To The Point
By Peter M. Muehleis D.D.S., FAGD
Editor
Fact or Fiction?
All of us come across articles directed at the general public on the topic of health. Some of
these articles have been known to alter the behavior of millions of people. The following
letter is a reprint of a letter I sent to American Fitness Magazine in response to a July
article on the dangers of mercury fillings. The article made several sweeping generalizations
and also had many inaccuracies. The editors have assured me that my response would be
published in their Nov./Dec. issue.
Dear Ms. Jordan:
As a dentist, I take exception to some implications and outright misinformation
contained in your article, “The Attraction of Silver” by Eda Ellis, DDS.
First, I am always leery any time someone claims to have experience in “holistic” anything. Her credentials
indicate that she is a graduate of New York University College of Dentistry. The holistic aspect of her
education, while not unimportant, is not a part of recognized dental school curricula. It further stated that
she is “certified” with the American Dental Association, as though this was an earned position accompanied
by some level expertise, when in fact it is no more than a membership in a club which any dentist can join
with the appropriate dues.
Now to the assertions; Dr. Ellis correctly points out that there is more mercury contamination that comes
from the environment including the food we eat than what we get with a mouth full of silver fillings. What she fails to mention, is just how much more. According to most studies, the amount of mercury vapor that
is released from amalgam fillings is statistically insignificant when compared to other forms of mercury
in the environment. We have known high levels of mercury in some fish, yet regulations governing their
consumption are fairly lax and merely guidelines.
Dr. Ellis uses the words, “might” and “may” quite liberally when asserting a connection with the ability of
women to conceive or the connection with Alzheimer’s or worsening symptoms of other diseases. These
words of doubt or probability have no place in scientific articles. She talks about a mercury threshold as
though this is a measurable level above which there are definable problems. Finally she concludes that “removal of mercury amalgam fillings can significantly lower your probability of developing chronic kidney,
liver and brain disorders”. Again, where is the proof?
Dental amalgam has been one of the most extensively studied materials. One would think that if a link to
any disease existed with a material that has been around for more than 100 years, we would have discovered
it by now. This is not to say precautions for unnecessary exposure is not prudent, however, how much do
we really know about all the new products containing ingredients such as methylmerthacrylate and ferric chloride? Science is an ongoing learning process. None of us have all the answers, however, it is unfortunate
that conjecture passes for knowledge, causing some to become unduly alarmed.
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Fellowship/ Mastership Attainable Goals
At the AGD National Meeting in San Diego, I received my Mastership Award. Sitting aboard the U.S.S. Midway
with 150 Masters and 250 Fellows was unique, hot, and a true honor worth aspiring for. I want to share with those
of you on the fence about the Master track and why you should consider the path to Mastership.
The AGD courses that I happened to go to were always well done with first rate speakers. When I joined the AGD, I
felt it was an organization that would represent me, provide good C.E. and perhaps, create friendships in Dentistry
over time as I went to the University of Minnesota and didn’t know many Wisconsin dentists.
I was already a self-proclaimed, continuing education junkie and easily took 4 or more courses a year throughout
the country, so I figured; why not let those credits work toward a fellowship award. In fact, by taking courses from
Shavell, Panky, Dawnson, etc., I was convinced that only through great continuing education would my love for
dentistry continue through my career. I am a third generation dentist and currently practice with my brother and
was always awe inspired when my dad would come home from work and sat at the dinner table, “boy did I great
day!” In fact, he was always going to courses on rthodontics, photographing cases and I am sure I am beneficiary
of the seed he planted in me years ago.
When I achieved enough credits for my Fellowship exam, I was tentative, nervous and not sure I wanted to go
through the hassle of relearning oral pathology and all of the other facts about anatomy, occlusion that I felt had
little relevance to my current dental life. I took the review course at Marquette Dental School and found that the
professors were current, professional, and really took great pride in offering the updates and reviews we all needed.
Taking the exam at Sylvan learning center was unusual and I was not prepared for the test results to appear immediately
upon hitting the last enter key. I had passed with flying colors and was now eligible for the convocation in
Nashville, TN. This was four years ago and I still remember the wonderful dinner I shared with the fellow Board of
Directors to celebrate the new Fellows and Masters. The brandy and cigars left me green in the gills but the fellowship
award afforded me pride in my accomplishments and left me with some well-deserved self-satisfaction for a
job well done.
Once I finished this I was not sure I would proceed with Mastership. I had already undertaken and completed a
goal, I was still a C.E. junkie and I really had nothing to prove to anyone so I figured why bother? That is when I
was fortunate enough to meet Sy Wachtenheim, the director of the Illinois Master Track together program. Not only
was Sy nice and personable, but he really made it seem that Mastership was attainable. He put together courses in
each required discipline, made sure that homework was approachable and always offered insights and solid criticism
that made the homework worthwhile. The two day courses always had a lecture and hands-on component
with homework given that could be completed at our leisure, and presented at a Thursday prior to the next Master
track course. The food was plentiful, the company engaging and by being surrounded by the creme of the crop, you
would always learn as much, if not more, after the meeting or on breaks than you did in the course itself.
Whether we were defrosting pig-heads or opening pig jaws with crowbars or doing rotary endo or learning how to
make Essix appliances, we always had fun and were in a supportive atmosphere. My personal growth has been substantial
from this experience. I went from taking photographs of my dentistry to 35mm slides. I used slide carousels
the first two homework assignments and then switched to digital cameras, laptop computers and PowerPoint presentations.
I now give professional lectures with professional photos and can integrate streaming video and graphics
into my presentations. This was all done in less than 1 year! The friends you make are outstanding and they led
me to apply and be accepted on to the Board of Directors a few years ago for the Wisconsin Academy of General
Dentistry.
I have become a better dentist, a better clinician, a better communicator and have gained many friendships because
of the AGD. I encourage any of you to step up to this very attainable goal. Visit our web site at www.agdwisconsin.
org and attend our courses. Call anyone on the board with questions, concerns or to let us know if you are interested
in the example for our patients, our peers, and our family and show that lifelong learning begins at home. In fact,
Sy Wachtenheim received his Lifelong learning award on the U.S.S. Midway. He is still setting the bar for me and
he has been retired for many years. It is people like my dad, Charles Winter D.D.S. and Sy Wachtenheim that make
dentistry a profession we can learn from, be passionate about and give back to throughout our careers. I want to
thank the Academy - the Academy of General Dentistry that is - for the gift they have bestowed upon me. Mastership
isn’t just a goal - it is a lifetime pursuit of excellence.
Please e-mail me with any questions or any member of our Board.
Sincerely,
Richard Winter, D.D.S., M.A.G.D., F.A.D.I.
What’s stopping you from being successful with dental implants?
Dental implants have become the “Standard of Care” for missing teeth worldwide. Each year there are more
implants placed and restored than there were in the previous year. This growth rate has been estimated to be
at 10% to 15% each year. Patients are becoming better educated about the possibilities of implant treatment as
a solution to their clinical cases and are requesting implant dentistry. The dental profession is challenged to
provide optimal care for these patients. Unfortunately, many dental professionals choose alternative treatment
options for their patients simply because they are not prepared to provide this service or they don’t believe they
can control the outcome of implant dentistry. We, as a profession, need to accept this challenge and prepare
ourselves to provide optimum care for our patients. It is our duty and privilege to provide this optimal care for
our patients.
The majority of dentists in this country and abroad are not involved in implant dentistry. Why? What are the
barriers in implant dentistry that keep many in our profession from providing this fantastic service? Ask yourself
the question, “If I was missing a tooth or teeth, would I rather have an implant supported restoration than
a bridge or a partial?” The answer to that question should determine your involvement in implant dentistry.
Offer and treat others as you would prefer to be treated. This is our responsibility as dental professionals.
I have been given a unique opportunity at LVI (the Las Vegas Institute for Advanced Dental Training) to develop
and teach an implant curriculum. We always start the course by asking each doctor in attendance, “What
is stopping you from being successful in implant dentistry?” The top five responses are:
1. I feel a lack of control during the implant process.
2. The implant process is too complicated.
3. I sometimes get poor aesthetic results.
4. There are long treatment times.
5. I feel there is a lack of training opportunities.
All of these concerns are very legitimate reasons not to get involved with implants. It is the intent of the LVI implant
courses to remove these five barriers to success. With the appropriate treatment plan and diagnostic tools,
implant dentistry can become extremely predictable and reliable. All one has to do is simplify the process and
control the case to ensure optimal clinical results.
The implant process is complicated, out of control and lacks aesthetic outcomes only when there are unknowns
in the implant process. With the proper tools (CT image, Planning Software, Guided Stints) and planning
protocol, these unknowns will vanish. The fundamental question that has to be answered first and foremost is
where do I want the final restoration to be, and do I have the proper bone placement to place an implant in an
optimum position to support that restoration? Both of these questions have to be answered as part of the planning
protocol. Unfortunately, implants are often placed in less than optimal positions because the focus on bony
structure leads to an inappropriate implant placement selection because the final restoration is fabricated. With
proper implant placement comes to major negative results:
1. Limited function due to improper occlusal forces acting on the restoration.
2. Poor Aesthetics
The proposed restoration should dictate where and at what angle the implant should be placed. Implant orientation
should not be determined solely by bone availability. A common complaint that I’ve heard from general
dentists is that they don’t get back from the surgeon (implant placement) what they expected. Fundamentally,
what they were saying was that the communication between the general dentist and the surgeon was not adequate,
therefore the diagnosis, subsequent treatment plan, and surgical processes were flawed.
Two things are required in order to guarantee proper position of every implant placed. Firstly, proper treatment
planning is required. Secondly, the outcome of this treatment planning should be a surgical stint that will completely
guide the planned implant placement. The components of a proper plan should be a CT scan coupled
with virtual treatment planning software which will generate a guided surgical stint. This protocol is a complete
blueprint to a successful aesthetic and functional implant result. It takes away all surgical surprises and
guarantees proper placement. A surgical stint that is made solely on a model and not evaluated by relating thestint to the underlying bone by the use of three-dimensional radiography is an inadequate stint and destined
for disappointment. In short, the surgical stint is the guide to success. It absolutely has to be both constructed
appropriately and used effectively. The surgical stint ties the implant and restoration to the bone and opposing
occlusion in its most optimum position.
An additional advantage of this guided surgical process is that it is completely reproducible whether you are
treatment planning a single implant or performing a full mouth implant reconstruction. Furthermore, since all
the unknowns have been discovered and accounted for prior or surgery, laying a surgical flap is reserved for
bone grafting or bone recontouring situations only. A punch technique for implant placement is the preferred
method if proper treatment planning has occurred prior to surgery. This type of surgery is much less invasive,
less traumatic, and of short duration. Post operative pain is almost nonexistent when surgical flaps are not
required.
The time required to place and restore implants is also a concern for patients and providers. Implant dentistry
requires some additional treatment time to obtain optimal results. In cases where there is inadequate hard and
soft tissue available to support an implant, treatment times will be extended to enhance those missing tissues.
It is appropriate to ask for help from dental specialists if providing hard and soft tissue support is outside one’s
comfort range or ability. A dentist should never provide services for patients they do not feel comfortable performing.
However, that fear or inability should not exclude a patient from receiving optimum care when that
patient desires it. Diagnostic tools are available today which help us very accurately assess patients limitations
prior to treatment. Treatment disappointments will be avoided with the proper diagnostic protocol.
Many cases that have adequate hard and soft tissue can be immediately or early loaded following implant
placement, dramatically reducing treatment time. Implant dentistry is not always the fastest treatment but it
is often the best clinical treatment. We as a profession, should be obligated to provide that treatment modality
to patients. Our fears, disappointments and confusions should not limit the majority of the dental population
from ideal treatment. If dental implant therapy is appropriate treatment at offices nationally and internationally,
would it not be appropriate in your office? Implant dentistry has been determined to be the standard of care;
furthermore, we are required to offer this service to our patients. It makes sense that we as dental professionals
need to get ourselves prepared to perform that standard of care. In my opinion, it is time for our profession to
accept this implant challenge and encourage optimal clinical solutions for all our patients. Informed patients
are asking about implants as solutions. Our fears, confusions and concerns about control should not keep them
from receiving ideal treatment.
There are many training opportunities around the country to help us get involved in the implant process. Like
all continuing education courses, some are better than others. If you leave an implant course more confused
than when you started, you are less likely to provide implant services for your patients. Unfortunately, this happens
in continuing education classes quite often. The implant courses at LVI are designed to remove implant
confusion. Our fundamental goal is to simplify the implant process, both surgically and prosthetically. We at
LVI want to give you an implant protocol that allows you to simplify the implant process and gain complete
control of the case before you begin. Control removes the unknowns and disappointments that are associated
with dental implants. Come join us at LVI and take the implant courses. The knowledge and control you gain
through these courses will enhance your practice.
Leo Malin, D.D.S.
LVI Implant Director
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