The Art of Customer Satisfaction

In The Paradox of Excellence: How Great Performance Can Kill Your Business, David Mosby and Michael Weissman describe the business paradox that occurs when high-performing companies unintentionally create unrealistic customer expectations that they are eventually unable to meet. They detail how many businesses fall victim to the paradox of excellence: The better they perform, the more invisible they become—to everything but bad news.¹

The owners of Niche Dental Studio believe success comes to those who take the time to become the very best at what they do. After years of training with some of the industry's most talented ceramists, they have become quite skilled at creating natural-looking restorations ( Figure 1). Early on, clients were stunned and patients speechless at insertion appointments. Compliments came in the form of letters and gifts. But, in time, that response began to fade; the dentists came to expect this same high-quality standard with every case. It was troubling at first, not because the ceramists needed constant positive feedback but because the amount of work and effort put into every case had not diminished. Like the electric company, the only time they received feedback was when clients felt the bill was wrong or the case just wasn't "spot on."

After being introduced to the paradox concept, it became clear that they needed to reinvigorate client response. As they considered various tactics to increase their visibility with clients, the familiar UPS slogan kept resonating with them. "What can brown do for you?" The authors decided to ask each of their clients,
"What can Niche Dental Studio do for you?" The overwhelming response was that the dentists wanted Niche to become an equal partner in patient treatment; that the studio would be there for them to address any concerns or questions regarding their patients. The authors then asked their clients to share their difficulties with patient management so that together dentist and dental technician could come up with creative and proactive solutions to those common issues.

Up Close and Personal

Thomas J. Leonard, a pioneer in personal and business coaching, noted that most of his clients came to trust him so much in his early days as a financial planner that they leaned on him for guidance far beyond finances. They asked his advice on business decisions and even personal choices like what color of car they should buy. By developing a culture of trust, technicians can play that same role for their clients—especially during difficult economic times when dental decisions require uncommon creativity.

This new strategy entails more phone time, more online communication, and more one-on-one interaction with clients overall. It required the authors to spend time they did not get paid for directly. At first glance, it may seem like a counterintuitive approach in an industry that has become fixated on increasing productivity levels. However, in the long term, this strategic move improved client relationships and the quality of work being produced, which led to less stress and more productivity. These "production capability" tasks may not be essential, but they are crucial to running a successful business.

Clients began to notice they were receiving more support, not only in creating restorations but also in troubleshooting cases. With this new strategy, Niche once again received an abundance of phone calls and e-mails commending their excellent work. The cheers, however, were not for the ceramic work; now, the gratitude was for the unusual situations the authors helped their clients solve. In tough times and in good, it is important for dental technicians to understand how critical their role is in acting as a support system for clients. By providing a slew of services and a wealth of creativity, laboratory professionals can keep surprising clients and winning their trust to continue relationship development and business growth.

The following cases exhibit examples of how the authors helped clients succeed while showcasing their technical skills and demonstrating how they can play a part in all phases of the restorative process.

Case 1: Trauma to Anterior Dentition

The patient presented as an emergency with trauma to her anterior dentition ( Figure 2). The authors were called into the clinic to photograph and document the intraoral condition. The patient exhibited extreme pain and discomfort, the source of which became evident upon further examination ( Figure 3). The patient's existing tooth No. 8 had detached, hanging loose by a shard of root ( Figure 4). The dentist asked if the authors had any ideas for an effective treatment strategy. While the patient expressed her primary concern about the cosmetic outcome of the case, the dentist was on the phone with a surgeon to see if he could get her an appointment that day. In the meantime, the authors had to strategize and come up with a good technical game plan.

Technicians have long been cutting extracted teeth in the laboratory for either personal study or for artistic images ( Figure 5), so it was obvious to the authors that they could use the patient's broken-off tooth as her temporary. Luckily, the surgeon had an opening that day. In the clinic, to prepare the surgeon with all the information he would need, the authors began milling out the patient's detached tooth to create a "temporary" for her. They milled the natural abutment completely out and left a lingual access hole as an extra detail for the surgeon to see ( Figure 6). While they were prepping her "temp-original" restoration, the dentist was bonding her other broken teeth. They sent her to the surgeon with everything ready for extraction and implant placement ( Figure 7).

The authors escorted the patient to her appointment with the surgeon. When they arrived, the surgeon got right to work extracting the existing fractured root ( Figure 8). The surgical procedure had to be atraumatic, so as not to lose the labial plate of bone. Once the root was extracted, the surgeon used the "temporiginal" restoration to verify alignment and placed a Neoss implant abutment (www.neoss.com) ( Figure 9). The authors then adhered the titanium temp implant cylinder to the "temporiginal" restoration using GC Metal Primer II and Gradia A1 Opaque (GC America, www.gcamerica.com), and the surgeon immediately placed the restoration. Although the patient suffered a disfiguring injury that morning, she was thrilled to be able to go home with her original tooth by day's end ( Figure 10). The authors, in their role as laboratory technicians not only helped the patient cosmetically, but were involved throughout the case and helped all the members of the team that day. They also established themselves as part of the restorative team after the patient healed ( Figure 11).

Dentistry courtesy of Barry Polansky, DMD, and David Edenbaum, DMD.

Case 2: Shade-Matching and Existing Restoration

Many times, technicians face the problematic situation of matching the shade of a broken crown that they did not fabricate. This can get tricky, as it is not always clear which porcelain materials and formulas were used. Dentists also face many challenging clinical problems in these situations—they have to cut off the old crown, re-prepare, re-temporize, and manage the patient behaviorally as well. For this case, the authors were called in to take a shade of an existing broken restoration ( Figure 12). The original crowns were less than 5 years old. In considering all the laboratory and clinical challenges discussed above, they decided to take a different approach to restoring this case.

The authors have always utilized feldspathic veneering methods (Figure 13), and decided to veneer the broken restoration instead of cutting and re-preparing. The dental team agreed on this restorative solution due to all the advantages afforded in time, lack of discomfort, and work saved. In the laboratory, the authors then fabricated an alveolar model to layer the ceramic ( Figure 14). They used GC Initial's MC Ceramic System (GC America) because of its opal and translucent selections. They then fabricated the "feldspathic chip," and the restoring dentist inserted it over the broken restoration ( Figure 15). At try-in, they observed that the finish line had to be polished down once cemented ( Figure 16). Before final cementation, the dentist treated and prepared the site using traditional etching and priming procedures. Once the restoration was cemented, he used silicone and Dialite^® polishing wheels (Brasseler USA, www.brasselerusa.com) intraorally to make the finish line invisible ( Figure 17). This was very rewarding for all involved because the treatment plan saved considerable time and energy as compared to labor- and time-intensive traditional restorative methodologies.

Dentistry courtesy of Dr. Barry Polansky.

Case 3: Meeting Cosmetic Demands for a Bridge

This case was presented to the authors as model work ( Figure 18). They received the mandibular model in the mail and were asked to help develop a restorative plan. They were told that the patient did not want an implant. As technicians, they have a responsibility to inform clients of all the possible options and potential outcomes for each case. For this patient situation, a cast Maryland bridge would be the typical option; however, the patient had beautiful existing dentition, was very cosmetically aware, and did not want any metal in her mouth. With this restorative demand in mind, the authors communicated to the restoring dentist and his patient that the option of a zirconia Maryland bridge would be the best choice. They let the patient know that zirconia, though still a metal, is highly biocompatible and white in color. When she heard the word "white," she agreed to the treatment plan. The dentist prepared the linguals slightly so the patient would not feel the zirconia wings of the bridge with her tongue, which was another of her concerns ( Figure 19).

The authors then took photographic images for color analysis since this case involved matching a single tooth to surrounding natural dentition ( Figure 20). Back in the laboratory, they made a matrix of a natural lower lateral incisor to create a good foundation to cut back from for their framework ( Figure 21 and Figure 22). They then completed a pattern resin framework to be scanned and then milled out of Lava™ Zirconia (3M ESPE, www.3MESPE.com) ( Figure 23).

Once they received the zirconia framework back from their scanning/milling partner, they double-checked the fit on the solid cast for accuracy and precision. The authors then used the GC Initial Zirconia Ceramic System (GC America) to realize their final restoration ( Figure 24 ). They were fortunate enough to see that their final work in the mouth met all the strict cosmetic and restorative demands of both the dentist and the patient ( Figure 25). They were then able to match the beauty of her exquisite natural dentition in both form and value ( Figure 26), while still meeting her demands for comfort and function ( Figure 27).

Although faced with a very difficult restorative situation, the authors were able to overcome all the restorative limitations and win the dentist's trust.

Dentistry courtesy of Michael Katz, DDS.

Conclusion

Although the cases presented are not world-class ceramic cases, they are examples of everyday dentistry that clients must routinely handle. These situations revealed to the clients that by collaborating and making dental technicians part of their team, everyone comes out a winner. In the end, the technician's job is to be as creative as possible in order to help clients succeed in everyday dentistry. By utilizing their creative talent, dental technicians can prevent the paradox of excellence that naturally occurs—even when they continue to produce beautiful restorative dentistry. Laboratory owners can modify the approaches described above to fit their own skill sets and use them as a springboard for devising more innovative ways to help dentistry progress and to help their businesses and their clients to flourish.

References

1. Mosby D, Weissman M. The Paradox of Excellence: How Great Performance Can Kill Your Business. San Francisco, CA: Jossey-Bass; 2005.

About the Authors

Joshua Polansky, BA, MDC
Owner
Niche Dental Studio
Cherry Hill, New Jersey

Emma Bjuhr, MDT
Master Ceramist
Niche Dental Studio
Cherry Hill, New Jersey

Barry Polansky, DMD
Private Practice
Cherry Hill, New Jersey