Are Pfms Disappearing, and Increasing your Profits ?

[rkm rdt]

Ever since I got my scanner and hooked it up to the interweb I don't have to hop in my car anymore.

 

[sidesh0wb0b]

Ever since I got my scanner and hooked it up to the interweb I don't have to hop in my car anymore.

lol, nice
though maybe clients are different where you are. ive even gone to an office to help them search for a lost implant screw. service wins every time

 

[rkm rdt]

lol, nice
though maybe clients are different where you are. ive even gone to an office to help them search for a lost implant screw. service wins every time

I'm in a dental building. Not every dentist appreciates personal service .

 

[Toothmouth]

Just found this site. Wish I had years ago. I've been doing High quality, fixed restorative for 35 years in southern California and I can tell you this, the dental lab business will shrink dramatically in the next 5 years. Mainly do to in-operatory cad-cam systems which will be a common fixture in the majority of dental practices, in the near future. I'm already seeing this first hand. One of my oldest accounts, ( over 22 years),purchased the newest generation of Cerec , ( CEREC Omnicam). If you're not familiar with this unit, you should be. The software is much easier to use then the earlier versions, plus it doesn't require disclosing powder and the optic scanner is much easier to use, allowing subordinate employees to scan, design, mill, crystallize and glaze a three unit e-max posterior bridge in about an hour. I'll tell you this, the aesthetics of a stain and glaze emax , IMO are no match in quality to the layered technique, however the cost to the Dentist is so much less that it's mind blowing, with a total material cost of about 50 bucks! In comparison, I charge $185 per unit for emax.

I really feel for the younger techs because you will see a huge drop in work and profits. This change is a paradigm shift for sure

Just curious if your seeing fewer pfms come into your lab in the last 6-12 months with Emax and FCZ growing so fast. And more importantly, has your bottom line dropped or increased because of that ? For the labs looking to buy a scanner, and or plus a mill, it does change your business and opens up a new world for your business to grow, or fail with the high payment cost.
Would also like to hear the pro's and con's stories of how the all ceramic business with and without a scanner has changed your lab. Are you working + or - hours per week, new accounts, hiring/ firing. Are milling bills eating up your profits. Do you think the cad/cam restoration will ruin the average small lab in the future with big box labs spitting out more units by the year at lower prices.. Will this drive the average lab out of business....
Will the obvious decline of pfms doom the small labs of the present and future ? Are techs being laid off now because of cad/cam being a must have, and with businesses being so slow because of the economy?
Are Cad/Cam restorations Doom or Gloom for the future-younger dental lab tech/techie.....Are we going to see a evolution also with the down fall of pfms......did I say that. lol
And you say ?

Charles

 

[paulg100]

i agree but dont forget to factor in the cost of buying the camera and mill and oven, the cost of paying an in house tech(nurse) to do the staining and glazing etc.

its not quite the massive saving you make it sound like.

 

[charles007]

whats a pms,,,,,,, I mean pfm if there still called that..

 

[Toothmouth]

Cerec Costs

It's significant enough. These technologies are not going away, they will become more prevalent, I hate to say. The cost to buy the chair side system is around 168K. That includes the oven. My lab bill last year with this account was 128K. He'll be able to capitalize his expenses in less than 2 years! My business is down over 90% with this account. It's that dramatic.
As you know, Dentist talk to one another and when he tells his other dentist friends, that after this thing is paid off he can realize true gains of almost 100k annually, They will listen.

He hasn't had to hire any personnel either, because once you learn the system it's fairly fast and simple. Not to mention, no Impression material, no temperization and no cementation appointment. That's a big money saver too, in time and materials.
Starting this summer, Cerec is intoducing to North America its' E-max Sirona milled implant abutments for ALL major implant systems. So if you think specializing in implantology will help you, guess again.

Most Dental schools now are embracing this new phase. I know that USC is for sure, which means the new Dentists will be using this technology exclusively when they open their practices.

I hate to be the bearer of bad news, but this IS the reality coming soon. This is the Dentists' dream come true; the elimination of laboratory bills from their practice.

Toothmouth

 

[rkm rdt]

..ahh we saw this coming 20 years ago.

 

[user name]

Howdy Toothmouth. Like rkm rdt said...we've seen it coming for 20 years. You sound scared. It all depends on what you want to make and to what level. If youre going to compete in a world of tooth colored caps then youd better jump on board with the digital crowd. My only goal is to provide the best, and I communicate this with the Doctors I serve. I hand wax and press alot. The results I can produce are better than a scanner and printer or mill can produce. In fact, my 3Shape has sat untouched so far this year. I raised my prices dramatically this year and I was afraid of loosing some, but Ive actually gained two accounts and so far, this year is setting records on the balance sheet. There are much faster ways to do things, but not better.

I just bought a couple rather expensive knives...military type. I took one to our local highly regarded sharpening guy. After picking it up, I invited him over to the lab for a peek through the microscope. When he compared what he did to what I was able to accomplish with patience and magnification...I think he'll be buying a microscope now too. Im just saying...one persons idea of good might not be a one-size fits all. The sky really isnt falling. You just need to know yourself and market it.

 

[Alistar]

We have had 3 docs go to a Cerec, and two of them quit because it SUCKS!!!!! The 3rd was a total hack of a dentist and it wouldn't surprise me if they have stopped too...even with how low their standards where.

Anyway I digress.

I was just at the ITI in Chicago last weekend...and some of the slides the docs were putting up of Cerec crap was embarassing...seriously. One presentation done by a proths that posts on here showed an e.max onlay milled off a high quality 5 axis mill for $100 and then the exact same onlay milled off a Omincam scan and milled on a MCXL. It was like I said..embarassing.

I think what you have to fear more is the propaganda of the Paterson sales reps, who in my opinion are right down there with snakes and politicians. If you are not in their Cerec club they are out there everyday talking crap about you and your outrageous lab fees, and how they could do it for much cheaper and same day if only they owned a Craplab. They give the docs completely false ROI reports on total cost of ownership of one of there machines. They negate to fully disclose all the yearly soft wear fees, tool fees, and general maintenance. They also do not educate on the extreme limitations of the system and inability to mill a light shamfer margin...feather margin forget it.

The best docs out there are going to Itero, 3M True Def IOS, and soon, if they can get a decent sales and marketing push the 3 Shape IOS. The 3M True Def is harder to use and the SLA models are accurate, but really suck to work on. My best doc has a Itero, which is the best IOS in my humble opinion, but even she has learned there are limitations in the "wet field" and if you want to impression the same day as surgery...sometimes an IOS is not going to work. Just like a Cerec machine is not a silver bullet. It's actually closer to a bb gun, so if your doc thinks he is going to be this "rockstar" Cerec doc...he may be having delusions of grandeur, unless he is truly smarter and much more tech savvy than the average.

All this aside, some "excellent" docs get acceptable results with Cerec.....and in office milling is only going to get better! I just saw Kavo released, or is releasing a 5 axis in office mill.

My advice...having been in the same position as you, go find some different docs, but don't burn the bridge they will still need your services for veneers, single centrals, anterior work, and large bridges.

 

[Toothmouth]

Yes, Patterson is doing a hard sell out here in Lotus Land. People are buying what they're selling too. I don't disagree with what you say either. I'm 57 years, and hopefully can retire in a couple years. I'm not too worried either way. However, what I think we can all agree on is, the Dental Lab biz is contracting and will keep contracting. I was trying to speak to the much younger tech who may want to shift sideways and train for some other skilled vocation. These things aren't going away, nor will they remain static.
As I have said, the monolithic cad-cam stain and glaze is no match in quality to hand layered restorations. The problem , at least out here, is the dentist is looking to maintain "profitability" in a market where insurances are paying less and less for fixed restorative. So even with the monthly global service fee, ( $250) which I was made aware of by the Patterson rep, he's still netting out quite nicely.

I've never been one to burn bridges. The exception is the occasional dead beat dentist and we've all had those from time to time.

My account assured me I would get all the layered anterior work. In the mean time I've had to lay off a couple of employees, which is, IMHO, one of the hardest things to do as an employer

Thanks for the positive advice

We have had 3 docs go to a Cerec, and two of them quit because it SUCKS!!!!! The 3rd was a total hack of a dentist and it wouldn't surprise me if they have stopped too...even with how low their standards where.

Anyway I digress.

I was just at the ITI in Chicago last weekend...and some of the slides the docs were putting up of Cerec crap was embarassing...seriously. One presentation done by a proths that posts on here showed an e.max onlay milled off a high quality 5 axis mill for $100 and then the exact same onlay milled off a Omincam scan and milled on a MCXL. It was like I said..embarassing.

I think what you have to fear more is the propaganda of the Paterson sales reps, who in my opinion are right down there with snakes and politicians. If you are not in their Cerec club they are out there everyday talking crap about you and your outrageous lab fees, and how they could do it for much cheaper and same day if only they owned a Craplab. They give the docs completely false ROI reports on total cost of ownership of one of there machines. They negate to fully disclose all the yearly soft wear fees, tool fees, and general maintenance. They also do not educate on the extreme limitations of the system and inability to mill a light shamfer margin...feather margin forget it.

The best docs out there are going to Itero, 3M True Def IOS, and soon, if they can get a decent sales and marketing push the 3 Shape IOS. The 3M True Def is harder to use and the SLA models are accurate, but really suck to work on. My best doc has a Itero, which is the best IOS in my humble opinion, but even she has learned there are limitations in the "wet field" and if you want to impression the same day as surgery...sometimes an IOS is not going to work. Just like a Cerec machine is not a silver bullet. It's actually closer to a bb gun, so if your doc thinks he is going to be this "rockstar" Cerec doc...he may be having delusions of grandeur, unless he is truly smarter and much more tech savvy than the average.

All this aside, some "excellent" docs get acceptable results with Cerec.....and in office milling is only going to get better! I just saw Kavo released, or is releasing a 5 axis in office mill.

My advice...having been in the same position as you, go find some different docs, but don't burn the bridge they will still need your services for veneers, single centrals, anterior work, and large bridges.

 

[BobCDT]

I saw Gordon Christensen at Vision 21 a few months ago. Just looked through my notes. According to Gordon. 20% of dental offices have in office milling capabilities. Many are not using it. He does NOT anticipate this number growing much in the next 10 years.

 

[ceram1]

It's significant enough. These technologies are not going away, they will become more prevalent, I hate to say. The cost to buy the chair side system is around 168K. That includes the oven. My lab bill last year with this account was 128K. He'll be able to capitalize his expenses in less than 2 years! My business is down over 90% with this account. It's that dramatic.
As you know, Dentist talk to one another and when he tells his other dentist friends, that after this thing is paid off he can realize true gains of almost 100k annually, They will listen.

He hasn't had to hire any personnel either, because once you learn the system it's fairly fast and simple. Not to mention, no Impression material, no temperization and no cementation appointment. That's a big money saver too, in time and materials.
Starting this summer, Cerec is intoducing to North America its' E-max Sirona milled implant abutments for ALL major implant systems. So if you think specializing in implantology will help you, guess again.

Most Dental schools now are embracing this new phase. I know that USC is for sure, which means the new Dentists will be using this technology exclusively when they open their practices.

I hate to be the bearer of bad news, but this IS the reality coming soon. This is the Dentists' dream come true; the elimination of laboratory bills from their practice.

Toothmouth

The do it yourself doc will not pay off that machine in 2 years at your expense, it wont happen. If this Doc is very efficient his cost per unit at five years will still exceed 200 per unit with the pain in the ass of in house manufacture.(200 does not include labor!) This Doc I will guarantee would never pay you 200 per for the quality that he or she will receive from an mcxl, but they will get it faster without a temp. Your Doc is bad at math skills and he cannot morally "cerec" every case. You need to educate on the shortcomings outside of esthetics as well, there are many. (even with the omni cam)

 

[Alistar]

I saw Gordon Christensen at Vision 21 a few months ago. Just looked through my notes. According to Gordon. 20% of dental offices have in office milling capabilities. Many are not using it. He does NOT anticipate this number growing much in the next 10 years.

Would be interesting to know what he was saying or thinking 5-8 years ago. Not saying what he says isn't true, but many of the young docs coming out of school are trained and feed the in office propaganda all the way through dental school, because all these companies..E4D and Cerec and 3M all have sweet deals with the dental education schools... and for them it's going to feel "weird" not having the capabilities of in office milling.

Wether it is financially prudent for them to invest in such technology is another matter. Graduating with $250k in school debt and then tacking on another $150-$175k for a in office mill would put a lot of financial stress on a new doc. Then tack on the dozen or so other tertiary expenses that go along with a mill and it would be quite daunting in todays tough market.

This could all change in the next 5 years to make it much more affordable for docs to get into milling in office, or at the least "out source" to "preferred" milling centers. Similar to what 3M and E4D are cooking up.

Pretty soon you will have IOS sales guys going in saying "hey buy our blah blah blah IOS for 10k(giving it to them for cost or loss),and you can get FCZ(or whatever monolithic) for $75 from our "preferred" lab."

That's the way it's going to be. Everything is consolidating.

The cost of business is going way up, because of taxes and regulation. What doctors are able to collect is going down, because all these crooked insurance companies are pinching their reimbursments and "delaying payments" for months or just flat out denying payment. It's forcing desperation, and if docs hear from a sales guy that if they do everything in office they can make an extra buck, they will do it, because they want to believe it that bad.

 

[Toothmouth]

Well, he seems to think so and he's been fed all the Cerec propaganda to the point ,that he feels this will be a big practice builder. At the 2 day sirona design course I was surrounded by a bunch of Cerec disciples. One of the Docs even had the audacity to say he would never use layered all ceramic anteriors again because he felt stain and glaze was far superior in aesthetics! Boy, My bullsh*t detector went off the charts when I heard that.

The do it yourself doc will not pay off that machine in 2 years at your expense, it wont happen. If this Doc is very efficient his cost per unit at five years will still exceed 200 per unit with the pain in the ass of in house manufacture.(200 does not include labor!) This Doc I will guarantee would never pay you 200 per for the quality that he or she will receive from an mcxl, but they will get it faster without a temp. Your Doc is bad at math skills and he cannot morally "cerec" every case. You need to educate on the shortcomings outside of esthetics as well, there are many. (even with the omni cam)

 

[rkm rdt]

...and yet the patient has no idea you exist.

Why are you surprised when you don't market to the real customer? They have no idea what a lab is or what i can do for their smile.

 

[Toothmouth]

You can say that again. I've been an advocate for the patient to have the right to shop for lab work for years.

...and yet the patient has no idea you exist.

Why are you surprised when you don't market to the real customer? They have no idea what a lab is or what i can do for their smile.

 

[rkm rdt]

I've done something about it.

Call an office and ask them if they are accepting new patients.

See how different you are treated than when you call them and tell them you are another lab in town.

 

[ts4341]

A little off subject, but what are some of the labs on DLN favorite choice PFM porcelain?
Rate 1 -5 Stars
Aesthetics
Handling/Stacking/Layering
Compatibility with Alloys
Chroma
Hue
Value
Over All

 

[labman01]

A little off subject, but what are some of the labs on DLN favorite choice PFM porcelain?
Rate 1 -5 Stars
Aesthetics
Handling/Stacking/Layering
Compatibility with Alloys
Chroma
Hue
Value
Over All

Are you asking what type of porcelain each one of us uses on DLN and why??