Reshaping Dental Labs & Education

Episode #310 with Dr. Mike DiTolla

Labs will tell you that crowns take two weeks to make. But this isn't true — it could be made much quicker! And to teach you why you should start demanding three-day turnarounds, Kirk Behrendt brings in Dr. Mike DiTolla to explain the correlation between seating times and the need for adjustments. More adjustments mean loss of patient confidence, loss of time, and loss of opportunities. Don't just settle for “how it’s always been done”! To learn more about the benefits of a faster turnaround time, listen to Episode 310 of The Best Practices Show!

Main Takeaways:

Seat crowns in three days instead of two weeks, and the need to adjust almost disappears.

Dental school normalizes the two-week turnaround time — but it should be three days.

Not many dental labs are willing to turn a crown around in three days. Start demanding it!

Check your dental assistant’s crown work for over-polishing before dismissing the patient.

Polish zirconia crowns instead of glazing them.

Quotes:

“One thing that largely hasn't changed from when I graduated is the two-week turnaround time that a dentist takes from the time they prep a crown to where they seat a crown.” (14:07—14:17)

“Going from waiting two weeks to cement a crown to three days is a game-changer. I mentioned earlier that I left and went to Sirona, where you can do same-day crowns. And that is an ideal that we should stretch for. But we’re still waiting for a really affordable value-based system that’s easy to use before most dentists dip their toe into making restorations chairside. But seating it the same day should certainly be our goal, at least for single-unit posterior crowns.” (15:17—15:47)

“Every dentist knows that if a patient is away for six weeks, or eight weeks, or six months with a temporary on, when they come back to have that permanent crown be cemented, the chances of it fitting decreases as that time increases. And I'm here to tell younger dentists that the opposite is true, that when you start seating crowns after three days instead of two weeks, your need for adjustments almost disappears.” (15:47—16:11)

“Most dental laboratories aren't willing to turn a crown around [in three days]. And they will actually tell you that it takes longer to fabricate a crown and make it, which just isn't true. You can make an E-MAX crown the same day. You can make a zirconia crown the same day. It needs to sinter overnight, but it’s ready on the second day. Really, what the problem is, the labs aren't hiring enough employees to be able to handle this workflow. And since dentists just have always said yes to two-week crowns, that's how it’s always been.” (16:14—16:44)

“Any time we take a bur to a crown, even if you polish away all the scratches on the surface, there’re still tiny little microfractures under the surface that you can't see that connect over time and cause failure, and the crowns are less aesthetically pleasing. And any time a crown gets thinner, it’s more prone to break anyway, besides these microfractures that are in there. So, our goal should be not to have to touch any crowns. Our goal should be to drop a crown from a foot above the prep and it just sucks into place. And for that to happen, this three-day turnaround is really important. And there's just not that many labs willing to do this three-day turnaround, and we need to all implore our labs to do it.” (17:46—18:24)

“Maybe we should all be heading to same-day dentistry. But that's $100,000 and a lot of training to learn how to design and make crowns. In the meantime, three-day crowns is a perfect stopgap. And it’s going to give you 90% of what you get from that same-day restoration.” (18:55—19:10)

“It starts in dental school. In dental school, we don't...