Quality dentistry is not guaranteed by attending multiple continuing education seminars, especially when prosthodontic procedures are involved. It certainly helps, but in fact “quality” and “dentistry” may be mutually exclusive. Mutually exclusive due to dentistry’s multiple steps process. To achieve more than a 90% successful outcome for any given dental procedure, labour intensive attention to detail is required.
A successful outcome is only achieved if each and every step is performed at a level which will guarantee almost 100% success. If we examine the steps needed to create a single crown the likelihood of that happening is remote. The tooth in question may or may not be vital, may or may not suffer from periodontal disease, may be fractured or may contain a large restoration. All of these scenarios point to added difficulties and additional steps. If it is also an anterior tooth we have aesthetic concerns and we haven’t even started the preparation yet. Next, we have to look at the patient’s medical and dental history. Perhaps we are dealing with a dental phobic or a severe gagger with multiple allergies and a history of TMD. All of these preoperative concerns impact on our ability to deliver a quality restoration; add to this, the involvement of a laboratory component in the production of the final product and then at the end, fitting, occlusal adjustment and cementation and the likelihood of success is doubtful.
It is important to add up the number of steps required for the successful completion of any dental procedure. If for instance there are 10 steps for completion and up until now a 90% success is considered an acceptable goal, This would mean (that we accept) that each of the above steps has a positive outcome 90% of the time. Using basic statistical analysis for all 10 events to be true with a 90% success rate, the probability of a successful outcome for the final product is .910 or 35%. Obviously, not very impressive.
In the duty bound world of dentistry, it is not easy to achieve quality results and to complete these procedures within prescheduled time slots. But this always seems to be the goal of practice management gurus. It thus seems to be a truth that, within multiple steps processes, quality care is not attainable if we only strive for a 90% success rate.
If we use 95% as the goal for each step, the probability of a successful outcome becomes .910 or 60%. This is still not quality work. This small 5% increase in the quality of each step has changed the outcome from 35% to 60%, an increase of 70% in total successful outcomes.
In prosthodontics, as in all disciplines in dentistry, attention to detail is the watchword.
How many times have we allowed a less than detailed impression to slip through because we were running behind. How many times have we been tempted to cement a less than quality restoration. How many times has the person responsible for the pouring of the master cast and mounting same been the least skilled person in the laboratory. I personally believe that we are all capable of producing quality dentistry. The problem lies in the pressure of practice when the focus is on production and the bottom line instead of quality of care. We also have a distorted view of our own worth. Of course, it is difficult when you constantly read the salary levels of the CEO’s of banks and the skewed earnings on a per hour basis of attorneys.
The key, I believe is always striving for excellent quality at each and every step of the procedure — accept no less from yourself, your staff, your laboratory and all those involved in the day to day operation of your practice. You might have to work a little longer each day but that is a small price to pay for quality. As I have written many times in this journal that we are all not “A” athletes and we certainly are not phenomes. Most of us are average, but very capable of quality work, just not at the same speed.
Special thanks to Raymond Monette CEO of Synca for the original idea. My son-in-law Adrian Kaplan for Phenomes.
I am deeply indebted to Oral Health for allowing me the opportunity to enrich the practice lives of 18,000 dentists in Canada.
