The Integration of Laboratory Technicians Into Clinical Practice

In a digital workflow, instead of receiving a handwritten laboratory slip with short instructions tossed in the box with the impression, the technician has so much more information and can communicate with the dentists using visual aids that aren't available in the analog world. Relatedly, the impact of digitalization in dentistry seems to be having another effect that may become more widespread in the future, and that is the trend of practices employing in-house dental technicians. Dental offices implementing more digital processes can benefit strongly from the presence of a dental technician in the building. When implemented correctly, this can reduce treatment times tremendously as a result of more efficient communication and resource allocation as well as reduced logistics requirements.

The concept of dental technicians working in dental practices is not new. In fact, in Germany, the concept of "praxislabor," or "the practical laboratory," which refers to a dental laboratory owned by and located in a dental office, is becoming much more commonplace. However, leveraging the benefits of having an in-house technician doesn't require practices to incorporate an entire in-house laboratory.

Bringing digital dentistry solutions into practices necessitates having someone on staff who possesses the skills and expertise to effectively operate the equipment. In many cases, dentists rely on dental assistants for such tasks, but this doesn't yield the same benefits as having a trained digital laboratory technician available. Digital dentistry solutions streamline the production of patient-specific devices, such as night guards, dentures, and crowns, but the entire process requires involvement from a highly trained expert. Although the process of making molds of patients' mouths has been overtaken by the use of digital impressions acquired with 3D scanners, the resulting digital files can't be immediately sent to a 3D printer for production. There is additional work that needs to be done to these files to optimize them. Moreover, 3D printed devices don't come right out of the printer ready to be inserted into a patient's mouth. Before dentists can use 3D printed devices for patient treatment, a few more actions are required to post-process them. Having an in-house dental technician who can optimize the patient scans, initiate the print jobs, and finish the appliances can have a significant positive impact on the timelines and quality of the treatment. There are many benefits that can be realized by employing an in-house laboratory technician, including the following:

• Enhanced collaboration. When clinicians and laboratory technicians collaborate more effectively, it results in improved communication that leads to better treatment outcomes.

• Streamlined workflows. Having an on-site technician enables real-time feedback for rapid iteration on device designs as well as in-house oversight of the production process, including quality control, which results in faster identification and resolution of any issues.

• Supply chain control. Manufacturing devices in-house mitigates risks regarding delivery times, reduces costs required for transportation, and benefits the environment due to fewer logistics requirements.

• Improved patient experience. Fewer required visits for scans and fittings and the availability of quality same-visit provisional restorations ultimately minimizes the impact of dental procedures on patients' lives.

This trend of employing in-office technicians is being driven by some of the most innovative clinicians, including Roxanne Lowenguth, DDS, MS, of ROC Perio & Implants in Rochester, New York. This periodontal surgical office was an early adopter of digital technology, including digital radiography, cone-beam computed tomography, intraoral scanning, and implant planning software. In 2018, the office fully committed to making 3D printing a part of its workflow. After conducting a thorough evaluation of commercially available printers at that time, the practice selected 3D Systems' NextDent^® digital dentistry solution.

Lowenguth and her team fully leveraged their partnership with 3D Systems to integrate the new technology into the office. "Not only is the technology superior to others, but the education and training that we received from the company was outstanding," she says. "From the moment our machine was delivered, we received pretraining instructions regarding the setup, required materials, and space and other requirements to plan our in-house training. Our liaison, April Newell, RDH, made herself available at any time to facilitate the process of integrating NextDent into our office. Because we were afforded time to review the process and practice printing, the training of our team was seamless, and the few stumbles that we experienced along the way were easily rectified with a phone call."

A technical team of two brothers, Matt Jones and Adam Jones, runs Lowenguth's in-house digital laboratory. The daily print jobs include occlusal guards, clear retainers, surgical guides, and provisional restorations, such as crowns, bridges, and hybrid and full dentures. With the inclusion of the NextDent digital dentistry solution, ROC Perio & Implants has not only streamlined patient care in its office but also empowered its digital laboratory to be able to assist referral dentists with their printing needs. Following the success of its first printer, the in-office digital laboratory has also added some smaller printers to increase productivity.

Digital dentistry solutions can be pivotal for modern dental practices due to their ability to enhance precision, efficiency, and the patient experience. However, these solutions are not one-size-fits-all. When integrating 3D printing workflows into a clinical setting, there are many factors to consider for success, including the following:

• Start with the application in mind. When considering new digital equipment for implementation, think about the target application or applications for which you want to use it. How will it benefit the practice and the patients? Start small and build on your successes to expand the applications. To maximize your investment and outcomes, partner with a solution provider that not only understands the technology but also has deep expertise in dental applications.

• Post-process for success. Proper post-processing of any 3D printed medical devices is crucial to achieving biocompatibility and optimizing the mechanical properties. There is no cutting corners here. These materials will only work if the manufacturer's guidelines are followed.

• Realistically leverage your production. Use your technician to the best of his or her abilities, but don't stretch it too far. Your chairside system and team should be specialized in efficiently producing quality provisional restorations. Although these restorations will later be exchanged for high-end, esthetic final restorations manufactured by an external laboratory and a technician specialized in that, they can use the same data that your in-house technician used.

• Invest in relationships. Operating digital dentistry equipment, such as 3D printers, requires not only deep dental knowledge but also a good understanding of IT infrastructure, including computers, networks, backup systems, cybersecurity, and more. Leaving all of these crucial items to your dental assistant will likely not get you the intended results. Therefore, beyond investing in an in-house technician, it's imperative to engage in a long-term relationship with your solution providers. The best maintenance is preventive maintenance. This approach will help mitigate the costs of downtime, the need for replanning, and patient disappointment.

The significance of digital dentistry cannot be overstated. It has revolutionized the landscape by providing a platform for enhanced collaboration and elevating the overall patient experience. When digital dentistry is paired with employing an in-house dental technician, dentists and dental assistants can dedicate more of their valuable time to being chairside with their patients, reinforcing the human touch in dental care. Simultaneously, the dental technicians are better positioned to focus on intricate tasks such as planning, designing, and fabricating prosthetic appliances, ensuring precision and excellence in every aspect of dental treatment. Embracing digital dentistry and bringing the laboratory technician into the dental office opens the door to a whole new realm of possibilities for the convergence of innovation and personalized care.

Stijn Hanssen is the director of Dental Applications & Business Development for 3D Systems.