When I was a practicing orthodontist, I realized the importance of effective communication with my laboratory. The lab is integral to dentistry — from fulfilling the clinician’s plan to providing materials for the individualized needs of the patient. The dental lab should have a partnership rather than vendor-type relationship with the dentist. According to the American College of Prosthodontists, “Unlike a pharmacy, where prescriptions are ‘filled’ with medications that are shipped to the pharmacy, dental laboratories fabricate each patient’s prosthesis prescription using industry-specific materials. The creation of these products begins at diagnosis, when the dentist determines a restoration is necessary for the patient.”1 The success of this partnership depends on open communication between the lab and the practitioner.
An article in the Journal of the American College of Dentistry attempted to sum up the complex dentist-laboratory relationship. It points out that the rapid changes in materials and procedures in the field of dentistry impact the way dental offices and dental laboratories work together. Complicating things even more, as the internet provides more information, patients have started to demand certain procedures and materials, sometimes even by brand name. “In order to navigate through these challenging waters, the relationship between dental office and laboratory must become one of partnership. The relationship between dentists and laboratories should be viewed as an interactive system. With full participation, better education, and wise management of information, this partnership can grow to the benefit of all concerned.”2
With the dentist obviously in charge of the diagnostics and treatment, cultivating full communication and collaboration between clinicians and the lab sometimes become frustrating. How many times does a lab just get prescriptions without interaction or additional details? Getting the case right involves much more than a piece of paper or electronic order. When a case doesn’t fit, or restorations fail, a lack of communication between the laboratory and the clinician could be the cause, especially in complex cases.
What can laboratory professionals do to promote effective communication? As a clinician, I turned to a person with both lab expertise and clinical connections, Roland DGA’s Dental Marketing Manager, Lisa Aguirre offered some insights.
Communication has to start in the treatment planning phase, Aguirre noted. Especially for complex cases, it’s important the lab makes it clear to the clinician that they want to be involved and can serve from the onset of the treatment planning. The more information the lab can receive from the dentist, the better they will be able to create a solution that suits individual needs. By opening up the line of communication, the lab can help set the patient up for success from the beginning. Lab professionals are very aware of specific materials that can benefit complicated or special needs cases.
As a lab professional, Aguirre shared several ways that the lab can become an integral part of a dentist’s process.
Communicate early
Communication from the onset of treatment saves the clinician time and avoids redos. This affects not only the clinician but also improves the perception of the practice. Every time that patient has to return for another piece of information that the lab needs, chair time and patient time is wasted. No one wants their patient to think, “What is wrong with these people? They can’t get it right? How did they not know they needed this from the beginning?” When an issue with the case early on creates a shadow of doubt in the patient’s trust, that often is the beginning of a bigger problem. Even if the glitch is not the fault of the lab or the dentist, early collaboration can fill in the information gaps and avoid resulting distrust. And, even better, the lab nurtures the perception as a valuable partner in setting the patient (and dentist) up for success.
Don’t assume
The lab should never be in a position where the doctor is assuming they can fill in any missing pieces of information. Effectively communicating goes beyond the doctor just speaking with the lab and sending the prescription. If a practitioner sends just a prescription, the lab representative can suggest that they would appreciate more supporting information for further insight such as a quality scan, study models, and excellent digital photos, both intraoral and extraoral.
Set realistic expectations
The lab can also serve to modify and put patient presumptions into perspective. The lab can help the clinician to set realistic expectations. For example, it is not unusual for a patient to request cosmetic treatment like a full mouth reconstruction and arrive at the consultation with a photo of a celebrity, requesting to look like that star. The photo is not usually just of the teeth. It is usually a full-body photo, so the patient is under the perception that after the procedure, they will look like the photo. Even the most remarkable dental reconstructive results probably will not make this type of patient happy. Lab reps can discuss with the clinician the expectations of the patient and the limitations on their expected results. That communication should include discussion of the various aspects of the patient’s challenges like insufficient bone structure, failing dental work, poor oral hygiene, a canted midline, or other details. All of those details trickle down to the laboratory. If the clinician does not relay the information to the laboratory for example that this patient wants to look like a specific celebrity or the patient’s insistence on a specific but unrealistic outcome, it can create friction in the lab/clinician relationship when the case is perceived as sub-par.
Armed with the total picture of the treatment plan and challenges, the lab can focus on what is actually possible clinically for that patient, and so with confidence, the dentist also can be honest with the patient and be able to say, “While I understand that you want to look like this, I know that I can give you an amazing new smile, but you cannot expect to actually look totally like this celebrity.”
Overcommunicate
It may be better to overcommunicate to the doctor than under communicate to avoid misperception and misinterpretation. This protects and maintains the integrity of the relationship between the lab and the practitioner. It’s important that a clinician knows that their laboratory can be trusted to be honest with their opinions. Basically the practitioner is putting his/her restorative reputation in the laboratories’ hands so the clinician needs to be confident in their recommendations. Being respectful but ready to offer constructive suggestions, the laboratory can truly become the clinician’s trusted partner. It often takes tact to help steer the doctors and patient in the right direction to keep them out of trouble.
Labs and doctors should act as treatment planning partners. When in doubt, everyone should be comfortable sharing ideas. Speaking up at the beginning is better than damage control down the road. The same way that the practitioner wants the patient to say, “I love my dentist,” the lab should look forward to hearing from the dentist, “I love my lab.”
References
- American College of Prosthodontists. Dental Laboratory/Dentist Relationship. (Position Statement of the American College of Prosthodontists). https://www.prosthodontics.org/about-acp/position-statement-dental-laboratory-and-dentist-relationship/. Accessed June 1, 2023.
- Warden D. The dentist-laboratory relationship: a system for success. J Am Coll Dent. 2002 Winter;69(1):12-4. https://pubmed.ncbi.nlm.nih.gov/12066434/. Accessed June 1, 2023.
Originally published in the Journal of Dental Technology – August/September 2023
Written by Dr. Lou Shuman
