Dentaltown October 2017 - 84

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Orphanos uses OmniOptic loupes from Orascoptic. "The optics on
these particular loupes are fantastic because they're magnetically
held," he says. "They're easily removed and you can replace them
with varying magnifications."

HF: What technologies are you
passionate about?
EO: First, good loupes. If you
can't see your dentistry, you can't
do your dentistry. I'm also a big fan
of 3-D technology. It improves our
diagnostic capabilities. I would tell
young clinicians to stay away from
intraoral scanners for now. Soon
they'll be able to do full-arch scanning
and capture soft tissue. CAD/CAM is
very expensive, so put that on the
back burner for now as well. The goal
for young clinicians is diagnostics and
carrying out good, basic dental care.
From a clinical standpoint, as a
periodontist, loupes and cone beam
are essential. I can't tell you how many
times I've diagnosed periodontic
lesions that were never picked up and
the prevalence of missed MB2 canals.
I know these young clinicians want to
treat maxillary first molars with endo
because it's a lucrative procedure, but
if you don't have loupes and you don't
have cone beam, you're going to miss
those MB2 canals, which are present
about 90 percent of the time.
HF: It seems like 10 percent of
dentists refer all crown-lengthening
procedures to periodontists and the
other 90 percent don't refer at all. What
does this say about crown lengthening?
EO: The most successful clinicians I
work with refer for crown lengthening.

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OCTOBER 2017 // dentaltown.com

Why? Because they get the results
they want. They get the soft-tissue
response. They have the architecture.
They have the prosthetics that allows
for a beautiful result. I understand why
some clinicians don't refer-it's an issue
of, "Am I going to lose a patient?" It's an
issue of money, but I can tell you this:
The finest clinicians in the world-many
of whom I work with and many of
whom I know-always refer out crown
lengthening.
HF: Some dentists say if you place
the crown and the margins on the
bone, the human body automatically
does a crown-lengthening procedure.
EO: Those dentists don't
understand what crown lengthening
truly is. It's not just vertically reducing
the bone and the soft tissue. It's also
horizontally recontouring the tissue,
such that you have a nice, scalloped
contour. Think about crown margins
today. How do you get a good crown
margin if you can't see it? How do you
seal that crown margin if you don't
have a great impression? How do you
remove the cement? That's just such a
weak argument, and from a biological
standpoint it's frighteningly wrong.
HF: What is your religion of the
sinus?
EO: I've been a periodontist for
23 years. I've had three sinus postop
complications during sinus surgery, and

the fault was my own for not getting
an ENT clearance to check the drainage
of the ostiomeatal complex. If we do
not have proper cone beam technology
to understand what we're looking at,
we shouldn't be messing with the
sinus. If we're messing with the sinus,
we should get clearance from an ENT
because just the trauma to a sinus is
going to cause inflammation, and that
inflammation can block the ostiomeatal
complex. You need to make sure you
have a patent ostiomeatal complex. If
you do these things, your success rate
for implants in the posterior will be
through the roof.
Now, on the flip side of the coin, am
I opposed to three-unit bridges? Let's
be more specific. Do any of those teeth
have endodontics on them? Because
if they do, your success rate drops
precipitously.
If there's endo on those teeth, on
an abutment tooth, you might want to
reconsider a three-unit bridge. There is
a time and a place for an implant with a
sinus procedure, and there's a time and
a place for a three-unit bridge.
HF: What knowledge could you
impart on All-on-4 that you think
dentists might not get?
EO: With my approach, All-on-4
is about facial analysis and restoring
the face. If you go to my website,
center4smiles.com, and visit the gallery
in the All-on-4 section, you will see it's
not based on teeth; I diagnosis from
the face on in, and not from the bone
on out. I also have a training center
where I train surgeons and dentists on
the approach. All-on-4 is probably one
of the most misunderstood concepts,
and if you're not adequately trained,
you're going to get yourself into
trouble. ■
http://www.center4smiles.com http://www.dentaltown.com
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