Digital Services in the Dental Laboratory Industry

Digital services offer laboratories the opportunity to transmit cases through either snail mail or the Internet to a product service provider. The types of products and services that are offered may vary depending upon the provider. This rapidly growing service segment of the industry was established to provide a broader spectrum of the industry with access to materials and products that required often large, expensive, automated production machinery to produce, machinery that was within the financial reach of only a few large laboratories. The ability to outsource production was a business milestone for smaller laboratories that were unable to afford the equipment and materials costs of in-house production and had therefor been cut out of the demand for these new digitally produced restorative products. For larger laboratories, offering laboratory-to-laboratory outsource services became a new and lucrative profit center. Previously viewed as competitors, these larger laboratories enabled their smaller counterparts to expand their client base and product lines. This new business model not only expanded the providers’ potential business growth and profitability but also simultaneously saved their laboratory customers the expense of equipment, materials, and labor investment. It was a win-win situation for everyone involved.

After a number of years, the laboratory-to-laboratory service model languished as more and more service centers sprang up and began competing for the same business dollars. At the same time, the reduced cost of automated machinery and software made the in-house production business model more appealing and within financial reach of some of the smaller laboratory businesses. However, the smaller businesses that made the capital investment in equipment soon realized their purchase came with added costs for materials inventory, software and machinery upgrades, and machinery milling replacement parts. Because these added costs were not anticipated, they could pose a significant burden to the laboratory’s business plan.

Today, outsourcing production to a digital service provider has experienced a revival and become a staple for many laboratories because of realized ROI (return on investment). Whether the provider is a manufacturer/distributor, an implant company, or even another laboratory, the opportunity for a profitable return on products purchased and then sold is achievable.

The digital services market has expanded into a multi-million dollar industry providing a multitude of service avenues. Services range from simple CAD designing to printing and milling of metal and all-ceramic end products, as well as material parts for casting, pressing, or layering. Web portals have now been designed to receive scanned intraoral files, which are then downloaded to the laboratory. Receiving clinical impression scans cuts shipping costs, which the laboratory would otherwise absorb, and eliminates the time-consuming infection control process. The wide variety of services available allows each laboratory to take advantage of technologies that would be costly to purchase, operate, and maintain, not to mention the additional expense of materials inventory. Digital services leveled the playing field, allowing businesses to be competitive in the dental laboratory market regardless of size or budget.

Prior to taking advantage of digital services, the status quo for laboratories when fabricating custom abutments was to order a plastic UCLA abutment and then contour to the desired shape in order to create the abutment design. Once manually designed, the UCLA abutment was then sprued, invested, burned out in an oven, and cast. This technique was not only time-consuming and expensive, but it also required an extreme amount of labor, as well as the additional expense of alloy in order to cast. Fortunately, as technology progressed, many service providers recognized this procedure’s inefficiencies. They created a multitude of implant platform databases from various manufacturers for the design and manufacture of patient-specific abutments. These platform databases allow laboratories to participate using two primary strategies—one for laboratories with scanners, and one for laboratories without. Those without scanners can ship the model to the service provider for scanning and design. Laboratories with in-house scanners simply scan the model and design the abutment, then electronically transmit the design to the service provider of choice. Once finished, the design center oftentimes allows customers to evaluate an abutment design prior to fabrication via specific viewers and links. Once approved, the custom abutment is milled out of titanium or zirconia and delivered back to the customer along with the model. Outsourcing this service allows the laboratory to concentrate on other restorative aspects of the case while the service provider fabricates the. In addition to abutment fabrication, many services offer substructure and crown fabrication for restoring the top of the abutment at an additional expense. This is an additional service for laboratories that do not have the in-house capability for milling full-contour crowns.

Manufacturer/implant service providers often offer scanners and software packages that can pay for themselves in a short amount of time and are a great ROI based on volume discounts and reduced shipping. Incorporating scan/design software expedites turnaround time, eliminates the cost of shipping working models, and gives total control of design to the laboratory prior to exporting the file. Having in-house design capability can also be utilized for custom implant bar fabrication for fixed/removable prostheses and combined with CT scan and SLA models to fabricate accurate implant guides as an aid in surgical placement of implants.

The growing popularity of zirconia as a restorative material has driven milling production service centers to the forefront of the digital service market. Zirconia is currently a CAM milled material that can only be produced from a digital scan and design. Milling service centers offer two business strategies for customers who would like offer zirconia as a restorative option, but do not have the in-house means to mill it. For customers without scanning and designing capabilities, the model can be mailed to the service provider with specific instructions enclosed. The milling service will then read a copy of the Rx, digitally scan the model, digitally design, and ultimately mill the requested product for the customer. Once the restoration is milled, it is stained and sintered by the milling provider. The model, Rx, and restorative products are then shipped back to the customer. The second common strategy allows laboratories that own scanning technology to scan and design their own cases, then export a multitude of design data files in “batches” to the milling provider. The milling provider then imports the files, reads any details accompanying the cases, and downloads the design to the milling machine for production. After milling, the restorations are stained, sintered, and shipped to the customer.

Digital milling services have proven to be dependable avenues for overflow of work volume or as a secondary source of manufacturing when in-house milling machines have technical issues. On the flip side, another advantage seen by laboratory customers from their digital milling provider is that by primarily using the provider, the customer can buy a high-quality, yet less-expensive, desktop milling system for cases with a quick turnaround time. The use of these services and strategies enables each customer to accurately establish low production cost, regardless of how digital milling service providers are integrated into ones business plan.

Additive layering technology, also known as rapid prototyping (RP), provides an alternative offsite means of fabricating end product or restorative parts for laboratories. The service allows laboratories to design the prosthesis digitally from in-house CAD software and email the design data to the provider or download the data file into a proprietary web host or server. These service providers save laboratories thousands, if not tens of thousands, of dollars from the initial expense of purchasing costly 3D printing or laser sintering machines. Materials used by the service provider are designed to mimic those used for conventional bench fabrication such as wax, model resin, or alloy copings and frameworks. RP services are ideal for businesses that have temporarily lost an employee or are looking to reduce labor and material expense by shortening steps or even eliminating departments used for the conventional fabrication process. Partial framework and metal substructure printing are rapidly growing areas of RP services because the service eliminates labor, duplicating time, and materials.

There are several different types RP technologies on the market but all are additive manufacturing processes that construct physical objects from virtual STL files using the same basic layer-by-layer building principle. Many providers that offer SLA technology services also offer other automated services such as sub-structure and crown design along with fabrication depending upon the final restorative materials.

As new technologies continue to increase in complexity, cost, and sophistication, digital service providers will become ever more important for laboratories of all sizes wanting to stay competitive and relevant in the marketplace. Today’s service providers will continue to bring new equipment advances, new fabrication processes, and new materials directly to the laboratory in an on-demand manufacturing model.

Here are a few suggestions to keep in mind when deciding if a digital service provider will be beneficial to your business.

• Start off slow and find a provider that offers materials or items you are currently not offering to your clients.
• You don’t need a scanner! Many service providers will accommodate their customers by scanning, designing, and milling or printing from a poured model.
• If you do have a scanner, your files can be exported to a provider for manufacturing. From there, service providers will ship all the restorations back in one box instead of a box for each case, saving on shipping expenses.
• Price shop and compare quality. Contour, color staining, and pricing vary, so try several production centers if not satisfied with your initial provider. Many providers offer discounts based on volume as well.
• Determine if alternating CAD materials for casting materials is more profitable (eg, titanium bars, implant abutments, noble crown and bridge substructures versus buying and inventorying casting alloys for these items).
• Figure out when to 3D print and when to mill. Service providers generally print products that need to be sprued, invested, and cast, such as alloy copings, cast crown waxups, and partial design waxups, and mill materials that can not be cast, such as zirconia substructures, zirconia implant abutments, and full-contour zirconia crowns.

Keith Miolen, CDT is a recent NADL Pillar Scholarship recipient.