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 Tips and Tricks to Reduce Remakes in Dental Restorations: A Guide for DentistsAt Reliable Dental Laboratory, we process thousands of cases each month, gaining valuable insights into common issues that lead to remakes. We have identified six of the most frequent reasons for remakes and are sharing this information to help you improve the accuracy of your restorations. National averages for dental remakes can range from 10-20%, reflecting common challenges in achieving perfect restorations. At Reliable, we pride ourselves on maintaining a much lower redo rate of around 7.5%. This achievement underscores our commitment to quality and precision, and we aim to provide actionable tips to help you further reduce remakes in your practice. By addressing key issues and adopting best practices, you can significantly enhance the fit and longevity of your restorations. 1. Achieve Clear Margins with Proper Gingival RetractionOne of the primary causes of crown or bridge remakes is unclear margins, leading to open or short margins that result in poor fitting restorations. This issue often stems from the gingival tissue obscuring the prepared margins during impression-taking. Below is an example of a case with unclear margins that failed:  Recommendation:Use a gingival retraction cord to retract the soft tissue and expose the full margin. This technique allows for an accurate impression by keeping the gum tissue away from the prep area. Additionally, ensure that the field is as clear of blood and moisture as possible to prevent interference with margin visibility. Inspect your preparations to ensure they are smooth and well-defined. Irregular or jagged preps make it difficult for lab technicians to accurately read margins, increasing the likelihood of an ill-fitting restoration.  Below are two examples of clear and concise margins:   2. Optimize Digital Impressions with High-Quality ScansDigital intraoral scanners are becoming the standard in modern dentistry due to their ability to capture highly accurate and detailed images of the prepared tooth. Poor-quality scans are a frequent cause of remakes, as inconsistent or inaccurate scans can result in restorations that don't fit properly. We have observed that a significant portion of remakes is due to inaccurate scans. For instance, consider the case below where two digital scans resulted in remakes, and a third attempt with a physical impression also did not align with the previous scans. The discrepancies among these three impressions highlight the issue: the scans were inaccurate, leading to inconsistencies in the final restoration. Our technicians attribute these problems to the initial scan inaccuracies. Scan #1:  Scan #2:  Impression #3:  Overlay of all 3 redo cases:  Recommendation:Investing in a high-quality digital intraoral scanner is highly recommended. Digital scanners provide precise and clear images, allowing for better detection of margins and occlusal details compared to traditional impressions. Ensure that the scanner is properly calibrated before each use to maintain accuracy. A well-calibrated scanner will capture a full, detailed picture of the preparation, reducing the chances of errors that lead to remakes.If a digital scan isn’t satisfactory, it’s often beneficial to retake the scan while the patient is still in the office. This allows for immediate adjustments to improve accuracy and prevents the need for a new appointment or traditional impression. The ability to review and adjust digital scans in real-time can significantly reduce the likelihood of remakes. 3. Address Undercuts in Bridge PreparationsBridge cases often require remakes due to undercuts that are not adequately reduced during preparation. If these undercuts aren’t addressed properly, the bridge will not seat correctly, resulting in an ill-fitting restoration. The pictures below illustrate a case where three separate impressions produced different results. This inconsistency led to multiple remakes, as each impression did not align with the others: Impression #1:  Impression #2:  Impression #3:  Overlay from all 3 impressions:   Recommendation:Use reduction copings and recheck your preparations for any undercuts. Ensuring that preps are parallel is crucial for proper fit, especially in complex bridge cases. If reducing undercuts intraorally is challenging, take extra time to verify prep alignment before sending the case to the lab. Small improvements in prep accuracy can significantly reduce the need for remakes. 4. Avoid Distorted ImpressionsDistortion of impressions during removal is another common cause of remakes. If the impression material becomes deformed while pulling it from the patient’s mouth, the final restoration won’t fit correctly. The pictures below show significant differences between two impressions. This discrepancy suggests that the impression may have become distorted when the dentist removed it from the patient's mouth: Impression #1:  Impression #2:  Overlay of both impressions show discrepancy from possible pulling of impression:  Recommendation:When removing impressions, take care to prevent any distortion of the material. After removal, inspect the impression closely for signs of warping or misshaping. If you opt for traditional impressions instead of digital scans, ensure that the impression material is not out of shape when removing it from the patient’s mouth. A stable, accurate impression is key to ensuring a well-fitting final restoration. However, digital scanners offer a significant advantage here, as they eliminate the risk of distortion associated with traditional impression materials. 5. Ensure Proper Positioning of Implant Impression CopingsIn implant cases, improper positioning or movement of the impression coping can lead to misalignment, resulting in an ill-fitting restoration. This is particularly common if the impression coping shifts during removal from the mouth.Sometimes, the position of the impression coping can shift when the dentist is removing the impression. This movement can lead to misalignment and result in an ill-fitting restoration see example below:   Recommendation:Double-check the position of the impression coping both during and after impression-taking. Even slight movement can result in an inaccurate final product. Verifying that the coping remains securely in place can prevent the need for remakes in implant restorations. Digital scanners can help in capturing accurate impressions of implant positions, reducing the risk of errors compared to traditional methods. 6. Capture Accurate Occlusion in RPD CasesA high percentage of removable partial denture (RPD) remakes are due to incorrect occlusion. If there’s a significant difference in bite registration between the initial impression and the try-in, the final restoration may not fit as expected.See below for example of these cases:     Recommendation:Take a thicker bite registration to ensure it maintains its shape during transport and handling. Thinner bite registrations are prone to distortion, which can lead to incorrect occlusion in the final restoration. A thicker registration provides more accuracy and can be trimmed by the lab if necessary, ensuring a proper bite fit and reducing the need for remakes. Digital bite registration methods can offer a more reliable alternative, providing precise occlusal details without the issues associated with traditional bite registrations.ConclusionBy addressing common pitfalls—such as unclear margins, poor-quality digital scans, undercuts in bridges, distorted impressions, misaligned implant copings, and inaccurate occlusion in RPD cases—you can significantly reduce the occurrence of remakes. Embracing digital intraoral scanners, while ensuring they are properly calibrated and capable of capturing a comprehensive view of the preparation, can further enhance the accuracy and efficiency of your impressions. If initial digital scans aren’t satisfactory, retaking the scan while the patient is still in the office can save time and improve fit.There is nothing more frustrating than a patient having to return for a second or third redo case. While remakes are inevitable, even at the best laboratories, with an average of 1 in 10 cases failing, implementing these best practices and leveraging advanced technologies can help ensure a smoother process for your patients and a more efficient workflow for your practice. Reliable Dental Laboratory is here to support you in achieving optimal restorations every time.The Reliable Difference Refer a friend or colleague to Reliable Dental Laboratory and get $300 account credit! Also, your referral will get to try out their first restoration with Reliable Dental Lab risk free! Refer your friend to this link New Client Special to claim the offer! Make sure they select Dentist/Office Referral and list your name or practice name under "Referring Office/Dentist" box to earn $300 Account Credit!   |
