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    Inside Dentistry

    September 2009, Volume 5, Issue 8
    Published by AEGIS Communications


    Dental Labs: A Vital Key to Your Success

    By Allison M. DiMatteo, BA, MPS

    Dental school graduates receive little or no laboratory education and, as such, they may be underutilizing their best resource for new technologies. The modern dental laboratory is more than just a restoration factory. It is the forefront of new equipment, materials, and techniques that are shaping the future of dental care.

    Ensuring that laboratories fully understand not only the proper processing of laboratory products but also the correct selection and use of innovative clinical support products is a top priority for companies like Ivoclar Vivadent. How to properly use different types of cements has become a very hot topic in the industry, explains Michael Gaglio, DDS, vice president of marketing. Understanding preparation guidelines and new impression techniques, as well as being able to explain them to the clinician, helps laboratories to support their customer, the dentist, by providing a value-added service, he says.

    During annual roundtables that Kerr conducts, an ever-changing group of dentists has an opportunity to discuss the products they need in the practice. What’s reinforced during these meetings, explains Greg Rome from Kerr Corporation, is the fact that whether it’s porcelain or composite, dentists many times leave the decision about what material to use for a case up to the laboratory technician. Or, they will rely on the laboratory to recommend what to use—whether generic material or a specific brand. Other times, the doctor will specifically request the material based on the indication, Rome says.

    “I think there are laboratories that recognize that they have a very important role to play in the industry as it relates to providing input and advice to dentists, and there are others that haven’t recognized that yet,” believes P. Christopher Holden, president of Heraeus Kulzer, LLC. “For those laboratories that do, we work side by side with them to help them educate their dentists, for two reasons. If the dentist is better versed with the technology, they are more likely to have success and to communicate more clearly with the lab. This leads to more predictable and better results for the patient, as well as an economic benefit for the dentist and the laboratory.”

    This month, Inside Dentistry strives to further an understanding among dentists of the value of working in concert with their laboratory not only on a case-by-case basis, but with their laboratory as an education and treatment planning resource to deliver the best care to their patients.

    First Things First: Educating Laboratories About New Products

    As dentistry emerges into new areas of technology, there’s an absolute requirement for manufacturers to provide the education for success, Gaglio says.Education really becomes an integral part of the value equation in providing an extra intangible for the customer.

    “First and foremost, when we launch a new product, at the very top of the priority list is providing education to the laboratory for this product,” Gaglio says.

    Holden explains that technology is only a vehicle to support a customer. It doesn’t exist for the sake of itself. When Heraeus Kulzer trains customers—laboratory technicians and owners—the training is developed in a comprehensive way, one that focuses not only on how to use the product, but how to better service their customers and how to talk to the customers about the expectations that their clients or even patients should have, he says.

    “It also involves a level of business training and enhancement. It’s not just about trying to utilize the product because it’s better or because it saves money,” Holden explains. “With offshore outsourcing becoming more prevalent and a number of dental companies supporting that, we have taken the position not to support offshore manufacturing and instead to support domestic manufacturing. As such, we are committed to helping those businesses not only survive in this economic climate, but also thrive. We offer a strong brand in Venus to our laboratory partners, as well as business skills training to help ensure they have the necessary tools to compete.”

    According to Rome, educating laboratories about new products and technologies encompasses multiple layers of information sharing and training. There are letters focusing on announcing the introduction of a product, and education that takes place in many forms, he says. From launches on the Kerr Web site to procedural guidelines and studies, as well as product manuals, DVDs, and videos, educating laboratories spans a variety of formats.

    “Courses are put together and training is conducting in conjunction with major conferences,” Rome elaborates.

    The Role of Laboratories in Product Development and Testing

    The role of the technician and the laboratory owners is crucial for product testing, explainsGaglio. He says that Ivoclar Vivadent iscontinually surveying laboratories, running focus groups, and gathering information from laboratoriesin order to develop products that they have aneed and use for, as well as which they see areason to implement into their businessstructure.

    “To create products outside of their need base really doesn’t support the growth of dentistry,” Gaglio emphasizes.

    When talking primarily about indirect technologies, Holden says that the dental laboratory plays a huge role in product testing because they are the real manufacturers of the finished product. The success of a technology or product, whether it’s a powder, block or any other kind of indirect technology, is largely based on how it’s used, he says.

    “We have had our share of products for which we could have done a better job of utilizing feedback specifically from technicians and laboratories,” Holden says. “From learning lessons the hard way, we utilize input from technicians from key markets around the globe to ensure that what we are building isn’t country-centric, because technologies need to have a broader platform.”

    Rome details a manufacturer/laboratory relationship in which dental laboratories are key to the new product and idea pipeline, with labs polled and surveyed regarding the feasibility of ideas and then involved in prototype testing and evaluations. Some dental laboratories may assist with formulating instructions for use/processing, as well as pilot production before official product release, he says.

    Laboratories as Gatekeepers of New Product Information

    Among dental laboratories, the perception of whetherdentists are aware of new products, materials,and technologies varies considerably. Further,the basis for their opinion also varies depending on how actively theybelieve clinicians are choosing to seek out andbecome informed about new restorative options.

    “I think to a certain extent, dentists are aware of new products. For instance, most doctors seem to know about non-metallics, but they often get confused with the different brands and types that are available,” explains Kareen Chamberlain, marketing director for Continental Dental Laboratories. “With everything from zirconia crowns to glass disilicates, often times it’s our job when dentists call us to educate them about the differences and the benefits of prescribing these restorations, not to mention the preparation and cementation requirements.”

    On the other hand, some laboratories feel that dentists are not aware of what’s available, because marketing literature—or anything with a price on it—seldom is read, according to Billy W. Drake, CDT, president of Drake Precision Dental Laboratory. He bases this perspective on the feedback he received from a dentist who now works for the laboratory, who suggested that dentists are skeptical of the marketing materials they read.

    “Dentists don’t keep up with products, but instead rely heavily on other people, whether it is their laboratory technician or a sales representative from one of the dental product manufacturers,” Drake comments. “They sometimes rely completely on us to give them a recommendation about what material to use.”

    The number of years a dentist has been in the profession may play a role in how in tune he or she is with new dental products and restorative materials, believes Shaun Keating, CDT, president and CEO of Keating Dental Arts, Inc. He believes that younger dentists and newer graduates are better able to follow up with new products and materials, while more experienced dentists and those with more years in practice may be set in their ways.

    “Some dentists don’t like to read the journals and only attend conventions for continuing education,” Keating suggests. “They may see some of the new technology coming out, but they adopt a wait-and-see attitude.”

    Of course, dentists can learn about new advancements in dentistry through dental journals or trade shows if they so choose, explains Dennis Fraioli, the owner and president of GlobaLink Solutions Dental. However, as Keating suggests, the fact of the matter is that they are not sure about them and do not keep up-to-date with them.

    “Their new greatest resource is their dental laboratory, the people who do their laboratory work,” Fraioli says. “The laboratories tend to know more about dental products because they’re using them each and every day. They spend time attending the trade shows to learn more about these materials and how to use them. This new relationship has to continue to expand between the dentist and laboratory, because the laboratory is really starting to become the technical consultant to their client, the dentist.”

    In fact, according to Scott Clark, executive vice president of Dental Arts Laboratories, Inc, most dentists might be willing to say that perhaps nothing is more confusing than sifting through myriad esthetic materials to choose the right product for any given case. The tendency for most practitioners—and rightfully so—is to become comfortable with one or two materials that provide them with predictable results, and then more or less make the patient fit the material, Clark has observed.

    “As a dental laboratory, we have the advantage of working with many clinicians who treatment plan and prescribe a wide variety of products on a daily basis. This experience is invaluable for educating our technical team so that we can better assist our customers in product and material selection,” Clark says. “We find that many dentists are familiar with a few well-known (branded) products or a category of products, but are not fully versed on the wide range of product offerings available and how they compare or interrelate to one another for optimum treatment planning.”

    Each category of material (eg, composite, stacked porcelain, pressed glass ceramic, lithium disilicate, alumina-based, zirconia-based, metal-based) provides various advantages to support different indications depending upon the case, Clark says. The various material considerations encompass strength, color, character, and overall esthetic value. He says it would benefit many dentists to spend time studying the advantages/indications of as many materials as possible so that they can consistently choose the right material to meet the demands of each individual patient.

    But, again, dentists may not be entirely aware of what different dental materials can or cannot do, says Bob Vartanian, vice president of sales and marketing for Trident Dental Laboratories. As a result, when faced with an advertisement or direct marketing campaign from a national, marketing-driven laboratory about a new product, a dentist may call their local laboratory to inquire about it, but the local laboratory also may not be aware of it, he says.

    “If the dentist is still intrigued by the product, they usually call the national laboratory to follow through with the inquiry or they don’t, leaving them out of touch with the newest products,” Vartanian explains.

    Sharing the Knowledge

    According to Chamberlain, the role of laboratories insharing knowledge with dentists has become so important with the advent of new CAD/CAM products. The variety of alternatives is confusing, she says. Therefore, it’s important for dentists and laboratory technicians to work together.

    “There are definite material and esthetic differences, and I think by communicating with the doctors, we can talk about the pluses and minuses and help them choose the best restoration for their patient,” Chamberlain says. “Case planning is so important, so if we can talk about the right product up front, it leads to less remakes for us on the back end and a happier patient and doctor relationship as well.”

    That said, dental laboratory technicians have a vast knowledge of what works and what is the reality of a restorative situation, emphasizes Keating. Some of the bigger laboratories will see more restorations and fixed prosthodontics in a month than most doctors will see in a career. This affords laboratory technicians a knowledge that can be shared with dentists to ensure mutual success, he explains.

    “We can share information with doctors about impression materials and bite registrations, what articulating system works, and things of this nature,” Keating says. “We do have a big responsibility as a dental laboratory to share any knowledge that will ultimately enhance the success of the case, whether it’s about issues we’ve experienced with certain materials or how to best use certain products.”

    At the end of the day, dentists really want to ensure that their cases go right the first time, Keating believes. They want to ensure that they’re using the right technique and following the right protocol so they’re not seeing a patient a second or third time, he says.

    “I think our biggest opportunity is to become an information resource for the dentist,” notes Drake. “In other words, dental laboratories need to always be correct in what they tell them about products and materials, but we need to also train ourselves personally on what dentists do. We can’t just be tunnel-visioned and look at cases just from a laboratory standpoint. We need to be the resource for anything connected to our cases.”

    Fraioli believes it really is the laboratory’s responsibility to take notice of new materials, read up on how these materials are performing, and keep their doctors up-to-date as to what they feel is the best alternative or best material to restore a given case. It’s all part of catering to customers and offering value-added services—knowing what the industry has to offer in terms of different materials, he says.

    Clark suggests that dental laboratories that beta test products for manufacturers may be able to share their experiences with those materials with doctors. Additionally, laboratories that work extensively in the “esthetic zone” have the advantage of working with a great variety of products based on the many combination cases that they are presented with, he says.

    “Cases that may involve several categories of materials for one individual case (ie, stacked veneers in combination with lithium disilicate crowns and zirconia bridgework) increase a laboratory’s exposure level and experience,” Clark explains. “Because dental technicians have the opportunity to work with various materials on a daily basis, it gives them insight that the individual dentist may not have access to and, therefore, enhances their role in knowledge sharing and allows them to become a resource for the dentist in the restorative treatment planning process.”

    Laboratories & Their Education Efforts

    The synergistic relationship between dentist and laboratory can benefit from educational programs conducted by laboratories for their dentist clients, suggests Fraioli. Laboratories routinely conduct seminars for dentists about various clinical techniques ranging from how to take proper impressions to achieving proper preparations for all-ceramic restorations, to new surgical techniques for implants using guide systems, he says.

    Vartanian says that Trident Dental Laboratories promotes education for dentists through all the typical means, such as direct mail, journal ads, articles that they place in journals, and their Web site content. Additionally, the laboratory’s diagnostic technicians include information at the end of a technical call to suggest other options and restorative alternatives as a means to educate dentists about available options.

    Laboratories such as Dental Arts Laboratories, Inc, provide dentists with scholarship programs to the various educational curriculums and centers with which the laboratory is aligned. Clark says this enables interested dentists to pursue further educational training. He says the laboratory also sponsors seminars throughout the United States, with various specialty clinicians. Clark adds that the laboratory’s own technicians lecture for various dental societies and study groups and share their experiences with materials, product selection, and new technologies. Free “lunch and learn” programs are also offered for dentists and their staff in the convenience of their offices on a variety of products and services, he says.

    Likewise, Continental Dental Laboratories affords dentists education about products and materials via everything from in-house seminars to patient education materials, office posters, statement stuffers, brochures, and catalogs, explains Chamberlain. However, she emphasizes that none of these education or communication vehicles are effective if the doctor isn’t interested in learning about the product.

    “Most doctors, from our experience, seem to be seminared out these days. Every laboratory and every major manufacturer seems to be pushing their products in continuing education,” Chamberlain acknowledges. “We have found that unless there is a significant appeal for the doctor or an honorarium, even with free CE credits most doctors don’t want to pay for this type of information, let alone give up their own free time without being compensated for it.”

    To educate his dentist customers, Drake uses a team of six laboratory representatives that speak to different study groups, with the number of attendees ranging from five to 10,000. These speakers, including one dentist, discuss different products and materials and what would be recommended for certain indications. These lectures encompass such topics as implants, esthetics, all-ceramics, and removables, among other topics, he notes. If necessary, the on-staff dentist will visit a practice and assist with seating or correct an issue with a case, Drake explains.

    “When we first start working with doctors, we’ll see what they send in and how things are looking. More so than not, they’ll ask for advice to make their jobs easier,” says Keating. “Much of the education we provide dentists, therefore, involves impression taking, temporization, obtaining bite registrations, and preparation design, and we offer different ideas about what materials work better than others and how/when in the process to perform these necessary steps.”

    It’s About Collaboration & Active Learning

    While laboratories are taking steps to reach out and provide information about new products and the clinical protocol that can ensure success, learning and communication about cases does require active participation by dentists. Fraioli encourages open communication between dentists with their technicians about each case that they’re doing. Photographs that they forward to the laboratory can provide a better idea of who the patient is and what the smile looks like so that thelaboratory knows what they’re trying to accomplish.

    Clark encourages dentists to attend programs such as those conducted at the Spear Institute and the Dawson Academy in order to enhance their learning and communication skills. He says both organizations provide thorough and comprehensive curriculums, and his laboratory (DAL) provides scholarship programs for dentists who are interested in developing this next level of restorative practice services.

    Considering that so much has changed in the last few years, especially with the emergence of CAD/CAM and digitalization, Chamberlain believes that the best way for doctors to actively learn about what’s available is to attend trade shows and seminars, read articles, and talk to their laboratory. This will help them to decide what is right to prescribe for their patients, she says.

    However, Drake cautions that some dentists may attend education and training programs that they’re not ready for based on their current clinical skill set. He says dentists should focus on education and training that they can apply in their dental office the next week.

    “They need to be able to take what they learn and utilize it in their everyday practice,” Drake emphasizes. “That is absolutely what any dentist needs to do.”

    But what Keating believes is important for communication and active learning is the relationship that a dentist should have with their laboratory. If there were any way for the doctor to visit the laboratory, it would be beneficial to both the laboratory and the dentist, he says.

    “This would allow the dentist to see what we’re doing and how we’re doing it, and we also can let the doctor know what we see when cases come in,” Keating explains. “In terms of active learning, we feel that bringing in dentists and their staff for continuing education offers the best benefit to help them be successful in their practice.”

    Courses span such topics as occlusion, temporization, and preparation design, as well as veneers and cosmetic dentistry over-the-shoulder (hands-on and live patient) programs, Clark says. He adds that it’s important for the educational programs to offer a well-rounded background in dentistry.

    However, whether it’s through seminars, trade shows, or professional conferences, the manner in which dentists will acquire information and obtain an education about new products, materials, and technologies is likely to change. According to Gaglio, the day of attending face-to-face classes is changing, just as the way society wants to receive information is changing radically and rapidly.

    “E-communications networks are changing the way we communicate, and they are starting to proliferate into the dental laboratories and the dental offices of today,” Gaglio says. “I think all manufacturers and educators are looking rapidly to see how we can model our information and training to better fit today’s age of information needs. The idea of holding a class six months from now on a particular technique or topic really doesn’t cut it, because in six months, that topic could be long gone.”

    Optimizing the Dentist & Laboratory Relationship

    To best enhance the relationship between dental laboratories and their dentist customers, Fraioli believes laboratories should be visible. A key person within the laboratory, and wherever possible, the owner of the laboratory, should be speaking directly with dentists—not through the office staff, he says. Inquiring about how things are going, how satisfied the doctor is, and what he orshe thought of the last case is a proactive way to a stronger relationship, Fraioli explains.

    According to Clark, laboratories must have the knowledge base in order to optimize its relationships with dentists. He explains that technicians should have higher education in order to maximize their relationship with customers and provide the knowledge base to optimize treatment design and case fabrication.

    “For example, we provide several levels of specialized service to support the various levels of case communication and required case specifications,” Clark says. “There are also improved communication tools such as study casts, diagnostic wax-ups, facebow/earbow records, incisal edge index, provisionals, and full-series photographs that build more predictability into case planning and final results for the patient.”

    Of course, Vartanian agrees that the less laboratories have to depend on verbal or written instructions, the better. Everyone’s interpretations and perceptions are different, he explains. As a result, the profession is gravitating toward scanning technology in order to reduce the margin of error that can occur between dentists and the laboratory as an inherent part of the communication process.

    Simultaneously, what can help to optimize the relationship between dentists and laboratories is if dentists maintain an open mind when it comes to the suggestions and recommendations that laboratory technicians have to offer, Vartanian says. For example, when dental technicians suggest that something won’t be ideal as part of the treatment plan, he encourages dentists to trust the technician who is working with those materials, since the laboratory is looking to avoid remakes, fractures, and an unhappy patient.

    “I think the dentists who respect their technician and value their expertise as professionals working with these materials are the ones who are going to see a better end result,” Vartanian says.

    Communication—or a lack of it—will make or break the relationship between a laboratory and the dentist. When all the laboratory receives is the prescription form for work with even the simplest mistake or omittance of information, it can lead to huge, costly remakes or a dissatisfied patient, Chamberlain explains. She elaborates that prescriptions frequently can be missing critical information, such as the patient name, shade, or type of restoration. Even though the laboratory may call the doctor to obtain this information, it can lead to delays, especially if the doctor’s office is closed.

    “We’ve spent a lot of time, effort, and money on customer relationship management software, our phone systems, and our internet applications so that we can stay as close to our doctors as possible. Every time doctors call us, we instantly have their information on the screen and any case information readily available,” Chamberlain says. “We need to have this information readily available, and it’s another vehicle for bridging that communication gap.”

    The face-to-face, personal approach is still effective for building relationships, too, Drake demonstrates. Representatives go on-site to speak and consult with dentists, provide diagnostic services, and when necessary, provide clinical assistance with cases chairside, he says.

    “We can’t work directly in the mouth, but we can coach them chairside,” Drake says.

    Keating offers other suggestions for optimizing the relationship between dentists and laboratory technicians. From establishing a dedicated technical adviser who works directly with the doctor to assigning a customer service representative specifically for that account, a relationship is built between key contacts and the dental practice (eg, office manager, assistants), he says. Additionally, a division manager at the laboratory might be brought in for some consultations, giving the dental practice a three- to four-person team with which to interact.

    “Many laboratories do the same thing. It’s something that, when it comes to successful dental laboratories and successful dental offices, requires the total relationship to be worked out at the beginning and nurtured along the way,” Keating says. “Such a solid relationship helps smooth things over when things go awry—and they will. If you have a good relationship, you accept that there are many variables in dental technology and dentistry, and you work together as a team.”

    Conclusion

    Technology and staying abreast of it will be a significant issue, especially in the coming months and years, Chamberlain believes.At every show, another latest and greatestinnovation is introduced, and much has changed just in the last two orthree years with computers and digitalization, she says.

    “Laboratory technicians and dentists need to work closer together than we ever have before, and I think our consumers are becoming more demanding than they ever have,” Chamberlain observes. “I think it’s vital for both of our successes that we communicate and understand all of these changes so we can deliver the best quality of products available.”

    Drake adds that technically, if a laboratory cannot help a dentist as far as being a resource, the dentist should not be using that laboratory because they are not helping them in any form or fashion other than furnishing them with a product. There is no value added to their service, he says.

    “As a manufacturer, our role is to help facilitate the relationship between the dentist and the laboratory. That relationship is facilitated through education and training, as well as through product development and better use of products and technologies,” Holden explains. “You know, really all we are is a facilitator. What we think we can do with the dental laboratory is to help them take this current economic environment and utilize it to their advantage, because there are opportunities no matter what the market may look like.”

    In today’s environment, facilitating relationships involves troubleshooting, answering questions, and cultivating a level of confidence among dental professionals—laboratories and dentists alike, Gaglio says. Using information and communication technology enables a responsive approach to restorative problem solving that ultimately benefits patients in a timely manner, he suggests.

    Whether for product education or case management in general, communication between the doctor and the laboratory is the most important aspect affecting the success of the relationship, Rome comments. It can always be improved, he says, adding that he is always amazed at how there is a disconnect of the two industries, especially when they need each other to survive.

    The Inside Look from...

    Without the candid comments shared by our interviewees, this Inside look at dental laboratories as a resource for the dental profession would not have been possible. The staff and publishers of Inside Dentistry gratefully acknowledge the following individuals, all of whom made valuable and insightful contributions to this presentation.

    Jim Buchanan
    National Manager of Key Accounts
    3M ESPE
    jsbuchanan@mmm.com

    Kareen Chamberlain
    Marketing Director
    Continental Dental Laboratories
    kchamberlain@continentaldental.com

    Scott Clark
    Executive Vice President
    Dental Arts Laboratories, Inc.
    sclark@dentalartslab.com

    Billy W. Drake, CDT
    President
    Drake Precision Dental Laboratory
    Bdrake@drakelab.com

    Dennis Fraioli
    Owner/President
    GlobaLink Solutions Dental
    dfraioli@glsdental.com

    Michael A. Gaglio, DDS
    Vice President of Marketing
    Ivoclar Vivadent
    Michael.Gaglio@IvoclarVivadent.us.com

    Hans Geiselhöringer
    Global Head
    NobelProcera and Digital Dentistry
    Nobel Biocare
    nicholas.wiedmann@nobelbiocare.com

    P. Christopher Holden
    President
    Heraeus Kulzer, LLC
    Chris.Holden@heraeus.com

    Shaun Keating, CDT
    President & CEO
    Keating Dental Arts, Inc.
    shaun@keatingdentalarts.com

    Greg Rome
    Kerr Corporation
    Greg.Rome@sybrondental.com

    Jan Slor
    Vice President & General Manager
    Dentsply Prosthetics
    Jan.Slor@dentsply.com

    Ralf Suckert
    President/Owner
    Teamwork Media Publishing Group
    r.suckert@teamwork-media.de

    Bob Vartanian
    Vice President, Sales & Marketing
    Trident Dental Laboratories
    bvartanian@tridentlab.com

    The CAD/CAM Milling Center Connection

    CAD/CAM technology is changing the face of dentistry and, subsequently, how dentists and laboratory technicians will approach treatments. However, according to Hans Geiselhöringer, global head of NobelProcera and Digital Dentistry for Nobel Biocare, a large number of dentists can significantly benefit from the latest CAD/CAM materials and product introductions because the range of treatment options for natural teeth and implants can be easily adjusted to the individual’s needs. In order to offer their patients the best possible treatment, he feels it is incumbent upon industry to ensure that dentists have access to the latest information and developments.

    “Our latest technology, material, and product offer, for example, comes with clear benefits for the dentist, the dental laboratory, and also the patient,” Geiselhöringer says of the NobelProcera CAD/CAM system.

    In fact, CAD/CAM in general is leading dentistry through a paradigm shift. “We are moving from a traditional workflow into a digitized workflow for both dentists and laboratory sites,” explains Jan Slor, vice president and general manager of DENTSPLY Prosthetics. As such, when assessing dentist awareness of new products and materials, he believes new technologies—and in particular, CAD/CAM—should be included in the evaluation.

    “Then I would say that dentists, in general, are aware of new products and materials,” Slor observes. “For example, zirconia is well known for its high strength and ability to be used intraorally in the anterior and posterior regions of the mouth, and it’s a material that can only be fabricated through CAD/CAM milling systems.”

    Slor elaborates that 69% of dentists indicate that their laboratories use some type of CAD/CAM technology. In other words, almost 70% of dentists do know about this material and understand that it must be fabricated using CAD/CAM technology, he says. What’s more, he notes that these dentists also know that their laboratories are involved with CAD/CAM technology.

    “Dentists rely heavily on their laboratory partners for recommendations, especially regarding selection of such materials as zirconia and precious metal alloys,” Slor says."Today, zirconia is available through many systems, such as lab-site systems and centralized manufacturing systems such as our recently opened DENTSPLY facility, Compartis USA Milling Center. Compartis provides our dental laboratory partners with DENTSPLY Cercon® zirconia copings so that they can apply their own artistry through porcelain application to produce a finished restoration.”

    The Role of Manufacturers & Laboratories in Sharing Information

    Geiselhöringer sees the modern dental laboratory playing a decisive role as a partner with the dentist. A joint team effort is crucial for long-term success of prosthetic restorations, since continuously evolving technological and material-related advancements not only influence treatment options, but also require a constant update of knowledge, he says.

    “Treatment planning is another important aspect to consider,” Geiselhöringer explains. “While modern CAD/CAM technology offers a broad range of solutions, material properties must always be considered. Despite the availability of zirconia, the material cannot be used in all clinical situations. Here it is certainly the responsibility of the dental technician to provide useful and relevant information to their customers.”

    Slor would agree, noting that the dental laboratory, the dental technicians, and the laboratory owner have a responsibility to share knowledge with dentists and educate them regarding available material options. Each restoration and prosthesis is unique, and for each application and patient, a different option, material, and technique can be used to produce the specific treatment, he says.

    “The laboratory will educate the dentist about what material options are available, along with indications and benefits, so that the dentist is able to make the best educated decision on behalf of the patient,” Slor says. “Laboratories typically have a proficient knowledge of the physical properties of the many material solutions, and if they share all of this information regarding choices and techniques with the dentists, the best solutions for the patient can be achieved. That’s what it’s all about.”

    “Communication between the dental laboratories and the doctors is very important when you consider all the variables that are part of the fabrication of a fixed dental prosthodontic restoration,” observes Jim Buchanan, national manager of key accounts for 3M ESPE, the manufacturer of the Lava zirconia CAD/CAM system. Until recently, this communication may have consisted only of a handwritten prescription and an impression that may or may not have been able to totally convey all of the information to the laboratory necessary for the technician to produce what the dentist wanted for their patient. “With the introduction of laboratory CAD/CAM and dentist chairside oral scanning technologies, the opportunity for ‘real time’ consultation between the dentist and their laboratory partner becomes reality. The result will be greater overall consistency, quality, and productivity for everyone. We’re already experiencing these results with dentists and laboratories.”

    Buchanan says that dental laboratories can raise their value proposition to the dentist and differentiate themselves by becoming a trusted partner and a resource for their dentist customers. Given all the material choices and complexities in the production of dental prosthetics, dentists look to them for information and guidance. Buchanan notes that 3M works closely with dental laboratories to help them be a resource that provides education to dentists, especially around the entire crown-and-bridge procedure.

    “We want to ensure that, at a minimum, we provide laboratories with science-based clinical information so they can help their dentists,” Buchanan explains of how 3M supports laboratories through their dental practice and digital solutions sales specialists. “Secondly, we like to work with laboratories as an educational resource to provide dentists with continuing education about materials, processes, technique, and procedures.”

    Geiselhöringer details three pillars in the information-sharing process. The first is joint attendance at relevant conferences and events. The second is constant communication during treatment, with laboratories sending regular updates and making suggestions throughout the process. Finally, it is important for laboratories to participate in regular seminars on various topics of dental and laboratory advancements and techniques, he says.

    “However, the most important aspect for the credibility of any laboratory is to critically assess, select, and offer only reliable solutions to their customers,” Geiselhöringer emphasizes.

    Milling centers such as those associated with Lava, NobelProcera, and now Compartis provide services for dental laboratories, not for dentists directly. The information about the restorative materials and products used with those related technologies is funneled through the laboratory to the clinician. Therefore, manufacturers strive to educate and train the laboratories using their systems to the highest level so that they, in turn, can best advise and make recommendations to their customers.

    “Compartis provides our laboratory customers with a lot of information about choices and techniques in the form of technical training, sales representative consultations, and technical support,” says Slor. “Our educated laboratory partners, in turn, share their knowledge with the dentist customers in order to achieve the best solution available for the patient.”

    From a materials and equipment standpoint, 3M ESPE works with laboratories to help them understand how they can use both to help meet dentists’ needs and demands, Buchanan says. This involves building awareness and education around the different solutions that are offered, he explains.

    Enhancing Communication, Learning, and Collaboration

    When it comes to active learning, the greatest challenge in today’s market is the vast number of different continuing education courses, with the difficulty being in selecting the best quality training, believes Geiselhöringer. Here again, the availability of structured courses supporting a team approach and recommendations will benefit both the technician and the dentist, he says.

    “There are two opposing sides. One is the need for active communication, while the other is the availability of time—which is certainly one of the most limiting factors for any business today,” Geiselhöringer says. “It is important for both parties to understand that proper communication does not always require extensive amounts of time, and concise details suffice after an adaptation period.”

    Yet, collaborative consultations are growing in popularity and becoming increasingly needed, Slor observes. In such situations, both the dentist and dental technician stand at the chair that the patient is in to perform the consultation together to determine the best possible treatment, he explains.

    “Technicians partnering with dentists to evaluate the patient’s case and options creates an environment of collaborative problem solving,” Slor says. “This allows the team, dentists, and dental technicians to discuss material options and patient indications on a case-by-case basis.”

    To help optimize this process and the laboratory/dentist relationship, NobelProcera offers a broad range of seminars, but NobelProcera’s system specialists are also available for any inquiries that customers might have, Geiselhöringer says. “The personal note is a key aspect here,” Geiselhöringer explains. “Providing additional support, such as handling instructions, invoicing courses, and so forth improves the cooperation significantly.”

    Optimizing the relationship between laboratories and dentists always benefits the patient, Slor believes. Providing standardized and predictable end results for the laboratory and dentist through centralized manufacturing (ie, milling) contributes to the confidence of receiving a consistent quality restoration. This in turn increases the trust and communication between the dentist and the dental laboratories, because the quality of the fit is predictable, he explains.

    “When both business partners are operating optimally, the results are sure to improve the patient’s satisfaction and outcome,” Slor says.

    Enhancing relationships between dentists and laboratories requires an understanding of what each needs to satisfy the other’s demands, Buchanan says. He explains that when working with dental laboratories, 3M ESPE seeks to understand from their perspective what dentists are asking for and what they really want to accomplish. This provides insight into what technologies presently exist or need to be developed to help the laboratory best satisfy a dentist’s requirements.

    “In addition to dentist involvement, when we introduce a new dental laboratory material or process, we have an advisory group of laboratories that are very involved in the testing,” Buchanan says. “You have to ensure that a product will work well in the hands of a dental laboratory technician so that they can deliver the restoration that the dentist desires and will meet the patient’s needs.”

    Communication between dentists and laboratory technicians has always been important to restorative outcomes. Buchanan predicts that as CAD/CAM and milling center technologies continue to change the workflow processes that are available to both laboratories and dentists, the concept of the laboratory technician as a resource will continue to grow, evolve, and become more significant.

    “As dentists begin to capture impressions digitally, you now have the opportunity for them to talk to their laboratories while they view the case via a digital impression at the same time,” Buchanan suggests. “As a result, laboratory technicians can communicate back and forth directly with dentists and ensure that they’re fabricating the restoration the way the doctor intended with the right material.”


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