DT U.S. 1610

‘Dental caries is not easily prevented or treated in the most susceptible children’ (entry) / AAE uses Root Canal Awareness Week to dispel myths / Three essential lessons for every new dentist / Simple estate and tax planning for dentists / ‘Dental caries is not easily prevented or treated in the most susceptible children’ / Event Preview / Industry News / Curve Dental receives ‘best of class’ technology award / Erosion comes to the fore / Industry News / HYGIENE TRIBUNE 7/2010 / LAB TRIBUNE 1/2010 (part1) / LAB TRIBUNE 1/2010 (part2)

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

June 2010

www.dental-tribune.com

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

Opening doors

Introduction of zirconia broadened design, application of all-ceramic restorations. u page 1B

Vol. 5, No. 16

LAB TRIBUNE
HYGIENE
TRIBUNE

HYGIENE TRIBUNE

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

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

A primer on air polishing

Using air and water pressure to deliver a slurry
of sodium bicarbonate.
u page 1C

Digital evolution

Designing multiple restoration types using one
dental CAD/CAM system.
upage 1D

‘Dental caries is not easily prevented or
treated in the most susceptible children’
An interview with Prof. Jill Fernandez and Drs. Neal Herman and Lily Lim of New York University
By Daniel Zimmermann,
Dental Tribune International

In July, pediatric dentistry specialists will gather in Pasay City, the
Philippines, for the seventh biennial congress of the Pediatric Dentistry Association of Asia.
Group Editor Daniel Zimmermann spoke with presenters Prof.
Jill Fernandez and Drs. Neal Herman and Lily Kim from the New
York University College of Dentistry
about their participation and recent
developments in the field.

The U.S. congress recently
approved a new proposal for
health care reform. In your opinion, what impact will this policy
change have on children’s dental
care?
Prof. Jill Fernandez: It is still too
early to know what the final health
reform bill will entail exactly, but
as of now it does include mandatory
pediatric dental care that requires
dental coverage be offered as part
of any essential benefits package
for children younger than age 21.
The new law will enable stand-

Secrets of success
for the new dentist

alone dental plans to offer dental
benefits as part of any health insurance exchange and/or subcontract
with medical plans.
The impact of this on the public
and the profession could be monumental — the message is to begin
oral health preventive interventions
early in the lives of children, and
that oral health is an integral part
of overall health.
The oral health of children in the
g DT page 11A

Dr. Lily Kim (middle) with colleagues bringing smiles to a child
after treatment. (Photos/Provided by
New York University)

NCOHF featured in
Wall Street Journal
By Fred Michmershuizen, Online Editor

So you’ve graduated from
dental school and are ready
to dive into private practice? Or perhaps you’ve
been out of school for a
year? Well, even if you’ve
practiced for 10 years
already, we’re willing to
bet you’ll find some pearls
of wisdom in this article by
Sally McKenzie.

National Children’s Oral Health
Foundation: America’s Toothfairy
(NCOHF) was recently featured in
a special section dedicated to oral
health in The Wall Street Journal. As
America’s Toothfairy, NCOHF is positioned to help shed light on the silent

epidemic of pediatric dental disease
and to help break its cycle.
NCOHF is a nonprofit organization
dedicated to raising awareness of and
fighting pediatric dental disease — the
No. 1 chronic childhood illness — by
facilitating delivery of compreheng DT page 3A
AD

g See page 4A

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[2] =>

2A
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News

Dental Tribune | June 2010

AAE uses Root
Canal Awareness
Week to dispel myths
By Fred
Michmershuizen,
Online Editor

Everyone’s
heard the jokes,
the
innuendos
and the comparisons to unpleasant things. NothWhen President Barack Obama used
ing can be so the phrase “as popular as a root canal”
bad, according to when outlining the many difficult chalpopular percep- lenges facing the nation in his first State
tion, as having to of the Union address earlier this year, the
undergo a root AAE cried foul. (Photo/Whitehouse.gov)
canal procedure.
(Except perhaps
an IRS audit.) That’s why every spring, the American Association
of Endodontists (AAE) holds Root Canal Awareness Week.
The idea behind the event, according to the AAE, is to help dispel long-standing myths about root canal treatment and increase
the public’s understanding of the procedure as one that is virtually
painless. The week also seeks to raise awareness of endodontics
as a specialty and highlight the importance of endodontists.
This year in particular, the AAE used its Root Canal Awareness
Week, held in the spring, to help encourage general practitioners
to refer more cases to endodontists and to help patients make
more informed decisions about whether to see a specialist.
With their use of advanced technologies and expertise in administering anesthesia, the AAE pointed out that endodontists perform
virtually painless root canal treatments that can last a lifetime. The
AAE also says that patients who require endodontic therapy should
ask general dentists about the benefits of consulting an endodontist, even if the GP does not recommend a specialist.
After all, the AAE pointed out, when it comes to many serious
health needs, family physicians turn to specialists such as cardiologists for heart disease and podiatrists for foot troubles. However,
when it comes to dentistry, general practitioners refer less than
half of patients who need root canals to colleagues who specialize
in the procedure, according to a recent survey by the AAE.
According to the survey, dentists refer an average of 46 percent
of root canal patients to endodontists, yet almost all general dentists surveyed, 94 percent, say they have a positive or very positive
perception of endodontists as well as the care they provide.
With more than 15 million root canals performed annually, the
AAE used Root Canal Awareness Week — which ran March 28 to
April 3 this year — to remind dental patients of the advanced training endodontists receive for this complex dental treatment.

Reacting to remark by Obama
Speaking of the public’s perception of root canal treatment, the
AAE did not let a negative reference to the procedure by President
Barack Obama in his first State of the Union address earlier this
year go unchecked.
Obama uttered the phrase “as popular as a root canal” when
outlining the many difficult challenges facing the nation. The
AAE pointed out that Obama unintentionally reinforced a myth
and outdated misconception about the “unpopular” nature of root
canal procedures.
“While we certainly understand the president’s intent, people
need to know that root canals don’t cause pain, they relieve it,”
remarked Dr. Gerald N. Glickman of the AAE, after Obama’s
address. “Root canals may sound daunting, but endodontists can
do this procedure quickly, efficiently and with virtually no pain
involved. The result is a restored natural tooth that can last a
lifetime.”
The AAE also explained that most root canal treatments can
be completed in one visit and are entirely comfortable. A national
consumer survey published in 2009 shows that an overwhelming
majority of root canal patients use positive words to describe the
experience.
According to a previous AAE poll, those who had a root
canal performed by an endodontist were six times more likely
to describe it as “painless” than those who had never had the
procedure. DT

DENTAL TRIBUNE
The World’s Dental Newspaper · US Edition

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

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

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

[3] =>

News

Dental Tribune | June 2010
f DT page 1A
sive pediatric oral health services and
eliminating this preventable disease
from future generations.
NCOHF draws on vast national
resources to secure and distribute
product and financial donations along
with innovative preventive programs
to a growing network of not-forprofit university- and communitybased dental clinics, health centers
and mobile programs throughout the
United States.
Christian J. Drake, chief operating
officer of NCOHF, told Dental Tribune that the exposure in The Wall
Street Journal, which appeared in the
paper’s Eastern edition on June 19,
helped shed light among members
of the public at large about the silent
epidemic.
“It is also tremendously valuable
to our work to help break the cycle
of its devastating effects through supporting our national network of affiliates, which provide vital prevention,
education and treatment services,”
Drake said.
Since 2006, NCOHF has distributed more than $6.5 million in direct
funding, donated dental products
and technical resources to the affiliate network to expand and enhance
critical oral health services for their
local communities. In only four years,
NCOHF affiliates have provided critical preventive, restorative and educational oral health services to more
than 1 million children.
The 10-year plan for the NCOHF
affiliate network includes treating
more than 5 million children through
more than 500 centers throughout the
United States and to begin providing
global support to developing nations.
In addition, NCOHF aims to educate and screen more than 20 million
children through schools, community events and ongoing, communitybased prevention activities.

Corporate donations
The NCOHF recently announced it
has received dental product donations from two of the largest dental
products manufacturers in the United
States.
Sybron Dental Specialties has
donated dental products valued at
more than $39,000 to NCOHF to provide vital dental treatment for children
from vulnerable populations. The
Children’s Dental Center of Greater
Los Angeles (TCDC), a member of the
NCOHF affiliate network, received the
donation of dental products to expand
and enhance oral health services for
underserved pediatric patients in the
Los Angeles area.
Like all community-based healthcare centers in the NCOHF affiliate network, the goal at TCDC is
to improve the oral health of local
families through comprehensive oral
health programs and services that
promote positive health behaviors
and treat the immediate oral health
care needs of underserved children.
Dan Even, president of Sybron and
past chairman of NCOHF, said: “As
an NCOHF founding underwriter,
Sybron is proud to support NCOHF

life-changing oral health programs
for underserved children. NCOHF
affiliates across the country continue
to show impressive results in their
efforts to provide quality, comprehensive care to the children who need it
most.”
“We are extremely grateful to Sybron Dental Specialties for their generous product donation to our affiliate
partner, The Children’s Dental Center,” said Fern Ingber, NCOHF president and CEO. “Sybron provided the
leadership gift to establish NCOHF
and continues to be a dedicated partner in our mission to eliminate children’s suffering from preventable
pediatric dental disease.”
In addition, DENTSPLY International donated dental products valued
at more than $163,000 to NCOHF in
2009 to provide vital dental treatment

for underserved children across the
country.
Twenty-two NCOHF affiliate
nonprofit oral health care centers
received donated dental products
throughout the year from DENTSPLY
Internationa.
Christopher Clark, president and
chief operating officer of DENTSPLY,
said: “DENTSPLY is proud to serve
as a longstanding partner for the
NCOHF affiliate network, providing
both financial and product support.
“NCOHF programs for underserved children meet the goals of
DENTSPLY’s corporate philanthropy
by improving dental prevention, education and access to care in our most
vulnerable children. Only by working
together can we eliminate the oral
health crisis plaguing our nation.”
“We are very grateful that DENTS-

3A

PLY has been a dedicated NCOHF
underwriting partner since our
founding in 2006,” Ingber said. “The
continued generosity of DENTSPLY,
through product donations as well
as financial and technical support,
has played a significant role in our
affiliates’ ability to reach more than
1 million children with prevention,
education and treatment services that
give them hope for a pain-free and
bright future.”
Thanks to generous corporate
underwriters such as Sybron, DENTSPLY and many others, 100 percent
of all contributions to America’s
Toothfairy go directly to fund lifechanging oral health care for the
children in the United States who
need it most.
More information about NCOHF is
available online at www.ncohf.org. DT
AD

[4] =>

Practice Matters

Dental Tribune | June 2010

Three essential lessons
for every new dentist
By Sally McKenzie, CEO

After years of schooling, thousands of dollars in tuition, hours
upon hours of clinics and exams,
and tests and on and on, finally
you entered the working world as
a dentist. Just you and the patients.
Wouldn’t it be great if it could
really be that simple?
It’s likely that it didn’t take you
long to realize that once your tour
in dental school was over, the
learning process had only just
begun.
Moreover, there are at least
three key lessons that were probably barely touched upon in the
dental school curriculum.

(Photo/Nruboc, Dreamstime.com)

Lesson No. 1: How to deal with
people
I’m not talking about the patients.
You’ve been trained to manage
them. I’m talking about the people
you see every day, the ones you
work with elbow to elbow, those
you depend on to represent you,
to make sure you have enough
money to pay your bills, to keep
your schedule on track, etc.
Obviously, I’m talking about
your team. Your success as a dentist is directly dependent upon
your employees’ success. Unfortunately, one bad hiring decision
can cost you a small fortune —
estimates range between 1.5 to 5
times annual compensation — it
can also damage patient relations,
staff morale and overall effectiveness of the practice.
Given what’s at stake, pay close
attention to Lesson No. 1: Do your
best to hire the best and never hire
under pressure. Follow these steps
and take a clear and measured
approach to ensure that every
employee you hire is the best fit
for your growing practice.
Assess the systems before you
bring in a new employee. If you’re
hiring an office manager, look at
business operations first. Are the
business systems, scheduling, collections, recall, etc., working efficiently? If not, this is your chance
to fix them, to integrate new protocols and establish up front how
you want these handled in your
practice.
Take 15 minutes. Set aside 15
minutes to think about what you
want the person in this position to
do. Make a list. Consider what you
are looking for in this individual.
Write a job description. Once
you’ve given some thought to the
position, update or write a job
description for the job tailored to
attract the employee you need.
Include the job title, job summary
and specific duties. This clarifies
what skills the applicant must pos-

sess and explains what duties she/
he would perform.
Cast a wide net. Develop an
ad and place it on multiple websites and in different publications.
Promote those aspects of the job
that will have the greatest appeal,
including money. Sell the position.
Keep the copy simple but answer
the reader’s questions — job title,
job scope, duties, responsibilities,
benefits, application procedures,
financial incentives and location.
Direct prospects to your website
to learn more about your practice
and the position.
Read the resumes; don’t just scan
them. Highlight those qualities that
match the position’s requirements.
Look for longevity in employment.
Be careful of those applicants that
only note years, such as 2008–
2009. Chances are this person was
hired in December of ’08 and fired
in January of 2009.
Watch for sloppy cover letters. The applicant may have poor
attention to detail. Flag resumes
with “yes,” “no,” or “maybe.” The
“yes” candidates are the first to be
considered.
Pre-screen applicants on the
phone. Address your most pressing
concerns up front. If there are gaps
in employment history, now is the
time to find out why. Ask the applicant what salary range she/he is
expecting. Listen for tone, attitude
and grammar on the phone, particularly if the position requires
handling patient calls. Based on
the applicant’s phone demeanor,
would this person represent your
practice well?
Prepare for the interviews. Conduct interviews using a written
set of standard questions for each
applicant so you are able to compare responses to the same questions.
Avoid asking any personal questions. Ask follow-up questions

based on the applicant’s responses. Jot down personal details to
keep track of who’s who. The candidate is likely to be on her/his
best behavior in the interview. If
the applicant doesn’t impress you
now, it will not get better after she/
he is hired.
Test for the best. Take advantage
of Internet testing tools that are
available to dentists. Such testing has been used in the business
sector for years to help companies
identify the better candidates for
specific positions.
Check ’em out. Once the interview and testing process has
enabled you to narrow the selection down to a couple of candidates, check their references and
work histories. This step can yield
tremendously helpful information
and will save you from multiple
hiring horrors.
Budget for training. Give your
new employee the tools and the
knowledge to achieve her/his best,
and you’ll both benefit significantly.
Above all else, when it comes to
staff hiring, make your decisions
based on real data, not a candidate’s sunny disposition or your
“gut feelings.”

Lesson No. 2: Lead your team to
excellence
If you’re frustrated by what you
perceive as average or below average team performance, determine
if you’ve given them the foundation to achieve the standards you
expect.
First, avoid the most common pitfall in leading employees: Assuming
that your staff knows what you want.
Don’t assume.
Spell out your expectations and
the employees’ responsibilities
in black and white, and do so
for every member of your team
g DT page 6A

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[6] =>

Practice Matters

f DT page 4A
from the beginning. Do not convince yourself that because they’ve
worked in this dental practice for
X number of years, they know how
you want things done.
They don’t, and they will simply
keep performing their responsibilities according to what they think
you want unless they are directed
otherwise.
Recognize the strengths and
weaknesses among your team
members. All employees bring
both to their positions. The fact
is that some people are much better suited for certain responsibilities and not others. Just because
“Rebecca” has been handling
insurance and collections for the
practice doesn’t mean she’s effective in those areas. Look at results.
Rebecca may be much more
successful at scheduling and recall
and would be a much more valuable employee if she were assigned
those duties. Don’t be afraid to
restructure responsibilities to
make the most of team strengths.
In addition, be open to maximizing
those strengths through professional training.
Give ongoing direction, guidance and feedback to your team so
that they know where they stand.
AD

Dental Tribune | June 2010

‘Give ongoing direction, guidance
and feedback to your team so
they know where they stand.’
Don’t be stingy. Give praise often
and appraise performance regularly. Verbal feedback can be given
at any time, but it is most effective
at the very moment the employee
is engaging in the behavior that
you either want to praise or correct.
Nip problems in the bud and
you’ll avoid numerous thorns in
your side. If an employee is not
fulfilling her/his responsibilities,
address the issue privately and
directly with her/him. Be prepared
to discuss the key points of the
problem as you see it as well as
possible resolutions.
Use performance reviews to
motivate and encourage your team
to thrive in their positions. Base
your performance measurements
on individual jobs. Focus on specific job-related goals and how
those relate to improving the total
practice.
Used effectively, employee
performance measurements and
reviews offer critical information
that is essential in your efforts to

make major decisions regarding
patients, financial concerns, management systems, productivity and
staff in your new practice.

Lesson No. 3: Keep your hands in
the business
Certainly, it doesn’t take long to
recognize that there are many hats
for the dentist to wear. The hat
that says “The CEO” is just as
important as the hat that says
“The Dentist.” It is critical that you
completely understand the business side of your practice.
There are 22 practice systems
and you should be well-versed
in each of them. If not, seek out
training for new dentists. The
effectiveness of the practice systems will directly, and profoundly,
affect your own success today and
throughout your entire career.
For starters, routinely monitor practice overhead. It should
breakdown according to the following benchmarks to ensure that
it is within the industry standard
of 55 percent of collections:
• Dental supplies: 5 percent
• Office supplies: 2 percent
• Rent: 5 percent
• Laboratory: 10 percent
• Payroll: 20 percent
• Payroll taxes and benefits: 3
percent
• Miscellaneous: 10 percent
Keep a particularly close eye
on staff salaries. Payroll should
be between 20 and 22 percent of
gross income. Tack on an additional 3 to 5 percent for payroll
taxes and benefits. If your payroll
costs are higher than that, they are
hammering your profits. Here’s
what may be happening:
• You have too many employees.
• You are giving raises based on
longevity rather than productivity/
performance.
• The hygiene department is not
meeting the industry standard for
production, which is 33 percent of
total practice production.
• The recall system, if there is
one, is not structured to ensure
that the hygiene schedule is full
and appointments are kept.
Maximizing productivity. Handin-hand with practice overhead
is production, and one area that
directly affects your production is
your schedule. Oftentimes, new
dentists simply want to be busy,
but it’s more important to be productive. Follow these steps to
maximize productivity.
First, establish a goal. Let’s say
yours is to break $700,000 in clinical production. This calculates to
$14,583 per week, not including
four weeks for vacation. Working
40 hours per week means you’ll
need to produce about $364 per
hour. If you want to work fewer

hours, obviously per-hour production will need to be higher.
A crown charged out at $900,
which takes two appointments for
a total of two hours, exceeds the
per hour production goal by $86.
This excess can be applied to any
shortfall caused by smaller ticket
procedures. Use the steps below
to determine the rate of hourly
production in your practice.
The assistant logs the amount
of time it takes to perform specific
procedures. If the procedure takes
the dentist three appointments,
she should record the time needed
for all three appointments.
Record the total fee for the procedure.
Determine the procedure value
per hourly goal. To do this, take
the cost of the procedure (for
example, $900) divide it by the
total time to perform the procedure ($900 ÷ 120 minutes). That
will give you your production per
minute value (= $7.50). Multiply
that by 60 minutes ($7.50 x 70 =
$450).
Compare that amount to the
dentist’s hourly production goal.
It must equal or exceed the identified goal.
Now you can identify tasks that
can be delegated and opportunities for training that will maximize
the assistant’s functions. You also
should be able to see more clearly
how set up and tasks can be made
more efficient.
A career in dentistry is one of
the most personally and professionally fulfilling fields you can
choose. With the right team, clear
leadership and effective business
systems, you can enjoy tremendous personal success and lifelong
financial security for you and your
family. DT

About the author

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

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[8] =>

Practice Matters

Dental Tribune | June 2010

Simple estate and tax
planning for dentists
Failing to plan can have a devastating effect on your dental practice and your loved ones
By Stuart Oberman, Esq.

Statistically, 70 percent of all dentists will die without a will, and that
number could be higher for dentists
who fail to implement tax-saving
strategies during their lifetime.
A failure to plan could directly
affect the amount of estate taxes
your estate may be required to pay
to the IRS, and the amount of taxes
you may be required to personally
pay on a yearly basis. In some cases,
estate taxes may be substantial.
Outlined below is essential estate
planning and tax information you
need to know today, so you can plan
for tomorrow.

A properly prepared life insurance trust may protect your life
insurance proceeds from estate
taxes. A living trust is used to control your property while you are living and to avoid probate.

Make health-care directives
By creating a health-care directive,
you will be able to set forth in writing your health care wishes and
intentions.
Unless you outline in writing
your health care wishes and intentions (life support, coma, vegetative
state), someone other than a loved
one may be forced to make life and
death decisions for you.

Make a will

Make financial power of attorney

You should state precisely who will
receive your property at the time of
your death (i.e., spouse, children,
etc.). If you have minor children,
you should appoint a guardian for
your children. By preparing a will,
you not only plan for the distribution
of your property, but you also plan
for your children’s future.

A general power of attorney will
allow you to appoint a trusted person to handle your finances if you
are unable to do so yourself.
If you become incapacitated or
disabled, who has the authority to
handle the day-to-day operations of
your dental practice?

Consider a trust

If you have minor children, you
should appoint a trustee in your will
(or trust) to handle the disposition
of your children’s property in the
event of your death.
If you fail to plan, your children
may receive a substantial amount
of property (land, dental practice,
etc.) when they turn 18 years old.
How long would $500,000 last in the
hands of an 18 or 20 year old? Your
will (or trust) should state what

There are two kinds of trusts, an
irrevocable trust and a living trust.
An irrevocable trust may be used
for a variety of reasons, such as to
avoid potential estate taxes, as well
as asset protection.
If you have a life insurance policy, one of the easiest ways to avoid
estate taxes on your life insurance
proceeds is to establish an irrevocable life insurance trust (ILET).
AD

Protect your children’s property

age(s) you wish your children to
receive their property (21? 25? 30?)

File beneficiary forms
If you have a bank account or investment account, you may be able to
designate a beneficiary for those
accounts.
Many bank and investment
accounts are “pay on death
accounts,” which will allow the
funds in such accounts to be paid
directly to your designated beneficiary. In most cases, “pay on death
accounts” are excluded from the
probate process.

Consider life insurance
If you have substantial assets (home,
investments, dental practice), you
must have life insurance. However,
in order to avoid estate taxes (which
may be as high as 51 percent of your
estate), you should consider establishing an ILET (irrevocable life
insurance trust).

Understand estate taxes
If you have accumulated any type
of assets whatsoever (house, bank
account, investments, life insurance
and especially a dental practice),
you must take the necessary steps
in order to reduce your estate taxes.
You have worked hard all of your
life, and if you fail to plan, your family may lose everything.

Protect your business
If you are the sole owner of a dental
practice or have a partner, you must
have a business succession plan.

A succession plan should specifically outline what happens to your
dental practice or your ownership
interest in the dental practice at
the time of your death. If you have
a partner, you must have a shareholder’s agreement.

Store your documents
In order to ensure a smooth estate
planning transition, the following
records should be easily accessible:
• Will
• Trusts
• Insurance policies
• Real estate deeds
• Certificates for stocks, bonds,
annuities
• Information on bank accounts,
mutual funds and safe-deposit boxes
• Information on retirement
plans, 401(k) accounts or IRAs
• Information on debts: credit
cards, mortgages and loans, utilities
and unpaid taxes
As the owner of a dental practice,
you constantly deal with the dayto-day pressure (accounts receivable, employee problems, marketing, patients, etc.). In the rough
and tumble world of dental practice
management, don’t forget to manage your own estate.

Key estate planning numbers for
the year 2010
Estate tax reform: As of December
31, 2009, Congress had not yet acted
to reform the existing estate tax law.
g DT page 10A

[9] =>

[10] =>

10A Practice Matters
Proper estate planning
can be very easy.

Dental Tribune | June 2010
Traditional IRA and Roth IRA
The traditional IRA and Roth IRA
contribution limit for 2010 remains
at $5,000. The IRA catch-up limit is
$1,000 in 2010.

Personal exemption phase-out
f DT page 8A

onciliation Act of 2001.

Accordingly, as of Jan. 1, there is a
one-year repeal of the estate tax.
After 2010, unless Congress has
acted, the estate tax will revert
to the rules that existed before
the Economic Growth and Tax
Relief Reconciliation Act of 2001
where the highest estate and gift
tax bracket is 55 percent, and the
applicable exclusion amount is
$1,000,000.

Retirement plans/defined benefit
dollar amount

Annual gift tax exclusion
The gift tax annual exclusion
remains at $13,000 for 2010.

Generation skipping transfer tax
As of Jan. 1, there is a one-year
repeal of the generation skipping
tax. Congress may attempt to reform
the estate and generation skipping
tax law in 2010.
If Congress does not act, the generation skipping tax will revert to
the rules in effect before the Economic Growth and Tax Relief RecAD

For defined benefit plans in 2010,
the maximum benefit at age 65
under IRC Sec. 415(b) cannot
exceed the lesser of (1) $195,000 or
(2) 100 percent of the participant’s
average compensation for his/her
high three years of active participation.

Defined contribution annual
maximum
The annual limitation applicable to
defined contributions plans for 2010
remains at the lesser of (1) $49,000
or (2) 100 percent of the participant’s annual compensation.

Elective deferral limit for SIMPLE
IRAs and simple 401(k) plans
The limit on SIMPLE plan contributions remains at $11,500 in
2010. Catch-up contribution limits
for individuals age 50 and older is
$2,500.

Taxpayers are entitled to claim a
personal exemption for themselves
and for their dependents.
This personal exemption decreases their income subject to tax. The
personal exemption amount remains
at $3,650 for 2010. The personal

exemption phase out is repealed for
2010.

A final word
As with any type of estate planning
and yearly tax planning, you should
always seek the assistance of a CPA,
financial planner, your financial
advisor and an attorney.
Proper estate and tax planning
can be very easy. However, the consequences of failing to plan can have
a devastating effect on your dental
practice and your loved ones. DT

About the author
Stuart J. Oberman, Esq., has
extensive experience in representing dentists during dental
partnership agreements, partnership buy-ins, dental MSOs, commercial leasing, entity formation (professional corporations,
limited liability companies), real
estate transactions, employment
law, dental board defense, estate
planning, and other business
transactions that a dentist will
face during his or her career.
For questions or comments
regarding this article, visit www.
gadentalattorney.com.

[11] =>

Interview 11A

Dental Tribune | June 2010
‘ECC is a bacterial disease that requires
more than just filling up the holes.’
~ Dr. Neal Herman
f DT page 1A
United States is poor and caries
figures are at an all-time high.
What are the reasons for this?
Fernandez: Actually, the oral health
of children in the U.S. has improved
significantly over the past few
decades when you look at a national
sample across all age groups. Today,
most American children have excellent oral health, but a significant
subset suffers from a high level of
oral disease.
The most advanced disease is
found primarily amongst children
living in poverty, some racial/ethnic minority populations, children
with special needs and children
with HIV/Aids infection.
You might be referring to the
National Health and Nutrition
Examination Survey that demonstrated an increase in dental caries
from 24 percent to 28 percent in the
2- to 5-year-old group.
The reasons for this are presently
unclear, but this increase has reignited efforts in the U.S. to improve
access to care for this age group
and motivate more dentists to treat
very young children in our population.
Early childhood caries [ECC] has
increased not only in the U.S., but
also worldwide. Should this area
be considered a new priority in
pediatric dentistry?
Fernandez: Early childhood caries,
and efforts in the intervention and
treatment of early dental decay, has
always been a major priority.
In order to combat the current
national epidemic of ECC in young
children effectively, a more comprehensive, collaborative approach
to the education of parents by all
newborn and pediatric health-care
providers, such as nurses, pediatric and general dentists, dental
hygienists, pediatricians, pediatric
nurse practitioners, obstetricians
and gynecologists, is essential.
The American Academy of Pediatrics [AAP] began a collaborative
effort with pediatric dentists to
address the issue of ECC. The AAP
has made strides in developing educational programs for pediatricians
and family physicians to identify
at-risk children and refer them for
dental treatment.
However, for many children,
access to dental care remains a
problem and the number with dental caries seems to be growing.
Many parents do not have dental
insurance; thus, they postpone dental treatments until the problem is
so advanced that it can no longer
be ignored.
It is unfortunate that even parents who have third-party coverage
for dental care [Medicaid, Child
Health Plus] and are from lower

socioeconomic backgrounds often
fail to seek dental care as part
of general health-care services. As
a result, pre-school children with
Medicaid may still have untreated
decayed teeth.
Frequent bottle feeding at night
has been identified as a driving factor for ECC. Other studies have found a microbiological
connection between mother and
child, labeling ECC a transmissible disease. What is your opinion
on the latest research and how
will it affect the way children
should be treated?
Dr. Neal Herman: The nursing bottle is only one of many confounding
factors in ECC. What we conclude
from the latest research is that dental caries is highly complex and
perplexing, not easily prevented or
treated in the most susceptible children. It is believed these days that
there are nutritional, behavioral,
immunological and bacterial factors that must be considered in
order to understand and prevent
dental caries.
The surgical approach to ECC
— the “drill and fill” solution of
placing restorations in teeth as they
become cavitated — has long been
proven futile and often counterproductive. Therapeutic interventions, particularly utilizing fluoride
varnish, have shown promise in
preventing, arresting and reversing
carious lesions.
Much more work must be done
to document its success, but at least
this “medical model” has begun to
address the fact that ECC is a bacterial disease that requires more than
just filling up the holes that are
merely its symptoms.
Root-canal treatments in primary teeth are also becoming more
common. Does the treatment differ in any way from that of permanent teeth?
Dr. Lily Lim: We’re not sure that
pulp therapy is on the increase but
if it is, it’s probably because more
parents and dentists realize it’s best
to try to preserve a primary tooth
rather than extract it whenever possible.
The goals of treatment for primary teeth are not much different to that for permanent teeth. In
both cases, diseased portions of
the dental pulp are removed in an
effort to preserve the hard structure of the tooth for functional or
cosmetic purposes. Anatomical and
physiological differences between
primary and permanent teeth make
a difference to the principle of rootcanal treatment.
A permanent tooth requires an
inert, solid, nonresorbable material
that can last a lifetime, and guttapercha fits that bill.

Dr. Neal Herman

Prof. Jill Fernandez

The ideal root-canal filling material for primary teeth should resorb
at a similar rate to the primary root
in order to permit normal eruption of the successor tooth; not be
harmful to the underlying tissues
or to the permanent tooth germ;
fill the root canals easily; adhere
to the walls and not shrink; be
easily removed, if necessary; be
radiopaque; be antiseptic; and not
cause discoloration of the tooth.
There is currently no material
that meets all these criteria, but the
filling materials most commonly
used for primary pulp canals are
non-reinforced zinc-oxide-eugenol
paste, iodoform-based paste [KRI],
and iodoform and calcium hydroxide [Vitapex].

conclusively what we already know
as clinicians — an intensive regimen of fluoride varnish, along with
adjunctive measures, can control
and often reverse dental decay, as
well as prevent it.
Lim: Starting in infancy, children
at-risk for dental decay should be
receiving twice yearly applications
of fluoride varnish, whether by a
dentist or dental professional, or as
part of their well-baby care from
their pediatricians. More than 40
states in the U.S. have implemented
such programs, and the outcomes
are impressive — as much as 40
percent fewer children with early
signs of ECC.
Fernandez: Collaboration between other health providers and
the dental professions is key to
combating the incidence of ECC.

A study in the Netherlands has
found that prevention involving the counseling of parents on
caries-promoting feeding behavior is often ineffective in the long
term. Is there a lack of quality
intervention strategies?
Herman: If we, or the World Health
Organization, could answer this
question, we’d have found the key to
unlocking the mystery of improving
or enhancing human motivation. It
is probably true that without continual and periodic follow-up, counseling will wear off even amongst
highly motivated individuals.
We think the key lies with education that begins early and promotes
a sound nutritional and sustainable
oral-hygiene model for parent and
child alike. As you might imagine,
this is a task not well-suited to
the traditional dental care delivery
model, and will require some serious paradigm changes to permit
effective implementation.
What preventative measures do
you recommend based on your
clinical experience in New York?
Herman: Preventive measures and
conservative therapies that confront
the cause of the disease, rather than
treat the symptoms, are the most
effective and work the best.
Fluoride varnish has proven to
be a godsend, although most of the
evidence to date is empirical and
anecdotal. Good long-term longitudinal studies are needed to prove

You will be presenting at this
year’s PDAA Congress in Pasay
City. What will the participant
be able to take home from your
presentation?
Lim: At New York University [NYU]
through education, outreach, training and collaboration with other
health professionals, we have
developed a multi-faceted approach
to the many aspects of oral-health
problems. Our presentation will
describe the coordination of the
strategies and programs that NYU
employs, particularly in combating
ECC.
Herman: Our presentation will
examine and offer solutions to the
management of ECC. We will offer
a clinical therapeutic protocol that
effectively stabilizes and/or arrests
active caries, and that suggests a
disease-intervention model of care
that replaces restoration of teeth as
the primary approach to the treatment of ECC in infants, toddlers
and pre-school children.
Fernandez: Participants will
learn about setting up an infant
oral-health program in their offices
using an auxiliary. The auxiliary
should be able to conduct a risk
assessment, provide anticipatory
guidance and prescribe an individualized preventive program. Our
presentation will outline the steps
in establishing an infant oral-health
program in the dental office. DT

[12] =>

12A Event Preview: AGD

Dental Tribune | June 2010

Headline
‘Savor the flavors’ of

dentistry in New Orleans

Deck
By line

By Robin Goodman, Group Editor

(Photo/www.sxc.hu)
AD

As the second largest dental organization in the world, the AGD’s
2009 annual meeting attracted more
than 3,000 attendees, which the
AGD notes was its second most successful meeting in 10 years.
This year’s event in New Orleans
the AGD has augmented its course
offerings and events. Here are few

highlights of note for the upcoming
event.

Dates to note
July 6 to 8: AGD House of Delegates
July 8 to 11: AGD Annual Meeting &
Exhibits

Featured speakers
• “Clear Aligner Therapy: How to
Use it Successfully in Your Practice”

Willis J. Pumphrey, DDS
8 a.m.–5 p.m., Friday, July 9
Learn the basic concepts of Clear
Aligner Therapy and gain a better
understanding of how it works and
how to apply it
• “The Artistry of Direct Composite
Veneers: Contour is King”
Michael R. Sesemann, DDS and Elizabeth M. Bakeman, DDS, FAGD
8 a.m.–5 p.m., Friday, July 9
Learn to place, sculpt and contour for to six direct resin veneers.
• “Materials Selection for Esthetic
Efficient Composite Resin Dentistry”
John O. Burgess, DDS, MS
8 a.m.–5 p.m., Friday, July 9
This is a demonstration as well as
a hands-on course. Create life-like
anterior and posterior restoration by
using new composite resin materials, adhesives, finishing materials
and matrix systems.
Learn why some materials work
and other don’t, and get answers
to your most difficult clinical questions.

Special events
• Welcome Reception
5 to 7 p.m., Thursday, July 8
Hobnob with those of a like mind
over cocktails and conversation. As
you wander, you can also peruse the
newest products and technological
advancements in the Exhibit Hall.
There will be hor d’oevres and a
cash bar, as well as entertainment.
If you have kids along, the Kids’ Corner will be open during the cocktail
hours.
• 5K Fun Run/Walk 5K
6 a.m., Saturday, July 10
You’ll need a ticket to run or walk
along the Mississippi River at this
early hour, but know that it will benefit the AGD Foundation.
• Convocation
4:30 p.m., Saturday, July 10
Held at the Hilton New Orleans
Riverside, join in honoring the AGD
fellows, masters, and lifelong learning and service recognition recipients. Your friends and family are
also welcome to attend.
• Savor Your Saturday Night
8 to 11 p.m., Saturday, July 10
Join the AGD at Mardi Gras
World, which overlooks the Mississippi River.
The site features an indoor plantation that translated into fun for the
entire family. Browse Mardi Gras
floats from the days of yore to the
present and indulge in Creole cuisine.
For more information about the
meeting, visit www.agd.org. DT

[13] =>

Dental Tribune | June 2010

Event Preview: IACA 13A

The spirit of Boston
By Robin Goodman, Group Editor

Here are selected highlights for
each day of the IACA meeting. In
general, there are from three to six
speakers during each time block for
each day.
For the complete listing, please
download the schedule on the IACA
website at www.IACA.org.

Thursday, July 22
8:30–10 a.m.
• “Realizing the Dream,” Dr. Steve
Rasner
10:30 a.m.–12 p.m.
• “Heart Attack, Stroke, Obesity: Is
Dentistry to Blame?” Dr. J. Brian Allman
• “Building a Practice that Fits Your
Personality,” Dr. Kent Johnson
1:30–3 p.m.
• “Scan 18: Friend or Foe?” Dr. AnneMaree Cole
• “Sleep in Your Practice,” Dr.
Volinder Dhesi
3:30–5 p.m.
• “Solving All Whitening Frustrations,” Dr. Rod Kurthy
• “Dental Alchemy: Using PrimeSpeak to transform an apathetic
patient into your ideal patient,” Dr.
Michael Sernik

July 23
8:30–10 a.m.
• “Insurance Panel: How To Soar
in an Insurance Controlled World
Where They Want to Keep You
Down,” Drs. Kurt Doolin, Jeffrey
Haddad, Amy Norman, John Pawlowicz, Shahin Safarian and Ed Suh
with Dr. Bill Dickerson moderating
10:30 a.m.–12 p.m.
• “Dr Thomas Understood: The Signs
and Symptoms of TMD,” Drs. Norman Thomas and Heide Dickerson
• “The 5 Ms of a Successful Practice,”
Sally McKenzie
1:30–3 p.m.
• “IDS: Immediate Dental Seal — An
Important Adhesion Update,” Dr.
Ron Jackson
• “Perio Update,” Dr. Dee Nishimine
Seminars: Imaging Systems; Cadent
iTero
3:30–5 p.m.
• “3-D Cone-beam CT and Neuromuscular Occlusion,” Dr. Dick
Greenan
• “Marketing: Just When You Think
You Know It All, the Game Keeps
Changing,” Dr. Curtis Westersund
Seminars: Loyal Patients (3:30 p.m.);
Compliance Services (4:15 p.m.)

July 24
8:30–10 a.m.
• “Why Are Women So Strange and
Men So Weird?” Dr. Bruce Christopher

10:30 a.m.–12 p.m.
• “The Critical Missing Element to
Complete Care: What You Need to
Know About Orofacial Myofunctional Therapy,” Barbara Green
• “Six Steps to A Paperless Practice,”
Dr. Lorne Lavine
• “Periodontal Therapy for the Laser
Hygienist,” Angie Mott

Into Your Practice for An Immediate
ROI,” Dr. Leo Malin
• “Team Environments: Dramatic,
Draconian or Down-Right Amazing,”
Tim Twigg

1:30–3 p.m.
• “Advanced Cosmetic Smile Design:
Let’s Take It to The Next Level,” Dr.
David Buck
“Implants: How to Incorporate Them

IACA After Dark

3:30–5 p.m.
• “The Real Truth About Success,”
Garrison Wynn
This fun-filled event will be screening video clips from dental folks with
talent outside the practice. (Note: the
video clip are PG rated). DT

Old South Church, Boston
(Photo/www.stock.xchng.com)

AD

[14] =>

14A Industry News

Dental Tribune | June 2010

Isolite dryfield illuminator

Fight oral cancer!

The Isolite dryfield illuminator is
an innovative dental isolation tool
that combines the functions of light,
suction and retraction into a single
device, solving many of the frustrations that dental professionals deal
with on a daily basis.
Isolite gently holds the patient’s
mouth open, keeps the tongue out
of the working field and guards the
patient’s airway, all while continuously evacuating saliva and excess
moisture.
The super-soft Isolite mouthpiece
used with the device makes for a
more comfortable experience for the
patient and allows dental professionals to complete procedures on
average 30 percent faster.
Latex-free Isolite mouthpieces are
available in five sizes and position in
seconds to provide complete, comfortable tongue and cheek retraction
while shielding the airway.
Recently, the company debuted
an even brighter, more technically
advanced LED Smart Stick for the
Isolite. The LED Smart Stick is a
key component of the Isolite system
and hosts the system’s light source,
cooling technology and illumination
settings.

Prove to your patients just how committed you are to fighting the
disease of oral cancer by signing up to be listed at www.oralcancer
selfexam.com. This website 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 self-examinations. 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 website, 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? DT

AD

(Photo/Provided by Isolite)
In addition to boosting the LED
Smart Stick’s light output by 100
percent, the engineering team at
Isolite Systems made improvements
to the structure and strength of the
polycarbonate lens, improved the
self-regulating cooling technology
and made the electronic component
almost completely resistant to
water/spray. To learn more, call
(800) 560-6066 or visit www.isolite
systems.com. DT

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

[15] =>

[16] =>

[17] =>

Dental Tribune | June 2010

Industry News 17A

Curve Dental receives ‘best
of class’ technology award
Curve Dental, developers of Webbased dental software announced
the company was one of 13 companies to receive the Pride Institute’s
Best of Class Technology Award for
2010. Curve Dental was a winner in
the emerging technology class.
“We’re honored to have been
selected by the Pride Institute and
recognized for the accomplishments
we have made in dental software,”
said Jim Pack, CEO of Curve Dental.
“We like nothing more than to
create web-based tools that improve
productivity, are more flexible to the
doctor’s lifestyle and much more
convenient. A web-based platform
lets us think outside the box and
deliver on our promise to provide a
fresh alternative to dental software.
“And as a result, doctors every
day are choosing Curve Dental over
traditional software because they
see us as a solution with less stress
and more freedom. Pride Institute’s
acknowledgment of what we are

bringing to dentistry is a major
achievement for Curve Dental.”
A panel of dental technology
experts, organized by the Pride Institute, a dental practice management
consulting firm based in Novato,
Calif., placed Curve Dental on the
list of winners in the emerging technologies class.
The winning companies and
their products were chosen through
an unbiased, rigorous assessment
selection process in conjunction
with a distinguished panel of known
technology experts.
The winning technologies were
selected by majority vote and divided into four categories: foundational, diagnostic, therapeutic and
emerging.
The Pride Institute Best of Class
Technology awards were launched
in 2009 as a new concept to provide
an unbiased, non-profit assessment
of available technologies in the dental space. Winners of the award are

Duration air/water
syringe tips
High-performance
stainless steel tips
eliminate enormous
amounts of ECO
waste while saving
you more than $4,000 over
a 5-year period.
Imagine the environmental
impact if every practice would
stop sending more than 4,000
single use single-use plastic air/
water syringe tips to landfills
each year. Hager Worldwide did,
and the result is Duration air/
water syringe tips:
• High performance (excellent spray pattern with multiport
air ports)
• Stainless-steel tips (made of
medical grade stainless steel)
• Eliminate wastes (say no
to single-use air/water syringe
tips)
• Save the average practice
more than $4,000 over a 5-year
period with Duration vs. cost of
disposables.
Thus, over those five years,

the average practice (with 4.1
operatories) will use 21,530 single-use plastic tips, at 21¢ apiece.
That comes out to $4,438.81.
Meanwhile, if over that same
period of time that average practice would instead use Duration,
the cost would be just $146.78
— a savings of nearly $4,300!
And that’s to say nothing of the
landfill space saved worldwide.
In addition, Duration is
backed by a five-year warranty,
and a percentage of Duration
sales is donated to the World
Wildlife Fund.
To place an order for Duration air/water syringe tips,
please call your preferred dental
dealer.
For more information on
this or any product from Hager
Worldwide, e-mail info@hagerworldwide.com, visit www.
hagerworldwide.com, or call
(800) 3280-2335. DT

invited to participate in a technology fair showcased at the American
Dental Association’s annual meeting.
“We deeply felt a gap in the area
of technology education and integration,” said Lou Shuman, DMD,
CAGS, President of the Pride Institute. “We feel the technology awards
are fair and are an ideal model to fill
that gap. Pride Institute’s commitment is to provide the finest information and counsel in all areas of
practice management.”
The panel consists of seven dentists with significant knowledge of
and experience in dental technology, including Dr. Shuman; John
Flucke, DDS, writer, speaker and
technology editor for Dental Products Report; Paul Child, DMD, CDT,
CEO of Clinician’s Report; Titus
Schleyer, DMD, PhD, associate
professor and director, Center for
Dental Informatics at the University of Pittsburg, School of Den-

tal Medicine; Marty Jablow, DMD,
technology writer and speaker; Para
Kachalia, DDS, assistant professor of
restorative dentistry at the University of the Pacific, School of Dentistry;
and Larry Emmott, DDS, technology
writer, speaker and dental marketing consulting.
“I feel very fortunate that a panel
of this magnitude has agreed to
contribute to the selection process,”
said Dr. Shuman.

About Curve Dental
Founded in 2005, Curve Dental provides web-based dental software
and related services to dental practices within the United States and
Canada.
The company is privately held,
headquartered in Orem, Utah, with
offices in Calgary, Canada and
Dunedin, New Zealand. Dentists can
call (888) 910-4376 or visit www.
curvedental.com for more information. DT

Pulpdent website features case studies
The Pulpdent website now includes case studies from Save That Tooth,
the popular book by Pulpdent founder Dr. Harold Berk. The excerpts
describe evidence-based, research-supported techniques for treating the
vital pulp and the pulpless tooth.
Case studies on the site include “Congenital Defect, Youngest Pulpotomy Case Ever Reported” (Baby Gilbert), “Traumatic Injury” (Johnny the
Newspaper Boy), and “Ectopic Eruption of a Dilacerated Central Incisor”
(Kirk). The online content can be accessed at www.pulpdent.com.
Berk practiced dentistry for nearly 65 years and taught on the faculty
of Tufts University School of Dental Medicine from 1946 to 2005. Save
That Tooth contains his clinical memoirs and chronicles the original
research in vital pulp therapy and root canal therapy, the techniques
he pioneered and some of the fascinating and often complicated cases
that were routinely treated by this most talented of educators and dental
practitioners. DT

[18] =>

[19] =>

Dental Tribune | June 2010

Industry Congress News 19A

Erosion comes to the fore

A report from a symposium dedicated to enamel erosion in children and adolescents
By Lisa Townshend,
Dental Tribune U.K. Edition

Tooth wear due to factors such
as acid erosion has become one of
the hot topics of dentistry in recent
years. With the recent appearance
of products such as toothpastes,
mouth rinses and mousses in the
consumer market, the profile of
enamel erosion has risen in both
the public consciousness and clinical spheres.
The pre-congress symposium of
the 10th Congress of the European
Academy of Paediatric Dentistry,
held jointly with the British Society of Paediatric Dentistry, focused
entirely on the issue of tooth surface
loss in children and adolescents.
The event was well attended for
a pre-congress event, with almost
300 people ignoring the pull of
beautiful sunshine in the Yorkshire
moors to attend.
Sponsored by GlaxoSmithKline
(GSK), the pre-congress symposium
was split into four lectures dealing
with a different topic around tooth
wear in children.
A first for paediatric dentistry,
and chaired by Sven Poulsen and
Jack Toumba, the afternoon started
off with a look at the general issues
surrounding tooth wear and some
of the different products on offer
that clinicians can recommend to
patients presented by Prof. Monty
Duggal.

The science of erosion
Duggal is currently professor and
head of paediatric dentistry at Leeds
Dental Institute and spoke about
“The Science of Erosion and Challenges for Children,” discussing the
significance of the introduction of
consumer products aimed at combating tooth erosion. These products have caused massive interest
research-wise about the efficacy of
the products, and many discussions
of the importance of tooth surface
loss as a condition.
Duggal discussed how it is
becoming a significant problem
globally, and the size of the challenge faced by clinicians both in
prevention and management of
tooth surface loss.
Duggal looked at the aetiology
of the condition, citing that one of
the main difficulties in dealing with
surface loss is that it is multi-factorial; a combination of acid erosion,
attrition, abrasion and abfraction.
One interesting point he made
is that clinicians are not necessarily “programmed” to look for tooth
wear, being more “addicted to caries.” So, in terms of diagnosis, how
good are clinicians at looking for
and recording instances of surface
loss?
In terms of research, Duggal

detailed a study he has been undertaking looking at a combination
of products aimed at treating the
condition to see what was more efficacious and in what combinations.
Duggal is very clear in his
thoughts that the use of a combination of products and advice in
a patient-tailored regimen is the
most beneficial to patients. From
the study, he found that one of
the best combinations was a mix
of GSK’s Pronamel toothpaste and
GC’s Tooth Mousse for helping to
manage surface loss.

Solving the mystery
Next to the stage was Dr. Martha
Ann Keels. Keels is currently the
division chief of paediatric dentistry
at Duke Children’s Hospital, located
in North Carolina in the United
States. Her presentation, “Solving
the Mystery of Tooth Surface Loss,
Role of Non-dietary Factors such as
GORD and its Management,” was
very specific in its look at gastrooesophageal reflux disease (GORD,
or GERD as the U.S. spelling variant) as a major causal factor of
tooth surface loss.
Keels treats the oral damage
caused by GORD in children and
sees the various levels of tooth wear
that it can cause. She detailed some
of the risk factors, including eating habits, emotional stress (school,
family issues, etc.), asthma sufferers and special needs patients. It
has been noted that the condition is
more prevalent in boys.
Using case studies, Keels highlighted some of the treatment
options available for sufferers and
explained the indices used to monitor the progress of tooth surface
loss. While her preference is dietary
change over medication or surgical
interventions, the list of treatments
available is fairly broad. The “5, 4,
3, 2, 1, almost none” lifestyle mantra is used at Duke Hospital:
• 5 portions of fruit/vegetables
• 4 glasses of water
• 3 structured meals
• 2 hours or less of screen time
• 1 hour of activity
• almost none: sugar
In addition, trying to treat child
stress using easy breathing techniques, or relaxing before bedtime,
is used to help alleviate any condition.
Keels looked at various medications that have been prescribed to
help reduce the acid production
in the patient’s stomach, including
acid reducers and acid blockers.
In some patient cases, surgery is
necessary in the form of a Nissen
Fundoplication.
When managing the dental
effects of GORD, Keels described
her simplified index, which can be

utilised by team members to chart
the progression of surface loss, be
verified by the clinician and then
used as a patient and parent visual
aid to describe what’s going on.

Preventing dental erosion
After a short break for coffee, the
delegates were treated to a presentation from Prof. David Bartlett,
head of prosthodontics at Kings
College London Dental Institute as
well as a consultant in restorative
dentistry and specialist in prosthodontics.
His presentation focused on “A
Risky Situation: Aetiology and Prevention of Dental Erosion.” He discussed the different causes of erosion and what actually happens to a
tooth as the enamel is eroded, using
a series of images from a scanning
electron microscope.
Bartlett looked at the need for
the dietary advice given to patients,
emphasising the need for the advice
to not conflict with medical advice
for healthy eating. His opinion was
that it’s not what is eaten or drunk,
it is the frequency and how it is
consumed. Using photos of tooth
wear, he illustrated his points with
anecdotes of patients he had seen
in his career, including one who
would take all day to eat an orange
segment by segment.
He then discussed the research
into tooth erosion he had been
involved in over the years, and
discussed the difficulties that clinical studies have in validating their
research. The use of superimposition of impression scans taken at
regular intervals gave the researchers reference points to examine the
surface loss over a distinct period of
time; in this case, three years.
Bartlett’s final message to delegates was very clear: clinicians

can have an effect on preventing
tooth erosion with a combination of
treatment and advice.

Adhesion to dentine
The final speaker of the afternoon
caused much excitement with the
handing out of 3-D glasses for his
presentation, “Adhesion to Dentine
in Primary and Permanent Teeth.”
Prof. Dr. Roland Frankenberger
is professor and chairman of operative dentistry at the University of
Marburg in Germany and began
his presentation with the acknowledgement that restorative therapy
in children is not an easy task.
Much of his talk centred on the
relative merits of the different etch
and bonding systems on both primary and permanent dentition.
Frankenberger stated that selfetch adhesives are very successful for primary teeth, but that the
three-step systems were better for
permanent teeth. “Use more bottles
for permanent teeth” was his mantra.
He also used many images to
illustrate the bonding strengths
under different conditions, some
in 3-D to fully demonstrate the processes taking place between tooth
and adhesive.

A relevant topic
This pre-congress symposium was
a fascinating look into the topic
of tooth wear in children’s teeth,
and raised many discussion points
amongst the delegates.
As a topic that is becoming more
relevant in today’s paediatric dentistry, the four presentations gave a
very thorough grounding in what
clinicians should be looking for, as
well as providing a guiding hand in
finding the evidence base needed to
do the best for patients. DT
AD

[20] =>

20A Industry News

Dental Tribune | June 2010

Midwest Stylus by DENTSPLY
DENTSPLY Midwest® has introduced a handpiece with Speed-Sensing Intelligence (SSI) and Superior
Turbine Suspension (STS), technologies that solve two longstanding challenges facing dentists: loadbased variations in speed that can
cause stalling and require time-consuming feathering and bur deflection and chattering that occur at
high speeds and can affect accuracy
and precision.
The Midwest Stylus™ ATC’s Speed
Sensing Intelligence (SSI) automatically optimizes the delivery
of power, no matter the load, to
provide smooth, consistent cutting
speeds for unmatched efficiency and
fastest removal of material — an
industry first.
Its Superior Turbine Suspension
(STS) allows the handpiece to operate at speeds of 330,000 RPM under
load with no noticeable bur deflection or chattering. This provides outstanding control time after time. No
handpiece on the market addresses

these challenges so effectively.
The result is a cutting experience
that is smoother and more effortless,
efficient and more powerful than
any other handpiece being offered
today.
The website, found at www.StylusATC.com, provides clinical experiences and technological presentations as well as additional product
information, user testimonials and
product reviews. Visit it today.
Dr. Len Litkowski, DDS, and
director of professional relations
and clinical research for DENTSPLY Professional stated: “This is
the greatest breakthrough in highspeed, air-driven handpieces since
their introduction by Midwest in the
1950s. Bringing electronic control
to the dental handpiece to provide
a constant speed, even under load,
will make the dentist’s experience
more efficient, effective and stressfree.”
In addition to Speed-Sensing
Intelligence and Superior Turbine

Suspension, Stylus ATC offers these
advantages:
• Most powerful air-driven handpiece available
• Exceptional swivel for freedom
of movement
• Low pitch and tone for more
relaxed Patient and Dentist
• Mini and mid-size heads available for exceptional visibility
• Light weight for all-day comfort
Regular and short shank bur
compatibility
• Brilliant fiber optic light for
superior illumination
Free in-office demonstrations can
be arranged. Visit www.StylusATC.
com to schedule a demonstration or
to request additional information.
For more information, please
contact your local DENTSPLY Professional Field Sales Representative
or your local dealer representative,
call DENTSPLY Professional Customer Service at (800) 9890-8825 or
visit www.StylusATC.com. DT

(Photos/
Provided by
DENTSPLY)

STA: essential for cosmetic dentistry
System works well
for P-ASA injections
The STA Injection System, a computer-controlled local anesthetic delivery or C-CLAD (Fig. 1), is not only
great for single-tooth anesthesia but
is also very useful for administering
multiple-tooth anesthesia injections
such as the palatal-approach anterior
superior alveolar nerve block (P-ASA).
The P-ASA is a single-site palatal
injection into the nasopalatine canal
(Fig. 2), which can produce bilateral
anesthesia to six anterior teeth and the
related facial and palatal gingival tissues (Fig. 3) without causing collateral
numbness to the patient’s upper lip,
face and muscles of facial expression
(Fig. 4). Patients have said they really
appreciate this.
Using significantly less anesthetic, this easy-to-administer injection
can take the place of at least four
supraperiosteal buccal infiltrations

and a palatal injection.
It is valuable for cosmetic restorative dentistry procedures such as
composites, veneers and crowns
because you can immediately assess
the patient’s smile line when the lip is
used as a reference point.
The P-ASA is also useful for endodontic, periodontal and implant procedures. In fact, it is recommended as
the primary injection for any or all of
the six maxillary anterior teeth.
During administration and postoperatively, the P-ASA is a very comfortable injection for your patients
because of the STA computer-controlled flow rate below the patient’s
pain threshold, the use of minimal
pressure and the ability to easily control the needle using the wand handpiece.
Check out the simple injection technique for the P-ASA on the STAis4U.
com website.
Milestone Scientific asserts it’s easy
to do, you’ll like it and so will your
patients. DT

Fig. 1: STA System

Fig. 3: Collateral numbness

Fig. 2: Nasal-palatine canal site

Fig. 4: Scope of anesthesia
(Photos/Provided by Milestone Scientific)

www.dental-tribune.com
Missed the latest editions of Dental Tribune?
You can now read some of the contents online!
5 ways dental practices can reduce waste and pollution
www.dental-tribune.com/articles/content/scope/news/region/usa/id/1894
Florida dentist pampers his patients with massages
www.dental-tribune.com/articles/content/scope/news/region/usa/id/1838
You can’t always get what you want (unless you clearly ask!)

www.dental-tribune.com/articles/content/scope/specialities/section/
cosmetic_dentistry/id/1859
One in five U.S. children lacks access to dental care
www.dental-tribune.com/articles/content/scope/politics/region/usa/id/1793

Here’s another you might be interested in …
Free yourself from the daily ‘grind’
www.dental-tribune.com/articles/content/scope/specialities/section/
practice_management/id/1806

[21] =>

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

June 2010

www.dental-tribune.com

Vol. 3, No. 7

Air polishing primer
By Stephanie Wall, RDH, MSDH, MEd

Studies have shown that adequate plaque control can prevent
gingivitis, periodontal disease
and dental caries. Plaque control
is achieved one of two ways —
mechanically or professionally.
Mechanical control includes
the self-care methods of proper
brushing and flossing by an individual.
Professional control includes
the in-office use of rubber cups
or brushes, scalers and curets,
or ultrasonic devices by a dental professional. Air polishing was
introduced as an alternative that
is less time-consuming and laborintensive than the previously
AD

mentioned professional methods.
The air polishing system uses
air and water pressure to deliver
a controlled stream of specially
processed sodium bicarbonate in a
slurry through a handpiece nozzle.
Fine particles of sodium bicarbonate are propelled by compressed
air in a warm spray.
Water temperature is controlled and maintained at about
37 degrees Celcius or 100 degrees
Fahrenheit. Air polishing has been
firmly established as an equally
safe and effective alternative to
traditional methods of plaque and
stain removal.
The first air polishing devices
became available in the 1970s with
mechanics that have not changed

much since that time. The device
uses pressurized air, water and
sodium bicarbonate powder as the
polishing medium. The inlet air
pressure from the device is about
60 psi, with the outlet pressure
being delivered at about 58-60 psi.
The water pressure ranges from
10-50 psi.
The sodium bicarbonate is a
food grade tribasic combined with
small amounts of calcium phosphate and silica that allow the
powder to remain free flowing.
This powder, combined with the
pressurized air and water, will
remove surface stains, plaque
and other soft deposits frequently
found on the tooth surfaces.
The decision to use air polishing should be based on the
patient’s medical history and
patient assessment. Indications for
use include:
• General post-scaling procedure
• Cleaning of pits and fissures
• Interproximal cleaning
• Tooth preparation prior to
etching
• Neutralization of acids prior to
other procedures
• Removal of temporary cement
residue
• Surface cleaning
• Cleaning of orthodontic bands
and brackets
Contraindications
for
use
include:
• Patients with respiratory, renal
or metabolic disease
• Patients with exposed cementum or dentin
• Prolonged polishing of root
surfaces
• Patients taking potassium, antidiuretics or steroid therapy
The air polishing technique is
one that can be used with all
systems. A correct technique prevents undue aerosols from deflecting back to the clinician and from
being directed into the patient’s
soft tissues.
To control aerosols, high speed
evacuation should be used. The
handpiece nozzle should be used
in a circular pattern with the tip
kept 3 to 4 mm away from the
enamel surface.
The angulation of the tip is
critical in order to prevent tissue
trauma. The universal angulations
are: 60 degrees to the anterior
teeth away from the gingiva, 80

degrees to the posterior teeth, and
90 degrees to the occlusal surfaces.
If directed at 90 degrees to the
anterior and posterior surfaces,
there will be deflection of the
spray toward the patient and clinician.
Research indicates there are
many advantages to the use of air
polishing over that of traditional
polishing. These include:
• Removal of up to 100 percent
of bacteria and endotoxins
• Use on implants
• Creation of uniformly smooth
root surfaces
• Greater access for stain
removal in pits and fissures
• Less abrasiveness
• Use before bonding or sealant
placement
• Increased patient comfort
• No heat generation
• No tooth contact
• Reduced operator fatigue
• Temporary relief of dentinal
hypersensitivity
Air polishing is safe for use
on amalgam, gold, porcelain and
orthodontic bands and brackets. It
is not safe for use on all types of
composites, glass ionomers, and
luting agents.
Air polishing with the recommended sodium bicarbonate mixture does not damage titanium
used for implants and is the method of choice for decontamination.
Recently new air polishing powders have been developed that
include glycine, calcium carbonate and calcium sodium phosphosilicate (NovaMin®).
Glycine is available in two
grades: pharmaceutical and technical. Glycine crystals can be
grown using a solvent of water
and sodium salt and then prepared
for use in powder formulations.
Calcium carbonate, a naturally occurring substance, is often
used as a filler for pharmaceutical
drugs and as a main ingredient in
antacids.
Calcium sodium phosphosilicate is a bioactive glass. It has the
ability to interact with oral fluids
and release sodium, calcium and
phosphate ions resulting in remineralization of tooth enamel.
Consider including air polishing in your professional armamentarium as an effective and safe
g HT page 2C

[22] =>

Clinical

f HT page 1C

Hygiene Tribune | June 2010
About the author

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

alternative to traditional methods.

References
•
•

Barnes, C. An In-depth Look at
Air Polishing. Dimensions of
DH, March 2010.
Essex, G. A Predilection for
Polishing. Dimensions of DH,
March 2005.

Stephanie Wall has been a dental hygienist for
more than 20 years.
She recently completed training as an orofacial
mycologist and will be opening her practice, The
Orofacial Myology Center of South Carolina, this
year. She is also an active member of CareerFusion.
Wall resides with her two cats in Mount Pleasant, S.C. You may contact her at rdhms@live.com.

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.
AD

HYGIENE TRIBUNE
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t.oemus@dental-tribune.com
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e.seid@dental-tribune.com
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r.goodman@dental-tribune.com
Editor in Chief Hygiene Tribune
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a.stone@dental-tribune.com
Managing Editor/Designer
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com
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New York, NY 10001
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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
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us know by e-mailing feedback@dentaltribune.com. We look forward to hearing
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[23] =>

News

Hygiene Tribune | June 2010

Xylitol a superhero in
crusade against cavities
Xylitol, the dietary substance long
used in the management of diabetes
and weight control, is proving to be
a healthcare powerhouse, say scientists and dental professionals around
the world. Repeated studies indicate
the sugar substitute has strong cavityfighting properties when used several times a day. Studies have also
shown xylitol to reduce sinus and ear
infections.
“The action of sugarless gum and
candy containing xylitol has been
a happy surprise to the healthcare
community,” said Dr. Allan Melnick,
a clinical dentist from Encino, Calif.
“This therapeutic sweetener substantially reduces the bacteria streptococcus mutans in the mouth. It
lowers oral acid levels, adjusts pH
and reduces tooth plaque, resulting
in less tooth decay and gum disease.”
Xylitol is a sugar alcohol found
in plants such as berries, corn and
plums. It also is produced in humans
during normal metabolism. Dental
effects include inhibiting decay-causing bacteria from multiplying in the
mouth, research shows. These bacteria, which love to feed on sugar, produce sticky acids that adhere to teeth.
The acids damage tooth enamel by
dissolving calcium on the tooth’s
surface. Frequent use of xylitol —
whether in the form of gum, mints,
toothpaste or oral wash — appears to
break this cycle.
“A yearlong study in Finland
showed an 85 percent reduction in
caries rates for subjects who chewed
gum containing 6.7 grams of xylitol

each day,” Melnick said. “The same
reduced decay rate was found in subjects who followed strict diet guidelines and used xylitol as a sugar substitute. In other short-term Finnish
studies at Turku University, dental
plaque accumulation was reduced by
about 50 percent in less than a week
of xylitol use.”
Similar results were found in
more recent studies in Russia, the
United States, New Zealand, Thailand and Canada. A Danish researcher has even correlated xylitol use by
mothers with decreased tooth decay
in babies. Decay in small children
can have a devastating effect on the
development of their adult teeth and
urgently needs to be prevented, say
dental experts.
“A 40-month, multinational chewing gum study published in the
Journal of Dental Research showed
decreased tooth decay for children
chewing xylitol gum in comparison
to those who chewed none or had
gum sweetened with other substances,” Melnick said. “In a follow-up
study five years later by the University of Washington, xylitol subjects
showed a 70 percent reduction in
tooth decay — evidence of long-term
benefits. That’s huge, especially for
high-risk groups.”
The sweetener has been linked to
tooth self-repair, reduction in bacterial levels, improved saliva levels
in dry mouth patients and reduced
ear infection cases in children, said
Trisha O’Hehir of Arizona, a dental hygienist, educator and a well-

Organic formula

(CHOH)3(CH2OH)2

Molecular formula

C5H12O5

Molar mass

152.15 g/mol

Density

1.52 g/cm3

Melting point

92 to 96 degrees Celcius

Boiling point

216 degrees Celcius

The properties of xylitol, a five-carbon sugar alcohol.
known xylitol expert. She noted that
there is no aftertaste and xylitol has
only half the calories of sucrose. Xylitol also has a slower rate of absorption than sugar — 88 percent slower
— which helps to keep blood sugar
levels stable.
Additional research has shown that
xylitol — like bacteria — has the
ability to adhere to body tissues. In a
controlled study, solutions of xylitol
were able to reduce the presence
of staph bacteria. Lab animals given
xylitol also exhibited an increase in
white blood cells, which are part of a
body’s natural defense against bacterial infections.
Animal studies in Finland indicate
xylitol in the diet promotes the intestinal absorption of calcium and has the
potential to reduce or reverse bone
loss in humans. Its use is being considered as a preventive measure to
deal with osteoporosis, which affects
more than 10 million people in the
United States.

The U.S. Army promotes the use of
this sweetener in its “Look for Xylitol
First” initiative, and in the last two
years dental associations in Wisconsin, Hawaii, California and Arizona
have endorsed xylitol for its preventive benefits. Several other state dental associations are planning the same
endorsement shortly.
“The average American consumes
half a cup of sugar a day in some
form or other. It’s having a devastating effect on our teeth and overall
health,” Melnick said.
“So, it’s crucial that we make
changes. While diet modification,
brushing and dental office visits are
obvious, something as simple as
chewing xylitol gum a couple times a
day can help dramatically. It tastes
good, it’s something you can carry in
your pocket, and you don’t have to
make an appointment. I recommend
it to all my patients.” HT
(Source: PRWeb)
AD

Visit us at CDA San Francisco Booth #1405

[24] =>

[25] =>

[26] =>

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

June 2010

www.dental-tribune.com

Vol. 1, No. 1

Designing
multiple
Sirona’s
restoration types using one
CAD/CAM
seminar
dental
CAD/CAM
system
draws crowd
industry event

Sirona Dental Systems, a company that pioneered digital dentistry
25 years ago and a leading producer
of dental CAD/CAM systems, held a
two-day inLab Discovery Seminar,
which focused on the benefits of digital dentistry at the Scottsdale Center
for Dentistry on April 30 and May 1.
With a jam-packed auditorium
that included several hands-on demonstration stations, Sirona’s inLab
Discovery Seminar turned out to be
the largest dental laboratory CAD/
CAM event in history, with more
than 150 industry professionals in
attendance.
Sirona presented the CAD/CAM
event complete with a handful of
distinguished lecturers in the dental and laboratory industry speaking on the hottest industry topics,
which included information on all
aspects of CAD/CAM and digital
dentistry.
Held amidst the backdrop of the
prestigious Scottsdale Center for
Dentistry, all inLab Discovery Seminar attendees were provided complimentary tuition, and C.E. credits
were also available for attending the
educational sessions.
“We were extremely excited to
present this seminar, and we were
very satisfied with the number of
attendees,” said Sirona Dental Systems President Michael Augins.
“The inLab Discovery Seminar was
an educational experience in which
each and every component of CAD/
CAM was thoroughly explored by
seasoned users who have employed
CAD/CAM technology as the workhorse of their success. It provided
dental professionals with the information they require to make an
informed decision about incorporating digital dentistry into their own
laboratories. I believe participants
walked away with a better understanding of how Sirona’s CAD/CAM
solutions can actually work for
them.”
Topics of discussion during the
inLab Discovery Seminar included
success stories, materials efficacy,
how any size laboratory can increase
productivity with CAD/CAM and
much more.
g LT page 2D

By John Aitchison, CDT, Minot Dental Laboratory
and Bob Steingart, SensAble Dental Products

To date, dental CAD/CAM systems have primarily focused on creating only one specific type of fixed
restoration — zirconia copings.
As the digital evolution in the
dental industry continues, innovative software combined with tightly
integrated hardware, as well as
new materials and fabrication techniques, are making it possible for
dental labs to purchase one system
and use it to create multiple types
of restorations.
For example, newer systems
allow the digital design of removable restorations — metal and flexible partials — along with full contour crowns and bridges.
With Baby Boomers and the current economic conditions fueling
demand for removable prosthetics, along with the ability to design
removables digitally instead of
painstakingly by hand, many labs
that may have outsourced partials
in recent years now view investing
in CAD/CAM to produce them inhouse as a viable way to grow their
businesses.
Our lab has been using the
SensAble Dental Lab system since
late 2008. We have completed
almost 14,000 restorations with it —
including both partials and crown
and bridge work — and the time
savings is tremendous.
We can digitally design and wax
a three-unit bridge in less than 10
minutes, compared to hand waxing, which used to take us 90 minutes. We can complete a press over
metal (PoM) crown in less than four
minutes.
We start with a tooth from one
of the fully integrated digital tooth
libraries; design the crown; and
then simply press a button to create
the anatomical coping. One technician digitally designed a porcelain
fused metal (PFM) coping in literally 45 seconds. We are also seeing
incredible efficiencies when digitally designing partials.
The system gives us the creative
freedom to tackle even the most
challenging cases. We don’t have
to make any special changes to

Fig. 1a

Fig. 1b
(Photos/Provided by SensAble Dental Products)
our system to accommodate partials, compared to crown and bridge
work.
We have found that the system’s
presets and built-in features deliver consistent results, regardless of
which restoration type we create or
which of our technicians designs it.

Two of our most recent cases
illustrate the system’s flexibility and
the time-savings we are able to
achieve — time that frees us to do
other cases — as well as the added
g LT page 3D

[27] =>

2D News

Lab Tribune | June 2010

An introduction
to the Lab Tribune
Dear fellow dental professional,
Welcome to the inaugural issue
of Lab Tribune!
Both dentists and laboratory
technicians alike can agree that a
commitment to invest in developing
an excellent working relationship is
time well spent.
As dental professionals, we need
to recognize the important contribution we make together for the
patients we serve and continue to
expand our knowledge and develop
our skills to excel in the dental profession.
With that in mind, we have
launched Lab Tribune as a monthly insert for our Dental Tribune
biweekly.
Our purpose is to bring to our
readers — both technicians and
dentists — information on top-

ics that are of utmost importance
toward fostering an excellent working relationship between the laboratory team and the dentists they
work with.
In addition, we would also like
to create an open forum that presents the current discussions on new
technologies, challenges we face
and solutions to everyday situations
we encounter.
We look forward to hearing any
suggestions you might have for article topics, as well as hearing any
general feedback you would like to
share with us.
Please do not hesitate to contact
me at laura@lkdentalstudio.com.
Sincerely,
Laura Kelly
Accredited Technician, AACD

LAB TRIBUNE
The World’s Dental Lab Newspaper · U.S. 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
Laura Kelly
l.kelly@dental-tribune.com
Managing Editor/Designer
Implant, Endo & Lab Tribunes
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
Account Manager
Gina Davison
g.davison@dental-tribune.com
Account Manager
Humberto Estrada
h.estrada@dental-tribune.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dental-tribune.com
Marketing & Sales Assistant
Lorrie Young
l.young@dental-tribune.com

f LT page 1D

Sirona also enlisted an impressive
who’s-who list of dental industry
speakers for the seminars, including:
• Eddie Corrales
• Russell Giordano, DMD, DMSc,
FADM
• Greg Harris, vice president,
Novadent Group
• Imtiaz Manji, CEO, Scottsdale
Center for Dentistry
• William R. Mrazek, BS, CDT
• Matt Roberts, CDT, AACD
• Mike Skramstad, DDS
For more information on all
future Sirona events, check www.
sirona.com periodically. LT

About Sirona Dental Systems
Recognized as a leading global manufacturer of technologically advanced,
high-quality dental equipment, Sirona
has served equipment dealers and
dentists worldwide for more than 125
years. Sirona develops, manufactures,
and markets a complete line of dental
products. Visit www.sirona.com for
more information about Sirona and
its products.

Tell us
what
you
think!

C.E. Manager
Julia Wehkamp
j.wehkamp@dental-tribune.com

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

Dental Tribune makes every effort to
report clinical information and manufacturer’s product news accurately,
but cannot assume responsibility for
the validity of product claims, or for
typographical errors. The publisher
also does not assume responsibility
for product names or claims or statements made by advertisers. Opinions expressed by authors are their
own and may not reflect those of
Dental Tribune America.

Corrections

Lab 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 report the
details to Managing Editor Sierra Rendon
at s.rendon@dental-tribune.com.

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

[28] =>

Clinical 3D

Lab Tribune | June 2010

‘In today’s
economy, labs
are seeking more
ways to work
smarter as well
as more efficiently
to produce precise,
high-quality
restorations.’

f LT page 1D

precision that comes from working
digitally.

Partials case
In the first case (Figs. 1a, 1b), the
patient had only six of his natural
teeth remaining on his lower arch,
and was about to lose two more – the
first bicuspids on each side (#21 and
#28). These two teeth were helping
to retain the patient’s current restoration in place.
SensAble’s system made it fast
and straight-forward to design a
new removable restoration specifically to meet the challenges of this
case.
Our technician designed a partial
with four I-bar clasps that contact
the four remaining teeth to provide
ample retention, while still being
positioned low enough as to not
show when the patient smiles.
Additionally, we added lingual
plates for the required bracing on
all four teeth. These lingual plates
will also be incorporated into each
bridge design that the patient will
need in the future.
Built in time-saving features such
as digital survey and block out; presets for clasps, mesh designs and
lingual bars; a digital waxing tool

Fig. 2
that allows us to precisely set wax
thickness; and a special tool that
rapidly creates sprues on the digital
model, enable us to complete our
digital designs in record time.
On this case, we surveyed and
blocked out in less than one minute
and digitally designed the partial in
less than 20 minutes — compared
to 45 minutes to 1 hour using tradi-

tional methods.
We also saved more time, and
reduced costs, because we didn’t
have to create or wait for a refractory model before we could get started
or purchase the refractory material.
When you hand wax a partial,
there’s plenty of opportunity for
human error, but with the SensAble
system, the accuracy is superb! Once

the digital design is complete, the
system prints a resin pattern, which
is then invested and cast using traditional methods and materials. The
metal frameworks are so accurate
that we literally take them out of the
casting oven and sandblast them,
and they’re ready to polish.
We save time and completely
eliminate the possible errors associated with using grinding wheels and
stones to finish the metal partials.
Additionally, because we have a
digital file of this partial, we can
easily modify this design to accomg LT page 4D

AD

[29] =>

4D Clinical
f LT page 3D

modate any future loss of dentition
that this patient may have. If we
were hand-waxing this partial, we
would basically have to start anew.
With the SensAble system,
our technician can simply recall
the original design and change it
as needed, without requiring the
patient to return to the dentist —
making it easier for the patient and
freeing up the dentist to see other
patients. Having digital files of our
designs also saves us time in the
case of a miscast.

Full-contour crown case
One of our other cases (Fig. 2)
involved a patient who completely sheared off the top of a molar,
and required a crown to restore the
tooth.
In this case, we felt an allceramic pressed restoration (monolithic) would provide a better solution than a porcelain-fused-to-metal
(PFM) crown because the high tensile strength of a ceramic pressable
restoration could withstand the constant pressure of chewing, required
of a molar.
Also, an all-ceramic crown would
be more esthetically pleasing — allwhite as opposed to white with an
unappealing, thin, black metal line

Lab Tribune | June 2010
where the crown and gum tissue
meet.
In this case, the dentist prepared
the top of the patient’s remaining
tooth.
Using one of the integrated tooth
libraries in the SensAble system, the
technician designed a full contour
crown (Fig. 2), literally in two minutes — a crown that anatomically
matches the patient’s other teeth
and fits perfectly.
Next, the digital design was printed in resin, which was used to create an investment mold. Then, in
one final step, the heated ceramic
ingot was pressed into the pre-heated mold to produce the final pearly,
luminous restoration.

Conclusion
In today’s economy, labs are seeking
more ways to work smarter as well
as more efficiently to produce precise, high-quality restorations. New,
highly versatile dental CAD/CAM
systems that deliver multiple types
of restorations, along with consistent results, regardless of which
technician does the work, give labs
a greater return on their technology
investment.
Labs that purchase with an eye
toward maximizing the use of their
CAD/CAM systems will ultimately
win out as our industry continues to
transition to a digital future. LT

LT About the authors
John Aitchison, CDT, owner of
Minot Dental Laboratory, has more
than 35 years of experience in the
dental lab industry. Minot Dental
Laboratory is one of the oldest
continually operating full-service
dental labs in the United States,
founded in 1906, with more than
20 staffers and a commitment to
quality and innovation.

Bob Steingart, president of
SensAble Dental Products, has
more than 25 years experience in
successfully transforming innovative technologies into commercial
solutions. He has held executive
positions in business development,
product management and marketing at Avid Technologies, EMC,
Lotus Development, Sitara Networks and Kurzweil Applied Intelligence. Steingart holds an MBA
from Harvard Business School and
BSEE and MSEE from MIT.

Aurident

[30] =>

Lab Tribune | June 2010

Industry 5D

Emdin celebrates 25th anniversary
Emdin International Corporation is celebrating its 25th anniversary of providing premium
quality dental laboratory products.
The company manufactures
dental casting investments, gypsum stones and plasters, alginate
impression material and an assortment of other products including
die lubricant, gypsum hardener
and debubblizer for dentists and
dental laboratories.
As an added convenience to its
customers, the company now also
provides premium non-precious
alloys, waxes, aluminum oxide
and other products to meet the
needs of laboratories.
Emdin specializes in developing
and manufacturing investments to
maintain the high standards of the
industry.
For the past 25 years, Emdin
has been providing Starvest, its
premier micro-fine phosphatebonded universal investment for
all alloys and pressable ceramics,
to the dental laboratory industry.
Since its introduction in 1986,
millions of castings have been
made in Starvest by thousands
of dental laboratories and jewel-

ers in more than 20 countries
and, according to the company,
it remains a very popular crown
and bridge casting investment in
the United States.
Laboratories appreciate the
versatility of the material as it
can be used for both standard
and rapid burnout, overnight and
repeated burnout, ring or ringless
technique, for precious and nonprecious alloys, as well as pressable ceramics and implants.
Starvest is known for having
the smallest particle size on the
market, smooth and bubble-free
castings, an easy-to-mix and
creamy consistency, excellent
working and setting time, ultra
smooth castings, superb batchto-batch consistency, reduced finishing time and materials and far
less rework.
To learn more about Starvest
and other Emdin products, please
visit the website at www.emdin.
com or e-mail info@emdin.com. LT

(Photo/Provided by Emdin
International Corporation)
AD

[31] =>

6D Industry

Lab Tribune | June 2010

Nobilium: History of flexible partials

(Photo/Provided by Nobilium)
AD

Flexible partials were first developed in the early 1950s. Arpad Nagy
of New York commercialized the
first nylon-based flexible partial
denture system, called Valplast, in
1953.
At the time, academics felt that
a partial denture must be rigid in
order to distribute masticatory forces to the remaining dentition.
As a result, the usage of flexible
plastic partial dentures was limited.
Another New York-based company
introduced a product in the early
1960s called Flexite. It was similar
to Valplast, but offered several varieties of materials.
As the “Hollywood Smile” became
a quest for dental patients in the

1970s and ’80s, dentists were forced
to look for prosthetic solutions that
were both esthetic and functional.
Flexible partial dentures were
becoming an accepted treatment
plan for some patients who demanded high esthetics and had healthy
remaining dentition.
In 1999, DENTSPLY International
introduced FRS, a flexible partial
system based on the “Success” injection system. One objective of this
system was to address a common
complaint among dental professionals using flexible partial denture
materials: adjustments/polishing.
Valplast has a relatively low melting temperature, so when a clinician
adjusts the material chairside, the
heat of a bur causes the material
to melt and form small balls on the
surface.
These surface defects are difficult
to remove, leaving users frustrated.
The FRS material has a higher melting temperature, thus this problem
was reduced. However, the higher
melting temperature of FRS results
in more potential for fracture as
compared to Valplast.
While an acrylic complete denture is easily repaired with methylmethacrylate, with a nylon-based
flexible partial it is very difficult, if
not impossible, to make a permanent repair.
The growth of flexible partials is
now in full swing.
The newest material on the market, introduced in 2008, is called
FlexStar, from Nobilium in Albany,
N.Y. This material uses advancements in plastics technology that
result in slightly higher melting
temperatures as compared to Valplast.
These features result in a material that is easier to adjust and polish chairside. In addition, it retains
flexibility in the mouth and is virtually unbreakable. There is a limit to
the clinical indication for a flexible
partial denture. Some patients with
severe periodontic problems are not
good candidates.
However, as long as “Hollywood”
is producing smiles, there will be a
demand for esthetic and functional
removable appliances. LT
(Source: Nobilium)

Send us your case study!
Have an interesting lab case you
would like to share with your peers?
To have your case study considered
for publication in Lab Tribune, send
your 800- to 1,200-word case study
and up to 12 high-resolution photos
to Managing Editor Sierra Rendon at
s.rendon@dental-tribune.com. Authors
will be notified of publication and have
an opportunity to review the designed
case study prior to final publication.
Cases will be published pending editor
approval and space availablility.

[32] =>

Lab Tribune | June 2010

Industry News & Products 7D

Aurident marks 35 years of making alloys
Aurident
Incorporated
was
founded by Howard and Fredelle
Hoffman in 1974 with one basic
philosophy — to manufacture dental alloys that provide crown and
bridge laboratories and dentists
nationwide with excellent quality
and service, and competitive prices.
In the past 35 years, Aurident has
grown extensively worldwide, and
has developed a wide range of PFM
and casting alloys.
“We’re committed to superior
customer service and satisfaction,”
said Leonard Hoffman, general
manager of Aurident. “Our goal is to

become a primary source for alloys
and dental materials in the years
ahead. Dental laboratories reliant

Aurident’s Auritex-40 reduces
costs on a high noble PFM alloy

Auritex-40 from Aurident is an
affordable white high noble alloy
for PFM applications.
Containing 40 percent gold, 40
percent palladium and 10 percent
silver, Auritex-40 is designed to
help laboratories reduce costs for
a white high noble alloy.
Compatible with a wide range
of porcelains, Auritex-40 is easy

to use and work with. The alloy is
ideal for high-stress applications
such as longspan bridges and as
single units. Earn six Aurident
Rewards Points for each ounce of
Auritex-40 ordered.
For more details on Auritex-40
or to place an order, call Aurident
at (800) 422-7373 or visit www.
aurident.com. LT

on fast service, quality and competitive prices continue to benefit from
purchasing Aurident alloys.”

Recently, Aurident reinstated its
rewards program, which provides
points for each alloy purchase.
Points can be redeemed for free
silver or gold coins.
Aurident is based in Fullerton
Calif. Local dental laboratories
enjoy same-day delivery as alloy
orders are placed, or they may them
pick up anytime during business
hours for same-day convenience.
For more information on Aurident, call (800) 422-7373 or visit
www.aurident.com. LT
(Source: Aurident Incorporated)

Aurident’s GH gold casting alloy
lowers costs

Aurident’s GH is a high noble,
fine-grain, type III crown and
bridge gold alloy containing 52
percent gold, 0.1 percent platinum, 8 percent palladium and
21.5 percent silver.
Excellent castings with a rich
gold color can be produced at a
lower cost than higher gold content alloys, without compromising quality.
Outstanding mechanical prop-

erties make GH suitable for single
units and bridges. GH is easy to
cast and work with, resistant to
tarnishing and can be efficiently used by either high- or lowproduction laboratories.
You also earn six Aurident
Rewards Points for each ounce of
GH alloy ordered.
For more information on GH or
to place an order, call (800) 4227373 or visit www.aurident.com. LT

AD

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