A joined up approach to Dentistry for an improved patient experience20 October 2015 Categories: Uncategorized
Mark Ambridge: Dental expert discusses ways in which Dental surgeons can get the best from the dental laboratory.
Getting the most from your laboratory & creating a great first impression!
- Information overload
2. Impression taking
6. Work protocol
Like most things in life you get out what you put in, if you take the time to give as much information as possible along with images then this is going to gain the best results for the patient. You can never give the technician enough information don’t forget you have met, and know the patient, you can see the way they talk, smile and visually look and conduct themselves. The technician usually has not met the patient unless we have conducted a smile consultation either at our lab or at the Dentists practice.
Take time to understand the patients’ expectations & what they really want to achieve and what the ideal scenario would “look like” to the patient. Patient consultation around why and what they want to achieve vs the right individual solution for them is critical in order to map and then set their expectation.
Consider sending pre-op and provisional images, full-face smiling, close ups with cheeks retracted, profiles, in fact as many images as you can from every angle.
Complete the lab card fully, i.e. age, sex and finer details of the patient is very important to the way we style the finished product.
Consider a meeting between the patient and your technician, if at all possible, it can make a real difference to the outcome, it also gives the patient a feeling of a joined up approach and an end to end solution. Patients often feel the importance of meeting their Technician and can have a tendency to be more open and honest to the person in the ‘back room’.
We can also look at combining other procedures such as teeth bleaching, implants and additional veneers, crowns etc. procedures that will improve the overall restorative results.
Take good impressions
The better the impressions the better the results; Obvious you may think, but, when using a silicone base do you:
- Use non-perforated, metal or rigid plastic trays or custom made special trays (perforated trays are for alginate only)
- Make sure trays are the correct arch size to prevent touching other teeth around the arch.
- Always use tray adhesive (prevents ‘lifting’ distortion)
- Use a stable silicone impression material (no shrinkage), NOT alginate unless cast straight away (within 10 mins.)
- If you mix putty by hand wear polythene, NOT latex gloves (latex can affect setting)
- Use a stopwatch or timer to allow the material to set properly (contact us for more information if needed)
- Use same impression material for both impressions. There’s no point providing a fantastic impression for the working model and then to produce something of inferior accuracy for the opposing/bite model.
- Make sure they are cleaned and disinfected (by HSE/HMRA/CQC instructions)
- Make sure it’s packaged properly ready for transportation, loosely packed in a ‘gripseal’ lab bag inside a box (enclose some damp tissues, not soaking wet as alginate can absorb and expand, in the bag if alginate was used to prevent dehydration).
- Make sure you use an excellent lab with a great service, which has a proven track record of delivering to the expected standard and capable of understanding your exact requirements.
For an in-depth article by Espe on ‘Making Better Impressions’ please go to:
Creating bridgework, especially interiorly can be virtually impossible to ‘get right’ when your Technician doesn’t know where the teeth should be. We suggest you consider starting those missing teeth cases with a diagnostic wax-up, from that with a simple stent or alginate you can make good looking provisional. The provisional can then be assessed in consultation by the patient and you and, when happy with the shape and position an impression can be taken. The impression should be sent with the work to give the Technician a Patient Approved Provisional (PAP) model, which they can matrix and copy for correct tooth position.
This technique is widely used in implantology where often the bone and soft tissue loss means the final teeth would be ‘floating’ in space without the addition of extra bone in surgery or ‘pink’ gum on the restoration.
Again when doing a medium to large anterior case or difficult occlusion case or even that difficult to match central consider a ‘Bisque’ try-in, (bisque is the pre glazed state of ceramic) so being rough this will enable you to adjust the ceramic easily or mark it where it needs adding or reducing.
If you want to add to the reshape please use wax not composite as this leaves an invisible residue that can affect the firing of ceramic.
Just as important but often forgotten about, the lab technician will often put his or her ‘all’ into designing and making a case look, what they consider to be correct. As mentioned before they may never have met, seen or ever will meet or see the patient, you will enhance their day, help them grow and assist their profile and career by keeping them up to date the end result of a case however complex, whatever the result; good, bad or indifferent. This is also great for morale personally and within the lab and can assist us with discussion points, knowledge share and experience.
Lab work protocol
To ensure an “end to end” joined up service we recommend that you have an up to date returns diary. We would suggest that you check your work returns schedule daily, to ensure it matches the patient’s appointments i.e. the day before the patients appointment check the work has arrived. In most cases it’s impossible for us to complete work last minute if the lab card doesn’t match the appointment date, due to the materials and processes we use. It’s crucial for an excellent patient experience this process is monitored and checked.
The most streamlined process we see is when there is a specific place for work “in” and “out” and there are two people responsible for logging it “in” and “out”.
Benefits to you and your patients
Using our “guide to impression taking” and “workflow suggestions” will help to provide the following benefits to you and your patients:
- Provides a more accurate detail of the mouth, the look and feel of the person we are making for.
- It can significantly cut out the chance for errors
- The work itself will be easier to fit
- It will create less chair time, so you have more you time to spend how you wish.
- Less chair time ‘stress’ for the patient which in turn helps to drive patient referrals and loyalty
- Excellent results – great fitting, fantastic looking restorations which speak for themselves, get noticed and happy patients who will promote your practice, through their smile!
If you would like any further information or to work with Ambridge Ceramics laboratory please contact us @ firstname.lastname@example.org or call our team on 01765 607347