Turning Wisdom Into Value

The Consultative Dental Laboratory

Daniel Alter, MSc, MDT, CDT

The restorative dentistry profession is experiencing a paradigm shift in the way we conduct our business and the services that we are able to offer our clinical clientele. This shift presents great opportunities for those who wish to expand their internal capabilities and knowledge base in order to tap into the consultative approach model. As restorative workflows and modes of collaboration evolve along with technology, the consultative element of the dental technologist's role has been taking on increasing levels of importance.

Creating value through education and other avenues, understanding that value, and having the confidence to appropriately monetize it will be critical in the future. How will you and your laboratory seize these opportunities and raise the bar to garner greater benefits for your work-life balance, employee morale, clinician satisfaction, and, ultimately, patients' best interest?

The conventional function of dental laboratories in the past was to fulfill the dentist's written authorization—something that was often done in disconnected silos that were physically separated with very little integration between the two entities. "The role of the dental technician has always been set to fill a prescription," says John Wilson of Sunrise Dental Laboratory in Yucaopa, California, "and as we have continuously developed our knowledge on the clinical side of dentistry, we can now make suggestions in a much more meaningful and significant manner. That is how we can truly become a more valuable asset to the entire dental team. I have wholeheartedly subscribed to that team approach to dentistry." The concept of providing the restorative perspective to the dental team is something that clinicians value and often seek out. It offers peace of mind to our clinical partners, as well as to the dental laboratory in an appreciable way. Having restorative expertise and input on the restorative protocol—whether it be material, positioning, or other factors—will greatly enhance the success and value proposition of the prosthesis for the patient and clinician alike.

A Business Tool

As a business model, the consultative approach opens avenues to communicate with all the disciplines of the dental team and offer invaluable input that makes attaining the best restorative outcome significantly more efficient and viable. "As a full-service dental laboratory, we have full-time employees consulting all day long," says BJ Kowalski, CEO of ROE Dental Laboratory in Independence, Ohio. "While many of our product lines have become commoditized, many others have not and cannot, and those need more consultation. Restorations such as full-mouth rehabilitation or implant-supported prosthetics require more communication throughout the process. Providing guidance on what is needed is imperative." A dental technologist needs to know all potential clinical complications and their consequences in order to truly add value through the lens of the restorative perspective of what will work and what will ultimately fail in the oral environment. One laboratory executive who requested anonymity shared an anecdotal experience about communicating via a web platform with a general practitioner and an oral surgeon, planning implant placement and subsequent surgical guides. He turned off his microphone briefly to check the patient data on file and confirm that the information was sufficient, and he heard the dentist comment to the oral surgeon that the laboratory team seemed like engineers and artists, and that they could manage everything for the case. Similarly, Wilson has found that his laboratory's value is appreciated by their clinical counterparts. "Clinicians come to us and ask, ‘What should I do with this case,' rather than dictating it," Wilson says. Those types of conversations really place the dental technologist at the table and insert them into discussions, tapping into the restorative perspective to achieve the best possible results for the patient.

Monetizing the value of this consultative approach can be tackled in various ways; some may separate consultation as independent line items, while others incorporate it into their price offerings for certain prostheses. Either of these approaches—or a combination of both—can work well, but the value proposition offered needs to be emphasized and then delivered at the highest of levels to command and offer the desired perceived value. Paul Edwards of Paul Edwards Dental Studio in Stockton, New Jersey, has been offering these services throughout his career and has found himself over the past few years communicating with more oral surgeons and periodontists than with general practitioners while planning implant-supported cases. As a small laboratory, Edwards says that level of participation is what dentists can expect when working with him on a case. "Dentists who utilize my laboratory get that service," he says, "and I find that it is the best way of achieving a predictable outcome." Whether for a large, medium, or small laboratory, the consultative approach allows for a greater influence on the restorative and treatment protocols, which translates to the laboratory's business health and vitality. "If you are not actively consulting with your clients and being available to consult on cases," Kowalski says, "and if you are not growing your dental laboratory business, then perhaps that is why. It is a key component and instrumental to the dental prosthetics services that we offer."

Technology and Education

Among the catalysts propelling this consultative model, two in particular are driving it forward. The first is the emergence of technology and its evolution within restorative dentistry. Dora Rodrigues of ID Dental Lab in Kenilworth, New Jersey, has witnessed first-hand how technology can push the limits of our capabilities and offer a heightened level of competence when restoring high-level prosthetics while using sophisticated options to produce best-in-class restorations. "I understood the value of what technology can do for me and for my clinicians," she says. "It was up to me to invest in it and bring it to their attention; once they saw the benefits, they never wanted to go back to their analog ways." Rodrigues' journey began in the analog process, and she admitted to having resisted technology at the onset. However, after seeing and appreciating the benefits it provided, she was quick to embrace and learn the digital process in order to actualize and reap its benefits. Her transition began with providing scanning services for her clients' patients, which translated to an appreciable reduction in appointment times. "Next, I showed them how I was able to uilize and merge all the technology together to better plan and predict the outcome," she says. "Once you go through that stage of adoption, everything flows a lot easier." As a result, Rodrigues is now recognized locally as the go-to source for large implant-supported prosthetics, and her laboratory began attracting new dentists and new practices just because of the value she provides by bringing the technology to them.

The second catalyst driving this paradigm shift is the changes experienced over the past decade in some dental school curricula, whereby restorative education has been replaced by other pressing professional needs. Emerging and new dentists may be less versed in some restorative processes, restorative materials, and the restorative options available at their disposal to restore complex cases. Similar to technology, this is an area where dental laboratory professionals excel, so it is an opportunity to offer a robust level of support through a consultative approach; however, this must be fortified by a vigorous level of education and experience. That takes a level of determination and commitment, but it is an endeavor that will certainly increase the laboratory's value. "When you provide that value, you are seen as an expert," Wilson says. "Dentists will come to you and ask questions." That creates a proactive engagement rather than the reactive one to which we are generally accustomed.

The commitment and drive to truly immerse oneself in the study of restorative protocols, both from a laboratory perspective and in systematically understanding the clinical aspects, will yield the best results. "I was fortunate to be involved in a study group whose members enjoyed having technicians join them for perspective, to ask the questions that a technician would think to ask," Edwards says. "For many years, I have been to courses that were not really designed for technicians, but I have learned a tremendous amount in them." Wilson agrees that obtaining as much education as possible is a worthy endeavor for any dental laboratory technologist. "Staying on top of all the innovative technology and restorative materials available is a full-time task," he says, "but it is one that is essential to stay at the finest level to serve your dentists' patients."

Whether you are formally trained or you utilized the many resources available today for training, you need a commitment and dedication to adding value and elevating your career. Rodrigues, who was formally trained in Portugal, says the best process of educating oneself today would be "understanding the analog but investing in the digital workflow. Focus on the basics of dental anatomy, the fundamentals, and restorative methodology." Her training was in removables and setting carded teeth; however, in the past decade, once she pivoted to implant-supported prosthetics designed digitally, she found that tooth morphology and occlusion require a different knowledge base than she previously had. "I invested in going back to the basics of dental anatomy, because you can easily lose the concept of what you are trying to achieve once you start transitioning to a digital workflow," Rodrigues says. "Learning the design software is easy; of course, there is a learning curve, but with the right support, you can learn really fast. However, if you do not understand the basics of function and what works in the oral environment, you will not be successful. Unfortunately, I see quite a bit of that with many of today's designers. They can be very fast going through the software, but they do not know the basics." Rodrigues suggests going back to the fundamentals with resources such as the Air Force's Dental Laboratory Technicians' Manual and investing in study clubs such as DLT Training and Education, of which she is a member.

There are so many chances for dental technologists to become better versed in any of the disciplines within dental laboratory technology, and Wilson says there are ample opportunities to continuously grow your value proposition to the dental team through knowledge. "There is so much information out there at your fingertips," Wilson says. "If you want to learn, you can jump on YouTube or social media and find 10 videos on one topic to get you familiar with it and move forward to try to think outside the box." However, learning and practicing the skill are different; that is where experience comes in, as the more cases you are involved in, the better you can grow and evolve. "We need to really evaluate the successes," Wilson says, "but more importantly the failures, and learn from them. That is where spending 10,000 hours to really become a master or expert in the space is critical." Wilson, a strong advocate for knowledge transfer, has been actively sharing his wisdom and feels that it is incumbent on others to do the same. "I believe the mentors—the people in this field who have been doing this work—have an obligation to give back, and this profession has been so good to me," he says. "I am happy to share because I believe that the more wisdom we can share with the next generation, the better our profession will become."

Different laboratories have slightly different approaches toward cultivating the knowledge base of their consultative staff, but opening the opportunity to raise the bar will only serve the best interest of the laboratory's clientele and thereby the success of the business as a whole. "It is all about the continual and constant communication and education for the staff," Kowalski says. "You must invest in your team; we have daily meetings about technology with our consulting team. Every morning at 10:00, we talk as a group about how to make customer service better. What is new and emerging in technology? What do they need to make sure they are aware of the technology and material options available? We are talking about them and their success." Efforts similar to these will yield a more informed consultation or customer service representative, which will establish the laboratory's status as a highly knowledgeable team of experts and a profound resource to the entire dental team for the successful outcome of the case.

Your Value

At the end of the day, the consultative approach adds significant value to the entire dental team. "Our hope is to achieve more clinical success," Kowalski says. "If cases go smoother, do not have problems, and do not get remade, that is a win. Clinicians tend to do repeat business with laboratories with which they achieve success more easily. Doing cases right the first time—and providing dentists with all the information needed for the cases to be done well—is key." This can be a very lucrative endeavor and one that fulfills our professional souls. "Really positive clients will understand the value that you are adding to the team," Wilson says, "and when you know that, you can lay your head on the pillow at night knowing that you have done everything right that you could. That is powerful." Wilson emphasizes, however, that knowing your worth is important. "You must understand the immense value that you bring to the team," he says, "and you must charge for it." Whichever way you choose to approach this paradigm shift, it is an endeavor that requires commitment and perseverance to grow and learn more, and not just about technology. Ultimately the goal must be to gain a keen understanding of the fundamentals along with elevated knowledge on clinical challenges and expectations. Having that breadth of consultation power will undoubtedly put you and your laboratory in a position of success.