material costs for various milled items, looking at AG Motion 2

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TheElusiveSasquatch

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Sorry if this isnt allowed for some reason, Im a dentist looking at AG Motion 2. we have 3 locations and would centralize the mill at one location.

For bite splints: whats the true material cost of these? 30-40 seems very high. we do a good amount of glidewell splints for $65 shipped.. they actually fit quite well. but PPO fees are terrible. if we can get our costs down to under $20 its worth it. Already have Exocad and IOS so it would be model-less and fully digital. Ive tried printing with nextdent orthoclear, but the results have been poor so far. 2 offices do NOT have IOS, so we would need to scan those in.

We also do about 30-40 crowns a month, and would mill the zirconia ones. probably not emax anteriors yet. From what ive seen its about $120-$180/98mm disc? And that should get 25-35 units per disc? Im assuming the software remembers the puck and whats been previously cut from it.. or i hope it does. if so we are looking at $4-$8 raw materials.

finally one site we have is medicaid, and they pay $400/arch for dentures. At $200/arch lab fees we simply lose money on the case when i factor chair and staff time. Id need to be able to get dentures down to $75 for a milled base/prefab teeth. Obviously need to work on chairside impressions with docs and proper baseplating and bite records, and need to invest in a couple extra modules of Exocad.

if we are using the mill for 50 items/mo it would average about $15/use over 5years. I think the ROI would be good and pay for itself in less than a year. It would get a little use for surgical guides as well, but the bulk will be splints, zirconia crowns, and dentures.

Right now have only considered the AG Motion 2, mainly for local support from Benco. But open to other options. Thank you everyone for the help.
 
CoolHandLuke

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it is allowed, i'm just not optimistic you'll get the answers you hope to get.

i will say this, though, 25-35 units per disc is optimistic. its zirconia so units are 25% bigger to begin with, this reduces the number of units you'd get from a disc, even if you put the same units in a pmma disc, you'll always get more from pmma and wax than zirconia. in my experience a puck of molars gets 15 units, and mixing premolars in there only buys you about 6 more. a puck full of 3 unit bridges cheats the numbers to get 3 full arches worth of teeth because units are so densely packed. don't trust zirconia suppliers who tell you how many units fit in your discs.

if you intend to get into digital dentures with AG, why not consider the Baltic system AG have worked so hard to trademark.

finally, welcome, and best of luck.
 
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grantoz

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T now you know why we charge what we charge. the only way you get your material cost down is with volume i would advise use your local labs and look after each other.rather than trying to skimp on you tech fees spend more time in the chair doing cases you are making the same mistakes as the cerec guys saving a hundred bucks on a crown but loosing 500 not working in the surgery.
 
rc75

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@TheElusiveSasquatch Give me call tomorrow. I'm a supply guy with some of the best quality & Pricing around.

Ron (877) 358-5833 or (626) 641-0856 - TD Dental Supply
 
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TheElusiveSasquatch

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Thanks for the replies. I don’t care about the difference between 15-20 units/puck and 25 units. Either way it’s cost effective.

I actually was a CEREC guy, but I don’t have the chair time to do same day and the MCXL wasn’t reliable. But those crowns dropped in and actually fit like a glove.

I appreciate the lab guys, Grant :) but I also appreciate $6000 in lab fees /mo that I’d like to knock down a little bit. But actually most of the reason is actually for better turn around times for our patients, but it still needs to make financial sense to justify the expense and work involved, hence the check of costs.

You also have to remember that dentists aren’t turning away patients to make time for in house milling. It’s $0 productivity time this would replace. I’m not delaying implant patients so my team can mill a crown, obviously that’s bad business.

Our removable guys havent been reliable enough and with our fees we can’t afford the $300/arch guys. The crown lab costs are tolerable, but that’s the part that needs to amortize the equipment; I can’t switch to this for removable if the crown savings don’t also pay for it.

My primary concern is if remvoable can be made at a good enough savings to justify the system without taking all of my business away from my crown guy
 
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Hi there,
I am one of the few DDS here, Perio/implant guy actually...Welcome!
There are so many things we can learn from the CDT peeps on this website. They are, understandingly protective of their turf, like we are.
But if you are willing to contribute, and please do, they will help you.
Good luck!
 
Affinity

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We can all help each other , only if we give more than we take.
I just wonder why you dont have a good tech to ask these questions to..? Who runs your mill? An assistant? My recommendation would be to find someone who can consult with you and make sure youre making the right choices, if youve moved away from cerec maybe you understand what I mean.. a patterson sales rep does not make teeth, they just sell stuff. The group consensus here is great, but having a system set up, that works, for your situation specifically is something different. I just read Cerec tech support is $199 for 15 minutes! I hope you can find the help you need, but figuring out how to mill crowns isnt what I want my dentist focused on.. With respect! welcome!
 
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grantoz

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I have a lot of time for Dr G he is one of the few dr's on this site that gets it unfortunately i think The elusive sasquatch has ears that are painted on.we are not protecting our turf we are trying to help him.
 
Chalky

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I mill a lot of splints on a motion 2 mill too (well 2 actually!),I have just ticked over 2000 in total this week. something to consider that we initially didn't factor properly was the tool use and cost associated. milling pmma will eat your tools compared to zirconia... I am yet to find an after market bur that performs as well as the AG burs so I have to pay premium for cutting tools that are reliable, all after market tools that I have tried break! this also costs time and money in repeating the program etc... it generally takes about 1 hour and 25 - 1hr 40 to mill one splint, in a wet strategy. going between milling dry and wet will take a bit of figuring out to make sure that you look after your mill, properly drying it out etc.. I would also be hesitant to go completely modeless in doing this, splints are a bit of a tricky thing to get right... each case needs to be assessed on its own merits, undercuts are very different from case to case and there is not 'one set of parameters that fits all' cases. you need to understand the parameter values and know definitively what it is you are adjusting in order to get things to work. this has taken me a lot of trial and error in the early days to understand and get right. having said all of this I very occasionally go modeless with pretty good success and have very reliable and consistent results.
 
JMN

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Thanks for the replies. I don’t care about the difference between 15-20 units/puck and 25 units. Either way it’s cost effective.

I actually was a CEREC guy, but I don’t have the chair time to do same day and the MCXL wasn’t reliable. But those crowns dropped in and actually fit like a glove.

I appreciate the lab guys, Grant :) but I also appreciate $6000 in lab fees /mo that I’d like to knock down a little bit. But actually most of the reason is actually for better turn around times for our patients, but it still needs to make financial sense to justify the expense and work involved, hence the check of costs.

You also have to remember that dentists aren’t turning away patients to make time for in house milling. It’s $0 productivity time this would replace. I’m not delaying implant patients so my team can mill a crown, obviously that’s bad business.

Our removable guys havent been reliable enough and with our fees we can’t afford the $300/arch guys. The crown lab costs are tolerable, but that’s the part that needs to amortize the equipment; I can’t switch to this for removable if the crown savings don’t also pay for it.

My primary concern is if remvoable can be made at a good enough savings to justify the system without taking all of my business away from my crown guy
Be aware that when going this way you are not eliminating or reducing you lab bill. Just hiding it.

Think of it as Uber vs car ownership. When you own the car you can control some of the cost better, but you only pay Uber when you actually need the transportation.

Most of this tech now has a roughly 5 year life. Ensure your ROI and TCO make sense in that timeframe.

If it's for you, that's cool. Just be cautious of confirmation bias. It's a big trap for all humans.
 
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TheElusiveSasquatch

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Thanks Chalky and JMN, that’s feedback thats useful. I’m not sure where others are assuming I’m asking how to do technical lab work when I was quite clear in my questions regarding costs involved, I’m not even sure how CEREC tech support costs are relevant to the thread at all. Thanks again Chalky and JMN and DrG.

Chalky-
That’s a great point, I was also wondering about the tool costs and the AG rep was telling me tools for PMMA can last maybe 4 discs. Is that what you are finding as well? I didn’t know if that was accurate but you seem to confirm they do actually eat up burs. If we find accuracy requires models then we will stick to using a lab for it. Night guards aren’t a huge value proposition, it would be a bonus for turn around times.

Time to mill isn’t a huge concern, it’s still faster than 2 weeks. It a matter of whether milling is more user friendly to my team than 3D printing. I have successfully printed splints but post processing is time consuming and introduces errors. My mill would have a LOT more downtime than yours so efficiency isn’t as much a factor for a dental office unless we are going for same day treatment.

JMN- you’re correct , it’s shifting costs, though I think I can have it pay for itself in 2 years. I’m expecting 4years of service so 5 would be a bonus:) but the patient gets their work faster with being in-house so I think that’s would be worth it. The plan is to take our existing lab costs , look at new costs if we get the mill, and then take the savings and pay down the equipment quicker.

But estimating those costs accurately affects the value proposition, hence this thread:) just trying to figure out the true costs involved to help determine if it will be worth it for the time savings to the patient. What i don’t want is to get into it and then realize it’s costing a lot more than expected :)
 
JMN

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Thanks Chalky and JMN, that’s feedback thats useful. I’m not sure where others are assuming I’m asking how to do technical lab work when I was quite clear in my questions regarding costs involved, I’m not even sure how CEREC tech support costs are relevant to the thread at all. Thanks again Chalky and JMN and DrG.

Chalky-
That’s a great point, I was also wondering about the tool costs and the AG rep was telling me tools for PMMA can last maybe 4 discs. Is that what you are finding as well? I didn’t know if that was accurate but you seem to confirm they do actually eat up burs. If we find accuracy requires models then we will stick to using a lab for it. Night guards aren’t a huge value proposition, it would be a bonus for turn around times.

Time to mill isn’t a huge concern, it’s still faster than 2 weeks. It a matter of whether milling is more user friendly to my team than 3D printing. I have successfully printed splints but post processing is time consuming and introduces errors. My mill would have a LOT more downtime than yours so efficiency isn’t as much a factor for a dental office unless we are going for same day treatment.

JMN- you’re correct , it’s shifting costs, though I think I can have it pay for itself in 2 years. I’m expecting 4years of service so 5 would be a bonus:) but the patient gets their work faster with being in-house so I think that’s would be worth it. The plan is to take our existing lab costs , look at new costs if we get the mill, and then take the savings and pay down the equipment quicker.

But estimating those costs accurately affects the value proposition, hence this thread:) just trying to figure out the true costs involved to help determine if it will be worth it for the time savings to the patient. What i don’t want is to get into it and then realize it’s costing a lot more than expected :)
Some of the flak you are getting is from all of us getting fussed at by a dentist for issues that same dentist will overlook when doing it themselves.

We are as protective as anyone else.

In my stste there's friction betwen the OS and GD on who where the caseplanning, fees and execution lines are located. It's actually illegal here for an oral surgeon to use permanent cement.
 
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TheElusiveSasquatch

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Thanks man. I get it, I’ve been on industry and hobby forums for 20yrs. I understand why people get territorial online and I person but I don’t let it bother me personally. It’s why I stuck strictly to costs and didn’t say anything negative about the labs I work with, I wanted to strictly stay on information gathering. Thanks for your inputs it’s appreciated.
 
Chalky

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Thanks Chalky and JMN, that’s feedback thats useful. I’m not sure where others are assuming I’m asking how to do technical lab work when I was quite clear in my questions regarding costs involved, I’m not even sure how CEREC tech support costs are relevant to the thread at all. Thanks again Chalky and JMN and DrG.

Chalky-
That’s a great point, I was also wondering about the tool costs and the AG rep was telling me tools for PMMA can last maybe 4 discs. Is that what you are finding as well? I didn’t know if that was accurate but you seem to confirm they do actually eat up burs. If we find accuracy requires models then we will stick to using a lab for it. Night guards aren’t a huge value proposition, it would be a bonus for turn around times.

Time to mill isn’t a huge concern, it’s still faster than 2 weeks. It a matter of whether milling is more user friendly to my team than 3D printing. I have successfully printed splints but post processing is time consuming and introduces errors. My mill would have a LOT more downtime than yours so efficiency isn’t as much a factor for a dental office unless we are going for same day treatment.

JMN- you’re correct , it’s shifting costs, though I think I can have it pay for itself in 2 years. I’m expecting 4years of service so 5 would be a bonus:) but the patient gets their work faster with being in-house so I think that’s would be worth it. The plan is to take our existing lab costs , look at new costs if we get the mill, and then take the savings and pay down the equipment quicker.

But estimating those costs accurately affects the value proposition, hence this thread:) just trying to figure out the true costs involved to help determine if it will be worth it for the time savings to the patient. What i don’t want is to get into it and then realize it’s costing a lot more than expected :)
about 4 discs is a pretty accurate assessment I would say... using AG tools we go through more 1.0mm than the 2.5mm tools, abrasion is worked out on time and the 1.0mm tools define the detail - more time is spent doing this. im not saying you cant go modeless, but it may be hit and miss in my opinion. It will take some time to get right I would think, maybe modeless as a future aspiration is more likely. when we have calculated the costs of volume vs production costs it is relatively similar to having additional technicians doing the production to maintain the volume output. difference lies in the consistency of product, mills don't get sick or need to take holidays, one person can easily design 12 - 16 splints in a day, the mills allow diversity in your range of products and more...
 
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i don’t see how your practice is losing money on partials and removables for 200 per arch. A removable lab doing quality work is worlds ahead of any digital technology on the market. Paying a lab 300 arch for consistency and dependability should be profitable and give peace of mind for the entire staff. I don’t understand the need to cut out the valuable commodity a lab offers as a vendor. My 2 cents.
 
Affinity

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I apologize if you thought you were peeing on my hydrant but why would I be territorial over someone who makes their own crowns, like you’re taking work from me..? my biggest account has a cerec. The correlation between the person that buys or operates the system and paying $600/hr for tech support is that if you have someone who knows what they’re doing, it runs more efficiently. You’re here so you understand where to get free support. I get it you’re here for the money-saving coupons not the recipe, sorry for interjecting. Buy Chinese pucks and you will save 40-50%, AG material is too expensive for cost-cutting.
 
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TheElusiveSasquatch

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Rkm- With SDC, the only patients I’ve had with them already were in it before I met them. But they have a clever marketing team. If anything it’s gotten me to think about how to produce aligners cheaper so I can be competitive. For now I haven’t lost Invisalign patients to them. In the end the cost savings benefit the patients. I’d rather provide aligners at $200 cost and sell for $2200 vs pay $1400 and sell for $3400. Better for the patients because they save money and if I’m doing it instead of SDC for the same price, better for the patient. Complex cases SDC is useless and those cases still require the full Invisalign fee.

Holly- Re:losing money on $200/arch lab fee... the office that does dentures is Medicaid. They pay $400/arch. 4 visits for $400 with $250 in costs (materials in addition to lab),you can start to see it not make sense. For my hybrids that I convert to immediate loads I pay $350-400/arch. Simply Can’t do that for the Medicaid ones tho :(
 
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Rkm- With SDC, the only patients I’ve had with them already were in it before I met them. But they have a clever marketing team. If anything it’s gotten me to think about how to produce aligners cheaper so I can be competitive. For now I haven’t lost Invisalign patients to them. In the end the cost savings benefit the patients. I’d rather provide aligners at $200 cost and sell for $2200 vs pay $1400 and sell for $3400. Better for the patients because they save money and if I’m doing it instead of SDC for the same price, better for the patient. Complex cases SDC is useless and those cases still require the full Invisalign fee.

Holly- Re:losing money on $200/arch lab fee... the office that does dentures is Medicaid. They pay $400/arch. 4 visits for $400 with $250 in costs (materials in addition to lab),you can start to see it not make sense. For my hybrids that I convert to immediate loads I pay $350-400/arch. Simply Can’t do that for the Medicaid ones tho :(
I support California clinics that have a much a higher lab fee than 200 arch for medicaid patients and the dentists drive luxury cars and do quite well. Paying a RDA 15-20 Hr with a qualified dentist utilizing patient chair time ought to be profitable, and more importantly the Lab plays in important role as a vendor in making the dental office money.
 

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