Article by Maribeth Marsico, Senior Editor at LMT Communications
Mention "remakes" in a room full of laboratory owners and you know you're in for a spirited discussion.
It's no wonder: not only do these cases-gone-wrong cut into your profits, but they can wreak havoc with
your production schedule and erode the relationships you've built with your clients.
Add to that the frustration expressed
by technicians who feel the bulk of remakes
are beyond their control; in fact,
Lab Management Today (LMT) survey
participants say more than three-quarters
of remakes in their laboratories
are due to dentist error. These laboratory
owners and managers repeatedly
say that – across all departments – most remakes can be traced back to
an inadequate impression.
Of course, the quality of the final
impression is dependent on a number
of variables, but what's equally important
is how cooperative the doctor is
when problems are brought to his attention.
While most of LMT's survey
respondents say dentists appreciate
a call about inadequate impressions,
they are divided on the most common
outcome: 41 percent say the dentist
generally sends a new impression and
another 41 percent are usually told to
"do the best they can."
To drive the point home and document
potential problems, many laboratory
owners are taking advantage of digital
communication, saying a picture is
worth a thousand words. "Providing
dentists with photos of inadequate
impressions enhances communication
and eliminates the blame game," says
Jessica Birrell, CDT, Owner, Capture
Dental Arts, Saratoga Springs, Utah,
who annotates digital photos with
captions and arrows using Photoshop
software and e-mails them to the dentist. "Sometimes, I'll also pour a
stone model and send photos of that
to point out specific problems. If the
doctor still wants me to go ahead and
guess at margin placement, I let him
know I cannot guarantee the success
of the case."
NO ONE-SIZE-FITS-ALL POLICY
More than half of all laboratories don't
have a defined remake policy, saying
that it depends on the specific case
and sometimes on the specific dentistclient.
"When a case is returned, we
have to determine the reason and handle
it accordingly," says Ross Gaiteri,
Owner, Benchmark Castings Inc., Columbus,
Ohio. "If the lab is at fault,
there's no charge. If the fault clearly
rests with the dentist, we charge 50
percent. However, if the dentist is
repeatedly at fault for remakes – or
we're told to proceed when we call
with concerns about his impression or
model – we charge him full price."
In an effort to eliminate the blame
game altogether, 17 percent of participants
routinely split the cost of remakes
and one quarter of them don't
charge at all for remakes, at least
until a certain remake percentage is
exceeded. (For a closer look at participants' remake polices, click here.)
To charge or not to charge is an issue
that often divides laboratory owners.
Some say laboratories shouldn't routinely
accept blame for cases that fail
through no fault of their own. "If you
don't enforce a remake charge, it gives
the dentist the impression that he can
send you an inadequate impression
or preparation at no risk to himself
and, therefore, there's no incentive to
do a better prep or impression," says
Marc Posen, CDT, Owner, Posen Dental
Laboratory, Birmingham, Mich.
On the other side are laboratory owners
who perceive free remakes as one
of the value-added benefits they offer
their customers. In most cases, they
say, the cost of doing the remake is
negligible given the value of a good
account. "I have only a few clients and
very low remakes, so my philosophy is
that doing the remakes at no charge is
part of the service I'm offering them,"
says Paul Francoeur, Owner, Rogue
Dental Solutions Inc., Ormond Beach,
Fla. "When we do have that rare problem
with a case, we communicate and
work together to solve it, and they appreciate that I will take care of
remaking it." Of course, this approach
requires laboratories to carefully monitor
clients' remake percentages and
immediately address any issues.
The bottom line: whether you have a
defined policy or not, keeping an eye
on your clients' individual remake factors
and having honest conversations
with them when things go awry is
your best bet. "We know our mistakes
cost dentists chairtime, just as their
mistakes cost us labor, materials and
transportation costs. But we're making a custom product for sometimes challenging,
difficult patients and the
partnership requires both parties to
be reasonable in their expectations,"
says Jim Thacker, Vice President, Utah
Valley Dental Lab, Provo, Utah. "A
flexible, relationship-driven approach
builds trust and value for both the
laboratory and dentist."
THE IMPACT OF NEW TECHNOLOGY
Is the proliferation of digital technology
having an impact on the industry's
remake factor? One effect is clear:
two-thirds of laboratories that receive
digital impressions say they result in
fewer remakes than do conventional
impressions. "The software for these
systems tends to 'force' dentists to provide
accurate reduction, enabling us
to fabricate more ideal restorations,"
says Jim Thacker, Vice President, Utah
Valley Dental Lab, Provo, Utah. "Models
created from digital impression technology are extremely accurate
and allow us to create more consistent,
predictable restorations for our
dentists." Milling, too, has had a positive
effect, although to a lesser extent.
While the majority of participants –
67 percent – say it hasn't changed
their overall remake percentage one
way or another, one quarter of laboratories
say milling has caused their
overall C&B remake percentage to
decrease due to more accurate fits.
