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Inside Dental Technology delivers updates on digital workflows, materials, lab techniques, and innovation in dental technology through expert articles and videos.
January 1, 2022
Volume 13, Issue 1, January 2022
Page(s): p. 6
Jason Mazda
Many of the newest milling machines on the market cost upward of $50,000, and a new 3D printer can be close to that range as well.1 Adding an experienced technician to the team to increase production means adding to payroll. While these are undoubtedly worthwhile investments, they are investments nonetheless. Not all workflow improvements require new expenses, however—for the laboratory, at least. Approximately half of dentists spend more than 10% of their yearly practice budget on new technology.2 This increasing digitization of dental practices can seem threatening to laboratories—and sometimes that feeling is justified—but in many instances it can help dental technicians do their jobs better and more efficiently. "The various technologies that help bring the patient to the laboratory in different ways really maximize the technician's ability to succeed," says Mauricio Lavie, DMD, MSD, a prosthodontist in Chatham, New Jersey.
Beyond Scanning
Lavie integrated CAD software into his office approximately 4 years ago to complement his intraoral scanning capabilities. He uses it to overlay scans from different stages of a case with designs from the laboratory. He also uses screen recording software to send videos to the laboratory detailing what each case requires, and he recently purchased a 3D facial scanner to provide even more comprehensive data to the laboratory. Various digital smile design applications are available as well.
"Intraoral scanning is not new to many people," Lavie says, "but it is how you utilize that technology that counts."
When a dentist incorporates CAD capabilities, a laboratory could understandably be concerned about being cut out entirely. Lavie, however, says he has no interest in fabricating his own restorations, for multiple reasons. Investing the time and money necessary to mill chairside restorations is only feasible for business models with a certain volume of work. Additionally, Lavie considers the laboratory to be like any other specialist.
"If someone can do it better than me, then I should not be doing it," Lavie says. "That is why I do not do orthodontics, root canals, or surgery. Similarly, it would be presumptuous of me to buy a mill and believe I could immediately do laboratory work just as easily as well-trained technicians."
Not all dentists share that philosophy, however. Jessica Birrell, CDT, owner of Capture Dental Arts in South Jordan, Utah, says promoting the prospect of decreasing or eliminating laboratory bills remains a common tactic among those selling CAD/CAM equipment to dentists. Birrell says, however, that the dentists who buy based on that are typically less desirable clients anyway.
"Over the years, clients I have seen leave to find a cheaper crown are the clients whose businesses are always struggling," Birrell says.
The more astute dentists understand that capital investments are best utilized for increasing production rather than cutting corners.
"The cost-cutting approach may save $1,000 per month off the laboratory bill," Birrell says. "I often remind clients that they can add $1,000 to their bottom line by billing out one more patient with one more crown. Cutting your laboratory bill can negatively impact your chair time, your patient satisfaction rate, and more; conversely, a good laboratory can help you increase your patient base and add much more to your bottom line."
Streamlining Provisionalization
In-office mills and 3D printers certainly can be utilized to fabricate products that otherwise might be produced in the laboratory, such as permanent crowns. However, these machines also can be utilized to complement and improve the laboratory's work.
Birrell encourages dentists to implement 3D printing for temporary restorations, as it shortens turnaround times and eliminates shipping costs. A dentist anywhere in the country can prepare a patient's teeth, scan the preparations, send Birrell the digital files, and have a laboratory-quality design back in time to print temporary restorations the same day.
"This provides the same advantage of a diagnostic wax-up, but so much more efficiently," Birrell says. "The dentist can satisfy and retain the patient—while also minimizing chair time—and the laboratory can more quickly reach the porcelain stage, which is where most of our profits are."
Lavie notes that, for a patient who is unsure of exactly what they want, he can pay a laboratory to design four versions of a restoration; he can then 3D print four prototypes in his office, allowing the patient to select two or three that they like, take them home, and make the most informed decision about what they like best. Asking the laboratory to mill four different prototypes, conversely, would be inefficient for both dentist and laboratory.
"When we can efficiently provide multiple 3D printed prototypes to the patient, the laboratory benefits because the patient's expectations are clearer," Lavie says.
Be a Resource—and More
The laboratory's involvement in in-office 3D printing can go beyond providing designs. As most laboratories know well, quality support is important with almost any product that a business utilizes. For many new technologies that dentists implement, the laboratory can provide some of that support.
"We all know what it is like to have someone we can call to help us find solutions," Birrell says. "If we can be that source for our dentists, then it will strengthen their trust in us and make them a bit more reliant on us. Honestly, they should not be focusing on mastering the technology if they are doing their jobs correctly."
Birrell has hosted dental assistants from around the country for stain-and-glaze courses, and while she admits she lost some work from those offices, she still provides remote support to their teams and handles those dentists' more complex and/or high-end cases. She also provides technical support for dentists on their 3D printers, and she suggests that some laboratories could even charge a monthly membership fee for some of these services.
"There are so many ways that a laboratory can support the clinic," Birrell says. "Once they start training and working with their clients, laboratories will learn there is so much they can teach them."
Teledentistry
As much as laboratories can help dentists, patients can help laboratories; the key is creating an optimal system, and technology can help there as well. One of the hottest clinical trends of the past two years has been teledentistry, with 14% of dentists in an Inside Dentistry survey saying they have implemented it and another 54% saying they are at least open to it.2 Can teledentistry help laboratories, though? Absolutely, says Sivan Finkel, DMD, a private practitioner in New York, New York. Finkel recently began blocking off 4 hours every Friday for virtual consultations via a HIPAA-compliant platform with high-definition video, and he says it has become both a powerful patient pre-screening tool, and has allowed him to reach potential patients in other states and countries.
"I began doing this out of necessity, for patients who wanted to discuss esthetics during the COVID-19 lockdown, because at the time I was not allowed to see any non-emergency patients in person," Finkel says. "When I reopened my practice, I saw virtual consultations as a way to minimize the number of people physically in my office at any given time. The concept was so well received that I decided to continue even once COVID fears died down. Now, I see four to five potential patients virtually every week, and they are not only from New York but from all over the world. This technology has really expanded my reach. A virtual session is a great way for a potential patient to get comfortable with me, the process, and the fees before they travel to New York for treatment."
Finkel adds that the virtual format also makes it easier for a laboratory technician to join the conversation in some cases.
"This technology can take the technician out of the laboratory without a major time commitment," he says. "We can consult with a patient who is already wearing temporaries and discuss together what they like and do not like, which helps us produce a better final outcome."
"This technology can take the technician out of the laboratory without a major time commitment," he says. "We can consult with a patient who is already wearing temporaries and discuss together what they like and do not like, which helps us produce a better final outcome."
Lavie takes it a step further, using 3D facial scans to send patients videos of their proposed smile designs.
"We can obtain advanced feedback before even printing prototypes," he says. "At the end of the day, technicians respect us for the dentistry and we respect them for their artistry, and when we can give them the best information possible about what the patient wants and needs, they can do their job to the best of their ability."
Bottom Line
Of course, not all technology adoption is as simple as tools that will help the laboratory. Some could be a threat. CAD software powered by artificial intelligence is a reality and likely will be in many dental offices before long.
When a dentist says they are incorporating new technology into their practice, Birrell's thought process is concise and definitive: "How can I better support them in their transition, and what services can my laboratory still provide?"
Lavie notes that, not too long ago, dentists' only way of bringing the patient to the laboratory—or vice versa—was physical transportation, whereas now it can be done virtually.
"Integrating photography, video, intraoral scans, and facial scans provides the entire patient to the technician," Lavie says. "They can rotate the patient's face to see the lateral view. Instead of working on casts, stone models, or even intraoral scans, they can work on a smile. They can see the face, the eyes, the lips, etc. They can minimize or eliminate remakes because the midline will never be off when they can see the patient's face while working; the plane of occlusion will never be canted."
Any technology that can help a laboratory do its job better and more efficiently is worth at least analyzing from a cost-benefit standpoint, and when the cost is only an investment on the part of the dentist, the laboratory can reap pure benefits.
"We should not be fearful of what the future holds," Birrell says. "Be excited, embrace it, and leverage it to your advantage."
