Tight Fit Problem

[Sda36]

Hey everyone,

We have this one case that is becoming a headache. We made a few crowns for a new doctor, same patient.

The first issue that comes is that none of the crowns fit in the mouth at all. Doctor says the go in just about 2/3rds of the way. A little puzzled on this we go ahead and make them again on a new impression, new model, etc. Doctor insists we didn't add die spacer because he doesn't actually see it on the model (We just tell him it's done digitally). We look on our side at all possible causes such as proper model work, etc, we even went ahead and calibrated our milling machine.

Second attempt fits a lot better but the crowns are way too tight. We made sure to add even more cement spacer on exocad than the previous time and we even added a little of axial spacing on the settings. Crowns fit well on model and pretty much fall off. Doctor keeps on saying we forgot the die spacer since they go in but they are too tight.

Any ideas what could it be? A little puzzled on this one. His preparations are good, and impression seem good. His impression is on rigid full arch tray where it seems he used putty as a rigid material and light body. I appears to have been done in two steps although we haven't confirmed it.

Compression or early pull, stretch then set but looks fine.

 

[user name]

At the risk of offending a few...Don't paint on die spacer. That's just pacifying the Dr and to his limited understanding, confirming his bias that he was right and basically, up to this point, you were lying.

The problem is his technique. Unless you can identify what hes doing wrong and can get him corrected, its a no win for you. In the mean time, while youre sharing his issues with us, hes likely talking to other Drs about 'another crappy lab'.

This isn't time for fiddling around to try and please him. This is a critical situation. How you handle it will either help you or hurt you. Theres no walking away like it didn't happen.

 

[user name]

I buy starter kits of this...from Nowak Dental Supply
http://affinis.coltene.com/nam/

The link says $110, but I think Im paying $85...?

Anytime theres an issue or I meet a new Dr that askes questions, I toss them one. Drs like freebies, and its a quality product. Just having something new in their hands sometimes gets them to focus a bit, and you get appreciation. I always say, 'everyone that tries it likes it', and for me, its true. It only takes one crown to recoup your costs.

 

[rgkbmk]

t with the H&H technique and and its variable over the years with some success and many failures with those who think they are doing it correctly. It comes down to who doing it. The H&H, double impress and all the variants I feel you need to use high expansion die stone on these cases. Something else to think about is the use of fast set impression material. Many don't realise that the insert is so quick, 30 seconds of less depending on temp, they they are placing rebound into the impression. Lastly find out if they are using the correct mixing tips. Found out that one clients office accidentally was using the polyvynal mixing tip for a poly ether material and ran into a fit problem as well.

 

[Car 54]

At the risk of offending a few...Don't paint on die spacer. That's just pacifying the Dr and to his limited understanding, confirming his bias that he was right and basically, up to this point, you were lying.

The problem is his technique. Unless you can identify what hes doing wrong and can get him corrected, its a no win for you. In the mean time, while youre sharing his issues with us, hes likely talking to other Drs about 'another crappy lab'.

This isn't time for fiddling around to try and please him. This is a critical situation. How you handle it will either help you or hurt you. Theres no walking away like it didn't happen.

No offense taken here, Bob. I just think it's another perspective that has some good wisdom behind it, as well as the rest of your post

 

[sidesh0wb0b]

first question, does it fit the model?

even if your models are made by a toothless unicorn that lives in the pakghanistan jungle, generally if it fits the model the lab has completed their duties to the best of their ability.

next, where are the pics? lets see these impressions. if, as mentioned above, its the horrrrrrrrrrbile H&H technique, i am willing to bet @2thm8kr left nuticle that the impression is wildly compressed. that method of impressioning is so difficult that i know very few GOOD doctors that can pull it off correctly. need to know if its compressed or not? is the wash blended with the medium body? if you can gently pry it apart i bet theres your issue.

call some impression material reps, get some samples, go chairside, make sure the doc follows timer and imp material instructions, and try a few until you find one the Dr is comfy with and you see good results.

 

[sidesh0wb0b]

t with the H&H technique and and its variable over the years with some success and many failures with those who think they are doing it correctly. It comes down to who doing it. The H&H, double impress and all the variants I feel you need to use high expansion die stone on these cases. Something else to think about is the use of fast set impression material. Many don't realise that the insert is so quick, 30 seconds of less depending on temp, they they are placing rebound into the impression. Lastly find out if they are using the correct mixing tips. Found out that one clients office accidentally was using the polyvynal mixing tip for a poly ether material and ran into a fit problem as well.

trying to correct expansion from improperly used H&H technique is like trying to diagnose your cars check engine light with a garden hose. YOU CANT GUESS YOUR WAY TO SUCCESS!

 

[2thm8kr]

i am willing to bet @2thm8kr left nuticle that

Hey man, wager your own!

 

[Car 54]

I buy starter kits of this...from Nowak Dental Supply
http://affinis.coltene.com/nam/

The link says $110, but I think Im paying $85...?

Anytime theres an issue or I meet a new Dr that askes questions, I toss them one. Drs like freebies, and its a quality product. Just having something new in their hands sometimes gets them to focus a bit, and you get appreciation. I always say, 'everyone that tries it likes it', and for me, its true. It only takes one crown to recoup your costs.

I've done that before, and in my case got a sample of Aquasil for the Dr to try, which he didn't. The Drs need to be open to our help, and not feel like a "subordinate" is telling them what to do, or where "they're" doing something wrong. You're right, it is a situation where we have to use tact, compared to our older accounts where we can share back and forth more freely, with worrying so much about offending them.

 

[rgkbmk]

trying to correct expansion from improperly used H&H technique is like trying to diagnose your cars check engine light with a garden hose. YOU CANT GUESS YOUR WAY TO SUCCESS!

I'm not correcting expansion issues with die stone . I have had clients over the years use the Dr Hoos technique and one thing that always stuck in my mind was those who complained, their labs tended to use the low expansion die material. You never can correct a bad impression. Just saying that when the H&H technique is done correctly, I feel high expansion die stone works better for me. Oh and I don't use die spacer either on the die's to : )

 

[sidesh0wb0b]

I'm not correcting expansion issues with die stone . I have had clients over the years use the Dr Hoos technique and one thing that always stuck in my mind was those who complained, their labs tended to use the low expansion die material. You never can correct a bad impression. Just saying that when the H&H technique is done correctly, I feel high expansion die stone works better for me. Oh and I don't use die spacer either on the die's to : )

fair enough. ive had multiple offices attempt the H&H, but only one in 20 years did it correctly (and with the right material) day in and day out.

 

[SiKBOY]

Whoever invented that technique should be shot. I haven't seen one of those impressions in years. It's caused our whole industry a massive headache. ha!

 

[omsk]

Well thanks a lot a again. I really appreciate the different opinions and ways of dealing with this. I've thought before of getting some intro kits to give to doctors that give problems but never really went ahead with it. I'll probably go ahead this time and order a few.

first question, does it fit the model?

even if your models are made by a toothless unicorn that lives in the pakghanistan jungle, generally if it fits the model the lab has completed their duties to the best of their ability.

next, where are the pics? lets see these impressions. if, as mentioned above, its the horrrrrrrrrrbile H&H technique, i am willing to bet @2thm8kr left nuticle that the impression is wildly compressed. that method of impressioning is so difficult that i know very few GOOD doctors that can pull it off correctly. need to know if its compressed or not? is the wash blended with the medium body? if you can gently pry it apart i bet theres your issue.

call some impression material reps, get some samples, go chair side, make sure the doc follows timer and imp material instructions, and try a few until you find one the Dr is comfy with and you see good results.

Yes, on the first try the crowns fit the model perfectly but didn't fit the mouth at all. Second try, crowns fit loose on the model since I added more die spacer and even added radial and axial spacing on exocad; these do fit the mouth but they're too tight according to the doctor. The second crowns pretty much fall right off the model (new model from new impression). I'll get some pics of the impression so you all can see it.

I agree that the technique brings just problems and it seems doctors just can't put 1 and 1 together when problems come up. I have another account whose crowns "SOMETIMES" don't fit just like in this case. And this always happens when doctor decides to do a two step impression. I've brought this up many times but it seems the doctor just ignores it.

 

[MasterCeramist]

I just love getting a phone call on Monday mornings, Hey I went to a course this weekend and have a new impression technique I'm going to try, oh boy here we go again. I hate the H & H technique. I give no warranties for cases fabricated with this impression technique other than it will fit the model.

 

[user name]

Might be interesting to scan the first model as a pre-op and the second attempt as a working, then see how accurately you can get them to mesh. Might show some substantial discrepancies.

 

[sidesh0wb0b]

how did the first crowns fit on the second model? and the second crowns on the first and third model?

 

[Getoothachopper]

At the risk of offending a few...Don't paint on die spacer. That's just pacifying the Dr and to his limited understanding, confirming his bias that he was right and basically, up to this point, you were lying.

The problem is his technique. Unless you can identify what hes doing wrong and can get him corrected, its a no win for you. In the mean time, while youre sharing his issues with us, hes likely talking to other Drs about 'another crappy lab'.

This isn't time for fiddling around to try and please him. This is a critical situation. How you handle it will either help you or hurt you. Theres no walking away like it didn't happen.

Not offended 'user' you are always respectful . In my experience "you know who does get offended ?" ,,,,,,,,,,,Doctors when the Lab guy explains how he should be taking impressions .Here is my reasoning , you get the crowns to fit by whatever means you have too . The next time the Doc tries a new lab for whatever reason --------back to tight fitting crowns again (work comes straight back to you). You spend the time sorting them out then 6 months later he finds a lab that do them cheaper and faster . Oh Damn ! I really am getting Cynical in my old age , lol

 

[Car 54]

how did the first crowns fit on the second model? and the second crowns on the first and third model?

Is this the Abbott and Costello "Who's on First", crown and bridge routine?

 

[sidesh0wb0b]

Not offended 'user' you are always respectful . In my experience "you know who does get offended ?" ,,,,,,,,,,,Doctors when the Lab guy explains how he should be taking impressions .Here is my reasoning , you get the crowns to fit by whatever means you have too . The next time the Doc tries a new lab for whatever reason --------back to tight fitting crowns again (work comes straight back to you). You spend the time sorting them out then 6 months later he finds a lab that do them cheaper and faster . Oh Damn ! I really am getting Cynical in my old age , lol

had this happen. no joke. except i helped the Dr fix an ongoing prob he had for 6 years and couldnt figure out. took us a few months but we finally got it straight....then guess what? 9mo into the relationship, his remakes were way down, his crowns were fitting properly, his impressioning technique was improved....and the local china lab came through with a cheap ass crown. hes gone, not even a hesitation. he left for a $60 crown and i helped him resolve all the issues he had been having since he graduated dental school.

 

[sidesh0wb0b]

Is this the Abbott and Costello "Who's on First", crown and bridge routine?

musical chairs! hahaha