THOUGHTS FOR THE
CONTEMPORARY PRACTITIONER

We all recall the statement, "be careful for what you wish - it just may come true." As it applies to dentistry, we've been granted restorative materials that years ago we could have only dreamt of. Handling and wear properties have far exceeded many of our expectations. Now here's the rub.

While it was, at one time, a no-brainer to recommend a crown on those borderline teeth, since direct restoratives just couldn't match up, we're approaching (may have already arrived at) a point in time when this is no longer the case.

The composites and bonding agents available today are so good, I'm inclined to believe that we as a profession are obligated to master their efficient placement, which leads us to the age-old question of fee vs. time spent.

Given what insurance carriers reward us and our patients for placement of such restorations, it seems the only way to turn a profit similar to what might be generated by an indirect restortaion, is to do several direct restorations at a time, using the old "quadrant approach."

Being able to knock out 3 restorations at $225 a pop (or better), in say an hour or so, will get you close to a single crown's profit, keep the benefit allotment under the (gag) typical $1000 annual max, result in less out of pocket for your patient, (resulting in low resistance to your recommendations) and improve several teeth as opposed to one.

Given the number of baby boomers out there with aging amalgams, one doesn't need to look far to take this approach.

What one does need to do is first develop a rationale and protocol for recommending these types of restorations to your patient and then become good at placing them. AND, of course, feel that you are improving the situation by placing your restorations.

The materials are now ours to use - we just have to embrace a way to use them profitably if we are to meet our financial expectations. I know I'm preaching to the choir for many, but it's a subject that is near and dear to my heart as has been evidenced by several of my Dentistry Today articles.

Efficient and effective posterior resin placement is core to the modern day GP's practice. We need to embrace it and find a comfortable way to make it as profitable as indirect restorations.

The reasons why are obvious. Just ask yourself the question before recommending a crown on the typical borderline case: "Is it for me? or is it for my patient's well being?" Tough question!!

The ultimate challenge is to (you'll excuse the expression), have your cake and eat it too. That is, find a way to improve your patient's dental status, earn an hourly rate that is commensurate with your practice goals, and stay within a framework that allows for easy acceptance.

Mastering posterior resin placement as well as developing a systematic approach to patient education and presentation can most likely get us there.

— Marty