Employees of the Future

In the 2014 edition of its annual survey of laboratories, the National Association of Dental Laboratories (NADL) charted an industry already heavily invested in digital technology. According to results of its 2014 Materials and Equipment survey, 88.9% of the nation’s 6903 laboratories have invested in digital technology with 48.4% providing both scanning and milling operations and another 36.9% owning a standalone scanner. Moreover, the amount of CAD/CAM adoption among laboratories is expected to increase at a compound annual growth rate of 15%, according to leading industry analysts.

Two prime drivers behind the industry’s growing interest in technology are CAD/CAM’s impressive benefits and laboratories’ needs to remain competitive. Bauer observes the production capacity of a technician using digital technology can outpace a worker relying on manual methods by “100% or more.” The technology can also reduce laboratories’ waste and turnaround time by half. 

“Digital is where the market is going,” says Bob Savage, vice president and CFO of Drake Precision Dental Laboratory, Inc. in Charlotte, North Carolina. “There’s an increased interest on the clinical side for digital impressions and similar technology, both for speed and accuracy.” Savage is also convinced that improved esthetics of digitally produced restorations will be an added attraction as manufacturers continue to introduce innovative materials.

This all adds up to laboratories’ future success and competitiveness being dependent on how efficiently they can incorporate—and operate—digital technology. “It’s going to be very challenging, even for what I call a boutique high-end laboratory not to have some digital technology going for it,” says Bennett Napier, CAE, executive director of NADL. “For a laboratory to continue to do most of its work in an analog fashion 5 years from now, it's going to be very, very difficult.”

Yet finding dental technicians with computer skills has been a challenge for the industry, and the issue presents a cloudy picture of laboratories making a seamless transition to digital workplaces. Part of the difficulty, say observers, can be attributed to longstanding manpower problems, such as prospective employees’ lack of knowledge about dental laboratory technology as a career and the allure of other professions with higher statuses and wages.

In addition, the formal educational system for the field is struggling. According to the American Dental Association’s Commission on Dental Accreditation (CODA), which accredits dental laboratory technology education programs, the number of accredited schools plummeted from 49 in 1990 (with 722 graduates) to 19 in 2012 (with 301 graduates). By the end of 2015, only 17 accredited programs are expected to remain, and about half of these will be offering digital training.

Unsurprisingly, the dental laboratory industry’s current digital workforce challenges mirror those troubling nondental manufacturers nationwide struggling with the lack of skilled employees. Last May, the Manufacturing Institute in collaboration with Accenture, a management consultant and technology services corporation, released a report titled Accenture 2014 Manufacturing Skills and Training Study. 

The survey of more than 300 manufacturers nationwide found that the companies anticipated reduced annual earnings of up to 11% as a result of increased production costs stemming from a shortage of skilled employees. In fact, 75% of the firms cited a moderate-to-severe lack of skilled workers (defined as those with an associate degree or equivalent 12 to 24 months of training and/or experience). 

When manufacturers are unable to fill skilled positions, overtime (to maintain base production levels), downtime, and cycle times increase; more materials are lost to scrap; and quality suffers. “The skills shortage facing U.S. manufacturers is apparent from this report, and its severity can be measured in dollars,” said Matt Reilly, senior managing director, Accenture Strategy, North America, in a company press release.

The Accenture report also cited several strategies some companies have used to successfully address the skills shortage. These include digital education, a combination of formal and informal training, and establishment of certification programs to help people build standardized skills. Some companies also are partnering with local colleges and vocational schools to draft curricula for specific skill sets. In addition, the Manufacturing Institute developed a program called “Dream It. Do It.” to educate high school students and others about the benefits of skilled manufacturing careers and the opportunities.

Dental laboratories have tried some of these approaches, though with slow progress primarily because optimal productivity in a laboratory depends on marrying digital skills with a firm foundation of dental knowledge. 

“Different laboratories have approached the challenge in different ways,” says Bauer of Edmonds Dental Prosthetics. “Some have gone to dental laboratory programs to hire people with traditional training and then tried to teach them CAD. Others have tried teaching the dental component to people they get from junior colleges educated in CAD or computer gamers with no formal training. Each approach has been a chore.”

Edmonds’ hiring method has largely been trial and error, Bauer continues. They’ve observed some gamers have picked up the dental component over time and proved very productive. Although some of the company’s in-house dental laboratory technicians did learn CAD, others struggled. “So there’s no one hard-and-fast rule,” Bauer says.

One constant is that the learning curve with on-the-job training can be steep for some, and, consequently, production lags. “It’s all a matter of giving them experience to let them build up their production capacity,” Bauer says. “We have a director of education who can teach them the basics. But then when you get to complex cases and you have to utilize more of the software’s capabilities and tools, then you have to have both the dental and computer knowledge to know what to use and when to use it. There are many variations and options to consider, and it takes them a while to maneuver through them all.”

Edmonds commonly seeks digital guidance from fellow members of the Technical Research Consortium of North America, an alliance of regional laboratories throughout the U.S. and Canada. “We all have CAD departments, and some of the laboratories’ capabilities are further ahead than others. There’s a lot of communication between laboratories sharing options and helping to resolve problems,” Bauer says.

To educate students about careers in dental laboratory technology, Edmonds staff members often address dental hygiene and dental assisting classes at a local junior college. The laboratory already has hired several students from the programs, and Bauer is talking with school administrators about adding a dental technology prerequisite to the dental hygiene and dental assisting curricula. 

“Students sometimes begin the hygiene and assisting programs and then decide that’s not what they want, especially if they’re people with artistic abilities,” he says. “The dental laboratory prerequisite would give them some basic knowledge about laboratory technology. Then if they decide they’re interested in it as a career, we wouldn’t have to start working with them at the ground level.”

At Drake, Savage says the laboratory has successfully hired digitally trained people and provided them with on-the-job dental education. One reason for that might be the laboratory’s meticulous screening process. 

“The digitally skilled people we brought in had an aptitude on the dental side as well,” he says. “They had the traditional dental laboratory technician pieces we look for: dexterity, the ability to see in three dimensions, a knack for thinking quickly on their feet, and an artistic background. Those all tend to be positives for us.” Drake’s training staff then provides the employees with ongoing dental education.

The company also has moved dental laboratory technicians into digital spots, typically relying on equipment vendors to provide CAD/CAM training. 

For both groups, those learning the dental component and those training on digital technology, the company has a deadline for attaining production goals. “We look for them to make an impact within a 12-month timeframe, if not before,” Savage says. 

He adds that Drake’s future efforts to build a pipeline for digital operations employees include investigating potential interest at a local community college offering computer numerical control (CNC) and dental assisting programs. “We are going to see if the students with the CNC milling technology background are interested and capable of applying that knowledge in the dental laboratory,” Savage says. “Dental assistants who decide they don’t want the clinical environment might be good hires. They have the dental background and, because they’re typically younger, they’re also probably computer literate. We don’t have any single group of prospective employees we always target. The best approach is to selectively hire.” 

Perry & Young Dental Laboratory began incorporating digital technology 10 years ago. Young estimates about half the laboratory’s work today is performed digitally. He notes that “once it’s properly running,” the digital technology does provide improved productivity and accuracy of restorations. But making the digital shift has posed challenges. 

The company’s digital department is manned by 6 employees, 3 of whom have computer backgrounds and were provided on-the-job training in dental anatomy and morphology. The other digital workers are dental laboratory technicians who received computer training. 

By far, the bigger education challenge between the two groups is teaching computer-savvy workers about dentistry. “It’s a huge learning curve,” says Young, who estimates employees need about a year to get a handle on the basics of dentistry. “At that point, they’d be able to do a couple of single teeth, but not a full-mouth case design.” It requires about another year of training for them to become adept with working on more complicated cases.

By contrast, dental laboratory technicians can digitally design about 80% of the work they receive after 3 months and the most complex cases after 6 months’ training.

The technicians’ learning curves tend to delay company plans to increase productivity, Young says. He agrees that more professional and standardized educational options—with digital technology included in each school’s curricula—would be a boon to laboratories scrambling to make the digital transition. “We would love that. It would be very useful for us to have a source like that,” he says.

The laboratories’ plight has caught the attention of dentists, professional educators, and training firms. At the Chicago Dental Society’s Midwinter Meeting in February, Productivity Training Corporation (PTC), which provides dental technicians with educational materials, unveiled a CAD training app that can be used in laboratories. The program is designed for technicians seeking to learn about digital design and those needing education on dental anatomy and morphology. “This program is an iPad app that the technicians would set next to their monitors they use for CAD, and it takes them step-by-step through the design procedures,” explains Jim Mahan, president and CEO of PTC in Morgan Hill, California.

“This introductory program will cover single- and three-unit bridges, and anatomy instruction will be embedded in it,” Mahan continues. “The app will use similar steps used in the analog procedure so that multiple people in the same laboratory will be able to provide consistent work.” Mahan adds that the company will soon introduce an Android version of the app.

Efforts also are underway to expand digital offerings in the traditional educational system. That task is no less than urgent, says William D’Aiuto, DDS, a general dentist in Longwood, Florida, and past chair of the ADA Subcommittee on the Future of Dental Laboratory Technology. “Digital technology has to be incorporated in the educational process, otherwise the laboratory schools are a thing of the past,” D’Aiuto says. 

He also cautions against emphasizing digital expertise at the expense of dental knowledge. “A technician still needs to understand morphology, the biomechanics of the human jaw, occlusion, and more in order to use materials to create a prosthesis that works in the human mouth. It’s not simply about designing a case in a machine and having no idea how it’s got to work, and what the dentist and the patient need to ensure a proper fit. It would be herculean for laboratories to provide that learning on-the-job training in a shorter period of time than that required in formal educational programs.”

The dental laboratory technology departments at Los Angeles City College in California, New York City College of Technology of the City University of New York, and Middlesex Community College (MCC) in Bedford/Lowell, Massachusetts are among the CODA-accredited educational programs that offer digital training. “I saw the writing on the wall: Digital is where the industry is going, and there is a large void for qualified skilled digital dental technicians needing to be filled,” says Daniel Alter, MSc, MDT, CDT, professor of restorative dentistry at New York City College of Technology. “So I created a new course curriculum that teaches both the theory and hands-on digital dental education.” The 2-credit course consists of 1 hour of lecture and 3 hours of laboratory work each week for the 15-week semester. Students learn digital design and manufacturing of individual copings, full contour, and multiple-unit frameworks. Coursework also includes digital manipulating and morphing, importing and exporting files, and the processes of nesting, milling, or 3D printing.

Also, the college in January introduced a 36-hour continuing education course offered on Saturdays. “This course is designed to help unemployed, underemployed, or working dental technicians looking to enhance their careers with digital technology,” Alter says. “It also aims to benefit the profession with an influx of qualified digital dental technicians.”

Dana Cohen, CDT, chairman of the dental technology program at Los Angeles City College, reports that his department plans to start offering continuing education courses in 2016 as an adjunct to its long-standing undergraduate CAD/CAM program.

Just last fall the dental laboratory technology program at MCC started offering digital coursework. The move was spurred by local demand, says Apollon Bouzerdan, CDT, director of the MCC dental laboratory technology program. “The calls we receive for digitally trained technicians is increasing exponentially,” he says, adding that the sources of the requests include dental laboratories, production centers, and dental practices. He’s certain that most requests will remain unfilled. “We are the only accredited technology program in New England, and we simply do not have enough graduates,” Bouzerdan says.

The current digital void in dental laboratories can be remedied only through professional collaborations, Alter notes. “Everyone who’s a stakeholder in dentistry—dentists, manufacturers, laboratories, educators, and dental profession leaders—need to put their minds together and come up with solutions to correct this crisis for the overall health and viability of our industry,” he says.

Currently, the NADL’s Foundation for Dental Laboratory Technology provides grants to schools to integrate new technology into their programs. But more initiatives are needed.

Manufacturers, Alter continues, could support schools by donating digital technology and consumables. In addition, laboratory owners and manufacturers could further promote interest in digital technology and make it more accessible.

“Every year, Nobel Biocare invites about 60 of my students to their facility to show them digital technology and get them excited about dental technology,” Alter says. “Laboratories, too, could provide internships to allow students and others to learn about digital technology.”

Bouzerdan also emphasizes the importance of collaboration and stresses that it must begin with addressing problems with the industry’s educational system. He makes the point that the digital-technician void cannot be viewed in isolation of the broader problem of the declining number of schools and dental laboratory program applicants. Without the laboratory programs and students, the profession lacks a firm, standardized dental foundation. Everyone in dentistry, he says, “needs to engage in serious conversations about the future of dental technology and collaborate toward improving the education of dental technicians.

“There’s a lesson to be learned from this current digital challenge. If we don’t have formally educated dental technicians with a firm knowledge of the dental sciences, they will be vulnerable to being made obsolete by whatever new fabrication process that comes along. So in order to ensure continued quality care and laboratories’ smooth transition from one fabrication method to another, we need the proper educational foundation. Only that will enable us to adapt to any change that might come our way.”

Did you miss something? Check out our feature story "Mastering the Digital Shift" to learn how laboratories are painting new futures. insidedentaltech.com/idt798.