Editor's note: This is Part 2 in Dr. Winter's four-part series on dentist-lab relationships.
As I explained in Part 1 of this series, having written quite a few pieces on lab communications over the years on tips and techniques for improving restorative outcomes, I thought I would poll both dental lab owners/technicians and then dentists to find out their “Top 5 Pet Peeves” in working with each other. Not surprising, you will see that many overlap – though from significantly different perspectives.
Part 1 discussed the first three of the labs Top 5 pet peeves. This included poor communication between the dentist office personnel and the lab, sending cases without the required information to successfully produce restorations, and scheduling patients before finding out when cases can be returned to the dentist's office.
This article will now discuss the final two: establishing who is responsible for remake costs and not properly disinfecting cases.
No. 4 – Responsibility for remake costs
Remakes are costly for both the dentist and the lab, and not surprising, made the Top 5 list for both groups, since it is associated with lost revenue for each.
For the dentist, it is office overhead and lost patient revenue. For the lab, it is facility overhead, material costs, and lost restoration revenue. With the annual salaries of highly skilled or master ceramists in the range of $100,000-$180,000 or more, lab overhead can match or exceed that of the dentist. Where there is often conflict is when determining whose “fault” it is, and who should absorb the expense of the remake.
Labs reported to me that they have lost clients to labs with a “no fault” remake policy when they feel the dentist is the one responsible for the outcome. While deciding which lab to use is a business decision every dentist makes based on their practice model and client base, it is not fair to assume that the lab is always at fault.
When the dentist provides all required information needed to produce a restoration (completed prescription, impressions – both analog or digital- with clear margins – and appropriate photos), and the lab proceeds without questions or clarifications, the lab should absorb either the partial or complete cost of the remake.
If the dentist sends incomplete information – whether it is the prescription, impressions without clean margins, or a shade designation without accompanying photos – or they do not provide additional information requested by the lab, it may be the dentist's responsibility to pay for all or part of the cost of the remake. In addition, if the dentist or their office tells the lab to “make it work,” the dentist should be responsible for costs since they have not provided enough guidance for the technician to be successful.
It is highly unlikely and fiscally biased for either party to assume the other is always responsible for the full cost of the remake. Before using a lab, be sure you discuss its remake policy and understand how these costs will be handled.
No. 5 – Standards for disinfection
Improper disinfection of items sent to the lab is a health hazard for both the dentist and lab and could potentially have legal ramifications. All dental practice staff responsible for handling impressions and other restorative items or components that could be contaminated by patient blood or saliva should be trained in their proper disinfection in alignment with current CDC and ADA guidelines – and that training must occur well before they send these items to your laboratory.
Such fluids can contain viral and bacterial pathogens, including HIV, COVID-19, and hepatitis A, B, and C. The process of cleaning any dental material involves removing all blood, saliva, etc. from the surface of the object. Do not dry with air or steam since either can spread aerosols. Disinfection methods depend on the materials being used and your office workflow (analog vs. semi- or full-digital workflow).
There are several guides available online outlining the appropriate methods. Communication between the dental practice and the laboratory is essential to ensure that appropriate disinfection protocols are implemented without overlap. Repeated exposure to disinfectants could compromise the quality of the impression and the restoration or appliance.
Parts 3 and 4 of this series will provide you with dentists' “Top 5” list and suggestions on how to avoid these pet peeves in your own practice-lab relationships. Being aware of the challenges each other face should help to improve the quality of interdisciplinary communication.
Robert Winter, D.D.S., is a member of Spear Resident Faculty.