Understanding labs

Sept. 1, 2002
Do you know what happened to your client from the time you recommended a crown to when he or she returned three months later with that new crown?

Do you know what happened to your client from the time you recommended a crown to when he or she returned three months later with that new crown? Have you ever blocked off your schedule or come in to the office on a day off to observe or even assist in restorative preparations appointments?

Hygienists can play a crucial role in the success of an esthetic case by being the liaison between the dentist, the patient, and the laboratory. It is an essential responsibility for a "master hygienist" to understand what it takes to get restorations back from the lab as desired by the client and the doctor. When hygienists increase their knowledge of laboratory procedures, it increases their value to the dental practice. By having the capability to discuss esthetics at a more comprehensive level with clients, we can provide appropriate client education, clarify the clients' expectations about smile outcomes, and enroll them into the appropriate clinical services.

An esthetic smile design case, quadrant dentistry, or even a single crown (which often is the most difficult to match with the natural dentition) necessitates documentation. This shared information includes:

Prior to preparation session

  • Pre-procedural photographs
  • Study models (polyvinyl, polyether, or alginate)
  • Pour in die stone
  • Face bow mounting for occlusal analysis (optional)
  • Diagnostic wax-ups (optional)
  • Smile analysis/hygiene esthetic and restorative evaluation form

Preparation session

  • Adequate impression of the preps with a 360-degree view of margins
  • Correct bite registration, including stick bite to verify that the incisal edge of centrals is parallel with the interpupilary line of the eyes
  • Opposing impression
  • Photographs
  • Shade selection of the prepped teeth (stump shade)
  • Utilization of the appropriate shade

Lab communication (share the following information with your laboratory)

  • Teeth to be restored, impressions
  • Prep shade (stump shade, assists in blending the shades for the final restoration)
  • Type of restorations requested such as crowns, veneers, inlays and/or any bridges or pontic design
  • Type of esthetic material, such as Feldspathic, Pressed, Leucite-reinforced ceramic
  • Color mapping is a detailed illustration of the shading and characteristics of the teeth being restored (technology assisted or free eye/hand)
  • Surface anatomy (high texture, medium texture, smooth texture)
  • Incisal translucency (halo replicates light reflection on the incisal edge) is referred to as light, medium, or heavy
  • Incisal characterization is described as, for example, mamelon development, prominent, moderate or smooth edge detail, chipped, pointed, square round
  • Checklines are added to mature the look of the restorations, including none, light (white, gray, brown), medium (white, gray, brown)
  • Color characterization, such as hypocalcification, yellow, brown
  • Smile design is enhanced, softened, natural, and age (older, youthful)
  • Teeth shape is square, tapered, or ovoid
  • Photos of pre-operative teeth, of preps, and of provisionals
  • Pre-operative models
  • Preference of articulator

Walking advertisements

An often-overlooked area in restorative dentistry is the provisional. Provisionals are your office's walking interim advertisement when the client leaves the practice. Functionally, while the definitive case is being developed at the laboratory, the provisional serves to:

  • Reduce sensitivity
  • Improve function
  • Maintain balance and contacts
  • Become a diagnostic model

It is usually preferred that the provisionals mimic the natural tooth or the desired smile's re-design.

Options for their manufacture include the restoring doctor, the lab, or a legally trained clinical professional. Remember, temporaries should provide the continual message and constant reminder to the client that he or she made the correct decision to proceed with smile re-design or restorative treatment with your office.

Develop the following checklist for provisional restorations:

  • Does the client need to be on an antimicrobial/ chlorhexidine rinse and or fluoride therapy during this stage?
  • Has a team member been designated to ensure complete client understanding of self-care requirements and product recommendations?
  • Does the client need hygiene service before the final restoration placement?
  • Does the client know how to care for the provisional restorations(s) - verbal and written instructions?
  • Is periodontal health complete? (Ensure that a legally qualified and trained team member removes all excess temporary cement, especially subgingivally.)
  • Note size, contour, shade, emergence profile, contacts, embrasures, and marginal fit
  • Note occlusion
  • Adjustments and polish
  • Determine the client's perception and attitude about the temporaries

Next month, in the second part of this discussion about building blocks of lab communication and color, learn some shade taking tips to help to ensure that the client receives their desired lustrous smile.

Kristine A. Hodsdon, RDH, BS, is a coach with Hygiene Mastery, as well as an international speaker, author, and software developer. She can be contacted about speaking or coaching at (888) 347-4785 or by e-mail at [email protected] or [email protected]. Visit her on the Web at www.pre-d.com and www.hygienemastery.com.