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today Nobel Biocare Global Symposium June 24, 2016

Nobel Biocare Global Symposium 10 science & research by Nobel Biocare n Dr. Tarun Agarwal, a general dentist, and Dr. Uday Reebye, an oral surgeon, advocate a team approach to implant dentistry that en- tails a surgical specialist, an anesthesiologist, a restorative dentist and a dental technician or laboratory. The editors of Nobel Biocare News recently asked these two doctors in the U.S. for their insights about teamwork in general and the All-on-4 treatment concept in particular. 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 at Chapel Hill. Later, after he had completed his oral surgery residency and opened his practice here in North Carolina, I began sending him the surgical cases that I was not comfortable treating. Our profes- sional relationship flourished when Uday en- couraged me to collaborate on our surgical cases. He was very open to sharing tips and tricks, even allowing me to participate in the surgery. Dr. Uday Reebye: At the same time, Tarun taught me about prosthetic and implant ad- vancements that had a great impact on my work. Agarwal: It became quite clear that the cases we did together were the cases that turned out best and had the fewest complica- tions. I think it was the strategic collaboration and taking a holistic (surgical and restorative) approach to the cases that made the differ- ence. For you, your dental practices and the pa- tient, what are the main benefits of the team approach? Reebye: Implant dentistry is rapidly evolv- ing and its complexities require solid prosthe- tic 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. Often, the greatest changes I make to my sur- geries are due to what Tarun has taught me on the restorative side; and conversely, Tarun has changed his treatment and prosthetic planning since he became involved in surgeries. Agarwal: What’s more, I now have the confidence to treat complex cases that I would never have even started in the past. The pa- tients truly benefit from our teamwork ap- proach in that they have a seamless treatment experience. Each member of the team is fo- cused on his or her core competency, and this leads to better results. I should also mention that practice productivity has steadily in- creased. As our mutual caseload has grown, so have referrals and our reputation within the community. It is like a snowball gaining size and momentum going downhill. Would you say that you each bring different qualities to the partnership? Agarwal: Without question. Uday is a dual-degree (M.D. and D.M.D.) board-certified oral-maxillofacial surgeon. His expertise and knowledge of surgery are far ahead of mine. I am an esthetically focused general dentist who has tremendous experience in digital dentistry. By each having an open mind, we are able to blend the digital technologies of restorative dentistry with 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 com- plexities and issues that the other deals 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 negotiate on the surgical side and sometimes we have to negotiate on the restor- ative 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 ab- solutely 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 differ- ences of opinion guided by a single principle: do what is in the best interests of the patient. Is the All-on-4 treatment concept especially appropriate for your team approach? Reebye: Yes, in my opinion, the All-on-4 treatment concept can only be successful as a team effort. It is a beautiful treatment con- cept 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 and assistants are happier, and some- how that combination results in great out- comes. 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. Start- ing with the endpoint in mind and collaborating to make it possible have routinely led to great out- comes. What do you regard as the main benefits of the All-on-4 treatment concept, for both clinicians and patients? Reebye: We see many edentu- lous or about-to-be edentulous pa- tients who need new teeth. Previ- ous 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 cli- nicians 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 con- cept is more affordable for patients, a greater number of patients become implant candi- dates. 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 tre- mendous support system to make you suc- cessful. Reebye: Before I took my first All-on-4 class, all I heard from many clinicians (none of whom had taken a class or performed All-on-4 surgery) was 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 considering adopting a team approach like yours, is there a secret to a successful partnership? Agarwal: You have 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: 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 fi- nally, enjoy! It is a wonderful journey. 7  Drs. Uday Reebye (left) and Tarun Agarwal agree that well-organized teamwork is beneficial for the patient and clinician alike.  Dr. Uday Reebye (left): “As similar as we are, I think we have a completely different approach to problems. The di- chotomy in the way we think, I believe, is what provides strength and success. Often, at the end of arguing about the correct treatment plan, we end up with a beautiful hybrid that otherwise would never have been realized.”  Dr. Tarun Agarwal (left): “Over time, we have pushed each other to take a closer look at each other’s perspective.” More to explore! To learn more about the All-on-4 treatment concept, all-on-4. Teamwork, for predictable outcomes “Working as a team allows us to make the most of our individual strengths and expertise.”

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