Laboratory Communication Essentials for Complex Dentistry

Author : Dental Product Shopper
Published Date 12/07/2010
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Laboratory communication is a recurring topic and much education is geared to it. The lack of effective laboratory communication is only evident when a case that has been carefully fabricated in the laboratory does not seat properly in the patient?s mouth. Ineffective lab communication and remakes are costly for labs and dentists because of increased chairtime and overhead, loss of patient confi dence, and disappointment for everyone involved.

Laboratory Communication Essentials for Complex Dentistry

Laboratory communication is a recurring topic and much education is geared to it. The lack of effective laboratory communication is only evident when a case that has been carefully fabricated in the laboratory does not seat properly in the patient?s mouth. Ineffective lab communication and remakes are costly for labs and dentists because of increased chairtime and overhead, loss of patient confi dence, and disappointment for everyone involved.

Poor, inaccurate, or distorted impressions can be the undetected demise of a case. Certainly the advent of chair side scanners and ?impressionless? dentistry will vastly improve the 3 degrees of separation from a patient?s oral cavity to the lab bench. However, clear communication is still a critical element for success. The accurate transfer of data regarding the patient?s condition along with the clinician?s preferences and desired outcomes are a must. This is even more true when dealing with complex dentistry, such as implant restorations, smile designs, and the treatment of occlusal disease. To ensure predictability in your results, you must have a relationship with your laboratory that allows you to cooperatively plan and restore cases regardless of the material chosen.

Predictability in Esthetic Implants

Implant restorations have risen dramatically in the last few years. Esthetic implants or those within the ?smile zone? require extra attention to detail. This more complex restoration requires the clinician to account for and communicate tissue height, tissue health, desired emergence profi le, appropriate fi xtures, and clarifying details on interproximal discrepancies.

Abutment choices, between milled or cast, are in large part dependent on the restorative material chosen. Where appropriate, zirconia CAD/CAM milled abutments provide the strength and allow for much more fl exibility in choosing an all-ceramic or lithium disilicate material to provide ideal color match, translucency, and natural vitality in the fi nal restoration. The precision in CAD/CAM milled abutments allows for virtual design so that when questions arise, your lab can send screen shots for verification.

The most important aspect to ensure success in these cases is choosing a laboratory that understands the fine details in developing an ideal esthetic implant restoration. A comprehensive knowledge of the vast array of systems and the ability to envision the result is critical to success. When considering a laboratory to work with you on esthetic implant cases, they should be asking you a series of questions to establish your preferences. There are many techniques, depending on the system, to appropriately transfer information that must be accounted for (see box).

Predictability in Treating Occlusal Disease

While there are many different philosophies of occlusion, whatever philosophy you subscribe to, you must have a laboratory that can follow your treatment sequences, understand how you achieved your bite registrations, and assist in material selection. In these cases there is no more important step than the person who is pouring, mounting, and verifying that the occlusal scheme is accurate. Incorporating a facebow and bite records, along with highquality impressions is a key component to accuracy.

Being educated alongside your ceramist and ensuring that he or she is staying abreast of the latest advances in materials, technologies, and techniques will enhance the overall process of providing complex dentistry. My education has been enhanced by my dental laboratory (Gold Dust Dental Lab in Tempe, AZ) because they have hosted a series of advanced Clinical Mastery programs. This commitment to education gives me the confi dence in my ceramists? ability, my clinical acumen, and our shared vision.

Materials become a primary concern for me when a patient may not be ready for a comprehensive treatment plan. The latest advances in monolithic restorations and in zirconia milled and supported restorations require open communication based on resulting functional concerns.

Predictability in Treating Smile Designs

Many of the same factors above apply to smile designs. Where communication becomes even more critical is in ?subjective? factors of beauty, such as contour, translucency, texture, size, and proportion. The truth that ?beauty is in the eye of the beholder? certainly resonates in smile design dentistry. What a clinician or patient may see as attractive or beautiful, may not be what the ceramist would necessarily design based on his or her personal perception. Calibrating your defi nition in these subjective areas is necessary to avoid disappointment and to deepen your relationship even further.

A Simple Solution

How do you avoid the many pitfalls of providing complex dentistry to your patients? It?s simple: expand your commitment to communication with your laboratory before challenges present themselves.

Joshua Stelzer, DMD, maintains a private practice in Ambler, PA, focused on complex dentistry. He graduated from Temple University School of Dentistry and has completed the prestigious postgraduate program, The Clinical Mastery Series with Dr. David Hornbrook with live patient training in full mouth reconstruction, esthetics, occlusion, and materials.

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