Want to be a better clinician?
In this post, I give some specific recommendations on how to become a better clinician. As with all recommendations, there are bound to be some that you'll be able to make work for you and some that you think are too much or not quite right for you - that's okay. As I usually say in the courses I run, "Take what you can use and ignore the rest😊"
You will see some of the things I did myself to improve when I was practicing and that I know some of the really talented colleagues I have spoken to around the world have also done.
Start practicing on models of the patients.
Practice on models as often as possible.
Take a few good alginate impressions on the patients you plan to perform treatment on anyway.
In addition to impressions of the teeth, it would be good to have a facebow registration, a bite registration and possibly a registration of the protruded bite so you can find the individual angulation of the condyles.... But maybe that's taking it a bit too far at first😊.
Make an effort - even with details that may seem unimportant
Mount your models of the patients in an articulator and make your own waxups.
Put effort into every part of the process. If you jump through the hoops once and maybe again later, you'll start to accept that it's okay to compromise again and again. Instead, make it a virtue to do everything you do to the best of your ability.
Take fabulous alginate impressions and accurate records
Pour out the models as best you can. (Tip: Let your lab teach you how - they do it very differently than we learned at dental school and there is a really good reason for this)
Trim the models and make sure to remove any small plaster excess that appears where there have been air bubbles in the impressions.
Mount the models into the articulator using the facebow registration - take 2 minutes to make it look a bit neat ( Check out the photos on this page)
Be careful with the mounting of the lower jaw after your bite registration. (If you use silicone bite registration materials, you will need to cut it quite a bit as the silicone is considerably more accurate than the plaster. So it requires a little work that gives respect to the labs' work processes. Although the physical models are not used so frequently any longer)
Look at the models and take some time to think about function, the appearance of soft and hard tissue. Will the end result be nicer if the gingiva is corrected? What shape will I give the teeth once I'm done? With the visualisation in mind, go ahead:
Waxup/Mocking up your models.
Once you start to get a routine with this, you can start to compare your diagnosis and planning with your clinical photos. Here you can think about whether the face is symmetrical or asymmetrical, how the teeth are positioned in the face, how you can optimize aesthetics and function so that it comes into better harmony with the face, etc. etc.
You don't need to buy lab equipment like the one you see in the picture. You can start by using some of the many free samples the composite the practice receives or is given when industry representatives visit. The most important thing is that you sit down and start working on a model in an articulator (yes it is important the models are in an articulator).
Use cancellations and no-shows as a good opportunity to practice some more. Then you won't feel like you spend time doing nothing at work.
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A good starter case
I think the best beginner cases are the aesthetic ones, where you have to waxup the entire anterior segment in the upper jaw. Mostly because it's motivating when it's a real case and there's a lot of pressure from yourself and the patient to make the result look great.
Moreover, it becomes very clear how difficult it is to create nice teeth. The good thing about models is that we can hold them in our hands and study them from angles that are not possible in the patient's mouth.
Once you've made a waxup or a fast mockup, leave it until the next day. When you look at your work again, you will notice a number of details you didn't notice before. Often these will be details that surprise you and where you might have the thought, "why didn't I see that while I was working on it?"
Overview of the details
My point is that the more you practice inside and outside of the mouth, the better you'll get at what you do. The way you see your work, the method you use, the sequence, etc. There are so many details that you suddenly see differently when you are sitting with a completely different view of a model in an articulator.
You've probably heard that you have to spend 10,000 hours to become really good at something. That's partly true. Because if we keep working the same way, without critically examining our own work, without pushing ourselves to the limit, to get better. Then there is not much difference between 1,000 and 10,000 hours.
When we start training purposefully to get better, the 10,000 hours really start to pay off.
The effects of long-term, focused training
If you want to see the results of 10,000+++ hours of focused training, spending endless amounts of time with mentors, theoretical and hands-on time in a lab. Then you can try to see what Marc Onuoha DDS is doing. In my opinion, he is one of the absolute best dentists, in the field of aesthetic treatments. Handling gingiva, bone and teeth - whether it comes to implants, porcelain or composite, he is absolutely phenomenal. It looks so easy when Marc is working - but make no mistake. That's only because he's practiced the same routines over and over and over and over again..................
Do you have a desire to become as skilled as Marc, a skilled surgeon, periodontist, endodontist or something else entirely. Common to all who have become very skilled is that it is not easy to get to where they are. If it was easy, everyone would already be doing everything they do.
There are several elements to becoming a good clinician... or good at anything. You "simply" need:
Competent help to train optimally and stay focused. (A mentor or coach)
A lot of time for training off the football field (mouth)
Real life testing (in your mouth)
Take lots of photos - before, during, after.
Start taking great clinical photos!
It also takes time to get good at taking photos.
There's just no way around clinical photography if you want to get really good at it. Because clinical photos give you the ability to evaluate your work in a whole new way.
I don't know how many times I've been really proud of having done the best work in the world. Until I saw the photos that I always took before the patient left the clinic.
In the photos, you suddenly see everything from completely different angles. Suddenly you see all your own faults painfully clearly.
The case shown was a relatively difficult composite reconstruction of one of my patients. When I saw it all in the mouth after spending 3 hours sculpting everything by hand, I thought it looked fantastic. But when I saw this picture after treatment, I noticed:
I did not like the shape of the distal corner of no 12. It points in the wrong direction.
The distal areas around the gingiva on 11 and 21 have a disharmonious shape.
The width of 11 and 21 is not the same - (It may be influenced by the angle the photo was taken in)
The surface architecture on all the anteriors seems a little too exaggerated, disharmonious and lacking in finish.
The polishing is poor.
If you are able to swallow your own pride and accept that you make mistakes. You open up the possibility of realising your full potential. Because it's through our own mistakes that we learn the most.
If you want to get better at taking clinical photos, possibly with a smartphone, click on the link below. It will take you to a free photo course that I developed for AlignerService.com. The course is designed for treatment with clear aligners, but can be used by anyone who wants to be able to take a series of clinical photos in 2 minutes.
Use a lab that makes demands on you
Find a dental lab that gives you honest feedback on your work.
A Danish study a few years ago revealed that up to 85% of all conventional crown impressions received by the 5 largest Danish laboratories were directly unsuitable for crown production. When the quality of 85% of all impressions is so poor that they are not even remotely acceptable, it is a sign of an imbalance in the whole industry.
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Laboratories are afraid to give clinicians the necessary feedback that would lead to better quality. Historically, this has led to dentists becoming angry and finding another laboratory. This happens only because too many dentists wrongly believe laboratories can "just" correct the errors and deficiencies that dentists themselves send to these laboratories. The reality is that laboratories cannot compensate for the bad work they receive.
If you find a lab where a technician will commit to delivering the best quality possible and at the same time give you feedback on anything that can be improved on your part. Then I promise you'll become a much, much better dentist.
I worked with a small American lab for over 10 years. My technician Bill did all his work through a microscope with between 10-20X magnification. When he saw something that raised doubts or was just not compatible with the production of a great porcelain restoration, he would take a photo through his microscope and send it to me with questions about what I wanted or with recommendations for what I could do better.
In the photo above you can see the little bump along the preparation border - hmmmmm.
In addition, he wrote that I had made an undercut facially in what he called a tulip shaped preparation - Thanks very much for the information Bill - I will correct and take a new impression😀
It is relatively hard and annoying, to receive photos of the junk you have sent to your lab. It is time consuming, unattractive and costly to have to put your patient back in the chair, anaesthetise, remove the provisional, make the correction, take the impression again and recement the provisional.
But it's also these experiences that stick with us and make us promise ourselves never to make the same mistake again.
Find a personal mentor or coach.
Get a good personal mentor or "coach" with whom you set goals. Get help to put together the right training program and on how and how much to practice. Stay in regular contact with your coach, share your progress, frustrations, successes and victories with your coach.
Working with a personal trainer accelerates you towards the goals you set.
As you have read earlier, I have used my technician as a coach. In addition, I have had some American instructors from the Pankey Institute, as professional online coaches combined with a very experienced Danish colleague. In addition, I have had all sorts of other personal coaches and mentors. Everything from an behavioural psychologist, a sports therapist, a dental coach, a sales trainer, a service expert, a business coach, a former top executive of a very large company, etc.
They have all strengthened my skills and accelerated my progression towards my goals far, far faster than if I had tried to achieve it all without their help.
Conclusions
Start practicing on models of the patients.
This increases your understanding of morphology and strengthens your eye for aesthetics and function.
Take lots of photos - before, during, after.
You can't take too many photos.
Each photo makes you smarter... if you take the time to look at them.
Use a lab that makes demands on you
They shouldn't accept when you send them something that should not have been sent. A lab that gives you competent feedback and makes you better.
Find a personal mentor or coach.
This will help you set realistic goals, allocate the right resources and stay focused on training appropriately.
If you have any questions or comments about the content, or anything you want me to highlight in future posts, please feel free to write to me:
Many kind regards
Jesper Hatt DDS
T: +41 78 268 0078
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