Noah Levine

The new VITA ZYRCOMAT 6000 MS sintering furnace is capable of sintering up to 25 units as well as 9-unit bridges in 80 minutes starting from room temperature. The furnace has been rigorously tested and proven to provide stress-free, natural air-cooling to 400º C for white and industrially pre-colored VITA YZ materials by using sophisticated electronics that lower the lift tray at a precise rate. Additional tests showed the quality and integrity of restorations sintered with the 80 minute cycle to be comparable to or exceed the density, bending strength, average grain size, simulated aging, fracture load and fit on the model of conventionally sintered restorations. Conventional firing processes are pre-programmed, and the furnace can handle high-temperature sintering for all dental framework materials. Controlled via the same VITA vPad labs with other New Generation VITA furnaces already have, the ZYRCOMAT 6000 MS has a very small footprint, and is offered at an economical price.

		Sinters up to 25 units as well as 9-unit bridges in 80 minutes

		Designed for high-temperature sintering of all dental ceramic substructure materials

		Four molybdenum disilicide heating elements for optimal heat distribution

		HighSpeed, conventional or user-defined sintering programs

		Controlled via the company’s VITA vPad

		LED display bar and acoustic signals for firing status from a distance

Articles

The new VITA ZYRCOMAT 6000 MS sintering furnace is capable of sintering up to 25 units as well as 9-unit bridges in 80 minutes starting from room temperature.

Tech Brief: Rapid and precise

It’s no secret that the general public has almost no understanding of the work done by 

. Most people don’t realize their dentist works with an outside expert when crafting their crowns, dentures or other potentially life-changing prosthetics.

For experienced technician Jose Walter, just how far off the public’s radar the dental laboratory industry actually is hit home when he typed, “who makes teeth” into a Yahoo! search and discovered that none of the top results even come close to identifying the role dental lab technicians play in the process. Now he hopes to change that by raising the profile of what dental technicians do.

“A lot of people don’t know about us and what we do,” he said. “I think it’s really important to let people know what we do, because with everything that’s going on, If we want changes, we have to go out and do something.”

The fact that the public doesn’t know much about what dental labs do is a problem for both labs and the public, Walter said. He believes patients deserve the 

 and to be fully informed of their restorative options. Without that information, they can’t make the best decision for themselves.

Walter likens a patient in need of a dental restoration to a customer looking at a new car. When planning to spend thousands of dollars on a vehicle, smart consumers research the options, choose features they want and can afford, and come away with the best car that fits their budgets. With dental restorations, Walter believes a more informed public would have a better idea of what’s available to them and thus would be empowered to make better decisions.

“I think if change is going to happen we have to go to the general public. They’re the end user and they should know what it is we do and what options they have,” he said.

The lack of visibility of the work technicians do only serves to devalue the industry, and this is certainly evidenced by the U.S. Department of Labor’s recent reclassification of dental lab technician to the unskilled labor category. That shift was something shocking to Walter who started working in a lab’s model department while in high school, learned the trade at the bench and has worked in a variety of labs for much of his professional life.
	
	When faced with a problem, Walter said he has always looked to find the best solution, and has invented a number of products, such as the W.O.W. articulator, during his career. The issue of the industry being largely invisible is another one of those problems he hopes to help solve. While he’s not sure dental labs can change things from inside the industry simply by working with dentists, he hopes he can use the pride many technicians take in their work to get the public interested in what they do.

“I now think the general public can be taught to demand better dentistry. I have an idea to educate the general public in a fashionable, non-intrusive way…and with the help of my fellow dental lab technicians,” he said.

With that in mind, Walter created his latest company 

 and launched a line of T-shirts, hats and other apparel that he refers to as “dental lab tech gear.” The current line-up includes shirts with slogans such as “Lab is good” and “Making teeth, it’s what I do.”

The gear is something of an icebreaker for the general public, and a way for technicians to invite the public into their world. While a bumper sticker can communicate an opinion to other motorists, a T-shirt is more personal and invites an interaction. It’s far easier to ask someone what his or her shirt means, than it is to chase down a car to ask about a bumper sticker or vanity license plate.

“I believe that we are all to a degree, walking messengers. By the way we dress or by what we wear each of us is sending out messages on a regular basis. I’ve noticed that a lot of times when you have a T-shirt on people go up to you and will ask you what it means. It’s a conversation piece,” Walter said. “I believe that each of us, on a daily basis, and with each interaction have the opportunity to create a positive message about the dental lab industry.”

Walter said the dental lab tech gear is designed to give technicians a public outlet for the pride they feel in the work they do. If the shirts serve as icebreakers for technicians wearing them, they turn those technicians into ambassadors for the industry.

The hope is that a more aware and engaged public gains a better understanding of the value and quality available from skilled lab technicians, and thus the entire industry becomes more valued by the public. Walter said he hopes this idea catches on with like-minded technicians who can begin raising the industry’s profile one person at a time.

“To me it has always been about the patient. I love what I do. I have a passion for making teeth. I want to duplicate nature with every product that I make and assure that I am giving the end user-the patient-the best restorations possible so that he or she can enjoy optimal oral health,” he said. “With that in mind I want to create public awareness within the general public of the dental lab industry to educate dental patients who will then demand good dentistry. As they demand better dentistry I believe it will also improve the dental lab industry.”

It’s no secret that the general public has almost no understanding of the work done by dental technicians. Most people don’t realize their dentist works with an outside expert when crafting their crowns, dentures or other potentially life-changing prosthetics.

Starting the conversation

	Information provided by Henry Schein Inc.

	A complete online digital prescription workflow that helps route and manage lab casework, DDX Labscripts is a new feature of Henry Schein’s DDX (Digital Dental Exchange) digital case management system.Designed to unify the many digital technologies used by labs and dentists into one seamless global network, DDX Labscripts starts with a customized prescription workflow that guides doctors through case submission while requiring complete case information. The system then automatically routes appropriate details of the case to any number of fabrication partners. DDX Labscripts can be set to automatically send and receive alerts from any outsource partner, and all case details including invoice and shipping status are accessible 24/7 via any Internet browser, reducing communication inefficiencies that slow production and patient care. The system is integrated with most lab and practice management systems, and partners with many major dental technologies, including D4D

		Digital prescription workflow to prescribe, route and manage lab casework online

		Guides doctors through case submission with customizable parameters to ensure complete case information is provided

		Automatically routes cases between any number of fabrication centers

		Can be set to automatically send and receive alerts from any outsource partner

		All case details stored in one place and accessible 24/7 via any Internet browser

		Integrated with most lab and practice management systems and partnered with many major dental technologies, including D4D

 Information provided by Henry Schein Inc.  A complete online digital prescription workflow that helps route and manage lab casework, DDX Labscripts is a new feature of Henry Schein’s DDX (Digital Dental Exchange) digital case management system.

Scripted for success

	For good and ill, taking your work home with you has never been easier. The Internet makes it possible to connect to just about everything from anywhere, and connecting to the Internet often is as simple as pulling your smartphone from your pocket or a tablet computer from your bag.

	According to numbers compiled by research firm comScore, as of April 32% of U.S. mobile phone users had smartphones capable of mobile Internet access and running a range of applications. Additionally there are millions of people who have added an iPad or other tablet computer to their mobile computing arsenal.

	If you’re among this growing segment of the population did you choose your phone or tablet with business uses in mind? If you didn’t have you found business uses creeping into the way you use your new technology? If you did make the purchase with business uses as a high priority, did you consider how it would integrate with your current business technology before making the purchase?

	These powerful mobile computers can keep you connected to your lab from your home, the golf course, while travelling to a conference or just about anywhere else you happen to wander. This connectivity means problems can be addressed immediately and numerous aspects of operating your business can be handled while you’re not physically in the office. Leveraged correctly, mobile computing via smartphone or tablet can mean you can address a dentist’s concerns about a case on a moments notice, or update the lab’s financial books while waiting for an inevitably delayed flight.

	Of course for all of his to work, your smartphone or tablet needs to be able to speak the same language as the systems you use in your office. With some systems this can be an almost seamless operation, but for others this can be a little trickier to set up, and unfortunately that is the way the companies creating these technologies want things.

	Just as in nature, a technology ecosystem is made up of a number of independent parts that interact with each other. A healthy ecosystem allows its various technological components to perform their individual functions and to work as a group when necessary. A computer network with automatic back up, and software applications that work together would be one example.

	Getting files from different ecosystems to talk to each other can often involve file conversions or other workarounds. When you set up a computer system for you lab it is likely you chose for all of the computers to run on Microsoft’s Windows or Apple’s OS X so that they could talk to each other and files that work on one computer would work on the others. Years ago transferring files between a PC and a Mac was much more difficult, but just as dental technology companies are migrating to open architectures and common file formats, demand and cross-platform software titles have made working between the two major desktop operating systems fairly simple.

	For the most part adding a mobile computer to the mix will work well with any of these desktop environments, but that will not always be the case. If the mobile system will be used just for handling phone calls, checking emails and possibly connecting a calendar you should have no problem regardless of the type of smartphone or tablet you choose. However, if you plan to work with documents, access your lab’s computers to remotely access case files and basically run your lab from wherever, knowing that machines can work together well should be a consideration from the start.

	The easiest way to make sure this is the case is the purchase mobile technologies running on companion software to the systems in your lab. This can work quite well for a Mac-based lab as the iPhone and iPad are proven technologies with a wide array of available applications, some of which are even dental lab specific. If the lab uses Apple’s iWork software package, there are mobile versions available and many other desktop applications have mobile incarnations.

	Apple is the company most dedicated to providing a fully interconnected ecosystem of traditional desktops, portable laptops, and fully mobile smart phones and tablets. Everything is designed to work together ever more seamlessly and the company has been proactive in designing its software titles to work well with files from other systems such as opening a Microsoft Word document in Apple’s Pages. Of course, some people feel penned in by Apple’s closed loop approach and overbearing control.

	For a PC-based lab to take a similar approach that would mean adopting a Windows Phone 7 smartphone and playing wait and see to determine if the company ever plans to move into the tablet arena. Of course software developers have not flocked to Windows Phone 7 and there are far fewer applications available for those smartphones. For now Windows seems to be behind the times in the smartphone arena and the former leader of mobile business technology, BlackBerry maker RIM, has been in a steep decline.

	The current leader in the mobile operating system market is none of the above. Google’s Android is the most widely adopted smartphone platform and it is mounting a challenge to Apple’s iPad tablet as well. The Android devices have a large number of available applications as well, but even though Google recently launched a cloud-based Chrome operating system for laptops, there really isn’t a desktop system that is set up for seamless integration with Android’s mobile devices.

	Google has pushed for remote data storage (more on cloud computing in next month’s column) but Android users can find many ways to use their mobile devices in conjunction with their desktop systems. In fact Android is probably the easiest to work with in terms of seamless and automatic integration. Whether you use a Windows system or a Mac, Google has made it easy to set things up so your phone’s calendar, contacts and other data will automatically sync back to your desktop system.

	Even if your mobile devices don’t match up completely with your desktop system, applications such as Applications To Go (available for both Android and iPhone) can let you access documents. An iPad or an Android tablet have both the screen size and web browser to access any computer systems you might log into from your home computer, and services such as LogMeIn and GoToMyPC allow remote control of any computer set up for the system. The former works with almost any mobile platform while the later is currently only available for iPad, with iPhone and Android support in the works. With such software you could even log into your lab’s design system and work on a CAD/CAM case from anywhere.

	Accessing your office via your mobile devices can be a great tool, but if you plan to really use your system to do any of your work remotely, you also need to think about the mobile network you will be signing up with. The technology today would allow you to take a phone call from a dentist, pull up the details on the cases he has at your lab, and even send him pictures of the case and possibly even capture and send a short video of work being done on the case via a webcam. But such a scenario could actually play out if Verizon is your mobile carrier.

	While AT&T’s network is often derided for poor service when compared with Verizon’s, they operate on different technologies, and the Verizon network doesn’t have the capability to handle both a phone call and data services at the same time. This will change in a year or two when both network move to the same platform for their 4G networks, but for now Verizon might be less useful to a lab looking to maximize mobile technology for work purposes.

	All of this connectivity and interoperability can be a wonderful thing in terms of efficiency and jumping at opportunities as soon as they present themselves, but there’s plenty to be said for getting away from the office once in a while. It’s important to remember that just because you can do work anytime and anywhere, it doesn’t mean you have to jump into lab mode every time there’s a buzz from your pocket or a ding from your briefcase. These mobile technologies all come with buttons to their power off, and from time to time those buttons can be more useful than any other function these devices can perform.

 For good and ill, taking your work home with you has never been easier. The Internet makes it possible to connect to just about everything from anywhere, and connecting to the Internet often is as simple as pulling your smartphone from your pocket or a tablet computer from your bag.

Tech Smart: Electronics ecosystems

	It’s not uncommon for a lab with a complete in-house CAD/CAM system to open up excess capacity as an outsource option for other labs. That can be a way to maximize return on the technology investment, but it doesn’t make the lab into a milling center.

	Creating a milling center in the truest sense of concept means building a business dedicated to providing dental labs with access to CAD/CAM produced parts that can then be finished into restorations ready for the prescribing dentist to place into the patient’s mouth.

 in Ann Arbor, Mich., said milling centers provide knowledge, technology and precision to labs, but because they don’t provide completely finished products, they are never in direct competition. Milling centers fill a need in the industry, but they follow a completely different business model than dental labs.

	“Setting up a dedicated milling center to support other laboratories and to not have any final products that you ship yourself, that’s a challenge,” Brown said. “With the other profit centers within a laboratory, it’s easier for a lab to add milling equipment than it is to set up to just be a milling center. The profit margin on production is much smaller at a milling center than it is at a full-service laboratory.”

	Still, there’s a reason milling centers exist, and Brown believes this is because of the efficiencies of specialization. Dental labs produce custom products made to meet the individual specification of each case, but digital design and computer-driven production allow for some steps to be automated, and a milling center provides labs with access to the expensive technologies required for this automation.

	“Efficiencies in manufacturing are starting to work their way into the dental lab world,” he said. “Just as GM, Ford and Chrysler don’t make every single part that they put in a vehicle-they outsource the fabrication of certain parts to people who are very good at doing that-now you’re seeing that same sort of philosophy behind milling centers.”

	While the business case makes sense for the industry, it must make sense for the individual milling centers if they are going to survive and thrive. Brown said starting Apex required a huge investment in expensive milling hardware, and the center needed a solid plan to make sure there would be a timely return on that investment. It’s also important for milling centers to completely examine the costs associated with the equipment being purchased. Costs for training, installation, electrical and other utility connections, and maintenance all must be a part of the equation. Brown stressed the importance of separating wants and needs and starting with a manageable investment plan with built-in scalability.

	“If you’re going to make a financial investment, you’ve got to know it’s going to pay for itself within a certain period of time, because if a new material comes out, you’re going to want to be able to work with it and that may mean a new capital investment,” he said.

	Purchasing the mills and related technologies is part of the process, but successfully running a milling center takes in-depth knowledge of how those systems work. Brown came to the dental milling world with a background in engineering and general manufacturing. While learning about the specifics of dental restoration production was a hurdle, he was already comfortable running the CAD/CAM technology at the heart of Apex.

	While every mill operates slightly differently, Brown and his staff make it their business to know the systems inside and out. A dedication to understanding how these mills function and how to use the software that controls them most effectively is critical to success.

	“It is complex machinery,” he said. “Things go wrong. You need to be able to recognize when there’s an issue with product, what the cause is and how to rectify it.”

	This knowledge also leads to being able to use these mills to create a superior product. A milling center must produce parts that meet the expectations of the labs that will be finishing them, while simultaneously maximizing the center’s own use of materials, time and energy. Brown said he and his staff at Apex approach this task with confidence because of their dedication to mastering the nuances of milling dental materials.

	“We are strong in milling knowledge and expertise. We’re strong in scan and design,” he said. “We use multiple scanners; we use multiple CAD packages. We recognize certain types of cases that will be best handled with different systems and different mills.”

	That knowledge is an asset for a milling center in multiple ways. It’s critical for achieving optimal results from the mill, but it’s also a resource for customers. Brown and his staff are ready to suggest material options and milling strategies the lab might not have thought about. In some cases he has shared his expert opinion with the prescribing dentist to help keep a case on a path toward an optimal outcome.

	“What we do in a day some of our customers are lucky to do in a month,” Brown said. “We see so many different cases, so many different types of preparations, so many different scenarios that we see what works.”

	A milling center needs to be ready to effectively translate milling and laboratory terminology and nuances. Every employee at the milling center doesn’t need this knowledge but it must be a part of the business.

	“You need the ability to interact with laboratories and doctors at their level, but you need to have the mechanical and technological background-especially if you’re going with open architecture systems-to plug it all in and make it work,” Brown said.

	Currently milling centers such as Apex provide scan and design services as well as milling, something Brown said will be the norm until scanners and design software become more common. When labs do have the ability to scan and design their own parts and full contour restorations, Brown believes there could be a business that exists to provide those labs with access to high quality milling.

	But even if the industry moves in that direction, milling centers will still play an important role by giving labs access to the precision production large-scale mills are capable of providing. This would allow for even more specialized production in the industry, as the milling centers could be the experts in new materials and new production technologies, while the labs retain their expertise in designing and finishing restorations. 

	“I like the concept of a milling center that can through volume afford to make the investment in the big equipment and let the laboratories stick to scanning, designing and finishing, and putting the personal touch on their cases. It’s what they’re great at,” Brown said.

 It’s not uncommon for a lab with a complete in-house CAD/CAM system to open up excess capacity as an outsource option for other labs. That can be a way to maximize return on the technology investment, but it doesn’t make the lab into a milling center.  Creating a milling center in the truest sense of concept means building a business dedicated to providing dental labs with access to CAD/CAM produced parts that can then be finished into restorations ready for the prescribing dentist to place into the patient’s mouth.

Nothing’s finished

Gnathodontics Ltd. is a full service dental lab located in Lakewood, Colo. with about 60 employees. The lab specializes in complex combination cases, implants and cosmetic work. 

Designed especially for extremely thin and regular application of powder and paste opaques, and zirconia liners, as well as mixing porcelains and closing tears, the Micro-Vibes hand instrument features a battery-operated micromotor attached to an excentric weight. The weight and motor produce vibrations in the tip that can be directed and controlled. Opaque and spatula tips are available. The tool has a sleek, slim design that fits comfortably in the hand.

Smile Line products have been part of the workflow at Gnathodontics Ltd. for several years, Fixed Restorative department manager Kevin Kelly, CDT, said.

“We love their porcelain trays and brushes, and  the Micro-Vibes has been a great addition that has helped streamline our opaque process. The Compo Cubo and the composite instrument set is also a great addition for the bench if you work with light curing composite materials. Smile Lines’s products are very stylish and are very practical at the same time,” he added.

So when he was searching for an instrument that would help increase efficiency and improve the application of paste opaques he figured Smile Line USA might have just the tool.

He was introduced to the Micro-Vibes two years ago at Lab Day Chicago and brought one back to the lab. The technician who handles the opaquing loved it right away, Kelly said.

“The Micro-Vibes has allowed us to apply paste opaques quicker and more evenly than with a conventional opaque brush,” Kelly said.

The double-ended attachment is available with two different sized ends. Kelly said this allows technicians to get into tighter interproximal areas on bridges without having to change tips. The device’s micro vibration helps eliminate bubbles and allows a smooth flow of material to the work surface.

Kelly said his opaquer loves the way it allows smooth, even application while being cleaner and faster than using a brush. She also commented that it has definitely helped her production, and it has helped eliminate bubbles in the opaque, with little to no learning curve, Kelly added.

The ceramists also found it to be a very useful addition to their instrumentation, using the Micro-Vibes to aid in the condensing of their ceramic materials.

“The ceramists also like the Micro-Vibes to vibrate porcelain into proximal steam tears of bridgework that may occur during the firing process,” he said.

Like the other Smile Line products used in the lab, Kelly and his team like the Micro-Vibes because of its innovative cutting edge design and the practicality of using it in the lab. In fact they’re always excited to find out about new tools available from Smile Line USA.

“Their catalog is a must in our lab, and the technicians like the way the products look and work on their benches,” he said.

The Lab Gnathodontics Ltd. is a full service dental lab located in Lakewood, Colo. with about 60 employees. The lab specializes in complex combination cases, implants and cosmetic work.  The Product

Real Time ROI: Smile Line USA’s Micro-Vibes

	Designed to recreate the internal effects and characteristics of natural teeth, Lite Art light-curing coloring pastes are highly fluorescent with low viscosities. Featuring a newly developed, multi-functional monomer and photo initiator, they  deliver excellent surface covering qualities.

	With optimal covering properties, they can be applied nearly as thin as porcelain due to the microfine particle structure. Lite Art pastes cure nicely whether being used on resins, composites, artificial teeth or frameworks. Once applied it is easy to reproduce fine and specific natural internal accents by covering Lite Art with an incisal or translucent composite layer. The pastes are designed to reproduce the natural fluorescence of teeth even when exposed to artificial light conditions.

	The system is designed with a novel coloring system that is actually based on custom mixing the classical primary colors of cyan, magenta and yellow. The three colors can be mixed in a wide range of combinations to create and match the exact natural colors needed for individual cases. Each of these primary colors can be used individually or mixed. However, 12 premixed colors imitating the color effects of natural teeth and pigmentation of the gingiva also are available, simplifying the mixing process. This means the system can be customized when needed, but also simple and ready to go when working on less complex cases.

	The Lite Art pastes are an ideal way to add characterization and color modifications to restorations produced from composite or acrylic resins. They also can be used for modifying hard resin teeth and acrylic resin teeth. Here the procedure for using the Lite Art pastes for adjusting the shade of composite crown as well as for a hard resin denture tooth are outlined.

 An individual occlusal internal effect is created via the application of a thin layer of the Orange Brown paste to the occlusal surface of the cured crown with a brush (Fig. A). Depending on the clinical case, Khaki colored paste or shade stains can be used to adjust the colors in interproximal and cervical areas.

 The crown is light cured for 1 minute with the Solidlite V (Fig. B).

 After curing, cover the stained surface with either incisal or transparent acrylic used to create the crown (Fig. C). In this case, Ceramage was used.

 After curing once more, the restoration is finished and polished in the usual manner (Fig. D).

 The surface of the denture tooth is roughened with a carborundum point (Fig. E).

 Dust is removed from the surface using either a dry brush or a blast of compressed air.

 Bond I of Cera Resin Bond is applied to the tooth and let set for 10 seconds (Fig. F).

 Bond II of the Cera Resin Bond is then brushed on the tooth (Fig. G), and light cured for 3 minutes with the Solidlite V.

 The A-Shade Lite Art paste is brushed onto the tooth surface (Fig. H) and then light cured for 1 minute.

 Clear liquid is used to dilute the color and adjust the viscosity of the paste to achieve the desired effects (Fig. I).

 The surface where the Lite Art paste was applied is covered with the Ceramage translucent T-Glass paste (Fig. J).

 The final results are shown after the tooth has been finished and polished in the usual manner (Fig. K).

 Designed to recreate the internal effects and characteristics of natural teeth, Lite Art light-curing coloring pastes are highly fluorescent with low viscosities. Featuring a newly developed, multi-functional monomer and photo initiator, they  deliver excellent surface covering qualities.

Character adjustment

No one really knows what’s coming just around the corner tomorrow-let alone throughout the next 12 months-but proceeding without even a general concept of what might be on the way can be just as risky.

Thinking about the future can be a useful exercise for a dental lab, or any other business. It can help when setting goals, planning for contingencies or even just enjoying a daydream about a pie in the sky, best case scenario. It starts with taking stock of the current situation, but from there it’s all about examining possibilities and deciding which course seems the most likely to be the correct path.

To help along that journey, we’ve talked to industry analysts, manufacturers, opinion leaders and lab technicians who shared what they think might be the big trends in technology, business plans and the overall dental lab industry throughout 2012. Read on to discover their thoughts on which categories are poised to grow, what’s on the CAD/CAM horizon, business models on the rise and the biggest challenges facing individual labs and the industry as a whole.

It should come as no surprise that industry analysis from business intelligence firm 

 predicts implants to be one of the largest categories for growth in the coming year. Dental Equipment Analyst Vishwajit Gaikwad said expanded marketing of implants to dental consumers will be driving this growth. He said the $900 million U.S. implant market is likely to grow by approximately 4% over the next three years.

But while talking with lab owners and technicians yields anecdotal evidence of growth in the removables arena, Gaikwad said GlobalData’s research and analysis shows greater potential for growth in the crown and bridge market which will grow an expected 6% in the next three years spurred by the continued spread of cost-efficient zirconia materials and expanded CAD/CAM fabrication.

The technology powering those efficiencies is also an area GlobalData believes will experience growth in the near term. Sales of CAD/CAM technologies are expected to grow by 7% during the coming three years, with adoption by mid- to large-sized labs powering this growth because they are in the best position to purchase new technologies, Gaikwad said.

“Affordability of CAD/CAM systems will be the chief criterion for their adoption,” he added.

If expansion of CAD/CAM technologies continues at its expected rate of growth, Gaikwad said it will be powering the creation of a majority of crown and bridge restorations by 2015. That milestone would be quite remarkable as Gaikwad cited data published by Lab Management Today showing just 4% of crowns and bridges were fabricated via CAD/CAM in 2003 and that number had risen to 18% in 2010.

But while the predicted growth in these categories for the U.S. is decent, Gaikwad said GlobalData’s research expects the rate of growth globally to be even more significant with double-digit growth percentages expected across the board, highlighted by an expected 9.6% growth in the European implant market and 15.5% in the Asia-Pacific implant market over the next three years.

While those macro-predictions can provide a general overview of the direction the dental lab industry is headed, for most labs it still comes down to providing high quality restorations at a fair price. The growth of CAD/CAM and the lower costs it offers to larger scale operations can make things more difficult for smaller operators to stay competitive.

However, that doesn’t mean small labs don’t have a way to stay up to date and capture some of the growth whether via outsourcing production to milling or printing partners or finding cost effective ways to add CAD/CAM in house. Dr. Mark Murphy, head of clinical education at MicroDental/DTI, said finding a production partner could be the move that keeps small labs afloat in 2012.

“Smart small to medium labs will have to adjust to this by saying ‘I can’t afford to digitize my processes so I’m going to have outsource more and more,’ ” he said. “Those who don’t adapt will be some of the numbers in 2012 who end up closing up shop.”

Outsourcing has established its place in the industry, and BEGO USA VP/General Manager William Oremus said he expects more and more labs will be using services such as his company’s BEGO Production Center-which offers the cost effective fabrication of non-precious metal copings via Selective Laser Technology-to eliminate the most time consuming and technique sensitive workflow steps.

While continued growth of outsourcing is a trend Oremus expects to see in 2012, he doesn’t see the availability of CAD/CAM copings to eliminate casting any time soon and he hopes labs making use of these services find ways to turn efficiencies into growth rather than shrinking the business to stay competitive.

“Hopefully no jobs will be lost, but it will just be a transfer of responsibilities where these people will go into new departments in the laboratory,” he said.

The other area where labs of all sizes are tapping into the efficiencies CAD/CAM offers are monolithic restorations. The influx of monolithic zirconia materials that started in late 2010 will continue in 2012 with the launch of materials from DENTSPLY Prosthetics and 3M ESPE among other companies. But while monolithic crowns can be produced rapidly via digital technologies, Steven Pigliacelli, CDT, VP at Marotta Dental Studio in Farmingdale, N.Y., hopes those materials and his preferred monolithic option, Ivoclar Vivadent’s e.max, are not used to cut corners when it comes to quality and esthetics.

“With the right technicians doing it, you can make a wonderful product,” he said. “It’s a great concept, but I don’t see why the answer is always let’s make it cheaper and make it quicker.”

But regardless of the route a lab takes to make workflows more efficient, it’s important for labs to understand what sets them apart and make sure those differences are highlighted to their customers. Digital technologies and outsourced production even the playing field in many ways, so labs need to set themselves up as an informational resource to their practices, Oremus said. In 2012 and beyond, the labs with the ability to leverage their knowledge and expertise as clinical resources are going to thrive.

“That is going to be so important in the future, especially in removables. The lack of education on both sides of the fence in removables is really there today, and the technician that can be the value add and take the doctor through the case will have an edge in securing that doctor’s business,” he said.

Unfortunately Pigliacelli believes one of the biggest trends for 2012 will be the continued loss of benchtop knowledge throughout the industry. With an aging technician population, shrinking educational opportunities and expanding automation increasing pressure from competition the core knowledge required to create high quality dental restorations is becoming an ever rarer commodity.

Pigliacelli said he thinks the dental lab industry is heading for a disaster where dentists who have never been taught about lab processes are working with technicians who are trained only on digital design and production. That might work fine for simple cases, but it’s the complex cases that can really change patients’ lives but only when these restorations are designed and fabricated properly, and that requires more educational opportunities for technicians.

This is something Pigliacelli is working on locally with the hopes of convincing Stoney Brook University to open a dental technology school. Others in the industry such as the Foundation for Dental Laboratory Technology also plan to use 2012 to raise awareness of the gaps in education and work to expand upon the limited training opportunities for new technicians. However, this is one challenge that will still be facing the industry when 2013 arrives.

“My goal is to train a new generation, but we’re just starting and they’re not going to be ready for another 4 to 6 years,” Pigliacelli said. “It’s going to get worse before it gets better.”

Technology as a trend is certainly nothing new for the dental lab industry. Every year there are new materials, new techniques and new ways of creating the prostheses and other products produced by dental labs. Dr. Murphy said this may not be new, but 2012 will certainly be marked by the continued shift of lab processes to digital technologies.

For most labs this will take the form of scanning impressions or models and using CAD software to digitally design restorations. There are numerous scanners already available and major players such as Dental Wings and Delcam recently launched their latest models. Some labs will adopt mills and with the influx of tabletop milling units from companies such as Wieland Dental Systems, CadBlu and soon Jensen Dental there are more milling options than ever before.

However, Dr. Murphy said labs that are not large enough to invest in industrial scale production technologies might be better served by outsourcing production to a business with the financial capability to pay for those technologies. This is because while most labs evaluate a technology purchase based on the potential revenue to be made from that investment, Dr. Murphy said they need to base those calculations on net profit from the investment or they might not be capable of taking in enough new business to pay for the new system.

Another caution for labs of any size making technology investments is the pace of development in both production technologies and materials. A mill might be efficient today, but the reductive nature of milled restorations means there is a lot of material wasted during the cutting of one crown or coping.

It is for this reason that Oremus said additive manufacturing processes such as SLM and other 3D printing concepts will be areas of growth. Additive processes require less material for production and thus have the potential to lower production costs. In 2012 BEGO hopes to be ready to offer SLM production in semi-precious metal to expand the cases for which framework production can be outsourced to the company’s facility and save even more production time for labs using the service.

“Those hours saved during the day allows them to sit at the ceramist bench where the artistry is really made,” Oremus said. “I think you’ll see more of the technology going in that direction. I think we’re already seeing it in the fabrication of models.”

Adopting new technology really needs to be about adding efficiencies without sacrificing quality. For this reason, Oremus sees 2012 as another year where there will be fewer cast frameworks and fewer hand-poured refractory models as SLM and milled framework and 3D printed models grow more common. Still lab technicians will be needed to add the customized esthetic touches to these restorations, and a close relationship with the doctor will remain key to delivering on those expectations.

“For any type of anterior work I think it’s always going to take the artistry of a technician to make it a win win for everyone and where the patient is going to be able to smile and be happy with it,” he said.

Pigliacelli agrees that digital technologies will continue to grow within the industry and he loves the potential they bring in terms of enhancing communication between dentists and technicians, and producing high quality restorations more efficiently. However, he worries that any gains in speed could be offset by a reduction in quality.

As the technology grows more common, Pigliacelli hopes that proper technician education and training will not be lost. It might be easier for someone off the streets to learn on a computer than on a bench, but no scanner, design program or mill is perfect and the industry will only move forward with this technology if it is being used by people who understand the principles behind the restorations being produced.

“I’m a firm believer in having trained technicians use it rather than people off the street,” he said. “You have to know what you’re doing to get the machines to do what you want them to do.”

While dental labs are seeing the pace of digitization increase, chairside CAD/CAM systems and digital impression technologies remain a niche and despite some innovative efforts from the lab industry, that is not going to change in 2012, Dr. Murphy said.

Starting with a digital impression can certainly increase the efficiency of a lab set up to work in a digital environment, but dentists are slow to embrace new ways of doing things and chairside technologies remain significant investments for dental practices. In late 2011 Dental Services Group (DSG) launched a rebate program in partnership with Sirona to defray the costs of adding CEREC AC digital impression systems to practices sending cases to DSG labs.

For an operation the size of DSG this makes sense, Dr. Murphy said, noting that DTI is likely to begin offering similar rebates and purchase support to help more practices add digital impression capabilities. This allows large scale lab operations to cut the costs associated with models and lower overhead in other areas. The scale of the lab operations allow for these efficiencies to work in a way that makes less sense for a smaller lab with less to be gained from creating the same efficiencies.

However, even if DSG’s program takes off and similar programs are put in place by DTI and other lab groups such as National Dentex, they are still unlikely to push digital impressioning into the mainstream. Dr. Murphy noted that even if all three lab chains are able to place 500 digital impression systems in practices before 2012 is out, that would still be just 1,500 systems total, not enough to outfit 1% of U.S. dentists.

“Digital impressions will tip when the scanners hit the market at some price that makes it cost effective to buy the scanner and not buy the impression material.”

The sluggish economy has been the story underlying the dental lab industry for the past four or five years as the U.S. slipped into recession and has struggled to recover in a meaningful way. A slower business environment has hit the industry in a number of ways, most notably by shrinking its size.

Dr. Murphy said he believes 2012 will continue this trend with fewer labs open by the time the year ends. Small labs are most vulnerable to these outside economic pressures. They have smaller margin for error or miscalculations, and Dr. Murphy said this is compounded when small labs are run by people who are technicians first and business owners second.

“If the economy was robust, we would still be consolidating, but with the economy not being very robust, it accelerates the mistakes many of us make in small business and magnifies the inefficiencies in the business side of small to medium sized laboratories,” he said.

Larger labs are better equipped to ride out the economic situation, but the decline in the number of dental labs is not just due to the slow economy. The lab industry was already beginning to contract before the recession due to the efficiencies large labs can realize via technology and outside investment capital takes an interest in profiting off this situation.

Still the consolidation and economic forces have yet to create a mega-lab capable of controlling more than a tiny fraction of the overall market for dental lab work in the U.S. This year is the beginning of that changing, Dr. Murphy said, and he believes lab groups such as DTI and DSG will continue to grow via acquisitions while other groups may be created and the size of the businesses operating in the industry may grow.

But this consolidation is not going to happen overnight or even during the course of one year, and even small labs will be able to thrive if they are run as smart businesses. Pigliacelli said Marotta Dental Studio has felt the impact of the economy but continues to be successful because they stick to what they do best -delivering quality restorations to accounts that have come to trust their lab as a partner.

“I feel a lot has to do with integrity and quality of work. We just try to do a good product,” he said. “We have a great relationship with our accounts. We give a consistent product to all of our doctors and we give consistent service to all of our doctors, and that’s very important to me.”

Having solid relationships as the foundation of the business is a part of weathering a difficult economic climate, but knowing the lab’s identity and sticking to it is just as critical, Pigliacelli said. Rather than cutting prices to compete with the biggest labs that can deliver a crown for less, Marotta focuses on delivering a quality product clients can rely on and the type of personal service and collaboration production focused labs can’t always provide. Just as there are different types of stores in a mall, there is room for different types of dental labs, and Pigliacelli said a lab that tries to straddle the line between competing on price or competing on service and quality will likely succeed at neither.

“I think you have to make a choice. You can’t be both,” he said.

Regardless of how a lab wants to position itself with its clients, it will need to operate efficiently from a business perspective to be successful in the coming year, Dr. Murphy said. Labs need to monitor expenses and income and find places where processes can be optimized from both a cost and a quality perspective.

Small labs will need to be lean in their operations and watch their overhead carefully to stay competitive. Still there are a variety of viable business models out there for smaller lab operations, Dr. Murphy said. There will still be room for boutique labs providing high end restorations, there will also be small operations that outsource most of the actual production and simply maintain close ties with their clients and add the finishing touches to restorations to make certain they are exactly what the clinician is looking for.

In fact, those client relationships might be the biggest advantage smaller labs have right now, Dr. Murphy said. A well maintained client roster held by a lab with solid financial footing can make the business a real commodity and something that might be of interest to the expanding groups such as DTI which grew its business in 2011 while acquiring more than $10 million in existing lab operations.

Dr. Murphy said that expansion is likely to continue in 2012, and older lab owners looking for a path toward retirement, or younger lab owners who want to get back to the bench and worry less about the business side of things could use the year to prepare for a transition from standalone business to part of a lab group.

Labs that want to merge while maintaining continuity in the client relationships are the most attractive to the existing lab groups and the people with investment capital scouting the industry. Those labs can gain access to the cost efficiencies of larger scale operations without giving up the day-to-day business they are used to, Dr. Murphy said.

“2012 would be a great year for a small to medium sized laboratory owner to clean their house and get their business ready for transition,” he said.

What the next 12 months will actually bring will always be a mystery. The industry will likely continue to experience change in the technologies and materials available to dental labs and the ways those labs operate as businesses. But while those changes are unstoppable, the value of a technician’s close relationship to the practices sending him or her cases will only continue to grow.

This is an industry built around people because at its core it’s about creating something unique for every case and that requires collaboration, trust and communication. There might be more machines and corporations involved but in the end it will always come back to the people who stand behind the work being produced.

2012: The year ahead

It’s not as if change is a new thing to the dental laboratory industry.

Innovation and embracing new materials, techniques and technologies always have been a part of running a successful dental lab business. However, the pace of that change seems to be continually accelerating, and labs need to constantly adjust to keep up.

The factors driving the changes come from a variety of internal and external sources, and what worked just a decade ago may no longer be the best plan to follow. Today labs must be ready to navigate ceaseless technological developments, global competition, changing patient populations, an evolving workforce and far more scrutiny from outside the industry. Adapting to meet these new challenges is a key to success today and tomorrow.

“Those people who were fat and happy cats in the early 2000s through around 2008, they’re having to find new ways of doing business,” said Jeff Stronk, owner of Treasure Dental Studio in Salt Lake City and President of the National Association of Dental Laboratories Board of Directors. “The labs have to evolve, they have to learn how to compete. I think part of the problem is that for all these years when things just ran so smooth, a lot of them were lab technicians who happened to have a business. They need to be businessmen who happen to own dental labs.”

One path to the increased efficiencies of running a successful business is through technology, which Stronk noted is shrinking the number of technicians required to produce the same amount of work in a lab. While staying up-to- date with new developments will always be important, he said it’s just as important for a lab to establish what type of business it wants to be so it stays closest with the technologies and developments that support that model. A lab will either need to scale up to produce in quantity or scale down to sell on high quality and unparalleled service.

“There’s going to be a dichotomy,” Stronk said. “Those smaller labs who cater to fewer clients and can give them incredible service and handle complicated cases, I think the labs that fit that niche will be just fine. Larger laboratories that are more production based will be fine, but they’re using technology now to find better ways to get things done without hiring more employees.”

Drake Precision Dental Laboratory Inc. in Charlotte, N.C., has been taking advantage of technology to position itself in that production lab arena, while still focusing on creating high quality prosthetics, said owner Billy Drake, CDT, who serves as Chair of the Cal-Lab Group. This year the 100-person operation added a CadBlu CAD/CAM system with a 3Shape scanner and a 3D Systems printer to increase production of copings and partials. That sort of investment is key to keeping the lab competitive, Drake said.

To stay up with the times, Drake said he and his management team are constantly traveling and talking with trusted industry contacts to see what’s new, what’s working and what might be a good fit at Drake. If he finds a technology he believes will provide a boost to his bottom line and a return on the investment in less than 20 months, the purchase usually makes sense. While smaller labs might have a more difficult time building a business model for such a quick return on investment, Drake said it’s still critical for them to “stay on the cusp” of new innovations.

“If somebody asks you about something you better be able to explain it to them, and if you don’t do it, you better be able to tell them why,” he said.

Of course with the influx of milling centers and production outsource partners into the industry over the last decade, it’s now possible for even the smallest labs to offer dentists just about any product on the market. Stronk said this is great for smaller labs, and it creates a new sector of the industry with the size and financial structure capable of bringing innovative materials and technology to labs, and thereby to dentists and patients.

Robert Miller, CDT, founder of Custom Milling Technology Center (CMC) in Arvada, Colo., said production facilities open doors for labs of all sizes, but they can be especially valuable partners to small labs. Those labs can work with production centers such as CMC by sending in a model, but can really maximize their profit margins by investing in an open-architecture scanner to control the design of outsourced parts and increase the product offerings available to their dentists.

“There’s so many different areas where it allows them to stay competitive,” he said, citing lowered per-unit costs, faster turnaround times, streamlined fabrication workflows, eliminated shipping costs for digital designs, and with CMC there is no charge for return shipping.

While some technicians argued in the past that they could fabricate a crown via traditional methods faster than they could design one digitally, Miller said the software has been developed to the point where design time is reduced with improved functionality, and it will continue to progress. Having an open-architecture scanner allows labs of any size to broaden their product offerings including offering custom abutments, digitally designed partials and full contour ceramic restorations which have been a huge growth area at CMC. Miller said they can be equally profitable for any laboratory with a scanner.

“The laboratory’s ceramist simply applies stain and glaze, delivering an esthetic restoration,” he said. “As materials evolve, there will be less need for a ceramist to lay out multiple powders to layer a porcelain crown.”

In fact, Drake said while his lab is large enough to invest in production systems to keep work in-house, smaller labs might be in a better position because of the wide range of outsourcing currently available. When small labs can build a trusting relationship with a production center, they can offer the same array of products as a larger lab, which means not every production lab will need to be a large-scale operation.

“What it’s done is opened up some of the new techniques and the new labor saving products by offering it to all of the smaller competitors. It’s hurt the big guy a little bit and helped the little guy in my opinion,” Drake said.

But just as labs of all sizes need to keep up with the latest developments in the industry, production centers need to stay at the leading edge by adopting the best new material options and integrating production technologies that will remain useful. Miller said this makes choosing a production partner as critical as choosing any other supplier for your business.

“To stay relevant you have to be looking ahead to see what’s the next possible development, whether it be material or machines,” he said. “As rapidly as our industry is changing, so do the milling machines, the CAM software; if you don’t have the ability to make these purchases than how do you keep pace?”

But while finding a trusted production partner is vital to a successful outsource-based business plan, Mary Borg, President of SafeLink Consulting, said it’s just as important to stay on top of any regulations that might come into play when you work with a production partner who might be in a different state or country.

It’s also important to think of the totality of a technology’s impact because technologies such as CAD/CAM can change more than just a lab’s workflow. Borg said these technologies can impact the space requirements for shipping and receiving, as well as infection control protocols, and it’s important to consider these factors.

Yet, just as technology is changing the way cases can move through a lab, it also has opened up the doors to competition from overseas labs. According to the NADL, 37% of the units placed by American dentists in 2010 were produced offshore.

These businesses can be difficult for American labs to compete against because of lower wages and workplace standards in China and other parts of Asia, which allow them to undercut local prices. While Stronk said international competition is here to stay, he sees positive trends taking root such as the rapidly rising wage expectations in China, especially among top Chinese technicians. The rising cost of international shipping also has impacted the financial advantages overseas labs have enjoyed.

“Economics are starting to play a factor with what’s going on in China, and that’s going to work to our advantage,” Stronk said.

Still some labs might find advantages of forming international partnerships, and certainly there will be dentists who look only at the bottom line, and thus will look overseas for their crowns, Drake said. While his lab doesn’t do any outsourcing, he believes any labs working with overseas parts would be best served by letting all of their doctors know some of the production is not done in the U.S., because hiding that information jeopardizes the trust that is so vital to the relationship between a dentist and a lab.

It’s also important information for dentists to be able to provide to their patients, Stronk said. Dentists need to be able to trust that the materials in the restorations they are seating match what they prescribed and patients have a right to know where those restorations were produced. Stronk added that such disclosure would help level the playing field with offshore labs, but it’s really about giving the patient the knowledge to make the choice between a crown made in China at one price or one made down the street at another.

“There’s not a shirt that you can buy and not an item of food that you can buy that doesn’t say what’s in it and where it comes from. When you replace a part of the human anatomy, I think it’s only fair that we learn that too,” he said.

The changes sweeping the industry are not just impacting the supply side of things. The patient population is changing with aging Baby Boomers who are keeping more of their teeth and demanding high esthetics in their dental work. This is leading to an increase in demand for partial dentures and implant-supported restorations, Drake said.

“There’s tremendous competition and price pressure on anything fixed-crown and bridge-wise-but not as much with partials and dentures if you’re good at them,” he said. “A lot of fixed technicians look down their nose at removable technicians, which they should not because going forward, I’m not real sure that’s not where the action’s going to be anyway.”

Technology is certainly heading that way with modules for the design of partials and custom abutments now available with many of the CAD software applications. Miller said a scanner, CAD software and a production partner can bring any lab the ability to produce custom abutments, digitally designed partial frameworks or other types of substructures. Removables is a strong area of CAD/CAM growth that is likely to continue expanding. In the future Miller said he expects technology to print digitally designed dentures and more.

It’s not as if change is a new thing to the dental laboratory industry. Innovation and embracing new materials, techniques and technologies always have been a part of running a successful dental lab business. However, the pace of that change seems to be continually accelerating, and labs need to constantly adjust to keep up.