The CAD/CAM Chorus: Weighing the options

January 2011 | Dental Lab Products

The CAD/CAM Chorus

Weighing the options

Sara Kazan, CDT – President, Nellmar Laboratory

by Noah Levine, Senior Editor

Currently, Nellmar Laboratory in Ann Arbor, Mich. doesn’t have in-house CAD/CAM capabilities, choosing instead to outsource the scanning and designing as well as the milling for the all-ceramic products the lab offers. Nellmar’s President, Sara Kazan, CDT, believes 2011 is the year to reduce those outsourcing expenses and bring at least part of the process in-house by adding a scanner and design center.

Like many in the industry, she is heading toward the daunting decision of which system will make the most sense for her lab. However, Kazan admits Nellmar is far from the typical lab facing such a decision. The lab is part of the campus of product review publication, THE DENTAL ADVISOR, and on the campus sits both a very high-tech dental practice, Enspire Dental, and Apex Dental Milling.

“We’re experiencing the processes of all the latest technology-almost all the systems on the market as far as chairside units-but at the same time we don’t have a scanner in our laboratory because Apex is right here,” she said.

Still, the lab, the dental practice and the milling center are businesses, and Kazan has been considering expanding her lab to include some in-house digital capabilities for some time. However, the economic downturn has hit the lab over the past few years, and last year Kazan chose to expand her lab traditionally with a new removables department rather than purchasing a scanner.  

“We felt that gaining that product line from our existing customers was the quickest way for us to generate more income in the laboratory,” she said.

Now, with business picking back up, Kazan feels ready to approach the digital market once again. In her mind, the move is a way to reduce outsourcing fees while embracing technologies that contribute to better dentistry. Working in zirconia rather than metals is an improvement from the standpoints of costs, esthetics and benefit to the patient. Kazan strongly believes CAD/CAM making its way through the lab industry will be a good thing in the end, even if it’s confusing for many right now.

“I think that most laboratory owners feel like they have no choice but to get involved in CAD/CAM, and personally, I think it’s a great thing to get involved in,” she said. “I can’t imagine not offering CAD/CAM restorations at this point. I think that it’s undeniably improved dentistry. They’re beautiful restorations, they’re strong, they’re proven, they’re highly esthetic and they’re very accurate.”

Those improvements come in a number of ways from the precision of milled ceramics to the way digital impressions and scanned physical impressions can help dentists get better at what they do. Once an impression is digital, every flaw in the prep is magnified and easy for both lab technician and clinician to see. Kazan said going digital on the lab side allows technicians to play an active role in helping patients receive higher quality dentistry.

“If we receive a sub-standard impression or prep, we often do our best to work with it without informing the dentist,” she said. “When we begin doing CAD/CAM restorations, we are forced to inform the dentist of any potential problems with a prep or impression because of the added cost of outsourcing. This enhanced communication improves dentistry.”

While Kazan is strongly in favor of providing her clients with access to CAD/CAM restorations, she does not believe it makes sense for every lab to have in-house milling capabilities. The profit margins are just not there for a lab the size of Nellmar, and at least for now, scanning and designing is the part of the process she’s most focused on.

Of course, making the choice of which scanner and design software will be the best for her lab is not a simple decision. Kazan said she is weighing both longevity and reliability of the manufacturers and their technology, but more importantly she needs to find a system that will work best on the types of CAD/CAM restorations her current client base is most interested in.

“You need to look at your product line and see which system covers all of that. It narrows it down,” she said.

Figuring out which system matches up with her current product list is one part of the equation, but it will also be key to stay in touch with her customer base before and during the transition. If any of her dentists are also considering a move to chairside digital impressions, she might lose their business if her new CAD/CAM offerings are not compatible with such a system.

For that reason, Kazan said she is intrigued by the prospect of working with a manufacturer to provide chairside digital impression systems to some of her doctors in exchange for their sending her a defined amount of business every month through the technology. This strategy would get the technology into practices, bring a steady stream of business to her lab, and improve care overall.

“The dentists don’t want to make the investment, but they want to have the technology, and this is a way the lab helps them do that,” she said. “I like that idea. It’s a way to guarantee work. It makes the dentists happy and it gets the chairside units in their offices, which improves their dentistry.”

Still, such a move would be a major step and one Kazan is not completely sold on as the best way for her lab to jump into the CAD/CAM arena. For now her focus remains more squarely on evaluating the existing scan and design systems to find one that’s a fit for Nellmar.

“The one thing that I am 100% comfortable with, with all the outsourcing I’ve been doing over the last few years, is for my lab in 2011 to find the most compatible scanner that ties in with my product base and to continue to outsource the production capacity,” she said.