The Imperfect Dentist


Recently I read about a very famous architect : Tadao Ando and its opinion on its work. Being an exceptional, awarded and very famous architect I thought immediately that his first quality was Perfectionism.

Yet Ando’s opinion on perfectionism was very different than I thought. He got famous for his ability to make compromises.
He is esteeemd for its ability to make the most of limited spaces with limited budgets. He is able to do this cause he fully understood that in order to get the best on something you have to settle for good enough on others.
Ando’s style is famous for prioritizing durability and design while compromising on comfort .
Ando has be able to become a top notch architect cause he put a very practical and realistic approach to his work .
He realized that ,in the real world ,predictable and ideal things rarely exist, they are easily found in academic world.
Yet the real world is another story.

When I read his interview many things started to resonate in my mind.
Soon in my career I dove in an ocean of dental courses, where everything showed was nothing less than perfect.
Perfect endodontic treatment, perfect restorative cases, all the patients treated were compliant. with the treatment plan. All of them had esthetic requests, no financial concerns.
Going back to my reality I faced instead a very different scenario. Most of the ideal protocols I learnt in the courses were useful in a bunch of cases. many cases were literally outside of the protocol.

I tried hardly to force my patients to adapt to these protocols. My aim was nothing less than doing perfect dentistry. After a depressing day in the office I was scrolling my laptop every night looking websites of scientific societies or swiping on social media looking stunning cases. I was comparing my photos to that photos….and the comparison was awful.
My scenario was not the ideal one, that was clear …but at that time my self esteem was highly related with the growth of my professional skill so i I didn’t give up and went on pushing my dentistry as hard as possible.
After few years my skill got better and i started having nice cases, yet these cases were just a small part of my everyday work. I was cherry picking cases for courses and social media, yet my unsatisfaction for my daily routine remained. I spent several years in this state of unsatisfaction, trying to push perfectionism in my imperfect reality.
Paradoxically I also got more angry over time ; it was like that collecting a lot of nice cases made more painful to cope with my daily routine, something like i was saying to myself : I have the potential for great dentistry but i am not allowed to do this every time.

With time I also started to collect failures …and some of them happened also on nice cases. This, at the beginning, was a shock for me … even good cases well executed could fail.
My perfectly executed shoulder under a microscope and the perfect seal made by my technician had a decay …my abutment restored under strict isolation and rubber dam and magnification with a fiber post debonded ….with the patient bringing the crown with the post hanging below.
I was forced to rethink what was working in the real world and, slowly, i started changing my vision. Not focusing on impossible ideals but trying to focus on achievable standards.
The real goal in a real dental office is not doing 1 perfect cases over 10, it’s to get let’s say 10 good /even if not perfect ) cases. This is less fancy ,yet this is what is going to change your life. Achievable standards is the key in our work, and after we can adjust these over time. Feeling satisfied doing good cases require a different mindset. I have to admit that for me this has been a long and tough journey. You have, like Tadao Ando, to prioritize.
That’s why for example my restorative work is nowadays focused on sound biomechanical and mechanical concepts and less on estethics. I purposely decided to give priority to long term outcome and function and to get something “good enough “on esthetics.

That’s why also in prosthetic work I ‘ve a similar approach, prioritizing some areas and getting good enough on others.
Understanding this now I am really satisfied after the majority of my working days. I am proud nowadays not to be able to show “nice cases “but to be able to produce consistent dentistry with a good yet achievable standard I can apply on a daily basis.

This has been a 20 years journey for me..a journey to recognize that traveling great distances depends on recognizing that perfection is a mirage -and a journey learning to tolerate the right imperfections ….till I realized that these weren’t real imperfections at all but the reality we really live, outside of the fake world others pretend to live in.
Tadao Ando got famous in the world acknowledging this, where are you on your personal journey away from impossible things?

Next vertical course is on learning real prosthetic dentistry for every day working, next will be 8-9-10 March 2024, limited places, contact me with a private message for further informations!


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