In 1982 I had just finished my Perio-Pros graduate program and was working as an associate three days a week in one office and renting space another three days a week in two different offices. In the fall of 1982 a group of eight dentists in Tacoma, Washington, asked me if I would mentor a new study club that focused on esthetics.
I had attended a few gold foil and gold inlay study club meetings as a dental student. I had also presented at a couple of study club meetings as a graduate student but had never considered mentoring a group of dentists. In the end I agreed, and that was the start of what would be an important part of my career for the last 38 years.
Spear has come a long way since those initial study club meetings, but I know relationships are everything for clinicians. Time spent together is valuable. Due to the health and safety concerns surrounding the year, many clubs are missing the ritual of gathering at the Spear Campus in Scottsdale and have traded in-person meetings for the safety and flexibility of virtual meetings.
While study club meetings are typically conducted around a pre-recorded case module, this new faculty-led Spear Study Club event was created to deliver a campus-like live experience they could share as a club. The learning outcomes from these live events inform future club meetings and improve interdisciplinary treatment planning.
The new live, faculty-led Spear Study Club format – delivered by a member of our Resident Faculty – brings a campus experience directly to your club, regardless of location. It's quite the departure from the conventional study club meeting format many of us grew accustomed to over our careers. Live study clubs leverage a virtual platform to create a dynamic event that mixes large-group learning with intimate breakouts for your club to discuss the presented case. The events conclude with a Q&A session so the Resident Faculty mentor can address your questions.
I'm currently leading this effort with my fellow faculty members Drs. Gregg Kinzer, Ricardo Mitrani and Jeff Rouse. Topics for the new live events are varied but problem-based:
Existing Maxillary Anterior FPD Needing Replacement: Deciding to Convert to Implants or Redo FPD
Presenter: Frank Spear, D.D.S., M.S.D.
Dates/Times: Jan. 7, 5:30 p.m. (PST); Feb. 4, 11 a.m. (PST); Feb. 9, 4 p.m. (PST); Feb. 23, 4 p.m. (PST)
- What the literature shows as the 5, 10, and 20 year survival rates for tooth supported FPDs and also implants.
- What the key factors are that impact long term success and survival for tooth supported FPDs and implants.
- What the most common risks of failure are for tooth supported FPD's and implants.
Managing the Un-esthetic Single Tooth Implant in the Esthetic Zone: Restore, Retire, or Remove
Presenter: Greggory Kinzer, D.D.S., M.S.D.
Dates/Times: Jan. 14, 2:30 p.m. (PST); Jan. 20, 4 p.m. (PST)
- Evaluate the common etiologies of un-esthetic anterior single tooth implants.
- Discuss the treatment options available for correction (restore, retire, removal).
- Provide a classification system to help set treatment protocols and sequencing.
Treating the Terminal Dentition: When Do We Keep Teeth and When Do We Extract Them and Place Implants?
Presenter: Ricardo Mitrani, D.D.S., M.S.D.
Dates/Times: Jan. 5, 5:30 p.m. (PST); Jan. 14, 3:30 p.m. (PST)
- What the literature shows regarding each potential route of therapy.
- What are the key factors needed to be considered as part of our decision process?
- Review a treatment planning algorithm conducive to making a more objective decision.
What Am I Missing? How Airway Changes Dental Treatment Planning
Presenter: Jeff Rouse, D.D.S.
Dates/Times: Jan. 6, 5:30 p.m. (PST); Jan. 13, 2:30 p.m. (PST); Feb. 16, 4 p.m. (PST)
- Differentiate between airway aware and airway directed treatment planning.
- Identify deviations from the norm that could be airway induced.
- Understand how treatment planning can impact the airway.
The meetings are designed to provide specific content related to the treatment planning decisions appropriate to the topic, then provide cases that Study Clubs can take into break-out sessions with their members to review the records and contemplate the treatment planning options.
Following the breakout sessions, the groups all go back live and the faculty mentor walks through the treatment planning options they considered, as well as the actual treatment that was completed.
Recaps of recent live, faculty-led study club meetings
Here is an outline of my first live online session on Dec. 1 to give you an idea of the format I used.
“Existing Maxillary Anterior FPD Needing Replacement: Deciding to Convert to Implants or Redo FPD”
The topic is very narrowly focused on patients with existing conventional FPDs, meaning full crown preps on the abutment teeth have already been done when the original FPD was placed. It is a very different topic than someone missing anterior teeth but who has unrestored teeth adjacent to the tooth or teeth needing to be replaced. Here are the segment descriptions:
- Literature review about FPD and implant survival and success rates at short-term (5 years), mid-term (10 years) and long-term (20 years), discussing which factors need to be evaluated to achieve a predictable outcome with each approach, converting to an implant, or redoing an FPD.
- Walk through a patient missing a central with a 3-unit FPD needing replacement, introduce a treatment planning algorithm that contains the key elements that need to be evaluated in the decision process, showing the treatment planning options considered and the treatment that was chosen.
- Study Club breakout rooms with their club members for 40 minutes, treatment planning three cases with existing FPDs needing replacement. The goal is to come up with what the members think is the ideal no compromise treatment plan, as well as a potentially acceptable compromise treatment plan.
The first patient has an existing 3-unit FPD replacing a central, a high lip line and significant bone and soft tissue loss in the pontic site.
The second patient has a 4-unit FPD replacing both centrals, a high lip line, and the right lateral abutment has endo and a slight horizontal fracture, as well massive bone loss in the central region.
“Amazing to see Dr. Spear and learn from him. Showing cases after 26 years is something very few people can do. You really teach us how to think outside the box.” – Dr. Andres Ramirez, Spear Study Club Leader
And finally the third patient has an existing 6-unit FPD replacing all the incisors, a very high lip line, and significant bone and soft tissue loss across the entire pontic area.
- After the breakout is completed, we all regroup, the records for each patient are shown, along with a list of possible treatment options. Then in real-time, all members can then anonymously click on the treatment option they thought was the ideal, no-compromise plan for each patient. The results are then tabulated and reported so everyone gets a sense for how different groups and members saw the cases.
The survey is done for each case, and then I show the options I considered, and the actual treatment performed. It is fun because I have 26-year follow-up on the first patient and 23-year follow-ups on the second and third patients.
Improving how general practitioners and specialists work together
My original study club meeting format was simple: my peers really wanted to learn about esthetic techniques and materials, as well as treatment planning – areas I had a strong interest in.
We met monthly, about nine months of the year, typically for three or four hours. I would identify an area I felt appropriate to the group's interests, put together a presentation on the topic, and then we would all discuss what each person saw and was thinking about the topic. Since the meetings were held in one of the members' offices, we could also bring in live patients to treat or for me to demonstrate on. The first year went well.
What I hadn't expected was that the eight dentists had been talking to their friends about the experience and suddenly by 1984 I had three more study clubs I was mentoring, for a total of four each month over only nine months. By 1985 the total number had grown to seven, and by 1987 my partner and I were mentoring 11 clubs a month. Then the challenge become time management for practice, for outside presentations around the country, and for some life balance of time off. Nevertheless, by 1989 we were up to 13 clubs.
What I learned from the mentoring process is that the Study Club experience can be incredibly rewarding for the members and mentor as well. This occurs because of the collaborative experience of having multiple sets of eyes, minds, and different clinical strengths all looking at the same problem yet coming up with many different potential treatment options to discuss.
For me personally the mentoring experience is how I grew my reputation in the communities in which the club members practice, which also resulted in many of the members becoming excellent referral sources for my practice once they were faced with a patient they were uncomfortable treating.
Around that same time, I became a member of the study club that would have the greatest impact on my own personal growth in treatment planning and collaboration. The club was started in 1983 by a general dentist in Tacoma, Washington, named Dr. Ralph O'Connor. Ralph and his practice partner, Dr. Dick Klein, were well-known in the 1960s and 1970s. They traveled the country doing two-day presentations on how to integrate four-handed dentistry and expanded function auxiliaries into your practice, teaching dentists to work out of more than one operatory and how to see more than one patient at a time. Today that may seem routine, but it wasn't back then.
What prompted Ralph to start the study club was a problem that was developing in his practice. What he was teaching worked great for simple dental problems, an amalgam, a crown, etc., but it didn't work well when patients had more complex issues, and Ralph realized his mature practice had lots of patients with complex issues not being treated because he didn't know how.
That meant lots of dentistry was not getting done. He got a group of us together for a meeting to consider his idea. The initial group consisted of an oral surgeon, periodontist, two endodontists, a pediatric dentist, an orthodontist, and a prosthodontist (me).
Classic study club mentorship amid virtual interdisciplinary dental CE
Ralph started the meeting by telling us that the reason he wanted to do this was because he wanted to help his patients with more complex problems receive treatment, and he knew he wasn't capable of doing it alone.
We named the study club the Northwest Network for Dental Excellence. We met nine months a year, 3-4 hours at a time, and the focus of the meetings was treatment planning – getting to hear how each person saw and thought about the problems of the patient who was being presented. The NW Network study club experience transformed my professional life. As time went on, we added more general practitioners, as well as a dentist who focused on facial pain.
The opportunity to experience all the different possible options that I as a restorative dentist was unaware of was eye-opening. In addition to all I was learning, the orthodontist in the group was Dr. Vince Kokich Sr. and the periodontist was Dr. Dave Mathews. The three of us bonded and went on to work collaboratively for more than 30 years, as well as speaking together as a trio over more than 150 days around the world. The NW Network was still meeting regularly all the way until COVID-19 hit us in March of this year, albeit with different members as some have passed or retired.
As you can probably tell, I believe very strongly in the value of the Study Club experience. As for what happened to the 13 clubs from 1989, my partner and I finally felt we couldn't keep up with the time commitments anymore, and we switched formats to two-day hotel seminars, and held hands on workshops in our office, the study club members could attend the seminars and come to the office for the hands-on portion, that went on until 1995 when I moved to a new office in Seattle.
After moving to the new office in 1995, something interesting happened: two different people, a dentist from Missoula, Montana, and a laboratory technician from Spokane, Washington, both approached me about mentoring study clubs. The Spokane club would be for one full day, 5-6 times a year, while the Montana club would two full days at a time, five times a year. The draw of the opportunity to mentor was so attractive I said yes and mentored both clubs for 15 years from 1995 until 2010, when Spear Study Club was created.
In closing, I feel like I am back where I started – live mentoring study clubs again, and it reminds me of why I did so many for so long. It is a great learning experience, and even at this stage in my career people come up with ideas I hadn't thought of.
I hope I get the opportunity to mentor you and your group on one of our sessions, and I know you will love the ones Gregg, Ricardo and Jeff have created as well.
Frank Spear, D.D.S., M.S.D., is co-founder of Spear Education and a member of Spear Resident Faculty.