Bridging The Gap Between Your Practice and The Ortho Lab
Updated: May 15, 2018
A part of the success of an Ortohodontist is their relationship with the orthodontic laboratory, in lue of that this article will be about getting the most out of the relationship between Doctor and Lab. As you read this the goal is not only to give thoughts on what to ask your Ortho Lab but to also provide you with solid ideas that you the Orthodontist can build from. How may this benefit you we will get to more on that later in this paper, but for now 2 things your business from are, the benefit from an environment that runs with less stress, as well as a growing relationship with a lab that starts off in the right direction from the very beginning. Communication between Orthodontist and Labs like any business can be lacking quality that ultimately keeps the businesses from reaching their true potential. After reading this paper it is also our goal that communication between you and the lab will be for the better. Increasing workflow while at same making it easier on both you and the lab, by going over questions that open communications and understanding between both you the Doctor, and your current Lab, or when seeking a new Lab. By the end it is the purpose of this paper that establishing a better relationship will also save your business time while increasing workflow ability, leading to more money and in a less stressful environment. It is a win win for both you and the lab when quality communication exist between the two.
Pur Communication cun leed tu confoosion - Anoying isn’t it
Communication between Doctor and Ortho Lab like many of the other pieces that, put together, make a practice run not only successfully, but puts you and your staff under less pressure. When evaluating all avenues that lead to your practice being successful it is crucial that it be looked at how to make communications between you and the lab that allow both to be running on the same page. Practicing better communication skills ultimately leads to a better business earning more money, and cuts expense or as some may call the “fat” of a business. The need to do remakes, or chairside adjustments which eats up time are problems for any Practice. Greater is the patients satisfaction, which when there is not communication that is solid, remakes, and long chairside adjustments are needed, the patient satisfaction does go. This stems from appliances being made wrong and the wrong can fall on the ortho lab or your practice, the goal is to open communication between you the Doctor and Lab, as being the Doctor there is no one that can better communicate with your Lab, and give specific detailed descriptions that allow the lab to craft exactly what you ask for, on the labs side a designated Orthodontic Technician should be assigned allowing for consistency, and keeping communication simple by not having to go over old discussions. The benefits of this open communication between Doctor and Lab leads as what was said before to patient satisfaction by reducing if not eliminating the majority of remakes which cause delays in the seating of the appliance, appointment cancellations, the loss of a patient and yes money. Coming back to the beginning, Stress is a major component of a business that when running at its peak, can truly be crippling by overwhelming staff, Patients, and you the Doctor. Should just 3% of your appliances need a remake a low percentage, but it does add up. Say hypothetically speaking you see a 1000 patients a year 30 of your patients are affected while most will not cancel thats 30 patients that need to be rescheduled and you are left eating the bill of how much it cost to leave that seat open. Scenario 2 is long adjustments are needed, reducing the number of patients a day you can see. Now if by open communication which is consistent with the lab you could reduce that number to 1% you will be reducing the cost by ⅔ as well as gain the approval and satisfaction of the 20 other patients leading to more referrals which means more money. No matter which lab you pick it should be one who has honed themselves to be able to tackle any appliance, if, and the key is if, the Doctor communicates exactly what is wanted, and I mean anything old or new this is the job of the technician to take what is described by you the doctor with both a well written Rx slip as well as verbally discussing before and throughout the making of the appliance that you the Doctor ordered. In the end the lab with this communication should be able to craft exactly what you ask for and of high quality that meets the demands of your patients health and not another remake. You are the Doctor take control and don’t be afraid to assert yourself as making a perfect appliance does exist when both Doctor and Lab communicate consistently, and again leading to that win win for everyone. You will see below ways that better the working relationship of the lab you work with currently as well as with starting off with a new lab.
Make sure you only have to deal with one Technician, unless for some un-asked reason that Tech not be able work for example death or near you should always be dealing with the same tech. With one Technician being the key block of the whole Lab, you the Doctor can build consistent communications with history that leads to a less stressful talk, which both you and the orthodontic lab will enjoy. That once eliminating dealing with multiple techs which you must either go over everything again, or wait while they read notes, which, never gives that person the knowledge that dealing with a single Tech does, you will have time to talk about little changes those changes could support a creation or invention of a new appliances, moving forward not bogged down by remakes and time consuming talks with different techs as they don’t know the history between lab and Doctor is.
As mentioned a little up above create history with your single Lab Technician, you and the Ortho lab Tech should be going over standard designs that you prefer in your devices for instance how you like your favorite types of removable appliances, and whether retention devices design change should their be wisdom teeth or no wisdom teeth as with a retainer. Go over the designs of the appliances you do the most as again with the retainer going over wire gauges, how you would like the acrylic on the retainer to be trimmed, and colors. If you order a RPE whether you fit the bands yourself or you want the Lab to fit them. Be specific and be patient if your appliances require rarely used pre fabbed parts, a successful lab will meet those requirements very quick by obtaining those pre fabbed parts and stocking them for future use on your cases reducing day of return on unique appliances.
Speaking of turn around time find out what it is get specific, fixed and removable appliances may be different. Do they offer rushes and if so how much. Knowing these times and should they meet your needs prevents your staff from scheduling patients to early or even worse to late as the sooner that appliance gets seated the better.
Just like the lab has one Technician, someone at your practice when you the Doctor cannot speak to the lab, or be it something that designated person can do like go over a color change on an appliance, and I really stress should there be something not right You the Doctor should talk to the designated Technician. Not only does this eliminate where the error is coming from on the labs side you the Doctor are the only one who knows exactly how you like your appliances, when you talk with the Tech and why it is so valuable is you can really get into details even the tiniest ones where your designated communicator cannot. For whatever reason another tech or on the practice side another who is designated to be the one from your practice change such should be communicated and introductions made. This keeps communication flowing better during times of change.
One day a patient or OSHA may ask, be prepared by asking the lab how they sterilize their appliances.
Working Days should be gone over from what is a normal work week, what times does the lab open and close, and what holidays the lab takes. Keep track of these dates scheduling patients under a well working system will bring down the stress of having everything up in the air.
Ask how long prescription forms are kept, a lab should keep them for years as they are wanted for reference on the patient as well as in lawsuits.
Hypoallergenic wire (nickel free) and Acrylic that is (methyl methacrylate free) is attainable, ask your Lab if they have access to these materials to accommodate these rare cases.
The expansion appliances you prefer have a total expansion amount, make sure the labs meets your requirements along with the turning ratios of the appliance, and if not can the lab get what you do require. Asking this in the beginning can allow the lab to order what your practice needs ahead of time, instead of bringing it up when a patient needs the appliance. reducing return of date time with unnecessary material order is something clear and thoughtful communication in the beginning will solve.
Inquire what the Ortho Labs warranty is, as the warranty is pretty straight forward the lab should be able to answer this, for your records have the lab send over a copy of the warranty for the ortho labs work. You want to see things like “all appliances failing due to Lab error or fault of the lab will be remade at no cost.” “Appliances breaking due to patient fault that can be fixed without a remake is a cost that is calculated case by case. The right lab has a Warranty policy should something fail at the fault of the Labs side, for instance a wire or the acrylic breaking during normal wear. Do not be afraid to ask on appliances as you start and as you grow with your lab what the warranty is.
If you would rather not draw anything on the Rx form, then a well written out description of what when finished by the technicians is the appliance you asked for is the way to go. A Well written descriptions can let a technician know also what may be confusing if it was just by the drawing itself, and even better is, if you are stressed over whether the Lab will get it right, a call can be one of the best ways to communicate. With a call you and your designated ortho lab technician, (should you be in business with ortho lab that does this.) can go over exactly how you want the appliance made.
Start slow with a new lab, send 1 or 2 cases for 1 or 2 weeks, if something needs to be done different a call to the lab can usually solve the issue. After two or three weeks of getting appliances how you like them, then as you feel comfortable start adding more and more work.
Experience Can Make or Break A Lab
Seeing hundreds of thousands of appliances a year does not trump experience, a lab tech with experience has seen what works and what does not, never be afraid to talk about a case with your designated ortho lab tech, usually a 5-15 minute phone call depending on complexity can bring the tech up to speed on what you want even if the tech has not heard of or you are trying new ideas, and concepts, a well ran lab can accommodate this. The Lab is your answer to limitless questions, utilizing your labs full potential is important. You as the Doctor will see a difference of what 15 minutes of your time, again only you the Physician knows how to explain it right, can do, and should you have a designated Tech, the service of a well ran lab will only increase over time.
Digital Still a Little Early But…
Ahh the world of Digital, should you be pondering going digital or already are, for Doctors who have not yet it may be better to stay analog, and those with digital to remain digital, for the Doctors without digital equipment and equipment needed to store data it may be wise to wait till the market on not only the cost of Intraoral scanners has lowered, but the material cost as well. With labs needing to charge $8-$15 an arch printed digitally it adds up quickly, whereas analog impressions and pouring with plaster and stone costs is minimal compared to digital printing materials. If you have decided to go digital, and are, calibration of your machine is also important, if you are noticing appliances that do not fit the patient's mouth but do fit the model a calibration error on the scanners part and not on the labs side may be the case. You can prove whether or not your scanner or the Labs printer is not calibrated right by:
Take a digital scan of your patient or of one of your staff.
With Alginate or other impression material take an impression of the same person.
Send file and impression or model if you poured to the lab.
Have the lab make the same appliance using one the digital file to which the lab 3D prints a model and two the plaster or stone model.
Fit both appliances onto the patient or one of your staff. If the Digital fails to fit and the stone or plaster does fit. There is a calibration error and it could be from either Your Intraoral Scanner or the Orthodontics lab 3D printer.
Send only the digital to another lab that has the ability to work with digital. If they send back an appliance that fits it is the Labs fault, however if it doesn’t fit then your intraoral scanner needs to be calibrated.
Technology Can Be Your Friend in Communication
Take advantage of today's technology by asking your lab to take a picture of an area if there is confusion as to what is going on there. Giving you the Doctor the ability to have eyes on your appliances whenever needed can clear up much confusion as you can see from the picture before it gets to you that this is what you want. However if it does need to be adjusted or just done wrong you can communicate with the lab what it is you want adjusted, or if something is wrong before the appliance is sent to you it can be fixed and made as you need it to be. With a constant line of communication using a range of ways created through history from mailing Rx slips and models, to being able to comm
unicate over the phone, to those phones being able to take pictures that in seconds can be in your view, and now though the internet is not new, having the ability to take an Intraoral scan and from that scan have a lab make 3D Models is new, and just as it always has, newer, and newer ways will make their way Doctor and Lab always learning, making communication between Doctor and your designated lab tech again one of the key blocks to running a practice that moves surely, and efficiently while providing to the patient not only a quality appliance but a quality experience. To sum it up work side by side with your lab utilizing all of a labs ability to communicate every aspect of what you want for the appliance. Error being weaved out through a well drafted Rx, to phone calls, and pictures, it should be look at as an investment, a little time spent by you the Doctor and a well ran lab that sets up times to talk with you, will insure less chairside adjustments, or even worse a patients cancellation, instead of earning those amazing referrals.
Artist writings were inspired:
By the works of Phil Pelligra article published in Seminars of Orthodontics: How to Communicate with Your orthodontic laboratories;
Phil Pelligra references were:
Marsico M. The remake debate. Lab Management Today; March 6-8, 2011.
Carr K. What do dentist want from you? Lab Management Today; February 6-11, 1994.