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What do you do when you find out your lab has closed?
What do you do when you find out your lab has closed?
What happens when the owner of your lab unexpectedly dies?
What do you plan to do when they just throw up their hands and quit?
Keep these questions in mind for the close of this article. (I'm not going anywhere!)
By Jon M Berry CDT
Don’t give up on “Hand Fabricated” yet!
The dental lab profession has been rapidly changing for a number of years. There have been remarkable moves in technological capabilities with scanning and milling machines. This has been forced by the hard reality that lab schools have mostly closed across the country and no new technicians are entering the field, and the constant that it takes a lot of time to train a highly qualified ceramist.
That was the impetus to develop pressable glass like Authentic, Empress and Emax. It was easier and quicker to train a waxer (1 month) than it was to train a ceramist (min 5 years). Wax and press to full contour, cut off the sprue and spay a glaze on it and you have a “tooth”.
While it was a quick short term solution, it also helped give “Hand Fabricated” restorations a bad name due to the large production facilities filling those positions with trainees who never learned tooth morphology, substrate design, occlusion or even anatomy. The “Hand Fabricated” reputation really took a hit!
Enter the age of milling machines with all the promises of precision and improvements over hand fab crowns. Little did anyone know, the “technicians” at the controls were merely high school grads that liked playing video games. The technology built into the scan software kept them in the ballpark, but without the basic information as listed before, many milled restorations failed miserably. To this day, many dentists are gun-shy of prescribing a layered zirconia restoration due to the overlay porcelain shearing problems that happened early on.
Many of the problems that caused so much concern, could have been eliminated had there been someone who had the experience and knew what to do in the design process. There wasn’t! There still isn’t. It costs too much for a production lab to have a qualified QC or instructor on staff.
Recently a dentist brought us a single crown that had been remade four times by his previous lab. Each time that lab’s QC controllers (yes – four different controllers) all promised the work would be right the next time. Each time it was still wrong! (Not to mention there were other problems that would have made the crown unacceptable as well, but weren’t even brought up!)
“But I do mostly single full contour crowns, how bad can that be?” some dentists ask. That crown I just mentioned was a single full contour zirconia milled restoration – by a lab that does thousands of those restorations a year. You would think they would have figured out how to do it by now.
One milling center owner expressed his concern to me one day at the Georgia Dental Lab Association Board meeting. We both are Board members and we were discussing the way our field has been changing. He has a very real concern that when all of the milling machines are all running the same milling libraries, there will be no competition for quality anymore – only price. When the outside pressure from restorations being milled in China is combined with a price driven American market, the concept of “quality” will be defined by milling software and who can mass-produce a crown for the lowest fee. In other words, quality will be an anachronism and price will drive the market. You won’t really get a choice except cheap and cheaper.
There undoubtedly will be some who say that’s fine by them – the cheaper the better. “More money in my pocket”, will be their rallying cry. You have to wonder what has happened to the “standard of care” all of us older technicians had to abide by as de-rigor protocol.
We are told the technology has gotten better over the years since its inception. I will tell you, it has! The materials have also improved in strength and esthetics. The problem is the little fact that every milled crown needs a good bit of finessing by a well-trained, experienced technician to correct some of the issues that are present with all milled restorations. This hasn’t changed since the first milled crown rolled out of the machine. Those corrections are necessary and have been necessary on every milled restoration I have seen since Berry Dental did the first one. We’ve worked with well known milling centers from across the country, from New York to California, from Texas to Minnesota and just about everywhere in-between. We’ve also worked with all of the local milling providers in Georgia. Every single restoration needs some “hand fabricated” know-how to make these restorations truly meet any reasonable “standard of care”.
Now what does all this have to do with my opening list of questions? When your lab tech dies or closes or just quits?
The executive director of the NADL, Bennet Napier, and I were talking at the last Hinman Dental meeting. He said six years ago, there were over 12,000 labs that had a payroll, were open in the United States. As of last March only about 5500 remained! That is an over 50% attrition rate in 6 years! It is now mid October and that number continues to drop. Experienced technicians are leaving the field, retiring, and unfortunately dying in record numbers. No lab schools mean they aren’t being replaced. I can’t even count the number of lab owners who have died in the last ten years.
Where are you going to go when you need more than a single crown done? When the patient needs more than a stopgap solution, but can’t afford an all-on-four implant restoration? What happens when those few qualified “all-on-four” technicians reach critical mass and can’t take on more work? Where are you going to find an experienced lab technician who can assist you through the process of restoring a difficult case? In five years, this new crop of so-called “technicians” will have CDT status under their belts (because they’ve worked in a lab for 2 years and can pass a constantly dumbed down multiple choice questionnaire exam.) The machines do all their thinking for them, and they never had to learn anything to keep their jobs! What then? I know of a number of them just like this.
Before it’s too late, it is time to take this problem on and determine to not leave yourself subject to the whims of milling centers with no real motivation to beat any other lab on quality. It’s all the same libraries after all!
Over the term of my GDLA Board membership, I have seen a number of labs fire all of their technicians and send work to offshore milling centers in China and Viet Nam for pennies on the dollar. These aren’t obscure labs no one has heard of – these are well recognized names right here in Georgia. Labs I would have never thought they would outsource any portion of their work. Yet they do. They require their remaining employees to sign non-disclosure agreements so the dentists never find out what they are doing. Some of these labs are explicit that their work is done here in Georgia and their doctor clients believe them – yet it is doubtful the owners even know how to hold a spatula and can still turn out hundreds of crowns a day from a 500 sq. ft. office “laboratory”.
In the last two weeks, two lab owners have died from cancer. Another one died a couple months ago from a heart condition. I know several who have left the field completely – one going into home renovation and the other bought a dry cleaner business. Some just go play golf and never look back.
If you know of a lab – like Berry Dental Lab – that still fabricates most of the work by hand, and takes the time to put the finishing touches that are so necessary to milled restorations, support them! Recommend us to your peers! Keep us busy and productive. Its not just our future you are preserving, it is also yours and your patient’s dental future as well. Don’t let dental technology get lost in the rush to the bottom of a pile of milling dust.
Support your local lab… or find one like Berry Dental!
-- - Jon M Berry CDT is a lifetime dental technician with over 44 years experience at the bench. He has held positions in large and small laboratories as the Quality Control person, the lab manager, department manager, supervisor, technical instructor and technician. He has owned Berry Dental lab for over 31 years and has been a Certified Dental Technician for over 35 years.