This is the third installment in a series of articles, What Your Lab Needs to Know: Simple Anterior Cases, that discuss what your laboratory needs to know to produce the best-case outcomes for your clients. The information that is considered essential to produce a case will vary from lab to lab, and may be dependent on the type of relationship you and your interdisciplinary team have established.

Bite record complex case

Communicating Complex Cases to the Dental Lab

The following are my suggestions to facilitate effective communication and predictable outcomes. As always, the first step is to complete the prescription form in a comprehensive manner. The following is the 'basic' information that should be included with each case:

  1. Impression/cast of preoperative condition
  2. Impression/cast of the prepared teeth
  3. Impression/cast of the opposing arch
  4. Facebow transfer of the patient approved provisional restorations.
  5. Bite registration and mounting – ideally at the vertical dimension of occlusion. When all or most of the teeth are prepared, it is preferable that the lab is able to cross-mount the case. When they are taken at the vertical dimension of the occlusion that is able to occur.
    • Mounting: The cast of the maxillary provisional is mounted with the facebow. This is done in order to confirm the level of the occlusal planes in both arches, and the midline inclination. The cast of the mandibular provisionals is mounted by hand articulation or by using a bite record, to the maxillary mounted cast.
    • Bite Registration: The bite registration records for this are most easily obtained by leaving only the two central provisionals cemented on each of the maxillary and mandibular anterior teeth to maintain the anterior stop. However, if the anterior occlusion is adjusted so there is no prematurity causing a lateral shift in the bite, the maxillary and mandibular six anterior provisionals can remain cemented.
      • First bite registration: Maxillary posterior prepared teeth to the mandibular provisional. This bite is used to mount the cast of the maxillary prepared teeth against the mounted cast of the mandibular provisionals.
      • Second bite registration: Maxillary posterior prepared teeth to the mandibular prepared teeth. This is used to mount the cast of the mandibular prepared teeth to the mounted cast of the maxillary prepared teeth.
  6. Preoperative portrait photograph with horizontal line behind the patient for reference between interpupillary line and the tip of the nose:
    • Repose
    • Smile
    • Lips retracted with maxillary and mandibular incisal edges 1-2 mm separated to see incisal and incisal planes relative to horizon
  7. Portrait of the patient with provisional restorations, with horizontal line behind the patient for reference between interpupillary line and the tip of the nose:
    • Repose
    • Smile
    • Lips retracted with maxillary and mandibular incisal edges 1-2 mm separated to see incisal planes relative to horizon.
  8. Shade requested
  9. Photograph of requested shade tab next to natural teeth
  10. Photograph of prepared teeth with shade tab
  11. "Go by" information
    • Cast of patient approved provisional restoration, photographs, etc.
    • Directed changes from provisionals, i.e. correct slight midline cast

Strongly Recommended:

  1. Facially Generated Treatment Planning (FGTP) template of pre-op and provisional restorations.
  2. Photograph of facebow transfer, both preoperative and with provisional restorations. This is used as verification that the mounting accurately represents the patient's occlusal planes relative to horizon.

Providing your technician with the items listed above will help your lab team produce restorations that meet the treatment goals established by you and your patient.


Robert Winter, D.D.S., is a member of Spear Resident Faculty.


Be first to post a comment