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.

View and Download Practice Resources.

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.

Taking a Bite Out of Time-consuming Denture Fabrication

Providing patients with fixed and/or removable dentures can often be challenging, time-consuming, and problematic. Multiple appointments are typically required, and a variety of records gathering and processing techniques may be required. For example, typical denture treatment planning eats up valuable chair time; requires coordination and communication among dentists, team members, the patient, and the laboratory; and is usually labor-intensive for all professionals involved. What’s more, dentures are prone to a variety of inaccuracies as a result of records-gathering and fabrication processes.

Traditional denture fabrication typically involves multiple appointments—including those for try-in—and a variety of customized components from the laboratory. Highly prone to errors, traditional methods have also failed to achieve consistent and predictable results.

For example, inaccurate records of a patient’s vertical dimension, bite registration, and/or centric relation are among the reasons for inconsistency and disappointments. Traditional base plates and occlusal rims prevent proper evaluation of phonetics, retention, fit, and stability. Additionally, when patients are edentulous, they lack the receptors responsible for initiating proper lower jaw positioning. From a materials standpoint, traditional denture fabrication involves hand measuring and mixing, and denture resins often undergo dimensional changes when polymerized that may not be anticipated.

Overall, the combination of inaccurate records and material inconsistencies lead to patient dissatisfaction and subsequent adjustments and remakes. This translates to more chair time, additional material and resource expenses, and no increased revenue for the practice.

Fortunately, technological and material advancements enable dentists and their DSG laboratory to increase efficiency and revenue when treating denture patients. From digital impression scanners to enhanced denture processing materials and techniques, several advancements are enabling dentists to treatment plan and deliver dentures in a systematic, efficient, and comfortable manner compared to traditional methods. When dentures are digitally treatment planned and processed, dentists can streamline the required clinical protocol, reduce necessary chair time, and deliver predictably esthetic and functional prostheses that are profitable to the practice.

View DSG® Dentures and Partials.

In particular, digital impression scanners and CAD/CAM design components are now being used to record every aspect of a patient’s condition, as well as design and execute the removable and/or fixed denture treatment plan. The information required to design and fabricate a patient’s dentures can be recorded digitally in a single appointment, stored electronically, and available for future use if an extra or replacement denture is needed. Additionally, if implants are required to stabilize the dentures, digital CAD/CAM design and processing can be incorporated to create precision surgical guides for accurate implant placement and streamline the design and fabrication of temporary, try-in, and definitive prostheses.

Incidentally, digitally fabricated dentures from DSG that are created using CAD techniques and 3D printing eliminate the problems associated with traditional dentures, such as a porous composition prone to staining and odor, unaesthetic tooth shape or arrangement, poor fit, and improper occlusal scheme. In fact, digital processes and 3D printing also eliminate the challenges associated with polymerization shrinkage for greater durability, function, and accuracy. Digital dentures are not prone to processing errors, so they seat comfortably, with minimal-to-no tissue impingements or sore spots.

What’s more, DSG can set the denture teeth digitally, adjust the occlusion as needed, and enable the dentist, team, and patient to virtually preview the proposed prosthesis to ensure ideal esthetics and occlusion prior to fabrication. As a result, the workflows necessary for developing treatment plans, creating virtual wax-ups, and 3D printing at the DSG laboratory become more accurate, predictable, and efficient, in addition to more convenient for patients.

Overall, unlike traditional dentures, digital dentures minimize patient visits, prevent the need for extensive laboratory customization, and eliminate remakes. By reducing chairtime and enhancing accuracy, digital denture processes enable dentists to provide patients with predictable dentures while increasing revenue and patient satisfaction.

Learn more about DSG® ProFX Digital Dentures.