Chances are, if you’ve gotten a new crown or tooth implants through a School of Dental Medicine clinic, you’re already familiar with Michael Bergler’s work.
As the director of Penn Dental’s CAD/CAM Ceramic Center, Bergler designs and creates all kinds of prosthetics for dental patients, from crowns and bridges, to full-mouth restorations. In addition, Bergler also provides feedback to software firms that design computer programs for dental technicians.
His job is a combination of art and science—a career that requires a keen eye, as well as technological know-how.
Bergler’s lab, located in the Evans Building, is outfitted with technology that can create a 3-D computer model from casts or molds taken by dentists. Sometimes he finishes the work by hand, using wax to sculpt a tooth and then casting the final product using a metal alloy.
If his work sounds like it’s a combination of tried-and-true techniques and state-of-the-art technological advances, it’s because Bergler says his job as a dental technician is changing rapidly—and the field has made tremendous leaps and bounds since he attended school back in his native Germany.
An internationally recognized expert in ceramic restoration fabrication, Bergler studied for a decade to be a master dental technician. It’s a considerable amount of schooling that taught Bergler about different manufacturing procedures, as well as chemistry and physics—what he calls “a combination of practical work and theory.”
The Current recently met Bergler in his lab to talk about his changing field, the process of creating a crown for a patient, and what he likes about his (relatively) new stateside home.
Q. What brought you to Penn Dental and Philadelphia?
A. First of all, it was always a dream of mine to live in this country. It was basically the starting point. And then, back at that time, I met Dr. [Markus] Blatz [chair and professor of Preventative & Restorative Sciences] at different meetings in Europe and … we got to know each other. ... At this time he was at LSU [Louisiana State University]. He asked, ‘Why don’t you come over to the States?’
Q. Did you originally go to Louisiana?
A. I was at LSU. I still had my lab in Germany. I was working at a university in Germany, as well, and I basically [came to the United States] at my own cost. It was a sabbatical. I still had my position, and it was for three months, to get an insight into this country, what’s going on and how the culture is, the people, the work relationships, because there are huge differences, I would say, between Europe and the United States.
Q. What are the biggest differences in work relationships there and here?
A. The biggest difference is that in Germany the laboratory is considered [more of] a partner [with dentists]. You both move in the same direction. … To be able to achieve the best possible result for the patient and in everybody’s interest, you have to work as a partner.
Q. Let’s talk about some of the work you do in this lab.
A. The whole job [of being a dental technician] will be changing in the future from traditional casting techniques, to more advanced stuff like the CAD/CAM technology. I would say, five or even six years ago it was just at the beginning, and it’s a huge developing market right now, like what you see here with the different scanners, different software, and different milling machines. It means the picture of a dental technician is completely changing right now.
I started building up this lab here. There are two parts involved. One part is, I don’t know if you call it research, but it’s software development. It’s development for different milling strategies, it’s related to different options to design a crown on the [computer] screen, for example.
The other part very much relates to the materials. With the materials … you do real patient cases combined with research about the material.
Q. Do you create crowns and other items for all patients associated with the school’s clinical practices?
A. I do real cases here, because … all the other stuff is basically [an instructional] set-up, it doesn’t [always] reflect the reality. My first boss I had, he was a very old chairman from the restorative department in Germany who always told me, ‘OK, Mike, how many of those theoretical things that you learn in school are the same as what you experience in your daily practical work?’ And when I really answered him honestly, I had to say, ‘Not a lot of them.’
So, therefore, for me, it’s important for me to work with real patients [so] you really can see what’s going on.
Q. Has working with real patients informed the direction that your other work has taken?
A. Yes, because it’s practical. Sometimes, it’s much more important when you consider the tiny little details—what can speed up your workflow, what can make your whole workflow easier, not only for me here in the laboratory, but for the dentists, for the patient? And that’s something I would say you only can see when you do it on a real-life case.
Q. Can you tell me a bit about the process of fabricating a tooth?
A. Let’s talk about a simple case when you produce a single crown. Before, you [sat] at your bench and produced your model, set something, and then you went ahead and built it up with your hands [using] wax and sculpted it. It’s called a burn-out process when you put it in a furnace and then the wax from the inside burned and [from that] you created a mold. Then you had to cast your materials in it, like gold or other metal alloys. Every time you cast materials or metal, it had porosities in it.
Nowadays, I can design [a crown] on the [computer] screen. My whole workplace changed from being at my workbench to being in front of the computer.
Q. Do you find that it’s more accurate when you do it on the computer screen? Can you tweak the design measurements to a greater degree?
A. It’s a more predictable workflow. There’s a transition right now, because on one hand we’re still working with old techniques, but that is more on the dentists’ side. They still work with impression techniques. Then, you combine that with the very advanced technique I have here. The precision of your restoration is always only as good as your model because this restoration is fabricated for the model.
It’s precise on the model, but it doesn’t necessarily mean I have the same precision in the patient’s mouth. [There are] new technologies on the market, like internal scanners. … You basically make a scan of the patient’s [mouth] instead of taking a real impression with silicon. But that is just in development. ... It seems very promising for the next one, two, three years.
Q. Do you still work with wax and ceramic, the more tried-and-true techniques, or do you try to, on your end, do everything from start to finish on your computer?
A. As much as I can, I do on the computer. But certain steps are still easier when you do it on your workbench instead of in front of a computer because you have a better three-dimensional overview, especially when it comes to full mouth rehabilitation.
Q. So, you really do everything from a crown to a full-mouth rehab?
A. My specialty was always implant cases, like full-mouth rehabilitations. It was, for me, always the most interesting because ... it is like the Olympics of dentistry.
But what I always say is, technology is nothing without the basic knowledge of what you have learned in school, or in your education. No technology can replace your knowledge. It’s always a combination because a computer is stupid. You have to tell it what to do.
Q. You also do some software development, as well. How does that work?
A. For a few [companies], I’m a beta-tester. It means I work very closely with them. When I am sitting here and I am working on a case and I realize there is something missing—what could make my workflow easier?—then I call them and give recommendations. That’s a big advantage because I’m able to bring my own ideas into the software development and am able to improve [products] for the outside market.
Q. How did you decide to go down this path of study years ago?
A. First of all, to be very honest, I don’t know! I always knew when I got out of school I wanted to be—it sounds weird—I wanted to be a dental technician. I [saw] a show on TV where I saw how they work with ceramics. It’s a combination of creativity, but also about technology, about many different things.
Q. You’ve been here since May of 2008. How do you like living here?
A. I traveled a lot in the United States. ... What I like [about Philadelphia] is that it has a lot of history for America. I like Philly because of the architecture, the old houses and, of course, there are some parts that are not that nice, but the diversity of the people—people from China, Japan, Mexico, Brazil, or Italy, Spain—whatever you name, it’s here. It’s more of a European city, I would say.
Originally published on December 13, 2012