hello and welcome to this episode of chair side lies I'm your host Megan strong thanks for tuning
in today we've got a great show that we've put together for you we're registered dental
assistant will Schmidt is here for another exciting segment of across the chair so call
on your assistant and watch today's across the chair together because will is showing us how
he sets up for large cosmetic cases he's covering all the bases from impressions to digital wax EPS
he's even talking about placing the acrylic mock-up one-step cuts are made and he's even
talking about photography and everything in between so let's check out wills protocol
for these large cases he's covering everything that happens before the drill hits the tooth
well thank you so much Megan a time after time here on chair side live we present the large
cosmetic case of the week for today's case of the week I want to focus on the preparation and
logistics that happen behind the scenes to make these presentations run smoothly and effectively
for the ideal aesthetic result we're looking for every time let's think of today's episode as the
case of every week and the pre procedural plan that our operatory at global labs follows does
not involve any service that is not available to you in your own practice in fact we operate
as a standalone entity within the lab and perform all treatments exclusively with options that are
available to every client the information that I'd like to pass on to you today comes not only
from my experience and time spent chairside as a registered dental assistant but also selling
coordinating and scheduling patient treatments it is important that your office staff has a
good feel for every aspect of the cosmetic case especially every step leading up to the point
when the handpiece meets the tooth here are my big case steps to success well you've evaluated
your patient they are motivated to begin the smile makeover that they have always thought about your
treatment presentation and service compensation makes sense the patient provider Trust has been
established now it's time to seal this deal at this initial appointment it is important
to provide some sort of actual physical service to start providing treatment to this patient
and to help them understand that we are in fact moving forward today I've seen all too often the
excitement of closing the deal and scheduling out for treatment only to receive the call a
few days later the patient is cancelling after going home second-guessing and then ultimately
doubting their decision instead explain to your patient that today we are beginning the
preliminary steps for treatment go ahead and take a full mouth impression up or lower full arches
include a bite registration clinical photographs facial measurements finish off any additional
radiographs and then include your patient in the lab slip right up for their diagnostic wax
models so after these steps are complete I like to schedule the patient out about a week and a half
for a 30 to 45 minute follow-up appointment while I send out for all of our diagnostic armamentarium
so when your initial correspondence went the lab include the full-mouth impressions in byte
registration along with all important photography smile design requests and measurement requirements
on a global labs Universal rx form if you are choosing to request professional study models
before the diagnostic wax up stage follow the same protocol for impression and byte registration but
simply delay sending photos and measurements until ready for the wax models well I'd like to request
my doctor's diagnostic wax models along with two additional items I'll ask for a putty fabricated
stent simply made from Gladwell's own capture VPS material this stent comes in handy on more than
one occasion throughout treatment we can first use it as a mock-up stent with acrylic to show
the patient how the wax teeth will look in the mouth then on our initial prep date mocked up
once again an acrylic to perform depth cuts for minimal prep veneers in cases where bio temps
are not used for temporaries this putty stint can also be utilized as a chairside temporary matrix
additionally a plastic preparation guide based upon the diagnostic wax up is requested to show
my doctor if she's made the proper reductions to allow the final restorations to be fabricated with
at least minimal thickness parameters in place I always double check to make sure that all items
are received by the time our patient returns for the next visit now our diagnostic wax up
duplicate models and stents have returned from the lab and our patient is in the chair for their pre
procedural visit this visit may seem at first like an unnecessary additional step but is important
to finalize the patient's understanding of the treatment as well as allow them to communicate all
details of their expectations with physical models in front of them this appointment is the best time
to use your putty stent to show the patient a simulation of the teeth size and shape as
long as no flared or Mao aligned teeth prevent the seating of this matrix before preparation if bio
temps are going to be utilized for the temporary stage this appointment is the best time to pick
a shade along with the items sent with your wax up you will find a special rx form to be used for
your final restorations looking at this form you can see the areas that allow dimensional changes
to be made or to continue moving forward with the proposed wax up shapes this form
is specific to your patient's case and include your account information and patients unique case
identification number and barcode this makes it easy for the lab to recall the information make
changes if needed and process your case to finish also by using this dedicated special rx form
Gladwell Labs extends a 50% discount off of your original diagnostic wax upcharge my patient can
now be scheduled for their procedural appointment in the meantime there are still two more important
steps that I consider for any cosmetic or smile makeover treatment that includes more than four
units I will always send for a custom tray to be fabricated all I need to prepare for the custom
tray to be finished is a single full arch model or impression to make it easier on myself I tend to
send one of the duplicate models that returned with my diagnostic wax up for the custom tray
to be made on I can fill out either a dedicated gladwell removable appliance rx form or universal
rx form for the custom tray I always notate that I would like holes to be placed in the trade to
ensure that the impression material locks into place I prefer the removable lab slip because
I can draw a diagram of what I'm looking for just to be specific finally no large case passes by me
without a chance to order by attempts lately I have been sitting out for CAD design bio timpz
more than anything if you want more information on the technology and fabrication process that
produces these digital bio temps doctoral buy explains everything in detail recently
on chairside live episode 187 depending on how my doctor wants to proceed with the preparations
this could mean one or multiple sessions for my patient in the chair bio temps can be designed
as a complete round house set as you see here keep in mind that the virtual preparations are designed
with draw and mind so the bio temps seat nicely without getting hung up on the model anywhere
this does not always translate exactly the same in the mouth when my doctor is more concerned about
occlusal space and minimal reductions you can also request your bio temps temporaries to arrive with
a plastic prep stent similar to the stent that arrived with your diagnostic wax model but in
this case it shows the virtual preparations that your gladwell Labs tech has made and can assist
in verifying the draw of your temporaries and your doctor's overall ideal reduction another
option for larger cases and I'm talking about cases of eight to ten units or more could be
to order the bio temps and segments as anterior and in Poe terior left-and-right splinted units
this is especially helpful for large veneer cases where the mesial and distal reduction is minimal
and interference may occur if a series of prep dates is scheduled this segmented approach allows
me to place the bio temps accordingly instead of having to separate a large round house bio
tamp chair site I get a good feel for how my patient will tolerate treatment consult with
my doctor and then decide the best route to take when ordering bio temps in the big picture I order
bio temps for the aesthetic look of the facial and incisal so if there's a little bit of realignment
needs to be done around the marginal area on a large span temporary I'm not too terribly
worried about it to order bio temps I fill out a dedicated Glidewell bio temps Provisionals rx
form and make sure to specify my preference to every detail of the final product I'm going to
include how I want them splinted or segmented wire retention if desired shade shape and all details
specific to this patient I'm going to send the opposing model or impression byte registration
plus a diagnostic wax model and the original study model or impression at this point if I
had followed the order of operations that I have outlined so far I should have all of the model
work complete and there will most likely be no need to send impressions if my doctor and patient
like the design of the diagnostic wax up I just asked the lab to fabricate the bio tips off of
that setup but I still make sure to specify shade and segment preferences if any on our patient's
initial preparation date I'm completely ready with all items to make this procedure run smoothly to
review once again from start to finish I've sent my initial impressions for study models if desired
and then for diagnostic wax model complete with duplicate models the putty scent of the
wax up and the plastic preparation guide after diagnostic wax up has been reviewed accepted or
had changes made I send for the custom tray and bio temps with or without a plastic prep guide
in addition to all of these items chair side I have temporary acrylic resin ready to go in
most cases I'm using Lux attemp ultra auto mix however feel free to use your acrylic of choice
this is here in case my doctor places a mock up using the putty stent and performs depth cuts
thank you so much for taking the time to watch today's episode I truly hope that this helps
your practice organize and stay focused when it comes to large cosmetic case preparation your
patients will notice and that will absolutely translate towards the value of their investment
with you doctors this information is great to review during your next team meeting or morning
huddle and then maybe again periodically just to refresh my advice today is simply a general
overview of a good order of operations that you can modify to make your own within your
practice and your own protocols you trust your skill and your staff knows how to make you look
great Gladwell Labs is here to assist in every way possible to keep you organized and prepared
for exciting and challenging cases ahead right back to you Megan thank you for that will and
if you have a question for will he'd love to hear from you you can shoot him an email at chairside
live at Gladwell dental com well that about wraps it up for today's show on behalf of everyone here
at glial laboratories thank you for watching and I'll meet you right back here next time
you