The theoretical frame of reference sheds light on the existing literature about the fourth industrial revolution, the dental technician industry and how the revolution affects the industry. A dental technician industry analysis summarizes the current situation the industry is facing. It starts with a broad review of the industrial changes and concludes in a conceptional model, which is based on our research questions and the resulting propositions.
Fourth industrial revolution
After the last industrial revolution in the 1970s the industry has been transformed again. The fourth industrial revolution is the most recent trend of automation, digitalization and data exchange in manufacturing technologies. This revolution connects automated manufacturing chains with the Internet of Things (IoT). Creating cyber physical systems while using cloud computing is the key characteristic of this transformation (Georgakopoulos, Jayaraman, Fazia, Villari, & Ranjan, 2016).
While talking about an industrial revolution in another generation the Germans came up with a description for that specific phenomenon. The concept of ‘Industry 4.0’ describes exactly the changes in the manufacturing technologies. Factories are about to get significantly smarter and more flexible while the production costs are being minimized. This change is not a revolution but rather a transformation because of the large number of development steps needed (Blau, 2014). Technological progress is as old as humanity. Therefore humans tend to interpret the future as a huge leap forward in evolution while forgetting that all these things are already existing and are just being connected (Weber, 2015, p. 1).
At the end of this so-called transformation, all successful firms will become digital companies. These enterprises are producing physical products inside while having digital interfaces and data based services to the outside. When implementing this change, digital enterprises will be able to work together with suppliers and customers in a digital industrial ecosystem. According to predictions, the annual revenue is about to increase for these firms by 2.9 percent while the costs are reduced by 3.6 percent (Geissenbauer et al., 2017, p. 4).
This ‘Industry 4.0’ is not a futuristic trend anymore. Big companies base their strategic decisions and their innovation processes on this phenomenon. The key benefit from this digitalization is lower cost. This results from big data analysis, flexible production concepts as well as system based real time monitoring of the manufacturing centers. This industrial transformation also comes with drawbacks. First-movers are forced to take big investments to convert their game changing idea into profit. Geissenbauer et al. (2017) reflect on companies which have not taken the step to invest in these digitalized technologies yet. Companies who did not invested strategically in the past are going to lose their competitive advantage in the future. Creating the needed networks and implementing the new communication tools is a big challenge for firms. A second challenge is capturing and analyzing the created data from different heterogeneous devices and systems. It becomes more difficult because of the increased lack of software, different communication protocols and diverse software architectures (Wan et al., 2016).
When managing all these challenges, the potential success can be huge (Geissenbauer et al., 2017). The expected return-on-invest of ‘Industry 4.0’ investments within two years is 55 percent. Until 2020, the level of digitalization will be doubled. As stated, the impact in a global context of this transformation is enormous. The Chinese equivalent to ‘Industry 4.0’ is the ‘Made in China 2025’ strategy (Jin, 2015, p. 1). Even before this revolution started, China had already started to investigate the European economy with their expertise in investing (Bruton & Ahlstrom, 2003, p. 236). With this strategy China will, within the next eight years, improve their overall manufacturing quality, create more variability and productivity as well as integrate new information systems (Jin, 2015, p. 1). In contrast to that, Geissenbauer et al. present that China will gain the most from this digitalization process due to the high flexibility of Chinese companies as well as their openness to digital change.
When reflecting the previously mentioned on the current industrial change, it becomes clear to see that China will stay competitive in the future. The rise of the Eastern Asian countries, especially China, has a big impact on the central forces of globalization in the world economy. This rise also significantly affects the competitiveness of the concerned firms in the Western economy and the labor market. In the last 30 years, China could grow their trade volume by 1600 percent which led to a rise of 50 billion euros in 2008 only. While China was able to increase their trade volumes by such a high amount the Western market was only able to gain half of this growth (Dauth, Findeisen, & Suedekum, 2014, p. 1644). This rise and the changes of the economy can be seen in various industries.
In the car industry, the changes of the Chinese market position also become challenging for European companies. In the past, China could not keep up with the Europeans because of their inner policy. Since the key marketing changed, China is able to increase the pressure on the European car manufactures due to their adjustments in their whole marketing and selling strategy (Jiang, Kleer, & Piller, 2017, p. 1). Also because of the Chinese changes in their R&D approach they can integrate modular concepts in their products to increase productivity as well as revenue. Their changes of governmental support and the supply chain in the past years had a huge impact on their car industry (Thoma & O’Sullivan, 2011, p. 216). However, these changes of the economy are visible not only in the car industry. McGuire and Islam (2015, p. 742) point out the significant industrial changes in the air craft industry, stating that China dramatically increased their innovation capacities in that industry sector.
All these alterations in the global economy indicate that China will become a bigger adversary for the European and Western companies. Even if the European economy had started earlier with the fourth industrial transformation, China will continue to exert pressure in the future and it will get more and more difficult for European firms to not lose their competitive advantage in that industrial change (Jin, 2015, p. 1).
Industrial transformation in economies of scope
When doing a make or buy decision, the most important factors to look at are the vendor’s production input and their economies of scope (Xu, Lu, Huang, & Zhang, 2013, p. 345). AM as well as the individualized production for every customer, have been becoming more and more interesting for years. The upcoming technology is also affected by the fourth transformation of the industry. Those new technologies are about to influence not only the production but also the supply chain design, the logistics, the product-life-cycle planning as well as the consumer behavior. The main two characteristics of this technology are, firstly, that it enables the production of physical objects from digital designed data, secondly, it allows private persons and industrial users to design and produce their own goods (Jiang et al., 2017, p. 2).
This specific technology facilitates the implementation of different business models. On an operational and on the strategic level processes and structures can be adjusted in a different way. This possibility of change can be either implemented to add value for the customer or to reduce the effort for the creation of value (Lutter-Günther, Seidel, Kamps, & Reinhart, 2015, p. 548). The past industrial revolution gave rise to new methods of mass production and allowed for the use of machines to replace labor. The competitive advantages moved towards the companies which can produce at the highest quality with the lowest costs. Back then costs were separated into fixed and variable cost. In economy of scale production, a high volume of products reduces the fixed costs of a product. When looking at economies of scope, the customer as well as the professional expertise of the work have central roles. The two economies differ in various specific parameters such as volume, customization, linear production cycles, transportation costs as well as the unique design and the changing set of competition (Petrick & Simpson, 2013, p. 13). In order to keep up with the trend of customization and individualization, new manufacturing technologies such as AM, and a different business model approach are needed. A company’s ability to embed this new disruptive manufacturing technology is a big step towards a new industrial service (Schröder, Falk, & Schmitt, 2015, p. 312).
This change of how things are manufactured have a transformative impact on many different industries. AM technologies create products in a different way. While before, a physical product was created by molding material or subtracting material from a raw piece, AM-methods create products by layer construction. This process starts either with a 3D scan of a real object or a representative digitally generated model. All this information is then transferred to a specified file format and is afterwards crafted by a machine in one piece. This allows a high customization for the companies as well as for the customer. In the early 2000s this manufacturing methods gained a wider acceptance by firms and customers because the manufacturing industry was able to handle this digitalized production. As stated above, these new manufacturing methods impact various industries. They facilitate the mass production of highly customized products while reducing the inventory cost to a minimum. The biggest impact on the traditional production channels is that with these AM-technologies a decentralization of the production is coupled with the possibility to integrate customer-tailored product design. The challenges arising from this revolutionary manufacturing methods for companies are the costs of an industrial 3D printer as well as the different materials used in each industry (Bechtold, 2016, pp. 519-520).
In the future, many different possible applications for AM can be imagined. But when looking to what Jiang et al. (2017) say, the biggest impact in the future is going to be on the production of spare parts, depending on if they are defined as critical or not. They also mention that intellectual property will get a bigger threat in the future. When a firm producing with AM-methods wants to stay competitive they have to find a solution for regulating the file sharing platforms. Mass production parts will be produced globally but customized production will occur locally (Jiang et al., 2017, p. 2).
For companies which cannot afford the initial costs of AM-machines or services the implementation of AM business models will get very difficult. A decision-making strategy on the operational as well as on the strategic level is necessary to add value to the company. Nevertheless when a firm want to implement AM processes, different adjustments regarding the process chain and the organization have to be made (Lutter-Günther et al., 2015, p. 1).
How do laboratories work?
As the industry is changing from their third stage to a new highly technological and connected fourth stage, so is the dental sector evolving from an analogue way of working to a more digital version. Torbica and Krstev (2006, p. 145) outline how the analogue production works: patients either see their dentist periodically or if they have problems with their teeth. When dentists find major complications and they decide that the patient needs treatment with prosthodontics, an impression3 of the patient’s mouth is taken. The impression is then used as the mold to cast a model of the lower and the upper jaw. Placed on an apparatus to simulate the bite and movement of the jaw both parts join as the whole model, the set of teeth. Together with a written specification the set of teeth is sent to the dental laboratory. According to those descriptions the dental technician shapes a wax model by hand and later uses this to cast the missing teeth and, if needed, the metal framework. The semi-manufactured piece’s surface is processed so that a final shell, a porcelain layer, can bond to it. With this outer layer, the final shape is defined and after the coloring the piece is burned in an oven for a few hours to harden the porcelain till the prosthodontic is finished. The better the quality of the product, the closer the shape and look match the original teeth.
In the last 30 years, the way dental laboratories work has been changing continuously. Computer-aided design and computer-aided manufacturing (CAD/CAM) developments as well as new dental material have affected the dental sector (Uzun, 2008, p. 530). Uzun states that even the first step in the collaboration between the dentist and the laboratories changed. The data capture got a new possibility added – digital scanning. Either the impression is taken the traditional way and then the model is scanned in a stationary scanner or the whole part is skipped and intraoral scanning is done. Intraoral scanning is the direct scanning of the patient’s mouth. The scanning can be done with or without contact to the examined object (Chang, Lee, & Wang, 2006, p. 42). The older and more unpopular version involves a touching probe moving around the surface. Today non-contact scanning via laser or other rays is more common. According to Uzun (2008, p. 533), the communication has changed from sending the model and the written specification in hard copy to computerized data sent online.
Continuing the path of the value chain, the next step is the restoration design. Uzun continues that prosthodontics are designed virtually in 3-D dental restoration CAD programs. The share of human work needed to design the product varies between the programs from almost nothing to complete user operation. After finishing the design, the file is sent to a CAM compatible milling machine. The software of the mill generates the tool path to cut out the product. When material is subtracted from a block or disc to get the final product the approach is called subtractive fabrication (Hintersehr, 1994). Here a lot of costly material is wasted. Another method, without wasting raw material, is AM, where the computer-generated path does not cut through the material but instead, laser treatment solidifies loose powder or liquids. Additionally, there are some combinations of the two ways: with a simple version of AM, called 3D Printing, wax is printed almost similar to an ink-jet printer. The built model can be used the same way as traditionally casted models.
Bilgin et al. (2016, p. 288) summarize the same thoughts in their review and add a few newly developed AM technologies. Furthermore, they state the advantages and disadvantages of digital fabrication of prosthodontics: the most important negative effects are the high cost of material and machines needed compared to conventional processes, and the absence of the possibility to try the prosthodontic on the patient before the final production. On the other hand, the positive effects are the decreased number of appointments the patient has to make, the risk of microorganism colonization and infections is reduced, and parts can be reproduced with ease and good quality control by the dental laboratory. Al-Mussawi and Farid (2016, p. 220) go one step further and add augmented reality (AR) to the task of dentists and dental technicians. With AR, implant placement can be diagnosed and treatment can be planned. They also state that at the moment this technology is still too expensive, but development goes on and there is progress all the time.
Barriers against new technology
Van der Zande et al. (2013, pp. 2–3) used semi-structured interviews to examine the barriers why dental practices adopt digital technologies. Their results are split into six parts. The first is ‘digitalization in dentistry’: current and future technologies, showing that modern technology like intraoral scanning is hardly used in dental practices due to a lack of know-how and how they could benefit by those systems. In the second part, ‘Benefits and drawbacks of digital technologies’, they state that the main reason towards or against new technologies is the relative advantage compared to conventional methods. Even if those temporal, financial or clinical advantages preponderate, some still postpone adapting new technologies because they hope the machines will be cheaper in the future. In ‘Quality, standardization and evidence’, representing the third part, it is stated that the clinical advantages (precision and accuracy) are important developments that came with digitalization. The main ‘Barriers to change’ were being afraid that the user does not have the skills to use the technology. This applies more to those people who learned in a non-technological environment. Other barriers are that the mostly small dental practices do not have a budget to invest in the costly technology and that it can be used in a limited number of cases only. Fifth, ‘professional orientation and innovativeness’ comprises that some technical, artisanal people just do not want to try out new technology because they like the way they work. This works the other way around as well, if someone is open for new things they might invest although they cannot see a real benefit. The sixth part, ‘social influence’ shows that hearing from the others’ experiences can influence someone to use or not to use digital technology. Apart from face-to-face communication, government policies and incentives of the industry can affect potential users.
1.1 Dental laboratories affected by the fourth industrial transformation
2 Previous research
2.1 Fourth industrial revolution
2.2 Industrial transformation in economies of scope
2.3 Dental industry
2.4 Swedish dental market
2.5 Dental technician industry analysis
2.6 Research question
2.7 Research model
3 Research methodology
3.1 Research Approach
3.2 Research Design
3.3 Data collection
3.4 Data Analysis
3.5 Ethical Considerations
4.1 Interviews with dental technicians
4.2 Interviews with dental industry experts
4.3 Interviews with dentists
5 Analysis of data
5.1 Competition on a global scale
5.2 Dental industry transformation
5.3 Networking as an opportunity
6.1 Managerial implications
6.2 Future research
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