State of the Industry 2010, Part II: Directions in Digital Dentistry
Posted Apr 28, 2011 in LMT Surveys
- Survey demographics
- 82% of Survey Respondents Offer CAD/CAM-Milled Restorations; here's how they access the technology)
- The percentage of survey participants offering CAD/CAM-milled restorations continues to grow
- CAD/CAM-Milled Units are Making Up an Increasing Percentage of C&B Caseloads
- Success in Generating Client Interest in CAD/CAM-Milled Restorations
- Percentage of Survey Participants Who Offer These Digital Restorations
- Average Monthly Production Figures for CAD/CAM-Milled Restorations
- Thoughts on Digital Technology
- Material Options From A to Z
- 52% of Survey Participants have Digital Fabrication Equipment in their Laboratories; Here's What They Have
- 50% of Survey Participants Plan to Purchase Digital Equipment in the Next Two Years; Here's What They Want to Buy
- Open v. Closed Systems: The Pros and Cons
We dreamed about it in the 70s. Talked about it in the 80s. Got a taste of it in the 90s. And, in the new millennium, we're transitioning to digital technologies at breakneck speed.
At the end of the 1990s, Nobel Biocare's Procera System was the only player in the U.S. market; today, there are about 40 manufacturers that offer either digital scanning, milling or rapid prototyping equipment andmaterials. And that number is even bigger on a global scale: at last year's IDS in Cologne, Germany, a reported 170 CAD/CAM companies were on hand.
Because of this technological explosion, what's happening to CAD/CAM users is much like what happened when the world moved away from mainframe computers to PCs. It seemed like every time we invested in a new computer, hard drive capacities improved, software was upgraded and our new piece of equipment became outdated overnight. Keeping up with every upgrade and new introduction is expensive and at times, overwhelming, especially for smaller laboratories.
Despite these challenges, many owners are embracing digital technology because it's enhancing their productivity and profitability; increasing their material options; improving internal operations; changing their business models; and impacting how they work with clients, manufacturers and other laboratories. And it's also having a positive effect on the mindset of owners, managers and technicians alike, who appreciate the new way of working and are discovering a new zest for their jobs.
"Our staff is energized by the potential of this technology and the fact that our tools have changed from a bunsen burner and carver to a mouse and keyboard," says Mark Jackson, RDT, owner, Precision Ceramics, Montclair, California. "The lack of interest from the younger generation may have been cured with these exciting developments."
Digital Workloads on the Rise Because of the production efficiency and accuracy of automated technology as well as the material options and ability to offer progressive services, 82% of respondents to LMT's State of Digital Technology Survey 2010, which was sent to C&B and full service labs, are offering CAD/CAM-milled restorations (Click here for a snapshot of survey demographics). Of that 82%:
- 47% are completely outsourcing to another laboratory or manufacturer.
- 25% have a scanner and milling system in their laboratory.
- 20% have a scanner in their lab and have the milling done by another laboratory or manufacturer.
- 8% use a combination of outsourcing and in-house production.
CAD/CAM-milled restorations are making up an increasing percentage of C&B caseloads. In fact, the percentage has more than quadrupled since 2003: seven years ago, CAD/CAM-milled units represented an average of 4% of C&B workloads; now, it's 18%. And owners expect this trend to continue: in 2015, our survey participants predict that more than half of their total caseloads (52%) will be CAD/CAM-milled restorations.
Our respondents predict similar growth in wax and metal printed restorations. Currently, 6% of their total caseload is fabricated using wax printers and 2% using metal printers; they predict those percentages to grow to 19% and 11% respectively. "Scanning and wax printing has given us a financial advantage, in that we do not need to increase staff and our remake factor has dropped below 1%," says Alfred Amendola, owner, Ama-Dent Porcelain Studios in Port Jefferson, New York.
As digitization speeds production and eliminates more and more traditional fabrication techniques, technicians' roles are changing. Traditional waxers are converting to digital waxers, model and die technicians are being retrained to monitor scanning and milling processes, and employees are shifting to other departments. "Our scanner is saving us time in the crown and bridge side and allowing us to use employees in other areas of need, specifically waxing removables," says Kay Hayden, manager, EC Chmel, Eau Clair, Wisconsin.
But as with any new technology, there are a number of areas about which respondents don't agree: the length and ease of the learning curve, the cost-effectiveness of the systems and the accuracy of the materials and equipment. For instance, one respondent touts his scanner saying, "One technician can produce three times as many partial frameworks using a scanner compared to traditional wax process," whereas another finds it slows him down, saying "I can wax, invest, cast and finish six copings by the time I scan, design, seat and fix margins on one milled coping." (For more information on material usage, see Material Options: From A to Z; for average monthly production figures, see click here.
Up with Outsourcing Even for those who embrace digital technology, the cost of these high-ticket systems, the sheer number of equipment options and the rapidly changing technology that can quickly render a system obsolete can be challenging, and outsourcing is one way lab owners are dealing with these concerns. "As a result of outsourcing, smaller labs can compete with larger labs by providing many different types of restorations," says Bill Mrazek, CDT, owner, Mrazek Prosthodontics, Naperville, Illinois. "However, if you outsource, you should continue to look at how frequently on your in-house labor costs versus the cost of the purchasing the equipment to fabricate the restorations and your return on investment. At some point, it could be more profitable to do the work in house rather than outsource."
Outsourcing is providing access to digital technology for many--67% of our survey participants have understructures fabricated by an outside laboratory--and, at the same time, creating new business opportunities for those providing the milling, printing and/or scanning services. In fact, almost one-third of respondents purchased their digital fabrication equipment with the intent of expanding their lab-to-lab outsourcing services.
All Dressed Up and Nowhere to Go While many laboratory owners are fired up about digital dentistry, getting many of their dentist-clients on board is another story. Only half of survey participants' clients are interested in trying new technologies and only 34% of their clients are prescribing CAD/CAM-milled restorations.
In fact, 20% of our survey participants say they've been marketing CAD/CAM milled-restorations without significant success. "The majority of my accounts still prefer to use the traditional PFM restorations. Most are occasionally ordering zirconia crowns and abutments but not all the time. I don't think they trust the materials enough yet to switch completely," says Dan Perera CDT, MDT, owner of D&L Dental Studio LLC, in Penndel, Pennsylvania.
Many laboratory operators credit the manufacturers' marketing efforts in helping make their dentist-clients aware of the restorative options of CAD/CAM. However, there's still a tremendous onus on lab owners/managers to take on the role of educator. More than 40% of survey participants say that their own efforts to educate clients--such as lunch-and-learn programs, promotions and one-on-one discussions--have been instrumental in getting their clients to prescribe these restorations.
When Will Remakes Be Put Out to Pasture? So much of adopting any new technology is adapting to change, and nowhere is this more evident than with digital impression-taking systems. While lab owners are excited about the accuracy, fit and reduction in remakes they're seeing with digital impression-taking systems, just 18% of our survey respondents are receiving digital impressions from their dentists, from an average of 11.5% of their customer base.
Even though lab owners are providing dentist-clients hands-on training and free seminars, sharing testimonials from other dentists and even offering credits on their lab bills for sending digital impressions, it's still a hard sell. Clients are resistant because they're uncomfortable with the technology, aren't computer savvy, feel the cost is too high or simply don't want to make a switch.
"It's difficult to convince dentists about digital impressions because they see nothing wrong with the traditional method," says Steve Brown, vice president-business development, Colonial Dental Studio, Davenport, Iowa. "The other problem is that the end result is still just a crown or a bridge, not a new type of restoration. So you have to hope that the value proposition--that it's going to fit better and need less adjustment--is enough to sell them on the technology."
Clients as Competition New technology is also bringing increased competition in the form of chairside milling systems, and 43% of respondents say in-office milling systems have affected their business compared to just 27% five years ago. "CEREC for doctors has taken tens of thousands from me annually," says a lab owner from Tennessee.
And, as the technology matures, others expect this trend will continue. "We've lost several clients--primarily those who are price sensitive--to chairside systems," says Jim Thacker, vice president, Utah Valley Dental Lab, Provo, Utah. "As these systems improve and the materials available to those systems increase, we expect to lose more of them. We have a responsibility to create value elsewhere to maintain our clients."
On the up side, other respondents have had a more positive experience: when a client purchases a system, his single-unit cases initially slow but eventually return in full force. "The effect of clients buying chairside CAD/CAM has actually been a positive one," says Brian Lindke, owner, Vividx, Buford, Georgia. "Most of my clients who were foolish enough to make the purchase have regretted it because of poor quality and high labor costs. By the time it's all said and done, they've lost money and now appreciate my services much more than before."
The Digital Future While automation is changing the face of dentistry, it's still in its infancy. When digital technology evolves to the point that it's replacing all the manual fabrication steps, that's when it will truly come to fruition and replace traditional craftsmanship.
Ultimately, every fabrication step will be done with a computer. The dentist will scan the patient's mouth with an intraoral camera to generate a digital impression, use a digital facebow to check occlusion and record movements, create a digital bite registration and take the shade using a digital shade-taking system.
The laboratory will work with a virtual articulator and digital data to create the opposing dentition and the final restoration. This 3-D world will eliminate the need for physical impressions and solid casts and eliminate much of the guesswork between the dental team members.
Looking 10 to 15 years down the road, manufacturers predict that technicians will be able to use rapid prototyping equipment to create layered frameworks and full-contour restorations with different types of ceramics, polymers or metals suspended in solution.
Regarding internal operations, automation will change the skills required of the technician of the future. The new "digital technician" must be computer-oriented and able to visualize in 3D, meaning have an eye for digital scan and design. Technicians will be paid more because it will take fewer technicians to accomplish the same amount of work, and this reduced need for technicians could peacefully coincide with the aging of our industry.
The higher pay scale--plus the computerized nature of the work--will make dental technology a more appealing career to younger people. Even though salaries will be higher, the cost-of-labor percentages will be lower because of the greater production efficiencies, resulting in higher profitability for laboratories. As more and more manufacturers partner with one another to create compatibility between systems, laboratories will have even greater access to digital technologies and more indications. There will also be greater lab-to-lab cooperation, with an increasing amount of data sharing and centralized manufacturing centers.
A new world order is on the horizon.
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