Are PFMs Dead?
If you don't know the exact number off-hand, about what percentage of your fixed business would you guess is PFM work? And how does this number compare to 10 years ago?
Whether you're a dental lab or a dental practice, everyone knows that not all restorations are created equal. But to answer the initial question, I don't think it's fair to say that PFMs are completely dead.
Like anything else, the constant development and involvement of science, information, and material has advanced dentistry. With PFMs it appears that a stack-able bilayered restoration with a sometimes bulky margin has been improved upon by the development of 2 monolithic options - zirconia and all other ceramic options.
In a 2013 survey conducted by Lab Management Today, 40% of respondents reported a decline in PFM fabrications, although fewer than 10 years earlier, respondents noted that nearly 85% of all crown and bridge work completed was metal-based. Perhaps directly related, 60% of these same survey participants reported a significant increase in the use of pressable lithium disilicate (IPS e.max®, Ivoclar Vivadent, ) over the past 2 years, and nearly 50% reported an increase in the use of zirconia layering ceramic.1
Does your work-load follow similar suit?
On top of the increase in e.max and zirconia work being prescribed, and the increasing demand for more aesthetic results by patients, is the trend for quicker completion times. Perhaps this need for speed can be attributed to a combination of our modern nature and the advent of CADCAM dentistry.
SPEAKING OF CADCAM dentistry:
I also think that the growing popularity of digital dentistry has been another notch in the belt of the decline of PFM dentistry. Not only are laboratories participating, but in-office milling is taking place as well - accuracy, speed, and strength are making their mark. And the materials available for these machines are metal-free ceramics!
So, whats a metal-lover to do?
HANG IN THERE! (But don't forget to adapt along the way.)
Just because PFMs are no longer the Bread-N-Butter of the industry, doesn't mean they should be taken off the shelf completely. We can't forget about attachments, long-span bridges, screw retained crowns - all indicated best for our tried and true PFM work!
What is your PFM to metal-free ratio?
And how do you feel about it?
Till next time!