Jeffrey Caso With the 4.0 software, proposals have never been better. There are times however when the software can become confused. We can send it a mixed message when we violate the basics – Prep, Powder and Picture. Generally, when we see a less-than-optimal proposal, with a few exceptions, there is a disconnect between what we are giving the software and what we actually want it to do. We have all experienced that heart sinking moment when we need a good proposal – usually when we are feeling rushed or struggling with a difficult patient – and the software gives us a bad one. We need to make that split second decision whether to keep it and work through the design process or go back and see where we went wrong.
Sometimes it’s a tough call. Many times, staying with the poor proposal and using the tools to correct things is our initial instinct. Going back, especially with a patient watching and asking questions, can be a bitter pill to swallow. Poor proposals can be looked at as a symptom of the underlying problem. The exceptions to that rule are when we are proposing Implant crowns and teeth in severe cross bite or other malocclusions. Those need to be worked out on an individual basis. It’s the ones that we expect a slam dunk and get something different that need our full attention and a hard decision.
So, when you get that bad one, first check to see that you did not accidentally call a full-coverage restoration a partial-coverage one or vice-versa. Correcting that can make all the difference in the world.
Next, go back to your images in all catalogs and look for any that are shaky or have a strong angulation that can create spikes and lines. Look for images with blood or saliva contamination and also look for ones where the margin is obscured or covered. Ignore the bad ones and reimage if necessary. Check the margin line for any little steps or loops. Correcting that is easy, just re-draw. Then look at the super- important insertion axis. In fact, after confirming that I declared the restoration correctly, that is the first fix I look to. Tweak the insertion axis and re-propose. Many times that solves the problem.
In addition, keep your occlusal minimal thickness parameter low and you will enjoy better overall proposals. Equally as important is to prep slowly and carefully. Give enough clearance and smooth the preps well. Get good tissue separation at the margins, powder lightly and take great images.
The software is what we all blame first. Generally, that’s not the case. Look to the information we are feeding it and you may just find the problem. Humbling? Yes. Are we bad dentists? No. Think back to the cases where our proposals were bad. Were we rushing? Was the patient difficult? Were there other things going on at the time to distract us? Those are usually the times we run into problems. Just another day in the life…
