The Burger King business model of providing customers with options is apropos of our industry in two ways: Lab owners want to offer clients as wide a selection of restorative services as possible. Balancing this, the contemporary lab owner also can turn to a choice of business partners ready to provide services, if and when needed.

With the advent and popularization of CAD/CAM as an effective modality for the fabrication of dental restorations—especially milled zirconia substructures—outsourcing has taken on a new role. Lab owners facing a shortage of qualified dental technicians have embraced CAD/CAM technology to help alleviate a growing labor deficit. The automation of labor that CAD/CAM scanning and milling equipment creates can in turn be taken advantage of by smaller one-to-five-person labs and used as an additional “technician,” but one who does not require health benefits, salary increases, or other human resources needs. Depending on the system, the milling machine can work unsupervised throughout the day, or all night long, producing substructure after substructure as long as the design data and millable blank forms are supplied.

Although CAD/CAM technology does offer many benefits in terms of streamlined and automated production, the cost as well as the physical size of the whole system (including the digital scanner, milling unit, and sintering furnace) may be out of reach of smaller labs. In addition, the various high-tech aspects involved might send the heads of computerphobes spinning. The modularity of CAD/CAM systems on the dental market fits perfectly with an outsourcing strategy by allowing labs to incorporate just those aspects that are needed or that they are comfortable with using. Also, just the increasing number of outsource centers open for business across the country leaves the lab owner with an array of options to establish a partnership to simplify CAD/CAM access while expanding business potential (See “Guide to Outsourcing” starting on page 25).

Like the majority of labs that outsource CAD/CAM restorations (See “CAD/CAM involvement” chart below right), Fountain Dental Lab in Woodinville, Wash., sits on the entry-level end of the outsourcing scale, sending prepared models to nearby a nearby Lava milling center for the complete scan/design/mill process. According to Don Fountain, Owner and sole technician, partnering with an outsource service to handle most of the computerization involved in zirconia milling has allowed Fountain to focus his resources into directly serving his client base by offering his 30 years of experience working with stacking porcelain to optimal esthetic effect.

Sending models to an outsourcer for the CAD/CAM work gives just about any sized lab a quick and easy solution to providing zirconia-based CAD/CAM restorations to its own clients without dealing with some of the drawbacks associated with integrating any of the hardware or software into the workflow. Sending models out for scanning also allows a lab to try different CAD/CAM systems to fit specific case parameters for size or material. Businesses such as Dale Dental in Texas or Laboratory Solutions in Georgia specialize in CAD/CAM outsource work, incorporating all or nearly all the CAD/CAM systems available, while da Vinci Dental Studios and Glidewell Labs in California both utilize several systems to provide options to their customers who send cases for CAD/CAM framework manufacture—all for a one-stop-shopping experience for the outsourcing lab owner.

According to a recent exclusive DLP survey,¹ of the labs that said they provide their dentist-clients with zirconia-based restorations, nearly two-thirds (61.7%) have embraced this concept of sending their models to an outsource center for scanned, designed, and milled zirconia copings and frameworks. Of the remaining lab owners using outsource services, 12.1% scan models and design their frameworks in-house, then send the digital files out to an outsourcer only for the milling process. Another 5.7% simply scan the prepared models and send just the raw data files to a service to handle the design and milling procedures.

With the capital outlay of a system scanner, however, the lab owner may feel tied to that system for its CAD/CAM work, for better or worse. Although currently limited in their scope and availability, open-architecture scanners and CAD/CAM systems potentially would minimize this limitation by allowing data from any scanner to be sent to any open-architecture design software and milling system. However, widespread practical implementation of connectable open-architecture systems that work over different platforms appears to be down the road a bit.

Until just a few months ago, Ceramic Design Technologies ha sent models to local outsource labs in north-central Ohio for the scan/design/mill steps, but then decided to take its business to the next level, and it purchased the 3M ESPE Lava Scan ST scanner to send design data to an outsource provider working with Lava zirconia materials. According to lab owner Michael J. Nichols, CDT, “We got to the point where we thought the milled frameworks were great, and they fit great, but we wanted a little more control of the design.”

In addition, the monthly number of cases that Ceramic Design was sending out for its 40-dentist client base was growing. “The market for zirconia frameworks is expanding,” said Nichols. “If I want future growth, I want it to be with zirconia.”

As such, he felt the prescription numbers offset the purchase of a digital scanner and software to enable the lab to transmit the design files electronically to its preferred outsource milling center.

Ceramic Design Technologies also has seen an increase in overall all-ceramic business from its in-house scanning capabilities. “Doctors know that we’re committing our dental lab to the product and that we’re making a big investment in it,” said Nichols. “I wanted to invest money in machinery to make our lab competitive down the line.”

He added that the lab just purchased an entire Lava CAD/CAM system to keep the entire process under his control and will be an Authorized Lava Milling Center by the beginning of 2008.

If one scanner in the lab can open up new avenues for outsourcing options, just imagine what scanners linked to different CAD/CAM systems could do. Both Forest Oak Dental Laboratory in West Palm Beach, Fla., and Miami Dental Arts in Miami have dual scanning capabilities through Cercon and Procera systems. Depending upon the case parameters (size, location, materials) and work structure, each lab owner has the choice of which system to use.

Dale Cornelison, CDT, President of Miami Dental Arts, said that he has been using Procera for 14 years, mainly for alumina-based anterior single units. When it came to metal-free bridges, however, he felt that zirconia provided the strength necessary for the span and started by outsourcing the work to labs with Cercon scanners that could accommodate bridges as well as zirconia.

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