How To Do An End To End 40 Minute Crown

Dr. Laskin is joined in-studio with Dave Pryor as they discuss the most efficient and patient-centered way to create a crown in 40 minutes.

 

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Welcome back to the Operatory I’m Dr. Bryan Laskin with me today is the man the myth the legend the patient David Pryor how you doing man I am doing great Bryan how you doing ? I am doing a little frustrated it isn’t because you relate today i was late that’s exactly why and that’s what i’m frustrated okay so i have to tell you and i told you he’s going to tell you why i was late on the podcast okay i wanted to see your expression i know our listeners at home can but ask me why i was late Bryan why were you late and would you like to stretch for your burpees for being late yeah that’s the thing that if you’re late for a meeting we have to do burpees allah darren hardy style but tell me i was stuck behind a truck you know i was going as Dave knows i have a tendency to go slightly above the speed limit and i was doing that but then i got stuck below the speed limit for quite a while and you know what i was stuck behind it um no i do not a truck okay there’s a specific type of truck i don’t know it was a mountain dew truck Dave yeah, it was like you were special like it was like your soul was making it hard for me to get here today to the podcast cause as everybody who has listened to our prior podcast no at least some of them Dave likes to drink Mountain Dew to basically make fun of dentistry and and the sugar and acid that that come come with it right I drink it because it’s delicious and just because it happens to torment you that’s a happy side benefit of the product and i was thinking not only is this like completely appropriate because Dave would be laughing hysterically because i knew he was sitting in the studio as i was running late and behind a mountain dew truck ah but it’s also where the ironic because if you think about it mountain dew is all about like extreme sugar and caffeine and you know right here your teeth and here’s this truck going five miles an hour that’s like oh man well actually i’ve that transitions well into our topic today about not being the mountain dew truck that was impeding my progress we’re talking today about how to do a forty minute crown so this is a clinical procedure from when the patients in the chair when they’re scheduled at nine a m to have them leaving your Operatory at forty nine forty with a completed restoration which is my average time foreign all ceramic restoration his forty minutes and Dave’s experience this well i’ve experienced both ends of that spectrum. Yes yes as we’ve talked about before you are my very first cad cam cyriaque restoration that took four and a half hours yes thank you thank you and Dave was like stone awesome i was losing my mind well as i’ve said on this podcast many times i don’t fear the dentist because i had orthodontic yes but no longer you know, seventeen years ago when i started doing cade camden history it took me a while but now we’ve got it down to forty minutes and i wantto start off night of the procedure part of it by talking about you do not need to rush to be fast like people think of fast is like moving quickly or cutting corners completely the opposite i believe to be true it’s all about having a plan and executing that plan and we’ve refined our systems over seventeen years with small tweaks and we are constantly looking at how we can do things better not faster but better and i believe that efficiency leads to quality because it means that you actually know what you’re doing right and then you go into it there’s nothing so unique about your your upper left molar Dave than i’ve got to think about it every time i go in right we’ve got we know what we’re doing we do it right as we talked about there’s a prior podcast if you wanna listen to it about the two minute perfect all ceramic restaurant preparation so we’ll go into the preparation we’ve done that already but i want to go into the other aspects of how do you actually have a forty minute all ceramic crown that’s world class are you ready ? I am ready like and you would think that some patient like me talking about things from the patient perspective wouldn’t really care but to be honest like there have been times where i’ve been in your office i’ve had a filling and from door to door it was twenty minutes in and out so not not sitting in the chair door to door and so that from from a patient perspective is awesome so i don’t know what what the average time should be for a crown i just know that my time was really, really well taken taken care of yeah and people view that by the way that’s most common people most kind of people most common comment that people say to us is you guys work like a well oiled machine yeah right and is because we’ve done even if if someone’s been assisting me for two weeks we’ve probably done that procedure many many times and they have already been told exactly how we do it every single time that you make a great point this isn’t just for crowns right this is this is the forty minute crown is kind of what we’re focusing on but we do this for absolutely every procedure from endo too extractions and everything is documented exactly why and how we do it and it’s actually leased a less dress you know we’re not we’re not like trying to figure out every time there’s one percent of times were things you know you have to alter the course but the vast vast majority of time we’re on autopilot i’ve done i’ve done ah over thirty five thousand all ceramic grown so it’s not like thirty five thousand won is going to be some big gigantic learning experience we have to think about it i should just you should just happen easily well and my last filling that was my last mountain dew inflicted filling that was done in your office wasn’t done by you is one of done done by one of the other doctors there because you were busy doing other things so it was it was the same it was the same from that doctor is it would have been from you so i was really impressed. Yeah, i think in dentistry we have these ideas that like what works in my hands that’s not the way the world works i mean, maybe a little bit like if you like a more viscous composite and one person doesn’t like sam more stiff composite but in reality prepping a tooth is prepping it too and ah, we we get together and i don’t come up with every system you know, we have some we have fantastic associates and auxiliary stat team members that we ah that that lend that add value and if they say you know what we should do we think we should use this material we should do it this way of course if if it makes sense but not just you do it that way let’s all do it that way we can all easily come to an agreement what’s the best way some things don’t matter so much right i mean i believe that things like adhesive it’s like everything works so just pick one that you think that everybody agrees upon and roll with it but if you find a little tweak to a procedure that will save you three seconds not just three seconds but that three seconds decreases the number of variables right ? Yeah that’s one of things that i’d like to talk about is that when you are efficient you actually decrease the patient’s anxiety because when they’re in the chair short of time that so they’re they’re squirming around less if you’re if you’re more efficient about bringing a restoration to the mouth when you’re doing adhesive bonding there’s less likely that they’re going to move their tongue and slaps saliva wherever you’re working so it’s not necessarily all about like all the tools and procedures and stuff it’s all the extra things you do that come together and starting off with what do you think the first thing that gets the appointment going in forty minutes is staff prep i guess i’m your guess you’re right probably should wait like we talked about that already, right ? We have everything documented we have photos of our set ups are we have the room there’s a great point that’s that’s a better first tip that i have you know we have documented exactly how we do every procedure including photos of our set ups but i was i was thinking about starting on time yeah right well when you when you have a practice like ours where you run efficiently the great thing one great benefit of that is that you know how fun things are going to take on dh and oftentimes you get done earlier because the patient makes your job you know your life easier we have to have a little bit of variance for people who are squirming around which we’ll talk about it a bit but ah starting on time and people people who are listening to a podcast were probably thinking you can’t always start on time because patients sometimes are plate right so what do you think the best way to get people to show up on time this well proper communication with from the office to the patient so that would be my guess that’s huge you know, it was obviously not maybe not obviously but with opera dds we have recalls an appointment reminders that that that tell you about that and you can set exactly when and so so communication with what the patient is key i think there’s something actually even as as as as employed important with the recall reminders like we have an opera dds i believe is you have to run on time oh for sure is that the president yeah you know people you actually trained people how to treat you right and if you’re running fifteen minutes behind ten minutes five minutes two minutes thirty seconds when when if the patients in your reception eri and they’re looking at the watch going you know i got a meeting right after this and you don’t respect their time they are not going to respect your right for fear and i can tell you and in our office if you’re ten minutes late you get a phone call if you’re fifteen minutes late we don’t see you our guarantee is same day and we were very efficient but we we ah we have to run time have patients show up on time the great benefit is that when you respect people’s time they respect yours yeah yeah no i agree so you come to my office you get that twenty minute filling you leave you know who alaskans gonna be ready at nine o’clock i’m gonna be there yeah right yep yep so that’s that’s number one and again what you said to planning you know having the heaven the assistant or a hygienist have the rooms set up the same way every time if you have fourteen assistance they that mirrors should be in the exact same spot every time the room should be set up the same way every time because if you walk in and you’re like what and we’ve talked about this before day that like i have this old cd or if i walk in a room and there’s one cotton roll instead of two on my left hand side i instantly know and i’m like i like it’s well it’s you know i’ll talk about my daughter because now it’s like my kids my kids listen to the podcast and my daughter who’s fourteen now when she was a baby she we called him once that she had forty for stuffed animals in her crib don’t do that parents because you’re not supposed to have stuffed animals with you but my daughter is a special case and so so she has a forty four stuffed animals in her grip and if you were putting in her into the crib and froggy wasn’t there it was like froggy where’s froggy and she got that from me so i if i’m walking in the laboratory and there’s not one burned my burkett i know exactly right and sometimes it’s worth mentioning sometimes it’s not worth mentioning usually it’s worth mentioned directly after the procedure so you can tell the the assistant you know next time make sure to this but those little things making sure that it’s the same way every time is crucial to running on time. Yeah, i can imagine no does that knowing you as i do when that one birr isn’t where it’s supposed to be does that prey on your mind and it’s like it just starts toe eat away at your brain well i’m getting older so you’re starting to let things go i know i’m not what i would say is i i’m letting time i’m trying you know i’m trying man i’m trying i’m trying to like oh but you as you also know about me is i don’t actually have to say anything because i everybody consents when i’m not happy particularly people that work with me every day and so so i kind of have to keep quiet most of the time because they already know that that there’s something amiss yeah and usually they know right away if i because of the first thing i’ll do is we have ah design ergonomics camera cabinetry which if you have if you’ve looking building office i would recommend it that’s a that’s a great point to we have our opera tory’s air actually eight by ten so they’re smaller than the average laboratory that means everything’s within reach so if you want to run on time you won’t make so if that bird isn’t there there’s a little i flip up by a cabinet and i’ve got extra burgers underneath we always use brand new birds that are laid out for me but there’s extra ones in case it was for gotten and so i can just flip that up, grab it and then the assistant knows they forgot it do the same thing with hygienist i don’t i never tell hygienists in in my office especially in front of patients that they missed a spot with calculus well, what i’ll do is i tell every hygienist that comes on board that if i grabbed the scaler and i’m cleaning you missed a spot right and then they just know it’s that’s that’s how we deal with it yeah scan so no one as we’re talking about birds that’s one one thing that i do differently than i think a lot of other officers that we have one kit for all restored it so we’ve worked hard to have twelve birds in my burkett and i have one kit that we use for all restorative like thea we used the um it’s like a kid that comes in a stainless steel piece on i think that’s important because then you don’t have to think about i’m doing this procedure in this burkett and frankly it’s not that veneers aren’t that much different than all ceramic crowns and endo is not that different than operative and i can post maybe i’ll post on the web site a post on the app store dot com what my birkett is and what birds we have and i always when i mentioned using always using new birds how is used new operative birds so my have to if you listen to the two minute crown preparation i have ah ah two millimeter in diameter egg that i used on a one point six millimeter in diameter modified shoulder ber with six degrees of taper and that’s how we do the preparation because it’s all built into those tubers ifyou’re interested again it’s a previous episode on the two minute all ceramic preparation preparation but the key pieces that not reinvent the wheel for every procedure right have have your instruments that use and you can use in all situations makes sense yeah i’m going to be interested so when you post that your kid i will be very interested to hear back from our listeners what they would change about your kit and why that would be interesting information have for you yeah oh yeah i mean if you have time saving tips yeah all means right shoot us she doesn’t know what love you here but more like likely i just want to see how many ways they can point out all Bryan you should really have this and just tell you what what things that you can do differently to make it better because i can’t imagine that there’s going to be a ton with the amount of energy that you spend on refining every single little detail to everything you do well as we’re talking about and i’m thinking that there’s probably a couple burgers we could take how it but you know we have i can’t remember of its twelve might be sixteen spots in the burkett but ah but you had that many spots you philip right right but yeah i mean the bird hit we have is for all situations from endo to operative teo the only things we don’t do i don’t have surgical birds in there because i don’t do extractions so we have a different hand piece and a different different longer birds for for surgery but yeah take a look at the ah at the opportunity dot com will post burkett and you khun let me know what we can what we should add delete or modified um then so so you’re set up patient shows up on time to come back thirty seconds early the next step in minnesota on da becoming more and more popular across this great nation is the next step has to be informed consent every time right and that’s one of the things that’s one of the reasons why we built out are consent forms within opera tedious because you can hand the patient ipad and then they consign it and automatically it’s put directly in their chart so we like to get informed consent before the procedure not when doing the treatment planning because sometimes things change and i want to make sure that we have the informed consent right before the procedure does that make sense yeah yep you know and and after the fact if you get that elektronik lee you don’t put this gigantic burden on your front desk to scan and shred and file and all that you know there’s another podcast we did on paper charts which are my i was just talking to somebody yesterday’s has a big wild paper charts and i was going why would you do that ? I’ll always see no is there anything in addition to being a having hypervigilance i’m also a germophobe so i can propose paper charts and i’m like the combination of a bacteria and be my penmanship i’m like holy crap i mean you have somebody filing those and no switch if you get nothing else on his podcast switched too digital consent forms that will make your life a lot easier and if your state doesn’t require them they probably will be soon s o so getting easy consent forms that and make sure you khun text them or email them the patient prior if they want teo you know that’s one of the things that we make it easy to get and get consent and then then communicate with patients before and after yeah well one of the things with specifically the consent form that i’ve heard you talk about before is being able like of a parent drops off their kids for their hygiene and being able to get a consent form from the parent remotely while they’re off doing errands it ends up being a huge huge barrier knocked down by electronic consent form so that enable a text it that is a huge issue you brought up all right we need to get consent from for minors and mom drops him off i’m just thinking about before we had for dds like how you would have to deal with that oh my god what a pain man yeah that was a pain and then now now also with opera dds when you’re ready wants to consent is for sinus formed having a ninja of this community communications that some like opera tedious chat to notify you that not only the patient’s ready consents received what you’re doing you can get all the information you can walk in the appointment prepared ready to rock yeah right on yesterday i got i got a note saying with a new patient new patient got them back i’m going to be taking x rays but that information is no good so you’re going to be ready for me at some point in time thanks for wasting my time when i read this right right i mean i i say that jokingly but it’s true that’s that’s the kind of stuff that that destroys the efficiency in an office right yeah let me know when you’re ready and what you’re ready and what you see right when i walk in if there’s a broken tooth please have an interval photo ready right and a radiograph with the p a we need to be those are the types of things that make us run on time right and then and consensual already gone over because when i walk in if the patient has asked me about put bullet point number three point four on consent you think that slows things down so the next thing score me patients we talked about them before they slow us down all right and also patients when they’re if they want to ask you about your questions slow you down and i know you’re going to get this one right Dave because it’s my new favorite toy man it’s it’s my my new how do we deal with patients that are anxious about having procedures done you know way we’ve talked about i think got a prior podcast but if you want to get going have people relaxed and distract them using a drug free sedative what do you what is it my man well that would be upper v r yeah virtual reality virtual reality really does help get things crank and in fact you can go straight from consent form to v r and then i walk in the room and patients are in la la land mean if you haven’t checked out opera via go to digital matrix dot com hopefully this helps you be more efficient in your crown preparations and making your patients happier with better and results. Thanks for joining us today on the Operatory if you want to learn more goto hungry dino dot com thanks for having me, Bryan. Thank you sir.