Laboratory Communication Essentials

Detailed pre- and postpreparation records ensure outcomes meet expectations

Dimple Desai, DDS

When tackling a case in the esthetic zone, how can we predictably achieve the high-end esthetics that our patients demand and even exceed their expectations? The simple—yet not so simple-answer is communication. Patients depend on us to be able to understand their expectations regarding outcomes based on what they tell us that they want. In order to execute cases, laboratories depend on us to be able to interpret and communicate those expectations by providing the detailed information that they need. And dentists depend on laboratories to fabricate cases based on the communication that they receive from us. Any misstep along this complex communication pathway can quickly derail a case.

A ceramist cannot execute a case to his or her fullest ability without seeing the patient either in person, via photography, or both. I have found the use of photography and intraoral scanning to be crucial to any esthetic case that I undertake. That is because the facial dynamics of every patient are unique. Therefore, each case—whether it involves veneers, crowns, or implants—has its own unique characteristics. Over the years, my laboratory ceramists and I have developed a communication protocol utilizing high-resolution digital photography and intraoral scans that provides us and the patient with a three-stage process to make any necessary adjustments to ensure a successful outcome.

Once my patient is ready to proceed with a smile makeover, a complete series of photographs and intraoral scans of his or her preexisting condition are acquired. The photographs are taken with a DSLR camera with the patient seated upright against a black background. For the face shots, I use a shutter speed of 160 with an f-stop of 8-10. The patient's head is positioned in a natural posture and confirmed with Kois Facial Reference Glasses, which facilitate digital measurement of critical aspects of the dentofacial esthetics during treatment planning and case execution. For the first photograph, I ask the patient to smile naturally. For the second photograph, I ask the patient to smile with exaggeration and squint. And for the third photograph, I ask the patient to say "Emma" with the lips at rest. Next, I acquire a series of 1:2 smile shots (frontal, right lateral, and left lateral) using an f-stop of 29-32, a series of retracted head shots with the patient wearing Kois Facial Reference Glasses (frontal in MIP, frontal open, left lateral open, and right lateral open), and finally, occlusal views along with a bite stick photograph.

For treatment planning, I upload all of the photographs into a Microsoft PowerPoint template that I created in order to stay consistent with each case. In PowerPoint, I mark up the photographs with notes and reminders about what needs to be done to achieve the desired final esthetic result. I also note what I am able to achieve without jeopardizing biologic parameters if that differs from what the patient is requesting. Before moving forward with the preparation and provisionalization appointment, I discuss the treatment plan with the patient to solidify our agreement about the end result. At this critical stage, communication with the laboratory plays heavily into securing a successful outcome. With all of the markups and notes, including the desired final result, indicated in the PowerPoint presentation, I send it to my laboratory ceramist and schedule a phone call to discuss the intricate details of the case.

I always make sure that I receive the mock-up days in advance of the provisionalization appointment in order to guarantee appointment security. After I prepare the teeth, I acquire shade tab photographs to communicate the preparation shade and the shade of adjacent teeth and put them into a second PowerPoint presentation along with the desired final shade. Provisional restorations are created in office to allow the patient to preview and test-drive his or her new smile and to make sure that it meets everyone's expectations. With the provisional restorations in place, I scan the patient, and if there is a need for minor adjustments, I add notes and markups to the PowerPoint file. This second PowerPoint presentation gives me another chance to really communicate to the laboratory what the end result needs to be.

Communication is a three-way pathway between my patients, my laboratory ceramists, and myself. Through a relationship with open and strong communication, my ceramist and I are able to understand patients' expectations to envision and create something exciting together. Open communication is essential to my practice and helps me achieve my goal of helping my patients gain confidence through their smiles to take on the world.

About the Author

Dimple Desai, DDS, is an accredited member of the American Academy of Cosmetic Dentistry and the owner of Luminous Smiles in Newport Beach, California.

Dimple Desai, DDS