The relationship between the dental practice and the dental laboratory: Q&A with Lee Culp, CDT

I have had the privilege of knowing and learning from Lee Culp, CDT, for the last eight years. It always interests and inspires me to learn how someone achieves so much and becomes known as an expert in his or her field. Lee has developed many of the techniques and processes today that have paved the way for truly esthetic quality dentistry and the improvement of CAD/CAM dentistry.

He sets an example as someone who is constantly working to ensure we, as dental professionals, offer our patients the best results possible from the lab in health, function, and esthetics. Lee instructs dentists, lab technicians, and team members all over the world on these same principles. Below is a little insight into his world.

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Hennen: How did your journey in dentistry begin and what led you to where you are today?

Culp: I was attending the University of Georgia and took a summer job as a lab tech. I enjoyed what I was doing so much that I decided not to go back to school and have been in the lab ever since. Early on, I was exposed to a different level of dentistry, attending programs from clinicians such as Dr. Peter Dawson and others of similar caliber. From there, I began to develop relationships with clinicians like Dr. Dawson, Dr. Larry Rosenthal, Dr. Bill Dickerson, Dr. David Hornbrook, and others who just thought differently, which led me to also think differently.

I remember getting the call from Dr. Dickerson asking me to do a veneer case in Empress. Back then, no one had done veneers in Empress. It just wasn't being done. I couldn't not do it, so I worked to develop the technique … which Ivoclar later called Empress Esthetic. Together, we successfully delivered the first Empress Esthetic veneer case.

Meet Heather Hennen, a member of the Modern Dental Assistant Editorial Advisory Board

Hennen: Things have only grown from there, from developing other now commonly used techniques to sitting as the CTO for a major lab to teaching your passion across the globe, either one-on-one or to hundreds at a time. Who was the first person to make a difference in your direction in dentistry?

Culp: Dr. Dawson was very early in my career. He taught me to understand a more complete view of dentistry involving occlusion, muscles, and esthetics. It's not about just making molars.

Hennen: You have been in and around many types of labs. From the lab perspective, what are the most common yet preventable problems between the lab and the dental practice and how can they be resolved?

Culp: I have to say first is education. If the lab technician and the doctor are of similar school of thought, the end results will always be better. Both being on the same page is the foundation of a successful lab/doctor relationship. Second would be my passion … digital dentistry. There is so much in the form of technology to be used to better the communication, quality, and efficiency for the doctor and the lab.

Learning opportunity: Understanding the new digital dental workflow

Hennen: Now the same question, but from the lab/assistant standpoint. How can we as assistants help?

Culp: That’s a great question! The assistant has the opportunity to be the doctor’s right hand! The assistant can make up where the dentist may be lacking. One common issue is bad impressions. The assistant can learn to evaluate the impression to make sure it is clean and clear and give the doctor feedback to ensure what the lab receives is the best possible impression. Next is probably poor communication on the case being sent. The assistant can make sure the doctor clearly communicates with the lab on the RX. "Call me" with nothing else on the RX is starting off the case with the wrong type of communication. If the assistant can help the doctor get these two things ideal, the case is bound to be correct.

Think of it this way … if I go to the store to buy a pair of size 10 men's Nikes, I could go to three different retailers and they would be the same color, fit, shape, and size of Nikes. Dentistry, and in this case the lab/doctor relationship, is one of the few situations that the supplier (the lab) is completely reliant on the consumer (the doctor) to provide an excellent product.

Feedback is key! Labs often ask for feedback on how their work is and if the doctor is happy. If the doctor or assistant could ask the lab for true feedback, things could improve. "How is this new impression material I'm using looking?" or "What can I do differently to get even better results?" This will only help improve both the relationship and results.

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Hennen: I think we can all agree not every patient is really shade A2. I know shade is a struggle for many offices for varying reasons. For practices with in-office CAD/CAM, I give different options than for lab communication. How would you advise an assistant to get the best possible results for a shade for every tooth?

Culp: I have done so much research on all of the tools out there to help with shade and have only found one I would rely on … a real camera. Not a small point and shoot, but a real full body SLR camera. The assistant can take multiple photos of the different shade tabs next to the tooth with the shade name in the photos. By doing this, even if the lighting is not perfect, the lab can relate the tooth to each tab. There is nothing that beats a quality picture.

From the lab perspective: Custom shade matching with an anterior implant case

Hennen: If you could name one product or tool every assistant should have, what would it be?

Lee: The camera. Remember … I said a REAL camera.