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Teamwork – For predictable outcomes

by: Jim Mack

Two doctors in the United States—one a general dentist, the other an oral surgeon—advocate a team approach to implant dentistry that creates a virtual clinic, consisting of a surgical specialist, an anesthesiologist, a restorative dentist and a dental technician or lab.

Drs. Uday Reebye and Tarun Agarwal agree that well-organized teamwork is beneficial for the patient and clinician alike.

We recently asked Drs. Tarun Agarwal and Uday Reebye for some insights about teamwork in general and the All-on-4® treatment concept in particular. Here are their answers:

How did you begin working together?          

Dr. Tarun Agarwal: I first met Uday while he was a medical student at the University of North Carolina. Later, after he completed his oral surgery residency and opened his practice here in North Carolina, I began sending him the surgical cases that I wasn’t comfortable tackling. Our professional relationship flourished when Uday encouraged me to participate and collaborate on our surgical cases. He was very open to sharing tips and tricks and even allowing me to participate in the surgery.

Dr. Uday Reebye: At the same time, Tarun taught me about prosthetic and implant advancements that had a great impact on my work.

Agarwal: It became pretty clear that the cases we did together were the cases that turned out best and went the smoothest. I think it was the strategic collaboration and taking the ‘holistic’ (surgical and restorative) approach to the case that made the difference.

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For you, your dental practices and the patient: What are the main benefits of the team approach?

Reebye: Implant dentistry is rapidly evolving and its complexities require solid prosthetic and surgical knowledge. Working as a team allows us to make the most of our individual strengths and expertise.

Sharing knowledge is essential for making advances in our field. Many times the biggest changes I make on my surgeries are due to what Tarun has taught me on the restorative side; and conversely, Tarun has changed his treatment planning and prosthetic planning since he began getting involved in surgeries.

Agarwal: What’s more, I now have the confidence to tackle complex cases that I would never have even started in the past.

The patient is the real winner in our teamwork approach. They are provided with a seamless treatment experience. Each member of the team is focused on his or her core competency, which leads to better results.

I should also mention that practice productivity has steadily increased. As our mutual caseload has grown, so have referrals and our reputation within the community. It’s like a snowball gaining size and momentum going downhill.

Dr. Uday Reebye (left): “As similar as we are, I think we have a completely different approach to problems. The dichotomy in the way we think, I believe, is what provides strength and success. Many times, at the end of arguing about the correct treatment plan, we end up with a beautiful ‘hybrid’ that otherwise would never have been realized.”

Would you say that you each bring different qualities to the partnership?

Agarwal: Without question. Dr. Reebye is a dual degree (MD and DMD) board certified Oral Maxillofacial Surgeon. His expertise and knowledge of surgery is light years ahead of mine. I am an esthetically-focused general dentist that has tremendous experience with digital dentistry.

By each having an open mind we are able to blend the digital technologies of restorative dentistry into the surgical world of complex implant dentistry. Over time, we have learned a great deal from each other, and now have a greater appreciation for the complexities and issues that each other deal with in the treatment process.

Do you ever have a difference of opinion when it comes to planning the treatment?

Agarwal: Of course we do! Sometimes we have to bend on the surgical side and sometimes we have to bend on the restorative side ...

Reebye: ... and it usually works out that whoever wins the argument has thought through the issue at hand a little longer and harder.

Agarwal: I can give you an example. Uday was hesitant to begin using computer guided implant surgery. Initially, it was slower than the traditional technique he was used to, but for me, it made the restorative component absolutely more predictable and quicker. After our first case, he became aware that the extra 20–30 minutes of his time saved the patient multiple visits on the restorative side.

Reebye: It was an easy trade-off to make. At the end of the day, we resolve any differences of opinion guided by a single principle—to do what’s in the best interest of the patient.

Related article: Just four implants, but countless benefits

Is the All-on-4® treatment concept especially appropriate for your team approach?

Reebye: Yes, in my eyes, the All-on-4® treatment concept can only be successful as a team effort. It is a beautiful treatment concept that marries surgical and prosthetic philosophies. 

I have to tell you that teamwork brings a great deal of enjoyment to the clinic. If you are happy when working, patients are happier, assistants are happier, and somehow that brew results in great outcomes.

Agarwal: It really does! In our team approach, the restorative dentist creates the case blueprint, the surgical specialist serves as an engineer—by verifying the blueprint is surgically feasible—and the anesthesiologist is totally focused on patient comfort.

Starting with the endpoint in mind and collaborating to make it possible has routinely led to great outcomes.

What do you see as the main benefits of the All-on-4® treatment concept, both for clinicians and patients?

Reebye: We see so many edentulous or about-to-be edentulous patients who need new teeth. Previous treatment modalities were so expensive and difficult that these patients left our clinics depressed, with no hope in sight. The All-on-4® treatment concept allows us as clinicians to give hope to many patients who once had few or no encouraging options. Now we can dramatically change the lives of these patients for the better. 

Agarwal: And because this treatment concept is more affordable for patients, a greater number of patients become implant candidates. For us, the All-on-4® treatment concept has virtually created a new market.

What would you say to clinicians thinking about starting with the All-on-4® treatment concept?

Agarwal: Go learn about it with an open mind! There are literally millions of patients who can benefit from this treatment. Nobel Biocare has a predictable workflow with a tremendous support system to make you successful.

Reebye: Before I took my first All-on-4® class, all I heard from many clinicians (none of which had taken a class or done All-on-4® surgery), that the concept was flawed and a recipe for disaster. Seven years later, all I can say is that I am so happy we did not listen to them. My advice? “Keep an open mind, take a course, and see for yourselves what a great service you can provide for your patients!”

For any clinicians out there looking to adopt a team approach like yours, is there a secret to successful partnership?

Agarwal: You’ve got to let go of your ego. We are all equals to the patient, after all, each bringing a different area of expertise to the team ...

Reebye: ... and let me add this: Listen to your patients. Be willing to talk to other clinicians to share ideas, and never be afraid to reach out when you need help. Most of us love to share what we know with each other—to be of help and to learn more at the same time.

And finally—enjoy! It’s a wonderful journey.

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