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Is all zirconia really the same?

How can zirconia be different?

History Lesson: Medical zirconia hip implants

What qualities do labs need from a manufacturer?

How does the future of digital impressioning affect dental labs?

What can labs do today?

What is 3M ESPE’s vision of a digital workflow?

Lava™

Precision Solutions

Future

history lesson

How can zirconia be different?Is all zirconia really the same?“ Zirconia is not zirconia.” — Gordon Christensen Dental Economics, Sept. 2007

A recent article in Dental Economics by Gordon Christensen

confirms what many manufacturers have been saying about

zirconia. Christensen continues, “The scientists from each company have developed their own

desired characteristics of their zirconium oxide materials...some labs are telling dentists that

any zirconia is adequate. I would be wary of this statement.”

If your Doctors are wary or confused, remind them that while all zirconia can be chemically

similar the processing methods that created the final zirconia product can be very different.

Suppliers of zirconia often guard their composition and processing of their zirconia much

like a chef who carefully guards the receipe to his secret sauce.

Why are they different?Processing methods for pre-sintered zirconia affect performance attributes.

Process Step Processing Methods Attributes Impacted

Powder

• CO-Precipitated

(most powders)• Mixed Oxide Process (cheaper) • Grain Size (0.07– 0.3µm)• Spray Drying & Organic Additives

• Translucency• Strength• Longevity• Hydrolytic Stability• Sinter Behavior

Pressing

• Axial Compacting• Isostatic Compacting• Pressure

(800–3,000 bar)• Clean Room (no imperfections

by airborne impurities)

• Marginal Fit• Translucency• Strength

Pre-sintering

• Temperature• Time

• Marginal Fit• Machinability

Machining

Coloring

• Pigments (part of the

powder processing)• Liquids

• Marginal Fit• Translucency• Strength• Longevity

Final sintering

• Temperature (1,360°C–1,530°C)• Time

• Translucency• Strength• Longevity• Hydrolytic Stability

A brand you can trust.

Know the facts.The Lava™ Zirconia Espertise™

Scientific Facts booklet includes five-

year clinical results for Lava™ Crowns

and Bridges and compiles data on the

material’s milling and fabrication process,

marginal fit, translucency and esthetics.

Use the information to help you choose the

right product and ensure you get the exact

properties you specified.

The fact remains all zirconias

are not the same, therefore

performance attributes of

each zirconia will also not

be the same.

In order to better understand

these performance attributes,

there are some very simple but

important questions you should

be asking your zirconia supplier:

• Is there solid scientific and

clinical data behind their

product?

• Do they have In-Vivo (in the

mouth) clinical studies?

Very few manufacturers have these studies.

Once dental professionals

understand the differences in

zirconia materials, choosing the

right material becomes clear.

1. 3-unit posterior bridges, P. Pospeich, University of Homburg, Homburg (Start 2000).

2. 0828 In-Vitro Vertical Marginal Gap Comparison of CAD/CAM Zirconium Copings, A.J.T. Shannon, F. Qian, P. Tan, and D. Gratton, University of Iowa, Iowa City, USA (2007).

3. 3M ESPE Lava showed the lowest marginal and absolute marginal gap in comparison to Cercon and DCS, A. Piwowarczyk, H.-C. Lauer, Determining the marginal fit of CAD/CAM bridge frameworks, Pan European Federation Conference (PEF; CED) #0254 (2006).

4. Lava 3-unit bridges showed smallest Marginal gap v. Etkon, Cercon brain, Cerec Inlab, F. Beuer, T. Fischer, K.-J. ERdelt, H.-U. Aggstaller, K. Spiegl, W. Gernet; (2005) IADR #1336 and In-vitro Study Marginal fit of Lava restorations; F. Beuer, T. Fischer, K.-J. ERdelt, H.-U. Aggstaller, K. Spiegl, W. Gernet, industrial report (2006).

5. Translucency of different zirconia materials, Prof. R. Scotti, Prof. P. Baldissara, Dr. A. Llukacej, Dr. L. F. Valandro and Prof. M. A. Bottino, Academy of Dental Materials Conference, 2006. [Abstract 103].

6. Zirconia ceramics or “By Night, all Caats are Grey”, A. Dambreville, M. Phillipe, A. Ray.

history lesson

How can zirconia be different?

Sponsored by 3M ESPE

Translucency and restoration esthetics.Lava zirconia shows a significantly higher

translucency relative to the competition shown.5

Medical zirconia hip implantsWhat happened? • Many manufactures entered the market as zirconia increased in popularity in the late 1980s

• Failures resulted from unexpected chemical phase transformation of zirconia hip implants

• In 2001, major FDA recall of selected vendors’ hip implants

• Manufacturers dropped out of market with five remaining major players worldwide

• Zirconia hips are still very successful 150–200,000 placed annually in the US —6% of hip implant market

Lessons learned. Zirconia is not all the same“Depending on the quality of manufacturing, the properties of zirconia obviously vary— as do the results observed: there is zirconia and zirconia”6

“Quality depends on purity, density, porosity, particle size, crystalline structure (content of tetragonal and monoclinic phases)”6

“Slight variances during the various manufacturing processes, compacting, sintering, HIP could have given rise to the defects...a few degrees during heating could reduce cohesion of particles...manufacturing secrets”6

Clinical studies are invaluable in confirming lab test results “In the absence of rigorous scientific clarification, information on bio-materials is frequently a source of confusion and misleading generalizations worrying to orthopedic surgeons”6

What is 3M ESPE doing to authenticate their zirconia?3M ESPE is implementing an authentication

system to help Doctors know if they are getting

authentic Lava™ Zirconia.

Doctors ask lab for Lava zirconia by filling out the Lava Post-it® Note prescription pad and marking the “Accept No Substitute” box on the form

Authorized Lava labs include the “Lava Sticker” with restoration

Doctors look for the “Lava Sticker” with their case

1.

2.3.

Marginal fit.Lava zirconia has excellent fit relative to leading

competition. 2,3,4

Strength and longevity— proven with clinical results.Lava™ Zirconia has a 100% survival rate in 5+ years of clinical studies.1

Crowns

3-unit bridges

3-and 4-unit bridges

Comparison PFM and Lava™ all ceramic crown N. Lasser, E. Pieslinger, University of Vienna, Vienna Start 2004

Lava all ceramic anterior crowns with reduced wall thickness (0,3 mm) D. Edelhoff, H. Spiekermann, University of Aachen; Start 2004 A. Raigrodski, University of Washington, Seattle Start 2005

3-unit posterior bridges P. Pospiech, University of Homburg, Homburg Start 2000 A. Raigrodski, G. Chiche, LSU, New Orleans Start 2001

One center study (general practitioner/university) J. Sorensen, Portland Start 2003 R. Perry, G. Kugel, Tufts University, Boston Start 2004 G. Laborde, P. Lacroix, Privatpraxis, Marseille Start 2005 (Post Market Surveillance)

Multi center study at universities R. Scotti, Bologna; D. Re, Mailand; F. Zarone, Neapel Start 2003

Multi center study at general practitioners T. Burke, University of Birmingham, Birmingham Start 2004

100%survival

A partner you can rely on.

What is 3M ESPE’s vision of a digital workflow?

Digital Conversion• Digital impressioning

• Scanning of model

What qualities do labs need from a manufacturer?You’ve done your homework, studied pros and cons and finally made a decision to purchase a piece of equipment. What happens next is what

defines a partnership versus just another sale. The best way to understand if it’s a partnership or just a sale is to talk to existing customers.

How does the training process work? How will you promote your new product or purchase? What kind of network is in place for service and support?

Do you have a clear understanding of the manufacturer’s capabilities and future digital vision? As you can see, quite often the real work begins after

the purchase.

Consistency• 3M has 100+ years manufacturing excellence

• Doctors ask for the Lava™ Brand by name

• Precision CAD/CAM system

Security• Last year, 3M spent $1.5 billion in research and

development, creating practical and ingenious

solutions to help its customers succeed

• 3M ESPE has a history of innovative products that are rigorously tested before being introduced to the market

• Strong commitment to digital dentistry highlighted by the purchase of Brontes Technologies in 2006

Support• 3M ESPE supports your business with technical service and educational resources

• 3M ESPE helps grow your business with business planning, marketing and sales support

• 3M ESPE has a nationwide sales force— more than 130 strong calling on dentists and labs daily

3M ESPE believes there is more to a partnership than just selling equipment. It is about consistency, security and support.

3M R&D Related Expenditures*2006 $1.522 billion

Total for last 5 years $6.390 billion

*Amounts have been revised to reflect 3M’s election to restate prior periods upon adoption of an accounting standard that required 3M to expense stock-based compensation effective Jan. 1, 2006.

The future begins with commitment and 3M ESPE

is committed to being a leader in the transformation

of dentistry from conventional processes to digital

processes. How is that transformation achieved?

Through a vision of a complete digitally enabled

workflow — an end to end solution. And what makes

the digital workflow vision a reality? It all begins with

a digital file that can come from a digital impression or

by scanning a model, and it is all made possible by an

integration of technologies and partnerships.

That digital file enables digital design, digital

manufacturing and will enable digital finishing. The

tremendous success of Lava™ Crowns and Bridges has

enabled the introduction of Lava™ Precision Solutions

and the promise of a technology platform is to lead this

transformation of dentistry.

A platform you can build upon. | Sponsored by 3M ESPE

How does the future of digital impressioning affect dental labs?

Digital impressioning is coming and will have a great impact on how dental labs conduct their

business. It is a very exciting time to be involved in the transformation from conventional to

digital dentistry.

There are many intangibles that promise to improve lab productivity but some very tangible

steps that will go away with digital impressioning include: shipping of impression from dentist

to lab, disinfection of impression, pouring impressions, base and pin model, die cutting,

trimming and articulation.

As you can see, a very real and different manufacturing process is coming to dental labs. It is

this process that will take you out of the “stone” age and into a future with infinite possibilities.

What can labs do today?Don’t panic. Have a plan. Outsourc-ing is an effective and proven way to maintain your business. You should not feel pressure to buy a piece of equipment. However, as your business grows and you look towards the future be certain that you partner with a manufacturer that has the flexibility and ingenuity to integrate future technologies.

What can 3M ESPE offer?1. Outsourcing

made easy...It’s easy for your lab to keep your existing dentists happy and attract new ones by outsourcing. You simply send the design and milling of the coping or framework to an Authorized Lava™ Milling Center (ALMC). You’ll receive the best canvas possible for your porcelain artistry — a coping or framework in a natural dentin shade. Secure your artistry with Lava™ Ceram, the only porcelain designed specifically for Lava™ Zirconia. As part of the Lava™ CAD/CAM System, Lava ceram has five years of clinical history.

2. Authorized Lava™ Design Center (ALDC)

As your Lava™ Restorations business grows, you have the option to do more work in-house. With the Lava™ Scan ST Scanner, you can design your own copings and frameworks for milling by your preferred ALMC. The scanner also gives you the ability to provide design services for other labs — an additional source of revenue.

3. Authorized Lava™ Milling Center (ALMC)

Yes, you can even grow your lab to the point where you become an ALMC. This means you control every aspect of creating genuine Lava restorations — from initial design, to milling, shading and sintering the framework, down to the porcelain artistry.

Digital ImpressionThe Lava C.O.S. will offer dentists the

ability to capture high speed and precise

digital impressions to feed a wide range

of digital production technologies.

Conventional Crown and Bridge ProcessesThe lab will receive a digital impression

file, mark the margins and receive a model

for producing PFM, Gold, Glass Ceramic,

etc. using conventional processes.

CAD/CAM Processes including Lava™ Crowns and BridgesLaboratories will design, mill and finish

restoration based on digital impression file.

Digital Design Laboratory ProcessesUtilizing digital impressioning along

with digital design technologies to enable

automated manufacture of final anatomy.

* not yet available for sale

What is 3M ESPE’s vision of a digital workflow?Digital Production• Milling

• Wax printing

• Stereolithography

Digital Finishing• Wax printing

• Full anatomy automation

Digital Design• Multiple substructures

• Full anatomy

Coming Soon...The Lava™ Chairside Oral Scanner C.O.S. will support conventional and CAD/CAM processes.With the Lava™ C.O.S.*, Doctors and labs will be uniquely positioned for the future of digital

dentistry. By leveraging our expertise in impressioning, scanning technology, and systems

integration, we will enable digital workflows with numerous possibilities.

Control Your Future.

© 3M ESPE 2007. All rights reserved. 3M, ESPE, Espertise and Lava are trademarks of 3M or 3M ESPE AG. Post-it is a trademark of 3M. Cercon, CEREC, Control Cast, DC Zirkon, Digizon, E.Max, Everest, Procera and Wieland are not trademarks of 3M.

Lava™

Scan ST Design Center

Control Your Design.

The Lava™ Scan ST Design Center will help you manage the transition to digital. With digital impressioning coming soon, now is the time to partner with a company that will lead you through the transition from traditional to digital dentistry.

A brand that you can trust+ The brand doctors ask for by name+ Differentiated zirconia+ 5 years of proven clinical results+ Excellent fit

A partner you can rely on+ Technical service and educational resources that support your business+ Business planning, marketing and sales resources that help grow your business

A platform you can build upon+ Coming soon: digital impressioning and integrated digital workflow

See the difference for yourself. Provide your doctors with Lava™ Crowns and Bridges from 3M ESPE. Or, to learn more, visit us at 3Mespe.com/lava.

Coming Soon! Lava™ Design Software 4.0 • Improved productivity• New Indications – Implant abutments – Maryland and Inlay/onlay bridges