Understanding dental CAD/CAM for restorations--dental milling machines from a mechanical engineering viewpoint. Part B: labside milling machines.

Nowadays, dental numerical controlled (NC) milling machines are available for dental laboratories (labside solution) and dental production centers. This article provides a mechanical engineering approach to NC milling machines to help dental technicians understand the involvement of technology in digital dentistry practice. The technical and economic criteria are described for four labside and two production center dental NC milling machines available on the market. The technical criteria are focused on the capacities of the embedded technologies of milling machines to mill prosthetic materials and various restoration shapes. The economic criteria are focused on investment cost and interoperability with third-party software. The clinical relevance of the technology is discussed through the accuracy and integrity of the restoration. It can be asserted that dental production center milling machines offer a wider range of materials and types of restoration shapes than labside solutions, while labside solutions offer a wider range than chairside solutions. The accuracy and integrity of restorations may be improved as a function of the embedded technologies provided. However, the more complex the technical solutions available, the more skilled the user must be. Investment cost and interoperability with third-party software increase according to the quality of the embedded technologies implemented. Each private dental practice may decide which fabrication option to use depending on the scope of the practice.

Standards, Regulation and Registration of Dental Laboratories. An Industry Update.

State dental associations are showing increased interest in maintaining current standards and regulations affecting the dental laboratory industry as mandated by the Food and Drug Administration. The domestic dental laboratory industry is being significantly stressed by foreign competition, rapid technology development and unprecedented consolidation, which are changing the way that prosthetic devices and restorations are manufactured and delivered to dentists. Of paramount importance to the prescribing dentist is the accurate documentation of the source and materials being used in prostheses being delivered to patients.

Dental technology services and industry trends in New Zealand from 2010 to 2012.

OBJECTIVE: To provide a snapshot of the New Zealand dental technology industry and influencing factors. BACKGROUND: Developing an understanding of the commercial dental laboratory environment in New Zealand can provide insight into the entire dental industry. METHODS: A web-based survey was the primary method for data collection, with separate questionnaires used for dental laboratory owners and dental technician employees. RESULTS: The mean net income for dental laboratory owners in New Zealand was similar to that of the United Kingdom, at $40.50 per hour. Clinical dental technicians are the highest paid employees, with a mean of $33.49 per hour. The mean technical charge for complete dentures was $632.59; including clinical services, it was $1907.00. The mean charge for a porcelain-fused-to-metal (PFM) crown was $290.27. Dental laboratory owners expressed fear about the possibility of losing dental clients to overseas laboratories due to the availability and cheap charge of offshore work. Only 25.4% of dental laboratories surveyed had computer-aided design (CAD) facilities, and even fewer (7.9%) had computer-aided manufacturing (CAM) systems. CONCLUSION: Clinical dental technology appears to be prospering. The dental technology industry appears to be adapting and remains viable, despite facing many challenges.

Complete digital workflow for the production of implant-supported single-unit monolithic crowns.

OBJECTIVES: The aim of this case series was to introduce a complete digital workflow for the production of monolithic implant crowns. MATERIAL AND METHODS: Six patients were treated with implant-supported crowns made of resin nano ceramic (RNC). Starting with an intraoral optical scan (IOS), and following a CAD/CAM process, the monolithic crowns were bonded either to a novel prefabricated titanium abutment base (group A) or to a CAD/CAM-generated individualized titanium abutment (group B) in premolar or molar sites on a soft tissue level dental implant. Economic analyses included clinical and laboratory steps. An esthetic evaluation was performed to compare the two abutment-crown combinations. RESULTS: None of the digitally constructed RNC crowns required any clinical adaptation. Overall mean work time calculations revealed obvious differences for group A (65.3 min) compared with group B (86.5 min). Esthetic analysis demonstrated a more favorable outcome for the prefabricated bonding bases. CONCLUSIONS: Prefabricated or individualized abutments on monolithic RNC crowns using CAD/CAM technology in a model-free workflow seem to provide a feasible and streamlined treatment approach for single-edentulous space rehabilitation in the posterior region. However, RNC as full-contour material has to be considered experimental, and further large-scale clinical investigations with long-term follow-up observation are necessary.

Agenesis of maxillary lateral incisor and tooth replacement: cost-effectiveness of different treatment alternatives.

PURPOSE: To evaluate the long-term cost-effectiveness of five treatment alternatives for maxillary lateral incisor agenesis where space maintenance and tooth replacement are indicated. MATERIALS AND METHODS: The following treatment modalities were considered: single-tooth implant-supported crown, resin-bonded fixed partial denture (FPD), cantilever FPD, full-coverage FPD, and autotransplantation. The cost-effectiveness for each treatment modality was determined as the ratio of the outcome of each modality divided by the cost. Direct costs, clinical and laboratory, were calculated based on national fee schedules and converted to international dollars using purchasing power parity exchange rates. Outcomes were based on the most recently published long-term (10-year) survival rates. Sensitivity analyses were carried out, testing the robustness of the cost-effectiveness analysis. RESULTS: The five treatment modalities ranked in the following order from most to least cost-effective: autotransplantation, cantilever FPDs, resin-bonded FPDs, single-tooth implants and implant-supported crowns, and full-coverage FPDs. Sensitivity analysis illustrated that the cost-effectiveness analysis was reliable in identifying autotransplantation as the most and full-coverage FPDs as the least cost-effective treatment modalities. CONCLUSIONS: When replacing a missing maxillary lateral incisor, the most costeffective, long-term treatment modality is autotransplantation, whereas the least cost-effective is full-coverage FPDs. However, factors such as patient age, the state of the dentition, occlusion, and tooth conservation should also influence the choice of restoration.

A cost-minimization analysis of an RCT of three retention methods.

BACKGROUND: There are few cost evaluation studies of orthodontic retention treatment. The aim of this study was to compare the costs in a randomized controlled trial of three retention methods during 2 years of retention treatment. MATERIALS/METHODS: To determine which alternative has the lower cost, a cost-minimization analysis (CMA) was undertaken, based on that the outcome of the treatment alternatives was equivalent. The study comprised 75 patients in 3 groups consisting of 25 each. The first group had a vacuum-formed retainer (VFR) in the maxilla and a cuspid retainer in the mandible (group V-CTC), the second group had a VFR in the maxilla combined with stripping of the incisors and cuspids in the mandible (group V-S), and the third group had a prefabricated positioner (group P). Direct cost (premises, staff salaries, material and laboratory costs) and indirect costs (loss of time at school) were calculated. Societal costs were defined as the sum of direct and indirect costs. RESULTS: The societal costs/patient for scheduled appointments for 2 years of retention treatment in group V-CTC were €497, group V-S €451 and group P €420. Societal costs for unscheduled appointments in group V-CTC were €807 and in group V-S €303. In group P, there were no unscheduled appointments. CONCLUSIONS/IMPLICATIONS: After 2 years of retention in compliant patients, the cuspid retainer was the least cost-effective retention appliance. The CMA showed that for a clinically similar result, there were differences in societal costs, but treatment decisions should always be performed on an individual basis.

A preliminary report of the cost-effectiveness of tooth replacement strategies for partially dentate elders.

OBJECTIVE: To compare the cost-effectiveness of conventional treatment using partial dentures with functionally orientated treatment to replace missing teeth for partially dentate elders using a randomised controlled clinical trial. BACKGROUND: In many countries, including the Republic of Ireland, the only publically funded treatment option offered to partially dentate older patients is a removable partial denture. However, evidence suggests that these removable prostheses are unpopular with patients and can potentially increase the risk of further dental disease and subsequent tooth loss. MATERIALS AND METHODS: Fourty-four partially dentate patients aged 65 years and older were recruited. Patients were randomly assigned to the two treatment arms of the study. The conventional treatment group received removable partial dentures to replace all missing natural teeth. The functionally orientated group was restored to a Shortened Dental Arch (SDA) of 10 occluding contacts using resin-bonded bridgework (RBB). The costs associated with each treatment were recorded. Effectiveness was measured in terms of the impact on oral health-related quality of life (OHRQoL) using OHIP-14. RESULTS: Both groups reported improvements in OHRQoL 1 month after completion of treatment. The conventional treatment group required 8.3 clinic visits as compared to 4.4 visits for the functionally orientated group. The mean total treatment time was 183 min 19 s for the conventional group vs. 124 min 8 s for the functionally orientated group. The average cost of treatment for the conventional group was 487.74 Euros compared to 356.20 Euros for the functional group. CONCLUSIONS: Functionally orientated treatment was more cost-effective than conventional treatment in terms of treatment effect and opportunity costs to the patients' time.

Knowing (and understanding) the key numbers for your practice.

Most dentists see accounting and bookkeeping as a necessary evil instead of a helpful tool. Yet the most financially successful and happy dentists understand the need for good financial management. Here's an overview that will help you better-understand the key numbers in your practice.

Different labs.

In this case a young dentist has signed onto a managed care plan that has several attractive features. Eventually, however, he notices that he makes little or no net revenue for some of the work that he does. A colleague recommends that he use different labs for different patients, with labs matched to each patient's dental plan and coverage. Offshore labs are used for managed care patients. Three knowledgeable experts comment on the case, two with many years of private practice experience, two who are dental educators holding master's degrees in philosophy and bioethics.

Complete denture services: clinical technique, lab costs, manpower, and reimbursement. One-year review.

Complete denture services at comprehensive care public health clinics are not common in part because of clinician concerns regarding outcomes. Educational debt forgiveness has attracted recent dental graduates to public health dentistry; however, not all recent graduates receive denture education experiences necessary to attain proficiency. While fundamental patient assessment and denture construction are taught, psychological assessment and communication with denture patients requires experience. A thorough understanding of occlusion, phonetics, esthetics and laboratory steps is also necessary. Expecting recent dental graduates to become proficient providing complete dentures at minimal reimbursement levels, with no mentorship or on-site laboratory support, is unrealistic. Public health dental clinics operate at full capacity performing emergency, preventive and restorative procedures. Complete dentures come with a laboratory fee approximately one-half the total reimbursement, meaning a remake drops clinic revenue to zero while doubling expenses. It is understandable that full schedules, marginal reimbursement, unpredictability and the risk of an occasional failure block clinician interest in providing denture services. This one-year report of services describes a three-appointment complete denture technique offering improved patient and laboratory communication, reduced chair time and controlled cost, resulting in high-quality complete dentures.

Estimating costs for shade matching and shade corrections of fixed partial dentures for dental technicians in Germany: a pilot investigation.

AIMS: To evaluate the additional operating expenses caused by shade matching by dental technicians in the dental practice and by color changes of fixed partial dentures. METHODS: A questionnaire was handed out to visitors of the 2010 ADT dental technician congress in Germany. Thirty-one completed questionnaires were evaluated. RESULTS: Mean costs caused by shade matching and shade correction per month were 1269$ (SD = 1278$; n = 25) and per unit of FPD 9.32$ (SD = 8.89$). CONCLUSIONS: An improvement of shade matching, shade communication and reproduction should be made in order to minimize the considerable economic damage for dental laboratories.

Evolução do financiamento da atenção à saúde bucal no SUS: uma análise do processo de reorganização assistencial frente aos incentivos federais / Dental care financing evolution in the SUS: analysis of the process of health care reorganization in relation to federal incentives

O trabalho descreve e analisa, na perspectiva do financiamento federal, o desenvolvimento da Política Nacional de Saúde Bucal (PNSB). O artigo considera o avanço no sentido da ampliação do acesso representado pela inserção das Equipes de Saúde Bucal (ESBs) na Estratégia Saúde da Família (ESF) e a criação dos Centros de Especialidades Odontológicas (CEOs) e dos Laboratórios Regionais de Prótese Dentária (LRPDs). Não obstante a importância da ampliação desse acesso, o objetivo deste trabalho é refletir sobre a seguinte questão: de que forma e em que medida a Portaria nº 302/2009, que desvincula as EBSs da ESF, será capaz de garantir a manutenção do acesso já conquistado com continuidade do aporte de recursos financeiros? Para tal fim, foi realizada análise bibliográfica e documental abrangendo os períodos de vigência das Normas Operacionais do SUS até a edição do Pacto pela Saúde 2006. Nas considerações finais, os autores destacam que o maior aporte de recursos financeiros voltado para a atenção à saúde bucal está em sintonia com as políticas adotadas pelo Ministério da Saúde (MS) na década de 1990: a reorganização da Atenção Básica através da ESF e a política de incentivos, como forma de repasse de recursos federais. Ainda é destacado o risco de retrocesso representado pela edição da referida Portaria, no sentido de comprometer tanto o processo de reorganização da atenção básica em SB quanto seu financiamento, uma vez que a política de incentivos do MS é voltada para esta Estratégia.

This paper describes and analyzes, in the perspective of federal financing, the development of the so called Política Nacional de Saúde Bucal (PNSB) [Dental Care National Politics]. It considers the progress of improvement of access provided by the inclusion of Dental Care Teams (DCT) in the Family Health Strategy (FHS), and the creation of Odontological Specialties Centers (OEC) and Regional Laboratories of Dental Prostheses (RLDP). Despite the importance of such improvement, this paper aims to reflect on the following issue: how the Decree 302/2009, that disengages DCT from FHS, is able to ensure the already achieved access with continuing financial resources? So a bibliographical and documental analysis was conducted, comprising the issue of SUS Operational Norms until the 2006 Health Pact. In the final remarks, the authors point out that most part of financial resources for dental care coincides with the policies adopted by the Health Ministry in the 1990's: primary care re-organization through the Family Health Strategy, and the incentives politics, as a way of transferring federal resources. Also, they highlight the risk of retreat brought by this decree, as it jeopardizes both the primary care re-organization process in dental care, and its financing, once the incentives politics of the Health Ministry is concerned with the Family Health Strategy.

Efficient resource use in simplified complete denture fabrication.

PURPOSE: Conventional dentures will remain the only treatment available to most edentulous people for the foreseeable future. In this study, we compared the efficiency of two methods of making complete conventional dentures-the traditional academic standard (T) and a simplified technique (S) used in private practice. We have previously shown that they produce similar levels of patient satisfaction and denture quality. MATERIALS AND METHODS: Data were gathered during a randomized controlled clinical trial of 122 subjects from initial examination until 6-month follow-up. For this report, the direct costs of providing one set of conventional complete dentures by T or S techniques were estimated. All materials used were recorded and their cost was calculated in Canadian dollars (CAN$). The costs of fabrication in an outside laboratory were added. Clinician's labor time was recorded for every procedure. Between-group comparisons for each clinical procedure were carried out with independent t-tests. The number of patients in each group who needed postdelivery treatment was compared with Chi-square tests. The effect of group assignment and of treatment difficulty on outcomes was analyzed with multiple regression analysis. RESULTS: The mean total cost of the T method was significantly greater than S (CAN$166.3; p < 0.001), and clinicians spent 90 minutes longer (p < 0.001) on clinical care. The difficulty of the case had no significant influence on outcomes. CONCLUSIONS: The results indicate that the S method is the more cost-efficient method and that there are no negative consequences that detract from the cost savings.