For me, std of care for 90 pts would be sort of intimidating. It's the charting that would scare me. With my efficient templates, DA's input, sterile logs (my DMO requires it to minimize sterile breaches), and my 65 wpm typing, it usually take me 5 min per chart to meet Board and Legal stds. Writing up 90 charts would take me about 4 1/2 to 5 hrs.
My templates are really comprehensive with "selections" that I just tell the DA to keep while deleting the rest of the fill in the blanks. Writing the same essay over and over is inefficient. Premade long form SOAP notes made my life a lot easier. It's the same thing over and over. RMHX/EOE/IOE/Clinical findings, Diagnosis, Treatment options, treatment recommendations, pros/cons of each option, reason for recommendation, patient's selection, procedure notes anesthetic, ext - troughing,sectioning,type of suture,method of suture, rct, access, location, WL, any perfs,extra findings/root fractures, etc...) I dictate all my findings to my staff, it's their job to sort (select the choices from my template) and write and for me to sign upon review. It's like a word vomit that my staff eventually got used to doing for me. They seem to do it well since I don't have to modify it very often.
I can't stand ortho too. It doesn't interest me at all. I see alot of GP's in metro areas do Invisalign (and it seems expected in those areas) but I don't think it's worth the CE. Better to punt that to orthodontist.
I really want to get into implant placement especially now that I'm 4 years out. Looking into taking the AAID Maxicourse. Which implant course did you take?
Took a weekend course and just read up on it. Placing an implant isn't rocket science. Keep the easy, refer the hard. You don't really need to to place 80 implants in a week to get the feel for it, as think of it like an endo, but for bone. Most of it is common sense. Don't heat the bone, use sharp drills, use chilled saline (cooler irrigants have better cooling and specific heat capacity of the liquid counteracts the heat generated from the procedure), know where you're drilling, know vital structures, understand the long axis of the your proposed restoration v. where the bone is at, know the importance of KT and how to get a good cuff around your implant, know when your implants are failing and how to fix it, and so on...
Let's look at a single tooth upper or lower workflow. First thing, take a CT. Do you have enough bone? Is it going to take more than 15 minutes or require a bunch of follow ups. If the answer is yes, probably should refer. If you have enough bone, how much bone do you have? Know the width and height. Width dictates width of implant. Don't have enough width, or ambigious? Look into versah burs and expand the bone after pilot drill. Height (determined by sinus/IA/mental/vital structures, determines length of implant). From there, you know width/length of implant that you should place. Give yourself lots of leeway. Next, look at position of proposed crown. Does it coincide with where the bone is? Bone will always determine where you can place the implant, but you should try and get the implant as close to the center of the crown and long axis of the tooth as much as possible for minimal lateral forces and optimal loading. Next, keratinized tissue, do you have enough? Do you need some? Can you apically displace keratinized tissue via miniflap to get a cuff around your restoration. If not, refer to perio to get KT + implant placement.
Now, if they've passed the referral gauntlet, now is the time for action. Open the area (bur, punch, or scalpel) to expose the bone. Drill pilot half to depth. Take a PA, if good, drill to full depth, then depending on your drill set, drill to final. Slow is not good here. The slower you go, the more friction you generate, and the more you're burnishing the bone. I prefer to undersize my osteotomy unless they got Type I bone. Place implant. I place 1-2mm subcrestal. Take PA to verify. If it doesn't look good, now is the time to back it up, change implants, graft and wait, or whatever needs to be done to make it look good. If it's good, then place your healing cap and take a final PA. 1 week follow up to make sure soft tissue is good, 3 week to make sure no bone loss occuring or suppuration.
This is a simplified version, use whatever system works best in your hands. I like internal hex, but I'm starting to like conical connection as well. I used to love restoring tri-lobes (I never placed them), but they tend to get more bone loss. Use whatever works best in your hands.
