Using Your Senses for Better Lab Communication

By applying some basic, consistent principles to daily lab-dependent procedures, the dentist and lab technician can transform restorations from acceptable to exceptional.

We should know how important communication is in all facets of life. Whether interacting with your spouse, significant other, children, or friends, messages of wants, needs, and desires are shared all the time. Just as much emphasis needs to be placed on the relationship between the dental lab and the dentist. In the dental world, disappointments, failures, and remakes are the result of communication breakdown. Maybe a line angle nuance was not addressed; perhaps the shading and characterization were not clear; or, quite possibly, an improper technique was applied. And this is all without mention of the time, money, materials, and patient frustration that is involved. By applying some basic, consistent principles to daily lab-dependent procedures, the dentist and lab technician can transform restorations from acceptable to exceptional.

Listen

As simple as it sounds, get to know your lab technician or ceramist. Open the lines of communication with meetings, phone conversations, or emails. Listen to each other. Ask how you, as the dentist, are doing with your preparations: Is there enough reduction? How are the margins? Are the finish lines in the proper places? What materials are best suited in this area?

Find out what it takes to become a better clinician in the eyes of the lab technician. Lab technicians have one big advantage. They see many restorations under a variety of situations. They know which one will work best and which one is likely to fail. Ironically, most labs will not call and ask for a new impression, because they are afraid of overstepping their boundaries. Each party involved in preparing, creating, and delivering the restoration wants the best for the patient, but disappointment can easily arise without a clear understanding of what an exceptional restoration requires.

When the restoration is ready for the patient, inquire about what products will make the seating appointment easy and predictable. What bur types should be used for adjustment — diamond or carbide? What polishing wheels work best? By listening to your lab technician, you will learn what works best for their types of porcelain. Your new-found knowledge may even save you from chipping an incisal edge and having to return it to the lab for repair! Good listening skills will help you exceed expectations.

See

Impressions → Clear impressions are the foundation for all successful restorations. When the crown doesn't seat or the margins are short, there is a reason. The impression must be clear to be understood exactly. When was the last time you looked at your impression to be certain it is really clear? If a margin has a bubble or is missed in one area, redo it or ask the lab technician to fill in the dots so he or she knows you are aware of a potential problem. Also, make sure to evaluate the bite registration for properly occluded teeth. As the patient records his bite, make sure it is unobstructed.

Bridgework has even more variables that need improved impressioning and communication. Pontic sites are always a nebulous area for the lab technician. Should the pontic area be scraped? Is this a recent extraction site? Will this be a ridge lap because the tissue is paper-thin over the bone? Technicians have a difficult time visualizing what the tissue looks like on a stone model. Give details about the pontic site — i.e., recent extraction, old site, or a thin ridge.

Digital photographs → Certainly one of the best communication tools in dentistry today is digital pictures. Photographs can bring the patient from the dental office to the lab without an extra visit. Characterization, increased detail, and facial considerations are just a few of the important traits that will elevate the final result.

Develop a consistent set of pictures that will relate the patient to the lab. Have you ever had to match a single central incisor? Think of all the teeth that have difficult color transitions or characterizations. How do you translate that to the lab? Using a systematic approach with digital pictures to "fill in the lines" for the lab technician is the ultimate communication tool.

X-Rite ShadeVision System

X-Rite shade colorimeter → While no instrument can take the place of the human eye and brain to interpret shade information, the X-Rite shade colorimeter has been found to be an invaluable tool. By measuring a basic shade and an average shade of three areas, a master map for the ceramist is created. Additionally, it acts as a digital camera to provide a color picture for characterization. The lab technician can literally do a virtual try-in to be certain the crown will blend with the adjacent dentition. This form of communication can save many frustrating shade attempts from failure.

Tactile

The basic written form of communication is the lab prescription. Unfortunately, words can be misinterpreted, unclear, or left out, thus muddling the fabrication process and final product. Lab scripts need to be detailed not only with patient information and colorization, but exact due dates and delivery times.

Extra communication that should be detailed on the lab slip is shading, color gradation, and differentiation. Realize that few teeth are monochromatic. A script that says "Tooth No. 9 is an A3" does not say much. Segmenting the tooth into three portions — gingival, middle, and incisal third — is most helpful. Drawings are also excellent.

Carefully decide which shade or feature is where and draw it on the script. Do not be afraid to map every detail for the ceramist. The more information you relate, the better the final restoration.

Working together achieves more

Open communication between the dental office and lab can be achieved if consistent, proven systems are in place. Initially, there might be a fear of the unknown or confusion about what one person expects from another. But in time, a reliable understanding for each other's ability will develop. By building on predictable techniques, frustration and remakes can be virtually eliminated. In working together, both the dentist and lab can begin to function as one in a seamless process not only to deliver exceptional restorations, but to achieve the goal of satisfying the patient's needs and desires.

Amos L. Harting, BS, AS, CDT
Mr. Harting owns and operates Harting Dental Arts Lab Inc., a family business for more than 44 years in St. Louis, Mo. Through mentoring by his master-ceramist father and today's technology, he strives for the best in aesthetics, quality, and laboratory communication.