There is currently a bit of a stir in dental technology concerning the loss of the artistic to the functionality of the machine. Doctors and patients want the “new” machined materials and speed, but they want this with the artistry of the old handmade materials. The generation of dental technologists that is phasing out of the industry have spent their careers developing artistic and functional values in the creation of feldspathic ceramics, full cast alloy restorations, and in the removable area. I have personally taken great pleasure and satisfaction in knowing that there are several thousand human beings walking this earth with restorations that I made by hand that are both functional and esthetic.
However, we are now faced with CAD/CAM and pressing technologies that either partially or fully remove the hand crafted artistry of years gone by. Most technicians can look at a cast of an impression and see immediately which of the teeth have been crowned and either brutally adjusted, or simply created without proper anatomical and occlusal features. We may have looked at a friend’s new crown the person was told was made “right in the doctors office,” and we may have wondered if anyone was looking at the surrounding tooth shade or form when it was manufactured in-house, and then we may have longed for good technology and days gone by.
Through automation we’ve been able to produce more in less time, produce more consistently, and produce for a lower price, but in many cases we’ve sacrificed some of the art. Of course some of this sacrifice is based on materials or their use. For example, you cannot see the same transmission of light through a stained glass window if it’s hung against the wall. The new dental technician/artist will need to learn anew the use of his media (materials) and know the material’s limits. Monolithic is also generally monochromatic. I’ve heard technicians complain about the translucency of a just-sintered zirconia crown as they compare it to the face of a shade tab. There is no dentin on the crown and no enamel overlay like the tab. What makes them think that a feldspathic shade tab will look like full contour Zirconia, without the artistic additions of a great technologist? Look at the reverse of the shade tab and see what’s there. It’s not that we are losing the artistry – we’re losing the artists.
Removables are not far behind. Two companies I know of are milling denture bases with sockets to place denture teeth. What will happen when we’re able to print colored acrylic in both base and tooth shades? We’ll be able to design and then print an entire denture. No more dripping wax and setting teeth.
Materials and patient demands are changing. “Style” and cost set the tone and limit our art. Production machines and computers are helping us capture designs and make measurements more consistently than we could by hand, and the new materials require a machine to process them. Complexities may yet exist in individual restorative work that will require the artist, but finding the right customer or patron/dentist who is willing to purchase fine tooth art is also a problem and generally not the norm. We all want a Monet or a Van Gogh on the wall of our front room, but most of us settle for a reproduction. Am I right? So do our patients when it comes to their teeth. There’s a market point where the restoration is “good enough” for the price someone is willing to pay.
The time we had to perfect our art with the feldspathic porcelains will no longer be available to us. The new materials will change too rapidly. New artist/technicians will appear who have worked feverishly to master the new materials, and hopefully they will be willing to teach, technicians will be willing to learn, and doctors and patients will be willing to pay for this new expertise in digital manufacturing and post-manufacturing artistry.
Modern art is not really my thing. But then neither is a mouth full of bleached teeth that come in two shades – chalk white and skim milk. I’m just one of those old technologists who appreciates the fine art of the crack line, and the ability to internally stain or naturally age a crown. I completely appreciate a well-set denture where the teeth aren’t lined up like a “Pickett” fence (yep, I just said that, and yep, I do have a picket fence), that are festooned and stippled properly, and that are then shaded to nature.
In order to blend this art with new materials, technicians and technology are going to need to make many changes. In a business that is compensated by the piece and not the time it takes to create it, we’re going to need dedicated artist/technicians who will spend the time on their own to master their materials and techniques. We also need artist/technicians who will communicate the proper use of the materials to their patron/dentists and patients, and who see their success as truly creating new smiles.
Artistry is not dying in dentistry. The art is just making the change into a new era.
ALSO BY CRAIG PICKETT:
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Relying on your dental lab for decisions on restorative materials
Are you frustrated with the fit of contacts on lab restorations in your practice? You are not alone!
