Jerry Ragle, CDT, owner of Ragle Dental Laboratory, Champaign, Illinois, has the unique distinction of being the first laboratory in the U.S. to become a regional production center for milling Cadent models based on data from the Cadent iTero digital impression-taking system. LMT talks to Ragle—a long-time advocate of digital technology—about his latest foray into the digital world and the future of milling.

LMT: How did it come about that you’re the first laboratory to become a Cadent model milling center?

Ragle: I’d been using the Cadent iTero Digital System since its launch in early 2007 and was immediately sold on the value of the system and the clinical results. I’ve always been fascinated by automation and how it impacts production. I became curious as to how the Cadent models were made and approached Cadent’s COO Tim Mack about my interest in becoming a milling center.
Cadent’s headquarters is based in New Jersey and last year when gas prices were rising, the costs to ship models via overnight service across the country were soaring. At the same time, I had purchased a new building and since we’re located in Illinois, we can offer most Midwest customers overnight service but only pay ground prices thereby reducing Cadent’s shipping costs. The timing seemed right for both of us and then Cadent and I came to a financial arrangement which included both equipment and services.

LMT: Tell us about the milling center.

Ragle: I purchased a defunct restaurant adjacent to the laboratory and converted about a third of the 3,900-sq.-ft. building into the production center. It now has four Haas milling machines modified to mill polyurethane dental models, and room for a fifth machine if we need it in the future.

The dentist takes a digital impression using the Cadent iTero intraoral scanner and transmits the data to Cadent, where a preliminary digital design of the model is created and then sent to the dentist’s laboratory for approval. Using the Cadent iTero CAD software, the lab analyzes the virtual 3D model data, checking for areas of further reduction, prep design and marginal integrity. Once approved, the data is sent back to Cadent for milling. However, if the lab is located in the Midwest, Cadent sends the data to us and we mill the models and dies and ship them directly to the laboratory customer. We have three shifts, each with one staff person, and we’re producing about 120 models every 24 hours. In addition to servicing the Midwest, we also handle overflow production from the New Jersey headquarters.

LMT: What kind of renovation did you have to do in order to accommodate the milling machines?

Ragle: Each milling machine weighs over 7,000 pounds and is almost 9' tall by 10' wide and 8' deep once set up. We had to cut out the existing 4" concrete slab floor and re-pour it to 8" to accommodate the weight of the machines. We installed a special door assembly normally found in car showrooms as our front door. It has one operating door of normal size but the other side can be unlatched to create a 9' by 9' opening. Even though we confirmed over and over the height of the machines, I was still sweating it on delivery day because if the opening was too small, I was going to be in trouble. Fortunately, the machines arrived on a semi with a 10,000-lb. forklift that easily picked up one of the machines and drove right into the building with room to spare.

Our renovation had all the normal issues, problems and delays most construction projects seem to go through. For a little over three months and four to six hours a day, I wore the contracting hat. Thankfully we had a great architect on the project with good drawings and detail.

LMT: What has been the reaction among your dentist-clients to the milling center?

Ragle: We have five local clients using the Cadent system. Others are very curious and impressed with the technology but they’re still resistant. For the most part, dentists feel they send adequate impressions. Some do, but the fact is that laboratories have simply done a great job at overcoming the inadequacies and imperfections of impression material.

It’s not uncommon to hear comments like, “I’m not sure digital impressions are any better than regular impressions,” “I’m not computer savvy,” or “I don’t change easily, I tend to stay where I am.” The last statement seems to be the greatest obstacle and we’re trying new strategies to overcome this mindset. We recently hired a new sales person and we’re sponsoring peer-to-peer courses in which clients who use the system explain their experiences. For instance, Dr. Curtis Mitchem was our first client to purchase the iTero system and we tracked his results carefully. Within one-and-a-half years, he reduced his patient schedule time by 38.5% and improved his bottom line by $140,000; his business with us increased 15% and he has had no remakes.

LMT: What impact has the milling center had on your laboratory business?

Ragle: While other areas of our laboratory business are down due to the economy, digital impressions are on the rise, therefore the milling center is proving to be a profitable niche that ultimately helps our bottom line.

LMT: What do you see for the future of milling and your production center?

Ragle: Currently, digital technology is all about fixed restorative work but that will change. As I watch these machines work not only in milling models but in other industry applications, I see it’s only a matter of time before we’ll be able to mill just about anything. For instance, with CT Scans and the virtual articulation data already available, it seems logical that at some point, we’ll be able to scan the edentulous arch and mill a denture; all we need is the software and correct material.

The processes I’ve done everyday for 36 years are becoming archaic and almost everything I knew is being thrown out the door. I look forward to it because we seem to be one of the last industries doing some of the things others have replaced many years ago.