Communication is the Key to Keeping Your Promises
The laboratory can only give predictable results if the dentist provides all the necessary information. All relationships between the restorative dentist and the technician come with responsibilities for both parties that need to be met. If we do not fulfill our portion of the responsibilities then there’s no way we can blame the technician if they don’t deliver the correct results.
Hopefully, we are in communication with each other from the beginning of the treatment planning process. Let’s assume that the teeth have been reduced adequately for the type of restoration and the material selected and our provisionals have been fabricated from our diagnostic wax up. After the teeth have been prepared, impressed and temporized how do we effectively communicate to the lab how to fabricate the case as temporized? In other words how do we communicate to the lab what we have promised to the patient?
Impressions and photographs of the provisional(s): For many reasons, it can be important to appoint your patient to evaluate the provisional. This will allow you to make any functional or esthetic alterations if they are needed. Our patients are not dentists and allowing them to comment on the function and esthetics of your provisional can eliminate costly and time-consuming remakes of the final restorations. Once you and your patient feel this is perfected, make an impression of the provisional for the lab to use as a guide for the final restorations. In addition, you should also take a picture of the patient smiling with the provisional in place to the technician can see the provisional relative to the face.
A Facebow and photographs: The Facebow is necessary so that the technician can mount and fabricate the case to a known reference. In addition, it can be helpful to photograph the patient’s face with the Facebow in place so the technician can see where it was oriented in relation to the eyes or a known horizontal reference like venetian blinds. The latter is used when the eyes are not a good parallel point of reference to the incisal plane. In these cases an external parallel horizontal plane can be very helpful. And this can only be communicated in a photograph with the facebow in place.
The lab mounts the models and marks a silicone index of the provisional as a guide. Most technicians will use a matrix of silicone putty of your provisional model. After that is made, they will fabricate the final restorations in order to recreate the correct incisal edge position and incisal plane that you created in the provisional.