Professional Documents
Culture Documents
ALL ABOUT
ZIRCONIA
Dr. John O. Burgess explains what it is,
how to use it, and which one goes where
p. 62
In This
Issue
10
On Dentaltown.com
18
Continuing
12 | Howard Speaks 62 | ALL ABOUT 89 | SPRING PRODUCT
Education Update
GETTING MORE ZIRCONIA SHOWCASE
OUT OF DENTISTRY
22 Howard Farran, founder of
Dr. John O. Burgess explains
the differences between
Dentaltown introduces more
than 30 new and redesigned
Live CE Events: Dentaltown magazine, shares zirconia materials, and when products and services that
Travel and Learn the importance of discussing each should be used. recently have launched in the
fi nances with patients and dental market.
24
how dentists can get their
current customers to buy more.
Industry News
26 16 | Professional Courtesy
GOODWILL HUNTING
Poll
Dr. Thomas Giacobbi, Dentaltown editorial director, shares the importance of building goodwill in
the dental practice.
Dr. Matthew F. Bickel walks readers through a recent two-implant sinus lift.
54 | FIXED-IMPLANT REHABILITATION
Drs. Andonis Terezides and Sundeep Rawal share their concept for fi xed mandibu-
lar full-arch rehabilitation.
76 | CLEAR UP COMMUNICATION
BOTTOM LINE Need more Dentaltown? Don’t miss the opportunity to have the most
DENTALTOWN.COM clinical and business-savvy information at the touch of your fingertips.
In This
Issue
88 eff randfield and Dale illerton of The Lease oach discuss the dos and don ts of
renewing a lease for your dental practice.
Ad Index
Dentally Incorrect
MESSAGE
BOARDS
48
they’ve been pleased to make.
MYSELF HYPED UP
ABOUT AN EXT.
A Townie looks for tips on a
molar extraction.
2018 Farran Media LLC. All rights reserved. Printed in the USA.
©
No article appearing in Dentaltown may be reproduced in any manner or format without the express written permission of Farran Media.
Dentaltown.com message board content is owned solely by Farran Media and may not be reproduced in any manner or format without its express written consent.
Farran Media makes reasonable effort to report clinical information and manufacturer’s product news accurately, but does not assume and disclaims any responsibility
for typographical errors, accuracy, completeness or validity of product claims. Neither Farran Media nor 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 Farran Media, Dentaltown.com or the publishers.
The Dentaltown.com “Townie Poll” is a voluntary survey and is not scientifically projectable to any other population. Surveys are presented to give Dentaltown.com 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. Email: sam@farranmedia.com or hop online at
dentaltown.com/magazine.
Dentaltown (ISSN 1555-404X) is published monthly on a controlled/complimentary basis by Farran Media LLC, 9633 S. 48th St., Suite 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., Suite 200, Phoenix, AZ 85044
Message Boards
New Giant Practice Down the Street! Panic Level?
Just two years into practice, this doc learns that a new practice is opening
up a half a mile down the street. How should this Townie prepare?
Giant Practice
Case Presentation
Losing Bone
Why Am I Losing Bone Here?
A doc second-guesses himself after an
implant shows signs of failure. Townies
weigh in on what could have gone wrong.
Online CE
Connect with Us
Composite Bridges the “dkdocterry” Way by Dr. Terry Shaw
Anterior missing teeth can be a conundrum. Do you do a Maryland Bridge,
a flipper partial, implant or conventional fixed bridge? For the past 25 years
Receive Dentaltown e-Newsletters
dentaltown.com/myprofile.aspx Shaw has been doing composite bridges with excellent success. This course
reviews how composite bridges are a great solution for post-ortho patients
missing anterior teeth until they’re are old enough for implants, seniors on a
limited budget, and other patients.
rehab not just once a year, but once a month. full-mouth rehab costs about as much as a new
They have $2 million, $3 million, $4 million car—and in 2016 Americans bought more than
practices, located in the same medical/dental 17.5 million new cars, at an average cost of
building as those other dentists who’ll never more than $35,000. If you tell me there’s no
do a $35,000 case in their life. money in your community, I’ll walk out into
If you have a PPO-only practice and your parking lot and say, “So how did these
say, “Everybody’s only going to take what people buy all these cars?” America has money!
the insurance pays in the yearly max,” your When I see dentists who are on PPO
lack of success is a mind game. If you believe treadmills, working in dental factories, it
that, I can’t change your mind—but I can looks like they’re running up a mudslide.
call you on your own hooey. The average They’re not getting anywhere, doing fillings
all day long and barely breaking even, and
doing cleanings for a loss. The energy just
drains out of them.
See Howard Live! It’s time to crank it up a notch
Howard Farran, DDS, MBA, is an international speaker who
I want to talk about energy. The older I get
has written books and dozens of articles. To schedule Howard
and the more practices I observe, I’ve realized
to speak at your next national, state or local dental meeting,
email rebecca@farranmedia.com. that people who work fewer hours are usually
more productive, because they’re going faster
Goodwill Hunting
L.L. Bean is one of the greatest retail companies a crown that fell off after six months would not be
of all time. Even if its “woodsy Maine” style doesn’t fit unreasonable. Every procedure we complete has some
in your closet, you have to respect the company’s total expectation for success. How you handle a case that
commitment to customer satisfaction. The company did not meet your expectations or the patient’s will
had an unconditional satisfaction guarantee have a huge impact on the growth of goodwill.
in place for more than 100 years with a When you have to redo a procedure, it’s an
lifetime return policy. The founder, opportunity to learn a valuable lesson
Leon Leonwood Bean, launched the the same way L.L. did more than a
policy when the majority of his first century ago.
batch of hunting shoes fell apart. Growing goodwill in your
Bean not only fixed the boots but practice is not just about pro-
also refunded each customer. viding a warranty or standing
This move generated tremendous by the quality of your work; it
goodwill with customers and led can be as simple as staying on
to a better boot the second time schedule, calling patients after
around. treatment or sending a thank-you
Recently, L.L. Bean announced an note for a referral. A happy dental
end to this generous return policy, because team will keep your patients happy, and
of growing fraud. Over the past five years the happy patients will give some goodwill back to
company lost more than $250 million to items returned you with a positive review. Building this intangible
in such poor quality they could only be sent to a landfill. goodwill adds value to your practice and ensures that
How did they lose a quarter of a billion dollars in just you will have loyal patients. It is a well-known fact that
five years? Some people took advantage of the company retaining your existing patients is less expensive than
by returning items they purchased at a thrift store or replacing them with new patients. You can then grow
found in their attic decades after purchase. Others your practice with referrals from your happy patients.
would treat the policy as an annual opportunity to trade This added value is important when it’s time to sell
their purchase for the latest model. Now, shoppers will your practice.
have just one year from the time of purchase to make a I don’t want to overstate the financial value of your
return. It was only a matter of days before an individual goodwill when you retire, but I will say that having
claiming to be “a loyal customer” filed a lawsuit. Last goodwill in your practice can make it much easier to
time I checked, loyal customers wouldn’t want their get up and go to work in the morning. There will also
favorite store to go out of business because buffoons are be times when you need to spend some of that goodwill,
taking advantage of their generosity. I digress. such as when your schedule is running behind, a lab
Getting back to the business of case is delayed or a tooth is sensitive after it was filled.
dentistry, this story begs the question: Therefore, my best advice is to pay attention to the
How do you generate goodwill with many ways you can grow the goodwill balance in your
the patients in your practice? Whether practice. Spend it wisely and be sure you have some left
you realize it or not, goodwill is in the account when you sell your practice.
something you should be generating Please feel free to comment on this article online
every day. A lifetime warranty on a at Dentaltown.com. You can follow me on Twitter
crown would be absurd, but replacing @ddsTom and email me at tom@dentaltown.com. ■
The Townie Meeting 2017 Series your dental office. Pulp therapy and stainless
The Townie Meeting 2017 series contains steel crowns are often considered complex when
13 courses from the meeting’s excellent performed on pediatric patients; this course will
speakers, including Drs. Cory Glenn, David alleviate any fear of the unknown that leads
Hornbrook, Art Volker, Bruce Baird, Anne to this misconception. Indirect pulp therapy,
Koch, Tarun Agarwal, Mark Murphy, Steve pulpotomy and pulpectomy are discussed,
Rasner and Mac Lee. You can also enjoy with emphasis on diagnosis and technique.
courses from Vicki McManus, Fred Joyal, The procedural steps for stainless steel crowns
Paul Edwards and Joleen Jackson. Together, are explained and shown, as well as Wren’s
these courses provide 25 hours of excellent process for using nitrous oxide, appropriate
education in both clinical dentistry and topical anesthesia and local anesthesia.
practice management.
Everyone who attended Townie Meeting Improving Case Acceptance
2017 can access these courses for free. If you by Dr. Mark Murphy
missed the meeting, don’t worry: It’s only $295 Helping patients want what we know they
to receive these 25 hours of CE credits. (But need drives the economic and reward engines
be sure to sign up for Townie Meeting 2018!) of our practices. Help patients have better
health, do more of the dentistry that fulfills
Dental Implants: Tips and Tricks and stimulates you, and be more successful
by Dr. Cory Glenn in your practice. This course demonstrates
Dental implants are a reliable option to how to improve the educational value of the
replace missing teeth, but at times can seem examination experience and how to overcome
unnecessarily complex and cost-prohibitive. the “insurance entitlement” behavior that
By utilizing some simple techniques such as patients often exhibit.
model-based guides, and learning basic implant
lab work, clinicians can make many cases more Composite Full-Mouth
predictable and profitable. Rehabilitations
the “dkdocterry” Way
Pediatric Dentistry: by Dr. Terry Shaw
Anesthesia, Pulp Therapy For the past 25 years, Shaw
and Stainless Steel Crowns has been doing composite bridges with excellent
by Dr. Josh Wren success. Bridges provide a great solution for
When the Affordable Care Act mandated post-ortho missing anterior teeth until the
dental coverage as an essential health care benefit patient is old enough for an implant, seniors on
for those 19 and younger, millions of pediatric a limited budget, or a fast solution for someone
patients were added to 150,000 dental practices. waiting for bone healing and remodeling before
Treating children likely became a necessity for more definitive treatment.
Full-Arch Implant Supported Zirconia help manage dental caries. This course will present indications
by Pinhas Adar and Dr. John Heimke for these materials, including using them as liners, bases, sealants
Implant-supported hybrid appliances have proven to be an and restorations for root caries and noncarious cervical lesions.
exceptional and highly specialized treatment option for patients Differences between traditional glass ionomers and resin-modified
with non-restorable teeth or existing edentulism. This presentation glass ionomers will be discussed.
will stress the importance of treatment planning, CAD/CAM
technology and the need for the laboratory technician’s human Next Level Endodontics:
touch. Surgical aspects, provisionals during healing, management The Expanding Role of Vital Pulp Therapy
of soft tissues and the protocol for final fabrication are discussed. by Dr. Martin Trope
New knowledge and materials may allow us more predictability
Silver Is the New Black: Improving Your Practice in vital pulp therapy in cariously exposed teeth. This course proposes
with Silver Diamine Fluoride a protocol for the treatment of carious exposures that expands vital
by Dr. Jeanette MacLean pulp therapy in the endodontic treatment of vital teeth.
Silver diamine fluoride is a revolutionary approach to combating
caries in an effective and noninvasive manner. Discover the history Fundamentals of Fixed Prosthodontics
and science behind this powerful oral medicine that recently received by Dr. Lane Ochi
the prestigious FDA “breakthrough therapy” designation and learn Successfully treating patients with fixed prosthodontics requires
how to successfully incorporate this caries management treatment a mastery of materials and mechanical concepts, as well as a respect
into your clinical practice today, including restorative options. for tooth structure. We need to be aware of the interactions between
preparation design, margin configuration, core buildups or posts,
The Top 10 List for an Emergency Kit: and the luting agent. After viewing this course, you’ll be able to
Color Coding identify the causes of failures and prevent them from recurring.
by Dr. Daniel Pompa
This course describes the essential drugs needed Avoiding Burnout: Use SMARTER
for an emergency kit and how to use them according Systems to Work Less, Make More
to color coding the medical emergencies. It also addresses how and Enjoy Practice Again
dentists can recognize the early signs and symptoms of potential by Dr. Chris Griffin
crisis situations. We all struggle. Burnout is an increasing problem
in our industry, and it’s not going away. Learn to apply Griffin’s
Improving Your Confidence and Competence “SMARTER systems” framework to create a practice that makes
in Office Oral Surgery: Atraumatic Surgical your dream lifestyle possible and experience the freedom of having
Extractions, Flaps and Splitting Teeth options. The system’s only goal is to help you work less, make more
by Dr. Jay Reznick and enjoy practice—because you deserve it!
This presentation, recorded at Townie Meeting, will cover
important oral surgery topics for the general dentist, including The Essentials of Endodontic Emergencies:
management of the patient on anticoagulants, antibiotic prophylaxis, Diagnosis, Safe Access
design and use of surgical flaps, handpieces and hand instruments, and Infection Management
surgical extractions, splitting teeth, retrieving root tips and atraumatic by Dr. Brett E. Gilbert
extraction techniques. This course teaches the essential skills needed to confidently
handle endodontic emergencies in a general practice setting. The
Dental Duct Tape material presented will help clinicians apply protocols and tips on
by Dr. John Maggio how to efficiently diagnose, access and locate canals safely. Infection
Glass ionomer materials have come a long way in the past management and postoperative instructions and communication
few decades; these bioactive materials are uniquely positioned to are discussed in detail. ■
NuSmile Launches
Pediatric Dentistry
Locator Website
Ultradent Products Celebrates 40th Anniversary NuSmile, a provider of pediatric
Ultradent Products, a family-owned, international dental supply and manufacturing aesthetic restorative dental prod-
company, is celebrating 40 years in the dental industry. ucts, recently launched its “I Love My
Forty years ago, Dr. Dan Fischer, a young dentist who had recently graduated from NuSmile” program. Through its website,
Loma Linda University, wanted to create a product that would act as a solution to a common this new program helps parents
problem dentists face—achieving predictable, rapid and profound hemostasis in the mouth. understand the best restorative dental
He began experimenting with different chemistries after-hours at his small dental practice options available for their child and pro-
in Salt Lake City, and by 1978, he had invented and patented Ultradent’s first product, the vides a locator feature to find providers
hemostatic Astringedent. That same year, he founded Ultradent Products. with nearby dental practices that offer
As business grew, Ultradent expanded from its first headquarters, a 40-by-60-foot metal NuSmile’s aesthetic pediatric crowns.
hay barn on Fischer’s property, to its South Jordan, Utah, headquarters, which encompasses Mike Loessberg, NuSmile director of
more than 460,000 square feet. The company has gone from one offering to more than 1,600 sales, North America, says the website
dental products worldwide, and has offices and subsidiaries in Asia, Australia, Europe and will help parents grasp the pros and
South America. Ultradent researches, designs, manufactures, packages and ships 95 percent cons of differing restorative options
of what it sells in its South Jordan facility. It also exports 70 percent of its products to more for their children, with photographs
than 100 countries. showing treatment outcomes of each.
Beyond the dental community, Ultradent supports and donates products to humanitarian He noted that this consumer-focused
efforts locally, nationally and internationally, including the Crown Council and Sealants approach has been successful in the
for Smiles. The company founded and sponsors its own 501(c)(3) nonprofit organization, orthodontic clear aligner market and
the Diversity Foundation, an outreach program committed to preventing hate crimes and should also work well with parents who
intolerance. The foundation is currently helping support more than 50 students in their are looking to find the best restorative
efforts to pursue higher education at the college and graduate level. treatment options for their child.
For more information, visit ultradent.com or call 800-552-5512. Diane Johnson Krueger, NuSmile
founder and CEO, thinks dentists will
appreciate the solution as much as
parents will, saying that the company
will make a significant investment in
Industry News
advertising that draws parents to the
website.
For more information about the
new program, visit ilovemynusmile.com.
Information in this section is culled from releases that were delivered to For more information about NuSmile,
news@dentaltown.com. All material is subject to editing and space availability. visit nusmile.com.
HYGIENE
Dentaltown’s monthly poll helps you see how other practices operate—
what’s working, what isn’t—and how dentistry is evolving.
The information we gather helps us measure the trends of the profession.
This poll was conducted Jan. 8 to Feb. 8. on dentaltown.com.
Are the hygienists in your office compensated based on a percentage of the production?
8 3 % 1 7 %
No Yes
Automated
12% Hygienist records manually
55%
An assistant helps the hygienist
33%
www.ultradent.com/genius
800.552.5512 | ultradent.com
© 2018 Ultradent Products, Inc. All Rights Reserved.
6% 34% 30%
9% More than >1:4
1:1 Yes
Yes 87%
No
11% 49% 70%
4% 1:3 1:2 No
It will within
a few years
A Simple Approach
to Crestal Sinus Augmentation
by Dr. Matthew F. Bickel The world of the general dentist has guided bone regeneration (GBR) and sinus
changed a lot over the years. When I grad- augmentation. One of the things I enjoy
Matthew F. Bickel, DMD, uated from the University of Medicine and most about implant surgery is that I have
and his wife, Kathleen
J. Bickel, DMD, own and Dentistry of New Jersey–New Jersey Dental total control over the restorative position of
practice at Dayspring School (now Rutgers School of Dental my implants.
Dental in Sewell, New
Jersey. The Bickels focus Medicine) in 1992, implant surgery was not
on providing advanced common among GPs. We got zero exposure Case study
dental technology,
including laser dentistry
to implants as undergrads; I merely knew A 59-year-old patient presented with a
and CBCT. He focuses on that they existed, and thanks to a sales rep failing implant at #4—which happened to
restorative, endodontics and implants, while she
focuses on restorative, orthodontics, and infant
at a school presentation I knew you had be one of the first implants I had ever placed!
tongue and lip tie revisions. to use a special plastic scaler to clean one. The patient had disappeared from the practice
Email: info@dayspringdentaltwp.com But that was the extent of my dental school for a couple of years before I could restore it,
implant education. he had been a smoker, and his periodontal
During my Advanced Education in Gen- disease was now uncontrolled. In addition,
eral Dentistry residency, also with UMDNJ, I the implant was placed without a CBCT,
had the privilege of being taught by Dr. Stanley and it’s possible there was an osseous defect
Praiss, a pioneering implantologist/surgeon GP that I was not aware of.
who taught the residents much more about Fig. 1 shows the CBCT images of the
surgery than we learned in dental school. failing implant and the resulting osseous
Praiss tried very hard to get the residents defect. You can also see sinus thickening
to learn implant placement, but the school because of the infection penetrating the sinus
administration would not sanction it; it floor. The patient was now a nonsmoker, and
believed that GPs had no business placing was fully committed to treating his periodontal
their own implants. My, how times have disease and restoring his missing teeth.
changed! Most, if not all, GP residency Step 1 was to remove the failing implant,
programs now teach implant placement, completely debride the area and graft the
and many older docs, myself included, have defect. A flap was laid with a WaterLase iPlus
taken continuing education to learn implant dental laser, and the defect was thoroughly
placement. curetted as well as cleaned with the laser
My implant surgery journey began in until we were down to clean, healthy bone.
Show your work 2013, when I took a Hiossen surgical course. The area was grafted with Steiner Socket
in Dentaltown! Through the teaching
Fig. 1
of some great specialists
If you’ve got a case you
think might be a great study and GPs (including my
for Show Your Work, email implant mentor, Dr. Paul
editor Sam Mittelsteadt:
sam@dentaltown.com.
Goodman), I was able
Be sure to include a sentence to start placing implants
that sums up why the case is in my off ice. A s my
so special to you, to help us
review and select the best experience progressed, I
contenders for publication. began taking courses in
recare schedule.
At this point, the patient was ready
to place implants on the UR. We would
be extracting #31 because the restorative
prognosis was poor, so we were looking to
replace #3 and #4 with implants. Fig. 4 shows
a sinus septum directly at the #3 position.
The decision was made to place implants
at #2 and #4, bypassing the septum (which
appeared fairly high, had a sloping ridge, and
was therefore more difficult to augment via
crestal approach), and to make a three-unit Fig. 4 Fig. 7
bridge from #2 to #4.
Fig. 5 shows the implant and sinus graft
treatment plan in the Anatomage software.
The plan was sent to the Anatomage lab
for fabrication of a surgical guide (Fig. 6).
Figs. 10 and 11 photos courtesy of Dr. Greg Steiner and Steiner Biotechnology
Fig. 9 Fig. 10 Fig. 12
Products used
• WaterLase iPlus dental laser
• Steiner Socket Putty Plus
• Cytoplast titanium-reinforced membrane
• Anatomage software and surgical guides
• Hiossen Crestal Approach Sinus Surgical kit
• Steiner Sinus Graft
• Hiossen ET3 implants
demteethies
Member Since: 03/04/06 I’ve been trying out some new (or new to me) materials to save time or money while main-
Post: 1 of 154 taining or increasing quality. Was curious if anyone else had done a similar project in their office.
Just a few changes I’ve made so far:
• Went from Kerr Extrude to GC Exafast. Set time from 5 min. to 2.5 min. (sweet), costs
half as much and delivers better impressions. Win, win, win.
• Decided to use Estelite Sigma Quick more often (I’d previously only used it sparingly
for hard-to-match areas). It’s a great composite, and is like $73 for 20 capsules, vs. most
composites $100–$110 for similar size.
• Shofu One Gloss for polishing (on the removable mandrels). $1.15 per polishing point
rather than $6–$7 for others.
• Microcopy for burs.
• Edge Endo — these files are way cheaper than the ProTaper Gold, and are actually better
and faster for me. Another triple win.
Any good-value products you use that do just as good or better than the big players?
Especially curious about people using stuff from smaller vendors—Parkell, Practicon, Apex,
stuff not sold through vendors. ■
10/12/2016
Tom Mitchell
Member Since: 02/16/04 • Surpass by Apex for bonding and desensitizing. No need for any Gluma product.
Post: 3 of 154 Procedure takes the same time as any other reputable bonding system. Bond strengths
created are higher than any other system.
• Anchor by Apex for buildups and for composite cement. No need for any other composite
bonding cement.
• RelyX luting powder liquid form for most cementing. Less expensive and stronger than all
the others. ■
10/12/2016
Drummariam
Member Since: 12/26/12 • Greater Curve bands for anything and everything that cannot be completed with a
Post: 5 of 154 sectional. No more, “Let’s pick which band to use.”
• Dentalree for burs. Learned about them here on Dentaltown, and are a good product that
is very well priced. ■
10/12/2016
jakewolf
Member Since: 02/28/14 I’m loving Bulk EZ from Danville for quads of fills. I switched to fast-set Genie Extra Light
Post: 8 of 154 and Regular Body, and love the cost and time savings. Also just started using Massad trays for
dentures—they are a big time-saver. ■
10/12/2016
cbusdds
Member Since: 03/17/11 System I and II alginate for dentures instead of polyvinyl. Best denture impression material
Posts: 15 and 21 of 154 in my hands.
For both the maxilla and mandible I use reusable silicone base formers. We block out the
tongue with wax or a paper towel on the mandible and I have taught my assistant to build the
models up absolutely huge in all respects. We can always trim them back, but it always gives my
lab every landmark and has made my life with dentures more tolerable. ■
10/13/2016
Extractor
Member Since: 10/29/02 The tip that will save a ton of money: Do not buy the disinfecting solutions that come in the
Post: 26 & 27 of 154 gallon jugs. Or on the wipes. Buy them in concentrate.
• Bi-Arrest from ICT (as far as I can tell, it’s the exact same thing as Birex). It sells for 60
bucks for a bottle of concentrate and it dilutes out to 16 gallons. That comes out to about 4
bucks a gallon instead of 30.
• Another one is HB Quat disinfection cleaner. This stuff costs about 70 bucks and I think
it dilutes to … can’t remember, but like 60 gallons. It’s even cheaper.
They are both hard-surface disinfection for areas that don’t have blood all over them. I put
barriers on places where blood might be found.
I changed from Impregum to PVS recently. It’s generally worked well, but with a few hiccups
depending on which assistant uses it. That saved some big money.
I order most filling materials from Safco Dental. Everything else I get from a company
called Goetze. I do this for convenience and for sales tax reasons; Safco doesn’t charge sales tax
on anything, Goetze charges the proper sales tax. In my state, I don’t have to pay sales tax on
products that stay in the mouth. This keeps me out of sales tax problems.
One last tip, and I can’t stress this one enough: Don’t let the staff completely take over the
ordering. Your money will fly away. You need to see the order and approve of it every week. The
staff gives me the order and I order it myself. There are online tools to order my supplies and the
process takes me 10 minutes a week.
I saved thousands of dollars a year, removing spend-happy assistants and spend-happy com-
pany reps from the ordering process. ■
10/13/2016
dds262
Member Since: 09/04/14 Temporary matrix buttons for crown temp impressions—accurate and inexpensive. I think
Post: 32 of 154 Advantage Dental makes them. ■
10/13/2016
jes1cajes
Member Since: 01/03/14 Not a material, but I buy patient sunglasses, kid toys, alcohol, hand soap and sanitizer at the
Post: 46 of 154 dollar store. Amazing what you find there—bandages, denture cases, floss picks, etc.
Paper products/stuffers/office supplies at Costco. ■
10/14/2016
tomdds
Member Since: 03/16/03 I think that if you can find a product that you like as much which costs less, then that is a
Post: 47 of 154 win. But I will say it again: Use a buying group/GPO like Synergy.
You will pay less for the products that you already use so that you don’t have to find a cheaper
alternative. But if you have found a cheaper alternative that you like, that product will be less
through Synergy as well. I use Komet burs from them and they cost $3.75—that is about what
disposable diamonds cost.
I have said it many times. Synergy is run by dentists who work in mouths every day. They
get the deal. We individual docs can’t negotiate the same deals that they can because they have
Epicurean74
Member Since: 12/14/13 Tristate Dental is a dental supplier located out of New Jersey. Excellent customer service to
Post: 48 of 154 boot. Check them out.
Mr. Coffee is a tabletop coffee warmer. I throw some compules of Tetric Evoceram Bulk
Fill in a ceramic bowl and place it on the coffee warmer right before I do some composite
restorations. The warmer helps warm up the composite nicely (and reduce its viscosity).
I tried to upload an image of the coffee warmer but couldn’t. Easily available at online and
all department stores (Target, Kohl’s, etc.). ■
10/15/2016
Brad Blair
Member Since: 01/11/08 One thing that saved me tons of $$$: Staff always seems to fall for the “buy 10, get 1 free”
Post: 56 of 154 gambit, but maybe I don’t want 2 years’ worth of something that expires. Or that I might not
like in 2 months.
Disposable stuff like paper towels we get from Staples. Order one afternoon, here by next
morning. Cheaper than Costco. ■
10/17/2016
schand2
Member Since: 03/13/02 Activa BioActive for bulk fill composite. Not cheap, but superfast—more than 50% speed
Post: 69 of 154 increase on composites. ■
10/28/2016
Adam W
Member Since: 08/04/11 Kettenbach for all crown and bridge impression material. Impression quality went way up,
Post: 71 of 154 and it’s cheaper than Aquasil. ■
10/30/2016
tooth college
Member Since: 05/06/07 Switches I have made that have made my life easier. Not necessarily cheaper or to save
Post: 92 of 154 money, but have saved my stomach lining:
• Surpass bonding agent
• SonicFill resin
• Greater Curve matrices.
• My wireless loupe/headlight
• Rubber dam
• Genie PVS
• Alveogyl for dry sockets
• My cheap intraoral eBay cams (biggest ROI to date)
• Not buying from Patterson Dental ■
3/15/2017
baqir3
Member Since: 10/29/09 Net32 for all disposables. ■
12/3/2017
Post: 115 of 154
Christmas Cancer
An oral surgeon shares a case that illustrates the importance of
performing thorough checks for head and neck cancer
toofache32
Member Since: 08/10/04 It seems like every December, I get a patient with head/neck cancer that I have to operate on,
Post: 1 of 52 so they spend Christmas in the hospital. This year I have three.
This poor guy had a lymph node in his neck start growing. A needle biopsy showed squa-
mous cell carcinoma, which prompted a search to look for the source (usually tonsil or base of
tongue). Couldn’t find the primary site, but this started to grow very quickly and soon began to
grow through his skin and was attached to his mandible. Strangely, he also had a huge lipoma in
his neck that went down under his sternocleidomastoid muscle (SCM) into the carotid sheath.
going into the deep surface. This shows the incision around the skin paddle, which was
12/24/2017
positioned over the muscle.
Fig. 12: Now the muscle/skin is elevated off the chest wall. This is the view from the deep
(muscle) side of the flap. You can kinda see the shadow of some ribs; also, the serratus
anterior muscle in the upper half of the photo.
Fig. 13: Another view of the lat dorsi flap flipped up and lying up on the shoulder. It’s still
being perfused by the thoracodorsal artery and vein, which is in the fat at the top of the
incision and not yet exposed. After this, we skeletonize the vessels through the fat. Then
ligate and divide the vessels so the flap of skin, subcutaneous fat and muscle is completely
freed from the body.
Fig. 14: The flap artery and vein were anastomosed to the superior thyroid artery and the
external jugular vein. This is done under a microscope using 9-0 nylon. Then the flap
is inset into the defect to cover the hole. He had this redness in the neck skin which I’m
not sure of. We took some biopsies at the beginning of the case for immediate frozens to
make sure it wasn’t cancer. I suspect it was an inflammatory reaction to the cancer eroding
through the skin. ■
12/23/2017
Bifid Uvula
Member Since: 05/17/06 Great case!
Post: 6 of 52 Haven’t seen a latissimus dorsi fl ap in a while. This is a really neat fl ap for head
and neck reconstruction because it can be used both as a pedicle-d fl ap (meaning kept
attached to its blood supply and extended as far as the artery and vein will permit) or as a
free-microvascular fl ap (as shown here, where it can literally be transplanted almost any-
where else on the body).
That giant lipoma is also pretty weird to be occurring at the same time. In residency we had
a lady in her 80s with a pretty big one on the back of her neck and head who also had an oral
squamous cell carcinoma, so she had both removed/resected. ■
Richy
Member Since: 03/30/10 Terrifying and amazing. Thanks for sharing. ■
Post: 7 of 52
Bifid Uvula
Member Since: 05/17/06 Let’s talk about his teeth here. What does he have in the mandible? This case will almost
Post: 8 of 52 certainly be receiving postoperative radiation therapy, given the neck involvement.
So what does he have in the mandible, and what, if anything, did you leave behind? I can
only make out some maxillary teeth in your photo, and it looks like this was only a marginal
resection of the inferior border of the mandible.
I usually explain to my GPs and the patient that we don’t always have to remove all of the
teeth. A lot goes into the decision. Reliable, compliant patients with an otherwise healthy/intact
dentition (and a good history of regular/frequent hygiene and restorative dental care) with a
stable/healthy periodontum may lose their second premolars back to second or third molars in
the mandible when it comes to the typical base of tongue, posterior lateral tongue, and tonsillar
squamous cell carcinomas.
Cancers located in an area that would prompt a greater field of radiation to include the
anterior mandible region (anterior central tongue, anterior floor of mouth, anterior mandibular
gingiva/mucosa/bone) will often obligate me to consider removing all of the mandibular teeth.
For our fellow Townies to understand, we don’t always know if a patient will definitely be
receiving postoperative radiation therapy, but we have a pretty good hunch who probably will
base of tongue, and neck lymph nodes. We did surgery on him because there was suspicion of
mandible invasion on the imaging. Radiation will not kill cancer invading into bone, and this is
usually an indication for surgery. ■
12/24/2017
Timmy G
Member Since: 04/14/02 What is the estimated five-year survival rate in a situation like this? ■
12/24/2017
Post: 22 of 52
toofache32
Member Since: 08/10/04 30–50 percent, depending on HPV status and other factors. ■
12/24/2017
Post: 23 of 52
drillher
Member Since: 04/22/02 I’m in awe of your skill and level of training! It scares me to think that tumor may have been
Post: 27 of 52 caused by HPV. I have been with more than one girlfriend who had mild dysplasia on a Pap, so
I’m thinking that I have been exposed to one or more of the types that can cause neoplasms. ■
12/25/2017
central incisor
Member Since: 01/19/05 So, no luck finding the source/primary neoplasm? Is this common? Is there a greater chance
Post: 32 of 52 of recurrence in this instance? ■
12/26/2017
toofache32
Member Since: 08/10/04 It happens, but not that common. Probably about 2–3 percent of all head and neck
Post: 34 of 52 cancers. ■
12/26/2017
Acelyn
Member Since: 04/30/07 Jeebus — that’s impressive and scary.
Post: 35 of 52 So, is this the right thread to ask what currently is the best recommended way to screen for
oral/head/neck cancer? Can I just refer patients to an oral surgeon for screening, and how much
would something like that cost? ■
12/26/2017
toofache32
Member Since: 08/10/04 We should all be screening all of our patients. I had a video I created of the “60-second oral
Post: 36 of 52 cancer exam” where one of my residents let me do an exam on him, but I can’t find it.
Look at the oral soft tissues. Visualize everywhere. I don’t grab their tongues and york
it around like Bessie the Cow. I grab four cotton-tip applicators (really long Q-tips) and
put two in each hand. The dry cotton is like a miniature 2x2 gauze because it sticks to the
tongue and soft tissue to let me push, pull and manipulate the tongue and soft tissue. Then
I say, “Open big and say ahhhh but don’t stick your tongue out,” because everyone wants to
stick out their tongue for some reason, which only obstructs your view of the pharynx. This
is about 30 seconds.
For the next 30 seconds, get up and walk behind the patient. This is important to be able to
use both hands at the same time to feel for symmetry. There are lots of times I will feel a “mass”
but then realize that the same “mass” is also on the other side and symmetrical. This is usually
the submandibular glands. The other common mass, especially in older skinny patients, is the
carotid bulb. When I feel a mass, I like to hold still for 3–4 seconds to see if it pulsates. If it does,
then it’s just the carotid artery.
In the past, if the mouth had no abnormalities and looked good, I would say, “That
looks good.” If the neck felt good I would say, “That feels good.” These days, if the neck
feels normal then I say, “Well, that feels normal.” Someone pointed out to me that I probably
JJ Westside
If you ever find that cancer screening video, I’d love to see it. ■ Member Since: 09/01/05
12/26/2017
Post: 37 of 52
alanrw
We were told in school to always to always do an oral cancer exam on each patient at six- Member Since: 05/16/11
month intervals. We were told if we caught one case during our careers, the effort would have Post: 38 of 52
been worth it.
So far, I have caught two cases in my career. Both on family members. ■
12/26/2017
Roboto
Absolutely amazing. So kind of you to dedicate some of your time to post photos and info. Member Since: 06/09/14
Just out of curiosity: If you skin graft, what happens with the donor site? Won’t that need Post: 42 of 52
skin graft as well, or would that be a site that you can close primarily? Would this latissimus flap
be able to heal by granulation (secondary healing)? ■
1/1/2018
toofache32
There are two types of skin grafts: split thickness and full thickness. They both have pros Member Since: 08/10/04
and cons. Post: 44 of 52
A split-thickness skin graft donor site does not need
to be closed; just put a bandage over it and it heals like
a bad case of road rash. A full-thickness graft must be
closed primarily; therefore, the size of the graft is limited.
So a skin graft (when used in this type of case)
would be a split thickness. It’s harvested usually from
the upper outer thigh using a dermatome that lets us
select the thickness of the graft, between 0.008 to 0.02
inch. That’s thousandths of an inch thick. Because the
dermis and follicular units remain in the wound, it will
re-epithelialize in a few weeks.
[Editor’s note: Go to dentaltown.com/graft-mesh to
watch a YouTube video this Townie linked to that demon-
strates using a dermatone and meshing the graft.] ■
1/1/2018
Got a question
for this Townie?
Search: “Christmas Cancer”
If this case got you thinking,
head to dentaltown.com and
search for “Christmas Cancer.”
This message board will be the
top result, and you can post your
question or opinion there.
Hoosh
Member Since: 10/11/11 I’ve been tiptoeing into the world of surgical extractions. I’ve had a lot of great, successful
Post: 1 of 30 cases so far. But I have a patient coming in on Friday for the extraction of #19 and I’m getting
nervous for it. It’s heavily decayed, thin/curved mesial root—see pic.
I have some thoughts on how I’m going to approach this, but I would appreciate a convo and
advice from all of you. How would you guys go about this? I prefer to go the flapless route. ■
1/3/2018
DoctorHowie
Member Since: 02/11/16 See if you can get some movement by luxating, then cowhorn in furcation. The roots are
Post: 2 of 30 fairly straight and along the same axis, so I bet you could get it out in one piece. ■
1/3/2018
Rance Davis
Member Since: 01/22/01 I would luxate 360 degrees, then in the furcation. Go directly to sectioning the tooth (B/L)
Post: 5 of 30 and remove the distal root. This can be accomplished in less than five minutes. Use the remain-
ing time to remove the mesial root which may be a little bit of trouble. The key is to not hesitate
on the sectioning. To help conceptually, measure your surgical against the X-ray. If you begin on
the buccal and show caution as you approach the lingual, you’ll be fine. ■
1/3/2018
Thomasaurus
Member Since: 03/05/13 I’ve found that if I can get at least some movement with luxators and elevators before section-
Post: 6 of 30 ing, the roots will move easier once separated. Also make sure to do a deep section so the pieces
have room to move. If I section shallow and the tooth isn’t moving, that is when I’ve gotten in
trouble with the roots just breaking off trying to elevate. ■
1/3/2018
rpiotrowski
Member Since: 01/11/02 Here’s my two cents. Go in a stepwise fashion.
Post: 9 of 30 Step 1: Luxate all around the tooth and into the furcation with either a luxator or spade
proximator. Try to get some mobility.
Step 2: Do the same thing with a 301 elevator. (I don’t have Tommy Murph’s hands and I
can’t go straight to a 301.) Try and get some mobility.
Step 3: Cowhorn forceps, squeeze and pump, and figure 8 motions. Try and get some
mobility. (Mobility will make it easier to remove the roots when you go to the next step.)
Step 4: If it still hasn’t come out, then section buccal lingually and elevate out each individ-
ual root. Hopefully each root is loose by this point and they come out easily.
Step 5: You didn’t get enough mobility (or the tooth didn’t allow it) and now you are trough-
ing in between the roots to make a space for your elevator to hopefully get some mobility. At
this point I’m usually using a thin-tipped instrument like a spade proximator or a luxator to
get into the PDL space around the root wherever it lets me.
Step 6: Still a no-go? Remember how it presented on the X-ray and remind yourself to refer
to an oral surgeon when it looks like that. Now start troughing on the buccal and using a thin-
tipped instrument to get some mobility wherever you can. ■
1/3/2018
Chmrb
Member Since: 02/25/17 I am not a fan of the 301 elevator though it does work. I prefer the Hu-Friedy 11A Stout
Post: 12 of 30 for elevation. The tip broadens as you move away from the tip so as you work the instrument in
between the teeth it gradually elevates more and more. Frequently I find that the 301 elevates
nicely to a point and then it just isn’t wide enough to elevate any more. The 11A is my go-to
elevator. Come to think of it, most teeth I remove I only use the 11A and, if necessary, forceps.
I use the 11A to dig out all but the smallest root tips. I use it to remove anteriors and posteriors.
I may begin using it to eat lunch—I like it that much. ■
1/3/2018
Hoosh
Member Since: 10/11/11 I really appreciate your feedback. Along with the other posters who gave their opinion and
Post: 16 of 30 how they would go about it.
So, I ended up getting to Step 5. Got out most of the tooth, then the D root split vertically
and the lower apical-mesial portion of the distal root remained stuck. No PDL to even squeeze
my spade proximator into. I elected to leave that sliver of root. Probably not what some others
would have done. But I’m okay with my decision to do so.
Just thought I would share for others who are in my shoes. We all have to start somewhere.
Learning can be difficult, but fun! ■
1/5/2018
bronco1
Member Since: 01/03/13 This was a disservice to the patient. OP knew several days ago he did not feel comfortable
Post: 19 of 30 with this extraction. He came on, posted his concern, received several “ideas” on how to do it
and talked himself into making a poor clinical decision and outcome … ■
1/5/2018
likeaduck
Member Since: 08/15/16 Everyone learns somehow. If remaining piece of tooth that wasn’t necrotic to begin with is
Post: 20 of 30 less than 3mm it’s okay to leave. ■
1/5/2018
Hoosh
Member Since: 10/11/11 Definitely less than 3mm. Necrotic. Extracted six teeth this week. This one was the trou-
Post: 23 of 30 blemaker. Moving on! ■
1/5/2018
rpiotrowski
Member Since: 01/11/02 Inform the patient that it’s there and tell them that “if” it ever gives them a problem, you’ll
Post: 25 of 30 take care of it for no charge. ■
1/5/2018
Bifid Uvula
Member Since: 05/17/06 Got a radiograph of the retained root portion to share with us? Did you inform the patient you
Post: 26 of 30 left part of the tooth behind? How long did you work on the patient before you threw in the towel? ■
1/5/2018
bronco1
Member Since: 01/03/13 Do not kid yourself into thinking it is appropriate to leave roots behind simply because you
Post: 28 of 30 could not finish the case. We are all held to a standard of care. Leaving roots behind in this
What’s your
extraction protocol?
Search: “Hyped Up”
This Townie had some hesitation
before extracting in this case and
left a portion of the root behind.
What would you have done?
To share your thoughts and
observations, go to dentaltown.com
and search the message boards
for “hyped up”—this conversation
will be one of the top results.
Grandio Blocs
In the world of CAD/CAM dentistry, many types of materials have been Complemented by superior strength compared with composite-based
utilized to produce final restorations, ranging from composite to lithium CAD/CAM blocks, Grandio Blocs provide a high-quality restorative solution.
disilicate to zirconia. Voco recently introduced Grandio Blocs, a new nanoc- Additionally, Grandio Blocs minimize the amount of healthy tooth structure
eramic hybrid technology that represents the latest evolution in the field. removed during tooth preparation due to its ability to work with thinner
The 86 percent-filled CAD/CAM block offers strength and ease of use, saving margins. The unique nanoceramic hybrid makeup allows for exceptional
practitioners up to half of their time when producing CAD/CAM restorations polishability and enables Grandio Blocs to be milled more finely and achieve
compared with pure ceramic CAD/CAM material such as lithium disilicate. The even greater accuracy of fit compared with pure ceramic CAD/CAM blocks.
product is indicated for crowns, inlays/onlays, veneers and implant-supported The material’s ease of use reduces the number of steps required within the
crowns. procedure, eliminates the firing process, simplifies polishing and character-
With toothlike physical properties, compressive strength, extremely ization, and allows for easy intraoral repairs.
low water absorption, and natural aesthetics with enhanced color stability, Processed using standard milling devices, Grandio Blocs are available
Grandio Blocs provide a new solution for practitioners and labs looking to in multiple shades, two translucencies and two sizes. These features,
streamline their CAD/CAM processes and maintain the high quality they pro- combined with Voco’s Futurabond U (universal adhesive) and Bifix QM (dual-
vide their patients and customers. Because of their high filler degree, Grandio cure bonded-in resin cement) in the Grandio Blocs kit, provide everything
Blocs offer physical properties that mimic human dentition, such as modulus practitioners need to finalize their CAD/CAM restorations.
of elasticity and thermocycling, enabling their restorations to behave like nat- For more information, visit vocoamerica.com and search for Grandio
ural tooth structure. They are antagonistically friendly and provide enhanced Blocs. ■
marginal integrity and overall longevity.
High Definition
Imaging
New High Definition Imaging (HDI) illumination technology from Designs pack operates with a one-touch button that can be activated with the user’s
for Vision utilizes an advanced photonic configuration that produces a new elbow. The first touch produces high-intensity (60,000 lux) light and the
standard in clinical LED illumination. HDI collects the light produced by a second touch provides medium intensity (34,000 lux.) A complete system
light-emitting diode and optically focuses it into the oral cavity. This patent- includes two power packs; each can operate up to nine hours with a full
pending technology provides evenly focused illumination with the quality charge and takes three hours to recharge.
of fiber-optic illumination and the benefits of a lightweight portable LED The LED DayLite WireLess Mini HDI is cordless and self-contained, using
headlight. Headlights with HDI technology provide 45 percent more light into HDI technology to provide bright illumination (27,000 lux) with uniform light
the oral cavity than similar non-HDI headlights. distribution. The rechargeable batteries slip into the headlight housing and
HDI headlights are available in wired and wireless configurations so the complete system weighs 1 oz. The Mini WireLess HDI is a modular design
clinicians can choose the platform that best suits their needs. The wired Micro that can attach to multiple pairs of loupes or safety glasses. The complete
HDI system is the lightest and brightest configuration, while the Mini WireLess unit includes three rechargeable lithium ion batteries and charging cradle.
HDI is cordless and untethered. Two batteries can be independently charged at the same time, allowing for
The LED DayLite Micro HDI headlight provides uniform light distribution a quick swap of batteries.
and weighs 0.6 ounces. The Micro power pack is the smallest and lightest For more information and to set up a 45-day trial, visit
headlight power pack (2.5 oz.) and uses a standard USB connection. The power designsforvision.com. ■
Fig. 8: Ideal prosthetic emergence of the zygomatic implant fixtures, achieved by treatment planning
and placing the implants in accordance with the ZAGA classification.
Meet these
featured
speakers
at Townie
Meeting 2018!
Drs. Andonis Terezides and
Fig. 9: NobelZygoma 45-degree implant. Sundeep Rawal are two of
the featured speakers at
Townie Meeting 2018, which
than a standardized implant trajectory the threads have been removed from the runs April 11–14 in Orlando,
Florida. To discover more
to determine the most ideal prosthetic implant head and body to decrease mucosal about the event, or to reserve
position of the implant platform emer- irritation and risks of mucosal dehiscence. a hotel room at the Townie
Meeting discount rate, visit
gence. Using the ZAGA concept, Aparicio The implant apex has been modeled to
towniemeeting.com.
demonstrated that zygomatic implant resemble the NobelSpeedy implant, which
surgery has the potential to be less invasive was designed for bicortical anchorage and
and faster, with less risk of sinus-related high initial primary stability.
complications. It also provides improved The new design permits for improved
prosthetic design/biomechanics, easier bone-implant contact and improved
hygiene, and improved comfort, speech soft-tissue attachment to the implant.
and aesthetics (Figs. 7 and 8). The implant body has also been widened
to provide for increased mechanical
Improvement in implant design resistance and implant strength. The
and prosthetic options restorative interface of the implants is
After more than 20 years of expe- now also available in the traditional
rience and success using the original 45-degree platform and a flat zero-degree
Brånemark machined and Ti-Unite platform (Fig. 9).
surface-coated zygomatic implants, a
redesign with improvement to the implants All-on-4 treatment concept
addressed some of the issues and complica- with zygomatic implants
tions such as mucosal dehiscence, sinusitis, A 77-year-old female presented with
prosthetic compromises and implant a failing maxillary PFM bridge and desir-
fracture. Most notably, the implants are ing a timely, less-invasive fi xed-implant
fully treated with a Ti-Unite surface and solution (Figs. 10–12, p. 58).
Fig. 15: Nobel Trefoil bar demonstrating the adaptive compensation mechanism to ensure passive fit
of the framework by compensating for angular, horizontal and vertical discrepancy in placement at
each of the three implant fixtures.
Conclusion
Brånemark had a vision of simplifying treatment for
patients: “A decisive factor in patient care is simplification
of dental treatment, which should be based on identifying
and utilizing the enormous capacity of existing original
anchoring tissues. When possible, one should avoid
unnecessary, advanced and complicated major grafting
procedures.”
Supported by a vast array of long-term scientific
literature, our treatment philosophy follows Brånemark’s
vision by successfully caring for the edentulous and
terminal dentition patient population through the use of
digital diagnostics and treatment-planning technology,
minimally invasive, graftless surgical procedures,
immediate-load/provisionalized fixed-implant prosthetic
solutions and personalized patient care. ■
Dental zirconium dioxide is formed into toughness describes the ability of a material
a polycrystalline ceramic called yttrium- to resist crack propagation or how a crack
stabilized tetragonal zirconia polycrystals, spreads from a notched specimen. Cracks
or simply “zirconia.” Materials containing originate from flaws in materials—created
only tetragonal phase are strongest, while by finishing, machining or porosity—and
cubic-containing zirconia is significantly act as an initiation point for crack growth.
weaker but more translucent (cubic zirco- For example, a car windshield hit with a
nia). The yttrium oxide, or yttria, content rock chips the windshield, and the crack
largely defines the mechanical and physical spreads from the chipped area across the
properties: windshield.
• Zirconia containing 3 mole-percent The energy required to grow the crack
yttria is strongest (100 percent is measured by fracture toughness. Low
tetragonal phase) but most opaque. toughness can lead to chipping and bulk
• Zirconia containing 5 mole-percent fracture in materials. Fracture toughness
yttria produces a more translucent measurements for feldspathic porcelain range
material, with approximately from 1 to 1.3, translucent zirconia, 2–4, and
50 percent cubic phase. opaque zirconia ranges from 7–9 MPa•m1/2.
Yttrium increases the zirconia grain Chipping occurs more frequently in the
size and lowers the coefficient of thermal less-tough veneering materials compared
expansion. with the zirconia frame. 5Y-TZP containing
more than 50 percent cubic phase has little
Ceramic flexural strength or no low temperature degradation and lower
vs. fracture toughness fracture toughness, and because the material
Flexural strength specimens are polished has little residual stress, water corrosion is
or milled samples (2 by 4 by 22 millimeters) limited. High-cubic-containing zirconia
and the strength is affected by the sur- is weaker but its strength does not degrade
face roughness of the specimen.4 Fracture further from low-temperature degradation.
of 1,000–1,400 MPa. The original frame 5 mole-percent yttrium has a flexural strength
zirconia contained 3 mole-percent yttria to of 600–900 MPa and a fracture toughness
partially stabilize the tetragonal phase. Alu- of 2.2–4 MPa•m1/2, compared with opaque
mina (0.025 percent) was added to stabilize 3 mole-percent yttrium-containing zirconia’s
grain boundaries, to act as a sintering aid flexural strength of 1,000–1,400 MPa and
to decrease pore formation during sintering fracture toughness of 5–9 MPa•m1/2. Lower
of the green state zirconia, and to prevent fracture toughness of translucent zirconia
water corrosion. But the alumina produced materials could mean more chipping and
additional opacity in the final restorations cracks in the translucent zirconia material.
(Fig. 3, p. 68). Water corrosion affects all Translucent zirconia has similar but
ceramic materials and leads to decreased higher f lexural strength and fracture
strength with water or saliva storage. toughness compared with IPS E.max lith-
The second major change in zirconia pro- ium disilicate, and this material could be
duced a more aesthetic translucent zirconia by considered a stronger but less translucent
reducing alumina from 0.25 weight-percent lithium disilicate. Translucent zirconia
to 0.05 weight-percent while maintaining the contains approximately 50 percent cubic
same yttria component as the original opaque crystals, which are weaker and do not
frame material. Although the reduction in transform. Zirconia with 8 mole-percent
alumina content produced a more aesthetic yttria will completely stabilize the cubic
restorative material, zirconia was still too phase,7 whereas the third generation of
opaque for anterior restorations. The most zirconia with 5 mole-percent yttria is partially
recent version of zirconia (translucent) stabilized zirconia with approximately
alumina remained at 0.05 weight-percent 50 percent cubic zirconia.7–9
while yttria increased from 3 mole-percent Stabilized cubic zirconia does not trans-
to 5–8 mole-percent, depending upon form at room temperature, and therefore
the brand. At 5–8 mole percent yttria, cubic zirconia will not undergo transfor-
the zirconia contains more cubic phase, mation toughening or low-temperature
preventing low-temperature degradation and degradation. Translucent zirconia has lower
improving zirconia translucency (Fig. 4). mechanical properties but does not transform
Cubic-containing zirconia is more over time.9-11
translucent but has lower mechanical prop- Current zirconia can be classified into
erties.19 Translucent zirconia containing 4 or two basic groups:
• Light scattering
Incident light caused by different index
Absorbed light
of refraction of light
Reflected light
due to different grain
boundaries
Fig. 6: SEM of zirconia surface with irregular borders showing how light is affected as it
attempts to pass through zirconia. Light is reflected, absorbed, transmitted or scattered
depending upon the crystal border, differences in the index of refraction of light in different
components in the zirconia, and porosity.
Clear Up
Communication
These subtle changes in intraoffice exchanges
matter as much to patients as clinical mastery
Article begins on p. 78
Imagine, if you will, a dental student preparing for a Class 2 restoration with a new
patient who represents the absolute definition of “skittish.” The student’s instruments,
equipped with radiofrequency identity (RIFD) chips, are laid out on a tray and “smart”
safety glasses sit snugly on the bridge of her nose. The dental chair has sensors in the seat
and drill, and is also equipped with a RIFD reader, biometric sensor and video monitoring.
The chair recognizes the patient and has begun monitoring the procedure, providing the
student with real-time data on his stress levels and her progress in finishing the restoration.
“Precision medicine will lead to a new kind of medicine that will serve
people in their individuality, as opposed to their average.”
— Stohler
Conclusion
“We have taken the boundaries down, and we would like to be part of shaping
the future,” Stohler said. “I think we have a clear vision of what the future is looking
like, and I think we know what we’ve got to do to ultimately get to the point where
we can demonstrate the utility of the concept of precision medicine.
“The director of the genome project once said the project was similar to
the federal government building a highway system: By doing so, it didn’t tell people
where to drive; it only gave them the tools to go where they wanted to go. I think
that’s what precision medicine at this point in time is: a project with a tremendous
understanding that will lead to a new kind of medicine that will serve people in
their individuality, as opposed to their average.” ■
Aseptico 5 1 Officite 77 23
Benco Dental 25 2 OperaDDS 79 24
BISCO IBC 3 Paradise Dental Technologies 45 25
C Notes 43 4 Planmeca 85 26
CareCredit 15 5 PNC Financial Services IFC 27
Carestream Dental 59 6 Preat 33 28
Compliance Navigation 61 7 Premier Dental 19 29
Dentalmarketing.net 65 8 Premier Dental 51 30
Designs for Vision 11 9 Professional Solutions Financial Services 47 31
Digital Doc 49 10 Ribbond 108 32
Engle Dental Systems 7 11 Riverside Dental Ceramics 17 33
Flow Dental 75 12 Scientific Metals 2-3 34
Garrison Dental Solutions 81 13 Smith-Sterling Dental Laboratories 67 35
Glidewell.io 9 14 Steiner Biotechnology 32 36
Greater Curve 23 15 The Lease Coach 101 37
Ivoclar Vivadent 13 16 Tokuyama Dental America 41 38
Ivoclar Vivadent 21 17 Trident Lab 1 39
Kettenbach 91 18 Ultradent Products 27 40
Kleer 29 19 Value Dental Centers 37 41
New West Dental Ceramics 39 20 VOCO America BC 42
NSK America 99 21 Zest Dental Solutions 71 43
NuSmile 63 22
Scan the tag on the right using your smart phone for access to any additional
information you may need about an ad or visit dentaltown.com/rsc.
by Dentaltown staff
Spring PRODUCT
SHOWCASE
Learn more about the newest products
introduced at this season’s dental shows
C Notes
Centric Notes
C Notes simplifies the writing of clinical notes by streamlining the time it takes to compose them;
comprehensive treatment notes are created simply by pressing buttons and following prompts. Using
the touchpad benefits of an iPad and “decision making routes,” dentists can write specific notes about
what occurred with each of their patients. The software covers 11 dental departments, so complete
notes can be written for many treatments.
Wish you had a template for every situation? C Notes, described as “templates on steroids,” solves the
problem of producing notes quickly without the need for manual editing of templates. For active practices
where both staff and doctor write notes, C Notes levels the playing field so all notes are written with the
same detail; all users have the peace of mind that comes from knowing that their notes are well written.
Soon the application will integrate with Dentrix practice management software systems, for even more
streamlined office communication.
Information: centricnotes.com
“C Notes saves me time writing treatment notes. I am able to capture the details
of my procedures without having to use a great deal of mental input. I simply follow
the prompts of the treatments I performed and a very good note is written.”
— Dr. Israel Finger, Metairie, Louisiana
Chlorhexidine Gluconate
0.12% Oral Rinse
Darby Dental
Offered in 4- and 16-ounce bottles, Darby Chlorhexidine Gluconate
0.12% Oral Rinse was created for professional use and in conjunction with
home care for gingivitis, periodontitis, oral irrigation and postoperative
healing. A mint-flavored oral rinse, it reduces bacteria in the mouth
while successfully treating bleeding, swelling and redness of gums.
Information: darbydental.com
“The EdgeEndo promise is simple: Save money on your files, save time on your
root canals and save your practice’s future. Giving you the confidence to perform
better procedures while using superior NiTi rotary files and saving users thousands
of dollars is why I created EdgeEndo. At half the cost and twice the cyclic fatigue,
EdgeEndo is all about elevating both your practice and your life.”
— Dr. Charles J. Goodis, Albuquerque
“The 3D Fusion Sectional Matrix System makes an already great matrix system
even better. Ease of use and perfect contacts every time makes the decision easy. In
addition, the new Wide Prep ring can make that one tricky tooth we all struggle
with more predictable.”
— Dr. Randy J. Kovicak, Muskegon, Michigan
“With Estelite Bulk Fill Flow, I am able to achieve both speed and aesthetics.
When I first used the product, I couldn’t believe how quickly the restoration could
be completed, and when I polished, it looked as good as the traditional packable
composites I was used to using. I strongly recommend you add this product to your
daily routine as a clinician. It will not disappoint.”
— Dr. Mitri Ghareeb, Ghareeb Dental Group, Cross Lanes, West Virginia
“The Greater Curve Band is one of the simplest yet most innovative products in
dentistry. The solutions we create and problems we solve using these bands are unlim-
ited. In our hands on technique courses, Greater Curve Bands always create a buzz
as participants discover a rare gem that they can immediately take back to use in their
practices. A day in my office without a supply of Greater Curve Bands is a bad day.”
— Dr. Bruce J. LeBlanc, Morgan City, Louisiana
“In the search for a system that would adequately polish porcelain and zirconia
after adjusting, I found that the Jiffy Universal System did the job beautifully. It’s
the best polishing system I’ve used yet.”
— Dr. Richard Creaghe, San Rafael, California
“Adding the LUM to our intraoral cameras was as good of an addition as the
intraoral camera itself. I’ve never seen cracks and the shadow of decay so clearly or
vividly. So many areas of ‘ innocent stain’ are confirmed to be decay with the LUM
technology, helping me avoid that ‘watch it’ conversation time after time. With the
LUM, I can now be confident when I say it is decay … or it simply isn’t.”
— Dr. Jordon Caine Smith, Broken Arrow, Oklahoma
Locator F-Tx Fixed Attachment System Locator R-Tx Removable Attachment System
Zest Anchors Zest Anchors
The Locator F-Tx Fixed Attach- The Locator R-Tx Removable Attachment
ment System is revolutionizing the System, building on 15 years of clinical experience
way clinicians think about fixed full- with the award-winning Locator, is a better, simpler,
arch restorations by not requiring stronger system that relies on the same restorative
screws or cement to affix the techniques as its predecessor. With the Locator
prosthesis. The system’s design R-Tx, clinicians will realize such benefits as:
allows it to be the only immediate • A novel, new-to-dentistry DuraTec titanium
solution on the market today to carbon nitride coating that’s aesthetic,
rescue a fixed-hybrid prosthesis harder and more wear-resistant.
when an implant fails. • An industry-standard .050-inch/1.25-mm
Included in the system is a hex drive mechanism that requires no
novel “snap-in” attachment that special drivers (excluding connections that utilize a 0.048-in hex
is picked up chairside, ensuring a drive mechanism).
passive fi t while working in har- • Dual retentive features on the abutment and nylon retention
mony with existing screw-retained insert that work in harmony with the redesigned denture
abutments, saving both clinicians attachment housing, allowing for a 50 percent increase in
and patients substantial time, money and frustration. pivoting capability (60 degrees between implants) and providing
Information: zestdent.com/ftxtotherescue easier alignment and overdenture seating during insertion/
removal for the patient.
The redesigned denture attachment housing also incorporates flats
and grooves that resist movement, and is anodized pink for aesthetics.
Information: 800-262-2310 or zestanchors.com/rtx
“The OVC gives dentists the potential to grow their practices by offering a service patients
will seek out. A clever and simple system, it can provide an affordable, conservative and aes-
thetic restoration in a single visit. What patient would not be interested in learning more?”
— Dr. Michael Miyasaki, Miyasaki Dental, Sacramento
“There are so many 3-D machines in the marketplace, but I purchased the Planmeca
ProMax 3D because of its Ultra-Low Dose protocol. It delivers the finest images at the
lowest radiation possible in the marketplace. Patient safety is important to me; when we
take radiographic images, we’re always concerned with the dosage that we deliver to our
patients. We’re looking to deliver the lowest dose possible to receive the highest benefit from
the images that we attain, and this machine allows me to do that. I believe the Ultra-Low
Dose protocol on the ProMax 3D gives the finest images available in the marketplace.”
— Dr. Gene Antenucci, Bay Dental Health, Bay Shore, New York
Dear Dentist,
If your lease is coming up for renewal in the next 18 months
(or you’re opening a new practice) call or email us to book
a no-obligation telephone consultation and receive a
SheerWhite! In-Office 20% Hydrogen complimentary autographed copy of our new book. It’s the
best investment you can make in your practice.
Peroxide Strips
CAO Group The Lease Coach Services
Using next-generation SheerFilm technology, flexible SheerWhite! L
Lease
ease Negotiations (new & renewal)
Midterm Rent Reductions
In-Office 20% Hydrogen Peroxide Strips easily conform to the teeth Site Selection (& site evaluation)
while holding their potent formula to the enamel without leakage. Building & Property
Acquisitions
It takes only one minute for a dental professional to apply them; Document Reviews
patients may then leave the office for the rest of the 30-minute (39 point inspection)
wear time—no isolation or lengthy chair time required. The strips Coaching and Consulting
(One on One)
provide an excellent option for an end-of-appointment in-office Lease Assignments
whitening experience and yield up to three shades whiter teeth in a Operating Cost Analysis /
Auditing Services
single application. Space Measurement
SheerWhite! strips are & Rent Recapture
available in a two-patient intro
Available at
kit and a six-patient value kit, Barnes & Noble, Amazon
both of which include strips or online at
TheLeaseCoach.com
for both the upper and lower
arches. Send patients home Dale Willerton@TheLeaseCoach.com (U.S.)
JeffGrandfield@TheLeaseCoach.com (Canada)
with the SheerWhite! Take- 1 (800) 738-9202
Home kit for up to eight shades
whiter teeth when combined
with SheerWhite! In-Office.
Information: 877-877-9778 or caogroup.com
Negotiating
a Lease Renewal
for Your
Dental Practice
by Jeff Grandfield and Dale Willerton Course description Learning objectives
Dale Willerton, top, Th is course details different avenues After reading this article, the participant
and Jeff Grandfield are dentists can take when approaching their should be able to:
commercial lease consultants.
They are professional speakers commercial lease renewal. If you agree • Understand why it can be so import-
and co-authors of Negotiating to the same terms and conditions as you ant to shop around for alternative
Commercial Leases & Renewals
for Dummies. Contact:
initially did with your landlord, you may sites to move a practice.
dalewillerton@theleasecoach.com miss out on numerous benefits. • Realize the amount of advance
jeffgrandfield@theleasecoach.com.
time required when approaching
Abstract a commercial lease renewal.
Th ere are numerous challenges you • Understand why one should not
must overcome to ensure a better—and automatically exercise a renewal option.
fairer—commercial lease renewal. To • Recognize why it can be so important
be successful, you must plan in advance, to talk to neighboring tenants in the
consider all other options to move, and be same property.
vocal about what you want or need from • Choose and negotiate for a more
the commercial landlord. appropriate lease length.
DISCLOSURE:
The authors declare that they are paid as consultants or lecturers to health care
professionals or commercial entities, representing approximately 75 clients per year.
Conclusion
Although it can be, negotiating your
lease renewal does not have to be a difficult
process. Even with multiple avenues of
approach, by keeping these tips in mind
you can renew your lease with ease.
POST-TEST
Answer the test on the Continuing Education Answer Sheet and submit by mail or fax with a processing fee of $36. Or answer the post-test questions
online at dentaltown.com/ce-850. To view all online CE courses, go to dentaltown.com/onlinece and click the “View All Courses” button. (If you’re not
already registered on Dentaltown.com, you’ll be prompted to do so. Registration is fast, easy and, of course, free.)
1. How should you approach your landlord regarding your renewal? 6. True or false: A dental tenant should renew a commercial lease
A. Search for alternative site options if things aren’t going well.
before contacting your landlord. A. True.
B. Contact your landlord to tell him that you B. False.
want to stay and have no intention of moving.
C. Ask your landlord if he wants to renew you and 7. What is the appropriate lease renewal length?
for a proposal for you to review. A. Two years.
D. Both A and C. B. Five years.
C. 10 years.
2. How far in advance should dental tenants begin planning D. It depends on your personal and practice’s
and selecting sites for their lease renewals? current situation or future.
A. Three months.
B. Six months. 8. When is the ideal and reasonable time for a landlord
C. Nine months. to return your damage deposit?
D. 12–15 months. A. Never—the landlord always keeps the deposit.
B. Within 10 days of your lease expiration.
3. Besides the rental rate, what else can a dental tenant C. Upon the expiration of your current term
negotiate for with a lease renewal? and signing of a renewal option.
A. Tenant allowances.
B. Free rent. 9. Which could be reasons that you may be in line for
C. Further renewal rights. a rent reduction on your renewal?
D. All of the above. A. Market rates have decreased.
B. You negotiated a large tenant allowance
4. True or false: You should share news of your into your initial lease term.
practice’s success with the landlord. C. You have a new landlord.
A. True. D. Both A and B.
B. False.
10. What is the average rental increase that landlords typically
5. Why is talking with neighboring tenants before charge dental tenants renewing their leases?
your commercial lease renewal a good strategy? A. 10 percent of the current rental rate.
A. It will give you a nice break from your workday. B. 15 percent of the current rental rate.
B. You may learn what they are paying for commercial rent. C. 25 percent of the current rental rate.
C. They can tell you if they plan to expand, downsize or leave the D. Whatever amount the landlord chooses.
property, which may impact your decisions.
D. Both B and C.
Legal Disclaimer: The CE provider uses reasonable care in selecting and providing content that is accurate. 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 health-care professional.
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.
EDUCATION form to 480-598-3450 or answer the post-test questions online at dentaltown.com/ce-850. This written
self-instructional program is designated for 1.5 hours of CE credit by Farran Media. You will need a minimum
ANSWER score of 70 percent to receive your credits. Participants pay only if they wish to receive CE credits; thus
SHEET no refunds are available. Please print clearly. This course is available to be taken for credit Feb. 1, 2018,
through its expiration on Feb. 1, 2021. Your certificate will be emailed to you within 3–4 weeks.
Name ______________________________________________________________________________________________________ 2. A B C D
Address ___________________________________________________________________________________________________ 3. A B C D
4. A B
City ____________________________________________________ State ___________ ZIP ________________________
5. A B C D
Daytime phone _____________________________________________________________________________________________
6. A B
Email (required for certificate) ______________________________________________________________________________
7. A B C D
o Check (payable to Dentaltown.com)
8. A B C
o Credit Card (please complete the information below and sign; we accept Visa, MasterCard and American Express.)
9. A B C D
Card Number ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ 10. A B C D
Expiration Date – Month / Year ______ ______ / ______ ______ ______ ______
Please circle your answers.
Signature ______________________________________________________________________ Date ________________________
____________________________________________________________________________________________________________________________________________________
For questions, contact Director of Continuing Education Howard Goldstein at hogo@dentaltown.com.
M
with us after that awful joke, we applaud your resolve. And if you have real resolve, you’ll
make it through all 68 teams in this year’s bracket until one comes out on top. But do you
know who really comes out on top during the swell of basketball fever? Dentists. Don’t
believe us? Basketball has a rate of 11 dental injuries per 100 athletes, which is the highest
MARCH
Toothquila
among all sports. Quite a lot for a “no-contact” sport, eh? Here’s a handful of other sports
keeping
Saint you ina business.
Patrick, fifth-century missionary You will need: Tequila, shot glasses, a
and bishop, probably didn't know that his handful of crowns, and no shame.
D
death on March 17, 461, would become a Instructions: Place one crown in a shot
Football Hockey Mixed martial arts
reason for the world to spend $5.38 billion
To make football playersdrink it without
and This onelooking. Guess the
is a no-brainer.
Historically, this one used to
on getting drunk
take the cake back before and buying green stuff. tooth
look like a bunch of wusses, by feeling with your tongue.
After Ronda Rousey’s famous Guess
N
Ireland's patron
mouthguards were common- saint achieved his sainthood
hockey players wrong?
weren’t re- Take another
defeat, shot.
she Repeat
admitted her until
place. By some estimates,
by converting thousands of the mostly pagan quired to wear helmets until teeth
you've guessed correctly. were so unstable that it
more than half the players the
Irish population to Christians. Presently, we start of the 1979 season. could be three to six months
Mouthguards still aren’t
in the 1950s suffered dental
dump 45 pounds of dye into the Chicago Flossy cup before she could eat an
E
injuries. Helmets have come mandatory. The stereotypical apple. More recently, fighter
aRiver to make
long way, it flow
which helps. green for fiimage
Keep ve hours,
of a hockey playerYou will need: Solomonrinse cups,
Rogers gotbeer,
kickedflso
oss
indrink
mind 13
thatmillion
it wasn’tpints
until of Guinness,withand go
a gap-toothed and
smilea lack
is a of newhardpatients.
in the head that viewers
1962 that pinching
around facemasks were people—which stereotype
in 2018for a reason, and
Instructions: of the
Makefighta could
toast actually
with a rinse
S
worn
seemsby every
reason player. even today
Thesefor a lawsuit,
enough so bemost pros
cup see
fulllos- see hisall
of beer, drink tooth fly then
of it, out ofposition
his
days the most common dental ing a tooth or two as a rite of gaping, unconscious mouth.
careful. In the spirit of the fourth-most it so that it hangs over the edge of a table.
injuries occur when fantasy passage. Player Duncan Keith If you haven’t thought of
popular drinking holiday in thehad U.S., weteeth missing
seven With flafter
oss wrapped around
buying yourbanner
a ringside fingers, aduse
football fans grind their teeth
S
present you with
for 16 weeks. That’s what you these dental drinking
taking a puck to the
the minty
mouth in strand to try
before, to
this fl ip
could the
be acup over
golden
games
get ... which
for thinking thatyou should
kicker was totallya never do. which
2011 game, so must
it lands
be face down on the
opportunity table.
to kick ’em Play
while in
going to be your X factor. some sort of record.teams or alone, they’re
sad. ■ down, so to speak.
OPTIMAL
WORKING
TIME
SHORT
SETTING
TIME
Call 1-888-658-2584
VOCO · 1245 Rosemont Drive · Suite 140 · Indian Land, SC 29707 · www.vocoamerica.com · infousa@voco.com
FREE FACTS, circle 42 on card