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    Any Lab Tips for a Noob Prosthodontist?

    Discussion in 'Removable' started by Paul Springs, Feb 12, 2017.

    1. Paul Springs

      Paul Springs New Member Full Member

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      Hi all. I'm a long-time lurker, and I have to thank many people on this forum for several smart tips over the years. This is my first post.

      I've been a general dentist for 3 years, and though I've always loved lab work, I've gotten more and more busy in the clinic, making me more lazy about increasingly leaning on some great lab techs over the years. For the last 20 months I've been in an office with an in-house lab and a PlanScan CAD/CAM system, which have been a nice scratch for my lab itch.

      That said, in June I'll be starting a Prosth residency, which means I'll have to re-find my lab flow from school. I'll be doing most of my removable lab work (I believe only processing and maxillofacial work are optional), as well as all steps for analog C&B and implants up until the coping wax-up stage. Ceramic stacking and pressing are usually done by a very gifted in-house tech, but can optionally be done by residents for the sake of turnaround time.

      To be honest, I'm rusty, and I don't want to be in the lab from 6AM to 9PM, but I also want to take this as an opportunity to push myself to learn more lab work and get better at it.

      So are there any tips you would offer to someone unused to doing much lab work that wants to have maximum efficiency and quality? I'm mainly thinking tips you wish you had known when you started, but anything you guys feel is of value is appreciated. Thanks in advance for your time.
       
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    2. Inna-Hurry

      Inna-Hurry Member Full Member

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      You know the sound a fishing reel makes when it's cast? THAT.
       
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    3. TheLabGuy

      TheLabGuy Just a Member Full Member

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      A few comments for ya.....First, Congrats!!!
      - As for Removables, the biggest issues I've found over the years is that soooo many Dentists (even Prosthodontists) always make the edentulous patient a Class I Denture. Then they wonder why the patient hates there denture....if they were a Class II or III, even slightly, you have to duplicate that clinically. Also, if you're the one responsible for extraction for an immediate and you don't know what an alveoloplasty is, especially in the maxially anterior, then count that as another fail in my book. Flexible RPDS work great in the mandible arch where the patient compliance of traditional metal RPD's aren't so hot. Those are my three tidbits of removable intel
      -As for tips, nothing can substitute being in a removable lab with a removable technician and putting your hands on actually doing cases. I"m not sure if your schedule will work, but you gotta be in the lab with us and be doing it to get better. Unbeknownst to Dentists, but we lab techs consider Friday a workday....might be a great lab day to dedicate yourself too. Might be a great way to start a new relationship with a removable lab as well. Appreciate the question....you excited?
       
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    4. Paul Springs

      Paul Springs New Member Full Member

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      Very excited. As you say, the only real learning comes from doing, and most of the direction the learning goes in comes from direct mentorship. I have some great dentist and lab mentors now, but I'm looking forward to working with a different level of expertise daily. Thanks for the tips. Those points are definitely well taken. Since you mentioned flexible lower RPDs, How do you feel about the "hybrid material" type RPDs that involve metal connectors and rest seats, but use flexible materials for tissue-retaining clasps? I never really understood why anyone would want to do flexible without that additional rigidity and support built in.

      Also, any tips for efficiency? For example, keep in mind that I was taught to bead and box a PVS impression with wax. so I'm sure there's a lot that you guys could teach me a lot about not wasting my time with fiddly nonsense like that
       
    5. Paul Springs

      Paul Springs New Member Full Member

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      Hmmm... Is that a Zen Koan like "the sound of one hand clapping," or the sound of a falling tree that no one is around to hear? If so, I'm getting higher level of guidance than I bargained for!
       
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    6. Doris A
      Innocent

      Doris A Well-Known Member Donator Full Member

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      Instead of bead and box use the wonderformer, its much faster. http://www.wonderfill.com/products/wonderformer/
       
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    7. JKraver
      Tired

      JKraver Well-Known Member Full Member

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      Just read every thread on this site there is enough information for you to do your job. Follow the guys/gals that are posting interesting well thought out arguments, or ideas.
       
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    8. CoolHandLuke
      Fiendish

      CoolHandLuke Well-Known Member Full Member

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      yeah not like the rest of us losers posting sarcasm and derailing threads with talk of hug shacks and mooses
       
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    9. JMN
      Curious

      JMN Christian Member Donator Full Member

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      Meese?
       
    10. TomZ
      Amused

      TomZ Well-Known Member Full Member

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    11. TheLabGuy

      TheLabGuy Just a Member Full Member

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      Hybrid RPD's (where the major connector is metal, and flexible material is used instead of traditional acrylic) are very popular. We see our fair share of these, especially if a patient had a previous metal RPD. That's where we tend to advise our Docs to use metal RPD's instead of flexible, is if the patient had a traditional metal RPD previously (for some reason, they hate flexibles after having the metal rigidity for awhile.) However, for a new RPD on the mandible, what's the patient compliance on metal RPD's...less than 20% was the last research study I seen. Where a flexible mandible on a new patient compliance is over 80%. Also, no rests needed when using the flexible material, doesn't mean you can't do it, but any half way decent tech will tell you that rests are not needed and overkill. As for tips, for efficiency, are you going to be press packing, cold curing, or injecting (IvoBase/IvoCap), or microwaving your cases in Prosth school, any idea?
       
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    12. araucaria
      Relaxed

      araucaria Balanced Staff Member Donator Full Member

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      IMO doing your own labwork is CRAZY! I'd recommend doing what you do best, and pay the labguys to do the tech stuff.
      Also, communicate as much as possible and use all appropriate media to assist, and spend time with the lab techs to improve teamworking skills. Study clubs and tech symposiums will help development, but just be patient and open-minded. 2c.
       
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    13. JKraver
      Tired

      JKraver Well-Known Member Full Member

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      Do as much labwork as you can in school, then dole it out to the lab guys so you know what the F they are talking about.
       
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    14. TheLabGuy

      TheLabGuy Just a Member Full Member

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      I'll be honest, the best General Dentists I've seen out there on a continually basis seem to always come from MUSC (Medical University of South Carolina) and UMKC (University of Missouri Kansas City)....and that was because (this may have changed now) they were all required to do almost all their own lab work during dental school. I use to work for some AEGD programs back in the day, and the graduates from those two places flew through that program. Sure, there are plenty of examples of exceptions out there. I mention this comment in a general sense, that doing your own lab work does make a huge difference in real life. Kudos to you if you can make this happen....but beware young Jedi, the magic wand is tough to capture :p
       
    15. rkm rdt
      Artistic

      rkm rdt Well-Known Member Donator Full Member

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      Why does everyone want to be a dental technician ?
       
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    16. JMN
      Curious

      JMN Christian Member Donator Full Member

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      Because patients bite.
       
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    17. CoolHandLuke
      Fiendish

      CoolHandLuke Well-Known Member Full Member

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      nothing wrong with wanting to do your own lab work. just food for thought, though: whatever you are learning to do, and are doing pretty ok at, most labs have 1000 times the experience.

      however, that said lets answer your questions: looks like digitally you may already have enough foundation to do analog work. but i caution you to do so, because it is much more labour intensive and time intensive. most prosthos i know like to stick to something they know, like implantology or cosmetics. doing the general dentistry route is highly complex. for you to do that AND your own lab work - i have to wonder how many hours do you think the day has ? pouring, articulating, scan design, digital manufacturing, baking, all on top of clinical evaluations, placing implants and cementing/bonding cases... that is an unfortunately impossible load of work without being a monumentally dedicated team.

      so basically i'm saying focus your efforts. be a lab that specializes in Lithium Disilicate (or Lithium Silicate) and grow.

      all good labs start as a small company focused on a single product, and grew. it so happens that the way many labs grow is focusing on one product above all others. hence glideterribly. a lab that focused on manufacturing one product, doing it as best they can, and content to mostly ignore all other efforts.

      so get on your horse and back it. if you do the clinical side, get people who do lab work well, and figure out how their skills can be put to use. a team of skilled porcelain artists will be crap at full contour digital manufacturing. but they will be good if someone can create for them good iZir style frames for layering. but again you need skilled partners to make those frames.

      so unfocused work will either lead you to outsource a lot, or focusing will allow your team to shine.

      i'll let you figure out where that leads.

      always have a lawyer and an accountant on speed dial, never plan to do something you have no experience doing, until it has been done for you enough times that you can confidently break ground.

      big expensive machines come with big expensive repair bills.

      places with >10 employees will need on the job WHMIS or other similar training if you are in Canada.

      your greatest assets to your lab get up and go home at night. treat them respectfully.

      take CE seriously.

      sometimes a single tooth can be harder to make than a 9 unit bridge. accept this fact and move on.
       
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    18. ztech

      ztech Active Member Full Member

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      Just curious, what program are you attending?
       
    19. Paul Springs

      Paul Springs New Member Full Member

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      Montefiore
       
    20. Paul Springs

      Paul Springs New Member Full Member

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      This is exactly the sort of tip I meant. That said, it's also something I already knew about, which is why I brought it up. It's a classic case of unknown unknowns -- you have no idea what you don't know until you find out you never knew it. Any similar lifehacks or re-thinkings of traditional techniques that really never made sense?
       

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