The CAD/CAM Gap

Have you ever heard the Brittany Spears’ song, “Oops I did it again” Well, those words are currently ringing in my ear because what I thought would be a one to two year retirement lasted but a few weeks. Instead of lounging in my home in Vancouver, I am back once again in the dental laboratory business after acquiring Frontier Dental Laboratories of El Dorado Hills, Calif. Frontier is a 100-employee dental laboratory that caters primarily to the cosmetic dentistry market. I consider it very unique in the world of dental laboratories as the majority of our cases are either all-ceramic or cosmetic as opposed to restorative. I am pleased to say that once again, I will be putting what I preach into practice. Better yet, I am putting my money where my mouth is as the Frontier Dental Laboratory team and I pursue the next stage of evolution for our laboratory.

Anyway, this month’s article is about bridging the CAD/CAM gap. In a previous article, I talked about how we should prepare a capital expense budget for our laboratories. The natural progression to that article is which CAD/CAM system to invest in? In my eyes, there are two distinct philosophies to deal with before you spend your hard earned dollars: You need to decide if you want to take advantage of CAD/CAM by doing your own computer aided design (CAD) and outsourcing your computer aided manufacture (CAM) or by doing both the CAD/CAM yourself. The Procera system is an example of the CAD without the CAM while choosing to buy a Lava, Everest, Cercon, Cerec is an example of CAD with the CAM. Why one versus the other? Well, from my experience, I have seen countless laboratories buy a new fangled scanner or machine, set it up in a corner somewhere, ask Johnny to figure it out, attend a program or two, and start advertising it to their doctors with the hope of bringing new accounts into the laboratory. Most times, the equipment ends up gathering dust (to the dismay of many manufacturers), the fabricated restorations don’t appear as the manufacturers had said they would and onwards goes the vicious circle. I guess what I am saying is that I am less concerned with which piece of equipment but more concerned about the core issue: Once you have decided on CAD or CAD/CAM, how do you adjust your production line to fully support and take advantage of your decision.

This requires a process change in the laboratory. If you are in the CAD camp, what kind of technician is required to operate the CAD device? How do you integrate it into your production line? Do you need a technician to operate this or are you better served with a trained CAD operator? Maybe even someone from the graphic design field? The answer is, it depends. I believe that with enough training and supervision, you don’t need your most talented technicians to operate the CAD device. The key again is to be committed to making it work for you and putting the process changes in place in your laboratory so that you have a separate production line focused on the technology. Yes, treat it as a separate line and invest in its development. Also, I believe that if you can’t get the CAD to work for you, the probability that you can get the CAM side to work is fairly slim. That’s because the CAM side requires even more commitment: quality control processes, regular calibration of equipment, more software and hardware upgrades and more work coming in so that you have the volume necessary to get proficient at it. I guess what I am saying is that if you are in a five technician or fewer laboratory, it maybe more profitable for you to outsource your CAM unless you are building your laboratory around a CAD/CAM commitment.

In closing, I would like to quote Albert Einstein’s definition of insanity: “Doing the same thing over and over and expecting a different result.”

I have seen too many people and too many laboratories dip their toes into CAD and/or CAM and ultimately fail. The equipment you choose, I believe, is secondary to the most important question: How do I create a change in my production processes to allow me to take advantage of the technology and who should champion this change in the laboratory?