Digital Trailblazers
How laboratories are leading the way in the dental industry
Ellen Meyer, MBA
Do you view your laboratory as a valuable resource and partner or merely as a vendor who provides a means to an end? Most dentists, if they were being honest, would probably answer the latter. Considering the industry changes that are already in motion at the bench and in the operatory, it’s time to reevaluate that position. Laboratories are ahead of the curve in terms of their adoption of technology and understanding of new materials. In many ways, laboratories today are leading the way, and dentists who don’t take advantage of these partnerships will miss out.
Being a laboratory technician in the current economic climate is not easy. According to Inside Dental Technology Editor-in-Chief Pam Johnson, the challenges facing a constricting laboratory industry today and in the future will largely boil down to the high cost of investing in and maintaining production technologies that can keep pace with the escalating demand for dental services.
“The US population is growing exponentially while the number of dental laboratories in the United States is shrinking. The dynamics of supply and demand will necessitate that laboratories transform their businesses to automated production processes in order to meet the needs of an ever expanding patient base,” she explains.
Indeed, Johnson expects that the pressure to meet future demands may transform the face of the industry beyond recognition—including how the players interact with one another. By necessity, laboratories have stepped up to become modern manufacturing facilities. Their transformation, Johnson points out, was largely due to the advent of zirconia, which required milling technology. “When zirconia came on the market and challenged the strength and biocompatibility of gold at a time when the price of gold was skyrocketing, dentists jumped on the bandwagon and created a demand so great that laboratories either had to access the material through milling centers or invest large sums of capital in milling technology to bring production in-house,” she explains.
The Laboratory–Clinician Technology Gap
Although the laboratory industry has responded to shifting dynamics and evolving technologies by changing radically in a short time, this has generally not been the case on the clinical side. David Hornbrook, DDS, is well acquainted with both sides of the industry, maintaining a private dental practice in San Diego, California, and serving as clinical director of education and technology at Keating Dental Arts in Irvine, California. Although he recognizes that technicians had no choice but to embrace technology, he is frustrated that dentists are lagging behind to such an extent. Hornbrook notes “a huge disconnect” between the labs, who want digital impressions, and dentists, who continue to send traditional ones. Results from a survey he conducted of 45 dental labs a year ago corroborate what is true of the 500 or so dentists served by Keating Dental Arts: only about 5% of dentists are providing digital impressions on a routine basis.
Mike Cash, CDT, director of sales and marketing at Glidewell Laboratories, says that interest in intraoral scanning seems to be on the rise, but the rates of adoption are still increasing rather slowly. "We see 9% of BruxZir crowns and 12.7% of BruxZir bridges being done from digital impressions, but it's not growing very fast," he says.
“Clinicians need to realize with many of the new dental materials used today in the dental lab, these traditional polyvinyl impressions are poured up as stone models in the lab and then scanned and digitized,” Hornbrook says. “Most laboratory technicians believe that a digital scan directly from the mouth is more accurate than the lab’s digitized version of the model poured from doctors’ PVS impressions. Clinicians need to understand why a digital impression is better than a scanned model that is subsequently digitized. Just as in photography, it’s always best to use the original, not a copy.
Proper technique is important to ensure that digital impressions are in fact advantageous to the laboratory. "If an office can't get good conventional impressions, going digital will not fix that problem, and it could make it worse," Cash says. He notes that the adoption of digital intraoral scanning means a huge change to office workflow that requires a serious commitment in terms of time and money.
Hornbrook agrees that cost is a major barrier to adoption of digital impressioning. Dentists may not be aware that scanners have decreased significantly in price. “Scanners now are small, lightweight, and affordable—the 3M scanner is about $16,000.” He suggests cost-conscious practitioners factor in the cost of shipping and impression material into the cost of delivering a crown to make a fair comparison between analog impressions and purchasing a scanner.
“Digital impressions also allow for many of our restorations to be fabricated without any models, which further reduces the cost to the dentist and decreases the time needed to fabricate the restorations,” Hornbrook says. “At Keating, with the accuracy of the digital scans, coupled with the ease of use of the imaging (CAD/CAM) software and the precise mills available, modeless crowns fit well and reduce adjustment time in the mouth.”
Material Matters
Hornbrook points out another area of disconnect—awareness of material technology. “Technicians in dental labs are very proactive on materials because they are barraged with information by reps who don’t deal with dentists. Because companies often have separate sales teams for dental technicians and clinicians, the dentists are targeted for purchases of cements, bonding agents, and impression material, while the lab technicians are pitched new ceramics or changes in ceramics.”
