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Sun 7 Oct 2007 01:29 PM

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Laws of the lab

Poor laboratory communication shows in your treatment results. MED reveals top tips from technicians that can upgrade your restorations from good to great.

Poor laboratory communication shows in your treatment results. MED reveals top tips from technicians that can upgrade your restorations from good to great.

It's often said that the secret to any good relationship is communication. Of course, people are usually talking about personal relationships, but why should business relationships be any different? Particularly in a profession such as dentistry that relies so heavily on teamwork. Within the structure of the dental team, the relationship between dentist and technician is one of the most important.

Vital to the success of certain courses of treatment, it relies on a mutual understanding between two people, which culminates in a positive experience for the patient.

Yet, if it is such an important aspect of specific treatments, why are remakes, disappointments and failed lab work so prevalent? According to the experts, it all comes back to communication again and a lack of it. Learning how to become a better clinician in the eyes of your technician can make laboratory letdowns a thing of the past.

A standardisation of terms would be very useful. When you get lots of different terms being used…we can think we are doing one thing when the dentist actually wants us to do another.

Talking point

"In Dubai there is very little communication between dentist and technician," says Lamberto Villani, director of dental laboratory Oral Design, based in Dubai Healthcare City. "It is something I want very much to change but it takes time and it will require a change in culture in the profession out here."

Villani, who opened his business in Dubai in 2006, cites a lack of willingness to discuss specific cases as the core reason for the breakdown in communication.

"The usual pattern of events is the dentist will ask for what they want and if, as a technician, you have any questions and ask for a meeting to discuss them, it is almost impossible to get them to agree."

His response to the problem is education and indeed, Villani is a well-known speaker on the subject with a stint at the upcoming FDI conference already booked in.

However, on a more regional scale, he is making contacts with European and local dentists and proposing the idea of creating a monthly study club, which will bring dentists and technicians together and encourage them to discuss any areas of debate and share their knowledge with each other.

"The idea of the study club is to get together on a regular basis to talk about any problems and to help improve our expertise. For example, if they are having trouble taking clear impressions, then we can study this together and take a significant step forward, which will help us all."

Comprehensive impressions are top of Villani's list for improving the dentist-technician relationship.

"For me clear impressions are the most important thing. Without a clear impression you can't do a good job," he says. "If the impression is flawed I have to invent or imagine what is there and then the work can be useless. It is a technical problem that can be solved with the right co-operation."

Cash queries

Villani also believes that the question of money should be considered right at the beginning of the relationship between surgery and laboratory. He has developed a three-tier pricing system, which is easy to understand and allows the dentist, as the client, to decide what kind of work they are looking for.

They can choose from a silver, gold or diamond package, with silver being at the lower end of the quality scale.

Villani says that pricing in this way ensures that both members of the partnership know exactly where they stand from the beginning and reduces the risk of financial disagreements further on down the line.

At the top of laboratory owner Mark Oborn's wish list for a hassle-free relationship with clients is the standardisation of dental terms across the board. Oborn, director of SBO Dental Laboratory in London, UK, says that he finds dentists use different terms to describe the same thing, depending on where they've trained.

"A standardisation of terms would be very useful for technicians," he says. "When you get lots of different terms being used it can get very confusing and you can often end up with a situation where we think we are doing one thing when the dentist actually wants us to do another."

When asked if a standard ‘prescription' form that dentists could use would make life easier, Oborn isn't convinced. "At our lab we've tried using a standard form for all dentists and treatment before but it has tended not to work," he says.

"I think this is because the lab and the surgery are so busy that you all start off with good intentions but it tends to fall apart after a short period of time."

"You have to remember that both ends of the process are being looked after by people who are very technically focused and want to do the work to the best of their ability, so often filling in forms and following very strict formats and protocols is counter-intuitive for them and it just doesn't get done. When the standard form procedure fizzled out I wasn't happy, but it's about looking at the needs of the dentists as a customer and the technician as a supplier and finding something that works for them, rather than forcing them to do something that they don't want to do."

"My attitude now is that if it doesn't work, we move on and try something different. There are always other avenues of communication to try."

Digital evolution

One such avenue that Oborn says has made a difference to his relationship with dentists is digital communication.

"The internet and email have made a big difference to communication because dentists are now able to send photographs over to us instantly," he explains. "It used to be that you could only get to grips with what the dentist wanted by seeing the patient and obviously that has considerable geographical limitations. Now photographs almost eliminate that need. It allows there to be a dialogue rather than one-way communication."

And, because technicians are not working ‘blind', Oborn explains, they are able to use their expertise to advise the dentist; creating a better end result. "Usually the dentist would say ‘this is what you've got to do', and because we hadn't seen the patient, we were in no position to comment."

Now, with photographs available, we are able to look at what the dentist wants and then, if necessary, phone them back and present other options.

"We have one dentist who takes photos with his mobile phone and emails them to us. Now, they are pretty useless, but it is still more information than we would usually get and it allows us to have a sort of virtual patient in front of us and a clearer understanding of what is needed."

Steve Chang is a technician at Ivory Dental Laboratories in Los Angeles, USA. Like Villani, one of his most pressing issues is the lack of clear impressions he receives from dentists.

"The only problem I have with my dentists is trying to get them to understand what's wrong with their impressions. A lot of my clients let their assistants take the impressions, which can cause problems with quality.

Generally I would like to see them undergo more training before being given that responsibility. When I raise this with the dentist it can be a little difficult to get my point across."

So how does he overcome these problems? "I think it is all about building up a good relationship to start with," he notes. "I mainly communicate with my clients regular phonecalls and I am able to build up a good working relationship over a sustained period of time. It fosters an environment where dentists feel that they can tell me when something I am doing is not quite right and vice versa. Obviously, you need to work at it, but it does make a difference to the job."

Unlike Oborn, Chang hasn't seen a massive increase in digital photographs as part of the process but thinks this will change in the future.

"I haven't seen a lot of advancement yet, but I'm sure this will change," he says.

"Digital imaging will start to play more of a part, particularly now that patients are more cosmetically driven. However, dentists need to be careful that certain digital images don't give patients false hope of the outcome. Sometimes the final result doesn't always match up to their expectations."

Med tips: technicians talk back

• "Keep up to date with the latest materials," says Lamberto Villani. "Zirconium dioxide and other metal-free materials are becoming increasingly important."

• Take as many photos of the patient as you can to help the technician with their work. Digital photos are ideal because labs can store them indefinitely and they can be shared among the team easily. Sometimes laboratories can manipulate an image to make certain aspects stand out more, which makes finding solutions to certain cases much simpler.

• "Writing legibly seems like a simple request but you would be surprised at the amount of people who don't do it," says Mark Oborn. "Taking time to make sure you do would really make a difference to your technician."

• Regular phonecalls between dentist and technician can be invaluable for building up a good relationship. Try to put 10 minutes aside a week to check in with the lab and ensure all is running smoothly.

• If you are going to use standard request forms for all work, make sure that everybody in the practice and laboratory is familiar with the terms and format, and uses the same form. It is no good part of the team being committed to a certain procedure and others opting out.

• If there is a particular problem with clear impressions, consider asking a technician to give up some time to give an impression workshop to the dentists in the practice. The time spent learning will be tiny compared to the time and goodwill you could lose by producing inadequate impressions.

• Make sure that everyone knows their role in the team and use each member's expertise to get the best result for the patient. Having a good technician on board is worth its weight in gold for a successful practice. Know your limitations as a clinician, and always ask for advice if you think somebody else has more experience.

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