Shortly after I started my career in Scarsdale, I moved into an elegant apartment complex on the Hudson River. I quickly made lots of friends and one of my best buddies was my neighbor across the street—Steve. Steve, who is now a retired teacher, was an athletic enthusiast and pursued many sports including tennis and white-water rafting. He had a lot of equipment and conducted rafting trips in his spare time. We once paddled across the Hudson River in a kayak to collect blueberries. So cool! Steve was not only a great friend, but he was also my patient.
In a few years, our lives took different turns. Steve moved to Florida, and I eventually moved to Arizona. We lost touch. All of a sudden out of a clear blue sky—he called me.
“I had to call you,” he said. “I have something amazing to tell you. “You know those crowns you made for me in 1984?” I said, “yeah.” “Well, I still have them after 39 years. One of my gym buddies is a dentist and he asked to see them. “Oh, those are Feinberg crowns!” he said. “How did he know?” Steve asked. “Obviously you and your dad have a stellar reputation.”
Perhaps Steve’s dentist buddy could tell that the crowns weren’t made with mainstream techniques. The real give-away would have been the X-Rays. I can pick my X-Rays out of a pile of patient X-Rays because the crowns are made to mirror the bone, whereas most crowns are no more than “tooth coverings.” This setup is the best architecture that you can have for health.
The truth is that I have many cases like Steve’s that have been in the mouth for decades. There is no greater pleasure in the world than having your patients come back year after year and watching your work last in health. Your patients no doubt have friends and relatives who are experiencing perpetual dental problems—and they are not. They know YOU are special, and they rave about you.
It is sad for me to watch so many of my fellow practitioners having difficulties with crown and bridgework that were actually solved many decades ago. These difficulties created an absolute epidemic of tooth extraction and implant placement. Many dentists today are not confident with their crown and bridge skills—including those who teach at fancy dental continuing education institutes. However, there is a growing number of dentists who have excellent implant skills.
Implants, however, are not what the average patient wants. Patients want to save their own teeth first. They are instinctively right to think that way. Researchers have discovered that “the long-term prognosis for implants has been shown to be far less promising than that for natural teeth, even when they are compromised by periodontal disease or endodontic problems.1” Ask yourself honestly: Wouldn’t you rather save your own teeth if you found yourself in the patient’s position?
I regularly see my colleagues on Facebook posting cases where they recommend extraction and implant placement for teeth that are EASILY salvageable with endodontics and full coverage restorations. One of these popped up in Facebook today, and I am horrified by this. “Often practitioners recommend implants even when teeth are only modestly compromised by caries, the need for endodontic therapy, or periodontal disease to provide the patient with a quick solution to the problem,” say researchers Giannobile and Lang. “Less trained individuals often recommend tooth extraction rather than retention. This condemns many teeth that could be treated and returned to good function. Even those teeth that are compromised have a much greater life span than the average implant1. ”
The truth is that there are basic principles that must be followed to ensure a predictable outcome for crown and bridgework. When basic principles are followed, the expected longevity for the vast majority of full coverage cases is at least ten years. I have many patients like Steve wearing dentistry that I created for them decades ago. It is important to realize that due to individual differences there is a point at which dentistry should be replaced. This point depends on changes that occur and can be very difficult to identify when changes are minimal and gradual. However, if the teeth are in good enough condition to support replacement restorations, that case is a success.
Seventy years of documented cases accomplished by my father and I demonstrate that by following basic principles it is possible for practitioners to create full coverage restorations with a solid protocol that always yields a predictable outcome. This protocol results in:
–the complete elimination of recurrent decay
–the arrest of periodontal bone loss so that it does not continue
–the prevention of exposed crown margins
–the creation of permanent and temporary restorations that do not fall out and require recementing
–the ability to salvage teeth with no clinical crowns WITHOUT posts, buildups, fancy orthodontic extrusion or extensive crown lengthening surgery
The basic principles taught by the ONWARD program come from Dentistry’s roots and require very little technology to accomplish. They are not taught in any dental school or continuing education venue that I know of. They come from the very roots of crown and bridge dentistry. Somewhere in history, the profession veered off the track, and that’s when dental practitioners started having failures with crown and bridgework.
I think the problems started when professors in the dental schools decided to teach students what they thought were easier techniques. In all fairness, the professors have limited time to teach students enough for minimal competency. They did not realize that the easier techniques they chose would violate the basic principles required for success and longevity. Here’s where I fault them: they neglected to tell the students that the techniques they were teaching were not the only way to do things, nor even best way. They neglected to emphasize that their education really begins on the day of their graduation. Students generally idolize their professors so it would never occur to them to question what they were being taught, unless they were encouraged to do so. So the newly graduated and experienced alike whole-heartedly believe that what they were taught in dental school is best. But nothing could be further from the truth.
Today’s dental students are exposed to the latest technology with state-of-the-art equipment during their training. They graduate with the idea that the most modern technology is always the best answer to solving restorative problems. Not true!! Technology by itself is only a tool; and it is the outcome that is most important–not the tool by which that outcome was achieved. I have observed laboratory technicians making the exact same errors on the computer that they made with analog hands-on laboratory work. Most dentists know very little about laboratory work and fall into the exact same traps as their technicians. The result is that today almost every patient receives oversized dentistry. The underlying cause of most of the problems with full coverage restorative dentistry—clinical and laboratory–is a general lack of knowledge about what basic principles are essential for a consistently successful outcome.
A successful outcome does not mean the esthetic result on the day of insertion. It means longevity! How long do those restorations last in health? Wouldn’t you like to have patients in your practice like my buddy Steve?
As yourself this: If the dentistry looks pretty on the day of insertion but does not last—is that something you should be doing? I think not! At lectures on crown and bridgework—and even at many implant lectures—we attendees almost NEVER get to see X-Ray follow-up for the presented cases. X-Ray follow-up is the evidence we need to see to determine whether the technique being promoted is any good.
A bit of concluding advice for getting the most out of continuing education: If a presenter shows follow-up evidence, sit up and take notes. However, if the presenter does not show follow-up—no matter how pretty the dentistry looks—always be skeptical. Don’t be impressed with fancy titles or possessions. These luxuries will not help you. Remember that science is never settled–no matter who claims to have settled it. Let’s see the evidence–then we’ll talk! “The important thing,” says Albert Einstein, “is to never stop questioning.”
1Dental Abstracts Vol 61, Issue 4; 2016; p.173; Keep the Ones Youve Got; Giannobile, WV, Lang NP: Are dental implants a panacea or should we better strive to save teeth? J Dent Res 95:5-6, 2016
Become the best practitioner in full coverage restorative dentistry that you can be! Don’t settle! Join the ONWARD program and learn how to do crown and bridgework with excellence and confidence, how to save “hopeless” teeth, and how to provide new options for patient treatment that you never thought of. Visit the website: https://theonwardprogram.com
Dr. Feinberg is also available to give presentations. His CV and speaker packet is posted on the website. (https://theonwardprogram.com/about-dr-feinberg/) Dr. Feinberg can be reached at info@theONWARDprogram.com.