Competitive Edge High Alloy Costs High alloy prices have lab owners looking for alternatives. With the current price of gold hovering around $900 an ounce and palladium pushing toward $500 an ounce, laboratories need to identify economical alternatives to alloy-based restorations. Conventionally cementable metal-free and press materials may hold promise to combat high metal prices. Metal-free, a cementable alternative
Metal-free restorative solutions are an alternative that laboratories can recommend to clients when a porcelain-fused-to-metal (PFM) restoration would normally be indicated. The best alternative to PFMs for single units (or some short-span bridges) is lithium disilicate because the cost of zirconia may be almost as high as the cost associated with high-noble alloys and more expensive than noble alloys. Single-unit restorations account for between 65% and 70% of the restorations that are fabricated with alloys. Lithium disilicate for these restorations represents a reasonable alternative to either zirconium-based crowns or PFM crowns that can still be conventionally cemented regardless of whether they’re fabricated using CAD/CAM or press technology. A recently introduced lithium disilicate material from Ivoclar Vivadent, IPS e.max Press LT, can be pressed full contour and easily stained and glazed in one firing for a very acceptable premolar or molar result. The same material only requires minimum enamel veneering in the anterior region for a highly esthetic result. This PFM alternative costs $8 to $9 per unit in materials, when units are batched together for pressing, and has the same labor cost as making a gold crown; some costs may be slightly more because of the higher esthetic requirements of veneering enamel on anterior restorations. Conversely, CAD/CAM lithium disilicate restorations require only about 15 to 30 minutes of total “hands-on” labor time for fabrication, depending on whether full contouring or slight veneering is needed. Although the material cost is higher (about $32 per unit), the labor savings can easily outweigh the added material cost. What’s more, the turnaround time can easily be measured in hours, rather than the days of labor involved in pressing. This can be a huge added value that doctors are willing to pay for. Alternative choices in alloys With alloy and precious-metal prices on the rise, other considerations might help laboratory owners maintain profitability when a PFM restoration is the only option. Taking advantage of any sort of controlled material price system is one recommendation. One controlled-price alloy is Callisto CP+ from Ivoclar Vivadent. It can be integrated into any laboratory that uses metal without additional technology investment. Additionally, laboratories should pay close attention to the expected yield based on alloy density. For instance, an alloy with a higher specific gravity will yield fewer crowns per ounce than an alloy with a low specific gravity. Callisto CP+ has a density of 9.0 g/cm3 compared to a typical high-gold alloy such as BriteGold that has a 19.0 g/cm3 density. Therefore, in addition to the obvious savings on intrinsic value of the alloy, Callisto CP+ can be expected to produce about double the yield per ounce. Considering the high-strength options If considering zirconia CAD/CAM options, laboratories should know that with these systems the initial equipment investment can be quite costly. Also, if the cost of learning a new system cannot be amortized to still ensure a good return on investment, then the new technology might not be worth it. Systems that fit into standard techniques, such as the lost wax technique, with minimal equipment investment offer the easiest savings. Consider also that if a zirconia CAD/CAM solution is warranted, the laboratory should factor in the “hidden” material cost associated with the system, such as milling burs, lubricant/coolant, and any per-unit milling fee. Each can add up to a significant per unit cost. On the other hand, some laboratory owners might advocate using zirconia restorations as a PFM substitute because the high cost can be offset by the savings in labor. Because zirconia substructures are essentially created in the milling machine, there’s no need for a waxer. Further, what little finishing is necessary may be accomplished by a ceramist, which could translate into a substantial savings in labor costs. Boost profits and productivity Laboratories may also need to explore ways to modify their operations to enhance productivity and profitability to offset skyrocketing costs. Listed below are several other suggestions that laboratories may consider to help offset or compensate for high alloy costs. 1. Make sure your casting area has the correct amount of splash guards. You’re always going to splash a little gold when using a traditional centrifugal casting machine. 2. Institute good accounting practices for precious alloys within the laboratory. 3. Train technicians on standardized systems. Doing so contributes to “hidden” savings. First, it helps laboratories save money on labor. Secondly, when technicians understand how materials handle, it helps to build efficiencies into the laboratory’s own processes. This also helps save money because more operations can be completed per hour. 4. Ensure that the laboratory implements good scrap collection practices. Many good scrap/grinding collection systems exist, but there must be a buy-in at the technician level to work effectively. If training is required for new systems, a big part should focus on vigilance at the level of the individual technician to minimize waste and maximize scrap collection. Scrap collection practices also include a good vacuum system. If possible, the area in which metal finishing is completed should not be carpeted to enable the vacuum process to capture as much “fly-away” scrap metal as possible. 5. Wax correctly. Waxers typically get paid per unit, and the natural tendency is to wax as fast as humanly possible. The result could be that three-tenths of a pennyweight of gold could be ground off. While that doesn’t sound like much, a typical laboratory that uses 10 ounces of alloy per month wastes 3 ounces or about $2,000, translating to about a $24,000 loss per year. 6. Work with doctors to ensure that preparations are appropriate for metal-free restorative alternatives. If the doctor cannot provide the type of preparations necessary for the PFM alternatives that the laboratory recommends, the laboratory won’t be able to fabricate them in a cost-effective manner.
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