Very difficult case. Experts only !!

[cosmicsport]

This case is a nightmare. Dr. took 3 impressions and all 3 look different. We redid this case 2 times already and it won't fit ?! Dr. says he took his time to let the impression material cure (5 mintues). [Patient is a gagger, so I do not know how the Dr let it cure for 5 min????]

Dr did not tell us that that Patient was gagger and threw up in the chair after second remake.

We got a digital impression model now but how muich can I trust this one ??

Please give me ideas because I do not what to do anymore.

Thanks everyone

 

[dmonwaxa]

I'd go with the digital model since it was processed at another site. As long as what you fabricate on there fits then you cant be held responsible. I hate do overs like that, been the done that. What digital system is he using?

 

[TheLabGuy]

I don't even think I would of accepted this case with those type of preps on it in the first place. I'd have to see some more pictures, but they look so undercut and those axial walls so tall that by the time you make the necessary block out you won't be able to find the margin in the first place. Hopefully you can communicate with your Dentist along the way, maybe a metal try-in first? bisque bake? try to do it in steps and if he balks at that then that's your out, anything remade is full charge.

 

[cosmicsport]

Thanks guys,
Dr and Pt. are already pissed. This third time most be perfect. Venneers are not fitting at all. We are taking about open margins of 1-2mm
Looks like I got 3 different cases in front of me, that how different the impressions are.
I charged 25% on 2nd remake. 3rd for free

 

[TheLabGuy]

OH, and I'd take pictures of EVERYTHING!!!!!!!!! You need to be in CYB (cover your butt) mode. I would even go as far as combining the pictures of all three to show the Dentist the differences that way he knows that the problem is at the CHAIR not the lab and charge accordingly, with those preps, I'd probably go full charge plus a aggravation fee. We all have had a case or two like this, sometimes even lost accounts because of it, COMMUNICATION with the Dentist is the only thing that will let your survive it with any sanity.

 

[charles007]

I would go digital........... and I'm sure you showed the doctors all the model...right

Seems strange that a doctor has a intraoral scanner and didn't use this on the first try........does that mean he has very little experience with it ?
A bad impression is a bad impression, no matter how the impression is taken.

If you need this account, I would bend over backward to get this right....and show him his failures as you proceed forward. I would show him the differences in all the models.... let him choose the model to use.......


Rocks of Luck

Charles

 

[cosmicsport]

This is the latest impression, with the 1st set of veneers !!!
How amazing is that ??

 

[TheLabGuy]

Let me put my Chinese glasses on.......yep yep, looks good!!!!!!

 

[charles007]

Like a doctor told me the first year I worked in the lab....all crowns fit, some fit better....... and this doctor couldn't take a good impression if his life depended on it........
Maybe your doctor is a distant cousin .

 

[dmonwaxa]

Midline is off....way off.LOL

 

[doug]

You are a brave man! I understand accepting a challenge, but this one is really not your financial responsibility.

 

[Al.]

I would take everything to him and let him trim the dies land mark the margins.

Doug do you still call the removal lugs tweeters?

 

[Wyolab]

Wow! Do you deliver these cases in person, or is it shipped. Maybe bringing all the models and restorations into the office would help the dentist learn from it. Present it like this "Dr. I really want this case to go well for you, as I know how frustrating remakes are for all of us. This patient sounds like a challenge. I need to sit down with you and look over this case so we can get the best outcome possible." try and be neutral. A gagging patient that throws up during impressions has to be a challenge for the dentist too, but you can't make a miracle from manure. When a dentist looks at a case you have poured up they often see things they did not see in a gagging or difficult patient because they wanted to get the heck out of there. If your Dr. realizes that your doing your best work with what you have been given maybe he will consider a new impression. The digital impression may be the best. I know one labs remake policy is 50/50 no matter who is at fault, but they don't keep a dentist if their work is not up to par. This dentist probably knows exactly why those crowns don't fit. He doesn't want this patient costing him any more, selfish I know, but he probably spent twice as long with them in the chair on the initial prep and impression. What I am saying is you got a giant pile of junk, it is not your fault, let the dentist see what he has done to you, and allow him to take some ownership. Don't be confrontational, just give him the facts and ask him for "ideas" so he can think about the why.

 

[JohnWilson]

No way that the imp is off that much if I was to guess this guy is new to adhesive dentistry and perhaps while making the temps he etched and the temp material bonded to the preps. He was then forced to cut it off and alter the preps.

Lots of guys when they temporize this type of case they "SpotEtch" and bond and use no temp cement to retain them. I bet this guy did not do that.

 

[amadent]

I would take everything to him and let him trim the dies land mark the margins.

Doug do you still call the removal lugs tweeters?

we do that as well -have even made 2 sets of models -1st set that you ditch in the lab -the 2nd to bring with you leave virgin -in case the doc doesnt agree with where or how the case is trimmed.
best of luck


Greg Amendola MDT

 

[cosmicsport]

Thanks Guys for your help. The question is: Am I doing something wrong ??? Is it maybe my fault ??? What can be done wrong in the lab ??

Thanks again guys. Your are awesome.

 

[amadent]

if your margins were sealed on the model you made venners on like john mentiond there must be something else going on, i dont care what kind of stone you use or model and die system - it is impossible for there to be that much of a difference from impression and model to the mouth-you mentioned that the Dr. sent you digital file , has the model been fabricated for that yet, if so how do the 1st setof venners transfer to that.
*we can only be as accurate as the information that we are given*
you also made mention that it looks like 3 different case in front of you
in order for this case to have any chance of satisfying the DR. and patient-your Dr. is going to have to be the captin and tell you witch imp you need to work with

 

[paulg100]

i really hope after all your efforts you will get some appreciation and loyalty from this guy.

Unfortunatly my experience with this kind of situation is that you will kill a load of time and money and the guy will end up blaming you. Even if you do finally get the case right he will end up drifting off elswhere due to the bad experience. Depends what kind of relationship you have with him i guess.

He is learning at your financial expense and my own gut feeling is to write this off as a bad debt, Espcially if he is not listening to your advise?.

For starters Impregum, an automix and rigid body trays for this type of multi unit work. Then he has good grounding for taking some decent imps. The rest is tissue and moisture control which is down to his own technique. If this is the problem then he needs some courses.


THIS is the kind of Dr that digital imp technology is made for.

 

[doug]

Doug do you still call the removal lugs tweeters?

Al, Yes, we do. I started that at Jim Cason's lab, told him that's what a bird d*ck looked like. Can I post that on here?

 

[rkm rdt]

"Thanks Guys for your help. The question is: Am I doing something wrong ??? Is it maybe my fault ??? What can be done wrong in the lab ??"

With all due respect,I would say you are at fault.Permit me to explain.

As mentioned earlier,the preps are very poor.The resulting impression has been distorted in some way.

Would you have prepped them the same way or would your preps have looked different?

I'll bet there was no diagnostic waxup nor did you provide the Dr a prep guide.Had you done that then perhaps the resulting preps from the Dr would have been more ideal for a proper impression.If not then you should be obligated to the patient to return the case to the Dr and get on the same page.

This is clearly a case of miscommunication and you have to accept the blame for not providing the blueprint.....now if only I could practice what I preach