Working Better, Not Harder Key to Success in Dentistry Today
ST. LOUIS, Missouri - The key to succeeding in dentistry today is not necessarily working harder, it is working better, according to a speaker at the Updates in Contemporary Dentistry meeting.Robert C. Margeas, DDS, who has a private practice in Des Moines, addressed a packed audience and said that he has been very successful, even though a majority of his patients are middle class residents who have been hard hit by the economy.
"I don't have many patients that can plop down $30,000 for dental work," Dr. Margeas said. "Most of my patients come in and tell me "I want my front teeth fixed." The only way to be more profitable [with these patients] is to be more efficient." Being more efficient starts with making the right diagnosis, then selecting the right tools and products for the work that needs to be done, he said.
Making the Right Diagnosis
Dr. Margeas noted that most patients who present to a dental office with wear on their teeth probably have gastroesophageal reflux disease (GERD), and many are unaware of it. For these patients, referral to a gastroenterologist is a good place to start, because treating the GERD will prevent future wear problems after the restoration is completed. Next, he said, treatment options include opening the bite. He cited one particular patient who had wear on the backs of his teeth. Dr. Margeas added wax to the original teeth, which helped opened the bite till the teeth touched, then he focused on even contact. He then focused on making a polyether impression, including trying it in, sand blasting it, etching, and then fixing it in place using a fourth-generation adhesive. It is in these phases where product knowledge can be helpful, Dr. Margeas said.
Discussing different types of etchers, Dr. Margeas noted that while the total-etch adhesives require phosphoric acid etching and are applied in 1 or 2 layers, the self-etch adhesives have the acid built into the adhesive. The etch-and-rinse category includes both 3-step and 2-step adhesives (such as Bisco's One-Step Plus) that remove the smear layer; whereas the etch-and-dry category includes 2- and 1- step adhesives, such as All Bond SE, that modify the smear layer without removal.
"I have been using All Bond 3, because I respect [Bisco president] Byoung Suh and the products he comes out with," Dr. Margeas said.
Choice of cement also will influence treatment outcome, Dr. Margeas said. He explained that there are several types of luting cements on the market, including light-cure only, which is generally more for veneers or thin restorations that light can penetrate, and dual-cured, which is for restorations where light cannot penetrate.
He discussed the Duo-Link from Bisco. He said it is a dual-cured luting cement with ultrafine filler particles and is intended to be used with an adhesive system. He noted it cures well.
Dr. Margeas said that durability of the dentin bond/seal depends on the ability of the individual adhesive/priming agent to effectively counter the movement of water/proteolytic enzymes within dentin structure. He noted that Bisco is looking into inhibitors of matrix metalloproteinases, which are responsible for this degradation, as a way to preserve the bond.
Dr. Margeas advised the clinicians in attendance that they should use the products that they are most comfortable with, but he also encouraged attendees to try new things if they feel it will improve their practice. He mentioned the fact that he recently tried the Gingitrac VPS retraction material from Centrix. He said this material simplifies the restoration process by eliminating the packing cord and cleanup. "It will retract the tissue, it was very good," he said.
Summarizing his presentation, Dr. Margeas urged audience members to research the products they work with, and focus on what works for them. "Remember, the magic is not in the magic wand, it is in the magician," Dr. Margeas said. - Colleen Platt
Disclosure: Dr. Margeas' lecture was supported through an education grant from Bisco and Centrix.