Ep. 708 - In-House Milling & 3D Printing: Making the Right Call for Your Practice

Is investing in a 3D printer or in-office milling system worth the substantial financial commitment, or should you stick with traditional lab relationships? This question faces many dental practices as digital technology becomes increasingly accessible.

Dr. Christopher Pescatore, a nationally recognized cosmetic dentist and pioneer in digital dentistry since the early 1990s, brings over 30 years of experience with in-office CAD/CAM and digital technologies. He is a graduate of the University of Medicine and Dentistry of New Jersey, holds a U.S. patent for a non-metallic post system, serves on the editorial board of REALITY magazine, and maintains a full-time practice dedicated exclusively to aesthetic dental procedures in Danville, California. Dr. Pescatore has lectured extensively on aesthetic procedures and digital integration, with publications in numerous dental journals including Practical Periodontics and Aesthetic Dentistry and Dental Economics.

This conversation examines the real-world economics of bringing lab work in-house versus maintaining traditional workflows. Dr. Pescatore addresses the hidden costs often overlooked in ROI calculations, from ongoing maintenance contracts to staff training, and challenges the common assumption that in-office production automatically equals cost savings. He provides candid insights into when these technologies make financial sense and when they become expensive equipment that collects dust.

Episode Highlights:

• Volume requirements for profitability suggest practices should perform at least 10 nightguards weekly for 3D printing or 18-20 crowns monthly for CAD/CAM systems to justify the investment beyond break-even calculations. The true cost comparison must include staff wages, benefits, training time, and opportunity costs of taking team members away from other productive activities.
• Hidden ongoing expenses significantly impact ROI calculations, including upgrade fees, warranty contracts, service agreements, material costs, and the reality that purchasing equipment represents a long-term commitment with recurring overhead expenses that many practices underestimate during initial decision-making.
• Material compatibility considerations favor open-system 3D printers that accept multiple resin types over closed systems, though closed systems like Dentsply Sirona's provide efficiency advantages through QR code material recognition and automatic curing cycle adjustments that reduce user error and workflow complications.
• Ceramic 3D printing capabilities represent the future game-changing technology that could shift the balance from milling to printing for in-office production. Current development by companies like Ivoclar with lithium disilicate printing suggests this transition may occur within the coming years, potentially making current milling investments obsolete.
• Strategic equipment sequencing suggests acquiring an intraoral scanner first, then considering a ceramic oven with custom staining capabilities before investing in production equipment. This approach allows practices to enhance lab work quality and reduce remakes while testing their comfort level with in-office finishing procedures.

Perfect for: General dentists evaluating digital equipment investments, practice owners analyzing ROI on technology purchases, and dental teams considering workflow modifications to incorporate in-house production capabilities.

This episode provides the financial reality check needed before making major technology investments in your practice.