Technology is Altering the Dental Laboratory Landscape
Chris Brown, BSEE
From tablet computers to smartphones to GPS receivers, technology seems to surround peoples’ lives, both personally and professionally. Mini-touchscreen computers are used to surf the Internet. Cell phones are now routinely used to receive e-mail and make dinner reservations. A GPS is used to navigate the route to the restaurant, monitoring traffic and weather conditions along the way. After dinner, people might watch a movie in 3-D at a local theater or go home and watch a movie streamed over the Internet on a flat-screen television that’s larger than the entire console that housed their parents’ “huge” 19-in. television.
In peoples’ personal lives, technology can be used to enhance knowledge, enjoyment, or convenience. In many cases using technology is a matter of efficiency as people strive to manage their increasingly complicated lives. If technology is able to help improve peoples’ personal lives, it can certainly be used to benefit production in the dental laboratory.
As many laboratories feel the competitive pinch from overseas labs with lower labor rates or from large domestic laboratories that can leverage volume and economies of scale to lower their operating expenses, they must find new ways to remain competitive, efficient, and, in some ways, unique. Most processes in dental laboratories have traditionally been manual operations. Laboratory equipment such as high-speed handpieces, lathes, vacuum mixers, and microscopes may help improve consistency and accuracy to a degree, but they do little to improve productivity. The strategic use of technology can be the great equalizer that allows laboratories to remain competitive, improve service, and potentially offer products and services that separate themselves from other laboratories.
Manufacturing companies use production management software to track materials, orders, and scheduling. Software reporting features enable companies to identify material costs, labor costs, and manufacturing times. The software can identify which stage in the manufacturing process a product or order is in. Dental laboratory management software programs are available as add-ons to common accounting software packages, or completely dedicated software platforms. Laboratories looking to streamline and optimize their operations are adopting production management software written specifically for dental laboratory processes.
Reporting utilities of lab management software identify true manufacturing costs of laboratory restorations and services. Profitable and nonprofitable products can be identified and prices adjusted accordingly. Depending on software features, lab owners may also be able to track consumable inventory and consumption, allowing them to order raw materials in optimal quantities when needed.
Understanding manufacturing times and identifying production bottlenecks can give laboratory owners valuable insight into how efficient the laboratory is and where improvements can or need to be made. Once production bottlenecks are relieved and efficient processes are in place, managers are much more able to schedule production more effectively. When schedules are predictable, deliveries are on time or early, and everyone wins.
As with most companies and industries today, dental laboratories are promoting their products and services via websites and are participating in social media with Twitter or Facebook pages. Online forums and discussion groups provide an excellent outlet for those technicians who enjoy showcasing their work to their peers. Internet forums or discussion groups provide an excellent resource for technicians to solicit recommendations on how to handle challenging cases or even just showcase their work to their peers.
Some progressive laboratories are beginning to accept and sometimes even schedule cases online. Some laboratories accept cases directly through their own websites, while others enlist the assistance of digital prescription services like DDX (Henry Schein Inc., www.ddxdental.com). With the DDX process, doctors enter prescriptions and all relevant case information online, essentially creating an “electronic case.” Digital photographs and x-rays can be included and stored online within a Health Insurance Portability and Accountability Act (HIPAA)-compliant system. Even certain digital impression cases can be included as part of a DDX prescription. Many laboratory production management software programs allow direct importation of DDX prescriptions. Direct import automatically populates all relevant case information for the order, eliminating costly manual order entry along with possible entry errors.
If the DDX case is entirely digital, such as a CAD/CAM-based restoration from a digital impression, the laboratory can work on the case almost immediately. If a DDX case involves traditional impressions, a case pan can be waiting for the impression with a “traveler” or case worksheet already attached.
CAD/CAM-based restorations have introduced many laboratories to the advantages of technology. Ironically, labs don’t even need to invest in CAD/CAM technology to take advantage of it. If a lab does not have the necessary equipment, numerous milling centers have the equipment and are eager to partner with such labs.
Employing 3-D scanners to digitize models, laboratories or milling centers are able to use special software to “design” substructures or full-contour restorations on a computer, rather than physically waxing them. This is the computer-aided design (CAD) portion of the process. Once restorations are designed they are sent to a milling or printing system for fabrication—this is the computer-aided manufacturing (CAM) portion of the process.
Anatomical substructures or full-contour restorations can typically be designed on a computer in less than half the time it takes to manually wax them, usually 2 to 7 minutes per unit. Restorations require a few more “hands-on” minutes to set them up in a project for milling or printing, but after set-up the printer or mill does all the work. Large milling or printing projects are often run overnight in what has become known as “lights out manufacturing.”
Printed or milled wax patterns still require casting or pressing, and substructures still require layering of porcelain or over-pressing. While these steps remain necessary, the efficiency of CAD/CAM still helps reduce the labor dollar content in these types of restorations.
Laboratories integrating with doctors’ digital impression systems can ease the burden on their model departments. For CAD/CAM-based restorations, substructures or full-contour designs can be milled or printed at the same time the model is being fabricated.
As more esthetic full-contour milled, or possibly printed, restorative materials become available, a significant increase in laboratory efficiency will take place. Software tools and characterization stains and glazes will still give laboratories control over appearance and function, but they will be spending minutes instead of hours on each restoration. Restorations will be designed on a computer, fabricated with a machine, and then a technician can provide final detail characterizations, possible even without a model.
Laboratories with model scanners and CAD software, or their milling center partners, are providing cost-effective custom implant abutment solutions. Model scanners are used to scan a traditional model with a special locator abutment placed in the analogue. Software interprets the precise location and angulation of the implant based on the locator abutment position. Depending on the abutment platform and software capabilities, the laboratory may be able to design the abutment itself or forward the model scan to another company to design the abutment. In many cases CAD/CAM-based restorations can be designed and manufactured concurrently with the custom implant abutment.
Cone Beam Computed Tomography (CBCT)
For some time, cone beam scans have been giving doctors new insight into treatment planning of implants. Based on the data collected from the CBCT scan, surgical guides can be fabricated by laboratories or third-party partners to assist surgeons with implant placement. Most dental laboratory CAD programs can integrate CBCT scan data to assist in custom implant abutment and restoration designs. Recognizing the opportunity, larger laboratories are placing cone beam scanners in their labs to offer these new services to their doctors.
When cases become digital, new collaborative opportunities abound. Cases that start or end up digital integrate seamlessly with doctors who go paperless. Cases can be securely shared via cloud-based servers or virtual drop boxes. Laboratories, doctors, and specialists can review and make changes to case planning in real-time with readily available screen-sharing software. Laboratories are no longer limited to 2-dimensional (2-D) pictures and diagrams and are no longer forced to wait for delivery services to send physical case samples back and forth. From custom implant abutments to framework design to full-contour restorations, laboratories and doctors can communicate and plan in ways they’ve never been able to before.
Most businesses do not operate today the way they did 20 years ago. Customers are demanding quicker, better results at lower costs. Today, laboratories are facing the same demands from their doctors, and integration of technology is changing the way laboratories operate. Not only can they process cases more efficiently, but they are finding new restorative products and services to offer either directly or by working with digital partners. In today’s extremely competitive environment, laboratories are actively using technology to expand and grow their businesses.
About the Author
Chris Brown, BSEE, Business Manager
Apex Dental Milling
Ann Arbor, Michigan