Magic Happens at the Dental Lab

When the boxes are opened, they may at first only seem to hold impressions and bites. What’s really there are years of longer life, improved health, lower medical expenses, and vastly improved quality of life for many people in each box. It’s the lab professionals who create medical devices that help people breathe better at night from the potential from what’s dropped off by FedEx and UPS. To unravel a bit of that magic and to help the dental team learn how they contribute to the quality they seek, Dental Sleep Practice sat down with Jason Wilson and Bill Jarnagin of Gergen’s Sleep Lab. Bill graduated from sleep technology school in 1978 and Jason has been working with David Gergen for 21 years, so these guys have some insight to share!
When the boxes are opened, they may at first only seem to hold impressions and bites. What’s really there are years of longer life, improved health, lower medical expenses, and vastly improved quality of life for many people in each box. It’s the lab professionals who create medical devices that help people breathe better at night from the potential from what’s dropped off by FedEx and UPS. To unravel a bit of that magic and to help the dental team learn how they contribute to the quality they seek, Dental Sleep Practice sat down with Jason Wilson and Bill Jarnagin of Gergen’s Sleep Lab. Bill graduated from sleep technology school in 1978 and Jason has been working with David Gergen for 21 years, so these guys have some insight to share!
DSP: Guys, walk me through what happens when a dentist sends a case to the lab.
Jason: Each case is opened by me or my team, and logged into our system. Because these are medical devices, FDA regulations require that every step of the process has to be documented and signed off by the technician who completes it. Every part, every material, and even the color has to be logged in; the lot numbers are recorded and if the doctor has asked for special details, those are noted as well.
DSP: What do you look for from the dental office?
Jason and Bill: Mostly what we need are quality impressions and good, clear bites. There has to be a prescription, of course – every week we get one or two without one. Some doctors send models – that’s just fine, but we wish they were always packed well. It’s too bad when we have to patch a model together or ask for a new one when all it would have taken is better shipping! Impressions don’t break in shipping.
DSP: Say more about the impressions
Bill: What we look for is distorted teeth – you can see where there was a pull, or the shape of the teeth just doesn’t look right, the tray wasn’t the right size or there’s not enough of the gums on the palate or outside of the teeth. Sometimes, it looks like the material wasn’t fully set or it was moved around on the teeth before it was ready. We’d like every impression to be inspected carefully by the doctor before it’s sent; many of these problems are pretty obvious.
DSP: Why do you need a palate?
Aren’t all of these devices just over the teeth?
Bill: Our Sleep Herbst cover only the teeth, but TAPs need that anterior palate area to be made right. And we want to see as much as we can past the teeth on the buccal so we can set our hardware in a spot that will be comfortable for the patient. Plus, if all we have is a small little horseshoe of teeth, we have to make up some kind of base so it can be mounted on the articulator.
DSP: Do you have a favorite impression material?
Bill: Any of the current vinyl impression materials will do – I have to constantly catch myself from calling them ‘rubber base’ when I’m talking with doctors – that’s how long I’ve been doing this! Even alginates if they are done well will make a good model. We sell one, Kromopan 100, that can actually be sent to us for pouring, but we don’t really encourage that. We just want the doctors or their assistants to know how to use whichever material they choose.
If the doctors take some time to inspect the impressions before the patient leaves, or check the models carefully before they go in the box, that would save a lot of time getting the product back to them.
DSP: What’s next, then?
Bill: We set up the models in an articulator so we can build the right strength into the sleep device. Our biggest problem in the lab is the kind of bites we see. We know that the lower jaw has to be set somewhere about 60% of the maximum protrusion so the patient won’t snore, and we have to have about 4mm minimum thickness between the back teeth for any of our devices to be strong enough.
DSP: Seems pretty straightforward. What are you seeing in the cases doctors send in?
Bill: Sometimes we get just the models and some numbers telling us what the protrusion is and the doctors expect us to set the models. We get wax bites, bites that obviously have the teeth shifted over to one side or the arches are tipped. One big problem is supererupted teeth – we sometimes have teeth so out of line that we can’t even make the first choice device and have to call the doctor to see if we can make something
different.
DSP: What coaching advice would you give to the doctor about bites?
Bill: Using some kind of positioning device makes it better. We think any of the guides are good – George Gauge we see a lot, PRO gauges, Andra, Moses Bites, – they all can be good, but we definitely need enough hard-setting polyvinyl bite material that we can set the models in the articulator without having to guess how they fit or where they should be. If the bite can be taken with enough space between the back teeth, we don’t have to open the articulator in the lab, which always makes it less accurate. If the doctors are getting appliances that hit too hard in the second molars, that’s a sign that the bite wasn’t taken with enough room for us to make the device.
Please ask the doctors to check the midlines and make a note on the prescription if the midline is off or shifts over when the jaw goes forward. If the mounting matches the note, we know we have it right and that saves time. If we have questions, we are going to call the doctor – that’s an interruption.
DSP: So now that you’ve mounted the models in the right bite position, then what happens?
Bill: We block out the undercuts, wax up the shape, put ball clasps in and position the hardware, then the acrylic techs use a high quality powder and liquid buildup to form each appliance by hand. The acrylic is processed in a pressure pot, finished and polished. The QC department inspects each one before shipping. The whole process takes about a week – we open about 35 new cases every day. Our acrylic is FDA cleared and David insists we get the best on the market for our devices. That makes it easier for us to turn out a quality product.
DSP: You guys are known for the blue sleep Herbst. Why blue?
Bill: Back to the FDA process – they’ve only cleared a few colors. We’ve chosen clear or blue, but we have purple and red to use if the doctor wants. Sometimes we get some crazy requests in like we do for ortho retainers, but we just can’t make a medical device in school colors or polkadots! Unless they are blue or red!
DSP: Tell me about scanning technology – wouldn’t that take care of the impression problem?
Jason: We have two doctors so far who are sending in scans for their cases, and we have a printer here to make the models, which end up being treated just like any other model. It adds about a day to the process and we still need that bite, but we think we’ll see more and more of this going forward. So far, these are going well – mostly because David invested in a pretty good printer.
DSP: Thank you, Jason and Bill. I hope this helps all our sleep dentists work better with their lab professionals so patients end up with better sleep appliances. Any final thoughts?
Jason: Thank you for your time. Anyone interested in working with Gergen’s Sleep Lab can get our Start-Up-Kit, which has everything a new doctor needs to get started making sleep appliances.