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