In Pursuit of Zero Remakes
The ‘dreaded’ re-make. The impact of remakes extends much further than time, costs and inconvenience. It has the potential to erode the confidence and trust in the dentist-lab relationship. The mutual reputations of both are compromised when the patient does not receive the desired quality outcome, incurs additional waiting time and inconvenience.
A zero-remake goal has become a common mantra. The reality? This March, the Chicago Dental Conference offered an industry remake average somewhere in the 3-4% range, so we have some work to do yet. Remakes come in many shapes and sizes, but there are some highly identifiable culprits, which are also highly avoidable. Education and communications are the key to mitigating remake risk and reducing remake ratios, costs and lost time.
The following are insights from our clients, as well as our own internal tracking data, lessons learned and tips. While some attempt to assign ‘blame’ at the feet of the dentist, or the lab, the only way to reduce remakes is through a collaborative dentist/lab process.
Most Common Remake Culprits
“The most important thing in communication is hearing what isn’t said” – Peter Drucker
Perhaps the single most significant factor leading to remakes is communications. While the litany of technical reasons are the actual symptoms, the real cause of the remake disease lies in communication breakdowns. Breakdowns from the dentist to the lab, the lab not pressing ahead when a ‘just to be certain’ phone call, or e-mail would confirm a doubt or piece of information, the lab’s own workflow and QC disciplines.
The communications breakdown is not what’s being communicated, but what isn’t. Something doesn’t seem right. The culture of the office or the lab rewards the innovation of challenging the reality of what needs to be done versus how it should be done.
- Removing Tooth Structure
‘Leave Enough Room for your lab to work with ‘. This is one of the oldest refrains in the books, but signals the intricacies of proper preparation and design. The degree of balance in tooth structure removal will dictate the labs ability, or inability to achieve the balance of strength integrity and aesthetics. As dentists indicate their preferences and direction case by case, so too should the lab have recommended preferences regarding specific cases and the degrees and measurement of tooth structure removal.
- Creating a Good Impression
Clearly a good impression is key to a successful result. Impression taking techniques vary widely, but the essential qualities of a good impression are consistent, clear margins, no distortions or undercuts, clean insertion path and proper bite. A dentist and their lab should share an open line of communication to ensure that from this critical first step the restoration can progress smoothly and without delay.
- The Right Prescription
Specific anatomy concerns, shade direction, crown type, the handoff of submitting an impression is akin to a torch relay. It’s usually won or lost, not by the speed of the athlete, but by the seamless exchange from on hand to the other. Aesthetic cases in particular cannot contain enough reference material. Photos with shade tabs ,or any visual indicators, which will drive the direction more clearly will provide the lab with critical reference material.
The RX is no less important than a blueprint. What we build and how we build depends significantly on the front end inputs and details.
- Accountability & Teachable Moments
The empowerment of employees and an engaged workforce begins with training and the ability to build a culture, which integrates ‘fails’ with a philosophy of corrective teaching, in the moment and across the organization. ‘Groundhog Day’ was an amusing movie, but not an impressive attribute for a dentist/lab relationship.
- The Impact of Digital Technology
“Technology is anything that wasn’t around when you were born” – Alan Kay
The digital explosion will not replace the need for right brain creativity, judgement and good old fashioned ‘Dental IQ’. Experimentation, tracking and the drive for outstanding patient outcomes will require balancing this transition by neither clinging stubbornly to the past, nor rushing precipitously into major capital commitments without having developed an integrated digital strategy, which compliments both the dentist’s approach and the labs ability to collaborate with solutions at their end.
- Engage the Patients ‘BEFORE’ the final step
Case planning and engaging patients in setting expectations is a consistent factor and cause of remakes. The reality of aesthetics is that we often fall prey to a process, which involves decision-making between the dentist and lab, but is too open-ended. Knowing the patient’s specific preferences up front will go a long way in avoiding the, ‘ I’m not happy with the away it looks’ syndrome.