|
Before |
After |
Let’s Talk Dentistry- Learning Full Mouth Rehabilitation
by Allison Watts, DDS
You may be able to tell by my posts that the part of dentistry I'm most passionate about is the behavioral–leadership, communication, etc. I enjoy the current level of competency I have in my practice. But it wasn't always that way….
I was reflecting on my journey through dentistry and remembering what it was like when I was trying to learn how to do extensive dentistry, specifically a full-mouth reconstruction. I went from course to course paying thousands of dollars and learned the individual steps but did not find anyone who taught the big picture or at least in a way that I could understand it. I am a big picture to small picture thinker, so I took all the pieces I was learning at the institutes I was training with and put them together to understand the big picture. Much of what I share is from Pankey, Spear and Dawson, but there are pieces from many other teachers.
My friends and colleagues tell me that I have a gift for putting it all together and explaining things in a way that makes it easy. Hopefully that comes across in print….
I thought it might be helpful to walk through the process and then break it down in future posts…
1. Phone call/First encounter needs to be great…. The purpose is to find out what the patient is looking for and to let them know a little about what your practice philosophy. Also, give them hope and possibility.
2. NP experience/First appointment-There are so many ways to do this. I have learned that although data collection is important, we can get this over a few visits. Finding out the patients understanding of where they are, how they got there and where they want to go are the most important. Much of this is listening skills and emotional intelligence.
3. Data collection completed-we need records such as FMX, pano, photos, and mounted models as well as documentation of periodontal charting and tooth, soft tissue exam, TMJ, muscle and occlusion.
4. During the exam, alone in your office or wherever you treatment plan, and when sitting with the patient in the codiagnosis or consultation, all this information—the data as well as what the patient has told you about what they want will be used to create a treatment plan and treatment sequence.
When going through the exam/diagnosis, it’s important to first make a diagnosis and then put on your “treatment planning hat” when treatment planning. After the solutions are figured out, they should be sequenced properly. I believe excellent diagnosis and treatment planning/sequencing is the most valuable service we provide for our patients.
*It is important to set a fee and look at it, not just by procedure, but also by the hour. Each office has an hourly amount it needs to make to survive and an hourly amount it needs to thrive. Patients generally accept the fees and pay them gladly if you believe in yourself and if you are good at building value for what you are proposing.
Start treatment. Although it’s not the same for each patient, a general sequence can be discussed here.
1. Diagnosis in the mouth and with records.
EFSB is the facially-generated model taught by Frank Spear. Esthetics, Function, Structure, Biology is the order that we are to Diagnose and treatment plan, but we need to make the diagnosis BEFORE we treatment plan. I have had a couple of teachers say reverse the order for diagnosis to B, S. F, E.
2. Mock-up/Trial smile if you are changing the esthetics significantly. Take an impression of the mock-up for reference when doing the waxup.
3. Diagnose and treatment plan on mounted models-vertical, etc
4. Urgent care may need to be done first, specialist care is likely to happen here but could be later, depending on the situation.
5. Waxup
6. Provisionalize in the order that makes sense- may be able to prep a quadrant at a time or we may have to prep and temporize (or use composite) if we are changing the vertical.
7. Complete final restorations when ready-can be done in sections. Lab communication is critical.
8. Photography used throughout to document and communicate with lab, specialists and patient is very valuable.
9. Finish the occlusion.
10. Provide a protective appliance if necessary. I almost always do this!
You MUST have photography and you MUST have mounted models! The photography is useful in diagnosis, treatment planning, patient education/case acceptance, and case documentation. The models are invaluable for esthetic diagnosis and treatment planning and occlusal information. I recommend mounting models in centric relation, as that is the most predictable starting point to work from.
I often have dentists call me for help with treatment planning with some photos of a pretty debilitated patient with missing teeth, occlusal plane problems, gingival level problems. We can begin to talk about some possibilities, but I always recommend they get a set of properly mounted models, with a corrected facebow and centric relation mounting before we make any decisions. Once we have that, and nice diagnostic photographs, we can begin to start to treatment plan the case.
I hope this helps. My intention is to write an article about each of these areas specifically over the next few months… Let me know if there’s something you want to hear about. You can leave a comment or question below, or connect with me on my Facebook Page. I will be more than happy to assist in any way that I can!