Christian has made a great Instagram post on this exact topic. Here’s a link to his original Instagram post.
Below is a list of the most frequently encountered mistakes in the restorative workflow and recommendations for improvements:
- Poor treatment planning
Lack of facially driven treatment planning understanding. No skills to convince the patient to do the right thing. Choosing the shortcut.
- Poor information shared with the lab
No facial information. Photos with wrong angles, or no video. Lack of protocols. Non-ideal tools. No standardized communication system. This is not only when starting the plan but also during treatment, when ordering modifications is necessary.
- Inadequate tooth preps
The majority of preps coming into labs shouldn't be accepted. Bad prep design. Lack of respect for enamel (key for longevity). No visible margins, path of insertion, clearance, sharp angles, unnecessary exposed dentine. Lack of hand skill training and vision of link between prep design and desired final restoration design. Lack of understanding of the link between prep design and gingiva behavior.
- Bad impressions or scans
This is a huge historical problem in restorative dentistry. The majority of impressions/scans shouldn't be accepted by labs. Challenges with proper soft tissue handling to allow ideal impressions. Lack of protocols. Bad provisionalization. Doing it in a rush. Not wanting to repeat.
- Inadequate bite registration
This is another historical challenge. Poor understanding of MIP/CR and when to use what. Poor training on why and how to register each one. Poor understanding of how to avoid distortions, how to deprogram, how to open, manipulate the jaw, adjust a jig, use the materials and transfer the information to the lab.
- Try in and adjustments
This sounds easy but is not! Lack of protocols for the dry try in, how to sequence the try in of multiple restorations, interproximal adjustments, checking the fit, understanding why it is not fitting and how to improve it, calibrating the emergence profile and its relationship with the gum. Wet try in color check. How to improve all the above chair-side or how to communicate with the lab to improve it.
- Proper bonding protocol
The big difference in longevity between doing it by the book and not doing it by the book; doing it with care and doing it in a rush. Many details can go wrong. When failures happen because of poor bonding/ cementation quality, labs are asked to redo for free or at a discounted price.
- Post-bonding occlusion adjustment/ refinement
This is one of the main reasons for restorative failure. Unfortunately there is very little education here as well. Having the comprehensive clinical experience to delicately check, adjust, refine and polish the occlusion. Distributing the load properly, creating smooth balanced movements. Making the patient comfortable and protecting teeth and restorations by minimizing risks.
Regardless of whether you use analog or digital, material X or Y, technique A or B, the topics above are the ones that create real quality and define a great restorative case.