When does speed kill your cash flow in the dental practice?

By David Rice, DDS, DrBicuspid.com clinical editor

January 9, 2020 -- Sit in on any practice management course today, and count the number of times the word "efficiency" gets used. I get it. More than ever, time is our most valuable commodity. What I hope to encourage you to ponder today is a better word -- effective.

  • How effective are you?
  • How effective are your materials, processes, and protocols?

Effective is the ultimate balance between efficiency and result. At the end of the day, I'm guessing we can agree that both matter.

With that, there are plenty of areas in our practices where we need to be clinically effective. Today, let's have a look at one. It's a big one for one reason. If your practice is anything like most, you're doing this multiple times a day, a week, a month, and a year.

Translation: There are a lot of results and money at stake.

Physical impressions

David Rice, DDS
David Rice, DDS.

When it comes to definitive physical impression materials, we have plenty from which to choose. For the sake of effectiveness, let's categorize them as vinyl polysiloxane (VPS) or polyether.

True, you and I could debate the merits of each for days. Legitimately, we'd have arguments for both camps. But bigger than that, let's talk about what the dental world wants to sell you, as well as what you should buy, based on effectiveness.

As a guy in the trenches, here's what I know:

  • We like to limit the products we purchase.
  • Time is money.
  • The lure of the fastest-setting impression materials feeds the above.

When does speed kill?

Let's face it, everyone markets to us based on efficiency. It reminds me of the old "Name That Tune" show. Our impression material sets in 3 minutes. Ours sets in 2.5 minutes. Oh yeah? Well, ours sets in 2.

From an efficiency standpoint, whether it's VPS or polyether, the faster the better, right? I mean, it's all about the patient experience and comfort -- until it isn't.

Speed (aka fast-set impressions) are amazing for one, two, and sometimes three prep cases.

Speed kills with almost everything beyond that.

Here's the rub. It's not the material, and, even worse, sometimes the problem can very easily go unnoticed -- until insert day that is. That's when the following occurs:

  • The unit doesn't fully seat and requires 10 minutes of adjustment.
  • It isn't going to fit and requires a reimpression and new appointment.
Impression material

Take a look at this impression. At first glance, it's pretty darn nice. Excellent retraction. Great detail. Now take a look at the mesiofacial of #10. There's a fold. That's really easy to miss. It's caused by one factor -- speed. The light body wash was setting prior to the tray with the heavy body being seated.

Wrapping up, there's a time and a place for fast set. There's a time and a place for regular set. Next time you're ready to choose, think about the impression above. The next time you order materials, think about the times you've blamed the lab. Quality polyethers such as 3M's Impergum or quality VPS like Ivoclar's Virtual and DMG's Honigum all deliver. However, they deliver when you and I stop listening to the sales noise and start reading the instructions for use (IFU).


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