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09/24/2006
A Lab's Lab: When Laboratory Outsourcing Makes Sense|A Lab?s Lab: When Laboratory Outsourcing Makes Sense
Published in Doctor of Dentistry
By Dan Walker
Laboratories are an indispensable component of any dental practice. They give dentists the ability to provide patients state-of-the-art technology and products that would otherwise not be affordable, no matter how large or small their practice.
But where do labs turn when they need a laboratory solution that's not available in-house?
Just like the dental practices they serve, laboratories are primarily local or regional operations, and can vary both in size and the resources available to quickly process work coming from their constituent dentists. And with new technology often requiring up-front investments measured in the millions of dollars, labs are increasingly turning to outsourcing as a way to immediately grow their business.
Outsourcing makes it possible for even the newest or smallest of labs to offer their customers the benefit of cutting-edge technologies, as well as deliver experienced application of innovative products and techniques. One of the more advanced outsourcing labs is Atlanta-based Laboratory Solutions, Inc. "We formed Laboratory Solutions because as the advancements in dentistry began to come about more rapidly, we saw an obvious need to help labs quickly adopt and profit from these new technologies," says Jeff Paulen, the company's founder. Paulen also runs his own lab, New Image Dental Laboratory, which he started back in 1984.
Laboratory Solutions had a definitive heads-up on implementing these rapidly advancing technologies. For starters, Paulen's lab had more than two decades of doing nothing less than seeking out new dental technologies and working to help manufacturers refine their products to better suit the needs of dental laboratories. "I'm a technology nut," admits Paulen, who tries to get the latest and greatest machines and materials in-house as quickly as possible, so his staff can play with them. "Because we partner with these manufacturers to beta-test their products, we get new technologies in-house often a year or two before they're officially introduced," Paulen adds. "That means that as we're testing, we're also providing input to the manufacturer. At the same time, we're getting to become very familiar with that new product, so we know exactly where it will benefit dentists the most in terms of quality or efficiency."
ON RESEARCH'S CUTTING EDGE
Another reason that Laboratory Solutions can offer advanced dental products and services is their partnership with the TEREC Group. TEREC (Technical Research Consortium) is a close-knit alliance of 13 strategically located laboratories throughout the United States and Canada. These labs work together, as a consortium, to research the best ways to work with and help guide dentists and dental manufacturers when it comes to choosing products and developing techniques that will ensure the best possible results for clients. TEREC labs routinely partner with a variety of organizations, including 3M ESPE, Ivoclar Vivadent, Dentsply, Whip-Mix, Nobel Biocare, Captek, Heraeus Kulzer and the Institute of Oral Art & Design, as well as notable clinicians and researchers.
"By partnering with TEREC, Laboratory Solutions can serve as the research and development arm of even a lab with only two people in-house," says Paulen. "We're able to test, evaluate, recommend and develop best practices for all the new technologies that enter the market, and that's a tremendously powerful resource for any lab to have."
LAVA IS HOT
Beyond Rx, a "lab's laboratory" provides a resource for profitably capitalizing on this research. Fay Ashley is Laboratory Solutions' Customer Service Relations manager. "Unless a small lab has a backer with very, very deep pockets, they can't just go out and buy these new technologies," Fay mentions while discussing some of the machines that are used in labs today. "For example, a Lava machine costs more than $225,000, and that's just for the machine. Then you need technicians who are thoroughly trained in how to use that machine to consistently get quality results. There are only a handful of labs in the country that can afford to do that." Laboratory Solutions was one of the first labs in the U.S. to purchase a Lava machine from 3M ESPE almost two years ago.
Today Laboratory Solutions has four Lava machines. "Having this resource lets us quickly handle orders from dozens of smaller labs," says Fay, "and that makes everyone a winner - the local lab, their client dentist and, of course, the patient."
Currently the Lava system is indicated for single-unit crowns and bridge frameworks with up to six units. Lava crowns are known for their fantastic fitts. "The Lava system was the first system to give a laboratory control of the cement gap, therefore, allowing us to achieve a much tighter fit," Fay explains. Lava substructures are available in eight coping colors, allowing labs to achieve the dentin color without using an opaque overlay to mask the color of the coping. "The aesthetics that are achievable with Lava are fantastic," Fay adds. Another advantage of the Lava system is that it was designed as a production unit in order to handle the increasing demand for zirconia. As of January of 2006, Laboratory Solutions has produced more than 40,000 units using their four Lava systems.
DEVICES FOR EVERY KIND OF DENTITION
Lava is just one of five different CAD/CAM (computer-aided design/computer-aided milling) technologies currently used by Laboratory Solutions. Each technology has its advantages and preferred applications, as evidenced by several years of beta testing and experience in practice use.
Everest by Kavo: The Everest system is the only CAD/CAM system on the market with five-axis milling technology. "This allows us to do frameworks and full contour crowns," explains Fay. "It is the most precise milling system that we have worked with, because the blocks are embedded in resin." Everest is indicated for single-unit crowns, bridges of up to six units, inlays and onlays. One of the main advantages of Everest is that it can be used with a multitude of materials, including both hard and soft zirconia, titanium, nonprecious, lithium disilicate and feldspathic glass. Based on the work done so far on Laboratory Solutions' in-house Everest machine, Everest shows the greatest potential for future applications, such as implant abutments and bars.
Zeno by Weiland: Laboratory Solutions also has a Zeno system in-house, which is just about to finish its testing phase. "Zeno is the only system we have worked with that can mill large span bridges, and up to 14-unit roundhouse bridges," Fay comments about the Zeno system, which can also mill single units and inlays. Additionally, Zeno can mill multiple blank thicknesses, from 10 mm to 24 mm. "Our CDTs report that the precision of milling and fits have been excellent," adds Fay.
CEREC inLab: Sirona Dental's CEREC inLab is a CAD/CAM system for the fabrication of copings, bridge frameworks, inlays, onlays and fully contoured crowns. The technology can trace its history back more than 20 years. Laboratory Solutions uses their inLab unit on a limited basis for full contour crowns, inlays and onlays.
Procera: Procera has been on the market for about nine years, but Laboratory Solutions began working with Procera 10 years ago. The company primarily produces Procera zirconia single unit crowns. Procera crowns made from alumina (Procera's original material) are also available. Laboratory Solutions feels that the finest product produced using Procera are their custom zirconia abutments.
FUTURE TECHNOLOGIES
Technology "and where it's going" is always a topic Jeff Paulen enjoys heartily, and he has several thoughts on what labs will be seeing in dental technology in the coming months and years. "Right now the current marketplace averages 15 percent ceramic restorations, and 85 percent porcelain to metal restorations," says Paulen. "Until zirconia, labs and dentists alike never had materials that were this strong." Paulen predicts that in the years to come, zirconia will probably account for over 40 percent of the marketplace " and that it will continue to grow. "Eventually, metal will only be used on a limited basis - basically a material of the past," says Paulen, who sees far more of the work being done on all crown and bridge substructures being fabricated by CAD/CAM procedures.
In addition, there are several new technologies on the near horizon, which will result in product availability within the next few years. One product that is getting close to launching is intraoral scanning/digital impression taking. "This technology will advance impression-taking to the next level, hopefully making impressions clearer, resulting in fits that are more precise," Paulen predicts.
Another exciting new technology soon to be introduced is 'RP' - short for rapid prototyping. The best way to describe RP is three-dimensional printing. "With RP, we'll be able to fabricate solid models from the computer in a process that will be very similar to the way you currently print a document using a printer," says Paulen. "Imagine that - being able to "print" out a new set of teeth." Paulen is quick to add to that thought that, as it is with all new technology, the most important thing that goes into a quality product is the quality of the workmanship - the art - and the quality of the materials.
WHAT'S IN YOUR RESTORATION?
Although outsourcing may seem like a panacea for labs, not all outsourcing options are the same. Many outsourcing centers are based overseas, delivering products of uncertain quality and reliability. Indeed, even issues such as sterility and potential toxicity of materials are now being discussed in response to the rise in use of unregulated imported restorations. According to the National Association of Dental Laboratories, imports of restorations made by low-cost foreign laboratories in China, Mexico and other countries are on the increase, without any regulation or other assurances that the materials being used in those products are FDA approved.
NADL is working with the FDA to ensure that importation of restorations use materials that are FDA approved. ?The FDA wants to make sure that, 20 years from now, patients don?t have substances leaching in their mouths because of materials used by foreign labs to make their restorations,? Paulen surmises. ?That fortunately isn?t a concern with restorations that are created here in the U.S.? The FDA regulates materials that can be used by U.S. laboratories.
Laboratory Solutions is one of several U.S. labs pursuing their DAMAS certification. The DAMAS (Dental Appliance Manufacturers Audit Scheme) process ensures rigorous quality control in the making of a dental device. Laboratory Solutions expects to have their DAMAS certification completed by the first quarter of 2006.
OTHER THINGS TO CONSIDER WHEN OUTSOURCING
Quality products and materials are, of course, paramount concerns when looking for an outsourcing lab, but there are other things to consider that can make a tremendous difference in the success that can be had from using an outsourcing lab.
Customer service and technical support are two things to consider. Laboratory Solutions, for example, has devoted several employees solely to ensuring a fast and stress-free customer experience. In addition to Fay Ashley, the lab has two technical support managers, Joey Crosby and Victor Harp, who are always readily available to provide phone support during working hours. "This is critical when it comes to outsourcing," explains Fay, "because if a dentist has a question or a concern, their lab has to produce answers quickly and thoroughly. After all, the dentist is used to dealing with one lab - they don't want to deal with delays or excuses."
To that end, Laboratory Solutions also goes an extra mile, offering education and training to their laboratory clients. "We can teach them how to apply the porcelain to the copings," says Fay, "and once a month, on a Friday, we offer a course to all of our clients or prospective clients to bring them up to speed on all aspects of CAD/CAM technology." The company offers training solutions, which range from a basic hour-long PowerPoint presentation to a hands-on course run by their technicians. They even offer coping and porcelain samples for labs to take home, so they can practice on how to perfect their skills without having to purchase these products in large quantities. "We also invite client laboratories to tour our CAD/CAM facility," says Fay. "That way, they can really understand the day-to-day workings of these systems."
To help labs market and explain all of the new products offered through outsourcing, Laboratory Solutions also offers marketing literature that client labs can order in quantity for distribution to their dentist clients. "These marketing tools go a long way toward educating dentists on these new CAD/CAM systems, which makes them feel far more comfortable in prescribing them for their patients," explains Fay.
Outsourcing is no longer an experiment - it's a proven way for smaller laboratories to quickly add new products and services that enable them to stay current with technology, while remaining profitable in the rapidly expanding and competitive dental laboratory business. |
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