Episode #307: Solutions to the Edentulous Dilemma, with Dr. Pat Lillis

More and more patients are losing their teeth. And according to Dr. Pat Lillis, this trend will continue to grow. Today, Kirk Behrendt and Dr. Lillis talk about how you can educate yourself so you can be equipped to help edentulous patients. Don't think this doesn't apply to your practice — people are outliving their teeth! To be better prepared with solutions, listen to Episode 307 of The Best Practices Show!

Main Takeaways:

• More and more people are losing their teeth, so dentists need to be ready with solutions.
• Be equipped — patients are educating themselves about these topics.
• Document your cases and build a library to show patients. Visuals are important!
• Many patients may opt for zirconia. Give them that option.
• Practice long enough, and failure will happen. Teeth will fracture or debond.
• Use the “power of threes.” Too many options can confuse patients.
• You'll need this in your practice, even if your current population is younger.

Quotes:

• “It’s becoming a bigger and bigger issue. When I started practicing, I would see some [edentulous] patients just trickle in through the door. And then, over time, it’s just becoming so rampant. And you kind of scratch your head thinking, ‘Why are so many people losing their teeth?’ and demographics of patients, etc. But I don't know. It seems like every week we get more and more of these patients that come in through the door.” (05:24—05:54)
• “[Edentulous] patients are coming into my practice. And they're definitely coming into your practice. And so, if you don't have the tools in the toolbelt, so to speak, then it’s going to be very, very difficult to treat these patients. And I just think it’s something that we have got to learn how to do, whether you like it or not.” (05:59—06:15)
• “[Early] on in my career, the options were a little bit limited in the porcelain world. But nowadays, with all the materials that we have, the zirconia, all the bars, and all this really amazing technology, we can do zirconia and we can do ceramics very, very routinely. And it’s a thinner restoration. It’s smaller. It’s more challenging to do it clinically, but it’s an amazing thing. And I see that getting left out of treatment plans. And the reason I say that is because on several occasions, people will come into our office for a second opinion. And we’ll give them the same, but then we give the zirconia option. And I can't tell you how many patients have elected to do that type of procedure.” (11:09—11:53)
• “I agree with Bill [Robbins]. It’s never been a better time to practice dentistry than right now. We have so many things at our disposal to really help these patients, to give them solutions that they never had before. If you were to lose your teeth 30, 40 years ago, what were your options? Wearing dentures. That was just the way it was. But now, 2021, what're your options? You can have teeth that are fixed in your mouth. You don't have to wear a denture anymore.” (13:30—14:05)
• “Nowadays, you can meet with your surgeon before you're doing the cases, and they can merge CBCT scans and intraoral scans. And you can start digitally planning these cases out with your surgeons. And you can get down to quality, how much bone to take away, where exactly the implants are going to go before you place them, how many you're going to place, where they're going to go, what's the prosthesis going to be. Those are all things that you can do now in the digital world. But the diagnosis and treatment planning stage hasn't changed. How we capture and how we plan has changed.” (17:16—17:53)
• “The number-one thing I see that goes wrong is material selection. Are you doing plastic teeth or doing zirconia teeth? And then, how much bone you have to reduce to do that procedure. So, that's the very first thing that I see that goes south on these cases.” (20:00—20:14)
• “I say [to patients], ‘Listen, you're not going to die because you didn't get this type of work done. So, there's no pressure, for starters, to do dentistry.’ When you do that, it’s amazing what happens to case acceptance. When you act like there's no pressure to do this stuff, they’ll do it.” (21:49—22:06)
• “The biggest thing you can do is say, ‘Listen, this is the consequence if you don't do this treatment. You're not going to chew your food correctly. So, if you can't chew your food correctly, how are you going to digest it?’ I think sometimes, we gloss over just that one little thing, is that if you can't chew your food correctly, what's your quality of life going to be? So, yeah, you're not going to die because you didn't get the work done. But your quality of life is going to suffer.” (22:22—22:45)
• “I hear that all the time, ‘I'm 85.’ I say, ‘Listen, we did implants on a 96-year-old patient one time. And she lived till she was 105. She got nine years out of that treatment.’ So, age is never a contraindication treatment. If they have all their faculties with them, if they really are healthy individuals and they know exactly what's going on, and they want to do that type of dentistry, I think it’s our duty to at least give them the option.” (22:51—23:19)
• “I had one lady say, ‘Well, I can't get a car if I do this treatment.’ I said, ‘Listen, you're going to drive to your restaurant and you're not going to be able to eat, so what difference does it make?’” (23:31—23:44)
• “When young dentists call me or when I lecture, I tell them, ‘Take pictures of all your stuff, document it, videos, everything, and put it into Keynote presentations or PowerPoints and have them in your consultation at the ready so that you can show that, ‘Hey, these are plastic teeth. This is zirconia. And, by the way, these are all my cases.’ And if you're starting out, you don't have your case library, call me. I'll give you my slides.” (25:18—25:40)
• “Practice long enough, and you'll see failures. If you do a traditional hybrid with plastic teeth on a titanium milled bar, the teeth are going to debond from the bar. It’s just going to happen. And you've got to tell the patients that, ‘Listen, it’s going to happen. And when it happens, don't worry. Just call us, and we’ll get you in.’” (28:29—28:50)
• “Luckily, we have PMMA overlays, meaning that we’re doing PMMA overlay in a bar so the fracture rate has gone down, which is good. But you're still going to get stuff that's going to break, and you've got to fix it. So, you've got to tell the patient, because a lot of times they're being like, ‘This is my last dental bill I'll ever have in my life,’ and we’re saying, ‘No, no, no, no, no. You're going to have some dental bills. You're going to have maintenance and you're going to have some fractures that we’ve got to fix.” (28:58—29:22)
• “One of the things [Chris Ramsey] talked about in his “Power of Persuasion” lecture was the power of threes . . . We can offer them seven, eight different options. Patients get confused, and they're not going to case accept. And I'm guilty of this, by the way. When I first got out of residency, I'm like, ‘Oh, I've got to give people eight, nine, ten treatment plans.’ But case acceptance was lousy. So, when I went to just three different options, I found that my case acceptance went up.” (30:59—31:40)
• “I'm like this too. I can't think past the third one. If you give me four or five [options], I just can't get there. So, we give people just three options, and three options only, to start off with. And so, we list good, better, and best. And it’s amazing when you do that how they can get their arms around it.” (31:42—32:01)
• “People are living longer. They're essentially outliving their teeth. Let's be honest, our teeth were not meant to last as long as they are. Which is great. We’re living longer and quality of lives are longer. But we’re outpacing our teeth. So, I think this issue which we’re talking about is only going to be more dramatic as time goes on. I really do. I don't see this slowing down at all. I think that actually is going to start to pick up steam. So, that's where I see this going. The ability to give patients this type of option has got to be something you have in your practice. And if it’s not, then you have got to be able to refer it to somebody that can do it.” (38:42—39:24)
• “Some of these younger dentists are saying, ‘Well, I practice in suburban,’ wherever it is, ‘I don't have these patients.’ And I just tell them, ‘It’s a function of time. Because the young families that you're seeing are going to have, what? Parents. Grandparents. And those grandparents are going to need this care.’” (39:29—39:47)

Snippets:

• Dr. Lillis’ background. (03:09—04:34)
• Why this is an important topic in restorative dentistry. (05:24—06:15)
• Be ready with solutions for the aging population. (07:18—07:40)
• How to get started in helping patients. (08:07—09:49)
• Give patients the option of zirconia. (10:44—14:26)
• Digital versus analog. (15:01—18:37)
• What dentists get wrong/biggest misconceptions. (19:24—21:08)
• The money challenge. (21:08—23:44)
• Build your library of cases. (24:57—27:38)
• Teeth will debond or fracture. (27:50—30:21)
• Helping patients make better decisions. (30:52—32:35)
• Patients want the straight answer. (33:06—35:15)
• Will this be profitable in the future? (36:00—38:07)
• Last thoughts. (38:39—39:48)
• Dr. Lillis’ contact information and study club topics. (39:48—43:24)

Reach Out to Dr. Lillis:

Dr. Lillis’ website: https://opdentaldesign.com/  

Dr. Lillis’ Facebook: https://www.facebook.com/patrick.lillis.33

@drlillis

Dr. Pat Lillis Bio:

Dr. Patrick Lillis graduated from Marquette University in Milwaukee, Wisconsin, with a Bachelor of Science degree majoring in Biomedical Science. After graduation, Dr. Lillis attended Creighton University School of Dentistry in Omaha, Nebraska, where he received his Doctor of Dental Surgery degree. Upon Completion of dental school, Dr. Lillis did a two-year Advanced Education in General Dentistry residency program at the University of Missouri Kansas City School of Dentistry in Kansas City, Missouri. This university-based residency program provided a heavy emphasis on implants and cosmetic and complex restorative dental modalities. Dr. Lillis’ training provided him a unique opportunity to focus and treat extremely difficult dental complexities. He had the opportunity to work under some of the foremost leaders in implant, prosthodontic, and cosmetic dentistry in the Midwest.

Dr. Patrick Lillis is among an elite network of dentists from around the country who routinely work together to discuss the latest dental technology. In addition to running a practice, Dr. Lillis holds the distinction of being a keynote speaker for several dental manufacturers. This allows him to lecture on such topics as dental implants and full-mouth rehabilitation utilizing esthetic and adhesive dentistry. Further, Dr. Lillis has had the opportunity to speak at numerous study clubs and larger peer-reviewed meetings nationwide. He routinely carries out these complex dental procedures in his practice both on patient and doctor referrals.

When he isn’t running a full-time private practice, lecturing, and teaching, he loves spending time with his wife and two children. His hobbies include running, skiing, and golf.