Milled Titanium Framework

[John in Canada]

I’ve had At least 8 titanium bars of various configurations done over the last 3-4 years. All good results except one wrap around opposing a full arch zirconia bridge. (I think wrong design application) Anyhow I got to thinking yesterday about what the prosthodontist charges for these technological works of art, and wondered if I’m charging appropriately for the product. What percentage do you upcharge for outsourced work? My minimum has always been 30%. But for a milled titanium bar ($1200),30% maybe is to low when doc is charging 30K.

 

[bigj1972]

I’ve had At least 8 titanium bars of various configurations done over the last 3-4 years. All good results except one wrap around opposing a full arch zirconia bridge. (I think wrong design application) Anyhow I got to thinking yesterday about what the prosthodontist charges for these technological works of art, and wondered if I’m charging appropriately for the product. What percentage do you upcharge for outsourced work? My minimum has always been 30%. But for a milled titanium bar ($1200),30% maybe is to low when doc is charging 30K.

100%...so if you have to pay for a remake, your not paying for the privilege to do the case.

 

[Brett Hansen CDT]

I went to a seminar put on by Nobel several years ago about All on 4 type cases. At the time, the patient was paying about 22-25K per arch. It was expected the lab's part of that would be somewhere around 4500-6000.

 

[JKraver]

From what other labs charge when we send out a case like that its about 6k per arch.

 

[lcmlabforum]

All the numbers do not do enough justice to what is involved usually, like whether it includes
the conversion at the time of surgery, the interim, the mock up for the final prosthesis etc . . .
LCM

 

[Andrew Priddy]

All the numbers do not do enough justice to what is involved usually, like whether it includes
the conversion at the time of surgery, the interim, the mock up for the final prosthesis etc . . .
LCM

yet labs in my area climb all over themselves to get these cases...
they can have them imo, I'll take singles in all day long and, sleep with a smile.

 

[JohnWilson]

yet labs in my area climb all over themselves to get these cases...
they can have them imo, I'll take singles in all day long and, sleep with a smile.

So I could not disagree more and I encourage anyone that agrees with you to take a minute and really contemplate how technology will limit your viability in the near future. I keep saying the same thing, quadrant dentistry is dead, you must adapt if you are not specializing today. Comprehensive dentistry is hard, many doing it are doing a poor job and there will be a huge influx of cases needing to be retreated. YOU can be the EXPERT, you can find a way to tap into this if you are prepared for the challenge of adapting not only your skill set but your focus and goals. It's impossible to coast these days and if you are not adapting your are failing and your days are limited.

Please understand I have shared this with all due respect and with the hopes that it might just get you thinking differently about your path and the future.

 

[Andrew Priddy]

John, I understand some of your points of view, but rest assured, im not the guy that "coasts thru" anything.
My skillset has included large cases, but yes, definitely has room to grow. that said, I see "poor work" in every avenue on the Central Coast. Work that is in "no wayY" comparable to what we can generate as "standard".
As long as trained techs keep leaving the industry, and are replaced by Pizza Hut drivers, im pretty sure I'll do just fine. schools have closed, so who is my replacement when the collective local dental IQ has dropped to that of a field mouse?

locally, all I see are clowns climbing all over each other to get "larger cases" so they can boost their ego's, and think they've done something special, financially out-racing each other to the bottom. this was my point.

Our business model is a 2 person lab that doesn't need to rake in cases to pay for building rent and a bunch of employees that are capable of one or two tasks, which in turn need to support a bunch of "non" producers... I could go on, and on.

I already am an expert at what I do John. im damn good at it, and ill always get better at what im good at... so is my wife, a removable tech.
but this doesn't mean I should be an "expert" in "everything". its been my experience that experts at everything usually don't know half of anything.

our intention is to service a handful of accounts, and move in the direction/s that fit their needs as well as ours. Im not flexible, im fluid.
our business "growth" will happen when I can purchase equipment and limit my manufacturing outsourcing, NOT by hiring employees and then chasing work to support payroll for said employees. I already know what I alone can produce daily, and im pretty happy with the projected numbers, even on the lower end of my expectations. add in my wife and maybe an admin employee on top of that? this is the exact position We should be in.

that said, could you please expand on

take a minute and really contemplate how technology will limit your viability in the near future

technology hasn't been used to the "fullest extent" in any lab I've ever worked in, so how will technology limit "our" viability? my intention is to "master" our software and new manufacturing tools as I can acquire them..
ive made some pretty big changes/leaps forward in that regard, despite my apprehension to "learn new tricks"... the cog in the wheel is me, so im quite sure I'll be up till 2am again with model creator module that we purchased a few days ago. fk it. i love it regardless of the hours ive got to spend, but here's the thing.. just because we bought the implant module, doesn't mean I'm going to run around looking for implant work? why, when 3 crowns is just as lucrative and takes the same amount of time.

this industry has shifted from "Full Technicians" in the lab at the bench to 1 Technician and a bunch of people who "call" themselves technicians.
how many technicians do you currently have that can take a case from start to finish themselves? there is a Massive void between digital and analog that isn't bridged unless there is a technician that understands both digital and analog, and can take both to the bench. look at your outsourced designs as a symptom, not a cure. this is the point where viability is limited "with" technology. not the other way around.

also, not sure "how" you are referring to on quadrant vs comprehensive and how that falls into what ive previously posted.

Lab manager I had, and have great respect for. his business motto was "keep your overhead down and work your ass off".
Solar has already been installed, so I guess I better get back to the second statement in his Motto.

 

[JohnWilson]

Again seems you are reacting rather than absorbing my words, I am not trying to do anything other than be the messenger. I have no idea where you are in your career, how much longer you want to play this game of teeth but when you say you would rather do singles all day that's where my opinion is based. I am sure you and your wife are excellent at what you do.

Please note technology is changing not what YOU know but what your clients can do themselves. As analog impressions go away with the click of a button you can imagine guys we deeper pockets will fill this void with such razor thin margins that you are no longer viable. Ai and fully automated workflows for singles is already here. It does and will suffice the biggest segment of this market.

As for my lab and my techs, we are a small lab with 8 techs 6 of them have worked WITH me for 20 plus years, one for 25. Each of the six can and will do cases from start to finish. Everyone of them knows the power of digital because they learned how to do it with their hands first. We saw where the market was moving early on. We adapted to provide something different than the rest. We adapted to change and embraced it.

After 35 years in the game making every mistake possible I post on these forums not to make myself feel superior but to hopefully inspire others to make wise choices that will no doubt need to be made in their career.

Good luck

 

[Car 54]

As for me, in getting close to retiring, I get what Andrew is saying and am anticipating being able to keep it simple in servicing the local accounts I have.
If I still had 15-20 years to go, I understand what you're saying John, and agree.

 

[Tayebdental]

I actually love the digital quadrant scan I get , after 44 years in this business as a ceramist/crown and bridge cdt. from start to finish on fabrication , and I went to dental lab school back in the seventies, as I see it single units and bridges are still the bread and butter for many labs.
Andy and John both have a point In this.

 

[Andrew Priddy]

As for my lab and my techs, we are a small lab with 8 techs 6 of them have worked WITH me for 20 plus years, one for 25. Each of the six can and will do cases from start to finish

I was under the impression you had a much larger lab, don't know why. if you've been able to retain good employees, then you've definitely done a lot "right". my experiences and my wife's experiences in this field have been nothing short of "brutal", so unfortunately that's where my mind leads, and I appologise.

Please note technology is changing not what YOU know but what your clients can do themselves. As analog impressions go away with the click of a button you can imagine guys we deeper pockets will fill this void with such razor thin margins that you are no longer viable. Ai and fully automated workflows for singles is already here. It does and will suffice the biggest segment of this market.

a little un-nerving, now that I understand your point better. but haven't we heard that AI will take over the market for years? that designers would become obsolete? is it that much different than a local lab pulling in all the work with a price drop? we've seen repeatedly where that leads. I've always felt that the human factor is already missing with some of these larger business models, and Dr's don't "appreciate" it.

has advances in the industry already made some jobs obsolete? most definitely, a lot of processes actually, but when labs are closing with technicians leaving the industry, the work still needs to "get done" so quality plummets and the work shifts to those capable of producing quality work. the direction of my career went where I was needed, definitely not where "I personally wanted to go".

"Deeper pockets" have tried to fully own the market, and still try to. no matter how much work I produced, it was never enough. the stress put on employees isn't sustainable, they leave. they leave the industry or 'do their own thing'.

for most, this isn't a career, its "just a job".

 

[CoolHandLuke]

has advances in the industry already made some jobs obsolete? most definitely, a lot of processes actually

yes, that's how that works. advances make people obsolete.

labs are closing with technicians leaving the industry, the work still needs to "get done" so quality plummets and the work shifts to those capable of producing quality work

as i have mentioned several times now, it is always easier to make a convenient process higher quality than it is to make a quality process more convenient. eg it is always easier to make milling quality better than it is to make layering porcelain easier. the mill is the convenience, the hand work is the quality process that can't easily be reduced to automatable tasks.

luxury marks like Rolex and Rolls Royce don't have advertizing. they don't need it. they don't want it. they do not want to be cheapened to influence more people to purchase their products through mass appeal. this is the whole essence of being a luxury brand. you don't mass produce.

look at the value of the rolex company though. today acording to google its nearly 8 Billion dollars.

compare with the value of 3shape https://www.zoominfo.com/c/3shape-inc/348241950 q1-q2 revenue 2021 says it earned 360million

theres nothing luxury about our products, i don't care what lab you are.

one of two ways porcelain will be eliminated from the dental world: 1. material sciences will find a material that is printable, or 2, someone will invent a dual arm layering robot. neither idea is far fetched in 2022. in 2012 this was a dream.

to John In Canada: heavily invest in your capacity to mill, get hyperdent's template generator. go to courses on cnc manufacturing. watch youtube if need be. you can easily mill bars with the smallest of effort. many providers already have solutions in place too.

 

[Foggy_in_RI]

People do not simply become obsolete- business leaders fail their employees by not proactively training them up to do more complex work before and while adopting new technologies. Employees who are laid off/let go because someone bought a mill or started printing are working for the wrong people IMO. These are business leaders who seem to put short term profits ahead of long term sustainability.

And as a side note:
"Spending around $56million, Rolex has (once again) outdone themselves and everyone else. Despite the fact that Rolex has spent their way into the top spot, over 70 brands spent at least $1million in 2019 on ads."

 

[rkm rdt]

Get back to me when Ai can put up with dentists for 45 years.
Bots on DLN posting on the " had enough " thread lol.

 

[sidesh0wb0b]

So I could not disagree more and I encourage anyone that agrees with you to take a minute and really contemplate how technology will limit your viability in the near future. I keep saying the same thing, quadrant dentistry is dead, you must adapt if you are not specializing today. Comprehensive dentistry is hard, many doing it are doing a poor job and there will be a huge influx of cases needing to be retreated. YOU can be the EXPERT, you can find a way to tap into this if you are prepared for the challenge of adapting not only your skill set but your focus and goals. It's impossible to coast these days and if you are not adapting your are failing and your days are limited.

Please understand I have shared this with all due respect and with the hopes that it might just get you thinking differently about your path and the future.

in your opinion, what are some of the best methods to become the "expert" in these and other types of comprehensive cases?

 

[JohnWilson]

in your opinion, what are some of the best methods to become the "expert" in these and other types of comprehensive cases?

Now we are talking my language.

After working alone in my garage for 9 years 6 days a week close to 13 to 16 hours a day I realized the grind of the trade and the sheer time it took to do mediocre work would not allow me to be seen as an expert. In the early 1990's I took my first implant course, I was the only tech and it was eye opening to me. At that point I started down my path to implant dentistry and started my journey to specialize. In my local area in so cal at that time there was very few labs proficient in this and the costs to do these restorations by hand were exceptionally high and risky. Componentry was through the roof in costs, clinically many were making horrendous mistakes and what we know today is so vastly different.

With that I started to view what my clients struggled with, and had to learn more of their part of the restorative equation to be able to troubleshoot and be seen as the answer man. This hand holding was laborious and tiresome but it soon afforded me clout in my local area. This was the starting point.

25 years later and with the advent of the most powerful resource we have "the Internet" everything is at your fingertips if you need assistance. With that my success comes from my analog days of understanding how to do it with my hands and now produce things leaner and more precisely with technology.

Starting as a denture tech being able to see teeth in a negative space and being able to arrange them in my minds eye FIRST undoubtedly was very instrumental in allowing my CAD designs to follow suit. Implant dentistry like most of the things we do require a solid fundamental and a system of steps that will allow you the largest window of success. Seems easy right? Why the hell do so many fail at this part? Here is why.....

Now the most important part of the equation as you are starting your journey, you must not just accept any new client that asks, some will drag you down some will lift you up and in the end you must first run your lab like a business and makes sure the people you partner with are accountable for their part on the team. Everyone thinks its easy until they fail, failing should not crush your spirit unfortunately it seems more common for people to point fingers rather than look close at the failure and learn from it.

If you really want to get involved with full arch comprehensive treatment but you are struggling with today's burdens of finishing the 15th molar of the day you need to make the hard choice to INVEST in yourself. This has a price, a path and a time to acquire the skills, if you are a small lab with no employees, keeping your head above the eb and flows of the daily grind makes things tougher. Make the choice to do something different, make the choice to run your business not on the terms of your clients but on the terms of what is best for you. With this you can cut the blood sucking leeches that do not respect you and find real partnerships.

I have had the highs and the lows in my career, today I have a business not a job, I have found joy in the lives I have changed and will change. I want that for everyone that chooses it. Get involved with one good client, most clients today use multiple labs, reach out to the guy that cuts a real nice prep and ask who they use for implant dentistry, if they say you, they are not the one. Keep asking if you run through your account base look harder and start in your local area. Get involved with study clubs if there is a local one, you may think you have nothing to add and it may take a while (this is the time and effort you must expense) but you will gain not just a client but a better understanding. If you are not digitally centric this is not a deal breaker BUT the future is here now and you need to learn this as data acquisition both with an analog and or a digital path is the hardest part of the treatment. Master this and then what you already have learned with morphology and occlusion will soon help you to grow.

The 10000 hour reference is valid in a lot of things and if you are not aware you have amassed way more than that in LIFE, this is no different if you choose to look at things differently than you do today.

Good luck, may your failures lead you to the success you have always envisioned.

 

[sidesh0wb0b]

Now we are talking my language.

After working alone in my garage for 9 years 6 days a week close to 13 to 16 hours a day I realized the grind of the trade and the sheer time it took to do mediocre work would not allow me to be seen as an expert. In the early 1990's I took my first implant course, I was the only tech and it was eye opening to me. At that point I started down my path to implant dentistry and started my journey to specialize. In my local area in so cal at that time there was very few labs proficient in this and the costs to do these restorations by hand were exceptionally high and risky. Componentry was through the roof in costs, clinically many were making horrendous mistakes and what we know today is so vastly different.

With that I started to view what my clients struggled with, and had to learn more of their part of the restorative equation to be able to troubleshoot and be seen as the answer man. This hand holding was laborious and tiresome but it soon afforded me clout in my local area. This was the starting point.

25 years later and with the advent of the most powerful resource we have "the Internet" everything is at your fingertips if you need assistance. With that my success comes from my analog days of understanding how to do it with my hands and now produce things leaner and more precisely with technology.

Starting as a denture tech being able to see teeth in a negative space and being able to arrange them in my minds eye FIRST undoubtedly was very instrumental in allowing my CAD designs to follow suit. Implant dentistry like most of the things we do require a solid fundamental and a system of steps that will allow you the largest window of success. Seems easy right? Why the hell do so many fail at this part? Here is why.....

Now the most important part of the equation as you are starting your journey, you must not just accept any new client that asks, some will drag you down some will lift you up and in the end you must first run your lab like a business and makes sure the people you partner with are accountable for their part on the team. Everyone thinks its easy until they fail, failing should not crush your spirit unfortunately it seems more common for people to point fingers rather than look close at the failure and learn from it.

If you really want to get involved with full arch comprehensive treatment but you are struggling with today's burdens of finishing the 15th molar of the day you need to make the hard choice to INVEST in yourself. This has a price, a path and a time to acquire the skills, if you are a small lab with no employees, keeping your head above the eb and flows of the daily grind makes things tougher. Make the choice to do something different, make the choice to run your business not on the terms of your clients but on the terms of what is best for you. With this you can cut the blood sucking leeches that do not respect you and find real partnerships.

I have had the highs and the lows in my career, today I have a business not a job, I have found joy in the lives I have changed and will change. I want that for everyone that chooses it. Get involved with one good client, most clients today use multiple labs, reach out to the guy that cuts a real nice prep and ask who they use for implant dentistry, if they say you, they are not the one. Keep asking if you run through your account base look harder and start in your local area. Get involved with study clubs if there is a local one, you may think you have nothing to add and it may take a while (this is the time and effort you must expense) but you will gain not just a client but a better understanding. If you are not digitally centric this is not a deal breaker BUT the future is here now and you need to learn this as data acquisition both with an analog and or a digital path is the hardest part of the treatment. Master this and then what you already have learned with morphology and occlusion will soon help you to grow.

The 10000 hour reference is valid in a lot of things and if you are not aware you have amassed way more than that in LIFE, this is no different if you choose to look at things differently than you do today.

Good luck, may your failures lead you to the success you have always envisioned.

thank you sir, this is spot on the path I have been on for nearly 9 years with my lab.

 

[zero_zero]

I usually don't bite on these type of threads, but here's my $0.02 FWIW:
The fact is, as long you are in the "lab" role, you'll be always running in circles... facing all the challenges mentioned here, trying to stay afloat and be profitable. When the only thing you gotta do, is just think outside the box.
I going to share my latest business model with you:
Setup shop at a lesser developed, non regulated, but booming location... there's zero competition, but plenty of costumers w/ mucho $$$. See the opportunity ? Offer cutting edge dental services w/ an inhouse lab, and the only full digital workflow in a 100 mi radius, if not more. Assemble a good team of professionals with plenty of know how, and some experts who can be flown in to get the job done and have a mini vacation at the same time. Win, win...
Now bring the local hospitality industry on board for their support and advertising, since we will be servicing dental tourism as well. Easy-peasy, since I am involved with the local, fast growing medical tourism already. The only thing I need to worry is supplies (being remote) and how to manage my team to keep the customers happy, nothing more. Opening in three weeks... word got out, and we're booking for July already... yeah, I got my arm twisted, but somebody has to do it So much for being retired... it only lasted for a year, fml

 

[CoolHandLuke]

april fools

actually its to get a really spicy accountant, then let all your invoices go unpaid for 90+ days then make just the minimum payment.

and you let them control the lab money and payroll.

knowledge and talent is for suckers.