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March 2009 | Dental Lab Products
Forward Trends: Digital Outsourcing

	RELATED CONTENT  CAD/CAM: The next generation Industrial-strength partner Concept: CAD/CAM

Some assembly required


The evolving digital workflow paradigm is expanding the role of the multi-system production facility while refocusing smaller labs as an assembly and finishing point for restorative parts.

By Richard Palmer

Traditionally a major aspect of the dental lab business, outsourcing is coming into a whole new age that will change the landscape of the profession from its historical hand-crafted artistry into a new-generation industrial model based on assemblage of mass-produced, yet still customized, components in a manufacturing concept unique to the dental industry. Digital technologies allow for customization before actual manufacture rather than as an integral part of the fabrication process and have set the stage for a new production paradigm.

The dental lab is in the process of evolving into a clearing house of sorts, designing case-specific parts, electronically sending those digital designs to various manufacturing partners for high-volume fabrication of the individual elements, then receiving the custom pieces to put them together as a whole. Only then does the hands-on physical manipulation of individual characterization (if necessary) figure into the equation for completion of the restoration before the final product is sent to the dentist, who probably won’t even know a revolution has occurred right before his/her eyes.

Technologies from CBCT radiography to intraoral digital impressions may eventually merge into a single patient file for complete digital treatment planning and restoration design by clinicians, technicians, and manufacturing partners.     SIZE MATTERS  Of those who use the services of a CAD/CAM outsource center, smaller labs are most likely to tap into this resource...  # of Technicians  % Outsourcing  1-2  47.3%  3-5  18.9%  6-10  16.2%  11-25  13.5%  26-50  4.1%  Source: January 2009 DLP Technology Survey

Technology is constantly changing and moving in new directions with innovations and advancements coming almost daily, and it presents nearly unlimited opportunities for growth for business owners willing and able to shift their mindset. The most prevalent technology to emerge in the dental industry in recent years has been CAD/CAM. Hardware (e.g., digitizing model or impression scanners, digital impression-capture devices, cone beam computed tomography, rapid prototyping 3D printers and laser sintering units, and milling machines), software (restoration design applications, treatment planning, file transfer, and communication protocols), and materials (millable zirconia blanks, 3D printable resins, laser sinterable polymers and metals, and CTE-compatible veneering ceramics) have all exploded through research and development and both facilitated and complicated the way dentists and labs interact.

The CAD/CAM outsource laboratory business model has incorporated most of these emerging technologies and amalgamated them into this new paradigm. Today, a growing number of centralized production facilities now specialize exclusively in receiving outsource business from other labs for producing CAD/CAM-based substructures for constructing restorations.

Production Partners

The evolving business model of the large centralized production center has blossomed, not as competition with traditional laboratories but as a partner. The smaller, 1-to-5-person labs that make up the majority of the 15,000-plus dental laboratories in the United States can continue to directly service their individual client bases while offering a more diverse menu of services and remain viable in a troubled economy, often with little or no capital investment.

According to the 2009 January DLP Technology Census survey of laboratory owners and managers,¹ more than half (54.0%) of labs use the services of a CAD/CAM outsource provider. Additionally, more of the smaller labs use these services than their larger counterparts, (See “Size matters” on the right).

Some outsource providers focus on a single CAD/CAM system and material, while other centers offer a wide range of materials and services (from zirconia frameworks and all-ceramic bull-contour crowns to 3D printed models,  polymer resin copings for pressing and/or casting procedures) created on a growing number of sophisticated CAD/CAM systems and technologies.
“The work coming back to the laboratory will be more like unfinished furniture,” said Dell Dine, VP of Research and Development for National Dentex. “They will be getting back something that is almost entirely completed to, in effect, put their signature on.”

The benefit to a central production concept helps not just the small, independent labs. According to Dine, “Centralized processing will become a significant advantage to [National Dentex] in being able to improve our management and our margins. We can do some centralized manufacturing for far less than what it costs to manufacture at the individual facilities.”

Digital Direction

Most of these outsource facilities continue to work from traditional stone models shipped by the labs for digital scanning to begin the CAD/CAM process, while others have moved to accepting (and promoting through reduced pricing) digital design information directly from the primary lab that has scanned the model itself or even received and processed a digital impression from the dental office. This direct-from-digital approach is gaining acceptance as labs purchase scanners for in-house digitization of models.

“The scanners are going to come down in cost, so the small labs can easily get their arms around it,” said Dine, who sees an economical scanner in the $7,000 to $10,000 range available within the next year.

As scanners and the compatible design software become more affordable, easier to use, and open to more CAM systems, a subtle yet important change is bringing forth a new business model.

“We’re building the dream partnership of the future for dental laboratories—a digital processing center requiring no capital investment by the lab,” said Mike Girard, CEO and President of Diadem Digital Solutions, which is set up to accept digital data from labs (Click here for “Industrial-strength partner”). The CAD work can be done by the lab or by Diadem staff, followed by lab approval. To offer aggressive pricing, Diadem will encourage its lab clients to handle the scanning, margin marking, and design. Data files can be sent electronically from the lab’s open, closed, or selectively open systems or forwarded from the dentist client’s digital impression device.

“My goal is to work with 200 to 250 labs who get it,” he said of his next-generation digital business model. “It’s going to be a digital processing center. The lab sends me the data; I print or mill the parts and send it back to them.”

On the CAM side of the operation, Girard has invested in a concentrated core of manufacturing technologies and incorporated them into a state-of-the-art facility with the objective of providing high-quality, nearly completed restoration components. Diadem is installing robust, industrial-strength Roeders CAD/CAM equipment that incorporates robotics for changing machining tools as well as multiple magazines of millable Ivoclar IPS e.maxCAD lithium disilicate “blue blocks,” Diadem’s Diazir house-brand zirconium copings and frameworks, and e.max ZirCAD zirconium oxide blanks. “It’s a big monster of a machine,” said Girard of the $500,000 behemoth. “You won’t see a lot of labs running out to buy this machine.”

A digital workflow also allows labs to divide the work among outsource providers. Certain CAD operating systems feature “file splitting” functions that permit the technologist to design the full anatomy of the restoration then divide the design into different components, such as a polymer model to be printed or milled, a zirconia coping to be CAM milled, and/or a wax/resin form to be 3D printed for pressing the overlay to full contour.

“You can design this all in one swoop,” Girard said. “You take an anatomical file that will dictate how the framework looks based on an anatomical file that fits into the contact points and occlusal scheme, then design the framework.”

Incorporating digital design into more of the fabrication process also allows each technician to perform more efficiently. “In many of the labs I visit, the average ceramist stacks and contours about 10 units a day. The average technician doing copings can wax, cast, and trim about 10 units per day” Girard said. “In this new automated digital world, one technician may be capable of designing 50 crowns a day or more. That’s 50 copings or bottoms, and 50 tops...100 units a day.”

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