Category Archives: Industry News


Understanding Offshore Lab Resurgence

Last month, a friend of mine told me his revenues were 30% over last year. He isn’t a technician and has almost no equipment. In fact, his 10 person sales force outnumbers his technical team, 10 to 1. His single technician only performs small corrections because my friend sends all cases offshore.

In the past 10 years, the number of dental labs has fallen more than 50%, lab fees have remained mostly flat or down, while the percentage of units sent offshore has continued to rise. Certainly, many are doing better this year due to lab attrition and the improved economy. But, why are some offshore labs outgrowing domestic labs?

Why the Revenue Shift

Dental technology has given every high production lab an edge, especially offshore, where dentists can find “Good enough” restorations for 30 – 50% cheaper fees.

Dental technicians are a part of healthcare, making “body parts” (medical devices) to help patients restore and maintain their health. However, unlike larger, more sophisticated “medical device” companies and their industries, unorganized, and generally unregulated dental laboratories are forced to compete with well-run, FDA and ISO certified offshore labs that produce lower cost “Good enough” from the same materials and equipment as domestic labs. Furthermore, when intra oral scanners gain larger market share, there’s a risk this disparity could increase.

Why it is Happening

There are four reasons why offshore labs are growing revenues 20 – 30%. First, digital technology and globalization has made offshore restorations more consistent and largely indistinguishable from domestic restorations.

The second reason is due to large dental office chains, DSOs. Their increasing numbers of locations and marketing are eroding private practice revenues in much the same way pharmacy chains have destroyed small pharmacies, and Home Depot has forced small hardware stores to close. Additionally, and unlike lab and dentist professional associations, the DSOs coordinate sophisticated marketing and political support through a highly effective national DSO organization, that unlike our organizations, is making strides with a laser-like focus on business. While some DSO offices work with domestic labs, much of their work goes offshore.

The third reason stems from insurance influence. Insurance companies own, control, and distribute up to 75% of dental patients, forcing 90% of dentists to join PPOs and agree to set fees at 1996-2002 levels. Insurance companies increase their profits by forcing a reduction in the number and value (fees) of clinical procedures, essentially controlling the flow [reduction] of revenue for the entire dental industry, including manufacturers and distributors. The combined effects of DSOs and insurance has helped lower annual dentist income to 1976 levels, and influenced their laboratory decisions.

With income pressures at an all-time high, it should not be surprising that more work is being sent offshore, especially if restorations are meeting the same or better standards at a lower cost. But there is a fourth reason that offers the most opportunity. To seize it, we must first get past Einstein’s definition of “insanity,” and stop continually doing the same things and expecting different results.

How to Fix It

Many would like to blame dental organizations, such as the American Dental Association (ADA) and the National Association of Dental Laboratories (NADL). While we can argue they have provided little help on the business side of things, especially compared to DSOs and insurance organizations, we need to consider that we are the ADA and the NADL, even if we aren’t members. Whatever they are or become, we either caused it or allowed it.

Einstein’s comments about insanity suggests that if we don’t like what is going on, we need to change. In contemplating change, there are three questions each of us must answer:

  1. What do I need to do?
  2. How will I do it?
  3. Will I do it?

We’ll begin to answer these questions in our next monthly article. Until then, please remember this: Improvements are the result of change. Without change, nothing will improve.

What’s happening to Dentistry, Why, and What to do about It

There was a time when people would say, “All you need to do is hang your shingle, and you’ll have it made.” Nobody predicted today’s exorbitant cost of a dentist’s “shingle” and the smaller ROI it now brings. The story of old has crumbled, and as the Brazilian lyricist and author, Paulo Coelho suggests, we need to tell a new story to bridge the gap between that which is, and that which should be.

 Facts: What is Happening

Private practice dentists, and those supporting them, are losing revenues. Outside interests, mainly insurance companies and DSOs (dental service organizations), are forcing changes to benefit themselves at the expense of the other 90% of the dental industry and sometimes, the patients they serve.

Outsider influence has raised the cost of a dental education to as much as $400,000, while its value has in many cases, plummeted. Sky high debt and inadequate education has made entering private practice upon graduation, largely impractical, and supports the growth of DSO practice models. Meanwhile, insurance companies are lowering the number of procedures performed and their reimbursements. This has caused average annual income for dentists to drop 22%, from 2009 to 2014, currently sitting at the 1995 income level. This has caused each private practice to lose annual revenues in excess of $100,000. If that amount were invested each year for 15 years, a 45 year old dentist would earn about $30,000 per month at retirement (5% annual growth, before taxes).

Facts: Why this is Happening

Dentists and their organizations have allowed these changes to occur, and in some cases, supported them. Good clinicians see patients as people who need care. Outsiders see them as the headwaters of the revenue stream, and the earnings they bring as low hanging fruit in a fragmented industry with no barriers. Influencing the mass market in ways that individual dentists can’t, consumers naturally form attitudes and beliefs shaped by outsider messages and brands.

Below is a link to typical DSO information being distributed. Individual dentists need to confront this  with an equally powerful, but more complete, rendition:

Wisconsin Dental Board Legislation

We are not opposed to DSO practice management services. Neither is state dental board oversight. Like us, state dental boards are interested in protecting patient welfare in all practice models, as they do now only in private practice settings, or, supposed to. The linked article provides no proof to support assertions that DSOs routinely save patients money over private practices. Further, complaints filed  by several state attorneys general would assert otherwise. Unfortunately, nobody is calling this out, publicly. We intend to on the grounds that patients deserve protection in all practice settings.

DSOs have the right to exist, but not the right to practice dentistry without a license. If they are not practicing dentistry without a license, why should they care about falling under state dental board regulation? 

Why is the DSO lobby opposed to that?

Why is no one in the public spotlight asking that question?

How is being regulated by state dental boards anti competitive?

 The Response: Take Action or Do Nothing

Trends from doing nothing are clear, and personal losses (above) astronomical. The question is, “What can we do?” The obvious first step is to organize. Only when organized will newly competitive opportunities surface.

If you are a dentist, laboratory owner, distributor, or manufacturer, now is the time to get busy.  The same mass marketing tools being used against us could be working for us. Together, we can take advantage of everything the internet offers (including social media marketing), and add public relations, pressure legislators and regulatory agencies, and develop new business models in direct competition for market influence, including insurance.

To change the trend line, we need to pull in one direction, for one purpose: Educate and attract consumers as informed patients. The good news is, consumers only want the truth, something traditional care is in the best position to provide. More good news: Accomplishing this is easier than in the past. Research shows that consumers want genuine information they can trust. No patient deliberately chooses to be misled or mistreated, yet it happens daily to hundreds, perhaps thousands while the industry remains silent. Ethical care is a key marketing advantage, but only if we make it one.

Great stories untold die in obscurity.

We have a great story to tell,

But only if we are willing to tell it.


“We believe big visions need big stories to match…We believe in the power of collaborative community, and the choices you can always make to change your story. We believe in messages that make people feel inspired and connected to something greater. We are truth-seekers teaching a new paradigm of story.Michael Margolis, CEO and founder, Get Storied

 This is Our Story to Tell

Through professional marketing and a consumer website, OPT-In Dental Advantage is the only dental organization telling the story about the value of traditional dental care and the dentists who provide it. We employ professionals for website SEO, SEO support for our members’ web pages, bi monthly consumer blogs with SEO, and more recently, a national public relations campaign, managed by Braithwaite Communications, to brand the image of traditional dental care and present our story to consumers, nationally.

We invite dental professionals and companies to join us in making the advantages of traditional dental care known, and preferred. Please help our voices to be heard through stories consumers want and need to hear. Contact us today.

Please visit our website, OPT-In Companies, or call us at 855-321-OPTN (6786). It’s time to be a part of the solution.

Nacera hi res logo

Is this the next Generation Zirconia: Results, Part 2

This may look like an ad, but it really isn’t. We are all simply very excited about a company that promised both strength and esthetics in zirconia, and delivered what they promised. So, read on, and if you agree, you’ll have a new tool to help your practice, your lab, and your patients. And one more thing. The company, Nacera US, is the only company helping private practitioners and dental labs become more competitive. To us, that is important.

A few months ago, a new zirconia from Germany came our way for testing called, Nacera. This is an update to an article we published last month on the experience of two lab members. We pointed out that Nacera claimed to be a higher grade of 1400 MPa zirconia purity with more translucency and improved esthetics. We determined after a few months of testing that the esthetics was better than any 1400 MPa full contour zirconia we had seen, with the potential to rival lithium disilicate, but stronger. In the photo below, you can see the unusual vitality that this full strength zirconia provides.

Roberto U Molar

There are two molars in this photo, one a finished full contour zirconia, the other, a newly sintered full contour zirconia. All samples in the photo are Nacera zirconia. The finished Nacera molar, provided by Roberto Rossi, MDT, was only lightly stained.

OPT-In lab members working with Nacera have commented on the improved margin accuracy and how true the shades are. That is not the case for all zirconia brands. Another aspect of Nacera zirconia is purity. Some brands have impurities that form pits on the surface during finishing, and also risk areas of weakness, internally. Other brands are naturally weaker and unpredictable because of faster and less thorough compression during compaction. We know better about Nacera.

To see a short video about Nacera manufacturing, click the below. When it ends, click it off or it will continue to other topics.

Nacera Video

This month, we visited the Nacera factory in Dortmund, Germany. The parent company, Doceram, is actually an industrial engineering company that routinely designs parts to meet sub micron tolerances. They then manufacture parts in zirconia  and test them to make certain those same tolerances have been met. This same precision approach is applied to dental zirconia, with constant testing and measuring. In fact, they test each zirconia batch, individually, and then measure each separate individual zirconia disc prior to packaging, printing the measurements on the label. Nothing is left to chance.

Visit Nacera US at Chicago Lab Day, Booth L-22

For information on Free Hands-on and Lectures, visit

Nacera US

The one word that kept surfacing during our visit was, Certainty. Dentists can now offer patients both strength and esthetics without paying more. However, if the need arises, a Certified Nacera Lab can also deliver the highest level esthetics when only veneered zirconia will meet a patient’s needs.

Ant Germano Rossi

Germano Rossi produced these outstanding results by veneering Nacera zirconia copings  with ceraMotion® (Dentaurum). CeraMotion® is used as a very thin, colored paste with a built-in glaze. When applied, it stays in place and finishes with only one bake. The thickness of the veneered surfaces are 1 mm or less.

Nacera US is a dental company. Dedicated to patients, dentists, and dental labs, Nacera US offers “best products” suitable for all dentists and dental labs who care about dentistry, regardless of the markets and patient budgets they serve.

We tested it, in fact, our lab members and their dentists are testing it daily. They, also, have come to the conclusion that What’s Inside Matters. That’s why OPT-In is proud to be a Nacera partner.

If you would like to try Nacera for your patients, contact us for a Certified Nacera Lab referral that fits your practice. Each was trained in November in how to consistently obtain the very most from Nacera. Having Certainty is always good. Having Nacera Inside takes Certainty to a higher level.

Almost forgot…the pink in the bottom photo, that too is Nacera!

Visit Nacera US for more information

Contact OPT-In for a Nacera Certified Lab

3 sample banner

OPT-In Tests a New Zirconia: The Results

A few months ago a new zirconia from Germany came our way for testing. It claimed to be a higher grade of 1400 MPa purity with more translucency and improved esthetics. Sound too good to be true? We thought so, however, after a few months of testing, we became believers.

Doceram Medical provided a couple of our labs with various samples of Nacera® zirconia, including Pearl 1 (white), and various value shades capable of reproducing 16 vita classic shades. After making the necessary adjustments to sintering and glazing times and temperatures, the results were in, all exceptionally positive. Nacera® zirconia was kinder to milling burs (lasted up to 15% longer), milled more precisely and smoothly, had less shrinkage variations (each lot/batch has its own shrinkage factor), and was more translucent than other high strength zirconia.

OPT-In member, Dennis King, CDT, has used the full line of Nacera® zirconia, including the multi shade pucks that come in A, B, C, and D shades. He has successfully provided several large full mouth cases of full contour Nacera® restorations that included anteriors, one case for a dentist’s wife. Dennis noticed that Nacera® mills far easier than e.max® and other zirconia, and that his burs have been lasting longer. He also stated that fit is consistently better due to more predictable shrinkage and smoother milling. With his successes fully documented, other OPT-In lab members have also commented positively on the same points.

Top photo of Nacera® Pearl 1.5 (A2), with  ceraMotion®, is courtesy of Master ceramist, Roberto Rossi, MDT, who has echoed Dennis’ comments. In a month of testing several different pucks and ceramMotion® (Dentaurum), Roberto noticed more translucency without sacrificing higher strength, better margins with less effort, and predictably better esthetics when compared to competing products. Of particular note, single-step stain & glaze ceraMotion®, distributed by Nacera US, not only improved esthetics, it saved time by requiring only a single stain & glaze bake.

Doceram Medical is establishing the Nacera® brand through a new US subsidiary, Nacera US. OPT-In members are excited about working with Nacera US through a special pricing program, exclusive for OPT-In members. Additionally, the Dental Lab Group, in Staten Island, will provide special Nacera®  outsource pricing [only] for those members without milling machines, as well as for custom milled titanium abutments.

Nacera US will be at booth L-22, Lab Day, Chicago, and provide continuous seminars in a private suite. Guests at the suite will enjoy food and beverages, and be able to test stain & glaze the new ceramMotion®  on samples of Nacera® zirconia. Roberto Rossi, and others, will be guest lecturers and guiding hands-on experiences. Nacera US has also promised important announcements in February, including the launching of their new website. For inquiries and more information about the entire line of Nacera® products, visit: Doceram Medical. For immediate questions, or to register for courses in Chicago, please call Nacera US at, 215-345-5283.

Dentists Feeling Global Slowdown: What’s it Mean?

Thanks to falling oil prices and increased employment, consumer confidence is improved and pent up demand is in bloom. They have also adapted to a new socio economic normal: economic stability with less income. Unfortunately, in 2014 the middle class earned 4% less than in 2000 (Pew), and fell from 61% of earners in 1971 to 50% in 2015. Similarly, the US Census Bureau reported that median income fell 9% from 2007 to 2014. That means, heading into 2016, confident consumers may be working their way up from negative territory. But, there’s more to this story.

As a risky undercurrent to consumer confidence, the economic pullback in China has led US manufacturing and exports to contract, other economies to slow, and raised fears of a new global recession. While the US economy is believed to be less affected than others, the now stronger dollar is impeding exports and causing some to wonder if layoffs are far behind? While there is little belief the US is on the brink of another recession, there is plenty of disagreement about the economic strength of 2016 going forward.

The New Consumer

The recent recession shaped consumer attitudes and habits into a new normal: “If my income is flat or less, then what I pay must be flat or less.” With support from the digital age, price conscious consumers expect and demand discounts in everything they buy. Moreover, with the internet, consumers are faster, better, and more efficient at finding value, making most everything a commodity.

The new normal caused 2015 retail sales to drop 8%, and prices to fall 2.9% from 2014 levels (Bureau of Economic Analysis). Additionally, mid priced retail stores are losing sales to “off-pricers,” such as Kohls and Marshalls.  Meanwhile, “fast design,” high production, low cost chains such as H&M and Forever 21 are expanding. Is dentistry seeing the same price pressures? This past Christmas, online shopping grew 20% while retail bricks and mortar sales fell 10%. In response, Macy’s will close 40 stores in 2016, and open 6 new low cost discount stores. Radio Shack, Staples, and Sears/KMart are closing a combined 1,800+ locations. Yes, in some ways, this is very similar to what we are seeing in dentistry: changes driven by consumers are forcing retailers to change or close.

Impacting Dentistry

Today, new technology provides consumers with consistently higher quality, mass produced (non distinct) products at lower costs. While we see this kind of innovative technology aiding dental labs, commoditized private practice dentists continue to operate without cost-saving scalability. Meanwhile, consumers often tell dentists the very same things they tell retailers: “Yes, expensive is nice, I would like it but I don’t need it, can’t afford it, and I’m not going to pay for it.” For many, dentistry has become a reluctant victim of consumerism’s commoditization.

The market, in general, isn’t as wealthy as it once was and doesn’t see dentists as it once did. Because the market is always 100% correct, dentists and lab owners need to see themselves as their markets see them and either provide what their markets want, or together, convince consumers they need and deserve better. That means, some dentists and lab owners might need to adjust their approach to how they deliver services and set fees. But remember, people pay for what they want. Dentists and their labs can provide what many consumers want, commodity care at a lower cost, or, help them to want something better. It’s entirely up to the professional team.

With pressures never before experienced, dentists, lab owners, manufacturers, and distributors need to look at new ways of collaborating and working together. To help, OPT-In is leading the way in building an alliance community of stakeholders. Nacera US, known for its high quality zirconia products, was first to provide financial support for the OPT-In national public relations campaign supporting private practice. We invite all dentists, laboratory owners, manufacturers, and distributors to contact us and participate.

hand in dominoes

Private Practitioners Raising the Competitive Bar, Changing the Trends

National Public Relations Campaign Underway

Thousands of consumers are selecting a new dentist each day. Because they can’t measure quality, their decisions are based on hopeful trust. Because consumers are often drawn to brands, private practices with weak brand presence are losing patients to large regional brands, representing more than $100,000 in lost revenues, annual . In response, a public relations campaign is being launched to help private practices compete more effectively.

Developing the Consumer Message

The first ever, Private Practice, national public relations strategy session took place on November 12, at the corporate headquarters of Braithwaite Communications. The three hour meeting, sponsored by OPT-In Dental Advantage, identified consumer concerns, why they exist, dental industry strengths and weaknesses, and storylines to be used. At the start, efforts were made to keep all messages positive. However, after sharing their own negative dental experiences, the Braithwaite team decided that too many bad things are happening too often, and that consumers need to be made aware of not just what to look for, but also, what to avoid. The discussion topics included potential advantages and disadvantages of different practice models and philosophies, insurance transgressions and competitive opportunities, and new structures to promote OPT-In member labs’ and dentists’ strengths over competitors’ weaknesses.

An Industry-wide Challenge

By the end of the meeting, enough storylines had been identified to keep the public relations campaign rolling for several months. In the meantime, OPT-In Dental Advantage members have received financial support from manufacturers, distributors. OPT-In dental laboratory members are playing a key role,  and are also earning manufacturer support, with many seeking ways to address the same problems. Dental laboratory owners are essentially in the same boat, in that, what happens to private practitioners happens to dental labs. Currently, OPT-In laboratory members, listed here, are the only dental laboratories investing in their private practice customers.

Storytelling, an Important Advantage

Braithwaite will be weaving stories for release through major news outlets that will help consumers understand the importance of seeking dental care in trustworthy settings. The importance of storytelling was highlighted in an article published in the Harvard Business Review, online. In the article, Keith Quesenberry, a researcher at Johns Hopkins, states, “People are attracted to stories because we’re social creatures and we relate to other people.” The article also points out, stories can open doors to emotional decisions that are closed to cold facts. We can use “data” to influence thought, “but it doesn’t inspire them to act; to do that, you need to wrap your vision in a story that fires the imagination and stirs the soul,” states author, Harrison Monarth. The team at Braithwaite will be providing this expertise through national outlets such as, The Wall Street Journal, New York Times, Washington Post, etc.

An Industry Working Together

Time is of the essence. With the number of non Medicaid dental patients remaining flat, revenues lost to competitors, and patient loyalty, are difficult, even impossible to regain. Additionally, patients need to be educated about the real cost of insurance company tactics to deny care and benefits. Addressing these issues, the OPT-In national public relations campaign is being launched because enough dentists and lab owners made it possible. Through broader cooperation, manufacturers, distributors, dental technicians, and dentists could accomplish even more, faster.

For more information, visit our website, OPT-In Companies, or call, 855-321-OPTN (6786).

Private Practice Dentists take matters in their own hands

Private practice dentists, and dental labs, are saying, “Enough is enough.” They are tired of patients being taught that dentists and dentistry are all the same, big clinics are cheaper and better, and that insurance companies create quality care. With too much to lose, OPT-In dentists and laboratory members are launching the first ever, Private Practice National Public Relations campaign.

Scheduled in 2015 for late fall-early winter, the public relations firm, Braithwaite Communications, is being contracted to support private practice with brand-building content in national news outlets such as, the Wall Street Journal, USA Today, Washington Post, Los Angeles Times, Associated Press, CNN, etc. According to Dr. Dean Mersky, founder of OPT-In Dental Advantage,

“Today, insurance companies and large corporate dental chains are unilaterally, influencing consumer decisions and attitudes. Meanwhile, private practitioners, with no representation, have no voice to help consumers understand the limitations of insurance, and the real differences between practice models. That’s about to change!”

Adopting, “Put up or shut up!” OPT-In dentists and lab members are funding their own National Public Relations Campaign, with additional financial support from dental companies.

Along with promoting private practice dental care, Braithwaite will also address detrimental insurance practices. PPO and lab fees are too often stagnated at 1998 levels, a time when the average car cost half of today’s $34,000 (USA Today). After 4 years, that’s enough to pay tuition for one child’s entire college education. To address this, the public relations campaign will educate patients on what to believe and what not to believe about their dental insurance, and how the wrong decision can negatively impact their health. They will find this information on our consumer website, OPT-In Dental Advantage.


Over the next two years, we must work together, dentists and lab owners, to ensure consumers understand the importance of finding a skilled, trustworthy dentist.

It is well known that wherever consumers go, so goes revenues. According to one OPT-In lab member, located in Florida, “Private practice dentists are losing patients, daily, to other clinical settings, and insurance continues to burden profitability for us all. I’ve seen too many dentists forced to sell or face bankruptcy. Finally, we have a collective answer to make us stronger and more effective. We’re supporting our dentists 100% in this effort!” To view the list of OPT-In Laboratory members supporting private practitioners visit OPT-In Lab Listings.

More lab and dentist members are needed to assure this campaign reaches the maximum number of consumers, and continues to grow successfully. Please take time to learn more about how you can join in this effort and help patients understand the truths about different practice models, the games insurance companies play, and the advantages that can be found in private practice. You can make a difference. Dentists should visit OPT-In Dentists. Dental laboratory owners should visit OPT-In Dental Labs. Dental corporations should visit OPT-In Corporate Partners.  Or, call 855-321-OPTN (6786).

“Coming together is a beginning; keeping together is progress; working together is success.” Henry Ford                                                                                                                             

OPT-In Dental Advantage member, Dr. Shad Lewis, Reading, PA: “We are the only experts in dental care. If we aren’t willing to take responsibility for our profession, who will? If we aren’t willing to protect patients, to whom will they turn? Whose responsibility is it, if not ours? Please join us in getting the message out, and getting the job done.”