Five years ago, I started a dental practice from scratch. Brand new building, brand new equipment, zero patients, and zero cash flow.

Building a Brand New Dental Practice

We were in a network with over 15 insurance plans, opened early mornings, and stayed open until late evenings — our patient base grew quickly. After two years, I found myself still working the same long hours, attempting to accommodate as many patients as I could.

I was working at my own practice three days a week and at another practice the other three days. I was totaling six days a week! I always valued continuing education, but my schedule only allowed for online education on the weekends or the “slow days” during the week.  

Burning Out or Slowing Down

As my own practice got busier, I found myself doing over 30 hygiene exams a day, along with seeing 12-15 restorative patients per day. I was jumping room to room nonstop. I started to realize I would not be able to keep up this pace forever. Something had to change.  

I had conversations with my team about going out of network with some insurance plans. The feedback I got from them was, “I think we will lose a lot of patients. Our patients are all insurance driven.” As a result, we kept “grinding it out.”

Shortly after, I attended a lecture by Dr. Jeff Baggett at a dental conference in town. When I saw his dentistry and his enthusiasm for dentistry, I thought to myself, “Man, I wish I was that enthusiastic.” I loved what I do, but I didn’t see myself going down a very good career path in dentistry.

I kept in touch with Jeff after the conference and he convinced me to go to the Pankey Institute. I was hesitant at first due to the time I would have to take away from work. Eventually, I took a leap of faith and signed up for Pankey Essentials 1 (E1).

To be continued…

A key tenant of Pankey philosophy is to know your patient before you treat them. It’s one of the most important lessons learned in our Essentials 1 course, Aesthetic & Functional Treatment Planning You begin to develop a self-awareness that you can cultivate throughout your professional life.

The concept of ‘knowing’ is worthy of much exploration, especially because what counts as knowing your patient is subjective to each individual. It’s about more than simply gathering data on their past dental history and current concerns in a pre-clinical interview.

To know your patient, you must be fully present with them. Then you must listen, truly listen. It’s difficult to remain quiet as your mind jumps from different solutions and possibilities to potential responses. That’s what makes listening a skill worth cultivating.

How to Listen More Effectively in a Pre-Clinical Interview

Start by taking stock of the moment before you even enter the room and acknowledge the patient. Pause. Evaluate your own mental space. Become curious about the unique individual who seeks your guidance and expertise.

Once you’ve transitioned to the interview, remind yourself that the patient should be doing 80% of the talking. It requires practice to stifle the urge to interrupt or re-direct, especially if you’re naturally talkative. On the other hand, during extremely busy days it can be a relief to settle back and focus on someone else’s thoughts.

Create a More Comfortable Environment for the Patient

One thing that helps you begin to know your patient is creating the right environment. Focus on them exclusively so that in the moment they genuinely feel like the most important person in the world. Hold eye contact, but also learn to take conversational cues from the patient. If they seem reticent, give them the space and freedom to be at ease.

During the interview process, ask open-ended questions capable of uncovering their values around health, fears or anxieties, and more. By providing them with answers to their questions and listening closely, you are already performing a service that is likely a rare experience in their daily life.

How do you cultivate understanding and trust in your pre-clinical interviews? Share your tips or advice with the Pankey community! 

Current digital splint technology requires workarounds to make it a feasible option for clinically exceptional dentistry. In Part 1 of this series, I described the challenges and opportunities of digital dental technology and explained some details of my preferred protocol. Here, I continue this explanation:

An Effective Digital Splints Protocol

In my practice, I mount digitally printed models using a centric relation record and a protrusive record for condylar inclination adjustments. This is just like we have done in the past with stone models. 

The lab technician can transfer this into the computer exactly as we have it in our hands. They do this with the use of a tabletop scanner. It’s important to note that the technician can now register original files for the impressions into position for the best accuracy. The greatest benefit today is the accuracy of these original scans (20-30 microns). 

The design portion comes next in this process. Communication with the technician can be done in real time online. My technician and I have been working with different settings in the software that give me the best chance of skipping the reline procedure patients don’t enjoy. 

I can also evaluate and do final adjustments on the mounted digital models and analog articulator. We have been successful about 80% of the time getting a splint that is rock solid and has an intimate fit on the occlusal surfaces. This is critical for fine-tuning adjustments and fracture resistance. 

If it ends up as an ill-fitting or loose-fitting splint, we can still reline just like we always have because it is a milled PMMA material (as dense as a denture tooth). 

Areas of Improvement for Digital Splints

My opinion at this time on digital splints is mixed:

Pro: We can produce a very high quality PMMA splint that lasts longer and generally gives the patient a better experience.

Con: We still need digital counterparts to essential analog skills that provide for all situations. 

Pro: I believe we will have printed materials that outperform current milled materials in the near future (this will lower the cost to produce splints). 

Con: It is frustrating that we are not getting better support from companies selling us  expensive equipment.

I am proud to be part of the Pankey family because our community encourages the use of technology to enhance good dentistry.