Reaching for the stars – An interview with Dr. Nitin Mahadevia

 

Dr. Nitin Mahadevia has consistently strived to maintain high standards in prosthetic dentistry, through his successful STARDENT LABORATORY. In fact, his lab is one of the eminent dental labs & has pioneered many new techniques in Indian dentistry. I have been a client of Dr. Mahadevia’s STARDENT LAB right from the first day of my practice. For this issue we have tried to profile & bring out many other aspects of himself & his lab. Read on-

1. How did you think of starting a dental lab?  In 1960 when I was in 1^st B.D.S. my father’s dentist advised that if you are good at technique you must do post-graduation in prosthetics & start your clinic with fully equipped lab. As I progressed up to 3^rd B.D.S. my work in prosthetic & oral surgery was highly appreciated. In final year I was inspired for post-graduation in both subjects. In those days it used to take 6-7 years. to complete post-graduation therefore I decided to start my clinic with fully equipped lab. I booked a flat of 1000 sq.ft exclusively for clinic & labs also purchased clinical & lab equipments. Unfortunately due to war with Pakistan supply of cement, steel & copper was stopped for construction of houses & completion of flat was uncertain, hence I joined Dr. M.R.Pai as clinical assistant. At the same time to avoid wasting of lab equipment I started lab on small scale on terrace of our bunglow in a room admeasuring 10”-12”.

 

2. People who have made positive contributions to your career? Dr. D.F.Boga a leading clinician, Dr. C.J.Menezes a well known orthodontist & my teacher for dental anatomy at G.D.C. were the main supporting pillars. They helped me in all possible ways. Little later on among many other clinicians I was fortunate to have Dr. H.D.Adhiya as customer.

3. Please describe the initial days of your career: In those days in India dental lab work was in preliminary stage. Beside encouraging support from above 3 clinicians & my strong desire to achieve mastery on prosthetics nothing was available to make a dashing start. My day used to start from 4:30 a.m. I worked for 16 hours a day; 3 hours as clinical assistant &13 hours for lab. In 1967, I got possession of premises for my clinic & lab. I worked for16 hours a day continued for another 3-4 years.

        Right from beginning I had to work hard to get my requirements, to establish delivery network all over Mumbai & also train delivery boys as well as dental mechanics.

 

4. What difficulties you have faced in your career: By 1970-71 work was pouring from all over the country, particularly Ni-Cr crown & bridge & cast partial dentures. My communication & interaction with dentists was increasing day-by-day. It was challenging job to get what I want from them & to give them back what they want from me. Most of them were senior to me. I was highly encouraged by a small group of dentists who were always eager to accept my suggestions, understand my difficulties, without any complaints. At the same time there were some who told me I don’t have to learn dentistry from you. According to some clinicians things go wrong only at lab.

 However to fulfill my strong desire to achieve mastery in prosthetics I was in need of quantity of work to increase my experience with variety of cases. I had to bear with unpleasant situations. Worst what happened that I was homeless in 1972 with family of 4 & in 1992 labour problems disturbed my 25 years of hard work like a tornado.

 I am proud of introducing most modern technology for prosthesis of different type & gave real market to other labs. I also gave almost 70 labs to dental profession run by technicians trained by me.

5. How has prosthetic dentistry changed over the years? Prosthetic dentistry demands perfection of a very high level which will need enough time. Whereas at present; without seriously considering indications & contraindications fixed prosthesis are demanded at very low price & in shortest possible time resulting in high failure rate. For this very reason most of the labs are not interested to process removable prosthesis. Those who do not have facility to process fixed prosthesis are half heartedly processing removables; those labs which are serious about removables are not getting healthy return from the activity. Removable prosthesis is the only option many a times, at the end of life of fixed prosthesis. On the whole quantity has increased; quality has suffered & returns are reduced.

On the positive side the present generations of dental surgeons are highly quality conscious. They attend almost all conferences & are eager to learn more & apply the same in practice. They think of innovative ways to adopt new technology. They have an excellent ability to convince the pts. for the best treatment options. Clinics are very well maintained now.

6. Common mistakes made by clinicians when they send the work to the lab: Even though clinicians are quite careful these days some of them are issuing hurriedly

 written instructions, sometimes not providing proper container for safety of impressions; sometimes there are no written instructions; impression is poured using poor quality of stone plaster by an untrained assistant .In fact model should be poured in the clinic & trimmed. Occlusion must be checked & only then sent to the lab.

7. Your suggestions to clinicians to improve the quality of their prosthetic dentistry: Prepare study models; study the case well; take decision about right type of prosthesis to be made; send a pair of study models to lab with clinicians view; take opinion of most experienced person in lab, understand his view, his limitations, his difficulties, etc. Then after taking final impression; send detailed instructions & re-discuss the case with him & after day or two again remind him what exactly you need & when .Rely on impression material on which you have mastery of handling, for e.g myself & Dr. Sanjay Sathe, a renowned implantologist, now practicing at New Zealand; we both have same technique of handling alginate. He uses alginate even for implant cases. Mix alginate in a thick putty mix with chilled water. The quality of the resulting impressions is as good as rubber base impressions & errors are minimized. Use good quality of stone plaster. If you are fully satisfied with the models & mouth preparation only then send models to lab.

8. Future of prosthetic dentistry & dental labs: Prosthetic dentistry demands perfection; perfection demands time & a financial backing with scientific principles. Dental lab is backbone of prosthetics. Future of prosthetics depends on how well clinicians are treating the labs; how well the labs are & how well they are rewarded the in form of finances. At present labs are not given enough time & enough returns. To run a lab is most difficult side of dentistry.

9. Please describe when & how & what type of additional training you have taken from abroad? I got training in Germany, Sweden, Switzerland, U.K, Singapore & Hongkong & U.S.A.

10. Your comments on the current Indian dental scene: Dealers of dental products have played excellent role in introducing modern technology & materials both for clinicians & lab, hence high quality of treatment is reaching the pts.. On the other hand many dentists are graduating out every year. In major cities there is close concentration of clinics which has resulted in cut-throat competition & as a result many of the practitioners are facing financial crunch, which is also affecting dental dealers & labs.

11. Your suggestions to clinicians who wish to undergo additional training in prosthetic dentistry: The best way to learn more about prosthetic dentistry is to form a study group of dentists & meet a senior prosthodontist once in a month with as many study models as possible; discuss every case for different possible ways of treatment & come to a conclusion which will be the best prosthesis to offer to the pts. & reasons for the same.

12. A common complaint from clinicians is that sub-ordinates of the proprietor may not be as quality conscious as the proprietor? How do you ensure that all your staff is quality conscious? In my lab one person attends only one or two steps of processing which gives them mastery on that particular process & at the same time the proprietor supervises them & then that goes to next person for further processing. The same thing is repeated till the prosthesis is completed.

More over lab should be equipped with modern technology like injection moulding system for acrylic work; vaccum induction casting machine, etc, which will eliminate human error; this way quality is controlled to greater extent. Human error is universal problem, we can only try to minimize it.

13. A few suggestions to junior clinicians & students: In initial stages of practice junior practitioners should invite senior specialist as a consultant so that his case is completed without any problem at the same time he adds to his experience. Juniors also spare more time for lower income group of pts. & also study each & every case thoroughly.

14. How viable is the activity of outsourcing dental lab work from other countries to India? Same problem, faster service at a low price is expected. It is not a very economically viable activity.

15. What can the dentist & the lab do when the prosthesis is required urgently? Perfection needs enough time; urgently made prosthesis cannot be always good. The delivery of cast partial denture can be advanced by a day, of ceramic prosthesis by few hours. It is possible but with compromises.

16. Requirements to set up a lab: Good finance; enough space atleast 700 sq.ft; main person should know how to process all type of prosthesis & should be good at handling sub-ordinates.

 

17. How many dental technicians you have trained? More than 100.

 

18. How to train dental technicians? Need mastery of prosthetic subject with natural talent of teacher.

 

19.  Your future plans: I have gained enough experience in one field; want to explore other fields of dentistry & to remain young & never stop striving towards perfection..

 

20. How do you ensure that the sub-ordinates do not score the impression surface of prosthesis? In my lab all the technicians are given full freedom to approach me even if there is slightest problem.

      Some finishing of impression surface is required in many cases. But that does not affect the fit of the prosthesis. If the correct casting technique & proper investment materials are used there should be no need to touch the impression surface of the prosthesis.

     The lab must be given plenty of time to fabricate a proper prosthesis.

21. Should the lab inform the clinician if the scoring is being done on the impression surface? Yes, the technician should inform the clinician that scoring has been done on the impression surface & the reasons for the same.

 

22. Specific suggestions for implants prosthesis: Implants must be advised only after studying the case thoroughly. Proper case selection is a must. Proper study models & radiographs must be taken prior to advising the pts. for implants.

23. Who should be taking the shade the clinician or the technician? The shade must be taken by the clinician & the clinician should communicate properly to the lab. If strange characterization is required then the pts. can be brought to the lab or the lab technician can visit the clinic.

24. How can a clinician detect whether a particular lab is re-using metal? There is no way a clinician can detect. 50% old + 50% new metal can be used. If vaccum casting machine is used then there is no deterioration in the physical quality of the metal.

                If the melting equipment of the metal is of an inferior quality then the quality of the prosthesis is compromised. In PFM cases, depending upon the layering skill of the ceramists an ordinary ceramic may be used on crowns & bridges but it may appear very good. The proper opaquer body, till glaze of the same company must be used on a particular crown & bridge. The only solution is that the dentist must visit the lab regularly & try & find out whether the lab is well equipped in terms of equipment, manpower & materials. Furthermore the technicians must be knowledgeable.

 

25. What should be the acceptable rejection rate of crowns & bridges? It could be around 4%. Now a days the rejection rate is 10%. This is affecting the profitability of operations.

 

26. How much time a clinician can spend in adjusting the crown & bridges before rejecting the casting? The clinician says impression technique is perfect & the lab says that the casting technique is perfect. Instead, find out the exact cause of failure. Repeat the impression & send it to the lab for adjustments.

27. Do you feel that RPD services are being underutilized by the clinicians? RPD services are being underutilized because of the emphasis on FPD, ceramics & implantology. Many of my pts. are happy with RPD & cast partial dentures.

28. How many areas of India is your lab servicing? All over the country.

29. You generally do not advertise: You may get more work then what you can handle, therefore I prefer not to advertise.

30. On lab-clinician communication: The clinician being superior to the technician, he must give full freedom to the technician to come up with any suggestions on mouth preparation or impressions. Most of the labs are afraid to do so. The manipulation done by the technician can then be avoided & the final product can be more accurate.

GETTING PERSONAL:-

 

31. Do you miss the charm of clinical practice? Yes, certainly.

32. A few management tips: Management of lab can be divided in 3 parts, 1) Collection & delivery, 2) Follow-up of instruction & 3) Technical backup. Main person in lab must keep check on all 3 departments & also keep in touch with clinicians to get feedback from them.

33. An ideal working day: When all staff members are present on time.

34. Favourite vacation spot: Mahabaleshwar.

 

35. You are passionate about: I am passionately committed to my responsibilities in all aspects of life.

 

36. An ideal Sunday: Exercise, yoga, pranayam, enough rest & good movie.

 

37. Favourite music: Music combined with Lataji’s voice.

 

38. Your Strengths: My responsibilities.

 

39. Your Weaknesses: At saying “No”.

 

40. Your Favourite Indian dish: Whatever my wife cooks with all her heart & mind.

 

41. Your wife’s contribution to your career: Great.

42. Who helps you in your lab now-a-days? My son Jay (B.D.S.) & my son-in-law Sanjay (engineer).

 

43. Are you looking backward or forward? Forward.

44. Your comments on dentistry today: Like a rising sun, slowly & steadily `DENTISTRY TODAY’ is enlightening the dental profession.

 

Contact address:- Dr. Nitin Mahadevia, 32-N, Laxmi Ind. Estate, New Link Road, Andheri (W), Mumbai-53. Tel: 02266920551, Mobile: 09833371389.

  Email: stardentlab@gmail.com