Nearly 50% of respondents to a recent LMT e-survey say they plan to invest in some type of CAD/CAM equipment within the next five years. If you're one of them, but are daunted by the options and don't know where to start, LMT's done your homework for you. Here, we talk to laboratory owners who've already made the investment and find out how they decided which system was right for them.
There's a long list of reasons to get involved with CAD/CAM technology: it's an automated, efficient method of production; it allows you to work with the latest materials and techniques; and it helps you maintain a reputation of being on the cutting edge. But with so many CAD/CAM outsourcing options available*, it's easy to offer your clients a CAD/CAM-fabricated product—so why invest in your own equipment?
For many lab owners, it boils down to one issue: control. For example, Larry Borman, co-owner of Tetra Dynamics, West Babylon, New York, had been outsourcing CAD/CAM restorations to other labs, but when he grew unhappy with the quality of copings, he bought his own scanner. "We were having issues with fit and were spending a lot of time adjusting the copings we got back," says Borman. "By scanning and designing our own restorations, our results are better and more consistent and we improved our product offering to our dentist-clients."
Other operations are looking to build a new profit center by offering milling services to other laboratories. "Lab-to-lab business is increasing as new products and technologies become available and we wanted to be active in this growing sector to generate an additional revenue stream for our laboratory," says Kevin Hudi, vice president quality systems at Knight Dental Lab, Oldsmar, Florida, which began offering outsourcing services to labs in October.
But even labs that aren't adopting the milling center business model are investing in complete systems because they see them as the answer to a changing market. For instance, Dene LeBeau bought a milling unit last year largely because his lab handles a high number of full mouth rehabilitations involving metal and, given the rising cost of gold, he wanted the ability to mill titanium. "In the foreseeable future, we'll still need metal substructure to fabricate bone loss/pontic-involved bridgework and a milled pure metal like titanium may now be a more viable option. It's always been a great metal, but was difficult to cast and there were limited choices of porcelain. Milled titanium eliminates those issues," says LeBeau, owner of 12-person Precision Aesthetics in Renton, Washington. And, since LeBeau works with a small group of high-end dentists, he wasn't comfortable outsourcing the work, so he brought the technology in-house.
Choosing a system
Your capital outlay is going to vary depending on your goals and how you plan to incorporate the technology into your laboratory. Complete systems that enable you to scan, design and fabricate range from $60,000 to over $300,000 whereas scanners and the related software typically sell in the $20,000-$30,000 range but you'll also have to pay to outsource the fabrication.
To calculate his return on investment, Borman considered a variety of costs, including training, labor, material and the volume and price of work he'd be fabricating. For instance, he was outsourcing about 40 units per month and knew clients would easily double that number if the laboratory improved the quality of the final product. He estimated that his per-unit cost would be about $100—including direct labor (scanning through porcelain build up), material and the scanner payment—so if he fabricated 80 units per month and charged $200 a unit, it was possible to pay off the $24,000 scanner within six months; he opted to pay it off after one year for the tax benefits.
Here are some others things to consider during the evaluation process:
Decide which types of restorations you want to fabricate. Restorations and material options vary by CAD/CAM system. Are you focused on single zirconia units, or do you need the ability to do more complex restorations?
Since David Nunnally's goal was to offer a zirconia product, he chose a system that mills both copings and bridges out of that material. "Our unit does 98% of what we need and then we outsource the other 2% we don't have the ability to handle, like a Maryland bridge or restorations with inlay abutments," says Nunnally, owner of Derby Dental Lab in Louisville, Kentucky.
On the other hand, since LeBeau works on a lot of complex cases, he needed a more versatile machine. "I wanted more than just the ability to mill zirconia," he says. "One reason I picked my machine is that it mills in five different mediums, including titanium, castable plastic and ceramic."
It's valuable to see "real-world" restorations for the type of work you want to fabricate by outsourcing to labs who already own the equipment. For instance, over the course of two years, LeBeau outsourced to about 20 different laboratories so he could evaluate the quality and marginal integrity of copings from the various systems. However, keep in mind that the quality and fit of the copings are only as good as the CAD/CAM technician doing the scanning and designing, so it's a good idea to try the same brand restoration from more than one source.
Determine your daily output requirements. A milling center will likely need a higher daily output capacity than a lab that simply wants to offer zirconia restorations to its existing dentist-clients. "Since I was going to offer milling services, the unit I chose had to mill enough units per day to make the investment worthwhile," says Chuck Warren, a CAD/CAM consultant and owner of Tempus Dental Lab and Wasatch Milling Center in Springville, Utah. "I looked at systems that ranged from $275,000 to $480,000 but since they could only mill between 35 to 80 units a day, the outputs didn't justify the cost." He ultimately chose a system that mills up to 120 units a day and was also less expensive.
Similarly, you want to be sure the capacity of your scanner and milling unit are evenly matched. For instance, if you can scan 60 units per day, can your milling machine fabricate the same number of units, or do you need two milling machines? Also, if a machine has two capabilities you want to maximize simultaneously—such as milling zirconia and milling resin copings—multiple systems may be necessary.
Assess software and scanner features. "A feature like automatic margin recognition is great because it will recognize the margin 95% of the time," says Warren. "But for the 5% of the time that it doesn't, make sure the software gives you the tools you need to manipulate it."
Also, does the software offer the bells and whistles you'll need? For example, the latest trend is a feature that allows you to design a virtual coping/framework and full contour simultaneously and then fabricate them out of two different materials. The coping can be milled out of zirconia and the full contour can be milled out of wax, then invested and pressed using traditional techniques. If newer features like this are not available, what updates does the manufacturer have planned?
Another consideration is the scanner type. For instance, a grid scanner takes scans from the top down, so it requires you to manually reposition the die at different angles. In a scanner with lasers and cameras, the process is automated but the hardware is also more expensive.
Ask if the system is open or closed. An open system is one that works with other manufacturer's equipment or software. For example, you buy a scanner from company A and use a milling unit from company B. A closed system is bought as a package from one manufacturer and cannot be combined with other manufacturers' hardware or software.
Warren has reservations about the open system concept, so he opted to buy an entire system from one manufacturer. "A lot of labs say they're waiting for the open architecture, but when you use two different manufacturers' systems there's no guarantee that, together, they'll work correctly," he says. "And who's going to back the end result if there's a problem?"
On the other hand, Knight Dental Lab felt an open system was the only way to go because of the versatility it offers, so it bought components from two different companies. "There are a lot of systems on the market now for milling, scanning and printing and each company has its core competencies. We wanted to work with the company that offered the best scanner and then evaluate who had the best end mill," says Hudi. "We also feel the technological revolution is in its infancy stage and we want to build our infrastructure so it's capable of interfacing with new digital and CAD/CAM technologies that are not currently available."
Evaluate the potential manufacturer-partner. A strong marketing campaign can help build demand among your dentist-clients. For example, the percentage of Borman's CAD/CAM-fabricated work has doubled in the last two years—from 8% to 16%—thanks, in part, to the manufacturer promoting its brand to dentists. "Ideally, the manufacturer is pulling out all the stops when it comes to marketing so you can ride the coattails of its efforts," says Borman.
Since the digital world is moving full speed ahead, buyers also recommend partnering with a manufacturer that's going to be committed to evolving with the technology. "The technology is advancing rapidly, so the key is to hook up with a company you have confidence in and that will continue to move forward and keep you up to date," says Warren.
Know the unit's space requirements. Manufacturers will typically give you detailed information on the system's total footprint so you can be certain you have the space to accommodate the unit. For instance, Haupt Dental Lab has a scanner, PC and a sintering furnace that take up about 20 square feet of bench space—prime real estate in the 4,500-sq.-ft. lab. "Our manufacturer even sent out a representative to our lab before shipping the product," says Ryan Haupt, manager of operations for the Brea, California laboratory. "If it wasn't for this service, we would have had to wait a considerable amount of time before we could have set up and used the equipment."
Ask about material costs if you're purchasing a complete system. With some systems there's a set number of units you can mill from one block; other systems allow you to "nest" units, meaning you optimize the number of units you can fabricate from one block, reducing your material costs. For instance, when Nunnally's software was upgraded to allow nesting, his per-unit price went down $11 per unit, from $36 to $25.
Also find out if the manufacturer allows you to buy materials from any source, which can help keep material costs down. For instance, since Hudi's system doesn't lock the lab into one vendor, it has access to more competitively priced materials and the lab's cost per unit has been reduced from about $40 a unit down to $12.
However, be wary of cheaper alternatives not approved by the CAD/CAM manufacturer. Warren learned that lesson the hard way when he tried fabricating a three-unit bridge from an after-market disk. "I used the same scan and design steps I usually do, but it didn't even come close to fitting," he says. "Who wouldn't like to save $200 a disk, but it's not worth it if you have to remake the case." If you do decide to use an alternative source for material, ask the vendors to provide written information backing up the materials and ask for the names of other lab clients as references.
