Making a Good First Impression by Dentaltown staff

Tips for getting even better results from the dental lab

by Dentaltown staff

Producing high-quality restorations for your patients requires precise work not only from the dental lab but also from the doctor submitting the case. Of course, because doctors are only human, there’s always room for improvement when it comes to sending precise impressions and including the necessary information for an accurate restoration. We spoke with six dental labs that shared helpful tips for submitting your case and getting even better results.

1. Packing cord enhances restoration designs.

While it may be tempting to skip packing cord while taking an impression, doing so results in a missed opportunity to enhance the accuracy and precision of the final restoration. Blood and crevicular fluid often distort impressions, leaving you with a final restoration that may require multiple chairside adjustments. We recommend packing cord to encourage a better final delivery experience for you and your patients. This strategy pushes the gums away from the impression material, allowing you to take a more accurate impression that will lead to a better-fitting restoration.

Logistically, there are many changes you can make to your impression routine to avoid lab remakes and ill-fitting restorations, even before you insert the cord. You first need to analyze what cord size should be used for your patient. In most cases, the smallest sizes—most commonly #00 and #0—should be used to properly displace the tissue without damaging it.

Next, determine whether a cord that has been processed with a hemostatic agent or other medicaments extraorally is necessary. Lastly, you will need to decide if the one-cord or two-cord technique is right for your particular case. The two-cord approach, which is more common, involves leaving one of the cords in the sulcus while taking the impression.

Using packing cord to take better impressions isn’t a new dental technique, but it can add a new sense of ease for your practice and patients when more of your final restorations seat well on the first try.

— DigiTech Dental Restorations
(digitechlab.com; 888-336-1301)

2. A picture is worth a thousand words.

Photography is one of the most powerful tools you can use to communicate with the lab. Your pictures, clipped to a prescription or sent digitally, showcase the vision of the smile makeover. Intra- and extraoral photographs assist your technical adviser, who works directly with you on your case to ensure that the proper restorative solutions are utilized to optimize results. Whether they’re used to discuss shade selection, material formulations or procedural techniques, pictures can aid in problem-solving if you run into questions or need guidance. And photos can be part of a more detailed patient record.

When taking pictures for the lab, remember these five tips:

1. Position your patient for head-on shots with the patient looking directly ahead in a relaxed manner.

2. For close-up shots, hold the camera

at a 90-degree angle from the teeth. The lens and teeth should be perpendicular, whether you’re shooting from a lateral view or head-on.

3. For difficult-to-reach posterior teeth, use a clean intraoral mirror with a long handle to retract cheeks and reflect the subject area at a more direct angle.

4. Ensure that intraoral pictures represent a natural bite to capture the true orientation of teeth. If patients are presenting an artificial smile—with protrusive jaw, stretched smile or bite out of centric occlusion—tell them to bite down on the back teeth and help them focus on natural positioning.

5. Document the treatment process. Start with “before” images of the patient and shade shots illustrating real-life tooth color. Follow with images of the teeth after prep, and visually document the stump shade, provisional restoration and final seating of the definitive restoration. Finish with “after” shots.

Taking high-quality photographs will become straightforward and easy once you’ve gained experience, but don’t hesitate to reach out to your technical adviser with any questions.

— Las Vegas Digital Dental Solutions
(lvddslab.com; 800-936-1848)

3. Taking a good bite registration is a team effort.

The trick to taking an exceptional bite registration is as much about initiating proper communication as it is about technique. Communicating with the patient about the bite registration process is vital. Before getting started, inform the patient of what to expect and rehearse what they need to do. Be sure to play an active role and ask if they have any questions. Most patients will be numb at this stage and some may have difficulty determining if they are biting down in the right areas. In order to properly convey the patient’s occlusion, you will need to maintain the correct orientation when inserting the bite registration material and confirm with the patient that they are biting down completely.

When you remain in tune to your patients’ concerns, comfort and comprehension, you will find that your bite registration leads to a better-fitting final restoration with minimal or no occlusal adjustments necessary. Communicating with your lab is also a key element to achieving a final restoration that doesn’t require multiple seating appointments. If you have any special information regarding your bite registration—for example, the patient might not have been able to bite down all the way and you had to take a separate bite registration—relay these changes to us on the lab slip so that our technicians can ensure you receive an accurate restoration.

— New West Dental Ceramics
(newwestlab.com; 800-321-1614)

4. Full-arch trays make the difference.

When it comes to elastomeric impressions, lab technicians agree: Full-arch impression trays outperform triple trays. This is especially true for cases of three or more units. Why? Restoring three or more units requires more information, a level of detail that impressions made with triple trays typically do not convey.

The smaller size of a triple tray, although convenient chairside, tends to introduce complications in the fabrication process. One of the most common difficulties that lab technicians face with impressions made from triple trays is successfully re-creating proper occlusion.

Such impediments at the lab bench can then require extra phone calls between your lab team and your staff members, resulting in precious time spent troubleshooting. Worst case? Those same hurdles could make it necessary to recall a patient to retake impressions, risking delays of your patient’s final delivery appointment.

To avoid these types of postponements, full-arch trays are the answer. In contrast to triple-tray impressions, articulation is a cinch with full-arch upper and lower impressions. This means better restorative results for your patients. If you already have a stock of triple trays on hand, you do not have to toss them. Instead, we suggest instructing your staff to use triple trays for taking impressions for straightforward restorative cases involving just one or two units.

And for cases in which patients need restorative care for three units or more, simply reach for full-arch trays. (It also should be noted that for bridge cases, it’s still important to include a bite registration over the prepared teeth.) Full-arch upper and lower impressions are the surest way to obtain predictable restorations that function well and look fantastic.

— Pacific Edge Dental Laboratories
(pacificedgelab.com; 800-889-9323)

5. Get better results with concise prescription notes, temporaries and wax-ups.

In some cases, the dental lab receives a prescription with so many notes and special instructions that the technician has a difficult time making sense of the desired specifications for the prescribed restorations. Brevity and concision are key. We recommend that you place emphasis on the most important high-level details, so that the lab can better focus on what matters most to your case.

If there are fine details you’d like the lab to be aware of when they design and fabricate the restoration, a simple note to “call doctor before beginning case” is recommended. A conversation with our technical support team can ensure that everyone is on the same page before restoration design begins and is often a more effective means of communicating details than Rx notes, which are sometimes difficult for the lab technician to interpret.

If your case is aesthetically challenging or located in the smile zone, conveying your restoration design through a temporary restoration or diagnostic wax-up can optimize your results. Making an impression that includes your patient’s temporary will ensure a restoration that meets both of your expectations. Further, temporaries give you an opportunity to fine-tune crown design and gain your patient’s approval before fabricating the final restoration.

Lab-fabricated temporaries, such as BioTemps Provisionals, save valuable chair time and can further enhance the accuracy of the final restoration. In addition to giving your patients a beautiful temporary, the digital design used to produce BioTemps Provisionals can be carried over to the final restoration after being updated with any chairside adjustments, giving your patient a predictable, highly precise outcome. For many dentists, a diagnostic wax-up is the ultimate tool for maximizing the results of aesthetically demanding cases, and our lab takes pride in using high-precision CAD/CAM technology to deliver a restoration that perfectly matches your wax-up.

— Riverside Dental Ceramics
(riversidelab.com; 800-321-9943)

6. Excellent results require good preparations.

While our lab strives to create excellent restorations for each and every case, ultimately there are only so many methods and tricks that a technician can employ to overcome problematic preparations. We understand that clinicians face unique challenges every day, making the creation of perfect preparations difficult; however, if you follow these two simple tips, the chances that your lab can create excellent results will increase dramatically.

First, make sure you’re familiar with the prep requirements for your chosen restorative material. There are significant differences in preparation dimensions, even for materials that might seemingly belong to the same family of products. This means that using only one style of prep isn’t acceptable. For example, if you select a high-strength zirconia, you may only need 0.5mm of occlusal reduction. If you’re selecting a different all-ceramic such as lithium disilicate, though, you would need a minimum of 1.5mm of reduction.

Each material type and brand requires a very specific set of preparation parameters, and it is incumbent that the dentist creates a preparation specific to the chosen material. Some good ways to find these parameters are by visiting the material manufacturer’s website, referring to an IFU or asking your laboratory technician. If you’re prepping teeth with the final material in mind, your results will improve.

Secondly, practice good isolation techniques. Whether you place a rubber dam, employ a vigilant assistant, use a modern isolation tool, or diligently place retraction cord, the benefits of achieving a relatively moisture-free environment are significant. You’ll gain a clearer, less distorted view of the prepared area. Solutions you apply to the prep won’t be contaminated or diluted by saliva and crevicular fluids, and blood will be less likely to alter your impression material. This will ultimately enhance your preparation and impression, aiding the lab in creating excellent results for you and your patient.

— Smith-Sterling Dental Laboratories
(smithsterling.com; 800-395-8205)