Ethical Tension: High-Volume vs. High-Quality Care

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In this powerful continuation of their two-part conversation, Dr. Melissa Seibert and Dr. David Attia dive beyond digital workflows to confront the deeper philosophical questions shaping modern implant dentistry. Building on last week's discussion of data stacking, SmileCloud integration, and biologically driven design, this episode explores the nuanced realities of aesthetic-zone decision-making, ethical treatment planning, and the human side of high-level clinical care.

Dr. Attia opens with an unflinching look at when—and why—implants may not be the ideal solution. Using examples from his collaboration with renowned prosthodontist Dr. Tony Rotondo, he explains why lateral incisors often perform better with resin-bonded fixed partial dentures (FDPs) rather than implants, especially in cases with limited mesiodistal space or compromised interproximal bone. He and Dr. Seibert examine the synergy between partial extraction therapy and resin-bonded FDPs, illustrating how biologic preservation can achieve long-term aesthetic stability with less surgical intervention.

From there, the conversation transitions to Attia's mastery of provisionalization strategies in the aesthetic zone. He details how he designs custom healing abutments and Maryland-style bridges that provide patients with fixed provisionals—even when primary stability is limited. Listeners gain an inside look at his precision-driven process for contouring the subcritical zone, controlling soft-tissue architecture, and creating minimal yet functional clearance between the pontic and abutment. His philosophy is simple but profound: every anterior patient should leave the chair with something fixed—even if it isn't load-bearing.

The discussion then widens to tackle the moral tension between commercial dentistry and biologic integrity. Dr. Seibert asks the hard question: How do clinicians reconcile high-quality, time-intensive dentistry with the economic pressures of high-volume practice? Dr. Attia's answer is unequivocal—ethical dentistry may take longer and require greater effort, but the money follows the mastery. He critiques the growing trend of overtreatment in both restorative and surgical spheres, warning of a coming wave of revision cases born from expedience and over-commercialization.

Attia advocates for a "longevity-first" mindset—prioritizing preservation over replacement, patient education over production, and sustainable outcomes over speed. Drawing from his own follow-ups across fourteen practices, he reflects on the humility and evolution that come with long-term case review: what he did six months ago wasn't wrong—but it can always be better.

The episode concludes with a candid meditation on values alignment in practice. Both clinicians emphasize the importance of knowing one's philosophy, communicating it transparently, and being comfortable acknowledging that "you're not everyone's dentist." Attia urges younger practitioners to resist the social-media allure of aggressive full-arch cases, reminding them that truly exceptional dentistry begins with sound biologic principles, refined communication, and disciplined restraint.

Listeners will leave this episode with:

• A framework for choosing between implants and resin-bonded FDPs in the aesthetic zone

• Strategies for designing custom provisionals that maintain soft-tissue integrity

• Guidance on educating patients about biologic and financial "costs" of treatment

• Insight into navigating the ethical crossroads of modern dentistry

This conversation is both technical and deeply human—a masterclass on how to balance innovation with integrity and how to practice dentistry that endures not just biologically, but ethically.