How to Make a Good Impression

At some point, many dentists struggle with the impression process. Frankly, getting an appropriate impression is a difficult procedure. The impression is similar to a photo in that it only captures one moment in time. But after that moment, things change. As a dentist, you are attempting to capture an image in a continually changing environment. And, any number of changes can, and usually do, take place immediately after the impression is taken: shrinkage or expansion of the tissue may occur and the prepped teeth or other teeth may shift. This likely wouldn’t present such a challenge if you and the dental technician were not charged with the task of creating and placing a restoration that has to fit. When you consider that the error ration is in microns, it is amazing that any restoration fits well at all.

Consider the types of problems that can occur when taking an impression. Many impressions are compromised because:

    * improper or expired materials are used.
    * contaminants, such as blood and saliva, are present around the prep area.
    * improper powder-to-liquid ratios are used and/or material is mixed for an improper time.
    * the amount of working time for the material was exceeded.

In many of these situations, the compromise can be discovered when you inspect the impression. Often, another impression can be taken before the patient leaves the chair. However, other errors can occur that can’t be detected until the laboratory technician pours the model.

Recently, a dental laboratory owner, who is also a Certified Dental Technician (CDT), told me that he could tell who prescribed a case just by looking at the impression. When I gasped in disbelief and pointed out that his laboratory worked with more than 30 dentists, he insisted that each dentist prepares cases and takes impressions in a way that becomes akin to a fingerprint to the technician who regularly performs the dentist’s laboratory work.

What is your impression fingerprint? Are there ways in which you can improve your impression-taking technique and avoid costly remakes? Absolutely. Here’s how:

Call. Start by calling the laboratory. Tell the dental technician that you would like to work together to reduce the amount of remakes. Ask the dental technician to review your impression-taking techniques. It is unlikely that you will encounter resistance from the dental technician. The technician sees impressions taken by many doctors, so he or she becomes expert in evaluating the results, and most technicians are happy to share their expertise. Also, it’s likely the technician will appreciate your request for his or her own reasons: Remakes are expensive from a material and time standpoint for dental laboratories, too, not just for dentists - in both cases, remakes account for lost revenue. Additionally, the technician is likely to want a good working relationship with you because he or she has a vested interest in keeping you and your patients happy.

Show. Invite the laboratory technician to visit your practice and observe how you take impressions. It is helpful if the technician becomes familiar with the challenges you face when working chair side with a patient. It is important for the technician to witness the parameters within which you have to work.

Discuss. Review your impression-taking technique with the technician. Is there a compromise that repeatedly appears in your impressions? Can the technician offer solutions so your office can avoid those compromises in the future? What material, trays, and techniques does he or she recommend? Ask the technician to explain the standards and procedures that the laboratory uses in handling your impressions so together you can better ensure consistent results.

Schedule a follow-up meeting with the technician in 60 days to discuss the changes that you have made and determine if there have been marked improvements in the number of remakes. Although it isn’t likely that you will be able to completely eliminate compromised impressions, you can greatly reduce their frequency by developing a good working relationship with a skilled Certified Dental Technician.