Working Toward Harmony

“The rules for having a great relationship between dentist and laboratory technician aren’t that different than any other relationship,” says Mark T. Murphy, DDS, lead faculty for clinical education at MicroDental/DTI Dental Technologies in Dublin, California. “The two things that remain constant for good relationships to work are effective communication and having common goals. The dentist and technician both must want what’s in the best interest of the patient. It’s not just communicating well, but it’s also having compatible beliefs and definitions about what’s best for the patient.”

The art of crafting relationships speaks to the economic reality facing the industry today. Just a few years ago, the dental laboratory industry had 13,500 domestic facilities. Today, the number is 8,700. Bennett Napier, CAE, executive director of the National Association of Dental Laboratories, estimates that amount may plateau at 7,000 in the coming years, attributing much of this to the trend of mergers of smaller laboratories. “In many cases throughout the country, 2- or 3-person businesses are merging with like-minded people to have a bigger footprint and better ability to invest capital,” he says.

The US Bureau of Labor Statistics estimates that as of 2013, the country had 96,000 general dentists.¹ The demand for dentists and dental services is rising with a 16% projected job growth rate—higher than average—in the next 10 years.² With fewer laboratories, a rising surge in the baby boomer population, and an increasing demand among some patient groups for complex restorative and cosmetic dental services, the opportunity for laboratories to build new relationships is significant.

Dentistry’s landscape is also being sculpted by reduced reimbursement rates imposed by dental insurance, which wields influence over the economic choices that some dentists make in regard to care. “Dentists are pressured all the time to find more efficient ways to do dentistry because of the insurance industry,” Murphy says. “The insurance compensation model doesn’t say to the dentist to do their best work.”

Dene LeBeau, owner of LeBeau Precision Aesthetics in Washington, notes that the financial pressures facing new dentists today may result in the growth of the group dental practice business model.

“There will always be plenty of patients who demand fee-for-service dentistry and a fair number of clinicians with the passion to provide exclusive dentistry to them,” he says. “The dentist of today will need to make an educated choice as to providing patients who demand fee-for-service or paid provider care, and it is a more important choice now.”

Being a good, strategic partner can aid with the success of the laboratory and the practice. A dentist may depend on laboratories for helping to support value propositions.

“I value my laboratory technician’s opinion and ideas regarding cases, and we interact often—during and after cases are completed,” says Gary Alex, DMD, who practices cosmetic dentistry in New York. “I recognize that I am only as good as the laboratory I am working with. I can cut the best preparation in the world and still get an average or poor result if the laboratory I send the case to is not capable of producing an excellent product. The laboratory technicians we are working with can make us look very good or very bad.”

And paying more for some dentists is not an issue if they believe they are getting the quality they want. “I don’t have any problem paying more for laboratory work if it’s going to be better for my patients,” says Brent A. Engelberg, DDS, who has operated a cosmetic, restorative, and implant dentistry practice for the past 11 years in Arlington Heights, Illinois. He works with four laboratories both locally and nationally for his needs.

Despite his practice specializing in higher-end restorations, he says he would never sacrifice the relationship he has with his four laboratories. He prizes the craftsmanship his technicians deliver routinely.

Lee Culp, CDT, Chief Technology Officer for DTI-Dental Technologies Inc. and Director of the Institute for Oral Art and Design, says, “In the dental laboratory industry, the client-supplier relationship is unique in that we are totally dependent on the client, who must supply a high-quality impression, preparation, diagnosis, and treatment plan, for the laboratory to be able to do high-quality work. We have to be educated alike, think alike—basically, we have to have the same philosophies. We have to have pure, open communication and respect for each other to be able to do the kind of work that we do. We are very dependent upon our dentist-customer to diagnose and treatment plan correctly, do the correct impressions, and give the correct information, so we can give a high-quality restoration back.”

Education is critical for everyone, says Gregori M. Kurtzman, DDS, of Silver Spring, Maryland. “Education is critical not only for the lab tech to understand new materials and methods, but also assuring that the practitioner also knows what the laboratory needs to use that material or technology and the limitations of those materials clinically. Thus, if the laboratory buys new materials and technology and wishes to make it successful for the laboratory, they need to provide education to their client base on how, when, and why to the practitioner.”

Kurtzman says laboratories seeking to gain an extra edge on the competition should take things a step further. “Sadly, most laboratories I have utilized over the years have not expended the effort on the educational front for their clients. As a lecturer who has spoken for laboratories across the country, I see that the most successful laboratories are the ones who place a high degree of effort into dentist education and attend those courses with the practitioners. It is much easier to work with a laboratory when you have developed a face-to-face relationship than when your only interaction is on the phone or via email.”

“Dental laboratories must be partners in the care of our patients,” Alex says. “This entails helping to design and sequence treatment in certain situations. Like dentists, dental laboratories must stay abreast of the latest materials and techniques and offer suggestions when appropriate.”

For the technician, it can all start with knowing who the partner is. Jessica Birrell, CDT, owner of Capture Dental Arts in Saratoga Springs, Utah, says she does this by ensuring that she is educated about the practice’s needs, desires, and goals.

“To be a good partner to the dentist, I try to put myself in their shoes and ask, ‘What would I want for my business?’” Birrell says. “That helps me to really feel like I’m a partner and want their business to grow and be successful. I need to see what their needs are in regard to technology and new techniques. First, I look at the practice and any client that I am going to work with and know that I need to understand what their practice means to them and what kind of practice they have—do they specialize in sleep apnea or orthodontics?”

Part of being a good partner is making sure the fit is sound. Although Culp’s laboratory works with a variety of dentists, it seeks out those it sees as aligning with its philosophies and value propositions. “We try to be at all the venues where dentists are really committed to continuing education because it’s much easier to work with a dentist who is already on the same philosophical level. We go looking for what we consider the right kind of client, one who is continually looking for advanced education and to do better work.”

Opportunities for good partnerships may exist in areas where laboratories may not consider. “The transition to digital laboratory technology may seem like a burden to some laboratories; however, it is a real opportunity for those that accept the change to use this knowledge to help the dentist adjust to the practice’s ever-changing technological landscape,” LeBeau says.

Also what counts is being the go-to resource for the client. With technology changing at a seemingly breakneck speed, a reliable source can be the technician. “As technicians, we need to help educate dentists on the new technology and materials available,” Birrell says.

Alex confirms that dentists like himself value a knowledgeable laboratory partner. “I know too many technicians who rarely, if ever, take continuing education courses,” he says. “An area where I see many dental laboratories lacking in is a true understanding of occlusion and comprehensive dental treatment. This is one of the most important and all-too-often overlooked areas of dentistry.”

This makes it a prime opportunity for connection. “Today you have to offer dentists a consistent product and the product knowledge to be able to provide solutions,” says Jeffrey Stubblefield, Technical Director at DAL, who operates a laboratory of 375 people throughout Illinois. “We are in a solution business more than we have ever been because we have digital solutions, from restorative materials to equipment. For us to be good partners, we really have to be partners who provide solutions to problems for our customers and the patient. That’s really where our business lies now.”

Kurtzman agrees, “Technology is growing at an accelerating rate in dentistry. New materials and technologies are being introduced continually. Most dentists do not have the time and in many cases the inclination to research these materials and technologies.”

He cautions that sometimes dentistry is too quick to jump on a new material or technology. “We have all been burned by technology that didn’t work as expected, and the laboratories have experienced this.

"Nothing is worse than investing in very expensive technology at the laboratory only to find out you really can’t do what was initially pushed by the manufacturer and now have a very expensive piece of artwork sitting in the corner of the laboratory," he says.

The solution is easy, he says. “Be skeptical consumers. Often in our desire to be on the cutting edge compared with our competition in the lab world, we wind up on the bleeding edge of technology and have disgruntled clients and patients because of that.”

“We all forget in our profession that we’re dealing with patients who have the same feelings and emotions as we do,” Birrell says. “I feel we should never underestimate the beauty of communication—communication with our patients and with our clients to understand their needs.”

Murphy acknowledges that reaching that balance is challenging. “It’s a delicate relationship. Unfortunately, the reality is that not all dentists are willing to improve the input on their own end and instead urge the laboratory to make it work or do their best when they aren’t doing theirs.”

This can be frustrating for the laboratory, so this is where relationship building takes on a new dimension. He suggests using flattery and gently reminding dentists about the need for excellence in preparations. “You want to reinforce good behavior,” he says.

When beginning a relationship with a dentist, he says, “a great question we all should be asking is: ‘What do you need from me so we can do our best work on behalf of the patient?’” Murphy suggests nailing down the basics with the dentist as in how they want their pontics, contacts, and other specifics.

Conversation is essential for dentists such as Alex. “I know that many dentists have never actually been to the laboratories they work with and some rarely converse with the technicians working on their cases. It is usually the laboratory that calls the dentist,” he says. “This is unfortunate, but the emergence of zirconia and lithium disilicate restorations has fostered a more collaborative relationship between dentists and their laboratoriess. To some extent, this is because many dentists are not certain of the best way to treat the intaglio surface of these restorations prior to placement or the best way to cement or bond these restorations, and they look to the laboratory for guidance in this regard.”

Kurtzman notes that technology has had a significant impact on the relationship between dentist and laboratory. “With the rapid move in technology toward high-tech and virtual designing, this has increased my communication with the laboratory for shared input in how the prosthesis will be designed. This was not possible in the past with traditional techniques. But today with the Internet and CAD/CAM software, no matter the geographic distance between the laboratory and practitioner, communication is like having both parties in the same room when designing and planning cases.”

Engelberg says he has no sticking points with his laboratory partners. “I would not be working with them if I did,” he says, adding that he values how his laboratory partners go the extra mile for him when he has a tight turnaround time on a case, for example. These seemingly small things add up to value for Engelberg.

Dentists such as Kurtzman observe that how well a laboratory communicates can make or break a relationship. “Communication is the key sticking point for me,” Kurtzman says. “When the practitioner takes time to detail out what is desired on the laboratory prescription and receives something other than what was requested, it can be frustrating. Also, when an issue is encountered, either with the impression, the mounted models or what is requested and the laboratory doesn’t call to discuss, that becomes frustrating for the team approach.”

Although happy with his six laboratories, Alex regards turnaround time as an issue for some patients. “One sticking point I sometimes have is the time required, which can be a month or so, by one of the high-end labs and ceramists I use for most of my cosmetic cases and full-mouth reconstructions. The work is so good that I am willing to reluctantly accept this compromise.”

“Laboratories have to create value in what they are offering,” Engelberg says. “To me, it doesn’t matter what their fees are. Most dental laboratories come to me and drop off their fee schedule, thinking price makes a difference. But I would never switch. I care about the relationship with my patients. Is the laboratory going to stand behind their work? What materials are they using? Those are the important qualities to me, not the fees.”

Alex values the personal touch. “It’s important for dental laboratories to touch base on a personal level. Visit the dentist’s office once in a while. Bring coffee and bagels. Offer to come in and go over cases, invite the dentist to visit the laboratory, and sponsor continuing education courses for your best accounts. But don’t be too pushy with new accounts.”

Kurtzman says it’s all very simple. “Communication, education, and communication,” he says. “Listen to what the dentist is requesting. When something can’t be done and a better material is available for that particular case, talk to the dentist and explain the ‘why’ and ‘how’ behind your suggestions. Education should be an ongoing aspect of the laboratory business, not only for keeping laboratory employees educated on the materials and technology that you have or are considering but also keeping your dental clients educated so they know the limitations and possibilities of what can be done with the materials and technology.

“Dentistry is a team effort between the practitioner and the laboratory. After all, the most successful practices have a skilled, quality laboratory standing behind them as part of the team.”