Artistry versus machine: Is artistry dying in dentistry and dental labs?

Craig Pickett has watched the profession of dental lab technologist evolve through the years, and some of the changes haven't been for the best, including losing some of the artistry involved with restorations.

perfect smile from dental labs
perfect smile from dental labs

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.

Perfect Smile From Dental LabI look at the changes we’re going through as I look at the periods in art history. Not all of us love the Dutch masters and their dark approach to painting composition. We could compare their style to the European restorations we saw in the ‘80s and ‘90s that could duplicate the caries and discolorations of all of the surrounding teeth. From an art aspect, these were created beautifully by talented technicians, but we couldn’t sell them here in the United States. Today we see bleached, bleached, and more bleached teeth. We argue translucency when much of the work out there is chalk white with a blue or grey tinge of incisal. Some of the teeth we see in patients are created much more in the Picasso or Seurat style (if you stand back a bit you can see it) than in a form and style we would recognize as artistically created restorative teeth.

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:
Is your dental lab staff taking care of the carborundum model trimmer wheels?
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!

Craig PickettCraig A. Pickett, AA, RG, CDT, TE, NBC certified in crown and bridge with technologist designation, is the Dental Technical Support Manager at Whip Mix Corporation. Before joining Whip Mix he managed in large and small crown and bridge /ceramic laboratories, owned Pickett Fabrication in California, and represented J.F. Jelenko & Co., Whaledent, and Dentsply as a Technical Sales Rep. As a 30-year CDT with over 35 years of C&B, ceramics, and industry experience, Pickett now assists in developing and evaluating new products, and represents Whip Mix by presenting technical clinics in the U.S. and internationally. He is the recipient of the 2014 NADL Excellence in Education Award. Learn more about him on LinkedIn.

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