Communication with dental

laboratory
INTRODUCTION
All members of the dental team must understand what they can
reasonably expect from each other in order to create a high-quality
fixed prosthesis.
It's critical that everyone understands each other's limitations.
When prescribing and delegating laboratory procedures, the dentist
who does not understand and appreciate the challenges faced by the
technician is at a significant disadvantage.
 A thorough understanding of technical procedures and their
rationale is essential for the development of sound clinical judgment.
 This six-unit anterior metal-ceramic framework did not seat.
After it was sectioned between the incisors, the adaptation of
the individual components was satisfactory. Note the (correct)
narrow width of the soldering gap

 Appearance of the two segments indexed with

autopolymerizing resin for subsequent soldering.

 The dentist sectioned this fixed dental prosthesis (FDP)

incorrectly: The soldering gap is much too wide (arrow), and
distortion during soldering will almost certainly result.
MUTUAL RESPONSIBILITIES
Good communication, which is crucial to the dental team's technical
performance, necessitates a close working relationship between the
dentist and the laboratory technician.
It is impossible to expect satisfactory results if the dentist does not
have a sufficient amount of dental laboratory experience and a clear
understanding of the techniques involved.
The dentist's active engagement in the technical procedures is
critical, and clinicians who invest the time to learn the ins and outs of
laboratory work make better clinical decisions because they are aware
of the relevant technical and material science limits.
MUTUAL RESPONSIBILITIES
• Only then can a dentist choose the optimal balance of technical
constraints, biologic considerations, and cosmetic requirements.
• Similarly, if the technician does not understand and respect the
dentist's clinical demands or treatment reasoning, the results will be
subpar.
• By being prepared to meet personal duties, listening closely to
technical advice, and actively engaging in the technical decision-
making process, the dentist can gain this respect.
• Dentists transfer a considerable amount of their responsibilities,
according to surveys of stationary prosthodontic laboratories.
MUTUAL RESPONSIBILITIES
• The surveyed technicians were frequently unsatisfied with the quality
of the assignments they were given; issues included insufficient
information in the work permission, the submission of poor
impressions, and insufficient occlusal data.
• Such studies reveal serious issues with dentist-technician
communication. Other research and viewpoints about dentist-
technician interaction, whether written by dentists or technicians,
stressed that better patient care can only be achieved through greater
patient communication.
MUTUAL RESPONSIBILITIES
• The ADA issued guidelines to improve the relationship between
dentist and technician. The introduction is reprinted as follows:
• Working relationships between dentists and dental laboratories: The
current high standard of prosthetic dental care is directly related to,
and remains dependent upon, mutual respect within the dental team
for the abilities and contributions of each member.
• The following guidelines are designed to foster good relations
between dental laboratories, dental laboratory technicians and the
dental profession. Applicable laws shall take precedence if they are
inconsistent with any of the following guidelines.
The Dentist Guidelines
• 1. The dentist should give the laboratory or dental technician written
instructions. Written directions should include a description of the task to
be done, as well as the materials to be utilized, and be written in a clear
and understandable manner. A duplicate copy of the written instructions
should be kept on file for as long as the law requires.
• 2. The dentist should supply precise impressions, casts, occlusal registers,
and/or mounted casts to the laboratory technician. It is necessary to
identify the materials that have been submitted.
• 3. In all circumstances, the dentist should identify the crown margins,
posterior palatal seal, denture borders, any places that need to be
alleviated, and the design of the detachable partial dentures.
The Dentist Guidelines
• 4. The dentist should provide instructions on preferred materials,
colour, and description of prosthetic tooth/teeth to be used for fixed
or removable prostheses, which may include a written description,
photograph, sketch, or shade button, but is not limited to.
• 5. When advised by a laboratory/dental technician that a case may
have a doubtful region, the dentist should grant verbal or written
consent to proceed with the laboratory process or make any relevant
changes to the written instructions, as the dentist believes necessary.
The Dentist Guidelines
• 6. Before transferring things to the laboratory technician, the dentist
should clean and disinfect them according to current infection control
guidelines. To avoid damage and ensure accuracy, all prostheses and
other materials delivered to the laboratory/technician should be
properly packaged and transported in an appropriate container.
• 7. If a prosthesis/appliance does not fit correctly or a shade selection
is inappropriate, the dentist should return all casts, registration, and
prostheses/appliances to the laboratory/technician.
The Laboratory Technician Guidelines
• 1. It is the responsibility of the dental laboratory technician to create dental
prostheses and appliances that are made to the dentist's specifications and that
are correctly mounted on the cast and mounting materials given by the dentist.
Original written instructions should be kept on file for as long as the law requires.
When a laboratory provides a dentist with custom-printed written instruction
forms, the laboratory document should include the lab's name and address,
ample space for the doctor's written instruction, areas to indicate the desired
delivery date, the patient's name, a location for the doctor to provide his or her
name and address, and a site for the doctor to sign. Other information that the
laboratory deems relevant or that is required by law should be included on the
form.
The Laboratory Technician Guidelines
• 2. If there is any doubt about the mounting's precision or the dentist's
bite registration, the laboratory should return the case to the dentist for
inspection.
• 3. The laboratory/technician should match the shade indicated in the
original written specifications as closely as possible.
• 4. If there is a cause for not continuing with the work, the
laboratory/technician shall tell the dentist within two working days after
receiving the case. Any modifications or additions to the written
instructions must be approved by the dentist, and authorized laboratory
workers must initial them. Upon conclusion of the case, a record of any
adjustments will be submitted to the dentist.
The Laboratory Technician Guidelines
• 5. Following the acceptance of the written instructions, the
laboratory/technician should custom make and return the
prostheses/appliances in a timely way, as is typical, and taking into
account the doctor's desire. If the laboratory/technician refuses to
accept written directions, the work should be returned promptly with
an explanation for the rejection.
• 6. Infection control guidelines for personal protective equipment and
cleaning of prosthetics, appliances, and materials should be followed by
the laboratory. All materials should be inspected for breaking and [such
breakage] should be reported as soon as possible if it is discovered.
The Laboratory Technician Guidelines
• 7. The laboratory/technician should educate the dentist about the
materials in the case and may provide suggestions on how to handle
and adjust them correctly.
• 8. All incoming items from the dentist's office, such as impressions,
occlusal registrations, prostheses, and other items, should be cleaned
and disinfected according to current infection control standards,
placed in an appropriate container, packed properly to avoid damage,
and transported by the laboratory/technician.
The Laboratory Technician Guidelines
• 9. Any subcontracting laboratory/technician used for case preparation
should be disclosed to the dentist by the laboratory/technician. The
dental laboratory that has been hired to conduct part or all of the
services on the original written instructions should get a written order
from the laboratory/technician.
• 10. Unless required by law, the laboratory/technician should not
charge the patient directly. Any commercial relationships between the
dentist and the laboratory should not be discussed or disclosed with
the patient by the laboratory.