RESTORATIVE DENTISTS: What are some things you wish your specialist colleagues knew?

[dentistinfuture]

Hi, I'm a prosthodontics resident and I'm preparing for an interdisciplinary presentation to future endodontists, periodontists, and orthodontists. I'm trying to develop guidelines that specialists can follow to help guide them through treatment with the restorative goal in mind. Ever refer a patient to ortho before restorative work and the teeth ended up looking nice but not in a favorable position for you? Have you referred a patient for an implant and it ended up in bone, but not in a good restorative position? What about crown lengthening that's way more or less than you needed? I would like to know what similar situations you've ended up in, and what you wish your specialist had done differently. Thanks!

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[nealofgrafton]

look at Seattle study club, spears, etc
all the pretty cases are all multi disciplinary
personally if I have an issue with any work a specialist did, i pick up a phone. if implant placers knew that the new hotness is screw retained that would be good. if ortho knew that i wanted all the teeth lined up (including 2nd molars so don't pop them brackets off if they aint lined up yet), if perio wouldn't sit on the fence about the tooth and drop the 'willy nilly' classifications and use useful or dog$hit to classify teeth.
for peds or prosth -> if i refer there I am washing my hands of the case

 

[schmoob]

Don’t do this.

 

[dentistinfuture]

look at Seattle study club, spears, etc
all the pretty cases are all multi disciplinary
personally if I have an issue with any work a specialist did, i pick up a phone. if implant placers knew that the new hotness is screw retained that would be good. if ortho knew that i wanted all the teeth lined up (including 2nd molars so don't pop them brackets off if they aint lined up yet), if perio wouldn't sit on the fence about the tooth and drop the 'willy nilly' classifications and use useful or dog$hit to classify teeth.
for peds or prosth -> if i refer there I am washing my hands of the case

Thanks for your input! Good to know that typically if you're referring to a prosthodontist you don't really want to see the patient again

 

[dentistinfuture]

View attachment 328890

Don’t do this.

Lolll we all know a certain someone whose cases all need rescuing.

 

[beannaithe]

I like when specialists call me to discuss a case prior to doing something off the wall. Usually, it's an oral surgeon to talk to me about aesthetic concerns for an anterior implant. Like I had a patient with a severe bony defect on #9 and the surgeon called to say he didn't think an implant would work due to the location of the bone. So we ended up doing a partial. Another time he called me to say he could only do a really angled implant on the anterior. The patient was deadset on an implant. So I talked to the restorative lab and we were able to develop a restorative plan to account for the angled implant. It went well and it's still in service years later. I've referred a patient to endo for 1 endo and sometimes, they'll need more. The endodontist I work with will usually call me and let me know what the patient needs.

As for the bad, I once sent a patient for a perio consult for grafting and they returned with a newly restored implant on a tooth that needed endo and the grafting wasn't done. I have one periodontist that patients will occasionally find and he'll send the patient back to me for me to complete the same procedure (SRPs, splinting, osseus sugery) I referred for. If I refer for procedure, it's because I don't feel comfortable doing it.

And no reports being sent is the biggest problem for me. My favorite game is playing "guess the implant" because the patient doesn't remember who did it and I never got a report from the specialist. If the patient raves about how amazing you are, I can't send you more patients if I don't know who you are. I've had a few patients find a surgeon near me (for implants or extractions) and said how amazing the office was, the doctor was fantastic, etc. They always forget this name. I have no idea who he is because I've never, ever gotten a report. So, I can't send him more patients. There's also an ortho like this. Beautiful results, great occlusion, happy patients. No idea who they are because no report and patients don't remember who they're seeing. Always, always send a report.

 

[TanMan]

I'm in the opposite camp. I don't want to keep talking to specialists about every single case. Phone calls should be reserved if I have any questions (as I operate under the assumption that the specialists are fully autonomous and will act on the best interests of the patient). I don't do full arch prosthetics, so communication isn't as key. From endos, I just need to know if/when it's ready to restore. For implants, I just need to know when it's ready for restoration, implant mfg/type/platform. For perio, let me know when restorative is ready to start. For ortho, just need to know when the planned date of debond and if there's a lot of crowns/veneers that need to be done, coordinate to send the patient back immediately for a retainer (although i prefer fixed lingual retainers since I can proceed with veneers without delaying the retainers).

Prosth/Peds/OFP/Full arch prosthetics/sedation - The intention is for them to keep the patient - do everything and don't send them back. It's their recalls now.

As I tell the specialists, do what you think is best for the patient. If you have to pull extra teeth, do extra endos, add extra implants, or whatever else, just do it (and if it's a full arch prosthesis/dentures, then I ask they send them to a dentist that they want to work with for that). I'll make most anything work, even for implants. The report is to have documentation that X procedure was acceptable to proceed to Y procedure.

 

[2TH MVR]

I'm in the opposite camp. I don't want to keep talking to specialists about every single case. Phone calls should be reserved if I have any questions (as I operate under the assumption that the specialists are fully autonomous and will act on the best interests of the patient).

Amen brother. As long as the specialist knows what you want .... all is good. I've had gps micro-manage everything I do. I like direction, but let me do my job that I was trained to do. If you have faith in this specialist. Seen the positive results. Happy patients. Assume the specialist did everything they could. Remember. They want YOUR continued referrals.

if ortho knew that i wanted all the teeth lined up (including 2nd molars so don't pop them brackets off if they aint lined up yet),

Ah. 2nd molars. The bain of most orthos. Yes. I agree. 2nd molars should be aligned. Problem ..... 2nd molar eruption is variable. Can't keep a kid in braces for another year just to align 2nd molars. That's reality. If I deband prior to full 2nd mlar eruption .... I'll keep an eye on the 2nd molars during retention. If they erupt and look like crap ... I'll usually place a retainer to fix.

Always, always send a report.

Yes. Usually a good idea. Unfortunately in a saturated city. These letters tend to be a waste of time when it comes to a patient that wasn't referred to you directly.

 

[tinman831]

View attachment 328890

Don’t do this.

This can't be for real.