Dr. Mario Flores joined the POS Family over 25 years ago. In addition to pursuing orthodontic education, Dr. Flores also studied periodontics and implantology at Loma Linda University and joined the faculty there after his graduation. In this interview, Dr. David Dana and Dr. Flores discuss the periodontal procedures GPs are capable of, and the ways orthodontics and periodontics go hand-in-hand.
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Video Transcript
DR. DAVID DANA: Hi everybody, I'm Dr. David Dana and I am here today with a very dear friend of mine, Dr. Mario Flores. Dr. Mario Flores has been a friend of Progressive Orthodontic Seminars for 25 years. He actually graduated from Progressive Orthodontic Seminars in the Orange County #5 class a year before I did so it's been 25 years since Mario became a friend of Progressive Orthodontic Seminars. Mario has a very long story. After he graduated from Progressive, he maintained his private practice doing general dentistry and ortho. Then Mario entered Loma Linda University for training; perio, implants and conscious sedation was part of your training for four years at Loma Linda University. After graduation from his perio implant training he ended up being part of the faculty and he's been part of the faculty until this day. During these 25 years or more Mario has always kept a private practice. Not only a perio practice as he is a periodontal specialist, but also a general dentistry practice where he used to also do orthodontics and keep up with what he learned here at Progressive. Mario also is our chair of the perio department at the McGann International School of Dentistry at Primas University in Indonesia which is a big job, and he is doing a fantastic, fantastic job. Mario also teaches for McGann Postgrad, the perio courses and some of the implant courses. Mario, it is a pleasure having you with us today and I just want to talk to you a little bit about what you do with general dentistry and perio.
DR. MARIO FLORES: Sure. Well, thank you for inviting me. It's an honor for me to be here.
DR. DANA: One of the things that I would like you to tell us a little bit about is when you're talking about esthetic perio, this is a topic that has kind of like taken off in the last few years. Before perio was see a pocket, cure a pocket. Today we have moved into esthetic considerations of perio. What is the philosophy, the way you look at this aspect of periodontal therapy?
DR. FLORES: Sure, well in general my philosophy is like in any field, any area in dentistry: do not harm the patient. Treat patients like they were part of my family, if they were friends. So that's my philosophy. In terms of periodontics, my thinking is to be progressive. I've been involved with post-graduation training in perio, ortho, and dental implants. Even though we still, I still do conventional periodontics like conventional open flap surgeries, guided tissue regeneration, bone grafting, tissue grafting, gingivectomies. But nowadays as you mentioned since the advent of esthetic treatments and dental implants, our periodontal procedures have become more and more detailed in order to deliver to the patient asking for esthetic procedures. They want to improve their function, aesthetics and their appearance. So our periodontal procedures have gone through a period of improvement and we have newer techniques. We have new materials that we utilize.
DR. DANA: Yeah and I am assuming that with your orthodontic experience you can generate new bone levels and change the patterns in order to get a much better result, not only periodontally but when the patient is ready to be restored then the patient will end up with a fantastic, not only functional but esthetic result.
DR. FLORES: Now I realize it became very handy to know about ortho because like implant dentistry now many cases you have to move teeth, then you have to mend bone and then place the implants. Actually my residents at Loma Linda are doing some ortho.
DR. DANA: Fantastic, so you're getting your residents into doing some of their own ortho so they can get a better understanding and hopefully when they are out and decide to become just limited to periodontics, they'll be able to communicate with the orthodontist or the general dentist that does ortho. Mario, you're talking about the newer and different techniques that we have today in periodontics in order to create better function and better esthetics. Also, we know that a lot of general dentists, I mean the levels of education and skills that they have is phenomenal. More and more are starting to come in to do a lot of periodontal surgery in their own practice. What are the techniques that are the most common periodontal esthetic techniques that you would recommend general dentists to start practicing and start getting the confidence necessary to move to the next step?
DR. FLORES: Sure, nowadays we have many patients that want to improve their appearance, their aesthetics, so periodontal treatment can help a lot of those patients. We do conventional periodontics but nowadays we can do treatments like esthetic crown gingival tissues of the patients. Sometimes we add tissue, sometimes we remove tissue. So esthetic crown lengthening it's a very, very rewarding procedure. We do tissue grafting. We can do connective tissue grafting, the so-called traditional free-gingival grafts or we can use these alternative materials like allografts. They are available in the market. Many of our young ortho patients they do need free gingival graphs in order to improve their gingival tissue before we start moving teeth.
DR. DANA: This is actually very important and very interesting because there is a difference between connective tissue graft and a free gingival graft and they both have a place in perio. Many times because connective tissue grafts have become so popular and I mean they are the best one to do good coverage, some people do connective tissue grafts instead of a free gingival graph when the free gingival graph was more indicated.
DR. FLORES: Sure, and obviously on this occasion you know we're not going to expand on the differences but yeah, you're right that's why I mentioned connective tissue grafting, free gingival grafts. There will be a time where we can go over this and explain all the different procedures and all the different tissue grafts.
DR. DANA: This is what you cover in your courses.
DR. FLORES: Yeah that's what we're covering. We are covering also suturing techniques, very, very important too. Extrusion of teeth before implants. We teach functional crown lengthening for proper restoration. We don't want to see bleeding gums because we invade the so-called tissues so we teach that so that's part of a cosmetic esthetic procedure.
DR. DANA: Create the proper biological conditions to receive a good restoration that will last forever. Well, nothing lasts forever but will last for a long time and will give the patient good service without causing all this inflammation that we see sometimes due to lack of creating proper biological conditions.
DR. FLORES: So as far as what can GPs do, basically they can do any or most of the periodontal procedures as long as they have good training, they have knowledge, and they know how to select cases and that's why it's very important, continuing education and hands-on training.
DR. DANA: Absolutely. Like you said case selection is one of the most important aspects of success and when you don't select your cases properly your procedures are not the correct one and you end up with problems.
DR. FLORES: So another of the procedures that we do in a lab nowadays with the advance of dental implants would be improving the quality of the tissues of dental implants because now we know for the long-term health and stability of the implants, they need some soft tissue grafting.
DR. DANA: Good quality, yeah that is absolutely right.
DR. FLORES: We are going to be covering those.
DR. DANA: Yes, I know that's part of what you cover I have actually learned from you and my implant procedures have changed many times. I create a better tissue condition by doing a graph whether it's connective or free-gingival before I go and put my implant and I see the results are much better and I know that you cover that in your courses. That is fantastic. What are the most common challenges that you see the general dentist having when they are doing periodontal procedures in their practice?
DR. FLORES: As I mentioned before, with proper training in case selection, general dentists should be able to know when to refer but most of the periodontal procedures can be done in a safe way. Of course, we know we have some patients like maybe they have like compromised situations or heavy smokers, diabetes, patient with heart conditions that they are probably going to bleed a lot. So be prepared, maybe get a medical consultation before we treat the patient so we can overcome those challenging situations.
DR. DANA: What do you think is the most challenging thing about esthetics? And I'm talking in general because the patient that comes with the esthetic desires, esthetic needs will need you as a periodontist, will need you as an orthodontist, and will need a restorative dentist to put everything together.
DR. FLORES: I feel like fortunately here at POS we get to meet great doctors and then if the general dentist feels like they need the help from other specialists. That's what will be my advice on complex cases, just get the help of other specialists, other doctors. But again, the majority of the cases they should be able to be treated in a general practice.
DR. DANA: If I hear you right, get a clear communication with other colleagues, specialists, experienced doctors and work the case to your level of expertise and what's outside of your level of expertise, with good communication have your colleague, whether a specialist or not, complete the case and with good communication it will mesh up into a beautiful [result].
DR. FLORES: Yeah that's why I recommend for general doctors, young doctors to begin taking continuing education where they have hands-on. They can start with...I'm not going to say simple cases, they're not really simple, but not too complex, not too difficult cases and then to build that to get the skills necessary to perform the best.
DR. DANA: Absolutely, and actually your courses have a lot of hands-on I've seen them. They get to do grafts on pigs or sheep jaws and they get to do flaps and so on and they are actually executing them and they're actually fantastic.
DR. FLORES: It is a very, very good way to start getting to feel the sutures and tissues so you don't have to go straight to a patient to do your first procedure. You can start with the hands-on. I'd really recommend that.
DR. DANA: That is absolutely true. Mario, it's been a pleasure having you here. It's really fantastic to have such a good friend for Progressive Orthodontic Seminars, such a good doctor giving us all the support and bringing all your knowledge into the McGann Postgrad lectures and of course training not only dentists out here in California but now training doctors at the McGann International School of Dentistry at Primas in Indonesia. It's been a pleasure to be with you. Thank you very much.
DR. FLORES: It is my pleasure to be here.
