Posted on 04-27-10

What The Dental Technician Needs From The Dentist To Provide A Quality Restoration

• Tooth Reduction (Negative Space) – Once the type of restoration and material to be used is decided by the dentist, sufficient tooth reduction is required for the laboratory technician to create an aesthetic, properly contoured dental restoration. Many dentists learn a specific way to prepare teeth and think that preparation design will work for all materials. This is simply not true! Methodical depth-cutting with known instrument diameters is essential for creating sufficient tooth reduction. Two-plane facial reduction of anterior and posterior teeth is required to avoid overcontoured restorations. Adequate posterior occlusal reduction (1.5 to 2.0 millimeters) following cuspal inclinations and creating depth in the central groove area, and 1.0 to 1.5 millimeters of incisal reduction of anterior teeth, will ensure that the restorative material in these functional areas is adequate to support the stress of mastication.
• Master Impressions – Most dental technicians will agree that too many impressions they receive for restoration fabrication are substandard. The goal of a final impression is not to capture only the restorative margin, but the root surface .5 millimeters apical to the margin. For an intracrevicular margin, a two-cord technique is very predictable and accurate. A smaller diameter cord is first placed in the sulcus, followed by a larger diameter cord. The large cord is removed, and the smaller cord remains as the light body is syringed into the gingival sulcus. The goal of the larger cord is to create “a moat around the castle.” There is no need use an air syringe, or hope the heavy body will displace the soft tissue adequately. Also, do not take the “Let’s pour it up and see what we got” approach. If there is not a “ring around the collar,” take another impression!
• Bite Registration And Facebow – Facebows align the incisal plane in reference to the cranial base. Without them, the laboratory technician can only align the incisal plane parallel to the bench top. An accurate interocclusal record in centric relation is essential to relate the upper and lower casts accurately.
• Shade Information – Digital photography and computerized shade-matching systems have elevated the ability of the dentist to communicate shade to the dental laboratory. Value is more important than hue when matching natural teeth, since many of the natural teeth in a single patient may vary in hue and chromatic intensity.

Selection Of Dental Laboratories: Some Points To Consider

• Big Labs Versus Small Labs – Small dental laboratories can provide consistent quality, since the same dental technician will do all of the work. In the days when gold was the most widely used indirect material, many dental offices had a “gold technician,” or the dentist may have done much of the work himself. As porcelain technology has become more advanced, the smaller laboratories often lack the financial resources to invest in all of the latest restorative systems. Therefore, the dentist’s restorative selections are extremely limited. For most, this would be gold inlays or onlays, or gold and porcelain-to-metal crowns. In this aesthetic-conscious society, most patients do not want gold showing on their teeth. More teeth are probably receiving crowns than need be, particularly if the dentist’s materials choices are limited.

Larger commercial laboratories’ biggest advantage is the variety of restorative systems that they have available to the dentist. With the number of systems and different types of dental restorations that are now available, many of the larger labs can meet the needs of the most discriminating dentist. Some of these labs also offer high-end aesthetic ceramics within a separate department of the porcelain lab for the demanding aesthetic patient. The different departments, such as removable, frameworks, implants, processed composite, and porcelain allow dental technicians to be more highly specialized in a particular area, as several people may be instrumental in the completion of any given case. The challenge internally is to bring it all together to deliver consistent quality restorations.

• Multiple Technicians or Laboratories – Just as one artist may always tend to draw in the same style, the same is true for the dental ceramist. Patients are more conscious of how they want their teeth to look than ever before. Therefore, one style may not satisfy all patients. For aesthetic cases, some patients want textured labial surfaces, some want flat and smooth surfaces. Some patients like incisal translucency, some don’t. Some patients like accentuated line angles and tooth anatomy, some like a softer look. It may be necessary to work with a few different laboratories, or dental technicians within a laboratory, to meet all of these needs. Remember, that’s okay. Many dentists are limited in what they can offer a patient because they feel they need to work with only one technician.

Quality Dentistry Requires A Quality Team

Both the dentist and the dental technician depend on each other to provide the best for the patient. When each side does the best they can do, the patient will ultimately benefit. Excellent laboratory support is an essential ingredient in supplying the best dentistry has to offer, both aesthetically and functionally. Don’t sell yourself short—choose excellent teammates, and provide them with what they need to do an excellent job for you. Your practice life will be much happier!