On one of my recent trips to Spear Education in Scottsdale to facilitate a restorative design workshop, I paged through one of the airline magazines. One of the articles written was titled “25 Things You Need To Know This Month.” The article was a listing of brief topics such as “smartphones that morph into laptops;” “bourbon aged maple syrup;” and “the real locations that make up Skull Island (King Kong movie sites)” among others. All were designed to be general interest articles that provide “awareness with no real substance.” They are typical airline infomercial material.
But one of the vignettes caught my eye and provided food for thought: “The salad analyzed - The theory of the perfect salad.”
I know you are asking yourself, “what does salad have to do with dentistry?” Read on and I believe it will make sense.
The article was written by Katie Caldesi and her husband Giancarlo. Katie is a restaurateur and wrote a book titled, “Around the World In 120 Salads”. While writing the book, they visited Vietnam and learned from Vietnamese chefs that the best salads, regardless of global region, have six key elements.
Those salads that include those key components ramp up “normal” salads. These salads were “wow-inducing,” as Katie states. For you foodies, here are the six key elements (for a “Wow” Orange and Avocado salad): “Wet” (e.g., orange slices), “Dry” (e.g., salt and pepper), “Soft” (e.g., avocado), “Crunchy” (e.g., sliced scallions), “Sweet” (e.g., juice from the orange slices), and “Sour” (e.g., lemon juice or wine vinaigrette). I must admit that this description and the photo of the salad look delicious! I look forward to trying it.
But this is not an article about salads. It is about creating “Wow” dentistry. As I reviewed the article and thought about the concepts of “six key elements,” “global” aspect and “ramped up” results, it began to occur to me that our “Spear Style” dentistry is very similar. Frank Spear routinely talks about “key elements” in treatment planning. His educational concepts and processes are very much “global.” And we all can testify that the dentistry that is provided by him is “ramped up” in comparison to others.
I realized that there are significant comparisons to this article and the type of dentistry we all are attempting to achieve. I would like to share with you my “tossed salad” concept of restorative dentistry.
Key ingredients of great restorative dentistry
Restorative dentistry is a very challenging profession. There are so many variables and so much information that must be analyzed and evaluated for the many different situations that we encounter with our patients. Like the ingredients of a salad (tomatoes, cucumbers, mushrooms, peppers, etc.), patient information, conditions, circumstances, etc. are “tossed” into a huge bowl of situation. They are stirred and combined with no order, no thought and no organization.
Then we, as restorative dentists, are expected to create a masterpiece of dental health and appearance from this “salad mix.” Sometimes we get lucky and our treatment plan and restoration turn out fantastic. Sometimes, by chance, we have the right mix of “mushrooms to peppers” to create a most amazing result.
The patient states that our work (“salad”) is incredible. They may ask, ‘"How did you make it look (“taste”) so good?" Unfortunately, in this instance, we cannot answer with precision. We don’t know which ingredients were the components that were instrumental in getting us to that acceptable finish. The stars happened to be aligned that day!
Often, in many dental practices, restorative success happens by chance. The “tossed salad” of diagnosis, planning and treatment occur haphazardly. The “guests” at the dinner party leave with full stomachs, but the “meal” is considered “just okay.” This is a very disappointing situation, but it is very regular in the world of restorative dentistry.
Our “salad” does not have to be so variable. We can “ramp it up” and create a smile of substance if we know the correct ingredients. With the inclusion of some key elements of planning, organization and execution, our results will be predictable, beautiful and tasteful!
Like Katie Caldesi's “perfect salad,” there are six key ingredients to creating “wow” dentistry for our patients with predictable and successful results. The six ingredients are clinical evaluation, treatment planning, communication/collaboration, treatment sequencing, surgical/restorative management and restorations. These ingredients are not unknown, new or special items. They are not uncommon or difficult to find. The key to beautiful, predictable and “wow” dentistry is that these six ingredients are included in in every patient restoration process (“salad”) and that the order of inclusion is specific. Let me explain and define these six components, in the ideal order.
To achieve restorative results that are ‘wow-inducing” for our patients, we need to thoroughly understand the patient's needs, objectives and desires. We must take the time to ask questions of behavioral origin (pre-clinical interview) to gain a sense of the patient's dental awareness, understanding and value for our service. We need to examine and assess their clinical presentation completely (comprehensive/co-discovery exam). And we must obtain all records necessary (photos, radiographs, models, etc.) to study and analyze their clinical condition.
Although this process is time-consuming, it provides a foundation of confidence and competence that our patients value and appreciate. It is common to hear a patient response such as, “no one has ever taken this much time with me or understood my situation so completely.”
Treatment planning is a “skill” that can, and must, be learned!
Treatment planning is the basis for all treatment that is undertaken. In its most rudimentary form, restoration of a single tooth that has minimal caries or an incisal fracture constitutes a “treatment plan.” The tooth is fractured, so we fix the fractured tooth. Plan accomplished!
Our tooth by tooth treatment planning process does not provide the “global view” that is necessary when the complexity of the situation involves every specialty of dentistry. In these complicated situations of wear, tooth malposition, excessive gingival display and the like, utilization of a “treatment planning process” is paramount for successful restoration.
Incorporating the Facially Generated Treatment Planning process provides the tools and the pathway to establish the framework for success in the final restoration. esthetics function, structure and biology are the basic determinants that must be considered for each tooth and the treatment plan.
Once we have determined where the teeth belong for biologic health, functional and structural stability, and esthetic appearance, the “how to” aspect of correcting any deficiencies may be explored. The FGTP treatment plan is “the road map” for achieving long-term and predictable restorative results.
With the “plan in hand,” we can organize the treatment process to achieve sensational results. Communication involves not only verbal discussion with the patient, but also creation of a “blueprint” or “scale model” of the proposed treatment.
The diagnostic wax-up and the intra-oral mock-up are critical tools for this communication of “seeing the end in mind.” The specific “how-to's” may be discussed with the patient and collaborated with the dental specialists. Everyone involved with the case may now visualize the proposed outcome, and the plans to achieve this outcome become crystal clear.
The power of the wax-up and the mock-up is readily seen in not only the patient's positive response, but in the dental specialists as they become more engaged and collaborate on a higher level.
With all parties on board with the “outcome-based” treatment plan, the sequence of treatment is structured. Many patients that require extensive and expensive treatment request that phasing or staging treatment be utilized. These stages can easily be organized and established for the patients through this sequencing process.
Performing the correct procedures in the correct sequence provides continuity, confidence and compliance. The organization of sequencing ensures that restorative and surgical procedures are performed at the appropriate time in the appropriate order to avoid delay and eliminate a haphazard treatment approach. When treatment proceeds smoothly, without complication or difficulty, it is a “win-win” for the patient and the team.
How does the restorative process progress? The management of the phases for care are determined prior to initiating treatment. Does the patent see the restorative dentist prior to the surgical appointment? Who is responsible for the surgical guide design and fabrication? What is the time frame for restoration following crown lengthening surgery?
These are only a few questions and situations of many that must be determined and calculated for a smooth and seamless patient care process. Managing these situations provides not only patient confidence, but predictable results. No stone is left unturned relative to managing patient care. By thinking through the processes and procedures and delineating the responsible parties, success and predictability is assured.
Ultimately, following all the evaluation, planning, collaboration and sequencing, the treatment and restoration process occurs. The predictability of the final restoration is totally dependent upon the above-named processes to achieve success. The materials selection, the preparations design and the dental laboratory process are all factors that affect the outcome of the final case. The restoration is the final determinant for a pleased and satisfied patient.
When they look in the mirror and view an outcome that appears like what “their mind's eye” envisioned, it's a very good day! Creating a “wow” experience for the patient is what we each aim for in comprehensive restorative dentistry. But having that patient acknowledge gratitude and appreciation for all our planning and hard work creates just as much of a “wow” experience for us. Restorative success is important on many levels.
Comprehensive restorative dentistry is a challenging profession. There are so many factors that are critical for successful treatment outcomes. Like a salad, many ingredients are “tossed into the bowl” with the hopes of achieving a tasteful and satisfying result. But if sound clinical concepts and collaboration are applied and treatment is planned and organized in a specific manner, the outcome can be “wow” inducing for the patients. It is up to each of us to determine what kind of “Tossed Salad Dentistry” we would like to achieve!