When a discussion among dentists turns to the topic of a PPO practice, a significant air of negativity (and even anger) can be displayed. It is true that a PPO practice, defined in traditional terms as a Preferred Provider Organization, carries some unpopular connotations. This negativity stems from what some consider an inferior level of dental service and limited fees.

A patient in a PPO is assigned to a preferred provider who has agreed to provide dental services for a specific, pre-determined fee. Contractual limitations applied to both the patient and the dentist create discord in the discussions.

But there is an alternative definition to a PPO practice. In fact, “PPO” is an equation for success rather than disappointment! By implementing the parameters of the PPO equation, a dentist will provide better treatment, be more successful and be happier in their practice. The following is the PPO equation:

Planning + Performance = Outcome

Planning, Performance and Outcome are the critical components of a successful PPO practice. It is obvious the important role each parameter plays by itself. But it is the order of the combination that makes the greatest difference.

When these components are applied to a specific concern or objective, the end results can be exceptional. To better understand how this equation may be put to work, let me define the specific points of the PPO equation in terms of Spear’s Restorative Design workshop.

In the Restorative Design workshop, it is our goal to help dentists achieve predictable and long-lasting restorative results. Tooth preparation is key to providing material support and proper shade and establishes tooth contours and shapes that are esthetic in appearance. Achieving these objectives requires the application of the PPO equation. Interestingly, however, the sequence of application is the secret ingredient to success.

We discuss the concept of “outcome-based” restorative design. It is our intention that before we apply a bur or diamond to the tooth, we establish the requirements for the outcome we intend. The vision for the end product is critical for achieving success. We plan the outcome before we perform!


All restorative dentistry begins with a plan. At Spear Education, we start our planning with the application of the Facially Generated Treatment Planning (FGTP) process. Esthetics, Function, Structure and Biology are the guiding parameters for planning and achieving success. Final tooth position, color and restorative material are important esthetic planning parameters. The functional determinants require assessment. How the teeth relate to one another during speech and mastication affects shape and contour. The structural integrity of the teeth and the biological tissue and bone support must be assessed as part of the planning process. All considerations for fit, function and color require a planned approach before any treatment is undertaken, whether the restorative process will involve a single tooth or entire dentition.

In restorative design, the planning process begins with the diagnostic wax-up. Sculpting the proper tooth positions and contours allows us to visualize the direction from which we need to plan for materials and preparation design to accomplish restorative success. This wax-up becomes the outline from which all subsequent decisions toward the end result are determined. The wax-up is the “scale model” of the finished result. It is used as a visual, a reference and a tool to guide our performance in achieving predictability and success.


We must perform our treatment at a high level of accuracy and predictability to obtain the desired outcome.

Successful performance is a function of knowledge and skill. In restorative design, for example, we have to know and understand the concepts of tooth preparation as they relate to material strength, desired shade and structural support for bonding or cementation. Depending on the desired tooth shade change, a specific amount of tooth structure must be removed to provide for shade as well as adequate material thickness and strength.

The amount of tooth structure remaining can have an effect on the predictability of cementing or bonding the final restoration. As such, every factor or decision we make regarding tooth removal and contouring must be considered, as each will affect the restoration’s outcome. Applying our knowledge to give direction to where we want to go from the start is critical.

Performance also involves skill. We must have the ability and the tools available to achieve success. Using silicone reduction guides fabricated from the diagnostic wax-up provides a guide for visualizing the amount of tooth removal and adequate depth reduction for material. Using diamond burs of known dimension also provides a reference point for performance. Skills are developed through continual practice and following specific steps in a calculated manner. All of the steps must be performed to the best of our abilities. And each step in the process is crucial in order to achieve the desired outcome.


“Outcome” is the final product. The outcome is the culmination of applied learning and skill. If we thoroughly plan and then perform our procedures to the best of our abilities, our final restorations will provide predictability and longevity for our patients. Happy patients are created through successful outcomes, and successful practices are based upon successful outcomes. 

Achieving success requires hard work and dedication. Dr. Bob Winter is quoted as saying that “tools for performance are important, but a successful outcome is accomplished through understanding and guideline for achieving success in the practice.

Jeff Bonk, D.D.S., P.C., Spear Faculty and Contributing Author - http://jeffreybonkdds.com

(Click this link for more dentistry articles by Dr. Jeff Bonk.)