The ADA has some useful information on the Dental Laboratory Technician training and responsibilities, and provides links from there to other sites of interest for a more in-depth exploration.
Organization of this Chapter
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How Large is the Dental Laboratory?
Dental Laboratory Technician: Basics
So who does the rest of the work?
If the dentist is doing something INDIRECTLY – the dentist will do part of the work, and the laboratory technician will do the rest.
The dentist will prepare a tooth or several teeth, or place an implant with an abutment, or prepare several teeth in one arch for a removable appliance to replace teeth in several areas, and then he/she will take an IMPRESSION. The situation in the patient’s mouth is temporized, with a temporary crown or bridge, or maybe nothing is needed – and mails the impression to the technician.
The prescription to the technician that accompanies the impression specifies exactly what the dentist wants done. It may be a gold crown, it may be an all porcelain crown, or a porcelain onlay or inlay, or a porcelain fused to metal crown, or a zirconia crown, or a bridge made out of a variety of different possible materials, or a partial denture with clasps and rests and guide planes in specific places, or even a full denture. The technician will know what to do if the specifications are detailed enough, and if the impression is good enough.
From the impression the technician will likely pour a hard-plaster model, on which the restoration can be made. They might need to pour the opposing model and make sure that the two models are hinged together in a way which mimics as much as possible the movements in the mouth. The dentist will have to provide the means to do that if it is necessary.
How Large is the Dental Laboratory?
This may be important – for the lab may have hundreds or even THOUSANDS of technicians that can do the work that the dentist requires! How could there be that many technicians in one lab you ask?
The largest dental laboratory in the U.S. is Glidewell Laboratories, in Newport Beach, California. It is TEN times larger than the next largest laboratory in the U.S.! But it is small compared to many dental laboratories in China ….
Why would laboratories in China be so large? Yes, it is possible that a dentist in the U.S. can mail or DHL the impression to China to get the work done, but why would they? The work is inexpensive! The profit is larger!
Given today’s shipping speeds between countries it is actually possible to get an impression to China and the work back in a reasonable timeframe for the patient – three weeks is about it.
ON THE OTHER HAND – it is also possible these days for the dentist to EMAIL the impression to China! We will discuss CAD/CAM more in the next chapter, but there has been enough discussion previously so that you can picture the taking of an OPTICAL DIGITAL IMPRESSION. This digital file can be emailed just like the pictures of your kids.
I sometimes tease my students, telling them that China is so far advanced compared to the U.S. that they have now developed the technology to email the crown back! Then I wait for a moment or two to see if they are paying attention. Soon they realize that we are not yet in the “Beam me up, Scotty” age.
Advantages of a Small Laboratory
I am a firm believer that for the dentist to provide the best work for his patients, they should have a personal relationship with their laboratory technician. That typically means a small lab.
When I had my practice I used several laboratories that specialized in certain things. And I got to know the technician or technicians well. When I needed something special, they were there for me. When I did something wrong, they would help me work it out. Yeah – that happens. Sometimes they have special skills that other technicians don’t have – they’ve figured out how to do something more easily than the traditional methods, and the dentist can capitalize on this.
Case in point – I had a technician that was good at making a custom cast-post for a tooth, and making the crown which will go over it at the same time. I only knew one technician that could do that and he had a special way to do it. That meant that I could save the patient one visit to my office by cementing both the post and the crown at the same time. But, I had to prepare the endodontically treated tooth for both the post and the crown at the same time, and get an impression both on the inside of the tooth and the outside at the same time. A little practice and I had it down, and the technician provided me with a great service which I passed on to my patients on many occasions.
Also, when working with a small laboratory I would hear from the technician tales about other laboratories they used to work for, and it was eye opening!
Disadvantages of a Large Lab
I pass on to my students one particular fact that makes total sense, and yet nobody would tend to think of it. If a laboratory has 30 technicians that are trained to make crowns, for example, some of these technicians are better trained, and have more experience than others – and they get paid more. Makes sense, right? Now, when you are a dentist submitting an impression to them for the first time, who do you suppose they will get to do your work? The cheapest technician or the most expensive?
Think about that for a moment. Got it? The most expensive, best technician. Why?
Because the work will be the best quality, and they want you coming back again. They want to make sure that the dentist is happy with the work and has nothing at all with which to be disappointed. The crown occlusal anatomy is gorgeous and natural, the contacts are perfect and the margins are very well adapted to the die.
BUT – and here’s the big BUT! When you send your SECOND impression to the lab, who will they get to do the work? The SECOND most talented and expensive technician. If THAT technician can make you happy, then the next time you get the THIRD best, until finally you complain. At THAT point, you are stuck with that technician for all time! “You” in this case being the dentist.
Now, why do YOU, as a patient, need to know anything about these goings-on? It is curious, to be sure. But, it illustrates that NOT ALL dentistry is done well, and the dentist doesn’t necessarily notice when there are problems with THEIR work, or that of the people they hire to make something that will be cemented into your mouth.
As well as you patients, there will be inevitably dental students reading this account while perusing this site, and they will be just as amazed as you!
Dental laboratory technician: Training
There are certainly school programs that they can attend, and programs where they can achieve certification of their skills and abilities. If their school program is accredited, then they can take their certification exams and become a Certified Dental Technician without much other education. The CDT is recognized as someone who has devoted their time and efforts to becoming skilled in all aspects of the dental arts. There are guilds and study groups of dental technicians that want to bring their best abilities to the dentists that hire them.
Can a laboratory train their technicians themselves? Yes. A large laboratory may train hundreds of technicians to only do particular tasks, and do them well – but they are not necessarily trained in the broad range of skills required in dentistry. It is of advantage to train them locally, as they can pay them a minimal wage and make more of a profit.
The Business of the Dental Laboratory
Don’t forget, a dental laboratory is a business! They have to make a profit, and to make a profit they need to reduce costs and expenses, including wages, and maximize their fees.
Some laboratories survive or even flourish because they develop a reputation for doing fabulous work, or work that other laboratories don’t do.
There is a laboratory in LA that I used once because I had a particular need of a Maryland Bridge that was made with a flexible composite framework, rather than the traditional rigid metal framework. I never used that laboratory for anything else, but they were advertising that they could do that, and sometimes that is really what is needed.
Dental laboratories are always advertising in the trade magazines about what they can do that others cannot. Some new crown fabrication method or material has been developed by someone, and the labs that can DO that technique first are likely to get the most business from dentists who see that method as of particular benefit to some of their patients.
Again, YOU, as a patient, need know nothing about dental laboratories. But, it would be well to realize that they aren’t really any different from any other business – there are good ones and bad ones.
It is up to your dentist to learn which is which and get the best work done for you.
In my practice I would have laboratory technicians come around every so often to tell me about how good there work was, and sometimes I would give them a try. I would send an impression and get the work back, a crown, for example, and see how good they actually were.
Once, in particular, this young guy came by and I gave him an impression for a 3/4 gold crown. I got it back and, believe me, the patient never saw that one! First, the grooves that I had carefully cut in the tooth to help retain the crown had NO gold in them. So I might not even have cut them. And, the occlusal anatomy looked like something a first year dental student would carve – it was lifeless. It had no anatomy that looked natural at all – it had grooves CUT into the gold on the biting surface, without the gold contours naturally forming the grooves as a continuation of the rest of the surface anatomy.
Your dentist is the professional you trust to get the best work done for you. You trust that he will find a laboratory or technician that will do their part of the work at the level of skill and insight that the dentist contributes him/herself.