How to gain a dental laboratory partner: Strategies to improve communication and share better records

The relationship between us as dentists and our laboratories is crucial to the success of our dental practice. Some practices are more restorative-based than others, but we all need labs. A dental lab’s role is to support the dentist, make them look good, and simplify difficult cases and workflows. But not all dental labs are created equal. There are specific lab processes and principles that need to be followed to keep the integrity of the incoming data, and ultimately the final product.

Let’s take implant dentistry as a prime example. Implant dentistry can be very challenging in accurate record-taking and in fabrication in the lab. No matter how well an implant is placed, a weak lab relationship can lead to remakes, unhappy patients, increased maintenance, and ultimately loss of chair time. Poor records, inadequate photos, and a lack of understanding of digital technology can all contribute to inaccurate results. Improving in these areas will help ensure your practice provides the best possible information to your lab, and in return, the best chance of success. Here are a few tips to help get the most out of your dental lab partner.

Getting better records

Accurate clinical records are essential for maximizing the quality of the product you receive from your dental lab. Poor intraoral scanning technique is arguably the largest source of this error that dental labs receive from dentists. IOS scanning is often delegated to auxiliary personnel without proper training on technique and proper “scan path” for optimizing accuracy and consistency.

The term “scan path” refers to the sequence of scanning the mouth in the most accurate and predictable way to capture the scanned data. This can vary with scanner brands; however, the basic principles are the same: Begin on the occlusal surface of the most posterior teeth on one side, moving anteriorly across the arch to the most posterior tooth on the contralateral side. Once there, tilt the scanner at a 45° angle toward the lingual surfaces of the teeth, then swing it back toward the side where scanning started. The scanner's tilt allows it to capture aspects of the occlusal surface that have already been scanned and properly stitch everything together. Once the occlusal and lingual have been fully captured, it is then safe to tilt toward the facial to scan the facials of the teeth. Some important principles to remember are to always start scanning in the same area of the mouth each time and to avoid random, sporadic movements that deviate from this scan path.

Not all IOS scanners are created equal in scanning accuracy, ease of use, and software interfaces. Take your time demoing many different scanners, interviewing reps, and meeting with companies that sell the equipment. A good support team is far more important than getting the latest and greatest equipment or the best price. Any hiccups or downtime using this technology will cost you very expensive chair time, efficiency, and, most importantly, patient satisfaction—all things that a busy practice cannot afford.

As a lab specializing in full-arch digital workflows, we spend a great deal of time advising our doctors on what equipment and technology to buy so that it works together seamlessly with the utmost accuracy and efficiency. We offer this service to our clients through our Prosthodontic Boot Camp.

As prosthodontists and owners of our lab, we are able to provide a unique service to our clients: my partner and I travel to our clients and spend two days with them and their team. The first day is spent in the clinic in a surgical or restorative setting, demonstrating digital workflows and teaching how to integrate technology, proper scan path, and proper clinical techniques. The second day is typically spent lecturing on these same techniques as well as more advanced ones. We find that this is a very solid foundation for our offices as they begin their digital journey.

Improving your photography 

Good clinical photos are the backbone of receiving excellent, predictable results from your dental laboratory. This is a tough one to master sometimes, as it is not something we were taught in dental school, nor is it needed for much in everyday dentistry. Full-arch dentistry, including dentures, rehabilitations, and especially All-on-X implant treatments are directly dependent on good photos.

A common myth and barrier to taking good clinical photos is the belief that you need a fancy camera to do so. This used to be the case back in the day; however, with the evolution of our smartphone cameras, it's just not the case anymore. Here are some tips and tricks to improve your dental photography or get you started in the right direction.

You must capture the face straight on with the eyes open. One of the most common errors that we see is eyes closed, heads turned, or photos taken too close to the patient’s face. The entire goal of capturing these photographs for your lab is that all of their design work is done on a computer screen without a face. Current CAD software allows us to align 2D photographs with the 3D design. This is critical to the design process, as it adds a face that can be evaluated alongside the new smile. The eyes serve as an important reference point to ensure the front teeth are properly aligned. 

Recording videos is also a valuable extra step to maximize your data collection for the lab. Video can be extremely valuable for diagnosing issues with the phonetic or vertical dimension of occlusal alignment. Simply stating on your RX “the patient is lisping” is not sufficient information to correct the issue. A simple exercise you can implement is having the patient count from one to 10 quickly while recording them from the front and the side. The video should show the relationship of the upper and lower anterior teeth to each other and be clearly visible in the video. This provides the lab with recordings from multiple angles that show the relationship between the anterior teeth: the foundation of speech.

Technology expansion: Work smarter, not harder

Learning to use your technology for procedures you already do in your practice can be a game-changer. A great example of this is using your IOS scanner for fast-tracking your denture process. Traditionally, making dentures for a patient is a process that requires at least five to six appointments over six to eight weeks. Digitizing this process will shorten treatment time and allow a lab to produce dentures much more quickly and accurately.

Scan a patient's existing dentures, 3D print a duplicate, and use it as a custom impression tray to facilitate a digital workflow. A predictable set of dentures can consistently be delivered in three appointments. This method is significantly faster and more efficient for everyone involved than the traditional analog approach.

The biggest misconception about digital dentures is that you must change your impression technique or that it requires doing something different than what you’re used to or know works. Impression techniques do not need to change, nor should they. We are simply using the IOS to digitize the impressions to kick-start the digital process and improve the workflow's efficiency.

Getting more out of your dental lab is largely a factor of better communication and better records—records taken in a way that your lab can utilize them to make you look better.

Clinics that consistently achieve high-quality results are those that keep accurate records, take clear photos, and increase their use of intraoral scanners to support other workflows.

Improving these things reduces remakes, decreases chair time, and makes your lab's workflow more efficient.