Sometimes I find myself posting pics showing rehabilitations of mine on social media, or taking part in some discussions among collegues and I always find a tipical Italian attitude, also widespred abroad:
“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…