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Professional Courtesy: Stop the Blame Game Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine

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Stop the Blame Game
– by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine
One dark Monday in December, I thought to myself, I cannot continue to practice dentistry as I am doing, or I will go insane. A hat trick of laboratory failures from three different labs was the reason. One case was a single crown with an open distal contact; this happens infrequently and I know the lab will make the correction quickly. The second case of the day was a custom shade from a local lab, on a patient who is a family friend; the crowns on 8 and 9 looked like a single shade and did not match the adjacent teeth. I always get patient feedback before I share my opinion, and she nailed the deficiencies in less than five seconds. The final straw was an implant case with a total of three implants (two together, one on the opposite side); the abutment was rotated on the single implant and the two custom abutments on the other side were out of parallel by less than a degree.

Any one of those events would be taken in stride as a day in the life of a dentist, but to have three in one day left me searching for answers. I am reluctant to blame the labs, but I can say that the missing distal contact was evident on the working model, the custom shade might have been done by a technician who lacked the artistic skills that I expected and the implant case was probably mishandled by the individual who created the model.

If you are reading this and you are a lab owner considering writing a “letter to the editor” that you plan to wrap around a stone model and throw through my window, please don’t. I am making a point. Dentists frequently blame the lab for poor outcomes and the labs frequently blame the dentists for low quality impressions and incomplete prescriptions. Hygienists blame the thickness of their X-ray sensor when they miss a contact, assistants blame each other when an instrument is broken or missing and the front office will blame the doctor when the office is running behind. The blame game is not limited to dentistry, as parents today will blame teachers for their children’s grades, referees are blamed when a team is losing and everyone in Washington D.C. blames each other for everything.

I don’t like the blame game. As a dentist, I am cursed with the urge to do everything myself. It stems from the adage that I learned from my mother: “If you want something done right, do it yourself.” It was this very thought coursing through my brain on that dismal Monday that made me think about CAD/CAM in the office. This is certainly not the first time I have contemplated this promising technology. In fact, I have most of my lab restorations fabricated using CAD/CAM and I am pleased with the accuracy of fit. Labs are using this technology because they also see it as a way to escape the blame game.

For many years, I have sat quietly on the sidelines observing the various players in the marketplace. CEREC has existed for 26 years, more recently E4D, Cadent iTero, LAVA COS and others have joined the mix. There are many more players on the laboratory side of the business as well.

There are a number of factors in play that lead me to believe we are on the verge of a tremendous upswing in CAD/CAM adoption by dentists. First, with the high price of precious metal, labs are seeing a rapid increase in volume of metal-free restorations. Second, newer materials such as LAVA Ultimate do not require a furnace prior to cementation; I would love to mill my Class II composites and ditch the challenge of interproximal contacts. Third, if labs are using similar technology and the same materials to fabricate my single units, I might as well do these cases in the comfort of my office. Finally, technology is the ultimate cure for the blame game; if I prep, scan and design my restorations, the only one left to blame is myself.

If you have recently purchased CAD/CAM for your practice, send a report on your experiences to tom@dentaltown.com. If you buy CAD/CAM in 2012, blame me.
Dentaltown Magazine
September 2025
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