A perfect lab for an imperfect dentist

The reality of being a cosmetic dentist is that even if you know exactly what patients want, prepare teeth flawlessly, and write the most lucid laboratory instructions - the world sees none of it.

The reality of being a cosmetic dentist is that even if you know exactly what patients want, prepare teeth flawlessly, and write the most lucid laboratory instructions - the world sees none of it. What the world sees are final restorations, yet these are fabricated in the lab. High-quality laboratory results are the best marketing tool for your cosmetic practice.

Since labs vary a great deal in the quality of their work, selection of a lab can make or break a dentist. Top laboratories are equipped with the most skilled and experienced technicians, who use the most effective techniques and best materials. They are very helpful, especially with my specialty, ceramic restorations.

Basically, there are three techniques for fabricating and coloring restorations. With one technique, ceramicists use feldspathic porcelain powder to essentially paint layers onto a model, then bake the model after each layer. Technicians create subtleties of color by using different colored porcelains at different stages. In a second technique, ceramicists press out a uniformly colored ingot of lucite-based porcelain, then technicians alter the color by staining. My preference, however, is a hybrid strategy perfected by MicroDental Laboratory. Technicians start with a pressed ceramic ingot, then cut it back and layer on various shades of feldspathic porcelain to create a bright and natural smile. This strategy combines advantages of the other two techniques. The ingot is stronger, longer lasting, less abrasive, tighter fitting, and retains its shade better than traditional feldspathic restorations. The cut back-layering technique allows for subtleties of color that cannot be obtained by mere staining. So, I strongly recommend that dentists find a lab that specializes in this hybrid technique.

This brings me to the issues of skill and experience. Although the hybrid technique can produce beautiful restorations, it is a complex and subtle form of artistry that can take years to master. Ceramicists use from eight to 16 shades of porcelain to create a wide range of optical properties. They mix and apply these shades differently to create the various-colored smiles that patients want (e.g., a Chiclet white, a darker, aged tone, etc.). The dentist may ask that the color break in thirds from the incisal edge to the margin, or gradually change colors horizontally from the middle to the edge. Ceramicists also must know how to combine contour with color to create subtle qualities such as masculine, feminine, cheerful, serious, gentle, or dignified. Good labs use comprehensive color and characterization guides, but it takes a hard-earned skill to apply these successfully in individual cases.

Since quality can vary so much, dentists should make an extra effort to determine that a lab’s ceramicists have the right skills and experience. Ask about both internal training and external education at respected institutions. Each should be significant and ongoing. Ask about years on the job, mentorship and supervision of newer technicians, and the communication among technicians. Ceramicists learn much from each other. Also, determine what kind of work the lab specializes in, and how many cases it sees. For example, it’s crucial to me that my lab have multiple, mutually supportive technicians who work solely on ceramic restorations, and who have encountered and solved virtually every possible problem.

We can learn much from the technicians themselves. After all, technicians work on more restorations in a month than we do in years. Technicians understand how dentists can help them to produce the restorations that patients envision. So, in addition to assessing lab expertise, determine whether technicians are willing and able to share their knowledge, and whether lab policy facilitates mutual feedback. The technicians at my lab work in small teams with a team leader. Thus, they have the efficiency and resources of a large lab, but can provide personalized care. I interact with the same team virtually every day; they know my preferences. I learn an immense amount from them.

In general, ask yourself whether a lab can function as a partner that elevates your dentistry and grows your practice. Does the lab offer excellent diagnostic waxups to help sell your patients, fabricate beautiful temporaries, and tweak cases to produce near-perfect final results? Does the lab provide regular, over-the-shoulder courses with lead technicians and/or expert dentists? Does the lab keep you informed about the latest innovations in materials and techniques? The right lab can be the best resource for any dentist, helping you produce beautiful smiles every time.

Dr. Christopher Pescatore lectures worldwide on topics such as state-of-the-art esthetic procedures, techniques, and materials. He holds a U.S. patent for a nonmetallic post system to restore endodontically treated teeth. He is the former clinical co-director and current featured speaker at the Las Vegas Institute for Advanced Dental Studies. He has a full-time practice in Danville, Calif., dedicated exclusively to esthetic dentistry. Contact him at (925) 362-9330, or at chrisdmd@aol.com.

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