What makes dental care a valued investment versus a fix patients choose begrudgingly? 

One morning I had an automobile breakdown in my “beater” weekend truck. We have all been there – filled with the inconvenience and anxiety of dealing with a problem that came up unexpectedly. I was hoping to find a place that could get me home that day.

I googled around until I found a reasonable looking repair shop close to the breakdown. They worked me into their schedule so I could get the old truck back on the road. It was pleasing to have the problem fixed, at least for that day, but I measured this against how I have experienced service at the shop that takes care of my daily driver car.

Dental Service Emergency vs Dental Relationship

There were many aspects of the breakdown with my old pickup truck that reminded me of a dental emergency. I found someone convenient and they had the best intentions to provide a fix.

It was a shop I didn’t have a relationship with. They were kind and helpful, but there were so many things missing that would have been unlikely to happen if I treated my old truck like I do the car I have been so much more diligent in taking care of.

The shop focused on the problem that was presented to them, not looking beyond a simple fix to get me back on the road. While I was appreciative, it is very unlikely that the next problem (or even the true cause of this one) was looked for. I did not leave with any feeling that I wouldn’t be in a similar situation as soon as the next problem arose.

I reflected on the years I have spent with the auto shop that takes care of my primary car. I have a valued relationship with them. They know me and know that I appreciate them taking the best care of the investment I have in the vehicle I drive every day.

When I take my car to an appointment, they look over everything. They tell me when to expect maintenance and repairs in the near future and throughout the life of the vehicle. I trust them and know that they have my best interest in mind. In return, I am very appreciative, expressing gratitude when I write them a check for their services. I have never broken down in the cars they take care of for me.

To be continued …

A patient presented to my practice with upper and lower implant hybrids and a long history of fracturing. I myself struggled with needing to replace her dentures regularly up until the point I decided something had to change.

Parafunction, Occlusion, and a Low Smile Line

The patient clearly needed some type of intervention. I looked at mounted models and evaluated her history of extreme parafunction to determine what we should do next. She had been restored in her hybrids with canine guidance and relatively steep anterior guidance. In light of all these factors, I recommended resetting the upper hybrid, opening her vertical, and both shallowing and balancing her occlusion.

These adjustments would hopefully make a big difference in her ability to maintain dentures for longer periods of time. There wasn’t much space to open vertical, but with the little we had we managed to lengthen the time between fractures from months up to once a year. That was a huge achievement on its own, but we knew we could do more. We had also made her an occlusal appliance that went over her upper hybrid. She consistently wore it, which was beneficial.

I shared this story with Wiand of Wiand lab and he was able to give me an important breakthrough. He asked me how high her smile line was and I told him it was very low. He had an idea that made all the difference. We took upper and lower impressions of the hybrids, bite records, facebow, fixture level impression on the upper arch, and gathered shade information.

Wiand lab removed everything from the original bar. Then, I had them send the entire case to Gold Dust Dental Lab. There, they waxed the upper to full contour over the bar. After this, the case was returned to Wiand, where an injection-molded composite was used to fabricate a one-piece upper over the patient’s original bar.

This seems to have finally done it for keeping my patient out of the dental chair. No maintenance has been necessary since. By relying on the advice of my fantastic partners in both dental labs, I was able to help a tricky patient. The lesson here is that patients who are hard on their teeth will be hard on restorations. Similarly, implants aren’t going to magically resolve issues for occlusally high-risk patients.

It’s impossible to go through a dental career without continuously encountering cases that challenge our clinical skills. Nor do I think that would be a good thing, as stagnation and complacency can lead down a slippery path to less optimal dental care. Even an expert has something more to learn.

The case I’m going to discuss here is a perfect example of why collaboration is so important in the dental practice. No matter how much I think I know about the techniques for tricky restorations, I’m always surprised by how much there truly is left to understand or adjust.

It’s important to rely on our peers and lab partners for case breakthroughs and insights. They can see things from a different perspective and give you exactly what you need to provide an exceptional outcome for patients. Even just the act of talking through impressions on a patient’s circumstances can lead to unexpected realizations.

A Case of Fracture, Wear, and Parafunction

This case frustrated me for quite a while before I understood how to solve it. The patient presented with upper and lower implant hybrids from another dentist. An examination revealed the problem she had visited my office for, which was fracturing of the upper right lateral denture tooth.

She was no stranger to the irritation of fractures. She shared with me that she had a long history of wearing down and fracturing her teeth. I was immediately interested in taking the time to understand the cause of this consistent fracturing.

The patient had multiple single unit implants placed for replacement of individual teeth. Her condition then worsened to the point where she had her remaining teeth removed. Implants were used for dentures with locator attachments, but this didn’t last long. The problem persisted and resulted in the need for more implant placements.

Upper and lower hybrids were created, yet still she went through 4-5 replacements of upper lateral and canine denture teeth. After seeing me, she and I had to replace upper anterior denture teeth several times over the course of a year. That meant removing the hybrid and replacing the screws each time.

To be continued …

There is a distinct difference between team versus staff. Teams work together toward a shared goal while staff are a group of people who happen to work under the same management. Team members work side by side, whereas staff members work in the same space.

If you are wondering how you might transition from having a staff to working within a team, you might consider engaging with your staff to learn each person’s communication style.

Communication Can Make Your Staff Into a Team

At Pankey, we focus on four communication styles: expressive, driver, analytic and amiable. However, people are multifaceted, so they almost never exhibit just one style but instead have a mix of styles. It is this mix that makes us fascinating and gives us individuality.

Teams are made up of people who develop meaningful relationships that initially center on shared work goals. These relationships form when people get to know one another. Taking the time to go through a communication styles exercise with your team allows them to deepen their knowledge of each other. It has the added benefit of helping to identify the strengths of each person.

The Pankey team shares some similarities with practice teams. We spend most of our time working together to serve others. For us, it is the doctors who attend our courses. For you, it is your patients. In both situations the team works together but focuses on someone outside the team.

Although there is no “best” communication style, our team has found that certain styles are more conducive to certain situations. Also, in challenging situations it is often best to pair people who share the same style.

Despite the fact that there are no hard and fast rules and everyone should be treated as an individual, I’ve also noticed that there are certain predictable behaviors based on the communication styles. Our team feels that the knowledge we share about our communication styles helps us work together and serve our community better.