Successful and rewarding implant dentistry demands a high level of clinical skill. In addition to the surgical implant placement the needed skill set include restoration of the implant and patient management. This Viewpoint is not a comprehensive article that covers all aspects of implant care, instead, provides a personal overview of an implant philosophy for many years. In essence it is based upon finding the BALANCE.
I believe that success in private practice is assured when the doctor, staff and laboratories find the proper balance between three critical factors: Art, Science, and Business.
Art: Dentist & Laboratory Technician utilize methods, skills and materials that will provide esthetic and functional restorations for the patient's and doctor's satisfaction.
Science: The materials and techniques used must be well researched and have documented consistent clinical results.
Business: The procedures used must give a consistent result. This allows the restorations to be fabricated and delivered in a timely manner, with beautiful results, and provide for maximum patient comfort and satisfaction during and after the procedures.
Our patients demand beautiful, cosmetic, and natural looking restorations in their mouths while providing optimum function as well.
An implant-supported crown would not be desirable by most patients. This result, I believe, is due to improper planning and execution without enough time allocated for tissue development.
This central incisor was functioning for twenty years before a root fracture occurred. An implant support crown was deemed to be the treatment of choice. The question then arose as to how one can achieve the desirable outcome with high degree of predictability.
The outcome of this case was indeed outstanding and was made possible, in part, by our patient's understanding of the time in- volved in the completion of the treatment and fabrication of the matching crown.
Having methods to achieve a predictable result lowers the stress element attached to daily practice. The all-important partnership with the patient is not based on expediency of the delivery but on the desire to achieve the best possible outcome. The often used phase of "under promise and over deliver" is replaced in my practice by conveying to our patients the notion that we will do "whatever it takes to give us the best possible results." The number of visits is less important that achieving the desired results. Finding the "balance" between expediency and predictability is a true example of combining art, science, and business.
The business part of this equation places significant pressure on the practitioner because it dictates minimizing the number and duration of the visits to maximize profits. Of paramount importance for this is to use consistently predictable treatment methods.
The most important first step is to start a conversation with the patient. I always ask the question: "why have you come to our office?" I continue with open-ended questions so that I can truly understand the patient's desires and needs. It is only after I understood my patient's emotional situation that I can use my dental skills to "solve" the dental problem.
The partnership that I have is not only with the patient but also with my dental laboratory. I personally can do only the most rudimentary lab work. It is amazing to me the consistent high quality of lab work provided to me in simple or complex cases alike. I always say that I do the easy part of preparing the teeth and the laboratory does the most difficult part or building the prostheses. To be successful I have to provide my lab with proper information. This includes not only the "color" which is made up of the hue, chroma, and intensity but also information about the tissue contour. The transfer of the proper tissue contour is critical because this allows for the fabrication of natural looking restorations.
In my office the financial aspect of a dental case is discussed before treatment commences. Many dentists ask me how I know the cost of treatment before finalizing my diagnosis and treatment plan. I believe that it is important to discuss with the patient a range of treatment costs because I cannot afford to proceed with expensive diagnostic wax-ups, models, and complex planning unless the patient has "bought into" the treatment. I do not believe in selling a case. Instead, I choose to respond to the patient's desire to a specific treatment outcome.
A simplified approach to obtaining informed consent, called
BRAN, was the subject of many of my lectures and has wored in my practice so well. It consists of the following:
The Benefits of receiving the proposed treatment.
The Risks involved in having procedures done that will give the desired outcome.
The different Alternatives of treatment available to the patient.
The "No Treatment" option including its consequences.
Replacement of the central incisor with an implant-supported crown is one of greatest cosmetic challenges. The treatment has to take in consideration the often deficient alveolar bone architecture, soft tissue deficiencies, development and management or post surgical peri-implant tissues, matching of hue, chroma, and intensity of the adjacent teeth -- all require tremendous skill on everyone's part.
Since the final restoration is the driving force in these cases a "top down" approach is required in planning every case.
The good relationship between treatment provider and recipient is of paramount importance. The techniques required to provide treatment are not difficult to learn. Finding the BALANCE between Art, Science, and Business is.
Dr Jeffrey Hoos has practiced in a private group practice located in Stratford, CT, for 30 years. Implant dentistry has expanded patient options and using Dr Hoos' simplified restorative methods has allowed dentists to becomemore comfortable with implant dentistry.