Choosing a Dental Lab as Dentists?

[newyorkblork]

Hello,

I'm currently a lowly pre-dental student, working part-time for a man who runs a dental lab. He primarily handles crowns and bridges, and his partner handles dentures/partials.

The business is looking to expand its territory some - obtain work from an office or two in Manhattan, perhaps. I was curious as to what dentists look for when they are choosing a dental lab, and what advertising or offers would provide a strong incentive for a dentist to send regular work to a new lab. Any marketing and expansion advice is more than welcome, from the perspectives of dentists and lab employees alike.

Thanks in advance!

(We're based in Staten Island, if that makes any difference).

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[DrJeff]

Hello,

I'm currently a lowly pre-dental student, working part-time for a man who runs a dental lab. He primarily handles crowns and bridges, and his partner handles dentures/partials.

The business is looking to expand its territory some - obtain work from an office or two in Manhattan, perhaps. I was curious as to what dentists look for when they are choosing a dental lab, and what advertising or offers would provide a strong incentive for a dentist to send regular work to a new lab. Any marketing and expansion advice is more than welcome, from the perspectives of dentists and lab employees alike.

Thanks in advance!

(We're based in Staten Island, if that makes any difference).

From a lab the main things I look for is quality and CONSISTENCY. I'm doing my darndest to give the lab a quality and consistent prep, and I expect the same back!

For a lab trying to expand in the current age of dental labs (especially for crown and bridge labs), it's not just a local area that you're often looking at, since with overnight shipping and digital photography a dentist can get "local" service from a lab clear across the country nowadays.

What draws me to try a new lab has been the following: 1) the offering of a new material/technology that interests me that my regular lab may not offer 2) occasionally frustration with my current lab (lack of communication and/or consistency issues 3) in certain rare cirumstances, price

If it's a local lab that wants to stay a local lab, then exapnsion will very often involve having lunch with local dentists and meeting them, showing them your lab work and talking about your lab and what you can offer. If a lab is looking to go from a local lab to a regional/national lab, then very often your talking not just local lunches, but places adds in state/national dental publications and attending multiple state + regional or national dental conventions.

Removable labs can be slightly different in that very often having a lab be local to a practice allows same day repairs/additions of teeth to a denture, and then very often that doc using the local removable lab will keep using that lab for all/most of their new removable work - once again communication and consistency are often the key

 

[Daurang]

My Medicaid, most posterior, most cash cases get sent to Prudental for $39; they have been extremely consistent over the years with one remake. My anterior esthetic cases get sent to Glidewell for $125 max. Them two provide the best quality and fit for the price after trying some 50 labs all over the world. Implant cases are ridiculously priced ($400-750) and I haven't figure out where to get them for cheap; so I shun them unless forced to.

Removeables are PIA no matter how good you or the labs are. Remakes and refunds are inevitable. I just pick a local lab because they're easy for quick repair.

 

[DrJeff]

Implant cases are ridiculously priced ($400-750) and I haven't figure out where to get them for cheap; so I shun them unless forced to.
.

This is what always baffles me, why an implant crown is so much more than a tooth supported crown If I ask for it, are they made out of the same metal substrate and porcelain?? Yup Do they come back in the same articulation set up?? Yup About the only difference is with the implant crown, the models come back with some soft tissue substitute, and I know for a fact that the ounce or two of material the lab uses DOESN'T cost hundreds of dollars.

Some will argue that an implant crown may include the abutment as an additional cost, but atleast in my case, 90%+ of my implant cases get sent to the lab with the final abutment already torqued into place on the implant, so all the lab has to do is place the lab abutment into the impression coping, squirt a bit of the soft tissue silicone around that lab abutment and pour things up with regular stone - no custom abutment frabrication, no sending the crown back to me with the final abutment and abutment screw. Just a crown that looks like, and is made out of what I'd use on a tooth supported crown for whatever region of the mouth and/or final shade I'm going for (and a MUCH larger lab bill for it)

 

[Cold Front]

Daurang, Dr. Jeff - do you guys place your own implants, or just restore them?

 

[DrJeff]

Daurang, Dr. Jeff - do you guys place your own implants, or just restore them?

Just currently restoring them. Placed some during my residency though. Lately though I'm seriously contemplating atleast placing some mini implants for overdenture retention. Doubtful atleast in my 5 year plan/outlook that I'll place full sized implants, as the 30 or so that I currently restore a year just wouldn't give me the same level of tissue management expertise and/or implant site augmentation skills as the oral surgeon I currently use, who places over 600 a year, possesses. And the last thing I'd want to do is place a gorgeous looking implant crown on #8 and then have the dreaded intra-papilla "blackhole" because of my potential surgical skill issues.

 

[diplo123]

Just currently restoring them. Placed some during my residency though. Lately though I'm seriously contemplating atleast placing some mini implants for overdenture retention. Doubtful atleast in my 5 year plan/outlook that I'll place full sized implants, as the 30 or so that I currently restore a year just wouldn't give me the same level of tissue management expertise and/or implant site augmentation skills as the oral surgeon I currently use, who places over 600 a year, possesses. And the last thing I'd want to do is place a gorgeous looking implant crown on #8 and then have the dreaded intra-papilla "blackhole" because of my potential surgical skill issues.

Could you give me an idea of how much an implant restoration roughly would cost? Say a pfm crown costs $1k, does the implant usually cost an additional $1k or is it less or more? Thanks.

 

[DrJeff]

Could you give me an idea of how much an implant restoration roughly would cost? Say a pfm crown costs $1k, does the implant usually cost an additional $1k or is it less or more? Thanks.

HUGE range of $$ for the implant body itself. Personally, the surgeon that I have place the bulk of the implants that I restore charges roughy $1400 an implant, however, other surgeons/endodontists/periodontists in my area that place them will charge upwards of $2000 for the same implant and I've heard in some major metropolitan areas of some docs getting upwards of $5000 for the same basic implant placement

Implant crown cost is another huge variable. You might see someone charging as little as $750-800 and as much as $3000-4000. Once again it's all about the market your in. Also, with fees for crowns, the loose rule of thumb for seeting your fee is 5 times your lab fee.

 

[OceanDMD]

This is what always baffles me, why an implant crown is so much more than a tooth supported crown If I ask for it, are they made out of the same metal substrate and porcelain?? Yup Do they come back in the same articulation set up?? Yup About the only difference is with the implant crown, the models come back with some soft tissue substitute, and I know for a fact that the ounce or two of material the lab uses DOESN'T cost hundreds of dollars.

Some will argue that an implant crown may include the abutment as an additional cost, but atleast in my case, 90%+ of my implant cases get sent to the lab with the final abutment already torqued into place on the implant, so all the lab has to do is place the lab abutment into the impression coping, squirt a bit of the soft tissue silicone around that lab abutment and pour things up with regular stone - no custom abutment frabrication, no sending the crown back to me with the final abutment and abutment screw. Just a crown that looks like, and is made out of what I'd use on a tooth supported crown for whatever region of the mouth and/or final shade I'm going for (and a MUCH larger lab bill for it)

For single units, I place the abutment, prep the abutment, and impress the abutment just like I would any other crown. Personally I dont see the need to use the analog "jibbies" to have the crowns made. When I send the impression to the lab, there is no mention of it being an implant crown. Obviously the lab tech will see the abutment for what it is, but my lab charges the same as it would for any other case. How could they argue to charge more? I dont see any advantage to using the impression analog implant materials. If I need to make an adjustment to the abutment with the handpiece, it takes literally a few minutes.

 

[Cold Front]

HUGE range of $$ for the implant body itself. Personally, the surgeon that I have place the bulk of the implants that I restore charges roughy $1400 an implant, however, other surgeons/endodontists/periodontists in my area that place them will charge upwards of $2000 for the same implant and I've heard in some major metropolitan areas of some docs getting upwards of $5000 for the same basic implant placement

Implant crown cost is another huge variable. You might see someone charging as little as $750-800 and as much as $3000-4000. Once again it's all about the market your in. Also, with fees for crowns, the loose rule of thumb for seeting your fee is 5 times your lab fee.

The cost of implants should come down within 5 years or so, as competition for implant patients leans towards GPs rather than a periodontist or an OS (or even Endos).

I think the next boom for GPs is already implants. Historically, when a new technique is introduced, there's skepticism as to its practicality, affordability, and patient acceptability. Once public become more aware of the tremendous value of an implant-supported prosthesis versus an RCT or other options, they are more willing to invest in treatment which has a 95% success rate. This creates new financial opportunities for general dentists, which makes economic sense for their practices. A decade or so ago, this was not the case. Fortunately, things have changed, as future of implants will heavily be managed by GPs, who will in return lower the cost of implants, as the paradigm shifts from team approach (a GP + an OS) to a 1 doctor (GP) doing the entire procedure - at least for the new generation of dentists.

 

[teeth63a]

For single units, I place the abutment, prep the abutment, and impress the abutment just like I would any other crown. Personally I dont see the need to use the analog "jibbies" to have the crowns made. When I send the impression to the lab, there is no mention of it being an implant crown. Obviously the lab tech will see the abutment for what it is, but my lab charges the same as it would for any other case. How could they argue to charge more? I dont see any advantage to using the impression analog implant materials. If I need to make an adjustment to the abutment with the handpiece, it takes literally a few minutes.

That is an excellent point that I'm going to look into. What abutment system is this?

 

[toothy2112]

I have found price and consistency to be the major reasons they choose a lab. I recently had to make up a chart with all the labs we use, the turn around time, price and materials. In the end the majority of our cases are going to the lowest priced lab which happens to be 1600 miles away in CA.

However, we started looking into all this because one of our labs ALWAYS had chipped/broken procelain margins or the porcelain would chip off.

My Dr. hates to constantly adjust the bite on crowns and bridges, so another reason he looked into switching.

 

[DrJeff]

That is an excellent point that I'm going to look into. What abutment system is this?

You can actually do it with just about any abutment system, and for the Zimmer implant company, they actually only make their primary titanium abutments in 1 length and want the clinician to trim the abutment to length. The endo specialists I use places Zimmer's and everyone once and a while I'll restore one if the endo crew couldn't save the tooth in question and the patient felt like having the endo crew place the implant instead of the OMFS crew that I use for most of my implant placements.

On the almost flipside of this, is 3i's relatively new encode implant system. The implant is placed, and right on the healing cap they've milled basically some reference points. Once you are happy with the tissue healing and osseintegration, all you do, without removing the healing abutment is take a final impression, and then the lab takes over from there and will return the crown, the abutment and the abutment screw to you. The the 1st time the healing abutment comes off is the day that you remove it to insert the final crown. I've done a couple of these now, and the only real downside I've seen to them (from the restorative Doc perspective), is they have a real big lab bill associated with them - the "cheapest" lab bill I've had so far with one of them was just under $450(for #10) and the most expensive of the 3 I've done so far was just over $550(for #30)

For reference sake, a "regular" crown from this same lab runs me these days in the $175 range.

 

[DrJeff]

I have found price and consistency to be the major reasons they choose a lab. I recently had to make up a chart with all the labs we use, the turn around time, price and materials. In the end the majority of our cases are going to the lowest priced lab which happens to be 1600 miles away in CA.

However, we started looking into all this because one of our labs ALWAYS had chipped/broken procelain margins or the porcelain would chip off.

My Dr. hates to constantly adjust the bite on crowns and bridges, so another reason he looked into switching.

Bottomline from a doc expected lab quality standoint. If you as the doc are giving the lab a goood impression, and the patient walks out the door with a temporary that has good centric + interproximal contacts(and the temporary is inplace at cementing day), that crown should be dropping into place with atmost minimal minor adjustments to the occlusion/contacts (and by minimal I mean should take maybe 1 minute atmost). If you as the doc are giving the lab a good impression and are making a good temp that stays inplace, IMHO the most amount of "work" that should need to be done at the cement visit is cleaning up the excess cement, if not, find a new lab!