Developing strategies for seamless information exchange
By Hardy Saliba
Crowns can now travel near the speed of light. Ok, more accurately, the “bundles” of digital information that allow technicians to create those crowns can now move via the Internet at these speeds. Today, it is often the case that by the time the patient is walking out the door with a temporary, final restorations may already be in production thousands of miles away.
This new age of dentistry provides unprecedented tools of communication between the clinician and the technician, and few subjects are more talked about on either side of dentistry. The documentation supporting the advantages of digital dentistry is substantial. However, this new speed in communication has created several specific vacuums in the laboratory—places where information is forgotten and left suspended while the design and fabrication processes move forward at unprecedented speeds.
Most technicians have encountered situations where they and a number of colleagues are handed a case and asked to “make it work,” and then have one or multiple aspects of that case become compromised. Once the case is completed, all are left wondering, “How did it get to that point? Could it have been prevented?”
In the author’s laboratory, experience has shown several “black-holes” where crucial information may be lost. Many of these “black holes” involve lapses in intra-laboratory communication. Some simple steps were implemented to solve the problems, and in order for the steps to work, colleagues must support each other.
Trust is the Cornerstone
Fabricating a dental prosthesis is much like staging a Broadway musical; each actor works off the cues of another. If actors miss a cue, lighting, sound effects, even vital lines by key protagonists can cause the production to derail. Audiences and critics remember failure, which in turn, results in finger-pointing back in the dressing room. Whether on stage or as a member of the dental team, the results of failure are not much different. In dentistry the patient blames the doctor, the doctor blames the laboratory, the ceramist blames the framework department, and the framework department blames the model department. This might be somewhat of an exaggeration, but not by much.
Communication among members of the laboratory team must occur on several levels and begin with each being responsible for following their own protocols. Without this individual commitment, information will be miscommunicated or omitted. Next, information must be recorded at the time it is communicated, as very few people have the capacity to remember every aspect of every case.
The author has a multifaceted approach that includes meetings, computer notes, hardcopy notes, and checklists. The information must be easily accessible to team members and simple to comprehend. Also, it must be distilled to only the essential elements. The following is a check system that works for the author’s laboratory team.
Check One: Email
Email is a valuable tool for communicating laboratory prescriptions, as well as for dialogue between the operatory and laboratory. Many laboratories today are going paperless, which offers many benefits, as well as one notable disadvantage—each technician must be careful to consistently check his or her the computer for email updates. To ensure no cases slip through the cracks, the author appoints one person in the laboratory to “flags” messages for every case and makes sure the email is available to the technician working on the case. For some, this will be on the computer only, for others it will be printed and attached to the script. It is then the responsibility of the technician assigned the case to read the “flagged” information.
Check Two: Texting
Texting is gaining in popularity at an amazing rate. Many times the author receives answers to texted questions almost instantaneously. This is awesome, right? Absolutely, if the information is documented and passed along to the next person. Documenting a text isn’t difficult, but keeping team members updated requires constant vigilance. In order to keep his team in the loop, the author will send a screen capture of a text to the laboratory’s email and attach it to the case notes. For laboratories that aren’t paperless, it is possible to print out a copy of the text and attach it to the script, or write it on a form set aside especially for this purpose. The notes must then be “flagged.” While texting, remember to refer to patient names according to the proper HIPPA guidelines.
Check Three: Cell Phones
Laboratories must be able to keep track of and document phone calls. However, the prominence of cell phones can make this a difficult task. A good rule of thumb is to limit communication regarding cases to laboratory phone lines, as it is next to impossible to keep track of each employee’s cell phone.
Check Four: Digital Impressions and Framework Design
Digital impressions and scanning have added a new dimension to the communication pipeline. After the laboratory receives an STL file (impression), the CAD designer may have questions for either the dentist or the technician assigned the case before it can proceed to the production stage. Without proper communication, CAD designers may begin running on auto-pilot. If this happens, cases can be sent to the mill without identifying or addressing potentially case-sabotaging concerns. If this happens, technicians then face the choice of redesigning and re-milling, or “making it work.”
An example of a situation that requires the input of a clinician would be a case where the occlusal clearance is insufficient. In such an event, it would be ideal to put in zirconia as an occlusal stop. This must be cleared with the clinician to determine whether the dentist would have preferred a reduction coping and occlusal porcelain, or would have been satisfied with zirconia as a stop. The clinician’s preference must be established prior to the file being sent to the mill to prevent any chance of a redo.
It is also imperative that scans are checked closely and the scanner and the ceramist have a direct line of communication. The presentation of digital models is often so esthetically pleasing that it can be easy overlook mistakes and assume they are correct.
Check Five: Digital Implant Design
Most of the major implant companies operate in the CAD/CAM realm, but there are still many independently-owned laboratories that do not have in-house scanners. Several companies allow those laboratories to send in a stone model for this purpose. The technician can then view and customize the abutment design online. This is a great feature, but it is important to make sure that the information is “saved” before the custom abutment is processed. If one forgets to push the “save”button before pressing the “process” button, the resulting abutment will have a generic design and any customization may be lost.
The above details but a few solutions to the communication gaps that stem from the speed of digital communication. The pace is going to continue to accelerate. Technology is the future of dentistry and will continue to create new communication challenges. Nowhere is that more evident than in the laboratory.
About the Author
Hardy Saliba is the laboratory ceramist at LAB 33, Inc. in Winston-Salem, NC.