Zirconia, Digital Impressions, and Restorative Accuracy with Dr. Michael Skramstad

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In Part 2 of this two-part conversation on Dental Digest, Dr. Melissa Seibert continues her discussion with digital dentistry educator and CAD/CAM expert Dr. Michael Skramstad. While Part 1 focused on the foundations of digital workflows, this episode explores the clinical nuances where digital dentistry either enhances precision or quietly introduces risk.

The conversation begins with one of the most under-recognized challenges in restorative dentistry: the accuracy of digital bite registrations and full-arch scanning. Dr. Skramstad explains that while intraoral scanners are highly capable, their accuracy is heavily dependent on clinician awareness and workflow management. In cases where patients struggle to find a repeatable bite position, digital or analog records may both become unreliable. In these scenarios, techniques such as deprogramming with a leaf gauge and capturing an open CR bite digitally can improve reproducibility and clinical outcomes.

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Dr. Skramstad then discusses one of the most important factors affecting digital impressions: margin management. While scanner technology has improved dramatically, the accuracy of digital impressions still depends primarily on the quality of the tooth preparation and effective hemostasis. He emphasizes that meticulous preparation design remains the single most important determinant of restorative fit, regardless of the digital system used.

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The discussion also explores practical strategies for managing subgingival margins. Techniques such as ViscoStat Clear for hemostasis, selective use of retraction cord, and careful isolation protocols can significantly improve scan accuracy and margin visualization. Importantly, workflow decisions may differ depending on whether restorations are fabricated in-house or sent to a laboratory, since file formats such as STL lack color information and can make margin identification more difficult for technicians.

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The episode then shifts to material selection in contemporary restorative dentistry, particularly the evolving role of zirconia. Early zirconia restorations were often criticized for poor esthetics, but recent material innovations have dramatically improved translucency and optical properties. Dr. Skramstad explains why modern zirconia systems—such as multi-layered zirconia materials—are increasingly used in both posterior and selected anterior applications, while still maintaining the exceptional strength that originally drove zirconia's adoption.

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The conversation also addresses:

• The clinical differences between bonding vs. cementing zirconia restorations • How preparation design influences retention and restorative longevity • The impact of speed sintering on zirconia optical and mechanical properties • When digital workflows simplify restorative dentistry—and when they introduce hidden complexity

One of the most important themes reinforced throughout the discussion is that digital dentistry does not replace clinical fundamentals—it magnifies them. Technology can improve efficiency and accuracy, but it cannot compensate for poor preparation design, inadequate isolation, or imprecise clinical technique.

For dentists exploring or expanding digital workflows, this episode provides a grounded perspective on how to integrate digital tools responsibly while maintaining the biological and mechanical principles that underpin successful restorative dentistry.

Topics discussed include:

• Digital bite registration and centric relation records • Margin management in digital impressions • Hemostasis techniques for intraoral scanning • STL vs PLY file formats in digital workflows • Zirconia vs lithium disilicate restorations • Speed sintering and modern zirconia materials

Whether you're already practicing chairside CAD/CAM dentistry or simply evaluating digital systems for your practice, this conversation offers a thoughtful look at how technology intersects with clinical judgment in modern restorative dentistry.