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Are you confident that every case that goes out the door of your laboratory is representative of your technical standards? Several of the cases received from the unsuspecting laboratories in LMT's Crown Experiment click here for the article included a quality control label along with the case, indicating the crown had passed a quality control inspection.
Admittedly, nine crowns is a very small number, but the experiment raises questions about the effectiveness of the measures some laboratories use to assure that all restorations leaving their laboratories are their best work. Here, laboratory owners share tips based on their experiences.
Start with the basics
It's critical that each technician understands the importance of his job and how what he does can affect the final product. For example, when a technician is working on frameworks he has to understand the parameters of porcelain thickness and structural design and why they are important. Knowing what to look for and why is the difference between success and failure.
To give my employees the big picture, I start all new technicians in the model and die department. In addition to procedural training--like how to disinfect an incoming case--I use day-to-day problems, like a poorly trimmed model or an unstable die, to illustrate our quality standard. Once the technician is ready to advance, he has a solid understanding of the importance of model work, what's acceptable and what's not.
--Scott Dyer, CDT, owner of four-employee Dyer Dental Laboratory, Las Vegas
Work under magnification
I'd be shocked if every lab isn't using some degree of magnification. Loupes used to be a tool technicians used as they got older and their vision changed, but now loupes are the minimum form of magnification we use here. Part of our standard operating procedure is that magnification is required for certain tasks, like finishing a margin, fitting a casting or building a crown--and our implant work is exclusively done under microscope. Investing in magnification is an expense up front, but a huge step to improving quality. If you can't see it, you can't fix it!
--David Nakanishi, CDT, owner of 64-employee Nakanishi Dental Lab, Bellevue, WA
Implement a formal quality management program
We decided to become ISO 9001:2000 certified because it provides our laboratory customers with the assurance and added level of confidence that they can fabricate their restorations on high quality copings and bridge frameworks manufactured to a set of stringent, globally accepted standards. It took six months to implement and we had to review all of our procedures and enhance our quality objectives for delivery time, customer satisfaction and accountability, but we now can ensure that our processes meet the highest standards in quality management."
--David Lesh, president of Dale Dental, Richardson, Texas
Stick to your guns
Our laboratory never works with a dentist whose first question is, 'What is your remake policy?' because that means he regularly has them. It's also our policy not to accept quadrant and triple trays: it's difficult to develop lateral and protrusive adjustments, and triple trays account for a high number of remakes because if the patient relaxes during initial set, the material telescopes. If the dentist doesn't want to abide by this policy, we suggest he go elsewhere. Our standards are not hurting our business; on the contrary: our work commands $450-$500 per restoration, and our lab is fully booked through next August with a long waiting list. Many of our patients wait months for a three-unit bridge, and do so for one reason only: Quality!
--David Guelde, CDT, MDT, owner of four-employee Michigan Technical Implant Inc./Prosthetics Unlimited Inc., Clarkston, Michigan
The dentist's work plays an important role in our ability to fabricate a quality product and we understand that our clients aren't able to see all cases or catch all of the errors that go out of their offices. Our policy is to call our dentist-clients when there's a problem. Ninety-nine percent of the time he'll accept responsibility and ask us to send back the case so he can correct it. This not only helps us have less remakes, it gives our clients the feeling that we're looking out for them, and they appreciate that.
--Karen Crace, vice president of 39-employee Lab One, Norfolk, Virginia
Be proactive about impressions
A great-fitting restoration requires getting good quality, accurate impressions from your clients. For all the products I use in my lab, I follow the directions to the letter and can guarantee that every crown we produce will fit the die perfectly. However, since I can't guarantee our ability to compensate for a poor quality impression, I advise my clients on which type of impression material and technique to use, and also ask for a bite wing radiograph to confirm the fit of the crown margins and contacts. As a result, I see very little remakes in my lab.
--Robert Loehr, owner of three-employee Allure Dental Laboratory, Pittsburgh, Pennsylvania
Get everyone on the same page
Once your technicians learn a technique or procedure they need to have something written to fall back on, so our laboratory created detailed fabrication manuals for each department that outline every step of the fabrication process. The denture department manual, for instance, outlines exactly how to do a cold cure reline, from drilling the initial holes in the palate for the impression through the final pumice; it even includes an illustration showing where to carve the post dam.
While writing the manuals was time-consuming--it took one year--we've eliminated a lot of mistakes and reduced our remakes by almost half. And, since my technicians had a voice in establishing our quality controls, they're now more vested in our quality control efforts and feel like valuable, empowered members of the team.
--Ryan Dutton, co-owner of 14-employee Dutton Dental Concepts, Bolivar, Ohio
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