"Let me invite you into the pages of Lab Management Today...our goal is to give you the tools you need to build a better, more profitable, smoothly operating dental laboratory business," wrote Publisher Judy Fishman in Lab Management Today's inaugural issue.
After its first few months, it became clear that LMT was destined to be more than just another industry trade magazine. LMT quickly earned its reputation as the "Go-To" resource for business, marketing and management strategies. We devised several ground-breaking crown experiments, created the much-anticipated biennial Wage and Fee surveys, implemented the industry's most comprehensive Buyer's Guide directory and brought you a comprehensive look at the State of the Industry every five years.
Thirty years later, we keep innovating, always with you in mind: in print through LMT magazine, in person through LMT LAB DAY and online at www.LMTmag.com.
In the 1970s, a buzzer on a porcelain furnace was considered a luxury gadget. Back then, many insisted that a true ceramist should be monitoring the progress of the bake by eye, not depending on a buzzer to tell you when the case is ready.However, by the end of 1984, an LMT survey found that two-thirds of porcelain furnaces used in dental laboratories were either partially or fully automatic. LMT then observed, “modern technology has brought us computerized furnaces with features not even thought of just a few years ago, but the prices for these units are considerable.” Many small labs in particular felt these furnaces—like today’s CAD/CAM systems—were beyond their financial means.
It wasn’t unheard of before 1985, but at the Chicago MidWinter meeting that February, cosmetic dentistry became the hottest topic around.
The concept wasn’t new; Dr. Charlie Pincus was air-firing and glazing laminate veneers for Hollywood stars back in the 1930s. But for the dental community, the timing was right. Enlightened thinking about cosmetics and new products—like DenMat’s Cerinate Laminates, Myron’s Chameleon Veneers, and Cerestore and Dicor castable ceramics—afforded the industry an opportunity to embrace metal-free dentistry. As LMT pointed out, “Our industry is on the verge of an incredible opportunity to maximize its business potential and capture the 50% of the population that never frequents the dental office.”
Cosmetic dentistry required a different type of marketing and savvy laboratories and dentists learned to sell by appealing to emotions and not focusing solely on quality or price. By the 1990s, cosmetic dentistry truly...
Since cosmetic dentistry marketing was typically an appeal to emotions, it was the perfect time for laboratory owners to take their message directly to the public. By all accounts, DenMat Corp. was the first: in the Fall of 1984, the company placed ads in consumer magazines—Reader’s Digest and McCall’s—saying, “Give a Smile for Christmas.” The ads elicited a tremendous response and the company’s telephones were jammed.
By February of 1985, Dr. Robert Ibsen, then president, told the crowd at a Cal-Lab meeting that DenMat was making over 1,000 Cerinate laminates a month for laboratories and dentists. “There are plenty of disposable dollars available for dentistry. But we have to go out there and get it. And marketing is our tool,” he said. “It happened to optometry when soft contact lenses were advertised directly to the public. Now it’s our turn.”
Later, during an ADA meeting in Atlanta, DenMat made another appeal to...
As the enormous marketing potential of laminate veneers became evident, patent infringement cases began. While DenMat held various material patents, two other companies—Jaff Investment Co., owned by brothers Al and Frank Faunce, and Deneer, Inc., owned by Tom Greggs—held patents on the fabrication process.
However, many laboratories were still producing laminates on their own and this fueled a number of lawsuits and out-of-court settlements. In 1992, the issue reared its head again when laboratories around the country received letters from Yukiyo Ltd.—which had purchased an existing patent for the refractory method of fabricating porcelain veneers—saying they were infringing on the patent. Nearly five years later, the patent was declared invalid.
Though first developed in the 1950s by Arpad Nagy of Valplast, flexible partial dentures didn’t take off until the 1980s; as the cosmetic wave hit dentistry, dentists and patients alike looked for solutions that were both functional and esthetic.
Today, flexible dentures make up 20% of the average workload for full service and removable laboratories, according to LMT’s 2012 Removable Survey, and demand is on the rise: half of these labs are selling more flexible partials than they were five years ago.
LMT took six impressions of the same prep and anonymously sent them to six different laboratories along with prescriptions for non-precious PFM crowns; one was made in the Philippines. In this ground-breaking experiment in 1985—with LMT Publisher Judy Fishman as the patient—we wanted to know: could a dentist tell the difference between the $35 crown and the $75 crown?
Among our panel of dentists, no one crown was rated head and shoulders above the rest. Although not uniform in their assessments, the dentists could not discern which was the most expensive and which was the least; in fact, several of them rated medium-priced crowns better than the higher-priced ones.
The Crown Experiment—an LMT tradition repeated three more times in our history—demonstrated that when dentists choose a laboratory, perception is as much a factor as the quality of the crown itself, proving the value of laboratory positioning and marketing.
In 2007, we kicked it up a notch and created...
In October 1985, amidst rumblings that U.S. laboratories were farming work out to offshore laboratories, LMT brought the issue out into the open. Our interview with Jerry Doviack, CDT, Owner of California-based Continental Dental Ceramics, took readers inside Interdent, his facility in the Philippines and sparked intense industry debate.
In the interview, Doviack explained his strategy behind setting up offshore production to provide outsourcing services to laboratories around the world, saying it wouldn’t take jobs away because the local laboratory would still provide a vital service to its dentist-clients. Still, readers spoke out about what they perceived as a threat to their businesses and their employees, as well as concern about the American economy.
Today, Interdent in Manila has grown to a staff of 700 and services several hundred labs in more than 75 countries. And, although the debate rages on, offshore outsourcing has come out of the shadows with many other offshore laboratories...
If you’re a regular LAB DAY Chicago attendee it may be hard to believe that a show known to be the largest gathering of dental laboratory decision makers in North America began with just 30 exhibitors and about 275 attendees.
Prior to 1985, the Chicago Dental Society (CDS)’s MidWinter Meeting was housed in the downtown Hilton Hotel and a handful of companies hosted programs for the laboratory community across the street in the Blackstone Hotel. But in 1985, the CDS moved its meeting to the convention center, which left some companies up in the air about what to do for their technician customers.
LMT President Judy Fishman—agreeing with some laboratory manufacturers who felt their companies would be dwarfed at the MidWinter—booked space at the Blackstone and offered exhibit tables to laboratory product marketers. The rest is history: This month, we celebrate our 30th Lab Day in Chicago with more than 200 exhibitors, over 3,000 expected attendees and nearly 250 educational...
October 1986, IECDT, New York City: Crowds of technicians attended Dr. Francois Duret’s lecture during which he demonstrated his chairside CAD/CAM system for the first time in the U.S. Based on micro-milling technology used to make titanium microchips for computers and missile parts, the system featured a laser scanner and milling machine that could fabricate crowns, inlays, onlays and up to three-unit bridges out of Dicor® material.
Touted as the system that “has the potential to change the way dentistry is done as we know it,” some attendees were concerned that chairside CAD/CAM would render laboratories obsolete and that an entire generation of technicians would lose their jobs.
On the flip side, other laboratory owners saw the potential of the technology and the positive changes that might occur as a result. For instance, the late Al Sabella, MDT, Sabella Dental Studios, Hartdale, NY, said, “In the future, dental technicians will have to become familiar with...
Although PFMs were still considered by many to be the esthetic standard for clinical longevity, pressable ceramics—starting with IPS Empress and Optimal Pressable Glass (OPC)—began to drive the metal-free dentistry movement in the late 1980s. The improved esthetics and biocompatibility—coupled with soaring precious metal prices—quickly made the pressable technique a successful and cost-effective way to fabricate metal-free restorations. Later, the technique was adapted to create press-to-metal and press-to-zirconia restorations.
In 1987, an HIV-positive dentist in Florida was found to have transmitted the infection to six of his patients. This first-known case of clinical transmission of HIV and the uncertainty during the late 1980s about the exact models of HIV transmission led the ADA to issue recommended infection control procedures and later work with the Centers for Disease Control to develop infection control recommendations for dentistry.
In 1991, OSHA released its Bloodborne Pathogen standard to limit employees’ exposure to potentially infectious materials that could result in the transmission of diseases such as HIV or hepatitis B.
Despite the fact that all recommendations made clear it’s best to eliminate cross contamination at the source—the dental office—labs are still reporting more than 20 years later that some clients still don’t disinfect their impressions, models or cases sent in for repair.
For years, porcelain was the material of choice for denture teeth because of its ability to replicate the appearance of natural dentition. But as we entered the 1990s, acrylic denture teeth had replaced porcelain as the industry standard; in fact, the use of porcelain teeth had dropped 50% during the previous decade.
Acrylic teeth offered several functional advantages: they were kinder to opposing dentition with less trauma to the bone and offered easier occlusal adjustment. However, earlier materials tended to craze and check and weren’t as esthetic as the tried-and-true porcelain. Over time, cross-linking techniques were refined, resulting in more durable acrylic teeth. Improved opalescence, translucency and shade consistency—especially among the new generation of composite teeth—further contributed to the growing use of acrylic teeth.
Invented by Dr. Itzhak Shoher and Aharon Whiteman, CDT, first-generation Captek™ was introduced to the international dental community in 1993. The unique capillary technology took the PFM world by storm because it produced a high noble metal coping right on the refractory die without casting. Dentists and technicians alike were taken by its resulting thin, gold-colored copings and ability to maximize soft tissue health; Captek remains an ideal option for patients with any type of predisposition to caries or perio concerns.
In 2007, Captek Nano™—stronger and thinner than the original materials—was introduced. The technology was sold to Argen in 2011 and, soon after, the company introduced Digital Captek, a 3D-printing service.
In its infancy, laboratory owners didn’t immediately see the internet’s application to their business. However, in the past 15 years, the number of laboratories with internet access has tripled, with 88% of U.S. laboratories LMT surveyed now having online capability. The ability to transmit data over the internet is fueling the growth of milling centers and subcontracting businesses. Emailing questions, case considerations and photos with clients has become the norm. And the opportunity for far-reaching promotion has prompted more than 40% of laboratories to market their nother third to use social media to network with clients.
Already widely used in European dental laboratories as well as in other industries, it wasn’t until around 1994 that laser welding took root in the U.S. laboratory market when American Recovery, Dentaurum and Tanaka Dental all introduced laser welding units. A key benefit was the stronger connections; a 1991 study published in Quintessence found the connections to be 266% stronger than solder, 43% stronger than microplasma welds and 95% as strong as the original alloy.
Because the laser focuses a beam that melts and welds a very small area of metal, laser welders also brought a higher level of accuracy and tremendous time savings to nearly every department in the lab.
After years of speculation, CAD/CAM came to fruition in the dental laboratory in 1998 with the official U.S. launch of the Procera® AllCeram Crown, featuring an aluminum oxide coping milled at Nobel Biocare’s production facility in Sweden. The success of Procera—and the introduction of a dozen new in-lab milling systems in the early 2000s—fueled intense interest among laboratory owners and made CAD/CAM the hot topic for the unforeseeable future.
The automated manufacturing process afforded an efficient, consistent method of production and also opened the door to using zirconia, the strongest material on the market for all-ceramic restorations; other material options, depending on the system, included aluminum oxide, lithium disilicate, composite, gold, non-precious alloys, reinforced ceramic-based materials and titanium.
As the number of systems on the market multiplied, laboratory owners who wanted to get on board grappled with purchasing decisions. Some opted to...
Computer systems across the globe were at risk of failing after midnight, December 31, 1999 thanks to the “Millennium Bug.” For decades prior to 2000, computer software had been designed with a two-digit year code—“98” for 1998, for example—and the fear was that when computers’ internal clocks changed to “00” the computers wouldn’t be able to tell the difference between the year 2000 and the year 1900.
Like business owners everywhere, some laboratory owners were concerned by what the “mother of all computer glitches,” would mean not only for their computer systems, but also embedded systems in things like furnaces, telephones and alarm systems. Even if they were safe, would there be glitches at their banks, suppliers or clients’ offices?
In the end—on January 1—the much-hyped pandemonium never happened and no major failures were ever reported.
In the early 1980s, industry forecasters predicted a boon in implant placement, a prediction that was premature for a market still in its infancy. Inadequate education, inconsistent techniques and unpredictable results contributed to resistance on the part of many dentists and laboratories.
However, by the time we entered the new millennium, implant treatment became the first choice in tooth replacement thanks to technical advancements, long-term success rates, and the abundance of manufacturer-provided education.
The advent of CAD/CAM and cone beam technology further impacted the precision of implant placement with the development of sophisticated treatment planning software and surgical guides, making surgery more straightforward for the doctor and less traumatic for the patient. As of 2013, laboratories reported that two-thirds of their dentist-clients were prescribing implant restorations, according to LMT’s Implant Survey.
Laboratories—most notably Glidewell Laboratories—have long dabbled in the manufacturer/supplier realm. But in the past 15 years, digital technology has been driving a role reversal as manufacturers/suppliers have begun stepping into the laboratory’s shoes.
Nobel Biocare was the first in the late 90s; now, there are more than a dozen manufacturer/suppliers that offer design and milling services for their laboratory customers. While some laboratory owners are concerned their suppliers are becoming their competitors, others aren’t bothered by the trend if the manufacturers aren’t serving dentists directly; they see it as one more way to obtain outsourced restorations and round out their product offerings.
Historically, the FDA—long involved in overseeing the manufacturers of dental laboratory materials—paid minimal attention to dental laboratories. In 2004, due to the dramatic rise in imports from overseas laboratories, that changed. Concerned that these restorations might not contain FDA-approved materials, the FDA started taking a closer look at foreign laboratories and consequently, the domestic operations that imported cases from them. Several laboratories reported random inspections and, later that year, the FDA invited the NADL to a meeting to discuss its concerns about public safety.
The FDA’s involvement in the industry continues to grow, with an emphasis on compliance with its 1997 Good Manufacturing Practices (GMPs) and adherence to its requirements for registration for offshore laboratories, importers, manufacturers of sleep apnea devices and snore guards, and repackaging or relabeling of Class II devices.
Thanks to its physical properties, esthetics and ease of use, Ivoclar Vivadent’s IPS e.max—the first lithium disilicate on the market—penetrated the marketplace with unprecedented speed. Introduced in 2005, an estimated 75 million IPS e.max restorations have been fabricated worldwide. Also a contributing factor to the product’s success: the company’s strong marketing efforts to create brand awareness among laboratories, dentists and patients alike.
“We had success with IPS e.max right from the start,” said Charlie Fager, BS, CDT, Owner, Fager Dental Laboratory, Camp Hill, PA, in 2012. “Our clients started with a case or two, then kept expanding the applications of it, doing more units and larger cases. Ivoclar Vivadent has done a good job creating awareness among dentists and basically IPS e.max sells itself.”
The buzz at the Dental Laboratory Owners Association of California’s CAD/CAM Symposium in November 2005: rapid prototyping technology. First developed in the 1980s and used in the automotive and aerospace industries, the technology had laboratory owners enthusiastic about what was called the “next generation of CAD/CAM.” Advocates said the additive technology would result in increased efficiency and less material waste.
Those forecasts were spot on. The technology continues to revolutionize the way laboratories fabricate waxups and metal restorations. And, like CAD/CAM, it’s changing things quickly. Since 2011, the percentage of laboratories who offer 3D printed metal restorations has tripled (from 8% to 24%) and the percentage with a rapid prototyping system for wax has more than doubled (from 8% to 17%), according to LMT’s Digital Technology Surveys.
Foreign Dental Work Put to Test, an investigative report about lead found in restorations made in China was the talk of the industry when it aired in February 2008 on Ohio’s WBNS 10TV. The story covered an Ohio woman who had experienced pain and infection in her jaw after her dentist placed an ill-fitting, three-unit PFM bridge the previous year. After learning the bridge was made in China, she had the bridge removed and tested for hazardous materials, and lead (160ppm) was found in the restoration.
In addition, the TV station ordered eight PFM crowns from four labs in China and also had them tested; one of them tested positive for lead (210ppm).
The media coverage fueled objections to offshore outsourcing and even breathed new life into the debate about mandatory laboratory certification and registration. The ADA announced it would do its own independent testing and released its findings a year later: scientists analyzed 44 different porcelain powders and 102 finished PFM crowns...
On the heels of widespread media attention about offshore crowns containing lead, two bills that required laboratories to spell out the origin and content of dental restorations passed in 2008: one in Florida and one in South Carolina. Although both bills only required the lab to provide the information to the dentist—and not for the dentist to pass the information onto the patient—supporters felt it was a step in the right direction because the information would be placed in the patient’s file and would provide a mechanism for traceability.
Illinois, Ohio and Minnesota have also passed disclosure laws; similar legislation is pending in Virginia and Kentucky, and efforts are also being made in New Mexico, Colorado and California. Although it’s not a law in Missouri, disclosure is a “best practice” requested by the state dental association. To date, there are no laws requiring dentists to disclose point of origin to the patient.