So you have or are looking at that fancy wand intraoral scanner. As practices move from just using it as a tool for Invisalign and difficult patients, and into digital dentistry and orthodontics, a very common conversation is taking place between doctors and lab owners:
Doctor: “What do you mean my appliances will cost an extra $15?!?”
Lab Owner: “There is an extra cost associated with printing the scans.”
Doctor: “What do you mean it will take extra time when I am zipping you the file?!?”
Lab Owner: “There is extra time needed to process and print scans.”
Doctor: “The fancy wand salesperson told me it was going to be cheaper and faster!”
Lab Owner (as they “spice” their coffee): “Okay, let’s start from the beginning.”
I was there in a doctor’s office with the fancy wand salesperson. The salesperson had me sold on it instantly and I was nodding my head thinking of how much it could help practices and labs.
But then the salesperson started telling lies. “Appliances will be cheaper and faster to manufacture.” That’s when I started shaking my head. Violently. –I think I hurt myself.
The salesperson, along with everybody else in the room, noticed my reactionary seizure, and caught up to me afterwards. He even stopped by the lab to see what we do and how we do it. He had no clue.
Our conversation sort of started out like this:
“Short term, small picture, digital orthodontics takes more time and costs more money, which means you are setting up doctors to be pissed off at you or at me, and if they are pissed off at me, you can be certain that I’ll make damn sure they are more pissed off at you.”
Look at it from my perspective, the small lab guy. I have been pouring impressions for decades, or getting poured models directly from the doctor. The cost is minimal: plaster, a vibrator, and an employee’s few minutes. Printing a model is an entirely different animal.
Instead of a $100 vibrator, I need a $40,000 3D printer and a few thousand dollars in software, minimum. Instead of plaster that goes for $1 per pound, I need resin that costs $100-$150 per kilogram. Instead of an employee’s few minutes, the scan has to be processed through software, sent to more software and then sent to the 3D printer, set, and then printed, which can take from two to eight hours depending on the printer. And that is not even mentioning the massive investment in research and development.
When I bought my lab 12 years ago, the previous owner did not even have a computer. Now, I have four computers connected to a network and I needed to rent extra space. I can make a pretty fair guess that I have invested more money and “non-manufacturing” time (R&D) in the past two years than owners have in the past 30 years.
But then there is the big picture, the long term perspective. For that, you need to put away the coffee “spice,” break out the Red Bull, and watch a movie on YouTube called “Mindwalk.” It is not the most exciting movie to say the least, but excellently informative. It is an introduction into system’s theory–something I had to watch in college for a science writing class.
With all of the investments, all of the extra time, can digital orthodontics be cheaper and faster? Yes. But just not the way that the salesperson was explaining it.
Time is money. Chair time is an expense. Extra appointments are an expense. How much is your time worth to you? How much is your assistants’ time worth to you? –and that is where digital orthodontics and that fancy wand can make things cheaper and faster.
Excellent impressions can be about as rare as a Flyer’s Stanley Cup. How much time and money do bad impressions cost you per year? I give “nice” offices a break on the price of “dog ate my retainer” remakes, but I charge full price on awful impression remakes. I have been told time and time again that appliances made on printed scans fit perfectly with little or no chair side adjustments.
Labs have also had a huge success rate with digital debonding, allowing you to return to the old way of taking an “impression” at the last braces check and having a perfectly fitting retainer at the debond appointment, saving an entire appointment slot.
Lost or broken retainer? A simple phone call from the patient to you and then you to me has them a replacement in a week.
And then there is the branding, the prestige, of offering scans versus impressions. How much is that worth?
And all of this is just the tip of the iceberg. We are just now entering the age of digital orthodontics. I do not think we have even touched the full potential of those fancy wands. But I’m trying to keep this to a two page letter, and I think the coffee spice is beginning to kick a bit too much, so I’ll end this here but add some more information in the online version.
–The Lab Guy
Umm, it’s not here yet.
I tried getting the intraoral scanner companies to get me information on their scanners so I could do a comparrison chart, but I have only received information from Trios.
Essentially, though, not all intraoral scanners are made equally, and not all intraoral scanner contracts are equal. You need to look at the up front costs, the annual subscription prices, and any extra costs associated with sending scans.
Sending me a scan is not instananeous. With iTero, I have seen a lapse of up to a day. With Trios, it can be instaneous.
Another question to ask is can your lab receive the scans? I am certified with 3M, iTero and Trios, which means I can. A lot of docotrs are looking at Cerec, but I can’t do anything with those scans without buying a $40,000 scanner myself as opposed to the $500 licensing fee with iTero, so it is never going to happen.
Carestream, a new player on the market? They have been as forthcoming as everybody else so I just don’t know.
The trick is I need to work with STL files, the standard in 3D modeling. Some scanner companies use a propriatry file type, like iTero and Cerec, that needs to be converted into an STL. I am pretty sure (don’t quote me) that Trios is the only true “open source” that you can export as an STL file. But it is definitely something to ask the salesperson.
To be honest, navigating through this new field is like captaining a ship in heavy seas with shoals and reefs all around. The best price is not always the best option. The best scanner might not be the best option. That clear path through the reefs ahead? It could have shallow bottom on the other side. Ask lots of questions and do a lot of research.
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