In Mark's latest article he discusses ways in which surgeons can get the best from their laboratory.
Topics that will be covered in this article :
1. Information overload
2. Impression taking
3. Diagnostics
4. Try-in
5. Feedback
6. Work protocol
Information Overload.
Actually there’s no such thing! You can never give the technician enough information about the patient, don't forget you have met, and know the patient, we, usually have not.
Consider sending pre-op and provisionalised images, full-face smiling, close ups with cheeks retracted, profiles etc.
Fill in the lab card fully, i.e. age and sex of patient is very important to style of finished work.
Patients' expectations & what they really want to achieve.
Meeting the patient if possible is also invaluable for the outcome, it also gives the patient a feeling of importance and they tend to talk more openly to the person in the ‘back room’?
We can also promote other procedures like teeth bleaching, implants and additional veneers, etc. procedures that could improve the overall restorative results.
Take good impressions: Obvious you might think, but, when using a silicone based do you:
- Use non-perforated, metal or rigid plastic trays or custom made special trays (perforated trays are for alginate only)
- Make sure trays are the correct arch size to prevent touching other teeth around the arch.
- Always use tray adhesive (prevents ‘lifting’ distortion)
- Use a stable silicone impression material (no shrinkage), NOT alginate unless cast straight away (within 10 mins.)
- If you mix putty by hand wear polythene, NOT latex gloves (latex can affect setting)
- Use a stopwatch or timer to allow the material to set properly (see instruction manual for exact times)
- Use same impression material for both impressions. There's no point providing a fantastic impression for the working model and then to produce something of inferior accuracy for the opposing/bite model.
- Make sure they are cleaned and disinfected (by HSE/HMRA/CQC instructions)
- Make sure it's packaged properly ready for transportation, loosely packed in a ‘gripseal’ lab bag inside a box (enclose some damp tissues, not soaking wet as alginate can absorb and expand, in the bag if alginate was used to prevent dehydration).
- Make sure you send it to a good lab which is capable of understanding your requirements
for an excellent and indepth article by Espe on ‘Making Better Impressions’ please go to:
http://www.ambridgeceramics.co.uk/guide/
Diagnostics
Creating bridgework, especially interiorly can be virtually impossible to ‘get right' when we don't know where the teeth should be. Consider starting those missing teeth cases with a diagnostic wax-up, from that with a simple stent or alginate you can make good looking provisionals which in turn can be assessed by the patient and you and, when happy with the shape and position an impression can be taken and sent with the work to give the technician a Patient Approved Provisional (PAP) model which they can matrix and copy for correct tooth position.
This technique is widely used in implantology where often the bone and soft tissue loss means the final teeth would be ‘floating' in space without the addition of extra bone in surgery or ‘pink' gum on the restoration.
Try-in
Again when doing a medium to large anterior case or difficult occlusion case or even that difficult to match central consider a ‘Bisque' try-in, (bisque is the pre glazed state of ceramic) so being rough this will enable you to adjust the ceramic easily or mark it where it needs adding or reducing.
If you want to add to reshape please use wax not composite as this leaves an invisible residue that can affect the firing of ceramic.
Feedback
Just as important but often forgotten about, the lab technician will often put his or her ‘all’ into designing and making a case look, what they consider to be correct. As we discussed before they may never have met, seen or ever will meet or see the patient, you will make their day by letting them know on a regular basis the end result of a case however complex and whatever the result, good bad or mediocre. The good will help to keep up morale, the bad will help to teach, and help improve the way the technician works and eventually there won't be so many mediocre and bad results, they will all be great!
Lab work protocol
Check your work returns schedule daily, i.e. the day before the appointment and have a returns diary. It's no good phoning the lab 1 hr. before the appointment asking where the lab work is only to find the lab card return date doesn't match the patients appointment.
Have a specific place for in and out work and have two people responsible for logging it in and out.
Benefits to you and your patients…(AKA the cheesy bit)!
Using our guide to impression taking and workflow organisation will provide the following benefits to you and your patients:
- Provides a more accurate detail of the mouth
- Cuts out any chance of errors
- Ease of fit of work
- Less chair time so more you time
- Less chair time ‘stress’ for the patient
- Results – great fitting, fantastic looking restorations and patients who will love you all the more and even refer their rich, paying friends!
With regards to impressions, you could always go fully digital!? We’ll be holding an open evening giving surgeons the chance to get hands on with the new fully digital system provided by iTero at the lab on the 6th April
More information and booking available here: http://www.ambridgeceramics.co.uk/news/article/itero_evening
Thank you
R M Ambridge
To read any of our other articles in full click on the link below, then on the site choose Mark Ambridge or Steve Campbell to see the articles written from our lab.
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