The digitization of numerous dental laboratory processes has made the world much smaller and to some extent, leveled the playing field among laboratories.

In my world, the large laboratory operation, we constantly evaluate developing technology to stay ahead of the curve. We find it preferable to own technology and to maintain the highest level of control. However, this preference certainly comes at a significant operational cost. Outsourcing provides a convenient, inexpensive way to “test drive” manufacturing capabilities without a large capital investment.

Most laboratories, however, can leverage existing investments by suppliers and even other laboratories to access technology and advanced materials on demand. This enables us as technicians to meet a very high percentage of our dentist customer needs and access expertise on an as needed basis. In short, we are able to focus on our strengths, and rely on trusted partners for their expertise. It is of note that this isn’t a new business strategy. Dentists have long since outsourced most implant, prosthetic and orthodontic operations to us. In turn, surveys reveal that many laboratories partner with other labs and central manufacturing services for an increasing percentage of cases.

At this stage of development, digital technology can be predictably and profitably used to provide consistently excellent internal adaptation of any fixed prosthesis, as well as cast Removable Partial Denture (RPD) frameworks. In the following sections, I describe some laboratory outsourcing options available through DENTSPLY Compartis that have been successful for Drake Precision Dental Laboratory.


With the need for the large, up front investment in capital equipment, labs can now seamlessly offer new services at competitive pricing. The beauty of the service lies in the fact that you still retain ultimate control when sending Cercon® art, or open architecture .stl files, to Compartis. Compartis delivers zirconia full-contour units and substructures, as well as precious and non-precious metal frameworks, precisely to your designs within 3 business days of file approval.


Yttria stabilized zirconia is the strongest and toughest all-ceramic option available to laboratories today. The high sintering shrinkage of the material necessitates the use of CAD/CAM technology to process this material. Services such as DENTSPLY Compartis zirconia structures allow labs to access this material option with complete control of CAD design.

Open architecture capability allows DENTSPLY Compartis® to receive files from any scanner that produces .stl files, in addition to Cercon® art scans. The scan data is then used by the milling equipment to produce single unit copings or up to 8-unit bridges to the exacting specifications provided, in choice of 16 highly popular shades.

Launched December 2011, full contour zirconia restorations are now available through Compartis. With enhanced translucency, Cercon® ht full-contour zirconia restorations are made of yttria stabilized zirconia (Y-TZP) and provide outstanding strength and esthetics, ideal for full-contour posterior restorations. They are also used in fabricating frameworks for fixed prosthetic restorations. The material has been proven to offer very low wear to the antagonist, even in comparison with clinically proven PFM veneering ceramics and other glass ceramics.

Restorations and frameworks are individually fabricated to your digital design specifications, such as anatomic shape, framework wall thickness and connector diameter or cementing gap.

Depending on the design, Cercon® ht frameworks can be veneered with ceramics or inserted as fully anatomical restorations. With fully anatomic restorations, no space is required for the ceramic veneer, which may allow the dentist to preserve more of the natural tooth structure. My experience has been that dentists appreciate the conservative tooth preparation protocol.


With the skyrocketing PM prices, non-precious alloy provides an economical restorative option for dentists and their patients. Compartis NP, manufactured with state-of-the-art SLM industrialized technology, ensures consistent quality and fit accuracy. The biocompatible and corrosion-resistant Cobalt Chromium alloy used at Compartis offers a full range of options for non-precious crown and bridge cases, from single-unit copings to bridges of up to 14 units. Using the Compartis® NP service offers the peace-of-mind support of DENTSPLY’s CAD/CAM technology expertise.


Even in this highly escalated precious metal market, Precious Metal (PM) substructures provide unique, lifelike restorative characteristics and are still favorably prescribed by some clinicians. Yet, significant savings and cash flow benefits can be realized through the elimination of precious alloy inventory. The use of a 3Shape Dental System™ (3Shape A/S), Dental Wings® (Dental Wings Inc.), or Cercon® eye (DENTSPLY) scanners provide the laboratory with the opportunity to scan the master cast, design the substructure to their specifications, and outsource the single-unit or up to 6-unit bridge design for fabrication. NOTE: 3Shape Dental System™ and Dental Wings® are not trademarks of DENTSPLY International, Inc.

Services, such as Compartis® PM, among others, offer high-precision, CAD-designed, 3D wax printed cast copings, in a range of premium yellow high noble, high noble, high palladium noble and premium silver noble alloys, as well as a crown and bridge alloy for full-contour restorations. For labs that want to offer high quality C&B services, but do not desire the excessive overhead of carrying PM alloy, subcontracting is a viable, intelligent business decision.


The dynamic growth in oral implantology during the past few years has expanded the opportunities for custom milled, implant-supported restorations. As this growth continues, it offers exciting new opportunities for better patient solutions and streamlined lab production processes.

The Compartis® ISUS product line includes CAD/CAM bars of any design and fixed detachable frameworks milled from Titanium or for higher strength requirements, Cobalt Chrome (CoCr). The CoCr material is also available for ceramic substructures for multiple-unit, implant-supported restorations. You can receive the completed structure, fit to the model and ready to send to your customers, within 9 to 10 business days (7 from lab design approval). The use of CoCr alloy is a significant cost reduction compared with hand-fabricated, cast precious alloy. CoCr is compatible with Titanium implants, which eliminates concerns of electrolytic reactions associated with other cast base alloys. A ceramic material, such as Ceramco® 3 with a compatible CTE, is optimal. What we’ve appreciated about Compartis ISUS services is that, with a simple production sequence, perfect-fitting suprastructures are delivered-the first time-reliably.


As illustrated in this overview, DENTSPLY SmartSourcing™ through Compartis provides a broad variety of digital restorative support for the contemporary dental laboratory. The rapidly developing technology sector continues to provide optimum clinical results with greatly improved efficiency at reduced operating costs.

In a well-adapted business model, companies, such as industry leader DENTSPLY, offer centralized manufacturing using scanning, milling and rapid prototyping through Compartis. This sub-contract service allows dental laboratories to take advantage of current vs. digital technology, which provides the greatest predictability of internal adaptation. Compartis® centralized manufacturing enables technicians to focus on ceramic application and esthetic excellence, while helping the laboratory to improve productivity, manage inventory, and minimize capital investment. That’s a smart way to grow.

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DENTSPLY SmartSourcing through Compartis provides digital restorative support for the dental labs of today

The team at Harmony Dental Lab first heard about Zest Anchor’s LOCATOR Attachments through dental trade shows and clients who were excited about what it could offer their patients. They began using the LOCATOR not long after it was introduced to the market and have been happy with what it’s done for their lab, their dentist clients and of course the patients.

“I would say on CAD/CAM bars we really like it because it has the drill and tap option,” Hodson said.

“That allows the lab or even the dentist the ability to change out and replace the attachment if needed. This could save a restoration if wear occurs throughout time. And it works with all CAD/CAM bars. Any company that manufactures the bars offer the LOCATOR attachment as an option.”

Other benefits include different levels of retention, angulation versatility and its low profile. The different levels of retention is a huge patient benefit, Hodson said. Some patients require very little retention, such as an elderly patient who may not have the same dexterity and hand strength to insert and remove the attachment as a younger patient. Other patients simply prefer to have it locked in tightly so it takes a lot of effort to remove.

Not only does the LOCATOR offer retention options for the patient, it’s also easy to work with and predictable, which can save labs time and money.

“The system is pretty predictable,” Hodson said. “We’re not buying extra components. We buy what we need for the case and that’s it. There is no need for angled abutments because the extended range males correct the path of insertion up to 20 degrees. It’s very easy to process. I think we save time relative to other systems.”

The LOCATOR also is versatile, Hodson said. While his lab mainly uses the drill and tap option for CAD/CAM bars, the bar attachments offer many other options for technicians, including laser welding and a cast-to attachment.

Hodson and the team at Harmony Dental have been happy with the LOCATOR system and what it offers, and would encourage other labs to give it a try. It’s versatility makes it a great addition to any lab, whether you’re using it directly on implants, on CAD/CAM bars, cast bars or anything in between.

“I think it just comes down to the patented pivoting action and the self-aligning design of the LOCATOR,” Hodson said. “The different levels of retention really make a difference, too.”

The team at Harmony Dental Lab first heard about Zest Anchor’s LOCATOR Attachments through dental trade shows and clients who were excited about what it could offer their patients. They began using the LOCATOR not long after it was introduced to the market and have been happy with what it’s done for their lab, their dentist clients and of course the patients. “I would say on CAD/CAM bars we really like it because it has the drill and tap option,” Hodson said.

How Harmony Dental Lab benefits from Zest Anchors' LOCATOR attachments

Said to be engineered with simplicity, the 

 duo cart provides all the basic features in a smooth, esthetic design. The system features a removable starboard work surface, which can remain on the cart or be used in other locations in the operatory. A doctor’s only version also is available.

 Said to be engineered with simplicity, the Model S-4350 Mobile System duo cart provides all the basic features in a smooth, esthetic design. The system features a removable starboard work surface, which can remain on the cart or be used in other locations in the operatory. A doctor’s only version also is available.

New Dental Product: Model S-4350 Mobile System by Beaverstate Dental Systems

Quality control measures like Lean manufacturing and DAMAS can increase your efficiency and productivity.

No one likes to be told what to do. As kids, your parents told you to clean up your room and eat your veggies. In school, your teachers instructed you to write neatly and follow directions. On the job, your bosses demanded that you do it their way because that’s the way it’s done. They might have told you it’s all for your own good, but you didn’t really believe it and vowed that someday you’d be your own boss, and no one would tell you what to do.

Then you opened a dental laboratory and faced myriad commands and regulations that you couldn’t say no to. The funny thing is, all those demands from parents, teachers, and bosses turned out to actually be for your own good in a way and now can help you make your business stronger and more profitable.


	While there are official regulations mandated by the U.S. Food and Drug Administration that dental laboratories must adhere to as a manufacturer of medical devices, having a basic in-lab system of quality assurance and standard operating procedures just makes practical business sense. Any system where the laboratory regularly reviews standards and practices and then establishes working guidelines will only move operations to a higher level of efficiency by flagging areas of weakness and showing areas needing modification.

“When you have a quality system, it allows you to catch [problems] quicker and take corrective action rather than waiting for a firestorm to hit where you can’t really recover,” NADL Executive Director Bennett Napier said. “The damage is done, and you have hundreds of cases that have been affected rather than a few.” With a quality system in place, the lab can trace the problem back to the source and take corrective measures to help ensure the problem does not reoccur.
	One system of setting benchmarks for quality standards that is widely used in many industries is known as Lean manufacturing. Although it isn’t a formal certification or regulation process, Lean manufacturing is more of a philosophical way of looking inward to advance the current of things moving forward.

The heart of Lean is the fundamental concept of eliminating waste and excess and streamlining procedures, said 

, Vice President of Sales & Marketing. “In the dental lab, it’s the flow of the work,” she said. “You are determining how you can improve workflow and make sure each of the steps you are taking is providing the maximum amount of value.”

Bob Long, Whip Mix Lab Relations Manager, said many instances of lab waste would seem common sense, but need to be observed and noticed through impartial eyes. “The biggest thing we try to do is get rid of the clutter, confusion,and chaos,” he said. “I’ve watched guys sit there and fumble with all these burs on their bench. They pick one up, put it in the handpiece, throw it back down, right back into the stack because it’s broken.”

The idea of eliminating waste goes beyond just squandering materials and supplies but permeates through many overlooked areas, Steinbock added. “Anytime someone has to wait for something to move through the process. Any time someone has to wait for a machine to become available. Any time they have to wait on materials to become available. Any time they have to wait on instructions. We’ve looked at that and tried to eliminate all those things that we call waste,” she said. “Those are basically just delaying the process and adding costs to the operation.”


	Not one to just talk the talk, Whip Mix also walks the walk of Lean manufacturing. A certified ISO 9001:2008 manufacturer, it is accountable for its own quality systems from producing materials, supplies, and equipment, which, in turn, help labs with their own Lean operations.

“Lean is really an integral part of our DNA,” Steinbock said. “Everything we make is with this mission in mind. We practice it here, and we certainly try to build that into the products that we make.”

Part of that genetic makeup is in what Long refers to as “cellular design” in the company’s facilities layout. “We haven’t added on in space, but we’ve made three acquisitions. We’ve been able to fit new product lines and production into our existing square footage by putting all the equipment into a cellular organization so the machine operators don’t take steps to work different machines. It’s all much more condensed in the space. We can put more product line manufacturing in the same space,” Steinbock said.

Long said he has heard from lab owners who have implemented a cellular design into their own production workflow schemes with exceptional results. The only complaint he has heard from the labs is they had expanded their footprint before incorporating the cellular design. “Now they have all this extra space they don’t need,” Long said. “They could have saved themselves money,” if they had used Lean cellular strategies instead of expensive construction.


	For many smaller labs, implementing and maintaining Lean manufacturing processes or similar quality assurance standards is as far as they need to go. They are able to improve efficiencies through an informal internal audit of their operating procedures and make adjustments when necessary without outside involvement. However, a handful of labs have decided to make the extra effort beyond basic compliance and on to third-party certification, and have seen additional benefits as well.

One such system is the Dental Appliance Manufacturers Audit System (DAMAS), which was created in Europe in the 1990s as a quality control standard geared specifically for dental laboratories that did not need full-scale ISO certification meant more for industrial mass manufacturers. The NADL modified DAMAS to fit the North American industry and to closer fit FDA regulations.

“DAMAS is really a boiled-down version of ISO for labs who can’t afford or don’t need ISO certification,” said Nick Azar, Founder of Azar & Associates (azarandassociates.com), an NADL-approved DAMAS trainer and consultant based in Santa Clarita, Calif.

Napier said lab owners are turning to the systematic format of DAMAS for different motives. “The primary reason, the driver for them, is they finally understand that if you implement something like this, it makes you more productive, reduces your waste, and in essence will make you more profitable, which allows you to be more competitive, in terms of turnaround times and consistency of product.”


	In addition to the benefits of increased efficiency, consistency and reliability to a lab’s everyday production advantage, DAMAS certification provides the bonus of long-term marketability.

“Dentists want to do business with a lab that has a quality system,” said Mary Borg, Co-Founder and President of SafeLink Consulting Inc. of Cumming, Ga. “And having been certified toward that or registered, that’s an assurance to that dentist, who is ultimately responsible for that device going into that patient’s mouth.”

“There’s a lot of quality-minded dentists out there,” Azar said. He sees the demand for quality as coming not just from the dental practice, but eventually from savvy consumers who may even ask for specific products, brands, materials, and labs based on strategic consumer-based marketing and advertising. “Ultimately, the consumer is going to ask the dentist, ‘Who made my product?’”

Azar said it might be a few years down the road, “But many people who are at the forefront, they are always thinking 2 or 3 years ahead. They have a good vision of where their company’s going to be 5 years from now, and they are positioning themselves to be at the front.”

Other labs may be positioning their business for a different consumer. With a growing percentage of lab owners nearing retirement age, growing fatigued by overwhelming competition from more and more supersized labs and chains, or worrying about uncertainty from overseas, the idea of merging or selling has become an attractive option.

Napier said labs that have a quality system in place will be more eye-catching to purchasers. They recognize that if they incorporate some of these systems, it’s going to make them more attractive because people will know that there are systems in place. They aren’t going to have to completely go in and start from the ground up to build an operational structure. All these forces that have taken place, the light bulb has finally gone off for people to see that this is just good business,” he said. Napier added that the labs that have systems in place also are seeing a higher payout at the time of purchase than those where the buyer has to start from scratch with their own quality system.


	In spite of all the benefits to a lab’s workflow and cash flow, less than 50 labs in the United States are DAMAS certified. The primary reasons cited are the burden of paperwork, the shortness of manpower, overregulation, staff reluctance, and the long-term commitment, Azar, Borg and Napier said. However, each is clear that the positives will outweigh any such negatives, which aren’t as difficult or time- and money-consuming as often perceived.

“Once you get a system in place and it becomes part of the protocol, it gets instinctual,”Napier said. “The mechanics of managing a quality system, to some extent some part of the process is going to touch every point in the lab so it’s layered out. It’s not like one person now has a 40-hour-a-week job; it could be five minutes at this particular task at this particular production department are now in the mix. Everybody now is involved in managing the process.” He goes on to caution that labs will need to have one person to monitor and oversee the entire process, but who is not responsible for all the details involved.

Of course, having a specialized DAMAS consultant like Azar or Borg onboard to help implement the process never hurts. But ultimately, it will be up to the owner or manager to keep things going.

“Top management needs to show their commitment that this is a priority, that this is important to the organization,” Borg said. “If you’re not supporting it from the top, all it’s going to be is paperwork.”

With administration backing the quality system, staff at the bench are more likely to be behind it as well. “We’re hearing less if they can sell this to the workforce in terms of the benefit,” Napier said. “The benefits are more clear now.”

“It’s about employees having a better understanding of why they’re doing things the way they’re doing them,” Borg said. “It gives a reason for the accountability. This Generation Y and now the Millennials, you’re bringing in a workforce that wants to know why. What’s in it for me? You have to deal with that.”

Richard Palmer is a former editor for Dental Lab Products and has years of experience covering the dental and dental lab fields.

Dental Lab Products-2012-10-01

DENTSPLY SmartSourcing through Compartis provides digital restorative support for the dental labs of today

How Harmony Dental Lab benefits from Zest Anchors' LOCATOR attachments

New Dental Product: Model S-4350 Mobile System by Beaverstate Dental Systems

How your lab can reap the benefits of Lean manufacturing