Creating a Successful Practice With Facially Generated Treatment Planning

Many, if not most, new practitioners quickly realize that dentistry is more than taking care of teeth. It also involves practice management, as independent practice owners also serve as the CEO, CFO, COO, director of HR and many other roles of the business. This can lead to a tough schedule combining clinical responsibilities and practice management responsibilities.

Many dentists are carrying large amounts of student debt. Couple that with a tough schedule of clinical and practice management responsibilities and the dentist can quickly be lured into the selling of dentistry and not the practice of dentistry or facilitation of health.

One way that practitioners can achieve some sense of predictability on the clinical side of their practice is to utilize Facially Generated Treatment Planning. This is not unique to Spear Education, nor is it taught and supported only by Spear Education. The systematic step-by-step process varies between teaching institutions and individual educators. The nuances can be respectfully debated; however, there is consensus that the outside-in approach of using the face to determine the proper position of the teeth can have a profound positive impact on restorative dentists, specialists and team members alike. The benefits that this systematic process and philosophy offers clinicians are numerous:

• Predictable treatment,
• Reduction of daily and overall anxiety
• Increased productivity
• Increased profitability

All of this can be achieved while simultaneously resulting in more personal satisfaction for the practitioner and the team. The increase in confidence and competence resonate throughout the practice. This creates an environment in which clinicians can work with the patient to identify appropriate steps toward health, which is very different from feeling the need and pressure to sell dentistry.

Predictable treatment

After incorporating facially generated treatment planning into practice, it quickly becomes evident that it works for every patient. The systematic approach will inevitably help the practitioner confidently diagnose and treatment plan the most difficult looking cases. In fact, the cases that seem so overwhelming at first glance often wind up being simple treatment plans. And conversely, using the systematic process for cases that would have been taken for granted as a “slam dunk” often reveals an oversight of a key component that would have complicated the process mid-treatment or, even worse, after the treatment was complete. 

The intentional flow of patient assessment guides the practitioner to diagnose each category and plan accordingly. Moreover, any compromises to the ideal plan will be evident and can be rationally discussed with the patient virtually eliminating any surprises during treatment.

1. Esthetics: Start with the location of the teeth in the head and face
2. Function: Next, evaluate the joints, muscles and occlusion
3. Structure: Now evaluate which teeth will be restored and how the process will be managed
4. Biology: Finally, evaluate which teeth will need surgery, bone augmentation, root canal therapy, extractions, etc. 

A key component of the process is the use of photography. As such, in the three-day hands-on workshop Facially Generated Treatment Planning participants are guided through an exercise taking a full series of photographs on each other. They are allowed to experience the role of patient, assistant, and photographer to help demonstrate the value and begin the process of intentional implementation in practice. Additionally, many other cases are reviewed and treatment planned, all beginning with specific photographs evaluated in a specific order to help solidify the benefit of trusting the process of the systematic approach. A predictable and trusted start for every case results in a predictable treatment that the practitioner can trust. 

The benefits of predictability when designing and creating a tooth are the same as designing or creating an occlusion and are both comparable to the benefits when building a room or an entire building. Visualizing the end before beginning – having a blueprint of the anticipated result before initiating the work – can be one of the greatest components of anxiety reduction in the dental office. Certainly, some preparatory work must be done before breaking ground, and it does take some time, yet the resulting efficiency and flow more than make up for the initial investment and effort to plan the specific needs and flow for the desired outcome. Mounted casts allow the practitioner to efficiently create a blueprint. During the process, compromises or short-comings may become evident, but the greater gift is the process of actually restoring the case (doing the case) before actually doing the case!

Reduce anxiety

One of the greatest benefits of a systematic approach to compiling data that rationally fits into just four categories is that it frees the practitioner up to learn with the patient. Traditionally, dentist-patient interaction starts with performing an exam, documenting the existing conditions, highlighting what is wrong, telling the patient what is broken or wrong, telling the patient how it can be fixed, and hoping they will agree to fix it.

When assessing and diagnosing the four areas with the patient, the practitioner can wonder and be curious about the findings as they are discovered. The anxiety-reducing benefits of using facially generated treatment planning to systematically visualize the ideal and allowing the practitioner to identify consequences to any compromises are two-fold: 

1. The practitioner can have a fact-based conversation with every patient.
   1. What do I/we see?
   2. What will most likely happen if nothing is done?
   3. How can it be corrected/restored?
   4. What are the benefits of treatment (outcomes from treatment, as opposed to doing nothing)?
2. Any compromise to ideal treatment possibly resulting in intra-appointment complications, less-than-ideal outcomes or a generalized reduction in predictability will be identified beforehand. This will allow both the doctor and patient to understand the compromises and develop a plan to deal with the compromise or the result of the compromise agreed upon.

By learning about the patient with the patient (assessing and diagnosing each of the four categories together), having a fact-based conversation and understanding the consequences of compromise, the anxiety around traditional case presentation and treatment complications is virtually eliminated. The practitioner will have created an environment in which they can thrive.

The use of photographs to learn and diagnose with the patient is an integral part of the anxiety-reducing communication process. The practitioner can “wonder,” be “concerned,” or even “worry” about what is being seen with the patient in real-time.  Sitting with and allowing the patient to take ownership of conditions, benefits, and desires with the assistance of photographs has changed the lives of thousands of dentists around the world. Something as simple as a photographs can bring joy to the daily flow in the office, as opposed to tension, awkward communication, and traditional selling tactics.  

By using photographs to help the treatment planning flow, the time and effort to create the blueprint decreases while the fun and predictability increases. The systematic approach to treatment planning is transferred to the systematic flow in the lab, reducing the anxiety and ambiguity of visualizing the end, which seamlessly transfers to the actual treatment in the chair. The result doesn’t have to be beautiful. The purpose is to see the end, the process, the options and the compromises so that there are no surprises in the process. A calm, confident and flowing day in the operatory is what most dentists are striving and struggling to obtain. The consistent reduction in anxiety in the office is seen and felt by the patients and team, both inside and outside of the office.   

Increase productivity and profitability

Visualizing the ideal restorative outcome often eludes practitioners even after a very thorough evaluation of the patient. As the compromises of less-than-ideal treatment become evident, the dentist can discuss them with the patient to determine the most appropriate plan at that given time in life, while always holding possible the more predictable and long-term option. The result of this is the virtual disappearance of the need to sell dentistry or even the feeling of selling dentistry. 

One of the several downstream outcomes of that is an increase in productivity. The treatment is more logical, resulting in more organized and efficient scheduling. There are also less no-charge “adjustment” appointments and less no-charge post-operative “emergencies” to clutter the schedule and distract from other appropriately planned and scheduled restorative treatment appointments. As a result of the patient not feeling “sold to” and the patient seeing the value, it also allows the accounts receivable system in the office to run more organized and efficiently, minimizing unnecessary time spent collecting money. Starting every patient with a systematic approach to treatment planning creates leverage for more logical and organized systems throughout the office flow, resulting in a more predictable bottom line.

Personal satisfaction

Anxiety, depression and unethical choices can feed off of each other, creating momentum for a downward spiral from which it is difficult to recover, let alone reverse. Many practitioners feel a constant pressure just to survive. Financial pressure, treatment complications and patients saying “no” to treatment can create the perfect recipe for the spiral. Facially generated treatment planning creates a platform for reliable systems in the office, consistent conversations with patients and an office culture that supports health.

The systematic and predictable system eliminates the need to sell dentistry. Instead, the practitioner and dental team can facilitate health, helping patients make healthy and appropriate choices. If anything is being “sold,” it is health, which is a commodity in which the majority of patients have an interest and desire to acquire. That said, the practitioner has the opportunity and honor to work with the patient and for the patient, not on the patient. As a result, the practitioner will develop more confidence and competence creating momentum for an upward spiral that will feed itself for many years of rewarding and satisfying healthcare, creating beautiful teeth with predictable function and long-lasting comfort for which patients will pay with gratitude and appreciation.  Inevitably, the benefits spill over into life outside of the office, creating more personal satisfaction and health in all components of life and relationships. 

(Click this link for more articles by Dr. Kevin Kwiecien.)

Kevin Kwiecien, D.M.D., M.S., Spear Faculty and Contributing Author