Providing Freedom of Time
New systems on the market and on the horizon can free up technicians for more skilled tasks
As the demand for restorative dental work in the US increases and the supply of skilled dental technicians decreases, efficiency is as important as ever for laboratories. Fortunately, various solutions are being developed to automate parts of workflows and allow technicians to focus on the tasks that require the most skill. One of the most progressive laboratory owners in this area has been Jesse Flor, MBA, CDT, the second-generation owner of Great Smiles Dental Services in San Bernardino, California. Inside Dental Technology spoke to Flor about the latest automation technologies on the dental laboratory market, what might be next on the horizon, and what the impact could be.
Inside Dental Technology (IDT): The concept of automation carries a certain stigma in this profession. Is it a real threat that dental technicians should fear?
Jesse Flor, MBA, CDT: I am a big fan of Isaac Asimov, so I grew up reading about robots, and I am more open to the idea of automation in the laboratory. It just frees us up to be more productive with our time. That is my definition of wealth: to have freedom of time. Investing in equipment that can help achieve that makes a significant impact.
When I first started working in the laboratory, we were hand-waxing copings, casting them, finishing them, opaquing them, etc; so many steps were required simply to fabricate a single PFM restoration. Now, thanks to new materials and machinery, we can mill out a full-contour crown in 15 minutes, sinter it, glaze it, and be finished. We can achieve levels of production that were unheard of previously. My father's laboratory, at its peak, had 42 employees; now, we have slightly fewer due to people retiring, but we are producing triple the amount of work because of the equipment.
Automation is a tool to make the technician's time more flexible, not to replace them. People just need to understand how to leverage that for their benefit. Doing more with less is the way of the future.
IDT: You mentioned milling. What are some of the other basic types of automation that laboratories currently utilize?
Flor: When 3D printing was first used in dentistry, the manual post-processing steps were extensive. The traditional workflow was to print something out, manually remove the build plate, clean it, place it in the tank, clear it, and then cure it. That all needed to be done with extreme care and precise timing, so in a busy laboratory, it was sometimes necessary to designate one or two employees just to handle that. Now, we have an increasing number of systems that perform the washing and curing with various levels of automation. I use a system that allows me to put printed products in an IPA (isopropyl alcohol) for approximately 20 minutes, and it automatically ejects them for air drying; I do not need to monitor it. In today's laboratory environment, freeing up those one or two employees to work elsewhere in the laboratory makes my workflow much more efficient.
IDT: That seems like it would be particularly helpful because of the PPE required for manual post-processing of 3D printed parts. Are there specific types of tasks for which automation can be most beneficial?
Flor: There are multiple applications primarily designed for safety. Our laboratory fabricates a high volume of removable frameworks, and one of the most dangerous parts of traditional fabrication was sandblasting to remove the oxides, investment, etc. Even with some of the top dust collectors, we were still inhaling some dust. One company, however, developed an automated sandblasting system that allows us to insert 10 to 15 trays and simply let it run for 30 minutes, and the sandblasting is completed without needing a technician to monitor it.
Another example is the 3D printing post-processing systems that I mentioned previously. When we were washing and curing manually, there was always a chance of splashing the resin on ourselves. I once got resin in my eye and had to go to the emergency room.
So, robotics can allow us to reduce the risk involved in certain processes, and I am certain that in the future, laboratories will be even more targeted in terms of utilizing automation for safety and efficiency.
IDT: Are there other areas that are particularly exciting in terms of new innovations?
Flor: One manufacturer is developing its own robotic arms to work with its equipment. This is particularly promising for orthodontics, because they are automatically loading vacuum-formed aligners and having the machine trim them, polish them, and prepare them for packaging.
Additionally, some of the new 3D printing solutions for orthodontics demonstrate that companies are thinking in this direction, automating tasks that are menial or very repetitive. Robotics and automation are perfect for those circumstances.
IDT: What are some types of automation that may not be available yet but that you'd like to see in the future?
Flor: Many intermediate processes still could be automated. Personally, I am working on automating the extraction of milled zirconia pieces and products. Usually, a technician needs to cut the parts out, but I am teaching robots to detect sprues and remove them without causing damage. That would free up a lot of time and space for our technicians; especially in a high-volume laboratory, those tasks take significant amounts of time.
The biggest push forward, however, will be in 3D printing. Eventually, we will be able to go from design to finished product without even a touch, in less than an hour. 3D printed permanent crowns have become a reality, but work remains to be done in regard to automation of the post-processing. Especially when using validated materials, you need to follow every step of the validated process as precisely as possible, so automation will be the next big leap in printing permanent crowns.
Another goal on which I am collaborating with some 3D printing companies is to automate the process even more by building robotic loader arms to take the prints, put them in the tanks automatically, remove them when ready, take them off the build plate, and process them as needed. Automation can create a seamless process that can run 24/7.
IDT: As exciting as all of this is, which processes in the laboratory should never be automated?
Flor: Morphology and design; AI can never entirely replace human intellect in those areas. Additionally, and perhaps most importantly, we as technicians work with clinicians who are human. Even with guided surgeries and other advanced technologies in the operatory, many interventions still require the human factor, and it is that dynamic that will always make technicians important members of the team. The human body is very unpredictable, and we need to be able to adapt throughout treatment. That is why skilled technicians and people who invest in education will always be busy. New systems will continue to automate bigger chunks of the workflow. Keep an eye out, and realize that this is not a threat; it is just a tool that can benefit us in a larger sense.