DT U.S.

Georgia dentist says state will pay for general anesthesia / News / Free yourself from the daily ‘grind’ / Receivables at risk / Virtual dental implant planning: the next step / Expanded convention center for the PDC / Industry / COSMETIC TRIBUNE 3/2010 (part1) / COSMETIC TRIBUNE 3/2010 (part2)

Open PDF View E-paper Edit Epaper Edit Epaper ads save

Table of contents

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

March 2010

www.dental-tribune.com

IMPLANT TRIBUNE
The World’s Implant Newspaper · U.S. Edition

Facing a daily grind?

If practicing is a grind, there are steps you can
take to change this.
u page 4A

AO annual meeting

Catch a glimpse of the new technologies introu page 1B
duced at the AO in Orlando.

Vol. 5, No. 7

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

Reducing gummy smiles

Increasing the crown-to-gum ratio in order to
decrease gummy smilles.
upage 1C

Georgia dentist says state
will pay for general anesthesia
Severe anxiety, phobia, severe
gagging, life-threatening allergies
and the inability to use local anesthetics are among the myriad of
reasons that more than 100,000
Georgians are unable to receive the
dental care they need in a dentist’s
office, says Dr. David Kurtman of
Marietta, Ga.
For these people, Kurtzman
says, dentistry ranges from something nearly akin to torture to a lifethreatening experience — yet many
want and need care.
In 1999, to little fanfare, the state
senate of Georgia passed a law to

help these people. Because their
only alternative is to have their dental work done while they are truly
and fully asleep, Senate Bill 66 mandates medical insurance to pay the
additional costs of general anesthesia and hospital costs for these
people.
“Once the prohibitive costs of
being fully asleep in the hospital are
handled, a lot more of these people
can afford the dental care they really
need,” Kurtzman explained.
“No one really talks about this
law, certainly not the insurance
companies,” says Kurtzman, who

Dental implant planning

Did you know that:
• 40 percent of the western population is missing one tooth or
more?
• in the United States alone, approximately 10 percent of the population is completely edentulous?
• every year about two million Americans loose a tooth due to
sporting accidents?
g See page 10A

has been treating such cases for
more than 20 years.
He says he had worked for years
trying to get these costs paid. Even
when he got to speak with people
within the insurance companies he
called, nobody ever mentioned it.
Not until a chance call to the
insurance commissioners’ office in
Atlanta led Kurtzman to the obscure
bill did his office start getting more
and more coverage for patients.
The law states that medical insurance must pay hospital and anesthesia fees for any person for whom a
successful result cannot be expected

using local anesthesia.
“Because of physical, intellectual
or another compromising medical
condition” of the insured patient,
anyone who really needs it can now
expect coverage for sedation dentistry.
“We are seeing people who have
lived with pain and infection for literally years,” Kurtzman says.
Care under general anesthesia in
the hospital operating room gives
thousands of these people hope for
a healthy, painless and beautiful
smile, he says. DT
(Source: PRWeb)

Certified GreenDOC offices
The Eco-Dentistry Association
(EDA), an international association
promoting environmentally sound
practices in dentistry, recently
announced a new offering for dental professionals.
The EDA’s GreenDOC dental office certification program
is a green business certification
designed specifically for dentistry.
The program provides everything
dentists need to achieve their perfect shade of green.

Transcendentist in Berkeley,
Calif., Pure Dental in Dallas and
ORA Dental Studio in Chicago
became the organization’s first
recipients of GreenDOC certification.
The EDA announced the first
charter-certified offices at the
recent Midwinter Meeting in Chicago.
The GreenDOC Checklist of
g DT page 2A

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

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

[2] =>

News

Dental Tribune | March 2010

AGD testifies
on access to care

(Photo/© Photoaged, Dreamstime.com)
David F. Halpern, DMD, FAGD,
president of the Academy of General
Dentistry (AGD), testified recently
during the open session of the Institute of Medicine’s (IOM) first meeting of the Committee on Oral Health
Access to Services in Washington,
D.C.
Halpern protested the IOM’s failure to include a single practicing
dentist on the committee roster.
“Over 90 percent of all practicing
dentists are in the private sector, and
over 80 percent of dentists are primary care providers. For this committee to lack representation from
the private sector totally deprives
the study of real-world input and
totally goes against the committee’s charge of reaching a balanced,
objective and credible conclusion,”
Halpern said.
Furthermore, Halpern expressed
concern that the committee’s framework would likely produce a onesided result of championing the use
of alternative or midlevel providers and neglecting commonsense
approaches that utilize the full dental team concept to address access to
care concerns.

“To those whose hands aren’t in
a patient’s mouth every day, alternative delivery models look good in
theory, but they are unlikely to be
able to answer the question of not
only whether they actually work
in practice, but if they are truly
also cost-effective, and not just costdelaying,” Halpern said.
The Committee on Oral Health
Access to Services is one of two
new IOM committees exploring oral
health policy under a contract from
the Health Resources and Services
Administration, an agency within
the U.S. Department of Health and
Human Services.
The second study committee, An
Oral Health Initiative, is scheduled
to hold its first meeting on March 31.
Halpern is scheduled to testify again
to protest the exclusion of practicing dentists on that committee and
to convey concern over the study’s
direction.
The AGD is a professional association of more than 35,000 general
dentists dedicated to staying up to
date in the profession through continuing education. DT
(Source: AGD)

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.
AD

f DT page 1A

DENTAL TRIBUNE
The World’s Dental Newspaper · US Edition

Standards for Green Dental Practice is the foundation of the GreenDOC program, providing comprehensive, eco-friendly initiatives in
eight implementation categories.
The GreenDOC Checklist is
available to EDA members on the
association’s Web site, located at
www.ecodentistry.org/GreenDOC.
The GreenDOC Product Guide
is a comprehensive dental industry
listing of products and services
that green dental offices need to go
green and stay green. The EDA has
sourced the products and services
that share a vision for clean, green
dentistry, making it easy for dental professionals to achieve earthfriendly initiatives.
Products and services appear
in one or more of the following
GreenDOC categories: sustainable
location; waste reduction; pollution
prevention; energy conservation;
water conservation; patient care,
workplace policies and community
contribution; leadership; and innovation.
Combined, the GreenDOC Product Guide and GreenDOC Checklist provide dentists with the first
key steps to greening their dental
practice.
“‘Where do I start and what
products do I use?’ These are the
two most common requests we
receive from dental professionals,”
said Susan Beck, director of the
Eco-Dentistry Association.
“Used together, the GreenDOC
Product Guide and Checklist make
the perfect going green starter kit
for dental professionals.”
Additional components of the
GreenDOC Program lead dental
practitioners through a rigorous
but attainable certification program. GreenDOC how-to guides,
action plans and worksheets make
it simple for dental professionals
to meet specific goals to achieve
bronze, silver or gold certification.
As a part of the program’s international launch, the EDA encourages dental offices to register to be
one of the first 100 certified offices
and become a charter-certified
office.
The EDA’s members are located
in 42 U.S. states and 11 countries.
The organization was co-founded
by Dr. Fred Pockrass, a dentist,
and his entrepreneur wife, Ina
Pockrass, who together created the
model for eco-friendly dentistry,
and operate their own award-winning dental practice in Berkeley,
Calif., recognized as the first in the
country to be certified as a green
business.
They formed the organization to
stimulate a movement in the dental
industry to employ environmentally sound practices, such as reducing waste and pollution; saving
energy, water and money; incorporating wellness-based methods and
incorporating the best technological advances in dentistry. DT
(Source: Eco-Dentistry Association)

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

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

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

[3] =>

News

Dental Tribune | March 2010

Plasma jets could
replace dentist’s drill
f DT page 2A
TK DT

Plasma jets capable of obliterating
tooth decay-causing bacteria could be
an effective and less painful alternative
to the dentist’s drill, according to a new
study published in the February issue
of the Journal of Medical Microbiology.
Firing low-temperature plasma
beams at dentin, the fibrous tooth
structure underneath the enamel coating, was found to reduce the amount
of dental bacteria by up to 10,000fold. The findings could mean plasma
technology is used to remove infected
tissue in tooth cavities, a practice that
conventionally involves drilling into
the tooth.
Scientists at the Leibniz-Institute of
Surface Modifications, in Leipzig, Germany, and dentists from the Saarland
University, Homburg, Germany, tested
the effectiveness of plasma against
common oral pathogens including
Streptococcus mutans and Lactobacillus casei. These bacteria form films on
the surface of teeth and are capable
of eroding tooth enamel and the dentin below it to cause cavities. If left
untreated this can lead to pain, tooth
loss and sometimes severe gum infections.
In this study, the researchers
infected dentin from extracted human
molars with four strains of bacteria
and then exposed it to plasma jets for
six, 12 or 18 seconds. The longer the
dentin was exposed to the plasma, the
greater the amount of bacteria that
were eliminated.
Plasmas are known as the fourth
state of matter after solids, liquids and
gases and have an increasing number
of technical and medical applications.
Plasmas are common everywhere in
the cosmos and are produced when
high-energy processes strip atoms of
one or more of their electrons. This
forms high-temperature reactive oxygen species that are capable of destroying microbes. These hot plasmas are
already used to disinfect surgical
instruments.
Dr. Stefan Rupf from Saarland University who led the research said that
the recent development of cold plasmas that have temperatures of around
40 degrees Celsius showed great
promise for use in dentistry.
“The low temperature means they
can kill the microbes while preserving
the tooth. The dental pulp at the center
of the tooth, underneath the dentin, is
linked to the blood supply and nerves,
and heat damage to it must be avoided
at all costs.”
Rupf said using plasma technology to disinfect tooth cavities would be
welcomed by patients as well as dentists. “Drilling is a very uncomfortable
and sometimes painful experience.
Cold plasma, in contrast, is a completely contact-free method that is highly

effective. Presently, there is huge progress being made in the field of plasma
medicine and a clinical treatment for
dental cavities can be expected within
three to five years.

Society for General Microbiology
The Journal of Medical Microbiology
provides high-quality comprehensive

coverage of medical, dental and veterinary microbiology and infectious
diseases. The original paper is available on request.
The Society for General Microbiology is the largest microbiology society
in Europe, and has more than 5,500
members worldwide. The society provides a common meeting ground for

scientists working in research and in
fields with applications in microbiology including medicine, veterinary
medicine, pharmaceuticals, industry,
agriculture, food, the environment and
education. DT
(Source: Society for General
Microbiology)

[4] =>

Practice Matters

Dental Tribune | March 2010

Free yourself from the daily ‘grind’
If you dread going into the practice each day, it’s time to re-evaluate your leadership role
By Sally McKenie, CEO

Are you settling for mediocrity?
Is your practice merely getting by?
Do you feel surrounded by complacency? Is there a lack of excitement
or enthusiasm?
Perhaps it’s not that the team
is outwardly negative or difficult,
it’s just that “average” has become
simply good enough in their minds.
New ideas seldom emerge
because they are shot down as
quickly as they surface. Issues
with systems are perpetually on
the backburner, kept there by the
proliferation of excuses explaining
why the changes won’t work, can’t
work or would simply be too much
work to fix.
So there you stand having lost
control of the practice you once
loved. It’s become the daily grind,
and it seems that you wile away the
hours at the mercy of those who
seemingly care to do nothing more
than simply get by.
As familiarity breeds contempt,
complacency breeds mediocrity. If
teams are not challenged to continuously improve, then when the
push is on to do things differently
the shift can be unnecessarily traumatic because the staff members
feel threatened and they resist any
ADS

change.
They’ve settled into their “way”
of doing things and don’t understand why what seems to have
worked perfectly fine in the past is
suddenly called into question.
Sounds like a major issue with
the team, right? Wrong. What we
have in circumstances such as this
is more likely to be a major issue
with the leadership. The team mirrors the leadership of the practice.

Take off the rose-colored glasses
Look carefully at your team. Do
they reflect your commitment
to excellence? Are they open to
change? Are you willing to challenge them to make changes? And
are you willing to invest the time
to educate them on why change is
necessary?
Or, do you shun better, more
efficient systems and procedures
because “Mary Jane” has been
there since the beginning of time
and you decided long ago that it’s
not worth it to challenge her negative attitude and poor performance?
You rationalize your fear of
addressing the problem by telling
yourself that she handles all the
insurance, or she knows all the
patients, or whatever the excuse.
If you’ve chosen to ignore the

(Photo/© Nyul, Dreamstime.com)

problem, you’ve abdicated your
responsibility as the leader. You
can count Mary Jane as one of
your concrete blocks — as in dead
weight tethering your practice to an
average standing for all time.
Being the leader takes courage
to examine systems, processes and
staff. Change those things that don’t
work, but most importantly, challenge everyone — not just yourself
— to continuously improve.

They follow the leader
Your team members are taking
their cues from you. If you have a
Mary Jane and she is unwilling to
change or do things differently, she
is the shining example for the rest
of the team to follow suit.
Employees are expert “boss
watchers.” They are quietly watching as you look the other way, make
excuses and allow employees such
as Mary Jane to run the show.
The irony is that most employees
want to excel, and they want to be
challenged. But they look to the
dentist to be the leader and address
Mary Jane’s unacceptable attitude
and poor performance. Yes, I know
it’s not easy, but it’s mandatory.
Read on.

Reluctant leaders
Dentists by virtue of their position
as CEO of the practice are the leaders, but often they don’t take to that
role naturally, and frequently they
do not have leadership experience
to prepare them for the responsibility.
Dentists are trained to be excellent clinicians and they are. They
are not, however, trained to have

the necessary communication or
business skills to lead teams and
steer clear of complacency.
However, dramatic leadership
improvement can occur under the
right circumstances if the dentist
truly wants a practice that reflects
the level of excellent dentistry he
or she provides.
In order to improve leadership
skills and avoid settling into a state
of mediocrity and ultimately the
loss of power and control over the
practice, dentists must take three
essential steps:
• Change your definition of
leadership.
• Change your behavior as the
leader.
• Change your expectations of
the desired outcomes.
The leadership definition for
small businesses is quite different
than it is for large companies. The
vision is to make a good living.
The plan is to work hard every
day delivering the best service and
quality to patients.
The required communication
skills consist of knowing what you
want your staff to do and telling
them.
The leader must explain to the
staff what is expected of them, how
their performance will be measured and how that performance
will be rewarded. In exchange, the
followers will be paid and appropriately recognized.
Rather than allowing your practice to sink under the weight of
mediocre minions, choose to build
g DT page 6A

[5] =>

[6] =>

Digital Matters

Dental Tribune | March 2010

‘Eeny, meeny, miney, mo …’:
How to choose a digital camera
Part 2 of 2: switching from analog to digital
By Lorne Lavine, DMD

In part 1 of this article we discussed how to choose an intraoral and an extraoral camera with
detailed information about how to
evaluate the different aspects of the
camera as well as an explanation of
pixels. Now, we’ll delve into making the leap from analog to digital.
For many dentists, the transition
to digital photography is exciting
and opens up many new possibilities for them. The difficulty for
most, however, is trying to figure
out how to digitize their current
photos and slides.
There are a few methods for getting your prints and slides onto a
computer where they can then be
manipulated and output to different sources.
Photo or picture CD. For film
that hasn’t been developed or with
negatives, you can ask the photo
developer to put your images on
a photo or picture CD. These CDs
can be read by all but the most
ancient CD-ROM players, and the
files on them can be downloaded
onto your computer’s hard drive.
Scanner. This is currently the
only method for getting existing photos or slides into a digital
format. I would recommend that
when you search for a scanner, find
one that has both a backlight and a
transparency adapter. Models that I

f DT page 4A
and lead a team of star players.
Focus initially on the following
manageable steps. You will see
improvement almost immediately. Those who are valuable to the
future success of the practice will
emerge as will those who aren’t.

Step No. 1: Get the right people
into the right jobs.
Some employees are perfectly at
AD

have found to be particularly good
are the Epson V700 and V750-M.
In addition, look for a scanner that
has the highest dpi (dots per inch)
resolution that you can afford. Better models have at least a 1,200 by
2,400 dpi.
Online. Many companies offer
online storage and scanning of
existing photos. While these online
services are an option, they are
hardly the cheapest. Expect to pay
from $1 to $10 per scan, which
can get very expensive if you have
hundreds of photos and slides to be
scanned.

After it’s all digitized
Once you find a method of getting
your analog or digital photos and
slides on to a computer, you need
to have some method of storing,
cataloging and manipulating these
images. The only method before
true integration became a reality was to use a stand-alone image
management program. Some of the
better and more popular ones are
XDR, Apteryx and Tigerview.
As dental practice management
software has evolved, there was
a need to find a way to integrate
these image databases with the
management program so most of
the developers of these programs
built “bridges.”
Most bridges, however, are still
one-way in that you can call up

ease asking for payment, while
others feel as if they were making some extraordinarily difficult
demand of the patient. In the Mary
Jane example above, she may be
an excellent employee who is in
the absolute wrong position.
I highly recommend personality
testing to place your team members in positions in which they can
excel, not just get by. The Keirsey
Temperament Sorter Test found at
www.keirsey.com is an excellent

the image management program
from the patient screen and all the
patient information will already be
transferred.
However, this method does not
allow images that you capture to
be transferred back to the patient
file in the practice management
program. To accomplish this, you
need true integration. This type of
integration is found with some of
the more prevalent programs such
as Dentrix, Softdent and Eaglesoft.

Output
Once you have access to your images and have manipulated them to
your liking, the final piece in the
puzzle is to determine how you
want to output these photos. Obviously, this will heavily depend on
how you plan to utilize the images,
such as patient presentations, dental lab communication, lectures,
insurance documentation or online
collaboration. Some of the various
choices include the following.
Inkjet printers. It is important
to use a printer that is not only
capable of printing medical quality
images, but using the right paper is
also important. The paper and supplies will tend to be more expensive for these types of printers;
ink cartridges run about $50 and
a high-quality paper costs 50 to 60
cents per page.
DVD writer. Most new comput-

tool to use for this process.

Step No. 2: Tell it like it is.

Develop job descriptions for each
position. Specify the skills necessary
for the position. Outline the specific
duties and responsibilities.
Include the job title, summary of
the position and its responsibilities
and a list of duties. This is an ideal
tool to explain to employees exactly
what is expected of them.

Step No. 3: Train.
I’ve watched this mind-boggling
scene hundreds of times: dentists
allowing untrained team members
to handle tens of thousands of dollars in practice revenues.
Nothing creates distrust, generates conflict or causes more internal
problems than team members who
are not trained.
They feel insecure and vulnerable because they’ve been tossed into
a situation in which they are expected to perform duties and are largely
guessing at how those responsibilities are to be carried out.
This is a recipe for failure. Think
about it: would you hand them the

ers come with DVD burners known
as DVD-R and DVD-RW drives.
These drives are capable of writing
the images (or any other files you
designate) directly to the DVD so
that you can easily send the DVD
through the mail or make backup
copies for yourself.
Removable media. There are
many types of removable media
that can be used depending on the
amount of storage capacity that
is needed. Some of these options
include USB flash drives.
E-mail. Once you have a digital image, any e-mail program
will allow you to attach files to be
e-mailed. You should ensure that
the images are in a standard format
that can be read by other programs
and, just as importantly, that the
files are compressed.
An image created with a
10-megapixel camera can be many
megabytes in size. Converting this
to a JPG file (these are files that
have the .jpg extension on the end)
will reduce them to 500–750 KB on
average. Keep in mind that many
people still use a dial-up connection to access the Internet and
downloading large files can be very
time-consuming, so compressing
the images makes a lot of sense.
Online collaboration. There are
many services that will allow you
g Continued, ‘Eeny …’

instrument tray, a couple of handpieces and say, “Have at it, let’s see
what you can do.”? Of course not!
Team members must be given
the training to succeed and expected
to meet specific performance standards.

Step No. 4: Encourage the best.
In addition to job descriptions and
clear and specific goals, your team
will also wants to know how you will
measure its success.
When the time comes to evaluate
your team, that too should follow
specific guidelines; it’s not just a
matter of assessing whether your
assistant is a nice person. It is about
evaluating how well she/he is able
to carry out her/his responsibilities.
Used effectively, you’ll find that
employee performance measurements and reviews can provide critical information that will be essential
in your efforts to make major decisions regarding patients, financial
concerns, management systems,
productivity and staff throughout
g Continued, ‘Free …’

[7] =>

Dental Tribune | March 2010
f Continued, ‘Free …’
your career.
Moreover, performance measurements and a credible system
for employee review consistently
yield more effective and higher
performing team members.
The fact is that when we understand the rules of the game and
how we can win, life and work are
a lot more fun and rewarding.

Step No. 5: Celebrate.
Inspire the team with a practice
vision and goals, and recognize
the progress you make together in
achieving those goals. Take time to

f Continued, ‘Eeny …’
to upload your digital files to a site
that will store and catalog these
files for viewing by other people.
The most basic ones, which are
not necessarily designed for dental
applications, are quite easy to use
and most are free of charge. Sites
that are built around online dental
collaboration, such as Brightsquid
and ddsWeblink, are excellent for
this purpose
The world of digital photography
has continued to grow over the past
couple of years, and this is to the
advantage of the dentist.
Prices will continue to drop,
image quality continues to improve
and the products and systems are
becoming even easier to use.
For any dentist considering the
addition of digital photographs to
his or her dental practice, the time
to take the plunge is now! DT

About the author

Dr. Lorne Lavine, founder
and president of Dental Technology Consultants (DTC), has
more than 20 years invested in
the dental and dental technology fields. A graduate of USC,
he earned his DMD from Boston
University and completed his
residency at the Eastman Dental
Center in Rochester, N.Y.
He received his specialty
training at the University of
Washington and went into private practice in Vermont until
moving to California in 2002 to
establish DTC, a company that
focuses on the specialized technological needs of the dental
community.

Practice & Digital Matters

pat yourselves on the back for the
accomplishments that you achieve.
Create incentives for staff members to use their skills and training
to develop plans to continuously
improve patient services, boost
treatment acceptance and build a
better practice, and reward them
for their efforts.
If you create a structured environment with clear expectations
and a plan for total team success,
then the Mary Janes and the rest
of the crew will likely rise to the
occasion. And you will no longer be
suffering through the daily grind.
Rather, you will be leading a
happy and successful team that is
not only open to change and continuous improvement, it is actively
pursuing it every day. DT

7A

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.the dentistsnetwork.
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.

AD

[8] =>

Financial Matters

Dental Tribune | March 2010

Receivables at risk

Does your practice extend open credits to your patients?
By Keith D. Drayer

Does your practice extend open
credits to your patients? This is an
important question as veteran dental practice owners know that their
practice’s fiscal health, profitability
and success require balancing a prudent patient financing policy.
Balance allows the flexibility to
accommodate your patients, and it
needs to be firm enough to avoid
cash flow/collection problems that
may have material consequences for
both the clinicians and staff. Even
a temporary cash flow problem is
stressful for a practice owner, creating the potential for uncertainty in
making the payroll.
What is a dental practice’s uncollectible percentage? While this number will vary substantially (due to
many factors ranging from service
mix, use of practice management
software, aggressive or lax payment
policy compliance), when averaged,
it shows the nationwide number of
approximately 2.5 percent. Many
practice owners think they can live
with 2.5 percent. However, further
inspection reveals a more in-depth
appreciation of collection effectiveness on a practice.
Let’s suppose a practice grosses $1 million annually. If the practice has bad debt or “uncollectible
receivables” of $25,000, that is 2.5
percent, then that write-off number
would be correct (See Table 1).
Accounts receivable trends for
any business, from a FORTUNE 500®
company to a dental practice, are
almost identical. Receivables are like
gravity. You can’t resist gravity and
you can’t resist receivables’ falling
value over time. Table 2 shows the
effects of time on receivables. Each
$1 of accounts receivable at 90 days
is statistically only worth $0.72.
Thus, the case can be made for
dental practices to devote more focus
to their “payment is due upon service” policy so the practice is not
acting as a bank to patients. Offering
patients (monthly, more affordable)
financing options makes optimal
treatment acceptance more likely, as
AD

Practice Annual Revenue

$1,000,000

Eligible Receivables

$850,000

Practice Annual Revenue
Less: Cash Payments*
Eligible Receivables

Bad Debt

$25,000

Bad Debt

Bad Debt as a %
of Eligible Receivables

2.5%

$1,000,000
$150,000
$850,000
$25,000

Bad Debt as a %
of Eligible Receivables

2.5%

(* Cash = Cash + Checks)

Eligible Receivables

$600,000

Practice Annual Revenue
Less: Cash Payments
Less: Credit Cards
Less: Insurance
Eligible Receivables

Bad Debt

$25,000

Bad Debt

$25,000

Bad Debt as a %
of Eligible Receivables

12.5%

Practice Annual Revenue
Less: Cash Payments
Less: Credit Cards

$1,000,000
$150,000
$250,000

Bad Debt as a %
of Eligible Receivables

4.2%

Table 1

Table 2: Value of aged accounts receivable
$1 is worth the following amounts over time
well as removes a practice that offers
selective financing from appearing as credit officers and lenders to
patients.
Today, a good patient financing
plan will accept from 50 to 60 percent of the patients who apply. There
are patient financing companies that
indicate an approval rate of 90 percent based on the total patient base
being considered. That may be a misleading number as not every patient

wants to be approved. Your patientfinancing candidates can automatically be any who might remark:
◗ “I forgot my checkbook.”
◗ “Just bill me.”
◗ “I can pay you $100 a month until
we’re done.”
◗ “I want to have the treatment,
but can’t afford it now.”
◗ “Let me know the balance after
the insurance pay-in.”
It is prudent to offer patient
financing when you examine what
consumers are advised to pay on a
graded scale. Data reveals the recommended consumer order of payments is as follows:
1) Child support. By law, credit
bureaus must report any information received about overdue child
support, as long as it’s verified by
the proper agency and is not more
than seven years old. Consumers are
told this should be the No. 1 payment
priority. Penalties, considered quite
serious, include garnished wages,
liens on property and a suspended
driver’s license. Dentists should be
aware that finance companies might

$1,000,000
$150,000
$250,000
$400,000
$200,000

consider an open child support lien
on a credit bureau report as very
negative.
2) Mortgage. After more than 90
days, late mortgage payments can
end up on a credit record. Mortgages
also tend to have hefty late payment
fees, and if a mortgage holder misses two or more, a lender may start
foreclosure proceedings.
3) Car loans. Repossession laws
vary — in some states repossession
happens after only one missed payment. Mass transit isn’t applicable
everywhere and the risk of not having a vehicle probably impedes a
person’s ability to work.
4) Taxes. The Internal Revenue
Service (IRS) is tough when taxpayers don’t pay on time. Penalties
accrue with time and the clock
keeps going from the time of the
infraction.
5) Bank credit cards. Credit cards
are important. Paying them on time
is more important than ever as late
payments give all credit card issuers the right to reprice a cardholder
because of economic risk status.
Recent legislation was passed about
sudden rate increases from credit
card companies, though the effective
date isn’t until later this year.
6) Department store cards. Many
will negotiate and/or accept lower
payments for various periods of time.
7) Utilities (electric, gas, water).
Utility companies may work out
payment schedules for consumers
(though security deposits for future
services will be a factor). Nationwide, rules vary as regional regulators have rules protecting homeowners from losing vital services
and keeping consumers safe.
8) Student loans. Federal student loans may be deferred during
times of financial challenge. When
g DT page 10A

[9] =>

[10] =>

10A Clinical: Digital Perspective

Dental Tribune | March 2010

Virtual dental implant
planning: the next step
By Dov M. Almog, DMD and Michael
Nawrocki, DMD

Already in 2005, a report from
Kalorama Information1 estimated
that the growth in implant-based
dental reconstruction products
would outstrip other areas of dental
devices and products.
AD

According to that report, 40 percent of the western population is
missing one tooth or more; in the
United States alone, approximately
10 percent of the population is completely edentulous; and every year
about 2 million Americans loose a
tooth due to sporting accidents.
As a result, there has been a rapid

increase in the number of practitioners involved in implant placement,
including specialists and generalists, with different levels of expertise.
Unfortunately, there has been a
simultaneous raise in claims and
suits involving dental implants,
mostly associated with damage to

the mandibular nerve and maxillary
sinus perforations. This is in addition to failure associated with poor
alignment.2
Therefore, considering that dental implants are the fastest growing
discipline in dentistry, there is little
doubt that cone-beam computerized
tomography (CBCT) is the pre-eminent method for viewing and understanding three-dimensional anatomy and the foundation for successful implementation of oral implantology, one of the most important
branches of dentistry today.
CBCT carries very important
radiographic, restorative and surgical information for dental implant
planning, taking the guesswork out
of what we do, and it is rapidly
emerging as the diagnostic imaging standard of care. This information includes implant trajectory,
distribution, depth and proximity to
critical anatomical landmarks such
as the mandibular canal, maxillary
sinus, adjacent roots and alveolar
cortical plates and undercuts.
g DT page 13A

f DT page 8A
loans are deferred, payments aren’t
required, but you can’t qualify for
deferment once the loan is in default,
so don’t wait until you are behind in
payments to apply. Continue making payments until your request is
approved.
9) Health-care bills. Most medical bills aren’t reported to credit
bureaus until they are sent to collection agencies. Doctors will rarely
initiate a patient credit check before
starting a major treatment case.
With health care bills ranked in
order at No. 9 and a new era with a
tough economy, can your practice
benefit from a proactive approach to
patient financing? DT

About the author
Keith D. Drayer is vice president of Henry Schein Financial
Services. Henry Schein Financial Services represents the
only 3.99 percent same-as-cash
patient financing and no dedicated terminal program. Henry
Schein is the leading distributor of services and products to
office-based health care practitioners. Drayer can be reached
at hsfs@henryschein.com or
(800) 443-2756.

[11] =>

Dental Tribune | March 2010

Clinical: Digital Perspective 11A

Fig. 2a

Figs. 1a–c (above and below): CBCT study performed with the iCAT CBCT machine (Imaging Sciences International,
Hatfield, Pa.) while the patient wore a radiographic guide (blue shadow). By utilizing ImplantMaster™ software
(iDent Imaging, Foster City, Calif.), the prosthetically aligned acrylic teeth in the radiographic guide, plus the residual bone trajectory and the mandibular canal, facilitated the optimal virtual planning of implants’ trajectory, depth,
length and diameter. Images are shown in two dimensions: panoramic slice (1a) and cross sections (1b, c). These
cross sections correspond to the patient’s lower right and left edentulous region (Nos. 19 and 29). Note the mandibular canal illustrated by the red lines and circles.

Fig. 1b

Fig. 1c

Figs. 2a–c (at right): By utilizing
ImplantMaster software, a 3-D
reconstruction of a patient’s anatomy was achieved and a virtual
surgical guidance template (2a, b)
was designed and computer manufactured with precise drilling hole
distribution and the trajectory for
implants Nos. 19 and 29 (2c). Special metal sleeves were assembled
in the holes that can house a series
of tool inserts that accommodate
a diversity of implant systems and
drilling sequence as required by each
implant brand.

Fig. 2b

Fig. 2c
AD

[12] =>

[13] =>

Dental Tribune | March 2010
f DT page 11A
The collected diagnostic CBCT
and the added dimension of 3-D
data will result in more predictable
outcomes, increasing patient satisfaction and reduced risk of potential
claims. If the patient declines the
CBCT diagnostic data, the practitioner should obtain and document an
informed refusal.2
In 1996, Quantitative Radiology
(QR) from Verona, Italy, introduced
the first dental CBCT machine called
the Newtom into the Italian market.
This ushered in the era of 3-D dental
imaging, sparking a rapid development of dental CBCT scanners by a
number of companies.
To date, there are more than 30
such CBCT machines available on
the market worldwide produced by
a wide variety of companies.3
During the last decade, as recognition in the concept of CBCT
has matured, and with the wider
availability of CBCT 3-D imaging in
imaging centers, mobile scanning
units and private offices, our profession has been fueled further by the
introduction of 3-D derived virtual
planning software solutions.4
About a dozen of these virtual
implant planning software solutions
are used for general oral implantology treatment strategy, of which only
eight are ultimately used to translate
the treatment strategy into an actual
physical surgical guidance drilling
template, thus taking the guesswork
out of oral implantology (Figs. 1, 2).
Utilization of these adjunctive
state-of-the-art technologies altered
the manner in which we pull together diagnostic data, plan and execute
both simple and complex implant
cases. These surgical guidance systems offer safer and more predictable placement of dental implants,
ensuring accurate transfer of critical
restorative and anatomical information to the surgical site.
Additionally, these surgical guidance systems offer an opportunity to
maximize a team approach between
surgeons, restorative dentists and
the labs, creating greater understanding, appreciation and professional camaraderie.
Of the eight 3-D derived virtual
planning software solutions that are
ultimately used to translate the treatment strategy into an actual physical
surgical guidance drilling template,
two systems differentiate themselves

Contact information
Dov M. Almog, DMD, prosthodontist, Chief of the Dental Service VA
New Jersey Health Care System
385 Tremont Avenue
East Orange, NJ 07018
Tel.: (973) 676-1000, ext.1234
Fax:973-395-7019
E-mail: dov.almog@va.gov
Michael Nawrocki, prosthodontist
VA New Jersey Health Care System

Clinical: Digital Perspective 13A

from all the other systems in that no
physical shipment needs to be made
to the guide manufacturer.
Being fully automated, digitally
manufactured solutions, only digital data is transmitted, which is
enough to manufacture the guidance drilling template using 3-D
printing technologies. These two
systems are: NobelGuide™ (Nobel
Biocare, Yorba Linda, Calif.) and
Scan2Guide™ (iDent Imaging, Foster
City, Calif.).
While NobelGuide can only be
used in conjunction with Nobel
implants, Scan2Guide is an open
platform that can be used with most
implant systems on the market.
Because the iDent system is
an open system, the company has
developed a variety of metal sleeve

sizes for placement in the surgical
guidance drilling template and a
series of tool inserts that accommodate a diversity of systems out there,
including the drilling sequence as
required by each implant brand.

Conclusion
This report attempts to provide an
argument in favor of the utility of
CBCT-image-based
3-D-derived
virtual implant planning software
solutions in oral implantology that
are ultimately used to translate the
treatment strategy into an actual
physical surgical guidance drilling
template.
Researchers studying these virtual surgical guidance technologies
agree that the quantitative relationship between successful outcomes

in oral implantology and CBCTbased dental imaging — coupled
with virtual planning and, ultimately, implant placement guided by surgical guidance templates — awaits
discovery through large prospective
clinical trials.5
Based on a series of case reports,
it has been demonstrated that using
CBCT-based dental imaging along
with surgical guidance templates is,
without a doubt, a reliable procedure, optimizing our patients’ safety
and well being.6–8 DT
A complete list of references is
available from the publisher.
(Photos/Provided
Almog)

by

Dr.

Dov

AD

[14] =>

14A Pacific Dental Conference
AD

Dental Tribune | March 2010

Expanded convention
center for the PDC

Meeting to be held at Vancouver Convention Centre, April 15–17
By Fred Michmershuizen, Online Editor

The 2010 Pacific Dental Conference
will be held April 15 to 17 at the newly
expanded Vancouver Convention Centre West Building. The new facility
provides many additional features to
enhance the meeting’s continuing education programs and the exhibit hall
under one roof.
Meeting organizers have put together an enhanced program of speakers
and workshops for 2010. The brand
new exhibit hall will be home to more
than 500 exhibitor booths showcasing
a wide range of dental products and
services. More than 130 sessions will be
offered on a wide range of topics.

Meeting highlights
To complement the new home for the
Pacific Dental Conference, meeting
organizers have announced some fresh
new additions to the program as well
(Photo/Tourism Vancouver)
as some enhancements to the Web site.
Among them are the following:
• A brand new exhibit hall location
This event promises “delicious wine, fresh bread
with an Internet Cafe and three dining lounges.
to accompany it, expert viticultural advice and a
• Extended exhibit hall hours.
• A new live dentistry stage, located in the exhibit knockout view.” The cost for the event is $37 plus
tax.
hall.
A “Friday Night Social” will be held Friday, April
• Up to 15 hours of C.sE. credits.
• A “So You Think You Can Speak?” educational 16, from 6:45 to 10 p.m. The Friday night event
provides a perfect opportunity to catch up with your
series.
Meeting organizers said they are excited to see friends and colleagues, enjoy a light snack and cool
the constant growth of the conference more than beverage, while the techno-lit dance floor beckthe past few years, with a new record of more than ons you to kick up your heels to sounds of ABBA
11,600 participants in attendance last year. Partner- CADABRA! This performance pays tribute to the
ing with valued exhibitors is important to the meet- musical supergroup ABBA.
“The PDC Friday Night Social is a perfect way
ing’s continued success, organizers said.
“Our exhibit hall, known for its value, afford- to start your Friday night in Vancouver,” meeting
ability and friendly atmosphere, has become the organizers said. The cost for the social is $25 plus
primary venue for dental professionals to experi- tax.
ence the latest products and services,” meeting
Planning tools
organizers said.
To help attendees make the most of their conferSpecial events
ence experience, meeting organizers have made a
A number of special events will be held during the number of planning tools available online.
You can create a personal schedule of sessions
meeting.
“Life Is Too Short to Drink Bad Wine — Southern that you plan to attend, including first, second
Hemisphere Edition” will be held Thursday, April and third choices in each timeslot. Each person
15, from 6 to 7:30 p.m. Attendees will be able to in your attendee account can have his or her own
sample a variety of wines from the Southern Hemi- schedule.
In addition, you can create a list of “must-see
sphere at the event.
Wine expert David Lancelot from Vancouver’s exhibitors” you most want to visit in the exhibit
popular Marquis Wine Cellars has hand-picked a hall, and get a floor plan map that will help you
fabulous selection of limited-production and hard- find them.
Each person in your attendee account can
to-find wines from such countries as Australia, New
have his or her own exhibitor map.
Zealand, Chile, South Africa and Argentina.
To access the planning tools, and to learn more
The event will be held in the Vancouver Convention Centre’s third floor foyer overlooking the Bur- about the meeting in general, visit www.pdconf.
com. DT
rard Inlet and North Shore Mountains.

www.dental-tribune.com

Have you read an ePaper yet?
You can access the most recent edition of Dental Tribune, Cosmetic Tribune, Hygiene Tribune, Implant
Tribune and Ortho Tribune as ePaper. In addition, regular online content includes dental news, politics,
business and events, as well as clinical content from all the dental specialities. Drop in for a “read”
anytime!

[15] =>

Industry 15A

Dental Tribune | March 2010

Fast and safe protecting and matrixing
with FenderWedge and FenderMate
good contact point is created by the
unique pre-shaped indentation in
the matrix. No burnishing is necessary.
FenderMate is available in two
wedge widths, regular and narrow,
and for left or right application. The
new innovative design accommodates most approximal spaces.
The combined use of FenderWedge and FenderMate sets a new
standard in dentistry with a tissue-

friendly approach for the preparation and filling of Class II cavities.
FenderWedge protects the adjacent tooth and separates the teeth,
thus creating a perfect contact point,
while FenderMate aids fast and efficient restorations with a one-piece
wedge and matrix application.
Information about Directa products and distributors may be found
at www.directadental.com or by calling (203) 788-4224. DT
ADS

FenderWedge

FenderMate

(Photo/Directa)

During Class II preparation there
is a major risk for damaging the
adjacent tooth. Research shows
adjacent teeth are damaged in up to
70 percent of all cases.
Until now, protection methods have the disadvantage that the
shield loosens when the approximal
contact point is cut away, increasing
the risk of accidental aspiration of
the shield.
The need for improved protection methods led Directa to design
and develop FenderWedge, a plastic wedge with an attached vertical stainless-steel band that protects
the adjacent teeth and, at the same
time, separates the teeth for an optimal restoration of the contact point.
FenderWedge is securely held in
place throughout the entire preparation.
FenderWedge is inserted into the
approximal space as easily as any
other wedge. As the wedge creates
interdental separation, the vertical
steel band automatically establishes

correct positioning for a good contact point. The comfort of knowing
that 0.08 mm of metal protection
will help avoid needless damage to
healthy teeth is simply priceless.
FenderWedge is available in four
different sizes from extra small (1.0
mm) to large (2.3 mm). They accommodate all interdental spaces.
In Directa’s quest to design and
develop high-quality useful products, the logical next step after the
use of FenderWedge is the introduction of FenderMate, an innovative
wedge and section matrix combined.
FenderMate offers a two-in-one step
procedure like nothing else in the
market.
After pre-separation of the interdental space with FenderWedge,
FenderWedge is removed and
replaced by FenderMate. After insertion, FenderMate adapts around the
tooth and holds shape without the
use of a retentive ring. FenderMate’s
flexible wing separates the teeth and
firmly seals the cervical margin. A

Zarosen desensitizing
cavity varnish and
dentinal tubule seal
Zarosen’s ® unique, strontium-chloride-based formula provides
immediate, long-lasting relief from hypersensitivity discomfort.
Zarosen is effective for weeks when applied to the enamel, dentin
or cementum of the tooth with a cotton pledget or microbrush.
Use Zarosen after prophy, scaling, tooth bleaching, restoration preparation, crown and bridge cementation and pin and post
seating. Zarosen’s special solvent system retains solids in solution
and does not require the addition of a thinner to maintain original
viscosity.
For more information, visit www.cetylite.com/zarosen.html. DT

[16] =>

[17] =>

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

March 2010

www.dental-tribune.com

Vol. 3, No. 3

Bite alteration to
reduce gummy smiles
By David S. Frey, DDS

The traditional method for correcting a gummy smile with too
high a gum-to-teeth ratio has been
enormously invasive. It has involved
cutting and lifting the gum tissue
back in order to remove bone, after
which the gums must be sewn back
in place.
This process requires a six to
eight-week healing process, which is
not only painful1, but esthetically displeasing during that period. Another
method, which involves repositioning the lip after cutting into the
vestibule, is equally invasive with an
excessively long period of healing.2
Today, cosmetic dentists often
perform a gingivectomy utilizing a
scalpel, electrosurge or diode laser
in order to correct an overly gummy
smile. However, these methods are
contingent upon the amount of biological width available in each individual patient.3 Two to three millimeters of gum tissue must remain

Fig. 1a: Before

Fig. 1b: After

over the bone after the tissue has
been removed. This biological width
limitation usually creates one of two
options.
Either the patient must be sub-

jected to invasive surgical gum flaps
accompanied by bone removal or the
patient must be satisfied with very
little change in the gum-to-teeth
ratio. If the patient presents with

a significantly short vertical index
(measured from the CEJ of tooth
No. 8 or No. 9 to the CEJ of tooth
No. 24 or No. 25), the gummy smile
condition may not be satisfactorily
corrected when only a gingivectomy
is performed.
Cosmetic dentists train regularly
to adjust horizontal smile abnormalities such as over-crowding and
large gaps. The idea of changing the
vertical dimension of occlusion as
part of improving dentofacial esthetics is not new.4 While occlusal philosophies may differ, most will agree
that the occlusion must be given
careful consideration when changing its vertical dimension, both as
part of the diagnostic process and to
avoid possible iatrogenic results.
When the patient presents with
a significant difference between
the mandibular position at habitual
occlusion relative to an optimized
occlusal position, increasing vertical
g CT page 4C

Comprehensive dentistry:
becoming a full-mouth doctor
An interview with Dr. David Frey
By Robin Goodman, Group Editor

You were the first dentist to use
and exploit the term, “full-mouth
revitalization,” and you commonly refer to yourself as a “mouth
doctor.” What does all this mean?
I did a Google search of the term,
“full-mouth revitalization,” when I
was writing my book, “Revitalize
Your Mouth,” in 2004, and nothing showed up. Thus, I am now the
proud owner of that trademark for
my signature procedure.
What I mean by “mouth doctor”
is that I can be one of three types of
dentists for my patients: a tooth doctor, a smile doctor or a mouth doctor. Some dentists are tooth doctors,
some are both tooth and smile doctors and others, like me, enjoy being

a mouth doctor.
A mouth doctor is comprehensive: correcting the teeth, the smile
and the bite. Correcting the bite
can enhance so much more for
the patient than merely restoring
the teeth in the patient’s current
habitual position. Patients can look
healthier and more attractive if you
proportionalize the lower one-third
of the face.
Correcting the bite can also
miraculously alleviate headaches,
ear pain, jaw pain and muscle pain
in the neck. It can even improve posture. In my experience, most patients
with unattractive smiles got that way
because of their malocclusion.
The bite is the engineering, backg CT page 2C

[18] =>

2C News

Cosmetic Tribune | March 2010

Dentist offers free services to
raise money for environment
By Fred Michmershuizen, Online Editor

Dr. Nushin Shir, owner of Artistic
Center for Dentistry, is celebrating
the grand opening of her practice in
Santa Monica, Calif., by offering free
comprehensive dental exams and
basic teeth cleaning services to 120
new patients.
In exchange for free dental treatment, the practice is asking that
all patients donate $10 to Heal the
Bay, a local environmental outreach
effort.
The monthlong promotion runs
from April 1–30.
“Among the great karmas to be
performed, charity is the greatest,”
said Shir, who is an expert in cosmetic and intricate dental procedures. “In these tough economic
times where many families are
hurting, the charitable contribution
to nonprofits and their important
missions has fallen significantly.
“This is an ideal time to repay
the support I have received from
the community and to give back to
one of the most important causes in
Santa Monica, Heal the Bay.”
The mission of Heal the Bay is
to promote the importance of making Southern California’s coastal
waters and watersheds safe, healthy
and clean, while fostering a global
value shift toward a sustainable and
secure future.
Artistic Center for Dentistry subscribes to this philosophy and is
doing its part to minimize its carbon
footprint. The practice is chartless
and therefore paperless, thus helping to save trees. The office also
reduces waste by eliminating the
use of plastic products.
The center’s choice to use digital X-rays eliminates the hazardous
chemicals that are used in their
development from contaminating
the waterways and also eliminates
unnecessary radiation to its patients.
The heavy equipment used is
both dry and oil-less and, therefore, does not wastefully deplete
water supplies. Oil-less machinery

f CT page 1C

bone and foundation behind a beautiful smile, and by taking a fullmouth approach; the gorgeous smile
that you create will stay that way
for a long time and look better than
ever!
Why is it important to correct a
patient’s bite?
If you build patients’ smile in their
habitual bite, you’re confined to the
size to which they’ve worn their
teeth down. This is a very small area.
When you incorporate bite correction into your work on a patient’s
smile, you have a lot more power,

reduces the waste production of
non-biodegradable materials that
contaminate the oceans.
“Support from third parties, such
as Artistic Center for Dentistry, are
key to promoting greater awareness, broadening our member base,
and generating funds to support
our research, education, community
action and advocacy,” said Natalie
Burdick, Heal the Bay’s constituent
development manager.
“We are excited to be able partner with Dr. Shir on a health program that offers free dental exams
to members of our local community.”
“We are committed to improving the local environment in our
community to create a cleaner safe
place to live and work. We understand the importance of making
environmentally responsible decisions for a sustainable future,” Shir
said.
The mission of About Artistic
Center for Dentistry is to create naturally beautiful smiles and enhance
patients’ overall well being by using
the latest dental technologies in a
stress-free, Zen environment.
Artistic Center for Dentistry offers
all aspects of general and cosmetic
dental services, including power
teeth whitening, porcelain veneers,
crowns and bridges, tooth restoration, root canal therapy, orthodontics and more. It uses digital
X-rays with the lowest radiation for
patients’ safety.
The center also offers a range of
beauty and relaxation treatments
that can bookend a patient’s dental
experience, such as massage, foot
reflexology, hand and facial treatments, and Botox and dermal fillers.
Shir has served many well-known
celebrities in addition to owning
and managing several successful
dental practices in Los Angeles
County since 1993. She graduated
from UCLA School of Dentistry in
June 1993. She earned her bachelor’s degree in biological sciences
from UC Irvine.

and you can correct vertical abnormalities. If you just treat the smile,
you’re very limited to horizontal
abnormalities such as gaps, spaces
and crooked teeth.
When a patient only wants four
teeth corrected in the middle of
the smile, I become a tooth doctor.
But only correcting those four teeth
compromises color and the natural
flow of the smile as it diminishes into
the corners of the lips.
Of course, the choice is always the
patient’s, and that means I have to
be able to be a tooth doctor, a smile
doctor, and a mouth doctor in order
to serve all of my patients.
However, the truth is that form

COSMETIC TRIBUNE
The World’s Dental Newspaper · US Edition

Dr. Nushin Shir treats a patient
in her practice in Santa Monica,
Calif. (Photo/Provided by Dr.
Nushin Shir)
The Consumer’s Research Council of America recently selected Shir
to be included in its 2010 edition of
Guide to America’s Top Dentists.
“Receiving this designation is an
honor,” Shir said. CT
(Source: PRWeb)

More information
Founded in 1985 by Dorothy Green, the organization’s
focus is on Santa Monica Bay
and the surrounding Southern California coastal waters.
However, Heal the Bay’s
efforts frequently affect the
water quality for California
as a whole and the rest of the
United States.
Please visit www.Heal
theBay.com for more information.

equals function, and art equals science. Without combining the two,
you can never make an incredibly
gorgeous smile.
When the bite has been corrected
or when I treat a patient with a
healthy bite, I can create the best
smile in the world because I can line
it up in proportion with the patient’s
face.
Would you tell me about the books
you authored, “Revitalize Your
Mouth” and “Revitalize Your
Smile”?
The books were written to explain
to patients everything they need to
know about a full-mouth or full-

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.
Cosmetic Tribune strives to maintain
utmost accuracy in its news and clinical reports. If you find a factual error or
content that requires clarification, please
contact Group Editor Robin Goodman at
r.goodman@dental-tribune.com.

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

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
articles about in Cosmetic Tribune?
Let us know by e-mailing feedback@
dental-tribune.com. We look forward to
hearing from you!

[19] =>

Cosmetic Tribune | March 2010
smile revitalization. Because this
procedure is very complex and
detailed, these books have been very
successful for my practice because
they’re easy to read and contain several before and after pictures.
Patients show them to other
potential patients, so they’ve been
very strong internal marketing tools.
It’s also easy for me to share these
books with other dentists. I allow
them to co-write my books by adding
their own before and after pictures
so that they can enjoy the marketing success that I’ve had. I call this
the Instant Author Program [www.
instantauthorprogram].
Your office is in Beverly Hills,
where many people are known to
get frequent cosmetic procedures.
Do you find that injections in the
face and lips — such as Botox,
restylane and collagen — cause
problems with a patient’s smile?
Yes. Women often enlarge the size
of their lips to the point of sacrificing their smiles. So when they smile,
they no longer show much of their
teeth.
In that case, these injections can
create a vertical abnormality. If they
want to show more teeth, they need
to open the vertical dimension in
their bites.
We must open the bite up so that
when they close their mouth, the top
and bottom teeth touch sooner. That
allows more of the teeth to show
and gives the dentist room to make
a larger central that peers through
the lips and gives the patient a more
youthful smile.
Not showing enough teeth is the
opposite problem of what you call
a gummy smile, correct?
Yes, a gummy smile is the opposite
vertical abnormality. With a gummy
smile, the patient shows too much of
the teeth and gums. These patients
often have a very small vertical
dimension, 13 to 14 millimeters.
By opening them up to their natural physiological vertical length,
which might be closer to 17 millimeters, they show more teeth and less
gum as the ratio between the gums
and teeth is reversed. By opening
the bite, you can also reduce gummy
smiles, as my article [in this edition]
illustrates.
What kind of patient would you
consider a good candidate for
what you call full-mouth revitalization?
People who have had lots of dentistry in the past or worn their teeth
down, as well as people who don’t
like their smile and want veneers on
the top and bottom teeth. If you’re
going to veneer 20 teeth, the only
remaining teeth are molars.
Many of these patients already
have amalgam fillings or crowns on
these teeth. So it only makes sense
to do the full-mouth with a corrected
bite on these patients.
If you fail to correct the bite, you
also fail to address the core problem
of why so much dentistry is already
in the patient’s mouth. By leaving

the patient in his or her habitual
bite, that patient is going to continue
to have the same problems he or
she has had for the past 30 years or
more.
However, by creating a harmonious environment between the temporal mandibular joint, the teeth and
the muscles of mastication, you can
achieve beautiful and long-lasting
restorations.
Are there patients who aren’t good
candidates for full-mouth revitalization?
Yes. There are times when it makes
sense to be a tooth or smile doctor. Someone who has all virgin
teeth without any cavities or someone with a vertical dimension of 17
to 21 millimeters with no history of

Interview
neuromuscular symptoms wouldn’t
require full-mouth revitalization.
The same can be said for someone who is very young and open to
the idea of orthodontics. If someone’s natural teeth are in the proper
shape, size and contour without any
contortions, they don’t require a fullmouth approach.
Do your patients often ask you to
fix a tooth and then end up going
for the full-mouth approach?
Yes, sometimes it’s important for
a patient to understand why his or
her teeth are fracturing and decaying. Teeth restored back into the
patient’s habitual bite may be very
limiting.
Again, it’s always the patients’
choice, but I want them to make a

very informed choice.
I have a patient now who is dissatisfied with his previous dentist.
He struggled with three teeth on the
bottom right where he was given
three
porcelain-fused-to-metal
crowns.
His bite is so tough and so limited
in the back molars that after his bite
was adjusted many times, he can
now see the metal on his crowns.
So I explained to him that I could
redo the crowns, but he will have the
same problem because his teeth are
very flat and worn down with a lot of
old dentistry.
I showed him how full-mouth
revitalization will open his bite and
allow the necessary room to restore
his teeth. Without this, he will continue to wear down his teeth. CT

[20] =>

4C Clinical
f CT page 1C

dimension can have dramatic cosmetic effects on a patient by increasing the crown-to-gum ratio and
effectively decreasing the gummy
smile.
The cases presented here illustrate that vertical abnormalities such
as gummy smiles may sometimes be
further enhanced and the need for
surgical intervention minimized if
the vertical dimension of the bite is
altered.
In adjusting the vertical dimension, care must be taken to insure
a functional occlusion in the finished case. Jankelson described the
method for muscle relaxation to
determine mandibular position at
true physiologic rest.5 Application

Cosmetic Tribune | March 2010
of transcutaneous electrical nerve
stimulation (TENS) (J5 Myomonitor*) for a period of 30–40 minutes
allows the muscles of mastication
innervated by cranial nerves 5 and
7 to relax.
While there is no universal agreement among dentists on occlusal
philosophy, the author has found the
Jankelson method of establishing
a true mandibular physiologic rest
position (PRP) to be highly effective.
PRP is objectively verified with surface electromyography and computerized jaw tracking (K7 Evaluation
System).
The K7 System provides calculations that show when the patient is
at physiological rest as compared
to habitual rest. These calculations
indicate how much vertical index

can be increased or how much freeway space can be decreased without
interrupting the patient’s true physiological rest position.
Concerns about changing the
entire arch to effect anterior defects
are unfounded for two reasons. First,
the newly diagnosed mandibular
position is verified as correct by
using an orthotic before anything is
done to the natural teeth. Secondly,
this technique of treating a gummy
smile is based upon opening the bite.
Therefore, when porcelain is
added to the full arch to increase
vertical dimension, it involves little
to no destruction of the natural dentition because the restorations are
placed over the occlusal surface.
In the author’s experience and as
illustrated in these cases, once PRP

of the mandible is established, the
increased teeth-to-gum ratio is significant prior to the removal of any
gum tissue. It is prudent to mention
here that if the patient’s PRP does
not differ significantly from habitual after TENS relaxation, very little
change in vertical dimension would
be available for this procedure.
Use of the Golden Proportion to
establish a pleasing esthetic effect
has been seen in art, architecture
and various scientific fields for centuries and used in dentistry for at
least 25 years.6
Like occlusal philosophy, some
question its validity.7,8 However, it
is used by many today in plastic
surgery, orthodontics and esthetic
dentistry as an element of treatment
planning of facial esthetics and, in
the author’s experience, patients are
highly pleased with the outcome.
Calculations utilizing the Golden Proportion equation can also be
applied to tooth shape and will show
whether the “golden” vertical index
can be reached through a combination of bite correction and gingivectomy. These simple calculations
indicate whether the vertical length
of the patient’s smile will be more
esthetically pleasing after the corrections have been made.
(Width of central incisor) ÷
1.618 = golden length of central incisor
(Length of central incisor) x
1.618 = golden vertical index
Based on these two calculations,
an orthotic in the optimal bite position for both esthetics and function
can be fitted for the patient’s upper
teeth.
The orthotic is worn for a period of approximately one month to
be certain that no headaches, neck
pain, grinding or chewing issues
ensue. This period also provides the
patient with time to become psychologically accustomed to the additional tooth length that shows prior
to the gingivectomy and application
of veneers. If the patient is dissatisfied with the length-to-width ratio of
the teeth in the orthotic, adjustments
can be made to the orthotic before
beginning the procedure.
Correcting the bite before performing a gingivectomy can offer a
greater esthetic result, significantly
reducing the amount of gum tissue
that shows before a gingivectomy is
performed. It should be noted that
placement of porcelain on the molar
teeth to increase vertical height is
extremely conservative because the
porcelain is lying on top of the existing teeth.
Even if the available biological
width is significant, correcting the
bite allows the dentist to remove less
gum tissue during the gingivectomy.
A frenectomy can also be performed,
when appropriate, to remove a small
portion of the lip frenulum with a
diode laser. This allows the lip to
move down slightly over the previg CT page 6C

[21] =>

[22] =>

6C Clinical

Cosmetic Tribune | March 2010

Fig. 3

Fig. 2

Fig. 4

f CT page 1C

ously exposed gums and can additionally reduce the amount of gum
tissue that must be removed during
the gingivectomy.

Case No. 1
A 27-year-old female presented with
13 mm vertical index (VI) requesting that her “gummy smile” be corrected or reduced. The average VI is
17–21 mm. Therefore, her VI would
be esthetically pleasing if increased
by a minimum of 4 mm, reducing the
gum-to-teeth ratio.
The patient’s teeth were out of
proportion, with the length to width
ratio of the central incisors almost
identical rather than the esthetically
pleasing ratio of 75 to 80 percent
width to length. Her gums were
inflamed and in poor condition.
Therefore, she was first referred to a
hygienist for cleaning, root planing,
deep scaling and debriding. (Fig. 1)
At physiological rest, the K7
Evaluation System showed that the
patient’s VI increased to 17 mm
before any gum tissue was removed.
The tooth-to-gum ratio had already
been increased significantly. The
Golden Proportion equations were
also utilized. The patient’s golden
vertical index calculated at 16.7 mm,
and the orthotic gave her a VI of 17
mm (Fig. 2).
It was determined that the patient
would have an even greater esthetic result by further increasing the
tooth-to-gum ratio. Sounding determined that 2 mm of gum tissue could
be removed safely, an additional 2
mm was burned away utilizing a
diode laser.
The diode laser immediately cau-

Fig. 5

terizes the tissue and causes less
bleeding and less postoperative
stress for the patient than other gingivectomy methods.
In the image (Fig. 3), gum tissue has been removed from three
teeth, showing the additional vertical length compared to the remaining teeth. The healing process following the diode laser gingivectomy
is approximately two weeks.
Sounding indicated that a gingivectomy alone would have allowed
for the removal of no more than 2
mm of gum tissue. In this case, the
patient’s VI would have increased
only to 15 mm, leaving her with a
gummy smile even after the procedure was complete (Fig. 4).
After administering a local anesthetic, a frenectomy was performed
on the patient to further release the
upper lip and reduce the gum-totooth ratio (Fig. 5).
The bite was checked again and
the temporaries were applied. The
final VI increase for the patient
following the bite correction, frenectomy and gingivectomy was 6
mm, increasing the VI from 13 to
19 mm. While the increase could
have remained at 17, the additional
2 mm was an esthetic improvement
(Fig. 6).
After the veneers were applied
and the gums had healed, the patient
showed an exceptional reduction
in her gummy smile, as well as
increased gum health with proper
stippling (Figs. 7a, 7b).

Case No. 2
A 37-year-old female patient presented with a 12 mm vertical
index and complaints of an overly
gummy smile. Although her gums

were healthy, she was referred to
a hygienist for a thorough cleaning
prior to her procedures.
The patient’s central incisors
were 9 mm wide, while the Golden
Proportion is 11.6 mm. The patient’s
golden vertical index, therefore, was
18.8 mm, which was an increase of
6.8 mm from her current VI (Fig. 8).
Measurements of the patient’s
teeth showed that the width-tolength ratio was almost identical
(Fig. 9).
The Myomonitor and K7 Bite
Evaluation System determined that
the patient’s bite could be opened
to a VI of 17 mm, which was a significant increase of 5 mm from her
original VI. The patient wore an
orthotic for a period of one month,
after which her bite was rechecked
and temporary teeth applied (Fig.
10).
Sounding determined that 2 mm
of gum tissue could safely be
removed. After a frenectomy and
gingivectomy utilizing the diode
laser, 2 mm of tissue was removed,
further increasing the patient’s VI to
19 mm, allowing for an exceptional
correction to the gummy smile condition of 7 mm from the original 12
mm VI (Figs. 11a, 11b). CT
* Myotronics, Inc., Seattle, Wash.

References
1. Canakci, CF, Canakci, V. Pain
Experienced by Patients Undergoing Different Periodontal Therapies. J Am Dent Assoc, 2007
Dec; 138(12):1563–1573.
2. Simon Z, Rosenblatt A, Dorfman
W. Eliminating a gummy smile
by surgical lip repositioning. J

[23] =>

Clinical

Cosmetic Tribune | March 2010

Fig. 6

Fig. 8: Before

Fig. 9: Before

Fig. 7a: Before

Fig. 7b: After

Fig. 7c: After close up.

of Cosmetic Dentistry
Spring 2007 volume 23,
Number 1.
3.
Kao RT, Dault S,
Frangadakis K, Salehieh JJ. Esthetic crown
lengthening: Appropriate diagnosis for achieving gingival balance. J
Calif Dent Assoc, 2008
Mar;36(3):187–191.
4.
Kois, JC, Phillips,
JM. Occlusal vertical
dimension: alteration
concerns.
Compend
Contin Educ Dent, 1997
Dec;18(12):1169-74,
1176–177.
5.
Jankelson, B. The
Myomonitor: Its use and
abuse.
Quintessence
Intl, 9: 1-6, Feb/Mar 1978
6.
Levin, EI. Dental
esthetics and the Golden Proportion. J Prosthet Dent, 1978 Sept.
40(3):244-52.
7.
Ong, E, Brown,
RA, Richmond, S. Peer
assessment of dental
attractiveness. Am J
Orthod Dento Orthop,
2006 Aug;130(2):163–
169.
8.
Ward, DH, A study
of preferred maxillary
anterior tooth width
proportions: Comparing
the recurring dental proportion to other mathematical and naturally
occurring proportions.
J Esthet Restor Dent,
2007;19(6):324–337.

7C

Fig. 11a: After

Fig. 11b: After close up.

Fig.10: Patient with orthotic.
(Photos/Provided by Dr. David Frey)

About the author
Dr. David S. Frey been in private practice in Beverly Hills,
Calif. for more than 20 years.
A graduate from the University of Pacific Dental School in
1989, Frey’s passion for learning and excellence has allowed
him to establish a very highend cosmetic and reconstructive
practice.
He has authored two books,
“Revitalize Your Smile” and
“Revitalize Your Mouth,” as well
as written for top United States
dental journals.
In addition, Frey has appeared
in People magazine for his work
on celebrity idol Elliot Yamin and
has made multiple appearances
on the The Learning Channel’s
programs “Ten Years Younger”
and “A Personal Story.”
You may contact him at
drfrey@drfreydds.com.

[24] =>

) [page_count] => 24 [pdf_ping_data] => Array ( [page_count] => 24 [format] => PDF [width] => 765 [height] => 1080 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => DT U.S.

[toc] => Array ( [0] => Array ( [title] => Georgia dentist says state will pay for general anesthesia [page] => 01 ) [1] => Array ( [title] => News [page] => 02 ) [2] => Array ( [title] => Free yourself from the daily ‘grind’ [page] => 04 ) [3] => Array ( [title] => Receivables at risk [page] => 08 ) [4] => Array ( [title] => Virtual dental implant planning: the next step [page] => 10 ) [5] => Array ( [title] => Expanded convention center for the PDC [page] => 14 ) [6] => Array ( [title] => Industry [page] => 15 ) [7] => Array ( [title] => COSMETIC TRIBUNE 3/2010 (part1) [page] => 16 ) [8] => Array ( [title] => COSMETIC TRIBUNE 3/2010 (part2) [page] => 22 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

[cached] => true )