by Dr Alex Fibishenko
I was motivated to write this article after reading some facebook correspondence between All-On-4 Clinic's provider Relations Manager, Laurie, and some dental prosthetists from New Zealand. I love how passionate my staff are about what we do. This article explores the contrasting views on the future of dentures as well as the roles and responsibilities of dental prosthetists.
The prosthetists' comments on facebook were as in response to an upcoming lecture that I am involved in, which is specifically for professional dental prosthetists. The lecture had the following header/synopsis:
A paradigm shift for Dental Prosthetists: the role and new opportunities during the implant boom and Gen'All-On-4'.
With the emergence of All-On-4 and cost-effective implant solutions that are not only fixed and predictable, but also immediate, traditional dentures are quickly becoming a thing of the past, which threatens the commercial viability of Dental Prosthetists.
However, many of the skills of the the dental prosthetist are highly adventageous in immediate implant rehabilitation, and a new role has emerged in the overall management edentulous or soon-to-be-edentulous patients, who in today's day and age would be turned off by the numerous limitations of dentures. Understanding this role is not only key to survival, but is also an opportunity for growth.
Its simple, dentures sell implants! So the only way forward for prosthetists is to be part of the implant process.
Hosted by Dr Fadi Yassmin, with special guest speaker Dr Alex Fibishenko, founder of All-On-4 Clinic.
Dr Fibishenko will discuss All-On-4 Clinic's patient management system and the workflow from consultation to diagnostics to surgery and immediate delivery, as well as long term maintenance. The understanding of all aspects of the treatment including surgery is paramount for the successful integration of the modern dental prosthetist into an implant clinic. He will highlight the areas where prosthetist's involvement would be adventageous, and how this would help protect their commercial interest in the industry.
Dr Yassmin and Dr Fibishenko will also demonstrate various cases to help understand the possibilities for different kinds of problems, including for patients who have sever atrophy.
BACKGROUND
A denture is a removable plate holding artificial teeth. When there are still some teeth present it is known as a partial denture, and the teeth provide some support by was of metallic clasps. When no teeth are present it is known as a full denture. Nothing holds a full denture in place apart from suction that is created by saliva and cupping effect. This may sometimes be effective in the upper jaw because the plastic plate covers the entire palate and there is a large surface area coverage for the cupping effect. In the lower jaw, however, the suction is not very effective because of the smaller surface area and movement of the tongue, and these are less tolerable.
By far the biggest complaints that I hear from people with any kind of denture is the feeling of something foreign in their mouth, and looseness. But whilst these two complaints may appear benign to those who don't have to wear dentures, they are often a significant problem for those who do. Dentures typically affect the quality of life of individuals by restricting the type of foods that they can eat, reducing their ability to taste their food and wine, and by affecting their confidence and self-esteem.
The construction of dentures is usually done by a Dental Prosthetist. These are professionals who are TAFE-educated and who are technically skilled in the construction and fitting of dentures. They often work under instructions from a dentist or prosthodontist, but can also work directly with patients to a limited capacity, such as taking impressions and fitting of dentures. Prosthetists are not qualified to diagnose or deal with any other oral conditions or dental problems, or to connect implant components. Making Dentures is their bread and butter, but with the rise in popularity of All-On-4 dental implants treatment, dentures are becoming a thing of the past, at least as far as I have seen from my experience.
Prosthetists see denture patients on a daily basis. Those patients are not seeing them because they love the fact that they have to wear dentures. They see them because they may not have heard of All-On-4 or other permanent alternatives with dental implants. Of course, for some people, it may be just that they cannot afford dental implants, but you should never just assume so. The denture problem for them may be far more severe than any presumed financial strain, in relative terms. It is, at least, a moral responsibility for any professional who is involved with any aspect of a patient's oral care, including prosthetists, to inform their patients about possible options without judgment or assumptions, and to provide them with the benefit of choice.
It's a Catch 22 for a prosthetist to offer their patients to see an expert regarding All-On-4 dental implants, as it could potentially drive business away. But here is the thing: the skill set of the dental prosthetist is highly advantageous in the All-On-4 treatment process, and with some training, their roles can evolve from only making dentures, to also facilitating the implant treatment process and offering their patients what the prosthetists would want for themselves if they had dentures, a potential improvement to their quality of life.
FACEBOOK COMMENTS
Below are some extracts from the exchange of comments between Laurie and certain prosthetists.
Prosthetist X:
Not threatened at all. With the very high cost of ” all on 4’s”, traditional dentures have a very long future. Let's see after 10 years how the @ all on 4″ are doing still ….
Laurie (All-On-4 Clinic):
Thank you for engaging. Its always interesting to hear a prosthetist’s view before they learn about All-On-4 Clinic’s methods.
The good news is that it is indeed well past the 10 year mark with All-On-4. With thousands of happy patients, and a success rate above 98% at All-On-4 Clinic, this is today’s most predictable alternative to dentures.
We see people with dentures every day, people who would spend every last of their dollar to get rid of them. Luckily they don’t have to. With the treatment cost for all-on-4 being typically about half that of old style implant restorations, and an immediate solution, no wonder All-On-4 clinic attracts denture wearers not just from Australia, but also from abroad.
Having listened time and time again how dentures ruin a person’s quality of life and self esteem, one thing is certain, its definitely not something I would want for myself. With the utmost respect, question is, would you?
Prosthetist Y:
Removable complete dentures have a long life span in the market because it is affordable.
Laurie (All-On-4 Clinic):
Of course there will always be a place for conventional dentures for those who cannot afford implants. At the All-On-4 Clinic its about arming patients with the power of knowledge and choice.
You should never assume patients can’t afford it. When given the choice to get rid of dentures, my personal experience is that most would borrow or re-mortgage their house if they had to, just to be able to get rid of dentures. However they rarely have to go that far. With the unique streamilined methods pioneered by our founder, Dr Fibishenko, and ability to fit final permanent prostheses within 24 hours, the price is far more affordable than old-fashioned conventional implant styles.
Prosthetist Y:
The concept of implant dentures is an interesting field especially when it is compared to conventional removable dentures with the history of patient complaints.
…when we are talking about the all on 4 concepts, it's all about collaborating skills. There is a massive percentage of how dental technology contributes to the patient exceptions with implant dentures.
Prosthetist Z:
Is it ethical to recommend a treatment that can almost ruin a patient financially to the extent of having to re-mortgage their house…
Laurie (All-On-4 Clinic):
Thanks Y and Z for you further engagement and discussion. Like you said, Y, it is absolutely all about collaboration. However in order to be able to collaborate, prosthetists need to be trained so as to enhance their understanding of the process, because even though the process relies on the prosthetis’s existing skill set, its a very different concept with very different criteria to full dentures. Only once the prosthetist is trained can they become involved, and commercially benefit from, the All-On-4 treatment. There are some Prosthetists who focused their businesses almost entirely on promoting and being involved in the All-On-4 treatment, including some of Australia’s biggest and well known laboratories. The threat is only in relation to the fact that a growing number of denture wearers in Australia hear about the All-On-4 treatment through TV, radio, newspaper, or the internet, and leave their prosthetists altogether to go directly to the clinic. If instead it was the prosthetist who introduced them to the concept, not only can the prosthetist then become involved in the process, but the benefit to their patient of re-gaining function with this treatment is so powerful that they often refer their friends. In relation to the question of ethics that Z raised, at All-On-4 Clinic we do not pursue with treatment that would ruin a patient financially. For those who do not have immediate access to the required sum of money, and who choose and have the ability to re-draw against secure assets like their house, this certainly does not ruin them financially, rather this gives them better extended terms to pay for their treatment. For those who are both desperate in terms of need, and who do not have the means, All-On-4 Clinic has performed numerous pro-bono treatments. I have only worked at All-On-4 Clinic for less than 3 years, but in all this time with many hundreds of patients I have not had one person who regretted spending the money. The value is clear, its life-changing for the patients. Its not only a moral obligation but a responsibility of professionals, including prosthetists, to discuss options with this patients without assuming they couldn’t possibly afford implant treatment. With dentures many feel like invalids, and would do anything possible to try and get normal function back. There certainly isn’t any suggestion that prosthetists get involved in dental treatment, they can’t. But they can arm their patients with knowledge and choice, and be part of a life-changing process. Like you accurately stated, Y, prosthetists can certainly ’assist towards the whole treatment plan’, and this is what the lectures are all about: how to be able to do this effectively and to the benefit of the dentist, the technician, but most of all …the patient!
