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Why is my lab not giving me what I am asking for?

Hi. My name is Dr. Leonard Hess. I'm a senior faculty member at The Dawson Academy, and I'd like to spend a few minutes with you today discussing some of the frustrations that we experience as restorative dentists when it comes to communicating with our dental laboratory. And more specifically let's focus in on the frustrations that we experience when we feel like we're not getting back what we wanted from the dental laboratory.

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Take Responsibility

I'll be honest with you. A lot of times as a restorative dentist when I felt frustrated in such as fashion, as I look back in time, I think that the problem has typically been with me. And typically I think a lot of dentists, as we're going through this process and as we start to encounter larger restorative cases and we start to tackle these cases within our practice, we have to realize that our responsibility to communicate with the dental laboratory actually needs to increase. If we can increase our communication with them, then we're going to be supporting the laboratory technician to give us back what it is that we desire.

Take Great Records

The communication for this starts with photography, making sure that we're taking our 21 diagnostic photographs, the same ones that we teach you in our Comprehensive Exam and Records course. Now, as you start to get into the restorative phase as well, it's helpful to include your laboratory technician in the two-dimensional and three-dimensional treatment planning phase as well. Whether or not you do the diagnostic wax-up or if your laboratory technician does the diagnostic wax-up, there needs to be a verification of this communication to make sure that it's acceptable for what it is that you need for the patient.

Perfect the Provisional Phase

Once this information is taken into the patient's mouth in the provisional phase of treatment, that's your opportunity now to verify whether or not you've established your functional, phonetic, and esthetic success with the case. And now it's imperative at this point that the restorative dentist will take impressions of the provisionals' facebow-mounted in centric relation on an articulator, and that you also have photographs of the provisionals as well. This needs to be clearly and concisely communicated to the laboratory technician because that is the way that you're going to communicate the three-dimensional tooth position, the anterior guidance, the envelope of function, the contours of the maxillary anterior teeth. That will allow them to create custom incisal guide table, and also allow them to create stents to duplicate the position of the incisal ledges and that lingual anatomy.

Verify the Final Restorations

Once they have that, they can transfer what you did in plastic, and put that now into porcelain. I think if you follow these steps, and if you can verify from what your technician gives you back off of these custom incisal guide tables and the stents that were created, that will allow you to also verify that things were done correctly. I think that you're going to find that your restorative results are going to become much more predictable, and you're going to have a lot better relationship with your laboratory technician. Thanks a lot.

Confessions of a Dental Lab Tech 

Picture of Dr. Leonard Hess

Leonard A. Hess, DDS is the Clinical Director at The Dawson Academy and joined the faculty in 2009. He owns Union County Center for Comprehensive Dentistry in Charlotte, North Carolina, and practices full time in addition to teaching continuing education courses. He is a member of the editorial board for Inside Dentistry and has had over 17 articles published in peer-reviewed journals. He is also a member of the American Academy of Restorative Dentistry, AACD, ADA, AES, and NCDS. Dr. Hess began teaching continuing education courses in 2005 on topics including occlusion, smile design, treatment planning, preparation design, and practice integration of Complete Care Dentistry. He’s taught full-day continuing education courses at the American Academy of Cosmetic Dentistry’s national meeting, The Greater New York Dental Meeting, AACD National Meeting, Pacific Dental Conference, Ontario Dental Association meeting, and The Yankee Dental Conference. Dr. Hess has taught courses in Japan, Germany, Poland, China, and Canada.