Prescriptions
Prescriptions serve as the primary communication method between dentists and their labs. Here are some tips for writing prescriptions:
- Legible and protected from moisture (wet models, pour-ups etc.).
- Keep a copy of the prescription in the patient’s chart to refer to as needed.
- Ensure the prescription is kept confidential as part of the patient’s dental records.
- Shades must be detailed, especially where restorations involve anterior or multiple teeth (cervical shade, translucency of the incisal third). Patients may also visit the lab to have the technician do a custom shading.
- Communicate to the lab which shade guide or device has been used.
- Anatomical details can also help the lab in creating an esthetic final restoration – mamelons, marginal ridges etc.
- Textures and lustres may also be required to ensure good matches with the surface finishes of adjacent teeth.
- Information of occlusal relationships is useful to the lab. Depending on the complexity of the case or if there are multiple restorations, occlusal/bite registrations, facebow and models may be required.
- Communicate any preferred choice of materials for the restoration (e.g. precious, semi-precious or non-precious alloy).
- Photographs of the patient in various positions and from differing angles can also assist the lab in creating the final restoration (requires patient consent).
- Complex cases, may require mock-ups or laboratory-fabricated provisionals to ensure the patient is involved in achieving his/her desired outcome. The mock-ups may be provided by the lab or may be fabricated by the dentist and provided to the lab.
- Additional information, such as pre-operative models and/or photographs which the patient has provided, may provide invaluable information to the lab.
Source: Essentials of Esthetic Dentistry. Principles and Practice of Esthetic Dentistry. Elsevier 2015
This is an excellent piece that will serve as a good guideline for communication with your laboratory.
One of the more common issues for us, which often results in a phone call to the client (and potentially resulting in a production delay), is how the clinician would prefer that a lack of restorative clearance be handled.
Once the case is articulated, the laboratory may identify an area of concern that was difficult for you to clearly view in the mouth. Is the preparation non-vital? Would you like us to reduce it and provide a reduction coping to ensure minimum viable thickness for the material selected, or, would reducing the antagonist be preferred with clear identification of the affected area on the model work for you to use as a guide? If the case is PFM or PFZ, would an ‘island’ of metal or Zirconia be acceptable?
One of my favorite quotes came from George Bernard Shaw who said “The single biggest problem in communication is the illusion that it has already taken place”. He very likely wasn’t thinking of our industry when he came up with that, but I’ve never read a more accurate and valid representation of the need for clear and complete communication, it is the foundation for predictability in our days and in yours.
Great article!