Don’t forget your professional ethics

The Inn-Keramik dental laboratory is located in the heart of Innsbruck, Austria. Three highly experienced dental technicians have been running this business for the past eleven years: they are Christoph Zobler, Max Wörishofer and Harald Gritsch. This first part of an interview conducted with Christoph Zobler addresses the opportunities and limitations of digital dental lab technology, the reliability of production processes and the issue of professional ethics in dental lab technology.

Mr Zobler, to what extent do you use digital techniques – and why?

Christoph Zobler: Digital technology is on the rise everywhere. It has also become omnipresent in dental laboratories. As a result, we have incorporated digital processes into our work routines. Nonetheless, we have come to recognize some limitations.

Please describe these limitations.

Christoph Zobler: There’s no doubt about it: Digital technology is great. However, it has not yet been perfected. There are still certain areas in which it is lacking. Therefore, we choose to carry out various parts of the fabrication process using conventional techniques. For example, some of our peers already work without models. We have made a conscious decision to continue using them. Because we believe in delivering high precision results, we prefer to set up the function of our restorations in the articulator. Furthermore, we still do the final work on the model using conventional methods, since digital technology is not yet sophisticated enough for this part of the job. As a result, we would rather err on the side of caution.

We always finish the margins of mechanically milled restorations by hand under the microscope to ensure that they fit accurately. We make sure that the transition to the tooth is of the highest quality. In other words, we manually enhance what has been excellently prepared using digital means. Compared with a milling centre, which has to allow for certain tolerances in order to work economically, we have the liberty of focusing on the details. We can concentrate on the given case with individually developed parameters and milling strategies in order to attain an excellent fit. Dental lab technology is and will always be a craft.

How can conventional and digital techniques be reconciled in the future?

Christoph Zobler: I think the key is to cleverly combine the two working methods with each other in order to make the most of their possibilities and benefits: that is, we have to come up with hybrid solutions.

When and in which cases is CAD/CAM your first choice?

Christoph Zobler: For example, when I’m working with zirconium oxide. This material has to be milled. This is also true for a number of other materials, such as IPS e.max lithium-disilicate. In addition, I think that Telio CAD discs offer a great option for fabricating functional splints of very high quality.

When we work with veneering materials such as IPS Style, IPS e.max and IPS d.SIGN we prefer to use conventional techniques. Therefore, we like to press veneers (made of IPS e.max ZirPress in particular) to zirconium oxide frameworks. We believe that this allows us to implement the functional, sequential wax-up technique more economically. In any case, zirconium oxide is not that suitable for the fabrication of full-contour restorations because of esthetic reasons, and esthetics are a priority for us. Full-contour zirconium oxide restorations lack the required fluorescence because of materials engineering aspects. As far as I know, the dental industry is working in high gear to come up with a solution. Corresponding products are expected to be launched in the near future.

What do you look for in a material and the way in which it is processed to ensure predictable results, so that everything will fit properly in the end?

Christoph Zobler: I like to rely on one product range. In other words, I use the products recommended by one manufacturer: materials, machines and coordinated work processes. I don’t like to mix things. As a result, I have the assurance of the manufacturer and the required legal backing. Furthermore, I can be sure that all the processes are followed correctly and that the results are of excellent quality. This approach has brought me success in the past.

With regard to professional ethics, is it difficult to reconcile making a profit and working within ethical guidelines?

Christoph Zobler: Certainly, it’s important to make money. However, it should not be the be all and end all. Dental technicians have or should work according to professional ethical standards. Nevertheless, I often miss this in our field. Many people today are concerned about saving time and making money. In my opinion they seem to have forgotten that we are working with people. We should never lose sight of this fact. This applies to dental technicians as well as the entire dental industry. While the fabrication of dental restorations is being sourced out to digital milling centres, dental technicians have the opportunity to work more closely with the patient and the dentist in finding suitable solutions. New business fields are opening up for dental technicians, which have to be communicated. The dental profession is in a state of flux and great changes are about to take place. In this digital revolution, my main aim is to focus on quality – for example, of margins and functional aspects. Furthermore, I would like to urge the dental industry not to sacrifice quality for the sake of efficiency. Only those who have spent a lot of time dealing with different cases can understand the complexity of the human masticatory system and how time-consuming it is to do justice to each individual case.

Could you please give us an example?

Christoph Zobler: The key topic of “function” is often neglected at the expense of esthetics. A restoration must not only look good; it must also function properly in the patient’s mouth. If this is not the case, even the most attractive restoration is actually worthless. At our laboratory Inn-Keramik we make sure that our restorations fit the occlusion of our patients. In other words, the restorations are specially made for every single patient. Mass production is out of the question. Each case is unique, since every person is unique. As a result, dental restorations cannot be produced on an assembly line like cars for example, which are all alike.

Patient-oriented collaboration between the dental technician and the dentistis also very important for me. Working well together will allow us to overcome the challenges of the future. Each party has to do their part. Our joint expertise is indispensable. Even the most sophisticated computers have their limits. Let’s use our combined knowledge and experience to offer our patients the best possible results!

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