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What to Look for in an In-Person Dental Education Program. Image courtesy of ASDF/stock.adobe.com. 


In-person education is back, but what makes in-person training worth the time and expense and what types of programs benefit clinicians the most?

Brent Garvin, Director of Product Training for Planmeca, says accountability is a significant benefit for in-person education events. The environment requires attendees to show up and pay attention. "They can't just walk away and grab something out of the fridge," Garvin says. "If they stand up at an in-person event, they will draw attention to themselves."

William Lee, DDS, private-practice clinician in San Francisco and Chair of the California Dental Association's (CDA) Board of Managers, agrees fewer distractions are a strength of in-person training. In addition, the networking and hands-on opportunities benefit clinicians, something he missed during the pandemic.

"We work very siloed," Dr Lee says. "So, when you go to these meetings, you see your colleagues that you haven't seen in a long time. I'm an instructor, so I see my students who have graduated. Also, there is an opportunity to go to the exhibit hall that you don't get in a virtual meeting. You can try products and instruments with vendors and companies and play with the equipment before buying it."

Anna Singh, DMD, Senior Vice President of Clinical Operations at Heartland Dental, says peer-to-peer learning in and out of the classroom benefits in-person learning. In addition, the in-person camaraderie education facilitates sharing best practices and best use cases, which is an essential part of the learning process.

"It's like the watercooler conversation in an office setting," Dr Singh says. "When you are all together, you're able to make personal connections and share with people a little bit more about you. It's hard to do that in a virtual format."

"Whenever we get doctors together, it's the best thing we love about hands-on, in-person training," Garvin agrees. "It's the opportunity for clinicians to come together to create a community, to bounce ideas off each other. Most of the learning we hope happens in the classroom. But much of the training they get is after hours when breaking bread and enjoying each other's company."

Dr Lee oversees “CDA Presents The Art and Science of Dentistry,” the biannual meeting for dental professionals that offers continuing education (CE) opportunities, networking, and an expansive exhibit hall. He thinks in-person instruction also provides a different interaction with the speaker.

"It's the dynamics of being there and having the opportunity to go up to the speaker afterward and ask a question, which you don't have in a virtual component," Dr Lee says.

"At CDA Presents, you are talking about thousands of attendees and an exhibit hall where you can go check out products and services one or attendees might be considering purchasing. It's a cool experience," Sarah Gargani, Director of CDA's Learning & Development, says, adding a different level of engagement to in-person education exists over virtual. "To see someone in front of you physically has a whole other magic to it."

Meredith Gantos, DDS, MAGD, private-practice clinician in Naperville, IL, says learning from leaders in the field and dentists on a similar path with the same pain points, challenges, and growth opportunities is also a benefit to in-person education. Plus, clinicians can try technology before they buy.

"This saves money, time, and stress," Dr Gantos says.

Lisa Thompson, CDA, RDA, Midmark® Dental Clinical Service Manager, says in-person education also benefits clinicians who want to delegate some learning to third-party educators. As an educator who teaches dental assisting, she says some proficiencies are better hands-on.

"Sending the team out to experts in education is helpful," Thompson says.

Midmark also offers in-office training options. This in-person education significantly benefits the ability to customize training for a specific practice, Thompson says. Often, the educator has worked with other dental practices and understands the roadblocks that can occur and how to troubleshoot challenges. Professional educators also understand different learning styles and can adapt to convey the message.

"Someone who is trained to educate has a better chance of evaluating the needs of the individual who is learning and getting the learning to stick," Thompson says.

Dr Gantos says that any hands-on component does need to be in person. It's essential to get direct input from an instructor and have a resource close by to be critical of one's work.

"The best courses are ones where you walk away with a new skill that you can apply the next day in the office, but this can only be gleaned with a practical component," Dr Gantos says.

Dr Gantos also thinks lecture-based programs benefit from a physical presence. Dr Gantos says a set schedule and timeline for the lecture is more straightforward to comply with than an online program with greater flexibility.

"From my experience, online education always sounds good in theory, but I never find the time to complete the things I sign up for," Dr Gantos says. "I need the accountability of in-person classes to carve the time out in my schedule and stick to it."

Garvin thinks anything that requires a tactile feel is suited to in-person education. For example, scanning techniques training in person allows Planmeca trainers to correct hand positions or how much force the clinicians use.

"Training on hardware is much better in person," Garvin says. "We have faster comprehension, and it's more efficient because we can react to them, see their face and visual cues, stand over their shoulder and point to the screen or move the mouse. We can control the training environment much more easily when we're face-to-face with them rather than through a computer screen."

Thompson agrees that new technology coming into the office is better served by in-person training. Getting in early on the learning curve and practice implementation is essential. Teams can see that other people have gone through the challenge of learning something new and came out okay on the other side. This interaction is informal but essential to engagement.

"Without engagement, it becomes the proverbial coat hanger because no one wants to use it," Thompson says.

"You can't learn how to utilize technology appropriately without getting your hands on it," Dr Gantos agrees. "This hands-on experience allows providers to leverage the technology to the fullest and feel more comfortable and confident when they head back to their office."

Garvin also believes that hands-on training with new technology is essential for implementation. The Planmeca Education Center in Hoffman Estates, Illinois, includes a 50-seat auditorium, 2 16-seat classrooms, and additional training rooms for breakouts. The Planmeca Digital Academy is the hub for in-person digital dentistry training for dental professionals and distributors. Post-pandemic in-person training is held in the facility every month and sometimes twice a month. They are also expanding their offerings to be more inclusive. Next year, Planmeca will expand programs to be more inclusive, adding entirely Spanish-language sessions.

Garvin says they keep lectures to a minimum at these in-person training events. For example, an 8-hour training will have 1 hour of class and 7 hours of running through sample scenarios and, sometimes, cases one of the attendees brought.

"It's pure, hands-on, over-the-shoulder taught tasks. Trainers and coaches are floating in the room, helping them understand the software and how to use it so they can go back to their office on Monday and execute it," Garvin says.

Dr Singh adds that leadership training is excellent for in-person education. The combination of the audience and speaker creates energy that inspires people. Dr Singh has seen a lot of speakers develop fan followings because of how they connect with and excite the audience.

"Leadership training is not a lot of note-taking. It's more about interacting with each other and sharing best practices," Dr Singh says.

Dr Singh has seen speakers that can generate excitement about doing a type of dentistry. The expert's passion for the technique and sharing it with others becomes aspirational to the audience. Also, in-person education programs like these inspire the team when they are together, making the program a team-building event.

"When you bring your team, and some of those learnings happen, the teams grow, and your patients will truly benefit from that," Dr Singh says.

Returning to What Was Missing During COVID

Dr Gantos says she missed the in-person community education helps clinicians build. The community becomes the best resource for bouncing ideas off, troubleshooting, or problem-solving.

"Dentistry can often feel like a lonely profession," Dr Gantos says. "Developing these connections with others creates a more collaborative approach to a field that can often feel isolating."

Dr Gantos also missed having first-hand feedback from a highly skilled instructor, which is invaluable for honing new skills. Having someone share what worked best for their success and what pitfalls to avoid is much more meaningful. Dr Gantos says that over-the-shoulder training cannot be replicated virtually or at home the same way it can in person.

The change of environment is something she craved, too. She struggles to get into the proper mental learning space at her practice or at home. Instead, she finds new settings conducive to learning something new.

"When I am in a classroom or unfamiliar setting, however, I am mentally more alert and prepared to synthesize new information," Dr Gantos explains. "I am also less distracted and sidetracked outside my comfort zone."

Gargani says members want more hands-on courses to hone their clinical skills. Attendees like sitting in a workshop environment and to learn hands-on with the ability to ask the instructor or the dentist sitting next to them a question.

"It's that kind of cohort learning environment where you're going through something together to learn something new. To do that in the virtual environment would have to be highly orchestrated, sending out supplies in advance. So, to do that in person is highly efficient and satisfying for the learner," Gargani says.

However, the CDA does not believe that in-person versus virtual education is an either/or proposition. Instead, they see a blend of both types to provide the best possible experience. Their members agree. At the September CDA Presents in San Francisco, many of the livestream attendees (40%) were also in-person attendees on a different day.

"One of the best things that has come out of the last 2 years is we're learning how to leverage those 2 mediums together," Gargani says.

Dr Singh agrees a blend of virtual and in-person learning is the future of education. Heartland Dental is exploring HyFlex options, where both live and virtual education is happening simultaneously. Dr Singh thinks blended possibilities like this provide the benefits of both in-person and virtual education programs.

"Technology has changed so much, all of that, so there will be a lot of blending happening," Dr Singh says

Heartland also focuses on the feedback they get from its audience surveys to improve in-person education events. The purpose is to enhance their presenters and enable their education programs to deliver results-producing action. Dr Singh says you can't provide a high-quality, in-person product if you're not listening to your audience

"We have evolved into experiences. So how do we create an experience of learning from the start when we give them a tag to the time they exit? That's the whole experience we're looking at," Dr Singh says.

Thompson says she missed the personal interactions, the "hugs, and handshakes" of in-person education that were not possible during the pandemic. A lover of trade shows, she enjoyed seeing the same faces every year, even if they were now in a different booth.

While in-person education is getting back to how they were before the pandemic, there are some lingering effects. The staffing issue environment prevalent in many dental practices makes in-office training essential to help manage the stress of a new process or product. Midmark has individualized, per-product, full-day in-office training with dental clinician instructors who "walk the walk and talk the talk" to help the team and doctors with their practice-specific recommendations.

"They can assess what is needed," Thompson says of the instructors. "Sometimes it's silly stuff like they get backed up because there are 2 people there at the same time, which is a logistics problem. Or they might recommend different scheduling workflows to solve the problem. Without in-person training, you could not identify these moments."

As a trainer, Garvin missed the camaraderie of bringing everybody together during the pandemic. However, everyone learning a new skill or technology is in the same boat, creating a sense of togetherness that wasn't the same in virtual settings. He also appreciates the energy that comes from teaching in-person that can resume now that in-person education is returning to pre-pandemic levels.

"The redundancy of getting on a virtual zoom meeting again, pressing play, and having a script is just not fun," Garvin says. "The ability to bring everybody together to bounce ideas off each other freely because you're in an environment that creates that excitement takes the conversation to a whole other level that you could never have done when you were doing this online."

Articles

In-person education is back. We look at what makes in-person training worth the time and expense and what types of programs benefit clinicians the most. 

What to Look for in an In-Person Dental Education Program

Panoramic X-rays: Taking a Wide View on Radiography. Image courtesy of vladdeep/stock.adobe.com.


Panoramic X-rays can capture the entire oral cavity in a single, two-dimensional (2D) image. There are a variety of clinical benefits, the patient care benefits, and considerations a dental practice should remember before investing in a panoramic X-ray system.

Panoramic X-rays show dental professionals many things about a patient's mouth. But perhaps the most significant benefit is that it shows the jaws and the teeth in 1 image, which allows dentists to understand what is happening in the patient's oral health.

For example, these images show the effects of advanced periodontal disease, cysts in the bones, jaw tumors and oral cancer, impacted teeth and wisdom teeth, temporomandibular (TMJ) joint disorders, and sinusitis.

 In addition, dental professionals might use these images to assess dental restorations or for dental surgery prep.

 Some dental professionals use panoramic X-rays to see infections or as a pre-treatment image for implants and dentures treatment planning.

Dental teams use panoramic X-rays for many indications. These include unerupted third molars, assessments for orthodontics, observing tooth development, detecting developmental abnormalities, or assessing trauma and significant lesions. Regarding anatomical variations, there are a few that dentists might find on their images, like bifid mandibular or retromolar canal. A dentist might also detect alterations like a calcified stylohyoid complex (hardening of ligaments), arterial calcifications (mineral buildups in the arteries), phleboliths (calcium in veins), sialolithiasis (hard stones in the salivary glands), or tonsilloliths (hard bits tucked into the tonsils). The panoramic X-ray is usually the initial radiology in these cases, and the dentist uses it to determine if a more detailed exam is necessary (i.e., a Cone Beam Computed Tomography or CBCT, scan) for diagnosis and treatment or if the patient needs a referral to another healthcare professional or dental specialist.

However, they are not a great tool for clinical situations that require details. For example, a panoramic X-ray would not be the best option for carious lesions, seeing the alveolar crests, the level of root canal filling, and gum disease or periapical lesions. These indications require more definition than Panoramic X-rays can deliver.

The Clinical Benefits of Panoramic X-Rays

Mark Greenwood, Vice President of Imaging Product Development at Midmark

, describes the panoramic X-ray as an excellent survey instrument to review a patient's overall dental health. These images cover a wide variety of dental anatomy and serve as a good starting point for looking at the patient. For example, not only can the clinician see the mandible and the maxilla in one image, but they can also see problems with the tissue like tumors, cysts, and the effects of gum disease—and all types of things you would not see in an intraoral image.

"Intraoral images are high-resolution images that give you small images of each tooth. The panoramic gives you a nice survey of the dental arch," Greenwood says. "It's a great overall survey tool for looking at the patient."

Greenwood says you can also look at specific problems with a panoramic X-ray. For example, clinicians can see impacted teeth and other teeth positioning issues across the mandible and the maxilla. In addition, clinicians can diagnose advanced periodontal disease and tumors, 2 things that would not be in a place they can see with an intraoral image.

"An intraoral image doesn't go much above or below the root tips," Greenwood says. "Panoramic is good for looking at TMJ issues because they include the condyles of the TMJ. They also go into the lower sinus so you can see things like sinusitis and other issues with the sinus."

However, Greenwood thinks the overall survey use case makes it even more helpful as something to have for your patients over time. The number of panoramic X-rays you can take varies by insurance companies, but a general time frame is every couple of years. So, the dental team can compare images over the years and see any changes.

"It's also a good communication tool between the dentist and the patient. In an intraoral image, patients don't always understand what the dentist is showing them or where it is in the mouth. It's only a portion of the tooth, and sometimes it doesn't always do the trick," Greenwood says of intraoral image capture. "Most people can look at a panoramic X-ray and say, 'yeah, that's my smile, that's my teeth.', and they understand what it is."

From a patient's point of view, Greenwood says that panoramic X-rays are more comfortable than bite-wing X-rays. Midmark does market research related to X-rays and patient experience at the dentist. It shows that patients do not like the sensor shoved into their mouths. Patients with smaller mouths or a strong gag reflex find it especially difficult.

Another benefit Greenwood and the team at Midmark learned through their research is that dental schools that had a clinic used the panoramic X-ray more often during COVID. There were fewer infection control concerns since the panoramic X-ray was extraoral and did not go in and out of the patient's mouth.

Also, Greenwood says a panoramic is efficient from an X-ray radiation perspective. The beam that is delivered is very collimated. The thin, narrow beam has less radiation to the patient than a full-mouth series or a CBCT.

"They also take less time," Greenwood says. "The panoramic is a 20-second scan. So, it's a shorter time frame than a full-mouth series, which takes several minutes for an assistant to go through."

What to Consider Before Investing in a Panoramic X-Ray System

Greenwood thinks dental practices that want to invest in a panoramic X-ray system should consider a few things, including:

 Greenwood says floor space is often at a premium in a dental practice. So, it is essential to know how much space the unit needs, the power requirements there, and where you want to put it.

Whether the practice might want to move to CBCT imaging someday: 

If so, Greenwood says the dental practice should ensure they can upgrade the unit to include 3D imaging. They should also know what is involved in that upgrade because sometimes they can be extensive. Greenwood says the adoption rate of CBCT is on the rise, making this information essential for a dental practice to know up front before purchasing a panoramic X-ray unit.

Advances in digital sensor technology make it easier to capture even more information from panoramic X-rays. For example, Midmark's Extraoral Imaging System (EIOS) system comes with autofocus that brings in more of the image to the focal area.

"When the first unit we installed in the field had that feature, the practice couldn't believe the consistent quality images of the panoramic. They noticed that as an improvement over the older panoramic," Greenwood says.

Greenwood thinks these improvements, like autofocus, can provide improved diagnostic images, especially compared to those panoramic radiology units from 10 or 15 years ago. As a result, panoramic X-rays can be valuable technology units for a dental practice.

"They can provide a lot of functionality and improve patient care," Greenwood says.

Radiological Society of North America (RSNA) and American College of Radiology (ACR) (2022) 

. Accessed October 7, 2022. https://www.radiologyinfo.org/en/info/panoramic-xray

How dentist uses Panorex X-rays to find dental disease

. Verywell Health. Accessed October 7, 2022. https://www.verywellhealth.com/panorex-definition-of-panorex-1059431

. Colgate-Palmolive Company. Accessed October 7, 2022. https://www.colgate.com/en-us/oral-health/X-rays/what-is-a-panoramic-dental-X-ray#

de Oliveira Capote, T. S. et al., 2015, 'Panoramic Radiography — Diagnosis of Relevant Structures That Might Compromise Oral and General Health of the Patient', in M. S. Virdi (ed.), Emerging Trends in Oral Health Sciences and Dentistry, IntechOpen, London. doi:10.5772/59260

Radiography helps you diagnose problems and diseases. We talk to experts about why it is essential to incorporate panoramic X-rays into your workflow.

Panoramic X-rays: Taking a Wide View on Radiography 

Understanding the Three Most Common Imaging Principles Used By Intraoral Scanners. Photo courtesy of Dental Pro Content/stock.adobe.com. 


In many operatories, the intraoral scanner is the hardest working technology in the dental practice. The scanner can help patients see what you see, facilitate diagnosis ownership and treatment plan acceptance, and provide an excellent road map for restorative success with detailed and accurate digital impressions.

Chances are you know how to use it, but not how it creates the images that do so many great things for your restorative cases.

Invented by Mörmann and Brandestini, scanners have been a part of patient care since 1985. However, the first scanners had problems with accuracy, particularly when scanning a wide area. The optical window of the scanner tip could only manage so much, so to complete the entire scanned area's image, the spatial data was aggregated, limiting the performance of scans to inlays or single crowns.

However, advances in optical systems and imaging processes are changing, expanding scanners' capability. Scanners can be used for more extensive cases, like longer fixed dental prostheses and implants. They are also applicable to intraoral devices like surgical guides, individual trays for dentures, and metal frameworks of removable partial dentures.

The 3 Technologies That Process Scan Data

Since 1985, more scanners have been on the market, competing for your business. No matter which brand you choose, a scanner has 3 parts that comprise its performance. These are the quality of the image capture, how it processes the data, and what it produces on screen. However, the critical element of performance is the imaging technology.

 says that an intraoral scanner's objective is to record the 3D Geometry of an object. This task relies on casting structured light upon an object from a handheld device, a sensor. The software then processes the images captured, creating a point cloud, which are the set of data points it collected about the object you are scanning. The software then analyzes the point cloud, creating a 3D surface model, aka a mesh, which the software outputs as an STL (which stands for stereolithography, or standard tessellation language or standard triangle language) file.

Chances are, some of you knew that already. However, for the rest of us, it is important to note that are a few techniques that come together to make this happen. These include triangulation, confocal, and AWS ( active wavefront sampling). 

A scanner operates on the same idea as Trigonometry. The knowns determine the unknown, aka, the object's surface.

The Pythagorean theorem (a2+b2=c2) plays a significant role in this area. The 3 points involved are the laser emitter, the sensor, and the object's surface. Since the software knows the distance and angulation of the images, it can determine the object surface.

Point-and-Stitch reconstruction is a typical process to reconstruct the 3D image of the object you want to capture. The emitting laser filters through a tiny pinhole to the desired object. Then the scanner captures the light reflected from the object and only that object. Then using the 2D images from the different confocal planes, the software puts the image back into 3D (hence, the point-and-stitch part of the reconstruction).

This technique is the sampling method behind some scanners' 3D-in-motion video recording feature. Internal sensors (complementary metal-oxide-semiconductor, or CMOS) capture 3D information from different perspectives (triple imaging). The single-lens circles around a point of interest. The pattern produced by each point gives the software distance and depth information needed to make the 3D images.

In addition, the Scottish Dental Journal  says Stereophotogrammetry enhances the 3D imaging process. Stereophotogrammetry estimates the coordinates by analyzing two or more images, collecting data and information that defines the shape and location of the object in relation to other images from different angles. One way to think of this technique is the way you use binoculars. For example, the left side lens produces one image, the right another, which you can see when you shut the other eye. However, with both eyes open the images viewed together through the binoculars are one image.

 The technology uses an algorithm based on passive light projection and software. This approach is different from the active light projection and hardware involved in other parts of the process.

Among its many uses, the scanner kicks off the CAD/CAM dentistry workflow. After prepping and scanning, the 3D images created from the tooth preparation and surrounding teeth are how the dental team can design the final restoration before sending it off to the mill. The intraoral scan for a digital impression is better for the dental team's ability to deliver an efficient, well-fitting, and complete restorative process on the same day. In addition, it is a better patient experience to skip traditional impressions.

Alex Kalmanovich, DDS, ABDSM, a private practice dentist in Laguna Beach, CA, says that early in his career, he had the luxury of working in a practice that utilized new technology. One piece of their pie was a digital scanner and a milling machine. Dr Kalmanovich says the practice owner mentored him and taught Dr Kalmanovich how to utilize the technology successfully.

"When I opened my own practice, it made the decision just a little bit easier to make the big investment into digital dentistry. I knew I needed a way to stand out in the community, where multiple dentists are on every corner. So, although financially it was frightening, I had confidence that I could make a return on my investment," Dr Kalmanovich says.

Dr Kalmanovich chose the CEREC system by DENTSPLY Sirona for his private practice in Laguna Beach, CA. He describes CEREC as the Tesla of digital dentistry.

"Dentsply Sirona has relentlessly continued to push ahead, bringing the advent of digital dentistry into normal reality," Dr Kalmanovich says. "Whether you love or hate CEREC, they were instrumental in paving the way for many other companies to start producing digital scanners and milling machines. More practically, consider the availability of CAD/CAM dentistry in the early 2010s. Most dentists have considered buying a CEREC whether they admit it or not, leading to the world we live in now, where most dental practices have digital scanning equipment."

Dr Kalmanovich says it is essential that members of the dental profession be open to change. New technologies are going to continue to change the digital workflow. While it may seem daunting to incorporate new technology, especially when things they are doing now seem to work fine, Dr Kalmanovich encourages dental professionals to continue to adapt to it, enhancing the patient experience and improving treatment outcomes.

"As CAD/CAM and 3D printing are becoming common in many practices, I see in the future utilizing artificial technology and image recognition to help our treatment plan and monitor oral disease," Dr Kalmanovich says. "I love how dentists continue to be open to ways to improve our wonderful profession."

Park, J., Shim, J., 2019, 'Optical Impression in Restorative Dentistry', in M. E.Machoy (ed.), Computer Vision in Dentistry, IntechOpen, London. 10.5772/intechopen.84605

Hwang, Henry Hann-Min; Chou, Chi-Wei; Chen, Yi-Jane; and Yao, Chung-Chen Jane (2018) "An Overview of Digital Intraoral Scanners: Past, Present and Future- From an Orthodontic Perspective," Taiwanese Journal of Orthodontics: Vol. 30 : Iss. 3 , Article 3. doi:10.30036/TJO.201810_31(3).0003

Patterson M. Intraoral scanners In dentistry – an update on digital technology - Scottish Dental magazine. www.sdmag.co.uk. Published 2018. Accessed September 20, 2022.https://www.sdmag.co.uk/2018/10/01/intraoral-scanners-in-dentistry-an-update-on-digital-technology/

ŞAHAN N. What is Stereophotogrammetry? - Surveying Group. Surveyinggroup.com. Published 2020. Accessed September 20, 2022. https://surveyinggroup.com/what-is-stereophotogrammetry/

You use it all the time, but do you know how your intraoral scanner works? We look at some of the imaging principles of this versatile technology and how scanning can lead to digital workflows that improve your patient experience and clinical outcomes. 

Understanding the Three Most Common Imaging Principles Used By Intraoral Scanners 

Many lab owners wonder where their future employees will come from, and not all of them have satisfactory answers. With the number of accredited dental technician education programs shrinking, finding answers is a priority.

However, the future is not as bleak as one might think. Rune Fisker, senior vice president of product strategy for 3Shape, says he thinks the future of labs is promising—and 100% digital. Therefore, the future dental lab team member must be a digital technician.

“You can already see today in the lab that it is not just ceramics anymore. The most highly paid employees are the CAD/CAM technicians,” Fisker says. “But to some extent, there is a shortage of good CAD/CAM technicians, and many [individuals] will retire within the next decade. So that makes the question even more important for where the future technicians would come from.”

So, where will these future lab techs with all this digital expertise come from? We asked industry experts, who also discussed the challenges facing dental technician education and what labs can do in response.

Hurdles Ahead for Dental Technician Education

Dental technician education programs have challenges, starting with shrinking numbers. Bennett Napier, MS, CAE, chief staff executive at the National Association of Dental Laboratories (NADL), says the number of accredited dental laboratory technician programs is shrinking. As of 2022, 13 programs remain throughout the US. However, 2 will end during the next year, bringing that number down to 11.

“In both cases,” Napier explains about the 2 programs dropping out of the Commission on Dental Accreditation (CODA), “they are potentially going to a certificate program or a 1-year program. However, the way the CODA accreditation standards are structured, you must have at least a 2-year program or above to be accredited. So, the NADL is submitting some recommendations to modify that.”

The NADL is responding in other ways. For example, the organization is collaborating with several providers on a 1-year program teaching digital workflow in a formal education arena. NADL leadership sees this as a way of keeping some schools open because it would allow them to graduate more students faster with more applied skills in a market-need area. “We can have at least one pathway where the students are getting more hands-on and where they could earn more money coming out of the school,” Napier says.

One problem with education programs is funding, says Richard Jentsch, CDT, head of research and development at Opulent Digital Specialists. Lab technician programs need to invest in the technology that dental labs use today, but few can afford it. Many manufacturers offer education pricing to programs, something Jentsch supports and would like to see more companies do. “Some other companies are doing that because they know that funding is an issue for the schools, and if the equipment is not there, the program is outdated in many cases,” Jentsch says.

“We are actually very lucky in that many of our technicians are offered on-the-job training and many manufacturers and dealers offer free education resources,” says Marybeth Starr, head of brand promise for Harvest Dental Products, LLC, in Brea, California. Starr also appreciates The Foundation for Dental Laboratory Technology, established by the NADL in 2008. The foundation provides scholarships, grants, and opportunities for lab technicians who want to develop skills; it also offers grants to educational schools. Lab owners, techs, manufacturers, and educators from across the nation come together through the organization to maintain a skilled workforce in restorative dentistry. “The Learning Library is a huge resource,” Starr says.

Napier says the foundation collaborates with manufacturer supplier partners to help transfer knowledge from experienced technicians to the recruits. Also, the NADL has created original content around critical skills regarding business management.

“If somebody comes in from outside the profession, we are trying as much as we can to give them the ‘101’ tools and provide broad-based feedback regarding job task analysis. We say, ‘To be proficient at this, these are the things you need to know,’ ” Napier explains. “Then, this helps the labs train [individuals] quicker on the important and relevant things because it could be overwhelming.”

Tom Zaleske, owner and dental technician at Matrix Dental Laboratory and Consulting, has more than 36 years of experience in removable prosthodontics and is a consultant for the dental industry. He recognizes that today’s newer dental workers do not understand the basics of building prosthodontics.

“All you have to do is go online and look at how many dental workers are asking rudimentary questions that, if they were dental technicians and had a foundational base of education, they could answer themselves,” Zaleske says. “Those who have that formal education are the ones answering the questions.”

Tomorrow’s lab technicians will come from outside the industry and train directly and informally in a lab, which Zaleske says will require a redefinition of dental worker vs dental technician. Manufacturers will train future technicians also. However, Zaleske thinks these new workers will not get the well-rounded training that accredited dental laboratory education programs provide regarding anatomy and design or materials science.

For example, formal dental lab technician education teaches basic polymer chemistry. If lab technicians without formal training do not understand these fundamentals about different polymers and their chemistries, Zaleske says, then these new techs cannot do more than follow directions. If something goes wrong, they will not know why or how to fix it or how to maximize its potential.

“I have been to many lectures, and they never talk about the clinical aspects of it as much as they talk about how you can use it in this application,” Zaleske says about manufacturers’ training programs. “They do not talk about any of the nuances, things that make a long-term success, or what you do not want to do with it. They would have to teach an anatomy course first to explain to [individuals] why it would not work.”

In Denmark, the technicians will not be coming from the school. It is closed, Fisker says. However, that does not concern him as much as schools teaching analog skills, which Fisker sees as outdated. Digital production decreases the need to adjust things by hand.

“The whole hand part of the process is going to be reduced. Primarily everything will be milled or printed,” Fisker says, adding that designing complex cases in detail will become more important.

However, artificial intelligence (AI) may handle the design for more straightforward cases. For example, 3Shape Automate is an AI-powered design program for upper nightguard and multiunit monolithic molar and premolar crown designs. The lab uploads the order; then, once it is ready, the lab approves the design or modifies it.

“Labs have accepted more than 500,000 cases with an acceptance rate of 92%,” Fisker says. “So, AI is coming in, but this is only for simpler cases. There will still be manual design on most of the lab cases.”

Like many in the lab space, Fisker wonders whether there will be enough individuals coming out of school who want to become dental technicians. Therefore, he sees the onus for recruitment and training fall to the lab. “We need to have in-house trainee education instead because the availability of educational institutions is growing short,” Fisker says.

Fisker sees 2 problems. First, on a global scale, there are not enough students enrolled at these schools. Second, the schools are not always teaching the appropriate skills. Fisker sees future dental education teaching the digital workflow. “More digital workflows will also be much better at attracting young generations into the field,” Fisker says.

Like the NADL, the National Board for Certification in Dental Laboratory Technology (NBC) is responding to change in the industry and the ubiquity of digital workflows. The NBC announced the development of certification for a digital workflow technician this past summer. Capturing the CAD/CAM design steps in the test formats and adding a digital component to the testing is vital. The new program establishes standards for digital dental lab technicians regarding their knowledge and skill in using the systems.

As a member of the NBC board of trustees, Jamie Stover, CDT, senior manager of dental lab applications for Carbon, says the digital workflow technician designation represents 

level of knowledge and skill to produce restorations that will fit. “It is important to establish that these technicians understand the correct dental terminology, as well as occlusion, function, and morphology, and can correctly interpret a prescription from a dentist,” Stover says.

Starr says the pandemic forced many individuals to turn to online education. Even as the industry is seeing a return to in-person classes, Starr says online will continue because it also solved an accessibility issue. Many technicians who could not attend in person now can attend any number of classes, often at no charge. “Online learning has the added benefit of lowering costs for the hosts, enabling a wider offering and a wide variety of classes, without the typical travel and venue expenses,” Starr explains.

Starr says hiring for niche markets like dental labs can be difficult. It’s a skilled technical position, but also a creative one. Starr says that presents a unique challenge for lab owners.

“Certain skills are intuitive and not something that can be taught, so it can be hard to ask for an exact skill set,” Starr says. “When recruiting options are limited, we have to identify key sources to target, such as creatives, art students, nail technicians, graphic designers, [as well as] get involved with local community colleges and high school vocational programs and your local [Veterans Administration].”

Starr says employee retention is the next hurdle. She recommends offering innovative employee perks such as flexibility in hours, competitive wages, cross-training, and remote work. “Also, you need on-point culture values,” Starr says.

With fewer education programs, it is natural to assume that there will be fewer lab technicians to employ. Stover thinks having fewer graduates from formal lab education programs means tomorrow’s technicians will come from outside the dental industry. Moreover, technological advances mean basic computer skills are enough, along with a good work ethic, reliability, and a desire to learn a trade.

“Our industry is unique in that you don’t need a college degree to gain employment; you can start with no dental experience in an entry-level position and work your way up through the other positions as you learn the trade through apprenticeship, and after 5 years on the job become a certified dental technician. This is more possible currently than in previous times due to the advancements in CAD/CAM technology and associated materials, and the roles created by this evolving technology,” Stover says. “You can earn a good living while doing rewarding work that is improving [individuals’] lives, restoring their smile, or improving their ability to eat.”

Dental technicians using exocad’s dentalshare are able to export their design as an encrypted link so the lab technician does not have to be in the same city or even in the same time zone. It uses compression technology, combined with a robust transfer protocol, so that even big datasets travel through unreliable mobile network connections and restrictive firewalls with ease.

Moreover, the NADL feels that the technology is an excellent student recruitment tool. Most technicians work with exciting technology daily, sometimes entirely, resulting in higher wages.

In 2021, dental technician employment levels increased by 9% compared with 2020, and employee counts are approaching pre-pandemic levels at 44,063 in 2021 vs 45,663 in 2019.

 Although the number of dental laboratories with a payroll decreased by 2% overall in 2021, employee wages are increasing over the previous year by over 8%, averaging around $56,524 in 2021.

The 2022 salary numbers are growing, too. Napier says the NADL’s market research survey for June 2022 revealed that the least experienced technicians make around $35,000 on average, and more experienced techs make $65,000.

 Moreover, the percentage of technicians making $100,000 or more has significantly increased, Napier says, and not just for management roles. This trend could be for technicians focused on quality results and high production.

“We have certainly turned a new leaf with technology,” says Tad Friess, NADL president and owner of Rockert Dental Studio in Wheaton, Illinois. “Modernizing how we do things has opened doors to useful technicians or employees [whom] we turn into technicians.”

“In terms of recruiting, especially for [individuals] from outside the field, this could be a very attractive market for them,” Napier says, adding that NADL is launching a new video and occupational awareness campaign to attract newcomers to the profession.

Stover, who has been a technician for 24 years, says awareness of the industry is key and agrees that if more individuals knew that being a dental lab technician meant working with technology like 3D printing and new materials, it might generate interest. Moreover, it could capitalize on a growing trend of students graduating and taking some time to figure out what they want to do.

“Technology and materials have evolved so quickly that we now have thousands of [individuals] working in this industry who are not doing any traditional analog steps at the bench,” Stover says. “Instead, they work in CAD/CAM roles, on computers, and running mills and printers. For example, some techs have learned to stain and glaze zirconia crowns without knowing many other fabrication steps. This is definitely where labs should focus their attention, developing systematic tools and training plans to educate the digital technicians.”

Jentsch agrees that the future of the dental lab is digital, and digital lab techs will come from all over 

the world. In addition, digital files are getting easier to send worldwide through portals or tools like exocad’s™ dentalshare, which allows techs to export their design as an encrypted link, so the lab tech does not need to be in the same city or even the same time zone.

“It is not a big deal anymore to send cases back and forth,” Jentsch says. “For example, I was on the phone with one of my accounts earlier, and we sent files back and forth. She is in Portland, Maine, and it does not matter if she would be in France or Italy, for that matter.”

“The question is,” Jentsch continues, “how will it be built out? How are you going to deal with the time difference, which may or may not work in your favor? How will you handle communication and troubleshooting if something is wrong? But other than that, it does not matter anymore where [individuals] are if it is digital.”

Moreover, the lab community is primarily optimistic about the future of recruitment for lab technicians. Napier says the NADL’s latest research shows that almost 60% of the respondents felt hopeful about where the market and lab technology were going.

“We have always had challenges. It is just a matter of what they are,” Napier says. “But we are pretty resilient as a profession. We find solutions.”

Labs can respond in many ways to these challenges facing the future of dental lab tech talent. Hoping for the best seems to be a strategy for some labs regarding talent retention, says Nelson Rego, CDT, AACD, owner and dental technician at Smile Designs by Rego. “For the last 5 or 6 years, they bring somebody in, train them and try to get them up to speed, and hope that once they are up to speed, they do not quit,” Rego says.

Smile Designs by Rego is in Santa Fe Springs, California, close to one of the nation’s few remaining accredited dental lab schools at Pasadena City College. The 2-year program has classes for orthodontics, pedodontics, partial dentures, and dental laboratory management. In addition, the program promises that after completion of the certificate in dental lab technology or the associate degree, graduates are prepared to take the certified dental technician (CDT) exam from the NBC.

Rego has 3 Pasadena City College program graduates employed at his lab. In addition, he has an internship program at his lab where he continues to train graduates with talent. “I want to make it a good experience for them and beneficial for me if the kids have talent,” Rego says.

Rego has tried different things to attract talent to his lab. For example, Smile Designs by Rego is next door to an Ivoclar Academy learning center. He has large, clear windows that show off the lab; Rego hopes seeing inside might entice a trainee to work for him.

Many of the dental lab technicians in the Los Angeles, California, area are Korean, so he also advertises in a local Korean newspaper. Rego offers 

an apprenticeship at $1000 a month to train. He recently had 4 applications for the program.

Rego agrees that digitalization helps open possibilities for dental lab technicians. For example, one of his best designers worked in information technology. However, when he came aboard, he knew a lot about computers and next to nothing about teeth.

“So, we set him down, and we showed him what we are looking for so he could learn,” Rego says. “We show them what the output will be, not just what they learn in a weekend seminar for free.”

Continuing education should be a priority for all labs, Starr agrees—including monthly training, whether it is technical or a culture class. Starr says LinkedIn Learning offers free classes in some areas. By staying engaged, the labs solidify interactive relationships with your employees.

Starr also thinks labs should consider being creative about where to look for workers. Also, she advises labs to remember that recruiting is a 2-way street. “Employers are looking for qualifications and personality, and those being recruited are looking for a company that will fit them culturally and financially,” Starr says. “Both should know what they want. But don’t narrow your focus, and be flexible, because the best candidate or company might be the most unexpected one.”

Stover thinks labs can also move some of the hands-on, labor-intensive steps at the bench to digital design and fabrication. By keeping it simple and having the new technicians focus on specific tasks, they can get creative with recruiting efforts. Moreover, he thinks labs should commit resources to develop in-house training programs for educating employees from outside the industry and recent technical program graduates, to prepare them for a production setting.

“They can also commit to moving to digital fabrication for every type of restoration possible. CAD/CAM technology and new materials allow labs to fabricate restorations digitally, meaning many of the steps don’t require years of hands-on experience to perfect, so labs that can’t find experienced techs to employ can train [individuals] from other industries, and even outsource some of the steps, such as digital design,” Stover says. “Fixed restorations transitioned to digital processes around a decade ago, and impactful materials and technology are now allowing dentures to move that way, too.”

Stover says that as part of the transition from analog work at the bench to digital design and manufacturing on mills and printers, the lab can hire individuals with no dental experience to perform some of the new production steps, with training and oversight from experienced techs. As a result, the experienced technicians become trainers and educators of the less experienced, passing on their knowledge to the next generation of digital techs.

“But some labs are not doing this,” Stover says. “Instead, they are leaving their most experienced techs in these analog production roles at the bench because they think it’s necessary to get the production done and the work out the door. When this happens, labs get stuck, and their digital implementation stalls. Transitioning to digital products such as 3D-printed dentures requires a strategic approach to moving step by step, from the training of technicians to the production processes to dentist communication and education.”

There are a few ways to ensure production does not falter during the transition. Stover thinks a plan that moves work digitally gradually by focusing on a smaller client segment can help the transition. Creative recruiting for new production roles and part-time apprenticeship programs for high school and community college students or even recent graduates can help, too. The strategy labs generally find effective is to transition the experienced techs from the bench to digital design, training, and digital workflow management roles and train the less experienced techs, or employees with no dental experience, to perform the new production steps such as running the mills and printers, post-processing, assembly, and polishing, among others. Unfortunately, this is where some labs stumble, Stover says.

3Shape Automate is an AI-powered design program for upper nightguard and multiunit monolithic molar and premolar crown designs.

“If labs get stuck in the mindset [that] they can only hire [individuals] with some level of dental lab experience, they miss the opportunity to scale their existing knowledge and skill by developing an in-house training program,” he says. “There is no shortage of dental work or dentists looking for competent labs. This means there is a lot of opportunity for labs, and the digital technology and materials available are the new tools [that] make it possible to succeed in the face of the staffing challenges facing our industry.”

Stover thinks many restorations that are possible with the new tech provides benefits over some traditional materials in impactful ways. For example, he says Lucitone Digital Print 3D-printed dentures (Dentsply Sirona) have twice the fracture strength of traditional denture acrylic when in the patient’s mouth at body temperature. Other benefits include fast reproducibility of a lost or damaged denture via the digital record, which eliminates the need to start over with a new impression and the 4 or 5 appointments involved in traditional denture refabrication; the ability to copy a patient’s existing denture and cut the required appointments down to as few as 2; and the ability for labs to involve less-skilled technicians in some production steps, mitigating the staffing issues discussed.

“These digitally produced restorations bring impactful benefits for patients, clinicians, and labs. Labs do need to develop a very strategic approach to training and implementation, but the reward for this effort is a streamlined and more profitable production process and a solution to the lack of experienced technicians our industry is facing,” Stover says.

Jentsch thinks labs should recruit and educate their future technicians. He has seen that in labs he works with, many recruits are not from the dental field. Instead, the labs recruit individuals with computer skills and train them for dental restorations. In this way, Jentsch says, the labs are redefining what a lab tech is. Although he acknowledges it would be better for all dental lab technicians to have a dental background and understand tooth biomechanics, having another technician managing such details for those producing digital files can be almost as good a setup.

“The struggle has been there for I do not know how many years, and it is getting progressively worse,” Jentsch says regarding the scarcity of new dental lab technicians. “How I see [labs] dealing with it is training their own [employees] personally, splitting the workflow into bite-sized portions.”

For example, one lab technician can run the camera and scanner and then pass it to the individual who handles the design. Once the job needs hands-on skills, like stacking porcelain or staining and glazing, that could be a different level job and skill set. However, Jentsch says breaking the job into chunks can make it easier to accomplish the tasks a comprehensive lab technician has previously done.

Doing the same thing can lead to employees feeling undervalued or bored. In addition to recruiting or changing how the job breaks down 

within a lab, Jentsch thinks offering a path for career development within the lab could encourage employees to join or stay in the profession. A goal to strive for regarding improvement in their skills is a motivating factor for many individuals.

“If that is an offer on the table for lab technicians, that is a big one,” Jentsch says. “Maybe take advantage of the knowledge from the [individuals] who will soon retire before they go.”

Friess has been finding talent through word-of-mouth marketing of other technicians. Showing these new technicians how the work is computerized, using 3D printers and digital milling machines, and how the technology offers remote work opportunities has been helping.

“We have a single dad right now who has a son. One day he designs from home,” Friess says. “The gap for labs is finding [individuals] and training them. The video will help because many youths do not know this is even an option for them. Awareness will be one of the biggest factors in getting kids interested.”

Labs have also used high school outreach programs to recruit new technicians. Napier says many labs use health occupation student association chapters to facilitate this effort. In some states, labs work with the state dental association, lobbying the legislature on dentistry. Also, there are pilot projects with some states having legislative funding to hire a career recruiter for all professions of dentistry.

“Wherever we can, we partner with those types of opportunities,” Napier says, adding that many of these state programs are driven by access to care. “We come in as a parallel piece to that because if you have a dental need, the laboratory helps dentists fulfill that need. So, it is a crucial part of the puzzle.”

Another way to overcome the deficit in accredited lab technician education would be for labs to establish accredited programs in-house, Zaleske says. Then, the core education would be part of the curriculum and produce dental technicians who could establish a collegial relationship with their dentists, he says. Without that education, the employee is a dental worker rather than a technician. “The problem is a lot of dental workers do not have that core knowledge base and cannot make that recommendation, or that recommendation they do make has not been substantiated,” Zaleske says.

He would like to see more pride in the profession, including the old-school ways of producing prosthodontics. A denture, particularly when it is well made, is more than an appliance that can help one to eat and feel better about a smile. Moreover, Zaleske says there is a significant difference between a denture and a removable prosthetic. A denture treats a hole in the patient’s face; a removable prosthetic treats the whole patient.

“There is a deeper attachment to what you wear in your mouth. If you do not believe me, all you have to do is look around. [Individuals] do not smile as much when things do not look right in their mouths. [They] feel less good about themselves when they do not feel complete,” Zaleske says. “The only way to make them feel complete is to address all the things that a dental technician can address rather than a dental worker.”

This question is one to which many individuals do not know the answer—including today’s lab owners. We talk to industry experts about the challenges facing dental technician education and what labs can do about them.  