DT U.S.

Report says 1 in 5 children lacks access to care / NYU dental professor receives $1.2 million to study bones and teeth / The secret tool: patient questionnaire / Changes and opportunities for health-care practitioners’ finances / Using resorbable barriers to make root recession coverage predictable / AACD to hold 26th scientific session / Plenty to do in Dallas / Industry News / HYGIENE TRIBUNE 4/2010

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

April 2010

www.dental-tribune.com

Vol. 5, No. 10

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

The study of bones and teeth

NYU College of Dentistry professor receives
$1.2 million for research.
u page 4A

Root recession coverage

From the patient’s perspective, root recession is
associated with aging.
u page 11A

Desensitization therapy

8 to 30 percent of the adult population suffers
from dentin hypersensitivity.
upage 1B

Report says 1 in 5 children
lacks access to care
By Fred Michmershuizen, Online Editor

A recent report from the Pew
Center on the States paints a sad
picture about the oral health of
many children in the United States.
The report, “The Cost of Delay:
State Dental Policies Fail One in
Five Children,” says that millions
of disadvantaged children do not
have access to adequate dental
care.
“Millions of disadvantaged children suffer from sub-par dental
health and access to care,” the

report states. “This is a national epidemic with sobering consequences that can affect kids
throughout their childhoods and
well into their adult lives.
“A ‘simple cavity’ can snowball into a lifetime of challenges,”
the report states. “Children with
severe dental problems are more
likely to grow up to be adults with
severe dental problems, impairing
their ability to work productively and maintain gainful employment.”
Leaders of two of the nation’s

Texas hosts the AACD annual meeting
The Gaylord
Texan Hotel
& Convention
Center is a destination in and
of itself with lots
to do on site. If
you are game
to venture out
from the meeting location,
there is also
plenty of things
to do in Dallas.

leading
dental
associations
weighed in with their opinions on
the report.
“We welcome the Pew organization to our longstanding fight
to improve the lives of American
children by helping more of them
enjoy the good oral health that
too many of them now lack,” said
Dr. Ron Tankersley, president of
the American Dental Association
(ADA).
“Pew’s presenting its informag DT page 2A

(Photo/Pew Center)

Murder fugitive found
by dentist after 40 years
By Daniel Zimmermann, Dental Tribune
International Group Editor

An oral surgeon from Bellevue,
Wash., has been helping authorities to identify a fugitive who murdered his grandfather almost 60
years ago. Dr. Clem C. Pellett,
who is currently listed as one of
the top dentists in oral and maxil-

lofacial surgery in the Puget Sound
area near Seattle, tracked down
78-year-old Frank Dryman in Arizona with the help of private detectives.
Dryman was immediately arrested and is expected to return to
Montana State Prison where he had
g DT page 4A
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g See pages
14A, 15A

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News

f DT page 1A
tion in the form of a report card
makes it easy for anyone to understand that too many kids in too
many states are suffering. And we
face huge challenges in changing
that.”
“We don’t agree with everything
in the report,” Tankersley continued. “But certainly, it highlights
some of the major policy areas that
the ADA and state dental societies
have advocated for years — things
like increased Medicaid funding,
school sealant programs and community water fluoridation.
“It also highlights the urgent
need for reliable routine data collection so that policies are well
informed and kids are not left suffering.”
Dr. David F. Halpern, president
of the Academy of General Dentistry (AGD), offered similar sentiments.
“With more than 51 million school hours lost each year
because of dental-related illness,
the way in which states ensure
that children have access to oral
health care services is clearly an
issue that deserves the devotion
and dedication necessary to reach
a solution so no child suffers needlessly from dental pain,” Halpern
said.
The Pew Center report is not
all grim. It states that a number of
cost-effective improvements can
be made.
“By making targeted investADS

Dental Tribune | April 2010
‘The AGD is opposed
to any promotion
or support of an
independent midlevel
dental provider,’ said
Dr. David F. Halpern,
president of the AGD.

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

ments in effective policy approaches, states can help eliminate the
pain, missed school hours and
long-term health and economic
consequences of untreated dental
disease among kids,” the report
says.
“Although a handful of states
are leading the way in breaking down these barriers, every
state must do more to put proven
policies in place to ensure dental health and access to care for
America’s children.”
“The report does omit some
policy areas that we believe are
equally important to improving
children’s access to care,” Tankersley said. “For instance, some
states have innovative programs
— like student loan forgiveness
and tax incentives — to help dentists establish practices in underserved areas or practice in com-

munity health centers.
“And when it comes to fixing
Medicaid, money is a huge issue,
but it isn’t the only issue. Patients
and parents need oral-health education to help them take care of
themselves and their families to
prevent disease.
“Many of them need additional
services, like transportation, in
order to be able to get to dental
appointments.
“If Medicaid did a better job
of these things, treatment costs
would decrease because we would
be preventing more disease and
treating less.”
It is also the AGD position that
improvements in Medicaid reimbursements to meet the costs of
service to the public, and expansions in water fluoridation and
sealant programs, are needed.
The AGD is opposed to independent dental providers who have
not graduated from dental schools
performing irreversible procedures for the very reason that a
provider who has not met the minimum educational requirements
in dentistry might be a danger to
the patient if he or she is providing
the primary care.
According to the AGD, accessibility without quality echoes the
“something is better than nothing”
approach to care, which does not
ultimately serve the public need.
Both the ADA and the AGD have
worked with state and federal
agencies, dental schools and other
organizations to promote public
funding, volunteerism and loan
forgiveness for dental students
working in underserved areas.
“The ADA and state dental societies have a long history as the
nation’s leading advocates for
oral health,” Tankersley continued. “ADA members donated some
$2.16 billion in free care to disadvantaged children and adults, both
as individuals and through such
programs as Give Kids A Smile and
Missions of Mercy, in 2007 alone.
“But we’re the first to admit that
we can’t do this alone, and charity
is no substitute for an effective,
equitable oral-health delivery system.
“We’re grateful for assistance
from the Pew Center and others
who are willing to lend a hand in
what undoubtedly will remain a
long, tough fight.” DT

Managing Editor/Designer
Implant Tribune & Endo Tribune
Sierra Rendon
s.rendon@dental-tribune.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Product & Account Manager
Mark Eisen
m.eisen@dental-tribune.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dental-tribune.com
Sales & Marketing Assistant
Lorrie Young
l.young@dental-tribune.com
C.E. Manager
Julia E. Wehkamp
j.wehkamp@dental-tribune.com

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

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

[3] =>

[4] =>

News

Dental Tribune | April 2010

NYU dental professor receives $1.2
million to study bones and teeth
By Fred Michmershuizen, Online Editor

Dr. Timothy Bromage, a New York
University College of Dentistry professor whose research on the microanatomical structure of ancestral human
teeth and bones is recognized with
having established the modern fields
of human evolution growth, development and life history, has received the
2010 Max Planck Research Award.
The award, chosen by a joint Max
Planck Society and Alexander von
Humboldt Foundation selection committee, includes a stipend of approximately $1.2 million (750,000 euros),
which will enable Bromage and Dr.
Friedemann Schrenk of the Senckenberg Research Institute to collaborate on the microanatomical study of
bones and teeth, and to research the
link between metabolic states, growth
rates, life spans and biological features
such as sex and body size.
A portion of the award will be dedicated to training junior scientists in the
United States and Germany to assist on
this research.
“Dr. Bromage has fundamentally
altered the field of human evolution
by prompting paradigm shifts in morphology, fieldwork and experimental biology, thereby establishing the
modern field of growth, development,
and life history in paleoanthropology,”
ADS

Dr. Timothy
Bromage is
an expert on
the microanatomical
structure of
ancestral
human teeth
and bones.
(Photo/NYU
College of
Dentistry)
said Dr. Charles N. Bertolami, dean
of the NYU College of Dentistry, upon
announcement of the award.
Bromage is a professor of basic science and craniofacial biology and of
biomaterials and biomimetics at the
NYU College of Dentistry. The award
selection committee cited his research
with showing a relationship between
bone and tooth microstructure and
body size, metabolic rate, age and
other biological features.
According to the NYU College of
Dentistry, Bromage was the first to use
biologically based principles of craniofacial development to reconstruct early
hominid skulls. His computer-generated reconstruction of a 1.9-millionyear-old skull originally discovered
in Kenya in 1972 by renowned paleontologist and archeologist Richard

Leakey showed that Homo rudolfensis,
modern man’s earliest-known close
ancestor, looked more apelike than
previously believed.
Bromage’s reconstruction had a
surprisingly smaller brain and more
distinctly protruding jaw than the
reconstruction that Leakey assembled
by hand, suggesting that early humans
had features approaching those commonly associated with more apelike
members of the hominid family living
as long as 4 million years ago.
In human evolution fieldwork,
Bromage’s 1992 discovery of a 2.4-million-year-old jaw in Malawi unearthed
the oldest known remains of the genus
Homo. The discovery, made in collaboration with Schrenk, director of
paleoanthropology at the Senckenberg
Research Institute in Frankfurt, Germany, marked the first time that scientists discovered an early human fossil
outside of established early human
sites in eastern and southern Africa.
In experimental biology approaches to human evolution research, Bromage discovered a new biological
clock, or long-term rhythm, which
controls many metabolic functions.
Bromage discovered the new
rhythm while observing incremental
growth lines in tooth enamel, which
appear much like the annual rings on
a tree. He also observed a related pattern of incremental growth in skeletal
bone tissue — the first time such an
incremental rhythm has ever been
observed in bone.
The findings suggest that the same
biological rhythm that controls incremental tooth and bone growth also
affects bone and body size and many
metabolic processes, including heart
and respiration rates.
“The rhythm affects an organism’s
overall pace of life and its life span,”
Bromage said. “So a rat that grows
teeth and bone in one-eighth the time
of a human also lives faster and dies
younger.”
The Max Planck Research Award
is presented jointly by The Max Planck
Society, which promotes basic scientific research at top international levels,
and by the Alexander von Humboldt
Foundation, which promotes collaboration between scientists in Germany
and other countries. DT
(Source: NYU College of
Dentistry) (Front Page Photo/
Pixelbrat, Dreamstime.com)
f DT page 1A
served 15 years for killing Clarence Pellett back in 1951. He had
been out on parole for three years
before he disappeared in 1969.
Local authorities told local news
station Channel 5 that he was
found in Arizona City, where he
ran a wedding chatpel and went by
the alias of Victor Houston. DT

[5] =>

[6] =>

Practice Matters

Dental Tribune | April 2010

The secret tool: patient questionnaire
A powerful way to find out exactly what your patients want so you can boost your income and patient base
By Dr. Bhavna Doshi, United Kingdom

Have you ever thought of what it
would be like if you could discover
the hidden pains your patients
go through daily because of their
teeth?
The kind of deep-rooted pain
patients often don’t mention and
occasionally don’t realise they are
even suffering with. These pains
may be so deeply embedded that
it never occurs to them they may
have a way out.

Many patients regularly suffer
from cosmetically debilitating features of their mouths. Most of
these patients often suffer silently
because they believe that there
are no solutions to their problems
or think they can’t afford it.
They think having their mouths
completely,
once-and-for-all
“fixed” is something that is for the
rich and famous.
My experience with treating
“Extreme Makeover UK” patients
has confirmed my thoughts of how

much people suffer in silence with
negative beliefs.

Uncovering hidden pains
The tool to help diagnose the
required and much needed dentistry for patients is the patient
questionnaire. This may sound
simple, yet its effects are immeasurable. It can be designed to be
as intricate or simple as you want.
For example, it can contain a
series of beautiful photographs
of the applications of cosmetic

dentistry.
This can be your work or that of
others — it simply visualises the
possibilities for the patient. But
more importantly, it must contain
thought-provoking questions that
allow your patients to focus on
their cosmetic concerns.
The questionnaire should be
strategically designed to root out
the major concerns patients may
have. It forms part of a discovery
process between you and your
patients in making your patients
aware of their fears, wants, desires
and needs.
It can form part of a beautiful patient-friendly package. This
means there is no work for you to
do except have an informative discussion with your patients about
their response to the questions.

What should you ask?
Simple thought-provoking questions need to be mentioned in the
questionnaire. It needs to be used
as a regular tool in your practice.
Every practice member must
understand its significance and be
able to talk to the patient about its
importance in discovering his/her
needs and the overall evaluation
process.

Sample questions
• Do you have any concerns in
your mouth?
• If you had a magic wand and
could change something in your
mouth, what would you change?
• What do you like about your
mouth and smile?
• What don’t you like about
your mouth and smile?
• What is the most important
thing to you about your mouth and
smile?
• Are there any aspects of dentistry you have been thinking
about that you would like to discuss?

Maximising performance
Sit down (in a preferably nonclinical environment) with the patient
for a consultation. Systematically
go through each question on the
card and ask why the patient gave
that particular answer.
Use the pleasing photographs
of the various smiles and cosmetic
work you may have done in the
past to ask what the patient is
looking for in a nice smile.
If you could have extra–oral
and intra-oral photographs taken
beforehand of your patient, this
would really optimise and visually reinforce your solutions to the
patient.
For example, if you had a photograph of a markedly deteriorating
restoration in an anterior tooth, it
would be easier to justify the need
for a new, cosmetically-improved

[7] =>

Dental Tribune | April 2010

Practice Matters

Sample patient questions

Fight oral cancer!

• Do you have any concerns in your mouth?
• If you had a magic wand and could change
something in your mouth, what would you
change?
• What do you like about your mouth and
smile?
• What don’t you like about your mouth and
smile?
• What is the most important thing to you
about your mouth and smile?
• Are there any aspects of dentistry you have
been thinking about that you would like to
discuss?

Income ge neration
This patient questionnaire would
allow you to generate more revenues because it would act like an
extra activity in marketing your
practice or you.
It is a well-known fact in the
marketing arena that the more
activities you perform, the greater
the number of potential customers
you are likely to attract. This methodology is a simple but extremely
effective system to acquire new
revenue sources.
It can be applied to both existing
patients and new patients alike.
The process itself is one of discovery, and other aspects of dentistry can come to light as a result
of this investigative procedure.
The more comprehensive the dentistry you provide your patients,
the more dentistry you do, hence
the more income you generate.
Patients that have developed a
good relationship with you as a
result of being listened to will
be happy customers of the ser-

vices you provide. Happy customers are more likely to refer other
income-generating patients like
themselves.

Don’t underestimate this tool
The patient questionnaire is a
dynamic marketing tool. It can
promote your work and develop your practice by giving you
the ability to grow and generate
income.
It is a diagnostic tool to help you
and your patients on the road to
discovering your patients’ needs
and requirements.
The closer you are to meeting
those needs and requirements, the
greater is the likelihood that your
patients will accept your treatment recommendations.
This in turn will allow you to
promote your dentistry and generate more income.
Uncover the successful and
effortless nature of this tool by
simply using it to unveil the hidden dentistry. DT

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About the author
Bhavna Doshi is
a senior dentist at
The Perfect Smile
Studios,
www.the
perfectsmileacademy.
co.uk. She has a
special interest and
focus on practice
productivity, marketing and growth strategies.
If you have enjoyed this article and would like a free leaflet
on “Cost-effective Marketing for
Dental Practices,” then e-mail
Doshi at bhavna@unlimited
newpatients.com with your
name and address.

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and protective restoration on that
tooth. Especially if this was a concern the patient expressed in his/
her answers to the questionnaire.
You will find after this discovery process that you will be able
to advise a lot more than you
would have initially. This process
allows you to better understand
your patients so that you can take
better care of them. It helps to
build a rapport and a long-term
relationship of trust and faith.
Many times patients require an
authoritative person who would
simply listen to them. This act
alone, if sincere, is enough to
build trust for patient loyalty. It
also is a major factor in influencing patients to accept treatment
recommendations.

id you know that dentists are one of the most trusted
professionals to give advice?
Thus, no other medical professionals are in a better position to show patients that they are committed to detecting
and treating oral cancer.
Prove to your patients just how committed you are to
fighting this disease by signing up to be listed at www.oral
cancerselfexam.com. This new Web site was developed for
consumers in order to show them how to do self-examinations for oral cancer.
Self-examination can help your patients to detect abnormalities or incipient oral cancer lesions early. Early detection in the fight against cancer is crucial and a primary
benefit in encouraging your patients to engage in selfexaminations.
Secondly, as dental patients become more familiar with
their oral cavity, it will stimulate them to receive treatment
much faster.
Conducting your own inspection of patients’ oral cavities provides the perfect opportunity to mention that this is
something they can easily do themselves as well.
You can explain the procedure in brief and then let them
know about the Web site, www.oralcancerselfexam.com,
that can provide them with all the details they need.
If dental professionals do not take the lead in the fight
against oral cancer, who will? And in the eyes of our
patients, they likely would not expect anyone else to do so
— would you?

[8] =>

Financial Matters

Dental Tribune | April 2010

Changes and opportunities for
health-care practitioners’ finances
By Keith Drayer

There are many areas that can
bring small and large changes to a
practice’s income as well as the individual health-care practitioner. Outlined below are a few of the changes
and opportunities.

The practice’s finances
An area to take advantage of is the
2010 IRS Section 179 Tax Code that
ADS

allows business owners to lower their
taxable income by acquiring eligible
property (such as dental equipment,
technology and off-the-shelf software). What makes the 2010 Section
179 benefit important is that in the
year 2011, this generous allowance
will come down to $25,000.
As more and more dentists
embrace equipment and technology,
such as all-tissue lasers, comprehensive scanning, designing and milling

CAD/CAM systems and cone-beam
dentistry, this benefit can be applied
to lower the buyer’s taxable income.
These investments make a practice
more efficient, productive and profitable.
One of the key areas we suggest
dentists to focus on each year is their
current fee schedule. Too many dentists leave thousands of dollars in the
hands of insurance companies every
month because of an unbalanced fee
schedule.
We recommend that dentists set/
balance their fees into the proper
percentiles for their particular zip
code. This will not only help to maximize the coverage of insurance the
employer has purchased for the
employee, but it will also be the best
way to increase profitability.
While this is not tax advice, as individual circumstances apply, dentists
should find out more about Section
199, a benefit for domestic manufacturing. A dentist could qualify for a
deduction of 9 percent of the lesser
of “Qualified Production Activities
Income (QPI),” or taxable income
from milling activities.
Dentists may significantly reduce
their tax bill on domestic production
activities as a result of the previous American Jobs Creation Act. This
deduction is permanent and should
be explored.

Personal finances
Most people have multiple credit
cards. The odds of unused credit
cards being canceled should not be
discounted.
Many of us keep extra, unused
credit cards for a “rainy day” (often in
a fireproof box, hidden in our home
or off-site at a bank-rented vault).
Additionally, many people have
taken a retailer’s credit card, as they
were making a purchase, for the
instant 10 percent one-time rebate,
which was the incentive for taking
that credit card. What has changed in
the new era is two-fold.
Financial institutions incur a marginal cost for providing credit. Thus,
many lenders are still reducing assets
and/or being selective about whom
they are renewing.
Canceling unused cards has been
happening over the last year and a
half and is not ending.
The credit-card consumers holding
onto credit cards for a rainy day could
mean “the flu” for lenders. Lenders

are worried that the person who has
not used a card in more than a year
is taking out their card because of
worst-case scenarios (recent unemployment, need to raise funds for a
called in home equity line, etc.).
To protect your credit card lines,
you may want to use your cards in
intervals (every six to nine months).

Finances and partnerships
A change in today’s lending environment affects partnerships. Before
the financial crisis hit, many lenders
needed one partner or 50 percent of
ownership to have decent credit.
“Decent” is defined differently
among different lenders, but a FICO
score of 675 could have helped a
health-care practitioner on an application-only loan (which means providing your name, address, social
security, license number) to obtain
approximately $250,000.
In today’s lending environment, all
owners are scrutinized. Thus, if one
partner or an owner with more than
a 20 percent stake has weak credit
(FICO below 675), then that could be
a detriment for the practice obtaining
financing.
It’s prudent to be proactive in finding out your partner’s credit before
you obtain financing. This is a surprise you want to avoid. DT

About the author

Keith Drayer is vice president of Henry Schein Financial Services (HSFS).
Henry Schein Financial
Services provides equipment,
technology, and practice startup and acquisition financing
services nationwide. HSFS can
be reached at (800) 853-9493
or hsfs@henryschein.com.
Please consult your tax
advisor regarding your individual circumstances.

[9] =>

[10] =>

[11] =>

Clinical 11A

Dental Tribune | April 2010

Using resorbable barriers to make
root recession coverage predictable
By Drs. David L. Hoexter, Nikisha Jodhan
and Jon B. Suzuki

Gingival recession is defined as the
location or displacement of the marginal gingiva apical to the cementoenamel junction (CEJ).1 Recession is
the exposure of root surface, resulting
in a tooth that appears to be of longer
length.
From a patient’s perspective, recession means an unesthetic appearance
and is associated with aging.
The gingiva consists of free and
attached gingival tissue, as seen macroscopically. The free marginal gingiva, located coronal to the attached
gingiva (AG), surrounds the tooth
and is not attached to the tooth surface. The AG is the keratinized portion of gingival tissue (KG) that is
dense, stippled and firmly bound to
the underlying periodontium, tooth
and bone.
In ideal health, the most coronal
portion of the AG is located at the CEJ,
where the most apical portion is adjacent to the muco-gingival junction
(MGJ). The MGJ represents the junction between the AG (keratinized) and
alveolar mucosa (non-keratinized).2
There are numerous etiological
factors that may result in recession.
Generally, the etiology can be categorized as either mechanical or as
a function of periodontal disease progression.
Recession usually occurs due to
tooth malposition3–5, alveolar bone
recession6,7, high muscle attachments
and frenal pull8, and iatrogenic factors related to restorative and periodontal treatment procedures.3,9

Before …

Fig. 1: Pre-op labial view of anterior
teeth: recession on tooth #6; tooth
#7 surrounded by a small adequate
zone of keratinized apical tissue.
The detrimental effects of recession include compromised esthetics,
an increase in root sensitivity to temperature and tactile stimuli, and an
increase in root caries susceptibility
due to cementum exposure. Thus, the
main therapeutic goal of recession
elimination is gingival root coverage
in order to fulfil esthetic demands and
prevent root sensitivity.
Miller classifies recession defects
into four categories:
• Class I: marginal tissue recession
does not extend to the MGJ;
• Class II: marginal tissue recession extends to the MGJ, with no loss
of interdental bone;
• Class III: marginal tissue recession extends to or beyond the MGJ;
loss of interdental bone is apical to
the CEJ but coronal to the apical
extent of the marginal tissue recession;
• Class IV: marginal tissue recession extends beyond the MGJ; interdental bone extends apical to the

Fig. 2: Flaps reflected preserve the
interproximal tissue, which preserves the blood supply and prevents
black triangles (unesthetic interproximal spaces).

Fig. 4: Gingival tissue was coronally
repositioned, covering the membranes and the roots of teeth #6 and
#7, and sutured in place.
marginal tissue recession.10
A possible treatment modality for recession includes restorative/
mechanical coverage, such as cervical composite restorations. This kind
of treatment may effectively manage
root sensitivity and root caries. However, such treatment entails a long-

Fig. 3: The GTR membrane was
shaped and placed over the root surfaces of teeth #6 and #7.
After …

Fig. 5: Post-op view: the previously
recessed roots of teeth #6 and #7 are
covered with attached pink, keratinized gingival tissue, with no pocket
depth upon probing.
term compromise from an esthetic
perspective. Composite restorations
stain over time, and any marginal
leakage may lead to secondary caries,
recurrence of sensitivity and/or local
inflammatory changes.
Additionally, color matching can
be difficult and such restorations may
g DT page 12A
AD

Visit us at the 26th Annual AACD Scientific Session, booth no. 504.

[12] =>

12A Clinical
f DT page 11A
involve the undesirable removal of
vital tooth structure in order to create adequate retention form. Thus,
clinicians must determine whether
the restorative benefits outweigh the
esthetic shortcomings and whether
is it possible to employ a treatment
modality with few, if any, functional
and esthetic disadvantages.
Another treatment modality for
recession is muco-gingival surgery.
Muco-gingival surgery refers to periodontal surgical procedures designed
to correct defects in the morphology,
position and/or amount and type of
gingiva surrounding the teeth.11
In the early development of mucogingival surgery, clinicians believed
that there was a specific minimum
apical-coronal dimension of AG that
was necessary to maintain periodontal health.
However, subsequent clinical12–15
and experimental studies16,17 have
demonstrated that there is no minimum numerical value necessary.
However, for esthetics, a uniform
color and value of AG is desirable
among adjacent teeth.18
Some of the earliest techniques for
correcting recession involved extension of the vestibule.19
The subsequent healing usually
resulted in an increase of AG. However, within six months, as much
as a 50 percent relapse of the softtissue position was reported.20,21 Thus,
these techniques did not adequately
address recession.
In order to improve esthetics and
increase KG for root coverage proADS

Dental Tribune | April 2010
cedures, current periodontal surgery
largely involves the use of gingival
grafts. There are a multitude of surgical techniques, which can be distinguished based on the relationship
between the donor and recipient sites.
Gingival graft procedures involve
either (a) pedicle soft-tissue grafts,
which maintain the pedicle blood
supply or (b) free autogenous softtissue grafts. Techniques involving
the latter type require the clinician
to prepare two surgical sites: one to
harvest the tissue and another one to
prepare the recipient site.
In this case, the autogenous softtissue graft has a separate blood supply to the recipient site. Combinations
of (a) and (b) have also been reported.22–24
The pedicle soft-tissue graft was
first described by Grupe and Warren
in 1956.25 This involved raising a full
thickness flap and laterally positioning and then suturing donor tissue
into place from an adjacent area while
maintaining a pedicle blood supply.
This technique and others that followed were designed to increase the
zone of AG.
Later modifications of the technique included the double papilla
flap26 — introduced by Cohen and
Ross in 1968 — the oblique rotational flap27 and the rotational flap.28
Another type of gingival movement
flap was described later as the coro
nally repositioned flap.29 This technique involves mobilizing a full thickness flap and repositioning the tissue to the CEJ, thereby covering the
exposed recession.
The use of free gingival grafts was

described in the 1960s by Sullivan
and Atkins.30 The free autogenous
graft can be made up of either epithelialized gingiva or connective tissue.
Initially, the therapeutic goal was to
increase the zone of KG. The clinical
objective has now evolved to covering the recessed root with a zone of
attached KG.
This can be achieved in one or two
stages. Initially, Sullivan and Atkins
described a one-stage procedure in
1968. Its purpose was to increase the
zone of KG without concentrating on
coverage of a recessed root. In the
1980s, a two-stage modification was
suggested for an increase in root coverage, which proved to be more successful with increased predictability.
This involves first placing the free
gingival graft or the free connective tissue graft apical to the area
of recession and using the coronally
repositioned technique after healing.
Free autogenous grafts are predominantly harvested from the palate.
Recently, materials other than gingival grafts have been explored. Using
a guided tissue regeneration (GTR)
technique, an acellular dermal matrix
has been reported to yield favorable
outcomes in root coverage.31,32 This
material may provide the patient with
a less invasive alternative than a palatal donor site in order to achieve root
coverage.
Procedures combining both free
grafts and pedicle techniques have
also been detailed. For instance, when
a connective tissue graft is employed,
the graft is placed sub-epithelially
with a coronal advancement of the
overlying keratinized tissue. GTR
techniques have also been developed
more recently. In 1992, Pino Prato et
al. described a combination technique
of sub-epithelial placement of a membrane with coronal advancement of
the flap, such as e-PTFE.33
The function of the membrane is
to maintain space during the healing period for tissue regeneration to
occur. From a patient’s perspective,
biodegradable membranes with GTR
might be preferable in order to avoid
a second-stage surgery for membrane
removal.
The goal is to restore gingival
health, color and esthetics by cov-

ering the exposed root predictably
with healthy gingival tissue and, in
doing so, decrease sensitivity. Using
GTR and coronal repositioning techniques, we achieve predictably covered roots.
Variations in muco-gingival procedures have been developed to include
root surface bio-modifications by
treating the root surfaces with a variety of materials. These measures
enhance the regeneration process of
a new connective tissue attachment.
In order to increase root coverage, a
new clinical attachment is necessary.
Root surface bio-modification
involves treating the root surfaces
with citric acid, tetracycline or EDTA
in order to remove the smear layer
and expose dentinal tubules and thus
facilitate a new fibrous attachment.
An enamel matrix derivative claimed
to support the action of enamel
matrix proteins by inducing acellular
cemetum, periodontal ligament and
alveolar bone formation is also available in the range of root surface bio-
modification materials.
The following case report considers predictable esthetic root coverage
by comparing a GTR technique to a
non-GTR technique in a split-mouth
procedure involving the same patient.

Case report
A young, adult male patient presented with recession bilaterally in his
maxilla. The upper right maxilla had
extensive recession on teeth #6 and
#7 (Fig. 1). The upper left maxilla
had similar recession on teeth #11
and #12. Additionally, tooth #11 had
a cervical groove, which was stained
and hard but not decalcified.
After local anesthesia using lidocaine, the desired flap design was
completed. There was an adequate
zone of KG present before treatment,
which was preserved and repositioned coronally. Upon reflection of
the tissue, the full extent of the underlying recession was evident (Fig. 2).
The area and recession were uncovered following removal of debridement and granulomatous tissue.
The resorbable membrane material was shaped and placed on the
exposed roots. The membrane was
first placed on tooth #6 and thus the

[13] =>

Clinical 13A

Dental Tribune | April 2010
Before …

Fig. 6: Pre-op labial view of anterior
teeth.

tooth appeared darker as it absorbed
blood. The membrane was placed on
tooth #5 second and thus the tooth had
not absorbed the blood at the time of
the photograph, which accounts for
the color difference at this time.
The coronally repositioned flap
was sutured in place with the flap
covering the now submerged membranes and previous recession (Figs.
3, 4). Periodontal dressing (Coe-Pak,
GC) was utilized as a bandage and
placed over the surgical area. It was
removed a week later at the same
time as the sutures. The patient then
lavaged and returned to the usual oral
hygiene routine, initially lightly and
gradually more vigorously.
Once healed and oral health was
maintained, the recession was covered and health regenerated. Upon
periodontal probing, no pockets were

present (Fig. 5). The final view presents a visual symmetry of health and
color that is maintainable.
Recession was also present at the
maxillary left side (teeth #11 and #12;
Fig. 6). After local anesthesia of the
areas involved, a full thickness mucoperiosteal flap was completed. This
exposed the extent of the recession
defects (Fig. 7). Tooth #11 was treated, as was the other side of the mouth,
by utilizing the GTR technique using
an acellular connective tissue membrane to preserve the space for regeneration.
Tooth #12 was treated the same
way, except that no membrane barrier, resorbable or non-resorbable,
was used (Figs. 8, 9). Thus, there was
no use of a GTR technique on tooth
#12. Both teeth had the flap manipulated with the coronally repositioned

graft, covering the recessed root and
suturing to the CEJ level.
Both sides were covered with periodontal dressing. Antibiotics (tetracycline) and an analgesic (TylenolCodeine) were prescribed for the first
week after the operation.
One week after the surgical
phase, the dressing and sutures were
removed and the mouth lavaged. Oral
hygiene was restored to good, maintainable habits following the healing phase of over two months. Upon
observation, tooth #11, for which the
GTR membrane had been employed,
had re-attached healthy gingiva that
was not probable.
The recessed root and the stained
cervical groove were covered. In contrast, tooth #12, for which no GTR
g DT page 15A
AD

Fig. 7: Cervical groove on tooth #11
is solid, hard and non-carious.

Fig. 8: GTR membrane placed over
the root surface of tooth #11 only; no
membrane was placed on the surface
of the recession of tooth #12.

Fig. 9: Gingival tissue coronally
repositioned to cover the GTR membrane on tooth #11 and tooth #12.

After …

Fig. 10: Post-op view.

[14] =>

14A Events: AACD Dallas
AD

Dental Tribune | April 2010

AACD to hold 26th
scientific session
By Fred Michmershuizen, Online Editor

The 26th Annual American Association of
Cosmetic Dentistry Scientific Session will take
place at the Gaylord Texan in Grapevine,
Texas, from Tuesday, April 27, through Saturday, May 1. Educators from around the world
will lead the charge in reinvigorating dental
continuing education.
Highlights of the meeting include deeper
learning during lectures and hands-on workshops, the debut of AACD Digital World, a bigger team program, the exploration of international laboratory models and more.
“It is an exciting time at the AACD. The
academy is continually growing and adjusting
to better advance excellence through responsible esthetics,” said AACD President Michael
R. Sesemann, DDS. “The scientific session is
where participants recharge in order to live the
AACD’s core values and purpose every day at
the office.”
More than 80 educators will offer presentations at the meeting, including Pat Allen, DDS;
Newton Fahl Jr., DDS; John Kois, DMD, MSD;
and Lorenzo Vanini, DDS, MD. These worldclass educators will lead the charge in reinvigorating dental continuing education.
“I feel fortunate to be part of the AACD at
this time when we can inspire and invigorate so
many individuals,” Sesemann said.
Here are some highlights of the upcoming
meeting.

General Sessions
Clay Shirky, a writer, consultant and teacher
on new media and the Internet, will speak on
Wednesday, April 28, about emerging technologies. Shirky is an expert on economics and
culture, media and community, and the open
source movement.
His consulting practice is focused on the way
network technologies provide new ways for
groups to get things done, including collaboration tools, social networks, peer-to-peer sharing, collaborative filtering and Open Source
development. His recent book, “Here Comes
Everybody,” explores the effects of open networks, collaboration and user-created and disseminated content on organizations and industries.
Tim Sanders, a business and motivational
speaker and tech trends guru, will offer a presentation on Thursday, April 29, on strong business relationships, both internal and external.
“Get them right,” he says, “and you’ll grow your
business during good and bad times alike.”
Sanders is author of “Love Is the Killer App:
How to Win Business and Influence Friends,”
“The Likeability Factor” and “Saving The World
at Work.”
Amber MacArthur, a Web consultant, strategist and journalist, will offer a presentation on
Friday, April 30, about the social media generation. MacArthur will trace the profound impact
of emerging technologies on the way we live,
work and play — and she will make it all fun,
informative and accessible.

Poster session
Without the dedication and passion of researchers within the dental community, the advancements of cosmetic dentistry would not be where

it is today. The AACD Poster Session will be on
display as an outlet for researchers and clinicians to share their scientific findings. The
poster session will be held Wednesday, April
28, through Friday, April 30, from 9:30 a.m. to
5 p.m.

Orientation
An orientation will be held on Tuesday, April
27, from 3 to 5 p.m. for new AACD members
and for those who are attending the annual
scientific session for the first time. Participants
can join AACD colleagues as academy leaders
and staff provide an in-depth overview of the
26th Annual AACD Scientific Session, from the
layout of the educational program to the mustattend social and networking events.
AACD’s orientation will assist attendees in
determining how they can reach their educational goals while getting the most out of their
scientific session experience.

Silent auction
At the AACD Charitable Foundation (AACDCF)
silent auction, meeting attendees will be able
to place bids on an array of items, including autographed memorabilia from Hollywood
and sports stars to dental equipment for use
in one’s practice. Auction items are gathered
through the generous donations of AACD’s
dental partners and those concerned with stopping domestic violence.
Proceeds will help the AACDCF make a
significant impact on the lives of survivors of
domestic violence. By donating items to the
AACDCF Silent Auction, contributors can help
heal the affects of domestic violence. For more
information on donating, contact the AACD
Charitable Foundation at givebackasmile@
aacd.com or (800) 543-9220

Celebration of Excellence Gala
A Celebration of Excellence Gala will be held
on Saturday, May 1, from 6 p.m. to midnight.
The night begins with a cocktail reception, followed by the newly accredited members and
accredited fellows recognition. Next, attendees will enjoy five-star dining, then the AACD
awards ceremony, inauguration of the AACD
president, followed by, live music and dancing.
Tickets are $125 per person.

About the AACD
The AACD is the world’s largest non-profit
membership organization dedicated to advancing excellence in comprehensive oral care that
combines art and science to optimally improve
dental health, esthetics and function.
Composed of more than 7,000 cosmetic dental professionals in 70 countries around the
globe, the AACD fulfills its mission by offering
superior educational opportunities, promoting
and supporting a respected accreditation credential, serving as a user-friendly and inviting
forum for the creative exchange of knowledge
and ideas, and providing accurate and useful
information to the public and the profession.

Meeting registration
Dental professionals can register for the 26th
Annual AACD Scientific Session online at www.
aacd.com or by calling (800) 543-9220 or (608)
222-8583. DT

[15] =>

Dental Tribune | April 2010

Events: AACD Dallas 15A

Plenty to do in Dallas
It’s always nice to plan a little fun
along with a trip, especially a meeting such as the AACD. Dallas is a city
with plenty of theme parks, cultural
venues and outdoor spaces.

Family fun
If you are traveling with your family,
there are many options for entertainment. Consider the following:
Amazing Jakes (indoor amusement
park); Dallas Heritage Village (living history museum portraying life
in Texas from 1840 to 1919); Dallas
Mozzarella Company (cheese-making classes and factory tours); Dallas
World Aquarium; Dallas Zoo, Fair
Park (location of the annual State
Fair of Texas); Galleria Dallas (featuring ice skating); Louis Tussaud’s
Palace of Wax and Ripley’s Believe
It or Not!; Medieval Times Dinner
& Tournament; Mesquite Championship Rodeo; Six Flags Hurricane Harbor (water park); Six Flags
Over Texas (theme park); Southfork
Ranch (film location tours of the
1980s TV show “Dallas”); Speedzone
(amusement park); and Westin City
Center (featuring ice skating).

Outdoor spaces
With moderate weather year round,
Dallas offers beautiful outdoor spaces for learning and play.
Such picturesque places include
the Dallas Farmers Market; Katy
Trail (hike and bike trail); Pioneer
Plaza (bronze monuments commemorating the trails that brought settlers
to Dallas); Texas Discovery Gardens;
The Dallas Arboretum; and the Trinity River Audubon Center.

Museums
For more family learning opportuni-

f DT page 13A
membrane had been utilized, displayed recession as prior to the surgery (Fig. 10).
In summary, this split-mouth technique demonstrated that using an
acellular resorbable barrier membrane is more predictable for achieving root recession coverage than coverage of a recessed root without such
a membrane. DT
A complete list of references is available from the publisher.
(Photos/Dr. David L. Hoexter)

Contact information
Dr. David L. Hoexter
654 Madison Avenue
New York, N.Y.
Tel.: (212) 355-0004
E-mail: drdavidlh@
aol.com

ties, visitors travel to the numerous
one-of-a-kind museums throughout
the city. From historic to cultural,
these venues invoke emotion and
inspiration.
The following are located throughout the area: African American Museum; American Museum of Miniature
Arts; Cavanaugh Flight Museum;
Crow Collection of Asian Art; Dallas
Firefighters Museum; Dallas Museum of Art; Dallas Museum of Nature
and Science; Frontiers of Flight
Museum; Dallas Holocaust Museum;
Mary Kay Museum; Meadows Museum at Southern Methodist University;

Museum of the American Railroad;
Nasher Sculpture Center; Old Red
Museum; the Sixth Floor Museum
at Dealey Plaza; and the Women’s
Museum: An Institute for the Future.

Cultural attractions
Dallas is an art-centric and cultural city. With the largest urban arts
district in the nation and countless
museums and art galleries, the city
gives families plenty to explore.
In addition to the art-themed
museums mentioned previously,
Dallas also boasts the following cultural and musical venues: Dallas

Center for the Performing Arts —
including the Margot and Bill Winspear Opera House, Dee and Charles
Wyly Theatre, Annette Strauss Artist
Square, Sammons Park and later City
Performance Hall; the Dallas Children’s Theatre; Latino Cultural Center; Morton H. Meyerson Symphony Center; Music Hall at Fair Park
(venue for Dallas Summer Musicals);
South Dallas Cultural Center; and
The Majestic Theatre.
To learn more, visit the Dallas
Convention & Visitors Bureau online,
at www.visitdallas.com. DT
AD

[16] =>

16A Industry News

Dental Tribune | April 2010

CEREC goes to Vegas
Sirona celebrates 25 years of CAD/CAM success with three days of speakers, courses and entertainment
By Kristine Colker, Managing Editor,
Dental Tribune Show Dailies

We’ve all heard the saying: “What
happens in Vegas, stays in Vegas.”
Except this time, you’re not going to
want it to stay there. This time, three
days in Vegas could change your
practice forever.
From Wednesday, August 25, to
Saturday, August 28, Sirona will hold
its CEREC® 25th Anniversary Celebration at Caesars Palace in Las
AD

Vegas to commemorate the company’s 25 years of CAD/CAM leadership and success. The event will
bring leading educators from across
the globe together to give CEREC
owners, staff members and dentists
interested in knowing more about
CAD/CAM an opportunity to learn
as much as they can in a single
location.
“A quarter century [of CEREC]
is a big deal,” said Sirona CEREC’s
Marketing Manager Julie Bizzell.

For more information,
visit www.CEREC25.com or contact
Jennifer Kist at (800) 659-5977, ext. 186
or jennifer.kist@sirona.com.
“This is a celebration of coming
so far with the technology. CEREC
owners can get together and meet
and discuss ideas and learn more
about the products. They can get

tips and tricks from peers and come
together in celebration.”
One of the highlights of the event
promises to be Prof. Dr. Werner
Mörmann, inventor of CEREC, who
will make his last public appearance
when he speaks on “The Evolution of the CEREC System.” Other
speakers include Dr. Frank Spear,
Dr. Gordon Christensen, Dr. Rella
Christensen, Mr. Imtiaz Manji, Dr.
James Klim, Dr. Mark Morin, Dr.
Sam Puri, Dr. Mark Hyman, Mr.
Fred Joyal, Dr. Dennis Fasbinder
and Matt Roberts, CDT.
Throughout the three days, Sirona will offer a variety of courses
and hands-on workshops catering to
everyone in the dental office, from
dentists to hygienists to the office
staff, as well as a track for laboratory CAD/CAM users. The event will
offer up to 18 hours of C.E. credits.
“There’s an extensive list of CAD/
CAM courses. If they are a new
owner, a middle-of-the-road owner
or an experienced owner, there is
something there for everyone,” Bizzell said.
Some of the topics include
“CEREC is Marketing Magic,”
“Proven Methods for CEREC Restorations,” “3-D CAD/CAM meets
3-D X-ray,” “25 Tips and Tricks to
Improve your CEREC Experience”
and “CEREC Bridges — More Than
a Provisional.”
In between courses, attendees
can frequent the exhibit hall, which
will be full of companies showcasing products and services that will
be helpful to CAD/CAM users.
And since this is Vegas, after all,
there will, of course, be entertainment, including a special performance by five-time Emmy® Awardwinning comedian and actor Dennis
Miller, a performance by legendary
improv theater and training school
The Second City, and a party at
PURE nightclub.
“This is a celebration that only
comes around once in 25 years,”
Bizzell said. “To get this type of education, to learn from peers and hear
from people who are making the
future of CAD/CAM every day — this
is a once-in-a-lifetime event.”
For more information on the celebration, including a complete list
of courses and a schedule, or to take
advantage of discounted tuition,
visit www.CEREC25.com or contact
Jennifer Kist by phone at (800) 6595977, ext. 186 or by e-mail at jennifer.
kist@sirona.com. DT

[17] =>

Industry News 17A

Dental Tribune | April 2010

Using risk identification
and credit granting
to build your practice
By Paul Zuelke

In 1980, when we took our first dentist as a client, almost all dental offices were routinely granting
credit to their patients. If a patient/parent needed a
few months to pay for his/her clinical treatment, a
payment plan was usually allowed.
Thirty years later, things have clearly changed.
Dentists today rarely grant credit because they don’t
want to assume the risk. Patients are pushed to pay
in full or to use third-party financing.
In fact, many of the practice management consultants who are active today are recommending their
dental clients be “cash only” and only provide thirdparty financing (finance company, bank, credit card)
for their patients.
The result is simply horrible rates of case acceptance, postponed/phased treatment, more singletooth treatment than ever in the past, significant
increases in failed appointments, a reduction in the
number of new patient referrals and a net reduction in production per dentist hour worked in many
practices.
This defensive behavior is unnecessary because
credit granting, internal credit granting, is safer and
more productive today than it has ever been in the
past!
While choosing not to grant credit, to be a cashonly practice, solves some delinquency and cash
flow problems, that policy often makes other problems worse. Failed appointments do not improve
and often become worse because when money is
tied to appointments, patients often find good reasons to postpone or cancel the appointments, and in
more serious cases they simply become a “no show.”
Although collection rates are good, actual cash
flow does not improve because of the single biggest
problem with being a cash-only practice, weak case
acceptance.
If your patients are not having you perform the
work for conditions you have diagnosed, or if they
only accept work covered by insurance, your production will be down and cash flow will be down as
well. Ultimately, being a cash-only practice contributes to the biggest problem of all: poor referrals and
weak new patient flow.
Let me note that there is no legal, ethical or moral
reason why any dentist needs to grant credit. The
only reason to grant credit is the obvious and practical one: You will have more patients who will accept
more of your treatment recommendations.
It is not a coincidence that during the last three
years, while our economy has been less than stellar,
practices that routinely allow their patients monthly
payments for their treatment have experienced significantly less of an impact from the economy than
have the cash-only practices.
Appropriate credit granting is often the answer
to building a consistently growing, productive and
profitable practice. Of course, “appropriate” is the
operative word.
While you cannot afford to have your great
patients postpone their treatment because of your
financial policies, neither can you afford the financial loss and other problems associated with granting credit to the wrong patients.
Obtaining credit reports on patients was the
answer to this dilemma in 1980, and it is still the
answer today. The difference today is that learning
a patient’s potential risk to the practice is much less
expensive, less intrusive, less time consuming and

(Photo/Endostock, Dreamstime.com)
much more accurate than it has even been.
The Zuelke Automated Credit Coach (ZACC) is
a Web-based tool available from DentalBanc that
has been specifically designed for the dental profession. ZACC evaluates stability, maturity and credit
integrity in exactly the same fashion as a bank loan
officer, but ZACC does it in a few seconds.
Once ZACC has evaluated your patient/responsible party, ZACC assigns a credit grade and even
makes a recommendation regarding the most liberal
financial arrangement that you can safely offer the
patient.
Although ZACC reads and interprets every line
and every column on a credit report, a ZACC inquiry
does not affect a patient’s credit score nor does a
ZACC inquiry show up as an inquiry to your patient’s
other creditors.
You can grow your practice with safe and appropriate credit granting. Take a look at ZACC at www.
getzacc.com. DT

About the author
Paul Zuelke is president
and founder
of Zuelke &
Associates, a
management
consulting
firm specializing exclusively in teaching
credit management and
accounts
receivable control techniques to health-care
practices.
Zuelke’s extensive professional background in lending and corporate finance,
combined with 30 years of experience with
more than 1,000 client practices located
throughout the United States, Canada and
Australia, position him as a leading authority
in using effective credit management to build
a quality health-care practice.

[18] =>

18A Industry News

Integrate

verb [trans.]
1. combine (one thing) with another so that they become
a whole
Integrating the VibraJect® dental
needle accessory into one’s dental
practice and including it as an integral part of an established injection
protocol will result in measurable
benefits for both the practitioner
and patient.
Progressive dentists are proactive when it comes to the adaptation and integration of new dental
technologies into their practices.
The VibraJect dental needle
accessory easily attaches to virtually any aspirating or intraligamental
syringe to block the pain of dental
injections based on the principles
of the Gate Control Theory. Its
effectiveness has been documented
by a university study, the results of
which may be examined at www.
itldental.com/cmtdoc/Queens_
University_Study.pdf.
Fear of injection pain rates
high upon the list of excuses for
dental appointment cancellations

and no shows. Removing the pain
and stress of dental injections can
become fundamental to building a
practice and appointment regularity. Once the VibraJect has been
integrated into your current office
dental procedures, a significant
number of your patients will have
no excuse for avoiding necessary
dental care and treatment.
In addition, by integrating VibraJect into your injection protocol,
you will be increasing office value
to your patients. Satisfied patients
experiencing comfortable injections will not keep silent about
their pleasant new dental experiences, resulting in multiple referrals and an increased bottom line.
Long-lasting benefits of VibraJect are that it’s economical, easy
to use and does not require extended, valuable chair time. For more
information about VibraJect visit
www.itldental.com. DT

Tuttnauer unveils the Elara11
Tuttnauer, a global leader in
sterilization and infection control,
has introduced the Elara11 preand post-vacuum autoclave, the
newest addition to its line of autoclave products.
The Elara11, with its new 11
inch chamber, automatic doublelocking device, digital readout and
touch pad, brings a whole new
dimension to fulfilling the pre- and
post-vacuum sterilization requirements. Additionally, steam is continuously provided by an independent steam generator, virtually eliminating wait time between
cycles.
The Elara11 is a table-top European Class B sterilizer designed
for sterilizing medical and dental surgical goods, which includes
wrapped, unwrapped, solid, hollow, porous products and goods
defined as hollow A (dental hand
pieces and suction pipes).
AD

The Elara11 comes standard
with five FDA-cleared cycles plus
two test cycles — the Bowie Dick
Test and Vacuum Test — to meet
all of your sterilization needs.
The new design of the Elara11
provides the options of an easily
accessible front water-fill or top
water-fill with sight glass indicator. The Elara11 with its 7.5 gallon
sterilization chamber is the largest
table-top Class B sterilizer. It also
comes equipped with five stainless steel trays and there are no
requirements to reverse or replace
the rack to switch between trays or
cassettes. For more information,
visit www.tuttnauerusa.com. DT

Dental Tribune | April 2010

The Atlas Denture
Comfort System
Narrow implants require no surgical incision and no sutures
It’s been said that more
dentures can be found
in their rightful owner’s
bedside drawer than in
their mouth. In fact, eight
out of every 10 denture
wearers experience problems with the fit and function of their prosthesis.
It is known that loss of
all teeth causes disability
for most people who wear
conventional
dentures
because they have difficulty performing two of
the essential tasks of life,
eating and speaking.1
Eventually, ill-fitting
dentures compel patients
to seek repeated professional help to adjust the
fit.
The use of two to four
implants to support mandibular overdentures has
been shown to have high
success rates.2,3
For many patients, though,
financial constraints and health
issues limit ideal bone augmentation and conventional implant
placement.
The design of the Atlas ® Denture Comfort ™ System by Dentatus
considers all aspects of edentulism
and eliminates known deficiencies associated with conventional
O-ring and metal housing technologies, thus providing affordable comfort to the estimated 50
million edentulous patients in the
United States.
The very narrow implants of the
Atlas Denture Comfort technique
require no surgical incision and
no sutures.
Available in 1.8, 2.2 and 2.4 mm
diameters, they can be placed in
thin, atrophic ridges without the
need for grafting procedures.
What’s more, patients can walk
out of the office wearing their
refitted dentures right away. This
implant system is designed to
overcome financial, physical and
time limitations.
The denture is retrofit to create a “seamline” that encases the
Tuf-Link silicone reline material,
eliminating the need for adhesives. This allows the implants to
be placed at diverging angles.
The soft resilient Tuf-Link
material grasps on and around the
implant’s head providing a cushioned fit, all in less than an hour.
This proprietary design feature
is considered to be significantly
beneficial to both clinicians and
patients as the Tuf-Link can be
lifted out to scissor away excess
material and returned into its selfaligning position and hermetic

encapsulation in the base.
The easy removal of the liner,
as opposed to having liners that
are attached with various adhesives, prevents bacterial infestation and odor accumulation that
occur at the denture interface of
bonded liners.
Dentatus makes getting started
with Atlas Denture Comfort easy
with a half-day hands-on workshop.
You will learn step-by-step how
to drill osteotomies in the model,
install four Atlas implants, prepare the denture base for retrofitting and reline the denture with
the Tuf-Link silicone material.
Participants will keep the model
for staff training and patient education. DT

References
1. Adell, R., Lekhom, U., Rockler, B. et al. A 15-year study
of osseointegrated implants
in the treatment of the edentulous jaw. Int. J Oral Surg.
1981:10(6):387–416.
2. Feine, J., Carlsson, G. et al. The
McGill consensus statement on
overdentures. Mandibular twoimplant overdentures as first
choice standard of care for
edentulous patients. Mandibular 2-Implant Overdentures as
Minimum Standard of Care for
Edentulous Patients. Quintessence Publishing 2003.
3. Jemt, T., Chai, J., et al. A 5-year
prospective multi-center follow-up report on overdentures
supported by osseointegrated
implants. Int J Oral Maxilofac
Imp. 1996:11(3):291–298.

[19] =>

Dental Tribune | April 2010

Industry News 19A

Air abrasion unit from Velopex
fits many occasions
FenderWedge protects the
adjacent tooth. (Photo/
Directa)

FenderWedge
protects the
adjacent teeth
Directa has produced a
new generation of protective
wedges to protect adjacent
teeth during preparation of
Class II fillings to avoid the
problem of iatrogenic damage to teeth caused by accidental contact with the bur.
Bur damage to neighboring teeth is, sadly, a common
problem in everyday dental
practice. Research proves
that teeth are damaged in
more than two-thirds of all
cases during Class II preparations when a regular bur
is used.*
Directa’s FenderWedge is
a combination of a plastic
wedge and stainless steel
plate that prevent any possible contact between the
bur and tooth during preparation and other similar
procedures.
It is easily inserted from
the mesial or buccal side,
helping to ease the teeth
apart before the application of a matrix system, and
stays firmly in place during
the entire procedure.
The protective plate is
highly resistant and fully
protects adjacent teeth during preparation.
Directa,
which
was
founded in 1916 and is one
of a number of companies
in the industrial group Lifco
AB, is a subsidiary of the
privately owned Carl Bennet
AB group.
It is one of the fastest
growing dental manufacturing companies in the Nordic
region operating in over 90
countries worldwide. The
company exhibits at most
international dental trade
fairs. DT
Directa AB, Sweden
Tel.: (203) 788-4224
www.directadental.com
* Qvist V, Johannessen L,
Bruun M (J Dent Res 1992 Jul;
71 (7): 1370-3 Lussi A, Gygax
M. (J Dent. 1998 Jul–Aug; 26
(5-6):435–441), Medeiros VA,
Seddon RP (J Dent. 2000 Feb; 28
(2):103–110)

There are many uses of the Velopex Aquacut Quattro Fluid Air Abrasion Unit. Here are some of them:
• minimally invasive and cosmetic
dentistry,
• patient-friendly stain removal and
cavity preparation,
• fast, efficient cutting and cleaning,
• ideal for repair of composites.
The Aquacut Quattro will give
you greater control and flexibility
than any other piece of equipment
you own. Some of its other benefits
include:

• no vibration, turbine noise, heat
generation or smell,
• greatly reduced need for local
anesthesia,
• a handpiece that creates a fluid
curtain around the powder medium,
• a triple-action foot control that
speeds treatment by allowing cut,
wash and dry operations through
the same handpiece,
• no chipping or stress fracturing,
• minimal loss of sound tooth material. DT

The Aquacut Quattro and stand.
(Photo/Velopex)
AD

[20] =>

[21] =>

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

April 2010

www.dental-tribune.com

Vol. 3, No. 4

‘Desensitization’ therapy
By Juli Kagan, RDH

Dentin hypersensitivity is a
painful dental condition often left
untreated. Prevalence of dentin
hypersensitivity in the adult population can range from 8 to 30
percent, with the majority of the
sufferers between 25 and 45 years
of age.
Therefore, a clinician will see,
on an average day, between one
and three patients who show varying degrees of sensitivity. The condition is slightly more prevalent in
women and periodontally involved
patients.
With the population aging and
keeping their teeth longer, there
is an increased incidence for dentin hypersensitivity, recession and
periodontal disease.
Additionally, the majority of this
older population is on medications
that cause xerostomia. Differences
in salivary flow or composition may
contribute to the development of
hypersensitive dentin by affecting
the formation of the smear layer.
The occurrence of pain from
hypersensitive dentin can occur

when patients brush their teeth,
use dental floss, eat cold (or
hot) foods, drink iced beverages,
breathe in cold air and/or eat sour,
acidic, sweet or sugary foods.

The hypersensitivity mechanism
The exact mechanism of pain
transmission from the tooth surface to the pulp has not been completely proven, however the hydrodynamic theory proposed by Martin Brännstrom in 1963 has been
the most widely accepted.
Fluids move within the dentinal tubules in response to external stimuli. The fluid movement
transduces physical stimuli at the
surface and stimulates mechanoreceptors, thought to be the A-delta
fibers, found around the odontoblast process near the pulpal end
of the tubule.
The fluid in the tubules may
expand with heat and contract
with cold. The fluid flow in turn
excites nerve terminals at the
inner ends of the tubules or in the
outer layers of the pulp. This excitation of intradental nerves acts
on the central nervous system and

causes pain.
There are five different types of
stimuli that can trigger pain when
dentin is exposed: tactile (mechanical), chemical, thermal, osmotic
and bacterial.
Tactile stimulation can be attributed to toothbrush bristles or filaments, friction from dental clasps
or prosthesis, and metal objects
such as eating utensils or dental
instruments.
Chemical stimuli are possibly
the most overlooked triggers of
dentin hypersensitivity. Acids present in many foods and beverages,
such as citrus fruits, vitamins, condiments, spices, wine, sauces and
carbonated drinks should be suspect more than any other stimuli of
dentin pain.
Acid foods and drinks have been
shown to soften dentin and may
remove deposits on the dentin surface. Ascorbic acid, from chewable
vitamin C tablets, can even be a
stimulus.
Up to 90 percent of individuals
suffering from dentin hypersensitivity report that the effect of
a thermal stimulus, particularly a

cold stimulus such as breathing
through the mouth on a cold day or
consuming a cold drink, causes the
painful sensation associated with
sensitive teeth.
Osmotic flow within the dentinal
tubules is important; there may be
variations in the way in which different stimuli affect fluid flow.
Bacteria produce acid when fermentable carbohydrates are available; it is this acid by-product, as
it relates to demineralization or
root caries, which can also cause
sensitivity.
An increase or decrease in sensitivity may be attributed to the
mechanisms of metabolic breakdown and products the bacteria
produce.
Related to periodontal disease,
it is known that periodontal pathogenic organisms penetrate dentinal
tubules a considerable distance.22
Once in the tubule, the bacteria
may create a continual source of
sensitivity.
Patients with sensitive teeth
often have larger, more numerous
g HT page 2B

‘Focus on children’s oral health should be ongoing’
By Fred Michmershuizen, Online Editor

According to many dental health
care experts, more should be done to
improve the oral health of the nation’s
youngest patients. One group, the California Dental Hygienists’ Association
(CDHA), says protecting the smiles of
young children requires a year-round
commitment, not just a monthlong
event.
“Taking a month to spotlight this
issue is a wonderful opportunity to
better educate parents and the public,”
said Daphne Von Essen, president of
the CDHA, commenting on the recent
National Children’s Dental Health
Month, which was held in February.
“But this really needs to be something
we as a society focus on 365 days a
year because we have millions of California children suffering from insufficient oral health care.”
According to the CDHA, the most
vulnerable Californians are children in
low-income families who have limited
access to dental care, lack of dental
education and nutritional needs — all
of which result in a high cavity rate
in children. The greatest racial and
ethnic disparity is seen among chil-

dren ages 2 through 8, especially in
Hispanic, African American and rural
communities.
Early childhood caries is one of
the most common diseases in this
age group, according to the CDHA. By
conservative estimates, it affects more
than one out of seven preschoolers
and over half of California’s elementary school children. “Poor oral health
not only results in cavities but sets
in motion the potential for long-term
health risks,” said Von Essen.
Poor oral health has been associated with heart disease, diabetes,
potential strokes, along with low
birth weight and preterm deliveries,
she said. Oral health problems can
also lead to pain, poor nutrition and
development, impaired speech, loss of
employment, time away from school,
and low self-esteem.
To combat these problems, CDHA
is reminding parents, guardians and
caregivers to observe a few simple
rules:
• Make sure each child has a dental
visit by his or her first birthday.
• Children should not fall asleep
with a sippy cup or bottle containing
anything other than water.

• Avoid letting children drink juice
from a bottle.
• At birth, starting cleaning a child’s
gums with a soft infant toothbrush or
washcloth and water.
“Tooth decay is the most common
disease for children,” Von Essen said.

“And all it takes is a little education and
a toothbrush to combat it.”
During National Children’s Dental
Health Month, hundreds of dental
hygienists in California and across the
country participated in community outreach programs. HT
AD

[22] =>

News

Hygiene Tribune | April 2010

Dear Reader,
I have been thinking slightly
outside of the box with my clinical
practice for about six years now.
My thoughts began to take a different direction after I was exposed
to an amazing hygiene meeting
and the hygienists in attendance.
I returned from that meeting rejuvenated and vowed I would switch
things up a little bit. This was a difficult undertaking for me because
I am a very traditional thinker.
The first thing I did is begin
practicing without any ceiling
lights in my operatory. While my
patients loved it, the dental assistant thought I was “off my rocker!”
It took her a while to try this
concept, but once she did, she (and
the dentist) was sold. Now they
can’t imagine practicing with the
lights on!
Since this time I have incorporated more small steps to incorporate a bit of “Spa Hygiene” into my
practice. Patients are treated to a

back massage while getting their
teeth cleaned.
A bolster pillow is placed under
their knees to conform their lower
back to the chair and the massage
pad. An extra pillow placed under
their neck provides support while
their neck is arched. A fleece blanket is available for those who feel
chilled while receiving treatment.
Patients have become so accustomed to these small additions we
have incorporated them into the
other hygiene operatory. Patients
enjoy coming to their appointment.
It is a time to rest and relax. Many
times, they don’t want to leave.
Our office staff has created a
special niche because I ventured
out of the box. Then, eventually,
others joined me.
Don’t be afraid to open your
mind to something out of the ordinary and try something new. It
may be the beginning of something amazing! HT

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

Publisher & Chairman
Torsten Oemus
t.oemus@dental-tribune.com
Vice President Global Sales
Peter Witteczek
p.witeczek@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 Hygiene Tribune
Angie Stone RDH
a.stone@dental-tribune.com
Managing Editor/Designer
Implant Tribunes & Endo Tribune
Sierra Rendon
s.rendon@dental-tribune.com

Best Regards,

Angie Stone, RDH, BS

Have you been thinking ‘outside of the box’ and seeing wonderful
results? If so, share your story with us and it might be featured in
Hygiene Tribune! Please send stories to Group Editor Robin Goodman
at r.goodman@dental-tribune.com.

‘Prevalence of dentin hypersensitivity in
the adult population can range from 8 to 30
percent, with the majority of the sufferers
between 25 and 45 years of age.’
f HT page 1B
dentinal tubules.

Managing dentinal hypersensitivity
It is important to note that dentinal
hypersensitivity is a manageable
condition. Management includes:
(1) differential diagnosis to
determine that tooth pain is actually a result of dentinal hypersensitivity;
(2) prevent, modify, remove or
control etiologic factors such as
plaque, improper toothbrushing,
and a diet high in fermentable
carbohydrates and/or acidic foods;
(3) patient home care and product use and
(4) professional application of
desensitizing agents.
Diagnosing
root
sensitivity requires a careful history and
methodical dental and radiographic examination.
The clinician must first rule
out dental caries, pulpal pathology, vertical cracks, cracked cusps,
abfractions, leaking restorations
and/or teeth in hyperfunction.
Often, the dental hygienist is

the first practitioner to recognize
dentinal hypersensitivity. It is
imperative to document dentinal
hypersensitivity as a part of the
treatment record.
Testing for hypersensitivity
should be part of an initial examination and can be as simple as an
air-blast test.
Patients who experience hypersensitivity appreciate it when teeth
are dried carefully with gauze or
cotton rolls before using the air
syringe. It would be important to
have a pretreatment record for
sensitive teeth before periodontal
therapy.

Treatment agents
Two groups of agents can be used
in the treatment of dentin hypersensitivity: chemical or physical.
Chemical agents include:
• potassium salts (most commonly potassium nitrate);
• fluoride agents in concentration greater than found in dentifrices (with or without iontophoresis);
• sodium citrate;
• corticosteroids, silver nitrate;

• strontium chloride;
• formaldehyde and
• calcium hydroxide.
Physical agents include:
• composite, microfilled and
unfilled resins;
• sealants;
• dentin bonding agents;
• glass-ionomer cements;
• varnishes and soft tissue grafts.
Desensitizing agents may be
classified by their mode of action.
Agents act either by inactivating the
nerve or by occluding the tubule.
For example, potassium nitrate is
an agent that inactivates the nerve.
Potassium nitrate is the most
common desensitizer in dentifrices. At the concentration of 5 percent potassium nitrate, Sensodyne®
(GlaxoSmithKline, Jersey City,
N.J.), has been shown in clinical trials to significantly reduce
symptoms within two weeks when
applied on a toothbrush twice daily.
It works by allowing the potassium ions to penetrate the length of
the dentinal tubules and block repolarization of sensory nerve endings, reducing the pain response.
Frequent use is necessary to avoid
recurrence of symptoms. For this
reason, it is ideal via a dentifrice.
Potassium nitrate-containing
toothpastes include Aqua-fresh
Sensitive, Colgate Sensitive, Crest
Sensitivity Protection, Dental Care
Sensitive Formula; other products
for sensitive teeth are Protect Sen-

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.
Hygiene 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.
Hygiene 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 Hygiene Tribune? Let
us know by e-mailing feedback@dentaltribune.com. We look forward to hearing
from you!
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.

[23] =>

Clinical

Hygiene Tribune | April 2010
sitive Teeth Gel Toothpaste, Rembrandt Whitening Toothpaste for
Sensitive Teeth and Orajel Sensitive Pain Relieving Toothpaste for
adults.
All of these toothpastes contain fluoride to strengthen dental
enamel and protect against cavity
formation.
To ensure maximum compliance, patients should be advised
to select desensitizing toothpaste
similar to their current preference
— be it whitening, baking soda,
gel or tartar control, or a specific
flavor (such as fresh mint).
Patients should be advised to
read and adhere to the labeling
found on the product packaging. HT

References
• Abel I: Study of hypersensitive teeth and a new therapeutic
aid. Oral Surg Oral Med Oral Path
11(49) 1–5, 1958.
• Absi EG, Addy M, Adamn D:
Dentin hypersensitivity: the development and evaluation of a replica
technique to study sensitive and
nonsensitive cervical dentin. J Clin
Periodontol 16:190–5, 1989.
• Absi EG: Studies on the etiology, apprearnace and treatment of
hypersensitive dentin. PhD Thesis,
University of Wales College of Medicine. 1989.

• Addy M, Mostafa P, Newcombe
RG: Dentine hypersensitivity: the
distribution of recession, sensitivity
and plaque. J Dent 15:242–8, 1987.
• Adreins PA, DeBoever JA, Loesche WS: Bacterial invasion in rat
cementum and radicular dentin
of periodontally diseased teeth in
humans. A reservoir of periodontopathic bacteria. J Periodontol
59:222–9, 1988.
• Buckley LA: The relationships
between malocclusion, gingival
inflammation, plaque and calculus.
J Periodontol 1(52):35–40, 1981.
• Chabanski MB, Gillam DG, Bulman JS, Newman,HN: Prevalence of
cervical dentin sensitivity in a population of patients referred to a specialist periodontology department.
J Clin Periodontol 23:989–92, 1996.
• Chabanski MB, GillamDG, Bulman JS, Newman HN: Prevalence of
cervical dentin sensitivity in a population of patients referred to a specialist periodontology department.
J Clin Periodontol 23:989–92, 1996.
• DeBiase C: Dental Hygiene in
Review. Philadelphia, Lippincott
Williams & Wilkins, 353–354, 2002.
• DeBiase C: Dental Hygiene in
Review. Philadelphia, Lippincott
Williams & Wilkins, 353–354,
2002.
• Flynn J, Galloway R, Orchardson R: The incidence of hypersen-

sitive teeth in the West of Scotland.
J Dent 13:230–6, 1985.
• Kerns DG, Scheidt MJ, Pashley
DH, et al.: Dentinal tubule occlusion and root hypersensitivity. J
Periodontol 62:421–8, 1991.
• Mandel ID. The new toothpastes. J Calif Dent Assoc
1998;26(3): 186–190.
• Matthews B, Vongsavan N:
Interactions between neural and
hydrodynamic mechanisms in
dentin and pulp. Arch Oral Biol
39(suppl):S87–S95, 1994.
• Nagata T, et al.: Clinical evaluation of a potassium nitrate dentifrice for the treatment of dentinal
hypersensitivity. J Clin Periodon
21:217–221, 1994.
• Nagata T, et al.: Clinical evaluation of a potassium nitrate dentifrice for the treatment of dentinal
ypersensitivity. J Clin Periodon
21:217–221, 1994.
• Weinberg MA et al.: Comprehensive Periodontics for the Dental Hygienist, Upper Saddle River,
NJ, Prentice-Hall, 60–67, 2001.
• Weinberg MA, et al: Comprehensive Periodontics for the Dental Hygienist, Upper Saddle River,
NJ, Prentice-Hall, 332, 2001.
• Wilkins E: Clinical Practice of
the Dental Hygienist. Philadelphia,
Lippincott Williams & Wilkins,
595–601, 1999.

About the author

Devoted to life-long learning, dentistry and wellness, as
well as physical and mental
fitness, Juli Kagan, RDH, is
a certified pilates instructor,
with a master’s degree in educational psychology.
Fusing physical and mental fitness, along with nutrition and wellness, her energy
and enthusiasm are known
to transform knowledge into
practice. She recently wrote
“Mind Your Body: Pilates for
the Seated Professional.”
Visit Kagan’s Web sites at
MindYourBodyBook.com or
JuliKagan.com.

[24] =>

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[cover] => DT U.S.

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