In November 2017, Dr. Gio and Dr. Mitchell attended an intensive training course in dental implant placement at a state-of-the-art training facility in Puebla, Mexico. In just four days, they each logged 45 hours of continuing education on the most current implant techniques. How will their newly gained knowledge benefit our patients at Winchester Dental? In this interview, Gio Iuculano, DDS and Frank Mitchell, DDS discuss details.
Tell us about the implant training course you recently attended. What was the focus of the lectures, and how much course time was devoted to the lectures?
The course covered all aspects of implant placement and dealing with implant delivery sites within the mouth. It helped us refine our existing implant skills. It was challenging and intense; we completed 45 credit hours in just four days. On some of those days, the class met from 7 or 8 AM to after midnight. It was demanding, but that’s what we both wanted.
The course was technically up to date on the latest standard of care. On the first day, we had 11 hours’ worth of lectures covering various aspects of implant surgery, which now differs significantly from how it was ten and even five years ago. We learned quite a bit about implant techniques; we can now do more with preparing sites and bone grafts for optimal implant placement. The instructors were highly qualified; one instructor was from UCLA and another came from NYU Dental School. They were great instructors who made everything clear. During the clinical work, there was one instructor assigned to both of us, and we assisted each other.
How did the hands-on portion of the course proceed? Did you work with volunteer patients?
The course center is a not-for-profit organization, and our participation in this course also served as philanthropic mission work. Local dentists brought in their patients and assisted those of us participating in the course. Dr. Mitchell is learning Spanish and got to practice speaking the language! As part of our coursework, we placed implants for the volunteer patients. Three to four months after the implant placement, the patients’ local dentists will make their final crowns (teeth). The mission covers the cost of the crowns for any patient unable to afford them.
We performed many procedures; though rather than just doing as many implants as possible in a short period of time, we were more involved in learning new techniques to help us here at Winchester Dental. Not all courses proceed that way; this course was indeed rich in learning.
What kinds of cases did you see?
We saw patients who were missing teeth in certain areas of mouth. Some patients received comprehensive general dentistry as well, but implant therapy is a more advanced level of care, and the local dentists were learning as they were assisting us. It was truly charitable, not a business enterprise. The sterile technique and the level of care was very high and very good quality.
Was the technology at the course center similar to the technology you use during implant procedures at Winchester Dental?
Yes, just as we do at Winchester Dental, in this course we used CBCT scanning (which is like a 3D x-ray or CAT scan) for proper diagnosis and verifying proper implant placement. This reinforced our skills with this technology, and confirms that our practice’s use of CBCT technology is ahead of the curve. By using the 3D visuals that CBCT provides, we can almost preview the surgery and know how the bone looks before we start. Use of CBCT is not yet the standard of care—not every dental office has the technology—but in the next few years it will be. (For more about CBCT, see our technology page).
We also used PRF (platelet-rich fibrin), which helps patients heal faster and with less pain than ever before. The course center really had everything that we needed; we used the same technology and many techniques that we believe in.
Did you use any technology that was new to you? If so, what was it?
Yes, we used a Piezomed instrument, a surgical instrument that makes doing atraumatic extractions of the teeth easier; it allows us to reach the bone and preserve the blood supply without injuring the surrounding soft tissue. This results in less pain and faster healing for patients. We’re in the process of purchasing a Piezomed instrument for our office, and we expect to have it very soon.
You mentioned that this course included a partnership aspect, where dentists worked in pairs. How do you feel that working with a partner enhanced what you learned?
By assisting each other, we were able to observe the procedures from another perspective. We could see things from different angles, as well as all the suturing techniques that are applicable and the different types of tissue grafts that can be used. The collaborative aspect was also beneficial to the patients with whom we worked: since the local dentists were assisting us and an instructor oversaw each pair of course participants, every patient had the attention of four dentists.
How many implants did you place throughout this course?
Overall, we each placed between 10 and 15 implants. On each clinical day, we started early and used the CBCT technology to plan all the surgeries. At the end of the day, we looked at all the results, and really had the opportunity to study about 120 cases altogether, because we got to see everyone’s before and after images.
What were the most important skills and insights you gained from this course to benefit your patients in Winchester?
This course made clear that the key to a successful implant surgery is the planning. Performing the procedure itself is actually easier than the planning; learning all the planning steps allowed us to know how to best place an implant and how to make it last longer through our performing extra grafting procedures. We also recognized that we can easily save our patients from going through a second surgery (and its associated discomforts) when we place an implant the same day.