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Like never before, laboratory owners and managers are tapping into the power of CAD/CAM technology, which is proving to be a valuable image enhancer, production booster and profit generator. LMT's exclusive Digital Technology Survey offers a look at where the digital technology market is now and where it's headed.
The advent of CAD/CAM and other digital fabrication systems is unprecedented in our industry. Never before has there been such a rapid explosion of technology embraced by so many, so quickly.
In the past 10 years, close to 30 scanners and milling systems have been introduced to the U.S. marketplace and 75% of the owner/manager respondents to LMT's Digital Technology Survey are taking advantage of all these systems have to offer: accuracy, efficiency and new material options. Whether they're offering CAD/CAM-milled restorations to their clients by fabricating them in-house or using outsourcing services, our respondents agree that automated technology is the future of our industry and necessary in order to maintain a cutting-edge reputation and meet client demand for new materials and all-ceramic restorations.
In addition to enhancing their laboratory's image, CAD/CAM technology is having a positive impact on respondents' internal operations and finances. Specifically, 55% of them say offering CAD/CAM-milled units has increased their laboratory's production levels and sales, and 63% say their profitability has increased.
The higher profit margins come from charging higher fees for a premium product as well as using the technology to pursue new avenues of business, especially for the smaller laboratories that can tap into it by outsourcing to other laboratories. "I recently did two full mouth rehabilitations by outsourcing the understructures," says Paul Gerhard, Gerhard's Dental Lab, a solo operation in Dunedin, Florida. "Prior to offering CAD/CAM, I would have turned these cases away."
Thanks to the marketing efforts of manufacturers and suppliers as well as laboratory owners and managers educating their clients about the benefits of CAD/CAM technology, more and more dentist-clients are getting on board. Respondents report that the average percentage of dentist-clients who are prescribing CAD/CAM-milled restorations has increased from 5% to 36% in the past five years. Consequently, CAD/CAM-related workload in the laboratory has increased 15% during that time frame, rising from 4% to 19% click here for Yesterday, Today and Tomorrow chart.
Our survey respondents are taking advantage of all the various ways to access CAD/CAM technology. Nearly half are sending their models to another laboratory or manufacturer to be scanned, designed and milled. Another 20% opt for more control, scanning and designing their own cases and then outsourcing the milling process. The remaining 30% have a scanner and milling system in their laboratory and handle the entire process in-house.
For those who have purchased a scanner or a complete system, the two biggest challenges to implementing the technology are the relatively high system and material costs as well as the time required to train technicians on virtual case design. "Technicians need to think on a different level to problem-solve these restorations," says Stan Okon, Stanley Okon Dental Lab and Stanley Okon Milling Center, Laguna Woods, California. "For example, CAD/CAM is more restricting in regard to prep design; there are some margins you can seal to the axial wall and others that are beyond the scope of the software that could result in a compromised fit. Laboratories need a training protocol in place to teach technicians how to identify these situations and communicate with their doctors."
There is one type of digital technology not receiving a warm reception from our industry: chairside CAD/CAM. It's had a negative impact on half of our respondents' workloads, especially their single units and inlay/onlay businesses. However, some respondents report that the effect has been short lived. "We've seen a decrease in sales during the first year after clients purchase a chairside system, but steadily the business has come back to 90% of what it was," shares Nick Ragle, manager of Ragle Dental Laboratory, Champaign, Illinois.
Predictions for the future
Looking forward to 2013, our survey respondents predict their CAD/CAM caseload will more than double--rising from the current 19% to 42%--and that 58% of their clients will be prescribing CAD/CAM-fabricated restorations, up from 36% today. Given their expectations for growth in the digital services market, it's no surprise that respondents plan on investing in more technology. For instance, 41% of respondents say they will purchase either a scanner or milling equipment in the next five years.
And CAD/CAM isn't the only technology on their shopping lists: 32% plan on purchasing digital impression-taking software in the near future [click here for chart] (/pdf/CC-fiveyrs.pdf). "Currently CAD/CAM milling systems are a good complement to conventional fabrication systems," says one respondent. "But as digital impression systems become widely available, they will revolutionize our industry!" And there's good news in this arena, as there will soon be three players in the marketplace: Sirona's CEREC Connect, 3M ESPE's Lava Chairside Scanner C.O.S. and Cadent's iTero.
Although the vast majority of respondents haven't yet seen an impact on their staffing needs as a result of digital technology, they have seen a shift in technical responsibilities and expect the role of the technician to evolve even further in the future. As fabrication techniques become more automated, technicians will need to be computer literate and will be able to focus on higher-skill tasks. An added bonus: the high-tech aspects of automated technology will attract much-needed newcomers to the profession. Click here for chart.
There's no doubt we're in a period of rapid technological change and it's leaving some respondents unsettled about their own future. "They used to think that no machine could replace the human hand and eye. Well hello 21st century!" says Tom Kluge, Kluge Dental Laboratory, Highland, California. "I do high-end work, about 95% of which is for prosthodontists, and I don't mind telling you that I'm a little nervous. At the rate technology is progressing, I can see 3-D printing technology replacing me in five years."
But others are excited and energized by the changes and prospects of working with new materials and the idea of an automated dental laboratory. For example, one respondent commented that he would love to do only CAD/CAM and eliminate PFMs from his laboratory entirely. Tom Jacobs, owner, Mobile Lab Technologies, Hendersonville, North Carolina, says, "After 42 years as a technician, CAD/CAM has made the work even more fun and has given me a tremendous boost."
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