Steven Pigliacelli, CDT, MDT
In the late 19th century, Dr. W. H. Stowe, a Boston dentist, was such a talented technician that other dentists asked him to do their work as well. He was so popular that he opened the first commercial dental lab in 1887. From that day forward, dental technicians opened labs and did the lab work while dentists focused on their patients. But in the last 10 years we've made a full circle back to Dr. Stowe, as many dentists have reverted back to doing their own lab work.
I can understand the appeal of having your own on-site, chairside technician. The situation appears to have many benefits - more control, the ability for custom chairside shading, and quicker turnaround time.
But what I don't see are any cost savings. Here's how I see the costs breaking down:
Let's say you hire a chairside tech to work full-time in your office. A base salary of $500 a week with major medical translates to $650, which adds up to $33,720 a year. A base salary of $1,000 with major medical turns into $1,210 and $62,840 a year.
This does not include the cost of materials, such as stone, investments, alloy, milling blocks, burs, porcelain, and other necessary materials. A fully stocked lab requires an oven, casting machine, porcelain oven, handpiece, suction, full assortment of burs, mandrel, polishing, and a porcelain kit with all desired shades. That's an initial investment of at least $25,000 to fully equip an in-office lab.
One ounce of base alloy can cost $12. One ounce of noble is $500, and one ounce of high noble costs $800. A single ingot of lithium disilicate e.max can be about $5, but a wax pot, instruments, investment, oven and pressing furnace, and ceramic furnace are required to do a crown.
A modest monthly estimate is $3,000, which translates to $36,000 a year. Wear and tear, maintenance, and depreciation of equipment are not included. That means the technician and material can be as much as $98,000 a year. How much is your current annual lab fee? Is it more or less?
If it seems that a modern lab equipped with digital technology would be cheaper, consider the costs of a chairside scanner and milling machine. You can spend between $120,000 and $150,000. Remember, there is a yearly maintenance contract, which can be a few thousand dollars a year. Some systems require a per-use dongle of a few dollars. You need blocks to mill in each shade, milling burs and final finishing burs, as well as other materials. You need veneering material and a sintering furnace, which can translate to about $5,000 a month. Now the most important question - who is scanning, designing, and veneering? If you have a chairside technician, we already estimated an annual salary of $62,840 a year.
You may also have your assistant take on the task of designing and milling. On one hand, this will reduce the need for a salary for a chairside technician, but it will result in a reduction of the normal duties of the assistant. You may need to hire an additional dental assistant, which will result in another salary.
If you're doing the lab work, how much does that cost? Let's say your chair time is $500 an hour.1 Let's say you traditionally take one hour per patient to prep, temp, and take the final impression. You go into another room to design, mill, sinter, stain, glaze, and insert. This can take another hour. So instead of billing another $500, you made a crown. In fact, you forfeited your valuable chair time to beat a $150 to $250 lab fee. Therefore, the crown cost you $500 plus the cost of materials. A single block can cost $39.
As a dental lab owner, I understand the costs of labor and materials to run a lab. I've accommodated the different personalities and attitudes of my technicians, the costs of time, overtime, holidays, and sick days, as well as unemployment and major medical. Moreover, I have dealt with the steadily rising costs of labor in both federal and health-care fees. I've also dealt with the costs of all types of dental machinery, from casting and porcelain ovens to scanners and milling machines.
I've had to endure the continuous nickels and dimes of maintenance, dongle costs, software updates, calibration, and broken-down machines that stop production. Let's not forget in-lab remakes from miscasts and inaccuracies. Furthermore, finding a good technician is incredibly hard. Most of the dental schools have closed and fewer qualified technicians are in the job market. If I can't find good technicians, I'm guessing you will have a similarly difficult time. If someone is really good, they usually start their own lab. I can honestly say that a large percent of ceramists and lab owners in New York have worked for me at one time. Once they become experienced enough, they go out on their own.
In the case of a multi-dentist office where the technician does the work for many dentists and patients, the overall investment is low and probably comes out to less cost than using a lab. But in the case of a one-dentist office, the yearly lab fee must be lower than the yearly labor and materials cost.
As a dental lab owner, I frequently try to figure out why any dentist wants to deal with these aspects of dentistry. But if you decide to go this route, I'll share some strategies I've learned over the years:
It is important to weigh all the costs and get estimates on all materials and machinery prior to investing in an in-house lab. If you're hiring a technician, try the person out for a while prior to hiring. You want to be on the same page as far as quality and personality. If you're buying an in-house milling machine and intend to do it yourself, many companies give a 30-day trial. Take advantage of this and make sure it works for you and you aren't working for it. Make sure you will have continuous support and that the company will not just deliver the unit but will follow up to make sure it's working well and offer support when necessary. Ask friends who have the system for their honest opinions, and make sure you like the quality of the work before you buy something.
1. I've learned to never assume or ask any dentist how much they charge or how much they earn. For the purpose of this article I've created price structures that may or may not reflect your price structure.
Steven Pigliacelli, CDT, MDT, has more than 30 years' experience with Marotta Dental Studio as a dental implant specialist. Mr. Pigliacelli is a faculty instructor in postgraduate prosthodontics at New York University, College of Dentistry. He manages Marotta Dental Studio and is the technical liaison between the dentist and lab. He directs the GPR and Prosthetic Resident Rotation at Marotta, an intensive educational program that focuses on the value of the technician/dentist relationship. Mr. Pigliacelli is president of the American Academy of Dental Prosthetic Technicians, and vice president of the Ethical Dental Laboratory Alliance. He has published in dental journals, and he lectures and performs hands-on demonstrations at study clubs and seminars.