By bringing fixed and removable technicians together in one department, industry leader Glidewell Laboratories has streamlined combination casework and dramatically enhanced communication.
Two heads are better than one. That simple axiom is the foundation of Glidewell Laboratories' combination case department, formed in 1996. Since then, the laboratory's combination caseload has increased 800% and now fabricates 1,000 ceramic or full cast restorations and 200 partial dentures related to a combination case per week.
The impetus behind the department—which now includes more than 100 C&B and removable technicians—was to enhance communication and to help smooth out problems that can arise when technicians with different specialties work together on the same case. "Working side by side in the same department, technicians have developed a better understanding of what they need from each other for a successful result," says Jerry Lord, CDT, general manager of the combination, crown and partial department at the Newport Beach, California laboratory. "They become experts in esthetics, function and retention. As a result, our combination cases are more predictable and we have fewer remakes and adjustments."
The key is that each technician—C&B or removable—has a complete understanding of the whole picture. For example, instead of just focusing on a crown, the fixed technicians learn to anticipate what's needed for a partial denture to fit over Sterngold's ERA® on a crown, including how much clearance is needed for a denture tooth and that the attachment must be parallel to allow for an even draw.
With this level of expertise, fixed and removable technicians work together to offer an extensive combination case design service. Before the doctor even preps the case, they develop a treatment plan by studying preoperative models, using a surveyor to highlight areas for retentive clasping on remaining teeth and offering guidance on undercuts, rests and prep designs.
"Dentists rave about how the case comes together at the end," says Phil Venard, manager, combination, crown department. "Because of all of these elements, we're able to produce cases now that weren't possible before, especially esthetic cases with no visible metal clasps. To do so, our technicians have to stay abreast of attachment technology."
Despite the fact that technicians are educated on many options, the ERA—celebrating its 25th year on the market—is by far the most commonly used attachment in the department. "The ERA is a great alternative to the metal buccal clasp and helps us be successful at the first try-in. Because it offers trouble-free delivery, dentists become more confident in combination casework and demand grows," says Venard.
"Our technicians appreciate the ERA's simple and predictable processing. The reduced vertical attachments are really helpful when setting denture teeth on compromised vertical cases because they allow more of the tooth structure to show and therefore enhance esthetics," says Dave Morales, CDT, general manager of the denture and Valplast department, which handles tooth setup and acrylic processing on combination cases. "Our doctors and their patients really like the seamless transition between the abutment teeth and the partial, and doctors are amazed at how easy it is to change the males without re-curing the acrylic."
Given that the ERA is the most frequently prescribed attachment in the department, it's no surprise that Sterngold, manufacturer of the ERA attachment, has had a key role in partnering with the laboratory. "Initially, Sterngold sent a specialist to train technicians; now those very technicians are highly proficient and today are the managers and supervisors who train new technicians in the department," says Venard. Sterngold's clinical consultant, Ron Baggott, CDT, is also at Glidewell frequently for support and troubleshooting, and Jim Ellison, CDT, the company's director of technical and educational services, provides annual training sessions.
The company also supports the laboratory's marketing efforts, producing brochures and laminated ERA quick reference guides for the operatory. Also, because of the strong collaboration between Sterngold and Glidewell, a special version of the ERA attachment was developed. "The laboratory wanted the attachment angled in a particular way and was modifying it in-house. We made a customized version of the female part so it's ready to place which has dramatically reduced finishing time," says Ellison. "It's an example of what happens when you truly listen to your customers: you ask how things are going, listen for the 'but' and then see how you can make things better."
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