As CAD/CAM systems evolve and digital impression-taking enters the arena, restorative dentistry is changing dramatically. The role of dental labs and their methods of communication also are advancing and rapidly becoming more and more technology-driven.

Last month in Part 1 of this Dentist/Lab Communications survey report, Glidewell Laboratories Director of Clinical Research and Education Dr. Michael DiTolla shared his insight on how GPs should use digital photography, shade guides, and shade-matching devices to communicate clearly with labs and help deliver the best possible restorations to the patient. Here, in Part 2, Dr. Ed McLaren, a CE program panelist for DPRWorld08, joins Dr. DiTolla in talking about digital impression-taking, continuing education, the future of communication, and the changing roles of dentists and labs.

The rapid inclusion of computer-driven technology both chairside and in the laboratory enables practitioners to more accurately diagnose and treat patients, and it is also revolutionizing how technicians fabricate crowns, bridges, and implants. Add to this the ever-growing number of new restorative materials and techniques, as well as educated, demanding patients, and it’s quite clear that dentists and labs need to communicate clearly as well as work hard to stay informed.

According to the results from separate surveys by DPR and Dental Lab Products, DPR’s sister publication for lab owners and managers, that were sent to GPs and labs, most practitioners are satisfied with what their laboratories are delivering. Almost two-thirds have not changed labs in the last two years. Of the 36% who changed labs, 74% did so because of inconsistent quality, while 53% did so because they believed the lab could not meet their technical needs.

“For me, it’s consistency, predictability,” Dr. DiTolla said. “To me, there’s nothing better, and most of the dentists I talk to agree. You want things to be predictable. You want to know that, if you prepare a tooth and take an impression and send it to the laboratory, you’re going to get back what you want. Now, depending on how much you pay per unit, it may look different. You know if you’re paying a lab fee of $500 per crown, you have much higher expectations than if you’re paying $80 per crown.

“But if you’re in an area where the $80 crown is the one that people are more willing to pay for, at least you know what you’re going to get every time. It’s that consistency that is really important.”

As a whole, your labs seem to deliver some nice cases. When we asked about your level of satisfaction with your outside lab, 35% responded Very Satisfied and 53% Satisfied. The numbers were just as impressive when we asked about your labs’ ability to achieve complete doctor and patient satisfaction—32% Very Satisfied and 57% Satisfied.

Both Drs. McLaren and DiTolla said there’s plenty of quality education available for GPs and technicians. Sometimes, however, it’s not easy to know where to turn.

The Scottsdale Center for Dentistry in Arizona (www.scottsdalecenter.com) opened last year and has many industry leaders feeling good about improved educational opportunities. The high-tech facility is designed to provide the latest in technologies and techniques to educate dentists and team members.

“When you ask if there are enough (CE) programs, I speak for dentists and say whole-heartedly ‘Yes,’ ” said Dr. McLaren, an associate professor at UCLA who runs both a master dental ceramist program and a two-year residency program on esthetic dentistry for dentists. “Although I think there is a lot of bias in some of these programs, they are generally very good for dentists. You’ve got newer initiatives like the Scottsdale Center starting with Gordon Christensen and a lot of other groups that have been very good. So I think the education opportunities are phenomenal for dentists.”

He added, however, that quality educational programs for the majority of lab technicians may be lacking. Expensive, high-end courses that tend to attract the same “one-tenth of one percent of technicians” are part of the problem, while closings and limited funding at a number of accredited lab programs, such as at community colleges, are other obstacles, according to Dr. McLaren.

Dr. DiTolla said the set-up at the Scottsdale facility will help participating dentists learn both the dental and lab sides of creating restorations. Additionally, he recommends GPs visit their labs and vice versa so that both sides can see just what works best and what leads to problems.

“The hard part for dentists is discerning what is the good education—but it is out there,” he said. “A good example of that is what Imtiaz Manji and Gordon Christensen have at the Scottsdale Center. They are doing a great job with CEREC 3 classes and implant classes for the general practitioner and they are really poised to take advantage of being leaders in this area.”

With the Scottsdale Center’s lab instructional area constructed adjacent to the teaching operatories, practitioners can work side-by-side with technicians while training. “They really want to be able to have the dentists work on patients and then walk 10 feet over where the laboratory technician’s working to really try to tie all of that together,” Dr. DiTolla said. “As a dentist, you prep a tooth and you say, ‘Oh, I think this is done. We need to take an impression and send it to the lab.’ Now you’re able to hear the lab guy say, ‘Wow, we don’t have enough room. What are we going to do here? We either have to put on less porcelain or we have to tell you there’s going to be a problem here making it look good.’

“The technicians can watch the preparation and seating procedures. And the dentists get the opportunity to watch a crown being made on one of their preparations. It’s an unbelievable eye-opener to see what the technicians go through when we [dentists] don’t do things exactly like we should.

“They [dentists] would really benefit from going to their own lab and watching their technician work on some of the models that they’ve prepared. That is a big deal, because then, all of a sudden, the technician can tell you, ‘OK on this one…boy, you prepped it really well over here! But on the distal side, it’s still sticking out. We need to figure out what we’re doing here to make this look real.’ ”

But because most practices do not have a lab in-house, it is critical to employ technologies such as digital photography, shade-matching devices, shade guides, and to take advantage of the Internet to send digital photos, case progresses, and general e-mail correspondence.