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Winter Park Dentistry-Teeth in a Day

 

Dr. Ramzi Matar (Winter Park Dentistry): Hello everybody, welcome to this episode of our podcast. Today’s topic is teeth in a day, or sometimes it’s called Clear Choice, I’ve heard it being called. There’s several different names, but currently the most common name I hear about is teeth in a day. My guest today is Dr. Don Tillery, he is an oral surgeon, and I’ve got to say, Don, I’m really excited to have you on. You’ve always been an influence for me, since I came to town and started practicing here. You started off at University of Florida for dental school, then went off to Texas, to Parkland, which everybody knows is the top premiere program, probably in the nation, for oral surgery. There’s a lot more into you being an oral surgeon, your father was an oral surgeon. It just kind of runs in your blood. You have two, three study clubs, every other day I hear you’re having a lecture, you’re a teaching dentist. I think clearly, if there was a geek squad for dentists, you would be the president. I think that it’s in your blood, in your veins, because you’re all about oral surgery, implants, and you’re always right there where you need to be as far as technologies.

I do remember one story, that’s the last of the introduction, we’ll move on with the interview… Early on, CAT scan technology was emerging in dentistry, and I think the price of one of those things is like a small house or something, I remember talking to you at one of the meetings, and it was just something that was coming out in journals, and us dentists were reading about it, it’s new and this and that and the other, and I remember you said something that was very clear “you know what? I’ve got one, it doesn’t matter what it costs, it’s better treatment, it’s faster treatment, it’s safer, more predictable”, and as far as I know, you were the first guy in town to have this technology, now a lot of guys have it, so for me, clearly, when I’m talking about this topic, all in a day teeth, same day teeth, you were the guy I first thought off, and I’m really glad, it’s Sunday night, it’s late, we’ve all had long weekends, really long for you because you were at the Gator game yesterday, so you probably had a very long week. But anyway, thanks so much for coming on.

Dr. Don E. Tillery, Jr: Thanks, Ramzi, it’s my pleasure to be here always.

Dr. Ramzi Matar (Winter Park Dentistry): So, let’s just get to the very introduction to it. I see commercials on TV, everybody’s who’s watching this podcast probably has seen companies like Clear Choice, there’s a practice somewhere, that has advertisement, they kind of advertise, that’s their specialty, maybe a sub specialty. What is teeth in a day? If I’m a patient watching this, I’ve heard about it, what’s the premise? What is it?

Dr. Don E. Tillery, Jr: As you mentioned there are a number of companies, and they market it with different names for each of the products, but by and large, it’s a mechanism where a patient who has failing teeth, they can come in and have their teeth removed while they’re asleep, of course, have a dental implant placed, a prosthesis placed, which is basically a replacement of all of the teeth, as well as some of the gum tissue, all placed and basically fixed into place and screwed into the dental implants, so they can come in with a mutilated teeth in pain, and basically that evening, for a modest fee, they can go home and eat with a new set of teeth and a new smile.

Dr. Ramzi Matar (Winter Park Dentistry): So we’re not talking about a denture, clearly everybody knows the typical denture that are rattling around and you put them in a jar and all those kinds of stuff, that’s fine, we’ve all had patients with dentures, but the innovation to this, what’s kind of new about it, these teeth are now fixed in their mouth, they’re attached to this implants.

Dr. Don E. Tillery, Jr: That’s right. They’re basically rigidly held to the actual jawbone, through an opening through the gum tissue, so they are as fixed and as permanent as the natural teeth once were. So they don’t come out at night, they’re not loose, they don’t have to use adhesives, they don’t have to be clipped in and out, and they’re extremely innocuous, they really don’t hurt. It’s amazing, it always surprises me when I call the patients who have tried this procedure. Last week I did a procedure on a very nice lady, and I always try to check upon them, and we called and I left her a voicemail, she wasn’t receiving calls. She called me the next day from lunch, with a friend, she went out to enjoy her new teeth, and that was the first time that she’d comfortably been able to go out and eat in public with the stability of teeth that weren’t loose, that didn’t come out.

Dr. Ramzi Matar (Winter Park Dentistry): What’s the general follow-up? Do you have to go to the dentist again, or are you done going to the dentist forever? Clearly, you do the surgery, and we’ll get into what’s the team involved, because I know it’s a team-approach, but just from a patient’s perspective, If I’m out there and I’m thinking about it, do I have to go the dentist anymore?

Dr. Don E. Tillery, Jr: No, you’re still going to go to the dentist! In fact, it’s probably even more critical to go, because if you think of anything that we have, an automobile for instance, maintenance is required, so you’re not off the hook. Quite honestly, what we find, our patients that are candidates for this, often times dreaded going to the dentist because routinely, they’re in pain, they have failing teeth, they’re frustrated and that trip to the dentist is perhaps an uncomfortable experience for them. With dental implants, it’s much the opposite, typically, there’s not a lot of pain associated with it, and the maintenance procedure is really pretty simple, it’s a routine cleaning, checking of the prosthesis, to make sure that it’s functional, and tightening if there’s any looseness to it, but not a painful experience at all for the patient. But like anything, maintenance is critical, so you’re not steering clear of the dentist.

Dr. Ramzi Matar (Winter Park Dentistry): What’s the age group, younger, older? Clearly, I assume, and I think it’s reasonable to say it’s usually an older population? Is there an age limit? You’re clearly well versed on putting people to sleep, that’s something you have a lot of training in, so who are the people out there who are most commonly in your chair doing this?

Dr. Don E. Tillery, Jr: It’s very interesting because one would think that they are older patients, who have been without teeth for quite some time, and they’ve accommodated and kind of gotten used to the failing dentures, that are loose, that are uncomfortable, and just as you pointed out, they’re watching midday television, they see a commercial come on, and they kind of scratch their head and say “do I have to travel outside of this community? Can I find somebody that could take care of this, that I’ve heard about, that has a reputation?”. Those are the patients that will call. There are also a consistent number of patients who’ve had medical conditions that have resulted in rapid loss of their teeth, a lot of decay, patients who have gone therapy radiations, who’ve had cancer, whose teeth become decayed and turn bad, and those patients that are on medication for either chronic pain, they’ve developed a dry mouth, and as you know when you develop a dry mouth because of medication or radiation therapy, it improves their quality of life and their life expectancy, but it deteriorates their tissue. When the teeth start to turn bad, it’s a bad deal. So those patients are extremely candidates for this type of procedure.

Dr. Ramzi Matar (Winter Park Dentistry): So the implants, they don’t get cavities, I take it? Are they free from cavities? If somebody who has this dry mouth, I know there’s several reasons why people get dry mouth, and you get implants, yes, you have to go in for cleanings and stuff, but the implants are resistant to decay, I assume?

Dr. Don E. Tillery, Jr: Yes, that’s right, they’re made of surgical grade titanium, and they don’t get rusty. They have a very unique property, they actually bond to the bone, and they become tighter fixed to the bone like natural teeth, and it’s terrific that there’s no decay, they are largely resistant to gum disease or periodontal disease as well. They’re made in an ideal material to resist the fractures of the dry mouth problem.

Dr. Ramzi Matar (Winter Park Dentistry): So this is something you touched on earlier, if I’m New Zealand, or Seattle, or Dallas, where you went to school, and I want this, how do I start? How do I look? Clearly, if I’m in Florida it’s very easy, I can call you, but if I’m anywhere else, can they go to their dentist? Do they have to find a surgeon who has this training? What’s the team assembled? I know there’s a specific team that approaches it, a part who does the surgery, another part of the team that does the teeth, and it’s kind of a combined effort, so if I’m a patient out there and I say “boy, I just want to know more about this”, where do you suggest they start looking into it? If they don’t have one of these centers, like Clear Choice or whoever, around them.

Dr. Don E. Tillery, Jr: One of the things that’s always important in health care is to develop a relationship with someone they trust. This technology is rapidly growing, it’s probably one of the most unique and inspirational procedures that I have seen come along in my entire career. As you mentioned, from our study club experience, there’s so much information that’s being forwarded to people in the community, so first and foremost, find someone that you trust. You don’t need to travel far to sit down with someone that you can discuss this with. Yes, as you mentioned, there are a number of clinics that capitalize on the team approach, and you mentioned several commercial, corporate programs, who have long since recognized the value of this type of procedure. The concept you alluded to is that it requires a team, it requires a surgeon, a restorative dentist and a prosthetic laboratory technician. The organization of that triad, these three professionals, is really the critical aspect to being able to provide good service. If you have an oral maxillofacial surgeon in your community that you trust, or that your neighbors trust or has taken care of family members, those are the people that would be ideal as far as seeking out their advice.

Second aspect, is the restorative dentist. The restorative dentist is the one who is going to continue to manage that person’s, that patient’s condition, as we already discussed. Routinely, in almost any community, you’ll have teams that have developed before that. There are rapidly advancing techniques that allow us to improve our team interaction relationships, and basically abbreviate the length of the surgery, the prosthetic reconstructive component, and using technology you discussed, the CT scanning, CAT computer generated designs, all of that makes things a lot easier on the patient as well as on the team. I’m certain that we’ll be able to continue to reduce the cost of these procedures by utilizing that technology.

Dr. Ramzi Matar (Winter Park Dentistry): To recap, you’ll have a dental surgeon, an oral maxillofacial surgeon in your case, and then there is some sort of a restorative dentist, sometimes a prosthodontist, someone who handles the tooth component of it. You’re kind of in charge of the surgery, putting the patient to sleep, and in between there, there’s a lab, using CAT scans, 3D printers, whatever, I think the commercial term is 3D lab, and they are the people who in between your procedure and the restorative dentist at the tail end of it, the lab is who makes the teeth and fabricates them, and then they’re kind of sandwiched between you. You’re there, managing the patient at the beginning, there’s a period in between, and then at the end of the day, the prosthetic component where you put the teeth in, and then the follow up is usually with the dentist. And then, are they seeing you to see the health of the implants regularly?

Dr. Don E. Tillery, Jr: Yes. Routinely, our protocol is the surgery is done during that surgical procedure, the restorative dentist and the laboratory technician, we are all involved.

Dr. Ramzi Matar (Winter Park Dentistry): Are they all in your office? So your office has the CAT scan, the computers, so that’s what I said earlier, you’re always on it, you have the technology. I didn’t realize you had everything at your office so both a regular dentist like me could go there at your office and do the whole A to Z. It’s not like the patient’s going around town with gauze in their mouth, bleeding out of their mouth.

Dr. Don E. Tillery, Jr: That’s right, yeah. It’s amazing to me how important it is to have trained individuals, it always blows my mind when I have a restorative dentist or a prosthodontist come, how talented you guys are, and how critical it is to have that component there. I’m new as an oral maxillofacial surgeon, I’m new to laboratory technicians, we don’t use them in our day in, day out routine or surgical procedures, but the value of having those individuals on hand at the time, it’s unbelievable how valuable that is. When I think that in this industry we’re used to working in our old little offices, and we often times forget how integrated team approaches can lead to superior outcomes and patient satisfaction. This technology, these procedures that we’re performing on patients, and the gratification that the patients are experiencing, it just is shout out loud how wonderful it is people who are well trained to do the parts of this when they come together in the same location, at the same time in order to help the patient. How fantastic the outcomes are.

I’d say, it’s a true team approach, and what we typically experience in our hands, our patients who might come in with a mutilated dentation, or their teeth are rotten, we’ll start these types of cases in the morning time, 7, 8 o’clock in the morning, we’ll let the patients go to sleep, numb them up. Once they’ve gone to sleep, we give them the injections inside their mouth anyway, and it all makes them totally know that there’s no way we can hurt them. I’ll go in and do the surgical part, the extraction of the teeth, the removal of any infectious matter that’s in there, all the time when the patient’s totally asleep, and then we’ll go on using these computer generated guides, place the implants into the specific locations, that’s pre planned, and at that point we’ll let the patients wake up, they’re numb, and we’ll let them wake up so that they can assist the restorative dentist with bite positioning, so as the prosthesis is being fitted and put in place, the patients are in no pain, they’ll drift off to sleep, but they’re not forced to sleep at that time, because it doesn’t hurt them, it’s important to have them go through biting and jaw movements in order to idealize the width the bite is made.

Dr. Ramzi Matar (Winter Park Dentistry): Things you can’t replicate when the patient’s asleep. I think, just to recap on the team approach, it’s breast cancer awareness month, we all know that’s always managed as a team. You go in, there’s a plastic surgeon, there’s the radiologist, there’s a whole crew and they’re all from cancer centers and the results are so much better because they are 3 or 4 or 5 people, in this case there’s three major elements, and I think it’s just great. Getting to my last few questions, everybody’s going to want to know, what should somebody expect as far as cost, in general. I realize it varies state from state, if you’re in London, if you’re in Tokyo, wherever you are, what sort of an average can people look at?

Dr. Don E. Tillery, Jr: I think it’s fair to look per jaw at 25 thousand dollars, and that should include the fee wrap-around for the surgeon, and for the restorative person and for the laboratory as well. Really, I think it’s been said, and I think that this is a pretty appropriate way, if things go well that morning, they typically do, we fully expect that the person will come in, not able to bite, concerned about their esthetics, and then they can walk out having all those issues addressed for less than the car than they drove in on.

Dr. Ramzi Matar (Winter Park Dentistry): I frankly thought it was a lot more than that. Last question, pressing question, I know you’re a big fisherman, so in your opinion, what would be harder, catching a prize black marlin or doing a teeth in a day?

Dr. Don E. Tillery, Jr: *laughs* Which one would be more fun or which one would be harder?

Dr. Ramzi Matar (Winter Park Dentistry): Either way, which would be tougher for you, reel in a thousand pound black marlin or to do a teeth in a day? Because both probably take about a full day.

Dr. Don E. Tillery, Jr: There’s no question about it, it would be much easier to do teeth in a day, or even two or three patients.

Dr. Ramzi Matar (Winter Park Dentistry): Well, that shows how good of a surgeon you are! For that to be easy for you is really impressive. I really appreciate it, anybody who’s watching this, I hope you learned something, please post your comments, me or Dr. Tillery will try to respond or try to get feedback as best we can, and Don, you’ve already mentioned, we probably have a hundred different topics we could get into, you have suggested a few, so stay tuned everybody, I think we’ll see some more of Dr. Tillery. Thanks so much, have a good night.