‘Why did you buy a Procera when you like the Straumann CARES so much…..?’

So this week we took delivery of a Nobel Procera and it seems that just about every technician in the UK found out within a few hours of delivery!  It is a small industry I suppose but what prompted me to write a long over due blog, was the initial emails, tweets and facebook messages I received when people heard I had bought a Procera.

‘Did you but a Procera because the new Straumann system isnt any good?’

‘Did you buy a Procera so you can do cheap Straumann abutments?’

‘Did you buy a Procera……’ and on and on the questions went mostly presuming we were stopping using our other CAD-CAM systems like CARES and Bellatek

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Firstly let me state something, the new CARES 8.0 from Straumann is flipping awesome and I’m not changing anything that I do on the Straumann system.

But back to the original question of why we bought a Procera, its a very simple answer.  

I bought a Nobel Biocare Procera scanner to do my Nobel Biocare implant work.  

I like to think as a lab we are as ethical as possible and my Nobel Biocare work has risen to record levels and I like to use genuine on genuine.  So all of my Nobel abutments and bars will now be done through my Procera machine.  Its an awesome machine with some fantastic easy to use, intuitive software that makes complex implant work a breeze to do.

My e-max, CoCr, Straumann abutments and everything else I use my Straumann CARES 8.0 for will remain exactly the same.  I’m baffled why anyone thought that would change.

So it made me think about labs and CAD-CAM and the future ahead.  I use what I honestly feel to be the best which is why we use Procera, Straumann CARES, Bellatek, Atlantis, GC-Tech, ISUS and several other CAD-CAM systems cherry picking what is right and what feel is the best for that type of job, using genuine parts where ever possible.  If you are looking for one system to do all your work, then you will be looking for a very long time.  As modern forward thinking technicians we need to be looking at multiple CAD systems.  I realise that for many small labs this is an issue and I’m afraid to say I’m not sure how great the future is for small labs that cant afford to invest in multiple systems but I think its the future.  Our customers expect me to offer the most cost effective, accurate CAD-CAM solutions and thats why I bought a Nobel Procera because its the best at making Nobel Biocare implant work.

So I hope that answers some of your questions.  My next question to myself is likely to be what awesome new systems will I be wanting to buy after IDS.  Now thats a much more exciting question!!

Soft tissue model on iTero implant models

“So how good as these iTero implant models” is a question that I get asked almost weekly if not daily.  ‘Fantastic but they have a few issues’ is my general answer.  The two issues are the pins and the tissue and I’ll answer and deal with both.  This post though is the soft tissue issue.

The models come with ‘hard’ soft tissue and when seating components thats a nightmare so now make soft tissue models.  Its quick and easy and takes about 10 minutes max.  Below is a full photo series of the procedure, any questions drop me a tweet @byrnesdental or post on our facebook.

So we have now not cast an abutment for over a year and its a great feeling.  With huge price hikes in the UK of gold parts, its not only no longer cost effective its also time consuming.  So several people have asked me, ‘how do you do your CAD-CAM abutments?”

Three ways, Straumann CARES, Atlantis on Dental Wings and Nobel Biocare (through sub contract).  Each has a benefit and each has issues and I dont think there is a simple one off solution.  We dont wax these abutments up but we do always do a full contour wax up.  From CADENT iTero scans its still a little of a guess as we cant scan in a wax up but I’m sure thats only a matter of time.  The Straumann CARES are the easiest for us, a simple scan of the scan body, wax up and soft tissue and then off to go.  I could teach anyone with an implant understanding to scan these in a very short space of time.  The other main issue with CARES is that its Straumann only unless you like two piece Zi abutments which I dont.

The Atlantis using Dental Wings works just like the normal Atlantis but you need a DW scanner and you send a scan, not the models.  They still design the abutment and you get it back a few days later.  Its quick and easy but I must admit I like designing my own abutments.

The Nobel option is a little flawed for us as I like what we get back but I’m sending to another lab.  They do a great job but they are making money that I should be making.  Why do I not own a Nobel Procera?  Well at present its still a little limited to what I can scan but if the new update allows me to scan multiple systems for beams and bars I think we may well be reassessing the situation.

So as a lab if you are still casting….why?  Its so easy to CAD-CAM now, its cheaper and better for the patients health so stop casting and get scanning! You know its the future!!

iTero bite issues solutions

The iTero digital impression scanning and model system is in summary quite simply fantastic but the one area we have a problem with is the bite.  If the bite is taken wrongly by the user or the patient didn’t bite in the correct position the models will not be occluding in the correct position.  This isnt a fault with the system, these are basic issues dentistry and working with patients.  The problem though is how to re-articulate the iTero models.  We’ve played with plaster, funny jigs and all sorts of complex methods and yet still be were not 100% happy until the solution suddenly came to one of the team at Byrnes Dental.  “Why dont we just saw the arm off the model and stick it back in the same position?”.  Genius! Sometimes the simple ideas are the best so thats we do now.  Its explained best in the images below but in short a new occlusal record is taken, the bite is checked and if wrong then one arm is cut off.  The models are then stuck together using the new record and then re-joined using Pi-Ku-Plast from Bredent (or similar duralay).  This technique whilst a little crude solves the issues and the artics from iTero, Denar etc can still be used.  Here are the photos that show the procedure:

Automated iTero and implants working a treat

Well the new automated service from Straumann and iTero models seems to working great on single teeth.  In summary the clinician scans a scan body screwed onto the patients implant and uses the iTero to scan it.  Easy peasy.

The scan arrives at the lab and we simple select the scan body and the software coverts that into a hole that we can buy a replica for direct from Straumann relevant to whatever the implant was (all of Straumanns fixtures are covered).  It then arrives at the lab and we simply pop in the replica.  The abutment can be designed from a simply export of the STL file direct into the CS2 scanner and the results….  Well have a little look at the images below:

iTero remounting issues solved

If you take a bite with iTero and its wrong a simple bite reg and re articulation isn’t easy with iTero.  The models do not mount well with plaster and of course the dies need to be removable.  We get asked this question a lot so we thought we’d share our ideas.  The key is fairly simple, a plasterless articulator.  We like the Amann Girrbach system with their

Artex articulator.  The models fit nicely onto the bases with minimal adjustment as these images show.  So next time you have an iTero that needs re-mounting, this technique works a treat for us from small singles to full arch work.

Oral design symposium 2011

The team at Byrnes all headed to the Oral Design Symposium to see some of the worlds leading technicians and clinicians show off their work.  It was held in London this year over two days and was an outstanding conference.  Full of hints and tips from all over the world the team really felt they picked up some great stuff.  Not only was it great for new skills we also picked up clients from as far as Australia!!  The interest from this blog seems to have reached the far flung corners of the world and its nice to be hunted down by people who want to work with us.

We have not posted much work recently as the lab has been busy and the latest and greatest technology has now become pretty much routine work for us and cases that may be of interest are fitted and forgotten so quickly now the technology is working so well for us.

So I have attached a few images, the two guys are Tony Byrne on the right and Douglas Terry, author of Aesthetics and Restorative dentistry on the left at a book signing.

CAD-CAM on Ankylos abutments

Using the CS2 software and scanner from Straumann we have seen huge cost savings for our clients in many areas but we have in the past struggled with accuracy and fit when using the Ankylos implant system.  The small balance abutments have been hard to scan and ensure we get accurate margins but with gold taking another hike, we had to crack on and try or face a lifetime of casting and trimming CoCr which is every technicians nightmare!

The CS2 has made it a lot easier, we cant deny that and the use of the Armann Girbach scan spray has finally meant large span bridges are easy to make.  So what does the cost saving represent? Well take the case below, its 10 units and on balance abutments plus it needs pink ceramic.  Estimated cost of alloy?  Around the £700 mark and that is being conservative.  So we scanned the CT guide in as it was made from the temporary denture and then designed the bridge using the CS2.  It was then milled in Coron and from the weight of the delivered CoCr we calculated the saving.  £847 saving!!  Thats quite a saving for a patient!

The bridge was then built up conventionally and veneered by David Sherrington at the lab (nice job Dave!) and fitted. Patient was delighted.

IDS report

Well IDS was a roaring success and it was clear to see that CAD-CAM was suddenly taking a giant leap forward.  I was there from Tuesday to Saturday and now I’m home exhausted!  The combination of walking, talking, networking and of course the parties, you almost need to have a ‘get fit’ program before you go.   We saw some new intra oral scanners but nothing matched the models from Cadent, loads of new CAD-CAM systems and a shocking amount of Chinese, Korean and Indian dental labs selling direct to the European and US market.  Scary times?  Maybe, but if we can use tools like CAD-CAM to stay ahead and focus on our customers, then maybe we can beat this manufacturing invasion from the East.  Anyway, back to the far more exciting world of developments of digital dentistry.

Developments: If I’m honest, in terms of technology I didn’t see anything ground breaking.  Tweaks of CAD-CAM, the new replicas for iTero implants (case to be document soon) were about the best but in terms of company developments, one stood out from the crowd.  Straumann, 3M ESPE (Lava) and Dental Wings have joined forces in terms of a license agreement.  This is powerful stuff!!  The two CAD-CAM software systems that stood out for us where Dental Wings and 3Shape with in my opinion, neither being better or worse than the other.  However, bolt Straumann and Lava onto Dental Wings and I think its obvious which becomes more attractive.

So what does that mean?  Well the top bods at Straumann and Dental Wings sat me down and tried to explain it as best as they could and used an analogy from one of my fav bits of kit, the iPad. “Imagine Dental Wings is the iPad platform, its the core system and allows you to scan things you were not ever able to scan before on the CS2 like competitor abutments, screw retained work on competitors and partial dentures. However as  CS2 user, you want to keep that Straumann quality so use the Straumann App.  The app bolts on and you use it for your crowns, bridge, emax and Straumann implants and keep that high level of work.  One platform, one scanner but you can buy bolt on apps”.  Now Straumann will want to protect their business so as a CS2 customer, everything I do on the CS2 will be greyed out and you will not have a choice to use another milling centre.  Thats fine my me, the quality is second to none anyway.  The exciting part for me is that everything that I cant do on the CS2 software, I can now do on someone elses milling centre.  I may not get the strict standards set my Straumann but at least I can hunt around and get the best abutments, partials etc that I can and get them made digitally.

Genius!  I really mean it!  The Dental Wings platform is powerful, seriously powerful but it is just a platform, if you want to mill or print your restorations, its your choice where to get that done.  I must be honest and say I have not seen any company milling as good as the major players like Straumann, Nobel and Biomet but thats mainly because of the investment those guys have and you will not be able to send ‘out of house’ scans to them unless approved.

This all goes live in September but we hope to do some testing earlier and get this on the blog asap.  Its a huge step and made the IDS worth attending!  I’ll post more on the IDS updates as we get them.  Thanks for reading.

Screw retained bridges using iTero. Did they fit in the mouth?

So we wrote last week about the screw retained CAD-CAM work on Straumann implants in this post.  So I stated I would not sleep till I knew if they fitted.  It was pushing the limits of the iTero and the CS2 and I wasn’t 100% confident it would fit.

Guess what?  It did fit!! WOOHOO! The response was amazing from the clinician and he was really impressed.  We will be publishing this case so I cant post the images but if you collar me at the IDS show I’ll show you the case on the iPad.  Nice to know it works so well.  Full arch next!