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ADA CE series to track patient from diagnosis to recovery

April 21, 2014

By Kimber Solana, ADA News staff

Bob Hartman
Editor's note: This is the first in a unique series of ADA News articles following a patient's full-mouth reconstruction from A to Z. Installments will appear as treatment milestones are reached.

Robert "Bob" Hartman recalls waiting to board a plane at San Francisco International Airport when a piece of his front tooth simply broke off.

"I wasn't eating, chewing or talking," Bob said. "It just fell apart."

Due to decay and bone loss from lack of proper care over the years, combined with a deteriorating tooth structure, the 62-year-old is in need of a full-mouth restoration. His jaw has also moved forward affecting his bite and the way he eats.

"It's either treatment now or more years with a lot of problems," he said. "I'm choosing treatment."

Led by Dr. Joseph Massad, of Tulsa, Okla., and co-treated by Dr. David Little, of San Antonio, Bob will have an immediate maxillary and mandibular dentures placed, with extractions of all of his teeth, appropriate bone reduction and placement of prosthesis.

It will not only ultimately correct his dental problems but also educate ADA members on the assessment and treatment of patients who need such an extensive treatment plan.

In an effort to vitalize online continuing education and creating ADA member value, Bob's case will be part of a CE online series where ADA members are able follow his treatment—from diagnosis to surgery—through courses to be posted on ADA CE Online.

Each step in the process will be filmed—from Bob's initial examination and diagnosis and taking appropriate recordings of his mouth to surgery and placement of implants and prosthesis.

In all, the process is expected to take about 18 months, culminating in a three-hour Education in the Round course at the ADA 2015—America's Dental Meeting in Washington, D.C., by Dr. Massad.

"This is going to be a conservative but rational approach," said Dr. Massad. "What we don't want to do is do everything in one day as Bob wouldn't adapt as well to the changes."

Diagnosing Bob: Robert "Bob" Hartman visits with Dr. Joseph Massad in Tulsa, Okla. Bob will undergo full-mouth restoration of his dental problems. The 18-month process, from diagnosis to recovery, will be part of an ongoing online continuing education series available at ADACEonline.org beginning in May.
Dr. Massad and Bob first met briefly during last year's annual meeting in New Orleans to see if Bob would be a good candidate for a future Education in the Round session. Bob, an accountant at the ADA, has staffed the annual event.

Bob's dentist in Chicago had already recommended that a full-mouth restoration was needed. Bob sought out "a second opinion" from Dr. Massad, who ultimately agreed.

When he was younger, Bob said, he had bad habits when it came to dental care, sometimes going days without brushing.

"When I ate candy, I actually chewed hard candy," he said. "I know these bad habits, and along with age, are the reasons my teeth has started to break down."

After the initial meeting, Bob sent over dental computerized tomography scans. In January, Dr. Massad further inspected Bob's mouth. Based on the findings, Dr. Massad said Bob was a moderate skeletal class III all his life. In addition, Bob has lost several teeth over the years. Bob had a more extensive visit in March.

These initial visits will be featured in the first CE online session at ADACEonline.org, expected to launch in May. To view the first online course, click here.

"We've done a lot of live patient courses at the ADA Annual Meeting since 2007 and many online courses featuring live-patient video," said Richard Schuch, ADA director of Continuing Education and Industry Relations. "But we've never taken a look at a patient from beginning to end and let our members follow that patient. We've wanted to do this for a long time.

"We feel ADA members and dental students will benefit from the value of this type of educational series and will look forward to experiencing each step of the case from the patient's perspective, as well as the practitioner's."

The second course in the series will feature Dr. Little, an oral surgeon, removing Bob's teeth. In addition, the first set of titanium posts will be placed into the jawbone, which will hold the teeth later. The surgery is scheduled for this month. After about six months, another set of implants will be added.

"I know there will be times when I'll think, 'What did I do?'" Bob said, regarding the recovery process. "But I've gone 30 years without a full mouth of teeth, so I'm looking forward to having a normal look and a normal smile."