Ten-point Crown Prep Checklist

In “The Checklist Manifesto,” Dr. Atul Gawande, suggests that your work efficiency and outcome can be improved by using a simple checklist. Dr. Gawande describes how this simple idea can make medical procedures safe, efficient and less expensive.

I've applied the ideas presented in this book to change my dental practice countless ways. As an example, the following is how using a checklist changed my crown procedures.

Before prep:

1. Anesthesia
2. Material and technique
3. Tissue management
4. Mold for prep
5. Shade and pictures
6. Opposing impressions
7. Verify anesthesia

Anesthesia: Getting the anesthesia started early on in the procedure gives us the chance to minimize delays just in case supplemental anesthesia is required.

Process decisions: Very often, single crowns are prepped for all ceramic restoration, double cord retraction placed, and then prep is scanned with a digital scanner. But it doesn't always happen this way. It helps to plan for any changes from routine.

Preliminary steps: While waiting for anesthesia to start working, all of the preliminary steps need to be completed. If I'm unavailable, my assistant checks for adequate numbness with a cold test.

After prep:

8. Verify clearance
9. Notes and pictures for the lab
10. Remove second cord

Final steps: I've found that I sometimes miss out on checking on clearance or providing the lab with photographic record of the prep shade when needed. So it's been a real help to include this on the checklist.

Analyze your workflow and make a list of things that are being missed or are done inefficiently. For example, make sure the anesthesia step comes first, well before your assistant would take the mold for temp; this is crucial.

The key is to identify specific tasks for your checklist in order to establish and maintain an efficient workflow.

Vivek Mehta DMD, FAGD, Visiting Faculty, Spear Education. Follow him on Twitter @Mehta_DMD.