specialty selling: Prosthodontics
Prosthodontists make it right
Have you seen the HGTV reality show Holmes on Homes? In the show, Mike Holmes (always dressed in overalls), rescues homeowners who are victims of shoddy, stupid or even criminally negligent home-repair contractors. Holmes comes to the house, and invariably, discovers a host of problems underneath the original ones spotted by the homeowner. One thing leads to another, and he usually ends up tearing down walls to the studs and tearing up floors– and then some. But the finished product is safe, beautiful and functional. His motto is "Make it right."
Prosthodontists are kind of like him.
A prosthodontist is a dentist who specializes in the aesthetic restoration and replacement of teeth, according to the American College of Prosthodontists. They restore optimum appearance and function to a person’s smile. And, given the three years of additional training they receive after dental school, they are distinguished from others who call themselves cosmetic dentists. (Cosmetic dentistry is not a recognized specialty by the American Dental Association. Prosthodontics is.)
Specialize in complex cases
Prosthodontists are used to dealing with very complex cases, says Susan Brackett, DDS, MS, Implant and Prosthodontic Associates, Oklahoma City, Okla. Indeed, their training is extensive, covering aesthetics/cosmetics, crowns, bridges, veneers, inlays, complete and removable partial dentures, dental implants, TMD-jaw joint problems, traumatic injuries to the mouth’s structures, congenital or birth anomalies to teeth, snoring, sleep disorders, and oral cancer reconstruction and continuing care, according to the American College of Prosthodontists.
"The main strength of our education is learning the diagnosis and appropriate treatment of the patient’s entire mouth, not just a couple of teeth here and there," says Brackett, who is a Diplomate of the American Board of Prosthodontics and a Fellow of the American College of Prosthodontists and the American College of Dentists.
Suppose that a patient presents with a tooth that’s worn down or cracked, in obvious need of a crown, she says. The prosthodontist, like Mike Holmes, often discovers that more is involved. "The patient bites down, and you see that the tooth that opposes it … has erupted or shifted to a point where there’s no room to put on a crown." A dentist who looks at single teeth won’t see how the patient bites, or how his or her joints work, etc., she says. "So we’re looking at the mouth as a closely integrated system that has to function well."
Prosthodontist as artist
But the mouth should not only function well, it should also look good. Prosthodontists are credited with developing the concepts and rules dictating a pleasing smile almost a century ago, in order to make dentures more appealing, according to American College of Prosthodontics. In this respect, the prosthodontist is as much artist as technician.
For example, Brackett speaks about an artistic concept called "radiating symmetry," citing Leonardo da Vinci’s "Last Supper" as Exhibit No. 1. In the painting, Jesus is seated in the middle of the table, with six disciples flanking him on each side. "The picture creates interest and is much more aesthetically appealing because there are subtle variations as the eye moves from the middle of the scene," she explains.
So it is with teeth. Dentures featuring a uniform set of big, blocky teeth look horrible, says Brackett. The mouth looks better if the angles of the teeth increase as one gets farther from the midline, if the lateral incisors are a little bit shorter than the front teeth, and so on.
"Prosthodontists have studied this, and even if we don’t think about it all the time, it’s inherent in what we do," she says.
Competitive positioning
Prosthodontists are distinguished from those who call themselves cosmetic dentists by virtue of the depth and scope of training they receive, says Brackett. "The problem we have is making patients aware of the difference, and valuing that difference."
Just as important are the general dentists in the area, who refer complex cases to the prosthodontist. "A lot of referrals are for dentures, because many general dentists don’t like working with them," says Brackett. Implants and implant-supported restorations are another frequent cause for referral. "And sometimes it’s a very challenging aesthetic situation," says Brackett. An example might be crowns on front teeth.
"Most prosthodontists are involved in the community of dentists where they practice," says Terry Kelly, DMD, director, maxillofacial prosthetics and dental oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Fla. If the prosthodontist does any marketing, it is often through CE courses via dental schools and organizations as well as local study clubs.
"I really don’t look at [other specialties] as competition," says Kelly. "It comes down to, basically, what can you provide that’s exceptional? If you’re able to provide that, with predictable outcomes, that will generally bode well for your practice.
"So competition is not at the forefront of most prosthodontists’ mindsets," he says. "It’s more about trying to build your reputation based on your ability to provide exceptional care and being able to take a patient’s comprehensive needs and walk through his or her treatment with other specialists and general dentists."
Prosthodontist as quarterback
Indeed, although prosthodontists are trained to perform a wide variety of procedures, the most successful ones don’t try to do it all.
"There may be times when it’s not feasible for patients to address all the problems that are occurring," says Brackett. "We prioritize, we listen, and we educate them on what needs to be done. And if they can’t do everything, we let them know the [consequences] of limited treatment."
Successful prosthodontists sometimes act as quarterbacks, coordinating a patient’s care with a number of different dental professionals. "There’s great opportunity in looking at maximizing what different specialists do best," says Kelly.
Technology
Both Drs. Brackett and Kelly see a bright future for prosthodontics. Technology will be a big part of it.
Cone beam imaging, for example, gives the prosthodontist an accurate view of existing bone and significant anatomic landmarks, and leads to a more informed discussion of the type of restoration best suited for the individual patient, says Brackett. "It may help us determine what type of implant-supported restoration is best for the patient."
Kelly is bullish on imaging technology as well. "It allows us to look at the volume of bone in a three-dimensional aspect, and to measure its quality," to aid in the placement of an implant-supported restoration or prosthesis. He is also excited about the possibilities of a broader class of biologics, which, he believes, will provide a different range of treatment options than what is available today. "Instead of prosthetic materials, biologics may be able to afford us a better or more predictable result."
"Technology and materials are changing as rapidly as we can embrace that change," continues Kelly. "[S]uccess may be achieved by letting go of some tried and true techniques when advances in technology and materials ensure a better outcome. Maybe technology will allow us to eliminate some unnecessary steps in the treatment process."
The profession
Young dentists remain attracted to prosthodontics, says Brackett. No doubt they are attracted by its income potential. But they’re also excited by the prospect of getting involved in many different aspects of dental care, including dentures, crowns and implants, she says. "It’s very appealing to dental graduates."
Prosthodontists are positioned for the future, because of their training, diagnostic skills and technologies, says Kelly. What’s more, given opportunities to subspecialize (as Kelly has, in prosthodontic care for cancer patients), the field is wide open. "There’s a lot of opportunity," he says.
"Our tool set will expand, and that’s something that excites residents and others with an interest in it," Kelly adds. "I expect to see our numbers grow. The question is, Will we have the resources to train people to provide this type of care? That’s a challenge not only for our specialty, but others too."
A word to distributors
Distributor reps are advised to approach prosthodontists with good clinical data about the products they carry, says Brackett. "Because of our training, we put emphasis on literature reviews, research and the belief that everything must be evidence-based. Prosthodontists will be innovative and embrace technology, but we’ll want to know more about the product than the fact that it’s a big seller. We will want studies showing how it compares to what we have been using."
Adds Kelly, "You can never provide too much service. Prosthodontists aren’t much different than anyone else; we’re all busy with the clinical aspects of care and – certainly, those of us in private practice – the business aspects too. When [the distributor] can be a backstop for things that we’re not experts in … and show us that you are ready to go to bat for us, it stands out."
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