Danny I am sitting down……phew.

I just finally finished my Dental Clinics of N. America chapter this weekend and had a drink. Gosh it was a hard thing to do.

In any event thank you so much for your kind words. IT does make a world of difference to me. In writing the final words of my chapter I resoundingly told people to please consider biologic principles in considering when to do closed crown lengthening and your words of wisdom were ringing in my ears.

I do believe that eventually we will figure out when to do closed with the laser and when to flap. I myself still believe that there is a role for CL of a closed flap variety but not some of the crazy stuff I see posted on the net.

I have come to at least consider when is it possible and not blindly fall into it.

I want to thank you for your kind post, and I am sure that you must at times shake your head with some of the posts here (including mine) but I think with time like in so many things we gradualize towards a common area where we both give a little and find some common ground.

I know that you have made significant attempts to open your mind and eyes to some new ideas includin LPT and this closed crown lengthening and you in doing so have made me think alot about flaps and when to do them.

THanks for your input on this and I hope to gradually get to a point where people say……..hmmmm….that is how to do it. I am far away from there now but getting closer all the time.

Thanks again Danny……..

Glenn

Hi Kelly: First off I want to compliment you on your always upbeat posts. They are a great reflection of the person I saw at the ALD who seems always positive…….thanks.

Kelly, I am trying to get away from this one tooth mentality that I have been saddled with and treat more comprehensively.

This patient if you look at the radiographs has a tremendous number of large amalgams.

I have never been able to convince her to have anything replaced if it aint broke or decayed. This is her first crown and only because the tooth was a little sensitive.

I totally agree with you about #30 and there are more besides this one.

THe patients are more likely to do the dentistry and less likely to complain about deep fillings that are sensitive.

The magnified images on video to the TV and also through pics on the camera help a huge amount.

Here is a case I did today………sorry no pics but the patient again is in a position where he needs some more work but we are starting with the tooth with decay.

You know what , I showed him the Gold only on #3 with the DB amalgam under it (amazing that they can see that with the scope) and told him it should be replaced.

I never knew it was there til I prepped the #2 today, and on the Bitewing there was recurrent decay under the amalgam because of the food trap (see the opening pics of the open contact).

I showed the patient this and the very very deep amalgam which was blushing on the pulp.

Used the laser to sterilize and we will see how the tooth responds.

That is the beautyof the scope……..it is a great teaching tool for patients and parents to see what is happening.

Had a little 6 year old guy with a large DO on a primary maxillary left first molar. Mom and Dad came into the room to observe (and make sure that I did the right tooth) and were they ever astonished when they watch me on the screens in the operatory working on the little guy. They saw the decay, how close it was too the pulp and me doing it all without anesthetic.

PS Marks spoons were AWESOME…….thanks again buddy they are still sharp and boy oh boy did they work great and is that ever a eye opener for parents to watch you scooping soft decay out of their sons tooth …….

You cant show them that with 6.0 power loupes.

Thats the great power of the scope……documentation, ergonomics and finally education of staff and patients.

The practicum student we have for the next 3 weeks is in awe watching every thing we do.

Hope that helps and Kelly you really have a way of being positive……..DONT EVER LOSE THAT.

Glenn

PS THe Dental Clinics of N . AMerica should be out in the fall as I was the last guy to get his work in ……..what else is new…..spending too much time here.

140 references, 50+ pages and 12 clinical cases.

It wasnt a walk in the park.

Glenn

HI Danny……..you know what you are right. Part of the problem is that with the scope I find so much work to do that it is exhausting sometimes because I am booked 2-3 months in advance. There is no real restraint here but the dental plans wont pay for you to keep restoring all teeth.

One problem is that I am trying to switch my practice to a more dentistry on less patients with a quadrant philosophy type dentistry.

Good microscope centered practices such as Arturo Garcia and Dr. David Clark do this and I am trying to slowly follow their lead.

I totally agree with you on your findings and I could work 7 day weeks of 16 hour days and still be booked for 2-3 months doing this. I have that many patients in the practice (probably 4-5000).

With the scope and the documentation everything changes, its tiring sometimes seeing so much. I also have figured out a long time ago that the key to wowing others was pictures shot at 10x mag and above. People quickly realize that I am doing something different , both the patients and dental colleagues.

I appreciate your insights and will tell you that very recently I raised my fees ( a hard thing for me to do here in Socialized Canada – where we have the blue collar hardworking Calgary Flames- great series huh) and I am trying to get to the mentality of replacing all restorations or most of them.

Its coming Danny…….slowly but surely.

Take care my friend.

I will post some other stuff tonight………

Take care

Glenn