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The Outsourcers

THE OUTSOURCERS

"The Outsourcers." OPTIONS Jan/Feb 2010: 22-25

Eight experienced CAD/CAM outsourcers talk about their businesses; the CAD/CAM systems, scanners and materials they use; the companies they partner with; their biggest challenges; questions they commonly hear from laboratory customer; changing market conditions; misconceptions they'd like to correct; plans for new technology purchases; forecasts for the future...and other CAD/CAM outsourcers they respect.

Here are Mark Jackson, RDT's responses

Questions answered by Mark Jackson, RDT, Vice President and Co-Owner. Visit www.pcdl-usa.com

Since what year have you been a CAD/CAM outsource service provider?

Back in 1984, we were the only laboratory promoting crown and bridge services to other ceramic laboratories. We added CAD/CAM options to those services starting in 1993.

Do you provide CAD/CAM services only to laboratories or also to dentists?

Precision Ceramics is a full service dental laboratory. We offer our complete menu of services to both laboratory and dentist clients.

What CAD/CAM systems do you use?

We've been involved in CAD/CAM and computerized dentistry from its early days, and are involved in R&D projects and beta testing of new technology. For example, we were involved in early development and trials of the iTero digital impression systems and Imagen 3D printing from the Ex One Company.

At this time we offer the following CAD/CAM services: Prismatik Clinical Zirconia, BruxZir Total Zirconia Restorations, Lava, Imagen, Procera, Cercon, Etkon, CAD/CAM implant bars, zirconia and titanium custom abutments, Wol-Ceram, NobelGuide Surgical Guides, IntelliPlant Surgical Guides, Roland milled wax & resin patterns, IPS e.max CAD, COS digital models and iTero digital models.

How often does a laboratory client choose the system that's used, and how often do you make that determination?

In 90% of our cases, the customer has requested the product by name.

Precision Ceramics offers its services the way a restaurant presents a menu to its guest. We make our selections known and let the customer choose from that menu. We do not try to talk someone out of a particular product, unless it is contraindicated for that application, or if we believe the customer may get a better result using another system or material. One example might be suggesting an e.max restoration when reduction is thin and substructure show-through is a concern, or using BruxZir when the occlusal scheme appears punishing.

From time to time, we may have a promotion for a particular product, and will make any cost savings known to the customer during the period that promotion is taking place. It may be as a result of a manufacturer incentive, or a new product introduction, but the final choice is always left to the client.

Approximately what percentage of your laboratory clients currently own their own scanners?

Very few of our customers scan and design their own work. Most send cases to us for scanning, design and fabrication. But inexpensive and easy-to-use open architecture scanners with a wide variety of design features are now available, so I expect this to change. We are prepared and have the capacity to accept these cases today.

Do you have clients who once handled both CAD and CAM functions in-house but have changed to outsourcing the CAM function?

Yes. We have quite a few customers who used to do all or some of their own CAD/CAM restorations in house. Some of these customers found that the amount of time required to process these cases was better spent performing their signature work. They either sold their CAD/CAM equipment or now use it only when time constraints require it.

Others found that the amount of money tied up in block inventory was better spent on their company's other cash flow needs. Still others found that customers were requesting a specific product by name and would not accept the alternative product they were offering, regardless of how similar it might have been to the one prescribed.

These are factors that need to be weighed carefully before a system is purchased-not after.

What's the most frequent question or concern you encounter from a new laboratory client?

I think the most common question we receive are the same ones a new dentist asks us, and the same ones our new lab customer's dentists ask him: Can you consistently deliver a high quality product?

Can you follow instructions and meet my specific personal preferences? Can you promise to deliver my cases on time?

What are the three most important things you want prospective laboratory customers to know about the CAD/CAM services you offer?

Our laboratory is DAMAS certified and meets FDA Good Manufacturing Practices. We receive a third party inspection and each of our cases has an unbroken, traceable chain of possession from the moment it arrives until the moment it leaves, and only properly trained and qualified/certified technicians are allowed to work on it. All lot numbers are recorded for your protection and in accordance with FDA regulations. Material disclosure and authentication is provided with every case.
Every customer's personal preferences are documented and printed on the laboratory work ticket, which accompanies each case. Quality control checks are performed at every stage and bar-coded. This data is used to generate QC reports and limit who works on a particular customer's case. CAD/CAM technology does take out some of the human error, but a customer's own personal preferences need to be incorporated in to the case, and we make sure that happens.
We know that our laboratory customers need as much time as possible to process their cases, so copings and substructures get priority treatment and go into the scanning queue first. Because of the way we split our shifts, we maximize manpower and machine productivity and ship your cases on time. Most cases leave within 24 hours of arrival. Our website, www.pcdl-usa.com, allows customers to log on and check the status of their cases, or trace those that have shipped or that are out for delivery.

What's the greatest challenge you currently face as a CAD/CAM service provider?

One of the biggest challenges for any lab owner investing in CAD/CAM equipment these days is the generic and counterfeit products that flood the market once a product becomes popular.

If, for example, a lab has invested $200,000 in a CAD/CAM systems that produces a particular product that is in high demand, and that lab's dentists are sudde3nly swamped with cheaper versions of a similar product, it makes investing in a new technology very risky.

One must ask: Can this new product be copied? Is there a way to differentiate this product from imposters, and if the substituted product fails, will my brand be protected? It's a very dangerous situation right now, one that necessitates caution in choosing partners.

What new CAD/CAM-related system/equipment/material that you don't yet own or use (or that is not yet available) are you looking at (or anticipating) with interest?

I am very interested in seeing more"additive" technology, but not in terms of waxes or pattern materials. I don't think that technology yet delivers any real benefits that aren't lost in the investing and casting or pressing steps. What intrigues me is the printing of restorative resins and ceramics, to full contour, and with gradient color.

I'm also excited to see the printing of powdered metal and ceramic implants from CT Scans, and other types of prosthetic solutions for implants based on CT technology. We've already made considerable investments in this area, including opening a CT Scanning and Implant Planning Center with a high resolution cone beam CT scanner in-house.

What's your expectation for your CAD/CAM outsourcing business in 2010?

I expect the economy to continue to be challenging for at least 2010, and perhaps in 2011. If that is the case, pressure to lower prices may lure unknowing dentists and labs into the trap of accepting counterfeit products.

I expect to see lower and lower block prices from the generic market, and I expect we'll see the open architecture scanners allowing more rapid prototyping companies to enter into dental technology.

I believe that as the war against terror begins to slow down, many of the rapid prototyping companies that made their living off military-related industry will see that some of their competitors will found a niche in dental technology and we'll see a second wave of new entries into our market.

Where will we see the most growth over the next five years-in the size/capacity of current outsource service providers or in the number of outsource service providers?

I think we'll see few new, large outsource providers. The outsourcing market is already over saturated and the capacity is much higher than the true demand. Some lab owners are being offered free milling machines in exchange buying blocks under contract from a certain supplier, which as eroded the base of medium-sized labs that delivered a lot of the volume to milling centers just a few years ago.

Not wanting to miss out on the outsourcing business, these little milling centers now enter the market place and further dilute the available client base. I have also seen many milling centers open that are dedicated to just lab outsourcing, like my friend David Lesh has done with Dale Dental. But can they continue to invest in new technologies and grow like David? Some of the labs who were ordering zirconia last year are using lithium disilicate now, leaving some small, dedicated milling centers with few or no customers.

Technology is changing so fast that some systems are obsolete before they hit the market, and as we start to leave the zirconia market and move toward new materials, some will require wet cutting environments or combinations of printing and laser technologies. Acquiring equipment, paying it off and funding new investments will require larger volumes of work , and smaller outsourcing labs may find it hard to keep up.

Finally, expect to see some labs bridge the gap between CEREC and conventional lab work, by offering single crowns and three unit bridges directly off of intraoral scans and delivered without a model.

What's the most common misconception you hear about CAD/CAM-fabricated work?

"All zirconia materials and all CAD/CAM systems are the same."

As a lab owner with a dozen different systems in-house, I am uniquely qualified to state unequivocally that each system has strengths an weaknesses, and I've been involved in enough beta testing to know you can't just take an open scanner and mate it to a milling machine and a generic block and expect the same results. There is a lot of science behind the big name-brand manufacturers who develop all-inclusive systems.

What do you say to laboratory owners who haven't yet gotten involved in CAD/CAM technology?

I believe that in the not too distant future, the majority of single crowns and three unit bridges will be done mostly using CAD/CAM technology in one form or another. They are not technically challenging and can be easily managed, sometimes without needing a model. Some of these will be processed using digital impressions and milled in a laboratory and some will be manufactured chairside.

On the other end of the spectrum, more sophisticated cases and immediate load implant prosthetics are being manufactured using CAD/CAM technology, as are surgical guides, orthodontic devices and even sports mouth guards. While there will always be a need for small, boutique laboratories, I think wise lab owners will keep abreast of CAD/CAM technology and partner with laboratories that can help them leverage this technology without having to gamble on a risky capital investment.

Please name another CAD/CAM service provider you respect - and explain why.

I have a great deal of respect for Glidewell Laboratories and their innovative product development. They have the horsepower to develop and market a "house brand," which is traditionally a very risky and expensive proposition. But all the marketing aside, their R&D efforts, quality control and innovative ideas impress me beyond words.

Prismatik Clinical Zirconia and BruxZir Total Zirconia are popular, high quality, cost effective restorations that allow a reasonable ROI for the labs that offer them. This was an organic development at Glidewell and a very successful one. I'm always inspired and motivated after a visit to their laboratory and meeting with their team of experts.

Contact Precision Ceramics at 909-625-8787 or 800-223-6322. Visit www.pcdl-usa.com

To read the full "Outsourcers" article click hereOptions Jan-Feb 2010 "The Outsourcers"

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