DT U.S. 2309

ADA continues to monitor proposals for health care reform / Eco Dentistry Association announces international launch / News / Journées Dentaires de Nice shines once again / Fiscally fit in 2009 / Keep the economic crunch from biting your practice / Dental informatics: the right time to invest in training and research? / Orthodontic surgery and esthetics (part1) / Orthodontic surgery and esthetics (part2) / Orthodontic surgery and esthetics (part3) / Case report: oral rehabilitation of severely worn dentition / Meeting in San Francisco offers plenty to learn - buy and do / Collaborative software connects dental professionals on a global scale / Industry / Cosmetic Tribune 6/2009 / Hygiene Tribune 6/2009

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

August 2009

www.dental-tribune.com

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

Ortho surgery and esthetics

u Page 13A

‘The Art and Science of Dentistry’

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

Fluoride varnish

Shading technique

Esthetic orthodontics is mainly adult orthodontics. Natural teeth are difficult to imitate.

Vol. 4, Nos. 23 & 24

u Page 1B

About 90 percent of adults over 40 have dental caries.
u Page 1C

ADA continues to monitor
proposals for health care reform
By Fred Michmershuizen, Online Editor

Take a gander at some of the highlights from the California Dental Association’s upcoming meeting in San Francisco, Sept. 10–13.
gCDA Meeting, pages 24A, 25A

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

Have you read an ePaper yet?

www.dental-tribune.com

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

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As Congress prepared to adjourn
for its summer recess, the American Dental Association was taking
a wait-and-see approach to pending
health care reform legislation.
“The dental provisions they contain can best be described as the
good, the bad and the undecipherable,” ADA President Dr. John S.
Findley told ADA News, the association’s official publication. “Our most
pressing concern is with the proposal for a government-run insurance plan that would compete with
private insurers in the marketplace
and private plans offered in the socalled ‘exchange.’”
Findley said that a proposal to
require dental coverage for children
would need clarification before the
ADA would support it.
“The whole concept of a public plan remains troubling, and we
would oppose any plan that required
dentists to participate, directly or
indirectly dictated fees for the private market or would lead to a
government-run system,” he said.
The ADA has continued to make
its message clear through dialog
with members of Congress and
the administration, following the
approval of policy by the ADA House
of Delegates at the 2008 annual session in San Antonio.
“The ADA does not support a

single-payer system because we
believe it would stifle access and
innovation and reduce the quality
of patient care,” said Findley, who
pointed out that the association’s
efforts in the nation’s capital are
ongoing.
“We are pursuing amendments
to improve the dental provisions,”
he said.
Findley said that flatly opposing
the whole thing is not an option.
“If we aren’t highly visible in the
process, we open the door to other
groups who will claim to be the
voice of the oral health community
and attempt to dictate what kind of
dental provisions get included,” he
said. “As the saying goes, you are
either at the table or on the menu.”
According to the ADA, the proposed legislation should be rewritten to enhance Medicaid reimbursement. Without it, Findley said, there
would be “no significant access
improvements for the poor and
other vulnerable populations.” DT
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[2] =>

News

Dental Tribune | August 2009

DENTAL TRIBUNE
The World’s Dental Newspaper · US 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

Dr. Fred Pockrass and his wife, Ina, operate the
first certified ‘green’ dental practice and are also
founders of the Eco Dentistry Association.

Eco Dentistry Association
announces international launch
New dental association aims to make profession eco-friendly one toothbrush at a time
The Eco Dentistry Association
(EDA), an international association of dental professionals, was
launched in May by the creators of
the country’s first green dental office
to give colleagues access to ecofriendly practices and consumers
the power to encourage their dentists to adopt earth-friendly methods.
• If every U.S. dental office
installed a device capturing mercury-containing waste, at least 7,400
pounds of toxic waste would be kept
out of the nation’s water supplies
each year.
• By switching to reusable and
non-toxic disinfection methods, the
dental industry would prevent 680

million disposable chair barriers,
light handle covers and patient bibs,
and 1.7 billion instrument sterilization pouches from ending up in
landfills yearly.
The Eco Dentistry Association
offers dental professionals practical
tips on reducing waste and pollution
and conserving resources, auxh as
using cloth wrappers instead of disposables to sterilize dental instruments, installing energy efficient
lighting, properly disposing of mercury-containing dental waste, and
incorporating planet-friendly building and office methods, such as nontoxic paint and recycled copy paper.
It provides the public with infor-

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

mation about digital X-ray systems
that reduce radiation exposure by up
to 90 percent, educates them about
keeping dental appliances free from
the hormone-disrupting chemical,
bisphenol-A, found in many plastics,
and gives them questions to ask
their dentists about environmental
stewardship.
Soon after launch, the new planetfriendly organization had registered
eco-conscious members in 20 states
and Canada. The group’s members hail from all over the country,
including places like Waxahachie,
Texas; Beachwood, Ohio; and Fort
Bragg, N.C.
The organization is the brainchild of Dr. Fred Pockrass, a dentist,
and his lawyer-turned-entrepreneur
wife, Ina Pockrass. Six years ago, the
couple created the model for ecofriendly dentistry, and they operate
their own successful dental practice
in Berkeley, Calif., the first in the
country to be certified as a green
business. They formed the organization to stimulate a movement in the
dental industry to employ environmentally sound practices.
“Dentistry and dental hygiene
have always been in the forefront
of preventative care. Now we are in
the forefront of planetary care,” said
Pockrass. “The Eco Dentistry Association gives dental practitioners a
single point of contact for resources
and research to green their practices, and access to a collaborative
community of like-minded professionals.”
“While some people still think
that doing environmentally responsible business costs more,” said Gil
Friend, CEO of Natural Logic, a
sustainability consulting firm that
analyzed costs and benefits for the
EDA, “our study busts that myth.
Nearly every eco-friendly innovation
is also friendly to the bottom line.
Even simple things, like making the
switch from paper patient charting to digital charting, can yield an
immediate payback.”
For more information please visit
www.ecodentistry.org. DT

Group Editor & Designer
Robin Goodman
r.goodman@dtamerica.com
Editor in Chief Dental Tribune
Dr. David L. Hoexter
d.hoexter@dtamerica.com
Managing Editor/Designer
Implant Tribune & 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
Sales & Marketing Assistant
Lorrie Young
l.young@dtamerica.com
C.E. Manager
Julia E. Wehkamp
E-mail: j.wehkamp@dtamerica.com

Dental Tribune America, LLC
213 West 35th Street, Suite 801
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 strives to maintain the
utmost accuracy in its news and clinical reports. If you find a factual error
or content that requires clarification,
please contact Group Editor Robin
Goodman, r.goodman@dtamerica.com.
Dental Tribune cannot assume responsibility for the validity of product claims
or for typographical errors. The publisher also does not assume responsibility for product names or statements made by advertisers. Opinions
expressed by authors are their own and
may not reflect those of Dental Tribune
America.

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

[3] =>

[4] =>

News

Dental Tribune | August 2009

Is it time to floss?
You’re a fantastic practitioner,
and when you go to dental meetings across the country you focus
mostly on the educational opportunities and products that allow
you to provide the very best in
patient care.
But how much fun are you
having with your patients and
staff?
Your patients will appreciate
the floss reminder when they see
this “Boss of Floss” clock on your
wall.
It’s one of many unique dental gifts available from Dental
Giggles, a North Carolina-based
company. They also have cool
tooth pillows, tooth soap and
even lip gloss.

Dental Giggles
(336) 420-9266
www.dentalgiggles.com

All the better to see you …

Align Technology and Ormco end
patent dispute, plan to collaborate
Align Technology, manufacturer and marketer of Invisalign, has
reached a settlement with Ormco,
a subsidiary of Danaher, to end all
pending litigation between the parties and to begin a new strategic
collaboration.
As part of the settlement, Align
will make a cash payment of
approximately $13 million to Ormco
and issue approximately 7.6 million
shares of Align’s common stock to
Danaher, that after issuance will be
equal to approximately 10 percent
ownership interest in Align.
The value of the shares is approximately $77 million (based on the
closing price of Align’s common
stock on Friday, Aug. 14).
Align and Ormco have also
agreed upon an exclusive collaboration over the next seven years
to develop and market an orthodontic product that combines the
trademarked Invisalign system with
Ormco’s trademarked Insignia orthodontic brackets and arch wires sys-

tem to treat the most complex cases.
Each party will retain ownership of its pre-existing intellectual
property, and each party will be
granted intellectual property licenses in their respective field for jointly
developed combination products.
“We are pleased to resolve this
ongoing litigation with Ormco and
to begin a new relationship that
meets our shared goals of providing
innovative products and excellent
service to our orthodontic customers,” said Thomas M. Prescott, president and CEO of Align Technology,
in a news release.
“This collaboration with Ormco,
a fellow innovator in digital orthodontics, gives us the ability to compete for a segment of the market
that is difficult to treat with Invisalign alone and accelerates our
long-term plan for a combination
product.”
(Sources: Align Technology and
Danaher Corp.)

Local anesthesia is truly
effective only when injected

Your patients, colleagues and friends will never have to guess what
you do for a living when you present them with your business card,
designed to look just like an X-ray. Holding it up to the light to read is
part of the fun!
X-Ray Biz Cards
(904) 260-1527
www.xraybizcards.com
* If you have some great ideas or products that help you have fun with
patients and staff, please share with us and we may feature them in our
pages! Write us at feedback@dtamerica.com.
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A painful truth in dentistry today
is that for most dental procedures,
local anesthesia is truly effective
only when injected. The problem,
of course, is that both the insertion
of the needle and the injection of
the anesthetic fluid itself can cause
discomfort.
Dentists have been using topical anesthesia to reduce the pain
involved in needle insertion and
fluid injection for decades, and they
have tried to use finer-gauge needles in the belief that they cause
less pain. However, recent research
has shown that needle gauge has no
effect on perceived pain level.
Topical anesthesia can be useful
for minimizing the pain associated
with needle insertion, but it has not
been proven to address pain associated with the actual injection of the
local anesthetic solution.
A recent study in Anesthesia
Progress examined the effectiveness of topical anesthesia in reducing pain associated with needle
insertion separately from the pain
associated with injection of the
anesthetic. Results were investigated after different intervals (two,
five and 10 minutes) to determine
the time for optimal efficacy of the
topical anesthetic.
In a double-blind, placebocontrolled study, responses from
85 people showed that the topical
anesthetic was statistically and significantly more effective compared
to the placebo for reducing the pain
caused by needle insertion alone at
all time points (two, five and 10).

However, it had no effect on
perceived pain intensity associated
with injection of the local anesthetic solution at any of the time
intervals.
At all time lengths, patients
reported the same degree of pain
from anesthetic solution injections
in topically anesthetized and placebo locations.
Therefore, the minimum twominute period appears to be sufficient for the topical anesthetic
application, as a five- or 10- minute delay has no added benefit in
reducing the pain of needle insertion.
To read the entire study, “Effect
of Time on Clinical Efficacy of Topical Anesthesia,” visit www.allen
press.com/pdf/anpr-56-02-03.pdf. DT

[5] =>

[6] =>

Editor’s Desk

Dental Tribune | August 2009

Journées Dentaires de Nice
shines once again
By David L. Hoexter, DMD, FACD, FICD, Editor in Chief

The Journées Dentaires de Nice dental meeting gathered
in Nice, France, in June — as it has for every other year since
1976 — to exchange information on all phases of dentistry, as
well as to give exciting up-to-date presentations on futuristic
possibilities in our profession.
In June, the sun reflects on the French Riviera like no other
place on Earth, making it a perfect location for practitioners
to sparkle with the knowledgeable exchange of dental presentations.
Participating supporters from the Chicago Midwinter Dental Meeting and the Greater New York Dental Meeting were
there in full force, sharing information with colleagues from
France and the rest of the world.
An added glow this year was a warm reception at a beautiful mansion and garden on the sea. There, the mayor of Nice
awarded personal citations and medals to a select few who
enhanced this wonderful cultural exchange.
Dr. Robert Edwab, executive director of the Greater
New York Dental Meeting, was one the recipients. Edwab
extended an invitation for all to come, share and participate
in the Greater New York Dental Meeting in November, which
attracted more than 55,000 attendees from around the world
last year.
Since its inception, every Journée Dentaires de Nice has
had a special auditorium devoted solely to implants and
AD

Denture Comfort
Tuf-Link
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Reline
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(From left) Dr. M. Kaduch, organizer of the Jounées Dentaires de Nice; Dr. Robert
Edwab, executive director of the Greater New York Dental Meeting (GNYDM); Dr. Cliff
Salm, general chairman of the GNYDM; Prof. David Hoexter, editor in chief of Dental
Tribune.

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1.8, 2.2 & 2.4 DIA.

implant-related presentations. While many meetings these days have
sessions related to implants, this group had the foresight and fortitude
to offer them years earlier than any other meeting.
Dr. Gerard Scortecci is the chairman of the implant section of the
Journeé Dentaires de Nice, and has been for many years. He has done
a formidable job with masterful presentation choices that are devoid
of the political or commercial pressures that sometimes surround such
organizations.
Scortecci is a wonderful practitioner, author and modest colleague
who endeavors to give a forum to practitioners, as well as implant
manufacturers, to elucidate new procedures, products and regenerative
materials so that participants can best serve their patients. He is to be
congratulated on his achievements and impartiality.
During the Nice meeting, the exhibits were presented in a neat and
orderly fashion, making it easy to find the new products as well as making them accessible to all.
Drs. M. Kaduch and M. Burdin have worked exhaustively over the
years to cultivate a wonderful meeting with a unique personality that
incorporates all of the style and class the French Riviera is known for.
I have attended this congress several times, and I hope this gem of
a biennial meeting continues to flourish and sparkle under the French
Riviera’s sun. DT

David L. Hoexter is director
of the International Academy for
Dental Facial Esthetics, and a clinical professor in periodontics at
Temple University, Philadelphia.

He is a diplomate of implantology
in the International Congress of
Oral Implantologists as well as the
American Society of Osseointegration, and a diplomate of the American Board of Aesthetic Dentistry.
Hoexter lectures throughout
the world and has published
nationally and internationally. He
has been awarded 11 fellowships,
including FACD, FICD and Pierre
Fauchard. He maintains a practice
at 654 Madison Ave., New York
City, limited to periodontics,
implantology and esthetic surgery.
He can be reached at (212) 3550004 or drdavidlh@aol.com.

[7] =>

[8] =>

Financial Matters

Dental Tribune | August 2009

Fiscally fit in 2009
Tax breaks and limited-time laws make 2009 the right time to invest in your practice
By Keith Drayer

The American Recovery and
Reinvestment Act of 2009 was
signed into law on Feb. 17 with
some of the best benefits having
limited remaining time eligibility.
Small business owners have limited time in 2009 to benefit from the
most lucrative tax incentives for
acquiring technology and/or equipment.
If your practice is ready to buy
equipment or software, the tax
incentives for doing so are better than ever. These benefits will
expire, or be reduced, as of Jan. 1,
2010.
The American Recovery and
Reinvestment Act accompanied by
lower interest rates make this a
strategic time to invest in your
practice to meet the demands of
today’s health care industry.
Because of these beneficial conditions, installing equipment and
technology in 2009 can create a
cash flow win-win for health care
practitioners “in the know.”

Can you deduct $250,000?
For the 2009 tax year, many small
businesses may potentially deduct
up to $250,000 if the equipment or
software is placed in service.
This valuable break is the Section 179 depreciation deduction
privilege, and it is an exception
to the general rule that you must
depreciate equipment and software
costs over several years.
Section 179 is an annual “use it

or lose it” accelerated deduction
benefit that optimally lowers taxable income.
The bonus depreciation is allowable for regular and alternative
minimum tax (AMT) purposes for
the tax year in which the property
is placed in service.
Property eligible for this treatment includes:
• Property with a recovery period of 20 years or less (almost all
dental equipment).
• Standard software/practicemanagement software.

Who can take the deduction?
This deduction is available whether
you are a sole proprietorship, partnership or corporation (S corporations are subject to different rules).
If you plan to acquire equipment
in the near future, purchasing it
before year’s end is prudent.

What type of financing is eligible?
Utilizing a finance agreement or
capital lease to acquire technology
or equipment will qualify for this
benefit, while true leases or fair
market value agreements will not.
If you use a finance agreement
to acquire your equipment and you
have deferred payments, you may
file your tax returns and achieve
the benefits before you have made
any payments.

Avoid last-minute decisions
Don’t wait too long to acquire technology or upgrade your office.
Although it is true that you can

Invest in your practice with HSFS
Henry Schein Financial Services
(HSFS) business solutions portfolio offers a wide range of financing
options that make it possible for you
to invest in your practice for greater
efficiency, increased productivity and
enhanced patient services.
HSFS helps health care practitioners operate financially successful
practices by offering complete leasing
and financing programs. HSFS can
help obtain financing for equipment

Annual Internal Revenue Code Section 179 Example

and technology purchases, practice
acquisitions and practice start-ups.
HSFS also offers value-added services including credit card acceptance, demographic site analysis
reports, patient collections, patient
financing and the Henry Schein Credit
Card with 2% cash back or 11/2 points
per dollar spent.
For further information, please call
(800) 853-9493 or send an e-mail to
hsfs@henryschein.com.

Calculations

Equipment not
more than $800,000

A. Equipment price
B. Section 179 deduction
C. 50% bonus depreciation
(A - B x 0.50)
D. 2009 MACRS deduction
(A - B - C x 0.20)
E. Total first year tax deduction
F. Combined federal and state tax
bracket
G. Total 2009 tax savings as a
result of capital expenditure
(E x F)

$300,000
$250,000

have equipment placed in service
by Dec. 31 to take advantage of
the incentives, waiting too far into
the year may mean that you will
settle on your selections because of
diminished year-end choices.
Now is the right time to meet
with an equipment or technology
specialist and discuss acquiring
the optimal production-enhancing
technology and equipment that will
help your practice stay fiscally fit.

Don’t forget bonus depreciation
Your practice may generally claim

$25,000
$5,000
$280,000
38%
$106,400

first-year bonus depreciation deductions equal to 50 percent of the cost
that is left over after subtracting
allowable Section 179 deductions
(if any).
If your business uses the calendar year for tax purposes, you only
have until Dec. 31 to take advantage
of the generous $250,000 allowance.
Don’t wait to see if 2010 will provide the same opportunity. Act now
and take advantage of all the benefits available through this current
legislative windfall. DT

About the author
Keith Drayer is vice president
of Henry Schein Financial Services, which provides equipment,
technology, practice start-up and
acquisition financing services
nationwide.
Henry Schein Financial Services can be reached at (800) 8539493 or hsfs@henryschein.com.
Please consult your tax advisor
regarding your individual circumstances.

[9] =>

[10] =>

10A Practice Matters

Dental Tribune | August 2009

Keep the economic crunch from biting your practice
Always ask for payment

By Sally McKenzie, CMC

As many of us have observed
or experienced firsthand, the
economy isn’t doing so great these
days. Patients are delaying treatment. They are looking for lower
cost options. If patients perceive an
appointment isn’t particularly necessary, chances are they will find
an excuse to cancel or reschedule.
Consequently, practices are scrambling to fill cancellations, and noshows are on the rise.
This is all the more reason why
patients need to understand that
dental care isn’t a matter of personal preference, nor an option to
be exercised when they have a little
more discretionary income. Rather, oral health is essential to the
patient’s overall health and wellbeing.
It’s up to the dental team to
use every opportunity to educate
patients that dentistry isn’t about
just brushing and flossing; it’s about
controlling diabetes, helping to
prevent heart disease and respiratory ailments, as well as helping to
ensure that pregnant women carry
their babies to term.
First, check the messages that
you are sending to patients. If you
are minimizing the need for care,
you are doing your bottom line no
favors. Hygienists must take the
time to verbalize exactly what they
see clinically.
In addition, at the end of the
appointment, remind the patient
about the findings, such as the
pocketing on the lower left that is
more of a concern now than it was
at a previous appointment.
In turn, the dentist must be singing from the same songbook. If she/
he walks in and says, “Everything
looks great. See you in six months,”
not only will both of you lose credibility, you’ll virtually ensure production shortfalls for both dentist
and hygienist. If everything does not
look great, emphasize the importance of addressing concerns.

Follow up or fall down
Follow up with patients who delay
care. In too many cases, patients
forgo or delay treatment because
they really do not understand the
importance of pursuing treatment.
In between appointments, conAD

tinue to educate patients.
Too often dentists will tell a
patients something once or twice
and believe they’ve done their part
to educate them on the matter.
Take a page from McDonalds’ —
everyone in the country knows
what a Big Mac is, but that doesn’t
mean they stop telling us, at every
opportunity, how delicious they are.
Patients are inundated with hundreds of competing messages every
day, which means that for the message to have impact, it must be
repeated multiple times and in multiple ways. You can’t just send out
the newsletter or the postcard and
expect to have to increase hygiene
days.
You have to continue to reiterate the message many times and
on multiple levels. Telling patients
something once or handing them
a brochure isn’t ongoing patient
education.
What’s more, patients need to
understand how they will benefit,
so make that an integral part of
your message. It’s essential that
patients recognize that the dental
practice is an essential stop on their
journey toward overall good health.
It’s up to you to bring them along.

Pursuing treatment should be
easy
Next, make it practical for your
patients to pursue treatment. This
may be a good opportunity for you
to review your financial policy and
guidelines. It should be neither too
lax nor too severe. A policy that is
too lenient can create undue financial strain on your practice. A policy
that is too strict can cause patients

to forgo necessary and elective dental procedures.
The plan should encourage
patients to pursue dental care and
pay for that care promptly. Consider
these possible options:
• If you choose to allow patients
to make installment payments,
determine how long you are willing
to wait for payment. For example,
perhaps you will allow all patients
undergoing procedures that cost
over a specific amount to pay for
the treatment in three installments
over a three-month period.
The timeframe can be longer
or shorter depending on your own
preferences. However, it must be
finite and it should only be extended
to patients undergoing more costly
treatment.
• Accept all major credit cards,
and in lieu of allowing patients
to carry large balances on their
accounts, encourage them to pay
with credit cards.
• Explore the availability of
patient financing companies, such
as CareCredit. Some patient financing companies will allow patients to
pay over 12 months or longer; however, the dentist receives payment
immediately.
• Encourage patients to build a
credit on their account before the
treatment begins.
Consider offering those patients
who are pursuing more costly and
more comprehensive dental care a
slight adjustment in the fees, such
as 5 percent, if they pay for the procedure in full upfront.
Expect patients that have insurance coverage to pay their portion
of the fee at the time the dental care
is provided.
• Provide a limited number of
specific options from which patients
may choose, and avoid the urge to
make too many exceptions to the
policy.
Many patients appreciate payment options because they have a
means to pay for procedures that are
necessary, but can become costly.
Certainly, options can and should
be provided, but they should never
compromise the fiscal integrity of
your practice or cause accounts
receivables to exceed more than
one month’s production.

Even during challenging economic
times, business staff must continue
to ask for and expect payment from
patients at the time of service. Keep
a few points in mind at the time of
collections to ensure that patients
fully understand the level of care
they have received for their investment.
When asking for payment,
explain the services provided and
make it easy for the patient to pay.
For example, t
Avoid asking patients if they
would like to pay today. Rather,
ask patients what form of payment
they would like to pay with today
— cash, check or charge? This
reinforces the payment expectation
and enables patients to determine
which form of payment will be best
suited to them.
Be prepared with specific scripts
that the staff can use when discussing payment options.
For example, if the patient says,
“I can make monthly payments for
the next 12 months,” the front desk
person should say, “Mrs. Jones, we
would be unable to accept monthly
payments for that duration because
this is a small business and we are
unable to extend credit for that
amount of time.
However, we do have a relationship with a patient financing company (provided such an arrangement exists) that will offer you an
interest-free loan. I just need a little
more information.”
This approach helps patients
understand why the practice cannot extend no-interest loans, yet
it provides a reasonable financial
option for patients to pursue.
g DT page 12A

About the author

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

[11] =>

[12] =>

12A Dental Informatics

Dental Tribune | august 2009

Dental informatics: the right time
to invest in training and research?
By Titus Schleyer, DMD, PhD

These days, technology appears
to touch most aspects of our lives,
and dentistry is no exception. The
plethora of possibilities and questions is seemingly endless.
Should you invest in chairside
computers, paperless records and/
or digital radiology? Does it make
sense for patients to have Web-based
access to their appointments and
dental record information? What
is Health Information Technology
(HIT) and what are the implications
for your practice? Can computers
really make you a better dentist and
help improve patient health?
The last question is one worth
pondering. If we look at all investments in our practices, we make
them typically for two reasons: to
improve patient care and outcomes,
enhance efficiency, or both. Health
information technology (HIT) is no
different. One issue with HIT, however, is that it is often hard to gauge
the true balance between costs and
benefits.
Medicine has pretty much decided
that the benefits of HIT outweigh its
costs. Many studies have shown that
HIT can enhance medical decisionmaking, reduce medication errors
and improve care outcomes. This is
why the recent federal stimulus plan,
as well as other initiatives, contain
measures to encourage the adoption of HIT by physicians, clinics and
hospitals. But, what about dentistry?
Evidence for the benefits of information technology (IT) in dentistry
can be found, but it is largely anecdotal. Practitioners report easy and
nearly ubiquitous access to patient
information. Electronic reports allow
tracking of patient completion of
treatment plans and even health outcomes. Digital information can be
e-mailed and shared with patients
and colleagues, for instance, to
increase patient compliance or to get

f DT page 10A
If the patient says, “I forgot
my checkbook. Can you bill me?”
respond with, “That is no problem
at all, Mrs. Jones as we take Visa,
MasterCard and Discover. Which
would you like to pay with today?”
If the patient says that she/he
doesn’t have a credit card and asks
that a bill be sent, respond with,
“Mrs. Jones, we can do better than
that. I can give you your bill right
now along with a printout of the services Dr. Smith performed today.”
Give the statement to the patient
along with a self-addressed,
stamped envelope. Smile at the
patient and say, “Thank you Mrs.
Jones, and if you would drop your

a second opinion. On the cost side,
investments in IT appear expensive
in the absence of good measures for
the cost/benefit ratio. Sometimes,
staff and colleagues are reluctant to
change ingrained ways of practice.
Unreliable, buggy or malfunctioning
technology are the bane of even the
most hardened enthusiast.
How can we find a way out of this
dilemma? I would argue that we
need a more systematic and fundamentally sound approach to conceiving, developing, implementing and
evaluating technology. We need to
focus on technology that has demonstrable benefits for practitioners and
patients, not chase every single new
gadget that is marketed with ambitious but ill- or unsupported promises.
While good ideas for new technologies can arise anywhere, many
are the result of successful collaborations between dentists and engineers, computer scientists or IT
people. We need to bring the best
technical approaches to bear on the
problems in our domain, and multidisciplinary collaborations tend to do
that well.
As many examples from the IT
industry show, it is possible to translate good ideas into great software
and/or devices. Unfortunately, this
is the exception rather than the rule.
Individual dental software applications contain many good features
and designs, but as a whole there
is great potential for improvement
of usability, as some of the studies conducted by our center have
shown. Improved usability translates
into day-to-day benefits for you, the
practitioner.
Implementing clinical software
applications in a practice is challenging but not impossible. Plenty of
offices have a well-run IT infrastructure in which data quality is maintained, data is backed up regularly,
and staff trained and productive.

Unfortunately, our dental education and licensing system isn’t wellpositioned to provide practitioners
with the skills needed to run IT well.
A frequently heard comment from
many of our students is: “Well, informatics is not on the national boards,
so it can’t be that important.”
Finally, we need to do a better job
of assessing what works and what
doesn’t with regard to IT in dental
practice. To date, we do not have
solid, empirical evidence for the
cost-benefit ratio of implementing,
for instance, paperless records. We
don’t know how patient outcomes
change when a practice begins using
computers.
Do more patients have better
clinical outcomes? Are they more
compliant in terms of getting their
treatment plans completed? Yet,
practitioners continue to invest millions of dollars every year in IT in
their practice.
How do we get beyond these
obstacles? In my opinion, we need
to invest more in research and training in dental informatics. The discipline of dental informatics comprises
many individuals who are very well
qualified to help bring technology
to the next level in dentistry. Many
of them understand the domain of
dentistry intimately and personally,
especially if they are dentists with
training in informatics. Due to their

in-depth knowledge of computer science and information science, they
are well positioned to come up with
innovative and workable problem
solutions.
Unfortunately, there are not
enough dental informaticians, and
their collective research activity is
not intensive enough to address the
pressing opportunities and challenges in leveraging IT for dental
practices. For many years, the training program at the University of
Pittsburgh has been preparing individuals for research and teaching
careers in dental informatics. But,
we produce a trickle where a flood
would be needed.
Through the generous support
of the National Institute of Dental
and Craniofacial Research (NIDCR),
we can provide dental informatics
training essentially for free to qualified applicants. NIDCR funds provide
a stipend, tuition, fees and health
insurance support, travel subsidies
and a state-of-the-art computer.
These positions are highly sought
after and admission is very competitive. Additional information about
the program is available at di.dental.
pitt.edu/postgrad.php. We are currently looking to fill several trainee
positions.
For any questions, please contact
the program director, Dr. Titus
Schleyer, at titus@pitt.edu. DT

payment in the mail to us when you
get home, we would greatly appreciate it.”
Financial negotiations should
be delegated to a trained financial
coordinator. The dentist is the clinician, the primary income producer
and the chief executive officer.
However, he/she is not the financial coordinator, and engaging in
this role is often both inefficient
and awkward for dentist and patient
alike. It also can undermine the
profitability of the practice.
Delegate financial discussions
to trained members of the team.
Those individuals most capable of
succeeding in this position are typically assertive, tactful, confident
and goal-oriented.

You may have excellent members of your team who are loyal,
kind and truly dedicated to your
practice. However, they may be
entirely too passive or very uncomfortable asking patients for payment. It is not a job that just anyone
can step into.
Some people are simply not suited for this responsibility. Pay attention to the personality type of the
individual responsible for collections and secure training to ensure
maximum success.
From time to time, as the dentist,
you will feel that certain exceptions should be made to the policy
for specific cases. Certainly, as the
business owner, that is your prerogative.

However, be judicious in making
those exceptions. Special arrangements that become common practice usurp the role of the financial
coordinator and can quickly render
financial policy useless.
Educate patients fully so that
they understand the health care
impact and the overall value of
the care you provide. Review your
collections policies, train those
who discuss financial arrangements with patients and ensure
that patients fully understand the
options available.
Before long, we’ll be well past
the current economic crunch, and
you will have kept your patients in
your practice and your bottom-line
intact. DT

Free training in dental informatics
The National Institute of Dental and Craniofacial Research
(NIDCR), funds dental informatics training to qualified applicants for
free (no kidding!). The NIDCR funds provide a stipend, tuition, fees
and health insurance support, travel subsidies and a state-of-the-art
computer.
These positions are highly sought after and admission is very
competitive. Additional information about the program is available at
di.dental.pitt.edu/postgrad.php.
For any questions, please contact the program director, Dr. Titus
Schleyer, at titus@pitt.edu.

[13] =>

Dental Tribune | August 2009

Special Topic: Surgery 13A

Orthodontic surgery and esthetics
By Prof. Nezar Watted & Prof. Josip Bill,
Germany
Dr. Ori Blanc & Dr. Benjamin Schlomi,
Israel

Orthodontic treatment generally follows esthetic, functional
and prophylactic objectives, where
individual aspects of isolated cases
are accorded varying importance
as they arise. Increasing esthetic
expectations and awareness of
modern dental treatment options
disseminated by the media have
resulted in increased interest and
greater willingness of adults to consider orthodontic treatment. Thus,
esthetic orthodontics is primarily
adult orthodontics.
A peculiarity of orthodontic treatment in adults compared with pediatric or adolescent orthodontics is
the age-associated involution of the
connective tissues that leads to a
reduction in cell density, thickening
of the fibre bundles, delayed fibroblast proliferation and reduced vascularization. These are the causes
of slower dental movement and
delayed tissue and bone reactions.
Absent sutural growth, the age of
the periodontium, specific periodontal diagnoses and tissue atrophy also
make treatment in adults particularly challenging.
As a rule, esthetically-oriented
adult orthodontics therefore has an
interdisciplinary inclination. Occlusion, function and esthetics are considered to be equivalent parameters
in modern orthodontics, and particularly here in combined orthodonticmaxillofacial surgical treatment.32,33
This was achieved through thw
optimization of diagnostic tools and
further development and increasing
experience in orthopedic surgery.4
Nowadays, treatment of adult
patients with dental malposition and
mastication impairment is one of the
standard tasks of the orthodontist. If
the discrepancies in spatial allocations of the upper and lower dentition are particularly pronounced,
and where the cause is primarily
skeletal and not only dentoalveolar,
conventional orthodontic therapy
is limited and combined orthodontic surgical therapy is indicated for
remodeling of the jaw bases.
Treatment for a skeletal dysgnathia (Class III) using combined
orthodontic-maxillofacial surgical
correction is discussed in this article.

Chronological development
of maxillofacial surgery
of the mandible
The first orthodontic-maxillofacial
surgical procedure on the mandible
described in the literature was that
of the American surgeon Hullihen
in 1848.13
This procedure was a segmental
osteotomy of the anterior mandible
(a posterior shift [retrusion] of a protruding mandibular alveolar process

following a burn injury).
Toward the end of the 19th century, the method of orthodonticmaxillofacial surgical correction
of dysgnathias by surgical retrusion or protrusion of the mandible
was revisited. Jaboulay14 described
resection of the Processus condylarism and Blair4 osteotomy on the Corpus mandibulae.
The continuity resection in the
horizontal branch by Blair was the
first surgical prognathism procedure. The patient first visited the
dentist Whipple in St. Louis in 1891
and was then referred to the most
renowned orthodontist of the day,

Fig. 1:
Diagrammatic
representation
of the osterotomy lines
on the outer
(continuous
line) and the
inner compacta
(dashed line) of
the mandible;
4 = inner saw
cut above the N.
mandibularis.
g DT page 14A
AD

[14] =>

14A Special Topic: Surgery
f DT page 13A
Dr. Edward Hartley Angle2, who
ultimately recommended the surgical procedure mentioned above.
Six years later, the procedure in
this osteotomy on the Corpus mandibulae was also published by the
Hamburg surgeon Floris.11 Parallel
with this development in the U.S.,
von Auffenberg3 in Europe conceived a step-by-step osteotomy for
correcting a mandibular retrusion,
which was performed by von Eiselberg in 1901.
The era of orthodontic surgery
in Europe began only after World
War I. The experience gained there
led to a substantial extension of the
indications for orthodontic-maxillofacial surgical procedures, as well
as to the transferral of this surgical
AD

technique to the area of elective
procedures.5,6,16–18,24
In the early 1920s, Bruhn and
Lindemann set transversal osteotomy of the Ramus mandibulae as the
standard method at the time for the
surgical correction of mandibular
prognathism. This method, which
continued to have many adherents
well into the 1960s, is today known
as the Bruhn–Lindemann procedure.1,6,25,45
In 1935, Wassmund, who saw its
drawbacks in a possible dislocation of the proximal segment by the
muscles inserted there, described
a modification of the Bruhn–Lindemann surgical technique.26
In the early 1950s, a new era
in orthodontic surgery of the mandible was begun with Kazanjian’s
resumption12,15,23 of the technique of

Dental Tribune | august 2009

Figs. 2a (left), b (right): Lateral view of the 25-year-old male patient,
showing lower facial retrusion diagonally forward. The frontal view
shows the right-sided deviation due to the laterognathia. The upper-lip
vermillion is relatively weakly developed (b).
transverse oblique severing of the
ascending ramus, first performed by
Perthes in 1922.22
Shuchard modified this method
in 1954 by enlarging the bony insertion surface, and in 1955 Obwegeser
introduced sagittal splitting at the
horizontal ramus of the mandible.
He shifted the buccal osteotomy
line obliquely from the last molar
to the posterior margin of the jaw
angle.19–21
In 1959, Dal Pont moved this buccal osteotomy line from the last
molar to the inferior margin of the
mandible.8,9 Since then, this method
of sagittal split at the mandible has
been called sagittal split according to Obwegeser–Dal Pont (Fig. 1).
Epker10 developed the incomplete
sagittal split into a routine method.

Clinical case presentation
History and diagnosis
A 25-year-old patient presented on
his own initiative. He complained of
functional (impairment of mastication and jaw joint pain) and esthetic
impairment (sunken face with facial
asymmetry). He had undergone
orthodontic treatment between the
ages of 8 and 15 and reported pain
in the area of the anterior mandible.
The lateral image showed a retrusive lower face inclined forward
with mid-facial hypoplasia — regio
infraorbitale — a flat upper lip and
an elongated lower face compared
with the mid-face — 47:53 percent
instead of 50:50 percent29 (Table
I; Fig. 2a). Owing to the negative
sagittal overjet, there was a positive
lower lip step. The frontal image
shows mandibular deviation (laterognathia) to the right, which can
be traced to growth asymmetry in
the jaw (Fig. 2b).
In addition, there was a Class
III dysgnathia angle with conspicuous mandibular midline deviation
to the right, frontal and right lateral crossbite, anterior mandibular
labial tilt and a steep anterior mandible. Tooth 26 had been missing for
some time (Figs. 3a–e). FRS analysis
(Table I and II) clearly shows the
strongly sagittal and relatively weak
vertical dysgnathia both in the softg DT page 16A

[15] =>

[16] =>

16A Special Topic: Surgery

Dental Tribune | August 2009

f DT page 14A

Fig. 3d

tissue profile and in the skeletal
region.
The parameters indicated a
mesiobasal jaw relationship and
a growth pattern with an anterior
course: the vertical grouping of the
soft-tissue profile showed a disharmony between the mid-face and the
lower face (G’-Sn:Sn-Me’; 47:53 percent). This was relatively weakly
expressed in the bony structures
(N-Sna:Sna-Me; 44:56 percent).
In the region of the lower face
there was also mild disharmony (SnStm:Stm-Me’; 31:69 percent). Complementary assessment of the mandible showed that the area from the
subnasal-labral inferius to the softtissue chin (Li-Me’), which should
have been 1:0.9, was shifted in favor
of the Li-Me’ part (0.9:1; Fig. 4). The
panoramic image showed a lucency
of teeth 31 and 41. A root canal procedure followed by root apex resection was thus performed (Fig. 5).

Therapeutic objectives and
treatment planning
The objectives of this combined
orthodontic maxillofacial surgical
treatment were:
• the establishment of neutral,
stable and functional occlusion with
physiological condylar positioning;
• the optimization of the facial
esthetics;
• the optimization of the dental
esthetics, considering the periodontal situation;
• the assurance of the stability of
the results achieved;
• meeting the patient’s expectations.
The improvement of the facial
esthetics not only in the sagittal axis
in the region of the lower face (the
mandibular region), but also in the
region of the mid-face (hypoplasia)
and in the transverse axis should be
noted as specific treatment objectives. The change in the region of
the mid-face was intended to affect
the upper lip and the upper-lip vermillion.
These treatment objectives were
achieved by two procedures:
• a dorsal extension of the manAD

Fig. 3a

Figs.
3a–e:
Clinical
situation
before
the start
of treatment.
Fig. 3b

Fig. 3e

Fig. 3c

dible with lateral sweep to the left
for correction of the sagittal and
transverse defects, as well as occlusion and the soft-tissue profile;
• bone augmentation in the midface for harmonization of the face.
It would not have been possible
to achieve the desired treatment
objectives with respect to function
and esthetics using orthodontic procedures alone.27

Fig. 4: The cephalometric X-ray shows
the disharmonious arrangement in the
vertical axis. The lower face shows an
approximately 60 percent enlargement
in relation to the upper face.

Fig. 5: Orthopantomographic image before
the start of orthodontic
treatment. An apical
lucency at tooth 31.
Pronounced maxillaryantrum expansion
between teeth 25 and
27. Orthodontic closure
of the gap is difficult.

Therapeutic procedure
Correction of the pronounced dysgnathia was achieved in six phases:28,30–33
• Splint therapy: a flat bite guard

splint was installed for six weeks in
order to determine the physiological condylar position or centrics
before the final treatment planning.
By doing this, the forced bite could
be demonstratesd to its full extent.
• Orthodontics for forming and
adjusting the dental arches relative to each other and decompensation of the skeletal dysgnathia (Figs.
6a–c).
• Splint therapy for determining the condylar position. This was
performed in the four to six weeks
prior to the surgical procedure. The
objective was registration of the
jaw joint in a physiological position
(centrics).
• Oral surgery for correction of
the skeletal dysgnathia: after model
operation, determination of the
transposition path and production
of the splint in the target occlusion,
the surgical mandibular translocation using sagittal split according
to Obwegeser–Dal Pont was per-

formed. Augmentation in the midfacial region was completed using
autologous bone.
• Orthodontics for fine adjustment of occlusion.
• Retention: 3-3 retainers were
cemented in the mandible.
Mandibular and maxillary plates
were used as the retention appliance. Prosthetic care was provided
after six months.

Results
Figures 7a to 7e show the situation
after the conclusion of treatment,
and after extraction of tooth 31 and
subsequent prosthetic treatment:
neutral occlusion and correct midline with physiological sagittal and
vertical bite.
The extraoral images show a harmonious profile in the vertical as
well as in the sagittal axis (Figs.
8a, b). The oral profile is harmonig continued

[17] =>

Special Topic: Surgery 17A

Dental Tribune | August 2009
Figs. 6a–c: Situation after orthodontic preparation for the surgical procedure.

Figs. 7a–e: Occlusion at the end of
treatment; there is a neutral stable
occlusion with physiological anterior bite in the sagittal and vertical
axes and a correct midline (a–c).
Monitoring images of the upper and
lower jaws. A ceramic bridge was
made in the lower jaw (d, e).

Fig. 6b

Fig. 6a

Fig. 6c

Fig. 7d

Fig. 7b

Fig. 7c

Fig. 7a

Fig. 7e

Parameter

Mean

Before
Treatment

After
Treatment

G’-Sn/G’-Me’

50%

47%

50%

Sn-Me’/G’-Me’

50%

53%

50%

Sn-Stm/Stm-Me’

33:67%

31:69%

33:67%

Sn-Li/Li-Me’

1:0.9

0.9:1

1:1

Table I: Proportions of soft-tissue
structures before and after treatment.
g continued
AD

[18] =>

[19] =>

Dental Tribune | August 2009

Special Topic: Surgery 19A

f continued

Fig. 10: Orthopantomogram after conclusion of orthodontic treatment and
before prosthetic care.
Fig. 8a
Figs. 8a, b: The extraoral treatment
results. The sagittal, vertical and
transverse were corrected.

Fig. 8c

Fig. 8d
Figs. 8c, d: Change in the oral profile: pre-op and post-op.

Fig. 9
Fig. 9: The cephalometric image
after conclusion of treatment shows
a harmonious ratio between the skeletal structures, as well in the sagittal
axis and the vertical axis, and harmonization in the soft-tissue profile
between the upper and lower face.

Fig. 8b
g DT page 21A
AD

[20] =>

[21] =>

0A
Dental TRubric
ribune | August 2009

Dental Tribune
| Month21A
2009
Clinical

Headline
Case
report: oral rehabilitation
Deck
of severely worn dentition
By line

By Dov M. Almog, DMD, Michel
Ferrara, DDS & Youngman Chun, DDS

Tooth wear occurs as a natural
physiologic process. The average
wear rates on occlusal contact
areas are estimated to be 29 µm
per year for molars and about
15 µm per year for premolars (1
micrometer = one thousandth of a
millimeter). 1
Pathologic wear occurs when
the normal rate of wear is accelerated by endogenous or exogenous
factors. 2 Tooth wear caused by
parafunction is estimated to progress three times faster than physiologic wear.3
Tooth surface loss has been
classified into the following types:
1) Erosion: loss of tooth surface
by chemical processes not involving bacterial action.
2) Attrition: denoting tooth
structure loss by wear of the tooth
surface or restoration caused by
tooth-to-tooth contact during mastication or parafunction.
3) Abrasion: loss of tooth surface caused by abrasion with foreign substances other than toothto-tooth contact.4
Another classification divides
tooth wear into two categories:
mechanical wear caused by attrition or abrasion, and chemical
wear caused by erosion.2
A differential diagnosis is not
always possible because often
there may be a combination of
these processes occurring. 5–8 Etiologic factors include bruxism,

harmful oral habits, diet, gastroesophageal reflux disease, occupation, eating disorders, xerostomia and congenital anomalies
such as amelogenesis imperfecta
and dentinogenesis imperfecta.1–12
Clinical parameters have been
suggested to aid in diagnosing the
type of tooth wear and determining its cause.2
Loss of the vertical dimension of occlusion (VDO) caused
by physiologic tooth wear is usually compensated for by continuous tooth eruption and alveolar
bone growth. In situations where
tooth wear exceeds compensatory
mechanisms, loss of VDO occurs.
The determination of the VDO
can be achieved with several
methods, such as phonetics, interocclusal distance and swallowing.8
In situations where loss of tooth
structure has occurred and VDO
is still acceptable, treatment may
include crown lengthening, orthodontic movement with limited
intrusion, surgical repositioning
of a segment of teeth and supporting alveolar bone, and placement
of crowns and fixed partial dentures. 8
In situations where loss of
the VDO has occurred, the cast
overlay removable partial denture (CORPD) may be a treatment
option. 13–15
This treatment option has been
suggested to be efficient and cost
effective, with the final outcome
pleasing to the patient.13–15 Potential disadvantages of the CORPD

Fig. 1: Panoramic.

Fig. 2:
Intraoral.
prosthesis include compromised
esthetics when the dentures are
removed; development of caries
or periodontal disease as a result
of poor oral hygiene; porcelain or
resin veneer fracture or discoloration; and possible dissatisfaction
with a removable prosthesis.
This clinical report describes
the use of maxillary and mandibular CORPD consisting of anterior
porcelain veneers and posterior
cast overlays in the treatment of a
patient with severe tooth wear due
to attrition and erosion, including
follow-up over three years.

Case report
A 63-year-old African-American
male veteran, the subject of this
case report, presented us with a
noteworthy case of worn dentition. The veteran was referred to
our dental service for prosthodontic treatment consideration. The
medical and dental histories were
recorded, and a full-mouth-series
(FMS) of radiographs and Panorex
(Fig. 1) were taken.
The relevant medical history
included hypertension, tobacco
g DT page 22A

f DT page 19A
ous. The upper-lip vermillion is distinctly visible in comparison to the
original situation (Figs. 8c, d).
The FRS shows the changes in the
AD
parameters that arose as the result
of the displacement of the mandible.
There is harmonization in the vertical arrangement of the bony and
soft-tissue profile. The disharmony
in the lower third of the face has
been corrected (Fig. 9, Tables I, II).
The OPG shows the positioning
screws in both jaw angles and the
fixation screws of the augmented
bone in the mid-face (Fig. 10). DT
Editorial note: A complete list of references is available from the publisher.

Contact info
Prof. Nezar Watted
Wolfgangstraße 12
97980 Bad Mergentheim
Germany
E-mail: nezar.watted@gmx.net

Parameter

Mean

Before Treatment

After Treatment

SNA

82°

90°

SNB

80°

93°

90°

ANB

2°

-3° (indl. 4,5°)

0° (indl. 4,5°)

±1 mm

-8 mm

-3 mm

ML-SNL

32°

20°

NL-SNL

9°

4°

ML-NL

23°

16°

Gonion-<

130°

120°

SN-Pg

81°

93°

90.5°

PFH/AFH

63%

74%

76%

N-Sna /N-Me

45%

44%

Sna-Me/N-Me

55%

56%

WITS-value

Table II: Proportions of skeletal structures before and after treatment.

[22] =>

22A Clinical

Dental Tribune | August 2009

f DT page 21A
use and post traumatic stress disorder (PTSD). The clinical examination revealed severe tooth wear
extending to the cervical level of
the teeth in some areas, attributed
primarily to amelogenesis imperfecta.
Clinical determination of the
VDO was achieved with the following methods: phonetics, interocclusal distance, swallowing, lip
competence and facial appearance. Following careful assessment, it was determined that a
7-millimeter loss of VDO was
caused by a combination of attrition and erosion (Figs. 2, 3a, b).
The patient’s chief complaint
noted a desire to improve esthetics (“poor appearance”), function

(“would like to chew better”) and
eliminate tooth sensitivity (“my
teeth are sensitive”).
Impressions of both arches
were made using stock trays and
irreversible hydrocolloid (Jeltrate
Plus, DENTSPLY Caulk, Milford,
Del.), and poured in stone (Quickstone, Whip Mix, Louisville, Ky.).
The diagnostic casts were articulated in a semi-adjustable articulator (Hanau H2, Hanau Teledyne,
Buffalo, N.Y.), using a centric relation record and a face-bow transfer.
During the following visit,
treatment options were discussed
with the patient, including crown
lengthening, root canal treatments, implants and fixed restorations.
After reviewing photos of other

similar cases and considering
the invasiveness, life expectancy
of fixed restorations, amount of
time and cost, the patient elected to have CORPDs using cast
frameworks, acrylic teeth and
a couple of posterior teeth with
metal occlusal surfaces in order
to maintain the prospective VDO.
The patient was also started on
0.4 percent stannous fluoride once
a day (Acclean, Home Care Gel,
Henry Schein, Melville, N.Y.) in
order to prevent further decalcification of his teeth.
Shortly after, maxillary and
mandibular transitional overdentures were fabricated. The new
diagnostic VDO and the plane of
occlusion were established based
on anatomic landmarks and averaged values. These overdentures

2009
Greater New York Dental Meeting
85th
Annual Session

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

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Fee!

MEETING DATES:
NOVEMBER 27th - DECEMBER 2nd
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For More Information:
Greater New York Dental Meeting™
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New York, NY 10018 USA
Tel: +1 (212) 398-6922
Fax: +1 (212) 398-6934
E-mail: info@gnydm.com
Website: www.gnydm.com

Please send me more information about...
Attending the Greater New York Dental Meeting
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fit tightly over the teeth and soft
tissues, enabling evaluation and
adjustment for phonetics, esthetics and occlusion.
The transitional VDO devices
were worn for approximately
eight weeks, during which time
occlusal adjustments were made
weekly, and occlusion was modified based on phonetic and esthetic principles as well as patient
comfort and ease of function.
In the meantime, the diagnostic
casts were surveyed to determine
the most suitable path of insertion of the definitive prostheses.
Each cast was placed in a horizontal position and slowly lowered
posteriorly on the surveyor until
undercuts at the disto-buccal of
the bicuspid and molar regions
were of sufficient depth (0.25
mm). A slight undercut in the
anterior region allowed for use of
a rotational path of insertion.
The information from the diagnostic casts was now replicated
intraorally. Unsupported enamel
was recontoured and polished.
Guide planes were placed on any
remaining proximal tooth surfaces. Because of the severe wear
of many of the teeth, a natural
undercut for adequate retention
could not be located. Therefore,
existing enamel surfaces were
slightly modified to create 0.25
mm undercuts.
Dentin exposure was managed
with a thorough maintenance program. Rest seat preparations were
not needed because the entire
occlusal surface of all the teeth
served as rests under the cast
framework.
Definitive casts were obtained
using a polyether impression
material (Permadine-Penta H and
Permadyne Grant 2:1, 3M ESPE,
St. Paul, Minn.) and custom trays
(Triad VLC Materials, DENTSPLY International, York, Pa.),
and mounted in centric relation.
The incisal guiding pin was then
adjusted for a 7 mm increase in
VDO.
Once the path of insertion
was established for both casts,
the undesirable undercuts were
blocked out with wax, and the
casts were duplicated and poured
in a refractory investment (HiTemp, Whip Mix Corp., Louisville,
Ky.). The refractory casts were
also mounted in the articulator
using a cross-cast mounting procedure between the definitive cast
and the refractory casts.
The frameworks were waxed
using a thin layer of wax (Flexseal
Patterns, DENTSPLY Trubyte/Austenal, York, Pa.) over the teeth, to
be included in the prosthesis. A
couple of the posterior occlusal
surfaces were waxed to occlusion.
The wax patterns were cast in
a chrome-cobalt alloy (Vitallium,
DENTSPLY Austenal, York, Pa.).
The cast frameworks were then
finished.
The frameworks were evaluated intraorally for fit, occlusion, retention and stability. A

[23] =>

Clinical 23A

Dental Tribune | August 2009
new maxillo-mandibular record
was made with the frameworks in
position, and the definitive casts
were mounted on the articulator.
The frameworks were returned
to the laboratory for acrylic teeth
in the esthetic zone. Although the
esthetic zone in the CORPD can
be fabricated either with composite or porcelain veneers, in this
patient, acrylic teeth were used
(Ivoclar Vivadent, Schaan, Liechtenstein) (Fig. 4).
At the patient’s next visit, the
CORPDs were inserted (Figs. 5a,
b). Following postoperative directions on how to properly insert
the prostheses, the patient was
provided with instructions on adequate oral hygiene and caries and
erosion prevention. These included the application of 0.4 percent
stannnous fluoride once a day.
The veteran was also instructed
to take the CORPDs out at night.
After two post-insertion visits that
included minor adjustments, the
patient was placed on a six-month
recall.
One year and four months after
insertion, the patient presented
to the dental emergency clinic
with discomfort associated with
tooth #8. According to the patient,
he had stumbled and clenched
his teeth together, resulting in a
root fracture of tooth #8, following
which he was referred to the oral
surgery department for a surgical
extraction. After removal of tooth
#8, a minor acrylic reline was
done in the respective underline
region in the maxillary CORPD.

Conclusions
This clinical case report demonstrates that the use of CORPD can
be a viable, non-invasive and relatively inexpensive choice of treatment for a patient with severely
worn dentition who expresses
concerns about treatment invasiveness, long-term durability and
cumulative costs for the long-term
oral rehabilitation and maintenance. DT
Editorial note: A complete list
of references is available from the
publisher.

Contact info
• Dov M. Almog, DMD
Chief, Dental Service, VANJHCS
• Michel Ferrara, DDS
GPR Program Director, VANJHCS
• Youngman Chun, DDS
General Practice Resident
(GPR), VANJHCS
Reprints request to:
Dov M. Almog, DMD, Chief
Dental Service (160)
VA New Jersey Health
Care System
385 Tremont Ave.
East Orange, N.J 07018
Tel.: (973) 676-1000, ext. 1234
E-mail: Dov.Almog@va.gov

Fig. 3a: Intraoral mandibular.

Fig. 4b: Overlay cast partials, bottom view.

Fig. 3b: Intraoral maxillary.

Fig. 5a: Intraoral with partials,
front.

Fig. 4: Overlay cast partials, occlusal view.

Fig. 5b: Intraoral with partials, left.
AD

[24] =>

24A CDA Meeting

Dental Tribune | August 2009

Meeting in San Francisco offers
plenty to learn, buy and do

Things to learn
The four-day meeting will feature
dozens of informative classes and
workshops for dental professionals.
Whether you want to expand your
practice, increase productivity or
even learn a new technique, you are
sure to find intellectual stimulation
in the lecture halls.
There are too many courses to
list them all, but highlights include
the following:
• David A. Garber, DMD
Accelerated Esthetic Restorative
Dentistry: Choices, Alternatives and
Options; Saturday lecture, 9:30
a.m.–noon; 1:30–4 p.m.
Today’s clinician must integrate
new esthetic procedures into his or
her armamentarium while ensuring enhanced esthetics and superior
predictability.
• James R. Dunn, DDS
Esthetic Restorative Treatments
and the Visual Communication Tools
Needed in a Contemporary Practice;
Sunday lecture, 8:30 a.m.–12:30 p.m.
This class will review the materials and techniques available for
bleaching, minimal intervention
with glass ionomers, direct composites, bonded ceramics, periodontal alterations and implant restorations.
• Ronald Jackson, DDS, FAGD,
AD

Missed a previous edition of
Dental Tribune? You can now
read some content online!
Informatics and IT in dentistry:
a look forward (Part 2)
By John O’Keefe, B. Dent. Sc.,
M. Dent. Sc., MBA
www.dental-tribune.com/arti
cles/content/scope/specialities/
section/practice_management/
id/596

By Fred Michmershuizen, Online Editor

For dentists on the West Coast,
Northern California is the place to
be this September, as it is the setting for “CDA Presents The Art and
Science of Dentistry” — to be held
Sept. 10–13 at the Moscone West
Convention Center in San Francisco.
The California Dental Association meeting (formerly known as
the “Scientific Session”) offers
attendees the chance to learn from
dynamic speakers and technical
exhibits, and to fulfill continuing
education requirements.
In the exhibit hall, attendees
will be able to explore cutting-edge
products and services. The meeting
also offers plenty of opportunities
for networking with colleagues and
friends, all amid the exciting attractions of San Francisco.

www.dental-tribune.com

IACA Conference: Enhancing
teamwork through ‘team play’
By Shery Blair, CDA
www.dental-tribune.com/arti
cles/content/scope/specialities/
section/practice_management/
id/597

AFAACD, DABAD
Giving Your Patients Something
to Smile About: Composite Artistry; Friday lecture, 9:30 a.m.–noon;
1:30–4 p.m.
This presentation will illustrate
the value of using direct composite
resin for treating anterior restorative and cosmetic needs.
Composite Artistry Workshop;
Saturday workshop, 9:30 a.m.–noon
(repeats 1:30–4 p.m.)
In this hands-on workshop by
Jackson, participants will have the
opportunity to use 4 Seasons (Ivoclar), a state-of-the-art, naturally
shaded composite system. Exercise
will include placement of an invisible Class IV.
• John O. Burgess, DDS, MS
Restorative Materials Update;
Friday lecture, 10 a.m.–12:30 p.m.;
2–4:30 p.m.
This clinically-oriented course
compares new materials with an
evidence-based approach to evaluate their clinical success.
Improving Composite Resin Restorations, Saturday workshop, 9:30
a.m.–noon (repeats 1:30–4 p.m.)
This fast-paced course by Dr.
Burgess will advance your dental
practice by improving your use and
selection of dental materials, and
will provide useful information that
can be used during your next clinic
day.
• Debbie Castagna and Virginia

Moore
Rejuvenate Your Practice — It’s
Easier Than You Think, Friday
morning lecture, 9:30 a.m.–noon
The instructors will inspire you
with their insight into topics and
issues you face every day, including staff meetings and solutions to
decrease no-shows and cancellations.
The Comprehensive New Patient
Experience: From “Thank You for
Calling” to “When Can We Start?”,
Friday afternoon lecture, 1:30–4
p.m.
In this session, Castagna and
Moore will teach practitioners how
to provide the new patient with an
exceptional experience.
• Joseph A. Blaes, DDS
Temporization Made Easy, Friday workshop, 9:30 a.m.–noon
(repeats 1:30–4 p.m.)
Participation in this hands-on
course will give you the knowledge
and confidence to fabricate functional and highly esthetic provisional restorations.
Pearls for the Dental Assistant:
Understanding Dental Materials
and Techniques, Saturday morning
lecture, 10 a.m.–12:30 p.m.
Dr. Blaes will demonstrate how
proper handling of materials can
make dental procedures faster, better and more fun for the entire
dental team.
The Journey to Becoming an Outstanding Dental Assistant, Saturday
afternoon lecture, 2–4:30 p.m.
Blaes will tell participants how to
start a journey to become the best
they can be. Learn communication
skills and create routines that will
help you take charge of your job
and your life.
• Bruce J. Crispin, DDS and
Charles W. Wakefield, DDS, ABGD
Perfecting Esthetic Results: Chairside Techniques to Optimize Direct
and Indirect Restorations, Two-day
workshop, Friday and Saturday, 9
a.m.–noon; 1:30–4:30 p.m.
Participants will master simple

IACA Confrerence: ‘To elevate
dentistry around the world…’
By Robin Goodman, Group Editor
www.dental-tribune.com/arti
cles/content/scope/specialities/
section/general_dentistry/id/598
Children on Medicaid receive
less care for cleft lip and palate
Source: American Cleft PalateCraniofacial Association
www.dental-tribune.com/arti
cles/content/scope/news/region/
usa/id/600

Here’s some other online
content that might be of
interest to you …
Interview: ‘Singapore is in
demand of high-quality dental
laboratory work’
By Daniel Zimmermann, DTI
www.dental-tribune.com/arti
cles/content/id/558/scope/busi
ness/region/asia_pacific
A great smile makes you appear
smarter, more successful
By Fred Michmershuizen,
Online Editor
www.dental-tribune.com/arti
cles/content/scope/news/region/
usa/id/577
Vivek Shukla talks about the
medical tourism market in India
By Daniel Zimmermann, DTI
www.dental-tribune.com/arti
cles/content/scope/news/region/
asia_pacific/id/393
The keys to early cancer diagnosis: careful examination &
timely biopsy
By Dr Sara Gordon, USA
www.dental-tribune.com/arti
cles/content/scope/specialities/
section/general_dentistry/id/343
Implants displaced into the
maxillary sinus
By Dov M. Almog, DMD, Kenneth Cheng, DDS & Mohammad
Rabah, DMD
www.dental-tribune.com/arti
cles/content/scope/specialities/
section/implantology/id/542

[25] =>

0A
Dental TRubric
ribune | August 2009

Headline
Going to

San Francisco?

Deck
For even more on

the CDA’s San Francisco meeting, including daily schedules,
product news and live
coverage
of all the
tk
seminars, exhibitors
and social events, be
sure to pick up Dental Tribune’s special
CDA San Francisco
editions, published
each day of the show.
See you there!

By line

chairside techniques using direct
composite and indirect porcelain
restorations that are indistinguishable from natural tooth structure.
• Joseph J. Massad, DDS and
Walter F. Turbyfill, DMD
Dueling Dentures Match at
Ringside, Friday morning lecture,
9–11:30 a.m.
Each speaker will present several
cases utilizing different approaches
to treating the edentulous patient.
Learn from the two remaining
“giants” in removable prosthodontics.
Exquisite Complete and ImplantRetained Overdentures Calibrated
for the General Practitioner, Friday
afternoon lecture, 1–3:30 p.m.
This presentation by Dr. Massad
and Dr. Turbyfill will cover the
most important aspects of complete
removable dentures reloaded to
include implant-retained overdentures.
The Ultimate Prosthetic and
Implant Impressioning Experience,
Saturday workshop, 8:30 a.m.–12:30
p.m.
This participation course taught
by Massad and members of his
teaching team will allow each
attendee to learn and experience
the best methods for impressioning
of prosthetic patients for the complete, immediate denture and the
implant restoration overdenture.
• John D. West, DDS, MSD
21st Century Endodontics: What
AD
Every General Practitioner Should
Know, Saturday lecture, 10 a.m.–
12:30 p.m.; 2–4:30 p.m.
This program will provide you
with the knowledge, skill and
thought process to make endodontics the most enjoyable, energizing
and profitable procedure in your
treatment day.
Mastering Safe, Simple and Super
Efficient Endodontics, Sunday workshop, 8:30 a.m.–12:30 p.m.
This program by Dr. West teaches the clinical pearls of successful
endodontics. This highly popular
technical class is designed to have
you beaming with newfound endodontic freedom and to change your
endodontic experience forever.
• Edwin J. Zinman, DDS, JD
The ABCs of Informed Consent,
Thursday, 9:30 a.m.–12:30 p.m.
This lecture will illustrate how

informed consent principles should
be applied to periodontal therapies, such as the laser-assisted new
attachment procedure, and included as an integral aspect of a case
presentation. This is a corporate
forum sponsored by Millennium
Dental Technologies.
• David Gates, DDS
Invisalign Clear Essentials I, Saturday
This course is designed specifically for the general practitioner
and team members who wish to
incorporate the Invisalign system
into their practice. There is a $1,695
fee for this course. Tuition covers
the dentist and up to four team
members.

Things to buy
Meeting attendees will have the
opportunity to keep up with the
latest technology and trends in the
exhibit hall, which will feature
more than 400 exhibiting companies showcasing the latest in dental
products and services. You can stay
ahead of the curve by checking out
the new products being launched.
The exhibit halls are located on the
first and second levels.
The exhibit hall hours are as follows: Friday and Saturday, 9 a.m.–5
p.m.; Sunday, 9 a.m.–2 p.m.
A grand opening ceremony will
be held Friday at 9 a.m. Family
hours are daily from 9 to 11:30 a.m.
Also on the exhibit floor, be sure
to check out The Spot — a lounge
for learning, networking and fun.
This new interactive area is a place
to learn, network and have fun. At
The Spot, you can see new products, plan your office renovation,
check your e-mail or enjoy a cup of
coffee and relax with friends. You
can even earn C.E. credit!
The Spot is located on the second
level of Moscone West. Hours are
Friday and Saturday from 9 a.m.
to 5 p.m., and Sunday from 9 a.m.
to 2 p.m.

Things to do and see
For those who want to venture away
from the exhibition center, a number of special events are planned.
Highlights include the following:
• California Academy of Sciences
On Friday evening, a bus trip to
the California Academy of Sciences

DCDA
ental TMeeting
ribune | Month25A
2009
in Golden Gate Park is scheduled.
The excursion will offer participants the chance to explore a tropical rainforest, experience the penguins of the African Hall and watch
aquatic life in a coral reef exhibit.
Nearly 10 years and $500 million
in the making, this new academy is
billed as a masterpiece of sustainable architecture that blends seamlessly into the park’s natural setting.
It features hundreds of innovative
exhibits and thousands of extraordinary plants and animals.
To participate, gather at 6:15
p.m. in front of the Moscone West
Convention Center to load the
buses. Buses will depart at 6:30 p.m.
and will return beginning at 9 p.m.
Appetizers will be served. There is
a fee of $65 to participate.
• Sunday Brunch
8:30–10 a.m.
CDA is offering a Sunday morning brunch for members and their
staff. This special event featuring
delicious food will provide attendees the opportunity to socialize
with friends, colleagues and exhibitors. The exhibit hall will open
before C.E. courses begin, allowing
brunch attendees time to enjoy the
food and take advantage of Sundayonly exhibit floor specials.
The menu will include full
brunch, coffee and orange juice.
Get your tickets early. On-site tickets will be available on a limited
basis. Perhaps the best thing is the
price — just $5 per person.
• Children’s Program
Children 10 and younger are
only permitted on the exhibit floor
from 9–11:30 a.m. each day. To
give kids something to do during
other times, a children’s program
is being offered by KiddieCorp each
day at Parc 55 Hotel. Age-appropriate activities are selected for the
children who join them during the
meeting. For more information and
to register, visit kiddiecorp.com/
cdafallkids.htm.
• San Francisco
Of course, the city of San Francisco is famous for its scenic beauty,
cultural attractions, diverse communities and world-class cuisine. This very walkable city is
dotted with landmarks recognized
throughout the world: the Golden
Gate Bridge, cable cars, Alcatraz
and the largest Chinatown in the
United States.
A stroll of the city’s streets can
lead from Union Square to North
Beach to Fisherman’s Wharf,
with intriguing neighborhoods to
explore at every turn. Views of the
Pacific Ocean and San Francisco
Bay are often laced with fog, creating a romantic mood in this most
European of American cities.

For more information
Complete show schedules, registration information, evaluations,
archives of past events and timely
information about future events,
and exhibitors and speakers lists
are available from the CDA. For
more information, visit www.cda.
org/sf09. DT

[26] =>

26A Industry

Dental Tribune | August 2009

Collaborative software connects
dental professionals on a global scale
By Robin Goodman, Group Editor

At the end of June, Modulus Media
— a Toronto-based technology development and marketing company
— announced the release of www.
DentalCollab.com. Company founder
Shane Powell sat down for an interview to highlight what this unique
service has in store for the dental
community.
DentalCollab.com is a prime example of “cloud computing,” but what
does cloud computing mean?
We use cloud computing services all
the time, such as Twitter, Facebook,
SalesForce.com, LinkedIn. Dental
Collab.com is a software program that
runs on the Internet through your
Web browser. It doesn’t care whether
you are using a Mac or a PC, if you
are a technological wizard or a regular computer user. All you need is an
Internet connection. It simultaneously
scales to meet the demands of each
individual user, so you don’t have
to worry about costly software and
hardware upgrades. It’s all upgraded
automatically, and for free.
Can you trust this online “cloud”
with your information and, more
importantly, your patient’s information?
Just as you trust online banking with
your finances, FaceBook with your
personal information, and Gmail with
AD

your e-mail correspondence, Dental
Collab.com has built a security system
that protects your data. At rest or at
play, your data is being secured with
256-bit encryption — just like what
the banks use — 24/7 system monitoring and redundant storage. Yes, it’s
secure and yes, it can be trusted.
Why isn’t all of our day-to-day dental software running in the “cloud?”
Most dental software was built to run
directly on your personal computer.
This includes everything from your
word processing to your practice management software. You can imagine
that it’s not easy, or cheap, to “rewrite”
software to run in the “clouds,” also
known as the Internet.
The vast majority of dental professionals have been using their practice management software for years.
Because of this, there are massive
numbers of users that are ostensibly tied to their desktop computers.
What’s the ideal solution? It’s simple.
Continue using your desktop-based
software and use DentalCollab.com to
bridge your offline practice with the
online global dental community.
Significant examples of software
trending to the clouds include: Microsoft Office Live bringing its office
products into the online cloud; Google
Docs, its online office suite was the
catalyst for Microsoft to start bringing its office products into the online
clouds.

What about all the other programs
dentists are currently running on
their practice computers, does all
this have to be replaced?
DentalCollab.com doesn’t replace
your desktop software; it will extend
your reach. Dentalcollab.com actually caters to the practices that need
a collaboration tool, an online workspace, an information hub that can be
securely accessed and easily shared
online. Connect with your team, specialists, referrals, any other dental
professionals or groups of professionals from around the globe.
Most dental offices are using legacy software that does a great job of
managing their day-to-day practice,
but it ties them to their desktop computer. We all know it isn’t practical
to replace your practice management software; therefore DentalCol
lab.com acts as the intermediary,
intuitively extending the reach of
your offline applications, or “in the
clouds” as we say.
How exactly does DentalCollab.
com’s cloud computing service help
dental professionals?
Now that dental professionals know
that they can still use their existing
software, they can relax. DentalCol
lab.com is designed to be super easy to
use. Taking this approach, we offer a
much shorter learning curve to effectively collaborate online. It’s quick
and it’s easy to get started, and excep-

tionally versatile.
There are tremendous benefits
for enhancing patient care through
extending one’s expertise through a
professional network of local specialists, as well as dipping into the vast
global talent pool.
Benefits include: open up treatment
mentoring with industry experts worldwide; better manage your referrals by
inviting labs, specialists, etc.; request
second opinions, something insurance companies love; provide patients
with access to their treatment plans,
X-rays and follow-up information.
Can you tell us more about the
Treatment Workspace and how one
navigates around it?
Actually, think of it as your “collaborative” Treatment Workspace. It’s as
easy to use as a blog’s and wiki’s, but
with specific functionality built in for
dental professionals. Apart from the
intuitive interface, users also benefit
from sharing their workspaces with
other professionals within their network. This is where the magic begins
and you start connecting and really
working together.
How secure is DentalCollab.com?
Isn’t the information just “out
there” for anyone to grab?
The world’s information is being
transferred to the Internet. It’s alarming how much you can learn about
someone nowadays. We trust popu-

[27] =>

0A
Dental TRubric
ribune | August 2009

Headline
Deck
By line

lar online services such as Facebook,
SalesForce.com, Gmail, and Hotmail
without batting an eye. Compared to
DentalCollab.com, their data is less
secure.
We have built a closed network
around each user’s account. If you
don’t specifically invite people to
access a Treatment Workspace, they
can’t get in. It’s as simple as that.
How can DentalCollab.com actually save time and money?
Time savings is realized through

improved organization and better
communication
between
team
members, suppliers, referrals and
even sales representatives, thus
saving you time
and headaches.
Whether you
are learning new
procedures, training with new
instrumentation,
or sharing your
own
particular
expertise,
Den
talCollab.com is
perfectly suited for
learning and mentoring.
Enhanced
patient health has tremendous shortand long-term benefits for your practice. No longer are you limited to your
local specialist. With DentalCollab.
com you can access world-class opinion leaders to enable you to make the
best decision possible. A happy patient
means more referrals.
Your insurance company will love
you. Managing your second opinions
through your Treatment Workspace
means that you automatically maintain a secure history of all your collaborations. Think of it as record-keeping

Dental TIndustry
ribune | Month27A
2009
insurance that helps to protect you
against patient problems.
e-Consultations are becoming a
requirement as many patients have
less and less time. Common treatment planning and follow-ups can be
done over the Internet. Securely invite
patients to view their complete treatment plan past, present and future.
How is charting handled?
We’re enabling you to connect any of
your existing software with the online
DentalCollab.com network. Quickly upload, organize and share your
charts, X-rays, photos and all related
files. Once you start working with the
system, you won’t know how you did
without this fabulous resource tool.
So would you walk us through a
visit to the site and what a dentist
would see once he begins using Den
talCollab.com?
Once inside, you’ll see right away how
easy it is to create a patient file, create a new Treatment Workspace and
invite collaborators to join in.
1) Log-in to your account.
2) Manage Patients: As easy as filling out a form. Invite patients to view
their treatment information anytime.
3) Create Treatment Workspaces:
Upload X-rays and supporting files,
create treatment plans, set priorities
and organize your tasks between collaborators.

Shane
Powell,
founder of
Dental
Collab.com

4) Invite Collaborators: Invite office
staff, doctors, specialists, mentors,
sales support staff from manufacturers
and patients. Any of these invitationonly “treatment collaborators” can
review/edit treatment plans, provide
a second opinion or simply provide a
follow-up e-Consultation.
5) How to Manage Collaborators:
Revoke access at any time, subscribe
to daily, weekly, monthly reports and
schedule reminders.
DentalCollab has a solid developmental roadmap. Looking into the
future we see many opportunities for
extending our functionality. However,
it’s important that we develop in the
right places.
We welcome your feedback and
have set up a special offer. Enter code
“DTCLOUD” for one free month’s
access. You’ll see why we believe that
collaboration makes the world a better place.
Please visit DentalCollab.com or
e-mail sales@dentalcollab.com for
more information. DT
AD

Dentist Preferred. Patient Approved.
• STA provides confirmation when you’re in the right
location for the intraligamentary injection
• STA allows you to anesthetize one tooth
– no collateral numbness
• STA delivers profound anesthetic for 30-45 minutes

Stop waiting for the Block, start using the
STA intraligamentary injection as
your PRIMARY technique
and start working
immediately.

LEARN ABOUT CCLAD • Obtain 4 CE Credits FREE • At www.stais4u.com

The more comfortable injection for the dentist
is the MOST comfortable injection for the patient.

800.862.1125
www.stais4u.com

[28] =>

28A Industry

Dental Tribune | August 2009

Savalife M100: Save
time, money … and lives
Every year in the United States,
30,608 emergencies occur in dental offices, according to the American Dental Association. So that
they can respond when one of
them inevitably occurs in their
office, dentists must have an
appropriate emergency response
plan and appropriate emergency
response equipment to match.
Savalife’s Quick Response M100
emergency drug kit includes the
pre-filled syringes, sprays and
inhalants needed to quickly and
effectively treat common patient
emergencies, including those
related to angina, asthma, insulin
problems, allergic reactions, fainting, heart attacks and more.
As convenient as it is necessary,
the kit saves patients’ lives while
also saving dentists’ practices, as
appropriate emergency response
can reduce dentists’ exposure to
risk and liability.
What’s more, because the kit is
free when they sign up for Savalife’s Automatic Drug Refill Program, it allows dentists to invest
AD

their time and money where it
belongs — with their patients.
For more information or to
order, call (800) 933-5885 or visit
www.savalife.com. DT

BeautiBond by Shofu
Shofu recently introduced
BeautiBond™, a seventh-generation bonding agent with an exclusive chemistry, as the newest
addition to its family of restorative
materials.
BeautiBond’s unique dual adhesive monomers work independently to produce equal bond strengths
to both enamel and dentin. Available in convenient unit doses for
easy, one-step, one-coat application, BeautiBond has a low film
thickness of only 5 microns.
BeautiBond’s enhanced bond
strength rivals that of leading sixthgeneration adhesives, but with the
convenience of a seventh-generation material. The light-cure,
self-etching adhesive produces a
durable, reliable bond and is ideal
for a wide range of applications.
With excellent biocompatibility and bonding durability, BeautiBond is an all-in-one adhesive
that enables etching, priming and
bonding in one simple step.
Yet, with many dentists unsure
of advances in adhesive technology, Shofu and Dr. Howard Glazer
hope to clarify any questions with
a new technique video available
on Shofu’s Web site. Visit www.

shofu.com to view this informative
video and learn more about the
advantages of seventh-generation
bonding agents. Available to view,
download or share, the video provides useful technique tips.
In addition to the technique
video, Shofu offers a variety of other
resources, including a step-by-step
animation that is an easy and convenient way to learn more about
BeautiBond. Information about
interactive Webinars featuring key
opinion leaders, such as Dr. Mark
Latta, reviewing recent scientific
updates on bonding agents is also
available at www.shofu.com.
Another key opinion leader has
g DT page 29A

[29] =>

Dental Tribune | August 2009

Industry 29A
AD

Dentistry grown up:
utilizing sedation
to care for children
By Alex Harris & Michelle Hannah

While adults can be like children at the dentist,
the reverse is not true. There are many distinctions between adults and children when it comes
to dentistry. Failure to recognize these distinctions
can result in significant harm and even death.
Specific training in pediatric sedation is essential
for treating children.
Each child must be treated according to his or
her unique characteristics. Fears, age, weight,
medications, supplements and allergies are just a
few factors that must be considered. Special considerations should be made for children who are
autistic, hyperactive, obese, asthmatic or prone to
seizures.1 An understanding of pediatric anatomy,
physiology and psychology provides the framework for safe and effective sedation.
Using oral sedatives and/or nitrous oxide to
properly sedate children can not only be effective
for the procedure at hand, but can help lay the
foundation for lifelong comfort with the dentist.
Even older pediatric patients who have previously
had negative experiences are able to develop new
comfort and resolve dental anxiety.
Fear of needles (belonephobia) and other dental-related fears often begin in childhood. Even
very young children can be emotionally scarred by
a painful dental experience. Though these young
children may be unable to understand why they
are experiencing pain, the cognitive association is
formed and a lifelong fear develops.1
Oral sedation can help resolve these issues.
Tense moments of fear and strain transform into
a relaxed calm. The calm presents the opportunity
to complete more high-quality dentistry in less
time, creating better patient comfort and more
practice profitability.
Sedation is not only a tool to help anxious
patients, it can also increase patient safety. A
squirming child afraid of the dentist and the sharp
metal instruments used is a recipe for disaster.
However, when properly sedated, a child’s procedures can be completed quickly and safely.
Isolated cases of health emergencies represent
a small possibility that dentists should be prepared
for.2 Acidosis and cellular death develop much
more rapidly in children during cardiac arrest as
they lack the oxygen reservoir that adults have
in their tissues and blood. The cells in a child’s
heart die quickly, and thus timing is of the utmost
importance.2 A dentist must know how to immediately and properly act in a medical emergency
should one occur.
Proper training in pediatric oral sedation, anatomy and the psychology of children can be found
at the Pediatric Oral Sedation Dentistry course
offered by DOCS Education. The course teaches
safe, effective and predictable oral sedation techniques, as well as safety procedures specific to
children. The differences between children and
adults are immense. Proper knowledge and preg DT page 30A

f DT page 28A
also weighed in on BeautiBond. Dr. George Freedman reviewed BeautiBond recently in his “First
Impressions” column. BeautiBond will also be
discussed in upcoming lectures by both Dr. Freedman and Dr. Glazer at the upcoming ADA meeting
and the Greater New York Dental Meeting this
fall. DT

TK DT

[30] =>

30A Industry

Dental Tribune | August 2009

Medidenta now offers
refining and waste disposal
With 65-plus years and counting,
the company Medidenta has truly
withstood the test of time and earned
the trust of dental professionals
around the world.
The company has recently acquired
a precious metal refining and waste
disposal operation, which will now
provide the entire dental community
a service that will be unsurpassed in
integrity and value, bar none.
Since 1944, Medidenta has
morphed into a boutique of dental
products where it dares to be different.
Some of its products from the
1940s included copper bands, prefabricated jacket crowns and posts
that sold for 15 cents each. And yes,
the original product line even included Karat, a pure gold filling material,
not to mention genuine silver points
for root canal obturation, which in
fact was the endodontic standard of
care in the ’50s and ’60s.
Some of these items can be viewed
on the “Nostalgia” section on the
company’s Web site, www.medidenta.com. Medidenta’s product line
has been synonymous with value
because of “direct to the dentist”
pricing.
The company’s most significant
breakthrough came in 1969 when
Medidenta introduced the Giromatic®, the first automated device
for root canal therapy; however, its
start was with precious metals used
in dental appliances and root canal
therapy.
In July 2007, Robert Achtziger,
an employee of Medidenta since
1973, became the sole owner, president and CEO. He has implemented
many changes, from streamlining
and improving customer service to
increasing the research and develpment budget, which will result in
some major dental product introductions in the coming months.
Through personal hobbies and
friends, Achtziger has developed a
deep-rooted commitment to environmental issues facing our world.
“Precious metals are a natural
resource of our Earth. Our planet
has indeed experienced significant
advances in technology, but not without a price because our environment
AD

amount within a week. As a bonus,
the practitioner will receive valuable
discount coupons for other products
listed in the Medidenta catalog.

In-office amalgam separator
The BOSS Amalgam Separator offers
up to three years of safety, convenience, simplicity and environmental compliance for the ultimate protection for the entire dental office.

Dental waste
Medidenta is a family-run company
with a 65-year history.
is exhausting and neglecting its natural resources, and this will take an
effort by all to save and conserve our
natural resources for future generations,” Achtziger said.
While some corporations have
only just begun to initiate conservation and recycling procedures, Medidenta has already integrated these
measures in its daily business operations, knowing it’s extremely desirous to implement environmentally
conscious changes within the dental
community it has served since 1946.
As mentioned, Medidenta is
announcing it has acquired a refining and waste disposal operation that
will now be integrated into Medidenta’s respected product and service line.
This division will encourage recycling and create initiatives, internally
and externally, that are kinder to
the environment and enable dental
offices to earn top dollar on precious
metal scraps that are refined and
recycled.
When Achtziger was asked, “Why
refining and precious metals and
recycling?” his response was, “Some
of Medidenta’s roots are with precious metals, and the overwhelming
majority of our product line is, in fact,
recyclable so this was a natural fit
for us.” Thus, Medidenta is currently
offering some new services.

Refining precious metal scrap
Medidenta can now smelt and
assay scrap to determine the precious metal content, and pay the
dental professional the highest dollar

Dental offices can now forget about
expensive long-term contracts for
disposal of dental waste. The company’s Sharps PLUS system is very
easy: Fill it. Seal it. Ship it! Everything is included, including the tape,
at a substantial savings.

Why Medidenta?
In an era of financial uncertainty and
mistrust of public conglomerates,
dental professionals have a trusted
name like Medidenta.
This family-run company that has
served the profession for more than
65 years can now recycle products
and facilitate their scrap and waste.
This service offers a profit center for
the entire staff because even old jewelry can be turned into instant cash!
Medidenta is the home for direct
pricing and huge incentives. Take
advantage of Medidenta’s refining
service and qualify for a bonus 10
percent off products, including current incentive programs available at
www.medidental.com.

Customer satisfaction is
Medidenta’s main priority
The company wants your www.medidenta.com experience to be rewarding and pleasant. The Web site
allows you to explore in more detail
the new refining and recycling services and browse the general product catalog filled with time-saving,
cost-effective products used in your
everyday practice.
You can browse the Web site 24/7,
and the company looks forward to
serving all your needs today, tomorrow and well into the future. DT

Mojo Veneer Cement
shifts confidence,
not shade
Give your patients their mojo
back with the cement that leaves
shade shift behind and helps you
create a seamless, natural-looking
smile. Pentron recently introduced
Mojo™ Veneer Cement, the latest in
adhesive technology from Pentron
Clinical.
Mojo Cement is a light cure,
esthetic cementation system that is
designed for use with porcelain,
ceramic and composite veneer restorations. This ideal cement offers
two very important features: tryin gels that consistently match the
polymerized cement and no detectable shade shift.
The simple, highly versatile
shade selections designed for a simple warming or brightening of the
veneer allow this material to be used
with a wide range of veneer cases,
while offering the least amount of
detectable shade shift available.*
The corresponding water soluble
try-in gels, included in the comprehensive kit, allow for a perfect
match to the cured cement. Mojo
Cement lets you give your patients
the self confidence they deserve.
Pentron Clinical is an established leader in the dental industry,
offering a wide variety of products
to suit your restorative needs. As
a pioneer of dental adhesive technologies, Pentron Clinical continues
to demonstrate its commitment to
advancing dentistry one innovation
at a time.
The company’s portfolio of trusted, quality dental products includes:
Fusio™ Liquid Dentin, Breeze®
self-adhesive resin cement, Lute-It
g DT page 31A

f DT page 29A
cautions cannot be ignored. A dentist should not assume that sedation
procedures are consistent across the board regardless of patient age. The
uniqueness of children demands proper education and training to protect
the interests of dentist and patient alike.
To learn more about pediatric oral sedation and DOCS Education’s
Pediatric Oral Sedation Dentistry course, visit DOCSeducation.org or call
(866) 592-9617. DT
1.

Dionne, R. et al. (2006). Balancing efficacy and safety in the use of oral sedation in dental outpatients. The Journal of the American Dental Association, Vol.
137(4). Retrieved from: jada.ada.org/cgi/content/full/137/4/502.
Malamed, Stanley F. (2004). Emergency medicine in pediatric dentistry: preparation and management. Oral Health, 94(2), 37–46. Retrieved July 9, 2009, from
CBCA Reference. (Document ID: 566438011).

[31] =>

Industry 31A

Dental Tribune | August 2009

tk tk
tk

tk
tk

PhotoMed
flash
brackets
This is an advance preview of
the R2 dual point flash bracket. The
original R1 bracket was designed to
allow the Nikon R1 macro flash to be
better positioned near the end of the
lens for intraoral views.
As an added benefit, the flash
heads could be positioned out to
the side for better anterior esthetic
photographs. The only downside
was that flash position adjustments
required you to set the camera down
and use two hands.
The soon-to-be-released R2 flash
bracket allows adjustments “on the
fly” with only one hand. Bring the
flashes in close to the lens for intraoral views or spread them out to the
side. The pivot joints are designed
for quick positioning and will hold
the flashes where you want them.
The bracket attaches to the camera tripod socket and does not cover
the battery door or interfere with
lens focusing.
The R2 bracket will hopefully be
available this month. If you would
like to be contacted when it is available, please send the company an
e-mail. DT

PhotoMed International
14141 Covello St., #7C
Van Nuys, Calif. 91405
Tel.: (800) 998-7765
Web: www.photomed.net
E-mail: info@photomed.net

f DT page 30A
Luting Cement, FibreKleer® Posts,
Bond-1® SF Solvent Free SE Adhesive, Correct Plus® impression materials and Artiste® Nano Composite.
For more information visit the
Web site, www.pentron.com, or call
(203) 265-7397. DT
* when compared to leading materials

Dentist helps girl with health challenges
By Fred Michmershuizen, Online Editor

Sometimes dental treatment can
be a matter of life or death. Just ask
Dr. Brian Nylaan of Grand Rapids,
Mich., who recently used his skill,
expertise and compassion — plus an
invaluable piece of equipment — to
treat a special patient with unique
needs.
Born with spina bifida, Catherine
had been neglected. By the time the
11-year-old wound up in foster care,
her internal organs were dangerously compressed. Her condition had
become so dire that doctors feared
she would not survive unless they
could perform surgery. But before
they would operate, the surgeons
insisted Catherine’s numerous dental
infections be treated.
The problem was that Catherine,
who had been heavily traumatized
her whole life, would not let anyone
near her mouth even for a cleaning,
let alone for extractions or fillings.
With no dental treatment there would
be no surgery, and with no surgery
she faced risk of death.
Luckily for Catherine, she was in
good hands with a compassionate
dentist. Nylaan, who knew that anything painful would be out of the
question, first had his senior hygienists take all the time they needed to
clean her teeth. Upon examination,

Catherine
received
treatment
with the
STA
System by
Milestone
Scientific.

he found several teeth that needed
to be extracted. Knowing that a traditional mandibular block injection was
out of the question, Nylaan used the
Single Tooth Anesthesia (STA) system
from Milestone Scientific to keep his
patient comfortable.
“I had one thing going for me
— one of her teeth was starting to
hurt,” Nylaan told Dental Tribune.
“So I looked at her, I got down on my
knees, and I said, ‘I have this “nummy
pen” here. It makes sounds and you
will hear 10 bells. As I continued to
work, she became more cooperative
and the look on her face started to
change a little bit.”
He was able to remove seven teeth
for Catherine, who went on to receive
the spinal surgery. It was a success,
and today Catherine is much happier
and healthier. Because she loves animals, she plans to someday become a
veterinary assistant.

It was a pleasing outcome for Dr.
Nylaan, who sees his role as a dentist
not only to treat teeth, but to help his
patients with their overall health.
“I would not have been able to
treat Catherine without the ability
to go in and numb up her teeth like
I did,” Nylaan said. “This machine
really saved this kid’s life.”
With its STA System, Milestone
Scientific is changing the way local
anesthesia is being delivered today.
STA allows a dentist to perform all of
the traditional injections that can be
performed with a hand-held syringe,
but in a superior manner, said Dr.
Mark Hochman, who shares in the
responsibility for inventing much of
the technology currently available
from Milestone Scientific.
The Dynamic Pressure Sensing
(DPS) technology used by the STA
System allows the dentist to precisely
and accurately control and monitor
needle pressure during an injection.
The system provides continuous visual and audio feedback, so the dentist
can optimize the rate of drug delivery.
“It makes your excellent dentistry
become an excellent experience for
the patient, from the very beginning
to the very end of the procedure,”
Hochman said.
“You can anesthetize a single tooth
in the mandible with instant onset,”
Hochman said. DT

Henry Schein exclusive distributor for Dentatus narrow body
implants in North America, Australia and New Zealand
Agreement expands Henry Schein’s offering to cover full breadth of dental implants
Henry Schein (NASDAQ:HSIC),
the largest distributor of health care
products and services to office-based
practitioners, and Dentatus, an innovative designer and manufacturer of
precision high-tech dental products,
recently announced a five-year agreement establishing Henry Schein as
the exclusive distributor of the Dentatus Atlas narrow body implant system
in North America, Australia and New
Zealand. Through this agreement,
Henry Schein will now be able to offer
dental practitioners the full breadth of
dental implants.
“In this important and growing
market, the Dentatus Atlas system
stands apart and is distinctly different
from other systems, with clear benefits
that shorten healing time and increase
patient comfort,” said Stanley Bergman, chairman and CEO of Henry
Schein.
“In North America alone, we estimate the edentulous population who
could benefit from this technology to
be approximately 50 million people,
with projected 6 million new edentulous patients per year. We look forward to working closely with Dentatus
to offer these important new products
to our North American, Australian and
New Zealand dental customers.”
The Dentatus Atlas implants sur-

rounded with the Tuf-Link Resilient
Denture liner provides secure retention and cushioned patient comfort.
The implant’s low profile eliminates
the need to drastically reduce the
denture, and its small diameter
allows placement where significant
bone loss has occurred without bone
augmentation.
The Atlas flapless surgical procedure, which is significantly less expensive than a conventional implant procedure, shortens healing time and
reduces discomfort.
The procedure requires no surgical incision and no sutures — both
of which are typical for wider, more
conventional implants — and it can be
performed using only local anesthesia
in the general dentist’s office in just 45
to 60 minutes.
The patient can walk out of the
office wearing his or her refitted denture right away.
With Dentatus Atlas implants, denture wearers of any age can experience healthier and better looking
smiles with comfortable and fully
functioning dentures. After undergoing the procedure, patients are able
to keep their dentures in place while
sleeping, brush them in the morning
and treat them like natural teeth.
Dentures can be easily removed and

reseated without any stress.
Patients are able
to laugh, smile,
maintain a nutritious diet and
eat their favorite
foods with confidence.
Dentatus Atlas
implants provide
patients with substantial relief from the pain and discomfort they previously endured with
ill-fitting dentures, while stimulating
the jawbone so less bone is lost. Dentures fit more comfortably and properly support facial features that may
have been previously lost, enhancing a
patient’s self esteem.
“In Henry Schein, we believe that
we have found a sophisticated distribution partner that can compellingly
communicate the significant benefits
of the Dentatus Atlas system to dental practitioners,” said Bernard Weissman, president of Dentatus USA.
“The company’s track record of
success in growing technology-driven
products is impressive, and we look
forward to a close collaboration that
will strengthen the position of this
innovative implant system in these
important markets.” DT

[32] =>

[33] =>

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

August 2009

www.dental-tribune.com

Vol. 2, No. 6

Shading technique in direct esthetic restorations
By Sushil Koirala, Nepal

Natural teeth are complex in structure and difficult to imitate because
many colours are distributed through
the enamel and dentin.1 The structural components of teeth — enamel,
dentin and pulp — have different
characteristics that greatly influence
their optical properties.2
It is well accepted that the colour
of a tooth is basically determined by
its dentin component.3
Dentin represents the opaque and
complex core — rich in hue, chroma
and fluorescence — and is covered by
an enamel shell, which is translucent
and opalescent.
This diversity, and the alteration
between enamel and dentin, explain
the unique and individual nature of
the appearance of a natural tooth.
The result achieved by applying
clear and translucent material (similar to enamel) over a saturated and
opaque material (similar to dentin)
has been described as the “double
effect layer.”3
Clinically, it is very important
to have a detailed examination of
colour, opacity, translucency, texture,
surface gloss and the presence of
any special characterization, such as
hypo-calcification, stain crack, etc., of
the tooth in need of restoration.
The detailed study of these components and colour mapping are quite
helpful in choosing the appropriate
restorative materials and shading
technique.
There are two shading techniques
commonly used in direct aesthetic
restorations: the blended shading
technique and the layered shading
technique.
Blended shading technique
In this shading technique, also known
as the traditional shading method,
two or more shaded restorative materials might be used to match the real
shade of a tooth in different regions
(Fig. 1).
Restorative materials with different chroma are used and blended
together with overlapping surfaces to
create the desired effect. The “double
effect layer” concept is not applied in
this technique.4

Fig. 1: Blended shading technique.

Fig. 2: Layered shading technique.

Fig. 3a: White spots on teeth #11 and
21.

Fig. 3c: Selective grinding of white
spot.

Fig. 3d: Application of enamel shade.

Fig. 3e: After finishing and polishing.

Fig. 4a: Cervical abrasion on teeth
#23, 24 and 25.

Fig. 4b: Bi-layered shading technique.

Fig. 4c: Application of dentin shade.

Fig. 4d: Application of enamel shade.

Fig. 4e: After finishing and polishing.

Fig. 3b: Mono-layered shading
technique.

Layered shading technique
This technique, also known as the
natural shading technique, is based
upon the anatomic and optical characteristic of the natural teeth and
emphasises the importance of using
materials specifically designed to
emulate the dentin and enamel layer
g CT page 3B

[34] =>

News

Cosmetic Tribune | August 2009

Six steps to a whiter smile
By Fred Michmershuizen, Online Editor

For your patients, having a whiter
smile may be as easy as changing
their behavior when shopping for
foods at the supermarket. Just ask
the folks at the American Academy
of Cosmetic Dentistry (AACD), who
point out that what a person eats and
drinks makes a huge difference in
the quality of a smile.
According to a recent poll conducted by the AACD, there is nothing
that can ruin a smile more than discolored teeth. What’s more, whitening treatments are the No. 1 requested cosmetic dental procedure and
have increased in popularity more
than 300 percent since 1996.
But a whiter smile doesn’t have to
involve expensive or uncomfortable
procedures.
“While daily home care and regular professional cleanings are essential for maintaining healthy teeth
and gums, certain foods can help
remove stains from your teeth,” said
AACD President Dr. Marty Zase.
“Foods such as apples, pears, celery,
carrots, cauliflower and cucumbers
produce saliva that combines with
the foods’ natural fibers to naturally
AD

clean teeth and remove bacteria.”
Specifically, the AACD recommends the following six steps when
it comes to having a whiter smile:
1) Eat strawberries. Believe it or
not, strawberries will naturally whiten your teeth. Yum!
2) Steer clear of Starbucks. Sorry,
but coffee — along with sodas, red
wine and even blueberries — will
stain teeth quickly, according to the
AACD. (But if you must partake,
the next two items will help limit
stains.)
3) Use a straw. For those who
cannot resist teeth-staining beverages, it is wise to drink from a straw
whenever possible. Doing so allows
food dyes to bypass teeth altogether.
4) Brush with baking soda. Sodium bicarbonate — also known as
baking soda — will work wonders.
The AACD recommends brushing
with baking soda twice a month, just
as you would with toothpaste.
5) Be like Roger Rabbit. Raw vegetables are not only healthy to eat,
but they will clean your teeth and
remove surface stains. So be sure
to stock up on lots of carrots, celery
and radishes when you visit the
supermarket.

COSMETIC TRIBUNE
The World’s Dental Newspaper · US 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
Group Editor & Designer
Robin Goodman
r.goodman@dtamerica.com
Editor in Chief Cosmetic Tribune
Dr. Lorin Berland
d.berland@dtamerica.com

6) Chew gum. The mechanical
action of chewing gum (sugarless,
of course!) can also stimulate saliva
and clean teeth surfaces. One caveat: gum is not recommended for
patients with TMJ.
The AACD is dedicated to advancing excellence in the art and science
of cosmetic dentistry, and it invites
consumers to locate a member cosmetic dentist via its free consumer
referral system at www.aacd.com or
by calling (800) 543-9220. CT

A great smile
makes you appear
smarter, more
successful
It’s no surprise that an improved
smile can make a person appear
more intelligent, successful and
attractive. Research conducted by
Chicago-based Beall Research &
Training, on behalf of the American Academy of Cosmetic Dentistry
(AACD), backs that up.
Dr. Anne Beall, a social psychologist and market research professional, carried out the independent
study for the AACD.
Pictures of individuals before and
after undergoing cosmetic dentistry
procedures were shown to more
than 500 Americans, a statistically
valid cross section of the population.
The respondents were asked to
quickly judge their impressions of
the people in the pictures.
Those with improved smiles were
rated more attractive, intelligent,
happy, successful in their career,
friendly, interesting, kind, wealthy,
popular with the opposite sex and
sensitive to other people.
“We’ve been telling people that a
beautiful smile was a great investment in their futures. Now we have
independent evidence,” said Dr.
Marty Zase, president of the AACD.
Perhaps what’s most interesting
is that the respondents were not told
that the study had anything to do
with dentistry. CT

(Source: AACD)

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
Sales & Marketing Assistant
Lorrie Young
l.young@dtamerica.com
C.E. Manager
Julia E. Wehkamp
E-mail: j.wehkamp@dtamerica.com

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

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

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

[35] =>

Clinical

Cosmetic Tribune | August 2009

f CT page 1B

Fig. 5a: Non-vital and discoloured
teeth #11, 21 and 22.

Fig. 5c: Application of opaque (flowable) shade to mask discolouration.

Fig. 5d: Application of final enamel
shade.

Fig. 5b: Tri-layered shading technique.

Fig. 5e: After finishing and polishing.

Fig. 6a: Fractured teeth #11 and 21.

Fig. 6b: Complex bi-layered shading
technique.

Fig. 6c: Creating a flowable frame
using translucent enamel.

Fig. 6d: Flowable frame after curing.

Fig. 6e: Application of white tint
after dentin shade.

Fig. 6f: Application of final enamel
shade.

Fig. 6g: After finishing and polishing.

of the natural teeth.
This technique involves the correct selection of a dentin and enamel
group of materials with their layerby-layer arrangement (Fig. 2).1 An
opaque and effect group of materials
is also used during the layering procedure to achieve the desired tooth
characterisation.
Various concepts of layered shading techniques — e.g., basic, classic,
modern and trendy — are used in
direct aesthetic restorations.
Each of these concepts is based
on the specific arrangement of the
two or three layers of the restorative
materials usually needed for large
Class III and Class IV restorations or
incisal buildups.
None of the above concepts mention single- or mono-layering techniques, which are frequently used in
aesthetic dentistry.
These concepts are hard to understand, not comprehensive and also

do not explain the clinical use of a
special opaque group of materials.
Hence, the layering techniques may
be better classified as follows.4

sion. As opaque materials are used,
proper shade selection and thickness
of the dentin and enamel layers are
critical to achieve an aesthetically
successful result (Figs. 5a–e).

achieving successful aesthetic restorations.
The new concept of classification of layered shading techniques
is simple to understand and easy to
remember as the name itself suggests the required number of the layers and various groups of restorative
materials necessary to restore the
tooth defects.
This classification also helps clinicians to imagine and understand
the aesthetic complexity of restorations. CT

Mono-layered shading technique
This is a very common and simple
layering technique using only one
group of materials, either dentin or
enamel shade, to restore the defective natural tooth (Figs. 3a–e).
Bi-layered shading technique
This technique demands a higher
level of clinical skill than in monolayering as it uses both the dentin
and enamel group of the materials
during restoration (Figs. 4a–e).
Tri-layered shading technique
This is the advanced level of layering
technique where dentin, enamel and
opaque materials are used in combination to mask the dark tooth discolouration or to block light transmis-

Complex-layered shading
technique
Any layered shading technique that
requires special effect materials (tint,
stain) during the restorative process is classified under the complex
category of this particular layered
shading technique. In this category,
the effect group of the materials is
normally used in between dentin
and enamel layers of the natural or
restorative layers of the restoration
(Figs. 6a–g).
Conclusion
We rarely use the blended shading
technique in modern aesthetic dentistry because the layered shading
techniques are more predictable in

Editorial Note: A list of references is
available from the publisher.

Contact info
Dr. Sushil Koirala is president of
the Vedic Institute of Smile Aesthetics (VISA). He can be reached at
skoirala@wlink.com.np.

[36] =>

[37] =>

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

August 2009

www.dental-tribune.com

Vol. 2, No. 6

Adding fluoride varnish
to your armamentarium
By Anita Roth, RDH, BSDH

Dental caries is an infection, and
the most common chronic childhood
disease. It is still a major public
health problem.1 About 28 percent of
the children between the ages of 1
and 5 are affected by early childhood
caries.2
About 90 percent of adults olderthan 40 are affected by caries, and
one fourth of adults older than 60 are
edentulous.1 In adults older than 70,
studies have showed an increased
risk of caries. The cause of this is
due to increased medication that
causes xerostomia and a decrease in
salivary flow.1
Some causes of dental sensitivity are the exposure of dentin due
to recession, abrasion, erosion and
periodontal therapy.
Adults with dental sensitivity, due
to exposed dentin, account for 20
to 30 percent of cases in the United
States.
When the dentin is exposed to
stimuli such as cold, hot, mechanical
(a toothbrush) or chemical (a rinse),
a painful response occurs.3
Fluoride varnishes have been
used in Europe, Canada and Scandinavian countries since the 1980s,
but are relatively new to the United
States.4
The Food and Drug Administration (FDA) approve fluoride varnishes for treating sensitive teeth and
use as a cavity liner.4

To control or reduce caries, application of fluoride varnish should occur
two times a year for two years.
The recommendation is every
three months for individuals at a
higher risk for caries. The right
amount and time interval for fluoride varnishes have not yet been
established.5

What is it? How does it work?
Fluoride varnish is a highly concentrated form of fluoride, which is
applied to the tooth’s surface as a
type of fluoride treatment.5 Fluoride
varnish adheres to the tooth structure for a longer period of time than
any other fluoride treatment.
Most fluoride varnishes contain 5
percent sodium fluoride in a colophony/resin base. Also, in most states,
health care professionals must apply
the fluoride varnish.5
Fluoride varnish works by intensifying the amount of fluoride in
the superficial exterior of the tooth.
This increases the absorption of
fluoride in the early phase of demineralization.5
The fluoride varnish is in contact with the tooth structure for
up to seven days. This is a longer
period of time that allows a greater
amount of fluoride to be deposited
on the tooth surface and work more

effectively during the early stages of
demineralization.5
Application procedure
It is recommended, but not required,
that a prophylaxis be performed. A
toothbrush, gauze or cotton roll may
be used as well. Excess moisture
may be removed with cotton rolls or
gauze. The varnish will stick to the
tooth surface with some moisture
present.
A thin layer of varnish is painted
on the tooth as per manufacturers
direction (0.5 ml). A thin brush or
single dose applicator may be used.
The varnish will set when in contact with the saliva. To spread the
varnish in between the teeth, dental
floss can be used interproximally.
So the fluoride varnish does not
come off prematurely, the patient is
instructed not to brush until a four to
six hour interval is over and to avoid
hot or alcoholic beverages or foods.2

Advantages/disadvantages
Fluoride varnishes are available in
various flavors for younger patients
and do not have a bitter taste. The
application is easy and the fluoride
varnish sets quickly in the presence
of salvia.
They are good for patients with
a gag reflex and require minimal
equipment set up. Fluoride varnishes are considered safe due to the
small amount of varnish used and
the quick set time.
Some fluoride varnishes can leave
a temporary yellow discoloration of
the teeth for about 24 to 48 hours.
Indications
Fluoride varnishes may be used on
children younger than 5 years old
who are at moderate to high risk of
caries. They serve as a desensitizing
and caries prevention agent for root
surfaces as well as a cavity varnish.
They are also utilized around
orthodontic bands and for people
who might swallow fluoride. They
g HT page 3C

Top 10 causes of tooth discoloration
By Fred Michmershuizen, Online Editor

Your job as a dental hygienist is to
help your patients maintain healthy
teeth and gums. They also want to
leave your chair with whiter teeth —
in fact the whiter the better. Nobody
wants discolored, dirty-looking teeth.
As you know, the causes of tooth
discoloration are many and varied.
Some factors can be reduced by
changes in patient behavior, while
others causes are beyond the control
of the patient.
A recent article at WebMD.com
pointed out the top 10 culprits of

tooth discoloration. Here they are:
1. Food and drink. Coffee, tea,
carbonated beverages and red wine
can discolor teeth. Even certain fruits
and vegetables can cause stains.
2. Tobacco products. Smoking or
chewing tobacco can stain teeth.
3. Inadequate brushing and flossing. If a patient doesn’t brush and
floss regularly, it is more likely that
plaque and stain-producing substances such as coffee and tobacco
will cause tooth discoloration.
4. Disease. Several diseases that
affect enamel and dentin can lead
to tooth discoloration. Treatments

for certain conditions can also affect
tooth color. For example, head and
neck radiation and chemotherapy
can cause teeth discoloration. In
addition, certain infections in pregnant mothers can cause tooth discoloration in the infant by affecting
enamel development.
5. Medications. The antibiotics tetracycline and doxycycline are known
to discolor teeth when given to children whose teeth are still developing
(before the age of 8). Mouth rinses
and washes containing chlorhexidine and cetylpyridinium chloride
can also stain teeth. Antihistamines

(such as Benadryl), antipsychotic
drugs and drugs for high blood pressure also cause teeth discoloration.
6. Certain dental materials. Some
of the materials used in dentistry,
such as amalgam restoration, especially silver sulfide-containing materials, can cast a gray-black color to
teeth.
7. Advancing age. As a person
ages, the outer layer of enamel on his
or her teeth gets worn away, revealing the natural yellow color of dentin.
8. Genetics. Some people simply
g HT page 2C

[38] =>

News

Hygiene Tribune | August 2009

HYGIENE TRIBUNE

f HT page 1C
have naturally brighter or thicker
enamel than others.
9. Environment. Excessive fluoride, either from environmental
sources like naturally high fluoride
levels in water, or from excessive
use, such as fluoride applications,
rinses, toothpaste and fluoride supplements taken by mouth, can cause
teeth discoloration.
10. Trauma. Damage from a fall
can disturb enamel formation in
young children whose teeth are still
developing. Trauma can also cause
discoloration to adult teeth.
Some of these factors can’t be
controlled, but others can be. By
encouraging your patients to make
a few simple lifestyle changes, you
may be able to help them prevent
P&F Ad-DTA

1/14/09

2:45 PM

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

discoloration of their pearly whites.
Coffee drinkers or smokers might be
persuaded to cut back or quit altogether. And of course, it never hurts
to remind your patients that brush-

Page 1

ing and flossing regularly will make
their next trip to see you result in
much less scraping and polishing. HT
(Source: WebMD)

Editor in Chief Hygiene Tribune
Angie Stone RDH, BS
a.stone@dtamerica.com
Managing Editor/Designer
Implant Tribunes & 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
Sales & Marketing Assistant
Lorrie Young
l.young@dtamerica.com
C.E. Manager
Julia E. Wehkamp
E-mail: j.wehkamp@dtamerica.com

Dental Tribune America, LLC
213 West 35th Street, Suite 801
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.

Contains no
Bisphenol A
If you’re one of the 1,000s of dental professionals who know
EMBRACE™ WetBond Pit & Fissure Sealant is easier to apply
because it bonds to moist tooth surfaces, provides a better seal and
is long lasting, you’re on top of your profession.
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

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!

For technical information
contact Pulpdent at

800-343-4342
Order through your dental dealer.

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

✔ Long lasting
■
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*Contact Pulpdent for study.

PULPDENT

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pulpdent@pulpdent.com • www.pulpdent.com

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[39] =>

Clinical

Hygiene Tribune | August 2009
f HT page 1C
cannot be used in areas of obvious decay, when the patient is
concerned about discoloration or
in patients with low risk of caries.
According to a recent study, fluoride
varnishes were shown to be 14 times
more successful than fluoride gels.1
What’s available?
The following companies offer fluoride varnish products.
• AllSolutions* (5 percent NaF in
a natural resin), available in a unitdose with an applicator. Dentsply
Professional. Phone: (800) 989-8826;
Web site www.dentsply.com.
• Cavity Shield (5 percent NaF in
a natural colophonium resin), available in a unit-dose with an applicator. Omni Products. Phone: (800)
445-3386; Web site: www.omniphar
ma.com.
• Durafluor (5 percent NaF in a
natural colophonium resin). Medicom. Phone: (800) 435-9267; Web
site www.medicom.com.
• Duraphat** (5 percent NaF in a
natural colophonium resin). Colgate
Oral Pharmaceuticals. Phone: (800)
2-COLGATE (800) 225-3756; Web
site www.colgateprofessional.com.
• Fluor-Protector (0.1 percent
difluorosilane in a polyurethane
base). Ivoclar Vivadent North Amer-

ica. Phone: (800) 327-4688, Web site
www.ivoclarvivadent.us.
• Varnish America (5 percent NaF
in a natural colophonium resin),
available in a unit-dose with an
applicator. Medical Products Laboratories, Inc. Phone: (800) 523-0191,
ext. 326; Web site www.medical
productslaboratories.com.
• ClearShield (5 percent sodium
fluoride) Zenith Dental. Phone:
(800) 662-6383; Web site www.zenith
dental.com/clearshield.
Conclusion
Fluoride varnish is advantageous
for children, adults and the elderly
who are at a higher risk for tooth
decay and for those who experience
dental sensitivity. Fluoride varnish
has helped contribute to improved
dental health and comfort.
Fluoride varnish should be added
to the practitioner’s toolbox to protect teeth and improve overall
health. In addition, fluoride varnishes can be utilized outside of the dental office in medical and community
programs, and has been shown to be
the best treatment due to the length
of time it adheres to the tooth structure. HT
References
1. Dais A. Joyce RDH, BA, MPH,
MSEd. Fluoride Facts. Dimen-

sions of Dental Hygiene.
www.dimensionsofdent
alhygiene.com/ddhright.
aspx?id=1173&terms=fluoride.
Accessed January 2009.
Hayes J. Mary, DDS, MS. Are you
using fluoride varnish? www.
wdjournal.com/articles/print.
html?id=322316&bPool=DE.pen
net.com%2fWDjarticle_tool_bar.
Accessed January 2009.
Radjenovich Donna, RDH,
BS.
Fluoride
varnish
to
the rescue. www.wdjourn
al.com/articles/print.
html?id=196790&bPool=DE.

pennnet.com%2fWDjarticle_
tool_bar. Accessed January
2009.
Lin Jenn-Yih, DDS, MS & Berg
H. Joel, DDS, MS. Going off
label. www.dimensionsofdent
alhygiene.com/ddhright.aspx?i
d=539&terms=fluoride+varnish.
Accessed January 2009.
www.kdheks.gov/ohi/down
load/Flvarnishpaper.pdf.
Accessed January 2009.
* AllSolutions is now called NUPRO.
** Colgate has a new product available
called PreviDent Varnish.

About the author

Anita Roth graduated from
the dental hygiene program
at Hudson Valley Community
College in Troy, N.Y., in 1986
and completed her bachelor’s

degree in dental hygiene, from
State University of New York at
Farmingdale in May 2009. She
is currently participating in a
research program on periodontal disease at Stony Brook University.
Roth is a member of the
American Dental Hygienist
Association and was given the
Poster Presentation Award at
the April 18, 2008, Conference
of Science, Health, Engineering
and Technology.
For more information, questions or comments, contact Roth
at anitaroth@mac.com.
AD

[40] =>

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[cover] => DT U.S. 2309

[toc] => Array ( [0] => Array ( [title] => ADA continues to monitor proposals for health care reform [page] => 01 ) [1] => Array ( [title] => Eco Dentistry Association announces international launch [page] => 02 ) [2] => Array ( [title] => News [page] => 04 ) [3] => Array ( [title] => Journées Dentaires de Nice shines once again [page] => 06 ) [4] => Array ( [title] => Fiscally fit in 2009 [page] => 08 ) [5] => Array ( [title] => Keep the economic crunch from biting your practice [page] => 10 ) [6] => Array ( [title] => Dental informatics: the right time to invest in training and research? [page] => 12 ) [7] => Array ( [title] => Orthodontic surgery and esthetics (part1) [page] => 13 ) [8] => Array ( [title] => Orthodontic surgery and esthetics (part2) [page] => 16 ) [9] => Array ( [title] => Orthodontic surgery and esthetics (part3) [page] => 19 ) [10] => Array ( [title] => Case report: oral rehabilitation of severely worn dentition [page] => 21 ) [11] => Array ( [title] => Meeting in San Francisco offers plenty to learn - buy and do [page] => 24 ) [12] => Array ( [title] => Collaborative software connects dental professionals on a global scale [page] => 26 ) [13] => Array ( [title] => Industry [page] => 28 ) [14] => Array ( [title] => Cosmetic Tribune 6/2009 [page] => Supplement1 ) [15] => Array ( [title] => Hygiene Tribune 6/2009 [page] => Supplement2 ) ) [toc_html] =>

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