July 1, 2005
by E. Dwayne Karateew DDS and Marco Beschizza MDT
Collective Understand and Mutual Aid- “CUMA”, describes the interaction of a highly skilled and driven team, consisting of both dentist and ceramist, practicing symbiotically through understanding, trust and expertise. As we had previously discussed, so much more should be involved in inter-professional communication than a laboratory prescription with A3 written on it and the rest left to chance. There are situations where the challenge goes far beyond what is standard, into the realm that is often classified as custom design. This personal contact is without doubt what allows our team to create the results, which we are able to achieve. Our demands on each other and the chemistry which we can create in the high pressure system of our clinical lives often takes us to the limits of technique and available materials to achieve goals that are often deemed impossible (Fig. 1).
However, regardless of the skills both parties may possess and the techniques and material that can be employed, the dentist and technician need to think and act as a singular unit-a cohesive team-which recognizes and understands each other’s abilities and limitations. This is the critical factor, which creates a successful working formula.
It is perhaps the top five percent (95th percentile) which ascribes to these levels of aesthetic and functional demands. It is those in this zone that break all the rules related to input and execution achieving exceptional results. We call this type of work “Super-Natural”. It is the transition from the 90th to the 95th percentile, representing a small change in numerical representation, but is so technically difficult to reach. Trying to achieve this top five percent is all about being a perfectionist and that in itself has the potential to be the downfall, as often perfectionists never know when to stop. The perfectionist needs to know where to stop or the work simply will never be completed (Figs. 2-4).
Today communication is becoming easier. With the digital age firmly here, technicians can benefit from the instant patient reference material available at the workplace. Likewise for the clinician, he/she too can examine areas of difficulty through this medium to discus with his technician a query or observation that requires addressing.
Digital photography via e-mail or CD-ROM provides a quick and easy two-way channel of dialogue that we have not had in earlier years, and in this respect we have made a quantum leap forward. However, we should not get too complacent as to its accuracy or accept it as a true reproduction. It is good, but only as good as the graphic card and monitor that delivers it and the CCD of the digital camera that took it.
If we do not fully understand the technology available to us we have the potential of falling short of the mark (Fig. 5). Thus it is our feeling, that although we utilize an accurate digital camera, we cannot forget about our traditional 35mm macro film photography and personal interaction between the patient and the ceramist. These are the only true ways of relaying all the information regarding the restoration at hand, a combination of technology and personal communication.
In years gone by, both clinician and technician often worked within close proximity or even with the same office, some still do. Today there is a trend to work over greater distances or even globally and depend heavily on technology to fill the association gap. In this respect our profession faces its greatest challenge, as the final result may be the product of interpretation and digital referencing.
Simply stated, the dentist cannot provide what we aspire to without the ceramist, and the ceramist cannot utilize his/her artistic abilities to create without the dentist. All too often the end result is diluted because lack of co-operation, understanding and mutual aid-CUMA. That often means the collective understanding is not complete and mutual aid is more a chess game than a coherent process.
What we all must remember is that although it may be the dentists vision as to what the end result may be, it is the ceramist who makes it all possible. Thus we can state that the sequential roles we play are as follows:
1. Dentist: Architect/Foundation layer
2. Ceramist: Artist
3. Dentist: Assembly of the artwork.
Neither of us is successful in any of our roles without the interaction of the other. The ceramist gives to the dentist the ‘artwork’ to assemble into a final picture. The ceramist is the painter and the dentist is the framer. A common pitfall is that neither partner fully understands how much effort, both mental and physical, goes into the execution and completion of each other’s role (Figs. 6-8).
True team spirit understands that limitations are not limitations for very long. Understand each other’s capabilities, which is often not the result of a lack of ability, but rather, understanding the possibilities, and then all can be achieved.
Therefore the best teams consist of members who have sought out each other. Then and only then can magic be created and the understanding be whole. Everyone involved knows each other. This means meetings, time put aside for discussion and the desire from both parties to ‘go for broke’ and the present to the group the ultimate challenge. In other words, you really have to like each other and you become a network of friends.
There is no, “he/she is the technician and I am the clinician”. There is only the team, which exists and creates for the benefit of the patient. Behind the scenes, collectively you become a single body of co-operation and understanding. Achievements become a daily exercise of contact and routine and one fully respects the other (Fig. 9).
In the final instalment of this trio of articles (Part I appeared November, 2004 Oral Health), we will explore how this interaction relates to a complex procedure and follow the progress from inception through to completion.
Marco Beschizza RDT, MDT, trained and qualified as a dental technician in England. He lectures extensively to dentists and technicians alike on Ceramic Systems and Aesthetics. He currently maintains a laboratory in Vancouver, BC.
Dwayne Karateew DDS, Dip. Perio, Dip. Prostho, obtained his DDS from Columbia University in New York and Diplomas in both Periodontics and fixed Prosthodontics from the University of Pennsylvania. He practices in Vancouver, BC. The authors are currently involved in the joint multi-media presentation of “Practicing CUMA-Collective Understanding and Mutual Aid”.
Oral Health welcomes this original article.