Implant Practice US talks to Dr Schulter and Dr Williams about their Mempis based practice

Can you tell me about your background? 

Dr. SChulter (herafter Dr. S): My professional career started with a degree in Pharmacy at the University of Tennessee. I returned to Pennsylvania to earn my dental degree from Temple University, D.D.S. cum laude. After graduation I returned to Tennessee and attended a dual training in Prosthodontics at the University of Tennessee and the VA Hospital in Memphis Tennessee. On completion of my residency I entered private practice in Memphis, Tennessee as a Prosthodontist. I am certified by the American Board of Prosthodontics in fixed prosthodontics, Past-President of the American College of Prosthodontists, Fellow in the American College of Prosthodontists, Fellow in the International Team of Implantology and American College of Dentists. I received the President’s Award and the Distinguished Service Award from the American College of Prosthodontist.

In 2005 I helped create Cagenix, Inc. Cagenix is a research and development company devoted to dental implant devices and restorative devices for dental implants. Currently, I serve as the President of Cagenix and we have entered the market with custom CAD/CAM designed and manufactured dental implant frameworks and bars for the majority of implant systems in the market. Clinically, I am the director of the restorative division of Dental Implant Aesthetic Center (DIAC).

Dr. Williams (herafter Dr. W): Professionally, I received my dental degree from the University of Tennessee in 1991.  I then spent a year at Jewish Hospital in St Louis, MO doing a general practice residency. After the GPR, I started my residency in Oral and Maxillofacial Surgery at St. Francis Medical Center in Pittsburgh, PA which I completed in 1996.  I then set up a practice in Collierville, TN which is a suburb of Memphis.  Dr. Schulter and I worked closely with each other for many years treating implant patients but no matter how efficient we were at communicating between the two offices we always felt we could do better.  That’s when we combined practices to form the Dental Implant Aesthetic Center.  We have found that when we are working under one roof, our quality of patient care and efficency have greatly increased. 

I am a Diplomat of the American Board of Oral and Maxillofacial Surgery, and I am a fellow of the American Association of Oral and Maxillofacial Surgery.  I am the past president of the Memphis Society of Oral and Maxillofacial Surgery.  My other professional affiliations include being a member of the Tennessee Society of Oral and Maxillofacial Surgery, the Memphis Dental Society, the Tennessee Dental Association, the ADA and the AO.  I am also an Assistant Professor in the department of Oral and Maxillofacial Surgery at the University of Tennessee Health Science Center in Memphis, TN.

When did you decide to become a specialist and why? 

Dr. S: During my pre-doctoral training at Temple University my interests were in Oral Maxillofacial Surgery and Prosthodontics. Through the guidance of the prosthodontic faculty and my love to create and design prosthetic restorations for my patients I entered the specialty of prosthodontics. At this time implant dentistry was just in its infancy and very few residencies offered training in implant dentistry. Prosthodontics opened my mind to new techniques in restoring function and aesthetics for my patients. After attending the P.I. Branemark’s course at the Mayo Clinic I switched my focus to implant dentistry and later developed the DIAC in Memphis, TN.

Dr. W: After graduating from dental school I didn’t know what I wanted to do.  I decided that a GPR would give me the opportunity to experience the different aspects of dentistry and help me decide whether or not I wanted to pursue a specialty.  I was accepted to a GPR at Jewish Hospital at Washington University Medical Center in St. Louis, MO. 

I started my GPR in 1991 right after Washington University had closed their dental school.  There were several oral surgeons that worked out of the area hospitals that no longer had resident coverage.  This gave me the opportunity to assist them on a large number of the hospital cases.  During this time, I found that I truly had a love for oral and maxillofacial surgery and that this was what I wanted to do for a career.
 
Is your practice solely Implant Dentistry or do you practice other types of dentistry? 

Dr. S: Implant dentistry can be separated into a surgical practice and a restorative practice. Being a Prosthodontist that is surgically trained in implant placement I understand the demands and limitations of both practices. Therefore, the philosophy of the DIAC is to bring together specialties in surgery and in prosthodontics. As complicated implant prosthodontics is, so is the surgical considerations in implant dentistry. Combining both specialties allows for a true team effort in patient care from diagnosis and treatment planning to surgical placement and the final restoration for the patient. Our primary focus and treatment is in implant dentistry. At times to complete the rehabilitation of the patient conventional dentistry is needed to complete the functional and aesthetic outcome of the treatment.

Dr. W: Our practice covers the entire spectrum of oral and maxillofacial surgery and prosthodontics.  That being said we are focusing more on implant dentistry than the other areas of our specialties.

Why did you decide to focus on implants?

Dr. S: Conventional dentistry has limitations in providing optimum care for our patients and has prevented us from treating our patients to the highest standards of care in dentistry. Implant dentistry offers us alternatives not available in conventional dentistry. There must be a mixture between conventional techniques and implant dentistry to provide this optimum care. Very few practices in our region of the country were able to provide this care for our patients. As our skills increased in implant dentistry we were able to focus on delivering implant dentistry to our patients. The demands for our services increased in the dental community and lead us down the path to creation of the DIAC.
 
Dr. W: Dental implants are becoming more popular with each passing year.  I feel that they are the best choice for replacing missing in most patients if they are done correctly.  By combining Prosthodontics and Oral and Maxillofacial Surgery under one roof I think that our practice can offer patients an extremely high level of care.

Do your implant patients come from referrals? 

Dr. S: Yes—from patients, referring doctors and physicians. Patients are our first line of referrals. We take great care in educating our patients of the benefits of implant dentistry and as a result they are our greatest source for referrals. The DIAC has created a Partner’s Program with our referring doctors allowing them to participate in treatment to the degree of their comfort and training. Some doctors wish to just understand treatment through diagnosis and treatment planning, others wish to learn about restorative treatments to restore their patients and other wish for us to completely treat their patients. If a doctor wishes to restore the implant placed in their patient, we require that they participate in additional educational training to restore the patient. If the treatment is complicated, the DIAC assumes the role of rendering complete treatment for the patient. One of the main goals at the DIAC is to educate the patient and the doctor of the advantages, limitations and outcomes in treatment. This can only be done through a comprehensive evaluation process and understanding the patients desired outcome from treatment. This philosophy has increased patient and referring doctors’ acceptance and referrals to the DIAC.

Dr. W:  Some patients come from referring doctors and some are generated in our office.

How long have you been performing Implant Dentistry and what systems do you use?

Dr. S: Together we have been performing implant dentistry since 1985. With over 20 years of experience we have placed and restored just about every system in the market. We started out with the original Nobelpharma implant system and have used Sterioss, Simplant, Straumann, Astra, Nobel Biocare, Neoss, just to name a few. Today we are using Neoss, Astra and Straumann in our practice.

The DIAC is experienced not only in implant placement and restoration but in augmentation of the surgical site with the latest grafting techniques from guided bone regeneration with meshes (titanium, etc.) and membranes, to platelet rich protein and to use of bone morphogenic proteins like Infuse. With our association with Cagenix we are trying many of the new system to test their claims in implant treatment. Cagenix is researching these different implant systems in an effort to design an implant to restore bone and tissue contours to anatomical form.

Dr. W: I was first exposed to implant dentistry in dental school.  I gained experience placing implants in my surgery residency and have been placing implants in my private practice for the past 12 years.  Currently we use Neoss, Astra, Straumann, and some Nobel Biocare implants.

Can you tell me more about the training you have undertaken? 

Dr. S: My residency in prosthodontics gave me the basics to begin my career in implant dentistry. Working with a number of master technicians and fellow practitioners I learned the basics to restore implants. There is a saying in implant dentistry that “Implant Dentistry is Restoratively Driven”. Knowing how to restore implants allowed me to analysis the surgical placement of the implants. By first determining the final prosthesis and outcome for the patient we can then determine proper placement of the implant. If an implant can’t be placed to deliver the desired outcome then further evaluation of the surgical procedure needs to occur. To further study these surgical procedures first hand I received my surgical training at Harvard University. This experience allowed me to see firsthand the limitations in proper placement of a dental implant.

Combining surgical and restorative knowledge made me look further into improving our diagnostic and treatment planning skills to predict the outcome of treatment before we treat our patients. In seeking this knowledge I studied the world of CT scanning and purchased a Hitachi Medical scanner for DIAC. In studying CT scanning technology and software to diagnosis and treatment plan an implant case prior to surgical placement added the knowledge need to treat our patients to a higher level of confidence and a more predictable outcome.

Dr. W: Other than the residency programs that I have completed, I have spent multiple hours over the years attending continuing education meetings with many of them focusing on implant dentistry.

Who has inspired you? 

Dr. S: Many notable doctors in the field of implant dentistry have inspired me in many different ways. From Dr. P. I. Branemark for his dedication to making sure everything was done correctly from surgical placement to the type of restoration and backing it up with science and research. Dr. Tom Taylor inspired me to try new concepts and ideas in implant dentistry and encouraged me to follow through with my own ideas to help change implant dentistry. Dr. H.P. Weber advised, educated and encouraged me in my specialty and in R&D. Dr. Lyndon Cooper exposed me to new concepts and the real world of research. Dr. Alan Winter and Dr. Alan Pollock inspired me to look at surgical placement with a new approach and encouraged me to continue my efforts in research and development of new products for implant dentistry. Each of these doctors and many more close friends and colleagues have taught, mentored and helped me in my career in implant dentistry.

Dr. W: I think that if you are interested in implant dentistry you have to be inspired by Dr. Branemark.  He laid the ground work for all of us who work in the field of dental implants today.  Another individual who has been an influence on me professionally is Dr. Robert Marx.  He is a leader in the field of oral and maxillofacial surgery.  His incredible body of work has greatly influenced and revolutionized the specialty.  I am also a firm believer that if you want to truly become successful at any undertaking you need to find inspiration from within.  If you are always looking to others for inspiration you will spend a lot of time disappointed and frustrated.

What is the most satisfying aspect of your practice?

Dr. S: It is the hugs given to me by my patients and seeing their lives change by enhancing their ability to eat and smile again. This is the ultimate gratification for the patient and the doctor. There is also gratification in treating a challenging patient that requires a multidiscipline treatment approach and finding a way to do something you never thought possible.

Developing new techniques in surgery and unique prosthetic restorations to treat these cases is extremely rewarding for our team. The ability to work with the best supporting staff and specialists makes our profession very rewarding. At the DIAC we have an education division where we train general dentists and specialists in basic and advanced techniques of implant dentistry. Seeing these doctors develop their skills in implant dentistry is very satisfying.

Dr. W: The most satisfying part of my practice is taking a patient who is essentially a dental cripple when they begin treatment and restoring their mouth to a healthy state where they can eat and smile without worrying about pain or embarrassment.  The transformation in patients from the beginning to the end of treatment is very rewarding.

Professionally, what are you most proud of? 

Dr. S: I am most proud of being President of the American College of Prosthodontists. Having the privilege to serve and help further the specialty of Prosthodontics is an honor that I truly cherished. It is through the experience of leadership and personal interaction with other leaders that allowed me to prosper in my life as a person and as a caregiver to my patients. Implant dentistry is but a small part of the roles each practitioner plays in treating their patients. It is the learned interactions with people that create the true doctor-patient relationship. From this we can grow as a person and continually be happy with the profession we have chosen.

Dr. W: The practice that Dr. Schulter and I have built.  The environment we created has given us the opportunity to practice implant dentistry at a level that we were previously unable to achieve.  Having prosthodontics and surgery under one roof, I believe, has made us better able to meet the expectations of a more informed and demanding patient base.

What do you think is unique about your practice? 

Dr. S: The DIAC is a very unique practice that brings together two specialties, the oral maxillofacial surgeons and the prosthodontists. Together we can provide our patients total implant treatment with a team approach shared each day from diagnosis and treatment planning to surgical placement and final restoration. Each step of treatment is analyzed by each team member to determine the best treatment for the patient. Within the practice there is a CT imaging center providing important diagnostic data needed to treatment plan each case. This CT imaging provides us with 3D images and models of the patient, the ability to virtually place implants in the 3D images and provide CAD files to manufacture surgical guides for the placement of implants. CT imaging is opening a new world for implant dentistry and patient education.

DIAC association with Cagenix has allowed us to have first hand contact with the research and development of new products for implant dentistry. Clinical trials and pilot studies are performed by DIAC to analyze the outcomes of the products developed. DIAC participates in brainstorming new ideas for Cagenix that will improve patient care.

Dr. W: I think that our uniqueness comes from the fact that we have combined prosthodontics and oral and maxillofacial surgery under one roof.  I think that this allows us to communicate between specialties in an unprecedented way resulting in better care of our patients.

What has been your biggest challenge? 

Dr. S: Our biggest challenge is in educating our patients and referring doctors of the benefits of dental implants. Teaching patients how they can improve their health and quality of life and teaching referring doctors the value that implant dentistry has to their practices. Implant dentistry has been established as a standard of care in treating patients for a number of years yet mis-information from outside sources or lack of knowledge of the benefits of implant dentistry exist in all communities today. We are reaching out to our patient through educational materials such as office CD’s, patient pamphlets, patient testimonials, patient  pictures showing before and after treatments, implant company educational handouts and presenting patients with their own personal folders to keep all office informational and educational materials. Referring doctors’ knowledge can vary from experienced to novice when it comes to their level of experience with dental implants.

Our Partnering Program invites our referring dentist to work with DIAC at the level of their educational abilities. For the inexperienced we offer an introduction course on the basic principles of implant dentistry. For the experienced we have educational programs that range from beginning to complex. Each is based on the concept of thorough diagnosis and treatment planning with CT scans and mounted diagnostic casts to determining first the restorative treatment and then determining the implant placement with the use of surgical guides. Once the referring doctors understand the treatment concepts and patient accept the outcome of treatment then the surgical placement of the implant is scheduled. Patients appreciate the knowledge of knowing the outcome first and what treatment is needed to restore their function and aesthetics.

An informed patient is your best patient. With referring doctors the same is true. They need to be informed of the treatment and what they can expect when the patient is returned to their practice. DIAC has developed on our webpage a mechanism for referring doctors to monitor their patients’ treatment from start to finish. They can see clinical pictures, all x-rays, CT scans, view software showing the virtual placement of the implant and the finished treatment of the patient. Once they experience the level of care given to their patient and the patient’s satisfaction with the treatment, then we have accomplished our goals at DIAC.

Dr. W: Prosthodontic and surgical offices function in very different ways.  I think that the biggest challenge has been in combining the two specialties into one practice and making it work efficiently.

What would you have been if you didn’t become a dentist? 

Dr. S: For sure I would have been an architect. As a Prosthodontist, we are designing and creating new structures each time we treat a patient. This desire to develop new designs is also reflected in the creation of our company Cagenix. I am constantly searching for better ways to treat my patients. This stimulates me to think of these new ideas then to develop them and research them. As a result of these efforts, Cagenix is coming to the market with our Accuframe™ implant frameworks. This product is making a difficult procedure simple and cost effective for both the patient and the doctor.
Dr. W: If I wasn’t a dentist I would have been a Marine Biologist. 

What is the future of Implant Dentistry? 

Dr. S: Implant dentistry is still in it infancy. The future for implant dentistry is endless and is pioneering the future of dentistry. CAD/CAM technology is making possible treatment we never thought possible. Combining it with advanced CT technology and imaging in the future we will be able to do unbelievable surgical and restorative treatments for our patient that are more predictable. The implants that we will place in the future will be totally different than the ones we place today. New materials will be used and new designs will help to restore not only the tooth’s root form to its original place in the mouth but restore the missing bone to its natural contours. There will be new grafting techniques that restore missing alveolar structures to their natural form. These techniques are the future of implant dentistry.

Dr. W: I think the future of Implant Dentistry is very promising.  The national and international market continues to expand at an impressive rate.

What are your top tips in maintaining a successful implant practice and what advice would you give to budding implant dentists? 

Dr. S: Probably the top tip is to build an office team that portrays confidence, a caring hand, interacts with patients with a positive attitude, cares about the other team members and demonstrates the guiding principles of your practice. Without this team you can’t be successful. The team will make your day easier and most of all you will be happy at the end of the day. The doctors play very important technical roles but at time miss the personal interaction with the patient. The team will carry the practice to success. The doctor must lead and guide the practice to reach its goals.

As far as the budding implant dentist, develop your people skills as well as your technique skills. You should have an open critical mind to new concepts but first thoroughly study the concepts before treating your patients. Don’t believe everything the implant companies are saying about their products. You should question them and study the literature for answers. Spend more time diagnosing and treatment planning then you do treating. An hour spent at before treatment can save you countless time in treatment.

Dr. W: Always strive for excellence. Look at each case with a critical eye.  You should be able to find something that you can improve on with each case.  If you think that there is no room for improvement, your patient care and quality of work will suffer. You cannot build a practice of this type overnight.  Make sure you surround yourself with a good staff that is able to communicate fluently about implants to your patients.

What are your hobbies and what do you do in your spare time? 

Dr. S: I like to refer to it as peaceful time. Time away from dentistry and time spent finding peace with God and my family. I plan time to tent to these needs by attend my church regularly and planning events around my family, a simple meal, a round of golf, a game of tennis or just a walk around the neighborhood. Health is another important part of my life. As a family we exercise regularly and plan nutritious meals. This peaceful time gives me the energy to tackle the challenges of work and everyday life.

Dr. W: I am very involved in martial arts.  I study karate, kendo and kali and have been doing so for many years. I also like to fish.  I find these interests to be even more enjoyable when they are done with my two boys and my wife.