In-house dental lab vs outsourcing: when it pays off

Making work in-house pays off when three things are true.

You have a steady flow of one kind of case, someone with the time and skill to make it, and a real use for the speed.

It does not replace a lab. Practices that mill and print still send out the work that needs a technician’s hands.

This guide covers what in-house means, what you gain and take on, how to do the sums, and what should still go out.

What in-house covers

An in-house dental lab can mean several things. It helps to see it as four levels.

Many practices that go in-house stop at the first or second level.

In a study of 1,777 US dentists, 9% used in-office milling and 88% had a commercial lab make most of their crowns.

That study dates from 2017, so the share may have changed. It still shows a commercial lab as the usual route, with in-house work as an addition.

What you gain

Speed. A same-day crown is prepared, made and seated in one visit. There is no temporary and no second appointment.

Control. The dentist sees the design before it is made, and can change it on the spot.

Fewer handoffs. Nothing is packed, shipped, tracked or waited for.

The patient’s time. One visit instead of two matters to people who take time off work to come in.

Scheduling changes too. One longer visit replaces two shorter ones, which suits some days and crowds others.

Each gain is real for the cases that suit it. None of them applies to work the equipment cannot make well.

What you take on

A lab’s fee covers more than the crown. When you bring the work inside, the rest comes with it.

• The equipment. A purchase or a lease, a service contract and software subscriptions.
• Materials. Blocks, resins and burs, with stock to manage and expiry dates to watch.
• Design time. Someone designs every case. That is the dentist or a trained team member.
• Chair and room time. The patient may wait in the chair while the crown is milled.
• Maintenance. Calibration, cleaning, and days when the machine is down.
• Training. For whoever runs it, and again when they leave.
• Remakes. A crown that does not fit is now yours to make again.
• The queue. In-house cases need tracking as much as lab cases do.

Check the rules as well. Who may design and finish an appliance is a matter for your provincial regulator.

This is the list a lab’s fee was quietly paying for, and all of it belongs in the sums.

Do the sums

The decision turns on a break-even point, and you can work yours out on one page.

Fixed cost each month. Add the lease or loan payment, the service contract and the software.

Cost of each unit. Add the material, the burs or resin used, and the staff time to design and finish.

What each unit saves. Take the lab fee you no longer pay. Add the value of the second appointment you no longer need. Subtract the cost of each unit.

Break-even. Divide the fixed monthly cost by what each unit saves. That is the number of units a month at which the equipment pays for itself.

Allow for the remakes you will now absorb. Use a cautious rate for the first year, while the team is learning.

Use your own figures throughout. The practice calculator asks for what an hour of your chair is worth, and that number belongs here too.

Then be honest about volume. Count the cases from the last six months that the equipment could have made well, and ignore the rest.

If your count is well above break-even, the case is strong. If it is close, a busy month pays and a quiet one does not.

What suits in-house, and what still goes out

The split is about the kind of work as much as the amount.

What often stays in, and what often goes out

Two lists of work. Often made in-house: single back crowns, inlays and onlays, night guards and simple splints, study and working models, and whitening trays. Often sent to a lab: front teeth that need custom shading, bridges and longer spans, complex implant cases, dentures and partials, and anything combining fixed and removable work.

Often made in-house

• Single back crowns
• Inlays and onlays
• Night guards and simple splints
• Study and working models
• Whitening trays

Often sent to a lab

• Front teeth that need custom shading
• Bridges and longer spans
• Complex implant cases
• Dentures and partials
• Anything combining fixed and removable work

These two lists are a starting point. A dentist with a gift for design will move work into the first, and one short of time will move it into the second.

The reason front teeth go out is skill. A ceramist layering porcelain by hand does something a single milled block does not.

Tracking is the hidden work

An in-house case feels safe because it never leaves the building. It can still be forgotten.

A scan is taken and never designed. A print finishes on Friday and sits in the tray. A guard is polished and nobody tells the front desk.

Give in-house work the same record as lab work: who, what, which stage and when it is due.

Night guards and splints: keeping appliance cases on track covers this for the cases that slip most.

Start small

A printer is the gentlest first step. The equipment costs less than a mill, and the first products are forgiving.

1. Print models first. A model that is slightly off teaches you without a patient involved.
2. Add night guards. The design is simple, and the volume is often steady.
3. Run it for three months. Count what you made, what you remade and what you still sent out.
4. Then look at milling. With real numbers from your own practice.

Keep a simple log beside the printer: what was made, by whom, and how it fitted.

3D printing night guards in-house follows the printing workflow step by step.

Keep your lab close

Going in-house changes what you send a lab. It does not end the relationship.

Tell your lab what you plan to make yourself. A good lab will tell you which work it would keep sending out in your place.

The work that remains is the harder work. That makes the Rx, the photos and the dates on those cases more important than before.

Many practices settle into a mix. How many dental labs should a practice use treats the mill or printer as one more lab on the list.

More on digital dentistry

Each of these guides takes one part of the digital workflow further.

• Same-day crowns vs lab crowns: a working dentist’s view
• The digital crown workflow, from scan to seat appointment
• Smile trials: how practices use printed mock-ups before veneers
• Digital impressions vs traditional impressions
• How to photograph a case for your dental lab
• Implant cases: what the lab needs from the practice

Whatever you make in-house, the cases that go out still need one place to live.

Tusko keeps the Rx, the scans and every message on a case that the practice and the lab both open.

See how it looks for practices.