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Our own Mark C. Jackson, RDT contributed to the

December 2011 issue of MENTOR - MentorIsSalesPower.com

THE ROAD LESS TRAVELED

By Rebecca Stone

If dental labs haven't been a part of your route, you may want to reset your GPS before you miss the exit to some rich sales opportunities.

They combine science and art to craft the perfect stand-ins for missing dentition: miniature master pieces whose strength, beauty and value - at least to the patient - surpass that of diamonds.

They combine science and art to craft the perfect stand-ins for missing dentition: miniature masterpieces whose strength, beauty and value — at least to the patient — surpass that of diamonds. They may work in a dental office, in a two-person lab or at a large commercial site, but wherever they ply their trade, dental lab technicians perform a critical function when it comes to enhancing smiles. To forge these custom restorations, technicians call on disciplines ranging from chemistry and metallurgy to anatomy and morphology. They also employ a mélange of materials and equipment — as well as skill and a sense of design. In the end, their handcrafted art not only must look good, but must also be functional, comfortable and strong enough to withstand high compressive force.

"Today's dental laboratories rely on a mix of technologies that includes such ancient and simple devices as alcohol Bunsen burners, spring-powered wind-up centrifugal casting machines, and belt-driven grinders, drills and handpieces," notes Mark Jackson, RDT, co-owner and vice president of Precision Ceramics Dental Laboratory in Montclair, Calif. "On the other hand, we also use sophisticated 5-axis laser scanning and measuring devices, precise German CNC milling machines and photopolymerizing stereolithography [i.e., 3D printers]."

Jackson points out that the kinds of consumables in demand for lab work range from those used in manufacturing processes, such as plaster, to those that are tightly regulated by the United States Food and Drug Administration (because they end up in patients' mouths). These include items such as gold alloys and ceramic layering materials. It adds up to fertile ground for savvy sales pros who familiarize themselves with the old standbys, as well as the cuttingedge developments in the modern dental lab. But whether it's an outside facility or in-house lab in the dentist's office, this market is either overlooked or under-tapped by many dealer representatives. Here, we will highlight the opportunities in this category, with the goal of putting high-revving sales reps on the road to success.

Point of sale
DENTAL LAB SALES

• One of the best ways to get a new product into the hands of a lab owner or decision-maker is to
offer samples or loaner kits.
• Investing in CAD/CAM equipment can save time and money — benefits patients will also appreciate.
• CAD/CAM blocks and blanks, ingots for pressing and veneering porcelain, alloy and polishing materials
are commonly ordered materials.
• Wax and plaster are two staples that are also in constant demand.
• Speaking of plaster, gypsum products come in a variety of densities and strengths, and lab technicians
must have full range at their disposal.
• Porcelain is still regarded by many as the most esthetically pleasing ceramic restorative.
• Zirconia is catching up to porcelain in esthetics, and also offers exceptional strength.
• Product reliability and vendor support are key considerations in lab-buying decisions.
• Build loyalty and secure new clients by providing lab managers with marketing materials, cooperative
advertising programs, and helping with website listings and seminars.

GOOD IMPRESSIONS

Although there's been no shortage of innovation in dental prosthetics, perhaps no process has undergone as dramatic a change as that of impressioning. Technicians' work in the lab begins with accurate impressions taken in the operatory. These may come in the form of alginate, acrylic, polyether, vinylpolysiloxane or silicone. What's more, increasing numbers of practitioners are using high-tech methods of "mapping" the oral landscape. Thanks to digital chairside oral scanners, full-mouth impressions can be captured with the sweep of a wand.

The convenience afforded by digital technology in the dental practice is not only more comfortable for the patient than traditional impression methods, it's also a time saver — especially in practices that offer in-office scanning and milling, which provides patients with a new restoration during their office visit.

When digital impressions are sent to an outside lab, they are digitally transmitted. There is no need for tray selection, impression material, patient gagging, disinfection, packaging, shipping, plaster pouring, cutting and trimming, or articulation. At the lab, the restoration is designed by a technician, and that design is sent to a mill for fabrication — usually from a block of composite resin, porcelain or zirconia — according to the dentist's specs.

But while CAD/CAM technology is proving to be a money saver — at least in the long run — the initial investment is pricey. At upward of $25K or more, it can be beyond the reach of small labs. In fact, when asked what he sees as one of the greatest challenges facing labs today, Laboratory Marketing Manager Andy Klein of Brea, California-based Vident replies, "Choosing between outsourcing or investing in the capital equipment needed to compete with process automation due to CAD/CAM. Automated processing has required labs to learn about CAD/CAM and spend more to stay viable."

"The reality is that chairside CAD/CAM has had an impact, though most laboratories have not lost a lot of business due to this technology," observes Bennett Napier, a certified association executive with the National Association of Dental Laboratories in Tallahassee, Fla. LET'S GET PLASTERED But many dentists still use tangible rather than virtual impressions, and these are still sent to the lab supplemented by prescriptions, or instructions. These form the blueprint for the lab technician. Once in the technician's hands, analog impressions are cleaned and disinfected.

LET'S GET PLASTERED

But many dentists still use tangible rather than virtual impressions, and these are still sent to the lab supplemented by prescriptions, or instructions. These form the blueprint for the lab technician. Once in the technician's hands, analog impressions are cleaned and disinfected.

Next, plaster is used to make a positive mold of the patient's dentition (or lack thereof). Plaster is one of the primary materials used in labs. Made of gypsum, it's what technicians reach for to create models from impressions. Available in varying strengths and densities, the choice of plaster is dictated by the task at hand. Diagnostic casts are often made of a soft, carvable plaster, while dental stone is preferred when more detail capture or strength are needed. Die stone is a good choice for cast restorations, as it is endowed with silica so it can withstand the heat of the furnace.

Once poured, the molds are usually placed on a vibrating table to eliminate air bubbles before being allowed to set. The resulting models are fitted to an articulator. This device replicates jaw movement and occlusion, ensuring alignment of maxillary and mandibular teeth. Using this model, along with measurements provided by the clinician, the dental technician creates a wax model of the recommended restoration.

WAXING POETIC

Wax is another important ingredient of lab work — and a regular consumable that needs constant replenishing. Diagnostic wax-ups are a critical component of a successful restoration. Like a dress rehearsal for the real thing, they help ensure correct placement, occlusion, alignment and height of the prostheses. They also allow the patient a preview of how the final restoration will look.

Wax-ups are especially useful in cases that require extensive work. In the case of dentures, lab technicians can create a wax rim, which is test-fitted in the patient's mouth. Measurements are taken and marks are made into the wax to assure speaking capability as well as facial and lip alignment. Acrylic teeth (available in an assortment of shapes and colors) can be positioned individually into the wax and easily adjusted for desired effect.

Wax is also used in lost-wax casting, a process in which a wax model, set in an investment, is heated so that the wax melts out. A material, such as acrylic or metal, replaces the void. Subsequently, porcelain (in the case of a porcelain-fused-to-metal restoration) is pressed or layered onto the cast framework, and the restoration is "baked" together in the furnace.

ALSO ON THE BENCH

Aside from such infrequently replaced heavy artillery as CAD/CAM and milling equipment, and the staples of wax and gypsum products, there is a vast assortment of supplies that are also critical to lab operations. Products on the wish lists of those with whom we spoke include millable CAD/CAM blocks, ingots for pressing and veneering porcelain, vacuums, handpieces, vibration units, alloy devices, polishing materials, and refractory investment materials.

"The laboratory industry has changed over the past few years," notes Robert Savage, vice president and CFO of Charlotte, North Carolina-based Drake Dental Laboratory. Savage ack - nowledges that his lab utilizes CAD/CAM equipment, digital scanners and wax printers. "But," he adds, "we still purchase the old standbys such as stones, plaster, cutting instruments, alloy, porcelain and denture teeth — as well as related equipment, such as mixers, handpieces, porcelain fur - naces and sand blasters."

According to Vernice Griffin, CEO of Griffin Dental Laboratories in Louisville, Ky., factors that influence a lab's buying decisions include cost-saving strategies and the desire to provide clients with more choices. "The equipment and consumables needed vary," she explains, "because purchase decisions are based on the type of lab and what the vision for that lab is."

terms to learn

Coping: A metal substructure onto which porcelain is pressed or layered to create a porcelain-fusedto-
metal restoration — commonly referred to by the acronym PFM.
Dental Stone: A type of plaster or gypsum used for creating models. Investment: Plaster that is
poured into a mold.
Sprue: Generally made of wax, the channel through which molten metal is poured into a void after wax
has been melted and evacuated in the lost-wax process.
Diagnostic Wax-Up: Used to visualize the potential outcome of a proposed treatment plan.

TAKING FUTURE STOCK

As with other facets of dentistry, the impact of new technologies on labs is seen in improved quality, plus time and cost savings. Bulletproof materials, such as zirconia, allow for the crafting of strong, metal-free restorations. Likewise, digital advances from scanning to impressioning are immensely influential. "When I started in the laboratory industry 11 years ago, CAD/CAM was relatively new," recalls Savage. "Today I can't even begin to guess at the number of systems on the market. This has enabled laboratories to compete with offshore manufacturing, as well as cope with the high price of precious metal."

Jackson, who, after the technological dust settles, foresees the emergence of two classes of labs, large and boutique, agrees with this assessment, adding, "Automation has leveled the playing field in terms of labor costs, and the price of gold has driven more dentists to prescribe all-ceramic or monolithic restorations that are uniquely suited to this method of manufacturing." He acknowledges, though, that smaller labs with more limited resources could be in for a tough time — a scenario that presents sales professionals with ripe opportunity to approach lab managers with cost-saving strategies and support programs.

As more dentists incorporate "one-hour" indirect restorations into their practices, the pace of this market's evolution will continue to accelerate. "The growing interest in intraoral scanning devices and patient desires for instant gratification will continue to compress delivery times and increase the popularity of chairside milling," opines Jackson. He also believes this will force lab technicians to become more familiar with sophisticated, multidisciplinary prosthetics and related technology.

smoothing the purchasing process

When asked how sales professionals can best smooth the purchasing process for their clients, Bennett Napier, a certified association executive with the National Association of Dental Laboratories, summed it up in five words: "Customer support and training follow-up."

Mark Jackson, RDT, co-owner and vice president of Southern California-based Precision Ceramics Dental Laboratory, offered this advice: "Perhaps the best way to get a new product into the hands of a lab owner or decision-maker is to offer samples or loaner kits, which will allow them to try it." Jackson adds, "Dental technicians are tactile people and often make decisions about materials based on handling characteristics, or how a product 'feels' in their hands. They need time to get comfortable with a material, and may need some technical support or onsite training when working with something new."

He also suggests that providing marketing materials and cooperative advertising schemes, and assisting management with website listings and seminars will help secure new clients and build loyalty. This desire for customer support echoes what we heard from most of the sources contacted for this story.

When asked what the most important considerations are when making purchasing decisions, Robert Savage, vice president and CFO of North Carolina-based Drake Dental Laboratory, notes that product reliability and vendor support are key. "Of course we consider price," he says, "but we also look at many other factors before purchasing a product or piece of equipment."

Vernice Griffin, CEO of Kentucky-based Griffin Dental Laboratories, agrees that vendor backup makes a huge difference. Without it, she says, the steep learning curve on some items might cause labs to stick with familiar products. Griffin also points out the value of easily accessible information about new products. "When information is not readily available, it can be difficult to make a decision and can definitely affect purchases," she says. Griffin also places high value on building relationships between suppliers and labs, noting, "Making a connection with the company that you want to work with is imperative to smoothing the purchasing process."

When it comes to mapping the way ahead, the experts with whom we spoke see several promising avenues,including advances in implants and ceramics. Whether it's negotiating a sale in the digital equipment department or becoming a regular vendor of the wealth of consumables that labs burn through, dealer representatives would do well to pay attention to this market. Once the supply sales force acquaints itself with the needs of the nation's dental labs, it's only a matter of time before the road less traveled becomes a primrose path.

outsourcing: friend or foe?

As an industry in the 21st century, dental labs have joined the ranks of others affected by outsourcing. As in so many other professions, advancing technology has exacted a price, and for some labs across the United States, that has been paid in layoffs and closures. In fact, according to Bennett Napier of the National Association of Dental Laboratories, there are currently 10,000 dental laboratories in the United States. That's a 22% decline over the last three years — and statistics show that the number of dental technicians has dropped just as severely.

Napier ticks off a number of reasons for the decline. These include an aging workforce, mergers and consolidations, "unrealistic" insurance pricing schedules, higher costs of entry into the business due to new technology, and offshore competition. Labs that don't yet have the latest equipment may farm jobs out to a partner lab either in the U.S. or on foreign soil. Dental practitioners may digitally ship work directly to offshore labs as well. In fact, Napier says that according to 2010 data from the U.S. Food and Drug Administration, 38% of unit production is being sent offshore, with as many as 32 countries importing restorations into the U.S. "It's a tool for some and a curse for others," he says.

The appeal, of course, is reduced cost, which can be passed on to the patient. Some practitioners agree that this practice is acceptable as long as everyone knows it's happening, while others worry about quality control when offshore labs are involved. "Our industry has been ravaged by cheap offshore competition, and a lack of formally trained technicians," opines Mark Jackson, RDT, coowner and vice president of Precision Ceramics Dental Laboratory in Montclair, Calif. "While initially viewed as simply filling a vacuum, this offshore work has grown very quickly, and with little or no control or oversight. The quality of the work is generally acceptable, but the use of unregulated materials is a constant concern."

In today's digital world, those limited to analog technologies are finding it tougher to compete. But, in the long run, the digital acceleration may actually end up benefitting U.S. labs more than their offshore competition. Andy Klein, laboratory marketing manager of Brea, California-based Vident, believes that changes are already in the wind. "Offshoring is not as big an issue anymore," he reports. "The pendulum of workload is swinging back to our shores as automated processes get faster and cheaper (on a per-unit basis)."

But whether restorations are made in this country or another, the digital revolution is here to stay, and adaptation is the prescription for survival. As Robert Savage, vice president and CFO of Charlotte, North Carolina-based Drake Dental Laboratory, notes, "As an industry, we have to find new ways to compete and provide value to our customers — and advances in technology are one way this can be accomplished. It is my hope that dental professionals will continue to see the value of the dental lab."

typical purchasing processes

If you're wondering how often labs are in buying mode, it varies. Naturally, the bigticket items like CAD/CAM and other types of equipment constitute infrequent purchases, while consumables — such as wax, gypsum and porcelain — are ordered on a regular basis. From her experience, Vernice Griffin of Griffin Dental Laboratories says, "Labs tend to purchase supplies as they are needed, and this could be weekly or monthly."

But according to Bennett Napier of the National Association of Dental Laboratories, "Many labs have gone to a centralized inventory system rather than allowing technicians or departments to order items as they need them — which has resulted in laboratories having too much of one material and not enough of another. A lot of labs are following lean manufacturing principles which minimize operational inefficiencies — and purchasing controls are one area of focus."

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