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Figure 6: Double-cord tissue retraction and laser
troughing tissue management
get back to the way you were chewing,
we can do this screw-retained, or
porcelain, and then I can get you back
to functioning even better than you
were before. So, those are the things
I look at. And I really ask that question
of my patients: “Do you want to
eat what you want, or eat only what
you can?”
BB: Regarding screw-retained dentures
versus porcelain, how do you make a
decision on which way to go?
DL: That’s a good question. What do
patients think? They all think porcelain
is better. Well, porcelain is better
if you have the space for it. And
lip support is the number one thing.
You’ve got to do a wax rim and make
sure your lip support is proper because
I think you can do a better job
with acrylic a lot of times. So, it’s all
in the diagnosis — looking at it and
seeing what is best for that individual
patient. Because the cost on those is
not as much as you’d think, when you
get to that point. A lot of factors are involved,
but really, listen to the patient.
I think that’s the main thing.
BB: A suggestion I’ve heard you give in
When I talk to
young dentists
who are coming
out of dental
school, I tell
them, “Don’t
biopsy wallets.”
... Always do
what’s best.
a past presentation is, “Treat the patient
as you’d treat yourself.” Can you expand
on that treatment approach?
DL: When I talk to young dentists
who are coming out of dental school,
I tell them, “Don’t biopsy wallets.”
Treatment plan what you would do
for yourself, for your mom. Don’t
make value judgments. Tell them what
you’d recommend. You can always
back off and sequence it, but always
do what’s best. They want what’s right.
I think that’s my best advice: Don’t
biopsy wallets.
BB: I also know you’re a big proponent
of education and the importance of
educating the team. What are your
thoughts along those lines?
DL: Here’s the truth: As dentists, we
spend more time with our team than
we do with our family during waking
hours, so we’ve got to be on the
same page. So many times you go to
a seminar and you’re all fired up, but
when you come back to the office, after
a couple weeks, things are back
to normal. Unless you take it back
and implement it, nothing happens.
And the key to that is, when you do
bring implants into your practice, you
have to have systems, strategies, and
everybody talking the same language
because the very first part of case acceptance
is the phone call. Sometimes
I’ll actually do random care calls. I’ll
call offices and say, “I need implants,”
and see what they say because everybody
needs to be on the same page.
BB: We were talking about different
technologies — guided surgery, cone
beam scanning. Another is intraoral
scanning. Are you involved in that?
DL: Absolutely, and I’ve been involved
with that from the beginning. Looking
at the different technologies out there,
I definitely get better fits when I use
an intraoral scanning device. I definitely
get less chairtime when I seat
them, so that’s the real value for the
dentist. There’s also that wow factor.
Patients love it, there’s no gagging. But
I really think it also makes you a better
dentist. If we take an impression
and look at it and go, “It looks pretty
good, the lab will make that work”
versus blowing it up and looking at it
and saying, “Wow, I can’t see that,” it
really makes us prepare teeth better,
and see things more accurately. Key,
though, is still tissue management.
Figure 7: Temporary abutment and provisional crown
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