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My First Implant with Paresh B. Patel, DDS

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Dr. Paresh Patel, general dentist in private practice in North Carolina, talks about his first implant patient and what led him to make the leap into the surgical side of treatment. He also addresses what he considers to be an often-overlooked opportunity for dentists to strengthen their quality of care.

David Casper: Paresh, thanks for being here today. I wanted to take a few minutes to chat about your very first implant case. As a general dentist, there had to be either a patient or an experience that pushed you over the edge into placing implants, where you finally said, “I have to jump in.” Tell us a little bit about that patient, why they were your first case and how it went.

Dr. Paresh Patel: Sure. I was always scared of the esthetic zone. What if I put the implant in and the gum tissue didn’t heal right? What if the implant had to be removed? What if I did a multitude of things improperly; would the recovery be worse than if I had just left the area alone to begin with? As a general dentist, I was always fearful of the mental nerve, the “big rubber band.” You have in your mind that it’s this big scary thing, but when you see it for the first time, it’s actually bigger than you imagined. So once I actually saw it I was like, “OK, so this is what I was scared about the whole time?”

DC: Not a big deal.

PP: Right, it’s not a big deal.

So my first implant was a #13 in the maxillary arch, which is not what we usually see; it’s usually a lower molar, #19 or #30. But in my mind I was scared of the esthetic zone, I was scared of the sinus, and I was also scared of the mental foramen, so #13 was my very first implant. It was far enough away from the patient’s smile line that I felt like I would have some leeway if it didn’t turn out perfectly. And I didn’t have to worry about the sinus. So that’s how I picked it. It was for a very good patient who had come through for hygiene multiple times and was wearing a flipper for one missing tooth.

DC: Really?

PP: I really felt bad for her, and I said: “Let’s consider doing an implant for you. If you’re willing to take that step with me, I want to provide that service for you.” And that’s how we stepped into our first implant.

DC: That’s fantastic. So did you get any sleep the night before? How did you prepare?

PP: We canceled all the other appointments that day. It was a big production for us. We made sure we had three or four different diameters of implants and three or four different lengths. We had everything we could possibly need, and we laid everything out on the table. It was just the patient, me, the assistant and the front office staff. So we got in there, and we did it. It took all of 40 minutes, and we wondered why we were setting aside the whole day to do this. But I think it’s better to be cautious, feel good about what you’re doing, and offer the patient every chance of success.

It took all of 40 minutes, and we wondered why we were setting aside the whole day to do this. But I think it’s better to be cautious, feel good about what you’re doing, and offer the patient every chance of success.

DC: You bet. And the patient was happy?

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PP: Oh, yeah. We put the implant in. In retrospect, I probably should have done what I normally do now, which is to either put on a temporary cylinder and some sort of temporary crown to help preserve the gum tissue and start to mold it in the direction that we want, or at a minimum not use a flat stock healing cap, but instead put something in that will actually preserve the dimension of the root.

DC: But after that first time you were probably just happy to be through with it.

PP: That’s right. I think it’s always nice to use a two-piece implant, where you can separate the prosthetic phase from the surgical phase. If you’re first starting out, you can simply put the implant in place and pause, take a breather, and then decide whether you want to continue or stop and bring the patient back.

DC: That’s great. So with the confidence gained after that first case, how long was it before you tackled the second case?

PP: It wasn’t long after that. If we had had another patient that day, we would have gone ahead and put him in the chair because the schedule was open (laughs) and the excitement level was there.

I strongly believe that dentists should invest in their staff. I would encourage all dentists to bring some of their staff with them to whatever courses they take — their main assistant or at least the front office manager, who needs to understand how to schedule these procedures. The last thing we want is for dentists, who maybe haven’t done their first implant, to get the surgical kit and ask their assistant to hand them the lance bur or the Lindemann drill or the hex driver, and then for the assistant to have no idea what they’re looking for in the kit. If the assistant goes to the courses too, it’s one more set of eyes and ears to sit through the seminar. And then if the dentist forgets a step, the assistant can say, “Doctor, don’t you need this next?” I’m guilty of that; my assistant is what makes me great. She’s the one who helps keep me in the right direction 90 percent of the time because the amount of things you try to manage in one appointment can sometimes be a little mind-boggling.

DC: Well, we’re glad you jumped into implantology, and we’re glad you stayed in. Thanks for sharing your story.

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