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American Academy of Cosmetic Dentistry Accreditation Workshop

Part 5 - Finding cases

Dr. Bradley Olson, DDS
Dr. Bradley Olson discusses how to find the best patients for AACD Accreditation case submission.

Alright so finding cases. We always get that question. How do I find cases for accreditation How can I workmy way through this process because you've told me that case selection is so critical to success. How do I find the right cases So a great place to start is right in your own office. There's nothing quite like a staff member who is on board with what you're trying to achieve, who's rooting you on, who's assisting you every step along the way and has one of these criteria that need to be covered in there own smiles. Okay. You're going to be providing the work for them anyway more than likely. So this is a perfect opportunity for you to use them plus great opportunity especially when you start talking about case 2, 4 and 5 which require lots of little touch ups, refinishing, re-contouring, different steps along the way. It sure is nice to have a staff member who can hop in the chair at 5:00 in the evening or first thing in the morning or right at lunch or when you have an open spot in your schedule and let you get in there and do some manipulation or changes some things around. So, staff member can be a great asset, family members. My accreditation, five cases, two family members, my father-in-law and my wife. They were two of my cases on there. Again, nothing quite like the patients of a family member. Understands what you're trying to do, is very patient with you, allow you to do more multiple try ins, you know, a busy business man who, you know, flies back and forth to Hong Kong on a regular basis and spends, you know, 200 days away from home a year and you chose to do accreditation cases on them, you got to think long and hard about that. You know you got to think about what's the follow up going to be. What's going to be the follow up photos What's going to be my follow up touch-up work that I'm going to have to do Are they going to take care of, all these factors are going to play Yes. Yes. Got them shot them raw. That's right conversion can go the other way. Okay. Existing patients. Now remember you're going back. You guys are geared. You're geared for action now. You're going to go back and you're going to look at your cases. They're sitting in the lab or cases that are coming through diagnostically for workup. You're going to go back and you're going to start doing your exams on Monday and you're going to be looking at your patient's a little differently. You're going to be looking at some of the things that they need, some of the things that you can recommend to them. How they might fit one of these criteria. Now look at your new patients that way when they come in for their examinations. You're going to talk to them about some of these things that would ideally fit into this spots. This was an interesting one. I had a friend of mine who took the workshop. She's now in the accreditation process. And she went home and lives in West Virginia and she works in the area where she said, you know, Brad the amount of cosmetic dentistry I do is limited to some degree. I tend to have bigger cases more compromised type of cases. And she said but I'm going to try something. So what she did is she sent out a letter to all her existing patients telling them exactly what she was going through with this process. She just shared with her whole patient base this is what I'm doing. This is what I'm going through. She didn't get an accreditation case out. But she wound up getting three or four cases of business, of just treatment, of people who came back in, revisited some of these ideas that she was talking about in her letter and they came in to do the work. So you say what's pertinent about that. Well here's what she shared with me which I though is interesting. The way she views it now is that if a case comes along that fits the criteria and seems to be ideal, she's willing to give that dentistry away or do it at a significant discount because she feels like from that list right there, she got three or four cases that she wasn't going to probably get or have done. So she feels like she's ahead of the curve now. So again up in this area right here you're probably doing either free or pretty significantly discounted dentistry so why not offer it to an existing patient if you feel they fit the right criteria and if you feel that they can work for you. Personal example case type 5. Patient comes in, she's 16 years old and she's field hockey and she's taking off section of her central incisor. And she also has a diastema. I spent a ton of time closing that space and taking it through class 4. So I actually did both of those. I did both of the components of case type 4 on her and I worked very hard on that. And one tooth was not exactly the same shade as the other a real challenge so I work really hard nailing down those two teeth but I got them to where I really liked it. I send it to my mentor. He looked at it. He sent it back to me and goes Brad looks nice. I really think you've done a nice job. That's a good case. Have you considered case type 5 Look at the laterals and cuspids again. I looked at the lateral and cuspids not too bad but not ideal, certainly could use some enhancement but minor, minor. Called Sandra's mom on the phone, I said, I'm going through just want to bring you up on the speed. You know she said by the way thank you. Sandra is thrilled with her two front teeth. They look great. We got prom coming up. She's very excited. Her teeth aren't going to look funky for her prom. She's very happy about this. I said well I got an offer for you. I said I did the two front teeth. They paid full fee for me to do those front teeth. I said how about Sandra comes in, I would do the other four teeth at no fee but I'd like to enhance her smile and part of this is a process that I'm going through. The answer was, what time do you want her there and how often. Sandra was thrilled. Mom's thrilled. I passed accreditation case type 5. To me that's a win, win, win. Okay. Everybody across the board won in that particular scenario. So again I'm not telling you that's the way you need to go. I'm not telling you that's the right or wrong thing to do. Just keep it in mind as you're going along to where, what can you do for the patient if they really fit these ideal molds. Now we'll also though caution you the other direction about getting too cavalier with that. We do do this for a living. Okay. And you don't want to just start giving away dentistry. Everybody walks through the door, hoping one of your accreditation cases come along. I'll be pretty, I'll make sure I was pretty locked and loaded. First of all I want them all to pay full fee. That's number one. But number two is if you decide that you can give something away, maybe you're doing the six anteriors and you're going to throw in a couple of bicuspids, just because that buccal corridor needs a little additional health. You know maybe something like that. But again I still want full fee if I can do it. But certainly you can think about an offer, you can think about working with the patient who is willing to put in the extra time. Cause you know this is their time as well. They're going to give you some of their time because you're going to be extra fussy as you're going along. May require extra try in, may require extra touch ups with the resin. Okay. Photo library you go through it and review it. Just look through and see what you have. See what's available. What do you have already in your office that you have the before shots on. Cause remember you haven't treated them yet so you can choose the before again just in raw and then you can talk to them about do they fit with what you're trying to do. You're specialist. You can engge them in a couple of different ways. One of the ways, engage your specialist in what you're trying to do. Oral surgeons are taking out anterior teeth. That can fit case type 3. Endodontist are treating anterior teeth. That can fit, be involved with case type 2. Orthodontist, periodontist can be treating patients in tooth movement. Maybe they're congenitallymissing some anterior teeth. Maybe they're leveling some gingival heights and moving teeth around but still need the final touch to the treatment. So again having your specialist engage in what you're trying to do also their staff. If you want to and they're nearby just say you know I'd like to offer your staff a free consultation. Have them come by and just look and see if there's somebody on the staff that would be interesting in going through this process with you. Spouse's friends, teenage kid's friends, again you know networking. If your spouse knows somebody and says you know what share with your spouse or your significant other, what you're going through, what your process is. Judy at work. She's got the worst looking front crown. I mean I tell you every time she smiles, it drives me crazy. Now you got a different way of introduce, you hate to go to Judy and tell her that her front tooth looks funky. But maybe now you got a different way you're going to approach it. You're going to approach her in a way of saying, hey, you know my husband or my wife is going through this process and why don't you just consider a screening with them or something like that. Let them do the presentation. You don't have to do anything more than that. Teenage kids the same type of thing. They're going through braces. Teenage kids are ideal for case type 5. I mean are you going to be preparing front teeth and doing all this if a teenager needs a smile design. That's where I use composite resin in my office. It's for 15-year-old or 16-year-old who has smile design issues. I'm not putting porcelain on those cases. That's just not my comfort zone. The resin is definitely in my comfort zone. They give them a more attractive smile. Keep staff looking out for you outside of the office as well start looking now. When you get back to it, you're making the commitment when you back and you're going to start looking at your cases Jeff, thinking about the docs that you're' working with. You're going to start looking for cases as they come through the door. Okay. If you go back and by next week you don't have all five accreditation cases lined up, it's okay. Take a deep breath. Don't get frustrated. It takes time. Maybe you can get lucky and they can just fall into your lab, boom, boom. You could also find four of them fall into your lap and you'll spend three years finding that fifth case. I mean it just; I've heard every combination under the sun. So it's again patients because remember it only takes one. You only have to demonstrate that case type 1 one time. You don't have to show it five separate times and five separate cases. Just take one case to forward your way through that. Okay. So talking about how case are examined then we're going to look at some cases here together. But there are five examiners in the room, majority rules. Cases are completely anonymous. We have no idea who you are when that case hits the screen. We talked about before in your submission. One case type per exam session. Pass rate has been over 60% over the last three years. So you say well that's not the greatest news I want to hear. That means 30% some of the people are failing. That's true but you have to stop and think about it from a different perspective on that. Remember we talked about before of getting feedback. Remember we have a certain percentage of people who submit cases with a full knowledge that they're not going to pass. They are ready for that news. They've already accepted it. They're ready for the news. They just want to see what the criteria are going to be and then who knows. Maybe it's not that far off, maybe I will pass. You know there's always that hopefulness that maybe the case could pass. But they're ready for it. They're okay with the fact that they submitted it for the feedback. You also have a certain percent of folks who submits stuff that I'm going to show you as the day goes on you're going to be like you're kidding, right. They didn't really submit it with the blood on the shot. Did they Yeah, they did. Yeah they did. So again some people are just not taking the criteria very seriously. They're just there. So again that percentage is a little bit deceptive in terms of a pass rate. Okay. Criteria sheet. Again, we'll talk about that this afternoon as we go through there and this is the examiners score card here. I know it's a little blurry the way it looks. But basically what these columns say is there's a place here for you to write the criteria number down, for examiners write the criteria number down then it says minor, major, and catastrophic and it's scored by points. So 2 points off for that, 2 points off for that, 4 points off for that, minus 4, minus 4, there was a plus 1 given for the overall end result of the case. So examiners have the perogative of checking this box down here if the overall look of the case is beautiful, they give it a plus 1. And the case was minus 7 and that case was a pass. The pass doesn't matter if it's minus 1 or minus 7. A pass is a pass. It doesn't matter if the pass is 5-0 or 3-2. It's a pass. So again there is a zone. There is a range here that allows that to happen as we go through. And again I keep harping advanced accreditation workshop but it's just a great opportunity to really do a lot of this in detail at that point in time. Okay so once you've completed your five cases and they've all passed, you have one more step and that is to pass your oral examination. And what we do in that is we're testing problems solving skills. We want, we give you a case and for it you will have 30 minutes and you're gong to review the photographs and the history that go along with that case. And you're going to work up a generalized treatment plan based on the patient's concerns and what you see in the photographs and you're going to present that to the oral exam team. While you're in doing that, the oral exam team is reviewing your five cases and they're going to pick some of those cases to discuss with you. You need to know intimately how you handled that case. That's going to determine your pass or fail on your oral examination. You can't come in with a case that shows beautiful veneers with ideal tissue positions and beautiful gingival alteration and say I don't know I gave it to the periodontist. He made the gum looks good. That doesn't get it done. Its okay that it went to the periodontist, you have to understand the principles by which they attained that and who is guiding the ship to get that. Oh, I did. I give them a diagnostic wax up. I give them a surgical stent. What I did is I asked for this cuspid to central and central to cuspid all be lined evenly. I asked for the lateral incisors to be a millimeter and you went through the details. Well how did they know whether they can just trim tissue or they have to trim bone Well they sounded the bone and they, you have to be able to answer these questions. You have to understand the principles that went into your case to achieve that success. Now again that pass rate is pretty good. You have to admit. Okay so far almost everybody, I say almost everybody has passed. But you will not pass it if you cannot verify what we see on the screen. So you have to be able to defend and understand your work and what you've done.