Single-Unit Crown Workflow - Opportunities to Optimize Efficiency in Dental Practice

Contents:

• Current workflow challenges faced by dentists
• Common areas of inefficiency in the Single-Unit Crown Workflow
• Financial implications of inefficiencies in the Single-Unit Crown Workflow
• Dentsply Sirona Single-Unit Crown Workflow Solution

Optimizing patient care and efficiency for the dental office has never been more important. Here, we’ll discuss current workflow challenges in the fabrication and delivery of single-unit crowns, common areas of inefficiency and the financial implications. We’ll also look at ways to address these challenges, create more positive experiences and grow your practice.  

Reasons for structural failures include:

• Using a crown material with insufficient strength for the clinical situation
• Insufficient clearance created while preparing the tooth or, when further occlusal reduction is not possible, failing to use a material that could be milled with a reduced wall thickness
• Selecting the incorrect cement or technique for the case (e.g., failure to use an adhesive technique or to condition the inner surface (intaglio) of CAD/CAM block materials). 

Common areas of inefficiency in the Single-Unit Crown Workflow

Common sources of inefficiency in the single-unit crown workflow include impression taking and the delivery of provisional restorations.

The number one source of inefficiency is excess trimming and adjusting of the final crown, which an accurate final impression and well-fitting provisional can help to avoid.¹ Accurate impressions require good soft tissue management, yet poor hemostasis is a problem that more than half of dentists report² and obtaining adequate hemostasis is regarded as the #1 challenge in final impression procedures.^1,5 In examining more than 1100 impressions from 3 large and 1 small dental laboratories, evaluators detected errors in 86% of them – more than half were critical errors affecting the finish line, such as impression voids, preparation margins obscured by soft tissue, or blood over the finish lines.⁵  

Final impressions are not the only contributor to inefficiency in the single-unit crown workflow. Let’s now explore the efficiency challenges for provisionals:

• 1 in 3 offices report spending ‘too much time’ fabricating provisionals¹
• 97% of clinicians say they ‘often’ need to repair or replace provisionals¹
  • 75% of issues were attributed to the preliminary impression
  • Other causes include selecting the wrong tray or using a weak provisional material.  

Financial implications of inefficiencies in the Single-Unit Crown Workflow

Inefficiency and disruptions in the dental office schedule result in an unrealized loss of revenue, unpredictability in schedules, and patient dissatisfaction.

The financial implications start to add up when the schedule is disrupted because a second impression may be needed or an additional provisional may need to be fabricated. Based on survey results,¹ provisional crown repairs and remakes can cost an office $900 or more per month in lost production.

In looking at inefficiencies related to impressions, the financial impact can be greater. Consider the following:

1. Let’s say it takes 15 minutes from start to finish to take a conventional impression (i.e., from tissue management and hemostasis, to examining the completed impression). So, how much does this cost based on production targets for a dentist? If we use a target of $4,500 per day for an 8-hour day,¹ that works out to $142. That means you lose $142 each time you retake an impression.² Obviously, the derived cost diminishes with a lower production goal, and vice versa.
2. In a worst-case scenario, impression errors resulting in an ill-fitting crown can require a second laboratory-fabricated crown, introducing a second lab bill against the revenue for one crown, in addition to the extra time needed for the impression and turnaround time.   

While patient care is the priority, the dental office has fixed and variable costs just like any other business. 

• Fixed costs occur regardless of production – if inefficiencies cause you to perform fewer procedures, then these costs go against a lower gross revenue.
• Variable costs such as impression materials and laboratory bills vary with the number of procedures – retakes are an additional cost without any increase in procedures.

Bottom line, revenue declines and net revenue declines disproportionately more leading to reduced practice profitability. When extra visits or a crown remake are needed, cash flow can also be impacted by the increases in turnaround time.

At a time when staff shortages and staff turnover are a limiting factor for production, the impact of inefficiencies and disruption is exacerbated. All the more reason to look for ways to improve efficiency!

Digital impressions can offer efficiency compared to traditional impression as they require less time. There are other efficiencies gained with digital impressions, such as improved communication and understanding between patient and dentist when images and digital mock-ups can be seen on the screen and discussed. Together, these efficiencies can also help with case acceptance. In addition, communication and collaboration with the dental laboratory is enhanced with easy transfer of the digital scan – as well transmission at the same time of any relevant digital clinical images and other patient information. This streamlines the process. Overall, the digital workflow makes it easier to discuss a clinical case with the laboratory, and it enhances documentation. 

If chairside same-day crowns are delivered, no provisional is needed – and turnaround time is reduced to the time it takes to manage soft tissue and obtain hemostasis, scan, design, manufacture, finalize and seat the crown.  

_{¹The Dental Co., CFO. Increase Dental Practice Profit by Measuring KPIs and Managing Production. Available at: https://www.thedentalcfo.com/blog/increase-dental-practice-profit-by-measuring-kpis-and-managing-production}

_{²The material provided in this article should be used for informational purposes only and in no way should be relied upon for financial advice.}

Dentsply Sirona Single-Unit Crown Workflow Solution

Here at Dentsply Sirona, we want to support you with a single-unit crown workflow solution that will improve efficiency each step of the way. 

Our Final Impression Solution includes soft tissue management using Hemoban^™ 25% Gel Aluminum Chloride Hemostatic Solution which quickly stops bleeding precisely and efficiently, and rinses off easily with no residue. It coats and lubricates retraction cords, making packing and removing cord easier and reducing the risk of secondary bleeding. Dentsply Sirona’s Aquasil^® Ultra+ Smart Wetting Impression Material formulated to help you optimize the accuracy of your conventional final impressions. This VPS material offers leading intraoral performance for both hydrophilicity and tear strength, adding an extra layer of confidence in challenging intraoral environments. Alternatively, digital impressions are fast, accurate and improve communication with the patient and the lab with Dentsply Sirona’s intraoral scanner CEREC Primescan^®.

Our Provisional Solution includes Dentsply Sirona’s Algin-X^™ Ultra, an alginate alternative that delivers predictable accuracy with dimensional stability. Our Integrity^® Multi•Cure Temporary Crown & Bridge Material delivers strength where and when you need it, with on-demand light curing to allow for immediate and precise trimming. It also finishes smoothly to help maintain tissue health. Cementation of the provisional is simplified with Dentsply Sirona’s Integrity^® TempGrip^® Temporary Crown & Bridge Cement which is moisture tolerant, and provides for sufficient retention of the provisional yet stays in the provisional during removal, making clean-up easy. 

Our CAD/CAM Restorative solution includes CEREC MTL^® Zirconia, a multi-transitional layer zirconia that offers high strength (>850 MPa) and excellent esthetics. CEREC Tessera^™ is also available, an advanced lithium disilicate that also offers excellent strength and esthetics for CAD/CAM restorations, whether in the laboratory or chairside. The Chairside Solution with CEREC Primemill^® and CEREC SpeedFire^® is designed for speed, accuracy and convenience, enabling the practice team to create and fit a restoration in just one patient visit.

Lastly, Dentsply Sirona’s Crown Cementation Solution offers efficient, and reliable cementation with easy clean-up. Calibra^® Ceram is an adhesive resin cement formulated for maximum strength, making it ideal for glass ceramics like CEREC Tessera^™ blocks. Simplified, reliable cementation is designed in, and when used with Dentsply Sirona’s Prime&Bond elect^® adhesive, no primer is needed, and excellent strength is obtained. Dentsply Sirona’s Calibra^® Bio cement is ideal for zirconia like CEREC MTL^™ Zirconia blocks. This cement combines esthetic shading with a self-etching adhesive. It is the simple choice for successful results and no need for additional etchant or adhesive.

Here at Dentsply Sirona, we are here to support you with our entire online dental academy complete with webinars, how-to videos, and real-world examples on how to create streamlined solutions with efficient procedures and even greater patient satisfaction. Contact us now and let’s get started!