CAD/CAM and New Material Technologies

In the dental laboratory industry, Computer Aided Design/Computer Aided Machining (CAD/CAM) can help keep laboratories competitive, productive and profitable. Simultaneously, in-laboratory CAD/CAM has been suggested as an answer to the impending technician shortage.

Currently, an estimated 50 percent of Certified Dental Technicians are over the age of 50. In many instances, laboratory technicians are retiring at a faster rate than they are being replaced. What’s more, statistics indicate that an average of 10 percent of technicians leave the industry every year. So, at a time when our industry is facing technician shortages, incorporating CAD/CAM into my laboratory has been like adding at least another technician or two.

Increased Production

I first tested the market for this all-ceramic modality by outsourcing the CAD/CAM processed copings. But when we built up a $14,000 a month bill to the outsourcing company, it was time to invest in this technology for ourselves. Purchasing our own CAD/CAM equipment has since enabled us to provide faster service, increase production, and enhance the skills of technicians who have now moved on to more creative ceramic work and profit centers.

What do I mean by profit centers? Well, when someone waxes or does something to affect the finished product, but doesn’t actually finish the product, their work is a cost of doing business. You charge a fee for that restoration and the technician’s labor is accounted for in the charge. But, what if you take that technician’s labor out of the equation - using a technology that enables you to increase your production by eight units a day - and actually have them finish the restoration? You’re now producing eight more units per day without adding an employee!

What was attractive about CAD/CAM for me was the potential to have employees replaced at positions that don’t actually produce billable products. Instead, these employees were developed and repositioned into more creative areas. For those technicians, it was an opportunity to make more money. The technology didn’t replace them; it replaced the tedious tasks they were doing for which I couldn’t charge a fee.

Now, granted, once someone develops more talents and learns how to finish ceramic restorations, you have to pay them more. So, you pay them $30,000 a year more. But, if you’re now earning more in additional production revenue, that math would work for me.

More Production in Less Time

Considering that many of the nation’s laboratories are ‘mom and pop’ shops, the typical call I receive from someone inquiring about whether or not to incorporate CAD/CAM into their own laboratory is usually from a one- or two-person laboratory. They’ll want to know if it’s worth it.

So, I’ll ask, “How many units do you do per day?” They’ll say between three and five. I’ll ask, “How many hours a day are you working?” They’ll say 14. Then I’ll ask, “If you could work only eight hours per day and still produce your three to five units, would CAD/CAM be worth the investment?” Well, of course it would! Or, I’ll ask, “Now, what if you wanted to continue working 14 hours a day but could double your production and make more money? Would it be worth it then?” Usually, the answer is yes!

Making the Technology & Materials Work for You

With the introduction of IPS e.max (Ivoclar Vivadent), laboratories can realize greater productivity, performance and esthetics when fabricating all-ceramic restorations by eliminating the need for inventorying multiple porcelains, streamlining the training of ceramists, and minimizing costly mistakes that result from using incompatible layering materials. That’s because IPS e.max is the first universal system for CAD/CAM and various pressable fabrication techniques that can satisfy what I call multi-media case needs, regardless of the esthetic, functional or complex requirements of the case.

What’s more, if you’re a laboratory considering CAD/CAM, you can invest in the CAD/CAM design and milling technology (which is about $34,000) and use the lithium disilicate IPS e.max CAD blocks, without the need to purchase a special oven. Rather, a conventional oven can be used. Better still, the IPS e.max CAD process for developing an all-ceramic coping that is ready for ceramic layering takes less than 53 minutes from start to finish (i.e., computerized coping design, milling, margin adjustment, and crystallization). Less than three of those minutes are spent in hands-on time.

In comparison to other coping alternatives-such as metal-the IPS e.max CAD process is significantly more efficient. Because the product line includes a layering ceramic (IPS e.max CERAM) that spans the CAD/CAM and pressable technologies, one ceramic system can be used for almost all restorative procedures (whether zirconia, pressable or lithium disilicate CAD/CAM), ensuring truly functional and esthetic harmony in the restorations we produce for a multi-indication case.

This to me is key. Up until now, when you would mix and match copings and apply a layering ceramic on top, if it didn’t look the same, or it wasn’t the same brand, then it was very difficult to achieve a unified, esthetic look in terms of value, nuances of shading, etc. But with IPS e.max, we can do a full-mouth rehabilitation case and use a CAD/CAM zirconia restoration in the posterior for strength, a CAD/CAM lithium disilicate restoration on the bicuspids and pressable veneers on the anteriors, knowing that they will demonstrate the unified esthetics we want.

Industry experts have observed an increased use of computer-based technologies in order to keep up with the demand for convenient and esthetic restorations. At a time when we’re faced with a shortage of talented and able technicians, incorporating CAD/CAM into your laboratory may enable you to realize greater productivity and profitability. Additionally, the use of recently introduced materials that are designed to maximize the efficiency of this technology may be beneficial.

Do you have a question for Nelson Rego, CDT? E-mail jdt@nadl.org.