Noah Levine

There may be a “cool factor” that gets some people excited about new technologies, but CAD/CAM systems are business tools designed to make dental labs more efficient and productive.

Taking something once done physically and moving it into a virtual environment can offer practical benefits to many labs. But if you aren’t marketing around your new capabilities and efficiencies, you’re not going to be maximizing your investment.

Terry Fine, Vice President of Sales and Marketing at AMG Creative Inc., said dental labs’ marketing efforts need to articulate the benefits their business can bring to their current and potential clients. While this is true for marketing all of a lab’s services, CAD/CAM investments provide labs with a great message to bring to the marketplace.

“Around CAD/CAM there’s the opportunity to message it a little differently with the fact that the lab is making investments in technology to streamline processes and deliver a better, more cost effective restoration,” Fine said. “You have the opportunity to promote your brand as an innovative cutting edge laboratory and I think that’s an important message.”

When a lab launches a new material or a new restoration type, they certainly want to get the word out to current clients. However, when a lab makes an investment in technology that can open a range of doors as it has a completely different story to tell, Fine said.

With CAD/CAM technology, labs should be talking about not just the latest product or material, but the increased production efficiency realized via their technology investments. Fine said the key is to help dentists understand how the technology can benefit the clinicians and their patients via faster, lower-cost production and increased restoration accuracy.

Labs should let their current accounts know about new technologies via newsletters and case-stuffers that go out with every restoration shipped. However, a one-on-one approach can be even more important. Don’t hesitate to pick up the phone or get out of the lab to bring the news directly to your most important accounts, Fine said. Of course the timing of these outreach efforts is critical. Whether it’s a full-system or a scanner-which Fine said is an investment that makes sense for even small labs-mastering the new technology must be done before you can start selling what it can do for your customers.

“The worst mistake you could make is introducing that product to your marketplace before you’re truly ready or able to deliver a quality product,” Fine said. “You get one chance to make a first impression. If you deliver something to the marketplace before it’s ready it’s going to have severe ramifications for a long time.”

Setting yourself up as a cutting edge operation is only part of the equation. If they think of you solely as someone clicking computer buttons, your products become commodities that someone else might be able to produce at a lower cost, Fine said. To avoid this, it’s important to focus marketing efforts on how your lab’s investment in technology enhances what you already do well.

“You’re streamlining but you’re improving the quality and you’re improving the final product that’s being delivered, and you’re able to do it more cost effectively,” he said. “The end result is they’re getting a better product for less.”

For dentists who view their lab as a commodity provider, lower cost will be an appealing message, but not all competition is about price. Fine said that whether a lab is marketing CAD/CAM or any other product or service, the message must speak to more than just price and communicate the role you play in working with the dentist to produce the best possible restoration.

“If you’re not doing that, at the end of the day you’re just a vendor and it’s easy to switch vendors; it’s much more difficult to find another partner,” he said.

When you’ve established your role as a valuable partner, you are in position to help your doctors find new products that provide improved patient outcomes while benefiting the bottom line for both practice and lab.

An investment in CAD/CAM technology allows labs to offer all-ceramic restorations, which often can be produced with a higher profit margin. Fine said any business would want to focus on shifting customers from lower profit products to ones that bring in a higher return. Therefore, dental labs should be making the case when they can offer an option that is better for everyone.

“The labs really should be getting the doctors off metal,” Fine said. “Every PFM case that goes out your door should have a case-stuffer that ties in a new all-ceramic option.”

Explaining that in many cases insurance companies are reimbursing at a higher rate for all-ceramic crowns than for PFMs can move some clinicians, but it’s important marketing efforts go beyond cost savings. Fine said labs can promote the way increased accuracy and fit of milled restorations can save a clinician chairtime at seating appointments. Including clinical studies showing benefits of all-ceramic restorations can be a good idea as well.

Not every doctor will be swayed to make a switch right away, and some might never glance at a case-stuffer. For those accounts Fine recommends a more personal approach. As with all marketing efforts, marketing around CAD/CAM comes down to understanding the audience and tailoring a message to appeal to their wants.

“If you can really look at that doctor’s practice and understand his hesitation to all-ceramics and address them directly, you have a great chance of him switching,” Fine said.

CAD/CAM marketing can be done in the same ways labs have always reached out to dentists. Fine recommends repeating the message in newsletters, case-stuffers and if a lab has a sales staff, in sell sheets they can leave behind. It’s important to keep your messages simple and targeted as too much text can obscure the point you are making that your investment provides direct benefits for your dentists.

Because all marketing is really about communication, Fine said the personal approach always should be a part of your efforts. Check in with your top accounts, and after you share the exciting news about your new technology, take the time to listen and answer questions they may have.

“I think so much of it comes back to the relationship you have with the doctor,” Fine said.

Regular communication with your top accounts can help you determine when you need to invest in something new to keep their business, and just as importantly, how to approach them to share the news that you’ve made a new investment.

Knowing your accounts also can help you determine how to promote new products you can offer via assistance from an outsource partner. Some accounts trust you and expect if you’ve partnered with someone they are going to provide the quality you’ve always delivered, while others will want to know more about anyone new you work with. Fine said you can market a product produced with help from an outsourcer, but you need to be sure the dentists you send those restorations to are provided with the information they expect.

“On an outsource basis domestically, I don’t think it’s that important to tell every client about your parts supplier, but when you talk outsource offshore, it’s a whole different equation,” Fine added.

Marketing around the advantages of your new technology investment is important to maximizing your use of the new capabilities, and reaching out to existing accounts will be critical to that success. Still, your investment might make your lab a good fit for new accounts as well.

If your investment means you can accept digital impressions captured chairside, you will want to inform current accounts with compatible technologies. Reaching out to potential new accounts with those technologies also can benefit your business, and Fine said getting involved with local study clubs and talking with your accounts about the technologies they’ve invested in can help you find the right targets for your marketing efforts.

When you are comfortable with and confident in your new technology, it’s easier to sell the capabilities to existing and potential customers. Knowing that your investment brings benefits to those customers and communicating those benefits can lead to success and help make sure your lab’s investment provides the returns you planned on.

“You need to make sure the technology platform that you’re promoting is the right one for your laboratory and most importantly for your customers,” Fine said.

Articles

There may be a “cool factor” that gets some people excited about new technologies, but CAD/CAM systems are business tools designed to make dental labs more efficient and productive. Taking something once done physically and moving it into a virtual environment can offer practical benefits to many labs. But if you aren’t marketing around your new capabilities and efficiencies, you’re not going to be maximizing your investment.

Marketing High Technology

	While Mark Jackson, RDT, and Precision Ceramics Dental Laboratory try to stay on the cutting edge of the materials currently available in the dental industry, he’s always keeping an eye on the latest developments in technologies from other industries.

	There are four areas that he sees developing the keys to the industry’s future; Genetics, Information, Robotics and Nanotechnology, which he sums up with the handy abbreviation GRIN.

	“Those are the four areas that are growing super quickly and are affecting medial device manufacturing like crazy,” he said.

	While he isn’t convinced genetic research will lead to patients being able to regrow entire teeth, he does see the development of biological implants that will be a bone graft of sorts that is then traditionally prepped and still requires a crown. Key developments the area of robotics set to impact dental labs will come in the form of ever more accurate, efficient and self-reliant, high-capacity milling technologies, Jackson said.

	“Robots with arms and legs will not be walking around the laboratory,” he added with a laugh.

	Still enhanced automation and CAM production will be key developments, as will new methods of information transfer. Digital file exchanges are already a part of today’s dental industry, and Jackson said this looks to continue to spread with remote design capabilities and long-distance collaboration already available.

	“Our labor isn’t going to be hands on labor, now it’s going to be intellectual labor,” he said.

	The final development Jackson is watching closely comes in the form of new nanotechnology-derived resins. This area of technology is likely to produce new resin infiltrated ceramics that blur the lines between how resins and ceramics are currently used, and eventually may blur the lines between ceramics and enamel.

	The timeframe for these technologies to hit the market is certainly not clear, but Jackson said he wants to make sure he and his lab are at the leading edge. In order to stay there he plans to carefully monitor every development throughout the GRIN.

 While Mark Jackson, RDT, and Precision Ceramics Dental Laboratory try to stay on the cutting edge of the materials currently available in the dental industry, he’s always keeping an eye on the latest developments in technologies from other industries.

Watching the GRIN

	Diagnostic imaging-especially the stunning 3-dimensional pictures provided by cone beam computed tomography (CBCT) scans-offers incomparable advantages to dentists planning and delivering a wide range of treatments, but the scans do involve exposing patients to small but not-insignificant amounts of radiation.

	X-rays have been common in medicine and dentistry for many years and CT scans of one variety or another have become far more common in recent years. However, a recent string of news reports such as the New York Times series “The Radiation Boom” have raised public concern about the risks and misuse of the technology in medical settings.

	While the rewards of properly used CBCT technology certainly outweigh the risks, it is important for clinicians to only use them when the information provided is key to the case being treated and to use them in a way that limits patient exposure to radiation as much as possible. Clinicians also need to be prepared to explain to their patients why the scan is needed and how the radiation exposure is being limited.

	“There has to be risk within reason. The dose is low, but there has to be a need,” said Dr. Allan G. Farman, President of the American Academy of Oral and Maxillofacial Radiology (AAOMR).

	CBCT systems emit a cone-shaped beam of radiation at the targeted area. The beam is circled around the target with a receptor on the other side ready to receive beam. Dr. Bruce Howerton, a specialist in Oral and Maxillofacial Radiology and expert in CBCT who runs Carolina OMF Imaging, explained that CBCT is very different than medical CT scans where a thin “fan” beam of radiation is used to scan the patient and a larger tissue volume often is exposed to capture the necessary information to create a useful diagnostic image dataset.

	“Whereas with cone beam computed tomography, all the radiation emitted to the source, is captured by the receptor, therefore not as much radiation is required,” he said.

	In terms of how much radiation is required for a typical CBCT scan, Dr. Howerton said it is the equivalent to the exposure required to take three to four dental panoramic images. To explain this in terms patients might understand, Dr. Howerton said one CBCT scan exposes the subject to approximately four days worth of the background radiation people experience every day from the sun, cell phones and other radiation emitting technologies and materials.

	Knowing those basics can be helpful, but Dr. Farman said it is important to realize that not all CBCT systems are the same in terms of the radiation they use. He said it is important to look at the newer system generations as many of them use lower radiation doses, and this can be limited even more by using a system that allows the beam to be suitably collimated.

	“While it is the truth that with most cone beam CT systems one can reduce the dose by at least one order of magnitude in comparison with medical multi-slice CT, and even further than that to maybe two orders of magnitude with some of the limited area cone beam CT systems, some of the earlier machines were relatively high dose,” he said.

	While the dose is smaller than a typical medical multislice CT scan, CBCT should still be used only for cases where the information from the scan volume will benefit the patient. Dr. Farman said this concept should apply to all dental imaging, not just CBCT. The key is to take an image with a specific use in mind rather than taking a 3D scan of a patient just so there is a 3D record of that patient’s oral anatomy on file.

	“That would be like taking radiographs of your feet every time you buy a pair of shoes. It doesn’t make any sense,” Dr. Farman said. “I would say, having read radiographic volumes that have been sent to me, that some practitioners are indeed taking more radiographs than they need to, and when I make reports, I tell them that.”

	The AAOMR is currently working with the American Association of Endodontists and the American Association of Orthodontists to develop position papers and guidelines on proper use of CBCT scans in dentistry. Dr. Farman hopes the guidelines will be ready by the fall because they should help clear up questions from dentists about whether they are using their CBCT systems appropriately.

	While some diagnostic situations are ideal for the scans, other cases are as yet ambiguous. Dr. Farman said CBCT scans should be the standard of care for implant cases both because of their benefits to treatment planning and because the implant patient population tends to be older, and thus the risks from radiation exposure are reduced. However, when it comes to orthodontic patients who tend to be younger, the risks can be much greater, and 3D imaging selection criteria guidelines could greatly benefit dentists using the technology.

	“We would like to have better evidence that CBCT images are necessary when we are increasing the dose in a patient population which is highly sensitive to radiation,” he said. “For sure in those cases where one really didn’t need a two-dimensional image, one certainly doesn’t need a three-dimensional image. No radiographs should be made merely as a routine.”

	Knowing the clinical reasons why a CBCT scan is needed is important, but knowing how to explain those reasons to a patient can be just as critical. Dr. Howerton said clinicians should follow the ALARA or As Low As Reasonably Achievable principle when it comes to the radiation doses being used and that should be explained to patients and referring practitioners.

	While patients should be informed that there is some radiation exposure, it can be very helpful to be able to explain to them all the ways the exposure and risks are being limited. This means lead aprons and when appropriate thyroid collars should be used, and staff should wear dosimeter badges to track their cumulative exposure.

	It also is important to make sure the CBCT system is working properly. It is quite possible that a patient might ask when the machine was last serviced; so being ready with an answer can be helpful. Calibration should be conducted per the manufacturer’s recommendation and differs machine to machine, but is likely to be around once a week. Similarly, regulations on the systems differ from state to state. It is absolutely critical to service a machine if any problem arises, and the system should not be used while it is waiting to be serviced.

	“If there’s any problem with the machine the images will not look similar to images that have been seen in the past,” Dr. Howerton said.

	Patients should be given a clear reason for the scan and made comfortable about the safety of the procedure. Both Drs. Howerton and Farman said it is important for CBCT technology not to be overused or scans to be conducted as “fishing expeditions” looking for general problems. However, there may be times when the scan captures more anatomy than the dentist intended, or the scan volume contains pathologies that the dentist does not recognize. In those cases, it is to the patient’s benefit to have all the data examined by an expert.

	“Certainly there is anatomy captured in this data that can be outside the maxilla or the mandible,” Dr. Howerton said. “If a dentist captures data that they are not sure about or not familiar with, it is very easy and inexpensive to have the data analyzed by an oral maxillofacial radiologist.”

	The potential benefits of CBCT scans often outweigh the risks, but that is not true in every case. Dentists using the systems need to be aware of how they work, and be ready to explain both the rewards and the risks to patients who will be scanned. With 3D imaging technology-like all dental technology-there must be a clear benefit to the patient before it is put into use.

	“Cone beam computed tomography is changing how dentistry is performed in that it allows the dentist to see anatomy in three dimensions that practitioners have not been able to see in the past, but it is a modality that should be used only to capture information that is going to help the patient,” Dr. Howerton said.

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

 Diagnostic imaging-especially the stunning 3-dimensional pictures provided by cone beam computed tomography (CBCT) scans-offers incomparable advantages to dentists planning and delivering a wide range of treatments, but the scans do involve exposing patients to small but not-insignificant amounts of radiation.

Am I glowing yet?

	There’s always a lot to see while walking the crowded confines of the Lab Day exhibit hall and last month’s show in Chicago didn’t disappoint with companies of all sizes showing off their latest products of both low and high tech varieties. But it should come as no surprise that my gaze was often drawn to the computer-powered end of the spectrum where I was not disappointed by the latest in CAD/CAM scanners, mills, printers and software.

	While checking out the new capabilities of all of these dental-lab specific technologies, I couldn’t help but notice a few brand names that in the past would have been much more likely to be found at the local Best Buy rather than on the show floor at one of the largest dental lab events around. But there they were.

	The crowds gathered around to see a live demonstration of 

’s Digital Partial Design Station were watching the 3D CAD process taking place on an interactive pen display from 

, a company known as a leader in interactive computer input devices often found in graphic design and photo processing firms. Then, down another aisle there was a new large-scale mill from 

 iPad serving as a removable touchscreen control.

	The integration of these consumer grade technologies into dental laboratory applications should come as no surprise. When considered as an industry, the dental lab business is rather small in scale with a specific focus. So rather than spend precious R&D resources developing interface and control technologies, it makes sense for companies creating high tech dental lab systems to adapt something “off the shelf.”

	This seems like a trend that is likely to continue, and may even expand. It’s definitely a trend that can benefit everyone involved. Companies developing new technologies and systems can bring breakthroughs in scanning and dental restoration design to market faster if the way users will interact with those systems doesn’t need to be reinvented along the way. This also decreases the cost of the systems. Users of these technologies can pick up and run with them, because there is less to learn along the way.

	This also brings up the possibility of having one device control all of the technology in the lab. Just as consumer electronics companies are developing integrated technologies for the home that will allow centralized and mobile control over lights, heat settings, appliances and even TV channels, it seems perfectly feasible for a lab to have one control panel that can send commands to a scanner, a mill, a printer, a furnace and even light, air and gas controls at the workbench.

	All the technology capable of to doing this is already here today; it’s really just a matter of integration. In some cases that integration will need to come from the top down. Until a piece of lab technology has some kind of wired, Wi-Fi or even Bluetooth connectivity, controlling it from a central device is not possible. For other systems applying a common interface may not work completely. The Wacom display used by CadBlu might be able to work with a number of systems out of the box, but for it to really work it’s magic completely, the software it’s controlling needs to be optimized for the interface.

	However, there are backdoors to letting one device such as an iPad take control of existing systems that are powered by computers. Applications such as LogMeIn and GoToMyPC allow an iPad or a laptop to remotely control the screen of any computer, providing access from anywhere. This remote access seems like an ideal use for a tablet such as the iPad, and while the device might not have the processing power for high intensity CAD applications, the magic of these programs is that the iPad is just providing an interface and the computer being controlled remotely is doing the heavy lifting.

	And of course the iPad is already growing more powerful. The just- launched iPad2 is designed to handle processor intensive tasks like editing movie files and programming digital audio. CAD tasks are probably just a few generations away. It really makes sense for the companies creating these systems to look for ways to integrate devices like this with their technology, especially if the start of the digital dental process moves more and more chairside via digital impressions. Then it’s just a matter of designing software as a pass-through to shape that data from an impression to a restoration design exported to a mill or printer that also can be controlled from the same device.

	Suddenly running a digital lab can be done from anywhere with access to the Internet. A powerful enough iPad or similar touchscreen tablet could handle everything from dentist-technician communication, managing the flow of patient data, running CAD software for restoration design, managing the production technology for manufacturing those designs and even provide a window into the physical lab environment via remote webcam.

	There will always be physical aspects to these processes because robots to load materials and tools into a mill, finish the CAM-produced restorations or package and ship them to dentists are not forthcoming any time soon. But the days when a lab’s digital work can be managed and completed from one device are not all that far off. And because that device will be off the shelf consumer technology, if you do have to take your work home with you, it takes just a few taps on the screen to switch from checking your records, managing your mill and communicating with you your accounts to blowing off a bit of steam by flinging around a few Angry Birds.

 There’s always a lot to see while walking the crowded confines of the Lab Day exhibit hall and last month’s show in Chicago didn’t disappoint with companies of all sizes showing off their latest products of both low and high tech varieties. But it should come as no surprise that my gaze was often drawn to the computer-powered end of the spectrum where I was not disappointed by the latest in CAD/CAM scanners, mills, printers and software.

Crossover appeal

	When hygienist Nikki Hayes called out “You guys have all gotta get down here and see this,” over the headset intercom system used by the staff at DPR Technology Editor Dr. John Flucke’s Lee’s Summit, Mo. practice, it sent everyone running. What they saw did not disappoint.

	This was back in April, and Hayes had just captured the practice’s first image with the at the time still pre-release 

 GXS-700 intraoral sensor. In fact because Dr. Flucke’s practice was the first in the world to get the new sensor for everyday use, this was actually the first digital radiograph the sensor captured in a truly clinical environment. The result made quite an impression on Dr. Flucke and his not-so-easily impressed staff.

	“It was just an amazing image. Just phenomenal,” he said. “We get a chance to try out and play with a lot of stuff in my office. My staff sometimes is not so wowed about some things that maybe might wow another staff, but the images that come off these sensors are eye opening. From resolution to the sharpness of the image to the delineations, you could see it was definitely game changing.”

	But this story begins long before this past spring, and it doesn’t start in Lee’s Summit. The GXS-700, which represents the 8th generation intraoral sensors from Gendex, was close to five years in the making, and its creation came about through the work of a number of teams located around the globe.

	There wasn’t a long break between the 2005 launch of Gendex’s 7th generation sensor, the eHD, and the start of work creating the GXS-700 sensor. Gendex Product Manager Filippo Impieri, who oversaw the project, said it all got underway after the company conducted a worldwide campaign of talking to Gendex customers, clinicians using digital sensors from other companies and clinicians using film x-rays to discuss what improvements they would find most useful.

	This information, referred to by Impieri as the Voice of the Customer or VOC, was used to define the project goals from the very beginning. Topping this customer-based wishlist was better image quality from a sensor that would work in a variety of settings and with a variety of x-ray systems.

	“For us, one of the key criteria with the new sensor development was being able to introduce in the market a level of image quality that was really top notch,” he said. “We have been working really hard from a technology standpoint to not only improve the resolution quality, but also the consistency of the image quality we can deliver.”

	But image quality wasn’t the only improvement customers were looking for, and improving on both the ergonomics and patient comfort was placed as the second priority in the new sensor design. The third major goal of the project was to improve the sensor’s portability and streamline its workflow by creating a direct USB connection between the sensor and computer with no exterior box or interface needed.

	Setting these goals is what Gendex Director of Operations Chris Koeppen called “Toll Gate One” the first major step of Gendex’s product development. The engineering team takes the lead, but once they’ve passed this stage Koeppen and his manufacturing and procurement teams get involved and stay closely tied to things to make sure the engineers’ concepts are feasible for large-scale production. Other parts of Gendex and its parent company’s other dental imaging organizations’ product development teams also are deeply involved throughout the process.

	“In all of our new product development programs, we kind of have a multi-headed monster that governs the process all the way through,” he said. “When it comes to taking this sensor to market cross functionally, our procurement operations group was involved very early.”

	Keeping various disciplinary teams involved helped the entire operation avoid problems because if one team hits a snag, another team often has an idea in waiting that provides a solution. Koeppen said the depths of the company’s resources are invaluable on a project with such a global vision and such lofty design goals, and it felt great to be a part of that process.

	“At the end of the day, we delivered on what we all signed up for at TG2 when we resourced the project,” he said.

	There were no real singular breakthroughs or eureka moments, but Impieri said experience designing the previous generation of Gendex sensors was important in guiding the GXS-700 project, and a clinical advisory team helped provide perspective along the way. He described the process as a steady march toward the established targets, and it’s been exciting to have achieved the three main objectives with a sensor he feels sets a new standard for the industry.

	“The product that we specced out at the end of our VOC is actually remarkably similar to what we actually have been able to deliver to the market,” he said.

	Working on all three goals simultaneously meant all the developments needed to be coordinated so they could all fit together in the same final sensor design. Adjustments to the case design could have great impact on the engineering work for the USB connection, but through it all, image quality was kept as the top priority.

	“We would not compromise anything for image quality,” Impieri said.

	The technological enhancements they worked toward focused on not only achieving the high image quality, but on making that quality reliable as well. The sensor had to not only capture great images under optimal conditions, but also work great for clinicians regardless of the x-ray system it’s paired with or the way that system is set up.

	Those efforts seem to have paid off with the GXS-700 capable of up to 2.4-megapixel images with more than 20 visible line pairs per millimeter and a pixel size of 19.5 microns. The company focused on using the latest in CMOS sensors and refining the algorithms that process the captured x-ray data to create the sensor capable of producing radiographs crisp enough to wow Dr. Flucke and his staff.

	“I think the combination of a complete, custom redesign for both the hardware and the software sensor components was extremely important for us to achieve a really high level of diagnostic results,” Impieri said.

	While looking at improving the ergonomics and patient comfort of the sensor, Impieri said his team explored a range of physical designs. Working with a fast prototyping company to produce workable models, ongoing blind tests were conducted to optimize the housing design in terms of both patient comfort and ease of positioning for the clinician.

	Plenty of plastic materials were studied to find the right choice to stand up to the mechanical stresses intraoral sensors must face, and it had to be able to be closed completely to protect the electronic components during sterilization. Still, the material had to feel right to both the patient and the clinician.

	Any time a new material or new piece of the sensor was considered, it sent Koeppen and his team back to work determining the logistical implications of this new part being included in the final version. It was important for him to make sure everything stayed on schedule and lived up to the company’s standards.

	“When we anticipate changes, we’re side by side with engineers, checking lead times, working to leverage not only our internal resources but across our whole supply chain, as well as across our parent company to make sure we pull out all the stops to hit project timing and project quality,” he said.

	Impieri recalls that after the design was close to ready and a working unit was put into a real clinical setting, the clinician was asked to swap the sensor he was using for a GXS-700 prototype in the middle of taking a full mouth series. He knew they had reached a goal when the patient immediately commented on the new sensor’s enhanced comfort.

	“That was a great moment, because after all of our blind testing and everything we tried during the development, we could see the results right there in a clinical environment, and it was great,” he said.

	When it came to developing the direct USB connection, it was all about minimizing the electronic components the sensor required so they would all fit on the back, and Impieri said a big R&D push in this area was among the first things they did when undertaking the project.

	Once the engineering and design was good to go, it was time for all of the resources Koeppen and his team had lined up to be put into action. He needed to be ready to meet whatever demand was generated by the engineering team’s developments. With this sensor he felt it would be big, and he felt everything was in place.

	“Once we internally decide this product is ready for market, we need to be able to run 100 mph and meet or exceed customer demands and dealer demands out there,” he said. “I can say with a big grin on my face that when we cross-functionally signed off that this product was ready to go to market, I had the highest confidence in our manufacturing processes, our people building the product, our supply chain and our partners. I felt really good when we went past that last toll-gate that from this point on the momentum was going to be unstoppable.”

	Of course getting that momentum all revved up was the task of another part of the Gendex team-sales. William Popek, one of Gendex’s Directors of Sales, began his involvement with the GXS-700 project about 12 months ahead of launch. He and the other directors were brought in to help define the sensor’s most attractive features and, through regional training sessions, to educate the entire sales team on every detail about the new technology.

	Popek said the experience his sales team gained through previous launches made it easier to get them up to speed on the newest launch. With the high-quality images and the sensor’s physical properties as the headline features, being prepared to thoroughly discuss the sensor in front of clinicians at a tradeshow or in their practice was the real key.

	“Each representative has their own unique style on how they deliver information, but we all need to be well-educated so that we know our facts, know our features, and know our benefits,” he said. “Ultimately when we’re one-on-one with a doctor, this is where it all comes into play. There’s a lot of dentists who are technically inclined and want to hear the details, and then there’s other doctors who only want to hear about how it will improve efficiency, and others who just want to know it provides a better image for diagnosis. We come to the table prepared to answer any question that is asked of us.”

	One feature of the sensor that has proven attractive to dentists is that it is available in both Size 2 and Size 1, which makes it ideal for pediatric patients. Popek said being able to offer the GXS-700’s image quality to dentists with big pediatric patient populations is important, and Dr. Flucke said having the Size 1 sensor has been a huge advantage for his practice.

	“They did a nice job of designing the form factor. It’s not real thick, the edges are rounded, it’s easy to place,” he said. “We used to spend a lot of time on children trying to get images and we’d frequently be relegated to phosphor plates, which is digital x-ray, but it’s certainly not a state-of-the-art digital x-ray. It’s nice to be able to have a No. 1 sensor that children don’t bite or gag on.”

	Of course making sure the company had that real-world clinical feedback was key to bringing the GXS-700 sensor to market. While other clinicians advised Gendex during the design process, Dr. Flucke said he was thrilled and honored to have the chance to be the first to put the sensor through its paces at a busy practice.

	After a month of testing the sensor, Dr. Flucke was on hand as Gendex officially launched the GXS-700 in May at this year’s California Dental Association meeting in Anaheim, Calif. Popek said tradeshows like that are an ideal way to show a large number of dentists just what the sensor can do, and having Dr. Flucke there to answer questions was important.

	“When you hear it from an actual user, an actual owner, it can make all the difference in the world,” he said.

	Dr. Flucke understood he would be called on to be that voice and he wanted to be sure he could provide honest answers to just about any question. He feels that honesty goes both ways between him and other clinicians as well as between him and Gendex, a company he said he is proud to work with because, “I really truly feel that they’re concerned not only about the doctor, but about the patient as well.”

	During his prelaunch time with the GXS-700, he and his staff made sure to move the sensor around between operatories and computers while using it with a variety of positioners. They all came away impressed, with Dr. Flucke describing the sensor as “a workhorse” that he can count on to provide a great diagnostic image without the need for further digital enhancement.

	“I’m still thrilled with it. The image is just that good,” he said. “Even after five months I’m still looking at the images and routinely blown away by what I see.”

	He also still enjoys being there when a fellow dentist first gets to see the images captured by the GXS-700. In the months since the launch, Dr. Flucke has attended other meetings where Gendex was demonstrating the sensor’s capabilities, and he’s always excited to watch another clinician experience the same thrill he and his staff felt when they were summoned over the intercom to see their first GXS-700 image.

	“It’s still pretty neat to see somebody go, ‘Wow that’s pretty sharp,’ ” he said. “And it is.” 

 When hygienist Nikki Hayes called out “You guys have all gotta get down here and see this,” over the headset intercom system used by the staff at DPR Technology Editor Dr. John Flucke’s Lee’s Summit, Mo. practice, it sent everyone running. What they saw did not disappoint.

Special Report: Bringing vision into sharp focus

	This month our feature story presented a “chorus” of voices offering a range of views and perspectives on CAD/CAM technology, digital dentistry and the way computerized and robotic processes are changing the dental lab industry. The voices in that article may have differed in their opinions about the technology, but the one thing everyone seemed to agree on was that CAD/CAM technology is here and has already begun to change the dental laboratory industry in numerous ways.

	But just because the technology is here, doesn’t mean every lab needs to run out and purchase a scanner, a mill, a 3D printer or a whole range of expensive new devices and tools. CAD/CAM technology has already produced a range of new business models in the dental lab industry, with others being tested out all the time. It’s likely one of those business models will fit your lab, and throughout the rest of 2011, Dental Lab Products will present this new column, Steps to CAD/CAM Adoption Now (or SCCAN) to share the stories of labs and companies that have entered the digital marketplace via differing paths.

	Beginning with next month’s issue, when we will focus on labs testing the digital waters via an investment in little more than design software that allows them to digitally design restorations and then link up with reliable outsource partners for production, the series will examine an escalating scale of ways to invest in the technology. From purchasing various types of scanners, mills and 3D printers, the series will stretch all the way up to cover what it takes to create and open a milling center so your lab can become that reliable outsource partner for others in the industry.

	SCCAN is about more than just looking at the categories of technology that make up the CAD/CAM side of the industry, and the series will showcase how these digital technologies foster various kinds of partnerships between labs of different sizes, technology manufacturers and even the companies producing materials designed for use in the CAD/CAM systems being covered.

	Adopting a CAD/CAM system goes beyond your purchase and implementation of new technologies. Bringing in these new tools not only can provide efficiencies, it can fundamentally change the way work flows through a lab. For this reason, the final two installments of the SCCAN series will look at aspects of CAD/CAM beyond just adopting the technologies available for purchase.

	In the first of these concluding columns, we will examine what is different (and what is the same) about putting the finishing touches on milled restorations as compared to restorations produced through more traditional lab techniques. Then, the SCCAN series will conclude with an examination of how new CAD/CAM services can become selling points for your lab with a detailed look at marketing strategies that work for labs that have already made the digital transition.

	CAD/CAM isn’t going to be an immediate fit for every lab, but with so many options already available and new systems and technologies always on the way, we hope the SCCAN series will offer some insight into the options available to your lab, so you can make the decision as to what type of involvement will work best for you and when it’s the right time to implement it in your lab.

	We welcome your feedback throughout the year. 

 This month our feature story presented a “chorus” of voices offering a range of views and perspectives on CAD/CAM technology, digital dentistry and the way computerized and robotic processes are changing the dental lab industry. The voices in that article may have differed in their opinions about the technology, but the one thing everyone seemed to agree on was that CAD/CAM technology is here and has already begun to change the dental laboratory industry in numerous ways.

SCCAN: CAD/CAM isn't one size fits all

Founded in 1983 by Thomas Wade, CDT, and his wife Sue Wade, New Horizons Dental Laboratory is a small boutique lab in Broomfield, Co., with a focus on high-quality conventional removables and implant prosthetics.

NobelProcera™ is a comprehensive CAD/CAM system for designing and fabricating individualized dental prosthetics ranging from crowns and bridges to implant abutments and overdenture bars. Material options include zirconia, alumina and titanium. Impressions or models are scanned at the lab with digital case design completed in NobelProcera Software. Production is completed at Nobel Biocare’s facility via state-of-the-art milling technology for precise fits and optimal strength.

With a reputation for fabricating quality removable prosthetics, Thomas Wade said New Horizons Dental Laboratory was “plugging along just fine” for the first 23 years he and his wife, Sue, ran the business. Implant-related cases made up a percentage of the work coming in to the lab, but the large majority of the work was creating conventional dentures, RPDs and bruxism splints.

Wade had restored full arch, multiple implant cases on cast bars that were fabricated by various crown and bridge labs because he had never gotten involved in the casting part of the fixed process. But six years ago, while attending a tradeshow in Chicago, Wade first saw the CAD/CAM system known as BioCad (Now NobelProcera) and instantly knew this was a technology he wanted to pursue in his lab. The computer-designed and milled titanium overdenture bars were so precise and had such a high level of structural integrity that they eliminated the problems of fit (passivity) and compromised strength that can result from imperfect castings that require sectioning and welding. These bars completely changed the way implant prostheses could be engineered and fabricated.

“There’s just no comparison between a cast bar and a milled titanium bar,” Wade said. “There’s no throwing of melted alloy that causes distortion and porosity, no cutting and welding, they’re perfectly passive.”

Over the past six years Wade and New Horizons have used the NobelProcera system to create the bars for implant supported and assisted cases, the implant-related side of the lab’s caseload has increased to close to 50% of the work. Now he is thrilled with the solutions he can offer to dentists and their patients because he can work with the clinician and the surgeon to ensure the prosthetically driven placement of the implants as well as a “state of the art” prosthesis that can withstand the significant forces implant supported dentures must endure.

When using NobelProcera implant bars, Wade knows the bars he receives from Nobel will fit the model very passively, which means he and the clinicians he works with must be exacting and diligent in their impression and model work. They are rewarded with confidence that the restoration will interface perfectly with the implants at the final seating appointment, which is often the shortest appointment for the clinician and the patient.

“Everything is well engineered and strategically put together,” Wade said. “Usually when these things go in the doctor calls and says it bolted right up because we know we’ve eliminated all the surprises.”

Wade said he is confident not only in the fit, but in the function because the restorations he creates have been designed using a reverse engineering approach made possible by the digital technology. When combined with Ivoclar Vivadent’s denture teeth and SR Ivocap injection acrylic material, the NobelProcera Bars make up “the recipe for state-of-the-art full-arch implant supported restorations.”

While he works with a range of implant systems and has completed cases with CAD/CAM bars from other sources, Wade said the NobelProcera bars stand out for their precision and high finish quality. It also helps that when working on a case using Nobel Biocare’s implants, the components available for the lab to work with are “second to none.” And because of the forces a patient can generate on a set of implant supported overdentures, Wade said he knows he cannot cut a single corner in the design, fabrication technique or quality of materials he will use on these cases.

“We have to try our very best to engineer these things to be bullet proof.”

This is because even with the best technology and materials behind the work, implant bar cases are complex in their design with many missteps possible. Moving to the NobelProcera system helps Wade eliminate a few of these possible issues, but even top notch technology is not a quick fix or a shortcut, and it is best suited for labs that are willing to meticulously work through these detailed cases to provide the highest quality restorations possible.

But for labs that are willing to really learn how Procera works, the results can be amazing. Wade said his lab has had its best years ever in the last few years and he gives his investment in technology a lot of credit for that success. Rather than being hit hard by the recession, Wade hired two technicians in the last few years and he said being on the cutting edge with NobelProcera helped New Horizons stay strong and take its work “into the 21st century in a big way.”

“Stumbling onto this technology six years ago, getting all excited about it and being motivated to learn it and get good with it has made a big difference in my lab,” he said. “I credit it for helping me be in a prosperous situation during a time that’s been difficult for a lot of other labs.

The lab Founded in 1983 by Thomas Wade, CDT, and his wife Sue Wade, New Horizons Dental Laboratory is a small boutique lab in Broomfield, Co., with a focus on high-quality conventional removables and implant prosthetics. The product

Nobel Biocare’s NobelProcera™

1. TS2000™ diamonds save time and money by simultaneously performing rapid gross reduction and creating a marginal finish line.

	2. The permanently brazed TS2000™ features proprietary P.B.S.® bonding that provides consistent performance and longer cutting life, and helps the burs withstand the high torque of electric handpieces while delivering smooth cutting action over multiple uses.
	
	3. The TS2000™ burs are designed with the spiral channel machined into the blanks before diamonds are applied, greatly reducing the likelihood of diamond particle loss.
	
	4. The spiral circulates water spray to the cutting site and flushes away debris that would otherwise clog the tip, creating cooler, more efficient cutting.

	5. Natural diamonds in a coarse grain size produce exceptionally smoother margins and axial walls, eliminating the need to use an additional fine grit bur to correct surface irregularities.

		A reliable highspeed handpiece: COMFORTdrive 200 XDR from KaVo

		A retraction system: Traxodent Hemodent Paste Retraction System from Premier Dental

	Once you’ve prepared the tooth, a digital impression system such as the E4D Dentist from D4D Technologies (

) can capture every detail of your well-defined margins. 

 http://premusa.com1. TS2000™ diamonds save time and money by simultaneously performing rapid gross reduction and creating a marginal finish line.

Enhanced speed and accuracy

	Video conferences, in one form or another, are certainly not a brand-new technology. But in the past, they’ve been mostly relegated to the bin of novelty technology because of either (or both) the high cost or low quality.

	Well, that will change soon. The number of computers, laptops, netbooks and smartphones equipped with cameras for the calls, as well as services set up to manage the video call traffic, are growing at a rapid pace. More importantly, Internet and wireless service providers are starting to catch up to the data demands of the calls, allowing a quantum leap in the quality available in computer-to-computer video connections.

	Of course, it takes more than surplus bandwidth to make a high-quality video call. If the cameras and screens on both ends are not up to the task, the quality of the calls will continue to lag, and this is where Microsoft’s new LifeCam Studio™ can really help out.

	While known primarily for the Windows operating system and business software titles, LifeCam Studio is a part of Microsoft’s expanding hardware portfolio and it’s been designed to work with the company’s Windows Live Messenger 2011 application as well as popular services such as Skype and Yahoo! Messenger.

	The centerpiece of LifeCam Studio’s technical specifications is the 1080p sensor capable of recording and transmitting true HD video in a 16:9 widescreen format. This means video calls can fill the entire widescreen computer monitor, or an HD TV connected to the computer. Unfortunately, current software limits the resolution to 720p, but that’s still a very high-quality image.

	With auto-focus, color-correcting technology and a physical hood protecting the camera’s optics, it can provide high-quality images and bright colors in almost any lighting condition. Mounting options allow it to be fixed atop a computer monitor or attached to a camera tripod. Additionally, the camera can swivel  360° to make it easy to aim at whatever needs to be broadcast, and an omnidirectional microphone lets the camera be pointed away from the person speaking on the call.

	Remember the first time you saw a HD TV with a picture more clear and sharp than previously imagined. Your old set seemed fine until that HD image came along, but now an analog image seems fuzzy and dated.

	The same principle applies to what a true HD camera can do for video calls. No longer are the calls confined to a tiny box with blurry images that might or might not be the face of the person you’re talking with. Video calls in HD almost seem to bring the person on the other end of the line into the room with you. And with the size of some TV screens, they can literally appear larger than life.

	Having an HD video pipeline from your lab can bring you even closer to the dentists with whom you work. If you both have a LifeCam Studio connected to your computers, it can be almost like you’re right in the operatory at critical times.

	Video calls provide the face to face experience that can strengthen the partnerships at the heart of the dental lab business. Adding HD resolution to that equation gives you and the people you work with the chance to see the fine details on the other end and makes incredibly close collaboration possible, even when everyone is divided by a great physical distance.

 Video conferences, in one form or another, are certainly not a brand-new technology. But in the past, they’ve been mostly relegated to the bin of novelty technology because of either (or both) the high cost or low quality.

Tech Smart: Open a window to HD Video Calls

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 Both Integra® Dental Casework and Artizan® Dental Furniture provide designs that meet ergonomic workflow, infection control, technology integration and unique storage requirements.  Artizan Dental Furniture offers flexibility with a wide variety of standard product configurations and the capability to provide custom product solutions in design, size and color.