Tradus Licenta Td

7/31/2019 Tradus Licenta Td

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The objectives of using a denture to treat a defect are preservation of remaining tissue and

improvement in the functional recovery rate. Close cooperation between dentist and dental

technician and a shared understanding of fundamental knowledge and technology, fromdenture design to production, are indispensable in order to successfully achieve a

combination of these objectives. Furthermore, accurate communication from dentist to

dental technician of all patient information gained from the preoperative examination andnecessary for production of the prosthesis is essential for a successful treatment outcome.

This information should be shared by both the dentist and the dental technician. It is

extremely important to describe this information appropriately and to append otherinformation as needed in order to convey this information from the dentist to the dental

technician by means of a dental technician specification. While this exchange of opinions

by means of accompanying materials is of course useful in the denture production process,

these materials are also valuable for re-evaluating the design of the prosthesis and handlingby the technician in case a problem related to preservation of remaining tissue or

improvement in the functional recovery rate arises during a subsequent visit by the patient.

It is important for the dentist and the dental technician to consider the following six factors

using the same criteria when treating a patient using a removable partial denture: (1)minimization of denture movement, (2) occlusion, (3) reduction of burden on the abutment,

(4) consideration of periodontal tissue, (5) consideration of sensation, and (6) aestheticconsiderations. To that end, the authors have found clinical application of a "design chart"

to be useful.

As for the team communication between clinical and technological sides in the denture

treatment,a smooth cooperative teamwork must be established in its target treatmentthrough individual adequate recognitions concerning the main points of sequential

procedures from examination, diagnosis, therapeutic designing, impression taking and biteregistration and then setting performed by a dentist on the clinical side as well asconcerning the main points of technical procedures indirectly performed by a dental

technician on the technological side in order to achieve the most improved preservation of

remained tissues with an increased rate of functional restoration, being the final target oftreatment. At present when an ultra-aged society is coming, the demand of denture

treatment has been enhanced more and more. In response to the enhanced patient's demand,

various modes of denture treatment have been introduced and the dental technology has

advanced remarkably. In particular, a technical procedure by means of partial parallelmilling representative of rigid support or of Konuskronen requires very complicated

working processes. In addition, the elasticity is also required including such an occlusal

construction as being harmonious with the jaw function or such tooth crown morphology asbeing prepared in consideration of periodontal tissues together with a lot of information

from the clinical side required as well in the denture treatment. In this study, therefore, the

dental technical procedures presently performed by referring to varied individualinformation are newly arranged and summarized so as that these complicated technical

processes and working steps could be performed more easily and accurately.


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The successful restoration of large esthetic and reconstructive cases largely depends upon a

set of exacting study models, impressions, bites, photographs and explicit instructions.

Each has its part to play during the process. The dentist is the architect on these cases andthe laboratory is the dental contractor. Without the right set of dental blueprints these

cases cannot be completed to everyones satisfaction. Without any one of these pieces of

information these challenging cases can become more complicated than necessary and theresults might be less than expected.

It is a given that the bite must be correct before any master impressions are taken and isprobably the most challenging registration provided by the dentist. Bite registrations are

achieved in various manners using TENsing, swallow bites, functional bites, K7

Instrumentation bites (e.g. Chan Scans) and then finally stabilizing the jaw position using a

removable and/or a fixed orthotic to determine esthetics and functional occlusion.

In the lab we must assume that the bites we receive are accurate unless a tell-tale sign

alerts us to a possible bite problem in which case the doctor is consulted.

The following is a list of Lab Needs that you, the dental Architect, must provide foroptimum success.

DIAGNOSTIC APPOINTMENT

1.) Provide full arch pre-operative study models capturing peripheral borders, retro-molar

pads and hamular notches. Anatomic landmarks are often referenced for mounting, plane ofocclusion and tooth position.

2.) Provide full face (no lip retraction) photographs showing the relationship of the upper

incisal edges to the lower lip line. Capture the patients entire head from slightly above thehair to slightly below the chin. This pose allows us to determine an accurate midline, the

long axis and middle of the face, and the horizontal plane of the anterior.

3.) Fox Plane Occlusal Registration (suggested) or a Facebow registration to determine a

anatomically correct maxillary cast orientation.*

4.) Accurate, verified bite. Indicate if the bite registration is a Neuromuscular bite, Centric

Relation bite or a Centric Occlusion bite registration.

5.) Provide the lab Rx describing the desired anterior incisal edge length, A-P position,shape of teeth (smile guide photos are helpful), indicate if Golden Proportion should be

used and any other pertinent information regarding the patient's particular needs to achieve

the desired result.

PREPARATION APPOINTMENT

1.) Provide accurate upper and lower full arch current condition impressions or study

models of the patients final adjusted (patient/doctor approved) provisionals. Do not send

the original diagnostic wax-up model since any adjustments to the provisionals made from

the diagnostic wax-up will make the wax-up model inaccurate for cross mounting. 2.)


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Provide an accurate full arch opposing impression or model. The same care should be taken

to provide opposing models as is taken for master models, as final laboratory porcelain

equilibration will be completed against the opposing model.

3.) Provide a full, face forward, natural smile color photograph (no lip retraction) showing

the relationship of the upper provisionalized incisal edges to the lower lip line. Capture thepatients entire head from slightly above the hair to slightly below the chin. This photos

allows us to see the midline, the long axis and middle of the face and the horizontal plane

of the anterior teeth.

4.) Shade: close-up photograph of an open lip-retracted mouth holding the selected shade

tabs next to the incisal edge of the natural tooth. Please include any written shade-mapping

instructions.

5.) Stump shade tab for all ceramic restorations should be recorded.

6.) Fox Plane or face bow registration.

7.) Send lab Rx with information on type of restoration (alloy type, all ceramic systemdesired, etc.) indicate bridge or singles, and any esthetic and functional information

necessary (it is critical to indicate any changes needed to the study model in order to

achieve the final desired result).


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Communication between the dentist and dental laboratory has entered a renaissance in

recent years. In the past, the dental laboratory technician was looked upon as a servant of

the dentist rather than as an integral member of the restorative team. Years ago the numberand type of laboratory-fabricated restorations were a mere fraction of those available today.

Staying abreast of new technologies within the dental practice and changes in dental

technology can be a quite a challenge.As a clinician who works for a laboratory I see firsthand the good, the bad, and the ugly of

the doctor/technician relationship. It all boils down to trusttrust that each party will listen

to the others challenges and work together to achieve a common goal. Working together asa team from treatment planning to insertion can eliminate problems by considering both the

clinical and laboratory technology issues. Considering both sides of these issues leads to

one resultpredictable success for the dentist. Predictable success results in reduced chair

time for adjustments at insertion and more chair time available for additional productiveprocedures.

This article will discuss all aspects of the communication process between the dentist and

the laboratory. What are the responsibilities the laboratory has to the prescribing dentist? In

what ways can the laboratory assist the dentist in the treatment planning and treatmentexecution phases? What are the methods of communication available to the dentist? Lastly,

how do you effectively communicate using the laboratory prescription in a clear andconcise manner?

TREATMENT PLANNING AND EXECUTION PHASES

How can the laboratory assist the dentist in the planning and execution phases of

treatment? Working as a team member, the laboratory can assist in several ways.

Communication between the dentist and the patient is critical during the treatmentplanning phase of a large aesthetic case. The patients expectations may not match the

dentists expectations. Further, the patient may have specific ideas about how his or hersmile should look. If the patients concept does not match the fabricated reality, he or shewill become dissatisfied with the end result.

Assistance in the material selection process is a service that a laboratory can provide its

dentists. Often the difference between success and failure with material technologies istheir proper selection for the case circumstances. The dental laboratory is in a prime

position to experience success or failure with the myriad of dental restorative materials and

their use in specific case circumstances. Therefore, the laboratory technician is able to offervaluable input as to material properties and their intraoral applications, limitations, and

techniques for success.

Laboratory-fabricated diagnostic wax-ups are an excellent tool for the treatment planning

phase. They can demonstrate for the dentist and the patient what the laboratory canaccomplish with specific restorative materials. Many contours can be created in wax, but

the specific dimensions required for a given material are an important consideration.

Knowledge of the restorative material combined with the wax-up can guide the amount ofpreparation required to duplicate the result created in wax.

Laboratory-fabricated provisional restorations allow patients to function with their new

teeth for a short period of time. During this time patients can evaluate the aesthetics of theprovisional(s). If the patient dislikes an area, he or she can more effectively communicate


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to the dentist the specific area(s) to modify. A provisional restoration also allows the

dentist to evaluate the patients function and phonetics. This is especially important if there

was significant incisal lengthening or diastema closure. The patient may have wantedlonger teeth but is unable to function in that position due to occlusal interference. It is

better to discover this in the provisional phase than to face a dissatisfied patient after the

final case has been inserted.Laboratory-fabricated prep guides quantify the amount of reduction necessary to achieve

the result that the patient expects. The prep guide is made from the diagnostic wax-up with

a specific material in mind. Without adequate reduction, the case cannot be made to mimicthe diagnostic wax-up. Following the prep guide will allow the dentist to prepare the case

so that the laboratory can duplicate the final restoration as close to the wax-up as possible.

METHODS OF COMMUNICATION

In most circumstances, the technician only has the information contained in the box. If

there is one impression, one opposing model, one bite registration, and a lab prescription,

then the amount of information available from these items is limited.Study models are a helpful tool during all phases of restorative treatment. Incisal edge

position, evidence of parafunction, the original width of the diastemas, and the contour ofthe virgin teeth can all be lost without study models. Properly mounted study models can

confer information that may be missing in the final impression of the prepared teeth.

Diagnostic wax-ups are an excellent communication tool for the dentist to discussproposed treatment with the patient. The diagnostic wax-up allows patients to communicate

to the dentist their likes and dislikes based upon the dimensions of the wax-up. It is much

easier for patients to point to a specific area and ask for it to be narrowed or broadened

versus attempt to describe their concept of how they envision their smile. In the end, adiagnostic wax-up can reduce costly remakes due to miscommunication of size, shape, and

contour.Model(s) of the provisional restoration(s) help guide the laboratory to provide the size,shape, shade, and contours that the dentist has created and the patient has approved. The

models are especially helpful if the patient has worn the provisional restorations for at

least a week. This trial run of their teeth allows patients to comment on the aesthetic andfunctional issues of their provisional restorations. Other than proper treatment planning,

this can be one of the most important financial and time-saving steps of the restorative

phase of treatment. As long as an adequate amount of reduction has been accomplished forthe material selected, there will be no surprises when the final restorations mimic the

provisional restorations.

Photographs can be worth a thousand words. Investing in a good digital camera and a CE

course to learn effective photographic techniques is an invaluable communication tool. Aproperly exposed and clear photograph can yield a wealth of information about contour and

anatomy. It is much easier to follow a photograph for the location of a hypocalcified area

or mame-lon than it is to attempt to draw or describe this area in writing. One thing aphotograph cannot convey at this time is shade. We cannot choose the shade of a

restoration with a single photograph. Other methods can help utilize photography for a

shade match, but at this time, a picture alone cannot convey the shade accurately.


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THE LABORATORY PRESCRIPTION

Aspecific delivery date is extremely important. The term ASAP is too frequently used.

ASAP means as soon as possible for the laboratory. Busy times of the year for dentallaboratories mimic those of dental practice. If you use ASAP as a return date, then you may

have situations when the case is not returned in time to meet your schedule. If yourlaboratory routinely delivers your single-unit PFM crowns within a week, but it is a busy

month for the laboratory, the PFM might be returned in two or two-and-a-half weeks. Thiswill depend on the number of cases in the laboratory that have specific return dates. Your

case will be fabricated when it fits into the schedule along with the cases that have specific

return dates. If you ask for a specific date, and if the laboratory is unable to accommodatethe request, you will be notified of the exact delivery date. In this way your administrative

team will always know exactly when a case is due to be delivered.

Clear handwritingis an important component of the laboratory prescription. Com-municating what is requested for a patients case can be a challenge. However, this

challenge can be compounded when the handwriting cannot be interpreted. The laboratory

should never have to interpret your writing. Remakes can be costly for the dentist and thelaboratory. It can be time-consuming for both parties if the laboratory needs to call the

dentist regularly to interpret his or her handwriting. Many software packages are designed

for the dental practice that have the capability to print the laboratory prescription. You can

save time on your routine cases by printing the prescription because all of the necessaryinformation has been pre-entered into the system in a clear and concise manner. Using

these types of systems can eliminate miscommunications due to penmanship.

It is important not to use nondental terms for reasons similar to those about clearhandwriting. Asking fortoilet bowl design, a redneck face-bow, oruse a dummy (pontic)

can cause a great deal of confusion. We have our own terminology in dentistry and we

must use it correctly so there is no confusion about what the dentist requests from the

laboratory. As in the case of clear handwriting, it can be time-consuming if the laboratorycalls the dentist regularly to interpret his or her own version of dental terminology.

Listing the items that you send with a case can accomplish 2 things: first, it serves as a

reminder for the person packaging the case to include all of the necessary items, andsecond, it serves as a double-check when the laboratory inventories these items when they

are unpacked from the box. In addition, the person at the office and the person at the

laboratory should initial the inventory. In this way we can work together to account for anymissing materials such as an opposing model or bite registration.

Specify the type and design of the restoration. For example, what type of alloy would you

like for your PFM or full cast restoration? The lab technician can choose for you, but if heor she does not know that the patient is allergic to base metals, then the technician might

make the wrong choice. What type of all-ceramic crowns would you like? The lab

technician can choose for you, but if he or she does not know that the tooth was restoredwith a metal post, then the technician might choose a restoration that is translucent, and the

metal will show through the final crown. What about the anatomical design and/or the

design of the embrasures and pontics? Many of these issues can be addressed if your

laboratory has your standard preferences on file. However, if these items are not specified,then the lab is forced to do one of two things: either pull you away from your patients and

ask you what material or design you desire for the case, or assume what you need and


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possibly make the wrong decision.

Create internal check lists for each type of case so that all necessary items are delivered

to the laboratory. Most practices have one person who packages each case for the doctor.However, if that person is busy or out sick, necessary items can be left out of the box.

Posted check lists for each type of case sent to a laboratory take all the guesswork out of

packaging the case for shipment. It also serves as a subtle reminder to include certain itemsfor one type of case and additional items for other types of cases. The laboratory may not

need a face-bow record for a single crown, but it does need one for a large anterior case or

a roundhouse bridge.

SUMMARY

Working as part of your team, your dental laboratory can increase your predictable success

and decrease the stress of daily practice. This partnership should begin during the treatment

planning phase and continue through to the insertion appointment. Many dentists are

beginning to view their laboratory technician as a bonafide member of their patient care

team.Thorough communication on both sides is crucial to reaching this predictable success. A

trusting relationship will enable the dentist and the laboratory technician to communicateeffectively. The laboratory must take the responsibility to communicate its concerns to the

dentist, just as the dentist must take the responsibility to communicate effectively with the

laboratory his or her needs and desires for each case.When effective communication techniques are followed, everyone is a winner. The dentist

is more productive per hour and has reduced stress. The dental laboratory does not have to

bear the burden of remakes, and spends less time on the phone or sending e-mail for

routine cases. And most importantly, the patient receives an exceptional restoration thatmeets his or her expectations.

In the end, the true measure of a great relationship between the dentist and the laboratoryis happy patients who refer friends and family to your practice for years to come.


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In economia actului medical rolul principal este jucat fara indoiala de catre medic. Dar

acesta depinde si de alte entitati. In cazul medicinei dentare este foarte important rolul jucat

de laboratorul de tehnica dentara, acolo unde se realizeaza efectiv coroanele si puntiledentare, fatetele ceramice, diferitele proteze etc.

Medicul este evident responsabil de calitatea lucrarii protetice, de cat de repede pacientulbeneficiaza de ea, de numarul sedintelor la care este supus. Intr-o ultima instanta,

contribuie decisiv la placerea pacientului de a avea o lucrare frumoasa si perfect

functionala cu un efort minim.

Fiecare capodopera porneste de la o schita

Dupa tratamentele efectuate in cabinet, medicul amprenteaza campul protetic. Prin aceasta

metoda inregistreaza pozitia dintilor, a gingiei si a bonturilor dentare ce vor sustineviitoarea lucrare. De aici inainte, implicarea laboratorului dentar este definitorie pentru

rezultatul final, tehnicianul preluand amprenta trimisa de medic, transpunand intr-un modelde ghips formele din gura pacientului.

Rigoarea, implicarea in modelarea si realizarea lucrarii dentare se reflecta asupra

pacientului: la prezentarea in cabinet este supus la mai putine manevre, nu are dificultati in

adaptarea lucrarii, iar timpul petrecut pe scaunul stomatologic este mai scurt si numarulsedintelor este mai mic. Asadar timpul si eforturile noastre depind intr-o masura destul de

mare de prestatia tehnicianului dentar.

Tehnician sau artist?

Anatomia dintelui este extrem de complexa si cere mult studiu pentru a putea fi inteleasa,

iar pentru a fi reprodusa este nevoie de talent si simt artistic deosebit. Forma, culoarea,

dimensiunea si, in fine, felul in care dintele se incadreaza intr-un tot unitar cu dintii vecini,cu fizionomia si tenul pacientului fac ca sarcina tehnicianului sa fie pe cat de grea, pe atat

de frumoasa. In toata istoria artei nici un artist nu s-a incumetat sa reproduca dantura la

vreunul din subiectii pictati sau sculptati, deoarece anatomia acesteia trebuie studiataindelung si separat.

Functionalitate estetica

Relatia dintre medic si tehnicianul dentar este determinanta si pentru valoarea estetica alucrarii, aspect foarte important pentru pacient in special in cazul unor lucrari ceramice din

zona frontala a danturii. Este recomandat ca in cazul unor astfel de lucrari tehnicianul sa ia

contact direct cu pacientul, pentru ca impreuna cu medicul sa aleaga nuanta potrivita, catmai apropiata de asteptarile pacientului, dar si forma viitorilor dinti in armonie cu forma

fetei.
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Prezenta unui laborator dentar in imediata apropiere sau chiar in cadrul cabinetului

stomatologic este de mare ajutor pentru medic, deoarece relatia cu tehnicianul este multmai facila, aspectele de mai sus si eventualele probleme putand fi mult mai usor

solutionate.


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Partnering For Success Doctor/Technician Communication

The Cosmetic Revolution, fueled by 80 million baby boomers who want to remain young

and beautiful, has forever changed the relationship between doctors and their laboratory

technicians. Times have changed for us all. Smile makeover patients demand perfectionand want (1) to be involved in choosing the shape and shade of their new smile, (2) to

know what it is they are buying, and (3) to actively participate in approving the final

restorations. For this reason, it is imperative that doctors and technicians follow specificcommunication systems to attain predictable, consistent results (Figure 1).

This article will discuss doctor/technician communication when providing patients with

pressed ceramic restorations such as Empress (Ivoclar Vivadent) or Authentic (Microstar),based on the actual format used by the authors. The same principles of communication can

be adapted to other types of aesthetic restorations.

EFFECTIVE COMMUNICATION STEPS

In the past, communication often consisted of minimally written directives on theprescription (eg, crown No. 13 shade A2), occasional verbal discussions about complex

case design or questionable margins, and periodic face-to-face meetings, usually regarding

shade issues on challenging cases. For the most part, technicians were attempting to createrestorations using stone models without faces.

Here are the steps of communication we have found to be the most effective:

Figure 1. Communication tools.

Step 1

Prior to the patient consultation visit, the doctor consults with the technician to discuss

questions regarding product choices, preparation design, and laboratory fee estimate. (Thisis helpful in determining your fees, which typically begin at 5 times the lab fee.) The

technicians experience with various techniques, products, successes, and failures can beextremely valuable at this stage.

Step 2
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Figure 2. Smile design tools. Figure 3. Stick bite used formounting.

Figure 4. Lingual finish lines. Figure 5. Tissue recontouring.

The patient and doctor meet to decide on treatment and discuss finances. At this orsubsequent appointments, the following information is collected for the laboratory:

(a) A smile design choice from the Las Vegas Institute (LVI) Smile Catalogue, the Lorin

Library, the Dorfman Smile Catalogue, or from magazine photographs supplied by thepatient (Figure 2).

(b) Preoperative photographs to be e-mailed or sent to the lab, including the following: full-

face smile, close-up smile, right and left views of close-up smile, retracted smile.(c ) If the patient will be imaged (in-office or outsourced), plan to send the photograph to

the laboratory.

(d) Stick bite taken with the patient standing to prevent cant during mounting (Figure 3).(e) Poured study models marked with a thin tip marker to indicate lingual finish lines(Figure 4) and where tissue recontouring, if any, will be done (Figure 5). This information

tells the technician where to stop the finish line of the diagnostic wax-up and will

significantly decrease the amount of flash to be cleaned up during temporization.(f) A measurement for the desired length of the central incisors on the finished case, if it is

to be different than the study model.

(g) A completed prescription with details for the diagnostic wax-up is then sent to thelaboratory along with the above items.

Step 3

Upon arrival at the laboratory of the aforementioned items and information, the technicianwill again consult with the doctor regarding any additional questions or feedback. We thinkthat technicians have an obligation to honestly inform their doctors of situations that will

not produce the best results. This open feedback can prevent a negative experience for

doctor, technician, and most of all, the patient.

Step 4


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Figure 6. Diagnostic wax-up. Figure 7. Incisal preparationguide.

Figure 8. Impression matrix.

Figure 9. Golden Shimbashi spreadsheet.

Next, the technician will fabricate and send you a diagnostic wax-up, incisal preparation

guide, impression matrix, and Golden Shimbashi spreadsheet.(a) Having a diagnostic wax-up to copy for the temporization ensures that the patient leaves


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the preparation visit temporized just the way the final restorations will look. Minor desired

changes in length or contour can easily be made prior to fabrication of the final pressed

ceramic restoration. This drastically reduces the potential for repairs or remakes atinsertion, which creates a win-win situation for doctor and technician. We strongly

recommend that you not skip this step, even if the patient is anxious to get started, with

money in hand. The alternative, doing a chairside mock-up, will not give you the anatomy,contours, and surface texture that can be created by skilled laboratory technicians (Figure

6).

(b) The incisal preparation guide is another insurance policy step to be used at thepreparation visit. The guide is made by the technician from the wax-up and is placed over

the prepared 6 anterior teeth using the bicuspids as stops to confirm sufficient labial and

incisal reduction. This double-checking step will prevent a halo effect in the restoration,

which occurs if the incisal third of the prep is not reduced or rolled sufficiently. It alsoensures an even thickness in the pressing stage, which maintains continuity of shade

(Figure 7).

(c ) An impression matrix made from SilTech (Ivoclar Vivadent) putty with a polyvinyl

wash is also created from the diagnostic wax-up. This matrix is used for the temporization,and because of the washit will transfer the detail and surface texture from the wax-up

to the temporary. We recommend Luxatemp (Zenith DMG) or Integrity (DENTSPLYCaulk) for the 20-minute, shrink-wrap temporization technique (Figure 8).

(d) Lastly, you will receive a printout of the LVI Golden Shimbashi spreadsheet, created by

Dr. Larry Emmott. These dimensions were used to create proper width/length ratios (Figure9).

Step 5

Figure 10. Crowneerpreparation.

We recommend a chamfer or shoulder preparation with 2 mm of incisal reduction and 1.5mm of marginal reduction, breaking all contacts (Figure 10). The preparation is a

crowneer or three-quarter crown, which provides enough room to press the restorationand then cut it back to layer color and incisal translucency. Gold posts and heavilydiscolored teeth should be blocked out at the chair with flowable, opaque composite. It is a

myth that the technician can correct this during fabrication. In order to block out at the

laboratory, an opaque ingot must be pressed, which causes the restoration to lose vitalityand look opaque in the mouth.


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Step 6

Information for the laboratory should include the following:

(a) Photographs of situations that will affect shade matching. For example, blocked outgold posts, dark teeth, or variations in color of the prepared dentin. (Photographing a shade

guide held up to the preps is also helpful.)

(b) Another stick bite, taken again with the patient standing, will prevent a cant when thecase is mounted.

(c) Always spend the extra 5 minutes to take a second impression since dies for the case

can be taken from both. This will prevent the knot-in-your-stomach phone call from thetechnician requesting a new impression, especially when it means cutting off and remaking

all of the temporaries to get that new impression.

(d) When preparing the final prescription remember to include the following:

any requested changes from the diagnostic wax-up. (Be sure to send the wax-up back

with the case.)

diagrams or descriptions regarding the amount and location of incisal translucency

desired.the amount of surface texture desired, using the diagnostic wax-up texture as the median.

stump and final shades, including diagrams of blends.final restoration product choice (or choices).

Step 7

On the day following preparation, schedule a consultation to verify the patients

satisfaction with the size, shape, and contours of the temporaries as well as phonetics. Ifminor in nature, changes can be communicated to the technician via fax, e-mail, or a new

study model. If significant changes are needed, it is better to stop now, have the diagnostic

wax-up changed or redone, have a new impression matrix made, and retemporize the

patient until he or she is completely satisfied. Spending the time now may prevent youfrom having to cut off permanently bonded restorationseveryones nightmare. We had

one doctors patient temporized 3 times before she was satisfied with the temporaries, but

the final restorations went in without a hitch.

Step 8

Figure 11. Finishedrestorations.

Figure 12. Becdens cosmeticpresentation box.

When the case arrives at the laboratory, the technician will follow all information from (1)

the original prescription, (2) recorded phone conversations, and (3) final prescription.


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Another SilTech matrix is made to ensure the finished restorations follow the diagnostic

wax-up (Figure 11).

Step 9

After the final qualitycontrol inspection, the restorations are placed in a cosmetic

presentation box to be used to enhance the experience of the patients insertion visit. Thepatient also receives a gift and a congratulatory note from our laboratory that also

compliments the talents of his or her doctor (Figure 12).

Step 10

The final step in this system, one that is often neglected, is to send the before- and-after

photos and patient testimonials to the laboratory. This is very useful in 2 ways: first, to lettechnicians see the fruits of their labor, and second, for laboratory trainers and

management to use the photographs in training sessions in the never-ending quest toward

perfection.

CONCLUSIONThe system described in this article may seem time-consuming or even a little neurotic.

However, those doctors who follow it create raving fans out of their patients, who in turn

create an internal network of referrals.

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Teamwork is essential for the provision of contemporary, high quality oral health care. Theprovision of successful intra-oral prosthetic appliances requires accurate communication of

prescriptions between dentist and dental technician.(1-6) Appropriate materials, effectivetechniques, and careful design are essential for optimal aesthetics and function.

The following materials (low risk class I - high risk class III) are used daily by dental

technicians around the world:

Examples of dental products: Class I - dental impression materials, artificial teeth, dentalcuring light; Class IIa - dental alloys, ceramics and polymers, orthodontic wire, Class IIb -

permanent implants; Class III, absorbable implants.(10)However, limited consultation between dentists and dental technicians regarding the choice and

handling of these materials is commonplace,(1, 3, 4, 11-14) and written laboratory instructions arenot always supplied by dentists.(3, 6, 15, 16). Effective implementation of safety requirements is a

further aspect dependent on close co-operation. The potentially confusing plethora of materialscurrently available to dentists, combined with the reduction of teaching in prosthetic

technology in many contemporary dental curricula, makes links between dentistry and dentaltechnology education more imperative.(13, 17, 18).

Teamwork between Dentist and Dental Technician

Teamwork and inter-professional relationships have been identified among the attributescontributing to professionalism.(37-41) These need to be fostered from the very beginning of

professional education and training.

Teamwork between Dentist and Dental Technician

Teamwork and inter-professional relationships have been identified among the attributes

contributing to professionalism.(37-41) These need to be fostered from the very beginning ofprofessional education and training education in both professions.(12) If consultation and

communication between dentist and technician is embedded in undergraduate studies it is morelikely that graduates will continue this habit into their professional lives.(52)

Shade selection, a common procedure, is a method of recording and matching natural toothcolour to artificial teeth provided as part of dentures, crowns or bridges. The dentist and the

technician attend the clinic together to design the prosthesis. The fourth or fifth year dentistrystudent prepares the mouth or tooth surfaces and the dental technician refines the design, inter

alia ensuring it is appropriate to the material chosen to replace lost tooth structure. He/sherefers to a range of shade guides provided by the manufacturer/supplier of the chosen material,

in close consultation with the dental student and the patient. Decisions are recorded using

drawings, photographs and symbols. The dental technology student then constructs the

prosthesis, and attends clinical appointments for try-in, insertion and adjustment.It is a valid hypothesis that the future dentist might acquire enhanced faith in, and respect for,

the technicians knowledge, skills and professionalism in such a collaborative environment.This setting brings greater transparency to the patient care experience. In these situations

patients also come to understand and to value the role of the technician, and are encouraged toprovide direct feedback on laboratory procedures as well as clinical outcomes. The significant

roles of the dental technician are not widely known by the public, so such interactions provideopportunities for enhanced professional recognition.(52, 59)

From situations such as this, clinical and dental technology students are encouraged to reflecton their interactions, which are formally assessed in the curriculum through reflective journals.

Anecdotal evidence to date suggests that both groups feel on a more equal footing, with betterunderstanding of the role each profession plays in patient care. When the dental technician

can observe the fitted prosthesis and experience the patients reaction, his/her opportunity for


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self reflection is enhanced, facilitating improved service to patients an essential element ofprofessionalism.

Tradus Licenta Td

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