Friday, May 20, 2011

Seattle Study Club

Hey all,

I have a friend that has never seen "Good Will Hunting." WHAT?!!! It is a phenomenal movie. I looked it up on my phone on Amazon, and there it was and there was a button that said, "Buy it now, with the push of one button, for $3.95." I was down. I pushed the button. 3 days later I got a package and it was "Good Will Hunting." One small problem - it was a VHS tape.

I haven't had a VHS player for about 5 years. So now I have almost $9 in a movie that I will never watch. I wrote to Amazon and told them what happened. They responded in about 5 minutes telling me that I will have a full refund. Wow. I wasn't expecting that. I guess that is why they are a gujillion dollar company.

I went to a new study club this week, new to me that is. It was the local chapter of the Seattle Study Club. I have always wanted to get in on this but just never did. I have heard good things about it, and I heard there were some real heavy hitters there. I wanted to be a part of this. You know, it is a little intimidating to go to a group that you really don't know. There were about 25 people there and I only knew about six of them. I went with someone but we didn't sit together because I wanted to see the screen better and I wanted to meet new people.

Here is how this meeting actually worked. There was a prosthodontist that told us about a patient that he saw. He showed us some x-rays and pre-op pictures and asked us to get in groups of 4-6 and figure out what we would do. The case was a full mouth rehabilitation and everyone knew that but the question was how to rehabilitate this patient.

We broke up into groups. I knew one of the six guys only by name. I would also say that the group I was in was fairly young; I was the oldest. But I am not one to think that I know everything. I do not like to tell people that what I think is the best way (maybe I am a little different as a blogger, it is easier to act like you know everything when you are just typing). But I did say that I thought this guy was in for a lot of dental work. Perio surgery, root canals, the whole bit. Being that most of these guys were young, they basically said that they hadn't done anything like this. I really respect people that are humble. I respect people that are listeners. I respect people that are there to just be sponges.

Let me tell you about this patient. This guy had every tooth on the bottom except 18 and 19. He had what I call a reverse smile line. His lower centrals were supererupted. He had some erosion of some sort going on but claimed he didn't have a reflux problem. The ling of the upper incisors were pretty abraded. All his lower premolars had root canals in them but were never restored (his brother is an endodontist in Ohio or something like that). The uppers just needed to be restored but the lowers were going to take a lot of work.

Our group talked about what it would take to restore his lower teeth. Would we tell him to go to Ohio for the day and do root canals on all his teeth? Then do crown lengthening on the lower anteriors and then crown them all? Hmm...

We didn't know. We waited for them to tell us. One group was going to keep this tooth and this tooth and do an implant here and an implant here. Everyone had a different opinion. The prosthodontist, who does some incredible work, put up the final pictures.

He took out all the lower teeth. Let me repeat myself slower. He took out all the lower teeth.

So this guy went for oral surgery. He had 12 teeth out, ridge augmentation (to flatten it out), 5 implants all in one day. Then he went to the prosthodontist's office ON THE SAME DAY, where he had a transitional denture already made that he put on the implants, meaning he cut a whole in the denture where the implants were and screwed the denture onto the implants. He did an immediate load screw-retained denture. Wow. I was blown away.

You see, the most conservative thing to do is take them all out. This 63 year old patient will never have decay issues again (on the lower). This patient will never a broken root from a post and core, or have to deal with a failing root canal. And you know what? I totally agree with this guy's treatment. Taking the teeth out was the most conservative treatment. It is blowing my mind just writing it.

I am going to follow this up on Wednesday. Let's talk about this some more. Everything I have learned in school, everything I have done for the last 15 years was to save teeth. Save teeth, save teeth, save teeth, save teeth. I have brain washed myself. Now I am learning that this is starting to become OVER TREATMENT. No perio surgery, no root canals, no post and cores, no prepping, no cord. All trying to save teeth. My head is spinning. I am going to try to get my thoughts together and we will talk about it on Wednesday.

Have a great weekend.


Anonymous said...

I am glad we are on this topic because i have been so impressed with your philosophy of saving teeth and trying to do a very conservative treatment. By conservative i mean, if there is an exposure of the pulp or if you think there is going to be an exposure of pulp-just leave some very deep decay and cap it with high fluoride releasing cement. Of course, dycal, if and when needed. I must say i had almost all of those patient coming back and complaining for some kind of discomfort. I wish i could email you and we can talk because i am a rookie dentist and i would like to know more but i don't know how.

gatordmd said...

Anonymous said...

Implants John. Now come to implant study club to really blow your mind away.

Thomas said...

Whoa... I must admit that I am almost always thinking of how to treatment plan to keep all teeth that are periodontally viable and their plan truly evaluated ALL options and provided a great service to the patient. I hate thinking about how I may treat a patient "inside the box" when what would be best is something "outside" that I am unaware of. I guess that is what study clubs are for!

Great post as usual, keep up the great work.


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