b'nothing could be further from the truth. More often than not,implant, he had been told by his restorative dentist to have a tooth not only does the restorative dentistwhether it be a generalextracted despite the fact that several other options to treat the dentist or a prosthodontistend up delivering more dentaltooth were possible. In another of the new cases, the patient had treatment, but those treatments are easier for the dentist toan immediate socket implant that was five millimeters too far below perform and easier for the patient to maintain, he said.the gum line, crowns on adjacent teeth that were placed too close to the bone, and a bone graft where part of the root had been left in. The reason: When the periodontist has completed periodontalFor each case, Dr. Horowitz shares treatment planning discussions therapy, the restorative treatment is performed in a healthierabout comprehensive care based on the latest periodontal literature, oral environment. This could be due to any number of reasons,techniques and biomaterials. In every instance, being able to work such as if crown lengthening transformed an area where decaywith the patients and their restorative dentists totally turned around had resided to one that is now peri- or supra-gingival to givethe treatment discussions and opened up the patients mind to the the dentist and laboratory better access for finishing margins.idea of comprehensive, interdisciplinary care dentistry.A related factor is the fact that the typical periodontal staff is better equipped to impress upon the patient the importance ofWhile this lecture provides a general overview, Dr. Horowitz and his comprehensive care and regular long-term maintenance, andcolleagues with whom he is working on this initiative, Drs. Leonard of having recall appointments with both the restorative dentistGarfinkel and Tyler Blackenburg, envision future lectures that would and the periodontist. Its crucial to have every office that waseach focus on specific aspects of periodontics. Possible topics include involved in the initial treatment be involved in supervising thecrown lengthening prior to crown and bridge therapy, esthetics of patients home care and monitoring their maintenance levels,anterior implants, creation of keratinized tissue, cosmetic surgery for he said. the maxillary anterior teeth, and the treatment of peri-implantitis.According to Dr. Horowitz, while most medical patientsSays Dr. Horowitz, I fully understand that not every patient will accept understand the differences between various medical specialties,or even need comprehensive, interdisciplinary care dentistry. But I the typical dental studentlike the typical dental patient also understand that if it isnt offered, no one can accept it. The hope does not understand how the capabilities of periodontists areis that once these students graduate and get established in general differentiated from those of general dentists or other specialties.practice, they will reach out to local periodontists and other specialists For example, they are not aware of what periodontists canto initiate discussions about how comprehensive, interdisciplinary care do with biomaterials, or how they can maintain teeth that aremight be pursued. questionable or improve the prognosis of ones that are hopeful. They also dont understand things like the lateral effect ofThe time is nowplaque, or what we can do with root resections or furcationDr. Horowitz and his colleagues are not intending to change the dental treatments, he said. In short, they really have no idea of howschool curriculum; they understand that CODA has strict regulations many things we can do that will benefit both them and theirand that overscheduled students have a great deal to study in many patients.aspects of dentistry. These lectures are to be given only to third Spreading the word and fourth year dental students who currently rotate through clinics and watch procedures out of context so all they see is carpentry. To help address this problem, Dr. Horowitz has developed aThese lectures would put into context what is behind the surgery. The lecture to be given to third and fourth year dental students. Theoverall picture of a complex case will dramatically improve and make overall goal is to improve the capabilities of the entire dentalpossible a more profound appreciation of what periodontics really teamincluding the general dentist and the periodontisttois. The lectures will help make third and fourth year students more provide for the needs of current and future dental patients,aware of the aspects of periodontal therapy that may not be taught said Dr. Horowitz. The lecture discusses the basic proceduresin the conventional curriculum. In this way, they can start considering commonly performed by periodontists that can improve healthreferral patterns and developing an understanding of interdisciplinary and patient outcomes typically not performed by generalcare for their patients, even while being trained to deliver all aspects dentists or other specialists. Dr. Horowitz has delivered theof dental treatment.lecturetitled A Week in the Life of a Periodontistto student groups at NYU College of Dentistry and other dentalDr. Horowitz realizes that many general dentists will be skeptical that schools as well as several groups of practicing general dentists.increasing referrals to periodontists will increase rather than reduce The lecture recounts four new cases and one maintenancetheir production. However, based on their observations of general case that came into his office the same week. In one of thepractices that have embraced the comprehensive care approach, new cases, the patient not only did not realize he had anthere is no question that comprehensive care works as well in practice as it does in theory.AAP Periospectives| 41'