Teamwork starts before the actual treatment

Most dental technicians know a great deal about the various restorative materials available and their suitability for specific clinical situations. Leverage this knowledge by involving your partner early—ideally before tooth preparation. This is most important for complex restorations but also relevant when a single tooth needs to be restored. The restorative material and restoration design (monolithic, cutback, framework) have an impact on the space required and hence on the amount of tooth structure that needs to be removed. Aiming to achieve the least invasive treatment possible, it is essential that tooth preparation is limited to the necessary minimum.

The better the records, the better the fit of the definitive restoration

Dental practitioners are often confronted with challenges in taking records of the initial situation and the situation after tooth preparation. Limited mouth opening, a lack of time or difficult moisture conditions are only some of the numerous factors that might prevent a clinician from taking a precise impression and bite registration. Nevertheless, it is decisive for the work in the dental laboratory to receive accurate records with all the necessary details, such as the preparation margin. Understanding what exactly a dental technician needs in order to deliver a precisely fitting restoration will surely have a positive impact on the motivation to take the records correctly from the start, regardless of the challenges.

For the dental technician, personally seeing the patient provides valuable additional information on the patient’s facial characteristics, the status and appearance of the teeth and the internal colour structure of the teeth. These details can support the dental technician optimally in producing true-to-life dental restorations.

Structured feedback from try-in facilitates targeted adjustments

Whenever try-in reveals that adjustments are required, well-structured feedback is important. It helps the dental technician modify the restorations exactly as desired, thereby avoiding additional appointments and wasting time in the practice and laboratory. 

Placement recommendations support long-term success

Many factors have an impact on how to pretreat and cement an indirect restoration, including the type of restorative material, flexural strength and restoration geometry. While (self-)adhesive luting is usually the preferred placement method for highly aesthetic restorations, restorations produced from high-translucency zirconia need to be treated differently from those made of lithium disilicate. Knowing the details about the restorative material selected, the dental technician should inform the practitioner about the measures to be taken in the dental practice.

Standardising the flow of information

There are many possible ways to standardise the flow of information between the dental practice and laboratory. Depending on the individual preferences and established workflows, a personal or digital approach may be selected. Those preferring a personal approach will possibly want to develop paper forms for some steps and rely on in-person interaction for others. The digital approach uses a combination of digital imaging technologies, case management software and communication platforms to exchange relevant information.

A personal approach
At the Laboratorio odontotecnico Castellano in Bologna in Italy, Vincenzo Castellano and his team pursue the approach of personally seeing almost every patient prior to treatment planning. The laboratory technicians’ opinion is determinant of the treatment plan to be developed. Their partner practitioners value their expertise in restorative materials and digital technologies, which are evolving very quickly. The team is able to advise on which material to choose in a specific situation to best manage the expectations of the patient and the functional needs of the case. “Determining the restorative material in this early phase is very important, as its mechanical parameters (minimum wall thickness, etc.) have an impact on the preparation design and depth. In fact, patients are always happy if they are able to meet the dental technician producing their restorations and, although already well informed by their dentist and the internet, often seize the opportunity to gather additional information about their planned treatment,” Castellano stated.

Also, during subsequent appointments, such as try-in, the dental technician responsible is present to evaluate the situation and gather feedback from the patient directly. In Castellano’s laboratory, online meetings conducted with patients substitute in-person meetings only when this is the only way to enable personal interaction because, in his opinion, in-person meetings always deliver more of the details important for a great outcome. He said: “The most important approach to the patient is the human one. When using advanced digital technologies, we risk standardising protocols to the extent that we forget that there is an individual in front of us, with his or her own unique characteristics and wishes, entrusting us with his or her most precious asset: his or her smile.”

A digital approach
A perfect example of a laboratory with a purely digital approach is DentLab, a Turkish dental laboratory founded in 2015 by Dentgroup, Turkey’s largest dental support organisation. Its founder, Dr Efe Çelebi, and his team have developed a special laboratory module for the group’s own practice management software, DentSoft. The module allows dental professionals to submit their orders by using online forms and uploading digital image data such as radiographs, intra-oral scans, face scans and photographs. Users are able to see at a glance what data and information are required. If desired, a user even receives procedural guidance, and specific devices, such as intra-oral scanners, as well as procedures and materials are recommended.

Once an order has been submitted, the software sends a delivery date notification so that the next appointment can be scheduled right away. The incoming order is then checked. If some details are missing, the dental practice is contacted via a chat function in the software. Orders with incomplete or inaccurate data are rejected. A feedback function allows the dental technician to specify what needs to be repeated, improved or modified. Once accepted, the ordered items are produced and shipped to the practice in a trackable box, which also contains pretreatment and cementation recommendations. Whenever necessary, patient feedback at try-in can be recorded on video or discussed in a virtual meeting. “Digitalisation has made physical distance irrelevant, and we are able to deliver high-quality restorations even if the patient is hundreds of miles away,” said Dr Çelebi. To facilitate improvement in DentLab’s work, the software has a case evaluation function that allows dental practitioners to evaluate the fit, function and look of every restoration.

Information important for material selection and treatment planning includes:

• Clinical findings
• Position of the required restoration in the mouth
• Whether the first restoration or a restoration replacement
• Whether the abutment is a natural tooth or an implant
• Level of decay or destruction
• Level of discoloration or the colour of the abutment
• Material sensitivity, the patient’s allergy history

Information important for production of the restoration includes:

• Impression
• Bite records
• Facebow records or functional analysis for complex restorations
• Intra-oral images
• Extra-oral images (aesthetic zone)
• Tooth shade information

Information important for targeted adjustments after try-in includes:

• Shade
• Shape, contour and morphology
• Proportions
• Pink and white aesthetics
• Facial appearance, lips and teeth
• Phonation and mastication

Information important for the cementation of the restoration includes:

• Type of restorative material used
• Whether the restoration has been pretreated in the dental laboratory
• Recommended pretreatment in the dental practice (sandblasting or hydrofluoric acid etching, as well as time)
• Recommended cementation procedure or cementation system
• Required cleaning measures after try-in

Conclusion

By establishing a well-structured, standardised and bidirectional flow of information between the dental practice and laboratory, it is possible to improve the overall quality of prosthodontic treatments. It can be implemented with the aid of existing workflow management software or set up according to individual demands using paper forms and in-person meetings.

Sitting down together to discuss the topic of communication in an in-person or virtual meeting has additional advantages. It will help everyone involved develop a better understanding of the procedures carried out and challenges faced by their respective partner in the busy work environment. With this knowledge, it becomes easier to build a strong relationship, as mutual feedback and advice help develop shared strategies for improvement. The result will be better streamlined work processes with less stress, higher-quality outcomes and happier patients.

Acknowledgements

Kuraray Europe would like to express our gratitude to Vincenzo Castellano and Dr Efe Çelebi for sharing their individual approaches and the thinking behind them.