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Expert Q&A – June 2020

Expert Q&A with: Dr. Varun Garg

"The most focus in any discipline of dentistry should always be on diagnosis and treatment planning. If we can plan something correctly and our execution is less than ideal, we can still get a functional result but if we start with a wrong plan, even if our execution is 100% failure is inevitable."

Dr. Varun Garg Prosthodontist BDS, DClinDent (Pros) (Melb)

Bio:

Dr Varun Garg is a Melbourne based and trained specialist Prosthodontist. He maintains his specialist practices in Collins Street (Prosthodontic Group) and Tullamarine (Tullamarine Prosthodontics). Dr Garg graduated from the dental school in 2007 and later received his Doctor of Clinical Dentistry in Prosthodontics from The University of Melbourne in 2017. During his postgraduate program he was awarded with the Dr. Steele Award for outstanding clinical skills. He enjoys all aspects of prosthodontics but has a keen interest in aesthetic, reconstructive and implant dentistry. During his postgraduation, he researched the use monolithic zirconia implant crown and studied their fracture resistance under cyclic loading. 

He is actively involved with prosthodontic teaching as a clinical supervisor at The University of Melbourne, other continuous education programs and hands on courses. He currently holds the position of treasurer for the Australian Prosthodontic Society (Vic Branch) and is affiliated with the International Team for Implantology and the Australian Dental Association. 

Outside prosthodontics he enjoys photography, playing cricket and spending time with his wife (Gazal) and three-year-old boy (Amiek).

You are involved in a lot of teaching to dentists and dental students of various levels of clinical experience. What areas of clinical dentistry do you feel that most young dentists should focus on?

 I think dentistry is a speciality in itself and then there are further sub-specialities like Prosthodontics, Periodontics, Orthodontics etc. This makes dentistry a very diverse field hard to master everything. It’s difficult to answer where most young dentist should focus on in dentistry. It depends largely on their personal interest but also the type of work they are exposed to. 

In general, if I was to say the most focus in any discipline of dentistry should always be on diagnosis and treatment planning. If we can plan something correctly and our execution is less than ideal, we can still get a functional result but if we start with a wrong plan, even if our execution is 100% failure is inevitable. 

Adhesive dentistry and more recently biomimetic dentistry have surged in popularity. As a result, more and more reliance is being placed on “the bond” versus the more tried and tested resistance and retention form when it comes to single unit indirect restorations. Do you think this is the future of dentistry or a trend that will stop with perhaps an increase in restorative failures?

Adhesive dentistry for sure has gained popularity in the last few years and it’s for a good reason. I think the biggest advantage of adhesive dentistry is conservation of the remaining tooth structure. With advances in our understanding of bonding, specific protocols and development of newer & stronger ceramics like lithium disilicates, the predictability with our restorations has increased immensely. Dentine bonding for sure has improved, especially with techniques like immediate dentine sealing (IDS) but the golden bond is still to the enamel and for me that is still a major factor that dictates how much I can rely on the bond itself. 

My advice to the young clinicians reading this will be that bonding is technique sensitive but when executed properly does give us a very predictable result. Having said that, if your bonding substrate either with or without IDS is majority on dentine and very less enamel, then plan your restorations to have some resistance and retention form as well. It’s not always a battle between using bonding or resistance/retention form but rather a subtle balance between the two to achieve an optimal long-term result for our patient. I do feel that the bond-o-dontics is here to stay but we sure will learn from our failure and make changes to our protocols as necessary. 

Occlusion is a big topic that can be hard to understand and implement into daily practice. What is your advice for clinicians seeking to learn more about occlusion and how they can implement it into daily practice?

Occlusion for over a century has been a topic of confusion and anxiety for dental professions. This is because occlusion is not an exact science and there is no conclusive evidence to support superiority of one occlusal scheme over the other, so we need to understand them all and apply the most appropriate scheme dependent upon the patient requirements. One of my mentors once told me “when it comes to occlusion many times things work not because of what we do but despite of what we do.” This is true but also is a very generalized statement. I do think understanding of occlusion is important when we plan either direct or indirect restorations. Occlusion is not hard to understand/implement when we are doing confirmative dentistry like a single crown with intact neighbouring teeth but becomes a lot more critical when doing re-organisational dentistry like in patients with extensive wear or needing a full mouth rehabilitation. These are the patient that do not have forgiving occlusion and as failures in dentistry are expensive can be stressful to deal with. 

If clinicians are planning to treat patients with complex occlusal wear or rehabilitation needs, make sure you firstly know how to diagnose their wear patterns and only then you can design a new occlusal scheme that can account for the patient habits that destroyed their own dentition to begin with. Talk to your mentors, take their guidance, attend continuous education programs with people who have a deeper understanding of this subject and then practice over and over, as that the only way to succeed. 

What advice do you have for dentists thinking about pursuing prosthodontics as a specialty?

 Of course, you are going to get a very biased answer for this question, but I also have to tell you what I honestly feel. Prosthodontics is the best thing that has happened to me. I have always been intrigued by prosthodontics even when I was a dental student and this fascination with the subject has only grown with time. I think prosthodontics is the most rapidly changing field and the advances we have made in the past few years have been phenomenal. It is really exciting time to be a prosthodontist. In the past prosthodontists have been accused of being too invasive with their treatment but that has totally changed now. Prosthodontist now have a very different view and approach to treatment planning.

Prosthodontics is the forefront of aesthetics, implants and reconstructive dentistry and it is only getting better. Each day in the office is different than the last and that is exciting for me. I won’t say that being a prosthodontist is easy or not challenging as we are dealing with quite complex situations most of the times, but it is equally rewarding as well. 

For anyone who is planning to pursue prosthodontics, I would encourage them to do so. Keep that fire burning within yourself, “Stay hungry, Stay foolish!”

 

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