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BB: Sounds like it’s a truly interdisciplinary
practice.
DL: Absolutely. We’re really blessed to
be able to jump in and take care of
things, especially trauma cases.
BB: You mentioned medical considerations
as a determining factor when deciding
what you might refer out. What
are red flags for you when you’re looking
at a patient’s medical history?
Figure 1: Digital treatment plan
Figure 2: Surgical guide
Figure 3: Denture-modified surgical stent
The key to
success is
treatment
planning from
the restoration
backward.
DL: First of all, you look at medical
history. Also, in our office, we can do
everything from just local anesthesia
all the way to IV sedation, depending
on what patients want along those
lines. Then, the key is to determine
the factors necessary for success: Is
it great bone? Is it good occlusion? Is
everything set up to make it successful?
If so, then it’s one that I’m going to do.
If the patient needs a sinus lift or bone
augmentation, I’m going to refer it. We
do really well referring together. The
oral surgeon will do the bone grafts,
we’ll do the implants, or if we need
periodontal plastic surgery, we’ll bring
in the periodontist. It actually works
very well.
DL: Uncontrolled diabetes, blood disorders,
the use of bisphosphonates —
those are things that we shy away
from. Essentially anything that makes
us uncomfortable. If I wouldn’t do an
extraction, then I’m probably not going
to do an implant on them. So, I use
that as my guideline.
BB: Do you have any advice for aspiring
implantologists — how they should
get started, and what they should look
for in first cases?
DL: First of all, I think you need to
have an eye for implants. I think you
have to start looking for cases where
implants will be the best solution for
the patient. Second, get educated.
Go out and really learn your craft.
And then use mentors. Mentors are a
really good thing. Today, by using a
team approach, you can work with a
laboratory like Glidewell, and sit down
and plan out the case, looking at it
from the restorative aspect backward,
so that everything is planned out. By
using CBCT and surgical guides, you
can do it very predictably and get
great results. The bottom line is: It’s
better for our patients.
BB: You mentioned earlier that you have
a cone beam scanner in your office.
DL: I do. Even before I had one, I
would send it out to get that done
because I think it’s really valuable information.
Sometimes all you need is
a scan to say, “Yes, OK, I’ve got this
much bone — great.” Sometimes I
look at it and go: “Wow, I’m glad I did
that. I didn’t want to do that case.”
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