In Search of Esthetic Laboratory Support

Implantology has changed the entire scope of restorative dentistry but its impact is rarely viewed from the technician’s vantage point. Complex laboratory work has evolved from tooth borne restorations with attachment retained removable partial dentures.  Case complexity while still demanding, now commonly relies on implants to restore edentulous areas.  Bone augmentation and tissue grafting has provided new possibilities in implant site development but esthetic expectations often still fall short at the time of delivery.  To fully comprehend the clinical-laboratory divide we must look deeper than minor discrepancies in color and contour.

Going, going gone.

In 1983 there where 60 accredited dental technology programs in the United States, in 2006 there are now ±23 (ADA 2004).  The loss of these programs speaks poorly of our readiness for the future of dental technology.  Escalating esthetic expectations and complex restorative treatment propose a difficult scenario for consistent success.  The argument for appropriate education can be stated quite simply that it is absolutely critical to understand not only how but why and it certainly applies for custom fabricated medical devices that are permanently placed in the human body.  It is beyond comprehension that the dental technology industry is regulated solely by a voluntary certification program.

What you can’t see, can hurt you.

Global changes in dental school education have lead to the removal of most if not all laboratory technology related curriculum.  Indirect restorations are now viewed as an outsourced product that is not truly understood.  Quality assessment is most often judged by appearance alone.  This is a precarious situation due to the fact that restoration costs are driven by fierce market competition and the frequency of insurance benefits.  Appearance over substance and quantity over quality will constrain long-term esthetic excellence.  The obvious mission of a dental school is to teach clinicians not technicians but a close alliance with technology schools would form a lasting bond that would benefit the entire profession.  Measures must be taken to put in place an appropriate curriculum on the evaluation of the final prosthesis.  If the quality of dental restorations is left exclusively to the technician, we are not providing our absolute best for our patients.           

Have and have not.

A solution to the shortage of qualified technicians is not easily defined or resolved but without intervention we will continue on a questionable path of success.  Implantology has finally brought the era of team approach dentistry to the forefront.  Successful outcomes are most often achieved by the diagnostic groundwork performed by the entire restorative team.  As the saying goes good individuals make great team yet very few educational programs are available to maximize the potential of existing talent.  The technical profession is at risk of becoming an unfortunate group that have and have not.  Top shelf technicians are extremely busy and demand good fees for their work.  The balance of laboratories that fabricate the lion share of restorative work will struggle to achieve excellence with complex work.  If advanced educational programs do not exist, the hidden potential of good technicians will remain just that.  Unfortunately, as complex restorative work becomes accessible to more patients, we will struggle to find enough individuals to fulfill the prosthetic demand.  Unless we address this issue as a restorative team, the search for esthetic laboratory support will surely become more difficult in the future.     

Credit given for credit due.

The view from the bench can be stark.  It is disheartening to see such a large part of the restorative sequence often receive little or no recognition.  The fabrication of the definitive prosthesis plays a key role in the esthetic success of patient treatment.  Extending the rules of artistic property rights to the dental technician would facilitate cooperation in a team-oriented environment.  The manufacturer of a dental product that is used in patient treatment is routinely noted in an article submitted for publication.  It is unfortunate that this courtesy falls short of the manufacturer of the custom fabricated appliance.  The European model which markets its laboratory product directly to the public may offer some insight into deficiencies in the US system.  As implants continue to open new possibilities in patient treatment, we must look to the future to ensure we have enough trained professionals ready to embrace these challenges.  Teamwork, as well as appropriate recognition will set the course for success.