Did you see Ric's post on Monday. It was like I was reading my own thoughts.
It was weird. I guess it was the same except for the fact that his was about 400 words and mine are 4000 (I don't want any comments on that). I think he is going to be very funny.
Hope everyone had a good weekend. Friday night my son was playing football and broke his pinkie finger on his left hand.
I keep telling Luke he is like a porcelain figurine.
It can't be because he is going through a growth spurt because he is short.
He does play hard though.
I am going to get right to it today. No fluff.
I was sitting in my office writing up charts, and my father was seeing a patient in the next room.
He came back into the office (we share office space) and showed me an x-ray of central incisal (non-dental people...tooth right in the front) that had internal resorption, and he had it bad.
The tooth could not be fixed. He put up the x-ray on the computer screen we have in the office, and we both knew what needed to happen to this tooth.
So I kind of listened in as he spoke to his patient. And then he recommended that this gentleman get a BRIDGE. I almost fell off my chair.
I would in almost every instance do an implant in this case.
I thought everyone felt the same way I did. At least everyone IN OUR OFFICE.
There would not be a single question on what I would do. I am trying to think of anyway if I lost
one tooth a reason why I wouldn't get an implant, and I can't think of one.
So my dad came back into our office and I said, "If you lost #8 you would tell me that you would want a bridge?"
He said, "Yes."
I was shocked. I said, "Why?"
He said a couple of reasons. He has just finished a case where the patient was trying to replace #8 and two implants failed in that spot. He eventually just went and did a bridge. So this jaded him.
Then he said he wouldn't want to wear a flipper for 6-8 months.
(I guess I have to preface all this by saying that we don't do immediate loading implants.
We don't trust them. Our periodontists don't trust them. I am not saying that immediate loading
implants are bad or wrong. I am just saying we don't do them. )
So these two thing, the flipper and past failures in this one patient, would be enough to have my dad prep #7, 9 and, 10.
I was speechless. I have always looked at the end result of NOT having to prep his virgin teeth and the ability to floss and the long standing success of implants as an overwhelming reason to go with the implant option. I have always looked past the misery of the first 6-9 months.
So my father told this patient the pros and cons of both. But most of the time they ultimately will ask, "Well, what do you think?"
Or in the way we present the pros and cons will sway the patient to your opinion (you know you do it). So basically it is going to be our decision.
This is kind of a harsh reality for me. I didn't think I ever thought much different than the majority. I make most of my decisions thinking that if 10 dentists were doing this 8 of them would agree with me. I know, I know, this is crazy thinking, but maybe it just makes me feel better.
The reality is for me that I have to educate myself. I have to know everything. I have to be armed with the knowledge of everything out there to better treat the person that says, "Well, what do you think?"
I have to think that I have. I have to think that I know most of the things going on out there.
I am not talking about doing all things that you know about.
I am not about hearing about a new thing and jumping in with both feet. I am about knowing about it, reading about it, and listening to the pulse of the dental community about it. That is what I am talking about.
Never has it been so clear.
We have a tendency to get in ruts.
You know you just go through the day practicing dentistry and the next thing you know you haven't been to a CE class in two years. Then you realize you have been using the same products for 5 years and don't even know what is out there.
I don't do this, but I can see how I could. I am using a product that really works. I hate changing. I hate using the "new" stuff and it not working. So I don't even want to know what is out there.
Okay back on track...
So my father's patient said, "Well, this has to be done so let's just schedule that extraction and bridge."
As he came back to the office, we talked about this point. The point that a patient is usually going to do what we think is best.
(My father said that he has recommended a bridge before and the patient still went with an implant. This brings up a whole other blog. What do you do if a patient wants to do something you don't recommend?)
I told him he should call his friends and see what they say.
I think I am in the majority on this one.
So I would like to hear what you would do. #8 internal resorption and the tooth can't be saved.
What would you do? Implant or bridge.
Let's end it here. If I get enough responses then we will talk about it.
But just don't say IMPLANT. Tell me your thoughts.
If you are a non-dental person, tell me what you would want and tell me your reasoning.
Have a great Wednesday,
ps Along the CE lines. I am going to the Florida Academy of Cosmetic Dentistry annual meeting
this weekend. Thursday is a photography lecture. Friday is John Kois all day. I am really jazzed about seeing him. I have probably seen him 4 times. One thing I hate is the first hour of this is the peridontium, to bring everyone up to speed. Then on Saturday, John Cranham all day. He is very good, also.