One of the problem areas that I see on a daily basis is people not knowing the limitations of their techniques, the materials they’re using, and understanding the need to have dentists with higher levels of training that they can refer to. Knowing what one’s limitations are is one of the best predictors of clinical outcomes.
Patients need to be led down the sequence of events that represent the road to their final outcome. They need to understand the risks of non-treatment, as well as the risks of treatments that will be performed.
Another limitation that I see is the fact that despite training in dental schools, dentists very rapidly find shortcuts to treatment after they graduate. One of the foremost examples of this is the use of an articulator. When a laboratory makes a single crown for someone, the upper and lower casts need to be placed on a hinge, and the outcome is only as good as that hinge is accurate.
The use of an articulator with models of the entire arch of teeth is a much more precise device than plastic hinges with flexibility that brings into question how the 4 or 8 teeth on each side of that hinge come together. Dentists are trained in dental school to use these “jaw movement simulators” but migrate away from the increased level of complexity once they graduate. The truth is, to attain perfection, the bite must be perfect before treatment is started, and that position must be maintained through completion of any dental care. To get the bite as perfect as I know how, I use a device called TekScan. Ask to see how it works, the next time you are in.
Our profession needs much more attention to detail, regardless of how many times these shortcuts have worked for the practitioner. Many dentists, because of acceptance of low payouts from insurance plans need to cut corners somewhere, and unfortunately, the recipients of managed care receive lower quality care in many instances. Just as it has been said, “A rising tide lifts all ships.” The converse is true here. A lowering of quality for some leads to a lower level of quality for all. This lack of attention to detail, unfortunately, is what sinks ships.
One of my colleagues, Dr. Michael Sesemann* recently wrote, “As an editorial statement, I would have to say that if a clinician is not scheduling, attending, and absorbing 100 hours or more of continuing education per year, they are falling behind. Individual state requirements for re-licensure are ridiculously low, averaging 10 to 20 CE hours per year, and they should never be confused of being a metric for optimal competence. Knowledge in four critical areas of diagnosis and treatment is essential. Those four areas of expertise include periodontics, biomechanics, occlusion/function, and dentofacial (esthetics).” In other words, for a successful outcome, one must understand the essence of engineering. There must be support for what you are planning, it must be in harmony with the muscles, and finally, within those parameters, you have to know how to make it look natural.
I am proud to state that I adhere to and support Sessemann’s statement. In the same article, Norkin has stated, “Cosmetic procedures warrant meticulous planning. Predictable esthetic and functional outcomes in these cases depend on taking accurate preliminary impressions, fabricating a wax-up of the proposed restorations that is in harmony with the patient’s esthetic desires.” He goes on to list everything dentists need to think about, which would only bore the reader here. The essence is meticulous planning.
*Inside Dentistry January 2012; Roundtable Discussion: What are the keys to predictable treatment outcomes? P32 -33