As a newly licensed general dentist in the US, Vasyl Leskiv, DDS followed his special interest in dental implantology when he set out to add to the skills and knowledge with which he had already served patients well in his native European country, Ukraine. During many years of dental practice, Dr. Leskiv has taken numerous specialized courses in this area—but as he tells us in this interview, two of the most important things he’s learned about dental implantology are also the simplest.
Dr. Leskiv, you’ve been practicing dentistry for 15 years. What sparked your interest in dental implantology, and over time, how have you developed your skill in this area?
When I perform an implant, I consider that my patient is really reacquiring a lost tooth. The implant functions as the root of the tooth so that a patient can get it back, and is the first step in a complete restorative process. This was very interesting to me when I began practicing dentistry in Ukraine. After moving to the US and getting licensed here, during the first year I worked in a practice, I took an implant continuum as part of my yearly CE (continuing education) requirement. The course took place over several weekends and covered many topics from the basics all the way to advanced levels of implant placement. It was intense, interesting, and very worthwhile. Soon after that, I went to the Dominican Republic and over several days, I participated in placing implants for volunteer patients there, working under the supervision of my instructors from the continuum. It was a very nice experience. After that I took many different courses, and probably 99% of them were focused on aspects of implant dentistry, such as sinus lifts, ridge splits, and bone grafts.
Developing skill and gaining experience in this area does not happen overnight. Looking back, I recognize how much progress I’ve made—it’s like night and day. Earlier this year I was in Mexico for an intensive course focused on soft tissue grafting, which is important to consider in implant placement. In my experience, this is an aspect of implantology that doesn’t always receive the attention it requires, but because it involves the gums, it is vital to the aesthetics, the predictability, and the restorative ability of implants. I consider it an advanced level of education. Implantology just became my pathway because of all the courses I kept taking. Over the years, this area of dentistry has changed and grown, and so have my knowledge, skills, and interest.
How have dental implants changed since you first began practicing?
The implant materials and dental technology have improved significantly. Nowadays, if an implant patient first requires removal of a permanent tooth, we can place the implant the same day—as long there is no infection present—due to the improved design of the implants themselves. As recently as just a few years ago, we had to first extract the tooth and allow a healing period of two or more months before we could begin placing the implant.
When patients come in now, I always start with a 3D scan, which we do right in our office. It’s painless and takes just a few minutes. From this I can determine the width of the bone and the distance to the nerves and sinuses. Then, based on all the measurements, I can determine the size of the implant I’ll place. If the patient is missing bone, I can also determine whether we can do a bone graft first. The implant system that we’re using now is great—the material integrates well with bone, which typically leads to a successful outcome. This kind of predictability wasn’t available when I started doing implants, and because of that, implants weren’t always as comfortable or aesthetic, and weren’t always successful.
For patients with dentures, the game has also changed. Some patients with dentures find that they don’t have enough retention or suction between their dentures and their gums. It can be difficult to achieve that. More and more people don’t want to use denture adhesive. The newest technology provides a solution for dentists to place implants to secure the dentures; in some cases, implants even allow us to place non-removable dentures. With the stability of several implants, patients no longer have to worry that their dentures will move around when they’re eating and chewing.
My own vision now is also completely different from when I began. Now I approach it from the restorative angle, the big picture. Which crown is available for the patient, and how aesthetic is it? How functional is it? How healthy are the patient’s gums? Those are my considerations as I plan for the best possible outcome. We can now plan and place implants with tremendous precision, and they are almost always successful.
How important are continuing education courses to your work, and how frequently do you attend training?
To support a professional license, every dentist must complete a yearly minimum of CE hours; but I always do many more than that; I just want to proceed in the field that I enjoy. In October, I’m going to a large symposium where major implantologists will come and share their cases, and we will learn from each other. I’m sure I’ll learn a lot, and bring it back to the other dentists in our practice and to my patients. It’s more important than ever to keep up with technology and science, and I find it extremely important for me and my patients.
Tell us about most recent training course you’ve taken in the area of dental implants.
So far, the intensive course I took in Mexico (in early 2018) has been the most eye-opening course. These days, dentists practicing implantology are beginning to pay more attention to soft tissue management and patients’ gums, rather than just focusing on implant placement. That course I took changed my approach and my vision, and it was the best. My first day back in the office after that course, one of my assistants remarked that I had taken longer than usual to prepare the patient’s gums—longer than with the implant itself—and I responded, “Right!” The course had taught me that the most important things are to take care of the gums and to use a proper suturing technique. Of course, you have to consider everything—the restorative aspects, the soft tissue, and the implant itself. Placing the implant is the easiest of these things and goes fast. The other two aspects take longer.
What kinds of questions do patients frequently have about the dental implant treatment you offer, and how do you respond?
The main question I get is about pain. No one wants pain. Many patients are concerned about pain during surgery and afterward; and there are so many people who are stressed about dental appointments in general and don’t even see a dentist regularly. We resolve our patients’ anxiety with light sedation. It’s very helpful. Patients who arrive shaking and sweating relax under light sedation; we can do the work they need, and in some cases, they become new people. There are patients who do not even want to let me administer an anesthetic, but under light sedation, we are able to do their needed dental work.
Regarding pain, whether we place an implant or perform any other procedure, we are certainly as gentle as possible. You’re taking care of people, so you cannot hurt them. We do everything we can to ensure that our patients experience minimum pain.
Many patients ask about pain after their procedures. Extracting a tooth can cause some soreness as the patient goes home and the anesthetic wears off. Then they would need to take some kind of pain medication, maybe an over-the-counter pain reliever. That kind of pain is normal. Placing an implant is actually much easier on patients than an extraction, because the recovery time is much less. Thy may experience some soreness that may come from stitches, but nothing major at all. After implant placement, the sensitivity is actually much less than most patients have after an extraction.
How does collaboration directly affect your team’s ability to provide the best possible care and outcomes for the patients you serve?
All our team members are truly part of one big team. I think it helps that our team has been stable over the years. Over the years, you get to know each other, and you stay on the same page. Our patients love to come to us.
Leadership is a tremendous part of this. In our practice, Gio Iuculano, who leads our team, plays an extremely important role in the practice by setting the highest standards for patient care and maintaining a dialogue with every team member. You can see by the patient feedback he gets that he is just great.
Who inspires you to reach beyond your comfort zone to learn new clinical skills?
It would be Gio, 100%! He has been my coach for all these years. He actively attends CE courses himself and encourages our team to do the same. I’ve learned so much from him.
You attended dental school in Ukraine, and led a practice there for eight years before you settled in the US. What kinds of differences in the practice of dentistry have you experienced between the two countries, and how do you think could dentists in these countries could learn from each other?
I think any dentists can learn from each other, whether they are in the same country or on opposite sides of the planet. When I came to the US, I brought my personal approach to patients with me, and it was very important in Ukraine. In the US, life is much busier and we don’t always have enough time to spend with patients. I regret that we don’t have that ability. I remember a long time ago when one of my patients in Ukraine came to my office for his first visit. He was so scared of dentistry that the first day he came, I booked an hour for him, and all we did was talk—about life and all kinds of things. He didn’t let me touch him during that first appointment, but then he came back and allowed me to do all the treatment he needed: fillings, crowns, years of neglected dental care. Because I took the time to talk to him, he calmed down, and in that day he changed his thinking about dentistry. In the US we are so busy and concerned with being on time, both dentists and patients. Assistants help calm patients and light sedation helps as well, but I would like to spend more time with my patients, talking to them more. This is the biggest difference.
Dr. Gio has said that every conversation you have is about patients, never about yourself. Why do you feel that having that focus is an important part of how you proceed?
I think dentistry (and finding the best possible outcome for patients) is just my passion. That is why. Of course my family is important too, taking care of them and having great times together. But at work, I must be focused and alert for patients. Sometimes Gio helps me with decisions, and sometimes I help him, especially when we need to resolve really difficult cases. That’s when a patient-based focus is most important.
What’s next for you?
My plan is to advance my knowledge in soft tissue management and grafting, and in bone grafting. I think the international implant symposium that I will attend in October will be very beneficial for me and for my patients.