What you DON’T Learn in Dental CE Courses – Interview with Dr. Ameen Al-Obaidi
Thousands of dentists attend courses each year to learn new clinical skills. However, these courses often don’t prepare dentists for the real world. While the theoretical skills are taught quite well, there is often a lack of practical experience offered. For example in a lot of dental implant courses the training is done on typodonts leading many dentists to travel overseas to gain experience at placing implants on real patients in Mexico, Dominican, etc.
We interview Dr. Ameen Al-Obaidi, a successful dentist with 4 practices in Ontario, and the lead instructor at High Tech Dental Seminars to discuss his experience with cosmetic dentistry and what he has had to learn the hard way over the last decade, questions and answers below:
Why Dental Courses Often Don’t Prepare You for the Real World
Nick: So, Dr. Ameen, one thing I was surprised to learn when speaking with you is what dentists actually experience when they take courses. The instructors teach them the theory, and how to do implants on a simulation, then, they tell them that they’re good to go– except they’re not really good to go, because they haven’t practiced on any actual patients. So, many dentists travel to Mexico or the Dominican Republic to get experience with real patients. That seems bizarre to me.
So, I wanted you to tell us, what was it like when you first started to learn how to do implants; What did you experience?
Dr. Ameen: Back in 2007 and 2008, implant courses were expensive. Only star implantologists taught those courses. So I decided to take my first course with a very successful implantologist. His name was Khamis. He has since passed away, but he was very well-known back then; he has many books. So I decided to learn from him. His books on surgeries and prosthetics provide a lot of theory and understanding of the basics you need before you go and start drilling.
So it was a very successful experience for me. I was lucky. I learned a lot, though I was only practicing on peg jaws or cadavers at the time.
But I saw all these beautiful cases done by great implantologists with tons of experience. It looked so easy for them. And they simplified the procedure for us when they were teaching. So once I had completed the ten-day course, I felt confident. I’d seen all these great dentists doing such good work, and I thought, “I can do this for sure”. But when I went to operate on a live patient, it was a completely different story. The typodonts are nothing like having a patient in the chair.
It’s difficult, and it takes tremendous effort. You can feel yourself sweating under your mask and your head cover. You start wondering, “Is this worth it?” But I’d spent so much money and time on those courses that I didn’t want to give up. I would run into all sorts of complications.
During the implant courses, they teach you that the dental implant success rate is something like 95% or 97%, but they don’t teach you how to deal with your patients to ensure that success. It takes experience to learn how to choose an ideal patient.
It’s also important to define what “success rate” means. In my dictionary, “success rate” means that implants stay in a patient’s mouth for more than ten years. So, if you place an implant, and the patient goes back to smoking and not showing up for routine visits– that can lead to implant failure. They didn’t cover this during the implantology course. No one taught us how to look for compliant patients.
They taught us about gum structure, bone structure, and all the other technical and theoretical aspects of implantology. But things like patient compliance, patient attitude, and patient selection are essential for establishing successful implants. And you learn those things through real-world experience.
The Problem with Practicing Dental Implants on Typodonts
Nick: It sounds like you don’t necessarily get the practical experience by practicing on plastic models or cadavers. It’s not the same as practicing on a real patient who may be nervous or unsure of the procedure.
How do you talk to them? How do you calm them down? But more than that, how do you get those patients to begin with? Simply having a certificate on your wall that says you do implants doesn’t mean that people are going to start coming into your office for implants.
Finally, how do your staff talk to patients about it? They need to have a treatment presentation for patients curious about the procedure. It doesn’t sound like these implantology courses cover any of this.
Dr. Ameen: I think it’s important to simulate the clinic atmosphere and environment. I don’t want anyone to think that, if they attend a course, they’ll learn exactly how to place an implant or a tissue graft.
Soft tissue grafting is especially difficult to simulate. You can’t do it on a table and expect to handle soft tissue from the palate. In a course, you take the graft and place it on another area of the mouth. It’s easy. But you can’t expect a pig to have the same material as a human. It’s totally different.
If I were to take a course now, I would want it to be structured differently. I would like it to be structured so that I could do my work myself with someone supervising me. I would like someone to start the procedure in front of me, and then allow me to practice on another patient under supervision.
Placing an implant or a graft on a table and watching a video the following day is not enough. Videos are helpful when it comes to remembering the sequence of the procedure. But believe me, it is very different when you go into the operating room with a patient and think, Okay, I’m placing this implant, what should I do now?
So, I think the best way to succeed in future courses is by simulating these operating rooms. Have a patient sit in the dental chair and have an assistant at your side. That way, you get the actual experience of placing an implant.
What Dental Courses Don’t Teach You
Nick: You told me something recently that shocked me. You said that, during the course, you placed an implant on a table and were told that it looked great. But afterward, you realized that, had that typodont been a human head with jaws and cheeks, you wouldn’t have known how to drill from that angle.
No one clued you into that. You drilled into a set of teeth on a table and were supposed to have learned everything you needed to know. But you weren’t actually working on teeth because there was no head there. These courses can cost tens of thousands of dollars, and that’s the best they have to offer.
So, now you’re interested in creating a course. How many implants have you done?
Dr. Ameen: I place between 150 and 200 implants a year. I also do statistics for implant cases every five years. I take these statistics from four dental offices. I evaluate around 500 specimens so that I know what I’m looking at: the type of implant, the surgical accessories, and the success rate of different types of material.
After all these years, I’ve been through courses on how to place implants, select a patient, do marketing for implant cases, and treatment and coordination for my staff inside a room for financial arrangement. I’ve also gone through two or three courses on placing implant tissue grafting. Then, one day I was talking with my colleagues and we decided that we would like to design a course that offers practical experience.
Of course, you need technical knowledge. But we want to simulate exactly what happens on a day-to-day basis: how to bring patients into the office, how to deal with them, how your staff should speak on the phone, how to present the treatments and gauge the patients. These skills are just as important as technical skills.
Why Proper Case Selection is Critical to Success
Nick: When you’re new, your chance of making a mistake is higher. You don’t know which cases to select and which ones to stay away from. Simulations don’t prepare you for actual patient scenarios. No one is there to help you. There’s no mentorship aspect to these courses. I know you run four practices and that you train a lot of associates. Is that what motivated you to start high-tech dental seminars, to give people much more practical experience?
Dr. Ameen: One of the main issues that stop dentists from doing something like clear aligners is the fear of failure. And failure is always a possibility, especially if you aren’t in the right kind of course where you simulate a real-world experience.
If you don’t know how to select the right patients, you will fail. Definitely. Many dentists have come to me, saying, “Okay, I know how to place implants, so I’m ready to own a practice.” I tell them, “Okay, but there is more to it than that. You need the real experience of placing an implant, to feel the tissue and bone.” I tell people that the ideal number of implant placements to have completed before starting your practice is 50.
The same goes for clear aligners. I went to an Invisalign course for the first time in 2014. It was a one-and-a-half-hour course. All we did was take an impression, and then the technicians showed us the software and some before and after photographs. Then you go out into the field to practice, and you’re like, “What’s going on?!” There’s no one to call to give you advice.
My passion was always cosmetic dentistry. So when I was placing implants, I found that there were a lot of issues that needed to be corrected before I proceeded to place the implants.
So that’s why I did a residency in Orthodontics for two years. Eventually, things started to make sense. I realized that I have to control my technician. I thought, “I will never rely on any videos they send me because I need to place my treatment plan. I need to control their game because they are there to follow my instructions. I’m not there to follow their instructions.” You will never learn how to do clear aligners in 2, 3, or even 7 hours. It’s impossible.
CBC conducted a marketplace investigation of Invisalign. They found that about 95% of the treatments turned out great. But the other 5% can make or break your business. Those cases could turn into absolute disasters. In the Invisalign course, they show you a video simulation, giving you an example of how to shift the patient’s teeth. Except, if you were to follow the example in the video, the teeth would negatively impact the patient’s breathing.
So it’s your responsibility as a dentist to take those kinds of issues into account. You need to come up with the treatment plan, not Invisalign.
Dealing with Implant Failures and Difficult Cases
Nick: So, these courses teach you all about how to achieve success, but what about failure? How do you deal with failure?
Dr. Ameen: In our course, we’re trying to focus on how to deal with all kinds of cases and scenarios, because, sooner or later, you will encounter these cases. You will find loose crowns and fractured implants, and you’re going to wonder, “Why did this happen?”
There are many reasons why such issues occur. Often, it’s because records were not taken or were not considered. For example, a clencher can break an implant. So, I’m very thankful for all those pioneers in implant dentistry and scientists, but it’s time for us to take the steps to improve the way we teach these courses.
It’s an art. It is surgery. It takes effort. It is expensive. It is stressful. So I need to take all this apart and put it into one unit that can be presented to the dentist. Then, when they place an implant and that patient comes for a hygiene visit and they say, “My crown is loose. Why did I just give you $3000 or $4,000?” they’ll know how to handle it. Currently, that’s not a situation you learn how to handle in an implant course. Right now, you will need to spend another $6,000 to go to another course to learn about how to deal with complications.
Success with Implants Requires a Team Effort
Nick: So, just because you’ve got a plaque on the wall that says you took an implant course doesn’t mean that people are going to start lining up to get implants. You need to know how to market those courses. So, Dr. Ameen, you run four very successful practices. What’s the trick? Is it all about having a good manager, or does it have more to do with bringing the team into the training and making sure everybody knows how to do every part of the job? Talk to me a little bit about that.
Dr. Ameen: I think the staff can either make you a success or a failure. To that end, any dentist who intends to give their staff more advanced work should make sure that the staff has received as much training as they have. Otherwise, when you’re operating, if your assistant doesn’t know the specifics of the operation, all the stress is going to be on your head. That leads to exhaustion and, eventually, burnout.
So, the key to success, in my opinion, is to give your staff the same level of training that you’ve received. And when I say “the same level,” I mean sending them to different courses in surgery, personalization, treatment coordination, etc. They need to experience the same courses to know firsthand how you want to run your office.
As a dentist, I do residencies, I go to workshops to advance my knowledge, but what about my staff? If I don’t bring my manager and my dental assistant to the same skill level as me, they are going to be out of the loop.
For example, during one of my venue residencies, I had to ask the facility there to bring my staff to the location where we were conducting the clinical so that they could see the dynamic. I wanted them to see how they do the advertising, how to place brochures and books in the waiting area, how to speak to the patients, etc. I can’t do all that by myself.
I can perform the surgery and run the software and manage the treatment. But I can’t take pictures for the patients. Most implant courses don’t teach you how to take pictures for your patients. You need someone to do that. I’m nothing without my staff.
The Little Things that Dictate Success in Dentistry
Nick: I’m not a dentist, but I’ve learned a lot from seeing how you work, and I think your course would be very helpful because you focus on the real-world aspects of dentistry.
Most courses don’t prepare you to navigate difficult conversations, like how to calm a nervous patient, or when to turn down a case. These are small things, but I don’t think people realize how big of an impact they have on your success.
As you’ve mentioned before, any course is going to teach you fundamental knowledge well. But people take all of those little things for granted.
How do you set up the room? What information do you ask the patient before accepting their case? How do you spot non-compliant patients? When you have enough experience, you can start to spot those people right away. But when you’re new and you’ve only done three cases, you don’t know how to identify these problems.
Most dentists have no choice but to learn the hard way, from experience. But it would be ideal if more courses spent more time talking about the business, logistical, and communication elements that are necessary to succeed with any kind of cosmetic dentistry.
Dr. Ameen: That’s all true. I’ve also had frustrated colleagues tell me that they’ve spent dozens of hours training a staff member, only to have them leave. You can’t anticipate every reason someone might have for leaving. People are always going to leave, but good people can also come. Just because another employee wasn’t worth your time, that doesn’t mean the next one won’t be either. So you should give the same level of effort and training to each employee. In the end, their success is your success. If you want to be successful, you need a successful team to support you.