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Knowledge-Sharing and Comfort Come First
Now that CAD/CAM is entering the removables arena, what are the most important considerations when collaborating on a case for implant-supported dentures?
When you're deciding on an appropriate treatment option, it's important to make sure that the expectations of the patient are aligned with the treatment options, so as not to overpromise or over-treat. I always offer the patient a series of choices in terms of money and time, ranging from the simplest option to the most sophisticated use of implants. It's best to never assume affordability for any patient; I offer implants to every patient regardless of socioeconomic status so that they can make their own decisions.
Whether you're using traditional or digital services, developing a successful treatment plan is based on physiology. No matter what the technology, denturists need to be well versed in the basics: an accurate impression and materials and the correct treatment options for the patient's needs. Digital is evolution, not revolution. It's not a completely new process; it's just enhanced with more and better data.
Nowadays, dentists and technicians are closer. Improved communication and specialized knowledge has contributed to higher mutual respect and less “us vs them.” Technologists and dentists are instead educating each other on a sophisticated level, learning to speak in the same language for the best results. With improved communication, fewer adjustments are needed, so the patient is happier. The technological advances improve the ways we work together, and the improved communication and respect help us all utilize the technology to the patient's advantage.
A true renaissance of dentistry has occurred over the last few decades. I first learned about implant-supported dentures back in 1984 when Per-Ingvar Brånemark introduced the concept in the US. Leaving the lecture, I overheard another dentist saying sarcastically, “If this stuff works, it's going to change dentistry forever.” But it's really come true; everything has changed. We're finding new applications for the technological advancements in our industry every day.
When we start collaborating on an implant-supported case, we share the information that is needed to analyze the physics of the case: what type of bite it is (Class I, II, or III), what kind of fulcrums are in place, and where the loads are going to be. These are all primary components in planning treatment for this type of case.
I make sure to discuss with the dentist his or her own comfort level and proficiency using certain techniques. One thing I've learned about suggesting new attachments is that if the dentist hasn't worked with them before, they may be hesitant to try something new. Until the dentist or surgeon is familiar with a certain case, the technician should always favor a retentive element that the dentist is comfortable using. I've taken a proactive approach to this now, actively educating dentists on new-to-them processes, like the All-on-4. The number of dentists now contacting me for this guidance has increased approximately 300% in just the past 4 to 5 years. The technician needs to encourage them to explore the process and explain the technical aspects in tandem with the actual steps to prevent anxiety. Holding the dentist's hand through their first procedure (sometimes literally) helps boost their confidence. It also strengthens the relationship all around because they know you will support them.
Communication continues beyond the planning stage, too. Not only do I tell them the instructions for the case over the phone, but I also write it out and staple it to the physical case as a reminder rather than email it. This way, the dentist has it right in front of them when they're ready to put the case in the patient's mouth.
The more I talk to my dentist clients, the more confidence they have in my laboratory, and the cases come out better. The technicians who embrace these collaborations by taking an active role in training their clients as needed; learning and using new technology; and continually educating themselves will ultimately be the ones driving the industry into the future.