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5 Things your Technician Wished You Knew – PDP074

‘An average Dentist working with an excellent Technician can go very far’, was the message my old training program director gave me. Technicians are often the unsung heroes whilst the Dentists collect all the praise and accolades. Who do we blame when things go wrong? Our technician, of course! Not fair at all – this is why I welcomed RDT Graham Entwhistle of Trueform Dental Laboratory to air his frustrations at Dentists – you will pick up some great tips here to improve your working relationship with your dental technician!

How to work better with your dental technician

Need to Read it? Check out the Full Episode Transcript below!

Protrusive Dental Pearl: Use websites like Loom or even Whatsapp to communicate with video and voice with your technician. Great, clear communication will ensure expectations are met for both parties.

SPOILER – the 5 things that Technicians wished we Dentists knew:

  1. Dentists need to improve their communication! Back to basics – if you want better work, you have to fill a better prescription form. Even just the lack of basic info drives technicians mad! We also discussed about Ivoclar Ingots for your ceramic
  2. Make sure your tooth preparation is appropriate for your material selection! Decide the material BEFORE you prep the tooth!
  3. Your impressions need to be clearer please! Do you always check for distortions, drags or voids? Could you consider trying Impregum?
  4. Shade guides – they can vary and can discolour over time. It’s important to ensure the shade guide matches your technician’s and the materials they use. Acrylic shade guides will discolour over time! We share some shade taking advice for Dentists
  5. Do you etch your own ceramic? If not, why not? Take control of your bonding, consider etching yourself to prevent ceramic over-etching. You can’t hold your technician accountable for your bond strength!

Check our Graham’s work on Instagram!

If you liked this episode, you will also enjoy the classic with Jason Smithson on eMax Onlays and Vertical preps!

Click here for Full Episode Transcription:

Opening Snipper: So do you trust your tech and if you ask for your etching to be done in the lab and then obviously the ultrasonic clean everything here but you're gonna hold me accountable for your bond because i've done the etch but then you've tried it in and you've had to re-etch i don't think your tech should ever be accountable for your bond i think that should be down to yourselves and when it comes to itching again back to communication tell me what you want and I'll do it...

Jaz’s Introduction: When I was a foundation dentist, my training program director was Raj Rattan who some of you may have heard of his speeches, his stories are famous in the dental circles. He was a great guy, and he gave some really good advice to me. He said, Jaz make sure you pick your technician very carefully. Because an average dentist with a good technician can go very far. Hello, Protruserati, I’m Jaz Gulati and welcome to this episode about five things your technician wish you knew. This episode is all about some things that we can learn as dentists from our buddies, the technicians, who honestly they work so hard and do such a great job for us. It’s such an important job, you know, we’re the ones who take that final photo and upload it to social media. And we get all the accolades and the applause. But it was actually the technician who made those veneers or technician who made that beautiful crown and made it blend in with all that natural anatomy. So I think technicians need to get the praise that they deserve. And I’m hoping this episode, they can actually contribute in another way. ie, I want Graham who is the technician. Graham Entwhistle, I want him to share his frustrations with us our basically learn what it is that we can improve so that it makes our technicians lives easier, and produce better work for us overall. So I actually didn’t send him any questions in advance of this episode, I just said just run through your five pet peeves, or five things that you wish dentists knew. And that’s how this episode was born. So before we join Graham and what he has to say on those five points and five lessons, I want to share a very relevant Protrusive Dental pearl with you. It’s about how we can communicate with technicians better, now we live in an era of WhatsApp and Instagram then why don’t we use it? In fact, the way I like to communicate with some of my technicians is via WhatsApp and on WhatsApp, I can send the only voice recordings and photos but I can actually show him videos of my patient, my patient smiling speaking so we can check the phonetics. And sometimes for my splints, if there’s an issue with one of my splints, I will make a video and I’ll send it to my technician say ‘Hey, can you please make sure that the OBD is increased or decreased or whatever.’ So I think that is the highest clarity or highest level of communication we can have. It’s so much better and less wordy than email, which we used to do. So I am a big fan of doing videos for communication. So I would encourage you all to do that. Now, if you don’t go the next level. I have mentioned it before in that episode with Finlay Sutton on Chrome dentures. If you haven’t checked that one out already, please do sensational content from Finlay on that one, we talked about the use of something called loom, which is loom.com as a website where you can record your screen and record your video with a presentation for example. And you can share that very easily with other dentists, your patients, technicians or whatever. Now sometimes if you’re doing digital smile design and you want to involve your technician in it, and if you go to loom and if you start recording the photoshopped smile design or start adding your lines in or [lensing] you can actually do that while the video screen is recording, and you could be speaking over it. So your voice is also recorded. That way, it’s another dimension of giving your technician videos and you giving your voice instructions for how you want the future work to be. So again, the level of communication is so much higher. And one thing I was taught many years ago is when you do videos, your technicians you can put your emotions, your anger, your frustrations, your desperation for things to go right in that video and it makes it so much more human so I hope you enjoyed that pearl and let’s join Graham Entwhistle and five things a technician wish you knew.

Main Interview:

[Jaz]
Graham Entwhistle welcome to the Protrusive Dental podcast. How are you my friend?

[Graham]
I’m very good. Thank you. I’ve been there haven’t had a hectic day but nice to be settled down and just chilling talking to you.

[Jaz]
Well I appreciate you joining me this evening and you are away from your family now if I remember correctly you have five kids?

[Graham]
yeah just literally just turned five children we had a baby girl on New Year’s Eve so yeah, hopefully the last one of the clan.

[Jaz]
Well congratulations for the latest addition. Tell me about is it was a boy or girl?

[Graham]
It’s a girl our first one was a girl and our last one is a girl so the rest of it all boys in between fight anymore boys. I think I would have taken a little one way ticket somewhere.

[Jaz]
What’s her name? The latest addition to the clan.

[Graham]
Hope. I think it’s quite suiting for the times that we’re living in as well as being a beautiful name.

[Jaz]
This podcast itself is about is more where you get to vent your frustrations in a good way, in a banter way, obviously, I’m gonna make sure we don’t lose any clients and stuff. But like everything that technicians ever wanted dentists to know. But before we get to that, I just want to, you know, for you to give an introduction about yourself, tell us about where you work, how long you’ve been a technician for, what your main interests are, in that sort of field.

[Graham]
I’m a one man band, basically, I have my own lab, it’s just me, I do everything start to finish on my own. I started Trueform Dental up in Harley Street originally with a friend of mine at [152 100 mile inshallah.] And yeah, he got rich on Bitcoin and decided that he was going to take some time off, and I took the brand, and I just bought your home pretty much. So I’m now in East Sussex, close to my family, I decided that I was never going to lead the sort of way that I’ve seen many technicians do, and you know, not seeing much of their family and, you know, spend all the time in London in basements. And you know, especially in the West End, everyone’s mainly in basements. And this year, you’re paying through the roof for rent. So yeah, I decided to make the journey home. And I started almost from scratch. I had one client who joined me right from the very start, and I’ve built from there really, so we’re very grateful, she joined me.

[Jaz]
Well, that’s cool story. But I want to touch on that actually, as a father myself got one kid, and he’s energetic. And I want to give him a lot of my time where I can, but you know, it’s a busy lifestyle. We live as dentists and as technicians, how do you do it with five kids?

[Graham]
it’s ridiculously hard work. And it’s hard to plan because as a technician, you know, we don’t have a booking in sheet or wherever, you know, where you’ve got your patients coming in at nine o’clock. 10 o’clock, 11 o’clock, 12 o’clock. We haven’t got that. So some days, we’ve got nothing coming through the front door. And as a technician, you just start worrying sort of, like no phone calls, no cases come in, no impressions, no lower [terror or Trio scans.] It’s just like, you know, what’s happening, and all of a sudden on Thursday, we get this absolute blog load of work, come through the door, and you’re just like, right, now we expect you to do all of this. Now, you know, in our last three days work, you know, pretty much. But the thing is, even if you’ve got little dribble of working, and if you’re not there getting it done, then that happens. And then you find yourself under the [cosh.] And that’s when you just start working ridiculous hours. So you know, just stick with it, keep going and the work will turn up on your front doorstep.

[Jaz]
I never appreciate I mean, thank you for giving us that insight. I never actually thought about it in that way, especially as a solo technician yourself. I can now put myself in your shoes and and appreciate that your work comes when it comes. And sometimes you might have quieter days. And sometimes it might come all at once. So you know, kudos to you for raising a family of a beautiful five kids, including Hope so that’s amazing, man, I’m so happy for you. You know, as a father, it’s so tough, especially in your industry. So hats off and keep going my friend keep doing the time for both family and for profession. But this episode is going to be all about profession. So give it to us, Graham. Don’t hold back the five things that you wish dentists we know, would know or start doing better start with number one, what is your biggest frustration with dentists?

[Graham]
The first thing and foremost is the communication that you get with dentists. And it’s not always there, some are really good at it, and some are really dismally poor. And you know, you’ve got no control over that really sometimes and you know, you might get a lab ticket, you’ve got no phone call, nothing got to tell you that the worst can arrive, you get the lab slip, and he says, Emax shade sito. And that’s it lets the detail that you’ve got, you know, a little [tooth implantation] most of the time, that little date return date box is filled, but it’s not always filled in, it’s just kind of so already, I feel like I’ve got to make a phone call on the job. And it’s just I’ve got the time to make like 10 phone calls, you know, it’s just based on the lack of information that we’ve got. So yeah, lab tickets, I mean, I’m quite guilty on it to update my lab ticket because it doesn’t ask for enough detail. So, you know, I asked for a shade, the stump shade, it would be nice to get some sort of patient expectation from that shade and any information on you know, whether there’s any adjacent restorations, because trying to match in Emax, for instance to upon [post lane, Bonded Crown] can be really quite difficult. And you choosing the right [in guts] can be really difficult on that sort of side of things.

[Jaz]
I guess the ideal dentist for you would be I mean, with the whole date thing. Yeah, I mean, totally. They should always be giving you a date, because it’s just how the world woks. But when it comes to the lack of information in terms of all they said is A3 Emax and that’s it. That’s sometimes, it might be because the dentist may not feel they need to give any more than that then fine. We can discuss that. But it might be actually due to a lack of knowledge from a dentist, right? So let’s educate them right now. In one minute. What additional information can they give you with prescription that will really, really help you.

[Graham]
Any sort of additional features of the teeth. Whether you want a heavy contact and light contact or contact point, every dentist kind of has their own way of doing things. So especially if you’re a new client, or we haven’t done any work together on, I haven’t done much work to give as much detail as you can put onto those lab sheets, the better. Obviously, you know, I’ve done crowns where I’ve just had to shade and I’ve done it, I’ve pressed it in a light, medium translucent in got, for instance, and the core has been great. You know, you haven’t told me that, but you expect the remake done for free? And it’s just like, well hang on a minute, you know, is it really my fault? You know, I don’t mind meeting you halfway, you know, seems it’s a first time incident. But if it happens again, then I’m gonna have to charge you for price, you know. So it’s all time taken out from myself. And like I said about other details, lead, return dates, you know, if they’re not there, I have to ring you up. And sometimes I’ll get a return date. And it’s a week and I asked for two weeks. But you haven’t phoned me up to ask me about that. So I’ve now got to make that phone call again to see if I can actually squeeze down

[Jaz]
Three things we can learn from that in reverse order. One is if you want a quicker turnaround, it’s just common courtesy to call your lab and almost like book it in like ‘Hey, heads up in three days time, impressions coming, I want a one week turnaround’. It gives you an opportunity, Graham to actually structure it and fit it into the right slot so it gets the right time. So that’s for sure. In terms of the ingots that some dentist might be listening to this young dentist and they weren’t they might not be familiar with this, Graham, it’s not actually common knowledge. A lot of dentists don’t know that Emax or lithium disilicate from Emax from Ivoclar, it comes in different Ingots. So like there’s high opacity, medium opacity, medium translucency, low translucency, you know that there’s five. So sometimes, maybe if you haven’t heard about this, that make this episode, the turning point where you’re gonna go and find out that information, maybe I’ll link to something on the Iveclar website for that, which would be good because that will help your technician. And the third thing we can learn from what you just said that is give an occlusal prescription is not okay to just say, you know, this is the shade, this is the crown, it helps a technician to say there are [shimstock called] on these teeth, put the crown it lightly inclusion in MIP with shimstock. And then you have something to follow as an occlusal prescription. Do you think I’ve summarized that well?

[Graham]
yeah, I think that’s quite a fair summarization, really, especially if you’re looking for a top end job. If you want everything just a drop in place. And you know, I’ll come on to this a bit later on. Especially when you’re just dropping things into place in some of my clients, they like just have everything ready, and they pop it in. And they don’t have to touch anything. But that’s because they’ve given me the right details, or we’ve been working together for a long time. But yeah, some dentist, obviously, you’ve got to try these crowns in first, make any adjustments that you might have had, and you know, every dentist got their own way of doing their own impressions, they’ve got their own ways of doing their temporaries. And sometimes, you know, the temporaries are swelling, you know, and pushing the adjacent teeth slightly apart, or they’re just shy of that. So you know, didn’t the restoration of made doesn’t quite fit as well as it should. But you know, we’ll touch some of this as we go along.

[Jaz]
I’m going to flip it around for you, Graham, and this is not against you. Because the fascinating thing about this podcast recording is and with respect to you, Graham, I really appreciate that you’re a solo worker, I know you’re a busy guy, and you’ve got lots of clients and stuff. And if anyone wants to use you again, great. But I know that’s not what you’re on here today. I think you’re on here because you’re passionate about I’ve got you on because you’re a passionate technician, you haven’t got anything to sell. And that’s why I want to bring you on as great we can have this discussion, but I haven’t used you yet. And there’s not say I might not use in the future. haven’t used it before. But so this is not an attack on you. But recently, I sent a resin bonded bridge to a lab, and I wrote my prescription and I can tell you now it’s a long essay, I write for these resin bonded bridge, because I want them done and specifically. So I am almost like a dream client for you with the information that I give. But I wanted the technician to cover over the premolar with the resin bonded bridge retainer. And I gave that very clearly in prescription but sometimes it doesn’t come back and then I have to send it back to labs like no cover, do what I said. So sometimes technicians when we give these a detailed sort of descriptions and whatnot, sometimes technicians will read it, they will not follow our instructions. So that’s me airing out our frustration. What do you say to that?

[Graham]
Well, I suppose it depends on where you’re sending your work. If you send it to a sole trader, like myself, you know, and the content is good. I mean, I use a lot of WhatsApp, if I’ve got anything that I want to do differently to your sheet. I will use WhatsApp and leave a paper trail I’ll ask you the questions. You’ll verify it with me. If you verify it and say yeah, that’s okay. Or then there got it in writing. So when it comes to fit, and you tell me ‘Oh, I asked for this different I’ll just write well, actually, we said this, you know, that’s what it’s about. It’s about everyone taking responsibility, having that communication in place. But yeah, if you’re gonna say send it to sort of lab work.

[Rupert]
So what I like about that Graham is that you said about about the WhatsApp, right? So you would send the framework for example, right. But you know, you maybe send a photo or a video the framework?

[Graham]
yes, or send photographs, anything like that. Although, with WhatsApp recently, I know the kind of the privacy is changing, so I’m going to probably have to swap that as well. But yes, we live with paper trail, you can send pictures, you can send a video if you need to give someone a little walkthrough or talk of what it is actually you’re looking at and why you can’t do it that way. You know, and, you know, give someone a justification for doing or suggesting to do what you’re doing.

[Jaz]
That’s, that’s a great one. So if you have a technician that you work closely with to exchange on WhatsApp is really good.

[Graham]
Yes, from your point of view, if you send some work to a larger lab, for instance, you’ve got four or five technicians there. Sometimes things can get lost in translation. And that’s where you know, you end up not getting exactly what you wanted.

[Jaz]
I do agree with you, Graham, I think that’s what it was. But you know, it got sorted in time for the patient, but it just yeah, an opportunity to have that kind discussion with you, buddy. Hit me with number two.

Unknown Speaker
So number two, is kind of to do with material choices and prepping. So basically, does your prep, accommodate the material choice for your restoration that you’ve chosen for for that, and I say this because, you know, going back to Emax again, unfortunately, Emax does not like it doesn’t like sharp edges, and it doesn’t like knife edge preparations. So now it’s down to mainly the particle size of the Emax particles. And if you polish them down trying to taper in nicely, so you haven’t got a step. Sometimes, because the particle size is quite large compared to Zirconia, for instance, you can just polish it away, and then you end up shot at the margins. And you end up with cracking and you know

[Jaz]
so yeah, absolutely. So as a dentist, we should be having a better command over materials. But you know what Graham, sometimes it’s a tough call, I say that. But I think there are some dentists out there who may begin a prep of a tooth for a crown. And they haven’t already decided in their head, which material the crown will be. And you know, I’m guilty of this. In the past, when I was a newly qualified dentist, and through lack of experience, I sometimes start prepping, and I’ll be thinking, I’ll see what the prep looks like at the end. And it was a lack of experience, lack of knowledge at the time, many years fast forward, you know that you have to begin with the end in mind, because only then can you create the correct preparation. So as a sweeping statement, Emax, you summarize it beautifully, no further edges, and no sharp internal line angles and sharp bits in general. So make sure it’s nice, smooth and flowing. Any other tips you want to get for any other material?

[Graham]
So when it comes to bonded crowns, as well, if you’re looking at leaving knife edge margins, don’t expect a nice back fit with the ceramic, you will probably end up with a slight gray line. So unless you shamfed for these things, or you know, give us a porcelain back fit margin, then you know, don’t expect a lovely looking fit onto the model. So, for instance, if you got a bonded crown, and you’re doing it supragingival, try and give us a little edge. And then we can blend the restoration in nicely without any gray area showing through

[Jaz]
How much space do you want at that margin ideally to be able to get a more aesthetic result to be able to not get the gray show through?

[Graham]
So for metal ceramic, I would say at least 1.3 millimeters at that margin. That’s my preference. But with Zirconia 0.5, Emax 0.5 as well, really, and then you can get a nice [pressing six], they’re flush. And you know, you get no defects. If you’ve got a good technician who knows what they’re doing.

[Jaz]
And with that Zirconia, we said, 0.5, would that be left monolithic? Or would you always layer, it any advice on that?

[Graham]
I don’t know the materials these days, especially over the last few years, the materials have come on leaps and bounds. So we’ve now got all these almost layered Zirconias within themselves. So they’re multi layered. So you’ve got the the core and the enamel, are dependent on how they’re set in the disk, and they’re in the software themselves. And you can get some really nice results. So on the original multi layer, though, I would say that, you know, you had a graduation line. But now this is kind of tapering out and you get some really nice ones coming through, and they’re blended really nicely. So I tend to use something called [ADA] for quite a few of my restorations and it’s a bit softer on the occlusal compared to some of the really hard zirconias that are out there. So it depends on the lab you’re using, you know, you really got to ask them what is the county as they really use and what they’re suitable for. So again, this comes down to communication. So I tend to use some really hard zirconias for bridgeworks. And I tend not to go past two pontics together as well. So big abutment, Pontic. If there’s another Pontic you can’t ever work from me. You know, it’s going to be a bonded bridge all day long if you’re going to go for a bridge, although I’ll still think fit Fix bridges. They always fail over time. But yeah, that’s just my point of view as well.

[Jaz]
Amazing. Great points there. And one thing I want to add on for the dentist listening to this is grooves and slots generally a no, no, for zirconia. I think you should go for more rounded hollows than actual traditional slots, which are better suited for metal work and gold. Would you agree with that Graham?

[Graham]
I agree, especially with the smaller style slots, you got to think at the end of the day, the [Zirconia always nailed.] So you’ve got to think all these little tools that go in and mail out that they only get to certain sizes. And obviously, if they’re slightly bland, and they don’t quite get in there, then it doesn’t fit down quite properly. And then the technicians got really all that next thing, you know, it’s loose, and it’s just like wobbling everywhere. So yeah, it’s not really ideal. And to put all the grooves in just something nice and almost parallel, you know, just a couple of degrees like, like a customer, [Batman,] for instance, would be ideal for in Zirconia.

[Jaz]
Amazing. I’ve enjoyed those two so far. Material choice as well covered. Number three, hit us, Graham. What are the next frustrations that you want to ease out with dentists?

[Graham]
so your impressions, almost everything, you can be great and spectacular, that you’re prepping. But if your impressions don’t match that sort of standard, then unfortunately, your lead words gonna come back and be nowhere near that standard. So please always check your impressions for any distortions or drags. Or, you know, if you’re not getting to grips with certain types of, you know, light body and putty sort of impressions, why not try you know, if the situation suits you, why not try Impregum, you know that there’s one thing that I have never had problems with Impregum impression given to me that prep is always pretty much spot on.

[Jaz]
What are the most common errors that you would get from impressions that you mentioned a few there? But what is the biggest bugbear?

[Graham]
Biggest bug bear? There’s a few things really. And again, it just depends on expectation from yourselves as dentists, you know, lots of people hate triple trays, for instance, and some people love them. But you know, I would say they’re great, and they’ve got their place in dentistry. And they can be used to good effect, but don’t always expect, you know, your final fit to be perfect, because obviously, you haven’t got all the excursions of the whole arch and you know, is for the occlusal function is not there for you to see or use. So, yeah, if you can use a triple tray, don’t expect the occlusion to be smack on. But everything else should be pretty well.

[Jaz]
I think the internal fit would be fine that it’s more about Yeah, like I said, the excursions were triple trays, which may not be on point. Well, there’s a live stream I did. And people can watch it on Instagram or on triple tray. So you can check that out. Sorry, Graham, I interjected it

[Graham]
The other thing is mainly drags, especially around the preps and adjacent teeth as well. So sometimes you can affect the the emergence profile, because the drags come down off the adjacent tooth and your contacts as well. So if you check your impression, you can probably always check your prep, but do you do check those adjacent teeth. So for the contacts, if you’ve got a drag on that, then obviously, on playing guess, you know, Guess how with you and you know, you could end up being shy of the contact at the fit with the patient.

[Jaz]
A really good tip I learned once was when you’re taking your final definitive impression. Let’s say you’ve got multiple preps is all around if you’ve got some big undercuts, some big embrasures spaces between the molars, block them out with either wax or ptfe tape anything you can to get a better path of withdrawal, that’s not going to put stress on your light body. And that is a good thing that you know, I think Jason Smithson taught me that. So I just wanted to throw that in there for the dentist listening because that will help to get a better impression, less distortions, less resistance to removing and then less of this sort of breakdown about impression material. I think.

[Graham]
that’s a nice tip. Yeah, also, when you’re doing sort of overlays and onlays, the detail underneath your prep line is also very important. Because if you want me to keep the harmony of the natural tooth that’s already there, and bring it back to kind of its normal life position, then obviously that detail is also crucial. So yeah, depends on how good a job you would write down with the case.

[Jaz]
obviously, with the onlays. We want to be supragingival because we should be especially if they’re Emax onlays we should be doing them ideally with ideal isolation under rubberdam. So we will be supragingival or maybe equigingival or you know, deep margin elevation, that kind of stuff. So in those cases, yes, it’s important to give you as much detail beyond the margin so you can get that proper emergence profile. So I totally agree with you on that as well. Number four, we do well for time Graham, I’m impressed.

[Graham]
How long have we been carried for?

[Jaz]
25 minutes and this is good. I was worried that you know, you’ll be ranting and then complaining about us, dentist all day long.

[Graham]
I’m not here to complain, I’m just here to give you guys some pointers, you know?

[Jaz]
no, no, I appreciate that you are helping us so much, you are helping us so much, please keep going.

[Graham]
So number four is shade guides and shade taking. So say for instance, you’ve got a shade guide, it’s a generic [v to classical,] just like my one. But it might not be like my one, your one could be 10 years old, you might have left it in the sunlight for a while, you know, and these things discolor over time. So not every shade guide matches another shade guide. So it helps if you for instance, have I try and supply my dentist with a shade guide that belongs to the lab, and also matches the materials that I use. So it becomes easier then to match these things up. But obviously, if you leave these things in random places, especially if they’re made from acrylic, they will discover over time. So yeah, before you’ve been your technician see how odd you show guide is and see if it matches up to you know, your technicians one, give him a chance.

[Jaz]
When you send your clients, the shade guides, do you send them the generic ones? Or do you actually send like samples of porcelain like from the person that you use. Is that something that you do?

[Graham]
Well is close to that I would love to be able to spend the time giving everyone the porcelain firing and do porcelain fire in every shape. I don’t have the time for that, unfortunately. But what I do is the company, I mean, I use GC products, use lots of them. And it’s quite a generic fill. Across the materials, everything’s got the same name, whether it’s like Lisi or whether it’s metal ceramic, or whether I’m using Gradia Plus, you know, everything has got the same name. And it’s got pretty much the same color. So far, give everyone a set of shade tabs for that, and they pick a generic shade, and then they pick an enamel to go with that, then that’s great, because I know then I’ve got to match, maybe an A3 and a more with the A2 shades, you know, we can get better results. And you can a generic, classical straight guide. Obviously, if there’s any internal details, I’ll give you a whole load of colors that are on there, just pick out a shade tablet, if you’re looking through, you see the color in the tooth. And instantly if your eyes seen that color, that’s true, pick it out and put it in the bag or put it in a box. Because if you start looking again, you’ll actually find that your eyes trick you and tell you that that color is not there. So you look on the next one, you pick out the next one. So yes, that one is it probably was one before because that’s what your eyes have seen. First, your eyes are drawn to it. That’s true. So yeah, hopefully there’s a couple of tips there for you.

[Jaz]
There certainly are. Have you have you dabbled with the eLAB protocol?

[Graham]
I haven’t actually, I do everything myself, I can take shades, I don’t mind taking a road trip, as long as it’s not, you know, too often. But a lot of photography really helps in the right type of light. And obviously, you’re holding the shade tabs up against the adjacent tooth that you want to kind of match not the temporary that you’ve got in there. And also talking about if you already taken a shade match or shade tab with a temporary there, you’re probably wrong, you should take the shade first before the teeth are dehydrated, otherwise, you get a shade discrepancy at the end. So if you take your shade first, then that’s the best way to do that. take some pictures of some shade tabs in there. And obviously, if there’s internal details, take some nice pictures tell me the random colors that you’ve seen in there. And I can mimic that to the best of my ability and generally good success rate. And I’ve heard that a lab and you know others don’t have the success rate that they maybe should have. You know, so overrated software.

[Jaz]
Brilliant, I appreciate that. And it’s want to give a dentist a little tip on composite work actually, the shade guide that we have for composite a lot are made of acrylic so they’re not true representations of the of the competent itself. So I’ve actually got a little kit, I got them from style or style italiano, you can actually make your own custom shade guide with a dentin and enamel using whichever composite system you want. I haven’t actually built them yet because I still haven’t found my go to composite. I’m still in that phase where I’m I love my genial I use it. But I’m getting to a stage where it’s going to be out of date soon. I bought it some years ago now. And I also want to use what my principles are by me as well. But I think as a practice, we switch to one and then we all like that system. It will be it will just work better. So I’m waiting, I’m almost there. But that’s one system that I like to use to master that system and then I’m gonna be making these custom shade guides. So I’m quite excited to get that done. Sounds very geeky. I know. But yeah, just that’s why I rely so heavily on putting little buttons of composite and curing them before I choose my shade because that gives me so much more information than an acrylic shade guide would do. So just want to throw that in there for the dentist. And then number five, my friend Graham, please tell us what is your final frustration with dentists? What do you wish that we all did better.

[Graham]
I was actually talking about this with a fellow technician the other day as part of my support network, great tech. But we were talking about etching restorations for your dentist. And why do we do it? Why do people ask for it to be etch now, either you’ve got a great trust with your technician, like I was talking about earlier, you know, I’ve got a couple of clients who just like to just pop them in, you know, without even checking, so that’s fine. If you want the matched, then I expect you to be pretty much doing that. But if you asked for them etch, and then you go and try it in the mouth, you make some adjustments, and you take it out, and then that etched layer is then compromised. So you then have to clean it all off yourself and reattach it. And then at this point, you can over etch and you can end up with a really gravelly, grainy, fit surface. And you know, depending on the translucency of the material that you’re using, it can start having an effect on the actual shade, and you know, color of the restoration. So do you trust your tech, and if you ask for your etching to be done in the lab, and then obviously, the ultrasonic clean everything here, but you’re going to hold me accountable through your your bond, because I’ve done the edge, but then you’ve tried to in and you’ve had to re etch. I don’t think your tech should ever be accountable for your bond, I think there should be down to yourselves. And when it comes to it, you know, again, back to communication, tell me what you want. And I’ll do it.

[Jaz]
I think it’s good to be prescriptive with the etching as well. Because what I like to tell my technicians to do is I will say use 5% hydrochloric acid for 20 seconds as per the protocol that I learned I use I hope I’m not putting you on the spot too much. But is that the concentration? Is that the time that you’re doing? Or do you follow a different protocol as per manufacturer’s guidelines?

[Graham]
It depends on the manufacturer guidelines or the you know, the the acid that you’ve got yourself. So the acid etch always comes with its own set of instructions, and some is generally about 20 seconds, I do all of mine for 20 seconds, but some of the 30. So ultimately, I suppose it depends on the concentration of the etch liquid that you’ve got yourself. And obviously these over time span as well. And they vary, they get stronger and weaker over times.

[Jaz]
I respect that massively. And I’m glad you do that, because there was a technician or chain of technicians I was using some years ago. And the onlays would come back and they’d look like super rich, they look like really chalky and I email saying, you know which concentration are you using? How long using for? Are you following my instructions? I didn’t tell him what my instructions were because I write them in every case. I said how long you’re doing for the email back a photo. They said, yeah, we used to do it for about 60 to 90 seconds. I’m like, No, you’re re etching it. So totally, it’s totally worth picking up the phone emailing and just confirming make sure that every technician within that chain knows, you know what it is that you want. So that I think the ideal way is exactly how you said it. If you can be anal about bonding, which we should be we should be anal bonding, then perhaps it’s time to do your own etching.

[Graham]
Yes, yeah, I agree. If you want to be 100% in control, do it yourself. You know, that’s that’s the only way to do your job properly. Especially if you want to do your try and have the crown [slashed,] you know, you should be in control of that. And just let your lab send it to you, you know, cleaned, steam cleaned or in the ultrasonic.

[Jaz]
Amazing. Graham, that’s it. that’s a five. And I really appreciated that we did it in a really good time actually, this will make for re listening will episode some I absolutely mammoth 90 minute ones. And sometimes you’ll feel bad for the listeners. So this could be great. I think what we’ve covered was really impactful, I think was really fresh, I think it was a real opportunity for technician then to sit down and just talk things out. And I’m hoping that hundreds, thousands of dentists out there will now be in a position to pick up the phone and have a better relationship with their technician. And hopefully, to hopefully you picked up a nugget or two from Graham and myself to improve your technical work Monday morning.

[Graham]
I do have one more nugget, if you want to. I have missed it out. So if you’re interested, it’s goes back to your prepping, basically. So it’s about emergence profiles and your contact areas. And we did touch this contact area thing earlier. Now sometimes you get an overlay that comes into the lab, and they want their contact areas, you know, nice and you know, but then again, you find yourself that the gaps quite large between the sort of like mesial contact point, but then you’ve got a really, really high prep line. So trying to get it across to that you’d end up with a big overcontour and creating a food trap, which is probably what helped cause the problem that is totally in trouble for in the first place. Now the tip that I’ve got is if you drop all these distal one mesial margins lower, you can change the emergence profile of that. So to then come up and bite against the contact nicely. So yeah, that would help myself and yourselves no ends if you can then pick up and do all that.

[Jaz]
That’s a fantastic tip there and I’m going to make it extra tangible for the young dentist who may not have got that I think you explained it. Well. I just I think if I was one or two, you’re qualified I might have thought, I don’t understand what that quote means maybe. And basically, imagine your crown comes back or an onlay comes out and overlay comes back. And there’s a big distance between your prep and the the tooth behind. But in the situation that you described, you get like a almost a pregnant appearance of your overlay because it has to stretch all that way. But you can put, like you said, If you prep a little bit more South a little bit more gingival, it allows you to get a less pregnant looking contact, that actually has a better emergence, hence, the term emergence. So that, you know, great, I’m so glad you mentioned that. Because I think, you know, when we come to prep, and looking at our contacts that we’re hoping to achieve these contact areas, it will be so much better now. So, Graham, with that, thank you so much for coming on today and sharing your time. And thanks for following as a technician. I mean, when I made my podcast, I never thought that technicians would listen. So honestly, so flattering, and I really appreciate you being a supporter of the podcast. And I wish you and your family all the best. It’s amazing, this busy life you live, and I’m so happy that you’re able to give up some of your time to join me today.

[Graham]
Yeah, that’s been great to come on. It’s been nice just to have a little change of what I do from day to day, you know, I’m lucky as a technician, I get to have breakfast with my kids, because obviously, I work just up the road from where I live. So I get to pop in and out almost as in when I like, which is nice. But you know, just to have something different than the current climate is really nice for me to stick as well.

[Jaz]
Are you in a position to accept more clients? I know you’re very busy. But you know, some people might have listened to this today and thought you know what? This Graham guy, he sounds really nice seems sounds really good. I’d like to send him some cases. Would you mind dropping me your details? So I could put on the website? Graham, is that all right?

[Graham]
Yeah, you can put Trueform Dental up on a website, on Instagram. Obviously, that’s probably my primary source. Although I do have a website. I’ll give that to you afterwards. But yeah, I do have some limited space for some clientele. So anyone who’s interested, I like to focus on quality. And that’s what I’m about everything is done by myself. And if I can do it.

[Jaz]
anyone locally to or even obviously, you can accept scans and stuff, but anyone local to to have that relationship that can visit you as well. That’d be a really good opportunity for a dentist who’s keen, who’s looking for that technician. So definitely check out Graham is at Trueform Dental. And again, I will link that in the show notes on protrusive.co. uk. Graham, thanks so much.

[Graham]
No problem says, Have a nice evening.

Jaz’s Outro: Thank you so much for listening all the way to the end, I hope Graham brought you some value there. If you want to check out his profile, I’ll put it on the website. So you can go to protrusive.co.uk, find this episode, and I’ll put a link to all his profiles, his lab, I know he’s super busy, so he probably can’t accept too many more clients. But I’m sure be happy to help you out where he can. I know I’ve mentioned it before, but we are having a protrusive Dental community or Protruserati whatsapp group, if you want to be in on this, you got to join the Protrusive Dental community Facebook group, if you can just search it on Facebook. And once you’re in there, there’s a whole thread about the coming upcoming whatsapp group, you just put your mobile number there, and I’ll make sure I get you on I’ve been promising this for a while. It takes a long time to add every single person as a contact and then make the group but I am getting some help with this soon. So hopefully by time you listened to it, you’ve joined in the party. And eventually we can have that whatsapp group that some of you have wanted. So do join that if you’d like to take part. Otherwise, I’ll catch you in the next episode, which I’m gonna keep a secret, but I’m gonna tell you this, this episode is gonna absolutely blow your mind. It’s gonna be sensational. It’s someone with some very famous and you will absolutely love it and I’m gonna keep it a secret. So I’ll catch you in the next episode, same time, same place.

Hosted by
Jaz Gulati

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