Dental laboratory

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Fabrication of aesthetic porcelain crowns in the dental laboratory Emax crowns on model.jpg
Fabrication of aesthetic porcelain crowns in the dental laboratory

Dental laboratories manufacture or customize a variety of products to assist in the provision of oral health care by a licensed dentist. These products include crowns, bridges, dentures and other dental products. Dental lab technicians follow a prescription from a licensed dentist when manufacturing these items, which include prosthetic devices (such as denture teeth and implants) and therapeutic devices (such as orthodontic devices). The FDA regulates these products as medical devices [1] and they are therefore subject to FDA's good manufacturing practice ("GMP") and quality system ("QS") requirements. In most cases, however, they are exempt from manufacturer registration requirements. [2] Some of the most common restorations manufactured include crowns, bridges, dentures, and dental implants. Dental implants [3] is one of the most advanced dental technologies in the field of dentistry.

Contents

Certification in the dental laboratory profession is strictly voluntary. Laboratories who have taken the extra steps to become certified represent the top of their field. The most easily obtainable certification is the CDL (Certified Dental Laboratory). A Certified Dental Laboratory has met standards in personnel skill, training, infection control, tracking mechanisms and good business and manufacturing practices. The certification is based on a third party review of photos of the facility. [4] [5] The next tier for certification is DAMAS (Dental Appliance Manufacturers Audit Scheme). DAMAS requires a third party on-site inspection. Based on international standards for the manufacturing of medical devices, the DAMAS certification ensures the lab environment operates in such a way as to ensure product and patient safety. It provides a formula for improved documentation of many aspects of dental lab activity (from dental prescriptions to material traceability). [6] DAMAS standards mirror the FDA's quality system and good manufacturing practice standards, which all domestic dental laboratories must comply with. [7]

The highest level of manufacturing certifications available to dental laboratories are through the ISO "International Organization for Standardization". The ISO develops standards through the consensus of standards organizations from 161 countries. Members represent both the public and private sectors of countries around the world. ISO standards are thought to represent the best interests and needs of the broader global society. [8] ISO 9001 is a set of standards for quality management systems. [9] ISO 13485 is a set of standards, published in 2003, that represents the requirements for a comprehensive management system for the design and manufacture of medical devices. [10] It emphasizes meeting regulatory requirements and managing risk in order to ensure the production of safe design and distribution of medical devices. Product documentation is thorough and covers the entire life cycle of product design, manufacture and post-delivery. Although not considered a substitute, ISO 13485 will align a dental lab's management system not only with the FDA QS-GMP regulation, but various other regulatory requirements found throughout the world. [11]

National Association of Dental Laboratories

The National Association of Dental Laboratories (NADL) was formed in the United States in 1951 after the merger of Dental Laboratory Institute of America and the American Dental Laboratory Association. It became a federation of state commercial dental laboratory associations. This merger took place in Chicago and then, in 1952, NADL established its headquarters offices in Washington, D.C., which were moved to Tallahassee, Florida later in 2001.

The association was known as the National Association of Certified Dental Laboratories from 1968 to 1971 when it changed back to its original name. Its mission is to be the recognized advocate for the dental laboratory technology industry by promoting professionalism, setting technical standards and providing valued services to its membership. [12] The stated purpose of NADL is to uphold and advance the dignity, honor and efficiency of those engaged as operators of dental laboratories, to advance their standards of service to the dental profession and to establish cooperation among its members. [13]

NADL offers several benefits to its members and one of such benefits is that it promotes high standards and aims to work as a unified voice for the dental laboratory trade. [14] NADL establishes alliances with professional businesses to benefit its members with either discounts or services. Members also benefit from NADL's educational programs ranging from seminars, conferences, materials, the NADL University which offers a Certificate in Dental Laboratory Management, to the Wealth of Knowledge Videotape Library. These programs inform and educate NADL members on topics such as production, marketing, and promotion, and also serve as continuing education credits. Furthermore, this association offers the NADL Pillar Scholarship aimed to provide qualified dental technicians the opportunity to take the necessary examinations to complete the Certified Dental Technician examination process.

NADL also has its set of communications tools to keep its members informed about the industry trends. Two examples are the Journal of Dental Technology (JDT), a journal published 9 times a year, and JDT Unbound, a mail newsletter that includes regular updates.

Its Board of Directors comprises 14 members and its current President is Robert Savage. NADL also has an independent board, the National Board for Certification in Dental Laboratory Technology, founded in 1955 as an independent certification organization. [15] It administered the first Certified Dental Technician (CDT) tests in October 1958 and awarded the first CDT certificates in March of the following year.

CDTs can retain certification if they apply to the NBC every year for renewal and prove they have complied with the local laws governing their work and undergone continuing technical education. They are also required to pay a renewal fee.

NADL regulations

It is in NADL best interests to protect the patients' health and assure their restorations are safe for use. To fulfill this objective, NADL has supported federal and state regulations since 2003 and has worked close with the U.S. Food and Drug Administration (FDA), state health officials and the dental industry as well. It has also developed regulatory guidelines aimed to be a basic standard of regulation. Although its main objective is to benefit the general public it is also intended to be effective for the dental technicians and the dental industry. One of the requests from NADL to the FDA has been to protect patient's safety. In this sense, the Association intends that the source of dental devices be disclosed to the patient.

NADL has expressed its support to establish mandatory certification and continuing education for dental technicians dedicated to restoration manufacture; mandatory registration of all dental laboratories with the competent authority; mandatory documentation of those materials used in any restoration and their point of origin; as well as mandatory documentation of the mentioned items in the patient's dental records. [16]

In their Guidelines for Establishing Statutory Regulation, NADL has noted that certification is a way to recognize individuals who have met established qualifications, therefore, they should be the only ones legally acknowledged to use the designated title.

Dental Lab Certification in the UK

All Dental Technicians and Clinical Dental Technicians in the UK are required by law to be registered with the General Dental Council (GDC). The GDC is an organisation which regulates all dentists and dental care professionals, they set and maintain standards in UK dentistry. [17]

Many of those who work for Dental Laboratories are also registered with the Dental Technologists Association (DTA). The DTA is a professional association representing the interests of dental technicians in the UK. [18]

The GDC ensures that dental professionals have the necessary qualifications and are trained to the necessary levels. Dental technicians must prove their knowledge is up-to-date by taking part in Continuing Professional Development (CPD).

Related Research Articles

A quality management system (QMS) is a collection of business processes focused on consistently meeting customer requirements and enhancing their satisfaction. It is aligned with an organization's purpose and strategic direction. It is expressed as the organizational goals and aspirations, policies, processes, documented information, and resources needed to implement and maintain it. Early quality management systems emphasized predictable outcomes of an industrial product production line, using simple statistics and random sampling. By the 20th century, labor inputs were typically the most costly inputs in most industrialized societies, so focus shifted to team cooperation and dynamics, especially the early signaling of problems via a continual improvement cycle. In the 21st century, QMS has tended to converge with sustainability and transparency initiatives, as both investor and customer satisfaction and perceived quality are increasingly tied to these factors. Of QMS regimes, the ISO 9000 family of standards is probably the most widely implemented worldwide – the ISO 19011 audit regime applies to both and deals with quality and sustainability and their integration.

Conformance testing — an element of conformity assessment, and also known as compliance testing, or type testing — is testing or other activities that determine whether a process, product, or service complies with the requirements of a specification, technical standard, contract, or regulation. Testing is often either logical testing or physical testing. The test procedures may involve other criteria from mathematical testing or chemical testing. Beyond simple conformance, other requirements for efficiency, interoperability, or compliance may apply. Conformance testing may be undertaken by the producer of the product or service being assessed, by a user, or by an accredited independent organization, which can sometimes be the author of the standard being used. When testing is accompanied by certification, the products or services may then be advertised as being certified in compliance with the referred technical standard. Manufacturers and suppliers of products and services rely on such certification including listing on the certification body's website, to assure quality to the end user and that competing suppliers are on the same level.

The ISO 9000 family is a set of five quality management systems (QMS) standards by the International Organization for Standardization (ISO) that help organizations ensure they meet customer and other stakeholder needs within statutory and regulatory requirements related to a product or service. ISO 9000 deals with the fundamentals of QMS, including the seven quality management principles that underlie the family of standards. ISO 9001 deals with the requirements that organizations wishing to meet the standard must fulfill. ISO 9002 is a model for quality assurance in production and installation. ISO 9003 for quality assurance in final inspection and test. ISO 9004 gives guidance on achieving sustained organizational success.

Medical software is any software item or system used within a medical context, such as:reducing the paperwork, tracking patient activity

<span class="mw-page-title-main">Medical device</span> Device to be used for medical purposes

A medical device is any device intended to be used for medical purposes. Significant potential for hazards are inherent when using a device for medical purposes and thus medical devices must be proved safe and effective with reasonable assurance before regulating governments allow marketing of the device in their country. As a general rule, as the associated risk of the device increases the amount of testing required to establish safety and efficacy also increases. Further, as associated risk increases the potential benefit to the patient must also increase.

Quality management ensures that an organization, product or service consistently functions well. It has four main components: quality planning, quality assurance, quality control and quality improvement. Quality management is focused not only on product and service quality, but also on the means to achieve it. Quality management, therefore, uses quality assurance and control of processes as well as products to achieve more consistent quality. Quality control is also part of quality management. What a customer wants and is willing to pay for it, determines quality. It is a written or unwritten commitment to a known or unknown consumer in the market. Quality can be defined as how well the product performs its intended function.

<span class="mw-page-title-main">Product certification</span> Performance and quality assurance

Product certification or product qualification is the process of certifying that a certain product has passed performance tests and quality assurance tests, and meets qualification criteria stipulated in contracts, regulations, or specifications.

ISO/IEC 17025General requirements for the competence of testing and calibration laboratories is the main standard used by testing and calibration laboratories. In most countries, ISO/IEC 17025 is the standard for which most labs must hold accreditation in order to be deemed technically competent. In many cases, suppliers and regulatory authorities will not accept test or calibration results from a lab that is not accredited. Originally known as ISO/IEC Guide 25, ISO/IEC 17025 was initially issued by ISO/IEC in 1999. There are many commonalities with the ISO 9000 standard, but ISO/IEC 17025 is more specific in requirements for competence and applies directly to those organizations that produce testing and calibration results and is based on more technical principles. Laboratories use ISO/IEC 17025 to implement a quality system aimed at improving their ability to consistently produce valid results. Material in the standard also forms the basis for accreditation from an accreditation body.

A biomedical engineering/equipment technician/technologist or biomedical engineering/equipment specialist is typically an electro-mechanical technician or technologist who ensures that medical equipment is well-maintained, properly configured, and safely functional. In healthcare environments, BMETs often work with or officiate as a biomedical and/or clinical engineer, since the career field has no legal distinction between engineers and engineering technicians/technologists.

ISO 13485Medical devices -- Quality management systems -- Requirements for regulatory purposes is a voluntary standard, published by International Organization for Standardization (ISO) for the first time in 1996, and contains a comprehensive quality management system for the design and manufacture of medical devices. The latest version of this standard supersedes earlier documents such as EN 46001 and EN 46002 (1996), the previously published ISO 13485, and ISO 13488.

<span class="mw-page-title-main">BSI Group</span> National standards body of the UK

The British Standards Institution (BSI) is the national standards body of the United Kingdom. BSI produces technical standards on a wide range of products and services and also supplies certification and standards-related services to businesses.

Verification and validation are independent procedures that are used together for checking that a product, service, or system meets requirements and specifications and that it fulfills its intended purpose. These are critical components of a quality management system such as ISO 9000. The words "verification" and "validation" are sometimes preceded with "independent", indicating that the verification and validation is to be performed by a disinterested third party. "Integration verification and validation" can be abbreviated as "IV&V".


The Dental Laboratories Association (DLA) is the professional body for dental laboratory owners in the United Kingdom. It is estimated that members of the DLA are responsible for over 80 per cent of the dental laboratory services in the UK.

Design controls designates the application of a formal methodology to the conduct of product development activities. It is often mandatory to implement such practice when designing and developing products within regulated industries.

The Nordic Institute of Dental Materials AS (NIOM AS) is a Nordic Cooperative Body for dental biomaterials. The Institute’s activities in research, materials testing, standardisation and research-based consulting are directed towards dental health services and health authorities in the Nordic countries. The Institute is owned jointly by NORCE and the Norwegian Ministry of Health and Care Services. Activities are financed by the Nordic Council of Ministers and the Nordic ministries for health services. Materials testing and consulting services also generate income. As a joint Nordic resource center, NIOM collaborates with dental schools and research institutions and provides services to government health authorities, dental professionals, and the public in the Nordic countries in the field of dental biomaterials.

<span class="mw-page-title-main">Bureau of Indian Standards</span> Indian organization for developing standards

The Bureau of Indian Standards (BIS) is the National Standards Body of India under Department of Consumer affairs, Ministry of Consumer Affairs, Food & Public Distribution, Government of India. It is established by the Bureau of Indian Standards Act, 2016 which came into effect on 12 October 2017. The Minister in charge of the Ministry or Department having administrative control of the BIS is the ex-officio President of the BIS. BIS has 500 plus scientific officers working as Certification Officers, Member secretaries of technical committees and lab OIC's.

<span class="mw-page-title-main">British Approvals Service for Cables</span>

British Approvals Service for Cables is an independent accredited certification body headquartered in Milton Keynes, United Kingdom. Here, the organization's dedicated testing laboratory also operates which is believed to be the largest of its type in Europe. BASEC was established in 1971 and principally provides product certification services for all types of cable and wire, ancillary products and management systems within the cable industry. The organization maintains operations throughout the world including Africa, Middle East, America, Asia and Europe.

Eurogentec is an international biotechnology supplier, based in Belgium, that specializes in genomics and proteomics kits and reagents as well as cGMP biologics. The company was founded in 1985 as a spin-off from the University of Liège. Eurogentec's contract manufacturing organization facilities are licensed by the Belgian Ministry of Health to produce clinical trial and commercial biopharmaceutical material and also licensed by the US FDA to manufacture a commercial recombinant protein product for the US market. Eurogentec operates two manufacturing facilities in Belgium that provide custom biologics and oligonucleotide-based components for diagnostic and therapeutic/prophylactic applications.

Patient management software (PMS) is referred to as software that is regulated as a medical device. It is software that is used to acquire medical information from a medical device to be used in the treatment or diagnosis of a patient. It can also be software that is an adjunct to a medical device and directly contributes to the treatment of the patient by performing analysis, or providing treatment or diagnosis functionality that replaces the decision and judgment of a physician.

A custom-made medical device, commonly referred to as a custom-made device (CMD) or a custom device, is a medical device designed and manufactured for the sole use of a particular patient. Examples of custom-made medical devices include auricular splints, dentures, orthodontic appliances, orthotics and prostheses.

References

  1. 21 CFR Part 872
  2. 21 CFR 807.65(j).
  3. "Which is the Highly Competent Dental Lab Technology Use Today". Archived from the original on 2018-09-02. Retrieved 2015-11-21.
  4. "National Board for Certification in Dental Laboratory Technology". Retrieved May 13, 2010
  5. Corcoran, C. 2007. Standard Bearers. The Journal of Dental Technology, August/September issue
  6. "DAMAS". Retrieved May 13, 2010
  7. Corcoran, C. 2007. Standard Bearers. The Journal of Dental Technology, August/September issue
  8. "About ISO". Retrieved May 13, 2010,
  9. [International Organization for Standardization (ISO)]
  10. [International Organization for Standardization (ISO)]
  11. Wichelecki, S. 2008. Understanding ISO 13485, Quality Magazine. Retrieved May 13, 2010
  12. "Background and History" . Retrieved 2010-07-13.
  13. "National Organization" . Retrieved 2010-07-13.
  14. "NADL's Educational Programs" . Retrieved 2010-07-13.
  15. "Welcome to NBC" . Retrieved 2010-07-13.
  16. "NADL". Archived from the original on 2010-07-16. Retrieved 2010-07-13.
  17. "General Dental Council" . Retrieved 22 October 2013.
  18. "Dental Technologists Association" . Retrieved 22 October 2013.