Others specifically target current customers or investors in specific scanning technology, offering a particular brand of zirconia such as Lava from 3M ESPE, Cercon from Dentsply, or Ivoclar’s IPS e.max zirconia milled with Sirona’s inLab system. Each of these manufacturer providers have expanded their CAD/CAM offerings to include such services as custom implant abutments, 3D printed wax forms, and full-contour ceramic crowns. There also are open-system outsourcing options.

We’ll take a look at examples of both and what they have to offer, but the important takeaway here is you can take advantage of most outsourcing models without buying any equipment. The majority of outsourcing vendors allow laboratories to send only the model for a zirconia case.

One of the newest outsource centers on the market, Dental Lab Concepts (DLC), just opened the doors to its domestic outsourcing milling center in Hawthorne, Calif. Unlike other products DLC offers that are sent offshore, its CAD/CAM initiative is an onshore center using a 3Shape scanner and design software and the DentMill milling machine powered by Delcam CAM software and milling Swiss-made Metoxit zirconia. Bob Vartanian, Vice President Sales & Marketing, said DLC’s domestic lab-to-lab service is meant to give customers a competitively priced, quick turnaround; $39 high-quality crown copings; and six- to eight-unit bridge substructures created in an open-architecture environment.

Their current zirconia milling block is comparable in flexural strength to that of Lava or Procera, Vartanian said. In the future, DLC will be adding shaded blocks. He believes domestically outsourced CAD/CAM products give laboratories the ability to provide clients with the products that traditionally are not part of their core business.

“Today, there is no reason to say no to one of your customers,” Vartanian said. “Products that are outside the core business of a laboratory and ones the laboratory has been reluctant to offer in the past are now available through a domestic outsourcing business model. It’s the laboratory that has the good relationship with the dentist. Let the laboratory be the consultant to the dentist to find the best source available for the products the client prescribes.”

Laboratories have the choice of sending DLC an impression from which DLC will pour up and scan the model; sending the model to DLC for substructure scan, design, and mill; scanning the model in-house and sending DLC the digital file for design and milling; or scanning and designing the case in-house and sending DLC the digital design file directly to the milling machine.

Scans from an open-architecture 3Shape or Dental Wings scanner can be sent for substructure fabrication, however some tweaking is necessary, so a phone call before sending a digital file is necessary. All substructures coming back to the laboratory have finished margins and are ready for layering or pressing.

Some outsource providers offer free scanning technology if a certain quota of cases can be met. Custom Milling Center (CMC), for example, requires 120 units a month to pay the lease fee of an open-architecture Dental Wings scanner with the Dental Wings Operating System (DWOS) software.

“Basing the lease fee on the number of units allows laboratories to pay little or nothing to acquire technologies that fit their business model,” said Bob Miller, CDT, President of CMC. “You can send us 120 units and get the technology free, or 75 units and only pay half the monthly lease fee.”

The open-architecture Dental Wings scanner allows laboratories to choose among several technologies CMC offers, including Katana milling using Noritake shaded zirconia blanks, Digital Dental’s DentMill milling machine, EnvisionTec’s DLP 3D wax form printer, Wieland’s Zeno CAD/CAM system, and soon CMC’s own private-label milling machine, which will be on display for the first time at the upcoming Zahn Expo October 23-26.

One of the advantages the DWOS operating system software provides users is the ability to split files for press-to technology or for casting. The laboratory can simultaneously send the substructure design to the zirconia milling machine and the full-contour wax form file to the EnvisionTec 3D printer, receiving back parts for invest and press. Laboratories can also send CMC a model and let the experts at CMC do the scan and case design work.

“With the new milling machine, we will be able to mill all-ceramic full-contour crowns,” Miller said. “With this restorative option the customer would only do minimal stain and glaze, eliminating the need for cutback and layering. These options give laboratories the opportunity to reduce their labor costs and increase profitability.”

Because CMC is closely tied to Zahn Dental, laboratory owners can opt-in to purchase add-on components from Zahn at any time. From leasing the scanner, the laboratory can then purchase the milling component and/or 3D wax printing technology. CMC through Dental Wings software will be able to receive intraoral scans from the Cadent iTero digital impression-taking technology.

“That gives us the opportunity to offer laboratories the full solution, including the zirconia discs,” Miller said. “Laboratory owners get their 2-day training here in Arvada, Colo., and purchase the equipment from Zahn Dental, who does the installation. When we begin selling our own private-label milling unit, CMC technicians will do the install.”

Glidewell Laboratories is a competitive provider of outsource services. Glidewell offers Lava, Cercon, Cerec inLab, Procera, and its own Prismatik Clinical Zirconia brand. For its Prismatik CZ, Glidewell offers several ways to take advantage of the demand for zirconia. Laboratories can send Glidewell their dies for scan, design, milling, and sintering. If a laboratory already owns an open-architecture 3Shape or Dental Wings scanner, a digital file can be sent just for milling at a lower per-unit cost. Glidewell also can receive intraoral scans from CEREC or Cadent iTero. Soon Glidewell will offer laboratories a complete CAD/CAM system (scanner, design software, milling unit) for less than $60,000. “We are in the late stages of production testing the Prismatik Mills, and it looks promising,” said Mike Cash, CDT, Glidewell Manager Sales & Marketing.

For its Lava product, Glidewell can accept models or digital files. “We are seeing more business coming in from laboratories that own the Lava ST scanner and are sending us digital scanned and designed files for milling,” Cash said.

One of Glidewell’s advantages is the marketing materials the company can provide to lab customers, Cash said. “Not only are we actively advertising in the dentist magazines monthly for our Prismatik CZ, but we are very proactive, providing labs with patient brochures, clinical DVDs, and brochures allowing them to promote it to their dentists,” Cash said. “We also can help our customers with custom direct-mail marketing campaigns.” Cash is also quick to point out that the copings Glidewell’s laboratory partners receive are shaded, sintered, and carefully finished for immediate porcelain layering.

Glidewell also has begun holding 2-day classes for laboratory owners interested in becoming further acquainted with CAD/CAM technology. These introductory courses cover the different CAD/CAM systems on the market, allow attendees to tour the Glidewell facilities and visit Glidewell’s Dupont digital manufacturing facility to see actual demonstrations of systems in operation. “We help our dental laboratory customers become more successful via high value products and outstanding marketing support so they buy more product from us, which helps us to become more successful, too,” Cash said.

Dentsply Prosthetics’ Compartis USA central milling center was designed to provide a versatile partnership with the network of Cercon laboratories. Compartis USA allows laboratories of all sizes to choose the level of involvement that best fits their business model. Laboratories can incorporate the full Cercon CAD/CAM system into their business and use Compartis USA for overflow, or choose to scan and design cases in-house, using Cercon’s CAD module, and have Compartis USA or a Cercon outsourcing laboratory partner provide the milled crown or bridge frameworks. The latter choices allow laboratories to build their zirconia business to the point that it makes financial sense to purchase the entire CAD/CAM system. “At Dentsply, we strive to be more than just a supplier, said Jan Slor, Vice President and General Manager for Dentsply Prosthetics. “We have developed a business model that helps labs to be more efficient and profitable.”

Last year the Compartis milling center expanded product offerings beyond zirconia to include resin/wax copings for casting metal frameworks in the dental laboratory. The material, called Cercon Cast, is a hard resin that Slor says Compartis customers are attracted to mainly for the remarkable alloy savings they get due to the consistency of CAD design. In the near future, new products will be added to the lineup that will propel Compartis to the forefront of the central manufacturing arena.

“We’re not done, and we’re not standing still. Additions of implant overdenture bars and precious metal copings will be offered in the near term, followed by milling full contour applications and custom implant abutments. Our Cercon and Compartis brands will provide the platform for delivering technological break-throughs across the dental industry.” said Slor.