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 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)
The whole field of digital 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 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 crowns, bridges, telescopes, 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, surgery and the insertion of a dental restoration (conservative or 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 if companies like 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 industrial companies that want to participate in the value added.
The future of the full denture is digital
That is definite. Although nowadays there are ways of simplifying individual work steps with a scanner and a CAD/CAM milling machine (prosthesis baseplate or basing arches made from industrially prefabricated blanks), consideration of the process chain as a whole has so far been missing. This is the approach adopted in the following illustrated solution with a full denture based on completely digital development and production. The entire solution concept is based on the principle of backward planning. In real terms this means that a full denture completed by a master craftsman is customized to suit the patient’s oral situation, with just one appointment! Very soon the production of a full denture will take place in a fully digital process—from digital impression taking to production, completely devoid of dust and plaster. Unfortunately the digital scanning systems available at present are not yet able to provide the option of comprehensive collection of oral situation information in a single appointment, but it is definitely only a matter of time. Until then the jaw relation, palate, centric relation and aesthetics will be recorded by analogue means and then transferred to the digital system. By this method, all the data for making the prosthesis later is collected in just one appointment.
The process is followed by comparing the digital data with a prosthesis database, selecting the appropriate milling blanks with previously polymerized dental arches, and the modelling of the gums, which vary from patient to patient. After transferring it to the CAM module all that has to be done is mill the respective maxillary/mandibular pair. That is followed by finalization in the dental lab and a second appointment at the dentist’s for the purpose of incorporation. The finished product is a functional, precision-fit, highly aesthetic dental restoration of master craftsmanship quality.
This new future-oriented method called Baltic Denture System uses digital technologies to make the production of a full denture economically profitable again for the dental practice and the dental lab, for the first time in years. Despite digitization, market participants remain the same and the value adding process takes place within the familiar, implemented structures
It remains to be seen who the winners and losers of increasing digitization will be. The fact is that we are not yet at the end of optimal digital workflow. It is still important to modernize and develop digital processes. However, the opportunities are quite clearly in the majority, and due to optimization in the process chain the resulting work has a higher level of precision achieved in a shorter amount of time. This means firstly that thanks to the declining proportion of expenditure accounted for by staff costs per prosthesis it is also becoming possible to increasingly internationalize German dental restoration work. Secondly, scope is being created for new lines of business such as dental aesthetics. The patient too benefits from digital production, which also saves time for him or her. Owing to the use of digital technologies and optimization of value chains the profitability of hitherto unattractive work is increasing again for the dentist and dental technician. What is more, in this way scope is created for additional service offerings, which in turn creates potential for additional business and income.
In spite of all the digitization and value chain optimization one must not forget that, despite everything, direct contact between the dentist, dental technician and patient is still crucial and important for the outcome: aesthetic and functional dental restoration about which the patient is not only satisfied but also enthusiastic in everyday life.