How digital workflow is affecting dental laboratory artistry

January 16, 2019

Some new technologies will require technical retraining, but embracing them might actually enhance your artistry and product quality.

Computers have promised to make our work lives easier, faster and more convenient. This is certainly the case in the dental lab.

But, for all the things that computers improve, just how has it changed? Has anything been lost? 

Digital artistry

Because CAD involves moving from an actual physical object to its representation on a computer screen, that foundational change requires a different relationship with the case, a workflow adjustment required of the technicians.

“The biggest change has been a retraining of the technician’s eye,” Mark Ferguson, General Manager, Vulcan Custom Dentalsays. “As opposed to holding a crown in your hand, retraining your eye is necessary to be able to see three-dimensional contours on a two-dimensional monitor. There are certain things about being an artistic dental technician that’ll never change, like knowing what the shape of a tooth should look like, understanding proper contours and function.”

As helpful a tool as CAD is, it is just a tool. While computers can do a lot of the heavy lifting, artistry still necessitates the technician’s skilled eye.

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“A lot of the pre-finishing work that was traditionally done by hand is now done digitally,” Travis Zick, CDL, Apex Dental Laboratory Group VP and COO observes. Zick is also the National Association of Dental Laboratories (NADL) President. “This includes diagnostic wax-ups and initial design/contouring of the restoration. We also have additional digital tools that didn’t exist before, such as digital smile design software, and the ability to take accurate shades. However, the esthetic outcome of the final restoration still comes down to a skilled technician who is an artisan creating the final contour, color and detailed features of the crown by hand.”

CAD can do a lot, but there is a lot requiring the human touch.

“Digital libraries have come a long way, but we still adjust nearly every proposed design to some extent,” he continues. “I believe this will continue to evolve with intuitive software that can ‘learn’ the adjustments that are being made to the proposed designs. However, as labs, we are producing patient-specific restorations for individual doctors and both have their own preferences that need to be built in. For that reason, I don’t see digital libraries ‘doing it all’ anytime in the near future. Certainly, on single posterior crowns they get close… and will continue to improve, but bridges, anterior work and complex cases will continue to require a skilled technician to design, regardless of software improvements.”

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More - not fewer - opportunities

Rather than limiting artistic expression, digital dentistry offers more opportunities for technicians to make beautiful restorations.

“This is a very exciting time for technicians who have esthetic capabilities and training and talents because we all have the opportunity to take those talents and transfer them into the digital world,” Laura Kelly, Senior Vice President, Customer Solutions for Dental Services Group says. Kelly is also the past president of the American Academy of Cosmetic Dentistry (AACD). “These machines can’t do it alone. They need a master technician who has the expertise to design and deliver esthetics.”

One of the biggest opportunities afforded by digital is the ability to turn out reliable, dependable results.

“I see the benefit of being a lot more consistent with [digital technologies] and being able to communicate with clients in a pre-op manner more consistently, and then also delivering the end product and… being able to be reduplicate it,” Kelly continues. 

“Machines don’t necessarily have a bad day. Being able to take a technician who’s on the track to becoming a master technician will be able to get up to speed quicker with the digital assistant. I don’t see it as a threat to the technicians and their talents, I see it as a pathway to have them be more productive and able to produce more beautiful, consistent esthetic dentistry.”

Those who want to add their own personal touch are not left out of the digital workflow - in fact, that signature style can become a regular part of the organization’s library.

“A ceramist has the ability to create their own anatomy,” Damon Liesse, Area Vice President of Digital Technology, Dental Services Group, says. “Much of the anatomy today could be done analog and then copied in, creating a tooth library that preserves artistry or has a signature to it, which is something that is always there. You still have the ability to crossover into the digital world. The accuracy and the ability to move files and look at files, three-dimensionally gives you different perspectives in digital, and the ability to blow things up, to zoom in and look at more detail. “

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Digital’s artistic opportunities go beyond just pointing and clicking - the technology also affords improved communications, providing more opportunity for esthetic cases.

“Digital allows the translation of information to be consistent,” says Lou Azzara, CEO of Dental Services Group. “It gives visual meaning to words and allows technicians, practitioners and patients to be on the same page and give a lot of resonance to the expressions and phrases of what they want to communicate. It makes the process incredibly efficient and a lot more effective. It heightens the experience across the board. From a structural standpoint, digital is really a scalable expression of knowledge. You still need a thoughtful technician with knowledge and a lot of talent and experience that solves a lot of other esthetics problems. This gives that technician, that team of technicians or that laboratory the ability to scale that knowledge out and create exposure among more people. It gives access to practitioners, to clinicians and patients that may not have access to that type of talent before. It really elevates all of dentistry and allows dentistry to experience something that we, only a couple of decades ago, were only for the very elite few…”

It comes down to the computer being a tool, not a technician’s replacement.

“The machines are taking away the labor and being able to produce a consistent form of a tooth,” says Rita Acquafredda, president, global laboratory business, Zahn Lab Group.

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Are we losing any artistry to digital?

Not only are technicians not losing anything to digital, computer skills broaden technicians’ artistic palette.

“It’s created a way for us to a make technicians even better,” Liesse says. “With the ability to have articulations, virtually, the accuracy increases from what we did in the analog world. There are areas that we may have missed that can now be more defined and more detailed… It’s just a mind shift from the analog to the digital world, and those that are embracing it, it’s making them better technicians and better at recognizing where the extra details could be…”

Kelly reminds technicians that just because a lab has a CAD/CAM solution, doesn’t mean that it’s an all or nothing proposition.

“It’s really a hybrid approach,” she says. “It’s not 100 percent CAD or 100 percent analog. You don’t have to approach this situation that way. I’ve seen some beautiful cases where a technician has applied very artistic surface textures to a CAD/CAM restoration. It’s absolutely gorgeous and it’s nice to see the combination of the two.”

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CAD has become somewhat known as a tool to produce units. But that doesn’t mean that it can’t be a force for artistry.

“Digital technology has given our skilled techs new resources to utilize to make their final restorations even better,” Zick says. “Certainly, digital technology in dentistry has led to a certain commoditization of our single, posterior units. However, those were never about art … they are about functionality. The artistic work done by labs is still going strong, and still comes down to the individual technicians doing the finish work. In fact, we see and hear more demand for artistic work in this age of commoditization. Cosmetic, esthetic dentistry is alive and well across the country and it still comes back to the skill of the technician.”

“There are probably people that would argue and say that digital is creating a loss in artistry, but I really think that if you can visualize your final result before you start the case, then that’s where it comes from,” Ferguson adds. “Because we’re designing teeth on a computer, as opposed to by hand, the shape of that tooth hasn’t necessarily changed. And, I’ve always considered that contour is king, so, if you get the right shape, you can be off a little bit and maybe in value or color or Chroma, but it’ll still blend in. We see enough people with natural teeth that that have multi-different shades all across the arch, but you see that commonality of shape and texture.”

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Professional development

Across all industries, computers have improved workers’ lives, but something is expected and required of those workers - computer skills. Are non-computer-savvy technicians being left behind?

“You have to look at it on an individual basis,” Kelly says. “There are some great opportunities for technicians who have been more in the fixed area moving into removables and enhancing their skill set using digital technology to get involved in one of the business segments that they had never really produced before. Digital can actually expand their skills.”

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Keeping up with the educational changes should not be an obstacle - it can be as close as the equipment manufacturer.

“This is where we, as an organization, play a big role,” Acquafredda says. “Through our various educational seminars offered by Zahn Dental, the dental laboratory business of Henry Schein, Inc., we are training technicians to move to the next level. Part of Henry Schein’s value proposition includes our commitment to delivering to the market. A technician could be in the industry for many years, but they are willing, ready, and able to learn and move to the next step. We're there to support that journey.”

Ultimately, artistry and esthetics require the eye and skilled hand of a talented technician. And while computers can certainly help, they can’t do it all.