Where Inspiration Strikes

Robert Elsenpeter;

Artists find inspiration seemingly anywhere and everywhere. Maybe they happened to look up and see a particularly beautiful cloud. Perhaps a song sparked an idea. It might even have been a conversation with a friend that planted the seed of a great idea. No matter where it comes from, inspiration helps fuel artistry—and the dental lab certainly benefits from inspired artists.

The Source of Inspiration
Lab technicians’ artistry comes from their skill and inspiration. The source of that inspiration can come from anywhere, depending on the artist.

“The most useful, I find, is to talk to friends and people out of the trade and also to just get into it and do it. Both will tell me, usually quite honestly, what I need to improve upon,” says Richard Jentsch, TZ, head of research and development for Opulent Digital Specialists and president of DENTwire, LLC. “I enjoy lurking around in the various Facebook groups, but it is—by far—less useful than talking to a close friend in the same trade or [getting] my hands dirty.”

Dane Barlow, CDT, owner of Smiles by Dane in Boise, Idaho, observes that nature can make you a better dental artist.

“There is so much in nature and in the world to seek inspiration [from],” he says. “The mountains themselves will remind you of what it’s like to look down marginal ridges and into the fossa—how to create shadows with your stains to create more depth.”

But the biggest source of Barlow’s inspiration comes from knowing that he’s helping others. Prior to his career in dental lab work, he owned a construction company. When the 2008 recession hit, he lost that business and realized he wanted to do something with more meaning.

“I remember looking at my hands, and I thought I hadn’t changed anybody’s life,” he says. “I’d never, personally, [made] a dedicated effort to try to help someone change their life. And I thought, ‘What if I were to make teeth?’...So I changed my career because I wanted to be able to help other people see themselves in a better light, [to] see themselves smiling.”

“I can recall sitting in a bar, talking with a friend, and he turned to me and said, ‘Hey, did you see No. 9? It’s real dark,’” laughs Tom Zaleske, CDT, owner of Matrix Dental Laboratory and Consulting in Crown Point, Indiana. “We could tell there was a crown there.

“If I go online, if I see a movie star or I see a public figure, I want to see how [their teeth look] up close,” he continues. “I want to see what people think is attractive. If you look at [someone like] Julia Roberts...you want to see the shape of their face, and how those teeth look when they smile, and those kinds of things. I gather a lot of inspiration from that.”

Inspiration and education go hand in hand, says Daniel Swamy, CDT, director of technology USA at Aidite (Qinhuangdao) Technology Co, Ltd.

“Newer generations of materials and refinement of products, for me, [are] really the way to go,” Swamy says. “For example, in the olden days, we used to layer...porcelain to actually make the restoration look esthetic and choose the right color. Now we have gradient zirconia, which actually looks like layered porcelain. The optical properties are better, and you’re actually cutting probably close to 75% of the amount of time that you would spend layering porcelain.

“So new materials are where I find inspiration,” Swamy continues. “I think that has really revolutionized the way we do restorations these days. And there’s always room for learning. Just when you think you’ve learned a little bit, [new materials come] out on the market, and you have to relearn techniques and materials.”

Lee Culp, CDT, the CEO of Sculpture Studios in Apex, North Carolina, finds inspiration in the work itself—from being able to deliver a high-quality, esthetic restoration.

“When I was young, my inspirations were technicians that could really replicate a tooth and you couldn’t see it in the mouth,” he says. “Things have changed in 35 years. We used to go out of our way to really learn techniques, to make teeth look as natural as possible, even though they were very unesthetic by today’s standards. I’ve got some work from 30 years ago that is beautiful, artistically, but we were sometimes matching really broken-down teeth. So we’re doing a little bit better now in trying to help the patient understand what we’re trying to do.

“And patients’ desires have changed, too. Back then, we were doing crack lines, and we were even putting amalgam in crowns and doing all of these crazy things to make them look real. But patients’ perceptions of esthetics have changed and prove that they don’t really want that anymore. They want nice, pretty teeth. So now it’s the shape of the tooth and some very subtle characterizations to give it a beautiful, natural look. And we can still do all that once we’ve designed the tooth. It still has to be milled, and we still have to finish it in ceramics, which is, again, where a lot of the artistry comes in at the end.”

Following the Rules
To properly craft a restoration, rules must be followed. That being said, there is still space for artistic wiggle room.

“Art, to me, is a part of what we do,” Culp observes. “I’m going to give art maybe 30% of what we do. We’re not fully creative. We can’t just do anything we want to; we’re more like architects. Our job is to copy nature, which is what a lot of artists do in sculpting or painting. They’re basically just looking at something and copying. Our goal is to replicate nature, to a point. When I was starting to really realize how to make teeth look like teeth or tissue look like tissue, I started going beyond what was in nature and creating caricatures of...what I was copying. I see this so many times when I’m training people or when I see young technicians doing work. It’s like they throw everything they can into a tooth, and it becomes more of a caricature of a tooth rather than a tooth. We’ve got engineering to think about, we’ve got occlusion, we’ve got biology—we’ve got so many things to think about.”

Off The Bench

Artistic inspiration and expression aren’t just limited to what goes on at the workbench—they can affect all sorts of aspects in the lab. For more on this topic, read, Off the Bench: Dental Lab Inspiration and Expression.

“The young people that get into our field want to be artistic, but the problem is that they don’t understand that artistry can be expressive artistry, and that’s what most of them come into,” Zaleske says. “They come into with it with an expressive artistry, meaning that they put their own take on the way they visualize it. And there’s a lot of overflourishing of what is being done out there because really the goal is the art of mimicking nature. And so the goal isn’t really to get all embellished and everything because we’re trying to imitate what exists in nature, but at the same time, not compromise the case—in other words, adding things like root eminences and food traps that may exist in real life. That’s not really the way you should do it.”

A Place for Art
That wiggle room, says Jentsch, depends on several factors: who your clients are, the kind of laboratory or studio you work in, your position and role in the laboratory, and how much experience you bring to the table.

“While you probably have very little artistic wiggle room if you work in, let’s say, the plaster department of a large-scale production lab, you might be able to give a case your personal touch if you are a trusted and valued employee of a small to midsize dental studio....I believe the more time spent with the patient and/or doctor, the more artistic freedom you may be able to negotiate for yourself,” Jentsch says. “If you never get a chance to ask [the] doctor or patient if it is OK to set the denture teeth more natural and you don’t have a picture included with a note on the Rx [that] says, ‘Please match picture,’ you simply have no choice but to follow the rules and set the teeth by the book.

“Your setup is determined, somewhat geometrically, by the patient’s jaw muscle, the frame,” Barlow says. “There are some areas that you can definitely take some liberties, and then there are other areas where you’re kind of stuck, unless the patient is asking for something they shouldn’t be asking for, which occasionally does happen. And then you have to decide if you’re going to break those rules and sign your name to that kind of work, unless it can be pulled off.

“In the beginning, when you lay out a case, I personally believe it all starts with the model work as your foundation. The better you do that, [the better the chances] you’re going to do your best work. So as you’re setting it up, what information do you have? Do you have a patient photo? Do you have preoperative photos? Do you have candid photos? How well do you know the patient? Have you been able to sit down and meet the patient, talk with them?”

Ultimately, technicians do not have carte blanche to indulge their artistic aspirations.

“A lot of times, technicians are not given a lot of credit because the dentist controls what goes on,” Swamy says, adding that despite “a ton of really good artistic work, there’s been a transition to production-type work. It’s kind of sad to say [that]. But there [are still] a lot of labs, smaller boutique type of labs, that do very, very beautiful work and creative work.

“Some of the best work that I see [is done by] people that are very creative, and they can figure out colors and materials and things like that. You still have to follow the protocols for materials use and instructions and things like that, but there is a lot of room for creativity.”

Balancing Act
A technician can create the most beautiful restorations ever; however, they mustn’t lose sight of the fact that the teeth need to, first, function properly. Where is the fulcrum when it comes to balancing form and function?

Barlow observes that often it is the patient who is more worried about looks than functionality.

“I would suggest that the most difficult part of [working in] an esthetic, or even a cosmetic, laboratory...is that people come in and want you to just work with the upper arch and give them an amazing smile,” Barlow says. “And they don’t take into account that they may have a canted smile. You can’t just throw in a 15-mm tooth and have 5-mm teeth on the other side. There are limitations. And in a case like that, I would probably frame the smile slightly canted. You can’t just receive a model and have all these corrections that the doctor wants. It’s not going to happen. The mouth wouldn’t function properly.

“I think a long-term treatment plan is where you’re going to have the most success because if they can’t afford to do everything—to get the esthetics where they need to be—then you really are talking some long-term provisionals or onlays on the lower occlusion in order to give you the space that you need or the layout that you need to get a better esthetic result.”

Swamy notes that to find that balance, the technician must first know the anatomical details of their work. Regrettably, he says, technicians are losing sight of that skill.

“Traditionally, there used to be schools that would teach you head anatomy and function of biometrics and methodology,” he explains. “These are all related to topics of form and function of occlusion. And then, generally speaking, a technician would learn tooth morphology and things like that. What has happened is that the transition from analog dentistry to digital has created this big void [with] the newer generation that is coming in to learn this. They’re just looking at a computer screen, and for better or for worse, the software actually gives you a predetermined form of the tooth. So, they, unfortunately, don’t learn the function part of it because they don’t understand tooth morphology that well. They’re just kind of going by what looks good on the screen, making some changes here and there.”

First Things First
Function is king. First and foremost, restorations must do their job. Then the technician can think about beautification.

“Function comes first,” Culp says. “We’re trying to rebuild something biological that works for a patient—and that’s more bioengineering—so it’s got to work. It’s got to function. You have to be able to chew. You have to be able to speak with whatever we’re doing. So those things come first, and then we bring in esthetics. If you remember back in the heyday of veneers, when there were so many really incredibly bad esthetic cases being done on a daily basis, they had nothing to do with function and all to do with esthetics. And these cases are totally breaking down.”

Jentsch adds: “For me, personally, any type of dental restoration can be as pretty on the eye as you want it to be, [but] if the function is not there, it will result, ultimately, in an unhappy patient or it will not survive in the mouth due to fracture. Both are total failures. ‘Form follows function’ will result in a long-term, stable restoration [that] blends in well. Functional wear facets, for example, make a restoration appear more natural and less fake. If you are restoring a single tooth, you have to follow and (at least to some extent) match what is there. We all try to give the patient something esthetically better than what they walked in the door with, but if we overdo it, the patient might not accept it due to a lack of function or it might break because we made those connectors too thin, trying to make it more esthetic.

“It is a balancing act most of the time,” he continues. “And while both patient and doctor seem to be more forgiving [when] it comes to the posterior region, we should always aim for the best we can provide with what was given to us. Now go and make those molars so damn sexy that they outshine your pal’s anterior crowns!”

For Zaleske, that balancing act can first be seen in nature and then applied to laboratory work.

“Dental technicians will say to me, ‘Oh, I love your work. It looks so natural,’” he says, adding that they often follow up by asking how he did it. “And I always tell people the same thing: It’s not mimicking what someone else is doing. It’s mimicking what you see in nature. And by mimicking what you see in nature, it will give you the natural appearance and give you the form and function that you’re looking for.”

Digital Designs
An artist’s expressive medium used to be solely physical—a painting, a sculpture, and so forth. That expanded with computers, and CAD/CAM has allowed dental labs to move from doing everything by hand to embracing a virtual workspace. But, just like a painter uses a paintbrush or a sculptor uses a chisel, dental lab technicians use CAD/CAM as an expressive tool.

Culp was a pioneer in the development of CAD/CAM technology and has seen its evolution unfold.

“I was the first digital technician to help CEREC develop the first laboratory system,” Culp says. “And that laboratory system was only for full crowns at the time. We didn’t do frameworks. We didn’t do anything else. And I developed the first artistic tooth libraries to go in those systems, but it’s a little bit different now. So there’s really no need to train people how to carve a tooth because they’re already done—myself and others have already created libraries. We designed them to be as optimally functional as we can in an average scenario. And then we can always morph those designs into proper function, proper esthetics to get the looks we want to see. But CAD is also part artistry and part function. There’s still art involved in the design of a tooth.”

“CAD/CAM actually has played a significantly positive role in that it does a lot of the work for you,” Swamy says. “It proposes different shapes and forms, and you can have a virtual articulator that you can use on the screen and see its function. The problem is...that if you’re just going through the motions and not really understanding what you’re doing, then it becomes more of a generic restoration rather than a refined restoration.

“We’re transitioning completely from analog to digital,” he continues. “And now having said that, there are certain parts of dental technology that always will need the analog part. We’re not there 100%. As far as CAD/CAM is concerned, you still need artistic people to actually finish the products.”

The Human Touch
The computer does a good job of helping to create a restoration, but its proposal is not set in stone. Skilled technicians can still countermand the computer’s recommendations.

“Most people I know and respect override the software quite a bit,” Jentsch says. “I am sure the software will get better, especially now with talk about [artificial intelligence], but as of today, it needs far more than clicking a few buttons and dialing in parameters. Having access to quality tooth libraries helps but is not a fix for all.

“I guess it also boils down to what is most efficient,” he continues. “Some days I am faster using the digital wax tools, so I use that. Other days it seems faster pushing and pulling ‘anatomic parts’ or ‘cusps’ around so I’ll do that. And in some cases, I might have to do ‘this first’ and then ‘that,’ or it won’t look right. Sometimes I get so tired of browsing through my tooth libraries being unable to find a close match that I just pick any one remotely close and free-form build it up to what I think it needs to look like. Thank God for the undo/redo button, digital pen, and [3-dimensional] mouse. It makes for a whole different and fun experience.”

Barlow adds that “you do have certain limitations. For instance, you may want to fill an arch. It might be so efficient that it wouldn’t look right to create teeth that filled a void without moving the teeth. So I’ve put in designs and then I’ve saved it as a wax-up, and then I’ve put the teeth in. And what happens is it’ll do an adapting procedure. And sometimes when it adapts, it creates these weird shapes, and all your teeth move and look horrible. But if I take the wax-up that I did and I save it as a preop, it will then reconfigure the teeth back into those shapes. So you can force CAD/CAM to do what you want.”

Inspiration is, undoubtedly, the fuel that powers the dental lab technician’s creative engine. And no matter where they find and how they harness that inspiration, its effects drive many parts of the lab.