Optimizing workflows with clinical operating procedures

Feb. 9, 2024
Without these three vital controls, your dental practice won't succeed. Learn what they are and how to apply them here.

It’s 11:50 am. Lunch is at noon. And you’re frustrated knowing you have a solid 30 minutes to complete this procedure, which means you’re going to have a short—if any—lunch again.

Sound familiar?

We’ve all been there: assistants needing to get up midprocedure, hygienists forgetting to take intraoral camera images, overlapped and unusable radiographs… In fact, years ago, this was routine in my practice too. One day, I’d had enough. As a team, we all looked at each other, frustrated, a little burnt out, and ready for better.

If you are too, keep reading.

There are three controls we need to sustainably succeed—and enjoy our dental practices:

  • Financial control
  • Systems control
  • Clinical control

With them, we thrive. Without them, we survive—at best. What that meant for us is what it means for every dental practice that wants better. We had to develop systems and clinical control—aka, we needed efficiency with our products in dedicated workflows—in other words, we needed clinical operating procedures (COPs) so we could stress less and become more productive and profitable.

So, as you and I assess our practices, there are six steps to integrate and achieve true systems and clinical control.

  1. Make a list of your top restorative day-in-day-out procedures.
  2. Define every step of each procedure and how long it should take.
  3. Note every material and technology needed.
  4. Determine who is accountable for each step, material, etc.
  5. Hold a team meeting to calibrate all clinical team members.
  6. Set goals to elevate your process and profit.

If you’re anything like me, having an easy-to-follow example helps bring it alive. Here’s just one that makes my practice’s top list:

Posterior e.max crown Steps:

  1. Seat patient, verify, and orient the day’s procedure: 3-7 minutes
  2. Check shade: 2-3 minutes
  3. Anesthesia: 2-5 minutes
  4. Fabricate putty matrix: 4-5 minutes
  5. Proximal slice: 1 minute
  6. Pack cord: 1-3 minutes
  7. Occlusal depth cuts and reduction: 2-3 minutes
  8. Remove all decay: 0-2 minutes
  9. Core build-up as indicated: 0-3 minutes
  10. Remove cord: 1 minute
  11. Axial reduction: 2-4 minutes
  12. Pack cord: 1-2 minutes
  13. Remove cord after 5 minutes
  14. Scan: 2-4 minutes
  15. Temporize: 3-5 minutes
  16. Tissue control: 1 minute
  17. Post-op Instructions and schedule next visit: 3-5 minutes

Total time = 30 - 59 minutes

Posterior e.max crown materials and tech:


  • Vita Classic Shade Guide


  • Septocaine (maxillary and mandibular infiltrations, AMSA, PDL)
  • Carbocaine (IANB)

Anesthesia needles:

  • 30-gauge short needle (maxillary & mandibular infiltrations; AMSA; PDL); 27-gauge long needle (IANB)

Putty matrix:

  • Ivoclar Virtual XD with quadrant tray

Burs - Microcopy:

  • Interproximal slice and occlusal depth cut = 330
  • Occlusal reduction = 2137C
  • Axial reduction = 1714.8C
  • Refine of prep = 1714.8 F

Core build-up - Ivoclar:

  • Adhese Universal
  • Tetric powerflow
  • Tetric powerfill
  • Tetric power cure curing light

Cord - Kerr gingiBRAID:

  • Smallest size that allows for ideal retraction

Scan - Trios 5 or Primescan based on availability

Temporary - DMG:

  • Luxatemp for all crowns with insert < 3 months
  • Luxacrown for all crowns with insert > 3 months

Tissue control:

  • Ivoclar = Cervitech +

Detailed? Yes! Efficient? Absolutely!

Friends, when you build your clinical operating procedures to this level of detail for every day-to-day procedure you do, you will deliver efficient aesthetics without fail, without stress, and with very high profit.

If you want to know more on how to—or you’d just like someone to do this for you—please reach out. I can show you the way.

Till then, cheers to your success!