Using Demonstration Models in Treatment Planning to Increase Case Acceptance

Dentistry Today


It is said that perception is reality. A patient’s reality starts when he or she first walks through our front door. When this happens, the patients’ 5 senses are in hyper-drive and their adrenalin is turbocharged. It is at this critical moment that first impressions can make or break a relationship. What our offices look like and smell like, how our professional staff greets and attends to the patients, how we dress, and how our office is decorated all contribute to a positive or negative first experience.
Since our reality comes from our senses, it only makes “sense” for us to create pleasing circumstances by tapping into how patients interpret the world around them. This concept is frequently referred to as “wowing” patients. In every way we must try to exceed their expectations.
Establishing a doctor-patient relationship is one of the first steps necessary to assess a patient’s needs. To do this, we must sharpen up our active listening skills. Many dentists do not spend enough time listening to their patients. To listen actively, we must look the patient in the eye and attentively listen to what the patient is telling us. As the patients express themselves we say nothing; we only listen. We try to act as a “mirror” for their thoughts, and at times we interject by saying, “Mrs. Jones, if I hear you correctly, it sounds like you would be very comfortable with…” or, “Mrs. Jones, if I am correct, I sense that what you want is…” By extracting useful information in this way, the dentist can assess the patients’ needs and wants. If patients feel that their needs were never met or what they were saying was never heard, then they will not be satisfied and will not accept treatment. Their feeling will be that the dentist is not acting in their best interests.

Figure 1. Sunflex partial denture.

Figure 2. IPS Empress all-porcelain bridge.

Figure 3. Porcelain-to-metal bridge.

Figure 4. Complete denture.

Figure 5. Clasped partial denture.

To be successful, a positive experience must carry itself through every aspect of the dental practice. To treatment plan successfully, we need to know which of the 5 senses this new patient uses most to interpret the surrounding world. We must ask questions that provide answers quickly. Is the person  seated before us “visual”? Is his or her interpretation of the world based strongly on what is seen? Is he or she an “auditory” person, one who interprets the world more by listening to what is said than by seeing? Most people tend to be visual, but many are a combination of both. It is important for us to identify the stronger of the two. Taste and smell are very important, and these senses can be easily addressed by the many products on the market that cater to them and make the dental visit more enjoyable. Lastly, touch is extremely important. It is incumbent on us to be gentle and be aware that we are treating a live person, not a mannequin or typodont model; these people are the lifeblood of our practice. Communication through the 5 senses is extremely important. It is difficult to communicate and demonstrate using visuals to a person who responds more to auditory communication. The same is true for the olfactory, taste, and touch communicators.
As we treatment plan our patients, we should also note how they respond to what we are telling them. Usual responses are by words, tone of voice, and physiology or body language. Studies have shown that 7% of people respond by words, 38% of people respond using their tone of voice, and 55% of people respond by body language. Paying close attention to the way people respond to what we tell them can ultimately relate to our treatment planning success. It is interesting to note how most people communicate without even saying a word!
One of the techniques we learned in dental school in dealing with pediatric patients is the “tell, show, and do” technique. Many of us practice this technique every day as we go about our dental lives. We simply tell patients what we plan to do, show them how we are going to do it, and then, with their permission, do it. Since it is very important for patients to be directly involved in their treatment, we must bring them into the treatment planning process.
In my office, treatment planning usually involves 3 visits. The first visit is for gathering information. A complete medical history, radiographs, study models, photographs, intraoral camera images, periodontal charting and assessment, soft-tissue health and the evaluation of hard tissues, and patient needs and wants are all part of the process. A treatment plan is formulated and, if necessary, an alternate plan. The plan (or plans) is presented at the next visit. At that time, I use the information gathered to communicate the necessary treatment to the patient. Since on the initial visit I already assessed how the patient intakes information, as well as how the patient responds using words, tone, and physiology, I am able to communicate better, as well as meet and exceed the patient’s expectations.
All of my treatment planning sessions involve explaining and showing the patient what he or she needs and then establishing what he or she wants. I start with study models of the patient’s mouth and then use patient demonstration models (Sun Dental Laboratory) to show what the mouth will look like and how it should function after I am finished. Sun Dental Laboratory offers a useful and reasonable set of models that demonstrate complete dentures, clasped partial dentures, Sunflex flexible partials, IPS Empress crowns (Ivoclar Vivadent), and porcelain-fused-to-metal crowns (Figures 1 to 5). I use them, along with other models, to show patients the nonmetal alternatives to crown and bridge. I allow them to take the bridges in their hands and compare the two (Figures 2 and 3). For those patients who would prefer to have their salvageable teeth removed rather than saved because they believe that extraction is a better alternative, I always hand them a set of complete dentures and allow them to hold them for a few minutes (Figure 4). I then ask them if they still think that dentures are a better alternative to natural teeth.
The aesthetic concerns of the clasped partial denture can be a source of consternation if the patient does not fully understand what he or she has agreed to in the initial treatment planning session. Using Sun Dental Laboratory’s clasped partial denture model along with study models of the patient’s mouth, all confusion and possible misunderstanding as to what the patient has agreed to become clear (Figure 5). An interesting aesthetic alternative to the clasped partial denture is the Sunflex partial denture, which can be fabricated in various ways, with or without metal. The key to the Sunflex partial denture’s success is the fact that the denture frame and clasps are made from a flexible rubber-like material, very much like Valplast (Valplast International), allowing for a new level of comfort (Figure 1). Using the model, I can demonstrate the differences between a rigid cast framework (Figure 5) and one that is flexible (Figure 1), thereby eliminating confusion. The models come conveniently and individually boxed, which saves significant time in initial setup.
Treatment planning does not have to be difficult.  Knowing how people gather information and make decisions enables us to communicate our various treatment alternatives clearly and effectively. The use of study models and other visuals, coupled with effective listening techniques, can result in finished treatment that meets and exceeds patients’ expectations. “Wow” is to be expected!

Suggested Reading

Davis M, Paleg K, Fanning P. How to Communicate Workbook: Powerful Strategies for Effective Communication at Work and Home. New York, NY: Fine Communications/MJF Books; 2004.

Schwartz S. It’s Your Choice! New York, NY: Jay Street Publishers; 2002.

McLeod Seminars Training Manual. Quest Intensive, Sonoita, Ariz: 1990.

Robbins A. Personal Power. San Diego, Calif: Robbins Research International; 1996.

Cornell AW. The Power of Focusing: A Practical Guide to Emotional Self-Healing. Oakland, Calif: New Harbinger Publications; 1999.

Cinotti WR, Grieder A. Periodontal Prosthesis Volume One & Two. St Louis, Mo: Mosby; 1968.

Cinotti WR, Grieder A, Springob KH. Applied Psychology in Dentistry. 2nd ed. St Louis, Mo: Mosby; 1972.

Dr. Bambara is a graduate and is on the faculty of the University of Medicine and Dentistry of New Jersey. He is past president of the Richmond County Dental Society and holds Fellowships in the American College of Dentists, the International College of Dentists, and the International Academy of Dento-Facial Esthetics. He is an adjunct assistant professor at the College of Staten Island and is on the attending staff at Methodist Hospital in Brooklyn and Seaview Hospital on Staten Island. He is a general practitioner with a private practice in Staten Island, NY, and can be reached at, (718) 356-9700, or by visiting the Web site

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