Limitations of CAD/CAM fabrication
Dr. Blaes: I read your comments on the Procera bridge in December 2001 Dental Economics. (See "Pearls for your Practice," Page 112.) My only comment is that further clarification should be made as to when to use these types of bridges or crowns that use the CAD/CAM technology.
If the preps are not ideal, if the abutment teeth are tipped, or if more than 2 mm of occlusal clearance exists, there can be problems. The fact that the CAD/CAM only spits out a coping that fits the die without any correlation to the occlusion or the amount of unsupported porcelain can and probably will lead to premature porcelain failure.
You easily could wind up with greater than 2 mm of unsupported porcelain. The CAD/CAM option will have its place, but the clinician must understand its limitations.
Dr. Barry Hammond
Disability: Life imitates art
Several years ago, you kindly published my letter about disability income insurance for dentists. The letter detailed Mass Mutual's failure to pay my legitimate disability claim after I had undergone three shoulder surgeries. Dental Economics magazine apparently has quite a large readership. The CEO of Mass Mutual read my letter. His representatives contacted me very soon after you published it!
I have learned a lot about how dentists can be victimized when we are disabled. Our livelihood is cut off, and we can be dependent on the whims of the insurance carrier. Your readers — our colleagues — need an education on what insurance companies can do to us and how we can protect ourselves.
For example, Mass Mutual demanded copies of my appointment books and sent private investigators to interview my former employees. Does that sound reasonable? They did this several years after I filed my claim, along with other stalling tactics, all designed to increase my legal fees and make me give up. All the while, Mass Mutual was in possession of my attending surgeon's statement (who was the chairman of the department), clearly detailing my physical condition and the surgeries performed.
In the movie, "The Rainmaker," an insurance company had the following approach to processing claims: The company denied all claims the first time around, and just hoped that the claimants would go away. Many did go away, frightened off by legal fees. Real life apparently resembles Hollywood, because that's exactly what happened to me, except that I pursued my case.
Every dentist has some disability coverage. We have all heard horror stories of dentists who became disabled and lost their practices. Because dentistry is a hands-on profession, we all are vulnerable. Slip in your bathtub and your life as a dentist could be over. All dentists rely on the security of their disability coverage.
Brian E. Weiss, DDS, PC
New York, N.Y.
I always look forward to reading Dental Economics. Not only are the articles timely and informative, but the letters to the editor are often thought-provoking.
In particular, Dr. Ellis Neiburger's question, "What is your definition of success?" (November 2001) is one which can only be answered by each person for himself or herself. The important factor is that a person seriously and thoughtfully takes the time to answer it.
My own definition is: "Success is the enjoyable, progressive recognition and use of one's total potential for the benefit of mankind." At any time, if I ask myself if I am living by this definition and answer "Yes!" then I am a success.
The following is my explanation of each element in my personal definition of success:
Enjoyable: If life is not enjoyable, if I am not happy, then I am doing something wrong.
Progressive: Life's experiences compound and provide increasing opportunities that I had not even imagined in my earlier years.
Recognition: I always need to be alert for these new opportunities and take advantage of them.
Use: I need to take action. The most noble ideas and opportunities are nothing if they are not used.
Potential: This includes all of my resources, finances, people, education, body, mind, and spirit.
Benefit to mankind: This is my reason to exist.
It will be fun to read others' ideas on this subject!
Neil S. Hiltunen, DMD, FAGD, FICD
North Hampton, N.H.
Preventing post-op sensitivity
I thank Dr. Myles for his response to my answer in the January 2002 issue of Dental Economics about post-operative tooth sensitivity in Class II resin restorations. I appreciated his addition to my answer.
Of course, rubber dam is essential for success in the placement of Class II, resin-based composites. I have used this procedure for my entire career for more than 95 percent of direct restorations in posterior teeth. I would expect that rubber dam or other suitable dry-field techniques are used in this procedure.
Apparently, Dr. Myles did not notice that the series of clinical procedures I suggested for the prevention of post-operative sensitivity represented an overview of the many successful methods to prevent this problem, rather than a sequence of treatment. All of those techniques, used separately, will prevent sensitivity. I noted my preferred, nearly foolproof technique of using a resin-reinforced glass ionomer liner followed by a self-etching primer.
Dr. Myles' support of a thick bonding agent, Optibond Solo Plus, is excellent if the practitioner elects to use a total-etch concept. In fact, one of my videos that was made before self-etching primers were available in the United States featured that concept and used the exact product he mentioned. This procedure is similar to using a standard total-etch bonding system and a layer of flowable resin that I mentioned in category 3 in my response.
There are numerous ways to prevent post-operative tooth sensitivity in Class II, resin-based composite restorations. All of the methods I mentioned in the column would prevent sensitivity, but so would the method Dr. Myles described. Despite the many techniques to prevent sensitivity, dentists still complain of this frustrating problem. I suggest that dentists select one of the methods that have been explained and perform that technique meticulously. They will overcome the problem of sensitivity in Class II, resin-based restorations.
Gordon J. Christensen, DDS, MSD, PhD