The Dental Technician of Today and Beyond

Technology in the dental laboratory has been evolving at an unprecedented pace. In fact, we have witnessed more innovation and change in the past 5 years than we have in the previous 50. These innovations may feel overwhelming at times; however, one's perception is one's reality, and what one may perceive to be happening quickly becomes their reality. The profession's perception of digital technology's role in the dental laboratory has certainly changed.

"I am definitely a different technician today than I was 10 years ago, from a business standpoint, working standpoint, workflow, and vision," says Joshua Polansky, BA, MDC, owner of Niche Dental Studio in Voorhees, New Jersey. "Things have definitely changed from the artist/handmade workflow. I still do a ton of handwork because doing the finishing touches by hand sets me apart from my competitors. But CAD/CAM does everything else. I have milling machines and 3D printers and will invest in any technology that will help me have a more efficient digital workflow. Without technology, I couldn't own a business today."

Digital technology offers so much in the form of efficiency and consistency; however, one important factor that is not often spotlighted is the elevated level of communication it offers. Never has it been easier to communicate and collaborate while viewing the same image or design using different media.

"Our role is more collaborative now and especially since we moved more into digital," says Jessica Birrell, CDT, owner of Capture Dental Arts in West Jordan, Utah. "Laboratories that did not move into digital and were fearful of it have seen their work significantly decline. Those who are embracing digital are now collaborating more with their dentists to help them be successful with digital technology and become partners for their mutual success." Similarly, Mark D. Hidde, CDT, owner of Rogue Valley Dental Arts in Medford, Oregon, reflects back on how his laboratory, which was previously owned by his father, functioned in the past compared to today. "The roles of the dental technician and dental laboratory have certainly changed," Hidde says. "Not so many years ago, communication with dentists was very limited, whereas now, I am communicating constantly with clients and it's truly a two-way street." This has become a necessity as material and restorative choices have expanded exponentially. Many dentists rely on the laboratory as a resource—to ask about a particular material that they might have heard about at a lecture, one they are thinking may be best for a particular patient, or which material would be the most durable for a particular patient's occlusion. These types of conversations solidify a greater working relationship and fortify a synergy, whereby the laboratory becomes truly an integrated part of the restorative team with specific expertise in material science and technology.

Expertise in restorative material science and fabrication methods has elevated the role of dental technologist from vendor to trusted advisor. Whether managing an in-house laboratory working intimately with the dentist and patient or owning a larger laboratory organization and consulting over the phone or in person, the dental technician's role is now, more than ever, as an integral partner with the dentist to achieve the best results for the patient. "The dental technician is now at the forefront, whereas 10 years ago, the dentist was dictating everything," says Polansky. "Dental technology skyrocketed in such a way that dentists have no idea what is going on. Which fabrication methods or materials are best to use? Therefore, they are really relying on the dental laboratory for that specific knowledge and expertise." Luke Caruso III, CDT, President and COO of Ottawa Dental Laboratory in Ottawa, Illinois, echoes those sentiments and agrees that the roles have changed. "Talent isn't always just about what you can do with your hands anymore; it has now become more about technology, the comprehensive oral environment, and communication that makes a technician really strong in the work environment," says Caruso. "Our seasoned technicians and those with specific dental knowledge are not at the bench working on cases; rather, they are case planning and advising our clients on patient outcomes. As a company, we need to manage that person's time to provide the greatest value for our clientele and the company." With its four locations, Ottawa Dental Laboratory has experienced such success that the company is currently building a centralized digital center to support its business growth.

As the role of the dental technician continues to dramatically change, so does the need to acquire specific knowledge and skill sets to attain the position of valued advisor. Sander Polanco, MDT, Owner of FMR Prosthetic Center in New York, New York, shares that, "Dental technicians need to broaden their knowledge on other facets of the field, such as guided surgery, implantology, removables, and fixed prosthetics," says Polanco. "You cannot only be a fixed technician or a removable technician anymore. Digital technology has helped us break down that separation by providing for technicians to be involved in all aspects of dental technology."

The complete and comprehensive technician is a philosophy shared by many today, which has evolved in recent years through the support of complex case planning and restorative protocols that were difficult or unattainable prior to digital means of fabrication. Now, with the technology and materials to fabricate these complex restorative options, technicians must be versatile in all aspects of dental technology, because at the end of the day, dental technicians restore the oral functioning environment, which often involves a combination of removable, implant-retained, and/or fixed solutions. "Technicians should take their knowledge in their own hands and seek out courses, conferences, books, magazines, and social media," Polanco says. "Many times we need to educate ourselves." As a lifelong learner with a hunger to continue learning, Polanco believes in this mindset wholeheartedly. This is what will set apart technicians as time goes on.

However, finding the personnel with the knowledge and skills to take on the roles of consultant, materials expert, and master of laboratory restorative procedures and techniques seems all but impossible. Caruso and Hidde say that they are looking to hire or promote a very special kind of person these days, one who understands both the artistry and technology involved in the processes. "We still need technicians who understand color, translucency, and so on, and that's becoming more and more difficult to find," says Hidde. Dental laboratories today must think outside the box for ways to find candidates and often cultivate them internally. Caruso's laboratory currently employs three trainers and offers its employees a paid progression educational system that allows a self-initiated test-out at each level that is peer reviewed. A written comprehension test and a hands-on, pass/fail skills test must be successfully completed at each level. Level Four mandates the technician become a Certified Dental Technician (CDT), which the company financially supports. "It shows people a path of progression," Caruso says. "We promote from within, and there is really no ceiling. It's up to the individual to decide how far or how much he or she is looking to progress within their career." For smaller operations, it's often the owner who is the knowledge keeper and needs to step away from the bench to take on the role of teacher. "As a laboratory owner, I now spend a considerable amount of time teaching dentistry to my employees," says Polansky. "It's not all in how to fabricate the restoration, but also how it will work in the mouth and why."

Technicians today also need to be more involved in what the dentists are doing. "You need to be in their world to understand how to best support them," says Hidde. "Get involved with study clubs and implant courses, and take the time to speak with dentists regularly about their practices, their structures, what challenges them, or what they want in a relationship with a laboratory." He believes that it is critically important for the laboratory to be ahead of what the dentist wants. Be progressive and learn everything that can be learned about technology and materials so that the dentist can always look upon the technician for any questions. Being an information resource for dentists is absolutely vital for laboratories in the future. If the technician understands what dentists are faced with every day in their practice, then she/he can better support and communicate with them.

Polanco lives by the philosophy of constantly educating yourself and growing your working knowledge. He is a laboratory owner who graduated with a computer engineering degree at the same time that his brother was attending college to learn dental technology. Polanco read all of his brother's books and learned all he could about dental technology. That ultimately led him to join the profession, and he now runs a progressive dental laboratory. "Besides acquiring digital and technical knowledge, technicians need to learn how to better communicate with dentists and oral surgeons," Polanco says. "It is important to learn the clinical aspects and vocabulary and be chairside to see what dentists face. I personally read a lot of clinical books because I need to learn all I can about clinical procedures, treatments, and challenges. The more I know, the easier it is for me to communicate and offer solutions."

"Learn as much as you can today. Be a sponge, and don't stop learning," says Polansky. This is a skill that he believes is needed in this industry. Digital is not going to take the technician out of the equation. "If you have the skills to be the best technician with your hands, then learn how to become the best technician digitally; now you are a triple threat," he says. "You have the knowledge of a dentist, the skill set of an old-school technician, and the computer skills of the modern technician. Master it all and never say there's only one way you can do a case. Stay positive. For me, this is the best it's ever been."

Offering this level of dental knowledge and resourcefulness for the dentist can truly be revolutionary for our profession. "We find that the deeper a dentist dives into digital technology, like by fabricating restorative materials in-house, the more they recognize and value a knowledgeable dental technician. It is simple to push a few buttons and out comes a crown, but the foundational knowledge of how and what we are designing and how it affects the patient's health will always be of importance and allow a collaborative partnership," says Birrell.

The transformation of the laboratory industry is not only expanding the role technicians play in the restorative landscape but also allowing dental laboratories to develop interesting and innovative business models that veer from the conventional mode of business practice, all facilitated by technology and creativity. Birrell has created a new business model for her laboratory that directly correlates the amount of time a skilled dental technician expends on a particular restoration to the cost of that restorative appliance. "We price everything according to time," she says. "The time needed to complete a restoration is how the price is established. A monolithic restoration has become our economy option, and if we need to layer porcelain to get a higher quality, the price reflects that hands-on effort. We've educated our dentists to understand that if the patient demands more to match a particular shade, this will require more of our time and the price reflects the extra time spent. Now the conversation with the dentist focuses on the patient's desires, needs, and price point. Most dentists leave it up to the patient to decide the level of quality."

Similarly, Polanco feels that new and different business models will certainly continue to evolve. Whether by offering design services for dentists and other laboratories or offering porcelain micro-layering services for chairside-milled restorations, he believes technicians need to look for opportunities to position themselves where they can offer the greatest value. "I think dental technicians will have the opportunity to carve out their own role in the future," he says, "working as a milling center or designer for a smaller laboratory, or, for a few, venturing out on their own." This is a unique business environment that offers an innovative laboratory the opportunity to really set itself apart from the rest.

Caruso feels the same for his laboratory and wants to encourage his team member technicians to think outside the box. "We are constantly finding new divisions and products within our company," Caruso says, "and when we find new opportunities for the right technicians who are up-and-coming young leaders with good attitudes and work ethics, these employees are the ones taking these new products/divisions to the next level, and providing the laboratory with new revenue streams and viability."

Among the many positives of adopting digital technologies, work-life balance and creating a positive work culture seem to be great benefits for the laboratory. "Ten years ago, I worked around the clock waxing, investing, layering, fixing, and so much more that digital is now doing for me," says Polansky. "We are a seven-person laboratory with the strength of an old-school 15- to 17-person laboratory. The machines are working overnight, and it's a different game today." Polansky and his team now work 40 to 45 hours a week, with no weekends spent at the laboratory. "Everyone starts in the morning and leaves at the end of the day," he says. "Digital has given us normal lives again. It's the first time in over 20 years that I can go on vacation and not work on the weekends. Internally, the laboratory is a totally different place today, with less stress and more consistency."

Hidde and his team work only 4 days a week, which he believes allows everyone to be creative and productive, and then have time to recharge over a three-day weekend and pursue their personal lives in full as well. "Dental technicians are incredibly passionate about what they do at the laboratory, but they all are equally passionate about their outside interests and hobbies," he says. "It is very important that they have a chance to go and pursue those hobbies and enjoy a well-balanced life."

Birrell passionately shares the belief that there is so much more to life, and by creating a healthy work-life balance, a laboratory owner can achieve more. "Many laboratory owners pride themselves on how hard they work and the hours they keep," she says. "I realized that if I wanted to own a business, I needed to understand business. I recommend all laboratory owners read Michael E. Gerber's The E-Myth series to look at all facets of your business and life as a business owner." In one book, Gerber asks: "One thing in life that we can never get back is time. So what is the best use of our time?" Birrell took these questions very seriously and hired a life/business coach to grow her business and create a work-life balance. She believes to operate a successful laboratory you do not need the best skills as a technician, but you absolutely need good skills as a businessperson. She asked herself and sought answers to two questions: What do you want to do with your life, and what do you want to accomplish? She then built her business around those core values. "Break it down by your yearly, monthly, and daily goals," she says. "This is very important, because if you make time for everything that recharges you and makes you who you are, then you show up to work fulfilled and focused on building the business of your dreams."

Establishing a good culture in the laboratory is paramount in order to have a holistic team that equally contributes to and celebrates the successes as a whole. The cultures that Hidde and Caruso have built in their laboratories revolve around passion and a willingness to help others. Caruso's core values ground everyone around the key goals of passion, professionalism, loyalty, customer service, innovative excellence, and collaborative success. He says these values are behind every decision the laboratory makes and ones the laboratory needs to succeed as an organization. "We work hard to take any negativity out before it spreads," says Caruso. "Energy and interest in what people are doing are critical for each technician's success. The world is moving so fast, faster than it has ever before, and you need to have a certain level of passion to excel in this field."

Rapid change will continue to impact the industry and its structure. The traditional breakdown of departments will change, and CAD/CAM will be supporting every single department within the laboratory. Technology will become a center for the laboratory and almost necessitates its own business model. Digital technology does create more collaboration with the dentist. Some technicians feel like it cuts them out, but in reality it just creates a different channel to get closer and better collaborations. Technicians of the future will be excellent communicators and operate daily with the dentist and technology, according to Polansky. "You can't fight the evolution of the industry, and history is a perfect example," he says. "Just look at Kodak and others. This is going to happen, with or without you. I decided 7 years ago to slowly dip my feet in, and now I am all in."

There is no question that the profession will continue to progress and innovate. The processes and treatment protocols of today may appear quite different in the future as innovation continues within and around our profession. One thing is for sure, though: those who have the proper attitude, passion, and willingness to learn will excel and thrive in the future. Innovation and change are nothing to fear, but harnessing that progress, growing with that change, is the true way to evolve. Keep in mind that change is a good thing and complacency is not. If one feels they know everything there is to know, then they are, in reality, moving backward as the rest of the world steadily moves forward. "The benefit of digital for me and my laboratory is that it affords me the opportunity and time to help educate my clients and guide them through these cases," says Polansky. "But the greatest benefit that I found is that it provides me with more time to do the things I enjoy and the things that grow the business."

1. Futuyma D. Evolutionary Biology. 3rd ed. Sunderland, MA: Sinauer Associates Inc; 1997:4.