I have had it explained to me how easy it should be for my doctors to seat my crowns. My favorite explanation came from none other than Dr. Mike Abernathy himself. He put it to me in a way that I could not possibly have misunderstood, sports. “I should be able to hook shot it across the room and it should hit nothing but net”. Having worked with Dr. Abernathy, I can assure you he is not kidding. I can also assure you that having that kind of harmony with your lab is no accident. In fact, you both have to know how to go out of your way to make it happen. It’s not hard, just a standard you must always hold the line on. That’s where things can go wrong. As a lab owner and technician, I can produce this crown for you if you are willing to do two things for me on every case, that’s it, just two simple things!! So what two things am I talking about? How simple are they? They are the culmination of my own personal investigation into the matter, and here’s what I learned.
I send out comment cards on all of my cases to allow my doctors to give me feedback on the crowns I send them. Once a month I gather up all of the cards I have received and read them to see how I am doing. The thing that caught my attention was that from one doctor I had cards that were filled out in three different styles of handwriting, none of which were the doctor’s handwriting. Then I noticed that within the three different handwriting styles, the results were very consistent. Hand writer number one seemed to have a lot of contact issues in the interproximals and hand writer number two had problems with contacts and occlusion, while hand writer number three had no problems at all and the crowns were hitting nothing but net. A simple phone call verified my sleuth-like suspicions; each hand writer represented a different assistant. So what was the problem? The temporaries were being made by three different people who used three different techniques. On the surface they all seemed the same, but if one assistant varied from another on the occlusion even a tenth of a millimeter, then the crown fit was affected in a major way. When you took that impression to send to the lab, you froze time. That model reflects what was going on in the mouth at that exact moment and that’s what my finished crown is made to fit. You must now preserve what you have frozen so that we can hook shot the crown into the mouth. If a contact is open or an occlusion is open when the temporary is made, the rest of the mouth has time to move and change the whole fit. Number one is the temporization process; it must be a consistent process that does not change, even if different people are making them.
The second thing I need from you is a quality impression. I know this seems obvious, but I think that it is so crucial to how the case will come out. There aren’t a lot of things that go wrong with impressions, but there are a few that I see a lot of, so let’s cover those. Most problems are things that I can see without even pouring the impression, so if you look for the signs then you will see them too. Look for pulls, tears, and voids in the impression. This does not take long and if you focus in on the prepped area you will spot them pretty quick. The second problem I see in impressions is that nobody seems to want to do proper tissue retraction. You must give me a margin that I can see, or I say you aren’t playing fair. Next, I would like to address the problem of tray selection. When you take an impression and pull it out of the mouth and you can see the tray anywhere near the prep, guess what? The patient has bit into it and if it was stretched out and then compresses after you took it out of his mouth, then the impression is already distorted and the odds of a crown fitting may already be zero!
Enough doom and gloom! Here is what I can promise you. I can deliver a crown that you can hook shot from across the room every time, whether it’s a single unit or a large smile makeover. It’s what I do and it’s what I am good at, but know this, we are a team and we will only do it together. Give me a call and let’stalk about teaming up and working on that hook shot. As a special incentive this month, I am offering half off your first all ceramic case, large or small.
Jimmy L. Fincher, CDT
Cosmetic Advantage Lab
McKinney, TX 469-424-2860