June 1, 2004
by Damon C. Adams, DDS
A unique experience leads to a new perspective
For the past eight years, I have had the privilege of getting to know dentistry from a most unique perspective! I have worked as an on-site dentist inside a commercial dental laboratory serving as doctor-technician liaison, technical consultant, and mentor to more than 200 dentists and technicians. In lectures I often mention that this experience has had a more positive impact on my dental career than anything else I have ever done.
In fact, I have learned much more from being side-by-side with my technician colleagues than I will ever be able to teach. It has now become my passion to help others value their laboratory relationships and improve their practices through the experiences that I have had with our esteemed partners in dentistry… our dental technicians.
Could dental schools prepare us better?
This is the time that awareness for laboratory skills and techniques should be paralleling the marked rise in doctor and patient (esthetic) expectations. Unfortunately, more and more dental schools have been taking laboratory techniques out of their curricula. It seems the message being given is that laboratory work is really not that important. As a result, many young dentists have been entering the profession with little experience or true appreciation for what the technician team players are doing for them. They usually find that they are unprepared to properly evaluate the technician’s work, and somewhat ill prepared in how to speak or understand the technician’s language. It is also difficult for many doctors to relate to how technicians are completing their tasks, the materials they are using, the value of their efforts, or who they are. Yet, these are core issues to any doctors striving to accomplish optimal care for their patients.
Is there room for professional growth?
There is a recent emphasis on better doctor-technician relationships in some post-graduate seminars and in certain publications. Consequently, definite pockets of improvement can be observed. This is seen more typically among the higher-end practices that are taking advantage of continuing education experiences that also involve the dental technicians in their hands-on courses. However, the dental profession as a whole has healthy room for growth. How many recent dental meetings have you attended where the technicians played an active role in the meeting planning or were encouraged to attend as a part of the dental team? Even if dental technicians are not routinely attending most continuing education events with us, there are some simple things we can do. I have found that doctors who are willing to spend more time side-by-side with their laboratory partners, soon begin to realize profound changes in the following areas of their practice:
treatment plans developed with a joint effort insure better predictability and longevity of cases,
understanding what technicians need, to get back what is expected,
the quality of preparations dramatically improves,
the working knowledge of occlusion is enhanced,
sharing and discussing photos leading to better results,
doctor-technician professional relationships grow stronger,
inter-professional referral of patients increases,
the overall level work related stress decreases,
profits increase for both the doctor and laboratory,
knowledge of indirect restorative materials is significantly elevated.
These are just some of the areas that you can expect to see positives changes when you begin to develop and employ a total team philosophy.
How can you keep up with all the new indirect restorative materials?
With new dental materials being introduced at a record pace, it is a Herculean task just to keep up. Many doctors are confused with not only the rapid introduction of many material types, but with multiple brand names, methods of manufacture, and the similar but critically different indications, preparation, and cementation techniques required. My advice is to start by learning more about the basics by asking the experts in indirect restorative materials, the technicians who create the restorations.
Learn about the restorative material before picking up the handpiece
Dental technicians can be that partner who offers great advice on when to, and sometimes more importantly, when not to use a particular dental material. For example, our technicians cringe when a prescription is sent into them requesting all-ceramic restorations in a patient with a pathologic occlusion. They know that this can invite pre-mature fractures and costly re-makes. Technicians also know intimately the type of preparation required for each type of material they fabricate. Sometimes they deal with cases that the preparations do not fit the requirements for the type of restoration requested. Preparation design is restoration driven. If asked, they are ready and able to offer assistance and preparation feedback on the minor, yet major, nuances needed to move your end result from ordinary to extraordinary.
Your dental technicians, who are world-class die trimmers (experience in numbers) and margin specialists, can offer great feedback on your tissue packing skills, impression and bite registration taking abilities. Usually your technician will know the basic types of cement indicated for each product delivered to your office. Clinical cementation techniques may be an area that most laboratories will prefer to refer you to back the manufacturer instructions. Proper advice in this area can have critical implications for the longevity of your restoration. In other areas regarding cementation or bonding they will be able to offer sound advice. Take for example the issue of whether to use silane or not. Your technician knows that they only use HF acid on all-porcelain surfaces. In turn, etched porcelain surfaces are the only ones that silane is used on to increase bond strength. On the other hand, silanization of non-porcelain surfaces, contained internally on certain all-ceramic restorations (aluminum or zirconium oxide copings), can be detrimental to the resin cement-to-porcelain bond resulting in premature failure.
Bottom line? Reduce stress and increase profits!
Are unread journals and articles stacked from your floor to the ceiling? Take a load off. You are not alone. Remember, it is impossible for you to know everything about everything. Meaningful communication and co-diagnosis with your dental technician early in the treatment planning process, before preparations are begun, can dramatically reduce your stress and increase profits. This will be a definite win-win for both you and your laboratory partner. We need to be reaching out to others on our professional team, instead of being isolated in our individual practices. We have at our fingertips the materials and collective knowledge to make huge differences in our patients’ lives. We only need to tap into the wealth of knowledge that others have available to share. The next time you call your dental technician, why not set up some time to get together and discuss your next case?
Or maybe see the latest dental materials and discuss indications and preparations that could help you achieve the very best esthetic and functional results. When you get there, do what it took me too long in my career to learn (better late than never). Pull up a chair, relax, sit a while, and be ready to listen. You will be amazed at how much wealth there is to gain from a better working relationship and a strong professional friendship with your dental technician.
Dr. Damon Adams is from Traverse City, MI. He is an Assistant Professor, Department of Otolaryngology, at Medical College of Ohio. Dr. Adams is an internationally recognized speaker who has lectured and consulted for many dental organizations and laboratories including the Shaw Group of Dental Laboratories headquartered in Toronto. Dr. Adams is listed in Dentistry Today’s Leaders in Continuing Education.