Dentaltown 2015august

Are You Preparing Properly for Retirement?
See Our Financial Package Starting on page 52
August 2015
August 2015
Retirement
Planning
Are the Top
1 Percent Safe?
p. 52
Debt-Repayment
Basics for Dentists
p. 58
The Three Dimensions

of Endodontic CBCT:
Treatment Planning,
Patient Understanding
and Referral Relationships
By Dr. Rowshan Ahani
p. 42
Implant Drivers and

Driver Tips for SingleTorque Wrenches
By Dr. Elizabeth J. Fleming
p. 48
CE: Stick With It:

A Systematic Approach
for Bonding CAD/CAM
Restorations
By Dr. Adamo E. Notarantonio
p. 76
AA Division
Division of
of Farran
Farran Media,
Media, LLC
LLC
INTRODUCING
Variolink Esthetic
Adhesive Cementation System
Exceptional handling and easy clean-up

Amine-free for long-term shade stability
Reliable bond strength results with a universal, easy to use bonding system
Try Variolink Esthetic today for FREE!

Visit www.ivoclarvivadent.us/variolink
100% CUSTOMER SATISFACTION

GUARANTEED!
ivoclarvivadent.com
Call us toll free at 1-800-533-6825 in the U.S., 1-800-263-8182 in Canada.

2015 Ivoclar Vivadent, Inc. Ivoclar Vivadent and Variolink are registered trademarks of Ivoclar Vivadent, Inc.
FREE FACTS, circle 38 on card
NTED
H T I NITI
IG
TO
ri
Ivoce
E
AT
The adhesive cement for exceptional

esthetics and user-friendly application
Esthetic Cementation
made Simple!
PROBLEM SOLVED.
Running a successful practice can feel overwhelming. You have

a lot to worry about providing the best patient care, increasing
team productivity,
Practice
Managementwhile looking for every way to improve your
business. Dentrix has the answers. Our business tools solve real
business problems so you can run a more profitable practice.
Dentrix.com/Solved
Dentrix is a proud winner of the 2014 Townie Choice Awards

Best Practice Management Software for Dentrix
Best Periodontal Charting for Dentrix
BRAIN POWER
Increase yours with Dentaltown.coms online CE.
contents
august 2015
In This
Issue
08
On Dentaltown.com
16
Continuing
Education Update
28
Poll
82
Product Prole: Uncomplicate Business
92
Practice Solutions:
Ivoclar Vivadent
97
Ad Index
108
Industry News
110
Product Prole:
LocalMed
112
Dentally Incorrect
34 | PEDIATRIC
DENTISTRY
Pediatric Dentistry, Parents,
and Spoiled Kids
Dr. Jeanette MacLean has
experienced the tyrant-intraining patients that are every
dentists worst nightmare.
Heres how she copes with
themand their parents.
The Three Dimensions

of Endodontic CBCT:
Treatment Planning,
Patient Understanding and
Referral Relationships
Dr. Rowshan Ahani explains
how CBCT technology helps
him work and communicate
better with his referrals.
88 | GENERAL
PRACTICE
Yoga for Dentists
Dr. David Hennington shares
how yogas physical, mental
and emotional benets can
have a gentle but profound
effect on the unique health
challenges of dentists and
dental teams.
10 | HOWARD SPEAKS
38 | HYGIENE
Do You Need to Retire Your Views

on Retirement?
Finding the Hidden Treasure: Prevention =

Treatment + Motivation + Compliance
Dr. Howard Farran, publisher of Dentaltown

Magazine, on seizing the daybecause it all
goes by so quickly.
Hygienist Barbara Vugteveen writes about how

to properly educate patients on hygiene topics
to help them maintain a healthy smile.
14 | PROFESSIONAL COURTESY
48 | PROSTHODONTICS
Product Perfection is Not Guaranteed
Implant Drivers and Driver Tips for

Single-Torque Wrenches
Dr. Thomas iacobbi, Dentaltown editorial

director, writes about the search for the perfect
dental product.
30 | PRACTICE MANAGEMENT
This image-rich resource list provided by Dentaltown Clinical Director Dr. Betty Fleming shows
the options available in implants and abutments.
5 Strategies for Maximizing

New-Patient Referrals
52 | FINANCE
Jay Geier explains how to enhance your

patient-referral program, and highlights
common misconceptions that can cost you.
Most successful dentists are in the top 1 percent

of income earners. Certied nancial planner
Reese Harper explains why your nances can
still turn upside downand what to do about it.
BOTTOM LINE
DENTALTOWN.COM
42 | RADIOLOGY
AUGUST 2015 // dentaltown.com
Are the Top 1 Percent Safe?
Need more Dentaltown? Dont miss the opportunity to have the most
clinical and business-savvy information at the touch of your ngertips.
contents
august 2015
58 | FINANCE
Debt-Repayment Basics for Dentists
Establishing an Accounts Receivable System
Financial expert Konstantin Litovsky provides an indepth look at how dentists should manage money, and
offers debt-management advice.
Well-known Townie and practice-management

consultant Sandy Pardue offers best practices for getting
paid on time, and how to follow up with accounts that
have gone awry.
62 | FINANCE
A Creative Approach to Retirement Funding
Authors Paul Homoly, Kenneth H. Mathys and Rob Ziliak
share a unique approach for funding retirement savings.
66 | ORTHODONTICS
Diode Use in Orthodontic-Related Procedures
Dr. Ron Kaminer explains how diode lasers help him
more easily perform various orthodontic procedures.
76 | CONTINUING EDUCATION
Stick With It: A Systematic Approach for Bonding
CAD/CAM Restorations
Why Dentists Need to Be Mobile-Ready
Rachel Taylor explains why phones and tablets are
the medium of choice for effective and timely patient
communicationand how you can be ready.
102 | RADIOLOGY
Rehabilitation Case with CAD/CAM Design and
Excellent Results
Dr. Abraham Stein and master ceramist Luke Kahng
describe a case in which a patients serious oral problems
were effectively treated with implants and crowns.
In this CE, Dr. Adamo Notarantonio demonstrates a stepby-step approach to bonding CAD/CAM restorations and
highlights their importance.
MESSAGE
BOARDS
22
70
PROSTHODONTICS
The Chasolen Effect
An in-depth look at how a Townie
treated a patient using implants
and a xed restoration after
attending the Chasolen study club.
PROSTHODONTICS
Thin Implants
Do you splint thin, short implants?
Check out this online discussion.
Dentaltown (ISSN 1555-404X) is published monthly on a controlled/complimentary basis by Farran Media, LLC,
9633 S. 48th St., Ste. 200, Phoenix, AZ 85044. Tel. (480) 598-0001. Fax (480) 598-3450. USPS# 023-324 Periodical Postage Paid in Phoenix, Arizona and additional mailing offices. POSTMASTER: Send address changes to:
Dentaltown.com, LLC, 9633 S. 48th St., Ste. 200, Phoenix, AZ 85044
2015 Dentaltown.com, LLC, a division of Farran Media, LLC. All rights reserved. Printed in the USA.
dentaltown
staff
EDI TORIAL ADVISORY BOARD

Editorial Director
Thomas Giacobbi, DDS, FAGD tom@farranmedia.com
Clinical Director
Elizabeth Fleming, DDS betty@farranmedia.com
Editor
Michelle Beaver michelle@farranmedia.com
Associate Editor
Kyle Patton kyle@farranmedia.com
Assistant Editor
Arselia Gales arselia@farranmedia.com
Graphic Designer/Copy Editor
Lisa Hewitt lisa@farranmedia.com
Graphic Designer
Ed Younkin ed@farranmedia.com
Production Artist
Anthony Grazetti anthony@farranmedia.com
Sales Director
Mary Lou Botto marylou@farranmedia.com
National Account Manager
Steve Kessler steve@farranmedia.com
Regional Sales Managers
Geoff Kull geoff@farranmedia.com
Benjamin Lund ben@farranmedia.com
Associate Sales Manager
Greg Farran greg@farranmedia.com
Executive Sales Assistant
Leah Harris leah@farranmedia.com
Circulation Director
Marcie Donavon marcie@farranmedia.com
Circulation Assistant
Sally Gross sally@farranmedia.com
Events Director
Marie Leland marie@farranmedia.com
Events and Tradeshow Coordinator
Kami Sifuentes kami@farranmedia.com
Marketing Coordinator
Juliann Yungkans juliann@farranmedia.com
Director of Continuing Education/
Message Board Manager
Howard M. Goldstein, DMD hogo@dentaltown.com
Global Clinical Director
Kenneth S. Serota, DDS, MMSc Kendo@farranmedia.com
I.T. Director
Ken Scott ken@farranmedia.com
Internet Application Developers
Nick Avaneas niko@farranmedia.com
Jake Reed jake@farranmedia.com
Mobile Application Developer
Richard Ortiz richard@farranmedia.com
Member Services Specialist
Bridget Mullican bridget@farranmedia.com
Multimedia Developer
Devon Kraemer devon@farranmedia.com
Digital Media Developer
Brian Morales brian@farranmedia.com
Publisher
Howard Farran, DDS, MBA howard@farranmedia.com
President
Lorie Xelowski lorie@farranmedia.com
Controller
Stacie Holub stacie@farranmedia.com
Receivables Specialist
Kristy Corley kristy@farranmedia.com
Seminar Coordinator
Rebecca Parent rebecca@farranmedia.com
Lee Ann Brady, DMD

Glendale, Arizona
Cari Callaway-Nelson, DDS

Las Vegas, Nevada
Doug Carlsen, DDS

Denver, Colorado
Howard M. Chasolen, DMD

Sarasota, Florida
Linda Douglas, RDH

Toronto, Canada
Joshua Halderman, DDS

Columbus, Ohio
Glenn Hanf, DMD, FAGD, PC

Plantation, Florida
William Kisker, DMD, FAGD, MaCCS

Vernon Hills, Illinois
John Nosti, DMD, FAGD, FACE

Mays Landing, New Jersey
Jay Reznick, DMD, MD

Tarzana, California
Elizabeth Fleming, DDS

Phoenix, Arizona
Donald Roman, DMD, AFAAID

Paramus, New Jersey
Seth Gibree, DMD, FAGD

Cumming, Georgia
Timothy Tishler, DDS

Sister Bay, Wisconsin
Stephen Glass, DDS, FAGD

Spring, Texas
Brian Gurinsky, DDS, MS

Denver, Colorado
Eyad Haidar, DMD

Weston, Massachusetts
Glenn Van As, BSc, DMD

British Columbia, Canada
Fayette Williams, DDS

Weatherford, Texas
Josh Wren, DMD

Brandon, Mississippi
19992015 Dentaltown.com, LLC. All rights reserved. Printed in the USA.

Copyrights of individual articles appearing in Dentaltown reside with the individual authors. No article appearing
in Dentaltown may be reproduced in any manner or format without the express written permission of its author
and Dentaltown.com, LLC. Dentaltown.com message board content is owned solely by Dentaltown.com, LLC.
Dentaltown.com message boards may not be reproduced in any manner or format without the expressed written consent of Dentaltown.com, LLC.
Dentaltown makes every effort to report clinical information and manufacturers product news accurately, but cannot assume responsibility for the validity of product claims or typographical errors. Neither do the publishers assume responsibility for product names, claims, or
statements made by contributors, in message board posts, or by advertisers. Opinions or interpretations expressed by authors are their own and
do not necessarily reflect those of Dentaltown.com, LLC.
The Dentaltown.com Townie Poll is a voluntary survey and is not scientifically projectable to any other population. Surveys are presented
to give Dentaltown participants an opportunity to share their opinions on particular topics of interest.
Letters: Whether you want to contradict, compliment, confirm or complain about what you have read in our pages, we want to hear from
you. Please visit us online at www.dentaltown.com.
on
.com
So you read the magazine, but did you know we also have an active online community?
The magazine is just a small part of what we do at Dentaltown. Visit Dentaltown.com for an ongoing conversation about
everything from tough cases to staff issues to whos going to win the World Series this year. Join the discussion!
Message Boards
Looking for Ideas for the Latter Half of 2015
Docs share tips and advice for increasing production during the second half
Inherited Case
of the year..
2nd Half
Case Presentation
Three Percent Can Retire at 60

A hugely popular thread dedicated to retirement topics (especially financial
Inherited Case
A great case from an oral surgeon involving a
70-year-old woman with a broken implant bridge.
planning) to help doctors work toward early retirement.
Can Retire
The doc needs help identifying the implants

before he can proceed.
Online CE
Plotino
Grande
Gambarini
ReciprocationAn Optimal
New Paradigm in Root-Canal Preparation By Gianluca Plotino, DDS, PhD;
Connect With Us
Nicola Maria Grande, DDS, PhD; Prof Gianluca Gambarini, MD, DDS
The reciprocating motion has been recently applied to specifically designed
Download the App
dental
town
nickel-titanium (NiTi) instruments. Reciprocation has reduced the risk of

fracture due to torsion and to the accumulation of metal fatigue, which
are the main shortcomings of rotary NiTi instruments. After four years of
extensive clinical use, research and teaching regarding these instruments, the
lecturers will describe and explain several advantages that are related to this
Receive Dentaltown e-Newsletters

www.dentaltown.com/myprofile.aspx
kind of movement.
howard speaks
column
Do You Need to Retire

Your Views on Retirement?
Planning for retirement is importantits true.
However, its important to live for today too, and not
get obsessed with the future.
Balance.
Plan for retirement, but enjoy today. Enjoy your
career.
This months cover stories focus on retirement
planning and debt management and theyre full of
valuable information for people at any stage of their
career. The most important stage though, is the one
youre in right now.
I love every day as a dentist. Thats why I still
practice. If I didnt want to practice, Id stop practicing. See, I dont do things I dont like to do for
money. The minute its not fun, I dont do it.
For all of you out there who want to retire early,
is there any chance you want to get out because you
hate your job? Are you doing something you dont
like to do for money? It seems that about half the
dentists I talk with love going to work and the other
half hate it and are burned out and fried and want to
retire. Some of the people who want to retire become
mired in the future and fantasize about it day after
day, even though retirement may be decades off. If
thats you, youve lost balance. Maybe its time to
make fewer decisions about what to do in retirement,
and more decisions about how to make your job better so youre not obsessed with retirement.
What can you fi x about your current situation? Lots of things!
Lets say you hate doing endo.
Well there are these people called
endodontists. Refer out! Now
lets say you dont like blood
and guts and you dont want to
place implants. Then dont place
implants. There are many types
of procedures in dentistry, which
by Howard Farran, DDS, MBA, Publisher, Dentaltown Magazine
10
means you have the choice to focus on the types

you like.
Concentrate on what you enjoy and get your
attitude right. Then get your team right. Get to the
point of camaraderie where your assistant fist bumps
you when you get that wisdom tooth out because
youre both in it together and because this is such a
great day and you both just rocked that procedure.
Live in the moment. When youre in retirement,
live in those retirement moments. Be present where
you are. Do what you like with the people you like.
When Im driving to work, Im happy because I
cant wait to see Jan and Christine and Robert and
Yoni and Zach. I just love working with our entire
team. Is there someone on your team you cant stand
to see, who is dragging you down and dragging your
business down and running off other team members?
Maybe he or she is part of why youre dreaming about
retirement all the time.
Talk to them. Maybe they have legitimate gripes
that are making them exude negative energy. Are the
concerns valid? Should you address them? Would
addressing those concerns make things better? Then
address those concerns. If that employee is better to
be around afterward, you have a happier employee,
you improved parts of your business, and youre happier because youre not around negativity. But, if that
person is just plain negative or, if there are core traits
to this person that you cant change, get rid of them!
Smart operators dont stand for people who drag the
business down or who push others out.
Im not Dr. Phil; I wasnt born to figure out why
someone is miserable no matter what. Its my job to
get rid of problems when I see them, and if someone
becomes a problem and makes you hate coming to
work, that employee may have become a problem to
get rid of. Improve your team and retirement might
not pop into your head as often.
Continued on p. 12
howard speaks
column
Continued from p. 10
Remember when you dreamed of going into
dentistry? Being in dentistry is what you wanted.
You may have wanted it as badly as you now want
to retire. What can you change so that you love dentistry again? Its possible to love the profession into
old age.
For instance: Kenny.
Kenny was my neighbor growing up and he is
the reason I wanted to become a dentist. Kenny
recently celebrated his 50th year in dentistry; this
guy is still practicing! I used to watch him take
X-rays and do root canals and I thought it was
awesome. I had to become a dentist, even though it
broke my dads heart when I didnt follow his footsteps and continue in the family business. I wanted
to be a dentist, and I still want to be a dentist. Every
year I get better and faster.
Dentists much older than I am say that every year
they get so much better, so much faster. Theyve had
thousands of people walk through their doors, they
have a client list a dozen feet longthey get better
each step of the way. Maybe around 55 they say their
goal is to work one hour less a day and make $100 a
day more, and they can.
Howard Live
Howard Farran, DDS, MBA, is an international speaker
who has written books and dozens of articles. To schedule Howard to speak at your next national, state or local
dental meeting, email rebecca@farranmedia.com.
2015
12-19
AUG
Integrated Dental Marketing

Australia
Aug 12 Melbourne
Aug 15 Sydney
August 19 Brisbane
For more information and to see
Howard speak at these events,
contact Carl Burroughs:
info@marketingdentistry.com.au
Kenny now works a few hours a day Monday

through Thursday and hes probably making more
money on Monday and Tuesday than any dentist is
making off their 401(k)s.
Another inspiring elder dentist is an Auschwitz
survivor who attended one of my seminars. This man
was 92 at the time, living in Los Angeles, and even
though hed lost his wife, he still loved life and dentistry. He stood there excited as can be telling me how
much he likes his new CBCT X-ray machine and that
hes all about placing implants. Imagine that. He may
have thought the entire time in Auschwitz that he
was going to be killed every day, and then he makes
it out of there alive and hes the happiest guy in the
world placing implants in his nineties while youre
talking about retirement.
Most of the time, when dentists 50 and under
start talking to me about retirement, it only takes
five minutes before I find out that they hate dentistry,
they want out, theyre done. Then you ask why they
hate it. Well, they hate a couple people on staff and
they hate some patients. Well, you can fire staff and
let patients go. You can work fewer hours and quit
doing certain things. Focus first on how youre going
to be happy right now and the farthest thing from
your mind will be how soon can you retire.
I love my work, in dentistry, and at Farran Media.
I get approached often by people who want to
buy Dentaltown and I always say no, and always will.
They say theyll give me a lot of money and I say,
What would I do with a bunch of paper?
What would I do with money that would make
me as happy as I am right now, when the first thing
I do every day is check the message boards and see
whats going on? Im addicted to my product. I love
my teams. I love dentistry. Sure, Im preparing for
retirement financially, but retiring is far from my
mind; Im too busy enjoying our profession and our
Dentaltown community.
Enjoy your retirement, and plan for it, but dont
squander the life you have today, wishing it away for
full-time golf. Live in the now, dental friends. Its a
good career you built. And if you dont like it, do
something else. Life is too short to do what you dont
like just for money.
Carpe diem.
Want to share some advice with our community? Visit dentaltown.com.
12
LETS REDEFINE EXPERTISE
RESTORATION
LA CARTE
Add CS Solutions elements

as your practice grows.
We created CS Solutions for streamlined restorations: one visit, one hour,
one crown. Best of all, you can build the system as you go. Start with the
portable CS 3500 intraoral scanner, which creates open-format STL files
compatible with many third-party CAD/CAM lab systems. Add CS Restore
software to design restorations, and complete them on the compact
CS 3000 milling machine.
Whether you do restorations within your office or work with a lab,
CS Solutions elements can be mixed and matched to seamlessly meet
your needs. Ready, set, grow!
Learn more about CS Solutions today by calling 800.944.6365

or visiting www.carestreamdental.com/solutions.
Carestream Health, Inc. 2015. 12772 DE CS Solutions AD 0815
SCAN
DESIGN
MILL
professional courtesy
column
Product Perfection
is Not Guaranteed
As we all know, the perfect dental product does
not exist. There are hundreds of new products introduced to the dental market each year and while some
are terrific, others are duds. As frustrating as this is,
trial and error is necessary for the advancement of
our profession. However, trial and error is also one
of the job gripes that dentists complain about the
most. We dont want to perform clinical tests on our
patients and we dont want to find out that a product
does not perform to its expectations after weve used
it hundreds of times. As an aside, this situation is not
always the fault of an inventor or manufacturer; one
of the most common reasons that a product does not
perform to expectations is failure to follow directions.
I believe first and foremost, every new product
comes to market with good intentions from the person or people who made it. They want the product
to be great, they want it to be successful and they
want to make your life as a dentist better. There is no
money to be made in a bad product. In fact, with the
cost of bringing a product to market, companies large
and small are on the hook to recover big development
costs before they can realize a dollar of profit. In
addition, the population of potential customers is relatively small so it is critical to get enough customers
to sustain the product in the long term. Occasionally,
youll see a product you like disappear from the market because there are not enough people using it.
Why do we unknowingly use some products
when they are not ready for primetime? In short, this
is the price of progress. Major manufacturers perform
extensive testing prior to bringing
a product to market, but if every
new product went through five to
10 years of rigorous clinical testing
before making it to market, we
would probably pay five to 10 times
the cost and we would currently
be practicing with the new products of 2005. I dont

know many dentists who would want to go back 10
years. In essence, we make this bargain to use our
best judgment in choosing the right products for our
patients with the sincere hope that they will perform
as advertised.
Finally, in the spirit of the golden rule, how do
you react when a product fails to meet expectations?
Is it the same way that you would want your patients
to react when their new incisal filling comes out six
months after placement or when you get a crown
from the lab and it doesnt fit? The reason that the
practice of dentistry is often referred to as an art and
a science is because things are not always perfect.
Treatment requires interpretation and choosing a new
product requires the eye of a scientist and the spirit of
an artist willing to try something new.
Three cheers for our colleagues who are on the
leading edge or the bleeding edge of new products
as they facilitate progress in the profession. I also tip
my hat to the manufacturers who listen to their customers input during product development and who
gather feedback when the product is on the market.
And of course Im thankful for Dentaltown.com, a
resource filled with candid conversations about products, where an honest opinion is never more than a
few clicks away. In fact, each year, we give our members the opportunity to vote for their favorite products on the Townie Choice Awards ballot. Voting
began July 6, and the winners will be announced in
the December issue of Dentaltown Magazine.
Do you have a favorite new product that was a
resounding success in your practice? Share your story
in the comments section attached to the digital version of this article online. If you have a question or
comment for a future column please send it to tom@
dentaltown.com. If you use Twitter, I can be found at
@ddsTom.
Comment on this article at Dentaltown.com/magazine.aspx.
by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine
14
Ten Years of Thanks
THANK YOU FOR MAKING ISOLITE TOWNIES CHOICE FOR TEN STRAIGHT YEARS
IN THE CATEGORY OF RESTORATIVE DENTISTRY: NON-RUBBER DAM ISOLATION.
Vote Early this year for the Chance to Win Prizes: www.Dentaltown.com/tca
continuing education
update
Whats New in Continuing Education?

August is now herethe last month of the summer
for those of us in the Northern Hemisphere. Which
means that, unless youre in Phoenix, its probably
the last month until next year to watch CE on your
iPad on your outdoor patio. Thats right, our CE is
viewable on iPads and other portable devices!
Townie Meeting 2015 Lecture Series

We cant bring you all the action from our annual
Townie Meeting in Las Vegas, but we can certainly
share some of the top-notch education that was
presented there. This month, we are releasing our
Townie Meeting 2015 series containing courses from
Lee Ann Brady, Ara Nazarian, Mike Melkers, Bruce
Baird, Mark Hyman, Neal Patel, Dale Miles and
many more. You now have access to more than 22
hours of excellent education in both clinical dentistry
and practice management.
As part of the registration fee for Townie
Meeting, all 2015 attendees have access to these
courses for free. Miss the meeting? Dont worry;
its only $225 to view for those who were unable to
attend. (But be sure to sign up for Townie Meeting
2016!)
Getting Staff and Patient Communication

Right for Increased Profitability
by Dr. Bryan Laskin
Effective communication keeps office stress low
and profitability high. Effective communication with
your patientswhich encompasses everything from
attracting new patients and answering the phone, to
treatment presentation and ensuring the patient leaves
happyalso increases your bottom
line. The strategies taught in this
course will enhance communication with your team, patients and
colleagues, allowing you to work
smarter and faster, with skyrocketing profitability. Simple tools and
techniques that are intuitive and
easily adopted can dramatically
change your patients perspective, building lasting

trust and confidence in your practice. These strategies
also build a cohesive team that works together to
drive more patient procedures in a day, increasing
the bottom line while increasing patient satisfaction.
With your staff communicating effectively, patient case
acceptance increases and your schedule stays full. Staff
are encouraged to attend this course, so your office
can role-play treatment-planning scenarios and adopt
communication protocols that fit your offices needs.
Confident Implant Placement Through

Digital Planning
by Dr. Armen Mirzayan
The concept of guided surgery and implant placement is often ignored for multiple reasons. Generally,
the cost of the surgical stents and the arduous process
of planning and fabricating the stent have been the
largest deterrents, and the majority of the modality
would have to be outsourced. With the advancements
in technology, a large number of doctors have been
able to incorporate both CAD/CAM and cone beam
into their practices to diagnose, treatment plan, and
deliver care to the highest standard possible. This has
also allowed the practitioner to have complete control
over the whole complex, from the precise fi xture
placement to the appropriate emergence profile for
the restoration.
This CE course will demystify the process and
show how a dentist can reach the fi nal product with
great efficiency and predictability. Surgical stent
processes are described in great detail, ranging from
simple tooth-borne cases to complex edentulous
procedures. Furthermore, the surgical options are
catalogued in great detail where the clinician can
make practice purchase decisions with regard to
the appropriate armamentarium needed to provide
the surgery. The presentation is provided in a neutral
manner without favoring any specific implant product
line and details how anyone with appropriate access
to the technologies can enter the field of guided
implant surgery.
Continued on p. 18
by Howard M. Goldstein, DMD, Director of Continuing Education
16
update
Dental Sleep Medicine: Sleep Principles

and Oral Appliances
by Dr. Barry Glassman
Much has been said about the dentists need to
diagnose sleep apnea and treat snoring. Despite the
fact that it is a relatively young science, myths and
exaggerations already abound on this critical subject. It is true that dentistry could and should be
the No. 1 portal for patients into sleep medicine.
What steps should the general dentist take in order
to help benefit his or her patients? What factors will
help the dentist make a decision as to exactly how
involved he or she should become in treatment?
In this two-hour presentation, we will review the
principles of sleep medicine, and the role of dentistry in treating snoring and other obstructive sleep
disorders. This honest look at sleep medicine will
concentrate on the challenges that face dentists who
incorporate dental sleep medicine in their practices.
Those viewing this presentation will begin to have
a thorough understanding of dental sleep medicine and
will be in a position to appropriately screen all their
patients. As important, they will have the information
to decide whether or not to incorporate oral-appliance
therapy in their offices and if so, what steps to take. The
oral-appliance review will help them select and insert
appliances and monitor appliance use. They will have a
realistic perspective on the possible untoward side effects
of appliance therapy on muscle and joints.
The Aesthetic Full-Mouth Rehabilitation

by Dr. John Nosti
Please do yourself a favor and take Johns newest
CE course on Dentaltown Learning Online.
Full-mouth rehabilitations are one of the most
difficult types of cases to handle in practice today.
Many times these patients have advanced occlusal
breakdown, along with the presence of a temporomandibular joint internal derangement. Learn how
these internal derangements are classified and how
they affect the long-term prognosis of your case.
Dr. John Nosti will detail the diagnostic records
necessary and steps he completes in performing a
full-mouth rehabilitation. He also describes how
to understand vertical dimension and how and
why to make changes, in addition to the how-to in
completing the bite records necessary in increased
18
vertical dimension cases both prior to and during

the preparation appointment. Preparation sequencing
is key in full-mouth reconstructions, and Dr. Nosti
gives you a simplified approach to tackling these
complex cases.
Practice Leadership 101

by Travis Frederickson
The changing landscape of health care brings
into sharp focus the necessity for dentists to engage
in the leadership process. This course is intended to
introduce the learner to what practice leadership is all
about, and the many benefits of this approach.
Practice leadership is often a foreign concept within
a dental practice; many dentists believe they are using
leadership, while theyre actually using management.
While both management and leadership are necessary to effectively operate a practice, the scales have
historically been tipped to management and remain
that way today.
The benefits of leadership within a dental practice are extensive, but largely underutilized. Practice
Leadership 101 introduces leadership principles as a
useful process for practice leaders.
With understanding gained from this class, the
learner is able to identify principles that will serve him
or her well, both individually and for the practice.
Many principles can be used immediately. As you
practice the principles, the many benefits of utilizing
a leadership model for practice operations will emerge.
HIPAA For Dentistry 10 Tips/Tools for

Compliance
by Leslie Canham, CDA, RDA
HIPAA regulations require covered entities to
comply with the privacy, security, and new omnibus
rules. Dentists must update their notice of privacy
practices, create written plans, conduct a risk assessment, create the necessary logs, update business
associates agreements, understand how to prevent
breaches and know what to do if a breach occurs.
In addition, workforce training must take place
periodically, covering office policies, procedures,
and plans to protect patients privacy. Awareness
training protects the practice and patient data, and
prevents breaches.
Continued on p. 20
Soft from the syringe.

Hard in the defect.
Prep. Dispense. Shape.
Placing bone graft has
never been this easy.
Once the coated granules of
GUIDOR easy-graft are syringed
into the bone defect and come in
contact with blood, they change in
approximately one minute from a
moldable material to a rigid,
porous scaffold.
Designed for ease of use
and predictability
100% synthetic and
fully resorbable
Ideal for ridge preservation and
filling voids around immediate implant
placements
This product should not be used in
pregnant or nursing women.
easy-graft CLASSIC
alloplastic bone grafting system
Register on the New GUIDOR.com to receive 15% Off your first online purchase.
To purchase or learn more, visit GUIDOR.com/easy-graft/ or call 1-877-484-3671.
Instructions for Use (IFU), including indications, contraindications, precautions and
potential adverse effects, are available at GUIDOR.com/IFU/.
2015 Sunstar Americas, Inc. All rights reserved. GDR15040 07012015v1
GUIDOR is a registered trademark of Sunstar Suisse, SA. easy-graft is a registered trademark of Degradable Solutions AG.
update
Pediatric Dentistry: Anesthesia, Pulp Therapy, and

Stainless-Steel Crowns
by Dr. Josh Wren
With the Affordable Care Act mandating dental coverage for
those under 19, more than 3,000,000 pediatric patients will be
added to 150,000 dental practices. Treating children may become
a necessity for your dental office. Pulp therapy and stainless-steel
crowns are procedures often considered complex when performed
on pediatric patients. This course will alleviate any fear of the
unknown that leads to this misconception. Indirect pulp therapy,
pulpotomy, and pulpectomy will be discussed, with emphasis on
diagnosis and technique.
Pulp therapy and stainless-steel crowns are

procedures often considered complex when
performed on pediatric patients.
Stainless-steel crowns will also be discussed and procedural
steps thoroughly explained and shown. Neither pulp therapy nor
stainless-steel crowns are possible without effective anesthetic techniques, so this course also discusses Dr. Wrens process for the use
of nitrous oxide, appropriate topical anesthesia and local anesthesia
in order to achieve a truly painless injection 100 percent of the time.
If you are treating children in your practice, this course is a must!
Buying a Dental Practice: There is More to it Than

Price. Recorded Live at Townie Meeting 2014
by Tim Lott
This presentation is designed to educate the prospective buyer
on how to approach the financial due diligence aspect of buying
a dental practice. You will learn what information you need, how
to piece it together and analyze it to formulate an offer. You will
also learn some of the other aspects of the process so you will be
prepared when you locate a practice to purchase.
We also have here on Dentaltown Dr. Howard Farrans
One-Day Dental MBA. Dr. Farran shares his proven techniques
to increase your productivity, boost your bottom line and
build your business. Dont miss his live and unfi ltered insights
on dentistry and business, along with an insiders view of his
dental practice.
Enjoy learning from the comfort of your home!
View more CE offerings on Dentaltown.com.
Log on to Dentaltown.com/onlineCE to learn more.
20
prosthodontics
message board
The Chasolen Effect

An in-depth look at how a Townie treated a patient with implants and a fixed restoration after
attending the Chasolen Study Club
Dentaltown.com > Message Boards > Prosthodontics > Fixed Prosthodontics > The Chasolen Effect
JasonL
Member Since: 04/13/00
Posts: 1-8 & 15 of 58
Related Message Boards

The Chasolen Quint
Chasolen Quint
The Chasolen and Strupp Special

The Perfect Core!
Chasolen and Strupp
Introduction:
I brought this case to the Chasolen Study Club in 2007 (was it that long ago?). This gentleman
has been struggling with an upper partial for many years. In addition, his remaining teeth have
gradually been failing, requiring extraction, additions to his partial, and more despair for him.
We discussed a full denture, implants, and everything in between a few years ago and he didnt
feel he should spend that kind of money on himself.
I was also a little unsure about how to phase him through any treatment since we were
getting awfully close to not having anything stable to hold onto. I went to the Chasolen Study
Club with the photos and ideas. The case discussion ended up being longer than I anticipated,
with treatment options ranging from telescopes on teeth to locators, bars, fi xed on implants and
sinus surgery. I came home, reviewed everything and presented it all to the patient with his wife.
They finally decided to move forward with extractions, implants, and a fi xed restoration. Here
is that story.
Fig. 1
Fig. 2
Smile (Fig. 1)
Occlusal view (Fig. 2)

Fig. 3
Fig. 4
Retracted view with partial in place (Fig. 3)
A model of the wax up used to make the

provisional (Fig. 4).
Conclusion:
I sent him for a CT scan and it came back that we would need significant sinus augmentation.
Given his lower dentition we decided we didnt need to restore molar-molar.
He was very nervous about having his teeth come out during the healing so we decided to
do an immediate fi xed restoration:
The teeth were in good alignment so I used them as a guide and
Fig. 5
sequentially placed an implant and removed a tooth. The implants
at #4 and 13 were normal placement and #6, 8, 11 were immediates.
All implants are BioHorizons Internal Tapered. PEEK abutments
were prepared extraorally (Fig. 5).
Luxatemp provisional cemented with UltraTemp (Fig. 6).
Fig. 6
Well, #8 failed.
So, I removed the implant, grafted it with Grafton and a DynaMatrix membrane and remade the provisional with Ribbond. Needless
to say, I then spent a lot of time babysitting the provisional as it kept
coming loose ... luckily it came loose and the implants didnt.
22
Continued on p. 24
prosthodontics
message board
I waited four months and went back into the area of 8 and 9 and placed an implant in each,
buried them and waited. Eight weeks later I uncovered them and incorporated them into a new
provisional.
Fig. 7
Fig. 8
A model of the PEEK abutments for
reference (Fig. 7).
The new provisional when 8 and 9
were incorporated (Figs. 8 11).
Fig. 9
Fig. 10
Fig. 11
So, cost was an issue here and I tried to work as much as possible to get a nice final result
and keep costs in check. One way to do that was by utilizing the abutment that comes with the
implants (called a 3-in-1) and have the lab prep it. I also used a few custom abutments in order
to get ideal contours in the anterior.
Fig. 12
Fig. 13
The framework was fabricated with
bite tabs at the vertical we had determined
in the provisionals.
The abutments were inserted and the
pontic spaces contoured (Fig 12 & 13).
The framework was then tried in
Fig. 14
over this (it fit great) and a pickup impression was done. At this time all of the porcelain directions
were sent to the lab along with some of the original photos.
The patient wanted things to look as natural as possible; he was
against white teeth.
Fig. 15
We fi nished this morning. Two cemented restorations. The fit
was terrific.
Minor adjustment on the occlusion. Plan on him wearing this
for three weeks and then I will tweak the occlusion and insert the
mouthguard. Many thanks to Howard Chasolen and the crew at the
study club. And more thanks to Arrowhead Dental Lab. Tech Jacob
Bryan did a fantastic job.
The lab bill was in the neighborhood of $2,300. Implant parts were $3,000 roughly. ($379
per implant, three custom abutments, impression parts, PEEK abutments).
Fig. 16
Fig. 17
Fig. 18
JUN 25 2009
sunburstlespaul
Post: 16 of 58
Beauty of a case Jason! I thought you said the CT showed the need for sinus lifts for
implants. Was it done? Or did you just stay anterior to the sinus?
JUN 25 2009
24
Continued on p. 26
THE NEW ANGLE
ON O-BALL IMPLANTS
Introducing the new SATURNO Narrow Diameter Implant System.
SATURNO is a narrow diameter, O-Ball implant
designed as a permanent solution for overdenture
retention. Engineered with straight and innovative
20 angled O-Ball implant options, SATURNO
gives clinicians something new in a narrow
diameter O-Ball implantFlexibility.
The 20 angled O-Ball implant option allows
for placement following the natural slope of the
maxillary ridge. This ZEST Anchors innovation
diminishes O-Ball facial emergence, a problem
that could produce areas of thin denture
acrylic and compromise denture strength
and/or esthetics.
Both SATURNO Implants provide the patented
Pivoting O-Ring technology pioneered by
ZEST Anchors. That technology allows for
passive denture seating when convergent/
divergent implants are present. With passive
seating, patients will experience easier prosthesis
insertion/removal, and less wear on their O-Rings.
SATURNO Narrow Diameter Implant System:
Self-tapping for ease of implant insertion
and increased implant stability
Progressive thread provides increased
primary stability
Proven RBM surface on the entire length
of the implant
Available in straight or 20 angled O-Ball
implant options; 2.0, 2.4, or 2.9mm
diameters; and 2 or 4mm cuff heights
Patented pivoting technology for resiliency
and 30 angle correction
Change your point of view on O-Ball implants with SATURNO, please visit
www.zestanchors.com/sndi/5 or call 800.262.2310 for more information today!
2015 ZEST Anchors LLC. All rights reserved. ZEST is a registered trademark and SATURNO is a trademark of ZEST IP Holdings, LLC.
prosthodontics
message board
JasonL
Posts: 17, 20, 24, 29 & 33 of 58
Exactly. If the bone were there I would have extended further on the right side since he does
have 30 and 31. We discussed the procedure, cost, etc. and he decided he could survive with
premolar occlusion. Ill post the radiographs shortly.
One of the big things that stands out in this case is the tissue. Look at the pre-op photos and
then the final. The tissue is dramatically improved. Inflammation down, bleeding decreased ...
overall a much healthier situation.
The whole story: The case came back and there was no characterization. I sent it back and
had them re-read the lab Rx. Then it came back like this. Much better.
Initially, the PEEK abutments determined the contour. I just prepped them equi-gingivally.
The lab then did a soft tissue model when I sent the abutment impressions in to them. Utilizing
the photos and descriptions they prepared 8, 9, and 11 as custom abutments with ideal
emergence and margins just sub-gingival.
The other teeth just utilized a prepped 3-in-1 abutment to the tissue level with minimal
contouring. When I did the try-in of the framework I
prepared the pontic spaces with a diamond round bur
and the Periolase MVP-7 on diode setting.
They poured the framework pickup impression with
Duralay and pink tissue and stone. Does that answer your
questions/requests?
I was a little concerned because, even after deprogramming, I had a hard time when I would just tell him
to bite. So, when I was ready to take the bite, I sat him
up and had him tap, tap, tap and I observed what he
did. Then I instructed him to tap and hold. I then
visually confi rmed that he was centered.
On the framework you can see the tabs for the bite.
When he was supine it was way off and he was biting all
over the place. As soon as I sat him up he closed right into
the tabs ... I was surprised somewhat.
The one fear I had, though, was that he would be
hitting hard on the posteriors while sleeping. So, I took
a bite with the framework in and him supine. The lab
could then see this position that he could get to while
sleeping (in theory). I wanted to make sure they knew
this range and built to it accordingly. I think they did a
great job.
JUN 26 2009
Join the discussion online at:
www.dentaltown.com
Chasolen Effect
26
dentaltown
poll
pediatric dentistry
Isnt it helpful to know what other practices are doing? With our monthly poll you can see how other practices operate, what
works, what doesnt and how dentistry is evolving. The information we gather each month helps us measure trends in the
profession. This pediatric dentistry poll on was conducted on Dentaltown.com from July 1, 2015 to July 17, 2015.
When you restore primary teeth, what percentage of the time do you use
a glass-ionomer-based restoration?
4 7 %
2 2 %
1 4 %
1 7 %
Less than 5%
6-25%
26-50%
More than 50%
Do you routinely place

sealants on newly
erupted adult molars?
77%
Yes
Do you allow parents

in the operatory when
treating their children?
Do you provide oral

sedation for kids?
23%
10%
No
Yes
90%
80%
No
Yes
20%
No
80%
77%
57%
75%
Do you refer the majority of

your pediatric patients?
Do you place fluoride varnish on

your pediatric patients at
their recare visits?
Do you use rubber dams

with children?
How many stainless-steel crowns

do you place in a month?
80% No
16% Yes
4% Im a pediatric dentist
77% Yes
23% No
57% No
19% Yes, routinely
24% Yes, sometimes
75% Zero
19% 1-5
1% 6-10
5% 16+
Which category of procedures do you hope to learn more about

in the next 12 months?
28
2 4 %
2 1 %
1 3 %
0 5 %
0 9 %
0 9 %
1 9 %
Implant placement
Endodontics
Occlusion
Implant restoration
Oral surgery
Pediatric dentistry
Esthetic procedures
practice management
feature
Setting a clear
referral goal for
your office
Make your
office referable
Strategies for
Maximizing
New-Patient
Referrals
Hold a staff
contest
by Jay Geier
Send out
Patient
newsletter
No plateau is a good plateau.

Whether its losing unwanted belly fat,
learning a new language, or increasing
monthly production, most people will
agree that there is always room for significant growth and improvement in any
given area. But what about areas over
which you may feel you have limited control, such as stagnating patient referrals?
Not one dentist has ever increased
referrals through willpower alone. But if
you understand that increasing referrals is
a game of strategy, requiring a little time,
effort, energy, and money, your intentional investments will reap enormous
rewards.
30
Communicate
that you want
referrals
Every time patients walk into your

office, you should visualize a line of people standing behind themall of their
friends, families, coworkers, Bible-study
members, etc. Usually it will be a pretty
long line! And your patient has a varying degree of influence with all of these
people. Keep in mind that if referred,
the people standing in these lines are
destined to be the best possible kind of
patient, requiring the least persuasion
and often arriving already confident in
you and the quality of your practice.
In fact, more often than not, these
patients will reveal their exact expectations to you and your staff through
practice management
feature
conversations, which takes the guesswork

out of making them happyan ideal
situation. If you are delivering consistently
exceptional value to your line-leaders
your loyal patientsthen each patient
should be sending three to four referrals to
your practice. So why isnt it happening?
The truth is that many dentists simply
arent intentional about actively increasing
their referrals. What exactly does that
mean for you? It means that if you become
more intentional about building up your
referrals, youll have a step up on your
competition, allowing you to influence the
pool of new patients in your city.
Before you take the leap

The first step is to unlearn any
misconceptions you might have about
referrals. These are the top three:
1. Only long-time patients refer.

When it comes to asking for referrals,
earlier is better 95 percent of the time. The
initial excitement created by an incredible
in-office experience and a new, positive
relationship is the most common spark
behind a referral. Unfortunately, this
excitement often fades over time. Dont
wait a year and then expect a flood of referrals. It doesnt work that way! Start asking
for referrals immediatelyas early as one
week after a patients first appointment.
multiple referrals from each patient is

to create a rewards program if your state
allows it.
How to get started

Now that weve uncovered the misconceptions, lets delve into the specifics
of creating a great referral program and
expanding on the loyalty of your patients.
A much more extensive list of detailed
referral tips is free to download at www.
schedulinginstitute.com/Dentaltown, but
for the sake of time and space, Ill give an
overview of my top five strategies.
1. Start by setting a clear referral
goal for your office. It might help to pull
your last six- to 12-month referral numbers
and come up with an average monthly
statistic. Consider creating a goal of a 10
percent increase in referrals over the next
six months. The key is to create a goal that
The key is to create a goal

that is attainable and
manageable, but also
big enough to get your
whole office excited.
2. Patients refer only after

theyve seen tremendous results.
You need to understand that referrals
often happen before the patient has experienced any results whatsoever. In many
cases, the mere thought of a result is more
exciting than the actual result itself.
3. If a patient has already referred

once, he or she wont refer again.
This is the misconception that baffles me the most. The truth is, as long
as you keep your patients happy, theyll
continue to refer. Drop the ball, and you
risk losing themand their potential
referrals. One great way to encourage
is attainable and manageable, but also big

enough to get your whole office excited.
2. Make your office referable. This
is deceptively simple, but its absolutely
crucial to meeting your goal. Start with
the physical appearance of your practice.
The parking lot should be clean and
well maintained. The exterior of the
building needs to be in good shape with
visible, eye-catching, up-to-date signage.
Pretend you are a new patient and walk
through your practices front doorswhat
would your first impression be? This first
impression significantly influences the
dentaltown.com \\ AUGUST 2015
31
practice management
feature
likelihood that your patients will refer

you. Is there someone at the front to greet
new patients as they walk in the door (not
behind a sliding glass window)? Are your
patients offered a variety of refreshments?
Does the reception area appear tidy and
modern? If the dcor of your office hasnt
been updated in 10 years, its probably not
a referable office. You should update your
officeeven minimallyevery three to
five years.
3. Communicate that you want
referrals. Dont assume that your patients
know. Many doctors are doing all the right
thingsthey have a referable office and
youve provided excellent service that day,

your patients will be more than happy to
reciprocate with a favor.
4. If youre not already sending out
a patient newsletter, start immediately.
A newsletter allows you to spread your
reach. When you routinely mail out a
newsletter with pictures of you and your
office on it to a thousand people, youll be
showing up in front of a thousand people
that daywithout them ever entering
your office. Every single newsletter you
send out should include several requests for
referrals, and have one section promoting
your referral program. Ask your patients
Once youve implemented these

strategies in your practice, be sure
to check that your staff is carefully
tracking your referrals.
their service is supreme, but theyre not
letting their patients know that they actually want referrals. And asking is much
simpler than it sounds. Just remember to
be sincere and direct, and to always make
your request face to face. For example,
as you leave the room or are walking the
patient to the front desk, say, Mrs. Jones,
we look forward to working with you as a
patient. We would love more patients just
like you. Would you reach out and tell two
or three of your friends or family members
about your experience with us? As long as
to share their newsletter with a friend for

a special bonus offer. Give your patients
an extra copy of the newsletter when they
visit you, and ask them to share it with a
neighbor. The referral possibilities of a
well-produced print newsletter are endless!
5. Hold a staff contest. The most successful referral programs happen in practices where the staff has taken ownership
of driving referralsand what better way
to motivate ownership than with a resultsbacked contest or incentive? The key to
motivating your staff on referrals is to set
a goal. This goal should be higher than

the number of referrals they were getting
before the contest. If you set it up like this,
you shouldnt have any hesitation about
paying out the incentive or giving away
the prize when they hit the number. These
referrals bring enormous value to your
practice, so consider staff incentives an
investment with a huge return. And dont
forget to promote and market the contest
to your teamif they arent excited about
it (or the prize), youll have an uphill battle
ahead.
Keeping the change

Once youve implemented these strategies in your practice, be sure to check
that your staff is carefully tracking your
referrals. If your referrals increase, keep
doing exactly what worked. If youve tried
every referral-boosting trick in the book
and your new-patient numbers just arent
rising, you might have a different problem
entirely. Referrals could be calling your
practice and never getting scheduled.
After analyzing thousands of practices,
my team and I found that an astonishing 98 percent of all practices are losing
thousands of dollars in new patients every
weeksimply because their teams have
never been trained in how to effectively
handle new-patient phone calls. If you
think youre doing everything right but
the results arent adding up, this could be
happening to you.
You work hard investing in your
patient relationships. Dont let your practice plateaueliminate your misconceptions, reward your staff and you can turn
your practice into one your patients will be
proud to refer to their friends.
How do you handle patient referrals? Comment on this article at Dentaltown.com/magazine.aspx
Author Bio
Jay Geier is the founder and president of the Scheduling Institute and creator of the world-renowned Five Star New Patient Generation Training Program that has revolutionized the way dentists attract new patients to their practices. He is revealing his secret for record-setting results (600+ new
patients in ONE week) in a FREE CD available now at www.SchedulingInstistute.com/dentaltown.
32
The Evidence is Clear:

The Best Image Quality Comes
From the DEXIS System.
V ISIBLE RE SOLUT IO N & CONT R A S T COMPA RISON
14.4 LP/mm
8.4 LP/mm
8.4 LP/mm
10 LP/mm
10 LP/mm
12 LP/mm
14.4 LP/mm
DEXIS Platinum
12 LP/mm
DEXIS Excels in Visible Resolution

and Contrast
PureImage Technology, the science behind the
DEXIS Platinum Sensor and software, delivers
the best image quality versus the other sensor.*
With the DEXIS system you get unparalleled
radiographs that are extremely clear, sharp and
highly detailed most importantly, at lower
exposure settings.
Schick 33
Examine
the Evidence
Yourself!
Go to
dexis.com/
best
1-888-883-3947 | www.dexis.com
*Data sources: DEXIS Sensor Competitive Performance Study and DEXIS Sensor Clinical Evaluation Report. Visit www.dexis.com/about-evidence-document for
study details. For DEXIS Platinum Sensor Indications for Use, visit www.dexis.com/ifu.
2015 DEXIS, LLC DX53060115REV0.5530
pediatric dentistry
feature
A Major Award! Todays entitled kids

receive trophies and certificates of
participation for every little thing they do.
by Jeanette MacLean, DDS
I want a pony! Our stickers and prizes often fail

to impress the pampered princesses who are the
product of their overindulgent parents.
Pediatric Dentistry,
parents, and spoiled
ids
Tips for handling parents in an era of Everyone gets a trophy!
et me be honest: After more than

10 years in pediatric dentistry, I find
the kids are not my challengeits their
parents. There I said it.
Dont get me wrong. The majority of
parents I see on a daily basis are delightful and I truly enjoy chatting with them
34
at their childrens visits, but a growing

percentage of demanding parents tests my
patience. The two greatest challenges I
face are the parents who overindulge their
children, and the know-it-all parents.
However, recognizing and managing
these helicopter or snowplow parents
can prove to be a fun and rewarding

experience. In fact, once you win them
over, they often become the greatest advocates of your practice.
Lets look at how todays culture
contributes to these perilous parenting
trends.
pediatric dentistry
feature
The overindulger
Nowadays you dont have to be
wealthy to have an overindulged child.
In many ways, our overscheduled lives
and complicated family dynamics have
bred a culture of guilt-ridden parents.
Contributing factors for parents who
overindulge their little ones may include
common stressors such as divorce, grandparents who serve as primary caregivers, or
both parents working full-time jobs.
As a working mom of two young children, I am guilty of this parenting pitfall.
Too many treats, too many toyswhy do
we do it? While I cannot speak for everyone, I know that I feel guilt from the long
hours I put in at the practice.
After a long, hard day managing
other peoples children at my office, the
last thing I feel like doing is wrestling my
3-year-old to get her to brush her teeth. I
just want to come home and relaxI want
my kids to be happyI dont want conflict. But having seen the perils of the tiny
dictators at my office, I quickly snap out of
it, put on my mommy pants and lay down
the law. The problem is the ever-growing
number of parents and guardians who fail
to be the parent and find it far easier to be
their childs friend. Because there is very
little discipline for bad behavior, often the
child is left with a sense of entitlement.
Another cultural phenomenon that
contributes to the overindulged child is
the new normal of parents striving for
Pinterest perfection. In an ongoing
attempt to not just keep up with the
Joneses, but rather one-up the Joneses,
every little life event is celebrated, documented and chronicled online for all the
world to see. There is a ribbon, a trophy,
or certificate of participation for all of
lifes precious moments. Even my 5-yearold son, who was more interested in his
soccer leagues postgame snack and never
scored a goal the entire season, still got
a trophy from his team. The trouble is,
when we try to get these little darlings to
cooperate for dental treatment, theyre no
longer impressed by a 25-cent prize from
our treasure tower.
To further complicate the matter,

their parents often have unrealistic
expectations of our abilities. They cant
even manage to brush and floss their
5-year-olds teeth, but were supposed to
use our Jedi mind power to get the child
to sit perfectly still for a pulpotomy and
stainless-steel crown.
recognizing and managing these

helicopter or snowplow
parents can prove to be a fun
and rewarding experience.
in fact, once you win them over,
they often become the greatest
advocates of your practice.
Heres where clear communication
is key. Level with the parent and explain
what you can and cannot do. This is part
of your informed consent. School-age
children may still be manageable with
tell/show/do and nitrous oxide, and in
fact, you may be surprised at how many
of these kids actually enjoy and crave a
little structure. You and your assistant
have to set the ground rules, right out of
the gate. Let your young patients know
you are the boss in your office, clearly
state your goals for their visit and expectations for their behavior, and yes, dangle
that carrotthe prize and sticker theyll
get when they are done.
There will be some patients for
whom this simply will not work, such as
preschool-age or particularly defiant or
fearful children. Extensive dental care may
require oral conscious sedation, intravenous sedation or even general anesthesia.
It is important to know your limits and
know when to refer to a specialist.
35
pediatric dentistry
feature
The know-it-all parent

The days of doctor knows best are
long gone. Nowadays its more like my
Facebook friends cousins mommy blog
knows best. Youve gotta love explaining a treatment plan to a parent only
to have her retort, Ill have to research
that. Yes, because a night on Google
somehow makes her more knowledgeable than her board-certified pediatric
dentist. Comments like these early in
my dental career really got under my
skin. I actually felt downright insulted.
It wasnt until I became a parent myself
that I realized that these parents are not
trying to offend us; they simply want
whats best for their child. Sometimes
they think that only they know whats
best for their child.
Many couples are now waiting
until later in life to marry, often putting
their education and career first. Theyre
waiting until theyre older and more
financially secure to have their first
child. When that perfect time finally
comes, many have already spent years
planning the perfect nursery and the perfect name,
and researching the
best stroller, the most
ergonomic carrier, and
the most eco-friendly
organic sustainable diaper. Theyve read every
maternity and parenting
book cover to cover, theyve
painstakingly planned and prepared for this moment for years,
theyve scheduled their IVF and
their C-section, and now theyre
going to tell you how to do their childs

filling.
Right or wrong, thanks to the
Internet and social media, dentists can no
longer hide behind the sanctity of their
doctorate. Some parents truly believe they
know enough to engage the dentist in
treatment options.
Sometimes parents are know-it-alls
by association. Youve seen these types:
My mom is a nurse, or My second
cousin once removed is an anesthesiologist. These people have filled your
patients parents heads with questions
and concerns. You wish you could say,
Well, since they know so much about
dentistry, why dont you have them
do little Johnnys extraction? But you
cant. This is when you need to stop,
take a deep breath and remember one
very important fact: they are sitting in
your office. Theyve already picked you.
You win. Be confident, offer them reassurance, acknowledge their concern and
indulge their extra questions. Know-it-all
parents want to be heard; they want to be
involved in the decision-making process.
Thats easy. Handouts, brochures, models, great online links and simply the time
and attention from you and your staff can
easily do the trick.
These parents may be needy at
f irst, but with a little hand-holding
and reassurance, a trusting doctor-parentpatient relationship blossoms. The seal
of approval from these picky parents can
be more valuable than any paid advertisement, as it often results in new-patient
referrals that are, ultimately, a dentists
own best reward for good behavior.
How do you handle the challenges of pediatric dentistry?

Join the conversation online at http://www.dentaltown.com/Dentaltown/magazine.aspx
Author Bio
Dr. Jeanette MacLean is a private-practice pediatric dentist and owner at Affiliated Childrens Dental Specialists in Glendale, Arizona. She is a
diplomate of the American Board of Pediatric Dentistry and her clinical research has been published in Pediatric Dentistry, the official publication of the American Academy of Pediatric Dentistry. Visit Kidsteethandbraces.com for more information.
36
YOU WONT BELIEVE IT.

(UNTIL YOU SEE IT)
SCHICK 33CHANGING THE DEFINITION OF DIGITAL DIAGNOSTICS.

When it comes to Schick 33s image quality, seeing is believing. And as soon
as clinicians see the incredible, crisp images this system delivers on a daily
basis, the advantage becomes perfectly clear. With its industry-leading 33
line pairs/mm theoretical resolution, dynamic image enhancement control,
and clinical-specific image mapping capabilities, Schick 33 gives you a
diagnostic advantage that even your patients will see.
GENERAL DENTISTRY
ENDODONTIC
PERIODONTIC
RESTORATIVE
Specialty presets allow you to see and save images based on diagnostic need.
To request a Schick 33 demo, visit godigital.schickbysirona.com
Exclusive
Distributor
OUR PARTNER IN PROVIDING YOU

UNPARALLELED SERVICE + SUPPORT.
800-873-7683
0% SHARPENING
50% SHARPENING
100% SHARPENING
Dynamic Image Enhancement allows you to maximize Schick 33s true diagnostic potential.
GLOBAL
NUMBER
hygiene
feature
FINDING
THE
HIDDEN TREASURE
TREASURE:
Prevention =
Treatment +
Motivation +
Compliance
by Barbara Vugteveen, RDH
38
have no idea why I used to check

Urban Dictionary almost daily. Maybe
I wanted to get my word of the day
and catch my kids using some inappropriate slang Id be unfamiliar with otherwise. Or maybe a part of me wanted to
know the jargon just in case I was ever in
the situation where I could use it. It offers
the craziest (and sometimes the crudest)
new words and phrases!
Then it happened: I finally got the
ultimate Urban Dictionary definition. It
was the best phrase any dental hygienist
could ever ask fordental swag!
Dental swag is defined as the complimentary stuff with which you leave
your dentists office: toothbrush, dental
floss, etc. I think the hygienist likes me; she
always loads me up with dental swag.
Since then, I rarely check my Urban
Dictionary Word of the Day, as I feel
my urban vocabulary is now complete.
A rich haul
Why is this so important and why
do your patients need to get their dental
swag on? Patients need motivation
through instructionto make all your
efforts in the office work over the longterm. They need the right tools for the job
to make this happen, and more important, they love the individual, case-specific
oral-hygiene instruction you give them.
When a hygienist gives a patient a proxy
brush, end tuft, Stim-U-Dent or any tool
that targets a specific problem area, the
patient loves the hygienist for it and will
often stay with the practice for life.
We all know periodontal disease isnt
cured; its maintained. We also know that
proper treatmenta prophy, a debridement with reevaluation for scaling, or
quadrants of scaling and root planing
wont be successful without the patients
compliance with home-care and daily
plaque-removal instructions. Educate
your patient about the disease process and
how critical it is that he or she participates
hygiene
feature
in the treatment. Education empowers

your patient to take ownership of the
disease. Ownership should be a desire for
overall oral and systemic health. Without
patient ownership, there will never be an
adequate level of compliance.
You can scale and educate your
patients about the disease process. You
can motivate them to follow through
with home care and give them the tools
they need, yet there is only so much the
hygienist can do to prevent disease without all of the steps coming together. In
short, prevention = treatment + motivation + compliance.
When all three are in place and working together, your patients hit the jackpot.
The hidden gems

Every patient has different motivations, and you must gauge what these are
before treatment and hygiene instruction
can be successful. Does he want to save
his teeth? Are cosmetics her main drive
to see you? What is her concern when she
walks into your operatory? Understanding
a patients motivation gears you toward the
conversation you will have about overall
oral and systemic health, in addition to
the patients participation in successful
treatment. If a patients main concern is
not addressed at every appointment, you
will lose the motivation and compliance
components to successful treatment.
For example, how do you educate and
motivate the patients in your chair who
have bleeding on probing, with light to
moderate gingivitis? Most hygienists would
tell these patients that healthy gums dont
bleed and give oral-hygiene instruction.
Most patients, in turn, will respond that
their gums always bleed and that is normal for them. Take it a step further and
motivate them to own their disease. Tell
these patients that chronic gingivitis will
lead to periodontal disease. Be direct and
show them how to disrupt the bacteria that
cause their chronic infection.
Get out the mirror and the swag and

show them the target areas. Bleeding is
a sign that all patients should recognize
as chronic disease. Its a symptom that
they can seeits concrete, so they will
be able to gauge how well they are doing
with their home care. Let them know
that it takes only a few days to see results,
so they will be rewarded for their efforts.
This keeps them engaged and motivated.
Now, it should be that easy, but unfortunately not all patients understand it after
the first explanation.
Why is this so important and

why do your patients need to get
their dental swag on? Patients need
motivationthrough instructionto
make all your efforts in the office
work over the long-term.
Following the treasure map
Offer your patients a follow-up
appointment in two weeks if their
bleeding is not under control. That
will not only get their attention but it
will also help them take ownership of
their disease by being participants in
their treatment. If they are compliant
with their home care and dont have
bleeding, there is no need for them to
come back until the next scheduled
recare appointment. If there is still
inflammation and bleeding, this return
appointment gives you an opportunity
to reevaluate the problem areas for
additional scaling, or decide if a simple
39
hygiene
feature
change of swag is needed before their

next recare appointment.
In either case, it is also the perfect
time to take a tour of your patients
mouth with the intraoral camera and
take pictures of these problem areas so
you both can see any improvement at
the next appointment. Review overall
oral-hygiene instruction in the mirror
and watch your patients technique,
as well. Be encouraging and kind. It
can often take several times to show
and tell something that we, as dental
professionals, find simplesuch as
proper flossingbefore the patient can
properly execute and/or understand the
importance of daily plaque removal.
Dont look at it as being repetitive; look
at it as being consistent. This will help
your patient not only with technique
but also with compliance.
A treasure chest of swag

I know some offices only give out the
toothbrush, floss and paste that come in
their bundled order. But dont be stingy
with your swag. Having several samples
of different home-care supplies on hand to
demonstrate and send home with patients
really helps customize their home-care
routine and meet their specialized needs.
If the patient wants a tongue scraper every
time she walks in the door, give it to her.
Always ask if there is anything else

your patients need, and if you dont
have it, order it for them. Youre not just
promoting successful treatment through
motivation and complianceyoure also
creating lifelong relationships with the
patients in your practice. Trust me: they
love it that you care.
And they love the dental swagjust
ask Urban Dictionary.
How do you motivate your patients to keep up on their hygiene?

Comment on this article at Dentaltown.com/magazine.aspx.
Author Bio
Barbara Vugteveen is a registered dental hygienist. She has 20 years of experience in
private practice and currently works in Tucson, Arizona. Vugteveen believes making a
personal connection and motivating her patients to be active participants in their overall health is just as important as restoring and maintaining periodontal health.
40
"OUR PHONES ARE RINGING AND

NEW PATIENTS ARE SCHEDULING
AND ACCEPTING TREATMENT."
- RALPH L. JACKSON | CORNELIA DENTAL
202K
495%
TOTAL REVENUE EARNED
RETURN ON INVESTMENT
Best Dental Marketing for the

Lowest Price on the Planet!
Guaranteed
Special Offer for Townies!

F R E E PAT I E N T D E M O G R A P H I C A N A LY S I S
Vi s i t D e n t a l M a r k e t i n g . n e t / s p e c i a l o r c a l l 8 5 5 - 3 9 1 - 1 0 4 4
Prefer to talk now?
CALL 855-391-1044
080115_DT_FLPG_IRMM
radiology
feature
The Three
Dimensions
of Endodontic CBCT:
by Rowshan Ahani, DDS, MS
42
radiology
feature
Fig. 1
The days of doctor knows best are

long gone. Nowadays, we consistently
have to earn the trust of our patients
and their referring dentists. To this end,
clarity and transparency are absolutely
paramount when proposing a treatment
plan. When you allow the referring dentists to clearly understand the reasoning
behind the treatment plan for their
patients care, they feel more comfortable
with your treatment-planning choices.
Using a CBCT image can greatly simplify what may otherwise sound like a
very complex treatment plan.
For example, a patient referred by
my colleague presented with irritated
gums over tooth #11. Clinical exam and
periapical radiographs revealed a buccal
external resorptive lesion on tooth #11
(Figs. 1 & 2). A CS 8100 3D scan was
taken to evaluate the depth of the resorption, and an oblique axial slice of the scan
revealed that the defect had extended into
the pulp of the tooth (Fig. 3).
Because the treatment plan required
both a root canal and a surgical proceduresomething that many doctors
would find excessivethe oblique sagittal slice (Fig. 4) was sent to the referring
dentist, who was amazed to see the clarity of the image and quickly understood
my treatment-planning rationale. When
you can point to the hole in the tooth
and show that it goes into the nerve (Fig.
5), this conversation takes about one
minute. With the aid of 3D imaging,
both the referring dentist and our patient
quickly understood and accepted the
treatment plan.
At our next visit, the tooth was
accessed and instrumented. A lubricated
gutta-percha point was placed inside the
canal and a surgical flap was reflected,
exposing the defect. The defect was then
restored with a resin-modified glass ionomer. The gutta percha in the canal served
to prevent the restorative material from
flowing into the open canal space. The
restoration was shaped and the gingiva

was sutured back in place.
At this point, the rubber dam was
replaced and the root-canal treatment
and bonded composite core buildup were
completed (Fig. 6). The entire procedure
took about 90 minutes, and the patient
was thrilled to be able to save his tooth.
Fig. 2
Using a
CBCT image
can greatly
simplify
Fig. 3
what may
otherwise
sound like a
Fig. 4
Fig. 5
very complex
treatment
plan.
Using 3D imaging to educate our
patients and referring dentists
Fig. 6
While we often talk about how conebeam CT technology is invaluable as a

diagnostic and treatment-planning tool,
time and time again I find that the use of
3D imaging technology facilitates communication with my colleagues and our
mutual patients.
In 2010, a 29-year-old male patient
was referred to my office by his general
practitioner after complaining of pain
and swelling associated with tooth #14.
After the periapical X-rays were reviewed
43
radiology
feature
(Fig. 7), a CBCT scan was recommended

and taken to further assess the lesion. The
CS 9000 3D scan revealed a large PA
lesion, which included the furcation of the
tooth. The existing root-canal treatment
appeared inadequate and there were screwtype posts in the mesiobuccal and palatal
canals (Fig. 8). A missed MB2 canal was
also noted (yellow arrow, Fig. 9).
Fig. 7
Fig. 8
restoration, the two posts and the gutta

percha were removed. The missed MB2
canal was located and all four canals were
debrided, shaped and irrigated with sodium
hypochlorite and EDTA. The canal system
was packed with calcium hydroxide and
the tooth temporized until the subsequent
visit two weeks later (Fig. 10).
When the patient returned, he was
The patient was extremely

grateful to have saved her
tooth without any additional
procedures. In looking back at
Fig. 9
this case, there is no telling how

it would have turned out without
Fig. 10
Fig. 11
Fig. 12
44
the benet of the CBCT.

My initial assessment of this tooth
was that the prognosis for retreatment
was poor, so I recommended extraction
and replacement with an implant or
possibly a fi xed bridge. The patient was
adamant that if there were any hope at
all, he wanted to try to save this tooth.
With this understanding, we proceeded
with retreatment.
After the consultation appointment,
I reviewed the CBCT scan with the
referring dentist, highlighting the challenges presented by this retreatment. This
allowed me to set reasonable expectations
for the long-term success of the case.
Without the information provided
by 3D scans, colleague collaboration in
interdisciplinary cases would be much
more challenging.
During the first visit, the existing
symptom-free and all of the swelling was

gone. Root-canal treatment, a post and
bonded composite core buildup were
completed (Fig. 11). He was advised
to have final restoration and return for
follow up X-rays in six months to assess
healing. He returned four years later for
an unrelated tooth. During this visit, a
follow up X-ray was taken, revealing complete healing of the lesion (Fig. 12).
Using CBCT technology to instill

trust in patients and referring
doctors
A third case that demonstrates the
benefits of incorporating endodontic
CBCT to improve colleague communication involves a healthy, 26-year-old
female patient with a history of trauma
Continued on p. 46
radiology
feature
Fig. 13
Fig. 14
Fig. 15
to her upper anterior teeth as a child.

Tooth #9 had recently become sensitive
to percussion. The periapical radiograph
revealed a completely calcified pulp canal
with a relatively normal PDL space (Fig.
13). Pulp testing resulted in a diagnosis
of necrosis with symptomatic apical periodontitis, and I recommended treatment.
The patient reported that her general
dentist wanted to schedule her for the
root-canal treatment on this tooth, but
she had elected to find a specialist on
her own. She found our office based on
online research.
In this case, I didnt feel that a preoperative CBCT would be as valuable as
a possible intraoperative scan. Following
a careful review of risks, benefits and
alternatives, we proceeded with treatment and the tooth was accessed. After
searching for the canal with ultrasonic
instruments to a depth of 15mm,
the tooth was packed with calcium
hydroxide and the access was closed
with a temporary fi lling. A periapical
radiograph revealed that my access was
slightly off center (Fig. 14). A CBCT
scan with the CS 8100 3D was taken
and the patient was scheduled for a follow-up appointment.
The CBCT scan revealed that my
access was slightly lingual and mesial to
the location of the canal (Fig. 15). The
Fig. 16
patient arrived for her subsequent appointment with a high degree of trepidation.
She asked many questions about what
might happen if we were not able to locate
the canal. While I truthfully advised that
apical surgery or extraction may be an
option, I very confidently advised her that,
armed with my 3D scan and my microscope, I should be able to readily locate the
canal and complete the case.
Indeed, 15 minutes after placing
the rubber dam and removing the
temporary fi lling, I was able to direct
my ultrasonic instrument 0.5mm in
the distobuccal direction and locate
the canal. Once the canal was located,
the root-canal treatment and bonded
composite core buildup were completed
uneventfully (Fig. 16).
The patient was extremely grateful
to have saved her tooth without any
additional procedures. In looking back at
this case, there is no telling how it would
have turned out without the benefit of the
CBCT. There is a much higher likelihood
that the tooth would have been weakened
or even perforated in looking for the canal.
When I reviewed the images with
her dentist, who had initially proposed
performing the root canal himself, he
was surprised by the degree of difficulty
of this case and was very relieved not to
have attempted it. This kind of interaction between the specialist and
referring dentist is a great way to
build bridges and increase future
referrals.
Connecting with referring

doctors through
CBCT technology
Clinical cases are just one way
of marketing my practiceand
technologyto referrals. As a
specialist, I always enjoy going to
lunch with general practitioners
to discuss how I can help their
46
radiology
feature
patients. My cone-beam CT unit gives

dentists a reason to come to my office
so they can understand the patient experience. Its great to show visiting practitioners what the system is like and how it
functions in my endodontic practice. One
thing I particularly like to do is pull up
their patients cases so I can go through
them in detail using the 3D software,
rather than the cursory overview of sharing only the resulting findings.
As a professional, I find it is critical to
be comfortable with modern technologies
as they emerge. In endodontics, the emergence of cone-beam CT has dramatically
enhanced our ability to diagnose, treatment-plan and execute procedures with
greater confidence than ever before.
Also, because we provide excellent

care using the most modern instrumentation, the office practically markets
itself. When used properly, CBCT helps
build relationships with both the patient
and the referring dental professional,
and working with like-minded dentists
makes practicing more rewarding in
every way.
Whats your experience with CBCT? Comment online at www.dentaltown.com/Dentaltown/magazine.aspx
Author Bio
Dr. Rowshan Ahani is a graduate of the UCLA School of Dentistry. He earned his certificate of endodoctics and MS in oral sciences from the SUNY
Buffalo. Dr. Ahani is a diplomate of the American Board of Endodontics and maintains a private endodontic practice, Bayside Endodontics, in
Daly City, California.
47
prosthodontics
feature
Implant Drivers
and Driver Tips
for Single-Torque Wrenches
Elizabeth J. Fleming, DDS,
Clinical Director, Dentaltown Magazine
Since I dont surgically place implants on

my patients, I work with a periodontist or an
oral surgeon who will give me the specifics
about the implants they place, enabling
me to prepare to restore them. Using this
information, I can order the implant parts
ahead of time, and have the torque wrenches
and drivers on hand. I have an arsenal of
parts for the various implant systems.
Could you tell which driver would be
needed by having this information and
viewing your assortment? If not, here is a
handy guide.
48
prosthodontics
feature
Abutment Driver Tips
.048 (1.22mm) Hex
ITI Driver ITI Driver Long
.08 (2.03mm) Female Hex
.048 (1.22mm) Hex Long
ITI Driver for Straumann SCS
For NobelBiocare, 31
LOC Triangle Driver
TG Driver
LOC Triangle Driver Long
For 31 TG Abutment, Straumann SCS
For NobelBiocare, 31, Friadent, Keystone,

MegaGen, Hiossen
.05 (1.25mm) Hex
For Locator Abutment

For Zimmer, Astra, BioHorizons, Intra-Lock,
MIS, SteriOss, Sybron, Implant Direct, PerioSeal
2015 Salvin.
Reprinted with permission.
.07 (1.7mm) Hex
For Paragon TSI Abutment
PROC Driver PROC Driver Long
Star Driver for NobelBiocare Active & Unigrip
Screw, Neoss
Screw Driver Screw Driver Long

Flat-Blade Screwdriver
.035 (0.9mm) Hex

For NobelBiocare, 31, Keystone, BioHorizons,
Friadent, PerioSeal
.05 (1.25mm) Square

.05 (1.25mm) Square Long
For Keystone, 31
49
prosthodontics
feature
If you place implants on your patients, likely you work with a few different implant systems and are familiar with the components.
For those of us who are just restorative dentists, remembering which driver and the corresponding torque value needed to restore the
various implant systems can be a challenge. To help, here is a comprehensive torque value chart from Genieoss.
Abutment Screw Torque and Driver

Manufacturer
Torque N-cm
15
20
24
25
30
Driver
35
45
Titanium Screw
Gold Screw
Atlantis titanium and zirconia abutments utilize the same torque and driver setting as the original implant manufacturer
Astra 3.0
Astra 3.5-4.0
0.050- 1.25mm hex

X
0.050- 1.25mm hex
Astra 4.5-5.0
0.050- 1.25mm hex
Astra EV 3.0, 3.6, 4.2, 4.8, 5.4
0.050- 1.25mm hex
BioHorizons External, Internal, Internal Tapered
Biomet 3i External Hex
0.050- 1.25mm hex

X
Biomet 3i Certain *
0.048" hex
0.048" hex
BlueSkyBio One Stage
Star & 0.048" hex
BlueSkyBio Trilobe
Unigrip & 0.048" hex
BlueSkyBio Internal Hex & Molar
0.050" hex
BlueSkyBio Conus 12 & Three
0.050" hex
BlueSkyBio Max
0.048" hex
BlueSkyBio Quatro
0.048" hex
Brnemark (Nobel Biocare)
Camlog & Conelog
Unigrip
Dentsply Ankylos C/X
1.28mm hex
0.048" hex
1mm hex
Glidewell iNCLUSiVE Tapered 3.7, 4.7, 5.2

Hiossen/Osstem HG mini (3.5)
0.050"- 1.25mm hex
1.2mm hex
Hiossen/Osstem HG standard (4.0, 4.5, 5.0)
Imtec 3M Endure
1.2mm hex
X
Implant Direct
0.050- 1.25mm hex
0.050"-1.25mm hex
Keystone/Lifecore Genesis* & Prima *
Square
Keystone/Lifecore Renova
0.048" hex
0.048" hex
Keystone/Lifecore Restore
Mega'Gen EZ Plus
Mega'Gen Rescue
Mega'Gen ExFeel internal (3.5)
0.048" hex
X
0.048" hex
1.2mm hex
Mega'Gen ExFeel internal (4.1, 4.8, 5.5)

Mega'Gen ExFeel external (3.3)
X
X
1.2mm hex
1.2mm hex
Mega'Gen ExFeel external (3.75, 4.0,4.5, 5.0, 5.5)
1.2mm hex
MIS Biocom & Seven
0.050"-1.25mm hex
Neoss
Unigrip (not compatible

with Nobel)
NobelActive & Replace
50
Square
0.050- 1.25mm hex
Dentium Super Line & Implantium

Dentsply Friadent/Frialit & Xive
Square
Unigrip
Square
prosthodontics
feature
Manufacturer
Torque N-cm
15
NobelActive 3.0
20
24
25
30
Driver
35
45
Titanium Screw
Unigrip
OCO Biomedical
0.050"-1.25mm hex
Southern Implant External
32
0.048" hex
Southern Implant Tri Nex
32
Unigrip
Southern Implant Octa
32
Star/Torx
Straumann Bone & Tissue Level
Star/Torx
Sybron Pitt Easy

Thommen SPI 3.5
Thommen SPI zirconia abutment

Zimmer
Square &
Unigrip
1.7mm hex
Four lobe
Thommen SPI 4.0, 4.5, 5.0, 6.0
Gold Screw
Four lobe
Four lobe
X
0.050- 1.25mm hex
* Biomet 3i Certain screws are gold plated only. Keystone Genesis and Prima abutment screws are made of titanium and have a titanium
nitride coating.
2010 genieoss.com. Reprinted with permission.
51
cover story
feature
Retirement
Planning
Are the top 1 percent
safe? Take steps to
create a secure future.
52
cover story
hen talking to a new client,

something I fear most is
hearing about a serious
investment loss. Suffering
the aftermath of a bad investment is a distressing experience for anyone, and while
some dentists can bounce back from
small setbacks, big losses can put you in
financial ruin.
The majority of successful dentists
are in the top 1 percent of income earners nationally. This affords you a huge
advantage when planning for retirement,
but you are not exempt from seeing your
finances turn upside down. Whats sad is
that you all have been in the trenches
youve studied your brains out and youve
sacrificed for years to get to this point.
Theres no doubt youve earned it.
Something I cant quite wrap my
mind around is just how rare it is for an
above-average earner to convert his or her
income into an above-average retirement.
Shouldnt it just happen naturally? Well
yesthats exactly my point.
So Im going to clue you in on something that will blow your mind. Ready?
feature
percentage of your income, youll retire

just fine, risk free. How many people can
say that? Most people have to take on
more risk and deal with more volatility
because their income isnt high enough to
retire comfortably without getting a good
investment return along the way.
Its time to make your income

your greatest asset
Im not recommending that you pour
all of your money into such a conservative, risk-free portfolio. Im simply illustrating the point that most of you dont
need to take much risk if your primary
goal is to accumulate enough money to
retire early and comfortably. For most
people, its the accumulation of a large
portfolio that really mattersnot so much
the return along the way. Your income is
your greatest asset because it allows you
to pile up large sums of cash quickly, as
long as you dont screw it up!
So why do so many dentists struggle
to retire on time if its really this easy?
The answer is simple: They screw it
up. They compromise the no-brainer
People in the top 1 percent can retire quite easily by saving

15 percent to 20 percent of their annual income into a
risk-free portfolio earning between just 3 percent to 4 percent.
The no-brainer retirement plan
People in the top 1 percent can retire
quite easily by putting 15 percent to 20
percent of their annual income into a
risk-free portfolio earning between just 3
percent to 4 percent. The risk-free portfolio is something professional finance
people use as a worst-case scenario. Its
the 30-year, U.S. Treasury bond. Not a
great returnbut an option that generates adequate income for someone with a
very large portfolio.
Just think about that for a minute. If you do nothing but save a small
retirement plan by taking unnecessary

risks that end up making it impossible to
accumulate a large portfolio. They have
one big lossone big mistake. They just
dont have enough years behind them to
recover, nor to accumulate enough liquid
assets to have a killer retirement.
Lets dive into this subject a little further by looking at some common risks.
Direct or private investments

Direct investments in real estate,
businesses or investment funds are
very different from publicly traded
investments (mutual funds, exchangetraded funds, stocks, or bonds). These

direct investments carry different risks,
and are often the silent killer of many
early-retirement dreams. I say silent,
because most people wont openly discuss
them: Who wants to admit to losing
money in a really bad investment?
Many people invest in opportunities
that appear attractive without having
adequate knowledge to distinguish the
good from the bad, and without adequate
financial strength to weather the potential losses. In other words, long before
theyve achieved financial independence,
they start making serious commitments
and gambles. Any gain is gobbled up by
loss, and retirement gets delayed, often
for years.
Ive seen these investments pull
retired professionals back into the
workplace, force them to overextend
their working years, and put strain on
their marriages, families and friendships. The truth is, its very difficult
to avoid fi nancial risk when you start
moving into private, direct investments.
These investments (unlike mutual
funds, stocks or bonds) have very little
oversight from a third party, like a
professional accounting fi rm. With no
third-party oversight, its hard to see
exactly whats going on and whether or
not the opportunity is legitimate.
Apply this logic until you become
financially independent. Financial independence means you have 20 to 30 years
worth of your annual personal spending
earning the risk-free rate I discussed
earlier. If you remember only one thing
from my bad-investments spiel, remember this: Avoiding big losses is more
important than making big gains. Heres
an example.
Mismanagement and
poor execution
Several years ago, I was hired to
research a potential investment in a new
massively multiplayer online (MMO)
Continued on p. 55
53
cover story
video game. Stargate Worlds, in association with Metro-Goldwyn-Mayer, promised to be an exciting competitor to the
popular World of Warcraft MMO series.
The video-game community was buzzing
with excitement, and investors committed
millions of dollars of capital to Cheyenne
Mountain Entertainment (CME) to help
build what was then one of the most
anticipated games in MMO history.
I visited CME headquarters in Mesa,
Arizona to do some onsite research. After
interviewing some of the staff and management, I recommended that my clients
withhold investing, because I identified
some red flags that turned me completely
off the venture. During my visit, I saw
an overly ambitious executive developing
multiple games at the same time, not just
Stargate Worlds. He felt these were good
opportunities. But any competent analyst
would have seen them as I didthey
were distractions.
To make a long story short, CME
went bankrupt and millions of dollars
worth of code never even made it to
market. The game wasnt developed in
time to meet contractual deadlines. The
investment opportunity was wasted, and
investors lifestyles were jeopardized.
My clients had the foresight to ask for a
second opinion before committing large
amounts of capital to this particular
venture, and Im sure they will continue
to exercise the same caution in the future.
Remember, no good idea can overcome
poor management and poor execution on
someone elses part. Exercise extreme prejudice when investing directly into another
business. If not, you may end up hanging
yourself out to dry.
Fraud
I grew up in a small town in Idaho,
where one of the largest Ponzi schemes
in U.S. history took a heavy toll. James
Paul Lewis of Financial Advisory
Consultants met with individuals in
my small community, and promised a
consistent, high return through various
small-business investments.
feature
This wasnt your classic, small-time

Ponzi. The guy was sharp, articulate, and
very informed. The prospectus displayed
very detailed descriptions of projects and
conservative statements about risk and
prudent investment practices. Statements
were delivered to investors on a regular
basis and consistently high returns were
delivered year after year. Dividends were
paid regularly, keeping investors happy
for more than 20 years. At its peak, the
fund was reported to have held $813 million dollars.
When it all fell apart, Lewis was
convicted and sentenced to 30 years in
prison by a federal judge. I know people
personally who were taken in by this guy.
It was a Bernie Madoff-type situation that
happened in my own backyard!
I share this story because the investors in this scheme, as well as many of
the investors in the Madoff scandal,
were not financial illiterates. They were
entrepreneurs, business owners and executives, some with substantial financial
backgrounds. But Lewis was paying 30
percent to 40 percent in annual returns.
Hindsight is 20/20, but greed often
makes people take more risk and ask
fewer questions than they usually would.
Theres absolutely no reason to invest
in something that claims to offer such high
returns over such a long period. Think
about it for a minute: this fund raised $311
million from investors. He was promising
40 percent and higher returns. Lets just
imagine for a second that the investors in
the fund continued to receive their returns
over the next 20 years. The fund would
have been large enough (approximately
$600 billion) to buy Disney, Coca-Cola,
Amazon, and McDonaldscombined. If
the fund had persisted for 30 years at these
returns, it would have been large enough
to purchase the entire U.S. stock market
(approximately $22 trillion). After just two
more years, the fund would have been large
enough to purchase every stock on the
entire planet (approximately $42 trillion).
When it comes to private, direct
investments, there is always a level of
55
cover story
feature
uncertainty that follows. This is especially true when the company in which
youve invested is producing financial
or accounting records. You never know
when you could be dealing with a
self-serving sociopath.
saturating their portfolios with any one

particular investment. Maintaining a
diversified portfolio with less concentration risk is absolutely essential to preserving your wealth.
Concentration risk
Investors should take baby steps as

they build knowledge and investment
acumen. If you dont know the difference between an actively managed and
an indexed mutual fund, you probably
shouldnt be dabbling with an investment
in the restaurant business, an IPO, or a
real estate development.
As a general rule, build up a broadly
diversified portfolio of public securities
In professional finance, a concentration ratio tells you how much of your

assets are invested in one particular deal.
Dentists can use a concentration ratio to
help guide their emotions when pressured
into making a particular investment. The
golden question is this: How much of
your personal net worth is invested in one
asset type?
My no-brainer guidelines
Even the most aggressive investors in Silicon Valley tech

startups avoid saturating their portfolios with any one
particular investment.
Lets use a simple example. In 20052006, the real estate market saw some
short-term appreciation. This caused
many investors to become greedy and
concentrate their portfolio and much
of their liquidity in real estate holdings.
This imbalanced approach resulted in
large amounts of their wealth vanishing
in the subsequent crash.
If investors had maintained liquidity
outside of their real estate holdings and
had kept a more modest concentration
of total net worth in this particular asset
class, then they would have been able to
weather the storm.
Even the most aggressive investors
in Silicon Valley tech startups avoid
(mutual funds, exchange-traded funds,

stocks and bonds) until you have practice
equity, retirement plans, and investments
that reach 20 to 30 times your annual
personal living expenses. Reach this level
before you invest in any direct, single
investment (if youre so inclined). Broadly
diversified mutual funds with very low
expenses should contain the majority of
your assets until these basic measures of
financial security have been met.
Once youve achieved this level of
wealth, keep it diversified and protect
it forever. Keep investing the same way
indefinitelythrough a broadly diversified
portfolio with global exposure. Statistically
speaking, its likely that this strategy will
yield a higher return than the alternative

of pursuing higher-yielding, direct investments. It will also help you sleep better
and is entirely passive (taking none of your
personal time).
But if youre inclined to be a little more
aggressive (and many of my clients are),
limit your concentration risk to 10 percent
to 20 percent of your additional investable
assets, especially when the opportunity is
outside your area of expertise. Ill revise
this advice if youre considering investment opportunities in which you will
be personally involved in management/
execution (for example, buying a second
dental practice or dental-related business).
If you have control over the outcome of a
business, then your personal level of risk
(execution risk) is lowered substantially. By
following this rule, dozens of individuals I
know would have been able to retire earlier and avoid significant relationship and
life-balance headaches.
High-risk investments wont jeopardize your future if you make them in
small enough quantities; however, you
should consider them only after you
have accumulated enough safe stuff.
The problem happens when people
risk too much of their capital,
often too early in life, leaving
them with very little time
or additional resources to
recover from a bad fall. In
my experience, an average
investor who avoids mistakes will always outpace a
superior investor who makes
one big mistake.
Youre in the top one percent, my
friendslets keep it that way. Slow and
steady wins the race.
Author Bio
Reese Harper is the founder and CEO of Aquire Advisors. His firm helps dentists make smart financial decisions and plan for a secure retire-
ment. He lives in Salt Lake City with his wife and four kids. Learn more at www.dentistadvisors.com.
56
When nothing but

the best will do
The award-winning TRIOS intraoral scanner gets your patients back up on

the bike quickly. TRIOS 3 makes your work more efficient, more precise
and your patients, more comfortable.
Three solutions in one:
Intraoral scanner for fast, easy-to-do 3D real color digital impressions
Digital shade measurement while you scan for more accurate and
predictable results
Integrated intraoral camera included in the scanner
Visit www.3shape.com/TRIOS for a full presentation
cover story
feature
DEBT-Repayment
Basics for DENTISTS
by Konstantin Litovsky
f you started practicing dentistry sometime in the last decade, you know that
being in debt is a fact of life no dentist
can avoid.
An education at a private dental school
can cost well over $400,000, and purchasing a practice in some states on either coast
can set you back anywhere from $500,000
to $1 million. In the past 15 years, the
average graduating dentists loan debt has
risen to $240,000,1 yet this number hides
the fact that a small (but increasingly
growing) number of dentists who specialize will have a student-debt level that can
be more than two times that amount,
putting tremendous pressure on new graduates and limiting their career choices.
In addition to student and practice
debt, most dentists will also have a mortgage and will also be responsible for their
childrens higher-education expenses.
Carrying a large amount of debt into
retirement can be a huge problem for
those who do not have adequate retirement savings.
For one thing, student debt is impossible to discharge in bankruptcy.2 Debt
repayment should be a key component of
every dentists financial plan, and there
is excellent and extensive advice on debt
management offered by financial gurus
like Douglas Carlsen.3 Lets concentrate
on the basics of loan repayment and
58
developing simple rules that will allow you

to make an informed decision regarding
your financial future.
Prepay or invest?
Whether you have student loans,
practice loans or a mortgage, one of the
most common questions is whether it
makes sense to pay off your loans early
or invest your money in stocks, instead.
Do your loan interest rate and principal
amount matter when deciding whether
to repay your loan quickly? What rate of
return do you need from your investment
to justify investing, rather than prepaying
the loan?
Lets take a 25-year, $500,000 student loan with 6.8 percent interest and a
monthly payment of $3,470 ($41,640 per
year), and consider two possible prepayment scenarios.

With 6.8 percent interest, if you opt
for a 25-year repayment period you will
effectively pay double your loan amount
in principal and interest payments. On
the other hand, if you pay off this loan in
5 years, you will save $445,000 in interest
payments. (See Table 1.)
Lets now consider what happens if,
instead of prepaying the loan, we invest
the money. For each prepayment scenario
above, well compare the remaining
principal under the regular payments and
the compounded extra payments at the
end of the repayment period. The compounded monthly extra payments have
to be larger than the remaining principal
to justify investing instead of prepaying.
Principal
Regular
Payments
$500,000
Prepayment
Scenario #1
$500,000
Prepayment
Scenario #2
$500,000
Interest
6.8 percent
6.8 percent
6.8 percent
$3,470
$3,470
$3,470
$0
$1,000
$6,000
25.00
14.82
5.24
$541,108
$294,749
$95,812
$1,041,108
$794,749
$595,812
$0
$246,359
$445,296
Monthly payment
Extra monthly payment
Repayment period (years)
Total interest payment
Total payment
Interest savings
Table 1. Interest rate savings for prepaying the loan.
cover story
feature
The following table (Table 2) shows what

happens when extra payments are invested
over the repayment period at different rates
of return.
Thus, the break-even point is achieved
when our investment return is equal to the
loan interest rate.
Based on the above example, we can
come up with the following basic rule: to
Another important factor to consider

is the overall cost of the loan. While prepaying a $200,000, 30-year, 4.5-percent
mortgage will provide the same rate of
return as prepaying a $1 million, 30-year,
4.5-percent mortgage, the difference in
cost savings when refinancing each mortgage is staggering (Table 3). Prepayment
savings (especially for high mortgage
Prepayment Scenario #1
Prepayment Scenario #2
Repayment period:
14.82 years
Repayment period:
5.24 years
Rate of return
Remaining
principal
Compounded
payments
Remaining
principal
Compounded
payments
5 percent
$305,432
$262,632
$452,010
$430,559
6.8 percent
$305,432
$305,432
$452,010
$452,010
8 percent
$305,432
$338,781
$452,010
$467,070
Table 2. Extra monthly payment invested at different rates of return over the repayment period of
each loan
justify investment rather than prepayment

with taxes included, the ROI has to be
higher than the loan interest rate. Your ROI
on loan prepayment will be the same as the
loan interest rate, less any tax deduction.
There is one exception to this rule.
Repaying smaller loan amounts, regardless
of the interest, may be more satisfying
than paying down a part of a large loan.
Limiting the number of loans you have
via consolidating or quick repayment of
low-balance loans can be a good strategy.
This rule can also help us decide
whether debt is good or bad. If you are
borrowing money to invest in a practice,
this debt can potentially generate a return
that would be significantly higher than the
interest rate on the debt, so practice debt
is good debt. Investing in a new luxury
car, a boat or a vacation house may be a
nice thing to do, but this is not the type of
debt that would produce a return to justify
this investment. Borrowing to invest in a
depreciating asset is usually bad debt.
While some might think of a home as
an investment, the long-term return on a
primary residence is mediocre at best, so I
would also call mortgage a bad debt.4
amounts) is the biggest reason to refinance

your 30-year mortgage into a 15-year one,
and to repay all large non-practice loans as
quickly as possible.
Types of debt
While credit-card debt can be a problem for some people, depending on where
you live a practice loan is probably the
biggest debt youll have, followed by your
mortgage and student loans.
1. Practice loans. The interest for
practice loans is tax deductible, and
these loans are usually paid out over the
period of 10 years. A typical loan has an
interest rate of around 5.5 percent, so the
effective interest rate for someone in the
33-percent federal and 5-percent state
tax bracket is 5.5 percent x (1 - 0.38), or
3.4 percent. You can continue taking out
practice loans if this will help your practice make more money.
2. Student loans. In the case of the
student loan in Table 1, prepaying the loan
would effectively produce a 6.8-percent
return on investment, given that for most
dentists the interest is not tax deductible.
While a typical graduate student loan will
have an interest rate ranging from 6.8 percent to 7.9 percent, the good news is that a
growing number of banks are letting dentists consolidate their student loans into a
fixed-rate loan with an interest as low as
5 percent. This loan should be paid out as
quickly as possible.
3. Mortgage. For most dentists, the
interest on their mortgage will be tax
deductible. If you are in the 33-percent
federal and 5-percent state tax bracket and
your 30-year mortgage interest rate is 4.5
percent, your effective interest rate would
be 4.5 percent x (1 0.38), or 2.8 percent.
If your AGI is too high and your itemized
deductions (including the mortgage interest deduction) are phased out, you might
want to consider refinancing into a 15-year
loan. If you happen to live in a state where
an average house costs $1 million, refinancing into a 15-year loan may also be a
good idea.
Investing in stocks vs. prepaying

Why not just invest in the stock
market instead of prepaying a 6.8-percent
student loan? After all, historical return on
the Standard & Poors (S&P) 500 was 10
percent over the past 100 years.
Can we expect to get a 10-percent
return if we invest in the stock market?
From 2000 to 2010, the S&P 500 10-year
return was 0.4 percent, and from 2003 to
2013, the 10-year return was 9 percent.
However, from 2000 to 2013 the return
Loan
amount
30-year loan
@ 4.5 percent,
interest paid
15-year loan
@ 3.5 percent,
interest paid
Total interest
saved
$200,000
$164,814.00
$57,357.00
$107,457.00
$1,000,000
$824,068.00
$286,788.00
$537,280.00
Table 3. Mortgage refinancing savings
59
cover story
feature
was only 3.5 percent. A conservative

balanced/diversified portfolio may have
gotten about a 6.5-percent return over
that time, yet a portfolio with 50 percent
in stocks and 50 percent in bonds still
fell as much as 25 percent in 2008, and
no one knew how long the markets would
remain down.5 In 2010, when the S&P
loan. Because loan repayment provides a

guaranteed return, it is always better to
repay a high-interest loan than to invest.
If you refinance your student loan,
you might get a rate that is closer to 5
percent. Should you invest in the stock
market rather than prepay this loan? I
would still argue that if you can prepay
While very few dentists are totally debt-free, the quicker you
shed most of your bad and unessential debt, the sooner you will
be able build up your savings.
return was 0.4 percent annualized over
10 years, a CD or a money-market fund
seemed like a great investment choice.
Most consequential stock market returns
(both positive and negative) happen in
short periods of time, and one or two
good years can easily skew the annualized
return numbers. A decade of bad returns
can be transformed by a quick rally, or a
decade of good returns can be destroyed
by an even quicker crash.
Extrapolating a historical return into
the future can create a false sense of security and may lead us to assume (unrealistically) that all we have to do is wait long
enough to get a 10-percent return from
the market.
Market statistics (and research) do
not support the hypothesis that historic
average returns can be expected in the
future. There may be scenarios under
which a portfolio can get a return higher
than 10 percent, but it can also experience negative returns and long periods of
drawdowns, so it is not advisable to count
on the stock market to outperform your
your student loans, you should do so, provided you take the following steps first:
1. Establish an emergency fund that
will cover between six months and 1
year of your expenses.
2. Contribute to Roth IRA. Use
a backdoor contribution via a
non-deductible Traditional IRA if
you are phased out.
3. If you are an associate, contribute
to a retirement plan, at least enough
to get the employers matching
contribution.
If a retirement plan is not available
to you, invest after tax until you can
buy your own practice. If you are paid
as an independent contractor, you may
be eligible to open your own solo
401(k) plan.6 As a practice owner,
you can start with a basic retirement
plan, such as SIMPLE IR A or a Safe
Harbor 401(k). After you pay out your
student loans, you can always catch
up on retirement savings by using a
custom-designed 401(k) plan and/or a
Cash Balance plan.7
Summary
Whether you prefer to repay your debt
quickly or take your time and invest your
money instead, simple rules can help you
develop an optimal approach to managing
your debt. For any type of loan, if you
want to invest rather than prepay the loan,
your ROI (after taxes) has to be greater
than the interest rate on your loan. It
would be a good idea to prepay your loans
carrying highest interest (such as student
loans) as quickly as possible, because such
prepayment generates a return that equals
the interest rate on your loan (less tax
deduction, if any).
Even if you can get an investment to
generate a higher ROI than your mortgage
interest, it is still a good idea to repay your
mortgage more quickly (ideally by refinancing into a 15-year mortgage), because
the cost of your mortgage is proportional
to the mortgage amount, so the higher the
original mortgage, the larger your mortgage cost will be. While very few dentists
are totally debt-free, the quicker you shed
most of your bad and unessential debt,
the sooner you will be able build up your
savings. Whether you want to retire early
or continue practicing dentistry, being
financially independent will give you more
control over your future plans.
References
1. http://www.asdanet.org/debt.aspx
2. http://www.nolo.com/legal-encyclopedia/student-loan-debtbankruptcy.html
3. http://www.dentaltown.com/dentaltown/article.
aspx?i=273&aid=3696
4. http://www.wsj.com/articles/dont-buy-a-home-as-aninvestment-1419728902
5. http://retirementresearcher.com/greatest-hits-part-2-thebond-market/
6. http://quantiamd.com/player/ygvmhdmbm?cid=1467
7. http://litovskymanagement.com/2013/04/retirement-plansbusiness/
Author Bio
Konstantin Litovsky is the founder of Litovsky Asset Management, a wealth-management firm that offers flat-fee, comprehensive financial
planning and retirement plan advisory services to doctors and dentists. Litovsky specializes in setting up and managing retirement plans for
small practices, including 401(k) and defined benefit/cash balance. He can be reached at konstantin@litovskymanagement.com.
60
iPad
iPad
iPad
practice solutions
Practice Solutions explores how specific products and services can be of use clinically or in practice management.
A Fresh Approach
to Retirement Funding
by Paul Homoly,
Kenneth H. Mathys,
and Rob Ziliak
Paul Homoly, CSP, is president of
Homoly Communications Institute,
a resource for developing practicebuilding skills and leadership for
dentists. He provides seminars,
workshops, and consultations on the
topics of the new-patient experience,
dental practice development and
management, and communication with
patients. Visit Paulhomoly.com or call
(800) 294-9370 for more information.
Kenneth H. Mathys, CPA, is founder
and CEO of Dental Practice Advisors,
LLC (DPA). The company supports
dentists who express the need
for quality, accessible practicemanagement support and for a much
deeper professional relationship
with their advisers. DPA provides
a wide array of services, including
practice management, business
planning, leadership, human
resources, transition support
and financial accounting. Visit
Dentalpracticeadvisors.com or call
(920) 593-7250 for more information.
Rob Ziliak, MPAS, CFP, is a wealth
advisor and office director at
Buckingham, a comprehensive wealthmanagement firm with a niche practice
area that focuses on financial solutions
for dentists and their families. Ziliak
also participates as an advisor in
the Dental Practice Area of the BAM
ALLIANCE, a community of more than
140 independent firms across the
United States. To learn more about the
BAM ALLIANCE and to find an advisor
near you, visit Thebamalliance.com or
call (888) 470-3064.
62
Dentists need a process that makes retirement savings a part of their everyday practice
experiences. Too often the pressure and complexity of delivering clinical care diverts the energy
and attention needed to implement retirement
strategies. Consequently, many dentists face
retirement challenges that are unsolvable without
drastic, unwelcome changes to their lifestyles.
There are hundreds of retirement articles
out there; however, very few of them take into
account the unique financial circumstances
that dentists are faced with at the time of
retirement. Fortunately, there is a new way for
dentists to fund retirement savings that also fits
into their clinical culture, a way that is often
overlooked by mainstream finance experts
whose target audience often excludes clinicians.
By offering interest-bearing patient
financing administered through a third party,
dentists can earmark the principal and interest
payments received from patients to a segregated retirement savings account.
This strategy allows dentists to avoid taxation on principal and interest payments and
allows those payments to grow in a tax-deferred
environment.
By offering a modest number of patients
these financing solutions, dentists can:
Fill empty chair times in the schedule
Treat patients who normally would not
have accepted care without financing
solutions
Enjoy referrals from these grateful
patients
Secure their retirement savings goals.
Dentists mindsets
Although many dentists have modest
business skills, their mindsets are more often
aligned with production, collection, case
acceptance, and scheduling. More specifically,
when patients do not accept treatment recommendations, time and money are lost in the
process, resulting in the dentists suffering.
To make treatment acceptance easier, dentists can offer patients financing options supported by financial institutions. This provides
the opportunity to link retirement funding
into dentists mindsets.
Dentists can make patient-financing solutions available through a company that shares
the financing interest paid by the patient.
The process:
1. Patients are offered financing solutions.
These solutions include a choice in which
they make modest down payments for
their dental care.
2. Dentists complete patients care and
patients make interest-bearing monthly
payments to the finance company. The
finance company earns a small percentage
of these payments and sends the remaining payment balance, with interest, to the
dentists.
3. Dentists take these interest-bearing
payments earned from patients and
deposit them into a segregated account
earmarked for retirement savings. Once
deposited into a retirement savings
account, the interest-bearing payments
practice solutions
grow in a tax-deferred environment like other

retirement savings.
This process fits perfectly into dentists mindsets because many dentists have open time in their
schedule. They also have many patients who would
not accept care if financing werent available. By
offering financing, dentists solve two problems.
One, patients who normally wouldnt accept care
without financing now accept care. Two, the open
time dentists have in their schedule is now filled
with these patients.
By solving the problems of patient refusal of
care and open time in their schedules, dentists can
simultaneously solve retirement funding without
having to alter their mindsets.
A closer look
Lets look at an example of how this could
work in a dental practice. Dr. Stephanie Kotter
began offering interest-bearing financing for her
patients two and a half years ago. She started
by offering it to her recall patients who needed
additional care but delayed treatment until it fit
within their budgets.
She discovered that of her 1,500 active patients,
close to one-third needed additional care, and,
when offered patient financing, 25 percent of those
additional-care patients chose to go ahead with
treatment. The average treatment fee for these patients

was $1,200, yielding Dr. Kotter an additional $135,000
in production, 80 percent of which she financed over a
period of 26 months at an interest rate of 12.99 percent.
In addition to the extra revenue from the initial
down payments (20 percent) and principal and
Number of new loans

(per month)
$8,640 total amount
(per month)
Principal & interest

payments,
less expenses
(per month)
5
$15,000
$8,800
26
months
78
patients
$5,000
1
12
months
24
months
36
months
Authors note: Information from sources deemed reliable, but its accuracy cannot be guaranteed.
Performance is historical and does not guarantee future results.
63
practice solutions
interest payments, she enjoyed increased patient referrals from patients who were grateful to her for making it easier for them to receive care. These results
gave her the confidence to offer financing solutions to
all of her new patients.
Now after two and a half years, Dr. Kotters
patient financing loan portfolio is worth $113,000,
yielding $8,800 a month in principal and interest
payments. Heres a chart of Dr. Kotters patient
financing progress. (See p. 63.)
Notice how, after 26 months of offering patient
financing, Dr. Kotter averages three loans a month,
totaling $8,640, and she is receiving $8,800 a month
in principal and interest payments. In other words,
she has reached a point where there is no cash-flow
risk. Plus, she gains in referrals from patients who
normally may not have accepted care without the
benefit of patient financing.
Dr. Kotter is in her late 40s, married, and has
two sons, both of whom are in private schools. Up
until now, Dr. Kotter has been paying down debt,
1-on-1 EXCLUSIVE - YOUR OFFICE

SIM LAB real time emergency scenarios
Airway management
Cases Selection
Drug Selection/Dosages
Monitoring Equipment
Team Approach Emergency
Plan of Action
Its all about the team
financing large purchases for her practice, compensating her staff well, paying tuition and enjoying a
reasonably nice lifestyle. Unfortunately, like many
dentists, Dr. Kotter has not been sufficiently saving
toward retirement.
By solving the problems of

patient refusal of care and
open time in their schedules,
dentists can simultaneously
solve retirement funding
without having to alter their
mindsets.
1-on-1 Q & A After Your Simulation

Updated Presentations with Current
Guidelines/Policies
One Year Post Course Hotline and

Email Q & A for Course Attendees
State-Of-The-Art, Real Time

Simulation Mannequins SIM LAB
Emergency Scenarios
Easy Language Lecture

Simplified, Team Emergency Plan
CHECK ONLINE OUR
COURSE DATES AT
SEDATIONREADY.COM
64
Dr. Kotters combined federal, state and local tax

rate is 40 percent. If all $8,800 of increased monthly
income is subject to ordinary income-tax rates, she will
net roughly $5,300 of the amount while paying the
federal, state, and local taxing authorities an additional
$3,500 per month. Retaining just 60 percent of the
principal and interest payments is not appealing.
The solution
Dr. Kotters new-patient financing loan portfolio
can fund her retirement savings and enable her to
pay less in taxes. For example, by funding a customdesigned retirement plan arrangement, inclusive of
both a defined contribution (401(k) profit sharing)
and defined benefit (cash balance) plan, Dr. Kotter
can defer all $8,800 of increased earnings per month,
while also having the assets grow tax-deferred until
withdrawn during retirement. When all $8,800 per
practice solutions
Conclusion
Dentists clinically-oriented mindsets often do
not coincide with good financial planning and follow-through. Too many dentists are forced to retire to
a less-than-ideal lifestyle. However, if retirement-fund
savings were connected to their everyday clinical
mindset, then creating abundant retirement savings
could be a predictable outcome. Interest-bearing
patient financing managed by an outside third party
can be the stress-free solution for dentists to save for
retirement and retire on their own terms.
To find out more about how to create a portfolio of interest-bearing patient financing, contact
Comprehensive Finance at (866) 964-4727 or visit
Comprehensivefinance.com.
Editors note: This article is an excerpt from the
white paper An Innovative Solution to Retirement Plan
Funding for Dentists. To download the entire white
paper, go to Comprehensivefinance.com/dt.
Dentists clinically oriented

mindsets often do not coincide
with good financial planning
and follow-through.
month is contributed into the retirement plans, the
earnings can be treated as pretax income for corporate and personal tax returns.
In other words, rather than share $3,500 of the
increased monthly earnings with taxing authorities,
all $8,800 will be deposited into a retirement-plan
structure.
To satisfy federal retirement-plan laws, Dr. Kotter
would need to share some of the $8,800 of monthly
savings with her staff. After Dr. Kotters staff census
was studied, she learned that 10 percent, or $800,
of the $8,800 total contribution would need to be
allocated to her employees so that the plans would
remain compliant with applicable laws.
By paying herself first, Dr. Kotter accomplished
key financial goals without sacrificing. Rather than
paying nearly 40 percent of the new earnings in
taxes, she was able to share 10 percent with her team.
She also did not need to modify her lifestyle
spending or compromise making new investments
into her practice.
65
orthodontics
feature
Diode Use in
Orthodontic-Related
Procedures
by Ron Kaminer, DDS
Lasers emergence
Fig. 1
It was just 10 years ago that dentists

had minimal interest in attending a laser
lecture.
Having used lasers for more than 20
years and having lectured on the topic
almost as long, I found it somewhat disconcerting that dentists couldnt see past
the major stumbling block of cost in
order to incorporate this incredible technology into their practice. Now, however,
more than half of all of the dentists in the
U.S. have one.
Diode laser energy is preferentially
absorbed by pigment and hemoglobin.
That characteristic allows us to cut soft
tissue effectively with little to no bleeding, and little to no thermal damage.
Difficult procedures become much easier
when bleeding isnt an issue. Esthetic
soft-tissue recontouring becomes very
predictable when there isnt recession.
Soft-tissue periodontal procedures are
enhanced with the use of the diode, and
virtually every specialty can find use for a
soft-tissue laser.
The general practitioner will find
many uses for the diode laser in the area
of orthodontics. Orthodontists have
embraced the technology. While we
could discuss many procedures, we will
focus on a few common ortho procedures
that anyone can incorporate into his or
her practice.
Fig. 2
Fig. 3
Fig. 4
66
Below are my five favorite ortho

procedures:
Laser tissue removal for placement of
brackets. Lasers cut and coagulate,
granting time and cost savings, and
improved patient comfort.
Laser tissue recontouring. As teeth
move, so does tissue. Its a breeze with
a laser.
Excess tissue covering brackets. Lasers
are safe around and on metal (unlike
electrosurge). This is huge advantage
for me and my patient.
Canker sores. Just 60 seconds of
bathing the sore with laser energy
stops the hurting and promotes
healing.
Frenectomies. These used to be
scary, bloody surgeries, but now
in just a few minutes I can remove
the frenum with a laser to help the
stubborn diastema disappear. Lasers
cut and coagulate in one simple step.
Heres how.
Maxillary frenums and their location have been shown to contribute to
diastemas between the maxillary central
incisors. Furthermore, a tight frenum can
cause the lip to roll when someone smiles
and can contribute to a strong vertical lip
pull, which may lead to showing excessive
gingiva.
Traditionally performed frenectomies
involve using either a scissor or scalpel
orthodontics
feature
to cut the frenum. Bleeding very often

distorts the surgical field and the inexperienced practitioner may struggle without
a clear operating field.
When done with a diode, the procedure typically involves anesthetizing
the frenum and removing the band of
tissue and its extensions between the
maxillary central incisors, midway to
the palatal tissue.
A groove director (available through
most dental distributors) can help in isolating and retracting the frenum, making
surgery even easier (Fig. 1).
Ideally, dissecting the tissue to the
level of the periosteum ensures proper
healing with little chance of relapse.
As the frenum is a fairly large and wide
piece of soft tissue, the area when cut
typically looks like a diamond-type incision following the anatomy of the band
of tissue (Fig. 2).
A suture or PeriaCryl prevents rapid

healing, which may lead to early reattachment of the fibers (Fig. 3). Healing is
rapid, as evidenced by substantial wound
closure after only five days (Fig. 4).
A common issue we see among our
ortho patients is overgrowth of tissue due
to poor oral hygiene. Regardless of what
we suggest to our patients in regard to
improving their oral hygiene, tissue health
rarely resolves without some surgical intervention. As this tissue is very inflamed,
traditional surgical modalities always cause
substantial bleeding. It is here that the
diode shines with its exceptional ability to
coagulate hemorrhagic tissue.
In order to properly perform this
procedure, one must first have a good
knowledge of the lay of the land. Probing
the overgrown and inflamed soft tissue is
necessary to know how aggressive a gingivectomy to perform (Figs. 5 & 6).
Fig. 5
Fig. 6
67
orthodontics
feature
Fig. 7
Fig. 13
Fig. 8
Fig. 14
Fig. 9
Fig. 15
Fig. 10
Fig. 16
Fig. 11
Fig. 17
Fig. 12
Fig. 18
68
Once that is done, the doctor can

remove the excessive soft tissue. This tissue
is very inflamed, but with the attraction
of diode to inflamed tissue, little energy is
needed to get the job done (Fig. 7). Using
minimal energy ensures rapid healing with
little to no post-op pain.
The diode is safe to use around metal.
Overgrown tissue around orthodontic
brackets does not present a problem as it
would if using an electrocautery device. If
overgrown tissue is left alone, aside from
creating a typical unhealthy soft tissue
environment, plaque can also accumulate
under the tissue and cause enamel decalcification. When tissue growth around
brackets is excessive (Fig. 9), some bleeding may still occur despite the diodes
ability to coagulate. Once the tissue is
sculpted around the bracket, a sharp
scaler may assist in removing the excised
soft tissue (Fig. 10). Once contouring
is completed, hydrogen peroxide in a
syringe with a brush tip can help remove
any sloughed tissue and clean up the surgical field. Healing is rapid, as evidenced
by the five-day post-op (Fig. 12).
As teeth are moved orthodontically,
soft-tissue discrepancies can occur.
These discrepancies, easily corrected
with a diode, can lead to dramatic
differences in someones smile. A little
goes a long way in these corrections,
and sometimes the difficulty lies in freehanding the gingival sculpting.
While the experienced diode user
may fi nd this an easy task, doctors who
are less experienced may fi nd freehand
gingival sculpting one of the most challenging aspects of the procedure. I simplified this procedure.
As with other gingival procedures,
periodontal probing or sounding of the
bone must be done prior to removing
any soft tissue in order not to encroach
on biologic width. After recording the
periodontal probing, upper and lower
alginate impressions are taken and stone
models are poured.
The probings and models are sent
to the dental laboratory with specific
orthodontics
feature
instructions to recontour the soft tissue

on the model following the enclosed
probings (Fig. 13).
Care must be taken not to exceed the
probings when recontouring the model,
even if it means a slight esthetic compromise (unless the patient is willing to go
through a true crown-lengthening procedure). Once the stone is recontoured, a
soft-tissue stent is fabricated to replicate
the change in the soft tissue (Fig. 14).
A common
issue we see
among our
ortho patients
is overgrowth
of tissue due
to poor oral
hygiene.
The stent is then tried in the mouth
before anesthetizing the patient to make
sure there is positive seat (Fig 15).
After confirming the fit of the stent
and anesthetizing the patient, the diode is
used to follow the outline of the stent to
create pleasing gingival contours. In this
particular case, the patient disliked the
knife-edge appearance of the gingival tissue around tooth #7 (Fig. 16). The tissue
was recontoured (Fig. 17) and typically,
what you see is what you get. Note the

lack of bleeding in the previous photo.
Healing is rapid and despite some esthetic
compromise due to biologic width issues,
the patient was thrilled with the final
result (Fig. 18).
Conclusion
As evidenced by a few of the highlighted procedures, using the Picasso diode
laser can enhance orthodontic-related
procedures. Other ortho procedures for
which a diode can be used include uncovering of soft-tissue impactions, removing
soft tissue for easy bracket placement, and
supracrestal fiberotomies.
Since the Picasso diode is relatively
inexpensive, the return on investment
is tremendous for the doctor. If a doctor performs only three cases a year of
overgrown tissue around orthodontic
brackets, he or she will be able to pay
for the laser, even at reduced reimbursement from insurance companies. Add
in a number of frenectomies, soft-tissue
smile-recontouring procedures, and the
plethora of other procedures that can
be performed with a diode in operative
dentistry and crown and bridge, and
the doctor will fi nd that the Picasso
diode is a sound investment in any
practice. Because complete training is
included, the learning curve is short
and the doctor can start using the diode
almost immediately.
Lasers have had a huge impact on
my practice over the last 20 years. While
change can be difficult, I assure you that
if you take the leap into laser dentistry,
it will change your practice forever in a
positive way.
Author Bio
Dr. Ron Kaminer is a 1990 graduate from SUNY Buffalo School of Dental Medicine. He maintains two practices in Hewlett and Oceanside, New York dedicated to minimally invasive and
laser dentistry. He consults for many dental manufacturers and lectures nationally and internationally on topics ranging from minimally invasive and laser dentistry to new materials
and technology. He is the founder of the Masters of Laser training course and facility in New
York, and has trained thousands of dentists on the use of a variety of dental lasers. He is currently the medical director of AMD lasers and is passionate about spreading the word on laser dentistry. He lives in Hewlett,
New York with his wife and three children.
69
prosthodontics
message board
Why, Why, Why Would You Not Splint

These Short, Thin Implants in the
Posterior Maxilla?
A well-documented review of previous placed implants
Dentaltown.com > Message Boards > Implantology > Why, Why, Why Would You Not Splint These Short,
billschaeffer
Post: 1 of 71
Related Message Boards

Easier Technique for Open-Tray
Implant Impressions
Tray Implant
Implant CaseVariations
on a Theme
Variations On
Introduction:
Lovely lady came in today for another implant in the lower jaw so it gave me the opportunity
to review some upper implants I placed in 2013. I pretty much never (and thats a word I rarely
use) splint adjacent units. My screws just dont
Fig. 1
Fig. 2
come loose and its never caused me a problem
doing them without splints.
Missing upper left molar and premolar
(Fig. 1)
Thin ridge (Fig. 2)
I did place a bit of particulate over the fenestration (Fig. 3).
Fig. 3
Fig. 4
Another view (Fig. 4)
Another view (Fig. 5)
Squeezed them in somehow in October
2013. These are both Ankylos implants that
are 3.5mm wide and 6.6mm long. Both
placed one-stage. Surely these small implants
Fig. 5
Fig. 6
will have to be splinted together to cope with
the forces of occlusion (Fig. 6)!
At check of integration in February 2014
(Fig. 7).
Unsplinted crowns fitted in March 2014
(Fig. 8).
And here they are today on May 6, 2015,
Fig. 7
Fig. 8
more than one year after loading.
Hows that overloaded bone looking
(Fig. 9)?
Clinical photo taken, as always, after
probing (no probing less than 1mm and no
BOP)(Fig. 10).
Fig. 9
Fig. 10
Conclusion:
I just dont see the problems that others
report when I dont splint my implants, even
implants as short and thin as these.
MAY 6 2015
70
Continued on p. 72
prosthodontics
message board
MatthewE
Post: 8 of 71
Do you ever get pressure

necrosis bone loss? Your cases
never seem to show any bone
loss in the crestal.
MAY 6 2015
billschaeffer
There may be many reasons

why we very occasionally get
crestal bone loss after we place
implants. Im not sure that pressure necrosis is one of them
though that is, of course, something that we were all
taught would happen.
Paulo Trisi has done quite a lot of work on this.
Here is just one of his papers:
J Craniofac Surg. 2013 May;24(3):860-5. doi:
10.1097/SCS.0b013e31827ca3cf.
Histologic and biomechanical evaluation of the
effects of implant insertion torque on peri-implant
bone healing.
Consolo U1, Travaglini D, Todisco M, Trisi P,
Galli S.
It could be concluded that high implant insertion
torque does not induce adverse reaction in cortical
bone and does not lead to implant failure.
And others:
Clin Oral Implants Res. 2015 Feb;26(2):191-6.
doi: 10.1111/clr.12316. Epub 2013 Dec 11.
Effect of insertion torque on titanium implant osseointegration: an animal experimental study.
Duyck J1, Roesems R, Cardoso MV, Ogawa T, De
Villa Camargos G, Vandamme K.
A negative impact of the created strain environment
accompanying H insertion torque implant installation
on the biological process of osseointegration could not
be observed, at least not at tissue level.
Int J Oral Maxillofac Surg. 2013 Apr;42(4):516-20.
doi: 10.1016/j.ijom.2012.10.013. Epub 2012 Nov 16.
Clinical outcome and bone healing of implants
placed with high insertion torque: 12-month results
from a multicenter controlled cohort study.
Grandi T1, Guazzi P, Samarani R, Grandi G.
No direct or inverse relationship was observed
between the insertion torque values and crestal bone
resorption. The results show that the use of high
insertion torque (up to 80 Ncm) did not prevent osseointegration and did not increase bone resorption
around tapered implants early loaded up to one year
after implant placement.

Post: 10 of 71
72
prosthodontics
message board
Clin Implant Dent Relat Res. 2013 Apr;15(2):227-33. doi: 10.1111/j.1708-8208.2011.00351.x.

Epub 2011 May 20.
Clinical outcome of dental implants placed with high insertion torques (up to 176 Ncm).
Khayat PG1, Arnal HM, Tourbah BI, Sennerby L.
The use of high insertion torques (up to 176 Ncm) did not prevent osseointegration.
Marginal bone levels in the control and experimental groups were similar both at the time
of loading and one year later.
MAY 6 2015
Anecdotally, crestal loss is much more common in implants that have the coronal microthread design. I would speculate that as a primary reason most manufacturers have abandoned
this feature.
mattcosta
Post: 11 of 71
MAY 6 2015
markmcdds
Especially when the microthreads are not completely buried in bone at placement.
MAY 6 2015
Bill, about the Trisi study, the author says it could depend on the implant design.
One implant manufacturer swore to me that implant design could indeed cause bone loss
because of too high torque at the crestal level during insertion, and that it had already been
burned by it (having to redo the design for another brand he was working for).

Post: 12 of 71
choixpeau
Post: 13 of 71
MAY 6 2015
73
prosthodontics
message board
raykwon2
Post: 16 of 71
Not so sure about this. What about Astra, BioHorizons, Zimmer, Dentium all have
microthreads at the top and did from the start. In fact, due to the increased surface area provided
by the microthreads, its more likely that less crestal bone loss should occur on these implants
since the biologic width of ~1.5mm is formed over a shorter distance vertically.
Its more about the connection, platform switching, surgical technique and initial depth of
implant placement.
MAY 6 2015
billschaeffer
Post: 21 of 71
Every implant system has its pros and cons. As you know, we place quite a lot of Ankylos
implants (1,677 in 2014) so we get to see what works and what doesnt with this system.
You will also know that we do some fairly silly things with our implants, like cantilevering
off single implants and restoring short skinny implants with unsplinted molar crowns (some of
the stuff we do with these implants makes even me nervous...!).
Do we see abutments fracturing? Yes, but very, very rarely.
We do not use zirconia abutments that have a ceramic connection inside the implants. That never
seemed like a good idea to me and I think that most people prefer to have a titanium-titanium I-A
interface these days. Why? Because those all-zirconia abutments broke on many different implant
systems and Ankylos was no different.
Honestly, I have zero financial interest in Ankylos other than that I place their implants, and
abutment fractures in our hands (45 percent of our implants are restored by the referring dentists
so they are not all expert hands) are incredibly rare.
MAY 7 2015
dentsim
Post: 28 of 71
billschaeffer
Post: 32 of 71
Could you share your follow-up protocol?

MAY 9 2015
We see the patient one month after the implant has been restored. Then six months after the
implant has been restored. Then yearly after the implant has been restored until I feel its stable,
and then Ill see the patient every two years.
During each appointment, I will examine the restoration and the gum, and ask, is it loose?
Is the gum discolored? Is there a draining sinus? Is there recession, etc.?
I will massage the gum and look for any pus from the gingival margin.
I will probe around the restoration. Does it bleed? Is there a deep pocket (pocket depth
itself is not as important as around a tooth, but its one more indicator of health or disease)?
Is there pus?
I will take a periapical X-ray. I will sometimes take photos, sometimes not. I will always
take photos at the fit appointment, and if there are any changes. If I take photos, they are always
taken after probing.
(Posted May 10, 2015)
Almost everything we do uses stock TiBase abutments*. We very rarely use Atlantis abutments. About the only thing we use them for is delayed loaded Syncone cases.
*Not all products are available in North America.
MAY 10 2015
Join the discussion online at: www.dentaltown.com

Thin Implants
74
Approved PACE Program Provider

FAGD/MAGD Credit
Approval does not imply acceptance by a
state or provincial board of dentistry or
AGD endorsement.
8/1/2015 to 8/1/2018
Provider ID#304396
feature
STICK WITH IT:
A Systematic Approach
for Bonding CAD/CAM Restorations
by Adamo E. Notarantonio, DDS, FICOI, AAACD
Abstract
This article will demonstrate a step-by-step approach
to bonding CAD/CAM restorations. The article will
demonstrate proper technique, as well as explain all
materials used and why they were selected.
AGD
Code:
615
76
This print or PDF course is a written self-instructional article with adjunct images and is
designated for 1.5 hours of CE credit by Farran Media. Participants will receive verification
shortly after Farran Media receives the completed post-test. See instructions on page 81.
feature
Objectives
Case presentation
1. Define CAD/CAM restorations as

they relate to dentistry, and discuss
their importance.
2. Present a case from start to finish,
restoring it with a partial coverage
CAD/CAM restoration.
3. Demonstrate a step-by-step approach
to bonding CAD/CAM restorations.
4. Discuss the importance of dualcured resin cements when restoring
teeth with CAD/CAM restorations.
5. Display the importance of proper
management of the adhesive interface
when bonding all ceramic restorations.
Computer-aided design and computer-aided manufacturing (CAD/CAM)
dentistry utilizes these technologies to
improve the design and creation of dental
restorations. These prostheses include
crowns, inlays and onlays, fi xed bridges,
dental implant restorations, veneers, provisionals, etc.
CAD/CAM technologies are useful
in dentistry for a myriad of reasons,
including increasing the speed of design
and fabrication; increasing the convenience, creation, and insertion processes;
and making possible restorations and
appliances that otherwise would have
been more time-consuming and difficult.
Other goals include reducing costs to
make restorations and appliances more
affordable. Finally, it is clear that tooth-colored restorations for posterior teeth have
been gaining popularity due to aesthetic,
biologic, and functional considerations.
With the help of chairside CAD/CAM
units, the fabrication of indirect restorations
in one clinical appointment is now a reality.
Adhesive cementation is a requirement
for the long-term success of many of these
indirect ceramic and composite restorations. This article discusses a step-by-step
guideline for their cementation with the
adhesive resin cement, Duo-Link Universal
(BISCO).
A 36-year-old male presented to the

office for replacement of a large amalgam
restoration (Fig. 1). Treatment options
of resin versus an indirect ceramic restoration, along with risks and consequences
of each, were discussed with the patient
prior to beginning treatment. The patient
opted for an indirect restoration.
An inferior-alveolar block injection
was administered using 1.8cc of mepivacaine. Following profound anesthesia,
tooth #19 was isolated with a rubber dam,
and a pre-operative scan of the tooth was
taken with a PlanScan Chairside CAD/
CAM unit. Following the scan, the existing failed amalgam was removed, along
with all evidence of decay (Fig. 2).
Generally speaking, the design of
preparations for indirect inlays and onlays
mainly depends on the physical properties of the restorative material and should
follow manufacturers recommendations.
Lava Ultimate, a resin nano ceramic
material block (3M ESPE) was chosen
for the final restoration. Less brittle than
glass ceramic, the resin nano ceramic
material also will resist chipping and
cracking when milled.
Following final preparation, a decision was made to place a base/liner in
the deep areas evident in the preparation
seen in Fig. 2. The material chosen was
TheraCal LC (BISCO). TheraCal LC
is a light-cured resin-modified calcium
silicate pulp protectant/liner designed to
perform as a barrier and to protect the
dental pulpal complex. The indications
for use include direct pulp capping carious exposures, mechanical exposures
and exposures due to trauma. It is also
indicated for indirect pulp capping,
used under amalgam restorations, as
well as under Class I and II composite
restorations. Further indications include
use under other base materials, under
cements or as an alternative to calcium
Fig. 1
Fig. 2
77
feature
hydroxide, glass ionomer/RMGI, and

cavity varnish sealer (Fig. 3).
The preparation was scanned with the
Planmeca PlanScan, driven by E4D technologies (Fig. 4) following the placement
of TheraCal LC. The restoration was
then designed and milled and followed by
try-in and evaluation. Next, the intaglio
surface for this Lava Ultimate restoration
was sandblasted, rinsed, dried and silanated per the manufacturers instructions.
A matrix band was placed around the
tooth with dry angles and along with suction to isolate the tooth prior to bonding
the restoration. The authors cement of
choice for bonding indirect restorations is
Duo-Link Universal due to:
Quick and easy clean-up
Easy identification on radiographs
for an effective diagnosis
Low film thickness, ensuring the
restoration is completely seated
An extremely high degree of conversion that ensures a long-lasting
restoration placement
Its ideal use for all CAD/CAM
restorations
Its outstanding bond strengths
to multiple substrates: zirconia,
ceramics/lithium disilicate, alumina,
metals, endodontic posts and
composites.
Following isolation and prior to selective etching and bonding the preparation
with All-Bond Universal (BISCO), the
dentin was scrubbed for one minute with
BISCOs Cavity Cleanser, a two percent
solution of chlorhexidine digluconate
(CHG) intended for cleansing and moistening/rewetting cavity preparations. It is
recommended for use upon completion
of tooth preparation or etching prior to
sealing the dentinal tubules.
Next, Select HV Etch (BISCO), a 35
percent high-viscosity phosphoric acid
etchant containing benzalkonium chloride (BAC), was used to etch the enamel
Fig. 3
Fig. 4
Fig. 5
Fig. 6
78
margins without etching dentin (Fig. 6).

The etchant was left in place for 15 seconds and then rinsed thoroughly for one
minute. An absorbent pellet was used to
remove excess water in order to avoid desiccation. Two separate coats of All-Bond
Universal were applied (Fig. 7).
CAD/CAM
manufactured inlays
and onlays require
adhesive bonding as
it increases retention
and improves
marginal seal, as well
as strengthens the
restoration and the
supporting tooth.
All-Bond Universal is an ethanol/
water-based dental adhesive that bonds
to dentin and to cut and uncut enamel.
It bonds to all indirect substrates, and
is compatible with all composite and
resin-based cements without an additional activator. The solvent was evaporated with a tooth dryer for 30 seconds
(Fig. 8) until there was no visible movement of the material and the surface had
a uniform glossy appearance.
The surface was then light-cured for
10 seconds. Duo-Link Universal was
applied directly into the matrix band (Fig.
9) enclosed preparation. The restoration
feature
was fully seated (Fig. 10) and the excess

cement was removed with a brush prior to
spot-curing the margins for two to three
seconds per quarter surface. After the
excess cement was removed and floss was
run through the contact, each surface of
the restoration was cured for 40 seconds.
Following final curing, the occlusion was
adjusted as the patient sat in an upright
position, the restoration was finished and
polished (Fig. 11) and a postoperative
bitewing was taken to ensure all margins
were indeed closed.
CAD/CAM manufactured inlays
and onlays require adhesive bonding
as it increases retention and improves
marginal seal, as well as strengthens the
restoration and the supporting tooth. A
strong and durable resin bond to ceramics
is dependent upon a true chemical bond
and micromechanical interlocking. It is
therefore mandatory to follow manufacturers recommendations closely when
following a cementation protocol.
Dual-curing resin cements provide
a sufficient degree of polymerization
(conversion rate) underneath ceramic restorations. Adequate polymerization may
not be achieved with strictly light-cured
composite resin cements, which is why
it is especially important when bonding
CAD/CAM fabricated ceramic restorations to utilize a dual-cure system. In
most cases, the restorations will be thicker
than 1mm, limiting the amount of light
that can penetrate the final restoration,
and completing the polymerization of the
resin cement.
Fig. 7
Fig. 10
Fig. 8
Fig. 11
Fig. 9
Without a blueprint for success and

the use of a proven system, a restoration
may look good at the time of insertion,
but it will never be able to stand the test
of time under the complexities of the oral
cavity. Proper management of the adhesive interface, a clear understanding of
the materials being utilized and a precise,
systematic clinical protocol are essential
for the long-term success of our adhesively retained restorations.
Author Bio
Dr. Adamo Notarantonio is a graduate of the State University of New York at Stony Brook School of Dental Medicine (2002), where he received
honors in both removable and fixed prosthodontics. He completed his residency in the advanced education in general dentistry program at
Stony Brook in 2003, and was chosen by faculty to complete a second year as chief resident.
Notarantonio is one of approximately 400 dental professionals internationally to achieve accreditation status in the American Academy
of Cosmetic Dentistry, and has been elected to serve on the American Board of Cosmetic Dentistry. He also volunteers for the AACDs Give Back
A Smile (GBAS) program, golfs often and is fluent in Italian.
79
feature
Claim Your CE Credits
P O S T-T E S T
Answer the test in the Continuing Education Answer Sheet and submit it by mail or fax with a processing fee of $36. You can also answer the post-test questions online at www.dentaltown.com/onlinece.
We invite you to view all of our CE courses online by going to www.dentaltown.com/onlinece and clicking
the View All Courses button. Please note: If you are not already registered on www.dentaltown.com, you
will be prompted to do so. Registration is fast, easy and of course, free.
1.
What does CAD/CAM stand for?

A) Computer-aided dentistry and computer-aided manufacturing
B) Computer-aided design and computer-aided manufacturing
C) Cosmetic-aided dentistry and computer-aided milling
D) Computer-aided dentistry and computer-aided milling
2.
Why do CAD/CAM manufactured inlays and onlays require

adhesive bonding?
A) To increase retention
B) To improve the marginal seal
C) To strengthen the restoration and supporting tooth
D) All of the above
3.
4.
5.
CAD/CAM restorations are useful in dentistry because they:

A) Increase speed of design and fabrication
B) Are possible in a single visit
C) Reduce cost and make restorations more affordable
D) All of the above
What maximizes the retention of a restoration?
A) Accurate occlusion adjustments
B) Design of preparation
C) Applying a pulp protectant/liner
D) None of the above
Resin luting cement is the only material recommended for cementing
this type of restoration because it
A) Bonds to only enamel
B) Doesnt bond to dentin
C) Increases microleakage
D) Enhances strength
6.
What are the advantages of inlays/onlays over direct resin composite

restorations?
A) Less likely to have open contacts
B) Better marginal integrity
C) Increased stability
D) All of the above
7.
Combining light and chemical curing components with a dual-cured

luting cement allows for
A) Only polymerizing on light exposure
B) Only polymerizing in areas where light doesnt penetrate
C) Chemical polymerization in areas where light doesnt penetrate
and polymerizes on light exposure
8.
What should be placed before the restoration is placed to reduce

postoperative sensitivity and avoid damage to the pulp?
A) Bond/Adhesive
B) Varnish
C) Protective base
9.
What are the advantages of using all-porcelain restorations?

A) Attrition to opposing teeth
B) Beautiful esthetics
C) Brittle and hard to handle
Legal Disclaimer: The CE provider uses reasonable care in selecting and providing content that is accurate. The CE provider, however, does not independently verify the content or materials. The CE
provider does not represent that the instructional materials are error-free or that the content or materials are comprehensive. Any opinions expressed in the materials are those of the author of the
materials and not the CE provider. Completing one or more continuing education courses does not provide sufficient information to qualify participant as an expert in the field related to the course
topic or in any specific technique or procedure. The instructional materials are intended to supplement, but are not a substitute for, the knowledge, expertise, skill and judgment of a trained healthcare professional. You may be contacted by the sponsor of this course.
Licensure: Continuing education credits issued for completion of online CE courses may not apply toward license renewal in all licensing jurisdictions. It is the responsibility of each registrant to verify
the CE requirements of his/her licensing or regulatory agency.
80
feature
CONTINUING
EDUCATION
ANSWER
SHEET
Instructions: To receive credit, complete the answer sheet and mail it, along with a check or credit card payment
of $36 to: Dentaltown.com, Inc., 9633 S. 48th Street, Suite 200, Phoenix, AZ 85044. You may also fax this form
to 480-598-3450 or answer the post-test questions online at www.dentaltown.com/onlinece. This written selfinstructional program is designated for 1.5 hours of CE credit by Farran Media. You will need a minimum score
of 70 percent to receive your credits. Participants only pay if they wish to receive CE credits, thus no refunds are
available. Please print clearly. This course is available to be taken for credit August 1, 2015 through its expiration on August 1, 2018. Your certificate will be emailed to you within 34 weeks.
Stick With It: A Systematic Approach ...
CE Post-test
1.
2.
3.
4.
5.
6.
7.
Daytime phone ______________________________________________________________________________________________
8.
E-mail (required for certificate) _______________________________________________________________________________
9.
By Dr. Adamo E. Notarantonio, DDS, FICOI, AAACD

License Number ______
______
______
______
______
______
______
______
______
______
AGD# ______________________________________________________________________________________________________
Name _______________________________________________________________________________________________________
Address ____________________________________________________________________________________________________
City ____________________________________________________
State ___________
ZIP __________________________
o Check (payable to Dentaltown.com, Inc.)

o Credit Card (please complete the information below and sign; we accept Visa, MasterCard and American Express.)
Please circle your answers.
Card Number ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______
Expiration Date Month / Year ______ ______ / ______ ______ ______ ______
Signature ___________________________________________________________________________
Date __________________________________________________
Program Evaluation (required)

Please evaluate this program by circling the corresponding numbers: (5 = Strongly Agree to 1 = Strongly Disagree)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Course administration was efficient and friendly

Course objectives were consistent with the course as advertised
COURSE OBJECTIVE #1 was adequately addressed and achieved
Course material was up-to-date, well-organized, and presented in sufficient depth
Instructor demonstrated a comprehensive knowledge of the subject
Instructor appeared to be interested and enthusiastic about the subject
Audio-visual materials used were relevant and of high quality
Handout materials enhanced course content
Overall, I would rate this course (5 = Excellent to 1 = Poor):
Overall, I would rate this instructor (5 = Excellent to 1 = Poor):
Overall, this course met my expectations
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Comments (positive or negative):_________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________
For questions, contact Director of Continuing Education Howard Goldstein at hogo@dentaltown.com.
81
product profile
feature
Uncomplicate Business:
All it Takes is People,
Time, and Money
I wrote Uncomplicate Business: All it Takes is People, Time, and Money because
anted to help fello business o ners gro and thri e elo you ll nd an
exclusive sneak peek of the book. I encourage you to explore the material whether
youre a new entrepreneur or are looking to improve your existing business.
Dr. Howard Farran, DDS, MBA, Publisher, Dentaltown Magazine
Excerpt from Uncomplicate Business: All it Takes is People, Time and Money.
As weve discussed, running a business doesnt have to be complicated if
you focus on three things: people, time, and money. Heres an example of a
business that missed the mark on the third item.
A new restaurant opened up near my home in Phoenix, Arizona. They had
been marketing in my area pretty stronglybillboards, advertisements in
the local shopper, and direct-mail cards with free dessert coupons. Almost
everywhere you turned, something displayed this restaurants name. Im a
creature of habit, so despite all the advertising, I hadnt really considered
going until a close friend of mine recommended it.
I took my family on a Thursday night. It was a pretty place with a pleasant
atmosphere, and the food was pretty decent. And the place was bustling.
The friendly and helpful staff hurried from table to table, waiting on diners
as quickly as possible so they could seat the people who had been waiting up
front for an hour. It really seemed as though this place would take off.
The manager came around to my table and asked me how I liked my meal
and if I was enjoying myself. I told her everything was great, but that I was curious to know how many new customers her restaurant was getting each month.
She appeared dumbfounded at first, but then she finally said: I dont
know. Probably around fifty? The woman had no idea.
I just let it go and decided Id wait and see how things were going with this
restaurant in a few months.
My favorite restaurant happens to be located across the street from this
place. It is one of four restaurants in my ZIP code that has stayed in business
for all 25 years I have lived there. I know the managers of all four, and they
know me.
So one night when I was dining at my favorite restaurant, I asked the
manager how many new customers he attracts in a month. He said, On average, about forty, but last month we had forty-two.
When I asked where his new customers came from, he said, Well, fi ve
came from our website, 10 came from a Google ad, 20 were word-of-mouth
referrals . . . He went on down the list.
This guy didnt even have to check his data. He knew it cold. He even knew
how many dollars per head his new customers cost him in advertising on his
website, direct mail, Facebook, and in the newspaper. Why? Because he wanted to invest his money where he was getting the most bang for his buck. He
was measuring his return on investment. A classic entrepreneur.
With Uncomplicate Business, Howard Farran

has created a concise, must-read, easy-to-follow
cookbook for any small-business owner, not just
dentists, to operate successfully.
Edward J. Zuckerberg, DDS
Father of Facebook Founder, Mark Zuckerberg
Eventually that other restaurant went out of business. When once no one
could get in, now no one wanted to go. It was a shame, really, but I saw it
coming from a mile away. Management cared more about how its product
was made than about watching the numbers. If youre not passionate about
running your business and watching your numbers, it wont matter whether
youre making crowns, pizzas, or depositions, because you wont have a business at which to make it!
Preorder Uncomplicate Business now for only $19.95 at HowardFarran.com.
82
practice management
feature
Establishing an Accounts
Receivable System
by Sandy Pardue
he most effective way to handle money management

is by implementing a step-by-step accounts receivable
(A/R) system. Its great to produce high numbers, but
its a waste of time if you arent getting paid. If you fail to establish a solid A/R system, you will lose money through nonpayment, late payments and staff time spent on collection efforts.
The fi rst action is to clearly defi ne when and how accounts
are going to be paid, as well as the payment options you will
offer. All of the actions within the A/R system require written
policies and procedures to give your team members direction
on how to carry them out. You will need to appoint a fi nancial
coordinator whose main purpose is to collect payments for the
dentistry that is delivered. This person should be informed
of the practices monthly collection goal of 98 percent to
99 percent.
If your practice is not currently collecting at least 98 percent
to 99 percent of adjusted production, the problem is most likely
in one or more of the following areas.
Financial policy
Your practice should establish a firm financial policy. It
should be in writing and include payment options (see the section
below). Post it on your website and give it to new patients and
existing patients making financial arrangements.
Payment options
All of the payment options you offer should be listed on a
professional financial arrangements form so patients can choose
84
Studies have shown that collections

come in more quickly if statements are
sent between the 25th and 28th of the
month. Some people tend to pay the
monthly bills that come in first.
how they want to pay. Each option should be clear and easy to
understand.
Pay as you go: The patient pays in full using cash, check, or
credit card on all visits as treatment progresses.
Easy paycredit card payment option: Three equal installments are paid by credit card. One-third of the payment is
due at the first appointment; one-third is due 30 days later;
and the remaining one-third is due 60 days from the initial
appointment.
In-office financing: Interest-free for up to 90 days, based
upon credit approval.
Advance-payment discount (receive discount): Five percent
bookkeeping courtesy discount for payment in full by cash
or check at the start of treatment, resulting in a one-time
payment.
Major servicetwo-payment option: A two-payment
practice management
feature
option for treatment with copayments of more than $300.

Pay the first half at the first appointment and the second
half at the subsequent appointment.
Third-party financing: by arrangement with a third-party
finance company. It is an interest-free term loan (up to six,
12, or 18 months) with no down payments, no annual fee,
and no prepayment penalty. Longer payment options are
available with interest.
There should be a place on the agreement for the date, total
fees, down payment, due dates and signatures of both the team
member presenting the financial arrangement and the person
responsible for payment. Always give a copy of the signed agreement to the responsible party, and keep a physical or scanned
copy on file.
In order for your systems to remain consistent, the following
guidelines and policies should be in writing:
Payment options for patients with insurance
Payment options for patients without insurance
How to handle secondary insurance policies
Financial arrangement form
Third-party financing protocols
Discounts you will offer (pre-pay, senior citizen,
staff/family discounts)
How to handle payments from transient and
emergency patients
Financial policy
Collections policy
Billing system
Establish an exact protocol for sending statements each
month. The financial coordinator is responsible for making sure
these are sent and the protocol is consistently followed, whether
they are outsourced or prepared in the office.
Studies have shown that collections come in more quickly
if statements are sent between the 25th and 28th of the month.
Some people tend to pay the monthly bills that come in first.
Send statements to everyone who has a balance, including
those accounts with outstanding insurance. If you do not, the
patients will get the idea that they do not owe you money. They
need to be aware of the total cost and monies still owed.
Your statements should include:
An exact due date, instead of, Due in 30 days
Account aging
Return envelope
Breakdown of services
No-charge or courtesy-discount procedures
Section to pay via credit card
Office address and phone number
How to pay online (if you have this option set up
on your website)
A notice of any rebilling fees that may be added to
past-due accounts
Any personal notes

Add Return service requested to the front of the envelope.
If your patient has a new address, the post office will research and
find it for you, for a small fee. This is helpful in keeping patient
addresses up to date. If a statement is returned, its important to
resend it with the new address that same day.
Custom nudge message(s) for the slow payer:
30 days past due
60 days past due
90 days past due
Keep a good credit record
Payment would be appreciated
Avoid being turned over for collections
Save on rebilling charges
Presentation of financial arrangements

The financial coordinator must be someone who has the right
personality for the job. If you have the wrong person or he or she
is not trained, the practice will suffer. Its impossible to change
or retrain a personality. The ideal candidate would have banking
experience, be motivated by goal setting, have good communication and listening skills, be good with numbers, and be organized
and diligent with follow-through. He or she needs to feel confident asking for money owed to the practice. This person cannot
over-sympathize with patients financial situations and/or worry
about them not being able to afford the treatment. A timid or shy
applicant may not be the person for the job.
Always make financial arrangements before scheduling
patients for treatment. It is almost impossible to take that
appointment back after they tell you they dont have the money.
Insurance system
To improve collections from patients with insurance, verify
benefits in advance and, when available, use online or phone predeterminations. This allows you to have more information about
their benefits. You can use effective verbal skills such as, Your
insurance company says you will owe $50.
Utilize electronic claims to speed up reimbursements. Make
sure you have included the full details that the insurance company will need for the claim, such as X-rays, narratives, etc. Send
X-rays on crowns, implants, root canals (before and after) and
SRPs. You will also need to include a perio chart for SRPs.
Generate an insurance aging report and track outstanding
claims each week. Name a set day and put it on the insurance
coordinators checklist. Pay attention to the clearinghouse status
report. Look for verbiage like zero payment, rejected, holding claim or unprocessed. Many practices wait to receive the
EOB (explanation of benefits) from the insurance company, and
that will delay payment 30 days or longer.
Consider using direct deposit for insurance payments. This
single action will help you get your money fasteryou can have
85
practice management
feature
payments within a week or less. In addition to being fast, it helps

prevent loss or simply waiting on the mail. Once claims are processed, you will receive notice from the insurance company.
Make sure your patients know your office policy regarding
dental insurance.
SAMPLE POLICY TO
SHARE WITH PATIENTS
Regarding Insurance Benefits:
We will file your insurance claims as a courtesy for you
and will accept assignment of benefits on your behalf.
Regardless of what we may calculate your insurance company
to pay, it is only an estimate. The financial obligation for dental
treatment is between you and this office, and is not between
this office and your insurance company.
We will do all we can to get the maximum benefits reimbursed for you. Please be aware that some of the services
provided may not be covered or may be considered above the
usual and customary. You are responsible for payment of
your account, regardless of any insurance companys arbitrary
determination of usual and customary fees.
you with procedures for collections, nonsufficient funds (NSF)

checks, and small-claims court.
Always note all collection efforts in your practice-management software.
Credits on patient accounts

An A/R area that gets little attention is patient credits.
Many practices are unaware of the thousands of dollars owed to
patients. These credits can make your A/R balance look better
than it is.
I recommend looking at this report on a monthly basis.
In most states, overpayments held as a credit are considered
unclaimed property. Dentists need to comply with state regulations. You must have written documentation from the patient
that you have his or her permission to keep this money as a
credit. There is also a limited period of time you can hold the
money, based on individual state regulations. I recommend that
you familiarize yourself with the guidelines in your state.
An A/R area that gets little attention

is patient credits. Many practices are
unaware of the thousands of dollars
owed to patients. These credits can
make your A/R balance look better
Collection
The financial coordinator should be working past-due
accounts on the aging report each month. Collect amounts due
as rapidly as possible and give discounts and incentives for early
payments. Use a plain envelope with a handwritten address for a
collection notice so that the patient will be curious and open it.
I recommend sending three notices before sending an
account to collection. If you are threatening collection on a pastdue account, always follow through.
Become familiar with Fair Debt Collection Practices Act.
State laws will vary. You can learn more about your state guidelines at your state attorney generals office. People there will help
than it is.
We know that patients who are current on their accounts like
your dentistry, but patients who are late tend to be more critical
of the services they received. Having a plan for controlling this
area of your practice can provide not only huge dividends, but
also happier patients. Better control with good systems is a fast
way to boost profitability and help ensure the long-term success
of your practice.
Questions for the author? Comment on this article at Dentaltown.com/magazine.aspx
Author Bio
Sandy Pardue is an internationally recognized lecturer, author and practice-management consultant. She has more than 25 years of experience
in helping doctors with practice expansion and staff development. Pardue is known for her comprehensive and interesting approach to dental
office systems, and offers a refreshing point of view on how to make a practice more efficient and productive.
86
THE LARGEST GATHERING

IN DIGITAL DENTISTRY
ARE YOU GOING?
SEPTEMBER 17-19, 2015

THE VENETIAN AND THE PALAZZO HOTEL, LAS VEGAS
www.CEREC30TH.com
general practice
column
Yoga for
Dentists
What Can This Ancient

Practice Do for Your Practice?
By David R. Hennington, DDS
All images are of Dr. Desire Walker. Walker was featured

in the June issue of Dentaltown Magazine in the article,
The Ninja Dentist Reveals Her Training Ground.
ental professionals face unique physical, mental, and

emotional challenges each day. These challenges can
create discord and imbalance, especially when theyre
combined. Contorting our bodies in order to gain
better visibility, sitting for long periods, and even hunching over our
computer keyboards can put enormous strain on our musculoskeletal
systems. Dealing with fearful patients, uncooperative team members,
and the frustrations of running a small business can sometimes become
overwhelming and lead to powerful feelings of anxiety, anger, and even
depression. Numerous coping strategies are available. One ancient remedy is my favorite and can help alleviate the detrimental effects of these
varied stressors. That remedy is the practice of yoga.
Derived from a Sanskrit word meaning to yoke together, unite, or
integrate, yoga is based on an Indian body of knowledge at least 2,000
to 3,000 years old. As yoga continues to evolve and become increasingly
diverse, it has become difficult to find a single, common definition that
can be agreed upon by all practitioners. For the purpose of this article,
yoga can be defined as the process of harmonizing the body, mind, and
breath through the coordination of various physical postures (asanas)
with specific breathing and meditation techniques.
It is this synchronization of the breath with the movement of the
body that is the basis for many of yogas benefits. Breathing in rhythm
with the poses is what separates yoga from other physical disciplines.
Without coordinated breathing, one is merely stretching. With the
breath, one is doing yoga. While a variety of breathing techniques (pranayama) can be used to accomplish specific effects, the one most commonly used is a deep, smooth inhale with an exhale of equal length. For
88
general practice
column
instance, take a deep breath for a count of

four seconds. Now exhale for four seconds.
Get into a rhythm with that. When you
start to feel yourself relaxing, expand the
inhale to five seconds, and the exhale to
five seconds. Next, try six seconds.
Deep breathing has many physical
and mental benefits. These include detoxifying the body, releasing muscle tension,
improving focus and an awareness of the
present moment, facilitating a feeling of
calm, and strengthening the lungs, heart,
and immune system. Its very simple, and
very effective.
Physical benefits
As a regular yoga practitioner for
more than 15 years, I have experienced
firsthand yogas many physical benefits.
Yoga can be used therapeutically to alleviate existing ailments and can also be
employed preventatively. Modern medical
research continues to verify the validity of
yoga as therapy to improve overall health.
Given the wear and tear our bodies experience over time as we practice dentistry,
yoga is especially beneficial for the dental
professional.
One of the obvious benefits of yoga is
improved flexibility, but the postures also
build muscle strength. That additional
muscle strength, particularly of the critical core musculature, is balanced by the
increased flexibility to help improve posture, both when sitting and when moving
through space. This, in turn, reduces strain
on the back, neck, shoulders, and other
muscles and joints, which decreases the
practitioners chance of developing future
degenerative musculoskeletal conditions.
Yoga improves blood flow by increasing your heart rate and delivering more
oxygen to your cells, which then function
better. While some styles of yoga can get
you into an aerobic target range, studies
have shown that even those that dont can
improve your cardiovascular conditioning.
Other studies have shown yogas
positive impact on a wide variety of physiologic functions, including strengthening
bones and reducing osteoporosis, lowering
blood sugar levels in diabetics, decreasing

blood pressure, boosting the functionality
of the immune and adrenal systems, and
improving sleep. In addition, because
yoga is a low-impact practice, its gentle on
joints that may be weak or compromised.
In short, yoga offers a way to counteract
Deep breathing has many physical and mental

ene ts. hese inc ude deto if in the od e easin
musc e tension im o in focus and an a a eness of
the esent moment faci itatin a fee in of ca m and
st en thenin the un s hea t and immune s stem.
or avoid many of the chronic physical conditions that are commonly seen in dental
team members.
Mental and emotional benefits

While it is the positive physical
impact that initially draws many people
to yoga, it is the mental and emotional
benefits that keep many coming back.
As yoga has evolved, the posture (asana)
component has become more emphasized. In fact, classical yoga teachings
saw the physical component as a way
Yoga poses range anywhere from as simple as

standing or sitting, all the way to complicated,
difficult poses that require athleticism and years
of practice. The difficult poses, such as the pose
demonstrated below, should only be attempted by
an experienced yogi.
89
general practice
column
to strengthen the body so that the yogi

could sit comfortably in meditation
for long periods. It was the meditative
practices that would lead to the ultimate
goal of yoga, which was a calming of the
fluctuations of the mind. As all dentists
know, there are numerous times during
our normal day when those fluctuations
lead to stress and anxiety. Yoga lowers levels of the stress hormone cortisol, leading
to greater sense of well-being and self-control. This, in turn, improves performance,
regardless of the setting.
It was the meditative practices that would lead to

the ultimate goal of yoga, which was a calming of the
uctuations of the mind.
Even such diverse groups as elite athletes and the Navy SEALS use yogic-inspired breathing techniques to lessen the
impact of stress during events and missions. Physiologically, yoga stimulates the
parasympathetic nervous system, which is
responsible for the relaxation response. This
is characterized by decreases in respiration
and heart rates, as well as blood pressure.
Another important and beneficial
component of yoga is its emphasis on the
present moment. Regular practice of yoga
and meditation can significantly improve
concentration, and this improved focus
helps practitioners decrease the chance of
reacting negatively to challenging circumstances that arise. It allows us to truly be
the calm in the eye of the storm. This
increased awareness can help us identify and break free of destructive habits
ranging from chronic anger, fear, and frustration, to addictions such as smoking.
Once we have done so, we are more likely
to experience more positive emotions, such
as gratitude, empathy, forgiveness, and
increased self-esteem.
Having practiced dentistry for more
than 25 years and yoga for more than
15, I am very familiar with not only the
physical, mental, and emotional challenges
each one of us faces daily, but also the
effectiveness of yoga in dealing with them.
Through my yoga practice, I have experienced changes in body and mind that I
never thought possible. If you are curious
about yoga, I strongly encourage you to
explore what it has to offer. You could try
public classes, private instruction, videos,
or online instruction.
I suggest trying different styles and
teachers until you find a style and teacher
that works for you. You may not like yoga
at first; it can feel uncomfortable at times.
I encourage you to try at least a few classes,
though. As your body starts to open, you
are likely to enjoy the classes more.
You can even practice yoga at work,
such as by concentrating on your breath.
You could take a break of a minute or two
just to bend forward (head toward your
feet). Let your arms hang. Let your head
and neck hang. Bend the knees slightly.
Relax and release. Dont pull. Dont strain.
Dont worry about how far you can bend.
Breathe in and out at the same rate. When
you start to feel relaxed, youve probably
gotten what you need from the break.
I hope youll experience many benefits
from yoga, and that youll also see quiet
yet positive changes in your practice, your
relationships, and your world.
Have a yoga experience to share or want to know more? Ask questions at Dentaltown.com/magazine.aspx.
Author Bio
David Hennington, DDS, has been a solo practitioner in Georgetown, Texas, since 1991. He has practiced various styles of yoga for more than
15 years and in 2012 was certified as a yoga teacher through Yoga Alliance (RYT-200). He recently participated in a podcast with Dentaltowns
founder, Howard Farran, discussing the benefits of yoga for dentists.
90
practice solutions
Seeing the True Colors
Achieving Esthetic Shade Harmony and

Consistency Across Lithium Disilicate and
Nanohybrid Composite Restorations
by Jason Olitsky,
DMD, AAACD
Dr. Jason Olitsky is the past
president of the Florida
Academy of Cosmetic Dentistry
and an accredited member
of the American Academy of
Cosmetic Dentistry. He is also
an accredited Digital Smile
Design Master and director
of esthetics and photography
with the Clinical Mastery
Series. Olitsky teaches portrait
and clinical photography and
over-the-shoulder anterior
esthetics courses with The
Clinical Mastery Series. He is
clinical adjunct faculty with
Arizona School of Dentistry
and Oral Health and a clinical
consultant with Dental Advisor.
Olitsky also owns WallSmiles.
com, a photography business
that sells clinical before and
after images, and portrait wall
art for dentists.
Olitsky is co-author of The

Naked Tooth: What Cosmetic
Dentists Dont Want You to
Know, published for the
general consumer. He publishes
on various topics of cosmetic
dentistry, has appeared in
numerous national beauty and
health magazines and serves
as product consultant for
dental product companies. He
maintains a private practice in
Ponte Vedra Beach, Florida.
92
Ensuring a harmonious shade match

among restorations and adjacent natural teeth
can sometimes be challenging, particularly
when a combination of restorative materials
(e.g., direct composite, all-ceramic) is used.
Adding to inherent shade matching challenges
is the need for composite core buildups underneath planned all-ceramic restorations.
Fortunately, a light- and dual-curing
adhesive luting composite (Variolink Esthetic,
Ivoclar Vivadent) with color-neutral shades is
available to promote esthetic cementation and
shade matching across a variety of restorations
and with natural tooth structure. Indicated
for the permanent cementation of ceramic
and composite restorations, Variolink Esthetic
facilitates precise shade matching of restorations
through its Effect shade system, an approach
that features five different shades for color-neutral cementation, but still enables brightening or
darkening of restorations, as needed.
Variolink Esthetics reactive and patented
Ivocerin light initiator, which ensures fast
and reliable curing of the material during
subsequent light polymerization, contributes
to the materials exceptional shade stability.
This unique combination of light initiator
and light sensitivity filter in Variolink Esthetic
also enables easy cleanup of excess cement
after pre-polymerization using a curing light.
Additionally, the cements viscosity controller
imparts good flow properties and stability,
allowing the material to be easily extruded
from the syringe.
Case presentation
A 34-year-old woman in good health but
with high caries risk presented with an occlusal
cavity in tooth #17, recurrent caries under existing amalgam restorations on teeth #18 and #19,
and a defective amalgam restoration on tooth
#20 (Fig. 1). Treatment options (e.g., direct or
indirect restorations) and associated risks were
discussed with the patient, and the decision was
made to restore teeth #17 and #20 using a nanohybrid bulk fill composite (Tetric EvoCeram
Fig. 1
The patient presented with an occlusal cavity in tooth

#17, recurrent caries under existing amalgam.
Bulk Fill), and perform a core buildup (Tetric

EvoCeram Bulk Fill) on teeth #18 and #19 to
ultimately support lithium disilicate (IPS e.max)
crown restorations. The existing amalgam restorations and occlusal cavity in tooth #17 were
removed, in addition to the recurrent caries in
teeth #18 and #19.
Bulk fill core buildup and restoration

Teeth #18 and #19 were prepared .5mm
subgingival to accommodate full-coverage lithium disilicate (IPS e.max) crown restorations.
A size 1 retraction cord (Ultrapack) was placed
in the gingival sulcus of teeth #18 and #19 to achieve

ideal isolation while placing the composite buildups.
A traditional Toffelmire matrix band was placed on
tooth #20 (Figs. 2 & 3). Typically the operator uses
Isodry isolation when performing subgingival crown
procedures; however, Isodry requires removal when
photographing cases.
The remaining dentin and enamel for all prepared
teeth were conditioned with 2 percent chlorhexidine
gluconate solution, and the enamel was selectively
etched using a 37 percent phosphoric acid (Total Etch).
The teeth were lightly dried with an air dryer (A-dec)
to remove excess moisture yet leave the dentin slightly
moist. A universal adhesive bonding agent (Adhese
Universal) that enables the option of leaving the dentin
dry or moist, thereby eliminating potential errors, was
applied to the preparations for 20 seconds and lightcured for 10 seconds per tooth.
A nanohybrid bulk fill composite (Tetric
EvoCeram Bulk Fill) was selected for all direct restorations. Since all cavity preparations and build-ups
were less than 4mm in depth, the composite was
placed in one increment, sculpted, and light-cured
for 10 seconds which was sufficient to ensure a complete depth of cure. Designed for fast and efficient
placement, Tetric EvoCeram Bulk Fill can be placed
in increments up to 4mm. The materials low shrinkage and low stress facilitate superior margin integrity
for predictable results, while the nanofill technology
enhances, high-gloss polish, and low wear.
The matrix band was removed from tooth #20,
and the tooth was again cured for an additional 10 seconds to ensure light penetration. The direct composite
fillings and buildups were adjusted and polished,
occlusion was checked, and the retraction cord pulled
for the quadrant impression (Fig. 4). A VPS impression
(Virtual) of the entire quadrant was then taken using
a double-sided impression tray to ensure that optimal
detail was captured for the laboratory technician (Fig.
5). Provisional restorations were placed on teeth #18
and #19, and the patient was dismissed.
practice solutions
Fig. 2
The amalgam restorations were removed and existing caries

excavated. A cord was placed on teeth #18 and #19 to ensure
optimal isolation for the bonding procedure.
Fig. 3
A traditional Toffelmire matrix band was placed on tooth #20 to

help achieve proper contours of the composite restoration.
Fig. 4
Tetric EvoCeram Bulk Fill restorative was placed in one increment throughout the entire quadrant, sculpted, cured, and
polished.
Fig. 5
Esthetic cementation of IPS e.max crowns

When the lithium disilicate restorations were
returned from the laboratory (Gold Dust Dental Lab),
the patient presented for delivery of the final restorations. The provisional restorations were removed,
and the IPS e.max crowns were tried in to verify fit
and complete seating, which was confirmed radiographically. To ensure a predictable and long-lasting
bond between the all-ceramic material and core
A double-sided impression tray technique was used with the

VPS (Virtual) impression material in order to capture accurate
marginal details.
93
practice solutions
buildup, the crowns were first cleaned with Ivoclean

and then chemically conditioned using a silanating
agent (Monobond Plus) (Fig. 6).
The patient was isolated with dry angles and
cotton while seating the final restorations. A size 1
cord was placed with Viscostat Clear to maintain an
isolated field for cementation. Teeth #18 and #19 were
cleaned with 2 percent chlorhexidine solution and
rinsed, after which the enamel was selectively etched
with 37 percent phosphoric acid (Total Etch). The
etchant was rinsed and the teeth dried with the A-dec
air drier.
Fig. 6
The internal surfaces of the restorations were cleaned with

Ivoclean for 20 seconds, rinsed and dried, an essential step
prior to placing a silane coupling agent.
Fig. 7
Variolink Esthetics reactive

and patented Ivocerin light
initiator, which ensures fast
and reliable curing of the
material during subsequent
light polymerization,
Adhese Universal was applied to the preparations and

scrubbed into each for 20 seconds each. Phosphoric acid etching is not necessary when using this universal adhesive.
Fig. 8
contributes to the
materials exceptional
shade stability.
Then, to enhance efficiency without sacrificing

bond strength, a single-component, light-cured universal adhesive (Adhese Universal) was placed onto
the preparations for 20 seconds with a scrubbing
motion to ensure adequate coating of all preparation surfaces, then air dried thoroughly with the air
drier (Figs. 7 & 8). The preparations were then light
cured for 10 seconds each with the LED curing light
(Bluephase Style) (Fig. 9).
The restorations were loaded with Variolink
Esthetic dual-cure cement and seated onto the preparations. The cement was then light-cured for three
seconds per quarter, which enabled excess to be easily
The necessary air thinning and evaporation of the dental adhesive solvent was completed using an Adec air drier to ensure
moisture and oil free air.
Fig. 9
The preparations were light-cured with an LED curing light

(Bluephase Style) for 10 seconds each. It is important to cure
the adhesive prior to placing the restoration.
Continued on p. 96
94
practice solutions
Fig.10
When the manufacturers instructions are properly followed, Variolink

Esthetic Cement will peel off the teeth with very little effort. The cement was
removed and the restorations flossed prior to placing a liquid barrier and final
curing of the restorations.
Fig.11
Immediate post-cementation, occlusal adjustment, and polishing view of the

final restorations.
removed with an explorer (Fig. 10). The restorations were flossed,

after which they were coated with a water soluble glycerin (Liquid
Skip) to prevent an oxygen inhibition layer before final curing of 20
seconds per surface. The occlusion was then checked, adjusted, and
the restorations polished (Fig. 11).
Conclusion
When placing IPS e.max lithium disilicate restorations on
composite core buildups that are also adjacent to natural teeth
and direct composite restorations, Variolink Esthetic can be used
to facilitate seamless shade matching, exceptional shade stability,
fast and reliable curing, and easy cleanup of excess cement. The
cements ideal flow and handling characteristics, as well as its durable and long-lasting bond strength, contribute to simplicity and
predictability when providing a combination of restorations in the
posterior region.
96
ad
index
ADINDEX
Our advertisers make it possible for us to bring Dentaltown to you each month free of charge. Support these advertisers
by using the reader service numbers listed below and the reply card. Also, almost all of the advertisers provide telephone
numbers in their advertisements for your convenience and fast response. Our advertisers want to hear from you.
ADVERTISER
PAGE #
CIRCLE #
ADVERTISER
PAGE #
3M ESPE Dental - Scotchbond

3M ESPE Dental - Direct Procedure
3Shape TRIOS
Accutron, Inc.
Adenna
Advertising.dental
AMD LASERS
Ashtel Dental / Owandy USA
Aseptico
Aspen Dental Management, Inc.
BISCO, Inc.
CareCredit
Carestream Dental
Comprehensive Finance
Continental Dental Laboratories
Dani Dental Studio
Demandforce, Inc.
Dental Office Lease Negotiations
DentalMarketing.net
DENTSPLY Implants
DEXIS, LLC
DryShield
First Pacific Corporation
Glidewell Laboratories
Henry Schien - Dentrix
Instrumentarium Dental
Isolite Systems
054
055
057
108
073
063
067
091
003
096
075
009
013
065
106
104
061
109
041
071
033
047
101
007
001
027
015
51
52
2
5
4
13
46
49
31
23
16
29
6
1
42
17
24
14
37
48
50
45
43
20
7
39
41
Ivoclar Vivadent, Inc.

Keller Laboratories Inc
LifeLine Sciences
LocalMed
New Patients Inc.
OperaDDS
Oral Arts Dental Labs, Inc.
Park Dental Research Corp.
Patient News
Patterson Dental
Perspectives Dental Lab
Planmeca, Inc.
Planmeca CAD/CAM - Division
Premier Dental
Premier Dental
Professional Solutions Financial Services
Ribbond, Inc.
Schick by Sirona
SecureTip
Sedation Ready, Inc.
Sirona Dental Systems - CEREC
Sunstar Americas, Inc.
Sunstar Americas, Inc.
The Scheduling Institute
VOCO America, Inc.
Zest Anchors, Inc.
CIRCLE #
IFC
011
005
111
083
045
021
069
103
051
IBC
095
023
020
099
026
112
037
105
064
087
040
019
029
BC
025
38
22
32
27
30
33
36
18
53
21
35
40
47
25
26
34
12
3
28
44
8
11
10
9
19
15
Scan the tag on the right using your smart phone for access to any additional
information you may need about an ad or visit www.dentaltown.com/rsc.
Get the free mobile app at
http:/ / gettag.mobi
97
practice management
feature
WH
YD
EN
TIS
TS
MO
BIL NEED
E-R TO B
EAD E
Y
by
Da
nL
in d
q ui
st
In
todays digital age, the way people recommend medical professionals to each other
has changed drastically. Word-of-mouth
still carries weight, but the way those words travel has
evolved. Businesses need to be mobile-ready.
According to Search Engine Watch, the landscape
in which businesses operate changed forever in early
2014, when app usage on mobile devices exceeded
Internet use on PCs for the first time.
98
practice management
feature
Tablets and mobile devices are taking over the market,

changing the course of Internet history in a way many recognize
but few are really cashing in on. Recent stats from Mobify help
illustrate this shift:
More than 1.2 billion people worldwide use their mobile
devices to access the Webthats 15 percent of all Internet
traffic.
As of 2012, 116 million Americans owned smartphones, a
figure that accounts for 58 percent of all U.S. consumers.
Mobile-based searches make up one quarter of all Internet
searches.
25.85 percent of all emails are opened on mobile phones,
and 10.16 percent are opened on tablets.
59 percent of all clicks on the confirm button in
Demandforce confirmation emails come from mobile
devices.1
Tablets and mobile devices are

taking over the market, changing
the course of Internet history in a
way many recognize but few are
really cashing in on.
Why dentists should go mobile

Pew Research Center conducted a study on how the Internet
is changing patients approach to health care. In March 2011,
their Internet and American Life Project and the California
Healthcare Foundation found that more than 80 percent of U.S.
Internet users search online for health-related information. One
of the studys most interesting findings was that 44 percent of
Internet users are actually looking for doctors and other healthcare providers when they search for health information online.
More specifically, mobile platforms can be used in multiple
facets of a dental practice. Communication methods include
sharing promotions, industry news and updates; networking;
sharing knowledge through a blog; or monitoring reviews and
feedback. And as we all know, social media is also an affordable
way to advertise your practice, as its often a free marketing
medium with reach that far exceeds your standard bus bench or
local magazine.
99
practice management
feature
These reviews are then syndicated across the Web to

build your practice a strong online reputation and
leverage network marketing. Having real reviews
and the ability to book an online appointment
right from their mobile device will help turn visitors to your pagewhether on Yelp, Citysearch or
Facebookinto new patients.
If your practice already has a website,

does it really need a mobile presence?
What kinds of mobile platforms should

dentists use?
When it comes to searching for businesses and services,
apps such as Yelp and Foursquare are hugely popular for driving
awareness of your practice and attracting potential patients.
According to Digital Marketing Ramblings, Yelp has 139
million unique visitors per month, and 59 percent of all Yelp
searches come from mobile devices. There are currently more
than 67 million reviews on Yelp, and 35 percent of those were
made from mobile devices alone.
According to Foursquare, more than 50 million people
use its app when theyre figuring out their plans for the day.
The mobile app offers users a personalized, local-search
experience. Essentially, it learns what users like and makes
recommendations based on their tastes and preferences, ratings theyve applied to similar businesses, and other users
feedback. While Foursquare is particularly popular for
restaurants and similar venues, many medical professionals
have had success on the platform.
Additionally, some services can provide your practice with
affordable and easy access to tools that will ensure your current
and prospective patients have a positive interaction with your
practice on their mobile device.
Demandforce, for instance, sends mobile-ready emails
that fit to the device on which theyre being viewed, as well as
enabling patients to easily book future appointments and provide feedback. Such solutions also automate review collection.
100
Its important to note that mobile websites are

different from regular websites, which are usually
designed for large desktop and laptop screens.
Viewing sites on a mobile screen is a much different
experience than viewing on a computer screen.
Without a mobile-friendly site, patients visiting
your page may experience too much unnecessary
scrolling, buttons that are too small, text that is too
tiny, drop-down menus that dont work, etc. These
issues are likely to drive visitors away from your page.
A great way to start is to understand what your
current website looks like on popular smartphone
screens. Sites such as DeviceAnywhere and Perfecto
Mobile let you test and preview your website on
different screens, for free. These previews can help you visualize
your mobile issues on different devices and guide your decisions
for making changes.
If you discover that you need to convert your existing site to
be more mobile-friendly, check out solutions like bMobilized,
Duda, and ProSites.
Make your practice easy to find

Having an attractive and easy-to-use mobile site wont be of
much use if people cant find you online in the first place. For
this reason, consider creating a Google+ page for your practice.
Why? Because its essential for boosting your ranking on Googles
search engine. By strategically optimizing a complete Google+
profile, you will ensure that Googles billions of users will have an
easier time finding your business.
Heres how to do it:
Make sure to include all relevant business information,
especially your location and URL, in your profile.
Remember to include your hours, directions and the best
places to park.
Post updates and news, and respond to comments or
questions.
Upload photos and videos.
Ask patients to write organic Google reviews on your page.
Services like Demandforce can make this even simpler, with
premade email templates sent to patients, directing them to
your Google+ page to post a review.
practice management
feature
Connect with your patients in more ways than one

A mobile presence not only makes your practice easier to
find, but also allows you to better cultivate a community of
patients and supporters.
No amount of advertising and marketing can match the
impact that positive testimonials have on new patients. Positive
testimonials help build trust, loyalty and respect for your practice. The goal in creating a mobile presence for your practice
remains the same: to create an easy-to-reach community built on
these values.
Mobile marketing is not just an extension of that community; its also an expansion of that community. For example, after
every visit Demandforce sends Thank You emails, requesting
feedback. And without requiring the patients to log in, they can
leave a review that is automatically syndicated to sites such as
Bing, Citysearch and Facebook.
Ultimately, making your practice mobile-ready will allow
you to always put your best foot forward, which enables you
to improve your patients overall experience every time they
walk through your door. After all, youve dedicated your life to
improving your patients smiles, so give them something to smile
about by placing your practice in the palm of their hands.
References
1. http://www.mobify.com/blog/13-stats-to-convince-your-boss-to-invest-in-mobile-in-2013/
How mobile-friendly is your practice? Let us know at Dentaltown.com/magazine.aspx.
Author Bio
Dan Lindquist has a decade of tech-industry experience between Yahoo! and Demandforce, where he currently manages the digital communi-
cations platform. He holds an MBA from the Kellogg School of Management and has also worked as a consultant at Deloitte Consulting, where
he advised companies on their product-development and technology strategies.
101
radiology
feature
Rehabilitation Case
with CAD/CAM Design and
Excellent
Results
Introduction
by Abraham E. Stein, DMD MS

and Luke S. Kahng, CDT
102
Our female patient presented with a

number of issues regarding her smile that
she was interested in solving. During a
diagnostic appointment with her dentist
she requested help with the situation. Upon
examination, he diagnosed the following:
#4 and 5 had failing crowns with
caries at the margins
#6 had a large abfraction lesion and
caries on the distal
#7 had a periapical abscess and was
nonrestorable
#8 and 9 had failing composites and

poor aesthetics
#11 and 13 had advanced caries and
were nonrestorable.
The treatment plan would involve
implants on #7, 11 and 13, with a zirconia
abutment on #7 and 11 and a titanium
abutment on #13. Tooth #12 was missing
and would serve as the pontic for the
bridge between #11 and 13. All other indicated teeth would be prepped for singleunit crowns.
Continued on p. 104
radiology
feature
Fig. 1
Case study
A preoperative photograph illustrates
the above outlined areas of concern (Fig.
1), most noticeably the old composites
and discoloration on the centrals 8 and 9.
Teeth #7, 11 and 13 had been extracted
and NobelActive implants placed with
healing abutments. Once healing had
been completed postsurgery, the dentist
took an impression and ordered a wax-up
as a guide for treatment to repair the
occlusion and aesthetics.
Once that had been accomplished
during the preparation visit, crowns on #4
and 5 were sectioned off, and teeth #4-10
were prepared for all-ceramic crowns.
The dentist photographed a retracted
Fig. 2
Preoperative
Fig. 3
Post-preparation, retracted
Occlusion view
104
radiology
feature
Fig. 4
view after the patient was fully prepped

for implant and single-unit zirconia with
layered porcelain crowns on #4, 5, 6, 8, 9
and 10, as well as a bridge for #11-13 (Fig.
2). An occlusion view of the model, showing preparation from bicuspid to bicuspid, with zirconia implants on #7 and 11,
and a custom titanium implant abutment
on #13, follows (Fig. 3). The patient left
the office with provisionals from #4-10.
The model was scanned digitally
(Fig. 4) via CAD/CAM, DOF Freedom
Scanner. After the scan and design process was completed, seven zirconia (Fig.
5) single copings and one three-unit
bridge were milled, using the Amann
Girrbach Ceramill Motion 2 milling
machine, in-house. The zirconia-frame
design stage is an important step in this
process, especially with a multi-unit
case. The lingual occlusal area has to be
well-supported in order for it to function
properly, with longevity in mind. The
full-contour single unit and three-unit
bridge copings were then placed on the
model after sintering for a fit and appearance check (Fig. 6). Multiple colors are
possible within the product offering
range, as shown in this image. After
firing at 1,450C for approximately four
to six hours, the copings then needed to
cool for another two to three hours.
The bridge, polished and finished,
was next tried on the model (Figs. 7 &
8) and photographed. Number 7, an
CAD/CAM scan and design/Freedom Scanner
Fig. 5
Post-milling, copings
Fig. 6
Fit and appearance check
Fig. 7
Implant bridge try-on the model (Figs. 7, 8)
Fig. 8
105
radiology
feature
implant crown with a custom zirconia

abutment with titanium connection, was
partially tried on the model (Fig. 9) and
then fully seated (Fig. 10) to check the
fit. The completed restorations were photographed on the model (Figs. 11 & 12),
before a retracted view was taken in the
mouth (Fig. 13). Abutments were torqued
to 30Ncm and sealed with Teflon/Fermit.
Please note the Golden Proportion of
teeth with a perfect match both vertically
and horizontally in the premolar buccal
corridor. The symmetry is perfectly
Fig. 9
Partial try-in, number 7
106
radiology
feature
Fig. 10
Fig. 13
Seated
aligned between teeth #4 and 5 as well as

#12 and 13.
Next we have an immediate natural
smile view post-cementation (Fig. 14) as
well as a rest position image (Fig. 15). The
patient was pleased with the final results.
Fig. 11
Retracted
Fig. 14
Conclusion
From the authors viewpoint, we
must evaluate and improve the patients
smile pre-operatively during the planning
stage. That is where the knowledge and
expertise combined between the dentist
and the technician will work together
to deliver the best possible results to the
patient. We can consider the color, size
and shape of teeth by checking our frame
design for full support and building it
with porcelain in a way that will enhance
the patients appearance. Our knowledge
of occlusion will help us create a bright
smile to rehabilitate the patients overall
function and appearance. When we work
together in this way, the dentist, patient
and technician can all be happy with the
results we achieve.
Finished restorations, on the model (Figs. 11, 12)

Fig. 12
Post-cementation, natural smile

Fig. 15
Rest position
Questions for the authors? Comment online at www.dentaltown.com/Dentaltown/magazine.aspx
Author Bio
Luke S. Kahng, CDT, is a world-renowned master ceramist, as well as owner and operating director of LSK121 Oral Prosthetics. He lectures
nationally up to 10 times per year, and has published more than 100 educational articles in professional dental journals, written six hardcover
books, and created approximately 55 instructional YouTube videos involving dental cases. He serves as a board member for Spectrum Dialogue,
Teamwork, Inside Dental Technology and Dental Lab Products.
Dr. Abraham E. Stein received his dental degree from Southern Illinois University School of Dental Medicine. He went on to complete his prosthodontic residency training at The Ohio State University. He has a passion for dentistry and delivering the highest-quality care to all of his
patients. Dr. Stein is a prosthodontist, one of the nine specialties recognized by the American Dental Association. He has special training in
restorative, implant, and esthetic dentistry. He was the recipient of the American Academy of Esthetic Dentistry and the American College of
Prosthodontist awards. He lectures nationally and is published in the International Journal of Oral and Maxillofacial Implants.
107
industry
news
Industry News
The Industry News section helps keep you informed and up to date about whats happening in the dental profession. If
there is information you would like to share in this section, please email your news releases to arselia@farranmedia.com.
All material is subject to editing and space availability.
www.dentaltown.com
American Academy of Periodontology to Hold its 101st Annual Meeting in Orlando

The American Academy of Periodontology (AAP) will hold its 101st Annual Meeting from November 14-17, 2015, at
the Gaylord Palms Resort & Convention Center in Orlando. Offering more than 25 hours of continuing education credits,
the meeting provides more than 40 different courses relevant to periodontal care, including treatment technique advances,
emerging technologies, scientific advancements, practice development and management, clinical applications, and more.
Attendees of the annual meeting can choose from a diverse selection of programming organized into eight program
tracks that focus on various aspects of periodontics. In addition, the corporate forums will feature presentations from
leading periodontal vendors, and the exhibit hall will feature more than 150 companies showcasing the latest industry
products and services. To register for the 2015 meeting or for more information, visit Perio.org/meetings, or call (800)
282-4867, ext. 3213.
108
industry
news
ACE Dental Integrates with DoseSpots Dental e-Prescribing Platform

DoseSpot, which provides an e-prescribing integration platform for medical, dental and telehealth software, announced that ACE Dental, a
provider of dental-practice management software and patient communications, has successfully integrated the DoseSpot platform. ACE Dental
chose DoseSpot Dental to meet its computer-generated prescribing (e-prescribing) needs and expand its product offering. This combination
offers dentists the ability to route e-prescriptions to the patients pharmacy of choice after automatically checking for any drug/drug and drug/
allergy interactions. For more information on DoseSpots software, visit DoseSpot.com/platforms.
Wrigley Oral Healthcare Program Launches New

Resources for Dental Professionals
The Wrigley Oral Healthcare Programs new resources,
designed to give dental professionals tips and insights to make
the patient experience more enjoyable, may ultimately help
dentists grow their practices. The Wrigley Oral Healthcare
Program has a long-standing commitment to partner with
dental professionals.
Program members will benefit from monthly emails featuring exclusive insights on what patients want, fresh ideas
and helpful tips on how to build stronger patient relationships, advice on how to communicate between visits, and stories from successful practices.
These new resources from the Wrigley Oral Healthcare
Program utilize research the company conducted in 2015 with
more than 2,000 dental professionals and patients to learn
more about what patients are looking for in a dental visit. Dental professionals can visit Wrigleyoralhealth.com to enroll in
the program.
Flax Dental Offers Scholarships to Students Pursuing

a Dentistry Career
Flax Dental, an Atlanta-based cosmetic and restorative dental
practice is investing in the next generation through the Knowledge
Matters Flax Dental Scholarship Program.
Flax Dental will award two scholarships in the amount of
$500 each to students pursuing a dental assistant program or dental hygiene program. In addition, Flax Dental is also offering a
$1,700 scholarship through the American Academy of Cosmetic
Dentistry (AACD) Apex scholarship program, which sends students to AACDs Annual Scientific Session to learn from the cosmetic dental worlds educators.
Visit the Flax Dental scholarship page: Flaxdental.com/
flax-dental-scholarship.
The Digital Dental Record Offers HIPAACompliant Secure Email

The Digital Dental Record, known for providing solutions
that optimize the digital workflow of dental offices, now offers
HIPAA-compliant, secure email from Hightail, an email
platform that allows dental offices to send patient health
information securely between providers, specialists and patients.
The unique partnership between the Digital Dental Record
and Hightail provides dental professionals the opportunity
to purchase an enterprise-level solution at a discounted rate
compared to other products in the dental market. Hightail is
capable of sending all patient information (i.e., forms, charts
and large diagnostic images), and also comes equipped with
custom branding, unlimited storage, e-signature capabilities,
Outlook integration and the capacity to share any file up to
500GB in size.
For more information, call (800) 243-4675 or email info@
dentalrecord.com to add secure email to your office.
109
product profile
feature
LocalMed
Can your patients schedule when it is
convenient for them, or only when you are
able to answer the phone? Are potential
patients choosing other ofces because you
are not making it easy? Do you want to make
scheduling easy for your patients, and ll up
more of your chair time? LocalMed can help.
What is LocalMed?
LocalMed is the first online scheduling platform that allows patients to
view accurate, real-time availabilities and book confirmed appointments,
24/7. In the same way you currently schedule, our system offers different
time slots based on appointment types. You select which appointment types
and chairs you want to make available; we take care of the rest.
How does it work?

By connecting with your existing practice management system, we can
read, display and fill your availabilities in real time. This is not a request system. Once an appointment is booked online by a patient, it is automatically
uploaded into your schedule.
Bring patient convenience to your practice

While online scheduling is standard for just about every other industry,
dental scheduling was often considered too complicated. But we thought,
Why can we book a flight across the country, but patients still cant schedule
a routine exam or cleaning?
The answer is that dental scheduling is like a jigsaw puzzle. Scheduling
involves a complex series of steps that differ for every practice, and in many
cases different plans for different days within the same practice. We saw this
missing piece in the dental industry and we have spent the past three years
building LocalMed to handle these complexities.
Putting it into perspective

More than 40 percent of appointments scheduled on our platform are
made when the office is closed. This means those patients likely had no way to
schedule during regular hours and, without an after-hours alternative, would
likely have found another provider instead. The loss of just one new patient
110
a month could cost the average practice more than

$10,000 a year in revenue.
Where do patients go to schedule?

The LocalMed Schedule Online widget brings real-time scheduling capabilities to multiple platforms. Adding our widget to your website and Facebook
page makes it easy for patients to view your providers, compare availabilities,
and book confirmed appointments. In addition, patients can schedule through
localmed.com and several dental insurance directories on partner sites. Our goal
is to bring real-time scheduling everywhere patients search, day or night.
No hidden fees, no long-term contract

We dont believe in locking our clients into long-term contracts, so we
work to earn your business every month. We let our dentists try LocalMed free
for the first month, and give them the option to cancel at any time. Our low
monthly fee includes:
Widget functionality on multiple websites, including your own
Customizable provider profile on localmed.com and partner sites
Staff training session
Personal support representative.
Bottom line: We make scheduling easy for

patients and more efcient for practices
A successful dental practice is not just about being a good dentistit is
also about running a business. Making it easier for your clients to schedule their
appointments will help make your business more accessible and help increase
your bottom line. Visit LocalMed.com/dentists, or call (225) 590-3054 today to
learn more.
dentally incorrect
feature
HOW FAR WEVE COME sorta

The last hundred years have given us more advancements than
the Panama-Pacific International Exposition, was a celebration
the previous thousand. Maybe. That sounds about right right? Its
to commemorate the completion of the Panama Canal and a
hard to argue when you take into account marvels like the pop-up
chance for the city to show its rebound after the disastrous 1906
toaster, the Commodore 64, the Leatherman multi-tool, and those
earthquake that killed 3,000 people and destroyed 80 percent of
battery-operated fans you can wear around your neck.
the city.
But to truly appreciate where we are today, you must first look
Now
back and see how much has changed in the last hundred years.
More people line up on Black Friday to risk human stampedes for a
Thats why weve compiled a snapshot of notable events and
sliver of a chance at scoring an off-brand, 50-inch TV.
inventions hailing from 1915 to serve as a reminder of just how far

weve come sorta.
A hundred years ago

AT&T became the first corporation to have one million
stockholders.
A hundred years ago

The first wireless message was sent from a moving train to a station.
Now
Now
There are more than five million people per second complaining
You can anonymously leave a mean comment on your sister-in-
about their cellphones via their cellphones to other peoples
laws YouTube video while sitting on the toilet at work.
cellphones.
A hundred years ago
A hundred years ago
The First Worlds Fair in San Francisco, otherwise known as
Dinosaur National Monument was established in Colorado and

Utah and serves as the first place in the United States where
visitors can see the splendor of dino remains still embedded in
rocks.
Now
Someone just paid $200 on eBay for a piece of gum still
Dont want it to break?

Use Ribbond.
Ribbonds super tough bulletproof fibers and patented

lock-stitch weave make Ribbonds fracture toughness
unsurpassed.
Periodontal Splints
embedded in a foil wrapper that supposedly came out of a

Kardashians mouth.
A hundred years ago
Joseph E. Carberry set an altitude record of 11,690 feet in a fixedwing aircraft.
Now
The miracle of human aviation is often reduced to arguing
the expiration date on your drink coupon with a grumpy flight
attendant, and silently willing the person in front of you not to lean
Apply Composite
Adapt Fibers
Finished Splint
Single-Visit Bridges
back in his seat.

A hundred years ago
Pluto, 4.67 billion miles away, is photographed for the
first time.
Before
Ribbond Framework
Exceptional durability
Superior ease of use
Virtually no memory
Completed Bridge
Proven history of success

Indefinite shelf life
Does not unravel
Now
Pluto, your neighbors chow chow, is photographed 50 times a day,
and the images are distributed over Facebook and subsequently
onto your news feed so often youve come to despise your
neighbor and that fluffy, unphotogenic mutt. Pluto is no longer
Sold directly by
Ribbond, Inc.
Ref. - 3/15
considered a planet, and some people on your news feed no
800-624-4554
Videos and more at www.ribbond.com
112
longer consider a chow to be a dog.
ribbond@ribbond.com
Note: Almost everything here is a work of fiction or loosely based on facts.
DenTech China 2015 210x285mm-EN.pdf 1 15/7/10 3:03
DENTECH CHINA 2015

The 19th China Intl
Exhibition & Symposium
on Dental Equipment,
Technology & Products
2015 China Shanghai International Conference on Prosthodontics
The 9th Asian Dental Lab Outsourcing Exhibition
October 21~24, 2015

C
Shanghai World Expo Exhibition and Convention Center

Shanghai, China
CM
MY
CY
1994~2015
CMY
DenTech China
EARLIEST & LARGEST IN CHINA
I am interested in DenTech China 2015, please send me more information on
295 EAST SWEDESFORD ROAD

STE 283
WAYNE, PA 19087
855.304.0133 | digitaldesignsdentallab.com
Innovative Solutions
For Your Practice
G
TM
IN
TR
O
DU
CI
N
DIGITAL DESIGNS
FULL CONTOUR
ZIRCONIA CROWN
Digital Designs Dental Lab and Mother Nature

have partnered to offer you the best in aesthetic
posterior restorations.
The Zr-40 has a simple clinical
protocol requiring as little as
0.5 to 1.0 tooth reduction yet
impressive strength and durability
with the vitality of natu
natural dentition.
$ 89
Looks like a
Look
natural
natu tooth.
Preps like
li gold.
La like a PFM.
Lasts
69
LETS GET STARTED TODAY!
855.304.0133
FIRST ZIRCONIA CROWN IS FREE !

FREE SHIPPING & DELIVERY
DT_Perspectives_0815.indd 1
8/4/15 8:17 AM
NO MORE SLUMPING
OUT OF CLASS VS!
[ conventional flow ]
83% filled means up to 50% more fillers than weaker

regular flowable composites. The new universal
GrandioSO Heavy Flow gives you the high wear resistance
only achieved by modern universal composites.
Highly viscous does not slump,
easily manipulated when needed
Heavy Flow
The rst owable composite that
is strong enough for occlusal surfaces
of class l and ll restorations.
Only 2.99% vol. shrinkage*

High radiopacity for easy x-ray identication
12 shades are available in non dripping syringes
or unit dose caps including A5 for geriatric dentistry
Excellent polish and polish retention
*Data on le
Learn more and order your
FREE SAMPLE
at www.vocoamerica.com
Call 1-888-658-2584
VOCO 1245 Rosemont Drive Suite 140 Indian Land, SC 29707 www.vocoamerica.com infousa@voco.com

Dentaltown 2015august

Hochgeladen von

Dokumentinformationen

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Dentaltown 2015august

Hochgeladen von

Copyright:

Verfügbare Formate

Are You Preparing Properly for Retirement?

See Our Financial Package Starting on page 52

The Three Dimensions

Implant Drivers and

CE: Stick With It:

Adhesive Cementation System

Exceptional handling and easy clean-up

Try Variolink Esthetic today for FREE!

100% CUSTOMER SATISFACTION

Call us toll free at 1-800-533-6825 in the U.S., 1-800-263-8182 in Canada.

The adhesive cement for exceptional

Running a successful practice can feel overwhelming. You have

Dentrix is a proud winner of the 2014 Townie Choice Awards

Best Periodontal Charting for Dentrix

FREE FACTS, circle 7 on card

Increase yours with Dentaltown.coms online CE.

The Three Dimensions

Do You Need to Retire Your Views

Finding the Hidden Treasure: Prevention =

Dr. Howard Farran, publisher of Dentaltown

Hygienist Barbara Vugteveen writes about how

Product Perfection is Not Guaranteed

Implant Drivers and Driver Tips for

Dr. Thomas iacobbi, Dentaltown editorial

5 Strategies for Maximizing

Jay Geier explains how to enhance your

Most successful dentists are in the top 1 percent

AUGUST 2015 // dentaltown.com

Are the Top 1 Percent Safe?

FREE FACTS, circle 31 on card

Debt-Repayment Basics for Dentists

Establishing an Accounts Receivable System

Well-known Townie and practice-management

AUGUST 2015 // dentaltown.com

FREE FACTS, circle 32 on card

EDI TORIAL ADVISORY BOARD

AUGUST 2015 // dentaltown.com

Lee Ann Brady, DMD

Cari Callaway-Nelson, DDS

Doug Carlsen, DDS

Howard M. Chasolen, DMD

Linda Douglas, RDH

Joshua Halderman, DDS

Glenn Hanf, DMD, FAGD, PC

William Kisker, DMD, FAGD, MaCCS

John Nosti, DMD, FAGD, FACE

Jay Reznick, DMD, MD

Elizabeth Fleming, DDS

Donald Roman, DMD, AFAAID

Seth Gibree, DMD, FAGD

Timothy Tishler, DDS

Stephen Glass, DDS, FAGD

Brian Gurinsky, DDS, MS

Eyad Haidar, DMD

Glenn Van As, BSc, DMD

Fayette Williams, DDS

Josh Wren, DMD

19992015 Dentaltown.com, LLC. All rights reserved. Printed in the USA.

FREE FACTS, circle 20 on card

Three Percent Can Retire at 60

planning) to help doctors work toward early retirement.

The doc needs help identifying the implants

Download the App