A desktop future for the dental lab

When considering the digital technology that exists today, it’s not hard to imagine a dental lab looking a lot more like a cubicle in a typical office with just a computer and a scanner as the only tools occupying the desktop.

Such a lab would take in cases either via digital impression or by scanning a traditional impression, design the restorations in a completely digital environment and then outsource production of the digitally planned restorations. Sure, the lab technician as digital designer would most likely do some finishing work on the restorations that come back from his or her production partner, but the majority of the effort could be handled virtually with greatly reduced overhead costs in terms of supplies, equipment and office space.

“Do I ever see a day when laboratories can survive with just scanning technology sitting in an office environment? You could conceivably do that today,” said Dave Nakanishi, owner of Nakanishi Dental Lab in Bellevue, Wash. “You could sit in a very sterile business office, take in those input scans, design copings or whatever you’re doing and then send them off for casting, producing and machining. It’s really not a heavy financial burden. It does take a change in the thought process in terms of workflow, in terms of how a laboratory wishes to create their product.”

Speed and savings

A self-described early adopter, Nakanishi’s lab uses a number of digital workflows and CAD/CAM systems including SensAble Technologies’ SensAble Dental Lab System and scanners from Nobel Biocare, Straumann and Biomet 3i. He said the software advancements and intuitive interfaces such as SensAble’s haptic system have advanced to the point where, “technology is actually allowing technicians to be able to better utilize their skills.”

It’s a similar thought that led Tom Nieting, CDT, and Norbert Ulmer, MBA, to create DENTATRUST, their vision of an all-digital workflow built around Sirona’s CEREC Connect network, which they helped launch. Ulmer said the digital processes save time and labor in a number of ways.

By taking in cases via digital file direct from chairside, DENTATRUST is able to greatly reduce the costs to pick up cases, which saves money even when those cases are coming from nearby dentists. This also speeds up the start of work, and because they outsource model fabrication to Sirona, the lab is able to begin working on designing the restoration immediately.

“While Sirona is fabricating these models, we usually already start fabricating the restorations, especially when it needs zirconium oxide or some substructure materials,” he said.

A part of the team

Another benefit of the system is the way it helps the lab stay close to dentists, Ulmer said. By being able to review and respond to the case immediately, DENTATRUST is often able to make sure everything is in order with the digital scan and the prep while the patient is still in the dentist’s office.

It’s this relationship that Eddie Corrales, owner of Downtown Dental Designs in San Diego, believes is a real key to succeeding in a digital dental landscape. Also built around the CEREC inLab system and CEREC Connect, his five-technician operation works so closely with its dentists that the techs hope to be considered almost part the staff.

“If we are on speakerphone with the doctor or live on Skype-we actually like Skype better-we actually help them with the scanning,” he said. “We kind of drive his hand directing him more lingual or buccal before he takes the next image.”

He sees himself as a resource for the dentists and hopes they view him and his lab as an extension of their chairside scanning technology. Corrales has also found a way to remain a part of their chairside milling technology because designing restorations virtually means they can be involved in cases that never leave the dentist’s office.

“We try to do everything digital where we offer designing directly on the doctor’s machine directly through remote desktop,” he said. “We can run their computers from our lab or from an iPad.”

Facing the future

While the CEREC system is celebrating its 25th anniversary this year, it is still a minority of dentists who have adopted either the chairside CAD/CAM or digital impression technology. However, Corrales said he believes chairside digital impressions and CAD/CAM will eventually grow to become the norm in dentistry.

This means dentists might eventually be doing most posterior inlays, onlays and crowns chairside and labs will need to adapt to the changes. Corrales said there will always be value placed on their knowledge and skills, but dental technicians will need to adjust to using them in new ways.

“If I was to start my business today, I would probably just have a big computer screen and maybe my own scanner and outsource my wax patterns,” he said. “That’s where we’re going as technicians, where we don’t need to have all the equipment anymore. As technicians we have to accept the reality and be the technicians we need to be, which is the cutting edge digital technician.”

Ulmer said being on the ground floor of the digital workflow between clinicians and labs is a good place to be. Even as more dentists begin using the CEREC system and take on more of their own production, they will always need a lab partner for the cases their chairside system is not capable of handling. Ulmer believes CAD/CAM will continue to grow in dentistry and by being a resource for dentists as they are learning their CAD/CAM system, DENTATRUST plans to become their trusted outsource resource for those cases still outsourced.

“Our industry is moving that way, and it is a strategic question, do you want to be involved in the future or not? And then to what degree do you want to be involved?”

Finding the right fit

Nakanishi said there are a number of different ways labs can get involved in a digital workflow and finding the right system to match the lab’s needs is really the key. He added just SensAble’s design system to his partial department because it is his smallest department and the company allows labs to buy into different system components separately.

His partials department uses just the scan and design capabilities of the system and outsources all of the printing. Regardless of which SensAble printing center they’ve used, Nakanishi said the results have been consistent and impressive. In fact, he said the high quality work coming from all his digital systems has been better than ever.

The thing that excites him most is seeing the rise of a more open architecture environment because as the various digital systems begin to work together, he can simplify his lab with one system capable of accepting a wide range of cases from a variety of sources. With so many ways to add digital capabilities to a lab today, Nakanishi said there are systems that should fit into any lab’s workflow.

“It’s really hard to avoid getting involved in at least scanning technology. There’s so many sources out there today to be able to print, to be able to mill, to be able to fabricate that small laboratories can get involved,” he said. “It’s not just a big laboratory game today.”

In fact, Ulmer said finding the right digital business model could be the key to smaller labs remaining viable as digital dentistry grows. The greatly reduced costs and increased production speed from a digital workflow can help smaller operations remain profitable in the changing landscape, but Ulmer said he doesn’t think the majority of labs see this yet.

“My vision is that the digital production, the CAD/CAM equipment basically offers the smaller sized labs to continue to have a place in this economic environment,” he said. “Right now what I see is that the majority of small sized labs are trying to avoid technology rather than embrace it.”

Corrales said he views the industry as several bubbles. The far larger bubble is the dentists who are not using CEREC and CAD/CAM technology, while he’s setting up shop and securing his place in the smaller CAD/CAM bubble because he sees that as the future.

“My bubble’s getting larger every day,” he said. “It’s certainly going to take a few years before it’s larger than the other bubble, but we are going to be taken over by these machines, so we have to find our niche.”

Dental Lab Products Senior Editor Noah Levine can be reached at nlevine@advanstar.com.