No Place for Laboratory Technicians?
Despite some dentists’ requests for chairside consulting, Dr. William D’Aiuto, chairman of the American Dental Association Subcommittee on the Future of Dental Laboratory Technology, questions the appropriateness of laboratory technicians being in the dental office with patients, except for a few limited circumstances. “I have great respect for dental laboratory technicians,” he says. “But the amount of input they can provide with the training they’ve had—beyond, say, helping with a difficult shade selection—is minimal.” With current digital technology, Dr. D’Aiuto continues, even the most complicated clinical problems can be photographed and discussed with the dental technician, with mounted study models, prior to the restorative treatment appointment when the patient is not in office. He adds that dentists and dental technicians will likely have a much more thorough discussion of treatment options if the patient is not present.
“After careful treatment planning, a dentist rarely requires additional expertise in the operatory,” Dr. D’Aiuto says. “The state dental practice acts of 49 states say that the only person who can do treatment planning, diagnosis, surgery, and irreversible procedures is the dentist.”
In her prosthodontic practice in Newport Beach, California, Dr. Cherilyn Sheets and her three partners employ eight dental laboratory technicians who routinely consult with doctors and patients in operatories. Dr. Sheets makes the distinction between technicians who collaborate versus those who guide the dentist’s treatment. “Collaboration is a concept I’m very positive about,” she says, adding that dentists can benefit greatly from knowledgeable laboratory technicians’ input during both case planning and complex treatment procedures. Likewise, technicians can learn more about patients’ prosthetic needs by meeting with them compared to working with models.
But Dr. Sheets does raise concerns about laboratory technicians who provide dentists with guidance on complex treatments such
as extensive implant procedures. “If you have [laboratory technicians] who are only educated at a limited number of implant manufacturers’ weekend courses that may not understand all the biological implications of the advice they are giving, and you combine that with a dentist who is a neophyte and may also not understand the biological and biomechanical implications of the advice they are getting, then you’re going to potentially have a higher rate of complications, and even failures.”
Dr. Sheets says the way to avoid these problems is to provide more multidisciplinary study clubs and hands-on courses for the dentist/dental technologist team. “That would be a great step forward for our profession,” she says.
In response, Wiand maintains that his guidance is not the equivalent of devising a treatment plan. He says he provides direction on issues such as “bone reduction to meet the space requirement necessary for the final restoration, and implant positioning for ideal spacing and position of access holes.”
Ultimately, he adds, “it is the doctor’s responsibility to understand the biological implications of the restorative choices he or she has made.”
Dr. Sheets also makes the case that “laboratory technicians’ increasing presence in the operatory points to a deeper problem in the dental profession—the lack of a standard credentialing program to ensure the quality of their input and the respectful position they deserve on the multidisciplinary oral healthcare team.”
“Dentistry in this country is missing a very important element that I believe is critical to providing quality care, and that is having knowledgeable, licensed dental technologists collaborating with dentists and helping them perform their duties,” she concludes.
“There is no mandatory licensing regulatory system to give credibility to technicians who come into your office. That has to change.”