Nothing’s finished

It’s not uncommon for a lab with a complete in-house CAD/CAM system to open up excess capacity as an outsource option for other labs. That can be a way to maximize return on the technology investment, but it doesn’t make the lab into a milling center.

Creating a milling center in the truest sense of concept means building a business dedicated to providing dental labs with access to CAD/CAM produced parts that can then be finished into restorations ready for the prescribing dentist to place into the patient’s mouth.

Business of production

Chris Brown, Business Manager of Apex Dental Milling in Ann Arbor, Mich., said milling centers provide knowledge, technology and precision to labs, but because they don’t provide completely finished products, they are never in direct competition. Milling centers fill a need in the industry, but they follow a completely different business model than dental labs.

“Setting up a dedicated milling center to support other laboratories and to not have any final products that you ship yourself, that’s a challenge,” Brown said. “With the other profit centers within a laboratory, it’s easier for a lab to add milling equipment than it is to set up to just be a milling center. The profit margin on production is much smaller at a milling center than it is at a full-service laboratory.”

Still, there’s a reason milling centers exist, and Brown believes this is because of the efficiencies of specialization. Dental labs produce custom products made to meet the individual specification of each case, but digital design and computer-driven production allow for some steps to be automated, and a milling center provides labs with access to the expensive technologies required for this automation.

“Efficiencies in manufacturing are starting to work their way into the dental lab world,” he said. “Just as GM, Ford and Chrysler don’t make every single part that they put in a vehicle-they outsource the fabrication of certain parts to people who are very good at doing that-now you’re seeing that same sort of philosophy behind milling centers.”

While the business case makes sense for the industry, it must make sense for the individual milling centers if they are going to survive and thrive. Brown said starting Apex required a huge investment in expensive milling hardware, and the center needed a solid plan to make sure there would be a timely return on that investment. It’s also important for milling centers to completely examine the costs associated with the equipment being purchased. Costs for training, installation, electrical and other utility connections, and maintenance all must be a part of the equation. Brown stressed the importance of separating wants and needs and starting with a manageable investment plan with built-in scalability.

“If you’re going to make a financial investment, you’ve got to know it’s going to pay for itself within a certain period of time, because if a new material comes out, you’re going to want to be able to work with it and that may mean a new capital investment,” he said.

Expertise required

Purchasing the mills and related technologies is part of the process, but successfully running a milling center takes in-depth knowledge of how those systems work. Brown came to the dental milling world with a background in engineering and general manufacturing. While learning about the specifics of dental restoration production was a hurdle, he was already comfortable running the CAD/CAM technology at the heart of Apex.

While every mill operates slightly differently, Brown and his staff make it their business to know the systems inside and out. A dedication to understanding how these mills function and how to use the software that controls them most effectively is critical to success.

“It is complex machinery,” he said. “Things go wrong. You need to be able to recognize when there’s an issue with product, what the cause is and how to rectify it.”

This knowledge also leads to being able to use these mills to create a superior product. A milling center must produce parts that meet the expectations of the labs that will be finishing them, while simultaneously maximizing the center’s own use of materials, time and energy. Brown said he and his staff at Apex approach this task with confidence because of their dedication to mastering the nuances of milling dental materials.

“We are strong in milling knowledge and expertise. We’re strong in scan and design,” he said. “We use multiple scanners; we use multiple CAD packages. We recognize certain types of cases that will be best handled with different systems and different mills.”

More than frameworks

That knowledge is an asset for a milling center in multiple ways. It’s critical for achieving optimal results from the mill, but it’s also a resource for customers. Brown and his staff are ready to suggest material options and milling strategies the lab might not have thought about. In some cases he has shared his expert opinion with the prescribing dentist to help keep a case on a path toward an optimal outcome.

“What we do in a day some of our customers are lucky to do in a month,” Brown said. “We see so many different cases, so many different types of preparations, so many different scenarios that we see what works.”

A milling center needs to be ready to effectively translate milling and laboratory terminology and nuances. Every employee at the milling center doesn’t need this knowledge but it must be a part of the business.

“You need the ability to interact with laboratories and doctors at their level, but you need to have the mechanical and technological background-especially if you’re going with open architecture systems-to plug it all in and make it work,” Brown said.

Primed for growth

Currently milling centers such as Apex provide scan and design services as well as milling, something Brown said will be the norm until scanners and design software become more common. When labs do have the ability to scan and design their own parts and full contour restorations, Brown believes there could be a business that exists to provide those labs with access to high quality milling.

But even if the industry moves in that direction, milling centers will still play an important role by giving labs access to the precision production large-scale mills are capable of providing. This would allow for even more specialized production in the industry, as the milling centers could be the experts in new materials and new production technologies, while the labs retain their expertise in designing and finishing restorations. 

“I like the concept of a milling center that can through volume afford to make the investment in the big equipment and let the laboratories stick to scanning, designing and finishing, and putting the personal touch on their cases. It’s what they’re great at,” Brown said.