More Esthetic Options Help Increase Efficiency

We utilize milling for all of our lithium disilicate restorations in some way. For time-sensitive restorations, milling it directly allows us to simply perform a 22-minute crystallization cycle and produce the crown in a similar amount of time to what dentists are doing chairside. On other cases, we design the restoration digitally, mill it in wax, invest it, burn it out, and then press it. This allows us to achieve the precision and accuracy of CAD/CAM while still utilizing our preferred pressing technique for lithium disilicate.

Milled multilayer PMMA has been a big game-changer, allowing for very esthetic long-term provisionals. It is also great for tissue management on implant cases, and we use it on top of multi-unit abutments for a lot of our all-on-four cases. PMMA has advanced similarly to zirconia; the pucks used to have a distinct body and incisal area, but now that fusion is much more integrated with color gradients. There are some really esthetic PMMA pucks available on the market today.

Nesting is critical. If the design is placed in the puck sub-optimally, multiple firings will be necessary with a cutback to create the esthetics that you need. If nesting is done correctly, I still believe that CAD only accounts for 80% and a qualified technician accounts for the other 20%, but that 20% can mostly focus on staining and glazing now. My laboratory once had nine ceramists; now, we have one because most of our high-end ceramists have become stain and glazers. Almost everything we fabricate is full contour. That is how much esthetic millable materials have changed our industry.

The level of esthetics that has become mostly standard across such a wide range of materials today allows laboratories—depending on their business models—to focus more on durability, customer support, and price so they can be as efficient as possible in providing exceptional work.

Keith Miolen, CDT, is the Chief Operating Officer of Aurora Dental in Auburn, New York.