Noah Levine

	Successfully running a dental laboratory requires more than just the technical capabilities and artistic skills that can win cases from dentist clients. And while producing high-quality restorations should be the ultimate goal, it’s important to pay attention to the nuts-and-bolts business details along the way.

	Making sure the laboratory has the day-to-day supplies on hand and examining the industry landscape for new innovations and systems to invest in are key aspects to running the lab as a business entity. While thinking about supplies and investments shouldn’t be your main focus, devoting time to planning how your lab will spend its money on items both big and small is unquestionably an essential component of success. Unfortunately, it’s also one that is overlooked at many labs.

	“Generally it’s done pretty poorly. The reason for that is that most labs aren’t big enough to have a full-time purchasing agent, let alone a professional ­purchasing person, so it tends to be somebody’s part-time job and it doesn’t always get the attention it deserves,” said Chuck Yenkner, President of Business ­Development Associates.

	This can be especially true when it comes to the consumable and material supplies that, while critical for the daily operations of a lab, can easily become afterthoughts or habitual purchases regardless of changing internal and external circumstances. Yenkner said he often finds labs making the mistake of getting into a purchasing rut that prevents them from making the best deals for their businesses.

	“A lot of laboratories do business with somebody out of habit. It’s because they’ve been with them, and they just keep buying and doing the same thing. They rarely check the prices against competitors. They rarely rate their vendors in terms of performance,” he said. “As a result, it eats into their efficiencies, not to mention their costs.”

	Conversely, Yenkner said other labs focus too much attention on trying to always find the best deal and jump from supplier to supplier with each order. While this can lead to savings, the time spent finding the deals might be better used in other ways. Additionally, the hidden costs of changing suppliers or materials in terms of product quality and service can come to bear when switching with every purchase.

	Putting together an annual purchasing plan as part of the lab’s annual business plan is one way to avoid either of those pitfalls. Mark Murphy, DDS, FAGD, Owner of Funktional Consulting and Lead Faculty for Mercer Advisor, said an annual financial plan is a necessity, and the section on planned purchasing should ideally be based on 3 to 5 years of data tracking the lab’s spending patterns. The plan for the upcoming year should be fairly similar to the one for the previous year with adjustments made for any planned changes and expected growth.

	“You can make decisions based on your consumption patterns and based on what you use it for and based on how often you’re going to use it. That’s a much more sensible way,” Dr. Murphy said.

	Consultant and lecturer Gary Maxon, CDT, also stressed the importance of planning, and added that he believes the principles of Lean Manufacturing can be applied to help labs of any size plan purchasing decisions. Understanding the lab’s product mix and areas of growth are important, but it’s also good to keep track of the prices of consumable goods to take advantage of the best possible deals.

	“It’s not only saving money on purchasing, it’s buying at the right time, buying in discount because most of the manufacturers are pretty competitive on that,” Maxon said.

	Still, that doesn’t mean stocking up on massive quantities of goods any time you can get a deal. That can lead to wasted expenses due to products not being used before their shelf life expires, or just taking up space and gathering dust. Both Maxon and Dr. Murphy said they can find wasted money in the bench drawers of just about every lab with which they consult due to technicians squirreling away supplies or preferring to use parallel material choices.

	Other than gold, which is currently gaining in value, every other purchase a lab makes loses value the longer it sits around. Dr. Murphy said labs need to realize the importance of having liquid assets on hand, and thus be aware that materials and supplies are money that has been turned from liquid to solid. Having a plan for ordering should eliminate those expensive last minute rush orders as well as the glut of items that just take up space and replace them with a steady flow of just what is being used.

	“What I don’t want to do is have a lot of implant parts, a lot of ingot and boxes and boxes of porcelain sitting around and gathering dust when that could be money that could be invested in something else,” Dr. Murphy said. “That’s money in the drawer. That’s money I can’t use to pay a bonus, money I can’t use to invest in education, it’s money I can’t use for capital expenses, it’s money I can’t take home myself from my own lab.”

	Ordering the right supplies can be as useful as ordering supplies at the right time, Maxon said, noting the importance of labs tracking the quantities of consumable supplies each technician uses to help plan order and distribution schedules. Additionally, getting all the technicians on the same page with the materials they use is important. This not only reduces the number of items being ordered while increasing the quantities of each item, but it can save time and money later on by eliminating variables from quality control efforts.

	It’s also important to consider a product’s useful life when looking at a bulk purchase for something that does not have a shelf life. Even if a lab is presented with a great bulk deal on something like plastic articulators that could last forever, Yenkner said it is important to consider that a change in technique or materials could make those items as obsolete as something long past its expiration date.

	“While there are some items that you can stock up on and buy in bulk, for the most part, I tend to vote for a more consistent flow of the product,” he said.

	Avoiding overpurchasing doesn’t mean labs must always miss out on the advantages of bulk savings. Yenkner said good pricing is available by working closely with suppliers and explaining the total quantity of something you plan to purchase throughout the year. Many times it will be possible to set up a monthly shipment along with monthly payments to keep inventory low while achieving cost savings due to the total volume being purchased.

	Of course, being in position to know what you’ll need over the course of the year requires a solid purchasing plan. Yenkner said this should be generated each year as a component of the lab’s overall business plan. Depending on the type of lab and the volume of work being done, consumables purchases should fall somewhere in the range of 14-20 percent of revenues. With all of this known ahead of time, a lab is in the best position to strike beneficial deals and optimize the value of purchasing decisions.

	“It can significantly impact on the ­bottom line,” Yenkner said.

	Planning is just as important when considering a major investment in capital equipment, but many more factors come into play when these decisions are being made. Knowing how such a purchase will fit in your annual budget is just one piece of pulling the trigger on a capital investment such as a scanner, mill or complete CAD/CAM system with a price tag reaching into the six-digit range.

	Putting some thought into purchasing plans is important, and as many business students learn, it’s the smart thing to do. In fact, Mark Murphy, DDS, said many business courses begin with an acronym for the word “smart” that can help outline the goals for any major purchases being considered.

	These goals can be taken one step further to become “Smarter” goals by the addition of “Ethical” and “Rewarding” for what Dr. Murphy described as, “a 21st century application of SMART goals,” for lab owners who want to bring a bigger sense of responsibility and meaning to how they run their labs.

	"That’s a significant investment for a small lab. It’s a significant investment for everyone,” Yenkner said. “There’s only two benefits to investing in the capital equipment and new products along this line: One, it’s going to bring you new business; or two, it’s going to lower your costs. If it doesn’t do one of those two things, you really need to think hard at it.”

	Investments such as these can lead to new product offerings from a lab, but Maxon said before even beginning to evaluate the systems that are currently available a lab should evaluate its existing customer base. If you survey your clients and discover they are not interested in what the new system will allow you to produce, it might not be a good fit for your lab. When moving into digital production, it’s also important to know if the system you plan to invest in will be compatible with chairside digital technology currently being used by your current customer base, Maxon added.

	“If the account doesn’t want it, it doesn’t matter which way you go,” he said.

	There are numerous factors to consider when contemplating a major capital equipment purchase, and Yenkner said these investments are really different than anything else a lab purchases. Labs need to be sure to cover all the details so dongle fees, maintenance contracts or upgrade costs do not become ­unpleasant surprises.

	Another often overlooked factor is company support of the product in the form of marketing, but Yenkner said the biggest question that needs to be asked when evaluating an investment in these types of systems is the expected lifespan of the technology. If the terms of a lease or a loan are longer than the useful life of the system, the investment will not pay off, and that can be a difficult assessment to make.

	“Right now, a crucial thing that’s happening in the industry is the life cycles of products is really shrinking,” Yenkner said.

	You yourself can become another obstacle to properly evaluating a new system. Dr. Murphy said that for some people, it’s difficult to ignore the appeal of high technology, but sound business decisions need to be based on a need for the new capabilities and not just a desire to have the latest gadgets in the lab. He advises avoiding becoming attached to the idea of adding a system to your lab until you can adequately plan out how that investment will bring positive returns to the business.

	“You may want a milling system, you may want a scanner, you may want some expensive piece of equipment that you may not really need, but if you become emotionally attached and you picture yourself using it, you’re going to have a hard time not buying it,” he said.

	Figuring out just how to calculate the potential return on investment for a purchase of this scale can be as complex and involve as many factors as evaluating the systems being considered for purchase. When sitting down to figure out how all the potential expenses and profits will shake out, it is important to get a grip on all of the variables involved.

	Maxon said this should start with an accurate calculation of the cost to produce a unit with the new system, as well as the cost per unit for any processes the new system will be replacing. This formula is basically the sum of materials costs, labor costs and overhead costs related to the production, and Maxon advises keeping those costs at or below 60 percent of the selling price.

	"If you don’t know how much it costs to make it, how do you know how much to charge for it?” he said.

	While most manufacturers will provide their own calculations that show how much use a system will need before it can turn a profit for a lab, both Maxon and Yenkner stress the importance of doing your own calculations. Yenkner said this is not because the manufacturers are out to mislead potential customers, but because they create their projections based on an average lab, and no lab will match up to that profile in every area.

	It is important to base your return on investment calculations on real numbers from your lab and realistic projections of the business the investment might bring in. An often overlooked aspect to these calculations that Yenkner pointed out is the way a new technology might shift the internal caseload at a lab. If the new business being brought in through the technology investment is actually reducing other areas of existing business, the lab may be gaining income in one area but losing most or all of those gains elsewhere.

	Another area often overlooked is the impact of the investment on a lab’s employees, Maxon said. Communicating with your team about potential purchases up front can help bring them on board with the changes. It’s important to know if the new technology will require fewer employees, new hires or additional training for the existing staff, so expenses related to that can be factored in.

	“Do you have the right people on the bus currently? Is there somebody there you can cross-train into CAD/CAM?” Maxon said.

	Yenkner advises labs to work with their accountant or financial advisor when doing these calculations. These advisors also can help with the crucial decision that often follows a positive return on investment projection: how to pay for the purchase. While he thinks each lab needs to work with an accountant to determine whether paying cash, financing or leasing capital equipment makes the most sense, the pace of change in dental lab technology makes it difficult for him to advise payment plans that stretch beyond two years.

	For Dr. Murphy, the decision of whether to purchase with on-hand cash or to finance a purchase is less of a quandary. Extolling the virtues of keeping cash on hand, Dr. Murphy said leasing or paying for capital investments over time is almost always the best way to go. With most customers paying 30 to 90 days after work is completed, dental labs making these type of purchases need to avoid situations where they find themselves, “cash poor and equipment rich.”

	“I should leverage my cash over time, and not pay cash for it, even if I can afford it because I lose the strength in my cash flow by not having that money available to do other things. People underestimate how important cash flow is,” Dr. Murphy said.

	All these factors weigh even more heavily on small labs looking to make large-scale investments, Maxon said. While large labs are usually better positioned to actively market a menu of services to potential clients, smaller labs generally must focus more on delivering high-quality service to existing accounts. Because of this, Maxon said smaller labs have more to risk when looking at adding in-house CAD/CAM and other expensive investments.

	“Smaller labs need to do better due diligence on getting involved with it,” he said.

	Of course with numerous milling centers and outsource labs operating today, small labs have more options than just purchasing an expensive CAD/CAM system. In many cases finding good outsource partners makes more financial sense for smaller labs, Maxon said. With no capital investment, they put a range of options into play for just about any lab.

	That factor there is the biggest value of looking to outsource rather than purchase, Yenkner said. It allows smaller labs to “hedge their bets” when it comes to choosing which technology will be around for the long haul and test out new product offerings for current customers.

	“In most cases, the beauty of outsourcing is the investing is minimal. You pay what you pay for the product, if you can sell it at a price that’s a profit, it’s a fairly simple decision,” he said.

	But working with a milling center or other outsource partner is still an expense for the lab, and basically amounts to purchasing parts from another supplier. Yenkner said it is important to document all the details of working with outsource partners to find the best resource for your lab.

	“This is where it gets similar to buying consumable supplies. You need to have a process in place where you can evaluate vendor performance, and not just anecdotally,” he said.

	Dr. Murphy also thinks outsourcing is a great option for many labs, but to determine if it makes more sense to outsource or keep work in house by purchasing a CAD/CAM system, a lab can run competing calculations of the return on investment from each option.

	Just like with evaluating the hidden expenses of capital investments, Dr. Murphy said it is important to look at similar factors with outsource options. If parts require finishing after they come back to the lab, the time and costs associated with that work must be factored into the cost of outsourcing that work. Still, he said it’s often the most viable option for smaller labs.

	“If I were a small laboratory, I would like to find appropriate channel partners who can provide me outsourced material processes that work for me and would help me be successful,” Dr. Murphy said. “I would buy as little equipment as possible.”

	The key to all of this is being smart about purchasing decisions to avoid mistakes that are truly costly to the lab. While Yenkner said this is why more research and planning needs to be done before the big purchases than smaller items, the industry is changing, and labs of all sizes need to figure out how they plan to operate in the ever more digital industry.

	“That’s something different for this industry,” he said. “This industry didn’t change very fast for a long time, so nobody had to make these decisions.”

	Now, it’s ever more important for labs to have solid planning for how their money will be spent. Ongoing purchases shouldn’t come as surprises, and big ticket items should be researched and weighed against competing options with a sound path to earning back the money invested. Without that focus on the business aspects of running a lab, the purchasing mistakes can quickly add up.

	“That’s what I’m afraid of when somebody runs around willy-nilly buying things but not knowing why and having a virtual museum of laboratory equipment that was purchased and not used over the last 20 years. That’s opportunity cost and money that changed forms that you can never get back again,” Dr. Murphy said.

Articles

 Successfully running a dental laboratory requires more than just the technical capabilities and artistic skills that can win cases from dentist clients. And while producing high-quality restorations should be the ultimate goal, it’s important to pay attention to the nuts-and-bolts business details along the way.

Before you seal that deal

	Any marketing effort that brings in more than 700 new patients would have to be considered wildly successful, and one that accomplished this with absolutely no upfront costs to the practice, probably sounds too good to be true.

	Well for the practices across the country that have been offering discounted services through online deal hub Groupon results like that have been the reality. Dr. Nazanin Barkhodari’s 2-year-old solo practice in San Francisco (nbsmiledesign.com) offered a discount on cleaning and x-ray services through Groupon on March 25, and the practice has already seen more than 50 of the 731 people who bought in on the deal.

	“It reaches such a large and broad demographic and for a small office like ours that’s relatively new and trying to build our patient base, this is such an effective way of doing that,” said Dr. Barkhodari’s office manager Monica Martinez.

	While it might not be familiar to everyone in the dental world, Groupon has been making an impact in the world of online retail since the company launched in Chicago in 2008. Now operating in more than 55 cities in the United States, and with recent expansion into Canada, Groupon offers a single deal at a local business in each market each day.

	Promoted on Groupon’s website, as well as through e-mail blasts and smartphone apps, the deals offer discounts of 35-90 percent off retail prices, and they work because of the collective buying power of the company’s 4.3 million subscribers. Each deal is agreed upon between Groupon and the business, and it is only activated once the deal “tips” when a predetermined number of people buy in.

	“We see Groupon as an alternative to traditional advertising,” said Groupon VP of Marketing Mark Desky. “With traditional advertising you pay up front and you hope that customers will come in. With Groupon there really is no upfront commitment at all. You’re featured on Groupon, and if the deal doesn’t tip nothing is owed to us and if the deal does tip we take the monies collected and we forward the agreed upon portion back to the business.”

	Originally Groupon’s offerings focused on entertainment, and many of the deals featured on the site come from restaurants, spas and similar businesses. The company has built its reputation on providing deals at businesses that are among the best in their industries.

	With online forums and plenty of social media integration, Desky said Groupon is constantly receiving and reacting to feedback from customers. Dental deals began to be offered in 2009, and they partially came about because some of that feedback indicated customers would be interested in finding a dentist through the site.

	“It started as an experiment to see how our consumer base would respond. We’ve been pleased, our customers have been pleased and the dentists have especially been pleased with the performance,” Desky said. “We kind of consider this a life’s essentials category. It’s things people need to get done, and if we can introduce our customers to a great dentist in their market, we think that’s a pretty good thing.”

	Thus far Groupon has offered 85 deals for dental services with most of them being discounts on either teeth whitening, or like the deal at Dr. Barkhodari’s practice, a cleaning and x-ray appointment priced at around $40.

	For the dentists offering the deals, those initial appointments are really just a way to get new patients into the practice. Once they’re on the schedule, it is up to the practice to provide a level of service that will keep the patients coming back. Martinez said her practice decided to offer a second discount for the Groupon patient’s next cleaning and they have already scheduled follow-up appointments for more than 35 of the patients they’ve seen while also providing follow-up care for about a dozen patients who had immediate treatment needs.

	“We’ve been pleasantly surprised,” she said. “We tried to have realistic expectations that a lot of the patients that came to us were probably going to be coupon hoppers who bought our deal, would come in and get their teeth cleaned and then buy the next Groupon for a dental office. We’ve done our best to provide the best customer service that we can.”

	While most of the people purchasing the Groupon are patients with no insurance looking for the best deal on the care they need, Martinez said the practice has even scored some new patients with insurance because of the Groupon deal. Those patients didn’t buy into the Groupon, but because of the site’s reputation for offering deals with the best businesses in town, they treated the association with Groupon as a recommendation for Dr. Barkhodari’s practice.

	Martinez said she got the idea to promote the practice through Groupon because she is a customer of the site and saw another dental practice offering a deal. Once she contacted Groupon and got her practice into the “pipeline” to offer a deal, she closely followed the success of the dental deals offered before hers in order to be as prepared as possible.

	She followed the online discussion about the other deals and quickly learned that her practice would fair better with the Web-savvy Groupon shoppers if it was well represented on social media sites such as Facebook, Twitter and the review site Yelp. She also made sure the practice website was as up to date as possible. Desky said this probably helped with their successful deal because Groupon’s customers tend to research businesses online before pulling the trigger to buy into a deal.

	“Our customers need to be able to see the business online,” he said. “They’re going to want to see and get a feel for the business. I would say a website is a prerequisite.”

	The other part of preparing for the offer was being ready for the deluge of attention on the day of the deal. From following the Groupon forums about other dental deals, Martinez said she learned that the biggest complaint from potential customers was a lack of responsiveness from the practice. Prior to the day of the sale, she had a second phone line installed in the practice, trained the practice’s dental assistant to back her up and came in ready for a long day. She arrived that day to two dozen voicemails and a dozen e-mails.

	“People weren’t waiting for (the offer) to even finish. They were buying it and immediately calling,” she said. “I came in early, I worked through lunch, I stayed late, but I called everybody back.”

	Now Martinez has been busy working to fit all the new patients into the schedule for their discount cleanings. While it has been tricky, the patients have a full year from the date of the offer to use the Groupon, and she said they mostly understand that there could be a wait of several months for an appointment.

	Still, customer service is always at the forefront of how she deals with every patient, and she has made special accommodations for patients with special circumstance. One couple reached her via Skype from Costa Rica and explained they would be back in San Francisco for just one day and she moved things around to get them in to use their Groupons for that day.

	Desky said Groupon is always on the look out for high-quality businesses interested in putting together a deal. While the site can not offer a dental deal every day or even every week, there are enough customers out there looking for a deal and the dental offerings have performed well enough to keep them in the mix.

	“We’re really just looking for dental practices with a great reputation, that are well known in their community for providing exceptional service,” he said.

	Putting together the deal is a simple process. Interested businesses can contact the site through their business-to-business portal at grouponworks.com. Once Groupon decides a business is a good match they get together to work out the terms of the deal. Desky said things are usually worked out in just a few phone calls, and once the date for the deal is set, the Groupon team writes up an entertaining profile of the business and the offer which everyone approves. Then the offer goes out with absolutely no payment required from the business offering the deal. According to Desky approximately 97 percent of the businesses offering Groupons said they would do it again. Martinez said she certainly would.

	“It’s just a genius way of marketing,” she added. “It’s a win win for everyone, for Groupon, for us and for the consumer, everybody wins.”.

	Noah Levine is a senior editor for DPR. Contact him at 

 Any marketing effort that brings in more than 700 new patients would have to be considered wildly successful, and one that accomplished this with absolutely no upfront costs to the practice, probably sounds too good to be true.

Reaching patient groups online

	Implants continue to gain momentum as the treatment of choice for a range of dental situations, so being ready to efficiently and cost effectively handle those cases grows ever more important to a lab’s financial success. While those cases can be complex, there are many simple steps that can be taken to make implants a key profit center for a lab.

	With more than 20 years of implant experience, Stephen Killian, CDT, co-owner of Killian Dental Ceramics in Irvine, Calif., has found one of the biggest keys to success with implants is being organized about everything right from the start. He starts each case with a worksheet containing more than 30 details he needs to review before any work gets started.

	This worksheet helps him track what the costs will be to his lab in both time and supplies so he can quote the right price to the dentist and eliminate accidentally undercharging by forgetting to factor in some expense at his lab. It also helps him obtain all the technical and clinical details he needs to complete the case to meet the doctor’s needs. A new addition to his work order sheet is a set of abutment emergence profile schematics the doctors use to communicate their plans. Killian said those little drawing have reduced calls back and forth to doctors and more importantly reduced the number of cases being sent back to his lab.

	“That’s a huge loser for both the doctor and the laboratory to have a case go back and forth,” he said.

	Another huge loser for a lab when it comes to implants is sitting on a stockpile of implant parts waiting for the right case. Since most implants are not rush cases, it is possible and actually more cost efficient to purchase the supplies needed for each case individually. Of course to do that efficiently you need to know everything you might need right from the start of a case. It is in this area that Killian said his worksheet is most helpful, but it’s also critical to have a good knowledge of all the implant systems that a dentist might be using.

	“You need complete visualization before you get started. Part of complete visualization is being expert on all systems. The clients depend on us to be an excellent technical resource,” he said.

	That technical expertise can come in the form of keeping manuals or websites from the major companies at your fingertips so you’re ready to talk with a dentist about any implant system. But it also means being knowledgeable enough to work with the dentist on planning that implant case.

	Killian said making successful implant restorations still comes down to the basics of understanding the tooth that will be replaced and replicating it both above and below the gumline. This means knowing root formations and the way a tooth emerges are important when fabricating custom abutments. Killian said he uses Typodont models from Viade which allow him to pull the teeth from a rubberized base to provide a better understanding of the emergence shape of root formations.

	Approaching implant cases as the expert resource his dentist clients can count on means Killian tries to answer any questions as quickly as he can, and when he doesn’t know something, he tracks down the answer for the dentist rather than sending the dentist off to find someone else with an answer to his question.

	“I’m their one stop shop, and I want to be in that position,” he said.

	To be ready to find those answers, Killian said he maintains a good relationship with pretty much all the major implant manufacturers. Those relationships make it easy for him to help his clients and to order the parts he needs for each case.

	The implant companies certainly welcome these relationships and try to be resources for information and assistance as well as parts suppliers. Martin Dymek, CEO of Straumann USA, said his company has a sales team dedicated to working with the lab side of the industry that tries to develop a unique approach to meet the specific needs of each lab they work with.

	“Our goal is to recognize the skill, the emphasis, the positioning and the activity of our partners and put together the appropriate relationship,” he said. “We’re always interested in partnering with laboratories, surgeons and general practitioners to help them promote their services to a new audience.”

	The major manufacturers can also help labs find cost efficiencies through their outsourcing services. Killian said when it is more cost effective for his lab to outsource custom abutments they are happy to send cases to a wide range of the custom abutment suppliers including Atlantis, Astra Tech, Biomet 3i and Nobel Biocare.

	Knowing when to send part of a case out can be helpful, but for implant cases to be a profitable part of a lab’s business there needs to be implant cases coming in. Killian said he always looks for ways he can drop prices on implants just a bit and when he can pass a bit of his savings on to his clients he’s sure to let them know.

	One area in which he recently cut his prices was for implant cases with solid abutment crowns. Those cases require less work at the lab, and so Killian decided to price them accordingly. He also dropped all extra implant charges for cases where the clinician orders and places the abutment without involving the lab.

	If a clinician is experienced enough and comfortable with handling that aspect of planning the case and wants to send the lab an impression of the abutment as if it were a standard preparation, then the case is just like a normal crown, and Killian said he bills it that way. For his dentist clients who are looking to save money on their implant cases, Killian said he is happy to help them find the resources they need to take their skills to the necessary level to handle implant cases to that point.

	“In order to stay profitable you have to assume you are getting new business and retaining it. You have to offer money-saving solutions to your clients,” he said. “If they want to get educated, we’ll help them.”

 Implants continue to gain momentum as the treatment of choice for a range of dental situations, so being ready to efficiently and cost effectively handle those cases grows ever more important to a lab’s financial success. While those cases can be complex, there are many simple steps that can be taken to make implants a key profit center for a lab.  It starts with organization

Make it pay: Implants

	So I didn’t get a chance to break away from the dental world to run around the massive tradeshow playground of the Consumer Electronics Show this year. But, like all the rest of the tech and gadget fascinated who didn’t make it to Las Vegas at the beginning of the month I followed religiously along to the coverage around the Internet and I picked up on two big themes of the show; soon everything we watch on a screen will be in 3D and tablet computers are preparing to take over the world.
	
	Tablet computers such as Motorola's Xoom and BlackBerry's PlayBook were the hot item at the 2011 Consumer Electronics Show. As these computer slates hit the market throughout the year, they will give Apple's iPad some competition and consumers choices in what computer format fits them best.

	OK, well maybe that’s a bit of an exaggeration, but CES is a show that tends to serve as a signpost of the consumer technology industry, pointing out the direction development is heading and firmly establishing the trends for gadgets and gear. This year saw progress on creating glasses-free 3D displays, something that seems key to widespread acceptance. But really the news from CES is that the tablet is the form factor where computer and smartphone companies are meeting in the middle, and Apple’s wildly successful iPad will soon face a horde of competitors.

	Tech blog Engadget put together a chart comparing the details revealed about no less than 45 different visions of what a tablet computer could be. Only a handful of those devices are available today, but even among that handful range of tablet concepts is on full display.

	Many companies are betting on a forthcoming generation of Google’s Android operating system, while others are loading up on the desktop version of Windows and still others, including big names in mobile like BlackBerry and HP/Palm are working on their own proprietary operating systems to allow users to put their tablets through their paces.

	And while every major tech company seems to be prepping the launch of a tablet device featuring a touchscreen as the primary interface, the visions of what these devices will look like vary greatly. Many of the devices feature cameras on the front and back for video calling and other purposes. Some have slide out physical keyboards, while others are designed to be docked,with keyboards for desktop use. All of the distinctions show differing views of how people will want to use tablets, but the critical mass is evidence that everyone agrees people want tablets.

	Just why people want them, and what they’re going to do with them might depend a bit on who you ask, but from looking back at adoption of the iPad which is still shy of its first birthday, I think it’s clear people will use them for everything they can. The tablet form factor is great for personal media consumption, especially if that media is video or the web. Smartphones are great for having a Web-connected computer around all the time, but the screens are too small for truly immersive experiences.

	I’m not a big believer in the smaller 7-inch tablets to deliver this same type of experience, but the slightly large 9- to 11-inch models that make up approximately half of the coming gadgets are just right for one person at a time to get lost on the Internet or amazed by video. As ultra-portable media stations, these devices are where it’s at, and for many people that is exactly what they want. These are people who use the Internet to connect with people, play some movies, send some e-mails and wander the Internet. For them a tablet might make more sense than an underpowered netbook, a larger than needed laptop and possibly even a desktop system.

	But what of the people who use their computers for work. For people pushing massive graphics around, the power of a desktop or high-end laptop cannot be matched by any tablet. However, the touchscreen interface tablets afford their uses may be a nice integration for manipulating the graphics. Using a CAD system where you could navigate and manipulate the designs via touchscreen-whether with multi-touch gestures, a stylus or both-sounds like a promising step. There’s little reason to think a tablet computer wouldn’t make a wonderful adjunct to a larger system, and it would be an adjunct you take mobile, and possibly even work from remotely.

	As personal media toys, tablets are a great model, and their work functionality will only continue to grow. With web cameras becoming almost standard, tablets could finally open the doors to widespread video chatting, (something that makes mobile and broadband data carriers alike nervous about their networks being overrun) and these devices may eventually become the window through which people communicate over long distances. It’s certainly something they can excel at, because face it, a tablet is just a big screen and a much better-sized screen than a smartphone’s when it comes to having a two-way video discussion.

	Software, as always will be key, but the processing and graphics power that can be held in one hand will only get better, and while Apple’s App Store has a huge jump on competing operating systems in terms of available programs to run on a tablet, it’s likely all the systems that come to market will wind up with plenty of programs for those looking to use their devices for both business and fun.

	What this all means as far as I’m concerned is that tablets look to be the first major computer form factor innovation since (depending on how you want to count) either the laptop first appeared or at least since the first smartphone showed up. (I lean toward the first of the two since the smartphone was as much a mobile phone innovation at first as it was a computer innovation even though it’s evolved to become more computer than phone.)

	Having not had a chance to play with them first hand, I can’t say which, if any of the tablets on display at CES would be the one to buy, and of course Apple is  likely to announce the second-generation iPad sometime soon. Many critics were impressed with Motorola’s Xoom, and upstart company Notion Ink’s Adam made noise as did BlackBerry with its Playbook. But all of them may be still too early in their development to be ready for heavy lifting. My gadget loving side wants to rush out and buy myself a tablet to use around the house and take with me when I travel, but I’m holding out a generation or two for better processing, better screens, more developed operating systems and mobile data networks that are up to the tasks I’d like to put these devices to work on.

	And what of the other technology I mentioned back at the start of this column? Well 3D screens are something that holds quite a bit of promise. But while the technology has certainly been commercialized already, I don’t believe it is ready for massive use just yet.

	Glasses-based 3D screens are a non-starter for me. I certainly don’t want to wear special glasses every time I sit down at my computer or put a movie on my TV. Achieving high quality glasses-free 3D video will be the real key for making this a technology with widespread use and wide-ranging usefulness. The technology to do this exists today, but as of right now it has major limitations.

	The biggest thing holding back glasses-free 3D screens is that current systems limit the angles at which you can view the screen to experience the 3D effect. Even worse, looking at those screens the wrong way produces blurred images and there have been reports of some people experiencing headaches from trying to make use of these screens.

	Clearly there are a handful of kinks to be worked out. But that isn’t stopping the tide of 3D video capable TVs, monitors and cameras, and it shouldn’t. 3D video offers enormous promise on a number of levels. Sure 3D movies are becoming more common because they bring viewers directly into the world of the film being watched. Live sports in 3D can do the same thing.

	Set to be the first 4G phone on AT&T's network, Motorola's Atrix also marks the first step in a new direction for smartphones. The Android phone works as a standalone smartphone, but is designed to dock with a special laptop body allowing users to use the phone's processor for larger scale computing tasks.

	But what of other uses for 3D video? Surely there is no need for 3D when working in a word document, sending an email or using just about any business software. But when it comes to graphics-centered computer uses such as digital restoration design, 3D may be a wonderful fit. Dental lab CAD systems are already employing 3D graphics on 2D screens. If those graphics were able to come to life outside of that screen in actual 3D, they might be even more user-friendly and interactive in completely new ways. Holographic case design could someday be standard operating procedure on the digital side of the dental lab industry.

	OK, I’m probably getting a bit ahead of myself and everyone else right there. Still, it’s hard not to look at the cutting edge of today’s technologies and try to figure out where they’re headed. Sometimes things you see in the future aren’t as far away as they seem.

	Last year I wrote about how smartphones have become incredibly powerful pocket computers that can soon rival their desk-bound cousins. I imagined a smartphone someday becoming the only computer needed as it could dock into and power other form factors. Well that vision of mine is actually coming to market this year in the form of Motorola’s Atrix 4G.

	This is a smartphone that comes with a laptop dock. Keep it in your pocket and have a powerful Android gadget ready for action. Then when serious writing, or other computing tasks need to get done, the device docks into an 11-inch laptop body to give it a desktop-style interface with a full keyboard. This is one model of future mobile computing that I think makes a lot of sense.

	It also illustrates the importance of keeping an eye on the trends in the technologies we use to communicate and power our workflows. New ways to put consumer-focused technologies to work are popping up all the time. Knowing when these trends have matured and are ready for daily implementation can be a key to avoiding bandwagons to nowhere and latching on to an innovation that can improve the way you work, play and live.

Tech Smart: Breaking down CES from afar

	Despite well-publicized reception issues, more than 1.7 million people purchased Apple's iPhone 4 in the first three days it was available.     

	Getting started on this Tech Smart column has been difficult because I’m finding it hard to pull myself away from the captivating and remarkably crisp screen of my one-day-old iPhone 4.

	I’ve spent quite a bit of time testing out and getting used to the quirks of my brand new smartphone since it arrived in the mail. Thus far it’s living up to all of the hype both good and bad. The screen is amazing, the processor peppy, the tweaked operating system an improvement on it’s predecessor, the battery life far more robust and the stylish external antenna a mixed blessing.

	My initial reaction is that I made a great decision to upgrade from my older model for the latest hardware to be given a spot on the austere tables of the Apple Store. In every way I’ve noticed it’s better than the 3G I’ve carried for the last couple of years, and it has a whole range of new capabilities such as video chats and multi-tasking.

	It’s certainly the state of the art for right now, but right now could be over in a matter of weeks. Something even more powerful and better running with further reaching capabilities will certainly be along soon. In some people’s opinions it’s already here in the form of HTC’s EVO 4G or DROID Incredible or Motorola’s DROID 2 and DROID X.

	But whether it’s smartphones or computers or scanners or mills, buying the latest and greatest still only guarantees a short stay at the cutting edge. Unless you’re financially blessed enough to upgrade everything constantly-and anyone who is so blessed probably didn’t get there by making wasteful purchases-it’s important to make purchases and upgrades when that cutting edge not only takes you to new places, but new places you’ll be comfortable staying at for a while.

	The next generation of every technology is perpetually right around the corner. It’s easy to immediately become unhappy with a purchase because it can’t do something the next device is capable of. Conversely, it’s just as easy to suffer purchasing paralysis by constant over analysis where you never pull the trigger on adopting a new technology because there’s always that newer, better version on the way, and buying now means missing out on that.

	Analyzing yourself and your needs first is the key to avoiding both pitfalls. By looking inward, you can gain an understanding of what your priorities are in terms of technological capabilities and efficiencies to be gained through their use. It is only after you know what needs are not being met that you should take a look around to see if there is a technology ready to assist you.

	So if it’s a CAD/CAM system you’re considering to expand the products you can offer at your lab, or like me, a new smartphone to help keep you connected to work, family, friends and information on multiple levels, it’s crucial to know how the new technology will be put to use before you begin looking at individual devices and systems.

	Once you know what you need, it’s important to look at technologies that will not only address those needs, but will (at least in some areas such as hardware) go well beyond your basic needs. That’s not to say it’s smart to buy technology with functions you will never use, but rather to look for technologies that have room for you to grow into, as well as the potential to grow themselves. Make absolutely sure the new gear will accomplish your key tasks efficiently and effectively. Any additional power or capabilities should be technological overhead that you are basically banking for the future.

	“It’s just as easy to suffer purchasing paralysis by constant over analysis where you never pull the trigger on adopting a new technology because there’s always that newer, better version on the way, and buying now means missing out on that.”

	If you buy a system or a device that is the latest thing out and you use every bit of the processing power and other hardware capabilities, your investment will essentially be a time capsule to the moment it was purchased, and as I already said it soon will be outdated. Of course hardware can be updated, but rarely without a significant new investment.

	On the other hand software updates are sometimes free and usually less expensive when they do have a cost. New software can make a system or a device seem brand new all over again, as it often unlocks some of the untapped hardware potential. When researching technology purchases, look into how often a system receives software updates, whether there is usually a cost for them and how substantial they tend to be.

	Software updates made my iPhone 3G a more valuable device during it’s two years of service, and based on Apple’s track record with these things, I expect my new iPhone 4 to be similarly upgraded during the years of service I have planned for it.

	I know Apple is on track to put out a new iPhone each year, but I plan to sit on the sidelines for the next few rounds. I have yet to find tasks I use my smartphone to accomplish that this one does not do, and what it does it does amazingly quickly. I bought this one confident that it is more than capable of doing what I need for more than the two-year lifespan of my mandatory AT&T contract.

	With my research done and my internal needs assessed, I am confident in my technology investment and am excited to watch my new smartphone plow through all the tasks I call on it to do. Sure I know my current one might no longer be the latest and greatest even by the time you’re reading these words, but I have no worries that it will fail to meet my needs during the lifespan I have planned for it.

	Now the only question I have left about my decision to go with the iPhone 4 is where to find a decent case to ameliorate those pesky antenna issues and protect this thing from the inevitable accidental drop or two it’s sure to be subjected to.

Noah Levine writes the monthly Tech Smart column on consumer electronics for Dental Lab Products. Contact him at 

 Despite well-publicized reception issues, more than 1.7 million people purchased Apple's iPhone 4 in the first three days it was available.       Getting started on this Tech Smart column has been difficult because I’m finding it hard to pull myself away from the captivating and remarkably crisp screen of my one-day-old iPhone 4.

Avoiding electronics envy

	Designed for high barrier protection, all S3 face masks are 

greater than 99% Bacteria (BFE) and Particle filtration efficiency (PFE)

 at 0.1 micron, providing peace of mind for all dental procedures.
	
	The filter offers 

 without unpleasant moisture build up.  
	
	The Quad-fold design provides 

Enriched and micro-coated with Active Aloe, Vitamins C and E

, these face masks moisturize and nourish while providing protection, and also are available in Cucumber coated and scented or Mint scented.
	
	The proprietary CoolSilk™ inner layer is 

free of lint, latex and chemical so it prevents itchy irritation

   Designed for high barrier protection, all S3 face masks are greater than 99% Bacteria (BFE) and Particle filtration efficiency (PFE) at 0.1 micron, providing peace of mind for all dental procedures.  The filter offers excellent breathability without unpleasant moisture build up.    The Quad-fold design provides 15% more breathing volume with a customizable fit.

Comfort, protection and breathability

	Sometimes great ideas are just sitting out there waiting to happen. For William Provancher, an assistant professor of mechanical engineering at the University of Utah, inspiration struck while he was watching a TV special about consummate Renaissance figure Leonardo Da Vinci.

	On screen the actor playing Leonardo was working on a painting with his hand supported by a simple device known as a maulstick. Basically a stick with cloth-covered balls on its ends that is used to support the hand during the painting of fine details, Provancher saw the maulstick as a technology ripe for an update.

	“People who have their hands out and up for extended periods of time experience a tremendous amount of fatigue,” he said. “Wouldn’t it be nice to have a local support for your hand that allows you to be able to do things precisely, but to have the ability to have that support wherever you wanted it to be?”

	Enter the Active Handrest, a computer-controlled motorized support that uses sensors to follow the users’ wrist movements to provide constant support. While still in development and currently limited to providing support along a two-dimensional plane, Provancher’s technology expands on the historical technology by allowing the support to stay constant even as it moves around the work area.

	The prototype machine has been put through a series of tests comparing the performance of users tracing circles with the aid of the Handrest with the performance of the same people tracing freehand, as well as with other fixed supports. Provancher said he’s been pleased by the results but will continue evaluating and improving this technology.

	“We find that people are performing more precisely when they’re aided by the Active Handrest,” he said. “however, I want to look more closely at the time-performance trade-offs of the device before we progress too much farther. That said, I feel pretty strongly about the results that we have so far.”

Further developments before commercialization

	At this point, Provancher said he feels there will definitely be commercial applications for the technology, although he is still unsure what field will drive the device’s initial commercialization.

	The two-dimensional prototype could lend itself to assisting with pick-and-place tasks such as detailed work on circuit boards, wrist rehabilitation, surgery, or painting, but Provancher sees a wider set of applications with further development of the technology.

	“One of the more challenging and compelling device improvements we are currently working on is to augment the current device to allow it to move in three dimensions. This will allow our technology to extend to a larger variety of applications,” Provancher explained.

	Support in three dimensions would allow the device to be more flexible in how it could be used in far more real world settings, and Provancher said he hopes to be able to extend this technology to the point where it senses the user’s hand movements in all directions and reacts to reposition the support to wherever the hand happens to go whether that is left, right, up, down or any combination. This extension to the planar Active Handrest will allow for general spatial motion while supporting the user’s hand, and would make the device useful for tasks such as sculpting detailed structures.

	“This type of general 3-D spatial motion and support is the same exact need that someone in a dental lab would have,” Provancher noted.

	While the commercial potential of this technology is apparent, Provancher plans to continue its development in his academic setting for the time being. He is set on refining the functionality and expanding the scope and capabilities of the Handrest, but is keeping an eye out for a potential partner who might help him bring his device to professionals who could benefit from its active support.

	“The first place that I would see this would come into application would be in the medical/dental field where there’s demand for this type of high-end performance,” he said. “In the meantime we’re looking for application partners.”

	For more information on the Active Handrest, visit Provancher's lab

 Sometimes great ideas are just sitting out there waiting to happen. For William Provancher, an assistant professor of mechanical engineering at the University of Utah, inspiration struck while he was watching a TV special about consummate Renaissance figure Leonardo Da Vinci.

Support for active hands

	The lower radiation output is among the regularly touted benefits of digital radiography, but the safety benefits for both patient and clinician do not yet make this technology foolproof and risk free.

	Whether using digital or film-based radiography, the routine for taking dental x-rays is pretty well established. The patient is given a protective apron, the sensor or film is placed, the x-ray is aimed, the clinician leaves the room and the image is captured. So it should follow that with greater adoption of digital radiographs, radiation exposure in dental offices should be on the decline, but according to Paul Maurer, President of radiation badge provider IC Care, that is not the case.

	“We have seen a gradual increase in dose throughout the digital era. It’s something that’s really horrible,” he said.

	Much like a game of Telephone where a phrase gets distorted as it’s passed from person to person, Maurer said the idea of digital radiography as a safer technology can sometimes be misconstrued to the point where it is thought of as a “safe” technology instead. Because of the lower doses, some clinicians may be shooting more images than are actually necessary, he added. This means more exposure for the patient, and more risk to the clinician as well.

	While the typical occupational radiation dose is just 3 to 4 millirems a month, Maurer said he’s seen instances where clinicians have been exposed to extremely high doses due to misuse of the technology. In one case after switching to digital radiography a woman began regularly taking four to five images per patient while standing in the room with the x-ray unit and her monthly reading shot up to more than 5,000 millirems.

	“I would expect that Homer Simpson, doing his job the way he does it, would get 5,000 a year, but this gal got 5,000 in one month,” he said.

	Exposure such as that is the extreme, but it underscores the importance of properly and safely using all technologies that involve radiation risks. The principle of ALARA, or As Low As Reasonably Achievable, should always be the basic guideline for exposing patients and staff to radiation and Maurer said the technology should only be used when there are clear benefits from the information it provides.

	Typically this means a patient is only occasionally exposed to radiation, but when it comes to the clinicians there are numerous instances each day when the technology may be called for and thus more regular exposure could be common. The extent of this exposure can be monitored via a dosimeter badge, and now the information those monitors provide can be put to use faster and more effectively.

	“It’s not OK to say my machine doesn’t deliver as much radiation so I don’t need to be cautious,” he said. “It’s the combination of the machine and how you operate the machine. The only way to know if that combination is correct and the only way to get those two things as low as reasonably achievable is by using badges.”

 launched Instadose™, a dosimeter that provides instant radiation exposure data when its USB plug is connected to a computer with Internet access. Quantum Products President Sander Perle said the instant access to exposure results is a huge improvement over traditional dosimeter badge monitoring where the badges must be sent back to their source for processing and results may not be known for up to three months after possible radiation exposure.

	“If you read it once a week you are going to identify if there is any issue,” added Quantum Products Vice President of Sales Lou Biacchi.

	Relying on direct ion storage technology, the Instadose badge is actually more sensitive to radiation and thus can track and report exposure to lower doses of radiation than traditional badges. If everything is done correctly during a typical dental x-ray even the Instadose badge should not show any exposure, but Biacchi said a clinician could use the system to check right away if he or she felt anything went wrong during a radiographic procedure.

	IC Care distributes the Instadose dosimeters from Quantum Products and is marketing service with the devices under the name RAD-Badge™. Maurer said the instant results are a great way to make the radiation monitoring process a more interactive and involved experience for clinicians. Badging employees and tracking exposure can also reduce some office liability, he added.

	“Now you have control. Now there’s greater compliance,” he said. “We think the industry is going to accept this better than they do with standard badges.”

	Perle, Biacchi and Maurer all agreed on one specific area where the speed of the results and the ability to instantly pull up personal reports of radiation exposure from a specific time period can be extremely valuable in a dental practice. Many of the people snapping dental x-rays are women of childbearing age and if they are pregnant, they might not learn this until a month or more after conception. With Instadose this clinician could pull up a report to see exactly how much or little radiation exposure has been experienced since the start of that pregnancy.

	Another advantage of instant results and easy to track exposures during specific periods of time is the ability to use the data to optimize the safety of procedures in a practice. While a single, safely performed x-ray might not create a measurable reading, Maurer said a clinician could track different exposure levels by spending a day or a week performing one x-ray protocol and then comparing those results with the same period of time spent with a different protocol.

	“You’ll know what the difference is, therefore you will inherently develop a much safer operating procedure,” he said while noting that exposure decreases exponentially the further a clinician can be from the radiation source.

	With the different color options available for the Instadose, it is easier for clinicians to make sure they are wearing the badge they have been assigned. However, the badges themselves know what online account they are connected to, and because those accounts are password protected, it is difficult for exposure results to be assigned to the wrong clinician. However, Biacchi said data could be reassigned to a different clinician in an event where someone does accidentally wear the wrong badge for a day or a week.

	Another use for the instant results from USB badges could be putting patients’ minds at ease. It’s possible for a practice to order a badge and have it assigned for use by patients with a reading taken at every appointment to show the patients how low the radiation levels they have been exposed to really are. However, Biacchi said if a practice were to do this, it would need to find a good place on the patient to clip the badge, and have a good way of quickly teaching a patient how to understand the Instadose results.

	“You could put this on the patient to give them a sense they didn’t get much of a dose, but you would have to educate them on what the numbers mean,” he said.

	While that may be taking the technology a step beyond its original purpose, optimizing procedures for clinician safety and tracking the impact of technologies involving radiation exposure on the clinicians using those systems does provide benefits for the patients as well. The instant results mean malfunctioning machines can be discovered more quickly and clinicians can be more comfortable with the piece of mind from having the data accessible whenever they want to check it.

	“If the practitioner is doing what’s best for the them, they’re probably doing what’s best for the patient,” Maurer said.

 The lower radiation output is among the regularly touted benefits of digital radiography, but the safety benefits for both patient and clinician do not yet make this technology foolproof and risk free.

Staying safe in a safer environment

	Speed and capacity are not common considerations when people think about utility services such as gas, water, electricity and even phone lines.

	All of these services are critical to both homes and businesses, and of course people look for ways to reduce their monthly bills through efficient and judicious use of these resources. However, it’s doubtful that you or anyone you know has turned on an electric or gas appliance, or picked up the phone and cursed at the slow speed of the gas, electricity or phone connection.

	OK, some places have insufficient water pressure, making it slow to arrive, but for the most part all of these services are reliable in terms of providing the amount of the resource you require when you require it. Furthermore, because they are almost universally metered services for which your bill is based on the amount of gas, electricity, water or phone use carried through the wires or pipes, getting cut off for overuse is not a concern.

 Speed and capacity are not common considerations when people think about utility services such as gas, water, electricity and even phone lines.  All of these services are critical to both homes and businesses, and of course people look for ways to reduce their monthly bills through efficient and judicious use of these resources. However, it’s doubtful that you or anyone you know has turned on an electric or gas appliance, or picked up the phone and cursed at the slow speed of the gas, electricity or phone connection.