Effective dentist to laboratory communication in smile makeovers

With the ever-increasing cosmetic dentistry market, many dentists are choosing to send their smile makeover cases to laboratories outside of their immediate working environment.

Laboratories that have invested heavily in their education and the technology required to produce the latest materials do not always exist in the same geographic location as our practices. Even when we are fortunate enough to have an in-house technician, there are principles of communication that need to be applied.

Cosmetic patients are investing in their appearance and we need to take careful steps to ensure that the messages sent to our technicians can be clearly understood and interpreted, so that the best result is achieved as efficiently as possible.

It is extremely helpful if a protocol is established between a dentist and the laboratory so that consistency in the communication is achieved. Such a protocol may include:

1. Prior to local anaesthetic, good quality before images of the patient should be taken: at least a full-face broad smile at 1:10 magnification and a retracted frontal image of 1:2 magnification. These can be taken with a digital SLR camera or a Polaroid to allow for quick transfer. Photographs can be emailed or burned onto a CD and included with the case. More photographs can be included as appropriate.

2. When prescribing a wax-up for diagnostic purposes, the dentist should describe the changes they would like to see to the existing condition and how many teeth he/she plans on treating.

This may be open to discussion and the ability to pick up the telephone to discuss the potential treatment plans with your technician is invaluable. Two pairs of eyes are often better than one, especially in complex restorative cases.

3. Following preparation, using a stump shade guide supplied by your laboratory, provide a stump shade of the upper centrals as well as any other dark or banded preparations.

Prior to checking the stump shade, be sure to rehydrate your preps. This will assure an accurate stump shade, which is critical, especially on minimally prepped restorations.

Holding the stump shade incisal to incisal, articulate the handle 90º to the prepared tooth and take a photo of the stump using a digital camera or the Polaroid Macro 5 SLR on setting ‘2x’.

It is critical that the stump shade, prepared tooth and stump shade number shown on the stump shade guide are all in the photo.

If you are using Polaroids, be sure to write the patient’s name, stump shade and tooth number on the film.

Additionally, if you are not treating the entire smile, it is imperative that you take photographs of the adjacent teeth with shade guide tabs positioned in the same vertical and horizontal plane edge-to-edge with the tooth.

It may be helpful to take several photographs at different f-stop settings on a digital SLR camera so that variations in colour tone and surface texture under different lighting conditions can be observed. Remember to note down which shades were photographed and under which photographic conditions.

4. In addition to using a face-bow, provide an anterior stick bite. It is preferable to have your patient standing when performing this procedure. You may decide only to have the patient sit up, however in any case never take a stick bite while leaning over your patient. This can and often does create the illusion of a cant.

With the stick bite (now cured) in the mouth, take a photo of the patient using the Polaroid Macro 5 SLR. When using the Polaroid Macro 5 SLR, you will notice a grid in the viewfinder. Preset the dial on the camera to the desired distance, setting ‘0.4x’ (1:10 magnification). Using the grid in the viewfinder, align the centre gridline with the patient’s inter-pupillary line. Move the camera in and out (away from or towards your patient) until the two white lights align and take the photo.

When the photo is ejected from the camera, write the patient’s name on the bottom of the photo.

5. As a rule in a smile makeover case, you will be seeing your patient for a post-operative appointment to adjust occlusion and check final length of centrals.

If the final length of centrals is adjusted, you must send new impressions of the final temps along with the new measurement of the final central length to the laboratory. Take a fully retracted view on setting ‘0.4x’ (1:10 magnification), showing the gingiva and the incisal edges silhouetted in a full face picture (forehead to chin).

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