Dental Tribune Pakistan Edition No.5, 2016

6 DENTAL TRIBUNE Pakistan Edition September 2016 CLINICAL PRACTICE Value chains being transformed by new digital dental technologies By Friedhelm Klingenburg, CEO Merz Dental GmbH T he definition of ‘value chain’ d e p i c t s t h e s t a g e s o f production as an ordered series of activities. These activities create values, consume resources and are linked to one another in Processes. According to the approach taken by Michael E. Porter[1], ‘Every firm is a collection of activities that are performed to design, produce, market, deliver, and support its product. All of these activities can be represented using a value chain’. Another definition describes the value (adding) c h a i n a s ‘ t h e s t a g e s o f t h e transformation process that a product or service passes through, from starting materials to final use’.[2] Value added is the difference between the income that the product generates dentist generated his value added by rendering services for patients. The chain has changed more and more over the past 20–30 years, mainly due to the introduction of digital technologies. The following outline presents selected developments based on use of digital technologies, plus a future-oriented project for the integration of total prosthetics into digital technology. Analogue meets digital (change in occupation profiles) T h e w h o l e f i e l d o f d i g i t a l technologies in dentistry has now become so extensive that not all aspects can be covered in this article. For example, digital technology has an impact on the following. . The profile of a dental technician's occupation, which is no longer a ‘plaster room’ job but rather a computer workstation position. As a surgery and the insertion of a dental r e s t o r a t i o n ( c o n s e r v a t i v e o r prosthetic). The other activities will be replaced by digital work processes. There would probably have not been any change in the value chain that had applied for decades (see Fig. 1) if companies like Sirona had not introduced the first digital technologies to dental practices and dental labs in the 1980s. And even though the concept of the shift in value added was already an integral part of the system, initially only work steps and work processes in the dental lab were facilitated, speeded up and thus made more efficient in implementation at the beginning of this digital evolution, by using scanners and CAD/CAM milling machines. Only in a subsequent step were other market participants included, e.g. milling centres in Germany and abroad or also had in the dental lab? The fact is that there has been a shift in the focuses of activity in in-house production towards more services in the digital planning and coordination process and the process chain has been minimised. In terms of quality not much has changed, even though it may have been expected. Without doubt, material quality is perceived by the patient only in terms of shade (from gold to white) and the fit/security of a dental restoration is still dependent on the job instructions that have been received from the dental practice. Process quantity has seen a major change—nowadays only half of the original dental lab processes are necessary in the lab in order to produce a functional, highly aesthetic dental restoration. Although in economic terms it means high capital investment costs for the dental lab owner, it also g n i t r o p p u S s e t i v i t c a Corporate infrastructure Human resources Technology development Procurement Inbound logistics Operations Marketing and sales Out bound logistics Customer service Primary activities Fig 1: Basic model of Porter’s value chain. Role of market participants in the value adding process, NOT INCLUDING Role of market participants in the value adding process, NOT INCLUDING digital digital steps taking a precious metal-based crown as an example technology taking a ceramic crown as an example P r o f i t m a r g i n argin Profit m I N D U S T RY D E B TA L L A B Manufacture and supply of precious metal alloy Plaster model Jaw relation recording (articulator) Modeling: wax sprue Investment Processing: metal framework Veneering plioshing D E N T I S T Diagnosis Preparation Shade taking Impression taking Temporary restoration D E N T I S T Diagnosis Preparation Shade taking Impression taking Digital scan Data transmission I N D U S T RY M I L L I N G C E N T R E Manufacture/ supply of materials Milling centre Range of services identical to those of an external milling centre Checking the dataset Design preparation limits Milling Dispatch to dental lab Optional: Completion and dispatch to dentist D E N TA L L A B Scan for conventional impression Design preparation limits Milling Veneering /finishing Optional: Purchasing from milling centre/industry Fig 2: Basic model of market participants in the value adding process, not including digital dental technology. Fig 3: Basic model of market participants in the value adding process, not including digital dental technology. Fig 4: Mandibular BDLoad, after milling process. THE CONVENTIONAL PRODUCTION PROCESS FOR A FULL DENTURE IS HIGHLY COMPLEX AND TIME TIME-CONSUMING Impression taking STEP 1 STEP 3 Functional impression taking STEP 5 STEP 7 STEP 1 Occlusal registration Try-in Incorporation DENTAL LAB Model casting Making the impression tray Making the bite rim Model analysis and model casting STEP 2 STEP 4 STEP 6 STEP 8 Corrections and finalisation H b m G l a t n e D z r e M © Fig 5: Illustration of the conventional method of production and treatment. Production of a full denture becomes aconomically viable by using Merz Dental’s innovative Baltic Denture System (BDS) with a considerably reducted process flow DENTAL OFFICE STEP 1 Functional impression taking and transfer DENTAL LAB STEP 2 Scanning the impression Computerised design Milling H b m G STEP 3 Incorporation Fig 6: Innovative digital method of treatment and production. l t a n e D z r e M © and the resources employed. To be specific, this means that the value chain is represented by the sum of all values added (margin) of each individual market participant. All market participants who wish to participate in a value chain together make up the value chain system of an industry. If this is applied to our industry, we must consider the specific situation of the market participants, ‘industry, dental lab, dental practice and patient’. All those involved are part of the value chain. In the past, industry generated its value added by manufacturing consumables or equipment for the dental technician or dentist, the dental technician generated his value added by making traditional dental restorations and the result, however, the requirements change for candidates because the modern-day ‘skilled trade’ calls for future applicants to be interested in computer aided design (CAD) for c r o w n s , b r i d g e s , t e l e s c o p e s , abutments, etc and the programming of milling strategies for transforming the CAD design into an end product that is made by subtractive or additive processes. It is advisable and essential to integrate such requirements into dental technician training at an early stage. . The rendering of dentistry services is calling for increasing use of state- of-the-art digital instruments and methods. In future, a dentist will not only make a diagnosis but chiefly focus on treatment preparation, industrial companies that want to participate in the value added (Figs. 2 & 3). Digitisation—an opportunity for the dental lab? For a long time now, innovative and marketing- oriented dental labs have recognised the advantages of digitisation and been benefiting from their timely entry to the world of CAD/CAM. Their wide range of services covers the entire dental technology portfolio with modern, stateof-the-art framework materials and veneering materials. Standard restorations in particular, such as crowns and bridges are made by CAD/CAM—nowadays that is already state of the art. But what impact have these change processes means that, depending on the amortisation period and the quantities to be made, he is able to make competitive prices when faced with market participants who attempt to penetrate the market by price dumping. These days, the dental lab is—more than ever—a service provider for the dental practice and less and less a skilled trade. That naturally involves risks for the skilled occupation, but it also offers substantial opportunities. A dental lab owner can highlight his locational advantage and provide his special services and cooperation in a spirit of partnership. What type of dental lab are you? Do you rank among the dental labs that are still highly characterised by

Dental Tribune Pakistan Edition No.5, 2016

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