Corporate Responsibility of the Milling Centers in the Overall Digital Workflow

Corporate Responsibility of the Milling Centers in the Overall Digital Workflow

As a prosthodontist trained almost twenty years ago, I have witnessed the shift from cast restorations from the lost wax technique to milled restoration using digital dentistry.  Honestly, everywhere I go, I am being bombarded by the message of how great digital dentistry is, how it is going to improve my patient’s experience and how it is reliable and predictable and it is here to stay.

Yes, there is no question that we have some powerful tools to do some amazing things. However, as a dentist from the receiving end, I have not witnessed an improvement in the overall process.  In fact, during the last five years, whenever I have to fabricate a full arch implant supported framework, I dread the thought of having to work with another third party milling center.  Between me, the lab and the milling center, the case is always taking more time than expected requiring me to reschedule my patient and causing frustration on both the patient and myself.

For example, this is a case I did the teeth try in on November 6, 2019 this year.  As soon as the case is ready to go back to the lab, I texted the owner of the lab to give him the heads up that this case is ready for the milled bar.  I told him, that from experience, it always take longer than expected.  Please stay on top of the case.  I don’t want to reschedule the patient.  I gave the lab three weeks.  The patient was initially scheduled for November 27, 2019.  I got a notification of a screenshot of the proposed implant bar that needs to be approved on November 18, 2019.  I didn’t give much thought to the timeline as I am honestly too busy and I thought the lab and the milling center will work towards delivering the case on time, which I have asked for November 25, 2019.  I would expect, if they foresee any delay, they will notify me.

On November 25, 2019, I asked my staff to call the lab to check the status of the case, knowing from previous experience, there is always a problem.  The message I got from the lab is they do not have the case and it is not ready.  They don’t have a reason for me why it is not ready.  For the following week, it was a constant back and forth between my office and the lab when the case is ready.  The messages are “it is not ready” or “I don’t know why we don’ have the case yet”

This happens all too frequently every single time.  As a dentist, I feel I am at the mercy of these milling centers who do not respect timelines.  This time, I needed some answers and asked to contact the person from the milling center.  From my conversation to the supervisor, he has no awareness that this case took this long.  When he tries to track back the steps involved, he can tell me the number of revisions made and when it was sent back to the lab for verification.  Yes, this is what I expected.  But what I thought was unacceptable, that he suggested that I write down the deadline for the case.    I thought this is common knowledge there is always a deadline for every case. But the fact that he asked that I put a deadline on my case and that he will follow up more closely my cases with my lab tells me there was never a system in place to ensure the timely delivery of their product.  Their digital workflow is great for them and everyone is in the production line following protocol.  But at the end of the day, no ones ensures the product is milled and delivered on time for me.  No one factors in the time for communication between the milling center, the lab and the dentist.  No one factors in the delivery time.  And when the case is delayed, I am the one to find out with no prior warning and I am left with dealing with lost time and a very unhappy patient.  I got the case back in my office on December 4th, 2019, almost four weeks later.  If this is the timeline I have to work with, I need to know that in advance to plan my cases and to inform my patient.

I am not here to defame anyone.  However, this happens all too frequently in the last few years.  I thought industry leaders would see this problem and develop strategy to fine-tune this process.  Honestly, it left me a very bad taste that I have considered going back to cast based restoration.  I know I will get back a cast bar much faster and more predictably.  It will come with a higher cost but at least I know that this process has worked for many years and I do not have to deal with an unhappy patient.  I hope this post will bring awareness to decision makers, industry leaders involved in designing and implementing digital technology.   It does not matter how great your product is or how great your digital workflow is and if the timeline is too long or unattainable, then you have to develop a strategy to improve it.  At the end of the day, you are delivering a product for the dentist and the patient. There is a timeline you have to respect; and you have to be held accountable for it.

I hope you find this post helpful.  Thanks for reading!

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