In-House Milling vs. Sending Cases to a Dental Lab: Which Is Better for Your Practice?

In-House Milling vs. Sending Cases to a Dental Lab: Which Is Better for Your Practice?

In modern dentistry, technological advancements are providing dental practices with innovative ways to offer same-day dental restorations and streamline workflow. A common debate for many dentists centers around milling crowns in-house versus sending cases to an external dental laboratory. Both options have distinct advantages and drawbacks, especially when considering cost, time, quality, and patient experience.

Let's dive into an analysis comparing these two options, focusing on costs, patient satisfaction, and overall workflow impact.

1. Cost Analysis: In-House Milling vs. Lab Cases

In-House Milling: Milling crowns in-house involves significant upfront investment in CAD/CAM equipment. On average, a chairside milling machine can cost anywhere from $80,000 to $150,000, with additional costs for a digital scanner and software updates, which could add another $25,000 to $50,000.

  • Cost Per Crown: For an average practice, the cost per crown, including materials and maintenance of the machine, can range between $30 and $50 once the equipment is purchased and installed. Factoring in depreciation, a practice may need to produce about 10-15 crowns per month for several years to break even on their initial investment.

  • Recurring Costs: Beyond the initial equipment purchase, you’ll also need materials (such as blocks and burs), which usually cost between $15 and $30 per crown, depending on the brand. Additionally, ongoing maintenance and software fees may cost a few thousand dollars per year.

Sending to a Dental Lab: Using a lab eliminates the need for substantial upfront investments, but it does involve variable costs for each crown.

  • Cost Per Crown: The cost of sending a case to a dental lab ranges between $100 and $250 per crown, depending on factors like the type of material, turnaround time, and quality of the lab. While this is more expensive on a per-case basis, it may make sense for practices with lower case volume or those that cannot justify the high initial expense of in-house milling.

  • Other Costs: Although there are fewer hidden costs, sending cases to a lab can incur shipping fees and potential remake fees if cases don’t meet standards.

Bottom Line: In terms of cost per crown, in-house milling tends to become more economical over time if you have a high enough case volume (generally 10+ crowns monthly). Smaller practices or those with low restorative volumes may find lab cases to be more cost-effective.

2. Quality and Customization

In-House Milling: Modern CAD/CAM technology allows for highly accurate and consistent restorations, but it does come with a learning curve. In-house milling provides a high level of control over the crown's design, shade, and fit, though this also requires time and skill from the practitioner or trained staff.

  • Material Limitations: Some chairside milling systems offer limited material choices compared to a lab. Zirconia, lithium disilicate, and composite blocks are common, but complex or high-aesthetic cases may require materials or techniques that only a specialized lab can offer.

Dental Laboratory: Dental labs often have access to a wider range of materials and techniques. Lab technicians specialize in creating highly detailed, aesthetically pleasing restorations and can tackle more complex cases requiring layered ceramics or custom shading.

  • Advanced Customization: For anterior esthetics or challenging occlusions, a skilled lab technician may provide a higher level of artistry that can be difficult to match with in-house milling alone.

Bottom Line: In-house milling can produce high-quality crowns, especially for straightforward posterior cases. However, for highly aesthetic cases or complex occlusions, a lab’s expertise and wider material range may result in a superior final product.

3. Time and Patient Experience

In-House Milling: A major advantage of in-house milling is the ability to provide same-day crowns. Patients save the hassle of a temporary crown and a second visit, which is a strong selling point for many practices. A same-day restoration can be completed in 1 to 2 hours from start to finish, depending on the complexity and the clinician’s comfort level with the equipment.

Dental Laboratory: Sending a case to a dental lab usually requires a 1-2 week turnaround time, depending on the lab’s workload and the shipping distance. This traditional route requires a temporary crown, which increases the risk of complications (like temporary loss or discomfort).

Bottom Line: In-house milling offers a major convenience factor, especially for patients who value fast results and fewer appointments. This can be a significant differentiator for practices that want to promote same-day services. However, for more complex cases, the wait time associated with a lab may be worth the added quality and customization.

4. Initial and Ongoing Training Requirements

In-House Milling: Operating a CAD/CAM system requires training, both for the dentist and any assistants who will operate the scanner or milling machine. Many manufacturers offer training, but there is still a learning curve. Ongoing practice is essential to achieve efficient and high-quality results, and this time investment should be factored into the decision.

Dental Laboratory: Sending cases to a lab minimizes the need for technical training and equipment upkeep. The primary requirement is accurate impression-taking and communication with the lab to ensure specifications are met, which are standard skills for most practices.

Bottom Line: In-house milling demands a commitment to training and technical proficiency, which can be challenging for some practices. Labs, on the other hand, alleviate the need for this learning curve, making them a better option for dentists who prefer to focus on clinical work without investing in the operational aspects of in-house production.

Final Thoughts: Choosing the Right Option for Your Practice

When weighing the choice between in-house milling and using a dental lab, consider your practice’s unique needs and goals:

  1. Practice Volume: High restorative volume? In-house milling may offer significant savings per crown.
  2. Patient Demand: If patients value same-day service, in-house milling could set your practice apart.
  3. Case Complexity: For highly aesthetic or complex cases, a skilled lab technician may produce superior results.
  4. Budget: In-house milling requires substantial upfront investment, which may be unrealistic for smaller practices.

Conclusion: For many practices, a hybrid approach — milling simpler cases in-house and sending complex or aesthetic cases to a lab — can balance cost, quality, and patient satisfaction. Evaluate your volume, budget, and goals to determine which approach best aligns with your practice.

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