Tips and Tricks from the Laboratory Bench
By: Lars Hansson CDT,FICOI
Bayview Dental Lab Chesapeake, VA
Communication has always been an issue when it comes to dentistry. This can be any thing from diagnostic work , photography to implant placement.
Hello and welcome to this newsletter that will give us an insight to what’s going on in the dental field today. As you noticed, this is a letter from the laboratory bench and what is happening in the dental laboratory world . We’ll be looking at materials, technology and much more. I also will discuss and show some tips and tricks that the dental community are using to improve and enhance the dentistry given to our patients.
I thought I would start with discussing communication. Not smoke signals or phone calls. What are the issues we encounter with cases that do not always go the right way or why do we have issues with some cases?
Diagnostic models: We know that the foundation for complete dentistry is based on the execution of a complete and thorough examination. This include an accurate PVC impression where we capture the full extensions of the vestibules and the full anatomic landmarks. Essentially, the diagnostic model needs to be a re-creation of the patient’s maxillary and mandibular arches, with an accurate representation of the teeth and supporting tissue. (Figure 1)
Photographs: This is a very important part of the communication to the laboratory. If the laboratory you are using is not an in-house dental lab where the patient is present, the only way for the technician to see the patient is by having photographs. Having a camera that takes good images is equally important and that digital cameras are being used. Digital cameras gives the possibility to enlarge images and to see smaller details on our computer screens. There are a certain set of views that are needed and a protocol that gives the technician the same photos every time. These are specific angles and a set of 12 photos. There are the pre-op photos for diagnostic work and the shade photos for communication of shade and texture. (Figure 2,3)
Diagnostic wax-up and diagnostic set-up: When we have made the diagnostic models and the photos, the laboratory now can create the diagnostic wax-up or the diagnostic set-up. The diagnostic wax-up is the method or process through which practitioners can fully visualize the restorative needs of the patient.
Implant placement: Implant placement should be a prosthetically driven treatment that is guided by the diagnostic work up. A surgical guide needs to be fabricated and used for implant placement. There are many ways of fabricating a surgical guide.It can be done by a full contour wax-up and processed or we can utilize a CBCT scanner and a guided surgery guide.
There are several systems on the market today to be used for implant planning and surgical guide fabrication. All these systems function the same and aid in implant placement. Here is and example of CBCT treatment planning software. We can see how detailed the images are and why this can aid in our placement of implants. (Figure 4)
If a CBCT scan has been done and downloaded to software, an easy way of communicating the treatment plan is to do a webinar meeting on the internet and involve all the specialties to participate in the planning. By doing it this way, live input can be discussed and issues can be worked out prior to executing any surgery. (Figure 5)
Dental laboratories have started to invest in CBCT scanners and software as a service for their customers. This can enhance the planning for the customers and help alleviate some of the issues and cost. What’s important is that the laboratory that gives this service must understand anatomy and understand treatment planning on a comprehensive level. (Figure 6)
Conclusion: In order to success fully work through the diagnostic process, the following records are necessary:
1. Well impressed models
2. Face bow
3. Centric relation (CR) bite record
4. Maximum intercuspation (MI) bite record
5. Protrusive bite record
6. X-rays: full mouth, panoramic, and cephalometric
7. Periodontal probing chart
8. Noted observations of temporomandibular joint (TMJ) status
9. Noted observation of muscle examination
10. Diagnostic photography