Impressing the Importance of Accurate Impressions, Part I

Day in and day out, the basis of everything a laboratory does is the impressions we receive from the doctor. This crucial, tangible information about a patient’s condition has evolved over the years, with different materials and impression-taking techniques being developed in an attempt to capture the most accurate and stable details. As a laboratory owner, I know first-hand how important it is to evaluate the quality of the impressions received in order to ensure productivity and profitability. After all, what we receive with the case prescription dictates our ability to deliver quality restorations that satisfy everyone’s expectations, without the need for costly and time-consuming remakes.

So, it stands to reason that how we handle impressions when they arrive and, more importantly, the manner in which we interact with doctors to correct problems identified in those impressions, can make or break a case, as well as the doctor-laboratory relationship. So, I ask you, what can you do to bring even greater value to your relationship with your doctors when it comes to impressions?

In this month’s column, I’ll provide some answers so that you can enhance the nature of your relationships with your doctor clients when it comes to resolving problems with their impressions. Next month, we’ll take a closer look at how accurate impressions - or the lack thereof - truly has an impact on a laboratory’s bottom line, its productivity, and its reputation.

Be Fast and Finicky

As soon as you’ve received a doctor’s prescription and impressions, thoroughly read the prescription and take an account of everything so that you can be sure you’ve received what you need to begin the case. If something is missing, or if the type of restoration requested won’t fit the bill, call the doctor right away so that there won’t be any delays. This simple courtesy call makes it obvious to the doctor that you’re on top of what they’re doing and looking out for them and their patients.

Along these lines, check the impressions you’ve received the minute they arrive. Now, as an example, the first thing I do is take the impression and look at the inside of it. One telltale sign to me that the impression needs to be re-made is a pulling away of the wash material from the heavy body material. If I notice this before any models have been poured, I’ve saved myself time and money and can immediately - upon receipt of the case - call the doctor to discuss the problems with the impressions.

Educate and Enlighten

Now, any laboratory technician can call a doctor and tell him or her that an impression needs to be retaken. They can even provide some guidance as to what the problem is with the impression. But if you’re looking to add greater value to your relationship, then you need to do more.

In the above scenario, I’ll call the doctor, describe the impression problem and then take on a problem solving approach by asking about the manner in which the impression process is sequenced. For example, I’ll ask if they’re dispensing the impression material in the tray at the same time they’re syringing in the mouth. Typically, they’ll say no, that they syringe in the mouth first and then start dispensing in the tray.

Well, this causes problems because the heat of the mouth causes impression materials to cure more quickly, even as they’re being syringed. If the assistant doesn’t start dispensing the tray material until the doctor is finished syringing the teeth, then the material in the mouth has already started to reach its gel stage and won’t properly adhere to the tray material once it’s placed. So, when the doctor seats the tray, it might look adequate. However, when the impression is poured, the two materials will pull apart. By enlightening the dentist about ways to avoid problems with their impressions in the future - as well as by recognizing the problem so quickly - you’ve just become a valuable resource.

Similarly, if I’ve looked at the impression and noticed that the heavy body material has pushed away or otherwise displaced the wash material, then I know that a different impression material is needed. We recommend a high-quality polyvinyl impression material (Virtual, Ivoclar Vivadent), which includes a very accurate light body wash material to capture all the details of the teeth, including the margins and into the sulcus, and an accurate heavy body material that won’t displace the wash material.

Or, let’s say the impression-taking sequence was fine, but there are bubbles in the impression. I’ll typically ask the doctor if they’ve used an astringent and, if so, what kind. Usually, they’ll respond with, ‘Yes, how did you know?’ That opens the door for me to explain that astringents with ferric sulfate or aluminum chloride, if not properly washed off the teeth, will retard the setting of impression materials. Again, by sharing what you know in a timely and problem solving way, you’re providing a value-added service.

Of course, we also routinely encounter soft tissue problems with the impressions we receive, such as evidence of poor hemostasis or gingival retraction. To facilitate more accurate and problem-free impressions, we’ll suggest the use of a liquid retraction cord to control bleeding. We also encourage the use of a soft tissue diode laser (Odyssey Laser, Ivoclar Vivadent) for gingival troughing - rather than placing retraction cord - and also for sealing off the capillaries so bleeding is diminished. The more options and information with which you can provide your clients, the more valuable a resource you become.

Conclusion

Combined, timely and responsive interaction with your doctors to correct impression problems and your constructive recommendations will let them know that you understand what they’re doing and how best to go about it. Being on top of their cases from the moment you receive their impressions helps to create a really ‘Wow!’ experience, one that demonstrates respect for their business, not just complaints about poor impressions. Next month, we’ll review the impact that poor impressions can have on a laboratory from a reputation, productivity and profitability perspective.