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.
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 lab uploads the order; then, once it is ready, the lab approves the design or modifies it.
“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.
Where Labs Can Find Tomorrow’s Techs
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.”
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 2019.1 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 $65,000.2 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.”
What Can Labs Do?
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.
“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.”