If you follow the latest trends in the dental media, at trade events, on Internet forum boards, and in conversations with colleagues, the inescapable wave of dentistry’s future is CAD/CAM and digital technology. From computer-aided design and manufacturing, to communications, to business management, digital technologies will be a part of nearly all aspects of the progressive lab. Lab owners who want to stay competitive and grow their business will need to incorporate computer-based technologies into their workflow parameters at some point along the operation and at some point in time.

	Splitting Images Pressable restorations really move into the fast lane thanks to high-tech digital design and production innovations. File splitting programs, such as part of the Dental Wings Operating System (below, top and middle), allow the digital technician to design a press-to restoration onscreen in a 3D visualization, then automatically divide the design into its separate coping substructure file to be milled or laser sintered and the full contour crown pressover form file that is then sent to a milling system or 3D printer that can generate dozens of wax patterns nested together in a single manufacturing session (below, bottom).

“Our industry is facing what can be called the industrial revolution in dental technology, where the process of fabricating dental restorations is being broken down into steps,” said Anna B. Verano, CDT, Dental Technology Manager for Pentron Ceramics. “There is an emphasis on productivity, so we’ve had to develop materials, like pressables, that make this breakdown simpler.”

Conventional PFM crowns and bridges—the most frequently placed type of indirect restoration—as well as those with a zirconia substructure require the skills of a highly trained ceramist to hand-sculpt multiple layers of porcelain with oven firing between each layer to build to final anatomy with natural esthetics. A time-consuming and exacting procedure that demands human precision for consistency.

According to Verano, “With pressing technology, a technician of any skill level will be able to make veneers, inlays, onlays, crowns, and bridges consistently with ease. Pressing restorations isn’t sacrificing the overall esthetics of the final product. The simplified techniques involved with fabricating pressed crowns are what enable technicians to make high-quality, esthetic restorations.”

Pressing not only simplifies the steps involved, depending on the type of pressed restoration, it also has the potential to eliminate most of the labor- and time-intensive layering procedures. Lithium disilicate pressed single-tooth crowns and short-span bridges, particularly in the posterior region, can be waxed and pressed to full contour, followed by a basic stain and glaze. In other cases where esthetics are more particular, the dentin-shaded pressed form can be created to nearly final anatomy, the incisal space cut back, and then a single thin ceramic enamel layer applied, followed by firing and finishing. The framework, for the most part, is the restoration.

“From a strategic point of view,” said Trevor Laingchild, RDT, “It’s a better approach than doing a framework and then layering in the dentin and then the enamel.” Laingchild, an American Academy of Cosmetic Dentistry-accredited technician and owner of Burlington Dental Studio in Toronto, said that he has worked with pressables more than half of his 30-year career and estimates that nearly 60% of his lab business involves pressed restorations. “Actually, I’m deliberately growing it,” he added. “I’m finding it more cost-effective for us, more esthetic, less labor, the list goes on.”

Bradley Jones, President of Professional Dental Arts in Boise, Idaho, admires the consistency pressing carries from a carefully prepared diagnostic waxup (see “Injecting to predictability” sidebar). “After the patient has been prepped and the provisional is in the mouth, we get a chance to see how this blueprint diagnostic waxup looks in the mouth. From that point, we make a matrix of it, and we can inject that onto our master dies,” he said. “If we were stacking these, we wouldn’t have that continuity from the very beginning to the very end.”

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