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Outcomes2006 Dentistry Outcomes2006 Dentistry Outcomes | 2006 Quality counts when referring patients to hospitals and physicians, so Cleveland Clinic has created a series of outcomes books similar to this one for its institutes and departments. Designed for a health care provider audience, the outcomes books contain a summary of our surgical and medical trends and approaches; data on patient volume and outcomes; and a review of new technologies and innovations. We hope you find these data valuable. To view all our outcomes books, visit Cleveland Clinic’s Quality Web site at clevelandclinic.org/quality/outcomes. 2 | Dentistry 2006 Dentistry | Table of Contents | Section Head Letter 5 Quality & Outcome Measures Maxillofacial Prosthetics 6 Implant Dentistry 8 Implant Retained Overdentures 9 Cosmetic Dentistry 10 Oral and Maxillofacial Surgery 11 Sports Dentistry 12 Periodontology 1 Orthodontics and Dentofacial Orthopedics 1 Oral Medicine 14 Craniofacial Pain and Jaw Disorders 15 Pediatric Dentistry 15 Patient Experience 16 Innovations 17 Staff Listing 18 Department Contacts | How to Refer Patients 20 Location 21 Cleveland Clinic Overview 22 Online Services 2 Cleveland Clinic Contact Numbers 24 4 | Dentistry 2006 Dentistry | 5 Section Head Letter | Cleveland Clinic Section of Dentistry, Department of Plastic Surgery, is committed to providing state-of-the-art dental care in an environment of research and education. The staff includes seven full-time and one part-time general and specialty dentists, three consultant staff, inclusive of the addition of a pediatric dentist, three hygienists and a very competent auxiliary staff, all of whom are committed to excellence and quality care. The primary objective of the Section is to be a resource for Northeast Ohio physicians and dentists to evaluate and/or treat complex problems of the stomatognathic system. These include, but are not limited to, the dental management of the medically compromised patient. We believe it is important to share our scope of services with our referring physicians, dentists, patients, and individuals interested in our dental program. We are grateful to all who have helped make the Dental Section one of the most successful in the country. James M. Christian, D.D.S., M.B.A. Head, Section of Dentistry 6 | Dentistry 2006 Quality & Outcome Measures | Section of Dentistry, Department of Plastic Surgery Maxillofacial Prosthetics (MFP) Considering there are fewer than 200 maxillofacial prosthodontists in the United States, the department is fortunate to have a full-time specialist on staff. Maxillofacial prosthodontists provide prosthetic rehabilitative services for patients with major oral and head and neck deformities. The wide-ranging services can generally be categorized into three patient groups: Congenital: The MFP staff provide both intra- and extraoral prosthetic services to a wide range of patients with congenital abnormalities. Patients from newborns to adults can be treated for conditions such as cleft lip and palate, ectodermal dysplasia and congenitally missing teeth. Post Head and Neck Surgery: Post head and neck surgery services include both extra and intraoral prosthetic rehabilitation. Typical patients are head and neck cancer survivors missing oral structures which cannot be surgically rehabilitated. Post-trauma: Extra and intraoral prosthetic rehabilitation for deformities post motor vehicle accidents (MVAs), gunshot injuries and similar traumas. Other services include the fabrication of unusual appliances and prostheses for various conditions: Radiation Therapy Services: Treatment appliances in radiation therapy services help control side effects such as xerostomia, trismus, and various protectors, locators and stents. Neurological Deficits: Prosthetic supportive therapy is available for patients with oral functional deficits of speech and swallowing secondary to stroke or neurologic impairments such as Amyotrophic Lateral Sclerosis (ALS). Breast Cancer: Prosthetic rehabilitation is a service designed for post mastectomy patients. Obstructive Sleep Apnea (OSA): Oral appliances can be beneficial in treating patients for primary or secondary treatment of obstructive sleep apnea for post mastectomy patients. Dentistry | 7 Referrals 30 Number referred per moving avg. Number treated per moving avg. Referred Treated Treated w/ Post Polysomnogram 20 Missing / faulty data # 10 0 2002 2003 2004 2005 2006 Referrals 25 Females Males 20 15 # 10 5 0 2002 2003 2004 2005 2006 Severity / Year 12 Mild Moderate Severe 8 Pre Tx AHI 4 0 2002 2003 2004 2005 2006 Apnea-Hypopnea Index (AHI) 8 | Dentistry 2006 Treatment Results by Severity 100 Pre treatment Post treatment 80 60 Average AHI 40 20 0 Mild Moderate Severe Apnea-Hypopnea Index (AHI) Implant Dentistry Dental implants have made a huge impact in the way each of our dental staff practices his/her specialty. The predictability and success of the implant allow us to present our patients with treatment options not available only a few years ago. Although dental implants have been utilized in our practice since the early 1980s, the initial use was the “Branemark” protocol for stabilizing or eliminating a complete lower denture by fabricating a hybrid-type prosthesis. These early endeavors proved so successful, treatment rapidly expanded to all other areas of the mouth, replacing both single and multiple missing teeth. In addition, implants can be used to stabilize both complete and partial dentures. Technological advancements in materials and texturing have resulted in dental implants becoming the most successful implant utilized in medicine, particularly due to its predictability in dental situations. Our maxillofacial prosthodontists also use the osteointegration of implants to place extra-oral implants to retain facial prostheses. The resources of all our dental disciplines and medical specialties allow for a thorough and comprehensive diagnosis. This ensures a treatment plan with the greatest opportunity for success for the implant patient. Truly, this is an exciting time for the dental consumer. Statistics have been kept since 2000 on implants placed versus implants failed. Historically, there has been a 97% success. Remarkable results have also been obtained with immediately placed and provisionalized implants. This significantly reduces treatment time since the implant and temporary restoration are placed at the time of extraction. Dentistry | 9 Implant Retained Overdentures Quality-of-Life Survey A quality-of–life instrument developed at the University of Iowa was used to evaluate patients’ satisfaction levels with their current level of functioning. The survey consisted of 2 questions that evaluate interactions and interpersonal relationships, social interactions, speech, mastication, pain and/or discomfort and satisfaction with implant overdentures. Ninety-two surveys were distributed to patients rehabilitated with maxillary complete dentures and mandibular implant- retained overdentures using either two or three implants with ball (retentive anchor) attachments. Sixty-one (66.%) of the anonymous surveys were returned. Results indicated overwhelming satisfaction with their treatment. Interpersonal relationships improved Never or hardly ever had difficulty with mastication Never or hardly ever experienced pain or discomfort with their overdentures Never or hardly ever had problems in social settings Satisfaction and less worry with their lives 0 20 40 60 80 100 % 10 | Dentistry 2006 Cosmetic Dentistry The term “cosmetic dentistry” is somewhat of a misnomer, as all dentistry should have a cosmetic component. Most of the general public has been “educated” to associate cosmetic dentistry relative to porcelain restorations, bonding procedures and dental bleaching. Continued rapid advancements in each of these disciplines make it mandatory that a thorough knowledge of materials and chair- side techniques be utilized. These are necessary to perform a restoration which meets the patient’s expectations and enhances the patient’s appearance and self- image in conjunction with delivering acceptable longevity. To consult with a patient, each staff acquires all necessary records in order to fabricate a treatment plan particular to the patient’s expectations and resources. We work closely with both our in-house laboratory and private laboratories to fabricate the specific prosthesis required. A large part of this success is due to utilizing specialty consults when needed. A distinct patient advantage is having these specialists available for consultation in our clinic. One recent and exciting treatment alternative is the procurement and utilization of a CADCAM milling technique (CEREC -D). Patients can undergo comprehensive treatment with a porcelain restoration from start to finish in one appointment. This eliminates multiple visits, using an interim (temporary) restoration and making an impression, and results in time savings and a less intrusive appointment for patients. Over 200 restorations have been completed within the past year. The success rate is nearly 100%. Follow-up of these patients will continue for evaluation of long-term success. We are confident our pursuit of continued advances in the dental sciences will open even greater opportunities in the future for our patients. Dentistry | 11 Oral and Maxillofacial Surgery The subsection of Oral and Maxillofacial Surgery focuses on several areas for the upcoming year. First, a working relationship is being further developed with the Department of Oral and Maxillofacial Surgery
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