Editor's note: This is Part 1 in Dr. Winter's four-part series on dentist-lab relationships.
I have written quite a few pieces on lab communications over the years, generally focusing on tips and techniques for improving restorative outcomes. These articles have all been based on my experience doing my own lab work or when working with technicians in my commercial dental lab.
For this Spear Digest series, I decided to poll dental lab owners/technicians and dentists to find out their “Top 5 Pet Peeves” when working with each other.
Understanding common issues by considering each other's perspectives only helps to improve communication between these two members of the interdisciplinary team.
When talking to dental labs and technicians, the No. 1 thing they described that inhibits their working relationship with dentists, was poor communication between the dentist office personnel and the lab. Specifically, receiving multiple calls from different people within the dentists' office asking the same questions about the same cases.
This is time-consuming for the lab, and often causes confusion in the dentist's office.
No. 1 – Poor communication
Consider these steps to improve communication between your office and the lab:
- Assign one person in your office to communicate with your lab or lab technician. This person should be the only one calling to check on cases or provide additional information not handled directly by the dentist. A backup person should be designated in the event your primary designee is unable to do the call.
- Keep a log to record calls and note the topic covered to help prevent repetitive communications. Complete the log with case specific questions you have before making your daily call to the lab. The log should clearly note the patient's name, the date of the call, the time of the call, the name of whomever was contacted at the lab, the reason for the call, the result of the call, if a follow-up is needed (and date of follow-up, if required).
- Consolidate all your questions into one call whenever possible. While last-minute questions can pop up during the day, waiting a bit and making a single call saves time.
- Return your lab's calls in a timely manner. Your case will likely “sit on hold” until they get a response from you, pushing back the anticipated return date.
No. 2 – Receiving 'complete' cases
There is an ethical and legal obligation that places specific requirements on dentists to provide adequate written instructions to the dental lab, and for the technician to manufacture the restoration based on the specifications provided.
In one of my previous articles, I referenced research published in 2011 that indicated 67% of dental prescriptions were non-compliant. One 2020 article indicated that things had gotten worse rather than better, with 85% of dental lab prescriptions not meeting the legal criteria required.
Best practice includes the following steps when submitting your cases to the lab:
- Complete the prescription in its entirety. It is a time-consuming step, especially for complex cases in the treatment process, but necessary to avoid restorations that fail to meet expectations. It minimizes or eliminates calls from the lab to gather missing information and reduces delays in receiving the case back. In the event one of your patients sues, an incomplete dental prescription can be used in the process of assigning fault. You also cannot expect a lab to remake a restoration for no charge if you did not provide the correct information to begin with (this will be addressed in Part 2 of this series).
- Be sure the photos sent to the lab are for the correct patient and include the required information (see my article, “Essential Photos to Achieve Predictable Outcomes - Lab Communication”). Failure to include this information can result in restorations that fail to meet expectations for shade, incisal and occlusal plane level, and tooth position and arrangement.
- Lab staff members I spoke with told me they often receive impressions/casts that are distorted, broken, or have not be disinfected. Double-check all impressions and casts for distortion and properly label and package them before sending. Proper padding or use of bubble wrap will help ensure your patient information is received at the lab in useable form.
No. 3 – Dentists and practice teams scheduling patients prematurely
It's a common frustration for labs to see dental practices schedule patients before finding out when their case can be returned to the dentist's office. While patients always want to have their case seated as soon as possible, and dentists often do not collect their fees until the seating appointment, dental labs simply cannot accommodate the specific schedule for every dentist and patient whose case they fabricate.
It is crucial that you and your staff set proper expectations with your patients about return dates. This is especially important now, as there are numerous pandemic-related supply chain issues with implant components and routine laboratory materials often out of stock, or manufacturers and supply companies experiencing shipping delays.
My suggestions to avoid the stress of having to reschedule patients:
- Wait to schedule your patient's seating appointment until you receive a return date from the lab. If you do feel the need to “preschedule,” be sure your patient and staff understand the appointment is tentative until you receive the case return date, and that the date may need to be moved. Your lab may accommodate a “rush case” for a premium charge, but this is often the exception rather than the rule.
- Set the proper expectations with your staff. This includes their understanding that labs produce and return restorations in the order they are received. Oftentimes, office staff do not understand what happens when the case leaves your practice and may have no idea about the amount of time it takes to produce a restoration, especially if you are working with a high-end lab. Just because your patient wants to have the restoration seated by a specific date does not mean the lab can accommodate that schedule. When faced with specific patient demands, it is beneficial your office personnel have a script to follow on how to handle this issue.
- Set proper expectations with your patients. My staff and I are very up-front with patients about the time required to produce a quality restoration and we let them know that we cannot set up their next appointment until the lab receives their case and provides a return date. Most are very understanding of scheduling limitations when you are truthful and specific in setting expectations. While labs understand your patients' desire to finish quickly, or prior to a “special event,” it is often impossible to expedite a case's return. When preferred scheduling is possible and additional fees will be charged, be sure the patient understands that they are the ones who will absorb the additional costs.
Part 2 in this series will discuss the final two pet peeve topics labs would like to see improved when working with dental offices, and some suggestions on how to mitigate any associated problems.
Robert Winter, D.D.S., is a member of Spear Resident Faculty.