Thursday, February 11, 2016

Finding the Right Lab

I’ve been in private practice for a little more than 25 years, and it finally occurred to me that I’m pretty good at this crown and bridge thing. I have to admit that I haven’t always (or ever) had this opinion of my work. What made me realize this after all these years? I changed labs.

Really, it was as simple as finding the right lab technician.

My former partner was a type-A perfectionist who was obsessed with perfect crown margins. He would pack cords, electrosurge, and Superoxol and impress and impress until he got margins that even Mr. Magoo could see. He prided himself (as we all want to, I guess) on his crown and bridge.

He also found lab technicians who were equally as obsessed with the details as he was. One local ceramist was a former patient of his who trained as a lab technician, and they worked closely together on cases. She insisted that die stone be weighed on a scale and then stored in sandwich bags, not Ziploc bags, since a few micrograms of stone dust could get trapped in the zip closure and thereby ruin the stone. She would come to his office to take shades, and her work was amazing. I saw his preps on models in our lab, and the only thing about them that impressed me was the amount of tooth structure that was removed. But it allowed the ceramist plenty of room to work her magic, I assume.

The final result couldn’t be doubted, though: The margins were imperceptible. I had the opportunity to check some of his patients at recalls, and I was impressed at how a sharp explorer just glided across from the tooth to the crown without a blip.

The sad thing was I couldn’t say the same for my work. In comparison, my margins could be detected with a baseball bat. I would pack cords, retraction gel, and electrosurge and get a readable margin, but my crowns still had some degree of chunkiness.

This was true until I found a new lab guy, who happens to be the last guy who my former partner used before he passed away. My new assistant (who worked for my former partner) suggested nonchalantly that I use him, and immediately, my crown and bridge skills improved! I now have margins that I’d let you take a crack at with the sharpest explorer in the kingdom. And I have achieved esthetics that look like all the stuff in the magazines!

The same thing happened with removable prosthodontics, too. I tried all sorts of impression materials and techniques and would still spend an hour trying to adjust a metal framework to seat. Again, this was true until I found the right lab. I don’t even do a separate try-in anymore, since I know it’s going to seat.

I knew I was better than to accept bulky margins but thought that all the shortcomings were on my end. And there is still plenty I could improve on, believe me.

They don’t call this the “practice” of dentistry for nothing.

Now if I could find someone to do my composites…

Bruce M. Scarborough, DMD, FAGD

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