American Academy of Cosmetic Dentistry Criteria Workshop

Part 7 - Top ten reasons for failure part 3

Instructors:

Dr. Bradley Olson, DDS

Dr. Bradley Olson, DDS

Dr. Olson is one of approximately 300 dental professionals internationally to achieve Accreditation status in the American Academy of Cosmetic Dentistry. In addition, Dr. Olson has achieved the AACD’s highest credentialing honor by becoming the 39th member awarded Fellowship in the Academy.

Final two reasons that AACD accreditation candidates fail a case submission.

Reason no. 2 case selection. Okay. For me this was my number one now this morning. This is a big one. For me, it's where you start looking for your accreditation cases and where you're going to take them on. Trying to start with this and bring this home for accreditation is going to be incredibly difficult. Of course they need restoration. Of course this patient needs care. This is a great case. I love when that case comes to my office. I looked forward to helping that patient but not for accreditation. There's too much happening here. There's too many going on. There's too many teeth that need to be treated. Okay. This is going to be tough. Look at all the stuff we got going on here in terms of tooth colors, in terms of existing bridge, in terms of missing tissue and the bone and the side of missing tooth. We've got lots of stuff happening here. Now am I telling you don't do this case You cannot do this case. I never tell a candidate they can't do something. Because I don't know your skill level, I don't know your talent level, I don't know your discipline, I don't know what you're involved in. I don't know anything about you from that standpoint so I'm not going to tell somebody they can't do this but I'll warn them they're about to dive into a very difficult case. Some candidates tell me I've got it. I got this under control. Fine. You got it. Go for it. Just are you recognizing the problem Yes. Here are the problems. They'll list the problem they see on there. Okay. They see them. That's great. They'll spend a lot of time on that case. There might be an easier one out there. So my advice to them would be go ahead and do this. Well this is my mom. Well then okay. You're going to do it for mom. You're going to do all this work for mom. That's great. Make mom look great. If it happens to run the accreditation gamut, beautiful, but if it doesn't keep an eye out for another case while you're working this one through. Why is this case a poor case selection Seeing if you're still awake here on this afternoon after your full bellies, dark room. Why is this case a poor case selection Stumped you. Axial inclination. Gum line. Placement of the implant. Location. How about the fact that the implant is already there. I tricked you. It's protocol. Okay. This patient comes to your office; this is not an accreditation case. It's great that the specialist referred them over cause they know how good you are and they know you're going to restore this and make it look great. The problem is the implant is already in place. Your preoperative radiograph and your preoperative photograph shows either the missing tooth or the falling tooth. But it does not show the implant already in place either radiographically or in the tissue site on there. So that fails on protocol. You can do a perfect job with that and that's still is not going to make it. Which case type are you going to do here I don't know. 5 Okay. That's a lot of resin work. Yeah, tough. It's tough. Now this is a tough one to bring home. What's the final expectation for this patient Listen doc I don't mind some spaces. I just, I like some brighter teeth. I don't want them as big. I want some nicer shades. Yeah, that's a good idea. We're ready to go with a case like that, just not for accreditation but there's lots of good you can do with a case like that. It's just not going to be able to bring this to accreditation. It's going to require a lot more workup than I can certainly tell from this photograph. This photograph does not have enough information for me to know what I need to do to care for this patient, let alone try to bring it to accreditation. Okay. Get that kind of wear going on there, there's lots of stuff happening here in trying to bring that accreditation. Extremely tough. I don't know if you remember that opacity case, where the teeth, where all the resin they were super bright white. That's what this case was here. So they just, there was no, opacity was completely unnatural. But not only that they did this all in resin. If I did this case in resin, I would be wanting to take the photos really fast. In fact that day or send them home, not, don't let them bring their teeth together for 24 hours and bring them back and photograph it again because after 24 hours I'm not sure where my resin is going to be for that particular patient. That's just my impression of this. I don't know. When you get these color striations in here. That's just tough. I'm not saying you can't do it. Just if you're going to build resin over that, you've got to know that you've got your hands full. You can do ceramic. It may involve you know this may not bleach up for you so this may involve a different type of preparation to try to get it there. And then are you going to have a natural opacity when it's done. The patient doesn't want any natural color. They want it white. They want really white and they want it white from top to bottom. I understand. Ceramist, you understand how often you get those to do. That's okay. It's your mouth. It's your time and it's your money and I will deliver that for you. A, don't tell anybody where you had it done. B, I'm not submitting it for accreditation. But we deliver that. We do that for our patients when that's what they want. If that's aesthetically what they see in their eye I will deliver that for them. I will certainly try to talk them out of it. I will try to show them other ideas that can work and still get them a great result but at the end of the day, it's their call. It just doesn't make an acceptable for accreditation. Okay. And no. 1 on the hit parade. Over and over and over again, we see it's the gum health. Okay. Tissue health is the one that puts us behind the eight ball. So here you are with inflammation. This is the way this case was submitted. Okay. Catastrophic or at least major at the very minimum but more likely catastrophic. Simply treating these two teeth here in the front and that's what the end result is. Remember we talked about sometimes trying to get a case all the way home from where you start and you have axial inclination issues. You have tooth position issues and you want to fill in the space and sometimes it's hard to get it there. So it's tough to get a great end result but regardless of what you get at the end, a draining fistula will always fail. Always, always, always, always. If you have a fistula in your after shot that case is not going to pass. Okay. I don't have the radiograph on here but we can probably take a guest what that looks like. Alright. So getting a case home sometimes tough when you're starting from here or you're treating multidisciplinary treatment to get it home. If the tissue, remember we talked about before and after, the tissue is in worst health after or even worst it goes from, you went to, you took this chipped tooth and use the ceramic restoration which first of all, which case type here. 4, I'm going 4 here. You know I'm building, I'm fixing, I'm fixing that chip edge in there. Unless they want they want more, if they want more. If they're talking about axial inclination issues and gaps and rotations or resin that creates a whole other treatment. But if they simply want that fix ed its case type 4. Case type 2 is probably a little more than necessary but okay. Fine. You choose case type 2. We'll give you the benefit of the doubt but you don't get the benefit of the doubt when that's what happens at the end after you started with that. If you can see it in a smile, the puffy red tissue, then you see it again in the after smile and of course when your magnification ratio of your smile is like this, you're not helping yourself. Okay, when the tissue starts like that and finishes like that, it doesn't matter. It was bad to start with, it's worst at the end. Catastrophic. It's going to fail. There you are. Once again those are your top 10. Those are the things we see the most issues with in your cases that you go through. Any questions about these 10, thoughts or concerns. Okay. Just a reminder again, Texas, Dallas coming up. Coming up not too far off, we got April. Make your plans. Great meeting. If you've had the chance to look at the line up at this meeting, its spectacular so and Gaylords are always first class accommodation. Remember we were down in Nashville, it was just, it was A-1 across the board so great opportunity. Make sure you get that in your book. What I want to close with is we finished with talking about a lot of negative. We talked about failure. We talked about failure, failure, failure and we ended up talking about failure. So instead we'll turn it back around just for a moment and I want you to think about and envision like anything in sports or anything in any endeavor you take on, one of the things is you envision where you're going to be. You envision where that t-shots is going to be. You envision how you're going to hit that pitch. You envision where you're going to put your serve. You envision yourself. You talk to any great athlete. They talk about holding the trophy. They see themselves at the end of the day as champions. They see themselves in that position. Take a moment and envision yourself in the position. This is one of the, you'll see some archive shots here for sure but these folks told me when I asked them for photos, they told me how they felt of this being one of the proudest days in their career. Here's a celebration right here. Across here, a jacket like this is not necessarily required for celebration. But if you know Marty, you know that that just fits perfectly. Black tie doesn't always mean black tie, does it Now I just want to point out something. Here's JA getting his awards and look at the smiles on the two people giving the award. Now when I'm getting my award, what's up with that These are my so-called friends, right here. So just again, just to point out, here they are, look at the smile, look at the smile, JA that's great. Look at over here. Now I mean Joyce gets her. Look at the grin on that face when Joyce gets her accreditation. Again, great celebration moment. I wish you the best. I hope you've taken today and viewed this as an opportunity to expand and grow your horizons but also to take this challenge. Dive in. Dive in both feet. Dive in head first whichever way you need to dive in, jump in, get after it. As we pointed out, this process accreditation is approachable and it's doable. It's achievable. So continue on the course. If we can help at all, that's what we're here to do. I'm happy to help out. You can find my name if you look up in the directory, email address is in there. So feel free to contact me if I can help you in any way or answer any of your questions I'm happy to do that. But there's a lot of great mentors in there, take advantage of that and wish you the best. Good luck with everything.