DT U.S.

Better sleep through dentistry / News / Jumpstart your production with ‘Stage III Customer Service’ / Practice transition planning (part 1 of 2) / Analyze this ... the consumer’s point of view / Better sleep through dentistry / Minimally invasive cosmetic dentistry (part1) / Minimally invasive cosmetic dentistry (part2) / Dentistry in the Windy City / OHA Gala to feature plenty of ‘bling’ / Chicago Midwinter Meeting0 / A new solution for dentin hypersensitivity / Industry News / AMD LASERS: one of the most affordable soft-tissue dental lasers / Industry News / Industry News / COSMETIC TRIBUNE 2/2010

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DENTAL TRIBUNE
The World’s Dental Newspaper · U.S. Edition

February 2010

www.dental-tribune.com

ENDO TRIBUNE
The World’s Endodontic Newspaper · U.S. Edition

The consumer’s POV

If you put yourself in the consumer’s shoes,
how would you rate your practice? u page 10A

Calcified canals

Follow along with Dr. Richard Mounce as he
u page 1B
troubleshoots a tricky clinical case.

Vol. 5, No. 4

CHosmetiC
RiBUNe
YGIENE TtRIBUNE
the
Dentistry
Newspaper
· U.s.
edition
TheWorld’s
World’sCosmetic
Dental Hygiene
Newspaper
· U.S.
Edition

Botox and dermal fillers

Extending the oral-systemic connection to the
esthetic realms.
upage 1C

Better sleep through dentistry
By Robin Goodman, Group Editor

When I was scouring the exhibit
floor of the Yankee Dental Congress
for new dental products, I had the
pleasure of meeting Rani Ben-David,
who is the president of Sleep Group
Solutions and was featuring the company’s Dental Sleep Magazine during
the event.
When I expressed an interest in
publishing some content on dental
sleep medicine, Ben-David kindly put
me in touch with Dr. Gy Yatros, who
is a diplomate of the American Academy of Sleep Medicine.
Yatros offers a practice that
endeavors to be on the cutting edge
of technology, but also emphasizes

the importance of dental health.
Aside from the variety of services
he offers, the practice motto piqued
my interest:
“Smile Better. Eat Better. Sleep
Better … Live Better.”
How many dentists had I seen promote better sleep through dentistry?
Well, none until Yatros.
What is dental sleep medicine?
Dental sleep medicine is a growing
area of dentistry through which dentists can help their patients sleep better and snore less, which helps their
bed-time partners sleep better too.
Obstructive sleep apnea [OSA]
is one of the most prevalent and
increasing medical problems in the

Dentists convene in the Windy City

“Chicago, Chicago, that toddlin’ town. Chicago, I’ll show you around ...
State street, that great street, I just want to stay. They do things they don’t do
on Broadway ...” Unfortunately, there’s no stanza about the Chicago Midwinter Meeting, but we’d like to help you write one.
g See pages 22A–28A

United States, and dentists who are
properly trained in dental sleep medicine can help control this life-threatening disease.
How can dentists help treat
obstructive sleep apnea?
Obstructive sleep apnea is a condition that occurs when the airway collapses during sleep, primarily due to
loss of muscle tone.
When the airway collapses, it prevents air from reaching the lungs,
causing a myriad of serious and
undesirable health consequences.
The primary muscle that contributes to this collapsing airway is the
tongue.
Dentists who are properly trained

Dr. Gy Yatros, Holmes Beach, Fla.
g DT page 13A

Ultradent supports
NCOHF mission
Ultradent Products, a developer of
high-tech dental and hygiene materials, devices and instruments worldwide, recently donated dental products
valued at more than $22,000 to National Children’s Oral Health Foundation:
America’s Toothfairy (NCOHF) to provide vital dental treatment for underserved children across the country.

“Ultradent is proud to be a part of
NCOHF’s fight to eliminate pediatric
dental disease,” said Dr. Dan Fischer, CEO and president of Ultradent.
“We are dedicated to improving the
oral health of all Americans, including
those who cannot help themselves —
g DT page 2A
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[2] =>

News

Dental Tribune | February 2010

Survey shows Tooth Fairy
is giving more per tooth
By Fred Michmershuizen, Online Editor

The Tooth Fairy is being more generous these days, according to a recent
survey. In fact, some are even saying
the increased amounts that children
are receiving for their teeth point to
signs of a recovering economy.
The 2010 Tooth Fairy Poll, conducted by Delta Dental of Minnesota,
showed that in Minnesota, children
are now receiving an average of $1.96
per tooth, which increased significantly from the previous year’s average of
$1.62 — a 21 percent increase. Nationally, the average is $2.13, which is a 13
percent increase over last year’s average of $1.88.
“This year’s Tooth Fairy Poll average reflects improvements we’re seeing in other areas of the economy,”’
said Ann Johnson, director of community affairs for Delta Dental of Minnesota, in a press release announcing
the poll results.
“‘For example, the Dow Jones
Industrial Average increased 23 percent during the same time period. The
Tooth Fairy may be another indicator that the economy is starting to
recover.”
The annual Tooth Fairy poll results
are derived from a national survey
randomly distributed to Delta Dental of Minnesota members and their
families across the United States who

are served by Delta Dental of Minnesota. The poll also revealed some other
interesting results.
Nearly half of children’s first dental
visits occur by age 2, which is a move
in the right direction, according to
Delta Dental of Minnesota.
“For the past few years, the poll
revealed the child’s first dental visit
was closer to age 3, so this is a positive
shift,” Johnson said.
“The American Dental Association
recommends that a child be seen by a
dentist as soon as his or her first tooth
erupts, but at least no later than the
child’s first birthday.”
Approximately 90 percent of parents
surveyed state their children receive a
dental exam every six months.
“The frequency of dental visits
should be determined by the child’s
dentist, based on an assessment of
the child’s unique oral health needs,”
Johnson said. “This process ensures
that each child receives the most
appropriate dental care.”
The poll continues to show children
are consuming fewer sugary drinks
and treats. More than half of parents
surveyed indicated their children consume an average of one to two sugar
drinks or treats per day.
“Encourage children to make
healthy choices,” Johnson advised.
“Teach them to eat a balanced diet and
limit in-between meal snacks of foods

Tell us what you think!
Do you have general comments or criticism you would like to share? Is
there a particular topic you would like to see more articles about? Let us
know by e-mailing us at feedback@dental-tribune.com. If you would like
to make any change to your subscription (name, address or to opt out)
please send us an e-mail at database@dental-tribune.com and be sure
to include which publication you are referring to. Also, please note that
subscription changes can take up to 6 weeks to process.

containing high levels of sugar. This
will help promote good dental health
as well as overall health.”
The poll also shows most Minnesota children are working hard to keep
their teeth clean. According to the poll,
79 percent of parents report that their
children brush their teeth in the morning, and 90.5 percent of children brush
at night, while only 3.1 percent brush
at noon.
“Children should brush with a peasized amount of fluoride toothpaste
after sugary or starchy meals or snacks
to help reduce the incidence of tooth
decay,” Johnson said.
“Children should also drink fluoridated water after meals to help cleanse
the teeth.”
Approximately 56 percent did not
know that tooth decay is contagious,
transmissible and a bacterial infection.
However, Delta Dental was pleased
to learn that 60.8 percent of surveytakers changed their toothbrush after
the cold or flu.
For the official Tooth Fairy Poll Web
site, visit www.theofficialtoothfairypoll.
com. It lists current Tooth Fairy rates,
statistics, oral health information and
Tooth Fairy customs from around the
world. DT

f DT page 1A
like the underserved children benefiting each day from NCOHF programs
and services.”
In addition to underwriting of operational expenses since 2006, Ultradent has provided more than $107,000
in donated products to the national
NCOHF Affiliate network of nonprofit
health care programs working in local
communities to combat America’s oral
health epidemic. Four NCOHF Affiliates benefited from the latest product donation from Ultradent, allowing
these facilities to expand and enhance
preventive and restorative services for
children in their area suffering from
pediatric dental disease.
“Millions of children across our
country are in dental pain so severe
it impacts their ability to eat, sleep
and learn,” said Fern Ingber, NCOHF’s
president and CEO. “Ultradent has
long been an invaluable partner to
NCOHF, and we are honored to work
with a corporation that shares our
commitment to ensure all children
have the necessary building blocks
for healthy, happy and productive
futures.”
The mission of Ultradent, based in
South Jordan, Utah, is to improve the
level of oral health care and to make
dental procedures more predictable
and hassle-free. Consistent with its
mission, Ultradent works to improve
the quality of life and health of individuals through various financial and
charitable programs. DT

DENTAL TRIBUNE
The World’s Dental Newspaper · US Edition

Publisher & Chairman
Torsten Oemus
t.oemus@dental-tribune.com
Vice President Global Sales
Peter Witteczek
p.witteczek@dental-tribune.com
Chief Operating Officer
Eric Seid
e.seid@dental-tribune.com
Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com
Editor in Chief Dental Tribune
Dr. David L. Hoexter
d.hoexter@dental-tribune.com
Managing Editor/Designer
Implant Tribune & Endo Tribune
Sierra Rendon
s.rendon@dental-tribune.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Product & Account Manager
Mark Eisen
m.eisen@dental-tribune.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dental-tribune.com
Sales & Marketing Assistant
Lorrie Young
l.young@dental-tribune.com
C.E. Manager
Julia E. Wehkamp
j.wehkamp@dental-tribune.com

Dental Tribune America, LLC
213 West 35th Street, Suite 801
New York, NY 10001
Tel.: (212) 244-7181
Fax: (212) 244-7185
Published by Dental Tribune America
© 2010 Dental Tribune America, LLC
All rights reserved.
Dental Tribune strives to maintain the
utmost accuracy in its news and clinical reports. If you find a factual error or
content that requires clarification, please
contact Group Editor Robin Goodman at
r.goodman@dental-tribune.com.
Dental Tribune cannot assume responsibility for the validity of product claims
or for typographical errors. The publisher also does not assume responsibility
for product names or statements made
by advertisers. Opinions expressed by
authors are their own and may not reflect
those of Dental Tribune America.

Editorial Board
Dr. Joel Berg
Dr. L. Stephen Buchanan
Dr. Arnaldo Castellucci
Dr. Gorden Christensen
Dr. Rella Christensen
Dr. William Dickerson
Hugh Doherty
Dr. James Doundoulakis
Dr. David Garber
Dr. Fay Goldstep
Dr. Howard Glazer
Dr. Harold Heymann
Dr. Karl Leinfelder
Dr. Roger Levin
Dr. Carl E. Misch
Dr. Dan Nathanson
Dr. Chester Redhead
Dr. Irwin Smigel
Dr. Jon Suzuki
Dr. Dennis Tartakow
Dr. Dan Ward

[3] =>

[4] =>

News

Dental Tribune | February 2010

ADA, other groups petition
against FTC ‘red flags’ rule
By Fred Michmershuizen, Online Editor

Following a recent federal court
decision, the American Dental Association (ADA) has joined with three
other national organizations representing professional health care
providers calling on the Federal
Trade Commission (FTC) to exclude
health professionals from controversial new regulation intended to
combat identity theft.
A letter sent to FTC Chairman
Jon Leibowitz by leaders of the ADA,
the American Medical Association
(AMA), the American Osteopathic
Association (AOA) and the American Veterinary Medical Association
(AVMA) is the latest challenge to the
so-called “red flags” rule.
According to the associations, the
FTC’s interpretation of the regulation imposes an unjustified, unfund-

ed mandate on health professionals for detecting and responding to
identity theft.
“Congress did not intend the original red flags legislation to apply to
small businesses, but rather it was
intended to encourage large businesses like banks, credit firms and
national retailers to implement best
practices to protect customers’ from
identity theft,” said ADA President
Ronald Tankersley, DDS.
In their petition, the organizations asked the FTC to make it clear
that the rule will not apply to their
members given the result of recent
litigation brought by the American
Bar Association against the FTC.
In that case, the U.S. District
Court for the District of Columbia
ruled that lawyers should be excluded from the requirements imposed
by the red flags rule.

The court decision follows wide
criticism that the FTC’s overly broad
interpretation of the Fair and Accurate Credit Transactions Act of 2003
(FACT) led the commission to create
a rule that oversteps its authority.
In response to these concerns,
the FTC postponed the rule’s effective date to June 1, but it has never
changed the position that the rule
will apply to health professionals.
In its ruling against the FTC, the
court said that the application of
this rule to attorneys “is both plainly
erroneous and inconsistent with the
purpose underlying enactment of
the FACT Act.”
The court also stated that the FTC
“not only seeks to extend its regulatory power beyond that authorized
by Congress,” but also “arbitrarily
selects monthly invoice billing as
the activity it seeks to regulate.”

“The court ruling sends a clear
signal that the FTC needs to reevaluate the broad application of the
red flags rule,” said AMA President
J. James Rohack, MD.
“Our four organizations firmly
believe that applying the rule to
health professionals, but not to lawyers, would be unfair.”
“Postponement of the rule’s
effective date is inadequate,” said
AOA President Larry A. Wickless,
DO. “Our four organizations need
a commitment from the FTC that
it will not apply the red flags rules
to health professionals if it is not
applied to lawyers.”
“The burdens of complying with
this rule outweigh the benefits,”
said AVMA President Larry R. Corry,
DVM. “The FTC’s interpretation of
the FACT Act should be redefined
to exclude health professionals.” DT

Eva’s Village: Paterson, N.J.-based
dental clinic seeks volunteers
Eva’s Village, www.evasvillage.
org, is a Paterson, N.J.-based comprehensive anti-poverty, social service agency with a mission to feed
the hungry, shelter the homeless,
treat the addicted and provide medical care to the poor with respect
for the human dignity of each individual.
Eva’s Village serves a warm lunch
365 days a year, operates shelters for
men, women and women with children, operates an inpatient recovery
center for men and women, as well
AD

as an intensive outpatient recovery
center, and has a free medical clinic.
Yet shelter, food, addiction services and primary health care aren’t
the only things provided.
Eva’s Village also gives residents much-needed free dental care
thanks to a program established by
Dr. Brian Ullmann, a prosthodontist
in Ho-Ho-Kus, N.J. The free clinic
operates each Wednesday, staffed
by volunteer dentists and a dental
assistant.
Funding from the Delta Dental of

New Jersey Foundation helps pay
the salary for the dental assistant
and a recording assistant. It also
helps pay for supplies and prosthodontic laboratory fees.
The clinic provides preventive and
emergency dental care, including
digital panoramic X-rays, cleanings,
fillings, extractions, root canals, oral
cancer screenings, stainless-steel
crown restorations and dentures.
“Proper dental care is tremendously important for people trying
to rehabilitate their lives,” said Ull-

mann. “It improves the way they
look and the way they feel — and
it can help give people more confidence and a positive attitude when
looking for work.”
Other volunteers at the Eva’s Village dental clinic include Dr. Yvonne
Callas and Dr. Ed Kim. The clinic is
presently in need of more volunteer
dentists.
If you are interested in volunteering, call Jennifer Doherty at (973)
523-6220, ext. 248, or e-mail her at
Jennifer.Doherty@evasvillage.org. DT

[5] =>

[6] =>

[7] =>

Dental Tribune | February 2010

Industry Practice Matters

Jumpstart your production
with ‘Stage III Customer Service’
By Roger P. Levin, DDS

What do patients remember
most after visiting your practice?
Mostly how you made them feel.
If they walked away with a very
positive attitude, patients perceive
excellent customer service and
they will return.
Any practice not exhibiting
superior customer service puts
itself at high risk for declining
production.
In a tight economy, great customer service matters more than
ever. Through the following Stage
III Customer Service™ strategies,
you can build better relationships
with patients and increase production as a result.

No. 1: Schedule patients promptly
If a practice fails to schedule new
patients quickly, runs late when
the patient arrives or isn’t prepared for the appointment, patient
confidence and trust decreases.

No. 2: Get to know patients
Learn their hobbies and occupations. Establish rapport with them.
Patients are more likely to accept
treatment from a dentist and a
team they trust.

No. 3: Always have the answers

payment by credit card; half the payment upfront, half before treatment
is completed; 5 percent off when
paid upfront; outside financing.

No. 5: Be the educational
resource for patients
Be a resource, not just an office
that provides a service. Educate
patients on proper oral hygiene.
Show them how to use certain
appliances, such as power toothbrushes or water jets. Provide
them with fact sheets and brochures addressing dental health
concerns.
Take the time to show your
patients how much you care. This
kind of above-and-beyond service
shows patients you care and helps
to instill trust in your team.

Conclusion
Increased production depends on
effective customer service more
than ever before. New patients,
patient retention, recare appointments — they all tie in with strong
customer service.
Through the steps outlined
above, your practice can exceed
expectations and reach Stage III
Customer Service. DT

About the author

Often times, patients will seek a
second opinion regarding recommended treatment, usually from
a front desk staff member. Ensure
that all team members understand
the top three benefits of each
treatment and are able to provide
responses that reinforce your recommendation.

No. 4: Give patients options
Three of the most powerful ways
to “WOW!” patients is by providing them options when it comes
to treatment, scheduling and payment.
Treatment options. A strong
service mix boosts production.
Practices should offer a mix of
need-based and elective services. In addition, offering at-home
products is an excellent strategy
for exceeding patient expectations
and increasing production.
Scheduling
options.
Allow
patients the freedom to choose
between two different times rather
than allowing them to determine
the date and time themselves. This
way, patients have choices while
the practice maintains a productive schedule.
Payment options. Patients have
different financial situations, especially today. Provide patients with
as many financial options as possible. Levin Group recommends the
following four financial options:

Dr. Roger P. Levin is founder
and chief executive officer of
Levin Group, a leading dental
practice management consulting firm that provides a comprehensive suite of lifetime services to its clients and partners.
Since 1985, Levin Group has
embraced one single mission —
to improve the lives of dentists.
For more than 20 years, Levin
Group has helped thousands of
general dentists and specialists
increase their satisfaction with
practicing dentistry.
Levin Group may be reached
at (888) 973-0000 and customer
service@levingroup.com.

Total Practice Success Seminar
Dental Tribune readers are entitled to receive a 20 percent
courtesy on Dr. Levin’s Total Practice Success™ Seminar held
for all general dentists on March 11 and 12 in Las Vegas.
To register and receive your discount, call (888) 973-0000
and mention “Dental Tribune” or e-mail customerservice@
levingroup.com with “Dental Tribune TPS” in the subject line.
For more on Levin Group programs and seminars, visit
www.levingroup.com.
ADS

[8] =>

Financial Matters

Dental Tribune | February 2010

Practice transition planning
This is part 1 of a two-part series on this topic
By Eugene Heller, DDS

For most dentists, ownership of
their dental practice is the major
focus of their energy expenditures,
financial situation and professional
lives.
Years of blood, sweat and tears,
coupled with the relationships
formed with both staff and patients,
have caused dentists to form a deepseated emotional attachment with
their practice.
For many, the dollar value of that
practice represents a significant portion of their financial assets.
For the new dentist, there is a definite value in acquiring the patient
base that has taken the transitioning
dentist years to develop and will provide an immediate and substantial
cash flow.

All experience transition
Whether it is due to a change in
career direction, a desire to cut back
on the responsibilities of ownership
while still enjoying the benefits of
clinical dental practice or the desire
to retire from dentistry, every practice owner faces an ownership transition.
Ownership transition can be a
total sale or a partial sale, that is, the
formation of a partnership. The level
of success achieved as a result of this
practice transition will be directly
linked to the amount of detail given
to, and the successful execution of,
the “Transition Plan.”

A buyer’s market
Decreased dental school enrollments
and other demographic factors have
created an imbalance in the numbers of graduating versus retiring
dentists.
This trend, which will continue
for at least the next 10 years, has
contributed to falling dental practice
sale prices, and has created a buyer’s
market.
This dental work force shortage
has made finding dentists to serve in
more rural dental practices, which
are difficult to market, almost impossible. These changes in the marketplace relative to practice transitionAD

over another.
The major factors considered
include:
(1) the practice’s overhead to revenue percent,
(2) number of active patients,
(3) new patient flow,
(4) recall system effectiveness.

ing have made advance, detailed
transition planning mandatory.

Goals of a successful transition
Before discussing the development
of a transition plan, a brief discussion of the goals of transition is
required. In addition to identifying
the actual goals, each dentist will
need to assign an order of priority to
these goals.
This prioritization will have a significant impact on certain aspects of
the transition plan. The most common goals discussed by dentists
include:
(1) In accordance with their preferred timetable, a desire to transfer
patient care responsibility.
(2) Securing future employment
for their staff and giving back to the
profession by passing the baton to a
new dentist.
(3) Maximizing their practice
equity (financial gain from the sale).
There is no right or wrong order
to the priority emphasis. The economic health of the transitioning
dentist will usually determine the
order of the priorities.
If the practice sale proceeds are
a significant portion of the dentist’s
retirement assets, then maximizing
the financial return will be at the top
of the list.
If the clinician has a well-funded pension plan or other financial
resources, and the sale proceeds will
enhance the quality of retirement
rather than providing the primary
support for retirement, the order
of importance will typically be the
desire to provide continuity of patient
care, ongoing employment and pass-

ing the baton, where maximizing the
financial gain appears at the end of
the list.

Factors affecting successful
transitions
Prior to discussing the components
of a transition plan, it will be useful to understand what is presently
occurring in the transition marketplace. For a successful transfer of
ownership, we must first have an
interested new dentist.
Subsequently, location is at the
top of the list relative to a new dentist’s interest in a specific practice
opportunity.
As previously discussed, rural
practices, although typically more
profitable than big city practices,
are having serious recruitment problems.
Ninety percent of all practice sales
today are in communities with populations of 50,000 or more, and 80
percent of these sales are in cities
where the metro population exceeds
500,000.
The second factor is the practice’s
ability to meet the financial needs of
the new dentist. As a result of current levels of dental school-related
debt, the new dentist must meet specific levels of production to pay for
the practice acquisition, school loans
and basic living expenses.
Therefore, a practice needs to
provide, on the average, $300,000
worth of production for an employed
dentist, and $400,000 worth of production if the dentist is purchasing
a practice.
It is for this reason that 85 percent
of total practice sales involve practices with gross receipts of $350,000
to $500,000.
While the highly productive and
profitable practices of today frequently exceed $500,000 in annual
receipts, the average new dentist
(five years or less since graduation)
does not possess the clinical skills
required to produce this level of dentistry, and subsequently, sales trend
toward the lower grossing practices.
After finding a suitable location
and determining that the practice
will provide for the financial needs
of the new dentist, the new dentist
will consider a multitude of other
factors in selecting one opportunity

In addition:
(5) quality and length of the staff’s
prior employment,
(6) practice history,
(7) types of procedures previously
offered and/or produced,
(8) involvement in any discounted
dental plans,
(9) appearance of the physical
space occupied by the practice, and
(10) the age, type and appearance
of the equipment and furnishings
will play a major role in the selection
process.
The 10 items listed above represents the major concerns and factors
reviewed by the new dentist.
However, the owner dentist is
concerned with:
(1) the ability of the new doctor to
pay for the practice — obtain financing with all the school debt, the tax
implications and subsequent net proceeds derived from the sale,
(2) the personality and ability of
the new dentist to relate to patients
and staff,
(3) the amount of post-sale relationship required between the seller
and buyer, and of course,
(4) the new dentists’ clinical competence.
With the exception of the final
concern, the other factors can be
readily determined and resolved.
Today, 100 percent owner financing is readily available, the tax implications can be calculated and, typically, several meetings with the new
dentist will address the communication skills and personality of the new
dentist. DT

About the author
Dr. Eugene W. Heller is a 1976
graduate of the Marquette
University School of Dentistry.
He has been involved in
transition consulting since 1985
and left private practice in 1990
to pursue practice management
and practice transition consulting on a full-time basis.
He has lectured extensively to
both state dental associations
and numerous dental schools.
Heller is the national director
of transition services for Henry
Schein Professional Practice
Transitions. For additional
information, please call (800)
730-8883 or send an e-mail to
ppt@henryschein.com.

[9] =>

[10] =>

10A Practice Matters

Dental Tribune | February 2010

Analyze this … the
consumer’s point of view
By Sally McKenzie, CMC

It’s all about relationships. No
doubt you’ve heard that line many
times. No matter what the profession — business, government,
education, health care — relationships are critical. And, of course, in
dentistry, they will build or break
the practice.
The relationships you establish with your patients as you are
addressing their oral health care
needs and wants can last a lifetime.
Most practitioners have many
patients who have been with them
for 10, 15 or more than 20 years.
Once they are in the practice, these
patients get to know you and your
team. They appreciate what you
have to offer.
But what about the new patients
that you need to sustain growth in
your practice?
What about the individuals who
are considering your practice, but
haven’t made their first appointment yet and have no established
relationship?
They are looking at their dental
options from a consumer’s point
of view. Like it or not, they are
analyzing, evaluating and judging
your practice against others and
basing that judgment on criteria
you may not feel is fair.
As most of us in the business of
providing a service know, consumers have very high expectations.
If you had to step back and take
a good hard look at your practice
from the consumer’s point of view
what would you discover?

Facing the facts
Conduct a “consumer analysis”
AD

of your practice and compare it
to two other practices that you
are competing with for patients.
Develop a series of criteria and
score your practice, or ask a friend
or relative to score your practice,
against the others.
Use a scale of 1 to 5, with 1
being the lowest and 5 being the
highest. Then step back and honestly consider how you stack up
in the consumers’ minds, starting
with convenience.
How conveniently located is
your practice compared to your
competitors? Is parking a problem?
Is your practice difficult to find?
Are there stairs patients have
to climb? Do you offer convenient
appointment times to accommodate busy schedules?
Can new patients get an
appointment within two weeks or
is the business staff telling them
they’ll have to wait months? New
patients will not wait two, four or
six months for an appointment.
If you don’t make room for them
in your schedule promptly, you
must not want them in your practice.
What kind of a first impression does your building make?
Will prospective patients who are
driving by say, “That looks like a
nice office.” Or will they say, “I
wouldn’t want my car parked in
that lot.”

Don’t trip over the telephone
If a prospective patient calls your
office, what impression does your
practice make? Is the person
answering the phone helpful or
does the caller feel like she or he
is just another interruption?
Does the business employee

make the scheduling process easy
and welcoming for the prospective
patient? Or are the first few words,
“Do you have insurance?” Does he
or she often say, “No, we can’t do
that.”
Is everyone who answers the
phone prepared to answer key
questions that prospective patients
are likely to ask? Does the person
answering the phone have a welcoming or annoyed tone to his or
her voice?
Never forget that the person
answering the phone in your office
represents the entire team. In the
first few seconds of a telephone
contact, the caller is making judgments about the quality of your
care and the helpfulness of your
staff. It may not be fair, but it’s
reality.
If you have even a glimmer
of doubt about the impression
your practice makes with callers,
explore mystery patient services,
which are now widely available to
dental practices.
In addition, above all else, train
your front line. Don’t assume that
they know how to handle these
essential practice-building calls.
Find out!
Many business staff are very
well intentioned and think they are
handling prospective patient calls
perfectly fine. They have no idea
that in just a few short sentences they are driving patient after
patient away, and that they need
to learn the right way to handle
these calls.

Follow-through or falling
through the cracks?
How well would your team score
on follow-through?
If a consumer calls and asks for
information on a specific procedure such as implants or veneers,
as well as information on the dentist or the office in general, do you
have materials to send via post?
How long will it take the busy
front-desk staff to get the information in the mail?
Better yet, do you have a Web
site prospective patients can visit
to learn more about the dentist,
team and the practice as a whole?
Today, having a Web site is
just as important as having a telephone.
Dental teams routinely underestimate the value of prospective
patient/consumer inquiries. If
yours is among them, it’s costing
you a fortune.
Pay attention to the seemingly
insignificant details. They have a
huge impact on whether the consumer/potential patient makes an

appointment with you or the dentist down the street. And, while
you’re at it, take a look at those
significant issues as well.

Factor No. 1: service
Take time to closely evaluate the
five most critical consumer factors, namely: service, reliability,
stability, expertise and price.
Service is listed first because
consumers expect excellent service, and it is one of the most
essential, but often overlooked,
factors that will instantly set your
practice apart from others.
Excellent service begins with
the first phone call and continues
with every interaction thereafter.
Something as simple as welcoming all patients — new and
existing — to the practice by name
when they walk in the door conveys a sense of appreciation and
good service.
Looking patients in the eye
when you speak to them and when
they speak to you tells them you
are genuinely interested in what
they have to say and you are sincere in what you have to tell them.
Keeping your cool — even
though it may be one of those
“full-moon days” — and treating
each individual as though he or
she is the only patient you have to
take care of at that very moment,
puts the patient at ease.
This is because he or she feels
the practice has things well under
control and takes his or her best
interests to heart.
Knowing the answers to common questions and providing thorough and complete information
tells patients you have your act
together and are well trained/pre-

[11] =>

Dental Tribune | February 2010
pared.
Similarly, getting back to
patients when you say you will
with the answer to a question indicates that you value their interest
in your practice.

Factor No. 2: reliability
Patients expect the office to run
reasonably on time. If the dentist or hygienist is behind schedule, telephone patients so they can
make changes in their plans or
reschedule if necessary.
If you can’t reach patients and
they have to wait for more than 20
minutes, give them a letter signed
by the dentist that:
• apologizes for the inconvenience,
• thanks them for their understanding,
• emphasizes that the practice
makes every effort to remain
on schedule,
• occasionally special circumstances arise that affect the
schedule,
• includes a $5 gift card to Starbucks (or something similar)
in the envelope.
Patients may still be frustrated about the delay, but they
will appreciate that the practice
acknowledged the inconvenience.

Factor No. 3: stability
A solid team is the mark of a strong
practice.
If Ann is at the front desk when
the prospective patient calls, but
has been replaced by Nicole when
the patient comes in for the first
appointment, who is later replaced
by Joe when the patient returns for
treatment ...
Well, you can bet that this new
patient is going to develop concerns about the stability of your

About the author

Sally McKenzie is CEO of
McKenzie Management, which
provides success-proven management solutions to dental
practitioners nationwide. She is
also editor of The Dentist’s Network Newsletter at www.thedentists network.net; the e-Management Newsletter from www.mckenziemgmt.com; and The New
Dentist™ magazine, www.thenew
dentist.net. She can be reached
at (877) 777-6151 or sallymck
@mckenziemgmt.com.

practice.
If the make-up of your team
seemingly changes as often as the
seasons, patients begin to wonder about things; in particular, the
quality of your care and the competency of your staff. Often, such
concerns are for good reason.
If yours is a revolving door practice, it’s a strong indicator of some
serious shortfalls in your personnel
systems, including hiring, training
and employee evaluations, just to
name a few.

Factor No. 4: expertise
Brag about each other. You simply
cannot overemphasize the expertise of the dentist and the team.
Take every opportunity to convey the message of excellence and

Practice Matters 11A
quality.
If a patient asks a team member if the dentist is good at a
particular procedure, answer with
an emphatic, “Yes, she (he) is the
best.”
The new patient packet and the
practice Web site should give information about the entire team’s
training and experience, particularly the dentist’s.
Routinely inform patients about
continuing education classes staff
have participated in.
This is as simple as placing an 8
x 10 frame at the reception counter
that highlights the staff member’s
accomplishment.
For example, “Please join us
in congratulating Dr. Jones for
her recent certification from the

American Academy of Cosmetic
Dentistry.”

Factor No. 5: price
Make it easy for patients to accept
treatment and pay for that treatment. Provide clear financing
options that are both practice
friendly and patient friendly.
Partner with a patient financing company, such as CareCredit.
These types of firms provide excellent financing options that benefit
both the practice and patient.

Conclusion
Make the most of what you have
to offer today’s consumers and you
will be far more likely to enjoy
them as your patients for many
years to come. DT
AD

[12] =>

[13] =>

Interview 13A

Dental Tribune | February 2010
f DT page 1A
in dental sleep medicine make
mouthpieces to hold the jaw and/
or tongue forward, resulting in an
increase in airway volume. There
is, however, more to it than just
making a mouthpiece. In our office,
these dental sleep devices are custom
made and adjustable.
Through our program we evaluate
subjective findings and obtain objective testing with portable home sleep
monitors. The results are evaluated
and the devices are adjusted to obtain
the maximum medical improvement
for each individual.
It is more of a process than just
handing someone a device. At Dental
Sleep Solutions, we call the process
Dental Sleep Therapy, and it generally takes us one to three months to
achieve the desired results.
How are the sleep devices different
from snore guards?
The real question here is: What is a
snore guard, and how do we know it
is just snoring? Has the patient had a
sleep study?
I know there are several overthe-counter “boil and bite” products
targeted at snoring prevention. In
addition, I know there are dentists
who claim to make “snore appliances,” but do not treat obstructive
sleep apnea.
Well, I have news for them: if you
are treating snoring, you are likely
treating OSA without a diagnosis!
Snoring and OSA are caused from the
same anatomic problem: a collapsing
airway. Patients who snore also have
an increased risk of having OSA and,
furthermore, snoring is often the first
sign of OSA.
Before making any type of device
for snoring, I feel the patient should
be evaluated for OSA with a sleep
study. The majority of time we will
find out it is more than snoring. Once
the diagnosis is complete, then proper treatment decisions can be made.
It really upsets me to see that some
individuals and dentists are treating
this very serious medical disorder
without a proper diagnosis and follow through.
What other treatments are
available?
The “gold standard” for treatment of
OSA has been CPAP, which stands
for continuous positive airway pressure. Basically, it is a pump that is
attached to a mask or nasal pillows
— tubes in the nose — that increases
the pressure in the airway. Much
like blowing up a balloon, the pump
is adjusted with enough pressure to
keep the collapsing airway open.
It is the most predictable way to get
air into the lungs and is a life-saving
device for many people. The major
problem is that many people can’t
tolerate its use. There are numerous
common complaints with the CPAP,
the most common among them are
claustrophobia, GI problems, skin
irritation and inconvenient use.
In addition, one of the common
reasons for seeking treatment for
OSA is excessive daytime sleepiness

[EDS]. CPAP can help, but sometimes the CPAP itself disrupts sleep
so much that the positive effects on
EDS are negated by this disruption.
Other treatment options include
various surgeries. Most of these surgeries are less predictable than treatment with dental sleep devices or
CPAP and they are, of course, nonreversible, painful and have medical
risks.
The American Academy of Sleep
Medicine recommends dental sleep
devices for patients with mild to
moderate OSA who prefer them to
CPAP, and for patients with severe
cases of OSA who cannot tolerate
CPAP. Surgery is recommended only
after the non-surgical options.

They work very well at relieving
symptoms and decreasing apnea for
mild to moderate OSA. They can even
work well in many severe cases, but
with less predictability.
A recent study by Dr. Aarnoud
Hoekema [Oral-Appliance Therapy
in Obstructive Sleep Apnea-Hypopnea Syndrome©, 2008] found that
dental sleep devices were 84 percent
effective for mild to moderate OSA
patients — 4 percent higher than
CPAP — and 69 percent effective for
severe OSA.

Are dental sleep devices comfortable?
I guess the best answer to this is
one of personal experience. I have
OSA, and I wear a device comfortably
How
well do
dental sleep
devices
every1 night and have been for more
Projekt2
07.01.2010
11:13
Uhr Seite
work?
than five years. Patients generally

find them much more comfortable
and portable than CPAP.
The compliance rates vary from
around 70 to 95 percent in studies. I
have found that the vast majority of
our Dental Sleep Solutions patients
find them to be comfortable and
wear their devices nightly.
What specialized equipment is
necessary for a dentist to become
involved in this kind of treatment?
The equipment necessary to successfully treat these patients for OSA is
not nearly as involved and costly as it
is for other areas of dentistry.
I’ve often thought if I were just
getting out of school, getting involved
in this area would be a great way to
get started. Due to the increasing
g DT page 14A
AD

EMS-SWISSQUALITY.COM

[14] =>

14A Interview
f DT page 13A
need for dentists in this area and the
minimal equipment costs, it can be
a great profit center for little investment.
A home sleep recorder, by Embletta, and the phayrngometer/rhinometer by Ecovision are the two pieces of equipment that I feel are necessary in treating OSA with dental
sleep devices. Our Embletta home
recorder is a way of completing a
home sleep study.
This precise piece of equipment
can be used for diagnosis if utilized
with the help of a board-certified
sleep physician, and is essential to
determine if our dental device is
adjusted properly.
The Embletta is a little computer
about the size of an iPod that is
attached to the patient while he or
she sleeps at night. It records many
channels of information including
airflow, pulse oximitry and respiratory effort. The Embletta is then
returned in the morning and we
download its information into the
specialized software.
This software will help us analyze
the data that was obtained to see if
our sleep device is adequately alleviating the apnea. Without this piece
of equipment, we would not be able
to tell if our devices are working
properly.
The Ecovision is an apparatus that
sends sound waves through the airway, giving us a volumetric reading
of the airway in a graphic format on
our computer screen. We can use
it to measure the nasal airway, the
rhinometer, or the oral airway, the
phyarngometer.
It is great for screening patients
for airway problems, and for helping
to determine the optimal jaw position
for our dental devices. By manipulation of the jaw while using the Ecovision, we can more adequately predict
treatment outcomes and more desirable jaw position. Both the Embletta
and Rhinometer can be purchased
solely through Sleep Group Solutions.
What special training does a dentist need to provide these services?
Dentists wanting to get involved
should take an introductory course
on dental sleep medicine.
There are many good places to
obtain education, but I recommend
that they take one of our courses at
Sleep Group Solutions.
AD

Dental Tribune | February 2010

I feel our courses offer an excellent non-biased curriculum and they
are geared toward getting the dentists started immediately.
I treat sleep patients every day
in my own office, and I am passionate about getting other dentists
involved in this exciting area. There
are other places to obtain education
in this area, but some of these are
sponsored by dental appliance companies.
At Sleep Group Solutions, we
can give our students honest advice
about dental sleep devices as well as
practical and useful systems to get
started.
Dental sleep medicine has become
a large part of my practice, and I
want to show other practitioners how
to do it for themselves. They can go
to www.sleepseminars.com/modules
to see the upcoming schedule.
Is there a need for more dentists to
become involved?
Are you kidding? Absolutely yes.
Because of the lack of available dentists with knowledge of dental sleep
medicine, I have been recruited by
the neighboring medical community
to provide care in the cities of Sarasota and Tampa.
In both of these areas, I was
recruited by sleep physicians to help
treat their patients because there
was no other trained dentist in the
area. We now have three offices of
Dental Sleep Solutions to help with
the demand. The prevalence of OSA
and snoring is overwhelming and
there are very few dentists available
to help.
How did you get involved in providing this service?
Much like most of my life: a little luck
and a little perseverance. Nine or so
years ago, I had a patient of record
who needed a dental sleep device,
which was prescribed by her physician. I didn’t know much about it at
the time, but I started learning.
The more I learned the more I
realized the need for help in this area
and the enjoyment that you can get
from treating these patients. Once I
became more educated in the area, I
realized that I, too, had OSA.
Of course, this increased my interest in the subject as well. The more
I learned about and treated this lifethreatening disorder, the more passionate I became. Now it is the primary focus of my practice, and I
love it.

What do you like best about providing this service?
That could be a lengthy answer.
There are a great many things that I
find enjoyable about treating OSA in
my practice. I guess the most impressive is that I am now providing a
service that is not only dramatically
improving peoples lives, it is actually
helping to save them. Not many dentists can say that.
In my restorative practice, I have
completed some fairly comprehensive rehabilitative cases. After
months and even years of work, I
have received many gratifying thanks
from happy patients.
The amazing thing about treating
OSA patients is that in a matter of a
few weeks, I commonly receive more
heart-felt gratitude from patients
then I do after months or years of
restorative treatment.
I routinely receive tearful embraces of appreciation from these desperate patients. Talk about going home
at night feeling good!
In addition, I find treating sleep
patients is a welcome hiatus from the
mental and physical challenges of
restorative dentistry.
Moreover, I guess it wouldn’t be
fair if I didn’t mention that it also
gives the practice a nice financial
boost in this down economy.
Which dental sleep device is the
best?
This is often the first question that is
asked at one of our Sleep Group Solutions seminars. I usually answer it by
saying that it isn’t a matter of which
device as much as it is about where
the jaw is placed.
There are many FDA-approved
devices for treatment of OSA, and
they all have pros and cons and they
all work. Although one may work better than another in some situations, it
is mostly a question of comfort.
It isn’t so much about the particular device, but more about proper
follow-through of their dental sleep
therapy.
How much does the treatment cost
and does insurance pay for it?
Of course, treatment costs can range
depending on the practice and the
particular patient. My estimated
range for dental sleep therapy would
be from $2,000 to $5,000. At Dental
Sleep Solutions, we are experienced
at medical insurance billing.
Of course, it depends on an individual’s coverage, but we are finding
that medical insurance is helping to
cover the costs in most situations.
{Editor’s note: See Dental Tribune Vol.
5 No. 2 for an article on medical coding by Marianne Harper in the pages
of Hygiene Tribune.}
What is the first step for a dentist
to become involved?
Take a course at Sleep Group Solutions. They offer a two-day course
that will get them off and running.
How does Sleep Group Solutions
service help a new dentist?
Of course, the first step is through

the educational courses we previously mentioned. Also, as previously
stated, Sleep Group Solutions offers
the two pieces of essential equipment
needed to treat patients with breathing disorders.
Finally, Sleep Group Solutions is a
great resource. It is one of the largest companies in the sleep field and
they have many contacts throughout
the country. I have had great experiences working with this company.
The representatives at Sleep
Group Solutions are always willing
to help and will continue to support
dentists new to this field with advice
as well as helping with relationship
building with other sleep professionals.
What is something you know now
after nine years of practice that
you wish someone had told you
before you began practicing?
I assume you mean after nine years
of practicing dental sleep medicine
because I’ve been practicing dentistry for 20 years.
I wish someone would have told
me or influenced me to get involved
in treating dental sleep patients earlier. I never knew how much I could
enjoy this field.
Do you have any other pearls of
dental practice wisdom you would
like to share with our readers?
I have many “pearls” for dentists who
are becoming involved in the treatment of sleep apnea, but my “pearl”
for those who aren’t is — consider
doing it. I think you’ll be happy that
you did.
Your practice’s Web site is very
inviting. Do you happen to know
how many new patients have
found you via your Web site alone?
Presently, we are getting one or two
cases per month from the Internet,
but we are completely revamping our
Web site along with search engine
optimization. We expect those numbers to explode in 2010 for Dental
Sleep Solutions. DT

About the dentist
Dr. Gy Yatros has been practicing
since 1992 and is a diplomate of the
American Academy of Dental Sleep
Medicine.
He is also a member in good standing of the ADA, AGD, Florida Academy of Cosmetic Dentistry, Academy of
Computerized Dentistry, Florida Dental Association and West Coast Dental
Association.
Yatros also teaches courses and
is available for practice consultation
with dentists interested in becoming
involved in dental sleep medicine.
Dental Sleep Solutions
3909 East Bay Drive
Holmes Beach, Fla. 34217
(941) 778-2204
dryatros@dentalsleepsolutions.com
www.dentalsleepsolutions.com
www.islanddentalspa.com

[15] =>

[16] =>

16A Clinical
AD

Dental Tribune | February 2010

Minimally invasive
cosmetic dentistry
A concept and treatment protocol for general practice

By Dr. Sushil Koirala, Nepal

Increased media coverage and the availability of free Web-based information has lead
to heightened public awareness and, thus, to a
dramatic increase in patients’ aesthetic expectations, desires and demands. Today, a glowing, healthy and vibrant smile is no longer the
exclusive domain of the rich and famous, and
most general practitioners are forced to incorporate various aesthetic treatment modalities
in their daily practices to meet this growing
demand.
The treatment modalities of any healthcare service are aimed at the establishment of
health and the conservation of the human body
with its natural function and aesthetics.
The concept
of
minimally
invasive (MI)
treatment was
initially introduced in the
medical field
and was adapted in dentistry
in the early
1970s with the
application of
diamine silver
fluoride.1
This
was
f ollowed by the development of p reventive
resin restorations (PRR) 2 in the 1980s and
the atraumatic restorative treatment (ART)
approach3 and Carisolv4 in the 1990s.
The major components of MI dentistry are
the risk assessment of the disease with a focus
on early detection and prevention; external and
internal re-mineralisation; use of a range of
restorations; bio-compatible dental materials
and equipment; and surgical intervention only
when required and only after any existing disease has been controlled.5–11
Current basic treatment protocols (TPs) and
approaches in MI dentistry are the use of air
abrasion, laser treatment or sono abrasion
to gain cavity access and excavate infected
carious tooth tissue through selective caries
removal or laser treatment;12,13 cavity restoration by applying ART, PRR or sandwich restoration; and the use of computer-controlled local
anaesthesia delivery systems14 with emphasis
on the repair of a failed restoration rather than
its replacement.15
Thus far, the focus of MI dentistry has been
on caries-related topics16 and has not been
comprehensively adopted in other fields of dentistry. Dr. Miles Markley, one of the great leaders of preventive dentistry, advocated that the
loss of even a part of a human tooth should be
considered a serious injury and that dentistry’s
goal should be to preserve healthy and natural
tooth structure.
His words are much more relevant in today’s
cosmetic dental practice, in which the demand
for cosmetic procedures is rapidly increasing.
With the treatment approach trend toward the
more invasive protocols, millions of healthy
teeth are aggressively prepared each year in
the name of smile makeovers and instant ortho-

dontics, neglecting the long-term health, function and aesthetics of the oral tissues.

The need for a new concept
Contemporary aesthetic dentist ry demands
well-considered concepts and TPs that provide
a simple, comprehensive, patient-friendly and
MI approach with an emphasis on psychology,
health, function and aesthetics (PHFA) (Fig. 1).
The need for a holistic concept and basic
treatment guidelines was expressed by concerned practitioners, aesthetic dentistry associations and academics around the world for
the following basic reasons:
• Owing to an increased aesthetic demand,
aesthetic dentistry is becoming an integral part
of general dentistry. The aesthetic outcome
of
any
dental
treatment plays
a vital role in the
patient’s
treatment satisfaction
criteria.
• MI dentistry
currently focuses
on
prevention,
re-mineralisation
and minimal dental intervention in
the management
of dental carious lesions. It has
failed to give the necessary attention to the
problems that negatively affect smile aesthetics, such as non-carious dental lesions or developmental defects and malocclusion.
• The treatment modalities of contemporary
cosmetic dentistry are trending toward more
invasive procedures with an over-utilisation of
crowns, bridges, thick full veneers and invasive
periodontal aesthetic surgeries, while neglecting long-term oral health, actual aesthetic
needs and the characteristics of the patient.
• Social trust in dentistry is degrading, owing
to the trend of fulfilling the cosmetic demands
of patients without ethical consideration and
sufficient scientific background (the more you
replace, the more you earn; a “more is more”
mentality).
In this article, I introduce a concept and
TP for minimally invasive cosmetic dentistry
(MICD), in order to address these facts properly
and integrate the evidence-based MI philosophy and its application into aesthetic dentistry.

‘Web-based information has lead
to heightened awareness and,
thus, to a dramatic increase in
patients’ esthetic expectations,
desires and demands.’

Defining MICD
As the perception of aesthetics and beauty is
extremely subjective and largely influenced by
personal beliefs, trends, fashion and input from
the media, a universally applicable definition is
not available.
Hence, smile aesthetics is a multifactorial
issue that needs to be adequately addressed
during aesthetic treatment.17 MICD deals both
with subjective and objective issues.
Therefore, in this article I define MICD as
“a holistic approach that explores the smile
defects and aesthetic desires of a patient at
an early stage and treats them using the least
intervention options in diagnosis and treatment technology by considering the psycholo-

[17] =>

Clinical 17A

Dental Tribune | February 2010
Fig. 2

Fig. 1: Smile Design Wheel

gy, health, function and aesthetics
of the patient.”18
The core MICD principles are:
• application of the “soonerthe-better” approach and exploration of the patient’s smile defects
and aesthetics desires at an early
stage in order to minimise invasive
treatments in the future;
• smile design in consideration
of the psychology, health, function and aesthetics (Smile Design
Wheel18) of the patient;
• adoption of the “do no harm”  
strategy in the selection of treatment procedures and the maximum possible preservation of
healthy oral tissues;
• selection of dental materials
and equipment that support MI
treatment options in an evidencebased approach;
• encouragement of the “keep
in touch” relationship with the
patient to facilitate regular maintenance, timely repair and strict
evaluation of the aesthetic work
performed.
The main MICD benefits
include:
• promotion of health, function and aesthetics of the oral tissues and a positive impact on the
patient’s quality of life;
• preservation of sound tooth
structures (banking the tooth
structure), while achieving the
desired aesthetic result;
• reduction of treatment fear
and increased patient confidence;
• promotion of trust and
enhancement of professional
image.

The MICD treatment protocol
In my experience, the TPs that
are currently in use in aesthetic dentistry are mostly based on
more invasive techniques and
procedures. With the use of such
protocols, c osmetic dentists are

knowingly, or unknowingly, heading toward the over-utilisation
of invasive technologies in their
practices, which is becoming a
professional and ethical concern.
The basic aim of the MICD TP
is to guide practitioners in achieving optimum results with as little
intervention as possible.
The intervention level of the
treatment in MICD depends on the
type of smile defects and the aesthetic needs (objective measurement and subjective perception) of
the patient.
The basic framework and pathway of the MICD TP are illustrated
in Figures 2 and 3. It is to be noted
that the TP in medical and dental sciences must be dynamic in
nature and should be flexible to
incorporate evidence-based facts.
Therefore, I have outlined the
MICD core principles that are
required to achieve the optimum
result in terms of health, function and aesthetics with minimum
intervention and optimal patient
satisfaction.
However, it is the practitioner’s
duty to incorporate all the necessary guidelines, protocols and
regulations of the authority concerned (state or affiliated professional organisations) into the
MICD TP.

Phase I: understand
In the first step of Phase I, the
perception, lifestyle, personality and desires of the patient are
explored. The primary goal of this
first step is a better patient–dentist
understanding. As the aesthetic
perceptions of the dentist and the
patient may differ, it is imperative to understand the subjective
aesthetic perception of the patient.
Various types of questions, personal interviews and visual aids
can be used as supporting tools. In

Fig. 3

this step, the practitioner should
ask the patient to complete the
MICD self-smile evaluation form.
The information obtained will help
estimate the perceived smile aesthetic score (a-score) and will be
used as the baseline data in the
evaluation step.
Next, diseases, force elements
and aesthetic defects of smile
are explored. Information on the
medical and dental history, general health and specific health (oral-
facial) of the patient is collected
and complete dental and periodontal charting is performed.
In order to understand the force
elements, the existing occlusion,
comfort and muscular activity,
speech and phonetics are thoroughly examined with the evaluation
of para-functional and other oral
habits, comfort during mastication and deglutition and temporomandibular joints (TMJ) movements.
The necessary diagnostic tests,
photographic documentation and
the diagnostic study models are
prepared during this step for the
further exploration of existing dis-

eases, force elements and aesthetic defects.
In the following step, the data
collected is analysed in relation
to the accepted normal values of
a patient’s sex, race and age (SRA)
factors.
The aesthetic components of
the smile are analysed in detail
grouped into macro- (facial and
dental midline relation, facial profile, symmetry of the facial thirds
and hemi-faces), mini- (visibility
of upper anterior teeth, smile arc,
smile symmetry, buccal corridor,
display zone, smile index and lip
line) and micro-aesthetics (dental: central dominance, teeth proportion, axial inclination, incisal
embrasure, contact-point progression, shade progression, surface
texture; gingival: shape, contour,
embrasure and zenith height).
The practitioner can now grade
the smile in terms of the patient’s
health, function and aesthetics as
follows:
• Grade A: The established
parameters of oral health, funcg DT page 18A
AD

[18] =>

18A Clinical
f DT page 17A
tion and aesthetics are within normal limits and aesthetic enhancement is required only to fulfill the
patient’s cosmetic desires.
• Grade B: The established
parameters of oral health and function are within normal limits; however, the aesthetic parameters are
below the accepted level. Aesthetic
enhancement can further improve
the aesthetic parameters.
• Grade C: The established
parameters of oral health or function or both are below the normal
limits. An establishment treatment
is mandatory prior to aesthetic
enhancement.
From the above, the practitioner
will obtain a smile aesthetic grading in terms of the patient’s health,

Dental Tribune | February 2010
function and aesthetics, as well as
a complete overview over the smile
aesthetic problems and the macro-,
mini- and micro-smile defects.
The patient’s PHFA factors are
the four fundamental components
of aesthetic dentistry18 and must
be respected to achieve healthy,
harmonious and beautiful smiles.
The design step depends on the
information obtained from exploration and analysis.
The information on psychology
is subjective in nature; however,
health, function and aesthetic analysis provide the objective information that will guide the design
with the various established and
basic principles of smile aesthetics
and also the feasible and practical
extent of the aesthetic desires of
the patient.

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ity depends on the professional
capability and experience of the
practitioner, simple and practical
methods are used to categorise the
MICD treatment complexity:
• Grade I: Treatment that may
require consultation with a specialist (preventive, simple oral
surgery/endodontics/periodontics/implants, short orthodontics);
• Grade II: Treatment that
requires the procedural involvement of other dental specialists
(complex endodontics/periodontics/orthodontics), but not oral
and maxillofacial surgery or plastic surgery; and
• Grade III: Treatment that
requires the procedural involvement of oral and maxillofacial surgery or plastic surgery.
With the aid of this simple
grading system, any practitioner
can determine the complexity of
the treatment involved for the
accomplishment of a new smile
design for an individual patient
and can plan for the necessary
multidisciplinary support.
The last step of this phase is
the most important in MICD TP
because in this step the patient is
presented with an image of his or
her future smile. Visual aids, such
as a smile catalogue, aesthetic
mock-ups, manual sketches, modified digital pictures, computer-
designed makeovers or animaused
2 5 ttions
h A can
n n be
ive
r s aas
r ypresentation
tools.
The results of the design step
are systematically presented to the
patient with professional honesty
and ethics. All pertinent queries of
the patient related to the proposed
smile need to be addressed during
presentation.
The treatment complexity, its
limitations, the risks i nvolved,
possible complications, treatment
cost estimation and maintenance
responsibility must properly be
explained to the patient.
The patient is thus involved
in finalising the treatment plan
and will sign the written informed
consent form before proceeding to
Phase II.

The aesthetic mock-up, manual tracing, digital makeover and
smile catalogues are some of the
popular tools used in this step.
A new smile, alternative designs,
types of treatments involved, complexity, possible risk factors and
complications, treatment limitation and tentative costs should be
established during this step.
For easy application, the aesthetic treatments in MICD are categorised as follows:
• Type I: micro-aesthetic components;
• Type II: mini-aesthetic components; and
• Type III: macro-aesthetic components: facial and dental midline
relation, facial profile, symmetry
of facial thirds and hemi-faces.
As the treatment modal-

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As per the TP, which is finalised
during the presentation step, all
necessary preventive interceptive
and restorative (curative) dental
treatments are conducted in order
to establish the proper health and
function of the oral tissues.
Owing to the complexity of the
treatment, a multidisciplinary
approach may be necessary for a
good result.
Once the case is stable in terms
of health (controlled disease)
and function (balanced force elements) with good oral habits, the
patient is requested to re-evaluate
his or her smile in terms of aesthetics with the help of the MICD
self-smile re-evaluation form.
This is important because in
some cases the patient is fully
g DT page 21A

[19] =>

Dental Tribune | February 2010

Clinical 19A

Fig. 4a: Gummy smile with lack of upper central dominance.

Fig. 4b: Harmonised smile with proper central dominance. Treated with MI
approach.

Fig. 5a: Smile after establishment treatment.

Fig. 5b: Smile aesthetic enhancement with non-invasive veneers treatment.
AD

[20] =>

[21] =>

Clinical 21A

Dental Tribune | February 2010
f DT page 21A
satisfied with the results of the
establishment step alone and may
modify his or her idea of further aesthetic enhancement. In
MICD TP it is considered unethical
should the practitioner not collect
self-smile re-evaluation information from the patient.
The enhancement step of MICD
is focused on the fulfilment of the
patient’s aesthetic desires, which
can be grouped into two categories
based on the patient’s needs and
wants.
Even though it is sometimes difficult to draw a clear line between
the two and their related treatment, in MICD they are categorised as follows:
• Needs — objective restorative
needs of the patient in harmony with the SRA factors and due
emphasis on health and function
of oral t issues (naturo-mimetic
smile enhancement)
• Wants — subjective desires of
the patient, which may not be in
harmony with the SRA factors (cosmetic smile enhancement)
During any want-based aesthetic treatment, where healthy oral
tissue is treated with no direct
benefit to health or function, the
treatment modalities should be
within the scope of non-invasive
(NI) or MI procedures.19
The patient’s cosmetic desires
alone should not be the rational
for the treatment.20 “Do no harm”
should always be the credo pertinent to all dental treatment procedures.

Phase III: keep in touch
Regular maintenance, compliance
and timely repair play a crucial
role in the long-term success of
a esthetic enhancement procedures.
Hence, MICD emphasises the
keep-in-touch concept and encourages patients to go for regular
follow-up visits. Responsibility for
maintenance is grouped into two
categories:
• Self-care — Patients are
advised to continue their normal
oral hygiene procedures. If necessary, special care and precautionary methods are given, as well as
protective devices.
Self-care should focus on regular tooth brushing, flossing, the
use of prescribed protective devicAD

es and other pertinent professional advice for maintaining general
health.
• Professional care — The oral
habits, health of the oral tissues,
and the functional and aesthetic
status of the work preformed are
well documented during each follow-up visit, and necessary maintenance repair jobs are carried
out.
Evaluation is the final step of
MICD TP. Any “completed” treatment without a proper evaluation
is considered incomplete in MICD
protocol. The following components need to be evaluated:
• Global patient satisfaction:
After receiving aesthetic dental
treatment, the patient is requested
to complete the MICD exit form,
in which the patient evaluates his
or her new smile, gives a second
perceived smile aesthetic score
(b-score), and indicates his or her
global satisfaction score.
The b-score is compared with
the previous a-score. This process helps determine the patient’s
actual satisfaction status. In MICD,
this is the main parameter for
evalu ating a patient’s aesthetic
satisfaction.
• Clinical success: Clinical
success is a multifactorial issue.
Selection of proper cases (the
patient), restorative materials,
TPs and their correct and skilful
application are the key factors for
clinical success. Therefore, MICD
TP suggests self-evaluation of the
following four factors (4Ps) using
the MICD clinical evaluation form:
• Patient factors — regular
maintenance status, compliance
issues and attitude of the patient
towards aesthetic treatment;
• Product factors — bio-compati
bility, mechanical and aesthetic
quality of the products used for the
treatment;
• Protocol factors — TP used in
terms of its simplicity, predictability and its evidence-based nature;
• Professional factors — existing
knowledge and skills, and attitude
toward developing these.
Detailed clinical documentation
of the case during maintenance
and evaluation can provide various cues to the practitioner in the
evaluation of his or her clinical
success in terms of case planning,
material and protocol selection, as
well as his or her existing restorative skills.

NI treatment options

MI treatment options

Smile training

Micro- and macro-abrasion

Tooth whitening

Selective contouring
(gums/teeth)

Re-mineralisation of
white spots

Direct restorations with
minimal tooth preparation

Short orthodontics
(sectional)

Adhesive bridges

Non-preparation veneers

Veneers, inlays and onlays

Enamel augmentation

MI implants

Adhesive pontic
(long-term temporary
restoration)
Oral appliance
Table 1: MICD treatment options

I believe that a thorough evaluation can support any practitioner in initiating practice-based
research and keeping up-to-date
with the recent trend of evidencebased dentistry (Figs. 4a–5b).

MICD treatment modalities
Various types of treatment modalities are available in MICD. Their
effective use depends on the level
of smile defects, type of smile
design, proposed treatment type
and the treatment complexity
grade.
There is only one principle in
selecting treatment modalities
in MICD: always select the least
invasive procedure as the choice
of the treatment.
The two categories of MICD
treatment are NI and MI treatment
(Table 1). However, conventional
invasive treatment modalities may
also be required, depending on the
complexity of the case.

Conclusion
MI dentistry was developed more
than a decade ago by restorative
experts and founded on sound
evidence-based principles. 21–30 In
dentistry, it has focused mainly
on prevention, re-mineralisation
and minimal dental intervention in
caries management and not given
sufficient attention to other oral
health problems.
I believe that the MI philosophy should be the mantra adopted
comprehensively in every field of
dentistry.
For this reason, I have explained
the MICD concept and its TP, which
integrates the evidence-based MI
philosophy into aesthetic dentistry,
in the hope that it will help practitioners achieve optimum results in
terms of health, function and aesthetics with minimum treatment
intervention and optimum patient
satisfaction. DT

Acknowledgements
In formulating the MICD TP, I

discussed the concept with several national and international colleagues in order to ensure that it
is simple, practical and comprehensive.
I would like to extend my gra
titude to Drs. Akira Senda (Japan),
Didier Dietschi (Switzerland),
Hisashi Hisamitsu (Japan), Oliver
Hennedige
(Singapore),
Dinos Kountouras (Greece), Mabi
L. Singh (USA), Ryuichi Kondo
(Japan), So-Ran Kwon (Korea),
Dr. Prafulla Thumati (India), Dr.
Vijayaratnam Vijayakumaran (Sri
Lanka), as well as Suhit R. Adhikari, Rabindra Man Shrestha,
Binod Acharya and Dinesh Bhusal
of Nepal, for their valuable comments, advice and feedback.
[Editorial note: A complete list of
references and the MICD forms are
available from the publisher.]

About the author

Dr. Sushil Koirala is the founding
president of the Vedic Institute of
Smile Aesthetics and maintains a private practice focusing primarily on
MI cosmetic dentistry (MICD).
He can be contacted at skoirala@
wlink.com.np.

[22] =>

22A Chicago Midwinter Meeting

Dental Tribune | February 2010

Dentistry in the Windy City
More than 30,000 dental professionals are expected at McCormick Place for annual convention
More than 30,000 dentists and
dental professionals will get a first
look at the latest innovations in dentistry at the Chicago Dental Society’s 145th Midwinter Meeting to be
held Feb. 25–27.
The meeting will feature nearly 600 exhibiting companies from
around the world. This year, the
Midwinter Meeting will consolidate
to three days, Sunday being eliminated. The exhibits will shift to a
Thursday through Saturday schedAD

ule, concurrent with the academic
portion of the meeting.
This year’s meeting, referred to
as “Go West CDS,” will be held at
McCormick Place for the 18th year
in a row — this time in the new
West Building.
The Chicago Midwinter Meeting
is one of the largest exhibits of dental products in North America and
one of Chicago’s top conventions.
The 2009 conference generated
more than $50 million for the local

economy, according to the Chicago
Convention and Tourism Bureau.
According to organizers of the
event, more than 25,000 professionals have already registered for
this year’s meeting, and the space
to exhibit on the trade show floor
is sold out.
“Our long-standing partnership
with McCormick Place remains
strong as we welcome dental professionals from the United States
and around the world to Chicago,”

said Chicago Dental Society President Dr. Michael Stablein, DDS,
PhD.
“This year’s Chicago Midwinter Meeting will provide the dental community with the information and tools it needs to better
serve its patients during the current
economic downturn. We also look
forward to continued growth and
innovation in the field of dentistry.”
Visitors to the Chicago Midwinter Meeting will not only have the
first peek at an array of new dental
products, but will also have the
opportunity to attend more than
200 scientific programs, including
approximately 30 hands-on programs covering topics like forensic odontology, cosmetic dentistry,
infection control during dental care
and how clinical hypnosis can help
relax nervous patients.

Scientific program
Dr. George Zehak, general chair;
Dr. Cheryl Watson-Lowry, program
chair; and Dr. Al Kleszynski, CDS
director of scientific programs, have
assembled a scientific program that
rivals any program of continuing
education.
“We are pleased to showcase a
virtual smorgasbord of 142 speakers, 175 courses and 40 participation courses — 50 percent of
the courses are free to attendees,”
Stablein said.
“All areas of interest are featured.
All disciplines and specialties of the
dental profession are covered. You
will also find featured speakers of
special interest to female attendees,
as well as courses in Spanish for the
second consecutive year,” Stablein
said.

Exhibit hall
The Chicago Midwinter Meeting
has been the venue for exhibitors
to debut new products and services
each and every year. This year will
be no different.
More than 600 exhibitors will
display their products in the West
Building, Level 3, Hall F. Meeting
organizers say the meeting is one
of North America’s largest exhibitions of dental products that will
bring companies from 45 countries
to showcase new innovations and
technologies aimed at dentists and
consumers.
The hours of the exhibition are
Thursday through Saturday, Feb.
25–27, from 9 a.m. to 5:30 p.m.

Free health screening
For the first time, Chicago Midwinter Meeting attendees can have a
health screening featuring 10 tests.
The Midwinter Meeting Wellness
Center Health Screening, presented
g DT page 24A

[23] =>

[24] =>

24A Chicago Midwinter Meeting
f DT page 22A
by BlueApple Health, will be located
at the rear of the exhibit hall.
You must pre-register for exams,
administered by appointment only.
Appointments are available each
day of the meeting, so take advantage of this opportunity.

Opening Session with Rita Rudner
Comedian,
actor,
best-selling
author, playwright and screenwriter Rita Rudner will bring her Las
Vegas headliner act to Chicago for
the Opening Session at the 145th
Midwinter Meeting. For the past five
years, Rudner was selected as the
“Best Comedian in Las Vegas” by
the Las Vegas Review-Journal.
In addition to performing regularly in Las Vegas, Rudner has
appeared in several television
shows and recorded several awardwinning comedy specials, including
“Rita Rudner: Born to Be Mild” and
“Rita Rudner: Married Without Children” for HBO and “Rita Rudner:
Live From Las Vegas” for PBS in
2008. She is contracted to appear at
Harrah’s in Las Vegas through 2012.
The Opening Session will be
held Thursday, Feb. 25, at McCormick Place West: Skyline Ballroom
E (W375E). The reception is from
4:30 to 5:30 p.m., and the program
will be from 5:30 to 7 p.m. and will
include opening remarks, award
presentations, entertainment and
closing remarks. The cost is $10 per
person (ticket required for admission).

An evening of pop hits
Blood, Sweat & Tears — the band
that fused horns, jazz and rock —
will light up the stage during the
Chicago Midwinter Meeting with its
greatest hits, including “Spinning
Wheel,” “Hi-De-Ho,” “When I Die,”
“Sometimes in Winter,” “God Bless

the Child,” “Lucretia McEvil” and
“You’ve Made Me So Very Happy.”
Later, Chuck Negron, formerly of
Three Dog Night, will take charge
of the band to finish the evening
with his hits songs that defined a
generation, including “One,” “Pieces of April,” “One Man Band,” “Easy
to Be Hard,” “Joy to the World,”
“The Show Must Go On” and “Old
Fashioned Love Song.”
The show will be held Friday,
Feb. 26. Doors open at 8 p.m., and
the performance starts at 9 p.m.
The cost is $35 per person.

Dental Tribune | February 2010

Cross the corridor to the west side. This year’s Midwinter Meeting will be held
in the new West Building in McCormick Place. (Photo/Fred Michmershuizen,
Online Editor)

President’s Dinner-Dance
Meeting attendees can complete
their 145th Midwinter Meeting by
attending the President’s DinnerDance honoring Dr. Michael Stablein and his wife, Dr. Caroline
Scholtz. Organizers say it will be an
evening of fine dining and dancing
to remember. The Chicago Hilton
& Towers will provide cuisine, and
the Don Cagen Orchestra will provide the music.
The event will be held Saturday, Feb. 27 at the Chicago Hilton
& Towers, Grand Ballroom. The
reception will be from 7 to 7:30
p.m., followed by dinner seating at
7:30 p.m. The dress code is black
tie optional. The cost to attend is
$85 per ticket, and tables of 10 are
available.

Table clinics — those concise, 15- to 20-minute presentations about materials,
procedures and techniques — are popular at the Chicago Midwinter Meeting. At
last year’s meeting, attendees gathered close to listen to Dr. Natanya Marracino
describe pulp revascularization. (Photo/Fred Michmershuizen, Online Editor)

About the CDS
Incorporated in 1878, the Chicago Dental Society represents more
than 4,000 dentists in the metropolitan Chicago area.
Its mission is to represent the
interests of dentists, promote the art
and science of dentistry and advocate for improving oral health for
all. The society is the largest local
affiliate of the Illinois State Dental
Society and the American Dental
Association. DT

Visit us at the Chicago MidWinter Show Booth #1213

Sybron Implant Solution’s Chris Black shares a laugh with meeting attendees. (Photo/Robin Goodman, Group Editor)

[25] =>

[26] =>

26A Chicago Midwinter Meeting

Dental Tribune | February 2010

OHA Gala to feature plenty of ‘bling’
The stunning $8,000 3-carat red
ruby ring to be raffled off is not the
only gem being offered to attendees of the Oral Health America
(OHA) Gala on Wednesday, Feb.
24.
This year’s auction features a
sparkling array of tempting treats,
including:

The Allison Inn & Spa at night.

• two tickets to see the Oprah
Winfrey Show (includes plane tickets and three-night stay in the Hyatt
Regency Chicago),
• two tickets in the faculty section of a Florida Gators game with

a gourmet breakfast prepared by
OHA Board Member Dr. Frank
Catalanotto,
• dinner with Henry Schein CEO
Stan Bergman and his wife Marion
at the Grand Tier Restaurant in
New York, followed by a performance at the Metropolitan Opera
or the American Ballet Theater,
• a stay at The Allison Inn & Spa
in Oregon wine country donated
by A-dec.
Sure to be a popular item, The
Allison Inn & Spa is the first fullservice resort in Oregon Wine
Country. It is surrounded by rolling hillsides, working vineyards
and farms, yet is only 45 minutes
from Portland.
Each room has a gas fireplace,
original artwork showcasing Oregon artists, spa-like bathrooms
with soaking tub, custom-crafted
furnishings, bay window seats and
views from a terrace or balcony.
JORY, the resort’s restaurant,
pays tribute to Oregon’s agricultural bounty, worldwide acclaimed
wines, microbrews, handcrafted
distilled spirits and designer cocktails.
The lavish spa offers 12 treatment rooms, co-ed lounge with
outdoor patio, a fitness studio,
swimming pool and Jacuzzi.
This year’s silent auction will
also feature a way to support local
communities. Oral Health America’s Smiles Across America ® program will be in 15 states by the
end of 2010.
Attendees will be able to contribute to programs in communities throughout the country.
The 10 highest bidders will
qualify for unique frameable
“dental” drawings created by Chinese children and contributed by
DNTLworks Equipment Corporation.
The gala also has a dazzling
new location: Chicago’s historic
Union Station. The site is considered to be one of the greatest
indoor spaces in the United States.
The black-tie-optional evening
features dinner and dancing in
addition to the auction. Tickets
are $300 after Feb. 1, if still available. A table for 10 can be purchased for $2,750 after Feb. 1, if
still available.
Reservations can be made by visiting www.oralhealthamerica.org,
by calling (312) 836-9900, or by
e-mailing joe@oralhealthamerica.
org.
Oral Health America is the
nation’s leading independent nonprofit organization dedicated to
connecting communities with
resources to increase access to
care, education and advocacy for
all Americans, especially those
most vulnerable=.
Find out more at www.oral
healthamerica.org. DT

[27] =>

[28] =>

28A Chicago Midwinter Meeting

Dentists dish on their
top 10 fantasy patients
By Keri Kramer, Chicago Dental Society

Who would dentists dream to see in
their chair?
The world’s best known personalities have dental needs too. But what
could modern dental treatments do for
some of history’s famous figures?
What fictional characters could use
some real time with a modern dentist?
The Chicago Dental Society surveyed more than 250 members to find
out which patients — real, fake, alive
or dead — they’d most like to see in
their chair.
Imagine this eclectic list of patients
together in a waiting room:
10) Dracula. Twilight fever has left
our dentists wondering about those
pointy teeth. Are they hollow like
drinking straws? Can drinking blood
cause cavities?
9) Elvis Presley. A visit with the King
might finally put to rest those rumors
about his death, but dentists are also
curious about what cosmetic dental
work was like in the 1960s.
8) Mona Lisa. Was a poor smile the
AD

reason the subject of the famous painting stayed tightlipped?
7) President Barack Obama. Bragging rights aside, dentists are generally
concerned with our presidents’ oral
health — from the effects of his smoking to jaw clenching.
6) Julia Child. How was the oral
health of one of America’s greatest
cooking legends? Our dentists would
like to know, and maybe also swap
recipes.
5) Tiger Woods. Some dentists admit
they want the scoop on his “transgressions” first hand. Others are just seeking a great golf partner. One wants to
fix Tiger’s “pesky” discolored tooth.
4) Albert Einstein. Access to one of
the greatest minds ever would certainly make for great conversation.
3) Jesus. Self-explanatory!
2) G.V. Black (known as the “Founding Father of Modern Dentistry”).
Quite unanimously, dentists agreed
treating him would be an honor.
And the No. 1 patient dentists would
like to see in their practice:
George Washington. Two words:
wooden teeth. DT

Dental Tribune | February 2010

Member poll
The Chicago Dental Society conducted its seventh annual
member poll to learn more about their opinions on current
trends, dental topics and more. From the more than 250 members who answered the fall 2009 survey, the society learned:
• The effects of the recession on the local dental industry have
worsened since last year.
More than 90 percent of dentists surveyed said their clients
are putting off cosmetic procedures, up from 60 percent. More
than 75 percent of dentists say their patients are putting off
needed dental work — in 2008 more than half of dentists noted
the same. And visits for preventative dental care are also on
the decline according to more than half of dentists, up from
more than 40 percent last year.
• Nearly 75 percent of dentists surveyed said their patients are
reporting increased stress in their lives.
And 65 percent of dentists are seeing an increase in jaw
clenching and teeth grinding among their patients, signs that
stress may be taking its toll on the mouth.
• Interesting food flavors continue to make their way into
dental products.
Nearly 40 percent of those surveyed are intrigued by mango
toothpaste, and more than a quarter of dentists wouldn’t mind
trying chocolate toothpaste. Some dentists are also curious
about cupcake or coffee dental floss and corn dog mint. DT

[29] =>

[30] =>

30A Webinar Preview

Dental Tribune | February 2010

A new solution for
dentin hypersensitivity
By Fred Michmershuizen, Online Editor

In an interview with Dental
Tribune, Dr. Fotinos S. Panagakos, director of clinical research
relations and strategy within the
Research and Development division of Colgate-Palmolive, discusses
dentin hypersensitivity, its effect on
patients and the dentists who treat
them — and a new product that can
help alleviate the condition.
How did you get interested in the
area of dentin hypersensitivity?
The Colgate-Palmolive company has
been very interested in the area
of dentin hypersensitivity for many
years. We have had a potassiumbased sensitivity toothpaste available in most countries for consumers to alleviate the pain associated
with dentin hypersensitivity.
Recently, Colgate launched a new
AD

dentin sensitivity product, Colgate
Sensitive Pro-Relief Paste, based on
the Pro-Argin™ technology. The ProArgin technology consists of arginine, a naturally occurring amino
acid, and insoluble calcium in the
form of calcium carbonate.
These ingredients are delivered
in a prophy paste containing a mild
abrasive system and can be applied
with a prophylaxis cup or a cottontipped applicator to teeth that exhibit dentin hypersensitivity.
Mechanism of action studies have
shown that this technology physically seals dentin tubules with a
plug that contains arginine, calcium
carbonate and phosphate. This plug,
which is resistant to normal pulpal pressures and to acid challenge,
effectively reduces dentin fluid flow
and, thereby, reduces sensitivity.
Recently, a number of studies
have been published supporting the

launch of this new product. Laboratory tests demonstrating the product’s mode of action, as well as clinical trails demonstrating instant and
long-lasting relief of dentin hypersensitivity, have been presented to
the dental profession as evidence
that the Pro-Argin technology provides instant and lasting relief of
dentin hypersensitivity.
The reader can access the full
range of research studies on the Colgate dental professional Web site,
located at www.colgateprofessional.
com.
Can you please explain what
causes dentin hypersensitivity
and, specifically, what is going on
with a patient biologically?
Dentin is normally covered by enamel or cementum. Due to any number of factors, including abrasion or
periodontal disease causing gingival
recession or erosion removing the
enamel, the underlying dentin and
dentin tubules can become exposed.
An external stimulus — such as
a change in external temperature
or air movement — or a physical
stimulus can cause discomfort for
the patient. The external stimulus
is usually transitory and the discomfort subsides shortly after the stimulus is removed.
The accepted theory of how dentin hypersensitivity pain is transmitted suggests that pressure or ionic
changes in the fluid that exists in the
dentin tubules stimulates the pain
experienced by the patient. This is
often referred to as the “hydrodynamic theory.”
Inside the dentin tubule, a change
in osmotic pressure causes fluid
movement, which is transmitted as
a stimulus to the odontoblastic process and fires the afferent nerve
ending in the dentin tubule.
Please describe how this condition affects patients — and how
it affects the dentists who treat
them.
Dentin hypersensitivity is growing
in incidence and is often a chief concern among patients. Dentin hypersensitivity’s main effect on individuals is the impact on quality of life.
Patients have to avoid certain foods
and beverages that may trigger a
painful response, thus reducing the
type of foods and drinks one can
enjoy.
In the dental office, what is normally a routine visit may end up
being a very uncomfortable appointment for a patient with dentin hypersensitivity. Simple procedures, such
as scaling and a prophylaxis, may be
painful. And, at times, the pain asso-

Attend a C.E.accredited Webinar

Dr. Fotinos Panagakos
On Tuesday, March 30 at 7
p.m. EST, Dr. Fotinos S. Panagakos will offer a free onehour Webinar, “Dentin Hypersensitivity — New Management
Approaches,” followed by a live
question-and-answer session
with the online audience.
Dentin
hypersensitivity
continues to be a problem for
patients and practitioners alike.
The increase in erosion, patient
aging and recessions and periodontal disease have all resulted
in an increased occurrence of
dentin hypersensitivity.
Correct diagnosis and effective treatment are critical to
relieving a problem, which can
seriously impact a patient’s
quality of life.
At the conclusion of this
course, the participant will
know and understand the following:
• The biology of dentin hypersensitivity.
• The current methods of
treating dentin hypersensitivity.
• Learn about new approaches to treating dentin hypersensitivity.
Attend the Webinar to find
out about new management
approaches in dentin hypersensitivity.
Participants will receive one
ADA-CERP C.E. credit. Attendance is free for the live broadcast on March 30. After that, the
recorded archive will be available for $95.
Attendees only require an
online computer with audio
capabilities. To register, visit
www.DTStudyClub.com
and
DT
click on Online Courses.

g DT page 32A

[31] =>

[32] =>

32A Webinar Preview
f DT page 22A
ciated with dentin hypersensitivity
may cause a patient to skip dental
appointments.
The diagnosis of dentin hypersensitivity often poses a challenge for
the dental professional. The cause
and description of the pain reported
by the patient can vary and is often
not adequate to make a definitive
diagnosis.
The dental professional often
needs to perform a thorough exam,
as well as additional tests, to determine why the pain is occurring.
The exam and test can help
develop a definitive diagnosis, which
allows the dental professional to
rule out other possible causes of the
pain — such as periodontal disease,
caries, etc. — and then implement
AD

an appropriate treatment plan for
addressing the problem.
Once the diagnosis is made, treating the problem can also be a challenge. Many products today do not
work instantly or last following application, or may take time, sometimes
up to weeks, for an effect to be felt by
the patient.
What are some of the ways that
dentists can diagnose and treat
dentin hypersensitivity today? How
is this different from, say, five or 10
years ago?
The treatment and prevention of dentin hypersensitivity, for many years,
has focused on eliminating the ability
of the causative agent to stimulate
discomfort. This has resulted in the
development of two major classes
of products — agents that occlude

Dental Tribune | February 2010
dentinal tubules and desensitizing
agents that interfere with transmission of nerve impulses.
Occluding agents act by physically
covering or “plugging” the open,
exposed dentinal tubules, thus preventing the effect of thermal changes or physical stimuli caused by the
movement of dentinal fluid due to
osmotic pressure changes.
These agents can be applied professionally in the dental office or by
the patient through the use of home
care products.
The second approach recommended by dental professionals to
help prevent and/or treat dentinal
hypersensitivity is through the use
of over-the-counter desensitizing
agents. Desensitizing agents work by
altering the levels of charged molecules in the dentinal tubule fluid.

The most commonly used agent
is potassium nitrate, usually delivered in a dentifrice that is applied
twice daily by the patient during
regularly tooth brushing.
The potassium ions enter the
dentinal tubule fluid, reducing the
excitation caused by the movement
of fluid in the dentinal tubules, and
blocking the transmission of the
stimulus from the odontoblastic process to the nerve in the pulp chamber.
Most products require continued
use over a four- to eight-week period before relief may be realized by
the patient. In addition, the product
often needs to be continued in order
to maintain the relief afforded by the
potassium nitrate.
For those patients who do not
positively respond to the use of
occluding agents or desensitizing
agents, the dental professional may
turn to covering the exposed dentin
using direct or indirect restorations.
Finally, periodontal surgery, involving the grafting of gingival tissue to
cover the exposed dentin, may be
performed.
Colgate Sensitive Pro-Relief paste
seeks to address some of the deficiencies seen in the currently available occluding and desensitizing
products. Treatment is simple. The
paste is gentle to gingival tissues,
does not elicit pain when applied
and has a pleasant mint flavor.
The dental professional applies a
small amount of paste to sensitive
tooth surfaces with a slowly rotating
soft prophy cup. It can also be spot
applied using a cotton-tipped applicator. Paste can also be applied to
furcations and other hard-to-reach
areas with a microbrush.
The dental professional should
carefully burnish the Colgate Sensitive Pro-Relief paste into all sensitive areas, focusing on the CEJ and
exposed cementum and dentin.
And, as mentioned previously,
clinical research has demonstrated both an instant and long-lasting
relief of dentin hypersensitivity in
patients who have had the product
applied versus a placebo prophy
paste.
Is there anything you would like
to add?
Dentin hypersensitivity is a common and growing problem among
patients. Effective diagnosis is key
in the management of this problem.
Use of an in-office product such as
Colgate Sensitive Pro Relief paste
provides instant and long-lasting
relief for the patient and a comfortable, productive dental appointment
for both patient and dental professional.
As with most things in dentistry,
trying a product first before committing to it is essential.
I encourage my dental professional colleagues to try a sample of
this new product to see for themselves how truly effective it is in
managing dentin hypersensitivity,
and to consider incorporating it into
the office’s patient management
process. DT

[33] =>

Dental Tribune | February 2010

Industry News 33A

Cetacaine Topical Anesthetic Liquid Kit
BOOTH
Cetylite’s new Cetacaine® Topical Anesthetic Liquid Kit is ideal for
scaling and root planing, providing
patients with effective, non-injectable, cost-effective anesthesia.
Only $2 for a full-mouth application, the included 14-gram bottle
yields up to 34 full-mouth applications.
The new unique dispenser cap
for Luer-lock syringes allows the
clinician to use only what he or she
needs, not exceeding a 0.4 ml maximum dose.
Cetacaine’s triple-active formula
(14 percent benzocaine, 2 percent

BOOTH

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Bluetoothenabled
apex locator

ApexNRG Blue is the world’s first
and only Bluetooth-enabled apex locator. It can be used with or without a
handpiece. This locator can be used
as a conventional apex finder with
audible and visual indicators. The user
will find it to be extremely accurate
and easy to use.
When the Bluetooth feature is activated, a large image will appear on the
user’s computer screen showing the
file advancing to the apex. This feature allows the patient to follow along
and gives the practitioner three ways
to measure progress: audibly, visually
and computer assisted.
Pricing of the ApexNRG Blue is
similar to a standard apex locator. It
is easy to use with your current apex
location procedures and no calibration
is required.
The ApexNRG Blue can be used
with or without the companion patient
treatment software that comes with
the unit. Progress of the apex location
procedure can be shown on one or
more computer monitors.
The unique digital signal processing (DSP) of the unit provides precision of 0.1 mm in all canal fluids.
The ApexNRG Blue is the only apex
locator in the world that comes with a
50-month warranty.
See the ApexNRG Blue in action
at the Chicago Midwinter Meeting at
booth No. 4728. Or, visit www.medic
nrg.com or call (888) 429-0240 for
additional information. DT

butamben, 2 percent tetracaine
hydrochloride) has onset within 30
seconds and duration typically lasts
30 to 60 minutes.
The kit contains a 14-gram bottle of Cetacaine Topical Anesthetic Liquid with dispenser cap, 20
Vista™ 1.2 mL Luer-lock syringes
and 20 Vista-Probe™ 27 ga tips.
Cetylite now offers a 14-gram
or 30-gram replacement bottle of
Cetacaine Liquid with the Luerlock dispenser cap.
The cap fits all Luer-lock syringes. This unique design also allows
for the single dip of a microbrush,

which is ideal for pre-injection or
other procedures requiring sitespecific topical anesthesia.
Dring the Chicago Midwinter
Meeting, the company will offer as a
show special: a free 14-gram bottle
of Cetacaine Liquid to anyone who
purchases three 14-gram bottles or
one Cetacaine Liquid Kit, as well as
a free 30-gram bottle with purchase
of three 30-gram bottles.
For more information about
Cetacaine, visit www.cetylite.com.
You may also stop by the Cetylite
booth, No. 4623, during the Chicago
Midwinter Meeting. DT

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34A Industry News

Dental Tribune | February 2010

BOOTH NO. 3413 in Chicago

Pentron’s new core material offers high depth of cure
Pentron Clinical, a leader in post
and core technology, is proud to
introduce new Build-It® Light Cure
Core Material.
Build-It Light Cure Core Material is specifically designed for clinicians that favor the on-command
cure afforded by light-cure only
core materials.
The light-cure only formulation produces outstanding physical
properties and is compatible with
4th through 7th generation bonding
agents, ensuring compatibility with
your preferred bonding agent.
The Build-It Light Cure addition
to Pentron Clinical’s award-win-

ning line of Build-It Core Materials
cures to a depth of 10 mm with
only 20 seconds of curing time per
surface without the need for time
consuming layering.
Pentron Clinical Technologies
product manager Jeremy Grondzik
said, “Ideal handling characteristics
together with the ability to instantly
light cure to a depth of 10 mm puts
the clinician in complete control of
the core build-up procedure from
start to finish.”
Once cured, Build-It Light Cure
performs just like the original
Build-It FR™, meaning it sets to
a rock-hard consistency that cuts

like dentin. Non-sticky, sculptable
handling that enables quick and
easy adaption to tooth structure
and the post are made possible by
way of a proprietary new BisGMAfree resin.
To satisfy individual dispensing
preferences, Build-It Light Cure
Core Material is available in both
a syringe and single dose delivery
option.
Build-It Light Cure Core Material is one of the latest innovations
from Pentron Clinical, an established leader in the dental consumables industry, offering a wide
variety of affordable products to

suit your restorative needs. As one
of the pioneers of fiber post and
nano-hybrid composite technologies, Pentron Clinical continues to
demonstrate its commitment to the
technological advancement of dentistry.
The company’s portfolio of innovative and award-winning dental
products includes: Fusio™ Liquid
Dentin, Bond-1® SF Solvent Free SE
Adhesive, Mojo™ Light Cure Veneer
Cement and FibreKleer® Posts.
For more information, call (800)
551-0283 or visit www.pentron.com.
You may also visit booth No. 3413 at
the Chicago Midwinter Meeting. DT

STA System keeps patients comfortable, even during the injection
By Fred Michmershuizen, Online Editor

When it comes to getting from here
to there, who wants to ride around
in a horse and buggy? And when it
comes to delivery of anesthetic before
a dental procedure, who wants to use
160-year-old technology?
Milestone Scientific, with its Single
Tooth Anesthesia (STA) System, is
changing the way local anesthesia is
being delivered today.
You can set aside that scary syringe
— which frightens patients and causes
undue stress —and instead pick up a
small handpiece and needle that you
hold in your hand like a pen. Because
the injection is administered below
the pain threshold, your patient will be
more comfortable.
According to Dr. Eugene R. Casagrande, director of international and
professional relations at Milestone

BOOTH
Scientific, who spoke with Dental Tribune, the Dynamic Pressure Sensing
(DPS) technology used by the STA
System guides the dentist to the correct spot to give a comfortable and
successful intraligamentary injection.
The system provides continuous visual
and audio feedback so the dentist can
know when the needle has left the
correct site or if the needle is blocked.
The STA System is also quite versatile. Casagrande says that despite the
device’s name, STA System is not just
for treating one tooth at a time. Any
injection delivered with the traditional
dental syringe can be administered
more comfortably and more easily
with the STA.
Two new, state-of-the-art palatal
injections — the AMSA and the P-ASA
— can be administered using the STA
System in a comfortable manner to
anesthetize multiple teeth and related

tissue. Also, an interligamentary injection that is different from the traditional PDL can be administered easily,
comfortably and successfully. There
are also benefits for the patient, who is
able to have a more comfortable experience, and to the practice itself.
“I call it a win-win-win,” says Casagrande. “It is a win for the dentist
because injections are very easy and
stress-free to administer. It is a win
for the patient because injections are
more comfortable, and there is no
collateral numbness to the lips, face
or tongue. And it is a win for the practice because the STA System affords
an efficiency factor that can result in
increased productivity.”
As Casagrande explains, a patient
can be treated in multiple quadrants
without having to return for multiple
visits. Even better, he says, it is not
uncommon for patients to refer others

Visit us at the Chicago Dental Society Midwinter Meeting, booth no. 3920.

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Dr. Eugene R. Casagrande says the
STA System is a ‘win-win-win.’
to a particular dental practice because
they are pleased with the way they are
treated with the STA System.
“Patients appreciate the fact that
dentists who use the STA are going out
of their way to make the most difficult
and important part of the dental experience as comfortable as possible,”
Casagrande says.
To learn more, stop by the Milestone
Scientific booth, No. 1514, during the
Chicago Midwinter Meeting. DT

[35] =>

Industry News 35A

Dental Tribune | February 2010
BOOTH

Implants begin
at the moment
of extraction

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The new way.

Luxator periotome instruments.
Directa’s Luxator instrument is
a specially designed periodontal
ligament knife with a fine tapering
blade that compresses the alveolar,
cuts the membrane and gently eases
the tooth from the socket. It was
invented and designed by Dr. Lars
Rundquist, a Swedish dentist and
specialist in maxillofacial surgery.
Here is what Rundquist wrote
about this instrument:
The requirement for an atraumatic treatment during tooth extraction
has been emphasized much recently
in the field of dentistry.
Prior to treatment for implants, it
is essential that there is as little bone
loss as possible during extraction to
obtain an optimal prognosis.
The increased number of patients
under medication with anticoagulants, who often are not allowed to
interrupt their medication when a
tooth is to be extracted, requires
extreme care to avoid postoperative bleeding. It is also necessary
to endeavour to strive for as little
damage to the tissues as possible to
receive the optimal possibility for
local haemostasis.
Patients treated with irradiation
or cytostatics must be treated with
minimal trauma to diminish the risk
of postoperative infections.
The possibilities of avoiding
unnecessary trauma when extracting teeth are considerably increased
if the operation is initiated or accomplished by employing a Directa Luxator to widen the alveolus and loosen the periodontal ligaments.
The delicate tip of Luxator Original can be inserted to a deep level
on the root, thus allowing the final
loosening and removal of the tooth
to be performed with a minimal
amount force.
During my many years as an
oral surgeon, I have found that
the use of Luxator instruments is
indispensable to meet the demands
for an atraumatic method of tooth
extraction. DT
Dr. Lars Rundquist is a former
member of the Department of Oral
Surgery and Oral Medicine, Faculty
of Odontology, University of Lund,
Malmö and the Department of Maxillofacial Surgery, Institute of Odontology, Karolinska Institutet, Huddinge,
Sweden.

The old way.

Enhancing dentistry with the
dental-video procedure scope
The MagnaVu dental-video procedure scope by Magnified Video Dentistry
By William Domb, DMD

Every once in a while a dental product comes along with the
ability to change our lives for the
better, such as the high-speed
handpiece.
The Dental Procedure Scope is
also one of those powerful tools.
We originally saw the MagnaVu
by Magnified Video Dentistry at a
trade show and immediately saw
the potential to improve closeup vision, even beyond our 4.5x
loupes.
Our dental supply dealer simply
removed our current exam light
and replaced it with the MagnaVu.
The MagnaVu provides us better lighting — up to 24x magnification — and allows us to sit up in
a more comfortable, upright and
ergonomic position while working
from a hi-res LCD display similar
to what medical surgeons have
been doing for years.
The MagnaVu provides the
same images and orientation as I
see with my eyes, so after a short
training session, it only took me
about a week to transition from
looking directly at the patient to
working from the screen with a
natural tactile sense and depth
perception.
The nice thing is that the MagnaVu doesn’t change the way I perform procedures, it just enhances
what I have always been doing.
In the past, I used to sit like a
pretzel, bent over my patient in
all sorts of back-contorting and
straining angles.
With the MagnaVu, I now have
the option of sitting up and working in high magnification; now it’s
rare that I put on my loupes.
I got the MagnaVu because I
wanted to see better, but then we
observed an even more profound
effect: I’ll probably practice years
longer because I’m no longer killing my back and neck.
Eventually, nearly every dental staff member will experience
some degree of back, neck or
eye strain, and many of us are
forced to retire earlier than we

had planned.
Before I began using the MagnaVu scope, by every afternoon I’d
start to feel a burning sensation
around the region of the right
scapula, sometimes radiating up
into the shoulder.
Now, however, even though I
am working out of several operatories and only have the MagnaVu
in two of them, I am consistently

making it through the afternoons
with little or no squawking from
my back and shoulder.
I now have increased magnification, better lighting, improved
patient understanding and I end
up feeling less fatigued during the
day and after work.
Using the MagnaVu Dental Procedure Scope is just a great way to
spend your day. DT
AD

[36] =>

36A Industry News

Dental Tribune | February 2010

AMD LASERS: one of the most
affordable soft-tissue dental lasers
In
January,
AMD
LASERS
announced the introduction of the
Picasso Lite soft-tissue dental laser.
Priced at $2,495, offering 2.5 watts
of power and three customizable presets, Picasso Lite is the most affordable
and easy-to-operate dental laser in the
world, according to AMD LASERS.
It was designed specifically to
replace the archaic use of scalpels
and electro-surge in the treatment of
soft tissue.
“With Picasso Lite, we accelerated
the paradigm shift in dentistry that
began with the introduction of the
Picasso soft-tissue laser in 2009,” said
Alan Miller, president/CEO of AMD
LASERS.
“We have ‘One Vision, One Goal’
— equipping every operatory with
a laser. Record numbers of dentists
are purchasing Picasso, and I’m sure
Picasso Lite’s more attractive price
and ease of use will quickly make it
the most popular laser in the world.
“Picasso Lite was designed specifically for first-time laser dentists
and hygienists, and at one-fifth the
AD

cost of other lasers, it’s truly affordable. We’ve shipped Picassos to more
than 50 countries, and the number of
dentists and distributors interested in
Picasso is truly amazing. I think the
real winners are the patients.”
Picasso Lite cuts and coagulates
tissue with reduced trauma, bleeding
and necrosis of tissue and is used for
soft-tissue surgery, including troughing, gingivectomies, frenectomies,
exposing implants/teeth/ortho brackets and treating aphthous ulcers and
herpetic lesions.
Featuring an ultra-compact, lightweight and sleek design, Picasso Lite
comes with an easy-to-learn set-up
DVD, online laser certification, accessories, world power adapter and a
two-year warranty.
Another first for the laser industry
is Picasso Lite’s ability to use convenient disposable tips or a low-cost
strippable fiber.
“We are proud to offer Picassos and
now Picasso Lites free of charge to
universities and dental schools, globally illustrating our commitment to

education and
charity,” said
Miller.

About AMD
LASERS
AMD LASERS
is a global
leader at providing ultraaffordable laser
technology for
dental professionals preparing to take their
practice to the
next level.
The
integration of the
Picasso
line
of soft-tissue
dental lasers
enables every dental practice to provide treatment for soft-tissue surgery,
periodontal/endodontic treatment
and laser whitening.
AMD LASERS is ISO 13485 and
C.E.-certified for worldwide distri-

BOOTH
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bution. For more information about
AMD LASERS, please call (86) 9992635, (317) 202-9530 {for overseas
dialers} or visit www.AMDLASERS.
com. You may also visit booth No. 415
at the Chicago Midwinter Meeting. DT

[37] =>

Industry News 37A

Dental Tribune | February 2010
41
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Mydent
introduces
DEFEND
prophy paste

Mydent International has
introduced DEFEND® Prophy
Paste, a new prophy paste that
contains balanced ingredients
for maximum stain removal
with minimal enamel loss.
Available in two formulas,
DEFEND+PLUS and DEFEND,
these prophy pastes are smooth,
pliable and contain 1.23 percent active fluoride ions to
strengthen tooth enamel.
DEFEND Prophy Paste tastes
great and both formulas are
available in four flavors: mint,
cherry, vanilla/orange and
bubble gum. All are gluten-free
to assure against allergic reaction and easily rinse clean with
water.
DEFEND+PLUS Prophy Paste
offers an easy-to-use, splatter-free formula that provides superior stain removal
and polishing properties. Both
DEFEND+PLUS and DEFEND
prophy pastes are available in
unit dose cups with 200 per
package of assorted or individual flavors.
Mydent International, home
to DEFEND infection control
products, disposables and
impression material systems,
provides dependable solutions
for defensive health care.
Mydent urges health care
professionals to: DEFEND. Be
smart. Be safe.
For more information on
Mydent International and its
products, call (800) 275-0020,
or go to www.defend.com.
You may also visit the company at booth No. 1541 at the
Chicago Midwinter Meeting. DT

Look for the
Dental Tribune
show daily in
Chicago!
Want to know what’s new
and interesting during the Chicago Midwinter Meeting? Pick
up your copy of Dental Tribune,
which is published daily, during
the show.
Our on-site team of editors
focuses on helping attendees
make the most of their time at
the event and includes live coverage during the event, speaker
interviews, daily course offerings, social events, etc. DT

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PhotoMed G11
digital camera
The PhotoMed G11 digital
dental camera is specifically
designed to allow you take all
of the standard clinical views
with “frame and focus” simplicity. The built-in color monitor
allows you to precisely frame
your subject; focus and shoot.
It’s that easy.
Proper exposure and balanced, even lighting are assured.
By using the camera’s built-in
flash, the amount of light necessary for a proper exposure
is guaranteed, and PhotoMed’s
custom close-up lighting attachment redirects the light from
the camera’s flash to create a
balanced, even lighting across
the field.
More information is available
at www.photomed.net, or call
(800) 998-7765. DT

Vision’s digital
communicator
Vision USA’s digital “communicator” is another priority
product for the company going
forward in 2010.
This camera/video is mounted on an adjustable stand,
allowing the user to capture and
transmit images of impressions,
implant parts, etc., at 10x to 20x
magnification with LED lighting.
The system automatically
attaches the photo/video to
your e-mail server, making it a
very user-friendly tool. The cost
ranges from $329 to $449.
Also available are microscope eyepiece adaptors to convert your existing microscope
into a digital camera for a cost
of $269.
For more information or to
view a video software demo,
please visit www.visionusa
supplies.com or call (800) 2575782 or (856) 795-6199. DT

BOOTH

Plak Smacker: Splash
toothbrush
Plak Smacker has announced
the latest addition to its line of
toothbrushes: the Splash Brush.
The Splash toothbrush is available in four bright colors: orange,
blue, pink and green.
This toothbrush has a comfortable, contoured handle for easy
grip while brushing. The soft
bristles add to the comfort of the
Splash Brush and provide gentle
massage to the teeth and gums.
Patients are sure to rave about
this brush.
For more than 20 years, Plak

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Smacker has been focused on
introducing new, innovative products to help patients feel good
about a trip to the dental office.
For more information or to
place an order, please call (800)
558-6684 or visit www.plak
smacker.com. DT
ADS

[38] =>

38A Industry News

Dental Tribune | February 2010

Studies confirm VibraJect effectiveness
Two independent studies have
confirmed the effectiveness of the
VibraJect® Dental Needle Attachment to block the pain of dental
injections.
The first study, by Fred Quarnstrom, DDS, et al., dealt with pain
level comparisons resulting from
usage of the Wand with those compared to usage of the VibraJect
dental needle attachment.
The second study, by Queens
University, statistically measured
and compared the amount of pain
reduction experienced by patients
given block injections of local
anesthesia using the VibraJect dental needle attachment with block
injections given to subjects using
conventional injection methods.
The following excerpt is from
the first of these two studies by
Fred Quarnstrom, DDS.
Ruth Woldemicael, DMD, and
David Chen, DDS, compared the
VibraJect to a computer-controlled
injection device to control pain for
injection of local anesthesia. Nineteen injections were done with the
Wand handpiece of the CompuDent™ system by Milestone Scientific and 17 with the VibraJect by
VibraJect LLC.
AD

Twenty-four were maxillary
infiltrations, 12 were mandibular
blocks. Patients reported the level
of pain for the needle piercing
their tissue, the injection of solution and their overall evaluation
of the injection. No difference was
seen for piercing the tissue, injecting the solution or overall report
of pain.
This study’s conclusion stated: “This study tends to indicate
there is little difference in the
pain perceived by a dental patient
when injected using the Vibraject
as opposed to injecting with the
Wand.”
The second study is from Queens
University, Belfast, Ireland, and
reveals the following findings,
A Queens University study on
400 patients showed that VibraJect
statistically reduced the amount
of “pain from 4.6 to 1.7, which has
never been statistically achieved
before VibraJect.”
According to the Queen’s University study …
Results: “Subjects receiving the
conventional injection methods
had a mean pain score of 4.6 (±
0.414). The VibraJect group had a
mean pain score of 1.71 (±0.235)

(P<0.05). Certain sites had larger decreases in the mean pain
score using the VibraJect. These
included the upper anterior segment infiltrations and lower right
IDB injections.
Conclusions: The vibrating
syringe attachment resulted in
reduced pain levels on receiving
intraoral injections.”1

Advantages of VibraJect
Beyond the obvious pain and stress
reductions; ease of use; low equipment expenditures and associated
cost savings, an additional advantage of the VibraJect dental needle
accessory is that it will “build dental practices through patient referrals.”
The news of stress-free and virtually painless injections travels
rather quickly and will result in
greater patient satisfaction and an
ever-increasing patient base.
Dental clinicians around the
globe are interested in eliminating
appointment cancellations; minimizing no-shows for dental procedures; reducing patient complaints
about injection pain with its associated stress; and eradicating the
number of squirming, wiggling

and screaming children in their
dental chairs.
VibraJect implementation has
been shown to virtually eliminate
these problems.
For more information on
VibraJect, visit ITL Dental online
at www.itldental.com. DT

1) A study by Fred Quarnstrom, DDS,
FASDA, FICD, FAGD, Diplomate, American Board of Dental Anesthesiology,
Diplomate, National Board of Dental
Anesthesiology; and Sun Hee Bang-Pastore, DDS

[39] =>

Industry News 39A

Dental Tribune | February 2010

CADapalooza ’10: ‘The biggest show in dentistry!’
June 17–19, Cowboys Stadium, Dallas, Texas
D4D Technologies and Henry
Schein Dental are proud to unveil
CADapalooza ’10 – The Biggest
Show in Dentistry! See dentistry
like never before — bigger and better than ever on the world’s largest
high-definition screen.
Join an incredible lineup of
speakers in what will be the event
of the year in CAD/CAM dentistry
as you sit in comfort at the all-new
colossal Cowboys Stadium and see
top innovators in business and dentistry present current innovations
and future applications in CAD/
CAM dentistry.
CADapalooza ’10 is guaranteed
to provide new insight into dentistry as a team sport with valuable information for all — dentists,
dental assistants and dental technicians. Whether you are considering
CAD/CAM for the first time or are
an experienced operator, there’s
something for everyone.
CADapalooza ’10 begins with a
Millin’ Around Welcome Reception
on the evening of Thursday, June
17, for all registered attendees at
the stunning Gaylord Texan Resort.
On Friday, June 18, participants will
enjoy watching the future of dentistry unfold at the largest domed
venue in the world.
Take in the valuable lectures
from the industry’s top visionaries
in the comfortable leather seats or
relax in the 33,000 square foot Club
Level for breaks, lunch and interaction with leading manufacturers.
All participants will have the opportunity to tour the stadium and end
the evening with a cocktail reception at the Star Bar, which sits seven
stories high overlooking the field
for a whole new view of dentistry.
Saturday is a special day for
all participants, who are invited
to visit D4D Technologies’ global
headquarters for Build-a-Crown ™
Workshops and facility tours. Be
there as CAD/CAMbassadors guide
you through the scan, design and
milling of your own restoration,
and work with ceramic experts to
impart the ideal color and strength.
If you already own a chairside
CAD/CAM system, you can elect
to participate in advanced design
workshops
from
experienced
designers to maximize your productivity in design and material
handling. Don’t miss this one-of-akind event!
See and experience the future
of CAD/CAM dentistry at CADapalooza ’10. Space is limited, so register yourself and your team today.
Registration is $295/person (can be
charged by credit card or Henry
Schein Dental account) before June
1, and $395 on-site or after June 1.
Up to 9 C.E. hours available. To register, visit www.CADapalooza.com.
To reserve your hotel room at
the Gaylord Texan Resort through

a special CADapalooza room block,
call the Gaylord Texan at (817)
778-2000 or visit, www.gaylord
texan.com. Transportation to and
from the Gaylord Texan to Friday’s
CADapalooza full-day program and
Saturday’s Build-a-Crown Workshops is included, as well as up to
9 C.E. hours.
CADapalooza ’10 is sponsored by
D4D Technologies, Henry Schein
Dental, Ivoclar Vivadent, 3M ESPE
and Premier Dental. Go to www.
CADapalooza.com to register or for

more information

About CADapalooza
CADapalooza is an annual conference designed to provide attendees
with the most recent information
and a vision of the capabilities of
chairside and laboratory dentistry
using products and technologies
offered by D4D Technologies and
Henry Schein Dental.
The interactive venue will also
feature the latest applications and
techniques utilizing materials

designed especially for digital dentistry today and in the future. DT

[40] =>

40A Industry News

Dental Tribune | February 2010

Vibringe: the next level of endodontic irrigation
Winner of the 2009 iF Product Design Award, the 2009 RED DOT Design Award and the 2009 Good Design Award
Vibringe Corp., headquartered
in Amsterdam, Holland, announces
the U.S. launch of its new irrigation device for root canal treatments,
called Vibringe®, which debuted at
the International Dental Show in
Cologne Germany in March 2009.
This new endodontic irrigation
system uses sonic technology to activate the manual flow of irrigation
solution in order to realize a faster
and more effective outcome with
increased predictability.
Vibringe heralds the next level
of endodontic irrigation and is
AD

the winner of the 2009 iF Product
Design Award (Germany), the 2009
Red Dot Design Award (Germany)
and the 2009 Good Design Award
(USA). iF and Red Dot are two of the
most important international product design awards, with iF garnering more than 2,000 entries from
approximately 37 countries.
“We strongly believe that a product’s design plays an important part
in the acceptance of new technologies in the dental industry. In addition, our research has shown that a
more user-friendly design also has a

positive effect on the patient’s comfort. Vibringe is a very effective ‘gotta
have it!’ piece of equipment,” said
Vibringe Managing Director Mart
Sips.
Founded in November 2007,
Vibringe Corp. is an innovator in
endodontic devices that allow dentists to realize their full potential by
developing easy-to-use products that
help to improve the effectiveness of
existing dental procedures.
The Vibringe device and its disposable syringes are already available
for dentists in most EU-countries,

BOOTH
NO

.1
62

7i
n

ic
ag

Turkey, Canada, Japan, Australia
and New Zealand.
The Vibringe irrigation system is
the result of an unprecedented collaboration between Vibringe Corp.,
designers, engineers and dental professionals. Real-life scenarios guided
product development through feedback from dentists who volunteered
to let Vibringe Corp. watch them
work. During testing, dentists from
around the world provided valuable
feedback and suggestions.
“This is a game-changing product.
It’s an incredible step forward in
the field of endodontics. We expect
that the number of endodontic failures will be significantly decreased
because one of the major causes
of failure in endo is the irrigation
procedure. Vibringe embraces the
actual irrigation procedure. Dentists
will save time due to the all-in-onefeature, but will realize much better
results due the simultaneous delivery and activation of the solution,”
Sips explained.

Industry insiders recognize
Vibringe
“When I first saw this unique product, I knew it would create a new
mindset in endodontics regarding
irrigation. As we all know, irrigation is the most important step in
endodontic treatment, but still one of
the most old-fashioned procedures
in dentistry that uses the conventional syringe,” Marketing Manager
of Henry Schein in Holland Willem
Kortland said.
“Vibringe introduces no additional
steps but will improve the irrigation
procedure by irrigating and activating at the same time. Since we have
introduced Vibringe in Holland to
our dentists, we’ve received an overwhelming level of response, interest
and inquiries on this neat device.
The demand for it has exceeded our
wildest dreams,” Kortland added.

What do Vibringe users say?
One of the first to use Vibringe was
Dr. Julian Webber from the United
Kingdom, who is a well-known and
respected endodontist. When he first
used Vibringe Webber summed up
his perspective with:
“It’s brilliant, simply brilliant!”
After using the Vibringe daily for
a few months, Webber commented that Vibringe is “a wonderful
new advance in endodontic irrigag DT page 41A

[41] =>

[42] =>

42A Industry News

Dental Tribune | February 2010

Grow your dental practice
Three ways to start doubling your growth right now, even if you’ve hit a plateau
By Jay Geier

How would you like to double
your practice growth? How would
you like to double your net income?
Of course you would! But what we
want and what actually happens
are two different things.
When you first started your dental practice, you felt the excitement. You experienced large percentages of growth for the first few
years. Then your dental practice
became stagnant.
You’re not seeing growth in your
dental practice now. Your “adjusted gross income” and “net income”
decreased to the point where it
depresses you to look at the numbers on your tax return.
You have hit a plateau, and it is
commonplace for all businesses,
including dental practices, to hit a
plateau at some point in their life.
Many will hit multiple plateaus.
I completely understand why
hitting a plateau or even a decline
in business would depress you. It’s
AD

because you’re seriously feeling
the squeeze. You discovered that
your expenses don’t plateau just
because your income has flattened
or declined.
• Your staff wants more money.
• You need more space.
• You need to purchase updated
and emerging technologies and
equipment.
• It takes more money to run
your practice.
Not only do your expenses
rise at the office, but they rise at
home too. You’ve got kids, private
schools, bigger houses, insurance,
higher taxes.
So how can you as a dental practice owner get off the plateau, take
your business to the next level and
make more money?

Get the right training, skills and
resources you need to build your
business
Look, you’re either on plan, off
plan or you don’t even have a plan.

If you have been in practice for any
significant amount of time and you
are not investing heavily in your
practice, I wouldn’t be surprised
if you’re experiencing a plateau in
your business right now.
You see, if you’re not learning
better ways to build your practice
then you are just doing the same
thing over and over again. How is
that going to solve your problem
and take your practice to the next
level? It isn’t.

Get the right employees:
implement a ‘no mediocre
employee’ tolerance policy
With so many people unemployed
today, you can find top talent.
There is no reason why you have
to accept mediocre performance.
Remember, you get what you
deserve. If you hire mediocre
employees or if you keep mediocre
employees, then you deserve to get
mediocre or sub-par results along
with the gray hair you’ll get for
dealing with these people.

In addition, it doesn’t take much
effort to hire the right staff. In fact,
I have a hiring system that allows
you to hire new staff with less than
60 minutes of your time.

Get a ‘no excuse’ mindset
If you want to shorten the lifespan
of your plateau, then you need to
stop being your own worst competitor. I mean this in the most caring,
loving way. You make and accept
too many excuses for why you can’t
get new patients.
For example, you blame the
recession. Yes, many small and
large businesses are failing. However, we’ve doubled our business
in this economy. I have clients
who’ve been practicing dentistry
for 35 years and they had their best
year ever in 2009.
A few of these top performers
are in the state of Michigan — one
of the hardest hit states during the
recession. If they can get new clients and double their practices, so
can you.

[43] =>

Industry News 43A

Dental Tribune | February 2010
Yet, you have to adopt what I call
the “two-economy system” mindset
that accepts no excuses.
I define the two-economy system as putting yourself in a bubble where the economy is good,
and keeping everything out of the
bubble that you don’t have control
over.
Thus, unlike most dentists who
let all of the negative energy ooze
into their office and into their existence, I reject it like the plague.
I adopted the policy that you
get what you deserve; there are no
excuses. I haven’t made an excuse
in 20 years.
If I get a bad result, I probably
deserved a bad result. It’s that
simple. So, I don’t make excuses. I
just say, “I got what I deserved, and
I need to figure out why and how
I’m going to fix it so I get a better
result next time.”
If you can figure out what actions
and efforts it takes to deserve more,
then “Bingo!” you can get it.
If you make excuses about your
ability to generate new patients,
such as your town or the economy
or whatever other pathetic, whiny
excuse you might have made in
the past, you literally cannot do
anything. It immobilizes you.

Want to start growing your dental practice?
Here are your next steps:
• Get the training you need.
• Adopt a “no mediocrity” tolerance policy.
• Don’t make or accept excuses.
When you complain, whine and
moan, you take all the power out of
your dental practice and completely destroy the mindset of your staff.
Remember, it starts with you.
Are you ready to grow your dental
practice? DT

About the author

Jay Geier adds 10 to 50 percent more new patients to his
clients’ practices with little or
no change to their marketing
or advertising budget by simply
leveraging their staff and getting
them to focus on new patients as
their No. 1 priority.
To see how your staff stacks
up against your competition
and more than 10,000 practices worldwide when it comes to
turning prospects into scheduled
appointments, take Geier’s new
five-star challenge for free at
www.schedulinginstitute.com.

f DT page 38A
tion. It irrigates and agitates at the
same time. It’s a novel concept that
improves irrigation effectiveness
without adding any extra time to the
procedure. It’s simply superb!”
Prof. Dr. George Eliades, a professor at the University of Athens, conducted a preliminary study between
conventional irrigation and Vibringe.
The results are very promising as
Vibringe showed no entrapped air
(blockage) in the root canal, which
is an important problem during endodontic treatment.
Furthermore, the study showed
that when using certain needles and/
or brushes available on the market
in combination with Vibringe, a thorough debridement and even disruption of the smear layer occurs better

than conventional irrigation.
At the Tokyo Dental College in
Japan, Prof. Dr. Nakagawa has proven the removal of the smear layer to
be more effective using the Vibringe
as well.
Additional studies are being conducted at several European universities with official results to be published in due time.

For more information
If you’d like more information, please
visit Vibringe at the Patterson booth
No. 1627 during the Chicago Midwinter Meeting.
You may also visit the company online at www.vibringe.com for
more detailed information about the
studies mentioned above or to find
an authorized dealer in the United
States. DT
AD

[44] =>

[45] =>

Cosmetic TRIBUNE
The World’s Cosmetic Dentistry Newspaper · U.S. Edition

February 2010

www.dental-tribune.com

Vol. 3, No. 2

Botox and dermal fillers
for every dental practice
The next big thing in dentistry may be expanding into the peri-oral and maxillofacial tissues
By Louis Malcmacher , DDS, MAGD

Esthetic dentistry has been an
absolute boom over the last 30
years, especially when it comes to
such innovative techniques as teeth
whitening and minimally-invasive
veneers like Cristal Veneers by
Aurum Ceramics.
Now that the teeth look good,
what about the peri-oral and maxillofacial areas around the mouth
and on the face? If the teeth look
good but we ignore the rest of the
face, then we have severely limited what we have done in esthetic
dentistry.
It is time to give serious consideration to extending the oralsystemic connection to the esthetic
realms and facial pain areas of
the face, which dentists are more

Fig. 1: Strong forehead muscle contractions cause pain and unsightly
lines in the forehead.

Fig. 2: Botox treatment gives a more
esthetic appearance and eliminates
facial pain.

familiar than any other health-care
practitioner. As dentists, we can
all do a magnificent job of making
teeth look great and also give people a healthy and beautiful smile.

of action for Botox is really quite
simple.
Botox is injected into the facial
muscles, but really doesn’t affect
the muscle at all. Botulinum toxin
affects and blocks the transmitters between the motor nerves that
innervate the muscle.
There is no loss of sensory feeling in the muscles.

How does Botox work?
Botox is a trade name for botulinum
toxin, which comes in the form of
a purified protein. The mechanism

Once the motor nerve endings
are interrupted, the muscle cannot
contract. When that muscle does
not contract, the dynamic motion
that causes wrinkles in the skin
will stop.
The skin then starts to smooth
out, and in approximately three to
10 days after treatment, the skin
above those muscles becomes nice
and smooth.
The effects of Botox last for
approximately three to four months,
at which time the patient needs
retreatment.

When is Botox used?
The areas that Botox is commonly
used for smoothing of facial wrinkles are the forehead, between the
eyes (glabellar region), and around
g CT page 2C

Dental professionals help survivors of domestic violence
More than 5 million people in the
United States are affected by domestic violence each year. In response,
the American Academy of Cosmetic
Dentistry Charitable Foundation
(AACDCF) created the Give Back a
Smile (GBAS) program.
The program provides free cosmetic dental care to survivors of
domestic violence.
More than 800 cases have been
completed by AACD dental professionals, who have volunteered
their time and expertise pro bono.
There are currently 400 applicants
being treated throughout the United
States.
“After suffering abuse, it is difficult for survivors to find something
to smile about and even more difficult when they don’t have a smile
to show,” said AACD Foundation
Program Manager Lisa Fitch.
“AACDCF volunteers assist survivors of domestic violence by treating their dental injuries, restoring
their smiles, self-esteem and, ultimately, their lives.”
As the national economy entered
its deepest recession in almost 100
years, many across the country felt
the increased stress, which resulted

in a sharp rise in domestic violence.
According to the National Coalition of Domestic Violence, 75 percent of battering occurs to the head
and face. This means the dental
office is in an extremely influential
position to intervene and help stop
the violence.
In addition to the GBAS program,
the AACDCF offers the Domestic
Violence Intervention & Prevention
(DVIP) program.
This program offers a free video
to dental professionals interested
in learning from an expert how to
approach difficult situations in the
dental practice when domestic violence is suspected.
Domestic violence survivors who
have suffered dental injuries from
abuse by a former intimate partner
or spouse can contact GBAS tollfree at (800) 773-4227, visit www.
givebackasmile.com, or e-mail givebackasmile@aacd.com.
Survivors must make an appointment with a counselor, domestic
violence advocate, social worker or
therapist to complete the advocate
section of the GBAS application.
GBAS conducts the initial review
of the application; however, the

dentist has the final say as to the
eligibility of the applicant.
If eligible, the AACD connects the
survivor with a local GBAS volunteer who provides treatment at no
charge to the recipient.
For dental professionals who are

interested in participating in the
program, more information is available from the AACD online www.
aacd.com or via phone (800) 5439220. CT
(Source: AACD Foundation)
AD

[46] =>

2C Clinical

Cosmetic Tribune | February 2010
become more popular in an uncertain economy because patients
want to do something to look better
that is more affordable than surgical esthetic options.

How do you get there?
Fig. 3: 42-year-old female had moderate nasolabial lines and uneven
lips.

Fig. 4: Dermal filler therapy gives
this patient a more youthful appearance and fuller lips with a desirable
pout and creates soft tissue esthetics,
which complement her teeth.

f CT page 1C

the corners of the eyes (crow’s feet)
(Figs. 1, 2) and around the lips.
Botox has important clinical uses
as an adjunct in TMJ and bruxism
cases, and for patients with chronic
TMJ and facial pain.
Botox is also used to complement
esthetic dentistry cases; as a minimally-invasive alternative to surgically treating high lip line cases;
for denture patients who have trouble adjusting to new dentures; for
lip augmentation; and has uses in
orthodontic and periodontic cases
where facial muscle retraining is
necessary.
No other health-care provider
has the capability to help patients
in so many areas as do dentists with
Botox and dermal fillers.

What about dermal fillers?
Dermal fillers, such as hyaluronic acid (Juvederm Ultra and
Restylane) are commonly used to
add volume to the face in the nasolabial folds, oral commissures, lips
and marionette lines (Figs. 3, 4).
As we age, collagen is lost in
these facial areas and these lines
start to deepen. These dermal fillers are injected right under the
skin to plump up these areas so that
these lines are much less noticeable.
Dermal fillers are also used for
lip augmentation and are used by
dentists for high lip line cases,
uneven lips and to make the perioral area more esthetic. The face
looks more youthful and is the perfect complement to any esthetic
dentistry case that you do.

What’s a dentist got to do with it?
We as dentists give injections all
the time; this is just learning how to
give another kind of injection that
is outside the mouth, but is in the
same area of the face that we inject
all the time.
Dentists also have a distinct
advantage over dermatologists,
plastic surgeons, medical estheticians and nurses who commonly
provide these procedures in that we
can deliver profound anesthesia in
these areas before accomplishing
these filler procedures.
Patients who undergo such treatment by other health practitioners
can be quite uncomfortable during
the procedure, and indeed this is
one of the biggest patient complaints about dermal fillers.
Many dentists are surprised to
find that more than half of the

United States allow dentists to provide Botox and dermal fillers to
patients. Why wouldn’t you provide
these services if you already offer
whitening and esthetic dentistry to
your patients?
I would make the strong argument that dentists are the true specialists of the face, much more so
than most other health-care professionals, including dermatologists
and plastic surgeons.
It is time to stand up for what we
know and what we can accomplish.

Do patients want this?
Is there a market for these services?
In 2008, close to $3 billion was
spent on botulinum toxin and dermal filler therapy in the U.S.
Think about this: that was money
spent on non-surgical, elective,
esthetic procedures that could have
been spent on esthetic dentistry, but
the patient made a distinct choice.
Interestingly, these procedures

COSMETIC TRIBUNE
The World’s Dental Newspaper · US Edition

Publisher & Chairman
Torsten Oemus
t.oemus@dental-tribune.com

Like anything else you do, offering
this type of service requires training. The learning curve is short
because you already know how to
give comfortable injections. I often
give training sessions in Botox
and dermal fillers and dentists are
amazed how easy these procedures
are to learn and accomplish compared to everything else we do.
Finding practice models is easy:
start asking family and friends who
will fight to have you practice on
them.
If you want even more proof, ask
women in your practice if they have
had or would like Botox or dermal
filler therapy.
You will be overwhelmed at the
positive response and shocked at
the number of people you know
already receiving these treatments.

Vice President Global Sales
Peter Witteczek
p.witteczek@dental-tribune.com

Conclusion

Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com

What’s the next big thing in dentistry? It may come as we start expanding outside of the teeth and gums
into the peri-oral and maxillofacial
tissues, which is within every dentist’s skill set.
All you need is knowledge and
practice. Then, you will be able to
deliver these new services to your
patients and truly complement the
rest of your dental practice. CT

About the author
Dr. Louis Malcmacher is a practicing general
dentist in Bay Village, Ohio, and an internationally recognized lecturer, author and dental consultant known for his comprehensive and entertaining style.
An evaluator for Clinicians Reports (formerly
Clinical Research Associates), Malcmacher has
served as a spokesman for the AGD and is president of the American Academy of Facial Esthetics.
You may contact him at (440) 892-1810 or
e-mail dryowza@mail.com. Go to his Web site,
www.commonsensedentistry.com, where you can
find information about Botox and dermal filler
live patient hands-on training, building the best
dental team ever, big case acceptance success
and sign up for his free monthly e-newsletter.

www.dental-tribune.com

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Eric Seid
e.seid@dental-tribune.com
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Published by Dental Tribune America
© 2010 Dental Tribune America, LLC
All rights reserved.
Cosmetic Tribune strives to maintain
utmost accuracy in its news and clinical reports. If you find a factual error or
content that requires clarification, please
contact Group Editor Robin Goodman at
r.goodman@dental-tribune.com.

Cosmetic Tribune cannot assume responsibility for the validity of product claims
or for typographical errors. The publisher also does not assume responsibility
for product names or statements made
by advertisers. Opinions expressed by
authors are their own and may not reflect
those of Dental Tribune America.

Missed the last edition of Dental Tribune?
You can now read some of its content online!
Patient appeal ratings: The science behind Web sites that work
By Frith Maier
www.dental-tribune.com/articles/content/scope/specialities/section/
cosmetic_dentistry/id/1233
Porcelain laminate venereers: an excellent option ...
By Dr. Robert A. Lowe
www.dental-tribune.com/articles/content/scope/specialities/section/
cosmetic_dentistry/id/1222

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hearing from you!

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[cover] => DT U.S.

[toc] => Array ( [0] => Array ( [title] => Better sleep through dentistry [page] => 01 ) [1] => Array ( [title] => News [page] => 02 ) [2] => Array ( [title] => Jumpstart your production with ‘Stage III Customer Service’ [page] => 07 ) [3] => Array ( [title] => Practice transition planning (part 1 of 2) [page] => 08 ) [4] => Array ( [title] => Analyze this ... the consumer’s point of view [page] => 10 ) [5] => Array ( [title] => Better sleep through dentistry [page] => 13 ) [6] => Array ( [title] => Minimally invasive cosmetic dentistry (part1) [page] => 16 ) [7] => Array ( [title] => Minimally invasive cosmetic dentistry (part2) [page] => 21 ) [8] => Array ( [title] => Dentistry in the Windy City [page] => 22 ) [9] => Array ( [title] => OHA Gala to feature plenty of ‘bling’ [page] => 26 ) [10] => Array ( [title] => Chicago Midwinter Meeting0 [page] => 28 ) [11] => Array ( [title] => A new solution for dentin hypersensitivity [page] => 30 ) [12] => Array ( [title] => Industry News [page] => 33 ) [13] => Array ( [title] => AMD LASERS: one of the most affordable soft-tissue dental lasers [page] => 36 ) [14] => Array ( [title] => Industry News [page] => 37 ) [15] => Array ( [title] => Industry News [page] => 42 ) [16] => Array ( [title] => COSMETIC TRIBUNE 2/2010 [page] => 45 ) ) [toc_html] =>

Table of contents

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