Problem with contacts

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Everything is going great...all the Drs I work with say things are perfect, except one. She works in an office with other Drs, they all use the same trays, same impression material. This last week she says all her contacts are too light, some not even in contact. Im racking my brain, but everyone in the office is reporting perfect results but her. Any ideas?
 
Tayebdental

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Slightly trim adjacent contact on the model before scanning for that doc.
 
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Juko

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Heavy contacts on the temps.
I agree with this. I would be interested to know about general fit on prep as well as margins. How are her impressions compared to the other docs? How is the fit on your contact models? Same as working? Rather than trim the adjacent teeth prior to scanning you should have the 'talk' with this doc first cause eventually you'll have really tight contacts that will cause her to do adjustments and that makes you look bad. Flex those muscles and help them get to the problem.
 
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I agree with this. I would be interested to know about general fit on prep as well as margins. How are her impressions compared to the other docs? How is the fit on your contact models? Same as working? Rather than trim the adjacent teeth prior to scanning you should have the 'talk' with this doc first cause eventually you'll have really tight contacts that will cause her to do adjustments and that makes you look bad. Flex those muscles and help them get to the problem.
We had 'the talk' today, thats why I was at a bit of a loss. I dont just want to do a work-around, I want to know what shes doing different.

Thanks guys...I think its got to be the temps.
 
desertfox384

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Do the docs in that office each have their own assistant(s)? Could be a certain assistant is making tight contacts on the temp like 2thm8kr said... I have a similar situation - 7 offices, all report drop in crowns except one, and its the only large office I work for, they have 2 docs and 6 assistants...Ive got them taking good impressions now, but temps are still all over the place, in my opinion its just the simple fact of too many cooks in the kitchen.. I decided to slightly relieve contacts on the solid and fit the crowns to that.. They occasionally have to adjust a little but are ok with it. I don't want to do a workaround either but chasing ghosts is sometimes worse.
 
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If you do a work-around with that doctor the problem never goes away and you will always be blamed for the contact problem your chasing.
Learn exactly how the other doctors in that office are doing their temps and have your doc duplicate that same technique with your help chairside.
 
JMN

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If you do a work-around with that doctor the problem never goes away and you will always be blamed for the contact problem your chasing.
Learn exactly how the other doctors in that office are doing their temps and have your doc duplicate that same technique with your help chairside.
Would you/have you approched another doc in that practice for assistance in this retraining effort, or just suggest the off doc do so? Trying to learn some more doctor management technique before I stick my foot in my mouth, again.
 
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When there are several doctors under one roof sometimes jealousy shows its head. ;) In those times the lab may step in and have
more of an influence. Maybe rare but it does happen.
As we all know some doctors prefer tighter contacts and prefer to do a slight adjustments rather than add ons.. That's the case
with one of my accounts.
Also had a doc who preferred to do slight occlusal adjustments rather than me make out of occlusion ....This
was a doc who went through the Pankey program..
When solid pour models don't help with proximal contacts your in deep dodo....
How do I know, because I'm living the dream of contact problems with one account...
All leads back to temps...... those that can, and those that can't admit their problem... Hmmmm2
 
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Car 54

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Her temps, she's (or assistant) is pushing things open just a bit..or more, periodontal ligament movement? I had one account, who I routinely had to scrape the last molar contacts by about 1/2 mm just to make sure he had contacts. It was a real nightmare, until his assistant left, and when the new one came on board, now no problems at all.

What I would do for that Dr, and I routinely do, is to keep aside a designated BP with a new blade in it, then on a solid cast, I lightly scrape each contact 3 times. I know it may seem inconsistent as far as day to day hand pressure scraping, but as long as you use the same BP and change the blade out once in awhile, this could help. I mark the bottom of the cast with a Sharpie of how many times I scraped it, just so we both know in case it's to much. Try that as a starting point with her, and go from there as far as your scanner settings or when your hand building units in confirming your contacts.
 
Tayebdental

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I have also have one doc in a busy practice who wants v tight contacts, so I trim the adjacent contacts on the model before scanning or fabrication and now he is happy. Yes, I think it is the tight temps. He aknowlaged the fit is fine on the models thou before adjusting.

It is very obvious of tooth shift on a last prepped tooth with one contact point.
 
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All good info. The consensus is temps, and that is the only variable thats changed. She and I have great history from another practice; she is new to the current situation and the other Drs are all having great success...but they have the 'favorite' assistants. Im only guessing here, but she got the mobile fill in girl.
 
PDC

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All good info. The consensus is temps, and that is the only variable thats changed. She and I have great history from another practice; she is new to the current situation and the other Drs are all having great success...but they have the 'favorite' assistants. Im only guessing here, but she got the mobile fill in girl.

Next time you get a nice clean impression, carefully trim the margins on the solid model and check your contacts. Then tell the doctor to see if her temporary will seat on it. If not, then she needs to refine her temp technique or refine her assistant's techniques. I also wonder if this happens more in the posterior than in the anterior. Maybe she is using those old tin can temps...they are terrible.
 
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If you have more than 1 account, I don't believe you are ever able to get every office you work for doing the exact same protocols. We are all just human. I've had to make several "accomodations" over the years. The one that worked for a situation such as yours was to simply not use a solid model. Don't know about everyone else, but we use Artimax articulators on small cases (1-3 units) and adjust the contacts to a separate solid model. I would say 99.9% of the cases require some additional adjustment of the proximal contacts to get the restoration to seat on the solid model. So, for the one doc who consistently complained of light contacts, we just stopped using the solid pour, and Voila - everybody's happy...
 
desertfox384

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Having to scrape contacts made me think I must be doing something wrong somewhere, until I spent a weekend at Peter Pizzi's lab and saw him scraping all his contacts too lol .. even the best deal with this.
 

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