Reality in Dentistry
The NO.B.S mindset to treat complex clinical cases (almost) impossible to find in books and conferences, thanks to Vertical Preparation 3.0
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"But that's the stuff of books!"
That was the sentence my father said at almost every dental conference we attended over the years.
Back in those days I had no experience and to be honest…I was having a hard time really understanding my father’s words.
My head was still on books and my hands had never touched a real patient.
So for me books were everything… a window to the world I dreamed of belonging to.
Of course, my curiosity was great and there were many times when I asked my father what he meant, but the answer was always more or less the same:
“You will understand it when you become a dentist.”
And in fact, that was exactly what it was.
In those days any form of preparation other than horizontal was seen as pure blasphemy.
All the books, conferences, and universities popularized the horizontal method and its variants…
…while vertical preparation was pure heresy.Drilling soft tissue and taking blood baths in the patient’s mouth was not dentistry to the experts … but “Child’s Play” with Chucky the killer doll.
Of course, I had no choice but to start there:
Horizontal Preparations and Shoulders.
Back in the day, I didn’t see it as a problem.
The case studies reported in books, lectures and in universities were incredible.
Clean shoulders on a carefully retracted dental sulcus … completely dry impressions without a single drop of blood.
That was excellence, and I wanted excellence.
So I began my career to the tune of horizontal preparations, what was considered academic excellence.
The rules for doing a great job with horizontal, at least on the surface, are simple:
- A good patient with a good stable mouth opening,
- Good oral hygiene before / along treatment
- Magnification both in office and lab
- Perfect handling of provisional restorations
- Perfect management of soft tissues for the impression
After some time, however, I began to understand my father's words:
Yes, because while the responsibility is on our ability to perform the work with care and precision …
…on the other hand, there are things that are out of our control.
There are patients with small mouths…
…poor dental hygiene…
…uncooperative…
…elderly people with problems due to old age…
…or even the woman with a teaspoon stuck in her palate who entered my office a few weeks ago.
Patients, their lives and their mouths are not all the same.
This, of necessity, has made it difficult to deal with cases that are complex or even slightly removed from the perfect clinical cases in lectures.
But that’s not all…
Over the years I realized how there were many more variables than that, for the simple fact that we dentists are NOT surgical robots…
…but human beings.
Some are more precise and some less so, but everyone makes mistakes.
And in our field it is very easy to make mistakes…
Because we only get ONE chance.
If our preparation is done wrong, if the sulcus are done wrong, if the shoulder is done wrong, if the impression is done wrong…
…we have no way to really fix it.
And in the real world running into these kinds of mistakes is easy.
All it takes is an uncooperative patient, a moment of inattention, a distraction, an unexpected problem.
I finally understood:
That was “book stuff” because in books you can’t consider all these variables.
But even so, books and lectures treat the dental world as if everyone has equal mouths.
As if everything depended solely on the faithful and accurate execution of protocols.
Yet I was not alone in finding myself redoing impressions for a small bubble on the margin….
…finding a recession on the day of the structure test…
…or finding recessions some time later…
…finding oneself with unmodifiable emergence profiles…
…stressing the impression…
…shoulders covered with inflammatory gingival tissue from a small distraction or defect….
And much more.
It was unreal dentistry… and not in the sense of being so effective as to be unreal…
…but difficult to apply to complex (or apparent complex) clinical cases.
In a nutshell:
It works, but only with ideal clinical cases.
And, in the course of my experience, I found that only about 15 to 20 percent of these cases came into my clinic.
So…
What was I going to do with the other 75%-80%?
Discard them? Is it really ethical?
Pretend that nothing was going on?
Many years have passed since that realization and…
…although it may seem too confident to say…
…these are just old problems for me.
They are things that I have already solved … and, indeed, have allowed me to improve our work protocols even more.
But then why did I tell all this?
Because there are hundreds, thousands, perhaps millions of dentists in every country in the world who feel as I did at that time.
Since 2014 I have been trying to lend my support online and live to those who want to find a different path, but today I wanted to share something more personal:
My story. The path that led me to question and ultimately refute my own beliefs.
It is a book that starts with our mindset and only eventually gets to the technique.
Because it makes us reevaluate our goals as dentists, particularly toward the patient, but not only.
That is precisely why it is not a book for everyone.
It is NOT for people who like to follow standards.
It is NOT a book that tells you what you want to hear.
It is a book that spits reality in your face–but also gives you a way to deal with it as best you can.
But only if you are ready to question everything you have studied and applied up to now.
If all this does not scare you….
In “Reality in Dentistry” you will discover how I and hundreds of dentists around the world have achieved…
FREEDOM.
Freedom to move many steps outside the clinical appointment, where we have the time, and not in the mouth….
…Freedom to manage emergence profiles on temporaries without having to change preparations…
…Freedom to manage zeniths…
…simplicity in dental preparations ergo an elevation of daily quality in the standard of preparation, especially in difficult or space-constrained pieces…
…simplicity in impression taking…
…elimination of the undercut below the shoulder with less need for horizontal divarication…
…simplicity in provisionals…
…greater margins of maneuver in minor impression inaccuracies…
…in other words, what I call “the magic of VertiPrep 3.0 versatility.”
You can download "Reality in Dentistry" in format for free!
What you will read will only be a prelude to the final version of “Reality in Dentistry” that will also be released in the future in physical format (but for a fee).
For now it is absolutely free, but as soon as the book is finished (soon) this page will be removed.
I hope it can help you first of all to think about our amazing world….
…then, if you would like to find out more about VertiPrep 3.0 and a “REAL” way of understanding dentistry I will be here waiting for you with open arms.
“When they zig…you go zag!”
Marco Maiolino
Studio Maiolino c/o Studio MEV S.r.l.
Via Matteo Beneventano del Bosco, 4
96100 Siracusa (SR)
P.iva: 01911780896