10/1/07 – DentalBlogs.com had the privilege of interviewing a new blogger, a true great mind in dentistry, Dr. John Cranham. In addition to his private practice in Chesapeake, Virginia, Dr. Cranham is on primary faculty with the Dawson Center and lectures independently with Cranham Dental Seminars. Here, he shares his insight, advice, and opinions.
About Dr. Cranham
DB: What is your relationship with the Dawson Center?
JC: The Dawson Center is a place dentists can come to learn about advanced restorative dentistry at the highest level. My official title is Director of Education. I teach two hands-on courses, Â Functional Esthetic Excellence I & II, as well as Seminar I & II with Drs. Dawson and Dr. DuPont. I’m currently working on restructuring the curriculum, which will roll out the last half of 2008. It will focus on a solid foundation with occlusion information, but also on esthetics, comprehensive care, implants, and the different modalities dentists use today. We will also have personal development and staff tracks, as well as a medical/dental track for doctors who want to treat facial pain, TMJ, etc. The official announcement will come later this year.
DB: You run Cranham Dental Seminars and are on faculty as an associate clinical professor with the Medical College of Virginia. How do you find time to run your private practice?
JC: CDS has been merged with Dawson Center, so many of the courses are now available through the Dawson Center. My lectures on the road are still with CDS, though. This year, I’m teaching 65 days; half of those are with Dawson, half are with CDS. As far as the college is concerned, I lecture for junior students a few times a year. I am practicing in Chesapeake 160 days per year. It keeps me busy!
Cranham on Clinical Topics
DB: You teach on digital photography. How important is photography to cosmetic and general dentistry?
JC: I look at cosmetic dentistry as part of comprehensive care. Cosmetic dentistry is not recognized as a specialty. It’s done by general dentists. For anyone who treats patients with any degree of problems, taking quality photographs is part of a good, thorough exam. What separates us at the Dawson Center is that we look at changing a patient’s appearance only after we’ve assessed him for disease issues – bite, decay, gum disease. A thorough exam always comes first.
Photography is critical to being complete and comprehensive because it allows us to diagnose and assess issues that not only affect esthetics, but also function. Classic examples are teeth too far out can affect speech and closing the lips; teeth too far back can cause fractures and other problems. Photography helps with proper diagnosis and assessment.
Secondly, digital photography allows us as clinicians to improve. We can evaluate what we’re doing by seeing before and after photos. My photography course gives doctors a predictable and efficient way to bring digital photography into their practice for a high standard of care.
DB: Many general dentists call themselves cosmetic dentists in advertising. What training makes a dentist qualified to hang out a shingle as a cosmetic dentist?
JC: I think that there certainly has to be quite a bit of study on treatment planning to recognize simple/complex cases. Any time you start messing with the front of the mouth, you need to know what you’re doing. Anterior teeth play a critical role in a person’s bite. Education on treatment planning, procedures, preparations, and most importantly, a thorough understanding of how the whole system works in harmony – an understanding of the gnathostomic system – is important. It takes a significant investment of time and resources.
DB: Do you condone use of a teeth-whitening light, and do you find it more effective than take-home bleaching systems?
JC: I think the light doesn’t do a lot. Teeth get brighter based on time, temperature, and concentration. There’s no question that patients can get good results from trays, but some prefer the speed of the light.
DB: Do you like the appearance of no-prep veneers, such as Lumineers? Do you use them in your practice?
JC: Hate them. One of the things that we believe is that in good restorative dentistry, when you put a restoration on a tooth, it’s cleanable and is in the proper physiological space. If you add something without taking anything away, the restoration will be bulky, in the wrong place, and not cleanable at gum line. Patients with microdontia may benefit from the additive stuff, but you still need to prep a margin for a good emergence profile. No-prep is trying to make it too easy.
DB You use CEREC in your practice. What do you think turns some dentists away from CEREC?
JC: We have CEREC and E4D going. I have done both, and there’s no question that this technology is here to stay. You can take great impressions, get good fit; the bonding is good, like any inlay/onlay restoration. The only issue is that it doesn’t always offer the right restoration. If I have a restoration that I don’t want to do a full crown on, but it’s too big for a filling, the CEREC or E4D is great. We just have to keep in mind, the material is supposed to fit the patient, not the other way around. A dentist considering CEREC should think about the number of restorations he does that fit in this category. If the number is 20 or better, it will be a good thing and will decrease your lab bill and allow you to offer restorations in one day, which is great for the patient. CEREC or D4D can be a very good thing in the right practice.
Cranham on Trends
DB: What’s the next big trend you predict in cosmetic and/or general dentistry?
JC: Cosmetics and implants are mainstream now. A high percentage of dentists are doing implants, or at least restoring them. CEREC and D4D allow us to do crowns in one day, but Brontes from 3M is a digital impression-taking device that, if it catches on, will completely change how we do it. Digital impressioning and imaging – iCAT – for treatment planning and impressions will be the next real range in the next five years.
DB: What is the greatest challenge that dentists face today?
JC: The greatest challenge is keeping up. The number of materials being thrown at us: porcelains, bonding agents, and all of the procedural stuff have a mind-numbing effect. On top of this, dentists have to remember that the basics of good treatment planning have to do with solid concepts for more complicated procedures. Dentists should stay grounded in good concepts, new materials, and procedures – it’s a huge problem today. In comparison with when I got out of school, we now have so many more options in implants, endodontics, all of the different things we can do. It’s hard for the GP to be good at all those things. To continually update yourself, you must maintain a commitment to and passion for dentistry. These things also makes our profession one of the most fun and rewarding, because the change keeps it fresh, challenging, interesting.
Cranham on The Future
DB: What is the best upcoming date on your speaking calendar?
JC: My favorite one is the World Aesthetic Conference in London in ’08. The UK is an interesting place with what’s happening in dentistry. It’s an honor to speak at such a venue. I’ll bring my wife, and we’ll have fun.
DB: As an accomplished author, do you have any articles, books, or curriculum in your future?
JC: I write consistently for Dental Products Report now, but that will end in December. The book I’m working on will take a few years, so you won’t see much from me in print for a while. By 2010, I think the book will be out.
DB: What is your favorite source for hot information in the dental industry?
JC: Â I read several journals, but the biggest thing is the other faculty members at the Dawson Center. They are my best resources for what’s out there and what’s working for them. Not only for information, but to assess what’s working and what isn’t.
DB: What books are on your nightstand?
JC: I just read The Greatest Game Ever Played and Pascal Magnet’s dental book.