How To Get Great Restorations From Your Lab

You're listening to The Dr. Phil Klein Dental Podcast Welcome to the show. I'm Dr. Phil Klein. Today we'll be discussing the use of digital and traditional impression-taking techniques and how to make things easier for the dental lab. This ultimately results in less stress for the dentist and better restorations for the patient. Our guest is Dr. Richard Lipscomb, Jr., a general dentist and international speaker who lectures on restorative and dental implant procedures. He is on the editorial board for Dental Products Report, and he is a Catapult member who speaks and evaluates new products. Before we get started, I'd like to mention that Dr. Lipscomb's webinar titled Products That Make Our Crown and Bridge and Class 2 Restoration Lives Easier is now available as an on-demand webinar on VivaLearning.com. Simply type in the search field Lipscomb, L-I-P-S-C-O-M-B, and you'll see it. Dr. Lipscomb, it's a pleasure to have you on Dental Talk. Nice to be here, Phil. And I thank you for the kind words. Dr. Lipscomb and I were talking before we went live here and he mentioned that he's been listening to the podcast show and he had all good things to say. So he automatically became my friend within seconds. Maybe that was strategic. I don't know, but it sounded like it was heartfelt. So we talked a little bit, Dr. Lipscomb, about the importance of a laboratory. So tell us what your thoughts are about using a laboratory and how it affects. the practice as a whole well i think that as dentists we we just don't understand what the lab really wants from us especially chronic bridge cases and there's just a whole slew of things that they need outside of what we know is okay we need two millimeters of clearance and send it out they need more than that and if we start with that two millimeters of clearance along with that they need to know okay they get the case what if they don't have the two millimeters what have you told them did you tell them to adjust the opposing did you tell them to make you a reduction coping those are the things that make the lab's life a little bit easier because they already know okay i don't have my two millimeters boom i do what the doctor wants me to do so that's helpful in their communications um to you and them the second thing is as dentists we never think about this but selecting the right type of margins that we create for our preps matters now especially when you're doing all this ceramic you can't put a feather edge margin with the ceramic that's just not what the lab wants when you're doing ceramics for the lab they want either a chamfer or shoulder that's it for a combination of both and i like to do a combination of both a nice wide margin with the chamfer from the transitional area from the axial wall to the floor the prep that's good and those are types of things that they want you can't just send them anything and just have them guess because when you do that it just lowers your chances of getting a great restoration in return the other thing is and a lot of doctors don't do this is smoothing out the actual walls after you've prepped the tooth you know we're used to getting in there cutting the tooth up with a coarse burr making sure the margins are there and then taking an impression these days especially with the scanner scanners do better and pick up images a lot quicker on smooth surfaces so if you you're prepping and then you're following that up with the same size prep maybe in a fine grit then you're doing a better job in terms of preparing the tooth and getting it ready for the lab to do its job also making sure that you definitely try to prep the occlusal one-third of your preps and that gives the lab a little more space to work with and also just evens out the occlusal forces that are coming down on that restoration and that way you have a more durable and long-lasting restoration another point would be no undercuttings no voids in your prep and the last thing you want to do is make sure that you have a well-defined margin meaning that your margin however way you want to do it whether it's laser or whether it's with burr you want to make sure that the margin is seen and visible by the lab what are some of the products that you found useful in achieving these goals of prep design in indirect restorations, which helps you with the laboratory? Well, we've gotten this far. We've dipped the tooth. We've smoothed it out. We're about to get it ready for an impression. But as we do that, you know, the burr that I like to go to are the solo burrs by Premier. They're single-use disposable burrs. They come clean out the package. They cut quick and smooth. They just do a good job of being able to deliver the type of preps that the lab is looking for. They also come in so many different sizes and shapes that you're bound to find the same shape and size you use in your current hers that you use. Let me ask you this. So a lot of KOLs that I've been talking to regarding dentistry have really tried to limit the inventory on their setups. So whatever they're doing in the office, let's talk about doing a full crown on number 19. um they have a certain number of birds that they use it may be three maybe four some of them even say two are you doing the same thing are you trying to limit the number of types of birds that you're using as far as shape and design so that you simplify the process i definitely try to keep the number down in terms of the number of birds that i'm going to be using but i still don't want to get away from making it more difficult for the providers you know we're dentists we're used to doing the things that we're used to doing and if it takes us five birds okay take five birds if it takes two birds okay take two birds but make sure that as you're going you're a giving the lab what they need and being efficient in your cutting and that's why i like again the disposable solo birds because they cut really good they make you efficient especially when you're cutting on multiple teeth whether you're doing a three unit bridge or doing multiple single units It just makes you more efficient when you use those type of burrs. So single-use burrs are becoming more prevalent now, and also for the infection control part, right? Because cleaning burrs is time-consuming. That costs money. The spread of disease is obviously much more of a risk when you're cleaning a burr than if you just chuck it away each time. And when you figure out the cost of hiring someone to clean these things and process them in the sterilizing system, I'm not sure it's worth it. So do you think most dentists are going to single-use burrs these days? Um, I don't, I'm not sure if I would say most, but a lot of them are for those reasons. It's definitely, like I said, they come clean out the package. So it's definitely a good situation in terms of how you're using them. No cross-contamination. Yeah. And these are diamond burrs that you're basically discarding after one use? Yes, they are. And like I said, I, when I do use it, I try to make sure that I'm using multiple teeth and more than, you know, just one tooth. Right. But if you had a single tooth to restore, you would still use a solo burr. And then after that, it's in the trash. Yes. Again, you're efficient. You're cutting faster and cleaner. And so even though you're throwing it away after the procedure, it's worth that. So you've switched completely from traditional compression material to scanning in the office? Well, I wouldn't say completely switch. you know scanners everybody is scanning we're scanning more every day all the time it's just how it's going and there's nothing wrong with that um i think right now the problem is is that we're just not there yet where you could just say okay i'm not going to do traditional materials anymore i'm just going to use a scanning that's hard to do because ultimately there's going to be some case some situation where the scanner is not going to work why is that um first because of the location of your margins sometimes when you have subject margin, it's really difficult to pick up the scan. Other places, you just can't get the right angle to capture the image. I think that's going to be the next big thing is the tips, the size of the tip. They're kind of big now, and if you have a patient with a small mouth, you're not going to be able to get angulation and be able to capture the image that you need to capture. So those are some of the limitations that go with scanning. However, on the flip side, There's a lot of positive things that go with scanning. So I'm not trying to poo-poo scanning, but I know for just using scanners for years now is that you can't ditch your traditional impression material. Not yet. They're working on it, but not yet. How is prep design for you different from a traditional, when using traditional materials versus scanning, prep design and also tissue management? Well, from the tissue management point of view, I think it's about the same. Scanning, probably you need to do a little bit better in exposing your margins, but for the most part, either packing cord or using retraction paste and caps are usually the two options that most of us go with. And for me, retraction paste and caps, especially this product called Traxxident by Premier, works great. It's an aluminum chloride clay -based material that not only retracts the soft tissue, but also stops the soft tissue bleeding around your preps. So you use that, and that comes in a syringe? Right. It comes in a syringe, but it also comes in preloaded tips where you can express it around your margins, usually two or three level layers of the material. And then upon that, you're placing the retraction caps. And the retraction caps that by Premier... They're a little bit different. They're anatomically shaped so that they put a little bit more force around the buckle and lingual portions of your margins to get the best retraction with these caps. You don't use cord when you use this material? No, you can. There is an option to use cord if you feel that you need more retraction. In those techniques, you would place a cord down around your margins and then place the traction upon the cord and then... possibly have the patient bite down with the retraction cap over top of that. Now that's a good method. It's not as traumatic as just packing cord by itself, but definitely just the pace in the cap is definitely less traumatic to the soft tissue than the cord. So what are some of the other advantages of using a scanner versus the traditional impression taking technique? The more exposure that you have. um to your preps and to the margins the better the scan is and the better chance that you're going to get a good scan as opposed to not and when you see that and you see not just the good things about it but you see the bad things and that's what i like i see my bad in the areas that i struggle so i know that okay this is a problem that i usually have let me try to overcome that and make it better so in that sense scanners make us better dentists because you're delivering better preps and thus the lab can deliver better products and the patients get better care what are some of the challenges that you're seeing in the scan that's alerting you to some of the ways you can improve your prep design some of it is undercutting um you can't always see that when you're prepping one of the things that's hard to judge also i like to have nice wide margins, the floor of my margins to be wide. And if you're using a shampoo, you might create what's called J preps. If I see that I can now, okay, make my adjustments, smooth out that floor, make sure to have a nice readable margin and take a great impression. I remember when I was in dental school, before I got into clinical upstairs, the doctor, he was a real nice guy from South America. And he said, the most important thing that you need to do as a dentist is take a good impression. He goes, you're not going to be doing the lab work yourself. You need to take a very good impression because that's what's going to determine your work. And of course, I was a secondary dental student and it sounded great. I wasn't sure what he was talking about, but it sounded good. But, you know, in retrospect. That dentist was 100% correct. I mean, right? I'm an endodontist now, so I didn't do a whole lot of restorative dentistry. You've been doing this for quite a while now. Is that the way you look at dentistry now as far as your indirect is how important that impression is, whether it's a scan or traditional materials? And obviously, the way you're talking, you're going to be using both for a little while. Yeah. Yeah, it's definitely everything has to stand upon. You know, you're prepping the tooth and you're trying to deliver, especially the margins in a way that you can see them. And I think that as dentists, because of the material that we're used to using, we kind of get away from them trying to make sure that the margins are seen or make sure they're nice and clean and defined. The thing is, that's what the lab wants. They want that because the cleaner they are, the less guessing they have to guess where your margin is, the better the restoration is going to be. And you continue to evaluate products for manufacturers before they go to market? Yeah, I've just been fortunate enough to be involved with a couple of organizations. One of them is Catapult. And not only do I speak, but I also evaluate products with them. And so I'm also involved with Dental Products Report. And that allows me to evaluate products and just kind of see what's coming out before it comes out. and just kind of a good sense of, okay, this is a good product. That's a good feeling to kind of know what's coming down the line and getting a chance to kind of use these products to see how they do against what I'm already using. Yeah, and that's a good point because it's always good for dentists to have an open mind because there's products that are designed to make things better, not only the clinician, but obviously for the patient. Thank you very much for your time. Oh, thank you for having me.