CMR DENTAL LAB
Excellence In Beauty
CMR Core Values
It's Not A Job, It's Our Passion
To ensure the best treatment for your patient at CMR Dental Lab, we encourage your team to contact Beth, our scheduling coordinator, as soon as your patient accepts treatment. This way we will reserve space on our schedule at the earliest time for the fabrication of all phases of your case.
Please have an idea of which restorative materials you want to use and which teeth are being treated when scheduling cases. We usually schedule a diagnostic wax-up before preparation on more complex cases. Using the silicone matrix of the wax-up to fabricate the provisional restorations saves clinical time, and serves as a template for the final case.
When scheduling full mouth reconstruction cases, be sure to communicate the sequencing of treatment; my personal preference is to do the anterior 20 teeth first, then the posterior 8 as a final phase of treatment. It is important to know this when completing the diagnostic wax-up to have the matrix fabricated to work with this sequence. We are also happy to schedule full-mouth reconstructions as a single-phase treatment if you prefer; we work with many different philosophies of treatment.
Once we schedule preparation and delivery dates for all phases of treatment for your patient, it is important to notify us of any changes in scheduling; we can only honor the return dates if all of the needed components of the case arrive at our dental lab promptly. We will take the same care to ensure your patient’s case arrives back in your office when expected.
Beth is always happy to discuss options and alternatives if you have questions regarding the scheduling of a case. By pre-scheduling cases, we control the workflow in our lab and ensure your restorations receive the time and dedication they deserve.
What To Send With Your Case?
1.) Master impression, maxillary, and mandible.
2.) Detailed impression or model of the provisional restorations.
3.) Pre-operative models for patients undergoing comprehensive treatment.
4.) Bite registrations for master models: indicate if the bite is taken at MIP, CR or a neuromuscular position. This helps us evaluate the mounting of your casts.
5.) Bite registrations to cross mount provisional restorations to the prepared tooth models. This is extremely important and needs to be accurate! We check the position of the final restorations relative to the position of the provisional restorations; if this isn’t accurate, then the mounting of the provisional model is compromised.
6.) Face bow transfer for full arch cases.
7.) Stick bite for all multiunit anterior cases.
8.) Photos for communication: The sample set provided below explains the need for each. You can also download the PDF of this to have a checklist in the operatory.
9.) Detailed lab slip.
10.) Some clients include a PowerPoint or Keynote presentation detailing the clinical condition and goals of the case. If you are good at this, it can be very effective communication. Short video clips of the patient talking about their goals for the treatment give me a good perspective. Videos of simple phonetic tests in the provisional restorations can also be helpful. Avoid feature length films.
We have provided a detailed laboratory prescription in an electronic format here on our website. You can fill it out digitally and email it to us or download it and print a copy to fill out by hand. This is designed to provide the basic information we need to fabricate your case and deliver it back to you on time. Information regarding the type of restorative material, the desired shade of the final restorations, the shade of underlying dentition and the length of the anterior teeth on comprehensive cases is critical to the success of treatment. Be sure to provide all information that is pertinent to the treatment of your patient. It is helpful for us to know the overall treatment plan and goals of the patient as well as information about the current phase of treatment. Providing all necessary information related to your case reduces the need for us to call and interrupt your day with questions about the basics of the case. We still may need to call and discuss treatment options and share ideas, but having the basic data allows us to make the most productive use of your time on the phone or iChat with us.
Our lab prescription is set up for complex, comprehensive cases; if you are treating a simple clinical situation with one or two teeth, it isn’t necessary to fill out everything on the form, just what is about the clinical situation being treated. If you have questions, feel free to call and ask us for clarification.
Material Choices at CMR Dental Lab
At CMR we offer the finest restorative materials to achieve beautiful long lasting results for your patient. The process of selecting the right material for your patient should be discussed in the treatment-planning phase to tailor treatment and material to your patient’s pre-existing dental condition. We can help to idealize the final result by choosing the least invasive option that will accomplish your patient’s desired result without compromising, either aesthetically or functionally. By customizing the treatment plan and material choice for each patient we can deliver the least invasive option that can be used successfully for your patient and their clinical situation. Our choices of material include the following categories.
e-max® lithium disilicate pressable material (Ivoclar-Vivadent) is the hottest new development in dentistry today. It is a high strength pressable that can be pressed as thin as .2mm and comes in a variety of opacities to handle various clinical applications. This is as close to a universal restorative material as we have seen in dentistry. It works well for minimal thickness, “no prep” veneers; it works equally well for full coverage, very thick molars, and everything in between those two extremes. It is etchable and can be bonded with a total-etch technique, but, can also be cemented with Multilink or Panavia in full crown posterior applications. Flexural strength is in the 400mpa range. The latest studies out of NYU by Dr. Van Thompson’s group rated this “the most robust “ restorative material in dentistry today. Their study simulated chewing forces with a variety of different types of restorations. The comparison between monolithic lithium disilicate and zirconium crowns was compelling: at 100,000 cycles with a load of 350n, 90 % of zirconium-based crowns had failed, mostly by chipping of the layering ceramic; at 1,000,000 cycles and 1000n of force none of the lithium disilicate restorations had failed! For single unit restorations with nice underlying tooth color, this is my first choice for a restorative material. Anterior bridges in low-stress areas I’m approaching cautiously. I would also prefer to see the restorations bonded rather than cemented, but the manufacture is ok with cementation as long as there are sufficient restorative thickness and retentive form to the preparations. We are still slightly limited by the availability of some colors in this system, which may result is the use of Empress® or feldspathic material for some cases.
Feldspathic veneers, inlays, and onlays type of restoration has been used for years to deliver some of the nicest esthetic results ever achieved in dentistry. They are fabricated with a powdered ceramic buildup on foil or refractory. Fits are good, and the color is excellent. These restorations must be adhesively placed to be successful. We recommend a total etch 4th generation dentine adhesive (Optibond FL) and a luting resin (Variolink) for delivery. Varying levels of opacity can be used with feldspathic restorations to mask underlying color problems and to create very nice contact lens effect margins. Flexural strength of feldspathic ceramic is around 85mpa. The limiting factor on use of this class of material is a low strength, which isn’t conducive to large areas of unsupported porcelain that occur in complex clinical situations. The development of lithium disilicate pressable restorations have replaced feldspathic veneers in very thin veneer applications and pressed ceramic in general is better to control extensive cases with full arch occlusion. Simple anterior veneers without excessive thickness or areas of unsupported porcelain can be done very successfully with feldspathic veneers.
Lucite reinforced pressed ceramic restorations have been used successfully for veneers, inlays, onlays, and full crowns for the last 20 years. Although there are many different manufactures represented in this category, we have chosen Empress® (Ivoclar-Vivadent) as our primary product. We have used this product successfully for thousands of restorations. Flexural strength is in the range of 175mpa, which allows thicker restorations with areas of ceramic unsupported by underlying tooth structure. Empress works great for anterior veneers as well as posterior restorations. Preparation depth of .7mm is necessary to use Empress restorations; more thickness is needed to mask darker colors of underlying tooth structure. This material has been almost completely replaced with the higher strength e.Max LiS2. We now use empress only for shade matching previous empress cases.
Pressed to Zirconia restorations have gained popularity over the last ten years. Applications include full crowns, bridges, and implant abutments. These restorations require full preparation and the same reduction requirements as PFM restorations (1.5mm axially and 2mm occlusal). Conventional cementation is recommended. Flexural strength of the Zirconia core material is 1200mpa, which makes it a good support for bridge applications. Unfortunately, the ceramic that is layered or pressed over Zirconia only has a flexural strength of 85mpa, leaving it very vulnerable to chipping and fracture. We do not offer pressed over zirconia restorations.
"As a prosthodontist, I have worked with many, many dental labs. The attention to detail and restoration quality that CMR dental lab delivers is exceptional. I highly, highly recommend them."
- Graham M. Actual Client of CMR Dental Lab
A Dental Lab That Is Completely Different
One thing we learned early on is second best is never good enough. At CMR Dental Lab we go the extra mile to ensure our products never just meet expectations, they exceed them. After all, don’t your patients deserve our best?
The one thing that fascinated me about dentistry when I got hooked on it as a teenager was how the industry always kept evolving, I vowed then and there to never stop learning. Education breeds excellence and at CMR Dental Lab excellence is what we are all about.
With both materials and techniques changing for the better over the years not improving is not an option. Visit our learn now section to see some of our newest creations and methods that enable people nationwide to have the brightest, straightest, most ridiculously gorgeous smile possible.
Meet The Team At CMR Dental Lab
Matt R. Roberts
Matthew Roberts, founder of CMR Dental Laboratory, is one of only thirteen accredited ceramists in the American Academy of Cosmetic Dentistry. He lectures nationally and internationally and has worked with many of the leading clinicians in the country. Matt is on the editorial board of numerous dental publications; Practical Periodontal and Aesthetic Dentistry, Signature Magazine and Reality. He is the founder of Team Aesthetic Seminars. He holds Advanced Dental Education training classes for dentists and ceramists. His goals are to elevate the quality of restorative treatment received by patients by redefining the working relationship between dentists, ceramists, and specialists.
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Raised in a town outside of Chicago, IL, Sandy became a technician in 1984, after pursuing an education in art and design at the University of Illinois. After working in several different labs ranging from full-service production, to an in-house lab, she moved to Idaho to try cosmetic dentistry in 1996. She became a CDT in 2001. As an active member of the American Academy of Cosmetic Dentistry since 2003, her work has been featured on three covers of the prestigious Journal, as well as many awards in previous Smile Gallery Competitions. She has recently achieved accredited status in the AACD, and received her award during the 2009 conference in Honolulu, HI, becoming one of 27 technicians; four of them being women. While experienced in the full range of laboratory procedures, she specializes in creating beautiful smiles in porcelain, and works with many of the leading clinicians in the U.S. Over the years, she has been privileged to help many doctors achieve their higher educational goals, and has had much experience teaching advanced-level courses for both doctors and technicians. She enjoys living and playing in Idaho with her husband, two step-children and daughter.
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