Treatment Planning

Treatment planning is an essential element in achieving successful restorations. To help even the most difficult case achieve a successful outcome the following guidelines are suggested:

Use photos
A photo provides us with the type of detailed information that we require to provide you with the best possible product. Quality photos and xrays are typically the best method of communicating the needs of your patient. Although, both phone calls and email can often provide considerable information to identify the specific requirements of your case, getting us photos will increase your chances of a successful restoration. Emailing them or enclosing them with your prescription should be a high priority step in your treatment planning procedure. You may click here to send your photos cdlpix@yahoo.com.
When appropriate, use diagnostic wax-ups & study models
When a patient has dental problems that require a more detailed analysis in order to determine possible solutions, we encourage the use of study models and diagnostic wax-ups.

Study models (impressions) of the teeth, and a bite registration are useful tools in planning treatment. They can be used to see things and show you things on the models that can’t be seen clinically. The models will show many factors, especially in tooth movement, such as whether teeth have moved, how far they have moved, how they may have affected other teeth, as well as other considerations. If fixed bridges, crowns or removable bridges (partials) are planned to replace the missing teeth, the design must be exact from the moment treatment commences until successful completion.

A diagnostic “wax up” can be used to visualize possible changes to the shape and alignment of the patients’ teeth. The wax up shows teeth and gum tissue, usually with white wax added. The original study model provides a three-dimensional look at the “before” condition of the patients’ teeth and the wax-up provides a three-dimensional “after” picture of what the patients’ teeth, replacements of missing teeth, etc. will look like when the treatment is completed. The wax-up can be examined to physically visualize proposed changes and approve them if acceptable. If the changes are unacceptable the wax-up can be modified to provide a different look.

Make a good Impression
A good first impression is essential and a time-saver. A good impression is the basis for a successful restoration and selecting the right tray for your case (triple tray, stock trays or customized impression tray) is crucial. If you encounter a problem selecting the right tray and material for your case, talk to a Colonial Lab customer service agent.
Submit a proper bite registration
A good bite registration is critical and essential to implement a successful restoration. Here are some general suggestions for providing a proper bite registration:

  • The patient is often numb and generally has no understanding of their centric bite. The staff member or dentist should guide them through the process of getting the perfect bite.
  • Frequently the less bite material that is used between the opposing dentitions, the better the bite registration.
  • Avoid the use of rubbery impression materials. Rubbery materials make it more difficult for our lab to accurately set and mount the opposing casts.

Opposing casts also require accurate impressions to help eliminate occlusal interference from bubbles or missed areas in the impressions.

Provide the correct shade
Achieving a perfect shading technique can be a challenging part of any case. However, including a photo with your case can increase your success rate in obtaining the proper shade.  Photos should be taken with the shade guide(s) appearing adjacent to the patient’s dentition.

Colonial Dental offers a shade taking service. If you wish, you can have your patient make an appointment with us to come to our laboratory where we will take digital photos and use our shade machines as required. We will then color map and diagram the custom shade for your patient. If necessary, the patient may return to us for custom staining.

Finally, note that when combined with the perfect fit , the perfect shade results in the perfect case.  Patients expect and deserve perfection in the color of their restorations. With more lighter and whiter choices available we can provide patients more perfection in the color of their restorations.

Carefully complete your prescription
Filling out an accurate and complete prescription is crucial to assure the best possible results. It is important that we understand and record the specific details needed to provide you with the perfect case outcome. Be sure to indicate the correct tooth numbers and indicate the alloys, specific designs, shades, and other important details that you prefer on your case.  Remember, as frequently stated, “the devil is in the details”.  Full and complete details provide the path to a perfect case.  The best restorations and dental prosthetics usually occur when both the dentist and the lab each have full details on the anticipated result and the case outcome.  To insure the success of a case please provide clear, legible, precise and complete instructions to our lab. It is imperative that each script contains your license number and signature!
Check for potential fit problems
Temporary restorations can be a serious, time-consuming problem when they don’t fit properly. Some common issues that occur are listed below:

  • If the temporary is loose in contact with the adjacent teeth, tooth movement can cause tight contacts for the final restoration. This may require multiple adjustments in order to successfully seat the crown.
  • If the temporary is tight in contact with the adjacent teeth, tooth movement can cause open contacts for the final restoration. This would require adding porcelain and an additional appointment for the patient.
  • If the temporary is loose in occlusion with the opposing teeth, the tooth could erupt and the final restoration may need multiple adjustments.
  • If the temporary is for a bridge, the temporary must include the pontic to splint the preparations in place during the bridge fabrication. Without splinting, the bridge may rock or not fit at all.

From time to time some large, challenging cases need to be reviewed for accuracy and should be tried in prior to case completion.  This will require extra steps and an additional appointment for the patient but the extra steps and additional time are far more acceptable than having the case fail.

Communicate!
A dental prosthesis or restoration is an artistic challenge.  It is subjective by nature and despite all of the detailed case planning and case communication tools used by both the dentist and the lab, the final outcome is still subject to individual preference.  Because of this, our staff is always available to quickly and accurately make any necessary adjustments for a successful case outcome.

We encourage you to work directly with our staff to create and adjust your case preferences.  By working together, we can continually improve the quality of your prosthesis and restoration and completely satisfy the needs of your patients.