A Quick Story about a Failure
Several days ago, I had recall a 70 year old female patient several months ago who came in for a recall visit since her last recall visit 5 months ago. Five months ago, in the hygiene room, it was determined that she had a massive implant failure in the upper left quadrant of her mouth. Three teeth on two implants were failing. There was a tremendous amount of bone that just disappeared over a period of 6 months. She had no pain or symptoms. The amount of bone destruction was radiographically staggering. The only choice was for me to remove the implants and curette the site clean. Soon after the procedure, I had a “sit down” follow-up with the patient. Nothing made sense to me. Medical history was clear. Her home care was excellent, recall great, implants not fractured, lab work looked awesome…”why the failure?” , I asked myself.
I asked the patient, “when was the last time you went for a medical check-up?” She replied, that she did not remember the last time. I suggested to start there.
Upon follow up with her PCP, it was determined that she had never gone for a colonoscopy. The GI doctor found a 5 centimeter cancerous mass in her colon with minimal metastasis. She had subsequently had the resection surgery and chemo. All was back to normal 5 months later. She currently feels great( the same prior to surgery) and we plan to replace those implants in 2020.
The Practice of Dentistry
The practice of dentistry involves, technical ability, artistic vision, emotional empathy and constant troubleshooting of the most esoteric situations. Dentistry is 95% predictable. Technical materials and delivery systems have greatly improve over the decades. However, with that being said, not every filling, root canal or implant is a success.Why?????? I would like to think we as Dentists are only as good as our materials, but it’s much more.
Dentistry fails for either One of Three Reasons.
First reason for failure and most common. The patient neglects home care and professional prophylaxis maintenance with routine check ups. This is tacit. You got to show up. I can catch something when it’s small, easy and inexpensive to fix.
Second reason, “Ugh. I’m having a bad day.” The least probable and thankfully, usually not the case. We are imperfect beings working on other imperfect beings hammering away at a microscopic problem with macroscopic instruments in a sea of emotional conflict saddled from previous dental experiences. I approach work everyday enthusiastic, rested and prepared. I love being a dentist.
The third reason for failure is third party associated. For example, an out sourced local laboratory technician mis stepping in model preparation or just not reading a lab slip correctly. Sometimes their technical abilities are stretched and they may often struggle with their own limitations.
My solutions are as follows:
We have a strong recall program in the office. Eight hygienists full time by 2019. The hygienists are up to date with C.E. training and are always free to suggest their opinions on how to improve their care. Approaches to prevention and elimination of periodontal disease and peri-implant related diseases is always being updated with the most current findings.
I eagerly await to acquire more advanced educational training and knowledge. So far, I have scheduled three dental seminars for 2019. This upcoming year, I am on track acquire 50 more C.E. hours to achieve my Full Diplomat with the I.C.O.I.. This drive to learn more and apply fuels my passion. Everyday is my first day at work.
Third party outsourcing has been limiting over the years. I currently create 90% of my dental work via the CEREC in house lab CAD/CAM and milling unit.This control ultimately insures a better product for you. The Dental Laboratory as I knew it, will be no more. The great Old school technicians are a dying breed, and sadly shall be never more.
The 5% Stress
What about the other 5%? The human body ultimately decides on what works. Dentistry is invasive. My feeling is that the body when stressed with a subtle covert underlying illness may not be able to tolerate an additional stress such as a dental implant, a root canal or a bone graft for example. Immunity resistance is a subjective quality that can not be quantified or measured. It’s best to know your body and respect it’s limitations.