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The Journey and its lessons

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It was 2001… freshly graduated with my excellent 110 cum laude I entered my  “family” office in my city of birth: Syracuse.

My father ran the studio in the “old way”, we didn’t work by appointment but by order of arrival, the rubber dam was that “thing” seen at conferences but which, in my father’s words, was “only used for courses”.

Endodontics involved multiple appointments and was completed by using a bit of cement with a gutta cone embedded in the middle and “decapitated” with a red-hot instrument heated with a lighter.

Appointment management was simple, 30 minutes per appointment including tidying up, the instruments were reduced to a minimum, the price list was truly simplified: a flat rate of 50,000 per session for each 30-minute appointment. If 3 appointments were needed for a molar, the fee was therefore 150,000 lire.

Only one assistant  from picking up  telephone (which rang continuously) to help doctors  (to the extent possible) to tidying up and sterilization (even more to the extent possible).

Lots of mobile prosthetics… lots of extractions and lots of “crowns”.

Not even 25 years ago…but it seems like a lifetime ago.

Needless to say, I arrived with the arrogance of a fresh  graduate who, thanks to the courses always paid  by his father, passed out opinions on how good dentistry should be done.

The first year of my profession I took a course in conservative dentistry, endodontics and prosthetics and, without even an assistant  to help me, I tried to put into practice what I had learned, certain that that knowledge and those protocols were the main road to personal success and of study .

Doing that dentistry was not easy and it took years to develop the skill that allowed me to document beautiful cases.

To do this I “forced” the patients to the protocol. However, managing the studio was very tiring. Carefully following all the “prescribed times” literally took me a long time and messed up the management of the treatment plans a lot… especially considering that at the time there wasn’t even a secretary or someone who coordinated the treatments, and, needless to say, not even a management software but a nice leather diary from the Italian commercial bank with everything written on it.

Retreating a tooth with a lesion and before doing  a crown,  doing  x-rays at 3-6-12 months to check the success of the treatment meant in the real world losing sight of the vast majority of patients, only to then see them again perhaps with a fractured tooth to extract it.

Doing a posterior crown lengthening and waiting those canonical 3-4 months to finalize the treatment was madness… considering, moreover, that I saw at least 5-6 subgingival cavities a day.

I tried to force the patients by giving rigid directives: “here we work well: either crown lengthening, endo and then prosthetic finalization after maturation of the tissues or extraction” …..with the result that the extractions increased (and also the implants ) which was absolutely not my aim .

I therefore began in certain cases to “skip” steps such as doing simple papillectomies (one minute of operating time) instead of crown lengthenings, discovering that these patients not only did not develop pockets and bleeding (as feared by invading the famous biological width of the famous 3 mm) but they were also better than the “elongated” ones, I began to oversimplify the occlusal modeling and remove the stains discovering that no patient complained, on the contrary…

I began to develop the idea that, often, we dentists have a point of view distorted by courses and conferences where every detail is magnified on a 10 by five meter screen. Details of exquisite beauty but which could only be appreciated by an expert, and which often did not even lead to better clinical results

After years of horizontal shoulders and preparation under magnification (already in 2006 I bought my first microscope) I started doing vertical preparations, at the time the “supreme” evil, illegal preparation, only to discover that they worked better than horizontals.

I could go on for hours describing all those changes from the “high road” that I did , but it would become boring; but the main point is that each change has led to a shortening and simplification of the procedures in the studio.

Each of us has different priorities within our studies… over the years I have tried to find a way to combine good clinical results with an optimization of time and simplification of procedures. Sustainable dentistry that I can do every day on every patient, even if I have a fever and argued with the assistant.

And with that priority in mind, I’ll gladly sacrifice some enamel in order  to make a crown if cementing that overlay is going to be akin to a battle of waterloo.

I don’t think my approach is valid for everyone, but there is certainly a portion of the dental world that would benefit from it.

And I claim the right to share certain clinical approaches that , in my hands, have given success over the years without having to wage a “war” just because they are different from the “official truth”, a truth which, over time, is also subject to changes. Do we want to talk about the dogma of the buried implant of “modern” implantology when our Tramonte were already carrying out immediate loading?

Because, as Nassim Nicholas Taleb says: “For real people, if something works in theory, but not in practice, then it doesn’t work.

For academics, if something works in practice, but not in theory, then it doesn’t exist.”

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