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Centralized milling and in-house milling: solutions for growth

by: Suvi Rantanen

Look at any industry and you will discover that various elements of production or service responsibilities are either performed in-house or that they are passed over to an external third party who specializes in that particular task. As each method of working has its own benefits, the decision to outsource or to keep a process in-house will depend on the business’ views and priorities.

Centralized milling unit

Outsourcing is a popular business model. Businesses often realize that they cannot do everything efficiently in-house to a consistently high standard, so they seek alternative suppliers to gain both operational and cost efficiencies. However, they may equally choose to keep a process in-house because of its own advantages, such as the reduction in logistical problems (e.g., fewer potential issues with the delivery of items). The decision of whether to outsource or to keep a process in-house similarly applies to dentistry.

In the dental profession, aspects of treatment have been outsourced for some time. For example, dentists refer to other dentists, which is a type of outsourcing, and indirect restorative work is often sent to a dental laboratory for fabrication. Likewise, for laboratories themselves, milling can be an ideal process to send to a centralized location. However, laboratories may prefer to keep the milling process in-house for several reasons. So, what are the benefits of each?

Benefits of centralized milling centers

Centralized dental prosthetic production facility

As a dental laboratory has limits on time, resources and investment capacity, assigning work to an external supplier may be the most viable option for growth. Along with satisfying growing customer demands, there are numerous other benefits that include:

  • Maximizing potential – not only can capacity be increased, the offering can be broadened with access to new types of materials and restorative concepts. In addition, work that is performed within the laboratory can be streamlined.
  • Staying ahead of the competition – by using an external specialist, a laboratory no longer has to turn down work because of limited capabilities, or a lack of time or resources. Dentists are satisfied as they only have to deal with one laboratory rather than multiple businesses.
  • Cash flow – by outsourcing work that is not the laboratory’s fundamental business, it can relieve pressure on cash flow. This is because new equipment is not required, reducing the need to invest in scan accessories that are used infrequently.
  • No stock – outsourcing the work means that the cost and space of stock of materials is reduced or eliminated. Instead, using centralized production ensures you receive products with consistently high quality, providing you with additional peace of mind.
NobelProcera Scan and Design Services

With the NobelProcera Scan and Design Service, the lab technician can order CAD/CAM abutments, crowns and implant bars as well as 3D printed models. Scan files from many different intraoral and desktop scanners are supported, allowing the acceptance of more cases.  With access to various implant platforms for implant bars and capacity to cater for a variety of restorative and prosthetic needs, it allows the technician to offer products with high quality and precision of fit.

Benefits of in-house milling

In-lab manufacturing of dental prosthetics

As an alternative to outsourcing, keeping a task in-house also has advantages that include:

  • Workflow efficiency – keeping the process in-house simplifies the workflow and can enable more efficient turnaround times for the clinicians.
  • Involvement in the whole process – by milling in-house, it is possible to stay up-to-date with each stage of the process and to make changes along the way, if necessary.
  • Efficient collaboration – depending on the milling software that is used, it can enable improved collaboration and data sharing.
  • Cost over time – the cost involved in the initial purchase of the milling equipment and software is offset in the long term by the reduction in laboratory costs.

Why use dental CAD/CAM services?

Computer-aided design (CAD) and computer-aided manufacturing (CAM) can be used for in-house milling or for centralized production. This technology has become progressively popular in dentistry over the past 25 years, and it is employed in dental surgeries and laboratories for many purposes, such as crowns and fixed partial dentures.1 CAD/CAM has also allowed for exceptional progress in the creation of dental restorations. Notably, CAD/CAM enables highly accurate implant reconstructions to be fabricated, with titanium frameworks showing the most consistent precision.2 High survival rates are also reported for CAD/CAM-fabricated crowns3 and one study has found that single crowns bonded on CAD/CAM screw-retained implant-supported zirconium dioxide complete-arch frameworks have favorable outcomes.4

CAD/CAM technology with DTX Studio suite

DTX Studio™ suite is a single digital platform for dental treatments that connects the workflow from beginning to end. It is easy to use and is easily connected with different desktop scanners, intraoral scanners and milling units in laboratories. With DTX Studio design software, production decisions can be made separately for each patient case. The latest NobelProcera restorations can also be accessed with ease through NobelProcera centralized manufacturing and as such, technicians can offer additional services by supporting production of surgical templates, models, tooth-based restorations and TempShell provisionals.

Nobel Biocare has a solution for laboratories whether they are looking for precision fit restorations or added flexibility with local production of tooth-based restorations, surgical templates and provisional models. 

More to explore

References

1 Davidowitz G, Kotick P. The use of CAD/CAM in dentistry. Dent Clin North Am 2011;55:559-570.

2 Katsoulis J, Merickse-Stern R, Rotkina L, Zbaren C, Enkling N, Blatz M. Precision of fit of implant-supported screw-retained 10-unit computer-aided-designed and computer-aided-manufactured frameworks made from zirconium dioxide and titanium: an in vitro study. Clin Oral Impl Res 2014;25:165-74.

3 Pozzi A, Tallarico M, Bartlattani A. Monolithic lithium disilicate full-contour crowns bonded on CAD/CAM zirconia complete-arch implant bridges with 3 to 5 years of follow-up. J Oral Implantol 2015;41:450-8.

4 Pozzi A, Tallarico M, Bartlattani A. Monolithic lithium disilicate full-contour crowns bonded on CAD/CAM zirconia complete-arch implant bridges with 3 to 5 years of follow-up. J Oral Implantol 2015;41:450-8.