Surrounded by a pletora of devices, techniques and toys we easily get confused by the multitude of things that we apparently need for performing a good dentistry. Being a sports-lover it resembles the pressure for supplements you find in each sport. Nutrition is for sure a great part of every sportsman but the emphasis on supplementation is overwhelming. I recently read a book where the importance of every detail of nutrition was classified in a sort of pyramid. hence I had the idea to to something similar in dentistry. What are the most important things in order to work with a good outcome in dentistry,
What is really important and what is instead just marketing or mainly so?
I had several chitchat on this topic with some younger colleagues who were thinking they were in need of many things. My opinion instead is different. We really need few things in dentistry to perform well.
So let’s start with my “List”:
On the top of the list I place the rubber dam, I am not a fanatic and I find there are some situations where to put a rubber dam is not worthwile but, in general, in +90% of cases rubber dam is a game changer. You work more relaxed, a better view, a better access and it allows a unparalleled management of deep margins when you need to cut some soft tissues and some bleeding occurs, in these cases the rubber dam will do its job allowing you to work dry .
Immediately after I would place a good magnification system with light, teeth are small objects and the ability to manage details with naked eye is not the ideal. You don’t need microscopes or very expensive things, a simple 3,5-4 x loupes with light will do their job for a long time. Being completely honest if you re very young and your sight is stunning (like I was in my twenties ) you can think you don’t really need, but approaching some more years of work (especially after forties ) this is no more a chance.
Endodontic revolution has been brought by Ni Ti files …doing endo with rotating instruments is way more easier and faster than in the past ….it’s still very unclear in my experience the role of irrigants on the final outcome and warm gutta-percha…I started working with single cone and cement and without irrigants (just physiologic water) at all .My father worked like this for all his life (roughly 35 years ) and I have to admit that, as long as you are close to the apex during instrumentation and obturation, the rate of failures is a little bit more, but many times less than you would expect. In the same way I don’t use any kind of activator or special device for activating irrigants. In the same way I also shortened my irrigation time without any clinical difference to just the time needed for shaping, after which I immediately move to dry the canals .
In Prosthetic field I found in 2009 my “path “ in vertical preparation, I performed from 2001 to 2010 mostly horizontal ones but after my +13 years experience with vertical and its follow up I think that the never ending topic of what is better is completely closed in my mind. For doing vertical preps you just need burs and even normal flame burs available all over the world with a little more dexterity may do the job .
I was in Colonia at IDS this year and it seems all the world is moving digital, digital impression, digital modeling ,cad cam machine and so on …yet what I ve seen is just a faster workflow /especially for lab), probably most comfortable for patients…but I didn’t see a better quality of the product, if anything quite the opposite. If I had to choose I would choose a good technician working in analogically way and pay him more than spending money for some digital toys. A old fashioned PVS impression will do his job more than anything else. The same trend is on orthodontics, all the world is moving towards aligners but, again, I saw zero clinical advantages if not again the reduced time on chair for each appointment and the esthetic of the treatment. A good Niti wire and braces will do a great job, the only advancement I saw in ortho was the MEAW technique by sato but this is beyond our topic (you can easily check it on the web).
Really we need few things to work with a good outcome … maybe the only thing that makes the biggest difference is the one we never talk about …TIME.
The time you spend on a procedure is chief…you can have all the toys of the world but If you run through two or three chairs behind your schedule, everything is useless.
If you don’t spend a little time documenting your cases so that you can see your follow ups and understand what is working what is not …everything is useless .
Getting older, I also realized that a good time is also beneficial for our health, for our wellbeing, to avoid burn out, to get a peaceful environment in the office. Time is the same for everybody, we all share 24 hours a day, yet many complain about not to have time…you have all the time you need as long as you set correctly your priorities in your life. That is maybe very old wisdom, even Hemingway in his famous “ the old man and the sea “ wrote : “Now is no time to think of what you do not have. Think of what you can do with what there is “.
and time is yours.