NK: Are you doing the whole tour with Nobel Biocare?
PO: I’m just doing the Ireland leg this time, although I did the UK one last time. But normally I think there’s a lot to be said for staying at home and working!
NK: How did you get involved with implantology?
PO: I qualified in Dublin and had a house position at the hospital but really my involvement came from my training in the States, and that was in periodontics and implant dentistry. That involved three years of training in surgical aspects of implant dentistry, so that’s where it came from. In the States implants were an in-office procedure, you were doing it yourself, which, at the time, was very different to over here. It was a big deal but not as big a deal. You didn’t need six or seven staff, all you needed was an assistant and one other person. It was more approachable and they took some of the mystique away from it. That was a great experience. In North Carolina, where I was, they were very much into the inflammatory aspect of it because a lot of their research was on link with general health, cardiovascular disease and low birth weight. They were very au fait; they didn’t place an implant in isolation, it had to be looked at holistically, with disease elimination and occlusal function as well as putting the implant in. It was very forward-thinking. You got a broad exposure to implant indications and treatment protocols because they had a big staff there, so you would get a lot of ‘this is what I do’ and it was great.
NK: Why did you choose to go to North Carolina?
PO: Two main reasons. One, at the time it was ranked the number one dental school in America; I think it’s number two now. And secondly, Sports Illustrated voted it the best college campus in America. It was a great place to spend three years. I loved it and I would go back.
NK: So what did you do when you came back to Ireland?
PO: I opened a practice focused on implants. On my first day my first patient was at 8 o’clock. The second one was at 3.30 the next day, so I had a day-and-a-half to get ready for the next patient! But, you know, it grew organically; from giving lectures, from a rapport with general dentists, from being flexible, being available, being affable. Just being all the things you’ve got to be if you’re in practice. You have to keep working at it but it’s going great.
NK: What do you think is special about Nobel Biocare’s commitment to continuing education?
PO: There are a few main things they’ve done and they’ve done them really well, really since the millennium. They focused on the more progressive, more innovative. They have tried to become, I think, a little more intuitive, combining the Swedish utilitarian approach with the cool California laid-back approach. They have blended together so you have something like the Replace system now, which I think is the ipod of implant systems in that it is just intuitive. You wouldn’t need anyone telling you what to do – you’d know looking at it what to do because it is laid out in a very simple manner and it’s colourful – it’s not just the stainless steel things they used to look like. It’s colour-coded now so general practitioners don’t need to get worried when a patient comes in, even if they’re only doing a couple of cases a year. They look at it, see it’s a yellow implant and so know they need a yellow bit to stick onto it. It’s not: ‘What size do I need? How do I connect the bits together?’ It’s all very easy. They’ve reduced the amount of components dentists use as well, so that’s where I think they’ve been innovative. And then they made this commitment to education in terms of the World Tour and the events in Las Vegas. They have really pushed to be at the forefront, showing innovative cases and getting the best people to show the best possible work to demonstrate to people this is where we’re at and where we can all aspire to be. We know our limitations but we also know what can be done. It’s not all pie in the sky any more; there aren’t any patients any more where nothing can be done. There’s a solution for everybody. The solution may not be in my hands, it may be is somebody else’s, but there are people who can solve every problem and that’s great. These are very exciting times.
NK: Do you think it is moving towards the remit of the GDP and there will be less specialisation?
PO: I think implants as a generic term cover such a wide range of procedures that some of them will fall within the realm of the general dentist. I think it will become part and parcel of general dentistry for particular procedures but then it equally goes to other extremes in advanced grafting or block graft or sinus lifts or zygomatic implants. These and other very advanced and technically difficult multi-disciplinarian approaches belong outside the realm of general practice and I don’t think general practitioners would want to get involved because they like procedures that they can sort of put a box around, that aren’t constantly evolving and they sort of don’t know where it’s starting and where it ends. But in terms of single units and the like, I think that will fall within the remit of the general practitioner, a bit like crown and bridge. It’s important for practitioners to know when they are out of their comfort zone. The thing is these really good guys can make the procedure look easy –I mean, that’s the skill – but you put it into a pair of hands that aren’t as experienced or aren’t as well trained and suddenly it becomes much more complex. One mistake at the beginning can have a multiplication effect. A small mistake at the beginning can turn into a much bigger one later on if you don’t know your limitations.
NK: Where do you see implantology going in the next decade or so?
PO: I think the push is from the public now. Not only do they want a tooth but they want a good looking tooth and they want it quickly, so I think the push is towards ever-improving aesthetics and speed. For patients speed is over cost. If you can do it quickly with minimal discomfort, both beat cost every time. The push form Nobel Biocare is to go graftless as much as possible, to try to come up with solutions that streamline things. There is a huge implant offering out there at the moment and different companies, and I think over time we’ll get things coming together more and more. Now for people dentistry is something they want to do. They want to go to the dentist because they want to improve something, not because they are in pain. So programmes like Extreme Makeover and The Swan are changing the public’s perception of dentistry. No longer is it: ‘I’m in pain, I need to get a tooth out’. Now it’s: ‘I want to look better. I’m going to go and see my dentist’. That’s good for everyone; it’s a win-win situation. Now, you may have to tweak their perceptions but they are making informed decisions because they’ve read up about it even before they’ve come into the surgery. I would say never sell to a patient because if the idea didn’t come from them and you then don’t meet their expectations, you’re in big trouble. But if they come in and say, ‘Listen, I want x’ and you tell them what they can expect, they’ll always remember you were realistic about it. I have a referral practice so the patients have been through the general dental sieve before they get to me, and have had a chat with their dentist who has decided that patient really wants something that is beyond the scope of their practice. By the time they get to me a lot of what I’m doing is tempering their enthusiasm and saying: ‘Oh yeah, I understand and yes we can do it but it’s not going to be as quick as you think’. Or sometimes we say we can do exactly what they want. I am in an envious position in that someone has already got the patient interested. And after the treatment, the patient and the general dentist are the ones with the relationship. I step in for a period of time and then I give them back! But of course I’m there for any concerns etc. afterwards.
NK: Is there a particular case that you are very proud of?
PO: There have been lots of cases where I’ve thought’ ‘hmmm, that was good’, but for lots of different reasons. Sometimes it can be that it’s a friend and it’s more kind of a ‘phew, I’m glad that went well’. Having the Dean of my school as a patient – a smoker and a diabetic – was one where all the way through I was worried but it worked really, really well. Other than that, people on TV or people in political power. All of those you’re thinking, ‘please work, please work’. Fortunately everything’s gone to plan so far.
NK: What would be your top tip for maintaining a successful practice?
PO: A mentor of mine had three As: availability, affability and ability. If you can maintain that and never do something for a patient that you wouldn’t do for a family member, it should serve you well. Always think, is this the best thing? Judge by asking yourself: ‘Would I do this for my mother, my father, my sister?’ That’s how I try to judge it. Also, try not to let patients talk you into treatment because those are the ones that are going to go wrong and will come back to haunt you!
Paul G O’Reilly BDentSC, MDentSc (Univ. Of Dublin). MS (North Carolina) graduated from Trinity College Dublin in 1990. After completing an MDent Sc. at the Dublin Dental School in 1993 he continued his studies in the periodontology department of the University of North Carolina at Chapel Hill, completing his MS in 1996. He is working in private practice in Dublin while maintaining a part-time faculty position in the Dublin Dental School for both undergraduate and postgraduate training. Dr O’Reilly’s interest lies in continuing education, having given over 80 courses in aspects of periodontology and implant dentistry, and he is the course co-ordinator for the continuing professional development course in periodontology.