Opening All Doors

"American laboratories, unlike European ones, tend to label dental technicians as specialists in certain areas, and that attitude extends to equipment and materials," says Chris Peterson, CDT, Vice President and Owner of Peterson Dental Laboratory in Delray Beach, Florida. "Thinking differently can open new revenue streams, improve workflows, and help us provide better products and services to our dentists and their patients."

Of course, overextending the laboratory in terms of either volume or specialization can be detrimental. However, within a business's capabilities, maximizing resources can be the difference between scraping by and thriving.

"Constantly running the numbers and evaluating what may be a good fit for your laboratory is the key," says Denise Burris, CDT, Co-Owner of By Design Dental Studio in Atlanta, Georgia.

Anita Cranford and Elise Holasek, Owners of Idental Dental Laboratory in Norman, Oklahoma, decided to add a 3D printer to their workflow to fabricate models in-house. Before the printer even arrived, they had developed a secondary use for it. In conversations with a dentist client, they found that he had a desire to design surgical guides but did not want to print them himself. When the printer arrived at the laboratory, the dentist began sending STL files to be printed there and delivered to his practice.

"Simply printing those surgical guides paid for our first printer and allowed us to purchase a second," Cranford says. "Now, in addition to models, we have been able to use it for applications such as PMMA and night guards as well."

Cranford and Holasek found similar success in expanding their thinking with their milling machine. They were achieving a stellar return on investment by primarily milling zirconia, but recently they decided to try milling lithium disilicate.

"We had been pressing lithium disilicate for years," Holasek says. "As our business has grown and skilled technicians have become increasingly difficult to find, we sought an alternative option. Now, we mill zirconia all day and lithium disilicate at night. We also mill wax for anything full-contour that we would normally press, which allows us to still cast or press without teaching someone to wax."

Design Dental in Albany, Ohio, leased a 3D printer with the goal of capitalizing on new denture materials to convert their removables business to entirely digital. They quickly found that the printer proved useful for several other applications, including bite splints and flexible partial try-ins.

"Splints are difficult to fabricate via analog processes, and we did not like milling them either, but printing them is easy," Owner Trey Ford says. "We have gone from two or three splints per month to two or three per day."

Some solutions for expanded use of resources are even more creative. Peterson, for example, invested in heavy-duty mills for fabricating custom implant abutments and bars, but he quickly began thinking of alternate applications.

"When these expensive machines are not running, they are just wasting capital," Peterson says. "Meanwhile, we were very unhappy with the primary options on the market for metal partials, to the point that we even explored returning to casting, which we had completely eliminated from our laboratory. We considered outsourcing, but then we asked ourselves, ‘Why don't we mill our metal partials?' Chrome cobalt was not cost-effective to do that, but we decided to try titanium partials, which are somewhat popular in Europe but less so in the US. We quickly found that the milling speeds are very fast, and the tooling is more economical for titanium, and the product line has proven very successful."

While outsourcing metal partials still might be slightly more cost-effective, Peterson says the benefits in quality and turnaround time that result from keeping the process in house are significant enough to make it worthwhile, especially because the investment in the milling machine has already been made for implant abutments and bars.

Some creative solutions have extended beyond the typical products that dental laboratories fabricate. A large number of laboratories printed face shields and other pieces of personal protective equipment during the early stages of the COVID-19 pandemic.

Cranford and Holasek found that their printer could even be used to help keep a mill up and running.

"A holder or spacer needed to be replaced, and the manufacturer was able to simply email us an STL file that we could print," Holasek says. "It worked perfectly, and it definitely saved us from dealing with the down time that we would have had if the part had needed to be shipped."

The creative approach can extend beyond equipment. Peterson cites an acetal resin that his laboratory had been using to mill flexible partials that proved useful for another application.

"Full-mouth reconstructions account for 65% of our business, and as we transitioned from analog to digital for provisionals, we needed to be able to deliver a full-mouth, immediate-load restoration that would not break," Peterson says. "Most laboratories are utilizing screw-retained PMMA temporaries, but I thought, ‘Why don't we mill these out of acetal resin?' The result has been not a single catastrophic failure; you cannot break these provisionals. We can even fit additional items such as partials into the pucks to maximize the material."

Of course, a laboratory's most valuable resources are its personnel, and that advantage can be maximized as well—starting with cross-training. Perhaps the most obvious example is the ability for fixed and removables technicians to make valuable contributions across the board, especially as digital tools become more helpful.

"We want total technicians," Peterson says. "We have a contouring department that handles everything after digital manufacturing, whether fixed or removable. A level-one technician needs to possess level-one fixed and level-one removables skills and knowledge. A person who works on posterior zirconia crowns needs to also be able to contour posterior flippers. More specialization might work better in larger laboratories, but for our 50-person laboratory, bringing our departments together and solidifying them by total skill has worked well."

Ford's laboratory is moving to a new location soon in order to allow for further growth, and he says the plan is to hire technicians who are less specialized.

"In the past, we had a crown and bridge side and a removables side, and they rarely crossed paths," Ford says. "Now, we have one digital designer for each, and they are starting to overlap, especially as our denture business grows. When we hire new technicians, we will not look for a crown and bridge finisher or a denture finisher; we will have a design department and a finishing department, but in the finishing department, the same technician will be able to adjust contacts on a crown or finish down a denture and fuse teeth onto it."

Whether a laboratory is printing night guards or surgical guides for the first time, milling titanium partials or acetal provisionals, or benefiting from skilled ceramists working on dentures, communicating your full breadth of offerings to your clients is the critical next step.

"A strong website is obviously important, but an open line of communication with your dentists can help even more," Peterson says. "It may be more difficult for large laboratories, but for small and mid-sized ones, the laboratory technician and general dentist need to have a circle of trust. Case planning is an element of quality control, and frequently this turns into making prosthetic changes that are in the patient's best interest, provide the clinician with long-term prosthetic success, and usually increase sales revenue for the laboratory. We are also able to cross-sell partial dentures and occlusal shell provisionals on the opposing dentition. Hybrids also lead to night guard sales."

Ford's laboratory focused primarily on crown and bridge until implementing the printed denture workflow, so they have actively marketed their digital dentures. Ford adds that digital cases make it easier to recognize opportunities for cross-selling.

"If we see a crown come through with a note to put a rest seat on No. 30," he says, "we know they will be using it for a partial denture, so we can inform or remind them that we can fabricate those digitally. Especially with splints, clients often say they had no idea we offered them, so they had just been using a large production laboratory."

Cranford says when the lines of communication with dentists are strong enough, a text message can be enough to make sure they are aware of certain offerings.

"If a dentist is unaware of something we offer, a quick text saying, ‘Hey, you should try this sometime' can prove very productive," Cranford says.

A laboratory may not need to mill lithium disilicate, print night guards, or use acetal resin for provisionals in order to achieve a strong return on investment for those machines and materials. The question is: Why not try? If the investment has been made but the product is not being used to its full capacity, the opportunity exists for bonus revenue.

"We did not necessarily need all these new applications in order to justify leasing a high-end printer," Ford says, "but once the printer had been incorporated into our workflow, we could not help asking, ‘What else can we do with it?'"

It may not quite be "free money," but in many cases, it is close. That extra revenue can be reinvested in your business through purchasing more equipment, hiring more employees, paying current employees more to help with retention, or any of number of other ways.

"It's icing on the cake," Peterson says.