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View from the Chairside: Teeth in a Day…Really?

Once again, I had the pleasure to work with and host Dr. Paul Belzycki, dental surgeon from Toronto. He continues his series of mentorship posts, presenting valuable clinical expertise gathered over four decades in private dental practice.

As usual we are very grateful and thankful for his valuable contribution and continued support.

I hope you enjoy watching the case. We always welcome your feedback, thoughts, suggestions, and questions. Email us at oasisdsicussions@cda-adc.ca or if you would like to call us, our toll-free number is 1-855-716-2747.

Until next time!

Chiraz Guessaier, CDA Oasis Manager

Dr. Belzycki’s Thoughts

Teeth in a day…really? Accurately fitting crowns in one appointment? All simple and easy with no fuss or muss!

Perhaps it is my idiosyncrasies or the peculiarities of the patients I treat. Over the course of four decades, I have come across cases that are complicated not only by the required technical demands to bring a case to a successful conclusion, but also by the psycho-social events that the patient may be experiencing, a part from the dentistry. I have come to realize that life is messy and that as compassionate healthcare providers, we sometimes struggle with our patients to overcome obstacles that are often beyond our control in order to provide comprehensive quality care.

Oasis Moment – Take Away Message (2.10″)

 

Full Case Presentation (27.36″)

 

11 comments

  1. Excellent documentation, once again. Love your play by play, thanx for the effort!

    • Dr. Paul Belzycki

      Thanks Cliff.

      Someone needs to dispel all the hype and misinformation regarding the delivery of quality dentistry. I figure it might as well be me. I have nothing to loose. No partners. No sponsors. Not faculty. No political affiliations to organized dentistry.

      Just totally accountable to my patients.
      Paul

  2. Paul, thank you for sharing this case.
    It’s important to educate patients about quality work and how long it takes to be done right; especially in the case of complex cases. I would love to talk more about the occlusion on the right side. The take-home message that quality dentistry is lengthy and time consuming should be considered the standard in complex cases.

    • Dr. Paul Belzycki

      Dear Rakan

      And that my dear colleague, is why I presented this case.
      It surprised me that I got it done.
      The patient was wonderfully cooperative while in the chair.
      She is a healthcare professional in her own right.
      Neither one of us set out to complicate the case.
      But life got in the way.

      Dr. Paul Belzycki

  3. Thank you Dr. Belzycki.. I really appreciate the way you are helping young clinicians here. These cases are really done in an excellent way and yes, we would love to see your more dental presentations. thank you again.

  4. Dr Elizabeth Newman

    Hi Paul
    Yes, I also am a “visual learner” and I loved this video.

    Thank you for your time and effort again in creating this presentation.
    Please keep all these excellent and informative videos coming. They are greatly appreciated.

    Kind Regards
    Liz

    • Dr. Paul Belzycki

      Dear Elizabeth

      Thanks for your kind and supportive words.
      Dr. Paul Belzycki

      • Dr. Elizabeth Newman

        Hi Paul
        This current comment of mine is about the use of amalgam restorations which you know I feel the same way about as you do
        It was very recently pointed out to me by an “old school”. dentist who teaches at U of T that the 2018 ODA fee guide is now the same for a bonded amalgam as it is for a bonded composite restoration.
        According to the ODA, the decision to make this change was initiated several years ago as a result of a dentist writing in to the ODA requesting that this happened. And the differential gap in fees between the two types of restorations was gradually closed over a number of years , with it resulting in the same fee for bonded amalgams and bonded composited in 2018.

        I was very happy to see this change in the fee structure

        Kind Regards
        Liz

        • Dr. Paul Belzycki

          Wow, and I gave up on the ODA Fee Guide Folks a lifetime ago. I could not make sense of their methodologies. They penalize folks such as myself, that practice comprehensive dentistry. The history behind my statement is as follows:

          It was my opinion, that every year, the fee for composite resin fillings increased the most. I gave them a call some 15 years ago, so I am relying on memory for the explanation they gave me. It went something like this… their aim is to increase the average income for a dentist by a reasonable percentage every year. Given that most dentists place composite resin fillings, that fee would increase more as compared to fees for other “less popular” services provided by GP’s. Periodontal surgery and amalgam fillings were some of those services. That fee would either remain stable or decrease in order to attain an overall increased average.

          So, I said to the representative, “Dentist such as myself are being penalized for placing conventional long-lasting restorations and doing periodontal surgery, while the Resin-Guys are enjoying a fee bonanza.”

          It takes as much time to do a good amalgam restoration as it does a composite resin. I failed to understand the ODA fee logic.

          In addition, this financial methodology promotes the use of methods and materials that will result in a less favorable outcome. Every study shows that amalgam lasts longer. Ironically, this fee disparity often worked to my advantage, When I would get into an argument with a patient over which material to use, I would claim that I can use composite resin, but they would be paying more for less of a restoration. I hoped the patient might think “here is a dentist willing to make less money for a filling…he is putting my interests ahead of his…he must be honest”. Most of the times, I won the argument.

          Now, I need to find a new argument?

          While on this topic, I cannot understand the lower fee for a full-cast metal crown as opposed to porcelain-fused-to-metal. Identical procedures are involved. In fact, it usually takes longer to adjust the occlusion on a full metal. Also recall that full metal crowns last longer than anything else. Again, the fees are dictating treatment choices.

          More emphatically, the time taken for providing a quality crown is equal, if not more, than the time to do a molar endo, yet the crown fee is less. Why? Is the technical difficulty less? Is the responsibility factor less? Another head scratcher.

          Those of us that provide periodontal surgery are placed at a financial disadvantage. Would it not make more sense to simply increase all the fees by the same amount and save costs on ODA annual fee surveys?

          I stress that this conversation took place 15 years ago.
          Perhaps their methodologies and algorithms are now different.

          I feel privately and personally vindicated in my choice to use amalgam now that refereed dental literature is surfacing to support this choice. It was there all along, but no one cared to listen, especially the dental materials manufactures, whose financial interest is to promote anything ‘New and Improved”. I am so tired of claims that a new plastic filling material “Changes Everything”. It only changes the bottom line for some folks. Am I the only one that sees this?

          Good to hear the ODA has finally caught up.

  5. Thanks Paul for your time and efforts and for sharing your cases with us! Highly appreciated! Love each of your presentation. Quality work and good dentistry needs time and knowledge! Always a good message delivered and a wake up call!

  6. Vasant Ramlaggan

    Thanks for the great presentation! Great documentation and great follow through over the years!

    Thanks for taking it old school and not doing the quick fix!

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