Team Approach: The Guarantee to Achieve High Functional and Esthetic Results in Prosthetic Dentistry

The basis for success of any serious prosthetic intervention is a team approach that implies close interaction of a dentist and dental technician at all stages of fulfilling the work. Such a statement is not innovative although it is not often used in practice. Nonetheless, this approach is becoming more adopted - at least in high-class works.

The patient is a full-fledged member of the team, too. In a funny way, apart from ideology, acceptance of this concept by the general public is being hampered by a purely organizational aspect. How many technicians are ready to invite a patient to their laboratory? Look around! Is your laboratory ready for an unauthorized and unprepared person to visit? Don’t get offended but look at the interior of your laboratory impartially. What do you see? Almost for sure there will be dusty, three-month-old models, dirt and remnants of food on the tables. The untidy appearance of the laboratory and staff may easily put off the patient.

The complete understanding between all members of the dentist - technician - patient triangle can lead to better result may seem controversial to some, but the achieved results and well-deserved respect among colleagues all around the world suggest that there is something to such idea.

Skeptics and pragmatics say the cost of dentistry is calculated and paid for only once. From that point of view, only the relationship between the treatment cost and the result of treatment may be considered as the criteria for efficacy of work. Indeed, a splendidly performed work yields higher revenue than less highly esthetic construction. But precisely here is the watershed between trade and creativity. In the end, how can one measure the satisfaction and joy experienced by all participants in the treatment process?

Although we live in different countries, we cooperate often and fruitfully because we sincerely believe that by doing so it is possible to achieve optimal results in prosthetic dentistry. Complete and unconditional understanding between the dentist and dental technician is absolutely mandatory. Any antagonism existing between the dentist and dental technician is fundamentally wrong. If such an antagonism does exist then this is only an evidence of their stagnancy and non-professionalism. An antagonistic relationship is the more so offending and unacceptable because it is no longer a problem to achieve high aesthetics and reliability in dentistry. Patients’ wishes are implemented in accordance with the abilities of dentists and technicians, their time and the materials at their disposal.

Nonetheless, when aloofness and alienation persevere between a dentist and technician the result is the technician viewing making a prosthetic as nothing more than a trade. When high aesthetics and functionality take a backseat to such parameters as time, volume of work and money and when function and esthetics are remembered only when delivering the work, then patients who want their dentures not to look artificial and their smile to be attractive become a nuisance. It is highly difficult to acknowledge such a situation as a normal one.

Well then, are demanding patients an evil? Not at all, especially if one assumes a creative attitude toward the work, sometimes even violating certain norms and prescriptions that abridge freedom of action. This provides a whole range of opportunities because the use of creativity, non-standard designing of shape and color, customer-tailored dressing of restoration surfaces and making of constructions will only positively emotionalize the patient.

And what about actively involving a patient into the work at all of its stages? Sometimes you yourself will be surprised how individual the construction made is and how naturally it looks like when the patient is involved.

When this happens there is no need for a dentist to use his eloquence and the most convincing arguments to get patient approval for a treatment plan. Instead, you together with the patient enjoy the attractive, perfectly done work.

How do you make a patient a full-fledged participant in the process of treatment? It is only necessary to find time and vigor to individualize methods of your own work, develop creative abilities and establish joint responsibility for the manufacturing of restorations. The first step must be to agree there is no way anymore for working in an old manner. Creativeness becomes a necessary element of the technician’s and dentist’s work. When there is a creative attitude about work, the most difficult processes in a remarkable manner become simple. The patient’s gratitude is expressed not only in terms of money, but also in sincere happiness from the process of treatment. Probably, someone will skeptically react to such an idea and say that this is theory that has nothing to do with practice. But the use of these principles really makes it possible to perform complicated and highly esthetic restorations thanks to creative cooperation between the dental surgeon, patient and dental technician.

These statements are illustrated by two clinical cases you can read about in the February 2007 issue of the Journal of Dental Technology. Neither case ends with the traditional photos of the prosthetic at various angles, but instead with patients’ faces expressing genuine joy from the obtained results. If one adds to this the satisfaction experienced by the surgeon and technician because of the complexity of the performed work and quality of the achieved result, then it would not be difficult to be convinced that the future belongs to such an expanded team approach.

Then the patient, along with the dental technician and surgeon, will become a full-fledged participant in a creative process that produces wonderful functional and esthetic results. Is all this not enough for such an approach to become a universally recognized one?

A Thought from Klaus Muterthies

Unfortunately it is necessary to admit that for many dental technicians the notion of individual work with a patient will be alien forever. Nonetheless, for those who decided to change their lives, persistence in implementing their own ideas will produce positive results. Individual work with a patient with the use, if necessary, of multimedia means will change the traditional approach and will turn a dental technician from a craftsman into a really creative individual.

And, certainly, an absolutely necessary element and guarantee of success is direct contact between the technician and the patient. Those times when a dental technician used only a working model without seeing a live patient are disappearing into the past.

At international conferences and in specialized magazines, dental technicians and dental surgeons call the restorations manufactured in the absence of the patient in a laboratory as unacceptable and harmful ones. However, the general public does not criticize the existing system according to which a dental technician is perceived solely as a servant of a gypsum model. Maybe, the time has come to get rid of the existing patterns and to overcome this practice of double standards. Then excellence will become the norm in communication between the technician, dental surgeon and patient.

A Thought from Sergey Chikounov

At present, the concept of active interaction between the dental surgeon and dental technician is not widespread and because of a number of objective and subjective reasons there are not many well-established dentist-technician pairs in real life. I prefer personal contact between members of the team during performance of the work. For this I often visit my colleagues in Germany where unique conditions for creative work have been established.

There is a desire to work together in a remote mode and now it is possible to do so. The Internet, digital photography, shade matching systems, articulators, face bows and the use of gnathology principles enable laboratories to operate a considerable distance from the dentist.

However, let us not forget that not only color is important but the shape and texture of the surface, too. Unfortunately, not much attention is being paid to this. But there indeed exist special coatings that disclose the texture of teeth (for example, the coating of the Picodent company). That is why, provided there is a desire, all these nuances may be identified and fixed with the help of digital photography and other technical means.

Only precise fixing of all nuances of a clinical situation and ideal performing of all stages of the work make it possible to obtain simultaneously both functionally and esthetic results. Of course, for an unaccustomed person this may seem difficult and non-mandatory, but it is a guarantee of success.