Hidden Wealth

Nov. 1, 2004
Can you find it in a DENTAL LAB? Rub elbows.

BY DAMON C. ADAMS, DDS

For eight years, I have had the honor and privilege of getting to know dentistry from a unique perspective: I have worked as an on-site dentist at a commercial dental laboratory, serving as doctor-technician liaison, technical consultant, and mentor to more than 200 dentists and technicians. During lectures, I often mention that this experience has had a more positive impact on my dental career than anything else I have ever done.

In fact, I have learned more from working beside my technician colleagues than I will ever be able to teach. I want to help others value their laboratory relationships and improve their practices through the experiences I have had with our esteemed partners in dentistry — our dental technicians.

Could dental schools prepare us better?

This is when awareness for laboratory skills and techniques should parallel the marked rise in doctor and patient (aesthetic) expectations. Unfortunately, more dental schools have taken laboratory techniques out of their curricula. The message sent is that laboratory work is really not that important. As a result, many young dentists have entered the profession with little experience or true appreciation for what technician team players do for them. They usually are unprepared to properly evaluate a technician's work, and somewhat ill-prepared in how to speak or understand a technician's language. It also is difficult for many doctors to relate to how technicians complete their tasks, the materials they use, the value of their efforts, or who they are. Yet, these are core issues to any doctors striving to accomplish optimal care for their patients.

Is there room for professional growth?

There is a recent emphasis on better doctor-technician relationships in some postgraduate seminars and in certain publications. Consequently, definite pockets of improvement may be observed. I see this more typically among higher-end practices that take advantage of continuing-education experiences that also involve dental technicians in their hands-on courses.

Nevertheless, the dental profession has healthy room for growth. How many recent dental meetings have you attended where the technicians played active roles in the meeting planning or were encouraged to attend as a part of the dental team? Even if dental technicians do not attend most continuing-education events with us, we can do some simple things. Doctors who are willing to spend more time side-by-side with their laboratory partners soon begin to realize profound changes in the following areas of their practices:

• Treatment plans developed with a joint effort ensure better predictability and longevity of cases.
• They must understand what technicians need to get back what is expected.
• The •uality of preparations dramatically improves.
• The working knowledge of occlusion is enhanced.
• Sharing and discussing photos leads to better results.
• Doctor-technician professional relationships grow stronger.
• Interprofessional referral of patients increases.
• The overall level of work-related stress decreases.
• Profits increase for doctors and laboratories.
• Knowledge of indirect restorative materials is significantly elevated.

These are just some of the areas in which you can expect to see positive changes when you develop and employ a total-team philosophy.

How can you keep up with all the new indirect restorative materials?

It would be impossible to cover all the topics mentioned in a single dental article. Therefore, as an example, I will focus on how your dental laboratory can be an invaluable resource to you with respect to indirect restorative materials. With new dental materials being introduced at a record pace, it is a Herculean task just to keep up.

Many doctors are confused with the rapid introduction of many material types and with multiple brand names, methods of manufacture, and the similar but critically different indications, preparation, and cementation techniques required.

Start by learning more about the basics. Ask the experts in indirect restorative materials — the technicians who create the restorations.

Learn about the restorative material before picking up the handpiece.

Dental technicians can be partners who offer great advice on when — and sometimes when not — to use a dental material. For example, our technicians cringe when a prescription sent to them re•uests all-ceramic restorations for a patient with a pathologic occlusion. They know this can invite premature fractures and costly re-makes. Technicians also know intimately the type of preparation re•uired for each type of material they fabricate. Sometimes they deal with cases in which the preparations do not fit the re•uirements for the type of restoration re•uested. Preparation design is restoration-driven. If asked, they are ready and able to offer assistance and preparation feedback on minor and major nuances needed to move your end result from ordinary to extraordinary. Your dental technicians, who are world-class die trimmers (experience in numbers) and margin specialists, can offer great feedback on your tissue-packing skills, impression and bite registration taking abilities.

Usually, your technician will know the basic types of cement indicated for each product delivered to your office. Clinical cementation techni•ues may be an area that most laboratories will prefer to refer you to the manufacturer instructions. Proper advice in this area can have critical implications for the longevity of your restoration in other areas regarding cementation or bonding. They will be able to offer sound advice. Take, for example, the issue of whether to use silane. Your technician knows to use HF acid only on all-porcelain surfaces. In turn, etched porcelain surfaces are the only ones on which silane is used to increase bond strength. On the other hand, silanization of non-porcelain surfaces, contained internally on certain all-ceramic restorations (aluminum or zirconium oxide copings), can be detrimental to the resin cement-to-porcelain bond resulting in premature failure.

Bottom line? Reduce stress and increase profits!

Are unread journals and articles stacked from your floor to the ceiling? You are not alone. Remember, it is impossible for you to know everything about everything. Meaningful communication and co-diagnosis with your dental technician early in the treatment planning process before preparations begin can dramatically reduce your stress and increase profits. This will be a definite win-win for both you and your laboratory partner. We need to reach out to others on our professional team instead of isolating our practices. There is no better time to practice dentistry than now. We have the materials and collective knowledge to make huge differences in our patients' lives. We need to tap into others' knowledge.

The next time that you call your dental technician, set up a time to discuss your next case. Or, maybe see the latest dental materials and discuss indications and preparations that could help you achieve the best aesthetic and functional results. When you get there, do what it took me too long in my career to learn. (Better late than never.) Pull up a chair, relax, sit a while, and be ready to listen to the technician. You will be amazed at how much wealth there is to gain from a better working relationship and a strong professional friendship with your dental technician.

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