In my early days as a dentist I thought of dental laboratories as an abstract concept. I had no idea what they looked like or what was done in them. Send the lab your models and impressions, then in a few weeks the patient's crown, bridge or prosthesis would return in a nice box.
Coming from dental school, I had no concept on how a lab worked or how to communicate with them in the accepted manner of the time. This faceless relationship worked to my detriment, since if a case was returned from the lab and it did not work, the lab was immediately blamed. Excuses such as, “The lab missed the margin,” or “The occlusion was sent back wrong,” trickled into my daily lexicon. I would call the lab to express my displeasure and essentially cast myself in a poor light with the labs I used.
I ended up changing labs several times to see if I could set up another victim for failure. What I did not realize at the time, was the labs that saw me in a poor light were getting rid of me because of my behavior and demands. Yes, friends, labs do ditch dentists. We see instances in Spear Talk where a dentist is disappointed in the lab, and says, “I am switching labs. Does anyone know a good lab?” Well labs do the same thing. They ask, “Where can I find a good dentist?”
As my career progressed, I had the opportunity to own a commercial dental laboratory. This became a transformative experience in my career. For the first time, I was able to see what processes a lab goes through in their daily workflow to fulfill prescriptions for their dentist clients. It put me in a somewhat unique position, as a dentist who sends his cases to a lab that he owns, and it cast a very unfavorable light on my previous attitude toward labs.
My newfound lab/dentist relationship finally enlightened me to how labs and dentists can work toward better understanding in order to provide the best services to our patients.
Dental practices and dental laboratories have two completely different business models. One is a human services business and the other is a design and manufacturing business. Since the business models are so different, it can be hard to understand what each entity encounters in their daily workflow.
This situation can lead to unfulfilled expectations and disappointment, when a lack of understanding between the lab and the dentist exists. The lab needs to acknowledge that cancellations on a dentist client’s schedule can profoundly impact their productivity for the day. The helpful solution is for the lab to deliver cases days prior to the appointment so that the schedule can be filled with productive procedures.
Conversely, labs appreciate understanding from dental offices when the manufacturing and shipping/delivery process can be delayed for various reasons.
The optimum solution to the disconnect problem is when labs and dental offices make the effort to know each other better. This can occur either through reciprocal visits for a couple of hours or, if distance is a factor, using teleconferencing. Mutual understanding of each other's business model is critical for both parties to make good decisions on behalf of their patients.
The stories go something like this:
A case from the dental office arrives at the lab. The lab has a question about the case and cannot proceed without more information from the dental office. The lab puts the case on hold in the production queue potentially delaying the delivery date until it hears from the dental practice. The dental practice does not return the lab’s call on a timely basis. Subsequently the dental practice calls the lab and asks, “Where is our case?” The lab says, “You never called back on this case. It will not be there when you requested it.”
The dentist calls the lab about implant parts that are essential for the patient's appointment in a few days. The lab doesn’t call back on a timely basis resulting in the patient's appointment needing to be rescheduled, resulting in lost productivity for the dental practice.
Both scenarios lead to bad feelings that could have been avoided if communication was done on a timelier basis. Taking the time to reciprocally provide necessary information will lead to a less stressful working environment and ensure that patients are treated more respectfully.
We all know how important photography has become in developing our treatment plans. In esthetic cases, it has become an indispensable form of communication between the dental office and the lab.
There are several ways to expedite your cases when sending photographs to your lab. Firstly, we and several of our dentist clients have benefitted from training a staff member to capably take all the images, manage the files and transmit them. We have found that taking the time to train is an investment in increased productivity, since the clinician can be doing other more productive procedures while the photography is managed by your trained staff member.
Labs love to see full-face photos when extensive rehabilitation cases and esthetic cases are prescribed by their clients. It allows them to digitize the facial images, allowing the face to be the primary framework of the restorative design. With the current digital design software available to dentists and labs, it is possible now to create virtually perfect balance, symmetry and esthetic design to transfer to the finished case. Our clients have found that using the face as the standard allows for a more predictable process with reduced chair time and a more relaxed insertion appointment.
Labs are so appreciative of any photos that come with the case but are most happy to see files come in that are taken with a digital SLR system using the optimum lens and flash setup. Labs do also truly appreciate the images taken with a smartphone, but we have found that the smartphone pictures present a convex “moon face” appearance for the full-face photos.
Most of our dentist clients are pleased that they made the investment in a good dental SLR camera system.
The best way to keep your trusted lab happy is to pay on time. Just as dentists are unhappy with aged accounts receivables, the labs are hit even harder because of the large comparative difference in profit margins for each business model.
Additionally, dental practices have a large patient base to spread out their accounts receivable whereas labs have a much smaller proportionate number of clients. This circumstance makes it harder for labs to overcome aged accounts receivable and to have enough funds for operating expenses.
In the not-so-distant past, our prescriptions were carbon copied paper and consisted of “PFM #19.” Now with the availability of many different restorative materials, the astute clinician can make clinical and esthetic decisions based on flexural strength, translucency, esthetic layering materials, occlusal design and sulcular emergence.
This volume of information has become critically important to the lab in order to provide a prescription that is fulfilled to the dental office’s satisfaction. Detailed narrative provided to the lab by the dental office keeps the case in the lab’s workflow instead of playing time-consuming phone tag and avoiding delays with the return date.
As a general trend, we are seeing many less paper prescriptions and more digital prescriptions. The first reason is that we are seeing more intraoral scans transmitted electronically. The scanning systems will cue the dental office through a file submission checklist before the scan file can be transmitted. This process essentially requires the dental office to provide adequate information to the lab before submission is approved. This has led us to receiving more detailed information from dental offices with the digital scan process.
Secondly, many of the lab’s clients are using their lab’s management software either through portals from the lab’s website or directly from the lab management software’s site. Communication through these portals allows the dental office to instantly send prescription details including photos.
For dental offices using the physical impression process, your prescription is already in the production queue even before your case physically arrives on-site. This process can save the dental office days in turnaround time instead of the lab having to wait for the paper prescription to arrive with the case.
What’s No. 1?
I had some discussions with lab owners about which of the above five items were most important to them. Unequivocally, they all said that having the dental office call back was by far more important than anything else discussed in this article.
I hope this article helped cast some light on a very important topic that is critical to the wellbeing of our patients.
Edward J. Roman, D.D.S., (www.romanvaughan.com ) is a dental laboratory owner who maintains a private practice in Washington, Pennsylvania. He is a member of Spear Visiting Faculty and a contributor to Spear Digest.