The Do’s and Do Not’s of Patient Consultations

Patient consultations may seem pretty straightforward—present the diagnosis, provide some information and education to the patient, recommend treatment options, and finally discuss payment. However, there’s more involved with creating an environment for ideal patient consultations and increasing case acceptance than scheduling an appointment, performing an examination, and informing the patient of the diagnosis.

A number of factors impact the success of initial patient appointments and subsequent case and treatment consultations. Everything that is said, done, and experienced during patient encounters influences a patient’s trust in the practice and their willingness to accept the presented treatment plan. In fact, everything that’s involved with the overall patient interaction—from check-in to how patients are transferred from one team member to another—influences the patient experience.

Fortunately, case acceptance can be increased when dental practice team members know what to do, when, and how, as well as what to say, the questions to ask, and how to respond to patients to help establish and maintain an open relationship. Unlike giving a patient a diagnosis, a treatment plan consultation is a conversation between the dentist and patient about their oral health, the problems that require a solution, and what is needed and recommended to correct their condition. When patients perceive the problems as significant and that the practice truly understands them, they’ll be more likely to take action—in other words, accept the treatment plan and generate revenues for the practice.

Therefore, first and foremost, dentists and their team members should use what they’ve learned about the patient’s priorities and their perception of their smile as a guide for delivering reasonable explanations for the proposed treatment plan, tying in the things that are important to them. Visual aids—including models, digital photographs, and virtual wax-ups—should be incorporated into the discussion to describe the treatment and anticipated results. When patients see images of their smile and teeth, they’re better able to appreciate and comprehend the proposed treatment.

During the presentation, information should be presented in a logical way, without technical or medical jargon that patients might not understand. Findings should be presented simply in a manner that emphasizes the benefits of treatment and how it can be sequenced according to their needs.

Once the proposed treatment plan has been presented, it behooves dentists and their team members to ask open-ended questions about how the patient feels about the treatment plan and how they’d like to proceed. Active listening, maintaining eye contact, observing and using body language, and paying attention to verbal and non-verbal cues that could indicate how the patient feels about what they’ve just learned is significant to continued patient engagement during the consultation.

In general, good communication is the foundation for successful patient consultations and case presentations. This requires sensitivity toward patients, which occurs when dentists and their team members consider their thoughts and feelings while disregarding their own pre-conceptions. That said, it’s important that dentists and team members never dismiss or disregard a patient’s concerns or questions, in addition to being mindful of how their own non-verbal cues can be either supportive or contradictory.

Of course, the fees involved with treatment may influence the patient’s decision to proceed. Even when dentists and team members maintain great relationships with their patients, the conversation about treatment fees can be uncomfortable for everyone involved. For this reason, conversations about finances should be separate from the conversations about oral healthcare and handled by a financial and/or treatment coordinator. Because patients may feel embarrassed discussing their budget and payment ability, the financial coordinator should ensure the patient is comfortable; that facts about treatment cost, estimated insurance coverage, and out-of-pocket expenses are presented in writing in a clear and organized way; and that the patient is given two to three payment options to choose from in order to decide how to best initiate treatment.

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Curing What Ails Predictable Indirect Restoration Placement

Today’s dentists need and want to perform adhesive bonding protocols more efficiently, and many dental product manufacturers have responded to the demand for simplicity by introducing new generations of bonding agents and cements.

However, selecting the ideal bonding and cementation materials can become challenging in light of various product claims regarding bond strengths. Additionally, bonding and cementation materials—regardless of their advertised predictability—still require adherence to their recommended, step-by-step procedures to avoid restoration failure due to marginal gap formation and subsequent secondary decay development. Deviating from recommended clinical techniques when definitively seating restorations—including improperly placing bonding agents and cement—can lead to failures, remakes, unhappy patients, and lost revenue.

When permanently seating indirect restorations, a variety of factors influence long-term treatment success, including the restorative material from which the restorations were fabricated, preparation design, isolation, and the selected cement or adhesive. Depending on the case, either conventional cementation or adhesive bonding techniques can be used.

 Successful conventional cementation depends upon preparation design and resistance in order for restorations to predictably attach to underlying tooth structure. For adhesive bonding, a micromechanical connection between tooth structure and the restoration is necessary.

Considering the variety of both restorative materials and cements/adhesives, it can be challenging to determine which is ideal and what techniques to perform. Fortunately, dentists can rely on their DSG Laboratory for information about predictably placing the restorations they’ve treatment planned. After all, the long-term quality and durability of the restorations DSG fabricates depends upon correct placement protocols, and using the appropriate adhesive, cements, and procedures is critical.

For example, when the dentist is treatment planning all-ceramic restorations, preparation design will be important, particularly for high-strength ceramics. In general, DSG advises that for all-ceramic restorations, the finish lines should consist of shoulder preparations with rounded internal line angles, and sharp line-angles or edges should be avoided. Deep chamfer preparations are also possible. Additionally, preparations should also accommodate the minimum material thickness required for laboratories to fabricate the anticipated restorations.

When preparations are short and have an excessive taper, the restorations should be adhesively bonded using resin cement. Adhesive resin cements—whether light-cure only or dual cure—require meticulous isolation. If predictable isolation cannot be achieved, then conventional cements can be used, particularly for high-strength ceramic restorations. Adhesive resins also require preparations to be etched and rinsed, after which they can be conditioned with an adhesive bonding agent and cured.

Feldspathic, leucite-reinforced, glass-ceramic, and fluorapatite ceramic restorations must be seated with adhesive resin cements to ensure necessary support. Veneers and partial coverage restorations, which do not enable mechanical retention, should only be adhesively bonded.

Note that when adhesive resin cements are used, the intaglio surface of glass-ceramic restorations must first be etched and silanized. Ceramic etchants contribute to retentive bonding surfaces on all-ceramic restorations and improve bonding between the resin cement and ceramic bonding surface. Silanization then mediates the bond between adhesive resins and such indirect restorative materials as glass ceramics, metal, and composite. Once these two steps are completed, adhesive resin can be placed in the restoration, the restoration seated, and appropriate light-curing performed.

Incidentally, thoroughly and predictably light-curing adhesively placed restorations is affected by several factors. These include delivering sufficient light at the correct intensity, as well as for the recommended length of time.

When preparations are long and only have a minimal taper, then the indirect restorations can be conventionally cemented. Conventional cements attached restorations to preparations by creating a hardened layer between the restoration and tooth structure. Lithium disilicate, alumina, and zirconia-based high-strength ceramics have appropriate mechanical properties to withstand occlusal loads without requiring an adhesive. However, conventional cements are contraindicated for glass-ceramic restorations.

Download DSG® Cementation Selection Guide.

It’s Never Too Late to Make a Great Impression

Dental impressions—whether traditional or digital—provide the foundation for restorative treatments. Because they form the basis for treatment planning and laboratory fabrication of restorations, accurate impressions benefit the patient, dental professionals, and laboratory technicians in multiple ways. Accurate impressions save chair time at seating, reduce the incidence of remakes, and ultimately contribute to patient satisfaction. Additionally, when taken efficiently and accurately the first time, impression processes that promote patient comfort encourage acceptance of future procedures, as well as potential referrals.

Traditional and digital methods offer unique benefits and challenges when trying to achieve detailed impressions, including capturing the correct margins and obtaining accurate occlusal records. Therefore, successful impression appointments require careful consideration of both individual patient characteristics and the planned restoration. This ensures that the most appropriate impression taking technique(s) are used and common mistakes are avoided.

Download DSG® Digital Impression Comparison Chart.

For example, when faced with a patient with considerable bleeding, traditional impressions are best, since digital impression scanners cannot capture what they can’t see. However, gag reflexes and other patient discomforts can compromise the accuracy and success of traditional impressions—now often referred to as analog impressions.

What’s more, traditional impressions of posterior preparations require an adequate amount of impression material to be placed on the adjacent occlusal surfaces. If an insufficient amount of material is used, the anticipated crown or bridge restoration will likely demonstrate an inaccurate occlusion. The patient will experience an awkward or less-than-natural bite after cementation, which may lead to costly remakes, rather than chairside adjustments.

However, adjusting or realigning an already set impression by adding more impression material in an attempt to correct this mistake often contributes to further discrepancies. Because the entire impression should be remade, the impression taking appointment now becomes longer for the practice and patient, inconvenience and discomfort for the patient are given, and material costs also now increase.

Digital impression systems, however, can potentially save both dental team members and patients approximately 30 minutes per treatment, in addition to helping practices realize other substantial benefits. Digital impression taking eliminates the often traumatic, stressful, time-consuming, and costly impression taking procedures typically associated with traditional materials.

Digital impression systems, however, can potentially save both dental team members and patients approximately 30 minutes per treatment, in addition to helping practices realize other substantial benefits. Digital impression taking eliminates the often traumatic, stressful, time-consuming, and costly impression taking procedures typically associated with traditional materials.

Incidentally, digital impression systems do not require impression materials, trays, shipping, sterilization, or physical storage, so a practice’s overhead costs are reduced. Further, unlike traditional materials that are indicated only for specific impression techniques and/or restorations, digital impression scanners can be used for all types of treatments, including single crowns, bridges, full-arch restorations, veneers, implants, inlays, and onlays.

Because they avoid the soft palate, digital intraoral impression scanners reduce—if not eliminate—patient discomfort and gag reflex. Additionally, by producing instantaneous and more detailed impressions, they also provide an immediate way for dentists and laboratories to visualize and evaluate preparations to ensure a better-quality restorative design. If modifications and subsequent new impressions are needed, those procedures can be performed right then, without the need to recall the patient and subject them to the discomfort of traditional impression taking.

Treatment accuracy and turn-around time—with a reduced need for adjustments or remakes—also improves, since digital impressions demonstrate ideal margin capture and visibility, and can be transferred instantly to dental laboratories, without fear of deformation. As a result of promoting faster—and possibly real-time collaboration with laboratories—overall case management efficiency improves.

Digital impressions do present a few limitations, such as intraoral scanner size, ability to capture only what the scanner can see, and decreased effectiveness when blood, saliva, or contamination are present in the oral cavity. In fact, similar to traditional methods, digital impression taking requires thoroughly dry and properly isolated preparations. Regardless of whether or not a contrast medium is used, saliva can create a reflective area on teeth that can distort the digital impression.

Download DSG® DI White Paper.