• Bad bites in cases with many prepared teeth. there are no study models or images for anterior crowns. • Unreasonable expectations with low-quality impressions, preparations for work. Rush cases with high quality expectations.
• New favorite: The doctor sends a digital case with margins marked by someone in his office. Then they send the case back saying, “Margins marked wrong, remake free of charge!”
• When a digital case is sent and the margins are not marked and they expect you to mark their incredibly terrible preparation and scanning!
• For the love of God, why can’t I scan with the right bite?!
• Suggestion for documents: Bite before numbing the patient while sitting
• One of my favorites are free-end bridges impressed with triple quarter discs or only quarter sweeps—no bite!
• Getting all the information about the lab script is always a plus
• Try to prepare the chewing more! Thin restorations fail. So you don’t use those cracked tin trays that bend.
• Never forget your bites and smile line! Remove a small amount of extra in the margins when preparing.
• Another challenge is accurate bite registrations or accurate mud/distortion free models that include accurate reference points and enough teeth to allow accurate articulation. Many times, the model will be accurate in the preparation area but less focus and attention is paid to the distal portion of the posterior teeth. This can have a detrimental effect if it distorts the bite relationship.
• Adequate occlusal space is probably one of the most common challenges we face every day, followed by hard-to-read margins
• Input path or design problems with bridges that occasionally require communication to resolve the problem.
• Proximal walls of adjacent teeth that occasionally lean toward the preparation may make it difficult to establish a good proximal contact due to the insertion path.
• Hardware selection has become much more difficult due to the many options available. It is helpful to communicate to know what end results are desired. This helps with material selection! If you are not sure, give the lab parameters to make the choice.
• Web Retrieval!!!
• Having an exact copy of old dentures so expectations for the final prosthesis are clear.
• Get minimal distance and expect no-load recovery after grinding on a crown that was already minimally thick
• Doctors take a midline on a biting lip when the patient is not directly in front of them—they do it sideways in the chair and then try to mark it. usually results in a bad mark and possibly a reset.
• Take a shade BEFORE preparing the teeth. During any clinical procedures, the teeth are dehydrated and this can dramatically change the shade.
• There is not enough space in the bite to make an emergency flap that will last more than a week.
• Assuming teeth can be added to a partial all the time
• When evaluating your impression, be sure to fully impression all teeth/all surfaces of the preparation.
• I have seen individual centrals that only took 1/3 of the intersection of the adjacent/remaining teeth. It is difficult to evaluate the texture, appearance profiles, etc. Same with rears — this seriously affects the occlusion.
• Use adequate impression material. some cases may require a custom disc.
• The preparation or impression is inadequate. It’s hard to get a group of doctors to nail both of them inconsistently.
• If you are doing an extraction in your office, find out what an anterior maxillary alveolar is and do it. Also, identify your patient’s skeletal category with dentition and don’t ask your lab to change it…that sets you both up for failure.
• We need enough space for material thickness and strength. 1 mm always.
• With modern materials, we need better margin from the knife edge and no sharp corners in preparation—slightly break those sharp edges! The preparation should look like a tooth, but smaller—the molars are not flat occlusally…we need room for a central fossa, maybe a tooth, and a nice incisal-gingival facial curve. Pretty simple basic concepts.
• Make sure your patient does not bite into the tray while taking the final impression! This leaves traction and distortion, which make the final restoration unpredictable.
• Consider the manufacturer’s recommendations and hardware limitations.
• Making a side or edge with a quarter impression and have no idea what the other side looks like, then sending the case back because it didn’t match the shape/size of the opposite.
• Incomplete dot information—ie, sex, age, shade, date, guidelines, stages, smile, canine lines, rims cut to determine incisor length, teeth removed from rebite tests.
• I would estimate that about 50% of our Rx’s are missing something: shade, photos, date, implant size, etc. Our doctors are awesome, but it’s so much extra work.
Communication challenges
Understanding each other, concerns with mutual respect and time…
• Poor case design
• You must talk to the assistant, not the doctor
• Hasty affairs with unrealistic expectations
• They are waiting for the dentist to order implant components, but still want the case in time
• Lack of mutual respect
• Physicians do not understand digital workflow or the importance of integrating it
• Contact!
• I like it when an office calls and schedules ahead of time so we have plenty of time to get it right. Hard to rush perfection!
• Accountability (or lack thereof)
• Tech talk with a dentist who does quadruple impressions with bridges: “He said he’s been practicing dentistry for 26 years and knows what he’s doing… I said okay, fine, but I charge for remakes where I’ve warned you about something.”
• A challenge is when the dentist sends a case to the lab that requires communication, has a due date, but the doctor is too busy to take a phone call or respond quickly, which increases the pressure of the case’s time requirements. I appreciate being able to text/email and photos to contact the dentist directly—IF there is a quick response!
• Losing the pride of good craftsmanship when competing with larger labs—get a small lab with some heart.
• Bringing back a case from two years ago and asking for a free remake with no explanation!
• COMMUNICATE! Dentists also love feedback on their skills!
• Contact our lab (this goes both ways), take us to your CE with you.
• Pay your bill by credit card on the first of the month.
• To be a successful dentist, you need to consider your lab a part of the team… ask for their input, especially on treatment planning.
• If your office staff calls you to schedule “x” and “x” is a same day procedure (simple hard reset/repair), don’t get upset with us when we have to call and tell you that “x” is really “xyz” and it will take a few days. Make sure your staff is ready for what we’re going to do so we can give you an accurate turnaround time. Your lack of information and planning is not an emergency on my part.
• Timely payments = respect for me (don’t put me last on the list)
• Be kind to the local labs and send them some of the difficult cases, not just the overseas labs.
• When we call the doctor for a new impression and get the answer, “Difficult patient, do your best.” We always do our best but we are not magicians.
• Stop rushing cases, don’t try to negotiate lab fees and pay when a technician comes to consult a patient.
Well, here it is. Unfiltered, uncensored and straight from the mouths of our teammates. Honestly, I’ve been guilty of many of these things over the past 14 years, but I’ve come to realize that ultimately, the buck stops with me. I know what’s good, what’s not, and I can’t blame the lab when the bug is clearly on my doorstep. I would also like to argue that lab techs as a whole really respect their doctors and want them to succeed! When we succeed, they succeed! They get a lot of amazing cases and good quality stuff from us, but there’s always room for improvement.
I’ll leave you with one last comment from a lab technician that really struck a chord with me – it’s true in many ways. The gratitude continues…
Calling the lab when they have done a good job and not just with problems. Dentists need to realize that lab technicians are an important part of the dental team – we depend on each other to be successful in this business. We all want to do great work and improve where we are weak. I agree, communication is key. We usually do not get to see the patients and rarely know if a case has gone well after we have sent it with prayer.
