What are the five words that send a chill down a laboratory owner's spine when spoken by one of his biggest dentist-clients? "I'm buying a CAD/CAM system."
To date, more than 5,000 dentists in the U.S. have purchased Cerec chairside CAD/CAM systems, and many laboratories have reported a noticeable decline in work from these clients. The effect can be especially detrimental to smaller laboratories that rely on fewer clients to round out their sales figures.
However, by taking a proactive approach, these laboratory owners are ensuring that chairside CAD/CAM doesn't negatively affect their bottom lines. Here are their strategies:
1. Educate your clients on their investment. Some laboratory owners feel that dentists aren't getting an accurate picture of the expenses involved with these systems and therefore try to ensure that clients who are contemplating a purchase are aware of all of the factors. "I've found that some dentists only consider the cost of the equipment lease in regard to their monthly break-even point; they don't factor in the costs of maintenance, porcelain blocks, milling burs and the most important thing--time," says Jeff Stronk, co-owner, Treasure Dental Studio, Salt Lake City, Utah. "I point out to my clients that they need to make $400+ an hour per operatory to be profitable, and the time they would spend grinding, staining and glazing is counterproductive to an efficient practice."
Stronk also urges clients to evaluate their return on investment in light of the rapid pace of technology coming onto the market. "I ask doctors to think about where the technology was five years ago and imagine where it will be five years from now," he says. "This present technology will not become profitable until the unit is paid for completely. Will it be outdated at that point? What will the doctor have to buy then to replace it?"
To further dissuade clients who talk to him about chairside CAD/CAM, Stronk throws this challenge: "I tell them that if they give me $100,000 upfront that I would charge $40 a unit and have it back to them within the day. That's comparable to what they'd get with an in-house system, except that they could continue to practice dentistry instead of making crowns," says Stronk. "Surprisingly, I haven't had any takers yet."
2. Change your client profile. Some laboratory owners are honing in on dental practices that are less likely to be big technology buyers. "We're targeting doctors who won't likely have an interest in in-house CAD/CAM, typically those in smaller or older practices and it has been working out for us," says Doreen Bailey, Bergman's Dental Lab, Lake Orion, Michigan.
Paul Westbrook of Westbrook and Associates is focusing on doctors who share his technical philosophies. "Pankey followers are uncompromising on occlusion as well as on natural esthetics. AACD dentists want optimum esthetics with perfect shapes and shades, and that's something in-office machines aren't capable of yet," says Westbrook, president of the Garland, Texas laboratory. "And even if those doctors have those machines, they probably aren't using them as often."
3. Partner with CAD/CAM-savvy dentists. On the other hand, if you own a CAD/CAM system yourself, seek out those dentists who have in-office systems. After all, they're sold on the technology and can't do everything themselves. "You need to find these dentists now. They could become your best accounts. Partnering is the answer," says Ed Flocken, Ed Flocken Dental Studio, Hendersonville, North Carolina. Let them know you're an advocate of the technology too, and ask them for the cases you can do with your system that they can't do with theirs: bridges, difficult shades, or more sophisticated restorations they're not comfortable attempting chairside. You may find that once the partnership has been formed, you will get some conventional cases as a bonus."
4. Take advantage of their interest in all ceramic. When Jeff Hucek's biggest account purchased a system two years ago, he thought it was going to have a huge effect on his business. Two years later, this isn't the case. Not only does the dentist limit the use of his machine primarily to inlays and onlays that he was doing chairside anyway, the technology has piqued his interest in all-ceramic work. "More of his restorative choices are now all ceramic. He has gotten more comfortable with prescribing all ceramics in a wider variety of clinical circumstances and this is partly due to the training he received when he purchased the chairside system," says Hucek, owner of Acorn Dental Ceramics, Crivitz, Wisconsin.
Also, Hucek says that being involved in CAD/CAM technology has made this client more attuned to the levels of quality in a ceramic restoration, which is key as he tries to veer his laboratory toward more high-end work. "It's sometimes difficult for clients to appreciate the difference between a 'stained' vs. 'stacked' crown, but this particular doctor is now more aware of the nuances between what he can do with his in-office system and what I can do," says Hucek.
5. Teach them to stain and glaze. Precisely because Hucek's client recognizes that his in-office CAD/CAM restorations are esthetically needy, he asked Hucek to show him how to stain and glaze--and Hucek agreed. "I'm banking on the value-added service of helping him accomplish what is really our common goal: serving the patient," says Hucek. "Whatever trepidation I may feel at helping him do more with his CAD/CAM system is reduced by the strengthening of our professional relationship."
Flocken agrees. "When you meet doctors with this technology, invite them into the lab to learn about staining and glazing and ideal prep design. This is where I'm getting a lot of my work. They come into my lab, feel great about how we're helping them and hopefully think, 'This lab is pretty savvy; I think I'm going to start sending them my work.'"
6. Don't burn bridges. A client is still a client, even if he's sending less work--and you never know if his interest in CAD/CAM technology will wane. In fact, many laboratory owners report that work from these dentists picks up after they try the system for awhile, because they feel it's not saving them as much time or money as they hoped. "It's my experience that after two years or so, clients realize that they can't do all they wanted to and it's not saving them anything. They end up using the machine only for those cases that the patient absolutely has to have in one day," says Jim Kidd, president of Creative Dental Arts, Raytown, Missouri.
Hucek agrees. "When I think back to how nervous I was when I first found out my client got a system to what has actually transpired, the angst was unfounded. If I had handled the situation in an adversarial manner, it may have indeed created a wedge. My advice: always focus on the relationship."
The jury's out on the future impact of in-office CAD/CAM
In-office CAD/CAM has been around for 20 years and is now in place in more than 5,000 dental offices in the United States. In addition to the desire to offer their patients cutting-edge technology, these dentists are lured by the concept of the "one-visit restoration," and the ability to cut chairtime and lab costs and increase patient convenience.
Other dentists are more skeptical, worrying that the quality of dentistry might be compromised as dentists endeavor to get a return on their investment. "These systems may encourage dentists to perform unnecessary or marginally necessary crowns in order to pay for the machine," says Dr. Joseph McNeff, Foley, Alabama.
This is a concern among laboratory owners as well. "Once a dentist embraces the technology, he feels compelled to use it," says Paul Westbrook, president, Westbrook and Associates, Garland, Texas. "I've had clients tell me, 'it's not the kind of work you do, Paul, but it's not bad.' If they've paid a lot of money for it, they're going to use it. It's hard competing with that."
Many laboratory owners competing with in-office CAD/CAM question what the impact will be as the technology gains more momentum and ends up in more dental offices. "I think the door is open for dentists to drastically reduce their dependence on the traditional dental lab," says Steven Barnard, Barnard Dental Laboratory, Inc., Tacoma, Washington.
But some industry experts say that laboratory owners needn't be doom-and-gloom given the limitations of the systems and the fact that an aging population means more dental work all around. "These in-office systems can't do PFM crowns, bridgework or implant-supported restorations; they can't easily color match or do highly characterized, high-end esthetic work," Dan Nathanson, DDS, of Boston University, told the CAL-Lab Group at its February meeting in Chicago. "Whatever the machine does, it's not going to be able to do what you do."