Milling custom implant bars and abutments has become a critical part of modern restorative workflows—but deciding whether to handle that work in-house or outsource it is not always straightforward. Labs must weigh the potential benefits of greater control and faster turnaround against the realities of equipment costs, training, and production volume. No matter the approach, consistent, high-quality results rely on expertise, reliable technology, and a solid working relationship between the lab and milling team.
Few understand these dynamics better than Scott Mappin, president of Strategy Milling in Pittsburgh, Pennsylvania. In this interview with Inside Dental Technology (IDT), Mappin shares what he has learned about building a high-performing milling operation—and what labs should consider as they refine their own strategies.
1. IDT: What goes into considerations for milling abutments and bars in-house vs out-sourcing?
Scott Mappin: Each laboratory is unique and needs to examine the cost/value benefit of taking on this task. What are the cumulative costs and resulting profits if a laboratory is outsourcing? At some point, if outsourcing grows, there would be a financial benefit to moving production in-house. This adds control while decreasing manufacturing time. Of course, the lab also must understand and be comfortable with the downside to this move.
Does the laboratory have the expertise to perform this task well? Have they invested in the equipment, trained staff, and resources to resolve the issues that will show up? If production is not high enough, then the return on investment could be out of line, pointing back to outsourcing as a sounder workflow. Several outsourcing resources in this industry made investments in personnel, mills, CAM software, tooling, tool path development, and related skills to position themselves as specialized resources to the industry. Finding those that can accommodate your desired outcome and building a strong relationship between the lab and outsource team then becomes the goal. If the decision is made to take that challenge on, be prepared for failures (i.e., learning opportunities). As you begin, plenty of learning opportunities will show up to help teach expectations vs reality.
2. IDT: What advantages does out-sourcing to a milling center offer to dental labs when it comes to custom implant bars and abutments?
Mappin: It certainly lessens, but does not eliminate, the headaches. It is easy to forget about the complexities of these tasks. If you are outsourcing and all is going well for you, what may not be clear are the issues experienced by the milling center that you never see. It can appear that the process, as it does much of the time, is plug-and-play. A lot goes into creating a service that, from the customer's point of view, is as simple as: “I design, press a few buttons, and magically I receive these parts in a few days.” Rarely do the milling centers, ours included, show the failed attempts or the trial-and-error bin, which exists at every milling center.
Outsourcing removes many headaches from the labs plate and can provide great parts in a reasonable time at a fair price with few remakes. There is financial value in this for the laboratory. Remakes are quite expensive—and as Chris Bormes of Preat Corporation expanded on a few years ago, with financial margins on products sold by laboratories being pressured, it takes more units than ever to recover from a remake. When the cooperation between the lab and out-sourcing resource works well, these benefits can be exponential for both parties and provide clarity around which workflow is right for an individual laboratory.
3. IDT: How do you ensure precision and consistency in the components you produce?
Mappin: This requires a great internal team, sound production practices, and the support of the resources we rely on as a milling center. At Strategy, we rely on our CAM engineer, tool developers, and material specialists to help us achieve our goals and refine our processes by listening to our needs and sharing their knowledge with us. They teach us how to manage new or difficult situations while, at the same time, share the new developments they are seeing from their vantage point in their respective specialty work.
Now, in my forty-sixth year as a dental technician, my career spans an exciting time as the industry transitions from analog to digital. While mostly unplanned, I have been fortunate to experience many unique, enlightening work opportunities over that time. I repeatedly found myself elbow to elbow with experts willing to share their knowledge, and I was always eager to learn from them. I often find myself seeing unique files to mill, which triggers me to train our team so they can benefit from my experiences, just like those who helped me.
I also have strong tenets about what we are doing as an outsourcing company. Strategy is a medical device manufacturer. I listen to that every time I say it and think about the patients we ultimately serve. What is their expectation? I believe all patients would think the restorations they are having placed in their bodies are manufactured to a high standard and are sound.
4. IDT: What do you do to ensure precision and consistency at the milling center?
Mappin: It’s been a major transition to move from technician to lab owner, to trainer, to developer of a milling center. Milling has become my passion, and we must respect the answers to these questions by implementing clear goals and working tirelessly to achieve them. I set the goal at Strategy to provide excellent milling service and products for the dental space. How does a resource deliver consistent products? Understanding where milling inconsistencies come from helps to eliminate them.
I invested in precise, fast milling platforms, with automation for part management, 24-hour operation, and tool cleaning with laser measuring of tool length, diameter, and radius each time the tool is put back in the tool belt. Tool cost is a large expense, and we work hard to maximize the life and cost of this expense. We discard tools with which you can easily slice your fingers. This practice of keeping tools in production, but not past the point of 50 microns of wear on any of the three elements of the tool dimension, is expensive but necessary if the expectation is that customers will not notice a fit difference from one part to the next, no matter the life of any tool used in the sequence being new or close to its end-of-life.
I don’t know any other way to deliver that level of consistency in the product. The mills themselves are precise, consistent, and frankly, overpowered in a sense, making light of this type of work. Financially, making these decisions to work at this level is a big-gulp moment. But we must remember, the mills are now the technicians. This investment will determine the outcome of the quality and consistency of the products being manufactured. I experienced less than satisfactory results as a lab owner. This experience is the mortar of the foundation of what I wanted Strategy to provide for the industry. The investment in mills, software, and tools is substantial, and one must come to terms with that and not pull back. After 12 years of Strategy tracking external remakes that were the fault of the milling center, we have proudly maintained a less than 0.5% external remake rate. This is the evidence I use to justify the practices in play at Strategy to answer this question of how we ensure precision and consistency at the milling center.
5. IDT: How can a lab best ensure proper fit, angulation, and emergence profile when designing custom abutments or bars?
Mappin: (1) Proper fit. From the milling side, transversely to the design side at your laboratory, be sure to use the correct design parameters provided by the milling center you are working with. All mills, cutting sequences, and tooling are not the same. Each milling center has design parameters that will provide the best fit for its products. Listening to the milling center’s advice on what scan flags and design library to use is also important. It’s a digital world and that brings a heightened accuracy to all things, but it also means the “MacGyvering” that is ingrained in the industry from its analog days, can lead to the risk of failures when all the details are not followed. Like following a good recipe, little changes along the way will most likely lead to uncertain results.
(2) Proper angulation. There are two angulation issues. One is the lab’s decision on how to design the prosthesis to overcome the situation being presented to them. The other is the milling center’s ability and knowing the boundaries of what their whole process can cut. For the lab side, I don’t see this as the milling center’s purview. The lab/technician is in control of this. The lab will be presented with ever-changing scenarios due to the uniqueness of this industry. Implants will be curiously placed, outcomes will be requested of them that seem impossible, and creative solutions from the laboratory will need to be explored to provide the patient with a sound restoration. As I see it, the milling center is responsible for investing in robust mills, software, strategies, tooling, etc., to mill whatever part it is that comes into the production center. I do not critique the designs that are sent unless they are out of bounds for our abilities. This is rare. I see our goal as this: Mill the part at the highest level. Our Roeders mills have strong 5-axis angulation capabilities and robust spindles, allowing us to rarely ever decline a design for angulation issues as it challenges our strategies, but it can happen and has little to do with the lab working to fulfill the prescription from the doctor.
(3) Emergence profile. Again, I go back to the narrow goal of Strategy, which is to be a great resource for milling your part, whatever you decide to do in your design. I do not see the prescription, nor am I familiar with the lab’s intimate relationship with its customers. We are here to serve the lab in their milled part goals, regardless of the discussions and requests are between the doctor and the lab.
