Chairside - Glidewell Dental Labs

you go over and the caller ID says “Frank Spear,” and you’re
like, “Really?” I can remember that evening at my house
because I went over to the phone and was screaming to my
husband, “It says Frank Spear.” My kids were like: “Answer
it. What’s your problem?”
MD: That’s great. And when you answered the phone, did you
say, “Frank, I’d love to talk, but I’ve got Gordon Christensen on
the other line”?
LB: (laughs) No. Unfortunately, I was so tongue-tied that I
don’t know what I said!
MD: I don’t blame you! So what was your role at Spear?
LB: I was the executive VP of clinical education.
MD: And you were there for how many years? About the same
amount of time you were at Pankey?
LB: A little bit less. I was there for almost three years fulltime.
MD: And you recently decided to get back into private practice
and spend a little more free time with your family?
LB: Absolutely. June of last year I left Spear Education as
an employee and went back into private practice. I practice
here in Glendale, Arizona. I am still teaching. My intent was
always to continue to teach some. But I really wanted a lot
more control over my schedule because, as I said, I’ve got
three kids and two of them are in high school and the other
is just about to be in high school. The other part of it for
me was I felt like I really needed to be seeing patients in
order to continue to grow as an educator. I had spent eight
years in formal general continuing education with very little
opportunity to interact with patients, so I wanted to go out
and do the things I was talking to other folks about.
MD: As I alluded to earlier, that really is an amazing
background. With the experience you’ve had, I’m not sure
what’s left for you to do, except maybe I’ll nominate you for
ADA president because it sounds like you have a hard time
saying “no.” But it really is an amazing background, and it
has all added up to someone who is not only able to do all these
things in your practice, but you’re able to teach it and teach it
well. That’s a gift, too.
To get back to occlusion, because I know you’re so well
grounded in that, here at the laboratory, about 75 percent of
the restorations we do are single-unit restorations, and then
another 11 percent are 2 adjacent units. Basically, 86 percent
of what we do here at the lab is either 1 or 2 units. So, from our
perspective, for the typical dentist out there sending us work,
it looks like dentistry is being done one crown at a time; not
big, full-mouth rehabs. For the doctors who spend most of their
time doing single-unit crowns, I think occlusion is having the
patient bite on the paper, see the blue dot and getting rid of an
interference, and that may be all they need to be concerned
about. But for those kind of basic cases, what do you do? What
do you look for? Are you doing full-mouth occlusal adjustments
on those patients who come into your practice and maybe just
need one crown?
LB: That’s a great question, and my practice really mirrors
what you guys are seeing in the lab. For the majority of my
patients, we do dentistry in very small units. Honestly, even
when I do patients where we’ve talked together about a
comprehensive treatment plan and the patient is ready to
do that, because of their time constraints or their economic
constraints, we have to figure out how we do dentistry in
little pieces over 10 years. So that’s mostly what I send to
the laboratory.
MD: Wouldn’t you agree that it’s much easier for most of us to
do 28 units of crown & bridge one or two crowns at a time then
it is to do it all at once?
LB: It depends what you mean by easier, but I think there
are pieces of it that are easier. It’s easier on the patient,
definitely, from a patient experience. Unless you’ve been
a patient and sat in the chair and had 14 units prepped
on the same day, you have trouble comparing that. There
are pieces of it that are easier from a treatment-planning
perspective, from a case-presentation perspective.
I guess for me, when you ask what people should know
about occlusion, it does go back to that planning piece. I
think we need to spend a little bit of energy understanding
who are our high-risk patients from an occlusal perspective.
Those are the ones where you do the single-unit or the
2-unit, and now you find yourself in a situation you’re
not sure how to get out of. So you lose your clearance on
your prep, or you grind the crown in and the patient never
feels that their bite is the same. You’re looking at the dots
thinking it looks right to you and wondering what the heck
they’re talking about. Or maybe, the worst one, where you
come in and there’s a hole in the provisional. In the old days
with porcelain fused to metal, at least you knew you could
adjust through and the worst thing that would happen is
you would tell the patient they had a little silver amalgam
in their crown. With all-porcelain, now you don’t have that
opportunity to back out any more. So I would say, figure
out who those high-risk patients are and, at a minimum,
know for yourself and have a conversation with the patient,
so if some of those sequelae happen, now it’s something
you knew might happen and it’s something you’ve already
talked about and predicted. It’s not something where you’re
wondering how you are going to make it right.
MD: Give me an example of a typical case that might walk in
off the street, something simple like a single-unit crown. The
patient walks in with a broken cusp — it’s cutting their tongue
or their cheek — and they’re basically begging you to prep it.
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