Dental AI solutions company, Pearl has announced the results of its Patient Trust and Technology survey, which polled 597 US dental patients and evaluated their trust in dental providers and their perceptions of how technology is being used in the field.

According to key findings, the patients surveyed overwhelmingly support the use of advanced technologies and are more likely to trust their dentist’s diagnosis if they are using artificial intelligence (AI) to assist in evaluating x-rays. The survey revealed that patients’ trust in their provider is a key factor in determining whether they will move on with treatment, which can have significant financial implications for providers, according to a press release from Pearl.

Fifty-Five percent of respondents report that trust in their diagnosis is the most important factor affecting their willingness to accept treatment, more than urgency (28%), and treatment cost (11%). The survey also found that providers looking to build patient loyalty and establish trust should focus on 2 main factors—ensuring clear communication and utilizing the latest technology. About 65% of respondents do not have a complete understanding of what their dentist is pointing out in their x-rays, the survey found.

Additionally, 61% of patients said they have taken alternative actions, including seeking a second opinion—which 25% of patients said they’ve done—or switching dentists, which 32% say they’ve done. The survey states that just 41% of respondents generally have complete trust in their dentist’s diagnosis.

The survey also found that 71% of those surveyed said they would be more likely to trust their dentist’s diagnosis if the dentist were using AI software to assist in evaluating x-rays.

The full results of the survey are available for download at 

Articles

According to key findings, the patients surveyed overwhelmingly support the use of advanced technologies.

Pearl Survey Offers Insights into Patient Trust, Perception of Technology

Stan Goff is the Managing Editor of Dental Products Report, Dental Lab Products and Modern Hygienist. He has covered the dental industry since 1999 and can be reached at sgoff@mjhlifesciences.com.  

The DWX-53DC is designed with lab space in mind, making it suitable for smaller areas. The dental milling machine is equipped with a fully integrated webcam for 24-hour remote monitoring and milling capabilities.

This new mill features an automatic 6-disc changer that touts a 50% faster exchange and a 15-station automatic tool changer. The DWX-53DC features a new 4-mm tool, allowing for 30% faster roughing of PMMA than 3-mm tools.

The mill contains a camera that works with VPanel and DGSHAPE Cloud software, combining these features into a sleek, sturdy, streamlined product. It uses a ball-screw system with 5-axis positioning, created to optimize machine performance. It also features automatic machine calibration, automatic air pressure control, and a replaceable spindle.

This new dry dental mill from Roland DGA will offer power and precision while being suitable for any size dental lab.

5Ws* DWX-53DC

Ivoclar has announced it is expanding its partnership with exocad, which will see Ivoclar’s Ivotion Denture add-on module integrated in the exocad DentalCAD software. This is designed to provide users with an efficient manufacturing workflow for the digital fabrication of removable dentures.

With this collaboration, customers of both companies will be able to utilize a seamless and state-of-the-art workflow for rapid digital fabrication of removable dentures. The Ivotion Denture add-on module will be integrated with the exocad DentalCAD system so that users of the software can design their digital dentures in the environment to which they are accustomed. The optimized workflow enables custom fabrication and a result that is adapted to the needs of the patient.

The integration also provides users with access to the popular Ivoclar tooth libraries with full-arch setups, morphing tools, and setup features. For even better offer customization, the third gingival shade that was introduced for the first time last year can also be used. The Ivotion Denture add-on module from Ivoclar also contains all the features of the oversize workflow in combination with the proven Ivotion Base, Ivotion Dent, and Ivotion Dent Multi discs. To round off the range of applications, the features of the monolithic workflow with Ivotion and Shell Geometry are also on board.

Thanks to its open structure, exocad DentalCAD can be easily used with existing systems in the Ivoclar range of PrograScan laboratory scanners and PrograMill milling machines and can be seamlessly integrated in the digital Ivotion workflow. The PrograScan PS5 and PS3 laboratory scanners have made a lasting impact on the market with their powerful and reliable scanning.

The Ivotion Denture add-on module will be available in October 2022 for all interested users.

Ivoclar’s Ivotion Denture add-on module will be integrated in the exocad DentalCAD software.

Ivoclar, exocad Extend Digital Denture Options with DentalCAD Integration

Renee Knight is a freelance writer and editor who's been covering the dental industry for 15 years. 

New Zirconia, Oven Combination Set a Sinter Speed Record


Three years ago, Zubler USA began working with a lab and milling center to develop a full-arch workflow for zirconia. Zubler USA provided the milling machines, sintering ovens, and zirconia, leading to fantastic results. But one area needed improvement: the zirconia sintering time.

Full-arch zirconia typically takes more than 12 hours to sinter; in this case, it was a 16-hour cycle. Zubler USA owner and President Bryan Parker decided that needed to change, so the team went to work on creating a zirconia with a faster sintering time. The result? After several years of research and testing, the company released 3:45 zirconia. Unlike any other zirconia on the market, according to Zubler USA, it can be sintered in 3 hours and 45 minutes, a significant improvement.

speed sintering of full arches, including implant-supported arch constructions, making it possible to sinter zirconia in 3 hours and 45 minutes while achieving optimal esthetics. It does not require a base or support structure during sintering and features beautiful shade, translucency, reliability, and strength. It can be used for all indications and can be sintered in a full-length 16-hour cycle. Preshaded (mono) available shades include: A0, B1, A1, and BL1. 3:45 zirconia features a strength of 1100 MPa and 48% translucency.

“Before, when you loaded the oven, you couldn’t touch the work for 16 hours, creating a bottleneck,” Parker says, noting that, with this material, new cases can go in the ovens every 4.5 hours. “We reduced the time but are still able to get the same results as with a 16-hour cycle, and for a lab that’s huge.”

Now, labs can turn their ovens over more than once a day. For example, if a lab starts the process at 8 AM, they can begin to sinter at 12:30 PM and again at 5 PM—meaning 1 oven can now do more work in 1 day, Parker says. Labs can take on rush cases they would have had to turn down before, bringing in more revenue.

Many technicians thought achieving such a comparatively short sintering time was impossible, but in the few months since the material was released, more than 700 arches have been placed, according to Zubler USA. Parker expects that number to climb rapidly.

Zubler USA’s 3:45 zirconia cuts down on the time it takes to sinter without sacrificing any of the qualities necessary for any suitable arch construction. The team at Zubler USA worked hard to bring this quick and quality product to the market, testing and perfecting over the course of many years. 

So far, technicians have been surprised by and happy with the results, Zubler USA Vice PresidentChris Wilson says. Although many customers would call the company asking for help in speeding up their sintering cycles, none expected to get it to under 4 hours. It became clear that lab technicians were looking to increase their throughput, which was another reason for Zubler USA to work on quicker sintering times.

 The process was difficult for the development team, because the formulation required control down to the basic raw materials to produce good results. After time and hard work, the development team at Zubler USA crafted 3:45 zirconia, and haven’t looked back since. It is available in 4 shades and touts a strength of 1100 MPa and 48% translucency.

“The answer was always the same: the zirconia manufacturer dictates the cycle for the zirconia, not the oven. The oven provides the capability,” Wilson says. “We have ovens that go so much faster than the parameters zirconia manufacturers provide, so we wanted to take advantage of those capabilities.”

During the development process, Parker ran much of the testing, with the goal of creating a material that could withstand the temperature increases and necessary heat rates for faster sintering while maintaining optimal esthetics.

The team continually repeated experiments, because it was important for Parker to achieve an always consistent result; 96 or 97 out of 100 wasn’t enough. The outcome is the same every time, with the high-quality raw materials and manufacturing processes being a big part of the reason the sintering time was reduced significantly. “We wanted it to be fast,” Wilson says, “but we didn’t realize how fast it would be.”

For these types of restorations, large chunks of zirconia are typically used to support the mechanical structure against the forces of heating and cooling, because they can cause warping and cracking during sintering. Zubler USA’s zirconia sintered with the 16-hour cycle never required that support, and it was important for that to remain the case with the new, faster-sintering material, Parker says.

Even with the rapid heating and cooling 3:45 zirconia requires, the stable material does not need extra support, Wilson says, saving zirconia that can be used for single posterior units or 3-unit bridges.

“The worst part about milling with support is after you sinter the zirconia, you have to cut the support out,” Parker says. “By doing so, you risk cracking, so it was very important for us to continue to mill without a support and to have the stability and the fit after it was sintered, so it can go from the sintering oven directly to layered porcelain or stain and glaze.”

In the past, you could speed up sintering times for single units (never a full arch like what is possible with 3:45), but the result was not the beautiful restoration doctors and patients seek. That is not an issue with 3:45 zirconia.

“We ran a lot of experiments in our different sintering ovens, and I’d always cringe as I watched it come down because I thought for sure esthetics were going to be an issue, but they never were,” Wilson says. “It’s amazing to see what it looks like after it’s been sintered. It’s just a great material to work with.”

Achieving the right chroma and translucency was paramount, and probably the biggest challenge, Wilson says. “It had to present well, be reliable and consistent, and perform well,” Wilson says. “The performance we got pretty quickly and the repeatability we got very quickly; it was more getting the color right, which we did.”

Investing in the right oven is just as important as the material, because most were not built to handle sintering so quickly. Many do not have the space to complete many cases at once. Zubler and Mihm-Vogt ovens handle the sintering, with some holding 6 to 8 full-arch cases and others as many as 10 to 12.

“The only thing we are challenged by is the limitation of some of the ovens,” Wilson says. “Some can’t sinter that fast. The tables won’t come down that quickly, or [even though] the ovens can reach the temperature ranges and heat rate necessary, they won’t allow you to cool down fast enough.”

The zirconia was repeatedly tested in Zubler and Mihm-Vogt ovens, so there was no doubt they could handle the material. “It’s the zirconia and it’s the oven,” Parker says. “And it’s very critical to put porcelain or some type of porcelain material on the zirconia after it’s sintered.”

The Zubler USA porcelain oven plays an important role, Parker says, because it provides the even heat distribution and cooldown that allow for a better success rate. “The last thing you want to do is spend the time, money, and effort on an arch like this and get to the end of the process and it cracks, because at that point you have no choice but to start over,” he says. “The equipment helps you achieve the success you want, and Zubler has been shown to have next to zero remakes with its ovens.”

Zubler USA is known for offering top-quality ovens that last, but a little help keeping them in good shape never hurts. The faster sintering time for the 3:45 zirconia is better for the ovens, Wilson says, because they spend less time at oxidizing temperatures.

As ovens improve, faster sintering times are the next logical step, Wilson says. “Everything is going in that direction,” he says. “We wanted to be ahead of the curve.”

The company is already working on its next release, which should be out shortly, Wilson says. The single-unit, multiple-layer material, with a sintering time of 20 to 30 minutes, is more complex than the 3:45 and is another significant advancement for zirconia restorations. For the past 2 years, the team has been tweaking the color, chroma, and translucency to get it just right.

Zubler continues to innovate, and today offers a zirconia material that sinters in a time frame no one thought possible. The team strives to offer “unbeatable” products, according to their mission statement.

“We built the company based on awesome products and awesome customer support,” Parker says. “We don’t want to offer a product unless we know it’s been tried, tested, further tested, and perfected, because our reputation is more important than a fly-by-night product. That’s why we offer the products we do and support our customers in every possible way.”

For the first time, full-arch zirconia can be sintered in less than 4 hours, a significant improvement over the typical 16-hour cycles.

New Zirconia, Oven Combination Set a Sinter Speed Record 

October DLP OTC + New Products

A look at some of the new dental lab product offerings this month. 

New Dental Lab Products October 2022

The most basic certification for US-based lab technicians, a CDT requires a candidate to complete 3 examinations in any order within 4 years: a written comprehensive exam, a written specialty exam, and a hands-on practical exam in the same specialty.

 The comprehensive exam has 160 multiple-choice questions and the specialty written exam has 80.

 The goal of these exams is to measure mastery of knowledge and applied skills that lead to the successful practice of dental technology.

Available at several universities across Europe, including Goethe University in Frankfurt, Germany, this program is designed for dental professionals seeking advanced qualifications in dental technology. Students develop their understanding of assessment procedures, planning, and evaluation of treatments requiring dental restorations.

 Additionally, dental technicians are trained to perform noninvasive treatment steps on patients.

 This course takes about 36 months to complete; graduates are awarded the degree of Master of Science (MSc) in dental technology.

This certification is available through the American Society of Master Dental Technologists (ASMDT), which was founded in 1973 to provide higher levels of education for dental technicians.

 This program consists of 19 lectures covering anatomy, physiology, and hands-on practical maxillary-mandibular reconstruction cases.

 The course is designed mainly for hands-on learning, but video lectures are also available on the ASMDT website. The curriculum aims to motivate and educate while keeping students apprised of new procedures and technologies.

An RDT is the basic credential for dental technicians in Canada. Although specific requirements vary by province, the Canadian Alliance of Dental Technology Regulators (CADTR) oversees 7 provincial regulatory bodies and provides evaluation and assessment services designed to support and assist aspiring dental technology professionals in becoming licensed.5 There are 3 main steps to receiving credentials through the CADTR:

There are 2 requirements—credential verification and comparing your credentials to the minimum dental technology education standard in Canada, which includes experiential hours.

The Dental Technology Entry-to-Practice Assessment measures the Canadian competencies required for entry to practice.

Apply to the dental technology regulator of the province in which you want to practice.

American Academy of Cosmetic Dentistry (AACD) Accreditation

The AACD offers accreditation services for excellence in cosmetic dentistry.

 The process begins with a written exam; dentists and laboratory technicians are eligible to apply. The AACD requires the completion of accreditation and criteria workshops, a clinical case examination, and an oral exam.

 Upon completion of the written exam, applicants can only submit their cases after attending at least half of the annual AACD Scientific Session and 2 of the required workshops.

Certified dental technicians. National Board for Certification in Dental Laboratory Technology. Accessed September 22, 2022. 

https://nbccert.org/certificants/certified-dental-technician/

Enhance your CDT. National Board for Certification in Dental Laboratory Technology. Accessed September 22, 2022. 

https://nbccert.org/certificants/certified-dental-technician/enhance-your-cdt.cfm

M.Sc. in dental technology. Goethe University. Accessed September 22. 2022. 

ASMDT home study course. American Society of Master Dental Technologists. Accessed September 22, 2022. 

Becoming registered. Canadian Alliance of Dental Technology Regulators. Accessed September 23, 2022. 

https://cadtr-acortd.com/becoming-registered/

AACD accreditation frequently asked questions. American Academy of Cosmetic Dentistry. Accessed September 23, 2022. 

Although board certification is not required to become a dental technician, being certified can be a good career move. That is not to say that accreditation gives you more technical knowledge or talent than your peers who are not certified. However, becoming certified can be a step toward advancing your career and fine-tuning your skills. Here is a look at the different certification options open to dental technicians.

The List: Top 6 Lab Technician Certifications and How to Earn Them

Many lab owners wonder where their future employees will come from, and not all of them have satisfactory answers. With the number of accredited dental technician education programs shrinking, finding answers is a priority.

However, the future is not as bleak as one might think. Rune Fisker, senior vice president of product strategy for 3Shape, says he thinks the future of labs is promising—and 100% digital. Therefore, the future dental lab team member must be a digital technician.

“You can already see today in the lab that it is not just ceramics anymore. The most highly paid employees are the CAD/CAM technicians,” Fisker says. “But to some extent, there is a shortage of good CAD/CAM technicians, and many [individuals] will retire within the next decade. So that makes the question even more important for where the future technicians would come from.”

So, where will these future lab techs with all this digital expertise come from? We asked industry experts, who also discussed the challenges facing dental technician education and what labs can do in response.

Hurdles Ahead for Dental Technician Education

Dental technician education programs have challenges, starting with shrinking numbers. Bennett Napier, MS, CAE, chief staff executive at the National Association of Dental Laboratories (NADL), says the number of accredited dental laboratory technician programs is shrinking. As of 2022, 13 programs remain throughout the US. However, 2 will end during the next year, bringing that number down to 11.

“In both cases,” Napier explains about the 2 programs dropping out of the Commission on Dental Accreditation (CODA), “they are potentially going to a certificate program or a 1-year program. However, the way the CODA accreditation standards are structured, you must have at least a 2-year program or above to be accredited. So, the NADL is submitting some recommendations to modify that.”

The NADL is responding in other ways. For example, the organization is collaborating with several providers on a 1-year program teaching digital workflow in a formal education arena. NADL leadership sees this as a way of keeping some schools open because it would allow them to graduate more students faster with more applied skills in a market-need area. “We can have at least one pathway where the students are getting more hands-on and where they could earn more money coming out of the school,” Napier says.

One problem with education programs is funding, says Richard Jentsch, CDT, head of research and development at Opulent Digital Specialists. Lab technician programs need to invest in the technology that dental labs use today, but few can afford it. Many manufacturers offer education pricing to programs, something Jentsch supports and would like to see more companies do. “Some other companies are doing that because they know that funding is an issue for the schools, and if the equipment is not there, the program is outdated in many cases,” Jentsch says.

“We are actually very lucky in that many of our technicians are offered on-the-job training and many manufacturers and dealers offer free education resources,” says Marybeth Starr, head of brand promise for Harvest Dental Products, LLC, in Brea, California. Starr also appreciates The Foundation for Dental Laboratory Technology, established by the NADL in 2008. The foundation provides scholarships, grants, and opportunities for lab technicians who want to develop skills; it also offers grants to educational schools. Lab owners, techs, manufacturers, and educators from across the nation come together through the organization to maintain a skilled workforce in restorative dentistry. “The Learning Library is a huge resource,” Starr says.

Napier says the foundation collaborates with manufacturer supplier partners to help transfer knowledge from experienced technicians to the recruits. Also, the NADL has created original content around critical skills regarding business management.

“If somebody comes in from outside the profession, we are trying as much as we can to give them the ‘101’ tools and provide broad-based feedback regarding job task analysis. We say, ‘To be proficient at this, these are the things you need to know,’ ” Napier explains. “Then, this helps the labs train [individuals] quicker on the important and relevant things because it could be overwhelming.”

Tom Zaleske, owner and dental technician at Matrix Dental Laboratory and Consulting, has more than 36 years of experience in removable prosthodontics and is a consultant for the dental industry. He recognizes that today’s newer dental workers do not understand the basics of building prosthodontics.

“All you have to do is go online and look at how many dental workers are asking rudimentary questions that, if they were dental technicians and had a foundational base of education, they could answer themselves,” Zaleske says. “Those who have that formal education are the ones answering the questions.”

Tomorrow’s lab technicians will come from outside the industry and train directly and informally in a lab, which Zaleske says will require a redefinition of dental worker vs dental technician. Manufacturers will train future technicians also. However, Zaleske thinks these new workers will not get the well-rounded training that accredited dental laboratory education programs provide regarding anatomy and design or materials science.

For example, formal dental lab technician education teaches basic polymer chemistry. If lab technicians without formal training do not understand these fundamentals about different polymers and their chemistries, Zaleske says, then these new techs cannot do more than follow directions. If something goes wrong, they will not know why or how to fix it or how to maximize its potential.

“I have been to many lectures, and they never talk about the clinical aspects of it as much as they talk about how you can use it in this application,” Zaleske says about manufacturers’ training programs. “They do not talk about any of the nuances, things that make a long-term success, or what you do not want to do with it. They would have to teach an anatomy course first to explain to [individuals] why it would not work.”

In Denmark, the technicians will not be coming from the school. It is closed, Fisker says. However, that does not concern him as much as schools teaching analog skills, which Fisker sees as outdated. Digital production decreases the need to adjust things by hand.

“The whole hand part of the process is going to be reduced. Primarily everything will be milled or printed,” Fisker says, adding that designing complex cases in detail will become more important.

However, artificial intelligence (AI) may handle the design for more straightforward cases. For example, 3Shape Automate is an AI-powered design program for upper nightguard and multiunit monolithic molar and premolar crown designs. The practice uploads the order; then, once it is ready, the practice approves the design or modifies it. The practice then can produce it in-house or at the lab.

“Labs have accepted more than 500,000 cases with an acceptance rate of 92%,” Fisker says. “So, AI is coming in, but this is only for simpler cases. There will still be manual design on most of the lab cases.”

Like many in the lab space, Fisker wonders whether there will be enough individuals coming out of school who want to become dental technicians. Therefore, he sees the onus for recruitment and training fall to the lab. “We need to have in-house trainee education instead because the availability of educational institutions is growing short,” Fisker says.

Fisker sees 2 problems. First, on a global scale, there are not enough students enrolled at these schools. Second, the schools are not always teaching the appropriate skills. Fisker sees future dental education teaching the digital workflow. “More digital workflows will also be much better at attracting young generations into the field,” Fisker says.

Like the NADL, the National Board for Certification in Dental Laboratory Technology (NBC) is responding to change in the industry and the ubiquity of digital workflows. The NBC announced the development of certification for a digital workflow technician this past summer. Capturing the CAD/CAM design steps in the test formats and adding a digital component to the testing is vital. The new program establishes standards for digital dental lab technicians regarding their knowledge and skill in using the systems.

As a member of the NBC board of trustees, Jamie Stover, CDT, senior manager of dental lab applications for Carbon, says the digital workflow technician designation represents 

level of knowledge and skill to produce restorations that will fit. “It is important to establish that these technicians understand the correct dental terminology, as well as occlusion, function, and morphology, and can correctly interpret a prescription from a dentist,” Stover says.

Starr says the pandemic forced many individuals to turn to online education. Even as the industry is seeing a return to in-person classes, Starr says online will continue because it also solved an accessibility issue. Many technicians who could not attend in person now can attend any number of classes, often at no charge. “Online learning has the added benefit of lowering costs for the hosts, enabling a wider offering and a wide variety of classes, without the typical travel and venue expenses,” Starr explains.

Starr says hiring for niche markets like dental labs can be difficult. It’s a skilled technical position, but also a creative one. Starr says that presents a unique challenge for lab owners.

“Certain skills are intuitive and not something that can be taught, so it can be hard to ask for an exact skill set,” Starr says. “When recruiting options are limited, we have to identify key sources to target, such as creatives, art students, nail technicians, graphic designers, [as well as] get involved with local community colleges and high school vocational programs and your local [Veterans Administration].”

Starr says employee retention is the next hurdle. She recommends offering innovative employee perks such as flexibility in hours, competitive wages, cross-training, and remote work. “Also, you need on-point culture values,” Starr says.

With fewer education programs, it is natural to assume that there will be fewer lab technicians to employ. Stover thinks having fewer graduates from formal lab education programs means tomorrow’s technicians will come from outside the dental industry. Moreover, technological advances mean basic computer skills are enough, along with a good work ethic, reliability, and a desire to learn a trade.

“Our industry is unique in that you don’t need a college degree to gain employment; you can start with no dental experience in an entry-level position and work your way up through the other positions as you learn the trade through apprenticeship, and after 5 years on the job become a certified dental technician. This is more possible currently than in previous times due to the advancements in CAD/CAM technology and associated materials, and the roles created by this evolving technology,” Stover says. “You can earn a good living while doing rewarding work that is improving [individuals’] lives, restoring their smile, or improving their ability to eat.”

Dental technicians using exocad’s dentalshare are able to export their design as an encrypted link so the lab technician does not have to be in the same city or even in the same time zone. It uses compression technology, combined with a robust transfer protocol, so that even big datasets travel through unreliable mobile network connections and restrictive firewalls with ease.

Moreover, the NADL feels that the technology is an excellent student recruitment tool. Most technicians work with exciting technology daily, sometimes entirely, resulting in higher wages.

In 2021, dental technician employment levels increased by 9% compared with 2020, and employee counts are approaching pre-pandemic levels at 44,063 in 2021 vs 45,663 in 2019.

 Although the number of dental laboratories with a payroll decreased by 2% overall in 2021, employee wages are increasing over the previous year by over 8%, averaging around $56,524 in 2021.

The 2022 salary numbers are growing, too. Napier says the NADL’s market research survey for June 2022 revealed that the least experienced technicians make around $35,000 on average, and more experienced techs make $65,000.

 Moreover, the percentage of technicians making $100,000 or more has significantly increased, Napier says, and not just for management roles. This trend could be for technicians focused on quality results and high production.

“We have certainly turned a new leaf with technology,” says Tad Friess, NADL president and owner of Rockert Dental Studio in Wheaton, Illinois. “Modernizing how we do things has opened doors to useful technicians or employees [whom] we turn into technicians.”

“In terms of recruiting, especially for [individuals] from outside the field, this could be a very attractive market for them,” Napier says, adding that NADL is launching a new video and occupational awareness campaign to attract newcomers to the profession.

Stover, who has been a technician for 24 years, says awareness of the industry is key and agrees that if more individuals knew that being a dental lab technician meant working with technology like 3D printing and new materials, it might generate interest. Moreover, it could capitalize on a growing trend of students graduating and taking some time to figure out what they want to do.

“Technology and materials have evolved so quickly that we now have thousands of [individuals] working in this industry who are not doing any traditional analog steps at the bench,” Stover says. “Instead, they work in CAD/CAM roles, on computers, and running mills and printers. For example, some techs have learned to stain and glaze zirconia crowns without knowing many other fabrication steps. This is definitely where labs should focus their attention, developing systematic tools and training plans to educate the digital technicians.”

Jentsch agrees that the future of the dental lab is digital, and digital lab techs will come from all over 

the world. In addition, digital files are getting easier to send worldwide through portals or tools like exocad’s™ dentalshare, which allows techs to export their design as an encrypted link, so the lab tech does not need to be in the same city or even the same time zone.

“It is not a big deal anymore to send cases back and forth,” Jentsch says. “For example, I was on the phone with one of my accounts earlier, and we sent files back and forth. She is in Portland, Maine, and it does not matter if she would be in France or Italy, for that matter.”

“The question is,” Jentsch continues, “how will it be built out? How are you going to deal with the time difference, which may or may not work in your favor? How will you handle communication and troubleshooting if something is wrong? But other than that, it does not matter anymore where [individuals] are if it is digital.”

Moreover, the lab community is primarily optimistic about the future of recruitment for lab technicians. Napier says the NADL’s latest research shows that almost 60% of the respondents felt hopeful about where the market and lab technology were going.

“We have always had challenges. It is just a matter of what they are,” Napier says. “But we are pretty resilient as a profession. We find solutions.”

Labs can respond in many ways to these challenges facing the future of dental lab tech talent. Hoping for the best seems to be a strategy for some labs regarding talent retention, says Nelson Rego, CDT, AACD, owner and dental technician at Smile Designs by Rego. “For the last 5 or 6 years, they bring somebody in, train them and try to get them up to speed, and hope that once they are up to speed, they do not quit,” Rego says.

Smile Designs by Rego is in Santa Fe Springs, California, close to one of the nation’s few remaining accredited dental lab schools at Pasadena City College. The 2-year program has classes for orthodontics, pedodontics, partial dentures, and dental laboratory management. In addition, the program promises that after completion of the certificate in dental lab technology or the associate degree, graduates are prepared to take the certified dental technician (CDT) exam from the NBC.

Rego has 3 Pasadena City College program graduates employed at his lab. In addition, he has an internship program at his lab where he continues to train graduates with talent. “I want to make it a good experience for them and beneficial for me if the kids have talent,” Rego says.

Rego has tried different things to attract talent to his lab. For example, Smile Designs by Rego is next door to an Ivoclar Academy learning center. He has large, clear windows that show off the lab; Rego hopes seeing inside might entice a trainee to work for him.

Many of the dental lab technicians in the Los Angeles, California, area are Korean, so he also advertises in a local Korean newspaper. Rego offers 

an apprenticeship at $1000 a month to train. He recently had 4 applications for the program.

Rego agrees that digitalization helps open possibilities for dental lab technicians. For example, one of his best designers worked in information technology. However, when he came aboard, he knew a lot about computers and next to nothing about teeth.

“So, we set him down, and we showed him what we are looking for so he could learn,” Rego says. “We show them what the output will be, not just what they learn in a weekend seminar for free.”

Continuing education should be a priority for all labs, Starr agrees—including monthly training, whether it is technical or a culture class. Starr says LinkedIn Learning offers free classes in some areas. By staying engaged, the labs solidify interactive relationships with your employees.

Starr also thinks labs should consider being creative about where to look for workers. Also, she advises labs to remember that recruiting is a 2-way street. “Employers are looking for qualifications and personality, and those being recruited are looking for a company that will fit them culturally and financially,” Starr says. “Both should know what they want. But don’t narrow your focus, and be flexible, because the best candidate or company might be the most unexpected one.”

Stover thinks labs can also move some of the hands-on, labor-intensive steps at the bench to digital design and fabrication. By keeping it simple and having the new technicians focus on specific tasks, they can get creative with recruiting efforts. Moreover, he thinks labs should commit resources to develop in-house training programs for educating employees from outside the industry and recent technical program graduates, to prepare them for a production setting.

“They can also commit to moving to digital fabrication for every type of restoration possible. CAD/CAM technology and new materials allow labs to fabricate restorations digitally, meaning many of the steps don’t require years of hands-on experience to perfect, so labs that can’t find experienced techs to employ can train [individuals] from other industries, and even outsource some of the steps, such as digital design,” Stover says. “Fixed restorations transitioned to digital processes around a decade ago, and impactful materials and technology are now allowing dentures to move that way, too.”

Stover says that as part of the transition from analog work at the bench to digital design and manufacturing on mills and printers, the lab can hire individuals with no dental experience to perform some of the new production steps, with training and oversight from experienced techs. As a result, the experienced technicians become trainers and educators of the less experienced, passing on their knowledge to the next generation of digital techs.

“But some labs are not doing this,” Stover says. “Instead, they are leaving their most experienced techs in these analog production roles at the bench because they think it’s necessary to get the production done and the work out the door. When this happens, labs get stuck, and their digital implementation stalls. Transitioning to digital products such as 3D-printed dentures requires a strategic approach to moving step by step, from the training of technicians to the production processes to dentist communication and education.”

There are a few ways to ensure production does not falter during the transition. Stover thinks a plan that moves work digitally gradually by focusing on a smaller client segment can help the transition. Creative recruiting for new production roles and part-time apprenticeship programs for high school and community college students or even recent graduates can help, too. The strategy labs generally find effective is to transition the experienced techs from the bench to digital design, training, and digital workflow management roles and train the less experienced techs, or employees with no dental experience, to perform the new production steps such as running the mills and printers, post-processing, assembly, and polishing, among others. Unfortunately, this is where some labs stumble, Stover says.

3Shape Automate is an AI-powered design program for upper nightguard and multiunit monolithic molar and premolar crown designs.

“If labs get stuck in the mindset [that] they can only hire [individuals] with some level of dental lab experience, they miss the opportunity to scale their existing knowledge and skill by developing an in-house training program,” he says. “There is no shortage of dental work or dentists looking for competent labs. This means there is a lot of opportunity for labs, and the digital technology and materials available are the new tools [that] make it possible to succeed in the face of the staffing challenges facing our industry.”

Stover thinks many restorations that are possible with the new tech provides benefits over some traditional materials in impactful ways. For example, he says Lucitone Digital Print 3D-printed dentures (Dentsply Sirona) have twice the fracture strength of traditional denture acrylic when in the patient’s mouth at body temperature. Other benefits include fast reproducibility of a lost or damaged denture via the digital record, which eliminates the need to start over with a new impression and the 4 or 5 appointments involved in traditional denture refabrication; the ability to copy a patient’s existing denture and cut the required appointments down to as few as 2; and the ability for labs to involve less-skilled technicians in some production steps, mitigating the staffing issues discussed.

“These digitally produced restorations bring impactful benefits for patients, clinicians, and labs. Labs do need to develop a very strategic approach to training and implementation, but the reward for this effort is a streamlined and more profitable production process and a solution to the lack of experienced technicians our industry is facing,” Stover says.

Jentsch thinks labs should recruit and educate their future technicians. He has seen that in labs he works with, many recruits are not from the dental field. Instead, the labs recruit individuals with computer skills and train them for dental restorations. In this way, Jentsch says, the labs are redefining what a lab tech is. Although he acknowledges it would be better for all dental lab technicians to have a dental background and understand tooth biomechanics, having another technician managing such details for those producing digital files can be almost as good a setup.

“The struggle has been there for I do not know how many years, and it is getting progressively worse,” Jentsch says regarding the scarcity of new dental lab technicians. “How I see [labs] dealing with it is training their own [employees] personally, splitting the workflow into bite-sized portions.”

For example, one lab technician can run the camera and scanner and then pass it to the individual who handles the design. Once the job needs hands-on skills, like stacking porcelain or staining and glazing, that could be a different level job and skill set. However, Jentsch says breaking the job into chunks can make it easier to accomplish the tasks a comprehensive lab technician has previously done.

Doing the same thing can lead to employees feeling undervalued or bored. In addition to recruiting or changing how the job breaks down 

within a lab, Jentsch thinks offering a path for career development within the lab could encourage employees to join or stay in the profession. A goal to strive for regarding improvement in their skills is a motivating factor for many individuals.

“If that is an offer on the table for lab technicians, that is a big one,” Jentsch says. “Maybe take advantage of the knowledge from the [individuals] who will soon retire before they go.”

Friess has been finding talent through word-of-mouth marketing of other technicians. Showing these new technicians how the work is computerized, using 3D printers and digital milling machines, and how the technology offers remote work opportunities has been helping.

“We have a single dad right now who has a son. One day he designs from home,” Friess says. “The gap for labs is finding [individuals] and training them. The video will help because many youths do not know this is even an option for them. Awareness will be one of the biggest factors in getting kids interested.”

Labs have also used high school outreach programs to recruit new technicians. Napier says many labs use health occupation student association chapters to facilitate this effort. In some states, labs work with the state dental association, lobbying the legislature on dentistry. Also, there are pilot projects with some states having legislative funding to hire a career recruiter for all professions of dentistry.

“Wherever we can, we partner with those types of opportunities,” Napier says, adding that many of these state programs are driven by access to care. “We come in as a parallel piece to that because if you have a dental need, the laboratory helps dentists fulfill that need. So, it is a crucial part of the puzzle.”

Another way to overcome the deficit in accredited lab technician education would be for labs to establish accredited programs in-house, Zaleske says. Then, the core education would be part of the curriculum and produce dental technicians who could establish a collegial relationship with their dentists, he says. Without that education, the employee is a dental worker rather than a technician. “The problem is a lot of dental workers do not have that core knowledge base and cannot make that recommendation, or that recommendation they do make has not been substantiated,” Zaleske says.

He would like to see more pride in the profession, including the old-school ways of producing prosthodontics. A denture, particularly when it is well made, is more than an appliance that can help one to eat and feel better about a smile. Moreover, Zaleske says there is a significant difference between a denture and a removable prosthetic. A denture treats a hole in the patient’s face; a removable prosthetic treats the whole patient.

“There is a deeper attachment to what you wear in your mouth. If you do not believe me, all you have to do is look around. [Individuals] do not smile as much when things do not look right in their mouths. [They] feel less good about themselves when they do not feel complete,” Zaleske says. “The only way to make them feel complete is to address all the things that a dental technician can address rather than a dental worker.”

Occupational employment and wages, May 2021: dental laboratory technicians. U.S. Bureau of Labor Statistics. Updated March 31, 2022. Accessed September 15, 2022. 

https://www.bls.gov/oes/current/oes519081.htm#nat

NADL 2022 Business Survey: Operations, Compensation, and Benefits. National Association of Dental Laboratories. April 2022. Accessed September 15, 2022. 

https://nadlonlinestore.payscapecommerce.com/2022-Costs-of-Doing-Business-Survey-Module-1-p475455327

This question is one to which many individuals do not know the answer—including today’s lab owners. We talk to industry experts about the challenges facing dental technician education and what labs can do about them.  

Where Will Tomorrow's Lab Techs Come From? The Challenging Future of Dental Technician Education

Align Technology, Inc. has introduced the latest release of the iTero-exocad Connector™, which integrates iTero intraoral camera and NIRI images within exocad DentalCAD 3.1 Rijeka software. The new integration is designed to support a seamless, end-to-end workflow for doctors and lab technicians.

iTero-exocad Connector is designed to optimize the design and fabrication of highly esthetic restorations by providing dental professionals with the ability to visualize the internal and external structure of teeth. Lab technicians can download files via the Connector and then design within exocad DentalCAD Rijeka software.

“With the iTero scanner’s origins in restorative dentistry, this latest innovation and integration with exocad CAD/CAM software demonstrates our commitment to providing advanced restorative solutions via integrated digital workflows and virtual tools designed to improve treatment efficiency, clinical and patient outcomes, and experiences,” Yuval Shaked, Align Technology executive vice president and managing director, iTero scanner and services business said according to a press release from the company.

The latest release of the iTero-exocad Connector will be made available for all doctors and labs using iTero 5D imaging systems and exocad 3.1 Rijeka CAD/CAM software beginning this month.

The new integration is designed to enable visualization for clinicians and labs.

Align Technology Introduces Latest iTero-exocad Connector Software

Getting Dental Treatment Plan Acceptance Starts With These 7 Tips. Photo courtesy of Odua Images/stock.adobe.com. 


Many things can get in the way of treatment plan acceptance, including the perception that you are "upselling" patients. International speaker Mark Hyman, DDS, MAGD, shares his best suggestions for helping patients progress with treatment plans.

Dr Hyman says that if you don't know your patient and you don't know what they value, that is where misunderstandings occur. It would help if you discovered the patient's goals for their health, teeth, and smile. Otherwise, he says your solution could be seen by patients as upselling even though you consider it part of upholding your responsibility as a healthcare provider.

For example, people use the term upselling when patients think the treatment is unnecessary. Dr Hyman points out that if you do not have a relationship with your patient, it is challenging to offer an appropriate treatment plan for where the patient is in their life.

"When 'upselling' happens, it comes from misunderstanding and poor communication," Dr Hyman says.

He thinks asking patients what they want for their oral health and taking the time to listen to where they are in life regarding it has become something that many dentists are unfortunately in too big of a rush in their daily work to do.

"As a profession, we have hurt ourselves with the false idea that busy or faster is better," Dr Hyman says. "And sometimes it is, but often it's not. When you have misunderstandings, you're not getting 5-star reviews. You're not getting people paying with appreciation and referring their friends."

Tip #1: Enhance Communication with an Intraoral Camera

Photo documentation helps with the communication part of the equation. Dr Hyman had an IRIS Intraoral Camera (DigiDoc) in every operatory to enhance communication in his practice. No one in the practice would discuss treatment without first showing patients pictures.

Seeing it helps in many ways. First, Dr Hyman says the patient can see the problem, which allows patients have ownership in the diagnosis. Then, the dental team can discuss options with the patient that already accepts there is a problem. Dr Hyman says after showing patients a picture, he could tell if they didn't care or wanted to know their options.

The philosophy Dr Hyman's practice used was to provide the appropriate care for the patient at this time in their life. Sometimes, he might buy the patient time to consider moving forward with more expensive treatments later by treating the problem with a "Band-Aid." However, this strategy has its problems, too.

For example, doing a provisional treatment to buy the patient time to think about moving forward with a more permanent treatment might mean the insurance won't cover any more work on the tooth with the temporary solution. As a result, a waiting period might ensue. Dr Hyman encourages dentists to explain this possibility to the patient when offering provisional treatment, so the patient decides with all the information. Otherwise, the patient could blame the dentist when the insurance denial occurs after the patient chooses to move forward.

Another scenario is that the provisional treatment doesn't work, which causes the original problem to worsen. It could be that a partial fracture a dentist fixed temporarily does not hold up. Now, instead of a crown and build-up on a tooth, the patient faces a surgical extraction and bone graft implant with a custom abutment. Again, the dentist should explain these risks up front to mitigate the misunderstandings that can occur.

"If we understand each other, then we can work comfortably together. The whole thing goes south when we haven't formed a relationship," Dr Hyman says. "For my team and I, we had a sensational level of case acceptance because we worked on patients who felt like friends because we had a relationship. We asked patients to make it crystal clear what their goals were for their teeth and smile, and then we gave them what they wanted."

Tip #3: Set Proper Expectations for Patients Regarding Annual Dental Expenses

Dentists could avoid some misunderstandings by setting proper expectations for patients, too. For example, someone whose generation did not have fluoride might need to hear that they can expect to spend $1500 per year on their teeth. Someone who grew up in an era that had fluoride might have less. Dr Hyman says being upfront about this possibility might help avoid some misunderstandings also.

"Sometimes I would say, 'do I have your permission to tell you what I see today, what changes are immediate, and what I anticipate in the next 3 to 10 years? Then, you can tell me how you want to get cared for,'" Dr Hyman says. "If you have the audacity to ask and listen, you will know what they want."

Tip #4: Avoid Letting Insurance Dictate What is Possible

Another contributing factor to misunderstandings is how dental insurance works. Dr Hyman says that insurance denials can make dentists feel foolish. He thinks that dentists and patients should not let insurance dictate the quality of care the individual seeks for their oral health.

"The insurance company, patient, and doctor have created a triangle that should not exist. The patient hired a dentist to care for them. If the goal is to keep the patient's teeth, why would they let insurance dictate the quality of care the dentist can offer?" Dr Hyman says. "I bet no one asked the patient when they were offered dental insurance what their goals were for their oral health, teeth, and smile. That's because insurance is a for-profit business transaction."

Moreover, dental insurers often reduce what they pay for services. Large dental insurance companies make a fee adjustment for the dentist's market and then remind dental practices that as many as 30% of their patients use their insurance company for their dental care. The implication to dental procedures is clear; take our adjusted (read: reduced) fee or lose a third of your patient base. Dentists feel they have no choice but to determine how to keep going with even less reimbursement from insurance.

However, Dr Hyman thinks dentists should not allow dental insurance companies to set their fees. Also, his practice had CareCredit as a financial partner that could help patients find a comfortable number within their budget that they could afford for treatment.

"I want dentists to let go of the limiting belief that they have to dance with the dental insurance companies, or they will lose a third of the practice," Dr Hyman says.

Dr Hyman realizes that having these conversations about what patients can afford or encouraging patients to move forward with treatment even if they face 100% responsibility could be uncomfortable for some clinicians. However, the dentist can train someone on the team to have the conversation instead. For example, the practice's business or office manager might handle the conversation, or treatment coordinators can address these issues for patients.

"It doesn't mean the conversation won't happen, but it may not happen with the doctor," Dr Hyman says.

Patients can be wary of supposed “upselling” tactics when they are faced with treatment plans, but there are ways to assuage their hesitation and ensure they get the care they need. 