Company: Ashford Orthodontics
Profile: Ashford Orthodontics is the largest orthodontic laboratory in the United Kingdom with a 12,000 square foot facility and over 50 employees, offering specialist orthodontic technical services to orthodontic and dental professionals.
Challenge: The lab had to adopt digital workflows to cater to the growing number of digital customers, but the high cost and complexity of operating large-scale 3D printers meant that they struggled to make a viable case for digital in their business.
Solution: By running a fleet of 12 Form 2 stereolithography 3D printers, Ashford managed to produce high-quality clear aligners at scale, and achieve a cost advantage that empowers them to grow and attract new customers.
- 1,200 clear aligners and retainers per month produced digitally.
- 24 hours saved in lead time compared to the traditional workflow.
- Overall costs comparable to the traditional workflow.
Ashford Orthodontics is the largest orthodontic laboratory in the United Kingdom with a 12,000 square foot facility and over 50 employees. The lab offers specialist orthodontic technical services to orthodontic and dental professionals and produces a variety of orthodontic appliances from complex, fixed, and functional appliances, to anti-snoring and sleep apnea appliances and mandibular advancement devices.
Sean Thompson, who founded Ashford in 2001, has always strived to keep the lab at the forefront of the industry, which today is now more important than ever. Orthodontics is currently in the midst of undergoing its most significant technological evolution to date, from traditional workflows to digital technologies.
“Digital orthodontics was something we knew we had to get into. We couldn't afford not to do it if we really wanted to be a leading player within orthodontics.”
Traditionally, clear aligners and retainers are manufactured by thermoforming over stone models that are produced from manual impressions. With the emergence of 3D intraoral scanners in dental practices, these manual impressions are replaced by digital scans.
Clear aligners and retainers are produced by thermoforming over traditional stone or 3D printed models.
The appliances are finished by hand by technicians.
To cater to digital clients, dental and orthodontic laboratories have to adopt digital workflows. Digitally, treatment planning for clear aligners and retainers is done using CAD software, then each substep of the treatment is fabricated by 3D printing a model, and thermoforming over these models.
In many cases, digital workflows can be more expensive, and labs struggle to offer prices that are competitive with traditionally produced appliances. By running a fleet of 12 Form 2 3D printers, however, Ashford has managed to produce clear aligners and retainers cost-effectively at scale.
Ashford Orthodontics began experimenting with digital orthodontics five years ago. At first, the lab purchased two Stratasys Objet30 3D printers—industrial machines that were marketed specifically for orthodontics.
The lab gained experience with the digital workflow and started accommodating digital jobs from clinicians, but, because of the high cost and complexity of operating these large-scale 3D printers, they struggled to make a viable case for digital in their business.
“You had to invest a lot in software upgrades and keeping [the machines] serviced and calibrated every year, to the point that once you factor in the actual resin costs, you couldn't really produce a model for the price that we wanted to produce it, and certainly not in the volume we wanted. Plus with any printer, if you build your business around it, you can't just have one, you need to have two, and you need to run both of them at 50%. In case one goes down, you can always upscale the other to 100%.”
As it would have been very expensive to expand the department using Stratasys machines, Sean decided to look for a smaller, but more efficient 3D printer, that would make scaling up feasible.
Ashford currently runs a fleet of 12 Form 2 stereolithography (SLA) 3D printers…
…and employs eight technicians in their digital department.
Ashford started off with one Form 2 3D printer, then quickly scaled up to two, four, and at present, they’re running 12 Form 2 printers. At the same time, the number of personnel in the digital department has grown from one technician to a team of eight digital technologists who are a blend of qualified technicians and computer experts.
“The Form 2 is very reliable. We call it a workhorse. We know when we go home at night that when we come in in the morning, everything will be printed. There's not going to be a failure; everything will be there. Because of that, we can build our business around them.”
The lab follows a well-structured daily schedule that easily accommodated the digital workflow. Each working day, the lab has a cutoff time at about 3 pm. They review new scans sent in by customers, plan treatments, and 3D print the digital models overnight. Early the next morning, a technician cleans and dries the 3D printed parts, and slightly later another technician thermoforms the clear aligners on the finished models. By the time most technicians arrive at the lab, the aligners are ready for post-processing.
“Once you've got a model to work on, there's very little difference. If you are a traditional lab and you want to go and push the boundaries to digital, once you've done the learning side of it, the manufacturing side is pretty similar.”
The digital workflow saves 24 hours; the finished appliances can be with the clinician within 48 hours from the scan.
In the afternoon, technicians package and dispatch the finished appliances, so they’re at the clinicians within 48 hours. Overall, the digital workflow saves 24 hours as the scans arrive at the lab instantly, allowing Ashford to turn around jobs quicker and accommodate more work.
“It works absolutely perfect for us. We launch the printers just before we go home at night; that's our night shift. We come in the next morning and by then, the night shift has done their job. It doesn't matter if they're sitting there for two hours, four hours, six hours—it's done. We totally rely on that coming in on the morning, so it's the quality and reliability of the print that matters to us.”
As of today, the lab digitally produces 1,200 aligners and retainers per month digitally with their 12 3D Form 2 printers, but the ratio of digital cases is increasing steadily. When Ashford got into digital orthodontics, it accounted for only 2% of their business. Now it stands at 15% and it is the fastest growing sector within the laboratory. Sean believes that digital technology can only surpass traditional workflows if it’s cost-effective. By passing savings on to their clients, they’re opening up the digital market to more and more clinicians, which Sean believes will be the way forward for everybody.
“It shouldn't cost you any more to provide your services to your clients and patients via the digital route than via the traditional impression route. So what we've done is quite simply that we swapped the cost of the plaster models—which aren't needed anymore—with the cost of the resin model. Therefore, your lab bill is exactly the same, whether it's done via the traditional route or the digital route, except you can have things back 24 hours sooner.”
With the digital workflow, technicians can remove brackets digitally so clinicians can debond the brackets and instantly fit all the retention products chairside.
By removing the brackets digitally, the lab can make an Essix, bonded, or a Hawley retainer, and a whitening tray all on the same model which isn't possible via the traditional route and plaster models.
This value proposition has proven to be successful in attracting new customers from the UK, as well as internationally. While the lab makes only small margins on the Essix retainers and digital models, they’re highly valuable as trust builders.
“We've got new clients coming to us every day who have never used us before, so they don't know if the quality is going to be good or if the customer service is going to be reliable. When they realize that what we're providing here is very good quality, they trust us to send us the more complex appliances. So invariably, within two months of getting a new client who wants to use our services for digital orthodontics, they start asking if we can do twin blocks, fixed appliances, or functionals. Before we know it, they're sending us lots and lots of work, because we can accommodate all of their needs.
At the moment, it's traditional techniques with a little bit of digital, but in a matter of two or three years, it's going to be digital techniques with a little bit of traditional. And that’s going to be the driving force for our department moving forward.”
|Application||Traditional models||3D printing on the Form 2|
|Orthodontic aligners and retainers||Cost||1X||1X (comparable to traditional)|
|Lead Time||72 hours (including shipping)||48 hours (including shipping)|