Chapter 22 Dentist–Lab Technician Communications
Communication among patient, dentist, and laboratory technician is one of the most important factors for a successful outcome in any case, from the relatively routine to the most complex. With thorough, accurate, and timely communication, all parties understand exactly what they are trying to achieve, what challenges they need to address, what options are available, and generally what to expect. The result is greater satisfaction all around. The technician has a satisfied dentist-client. The dentist has a happy patient who will refer family and friends. And the patient has a smile on his or her face—the smile that the patient wanted from the moment he or she walked in the dentist’s door.
On the other hand, with inadequate or imprecise communication, even the most skilled professionals can fall short. Especially today, with so many options available at every stage of the restoration process, communication is the key to making decisions that lead to the excellent result everybody wants.
In the past, communication was brief and simple. The dentist would specify a porcelain or metal crown, assign it a shade, and sign a work authorization for the laboratory. Today the material selection process is far more complex, and there are many more options. To make the optimal decisions in each case, the laboratory needs more information from the dentist (Box 22-1). At the same time, laboratories have evolved from simply filling orders to being an important resource to dentists, consulting on everything from materials to procedures. To take advantage of that resource, dentists are communicating with their laboratories closely and continually throughout the restorative process.
Box 22.1 Checklist for Cosmetic and Large Restorative Cases
The channels for these communications have also broadened and deepened, with communications increasingly being handled digitally. The ease of transmitting photography—as well as work authorizations—digitally is improving the accuracy, thoroughness, and speed of all communications between dentists and laboratories, with correspondingly better results for patients.
All esthetic cases require communication among the technician, dentist, and patient from the start. As the dentist begins discussing with the patient what he or she does and does not like about his or her smile, and what concerns the patient may be having with form, fit, and function, the laboratory can play an important collaborative role in designing the diagnostic aspects of the case. With implants and similarly complex restorative cases, dentist–laboratory technician communications are always essential. If orthodontic movement, periodontal therapy, or oral surgery is involved, the laboratory technician should always be part of that team to help facilitate a precise and esthetic outcome.
Even with a single tooth case, results can be compromised with inadequate communication. In fact, the laboratory needs as much information with a single central as with a full anterior restorative case. For example, it is important that the laboratory technician know the design of the preparation and the underlying tooth structure in order to properly select the suitable restorative material. If the crown is to cover a metal substructure, or a root canal with a metal post, some materials, such as zirconia, might not block out the metallic coloration sufficiently. A more opaque material or a porcelain-fused-to-metal restoration such as Captek (Altamonte Springs, Florida) would be a better choice.
The more time and effort that the dentist spends intra-orally on fine-tuning the provisionals, the better the template that the laboratory has to work from and the more closely aligned the outcome will be with the doctor’s and patient’s expectations. Skilled laboratory technicians can do much to enhance the quality of the restoration. But form, fit, and function should be clearly established in the finished provisionals, which serve as the final blueprint for the laboratory’s work.
Taking shortcuts at this crucial stage leads to communication problems that can seriously undermine the result. A dentist who changes laboratories in the middle of a case and requests that the new laboratory complete the restorations using provisionals based on the patient’s old crowns will receive crowns that are both inaccurate and inadequate, with the resulting restoration satisfying neither the dentist nor the patient. The correct decision is to start again, with full provisionals, a Master Diagnostic Model (MDM), and ongoing communication among patient, dentist, and laboratory. Although it requires more time, the patient will be far more satisfied with the final result, and the dentist preserves or creates a valuable relationship.
A great deal of information can be conveyed between dentist and laboratory verbally, and there is no substitute for conversation when it comes to discussing certain aspects of a case. Verbal communication is direct, open, and fast and conveys emotional as well as factual information. It is perhaps the ideal way for the laboratory technician to get a sense of the results that the dentist and patient want. On the other hand, conversation is easy to forget and open to interpretation, which is why it is crucial to have a written laboratory prescription and notes from consultations, as well as photographs. The technician should keep these records in the case file for 10 years, which means that if the laboratory should return to the case several years later, there will be no question ab/>