Although I'm relatively new to dentistry, I've been involved with 3-D scanning technology for a long time and have seen scanning revolutions--similar to what's happening in dentistry--in other industries.
Ten years ago, for instance, hearing aids were made with a process similar to conventional crown fabrication. Now, all the major hearing aid manufacturers are completely digital, and that conversion happened within three years.
Digital dentistry is in its infancy because it's still replicating what can be done by hand. Things will really get exciting when the dental team can do things digitally that it can't do with manual technologies; for instance, when procedures such as placing an implant and restoring it with a crown will require only a single visit. The advance of digital scanning, rapid manufacturing and materials technologies will converge to make the dental patient care more efficient and comfortable.
The digital technologies currently being used for diagnostics, such as cone beam CT scan, will eventually be used for restorative imaging as well. Patients will undergo periodic scans to get baseline surface data of their teeth which can then be used if and when they need their teeth restored.
Consequently, there will be a need for substantial data storage and maintenance. Just as PACS (picture archiving and communication systems) for storing DICOM files (Digital Imaging and Communications in Medicine) are widely used by medical offices, so will they become commonplace in the dental office and laboratory. Data storage and management will most likely be handled through a third party because it will be easier and more economical than handling it in-house with an IT staff and servers.
Improved 3-D scanning devices are coming and ultimately, the only thing the dentist or technician will physically fabricate is the restoration itself; there will be no physical impressions, bite registrations or models to make, ship or store. 3-D imaging can accurately simulate and quantitatively measure fit, which is something that's difficult to measure now.
Laboratories will be receiving more and more digital data rather than impressions, and doing design and manufacturing using entirely a digital process. This means the traditional craftsmanship will be replaced by CAD/CAM and a laboratory that can successfully transition itself into technology center will have a better chance to succeed.
Labs will also be dealing with customers farther and farther away and using the Internet and electronic communications to discuss the prep line and/or case design. Apple's iPhone is high definition and I can envision a time when a laboratory will e-mail an image of a complex case to the client's iPhone for review before the fabrication process begins. There will be a lot more meaningful, upfront communication in 3-D space that will give both the technician and the doctor greater confidence in the outcome of the case.
There will also be greater lab-to-lab cooperation. We're already seeing this with the increase in CAD/CAM outsourcing services but the amount of data sharing and exchange will only increase in the future. As technology makes more types of treatment accessible to the GP, we're seeing convergence of different therapies. GPs are now successfully branching out into areas of orthodontics and prosthodontics as a way to grow their practices. The question laboratory owners need to ask themselves is, "how can I capitalize on this trend?"
Advice for small labs
In the past, the two-to-three person lab could compete with a 2,000-person lab because there was no benefit of scale. Now, with the capital costs of some of these digital technologies, there are advantages to scale, meaning larger labs are better positioned to afford the equipment and maximize its usage to cover the cost. The key to a smaller lab's survival is to gain access to these technologies without having to bear the brunt of all of the associated overhead and without losing control of its customer base.
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