The Next Generation Speaks

At 32 years old, ceramist Armando Doku is the founder and owner of Avaneer Dental Studio, a full-service laboratory with more than 30 employees located in Warren, Michigan. IDT asked Doku how he turned his fledgling laboratory into a booming business in just 4 years.

IDT: Opening a laboratory is an incredible undertaking, and yet you've been able to build a sizable business. What experiences do you think have led to this success?

Armando Doku: I worked for a big laboratory for more than 8 years, so I learned the technical skills there, but I also went to business school during that time. What is really important in opening a business is being able to translate theory into actual manufacture. We are a full-service laboratory, growing more as clients come back around from sending their work offshore. Dentists still want competitive prices, however, so we need to sell them on the quality of the work, and we need to build a rapport with them, just like any other business. It's a lot of hard work, but I'm glad to have employees like Claudia Cadorin, one of my first collaborators in this venture.

IDT: Do you see technology changing how dental laboratories practice their business?

AD: Things will continue to change tremendously in the industry, especially with the technology. I think more dentists will purchase milling machines, but technicians need to go with the flow on this. Rather than clients sending us cases to work from start to finish, they may only need the laboratory as the designer or for milling or layering. Some technicians will also find themselves working more as consultants.

As more dentists purchase scanners, we will see exceedingly fewer physical impressions. With that, I see laboratories converting their modeling rooms into 3D-printing rooms. Laboratories that are not willing or able to adapt just will not be able to compete. Laboratory owners cannot get too comfortable or stop growing. Those not willing to move with these trends will probably get left behind.

IDT: Your laboratory is quite large for an independent operation. In an industry where it can be a struggle to find experienced technicians, how do you recruit and keep your employees?

AD: I'm an avid believer in company culture; everybody is here because they want to be here. We find people who have passion, even if they don't have the most experience. You can train skills, but you can't train passion or commitment. We might not be able provide the best compensation, but what we can do is make this a great place to work. I've had people leave higher-paying jobs to work here because they understand that a job is about more than just the money. We want to make sure everybody will get along and want to come to work every day. These are the things that help a business grow and stay successful.

Really we are one big team. I see the future of my business in being a full-service laboratory, and we will use our size to our advantage by sharing knowledge, rather than dividing people up into specialties. The more that everyone sees their role in the larger process, the more they are invested in the finished product. That's part of the team spirit, too. It's great for producing high-quality products and keeping our technicians happy.

IDT: What kind of experience has been the most eye-opening to you as a dental technician?

AD: I work on the bench as a ceramist, but I have found it is really important to work chairside. Everyone should try it if they have the opportunity. Being there with the dentist, able to see the restoration in the mouth, is invaluable to dental technicians. Otherwise we are blinded by the model, working only in the laboratory, unable to connect this thing we are making to how the dentist puts it into a real, live person. There are so many variables we're not aware of without this experience.

Jennifer Crane, CDT, 26, has worked her entire career at Pizzi Dental Studio in Staten Island, New York, starting with a high school co-op. While she assists with digital design, Crane's work is still very hands-on and includes diagnostic wax-ups and provisionals, lithium disilicate restorations, and ceramic layering.

IDT: You've been in this industry for more than 10 years—a tumultuous decade in restorative dentistry. How have these changes altered your career?

Jennifer Crane, CDT: There is significantly more CAD/CAM involved in the process now. In my high school program, we didn't use CAD/CAM. However, it has become so much more common; I use it all the time. When I started out, I never imagined it would be part of my everyday routine, but digital dentistry has really taken over.

IDT: How do you see this playing out in the future? Are the "traditional" or "analog" methods doomed to extinction?

JC: In some ways, I see the field going back to the basics: waxing a case by hand rather than letting the computer do it for you. Technicians must still possess and understand the benefits of analog skills. New technology is a helpful tool, but laboratories will always need to be grounded in the fundamentals.

IDT: What have you found is the most important consideration for working on cases?

JC: It is really important to have the knowledge to communicate with our dentists, to know enough dentistry to understand each other's perspective. We also need to be able to translate our knowledge of materials to them. Any technician talking with clients must be confident in their understanding of what the dentist wants and communicate what the laboratory can bring to the final product.

Max Thomas, turning 27 this month, grew up working in Crown Creations, founded by his father, James Thomas, CDT. Now co-owner and General Manager of their two Oregon locations, the younger Thomas has crystal clear vision for taking the business to the next level.

IDT: How did the blend of technical skills with business acumen impact the family business? 

Max Thomas: I grew up inside dental technology, because my father opened his laboratory in 1996, and I learned all aspects of fabrication there. I worked outside the laboratory in business for a few years before I struck a deal with my father: If I earned a business degree, then I could open my own location of Crown Creations. That was how the business started growing again so quickly.

IDT: You obviously have strong ideas about the future of the business. Has your vision had an impact on the business strategy of your family's laboratory?

MT: My vision has significantly changed how we approach the business. My father's motto was, "If it's not broken, don't fix it." That's great for maintaining the status quo, but we need to change things if he wants to retire someday. I am looking at the business both long-term and short-term.

I spend about 60% of my time on the bench, doing the finishing touches and quality control, and 40% of it on the business side. Focusing more on business is paying off. I have been working on bringing in new accounts and clients, as well as integrating new technologies. We have also tripled our number of employees, from 5 to 15, and I hope to add up to 10 more.

IDT: We all know how the shift to CAD/CAM is affecting laboratories. How do you think it's affecting patients and clients, and what do you see as the role of dental technicians in all this?

MT: Everybody wants products faster, within 2 to 3 days versus 2 to 3 weeks. It's a race to the bottom in terms of turnaround times—and costs. Additionally, equipment manufacturers continue to try to sell fabrication machinery directly to dentists, effectively cutting out the dental laboratory.

With both of these trends, I worry about short-changing the patient. Technology should help create better outcomes, so why should the dental industry accept anything less? Is faster and cheaper really worthwhile when things do not fit or do not last? Dental technology is constantly evolving, and dentists may not have the time or energy to keep up with all the advances. Dentists who try to do it all themselves may be shooting themselves in the foot when patients are left to accept "good enough." So much more is possible.

There is a compromise, though, when laboratories become more service oriented. Being that source of knowledge for the dentist is very valuable. Combining the knowledge of both dentist and technician can only benefit the patient.

IDT: Some people in the industry worry that laboratory technicians won't be needed in a world of milling machines and 3D printing. Do you think that's true?

MT: I hear a lot of veteran laboratory owners saying that there is no future in the industry, but I don't want the younger people to get scared off. What these technicians fear is that traditional skills and methods will fall by the wayside, which really isn't true. We need to encourage newcomers to the industry because no machine can replace the skilled dental technician, especially the artistry that combines graphic design and hands-on skill. Discouraging younger people is also a disservice to patients and clients.

At my laboratory, we never say no to someone who wants to see what we do, whether as a visitor or an intern. We host seminars for dentists as well as dental assistants, so everyone can benefit from knowing the process. Sharing knowledge is a good thing in this industry. There's no need to fear it.

IDT: You've been making a lot of strides in the relatively short time you've been managing a laboratory. You must have a very clear sense of where you want to see your career go.

MT: I am definitely ambitious. I plan to take over the business more and more over the next 5 years, so my father can ease into retirement. In 10 years, I hope to completely buy out the business.

I am also thinking beyond Crown Creations. I recently became the youngest person ever voted to the board of directors for the Oregon Association of Dental Laboratories, and my plan is to be the youngest head of the association. I'd like to require all dental laboratories in Oregon to be certified laboratories, requiring a CDT on staff per a certain number of employees. Having this standard of accreditation would only benefit the laboratory industry.

Prior to entering the field of dental technology 8 years ago, Josh Throndson, CDT, 35, ran a restaurant franchise for 5 years. He's taken that business experience to become Director of Operations and co-owner of Innovative Dental Technologies alongside his brother, Darin. IDT asked his perspective on the business of running a laboratory and technological advancements within the industry.

IDT: How are advances in technology impacting the business structure of some laboratories and changing the role of dental technicians?

Josh Throndson, CDT: One major impact has been that the lines between fixed and removable laboratories are being erased. Instead of having one side of a laboratory for removables and the other for fixed restorations, technology allows us to design a denture or a partial the same way we would design a crown. It is a huge change.

These changes make it easier for smaller laboratories to expand their product offerings and offer "full-service" capabilities. There are so many product options and materials, whereas in the past there were very few options. Now restorations can be many, many different things—not just PFM or gold crowns. Today there are so many more product options and materials available to the laboratory. As a result, dentists must rely more on dental laboratories for their expertise. They need dental technicians to be materials experts and offer value through knowledge.

IDT: What kind of technological advancements do you see in the future of this industry?

JT: 3D printing will take over denture production. The field of removable prosthetics is going through the same sea change today that crown and bridge did years ago. Even without 3D printing, casting metal partials is disappearing as new materials such as CAM-milled PEEK and PEKK make the process easier than traditional methods like casting and boiling out.

We use various software programs from different manufacturers, each with their own nuances. I envision the future technician being very computer-savvy, potentially even having a CAD background, because some of the programs we use are not even based in dentistry at all. Until CAD/CAM software exists that can be used from start to finish, it would be hugely advantageous for anyone wanting to get into the field to have that CAD expertise and be comfortable with switching between and keeping up with new software and other advances in the field.

Augmented reality* will start playing a new role in dentistry in the near future. At first, I see it being used more on the clinical side, with patient case presentations. Patients will be able to see in real time how they will look based on certain treatment plans, tooth whitening, etc, at the dentist's office. They could even see the impact of different types of materials or approaches, and the dentist and technician could share this information remotely.

Cone-beam computed tomography (CBCT) is hugely valuable as well. We can use it for basic applications but also tasks such as implant planning, TMJ treatment planning and solutions, and so on. In the near future, the majority of dentists will use a CBCT scanner and send DICOM files to the laboratory, where technicians can print surgical guides, collaborate with clinicians on implant planning, and more.

The first recipient of the Northeastern Gnathological Society's Vincent Alleluia Technician Award, Olesea Galusca, 30, is a Dental Technologist at NYC Prosthodontics in New York, New York. There she does everything from pouring molds to receiving hands-on training for all types of cases, even incredibly sophisticated restorations of cleft palates and jaw reconstructions.

IDT: You grew up in Moldova and became a flight attendant after attending university in Romania. How did you come to start a career in laboratory technology?

Olesea Galusca: As a flight attendant, I was based in Dubai, where I had a friend who owned her own laboratory/clinic. When I started thinking about a career change, I visited her laboratory. I was so intrigued by the combination of science, artistry, and engineering that went into making restorations. That's when I decided this was something I really wanted to learn and be a part of.

IDT: Have you found that your experience outside dental technology helps you in this field?

OG: As a flight attendant, I learned how to talk to people and read their expectations, which is directly applicable when I work with patients. Time management on a flight is critical and so is being able to depend on the people you work with—just like in the laboratory. You need to know your team and tools to get the job done, but you also must be flexible and accommodating.

IDT: You graduated from the New York City College of Technology program in 2017. What differences have you observed between learning in school versus working in your current role?

OG: In school, everyone has to work on their own with minimal guidance, but in the laboratory, we all support each other to complete the job. It's collaborative, not competitive. Plus, I have immediate access to dentists and more access to patients. I have a better grasp of function and occlusion now that I can see the clinical side, which would not happen in most other laboratories.

I feel really lucky because I work with dentists and lifelong laboratory technicians who are at the top of their fields. They told me from the beginning that they were going to teach me everything. One of my first cases required implant restorations. It has been challenging, but I have really increased my knowledge of the steps and the process. I still consult my colleagues often, of course, especially on esthetic cases.

In school, we learned all the analog processes, and learning to work with metal was so challenging because it's so precise and not easily repeatable. While metal can be used for CAD/CAM, we simply do not use it at all in this laboratory. There is a greater range of materials in the laboratory compared with the limited number of materials in the school.

IDT: Where do you see yourself in the next 5 or 10 years in dental technology?

OG: Right now, I'm just very passionate about this job and want to continue improving my skills. It is still so early in my career; I want to grow and educate myself. I'm planning to become a CDT and get involved in research opportunities, perhaps author a case, and learn more about photography. There's so much to learn. My colleagues here have been in the industry a long time but are still interested, talented, challenged, and successful. I'm also inspired by how we can change the lives of patients through processes such as jaw reconstruction, fixing cleft palates, or just improving someone's smile. I'm really excited about the opportunities in the industry and very glad to collaborate and learn from so many people.