The joy of cooking optimal care

June 21, 2012
Dr. Irwin Becker uses anterior guidance as an example to explain how an individualized approach to each patient and each situation is essential for success in dentistry. Here, he offers a thoughtful, six-step recipe to prepare a patient to proceed with the very best dental treatment.

Far too frequently, dental education is based on a single quip or a series of easily memorized steps. The willing student leaves with a positive attitude because of the ability to parrot back the quip with a false sense of security. I say false sense because, when the student runs into an exception, all too commonly, he or she is again lost, or at least not sure how to apply the “cookbook” recipe. What we need is a thought process and enough basic knowledge to think independently through the sophisticated challenge of dentistry. Success occurs when an individualized approach is applied appropriately to each patient and each situation.

Working out anterior guidance is a prime example. Some say there is a golden average length of anterior teeth (measured at upper to lower cuspid gingival height) that fits every patient. This, then, leads to a “no thought” decision to open most patients vertically to create this golden length. No consideration is given to the envelope of function (chewing stroke), rest position, free way space, or the patient’s acquired vertical (determined by contracted length of the powerful closing muscles).

There are many factors that help decide what the new anterior guidance should look like. The successful process includes consideration of the immediate posterior disclusion, esthetics and phonetic requirements, envelope of function limitation, smooth cross-over function, facial parameters, gingival display and periodontal condition, lower incisal plane requirements, vertical dimension, restoration requirements, and so on. So, a quick measurement and insertion of 20 new units the following weekend could be disastrous. But, until failure is encountered, the young, inexperienced dentist could be feeling really good about the cookbook approach of esthetic reconstruction. My own discoveries led me to write the book Comprehensive Occlusal Concepts in Clinical Practice (Wiley, 2010), which focuses on the ill effects of parafunctional destruction. That’s when improperly restored anterior guidance becomes a major noticeable problem.

When approaching the new-patient experience, there is a basic recipe to follow that is highly successful. Once the emergency or chief concern is addressed, it is altogether appropriate to ...

1. Get to know the patient.

2. Develop a beginning doctor/patient relationship.

3. Utilize a preclinical conversation to hear about the patient’s understanding of his or her past dental experience and own dental condition.

4. Invite the patient to experience a thorough co-discovery and behaviorally interactive evaluation.

5. Perform, to some appropriate degree, a diagnostic workup on the patient’s accurately articulated casts.

6. When appropriate, present the most optimal treatment plan that you have customized for this patient.

The beauty of these six steps is that they work if the dentist applies them in a behaviorally intelligent manner. They often yield a patient who is ready to proceed with optimal treatment. However, we may still have to do the treatment in phases and help the patient along in owning and accomplishing his or her dentistry.

So, is this a recipe for success? You bet it is, but it’s a thoughtful one.

Author bio
Dr. Irwin M. Becker chaired the Department of Education of The Pankey Institute from 1984 to 2008 and 2009 to 2010. He received his dental degree from the Medical College of Virginia in 1969 and attained his Board eligibility from the Boston University School of Graduate Dentistry in periodontal prosthodontics. In his private practice, Dr. Becker achieved a high level of success as a restorative dentist. He lectures and has published extensively on clinical topics and a philosophy of the practice of dentistry. In 2005, the Academy of General Dentistry honored him with the Weclew Award. Dr. Becker offers in-office coaching, team workshops, and also Red Sky Dental Seminars for colleagues who share a passion for fly-fishing. In 2011, Wiley published his new textbook Comprehensive Occlusal Concepts in Clinical Practice. For more information, visit