"We are committed to excellence through continuous provision of resources for :-
new technology, training and personal development”.
The expanding parameters of dental medicine, the media, a better informed patient, all bring to bear on the demands of the dental surgeon today. You are led both by your professional skills and a sophisticated marketplace.
Here at McDowell + Service by staying at the leading edge of technology we can supply that demand. We aim to forge a bond between surgery and laboratory that is not only lasting but keeps both you and your practice one step ahead.
1. Communication. Everyone realises that the importance of good communication between laboratory and dentist is key to a successful outcome for you and your patients. Communication comes in the guise of many forms; lab prescriptions, phone calls, photographs to mention a few. Time is of the essence for you as well as the laboratory and unnecessary phone calls due to lack of information, will cost everyone unnecessary waste of time. Here are a few indicators that could save you and us, time.
a) Lab prescriptions. McDowell + Service issue two types of laboratory prescription; one for Crown & Bridge and the other for Removable Prosthodontics. Each prescription contains a selection of the types of restorations available from McDowell & Service. It is important to complete the appropriate section in order to avoid an unnecessary phone call requesting further information. Dentist, name and address, patient’s name, restoration type, date required, shade, any further instructions and finally the prescribing dentist’s signature. It is sometimes surprising how often simple details like these are missing from prescription sheets.
b) Full arch impressions in rigid trays. It is good dental practice to provide full arch impressions in order for the technicians to establish correct occlusal relationships where necessary. McDowell + Service cannot be held responsible for errors in occlusion due to the use of quadrant impression techniques.
c) Bite registration and Facebow recording. One of the most common problems encountered in dentistry is poor interocclusal records. There can be several factors affecting errors in occlusion, including distorted impressions, air blows in the impression material, type of impression tray used and incorrect use of facebows and/or articulators. Restorative procedures that require the mounting of casts, often require accurate interocclusal records. McDowell + Service recommend Denar as their choice of articulator. Any material used to record occlusal relationship should ideally feature the following properties:
Easy to use Tolerance for the patient.
Initial low viscosity.
Be able to record ample detail.
Be rigid enough when set without being brittle.
Examples include: Polyninyl Siloxane, e.g. Blu-Mousse Acrylic Resin e.g. Duralay LS Wax (good quality)
2. Appropriate Preparation Design. See the download section for advice on the correct and appropriate prep design for the type of restoration required. One recurring issue that crown and bridge technicians regularly face regarding prep design is enough tooth reduction provided in order for them to create a functional, strong and aesthetic restoration. Most restoration types require an absolute minimum of 1.5mm to accommodate the material to be used, whether it be metal and porcelain, porcelain only, porcelain and zirconia etc. Too often technicians are expected to produce restorations that has all the prerequisites and yet is provided with insufficient space to do so. In the case of all-ceramic restorations, sharp lines angles and 90 degree corners should be avoided, as this can lead to stress fractures occurring within the ceramic; this sometimes, may not be initially apparent and may only come to light at a later stage. It is advisable that marginal clarity is present on observing the impression prior to sending it to the laboratory. Also check for drags and distortions and airblows that have occurred. Make sure the appropriate marginal finish line has been provided for that particular type of restoration. Avoid ‘J’ type margins when prescribing zirconia based restorations or any CAD/CAM type restorations. Smooth margins are essential for attaining the perfect fit as irregular or ‘saw-tooth’ type finish line can be troublesome for the technician achieving a perfectly fitting restoration. This may seem obvious but technicians are constantly surprised at how little attention is paid to this detail.
3. Photographs. In today’s digital age, it is far easier to send photos to the laboratory. You can use digital cameras, smart phone cameras as well as tablets to take photographs to send to the laboratory. Include pre-operative situations, an overall oral photo as well as detailed photos of the preparation and adjacent teeth; include the necessary shade tabs WITH the shade clearly visible for the technician to make reference to. PLEASE NOTE; it is not possible for the technician to take a shade from any type of photograph. A picture paints a thousand words and can be invaluable for the technician to create the finer detail in shade, characterisation and texture for the restoration. The more information the technicians have at hand, then the more likely they will produce a more accurate result.
4. Become Familiar With Your Materials. It is wise that you must be aware of the different properties that different types of restorations present. The clinician is however, ultimately responsible for deciding on the choice of material albeit following discussion with the technician and the patient. It is up to the clinician to inform the patient of the pros and cons of the different type of restorations available.
5. Be Contactable. As mentioned above, time is important to all of us; dentist, technician and patient. A lot of phone calls may be deemed unnecessary but sometimes they are essential in answering queries about work in progress. Ultimately, this is a team game and delaying responding to queries by either party will only lead to frustration and possible delays in returning the work to the surgery. Email is also a good tool for contacting the technician if the dentist feels that a phone call is not essential.
1. Do you use CE approved materials?
In the light of recent scandals it is imperative that you know your lab is using reputable materials and can source their origin.
2. Do you use genuine manufacture parts and hardware for implant restorations?
There are many copycat components out there, some good, some not so. Make sure your lab use only reputable components and they send you a copy of exactly what was used. Cheap copies are putting you and your patient at RISK.
3. How do you perform quality control checks on your work?
It takes time to produce quality work. If it needs to be rushed can you guarantee consistent results? Does your lab use quality systems such as DAMAS and ISO? Are the technicians registered and fully trained?
4. Do you send work off shore?
Many labs now send their work to China, India and Turkey to take advantage of low labour costs. Can you feel confident that a crown costing as little as £30.00 will truly contain gold and silver alloys or do you close your eyes and hope to blame the lab if something goes wrong?
5. May I inspect your lab?
A quality lab should welcome an inspection and be proud to show you around. It should be clean with no plaster coated work pans and articulators. Ask to see their quality certificate if they are not already displayed.
6. Talk to the owner and see if you get along.
This should be a long term relationship, make sure you can build a relationship with each other to promptly overcome situations when there are issues with bites, impressions, fit of case etc.
7. How to safely transition to a new dental lab.
Do not send all your work in one go, start slowly and get to know each other.
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