Kreyer on Removables: Digital prescriptions

We have all experienced the inadequately written dental laboratory prescription: “Pour impressions.” “Make baseplates and rims.” “Set teeth.” “Process and finish.” These all are various vague terms that we have read on work authorization orders or prescriptions.

To write a comprehensive dental laboratory prescription, a clinician must have technical knowledge of removable prosthetic laboratory needs. Understanding these technical needs is a necessary component of effective clinical and technical interdisciplinary communication. The parameters of interdisciplinary communication are prosthetics, esthetics, occlusion, design and materials.

Achieving consistency in clinical and technical communication during treatment planning will result in a predictable and consistent prosthetic product during delivery of the prosthesis.

I so passionately believe in improving communication and collaboration between clinicians and technicians that I wanted to devote this column to a new removable prosthetics digital tool that sequentially provides a clinician with the necessary technical knowledge to create a comprehensive laboratory prescription.

The InteRcom Case Planning System from Ivoclar Vivadent is a web-based portal that provides a sequential approach to clinical understanding of technical needs while assisting the clinician and technician in exceeding expectations and achieving consistent prosthetic results.

01 Fig. A shows the Welcome page to InteRcom Case Planner. After completing your personal login, this page will appear and give you the option of creating a new case plan, continuing with an existing case plan or tracking a case.

02 The system gives the clinician an option of creating a new “Fixed Restoration” or “Removable Restoration” case plan (Fig. B). Because my column is devoted to removable prosthetics, I will cover only the complete removable option in this article.

03 Page one is “Patient Information,” (Fig. C) which allows the clinician to enter pertinent information to this case. This information includes a case identifier, due date, first and last name, age and gender.

04 Page two of the Case Planner is “Appliance” and gives the clinician the option of designing a case plan for Complete or Partial prosthetics (Fig. D). The complete option includes implant retained and supported restorations.

05 Fig. E shows page three of the Case Planner, “Teeth,” which enables clinicians to select which type of teeth they would like to use on this removable restoration.

06 Page four, “Base,” gives the clinician an option between Injection or Conventional Press Pack compression processing (Fig. F). In the clinical resources section on the lower right. there are pdf brochures that explain the difference in technique and materials.

07 Page five is “Shade” selection (Fig. G). Just click on the desired tooth shade, and it pops up from its guide. Selecting a denture base shade is necessary as well, so the options are listed, and the clinician just clicks on the desired base shade.

08 Fig. H shows the “Mould and Occlusion” selection. Because this should be a clinical responsibility, a help video is available under Clinical Resources instructing on the proper approach for correct mould selection.

09 Page seven is “Patient Records,” which includes Denture Gauge and Papillameter measurements (Fig. I). These two measurements are critical for a technician to create a clinically acceptable occlusal rim and esthetic control base and for setting anterior teeth. For recording correct incisal and gingival display in relation to lip length, use a papillameter as shown in the video under Clinical Resources. Denture gauge records are important for duplicating an existing denture’s vertical and horizontal anterior tooth placement in relation to incisive papilla. A denture gauge video is available as well.

10 Digital patient photos can be uploaded and attached to your web-based prescription (Fig. J). Ten photos of various facial and intraoral shots can be uploaded to the digital case planner. This section reminds the clinician of how important it is to include photos with a prescription, thus giving the dental laboratory technician optimal information about patient needs and desires.

11 The review section (Fig. K) allows the clinician to double check the accuracy of all information that has been included in sections 1-8. He or she simply scrolls down to review and verify all information in the case planner before generating the Removable Prescription.

12 Finally, the case planner generates the digital “prescription” (Fig. L), which contains all removable prosthetic information that a dental laboratory will need to predictably and consistently create a successful complete denture that meets or exceeds expectations of a compromised edentulous patient.

Interdisciplinary Communication (InteRcom) case planning uses a sequential approach to treatment that is supported by the Clinical Resources section and should be an essential part of a multidisciplinary prosthetic team dedicated to improving collaboration and communication between the clinician and technician. 

Ivoclar Vivadent’s InteRcom system can be accessed by visiting intercom.ivoclarvivadent.com.