Sending a crown or denture case to a lab is a very important decision for a dental practice. However, there is another aspect of the sending process that does not apply to other provinces. A Dental Lab in Ontario must be supervised by either a Registered Dental Technologist or a licensed Dentist; therefore, the laboratory is regulated by the regulatory body as well as the clinics that send them work.

As mentioned above, the existence of the regulatory layer is due to the fact that dental technology has direct implications for patient safety. Poorly fitting crowns and inaccurate partial frameworks are more than simple annoyances — they can lead to bite issues, soft-tissue irritation, and long-term wear on adjacent teeth. Ontario’s framework was designed to minimize these risks by mandating appropriate supervision at each commercial facility.

The Regulated Health Professions Act and the Dental Technology Act provide the framework for the laws that govern the practice of dental technology in Ontario. The College of Dental Technologists of Ontario is charged with enforcing these acts on a daily basis. The College establishes standards for the design, construction, repair, and release of all cases, and also maintains a publicly accessible registry of those individuals who are authorized to perform the technical aspects of each restoration, allowing both dentists and patients to verify exactly who performed the technical work associated with their restoration.

As an actively practicing dentist, you don’t just fill out forms and file paperwork; the form of supervision provided by the facility that employs a Registered Dental Technologist (RDT) will ultimately determine whether or not your lab makes it to the final round of selection. If a lab is under the direct supervision of an RDT, then they can provide both their name and license number for every single case that is shipped out of the facility. This is important in case any issues arise where you need to trace back a case, or if someone questions the quality of work performed.

Beyond the regulations, it is simply a matter of logistics. Ontario is a very large province with different expectations for delivery times. Some practices are located downtown and can expect to receive their orders within one week; other practices may be several hours away and rely upon a courier service. Therefore, pickup and delivery schedules will be equally as important as the professional skills of the staff in the facility.

When looking at different laboratories, dentists generally disregard advertising claims and focus on more practical issues such as: how accurate is the shade matching process? How frequently does a case need to be sent back for adjustments? How readily can someone be reached to clarify any discrepancies with the prescription? A dental laboratory in Ontario that provides positive answers to these types of inquiries will generate repeat business at a much higher rate than a laboratory which advertises only the latest technology available.

Most large laboratories in the province use digital workflow; with intraoral scanning, many types of cases no longer require physical impressions. However, some dentists continue to submit traditional impressions for various removable works. Therefore, labs that can process both digital and analogue cases successfully are able to provide service to a greater number of dental practices.

There is also wide variation among the different types of labs regarding their specialties. Some labs specialize primarily in removable prosthetics such as full or partial dentures; other labs specialize primarily in fixed restorations and implant componentry; while still other labs attempt to provide services across the entire spectrum. Understanding a lab’s true strength, as opposed to assuming that all labs are equally proficient in providing every type of service, can save you much frustration over time.

Dentists with negative experiences regarding remake procedures tend to evaluate the cost of an option based upon the likelihood of reliability rather than simply selecting the lowest price available. In fact, a less expensive case that requires two remakes will ultimately result in greater costs for chair time, materials and patient dissatisfaction than a somewhat more expensive case that successfully fits the first time.

Many new clinics will find out how important their relationship with a laboratory is after they experience some difficult patient cases. On the other hand, most older practices have found one laboratory that they use regularly, and then another one as a secondary option for when they need extra capacity or specialized services. These relationships are developed over time with trial and error, rather than just doing a quick internet search.

The differences between reliable dental labs in Ontario and those that are just “okay” are generally not based upon some major dramatic difference; rather, they are the result of many smaller items completed consistently well. These items include providing accurate shade work, being open with customers when delays occur, and delivering cases that require minimal chairside adjustments.

Quality assurance is an additional accountability measure; while it is transparent to those dentists who submit cases, they are nevertheless able to take advantage of this quality assurance program. To remain registered as a technologist, one must participate in continuing quality assurance programs. As such, the knowledge and skills associated with a particular case do not remain constant. Rather, as new materials and procedures develop, so too will the knowledge and skill base of the registered technologist.

Ontario has also taken steps to address unregulated businesses operating outside the control of the regulatory body in the past few years. There are now verified lists available to dentists of authorized commercial facilities, allowing them to verify whether a laboratory is registered prior to placing orders for products, instead of assuming that the facility is operating legally. This level of transparency is essential in a profession where most individuals who construct dental restorations are never seen by the patient, nor does the patient have any way of independently verifying the legitimacy of the individual constructing the restoration.

Conclusion

Regulation, geography and specialization are three of the main reasons why Ontario dentists select specific dental labs to build their cases; however, each reason is interrelated. When a lab has proper supervision, clearly communicates with the dentist, and provides a consistently fitting product, it will develop a strong relationship with the dentist. In a profession as precise as dentistry, this long-term relationship is far more valuable than anything that can be listed on a specification sheet.