Dr. Hornbrook (Clinical Director of Education & Technology) at Keating Dental Lab recently sat down with Dr. Mike DiTolla, a long-time friend and colleague, where they covered everything from the changes in dentistry to digital scans to Dr. DiTolla’s new position as Clinical Director at Sirona. 2 of the biggest names in dental history both have found their passion in clinical dentistry education, and have unique insights into the growth of the industry.
Dr. DiTolla’s Background
Before coming to Sirona, Dr. DiTolla spent 15 years as the Clinical Director for Glidewell. There, he was able to learn how the average American dentist works as they prep and impress, which is valuable information to learn.
There, they began filming procedures to help educate dentists, taking advantage of the “peeping Tom” effect: dentists like seeing what others are doing and getting glimpses inside the lab.
Once he moved to Sirona, they began doing more Chairside CAD/CAM, which was an educational process for him, as well. Dr. DiTolla understood that many doctors may be hesitant to invest in this type of technology, and worked to show the value of a Chairside CAD/CAM. He was learning the process in real-time and documenting the value he saw in it.
The All-Dentist Workflow
With the CEREC developments over the past few years, dentists are able to do more of their own lab work, which puts labs in an interesting position. Dr. DiTolla believes that, while dentists would feel comfortable and willing to do the simpler work, for bridges and anterior work they would still send it to a lab. The theme “dentists don’t want to be lab techs” will still be applicable in the near future for these more complicated restorations.
The CEREC SpeedFire
Of the many changes in dentistry that happens over 20 years, there’s the process for sintering and glazing zirconia crowns, like the BruxZir. When dentists added the CEREC system, they are able to turn a multi-visit process into a single visit and patients are able to get a crown in just one visit.
Drs. Hornbook and DiTolla know that their fellow dentists don’t want to be lab techs. That being said, the CEREC SpeedFire offers a software controlled process that’s less intimidating. The CEREC software determines the size, thickness, and shade and just does it.
It also cuts sintering time from 6-8 hours to 10-13 minutes, by using induction technology. So yes, the dentist takes on some of the lab work, but the guesswork is taken out and they’re able to improve their patient’s experience. (Which is why labs still use a process that takes 6-8 hours.)
Open Architecture Digital Scan Systems
CERAC is a closed system, which means that only a lab with a CEREC system will be able to read your scans, much like how Apple is a closed system. This can cause some issues when doctors are unable to send their scans where they want, though there are ways around it.
While Dr. DiTolla recognizes this is a major pain point, he explains that it’s challenging to ensure all pieces can play together, that CEREC doesn’t want to open it up and begin the finger-pointing process when different developers’ products fail to work together.
The E-Max Test
E-Max is now 11 years old, and as a zirconia competitor, so to speak, it’s a beautiful material. Although from a Chairside mills perspective, Dr. Hornbrook sees with E-Max is mediocre. At one point Dr. Hornbrook did a blind study where both E-Max and zirconia were both milled to each HT level, then each was independently evaluated.
In the blind study, five here at Keating Dental Arts answered two questions: which was the most aesthetic, and which was less ugly. Heany, a zirconia manufacturer, was picked first. E-Max wasn’t chosen as second or third, either. This could be due, at least in part, to Zirconia working well on metal posts and cores, whereas if E-Max was used the post would show through.
Dr. DiTolla continues on that zirconia looks better anatomically, which came at a surprise, as no one had necessarily looked at it from that angle before.
Dentsply and Sirona’s Merger
Dentsply and Sirona recently merged, and Dentsply’s Celtra Duo is E-Max’s main competitor. The Celtra Duo is named as such is because dentists could either mill and polish it then bond it into place, or they could sinter and submit it.
The Celtra Duo is composed of lithium silicate, and while it may look slightly different from the Empress, there’s not a big difference. Because the’ve had time to work with the product and improve it, it can compete against E-Max.
Even though the goal is to improve Celtra and continue competing against E-Max, Dr. DiTolla is a dentist first when it comes to competing in the industry for competing’s sake. “[Because] I am a dentist first… it just flies in the face of common sense and you will just turn off dentists if you do something like that.” They’re being careful about how they sell Celtra, but they are also looking has how they’ll improve upon it, whether it’s price, availability, shades, or something else.
Both Dr. Hornbrook and Dr. DiTolla have found their passion in clinical dentistry education, and have created a number of resources one a variety of topics. If you’re interested in hearing more from Dr. DiTolla, you can visit his to listen to his podcast, “The Accidental Genius”. Looking for more resources? Our other podcasts are available on Dental Up. And thank you, Dr. DiTolla, for joining us today.