Communication between the dentist and dental laboratory is paramount to successful treatment. The practice of writing a prescription and drawing sketches to describe what is desired has been supplanted by high technology. Modern laboratory technicians expect and should receive better tools to help illustrate the desired end result. Through excellent communication, the dentist and lab technician can often achieve the result wanted without extra appointments for the patient. This reduces the cost of performing treatment and the stress of lost time for the dentist, the patient and the technician.
PHOTOGRAPHY
One tool that has become commonplace is the use of photography. Instant pictures, 35mm photographs or slides, digital images or prints from digital images all can be used to relay the true clinical situation to the laboratory. Most dentists I know today are using digital cameras and sending prints or compact discs with images to the lab. Some dentists communicate by sending digital images over the internet.
I have found that many lab technicians appreciate a full face image of the patient as in Figure 1. Things like facial character, skin tone, face shape and age can be seen clearly in a portrait and can help determine some of the desired characteristics of the final restorations. A close-up view of the patient’s smile (Fig. 2) is also helpful. This can help determine how much gingival tissue shows and where the lip drapes over the tooth surface. The curve of the lower lip seen in this view can help determine incisal edge shape and position. A retracted anterior view as in Figure 3 gives the technician information about overall tooth shape, chroma, value differences, alignment, wear patterns, texture, etc. Occlusal views (Figs. 4 & 5) can help illustrate anatomy, arch form and lingual contours. Other views such a close ups of particular teeth may help define characterization.
MOUNTING
A facebow record such as the one in Figure 6 helps position the preoperative and working models on a semi-adjustable articulator in similar position to the temperomandibular joint. This can be a crucial factor in treatment planning and helping to minimize chairside adjustments to final restorations. Preoperative impressions as in Figure 7 are used to capture the current shape of the patient’s dentition so that accurate models can be poured and mounted. An occlusal registration in centric relation (Fig. 8) is used to accurately interdigitate the maxillary and mandibular models during the mounting process.
After the properative models are mounted, a wax-up of the desired end result can be fabricated by the technician (Fig. 9). This can be used as a diagnostic tool or as a tool to illustrate the potential final result to the patient. The wax-up can be duplicated in stone as in Figure 10 and a vacuum formed plastic shim (Fig. 11) can be made for use as a preparation guide and a mold for the provisional restorations.
ADDITIONAL PHOTOGRAPHY
The laboratory technician can benefit by seeing some additional images. A retracted view of the prepared teeth (Fig. 12) and maxillary and mandibular occlusal views are helpful in determining chrome and value of the prepared teeth and stump shades.
PROVISIONAL RESTORATIONS
Provisional restorations as in Figure 15 can be made to closely resemble the anatomy in the duplicate model made from the wax-up of the desired end result. After these are placed on the prepared teeth (Fig. 16), photo images and impressions for models of the temporary restorations can give the laboratory technician valuable information about desired contours, incisal edge position and even color.
THE FINAL RESTORATIONS
When good communication is achieved between the dentist and technician, the likelihood of functional and esthetic excellence is enhanced. Restorations with the desired shading, contours, occlusal scheme and texture may be achieved at the first try. Figure 17 shows such a case. Twenty two all-ceramic restorations are shown on the articulated model. The internal etched surfaces of the restorations can be seen in Figure 18. They are shown in the retracted facial view three months after being bonded to place. The maxillary and mandibular occlusal views in Figures 20 and 21 illustrate the beautiful anatomy that the technician was able to achieve due to the communication he received from the dentist. Note that there is no sign of extensive intraoral adjustments because very little adjustment was needed in this case.
The patient’s new smile is shown in Figure 22 and his portrait in Figure 23 shows a confident and more youthful appearance.
CASE CONCLUSION
This case was prepared and placed in only two appointments with no need for remakes or changes at the dental laboratory due to thorough use of communication tools between the dentist and technician. Such a team approach can make the job of both professionals more rewarding, less stressful and more profitable and the experience for the patient more comfortable and satisfying.
A NEW TOOL
Recently I have been introduced to a remarkable new tool for communication between the dentist and laboratory. It is called EDENTALINK.
EDENTALINK is a fully secured electronic tool which connects the dental clinic with the laboratory on a real time basis. Its primary purpose is it to significantly reduce the verbal communications required between the doctor and the lab when working on a file.
Using an electronic Rx Form (Fig. A), a dental office creates a specific file to which original and doctor-annotated pictures are added (Fig. B). Important information such as shade, requested date of return and specific work to be done are added for clarity (Fig. C).Through this tool, the laboratory retrieves all the information, prints work orders with annotated images, and updates the file as the job status progresses. Doctors are notified automatically when additional information is required, or if the expected date of completion is later than the requested date. With communication between the dentists and laboratory being so important, I am excited about this new tool. With modern systems such as this, dentists and their staff can surely allocate more time to the chair and patient results and laboratories can receive clear and complete requests that can result in higher dentist and patient satisfaction.
Ross W. Nash, DDS is co-founder and president of the Nash Institute for Dental Learning in Charlotte, NC, where he provides esthetic and cosmetic dental treatment for patients and continuing dental education for dentists and team members. He is a Fellow in the American Academy of Cosmetic Dentistry and a Diplomat for the American Board for Aesthetic Dentistry. Dr. Nash is a consultant to numerous dental products manufacturers. rosswnashdds@aol.com. Nash Institute at www.thenashinstitute.com.
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