Current state and future of removables, my thoughts.

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sas

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I read with great interest the comments on this forum as removables have been a big part of my life for over 50 years. My practice is limited to them and I also do my own lab work so I have a great deal of exposure to all the phases. I also participate in a couple of CE programs as a lecturer each year so I get to feel out the more or less thoughts and techniques of the practicing dentists and technicians. I have come to several conclusions which I think we need to consider in our chosen profession.

Although I am not "down" on the younger population, that segment of the dental profession, by and large, lack either the knowledge, skills, or desire to make acceptable removables. Why? First of all the curriculum is moving farther and farther away from full dentures and partials. Secondly, the students themselves don't seem to have much interest in them. We are bombarded with too much digital, cosmetic, implants etc so that getting their sleeves rolled up and digging in is not fashionable. Third, too much treatment being done by assistants, and not the dentist.

Well, so what? It means that the quality of the models, bites, etc that reach the lab tech are not going to be what is needed to fabricate a functional prosthesis. Grossly overextended alginate impressions, putty bites on unstable base plates, vertical and centric not even close, etc will not render a result that is acceptable. Thank goodness, we can always blame the lab, or global warming, or a solar eclipse, just about anything that comes to mind. I think it would be very impressive to have a dentist sit down and make a nice set of dentures using the junk many of them send to the lab. And likewise, it would be interesting for the technician to deal face to face with the patient who is ready to proclaim "they don't fit" when you haven't even got them fully inserted at delivery time.

There is a subtle thought going around that implants and digital impressions will save the day for laziness and lack of proper technique. Can we talk? Implants as we know them now are wonderful. But expensive. Lets be practical. Loss of teeth is suffered more by those in the lower economic status that higher status, for the most part. These people flat out can't afford implants. Food, shelter, and medicine are taking their bucks. I am convinced that we are going to need conventional dentures for a long, long time.

And who is going to make them? The removable technicians are getting along in age as well. IMO there will one day be a designation of Denture Therapist or some exotic sounding name for a non-dentist to provide removables. This may be the same Denturist we have today but it will be recognized as someone who has completed formal training, perhaps apprenticeship, and passed an exam to provide directly. The dentist will do the first phase of examining, extracting, etc and this Therapist will make the dentures. Since the oncoming dentists don't appear to care about removables there will be very little opposition and the technicians will have a good argument that they are doing most of it now. There will still be some dentists who will make the impressions etc. and some technicians who do not like to deal directly with patients.

Until that day if you have a dentist you like to work with I hope you both will have a team effort and pool your knowledge and skills to do the patient the best that you can. In spite of all the technical knowledge and technique we have and adhere to, the final result will depend greatly on the attitude and adaptability of the patient. The most underestimated factor in denture construction is the mind set of the patient. I have seen countless patients with no ridge, no saliva, no muscle control wearing dentures and getting along very well. And many with text book mouths just won't accept them. Given a prosthesis that is made correctly the problem between the ears is the deciding factor.

I see some beautiful work displayed on this web site. I wish I had the ability to do some of these cases as presented. They are truly gorgeous. One thing I do see is overkill on some wax ups. I just do not see all of these bony areas protruding past the cuspids as indicated on some wax ups. And the first upper bic should be waxed with the clinical crown a little shorter than the cuspid and not as short as the second bic. The two bics are not the same length and will look too short in a smile situation.

Best wishes to all in your chosen field as it is highly important to a dental cripple.

SS
 
CoolHandLuke

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if it is a fallacy to assume a poor person cannot and will not pay for implants, why would such a person volunteer to visit a specialist to pay speciality denture fees for "great" dentures ? no these people will have sub-par dentures. they will use and abuse them until they are bits of jaundiced acrylic crusted by years of poor oral health. not until socialized dental care is available. then the average person will be able to get great dentures all paid for or at least (forgive the use of the word) partially.

good work by good technicians comes with a good pricetag.

CADCAM is not about eliminating technicians - it helps eliminate poor workmanship by already accounting for details that some techs just can't produce or engineer. it raises the collective ability of us as a whole. it brings all our work into a higher quality bracket, and at the same time a lower price bracket.

with PEEK the pricetags come lower and lower. every year printing gets better and better.

if you arent focusing on CADCAM now, then your handmade artisanry had better be far over the current cadcam status and stay there. else it will not take long for it to overtake your abilities, and with you not in the game you will be left behind.

that's why the youth are so into it. in a few short years there won't be any more need for handmade. no setups. no mess. no hot irons. no 16 hr days of benchwork. a few dozen clicks to a fantastic smile. a few short hours of ready-to-insert printables, and go home at 4pm.
 
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if it is a fallacy to assume a poor person cannot and will not pay for implants, why would such a person volunteer to visit a specialist to pay speciality denture fees for "great" dentures ? no these people will have sub-par dentures. they will use and abuse them until they are bits of jaundiced acrylic crusted by years of poor oral health. not until socialized dental care is available. then the average person will be able to get great dentures all paid for or at least (forgive the use of the word) partially.

good work by good technicians comes with a good pricetag.

CADCAM is not about eliminating technicians - it helps eliminate poor workmanship by already accounting for details that some techs just can't produce or engineer. it raises the collective ability of us as a whole. it brings all our work into a higher quality bracket, and at the same time a lower price bracket.

with PEEK the pricetags come lower and lower. every year printing gets better and better.

if you arent focusing on CADCAM now, then your handmade artisanry had better be far over the current cadcam status and stay there. else it will not take long for it to overtake your abilities, and with you not in the game you will be left behind.

that's why the youth are so into it. in a few short years there won't be any more need for handmade. no setups. no mess. no hot irons. no 16 hr days of benchwork. a few dozen clicks to a fantastic smile. a few short hours of ready-to-insert printables, and go home at 4pm.
if it is a fallacy to assume a poor person cannot and will not pay for implants,
re your first sentence, it's cannot INSTEAD of will not.
 
araucaria

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Extract;

The most underestimated factor in denture construction is the mind set of the patient. I have seen countless patients with no ridge, no saliva, no muscle control wearing dentures and getting along very well. And many with text book mouths just won't accept them. Given a prosthesis that is made correctly the problem between the ears is the deciding factor.

So true
 
JohnWilson

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I really liked this post and agree with much of what has been said

As a removable tech that learned fixed my heart will always be with denture work. As a lab owner the state of this industry is not bringing any good young new techs to the trade that want to learn this craft. Its nearly impossible to make a living wage trainng OTJ. I have been looking for over a year for a denture tech to join my team. I want a tech that is proficient and doesn't need me to hold his/her hand. I have not been able to find anyone that fits this bill.

As the older gen techs die off or retire I agree the future is rather bleak. Digital dentures still rely upon record bases and bite rims and god knows any idiot can make them but the practitioner still needs to know how to record centric and VDO which the majority are very sketchy at. I have been lucky to work with a bunch of talented guys and I have taken more CE than I like to admit too but it was the only way I could learn and offer a product I could be proud of.

I had hoped as the ceramists positions were being eliminated or simplified with CAD that they would strive for a new challenge and look for denture tech positions. Time will tell if that happens
 
LA Ceramics

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And then came the bushwhackers with their crockpots and channel locks Afraid
 
droberts

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At my age with the booming of removable right now. Does one still grow and try and teach the young,
or ride it out and take it in. Like John said above, (he's been looking for the right tech) to have to not hold their hand.
Lucky enough, I have found mine. But now even with the two of us, the work load is becoming more to now possibly add
another tech. Oh where, oh where can 'he/she' be? With CadCam mentioned above as well. I do feel that it has its place.
A sad note to that: there are many talented techs that have been taught how to design a crown on a screen.
But if the power went out, they wouldnt have a clue how to wax one...
Also belonging to a study club group that a client interviewed a young dentist that all he wanted to do was place implants. The doctor
asked him why? Thats where the moneys at, he replied. Then he asked him what he knew of occlusion?
He replied "why do I need to know that"? Banghead Good day!
 
Tom Moore

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John, I have seen your abilities with the new technology and you become more valuable in the market every day.

I wish we could find dental CAD design techs with half your abilities to fill our current need.

As an old tech I remember the OLD techs that were in charge when I graduated lab school in 70' saying that we new school trained techs were worthless and when they went it was all going to hell. Didn't happen.

If we keep a market based economy the market will present the needs and they will be filled by someone. One path to having value is recognizing the need in the market and filling it with what the market wants NOT what we want to give it.

I read this site all the time because most here embrace change and demonstrate it with what they do plus a willingness to help those on that same path.
 
Dentala

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I really liked this post and agree with much of what has been said

As a removable tech that learned fixed my heart will always be with denture work. As a lab owner the state of this industry is not bringing any good young new techs to the trade that want to learn this craft. Its nearly impossible to make a living wage trainng OTJ. I have been looking for over a year for a denture tech to join my team. I want a tech that is proficient and doesn't need me to hold his/her hand. I have not been able to find anyone that fits this bill.

As the older gen techs die off or retire I agree the future is rather bleak. Digital dentures still rely upon record bases and bite rims and god knows any idiot can make them but the practitioner still needs to know how to record centric and VDO which the majority are very sketchy at. I have been lucky to work with a bunch of talented guys and I have taken more CE than I like to admit too but it was the only way I could learn and offer a product I could be proud of.

I had hoped as the ceramists positions were being eliminated or simplified with CAD that they would strive for a new challenge and look for denture tech positions. Time will tell if that happens
I am prepared to do some work for you as an ex lab owner and qualified in 1980's !!
 
Dentala

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John i need to expose myself to more CAD CAM and show our guys here,thats why i need to come over and equip myself and at the same time do some handwork for u!!
 
Flipperlady

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I agree with the original poster, good post.
 
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Since the oncoming dentists don't appear to care about removables there will be very little opposition and the technicians will have a good argument that they are doing most of it now.
SS

Thank you for a generally insightful post, however with all due respect, the statement above is borne of ignorance of the politics of dentistry. Being both a third generation and third generation past president of our state trade association, I have had many, many dealings with the state dental society regarding legislative issues. One is an absolute certainty. The dental society is so provincial in its need to be the dominant voice in legislation it will act to the detriment of its membership and the industry to protect its place as the preeminent voice in lobbying and legislature.

It is these political arms of dentistry that will preside over the death of the lab industry as we know it. In tandem with the comment that most dentists don't want to do removable, is the truth that most dentists aren't qualified to the judge the quality of removable when they see/get it. So when the current laws mandate that the dentist is the judge of what prosthetic is best for the patient, the premise for that law is patently false. Yet, sit in a meeting with the BOD of a dental society and see how they feel about amending those laws to benefit patients, dentists, and the industry, and you'll find a stone wall of opposition. These are not reasonable people. They honestly believe that they are serving the industry better by keeping 100% of the voice in their hands, even when they know that as individuals, they could not function properly without the aid of technicians guidance.

This is not a bitch, it is a real world assessment, it is what it is.

What these politico's have done, is create a perfect storm of demise for their own industry in which the competency will erode. Talented people are not entering the industry to be trained because we can't offer them a career path commensurate with their talents. By avoiding laws that create licensing, dental societies have succeeded in keeping prices low for their constituency, by allowing incompetent competition, but at a cost that will change the industry for the worst. What we are seeing today with the advent of Dentsply and Schein entering the lab business, is the future. The dentist will get what the lab provides, period. There will be no choice, because the options will be limited. State dental societies will be toothless to impart change at that point because options for that change will have disappeared. Big corporate will then dictate the level of dentistry performed...and yes, the net result will eventually, (I can't stress that word enough because it will take time) create legal denturism, the thing that most scares most dental societies.

So, what irony. The legislative ideology in place today, is not only going to harm the entire industry, it will give rise to the thing they most want to avoid.

My personal story is that I left the industry about 18 years ago (became a pro fisherman) and just returned 5 years ago. In all liklihood, I will be exiting the industry again because of the current climate of the industry, erosion of profitability, and the direction it seems to be trending, somewhat quickly.

I would like to be wrong on this, because it wouldn't be good for anyone, but have a high degree of confidence I am not.

Regards,
Chip
 
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2thm8kr

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Thank you for a generally insightful post, however with all due respect, the statement above is borne of ignorance of the politics of dentistry. Being both a third generation and third generation past president of our state trade association, I have had many, many dealings with the state dental society regarding legislative issues. One is an absolute certainty. The dental society is so provincial in its need to be the dominant voice in legislation it will act to the detriment of its membership and the industry to protect its place as the preeminent voice in lobbying and legislature.

It is these political arms of dentistry that will preside over the death of the lab industry as we know it. In tandem with the comment that most dentists don't want to do removable, is the truth that most dentists aren't qualified to the judge the quality of removable when they see/get it. So when the current laws mandate that the dentist is the judge of what prosthetic is best for the patient, the premise for that law is patently false. Yet, sit in a meeting with the BOD of a dental society and see how they feel about amending those laws to benefit patients, dentists, and the industry, and you'll find a stone wall of opposition. These are not reasonable people. They honestly believe that they are serving the industry better by keeping 100% of the voice in their hands, even when they know that as individuals, they could not function properly without the aid of technicians guidance.

This is not a bitch, it is a real world assessment, it is what it is.

What these politico's have done, is create a perfect storm of demise for their own industry in which the competency will erode. Talented people are not entering the industry to be trained because we can't offer them a career path commensurate with their talents. They have succedded in keeping prices low for their clients, but at a cost that will change the industry for the worst. What we are seeing today with the advent of Dentsply and Schein entering the lab business, is the future. The dentist will get what the lab provides, period. There will be no choice, because the options will be limited. State dental societies will be toothless to impart change at that point because options for that change will have disappeared. Big corporate will then dictate the level of dentistry performed...and yes, the net result will eventually, (I can't stress that word enough because it will take time) create legal denturism, the thing that most scares most dental societies.

So, what irony. The legislative ideology in place today, is not only going to harm the entire industry, it will give rise to the thing they most want to avoid.

My personal story is that I left the industry about 18 years ago (became a pro fisherman) and just returned 5 years ago. In all liklihood, I will be exiting the industry again because of the current climate of the industry, erosion of profitability, and the direction it seems to be trending, somewhat quickly.

I would like to be wrong on this, because it wouldn't be good for anyone, but have a high degree of confidence I am not.

Regards,
Chip


Fishing is more fun anyhow.
 
TheLabGuy

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I like fishing stories...professional bass fishing?
 
CoolHandLuke

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HlLMv8A.jpg
 
Tom Moore

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Reds and Specks, Venice La. Black Bass, Lake Fork, TX. everything else, Chosen River AK.
 
denturist-student

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There will be digital impressions, simulated tryind, centric relation registrations and everything else. It will finally be printed by a 3d printer right in the dentists office. I am thinking ten or twenty years down the road which fortunately is beyond what I want work for. Howeveer those are for the majority falling within the parameters of the software programs....So dentures may get easy...RPDs will take a while to develop into that style of process.
 
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From the side of the dentist:
I am not sure how much the current students are being taught about removables.
I graduated in 2001 and went to Temple Univ. School of Dentistry.
We did our own denture setups, all modifications, finishing steps (festooning) but did not process.
We learned, in depth, the anatomical design of the post dam for optimal retention of he upper.
Everything that I learned has helped me tremendously in delivering exemplary outcomes in both fixed and removable cases.
I am still looking for a great removable tech to work with me on a daily basis.
I don't mind paying for great work as I know when shortcuts are made.
I hope the technical training programs provide a solid background in removables, but I am not so sure.
One of the instructors there came to work for me for a while.
In cases where the VDO allowed for the teeth to be set without reduction, he processed perhaps hundreds of cases without deglazing the teeth.
Here we are 3 years out and see teeth popping out on an almost weekly basis.

Many patients have unrealistic expectations, and that is a big reason why there is little interest in doing removables.
I don't think we have many of the political issues mentioned in a previous post in NC.
However, I would suggest that much of the skilled labor are working for the big chains of denture centers.
At least the work there is stable and consistent.

Chris
 
Chalky

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It seems there are many common problems that face the removable aspect of the trade across the globe. I worked in a lab for 12 years under an excellent technician with vast knowledge having been a former maxillofacial techo. Sadly I will most likely be the only person that will have the privilege of learning all he has to teach. He has become most disheartened with the attitude of younger people who basically aren't prepared to work... and now simply will not even consider taking on an apprentice (never did while I was there),or even a less experienced qualified technician now I have left. All he has to offer will retire with him, and I am sure there are many masters of our trade that will fade away taking their knowledge with them. Technicians are a fairly secretive bunch generally, not wanting to give away ALL their secrets, so that they are able to do or offer something the other guy possibly can't. Techniques sometimes take months or even years to streamline and master, and without the next generation there to pick up where the 'old boys' have left off it leaves a big void in the industry. Technology has come leaps and bounds in the last 5-10 years (forgive me as I'm not a fixed technician, so my true knowledge is rather limited in this area),providing much better fit and quality than what was on offer when scanning/milling first hit the trade. I believe that setting and waxing by hand, by a technician in a lab for both partial and full dentures will be a cheaper option than scanning and milling. BUT, if the quality of work simply is not there due to a lack of skilled technicians available to do it, then I think cheaper more accurate methods of denture construction won't be that far away purely due to the void that will need filling by lack of master technicians passing on their trade skills. At my old lab, I can honestly count on one hand the number of dentures that haven't fit in the last 10 years, from what have already seen working somewhere else new dentures not fitting is a normal occurrence. This simply should not happen. I feel a responsibility to help my trade, and pass on some of what I have learned to make the newer less qualified, less experienced technicians better at their (OUR) craft so the quality of work that gets distributed improves. One of the old guys at the hospital where I did my apprenticeship told me many times 'leave now boy... this is a dying trade' 20 years later its starting to look like he may have been right!
 

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