Did you Know? Submitted by Hobe & Lucas CPA’s Inc

The state of Ohio has been stepping up its efforts to collect more revenue! Taxes based on the “honor system”, like sales tax, are lucrative targets. Did you know that buying dental products such as implants, Invisalign, and other tangible property out-of-state does not protect you from paying Ohio sales tax? If out-of-state vendors are not charging sales tax, the purhasers are responsible for paying use tax to the state of Ohio. Recently, Ohio has audited vendors such as Straumann Implants and Invisalign and determined that they are not charging sales tax properly. During the audit process Ohio auditors have extracted names of vendors’ dentist customers, and consequently audited them as well. This has been quite a gold mine for Ohio when you factor in tax plus sizable interest and penalties. 

One other thing…unclaimed funds audits are picking up in Ohio. Does your dental practice have old accounts receivable credit balances or uncashed refund checks that are over 3 years old? In many cases, these must be remitted to Ohio. 

Honesty is the best policy – if you don’t have a usetax account, you probably should; if you aren’t remitting unclaimed funds, maybe you should be. Contact Hobe & Lucas CPA’s Inc. or your tax advisor, or go to: http://www.
tax.ohio.gov/sales_and_use.aspx and http://www.com.ohio. gov/unfd/HolderFaq.aspx for more information.

TLZ-SR - Compatibility for A Great Solution

TLZ-SR is an incredibly popular restoration for restoring single and multiple unit implant cases. As we mentioned in a previous newsletter, screw-retained has made a big comeback due to the absence of intraoral cementation, the low fee ($299), and the high quality. However, not all TLZSR cases are the same! If we do not have what’s called a Ti base, the stock component attached to the crown, then we must order a stock abutment from the manufacturer and raise the fee an additional $100-$180. When completing the work authorization request that we call to discuss pricing.

Check out our compatibility and implants that require special parts and fees: http://www.roedentallab.com/product_implant_options.html 

Digital Dentures - A Quantum Leap

Avadent Digital Denture

Leading the Way For more than 5 years, Avadent has offered a digital option for dentures. Its product is very impressive, and can be reviewed on our web site. If a patient has an existing denture, and it is time for an upgrade, you simply duplicate the denture chairside, capture a reline impression
and bite and send to ROE to be digitized. In 3 days you will receive a virtual preview, and in 2-3 weeks an amazing new denture. If you are within driving distance of ROE, you can capture the records using the existing denture and ask your patient, or our currier, to deliver the case to ROE for sameday scanning! We call this our 35-minute denture! Call us for more information.








Pala Digital Denture - A New Heraeus Product

Heraeus also offers a digital denture. Its system is more ideal for patients who do not have an existing denture. With Pala, the doctor selects one of four sized Gothic Arch Tracing devices, captures an impression, adjusts the device to record the vertical dimension, then is functionally manipulated to capture centric. Pala then uses science to map tooth location based upon the arch-form and other anatomical
features. The case can be returned for try-in, if desired, prior to fi nishing.

LabTrac - Keep Your Cases On Track

In our continuous efforts to provide superior restorations in a timely fashion, we invested in a magnificent new software platform; one that is more robust and user-friendly, and that allows our clients enhanced communication. Our new software is called Labtrac. Internally, Labtrac manages case-fl ow based upon the tasks involved, employee skill level, and volume of case load, and even allows our customers to have assigned technicians. With this sophisticated software, we now have the ability to micro-manage every aspect of your case to ensure that you and your patient receive exactly what is expected. With Labtrac’s web-based portal, customers can track the progress of cases, receive emails when cases are received, shipped, or on hold. Doctors can request pick-ups, print Rx’s for case-shipping and records, and upload information such as images, digital impressions, and DICOM

DAMAS - An FDA-Type Compliance Certification

Since 2007, in the interest of our valued customers, their patients, and our organization, ROE has devoted thousands of man-hours and a large financial commitment to become accredited by DAMAS. We are pleased to report that ROE recently joined the approximately .4% of dental laboratories in the United States to become DAMAS-certified!

You might ask, what is DAMAS and what does it mean for you, our customer? DAMAS stands for Dental Appliance Manufacturers Audit Scheme (DAMAS). It is an internationally recognized standard for quality that validates the materials and processes utilized to produce prosthetic devices. These standards closely mirror a strict protocol that follows the U.S. Food and Drug Administration’s Quality System/Good Manufacturing Practice (QS/GMP) specifications, which are required of all dental laboratories conducting business in the United States. DAMAS provides a clear-cut method for documenting every facet of laboratory operations, including dental prescriptions/work authorizations; patient contact materials; subcontractor/supplier agreements; material and equipment purchases; employee training; maintenance and calibration of equipment; labeling; customer complaints, and cleanliness. Due to the strict standards of DAMAS, only 30 of 6700 dental laboratory in the United States have achieved the DAMAS status and we are proud to be one of them. It is noteworthy that only 20 of these laboratories are, like ROE, independent.

The DAMAS certification ensures that the laboratory environment operates in such a way as to ensure product and patient safety. It provides a formula for improved documentation of many aspects of dental lab activity from dental prescriptions to material traceability. Celebrate this achievement with us. You can be proud to inform your patients that restorations produced by ROE are made under the strictest guidelines and that your laboratory is among an elite group. We hope our efforts provide comfort and peace-of-mind to your patients. With DAMAS we emphasize our commitment to excellence every day.

Digital Models - All Impression Systems Welcome

ROE has once again made a major investment in digital technology. To facilitate an efficient and predictable means of producing models from digital scans, we purchased two of the finest model-printers available. With this equipment we are n

o longer inhibited by the delay times of model-producing companies and delivery services. Production is more streamlined and model-fabrication is now a ROE controlled process.

Doctors who are investing in digital impressions may be interested in model-free dentistry. This is possible for many posterior cases. However, to fabricate a veneer, bridge, layered crown, lower partial denture, or bite splint, it is still necessary to work from a physical model.

Add caption

Help ROE design a great smile for you by downloading our Smile Selection Guide. Once downloaded, simply click through the smiles and select a smile that satisfies your patient.

Triple Tray Check Bite

It is known that patients frequently bite differently when anesthetized, and after being open for an extended period of time during the preparation procedure.  So, Dr. Damon Adams, visiting lecturer and editor-in-chief of Dentistry Today, promotes a unique method of ensuring an accurate bite when taking a dual-arch (triple tray) impression. The first step is to capture a centric occlusion (CO) bite on the contralateral (non-prep) side prior to administering anesthesia and before tooth preparation. When taking the final quadrant impression on the prep side, the clinician will use the contralateral bite to confirm accuracy of closure. In other words, the clinician can observe the initial CO bite (seated in place on the contralateral opposing arch) as the patient slowly closes into the impression tray on the prep side. The contralateral CO bite will serve to “guide” the patient into a proper centric. Without a verification technique such as this, slight variations in bite often go unnoticed, creating lengthy occlusal adjustments with unnecessary stress for the clinician at the delivery appointment. 

Protrusive Considerations

When preparing anterior teeth, it is always a good idea to have the patient perform protrusive and lateral disclusion after the initial preparation. It is important to verify that adequate space has been provided for functional movements.

Occlusal & Contact Issues - Simple as +/-

In order to minimize chairtime and maximize the value of our restorations, we have established an innovative system for communicating and implementing preferences for interproximal and occlusal contacts. Proximal contacts have been separated into two categories, ‘fit’ and ‘shape’. Proximal ‘fit’ determines the amount of contact ranging from ‘extra light’ to ‘tight’, and the ‘shape’ ranges from ‘point’ to ‘extra broad’.  Occlusal contact preferences focus on the amount of ‘resistance’ to the antagonist. The system is uncomplicated, from a communication perspective, and has been implemented in both our fabrication process and final quality-control evaluation. If you are interested in discussing your preferences and reducing chairtime, your Technical Consultant will provide information on our system and discuss how your feedback will refine our fixed restorations.

Sphero-Flex - A Solution for Divergent Implants

When a freestanding appliance is desired, but divergent implants present a challenge, Locators and O-Rings are not always the best option. Often, the total degree of divergency between all the implants is greater than the aforementioned attachments allow, or accommodate. In such a case, we recommend a unique product called Sphero Flex. This system uses compensating plastic sleeves (figure 2) to correct the angulation, and eliminate what the manufacturer, Rhein83, calls “insertion trauma”.

With this correction, the appliance should seat easily and the inserts will wear less.

As with other systems, collar height, space, and angulation must be determined prior to ordering the components. Please send an implant level impression and a duplicate of the patient’s appliance. If fabricating a new appliance, ROE will order the parts during the prosthetic development. 

Send A Smile

We always request that photographs be included with anterior restorations. While pictures are also beneficial for shade and texture, they are invaluable for contour, length and esthetics. It is important to know that for contouring purposes, our favorite image is a natural smile. This image shows us critical soft tissue considerations, such as neutral zone and lip position. Too often this image is not included with the case. Thanks for your help!

All-On-4 - Total Treatment Support

When restoring an All-On-4 case, rely on ROE for chair-side assistance. One of our three Clinical All-On-4 Specialists will visit your office on the day of implant placement and convert an existing denture into a hybrid. If requested, they will also advise on abutment and parts selection as well as impression and pick-up techniques. ROE has completed hundreds of chair-side conversions and we would like to share our expertise with you.

ROE offers the complete solution for this popular treatment option: immediate dentures, conversion, guided surgery, bone reduction guides, treatment planning, and of course final restoration. The fee for chairside denture conversion is $600, which includes all laboratory work. Travel expenses will apply when out-of-town visits are requested. 

New Associate - Tera Dearstine RDH

We are proud to introduce the latest member of ROE Dental Laboratory, Tera Dearstine, RDH. Tera brings 15+ years of clinical experience to our sales and technical support team. We are excited to have her join our team and know she will go above and beyond to support the practices of the dentists we have the pleasure of serving.

Tera completed her RDH at Stark State College and is passionate about dentistry. We believe that her many years as a hygienist have prepared her well for her new position at ROE. She looks forward to serving you.

PFM's & Full Cast - A Whole New World

ROE pioneered CAD/CAM PFM’s over a decade ago using CAM printed plastic patterns. Now, many years later, thanks to sophisticated dental engineering, the majority of our full gold crowns and PFM restorations are manufactured using three of the industry’s state-of-the-art systems.

After the design stage, restorations are fabricated directly from the selected alloy, without investing or casting. The benefits to the dentist include low, flat fee, (except 55 Au) reduced fabrication time, dense porosity free castings, digital design file storage, unsurpassed alloy purity, and lot number traceability. Below is a brief summary of how three of our restorations are currently being produced.

Full Cast Crowns – Full-cast restorations are milled in Röders RXD5 machines from solid pucks of either yellow noble (2% Au) or yellow high noble (55% Au). The fit of these milled restorations is unmatched, and the porosity-free, metal blank provides incredible smoothness and density.

Base Metal PFM – Using our Datron D5, an amazing German milling machine, these restorations are sculpted from a solid puck of CoCr. Virtually any design is possible, including long-span bridges, rest seats, and some attachments. It is by far the strongest alloy we offer, and porcelain adhesion is excellent. Thanks to this robust milling machine, it is the finest PFM we offer.

Noble and High Noble PFMs – Created with Selective Laser Melting (SLM) this additive technology builds the coping layer-by-layer. The process is extremely accurate, creates less product-waste and saves time. Unlike some conventional castings, each set of copings is created from 100% new metal. Presently, these restorations are limited to 3 unit bridges.

  

Although all-ceramic restorations represent the most popular choice of our clients, metal-based restorations remain a proven option and an excellent choice for many situations. Rest assured, when you chose ROE, you and your patients are getting the most advanced restorations available.

Custom Abutment Upgrades

Several months ago we upgraded our zirconia custom abutments. We began infiltrating a dentin shade throughout the abutment and adding a pink hue below the finishline, so that the abutment is less visible on patients with thin biotype or tissue recession.

Now, on select titanium abutments  and on all hybrid bars, we are anodizing - a process of releasing an anode/hydrogen and cathode/aluminum current through the titanium. This electronic concentration can produce an array of colors, determined by the amount of voltage applied. The process changes the surface of the abutment without adding any thickness, and produces a chameleon effect on the metal substructure to help provide more esthetic restorations. Yellow and pink are the two colors we utilize.

 

Anodizing is used in ma

ny industries as a safe alternative to coatings. If you wish to be excluded from this new standard, please indicate on your work authorization or call your technical consultant.

We are not charging for any of these product upgrades, but we believe these small changes will have a big effect on the success of the restoration.

Datron D5 - Dental Milling at its Finest

If you would like to observe something impressive, stop by the laboratory to see our new milling machine. Weighing nearly a ton, our new 5-axis mill is something to behold. We could go on for pages about its 13-station tool changer with automatic length and tool-break sensor, or its 8-disk automation system for one hundred hours of uninterrupted milling, and all that might sound great. But, what is ultimately important to our customer is that, with the D5 onsite, we can consistanly deliver accuracy and fast turnaround time.

Purchasing this equipment is a serious investment in the future of CAD/CAM at ROE. The D5 was built from the ground up to meet the specific demands of the dental market for the production of complex tooth and implant geometries. The D5 mills materials within +/- 5µ, which means extreme accuracy. In addition, we fabricate abutments, implant bars, copings and substructures more quickly than ever before. The D5 mills all dental materials, but we have dedicated  our new machine specifically to titanium and cobalt/chrome (read below). We are very excited to provide this level of engineering and sophistication to our clients.

Cobalt/Chrome, the New Biocompatible PFM

Given the ability to mill extremely precise substructures with our Datron D5, ROE is introducing cobalt chrome (Co/Cr) as an excellent alloy for PFM restorations. There are many reasons to make the switch to Co/Cr. It has been a trusted alloy in dentistry since the 1940’s in tens of millions of restorations. The alloy has been the standard-of-care for PFM’s in Europe for many years. Co/Cr is a very strong alloy that is biocompatible and free from nickel and beryllium. All Co/Cr PFM restorations are produced with our new D5 high-tech milling machine. These CAD/CAM-designed, porosity-free copings are extremely precise. The days of waxing, investing, casting, divesting, and finishing are gone. Due to the elimination of so many variable-filled steps, greater predictability and accuracy are inevitable with milled PFM restorations. Once the copings are created, ceramists use traditional layering techniques to produce esthetic restorations.


Milled Co/Cr PFM restorations represent the most technologically advanced PFM restoration available. With the high cost of precious alloys, the flat fee of $150 per unit makes these restorations a great value. 

Ultra-Z The Next Generation of Metal Free

ROE now offers the perfect combination of low-cost, high-strength, and esthetics. Resin-filled zirconia is being introduced to dentistry as the next-generation, monolithic restoration.  Ultra-Z is 20% nano-resin and 80% zirconia, yeilding high flexural strength. Ultra-Z also offers compressive strength of 480 MPa, which is the strongest of the esthetic ceramics on the market. Its unique material blend offers a high modulus of elasticity, which promises to prevent fracturing under stress. The resin filler also delivers a translucent effect that is not found in other monolithic materials of this strength.

Similar to monolithic zirconia, this material is primarily suitable  for posterior restorations.

Due to lower material cost, less laboratory production time, and no sintering requirement, Ultra-Z is available for only $79 per unit. 

Available Cusp Shades A1, A2, B1, C1. We can custom stain the body and gingival, but the cusp shades are limited at this point... more shades coming.

TLZ-IB Prettau Bridges Update

We continue to have great success with our full-arch zirconia restorations. Unlike many companies, ROE designs and fabricates all phases in-house for better design-control and improved turnaround time.

TLZ-IB Prototype

Base upon our experience with this prosthesis, we recommend utilizing a PMMA prototype.This milled provisional is used to finalize all functional and esthetic aspects of the prosthesis, and is kept in the mouth for no less than 6 to 8 months to allow adequate time for the tissue and bone maturation. Without this healing-adjustment period, it may be necessary to add to the intaglio surface with Gradia composite. Please visit our web site for additional details and processes.

Thommen & SynOcta - Custom Abutments Now Available

If you restore either of these systems, you’ll be glad to hear that they are now compatible with ROE’s line of custom iRIS abutments. Thommen is available in both titanium and zirconia, and Straumann’s SynOcta can be produced with titanium. Also, both are compatible with our very popular TLZ-SR screw-retained, monolithic crown or bridge. Furthermore, if you posses a digital impression machine, such as 3Shape, iTero, Lava TDS, Cerec, E4D Nevo, or CS3500, we can offer scan-bodies for intra-oral scanning. This increased accuracy reduces both laboratory and chairside time, while reducing cost.

Avadent Partner Laboratory

ROE is now an Avadent partner. Avadent is a digital denture company that boasts the ability to produce a complete denture in 2 appointments. The ability to mill a denture base and teeth from a dense, porosity-free, zero-shrink puck of acrylic, and the sophistication of their tooth-manipulation software is very impressive.

Ivocap Update

ROE has utilized Ivoclar’s SR Ivocap Pressure Injection system since the mid 1980’s to process dentures with great success. Ivocap virtually eliminates the problem of acrylic shrinkage by controlling heat/pressure polymerization during the injection process to continuously adding acrylic into the flask as the acrylic cools and shrinks. For our customer this means dense, strong, porosity-free dentures that fit. Recently, we upgraded our entire system to the new Ivobase processing equipment. The computer-controlled system eliminates the possibly of human error, ensuring outstanding success on every case.

Root Tip – A Natural Abutment

When a partially edentulous case presents, and the coronial aspect of a tooth has been or will be lost, before removing the tooth root you may want to consider a tooth-borne attachment.  Using the root to retain an attachment, similar to how an implant is placed, is a conservative alternative, and can be accomplished using a Micro Era from Sterngold, or Locator or Zaag from Zest Anchors.

The technique is somewhat sensitive. To achieve optimal results we suggest discussing the design with us in advance of the preparation appointment. How you prepare the tooth and canal differs depending upon the attachment selection and which technique is chosen to create the impression and indirect, telescopic attachment. It is usually best to minimize the height of the attachment, allowing space for the prosthesis. In fact, when vertical dimension is limited it may be advantageous to use a direct-technique, eliminating the cast coping and bonding the attachment directly to the tooth structure and canal. With proper planning, this type of case design can be a great service to your patients. 

Partial Denture Digital Presentation

For the past four years ROE has employed CAD/CAM technology to create cast-partial dentures. Master casts are digitized and sophisticated software is used to create the final design. A stereo lithography framework pattern is then printed for casting. Our CAD-produced partial dentures are far superior to their hand-fabricated predecessors.

ROE has always provided a complimentary conventional survey and design service. The design is penciled on the study cast and returned for rest-seat preparation and final impression. Now, because of our high-tech approach, clients can send study casts and request a digital survey and design, which includes virtual teeth. This virtual work-up is emailed as a viewable 3D model that can be rotated to any view. The web-based preview can be shared with patients who may be particular about the design. The service even allows you to email a full-smile photograph of your patient to be used in the work-up. The patient photograph allows us to provide a 2D image of the final result, allowing the patient to be aware of clasping in the esthetic zone. This service is available for $25.

Zirconia or Emax, Monolithic or Layered – Decisions, Decisions

Based upon our experience, and reinforced by gurus in our industry, we’d like to make a recommendation of restorative materials and how they relate to location in the arch. The basic selection process for dental materials has not changed over the years - the stronger the restoration the less esthetic, and vice-versa. In the mouth, this directly correlates to stronger in the posterior, esthetic in the anterior. Fortunately, due to material improvements over recent years, the range between the two ends of the spectrum is narrowing. But a combination of treatment around an arch often presents a conundrum.

ROE’s standard recommendation for material-selection is as follows: in the molar area we suggest full-cast gold restorations or full-contour zirconia (TLZ, BruxZir) as the most predictable and reliable. With centrals and laterals, when occlusion is stable, we suggest our very esthetic, layered eMax. Our choice for bicuspids and cuspids varies depending upon a number of factors, such as occlusion, guidance, opposing surfaces, translucency, final shade, and stump shade. For example, if strength is the primary concern, full-contour zirconia might be the best choice; conversely, if a younger patient presents with translucency requirements and a stable occlusion, layered eMax or even monolithic eMax might be well-suited. If the patient has a dark preparation-shade, PFZ, full-contour zirconia, or monolithic eMax is the best choice to mask the discoloration.

In more extensive restorations, it may seem prudent to use the same material to maintain continuity within the smile. However, the patient’s particular needs, and the spectrum of materials available, may complicate the choice of material. In these situations, feel free to gather information and discuss treatment-options with your ROE Technical Consultant. They are experienced and trained to help dentists decide the best material for the situation.