Learning from one another is one of the top benefits of dental continuing education.

One of the things that I value about continuing dental education is the opportunity to spend time with other dentists.  I always learn something I can bring back to my office. Recently while lecturing at Midwestern Dental School to the faculty, on of the faculty members told me about a new way to stabilize lower models when mounting, and was even kind enough to give me some samples.

Stabilizing a lower model during mounting with centric relation records is critical to the accuracy of the mounting.

Over the years I have tried about every idea possible to optimize mounting the lower model. If the model moves in the bite registration due to pressure during mounting, tipping or shrinkage of the stone it interferes with the accuracy of the mounting. To overcome this I have tried hot glue, compound, rubber bands, hanger wire bent into a V and probably many more.

We realized the Fleximount was incredible the first time we used it. Sold by WhipMix and developed for their articulator systems, I will say I have used it on other systems, and as long as there is a knob on the upper member of the articulator it works fantastic. The Fleximount is trapped inside the stone, so they are disposable. The lower model is held with even pressure directly against the upper( if mounting in MIP) or the bite record, therefore no tipping forces are present as with other stabilizer systems. Because it stays in the stone, you can walk away and let it come to a complete set, instead of having to stand and remove the stabilizer while the mounting stone is still somewhat soft. Both of these features result in a very accurate mounting.

Once the stone is set you simply cut away the rubber band material that is not inside the mounting stone. Now you can finish and groom the lower mounting.

Indirect restorations are the mainstay of most general practices.

Deciding whether to take triple tray or full arch impressions is a process that represents the classic dilemma we all face. It feels like we are deciding between “quality” and “economics”. In truth I think there are “quality” and “economic” pros and cons to both types of impressions.

From an economic perspective triple tray impressions are a straightforward decision.

A triple tray and the VPS to take it represent about $10 in materials compared to two full arch trays, VPS material, facebow and bite registration at a cost of about $25 in materials. Additionally a very important economic factor is productive chair time. A triple tray impression should take about 5 minutes of chair time, whereas full arch impressions and all the accompanying records take approximately 15 to 20 minutes.

The balance to the chair time on the front end is the chair time required to seat and adjust the case. In order to do an accurate comparison of the seat appointment we need to discuss the technical risks and benefits of the two approaches. We are going to assume on the front end that both techniques are done with proper retraction and accurately represent the prep and margins. A triple tray impression captures the occlusal information at maximum intercuspal position extremely accurately, but it is the only functional position they can replicate.

Full arch impressions taken without a facebow transfer, either hand articulated, or with a bite registration only over the prepared teeth only give the same information about maximum intercuspal position to the laboratory as a triple tray.

The advantage to taking full arch impressions is that they can be mounted with a facebow transfer and allow the laboratory to see the interaction of the teeth in excursive and end to end positions. A facebow records the relationship of the maxillary arch to hinge axis in all planes of space, and then transfers this information to an articulator. It can also be used to communicate esthetic information about the relationship of the incisal and occlusal plane to the horizon if the bow is leveled when the record is taken.

So the ultimate difference between a triple tray and full arch impressions is the addition of functional information about excursive movements and end-to-end positions. This requires taking a facebow record, and can be increased in accuracy by setting the condylar elements on a semi-adjustable articulator either with a protrusive bite record or an end to end retracted photograph. Using either technique the most accurate bite record is always captured with the unprepared teeth in full occlusal contact. So the decision between the two approaches really depends on the functional and esthetic risk factors of the case. The more esthetic and functional information we send to the laboratory the higher our chances of managing the esthetic and functional issues of the case precisely.

It’s critical to have discussions with team members about what behavioral influence entails.

Behavioral conversations are efforts with patients to encourage health. They involve discovering current perceptions and encouraging choices for improved health – especially dental health. Considering today’s understanding of the oral-systemic connection to overall well being, we owe it to our patients to continually offer them the opportunity for health.

Avoiding the BS Trap

As such, it is essential to consider that social conversation is not behavior conversation. I call it the BS trap. Yes, there is a social component to behavioral. Connecting on a personal level is critical.

As Robert Cialdini says in his book “Influence,” people like doing business with people they like. In a relationship-based practice, full engagement with patients is critical. Engagement increases the likelihood of being listened to and influencing healthy behavior.

AND, we must avoid the BS trap. Conversations need to be about them, not us. Conversations to influence values and behaviors need to be about patients. So, how do you know when social conversation has slipped into BS?

Encouraging Meaningful Discussion With Patients

The key is to realize when you are interjecting yourself into the conversation. Avoid personal words: I, me, my, mine, us, we, our, etc. It is not about us – our story – but about the patient, the patient’s story, the patient’s health values, and their objectives.

Avoid:

• “I went there …”
• “When I did that …”
• “My experience …”

How do you shift from social (the starting point in conversations) to behavioral? Have one or two powerful questions to shift the conversation:

• “How are you feeling about your health?” (Perhaps more powerful than: “What has changed in your health?”)
• “What are you doing to enhance your health?”
• “How are you taking good care of yourself?”

Then “Stay in the Question.” Continue to follow the thread they share. Remember …

Their first response is not the answer. It is their first response.

Questions are NOT the key. Listening is. Go below the surface.

• “What else?”
• “What do you feel?”
• “Say more about that.”
• “Do you have any ideas?”
• “Tell me more about …”
• “Yes, I understand.”
• “I’m glad to know that.”
• “Thank you for sharing that.”
• “Is there anything else?”
• “What is your suggestion?”

These questions work both ways. Teaching you to turn the focus onto the patient and teaching the patient to communicate their needs more clearly.

Have you read this article from team behavior expert Mary Osborne on understanding a hygienist’s true expertise?