Like peaches and cream…
Luke Barnett considers the ingredients which go into creating the perfect working relationship between dentist and technician
Lennon and McCartney; Fred and Ginger; Morecambe and Wise; Dalglish and Rush. That is how a good relationship between a dentist and a technician should look. They complement each other and go together wonderfully. And, I am lucky enough to say that in the most part, that is my experience with the dentists that I work with.
I have always maintained that the relationship between clinician and technician should be that of a partnership – we can both learn from one another. We will only deliver the best results to our patients if we work as a team and pool our knowledge and shared experience. Nowhere is this truer than in the field of aesthetic and cosmetic dentistry. The more that technicians and dentists can communicate, the better that they can understand each other’s role in the process. I have spent some time considering those parts of our mutual work which have the potential to be problematic and how we can work together to overcome these.
How often should a dentist and technician be speaking? Perhaps some of you are surprised that we even should be and that the lab docket will convey everything? Well, a good docket (and there are some bad ones out there) should contain the information required in most cases. Make sure that the lab dockets you are using give enough space to relay all of the case details. Vital in larger cases, but in any case, the more information that we have the better. Take the time to relate this to us and we can deliver what the patient desires first time.
However, there will be those occasions where more details or a further discussion is needed. And at that point, it is important the dentist and technician do communicate. We don’t need to be in each other’s pockets or speaking five times a week! But occasionally it is necessary that we do communicate, and that dentists realise that the technician is not trying to waste their time. Cases can be delayed in the absence of that conversation and this is good for no one. The more closely that we work, the better the understanding that will develop and the better the final result. Dialogue is essential for a good long-term working relationship and the technician should be considered as another member of your dental team. This communication doesn’t necessarily need to be verbal – the modern world has made keeping in touch so easy. Facebook, Twitter, WhatsApp, and Messenger – these can now be used on phone or tablet.
Indeed, digital communication is on the march more generally – it is not just about accurate substructures anymore. Digital Smile Design continues to grow unabated. Many continue to invest heavily in 3D printing and state-of-the-art milling equipment. We are able to accept STL files from dentists and other laboratories – open source via Dropbox is an exciting prospect as it allows everyone to share files. Ultimately, digital intraoral scanning may eventually even lead to the end of impressions (perhaps some way off).
All ceramic work
It seems to me that many people underestimate just how difficult this can be – it is much more complex than some give it credit for. Tooth colour is absolutely critical and I am sad to say that it is not uncommon that we don’t get all the information first time. I also believe that some in the industry have perhaps oversold the benefits of minimally invasive dentistry. In an ideal world, the patient would visit the laboratory for a consultation. By doing this, we can achieve the most accurate reproduction of natural dentition.
We and you need to invest time, effort and (unfortunately) money in dental photography. If it isn’t possible for the patient to visit the lab for shade matching, then this becomes even more crucial. Attend a course if appropriate and ensure that you can take well-lit, crystal-clear photographs. Make sure that you know your camera well and the settings are correct for each picture. A good place to start would be www.bacd.com to download the British Academy of Cosmetic Dentistry’s guidelines for photography. Once the pictures are taken, social media is a great way to share them.
Any case should begin with accurate models. It is still a regular occurrence for the lab to receive models with no margin. I know of a large number of dentists who will get their nurses to do the alginates without training them or then invest their own time in knowing how to read them properly. Ensure that the laboratory that you are working with is using a high quality model-making system such as the Pindex, Girrbach or Zeiser.
Consider your options
When considering anterior work and smile design, bear in mind options such as short-term and long-term orthodontics and soft and hard tissue changes which can make all the difference to the final outcome. Composite can be an option but for the long term, porcelain crown and bridgework is hard to beat. It is a sign of modern times that many of today’s patients are interested in the quick fix – as clinicians and technicians we have a duty to make them aware of the drawbacks of such an approach.
I know that many GDPs find it difficult talking about the money side of things. However, if a patient doesn’t understand why, for instance, a single anterior attracts a high price then of course, there is no way they will pay that premium. They need to be educated into what goes into a superb anterior – the layering and time involved to deliver a really lifelike result. Then, GDPs may be surprised to find how many will pay for real craftsmanship – certainly we are lucky with the dentists that we work with.
I’ll be blunt. Don’t go to China. If you do, and you’re still in your 30s, you may find that when you want high-quality laboratory work by the time that you reach your 50s, this will be unavailable in the UK. The work from China is uncontrollable, unpredictable and damaging to UK dental technicians and UK dentists. You may also find yourself ending up in a dento-legal battle down the line when it’s discovered the work contained substances that it wasn’t meant to.
I like to look at the standard level laboratories in the UK as the acorns from which the mighty oaks can grow. And if you use Chinese labs, these UK-based labs will go out of business and there will be no UK technicians with careers to progress. I think that we all have a duty to preserve the best of the UK professionals and artisans for future generations.
Again, almost all of these key areas boil down to good communication. I hasten to add that this improved communication and demand for more information is now likely to be driven by the modern patient. They can, and have every right to be, very demanding and only by working closely together, will dentist and technician be able to satisfy their demands for perfection. I would also like to point out that you are likely to end up with a friend into the bargain! It is certainly not unusual for me to consider many of my clients to be friends – I consider it a privilege to work closely with such motivated clinicians.
The alliance between a dental technician and dentist is truly a relationship – and benefits from all the good things that brings, as well as occasionally, the detrimental ones!