#AskT-Bone – Ep32 – Bundles on the laboratory vs in-house – CAD CAM in-house vs digital scanner



How is everybody doing today?

Welcome back to another episode of #AskT-Bone on the T-Bone speaks podcast.

I’m your host Dr. Tarun Agarwal and today we have been submitted a question from Steve. Actually Steve, I apologize you sent this question in a few months back and it got lost in my inbox, so I wanted to get around to it.

The question or the email states:

T-Bone! You are initiating a great service. Dentist in general need to help one another along. When it comes up I would like to hear the discussion of GALILEOS CEREC interface for surgical guides and implant planning and restoration. How is the cost of buying an all-inclusive bundle from Glidewell Dental Lab versus the cost of buying TiBasic, Scanbody and mesostructure block, Standing glaze time and cost from Paterson, how all those compare? We all bought in the CEREC to produce Restorations. It would not change but being a repeat decision when Glidewell and many other labs can produce this restoration in-house so inexpensively, one scratches their head as to purchase a Solus scanner and money-wise being financially ahead faster. I don’t know if I’m ahead yet or not being a CEREC owner since 2001 and updating along the way. I look forward to your future Insights.



Steve thanks for sending in the statement and you’re right, I think dentist can help each other along and one of my goals personally is to help as many dentists as possible. And to do that I need us to help me by sharing our podcast at anytime you meet a dentist or dental professional, grab their phone from them, go to the podcast app on their phone and subscribe to the T-bone Speaks Podcast for me if you don’t mind. The more people we can get listening to this and downloading it, the better. And honestly, it pushes me along to continue to make content and make content even better. I would greatly appreciate each of your help in this matter.

So, there are two different parts to this question. One is comparing the all inclusive bundles on the laboratory versus doing it in-house and then the second part of it is comparing a laboratory vs. making CEREC in house and choosing a digital impression machine versus a full CAD/CAM system so let’s tackle that part first, the later question about CAD/CAM in-house versus digital scanner.

I’m a firm believer that every practice should have a digital impression machine in their office. Because there’s no reason for us to take impressions, impressions cost us money on average and impressing cost us $25 to take, there is the impression material, there is the trade is the tip, the tip on the tip, and then there’s a percentage of remakes that we have to do in terms of the quality of the impression. So to me there’s all kinds of reason to have digital impression machines, good digital impression machines are on the $30,000 ballpark these days, and a more ties that over 5 years and you’re looking in the $400-$500 Ballpark and I can promise you that you’re spending more than that on impression material and taking Impressions.

Now with that being said, I think I’m that makes a lot of sense for everybody. But to me the real financial benefit comes in in terms of being able to make restorations In-house. Now listen, at the end of the day in my opinion from a practical business perspective, we can’t produce Restorations as cheap as the lab produces them. So when in overall another labs are producing these restoration for $59, $69, $79 it’s very hard to just by milling this in office. So if you look at from a pure business perspective, just that alone I can certainly see your point. But to me it’s more important than that. Our most expensive item that we have is time, and see every time you produce something with the lab, it involves another visit. And to me that’s where the problem comes in. If you ask your patience which would they prefer, they will all tell you they prefer to get it done today. And in today’s world we can produce a quality restoration within 30 minutes. Now,  when we can produce a quality restoration within 30 minutes and we can bond with cement in place and have our patient walk out of the door, then we don’t have to see the patient back. We don’t have to turn the room over, we don’t have to make a confirmation call,  we don’t have to do any of those things. We don’t have to make a temporary, we don’t have to risk that the tooth moves in the temporary face or that the temporary pops off. So listen, being an honest business person I can tell you that when you can produce a restoration through a lab of  $59, $69, $79 that economically that does make justified in office CAD CAM along those lines a bit more difficult. But when you have control, when you can produce that restoration $30 and saved the time that it takes of having to send the case, having to receive the case, having to manage, making sure that case comes in and comes back, making sure that the patient is scheduled on time, making sure that cases is here when the patient comes in. These are all the little things that we take for granted and these all the little things that drive our costs up, that we don’t realize. And so to me our most expensive overhead item that we have is time, so anything that we can do that saves us time, saves the patient time, is always beneficial. And then if something doesn’t fit you know right away, if you need to make a proper adjustment you know right away, there’s so many clinical advantage of it. So and kind of a repeat there, I believe every practice should have a digital impression machine, personally I firmly believe that. And then I believe the economic benefits of CAD CAM, in-office CAD CAM, in office milling, seriously out way, these low-cost Laboratories. simply because we can produce the same quality restoration, we can produce a same, more if not better esthetics and we can save our patient time, we can save ourselves time, we can save our team members time. So, to me that and on itself justified in office CAD/CAM. So blessed not get stuck too much on the numbers like every dollar. Let’s get stuck on building our practice in the big picture, and the big picture is what can this do to help grow my practice? Not how many beings can I count, how many pennies can I jump over, you know, how many things like that.

Now to the second part of the question, Glidewell, I like Glidewell I know Jim Glidewell Jim Shuck, Mike Cash and a lot of those guys over there are there, are they all fantastic and I think they should be commended for what they’ve done because they push dentistry in a positive way in fact they made, in my opinion, they made a solid zirconia a household name with the BruxZir. So I think there’s a lot of credit to be given to Glidewell and they produce unbelievable stuff there. If you ever get a chance to visit the lab you really should. They have an unbelievable implant department they have an unbelievable implant manufacturing facility. There is lots of good things going on there. So they sell a all inclusive implant bundled, where you can buy from them the implant and the drill that goes with it everything for a very reasonable cost. I don’t remember the number on the top of my head but probably somewhere in the $600 ballpark. So, how does that compare to doing it yourself? Now again if you look out and on a material by material costs, it’s a wash. Because by the time you buy the implant you milledl the surgical Guided, You buy the TiBase, you buy the mesostructure block, you’re probably in the same cost. But to me it’s about the time, and the opportunity with Implant Dentistry and with having things in the office, the opportunity is what we don’t realize often as dentist. There’s a cost of lost opportunity, so if I have a patient in today that wants this done, I can say yes today. If I have open time but if I’m dependent on the lab to do these things for me, again I have to send it somewhere. Then I have to wait and even if I the lab was next door I would have to wait a day or two or whatever it took to get all of this done. And to me, where I believe that CEREC owners are really not realizing the of the full benefit of the CEREC and cone beam technology is how did get this down to one hour of your chair time. Our average implant case for single unit implant case from start to finish is one hour of chair time, that includes planning, placement and delivery. And to me that’s really where our ultimate 3D program is focused on. It is focus on that three visits, one hour chair time, one to one and a half hour chair time per implan, Keeping the cost using name bran implants, keeping the cost to $500, $600 and making everything in-house and having complete control.

so I think to me, you can’t…, I don’t want us to get caught up in looking at the cost of materials. Because the material cost at the end of the day, they had up but they’re not the biggest part of our cost. Our biggest cost this time. At the end of the day we need to understand we are selling our time to Patient, so when we do a feeling that takes 45 minutes and we get paid $150 for it, or we could be doing an implant that takes 45 minutes and we get paid $2,000 for it, we are still selling our time, because we only have so much amount of time, we have only so many office hours, so our our focus, the focus of the smart dentist should be how do I increase my revenue per hour without see more patients? And that comes from improving patient experience that it comes from expanding services and that it comes from leveraging technology. So I want us to focus on that and I hope I answered that question and go from there. And Steve, if you have additional questions or if anyone else has questions please don’t hesitate to visit www.tbonespeaks.com. You can leave a voice question or you can leave an email question there is two buttons on the web page there.

Thank you very much and I hope everyone has a great day.

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