The challenge of learning the technology was not so difficult. The bigger challenge was consistently implementing it to the point where it became the new, most frequently used behavior. The first layer of training was for the dentists practicing in the offices. Highly qualified external trainers were chosen for this.
When it came time for actual in-office use, obstacles were present on many levels. As is often the case with dentists, we seem to always find a reason why we can't do something. There was a need to address the excuses.
I can't do CEREC on this tooth because the gums are bleeding too much.
How about using an astringent agent or a diode laser?
I can't fit the camera to get the second molars imaged.
How about an impression and image the model?
I can't get done before the patient has to leave today.
Use a temporary and have the patient come back tomorrow for cementation.
An important realization was that a large portion of the CEREC process is not clinical and more technology-based and could lie in the hands of the dental assistants. The secondary team layer to be trained was the chairside assistants. This helped to encourage use of CAD/CAM by the doctors as well, as they felt more confident in the team members that surrounded them. With the office already fairly adept with the use of the technology, the only weak spot would be any recent hires, whether assistants or doctors. The third layer of training involved any new hires.
While Office 1 methodically jumped through the steps of training, Office 2 was often hesitant and resistant. Office 2 would have short gains followed by a reverse. By the third year it was evident that Office 2 was stagnant with CAD/CAM use. This was quickly followed by in-office training as well as team training, all with little to no success. Clearly Office 2 needed to believe in the value of the technology, be comfortable with the technology, and be open to the full potential that lies within a complete technological integration. Without the clinical leadership at the office promoting the best use of CAD/CAM based technologies, the second office could only maintain its current position.
At the end of 2011, there was a 3.5 point difference in year-end lab and supply expense. That might not seem like such a big number, but for an office doing $100,000 a month in revenue, for example, it translates into $3,500 per month difference. Over the course of a year, that is $42,000 (Figure 2). In the specific case examples shown here, both offices average over $200,000 per month in revenue. That makes the difference between the two offices' lab and supply expenses a minimum of $84,000 for just the year 2011.
Additionally, at Office 1, there was a 4.5% drop from 2006 to 2011 for year-end lab and supply expense. Based on the minimum Office 1 revenue already mentioned, that is over $108,000 ($200,000 X 4.5% X 12 months) in improvement when comparing year 2011 to 2006 for Office 1. These are significant numbers that drop straight to the bottom line of a profit and loss statement. Office 2 had a 2% drop in lab and supply expense with only half as much utilization of the CEREC machine.
