I spent part of the day today putting the final touches on a presentation for the Minnesota Academy of Comprehensive Dentistry entitled “Avoiding Restorative Failure”. The title brings up a great question we all must manage “Can we avoid the ultimate failure of restorative dentistry?”. There was a time in my professional life that I believed , or maybe it was more of a hope, that if I was really good at what I do technically, and a really good communicator, that my patients would never have another cavity once we finished restoring them. I’m betting some of you may be chuckling a bit reading that, both our of recognition of the hoped for and the unreality of it happening. If all dentistry has a life span, and will ultimately reach that lifespan, we are left with another question, ” How do we define failure?”
Often in dentistry we ask this question a different way, by talking about how long we warranty our work for. I’ve come to the conclusion, there is no hard and fast answer to this question becasue I provide dentistry to many unique individuals, each with a different set of risk factors. I’ve come to look at this question from another perspective and it started by looking up the word failure int he dictionary. One definition is that failure is the inability to achieve an expected outcome. At it’s essence is our expectations. Lots of things wear out, stop working, break or otherwise loose their effectiveness and we do not call it a failure. For example if my twenty year old refrigerator starts to have trouble staying cool, I’m not thrilled about it, but I get about my business of buying a new one or having it repaired without much upset. On the other hand, if my refrigerator that is 6 months old stops getting cool, it has failed, I’m very upset, and may even think the manufacturer produces substandard appliances and more.
I think the success or failure of restorative dentistry should be viewed from the same perspective. Both the dentist and the patient have an expectation about how long it will last and how it will look, feel and function. Dealing with failure is about being able to clearly understand the risk factors present for an individual patient and accurately create expectations around longevity for both ourselves and the patient. So when a patient asks me “How long does a crown last?”, instead of getting squirmy I can say with confidence ” That’s a challenging question to answer because it is different for different people. I can give you a range, averages or statistics. We can also talk about the things that cause a crown to need to be replaced, what your risk is of those things happening, and if your interested what things could reduce those risk factors.”
Tim Langguth says
Thanks for spending the day with us in Minnesota Friday. It is back to wearing a watch, as it is Monday. Hope your travels were ok. Would you please email me the “handout” for your presentation and the info on drawing the maxillary anteriors. Thanks again and best wishes for a wonderful Thanksgiving. Tim Langguth
Thanks Lee Ann for your insight. Informing the patient about the possibility for failure before it ever happens would be the ideal scenario. For example the lateral incisor with the endodontic treatment. If we were smart we would let them know at some point this tooth can fracture. The other option would be to remove it and replace it a different way. How would you like to proceed? I think most people would take the risk and keep the tooth. Then if it breaks they are not looking at us as the cause of failure. Again, thanks for your posts.