You can’t always get what you want (unless you clearly ask!)

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You can’t always get what you want (unless you clearly ask!)

Shade tab placed in the same plane as teeth, ensuring the tab and corresponding shade number is in the photo. (Photo/Provided by Laura Kelly and Dr Jeff Morley)
Laura Kelly, USA

Laura Kelly, USA

Mon. 12 April 2010


Let’s be honest: There are times when your laboratory technician simply doesn’t deliver what you envisioned so clearly in your mind. A bit more translucency or a specific gingival color; a minor mesial rotation on that bicuspid or an occlusal table that’s just a little too wide.

Twenty years ago, when I began my career as a laboratory technician, we had only a few tools at our disposal.

Hastily made sketches on the back of prescription pads, a few colored pencils to indicate body shade, incisal level or some other specific instruction; and sometimes pre-op models were sent.

Looking back, I’m amazed at what we pieced together given such limited communication tools. Yet that was the best the dentists could provide to the technician, and we had to work from what we had. It was challenging to create the specific results for, say, a single unit anterior crown.

Often there were trips between the laboratory and the practice or extra meetings—not to mention costly remakes for everyone. As we got better, we pulled it off, but it wasn’t easy.

Fast forward two decades to the era of digital camera, e-mail and Skype and the way we work together is instantly and forever transformed. No longer must we guess, imagine or try to convey with facsimiles or mere words. These tools have totally changed the way the dentist and laboratory technician collaborate on their work, and everyone—the patient included—has been the beneficiary of this technology.

Imagine if you had to work without a digital camera today: Film. Developing. Printing. Waiting. Time. Out of focus. Do it again. Wait some more.

With today’s digital technology, the clinician can instantly determine whether the information in the photograph will adequately convey everything necessary to the technician.

Many cases require more than a shade tab number written in the shade box on the prescription, and taking full face, retracted and lateral views make all the difference to the technician working on your cases.

Once the image is captured, e-mail can transfer the information virtually instantaneously, permitting the dentist to choose a technician anywhere in the country. This allows the dentist to work with a technician with whom he or she can work best, regardless of geography. The technician, in return, can send preliminary images of his or her wax up and bisque bake along with the final stage images for the dentist’s approval. Both parties can then have confidence that the case has been fabricated exactly as envisioned by the dentist and the patient.

This process of instruction, feedback and adjustment has allowed more dentists to deliver an increasingly sophisticated product created by more clinically astute and in-tune technicians — usually in less time and with greater precision from the beginning.

A laboratory technician would always prefer to work with a photograph and would prefer this level of information than not, thus, these tools have become the new standard of care.

It must be said that in addition to increasing the predictable results, using these communication tools increases profitability for both the laboratory technician and the dentist.

When you consider the cost of remakes and adjustments as well as sending cases back and forth multiple times—not to mention patient dissatisfaction with these frustrations—the savings are real and the profits are equally real. When professionals spend more time at the beginning and avoid costly mistakes, the benefits are tangible.

Even with these improved technologies, the most important tool we have is the time the dentist and laboratory technician invest in one another.

By taking the time meet and discuss cases, being clear about mutual expectations and giving immediate feedback to one another, the dentist and technician can build a strong working relationship that can last for years and even decades.

Labs evaluate you too

We all know that dentists are constantly evaluating their laboratory technicians and relationships, but the same is true for the technicians.

When we receive a case from a client who communicates well, makes expectations clear, works in a collaborative partnership and gives candid and timely feedback, we know we have to be on our toes and it challenges us to do our very best.

When we work with a dentist who sends clear impressions, focused photographs and who alerts us to the arrival of the case, we know that dentist is serious and that his or her expectations are high.

However, when impressions are distorted, margins are unreadable or prescriptions are incomplete, it sends a very different message indeed. Perhaps it doesn’t matter much to some dentists? Perhaps, just about anything will do? Perhaps your case can wait?

In many larger laboratory environments, the most highly trained technicians are assigned the cases of the first dentist—the one who sent clear impressions that is—because their time is too valuable to work with poor material and information.

Here’s a little secret: technicians are naturally pleasers and we want to impress you, make you happy and rise to meet your needs.

If you want the best technicians working on your cases, make it your business to send them the best, communicate with them until you work like a well-oiled machine and demand excellence in return. The way you communicate will affect all of this.

In modern dentistry, it is easy to do the right thing. We have the tools. We have the standards. We have the desire. We can work better together. Just tell us what you want and we can deliver.

When looking for a new lab …

  • Call and introduce yourself, communicate what it is you are looking for and what is missing from your current lab relationship. (We need to know what you don’t like so it’s not repeated!)
  • Ask to see photos of their work, and find out who receives the e-mail photos that you will be attaching to your cases.
  • Ask how the lab assigns your cases to a technician(s) and request to speak directly with the technician you will be working with.
  • Visit the lab if possible, or use Skype for instant communications online.
  • Ask for a bisque bake photo to be e-mailed to you for approval before sending the case out. This saves time and the dentist can give useful feedback at a time when modifications are easily made.
  • Schedule quarterly phone or in-person meetings to discuss how everything is progressing; so engage in regular meetings.
  • Ask other dentists what their experience has been with the laboratory you are considering.
  • Outsourcing cases overseas has increased in the laboratory profession. If this is important to you, you may want to inquire as to where your restorations are being made.

What to include

  • Clear, full arch impressions
  • Bite
  • Photos
  • Face bow or stick bite
  • Pre-op models
  • Model of temps or diagnostic wax-up to follow
  • Concise instructions

Labs evaluate you by …

  • Quality of impression, free of pulls, distortions or voids on the margins.
  • Photographs sent with shade tab desired, as well as prep or “stump” shade for all ceramic restorations.
  • Detailed prescriptions and ‘call to discuss’ written on cases that require more communication.
  • Your willingness to be open to feedback. Ask your technician what you can do to make his/her job easier and he/she will be happily surprised.
  • Your direct and honest feedback. Technicians need to know what you like and what you don’t in order to improve and meet your expectations.

Contact info

Laura Kelly may be contacted at

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