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GlaxoSmithKline taking zinc out of its denture products / News / Give feedback or face backlash / Practice transition planning (part 2 of 2) / Oral Pathology / Class II challenge / Hinman Meeting Preview / Want to update your knowledge of implants? / Evolution of the toothfairy / Industry News / Industry News

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

March 2010

www.dental-tribune.com

Vol. 5, No. 6

HEYGIENE
RIBUNE
NDO TT
RIBUNE
Diagnose this …

Multiple lobulated reddish to bluish swellings
over the tongue and lower lip.
u page 11A

Class II direct composites

Clinical solutions to common problems when
placing these types of restorations. u page 14A

The
World’s
Dental
Hygiene
Newspaper
· U.S.
Edition
The
World’s
Endodontic
Newspaper
· U.S.
Edition

AAE annual meeting

The event has a special focus on hot topics and
controversies in endodontics.
upage 1B

GlaxoSmithKline taking zinc
out of its denture products
By Fred Michmershuizen, Online Editor

GlaxoSmithKline (GSK), manufacturer of several versions of denture
adhesive sold under the Super Poligrip brand name, recently announced
it will introduce zinc-free versions of
the products.
“While zinc is an essential part of
the diet, recent publications suggest
that an excessive intake of zinc-containing denture adhesives over several years may lead to the development
of neurological symptoms and blood
problems such as anemia,” a consum-

er advisory from the company reads.
“Neurological symptoms may
include numbness, tingling or weakness in the arms and legs and difficulties with walking and balance.”
The company insists the products
are safe when used as directed, but
said that it is removing zinc as a precautionary measure for consumers
who might use too much.
“Super Poligrip is safe to use as
directed in the product label,” the
statement reads. “The majority of consumers follow these directions. However, some consumers apply more

Heading to Atlanta this month?

adhesive than directed and use it
more than once per day. Therefore, as
a precautionary measure to minimize
any potential risks to these consumers, GSK has voluntarily stopped the
manufacture, distribution and adver-

The director of Salon Dental
Chile, the main dental expo in
Chile, told Dental Tribune Latin
America over the phone that the
capital, Santiago, was only slightThe Hinmann Dental Meeting is known for its reputation of excellence,
one that brings together the highest quality programming from the
leading authorities in the field of dentistry.
g See pages 17A, 18A

tising of these products.”
The new products will be clearly
labeled on their packaging as zincfree. GSK reported that it has discussed this situation with the FDA and
that no further action is required. DT

Chile meeting a go
despite earthquake
By Javier de Pison, Editor in Chief Dental
Tribune Latin America

Dental Tribune America
213 West 35th Street
Suite #801
New York, NY 10001

PRSRT STD
U.S. Postage
PAID
Permit # 306
Mechanicsburg, PA

DENTAL TRIBUNE

ly affected by the recent powerful
earthquake and that there was a
tense calm in the nation, caught by
surprise in the middle of the summer vacation.
Salon director Miguel Wechsler
said that Chile’s “strict building
g DT page 2A
AD

[2] =>

News

Dental Tribune | March 2010

Record level of support
for 20th annual OHA Gala
Oral Health America (OHA), a
non-profit organization founded in
1955 and headquartered in Chicago,
held its 20th annual gala and benefit on Feb. 24 at Chicago’s historic
Union Station. Nearly 900 guests
participated in silent and live auctions to benefit OHA while networking with fellow professionals
before the Chicago Midwinter Dental Meeting.
The event raised more than
$400,000 — the highest amount in
the gala’s 20-year history — for
OHA’s programs that bring healthy
mouths to life.
Proceeds from the auctions support Smiles Across America® (SAA),
an OHA program that assists oral
disease prevention services in
schools for children who are unable
to obtain routine dental care due
to lack of resources, low literacy or language barriers. The program was launched in Chicago in
1994 with the Chicago Department
of Public Health, Chicago Public
Schools and community partners,
and now reaches 90 treatment partners in 27 states. Through 2009, SAA
has provided $1.5 million in funding
and supporting services to an estimated 250,000 children annually.
“Oral Health America is privi-

leged to work to improve the oral
health of Americans of all ages, particularly those who are most vulnerable,” said Beth Truett, president
and CEO of Oral Health America.
“Our gala shined a special spotlight on our work with children in
school-based and school-linked settings across the country, and gave
attendees the opportunity to support
a national program that is at work
with at-risk children and families in
schools, clinics and neighborhoods
in their own communities.”
The gala was sponsored by DentaQuest, Patterson Dental, Ivoclar
Vivadent, Midmark, 1-800-DENTIST, Colgate-Palmolive, Henry
Schein Dental, Chicago Dental Society, Belmont Publications, SciCan,
National Dentex, Philips Sonicare,
Unilever, Mr. and Mrs. Bernard
J. Beazley, Burkhart Dental Supply, ConFirm Monitoring Systems,
Argen Corporation, Tokuyama
Dental, DENTSPLY International,
GC America, DentalEZ Group and
OralDNA.
Dentalcompare donated the production of a video, shown for the
first time at the gala, that highlights the impact of OHA’s SAA program. The video makes the case for
oral health’s importance to over-

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

all health, and OHA’s support of
community-based efforts to ensure
that children get a healthy start
through having a healthy mouth.
The video can be accessed at www.
dentalcompare.com/video_view.
asp?videoid=528.
OHA’s mission is to change lives
by connecting communities with
resources to increase access to oral
health care, education and advocacy
for all Americans, especially those
most vulnerable. For more information about Smiles Across America or
any of OHA’s programs, visit www.
oralhealthamerica.org. DT

ADS

f DT page 1
codes have saved thousands of
lives, and 95 percent of the infrastructure in the capital is intact.”
The Salon Dental Chile, which in
2009 had more than 5,000 visitors,
will take place as scheduled May
27–29.
Wechsler said the 15-story building where he lives in Santiago
rocked 12 feet (5 meters) from side
to side during the temblor, but that
only some ornaments in his home
fell to the floor and broke. Electric
power was restored in most of the
capital two days after the earthquake.
Though the strength of Chile’s
earthquake was 500 times more
powerful than the quake that devastated Haiti, the loss of life has
been considerably less in the South
American country. Haiti’s death toll
was more than 200,000, while the
death toll in Chile was more than
700.
Wechsler said that Salon Dental
Chile is offering a new feature at
discounted rates: a large “Business
Center” (12 booths) where event
organizers may arrange meetings
in advance between foreign companies and Latin American distributors. It will also provide free
translators, included in the rate for
g continued

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] =>

News

Dental Tribune | March 2010

Top tips to prevent tooth grinding
By Keri Kramer, Chicago Dental Society

How are Americans dealing with
these difficult economic times? If
you ask dentists, they’re taking the
stress out on their teeth. In the fall
of 2009, the Chicago Dental Society
surveyed more than 250 of its members to see if stressing about the
economy was wreaking havoc on
patients’ oral health.
Nearly 75 percent of dentists surveyed said their patients reported
increased stress in their lives. And
65 percent of dentists said they have
seen an increase in jaw clenching and teeth grinding among their
patients.
Jaw clenching and teeth grinding, or bruxism, can be a temporary
nuisance during stressful times that
causes headaches and sleep problems, but it can also cause lasting
problems for your teeth and gums.
It can lead to muscle inflammation,
broken teeth or even damaged dental work, such as crowns and fillings.
Dentists are sharing the following
tips with their patients to help them
cope with the pressures of the world
— before their teeth pay the price:
Take a pain reliever. If grind-

f continued

Salon Dental Chile Director Miguel
Wechsler at the Salon Dental Chile
expo entrance in 2009.
Business Center attendees.
The president of the Chile Dental Association, Dr. María Eugenia
Valle, was in California when the
quake struck her country and said
in an e-mail that she was very nervous because she was there with
her three young grandsons, unable
to fly to Chile.
The executive secretary of the
association, Dr. Patricio López,
said from Santiago that the narrow
geography of Chile has made it
difficult to assess the total damage
because there are no alternative
roads to the main ones to travel
south.
The city most affected by the
quake was Concepción, 311 miles
(500 kms) south of the capital. After
some initial riots caused by the
closing of the main supermarkets
there, the government said that
order was restored in the city. DT

ing and clenching is causing you
headaches and muscle soreness in
your jaw, take an anti-inflammatory
medication, such as Advil or Aleve,
shortly before bedtime.
Massage. Try massaging the muscles along your jaw line, from the
joint near your ear all the way to
your chin to relieve jaw soreness.
Avoid caffeine. Coffee may help
you get going in the morning, but
caffeine combined with stress can
lead to increased muscle tension.
Increase your consumption of water.
If cutting caffeine completely from
your life won’t work for you, at least

try to avoid it within several hours
of bedtime.
Be careful with your diet. When
the jaw muscles get inflamed, it’s
best to go easy on them for a while
by avoiding foods that require vigorous chewing. Ice and gum chewing are a definite no-no. And don’t
even think about that triple-decker
cheeseburger that almost requires
you to unhinge your jaw to eat it.
Exercise. You didn’t want to
hear this one did you? But exercise
relieves stress and reduces anxiety,
the two biggest culprits of grinding.
Meditate. Try a yoga class to

achieve some relaxation. Even taking a moment before bedtime to do
some deep breathing can be a big
help.
Wear a mouth guard. If you have
serious grinding and clenching
issues, talk to your dentist about a
mouth guard to wear at night.
The Chicago Dental Society
recently held its 145th annual midwinter meeting, which brought
more than 30,000 dental professionals to Chicago in February.
The meeting is a forum for dentists to learn about new products,
technologies and methods. DT

[4] =>

4A

News

Dental Tribune | March 2010

‘Lack of dentists on oral
health panels,’ ADA protests
The Institute of Medicine Committee on Oral Health Access to Services
was taken to task recently by the
American Dental Association for its
decision to exclude private practice
dentists from two panels it is convening at the behest of the U.S. Department of Health and Human Services.
The panels are tasked with studying
oral health care delivery and access.
ADA President Dr. Ronald Tankersley testified before the Institute
of Medicine (IOM) on March 4. He
pointed out that private practice dentists represent nearly 92 percent of all
professionally active dentists, and he
said their input is crucial to addressing the oral health care access issue.
“I am obligated, on behalf of our
members, to protest the IOM’s continuing failure to include representatives of the private practice dental
community on either of its two oral
health panels,” Tankersley said. “We
respect the experience and knowledge of the committee members, but
the nation’s 167,000 private practice
AD

By Fred Michmershuizem, Online Editor

dentists represent some 92 percent
of professionally active dentists in
the United States. Without them,
there can be no significant impact on
access to oral health care, regardless
of the delivery system.”
Tankersley went on to outline
the ADA’s efforts to address ways
to improve access for underserved
populations.
“The ADA believes that oral health
depends on preventing oral disease,”
he said. “The nation will never drill
and fill its way out of this problem.
Our efforts to improve access to care
have taught us that there are many
contributing factors and barriers to
the problem. Some are economic
and others environmental. Some are
direct and others indirect. Some are
related to the individual and others to the provider. The ADA has
been on the vanguard of advocating
access solutions.”
Tankersley cited the following
ADA initiatives as examples:
• Designing and implementing

a pilot program for its preventionfocused Community Dental Health
Coordinator, a community health
worker with dental skills now active
in Philadelphia, rural Oklahoma and
Indian tribal areas.
• Convening an Access to Dental
Care Summit in 2009 for a broad
range of 144 stakeholders to identify short- and long-term ways to
improve oral health for underserved
populations.
• Creating a Public Health Advisory Committee to provide a formal
presence within the ADA to receive
input on issues of public health significance.
• Convening the 2007 American
Indian/Alaska Native summit to
collaboratively address the unique
needs of these populations.
• Implementing an initiative to
address oral health needs of the
vulnerable elderly, one outcome of
which will be the introduction of
federal legislation.
• Seeking to increase collaboration among private practice dentists
and those working in federally qualified health centers and other dental

safety net clinics, where about 69
percent of the dentists are members
of the ADA.
• Lobbying for virtually every federal program that could effectively improve access for the dentally
underserved.
“While the current dental delivery
system serves most Americans well,
we must work together to extend
that system to the most vulnerable
among us, who are at the greatest
risk for developing oral disease,”
Tankersley said.
He said the ADA believes that
there are three ways to help prevent
oral disease:
• To rebuild the public health
infrastructure and expand and adequately fund safety-net programs,
including Medicaid.
• To increase community-based
prevention programs.
• To improve oral health literacy.
“Our current dental public
health infrastructure is insufficient
to address the needs of the underserved, and the gap between needs
and the ability to address those needs
is growing,” Tankersley said. DT

Best smiles at Oscars?
By Fred Michmershuizem, Online Editor

We’ve all heard of the best and
worst dressed lists that fashionistas
compile after the annual Academy
Awards ceremony. Now, there’s a list
of the celebrities who flashed some
of the best (and worst) smiles on the
red carpet.
Dr. Catrise Austin, owner of VIP
Smiles and author of “5 Steps to the
Hollywood A-List Smile: How the
Stars Get That Perfect Smile and How
You Can Too,” surveyed the hottest
Hollywood smiles before the recent
Oscars ceremony and announced her
top picks for the most notable smiles.

And the envelope, please ...
According to Austin, Queen Latifah
not only looked stunning in her onshouldered studded dress, but she
also had one of the most radiant
smiles of the night. Austin referred to
Latifah’s pearly whites as the “Smile
Fit for a Queen.”
The award for “Best Male Celebrity Smile” went to playful Hollywood
hunk George Clooney.
Austin commended heartthrob
Zac Efron — who reportedly transformed his smile before becoming
a superstar by closing his gap with
porcelain veneers — for rocking a
“very sexy white smile.”
Meryl Streep showcased a dazzling white smile along with her

beautiful white dress. “From head to
toe she was simply gorgeous,” Austin
said.
At least one celebrity, however,
did not fare so well.
Morgan Freeman, whose teeth
looked like they “desperately needed
a boost of teeth whitening to brighten
his dull yellow smile,” received the
award for “A Smile Not Worth a Million Dollars.” Ouch!
Teeth whitening is the No. 1
requested cosmetic procedure in
cosmetic dentistry practices across
the nation, said Austin, who also recommended either porcelain veneers
or clear removable braces such as
Invisalign or Clear Correct to make
Freeman’s teeth straighter.
Another celebrity who could show
improvement, Austin said, was Miley
Cyrus. While the teen superstar has
an “overall nice smile,” Austin said,
she noted that her teeth appeared
to be a bit asymmetric as one front
tooth actually hangs a tiny bit lower
than the other.
Austin recommends that a simple
procedure such as tooth recontouring or perhaps redoing the upper
front veneers will put the smile of
the popular singer and actress back
on the A-list.
Austin, who is based in New York
City, calls herself a “celebrity dentist.” Her goal is to offer her patients
“Hollywood-inspired” smiles. DT

[5] =>

Dental Tribune | March 2010

Practice Matters

Give feedback or face backlash
By Sally McKenzie, CEO

It’s likely you realized early on
that as the owner of your practice,
there are many hats you must wear.
You are, after all, “the boss.” You are
the one your team looks to for direction, guidance, mediation, fairness,
etc. And for many dentists, it’s those
“other duties as assigned” that create
the biggest headaches in running a
practice.
Employees are a needy bunch. You
have to tell them what to do. They
often require additional training.
They can be mercurial. And one particularly frustrating characteristic of
most employees — they want regular
feedback from you, their boss.
If only signing the paychecks was
all that was required to effectively
manage a team. Now you need a solid
set of skills, a strong sense of integrity
and professionalism and a willingness to encourage excellent performance through motivation, accountability and, yes, plenty of constructive
feedback.
Most dentists pat themselves on
the back if they give employees feedback once or twice a year. “Feedback” as many view it would be that
perfunctory exchange that is commonly attached to the annual salary
review.
If there are no problems, most likely the dentist tells the employees they
are doing a fine job, slaps a couple
extra percentage points on the paycheck and quickly strikes this routine
matter off the to-do list. “There, that’s
done. Now on to real work!”
Or perhaps you are one of those
who reasons that if the employee gets
a paycheck and isn’t shown to the
door that is feedback enough in your
book. “If I wasn’t happy they’d know
it. Why would I need to give any more
feedback than that?” If that’s your
story, you’re probably filling vacancies in your office rather regularly.
Maybe your idea of feedback is
dropping a subtle hint here or there.
The dirty instruments pile up in the
sink and you stick a post-it-note above
it with a frowning face.
Or let’s say, you’re looking at a
record shortfall in income this year
and you casually mention in a staff
meeting that money is a little tight.
This isn’t feedback because:
• It doesn’t help the collections
coordinator understand that she
needs to increase over-the-counter
collections immediately.
• It doesn’t tell the scheduling
coordinator that the scheduling to
meet production goals is established
for a reason.
• The staff members leave the
meeting assuming everything is fine
where they are concerned. After all, if
money were a serious problem surely
you’d do more than mention that
things are a little tight.
• Meanwhile, you are sure the
team is going to take some real steps
to improve their performance. (Yet,

this is, in fact, not true.)
Vague generalities don’t work and
they don’t constitute feedback. So
how does the dental practice actually
incorporate effective feedback into its
systems?
First, drop the notion that feedback is part of the performance/salary review. They are separate issues.
Performance rewards must be based
on performance measurements, but
that is another article.

Daily dose
Constructive feedback should be
given and received daily to help

employees continuously fine tune
and improve the manner in which
they carry out their responsibilities.
Feedback given and received constructively is professional pixie dust
for the employees.
It’s that unseen magical ingredient
that helps them to improve and to
grow. It’s also the dentist’s most vital
tool in shaping and guiding average
employees into effective, high-performing team members.
But expecting anything constructive or positive to come out of occasional doses of feedback is like having
a patient who brushes his teeth occa-

sionally yet expects to have excellent
oral health. It simply doesn’t happen.
Verbal feedback can be given at
any time, but it is most effective at
the moment the employee is engaging in the behavior that you either
want to praise or correct. If Sue at the
front desk negotiated payment from
the ever difficult Mrs. Jones with
the deft and political acumen of a
highly trained peace keeper/financial
genius, tell her!
Similarly, if her handling of a situation is not consistent with the pracg DT page 7A

Visit us at Hinman booth no. 913
for your FREE gift!

[6] =>

[7] =>

Practice Matters

Dental Tribune | March 2010

f DT page 5A
tice’s overall performance objectives
and/or your practice philosophy,
explain to her constructively how you
would like for her to handle similar
situations in the future.
Verbal, on-the-spot feedback
should be the goal. The environment
of the practice should be one that
encourages positive feedback and
openly provides constructive feedback when necessary.
Choosing to avoid opportunities
to give employees feedback is like
choosing to help them to fail.

What goes around comes around
Similarly, dentists should consider
soliciting feedback from their teams.
Scary thought, isn’t it? It can be
handled as simply as asking every
employee to anonymously write
down one thing that they would
change about the office — no personal attacks allowed.
The focus is constructive feedback on a system or a procedure
that the employees believe would be
an improvement. It could be daily/
monthly meetings, new patient packets, scheduling difficulties, increased
training opportunities, clear office
procedures, conflict resolution strategies, etc.
If you are particularly brave, ask
your team to rate you personally on a
set of skills such as your leadership,
your ability to delegate, your adherence to following established office
procedures, your openness to input
from the team.
In addition, ask them to identify
something specific that they believe
you could do to improve your role as
leader of the practice.
Remember, all of this is to be anonymous, so do whatever is necessary
to make sure the submission of this
feedback retains employee anonymity.
For instance, you could set up an
external e-mail account (aol, gmail,
yahoo!, etc.) and give all employees
the access codes to this account (or
post it where only employees will
see it, such as a breakroom). Then,
employees will be able to access the
account from home or elsewhere to
send an anonymous e-mail to the
dentist’s personal address.

Employees: ‘This is for you.’
Feedback is only as good as what
you do with it. There is no doubt that
dentists need to provide feedback to
employees daily, but this street runs
both ways and employees must be
willing to accept the feedback and
take action on it.
In reality, if employees are open
to it, feedback is all around them,

particularly from their colleagues in
the dental practice. The key is to take
the feedback and turn it into positive
action.
Some employees, no matter how
carefully they are handled, will take
every constructive comment as criticism. They only want to hear how
well they are doing, not how they can
improve.
Take a good look at how you
respond to suggestions and comments from those around you. Are
you defensive? Do you take it as a
personal affront? Are your feelings
hurt or do you become angry when
someone recommends doing something a different way? Do you dismiss
feedback because you don’t like the
person giving it?
The key is to separate yourself
from the action and look at feedback
as an objective view of a particular
task or procedure and, most importantly, as one of the most essential
tools you can use to excel.
Too often supervisors and coworkers are so overly concerned
about offending a staff member they
shun opportunities to give feedback.
So when a co-worker steps forward
and actually offers feedback, he or
she is taking a major risk and should
be thanked for the willingness to help
you become a better employee.
Ideally, the culture of the practice should encourage open feedback
among the team members to continuously improve systems and patient
services.

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.mckenzie
mgmt.com; and The New Dentist™ magazine, www.thenew
dentist.net. She can be reached
at (877) 777-6151 or sallymck
@mckenziemgmt.com.

Denture Comfort
Tuf-Link
Silicone
Reline
3.0

You asked for it
The best way to become comfortable
in receiving and acting on feedback
is to ask for it. We are completely
incapable of seeing ourselves as others see us, which is why being open
to feedback is essential in achieving our greatest potential and recognizing those professional habits and
approaches that are interfering with
that potential.
When receiving feedback, make
a conscious decision to listen carefully to what the person is saying and
control your desire to respond. In
other words, resist the urge to kill the
messenger.
Ask questions to better understand
the specifics of the person’s feedback.
If the person giving the feedback is
angry, ask him or her if you can sit
down and discuss the problem when
you are both calmer and can respond
wisely rather than emotionally.
Thank the employee for trying to
help you improve, even if you didn’t
particularly care for what he or she
told you. Resist the urge to blow off
those comments you considered to be
negative.
Push yourself to write the com-

back; actively solicit it and use it!
Recognize that feedback is one of the
most critical tools you have in achieving your practice’s full potential. DT

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‘Feedback given and
received daily is professional
pixie dust for employees.’

ments down and focus on the substance of the message rather than
what you might perceive as a negative tone from the messenger. During
the next 48 hours, think about the
information you have been given and
devise three to five steps you can take
to change your approach.
For example, Mary the assistant
is very frustrated because she feels
that Sue at the front desk is interrupting staff members with insignificant
matters when they are with patients.
Sue’s initial reaction is very negative
because she feels that Mary is trivializing her need for clear communication with the staff.
Instead of lashing out, Sue decides
to ask for examples and listens to
Mary’s perception of the interruptions. She thanks Mary for calling
her attention to the issue and decides
to focus on addressing the matter
constructively rather than reacting
negatively to what she could choose
to interpret as unjust criticism.
She develops a plan to raise the
issue at the next staff meeting and
solicit input from the clinical staff.
Sue is prepared to share with the
team situations in which she has
felt the matter necessitated an interruption and would like guidance on
how to handle similar matters in the
future.
Don’t sit back and wait for feed-

[8] =>

Financial Matters

Dental Tribune | March 2010

Practice transition planning
This is part 2 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
deep-seated emotional attachment
with their practice. For many, the
AD

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.

Patients’ evaluation of the new
dentist
Most senior dentists know and

understand that the senior dentist’s
own patients judge their clinical
competence by non-clinical factors, such as personality, gentleness, office appearance, etc. It is
generally not possible to assess
clinical competence until a year or
more of actual clinical procedures
performed by the new dentist are
reviewed.
Unless the transition is preceded
by a period of employment prior
to the actual ownership change,

senior dentists must understand
they will not be able to address the
clinical competence issue.
Senior dentists must accept the
fact that the only control they have
over this subject is the fact that the
new dentist has been tested and
licensed.

Determining the transition plan
The first step in formulating a transition plan involves an appraisal
of the practice. The information
gathered and evaluated during the
appraisal process will aid in determining available transition options.
These options may include (1)
an outright sale, (2) role reversal
sale, (3) partnership, (4) merger or
(5) production acquisition transaction.
In addition, the appraisal will
typically provide a comparison with
other practices involved in transitions, thereby allowing an understanding as to how salable this particular opportunity might be.
Finally, the appraisal should also
provide ideas regarding enhancing
the value of the practice and its
desirability as a transition candidate.

Locating a competent transition
consultant
The next step is locating a competent transition consultant. A transition consultant is one who understands the entire transaction, the
various types of transitions, contractual matters, the operational
issues of running a dental practice
and the need to have the relationships of the buyer, seller, staff
and patients intact after the deal
is done.
The best source for these individuals is word-of-mouth referrals
and/or recognized reputation. They
may be a national or regional “transition guru,” the dentist’s personal
accountant or another accountant
who restricts his/her practice to
health-care providers and is familiar with the health-care transition
field or an experienced local dental
practice broker.
Some of the dental supply companies also have knowledgeable
consultants who have been assisting in transitions for years.
The transition consultant will
help the dentist identify various
aspects of his/her transition. Questions that need answers include the
dentist’s financial ability to retire
and his/her personal transition
goals.
For example, how long does the
dentist wish to stay on as an associate and/or remain available to aid
in the transition process? What is
g DT page 10A

[9] =>

[10] =>

10A Financial Matters
f DT page 8A
the dentist’s preferred timetable?
Are there any preliminary steps
required to enhance the value of
the practice? Which method of
transition has the greatest chance
of successful completion?

Make a plan outline
The answers to these questions
should result in a brief written outline of the plan. The topics should
include:
(1) goals,
(2) a timetable,
(3) appraised value,
(4) anticipated post-tax and
sale’s expense net sale proceeds,
(5) planned transition options
and
AD

(6) a list of consultants to be
involved.
The plan should also contain
an action plan for completion of
any activities that will enhance the
value of the practice or increase the
chances the practice will be selected by prospective new dentists.
Understanding that an inactive
practice loses 5 percent of its value
per week, an important part of the
plan should also include a list of
people to be called in the event
of an unanticipated career-ending
disability or death.
A letter of instructions to family
members should be included that
lists those contacts and stresses
the urgency to act expediently in
transitioning the practice. A part of
the plan needs to include sharing

Dental Tribune | March 2010
this letter and plan with designated
family members.
Many dentists, especially if
incorporated, will execute a power
of attorney authorizing a specific
individual to immediately begin
transition proceedings if required
due a dentist’s death.

When and how to start
If an appraisal has not been completed or updated within the past
two years, this is the first step.
Developing an exit strategy plan,
even if it is years away, should also
begin as soon as the appraisal is
completed.
A stockbroker will advise that
one should set a target sale price
the day one acquires a stock. Similarly, the exit strategy is part of

the potential financial reward of
practicing.
Good business sense dictates
the plan should really have been
started when the practice was first
acquired.
Part of a transition plan started
early in one’s career will allow for
inclusion of a well-funded pension
plan and less reliance upon practice sale proceeds for retirement
needs.
The timetable for the actual
implementation of the plan will be
dependent upon the personal wishes, needs and financial resources of
the dentist.
Metro areas are seeing a common market time of one to two
years from listing to sale. Rural
area practices face three to five
years if they can be transitioned
at all.
The length of time required for
location of a prospect and transitioning of the practice requires that
the practice opportunity be listed at
the earliest time that the dentist is
willing to complete the transition.
If the seller is fortunate enough
to immediately locate a buyer after
listing, the dentist needs to be ready
to act.
At the time of listing, the dentist
must also realize that he/she may
continue to own the practice for a
long time.

An alternative
For dentists considering retirement, many have a difficult time
starting the process because of the
emotional attachment to their practice.
These dentists, unless or until
they find something else they would
rather do than practice dentistry,
will be unable to activate their transition plan.
If the practice of dentistry is their
only interest, their hobby and the
center of their later life, there is no
law stating that they must transition their practice.
For these dentists, their transition plan is to practice until they
can no longer do so. Their plan may
be as simple as one day closing the
doors and retiring. 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.

[11] =>

Dental Tribune | March 2010

Oral Pathology 11A

Diagnose this …
Identify the swellings
By Drs. Anil Ghom
and Anuja Holani, India

A 58-year-old male complains of multiple lobulated reddish to bluish swellings over the tongue and
lower lip for the last two
years.
No associated pain or
paresthesia, no history
of discharge and no history of trauma except for
the discomfort caused by
lobulated masses. The
patient has an unremarkable medical history; no
known allergies; and is not
taking any medications.

Extra-oral examination

Lobulated masses of deep
reddish to bluish lesions
seen over lower lip.

Intra-oral examination

Lobulated masses of deep
reddish to bluish lesions
seen over lower lip and
tongue region. The lesions
are soft in consistency and
have a smooth surface.

Questions
1) The clinical differential
diagnosis may include:
a) Hemangioma
b) HIV-related lesion
c) Lymphanangioma
d) Drug allergy
e) Multiple mucosal
neuromas
2) Which of the following diagnostic tests may be
useful (circle all that apply)?
a) Pressure test
b) Serology
c) Biopsy

Turn to page 12A
for the answers

Do you have an interesting
oral pathology case you’d like
to share with Dental Tribune
readers?
If so, please contact Group
Editor Robin Goodman at
r.goodman@dental-tribune.
com.

Welcome to a new topic area among the pages of
Dental Tribune!
The thanks for this new topic area go to a number
of oral pathologists who seek to expand their role in
the dental community by writing for Dental Tribune.
These authors will provide us with selected case
studies to help educate our readers about the various oral pathology situations they might encounter
in daily practice.
We hope you enjoy this new topic area and welcome your feedback at feedback@dental-tribune.com.
In addition, if you would like to submit a pathology case for publication, please contact r.goodman@
dental-tribune.com DT

[12] =>

12A Oral Pathology

Dental Tribune | March 2010

AD

Identify the swellings
1) The clinical differential diagnosis may include:
a) Hemangioma
b) HIV related lesion
c) Lymphanangioma
d) Drug allergy
e) Multiple mucosal neuromas

Answers
1) a
2) a

Going further…
The following tests were performed:
• Pressure test = positive
• ELISA test = negative
• Histopathology as shown below

3) The histopathological differential
diagnosis is which of the following?
a) Pyogenic granuloma
b) Capillary hemangioma
c) Hemangiopericytoma
d) Hemangioendothelioma
4) Are the following statements about
hemangioma true or false?
a) Pressure test positive
b) ELISA positive
c) Histopathology shows endothelial
proliferation
d) Histopathology shows chronic inflammatory cell infiltrate
e) Histopathology shows stag horn
pattern of vascular channels
5) All of the following statements are
true about hemangioma except:
a) A true neoplasm
b) Hamartoma
c) Common in darker-skinned individuals
d) Three times more common in
females
6) Are the following statements about
Hemangioma true or false?
a) Hemangiomas are present since
birth
b) Hemangiomas are more common

in the head and neck regions and
rare in the oral cavity
c) Hemangiomas can be seen centrally
d) Central hemangioma can have
sunburst appearance
7) Hemangioma is a feature of each of
the following syndromes except:
a) Struge-Weber syndrome
b) Rendu-Osler-Weber syndrome
c) Kasabach-Merritt syndrome
d) Gorlin-Goltz Syndrome

Discussion

Hemangioma is a hamartoma. It is
never seen at birth but develops within
the first year of life. It is more common
in the head and neck regions and rare
in the oral cavity. It is more common
in females.
Its occurrence is more frequent in
white-skinned individuals. It can be
seen centrally. Radiographically, central lesions can have a sunburst or
honeycomb pattern.
Histopathologically, it shows areas of
endothelial proliferation. Hemangioma
is associated with many syndromes
like Struge Weber, Rendu Osler Weber,
Kasabach–Merritt.
Treatment modalities includes injection of sclerosing agents, intralesional
injection of corticosteroids, flash lamp
pulsed dye laser and embolization.
Answers
3) b; 4) a) true, b) false c) true, d) false,
e) false; 5) c; 6) a) false, b) true, c) true,
d) true; 7) d

2) Which of following diagnostic
tests may be useful (circle all that apply)?
a) Pressure test
b) Serology
c) Biopsy

About the authors
Dr. Ghom has more than 12 years of
experience in the areas of teaching oral
medicine and radiology and conducting
scientific research. He has published
textbooks on oral medicine, oral radiology and oral pathology as well as a mini
atlas of oral medicine.
Ghom is also the editor in chief of the
Journal of the Indian Acadamy of Oral
Medicine and Radiology.
Dr. Anil Ghom, professor and department head, Oral Medicine and Radiology, CDCRI, Rajnandgaon, Chhattisgarh,
India
E-mail: dranil.ghom@gmail.com
Dr. Anuja Holani, professor, Deparment of Oral Pathology, M.I.D.S.R. Dental College, Latur, Maharastra, India

[13] =>

[14] =>

14A Clinical

Dental Tribune | March 2010

Class II challenge
Clinical solutions to common problems when placing Class II direct composites
By Robert Lowe, DDS, FAGD, FICD, FADI,
FACD

the recurrence is usually self-limiting. This is not true with metallic restorations that are not bonded
to tooth structure. However, if the
defective area is at the proximal gingival margin or line angle, access is
not possible.
Therefore, precise marginal adaptation of the direct composite restorative material and the seal of this
margin in the absence of moisture
or sulcular fluid contamination is of
paramount importance.
However, whether due to the subgingival level of decay and/or gingival inflammation, it can be difficult
to seal the gingival margin with a
matrix in the presence of blood.

Direct composite restorations that
involve posterior proximal surfaces
are still a common finding in many
dental patients.
Unlike dental amalgam, which
can be a very forgiving material technically and can be condensed against
a matrix band to create a proximal
contact, proper placement of composite restorative materials presents
a unique set of challenges for the
operative dentist.
The adhesion process itself is well
understood by most clinicians as far
as isolation and execution, however,
there are some steps in the placement process that cause difficulty
and ultimately lead to a less than
desirable end result.
In this article we will look at
three specific areas: management of
the soft tissue in the interproximal
region; creation of proximal contour
and contact; finishing and polishing
of the restoration.

Fig. 1: This occlusal preoperative
view shows a maxillary molar
that has radiographic decay on the
mesio-proximal surface.

Fig. 2: After the cavity preparation
is completed, bleeding is seen in the
proximal area.

Fig. 3: Expa-syl (Kerr) is placed into
the proximal area with the delivery
syringe then tapped to place using a
dry cotton pellet.

Fig. 4: After rinsing away the majority of the Expa-syl (note that a
small amount of Expa-syl remains
sub-marginal for additional hemorrhage control), the proximal tissue
is deflected away and bleeding is
absent, allowing for easy placement
of the sectional matrix band.

Proximal contact and contour
Another challenge for the dentist has
always been to re-create contact to
the adjacent tooth and, at the same
time, restore proper interproximal
anatomic form given the limitations
of conventional matrix systems.
The thickness of the matrix band
and the ability to compress the periodontal ligaments of the tooth being
restored and the one adjacent to it
can sometimes make the restoration
of proximal tooth contact arduous at
best.
Anatomically, the posterior proximal surface is convex occlusally and
concave gingivally. The proximal
contact is elliptical in the buccolingual direction and located approximately one millimeter apical to the
height of the marginal ridge.
As the surface of the tooth progresses gingivally from the contact
point toward the cemento-enamel
junction, a concavity exists that houses the interdental papilla.
Conventional matrix systems are

Management of the interproximal
gingival tissue

made of thin, flat metallic strips that
are placed circumferentially around
The most common area for the adhethe tooth to be restored and affixed
sion process to fail is the proximal
with some sort of retaining device.
gingival margin. Compounding this
While contact with the adjacent
problem is the inability to gain access
tooth can be made with a circumferto the area to effect a repair without
ential matrix band, it is practically
removal of the entire restoration.
impossible to re-create the natural
As stated by Dr. Ron Jackson,
convex/concave anatomy of the posbonded restorations are unique in
terior proximal surface because of
that minor defects (decay or microlethe inherent limitations of these sysakage) at the marginal interface can
tems.
often be “renewed,” or repaired by
Attempts to “shape” or “burnish”
removal of the affected tooth strucmatrix bands with elliptical instruture and repaired with additional
mentation may help create nonanacomposite restorative material.
tomic contact, but only “distorts” or
Because of the bond of the restor“indents” the band and does not reative material to enamel and dentin,
create complete natural interproxiAnzeige METAL-BITE USA 2009/10:METAL-BITE 2009/10 01.11.2009 22:31 Uhr Seite 1
mal contours.
Without the support of tooth conAD
tour, the interdental papilla may not
completely fill the gingival embraUniversal and scanable
sure, leading to potential food traps
registration material,
and areas for excess plaque accuthat’s it!
mulation. Direct Class II composite
restorations can present even more
of a challenge to place for the dentist because of the inability of resin
materials to be compressed against
a matrix to the same degree as amalgam, making it difficult to create a
proximal contact.
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Direct composite material does not
carve like amalgam, although many
clinicians wish that it did! Unfortunately, this means that most posterior
composites are carved with a bur.
This is not part of the finishing and
polishing of the restoration. It must
be remembered that cuspal forms

are convex and cannot be carved
with a convex rotary instrument that
imparts a concave surface to the
restorative material.
Composite should be incrementally placed and sculpted to proper
occlusal form prior to light curing.
The finishing and polishing process
is done to accomplish precise marginal adaptation and make minor
occlusal adjustments.
Rubber abrasives further refine
the surface of the composite, and
surface sealants are used to gain
additional marginal seal beyond the
limitations of our instrumentation.

Case report
The patient shown in Figure 1 presented with radiographic decay on
the mesial proximal surface of tooth
No. 3. The operative area is isolated
using an OptiDam (Kerr Hawe). The
decay is minimal, so the operative
plan is to keep the preparation very
conservative.
After removal of the decay and
completion of the proximal and
occlusal cavity form, the operative
area is isolated with a rubber dam in
preparation for the restorative process. Figure 2 clearly shows that the
proximal gingival tissue was abraded
during cavity preparation and there
is evidence of hemorrhage.
It is not advisable to try and “wash”
the hemorrhage away with water and
quickly apply the matrix band.
Even if this is successful, it is

[15] =>

Clinical 15A

Dental Tribune | March 2010

Fig. 5: A sectional matrix band
gripped by Composi-Tight Matrix
Forceps, an instrument that enables
precise placement of ectional matrix
bands without deformation.
likely that blood will infiltrate into
the preparation in the gingival area
and make etching and placement of
the dentin bonding adhesive without
contamination impossible.
An excellent way to manage the
proximal tissue hemorrhage quickly
and completely is to apply Expa-syl
(Ker) to the area, tap it to place with a
dry cotton pellet, and wait one to two
minutes (Fig. 3).
Using an air-water mixture, rinse
away the Expa-syl leaving a little bit
of the material on top of the tissue,
but below the gingival margin of the
preparation (Fig. 4).
The Expa-syl will deflect the tissue
away from the preparation margin,
maintain control of any hemorrhage
and facilitate placement of the proximal matrix without the risk of contamination of the operative field.
Class II preparations that need
a matrix band for restoration will
require rebuilding of the marginal
ridge, proximal contact and often a
large portion of the interproximal
surface.
The goal of composite placement
is to do so in such a way that the
amount of rotary instrumentation for
contouring and finishing is limited.
This is especially true for the interproximal surface.
Because of the constraints of clinical access to the proximal area, it is
extremely difficult to sculpt and correctly contour this surface of the restoration. Proper reconstitution of this
surface is largely due to the shape of
the matrix band and the accuracy of
its placement.
After removal of caries and old
restorative material, the outline form
of the cavity preparation is assessed.
If any portion of the proximal contact
remains, it does not necessarily need
to be removed. Conserve as much
healthy, unaffected tooth structure
as possible.
If the matrix band cannot be easily positioned through the remaining
contact, the contact can be lightened
using a Fine Diamond Strip (DS25F,
Komet USA). The Composi-Tight
3D™ Matrix System was chosen to
aid in the anatomic restoration of the
mesial proximal tooth morphology of
this maxillary first molar.
The appropriate matrix band
chosen is one that will best correspond anatomically to the tooth being
restored, and also to the width and
height of the proximal surface.
The height of the sectional matrix
should be no higher than the adja-

Fig. 6: The WedgeWand during clinical application with the wedge bent
at a 90-degree angle to the handle.
cent marginal ridge when properly
placed. Because of the concave anatomic shape, the proximal contact
will be located approximately one
millimeter apical to the height of the
marginal ridge.

Fig. 6a: WedgeWands provide an
excellent seal.

Fig 7: The Soft Face 3D-Ring in
place. Note the precision of the cavosurface and marginal seal by the
sectional matrix.

The Composi-Tight Matrix Forceps are used to place the selected
sectional matrix band in the correct
orientation in the proximal area.
The positive grip of this instrument will allow for more exact place-

ment than a cotton plier, which could
damage or crimp the matrix band.
The sectional matrix band (Garrison Dental Solutions) is positioned
g DT page 16A

[16] =>

16A Clinical

Fig. 8: The composite restoration

is completed prior to removal of
the matrix band. Placement of
the matrix precisely reconstructs
the proximal tooth form.
f DT page 15A

and placed using the Composi-Tight
Matrix Forceps to the mesial proximal area of tooth No. 14 (Fig. 5).

Dental Tribune | March 2010

Fig. 8a: The restoration immedi-

Fig. 9: The pointed Q-Finisher carbide finishing bur is used to make
minor occlusal adjustments and
refine the restorative margins.

Fig. 10: The ulta-fine pointed composite finishing bur is used to further
refine and finish the restoration’s
adjusted areas.

The orientation of the band and
the positive fit make precise placement possible, even in posterior
areas with tight access.
Next, the gingival portion of the
band is stabilized and sealed against

the cavosurface margin of the preparation using the appropriate size.

ible wedge should be wide enough
to hold the gingival portion of the
matrix band sealed against the cavosurface of the preparation, while the
opposite side of the wedge sits firmly
against the adjacent tooth surface.
To place the wedge, the Wedge
Wand is bent to 90 degrees where
the wedge meets the handle.
The flexible wedge can now be
placed with pressure conveniently,
without the use of cotton forceps,
that often can be very clumsy. Once
the wedge is in the correct orientation, a twist of the wand releases the
wedge.
The G-Ring® forceps are then
used to place the Soft Face™ 3D
Ring into position. The feet of the
Soft Face 3D Ring are placed on
either side of the flexible wedge and
the ring is released from the forceps.
The force of the 3D Ring causes a
slight separation of the teeth due to
periodontal ligament compression.
The unique pads of the Soft Face 3D
ring hug the proximal morphology
of the buccal and lingual surfaces
of the adjacent teeth, while at the
same time creating an unbelievably
precise adaptation of the sectional
matrix to the tooth cavosurface margins (Fig. 7).
Once the sectional matrix is properly wedged and the Soft Face 3D
Ring is in place, the restorative process can be started.
A 15-second total-etch technique,
10 seconds on enamel margins and
five seconds on dentin surfaces, is
performed using a 37 percent phosphoric etch.
The etchant is then rinsed off
for a minimum of 15 to 20 seconds
to ensure complete removal. The
preparation is then air-dried and
treated with AcQuaSeal desensitiser
(AcQuaMed Technologies) to disinfect the cavity surface, create a
moist surface for bonding and begin
initial penetration of HEMA into the
dentinal tubules.
A fifth generation bonding agent
(Optibond Solo Plus, Kerr) is then
placed on all cavity surfaces. The
solvent is evaporated by spraying a
gentle stream of air across the surface of the preparation. The adhesive is then light cured for 20 seconds.
The first layer of composite is
placed using a flowable composite
(Revolution 2, Kerr) to a thickness of
about 0.5 mm.
The flowable composite will
“flow” into all the irregular areas
of the preparation and create an
oxygen-inhibited layer to bond sub-

ately after matrix removal.

WedgeWand flexible wedge (Fig.
6)
The size of the WedgeWand® flex-

[17] =>

Dental Tribune | March 2010

Hinman Meeting Preview 17A

f DT page 2A

Fig. 11: A fine-pointed diamond composite polisher smoothes adjusted
areas during polishing.

Fig. 12: An occlusal view of the
direct MO composite restoration
after application of Seal-n-Shine
sealant.

sequent layers of microhybrid material.
After light curing for 20 seconds,
the next step is to layer in the microhybrid material.
First, using a unidose delivery, the
first increment of microhybrid composite (Premise, Kerr) is placed into
the proximal box of the preparation.
A smooth-ended condensing
instrument is used to adapt the
restorative material to the inside of
the sectional matrix and preparation.
This first increment should be
no more than 2 mm thick. After
light curing the first increment, the
next increment should extend to the
apical portion of the interproximal
contact and extend across the pulpal
floor.
Facial and lingual increments are
placed and sculpted using a Goldstein Flexithin Mini 4 (Hu-Friedy).
A #2 Keystone brush (Patterson
Dental) is lightly dipped in resin and
used to feather the material toward
the margins and smooth the surface
of the composite.
Figure 8 shows the restoration
after completion of the enamel layer
prior to matrix band removal.
The Composi-Tight Matrix Forceps were used to remove the sectional matrix after removal of the
flexible wedge and Soft Face 3D
Ring.
The Composi-Tight™ 3D Ring
reduces flash to a minimum. Finishing and polishing were accomplished using Q-Finisher Carbide
Finishing Burs (Komet USA).
Typically, three grits and, correspondingly, three different burs
are used to finish composite materials. With the Q-Finisher system,
the blue-yellow striped bur with its
unique blade configuration does the
work of two burs with one.
An excellent surface quality
on composite and natural tooth is
achieved due to the cross-cut design
of the cutting instrument.
The small, pointed (H134Q014) Q-Finisher was used to make
minor occlusal adjustments on the
restorative surface as needed and
to smooth and refine the marginal areas of the restorative material
where accessible (Fig. 9).
The fine, white stripe ultra-fine
finishing bur (H134UF-014) was used
in the adjusted areas for precise fine
finishing (Fig. 10). Komet Diamond
Composite polishing points (green,
polishing; and gray, high shine)
were then used to polish and refine
the restorative surface (Fig. 11).

Once polishing is complete, the
final step is to place a surface sealant (Seal and Shine, Pulpdent) to
seal and protect any microscopic
imperfections at the restorative
marginal interface that may be left
as a result of our inability to access
these areas on the micron level.
Remember, an explorer can “feel”
a 30-micron marginal gap at best.
Bacteria are 1 micron in diameter.
The purpose of the Seal and Shine is
to fill these areas. Figure 12 shows
an occlusal view of the completed
Class II composite restoration.

Conclusion
A technique has been described:
1) to control proximal tissue
bleeding prior to matrix placement
with Expa-syl (Kerr),
2) utilize a sectional matrix system (Composi-Tight 3-D, WedgeWand, Garrison Dental Solutions)
and a nanofilled microhybrid composite (Premise, Kerr) to create an
anatomically precise proximal surface, and
3) use the Q-Finisher, two-bur
composite finishing system (Komet
USA) to finish then polish with diamond composite abrasives (Komet
USA), refining marginal integrity
without destroying occlusal anatomic form.
The interproximal surface has
been re-created with natural anatomic contour and has a predictable,
elliptical contact with the adjacent
tooth.
With proper occlusal and proximal form, this “invisible” direct
composite restoration will service the patient for many years to
come. DT

About the author
Robert
A.
Lowe,
DDS,
FAGD, FICD,
FADI, FACD,
maintains
a
private practice in Charlotte, N.C.
A diplomate
of the American
Board
of Aesthetic Dentistry, Lowe
lectures internationally and is
chairman of Advanstar Dental Media’s continuing education advisory board. He can be
reached at (704) 364-4711 or at
boblowedds@aol.com.

Hinman
offers new
highlights
The 98th Thomas P. Hinman Dental Meeting will take place March
25–27 in Atlanta. According to organizers, the 2010 meeting is where
excellence will abound.
In fact, the Hinman meeting is
known for its world-renowned reputation of excellence — bringing
together the highest quality programming from the foremost authorities in
the field of dentistry.
Some of the highlights at Hinman
2010 include the following:
• More than 60 leading experts in
the field of dentistry will offer presentations.
• More than 25 percent of courses
offer the opportunity for hands-on
participation.
• New, all-day educational tracks
will be offered for dental hygienists,
assistants and business office personnel.
• Also new this year is Art in the
Hall. Hinman and The Foundation
for Hospital Art will combine forces
to create murals for medical facilities
in need. Meeting attendees can stop
by and paint for a few minutes or stay
until a mural is finished.
• Two hours on Saturday will be
dedicated exhibit hall time, with no
education held during this period.
• The exhibit hall will offer courses for assistants and dentists, interactive artwork and the return of the
popular Hinman Eatery.
The meeting also offers plenty of
networking opportunities and social
events.

Educational opportunities
This year, Hinman has designed special, full-day courses for each team
member. A “Prevention Convention”
for hygienists will be held on Thursday, a “Business Office Bonanza” and
an “Assisting Extravaganza” will be

held on Friday.
These special courses are offered
so that each team member can get
a variety of information on different
topics from six of the most respected
lecturers in their specific areas of
expertise.
In addition, there are separate
speaker “tracks,” highlighting all the
speakers who might be of interest to
hygienists, business office staff and
assistants.
Each lecture is 50 minutes with
a mid-day break for lunch and to
visit the exhibit hall. These unique
courses are offered at a special fee of
$75 for the full day.
A variety of lunch options are
available at the Hinman Eatery in
the exhibit hall.
This year’s keynote session not
only presents an esteemed roster of
expert speakers, but also features
one of Hinman’s more unique keynote speakers in recent history.
Frank W. Abagnale is one of the
world’s most respected authorities
on the subjects of forgery, embezzlement and securities documents. His
name might sound familiar.
The movie Catch Me If You Can,
starring Leonardo DiCaprio and Tom
Hanks, was based on his life and
book.
g DT page 18A

[18] =>

18A Hinman Meeting Preview

f DT page 17A
In addition, a dentist reception
will be held on Saturday night and an
auxiliary reception on Friday night.
With live music and buffets filled
with the most appetizing foods,

attendees will get to spend time
catching up with friends and colleagues and dancing into the wee
hours of the night.

Technical exhibits
Hinman’s 90,000-square-foot exhibit

Dental Tribune | March 2010
hall will feature the leading dental industry companies, sharing the
latest products and services in the
dental field.
The hall will not only feature
nearly 400 leading industry companies, but will again include the
Hinman Eatery, where attendees can
take a break and grab something to
eat and drink without having to leave
the convention center and search for
other options.
In addition, Hinman has heard
many attendees say that they want
more time in the exhibit hall that
doesn’t conflict with the course
schedule.
On Saturday, there will be two
hours of dedicated time in the exhibit
hall when attendees don’t have to
worry about missing a course and

can devote more time to visiting their
favorite booths.
The exhibit hall floor will be
open on Thursday from 10 a.m. to
6 p.m.; Friday from 9 a.m to 6 p.m.;
and Saturday from 9 a.m. to 4:30
p.m.
Meeting attendees can start their
exhibit hall visits with complimentary morning and afternoon snacks
each day. Snacks and drinks will be
available in the rear seating areas
while supplies last.
In the afternoon each day, cocktail
bars will be open for attendees to
purchase drinks.
The exhibit hall will also offer the
following:
• C.E. opportunities: Meeting
attendees can sign up and receive
C.E. credit for attending courses
offered by the American Dental
Assistants’ Association. (These courses are limited attendance.)
• Cyber café & C.E. printing station: Attendees can search for exhibitor products, check e-mail, access
the Internet and print out C.E. certificates.
• Daily prize drawing: Attendees
can register to win a $500 American
Express gift certificate by dropping
the appropriate prize ticket in the
Exhibit Hall tumbler.
• Free food: Each day, complimentary morning and afternoon snacks
will be available in the rear seating
areas while supplies last.
• Hinman Dining Dollars: Attendees can redeem Hinman Dining Dollars for special values with food vendors in the Hinman Eatery and those
located throughout the exhibit hall.
• Hinman Eatery: A central location offers food available for purchase and free wireless Internet
access.
• Hinman table clinics: Attendees
can earn one hour of C.E. credit by
attending six table clinics.
• Show specials: Some exhibitors
will offer show specials, offered only
to 2010 Hinman attendees.

Atlanta attractions
For those who are looking for something to do after attending courses
and visiting the exhibit hall, Atlanta
is considered one of the most exciting cities in the country.
There are plenty of places to eat,
shop and visit, including the following:
• Atlanta Botanical Gardens
• Atlanta History Center
• Braves Museum & Turner Field
• Fernbank Museum of Natural
History
• High Museum of Art
• Jimmy Carter Library & Museum
• Margaret Mitchell House
• Martin Luther King Jr. National
Historic Site & Sweet Auburn District
• Piedmont Park
• The Children’s Museum of Atlanta
• The Fox Theatre
• Underground Atlanta
• Woodruff Arts Center
• Zoo Atlanta
More information on the Hinman
meeting is available online at www.
hinman.org. DT

[19] =>

Dental Tribune | March 2010

Online C.E. 19A

Want to update your
knowledge of implants?

f DT page 2A

Can’t make it to Heidelberg, Germany, for the eigth annual “Update
Implanntology” at the Steigmann
Institute? Not to worry!
You can still catch the high-quality implant program, covering the
most current topics in implantology.
This meeting is geared toward new
implantologists who want to update
their knowledge of implants.
The program features a panel of
reknowned international speakers,
who will share their recent findings
and methods about surgery and prosthetics.
The FIZ Heidelberg e.V. and young
implantologists developed this program to specifically provide an overall
perspective on the new developments
in implant dentistry.
Collaborating with different societies, a neutral view on established
therapeutical methods and updated
treatment aspects are offered.
Participants will learn tips and
tricks to use immediately in their
daily practice. The workshops and the
pre-congress will provide a deeper
insight on methods to improve everyday skills.
Take advange of DT Study Club’s
online version of this event in the
course Update Implantology VIII. The
program begins at 7:20 a.m. EST,
Friday, March 26, and at 3 a.m. on
Saturday March 27.
If you sign up for the live event,
you will also have 30-day access to
the recorded archive of each lecture
(which means you can sleep in on
Saturday and watch the courses you
missed at another time).
The online course fee is $265,
which is a 50 percent discount from
the regular course fee.
All congress lectures will be simultaneously translated into English from
German.

Friday, March 26

• 12:35–1:05 p.m. EST
Dr. Claas Ole Schmitt,
Oppenheim
Upgrade your implantology: computer-based strategy, implantation and CAD/
CAM
• 1:05–1:20 p.m. EST
Discussion

Saturday, March 27

• 3–3:30 a.m. EST
Dr. Marcus Parschau,
Buchholz
Integration of implantology in young practical
experience
4–4:45 a.m. EST
Dr.
Phillipe
Russe,
France
One–piece
implants:
myths and facts
• 8:15–8:45 a.m. EST
Dr. Jörg Schmoll, ZTM
Wolfgang Bollack
The team approach; surgical,
dental technic implementation of
complex implant treatment, 3-D
planning, template technique, surgery, prosthetic-strategic proceeding, decision of fixed or removable dentures

• 7:20–7:50 a.m. EST
Dr. Frank Kistler, Landsberg
Socket preservation as an
alternative to immediate implant
placement

• 8:45–9:15 a.m. EST
Dr. Claudio Cacaci, Munich
The role of provisional arrangement for long-term implant success

• 7:50–8:20 a.m. EST
Dr. Thomas Hanser, Olsberg
Hard- and soft-tissue management with predictable results:
guidelines to esthetical and functional implant success

• 9:15–9:45 a.m. EST
Dr. Ernst Fuchs-Schaller, Zug
Preservation and reconstruction of the bioactive container

• 8:20–8:50 a.m. EST
Dr. Jordi Gargallo-Albiol, Barcelona
Immediate loading: Where are
the limits?
• 8:50–9:05 a.m. EST
Discussion

• 9:45–10:15 a.m. EST
Dr. Túlio Valcanaia, Brazil
Vertical bone growth, bone
graft and distraction osteogenesis
• 10:15–10:45 a.m. EST
Dr. Marius Steigmann, Neckargemünd
Incision, cloth and seam —
adapted for esthetical implantology

• 10:45 a.m. EST
Discussion and end of convention

For additional information,
please visit www.dtstudyclub.
com. DT
AD

[20] =>

20A Giving Back

Dental Tribune | March 2010

Evolution of the toothfairy
By Ken Munkens and Kristin Kenyon

ADS

Remember when you were little
and you lost a baby tooth? The tooth-

fairy was very real to you then, an
airy apparition who visited you overnight and left something wonderful
under your pillow.
Some people believe they’ve outgrown the toothfairy, that she has
become obsolete.
Not so fast: the toothfairy has
evolved into someone we can all
believe in.
Today’s toothfairy has transitioned from simply rewarding children for their lost teeth to a very
important role of helping children
retain their permanent teeth, have
beautiful smiles and enjoy healthier
lives.

This little mystical icon has
become a dedicated champion in the
fight against the No. 1 chronic childhood illness in our country: pediatric
dental disease.
Now a revolutionary Superhero
armed with a powerful message,
she is not just any toothfairy; she is
America’s toothfairy.
For many years caring dental
professionals, including pediatric
dentists, dental hygienists and other
health-care groups, have worked
tirelessly to bring dental treatment
and preventive therapies to underserved children.
Despite their efforts, however,
pediatric dental disease continues
to increase in America, causing pain
and suffering for millions of children.

Dental disease affects us all
Children with untreated dental disease may find it difficult to eat, sleep
and speak clearly, which affects
their ability to concentrate in school,
make friends and develop the social
skills necessary to be successful
adults.
It is a progressive disease, and
children’s suffering worsens as
they get older. They can experience chronic pain, and they can face
gum disease, broken or lost teeth,
abscesses, infections and even risk
of death.
Until recently there was little
emphasis on the connection between
the mouth and a person’s overall
health. Studies are now widely available that link tooth decay to heart
disease, stroke, diabetes, pneumonia, poor pregnancy outcomes, secondary infections and dementia. But
that is only part of the inherent risk.
There is also a logical progression
associated with this disease.
A child experiencing mouth pain
may have difficulty eating a balanced diet with foods such as vegetables and grains, which are notoriously harder to chew.
Additionally, a child suffering
from pediatric dental disease is
often not able to chew properly or
long enough to promote good digestion, resulting in the loss of valuable
nutrients.
Malnutrition because of dental
complications ultimately leads to
poor growth development, weakened bones and muscles, allergies,
inability to concentrate, emotional
problems and other systemic health
ailments not immediately recognized as being linked to tooth decay.
According to the U.S. Department
of Health and Human Services, more
than 51 million school hours and 164
million hours of work are lost each
year due to dental related absences.
The number of Americans without dental insurance is almost three
times the number of those lacking
medical coverage, and uninsured
g DT page 22A

[21] =>

[22] =>

22A Giving Back

Dental Tribune | March 2010

f DT page 20A
children are two and a half times
less likely than insured children to
receive dental care. When these
neglected mouths finally demand
attention it is often through emergency room treatment, costing taxpayers millions of dollars each year
for a disease that is largely preventable.
Information released by the Coalition on Oral Health Care estimates
that for every $1 spent on oral health
preventive measures, as much as
$50 is saved in emergency and
restorative treatment expenditures.
Overall higher health-care costs
and insurance premiums, lower productivity levels of the workforce and
even costs related to an elevated
crime rate are a price we all pay
when children with dental pain go
untreated.
It’s easy to see the need for a
certain kind of magic to fight pediatric dental disease. Fortunately, the
toothfairy has evolved into America’s
toothfairy and she is coming to the
rescue.

America’s toothfairy: delivering
hope
The National Children’s Oral Health
Foundation is America’s toothfairy,
a non-profit organization solely
AD

focused on eliminating America’s
most common chronic childhood illness — pediatric dental disease —
through comprehensive treatment
and preventive and educational initiatives.
America’s toothfairy (www.
americastoothfairy.org) serves as a
national resource for health-care
professionals and individuals alike,
whether they are currently working
to combat this devastating and preventable disease or looking to join
the fight.
The organization raises public
awareness of pediatric dental disease and the lifelong health complications associated with it, while
supporting an affiliate network of
non-profit oral health programs pro-

viding comprehensive care to underserved children across America.
In less than four years, America’s
toothfairy has delivered more than
$6 million in valuable product contributions and direct funding to affiliate partners, touching the lives of
more than 1 million children nationwide! Because generous corporate
underwriters cover all operational
expenses, every additional dollar
contributed to America’s toothfairy
is allocated to programs giving children a healthier future.
The toothfairy has long been a
symbol of the magic of childhood, a
mystical figure only materializing as
a child lay peacefully asleep, dreaming of the gifts to be found under his
or her pillow the next morning.

Over 4 million children in America are suffering right now from
oral pain so severe it keeps them
up at night. For those children,
and for anyone concerned with the
healthy growth and development of
our nation’s most valuable resource,
National Children’s Oral Health
Foundation has created America’s
toothfairy.
She is a symbol of change: an
educator, preventer, protector and,
perhaps most importantly, a source
of hope for children everywhere.
Is America’s toothfairy real? She
is as real as we make her.
For more information or to make
a contribution, call (704) 350-1600
or visit www.americastoothfairy.
org. DT

[23] =>

[24] =>

24A Industry News

Dental Tribune | March 2010
Hinman
BOOT
HN
O.

Blackline: LED carbon-fiber handpiece
The new line of Bien Air highspeed handpieces combines avantgarde technology with exceptional
ergonomics. Utilized in aerospace,
sailing and competitive sports,
carbon fiber is the latest advancement in the dental industry.
Ten times the strength of steel,
carbon fiber is extremely lightweight and offers improved resistance to wear, friction, torsion and
impacts, making the material an
easy choice for any dental practice.
The new Blackline series also

encompasses innovative LED
lighting. LED has a service life
that is 10 times longer than that of
a traditional light bulb, dramatically improving the visibility of the
operative field while leaving virtually no shadow area.
Coupled with the market’s only
air-cushioned swivel, these handpieces provide unmatched maneuverability, free from drag caused
by the tubing.
This series of handpieces comprises the Bora turbine, characterized by its extraordinary power,

and the Prestige turbine, fitted
with one of the smallest heads
available on the market.
In addition to the lightweight
carbon fiber core and luminous
LED light, Bien Air’s Swiss-made
Blackline handpieces utilize dualoptic glass rods, triple-separated
air and water spray for perfectly

balanced cooling, long-lasting
ceramic ball bearings, an anti-heat
push button and a vibration-free
chuck assembly.
Help alleviate issues caused by
other handpieces by upgrading
your office to the Bien Air Blackline series, a part of a Swiss tradition of excellence. DT

Programat
500 ceramic
furnace
Hinman
BOOT

172

Ivoclar Vivadent introduced the new power-saving, second-generation Programat 500 ceramic furnace
at the Chicago Midwinter
Meeting.
The furnace’s new powersaving technology is said to
reduce power consumption
in the stand-by mode by 40
percent.
Additional features include:
• a new program structure that offers 120 Ivoclar
Vivadent programs and 500
individual programs;
• a color touch-screen
with modern user interface
and color graphic display;
• Thermo Shock Protection to prevent thermal
shock of the ceramic if the
furnace head is closed while
it is too hot;
• Cooling Shock Protection to prevent tension within the ceramic with a special
furnace head opening process.
For more information, call
(800) 533-6825 or visit www.
ivoclarvivadent.com. DT

913

[25] =>

[26] =>

[27] =>

Dental Tribune | March 2010

Industry News 27A

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, purple and
green.
This toothbrush has a com-

fortable, 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

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) 5586684 or visit www.plaksmacker.
com. DT

15
O.

BOOT
Hinman

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
fourth through seventh generation
bonding agents, ensuring compatibility with your preferred bonding
agent.
The Build-It Light Cure addition to Pentron Clinical’s awardwinning 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. DT

Hinman BOOTH NO. 1520

[28] =>

28A Industry News

Dental Tribune | March 2010

f DT page 2A

The adjacent tooth is innocent
Hinman

By Jan Johansson, DDS

Mate , to meet the urgent demands
for a modern, more efficient and
safer protection and matrix system.
FenderWedge is a stainless-steel
matrix plate to protect the tooth,
affixed to a soft plastic wedge, the
wedge that compacts the gingival
papilla. During preparation, the
wedge has a separating effect on the
teeth — “pre-wedging” — simplifying insertion of the matrix. FenderWedge is available in four sizes to
accommodate interdental spaces, XS,
S, M and L, and are color-coded for
identification.
FenderMate is a combined section
matrix and wedge that may be inserted buccally or lingually. The matrix
has a pre-contoured curvature to
adapt to the tooth and a pre-formed
contact point. It reduces the possible
risk of excess filling material remaining on surfaces, especially cervically,
under the contact point.
Thus, the contact is achieved
directly during application and the
whole process is simple, fast and
safe. FenderMate is available for left
or right application and has a regular
or narrow attached wedge. It is also
color-coded for ease of identification. FenderMate can accommodate
®

When composite was first introduced for Class II fillings, the most
common matrix technique used
was the same as that for amalgam,
a stainless-steel band wrapped
around the whole tooth in conjunction with a retainer. There
are many problems with this technique: attaining a good contact
point, the retaining ring dislocating
the position of the teeth, leakage
of material and cervical overhang.
Major studies have concluded
that during preparation for Class
II fillings, in more than 60 percent of cases the adjacent teeth
suffer damage unless adequately
protected.
The recent global focus on
minimally-invasive dentistry has
greatly increased interest on tissue
preservation. There has also been
a strong interest in being able to
prepare and complete Class II fillings with a both faster and safer
technique and method.
In 2004, the Swedish dental
manufacturing company Directa
AB developed both a preparation
protector, FenderWedge®, and a
sectional matrix system, Fender-

BOOT
H

NO. 1
2

Tight contact and tight cervical
margins with FenderMate.

around 60 percent of all Class II
cases. DT
Dr. Johansson has been a dentist
and private practitioner in Stockholm since 1968. He is a member
of the board of the Swedish Dental
Society and chairman of Dental
Vision, an independent group of 400
dentists working for dental clinical
development. Since January 2008,
he has been at Directa AB, as a consultant, advising on product development.

Botox/dermal filler injections
Botox and dermal filler injections have been recently introduced to the dental field and are
performed by a growing number
of dentists worldwide.
These injections were a major
education training course at the
2009 Greater New York Dental
Meeting. They will be included
in the education program of the
2010 AEEDC meeting in Dubai,
expanding worldwide awareness
of these procedures for dentistry.
Botox injections can be used
for dental treatments such as
TMD and implantology. Dermal
fillers can be used when dealing
with asymmetrical lips, minimizing underlining skeletal discrepancies and many other uses.
To administer Botox and derAD

mal filler injections, the mouth and
lip area need to be anesthetized. A
common method is to give an infraorbital nerve block injection. This
can be a painful injection if a device
such as VibraJect® is not used to
block the pain.
Dr. Louis Malcmacher, a leading
opinion leader in the United States
for Botox and dermal filler injections
for dentistry, has used VibraJect and
provided this endorsement: “Infraorbital and VibraJect is great for that
and any regular dental injections.”
For more information on VibraJect, visit the ITL DENTAL Web site
at www.itldental.com. DT
ITL DENTAL
31 Peters Canyon
Irvine, Calif. 92606

Tel.: (800) 277-0073,
(949) 223-8950
Fax: (949) 223-8960
E-mail: sales@itldental.com

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.

[29] =>

Dental Tribune | March 2010

Industry News 29A

World dental implant and bone
graft market to top $4.5b by 2012
By line

Global sales of dental implant systems — fast becoming the preferred
restoration for replacement of missing or extracted teeth or as supports
for dentures, crowns and bridges
— are expected to maintain doubledigit growth over the next five years,
soaring to more than $4.5 billion,
according to “Implant-Based Dental
Reconstruction: The Worldwide Dental Implant and Bone Graft Market,”
second Edition, a new study released
from Kalorama Information.
Sales of dental implants and abutments rose more than 15 percent in
2006 alone, reaching nearly $2 billion, led by Europe, where the popularity of implants saw sales peaking
at $760 million, or 42 percent of the

global market.
Advanced bone grafting and
regeneration techniques have radically expanded the possibilities for
implant-based restorative dentistry.
World sales of dental bone grafts
reached $130 million in 2006, up 12
percent over 2005. The report projects the use of bone grafts will more
than double by 2012 with revenues
reaching $266 million.
Grafting techniques are making
it possible to expand the candidate
pool for implants to include a sizable
population of edentulous patients
who were poor candidates for dental implantation due to severe bone
resorption.
“The most closely watched

research and development projects
in dental bone grafting today involve
bone morphogenic protein [BMP]
products. BMPs have the potential
to transform the bone grafting market and surpass all other products
on the market including synthetic
substitutes, allografts and demineralized bone matrices,” notes Anne
Anscomb, the report’s author.
“With the announcement in March
that the FDA approved Medtronic’s
InFuse Bone Graft for certain oral
maxillofacial and dental regenerative
bone grafting procedures, the future
of BMP and increased use of grafts
and implants looks very promising.”
Implant-Based Dental Reconstruction includes revenue forecasts for

each segment through 2016, global
market share for four geographic
regions, more than 35 tables and
figures with detailed market data,
reviews of new products and computer-aided dentistry and reimbursement trends.
It can be purchased directly from
Kalorama Information by visiting
www.kaloramainformation.com/
Implant-Based-Dental-1399457.
It is also available at MarketResearch.com. DT
CK Dental Industries
Tel.: (800) 675-2537
Fax: (800) 634-1788
www.ckdental.net

Dentist population could contract by 2012
Recent survey projects that retirement and career changes could outpace the number of dental graduates
If current trends continue, getting an appointment with a dentist
might become more challenging in
coming years. A recent survey by the
independent research firm The Long
Group, and sponsored by the not-forprofit Delta Dental Plans Association, found that the dentist population
could begin to contract as early as
2012.
Researchers looked at current
dentist retirement rates and at survey responses from dentists who
expressed a desire to make a career

change within the next five to 10
years and compared those numbers
with the current dental school graduation rate.
Projecting these trends into the
future, the study found that the 2009
dentist population of approximately
179,600 will increase through 2011
but retirement and career changes
could outpace dentist school graduation beginning in 2012.
By 2019, the dentist population
could be smaller by nearly 7,000,
assuming consistent dental school

graduates of 4,500 annually.
“As more people acquire dental
coverage through an employer, an
individual policy or through some
form of government-assisted program, it is crucial that dentists are
available to actually see and treat
them,” said Kim E. Volk, president
and CEO of Delta Dental Plans Association.
“With more than 132,000 dentists
participating in our network, we’re
interested in helping affect, not just
monitoring, these trends,” said Volk.

Groups such as Delta Dental and
others are having success attracting
dentists to underserved areas and
are providing prospective dentists
with some hope that they won’t leave
school with insurmountable debt.
According to the American Dental
Education Association, graduates of
dental school enter the workforce
with an average of $170,000 of debt.
Increasingly, a dentist who is willing
to practice in a federally designated
g DT page 30A
AD

Visit us at the Hinman Show Booth #1531

[30] =>

30A Industry News

Dental Tribune | March 2010

Grow your dental practice
f DT page 2A

Three ways to start doubling your growth right now, even if you’ve hit a plateau

By Jay Geier

make more money?

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
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.

Get the right training, skills and
resources you need to build your
business

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

f DT page 29A
dental health professional shortage
area can see $80,000 to $100,000 of
debt wiped away over three to five
years.
AD

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 subpar 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’ mind-set
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

Dr. Arron McWilliams practices in
rural Crawford County, Iowa, thanks
in large part to the Fulfilling Iowa’s
Need for Dentists (FIND) program,
funded jointly by Delta Dental of
Iowa and local business, govern-

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 Michigan — one of the hardest hit states during the recession.
If they can get new clients and
double their practices, so can you.
Yet, you have to adopt what
I call the “two-economy system”
mind-set 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.

ment, health and civic organizations.
With a population of just more than
7,000, the city of Denison might not
have been the first choice of a dentist
looking to establish a practice.
“If it was not for the FIND program, Dr. McWilliams would be
practicing in another community,”
said Don Luensmann, executive
director of the Chamber and Development Council of Crawford County.
A similar sentiment is expressed by
leaders in other rural parts of the
country.
“Our health-care providers play
a key role in our community’s economy,” said Jeffrey Johnson, branch
president of BankWest in Gregory, S.
D., a town with fewer than 2,000 people. “Delta Dental’s loan repayment
program is helping ensure that our
city’s one dental practice remains
open.”

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 says he 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.

“These types of programs are
proving to be a win-win-win,” said
Volk. They’re a win for the dentist
who needs to pay down debt, a win
for the local economy and a win for
the residents in need of care.”
Delta Dental member companies
currently support dentist school loan
repayment programs in Arkansas,
Iowa, South Dakota, Maine, New
Hampshire and Vermont. Delta Dental also invests millions of dollars
in dental education throughout the
country.
The not-for-profit Delta Dental
Plans Association (www.deltadental.
com) based in Oak Brook, Ill., is
a national network of independent
dental service corporations specializing in providing dental benefits
programs to 54 million Americans in
more than 89,000 employee groups
throughout the country. DT

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