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Opening doors of communication
Dentist/Lab communications Part 1 Part 2 You and the lab technicians you work with appear to be taking advantage of technology to assist in the fine art of communication. This survey report indicates just how important communication is when it comes to creating the best restorations. By Stan Goff In a perfect world, dentists and lab technicians would all work together in the same building to optimize communication, or at least make sure the technician gets a face-to-face with the patient. But with today’s technology—including digital photography, the Internet and digital shade-taking devices—the quality of communication between dentist and technician can equal—in fact, surpass—what’s possible live and in person.
Laboratories, believes using a shade-matching device like the Vident Easyshade (Vident, www.vident.com) along with some nice digital photos can actually better prepare technicians to create beautiful crowns.
According to the numbers from recent separate DPR and Dental Lab Products (DPR’s sister publication for lab owners and managers) surveys (see “DPR exclusive surveys,” left) sent to GPs and labs, both groups surely are taking advantage of technology to help communicate clearly with one another. In Part 1 of this 2-part survey report, we take a look at how digital photography, shade-matching systems and the Internet have helped change the way you communicate with labs. Part 2 next month will cover topics such as digital impression taking, continuing education and what the future may bring in terms of labs and doctors working hand-in-hand to ensure the most esthetic and function restorations possible. Not surprisingly, most of the respondents continue to use tried-and-true communication tools: shade guides (96%), study models (nine in 10) and shade tabs (more than two-thirds) (see “Shade guides at top of tool list,” page 44). Additionally, more than half are using direct technician contact with the patient (57%) and digital photographs (56%). Dr. DiTolla, however, is a little disappointed that just 11% of our readers have gone to a computerized shade analysis system. It is critical for labs such as Glidewell (www.glidewell-lab.com) that work with client-dentists from all over the country to be able to provide technicians with shade-matching information, and that includes photographs of the adjacent teeth. “That’s where the challenge is for dentists to communicate with their laboratory,” he said, noting that Glidewell is an exclusively mail-order lab. “And technology has actually made this a lot easier. For example, one of my
favorite products—and you can’t really call it ‘new’ anymore because it’s been out for a couple of years—is the Easyshade from Vident. To be able to take this little ‘gun’ and set it on the tooth and pull the ‘trigger’ and have it give me the correct shade every time is pretty amazing. And you calibrate it every time. You get ready to use it and you can always put it on a shade tab and verify that it is in fact giving you the correct shade. “Dentists worry a lot about shades and whether they’re selecting the right one. It’s surprising to me that a dentist won’t spend $4,000 once to ensure that they always take the shade correctly by using this machine. And the adaptation of this technology has been embarrassingly slow by dentists. Of course, there’s more to the process than that, but computerized shade matching is a good first step to make sure you get the shade correct.” Digital photography Fifteen percent of our readers use film-based photographs to communicate with their lab(s), but the shift has gone to digital (56%) for a number of reasons including speed, e-mail capabilities and eliminating the need to purchase film. Dr. DiTolla adds that taking these digital images is something that staff members can easily master and manage, allowing the dentist more time to concentrate on patient care. “The second big technology — with the first being the shade-taking technology — is digital photography,” he said. “To call it new is ironic because most dentists own a digital camera for recreational use. “Digital photography is just as simple in the dental operatory as it is on the soccer field or the hockey rink or wherever else it might be. And it is certainly something that could be delegated to auxiliaries.”
While a fairly easy task to master, Dr. DiTolla noted that digital photography is the topic of courses at most major dental meetings. “What you need to do as a dentist is take a picture of the tooth before you start working on it; then you take a picture of the adjacent tooth with shade tabs in place,” he explained. “So you use the shade-matching device on the tooth next to the one you’re preparing and it tells you what shade it is. Then you take the appropriate shade tab, hold it next to the adjacent tooth, and take a picture with that shade tab in place. This allows the laboratory technician to see the comparison between those two. It’s also sometimes helpful to take a picture of the temporary in place. There’s no such thing as e-mailing too many digital photographs to a laboratory.” “As recently as 10 years ago, there was a reasonable excuse for not doing this,” Dr. DiTolla said. “Back then, the problem was to do it you had to shoot slide film, or prints, wait for them to be developed, and hold onto the case for a couple days while it was developed. When you got the photos back, you put them in the case and sent it along. It really slowed everything down and was difficult to keep track of. Standard photography back then was the realm of the high-end kind of boutique dentist who was charging premium fees to make sure that all this got done. “Today, it’s as simple as shooting a couple shots, taking out the memory card and sticking it in your computer, and then e-mailing the image to the lab. They get the case in the mail and they match those up. Except for laziness, there’s no excuse today for not using digital photography to help make these crowns look that much better. And it can totally be delegated to auxiliaries. There’s no reason why a dentist should have to take time to do it themselves. The staff enjoys doing it. And you have a much better chance of getting the type of result back from your laboratory than you’d expect.” According to the survey, 21% of the GPs use the Internet to communicate with their labs (see “Using the World Wide Web,” above)—and of those, 95% are sending digital photographs and 31% send e-mail notifications on the progress of cases. Additionally, when we surveyed lab owners, we learned that 95% of them are satisfied with the overall quality of information dentists provide for crowns and bridges, and 94% report being satisfied with their dentist-clients’ ability to provide a good impression. Choosing a lab When we asked our readers to indicate what criteria are important to them when choosing a lab, quality of work (92%) topped the list, and good communication (51%) was next (see “What you want in a lab,” page 46). Other key factors included fee schedule (41%), reputation (34%) and turnaround time (21%). According to Dr. DiTolla, consistently providing good results is something that dentists desire from their labs. “I guess if I had to make a list like that (and I’m not sure whether the dentist meant the same thing by quality), for me it’s consistency, or predictability,” he said. “To me there’s nothing more critical. Most of the dentists I talk to agree that you want things to be predictable. You want to know that if you prepare this tooth, take an impression and send it to this laboratory, you know what you’re going to get back and you know how it’s going to look. Now, depending on how much you pay per unit, it may look different. You know if you’re paying a lab fee of $500 per crown, you have much higher expectations than if you’re paying $80 per crown. “But if you’re in an area where the $80 crown is the one that people are more willing to pay for, at least you know what you’re going to get every time, and it’s that consistency which is really important. It’s funny...as much as dentists talk about communication with us labs, we do try to communicate with our dentists a lot. We will call dentists and tell them, ‘You took an impression here and we’re looking at the margins, and we’re having a difficult time seeing where the margins are all the way around the tooth. You should probably take another impression.’ Surprisingly, a lot of dentists will reply, ‘You know what, I tried as best as I could. Do your best with it and see what you guys can do.’”
When it comes to choosing a lab for the first time, most of you rely on a dentist colleague’s recommendation (84%), while almost six out of 10 are influenced by samples of the lab’s work (58%). Almost two-thirds of the responding GPs have not changed labs in the last two years. Of those who have changed, top factors include inconsistent quality (74%), failure to meet technical needs (53%), and fees that were too high 40%). But close to one-third also noted they changed because of prescriptions not being properly followed (35%), or due to poor communication (32%).
• In the survey to dental lab owners, we learned that 77% of the labs recommend specific preparation guidelines and techniques to their dentists, and 57% recommend specific products for clinical use. Also, 10% of labs employ the services of a dentist to facilitate communications. • Twenty percent of the GPs maintain an in-office laboratory, and of those who do not, the largest single group (38%) uses three outside labs (see “Labs in, outside the practice,” top left.) • More than three-fourths of the responding lab owners/managers recommend specific preparation guidelines and techniques to their dentist/clients (see “Advice for your dentist/clients,” at left), while 57% offer advice on specific products for clinical uses. Stan Goff is a senior editor for Dental Products Report. He can be reached at 847-716-8139 or via e-mail at sgoff@advanstar.com.
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