Creating a passion for dentistry

Jan. 1, 2004
Redefining dental education with The Hornbrook Group

Redefining dental education with The Hornbrook Group

In a discussion with Dr. Ron Ritsco, a co-founder of The Hornbrook Group, Dr. David Hornbrook outlined his feelings regarding the direction and importance of continuing education given by The Hornbrook Group.

The topic of discussion is achieving aesthetic and adhesive dentistry excellence through education. Aesthetic dentistry, Hornbrook said, is the gateway to a thriving, profitable, and rewarding practice. Improving patients' smiles and self-image, combined with the excitement generated by using new materials and techniques, offers rewards not realized in any other aspect of dentistry.

What's the best way for dentists to learn new skills in aesthetic dentistry?

There are so many opportunities and ways clinicians can learn about the new and exciting materials and techniques available today. Since most clinicians, even many of those who will graduate this year, do not learn about adhesion and aesthetics in dental school, post-graduate education becomes increasingly important to keep up with all the changes. This education can be achieved in numerous ways, from reading articles in the leading journal to actually treating a patient under the direct supervision and tutor ledge of the leader in dentistry. For many, the experience and expertise gained by attending over-the-shoulder or live-patient treatment programs have "jump-started" their aesthetic and adhesive careers to unexpected levels. A primary goal of The Hornbrook Group was to take this type of education to the people. Previously, dentists had to travel to training centers. It was time consuming and not affordable. Now the group is spreading the passion and bringing this type of education to dentists by providing courses across the country.

Materials and techniques are always changing in the field of adhesive and aesthetic dentistry. What's the best way to keep abreast of those changes?

Again, education is the best choice. Not only initially to learn about the basics of these new materials and techniques, but also to keep up. It is virtually impossible for the average, practicing clinician to keep up with all the new changes. Many of the leading educators, however, have made it their life ambition to work with the manufacturers in product research and development, and refinement, and have many more opportunities to evaluate these materials before the general dental population. The networking of many of these leading educators and researchers also gives them a unique advantage over the full-time practicing clinician, so they often become a wealth of knowledge based on a sharing of experiences and knowledge with other leaders and researchers. Periodicals based on the changes in this exciting facet of dentistry are indispensable. One such example is Reality, where materials and techniques, as well as literature, are evaluated by many leaders in our profession. Reality, founded by Dr. Michael Miller of Houston, Texas, also recently established a research lab where materials can be evaluated more objectively and scientifically.

What change has had the biggest impact in aesthetic dentistry during the last five years?

I can think of three primary things, and they are increased research and development in easy-to-use, predictable dentinal adhesion, advancement in metal-free restorations, and the use of lasers.

As far as dentinal adhesion, the concept of self-etching primers has opened new doors for those clinicians concerned about post-operative sensitivity and predictability in the past. Whether agents that are available today is the answer or meet our needs long term has yet to be seen, but they are the predecessors of the dentinal bonding agents of the future. This is the beginning of an entirely new era in adhesive dentistry, and it is exciting to imagine what the future brings.

For metal-free dentistry, the manufacturers are continuing their quest to provide strong, aesthetic materials that will replace the need for metal support, even with multi-span bridges. Materials such as lithium disilicate (Eris [Ivoclar]) and zirconium (Cercon [Dentsply] and Lava [3M]) have given clinicians increased opportunities to eliminate the unaesthetic compromise that metal has historically provided. In the realm of direct resins, manufacturers have also aimed their research and development toward more lifelike, "enamel-mimicking" materials with more filler particles for strength, durability, and handling, and different glass fillers for greater polishability and long-term aesthetics.

Lasers first entered aesthetic dentistry back in the early 1990s to more rapidly polymerize composite resins. Although this concept sounded good at the time, research has shown little advantage in time saving and possible decreases in the physical attributes of these materials. Today, lasers are used extensively to contour gingival tissue in anterior aesthetic cases, achieving ideal symmetry and better height-to-width ratios. The laser of choice for this treatment is the diode laser. I probably use a diode laser in more than 95 percent of my anterior aesthetic cases. We have obviously incorporated their use in our Hornbrook Group live-patient programs. Even those clinicians who have previously not emphasized gingival tissue in achieving ideal aesthetics of a smile instantly see advantages of the diode laser once they see it in actual clinical use.

Overall, we have seen a general trend toward more conservative dentistry, with an emphasis on providing our patients with beautiful, invisible, and long-lasting dental care.

What trends in continuing education do you see?

Education 10 years ago consisted primarily of sitting in some university or hotel lecture hall looking at slides of cases, techniques, and philosophies. That limited seeing things in three dimensions and witnessing potential complications that actually occur during actual clinical treatment. We have all been at a lecture where we learned something new and exciting that looked so easy on the screen but presented an entirely new set of complications when we tried to duplicate the procedure. Although this type of single-day education still exists because of locality and affordability, other types of education, especially in more advanced applications, have supplemented these day lectures.

One option is an over-the-shoulder style program. It usually consists of an educator actually treating a patient while attendees look over his or her shoulder to watch. Advantages include the small intimate group where questions are encouraged and where watching actual patient treatment is easily accomplished. I have been involved in several of these programs, usually sponsored by a major dental laboratory, where I prepared and seated all-ceramic restorations on a patient while 10 to 20 clinicians watched. Seeing an experienced clinician and the manner in which the bur is oriented or dentinal adhesive applied, or margins finished three dimensionally can be invaluable. The cost to attend these programs is generally higher because of smaller class sizes and more intimate, individualized attention.

The ultimate in aesthetic education is the live-patient treatment program. This usually consists of two weekends during which clinicians actually treat a patient under the guidance of leading educators and clinicians in the field. Even those who have experienced all levels of extensive continued education attest there is no substitute. Popularity has dramatically increased during the past seven years.

Usually these programs require clinicians to travel away from their home cities because of logistical requirements for such intense courses. Examples of this are Aesthetic Advantage (New York, Florida), PAC~live (San Francisco), and LVI (Las Vegas). Although costs and patient travel requirements are frequently forgotten once the educational value is realized, time away from practices and the logistics involved have prohibited many interested clinicians from attending. This is especially true since Sept. 11, 2001. The future of continued education, I believe, is to take the ultimate educational experience, live-patient treatment, and make it more accessible and more affordable by developing a leading team and unparalleled curriculum and establishing multiple centers across North America.

With this in mind, I, along with Dr. Mark Montgomery and Dr. Ron Ritsco, created the Hornbrook Group. This year alone, we are teaching these live-patient programs in New York, Kansas City, Houston, San Francisco, Fort Lauderdale, Fla., Memphis, Tenn., Louisville, Ky., and Calgary, British Columbia. By working with the universities in these cities, we can substantially reduce tuition for the courses. I believe this is the future, and I think we will probably see other institutes and programs follow this model. The more clinicians we touch and the more who have the opportunity to experience the excitement of changing another person's life by changing a smile, the better for all of dentistry.

Passion is a strong word to be used in the same sentence as dental education. What is the take-home message of The Hornbrook Group?

The future is bright, and this is what we affectionately refer to as the "Platinum Age" of dentistry. There has never been a better time to be a dentist, and the excitement escalates with every new day. If excellence and perfection is a destination, education and learning is the journey. There is simply no substitute for education and advancing our knowledge if we want to offer our patients the very best care we can. Education becomes our responsibility to warrant the trust and faith that our patients have placed in our skills. The journey of education is what breeds passion, and passion is the catalyst to achieving excellence and enjoyment in this wonderful profession of ours.

Dr. David Hornbrook, DDS, FAACD is privileged to instruct dentists nationwide on the latest advancements in cosmetic dentistry. He is considered a pioneer in live patient treatment education. Graduating from UCLA in 1986, he has been ranked as one of the top three cosmetic dentist in the nation by his peers. As one of less than 300 accredited members in the world of the American Academy of Cosmetic Dentistry, he holds positions on editorial boards of over 10 professional journals. He currently practices in San Diego, Calif. As the executive director of The Hornbrook Group, he brings his leading-edge program across the country to hundreds of clinicians, creating a passion for dentisty.