I wanted to know how the colleagues evaluated such an outcome at the end of an implant rehabilitation:

The one you see is a patient of mine whom I treated some years ago. At that time my evaluation of the result had been very similar to the one my colleagues politely gave while answering the survey:

A RESPECTABLE RESULT.

Let’s say neither very bad nor very good. A routine outcome.

Some of them underlined the lack of buccal volume, but consider that  looking at a macro photo aimed at showing details is one thing, while routinely working in your practice is something else.

I promise you that, some years ago, when I delivered that implant supported crown I said goodbye to the patient and I went to bed very relaxed at night,convinced that I had done a good job.

Why should one complain for such a result in the posterior zone?

Before telling you the real story, let me disclose you a tough truth quoting a sentence by Jacques Horowitz:

“VERY FEW UNHAPPY CUSTOMERS ACTUALLY LODGE A COMPLAINT…. CUSTOMERS USUALLY PREFER TO GO ELSEWHERE OR REMAIN SILENT.”

Stick this concept in your mind because people often say “I do like that, blah blah blah… and no one complains”. The real problem is that when a single one complains it means the unhappy ones add up to either 10, or 20, or 100… it depends on how much your company asks for reviews (or how much it tries to hide them!).

And it was this very case that pushed me to change the way I deal with the great majority of implant cases, digging deeper in the soft tissue management field.

When I saw the patient one week after  the procedure I asked as usual:

“How is it going, Valentina?”

And the unexpected answer

“badly…”

“It’s very far from a real tooth”

I had two options. I could adopt the Gold Tecnique, which I’ve already explained in the last article, starting to cheat the patient and telling her that it was the best result achievable and thus the right one… that an implant is not a real tooth, that it was working well… and blah blah blah… to cut a long story short: that she was supposed not to  bother me with her crap.

Or I could question myself and  downsize my ego.

Luckily for me I chose the last option and today Valentina is still a super-satisfied patient of us. Obviously I had to fix the buccal lack of volume. Increasing the soft tissues… the hard ones were definitely enough!!!

Someone could  state that, being the first upper molar a NON-AESTETHIC zone, an aesthetic surgery in that area might be too invasive.  My answer: pure bullshit!

We must stop projecting our fears onto the patient and blaming them when we don’t have the guts to perform a surgical procedure!

The patient has every right to receive the best possible result and if they are given the correct explanations, none of them will refuse a that simple fixing treatment:

• Less than 30 minutes surgery (I’ve checked the acquisition times of the pics)
• The same palate discomfort you get when you burn it with hot pizza
• Possibility to bleed a little bit from the palate (much less than the blood you sometimes lose in case of nosebleed)

Furthermore, this surgery is not skill sensitive! We are not speaking about a 11mm vertical GBR. It is,  beyond any doubt, something which can be done by anyone  who’s got:

• A degree in dentistry
• A professional licence
• Blade, tweezers and needle holder
• The right knowledge

Trust me: you don’t need magic hands in this case.

And remember that the achieved result will be brought around by the patient for the years  to come; the discomfort (or the little pain), instead, will only last for a couple of days and he or she will forget it in less than a month.

I’m not speaking about marketing: I’m speaking about the patient’s best interest!!!

Years of satisfaction and maintainability in exchange for 2 or 3 days of mild palatal burning.

Look at this photo taken at the end of the surgery. Do you foresee big troubles for Valentina?

Today, after 5 years, this is the image of Valentina’s tooth. I guess you wouldn’t be able to spot  the implants simply by looking at this photo. And trust me, the patient doesn’t remember at all which one’s the fake tooth.

In  plenty of cases a good soft tissue management allows you to obtain an excellent result both in terms of aesthetic, comfort and maintainability.

This being said… I didn’t want to write this article. I did it between a patient and another because some colleagues, in the comments below the survey, were wondering how the story ended.

But considering that I took some time to write it,  let me remind you that  you have a chance to learn all that you need to know about the most recent techniques in the field of soft tissue management around teeth and implants simply by buying my online course. What are you waiting for?

  BUY IT NOW!

Bye,

Federico

L'articolo WHAT THE HELL IS THIS SOFT TISSUE MANAGEMENT? – ACT 2 sembra essere il primo su Mastering Dentistry.

“Well, it seems a little bit too invasive as a solution!”

A statement referred to complex rehabilitations which are indeed managed within their complexity.

Now, let’s assume that in hospitals pain is treated if the patient declares a VAS score higher than 4.

The average value of “maximum pain” percived along the first week after my big horizontal and vertical bone reconstructions, which are the most frequent cause of the quoted statement:

is 3.1. And the average value of satisfaction 7 days after surgery (“how satisfied are you with the surgery you underwent?”) is 8.8! Consider that a big part of these patients underwent a full maxillary reconstruction with bone blocks, duble sinus floor elevation and double harvesting from the mandibular rami.

What  the fuck! Either I’m a miracle-worker… or I’m helpless at collecting data (I hope this  isn’t the case, ‘cause even Candlewick with his donkey ears would be able to make  tick a certain box!)… or there is a cultural  issue in the mastering of dentistry that

WE MUST DEFINITELY UNDERMINE!

Let me make myself clear.

At night I sleep soundly, like a little baby, I  doze off before my ears touch the pillow and in the morning, entering my clinic, I’m totally unaware of what I’m going to do with patients, furthermore I’m not  flooded with phone calls of suffering patients dying from swelling or bleeding even though…unbelievable… I mostly deal with advanced oral surgery.

The “a little bit too invasive!” one

I want to explain you the reason why I’m so relaxed…

“well, it’s obvious, my dear Federico… you’re used to it all!”

Unfortunately it doesn’t work like that. As you can see looking at my fb profile image, as a sport, I do boxing, I can’t call myself a boxer because I definitely don’t deserve that name, but less than two yeras ago I had my first real match and I had to train really hard. Let’s get stright to the point… As time goes by, when I have to step onto the ring  for sparring, I literally shit my pants, even if after more than three years I shoud have got used to it. At the beginning I couldn’t wait for the master to make me “fight”, now I obviously don’t  hold back, but if it doesn’t happen I’m much happier. And you wanna know why?

Because when something hurts you, you don’t get used to it! Do you?

You can face it, train yourself,  play the tough guy, but deep down there is something I call ASS-QUAKE. An anything-but-pleasant feeling: do you know when stomach flu catches you by surprise while you’re queueing for a concert?!

I have to admit that while performing the first surgeries I used to feel some cramps deep down in the gut, but later on my ass stopped quaking because I eventually understood that “a little too invasive surgeries” hurt neither my patients nor me.

The huge problem is that nobody had  explained that concept to me before! I was told the opposite, instead:

THESE SURGERIES ARE A LITTLE BIT TOO INVASIVE… FOR A DENTIST TO BE PERFORMED… IN A PRIVATE PRACTICE… UNDER LOCAL ANESTHESIA… FOR THE GREAT MAJORITY OF PATIENTS… AND ALL THE BULLSHIT YOU KNOW JUST FINE!

University dogma still permeates the dental field and no one considers that we are talking about some minor surgeries  when compared to all other surgical fields in medicine.

One thing is definitly true: they involve some pretty tricky surgical techniques which require a skillful and steady hand, big knowledge and a lot of experience. But  just because they require skills and they’re difficult, it doesn’t mean that they are invasive for the patient!

The great problem is mixing up technical complexity with invasivity. And trust me, that mistake prevents you from using a lot of useful therapeutic options which would be ideal, but are ruled out because… well “they are a little bit too invasive!”

How the hell are we supposed to treat a case like this….

Or like this…

without advanced implant surgical techniques?

 Do not get me wrong: I said advanced, not invasive

Let me be staight with you, all right?

WE CAN’T COMPARE TECHNIQUES WHICH LEAD TO VERY DIFFERENT RESULTS BY COMPARING THEIR RELATIVE INVASIVITY.

Here are the outcomes of the two cases:

In the second case, for example, a bridge solution is not comparable with the outcome of the reconstructive solution  I performed. Not  way! So it is useless to say:

“The bridge would have been less invasive”

Because the bridge is not the right option in this case! End of story! It would have required a huge biologic sacrifice in a young 28-year-old lady, and it would have led to a shitty aesthetic result given the lack of pink volume  due to the removal of the infected implant and I’m not speaking only about very advanced cases like the ones above.

Let’s take a look at Alessia’s case. She is 33:

You can throw down two screws and put two teeth on them, achieving a result very fram from the natural one.

Or you can REHABILITATE the patient in the right way:

But to achieve such a result there is no magic dust made of dinosaur’s bone or one millimiter implants. There are only years of study, sweat and blood (AND ASS-QUAKE!) for us… and a 2 points VAS pain score for the patient!!!!

So if you are an enthusiastic young dentist REJECT THE FALSE DOGMA,  roll up your sleaves, improve your skills, and take care of your patients as they deserve!

To help you in the task, here’s a free video which explains bone harvesting from the ramus. In this very case the harvesting lasted 15 minutes and the satisfaction of the patient 7 days after surgery was a VAS 9.

As you probably know, a key factor in reducing a patient’s symptoms (and therefore in the reduction of the invasivity), is a  proper soft tissue management and this is the reason why if you haven’t bought my soft tissue management online course yet you are making a huge mistake!!

It costs  just as much as you get from a patient for a root canal, but it can give you very important pieces of advice to free yourself from the slavery of the INVASIVITY DOGMA!

When the going gets tough, the tough get going!

Federico

Oh, I almost forgot…

BUY IT NOW!

L'articolo You must never ever harvest bone from the mandibular ramus. Never! Got it? sembra essere il primo su Mastering Dentistry.

It Italy, there’s a growing number of national and international chains which, thanks to large amounts of capitals, are opening clinics offering a wide variety of services at low prices. This is an issue that’s worrying many professionals in the dentistry field. To be honest, I don’t know if this situation is perceived as threatening in the rest of the world as well.

Surely, there’s been a worldwide economic crisis. Or at least, that’s what the media wanted us to believe.

Yes, because my associate Stefano and I have not felt the pinch at all.

Maybe we’ve just been lucky; still, we believe it hasn’t been a stroke of luck, but rather a series of marketing strategies, combined with a strive for excellence in the clinical field, which supported all the efforts made in terms of practice management.

Actually, we have no idea how dentistry is practiced in the rest of the world. In some countries it may be a public service.

Or maybe in other countries there has been no financial crisis at all.

For sure, the Italian situation is subject to national laws, rules and regulations that may make some articles unrelatable for a foreign dentist (specifically, the ones concerning a dental practice management).

But we are sure we have a lot to say in the clinical field, so we are ready to start the great adventure of spreading our philosophy in the world, hoping to have the same success we are achieving here in Italy.

As I told you, the introductory post refers to the Italian situation in many ways but, with some adjustments, I think it can give you a general idea of what our Mastering Dentistry project is.

and now let’s go with the two trtuhs which will make you win the fight against low cost clinics

It often happens to me to talk with colleagues, during courses or congresses, and I couldn’t help but notice a common trait which they all share:

THEIR STRONG BELIEF THAT THE PATIENTS’ DECREASE IN THEIR PRACTICE IS DUE TO LOW COST CLINICS (!!!)

Their rigmarole, then, is always the same:

“these offices are compromising our profession’s quality standards …”

“ …they don’t play fairly…”

“…they screw me up…(both because they steal my patients and screw up the patients’teeth)…”

“..and so on…”

And, moreover: “it’s their fault if the number of patients in my office has decreased. Let’s run to our trade union association and start a class struggle”

We can find the same belief spread over Facebook, where group of dentists having various interests all agree on the communal accusation against LOW COST CLINICS, which are dismissing the HOLY DENTAL PROFESSIONAL PRACTICE.

Let me show you something:

This woman has just had this job done by a dentist in my area who, guess what…drum roll……..tumturutumtuntum…….

IS NOT A LOW COST DENTIST!

I know this will shock you, but I am going to reveal the first truth I had promised to tell you:

low cost practice is not dismissing our profession, but LACK OF ONGOING EDUCATION AND STUDY IS.

Other patient, 24 years old.

Look at this: do you see how inaccurate the crown is?

This crown was made about a year ago by one of the most prestigious dentists in my town. Office in the most high-end road. Totally the opposite of a low cost clinic.

The patient turned to us because he noticed the crown had some problems and his dentist had adjusted it (I am quoting) “about fifty times” before bonding it. Let me show you a picture of this, as well:

After few months he pierced it, to treat the tooth again, and then he filled it.

Do you think it was appropriate to leave such a situation in one’s mouth?

That after a year after the patient’s treatment (and payment) may still look like this?

In a 24 years old patient?

Or maybe starting all over again would have been a better call?

Now let’s examine what the two patients I presented you have in common. It is a very interesting aspect to support my thesis.

THEY BOTH DESERTED THEIR PREVIOUS DENTIST FOR GOOD AND THEY CAME TO OUR PRACTICE,

which, guess what?…IS NOT A LOW COST ONE. It actually ranks among the most expensive private dental offices in our province.

No way, that’s surprising! A non-low cost office which does a shitty job (INCREDIBLE!!!) and a patient who deserts his “trusted” dentist (???) to go to a new structure  which (THAT’S UNBELIEVABLE) is not a low cost office either…!

Now please listen, I’m about to reveal the second secret, please sit down.

The fact that “old” offices are getting out of patients isn’t about fucking low cost offices. Just as it isn’t about the fucking economic crisis.

I’m going to tell you a story, the title is

“FROM SCRATCH TO THE EMPIRE”

Our dental practice was opened from scratch in a flat, in a small countryside village in 2006. “From scratch” here means that:

– no relatives were dentists in our families

– no pre-existing practice was taken over by us.

OPENING A YEAR AFTER GRADUATION AND JUST WAITING FOR SOMEONE TO WALK THROUGH YOUR DOOR.

Of course, at first we kept a low profile: two chairs and no employees.

By the way….this was us, during our last year at University?

And this is us again, still in our very first little office, at first dealing with clients ourselves and then, after a few months, hiring an assistant…

You may remember the year 2007. I do, very well, because I got married. Before leaving for my honeymoon I bought some safe stocks which had been constantly growing for years, at least since 2002, without ever dropping their growing trend. I bought them on May 4^th, their value was 7.6 € per each stock (their historical peak!), then I got married and left for Australia for three weeks. When I came back they were already worth one Euro less, let’s say a 13% drop in less than a month…and from there, what we all know

THE GREAT RECESSION!!!

(aka THE ECONOMIC CRISIS)

Ok, besides my personal loss in the stock market – luckily not a serious one, given the little money I had invested – I’d like to show you how our dental practice did during that period. Look at the revenue trend.

The blue line is our revenue, the red one is the average revenue of the other dental firms in Italy in 2009 (224800 €)

Just compare them and remember the shocking truth:

We are NOT  a low cost practice, we are NOT  a franchising business.

Still, we are leaders in our field in our province. We were simply an OLD practice and now we are a new one, we rejuvenated as time went by, or, even better:

WE UPDATED!

Now we are 36 years old, we work on 12 dental units, we benefit from the extremely valuable competence of other 5 dentists (obviously working full-time) , 5 hygienist (obviously working full-time as well) and 28 employees.

Maybe we have to go back to our initial question and understand that the question itself is what’s wrong. To have a booming business, which allows us to have economic stability, live peacefully and be able to express our professionalism at our best, facing all the investments in technology that this goal requires, we mustn’t beat low cost business, we must simply get that:

THE WORLD CHANGES, PEOPLE CHANGE AND THE MARKET CHANGES WITH THEM.

Either we beat these changes adjusting to them as soon as possible, or we are doomed to be swept away forever with even more violence.

This blog was born to help you face the radical changes of our time, by providing practical tips –both technical and managerial, which will help you stand out of today’s challenging market (and I know you don’t like this term, but you’ll have to swallow it).

L'articolo WELCOME TO MASTERING DENTISTRY: DISCOVER THE TWO TRUTHS WHICH WILL MAKE YOU WIN THE FIGHT AGAINST LOW COST CLINICS! sembra essere il primo su Mastering Dentistry.