"We are one of the last industries to produce anything custom-made. To create a great custom-made restoration can only be achieved by virtue of excellent communication between the dentist and his/her lab."
— Ian Shuman DDS, Glen Bernie, Maryland 

To fully benefit from your dental lab, you need to approach the relationship from two perspectives: first, from your practice perspective and secondly, by understanding the motivations and procedures of the laboratory.
Which of your practice goals are affected by the relationship with a dental lab? Three goals fall into this category:

• Minimizing non-profitable chair time
• Creating restorations that have appropriate maximum life expectancies
• Providing restorations that meet the esthetic expectations of patients

These goals all relate to the profitability of any practice and can be affected by the quality of your relationship with a lab.

Begin with a solid foundation

If you want to minimize unprofitable chair time resulting from remakes, you must give your laboratory a solid foundation on which to build. Obviously, quality impressions are the foundation for all restorations. If great care is not taken to ensure that the impressions are accurate, the positive outcome of the case is in doubt. Prepare your patients and staff so the patient doesn't leave until you have a confirmed "perfect" impression.

I suggest checking impressions with magnification in good light from a facial and lingual view. This may seem like a lot to do, but you look much better to your patients if they know that you won't be satisfied until it is right. Even if it increases your prep-time appointment, it is less expensive than bringing a patient back in for an extra re-impression appointment. If your patients knew that an extra 30 minutes at the prep appointment would save them from new injections and cord-packing what choice would they make?

Make the first pour in your good impression in your office and check it. Many flaws are more obvious in stone. Pour at least the die and check it before the patient leaves. Much less time is invested to do this on every case in a year's time than in a couple of reappointments for new impressions.

Worse yet, you have patients arriving expecting to get a crown or crowns - patients who have excitedly told all of their friends and loved ones about it. Then they are really disappointed when they don't get it. What do they do? They tell their friends about that! It is very impressive to a patient to know that you are not going home until the impression is right! Referral, referral, referral! Begin with a solid foundation

If you want to minimize unprofitable chair time resulting from remakes, you must give your laboratory a solid foundation on which to build. Obviously, quality impressions are the foundation for all restorations. If great care is not taken to ensure that the impressions are accurate, the positive outcome of the case is in doubt. Prepare your patients and staff so the patient doesn't leave until you have a confirmed "perfect" impression.

I suggest checking impressions with magnification in good light from a facial and lingual view. This may seem like a lot to do, but you look much better to your patients if they know that you won't be satisfied until it is right. Even if it increases your prep-time appointment, it is less expensive than bringing a patient back in for an extra re-impression appointment. If your patients knew that an extra 30 minutes at the prep appointment would save them from new injections and cord-packing what choice would they make?

Make the first pour in your good impression in your office and check it. Many flaws are more obvious in stone. Pour at least the die and check it before the patient leaves. Much less time is invested to do this on every case in a year's time than in a couple of reappointments for new impressions.

Worse yet, you have patients arriving expecting to get a crown or crowns - patients who have excitedly told all of their friends and loved ones about it. Then they are really disappointed when they don't get it. What do they do? They tell their friends about that! It is very impressive to a patient to know that you are not going home until the impression is right! Referral, referral, referral! Begin with a solid foundation

If you want to minimize unprofitable chair time resulting from remakes, you must give your laboratory a solid foundation on which to build. Obviously, quality impressions are the foundation for all restorations. If great care is not taken to ensure that the impressions are accurate, the positive outcome of the case is in doubt. Prepare your patients and staff so the patient doesn't leave until you have a confirmed "perfect" impression.

I suggest checking impressions with magnification in good light from a facial and lingual view. This may seem like a lot to do, but you look much better to your patients if they know that you won't be satisfied until it is right. Even if it increases your prep-time appointment, it is less expensive than bringing a patient back in for an extra re-impression appointment. If your patients knew that an extra 30 minutes at the prep appointment would save them from new injections and cord-packing what choice would they make?

Make the first pour in your good impression in your office and check it. Many flaws are more obvious in stone. Pour at least the die and check it before the patient leaves. Much less time is invested to do this on every case in a year's time than in a couple of reappointments for new impressions.

Worse yet, you have patients arriving expecting to get a crown or crowns - patients who have excitedly told all of their friends and loved ones about it. Then they are really disappointed when they don't get it. What do they do? They tell their friends about that! It is very impressive to a patient to know that you are not going home until the impression is right! Referral, referral, referral!

Preplan cases with your lab

If you're are not sure what direction to go as far as material selection or case design - even before the preparation appointment - have your lab evaluate study models of the case.

Let the lab know your goals and the patient's concerns. Have the lab do prep guides and write a dialogue for suggested materials and case design. Let your laboratory help in the selection of materials. With all of the choices available today and the claims of manufacturers, your lab can help you sort through the best materials. (Labs see the failures and know better than even some manufacturers what will work and what will fail in any given situation.) How many times have you promised and sold a patient on a metal-free restoration, only to receive a call from your lab person telling you that he or she would not recommend the prescribed restoration due to lack of space, preparation design, or other factors that call for another type of restoration?

You look much better to your patients if you are armed with a case design before you develop a treatment plan and sell a patient what really can be done, instead of changing that beautiful Empress crown to a PFM with a metal island or scheduling a re-prep appointment.

Educate Patients

You and your dental team must be the professionals and dictate what the treatment plan is and the requirements of time and appointments. This is best done as ongoing education, so that patients become indoctrinated with the scenarios that they will have to work with to have quality restorations completed.

Patients often pressure you to skip certain steps or select materials or types of restorations that won't meet their needs. It is up to you to lay the foundation of appropriate education with patients, so that they have reasonable expectations about turnaround times, material choice, and the number of appointments required.

A medical doctor doesn't let a patient who needs bypass surgery control how many appointments will be required or what materials the doctor may use for arterial stints. Your professional judgment - with the aid of your lab's experience - should dictate what type of restoration is best and how long it will take to create it. Educate Patients

You and your dental team must be the professionals and dictate what the treatment plan is and the requirements of time and appointments. This is best done as ongoing education, so that patients become indoctrinated with the scenarios that they will have to work with to have quality restorations completed.

Patients often pressure you to skip certain steps or select materials or types of restorations that won't meet their needs. It is up to you to lay the foundation of appropriate education with patients, so that they have reasonable expectations about turnaround times, material choice, and the number of appointments required.

A medical doctor doesn't let a patient who needs bypass surgery control how many appointments will be required or what materials the doctor may use for arterial stints. Your professional judgment - with the aid of your lab's experience - should dictate what type of restoration is best and how long it will take to create it. Educate Patients

You and your dental team must be the professionals and dictate what the treatment plan is and the requirements of time and appointments. This is best done as ongoing education, so that patients become indoctrinated with the scenarios that they will have to work with to have quality restorations completed.

Patients often pressure you to skip certain steps or select materials or types of restorations that won't meet their needs. It is up to you to lay the foundation of appropriate education with patients, so that they have reasonable expectations about turnaround times, material choice, and the number of appointments required.

A medical doctor doesn't let a patient who needs bypass surgery control how many appointments will be required or what materials the doctor may use for arterial stints. Your professional judgment - with the aid of your lab's experience - should dictate what type of restoration is best and how long it will take to create it.

Understanding your lab's mindset

Your lab truly wants all of your cases to be "perfect." Labs hate remakes as much as you do, but they proceed with work on impressions that they know are not right. Why? What motivates labs to do work on foundations that they are uncomfortable with; i.e,. subpar impressions? I believe there are at least four possible motivators: Understanding your lab's mindset

Your lab truly wants all of your cases to be "perfect." Labs hate remakes as much as you do, but they proceed with work on impressions that they know are not right. Why? What motivates labs to do work on foundations that they are uncomfortable with; i.e,. subpar impressions? I believe there are at least four possible motivators: Understanding your lab's mindset

Your lab truly wants all of your cases to be "perfect." Labs hate remakes as much as you do, but they proceed with work on impressions that they know are not right. Why? What motivates labs to do work on foundations that they are uncomfortable with; i.e,. subpar impressions? I believe there are at least four possible motivators:

• Fear that if they offend their doctors by asking for a new impression, the doctors will leave and go to another lab.
• Misdirected actions that come from genuine respect for the doctor's and patient's time - i.e., trying to avoid an extra appointment by "making it work."
• An incorrect assumption of where they fit on the totem pole, rather than seeing themselves as an equal member of the dental team.
• Being under significant pressure to "make it work," and get into a pattern.

The first step that the doctor can take is to let laboratory know personnel know they are a part of your team and that you want them to call you if they have a question about an impression or material selection. If your laboratory recommends a new impression, give it a lot of weight. Remember, the lab hates remakes as much as you do.

Next, ask your lab what it needs in order to do quality work. With the newer metal-free restorations, the needs are different than what they used to be. All of us in the dental industry are working with one foot in the world of science, one foot in creative arts, and trying to combine the two into a healing art. No easy trick! Give your lab the tools it needs. Remember, having more information than needed is better than having too little. With that said, keep your narratives as concise as possible. Bullet points will be read and understood easier by the majority of technicians than a "novel."

Your lab will love you and do better work if you give them preoperative models, photos, shade-mapping, bites, and full arch impressions on every case. On larger cases, take time to let the patient live with provisionals. You can touch-up the shape in that phase rather than in the finished work, and give your lab a model of the patient-approved provisionals. Eliminate the guesswork in the lab as much as possible.

Finally, a special note regarding all ceramic restorations. It is critical that the color of the underlying tooth structure is communicated to your lab. You will be in for a rude surprise if you want B1, and the lab makes a perfect B1 when you neglected to tell them that it was on an A6.5 tooth. Labs can control the final shade well if they know what the foundation color is. Take a picture with a shade tab next to the prepared tooth.

Our common goal is to build something together that we can be proud of and that your patients will be awe-struck with. Healthy communication is 95 percent of the secret to profiting from your lab relations.

• Give the lab full-arch impressions (They are the best way to get predictable occlusions.)
• Chamfer or shoulder margins can be read easier, picked more easily if the impression is not 100%, give you a healthier emergence profile from the margin, and are less likely to cause porcelain to fracture near the margins at seating. Technicians often have to guess when trimming long bevels and featheredge margins.
• Ask your lab to attach your particular preferences to your cases.
• Include your phone number on the lab slip, make sure that the lab knows how to get in touch with you, if really necessary, out of the office.
• Make returning calls to your lab a priority; remember that it is your case that is sitting on a desk waiting for instructions.
• Prepare your patients for the proper turnaround time. Any lab can do a crown overnight, but at what cost to quality control.
• I would suggest a two-cord technique; the marginal clarity is far superior to the single cord technique.
• The Macro 5 camera from Polaroid is the easiest tool for communicating shade and blends to your lab.
• Take the photos with a shade tab edge to edge with the tooth.