Rapid advances in materials and technologies intensify the demands on the dental team
Because of the rapidity of these new advancements, dental technologists have been catapulted to the forefront of ethical responsibility for understanding the application and indication of these new material options and processes to meet the long-term functional and esthetic expectations of today’s patients. Sharing that knowledge with clients to decide as a team on the best-practices approach to a case is the greatest safeguard for patients.
“It is only through collaboration between the technologist and dentist that we gain the strongest protection for the patient from the standpoint of quality control,” Malament says.
This mutual understanding results in a shared responsibility for best-practices patient care. However, the challenge that teams face lies in keeping current with new processes, techniques, and materials on both the clinical and technical fronts. “Our world as dental technologists has changed dramatically,” says Peter Pizzi, CDT, MDT, owner of Pizzi Dental Studio in Staten Island, New York. “The struggle for technologists today is that change is happening so fast that it is difficult to stay abreast, let alone catch up if you haven’t stayed in the loop.”
Effective and immediate team communication becomes most critical when patients need more complex restorative solutions. For Simon Wong, MDT, and Vincent Celenza, DDS, a prosthodontist in New York City, that discussion begins once the diagnosis is made and the treatment plan has been decided. “With the number of material choices on the market, we need to take a look at what we want to do for this patient and which materials would work best to accomplish that result,” Celenza says. “I try to avoid metal-ceramic solutions as much as I can, but I am not going to risk using a new material that hasn’t been tested in certain areas of the mouth.” Celenza confers with Wong, who works alongside Celenza in the practice, or with his CAD/CAM technician in Italy via FaceTime, and discusses which materials and processing solutions would result in the best long-term outcome for the respective patient.
The ability to communicate in real time with team members who are just a few miles or even a continent away with the touch of a button takes case collaboration to the ultimate level. “If a restoration is not fitting right or the shade is slightly off, the dentist can take a quick picture or video while the patient is in the chair, send it to the laboratory, and have a discussion on FaceTime or Skype about a solution,” Pizzi says. “Communication technology is bringing the dentist–technician relationship back to where it was many years ago when technicians worked in the practice and worked closely with the practicing dentist.”
Malament takes the lines of communication one step further in decision-making by engaging the patient in the diagnostic, treatment-planning, and restorative discussion. This practice can help ensure case acceptance and improved long-term restorative outcomes. “Unless you have that collaborative relationship not only with your peers but with your dental technologists and patients, the patient is being shortchanged significantly if not left out. Collaboration is the soul of dentistry.”
If dentistry was driven more by a patient-first philosophy in which the patient, dental technologist, and dentist were all engaged in the restorative process, the decisions regarding material choice would center more on what is best for the patient. That may mean advising against the use of a certain procedure or material, according to Malament. “There is great opportunity for today’s dental technologist to take the lead when it comes to advising on material choice. But with that responsibility comes the obligation to say no if a client wants to use a new material in a non-indicated fashion.” However, he notes how difficult this is in an industry that is forging ahead with the promotion of new and advanced materials that have not undergone long-term clinical testing before being launched on the market and yet are in high demand by the dental community. That’s why Pizzi believes that technologists should have sufficient education regarding these new materials in terms of hardness, optical properties, and esthetic factors to understand what is being placed in the mouth and the circumstances under which those materials should be used. “We are members of the healthcare industry. As such, we have to choose what is best for the patient and not be biased about the material because it is the hottest and most profitable material on the market,” Pizzi says. “That’s why education today is so critical.”
Malament says, “Remember, when a restoration fails, dentistry always blames the technician and remakes cost laboratories a fortune every year.” The fact that some dentists accept little-to-no responsibility for the long-term success of a restoration is a profound problem, Malament believes. “So what is the value of collaborative dentistry? Why should all of us be paying more attention than ever before to a team relationship? The answer is simple: economics.” His contention is that practices working closely with their technologist partners will find that the number of common problems and even more serious ones will become fewer. “Team dentistry is a business relationship and partnership that can positively impact the bottom line of both partners,” he says.
The Team and the Role of Technology
While material choices for indirect restorative care have expanded the dental team’s armamentarium for restorative treatment, new production processes in the laboratory have exploded onto the scene, helping to streamline the workflow and to process materials married to computer-driven production machinery. Advances in consumer-based and dental-specific digital communication and capture devices offer the opportunity to virtually connect the dentist with the patient, the laboratory with the dentist and patient, and dental team members with each other.
“Dentists can now use their iPhones and iPads to digitally video record the speech patterns and phonetics of patients, capture still-smile images, and use digital impression technology to capture the intraoral situation chairside and then transmit those valuable information files to the laboratory,” Pizzi says.
However, the clinical adoption rate for the use of digital communication tools remains disappointingly low, Pizzi says. This fact presents dental technologists with opportunities to become thought leaders and to help educate clients on their uses and values to the restorative processes. “Technologists can show their clinical partners how these technologies help save chairtime and improve the restorative outcome. Demonstrating the mastery of these technologies and helping promote clinical adoption raises the value of the technologist as a member of the dental team,” he says.
Digital tools and materials are not the only technological advances that are impacting case workflow and outcome. New injection methods, material improvements, and other advances allow combining digital with improved analog processes to produce a finished product that significantly reduces chairtime. “For example, we as technologists can now blend all of these new materials and technological advancements to provide our clients with a complex full-arch implant-bar solution that instead of taking hours or several appointments to seat may only take the dentist an hour to place,” Pizzi says. “This is one of the many value propositions that we can bring to the cases we deliver and to our clients.”