Digital Dentistry: What Change Could Look Like In Your Lab

by George Cowburn

In our last article in Oral Health Labs’ Fall 2015 edition, we looked at how digital dentistry is slowly crossing the adoption cycle chasm. Digital dentistry has been slow in coming, largely because the learning curve for new methods and tools is steep indeed. Given their professional responsibility for patient care, dentists have every reason to be measured and thoughtful in adopting new methods; “Sorry, that didn’t work” is not what patients are willing to hear. A lab can test ideas and procedures on models to refine and perfect their methods before bringing them to market, but dentists are not afforded this opportunity. Until digital workflows are quick, easy and reliable, digital dentistry will continue to be a gently flowing stream of gradual change.

Dental labs in contrast already have digital tools and workflows, which are quick, reasonably straightforward and highly reliable. The change is and will be an overwhelming tsunami flooding the entire landscape. Labs are being forced to decide to head for higher ground or retire. A recent survey showed by 2020, over one-third of labs plan to sell off their equipment or sell their business to a competitor or lab group.

Dental labs are responsible for producing whatever the dentist requires. The dentist needs results, and is less concerned with how those results are achieved. Three-dimensional printing versus milling a model is irrelevant to most dentists; they just want the restoration to fit.

There is therefore, no limit on the pace of technology adoption in dental labs — new ideas can be very rapidly adopted. How can smaller labs deal with this situation?

Historically, full service labs did it all but with the heavy equipment investments in newer workflows, labs are forced to outsource, and often with a twinge of regret. “We really should be able to do that.” Unless you are a very large lab with deep pockets, most labs simply can’t continue to provide every service in house.

As the waters of change rise, labs can’t stay moored to the old dock. The only way to survive is to cut loose and become a rider on the storm.

As a lab, you have an intimate relationship and understanding of what your doctors want. With a bit of training, that design skill can be transferred from physical design to software driven design. CAD can become your core area of expertise.

Large milling operations have the benefit of economies of scale. They can buy many machines and have extra capacity available when inevitable breakdowns occur. They can invest in researching efficiencies in manufacturing and optimize it over hundreds and thousands of cases. Missteps are survivable as they bring in and test out new machines and procedures and recover from their failure without going under.

As the technology matures, it may make sense to bring milling in house. Milling centres recognize and support this evolution. They leverage their knowledge and expertise to empower smaller labs to enter the milling business. What they stand to lose in market share, they regain in providing support services, affordable materials and, most importantly, they can step in to fill orders if the local mill has an issue. This allows smaller labs to gain experience with digital workflows without significant capital outlay and risk while providing reliable products of exceptional quality for reasonable costs. These milling companies are also riders on the storm, intelligently navigating a sea of change.

The dental lab industry is now becoming a computer technology industry.

Google is one of the most successful computer technology companies in the world. Eric Schmidt, Google’s former CEO, summed it up well: “Be a damn good router.”

From a dentist’s perspective, what matters is quality, timeliness and cost.

So let’s walk through the digital production process. First and foremost, you have to support dental staff in learning what data they need to provide you with in order for you to achieve mutual success. A recent survey of labs showed one in four of impressions received from dental offices are unacceptable. Working with poor inputs makes high quality products impossible to achieve.

Then the practice has to learn how to send you digital image files, along with clear and precise instructions. This too is a new skill, and you want to be a supportive part of the learning process, to train the office to efficiently route information to you.

Then you want to manage and monitor every step of the production process. The dentist’s instructions should be interpreted by a design expert, preferably one with knowledge of the subtle preferences of the specific client. In an ideal world, the proposed design would be reviewed and approved by the doctor, or patient, before proceeding to manufacturing. In the event the client isn’t satisfied, redesigning a virtual case is far easier and less costly than remaking physical work.

The manufacturing process may have several steps, depending on the product required. At every step, progress is logged and tracked, so that you, and your client, know precisely what stage the work is at. Expectation is the mother of disappointment; allowing transparency is a highly effective way of managing expectations. At a minimum, you must be a damn good router.

It is entirely possible for a modern lab to be nothing more than a router.

After building and renovating several clinics, we see similarities between the dental lab industry and the construction industry. Any homeowners can choose to be their own general contractor, and manage the whole process. But a homeowner who does that ends up spending an enormous amount of time chasing after contractors and managing the project schedule. “The drywaller didn’t show up again, now I have to rebook the painters and figure out how to get the project back on schedule so it doesn’t affect the move-in date.”

With dental labs, the situation is far more complex, because there is an ever-changing suite of technologies to choose between. Dentists are seldom interested in assessing emerging technologies – they just want the restoration to consistently fit, look good and be affordable; how it came into existence is of far less concern. It becomes your responsibility to pick the right solution to provide a product of good value and uncompromising quality – as their general contractor.

The more change and upheaval there is in the dental industry, the more value a router will have. New solutions and efficiencies are being discovered every day and good routers are always on top of the latest developments, and know when to adopt them.

Traditional dental labs employ people in departments and simpler tasks are done by regular technicians, who become experts in a relatively limited set of tasks. But the success of a lab commonly relies on a few highly skilled ‘star performers’, who have a deeper understanding of the overall picture.

In a digital workflow environment, these ‘star performers’ will have a different set of skills which are not yet part of any school program and cannot be hired ‘off the street.’ Persons with the interest and ability to become experts in dental lab workflow management and automated production will be few and far between.

You absolutely must retain these key employees. Forging “golden handcuffs” is essential: create an environment where employees have it so good that they could never consider leaving.

Part of the solution may be financial; some labs offer high wages, bonuses, profit sharing, shares in the company, or additional benefits and holidays.

Research continually shows that the most effective incentives are not financial. The key to success is developing a culture that people want to be a part of, and one that fits the new business model. If your people are happy, processes will flow smoothly, dentists will be pleased, and patients will be well cared for.

Computer Assisted Design (CAD) is a function that likely fits well with your current lab’s skill set. This is the most critical component of the digital process in the lab’s control, so quality is key.

Many five axis mills produce great results, but the product is only as good as the design. Mistakes in the virtual world aren’t significant issues until they’re milled and become real problems.

In CAD design, a culture of quality is critical. A new technology is always suspected, and the results will have to be even better than the conventional state of the art to convince skeptics.

Once you have talented CAD experts in-house, utilize them to train others. This skill set will be ever more valuable, and it is essential that you manage your dependency on the star performers that your competitors will be seeking to lure away. Many of our best technicians are retiring, so we must mentor a new generation.

Companies are now specializing exclusively in CAD and work closely with milling companies to deliver integrated solutions. If you have weaknesses in CAD, try sending a couple test cases to outsourced CAD companies and evaluate the results.

Irrespective of your labs position in the industry, you need to have a solid process management system in place.

Implementing a new software system is always challenging, but offers efficiencies. The sooner these efficiencies are realized the more significant impact they can have on your business. Being digital-ready sooner means that by the time the digital market really opens up, you’re more than ready for it.

Digital data transfer rules are reasonably new. We’ve had cars for a hundred years and every driver is familiar with the rules of the road. The new information highway is not as well understood by the people who navigate its lanes. To communicate with dental professionals, you should utilize a system, which is PIPPA/HIPPA compliant.

The software you choose will literally become the brains of your business. You either need integration with your lab management software or an all-in-one solution. Here are some things to consider:

Is there a client portal where they can quickly log in and see all communication and files sent? This will save you phone calls to see where cases are. Web based cloud-data solutions are generally preferable to those in which the software and data are stored on your own machine – which must then be backed up and secured.

Is there invoicing and integration to accounting programs such as quickbooks? This will save you time and money. Your bookkeeper and accountants will thank you.

Can it streamline and sort information more efficiently? Software solutions, such as CAPzilla and Lab- Star, have the ability to acquire information, such as the patient’s name, directly from the 3Shape files, reducing the time and error inherent in double entry.

Does my software meet my current and long term needs? This is perhaps the most important question, as switching systems is always challenging. Make sure you choose a software vendor that has a long-term vision and the ability to adapt with the industry.

These are stormy seas of change – but if you cut free and ride on the storm, these will be the winds of opportunity!

About the Author

George Cowburn, D.D., began researching digital dental solutions in 2003 while studying denturist technology at the Northern Alberta Institute for Technology. He went on to cofound one of the largest denture clinics in Western Canada. For the last five years, Cowburn has been dedicated to researching and developing digital treatment workflows. This passion for digital solutions was fully realized with the launch of Perfit Dental Solutions, a company dedicated to facilitating the adoption of digital technology in the dental industry.

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