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Inside Dental Technology
February 2015
Volume 6, Issue 2

Mastering the Digital Shift

Without a compass, owners and managers are forging their own paths in the digital frontier

By Pam Johnson

Over the past decade, a convergence of emerging forces has pressured dental laboratories to transform their businesses from purely manual to quasi-automated production structures. It has been—and remains—a disruptive transition that holds potential for opportunity for those who adapt and adopt and is a harbinger of obsolescence for those who do not. For most, the dramatic changeover continues to be unsettling as business owners labor to find their comfort zone in a technological environment that is relentlessly moving forward with or without them. Today, the focus of industry decision-makers is less on the “when” to invest than it is on the “what” to invest in and “how” to successfully integrate the technology into existing production processes.

For those just entering into this new industrial age or still clinging to tradition, the learning curve is steeper and the changeover more difficult but the opportunity to reap the benefits of more mature technologies and learn from those who went before them aids in the transition.

It is, as Jeff Stronk, co-owner of Treasure Dental Studio in Salt Lake City, Utah, describes, “a continual work in progress.”

Once the decision is made to invest, there is no looking back. The pressure of continual change becomes the new normal. “We look at every new innovation that is coming onto the market,” says George Alioto, CDT, owner and CEO of Expertec in Westland, Michigan. “We, then, carefully watch the market reaction to assess whether this new piece of equipment or material will be the next generation. There is no hesitation to buy it or offer it if the market reacts positively.” Return on investment (ROI) becomes less of a concern than being left behind or unprepared to capture market share in a volatile business environment. “Purchasing expensive machinery is just the nature of doing business today,” Stronk says. “ROI is no longer the main focal point when making a buying decision.”

So which critical steps must business owners consider when bringing automated workflow into the business or taking their commitment to the next level?

Creating Vision

For business executives and management, the transformation to an in-house digital workflow must be driven from the top down. Before any changes are made, the “why,” “what,” and “how” must be clearly articulated and understood by employees, especially the benefits that will be reaped as a result. The changeover will not be successful unless employees rally around the vision set forth by management. The most common reaction by staff is fear of job loss followed by the fear of the unknown. It can be equally frightening for business owners. “The decision to transition to digital production processes was driven by my fear that if we didn’t, we wouldn’t have a laboratory in the future,” says Brad Duncan, CDT, CFO of Duncan Dental Lab, Inc. in Charleston, South Carolina. Once he had conquered his own trepidations and made the decision to move forward, it was imperative his employees be involved in the decision. “The most important first step was getting our employees on board with the concept.”

Transparency is the key, says Stronk, who gathered his staff for a 2-hour presentation on change and change management. His employees had adapted well to the outsource business model Stronk had in place, but the decision to bring production in-house with the purchase of a milling machine would drastically change the workflow and types of jobs needed. “The picture I tried to convey to our people was that as a business, we needed to grow and this was the next step in that plan. I wanted the staff to understand that we wanted their participation in that growth process, but it would mean that the job they had in January 2014 may not be the job they are doing by December 2014.” However, overcoming resistance to change and traditional bench thought processes as well as fear of job loss and/or income was not as simple as Stronk had hoped. “We tried to preface our transition to digital with this presentation and not scare our staff. If I had adopted the same initial attitude as my employees that doing the same old thing would bring in more work, our doors would be closed today. It is one of those tough decisions you have to make to maintain viability in the marketplace.”

In some cases that tough decision means the loss of employees who are more like family than staff but who can’t adapt to the new reality. For Alioto, the tipping point came 5 years ago when full-contour zirconia hit the market and the demand for all-ceramic skyrocketed. The outsourcing model he had in place no longer made sound business sense. “We looked at our ROI and were leaving too much money on the table,” Alioto explains. “We knew that buying a milling machine would eliminate certain departments and those who couldn’t or wouldn’t make the transition to new jobs would no longer be with us. It was a hard decision to make, but it had to be done.” Alioto presented the business decision to his employees as the future path of the industry but, as predicted, not everyone could adapt to the disruption that followed and some eventually left.

Changing employee thought processes and mindset on how products are produced is the most difficult hurdle owners face. The internal politics of those individuals in positions or departments that were once important and now relegated to lower status can often impede the transition process. But successfully getting everyone on the same page and thinking progressively to create different ways of evolving the business can be very rewarding. “Our employees are thinking differently today,” Stronk says. “When we faced an overload in our scanning department, one employee suggested we outsource the overload to a specialty scan and design company. That saved us from a potential work slowdown.”

Overcoming the Learning Curve

A cavernous gap exists between convincing employees of the need to transition and changing their production-process mindset. That is the learning curve. The process and time required for mastering CAD design and CAM milling to achieve a smooth, streamlined production flow can be daunting and even demoralizing for some. It is also ongoing as new software updates, new machinery, and new products and processes are brought online.

“The unsettling thing about innovation and disruption is that they don’t stop once you make the commitment,” says Chris Brown, BSEE, founder of Aclivi, a CAD/CAM consulting and technology resource firm in Pickney, Michigan.

For those just entering the digital realm, the realization hits that the years spent mastering the manual art now must be repeated learning the digital process. “The scary thing for me was that I’ve spent years mastering the art of dental technology. In order to become as proficient in CAD as I am with my hands, I’ll need to invest the same amount of time to achieve that same level of proficiency,” laments master ceramist Joshua Polansky, owner of Niche Dental Studio, a three-person laboratory in Cherry Hill, New Jersey. He has mastered enough of the CAD design process to create the more simple cases, but full-mouth reconstructions and implant cases still present a learning curve, he notes. “However, it is a transition that is definitely making my business more productive,” he says.

For business owners who are integrating technology into the production processes, it is critical to understand how the technology works to ensure that end results and benefits are maximized. And even then, reaching full-production level from the equipment may take longer than expected.

“For someone without any experience in CAD/CAM, there was definitely a learning curve,” says James Grady, General Manager of Grady Dental Laboratory in Kinston, North Carolina. “It took us a week to become fully proficient with the CAD software and a month before we were able to realize a return on investment.” The stumbling block, Grady admits, was not spending enough time thoroughly learning and understanding the milling machines. “I also wasn't prepared for all the unexpected software upgrade difficulties and network issues between our scanners and design stations,” he notes. He has since hired two computer-savvy CAD/CAM technicians to work out the nuances of new software upgrades and troubleshoot should something go wrong.

The disruptive nature of the transition can also impact the learning curve. It is imperative that management and employees be given the time to focus on not only learning the technology but also planning the workflow. Stronk strategically set aside a slow period for the transition. “August is our slow month, which gave us the opportunity to deal with a lower volume of work and fine-tune our operations so that when volume picked up later in September, the stress levels would be minimized and we could be running on all cylinders.”

Building the Infrastructure

Integrating technology into the workflow demands more than conquering the minds of employees and mastering the learning curve. In many cases, it also requires infrastructure considerations and added expenditures. Installation and maintenance costs, electrical upgrades, need for add-on vacuum or air compression, data storage, and reinforced floors to reduce vibration are just some of the considerations prior to delivery of the equipment. “A good rule of thumb is to count on 10% of the cost of the investment to get it installed and up and running,” says Brown.

For Grady, that meant investing in industrial-grade air compressors and three-phase electrical power to operate the two milling machines the laboratory now has. Problems with the electrical supply also required the city to install a transformer. “These are all the things people just don’t consider when they purchase,” Grady says.

As Alioto observes, networking scanners, workstations, milling machines, and 3D printers as well as having the computer power to handle large amounts of data especially for a larger operation can also be a stumbling block. With four milling machines, four scan stations, and six CAD stations and overlapping shifts to handle the case volume, he needed the computer power to handle all the data being generated. “We hired an IT professional to handle the networking and to build a robust computer tower to handle the large amounts of data required for designing large full-mouth reconstruction and implant cases,” Alioto says. “You need to think about computer issues when you integrate these technologies.”

Physical space and temperature control also must be considered. For Stronk, physical space was not an issue. Seven years ago when moving his laboratory to a new building, he chose the space based on a decision he knew he would have to make eventually. “Even back in 2008, I knew that at some point in time we would make the business decision to purchase a milling machine and would need a solid floor,” he says. “The new space is an old bank with a vault on the ground floor, which is perfect for keeping our milling units separate from the rest of the laboratory.” Outfitted with self-enclosed ventilation system, the enclosure eliminates outside vibration and reduces the noise that milling generates.

Humidity and temperature control can also be an issue. Many of the more sophisticated milling machines have built-in temperature compensation controls that keep the units calibrated with fluctuations in ambient temperatures. Smaller units do not, says Brown. “Keep in mind that if the scanner or mill was calibrated to operate in a 70-degree environment and your CAD or CAM area reaches 85 degrees or more by midday that is 15-plus degrees outside the calibrated operating temperature and may mean the machines are operating out of tolerance, which will impact the accuracy of the end product,” explains Brown. “If you calibrate first thing in the morning, just realize that the temperature in the laboratory is most likely lower than when everyone is in and in full production.” He notes that temperature swings of 15 to 20 degrees most likely will not impact the accuracy of simple cases, but may be critical when producing larger, more complex structures. For high-volume laboratories, frequent quality control checks can catch inaccuracies that creep into the system, but smaller laboratories don’t have sufficient sample size to narrow down the problem.

Unique issues may also arise based on location whether in areas of high humidity or in high elevations. For Grady, whose laboratory is in muggy North Carolina, it was condensation in the air compressor lines. He had to purchase a dehumidifier because the high humidity in his location made the compressor lines sweat, transferring the moisture to the milling machine.

Reorganizing Workflow

Perhaps the greatest challenge for owners and managers and their employees is finding the delicate balance in efficiencies between analog and digital steps to streamline production. Incoming cases that once moved from the model department to die cut and trim and then to the waxing station may now skip the traditional modeling and waxing department altogether and move directly to a CAD station or follow a slightly more traditional route to die cut and trim but then skip the waxing station and move to a scan station, CAD station, and mill. The production steps and bench layout that maximized efficiencies for conventional production processes do not necessarily translate to the new digital workflow.

“Layout in the digital laboratory is critical,” says Bob Yenkner, consultant and president of Practical Process Improvement. “You have to analyze how the material or product moves through the production process and envision a continuous flow of cases with no disruptions or stoppages.”

Prior to incorporating a digital workflow, Alioto had invested in redesigning the layout of his laboratory to apply LEAN manufacturing principles that would remove waste in the process and improve efficiencies. “We were only 35% all-ceramic at the time,” says Alioto. “As we transitioned to the 95% digital workflow and 86% all-ceramic where we are today, we found the layout that worked so well with PFM did not translate to all-ceramic digital production efficiencies.” The laboratory layout was again reconfigured to best accommodate the new workflow. “My advice to laboratory owners who are thinking about redesigning their work space is to keep your benches mobile so that you can reconfigure as the workflow changes.” To help solve the layout problem and move cases efficiently among the fixed-in-place work areas, Alioto installed a gravity-feed system that reduces the need for someone to transport cases from one station to the next.

As the industry moves forward and technologies become more entrenched in the production processes, Yenkner believes laboratories will need to continually analyze the analog and digital processes and address them as a complete system, not as individual work areas, in order to maximize the production efficiencies of each department. It is in preparation for a future in which fewer laboratories will exist to meet the demand of a growing dentist and patient demographic. “In the future, you will see the demand for faster turnaround from dentists and patients pressure laboratories to operate 24/7 to compete with chairside and outside forces to meet that demand,” Stronk says.

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