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Problem: I'd like to purchase a complete CAD/CAM system, but I've heard a lot of lab owners get burned by high material costs.
Strategy: When doing your research, find out if there's a set number of units you can mill from one block or if you can "nest" units, allowing you to optimize the number of units you can fabricate from one block, reducing your material costs.
Also find out if the manufacturer allows you to buy materials from any source; this can help keep material costs down. For example, when David Nunnally, Owner of Derby Dental Lab in Louisville, KY, switched from a system that required him to purchase materials from the manufacturer to a system that didn't, his per-unit zirconia cost was reduced from $30 to under $10, and his per-unit wax coping costs went from $4 to 50 cents. In zirconia material costs alone, the lab is saving $37,500 a week or nearly $450,000 annually.
If you do decide to use an alternative source for material, find out if it invalidates the system manufacturer's warranty and be sure to ask the vendor to provide written information backing up the materials and the names of other lab clients as references.
Problem: One of my biggest accounts just bought a chairside CAD/CAM system.
Strategy: If you can't beat 'em, join 'em! Make dentist-clients who are using a chairside system your ally by offering to hold a course in staining and glazing or ideal prep design. If you take a partnership approach and earn their loyalty, you may be able to capture the larger cases they don't want to do chairside.
If you own a CAD/CAM system, 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. If the client is happy with the results, maybe you'll get some of his conventional cases, too.
Problem: A few of my clients are talking about purchasing a chairside CAD/CAM system and want my input.
Strategy: Educate them on their investment. Some laboratory owners feel 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 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, UT. "I point out to my clients that they need to make about $600 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?"
Problem: My CAD/CAM outsourcing partner is giving me copings that don't support the porcelain.
Strategy: Proactive communication is key to getting the results you want from your outsourcing partner. Here are some tips:
• Send an illustration, including specific measurements, that shows the technician exactly how the coping should be designed; draw the prep in one color and the coping in another.
• Pour up two models. Many labs keep one model and send the other to the outside lab so they can communicate over the phone and both be looking at the same thing.
• Block out or modify the die, if necessary, before it's scanned. For example, if a case needs more support because the adjacent tooth is too far away, manually wax out the die before sending it to the laboratory to be scanned to be sure the milled coping will adequately support the porcelain.
• Review the final design of large cases. For larger cases, like bridges, where remaking an already-milled framework would be especially costly and inconvenient, ask to see a scan of the design before it's milled. If the design needs to be tweaked, ask the lab to fix it and send a second image for approval.
• Photograph problems. If you receive an overextended coping, photograph it before making your adjustments, then send the laboratory the before-and-after shots so it can see what you're looking for.
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