Dental technicians represent integral members of the dental team and much of our clinical work would not be possible without the input and expertise of our technical counterparts.
With the ever-increasing range of materials and products available in modern dentistry, effective communication between dentist and technician has never been more important.
Jignesh Panchal (JP): What is your role at Liverpool University Dental Hospital (LUDH)?
Mike Aspden (MA): Officially I have two separate roles at LUDH. My first is based in the hospital’s prosthetics production laboratory – which is the role that first brought me to LUDH. Here I am involved in the construction of many different kinds of appliances from simple acrylic dentures to complex implant retained cases. We work differently from many dental laboratories in that you complete all cases from start to finish instead of just being responsible for one aspect of the construction process for an appliance; this is one of the reasons that attracted me to working within the dental hospital.
My second role is as a dental instructor in the teaching laboratories. This involves working with the BDS undergraduates, mainly the second year Introduction to Clinical Practice course.
JP: Which topics do students often struggle to grasp?
MA: The dark art of removable partial denture (RPD) design – I would say this by far is the number one topic I get asked about, and I think one of the main reasons why is that there is no single correct solution to each denture design. What one clinician would do in a certain situation another clinician would do slightly differently and I think this is what makes students question their denture designs.
Another aspect that students often struggle with is what information the technician requires to construct a successful immediate denture. Immediate dentures are often the first denture the patient is ever going to wear and not only must it function as a dressing plate and maintain/restore masticatory function, they must be aesthetic as the patient has to wear it until bone resorption has stabilised.
As they are usually constructed without the patient able to have a try-in to assess the aesthetics, the more information about how the patient would like the set up of the teeth the better.
Combination cases – these can be a headache for everyone involved if the treatment plan is not thought through properly. The order and timing of appliance construction when dealing with a patient that requires multiple appliances can be a problem if communication with the laboratory is not excellent – remember the denture design is your first job but the denture itself will be the last thing to be constructed. Make sure you are fully aware of what you are doing and in what order, and if in doubt seek out advice.
JP: What advice would you give with regards to some of these difficult concepts?
MA: When considering RPD design, you have to be confident in the basic technical rules. If you don’t know these, you are going to find it difficult to formulate a suitable design.
Students should know the specific reasons when to use certain components in particular situations and this is one of the first steps to becoming competent at RPD design. If the patient already has an RPD that they have worn successfully, it would be prudent to your base your design around the old prosthesis, utilising the acceptable design aspects and improving upon the incorrect elements.
Articulated study models are required to correctly design a RPD and their correct use will minimise spending valuable clinical time grinding CoCr rest or clasps that are interfering with the patient’s occlusion.
Lastly, do not be afraid to ask questions if you do not understand the reason why someone has designed an RPD in a particular way.
My advice for students regarding the concepts of immediate dentures and combination cases would be to make sure you have a basic understanding of what the technician has to do once the work is in the laboratory. Mistakes, delays and remakes can be avoided or at least minimised with appropriate communication.
Top tips for young dentists sending work to the lab
- Good communication – this cannot be stressed enough. Poor communication can be the difference between a happy patient and a remake
- Give your lab feedback – if something worked well, great, give positive feedback. A lot of effort goes into making dental appliances, which the patient, and often clinician, is unaware of. It is nice to hear that the patient was happy with something you made. On the other hand, if something didn’t go as planned tell the lab, we cannot fix something if we don’t know about it!
- Do not cut corners – in my experience this is the fastest way to end up having to remake an appliance. Undertaking each step in a comprehensive manner will maximise the chance of success
- Remember to disinfect – not just your impressions but all appliances that have been in the patient’s mouth – the lab cannot work on anything that doesn’t have proof of disinfection
- Only send your best effort – if you look at your impression and think it could be better, do it again. It will probably save you time and effort in the long run
- The lab is your friend – we are here to help and give advice if you need it, if you’re not sure just ask!
Jignesh Panchal is a fourth year BDS at the University of Liverpool.