Revolutionizing Case Acceptance with CBCT and Motivational Interviewing

We can quickly take that screen, put up that CBCT, move that over to the monitor, and then we can draw and color on that. Be able to prove that root fracture right there, boom. And then we can print that, we can send that capture, we can send that to them on email. I was the third person she came to see. She never had an explanation of what happened, and now you can give a reason. Welcome to the Phil Klein Dental Podcast. Today we're exploring a game changer in dental diagnostics, CBCT technology. From uncovering hidden pathology to enhancing treatment planning, CBCT is transforming how dentists diagnose and, more importantly, how patients understand their treatment needs. But that's only part of the story. Combine powerful imaging like CBCT with motivational interviewing, a patient-centered communication approach, and you've got a formula that significantly boosts case acceptance. When patients see their issues clearly and feel heard in the process, trust grows. and so does the likelihood that they'll say yes to care. Joining us today is Dr. Lori Trost, a recognized dental educator, author, and clinical consultant who maintains a comprehensive restorative practice in the greater St. Louis, Missouri area. She's going to share with us today how she uses CBCT and motivational interviewing, along with the right technology stack, to guide patients toward better health outcomes and higher case acceptance. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases, and our entire production team will really appreciate it. Before we begin talking to Dr. Trost, I would like to thank our sponsor, Microcopy. Microcopy is a great company that has existed under the mindset of creating innovations for efficient, safe, and simple dentistry for nearly 50 years. You're probably familiar with their exceptional line of rotary instruments, including their Neo Diamond Burr. Used by thousands of dental clinicians, the Neo Diamond Burr is getting great feedback. Many are saying, and I quote, it cuts like a hot knife through butter. And with today's hard ceramic materials and zirconia, of course, that's exactly what we need in a rotary instrument. So check out microcopydental.com. They have single patient use packaging, which is ideal for infection control and also keeps your costs down overall. To learn more about the entire product line at Microcopy, visit their site, microcopydental.com. I assure you, you will love the burrs and you will also love the price. So we thank you, Microcopy, for sponsoring this podcast. We're very happy to have Dr. Trost with us today. Dr. Trost, welcome to the show. Thank you, Phil. I'm very excited to be here. So in this episode, we're going to be talking about using technology and motivational interviewing to boost case acceptance. But before we get into the MI part of it, let's talk about the technology. The question is, and what many dentists tend to struggle with, is that there's a lot of technology out there. So you have to make a wise purchasing decision. And then it has to work with your office. It has to work with your workflow, your staff, your space. So there's certainly a lot to think about. So tell us how you sort all this out when it comes to buying technology for your practice. I think the very first thing you need to do is you need to figure out what your brand is. And I think you need to figure out what your practice is going to look like. What kind of patients do you want to attract? What kind of procedures do you want to perform that you become very proficient at? With that, it's ridiculous. Let's say, for example, why would I buy a certain technology if I'm not going to be doing those kind of procedures? You understand what I'm saying? So a lot of times we get hooked. And as dentists, we're gadget people. I have lots of gadgets that I've purchased and I've learned from that. So I was starting this new practice about six years ago. I went in very intentional. I knew what my brand was going to be. I knew that I was going to be a comprehensive restorative dentist. I was always going to work with Airway. And that's exactly where I put my pigeonhole at. So how did I branch out from there? Airway. You said you mentioned Airway. Is that what you mentioned? OK, it wasn't clear. OK, so did you do Airway your entire practice or that was something fairly recent that you started to get some expertise in? So when I started this practice, my tagline is smile more, sleep better. So just curious, what made you dive deeper into airway? Well, I just, I continually, and I just, six years later, I still see the need. It's massive. And I see it, I see the need even more so for younger. patients too. It's really, it's just exploding. And I think once you understand the gravity of the health impact that it has, and we're in the first line of defense, we see these patients much more often than what their medical doctors do. And medical doctors can approach this in a different manner. I think we have an ability to really approach it and really help the patient in a much better fashion. We should think about doing a separate episode on airway and general dentistry since it is so relevant. to the condition of our oral health and systemic health, and it affects our cases. I mean, we end up doing the same restorative work over again because of recurrent decay and other issues related directly to airway obstruction. Yes. So let's use the office that you started six years ago, Dr. Trost, as an example of how you decided which technologies you should purchase and integrate into that practice, into your new practice that you're working in now. So as a comprehensive restorative dentist, I want to be able to make sure that I have and my role model right now is that I work with my lab. I do tons of indirect restorations. They are the ones that either mill or print those restorations. And so therefore, I have the temporization model that I do chair side, obviously, then we send off that scan. So I'm going to need a scanner. So my first. I guess, tap on that door and phone call was to my lab. What scanners do you see coming in? What platforms do you like to work on? You know, there's great platforms out there now, design platforms that are available. And there's some that I can even really start to use and work with myself too. And I can start to understand a little bit better on that design, but that's really critical. I think to have a very good lab partner to lean on them, to have them really mentor you in a direction of what they see, because they see tons of scans that are coming in every day. You can sit there with the designers and you can see what they look for, why that scanner captured that, maybe why it didn't, how it could have been better. There's lots of things that you can just look from them. So to me, that was time very well spent. The other thing I'd love to do is just talk to peers, find out what courses are available, because then from that course, I'm going to understand what do I need in my toolkit? What are they using? What are they mastered? What makes good sense? And then start putting the pieces of the puzzle together about what works with my brand. If I'm doing comprehensive or sort of done it, do I want to look at? How does this digital picture look for me? And how does each piece of that puzzle jigsaw together to create a format and a flow that's really unique? And it minimizes and it creates an efficient just workflow and procedure, which is just really, to me, mind-boggling. So you had the experience of doing all this stuff with technology before you set up the office that you're currently in, which, as I mentioned, is six years old. created that new office, did you just go out there and purchase all the technologies you knew you would need in your workflow? Or did you still do it step by step? Great question. So Obviously, everything is digitized within the operatory. I'm going to look at a CBCT because I knew that was going to be a critical element if I were going to do airway. I knew that a scanner was going to be a critical element. Those were my two anchoring points of which I sought after right off the bat. Electric handpieces. Those are marvelous tools and having them just incredible. So, for example, when you're looking at a CBCT, what do you want it to be able to do? And you need to make sure that you have apples to apples. when you're looking at this. Again, take courses Talk to as many people as you can because salespeople will tell you what they want you to hear. And you have to see what really works clinically. And I've fallen prey before to buying something, purchasing something that really was not what I exactly needed. And I just didn't know the questions to ask. So it's really important to really educate yourself. That way you know the questions to ask. Keep it true to your brand. Talk to your peers, see what's working clinically for them, and really have them help you put through the paces of what you want to do and how you want this to work in your practice. How does this show up for my patient? You know, the other thing is, what's the benefit for my patient? Can I use that for treatment planning? Can I use that to send off to and collaborate with a, you know, a periodontist or an oral surgeon or an endodontist? You know, it's all those kind of components too. How easy is it to transfer that information? How easy can I get on a platform and we can do a group treatment plan on this? So that's another factor in a lot of this consideration too. So now that you're using the newer technologies, the 3D imaging, the AI software that comes with some of this CBCT and some of these packages are independent third party, have you seen a significant difference in case acceptance because of these new tools versus what we used to use in the past? oh absolutely i think it's surprising i know um you know you look at uh you know we talk about shades of gray and we talk about how ai plays out in just typical radiographs and so You know, we're limited with what we're able to visualize. We're looking at, you know, 50 to 70 shades. And if you can sit there and have an AI program that comes in at 550 to 700, that can really climb well over what I'm able to do. That creates, obviously, a better presentation, a more predictable presentation. And I think the confidence that you place in this technology is really astounding because it does prove to be true. And then you open up into that tooth and you see the fracture or you see. you know, there's a combination of so many things that we're able to tell now and use this technology for. It's really, really, and it's surprising too, because then I feel like I can lean on that. It's a partner for me as well. So give us a clinical example of how you would approach a patient using this new technology when there's a question of pain in the tooth that you suspect a root fracture, but other dentists have not found it. I had this happen to me here two weeks ago. Actually, I had back-to-back root fractures. And without CBCT, I would never have been able to absolutely definitively say that's exactly what it was. So the very first question we always ask is, how can we help you? And you tell me that. So then from there, I'm going to go ahead and say, look, we really want to get a close-up view on this. This is going to allow us to peel back the layers of the onion and really see what's in there and what's happening. And without this, I have no way of telling exactly 100% what you need. So let's go ahead and do this technology. And we line them up. We take the picture. And then from there, we can peel across those layers and just show them. And it's really impressive because what I hear constantly and consistently is, wow, we've never seen this before. I didn't know you could do this. And you've got them. And not that people expect to have that now, but it is, I think, becoming. And I'm in a rural area, too, which is interesting. So it stands out. And I think it's really dynamic. They know that they're getting the best care. So I think it provides the best care. I mean, the wow factor for the patient must be amazing, especially if they were at another dentist where that dentist could not. make a definitive diagnosis because they had 2D technology. And obviously, we all know that detecting a vertical root fracture using a 2D x-ray is impossible. If you're lucky, you can find it other ways, like you mentioned, perioprobe, transluminator. But when a patient comes into your practice and you're able to do this using CBCT and show it visually on the screen, there's no question that's a game changer. Yeah, so it becomes very powerful. We have in our toolkit here, we have large monitors in each operatory, which is, I encourage that. That's just such a wonderful thing. And we actually, it's kind of fun. I'm going to segue for a second. But we have like educational things rolling and scrolling and we change that out seasonally. And we do a trust trivia. We put fun little questions on there. So we mix it up. We put maybe new events that we're doing, something maybe that's going on in town, something that maybe somebody we want to showcase or spotlight. So there's a whole lot of information on there, okay? I mean, everything from how to properly toothbrush to maybe using an air flosser. I don't know. Who knows, right? Plethora of things. But we can quickly take that screen, put up that CBCT, move that over to the monitor, and then we can draw and color on that. And then we can print that. We can send that capture. We can send that. them on email we have the ability to do all of those and that's again a very powerful thing i had a patient two weeks ago came in had had this pronounced just this pain upon chewing and it could never and it was never identified i was the third person she came to see And boom, we take that, be able to prove that root fracture right there. Boom. She's like, can you send that? I'm like, yeah. And so I sent that to her and her husband, I, you know, he, he actually is a patient here and he thanked me. He said, she never had an explanation of what happened. And now you can give a reason. So it becomes a very powerful loop. You know, when you show the picture, be able to draw on it, can email it, share it, whoever, whatever. I can quickly send it to my endodontist to my oral surgeon that I work with. And then we can really just. have a great complete care plan that we develop very quickly. So once you identify the pathology, Dr. Trost, and you show the patient like you explained, what's the process of communicating this with the patient in the best way to boost case acceptance? So I think the most important thing, we use a... kind of a process here, motivational interviewing. And it's a process that's been around for some time and it's used in counseling and behavioral management and changes, et cetera. But I find it to be very, very helpful in the dental field because it's kind of, to me, a four-step situation where when you engage the patient, first of all, you're going to say, how can I help you? And then from there, those five powerful words to me are very important because when people come to you for a second or third opinion or they're coming to you initially, when you say, how can I help you? To me, that infers that I'm going to, one, help them. I'm going to figure them out. I'm going to take good care of them. And help is a really strong word because maybe they haven't been helped before. Maybe no one offered to help them. Maybe they didn't even know where to turn or to reach to. And so that kind of really sets the tone, I think, And it really calms their fears and their nerves right there. Next, you're going to sit there and having them talk. You want to listen. That's the second step of all this. It's very reflective listening. You want to be very, very attentive. And then sometimes repeat even what they say. So you're very clear in what their help, what they need. Okay. And from that point in time, let's say with the fracture. probably have to have this tooth out. We know that. But here's the good news. I think that we'll be able to restore this space. We have the option to do an implant. That implant's never going to get a cavity on it. So now we start to paint a brighter picture and offer a better opportunity. And that opportunity to me, after that fact finding that we've all done, it just calms the waters a little bit. And you're able to sit there. I don't care what if you're showing radiographs, your measurements, whatever, but you're creating an opportunity for an improvement. And that's where the patient really starts to grab. and understand, hey, guess what? I have now a chance to make this better. And that buy-in for them, that really, that's an emotional valve release because then they go, I know that, oh, that's a good option. And they understand that now. And then I think the fourth thing that is really to me critical is, and everyone talks about sealing the deal and the whole thing. I don't talk about selling dentistry. I just want to give good dental care to people, period. right? And I think when you present a treatment plan, you put that in front of them, what that process is, you know, and be prepared to answer the questions about the implant. And so does your team. You've got to spill this out throughout your time. team to be consistent in that messaging as well. That way everyone can answer those kind of questions. If you step out of the room, if they're calling their front desk again, they need to know whatever. However, you've all got to be on that same page. So it's very important to have very consistent understanding and knowledge and education of each of the procedures. But I think where a lot of dentists lose sight of now sealing the deal for lack of a better term, and I hate that, but I love to use tons of building analogies. I like to keep it very simple. I think people, they gravitate to simple. I want something simple. I don't want to have a lot to think about. Here's my next steps. Phil, if you've got this broken tooth, here's what I want you to do. I've got a couple different places. Where would you like to travel to? In our area, I'm going to ask you where you want to travel to. I've got different partners. I've got periodontists, I've got oral surgeons who can help perform this for you, and they're going to give you great care. They would take care of me or any of my family members that I love, okay, period. They're going to take very good care of you. And here's what they're going to do. They're going to build this up. They're going to remove that tooth. It's going to be a procedure that's going to be very predictable. They're going to be able to fill some bone in there most likely, and they're going to be able to place an implant that will perform for the rest of your life. And then you're going to come back here. I'm going to restore that, and it's going to be an excellent restoration. And you're going to look back at this and go, wow, I didn't know it could be this good. So with that very positive feedback that you're giving that patient, which is great, do you show them something visually that would give them an idea of what that would look like using the software? Tell us about how you could actually show that to them. And it's a lot for some patients to take in at one visit. Maybe talk to us about how much time they need to make that decision to get referred to a... you know, an oral surgeon or a periodontist to move forward with, well, you need to get the tooth taken out first and then the implant. So what's the timeframe as far as when they make these decisions and also what kind of software and what do you do to show them what it would look like, you know, down the road? Right. So the beautiful thing is with that CVCT, you can literally choose any kind of implant just to give them an idea. Because sometimes, and again, you've got to gauge your presentation and what your verbiage is going to be per patient. Everyone's different. You know, if you're a little more technical, if you're an engineer or an attorney or a surveyor, you're going to want to have a lot of detail. So I'm going to probably choose an implant. I'm going to place it into that space to show you what that can look like. So you get a visual in your mind now. Everyone is visual. The more you can... show with this technology, the better off you are and the better your treatment plans will be accepted, period. Do you do that show and tell with the digital wax up and all that with the implant in there in the operatory? Easy. Easy to do. Yes. Okay. So you do it right there in the operatory. Easy. After you've told them they for sure have a vertical root fracture and for sure this tooth is not savable. Yes. And the other thing is I have, you know, when you practice long enough, photograph everything you do because then you can have a library of your own personal cases. And so I can quickly show this. I have models. Every implant manufacturer will give you a model. you can have them hold that maybe they need to hold it close up to see what it looks like you know and and give the description but all of those things whether it's on the screen in their hands whatever It gives them something that's very tangible at that point. And that buy-in is great. Here's where the next step, I believe, you have to make it. You have to make sure that you have the next steps locked down because a lot of people leave dental practices today. They don't know what their next step is. They have not been prioritized. They don't have a comprehensive plan. They don't even know why they're coming back to you sometimes. So you've got to be able to communicate all of that. And that sounds so... elementary but it's not it's very important to have everyone on the same page so with that being said you've got again next steps and lock them down they know i know it's written in their chart we have no question a second grader could look at this and read what the next visit says and we're all good to go we have that patient before they even leave with our technology that here's the best part the beauty of it all boom we fire all those radiographs off however where pictures whatever we've got we've already created a file folder that's going to go to that that next step referral source for us who's going to take care of that patient we've already made that introduction All the work that you did in that operatory, the diagnostic stuff, the imaging, whatever images you took, that's all now in a file or in the patient's record. And then when the visit is over. After you've explained this to me and I've agreed, yes, I want to move forward, do you walk the patient up to the front desk and make the appointment for the, let's say, oral surgeon to have the extraction? Or do you wait for them to do it? What's the process there? We will send over their information. We'll tell them. And so literally what I'll do is I'll walk out of the operatory for just a bit. I'll tell my front office person, hey, guess what? They're going to go ahead. We're going to make the choice to do this. I'll walk back in. And then that's her message to go ahead. Boom. She's going to fire that whole file over with all that information. already made the connection we have the referral made and that we'll say they're expecting your call so does the oral surgeon sometimes call the patient to say you've been referred to our office, what's a good time for you to come in? Or the oral surgeon waits for the patient to call the oral surgeon? We'll have the patient call the oral surgeon. And that acceptance rate is massively high for us because we've made the next steps for them and that connection. You give them a timeline for the whole restorative process to take place from start to finish. Like if they went through with this, well, you don't really know when the oral surgeons, you don't know the availability of the oral surgeon. So it depends on that too, obviously. We give them a rough estimate. And sometimes too, I mean, And life happens, you know. We've had interruptions with people's health and other things. You know, it can be random sometimes. That's rare. But for the most part, we give them, you know, we say, hey, you know, we're looking at four to six months most likely here for this. And we'll take good care of you during that time. So given that you're working with outside specialists to do the work to get this, for instance, this root fracture case done, the extraction, the surgical implant, and everything else, bone grafting is most likely going to happen. How do you integrate those costs into your treatment plan when you're getting the patient to say yes, if you're relying on the services of specialists? Yeah, so I think what you have to do is you have to work with your oral surgeon, whoever you're going to refer to. Okay, in my case, I got an oral surgeon, a periodontist, however I go about that. And they go ahead, and we have a ballpark, and we have somebody who they can have their contact person. They can make that connection to literally get all those next steps, get the price down, and then be honest. I mean, the best thing is to be honest. And a lot of times if patients can't afford that, say, the final restoration, let's push that off maybe to the next calendar year for your insurance. I mean, that's... the worst case scenario but at least you've got the implant and i always tell patients this it's like you have a pie and sure you might want to eat all the pie but let's just take slice by slice you get this much done and everything will build and build and build upon what we're choosing nothing's obsolete we don't have to redo and it builds upon itself and that's a really key element to everything i i think you do from the ground yeah that's a good point So here's what you posed to me earlier. How important is this technology? The factor that that person came to me, and she was told by two other people they couldn't find anything, and I found this, and now she's getting an implant. Let me ask you how important that was. Yeah, it's amazing. So as a general dentist looking at CBCT, when you look back before you had it, it must be mind-boggling to you to think that you actually practiced dentistry without it. No, I mean, I know it sounds crazy to say that because there's still tons of general dentists that do not have CBCT. They're still taking 2D radiographs, and that's still considered acceptable. This is not malpractice to use 2D imaging. I mean, that's what we've been using forever, right? Now, as an endodontist, I don't think an endodontist could practice endodontics without CBCT at this point. Yeah, they need a microscope. Exactly, CBCT and microscope. And a microscope, yeah. And then they need good training and then all the equipment that goes with it. But a general dentist, if they're not doing endo and they're chugging along doing the basic stuff, you know, you could make an argument to say, I don't necessarily have to run in to get a CBCT at this point. It is a game changer. And from my standpoint, I look at a general dentist and say, hey, if you want to really be a true diagnostician when someone comes in with a problem, you can't tell them that, you know, what your opinion is if you don't have the substantial evidence to show what's really going on. You know, if we have technology that can actually find things that exist that otherwise would not be found with a 2D image, I think it behooves the... general practitioner to have cbct or refer the patient to a center that has a cbct right in that yes specific instance and of course you don't need it for every patient if you have a you know a healthy 18 year old who's coming in for no reason right but those cases where there's that you know every dentist has seen it many times where that patient has that nagging pain that comes and goes. They eat something hot. It hurts sometimes. Sometimes it doesn't. You know those cases. And then you don't see anything on the 2D x-ray, which is very expected. I mean, for you to see a vertical root fracture on a 2D x-ray is almost, is impossible. There's no way. So in wrapping this up, are there any particular AI systems that you like? Oh, this is, to me, just getting so much more fun. And what you hit on earlier, I don't know how I practiced without a CBCT before. Let's just say that right there, okay? That's number one. It's eye-opening. I love with the radiographic components now of all these AI-driven decay, perio. I mean, oh, my gosh. I look at, you know, Pearl, I look at Overjet, all of these different programs, again, so powerful that you can, again, visually put that up there, the predictability. You know, before, were we objective before or were we subjective? So now when you put that up, it's eye-opening even for me sometimes, and it just, it's a partner for me. That's how I see it. This technology is a partner, and it just helps me provide better care. So it helps you corroborate your, the second opinion software really makes you. gives you peace of mind. Peace of mind is huge. Well, listen, great stuff, Dr. Trost, and I'm glad you're taking advantage of all this technology. I really don't see a mentor, a key opinion leader, or an instructor, or a teacher that's really teaching the next generation of dentists how to practice dentistry. uh and not have a CBCTin the in their in their workflow right i mean do you agree that that absolutely yeah and especially now with like the facially driven uh proportions and vertical dimensional occlusion and how we're able to superimpose the sky's the limit now and it's only going to keep on getting better and better and easier to use that's easier right the lab is is literally having a virtual patient sitting in their laboratory as they merge all these facial scans and they just put everything together and they can literally yeah it's like a it's it's like an articulator that we used to do in dental school virtually yes and they could do the wax ups digitally and do all the designing and It's unbelievable. You just got to cut those preps well, right? And put those chamfers on. You still need to place a great prep and do a margin. Right. And no more feather edge margins. Those days are over. Not at all. Exactly. Yeah. We'll talk about that on another episode. It's always fun to have you on the show, Dr. Trost. Thank you so much. And we'll get you on another episode soon. Be well. Thank you. Thank you.