Whether production facilities for dental prostheses are “around the corner” or in the Far East – that no longer plays a role today. The increasing digitalization gives the dentist the choice. Although Dr. Knut Grevener still works with a German laboratory, the majority of his patients choose the cost-effective alternative with at least partial production abroad. In an interview, he describes the advantages.
Fig. 1a: Strongly damaged teeth, regions 11 to 23
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Fig. 1b: Situation after completion of treatment, monolithic crowns, regions 11 to 23
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Fig. 2a: Implant region 46, gingiva profile scan
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Fig. 2b: Scanbody
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Fig. 2c: Restoration with monolithic crown 46 directly after insertion
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Fig. 3a: Diastema and gaping UK Front
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Fig. 3b: Diastema mesh with monolithic crowns 11, 21, 31, 41
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To what extent do you follow the wishes of your patients for inexpensive dental prostheses in your practice?
Grevener: Of course we respond to the wishes of our patients, so we expanded our range a long time ago. High-quality dental prostheses at reasonable prices can be easily produced today. This is made possible on the one hand by increasing digitalization, the keyword being “monolithic zircon”, and on the other hand by at least partial production abroad.
So you no longer work with a German laboratory? When and why did you decide to cooperate with foreign dental prosthesis providers?
Grevener: The one does not exclude the other at all. Today, I work with a local laboratory and a renowned supplier of foreign dentures. However, patients almost always opt for the cheaper offer while maintaining the same quality.
Does the patient clientele play a role in this?
Grevener: Actually only secondary. Even economically better-off patients are now very price-conscious. For socially weaker patients, however, it is often the only way to get access to good dentures at all. I treat also in the local JVA, there many supplies would not be realizable otherwise at all.
How does the communication with the patients work? How do they react when it comes to foreign dentures?
Grevener: As a rule, decisions have long since been made there, as in other areas of life. If you can get an equally good or even better quality for a not inconsiderably lower price, it is clear where the order is going. Everybody has his budget and nobody wants to “give away” money. This applies in particular to normally very cost-intensive supplies.
Take implant prosthetics, for example: two thirds of the costs incurred go to the laboratory. What does this look like with foreign dentures?
Grevener: There’s a complete reversal of the relationship. That of course helps me to work more economically. So the patient’s choice of restoration is more often based on an implant restoration.
What about the control and repair options? Is that a problem? Does it work just as well as it does in cooperation with German laboratories?
Grevener: I’m still amazed at how seldom it comes to a rework. But if that should be necessary, Permadental will implement my wishes as soon as possible. There is no difference to the laboratory on site.
How, for example, does color determination work?
Grevener: Many patients are now opting for larger restorations, i.e. complete fronts or more. However, even with individual crowns and bridges in the anterior region, the photos showed excellent results. Smartphone his thanks.
What kind of care do you or your patients prefer?
Grevener: If a removable restoration is required, we usually recommend a telescopic replacement to our patients. But wherever possible, crowns and bridges are the first choice. Of course, implants play an increasingly important role in this.
If the choice is fixed dentures, are monolithic crowns made of silicate ceramics, oxide ceramics or zirconia standard or do you still veneer?
Grevener: In fact, we try to avoid delusions as much as possible. Many patient cases can now be treated monolithically with modern materials. Fig. 1 and Fig. 2 show a patient who was treated with monolithic crowns from 11 to 23. “Digital” therefore works. The aesthetic result convinced the patient, as did the calculation.
Keyword “digital”: You have switched to optical impression taking. What advantages does this offer, especially with regard to the cooperation with Permadental?
Grevener: We’ve been using a TRIOS scanner for some time now. Not exclusively, but more and more often. But no matter if conventional impression or intraoral scan, the quality remains the same. But the scanner helps to save some time, and the patients really like it very much.
Are there still indications today that require a traditional, i.e. purely handcrafted dental prosthesis?
Grevener: Of course not everything is digital. The craftsmanship of the dental technicians remains important. Only those who have a sound education are in a position to exploit the digital potential in the future. And here, too, I feel very well looked after by my laboratory partner Permadental.
So far, monolithic restorations have not been considered truly aesthetic.
Grevener: The aesthetic possibilities with monolithic materials have improved enormously in recent years. Such fittings also fit particularly well into the “digital workflow”. It is becoming increasingly possible to work completely model-free. And especially for young dentists and start-ups, the use of a scanner will no longer be a special feature in the foreseeable future. From patient files to imaging procedures to intraoral scanners – the increasingly enlightened patient expects such offers.
To what extent has the image of foreign dentures changed? Are we still talking about foreign dentures?
Grevener: Actually not any more, with monolithic supplies this only plays a subordinate role: quality and price must be right. Above all, the chipping problem is no longer an issue with monolithic restorations. Scientific studies have also shown that abrasion is no longer a clinically relevant problem when applied correctly.
In other words: the future belongs to monolithic supplies?
Grevener: That definitely applies to my practice. And it doesn’t matter whether all production facilities are around the corner or in the Far East. Permadental, for example, offers both, production on site and in Shenzhen.