An Interview with Kristi Gregory, CDT

Custom-milled, implant-retained solutions provide patients with more stability, a more comfortable fit, and more natural function. Even though this market segment was impacted significantly in 2009 and 2010 as a result of the economic downturn, we are projecting a 15% to 18% market growth pattern in 2011. Patients who pulled back from optional treatment or delayed treatment in the past 2 years are rebounding with the promise of a more stable economy.

Another driver is the laboratory. Milled bar solutions, such as ISUS (Implant SUpraStructures) from DENTSPLY Compartis^® USA Services, eliminate the time-consuming, precision-sensitive labor processes of waxing and casting implant bars. Custom-milled bars and bridges allow laboratories to flex with patient demands, streamline laboratory production processes, and provide customers with a high-end solution for their patients.

IDT: What types of CAM-milled custom solutions are currently available for laboratories that want to offer these CAM patient solutions?

KG: DENTSPLY Compartis and its wholly owned subsidiary, ES Healthcare milling center, offer a broad range of milled bar designs that support more than 250 implant systems. Located in Belgium, ES Healthcare services both the US and European markets for DENTSPLY International.

Laboratories can order implant-retained, hybrid attachment type bars and standard bars, as well as bridges in any design to be milled from pure Grade IV titanium or chrome cobalt. We can manufacture internal or external connections, mill to an abutment, or mill a combination all within the same arch. The bars feature a truly passive fit, meaning that there is no stress on the implant, screws, or on the appliance itself. Each milled bar comes with a 10-year guarantee.

IDT: What must the laboratory send you to begin the ordering process?

KG: It starts with the impression from the dentist. The laboratory pours the model, creates a removable soft-tissue cast, and completes a diagnostic wax-up of tooth placement in order to know the parameters while designing the bar. If the customer would like to send a wax-up of the bar design, we would then copy-mill that design. The unarticulated model with soft-tissue cast, analog, and diagnostic wax-up of tooth placement or bar design are sent to our facility in York, Pennsylvania, along with a detailed work order.

There, trained technicians create scans of the model with analog, the soft-tissue cast, and the wax-up, then combine all three scans for the bar design process. Because we offer a warranty that guarantees fit to the model, we ask customers to make a verification stent. Once the bar design is complete, a 3-D viewer data file of the design is sent via e-mail to the customer for approval. At this point, the customer gets a phone call from me to discuss the design approval or any changes.

Once approved, the suprastructure design is sent to the CAM team at ES. For each bar design, they conduct a dry-run test of the mill on the computer to ensure a successful outcome, and then move to the milling process. The milled bar is returned to the York facility, where it undergoes a quality check and is then delivered to the customer. Once the viewer file is approved, the turnaround time for the bar to get from ES Healthcare to the customer is 7 days. It takes 2 to 3 days to prepare the design and get customer approval, for a total of 9 to 10 days.

IDT: What new improvements or products are coming down the pike regarding custom-milled overdenture bars?

KG: We are constantly expanding the library of 250 implant systems that Compartis ISUS supports as well as the range of services that we offer. Our specialized design software allows us to competitively provide a level of flexibility in the design of milled bars and bridges that meet any needs the technician, dentist, and patient may have. Currently, we are working on a new bar configuration that includes a secondary structure. It allows patients to remove the appliance from the implant-retained primary structure for hygiene purposes, giving them the best of both worlds. This bar design has been on the European market for many years, and we are currently validating it for the US market.

We will continue to expand our design flexibility and the range of options available; to innovate by offering new design solutions; and to increase our flexibility to meet the ever-evolving demands of the market.

Kristi Gregory, CDT, is a technical specialist with DENTSPLY Prosthetics and has more than 20 years of experience in the dental laboratory field. She is the US Prosthetics expert on custom-milled Compartis ISUS overdenture bars from ES Healthcare and lectures extensively both domestically and internationally.