Improving Your Working Relationship with Your Dental Lab

By Carrie Pallardy

When patients sit down in the operatory chair, they might see a dental hygienist and their dentist. But, behind the scenes, many dental cases require a collaborative process between different specialists. The team at your dental lab is among those vital specialists.

“A dentist’s success depends on the product he gets back from the laboratory,” said Neil I. Park, DMD, vice president of clinical affairs at Glidewell Laboratories in Newport Beach, California. “The beautiful crowns, bridges and veneers that we want to provide for our patients — they can’t be fabricated without the help of a laboratory.”

That relationship between a practice and a lab takes time and effort from both sides to build. A good working relationship between the two results in quality products that ultimately help dentists deliver the best possible patient care. A breakdown in that relationship creates frustration in the dental practice and can impact patients.

What does a good relationship between a practice and lab look like, and how can practices build one?

The Dental Lab Industry

Understanding the state of the dental lab industry can help dentists build better lab partnerships. Like dentistry as a whole, the lab sector is grappling with a labor shortage. The number of dental laboratories with payrolls dropped from 7,715 in 2001 to 5,286 in early 2022, according to data from the National Association of Dental Laboratories.(1) As of May 2023, there were 34,190 dental laboratory technicians(2) serving 202,304 practicing dentists in the United States.(3)

The shortage of dental laboratory technicians is in part due to fewer educational programs. In 2012, there were 19 dental laboratory education programs. By 2023, that number dropped to 13.(4) From 2011 to 2012, 276 people graduated from dental laboratory technology programs. A total of 174 graduates completed programs from 2022 to 2023.(4)

Compounding the problem, experienced lab technicians are leaving the field. “Experienced technicians are aging out or retiring,” said Joe Young, president-elect of the National Association of Dental Laboratories and marketing manager of Young Dental Laboratory in Philadelphia.

Many labs struggle with staffing, a challenge heightened by the COVID-19 pandemic.(5) May 2019 labor numbers showed 34,460 dental lab techs in the profession,(6) which indicates a loss of only 270 positions; however, considering the continual growth of the dental industry as a whole, this relatively small decrease actually represents a larger shortfall. Despite workforce challenges, the demand for dental lab work has not decreased.

“The lab tech shortage, paired with an unfortunate decrease in the amount of lab work taught in dental schools and an increase in the numbers of dentists, have resulted in a heavier burden placed on all labs,” said Leila S. Zadeh, DMD, FAGD, an associate dentist with Revive Dental Implant Center in Mesa, Arizona.

But labs are adapting in this landscape. With a lack of outside education, many labs have turned to in-house training. “We do training in our own facility, and, with that level of in-house training, they can qualify to become CDTs [certified dental technicians] and even MDTs [master dental technicians],” Park said.

While both practices and labs contend with the realities of today’s labor market, they are also subject to shifting technology trends. The field of dentistry is increasingly becoming digital, although not at a uniform rate. Analog protocols persist in many aspects of dentistry at many practices. “It was really just last year that Glidewell Laboratories started receiving more cases digitally than we did with traditional types of impressions,” said Park.

Making the transition from analog to digital can improve the relationships between dental practices and their labs. “The dentist who’s gone digital has a chance to look at the screen with his acquisition software and really see whether he’s giving his best work so the laboratory can do their best work,” said Park.

The Institute of Digital Dentistry (iDD) surveyed more than 1,000 dentists from 109 countries — the majority of whom were general dentists — and 78.8% reported using intraoral scanners in their daily work.(4) “At this point, if an office doesn’t have an intraoral scanner, it’s definitely behind the times,” said Matt Winstead, CDT, vice president of Oral Arts Dental Laboratories in Huntsville, Alabama.

If a practice is just starting its digital journey, its dental lab can be a valuable resource. “Many times when our clients are ready to make the transition to a digital workflow they look to us for guidance on which system they should invest in,” said Denise Burris, CDT, president of the National Association of Dental Laboratories and cofounder and owner of By Design Dental Studio in Atlanta, Georgia. “We can help with directing the dentist and staff on getting information to us, learning the scanner, and building confidence in trusting the software.”

Zadeh has seen how digital dentistry can drive more efficiency, from the perspective of both a lab technician and a dentist.

“I used to be a lab tech at Renew Full Arch Lab, our fully digital in-house lab, which has about 60 clients across the country,” she said. “Working in both a clinic and lab, using cutting-edge digital technology such as photogrammetry, I can personally attest to how digital technology can streamline and make prosthetic workflows more predictable and efficient both chairside and on the lab side.”

While that efficiency is an incredible boon to the relationship between dental practices and labs, adopting digital workflows still requires skill to deliver digital images that labs can use to create the best possible products.

“The ability to take an excellent intraoral scan is a skill that I think is underestimated sometimes,” said Park. “One of the rules we have at Glidewell is that you can’t digitize a process until you’ve nailed it on the analog side.”

As dental practices take on the digital learning curve, labs can provide valuable feedback. “If your laboratory gives you feedback on that scan, take it seriously,” Park recommended. “They’re looking at a large number of scans, and chances are they’re seeing a situation that they’ve seen before.”

In-House vs. Outsourced Lab Work

Many dental practices will debate the merits of in-house versus outsourced lab work. In-house capabilities give dentists more control. Why manage an outside relationship if you can do it yourself?

In-house milling and 3D printing, for example, may be lab capabilities that a practice could adopt to its benefit. The iDD survey found that 9.8% of respondents have only a milling machine, 10% have only a 3D printer, and 11.8% have both. Nearly a third of respondents (31.5%) have in-house computeraided design/computer-aided manufacturing (CAD/CAM) tools.(7) (About 5% of iDD survey respondents were dental lab techs, so these percentages likely include dental labs in addition to dental practices.)

If dentists are considering adding these in-house capabilities, they need to consider return on investment. Does it make sense from a financial perspective?

“The cost of equipment, software and additional staff will most likely make sense for practices that have multiple dentists. It isn’t typically cost-effective for a single practitioner,” said Burris.

Winstead pointed out that dentists need to consider chair time when calculating return on investment. “If you prep, scan and mill a crown in your office, how long is your chair time going to be tied up trying to get that same-day single-unit crown done compared to how many crowns you could have seated if you scanned and sent the case to your preferred dental lab?” he asked.

Lab work also demands a high level of specialized skill, and Zadeh points out that many recent dental graduates do not receive as much lab work education as has been offered in the past.

“I think many dentists who want to have in-house labs should not undertake starting one unless they feel confident enough in their training to be able to do right by their patients and provide the top-notch quality of prosthodontic oversight that years of doing lab work can instill,” she said. “Although advances in digital software can help streamline and speed up many lab processes, the difference between ‘good enough’ and ‘great’ is a matter of proper training and/or years of continuing education.”

The decision to bring specific lab processes in-house will be unique to each practice. Some dentists will have the skills and resources to make these processes successful and profitable. Others may find it makes more sense to rely on outsourcing. In most cases, it likely will not make sense to bring lab work entirely in-house. Indeed, even as the popularity of milling and 3D printing technology in dental practices has grown, Inside Dentistry reported in 2023 that 97% of dentists who responded to a survey still used a dental laboratory, with 83% using more than one laboratory; 14% of respondents reported doing some form of laboratory work in-office — such as milling or 3D printing — indicating there is overlap among dentists who are using CAD/CAM technology in office but still collaborating with a dental lab when needed.(1)

“A large or complex case that is multidisciplinary involving fixed and removable prostheses plus implants, in my opinion, will never be manufactured within the clinic unless the clinic is a large group of offices [that has] a fully capable lab internally with a similar setup as a production lab,” Winstead explained.

Building the Bridge Between Practices and Labs

With the importance of the practice-lab relationship firmly cemented, how can dentists evaluate the health of that connection and improve it?

The health of dental practice-lab relationship is best seen in the end results. Is a practice receiving what it expects? Are feedback and requests reflected in the products delivered?

“That’s probably the best way to determine whether you’ve got a good relationship and a laboratory that’s interested in doing its best for you,” said Park.

A good relationship requires a steady flow of communication and action following that communication. Lab technicians need to respond to feedback from their clients, but dentists also need to listen to what their labs have to say.

“If a great dentist provides a perfect impression to a poor-quality lab, a poorly made product might be returned,” said Zadeh. “Conversely, if a dentist provides a terrible impression to a fantastic lab, the lab techs have their hands tied because they cannot correct operator error, such as bubbles on the crown margins of a polyvinyl siloxane impression.”

Strong communication between the clinician and the lab opens the door to a mutual understanding of expectations and preferences. Dentists can share their preferences, and labs can ensure those preferences are uploaded to their design software.

“This can be everything from the amount of relief on the intaglio surface of the crown for cement space versus how heavy the proximal contacts are to what kind of occlusal contacts you want. All of those things the laboratory needs to dial into the preference of the individual doctor,” Park explained.

On the other hand, dentists can ask labs how they prefer to work with dentists. What makes the technicians’ jobs easier, ultimately resulting in the best possible product?

“Simply understanding the lab side of articulation and bites could eliminate an immense amount of remakes and stress for the dentist. The more a dentist knows about lab work, the better a dentist they become; the more a technician knows about clinical work, the better a technician they become,” said Winstead.

Accepting feedback, especially if it is negative, can be a tough pill to swallow. “The first step to improving any relationship involving a dentist and lab is staying humble and receptive to feedback with the goal of being a better clinician or technician,” said Winstead.

In a healthy relationship, the process of giving and receiving feedback does not need to be adversarial. Rather, it is a part of making sure both parties are doing everything they can to deliver the best end result for the patient.

“Give valuable feedback at delivery so you and the technician can alter those parameters in the software so that what you’re getting back is more predictable every time,” said Young.

The methods labs and dentists use to communicate is another aspect of defining and improving that relationship.

“Texting back and forth has been popular, and it’s pretty efficient,” said Young. “We text with our clinicians — case concerns, questions, all types of issues that may come up in the lab. And, likewise, doctors will send us photos to our phones. … I’ve even FaceTimed with clinicians to be able to see patients in the chair.”

When it comes to communication between dental practices and labs, a picture is often worth a thousand words. “Dental photography skills are underrated. High-quality photos can be a big help to the technicians making the case,” said Winstead.

Taking high-quality photos is one of the most impactful ways dentists can contribute to the success of their lab relationship. Dentists can ask labs what photos they need to make sure they get the best results for their patients.

“This is critical for scan alignment in digital workflows, shade selection, relaying critical information about the incisal edge position or any occlusal cant relative to the interpupillary line, smile line, tooth shape/mold, shade, etc.,” Zadeh explained.

Those photography skills are invaluable on the front end of a case, but they can also come in handy after dentists complete their work. Dental lab technicians put a lot of work into a final product, but they don’t always have the opportunity to see the final result.

“Remember, technicians are trying to provide beautiful restorations for your patient, but they don’t have the benefit of seeing your patient like the doctor does,” said Park. “Take that final photo, and go ahead and put it in an email to your technician or your technical consultant.”

Many cases that bring revenue to dental offices require the involvement of a lab. That relationship, for better or worse, has a direct impact on the bottom line. When a lab is delivering high-quality work, it can be easy to forget how much time and effort is poured into those results.

“Cranking out good-quality lab work is not as easy as it looks and takes constant continuing education to keep up with the ever-evolving digital landscape,” said Zadeh.

Dental lab technicians are specialists who are valuable resources for dentists. “The best indication of a strong dentist-lab relationship is when the dentist considers their laboratory an extension of their interdisciplinary team,” said Burris.

Working with a New Lab

Sometimes, it just doesn’t work out. Dentists may reach a point where the communication and results from a lab just aren’t meeting their needs. How can a dentist build a strong relationship from scratch?

Talk Expectations

Start with why you decided to leave your last lab.

“If you typically had problems with prior labs on certain issues, be sure to tell this to the new lab,” Matt Winstead, CDT, Oral Arts Dental Laboratories, recommended. “There are adjustments the lab can make to mitigate typical issues that doctors might have, like contacts, occlusion, fit, etc.”

Tour the Lab

Seeing for yourself how a dental lab works can help you decide whether it is a good fit, and it can also pave the way for a smooth working relationship.

“If it’s local enough, visit the lab. Ask questions about their equipment, the materials that they use. Ask questions about the type of credentials or continuing education that they received or conventions and other types of seminars and presentations that they attend to help them better themselves,” said Joe Young, National Association of Dental Laboratories president-elect.

If it isn’t feasible to make an in-person visit, schedule a virtual tour, and come prepared with a list of questions.

Invest the Time

Like any relationship, the one between a dental practice and a lab takes time to establish. “It requires more than a handful of cases to build that relationship,” said Young.

During the first few months of working with a new lab, dedicate more time to communication. Talk to the lab staff about your preferences. Point out any concerns in the work being returned to the practice. Ask questions about your own work and how it could be improved to empower the lab to deliver the results you want.

“The reality is that not all labs and dentists are a good match for one another,” said Denise Burris, CDT, NADL president. “But once a lab and dentist really work together to foster communication, that is where the magic happens.”

Carrie Pallardy is a freelance writer and editor based in Chicago. To comment on this article, email impact@agd.org.

References

1. Brzozowski, Carol. “The Future of Laboratory Workflows: Technology Is Enabling New Models of Collaboration to Navigate the Waters of Dentistry.” Inside Dentistry, vol. 19, no. 5, May 2023, aegisdentalnetwork.com/id/2023/05/the-future-of-laboratory-workflows.

2. “Occupational Employment and Wages, May 2023: 51-9081 Dental Laboratory Technicians.” U.S. Bureau of Labor Statistics, May 2023, bls.gov/oes/current/oes519081.htm.

3. “The Dentist Workforce.” American Dental Association, ada.org/en/resources/research/health-policyinstitute/dentist-workforce. Accessed 7 June 2024.

4. Health Policy Institute. “2022-23 Survey of Allied Dental Education: Report 3 - Dental Laboratory Technology Education Programs: 2022-23 Dental Laboratory Technology Report.” Commission on Dental Accreditation, Find a Program, CODA Survey of Allied Dental Education, Oct. 2023, coda.ada. org/en/find-a-program. Accessed 29 May 2024.

5. Fine, Terry. “How Dental Laboratories Joined the COVID-19 Digital Trend.” Inside Dental Technology, AEGIS Dental Network, Aug. 2021, aegisdentalnetwork.com/idt/2021/08/how-dental-laboratories-joined-the-covid-19-digital-trend.

6. “Occupational Employment and Wages, May 2019: 51-9081 Dental Laboratory Technicians.” U.S. Bureau of Labor Statistics, May 2019, bls.gov/oes/2019/may/oes519081.htm.

7. Al-Hassiny, Ahmad. “Results: The World’s Largest Survey on Intraoral Scanners by iDD.” Institute of Digital Dentistry, 22 May 2023, instituteofdigitaldentistry.com/cad-cam/results-the-worlds-largest-survey-on-intraoral-scanners/.