Dental Labs by the Decade

If one really wanted to be pedantic, it could be argued that the first dental laboratories existed in Mexico, circa 2500 _BCE. That is when the oldest set of false teeth (made from wolf molars) was dated. Although the toothless patient probably was elated to be able to chew again, thanks to a contemporary’s ingenuity, dental labs as we know them today trace their roots to the late 19th century.

Labs have always been on the forefront of technique and technology, all for the patient’s benefit. In the nearly 150 years since then, labs have continued to evolve and innovate—and there seems to be no slowing down.

First Commercial Dental Laboratory

“The early 20th century is when dental labs emerged,” observes Marybeth Starr, head of brand promise for Harvest Dental Products, based in Brea, California. “They were workshops where skilled artisans crafted dental prosthetics by hand, changing dentistry forever.”

According to the National Board for Certification in Dental Laboratory Technology, in the late 19th century dentistry was evolving and improving. But not every dentist was adept at every skill. Some were better at certain skills than others, creating unexpected opportunities. For instance, some were particularly skilled in fabricating prosthetic equipment. Those dentists found another revenue stream by selling the fruits of their labor to other dentists. And that is where the dental lab that we know today began.

Boston, Massachusetts, dentist William H. Stowe was particularly talented in creating prostheses. In fact, he was so talented in laboratory work that he no longer had time for treating patients. In 1883, he started focusing solely on the laboratory side of his practice, catering to a select few dentists.

But by 1887, business was so good that Dr Stowe opened a dedicated dental lab, which was later joined by his cousin, Frank F. Eddy (the lab was later known as Stowe and Eddy) and is widely regarded as the first commercial dental lab in America.

Giant Step

There have been many milestones in the past 150 years, but which decade has seen the greatest evolution? In the past 20 years we have seen remarkable advances, most of which convince industry leaders that was a key era in dental lab history.

“I’m going out on a limb here and not saying the 2000s; it was really the 1960s that brought about the biggest change in the dental lab industry with the introduction of CAD/CAM technology,” Starr says. “It literally revolutionized prosthetic design and production for many industries, including dentistry.”

Although dental labs have been around since the late 19th century, perhaps the biggest change has occurred in the past couple of decades—in terms of materials and equipment and the business of dental labs. “Probably there wasn’t a whole lot going on in the ’90s,” adds Conrad Rensburg, CEO and president of Absolute Dental Services, headquartered in North Carolina. “It was a lot more of the same. We had better ceramics, but the techniques still required using a lot of highly talented hands to fabricate the prosthetics. I think where things really started changing was after 2010, when we started seeing 3Shape come out, digital design came out, but I don’t think it was really until zirconia became a feasible restorative solution that things really changed in our industry.”

Tools

Analog tools are the bedrock of lab work, and it is no secret that although they are still used, the tools have become even more high tech. It is not just the gee-whiz factor of technology that makes things like CAD/CAM appealing. That technology makes the fabrication process more efficient, less expensive, and more consistent.

“Considering the evolution of analog tools over the past 30 years in the industry, I believe technology like induction-heated tools made a big impact and helped dental labs move away from the Bunsen burner,” Rensburg says. “That was one of the biggest shifts in analog tools in my time, in the early 2000s. That’s when you saw a lot of analog tool changes or improvements.”

The human touch is, of course, a valuable and essential part of lab work. However, the ability to automate and streamline processes showed CAD/CAM to be a seismic shift in lab work, having ushered in an era of faster, consistent, and more replicable work.

“Dental lab tools have evolved from traditional hand tools to high-tech CAD/CAM systems, digital scanners, and 3D printers, enabling precision and efficiency in prosthetic fabrication,” Starr says. “We still love analog and handcrafted restorations and [although] the hand tools aren’t as popular, there is still a demand for them, and they have evolved as well.”

Materials

From wolf molars to metal to zirconia, materials continue to evolve and advance. Although the current attention to materials tends to focus on CAD/CAM, Rensburg notes that earlier generations of materials and processes led to more esthetic results.

“The ’60s, ’70s, ’80s, and ’90s were all owned by layering ceramics, feldspathic materials, those kind of PFM [porcelain fused to metal] materials,” Rensburg adds. “In 2005, we started seeing zirconia, but it wasn’t really a contender probably until about 2015. And I think between 2010 and 2015, zirconia completely eradicated layering ceramics. So, surprisingly, there hasn’t been a whole lot of different materials. You had PFMs—which really ruled the world for 30 or 40 years—and now the next generation, or the current generation of materials, multilayer zirconia has eradicated layering. And the reason for this is it has a digital workflow. Layering ceramics does not have a digital workflow. You bring in a lot of analog processes and analog mistakes and human interpretation of the data, where as zirconia has eradicated that need for the ceramics to decide how far to build something.”

Materials continue to evolve. Milling and CAD/CAM are reductive processes, meaning a block or puck of material is placed into a mill and then pieces are carved away until the final prosthetic is produced. This is a wasteful, inefficient process, and Rensburg expects 3D printing to be the next phase of lab materials.

“The next revolution or evolution will be printable materials, printable polymers,” he says. “There’s a lot of new materials, like a new graphene that they launched at IDS [International Dental Show] in the spring. That was a big material. A lot of these things are still millable. It’s reductive technologies instead of additive. I’ll stick my neck out and say, within the next 5 years, you’ll start seeing the eradication of reductive technology. It’s going to be the next thing. Milling is slow and it’s dirty and expensive.”

Artificial Intelligence

But advances are not just in dental labs’ rearview mirrors. Technology continues to march forward. The latest advancement is artificial intelligence (AI). For example, dental AI company Overjet (overjet.com)—already used by many of the largest dental service organizations in the nation—saw growing demand from dental labs. In the laboratory setting, AI has transformed how dentistry operates by making restoration production more accurate and predictable, and Overjet has emerged as a powerful tool for dentists.

AI, like CAD/CAM, is an end-to-end solution, starting at the dental clinic before progressing to the lab, and it also provides the ability for streamlined in-office visits. Last year, Overjet launched a partnership with Glidewell to improve dental diagnoses for patients by enabling easier access to AI-powered x-ray analysis and clinical insights. Glidewell’s customers, such as dental practices, can tap Overjet’s AI technology to help dentists identify areas of concern, such as cavities, gum disease, and other dental issues. In addition, Glidewell uses Overjet’s AI to identify restorative treatment needs, enhance the patient experience, and strengthen the patient-clinician relationship.

Overjet complements the glidewell.io In-Office Solution, which offers dentists everything they need to scan, design, mill, and deliver same-day restorations. The glidewell.io In-Office Solution uses AI technology to create single-visit restorations made from BruxZir NOW fully sintered zirconia and other industry-leading materials. This AI-driven chairside CAD/CAM system gives clinicians full control over the restorative process and makes it simple to provide patients with high-quality, convenient treatment options while increasing practice profitability.
Ultimately, AI improves outcomes for better patient experiences. “Having a consistent and accurate clinical diagnosis is foundational to good patient care,” says Teresa Dolan, DDS, MPH, the chief dental officer at Overjet. “Crowns, bridges, and implant dentistry are more likely to be successful when the dentist accurately diagnoses the patient’s oral health status and develops a comprehensive treatment plan. Artificial intelligence can help guide that assessment and decision-making by providing quantified data. It replaces subjectivity with objectivity.”

In the lab, AI streamlines their fabrication process, making fabrication faster and more efficient. “I think we’ve already seen it with a single-crown design,” Rensburg says. “It’s made a huge difference for us. We use a lot of AI for single crowns. I think it’s going to get better with time. I do believe that AI will eradicate human digital design at some point. Not all of it, but I think at least 80% of it. So, the same as zirconia eradicated ceramics, I think AI will ease digital designers’ responsibilities.”

But, for all the talk about AI, there remains the need for a human’s eye and touch. As such, do not expect the computer to do everything—at least, not yet.

“I believe people are still needed,” Rensburg says. “Our artistry is now the final contour, the line angles, the labial anatomy; those little details are the fine-tuning that I don’t see computers replacing the human touch for probably the next 20 years. That’s very hard to tell, but I don’t see it, hopefully, in my lifetime. It’s changing so fast, but I think for the next 10 years at least, AI will make technicians’ lives easier. It’ll make us more efficient. It will reduce the amount of hand processes needed to do things, but I don’t think AI and technology will be able to replace artistry, not in the next 10 years. I think after that, it’s a free-for-all, but [for the] next 10 years, artistry is still alive.”

Business

But for all the talk about the nuts and bolts of dental labs, it is important not to lose sight of the fact that labs are businesses, and the business of dental labs has changed in the past 150 years as well. “I think it actually became scalable,” Rensburg says. “Starting in 2010 onward—between 2010 and today—it’s become more of a business than an art form. I think before CAD design, before millable zirconia, highly esthetic zirconia, polymethyl methacrylate (PMMA), those kinds of things, everything was still pure artistry. It was very expensive. It was almost reserved [for] special technicians and the real artists [who] used ceramics as a canvas. I think after that, the playing field was leveled a little bit more, but I think the labs that still try to bring that artistry into the technology came out better on the back end. It’s more predictable, more consistent products. And I think although the artistry is not from start to finish anymore, the artistry is now applied on the back end. Before you send the case out, that’s when the artistry comes in.”

Dental lab workflows have certainly evolved, especially in the past 30 years. “When I started [in] this industry, I had to do the substructure,” Rensburg remembers. “I had to do the layering, then I had to do the contouring, and then I had to do the glazing. And that’s all done by computer now. And now the ceramacist or the contourer applies the final artistry before it gets glazed and stained and before it gets sent out. So, it’s become more of a scalable business. I think it’s more predictable and I think a little bit more of a business than the starving artist we used to be in the ’90s and 2000s.”

The dental lab industry saw a consistent, steady growth into the early 2000s. According to the US Bureau of Labor Statistics, there were 7863 laboratories and 49,597 employees that peaked in 2004. Unfortunately, since then, laboratories and employees have declined. By 2015, there were 6584 laboratories, a 16% drop from the peak in 2004. Further, the number of employees dropped by 10%. Factors contributing to that decline include globalization of the economy along with offshore laboratories, taking up to 40% of the work away from domestic labs.

Labs went from small studios (many of which still exist, of course) into larger endeavors. “In the beginning, it was small artisan studios. Dental labs have transformed into modern enterprises both large and small with a focus on customer experience, efficient workflows, and online visibility through platforms and social media, elevating the industry’s overall presence and professionalism,” Starr says.

In the grand scheme of things, dental labs are a fairly new industry. For example, Peugeot, founded in 1810, is the world’s oldest automaker. Even AT&T predates the first dental lab (only by about 10 years). Still, since its humble beginnings as a service provided to a select few Boston dentists by Dr W.H. Stowe, dental labs have experienced amazing ups and downs in terms of the equipment and materials they use, but also business. Progressing further into the 21st century, dental labs can expect even more growth, evolution, and opportunity.