Some HMO's are paying ZERO dollars for services like SRPs and Fillings, in addition to paying out miserably low fees for crowns. So what are your options? 1. Lower the level of care you deliver and cut corners 2. burn yourself out and go broke 3. Increase your skill set and value, fill in the opportunity gap found in doing surgery and get rewarded for it.
SUPER important tips
This was going to be a tough mission. Gingival fibromatosis presents with dense fibrotic tissue.
I advised Dr. Milan to use a combination of #15 blades (a full box would be needed) and cautering device like a laser or electrosurgery for coagulation, resection and gingivoplasty. I made some general illustrations for Dr. Milan so we are all on the same page.
Non-conventional incisions
Because of the immense tissue volume I recommend a series of incisions.
I thought the best way to start is a perpendicular incision at the level of the CEJ (approximately) and roughly scallop it. Once the teeth were exposed, this would give Dr. Milan and stable reference point to make all other incisions.
It would make his life easier when it came to the external bevel and thinning of the palate.
The problematic palate
The palatal tissue is a challenge even under normal circumstances. This patient's palatal tissue was almost 10 times thicker than the norm. I advised him to do his best to thin it out and to expect challenges.
We talked about the rectangular distal wedge and how bone islands can be exposed and of course the secondary intention healing.
It's Surgery time!
Once the excess is removed bleeding control is going to be a problem. I warned Dr. Milan about this and that primary closure will not be possible and not a goal. The soft tissue will need to be reshaped with a large diamond bur a laser. Hopeless teeth should ideally be extracted at the same time and postpone restorative treatment fo later. I also told him to expect the unexpected. It wasn't going to be a conventional surgery!
Good luck!