More than one meaning to teamwork

It seems to me that in most articles about teamwork today-including several of mine-the teamwork concept is almost always talking about the dentist/technician relationship and the process that takes place between the laboratory and the operatory.

From the impression to the cast work or the transfer of the horizontal reference point to the photographic information for shade evaluation, all are important. As critical as this team concept is, what about the team relationship in our own offices? How much time do we put into creating a work environment with a common goal and a team concept that can be used to reach that goal?

As we know, a good team has many players who provide different roles and ability to work, sacrifice and support the other teammates. Depending on the laboratory size, there are different types of teams that are set up from laboratory to laboratory. Larger laboratories sometimes will have internal teams where groups of people work together as team “A” or “B,” while in the smaller laboratories, which are much more common today, there are just a few people to make up the team. These labs usually have three to five people.

Cross-trained Technicians

In my laboratory, I have a team of three people including myself. Each member of this team has critical roles that lead to the success of the lab and its business. Although each of us have somewhat of a specific task, each of us can or at least have a knowledge in what the other team members do. This cross-trained ability allows the team to work toward the common goal of producing the best restoration.

This sometimes differs from larger labs where you would not usually see the model-and-die person working on metal or the implant specialist building ceramic. However, in smaller labs such as mine, this cross-training allows us to not only keep the team concept, but to become more productive in the quality.

One of the areas this cross training becomes most effective is on large case work. Having a team that can produce similar results with each material allows us to break up certain cases and share the load. On a full-mouth case where I would tend to be the lead ceramist, one of the teammates can absorb some of the posterior section, making my responsibility less stressful.

The ability to produce a molar, for instance, and know who in the lab did it is crucial. However, the team must function as one and have a visualization of the same final product. This comes from the education process of learning together. Whatever one teammate learns must be shared and processed by the other teammates.

When learning together, this process is easier yet. Still, each person tends to hear different things. So our goal becomes to discuss what we learned, whether it was individually or together, and figure out if it is implementable, and if so, how it should be implemented.

As an educator, I probably hear the most helpful information during my travels, and because the team does not always travel together, part of my job becomes to share any or all of what was taken in. In some cases, we substitute the playing of a course audio tape for the radio on certain days or just bring up any new topic during the lunch period. In some laboratories, a weekly meeting takes place to discuss the goal for the upcoming weeks. Alternately in my lab, we usually discuss this on a daily basis to help with the organization, which is shared as a team responsibility.

Tackling a case as a team

Although we do lots of different kinds of work in the laboratory, full-mouth rehab cases take up most of the production time. This is where the team approach can really shine.

When an upper or lower arch of a case comes on my bench with the bite verified though a palatal index (Fig. A) and the posteriors are done or even close to done, I can now focus on the anterior section without the worry of the time needed to complete the full arch. And let’s face it, a lot of the time the anterior esthetics sell the case. Although this is not always the case, it is very helpful when it works out that way.

In this case, pre-op photos helped the operatory/laboratory process but then also were used to help verify the cast position on the articulator (Figs. B, C, D, E). Diagnostic waxups were done at a previous stage (Figs. F, G).

After the mountings have been checked and verified to be in the correct position, Keyon Jack, MDT, began the lower posterior ceramic buildup. This case will be done in stages, and although we normally start our full-mouth cases with the maxillary 6, there were some immediate needs to start with the lower posteriors and support the vertical opening.

The mandibular porcelain-to-metal restorations were placed (Figs. H, I, J), and the mandibular anteriors were prepared and temped by the doctor with the use of the diagnostic waxup (Figs. K, L). Though this case is still being restored, the before and after posterior restorations look great intraorally (Fig. M) and provide the ability for either of us to restore the maxillary posterior while I will finish the max/mand anterior teeth at a later date.

Special thanks to Keyon Jack, MDT, for his ceramic work and to Abraham Rodriguez, MDT, for all the model and die, waxing and opaquing.