Why am I Experiencing Clinical Failures?

By: Dr. Leonard A. Hess, DDS
Clinical Director, The Dawson Academy
The Article Originally Appeared on TheDawsonAcademy.com

If we’ve been practicing for any length of time at all, we’re going to see some clinical failures.

I think sometimes the perception is if we’re faculty at The Dawson Academy, that it never happens, and you should know that we all see clinical failures.

Reasons Why We See Clinical Failures

We just want to limit them as much as possible, and so there’s really going to be three reasons that something fails.

1. Simple Biological Failures

The first is biologic failures.

This can be from not doing our restorative dentistry at the detail that we would like. So maybe we don’t get our margins quite the way that we need to, and that can be because of preparation issues, retraction, or poor impression techniques.

It may be just not having a good diagnosis, in terms of the periodontal conditions that are going on. But what I find is most of those clinical failures happen earlier in our career when we’re gaining reps. I think that if we’re paying attention, we work hard, and we follow the principles that we learned in dental school, we can really limit that.

2. Failures from Force Management and Occlusion

The second type of failure that we’re going to see that I think frustrates us the most has to do with force management or the occlusion.

These are situations like porcelain breaking, crowns or veneers de-bonding, and spaces opening up around teeth.

All of those things are related to not having good control of the occlusion. So a lot of what we teach at The Dawson Academy is for our students to recognize, first, occlusions that are unstable to begin with and then give a formula where we can apply Dr. Dawson’s principles of occlusion to gain stability before we start doing the restorative dentistry.

The Importance of Recognizing Instability Before Doing Treatment

It’s very logical that if a patient starts with a functionally stable occlusion, that we can do crown and bridge on it and have good success.

But if we start recognizing the signs of instability, such as wear, mobility, migration, sore muscles, TMD issues – and one of the first things we should do after getting the mouth biologically stable is to get the occlusion functionally stable.

And once the occlusion is functionally stable, then we can do our prosthodontic treatment with great degrees of stability.

3. Biological Issues From Old Age

The third thing that you might see also is in the biologic realm, but it can be very frustrating. You may see patients that you did restorative dentistry on many, many years ago, and now the patients are getting older, and they’re on lots of medications, and their mouths are dry.

I’ve been in practice now for nearly 30 years, and this is one of my points of frustration where I’ll see these patients towards the end of their life losing their saliva, and they start getting decay around restorations that have been stable forever, and that’s a tough one.

So starting to employ techniques in your practice where you can really help them with increased fluoride and maybe chlorhexidine rinses two weeks before their cleaning to try to alter some of the bacterial count can be very helpful.

Pay Close Attention to the Small Details to Help Decrease Clinical Failures

So I think if you really start paying attention to the details of your just nuts-and-bolts restorative work, and your big cases, and:

  • getting really good, clean margins
  • good protocols for periodontal treatment before the restorative phase
  • starting to really employ good occlusal therapy in your cases (which we certainly can help you with)
  • have a protocol in place for some of high-risk caries patients

…that can really decrease the number of failures you see in your practice.

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Dr. Leonard Hess, DDS

Dr. Leonard Hess, DDS

Dr. Leonard Hess began teaching continuing education courses in 2005, and the topics include occlusion, smile design, treatment planning, preparation design, and practice integration of complete dentistry. He’s taught full-day continuing education courses at the American Academy of Cosmetic Dentistry’s national meeting, The Greater New York Dental Meeting, AACD National Meeting, Pacific Dental Conference, Ontario Dental Association meeting, and The Yankee Dental Conference. Dr. Hess also has taught courses in Japan, Germany, Poland, China, and Canada. Dr. Hess is currently serving as the Senior Clinical Director at The Dawson Academy. He also owns Union County Center for Comprehensive Dentistry in Charlotte, North Carolina.