Jan. 1, 1999
I am so involved giving continuing-education courses that I do not take as many CE courses as in years past. Recently, however, an ad for a course at a resort location caught my eye, and I signed up. The all-day course was on esthetic dentistry with a "jack in the box" format of nine speakers in one day. I usually consider this format to be a less-desirable format for a CE course, but this particular course turned out better than I anticipated, due mostly to the experience of the presenters.

HOW TO PROFIT FROM... esthetics

Give your practice a high profile

Douglas P. Clepper, DMD

I am so involved giving continuing-education courses that I do not take as many CE courses as in years past. Recently, however, an ad for a course at a resort location caught my eye, and I signed up. The all-day course was on esthetic dentistry with a "jack in the box" format of nine speakers in one day. I usually consider this format to be a less-desirable format for a CE course, but this particular course turned out better than I anticipated, due mostly to the experience of the presenters.

Most of the presenters were names many dentists would recognize from the lecture circuit. It was obvious to me that esthetic dentistry has done for these presenting clinicians` practices what implant dentistry has done for my practice over the past 20 years. Esthetic dentistry or implant dentistry can attract patients who are not necessarily candidates for esthetic or implant procedures.

Over the years, numerous patients have come into my practice and told me that they chose me because I did implants, even though they knew they currently did not need dental implants. These patients typically would say that they wanted to become patients in my practice in case they needed implants in the future. Is this a valid reason for choosing a dentist? Probably not, but it is a reason I have heard from several patients.

I suspect that patients enter the practices of dentists with a high profile in esthetic dentistry for similar reasons. The patient may have talked to a friend who had a complex esthetic procedure done and was very satisfied. Even though this prospective patient was not ready to have "his smile redone," he wanted to start going to a dentist who could do the necessary procedures later.

Fortunately, there still are several ways to build a successful practice. Dentists can develop good clinical skills in several disciplines like endodontics, pediatric dentistry, or TMD treatment. Dentists, however, cannot learn to do specialty-type procedures in too many areas. I talk to general dentists who are trying to do orthodontics, esthetic dentistry, surgical, and prosthetic aspects of implant dentistry, as well as endodontics. These dentists would have a more productive practice and a more relaxed lifestyle if they would not try to be an "expert" in so many different clinical areas. I have known several of these "jacks of all trades but masters of none" over the years. They usually change their ways or end up trying to do a wider scope of treatment on a shrinking number of patients.

I believe it makes economic and professional sense to refer patients to specialists. However, general dentists would serve themselves well to develop expertise in at least one or two fields that may be the domain of some specialty groups.

Esthetic dentistry and implant dentistry are similar in that they are not really in the domain of any particular specialty group. Prosthodontics may "claim" esthetic dentistry, but many of the leading clinicians in esthetic dentistry are general practitioners. [Implant dentistry was done primarily in this country by general dentists prior to the introduction of the osseointegration concept in the early 1980s.] Since the mid-1980s, implant dentistry has been claimed by oral surgery, periodontics, and prosthodontics. Esthetic dentistry and implant dentistry still are clinical disciplines that can be incorporated by a general practitioner.

A general practitioner might ask, "Why should I go to the trouble and expense of learning new procedures like complex esthetic dentistry or implant dentistry when I can practice profitably doing my single-unit crowns and operative dentistry?" The answer is that dentists make their practice more high profile with esthetic or implant dentistry. To many dentists, this seems easy enough; they will just add a specialty area to the procedures they already list in the Yellow Pages. Most dentists understand that it takes more than a Yellow Pages ad to become an expert.

Below are some suggestions to start becoming an expert in a clinical discipline such as implant dentistry or esthetic dentistry.

Know yourself

Most dentists have taken lectures of implant dentistry and esthetic dentistry. They probably have participated in some implant cases or done some porcelain laminate-veneer cases. A dentist should decide carefully which clinical disciplines to pursue. Perhaps he already is confident with his competency level in esthetic dentistry but would like to develop skills in the surgical and prosthetic phase of implant dentistry.

If a dentist does not like the adrenaline rush of doing certain surgical procedures, but enjoys doing meticulous procedures such as bonding teeth, he should not invest in CE courses on the surgical placement of dental implants. If bonding teeth or seating veneers bores a dentist to tears, but he likes to cut, flap, and suture, then he may want to consider taking some courses in the surgical aspects of dental implants, as well as purchasing the necessary surgical equipment.

Be a joiner

Implant dentistry and esthetic dentistry have several associations or academies. There are several advantages to being a member of one of these professional groups. Each organization has a process for credentials through taking a test and presenting certain types of cases to a review board.

Even though the advertising of earned fellowships or credentials is controversial, the process of obtaining these credentials or fellowships is undeniably educational and professionally beneficial. A dentist will be forced to correctly diagnose and treat cases that are presented in the review process. The process to obtain fellowship status will require good clinical photographs to be taken, and the dentists must be able to defend his or her treatment before a panel. The process of learning to photograph and present cases is very beneficial.

The organizations have top speakers at their annual meetings and, perhaps most important of all, a dentist will be taking a journey through an educational process with other practitioners who share his or her interest. As dentists, we do not typically work around other dentists who share our same professional goals. It is very synergistic to a dentist`s career to be around other dentists who have similar professional goals.

Implement procedures

About 20 years ago, I took one of several courses that I have taken at the Pankey Institute in Miami. This particular course was a week long, and the participants learned to make the Tanner appliance, a TMJ appliance. It was a very good course. The participants spent many hours in the laboratory grinding and adjusting their appliances. As is usually the case in an environment like the Pankey Institute, the dentists went out to dinner in groups at night; and some friendships developed. I was paired in the laboratory with a dentist from Oklahoma. As the week went on, the Oklahoma dentist and I talked about how we could implement our new skills in our practice.

When I returned to my practice, I made a Tanner appliance for a patient the first week I was back. The patient was a middle-aged, single, working woman with a very modest income. She had a terrible bruxism habit and constantly was fracturing her teeth. I told her I would make her the appliance at a reduced fee. The dentist from Oklahoma called me two or three weeks after the course was over and said he had not found the "right patient" yet for a Tanner appliance. He called me two or three times over the next several months and said he still was looking for the "right patient." By the time he called me the last time, I had treated several patients with the appliance and it was becoming obvious that he probably was not going to find a patient to use his new skill on.

When I started taking courses on implant dentistry about 20 years ago, I developed friendships at the courses with several dentists who never actually placed any implants. The point is this: Decide on the procedures you want to do, take the necessary courses, and then do cases.

The best way to find cases is to offer deserving patients what I call "teaching case" discounts. Remember, it is fraudulent to discount fees after filing insurance. Many esthetic and implant procedures, though, are not covered by insurance. Make sure your lab fees and some basic costs are covered, then discount the procedures so that you can allow some patients to have procedures done that they would otherwise not have done. Remember that when you were in dental school you did not get paid for any procedures. The best time to do a clinical procedure is as soon as possible after taking the course. Sometimes dentists are too cautious and conservative, and they deprive themselves and their patients of the benefits of the procedure.

Even though I will continue to treat patients with implants and lecture about implants, I saw some esthetic procedures presented at the course I attended that looked real nice. I think I will be finding a "teaching case" or two soon in my practice to try out some of these new procedures.

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