Periodontic

Treatment Philosophy

Dr. Nattkemper’s treatment approach is quite simple: he treats each patient as if they were a friend or family member.  He is careful to take into account an individual’s concerns, desires (so far as retaining their teeth and/or interest in pursuing the best treatment possible), and their “comfort level” with dental treatment.  It is extremely important that all patients feel completely at ease and that treatment decisions are made after they feel well-informed and confident in treatment goals.  Treatment is often “staged”- where conservative therapy is initially performed and subsequent treatment decisions are made based on each patient’s response.  The surgical microscope and/or various types of magnification are utilized for all surgical procedures in order to minimize post-op problems and ensure the best results possible.  Dr. Nattkemper consistently incorporates new technology and techniques in his practice, and feels strongly that patients deserve the most up-to-date individualized care possible.

Excerpt from Testimoial to Academy of Microscope Enhanced Dentistry

Lloyd P. Nattkemper, D.D.S.
“Testimonial” for AMED
November 27, 2004

There are a few vital priorities which, from the time I began my practice in periodontics, have shaped the style of the practice and the type of referrals my practice tends to attract.  They are priorities probably common to most members of our academy.  Most important among them is a desire to provide excellent quality care with consistent results.  Closely tied to this is the desire, or more the NEED, to provide periodontal care that is comfortable both during and following treatment.   It has always been difficult for me to see patients suffering from postoperative pain, and was a major challenge for me even when recommending treatment when I was first in practice, knowing that they might suffer as a result of treatment I would perform.  Finally, it has been my goal to always be available to my patients on a personal level, to provide clear, honest, understandable explanation and instruction.  Involving the patient at least on some level in their care has proven to be tremendously valuable—they not only care more about it from that point, they usually concur that it should be performed to the highest level possible.

I practice traditional periodontics, including osseous surgery, root planing, regenerative procedures, ridge augmentation, dental implant therapy and a variety of soft tissue graft procedures.  Many procedures require chairtime exceeding two hours—some three and four hours.  Most require that root surfaces are debrided definitively in order for successful outcomes, that bony surfaces are handled delicately, that soft tissues are opposed gently.  All of this requires good light and vision, and has usually necessitated uncomfortable operator positions and frequent eyestrain, sometimes for extended periods of time. 

I had the good fortune to attend a presentation Dennis Shanelec gave on microsurgical connective tissue grafts at the California Dental Association Scientific Meeting in 1995.  His words and photographs, not to mention his practice and life philosophies, affected me profoundly.   On Dennis’ suggestion I purchased a set of surgical loupes, and a year later attended a two-day course at the Microsurgical Training Institute in Santa Barbara, given by Dennis and his neurosurgeon colleague Neil Watson.  I purchased a microscope for my office two months after attending the MTI course.

Over the subsequent years I found myself using the microscope only occasionally.  There seemed to be a huge void between the quality of work Dennis Shanelec demonstrated to us on practice models and patients in the course and what I could achieve with my own hands using the microscope.  Procedures I attempted using the microscope took hours longer than work with my loupes.  I questioned whether I could master use of the microscope.

 In the meantime, I purchased a light system for use with my loupes, and while the quality of work I was performing was far and away superior to that prior to purchase of the loupes, I began having frequent neck and back pain.  This occurred during longer procedures, and more significantly, began waking me up literally every morning.

In November of 2001 I attended a two-day microsurgical course on connective tissue grafts and papilla regeneration procedures given by W. Peter Nordland at the Newport Coast Orofacial Institute.  Peter’s course was in my opinion the finest, most valuable continuing education experience of my career.  The carefully presented rationale for Peter’s approach and the techniques which we had ample opportunity to practice and then observe performed on live patients I found I was able to duplicate, slowly at first but then with increasing speed and precision, within just a few weeks after returning to my office.  A subsequent course at NCOI with Rich Schmidt and Martin Boudro helped improve my skills using the microscope in each area of the mouth. 

The last few years—particularly since attending AMED in November 2003, have been spent putting the rubber to the road— using the microscope in (or at least for a portion of) all my surgical procedures.  If I have a criticism of the “continuing education industry”, it is that there is no course available currently which addresses the challenges of periodontal flap surgery in each area of the mouth using the operating microscope.  Obviously the problem is that so few periodontists are doing this—and that the practicalities of teaching such techniques are daunting.   

If there is a word to describe what use of the microscope has given me, it is comfort.  Physical comfort for myself and my patients—my back and neck are rarely sore—and only, in fact, after performing procedures using direct vision.  My eyesight is no longer blurry after spending hours using my loupes.  My posture is distinctly better as I am simply used to sitting up when performing dentistry.  My patients, literally without exception, have minimal postoperative discomfort or swelling following surgical procedures.   Emotional/psychological comfort—there is absolutely no doubt that when I have completed a procedure, it has been performed to the highest standard—and that the patient will have a positive outcome.  Being able to see detail clearly with generous light produces a level of reassurance during surgery that, once I experienced it, convinced me I could never go back to performing surgery without the microscope.  Professional comfort—or better, professional reassurance—referring colleagues comment, time and again, on how consistent and remarkable results of treatment in my office are.  I now find myself seeing several as patients, as well as numerous staff members from referring offices.  My own staff, while initially intimidated and (a bit!) resistant regarding use—especially  regular use—of  the microscope, now are incredibly supportive of me and our work.  They take part, every day, in procedures that demand the best in them, and rising to that has I believe motivated them far more powerfully than anything I have yet seen.  This last week, as I began a procedure to repair a subgingival root resorptive defect within a mandibular molar furcation, I mumbled that the task might just be too much, that anybody else would extract the tooth.  My assistant said, in a much firmer voice, “We can do it.  We can do just about anything.”  The morale and support I see in my staff, to say the least,  reassures me that I am taking the right path.  The procedure, by the way, was challenging—but I’ll wager that my patient will keep that molar for his lifetime.