Upper vs. Lower NG confusion

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Jyuddy

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Hi -- we're getting our NGs from some labs and an issue we always run into is that the lab will make an upper instead of a lower (b/c it's the default). We've tried making it more clear on the RX and writing it multiple times, but when you do a lot, it will still happen. Any ideas? Tips? I'd like to think we work with good labs and they must see this a lot too, but it's just shocking how it happens given how straightforward it is.
 
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Jyuddy

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Hey All -- we work with a few labs on night guards and the common mistake is that they send us an upper instead of a lower (since uppers are the default). It happens with every lab we work with and we've tried highlighting our RX to be more clear (including writing "lower" multiple times) but it still happens. Obviously there's a lot of cases, so it's bound to happen occasionally. But just curious if anyone has any good tips to put on the RX to make it extremely clear... Thanks!
 
JMN

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Greetings @Jyuddy ! Welcome!

First five posts are time delayed for moderation. After those posts show immediately and you will be able to upload images directly without linking from another hosting site and you can start private conversations using an envelope that will appear between the bell and your avatar picture near top right.

Write the word lower in magic marker 2 inches tall and all other words normal size.

If they are unwilling to read the RX every time have to draw enough attention to make them look.
 
eddydy

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I make my own guards, if RX says lower, I draw a huge X right in the middle of the upper palate.
 
Sda36

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Hey All -- we work with a few labs on night guards and the common mistake is that they send us an upper instead of a lower (since uppers are the default). It happens with every lab we work with and we've tried highlighting our RX to be more clear (including writing "lower" multiple times) but it still happens. Obviously there's a lot of cases, so it's bound to happen occasionally. But just curious if anyone has any good tips to put on the RX to make it extremely clear... Thanks!
Depending on skeletal relationship max/ mand may be just the best choice for treatment. Lets take a Pt with significant overjet, you really want a mandibular NG where the Pt feels they have a golf ball in front of their lower incisors? Its always a balance of everything in play for a given Pt. You need to see these cases articulated on a proper articulator Before choosing type. Having said that, mounted study models are part of Treatment Planning. Once you see what we see you may want to re- think your multiple requests. There are Very good designs from a whole bunch of great clinicians "Spear" etc. Real work begins with a facebow record, open bite records with a "Lucia Jig" and proceeds flawlessly from there. I'm really sick and tired of Docs who take 2 alginate impressions, Rx a bitesplint and do nothing more but to charge an ENORMOUS FEE for doing almost nothing at all. I know good Docs who will spend 2 hours or more chairside fine tuning these appliances. This is where designs meet the mat and are what is required. Otherwise an Rx to Wallgreens or Walmart would likely result in a more Pt friendly device. Enough said
 
bigj1972

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Pcguru
 
Last edited:
rkm rdt

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Hi -- we're getting our NGs from some labs and an issue we always run into is that the lab will make an upper instead of a lower (b/c it's the default). We've tried making it more clear on the RX and writing it multiple times, but when you do a lot, it will still happen. Any ideas? Tips? I'd like to think we work with good labs and they must see this a lot too, but it's just shocking how it happens given how straightforward it is.
This sounds like you are working with a production lab. One tech doing ngs all day long,5 days a week, paid by the unit.
They all look the same after a while.
Was that with or without fries?
 
Doris A

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Hey All -- we work with a few labs on night guards and the common mistake is that they send us an upper instead of a lower (since uppers are the default). It happens with every lab we work with and we've tried highlighting our RX to be more clear (including writing "lower" multiple times) but it still happens. Obviously there's a lot of cases, so it's bound to happen occasionally. But just curious if anyone has any good tips to put on the RX to make it extremely clear... Thanks!
The very first thing that I was taught when I became a tech and it still holds true today and always will.....READ the Rx BEFORE you do anything to the case!! This holds true for everyone who has hands on the case from the person who logs it in on arrival all the way to the person doing quality control on the way out of the door! I would be making a call to the lab and talk to the owner or manager.
 
npdynamite

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This seems 100% unacceptable. Everyone in a lab that deals with the case should read and understand the rx. The only situation I would maybe make an exception is if, in a 3shape lab were receiving cases from Trios and if the dr. set them up as an upper but then specified in the rx that they wanted a lower.
 
rkm rdt

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I want to see the doc's hand writing before jumping to any more confusions.
 
Doris A

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I want to see the doc's hand writing before jumping to any more confusions.
This is true. Most take a class in Chicken Scratch, and they pass with flying colors.
 
bigj1972

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Probably cheap production lab. Got the $59 mailer. You think with the cost of materials, overhead, and labor anybody is going to bother reading or care if your happy? 100 more came in since the OP. Pay little, get little.
 
LuthorCorp

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Seems pretty cut and dry, you request something specific and they aren't delivering, its like basics 101 read the RX. If you talk to them about the issue and they still provide the same problems over and over, it doesn't seem like they care enough to provide that small effort in ensuring your RX is followed, and maybe they don't deserve your business
 
TheLabGuy

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You could always write Michigan Splint (which refers to maxillary) or a Tanner (which refers to the mandible). Not sure how to solve the issue because we really don't have that problem. But then again, reading the Rx is done multiple times for the same case many times before it goes out. Sounds like a Quality Control/Lazy Tech issue to me.
 
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Sounds like the techs heads not in the game. Give the lab a call and ask them why this keeps happening, if the problem keeps happening switch to a lab that can read. My dentists always orders either Michigan or Tanner splints to make it as clear as possible what they want.
 
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write it in Chinese and see if you get a better result. Im not joking i bet its an outsource lab they cant really understand the job sheet they just look for the usual boxes ticked thats about it.
 
Sda36

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Hi -- we're getting our NGs from some labs and an issue we always run into is that the lab will make an upper instead of a lower (b/c it's the default). We've tried making it more clear on the RX and writing it multiple times, but when you do a lot, it will still happen. Any ideas? Tips? I'd like to think we work with good labs and they must see this a lot too, but it's just shocking how it happens given how straightforward it is.
You still at this? Can't you call your lab and discuss this issue?? You really think you need to come onto this network to discuss your communication with your "labs"
 
bigj1972

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, but it's just shocking how it happens given how straightforward it is.
Yeah...I would save the hassle and just make them yourself. And as a Dentist, you could save all that stress and money.
 
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