as well! Heck, just being able to fabricate dentures digitally rather than with tray based impressions, is saving me 2-3 visits per case, which allows me to get new removable units to my patients faster, and that also translates into more available chairtime for me to see other patients. And the amount of chairtime that digital impressions can end up saving a clinician can't be glanced over

Truthfully the biggest game changer for me in the now roughly 25 years I've been doing clinical dentistry

 

[Saddleshoes]

Just based on my personal experience, with improved fit from the lab, less adjustments at seating time, the ability to get a REALLY good look at your preps once scanned, etc, I would make the point that the improved final product that a scanner allows most any clinician to deliver their patients, makes the cost of a scanner more than worth it for just about any practice that is doing most any procedures where a lab fabricated item is part of a treatment plan, and that includes removeable units as well! Heck, just being able to fabricate dentures digitally rather than with tray based impressions, is saving me 2-3 visits per case, which allows me to get new removable units to my patients faster, and that also translates into more available chairtime for me to see other patients. And the amount of chairtime that digital impressions can end up saving a clinician can't be glanced over

Truthfully the biggest game changer for me in the now roughly 25 years I've been doing clinical dentistry

Hey Dr. Jeff
Have you ever done a cost per crown analysis on your scanner set up?

 

[DrJeff]

Hey Dr. Jeff
Have you ever done a cost per crown analysis on your scanner set up?

To the penny? Nope,

Roughly? Yes

PVS crown and bridge was running me roughly $200 a unit between the materials and lab fees (lab was charging me roughly $150 a unit)

Digital runs me about $125 a unit (since I almost always go model free now and the lab I use charges me about $100 a unit)

Between my partner and I, we average about 50 units a month, so over the course of a year, even when you add in the annual service fee that Trios charges us, we're saving somewhere around 30k in overhead with the scanner. So the cost of the machine quickly became a non issue.

Add in the chair time we're saving on cement visits as well as during the denture fabrication process and for our practice atleast it really has been a great thing both interms of overhead expenses as well as improvement in final product quality and even in how I go about prepping a tooth now

 

[Saddleshoes]

To the penny? Nope,

Roughly? Yes

PVS crown and bridge was running me roughly $200 a unit between the materials and lab fees (lab was charging me roughly $150 a unit)

Digital runs me about $125 a unit (since I almost always go model free now and the lab I use charges me about $100 a unit)

Between my partner and I, we average about 50 units a month, so over the course of a year, even when you add in the annual service fee that Trios charges us, we're saving somewhere around 30k in overhead with the scanner. So the cost of the machine quickly became a non issue.

Add in the chair time we're saving on cement visits as well as during the denture fabrication process and for our practice atleast it really has been a great thing both interms of overhead expenses as well as improvement in final product quality and even in how I go about prepping a tooth now

Thanks Dr. Jeff
That is great info!

 

[TanMan]

Are you guy actually using 6 scan/milling machines at one time for a single doc office?

Rarely do I have all 6 cerec scanners going on all at once. I usually have a mix of cerec scanners and trioses going on simultaneously. I have had at most 6 mills going on all at the same time. I believe in redundancy and making sure I always have a spare in case anything goes down.

I do have an 8th mill I rarely use called the motion 2. I experimented on trying to do same day 6 unit immediate bridges with mixed results. The design software was just awful and required too much time. I got an oven that can sinter up to a 9 unit bridge in 54 mins. Big costly investment that did not pay off much. I'd rather just send those 6 units to the lab

To the penny? Nope,

Roughly? Yes

PVS crown and bridge was running me roughly $200 a unit between the materials and lab fees (lab was charging me roughly $150 a unit)

Digital runs me about $125 a unit (since I almost always go model free now and the lab I use charges me about $100 a unit)

Between my partner and I, we average about 50 units a month, so over the course of a year, even when you add in the annual service fee that Trios charges us, we're saving somewhere around 30k in overhead with the scanner. So the cost of the machine quickly became a non issue.

Add in the chair time we're saving on cement visits as well as during the denture fabrication process and for our practice atleast it really has been a great thing both interms of overhead expenses as well as improvement in final product quality and even in how I go about prepping a tooth now

Just curious, are you able to do full dentures with the trios?

 

[Mauricio45]

I have used CERECs before in a prior associateship and I did like them. Patients LOVED having it done same day. I found my endos decreased dramatically by having no temporaries.

Unfortunately , too many dentists under-reduce their preps for CEREC. Seen many fractures from other offices. You gotta have 2mm occlusal reduction, no sharp corners, and 1mm chamfer to make it work. Also, isolation is a must especially when bonding 2nd molars.

But yeah , CERECs are very expensive. Is it worth it the trade-off vs PVS impressions?

 

[PerioDont]

I have used CERECs before in a prior associateship and I did like them. Patients LOVED having it done same day. I found my endos decreased dramatically by having no temporaries.

Unfortunately , too many dentists under-reduce their preps for CEREC. Seen many fractures from other offices. You gotta have 2mm occlusal reduction, no sharp corners, and 1mm chamfer to make it work. Also, isolation is a must especially when bonding 2nd molars.

But yeah , CERECs are very expensive. Is it worth it the trade-off vs PVS impressions?

Removing bonded crowns when they fracture too is no fun

 

[TanMan]

I have used CERECs before in a prior associateship and I did like them. Patients LOVED having it done same day. I found my endos decreased dramatically by having no temporaries.

Unfortunately , too many dentists under-reduce their preps for CEREC. Seen many fractures from other offices. You gotta have 2mm occlusal reduction, no sharp corners, and 1mm chamfer to make it work. Also, isolation is a must especially when bonding 2nd molars.

But yeah , CERECs are very expensive. Is it worth it the trade-off vs PVS impressions?

With the advent of same day Zirconia, the traditional cerec rules no longer apply. You could have knife edge margins, 1mm reduction, sharp corners and it'll still work. You're probably referring to emax and the older generation materials. In my office, I no longer do emax - too many annoying variables that make it not work from the milling to the glazing, baking, and try-in, to its overall weak strength... don't even get me started on the cerasmart materials, ugh. There's Katana, 3M, Tessera, Straumann, and so on that's better than emax. Again, screw emax.

CERECs are totally worth it as you don't have to see the patients a second time, no material cost with PVS/trays, less ways to screw it up than PVS, you can fit more crowns in a single production day, and lower lab/materials costs. The trick is to have extra chairs for patients to wait on their crowns so you can prep more crowns. It's not going to work as well if you only have one scanner, one mill, and one oven. I found my sweet spot at 6 scanners, 2 primemills, 5 mcxl's, and 2 speedfires. the two primemills can do zirconia very quickly so they can handle 6 different scanners for 6 different zirconia cases, the 5 mcxl's can be used for multiunit glass ceramics, and the 2 speedfires can do a 3 unit zirconia bridge or 2 single unit zirconias in about 22 minutes. I haven't found the speedfires to be bottlenecks yet (although I project they can be if they have any reliability issues pop up), but I'm afraid I may need a 3rd one if one of them fails for a prolonged period of time. I do have a CS4 backup oven, but I rarely have to use it.

As I emphasize with my other colleagues, one set of cerec scanner/mill/ovens are simply not enough and they will bottleneck each other very quickly. Even two sets can bottleneck each other.

The biggest homerun for the CEREC system is the RCTBuCrn method. Single visit, single tooth solution. You can do multiple patients simultaneously that drive your productivity much higher. If you can fit in at least one extra crown per day, I think that the system paid for itself already.

Removing bonded crowns when they fracture too is no fun

There's easy ways of removing bonded crowns in under a minute. Either use an Er:Yag laser or treat the crown like enamel and undermine it till it shatters (unless they overprepped the hell out of it already). Using an off-axis chattering bur with an electric handpiece will destroy that crown in no time flat.

 

[schmoob]

don't even get me started on the cerasmart materials, ugh.

I was doing an onlay with cerasmart last week and it broke coming out of the machine. Twice in a row! So I just did an emax. I want to switch over to zirconia but I have a ton of emax and other materials to finish first. Plus I don’t have a SpeedFire, I’m still using a Programmat for baking.

 

[PerioDont]

I was doing an onlay with cerasmart last week and it broke coming out of the machine. Twice in a row! So I just did an emax. I want to switch over to zirconia but I have a ton of emax and other materials to finish first. Plus I don’t have a SpeedFire, I’m still using a Programmat for baking.

I hate cerasmart. Never had it work for me either. Always breaks

 

[schmoob]

I hate cerasmart. Never had it work for me either. Always breaks

Did you have any better luck with Lava or Empress?

 

[TanMan]

I was doing an onlay with cerasmart last week and it broke coming out of the machine. Twice in a row! So I just did an emax. I want to switch over to zirconia but I have a ton of emax and other materials to finish first. Plus I don’t have a SpeedFire, I’m still using a Programmat for baking.

The switch to zirconia is completely worth it. Most of our restorations are zirconia now. Way more predictable, save time on try-ins, and don't have to worry about a dreaded crunching noise when seating.

 

[Mauricio45]

Has same-day Zirconia come a long way in terms of esthetics? I remember the old ones looked like popcorn, lol.

Cementing 2nd molars sure beats bonding.

 

[TanMan]

Has same-day Zirconia come a long way in terms of esthetics? I remember the old ones looked like popcorn, lol.

Cementing 2nd molars sure beats bonding.

3M Chairside Zirconia and Katana have gone a long way and are quickly sintered. Comparable to Emax LT.

 

[PerioDont]

Did you have any better luck with Lava or Empress?

I haven’t tried them, switched to Katana and emax. Katana is way to go…I mean if @TanMan is doing it…us mere mortals have no choice but to follow 😁

 

[TanMan]

I haven’t tried them, switched to Katana and emax. Katana is way to go…I mean if @TanMan is doing it…us mere mortals have no choice but to follow 😁

Hahaha. Katana still has its weaknesses - it's harder on the carbide burs, more prone to fracturing in the green state, and can still fracture with heavy bruxers. I prefer the 3M Zirconia more due to never having a fracture and easier to polish. Katana for premolars, 3M for molars, and if I'm in a rush on a non-bruxer, I'll use straumann nice on premolars. I hate emax with a passion. Got rid of all my emax blocks.

 

[Mauricio45]

What is difference between Katana vs Bruxir?

What are your guys thoughts on zirconia bridges? I'm not a fan. I've had some fracture at connector. I won't do another zirconia bridge again. However, I've been bold and done CEREC posterior bridges (even though contraindicated for posterior bridges) and they're still surprisingly holding on well years later.

I think PFM is still best material for bridges.

 

[TanMan]

What is difference between Katana vs Bruxir?

What are your guys thoughts on zirconia bridges? I'm not a fan. I've had some fracture at connector. I won't do another zirconia bridge again. However, I've been bold and done CEREC posterior bridges (even though contraindicated for posterior bridges) and they're still surprisingly holding on well years later.

I think PFM is still best material for bridges.

Bruxzir is a full strength (3Y) zirconia from Glidewell with lower translucency; Katana is a 5Y zirconia from Kuraray with a higher translucency and shade gradient. Much weaker though. I like the 3M since it's a 4Y with a good balance of translucency and strength.

I like zirconia bridges, bur zirconia connector design is very important. PFMs still have their place in longer span bridges, large deviations in draw, and pier abutments. I like stressbreaker bridges in that I can prep more ideally and not have to worry about draw. Works much better in the maxilla since you can hide the connector. For PFM bridges, only non-precious PFM makes sense, semi-precious(Noble/HN) are too soft - you might as well go PFZ or monolithic zirconia at that rate. Also, point of failure for PFM bridges is at the interface of metal to porcelain.

 

[PerioDont]

Hahaha. Katana still has its weaknesses - it's harder on the carbide burs, more prone to fracturing in the green state, and can still fracture with heavy bruxers. I prefer the 3M Zirconia more due to never having a fracture and easier to polish. Katana for premolars, 3M for molars, and if I'm in a rush on a non-bruxer, I'll use straumann nice on premolars. I hate emax with a passion. Got rid of all my emax blocks.

What are you using for anterior crowns? or sending those to lab?

 

[schmoob]

I have a 4 unit anterior case that I decided to try Katana. I’m curious to see what it looks like when i get it back from the lab.

 

[DrJeff]

Rarely do I have all 6 cerec scanners going on all at once. I usually have a mix of cerec scanners and trioses going on simultaneously. I have had at most 6 mills going on all at the same time. I believe in redundancy and making sure I always have a spare in case anything goes down.

I do have an 8th mill I rarely use called the motion 2. I experimented on trying to do same day 6 unit immediate bridges with mixed results. The design software was just awful and required too much time. I got an oven that can sinter up to a 9 unit bridge in 54 mins. Big costly investment that did not pay off much. I'd rather just send those 6 units to the lab



Just curious, are you able to do full dentures with the trios?

As long as we can get a good scan of the tissues and the patient has decent vertical ridge height, yup, doing fulls with our Trios, and have been very happy with the results as well

 

[FeralisExtremum]

I tried an RTX 3090 and Quadro 6000 w/ an i9-11900 to no avail

Can I get that RTX 3090?

 

[TanMan]

What are you using for anterior crowns? or sending those to lab?

It really depends. If it's matching existing crowns that are pretty opaque, I can do it in house, or if it's a canine that's easy to match, I can do it in house. For anterior 4 or 6 cases, I send it out to the lab. I don't have the time to design, stain, and do all the other stuff to make it profitable.

 

[DrJeff]

It really depends. If it's matching existing crowns that are pretty opaque, I can do it in house, or if it's a canine that's easy to match, I can do it in house. For anterior 4 or 6 cases, I send it out to the lab. I don't have the time to design, stain, and do all the other stuff to make it profitable.

Agree 100%!

I enjoy the fact that the lab I use for the majority of my cases is about 10 minutes from my office, so on an anterior case, I just have the patient go to the lab and sit with the ceramist for the final staining and glazing work prior to me cementing the case.

If one if lucky enough to have a lab that they like that is close by their office and offers custom staining services, it can certainly be a HUGE plus both for decreasing your stress level at cementing time, as well as for patient word of mouth as I can't tell you the number of times over the years that I have had a patient, say that one of their friends was telling them about how great their front tooth/teeth looked and how they were impressed that they went right to the lab where the ceramist worked their magic. Happy patient, happy dentist, happy lab with satisfied clients. a win-win-win situation

 

[schmoob]

Agree 100%!

I enjoy the fact that the lab I use for the majority of my cases is about 10 minutes from my office, so on an anterior case, I just have the patient go to the lab and sit with the ceramist for the final staining and glazing work prior to me cementing the case.

If one if lucky enough to have a lab that they like that is close by their office and offers custom staining services, it can certainly be a HUGE plus both for decreasing your stress level at cementing time, as well as for patient word of mouth as I can't tell you the number of times over the years that I have had a patient, say that one of their friends was telling them about how great their front tooth/teeth looked and how they were impressed that they went right to the lab where the ceramist worked their magic. Happy patient, happy dentist, happy lab with satisfied clients. a win-win-win situation

Last week I had a pt come in for an appt for wax rim try in, he was wearing immediates still. The rims were so God awful and needed to be remade. Instead the lab tech came in to take impressions. She used his immediates as a template and then soft tissue. She must have used 7 or 8 tubes of PVS and kept taking it out and placing more impression material and impressing again. Then she says “all done! Ready for processing and delivery of final denture in 2 weeks.” What? What is this sorcery? I’m very curious to see the results. If it’s good then I will line up my denture patients and have her come in for a few hours taking impressions. I don’t care that I have to pay her and the materials cost because it saves so much chair time for me and much less of a headache. I’ll let everyone know the outcome.

 

[PerioDont]

Last week I had a pt come in for an appt for wax rim try in, he was wearing immediates still. The rims were so God awful and needed to be remade. Instead the lab tech came in to take impressions. She used his immediates as a template and then soft tissue. She must have used 7 or 8 tubes of PVS and kept taking it out and placing more impression material and impressing again. Then she says “all done! Ready for processing and delivery of final denture in 2 weeks.” What? What is this sorcery? I’m very curious to see the results. If it’s good then I will line up my denture patients and have her come in for a few hours taking impressions. I don’t care that I have to pay her and the materials cost because it saves so much chair time for me and much less of a headache. I’ll let everyone know the outcome.

Is your lab tech a denturist? I wonder why she needed that much PVS.

Since there were immediates, you just skip wax try in and replicate those?

 

[schmoob]

Is your lab tech a denturist? I wonder why she needed that much PVS.

Since there were immediates, you just skip wax try in and replicate those?

I guess. She was able to capture CO/CR with this magnificent monstrosity too.

For the pre-dents reading this who happen to not get any offers of admission, become a lab tech and become a damn good one. This woman had no student loans, was doing very well financially, Louis Vouitton threw up all over her, and I think at one point she was emitting some sort of heavenly glow.

 

[TanMan]

Last week I had a pt come in for an appt for wax rim try in, he was wearing immediates still. The rims were so God awful and needed to be remade. Instead the lab tech came in to take impressions. She used his immediates as a template and then soft tissue. She must have used 7 or 8 tubes of PVS and kept taking it out and placing more impression material and impressing again. Then she says “all done! Ready for processing and delivery of final denture in 2 weeks.” What? What is this sorcery? I’m very curious to see the results. If it’s good then I will line up my denture patients and have her come in for a few hours taking impressions. I don’t care that I have to pay her and the materials cost because it saves so much chair time for me and much less of a headache. I’ll let everyone know the outcome.

Labs in my area send their lab techs for all-on-X provisionalization and charge a hefty fee; however, the dentist doesn't have to do anything but place the implants. That's a lot of PVS though. Hopefully the lab fees are significantly less than your denture/prosthesis fees.

I guess. She was able to capture CO/CR with this magnificent monstrosity too.

For the pre-dents reading this who happen to not get any offers of admission, become a lab tech and become a damn good one. This woman had no student loans, was doing very well financially, Louis Vouitton threw up all over her, and I think at one point she was emitting some sort of heavenly glow.

Being a lab technician can be quite difficult, dealing with all the crap that dentists give them, from unreasonable expectations to horrible impressions and late nights in the lab, along with the price competition among the bigger laboratories. This might sound jaded, but LV is kinda passé these days - everyone has one and it's kinda like the new Coach of 10 years ago.

 

[PerioDont]

Labs in my area send their lab techs for all-on-X provisionalization and charge a hefty fee; however, the dentist doesn't have to do anything but place the implants. That's a lot of PVS though. Hopefully the lab fees are significantly less than your denture/prosthesis fees.



Being a lab technician can be quite difficult, dealing with all the crap that dentists give them, from unreasonable expectations to horrible impressions and late nights in the lab, along with the price competition among the bigger laboratories. This might sound jaded, but LV is kinda passé these days - everyone has one and it's kinda like the new Coach of 10 years ago.

What’s TanMans brand? Haha.

I’ve never been one for brand name clothes. Personally if I’m spending $$ it’s gonna be on custom tailored clothes that fit well not something with a logo plastered all over

 

[schmoob]

Labs in my area send their lab techs for all-on-X provisionalization and charge a hefty fee; however, the dentist doesn't have to do anything but place the implants. That's a lot of PVS though. Hopefully the lab fees are significantly less than your denture/prosthesis fees.



Being a lab technician can be quite difficult, dealing with all the crap that dentists give them, from unreasonable expectations to horrible impressions and late nights in the lab, along with the price competition among the bigger laboratories. This might sound jaded, but LV is kinda passé these days - everyone has one and it's kinda like the new Coach of 10 years ago.

The prices are okay. But the price to get the tech to take impressions is totally worth it for me because of the saved chair time I free up a ton of slots. One single appt slot where I cut a crown more than pays for multiple visits from the tech

And I think her shoes were Balenciaga

 

[TanMan]

What’s TanMans brand? Haha.

I’ve never been one for brand name clothes. Personally if I’m spending $$ it’s gonna be on custom tailored clothes that fit well not something with a logo plastered all over

I have no specific loyalty to a brand. I like to wear what fits well and looks good. LV has become one of those brands where everyone and their mom and secretaries all have. If you're trying to showoff your purchasing ability with brand name but everyone has it, "it" seems to be commonplace and drab. I gotta admit that bespoke suits are probably some of the best clothing I have. Not cheap, not suits I could wear everyday, but when I need to dress for an event of sorts, I look good and feel good. And as for watches, some people say that rolex is overdone, but in dentistry, watches have one real functional purpose... to protect my wrist. I've banged up my rolex so many times, but I know that my wrists are worth more than the rolex. Now, I could just as well wear a seiko, but I still like the look. If it's going to be a functional wrist protector, it might as well look good.

The prices are okay. But the price to get the tech to take impressions is totally worth it for me because of the saved chair time I free up a ton of slots. One single appt slot where I cut a crown more than pays for multiple visits from the tech

And I think her shoes were Balenciaga

Sounds like a great deal. Subcontract busy work to free you up for more productive work. The lab tech's time doesn't seem that expensive either. I only wish I had some cheap lab techs in my area. Still, I hate dentures with a passion or anything that requires a follow up.

 

[schmoob]

I have no specific loyalty to a brand. I like to wear what fits well and looks good. LV has become one of those brands where everyone and their mom and secretaries all have. If you're trying to showoff your purchasing ability with brand name but everyone has it, "it" seems to be commonplace and drab. I gotta admit that bespoke suits are probably some of the best clothing I have. Not cheap, not suits I could wear everyday, but when I need to dress for an event of sorts, I look good and feel good. And as for watches, some people say that rolex is overdone, but in dentistry, watches have one real functional purpose... to protect my wrist. I've banged up my rolex so many times, but I know that my wrists are worth more than the rolex. Now, I could just as well wear a seiko, but I still like the look. If it's going to be a functional wrist protector, it might as well look good.



Sounds like a great deal. Subcontract busy work to free you up for more productive work. The lab tech's time doesn't seem that expensive either. I only wish I had some cheap lab techs in my area. Still, I hate dentures with a passion or anything that requires a follow up.

On average how many units of fixed do you personally produce a day, if you don’t mind me asking. No worries if you prefer not to answer.

 

[TanMan]

On average how many units of fixed do you personally produce a day, if you don’t mind me asking. No worries if you prefer not to answer.

Average, maybe 7-10 units? There's ups and downs. Sometimes, I could have 20+, sometimes, I could have 3.

 

[PerioDont]

Average, maybe 7-10 units? There's ups and downs. Sometimes, I could have 20+, sometimes, I could have 3.

How do you keep your hand from fatigue when prepping 20+ units in one day?

are you doing other things during this time or do you block off solely for doing what I assume are full mouth cases?

 

[TanMan]

How do you keep your hand from fatigue when prepping 20+ units in one day?

are you doing other things during this time or do you block off solely for doing what I assume are full mouth cases?

It's not hard. Prep smart, not hard. Electric handpieces, extracoarse burs, lots of irrigation to prevent your burs from clogging, and it's pretty easy overall. Bridges are examples where you can produce 3+ units with a minimum of 2 preps. 20+ units doesn't always mean 20+ preps.

Of course I would be juggling a full schedule on this (hyg and ops). I never block off time just for one patient/case - that's totally unproductive (and risky if a patient noshows). Now, if I had a bunch of patients not show up and I had just one ops patient for the 15/30/1hour block, then so be it. I don't do full mouth cases, VDO alterations, or anything of the like, so this is usually a bunch of patients with multiple units of prep.

I tried to do an anterior 6 same day bridge case, but it just did not work out from a production level. Few mins for prep, 90 minutes for milling, 60 mins for sintering, 15 mins for characterization... was just a total PITA to try and execute the same day. I'd rather take a DI, temp and send off to the lab.

 

[schmoob]

Just an update here. The lab tech came and delivered two complete arches. They were incredible. Perfect fit, retention, esthetics, phonetics, etc. the pt was thrilled, especially with phonetics. If he needs to come in for me to relieve a spot here or there I don’t mind because I saved so much chair time.

To make things even better, the pts wife is doing an immediate load maxillary All-On-X that I will be restoring soon. With the pt happy, the wife will be more motivated to get her tx done ASAP. If she is happy, let’s hope she will do her lower arch as well. Looking forward to seeing some more of her magic. I’ll try to take some pictures and post them.

 

[TanMan]

IOS Update(s) and lesson on mission critical systems (in general):

Primescans seem to have an issue with camera cords. I had the misfortune of 2 primescans acting up due to camera cords. One I was able to fix with some packaging tape temporarily, the other I wasn't. Henry Schein was able to do a permanent fix (since fixing it myself permanently might void my warranty) on one, but waiting on another camera cord for the other one. This is the weakness of the primescan right now - reliability.

Also, if you're going to have mills, make sure they are hardwired and make sure that you have a strong wireless signal with your IOS/mill at all times. If it means creating a mesh network and/or upgrading your wireless adapter, do it. 1GbE network can be saturated pretty quickly and I would recommend looking at upgrading parts or your whole network to 10GbE, with a strong mesh router system (although I prefer a hardwired backbone to the mesh router system). Asus has a pretty cool feature called AiMesh where you can have two routers acting like mesh routers. The off the shelf mesh routers are still pretty weak imo and we ended up putting two ASUS ROG AX11000 routers in tandem along with another asus router just so there's no dead zones.

Anyway, important lesson for IOS's and other technology. If it's a major game changer and involved in your daily operations, it's always a good idea to have redundancies in your system. I'd recommend having two scanners (and mills), two compressors/vacuums, two servers, backup computers, sensors, and anything else that you use everyday (even backup power). It is very expensive to lose a day or two of productive work.

Just an update here. The lab tech came and delivered two complete arches. They were incredible. Perfect fit, retention, esthetics, phonetics, etc. the pt was thrilled, especially with phonetics. If he needs to come in for me to relieve a spot here or there I don’t mind because I saved so much chair time.

To make things even better, the pts wife is doing an immediate load maxillary All-On-X that I will be restoring soon. With the pt happy, the wife will be more motivated to get her tx done ASAP. If she is happy, let’s hope she will do her lower arch as well. Looking forward to seeing some more of her magic. I’ll try to take some pictures and post them.

That's cool - have you calculated your hourly production with all on X cases compared to your standard workflow? I tried exploring that avenue with a system called hybridge and while the system seems good in terms of time savings, it didn't seem to meet my hourly rate (I'd actually make less money per hour and assume more liability).

 

[schmoob]

That's cool - have you calculated your hourly production with all on X cases compared to your standard workflow? I tried exploring that avenue with a system called hybridge and while the system seems good in terms of time savings, it didn't seem to meet my hourly rate (I'd actually make less money per hour and assume more liability).

I have not calculated my hourly production yet. Factoring in patient time, lab time, lab fees, etc. I’m sure it’s going to be good, but not super amazing. Besides I’m only restoring, I’m not doing the exos and grafting.

I had another denture case yesterday so I called the lab tech again. No preliminary impressions, no custom tray, no wax rims, no try in. Just the lower arch after I extracted his teeth a few weeks ago. He has full arch bridgework up top. She took this giant impression and it’s straight to processing. She captured vertical, soft tissue, etc.
The most important thing besides the chair time is my peace of mind. She’s going to do a better job than me and I don’t deal with the headache. After the new year I will probably convert it to an overdenture.

What material do you use for anterior cosmetic work? I don’t use CEREC for big cases. My last few times I’ve used Katana and have been very pleased with the results.

 

[TanMan]

I have not calculated my hourly production yet. Factoring in patient time, lab time, lab fees, etc. I’m sure it’s going to be good, but not super amazing. Besides I’m only restoring, I’m not doing the exos and grafting.

I had another denture case yesterday so I called the lab tech again. No preliminary impressions, no custom tray, no wax rims, no try in. Just the lower arch after I extracted his teeth a few weeks ago. He has full arch bridgework up top. She took this giant impression and it’s straight to processing. She captured vertical, soft tissue, etc.
The most important thing besides the chair time is my peace of mind. She’s going to do a better job than me and I don’t deal with the headache. After the new year I will probably convert it to an overdenture.

What material do you use for anterior cosmetic work? I don’t use CEREC for big cases. My last few times I’ve used Katana and have been very pleased with the results.

That's cool that you have auxiliaries to do your removable/full arch work.

I rarely do anterior cerec's unless it's a slam dunk easy match such as matching existing PFM/zirconia crowns. For anterior cosmetic work, I prefer bruxzir esthetic with custom shading. It has the strength, it's more translucent than 3Y full strength zirconia, very wear resistant, and looks as good as emax (when shaded properly). These stressful times has changed the types of procedures and presentations that I'm seeing. I'd say about 90% of my patients are grinding/clenching + parafunctioning at this time. I trust zirconia more than emax or any other LiSi material at this time.

I like Katana, but I'm looking to switching to Cerec MTL zirconia. Katana still has some pitfalls and I've had some extreme bruxers that have broken katana upon try-in. Never happened with the 3M, but it's not as esthetic.

As we speak, I'm trying/milling out Zircad Prime right now on a 5 unit bridge. We'll see how it works. If it doesn't work out well, I may try Zirkonzahn prettau or origin beyond plus. I may start doing more labwork in house if I get good results and outsource the designs so I can mill them. My lab costs are ridiculously high even with all the cerec we do.