DT U.S. 1509

Treatment acceptance: could have - should have - would have (entree) / Dentists and cardiologists should work together to prevent disease - experts say / Endo is on the menu at Dental Study Club of N.Y. / Treatment acceptance: could have - should have - would have / Five of the top 10 reasons why associateships fail / Greater N.Y. Dental Meeting’s Live Dentistry Arena attracts record number of attendees / Former hygienist now dentist - president of AGD / Dentistry meets ‘cloud computing’ match in DentalCollab by Modulus Media / Industry / Cosmetic Tribune 5/2009 / Hygiene Tribune 5/2009

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DENTAL TRIBUNE

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E

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

JULY 2009

www.dental-tribune.com

VOL. 4, NOS. 15 & 16

AGD Baltimore

Mutilated dentition

Gums gardening

Catching up with AGD President Paula Jones about the
upcoming meeting.

Full-mouth ﬁxed rehabilitation of mutilated dentition is a
clinical challenge.

Antimicrobials enhancing
the outcomes of nonsurgical
periodontal therapy.

XPage

XCosmetic Tribune

Treatment acceptance: could
have, should have, would have
By Sally McKenzie, CMC

When it comes to treatment
acceptance — or lack thereof — it
seems as though a lot of time and
energy are wasted on that familiar trio “could have, should have
and would have.” You spend hours
analyzing how things could have
been if you had just used a different approach. How things should
have been if you had just taken
more time to educate the patient on
why the treatment was necessary.
How things would have been if you
had listened more carefully to the
patient.
Oftentimes, dental teams mistakenly view the treatment presentation

as a one-time event that is a makeit-or-break-it situation. You either
win or you lose based on that 15
minute song and dance. In reality,
patient treatment acceptance begins
long before you sit across from him
or her eager to present the best that
your dentistry has to offer. Consider
our patient, Mary, who goes to Dr.
Smith’s ofﬁce.
“Dr. Smith’s ofﬁce is great for
cleanings and that, but he always
seems so rushed. He takes a quick
look at my teeth after the hygienist
cleans them and sends me on my
way. I want to ask about veneers,
but I never feel like I should bother

XHygiene Tribune

Journeés dentaires internationales du Québec

Participants in a hands-on workshop at the Journeés dentaires internationales
du Quebec, held May 23–26 in Montreal, learn about periodontics and esthetics. Read the event review online at www.dental-tribune.com/articles/content/
scope/news/region/usa/id/428. (Dental Tribune photo/Fred Michmershuizen)

J DT page 5

Fetter retires from National Museum of Dentistry

Rosemary Fetter, executive director of the National Museum of Dentistry for the past 10 years, is retiring.
“We have beneﬁted enormously
from her commitment and passion
for our museum,” said Board of Visitors Chair Michael Sudzina. “Under
her leadership, the National Museum of Dentistry has become the premier dental museum in the world.”
During Fetter’s tenure, the
National Museum of Dentistry
became an afﬁliate of the Smithsonian Institution and was designated
by Congress as the ofﬁcial museum
of the dental profession in the Unit-

ed States.
“I leave with a tremendous sense
of pride and appreciation for the
work of our friends, supporters and
staff in helping to bring the museum
to this level of accomplishment,”
said Fetter, whose retirement is
effective June 30.
The museum is located on the
campus of the University of Maryland Baltimore, home of the world’s
ﬁrst dental school.
To learn more about the museum,
visit www.smile-experience.org. DT
(Source: National Museum
of Dentistry)
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News

DENTAL TRIBUNE | JULY 2009

Dentists and cardiologists should work
together to prevent disease, experts say
By Fred Michmershuizen, Online Editor

The cooperation between the cardiology and periodontal communities is an important ﬁrst step in
helping patients reduce their risk of
these associated diseases, according to a consensus paper developed
by the American Academy of Periodontology (AAP) and The American
Journal of Cardiology (AJC).
“Inﬂammation is a major risk factor for heart disease, and periodontal
disease may increase the inﬂammation level throughout the body, said
Kenneth Kornman, DDS, PhD, editor of the Journal of Periodontology
and a co-author of the consensus
report. “Since several studies have
shown that patients with periodontal disease have an increased risk
for cardiovascular disease, we felt
it was important to develop clinical
recommendations for our respective
specialties. Therefore, you will now
see cardiologists and periodontists
joining forces to help our patients.”
The paper is published concurrently in the online versions of the
Journal of Periodontology (JOP), the
ofﬁcial publication of the AAP, and
AJC, a peer-reviewed journal circulated to 30,000 cardiologists.
Developed in concert by cardiologists and periodontists, the paper
includes clinical recommendations
for both medical and dental professionals to use in managing patients
living with, or who are at risk for,
either disease.

As a result of the paper, cardiologists may now examine a patient’s
mouth, and periodontists may begin
asking questions about heart health
and family history of heart disease.
Speciﬁc clinical recommendations include the following:
UÊ *>ÌiÌÃÊ ÜÌ Ê «iÀ`ÌÌÃÊ Ü
have one known major atherosclerotic cardiovascular disease (CVD)
risk factor — such as smoking,
immediate family history for CVD
or history of dyslipidemia — should
consider a medical evaluation if they
have not done so within the past 12
months.
UÊÊ«iÀ`Ì>ÊiÛ>Õ>ÌÊÃ Õ`
be considered in patients with atherosclerotic CVD who have signs
or symptoms of gingival disease,
signiﬁcant tooth loss or unexplained
elevation of hs-CRP or other inﬂammatory biomarkers.
UÊ Ê «iÀ`Ì>Ê iÛ>Õ>ÌÊ vÊ
patients with atherosclerotic CVD
should include a comprehensive

Tell us what you think!
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examination of periodontal tissues,
as assessed by visual signs of inﬂammation and bleeding on probing;
loss of connective tissue attachment detected by periodontal probing measurements, and bone loss
assessed radiographically. If patients
have untreated or uncontrolled periodontitis, they should be treated with
a focus on reducing and controlling the bacterial accumulations and
eliminating inﬂammation.
UÊ 7 iÊ «iÀ`ÌÌÃÊ ÃÊ iÜÞÊ
diagnosed in patients with atherosclerotic CVD, periodontists and
physicians managing patients’ CVD
should closely collaborate in order
to optimize CVD risk reduction and
periodontal care.
The clinical recommendations
were developed at a meeting held
in early 2009 of top opinion leaders
in both cardiology and periodontology. The consensus paper also
summarizes the scientiﬁc evidence
that links periodontal disease and
cardiovascular disease and explains
the underlying biologic and inﬂammatory mechanisms that may be the
basis for the connection.
Although additional research will
help identify the precise relationship between periodontal disease
and cardiovascular disease, recent
emphasis has been placed on the
role of inﬂammation — the body’s
reaction to ﬁght off infection, guard
against injury or shield against irritation. While inﬂammation initially
intends to have a protective effect,
untreated chronic inﬂammation can
lead to dysfunction of the affected
tissues, and therefore to more severe
health complications.
Cardiovascular disease, the leading killer in the United States, is a
major public health issue contributing to 2,400 deaths each day. Periodontal disease, a chronic inﬂammatory disease that destroys the bone
and tissues that support the teeth,
affects nearly 75 percent of Americans and is the major cause of adult
tooth loss. While the prevalence
rates of these disease states seem
grim, research suggests that managing one disease may reduce the risk
for the other.
“Both periodontal disease and
cardiovascular disease are inﬂammatory diseases, and inﬂammation
is the common mechanism that connects them,” said Dr. David Cochran,
DDS, PhD, president of the AAP and
chair of the Department of Periodontics at the University of Texas Health
Science Center at San Antonio.
“The clinical recommendations
included in the consensus paper will
help periodontists and cardiologists
control the inﬂammatory burden in
the body as a result of gum disease
or heart disease, thereby helping
to reduce further disease progression, and ultimately to improve our
patients’ overall health. That is our
common goal.” DT

DENTAL TRIBUNE
The World’s Dental Newspaper · US Edition

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Torsten Oemus
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Robin Goodman
r.goodman@dtamerica.com
Editor in Chief Dental Tribune
Dr. David L. Hoexter
d.hoexter@dtamerica.com
Managing Editor Implant
& Endo Tribune
Sierra Rendon
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Managing Editor Ortho Tribune
& Show Dailies
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Published by Dental Tribune America
© 2009 Dental Tribune America, LLC.
All rights reserved.
Dental Tribune strives to maintain the utmost
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If you ﬁnd a factual error or content that
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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

www.dental-tribune.com

[3] => DTUS1516_1-24.pdf

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4

News

DENTAL TRIBUNE | JULY 2009

Endo is on the menu at Dental Study Club of N.Y.
By Fred Michmershuizen, Online Editor

When it comes to stimulating dinner conversation, root canal therapy
is not typically considered the most
appetizing topic.
That is unless the room happens
to be ﬁlled with dentists who want
to be the very best. Add to that a
dynamic and entertaining speaker
with years of experience in proper
materials and methods of achieving
predictable success in endodontics,
and you have a most memorable
evening.
Dr. Jeffrey Linden, a New York
City-based endodontist, educator
and lecturer, presented “Revelations in Endodontics: Foundations &
Clinical Applications” at the Dental
Study Club of New York’s meeting
in May, held at the Harvard Club. In

attendance were 46 dentists, including both specialists and general
practitioners.
Linden’s presentation was entertaining as well as educational.
Included in his slide presentation
were pictures of Marilyn Monroe —
who, lecture attendees learned, has
a ﬁgure quite similar to the oftentroublesome apical third of a root.
Linden showed attendees how to
use rotary instruments to properly
clean and shape such shapely anatomy. He also discussed irrigation and
obturation techniques.
Made up of about 100 members,
the Dental Study Club of New York
is an active, thriving group of dental
professionals who are dedicated to
ongoing education and collaboration. Each monthly meeting features
a different topic and speaker. DT

www.dental-tribune.com
Missed the last edition of Dental Tribune? You can now read some
of its content online!
Leadership esentials for the ‘rookie’
By Sally McKenzie, CMC

Dr. Jeffrey
ff y Linden,, left,
f , is welcomed to the Dental Study
y Club off New York by
Dr. Steven J. Mondre and Dr. Michaelt Leifert. (Dental Tribune photo/Fred
Michmershuizen)

Cosmetic periodontal surgery: pre-prosthetic soft-tissue ridge augmentation (Part 1)
By David Hoexter, BA, DMD, FACD, FICD

White wine can increase tooth staining
Source: New York University

Here’s some other online content that might be of interest to you …
Informatics and IT in dentistry: a look forward
By Dr. John O’Keefe

AD

Interview with Dr Jolán Bánóczy, Hungary, about the basics of dentine
hypersensitivity
By Claudia Salwiczek, DTI

[5] => DTUS1516_1-24.pdf

DENTAL TRIBUNE | JULY 2009
I DT page 1
him with questions,” Mary says.
Dr. Smith, meanwhile, is befuddled when patients don’t accept recommended treatment. Yet he gives
little thought to the manner in which
he and his team build, or erode, the
foundation upon which successful
treatment acceptance is based.
In Mary’s case, Dr. Smith doesn’t
realize that he is undermining
Mary’s trust in his care. Mary will
be far less likely to proceed with
recommended treatment because
Dr. Smith has created the impression that he is always in hurry to
get to the next patient, which makes
her feel uneasy and unimportant.
Worse yet, Mary is interested in a
certain procedure but doesn’t even
feel comfortable asking about it.

It’s a matter of trust
Certainly, patients trust you enough
to come in for routine appointments.
But when the patient needs or wants
care that goes beyond “routine” procedures, have you and your team
instilled in the patient the conﬁdence, the dental education and the
necessary trust in you and your
practice overall for him or her to
accept the treatment recommended?
In some cases, patients are motivated to pursue treatment merely
because they seldom question rec-

ommendations from their health
care providers. But those patients
are growing fewer and farther
between each year.
Most patients today base major
decisions, such as extensive dental treatment, on multiple factors:
full comprehension of the need for
treatment; the importance of the
procedure to them in terms of quality of life, esthetics or health; possible ramiﬁcations if they choose to
procrastinate or elect an alternative
procedure; and how they feel about
the practice as a whole.

Recommendation acceptance
When it comes to treatment presentation, we ﬁnd that most dentists and
teams understand the fundamentals
of the concept, but they forget that
patients base their recommendation
acceptance on multiple factors.
In addition to always treating
every patient as if she or he is the
most important person in the room
with you, and always taking the time
to solicit questions from the patient,
consider a few other ways in which
you build trust with every patient
and at every opportunity.
Be candid. Most patients are
aware of some general risks in treatment so they are waiting for you to
be frank about what, if anything,
they might be faced with as a result
of the treatment. If they are given
advantages and disadvantages,

Practice Matters

‘don’t make the patient feel that
his mouth is a ‘mess’ ’
research shows that patients are
more willing to trust you to deliver
their care. Patients always feel better when they know the beneﬁts and
risks of proposed treatment.
Always speak at the patients’ level
of understanding. Jargon and “$10
words” can confuse patients and
make them uncomfortable because
they don’t understand, but they likely won’t ask you what you mean.
Exhibit clear conﬁdence in your
recommended course of treatment.
A personal testimonial about recent
treatment for another patient and
the results obtained, for example,
underscores that sense of security. It
demonstrates that you have no doubt
that you will get a good result for this
patient.
Be aware of the perception of
“fairness.” Many issues having to do
with trust are linked to the patients’
perception of the value they are
receiving. Studies show that patients
avoid dental treatment due to cost
more than pain. Yet, if they feel that
the costs measure up to the service received, there is no complaint.
Many patients will not question fees
if the practice has demonstrated that
they can deliver superior service.
From the ﬁrst phone call to dis-

missal, consistently demonstrate the
“value” for services that the patient
is receiving.
Many patients today expect more
than just a routine visit. They are
smart, savvy and are much more
aware of recent advances in dental care and treatment options than
patients 20 years ago. Numerous
patients would love to change something about their smile or improve
their oral health, but few will verbalize those desires without prompting.
Others have concerns, but don’t want
to appear foolish in raising them.
Yet, if new and existing patients feel
that the dentist and dental team are
sincerely interested in their needs,
wants and concerns, they are far
more likely to be open to the treatment recommended.

Encouraging acceptance
Follow these steps to set the tone for
patient treatment acceptance.
UÊ Ài>ÌiÊ >Ê VvÀÌ>Li]Ê
rushed environment when explaining
treatment. Don’t have the schedule
booked so tight that you are perceived as being in a rush. Patients
need to feel that they are important
J DT page 6
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6

Practice Matters

I DT page 5
and worthy of your time.
UÊ Ý«>Ê Ê Ã«iÊ >}Õ>}i
the reasons the procedures are necessary. Choose language that ﬁts the
ADS

DENTAL TRIBUNE | JULY 2009

patients educational level of understanding and speak slowly, using
pictures to illustrate.
UÊ Ý«>Ê Ì iÊ ÃÌi«ÃÊ vÊ Ì iÊ «ÀVidures and how many appointments
and how long each appointment will
take. Explain to the patient how you

will make her/him comfortable during treatment and what options are
available, such as anesthetic.
UÊ ÃÊ Ì iÊ «>ÌiÌÊ µÕiÃÌÃÊ ÌÊ
detemine if she/he has any false ideas
about treatment. (Many patients
still think that root canal therapy
involves removing the roots.) Use
educational tools, such as chairside
videos or other visual aids. When
using video or other educational
aids, summarize what the patient
has viewed and ask if there are any
areas that need further explanation.
UÊ iÊ i«>Ì iÌVÊ ÌÊ Ì iÊ «>ÌiÌ½Ã
concerns about the condition of the
teeth. Don’t make the patient feel
that his/her mouth is a “mess.”
Patients who have postponed dental care are often embarrassed
and don’t want to be perceived as
neglectful or hopeless. Encouragement coupled with kind words can

™

build trust and respect.
UÊ Ý«>Ê >ÌiÀ>ÌÛiÃÊ ÌÊ Ì i
treatment. Make sure the beneﬁts
and the possible risks to the procedures are understood. Informed
consent in writing is necessary
when there are risks and when the
outcome could be less than favorable.
UÊ Ê Ì iÊ «>ÌiÌÊ Ê Ì iÊ iÞiÊ
when discussing treatment. Sit at the
same level as the patient and lean
slightly forward to show interest and
care. You will be able to listen to and
observe the patient’s response more
readily.
UÊ -iÊ >`Ê `Ê ÞÕÀÊ i>`Ê Ê
understanding as the patient
responds to the presentation. This
is proof to the patient that you are
truly listening to each word said.
UÊ iÛiÀÊ ÌÕÀÊ >Ü>ÞÊ vÀÊ Ì iÊ
patient while she/he is speaking. Not
only is this rude, but it also shows
that you are not listening to what the
patient is telling you.
Certainly, presenting treatment
to patients requires skill and understanding of patients’ needs. Many
people learn these skills by trial and
error, which can be quite costly. If
treatment acceptance is a struggle
among either new or existing
patients, or both, it’s time to ﬁnd out
exactly where this critical system is
breaking down. DT

About the author

Sally McKenzie is CEO of
McKenzie Management, which
provides success-proven management solutions to dentistry
nationwide. She is also editor of
The Dentist’s Network Newsletter, www.thedentistsnetwork.net;
the e-Management Newsletter
from www.mckenziemgmt.com;
and The New Dentist™ magazine,
www.thenewdentist.net. She can
be reached at (877) 777.6151 or
sallymck@mckenziemgmt.com.

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Financial

DENTAL TRIBUNE | JULY 2009

Five of the top 10 reasons
why associateships fail
By Eugene W. Heller, DDS

The “American Dream” is still to
own a home. The “Dentist’s Dream”
continues to be the ownership of
a practice. Thirty years ago, the
dream was to graduate from dental
school, buy equipment, hang out a
shingle and start practicing. Today
the road to ownership is a little diff
ferent.
Due to extensive debt, most new
graduates enter practice as associates to improve their clinical skills,
increase their speed and proﬁciency
and learn more about the business
aspects of dentistry.
Most hope the newfound associateship will lead to an eventual ownership position. Instead, many ﬁnd
themselves building up the value
of their host dentist’s practice, only
to be forced to leave. This forced
departure is the result of a non-compete agreement when the promised
buy-in/buy-out doesn’t occur.
The following reveal the ﬁrst ﬁve
of the top 10 reasons many associateships fail to result in ownership
or partnership.

detailing the proposed equity acquisition.

Reason No. 3: insufﬁcient patient
base

If the purchase price has not been
determined before the commencement of employment, the parties
ﬁnd themselves on different ends of
the spectrum as to what the practice
is worth and what the buy-in price
should be.
When purchase price is established before the commencement
of employment, three out of four
associateships lead to the intended
equity position.
Conversely, if the purchase price
has not been determined, nine out
of 10 associateships lead to termination without achieving the ownership intended or promised.

Approximately 1,000–1,200 active
patients are required per dentist
in a dental practice. If the senior
dentist does not intend to restrict or
cut back on his/her number of available clinical treatment hours, then
the conversion from a one-dentist
to a two-dentist practice requires
an active patient base of approximately 1,400–1,800 patients and a
new patient ﬂow of 25 or more new
patients per month.
Many senior dentists count their
number of active patients by counting the number of patient charts on
a wall. However, the best way to estimate the active number of patients
involves utilizing the hygiene recall
count.
Insufﬁcient numbers of patients
and/or an insufﬁcient new patient
ﬂow signals that all expenses relating to the new dentist are coming
directly out of the bottom line. The
practice then begins to experience
ﬁnancial pressure.
Creation and maintenance of a
sufﬁcient patient base is an extremely important aspect of the business.
If the senior dentist is nearing retirement with the intent that, within
one to two years, the senior dentist
will turn over total ownership of
the practice and intends to cut back
shortly after the beginning of the
second dentist’s employment, this
problem is not as critical.
Often the senior dentist brings in
an associate dentist as the answer to
increasing business. A practice with
insufﬁcient new patient ﬂow that
experiences the addition of a new
practitioner may result in termination of employment for the associate.

Reason No. 2: the details

Reason No. 4: incompatible skills

The more items discussed and
agreed to in writing beforehand,
the better the chance of a successful equity ownership occurring as
planned.
The written instruments should
be two speciﬁc documents — an
Employment Agreement detailing
the responsibilities of each party for
employment and a Letter of Intent

The incompatibility in clinical skills
between practitioners may include
the possibility of one practitioner’s
skill level being below standard, but
it may also include different practice philosophies. On the surface, it
would appear that having different
skill levels and philosophies might
be desirable. In reality, the patient
base available to the younger practi-

Reason No. 1: purchase price

Most hope the newfound associateship will lead to an eventual ownership
position. Instead, many ﬁnd themselves building up the value of their host
dentist’s practice, only to be forced to leave.

tioner may not lend itself to various
types of dentistry.

Reason No. 5: timeframe
The failure to identify when the
buy-in or buy-out is to occur and
when to execute it can result in failure to achieve an ownership status.
The Letter of Intent may have
stated that the buy-in was to occur in
one to two years, but certain behaviors and signs during the continuing employment relationship might
give an indication that the senior
doctor is having difﬁculty honoring
the intended buy-out or that the
associate does not feel ready to consummate the transaction within the
original outlined timeframe.
Either position might result in the
demise of the buy-in as involved parties lose patience over such delays.

Summary
This article has been aimed primarily at a one-dentist practice
evolving to a two-dentist practice;
however, the issues apply equally to
larger group practices.
One-to-two-year associateships
with the senior dentist retiring at
the end of the associateship and a
three-to-ﬁve-year partnership ending with the new dentist purchasing the remaining equity position
of the senior dentist at the end of

ﬁve years can also beneﬁt from the
insights provided in this article.
Unfortunately, nothing can guarantee a successful outcome will
occur. However, by identifying the
potential pitfalls at the beginning of
the relationship, chances of success
can be greatly improved. DT

Look for the remaining ﬁve reasons in the next edition of Dental
Tribune.

About the author
Dr. Eugene W. Heller is a
1976 graduate of the Marquette
University School of Dentistry. He
has been involved in transition
consulting since 1985 and left
private practice in 1990 to pursue
practice management and practice
transition consulting on a full-time
basis. He has lectured extensively
to both state dental associations
and numerous dental schools.
Heller is presently the national
director of Transition Services
for Henry Schein Professional
Practice Transitions. For further
information, please call (800) 7308883 or send an e-mail to hsfs@
henryschein.com

www.dental-tribune.com

[9] => DTUS1516_1-24.pdf

09YS9681

When It’s Time to Buy, Sell, or Merge Your Practice

You Need A Partner On Your Side
ALABAMA
Birmingham- 4 Ops, 2 Hygiene Rms, GR $675K #10108
Birmingham Suburb- 3 Ops, 3 Hygiene Rooms #10106
CONTACT: Dr. Jim Cole @ 404-513-1573

ARIZONA
Shaw Low- 2 Ops, 2 Hygiene Rms, GR in 2007 $645,995
CONTACT: Tom Kimbel @ 602-516-3219

CALIFORNIA
Alturas- 3 Ops, GR $551K, 3 1/2 day work week #14279
Bakersfield- 7 Ops, 2,200 sq ft, GR $1,916,000 #14290
Central Valley- 4 Ops, 2,000 sq ft, 2007 GR $500K. #14266
Dixon- 4 Ops - 2 Equipped, 1,100 sq ft, GR $132K #14265
Fresno- 5 Ops, 1,500 sq ft, GR $1,445,181 #14250
Fresno- In professional park. Take over lease. #14292
Lindsay/Tulare- 2 practices, Combined GR $1.4 Mill #14240
Madera- 1,650 sq ft, 3 Ops, GR $449K #14269
Madera- 7 Ops, GR $1,921,467 #14283
Modesto- 12 Ops, GR $1,097,000, Same loc for 10 years
#14289
Oroville-3 ops 3 days of hygiene 2005 GR $338K #14178
Porterville- 6 Ops, 2,000 sq ft, GR $2,289000 #14291
Red Bluff- 8 ops, GR over $1Mill, Hygiene 10 days a wk.
#14252
Redding- 5 Ops, 1950 sq. ft. #14229
San Francisco - 4 Ops, GR 875K, 1500 sq. ft. #14288
San Marino- 6 Ops, 2,200 sq ft, 2008 GR $762K #14294
South Lake Tahoe- 3 Ops, 647 sq ft, 2007 GR $534K #14277
Thousand Oaks- General Prac, New Equip, Digital #14275
CONTACT: Dr. Dennis Hoover @ 800-519-3458

Chicago- 14 Ops, $2 Mill specility office, On site lab #22121
Chicago- Established Practice Looking for Dentist #22122
1 Hr SW of Chicago- 5 Ops, 2007 GR $440K, 28 years old
#22123
CONTACT: Al Brown @ 800-668-0629
Kane County- 4 Ops, building also available for purchase
#22115
Rockford Area-5 ops solid practice. Very good net #22118
CONTACT: Deanna Wright @ 800-730-8883

Eastern Kentucky-3 Ops, Good Hyg. Program, Growth
Potent.#26101
CONTACT: George Lane @ 865-414-1527

MAINE

OHIO

INDIANA
St. Joseph County- GR $270K on a 3 1/2 work week. #23108
CONTACT: Deanna Wright @ 800-730-8883

KENTUCKY

Auburn- Looking for Assoc.GR $2 Million #28111
Lewiston- GP Plus real estate, state of the art office #28107
CONTACT: Dr. Peter Goldberg @ 617-680-2930

MARYLAND
Southern- 11 Ops, 3,500 sq ft, GR $1,840,628 #29101
CONTACT: Sharon Mascetti @ 484-788-4071

MASSACHUSETTS

Grass Valley- 3 Ops, 1,500 sq ft, GR $714K #14272
Redding- 5 Ops, 2,200 sq ft, GR $1 Million #14293
Santa Rosa- Patient records sale - Appox 245 patients. #14286
Yuba City- 5 ops, 4 days hyg, 1,800 sq ft, GR $500K #14273
CONTACT: Dr. Thomas Wagner @ 916-812-3255
Sunnyvale- 3 Ops - Potential for 4th, GR $271K #14285
CONTACT: Kelly McDonald @ 831-588-6029

New Bedford Area- 8 Ops, $650K #30119
CONTACT: Alex Litvak @ 617-240-2582

CONNECTICUT

MICHIGAN

FLORIDA
Miami- 5 Ops, Full Lab, GR $835K #18117
Ocala- Associate buy-in #18113
Pensacola- 4 Ops, GR approx $550K, large lot #18116
Port Charlotte- General practice for sale #18109
Port Charlotte- 3 Ops, 1 Hygiene Room, GR $295K #18115
Southern- General practice for sale #18102
CONTACT: Jim Puckett @ 863-287-8300

GEORGIA
Atlanta Area- 2 Ops, 2 Hygiene Rms, GR $480K #19114
Atlanta Suburb- 3 Ops, 2 Hygiene Rms, GR $861K #19125
Atlanta Suburb- 2 Ops, 2 Hygiene Rms, GR $633K #19128
Atlanta Suburb- 3 Ops, 1,270 sq ft, GR $438,563 #19131
Dublin- Busy Pediatric practice seeking associate #19107
Mabelton- 6 Ops, GR $460K, Office shared with Ortho
#19111
Macon- 3 Ops, 1,625K sq ft, State of the art equipment
#19103
Near Atlanta- 2 Ops, 2 Hygiene Rms, GR $700K #19109
North Atlanta - Spacious Oral Surg. Office, GR 518K #19123
Northeast Atlanta- 4 Ops, GR $750K #19129
Northern Georgia- 4 Ops, 1 Hygiene, Est. for 43 years #19110
NW Atlanta Suburb- GR $780K, Upgraded Equip #19113
Savannah (Skidaway Island)- 4 Ops, GR $500K #19116
Savannah- Group practice seeking associate. #19108
South Georgia- 4 Ops, 1 1/4 acres #19121
South Georgia- 1,800 sq ft, GR 400K #19124
CONTACT: Dr. Jim Cole @ 404-513-1573

IDAHO
Boise- Dr looking to purchase a general dental practice #21102
CONTACT: Dr. Doug Gulbrandsen @ 208-938-8305

ILLINOIS
Chicago-3 Ops, Condo available for purchase #22108
Chicago-3 Op practice for sale #22108

NORTH CAROLINA
Charlotte- 7 Ops - 5 Equipped #42142
Foothills- 5 Ops #42122
Foothills- 30 minutes from Mtn. resorts #42117
Near Pinehurst- Dental emerg clinic, 3 Ops, GR in 2007
$373K #42134
New Hanover Cty- A practice on the coast, Growing Area
#42145
Raleigh, Cary, Durham- Doctor looking to purchase #42127
Wake County- 7 Ops, High end office #42123
Wake County- Beautiful Cutting Edge Digital Office #42139
Wake County- 4 Ops #42144
CONTACT: Barbara Hardee Parker @ 919-848-1555

Boston- 2 Ops, 2 Hygiene, GR $650K. #30113
Boston- 2 Ops, GR $252K, Sale $197K #30122
Lowell- GR $400K #30106
Middlesex County- 7 Ops, GR Mid $500K #30120
Somerville- GR $700K
Sturbridge- 5 Ops, GR $1,187,926 #30105
Western Massachusetts- 5 Ops, GR $1 Mill, Sale $512K
#30116
CONTACT: Dr. Peter Goldberg @ 617-680-2930

East Hartford- 2 Ops, GR $450K #16109
Fairfield Area- General practice doing $800K #16106
New Haven- Perio practice-associate to partner #16107
New Haven Area- Associateship general practice #16102
Southburg- 2 Ops, GR $250K #16111
CONTACT: Dr. Peter Goldberg @ 617-680-2930

Syracuse- 4 Ops, 1,800 sq ft, GR in 2007 over $700K #41107
CONTACT: Richard Zalkin @ 631-831-6924
New York City - Specialty Practice, 3 Ops, GR $400K #41109
CONTACT: Marty Hare @ 315-263-1313

Suburban Detroit- 2 Ops, 1 Hygiene, GR $325K #31105
Grand Rapids Kentwood Area- 3 Ops, Building available.
#31102
CONTACT: Dr. Jim David @ 586-530-0800

MINNESOTA
Crow Wing County- 4 Ops #32104
Hastings- Nice suburban practice with 3 Ops #32103
Minneapolis- Looking for associate #32105
Rochester Area- Looking for associate #32106
CONTACT: Mike Minor @ 612-961-2132

MISSISSIPPI
Eastern Central Mississippi- 10 Ops, 4,685 sq ft, GR $1.9 Mill
#33101
CONTACT: Deanna Wright @ 800-730-8883

NEVADA
Carson City- 5 Ops, 2 Hygiene, 2,200 sq ft, GR $1 Mill
#37105
CONTACT: Dr. Dennis Hoover @ 800-519-3458

NEW HAMPSHIRE
Rockingham County- 2 Ops, Home/Office #38102
CONTACT: Dr. Thomas Kelleher @ 603-661-7325

NEW JERSEY
Jersey City- 2 Ops, GR $216K, 2 days a week #39107
CONTACT: Dr. Don Cohen @ 845-460-3034
Marlboro- Associate positions available #39102
CONTACT: Sharon Mascetti @ 484-788-4071

NEW YORK
Bronx- GR $1 Million, Net over $500K #41105
Brooklyn- 4 Ops, 2 Hygiene rooms, GR $1 Million, NR
$600K #41108
Dutchess County- 80% Insurance, GR $200K #41106
CONTACT: Dr. Don Cohen @ 845-460-3034
Oneonta- 3 Ops, Approx 1200sq ft. #41101
CONTACT: Deanna Wright @ 800-730-8883
Putnam County-6 Ops, GR $1.7 Million #41102
CONTACT: Dr. Peter Goldberg @ 617-680-2930
Syracuse Area- 6 Ops all computerized, Dentrix and Dexis
#41104
CONTACT: Donna Bambrick @ 315-430-0643

Akron- Excellent Opportunity, 2,300 Active Pts, 6 days of
Hyg. #44141
Columbus- 4 Ops, FFS practice for sale #44125
Darke County- 35 yrs, 1200 Act. Pts, GR $330K #44139
Dayton- 10 Ops, Associateship with buy-in option #44121
North Eastern- 2 Yr. Old Facility, State of Art Tech. GR
$830K #44143
North of Dayton- 6 Ops, 15 days of hygiene/wk #44124
South of Dayton- 6 Ops, 4,000 sq ft, GR $3 Million Plus
#44145
Toledo- 2 Ops, GR $225K, Est in 1988 #44147
CONTACT: John Jonson @ 937-657-0657
Medina- Associate to buy 1/3, rest of practice in future.
#44150
CONTACT: Dr. Don Moorhead @ 440-823-8037

PENNSYLVANIA
Beaver County- Ortho practice for sale. #47118
Mon Valley Area- Practice and building for sale #47112
Pittsburgh Area - High-Tech, GR $425K #47135
Pittsburgh- 4 Ops, GR over $900K #47114
70 Miles Outside Pittsburgh- 4 Ops, GR $1 Million #47137
Northeast of Pittsburgh- 3 Ops, Victorian Mansion GR $1.2+
Mill #47140
Robinson Township Area- GR $300K #47108
Somerset County- 3 Ops, 2006 GR $275K+ #47122
Southside & Downtown Pittsburgh- 2 practices for sale.
#47110
CONTACT: Dan Slain @ 412-855-0337
Dauphin County- 6 Ops, GR over $1,100K, Sale price $718K
#47133
Harrisburg- 3 Ops, GR $383K, Listed at $230K #47120
Lackawanna County- 4 Ops, 1 Hygiene, GR $515K #47138
Lancaster County- Associate positions available #47116
West Chester- 3 Ops, 10 years old, asking $225K. #47134
CONTACT: Sharon Mascetti @ 484-788-4071

RHODE ISLAND
Southern Rhode Island- 4 Ops, GR $750K, Sale $456K
#48102
CONTACT: Dr. Peter Goldberg @ 617-680-2930
SOUTH CAROLINA
Charleston Area- 8 Ops fully equipped #49101
Columbia- 7 Ops, 2200 sq ft, GR $678K #49102
CONTACT: Dr. Jim Cole @ 404-513-1573

TENNESSEE
Chattanooga- For sale #51106
Elizabethon- GR $400K #51107
Loudon- GR $600K #51108
Spring Hill- 4 Ops, Good Hyg. Program, Fast Growing Town
#51103
Suburban Knoxville- 5 Ops #51101
CONTACT: George Lane @ 865-414-1527

VIRGINIA
Burgess- General practice #55101
Danville Area- 3 Ops #55105
Newport News- 2 Ops, GR $804,433, Est 1980 #55109
CONTACT: Bob Anderson @ 804-640-2373

For a complete listing, visit www.henryschein.com/ppt or call 1-800-730-8883
© 2009 Henry Schein, Inc. No copying without permission. Not responsible for typographical errors.

[10] => DTUS1516_1-24.pdf

10 Event Review

DENTAL TRIBUNE | JULY 2009

Greater N.Y. Dental Meeting’s Live Dentistry
Arena attracts record number of attendees

A total of 57,854 registered attendees during its 2008 meeting solidiﬁed the Greater New York Dental
Meeting (GNYDM) as the largest
dental convention and exposition in
the United States. Included in these

results were 17,710 dentists from all
50 of the United States and 123 countries around the globe.
The GNYDM has always been
known for its impressive array of
cutting-edge educational programs.

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Among the new additions initiated, the shining star was the Live
Dentistry Arena. While many dental meetings offer workshops where
attendees watch a pre-recorded surgery, the GNYDM led the way out
of the “recorded past” and into the
“living now.”
The new Live Dentistry
Arena allowed attendees to
feel as if they were seated
right beside the worldrenowned
clinicians
performing
procedures on patients in
real time. This unique
educational experience was conducted
directly on the exhibit
ﬂoor and was offered
with no tuition costs.
Multiple 60-inch displays were strategically
placed for easy viewing
around the Live Dentistry Arena while attendees
watched some of the most
highly respected educators
in the world conduct live patient
demonstrations. These procedures
featured the latest materials and
equipment available on the market.
The arena was ﬁlled on a ﬁrst
come, ﬁrst seated basis. This history-making program not only ﬁlled
the arena’s seating for 300 persons
during the entire four days of the
exhibition, but also had up to another 100 attendees standing or seated
on the ﬂoor outside the seating area.
The meeting offered eight unique
three-hour sessions: anterior and
posterior endodontics; anterior and
posterior composites, immediate
implants and loading; mini implants
and overdentures; veneer preparation, temporization, ﬁnishing and

cementation.
As general chairman of the
GNYDM, the ﬁrst dental meeting
offering this four-day extravaganza,
Dr. Clifford Salm commented: “The
chance to watch dental procedures
performed live, not prerecorded or on an inert
model, affords an amazing educational opportunity. We were thrilled to
showcase such a unique
program right on the
exhibit ﬂoor.”
Never wishing to
rest on its laurels,
the organizers of the
GNYDM have already
begun work to both
enhance the existing Live Dentistry
Arena, and to add a
second arena as well.
Many programs, including additional seminars
and workshops will also
be added to the redesigned
exhibit ﬂoor.
Be sure to watch the Web site,
www.gnydm.com, for information
and updates on this year’s Live Dentistry Arenas and all of the other new
programs offered at the 85th annual
meeting. Remember, there is never
a pre-registration fee.
Mark your calendar for Nov. 27 to
Dec. 2 to be a part of the excitement
of the 2009 Greater New York Dental
Meeting and experience all that New
York has to offer!
For additional information please
contact the Greater New York Dental
Meeting at 570 Seventh Ave., Suite
800, New York, N.Y., 10018-1806;
telephone (212) 398-6922; fax (212)
398-6934; info@gnydm.com. DT

www.dental-tribune.com

Illustration by Yodit Tesfaye Walker

[11] => DTUS1516_1-24.pdf

AGD Meeting 11

DENTAL TRIBUNE | JULY 2009

Former hygienist now dentist, president of AGD
In an interview with Dental Tribune, Dr. Paula Jones, president of the Academy of General Dentistry (AGD), discusses her love of dentistry, some of
the challenges facing dental professionals today and how the organization she leads is addressing these challenges
By Fred Michmershuizen, Online Editor

Would you please tell our readers a little bit about you and your
background?
I graduated from Indiana University in 1975 as a dental hygienist, and
after working for three years found
that I loved the practice of dentistry
so much that I wanted to be able to
perform more procedures. In order
to be able to perform more dental
procedures than I was allowed to do
as a hygienist, I knew that I would
have to attend dental school.
I took courses at night to achieve
all the requirements for dental
school and was accepted to Case
Western Reserve University in 1978.
One of my favorite instructors there
introduced our class to the AGD, and
I have been a member ever since. I
thought that I could not go wrong by
joining an organization that was all
about lifelong learning.
Once I heard about fellowship
in the AGD, that became my next
career goal after graduation. I am
proud to say that I did achieve this
personal goal in 1995 and received
it at the AGD Annual Meeting, which
was held in Baltimore that year.
So now I feel as if my dental
career has come full circle because I
will be leaving my presidential term
in Baltimore this coming July. I had
also received the AGD Distinguished
Service Award in 1995, so Baltimore
holds many fond memories for me.
What are some of the AGD’s shortand long-term goals?
Advocacy for general dentists and
our patients and membership go
hand-in-hand with our core competency of education. Our fellowship
and mastership are highly regarded
in the dental community and a personal goal of many of our members,
all of whom are dedicated to lifelong
learning. With dentistry in the minds
of policy makers in Washington as a
part of health care reform and in the
individual states with access to care
issues, it is more important than
ever that the AGD speaks for the
general dentist.
Advocacy has become a key goal
for the AGD, both now and in the
future. If general dentistry is to
retain its autonomy in a world of
change, then we must be at the discussion table, wherever that may be.
Advocacy is what our members are
demanding, and that is what we are
providing in many different ways.
We advocate for our patients as
well. Check out our consumer Web
site — knowyourteeth.com — to see
the beneﬁts and education that we
provide for the general public.
What can those who plan to attend
the upcoming AGD meeting in Baltimore expect?
Our Annual Meeting & Exhibits,

to be held in Baltimore July 8–12, is
the premier general dentistry event
of the year.
There are a number of new and
exciting highlights for our attendees this year, such as: joining AGD
at the University of Maryland Dental
School to experience cutting-edge
continuing dental education and
the cutting-edge facility; attending the opening general session
with keynote speaker Cal Ripken
Jr., Baseball Hall of Fame member, who played his entire baseball
career for the Baltimore Orioles;

participating in the AGD Premier
Celebration on Saturday evening;
networking at the welcome reception in the Exhibit Hall; and more
dental team courses to help train
teams in the best practices in dental care.
Free registration is available
for all dental students, residents
and recent graduates. Dental team
members also receive free registration when their dentist registers
for the full meeting. To learn more
about AGD 2009 Baltimore or to
register for this event, visit www.

agd.org/baltimore09/.
/
In your view, how is the current
economic downturn affecting
AGD members and their patients?
I have had many mixed messages from our members. Many are
severely affected by the economic downturn of our country, while
some say that they are as busy as
ever. The common thread seems to
be the fact that patients are not pursuing cosmetic dental procedures
like veneers and whitening as much
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[12] => DTUS1516_1-24.pdf

12 AGD Meeting

DENTAL TRIBUNE | JULY 2009

‘The preventive
practice is still
the gold standard’

I DT page 11

ticular area and unemployment is
high, this seems to be where the
dentists are most affected.

AGD President Dr. Paula Jones
and only agreeing to treatment that
is absolutely necessary, and many
are postponing the larger comprehensive reconstructive treatments
until the economy picks up.
One favorable issue for dentistry
is that it is a health care profession and health care is a necessity,
not usually an elective treatment.
There is still a huge need in the
general population for routine dental checkups and restorative treatment.
The downturn in treatment
acceptance and busyness among
dentists seems to be most affected
by a geographic consequence — if
the economy is very bad in a par-

What is something you would like
to see changed about the way dentistry is practiced today in the
United States?
I personally feel that the dental
team concept has served us, and our
patients, very well over the past 30
years that I have been involved in
practice. We as practitioners have
become more efﬁcient in the use
of our chair time and scheduling,
new and better dental materials and
with the use of expanded function
auxiliaries.
The preventive practice is still the
gold standard and the reason that
dentistry has been able to retain its
autonomy in the health care profession when the practice of medicine
has been specialized and splintered
to the detriment of patients everywhere.
The only thing I feel that makes
sense in changing the way dentistry

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is practiced is to try to achieve a better distribution of the existing dental
workforce. There are geographical
locations that are saturated with
dentists, while other areas of the
country are severely limited in the
number of practitioners or absent
any dental care at all.
I do not feel that a second tier of
dental practitioners is the answer to
the access problem.
We need the most well-educated
practitioners providing optimal care
for every patient, not to provide a
lesser educated practitioner — such
as a proposed midlevel provider —
for the segment of the population
who, due to socioeconomic factors,
are least able to afford to pay for
their dental care.
Is there anything you would like
to add?
Yes, thank you for asking. General dentistry today is at a crossroads
with threats on every side.
There are specialists who are
trying to restrict certain procedures
that general dentists have historically been trained to provide for
their patients.
There are the dental hygienists who are trying to develop the
advanced dental hygiene practitioner who will be able to perform irreversible procedures such as cutting
tooth structure, placing restorations
and extracting teeth.
There are government entities
that are trying to pigeonhole dentistry into the medical model and
revamp the ever-successful practice
of dentistry with the dental team
as the core into something like the
socialized and tiered practice of
medicine.
There are the dental schools
whose curriculums are turning out
general dentists who have never
extracted a tooth, never performed
any kind of periodontal surgery and
never placed an orthodontic bracket
on a live patient.
We as a profession need to be
vigilant and to speak with one voice.
The Academy of General Dentistry is the only organization that
speaks solely for the general dentist.
We encourage membership in the
American Dental Association as well,
but know this — if we do not stick
together as a profession we will be
torn apart by the forces mentioned
above that would like nothing better
than to have general dentists as an
impotent group that directs the practice of dentistry by remote, electronic
means and to have as little contact
with the patient as possible.
For your readers that may think
this notion is farfetched, then maybe
you should move to Minnesota or
Maine, where this farfetched scenario is becoming a reality. DT
www.dental-tribune.com

[13] => DTUS1516_1-24.pdf

Industry 13

DENTAL TRIBUNE | JULY 2009

Dentistry meets ‘cloud computing’ match in DentalCollab by Modulus Media
Web-based software unites centralized, treatment management system with an online social networking system to create a ‘Treatment Workspace’
TORONTO, CANADA, June 8 —
Modulus Media, a Toronto-based
technology development and marketing company, announced the
June 26 launch of DentalCollab,
a Web-based software available
at www.DentalCollab.com, which
ﬁnally unites a centralized, treatment management system with an
online social networking system to
create the ideal “Treatment Workspace” for the ﬁeld of dentistry.
For those new to this terminology, the “cloud” in cloud computing
is a metaphor for the Internet. As an
expression, cloud computing entails
offering Web-based software services via the Internet where the data
and software are stored on servers
managed by the service provider.
Thus, cloud computing users do
not need to spend untold dollars
on hardware, software, upgrades or
ancillary support services, but need
only to pay for the services they use.
Some of the more trusted and
familiar cloud computing services
are online banking, e-mail accounts
such as Gmail™ or Yahoo! Mail®,
social portals such as Facebook and
MySpace and Internet-based photo
albums on sites such as Flikr® or
Webshots.
Similarly, DentalCollab is a
cloud computing service that allows
the dental community to not only
facilitate all aspects of treatment
management, but also to collaborate with specialists, consult with
patients, coordinate with referrals,
mentor or be mentored by peers and
share cases with labs and suppliers.
Through its creation of a shared
Treatment Workspace, DentalCollab allows practitioners completely secure patient information
management and includes seamless treatment planning, while also
facilitating networking with experts
anywhere on the planet who have a
computer with Internet access.
The Treatment Workspace is
an easily navigated mini-Web
page where all those involved in a
patient’s care can coordinate their
efforts as well as share and manage
vital information.
Additionally, the practice can
schedule appointments, follow-ups
and reminders, consult with patients
and manage multiple schedules for
even the busiest practice.
“Our comprehensive software
allows you to easily interface many
of your other programs such as
charting systems, digital X-rays and
patient ﬁnancing services, thus consolidating your information,” said
DentalCollab founder Shane Powell.
DentalCollab uses the same hardware and software security provisions that online banking providers use — end-to-end encrypted
data infrastructure; back-ups/data
redundancy; 24/7 system monitoring; permissions/roles-based user
management; and 256-bit bankgrade security certiﬁcates with a
$100,000 warranty.

Finally, dentists have a place to do
everything they need, and want, to
provide the utmost in treatment planning and meet the modern needs of
their techno-savvy patients by going
beyond the traditional method of
contact via telephone and snail mail.
Using DentalCollab means dentists can avoid costly software
upgrades, hardware upkeep and the
time wasted seeking out technical
support or repairs.
“The DentalCollab software functions like a basic Web page, so it
feels as if it is running on your own
computer. This translates into a
very short and fast learning curve,”
explained Powell.
DentalCollab saves practitioners

time and money. For more information, please visit the ofﬁcal Web site

at www.DentalCollab.com or e-mail
sales@dentalcolab.com. DT
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[14] => DTUS1516_1-24.pdf

[15] => DTUS1516_1-24.pdf

Industry 15

DENTAL TRIBUNE | JULY 2009

A partner in patient ﬁnancing
ChaseHealthAdvance, part of
Chase Card Services, a division
of JP Morgan Chase & Co., provides innovative patient ﬁnancing solutions with personal
service and advanced business
management tools.
As there have been recent
market developments in the
patient financing business,
ChaseHealthAdvance realized
that these developments may
put practitioners and their practices in need of a strong patient
ﬁnancing partner.
As part of Chase, ChaseHealthAdvance beneﬁts from the
strength and stability of more
than 200 years of ﬁnancial experience.
“I think everyone is feeling the strain in the economy
and is being careful in terms of
how they are managing their
ﬁnancial situation,” said Barry
Trexler, senior vice president,
ChaseHealthAdvance.
“Now more than ever is when

ﬁnancing can play a positive
role in enabling patients to
get dental treatment. Instead
of being confronted with a bill
that requires them to pay all of
it up front, patients have the
opportunity to pay with lowcost ﬁnancing over 12, 18 or 24
months with $0 down payment
required.”
ChaseHealthAdvance has
pioneered the most extensive online fee presentation
and ﬁnancing tools for dental
practices. Real-time activity
reports are available 24/7 for
each enrolled location.
An easy-to-use electronic
process for submitting credit
applications with instant credit
decisions, processing transactions and customized fee presentation tools help dentists and
their staff increase productivity.
Provider enrollment is free
and you can learn more at
www.Advance withchase.com
or by calling (888) 388-7633. DT

At the AGD Meeting
Free oral body inﬂammatory resource guide for AGD attendees
AGD attendees are invited to visit the ChaseHealthAdvance booth No. 1311 to
receive a free copy of “Evaluation and Management of the Oral Body Inﬂammatory
Connection Resource Guide.” The guide will enable dental practices to manage
and treat periodontal disease conservatively and provide the results of treatment
to the cardiologist/physician.
Included are standard examination reporting forms and correspondence that
can be sent directly to the treating physician. With this information, the physician
can be motivated to share at-risk patients with the dentist where possible to reduce
risk of present and future disease. The authors, Neil Gottehrer, DDS, and Marvin
Slepian, MD, will be presenting a full-day course on Friday, July 10, on the subject
at the 2009 AGD Annual Meeting. Gottehrer will also be available to speak with
attendees at the ChaseHealthAdvance booth on Saturday, July 11, from 11 a.m. to
1 p.m.
Visit ChaseHealthAdvance at booth No. 1311 during the AGD Meeting!

Crosstex responds to the
H1N1 (swine ﬂu) virus
* Vita is a trademark
of Vita Zahnfabrik

The fusion of composite
and adhesive technology
Fusio™ Liquid Dentin represents
the next generation in ﬂowable
composite technology. By effectively fusing together self-adhesive
and restorative technology into one
product, clinicians can now restore
teeth faster than ever, saving both
time and money.
Fusio Liquid Dentin’s ability to
tenaciously bond to both dentin and
enamel without a separate adhesive
opens up new possibilities for this
segment of restorative materials.
Pentron Clinical Technologies
Product Manager Jeremy Grondzik
states: “While it shares many of the
same indications as a traditional
ﬂowable composite, its use as a dentin replacement material or a selfadhesive base liner shatters previous perceptions of where and how
ﬂowable composites can be used.”
This new generation of ﬂowable
composite is priced similar to traditional premium ﬂowable composites
and is available in the popular Vita*
shades: A1, A2, A3 and B1.
Fusio Liquid Dentin is one of

the latest innovations from Pentron
Clinical Technologies, an established leader in the dental industry,
offering a wide variety of products to
suit your restorative needs.
As one of the pioneers of ﬁber
post and nano-hybrid composite technologies, Pentron Clinical
has successfully demonstrated its
commitment to the technological
advancement of dentistry.
The Pentron portfolio of innovative and award-winning dental
products includes: Flow-It® ALC™
Flowable Composite, Breeze® SelfAdhesive Resin Cement, BuildIt® FR™ Core Build-Up Material,
FibreKleer® Posts, Correct Plus®
Impression Materials and Artiste®
Nano Composite. For more information, call (800) 551-0283 or visit
www.pentron.com. DT

Pentron Clinical Technologies, LLC
53 North Plains Industrial Road
Wallingford, Conn. 06492
www.pentron-clinical.com

Crosstex® International, Inc., a
division of Cantel Medical Corporation, and one of the largest manufacturers and distributors of face
masks in the United States, is taking
an increasingly aggressive role in
meeting the demand for masks and
infection control supplies in light of
the recent H1N1 virus outbreak.
To keep pace with the recordbreaking global demand for its face
masks, Crosstex has doubled production of its entire face mask line.
In particularly high demand are
Crosstex Ultra Face Masks, which
provide one of the highest levels of
ﬁltration available. This surge in
orders of face masks — as well as
other ﬂu-related prevention supplies
such as the N95 Particulate Respirator, SaniTyze® alcohol-based hand
sanitizer and disinfectant wipes —
has come from distributors, health
care practitioners, private industry,
hospitals and government agencies
worldwide.
“Many people have asked how
we were able to mobilize so quickly.
The simple truth is that our parent
company, Cantel*, has been developing and marketing ﬂu preparation products, programs and consulting services for the past two
years with our help, which has been
immensely invaluable to the success of our current efforts,” states
Andrew Whitehead, vice president
of sales and marketing at Crosstex.
“Since we are dedicated to preventing the spread of infectious disease
in the health care community, we
also have a social responsibility to

help combat these threats when they
affect the general public,” continues
Whitehead.
As part of this ongoing commitment, Crosstex supports a wide
range of charitable organizations
worldwide, including Feed the Children Foundation, a private organization that supplies food and other
essentials to children and families
in all 50 states and in 32 foreign
countries. Crosstex recently donated
half a million masks to the organization, making it possible for it to be
prepared for the current H1N1 viral
threat.
Crosstex is also spearheading
public health education and awareness efforts. As part of these initiatives, Crosstex recently sponsored
a local professional sporting event,
where it distributed free SaniTyze
hand sanitizer to more than a thousand fans along with swine ﬂu prevention literature.
“Public education and involvement are essential to containing the
spread of infectious disease,” states
Whitehead. “Through the use of
simple common sense precautions
such as proper surface disinfection,
frequent hand washing and the use
of alcohol-based sanitizers, people
can cut their risks signiﬁcantly.”
For more information on how
Crosstex can help you protect yourself, your family and your practice or
business from infectious diseases,
visit www.crosstex.com. DT
*Cantel Medical Corp., Little Falls, N.J., is
listed on the NYSE, symbol CMN

[16] => DTUS1516_1-24.pdf

[17] => DTUS1516_1-24.pdf

COSMETIC TRIBUNE
The World’s Cosmetic Dentistry Newspaper · U.S. Edition
JULY 2009

www.dental-tribune.com

VOL. 2, NO. 5

Full-mouth prosthodontic rehabilitation
Combination of porcelain fused to metal and full ceramic restorations
By Ansgar C. Cheng & Elvin W.J. Leong,
Singapore

Full-mouth, ﬁxed rehabilitation
of a mutilated dentition is always a
clinical challenge. Accurate diagnosis,
prudent choice of prosthodontic materials, and meticulous treatment execution are essential for a successful
treatment outcome over a long period
of time. The prosthodontic treatment
of a partially edentulous oral cavity with loss of vertical dimension
of occlusion is presented. Innovative
prosthodontic materials were used in
this report.
Prudent clinical judgement and a
careful balancing of the risks and
beneﬁts of various treatment options
are essential for the long-term success of prosthodontic treatment. It is
known that the loss of vertical dimension of occlusion may pose signiﬁcant
clinical difﬁculties in prosthodontic
treatment. The re-establishment and
maintenance of a new vertical dimension of occlusion is seldom taught
in the undergraduate dental curriculum. Various methods have been
proposed for the assessment and reestablishment of treatment of the vertical dimension. In general, alteration
of the vertical dimension of occlusion
should be approached with great care
and excessive changes of the vertical dimension of occlusion should be
avoided.
One of the challenges in full- mouth
ﬁxed rehabilitation is obtaining an
accurate impression of multiple abutment teeth. Dental impressions sent
to commercial laboratories for conventional ﬁxed prostheses have commonly been found to be deﬁcient in
several respects. One of the major
deﬁciencies is that the prepared margins of tooth preparations are inadequately registered in the deﬁnitive impression. Because the master
blueprint for crown restorations is
the deﬁnitive impression, it is crucial that a good impression technique
be employed to obtain an accurate
impression that will allow fabrication
of precisely ﬁtting indirect restorations, which may in turn, determine
the restoration’s longevity. The optimal method of impression making
is to use as minimum an amount of
low-viscosity material as possible to
register ﬁne detail. The bulk of the
impression is made with high viscosity material.
This article describes the prosthodontic management of a mutilated dentition using different types of
conventional and implant-supported

Fig. 1: Pre-treatment intra-oral
frontal view
presenting with
attrition, loss of
posterior support, reduced
occlusal vertical
dimension and
compromised
esthetics.

Fig. 2: Pre-treatment orthopantomogram X-ray showing inadequate
endodontic ﬁllings, dental attrition
and inadequately restored teeth.

Fig. 3: Completed tooth preparations
for full coverage restorations
at the approximated treatment
occlusal vertical dimension. Note
the equi-gingival preparation
margins.

ﬁxed restorations.

Wide-vue, Teledyne Waterpik, Ft.
Collins, Colo.). Diagnostic wax-up
was carried out to restore the anterior teeth into proper form.
The resulting diagnostic waxup indicated an increase of vertical
dimension of 1.5 mm at the incisal
pin level. It was the author’s experience that such level of change of
vertical dimension required no practical need for prolonged provisionalisation before deﬁnitive prosthodontic treatment.

Clinical report
A 45-year-old woman presented with
multiple missing and discoloured
teeth.
The patient desired to restore function and aesthetics. She presented
clinically with moderate dental attrition, defective restorations, loss of
posterior support, loss of occlusal
vertical dimension and compromised
aesthetics (Fig. 1).
The pre-treatment radiograph
showed inadequate endodontic obturation, missing mandibular posterior teeth, over-eruption of maxillary
posterior teeth and attrition of the
incisors. In spite of the overall condition, the natural teeth were free from
active dental caries and periodontal
probing was within normal limits.
The mandibular posterior bone sites
were diagnosed as type 2 (Fig. 2).
The overall treatment plan included placement of endosseous implants
in the mandibular posterior area, reestablishment of the vertical dimension of occlusion, re-treatment of the
endodontically involved teeth and
placement of ﬁxed restorations in the
maxilla and mandible.
Maxillary and mandibular diagnostic casts were made of type IV dental
stone (Silky-Rock, WhipMix, Louisville, Ky.). The casts were mounted on
a semi-adjustable articulator (Hanau,

Because most of the teeth in the
maxillary arch required full coverage
restorations, ﬁxed partial dentures
were prescribed for the replacement
of the missing maxillary right ﬁrst
premolar and left ﬁrst molar. Upon
completion of endodontic treatments,
posterior teeth were restored with
post-and-core foundations prior to full
coverage restoration preparation.
Seven
endosseous
implants
(Nobelreplace, Nobel Biocare, Yorba
Linda, Calif.) were placed in the posterior mandible with the presence of
a prosthodontist. All implants were
placed with 45 Ncm insertion torque.
In order to establish anterior guidance13, the treatment indicated that
the restoration of the anterior teeth
should be completed before the completion of the implant restorations.
The anterior teeth were prepared in
the usual manner for complete coverage crown restorations (Fig. 3).
The left maxillary and mandibular
second molars were also prepared to
receive provisional restorations for
additional vertical dimension support. Margins of the tooth preparations were kept supra-gingival and
no gingival displacement procedures
on the prepared teeth were necessary. High-viscosity vinyl polysiloxane
material (Aquasil Ultra Heavy; Dentsply DeTrey GmbH, Konstanz, Germany) was carefully injected onto all
tooth preparations, ensuring that all
tooth surfaces, including the margins,
were recorded.
A stock tray loaded with putty
J CT page 2
AD

[18] => DTUS1516_1-24.pdf

Clinical

COSMETIC TRIBUNE | JULY 2009

I CT page 1

COSMETIC TRIBUNE
The World’s Dental Newspaper · US Edition

material (Aquasil Putty; Dentsply
DeTrey GmbH, Konstanz, Germany)
was seated over the entire dental arch
to make the deﬁnitive impression. A
centric relation record was made with
a vinyl polysiloxane material (Regisil
PB; Dentsply).
The development of the planned
deﬁnitive complete coverage, indirect restorations, were carried out as
usual on the deﬁnitive casts. All maxillary and mandibular anterior teeth
were restored with Cercon (Degudent
GmbH, Hanau, Germany) full-ceramic crowns (Fig. 4).
The completed anterior restorations were cemented in resin-modiﬁed
glass ionomer luting agent (Rely-X
Unicem, ESPE, St. Paul, Minn.). Provisional crown restorations (Luxatemp
automix, Xenith/DMG, Englewood,
N.J.) were placed on the left maxillary and mandibular second molars
at the established vertical dimension
of occlusion.
Maxillary posterior teeth were prepared for restoration with complete
coverage porcelain fused to metal
crowns with metal occlusal surfaces.
(Fig. 5) Mandibular posterior teeth
were restored with complete coverage
porcelain fused to metal crowns with
porcelain occlusal surfaces (Fig. 6).
Deﬁnitive maxillary and mandibular impressions were made using
the technique described earlier. The
development of the deﬁnitive posterior restorations were carried out
in the usual manner on the deﬁnitive casts. Splinted, cemented-type
porcelain fused to metal restorations
with porcelain occlusal surfaces were
prescribed for the implant supported
mandibular posterior crowns.
After the mandibular implant, abutments were torqued to 32 Ncm. The
abutment screw holes were sealed
with gutta-percha (Mynol; Block Drug
Corp, Jersey City, N.J.). All maxillary and mandibular posterior crowns
were cemented in resin-modiﬁed
glass ionomer luting agent (Rely-X
Unicem, ESPE, St. Paul, Minn.).

Discussion
This clinical report required an
increase in the occlusal vertical
dimension. It was thus necessary to
make impressions that register all
tooth preparations in the anterior segment simultaneously.
The patient desired a high level
of esthetics; full ceramic restorations
were chosen for all anterior restorations. Because the minimum core
thickness for this full ceramic system
is 0.4 mm, this enabled conservation
of tooth structure while achieving reasonable aesthetics simultaneously.
Traditional porcelain fused to
metal anterior crown restorations
require the placement of labial crown
margins within the gingival sulcus in
order to mask the hue and value transition between the root surface and
porcelain fused to metal restoration.
By prescribing full ceramic restorations, intra-sulcular placement of
crown margins on the labial surface
becomes less crucial from an aesthetic point of view.

Publisher
Torsten Oemus
t.oemus@dtamerica.com

Fig. 4 Completed
anterior full ceramic
crown restorations.
Additional occlusal
support was gained
by provisional restorations to the left maxillary and mandibular
second molar.

President
Peter Witteczek
p.witteczek@dtamerica.com
Chief Operating Ofﬁcer
Eric Seid
e.seid@dtamerica.com
Group Editor & Designer
Robin Goodman
r.goodman@dtamerica.com
Editor in Chief Cosmetic Tribune
Dr. Lorin Berland
d.berland@dtamerica.com
Managing Editor Implant
& Endo Tribune
Sierra Rendon
s.rendon@dtamerica.com

Fig. 5: Occlusal view
of completed deﬁnitive maxillary retorations. Note the metal
occlusal surfaces on
the posterior teeth.

Managing Editor Ortho Tribune & Show
Dailies
Kristine Colker
k.colker@dtamerica.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dtamerica.com
Product & Account Manager
Mark Eisen
m.eisen@dtamerica.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dtamerica.com
Sales & Marketing Assistant
Lorrie Young
l.young@dtamerica.com

Fig. 6: Occlusal view
of completed deﬁnitive
mandibular restorations with porcelain
occlusal surfaces.

C.E. Manager
Julia E. Wehkamp
E-mail: j.wehkamp@dtamerica.com

Dental Tribune America, LLC
213 West 35th Street, Suite 801
New York, NY 10001
Tel.: (212) 244-7181
Fax: (212) 244-7185

Fig. 7: Postoperative
radiograph showing
the combination of
prosthodontic treatment modalities. The
radio-opaque nature
of the full ceramic
restorations allow
radiographic assessment of restoration
ﬁt.

In this report, the anterior teeth
were essentially caries free, teeth
preparation margins were made at
the gingival level and gingival retraction procedures were eliminated. As
gingival retraction cord packing was
not required, there was less physical
trauma to the gingival tissues and
less clinical time was needed. This is
particularly beneﬁcial for thin gingival
biotypes.
Porcelain fused to metal restorations were used in the posterior teeth
because of their well documented
and long-term clinical track record.
In order to maximize the aesthetic
outcome, porcelain occlusal surfaces
were prescribed in the mandibular
teeth. In the maxillary posterior teeth,
metal occlusal surfaces were prescribed for its ease of fabrication and
superior structural strength.

report. A combination of full ceramic
restorations and porcelain fused to
metal restorations with metal and
porcelain occlusal surfaces enhances
the overall aesthetic outcome as well
as functional predictability. CT
(A complete list of references is available from the publisher.)

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@
dtamerica.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.

About the authors
Dr. Ansgar C. Cheng obtained his dental training from the University of Hong Kong,
his prosthodontics specialty training from Northwestern University and his Certiﬁcate in
Maxillofacial Prosthodontics from UCLA. He is a prosthodontist with Specialist Dental
Group™, Mount Elizabeth Hospital, Singapore, and an adjunct associate professor at the
National University of Singapore.
Dr. Elvin W.J. Leong obtained both his dental training and prosthodontics specialty
training from the National University of Singapore. He is a member in Restorative Dentistry (prosthodontics) of the Royal College of Surgeons (Edinburgh) and a fellow of the
Academy of Medicine, Singapore. He is a prosthodontist with Specialist Dental Group,
Mount Elizabeth Hospital, Singapore.
For correspondence, please contact:

Conclusion
The functional management of a complex prosthodontic rehabilitation is
always a clinical challenge. Various
restorative materials were used in this

Dr. Ansgar C. Cheng
3 Mount Elizabeth #08-10

Web site: www.specialistdentalgroup.com

Singapore 228510

E-mail: drcheng@specialistdentalgroup.com

Republic of Singapore

[19] => DTUS1516_1-24.pdf

A Fusion of Composite &
Adhesive Technology!

Introducing Fusio™ Liquid Dentin, the flowable composite that
tenaciously bonds to both dentin (25.5 MPa*) and enamel (22.7
MPa*) without acid etching or a
bonding agent. By fusing together
adhesive and restorative technology into a single product, we’ve
created one of the most versatile
materials in dentistry. Whether
you use it as a dentin replacement, self-adhesive base liner, or
a pit and fissure sealant, it doesn’t get any easier than this.
Simply syringe into the preparation, agitate and light-cure. To find out
just how Fusio Liquid Dentin can improve the way you practice
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*Internal data. Offer expires June 30, 2009. Additional shipping charges may apply. Subject to change or cancellation without
notice. Orders subject to credit approval. Copyright © 2009 Pentron Clinical Technologies, LLC. All rights reserved.

[20] => DTUS1516_1-24.pdf

[21] => DTUS1516_1-24.pdf

HYGIENE TRIBUNE
The World’s Dental Hygiene Newspaper · U.S. Edition
JULY 2009

www.dental-tribune.com

VOL. 2, NO. 5

Pest control in gums gardening
Locally applied antimicrobials as adjuncts to nonsurgical periodontal therapy
By Sandra Pierce, RDH, MPH

Although the tip is somewhat bulky,
it can be modiﬁed with pressure
from the end of a mirror handle
and made ﬂat enough to insert into
a pocket.
UÊ º*>ÌiÌÃÊ ÜÌ Ê >`Û>Vi`Ê «iÀodontal disease, or smokers are 2
to 3 times more likely to respond
(than to placebo or control?),”
(Paquette 2004).

Success in gardening depends
partially on pest control. The use
of chemicals to inhibit pest growth
often yields a healthier crop. Periodontal therapy is to gums as pest
control is to soil.
The focused use of chemotherapeutics as antimicrobials can
enhance the outcomes of nonsurgical periodontal therapy, resulting in healthier mouths for our
patients.

Atridox
Two syringes are combined to
VÀi>ÌiÊ >Ê `ÝÞVÞViÊ }iÊ Ì >ÌÊ ÃÊ
iÝ«ÀiÃÃi`Ê Ì ÀÕ} Ê Ì iÊ V>Õ>°Ê
When it comes in contact with sulcular ﬂuids, the gel solidiﬁes. The
`ÝÞVÞViÊ ÃÊ Àii>Ãi`Ê ÛiÀÊ ÌiÊ
as the product biodegrades in the
pocket.

Introduction
The beneﬁts of chemotherapeutics
as adjuncts to nonsurgical periodontal therapy have been well
established. As a rule, locally
applied antimicrobials (LAAs) are
used in pockets with 5 mm or
greater depths. They can be placed
at the time of initial nonsurgical
therapy or as a secondary treatment for nonresponsive sites.
As adjunctive nonsurgical therapies have developed during the
last 30-plus years, several challenges presented themselves. The
antimicrobial products need to be
concentrated for an adequate time
in the treatment sites in therapeutic doses.
Although there are many antimicrobial mouth rinses, they do not
remain at adequate levels of concentration for a therapeutic length
of time. LAAs are another alternative.
LAAs are often a better choice
than systemic antibiotics in the
treatment of periodontal disease.
There are fewer risks and side
effects, such as upset to the gastrointestinal tract, systemic opportunistic infections, the development
of drug resistant bacteria, anaphylactic shock and patient compliance.
Systemic antibitotics are most
effective against individual bacteria. When they colonize into a
bioﬁlm, the antibiotics must be
250 times more concentrated to be
effective.
According to Wilkins (2009),
general characteristics of an
effective chemotherapeutic agent
should include:
UÊ ÌÝV\Ê Ì iÊ >}iÌÊ `iÃÊ ÌÊ
damage oral tissues or create systemic problems.
UÊ ]Ê ÀÊ Ìi`]Ê >LÃÀ«Ì\Ê Ì iÊ
action is conﬁned to the oral cavity.
UÊ -ÕLÃÌ>ÌÛÌÞ\Ê Ì iÊ >LÌÞÊ vÊ >Ê

Arestin placement.

agent to be bound to the pellicle
and tooth surface and be released
over a period of time with retention
and potency.
UÊ >VÌiÀ>Ê Ã«iVwVÌÞ\Ê >ÞÊ LiÊ
broad spectrum, but with an afﬁnity for the pathogenic organisms of
the oral cavity.
UÊ ÜÊ `ÕVi`Ê `ÀÕ}Ê ÀiÃÃÌ>Vi\Ê
low, or no, development of resistant organisms to the agent.

LAA summaries
Arestin
Microspheres of minocycline are
applied to the pocket in powdered
form. As ﬂuid circulates, the minocycline is released over a period
of time.
Disadvantages
UÊ ÀiÃÌÊ V>Ê LiÊ VÃÌÞÊ ÌÊ >««Þ]Ê
especially if it is needed multiple
times in multiple sites; there is
only one application per cartridge.
UÊ Ê Ì iÊ Ì>Ê ÃÌÕ`ÞÊ vÀÊ  Ê
approval, the product was applied
on three occasions.As sales representatives approached clinicians,
this fact was not disclosed and
clinicians failed to achieve similar
results, causing distrust with the
product.
UÊ*>ÌiÌÊ>VVi«Ì>ViÊÜiÌÊ`ÜÊ
when second and third treatments
were recommended.
UÊ / iÊ V>ÀÌÀ`}iÃÊ V>Ê VV>Ãally be faulty, and may be damaged
by the operator.

UÊÌÊÃÊiViÃÃ>ÀÞÊÌÊ >ÛiÊÃ«iVwVÊ
equipment to place (the syringe).
Advantages
UÊ -ÕLÃÌ>ÌÛÌÞÊ ÃÊ ÛiÀÞÊ }`]Ê >`Ê
the product can last up to 21 days.
UÊ / iÊ >««V>ÌÊ ÃÊ VÛiiÌ°Ê
ÌÊÃÊµÕVÊ>`Êi>ÃÞÊÌÊ«>Vi°
UÊ / iÊ «À`ÕVÌÊ `iÃÊ ÌÊ ÀiµÕÀiÊ
refrigeration, yet it has a good shelf
life.
UÊÌÊº>ÞÊLVÊV>}i>ÃiÃÊÌ >ÌÊ
are implicated in host tissue breakdown” (Oringer 2002).
UÊ / iÊ >««V>ÌÀÊ ÃÊ >`>«Ì>Li°Ê
The cartridge can be bent to accommodate correct insertion angles.

Disadvantages
UÊ / iÊ «À`ÕVÌÊ >ÃÊ ÌÊ LiÊ Ýi`Ê
chairside 100 times, which can be
time consuming. (Some hygienists
>ÛiÊ Ì iÀÊ «>ÌiÌÃÊ ÝÊ ÌÊ Ü iÊ
they complete instrumentation, to
save time.)
UÊ / iÊ ÃÌVÞÊ >`Ê ÛÃVÕÃÊ >ÌÕÀiÊ
of the gel can cause it to stick to the
application canula, and be pulled
out as the canula is removed from
the pocket. This makes it somewhat
technique sensitive.
UÊ / iÀiÊ >ÛiÊ LiiÊ >iV`Ì>Ê
Ài«ÀÌÃÊ vÊ Ì iÊ >ÌÀÝÊ ivÌÊ Li `Ê
>vÌiÀÊÌ iÊ`ÝÞVÞViÊ >`Ê`ÃÃÛi`°Ê
Those remnants could potentially
harbor bacteria if left in the treated
site for a prolonged time.
UÊÊ>iÀ}VÊÀi>VÌÊÃÊ«ÃÃLi°
J HT page 3
AD

[22] => DTUS1516_1-24.pdf

2

Editor’s Letter

HYGIENE TRIBUNE | JULY 2009

HYGIENE TRIBUNE

Dear Reader,
When you read an article in a
book or magazine or newspaper,
do you ever wonder how the author
managed to get her writing printed
or, maybe more importantly, how
did she know what to write about in
Ì iÊ wÀÃÌÊ «>Vi¶Ê vÊ ÞÕÊ >ÀiÊ >Ê >Ã«Àing writer, these questions may
come to mind.
Dental hygienists have many
opportunities to write and there is
no shortage of topics! Talk to any
dental hygienist about the profession and she (or he!) will talk until
you ﬁgure out a way to gracefully
LÜÊÕÌÊvÊÌ iÊVÛiÀÃ>Ì°ÊvÊÞÕÊ
are a wannabe writer, listen to
people. Topics pop up left and right
AD

in everyday communications.
Better yet, listen to yourself
when you are having a discussion.
Subjects that make your voice raise
and make you speak faster are usu>ÞÊÌ }ÃÊÌ >ÌÊiÝVÌiÊÞÕ°ÊÊÊÜÕ`Ê
recommend writing about those
issues. When deciding on a topic,
take into consideration your pasÃÃ]Ê >Ài>ÃÊ vÊ iÝ«iÀÌÃiÊ >`Ê VÕÀrent hot topics.
The ﬁrst step is to sit down and
ÜÀÌiÊÃiÌ }\Ê°i°]ÊºÃi>ÌÊvÊ«>ÌÃÊ
ÌÊ Ãi>ÌÊ vÊ V >À]»Ê ÃÊ Ì iÊ iÝ«ÀiÃÃÊ
our group editor at Hygiene Tribune likes to use. Write about the
topic as you would speak about it
if you were talking to someone in
person.
Don’t worry about making everything perfect, just get your best

thoughts out as they come to you.
ÀÊ i]Ê ÞÊ LiÃÌÊ `i>ÃÊ ViÊ ÌÊ
iÊ>ÃÊÊ>ÞÊÊLi`Ê>ÌÊ} ÌÊÌÀÞ}ÊÌÊ
v>Ê >Ãii«°Ê Ê Ê ii«Ê >Ê ÌiÊ «>`Ê >`Ê
«iÊÊÞÊ} ÌÃÌ>`ÊÃÊÊV>ÊÜÀÌiÊ
thoughts down as soon as they pop
Õ«°Ê }ÕÀiÊ ÕÌÊ Ü iÊ ÞÕÊ }iÌÊ ÞÕÀÊ
best ideas, and make sure you have
pen and paper handy.
Ê V >i}iÊ ÞÕÊ ÌÊ >ÛiÊ ÃiÌ }Ê ÜÀÌÌiÊ LÞÊ Ì iÊ iÝÌÊ i`ÌÊ vÊ
Þ}iiÊ /ÀLÕi°Ê Ê Ì >ÌÊ i`Ì]Ê Ê
ÜÊÃ >ÀiÊÜÌ ÊÞÕÊÜ >ÌÊÌÊ`ÊiÝÌt
Best Regards,

Angie Stone, RDH, BS
Editor in Chief

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

Publisher
Torsten Oemus
t.oemus@dtamerica.com

President
Peter Witteczek
p.witeczek@dtamerica.com

Chief Operating Ofﬁcer
Eric Seid
e.seid@dtamerica.com
Group Editor & Designer
Robin Goodman
r.goodman@dtamerica.com

Editor in Chief Hygiene Tribune
Angie Stone RDH, BS
a.stone@dtamerica.com

Managing Editor Implant
& Endo Tribune
Sierra Rendon
s.rendon@dtamerica.com

Managing Editor Ortho Tribune &
Show Dailies
Kristine Colker
k.colker@dtamerica.com

Online Editor
Ài`ÊV iÀÃ Õâi
f.michmershuizen@dtamerica.com

Product & Account Manager
Mark Eisen
m.eisen@dtamerica.com

Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dtamerica.com

Sales & Marketing Assistant
Lorrie Young
l.young@dtamerica.com

C.E. Manager
Julia E. Wehkamp
E-mail: j.wehkamp@dtamerica.com
Dental Tribune America, LLC
213 West 35th Street, Suite 801
iÜÊ9À]Ê 9Ê£äää£
Tel.: (212) 244-7181
>Ý\ÊÓ£Ó®ÊÓ{{Ç£nx
Published by Dental Tribune America
© 2009 Dental Tribune America, LLC.
All rights reserved.
Hygiene Tribune strives to maintain utmost
accuracy in its news and clinical reports.
vÊ ÞÕÊ w`Ê >Ê v>VÌÕ>Ê iÀÀÀÊ ÀÊ VÌiÌÊ Ì >ÌÊ
requires clariﬁcation, please contact Group
Editor Robin Goodman, at r.goodman@
dtamerica.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
iÝ«ÀiÃÃi`ÊLÞÊ>ÕÌ ÀÃÊ>ÀiÊÌ iÀÊÜÊ>`Ê>ÞÊ
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@dtamerica.
com. We look forward to hearing from
you!

[23] => DTUS1516_1-24.pdf

Clinical

HYGIENE TRIBUNE | JULY 2009

3

I HT page 1

Locally Applied Antimicrobials Available in the U.S.
Product
name

Type of antimicrobial

Delivery method

Estimated
cost

Arestin

minocycline

powdered microspheres are
iÝ«ÀiÃÃi`ÊÌÊÌ iÊ
pocket

$15–20 per site

ÌÀ`Ý

`ÝÞVÞViÊ ÞV>Ìi

gel in preﬁlled
$11–69 per site
syringe with canula

PerioChip

V À iÝ`i
gluconate

dissolving chip
inserted with
forceps

Advantages
UÊ`ÊÃ>viÌÞÊÀiVÀ`°
UÊÌÊÃÊi>ÃÞÊ«>Vi`ÊÌÊÌ iÊ>Ýmum pocket depth due to the small
size of the application canula, and
its ﬂowability allows it to adapt to
root morphology.
UÊ/ iÀiÊ >ÛiÊLiiÊÊÀi«ÀÌÃÊvÊ
resistance to localized applications
vÊ`ÝÞVÞViÊÌÊ`>Ìi°
UÊ >ÃÌÃÊ Õ«Ê ÌÊ Ó£Ê `>ÞÃÊ ÌÀ`ÝÊ
Website).
UÊ7ÀÃÊÊÃiÀÃÊÕÃÌÊ>ÃÊÜiÊ
as nonsmokers (Ryder 1999).
UÊ ÌÃÊ ºivwV>VÞÊ V>Ê VÀi>ÃiÊ ÜÌ Ê
retreatment” (Lessem 2004).
UÊ ÌÊ >ÃÊ «ÀÛiÊ >««V>ÌÃÊ Ê
peri-implantitis (Renvert 2008).
UÊÌÊÃÊVÃÌÊivviVÌÛiÊLiV>ÕÃiÊiÊ
ÃÞÀ}iÊ V>Ê LiÊ ÕÃi`Ê Ê Õ«Ê ÌÊ ÃÝÊ
sites.
PerioChip
A ﬂat rectangular chip, similar
in appearance to a popcorn hull,
the product is placed in a pocket,
where it dissolves slowly, releasing
V À iÝ`i°
Disadvantages
UÊ / iÊ «À`ÕVÌÊ ÕÃÌÊ LiÊ ÀivÀ}iÀated before placement.
UÊ >`}Ê Ì iÊ V «Ê LiViÃÊ
more difﬁcult as it warms. The chip
loses its rigidity, and becomes difﬁcult to place.
UÊ/ iÊi>ÃÊvÊ`iÛiÀÞÊ«ÀiÛiÌÃÊ
taste alterations and tooth staining,
V«>Ài`ÊÌÊV À iÝ`iÊÀÃiÃ°
UÊ iV>ÕÃiÊ Ì iÊ V «Ê ii«ÃÊ ÌÃÊ
basic form, it tends to become displaced or lost before the antimicrobial action is complete.
UÊ/ iÊ«À`ÕVÌÊViÃÊÊ>ÊÃ >«iÊ

$15–20 per site

that is not ideal for all pockets.
UÊ / iÊ V «Ê ÃÊ ÌÊ Ü`iÊ vÀÊ >ÞÊ
pockets.
UÊ / iÊ V «Ê `iÃÊ ÌÊ VvÀÊ ÌÊ
root morphology, especially in furcations.

PerioChip placement.

Advantages
UÊ7 iÊÌ iÊÃÌiÊÃÊ`i>]ÊÌ iÊ
product is quick to place.
UÊ ÊÃ«iV>ÊÌÃÊ>ÀiÊÀiµÕÀi`ÊÌÊ
place the chip.
UÊ ÌÊ >ÃÌÃÊ ÛiÀÊ ÃiÛiÊ `>ÞÃÊ «iÀÊ
package insert).

Considerations
With all of these antimicrobial
agents available to us, the question
can be how to decide which one to
use. The answer depends on practice philosophy, availability, cost,
efﬁcacy, anatomical considerations,
allergies and treatment planning.
Some insurance companies won’t
pay for periodontal surgery for up
to two years after a site has been
treated with an LAA.

PerioChip packaging.

Conclusions
Ê}>À`i}]Ê>ÊÃii`ÊÕÃÌÊLiÊ«>Ìi`Ê Ê Ì iÊ «À«iÀÊ Ã°Ê ÌÊ ÕÃÌÊ LiÊ
watered, nourished and protected
from pests.
Dental hygienists are caretakers
of our patients’ health. With LAA,
VV>ÃÊV>ÊiÝ«iÌ>ÞÊi >ViÊ
the beneﬁts of nonsurgical periodontal therapy.
Come garden in the gums with
me! HT

A complete list of references is
available from the publisher.

About the author
Sandra Pierce has been a dental
hygienist for 14 years, the last 12 of
which have been spent in a periodontal
practice. She has ﬁlled several service roles, most recently as vice president of the Utah Dental Hygienists’
Association. A clinical instructor and
associate professor at Utah College of
Dental Hygiene, Pierce is known as
º/ iÊ ÕÃÊ >À`iiÀ°»Ê - iÊ iVÌÕÀiÃÊ
nationally on nonsurgical periodontal
therapies and dental hygiene issues.
You may contact her at:
Tel.: (801) 372-0430
E-mail: sandypierce_rdh@yahoo.com
Web site: www.thegumsgardner.com

Arestin syringe.
AD

[24] => DTUS1516_1-24.pdf

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[cover] => DT U.S. 1509

[toc] => Array ( [0] => Array ( [title] => Treatment acceptance: could have - should have - would have (entree) [page] => 01 ) [1] => Array ( [title] => Dentists and cardiologists should work together to prevent disease - experts say [page] => 02 ) [2] => Array ( [title] => Endo is on the menu at Dental Study Club of N.Y. [page] => 04 ) [3] => Array ( [title] => Treatment acceptance: could have - should have - would have [page] => 05 ) [4] => Array ( [title] => Five of the top 10 reasons why associateships fail [page] => 08 ) [5] => Array ( [title] => Greater N.Y. Dental Meeting’s Live Dentistry Arena attracts record number of attendees [page] => 10 ) [6] => Array ( [title] => Former hygienist now dentist - president of AGD [page] => 11 ) [7] => Array ( [title] => Dentistry meets ‘cloud computing’ match in DentalCollab by Modulus Media [page] => 13 ) [8] => Array ( [title] => Industry [page] => 15 ) [9] => Array ( [title] => Cosmetic Tribune 5/2009 [page] => Supplement1 ) [10] => Array ( [title] => Hygiene Tribune 5/2009 [page] => Supplement2 ) ) [toc_html] =>

Table of contents

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