- Email: [email protected]
How to communicate with orthodontic laboratories
Author's Accepted Manuscript
How to Communicate with Orthodontic Laboratories Phil Pelligra BS, BA (Bus. Mgt.)
www.elsevier.com/locate/ysodo
PII: DOI: Reference:
S1073-8746(16)30005-6 http://dx.doi.org/10.1053/j.sodo.2016.04.005 YSODO449
To appear in:
Semin Orthod
Cite this article as: Phil Pelligra BS, BA (Bus. Mgt.), How to Communicate with Orthodontic Laboratories, Semin Orthod, http://dx.doi.org/10.1053/j. sodo.2016.04.005 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
HOW TO COMMUNICATE WITH ORTHODONTIC LABORATORIES
Phil Pelligra BS, BA (Bus. Mgt.) President, Perfect Finish Ortho Lab, Inc. 101 Bilby Rd., Unit F Hackettstown, N.J. 07840 908-852-3035 [email protected]
HOW TO COMMUNICATE WITH ORTHODONTIC LABORATORIES
ABSTRACT: The purpose of this article is to help improve the relationship between the orthodontic practice and their laboratory vendors. It seeks to provide ideas and suggestions on how to achieve this goal by knowing the right questions to ask your laboratory. Improving dialog ultimately leads to a less stressful and more positive business relationship. The lack of quality communication with vendors is a common problem in business, as well as with many orthodontic practices. This article will provide the orthodontist with tips and direction on how to improve on your current laboratory communications and will outline specific questions to ask your current and prospective vendors. The goal is to make your life easier and more productive by saving the practice time and money.
BACKGROUND AND DISCUSSION: One of the many essential components to a successful orthodontic practice is good laboratory communication. Clarity in communication is critical at a time when all practices have to reevaluate every aspect of their business. Communicating well will ultimately save time and money by making your business model more efficient. Without open communication and a solid working relationship in place, appliances may be made incorrectly, resulting in time consuming chairside adjustments, or even the need for complete remakes. This in turn may ultimately result in delays in appliance insertions, appointment cancelations, additional cost, and in extreme cases, even lost patients. The resulting frustration and stress to you, your staff, and patients is a major concern in trying to run a successful business in today’s competitive orthodontic environment. The orthodontic laboratory industry average for remakes is 2.78%1. In my experience, labs that are below a 1% remake average achieve this benchmark because of open and consistent communication with their clients. Remakes reduce profit and are not conducive to a good working relationship. As professional technicians, we continually strive to maintain a low remake factor. We hone our skills and take the latest laboratory related continuing education courses. Our ultimate goal is to give our clients and their patients the best possible appliances at competitive costs. Many doctors have expressed the feeling that a contemporary orthodontic practice is, to some degree, a field of narrowing control. The laboratory relationship is one area in which the doctor still has control, take advantage of it. The following are recommendations when establishing a working relationship with a laboratory partner:
1. Establish a primary contact person (PCP) at your lab. There should be one key person who you communicate with regarding laboratory issues and concerns. 2. Establish your design standards up front for your retention appliances of choice. You may have different retainer designs for different types of cases such as extraction verses non-extraction. Ask the lab to keep a “Client Preference Card”. This will provide a basic reference for routine appliance designs, wire gauges, acrylic trim styles, acrylic colors and expansion appliance preferences. 3. Know what your laboratory’s normal turn around time is for appliance fabrications. If there is the need for a rush on a case, make sure you know your lab’s requirements for doing so and whether or not there will be any extra charges. 4. If your PCP has delegated responsibilities in various areas within the lab, and conversely you have a designated person in your office who deals with lab related issues, make sure the individuals within both businesses who are responsible for answering technical questions, placement date concerns and billing inquires have been identified to each other. Exchange extensions and emails of all responsible parties. Alert your lab partners if any staff changes occur to ensure that the lines of inter-business communications remain open. 5. Make sure you know your lab’s warranty policies for appliances (wires, acrylic, solder joints, etc.). 6. Ask about sterilization/infection control procedures. It may come up regarding OSHA compliance or through a patient inquiry. 7. Inquire about lab closure times and policies for holidays, vacations, training or bad weather days. Log these dates into your appliance scheduling book. 8. Find out how long your lab retains the prescription sheets. This may have practical as well as administrative law related concerns.
9. Ensure your lab has the ability to use hypoallergenic wire (nickel free) and acrylic (methyl methacrylate free) for patients presenting with a history of allergies to these materials. 10. Make sure you know how much total expansion your preferred expansion appliances have, and what the turning ratios are (turns/mm). 11. Find out what your lab’s remake policy is and request a copy of it. 12. Finally, ensure that your Business Associates Agreements are up to date. There are proper procedures for filling out a lab requisition / prescription form (Rx). It is best to draw the design out on the Rx form as well as fully writing out the instructions. If your drawings are not legible, then only write out the instructions. A sloppy drawing or slip of the pen may look like a clasp or finger spring to the technician. The following figures demonstrate an unclear prescription (Figure 1.) followed by the corrected identical prescription (Figure 2.)
Figure 1.
Figure 2.
1. In this example, the Dr. is asking for a Lower Spring Aligner, however neither the type nor style is specified and the number of teeth to be reset teeth is unclear. The Hawley description asks for 3-3 Labial Bow but the drawing appears to indicate that the bow is to be soldered to the Adam’s clasps. In addition, the finger spring request is unclear on both direction and type. Finally, the placement date has been left blank. 2. In this Rx, a lower Modified Spring Aligner is requested with the set-up clearly indicted. The design of the upper Hawley bow is clearly 3-3. The finger spring direction and 1 coil design is stated. A specific acrylic color is also requested. The placement date is conspicuously noted. In short, the prescription is fully completed. Ancillary considerations when completing a prescription are:
•
Do not use gel pens. They bleed or get washed out and become unreadable when the Rx gets wet.
•
Agree on the same designation / notation for identifying teeth, Palmer v. Universal. Don’t ever mix the 2.
•
If not providing a laboratory analog for T.A.D. fabrication, clearly mark the cast for T.A.D. location, not the Rx.
•
In any deep bite case or situation where anterior teeth will be reset, always send a counter.
•
When placing pontic teeth in an appliance make sure to specify the correct shade desired and provide a counter for occlusal reference.
Use your lab as a resource and a vehicle for feedback. Many labs see hundreds if not thousands of cases a month. Tap into that resource for the availability of new products and appliances that you might have heard or read about. You may want to incorporate some of these adjunctive appliances into your practice. Before trying a new product or appliance, ask your laboratory about what they have experienced and what type of feedback they have received from other practitioners they service. A phone call could save you a lot of time and money as the lab may have received negative feedback from other doctors. I speak to accounts daily on a variety of topics such as software, intraoral scanners, adhesives and expansions screws. I have the advantage of seeing the before and after casts of patients. Orthodontic labs have the advantage of prospective hindsight as over time they get to see which appliances function well and which ones don’t, be they fixed, removable, or functional. Labs often see the clinical contraindications associated with many appliances. In a joint survey of 5,000 dentists nationwide, 70% indicated that better communication was the most important feature / service they look for when choosing a laboratory. 2 Because of my business relationships, many of which are orthodontic training programs, over time I have seen a growing trend of orthodontic programs de-emphasizing the laboratory aspect of orthodontic practice. In short, appliance design and appliance fabrication are becoming increasingly less important relative to the curriculum. Without such training it becomes even more important that the appliances are not only designed correctly by the practitioner, but made correctly and accurately at the lab because the orthodontist may not be equipped to adjust or repair the appliance properly. This is another example of the need for strong communication between office and lab.
A new area regarding communication considerations is 3D digital technology. If you are entering into the field, or are already using it, you are finding out about the learning curve associated with software, data storage, and transmission. Before purchasing intraoral scanning equipment have discussions with your lab to make sure files and software are “open files” and not proprietary closed files that may prohibit you from using them as you choose. Ask the vendors if they offer assistance with staff training as it relates to data transmission with your lab. Digital impressions will result in fewer remakes and better fitting appliances as models that are created from using this technology are extremely accurate. Another new development in the area of digital communications that some orthodontic labs are beginning to use is smart phone technology. In the past, if we had an unclear Rx or cast, we would have to call the orthodontic practice and try to communicate over the phone what our concerns were. At times, it was quite challenging to describe a possible impression distortion or unclear prescription drawing over the phone. The Dr. or staff member is at a disadvantage without the visual aid in front of them. With the smart phone we are able to take a clear photo of the area in question and email or text it to the interested parties. They are then able to make a better decision on how to proceed as they now have the same information that the lab has. For offices that are using this advantageous communication tool, it has saved a lot of time and frustration; negative aspects in the laboratory part of practice that have in the past been considered an unfortunate part of doing business. Providing direct email and cell phone numbers to your lab partners often make the lines of communication more positive, productive and profitable. Make your lab part of your team. They can help you with the success of your practice. Good communication will save you time and money by creating a better and more productive business environment.
REFERENCES 1. Marsico M.; The Remake Debate. Lab Management Today 2011; March: 6-8. 2. Carr K.; What Do Dentists Want From You? Lab Management Today 1994; Feb: 6-11.
How to Communicate with Orthodontic Laboratories Phil Pelligra BS, BA (Bus. Mgt.)
www.elsevier.com/locate/ysodo
PII: DOI: Reference:
S1073-8746(16)30005-6 http://dx.doi.org/10.1053/j.sodo.2016.04.005 YSODO449
To appear in:
Semin Orthod
Cite this article as: Phil Pelligra BS, BA (Bus. Mgt.), How to Communicate with Orthodontic Laboratories, Semin Orthod, http://dx.doi.org/10.1053/j. sodo.2016.04.005 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
HOW TO COMMUNICATE WITH ORTHODONTIC LABORATORIES
Phil Pelligra BS, BA (Bus. Mgt.) President, Perfect Finish Ortho Lab, Inc. 101 Bilby Rd., Unit F Hackettstown, N.J. 07840 908-852-3035 [email protected]
HOW TO COMMUNICATE WITH ORTHODONTIC LABORATORIES
ABSTRACT: The purpose of this article is to help improve the relationship between the orthodontic practice and their laboratory vendors. It seeks to provide ideas and suggestions on how to achieve this goal by knowing the right questions to ask your laboratory. Improving dialog ultimately leads to a less stressful and more positive business relationship. The lack of quality communication with vendors is a common problem in business, as well as with many orthodontic practices. This article will provide the orthodontist with tips and direction on how to improve on your current laboratory communications and will outline specific questions to ask your current and prospective vendors. The goal is to make your life easier and more productive by saving the practice time and money.
BACKGROUND AND DISCUSSION: One of the many essential components to a successful orthodontic practice is good laboratory communication. Clarity in communication is critical at a time when all practices have to reevaluate every aspect of their business. Communicating well will ultimately save time and money by making your business model more efficient. Without open communication and a solid working relationship in place, appliances may be made incorrectly, resulting in time consuming chairside adjustments, or even the need for complete remakes. This in turn may ultimately result in delays in appliance insertions, appointment cancelations, additional cost, and in extreme cases, even lost patients. The resulting frustration and stress to you, your staff, and patients is a major concern in trying to run a successful business in today’s competitive orthodontic environment. The orthodontic laboratory industry average for remakes is 2.78%1. In my experience, labs that are below a 1% remake average achieve this benchmark because of open and consistent communication with their clients. Remakes reduce profit and are not conducive to a good working relationship. As professional technicians, we continually strive to maintain a low remake factor. We hone our skills and take the latest laboratory related continuing education courses. Our ultimate goal is to give our clients and their patients the best possible appliances at competitive costs. Many doctors have expressed the feeling that a contemporary orthodontic practice is, to some degree, a field of narrowing control. The laboratory relationship is one area in which the doctor still has control, take advantage of it. The following are recommendations when establishing a working relationship with a laboratory partner:
1. Establish a primary contact person (PCP) at your lab. There should be one key person who you communicate with regarding laboratory issues and concerns. 2. Establish your design standards up front for your retention appliances of choice. You may have different retainer designs for different types of cases such as extraction verses non-extraction. Ask the lab to keep a “Client Preference Card”. This will provide a basic reference for routine appliance designs, wire gauges, acrylic trim styles, acrylic colors and expansion appliance preferences. 3. Know what your laboratory’s normal turn around time is for appliance fabrications. If there is the need for a rush on a case, make sure you know your lab’s requirements for doing so and whether or not there will be any extra charges. 4. If your PCP has delegated responsibilities in various areas within the lab, and conversely you have a designated person in your office who deals with lab related issues, make sure the individuals within both businesses who are responsible for answering technical questions, placement date concerns and billing inquires have been identified to each other. Exchange extensions and emails of all responsible parties. Alert your lab partners if any staff changes occur to ensure that the lines of inter-business communications remain open. 5. Make sure you know your lab’s warranty policies for appliances (wires, acrylic, solder joints, etc.). 6. Ask about sterilization/infection control procedures. It may come up regarding OSHA compliance or through a patient inquiry. 7. Inquire about lab closure times and policies for holidays, vacations, training or bad weather days. Log these dates into your appliance scheduling book. 8. Find out how long your lab retains the prescription sheets. This may have practical as well as administrative law related concerns.
9. Ensure your lab has the ability to use hypoallergenic wire (nickel free) and acrylic (methyl methacrylate free) for patients presenting with a history of allergies to these materials. 10. Make sure you know how much total expansion your preferred expansion appliances have, and what the turning ratios are (turns/mm). 11. Find out what your lab’s remake policy is and request a copy of it. 12. Finally, ensure that your Business Associates Agreements are up to date. There are proper procedures for filling out a lab requisition / prescription form (Rx). It is best to draw the design out on the Rx form as well as fully writing out the instructions. If your drawings are not legible, then only write out the instructions. A sloppy drawing or slip of the pen may look like a clasp or finger spring to the technician. The following figures demonstrate an unclear prescription (Figure 1.) followed by the corrected identical prescription (Figure 2.)
Figure 1.
Figure 2.
1. In this example, the Dr. is asking for a Lower Spring Aligner, however neither the type nor style is specified and the number of teeth to be reset teeth is unclear. The Hawley description asks for 3-3 Labial Bow but the drawing appears to indicate that the bow is to be soldered to the Adam’s clasps. In addition, the finger spring request is unclear on both direction and type. Finally, the placement date has been left blank. 2. In this Rx, a lower Modified Spring Aligner is requested with the set-up clearly indicted. The design of the upper Hawley bow is clearly 3-3. The finger spring direction and 1 coil design is stated. A specific acrylic color is also requested. The placement date is conspicuously noted. In short, the prescription is fully completed. Ancillary considerations when completing a prescription are:
•
Do not use gel pens. They bleed or get washed out and become unreadable when the Rx gets wet.
•
Agree on the same designation / notation for identifying teeth, Palmer v. Universal. Don’t ever mix the 2.
•
If not providing a laboratory analog for T.A.D. fabrication, clearly mark the cast for T.A.D. location, not the Rx.
•
In any deep bite case or situation where anterior teeth will be reset, always send a counter.
•
When placing pontic teeth in an appliance make sure to specify the correct shade desired and provide a counter for occlusal reference.
Use your lab as a resource and a vehicle for feedback. Many labs see hundreds if not thousands of cases a month. Tap into that resource for the availability of new products and appliances that you might have heard or read about. You may want to incorporate some of these adjunctive appliances into your practice. Before trying a new product or appliance, ask your laboratory about what they have experienced and what type of feedback they have received from other practitioners they service. A phone call could save you a lot of time and money as the lab may have received negative feedback from other doctors. I speak to accounts daily on a variety of topics such as software, intraoral scanners, adhesives and expansions screws. I have the advantage of seeing the before and after casts of patients. Orthodontic labs have the advantage of prospective hindsight as over time they get to see which appliances function well and which ones don’t, be they fixed, removable, or functional. Labs often see the clinical contraindications associated with many appliances. In a joint survey of 5,000 dentists nationwide, 70% indicated that better communication was the most important feature / service they look for when choosing a laboratory. 2 Because of my business relationships, many of which are orthodontic training programs, over time I have seen a growing trend of orthodontic programs de-emphasizing the laboratory aspect of orthodontic practice. In short, appliance design and appliance fabrication are becoming increasingly less important relative to the curriculum. Without such training it becomes even more important that the appliances are not only designed correctly by the practitioner, but made correctly and accurately at the lab because the orthodontist may not be equipped to adjust or repair the appliance properly. This is another example of the need for strong communication between office and lab.
A new area regarding communication considerations is 3D digital technology. If you are entering into the field, or are already using it, you are finding out about the learning curve associated with software, data storage, and transmission. Before purchasing intraoral scanning equipment have discussions with your lab to make sure files and software are “open files” and not proprietary closed files that may prohibit you from using them as you choose. Ask the vendors if they offer assistance with staff training as it relates to data transmission with your lab. Digital impressions will result in fewer remakes and better fitting appliances as models that are created from using this technology are extremely accurate. Another new development in the area of digital communications that some orthodontic labs are beginning to use is smart phone technology. In the past, if we had an unclear Rx or cast, we would have to call the orthodontic practice and try to communicate over the phone what our concerns were. At times, it was quite challenging to describe a possible impression distortion or unclear prescription drawing over the phone. The Dr. or staff member is at a disadvantage without the visual aid in front of them. With the smart phone we are able to take a clear photo of the area in question and email or text it to the interested parties. They are then able to make a better decision on how to proceed as they now have the same information that the lab has. For offices that are using this advantageous communication tool, it has saved a lot of time and frustration; negative aspects in the laboratory part of practice that have in the past been considered an unfortunate part of doing business. Providing direct email and cell phone numbers to your lab partners often make the lines of communication more positive, productive and profitable. Make your lab part of your team. They can help you with the success of your practice. Good communication will save you time and money by creating a better and more productive business environment.
REFERENCES 1. Marsico M.; The Remake Debate. Lab Management Today 2011; March: 6-8. 2. Carr K.; What Do Dentists Want From You? Lab Management Today 1994; Feb: 6-11.