Night guards and splints: keeping appliance cases on track
Night guards and other appliances are the lab cases a practice forgets most easily. Here is why they slip, and a routine that gets each one delivered.
By the Tusko team
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Appliance cases are the easiest lab cases to lose. They start with a two-minute decision, and no appointment at the far end pulls them through.
The fix is to give each one what a crown gets without anyone thinking about it. A record at the moment of the scan, a delivery visit in the schedule, and an owner.
This guide covers why appliances slip, what goes on the Rx, and a weekly check that catches the ones nobody chased.
Why appliances slip
A crown has a preparation visit, a temporary in the patient’s mouth and a seat booked. Three things keep it in mind.
A night guard has none of them. It is decided in passing, often at a hygiene check, and the patient is in no discomfort while they wait.
What keeps a crown in mind, and what a night guard lacks
Two columns compare a crown with a night guard. A crown has a preparation visit, a temporary in the patient’s mouth and a seat booked. A night guard is decided in passing, the patient is in no discomfort while they wait, and no visit is booked.
A crown
Three things keep it in mind
- Yes: A preparation visit
- Yes: A temporary in the patient’s mouth
- Yes: A seat booked
A night guard
It has none of them
- No: Decided in passing, often at a hygiene check
- No: No discomfort for the patient while they wait
- No: No visit booked to pull it through
Dr. Joel Gaudet, the dentist who founded Tusko, describes where that leads:
“The patient comes in a week later for the night guard, and it isn’t ready, because nobody made it.”
Dr. Joel Gaudet, Wave Dentistry
Five things make these cases fragile.
- The decision is quick. The dentist says “let’s make a guard” on the way out of the room.
- Someone else takes the scan. The person who knows what was wanted is already with the next patient.
- No Rx is written at the time. The scan sits in the scanner, waiting for details.
- Nothing is booked. With no delivery visit, no date forces the issue.
- The patient does not chase. They assume it takes a while.
None of this is anyone being careless. The case simply has no hooks.
Which cases this covers
The same weakness runs through every small appliance.
| Appliance | Why it gets forgotten |
|---|---|
| Night guards and occlusal splints | Decided in passing at an exam |
| Retainers | Ordered at the end of treatment, when attention has moved on |
| Whitening trays | Seen as a small extra |
| Sports guards | Requested by a parent at the desk |
| Replacement appliances | Asked for by phone, with nobody in the chair |
Treat all of them as lab cases. The fee is smaller than a crown’s, and the wasted visit costs the same.
Start a record at the scan
The moment the scan or impression is taken, the case exists. Write it down then.
Add it to your case list before the patient leaves the room. Four facts are enough to start.
- The patient
- The appliance, and which arch
- Who will make it: a lab, or the printer in the practice
- The date of the scan
If the Rx is not finished, mark the case as waiting for it. A case that is visibly incomplete gets finished. An invisible one does not.
The dentist confirms the details the same day. A scan that waits a week for instructions has already lost a week.
Decide who writes the Rx
Agree on this once, for every appliance. The assistant who took the scan can start the Rx, and the dentist confirms the type before the day ends.
An Rx that everyone assumes someone else will write is a familiar reason for a scan to sit.
What goes on the Rx
An appliance Rx is short, and it still has to be complete. Ask your lab for its own list, and expect it to include these.
- The type of appliance, and the material the dentist wants
- The arch it is for
- Scans or impressions of both arches
- A bite registration, if the dentist wants the bite opened or set
- Any teeth to leave uncovered, or that are about to change
- The date it is needed
The fifth item is the one that causes remakes. An appliance made to today’s teeth will not fit after a crown is seated next month.
If other treatment is planned on that arch, the dentist decides the order. Put the decision on the Rx so the lab does not make the guard too soon.
A lab or the printer in the practice
Some practices print their own guards. That changes who makes the case, and it does not change the need to track it.
An in-house case has its own ways to stall.
- The scan is never exported to the design software
- The design is done and nobody starts the print
- The print finishes on Friday and sits in the tray over the weekend
- Finishing and polishing wait for a quiet hour that does not come
Give in-house work the same stages as lab work: sent, being made, ready, delivered. Put a name beside each one.
Write the routine down, with who covers when the usual person is away.
3D printing night guards in-house covers the steps and how to keep a queue moving.
Book the delivery before the patient leaves
Every appliance gets a delivery visit, booked at the desk on the day of the scan.
It can be short. What matters is that a date now exists, and the case has to be ready for it.
Count forward from your lab’s schedule for appliances, or from your own printing routine, and add a gap.
The front desk then treats it like any seat appointment. It is checked two days ahead, and the patient is called if the appliance is not in the building.
Some practices hand appliances over at the desk without a visit. Book it anyway, so that it has a date and someone checks the fit.
Tell the patient when to expect it. A patient who knows the date will phone if they hear nothing, and that is a useful backstop.
Run a weekly appliance check
Once a week, filter your case list to appliances only. Read every row.
| What you see | What to do |
|---|---|
| A scan with no Rx after two days | Ask the dentist today |
| An Rx that was never sent | Send it, and tell the patient the new date |
| A case at the lab past its date | Phone the lab |
| An in-house case stuck at one stage for three days | Ask who has it |
| An appliance ready for more than a week | Phone the patient |
It takes about ten minutes. It is the one check that would have caught the guard nobody made.
Look for patterns after a month. If scans often wait for an Rx, change who writes it and when.
When the appliance is ready and the patient is not
The last place an appliance stalls is on your own shelf.
Call the patient the day it arrives. If they do not book, call again in a week, and note both calls on the chart.
Keep ready appliances in one place, in date order. A guard found at the back of a drawer six months later is awkward for everyone.
Put appliances on the same list as everything else
The root of the problem is that appliances live outside the system. They are a note on a schedule, or a scan in a folder.
Move them into whatever tracks your crowns. How to track dental lab cases in your practice compares the options.
Our free case tracking sheet works for appliances as it stands.
On Tusko, an appliance is a case like any other, with its Rx, its scans and its date. Chair Time flags it when it will be late for its visit.
See how it looks for practices.
Who should own night guard cases in a practice?
The same person who owns every other lab case. Appliances slip when they are treated as a side job that belongs to whoever took the scan.
Should a night guard have its own delivery appointment?
Yes. Book it before the patient leaves, even if it is ten minutes. An appliance with no appointment has no deadline, and work with no deadline is the first to be forgotten.
Can appliances go on the same list as crowns?
They should. One list of every case, whoever makes it, is easier to check than two. Mark the type so appliances can be filtered when you want to look at them alone.
What does a lab need to make a night guard?
A scan or impression of the arch it sits on, the opposing arch, a bite record if the dentist wants one, and an Rx that names the type, the arch and the date. Ask your lab for its own list.
Related guides
Every practice tracks lab cases somehow. Here is what a tracking system has to do, where a spreadsheet works, and when software earns its place.
A new lab workflow sticks when it starts small. Here is how a dental practice can change how it sends and tracks lab cases without losing chair time.
A lab statement shows fees. The real cost of a dental lab includes remakes, adjustments and moved appointments. Here is how to work it out per lab.