The Benefits of Live Surgery Training
A discussion with Kris Volcheck, DDS, MBA
Inside Dentistry (ID):What makes your live surgery training programs unusual?
Kris Volcheck, DDS, MBA (KV): The boards of dentistry in most states do not permit licensed dentists to treat patients in other states, even if the treatment rendered is part of a training program. In many states, especially smaller ones, that limitation can make it challenging to find opportunities for training. Historically, this has resulted in many dentists traveling out of the country to places such as Mexico or Costa Rica for training courses. For approximately 25 years, however, I have utilized an Arizona law that permits dentists to cross state lines to volunteer at a nonprofit. It began as simply an opportunity for vacationing dentists to volunteer, but we soon realized that we could combine this opportunity to volunteer with training. Arizona's state dental board was agreeable to it, and with the help of Scott Ganz, DMD, and Isaac Tawil, DS, MS, along with Joel and Emilie Gonzales of MegaGen America, we developed a program that is productive for all parties involved.
ID: Who are the patients for your training programs?
KV: We work with homeless and recently homeless individuals, including veterans, as a focal point. Those who are still on the street can only receive emergency care because they cannot be sufficiently compliant with hygiene to justify the expense of placing implants; we cannot defy the laws of dentistry. Therefore, most of the patients that we treat in our implant surgery trainings are previously homeless people who have gone through rehabilitation programs and are stabilized to the point that we are confident that they can be compliant. But these are also patients who really need the treatment, such as veterans who are stable, housed, and working but being held back by smiles that are not presentable or people who are suffering from health issues because of their inability to chew properly.
ID: Why do you think that so many dentists gravitate to this opportunity?
KV: Our instructors work with our internal dentists to prepare the cases, so when the visiting dentists arrive, they have well-selected, carefully curated cases ready for them. That helps them to move through the courses efficiently, and they have access to the instructors' skills while they are learning. In addition to receiving the highest level of training, participants are exposed to a worthy population that really challenges their perceptions about what it means to be homeless or previously homeless. They are also working on complex cases. Even for a single implant, they may be placing it into a mouth with a variety of issues rather than the less problematic mouth of a wealthy person who simply cracked tooth No. 3. If a dentist can work on these patients successfully, going back to his or her private practice and doing it will be easier. All of these elements contribute to a very comprehensive experience for our participants.
ID: But a dentist can learn from experts at a trade show or online. Why is the hands-on component so important for implants?
KV: The hands-on part is really everything. Attending those other types of courses is beneficial regarding getting an introduction and acquiring as much preliminary knowledge as possible, but the only way to truly overcome the learning curve is to actually place implants. That might require completing eight cases over the course of two or more days, but when dentists leave here, they feel comfortable enough to at least handle simple cases in their own offices. Getting over that uncomfortable feeling of not being able to do it on their own is critical.
ID: Is your program better for beginners or for more experienced implant dentists looking to learn new systems or more complex techniques?
KV: Both can benefit. Our instructors and manufacturer partners assess the skill levels of participating dentists and customize a program for each of them. For example, for dentists who have never placed an implant or have placed very few, patients and procedures are selected to prioritize just getting them comfortable placing single implants in different situations. For dentists who have placed many implants, the programs are customized to perhaps include placing multiple implants or involve more complicated cases. This assessment and customization starts prior to their arrival, but it continues as the instructors observe their skills, and the programs are adjusted accordingly. Each dentist leaves the program with his or her abilities optimized.
ID: What challenges are involved in teaching such an invasive procedure to beginners?
KV: Like when teaching any other technique, our instructors do a lot of hand-holding—explaining why things need to be done a certain way, helping with the actual placement, and sometimes, starting a case and then letting the participant complete it so they have a good feel for the quality of the bone that the participant is moving through. We have one proctor or one surgeon with every two trainees, so there is always somebody there in the chair with them. That level of supervision lends itself to creating the best learning experience.
ID: Beyond ensuring that patients are in need and in situations in which they can be compliant, are there specific types of cases or oral environments that you prefer to treat?
KV: Typically, the parameters are the same as those that we would consider for the general population. We need sufficient bone, and we need to consider if the patient's overall health is compromised. We are not a surgery center, so we cannot treat patients who need to be managed in a hospital environment.
ID: If the need exists among patients, and the demand and willingness exist among dentists, instructors, and manufacturers, why is this setup not common all over the country?
KV: In most places, legislative changes would be necessary, but beyond the challenges associated with that, I do not know the reasons. It is an excellent method to provide important training while serving a population in need.
ID: What impact does the lack of other opportunities like this have on the profession?
KV: Without live surgical training, dentists cannot safely start placing implants. That is a barrier. Live training is the key component to translating knowledge into practice. A trainer can visit your office and help you, but the volume and repetition experienced at a training center are invaluable to becoming comfortable and gaining confidence in your technique.
Kris Volcheck, DDS, MBA, is the founder and CEO of the Brighter Way Institute in Phoenix, Arizona, a nonprofit that hosts implant training for dentists from around the country while serving vulnerable adults and children, veterans, those experiencing homelessness, and individuals with special needs. Inside Dentistry spoke with Volcheck about the advantages that his program offers for dentists.
