October 22, 2009
Earlier this week, I wrote a post concerning 3M’s response to Ivoclar’s new marketing blitz touting e.Max (lithium disilicate) as the most robust all-ceramic restorative system available. 3M brought up issues regarding framework design parameters used in the study, and some other information regarding the flexural strength of the veneering ceramic fired to zirconia substructures, and I tend to think they may have some valid criticisms of the study upon which Ivoclar is basing their advertising. However, one claim in 3M’s webinar really got my attention – in short, that the “strength” of lithium disilicate has been shown to degrade in a wet environment.
I received a comment to my post from an old friend within the industry. We chatted yesterday and my friend made basically the same claim, adding that the degradation began to appear in the 18-24 month time range and was exacerbated by adjustment of the glazed surface of a “finished” lithium silicate restoration. I have a deep amount of respect for my friend, and was pretty alarmed by what he was saying. I’m a big believer in “where there’s smoke there’s fire”, so I called Ivoclar directly to get their response. I was directed to Dr. Thomas Hill of Ivoclar who emailed me the following -
“E.max lithium disilicate does not degrade or have significant loss in strength in a wet environment. We have heard these “claims” too. They appear to have come from a study done with a lithium disilicate material that never reached market and did have an issue with leaching, hence why it never reached market. The lithium disilicate was reformulated for the present e.max materials and has no such issues. Also, the data that has been produced by NYU which examined the durability of e.max CAD (the study which our current e.max Lithium Disilicate ad is referenced) was fatigued in water. If there was an issue with the material in water this testing would have demonstrated it. As for the “critical point” for breakage of 18-24 months. This data I would like to see because all of our clinical data presently which is past this point displays no such failures and has a failure rate of approximately 1%. Please ask who gave you this information to please provide any studies which show this. The first chair side study we have in the US is being published presently by Dr. Fasbinder using e.max CAD with several types of cements both adhesive and self adhesive demonstrate no failures up to two years and the 3rd year data being collected now still continues with no failures.”
So, there you have it.
Have what?
Exactly.
Look, I’m just a poor, dumb dental technician – not a materials engineer. I’m going to take Ivoclar at their word, and continue to produce e.Max restorations (Our own failure rate is less than 1% to date), but I think I will go on record as limiting our warranty on such restorations to 2 years. If Dr. Fasbinder’s study provides conclusive evidence that I can stand behind it for 3 years, I’ll cross that bridge when I come to it. Caveat Emptor?
If anyone has insight into this matter and wants to chime in , please leave a comment…
October 21, 2009
They are the Here & Now!!!
Okay, maybe a little hyperbolic.
You get that way after spending two hours listening to Mr. Mike Walsh of Cadent, Inc. extol the virtues of his company’s iTero digital impression system. The dude knows his stuff. He’s entertaining, and he’s clearly passionate about his product, as he should be.
I’m not here to push any particular system – We have the ability to work with data from Cadent, 3M’s Lava COS, and Cerec – I’m writing this because I believe – Check that, I know – these systems work NOW, and that using them will improve your quality of dentistry and the quality of the restorations you receive from your laboratory, whether it be me or someone else.
As for Cadent -
- The company’s system is unique in that it does not require powdering.
- The company claims that it captures “all the data” unlike other systems which capture reference points (enhanced by the powdering) and then extrapolate any missing data.
- The company’s output is defined as Open Architecture, which means I’m not restricted to what I can do with the data once I receive it.
- The company claims the system – as is, right now – is capable of handling 95% of your cases. They are currently working on developing implant impression protocols, which will go along way towards moving the dial up to 100%. (Mr. Walsh stated last night that they have worked with Biomet 3i’s Encode system and have cases in the mouth right now, but that protocol has not been released.)
- Most single tooth impressions can be accomplished in as little as 3 minutes. Assistants can easily be trained to perform the opposing arch scans, which leaves the dentist to take the scans of the preparation, adjacent teeth and bite relation which can all be done in under two minutes. Having recently discussed this with our client who is currently working with iTero, I can tell you these numbers stand up in the practical world.
Last, but not least, Cadent is offering a great promotion where they will waive the first $5000 in scan fees if you purchase a system before the end of 2009. Scan fees range from $25 for a quadrant impression to $35 for a full arch impression – comparable to the material costs incurred using conventional impressions. The $5K should get you somewhere between 150-200 scans.
I’m thinking that you may just see a similar promotion from 3M for the Lava COS sometime in the very near future, and I don’t care which system you buy – JUST BUY ONE!!! Once your insertion times drop to a routine 5 minutes, and your patients are singing your praises, you will wonder why you waited so long…
October 20, 2009
Sometimes, I wonder who dreams this stuff up.
According to sources, the new Lava Digital Veneering System (DVS) may be DOA. If you aren’t familiar with the concept, let me explain -
Using the new Lava 5.0 software, a full contour image of the tooth to be restored is modeled using data from a scan set that includes the preparation, adjacent teeth and opposing arch. Using preset parameters within the software, the program performs an automated “cutback” which basically divides the full contour image into an anatomical coping and veneer. The anatomical coping data is milled using Lava Zirconia, and finished in the conventional manner. The veneer data is then milled using a proprietary glass ceramic. Supposedly, the two separate mills are then returned to the laboratory where they are fused together by applying a fusing ceramic to the coping surface, and then “squishing” the glass ceramic over the prepared coping and fusing the three materials together in a conventional ceramic furnace. Once, fused the crown is then contoured (hopefully minimally) and then stained and glazed.
Sounds great…
Except for two little details.
First, the Lava 5.0 software is not nearly as advanced as other CAD/CAM packages on the market. I am sure that there are people out there that can “make it sing” – unfortunately, I and other staff members who use it on a daily basis are not among them. I just happen to think getting to the final result takes a lot more time and expertise then the other programs we have at our disposal.
Second, I think 3M still thinks its 2007. I have been told the pricing for milling the ceramic veneer (for Lava ALDCs. ALMCs costs will be $25 for the milling block) will be somewhere north of $40. So, if I have this right – I’ve got probably 10-12 minutes of design time, $40-45 in material cost, and then another 10-12 minutes of finishing, staining and glazing. If my math is correct, I probably have somewhere between $50-60 minimum invested in simply veneering a Lava coping. I know I can pay a very good ceramist significantly less than that – or use press technology – so unless there is a compelling difference in the material performance, it just doesn’t make economic sense. When you throw in the cost of the coping, I would be looking at offering a Lava DVS restoration at a significantly higher price, and nobody’s told me why it would necessarily be a superior product to a pressed restoration, like CZR Press or Vita’s PM9.
Look, I think 3M is a great company to work with – almost too a man they are highly professional, well-informed and helpful to a fault. But, there’s somebody somewhere making price-point decisions that is just not in touch with what’s going on in the dental laboratory industry. I know they are losing market share to what they consider “off-brand” zirconias because they have failed to stay competitive with their pricing of Lava. Now, they’re going to put a lot of money into promoting a system which looks like a non-starter for me.
Good luck with that…
October 19, 2009
As a Lava ALDC, we had the opportunity to watch a webcast in which 3M mounts a challenge to Ivoclar’s latest e.Max marketing blitz – you know, the one touting e.Max as the most robust all-ceramic material on the marketing.
It appears that its possible Ivoclar’s research conclusions may be tainted by some questionable design parameters within their study. According to 3M, potential issues include:
1. The NYU study used an extremely short time horizon simulating 100,000 cycles which amounts to approximately 3 months intraorally. 3M has intraoral studies on Lava going back over 7 years. I have to admit that with Ivoclar’s study showing a failure rate of 90% at 100,000 cycles, I’m not sure what point 3M is trying make with regards to the number of cycles…
2. The zirconia used in the study is Ivoclar’s own e.Max ZirCad material, and the design of the veneered framework was incorrect with respect to known principles of ceramic support – a probable contributing factor to the relatively poor showing of the zirconia restorations. During the webinar, 3M took the opportunity to espouse the use of their Lava 5.0 software to insure proper framework design. I’m all for that – I just wish the Lava software functioned even 1/10th as well as the 3Shape CAD package.
3. 3M pointed out that not all zirconia is created equally. I’m sure their right about this, but having used various zirconia products for about 8 years now, I can say our experience is that -of the one’s we’ve used (Cercon, Procera Zirconia, Invizion, e.Max ZirCad, Vericore, Lava, and Crystal), there has been no discernible difference in failure rates. All of the mentioned materials have a failure rate of less than 1% for us.
4. 3M mentions that lithium disilicate’s strength is diminished in a wet environment. I did not know that, and would like Ivoclar’s take on that statement. If that turns out to be true, I think I would have to strongly consider never buying another product from Ivoclar. They have some great people working for them, but such a development – on top of memories of Targis/Vectris and Empress 2 – would completely destroy the company’s credibility for me.
I’m going to watch Ivoclar’s e.Max webinar on Wednesday. 3M’s questions regarding the subject matter should make it more interesting viewing…
BTW – as part of the webinar, 3M said they are coming out with a loyalty program for Lava by which doctors can gain access to special educational events by going online to validate their Lava restorations using the Lava bar code label. I wonder about the efficacy of such a program considering that these labels have been handed out like candy in the past (they are supposed to be dispensed with each Lava restoration and come from the milling center). Also, taking in to account the fact that many doctors request a zirconia restoration, and the laboratory makes the final decision as to the actual material choice, why aren’t laboratories rewarded for their loyalty? Not a sermon, just a thought…
October 15, 2009
AstraTech Dental announced yesterday that they now have the capability to mill zirconia abutments (shaded or unshaded) for the NobelReplace NP platform.
Also, for those who are sitting on the fence with regards to using our new Crystal FZC (Full Zirconia Crown), I had the chance to speak with one of our local clients who has done a handful of such units, and he had nothing but good things to say. The fits have been great, with little to no adjustments necessary. Patients are happy because they’re getting a virtually unbreakable, esthetic restoration with a lifetime warranty. And, in contrast to Full Gold Crowns – with gold well in excess of $1000/0z. – FZCs offer an exceptional value with a stable price point.
For more information, please call me directly @ 800.678.7354
