DT U.S. 1709

Implants displaced into the maxillary sinus / Five of the top 10 reasons why associateships fail / The Pacific Northwest: Where education meets beauty! / Events / Industry / Industry / Cosmetic Tribune 4/2009 / Hygiene Tribune 4/2009

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

July 2009

www.dental-tribune.com

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

Miniscrew series

Part II offers tips for optimal miniscrew insertion.

u Section B1

ENDO TRIBUNE
The World’s Endodontic Newspaper · U.S. Edition

Apical microsurgery

Consider these nine basic steps when surgery is required.

u Section C1

Vol. 4, Nos. 17 & 18

CosmetiC tRiBUNe
the World’s Cosmetic Dentistry Newspaper · U.s. edition

Mutilated dentition

Full-mouth fixed rehabilitation of a mutilated dentition.

u Section D1

Implants displaced into PND Conference: Where education meets beauty!
the maxillary sinus
By Dov M. Almog, DMD, Kenneth Cheng,
DDS & Mohammad Rabah, DMD

As some have predicted,1 the growth
in dental implant-based procedures
increased considerably in recent years.
As a result, there has been a rapid
increase in the number of practitioners involved in implant placement,
including specialists and generalists,
with different levels of expertise.
At the same time, although at a low
frequency, we are witnessing a diversity of unusual complications associated with these procedures, some of
which are displaced implants into the
maxillary sinus.
A literature search revealed several

published reports of displaced foreign
bodies into the maxillary sinus.2–6 Generally speaking, foreign bodies in the
maxillary sinus include multiple displaced objects. These include teeth,
roots, impression materials, dental
instruments, broken burs and, more
recently, dental implants.
Although foreign bodies in the
maxillary sinus are not common, it
behooves us to familiarize ourselves
with such an unusual complication
and its management. Displacement
of such foreign bodies into the maxillary sinus occurs following dental
procedures that create an unplanned
oroantral perforation.
g DT page 2A

The 122nd annual Pacific Northwest Dental Conference (PNDC) offers two
days of continuing education in one of the most picturesque and family-friendly settings. (Photo/Beverly Sparks) gPND Conference, page 10A

Washington cracks down on
tobacco, and ADA approves
By Fred Michmershuizen, Online Editor

The American Dental Association
(ADA) is applauding new legislation to
regulate tobacco. The Family Smoking
Prevention and Tobacco Control Act
gives the U.S. Food and Drug Administration (FDA) the express authority to
regulate the manufacture, marketing
and distribution of tobacco products.
The ADA has a long-standing policy
that nicotine is a drug and that cigarettes and other tobacco products are

nicotine delivery devices and, therefore, should be regulated.
“Dentists are the first line of defense
in the war against oral cancer and
many other tobacco-related diseases,”
said ADA President Dr. John S. Findley.
“About nine out of 10 people who will
die from oral and throat cancers use
tobacco.”
“Tobacco products are also associated with higher rates of gum disease,
one of the leading causes of tooth loss
in adults,” Findley said. DT
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2A News

Dental Tribune | July 2009

Orange juice bad for
teeth, scientists say
tk
Source: ADA

By Fred Michmershuizen, Online Editor

Scientists at the University of
Rochester Medical Center who
were recently studying the effects
of whitening agents on human
teeth discovered something alarming: acidic fruit juices markedly
decreased hardness and increased
roughness of tooth enamel. No
significant change in hardness or
surface enamel was found from
whitening.
“Orange juice decreased enamel hardness by 84 percent,” said
YanFang Ren, DDS, PhD, of the
university’s Eastman Institute for
Oral Health.
In the study, “Effects of tooth
whitening and orange juice on
surface properties of dental enamel,” published in the Journal of
Dentistry (Volume 37, Issue 6,
June 2009), Ren and his team
determined that the effects of 6
percent hydrogen peroxide, the
common ingredient in professional and over-the-counter whitening
products, are insignificant compared to acidic fruit juices.
Weakened and eroded enamel
may speed up the wear of the
tooth and increase the risk for
tooth decay to quickly develop and
spread.
“Most soft drinks, including

sodas and fruit juices, are acidic
in nature,” Ren said. “Our studies
demonstrated that orange juice, as
an example, can potentially cause
significant erosion of teeth.”
It’s long been known that juice
and sodas have high acid content
and can negatively affect enamel
hardness.
“There are also some studies
that showed whitening can affect
the hardness of dental enamel,
but until now, nobody had compared the two,” Ren explained.
“This study allowed us to understand the effect of whitening on
enamel relative to the effect of
a daily dietary activity, such as
drinking juices.”
“It’s potentially a very serious
problem for people who drink
sodas and fruit juices daily,”
said Ren, who added that dental researchers nationwide are
increasingly studying tooth erosion and are investing significant
resources into possible preventions and treatments.
“We do not yet have an effective
tool to avert the erosive effects,
although there are early indications that higher levels of fluoride
may help slow down the erosion,”
he said. DT
(Source: University of Rochester
Medical Center)

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The procedure associated with the
removal of foreign bodies from the
maxillary sinuses is considered very
invasive. In this case report, the authors
describe a systematic approach to the
removal of two implants displaced into
the right and left maxillary sinuses.
Currently, there are two accepted
methods for removing foreign bodies
displaced into the maxillary sinus. One
method is the endoscopic transnasal
maxillary sinus surgery.7-10 Access to
the maxillary sinus is achieved through
the nose via the ostium. The foreign
body is captured and removed using
an urological retrieval basket through
the endoscopic working channel port.
The advent of endoscopic techniques
has made it the preferable choice,
especially for patients with chronic
sinusitis.
The most commonly used technique for retrieval of foreign bodies
displaced into the maxillary sinus is
the Caldwell-Luc procedure. In contrast to the endoscopic technique,
which involves accessing the maxillary
sinus via the nose, the Caldwell-Luc
procedure involves gaining access to
the maxillary sinus by the fenestration
of the anterior lateral wall of the maxillary sinus or canine fossa.11,12
The Caldwell-Luc procedure offers
better direct visual access to the maxillary sinus as compared to the endoscopic approach, but is considered
more aggressive with potentially more
serious complications. Some of the
possible complications are dysesthesia
of the infraorbital nerve, numbness of
the maxillary teeth, injury to the floor
of the orbit and facial edema. This
older and perhaps less conservative
technique for accessing the maxillary
sinus was first introduced by two otolaryngologists (American and French)
in 1893.11

Case report

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@dtamerica.com. If you would like to
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DENTAL
ENTAL TRIBUNE
RIBUNE

f DT page 1A

A 50-year-old African-American male
Vietnam veteran presented to the VA
New Jersey Health Care System Dental
Service at East Orange seeking dental
care.
A comprehensive oral and maxillofacial examination included an intraoral and extraoral exam, including
cancer screening, full-mouth X-rays,
and a cone-beam CT (i-CAT™ 3D
CBCT Imaging Sciences International,
Hatfield, Pa.) revealing, among other
things, two implants displaced into the
right and left maxillary sinuses.
Ultimately, the exam revealed a
diversity of oral and maxillofacial problems, such as retained roots, decay and
missing teeth, to name a few. Nevertheless, the chief complaint noted by
the patient, and most profound clinical
finding, was “two implants displaced
into the right and left maxillary sinuses” (Figs. 1–3). The medical history
was non-contributory.
Proceeding with careful assessment
of all the available diagnostic information, and upon further discussion with
the patient, several treatment options
were developed in association with
his retained roots, caries and missing teeth. As far as the patient’s chief

5/22/09 10:01:31 AM

g DT page 4A

TheWorld’s
World’sDental
DentalNewspaper
Newspaper· ·US
USEdition
Edition
The

Publisher
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Robin Goodman
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Ortho Tribune & Show Dailies
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Published by Dental Tribune America

© 2009, Dental Tribune America, LLC.
All rights reserved.
Dental Tribune strives to maintain the utmost
accuracy in its news and clinical reports.
If you find a factual error or content that
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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
Editorial Board
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Clinical

Dental Tribune | July 2009

f DT page 2A

tk DT

Fig. 1: Pre-operative diagnostic cone-beam
CT revealing, among other things, two
implants displaced into the right and left
maxillary sinuses. By utilizing the i-CAT™
3D CBCT (Imaging Sciences International,
Hatfield, Pa.), which includes clear-cut
panoramic and cross-sectional slices of
any desired location, one obtains precise
anatomical information.

Fig. 3: Three-dimensional virtual
rendering (3-DVR) of the displaced
implants provides the surgeon feedback as to the surgical approach. In
this case, a Caldwell-Luc procedure
was performed using a bur to create
an access window through the lateral
wall of the maxilla, thereby gaining
direct access to the displaced implant.
complaint, one treatment option was
offered to him, that is, the CaldwellLuc procedure to remove both displaced implants in his maxillary
sinuses. After careful consideration,
the patient chose to proceed with the
proposed treatment plan.
A Caldwell-Luc procedure was performed bilaterally under general anesthesia. Specifically, the Caldwell-Luc
procedure involved making an incision in the bucco-gingival sulcus in the
area of the maxillary canine and bicuspid teeth, exposing the anterior lateral
wall of the maxilla. Care was taken to
avoid injury to the infraorbital nerve as
it exits in the infraorbital foramen.
Using a bur and Kerrison’s rongeurs, a window was made through
the anterior lateral wall of the maxilla,
thereby gaining access to the maxillary
AD

Fig. 2: Axial slice is useful for revealing the two displaced implants from a different angle.

Fig. 4: Caldwell-Luc procedure is useful in gaining access to the maxillary sinus by the fenestration of the anterior lateral wall of the maxillary
sinus. Note successful retrieval of implant from the maxillary right sinus
through the access window.
sinus. Antral currettes and a hemostat
were used to retrieve the displaced
implants (Fig. 4). The sinuses were
then irrigated and packed with iodoform gauze, which was later removed.
The incision was closed. Postoperatively, the patient did well and no
complications were reported.

Conclusions
As described in this case report,
the clinical management associated
with the removal of dental implants
displaced into the maxillary sinuses is
considered very invasive.
While numerous dental reports
described patients treated for displaced implants into the maxillary
sinuses, none illustrated those from a
preventive standpoint, that is, the use
of CBCT-based dental imaging before
placing dental implants.
While the quantitative relationship between successful outcomes in
dental implant treatment and CBCT-

based dental imaging is unknown and
awaits discovery through large prospective clinical trials, the authors
strongly believe that using CBCTbased dental imaging is becoming
a reliable procedure from a precautionary standpoint based on a series
of recent preliminary clinical studies
and case reports.
Therefore, the authors strongly
believe that by making a CBCT-based
study prior to placing dental implants,
displacement of dental implants into
the maxillary sinus can be avoided. DT
(A complete list of references is available from the publisher.)

About the authors
Dov M. Almog, DMD, Chief of the
Dental Service, VA New Jersey Health
Care System (VANJHCS)
Kenneth Cheng, DDS, Oral and
Maxillofacial Surgeon, VANJHCS
Mohammad Rabah, DMD, Oral and
Maxillofacial Surgery Resident, VANJHCS
For reprints:
Dov M. Almog
Chief, Dental Service (160)
VA New Jersey Health Care
System
385 Tremont Avenue
East Orange, N.J. 07018
Tel.: (973)-676-1000, ext. 1234
Fax: (973) 395-7019
E-mail: Dov.Almog@va.gov

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Financial

Dental Tribune | July 2009

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

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

Reason No. 1: purchase price
If the purchase price has not been
determined before the commencement of employment, the parties
find themselves on different ends
of the spectrum as to what the
practice is worth and what the
buy-in price should be.
When purchase price is established before the commencement
of employment, three out of four
AD

associateships lead to the intended
equity position.
Conversely, if the purchase
price has not been determined,
nine out of 10 associateships lead
to termination without achieving
the ownership intended or promised.

Reason No. 2: the details
The more items discussed and
agreed to in writing beforehand,
the better the chance of a successful equity ownership occurring as
planned.
The written instruments should
be two specific documents — an
Employment Agreement detailing
the responsibilities of each party
for employment, and a Letter of
Intent detailing the proposed equity acquisition.

Reason No. 3: insufficient patient
base
Approximately 1,000–1,200 active
patients are required per dentist in
a dental practice. If the senior dentist does not intend to restrict or
cut back his/her number of available clinical treatment hours, then
the conversion from a one-dentist
to a two-dentist practice requires
an active patient base of approximately 1,400–1,800 patients and
a new patient flow of 25 or more
new patients per month.
Many senior dentists count
their number of active patients
by counting the number of patient
charts on a wall. However, the best
way to estimate the active number

Most hope the newfound associateship will lead to an eventual ownership
position. Instead, many find themselves building up the value of their host
dentist’s practice, only to be forced to leave.
of patients involves utilizing the
hygiene recall count.
Insufficient numbers of patients
and/or an insufficient new patient
flow signals that all expenses
relating to the new dentist are
coming directly out of the bottom
line. The practice then begins to
experience financial pressure.
Creation and maintenance of
a sufficient patient base is an

extremely important aspect of the
business. If the senior dentist is
nearing retirement with the intent
that, within one to two years, the
senior dentist will turn over total
ownership of the practice and
intends to cut back shortly after
the beginning of the second dentist’s employment, this problem is
g DT page 8A

[7] =>

09YS9681

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

You Need A Partner On Your Side
ALABAMA

Birmingham- 4 Ops, 2 Hygiene Rms, GR $675K #10108
Birmingham Suburb- 3 Ops, 3 Hygiene Rooms #10106
CONTACT: Dr. Jim Cole @ 404-513-1573

ARIZONA

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

CALIFORNIA

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

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

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

MAINE

OHIO

INDIANA

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

KENTUCKY

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

MARYLAND

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

MASSACHUSETTS

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

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

CONNECTICUT

MICHIGAN

FLORIDA

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

GEORGIA

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

IDAHO

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

ILLINOIS

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

NORTH CAROLINA

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

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

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

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

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

MINNESOTA

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

MISSISSIPPI

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

NEVADA

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

NEW HAMPSHIRE

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

NEW JERSEY

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

NEW YORK

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

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

PENNSYLVANIA

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

RHODE ISLAND

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

TENNESSEE

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

VIRGINIA

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

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

[8] =>

8A

Financial

f DT page 6A
not as critical.
Often the senior dentist brings in
an associate dentist as the answer
to increasing business. A practice
with insufficient new patient flow

Dental Tribune | July 2009
that experiences the addition of
a new practitioner may result in
termination of employment for the
associate.

Reason No. 4: incompatible skills
The incompatibility in clinical

identify the potential
pitfalls at the beginning
of the relationship

ADS

skills between practitioners may
include the possibility of one practitioner’s skill level being below
standard, but it may also include
different practice philosophies.
On the surface, it would appear
that having different skill levels
and philosophies might be desirable. In reality, the patient base
that is available to the younger
practitioner may not lend itself to
various types of dentistry.
P&F Ad-DTA

1/14/09

2:45 PM

Reason No. 5: timeframe

Page 1

The failure to identify when the
buy-in or buy-out is to occur and
when to execute it can result in
failure to achieve an ownership
status.
The Letter of Intent may have
stated that the buy-in was to occur
in one to two years, but certain
behaviors and signs during the
continuing employment relationship might give an indication that
the senior doctor is having difficulty honoring the intended buy-out
or that the associate does not feel
ready to consummate the transaction within the original timeframe
outlined.
Either position might result
in the demise of the buy-in as
involved parties lose patience over
such delays.

Summary
™

*

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

Contains no
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because it bonds to moist tooth surfaces, provides a better seal and
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Now after six years of clinical use,
EMBRACE Sealant sets a new standard
of success – intact margins, no leakage,
no staining, caries-free.
Six-year followup photo
photo courtesy of Joseph P. O’Donnell, DMD

About the author

For technical information
contact Pulpdent at

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Order through your dental dealer.

One call can bring a smile to your face and your patients:

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*Contact Pulpdent for study.

This article has been aimed primarily at a one-dentist practice
evolving to a two-dentist practice;
however, the issues apply equally
to larger group practices.
One-to-two-year associateships
with the senior dentist retiring
at the end of the associateship
and a three-to-five-year partnership ending with the new dentist
purchasing the remaining equity
position of the senior dentist at
the end of five years can also benefit from the insights provided in
this article.
Unfortunately, nothing can
guarantee a successful outcome
will occur. However, by identifying the potential pitfalls at the
beginning of the relationship,
chances of success can be greatly
improved. DT

PULPDENT

®

Corporation

80 Oakland Street • Watertown, MA 02471-0780 • USA

pulpdent@pulpdent.com • www.pulpdent.com

Dr. Eugene W. Heller is a 1976
graduate
of
the
Marquette
University School of Dentistry. He
has been involved in transition
consulting since 1985 and left
private practice in 1990 to pursue
practice management and practice
transition consulting on a full-time
basis. He has lectured extensively
to both state dental associations and
numerous dental schools. Heller
is presently the national director of
Transition Services for Henry Schein
Professional Practice Transitions.
For further information, please call
(800) 730-8883 or send an e-mail to
hsfs@henryschein.com.

[9] =>

[10] =>

10A PND Conference

Dental Tribune | July 2009

The Pacific Northwest:
Where education meets beauty!
The Pacific Northwest Dental Conference, July 23 and 24, in Seattle, Washington
solitary creatures working in independent practices, and the PNDC
provides us with an opportunity to
unify and learn together.”
And in these difficult economic
times, attending the PNDC makes
sense for your pocketbook. ADA
members can acquire up to 14 C.E.
credits and attend any lecture they
want by purchasing a full conference badge for $250–$290, and
their staff is just $160.
While other dental meetings
throughout the nation charge by
lecture, PNDC attendees have
access to more than 50 speakers and over 60 lectures at no
additional cost. The PNDC offers
affordable, quality education for
the entire office. Here are some of
the world-renowned speakers at
this year’s conference:

Nearly 9,000 dental professionals from around the globe are
expected to converge in the Emerald City for the 122nd annual
Pacific Northwest Dental Conference (PNDC), organized by the
Washington State Dental Association (WSDA). Recognized as one of
the finest dental meetings in the
country, the PNDC offers two days
of continuing education in one of
the most picturesque and familyfriendly settings.
Surrounded by snow-capped
mountains and calm emerald
waters, the PNDC, held July 23
and 24 in downtown Seattle, offers
attendees a chance to earn affordable, cutting-edge C.E. in one of
the most majestic regions in the
world. If you haven’t experienced
the Pacific Northwest in the summer time, then you can’t miss this
opportunity.
“The beauty of the PNDC is the
sense of oneness that the dental
family feels when sharing ideas
and expertise,” said Dr. Larry
Lawton, former WSDA president.
“Dental professionals are often

• Dr. Harold Crossley, Pharmacology
• Dr. Donald Coluzzi, Lasers
(includes a workshop)
• Drs. Chris Delecki and Bryan
Williams,
Pediatric
Dentistry
• Dr. Anthony DiAngelis, Trauma

ADS

(Photos/Beverly Sparks)

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• Dr. Timothy Hempton, Crown
Lengthening (workshop) and
Hygiene
• Dr. David Levitt and the Perio
Institute, Implant Surgery (workshop)
• Drs. Stanley Malamed, Ken Reed
& Morton Rosenberg, Sedation
• Dr. Buddy Mopper, Restorative
• Dr. James Tinnin, Endodontics
• Dr. Corky Willhite, Esthetics (lecture and workshop)
Combine all of this with more
than 75 additional lectures and
workshops by renowned professionals like Dr. Anthony DiAngelis, Dr. Sally Hewett, Dr. David
Levitt, Dr. Dennis Lynch, Dr.
Rhonda Savage, Dr. Uche Odiatu
and Kary Odiatu, and you’ll see
why this year’s conference should
not be missed!
In addition to top-notch C.E.,
the PNDC offers an array of other
activities to keep attendees busy.
With a robust exhibit hall that
features over 300 exhibiting companies, attendees will have the
opportunity shop the latest and

greatest in dental products as well
as try their luck at huge prize
giveaways drawings throughout
the conference. It’s a lively area
filled with energy and conversation about the art and science of
dentistry.
New in 2009, the exhibit hall
will feature a relaxation lounge
with free head and neck massages provided to any attendee
who needs a rest from the day’s
activities.
Attendees can also take advantage of many special events held
throughout the conference, including the 2009 Staff Appreciation
Luncheon, the annual Fun Run
along Seattle’s waterfront, and the
Ride the Ducks of Seattle Tour.
In addition to special events,
Seattle is filled with an eclectic
mix of restaurants, music venues,
shopping, farmer’s markets and
summer festivals to help make
your stay even more enjoyable.
To register, or for more information, please visit www.wsda.
org/pndc/pndc.view, or call (800)
448-3368. DT

www.dental-tribune.com

[11] =>

Events 11A

Dental Tribune | July 2009

Greater N.Y. Dental Meeting President’s Luncheon
It’s hard to deny that the Greater
New York Dental Meeting (GNYDM)
has always provided the best in education and exhibits, but the social
programs have always been top notch
as well, and 2008 was no exception.
Some 57,854 registrants from 123
countries solidified this event as the
largest dental convention and exposition in the United States.
The 2008 Greater New York Dental Meeting’s Annual President’s Luncheon, held on Monday, Dec. 1, and
was attended by 56 presidents and
executive directors of dental associa-

tions from around the world. These
international leaders in dentistry
were recognized for their outstanding contributions in the advancement
of dentistry around the globe.
Mark your calendars now for the
2009 meeting, Nov. 27–Dec. 2 and
remember: there is no registration
fee for the GNYDM.
For additional information, please
contact the Greater New York Dental
Meeting at 570 Seventh Ave., Suite
800, New York, N.Y., 10018-1806; Tel.
(212) 398-6922; Fax (212) 398-6934;
e-mail info@gnydm.com. DT

IDEM Singapore 2010 granted Trade Fair Certification status
The U.S. Department of Commerce’s U.S. Commercial Service
has granted Trade Fair Certification status to IDEM Singapore 2010,
which will take place at the Suntec
Singapore International Convention
& Exhibition Center, April 16–18,
2010.
Through certification, the U.S.
Commercial Service recognizes
the capability and experience of
Koelnmesse to organize a world-

class pavilion for U.S. exhibitors to
showcase U.S. dental products and
services. The U.S. Pavilion serves as
an excellent venue for U.S. companies to establish or expand overseas
distribution, generate sales leads,
evaluate competitors and work with
U.S. Commercial Service trade specialists to identify potential buyers
and partners.
“The Trade Fair Certification
Program is an excellent example

of the collaborative efforts of the
U.S. Government and private sector trade show organizers,” said
Michael Thompson, who directs the
program for the U.S. Commercial
Service. “Together we are working
to broaden the customer base of U.S.
exporters by introducing them to key
trade fairs where they can meet their
export objectives.”
The U.S. Commercial Service helps
U.S. businesses export by working

with them to establish international
business relationships. The agency’s
global network includes locations in
more than 100 U.S. offices and in
American embassies and consulates
in nearly 80 countries. For more
information on the U.S. Commercial
Service, visit www.export.gov. U.S.
companies interested in exhibiting
at this event should contact Silke
Eidam, s.eidam@koelnmessenafta.
com, tel. (773) 326-9929. DT
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• STA allows you to anesthetize one tooth
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The more comfortable injection for the dentist
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800.862.1125
www.stais4u.com

[12] =>

12A Industry

Dental Tribune | July 2009

The future looks bright for
Shofu with new president
and strategic alliance
tk DT

Introducing Kolorz ClearShield
5% Sodium Fluoride Varnish
in new bubblegum flavor
Watermelon and bubblegum flavors now available in 200- dose boxes
On Aug. 1, 2009, DMG America
will introduce the latest addition to
its Kolorz® line of professional dental
hygiene products: ClearShield® 5%
Sodium Fluoride Varnish in bubblegum flavor. ClearShield bubblegum
and watermelon flavors are now
available in both 35-dose and 200dose boxes. Unlike many brands of
fluoride varnish, which give the teeth
a discolored appearance, ClearShield
goes on smooth and clear, and tastes
great for greater patient acceptance.
One of the fastest growing
hygiene product lines in the market,
ClearShield received two Top Dental Advisor Awards in 2009 for Top
Fluoride Varnish and Top Hygienist’s
Choice.
ClearShield, like all Kolorz products, is manufactured with proprietary flavorings developed by gourmet food-industry professionals.
ClearShield’s child-friendly bubblegum and watermelon flavors are
guaranteed to taste better than any
other fluoride varnish, or your money
back. All Kolorz products, including ClearShield, are gluten free and
contain no saccharin or aspartame.
ClearShield is sweetened with natural
sweeteners, including xylitol, which
has been shown to reduce dental caries in both high- and low-risk patients.
ClearShield fluoride varnish is indicated for immediate and long-lasting
dentinal hypersensitivity with its
maximum 5 percent sodium fluoride
formula, and as a cavity liner under
amalgam restorations. Although drying the teeth before application is
recommended, ClearShield is moisture tolerant. Hygienists will find that
AD

it has an easy-to-mix consistency,
can be applied smoothly and thinly
with no clumping, and has excellent
adherence to the teeth.
Each 0.40 mL hygienically-sealed
unit-dose package includes an applicator and a mixing well to ensure
consistent fluoride levels. Instructions
for the clinician and a pad of posttreatment instructions for patients are
also included.
ClearShield bubblegum flavor
joins the complete line of greattasting Kolorz products: Prophylaxis
Paste, Sixty Second Fluoride Foam
and Gel, Neutral Fluoride Foam
and Topical Anesthetic Gel. DMG
America manufacturers and distributes quality restorative materials and
prevention products. For more information, call (800) 662-6383 or visit
www.dmg-america.com. DT

Fight oral cancer!
Did you know that dentists are
one of the most trusted professionals to give advice? Thus, no other
medical professionals are in a better position to show patients that
they are committed to detecting and
treating oral cancer.
Prove to your patients just how
committed you are to fighting this
disease by signing up to be listed at
www.oralcancerselfexam.com. This
new consumer Web site shows them
how to do self-examinations for oral
cancer. DT

Shofu has just made two
announcements.
The first was
the appointment of a new president. In a separate announcement,
Shofu has entered into a strategic alliance with Mitsui Chemicals
and Sun Medical.
Effective Thursday, June 25,
Noriyuki Negoro became the president of Shofu. Formerly the director of research and development,
quality assurance and production
at Shofu, Negoro has been with the
company for over 28 years and,
as a researcher, developed such
successful products as Beautifil,
Solidex and Ceramage.
Katsuya Ohta, the former president of Shofu, held the position for
the past nine years and will continue to serve as chairman.
Shofu America’s President Brian
Melonakos congratulated Negoro
on his promotion and said, “Working closely with Mr. Negoro for the
past five years, I have valued the
opportunity to observe first hand
his leadership and to witness his
technical knowledge. I have every
confidence in his grasp of the
industry and in his ability to guide
Shofu in these globally challenging economic times.”
In addition to the change in

Shofu President Noriyuki Negoro
leadership, Shofu continues to
look toward the future by initiating a business and capital alliance
with Mitsui Chemicals and Sun
Medical.
Mitsui, as a multi-billion dollar manufacturer of raw materials, has a strong core competency
in materials development and is
engaged in the dental materials
business through its subsidiary,
Sun Medical.
As the business environment for
dental materials becomes more
challenging with intensified global competition, Shofu, Mitsui and
Sun Medical hope that their alliance will contribute to the efficient use of business resources in
g DT page 15A

www.dental-tribune.com
Missed the last edition of Dental Tribune? You can now read some of its
content online!
Treatment acceptance: could have, should have, would have
By Sally McKenzie, CMC
www.dentaltribune.com/articles/content/id/509/scope/specialities/
region/usa/section/practice_management
Dentists and cardiologists should work together to prevent disease,
experts say
By Fred Michmershuizen, Online Editor
www.dental-tribune.com/articles/content/scope/news/region/usa/
id/416
Five of the top 10 reasons why associateships fail
By Eugene W. Heller, DDS
www.dental-tribune.com/articles/content/id/507/scope/specialities/
region/usa/section/practice_management
Former hygienist now dentist, president of AGD
By Fred Michmershuizen, Online Editor
www.dental-tribune.com/articles/content/id/508/scope/news/region/usa

Here’s some other online content that might interest you …
Company urges dentists to screen for snoring and obstructive sleep
apnea
By Fred Michmershuizen, Online Editor
www.dental-tribune.com/articles/content/scope/business/region/usa/
id/494
National Museum of Dentistry celebrates opening of ‘Smile
Experience’ exhibition
www.dental-tribune.com/articles/content/scope/news/region/usa/id/503
Dental implant procedures go virtual
By Paula Hinely, USA
www.dental-tribune.com/articles/content/scope/news/region/usa/id/431

www.dental-tribune.com

[13] =>

[14] =>

[15] =>

Industry 15A

Dental Tribune | July 2009

Pupldent launches new Web site

Same Day
Inlay/Onlay
technique
Patients are demanding esthetic,
reliable and conservative options to
replace their defective amalgam restorations. The Same Day Inlay/Onlay
technique was pioneered to improve
both patient care and practice economics. Learn this amazing technique and earn eight Academy of
General Dentistry credits. You can
eliminate temporaries, the second
visit and embarrassing emergencies between appointments. With
less time and no lab bill, your bottom line will benefit as well.
Due to the success Dr. Lorin
Berland has had with Same Day
Inlay/Onlays, he has created an
instructional CD outlining the
techniques, materials and equipment necessary to provide this
wanted and needed service.
To order, call (214) 999-0110 or
send an e-mail to xia@dallasden
talspa.com. You may also visit
online at www.berlanddenta larts.
com. DT

f DT page 12A
their respective specialized fields,
leading to the enhancement of
the business effectiveness, market
presence and corporate value of
all three companies.
Melonakos said, “Mr. Negoro’s
insight and vision for the future
will also be critical to lead the
transfer of technology and collaborations between Shofu, Mitsui
and Sun Medical.”
With a joint task force, Shofu,
Mitsui and Sun Medical plan to
promote the development of new
products in the dental field, optimize manufacturing technology,
explore new advancements in
materials technology and enhance
chemical products currently in
development.
President Negoro said, “Our
goals remain unchanged, which
include speeding up the development of new products and expanding our business globally.”
Melonakos added, “This is a sign
that Shofu recognizes new product innovation as one of the most
important components of success
and growth in the future.”
For more information, please
call Shofu at (800) 827-4638 or
visit www.shofu.com. DT

Pulpdent has launched a comprehensive new Web site that offers clinical information and case studies, as
well as in-depth information about
Pulpdent’s proven products for dental
professionals. The Web site can be
found at www.pulpdent.com.
The Pulpdent Web site is easy to
navigate and includes articles and
other educational content, news and
events and product information. Product pages include a product overview,
instructions for use, MSDS sheet, and
in many cases, related articles and
studies, frequently asked questions,
and illustrated step-by-step clinical
procedure instructions. There are
PowerPoint presentations for many of

the products.
“We wanted the
Web site to be informative and easy to use,”
said Ken Berk of Pulpdent, “but above all, we
wanted it to be a place
dental professionals
will enjoy coming to.
It’s like a dental amusement park.”
Visitors to the Web
site will find a link for
signing up to receive the free Pulpdent informational e-newsletter and
an archive of past newsletters.
Customers can also place orders
for Pulpdent products on the Web site,

and Pulpdent will forward the order to
the customer’s preferred dental dealer
for processing. For more information,
call (800) 343-4342 or visit www.pulp
dent.com. DT
AD

[16] =>

[17] =>

IMPLANT TRIBUNE
The World’s Dental Implant Newspaper · U.S. Edition
JULY 2009

www.implant-tribune.com

VOL. 4, NO. 7

AAP headed for Boston

Materialise in Monterey

Want success?

Clinicians, companies
convene on Pacific coast

Here are the 7 questions
you need to ask yourself

Page

ICOI
headed to
Vancouver
The International Congress of Oral Implantologists
will host its World Congress
XXVI from Aug. 20-22 at the
Vancouver Convention Centre in Vancouver, Canada.
Here is just a small sampling of speakers and topics
to be featured at this event:
• Dr. Lyndon Cooper:
“Dental Implant Function
and Occlusion – Risk and
Benefit”
• Dr. Scott D. Ganz: “The
Impact of Digital Dentistry
on Prosthetic Paradigms”
• Dr. Jack Krauser:
“Guided Implant Surgery –
The Good, The Bad and The
Ugly”
• Dr. Edwin A.
McGlumphy: “How Fast Can
We Go? Ohio State Implant
Clinical Trials: What We
Have Learned About Early
and Immediate Loading”
For more information
about the event, see
www.icoi.org, where you can
register online and learn
more information about
schedule and hotels. IT

Page

A procedure using stem cells may
provide a more thorough regeneration of periodontal tissue around
dental implants, according to a new
report published in the Journal of
Oral Implantology.
Dental implants closely resemble
natural teeth, but an implant’s ability to react to patient growth, pressure from chewing and future orthodontic work is diminished if it is not
surrounded by sufficient periodontal
tissue. In this study, the authors
engineered this periodontal tissue in

14B

a fresh socket of a goat animal
model.
Each of five goats was fitted with
two titanium implants immediately
after tooth removal. A poly DL-Lactide-co-Glycolide scaffold was fitted
around each implant, but the control
received only the scaffolding. The
experimental implant received scaffolding seeded with bone marrow–derived mesenchymal stem
cells (BMDSCs). All implant sites
showed some level of tissue development at 10 days after the opera-

tion. At one month after, the control
side showed no signs of tissue development, whereas the experimental
side had developed cementum, bone
and periodontal ligament, the three
tissues required for regeneration of
periodontal tissue.
Past studies have demonstrated
positive results with BMDSCs in
periodontal defects around natural
teeth. Others have shown promising
results without BMDSCs, using pro IT page 2B

Miniscrews: a focal point in practice
Part two in a six-part series
By Dr. Björn Ludwig, Dr. Bettina Glasl,
Dr. Thomas Lietz and Prof. Jörg A. Lisson

Basic information on the
insertion of miniscrews
Preparing for insertion
The insertion of a miniscrew is a
very simple and rapid therapeutic
measure. Although there are several methods that will yield good
results,
successful
insertion
requires adherence to a few import IT page 4B

INDUSTRY TRENDS

Avoiding the pitfalls of
implants with 3-D imaging
Once only a solution for the rich
and famous, dental implants have
become a popular option for people
across all economic categories.
Along with the popularization of this
procedure, while implants were usually delegated to specialists, technology, such as in-office cone-beam

Page

Stem cells may improve the
adaptability of dental implants

(Source: ICOI)

By Terry Myers, DDS

11B

scans and digital imaging allow general practitioners to offer this type of
service while also avoiding the pitfalls that result from a lack of precise
information.
Research illustrates both the
growing popularity of implants and
the increasing desire of general den IT page 2B

Fig. 1: X-ray positioning aid
(X-ray pin,
FORESTADENT)
shown in situ in
relation to the
adjoining tooth
axes.
AD

[18] =>

Industry Trends

IMPLANT TRIBUNE | JULY 2009

IT page 1B

tists to provide their patients with
this procedure. A recent survey cites
that 19 percent of general dentists
have placed implants for three years
or less. Many practitioners want to
add this procedure as a response to
requests from their patients. The
study also showed that 77 percent of
general practitioners said the number of patient inquiries about
implants in their practice has
increased during the last three years.
For the general dentist, the proper
technology can reduce stress and
expand the comfort zone, as well as
increase the safety and comfort of
the patient during implant planning
and surgery.
A successful implant surgery is
dependent upon many details, a
majority of which are hidden
beneath the gingiva. A 2-D X-ray or
pan cannot discern certain anatomical conditions of the dentition that
may determine the direction and
scope of the treatment plan. Without
a 3-D scan, the dentist needs to
devise several “just-in-case” options,
to provide for the various possible
scenarios taking place under the
gum tissue. While this may seem to
you like “covering all bases,” it may
decrease the patient’s confidence in
your diagnostic ability.
A comfortable and positive experience will determine whether you
retain a loyal patient or get bad press
among his/her friends.
Beginning an implant without a
3-D scan is like trying to navigate
through a dark room without a flashlight. You are sure to bump into
something that will stop your
progress. A 2-D pan alone cannot
clearly establish the dimensional
shape of the bone. Without the exact
measurements of the width and
height of the bone provided by the
cone-beam image, it is likely that you
may flap back the tissue only to find
insufficient bone to support an
implant. The patient ends up with
pain, stitches, and an additional
appointment to complete the next
stage.
Besides the amount of bone, the
3-D scan avoids other possible obstacles to a successful implant. The
ability to view abnormalities of the
roots, the tooth’s proximity to adjacent teeth, supernumerary teeth and
the proximity to the nerves and sinus
provides valuable insight, avoiding
surprises once the surgery is underway.
The cone-beam scan improves
patient communication, avoiding
misunderstandings and improving
patient acceptance. Back to the survey scene, more than 98 percent of
those surveyed were involved in
patient education on implants. Education is easy with a 3-D image. The
dentist can point out the possible
trouble spots on the 3-D model, slicing, rotating, enlarging and exploring the patient’s dental anatomy from
all angles.
Whether you are a general dentist
or a specialist, no one wants the
stress of a possible failed implant, or

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

Publisher
Torsten Oemus
t.oemus@dtamerica.com
President & CEO
Peter Witteczek
p.witteczek@dtamerica.com
Chief Operating Officer
Eric Seid
e.seid@dtamerica.com

Severe buccal destruction easily detected on a 3-D cross-section from Cone Beam
(GXCB-500), and successful implant placement verified by a digital X-ray (DEXIS).

Group Editor & Designer
Robin Goodman
r.goodman@dtamerica.com
Editor in Chief
Sascha A. Jovanovic, DDS, MS
sascha@jovanoviconline.com
Managing Editor/Designer
Implant & Endo Tribunes
Sierra Rendon
s.rendon@dtamerica.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dtamerica.com
Online Editor
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Account Manager
Humberto Estrada
h.estrada@dtamerica.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dtamerica..com
Marketing & Sales Assistant
Lorrie Young
l.young@dtamerica.com

3-D reveals narrow ridges and provides precise measurements for safer placement.

C.E. Manager
Julia Wehkamp
j.wehkamp@dtamerica.com
Dental Tribune America, LLC
213 West 35th Street, Suite 801
New York, NY 10001
Phone: (212) 244-7181, Fax: (212) 244-7185

The undercut
mandible as
seen in 3-D
prior to
surgery.

a disappointed patient.
In conjunction with 3-D imaging,
many surgical guides are available
that provide even more direction
during the surgery, and 2-D digital
images taken during the surgery can
offer a quick check of drill lengths
and placements.
While success in any surgical
endeavor cannot be totally guaran-

teed, having all of the facts beforehand does stack the odds in your
favor. With cone-beam technology,
general dentists can keep their existing patients in-house, attract new
patients and expand their dental
horizons. There’s no need to do surgery in the dark because 3-D imaging is available to shed light on all
the pertinent facts. IT

About the author

Dr. Terry Myers completed his residency in
advanced general dentistry and served as an
instructor
in
the
advanced education in
general dentistry residency program and as
director of the faculty
practice at the University
of Missouri-Kansas City
School of Dentistry. He is
a fellow in the Academy
of General Dentistry and
a member of the Acade-

Published by Dental Tribune America
© 2009, Dental Tribune International
GmbH. All rights reserved.

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 publishers
also do 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 International.

IT page 1B
my of Cosmetic Dentistry
and the Dental Sleep Disorder Society. Myers is on the
board of directors at
Research Belton Foundation
and is a participating
provider for the dental care
program to improve children’s dental care. His private practice, where he utilizes the Gendex GXCB-500
and DEXIS, is in Belton, Mo.
Myers can be reached
by
e-mail
at
office
@keystone-dentistry.com.

genitor cells from the remaining ligament in certain limited situations.
But unlike past studies, this report
demonstrates that using BMDSCs
can ensure a more thorough, adaptable regeneration of periodontal tissue with titanium implants.
To read the entire article, titled
“Experimental
Formation
of
Periodontal Structure Around
Titanium Implants Utilizing Bone
Marrow
Mesenchymal
Stem
Cells: A Pilot Study,” visit:
www.allenpress.com/pdf/ORIM-353-106.pdf. IT

[19] =>

[20] =>

IMPLANT TRIBUNE | JULY 2009

Clinical

IT page 1B

ant principles. The following text
details those insertion steps that
offer a high degree of safety for both
patient and dentist (see checklist for
insertion on page 8). It should be
noted that this information is generalised and must be adapted to individual circumstances.
General notes on insertion
Accurate pre-operative planning
is a basic requirement for successful
treatment with miniscrews. Such
planning includes a comprehensive
anamnesis and an accurate assessment of the findings. It is essential
that the treatment be thoroughly
explained to the patient.
Proper hygiene must be ensured
throughout the entire operation.

Both the dental chair and the treatment process must be prepared with
this in mind. During the insertion of
a miniscrew, adherence to all
hygiene measures required for an
invasive procedure, such as a sterile
work environment and gloves, must
be ensured.
All instruments required for
insertion must be checked for completeness, functionality and sterility.
The patient may rinse with a disinfectant solution, or a suitable disinfectant can be locally applied. The
patient should then be positioned to
ensure a clear view of the operational area and ergonomically facilitate insertion for the treating dentist.
Pre-operative planning
To function correctly, a miniscrew requires firm anchorage in
the bone (primary stability) and the

positioning of its head in the denser
gingival tissue (gingiva alveolaris).
The selection of the insertion site
must take clinical and para-clinical
findings into account (X-ray image,
model), as well as the goal of the
treatment and the resulting orthodontic appliance. For interradicular
insertion, a bone thickness of at
least 0.5 mm around the miniscrew
is required. This means that for
a miniscrew with — for many reasons — an optimal diameter of
1.6 mm, the roots must be at least
2.6 mm from each other. Thus, the
bone status and the longitudinal axis
of the insertion site must be carefully evaluated.
Basic information regarding this
is obtained by carrying out measure IT page 6B

Figs. 2a–c: The top image shows the initial
situation. An X-ray pin was inserted into
the first and second quadrants of the upper
jaw (in the 6–5 region) to check the bone
site, followed by the miniscrew. Both
screws were inserted in a manner that is
clinically safe, but the X-ray images show
damage to the adjoining root in the righthand quadrant, indicating a false-positive
initial interpretation of the situation.

Figs. 3a–c: The clinical image shows two
miniscrews inserted into the palate in the
safe zone to the distal side of the transversal line linking the two canines. The
FRS and the PA image confirm the bone
support in the insertion region.

[21] =>

[22] =>

IMPLANT TRIBUNE | JULY 2009

Clinical

Figs. 4a and 4b: Injection pen with needle and anaesthetic cartridge,
and injection of anaesthetic.

IT page 4B

ments on the model. It often helps to
mark the vertical axis of the teeth
and the progression of the mucogingival line on the model, based on
the clinical and radiological findings. This will allow for an
improved assessment of the spatial
AD

Figs. 5a and 5b: Superficial anaesthetic device in pen form with cartridge, and application of superficial anaesthetic.

circumstances in combination with
the X-ray image. To assist the
accurate determination of the insertion site, X-ray aids (Fig. 1) are
available.
Although their use facilitates the
selection of the insertion site, they
cannot replace other diagnostic
measures. This is because, depending on the positioning of the X-ray
tube, object, film, and/or sensor, all

types of X-ray devices and images
may yield some optical distortion.
Interpretation of images can thus
lead to false-negative or false-positive results (Figs. 2a–c).
Therefore, the placement of a
miniscrew should always be based
on the clinical findings. If a miniscrew is to be inserted into an area
in which there is no risk of damage
to roots, nerves or blood vessels

Fig. 6: Measuring the thickness of the mucous membrane in the direction of
insertion. (Photo: Dr. Pohl)

(e.g., into the palate just behind the
transverse line linking the two
canines), the position of the screw
may be freely chosen (Figs. 3a–c).
Anaesthetic
During the interradicular insertion of a miniscrew, the sensitivity
of the periodontal tissue of the
adjoining teeth should be retained.
For this reason, the following two
procedures are recommended:
a) a low-dose injection of
approximately 0.5 ml anaesthetic (Figs. 4a and 4b); and
b) the induction of superficial
anaesthesia of the mucous
membrane at the insertion
site, for which a topical anaesthetic gel is suitable (Figs.
5a and 5b). No general anaesthetic is ever required for this
procedure.

Choice of screw
Measuring the thickness of the
mucous membrane (optional)
A pointed sensor with an
attached rubber ring is used to
measure the thickness of the gingival tissue in the direction of insertion (Fig. 6).
This information may be useful
when determining the final length
of the screw and possibly when
inserting the miniscrew.
When choosing the length, the
bone repository and the thickness
of the mucous membrane in the
direction of insertion play a role; in
the retromolar section of the lower
jaw and in the palate, the thickness
of the mucous membrane is often
more than 2 mm.
The part of the miniscrew inside
the bone must be at least as long as
the part outside the bone. The various dimensions must be taken into
account.
The thickness of the bone in the
direction of insertion determines
the required length of the miniscrew:
• bone thickness > 10 mm: miniscrews with a length of up to
10 mm are to be used;
• bone thickness < 10 mm and
> 7 mm: miniscrews with a
length of 8 mm or 6 mm are to
be used; and
• bone thickness < 6 mm: miniscrews cannot be used.
The following guidelines aid in
selecting the length:
• in the buccal region of the
upper jaw: 8 mm or 10 mm;
• in the palatinal region (depending on the region): 6, 8 or
10 mm; and
• in the lower jaw: usually 6 mm
or 8 mm.

[23] =>

IMPLANT TRIBUNE | JULY 2009

Figs. 7a and 7b: Diagrams showing the thread mechanisms: self-cutting and self-tapping.

Fig. 9: Sterile miniscrew supplied in pinholder (tomas-pin, DENTAURUM).

Determination of the type of thread
Self-cutting miniscrews require
pre-drilling (also known as pilot
drilling) appropriate to the length
and diameter of the screw, as well
as to the quality of the bone.
A self-tapping miniscrew will
find its own way into the bone and
requires no pre-drilling (Figs. 7a
and 7b).
Bone is more or less elastic

Clinical 7B

Figs. 8a and 8b: Pre-drill with a 4 mm long blade and limit stop: Drill
(FORESTADENT) and tomas-drill SD (DENTAURUM).

Figs. 10a–d: Preparation of the work rack and removal of the blades.

depending on site, age and structure. However, the screw diameter,
the thickness of the cortical bone,
and the hardness of the bone at the
insertion site limit the extent to
which this method can be used.
Without pre-drilling, the bone
will be strongly compressed during
insertion and thus suffer related
tension stress.
This may result in the cracking of

the bone around the insertion site.
When the screw is screwed into
the bone, it is subjected to high
loads. Depending on the bone quality, the resistance against insertion
and the continuity of the rotational
movement, high torsional forces
can result.
In regions with thick cortical
bone and a much looser bone structure (e.g. the upper jaw), the use of

self-tapping screws is recommended.
In regions where the cortical
bone is thick and the bone structure
is dense (e.g., the anterior lower
jaw), both self-cutting and self-tapping screws may be used, in each
case following perforation of the
compact bone.
 IT page 8B
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[24] =>

IMPLANT TRIBUNE | JULY 2009

Clinical

IT page 7B

Checklist for insertion
Pre-operative planning
and preparation:
• planning documentation (X-ray,
situational models);
• marking of the muco-gingival
line and tooth axes on the model;
• determining the site of insertion;
• sterilisation of the instruments
and preparation of the workstation.

Transgingival penetration
The miniscrew must penetrate
through gingival tissue, which must
thus be perforated during insertion.
Two methods are used for the perforation of the gingival tissue:
a) excision of the gingival tissue; or
b) direct insertion of the screw
through the gingival tissue.
There are currently no published
studies that investigate the effect of
these two methods on postoperative
problems, histological effects and/or
the loss rate of miniscrews.

Anaesthetic and assessment
of the insertion site:
• anaesthetic;
• use of X-ray aids;
• control image.

Preparation of the bone site

Selection of the screw:
• measuring of the thickness of the
mucous membrane (optional);
• determination of the length;
• determination of the type of
screw.

Protection of the bone is an important
aspect. Insertion without pre-drilling
results in tensional stress within the
bone, which may lead to postoperative complications. Particularly in the
case of crestally placed screws, bone
displacement may result in a severe
expansion of the periosteum. The
thickness of the cortical bone, especially in the lower jaw, can have a significant effect on the torque of the
screw. To ensure that the screw is not
overloaded during insertion, the
compact bone of the anterior lower
jaw should be perforated by predrilling, as mentioned earlier. Predrilling should be done at a maximum of 1,500 rpm–1, using a short
pilot drill and water-cooling to
reduce the risk of damaging the root
(Figs. 8a and 8b).

Insertion of the miniscrew
The miniscrew must be removed
from its sterile packaging (Fig. 9) or
the work rack (Figs. 10a–d) without
contamination. The thread of the
screw may not be touched. The screw
should be inserted at a constant rotational speed (at approximately
30 rpm–1) and with as uniform a
torque as possible.
Manual insertion
Manufacturers supply various
screwdrivers and blades in several
lengths for the manual insertion of
the screws. Because of their dimensions, long blades pose the risk of
attaining a very high torque during
insertion.
Thus, insertion must be carried
out carefully to avoid breaking the
miniscrew. Torque ratchets are available for use with some systems (e.g.,

Transgingival penetration:
• excision of the mucous membrane or perforation with the
screw.

Figs. 2.11a–f: Preparation of the instruments and insertion of two miniscrews into the
palate by machine.

tomas, DENTAURUM; and LOMAS,
Mondeal), which provide a certain
amount of control over the insertion
torque.
Machine insertion
Machine
insertion
requires
a surgical treatment unit (the torque
of which can be controlled) or at least
a low-rpm dual green handpiece.
Accurate setting of the torque and the
number of rotations is required; the
rotation rate should not exceed 30
rpm–1, and the torque must be
restricted to the maximum load limit
of the screw.
Machine insertion helps to achieve
a consistent torque during insertion
but means that the operator loses
perception of the bone. During manual insertion, it is possible to perceive
the interaction between the screw
and the bone by tactile senses. Insertion by machine is shown in Figures
11a–f.
Attaching the orthodontic linking
elements
As no healing phase is required,
load may be placed on the miniscrew

Fig. 12: Linking of the miniscrew to the orthodontic appliance.

immediately after insertion. The
selected linking element must be prepared accordingly and attached to the
head of the screw (Fig. 12).
To avoid damage to the teeth to be
moved, the load on the linking element should be between 0.5 and 2 N
(about 50 and 200 g).
Basic postoperative care
The healing of the gingival tissue
and hygiene status after insertion
must be regularly reviewed during
the entire time that the miniscrew
remains in place. The patient must be
informed that any manipulation of
the screw head with the fingers,
tongue, lips, and/or cheeks should be
avoided, otherwise the screw may be
prematurely lost.

Removal of the miniscrew
A miniscrew can be removed under
local anaesthetic. After the linking
elements have been removed, the
miniscrew may be removed with the
same tools used for insertion. The
resulting wound requires no special
care and usually heals within a short
time. IT

Preparation of the bone site:
• optional marking of the bone;
and
• perforation of the cortical bone
or deep pilot drilling, depending
on the type of screw.
Insertion of the miniscrew:
• manually or by machine.
Start of orthodontic measures:
• attaching and fixing of the linking elements.
Postoperative care:
• notes on care and behaviour;
• check-up dates.
Removal of the miniscrew:
• removal of the linking elements;
• removal of the miniscrew.

Contact information
Dr. Björn Ludwig
Am Bahnhof 54
56841 Traben-Trarbach
Germany
Tel.: +49 65 41 81 83 81
Fax: +49 65 41 81 83 94
E-mail: bludwig@
kieferorthopaedie-mosel.de

Figs. 13a–c: Miniscrew in place, after removal, and following a four-week healing period.

[25] =>

IMPLANT TRIBUNE | JULY 2009

Events 9B

AAP to host meeting in Boston
The American Academy of Periodontology (AAP) will host its 95th
Annual Meeting in Boston, Mass.,
from Sept. 12–15 at the new Boston
Convention and Exhibition Center.
Attendee registration is now open, and
dental professionals from all specialties are encouraged to register to learn
about the latest advancements in periodontology. More than 5,000 dental
professionals and participating vendors are expected to attend.
The four-day meeting will include a
variety of educational and scientific
sessions in seven distinct program
tracks, covering topics such as dental
implants, periodontal-systemic relationships, practice development and
management, and regeneration and
tissue engineering. Traditional contin-

uing education courses, as well as
hands-on workshops and clinical
technique showcases will be offered.
In total, more than 50 educational and
scientific sessions will be offered.
Of particular note is this year’s
Opening Ceremony, which will officially kick off the meeting on Sept. 12
with welcome remarks from the 2009
AAP President, David Cochran, DDS,
PhD. The academy is also pleased to
announce Paul M. Ridker, MD, as the
opening ceremony’s keynote speaker.
Ridker is a leading researcher in
inflammation and cardiovascular disease, and was an important contributor to the recent joint consensus paper
on cardiovascular disease and periodontal disease published by The
American Journal of Cardiology and

the Journal of Periodontology.
“This is an exciting time in periodontics, so I am thrilled to invite the
dental community to join us in
Boston,” Cochran said. “It has become
critical that all dental professionals
understand the connection between
periodontal disease and other chronic
diseases of aging, such as cardiovascular disease, and especially the role
inflammation plays in this connection.
Our 2009 Annual Meeting offers an
exciting and informative forum to
learn
about
these
important
advances.”
For more information or to
register for the Annual Meeting,
visit www.perio.org/meetings or call
(312) 573-3216 or send an e-mail to
angela@perio.org. IT
AD

[26] =>

[27] =>

IMPLANT TRIBUNE | JULY 2009

Events 11B

SimPlant World
Congress focuses
on 3-D in Monterey
Materialise Dental event featured leading experts
By Sierra Rendon, Managing Editor

The 2009 SimPlant® Academy
World Conference, held at the Monterey Marriott in coastal Monterey,
Calif., from June 25–27, concluded
with many high points regarding the
advancement of implant dentistry for
the several hundred periodontists, oral
surgeons, restorative specialists and
general practitioners in attendance.
“Materialise Dental is thrilled to
offer a fantastic program at the SimPlant Academy World Conference,”
said John Thomas, General Manager
of Materialise Dental USA and Canada.
“We assembled the finest group of
implant dentistry experts and industry
patrons one could imagine, and those
in attendance have been treated to
three days of unsurpassed education
in our never-ending quest to make
implant surgery even more successful.”
Just a sampling of the speakers at
the event include Drs. Lyndon Cooper,
Mazen Dagher, Doug Erickson, David
Guichet, Randolph Resnik and many
more.
The conference’s mission was to
provide a comprehensive understanding of the use of 3-D digital dentistry in
order to improve implant treatment
planning services.
Clinicians who had limited knowledge about SimPlant and SurgiGuide®
drill guides congregated to take their
knowledge of this state-of-the-art technology to the next level.
Delegates participated in intensive
hands-on SimPlant software training
workshops, high-quality lectures by
renowned speakers in the field and
hands-on laboratory sessions where
participants learned how to use
SurgiGuide drill guides and create all
types of scanning prostheses.
“I can say without reservation that
the quality of the guest lecturers and
their presentations was absolutely topshelf, and I’ve taken home many
‘pearls’ that I will be able to put into
immediate use in my implant practice,” said Dr. Lynn Pierri, a board-certified oral and maxillofacial surgeion
from Long Island, N.Y.
“It was extremely rewarding to
exchange experiences, both surgically
and prosthetically, with Materialise
Dental users in the international
implant community in a common
effort to take our practices to an unparalleled level of precision in both planning and execution.”
Software training was available for
all levels of participants. Participants
were also offered rotating workshops,
in which everyone had the chance to
learn about all of the components that
go into CT Guided surgery, including:

dental laboratories, CBCT, SurgiGuide
selection and design and SurgiGuide
functionality using CT-guided surgical
kits.
Also at the conference were 12
 IT page 13B

Dr. Doug Erickson hosts a very interactive group discussion on ‘CT Data and Processing Cases on the Fast Track’ at the SimPlant Academy World Conference in
Monterey, Calif., from June 25–27.

AD

[28] =>

[29] =>

IMPLANT TRIBUNE | JULY 2009

Events 13B

IT page 11B

exhibiting companies, including Astra
Tech
Dental,
BIOMET
3i,
PreXion 3-D, Straumann, iCat and several others, all there to show support
of this technologically advanced dental
concept.
Implant manufacturers, CBCT
manufacturers and surgical supply
companies gathered to show the delegates how their companies could help
improve their CT-guided implant practices.

New product highlights

Dr. David Guichet speaks on ‘Computer-Guided Treatment and the Immediately Loaded Prosthesis’ in a Plenary
Session at the SimPlant Academy
World Conference.

An attendee gets some information at
the PreXion booth during a refreshment break at the SimPlant Academy
World Conference. A total of 12 companies supported the event and exhibited products on site.

Dr. Lyndon Cooper discusses ‘Data In
— Data Out: How Careful Case
Preparation Can Influence the Scan,
the Plan, the Guide and the Lab Fabrication for Esthetic Restoration.’

Chief among the highlights of the
event was the launch of the Universal
SurgiGuide and surgical kit. Expanding on the SimPlant CompatAbility
model, the Universal SurgiGuide system allows you to continue to use your
standard surgical drills and the

Materialise Dental launched the Universal SurgiGuide® at the World Conference.

implant brand of your choice, while
making the drilling sequence easier.
One guide that can be fixated into
place is used in conjunction with a
series of drill keys in order to account
for the increase in diameter as you
drill to create an osteotomy.
A sneak preview of the SimPlant 13
and DentalPlanit, an upgraded version
of
world’s
first
interactive

3-D implant planning system and
online communication portal that are
scheduled to come out later 2009, were
also on display.
“I find Materialise Dental a leader
in computer-guided treatment planing
for implants,” said attendee Dr. Faisal
Aldujaili.
“If you are placing implants, you
must have them on your side. I highly
recommend the software; it’s userfriendly and their support is always
there. The Materialise Dental World
conference was a great educational
experience for me in beautiful Monterey with an exceptional organization.”
For more information on SimPlant
Academy events and courses, visit
www.simplantacademy.org.
IT
(Matt Tedrow of Materialise Dental
contributed to this report.)
AD

[30] =>

14B

Practice Management

IMPLANT TRIBUNE | JULY 2009

7 questions of implant success
By Roger P. Levin, DDS

What defines a successful relationship between an implant practice and
a referring office? That’s simple —
interdisciplinary teamwork! A strong
systemized relationship with referring
offices is essential to your continued
success. In an uncertain economy, you
must do everything necessary to grow
your implant practice, and interdisciplinary teamwork will be key to that
growth. Adding value and support is
critical to your future.

Getting in sync
At a recent Total Practice Success™
seminar where I was speaking to several hundred restorative doctors, I
pointed out that motivation — any sort
of motivation — lasts about one week.
For that reason, all new patients and
big cases should be scheduled within
seven to 10 days. Doing so greatly
increases the likelihood of case
acceptance.
At this seminar, a restorative doctor
shared with me a problem he was having with his referring oral surgeon.
This general dentist liked restoring
implant cases, but the oral surgeon
couldn’t see implant consults for about
six weeks. The dentist found the waiting period was simply too long. By the
AD

time his patients were seen by the oral
surgeon, motivation had waned and
case follow-through was quite low.
Shortly after the seminar, I spoke
with several oral surgeons about this
subject. These doctors all acknowledged that the implant consults should
occur as quickly as possible. For a
team approach to work, both restorative and surgical practices must be on
the same page.

A better implant team
To strengthen relationships with referring dentists, clear communication is
essential. Remember, just because a
surgical practice has been managing
the implant process the same way for
years, doesn’t mean it’s the most effective method. There’s always room for
improvement. Levin Group recommends that restorative doctors and
specialists reach agreement on these
seven questions regarding interdisciplinary care:
• Who will provide patient care
during each step of the implant
process?
• How soon can the surgical practice see a referred patient for an
implant consultation?
• Who will provide case planning
input?

• How will communication occur
between the restorative practice and
the implant surgical practice?
• Who will present fees to the
patient?
• When the situation is appropriate, who will arrange financing for
patients?
• How soon can the patient expect
to start implant treatment when a case
is presented and accepted?
While there are many other issues
to consider as well, finding answers to
these seven questions will give you an
excellent starting point for establishing a solid, productive and hopefully
long-term relationship with referring
offices. Bridge the communication gap
and cross over into more success! IT
Want to learn more about building
superior relationships with referring
offices? Make plans to attend Dr.
Levin’s latest Total Implant Success™
seminar Sept. 24–25 in Baltimore.
Implant Tribune readers are entitled to
receive a 20 percent courtesy on this
seminar. Call (888) 973-0000 and mention “Implant Tribune” or e-mail
customerservice@levingroup.com with
“Implant Tribune” in the subject
line. For more information, visit
www.levingroupimplant.com.

About the author

Dr. Roger P. Levin is founder and chief
executive officer of Levin Group, a leading implant practice management firm.
Levin Group provides Total Implant Success™, the premier comprehensive consulting solution for lifetime success to
implant clinicians in the United States
and around the world. For more than two
decades, Dr. Levin and Levin Group have
been dedicated to improving the lives of
implant clinicians.
Levin Group
10 New Plant Court
Owings Mills, Md. 21117
Tel.: (888) 973-0000 or (410) 654-1234
E-mail:
customerservice@levingroup.com
www.levingroupimplant.com

[31] =>

[32] =>

[33] =>

ENDO TRIBUNE
The World’s Endodontic Newspaper · U.S. Edition
JULY 2009

www.endo-tribune.com

VOL. 4, NO. 7

David Rosenberg

Changing technology

Faster version

Endodontist, wife die
in rafting accident

How do you decide
what to participate in?

GuttaFlow® FAST
offers innovative system

Page

Page

2

Predictable apical
microsurgery
Part 1: Preparation of the patient
By John J. Stropko, DDS

Surgery will never replace solid
endodontic principles and should
always be a last resort. Apical microsurgery consists of nine basic steps
that must be completely performed
in their proper order so we can
achieve the desired result for our
efforts.
The nine steps are as follows:
1. Instruments, supplies and
equipment are ready.
2. Patient, doctor and assistants
positioned ergonomically.
3. Anesthetic and hemostasis staging completed.
4. Incision and atraumatic flap elevation.
5. Atraumatic tissue retraction.
6. Access, root-end bevel (root-end
resection, RER, and REB) and crypt
management.
7. Root-end procedures: root-end
preparation (REP).
8. Root-end fill (REF) techniques
and materials.
9. Sutures, healing and post-op
care.

Fig. 1: The Six-Handed Team
approach enables us to maximize
today’s technology today!

Predictable microsurgery requires
the use of an operating microscope
(OM) and a team committed to operating at the highest level. The SixHanded Team approach optimizes
the instruments, equipment, techniques and materials that today’s
level of technology presents for the
benefit of all — especially the patient!
Dr. Berman, an old retired general
surgeon, and one of my senior-year
dental school instructors, would
 ET page 6

Removal of warm
carrier-based products
with the Twisted File
By Richard Mounce, DDS

“Does anyone have any advice on
how to remove Thermafil with twisted files?”
Recently, I received this question
via e-mail from a colleague. Thermafil is a warm carrier-based obturation product of Dentsply Tulsa
Dental Specialties (Tulsa, Okla.).
The Twisted File (TF) is a product of
 ET page 4

Fig 1a, 1b: Clinical cases treated in
the manner described. The Twisted
File (SybronEndo, Orange, Calif.)
was used to remove the plastic Thermafil Carriers (Dentsply Tulsa Dental
Specialties, Tulsa, Okla.).

7

Page

7

AAE names new officers
at 2009 annual session
The American Association of
Endodontists installed the new officers of the AAE Executive Committee for the 2009–2010 term at the
group’s recent annual session in
Orlando, Fla.
• Gerald N. Glickman, DDS,
MS, MBA, JD, was named AAE’s
president. His agenda for the AAE’s
year centers on “Access to Care,”
finding ways to deliver endodontic
care and help people save their
natural teeth. Glickman is professor and chair of the Department of
Endodontics and Director of Graduate Endodontics at Texas
A&M/Baylor College of Dentistry in
Dallas. Long active in leadership
roles for the AAE, he has been a
member of the executive committee since 2005. He also is a diplomate and past president of the
American Board of Endodontics.
• Clara Spatafore, DDS, MS, was
named president-elect. Spatafore is
a full-time private practitioner in
Pittsburgh who also is an assistant
professor of endodontics at Drexel
University’s School of Medicine
and Alleghany General Hospital. A
member of the AAE since 1987, she
has held a variety of leadership
roles with the organization, including secretary and vice president of
its executive committee and director representing AAE District I.

• William T. Johnson, DDS, MS,
was named vice president. Johnson, the Richard E. Walton professor and chair of the Department of
Endodontics at the University of
Iowa College of Dentistry in Iowa
City, has had a long record of service to the AAE. In addition to representing District V on the AAE
Board of Directors, Johnson has
been board liaison to and a member of various AAE committees.
• James C. Kulild, DDS, MS, was
named secretary. Kulild is a professor and director of the Advanced
Specialty Education Program for
Endodontics at the University of
Missouri-Kansas City School of
Dentistry in Kansas City. An AAE
member since 1981, he has represented AAE District III on the AAE
Board of Directors since 2005.
• Robert S. Roda, DDS, MS, was
named treasurer. Roda is an
adjunct assistant professor at Baylor College of Dentistry in Dallas
and a visiting lecturer at the Arizona School of Dentistry and Oral
Health in Mesa. An AAE member
since 1991, Roda has chaired its
Continuing Education Committee
and has served as an associate editor of the Journal of Endodontics
since 2002. ET
(Source: AAE)

AD

[34] =>

News

ENDO TRIBUNE | JULY 2009

ENDO TRIBUNE
The World’s Endodontic Newspaper · U.S. Edition

Dental Tribune Study Club
develops case studies database
As modern technology advances,
so does the opportunity of using and
sharing data. Nowhere is this truer
than with medical data.
The benefits of providing shared
access to a practitioner’s case studies
are becoming increasingly evident
throughout medical communities,
and especially in dentistry. For dentists, this type of knowledge sharing
has been recognized as a key to
improving their clinical decision
making abilities.
Case studies:
• Allow the application of theoretical concepts to be demonstrated,
thus bridging the gap between theory
and practice.
• Encourage active learning. Dental professionals who learn through
colleagues’ experiences benefit from
exposure to real-world data.
• Provide an opportunity for the
development of key skills such as
communication and problem solving.
• Increase dentists’ enjoyment of
a particular topic, and hence their

desire to learn and improve their
skills.
However, the predominant benefits of sharing case studies are accelerated scientific progress, improved
patient outcomes, reduced research
costs and decreased time in moving
discoveries from paper to actual
practice.
A great case study consists of a
problem, the implementation of a
solution and the results. The problem
should have significant practice
impact for the reader. The implementation demonstrates how the
practitioner resolved the problem.
Finally, the case must be supported
with measurable results: statistics,
photos and even tables when appropriate.
Dental Tribune Study Club (DTSC)
is an online educational platform
where you can not only earn C.E.
credits, but also share your own case
studies and examine those submitted
by other dental professionals from
around the world. Dental Tribune

welcomes case submissions for its
online Case Study Database at
www.DTStudyClub.com. The submission process is easy:
• Become
a
member
of
www.DTStudyClub.com (it’s free!).
• Access “Discussion Groups” and
select the field of dentistry that
applies to your case. From there,
select “Case Study Discussions” and
then select a new thread.
• Now you will have the option of
writing a case description; posting
relevant photos, tables or charts;
adding tags; creating a poll to encourage peer feedback; etc.
Congratulations! Posting cases
couldn’t be easier.
The DTSC Case Studies Database is
constantly growing, with many members contributing cases on a regular
basis. DTSC accepts case submissions
in all areas of dentistry including general dentistry, cosmetic dentistry,
endodontics, implantology, periodontics, orthodontics, dental hygiene and
practice management. ET

Endodontist David Rosenberg
and wife die in rafting accident
By Fred Michmershuizen, Online Editor

David B. Rosenberg, an endodontist with a practice at Vero Beach,
Fla., and his wife, Jean, died in an
accident on June 11, according to a
local media report. An article posted
to the online edition of the Vero
Beach Press Journal reported that
Rosenberg and his wife were killed
in a whitewater rafting accident
while vacationing in the Dominican
Republic.
Rosenberg was highly recognized
as a leading expert in the field
of endodontics. He practiced and
taught endodontic retreatment for
more than 15 years, and he was a
regular presenter at endodontic
meetings throughout the country. He
also offered hands-on conventional
endodontic and re-treatment courses at his practice in Florida.
Fellow specialists who knew
Rosenberg expressed admiration.
“David Rosenberg was an outstanding endodontist who was passionate about our specialty,” said Dr.
Frederic Barnett, editor in chief of
Endo Tribune and chairman and
program director of the IB Bender
Division of Endodontics at the Albert
Einstein Medical Center in Philadelphia, Pa. “He was a true gentleman
and will be missed by the many people that he touched.”
“David was one of the best people
I have ever known, both as a human
being as well as an endodontist,”
said Dr L. Stephen Buchanan. “He
was honest and true, he had his pri-

Dr. David B. Rosenberg was a respected and well-known endodontist.

orities in line, and I couldn’t ask for
a better friend. I first got to know
him as a young endodontist who
looked to me as a mentor, but very
quickly he became mine. Some of
the best things I have learned in my
career were taught to me by him,
and it was always cool to hear his
latest thoughts on procedures. He
definitely thought outside of standard convention with the only rigidly held principles being that the
patient was first, that anything that
could make a procedure more successful was worth the effort, and that
doing things well was its own
reward.”
“Dr. Rosenberg was one of my
closest friends in the business,” said

Jim Kelley of Dental Education Laboratories. “He was a talented clinician and an innovative thinker who
was well respected among his peers.
But above all, Dr. Rosenberg was a
devoted husband to Jean and an
active participant in the lives of his
sons, Eddie and Steven. While we
talked often, business was always
secondary to the stories and adventures he shared with and about his
family.”
Rosenberg was well liked by his
patients. Some of them posted online
comments about him to the
tcpalm.com Web site.
“Dr. Rosenberg did a root canal
for me a few years ago,” one of his
patients wrote. “He got me in at the
last minute and stayed until my root
canal was done, well after 8 p.m. He
could not have been more kind and
professional.”
“This makes me so sad,” another
wrote. “I was in his office a few
months ago. [He was an] excellent
doctor and just a genuinely nice person. My condolences to his kids and
his office staff.” ET

Corrections

Endo 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
Sierra Rendon, managing editor, at
s.rendon@dtamerica.com.

Publisher
Torsten R. Oemus
t.oemus@dtamerica.com
President & CEO
Peter Witteczek
p.witteczek@dental-tribune.com
Chief Operations Officer
Eric Seid
e.seid@dtamerica.com
Group Editor & Designer
Robin Goodman
r.goodman@dtamerica.com
Editor in Chief Endo Tribune
Frederic Barnett, DMD
BarnettF@einstein.edu
International Editor Endo Tribune
Prof. Dr. Arnaldo Castellucci
Managing Editor Implant & Endo
Tribunes
Sierra Rendon
s.rendon@dtamerica.com
Managing Editor Ortho Tribune
& Show Dailies
Kristine Colker
k.colker@dtamerica.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dtamerica.com
Product & Account Manager
Humberto Estrada
h.estrada@dtamerica.com
Marketing Manager
Anna Wlodarczyk-Kataoka
a.wlodarczyk@dtamerica.com
Marketing & Sales Assistant
Lorrie Young
l.young@dtamerica.com
C.E. Manager
Julia Wehkamp
j.wehkamp@dtamerica.com

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

Published by Dental Tribune America
© 2009, Dental Tribune America, LLC.
All rights reserved.
Dental Tribune America 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 publishers also do
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.

Editorial Advisory Board
Frederic Barnett, DMD (Editor-in Chief)
Roman Borczyk, DDS
L. Stephen Buchanan, DDS, FICD, FACD
Gary B. Carr, DDS
Prof. Dr. Arnaldo Castellucci
Joseph S. Dovgan, DDS, MS, PC
Unni Endal, DDS
Fernando Goldberg, DDS, PhD
Vladimir Gorokhovsky, PhD
Fabio G.M. Gorni, DDS
James L. Gutmann, DDS, PhD (honoris
causa), Cert Endo, FACD, FICD, FADI
William “Ben” Johnson, DDS
Kenneth Koch, DMD
Sergio Kuttler, DDS
John T. McSpadden, DDS
Richard E. Mounce, DDS, PC
John Nusstein, DDS, MS
Ove A. Peters, PD Dr. med dent., MS, FICD
David B. Rosenberg, DDS
Dr. Clifford J. Ruddle, DDS, FACD, FICD
William P. Saunders, Phd, BDS, FDS, RCS Edin
Kenneth S. Serota, DDS, MMSc
Asgeir Sigurdsson, DDS
Yoshitsugu Terauchi, DDS
John D. West, DDS, MSD

[35] =>

[36] =>

Clinical

ENDO TRIBUNE | JULY 2009

ET page 1

SybronEndo, (Orange, Calif).
It is a fair statement that many of
the general dental clinicians who
use warm carrier-based obturation
in endodontics have never re-treated (removed) them when it is placed
in root canal treatment that fails.
Thermafil is a valid obturation
technique that is supported in its
efficacy by the endodontic scientific
literature. The concept most certainly has its advocates and champions.
This said, aside from the cost relative to other options, removal of
the carrier can, at times, be challenging. This column was written
for the general practitioner to be
exposed to and made aware of the
basic steps involved in retreatment
of warm carrier-based products in
which the carrier is plastic and to
discuss its removal with the TF.
Clinical use of the techniques
described would be best learned in a
continuing education format using a
surgical operating microscope
(SOM) (Global Surgical, St. Louis,
Mo.) beginning with practice in
extracted teeth.
As mentioned, retreatment of
warm carrier-based products can, at
time, be problematic. Carriers that
have been placed with significant
frictional retention into long, narrow and curved canals are more difficult to remove than other such
devices. Metal carriers were utilized
in early warm carrier-based product
versions.
In my clinical experience retreating warm carrier based products,
metal carriers have generally been
easier to remove than the plastic
ones. Whether metal or plastic,
techniques for removal varied from
the use of solvents, such as chloroform to dissolve out gutta-percha
from around the carrier, blended
with Hedström files to lift the carriers. For plastic carriers, a rotary
nickel titanium (RNT) file spinning
counterclockwise, could, in theory,
pick up the carrier and propel it out
of the canal.
Heat could also be used to melt
the plastic carriers to create access
into the canal or alongside a plastic
carrier. Carrier retention is a function of canal preparation as well as
carrier fit. If the canal did not have a
continuous taper, frictional retention of the carrier is more likely
along more of its length.
Using a carrier that is slightly too
large for the prepared canal space
can often have the same effect. Plastic Thermafil carriers will not dissolve in solvents, such as chloroform. Up to this point in time, RNT
instruments have not been able to
predictably machine out the plastic
carriers of warm carrier-based
obturation techniques. The TF, if
used correctly, is the first RNT file
that I have used that can do so with
predictability.
The TF is never cut across its
grain structure in manufacture. The
file is twisted in its manufacture
while in a crystalline phase struc-

Figs. 2a, 2b: Clinical cases treated in the manner described. The Twisted File
(SybronEndo, Orange, Calif.) was used to remove the plastic Thermafil Carriers
(Dentsply Tulsa Dental Specialties, Tulsa, Okla.).

men. No RNT system should be used
beyond the minor construction of
the apical foramen and the TF is no
expectation to this rule.
Usually, it will take approximately two TF instruments (or one) to
machine a plastic carrier out of the
canal. When the carrier has been
machined through and the clinician
reaches the apex, if a film is taken,
usually, the clinician can see small
fragments of the carrier at the lateral root walls of the canal.
Use of solvents (most often chloroform) and Hedström files to tug
these fragments out of the canal is
simple, predictable and can render
the entire canal free of any substantial gutta-percha or remnants of the
plastic carriers. After carrier
removal, optimally, the clinician
would gauge the minor constriction
of the apical foramen (use a hand K
file to determine the initial diameter
of the MC) and then finalize the
preparation to the master apical
diameter.
While it is empirical, it is a common technique to gauge the apex
and finalize the canal preparation to
three sizes larger than the first file
that bound at the MC. Inherent in
this recommendation is the awareness that the MC is not being
enlarged or transported and that the
canal is being shaped up to the MC
and not beyond. In essence, the MC
that is present is left alone and not
moved, enlarged or altered in any
way.
A clinically relevant discussion of
plastic carrier removal has been
provided with the goal of informing
general practitioners of common
methods of carrier removal using
new and innovative technology in
the form of the Twisted File.
I welcome your feedback. ET

Fig. 3: The Twisted file (SybronEndo, Orange, Calif.)

ture known as R phase, which is an
intermediate phase between austenite and martensite (the resting
phase of nickel titanium and the
phase present under stress during
function, i.e., rotating through a curvature during canal shaping). In
addition to twisting, TF manufacture is finalized with a final deoxidation process that maintains the
files’ surface hardness and sharpness of the cutting edges.
These properties make the TF
very different in its capabilities relative to other RNT instruments that
are ground from a nickel titanium
wire. One of these functional capabilities is the ability of the TF to
grind through plastic carriers. Clinically, depending on the size of the
canal to be retreated, usually, either
a .08 or .10 TF instrument will be
used for this purpose. The TF is
used at enhanced rotational speeds
for this purpose, usually 900-1200
rpm. It is designed to be used in one
canal or one tooth, be that one canal
or five canals.
In plastic carrier removal, the TF
is advanced passively into the carrier as far as the carrier will allow it.
“Passive” is the operative word; if
the TF does not want to advance

into the plastic carrier slowly and
gently, the next smaller TF is used.
No gutta-percha solvent is used for
this first step; this initial insertion is
done dry in the canal, optimally
through the surgical operating
microscope (SOM) (Global Surgical,
St. Louis, Mo.).
After the initial TF insertion, irrigant can be placed in the canal, if
the clinician opts to use irrigant,
optimally 2 percent chlorhexidine
(CHX). As mentioned, when the first
TF inserted will not advance passively through the plastic carrier
any further, it is withdrawn, the
CHX is added (as and if desired) and
the remainder of the carrier
removal is performed.
If the same TF taper will allow
passive advancement, it can be reinserted; if it will not, the next smaller
TF is inserted. It is essential that the
clinician be cognizant of two things
in the TF’s use for this purpose:
1) taking care not to strip the furcation of the root, in essence to not
allow the TF to be pushed toward
the furcation and/or preferentially
remove dentin toward the furcation.
2) The length of the canal must be
kept in mind to prevent the TF from
being taken beyond the apical fora-

About the author

Dr. Richard Mounce lectures globally and is widely published. He is in
private practice in endodontics in
Vancouver, Wash. Mounce offers
intensive customized endodontic
single-day training programs in his
office for one to two doctors at a time.
For more information, contact
Dennis at (360) 891-9111 or write
RichardMounce@MounceEndo.com.

[37] =>

[38] =>

Clinical

ENDO TRIBUNE | JULY 2009

ET page 1

begin each general surgery lecture
by tapping the lectern with his pencil, and after getting our attention, he
would say, “Treat the tissues with
tender loving kindness and they will
respond in a like manner.” I have
heard those very words many times
while performing apical microsurgery. It is truly a gentle technique
when the steps are followed in the
proper order.

Fig. 2: The six-handed team creates
an environment for ergonomics and
the most efficient use of time.

Fig. 3: Smaller straight Tempur pillow can be used for the neck, lower
back, or knees to give added support
for patient comfort.

Fig. 4: Patient’s head and chest are
draped and the patient’s vital signs
are constantly monitored using a Pulsoximeter.

Fig. 5a: Modified Monoject needle
bent similar to the ultrasonic tip used
for the REP.

Preparation of the patient for
predictable apical microsurgery
A thorough past medical history and
dental examination, using as many
diagnostic aids as possible, is a
requirement for a predictable microsurgical event. Being thorough can
also avoid unfavorable experiences.
For example, if the patient, or the
physician, states he or she is sensitive or allergic to epinephrine, to any
degree, the author highly recommends that apical microsurgery not
be performed. One of my golden
rules of thumb is, “No epi, no surgery
… Period!” If the doctor chooses to
proceed with the microsurgical procedure, it will be exceptionally more
difficult for both the doctor and the
patient.
The technology that exists today
presents us with so much more
presurgical information than was
available even a few years ago, and
the recent advances should be
included in the diagnostic process
whenever possible. A good example
of current technology is cone-beam
computed tomography (CBCT). The
radiological images we have been
using for many years were the best
we had, but were very limited. Now,
CBCT enables the microsurgeon a
view of all angles of areas of concern
in the maxillofacial region and supplies much of what was missing in
the field of dentistry.1
The preparation of the patient not
only takes the patient into consideration, but also the entire surgical
team. The microsurgical protocol we
teach involves four people: the doctor (pilot), the scope assistant with
the co-observer oculars for evacuation and retraction (co-pilot), the
surgical assistant using the monitor
as a visual reference (flight director)
and the patient (first-class passenger).
The medical history and all necessary pre-medications are reviewed
with the patient to be sure that the
latter are taken at the appropriate
times before the surgery appointment. The patient is also instructed
to rinse with Peridex and take an
anti-inflammatory (preferably 600
mg of Motrin, if no allergies are present) the night before and also on the
morning of the surgery. At the time of
the appointment and before the
patient is seated, he or she is once
again asked to rinse with Peridex.
The dental chair should allow the
patient to recline comfortably and
even allow the patient to turn to one
side or another. Small Tempur pillows placed beneath the patient’s
neck, small of the back or knees,

Fig. 5b: Set of three Stropko Irrigators with a variety of tips in place for
possible use during the surgical procedure.

Fig. 6a: Due to the ballooning and
blanching effect, the muco-gingival
line becomes more pronounced during the hemostasis staging injections.

Fig. 6b: When the buccal portion of the
hemostasis staging is complete, the
operator can easily plan the incision.

Fig. 7: Rinsing the entire surgical site
with Peridex.

make a big difference when used.
After the patient is completely
comfortable in the chair, he or she is
coached on how to make slow and
small movements of the head, if necessary during surgery. The patient is
appropriately draped for the surgery.
It is especially important to wrap a
sterile surgical towel around the
head and over the patient’s eyes for
protection from the bright light of the
microscope and any debris from the
surgical procedure.
An important psychological point
is being sure to not tell the patient he
or she “can’t move”! To an already
tense patient, saying “don’t move”
would probably cause unnecessary
apprehension, stress or panic. In
more than 500 surgeries, I’ve only
had one patient that didn’t hold nice
and still during the procedure once
he was relaxed and had profound
anesthesia.
Now is the time for the surgical
team to get comfortable with the
position of the patient, the microscope, endoscope and associated
equipment. Modern OMs have many
features to enhance comfort and pro-

ficiency during their use. Accessories
like beam splitters, inclinable optics,
extenders, power focus and zoom,
variable lighting and focal length,
etc., all contribute to ease of use,
ergonomics and proficiency for the
entire surgical team. The mutual
comfort of the patient, the surgical
assistants and the doctor is of the
utmost importance. The microsurgical technique may take an hour or
more, so unnecessary movements or
adjustments for comfort’s sake during the operation may cause considerable inconvenience.
The doctor’s surgical stool must
have adjustable arms to allow the
elbows to support the back and serve
as a reference point, or fulcrum, if
the doctor has to reach for an instrument during the procedure. Ideally,
neither the doctor nor the scope
assistant have to remove their eyes
from the oculars of the OM during
the entire operation. The task of
directing the whole operation
belongs to the second surgical assistant. The second surgical assistant is
the choreographer for the procedures that take place with the OM.

He or she is in a position to observe,
coach and/or pass instruments to
either the doctor or the scope assistant. The second surgical assistant
can see the entire surgical environment and is the only one on the team
that has an overview, to keep track of
everyone’s needs. It is important that
all possible surgical instruments are
organized for ease of access during
the operation.
While the anesthesia is getting
profound, this is a perfect time to
modify the needles that will be
placed into the tips of the Stropko
Irrigators (www.stropko.com) for
use during the surgery. The notched
ends of 25 gauge Monoject Endodontic irrigating needles (SybronDental)
are removed by bending with Howe
Pliers and placed into the end of the
Stropko Irrigators. One tip is used
with an air/water syringe and the
other tip is used on the dedicated
“air-only” syringe (DCI). The
endodontic irrigating needles are
then bent in the same configuration
as the ultrasonic tip that is being
used for the root-end preparation.
After the needle is bent, the
ergonomics of the bend can be verified quickly and easily because the
patient is in the proper position and
so is the doctor.
Optimally, there are three Stropko
Irrigators available for any surgical
procedure: one three-way syringe fitted with a larger blue tip (SybronEndo) for more general flushing of the
surgical area (we call it the “Big
John”); another three-way syringe
fitted with a modified 25-gauge needle for more precise cleaning and
drying (“Little John”); and one with
an “air-only” syringe, fitted with a
modified 25-gauge needle, for precise and dependable drying of the
specific area without worry of moisture contamination.
Also, because the lumen of the
high-speed evacuator tips (Young’s
Surgical) is small, be sure to have
extra tips readily available if one
should become clogged. A beaker of
water should be available so the
scope assistant can occasionally
clear the evacuator system of blood
and tissue debris from the evacuator
tip.
After topical anesthetic is placed,
local anesthesia is started using less
than one carpule of warmed 2 percent lidocaine containing 1:50,000
epinephrine. This small amount is
done to anesthetize the injection
sites that will be used next for the
blocks and infiltrations. The 1:50,000
lidocaine is used prior to the 0.5
percent bupivacaine (Marcaine)
because the Marcaine tends to burn
upon injection, whereas the lidocaine is much friendlier to the
patient. This is then followed with
one or two 1.8 cc carpules of warmed
Marcaine for nerve blocks and/or
infiltrations. All anesthetic is
warmed and injected very slowly to
avoid any unnecessary trauma to the
tissue, which also creates much less
discomfort for the patient.
After the completion of adminis ET page 7

[39] =>

Industry 7C

ENDO TRIBUNE | JULY 2009

GuttaFlow
FAST needs
no heating
Coltène/Whaledent recently
announced the introduction of
Hygenic GuttaFlow® FAST, the fast
setting (eight to 10 minutes) version of the innovative GuttaFlow
obturation system. GuttaFlow is
the first flowable gutta-percha
obturation system that combines
gutta-percha and sealer in one
material.
This self-curing, injectible system works at room temperature,
ensuring an excellent seal without the shrinkage that occurs
with heated obturation systems.
With the excellent flow and sealing properties of GuttaFlow, condensation is not required.
GuttaFlow and GuttaFlow FAST
come in single unit dose capsules
that deliver a consistent dosage
and minimize contamination. It is
also radiopaque and can be
removed easily should retreatment or post placement become
necessary. Faster, easier and
more economical than heated,
injectible obturation systems,
GuttaFlow® is also biocompatible,
providing dentists with a safe,
reliable and time-saving root
canal obturation system.
For additional information,
call (800) 221-3046 or visit
www.coltenewhaledent.com. ET

ET page 6

tering the local anesthetics, it is time
to perform hemostasis staging using
2 percent lidocaine containing
1:50,000 epinephrine. It has been
shown that 2 percent lidocaine containing 1:50,000 epinephrine produces more than a 50 percent
improvement in hemostasis compared to 2 percent lidocaine containing 1:100,000 epinephrine.2
While keeping the bevel of the
needle toward the bone and directed
apically toward the root ends, small
amounts of 2 percent lidocaine
1:50,000 are slowly injected into the
free gingival tissue in two or three
sites to the buccal of each tooth (MB,
B, DB), approximately 3 mm apical to
the muco-gingival line. Slow injection of just a few drops of the anesthetic causes a slight “ballooning”
and blanching of the tissue in the
immediate area. This is an important
step because it causes the muco-gingival line to become more pronounced, allowing the operator to
have better vision, resulting in more
accuracy with the following hemostasis injections.
As the anatomy of the tissue
unfolds during the injections, the
operator should begin visualizing
and planning the incision. The
amount and nature of the attached

The evolution of media in dentistry
In the ever-changing world we live
in, technologies are evolving at a pace
that surpasses most of our learning
curves.
Blogs, social networking sites, message boards, Twitter, Facebook,
MySpace and many more interactive
media are becoming a part of our
every day lives.
Realistically, we must carefully
choose which of these multimedia
outlets we participate in or, otherwise,
there would be no time left in the day
for work, friends or family.
When choosing a multimedia
forum, one must ask oneself the following important question: “How is
this technology improving my life?”
As a dental professional in the year
2009, there are many new technologies being introduced to our industry
at a rapid pace. What was once a
media-shy industry has evolved to the
tune of more than 1,000 media forums
aimed at dental professionals. With all
of these sites claiming to help you —
how can one reasonably choose which
to join and participate?
Recently, a new dental multimedia forum was launched called
www.endomailmessageboard.com.
You may ask what makes this site any
different from the others. Well, the
answer is the community response to
the site has been overwhelmingly positive. Endomailmessageboard currently has more than 800 members, all
of whom joined after the inception
date of September 2008.
The new online community offers
an interactive online forum focused

gingiva is an important consideration whether a full sulcular or a
mucogingival (Leubke-Oshenbein)
flap is used. In general, a full thickness, sulcular flap is routinely used
unless esthetics is a concern and
there is an adequate zone of attached
gingiva present. To ensure optimum
hemostasis, the lingual tissues
should also be infiltrated.
If doing surgery on the posterior
quadrant of the mandible, special
attention should be given to the apical region of the mandibular second
molar. On occasion, a small foramen,
called the foramen coli, may be present. The foramen coli, if present,
contains an ascending branch of the
mylohyoid nerve. This added step,
“lingual hemostasis staging,” can
contribute to more profound anesthesia, enhance crypt management,
and, as a result, contribute to a more
predictable event with less stress for
the entire team.
If the surgery is to be performed
on the maxillary, the patient is
instructed to close on approximately
eight layers of sterile gauze, (four
2x2’s folded over once) for stability of
the jaws and to keep any debris from
inadvertently entering the oral cavity. A single piece of a sterile 2x2 is
also gently placed distal of the
tooth/teeth to be operated on. If the
surgical procedure is on the
mandible, especially when a full sul-

Unlike traditional blogs
and message boards,
endomailmessageboard
truly utilizes
modern technology
while remaining
user-friendly.
on excellence in dental education.
Recently, the multimedia site has
enhanced its online features by offering dentists free continuing education
credits to its members.
Dentists will be able to print their
certificates immediately with a passing grade of 70 percent, and the entire
test history will be stored for their
record-keeping convenience.
In addition to offering free and
innovative continuing education, the
message board is a place where dentists can come together to share ideas,
post questions, gain peer advice and
learn about industry news in a nonthreatening environment.
Unlike other message boards,
endomailmessageboard does not
allow its members to have anonymity.
Further, members are held to humane
standards of professionalism. The
Web site was created so dentists can
safely post cases and questions and
gain constructive advice from their
peers without fear of embarrassment
or ridicule.
Members come from countries all
around the world, creating a global
community of dental professionals. A
dentist from India can post a case and

cular flap is used, the operator may
want to make the incision with the
mouth slightly open before placing
the gauze.
In either case, with the aid of the
OM and using a pre-filled 3 ml.
syringe fitted with a 20-gauge needle, the entire surgical site is rinsed
with Peridex to make sure the area is
clean of debris and free of plaque
before the incision is made. The surgical site is now ready for the next
important step in the procedure: Flap
design, the incision and atraumatic
flap elevation.
ET
(This is part one in a six-part series
on apical microsurgery. Look for part
two in the next issue of Endo Tribune.)

References
1. Thomas SL, Angelopoulos C.
Contemporary Dental and Maxillofacial Imaging, Dent Clin North Am
2008; 52: xi
2.
Buckley JA, Ciancio SG,
McMullen JA. Efficacy of epinephrine concentration in local anesthesia during periodontal surgery. J
Periodontol 1984; 55: 653–57
3.
Harrison JW, Jurosky KA.
Wound healing in the tissue of the
periodontium following periradicular surgery II. The dissectional
wound. J Endod 1991; 17 (11): 544–52

receive feedback from his or her peers
in Saudi Arabia or Ireland. The sense
of globalization is present throughout
the site. Dentists quickly realize that
clinical cases do not differ from country to country.
Endomailmessageboard
also
allows dentists to upload X-rays,
videos, documents and 3-D images
and write private messages or provide
content to share among peers.
The message board encompasses
technology to create a modern and
efficient multimedia forum. Unlike
traditional blogs and message boards,
endomailmessageboard truly utilizes
modern technology while remaining
user friendly.
Recently endomailmessageboard
conducted a survey of its members.
The feedback that the Web site
received was overwhelmingly positive. The members all agreed that the
site offers them a safe haven on the
Internet where their clinical questions
are answered professionally and in a
timely fashion. The members also
stated that the site was unlike any others that they have experienced as dental professionals.
ask
yourself,
“Is
the
So,
technology I am using today improving my life?” If you even have
a moment of hesitation, you
should take the time to view
www.endomailmessageboard.com.
It may be the vehicle you need to
enhance your clinical skills. ET
(Source: Essential
Dental Systems)

About the author
John J. Stropko received his DDS from
Indiana University in 1964, and for 24
years
practiced
restorative
dentistry. In
1989, he received a certificate for
endodontics
from Boston
University
and recently
retired from
the private
practice of endodontics in Scottsdale,
Ariz. Stropko is an internationally recognized authority on micro-endodontics.
He has been a visiting clinical instructor
at the Pacific Endodontic Research
Foundation (PERF), an adjunct assistant
professor at Boston University and an
assistant professor of graduate clinical
endodontics at Loma Linda University.
His research on “in-vivo root canal morphology” has been published in the
Journal of Endodontics. He is the inventor of the Stropko Irrigator, has published in several journals and textbooks
and is an internationally known speaker. Stropko has performed numerous
live micro-endodontic and micro-surgical demonstrations.

[40] =>

[41] =>

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

July 2009

www.dental-tribune.com

Vol. 2, No. 4

New smile, new life: Innovative technologies
and techniques can transform a smile
By Lorin Berland, DDS, FAACD
& Sarah Kong, DDS

An actor-turned-director came
to our practice from www.denture
wearers.com. He was seeking a
solution to enhance and reconstruct his smile. Over the past several years, he had noticed his face
slowly “sagging,” despite an upper
denture made by a cosmetic dentist
in Las Vegas (Fig. 1a).
Since then, he had seen numerous dentists, including several prominent prosthodontists,
to resolve his smile, and more
importantly, his facial concerns.
However, the patient was not prepared to commit to extensive treatment plans, neither in time nor
in finances; not to mention the
pain and recovery period associated with the multiple surgeries
he would have to undergo for a
permanent solution.
Among the numerous treatment
options we discussed for his dental requirements were implants, a

Fig. 1a: Pre-op full-face view.

Fig. 1b: Final full-face view.

new denture, a precision partial,
veneers and crowns. He was then
presented with an entirely innovative option he had not heard of
before: a new full denture for the
upper arch and a Snap-On Smile
for the lower arch, to create the

beautiful smile and natural facial
dimensions for which he longed.

Case presentation
A full diagnostic workup was performed, which included a thorough
examination, a full series of digital

radiographs and photographs, and
cosmetic imaging with smilepix.
com (Figs. 2, 3). We had transformed another gentleman’s smile
the previous week by opening his
vertical dimension with a set of
Snap-On Smiles.
The latest technology from
DEXIS Digital Diagnostic Imaging
allowed us to access the beforeand-after photographs in a matter
of seconds, and show an actual
case illustration of how opening a
person’s bite through dentistry can
change the appearance of the face
to make it look younger and, naturally, better.
We then went through the Smile
Style Guide developed with Dr.
David Traub (www.digident.com)
to select the shape, P-4 (pointed
canines with square-round centrals and laterals), and length
combination, L-2 (laterals slightly
shorter than the centrals and the
cuspids), he preferred for the cosg CT page 3D

‘Aren’t you that guy on “Extreme Makeover”?’
An interview with the face of modern cosmetic dentistry, Dr. William M. Dorfman
By Robin Goodman, Group Editor

Dr. Dorfman, you’ve become the
face of modern dentistry for millions of people. What made you
choose dentistry as a career?
I don’t feel like I chose dentistry,
it chose me. When I was 2 1/2 years
old, I fell and hit my baby teeth so
hard that they were pushed back up
into the gums. As a result, I had to
have multiple surgeries to prevent
damage to the adult teeth. The
entire experience intrigued me, and
I decided at that age that I wanted
to help people the same way.
Is it true you were a cheerleader in
college? What made you do that,
and how did it affect the way you
practice and started a business
like Discus?
When I was in high school, I was
on the swim team and started gymnastics. One of the cheerleaders in
my math class asked me to be her
Yell Leader partner and I had a
blast and instantly had a whole new
group of friends. When I started at
UCLA, I felt lost. So I tried out for
Yell Leader and made it. Believe it

Can you tell us more about your
new TV show?
Right now, I feel very fortunate to
be a part of the No. 1 new daytime
talk show, “The Doctors,” on CBS. It
is a show with a panel of four doc-

tors and occasionally I am the fifth
doctor on the panel. The show is a
spinoff of Dr. Phil and deals with
medical issues much the same way
g CT page 2D

Dr. William M. Dorfman
or not, I learned more about how
to run a business working with all
the “Type A” members of the squad
than in any other class.
You were one of the first “top tier
dentists” to advertise your services. Was it effective?
I started advertising right when I
started my practice. I was hardly a
“top tier” dentist. I was passionate
about wanting to do cosmetic dentistry, but knew I needed patients.
So I started an “educational” advertising campaign to drive patients
into the office.

[42] =>

Interview

f CT page 1D

Cosmetic Tribune | July 2009
demands. The hard part is trying
to treat all the patients like “stars.”

as Dr. Phil deals with relationships.
How do you manage everything:
your busy, multiple doctor practice, your speaking schedule, Discus Dental, your TV show and
your personal life?
I don’t sleep much, only four to
five hours a night. And I have a
lot of help: a great office manager,
and an awesome nanny, a brilliant
publicist, an incredible personal
assistant and a competent team at
Discus.
You see a lot of celebrities as well
as everyday people. Is there a difference between the two?
You kidding? Like night and
day when it comes to the patient’s

Do you have any hobbies?
I used to paint, draw, sculpt and
write. Then I had three kids, two
dogs, 25 employees in my dental
office and 500 employees at Discus.
Hobbies ... they can wait.
Any funny anecdotes from your
“Extreme Makeover” days you’d
like to share?
Once I was flying from New
York to Los Angeles and a flight
attendant was looking at me and
finally came up and asked, “Aren’t
you that guy on Extreme Makeover?” Just as I was about to say
yes, her co-worker looked at me
and said, “What did they do to
you?”

Where do you think dentistry
will be in five years? How about
in 10?
Dentistry keeps getting better
and better. Today, 90 percent of
what I do in my practice I did not
learn in dental school. As materials and technology continue to
evolve, our profession becomes
more interesting and fulfilling
everyday. CT

Contact info
William M. Dorfman, DDS,
FAACD
2080 Century Park East, #1601
Los Angeles, Calif. 90067
Tel. (310) 277-5678
Fax (310) 277-3294

The World’s Dental Newspaper · US Edition

2009
Greater New York Dental Meeting
th

85
Annual Session

The
Largest Dental
Convention/
Exhibition/Congress
in the United States

COSMETIC TRIBUNE

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Ortho Tribune & Show Dailies
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Fred Michmershuizen
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Anna Wlodarczyk
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E-mail: j.wehkamp@dtamerica.com

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Please send me more information about...

Cosmetic Tribune strives to maintain utmost
accuracy in its news and clinical reports.
If you find a factual error or content that
requires clarification, please contact Group
Editor Robin Goodman, at r.goodman@
dtamerica.com. Cosmetic Tribune cannot
assume responsibility for the validity of product claims or for typographical errors. The
publisher also does not assume responsibility
for product names or statements made by
advertisers. Opinions expressed by authors
are their own and may not reflect those of
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Let us know by e-mailing feedback@
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hearing from you!

[43] =>

Clinical

Cosmetic Tribune | July 2009

f CT page 1D

Fig. 7: Pre-op close-up smile.

Fig. 12: Final right lateral view.

Fig. 4: Smile Style Guide for smile
design.
Fig. 8: Pre-op retracted view.
Fig. 13: Final left lateral view.

Fig. 2: Cosmetic image of upper arch.

Fig. 9: Pre-op occlusal view.

Fig. 5: Smile Design P-4: pointed
canines, square-round incisors.
Fig. 10: Final close-up smile.
Fig. 14: Final occlusal view.

Fig. 11: Final retracted view.

Fig. 3: Cosmetic image of upper
and lower arches.
metic image, and ultimately, for
his new smile (Figs. 4–6). The
digital photographs stored in the
DEXIS hub, in combination with
his cosmetic images and the idea
of a Snap-On Smile, encouraged
the patient to immediately accept
the treatment for his smile transformation.
We began by duplicating his
existing upper denture for the wax
try-in, using a kit made by Altadontics to impress the denture. Then
we poured in a bisacryl temporary
material, such as Luxatemp Automix Plus (Foremost), Fill-In (Kerr),
and Integrity (DENTSPLY Caulk).
After about 40 minutes, we had a
duplicate of his old denture to use
as a custom tray with excellent
borders.
Once the duplicate denture had
been trimmed, smoothed and tried
in, we applied PVS adhesive and
took a wash impression with a light
body PVS, such as Splash! (Discus
Dental) and Virtual (Ivoclar Vivadent).
With this time-saving denture
duplication technique, we were
able to take a very accurate final
impression during the patient’s
first appointment.
An impression of the lower arch
was taken using System 2 Alginate
(ACCU-DENT), to create a lower
custom tray. To address one of the
patient’s main concerns, his “sag-

Fig. 6: Length code L-2: laterals
slightly shorter than centrals and
cuspids.
ging face,” we explained that his
vertical dimension had decreased
over time as he lost posterior teeth
and ground down teeth 22 to 27
(Figs. 7, 8). Only teeth 21 and 31
had close to the original occlusal
height (Fig. 9).
The patient had no desire to
treat tooth 31 as he really wanted
a painless solution for the time
being, especially with the holiday season approaching. We took
a neuromuscular bite registration with a slow-setting material
(SuperDent bite registration), after
a 45-minute TENS treatment with
the Myomonitor, to record his ideal
jaw relations.
At the wax try-in appointment,
we confirmed the look and feel of
the upper teeth. We then took an
alginate impression of the wax tryin to oppose the Snap-On Smile.
For the wax try-in and eventually the final denture, we selected
esthetic denture teeth, such as Portrait IPN (DENTSPLY Caulk), Physiodens (VITA) or BlueLine (Ivoclar
Vivadent), to create a more natural
appearance.
At this appointment, a PVS
impression of the lower arch was
also taken in a custom tray with
a regular-set material like Splash!
(Discus Dental) or Virtual (Ivoclar
Vivadent) for the fabrication of his
Snap-On Smile.
About three weeks later, the

patient returned for his quick,
painless smile transformation
(Figs. 1a, 1b, 10–15). The patient
was delighted with his new smile,
but was even more excited about
the way his new smile was created.
He knew that he looked older
than he should, and did not wish
to go the plastic surgery route.
Rather, he needed to restore his
face with a smile lift, which was
accomplished quickly and painlessly through high-tech dentistry!
By using the Snap-On Smile to
restore his lower dentition, the
patient now has a beautiful smile
and, more importantly, is able to
experience the look, feel and func-

Fig. 15: Final close-up smile.
tion of a more permanent solution.
When he came to us, the patient
was not willing to undergo total
mouth rehabilitation in the near
future. Now he is seriously considering a more permanent solution when time and conditions
allow. Also, his Snap-On Smile can
be used as a surgical guide for
implants.
In the meantime, he is reaping
the benefits of the smile transformation that modern dental technologies and techniques have
helped to create. CT

About the authors
Dr. Lorin Berland, a fellow of the AACD, pioneered the
Dental Spa concept in his multi-doctor practice in the
Dallas Arts District. His unique approach to dentistry
has been featured on television (20/20) and in national
publications and major dental journals, including Time
magazine. In 2008, he was honored by the AACD for his
contributions to the art and science of cosmetic dentistry. For more information on The Lorin Library Smile
Style Guide, www.denturewearers.com, and Biomimetic
Same Day Inlay/Onlay 8 AGD Credits CD/ROM, call
(214) 999-0110 or visit www.berlanddentalarts.com.
Dr. Sarah Kong graduated from Baylor College of Dentistry, where she served as a professor in restorative
dentistry. She focuses on preventive and restorative
dentistry, transitionals, anaesthesia and periodontal
care. She is an active member of numerous professional organizations, including the American Dental Association, the Academy of General Dentistry, the American Academy of Cosmetic Dentistry, the Texas Dental
Association and the Dallas County Dental Society.

[44] =>

[45] =>

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

July 2009

www.dental-tribune.com

Vol. 2, No. 4

Protective extraoral and reinforced
instrumentation strategies
was done by utilizing intraoral scaling
techniques, not extraoral techniques.
Extraoral fulcrums and reinforced
scaling “tips” were often introduced
during the second year of the dental
hygiene program.
Thankfully, with the awareness
of documented injury in the dental
hygiene profession, proper hand ergonomics that incorporate a neutral position of the hand, wrist and arm while
using extraoral techniques are being
taught in many dental hygiene schools
the first semester of the program.

By Diane Millar, RDH, MA

Imagine working in your profession as a dental hygienist without
ever experiencing work-related pain.
Dental hygienists expect to have long
careers once they enter their profession after graduation. Unfortunately,
having a long career in dental hygiene
can be problematic if protective reinforced instrumentation and ergonomics are not implemented. Numerous
hygienists experience pain, fatigue
and injuries that lead to a shorter
career. Scaling is no longer exclusively about calculus removal. It is
about calculus removal and protecting oneself from injury.

Learning extraoral fulcrums
to prevent injury

Utilizing protective extraoral reinforced instrumentation techniques
requires scaling teeth with two hands,
instead of one, to ensure optimum
performance and to promote occupational health and career longevity.
These techniques allow the non-dominant hand to assist and reinforce the
dominant hand while primarily using
extraoral fulcrums. Reinforced instrumentation techniques can extend
career longevity in the field of dental
hygiene, which has documented evidence of ergonomic disorders.
There are several ways to learn
protective instrumentation strategies
to help prevent injury if a hygienist isn’t sure how to utilize extraoral
reinforced techniques. There are
“hands-on” courses offered at semi-

Incorporate hand and arm exercises

nars for dental hygienists who want
to practice on typodonts, as well as
a book that was written for dental
hygienists in private practice, titled
“Reinforced Periodontal Instrumentation and Ergonomics for the Dental
Care Provider,” published by Lippincott, Williams and Wilkins in 2007.
This book shows extraoral, reinforced
fulcrums in every area of the oral cavity, ergonomic positioning techniques
that guide the practitioner to utilize
the 8 o’clock position to the 2 o’clock
position around the dental chair for
improved access, and stretches that
can be done in the operatory for wellness and career longevity.
Unlike years ago, many dental
hygiene schools are now introducing
extraoral fulcrums during the first

A-Rod’s brushing habits
detailed in tell-all book
By Fred Michmershuizen, Online Editor

The book “A-Rod: The Many Lives
of Alex Rodriguez” by Sports Illustrated writer Selena Roberts contains more than just allegations of
steroid use by the New York Yankees third baseman. According to
the book, which was released May 4,
A-Rod brushes his teeth after every
game.
But in a bizarre revelation, the
book also reports that A-Rod gets a
clubhouse attendant in the locker
room to load the toothpaste onto his
toothbrush and hand it to him. Talk
about being pampered!

The book describes A-Rod as an
insecure prima donna who used steroids. The book also alleges that
he spent wild nights with strippers
and had an obsession with Yankees
shortstop Derek Jeter.
At least dental hygienists can take
comfort knowing that the baseball
all-star — who makes $28 million a
year playing for the Yankees — has
clean teeth!
The preloading of the toothbrush,
which the book claims took place
after every game A-Rod played in his
three seasons with the Texas Rangers, was described as a “time-saving
measure.” HT

semester in pre-clinic. The primary
reason for this is extraoral fulcrums
need to be utilized in order to use
an ultrasonic scaler correctly. There
is also more of an awareness of the
importance of proper hand ergonomics to prevent injury by keeping
the hand, wrist and arm in a neutral
position. With this awareness, dental
hygiene schools utilize ultrasonic scalers, magnification loupes and protective extraoral fulcrums.
In the early 1980s and earlier,
the ultrasonic scaler could only be
used for heavy calculus removal in
many dental hygiene programs. It was
important to first and foremost learn
how to scale by hand and not depend
on an ultrasonic scaler. Also, scaling by hand in those days primarily

Hand strength is important to successfully implement extraoral fulcrums.
In fact, fulcrum pressure determines
whether an instrument stroke will
be appropriately controlled. Other
important factors include an extended
grasp and adequate pressure exerted
against the patient’s cheek and jaw for
support. The amount of pressure that
needs to be exerted throughout the
appointment and throughout the day
with each patient is significant. If a
dental hygienist’s hands and arms are
weak and are lacking muscle tone and
strength, injury can occur.
Ideally, dental hygiene schools
should be implementing hand and
arm exercises to increase muscle
endurance, which can help prevent
injury while in the hygiene program
as well as in private practice. This
would also set a standard of awareness to exercise one’s hands and arms
on a regular basis. Using squeeze balls
g HT page 3E
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[46] =>

2E

Editor’s Letter

Dear Reader,
We have been blessed with the
ability to work in a profession with
endless potential, but where do
hygienists find out about opportunities available beyond the walls
of an operatory? In the 25 plus
years I have spent in the dental
world, I have heard colleagues
ask, “What more can I do with
my hygiene degree?” While there
are many possibilities, none will
be realized if we don’t put forth
the time and energy necessary to
discover new endeavors.
As with our hygiene career, all
new roads begin with education.
Learning about alternative prospects in dental hygiene is easy
in today’s world. The Internet
AD

abounds with educational resources. A great place to begin learning
is visiting online dental hygiene
communities. These groups are
composed of hygienists who are
utilizing their degrees in numerous ways. While several groups
exist, those that come to mind
are DTStudyClub.com, AmyRDH.
com and Hygienetown.com. Look
at the sites available, see what
others are doing and learn about
opportunities.
Continuing education regarding non-clinical hygiene topics is
another source of learning. Look
for courses that discuss writing,
speaking, consulting, etc. Again,
networking with the people who
attend these conferences is a wonderful way to gain insight on what
is available. Many conferences

Hygiene Tribune | July 2009
provide these opportunities. Two
that are especially memorable to
me are RDH magazine’s Under
One Roof (rdhun deroneroof.com)
and CareerFusion (careerfusion.
net). These gatherings have the
ability to change the professional
world of dental hygienists.
Explore the world of continuing
education and plan to attend at
least one session this year to get
career enhancement on the move!

Best Regards,

Angie Stone, RDH, BS
Editor in Chief

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

Publisher
Torsten Oemus
t.oemus@dtamerica.com
President & CEO
Peter Witteczek
p.witeczek@dtamerica.com
Chief Operating Officer
Eric Seid
e.seid@dtamerica.com
Group Editor & Designer
Robin Goodman
r.goodman@dtamerica.com
Editor in Chief Hygiene Tribune
Angie Stone RDH, BS
a.stone@dtamerica.com
Managing Editor/Designer
Implant & Endo Tribune
Sierra Rendon
s.rendon@dtamerica.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dtamerica.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dtamerica.com
Product & Account Manager
Mark Eisen
m.eisen@dtamerica.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dtamerica.com
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Lorrie Young
l.young@dtamerica.com
C.E. Manager
Julia E. Wehkamp
E-mail: j.wehkamp@dtamerica.com

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

Published by Dental Tribune America

© 2009, Dental Tribune America, LLC.
All rights reserved.
Hygiene Tribune strives to maintain
utmost accuracy in its news and clinical
reports. If you find a factual error
or content that requires clarification,
please contact Group Editor Robin
Goodman, at r.goodman@dtamerica.
com. Hygiene Tribune cannot assume
responsibility for the validity of product
claims or for typographical errors.
The publisher also does not assume
responsibility for product names
or statements made by advertisers.
Opinions expressed by authors
are their own and may not reflect
those of Dental Tribune America.

Tell us what you think!
Do you have general comments or criticism you would like to share? Is there
a particular topic you would like to see
articles about in Hygiene Tribune? Let us
know by e-mailing feedback@dtamerica.
com. We look forward to hearing from
you!

[47] =>

News

Hygiene Tribune | July 2009

Fones School grant allows hygienists
to treat needy children in Connecticut
The University of Bridgeport’s
Fones School of Dental Hygiene
has been awarded a $50,000 grant
from the Connecticut Department of Social Services to provide
teeth cleanings and other services
to children in Bridgeport, many
of whom lack insurance or other
means to obtain oral health care.
The one-year Dental Improvement Initiative Grant enables Fones
student hygienists and a clinical
instructor to serve up to 650 students at Tisdale Elementary School
and provide oral health education
to their families for a 10-month
period, starting in September 2010.
The program complements similar outreach programs at Fones,
which each year provides subsi-

dized services, including cleanings,
cancer screenings and X-rays, to
2,000 individuals at its clinic on
the University of Bridgeport campus. The Fones School also serves
10,000 individuals annually at sites
throughout Connecticut.
The program at Tisdale School,
which has a dental clinic on its
campus, is open to all students,
one-half of whom are enrolled in
HUSKY (Healthcare for Uninsured
Kids and Youth), the state’s insurance program for low-income children.
Meg Zayan, dean of the Fones
School, said the Connecticut
Department of Social Services grant
helps the school fulfill a “large and
unmet need” to protect children’s

health.
“More than half of Bridgeport
children live below the federal poverty level, and only 40 percent of
Bridgeport children insured under
HUSKY go to a dentist for preventive
care,” Zayan said. “This important
grant not only helps the children in
Bridgeport, it also lets us reach out
to their guardians, parents and families so they can avail themselves of
our services at the Fones Clinic on
campus.”
Under the program, six senior
dental hygiene students and a
clinical instructor will visit Tisdale School three days a week to
provide on-site screenings, cleanings, fluoride treatments and other
care. Students also will receive free

toothbrushes, nutritional counseling and education on how to protect
their teeth. Family members of Tisdale students will be referred to the
Fones Dental Hygiene Clinic on the
UB campus for preventive oral care.
Fones School of Dental Hygiene
was founded in 1913 by Dr. Alfred
Fones, a Bridgeport dentist who
was convinced that cleaning and
other preventive care would help
the city’s poorest residents better
protect their teeth.
“This partnership working with
Bridgeport children at Tisdale
School maintains the original philosophy initiated by Dr. Fones,”
Zayan said. HT

f HT page 1E

lowing benefits:

instrumenting. In turn, this helps the
hands, wrists and arm remain in a
neutral position. These added benefits help guard against injury that
can occur while scaling and root planning.
Our profession requires good ergo-

nomic techniques for career longevity
as well as career satisfaction. Thus, it’s
important to try new innovative scaling techniques not learned in school.
The results are well worth the effort to
ensure a long career as a dental hygienist. HT

and light weights daily will increase
strength, improve muscle tone and
provide increased endurance. Hygienists who do this and graduate from
dental hygiene school and enter into
private practice will have the muscular strength and endurance to treat
eight to nine patients per day, and will
be less prone to injury.
If a dental hygienist has had a problem with carpal tunnel syndrome, tendonitis or any other upper body musculoskeletal injury, incorporating protective reinforced techniques will help
reduce additional injury by utilizing
both hands to scale. Coupled with that,
the larger muscle groups in the arms
versus the smaller muscle groups in
the hands will be used.

Advantages

Scaling with both hands while utilizing protective extraoral techniques
will enhance scaling technique efficacy and reduce the incident for injury,
especially when treating patients with
heavy calculus, by providing the fol-

• Allows the hands to work as a
unit.
• Provides more stability to the
dominant hand.
• Enhances the balance of both
hands for instrument placement.
• Incorporates a stable fulcrum.
• Helps prevent hand, wrist and
arm fatigue.
• Increases control of the instrument blade.
• Provides more power and
strength.
• Enhances lateral pressure.
• Improves scaling efficiency.
• Helps to prevent instrument slippage.
• Helps to decrease hand, wrist and
arm pain.
• Prevents injury and work-related
disability.
The benefits of using extraoral
fulcrums in comparison to intraoral
fulcrums are many. Most importantly, these protective scaling fulcrums
stabilize the clinician’s hand while

(Source: University of Bridgeport)

About the author
For over 25 years, Diane Millar’s career in
dental hygiene has embraced working in private
practice coupled with leadership roles such as
faculty positions as an associate professor, public speaker and, in 2007, a published author of
a dental hygiene instrumentation manual, titled
“Reinforced Periodontal Instrumentation and
Ergonomics for the Dental Care Provider.” Millar
obtained her dental hygiene degree from West
Los Angeles College in 1981, a bachelor’s of science degree in health science: health care at
the California State University of Long Beach
and a master’s degree in education from Pepperdine University in 1999. Visit her online at
www.dianemillar.com. If you are interested
in purchasing Millar’s book, please visit
www.LWW.com.
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OctOber 16 -17, 2009, Las Vegas, NeVada

Don’t miss the premier educational and networking event for dental administrative professionals!
SPACE IS LIMITED! For more details or to register, visit www.dentalmanagers.com or call 732-842-9977.

Office MaNagers • Practice adMiNistratOrs • iNsuraNce & fiNaNce cOOrdiNatOrs • PatieNt & treatMeNt cOOrdiNatOrs

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