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1.3.5 Types of Dental Clinics and Business Models
The rise of digital technologies is also modifying the dental clinic business itself, bringing innovations that can enhance traditional niche clinics and create new business models. As the equipment used in digital dentistry is highly specialized, different business models may be required, depending on the specific field of study.
Some examples of equipment and set‐ups that can be created for special purpose clinics are shown in Table 1.1. However, multidisciplinary practices may eventually influence the hardware and software needed.
Digital imaging diagnostic and radiology centers: may invest in digital imaging equipment (panoramic radiographies, CT scanner). Depending on the services offered, some practices could provide intraoral scanning (or model scanners) and digital pictures for outsourced surgical planning. There is dedicated software available for imaging centers to provide better diagnostics and send back the requested information to the clinician.
Digital esthetics: there will be a large demand for ceramic restorations (veneers, crowns). Practices could invest in smile design software, 3D printers, and single‐unit ceramic milling machines.
Digital implantology: a digital implantology center would probably need in‐house imaging equipment and an intraoral scanner to correctly diagnose and create treatment plans. Additionally, guided surgery software would be needed to fabricate surgical stents, with a 3D printer. If digital restorations are to be executed, additional equipment similar to oral rehabilitation practices will be required.
Oral rehabilitation and prosthodontics: oral rehabilitation is a complex area that encompasses many of the main specialty areas of dentistry. Therefore, a digital prosthodontics clinic could require equipment and software to create at least some items in house, while outsourcing more complex work. To do so, good additions would be an intraoral scanner, chairside software to design restorations, a small ceramic milling machine to produce single‐unit same‐day restorations, and a ceramic furnace. If more complex in‐house prosthetic production is desired, a dedicated internal digital laboratory can be created.
In‐house dental laboratory: there is no limit to the work that can be created by an in‐house dental laboratory when compared to commercial counterparts, since the same equipment and software can be acquired. However, a complete laboratory set‐up would require a more robust financial investment in machinery, software, and materials. Additionally, a dedicated space is needed with special infrastructure planning to accommodate the hardware, and specialized personnel are needed to operate the machinery. The size, organization, and production rate of devices must be compatible with the desired workflow. Equipment for digital dental laboratory would include that required for a traditional lab plus a desktop scanner, a milling machine for 5‐axis capability for large blanks and ceramic blocks, a ceramic furnace, a sintering furnace, CAD software to design prosthetics, and a resin 3D printer.
Orthodontics: the digital orthodontist can enhance their practice with intraoral scanners. It is possible to acquire dedicated software and 3D printers to plan treatment outcomes, as well as in‐house fabricated aligners.
General practitioner: can invest in intraoral scanners in order to easily digitalize their orthodontic, restorative, and prosthetics patients. Digital sensors for radiographies are also widely used.
Surgery: oral and maxillofacial surgeons can acquire dedicated software to plan orthognathic surgeries and would need at least desktop scanners to digitalize models, although an intraoral scanner would be preferable.Table 1.1 Estimate of the amount of machinery, equipment, dedicated software, specialized personnel, and physical space dedicated structure to operate different types of digital dental business models.Intraoral scannerDesktop scannerDigital imaging3D printerSmall milling machineLarge milling machineCeramic furnaceSintering furnacePhysical space structureSpecialized personnelDedicated softwareOrthodonticsXxxxxGeneral practitionerXXXxxxEsthetic dentistryXXXXxxxDental implantologyXXXXXXxxxxxxOral rehabilitationXXXXXXXXxxxxxxSurgeryXXxxxDental laboratoryXXXXXXxxxxxxxxImaging centers and diagnosticsXXxxxxPlanning centerXXxxxxScan servicesXXxMilling centersXXXxxxx
Planning centers: a digital planning center is a new business model aiming to provide outsourced services to any dentist or practice, by means of dedicated software. The range of services provided can encompass orthodontics, implant surgery, smile design, oral surgery, prosthetic design, and so on. Software licenses can be expensive and require initial investment and often subscription updates charged yearly. Additionally, professionals are highly trained in software and can discuss the design with the dentist before delivery. The outcome of a digital treatment plan can be a physical item such as a surgical template or even digital files or pictures.
Scan services: for those who do not possess an intraoral scanner but would like to use one, scan services bring the scanner to the customer's practice in order to register the digital impression. This novel business model can occur as a standalone company or be offered by digital dental laboratories.
Milling centers: a digital milling center is a specialized dental laboratory focused on the production of milled structures or restorations. Specific materials such as cobalt‐chromium structures are commonly used in prosthodontics but as highly dense materials, they are extremely hard to mill, requiring specialist and expensive tools and machinery. Therefore, many small laboratories tend to outsource their metal milling to milling centers. Depending on the focus and services offered by milling centers, other materials can be used such as zirconia, ceramics, PEEK or PMMA.
1.3.6 Financial Aspects of Digital Dental Clinics
The digital clinic can be more complex than a regular individual private practice, which generally presents lower complexity, operational costs, and levels of document digitalization and a smaller professional administration team. Therefore, the operation of a digital dental clinic is similar to a business company, something that dentists may not be used to. Potentially higher financial investments are necessary to equip a digital dental clinic, which makes it difficult for any clinic to enter the market. It is noteworthy that these issues are less likely to be experienced by larger dental clinics and hospitals.
A digital dental clinic can be potentially bigger than a regular practice, but not necessarily a more profitable business. As a practice grows and enlarges its operation, facilities, and employees, there is an increase in profits and liabilities in the same proportion. Therefore, in the real world, studies of economic viability of dental clinics, or related to some specific equipment incorporation, can determine if a company will perish or thrive. More than ever, a successful dental practice needs a combination of highly skilled dentists and entrepreneurial skills.
1.3.7 How to Calculate the Return on Investment (ROI)
The return on investment is a ratio between net income and the funds spent on the investment, over a period of time. Applied to a dental clinic, the ROI calculation may predict how long it will take to return the money to the entrepreneur.
The estimation of ROI is based on complex calculations comparing initial costs, earnings, and projected estimate of cost/benefit after making an investment. To achieve the same production end, more than one digital solution is available and can be compared [9].
Return on investment calculations have three aspects.
Earnings: how much revenue will the investment bring? Will there be an increase?
Costs: how much will the investment save (time, clinical steps, personnel costs, consumables)?
With this information mapped, it will be possible to create a break‐even estimation, which is the prediction of when in time the investment will return. Reaching anything more than the break‐even is considered profitable.
Estimations of ROI must take into consideration that