Implant Fundamentals

Passing knowledge to the next generation

Jason Mazda

As technology continues to commoditize simpler indirect restorative procedures in dentistry, laboratories nonetheless find their services in more demand than ever for implants. General dentists are keeping more implant cases—and more complex ones—in-house, and laboratories with extensive knowledge and education to support them on these cases present tremendous value, as dental schools alone typically cannot prepare clinicians for these types of cases. "We are seeing more and more that we are needed for successful implant case planning," says Dennis Urban, CDT, Director of Operations and Clinical Education for MicroDental New York.

To meet this need, however, laboratories must themselves have educated technicians—a challenge that becomes greater with every dental laboratory college program that closes.  Only nine such programs remain, so the burden falls largely on others to provide that education. Manufacturers often provide extensive education, but that is typically geared toward specific products. When it comes to ensuring that important general knowledge about dental implants is not lost on the next generation of dental laboratory technicians, there are still various other sources for education, however. Inside Dental Technology (IDT) spoke to leaders in the profession to get a glimpse at different methods by which technicians can become educated on implant dentistry.

In-House Training

The most basic, and likely most common, form of implant education for dental technicians is in-house training by veteran employees within the laboratory. Urban provides this at scale for the MicroDental network, traveling the country to give courses. "We do send people to various outside trainings, but every laboratory has its own foundations and priorities, so in-house trainings are a way to control the exact message," says Urban, an IDT Editorial Advisory Board member. "It also tends to stick with people better, because we can review periodically and answer questions any time." Urban says technicians often follow up with questions about specific cases; he asks what they think and then talks them through why they were right or wrong.

In-house training courses also can be supplemented by videos, reading, and more. Urban often allows technicians to listen in on his conversations with dentists. "That helps them get comfortable talking to dentists themselves on these cases," he says.

Even over-the-shoulder observation of more experienced technicians can help younger employees. "Years ago, it was unheard of to look over the shoulder and watch another technician work," Urban says, "but now, I make it mandatory that everyone share. We get together and talk about cases, and then we watch each other working on them, and everyone learns from it."

Urban emphasizes that even the most experienced technicians can benefit from brushing up their skills at times. "Just like in any business, people forget things," he says, "so we reinforce everyone's training on an ongoing basis."

Conference Lectures

Another common way of obtaining continuing education is through lectures at conferences and other events. Veteran technicians use the so-called "lecture circuit" to share their knowledge. These lectures are usually sponsored by manufacturers, so some are more promotional than others, but some are still very educational. "I rarely mention brand names, and I only thank my sponsor at the beginning and end of the lecture," says Alexander Wünsche, CDT, an IDT Editorial Advisory Board member and president of Zahntechnique laboratory in Miami, Florida. "I might mention a product in a slide if I really like it, but usually, my lectures are not promotional at all. That is a priority for me personally, and it was also something I was adamant about when I was vetting speakers while serving on the Florida Dental Laboratory Association board." Wünsche concedes that more established lecturers have an easier time insisting on being nonpromotional when sponsors pressure them, but he said he has no problem walking away if a sponsor insists on a presentation that is overly promotional.

Lectures at conferences are often as short as 1 hour, but Wünsche says audiences are most engaged when he is speaking for 3 hours or more. Hands-on elements help as well. "I always want people to learn something that they can apply soon after my lecture," he says.

Often, the most productive learning occurs after the lecture. Wünsche and many other presenters provide their personal contact information at the end of their courses. "There are almost always at least two or three people who follow up with questions or want to get my input on a specific case," Wünsche says. "They email, text, or send direct messages on Instagram. Many of them stay in contact for years, and I always help them whenever I can. That adds up, and it is rewarding to know that I am truly helping people and passing on my knowledge in that way."

Advanced Education Organizations

More extensive education on implants, among various subjects, is available at educational centers such as the Kois Center, the Dawson Academy, the Pankey Institute, and Spear Education. Some of these centers offer substantial discounts for dental technicians. "The main benefit across the board is that, any time clinicians and laboratory technicians are learning together, the value is tenfold," says Peter Pizzi, MDT, CDT, editor-in-chief of IDT and owner of Pizzi Dental Studio in Staten Island, New York. "You are hearing the same things your clinical partners are hearing, so your approach becomes better.

While many of these centers have support from and/or affiliations with certain manufacturers, the education still is largely non-product-focused. "Is there influence? Of course," Pizzi says. "But they are still purer than infomercials."

Pizzi notes that he has successfully encouraged a number of technicians over the years to attend the Kois Center, where he is a mentor, but he says he would like to see more laboratories take advantage of these opportunities. "Especially for bigger laboratories, the cost does not seem to be as much of a factor as sending a technician into such a clinical environment," he says. "Many of them tie in the laboratory well, but the conversation still is almost 95% clinical. It needs to be clear that the technician is going there for clinical learning."

While implant courses account for only a portion of the education offered at these centers, Pizzi says it is the most critical. "We talk about dentists asking for input on cements or when to etch in crown and bridge, but the importance of the laboratory's knowledge base is tenfold in the implant world," he says. "Understanding secondary components, angulations, how to utilize materials for longer arch spans or difficultly positioned implants, etc, is so important. Working on implants places more weight on the technician's shoulders, so the more knowledge they have, the better off they are."

Formal Education

It stands to reason, of course, that replicating what is taught in 2-year college programs with a half-day, full-day, or even monthslong course will always be challenging, so the nine remaining college programs for dental laboratory technology still play an important role in the profession.

Daniel Alter, MSc, MDT, CDT, executive editor of IDT and a professor of restorative dentistry at New York City College of Technology (NYCCT), says his students graduate with a foundation that enhances the value they can glean from continuing education in the future. "A sound foundation, rather than just learning processes, makes these technicians critical thinkers," Alter says. "When they start working in a laboratory, they have this hunger and need to learn more."

NYCCT teaches concepts ranging from the importance of concavities subgingivally for single-unit custom abutments to the implications of anterior-posterior spreads, hygiene considerations, and more. Alter says new graduates might not necessarily be ready to handle implant cases on their own immediately upon starting at a laboratory, but that the learning curve will be shorter. "They understand the fundamentals of the physics and biomechanics involved, as well as the importance of the utmost precision in achieving passive fits, so they can better execute the protocols that they ultimately learn in the laboratory," he says.

That level of depth in one's education creates invaluable confidence, Alter adds. "When you are supremely confident in your knowledge, you can better collaborate with the dentist and elevate the entire team," he says.

Respecting the Complexity

Of course, all of these modalities can be utilized for education in any discipline of dentistry. As important as implants are, Wünsche emphasizes that a well-rounded education is critical, given how much goes into implants.

"Implant dentistry is an important topic, more so than ever before, because everybody wants to do implants and it is still a very profitable segment for laboratories of all sizes," Wünsche says. "In reality, however, every topic needs addressing. Single-unit implants require a lot of the same knowledge that is needed for crown and bridge; full-arch implants require removables knowledge. I encourage multidisciplinary education. In my own laboratory, I have a hard time even differentiating the departments because there is so much overlap. That is where our education needs to go, too."

Alter notes that perhaps the most important overarching concept is respecting the complexity involved with any implants, from single units to full arches. "Implant dentistry is a very powerful prosthetic solution," Alter says, "and we need to treat it with the respect that it deserves. We need to understand the physics, the engineering, and everything else involved because these are not just cases; these are human beings, and they deserve the very best. Lifetime learning alongside like-minded individuals is the best way to provide that."