Intraoral Scanner ROI: Printer or Milling Machine?

In recent years dental practices have purchased Intraoral Scanners at a rapid rate. Carestream, Medit, Itero, 3Shape and Planmeca scanners have become the norm for the common dental office. But many who have purchased scanners are left wondering what is next, do I send my files to a Laboratory or purchase a printer or milling machine? How will I make my Return on Investment?

To answer this question let’s look at history in dental laboratories. In the early years of the CAD/CAM explosion most labs purchased a scanner first, such as 3Shape and sent design files to Milling Centers to fabricate crowns for them. The milling center would charge $40-$55 a unit depending on the material used and if the sender designed the file prior. 

Outsourcing to milling centers made sense because it allowed the laboratory to service their clients without the perceived cumbersome process of milling and finishing. However, this industry norm did not last long because outsourcing became expensive and the sender would lose control of the product once they sent it to another company. 

When laboratories discovered that when you combine per unit material cost with the monthly finance payment of a milling machine was considerably less than outsourcing, most laboratories purchased a milling machine. After integrating a milling machine into the laboratory they discovered that the majority of the work was in the design process, which they were already doing. Once they had full control over the workflow they were able to “fine-tune” their workflow. This saved time and money!

We are at a similar fulcrum on the clinical side of dentistry. Many Dentists have invested in scanners because they believed it was the first step to going digital. Only to discover that having a scanner only doesn’t reduce overhead or increase efficiency without control over the full workflow. So what is next?Crowns, Bridges, All on X, Hybrid Abutments, Titanium Abutments, Bite Splints, Surgical Guides, Ortho Appliances and more are all available to produce in-house using CAD/CAM.

You can buy design software and send the file to a laboratory to fabricate. You will be able to take control of the design of your cases which is better than no control at all. The two best softwares Dental CAD softwares available are Exocad and 3Shape. Both offer everything from standard CAD to Surgical Guide Planning capabilities. 

The third option is to buy a CAD software and printer for your practice. With this setup you will be able to print your models, temporaries, temporary dentures, surgical guides and bite splints. If you want to do Ortho cases you can send your files to a third-party design company that will return files to print. The only limitation you have with this setup is the ability to produce a final restoration in-house.  Nextdent, Sprintray, Envisiontec, Voco and Kulzer all offer great products for this.   

The final option is to buy a milling machine and produce everything in-house. Purchasing a milling machine is a bigger investment than the other options. However, similar to the laboratories, you will not make a complete return on the scanner investment until you produce restorations in-house. So the monthly payment plus material will be much lower than your outsourcing bill. Amann Girrbach, Roland, VHF, Zirkonzahn and Ivoclar all offer great products for this. If you add a printer to this package you will have a complete workflow with maximum ROI. 

In conclusion, understand your needs before making a commitment. If your goal is to reduce overhead while taking control of your restorations then a milling machine and printer is best for you. If you simply want to reduce physical impression taking, then find a good laboratory that is knowledgeable with the digital workflow. Whatever your decision is, I hope this article helps you see the “pros and cons” of each scenario.