Chairside - Glidewell Dental Labs

2 millimeter hole in a molar, it goes all the way down to the
base of the amalgam. So, for some reason, dentists don’t have a
problem prepping 2 millimeters into the tooth if it’s for a direct
restoration, but when it comes to an indirect restoration, all
of sudden, 2 millimeters seems like it’s over the top. I’ve never
quite figured out where that disconnect comes from.
LB: I actually don’t know. I haven’t thought about that.
But, you’re right, that’s my experience of it, as well. I don’t
know, maybe it looks more aggressive when the cusps are
gone, but with a Class I or Class II direct restoration, it
looks like there’s tooth there. I’m old enough that, when I
first learned how to do crown preps, we actually depended
on retention form and resistance form to keep them in.
So my brain is going, “How much wall height do I go?”
Nowadays, we bond everything, so that’s really almost
become a non-conversation.
I know that when I really started paying attention to this,
one of my least favorite words ever in dental school was
“armamentarium.” If someone says that to me again, I’m
going to lose it. Every day in the clinic you’d go to get ready
and they would say, “Tell me about your armamentarium.”
Oh man! Now I teach that to dentists and I use that word
because, especially when it comes to preps and indirect
preps, you’ve got to know what you’re putting in that
handpiece. Tell me the diameter of that bur. Tell me the
length of that bur. Tell me what the tip looks like. Are you
trying to cut a chamfer or a shoulder? Well you need to put
the right bur in the handpiece to do that, or you’re going
to frustrate yourself and your lab is going to wonder what
they’re supposed to do with it.
MD: Exactly, and so my prep technique — I just had to come
up with it for myself because I couldn’t prep well without it —
is really intellectually insulting, in a sense. I’m a professional,
and my whole prep technique is a 2 millimeter hole on the
top and a 1.5 millimeter one on the axial and a 1 millimeter
round bur cut on the gingival. At times I think, “I should be
better than this.” I graduated the same year you did. I should be
able to prep this tooth and get it right without any depth cuts.
But, you know what, it’s not a big deal. Pilots have a checklist
before they take off in a plane for the 2,000th time. To me, it’s
just an easier way to do it than to prep it and then go in with
bite registration after the fact, or wax and calipers, and try to
measure how much you took off. Just put some holes there and
prep until you can’t see the holes.
LB: That’s exactly how I do it. The other thing I would
say on that is, I think it’s actually more efficient. When I
watch dentists prep, it seems less efficient when they’re
taking the same burs in and out of the handpiece multiple
times, versus using this one first until they’re done, this
one second until they’re done. I find that by having those
marks on the tooth, I can cut a tooth way faster and more
efficiently than I ever did before, and it’s more effective! So I
don’t get those phone calls from the laboratory. We love you
guys and all, but I have to tell you that when my assistant
tells me the lab is on the phone during the day in the office,
I’m thinking: “Oh really? What did I screw up?” (laughs)
MD: Exactly. Once you have the depth cuts in, it’s just a race
to see how quickly you can get the rest of the tooth structure
off because you know exactly where you’re going. And, by the
way, I hate the word “armamentarium,” too. I want to back
you up on that. It’s my second least favorite word. My least
favorite word in dentistry is “dentifrice.” Why are we calling it
dentifrice? I hate when we try to sound like we know more than
the patient does. “I’m going to suggest a dentifrice for you that
I think is going to help with your abrasion problem.”
One of the things I teach at my courses, which I’ve learned from
being here in the laboratory, is there doesn’t seem to be any
easier or quicker thing you can do to get better results from
your laboratory when it comes to esthetic dentistry than digital
photography. I just notice here when I watch the technicians
work that they try harder when there is a digital photograph in
front of them because now they see what they’re aiming at. We
are here in California, but we have dentists that prep crowns on
tooth #8 and #9 in New Jersey, and they’ll send us the impression
to make crowns on #8 and #9 using IPS e.max, shade A2, and
there’s no photograph that goes with it. We can match the shape
of the laterals next to it on the model, but there’s nothing about
what the teeth look like, what the lateral incisors look like. It
seems like a tall order for the technicians, and they have to
think: “You’ve got to be kidding me. You want me to make
crowns and match these teeth based on a yellow stone model?”
I see what happens when we give them digital photographs.
Then they know it’s a dentist who cares, who has a little bit
higher standards. Even if they weren’t great photographs, I
think digital photography is a great way to ensure that you
get the highest-quality esthetic dentistry your lab is capable of.
I know you teach courses on digital photography, and I just
want to get your take on that.
LB: I couldn’t agree more. I couldn’t practice without
photography. Let’s go back one step even before laboratory
work. I would tell you that taking photographs in my
practice is the thing that transformed my case acceptance,
even if it’s just four simple photographs. You just want to
take an upper and lower occlusal, a smile and a retracted
with the front teeth in it. Now you and the patient can sit
and look at the same thing. We don’t think about the fact
that our patients don’t know what their teeth look like.
They don’t know what their mouth looks like.
MD: Did you use an intraoral camera at any point, or have
you always done it with digital photography?
LB: Yes, I used to use an intraoral camera myself. I actually
still have an intraoral camera and both of my hygiene
operators have them. To show a patient a single tooth, such
as a recall patient where everything is healthy, but there
Interview with Dr. Lee Ann Brady51