What goes around comes around

Iam continually amazed at what life throws at us. Now that I have been practicing general dentistry and teaching for 28 years, I have gained a certain historical perspective.

I am continually amazed at what life throws at us. Now that I have been practicing general dentistry and teaching for 28 years, I have gained a certain historical perspective. I actually have a few different historical perspectives - one a general dentist with a private practice and the other as a consultant, researcher, and lecturer. I get to spend time with patients in the office, and I also spend time with many of the key leaders in dentistry, as well as many of the dental manufacturers. At my lectures, I also spend a lot of time with general dentists all over the world. I’ve probably learned the most from you, the general dentist, who sees and treats patients every single day. Whenever I think I’ve seen everything, all I have to do is talk to a fellow dentist who has a new idea or perspective on a challenge that has cropped up. Dentists are very creative, problem-solving people and I love to spend time with my peers.

What I have really learned is that what goes around comes around. When porcelain veneers first came out 30 years ago, they were a very conservative alternative to full crowns. The early porcelain veneers were used for cases that needed very little tooth reduction. They were attached to the outside of teeth with this new thing called “bonding.” They could give anyone a Hollywood smile, without having to do full crowns.

Nowadays, when you see most porcelain veneer cases in dental journals, you see three-quarter crowns being called porcelain veneers and touted as a conservative alternative to full crowns. Unfortunately, many times these preparations are being done on virgin teeth. Don’t misunderstand me - there are many instances where preparation is necessary for these porcelain restorations, such as discolored and rotated teeth. However, there also are many situations where porcelain veneers can be done with no or minimal preparation in the enamel only.

A major paradigm shift is finally happening in the dental industry. We are going back to what porcelain veneers were originally intended for and that was either no preparation or minimal preparation cases. In my lectures, I always call this “Back to the Future,” because this is exactly what is happening with porcelain veneers. Once many of the dentists I talk to understand what a porcelain veneer should be, they frequently tell me they remember doing no or minimal preparation porcelain veneers years ago and then forgot about it. They still see those patients every single year, or twice a year at recall, and yet, somehow, they forgot about the technique and got swept up in the heavy preparation, three-quarter crown porcelain veneers.

The Den-Mat® Corporation deserves a lot of credit for staying the course with this minimal preparation technique with their Lumineers. It’s nice to finally see this technique become the preferred method of doing porcelain veneers. Learn how to do these - patients love the fact that they don’t have to have their teeth ground down for Lumineers, yet can still have a great-looking smile.

Valplast® partial dentures are another example of what goes around comes around. I remember doing Valplast dentures some 20 years ago. It looked like an interesting technique. I tried it on a few patients and had some successes. Over time, I tried other partials and just forgot about Valplast. Then, a few months ago, I tried a few cases with Valplast again and couldn’t believe the results I was getting! My good friends at Trident Dental Laboratories suggested Valplast on a case, guided me through the process, and now I am doing Valplast partial dentures again. Trident Dental Laboratories do as many of these as anyone, so I have been very pleased with the results. They are thin, esthetic, and much lighter than anything else on the partial denture market. As with other things we do, you need to know the appropriate cases for using Valplast (they work best on a teeth-borne partial denture). Valplast may not have received as much marketing as it deserves, but it is becoming popular once again. Another example of what goes around comes around.

Sometimes, the best things in the life of a dental practice are not new things, but time-tested techniques that were innovations years ago and way ahead of their time. Let’s take a look at what has been successful for dentists and patients for the last 25 years, and bring those successes back to our offices. Let’s use “what goes around comes around” to our advantage to provide the best we can for our patients.

Dr. Louis Malcmacher is an international lecturer and author known for his comprehensive and entertaining style. An evaluator for Clinical Research Associates, Dr. Malcmacher is a consultant to the Council on Dental Practice of the ADA. For close to two decades, Dr. Malcmacher has inspired his audiences to truly enjoy practicing dentistry by providing the knowledge necessary for excellent clinical and practice-management skills. His group dental practice has maintained a 45 percent overhead since 1988. For details about his speaking schedule, Dr. Malcmacher can be reached at (440) 892-1810, or via e-mail at dryowza@iname.com.

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