by Joseph J. Massad, DDS
Welcome back! This month I would like to respond to numerous questions that I have been asked over this last year from newly graduating dental students who have attended my presentations. "How can I do what you do and pay my school loans and make a living?" The context to this question stems from their concern on the length of time that a high quality denture would take to perform relative to the fee received coupled with working with a corporate dental entity on production income. These concerns are truly valid and are too complex to address with a simple one liner of motivational flavor. I truly understand the economics confronting many new dental graduates and my response will be more than one or two lines to adequately answer. First of all, removable prosthetic training over the last 20 years has decreased in percentage more than any other dental area. So it is quite frustrating for many dentists who may want to delve into this area but are stopped because they believe it will take too long to complete these procedures and not be as profitable as other procedures they are more comfortable in performing. Let me compliment all those dentists inquiring since open, transparent discussions of this sort indicate that our young, new professionals are seeking ways to provide high-quality dentistry.
It has been established in both medicine and dentistry that quality, accuracy, and speed equate to following valid procedural methods coupled with well-established algorithms. The missing link in the field of removable prosthodontics is the lack of updated evidence-based education. If we can establish and agree on this, then my answer to the million-dollar question becomes a no-brainer. Understanding that the only true roadblocks are securing the education and the associated learning curves makes it possible for dentists to treat the full-mouth cases. The secondary gain in becoming proficient in this area supersedes the treatment of edentulous cases and opens up virtually all procedure improvements relating to full-arch reconstruction.
For the last 20+ years I have been concentrating on developing improved methods for the totally edentulous by developing a new mix of evidence-based procedures leading to more accurate and predictable outcomes and resulting in less chairtime. So the question, "How can I do what you do and pay my school loans and make a living?" can now be answered in the proper context. Update your knowledge and implement the proven procedures to include an algorithm. As you become confident with your results, then you can do what I do with quality in less time and with fewer appointments. An extra bonus of higher fees will not be an issue for patients seeking quality prosthetics. I have included a sample procedure-based algorithm for one of three appointments I use in my practice for a full maxillary/mandibular total denture procedure.
First appointment for final upper and lower arch impressions:
- Assistant explains procedure to patient.
- Assistant sizes the impression trays and then heats the thermoplastic trays to customize. Reasonable tested time (RTT) 15 minutes.
- Dentist enters and makes tissue stops for both arches. RTT 5 minutes.
- Assistant trims any excess impression material and applies adhesive over tray borders. RTT 4 minutes.
- Dentist returns and performs border molding procedures. Maximum 7 minutes.
- Assistant removes excess material and relieves tray in areas of pressure, then applies adhesive to any exposed areas and thoroughly dries impression surfaces. RTT 8 minutes.
- Dentist returns and makes the final wash procedures for both arches. RTT 8 minutes.
- Assistant cleans up and dismisses patient. RTT 8 minutes.
Dentist RTT time: 20 minutes
Assistant RTT time: 35 minutes alone and 20 minutes with dentist (total: 55 minutes).
I hope my pleasure in dentistry will also be yours. Until next month, be safe.
Dr. Joe Massad may be reached by phone at (918) 749-5600 or by e-mail at firstname.lastname@example.org.
To see Dr. Massad's video tips, visit www.DentalLibrary.com
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