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Protocol # 33 (Excerpt from "The Protocol Book")
This protocol states that you place an indicator (sticker, initials, etc.) next to any patient in the treatment schedule that definitely needs a crown but has not committed. It implies that you'll have the intra-oral camera ready in that room, ready to operate.
 After moving the old restoration and caries, take an intra-oral photo of the prep. Don't make a major announcement of this, just routinely do it. Use the full screen setting. Sit the patient upright, and say something like this:
"First, I want to make it clear that I'll do my best for you no matter what materials we use. But, I just want to show you what I'm looking at. What we're up against."
Show them the natural tooth remaining, and why a full coverage restoration would be more successful. Have out-of-pocket dollars already figured out (from the morning meeting).
"Let me call Michele in to see what your out-of-pocket would be."
You leave. Then Michele proceeds accordingly - 95 out of 100 will accept your recommendation.
Rationale
In the early 90's, taking 300 hours of continued education per year, I had astounding case acceptance. Even when that occasional patient in hygiene would resist my recommendation, more often than not I would convince them of the appropriate treatment. And guess what happens on appointment day? A broken appointment. A no-show. Not only that, it also created something you can do without, called "bad will." Caught up in my own enthusiasm for the "best dentistry," I felt compelled to get the "yes" right on the spot.
It's far more effective to go along with the patient's resistance than to fight it. There are a host of reasons why patients resist full coverage instead of a "large filling." Cost, a prior bad experience, or a lack of understanding to "why" they need it. This became rather clear to me the day I presented a recommended crown to a rather loyal and articulate patient.
In a nutshell, don't push your treatments if you meet resistance. Prepare to show the patient at the actual visit why you have recommended a procedure. Above all else, if they still decline, give them your best 4-surface amalgam. And do it with a smile.
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