The objectives of using a denture to treat a defect are preservation of remaining tissue and improvement in the functional recovery

rate. Close cooperation between dentist and dental technician and a shared understanding of fundamental knowledge and technology, from denture design to production, are indispensable in order to successfully achieve a combination of these objectives. Furthermore, accurate communication from dentist to dental technician of all patient information gained from the preoperative examination and necessary for production of the prosthesis is essential for a successful treatment outcome. This information should be shared by both the dentist and the dental technician. It is extremely important to describe this information appropriately and to append other information as needed in order to convey this information from the dentist to the dental technician by means of a dental technician specification. While this exchange of opinions by means of accompanying materials is of course useful in the denture production process, these materials are also valuable for re-evaluating the design of the prosthesis and handling by the technician in case a problem related to preservation of remaining tissue or improvement in the functional recovery rate arises during a subsequent visit by the patient. It is important for the dentist and the dental technician to consider the following six factors using the same criteria when treating a patient using a removable partial denture: (1) minimization of denture movement, (2) occlusion, (3) reduction of burden on the abutment, (4) consideration of periodontal tissue, (5) consideration of sensation, and (6) aesthetic considerations. To that end, the authors have found clinical application of a "design chart" to be useful.

As for the team communication between clinical and technological sides in the denture treatment,a smooth cooperative teamwork must be established in its target treatment through individual adequate recognitions concerning the main points of sequential procedures from examination, diagnosis, therapeutic designing, impression taking and bite registration and then setting performed by a dentist on the clinical side as well as concerning the main points of technical procedures indirectly performed by a dental technician on the technological side in order to achieve the most improved preservation of remained tissues with an increased rate of functional restoration, being the final target of treatment. At present when an ultra-aged society is coming, the demand of denture treatment has been enhanced more and more. In response to the enhanced patient's demand, various modes of denture treatment have been introduced and the dental technology has advanced remarkably. In particular, a technical procedure by means of partial parallel milling representative of rigid support or of Konuskronen requires very complicated working processes. In addition, the elasticity is also required including such an occlusal construction as being harmonious with the jaw function or such tooth crown morphology as being prepared in consideration of periodontal tissues together with a lot of information from the clinical side required as well in the denture treatment. In this study, therefore, the dental technical procedures presently performed by referring to varied individual information are newly arranged and summarized so as that these complicated technical processes and working steps could be performed more easily and accurately.

The successful restoration of large esthetic and reconstructive cases largely depends upon a set of exacting study models, impressions, bites, photographs and explicit instructions. Each has its part to play during the process. The dentist is the architect on these cases and the laboratory is the dental contractor. Without the right set of dental blueprints these cases cannot be completed to everyones satisfaction. Without any one of these pieces of information these challenging cases can become more complicated than necessary and the results might be less than expected. It is a given that the bite must be correct before any master impressions are taken and is probably the most challenging registration provided by the dentist. Bite registrations are achieved in various manners using TENsing, swallow bites, functional bites, K7 Instrumentation bites (e.g. Chan Scans) and then finally stabilizing the jaw position using a removable and/or a fixed orthotic to determine esthetics and functional occlusion. In the lab we must assume that the bites we receive are accurate unless a tell-tale sign alerts us to a possible bite problem in which case the doctor is consulted. The following is a list of Lab Needs that you, the dental Architect, must provide for optimum success. DIAGNOSTIC APPOINTMENT 1.) Provide full arch pre-operative study models capturing peripheral borders, retro-molar pads and hamular notches. Anatomic landmarks are often referenced for mounting, plane of occlusion and tooth position. 2.) Provide full face (no lip retraction) photographs showing the relationship of the upper incisal edges to the lower lip line. Capture the patients entire head from slightly above the hair to slightly below the chin. This pose allows us to determine an accurate midline, the long axis and middle of the face, and the horizontal plane of the anterior. 3.) Fox Plane Occlusal Registration (suggested) or a Facebow registration to determine a anatomically correct maxillary cast orientation.* 4.) Accurate, verified bite. Indicate if the bite registration is a Neuromuscular bite, Centric Relation bite or a Centric Occlusion bite registration. 5.) Provide the lab Rx describing the desired anterior incisal edge length, A-P position, shape of teeth (smile guide photos are helpful), indicate if Golden Proportion should be used and any other pertinent information regarding the patient's particular needs to achieve the desired result. PREPARATION APPOINTMENT 1.) Provide accurate upper and lower full arch current condition impressions or study models of the patients final adjusted (patient/doctor approved) provisionals. Do not send the original diagnostic wax-up model since any adjustments to the provisionals made from the diagnostic wax-up will make the wax-up model inaccurate for cross mounting. 2.)

Provide an accurate full arch opposing impression or model. The same care should be taken to provide opposing models as is taken for master models, as final laboratory porcelain equilibration will be completed against the opposing model. 3.) Provide a full, face forward, natural smile color photograph (no lip retraction) showing the relationship of the upper provisionalized incisal edges to the lower lip line. Capture the patients entire head from slightly above the hair to slightly below the chin. This photos allows us to see the midline, the long axis and middle of the face and the horizontal plane of the anterior teeth. 4.) Shade: close-up photograph of an open lip-retracted mouth holding the selected shade tabs next to the incisal edge of the natural tooth. Please include any written shade-mapping instructions. 5.) Stump shade tab for all ceramic restorations should be recorded. 6.) Fox Plane or face bow registration. 7.) Send lab Rx with information on type of restoration (alloy type, all ceramic system desired, etc.) indicate bridge or singles, and any esthetic and functional information necessary (it is critical to indicate any changes needed to the study model in order to achieve the final desired result).

Communication between the dentist and dental laboratory has entered a renaissance in recent years. In the past, the dental laboratory technician was looked upon as a servant of the dentist rather than as an integral member of the restorative team. Years ago the number and type of laboratory-fabricated restorations were a mere fraction of those available today. Staying abreast of new technologies within the dental practice and changes in dental technology can be a quite a challenge. As a clinician who works for a laboratory I see firsthand the good, the bad, and the ugly of the doctor/technician relationship. It all boils down to trusttrust that each party will listen to the others challenges and work together to achieve a common goal. Working together as a team from treatment planning to insertion can eliminate problems by considering both the clinical and laboratory technology issues. Considering both sides of these issues leads to one resultpredictable success for the dentist. Predictable success results in reduced chair time for adjustments at insertion and more chair time available for additional productive procedures. This article will discuss all aspects of the communication process between the dentist and the laboratory. What are the responsibilities the laboratory has to the prescribing dentist? In what ways can the laboratory assist the dentist in the treatment planning and treatment execution phases? What are the methods of communication available to the dentist? Lastly, how do you effectively communicate using the laboratory prescription in a clear and concise manner? TREATMENT PLANNING AND EXECUTION PHASES How can the laboratory assist the dentist in the planning and execution phases of treatment? Working as a team member, the laboratory can assist in several ways. Communication between the dentist and the patient is critical during the treatment planning phase of a large aesthetic case. The patients expectations may not match the dentists expectations. Further, the patient may have specific ideas about how his or her smile should look. If the patients concept does not match the fabricated reality, he or she will become dissatisfied with the end result. Assistance in the material selection process is a service that a laboratory can provide its dentists. Often the difference between success and failure with material technologies is their proper selection for the case circumstances. The dental laboratory is in a prime position to experience success or failure with the myriad of dental restorative materials and their use in specific case circumstances. Therefore, the laboratory technician is able to offer valuable input as to material properties and their intraoral applications, limitations, and techniques for success. Laboratory-fabricated diagnostic wax-ups are an excellent tool for the treatment planning phase. They can demonstrate for the dentist and the patient what the laboratory can accomplish with specific restorative materials. Many contours can be created in wax, but the specific dimensions required for a given material are an important consideration. Knowledge of the restorative material combined with the wax-up can guide the amount of preparation required to duplicate the result created in wax. Laboratory-fabricated provisional restorations allow patients to function with their new teeth for a short period of time. During this time patients can evaluate the aesthetics of the provisional(s). If the patient dislikes an area, he or she can more effectively communicate

to the dentist the specific area(s) to modify. A provisional restoration also allows the dentist to evaluate the patients function and phonetics. This is especially important if there was significant incisal lengthening or diastema closure. The patient may have wanted longer teeth but is unable to function in that position due to occlusal interference. It is better to discover this in the provisional phase than to face a dissatisfied patient after the final case has been inserted. Laboratory-fabricated prep guides quantify the amount of reduction necessary to achieve the result that the patient expects. The prep guide is made from the diagnostic wax-up with a specific material in mind. Without adequate reduction, the case cannot be made to mimic the diagnostic wax-up. Following the prep guide will allow the dentist to prepare the case so that the laboratory can duplicate the final restoration as close to the wax-up as possible. METHODS OF COMMUNICATION In most circumstances, the technician only has the information contained in the box. If there is one impression, one opposing model, one bite registration, and a lab prescription, then the amount of information available from these items is limited. Study models are a helpful tool during all phases of restorative treatment. Incisal edge position, evidence of parafunction, the original width of the diastemas, and the contour of the virgin teeth can all be lost without study models. Properly mounted study models can confer information that may be missing in the final impression of the prepared teeth. Diagnostic wax-ups are an excellent communication tool for the dentist to discuss proposed treatment with the patient. The diagnostic wax-up allows patients to communicate to the dentist their likes and dislikes based upon the dimensions of the wax-up. It is much easier for patients to point to a specific area and ask for it to be narrowed or broadened versus attempt to describe their concept of how they envision their smile. In the end, a diagnostic wax-up can reduce costly remakes due to miscommunication of size, shape, and contour. Model(s) of the provisional restoration(s) help guide the laboratory to provide the size, shape, shade, and contours that the dentist has created and the patient has approved. The models are especially helpful if the patient has worn the provisional restorations for at least a week. This trial run of their teeth allows patients to comment on the aesthetic and functional issues of their provisional restorations. Other than proper treatment planning, this can be one of the most important financial and time-saving steps of the restorative phase of treatment. As long as an adequate amount of reduction has been accomplished for the material selected, there will be no surprises when the final restorations mimic the provisional restorations. Photographs can be worth a thousand words. Investing in a good digital camera and a CE course to learn effective photographic techniques is an invaluable communication tool. A properly exposed and clear photograph can yield a wealth of information about contour and anatomy. It is much easier to follow a photograph for the location of a hypocalcified area or mame-lon than it is to attempt to draw or describe this area in writing. One thing a photograph cannot convey at this time is shade. We cannot choose the shade of a restoration with a single photograph. Other methods can help utilize photography for a shade match, but at this time, a picture alone cannot convey the shade accurately.

THE LABORATORY PRESCRIPTION A specific delivery date is extremely important. The term ASAP is too frequently used. ASAP means as soon as possible for the laboratory. Busy times of the year for dental laboratories mimic those of dental practice. If you use ASAP as a return date, then you may have situations when the case is not returned in time to meet your schedule. If your laboratory routinely delivers your single-unit PFM crowns within a week, but it is a busy month for the laboratory, the PFM might be returned in two or two-and-a-half weeks. This will depend on the number of cases in the laboratory that have specific return dates. Your case will be fabricated when it fits into the schedule along with the cases that have specific return dates. If you ask for a specific date, and if the laboratory is unable to accommodate the request, you will be notified of the exact delivery date. In this way your administrative team will always know exactly when a case is due to be delivered. Clear handwriting is an important component of the laboratory prescription. Communicating what is requested for a patients case can be a challenge. However, this challenge can be compounded when the handwriting cannot be interpreted. The laboratory should never have to interpret your writing. Remakes can be costly for the dentist and the laboratory. It can be time-consuming for both parties if the laboratory needs to call the dentist regularly to interpret his or her handwriting. Many software packages are designed for the dental practice that have the capability to print the laboratory prescription. You can save time on your routine cases by printing the prescription because all of the necessary information has been pre-entered into the system in a clear and concise manner. Using these types of systems can eliminate miscommunications due to penmanship. It is important not to use nondental terms for reasons similar to those about clear handwriting. Asking for toilet bowl design, a redneck face-bow, or use a dummy (pontic) can cause a great deal of confusion. We have our own terminology in dentistry and we must use it correctly so there is no confusion about what the dentist requests from the laboratory. As in the case of clear handwriting, it can be time-consuming if the laboratory calls the dentist regularly to interpret his or her own version of dental terminology. Listing the items that you send with a case can accomplish 2 things: first, it serves as a reminder for the person packaging the case to include all of the necessary items, and second, it serves as a double-check when the laboratory inventories these items when they are unpacked from the box. In addition, the person at the office and the person at the laboratory should initial the inventory. In this way we can work together to account for any missing materials such as an opposing model or bite registration. Specify the type and design of the restoration. For example, what type of alloy would you like for your PFM or full cast restoration? The lab technician can choose for you, but if he or she does not know that the patient is allergic to base metals, then the technician might make the wrong choice. What type of all-ceramic crowns would you like? The lab technician can choose for you, but if he or she does not know that the tooth was restored with a metal post, then the technician might choose a restoration that is translucent, and the metal will show through the final crown. What about the anatomical design and/or the design of the embrasures and pontics? Many of these issues can be addressed if your laboratory has your standard preferences on file. However, if these items are not specified, then the lab is forced to do one of two things: either pull you away from your patients and ask you what material or design you desire for the case, or assume what you need and

possibly make the wrong decision. Create internal check lists for each type of case so that all necessary items are delivered to the laboratory. Most practices have one person who packages each case for the doctor. However, if that person is busy or out sick, necessary items can be left out of the box. Posted check lists for each type of case sent to a laboratory take all the guesswork out of packaging the case for shipment. It also serves as a subtle reminder to include certain items for one type of case and additional items for other types of cases. The laboratory may not need a face-bow record for a single crown, but it does need one for a large anterior case or a roundhouse bridge. SUMMARY Working as part of your team, your dental laboratory can increase your predictable success and decrease the stress of daily practice. This partnership should begin during the treatment planning phase and continue through to the insertion appointment. Many dentists are beginning to view their laboratory technician as a bonafide member of their patient care team. Thorough communication on both sides is crucial to reaching this predictable success. A trusting relationship will enable the dentist and the laboratory technician to communicate effectively. The laboratory must take the responsibility to communicate its concerns to the dentist, just as the dentist must take the responsibility to communicate effectively with the laboratory his or her needs and desires for each case. When effective communication techniques are followed, everyone is a winner. The dentist is more productive per hour and has reduced stress. The dental laboratory does not have to bear the burden of remakes, and spends less time on the phone or sending e-mail for routine cases. And most importantly, the patient receives an exceptional restoration that meets his or her expectations. In the end, the true measure of a great relationship between the dentist and the laboratory is happy patients who refer friends and family to your practice for years to come.

In economia actului medical rolul principal este jucat fara indoiala de catre medic. Dar acesta depinde si de alte entitati. In cazul medicinei dentare este foarte important rolul jucat de laboratorul de tehnica dentara, acolo unde se realizeaza efectiv coroanele si puntile dentare, fatetele ceramice, diferitele proteze etc. Medicul este evident responsabil de calitatea lucrarii protetice, de cat de repede pacientul beneficiaza de ea, de numarul sedintelor la care este supus. Intr-o ultima instanta, contribuie decisiv la placerea pacientului de a avea o lucrare frumoasa si perfect functionala cu un efort minim.

Fiecare capodopera porneste de la o schita

Dupa tratamentele efectuate in cabinet, medicul amprenteaza campul protetic. Prin aceasta metoda inregistreaza pozitia dintilor, a gingiei si a bonturilor dentare ce vor sustine viitoarea lucrare. De aici inainte, implicarea laboratorului dentar este definitorie pentru rezultatul final, tehnicianul preluand amprenta trimisa de medic, transpunand intr-un model de ghips formele din gura pacientului. Rigoarea, implicarea in modelarea si realizarea lucrarii dentare se reflecta asupra pacientului: la prezentarea in cabinet este supus la mai putine manevre, nu are dificultati in adaptarea lucrarii, iar timpul petrecut pe scaunul stomatologic este mai scurt si numarul sedintelor este mai mic. Asadar timpul si eforturile noastre depind intr-o masura destul de mare de prestatia tehnicianului dentar.

Tehnician sau artist?

Anatomia dintelui este extrem de complexa si cere mult studiu pentru a putea fi inteleasa, iar pentru a fi reprodusa este nevoie de talent si simt artistic deosebit. Forma, culoarea, dimensiunea si, in fine, felul in care dintele se incadreaza intr-un tot unitar cu dintii vecini, cu fizionomia si tenul pacientului fac ca sarcina tehnicianului sa fie pe cat de grea, pe atat de frumoasa. In toata istoria artei nici un artist nu s-a incumetat sa reproduca dantura la vreunul din subiectii pictati sau sculptati, deoarece anatomia acesteia trebuie studiata indelung si separat.

Functionalitate estetica
Relatia dintre medic si tehnicianul dentar este determinanta si pentru valoarea estetica a lucrarii, aspect foarte important pentru pacient in special in cazul unor lucrari ceramice din zona frontala a danturii. Este recomandat ca in cazul unor astfel de lucrari tehnicianul sa ia contact direct cu pacientul, pentru ca impreuna cu medicul sa aleaga nuanta potrivita, cat mai apropiata de asteptarile pacientului, dar si forma viitorilor dinti in armonie cu forma fetei.

Prezenta unui laborator dentar in imediata apropiere sau chiar in cadrul cabinetului stomatologic este de mare ajutor pentru medic, deoarece relatia cu tehnicianul este mult mai facila, aspectele de mai sus si eventualele probleme putand fi mult mai usor solutionate.

Partnering For Success Doctor/Technician Communication The Cosmetic Revolution, fueled by 80 million baby boomers who want to remain young and beautiful, has forever changed the relationship between doctors and their laboratory technicians. Times have changed for us all. Smile makeover patients demand perfection and want (1) to be involved in choosing the shape and shade of their new smile, (2) to know what it is they are buying, and (3) to actively participate in approving the final restorations. For this reason, it is imperative that doctors and technicians follow specific communication systems to attain predictable, consistent results (Figure 1). This article will discuss doctor/technician communication when providing patients with pressed ceramic restorations such as Empress (Ivoclar Vivadent) or Authentic (Microstar), based on the actual format used by the authors. The same principles of communication can be adapted to other types of aesthetic restorations. EFFECTIVE COMMUNICATION STEPS In the past, communication often consisted of minimally written directives on the prescription (eg, crown No. 13 shade A2), occasional verbal discussions about complex case design or questionable margins, and periodic face-to-face meetings, usually regarding shade issues on challenging cases. For the most part, technicians were attempting to create restorations using stone models without faces. Here are the steps of communication we have found to be the most effective:

Figure 1. Communication tools. Step 1 Prior to the patient consultation visit, the doctor consults with the technician to discuss questions regarding product choices, preparation design, and laboratory fee estimate. (This is helpful in determining your fees, which typically begin at 5 times the lab fee.) The technicians experience with various techniques, products, successes, and failures can be extremely valuable at this stage. Step 2

Figure 2. Smile design tools.

Figure 3. Stick bite used for mounting.

Figure 4. Lingual finish lines. Figure 5. Tissue recontouring. The patient and doctor meet to decide on treatment and discuss finances. At this or subsequent appointments, the following information is collected for the laboratory: (a) A smile design choice from the Las Vegas Institute (LVI) Smile Catalogue, the Lorin Library, the Dorfman Smile Catalogue, or from magazine photographs supplied by the patient (Figure 2). (b) Preoperative photographs to be e-mailed or sent to the lab, including the following: fullface smile, close-up smile, right and left views of close-up smile, retracted smile. (c ) If the patient will be imaged (in-office or outsourced), plan to send the photograph to the laboratory. (d) Stick bite taken with the patient standing to prevent cant during mounting (Figure 3). (e) Poured study models marked with a thin tip marker to indicate lingual finish lines (Figure 4) and where tissue recontouring, if any, will be done (Figure 5). This information tells the technician where to stop the finish line of the diagnostic wax-up and will significantly decrease the amount of flash to be cleaned up during temporization. (f) A measurement for the desired length of the central incisors on the finished case, if it is to be different than the study model. (g) A completed prescription with details for the diagnostic wax-up is then sent to the laboratory along with the above items. Step 3 Upon arrival at the laboratory of the aforementioned items and information, the technician will again consult with the doctor regarding any additional questions or feedback. We think that technicians have an obligation to honestly inform their doctors of situations that will not produce the best results. This open feedback can prevent a negative experience for doctor, technician, and most of all, the patient. Step 4

Figure 6. Diagnostic wax-up.

Figure 7. Incisal preparation guide.

Figure 8. Impression matrix.

Figure 9. Golden Shimbashi spreadsheet. Next, the technician will fabricate and send you a diagnostic wax-up, incisal preparation guide, impression matrix, and Golden Shimbashi spreadsheet. (a) Having a diagnostic wax-up to copy for the temporization ensures that the patient leaves

the preparation visit temporized just the way the final restorations will look. Minor desired changes in length or contour can easily be made prior to fabrication of the final pressed ceramic restoration. This drastically reduces the potential for repairs or remakes at insertion, which creates a win-win situation for doctor and technician. We strongly recommend that you not skip this step, even if the patient is anxious to get started, with money in hand. The alternative, doing a chairside mock-up, will not give you the anatomy, contours, and surface texture that can be created by skilled laboratory technicians (Figure 6). (b) The incisal preparation guide is another insurance policy step to be used at the preparation visit. The guide is made by the technician from the wax-up and is placed over the prepared 6 anterior teeth using the bicuspids as stops to confirm sufficient labial and incisal reduction. This double-checking step will prevent a halo effect in the restoration, which occurs if the incisal third of the prep is not reduced or rolled sufficiently. It also ensures an even thickness in the pressing stage, which maintains continuity of shade (Figure 7). (c ) An impression matrix made from SilTech (Ivoclar Vivadent) putty with a polyvinyl wash is also created from the diagnostic wax-up. This matrix is used for the temporization, and because of the washit will transfer the detail and surface texture from the wax-up to the temporary. We recommend Luxatemp (Zenith DMG) or Integrity (DENTSPLY Caulk) for the 20-minute, shrink-wrap temporization technique (Figure 8). (d) Lastly, you will receive a printout of the LVI Golden Shimbashi spreadsheet, created by Dr. Larry Emmott. These dimensions were used to create proper width/length ratios (Figure 9). Step 5

Figure 10. Crowneer preparation. We recommend a chamfer or shoulder preparation with 2 mm of incisal reduction and 1.5 mm of marginal reduction, breaking all contacts (Figure 10). The preparation is a crowneer or three-quarter crown, which provides enough room to press the restoration and then cut it back to layer color and incisal translucency. Gold posts and heavily discolored teeth should be blocked out at the chair with flowable, opaque composite. It is a myth that the technician can correct this during fabrication. In order to block out at the laboratory, an opaque ingot must be pressed, which causes the restoration to lose vitality and look opaque in the mouth.

Step 6 Information for the laboratory should include the following: (a) Photographs of situations that will affect shade matching. For example, blocked out gold posts, dark teeth, or variations in color of the prepared dentin. (Photographing a shade guide held up to the preps is also helpful.) (b) Another stick bite, taken again with the patient standing, will prevent a cant when the case is mounted. (c) Always spend the extra 5 minutes to take a second impression since dies for the case can be taken from both. This will prevent the knot-in-your-stomach phone call from the technician requesting a new impression, especially when it means cutting off and remaking all of the temporaries to get that new impression. (d) When preparing the final prescription remember to include the following: any requested changes from the diagnostic wax-up. (Be sure to send the wax-up back with the case.) diagrams or descriptions regarding the amount and location of incisal translucency desired. the amount of surface texture desired, using the diagnostic wax-up texture as the median. stump and final shades, including diagrams of blends. final restoration product choice (or choices). Step 7 On the day following preparation, schedule a consultation to verify the patients satisfaction with the size, shape, and contours of the temporaries as well as phonetics. If minor in nature, changes can be communicated to the technician via fax, e-mail, or a new study model. If significant changes are needed, it is better to stop now, have the diagnostic wax-up changed or redone, have a new impression matrix made, and retemporize the patient until he or she is completely satisfied. Spending the time now may prevent you from having to cut off permanently bonded restorationseveryones nightmare. We had one doctors patient temporized 3 times before she was satisfied with the temporaries, but the final restorations went in without a hitch. Step 8

Figure 11. Finished restorations.

Figure 12. Becdens cosmetic presentation box.

When the case arrives at the laboratory, the technician will follow all information from (1) the original prescription, (2) recorded phone conversations, and (3) final prescription.

Another SilTech matrix is made to ensure the finished restorations follow the diagnostic wax-up (Figure 11). Step 9 After the final qualitycontrol inspection, the restorations are placed in a cosmetic presentation box to be used to enhance the experience of the patients insertion visit. The patient also receives a gift and a congratulatory note from our laboratory that also compliments the talents of his or her doctor (Figure 12). Step 10 The final step in this system, one that is often neglected, is to send the before- and-after photos and patient testimonials to the laboratory. This is very useful in 2 ways: first, to let technicians see the fruits of their labor, and second, for laboratory trainers and management to use the photographs in training sessions in the never-ending quest toward perfection. CONCLUSION The system described in this article may seem time-consuming or even a little neurotic. However, those doctors who follow it create raving fans out of their patients, who in turn create an internal network of referrals. http://www.docstoc.com/docs/78418207/Interdisciplinary-Collaboration-of-the-DentalTechnician

Teamwork is essential for the provision of contemporary, high quality oral health care. The provision of successful intra-oral prosthetic appliances requires accurate communication of prescriptions between dentist and dental technician.(1-6) Appropriate materials, effective techniques, and careful design are essential for optimal aesthetics and function. The following materials (low risk class I - high risk class III) are used daily by dental technicians around the world: Examples of dental products: Class I - dental impression materials, artificial teeth, dental curing light; Class IIa - dental alloys, ceramics and polymers, orthodontic wire, Class IIb permanent implants; Class III, absorbable implants.(10) However, limited consultation between dentists and dental technicians regarding the choice and handling of these materials is commonplace,(1, 3, 4, 11-14) and written laboratory instructions are not always supplied by dentists.(3, 6, 15, 16). Effective implementation of safety requirements is a further aspect dependent on close co-operation. The potentially confusing plethora of materials currently available to dentists, combined with the reduction of teaching in prosthetic technology in many contemporary dental curricula, makes links between dentistry and dental technology education more imperative.(13, 17, 18). Teamwork between Dentist and Dental Technician Teamwork and inter-professional relationships have been identified among the attributes contributing to professionalism.(37-41) These need to be fostered from the very beginning of professional education and training. Teamwork between Dentist and Dental Technician Teamwork and inter-professional relationships have been identified among the attributes contributing to professionalism.(37-41) These need to be fostered from the very beginning of professional education and training education in both professions.(12) If consultation and communication between dentist and technician is embedded in undergraduate studies it is more likely that graduates will continue this habit into their professional lives.(52) Shade selection, a common procedure, is a method of recording and matching natural tooth colour to artificial teeth provided as part of dentures, crowns or bridges. The dentist and the technician attend the clinic together to design the prosthesis. The fourth or fifth year dentistry student prepares the mouth or tooth surfaces and the dental technician refines the design, inter alia ensuring it is appropriate to the material chosen to replace lost tooth structure. He/she refers to a range of shade guides provided by the manufacturer/supplier of the chosen material, in close consultation with the dental student and the patient. Decisions are recorded using drawings, photographs and symbols. The dental technology student then constructs the prosthesis, and attends clinical appointments for try-in, insertion and adjustment. It is a valid hypothesis that the future dentist might acquire enhanced faith in, and respect for, the technicians knowledge, skills and professionalism in such a collaborative environment. This setting brings greater transparency to the patient care experience. In these situations patients also come to understand and to value the role of the technician, and are encouraged to provide direct feedback on laboratory procedures as well as clinical outcomes. The significant roles of the dental technician are not widely known by the public, so such interactions provide opportunities for enhanced professional recognition.(52, 59) From situations such as this, clinical and dental technology students are encouraged to reflect on their interactions, which are formally assessed in the curriculum through reflective journals. Anecdotal evidence to date suggests that both groups feel on a more equal footing, with better understanding of the role each profession plays in patient care. When the dental technician can observe the fitted prosthesis and experience the patients reaction, his/her opportunity for

self reflection is enhanced, facilitating improved service to patients an essential element of professionalism.