Cad/cam at the clinic + lab

[Xydorf]

Hello dear lab tech friends,

I am John, a 25-year-old dentist from Sweden with high dreams and ambitions for the future. I am now working with my father in a small practice (3 rooms) outside Stockholm, and I want to create a practice with the following possibilies;

1. To take digital impressions.

2. To create a crown directly in less than an hour (production time, not chair time, chair time for the patient is probably about 2hrs i presume),with the help of a lab tech with the aestethics.

3. To have my own lab next to the clinic (hopefully we can buy a villa and have it on the 2nd floor or something),that is highly computerized and not that labor-intensive. It is the only way to have any type of profitability in todays lab competition I presume. My hope is to be able to offer crowns for less than $130 per unit, inlcluding pick-up etc, to my dentist colleagues.

So, what to do? I have realized that iTero is proably the way to go when it comes to digital impressions, since it is the only open system (you don't happen to know the scan fee?),unless the local 3M salesman (or woman in this case) has given me the wrong information.

3shape also seems like a decent scanner/software company (please tell me if you disagree),but how do I solve the crown production problem without Cerec? What can be milled in 1 hour? With which machine?

I met a german guy from AmannGirrbach (behind Ceramill as you obviously know),that seems to have a rather cost-effective production system. But they couldn't solve my 1-hour-crown problem, if I understand them correctly (the Germans have a funny accent, funnier than swedes ).

I also want to know how to make cost-effective cad/cam veneered porcelain to add to the zirconium framework (like vita trilux forte, only not as expensive and not for inlab only). Emax is of course an alternative, but nevertheless it is not officially recommended for posterior bridges yet.

Anyway, how to solve my problem? any suggestions? as a thank you I can of course send a case or two to you

Best Regards,

Dr. John Barksenius DDS Sweden

 

[TheLabGuy]

I'd look into E4D if I were you. Click here
and welcome to DLN.

 

[Xydorf]

But the E4D can't produce bridges? Isn't the system very closed?

Thank you, I feel welcome

 

[DMC]

You will need millions of dollars worth of equip.

A very large building with many many Docs would be needed to keep the machines busy enough to pay for them. The building and all equip. will be funded by investors, and run like a business or even a hospital. Any one Doc will be a tiny part of the equation.

The public will love the time savings of one visit Dentistry. The cost will go down to patient, as the "Hospitals" or "Wall-Marts" of Dentistry put out of business most other Dentists that don't join the club. It will be tought to compete with that technology/service/savings. That's the next business model in Dentistry.

 

[amadent]

not sure the price will go down-
Drs for the most part dont pass on savings from labs to patients now- dont see why that would change in the future

 

[rkm rdt]

The public hate being treated like cattle. Sure I buy my socks at Walmart too however I wouldn't want my teeth made there.

Call me a ludite but I'm not too keen on an 85 year old "greeter" sticking a Cerec in my mouth.

 

[Xydorf]

The thing is that I would prefer to avoid cerec/sirona as much as possible. Partly due to the cost (of material, not equipment),and partly because I hate the idea of having to spray a blue layer in the patients mouth... It just just not going to work for me.

Now, presume I have an infinite amount of money to put on equipment, but I want low production costs, how should I do it?

Best Regards,

Dr. John

 

[rkm rdt]

Chair time ~ 2hrs
fab time ~ 1hr
total ~ 3hrs It would take less time to do it the conventional way.

1st visit 1hr
2nd visit 1hr
total 2hrs

" Now, presume I have an infinite amount of money to put on equipment, but I want low production costs, how should I do it?"

Send the case to the lab!

You and your patient are getting the best value for your dollar/Krona money can buy.Lab labour fees are probably one of the lowest rates of any profession out there.

Try hiring a plumber or an electrician for under $60/hr( cdn)

What does your local garage charge per hour?

 

[Xydorf]

Rkm: I TOTALLY agree that Lab Techs earn too little. It is horrible that it is this way. I am convinced that modern technology will benefit the lab techs in the western world, due to the highly automized (Sp?) possibilities that will come in the future. I was just in Shanghai, and there I spoke to my friend Jennifer who owns a small factory that produces dental rotary instruments for labs and dentists (mainly polishers). Anyway, she told me that in China, Lab Techs were regarded as highly skilled labour that earned about twice to three times as a factory worker. This would be around 600 dollars per month, which is very much in China. So it is not the same in every culture, perhaps the tide can turn in the western world again.

 

[DMC]

You don't see the extra labor of making a temp and cementing it, adjusting it, having it come off a week later. Then taking off temp, cleaning area....

Receptionist have to check in patient 2x. drive back and fourth 2x.

 

[rkm rdt]

That extra labour is usually performed by the assistant.

Back to the 1hr crown....1st you will need a material that can be milled within that time frame,therefore it will need to be milled in its final state,ie postsintered.However this material needs an acceptable flexural strength as well.

2nd,this material needs to be esthetic and it needs to have the properties that will allow it to be cementable.You can't bond in a wet enviroment.Temporaries give you a better chance create a dry enviroment.

3rd,check out Al's pics and ask yourself if you can do that in one hour!

 

[DMC]

Do I (patient) want to take off from work 2x and schedule appointments, or just once.

How does the assistant help a patient with that?
Anethesia 2x? No thanks! I'll take just one serving of that.
Labor for cleaning instruments 2x, insurance paperwork 2x, doc washes his hands 2x and has to fill out chart 2x, on and on.......

Laser sintered ceramics (not milled at all) all sorts of materials.

Laser sintered metal. ZAP-POW! Porc "top" could be milled simutaniously?
You could even have time to do traditional porc build up if patient waits another hour.
Rapid prototyped denture (I know of two companys doing this now in beta. Even print the denture teeth!) Printer will be well over one million.

Femtosecond laser ablation technique? Not cheap!

Ultra-sonic milling of metal? Not cheap, or small.

In the long run, All of these monster machines will be more efficient than current stuff. No little set-up will compete for many reasons.

I think we will see around $4-10 million in machines to cover the range of Dental needs. Milling titanium harware and tools on-site, while paying copyright $$ to companys just for the design files. Crazy huh?
No need to order anything, but chemicals and raw materials.

Need an old implant screw? That will take 30sec!
Need a new torq wrench for the latest system?
Just download file for one-time milling from ?? and mill your own
parts in an hour. Forget UPS!

 

[DMC]

For example...

Here is a complete Ortho-implant kit. everything! All the tools, the actual implant, surgical stuff, etc.... (It's a prototype for a customer)
I could have it milled right now. I have printed it, but I can't find my camara charger anywhere. Have you guys seens it around? small, Black Nikon charger? anyway...I'll take pics tommorow.

 

[araucaria]

Rapid prototyped denture (I know of two companys doing this now in beta. Even print the denture teeth!)

very interesting, any further info on the developments of these systems ?

 

[DMC]

needs FDA approval.

Multi-material plastic printer. layer-by-layer with many different materials. Some heat cured, some light cured. I'm sure many other companies are working on this.

Scott

 

[Xydorf]

The reason why I want to start going 100% digital now, is that it will be too late in 10 years - just as stated due to the cost of equipment. It is time to be a thought-leader in dentistry, or be outsmarted by someone who is.

 

[rkm rdt]

Don't forget the transporter to send the patient to the lab for a custon shade....hey wait we could transport to the clinic too. Might have to send my clone if I get real busy.

2x visits,3xvisits? Patients do return to their dentists on a regular basis for checkups etc.

We are all thought leaders in denistry.Talk to your patients and ask them their thoughts too.

 

[Xydorf]

RKM: If you talk to patients, they of course want it done immediately (i e not having to wait for a crown to be fabricated at a lab). At the same time, I want to make sure that I deliver highly estethic, high quality lab jobs to my patients, therefore I want my own lab next to the clinic.

 

[araucaria]

Don't forget the basic principle - we're in Business. Being Super,Brilliant, Wonderful, etc doesn't bring in the money on its own.
Good product, service, communication, support, reliability, and Value for money etc will be the foundation. High tech is great for all us enthusiasts but this technology requires us to hit a very high numbers target. Maybe within your local/regional dental community there's an option for a shared supply resource to reduce the impact of the investment that's required.

 

[rkm rdt]

"RKM: If you talk to patients, they of course want it done immediately (i e not having to wait for a crown to be fabricated at a lab). "

They do? I think that is what you want.

Patients would prefer to keep their teeth.