Focus On: Case Acceptance

Ara Nazarian, DDS


Ara Nazarian, DDS, focuses on ways GPs can improve large-case acceptance. 

Q: What’s the No. 1 question that doctors are asking when you lecture?

A: I have been very fortunate to be able to practice the type of comprehensive dentistry that I do within my private practice, whether it is full-mouth reconstruction with dental implants or a rehabilitation with indirect restorations on an existing worn dentition. I am continuously asked, “How can a dental provider improve on case acceptance for these types of cases?” Patients accept dental treatment once they understand the condition or issue with which they are presenting. Sometimes, this is very apparent, such as in the patient who is edentulous and now wants teeth to chew and function. However, sometimes the dental condition is not as apparent, such as in the patient who suffers from occlusal disharmony and wear. These patients might suffer from discomfort due to their conditions, but they really don’t know why they have pain. In both examples, it is imperative to describe the problems associated with their conditions, explain what will occur over time if their problems are not addressed, and what will be required to address and correct their problems. As clinicians, the first urge is often to jump right to the solution and fix our patients’ problems. However, patients need to understand their presenting conditions and the ramifications of any proposed solutions before accepting treatment.

Q: What’s the best way to communicate the needed information with patients?

A: There are several ways my team and I collect the information required to properly diagnose, treatment plan, and communicate effectively with the patient. Digital radiographs are needed to accurately diagnose and identify areas of decay and periodontal disease that may result in further bone loss. However, having a CBCT scan allows the clinician to see even more detail by being able to focus on a specified area that is clear and free from distortion. For example, most CBCT machines on the market give you a variety of different perspectives or planes that are axial, coronal, or sagittal in nature. In addition to these views, CBCT software constructs 3-D visualizations that further enhance the visual content for the clinician and the patient by virtually mapping out the placement of implants or in designing a prosthetic work-up of the definitive restoration. Most importantly, any anatomical landmarks, like sinus cavities or nerve canals, can be easily identified.

Photo documentation is also essential for success. A trained office team member captures extraoral and intraoral digital images using an SLR camera that is preconfigured for dental photography. The extraoral images include a face shot at rest and another smiling. The intraoral images include frontal retracted closed and open bite views as well as occlusal views of the maxillary and mandibular arches. Using Bluetooth technology, these images are conveniently transferred to an LED flat screen in the operatory so that the patient can easily visualize any areas of wear, decay, failing restorations, etc. In addition, a handheld digital intraoral scanner allows us to quickly and effectively create a photo-realistic image that can be merged with the information acquired from the CBCT technology.

Q: During the case presentation process, how do you illustrate and explain the various treatment options to the patient?

A: Successfully explaining the various treatment options to most patients is no easy task! Using models, animations, and photos is very effective in making an otherwise complicated process easy to understand. For example, if a patient without teeth presents wanting solutions to edentulism, then ask the patient if he or she would like teeth that are removable or fixed. You will likely find that patients will always request teeth that are fixed instead of removable. However, certain barriers may inhibit this decision. For example, the patient may not have enough remaining bone for a fixed prosthesis, or it might not fit in his or her budget. When this is the case, patients will want to know what the alternative prosthesis (ie, an overdenture) looks and feels like. For this reason, we have several different types of dental implant models available to better explain their options. These usually include an overdenture, which illustrates a “snap-in” appliance; a fixed, hybrid, screw-retained restoration (acrylic/titanium and zirconia); and a fixed dental implant bridge consisting of custom abutments and a cementable bridge. To be effective in optimizing your communication with the patient, you need to have these educational dental implant models always available. In addition, it is important to present several before and after images (close-up retracted and full-face images) of the various forms of treatment.

Q: Dental fees can sometimes be a barrier in large or complex cases. What are some ways to make treatment more affordable?

A: Patients need an easy and affordable way to pay for the recommended treatments. For this reason, several different third-party payment options can be offered that have low-to-no interest rates and high approval rates. Using the Internet, our treatment coordinators can easily assist the patient with filling out the online forms and quickly receiving approval for the treatment plan that he or she desires and has agreed upon. Dentistry doesn’t have to be out of reach, and there are financing companies that are usually able to allow the patient to have the necessary work completed. 

Q: Once the treatment team has collected the necessary diagnostic information and presented it appropriately, what are other recommended suggestions to further enhance the process?

A: It is one thing for a potential patient to hear the doctor and team speak of the advantages and benefits achieved with comprehensive dentistry, whether they are with dental implants or teeth; it is entirely different to hear it from a real patient, via a video interview, who has already been successfully treated by you. Even better yet, a real patient testimonial will really resonate with most potential patients. In my practice, there are a handful of patients who have offered to personally speak with any potential patient and share their personal treatment experiences.

Dr. Nazarian is in private practice in Troy, Mich. He is a Diplomate in the International Congress of Oral Implantologists, the director of the Ascend Dental Academy, and he lectures internationally. He can be reached at

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