By: Dr. Scott R. Harden
As a sequel to last month’s article regarding crowns, this article offers you information about dental laboratories and the services they perform for dental patients.
The true unsung heroes in dentistry are dental laboratory technicians. The dental lab technician (or technologist) is a crucial member of the dental team. They provide a tremendous service in fabricating crowns, bridges, veneers, dentures, orthodontic retainers, implant-related appliances, and even snoring and night guard appliances. Labs can specialize in any one of these areas or can be a full-service laboratory that typically has different departments with many employees. These services are the end product that patients enjoy and utilize every day of their life.
Lab technicians are postured behind the scenes with the challenging task of combining the art and science of dental lab work with the infinite variations of requests that come from the many different dentists they work with. To say this is an overwhelming task is a significant understatement.
The most common crown fabricated in the world today is the porcelain-fused-to-metal crown. Traditionally, there are easily over one hundred steps in the fabrication of this crown known as a “PFM”. The dentist provides the necessary materials to the lab and a prescription ordering the crown. The lab must then pour a stone model, perform a wax-up technique by hand, fabricate a metal casting and ultimately hand-stack porcelain to finish the crown to the proper specifications from the dentist.
Modern dental technology permits the use of computerized automation to achieve the results that historically used to be performed almost exclusively by hand. The current technology allows labs to use CAD/CAM principles in the fabrication of dental restorations, and is the same high quality design and engineering parameters that are used in the fabrication process of an automobile. The marvels of present-day laboratory software provide structural parameters to ensure proper integrity and strength in prosthetic designs. If a prosthetic device is inferior by some design standard, the computer will inform the operator and interrupt the process.
There are many different types of crowns today that can be prescribed by the dentist for the laboratory to fabricate. These crown styles include traditional PFM’s and CAD/CAM all-ceramic crowns as mentioned above. Materials in all ceramic crowns include pressable ceramics which are pressed Lucite cores, including milled alumina or zirconia cores, or stacked feldspar porcelain. There are approximately 10 to 15 different manufacturers of pressable ceramics that includes Empress, Eris, OPC, OPC3G, Authentic, Hera Ceram, CZR Press and Nortaki, to name a few. The milled alumina porcelain crowns include name brands such as ProCera and WolCeram. The zirconia based all ceramic crowns include LAVA, Zircon, ProCera Zircon, Everest, Katana, Zino, to again name a few. You can quickly begin to envision why the field of dentistry has become very complex with the introduction of many new great solutions for the needs of the dental patient.
Denture laboratories have been around for centuries and serviced millions of people. Wonderful advances in dentures have included flexible clasps, specialized attachments onto teeth, esthetic quality and stabilizing dentures with implants.
Implant systems are another tremendous financial undertaking for laboratories and are very complex because of multiple designs and so many different manufacturers. Some manufacturers include Zimmer, 3I, BioHorizons, Innova, Life Core, Nobel Biocare, Friadent, Astra, Camlog, Imtec, Straumann, and Sargon. Each of these systems requires the lab to stock tools and parts that permit efficient turnaround time for lab cases. Implants require the interaction of four parties that include the patient, the dentist, the lab and the implant surgeon. The final prosthetic appliance fabricated by the lab culminates all the time and energy from all parties, and will often last the patient a lifetime.
The ongoing decision for laboratories is to decide whether to implement the latest new technology or get left behind. Compton Dental Laboratory has invested tens of thousands just recently to ensure continued quality of care. The laboratory investment for the all ceramic systems ranges in cost between tens and hundreds of thousands of dollars. Burbank Dental Laboratory in California was interviewed and has invested over $1 million in laboratory equipment to specifically fulfill the demands of metal free, all ceramic crowns, as requested by their dentists. The Empress system costs $16,000, while the LAVA system costs $250,000.
With ongoing technological advances and high demand for esthetic quality from patients, communication between the dentist and the dental laboratory is more important than ever. The use of digital photographs that can be e-mailed across the Internet, diagnostic wax up models and custom temporaries to preview how final treatment will appear — all provide the lab better communication and consistently allow for quality care that meets the needs and desires of the patient.
If it were not for dental laboratories taking on the tremendous financial burden of purchasing new dental equipment, patients would not benefit from the latest technology that dentistry can offer. Their dedication is a quality of the dental team that deserves our appreciation, especially considering they seldom meet the patient and receive the praise they deserve.