The only constant in the world is change. For some change and adaptation to change is welcomed and is as normal as the passage of time. But for many people change is difficult. We get set in our ways, we become complacent.

Things are going well, why do I have to change? I suppose you don’t. There are many people who are happy with what they have been doing in dentistry and in life and will stay at that same level all long as they can. Who am I to say that you are wrong?

The problem is we do not stay the same for very long. Either we grow, or we fall behind. But change takes some risk if your intent is to change and grow in a positive manner.

There is a risk that if we change and do something different, we will fail because we cannot predict what the future results will be. However, if we get good advice and training from people that have tried these “new” ideas with successful results, we can take their ideas and incorporate those ideas into our lives.

Raised old school

I grew up with the ideals of courtesy, integrity, respect and hard work. The importance of family values and sharing with others. Family meals and conversation, spending time with the ones you love. My wife and I have tried to instill these values with our children and grandchildren.

As I entered dentistry, I incorporated these values into my practice. I developed relationships with my team and our patients. Lead by example. I have a very “old school” practice. I believe that is also true in my relationships with my team and my team’s relationship with our patients.

However, when it is time to perform dentistry, I am very new school, but with an old school thought process.

A dental relationship starts old school, like a visit with a friend. I sit facing my patient, knee to knee, eye to eye with a pen and paper, and get to know them before I hear their dental concerns. In the background, my assistant is typing notes into a digital record. When the visit is completed, I review her notes and add or modify where needed.

Doing comprehensive care, changing lives, building a successful practice all starts with trust. Building trust is very old school. At the completion of care for a patient have you ever asked your patient why they allowed you to do the care for them? I have.

Trust is the No. 1 answer I hear. I usually respond, “Thank you for allowing me to do my best work for you.” Sometimes that provokes a question from my patient. This is also the perfect time to ask for a referral.

Growing in the new school

Scanners, CBCT, MRI, milled restorations, and more. Yes, these are the new technologies changing how we practice. But I believe technology is a thought process. When I take a face bow of a patient I routinely hear, “Why didn’t my other dentist do this?” I explain why I use a face bow and the benefit to them.

Patient with a face bow.
Figure 1.

I do believe some old school things in clinical dentistry may never change. The biology of how our body responds to care should be constant. However, never say never. Human genomics may make science fiction reality.

New school technology has been incorporated into my practice with an old school thought process. At Spear we teach the principles of a Facially Generated Treatment Plan by using a pencil and tracing paper over a photograph of a patient’s smile.

It works to develop the thought process as to why we create what we do. In my office I use my computer and templates to create a similar outcome. Using new school technology with an old school thought process.

Facially Generated Treatment Planning.
Figure 2.

Sitting with patients and discussing their concerns using a new school approach has enticed patients to ask for care. It seems to me that when a patient is engaged with their care and understands what has happened and how it will be addressed allows a fairly seamless progression.

While it is important to add new school technology (CBCT, MRI) for diagnosis when indicated, most patients can relate to photographs and drawings. How many patients have said to you when you show them digital radiographs, “They look like toes?”

Understanding airway and the options to address airway has created an evolution to my treatment planning that has opened my eyes to patients I see. Not only do I get to “fix teeth,” I have an opportunity to help my patient get healthier by breathing better. Very new school!

The days of digital articulators and digital wax-ups have arrived. I am still old school here. I want to have the practice and information I can glean from models of occlusal function from what I will be doing in my patients mouth. But if you have made the change to new school, you probably have done enough old school to be thinking old school as you use new school techniques.

Dental models.
Figure 3.

Until the day comes when we have computers prepare our patient’s dentition intraorally, we will be doing so old school with some new school updates. Electric handpieces with increased torque allow a different level of control versus air-driven. I cannot image how I ever worked on a patient without magnification and an LED headlight.

While I do not know many that use 8x loupes as I do, many do use microscopes. The better you can see, the better you can do!

Consider going to higher magnification. The new school technology has made higher magnification loupes a comfortable focal distance and field of vision.

Without a doubt, preparation design is new school

The materials we use today and our ability to adhere them to tooth structure requires attention to detail. To use an old computer programing term, “Garbage in, garbage out.”

Case example.
Figure 4.

How do you temporize? Yes there was a time I was very old school when I would block carve jet acrylic and restore with porcelain fused to gold or gold.

Case examples
Figures 5A-5C.

Today, using Bisacryl or milled PMMA is the standard for me. Some practices will scan preps and mill temps while the patient waits. Or, just mill the final restorations! Very new school.

The miracle isn’t in the technology but what you do with it. The magic happens when you have the before pictures up on your computer monitor (new school) so you patient can see it while you give them a hand mirror (old school).

The transformation is in the provisionals. They are a blueprint of the final restoration. Most won’t see an enormous change from provisionals to the final restoration.

How do patients judge old vs. new schools?

Before and after case examples with provisionals.
Figures 6A-6B.

Then one of a few things will happen. “Wow,” crying, or silence.

The third concerns me. Now it is old school time.

Wow! Your patient is probably pleased. Crying. I have several patients cry at this stage because they are experiencing an emotional life changing experience. Silence. Why? While not common, the silence is usually from your patient not recognizing who they see in the mirror.

They may be second guessing the choices made. In all cases I like to see my patient in a week or so to confirm all that was done is correct, without anesthetics clouding the picture. The next visit allows us to address any concerns.

My impressions are PVS. Scanning will work well also. Once all of the data is sent to our lab they will create the restorations digitally. The final restorations in this case were E-max cut back with porcelain layering.

The final restorations were E-max cut back with porcelain layering. So when is the right time to change? When the student is ready, the teacher will appear. Repetition works.
Figure 7.

All the best on your journey, may it lead you to where you want to go!

Carl E. Steinberg, D.D.S., M.A.G.D., L.L.S.R. (www.DentistryinPhiladelphia.com) is a member of Spear Visiting Faculty and a contributor to Spear Digest.


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