Automation Has Arrived in Full Force

Inside Dental Technology (IDT): What have you automated in your laboratory?

Jesse Flor, MBA, CDT: We have focused a lot recently on design services for our dentists, and with a shortage of staff that is qualified to do all the work, automation has become a key component. Obviously, artificial intelligence (AI) design software is available, and more companies are creating their own versions with their own libraries. Utilizing that tool is becoming a larger part of our business, but it is still not to the point where we can utilize it on 100% of cases. It is important to remember that at this point, AI is machine learning based off of an aggregate of data. So the accuracy and complexity it can perform is reliant on the data subset that it is using. Some AI train on the laboratory's own cases, whereas other software collect data from all of their users to create a database of more scenarios for the AI to learn from. With the leading AI design integrations, if a dentist needs a rush case, AI can create an initial design quickly that the laboratory technician can then refine.

Automation also has come into play with our machinery, of course. Disc changers are becoming an essential component for any milling machine in order to keep up with the volume of work that we have. From our smaller mills with 6-disc changers to our more robust mills with 18-disc changers, that automation really makes a difference in increasing production. I also have been using a popular AI program (Bite-Finder) for calculating bite and jaw positions in digital scans, and that really helps because dentists are tight for time, and they want everything to be as fast and accurate as possible. Other popular design software companies, such as exocad, 3Shape, and IconixAi, also offer various AI enhanced functions to increase the efficiency of the design process.

IDT: Do you automate much in terms of 3D printing?

Flor: We have looked at a couple of printers that have some promising options. There have also been some ideas that seemed good but never caught on in the market, and there are still multiple camps when it comes to how best to automate certain parts of the 3D printing process. Nothing is definitive yet in terms of a fully automated process, unfortunately.

That said, one of the most successful pieces of automation has been the finishing aspect of printing. There are now printers that include optical polishing for 3D printed night guards. So, instead of having to polish and finish the night guard by hand after printing, they have minimized the support structures and added optical polishing such that you can really finish a night guard in 5 to 7 minutes. There's also a similar automation for direct-to-finish clear aligners which, again, eliminates time we would spend cutting them out, trimming them, polishing, and deburring the edges. In the next year or so, there probably will be more options for start-to-finish automation that will be more widely adopted.

IDT: Why do you think there is nothing definitive yet in that space?

Flor: It is a huge leap forward, and there are certain steps that are very detailed and important. For example, removing the sprues correctly is critical. We need to decide whether less experienced labor can supplement that step or whether we need highly-trained labor to make sure the machine does not, for example, remove too much anatomy or contacts, or damage an implant connection.

IDT: How have your technicians reacted to automation being implemented?

Flor: I have an older technician who is very open to automation because it allows him to focus on the porcelain work that he enjoys—the little details that just cannot be automated at this point—and everything else is handled by the technology. The newer generation has benefited as well. For example, one of my younger technicians initially worked at the front desk and just started experimenting with designs, and she picked up on it quickly. Technology has created a new subset of workers who can operate within those dynamics.

IDT: When you are exploring new automation solutions, what catches your eye? What are red flags?

Flor: One red flag is when a salesperson uses the phrase, "So simple a child can do it." Everything we do is unique, so there still needs to be supervision, guidance, and training. Conversely, one thing I have been excited to see recently is a lot more interest in how to simplify our work processes. For example, some of the new multi-material 3D printers have piqued my interest because they are basically printing lifelike restorations from the ground up. If they can develop further automation, it could really be the winning package. Imagine automated, multi-material printing with high-impact, durable materials; that would be very popular. Even without the strongest materials, those technologies will be significant. I have been trying to train my dentists to accept that perhaps a denture does not need to be 100% durable for 5 to 7 years; maybe it can be disposable and replaced every year or so. We might reach a point of being able to fundamentally shift what we perceive as durable if the technology allows the cost of production to be reduced enough.

IDT: What other automation solutions would you like to see in the future?

Flor: I definitely want to see a lot more of the manual setups automated. I have seen software solutions that automate accounting and billing, and I envision those taking a bigger hold in the marketplace. In general, I believe an open ecosystem will develop, whereby each laboratory can parse and choose automated solutions to create customized workflows that simplify as much as possible.

IDT: You mentioned design services and multi-material printers. Do you envision a time when laboratory work, including esthetics, can be handled mostly in the design stage, and automation can allow for the hardware to be largely housed in the dental practices?

Flor: I think every company will be racing to try to create those workflows for us. A simple example is that one 3D printer manufacturer recently released occlusal polishing trays that allow dentists to print night guards that require minimal touch-up and finishing. Manufacturers are really starting to think end-user-forward: How do we make this as simple as possible to get it into the hands of the patient? I might be bold enough to say that 15 to 20 years from now, we might see direct-to-consumer applications that even bypass healthcare providers. Although early attempts at this ultimately failed, there will someday be a market for that because we see automation making it possible in other industries. Imagine if a patient loses their night guard, and instead of going to their dentist, they can go to a little booth and have a robot scan their jaw, design a night guard, print it, process it, and give it to them in real time. That is the innovation I see, and bigger laboratories are already approaching that. That is exciting. It might be scary for laboratories, but at the same time, we can use those same tools to leverage ourselves on a different level. US laboratories continue to lose business to overseas outsourcing, but if a local laboratory can utilize automation and AI to provide services in real time, instead of overnight, we can stay one step ahead of that pressure. We just need to look at everything with an eye toward the future. The key will be keeping an open mind about automation while mentoring the next generation of technicians. A lot of growth is still needed for AI design programs to really give us quality designs, and standards of quality should be more universally applied. It is not necessarily about what laboratories think or what dentists think. It is about the end user: our patients. If we do not do right by them, none of the technology matters.

Jesse Flor, MBA, CDT
Educator and Specialist
Full Mouth Rehabilitation and Implant Restorations