DT U.S. 2509

‘American dentistry at its best is remarkable’ / Curbing cancellations and no-shows begins chairside / Business continuity and IT mangement (Part 1 of 2) / Fiscally fit in 2009 / Events / Industry / Pediatric advanced life support (PALS) customized for dentists / Cosmetic Tribune 7/2009 / Hygiene Tribune 7/2009

Open PDF View E-paper Edit Epaper Edit Epaper ads save

Table of contents

n
iti
o
Ed
ia
l AAP
Sp
ec

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

September 2009

www.dental-tribune.com

IMPLANT TRIBUNE

ENDO TRIBUNE

Bone reconstruction methods

Apical microsurgery: part two

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

JOP report compares distraction osteogenesis
and autogenous bone grafting.
u Page 5B

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

How to handle the incision and atraumatic flap
elevation.
u Page 1C

Vol. 4, Nos. 25 & 26

CHosmetiC
tRIBUNE
RiBUNe
YGIENE T
the
World’s
Cosmetic
DentistryNewspaper
Newspaper· U.S.
· U.s.Edition
edition
The
World’s
Dental Hygiene

Patient acceptance

The Mix to Match Method is an extra step
where the ends justify the means
u Page 1D

‘American dentistry at AAP heads to Boston
its best is remarkable’
Dr. Harold C. Slavkin shares his thoughts on what’s good about dentistry today
and what’s needed from Washington
By Fred Michmershuizen, Online Editor

Dr. Harold C. Slavkin is the 2009
recipient of the American Dental
Association’s Gold Medal Award
for Excellence in Dental Research.
Established in 1985 and presented
by the ADA once every three years,
the award honors individuals who
contribute to the advancement of
the profession of dentistry or who
help improve the oral health of the
community through basic or clinical
research.
Slavkin, a noted policymaker,
educator and researcher served as

dean of the University of Southern
California School of Dentistry from
August 2000 until his retirement in
December 2008.
He is currently on sabbatical, but
he plans to return to USC in early
2010 to resume being part of the
Center for Craniofacial Molecular
Biology (of which he is the founding
director) and teaching in the graduate school and dental school.
Before becoming dean at USC,
Slavkin served as the sixth director
of the National Institute of Dental
g DT page 2A

The American Academy of Periodontology will host its 95th Annual Meeting
from Sept. 12–15 at the new Boston Convention & Exhibition Center.
gSee page 14A

AD

Texting during treatment a problem
More than four out of five dentists
surveyed by the Chicago Dental Society revealed that patients send and
receive text messages on their cell
phones while receiving dental care.
The survey was conducted from
July 16–25 via e-mail and among
dentists in the Chicago Dental Society’s Facebook Fan Page.
In addition to the dentists who
said their patients regularly text in
the dental chair, 46 percent said this
habit hampers their ability to provide
care. The high number of dental

chair texters is also surprising, given
that 32 percent of the dentists indicated they have a cell phone/mobile
device policy posted in a visible location in their office.
“We have signs up in the waiting room and directly in front of
where the patient sits stating that
they need to turn off their phones,
but most simply ignore them,” said
one respondent.
But not every dentist views texting
g DT page 2A
AD

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

PRSRT STD
U.S. Postage
PAID
Permit # 306
Mechanicsburg, PA

[2] =>

Interview

f DT page 1A

Dr. Harold C. Slavkin is being honored by the ADA for excellence in
dental research and for advancing
oral health.
and Craniofacial Research, which
is one of the National Institutes of
Health (NIH). He is past president
of the American Dental Research
Association and a member of the
International Association for Dental
Research.
Slavkin, who has been called by
ADA President Dr. John S. Findley
“one of dentistry’s most influential and forward-thinking leaders,”
spent a few moments with Dental
Tribune discussing his thoughts on
dentistry, the current state of affairs
in our nation’s capital and what he
does in his spare time.
You are being honored by the ADA
with the Gold Medal Award for
ADS

Dental Tribune | September 2009
Excellence in Dental Research,
which is quite an honor. Who
influenced you most in your
career and how?
I am deeply honored that my peers
in the dental profession have
extended this tribute to me. Yet, I
am the beneficiary of extraordinary
immigrant parents who provided
me with unconditional love and a
sense that anything was possible.
While a young soldier at Fort Sam
Houston I met Dr. Henry Sutro, who
modeled the best of what dentistry
could be at that time in history. I
was coached by many to seek a liberal arts education before going to
dental school.
I received excellent clinical training and had fabulous people, such
as Professors Dick Greulich and
Lucien Bavetta, mentor me during
my post-doctoral training. Thereafter, hundreds of students, residents,
graduates and postdocs profoundly
infuenced my journey in science.
From my perspective, living was
learning and the journey has been
a glorious experience, and still continues.
How do you feel about the state of
dentistry as it is practiced today?
American dentistry at its best is
remarkable. All over America, I
have met and seen amazing oral
health care being provided to all
types of people.
There is a debate going on today
in Washington about health care
reform. If you could write the legislation yourself and get it enacted, what would it include for

dentistry?
It sounds trite, but the mouth is part
of the body. From my perspective,
comprehensive health care must be
available for all people of all ages
and must include mental, vision
and oral health, with an emphasis
upon prevention.
While I worked in Washington as
director of the National Institute of
Dental and Craniofacial Research
at the NIH, I had the unique opportunity to be a small part of the Surgeon General’s Report “Oral Health
in America,” which was released in
May 2000.
In that report we learned that
110 million Americans did not have
dental insurance and that there
were enormous oral health disparities according to socioeconomic
determinants. We need to find a
way for all Americans to experience
optimal oral health, especially children under 5 and our elderly.
In your view, what does the future
hold for general dentists?
If I look beyond the current economic crisis that has challenged all
of society, domestic and international, the future of our oral health
profession is very bright and filled
with enormous opportunities. The
emerging science, technology and
patient needs of all ages will truly
enhance our profession’s future.
We know a lot about your work
and your professional life, but
what is something people might
be surprised to know about you?
What do you do for fun?
Fun is being with my wife, children
and grandchildren in essentially
any venue. Fun is doing watercolor painting. Fun is sailing our
boat “Winnie” and having the “Zen”
experience of being on the Pacific
Ocean. Fun is learning. DT

f DT page 1A
as a societal evil. Dr. Cissy Furusho,
a pediatric dentist in Chicago, said
her young teen patients have mastered texting to the point that they
don’t even have to look down at their
phone keyboard during treatment.
“This may surprise people, but
most of my younger patients are very
polite about using their cell phones
in the chair,” she said. “The kids
never answer their phone while getting treatment.”
Even dentists who don’t have a
stated policy against texting say it can
still interfere with communication
between dentist and patient.
Niles, Ill., dentist Dr. Alice Boghosian said that there is a time and
place for most things, but texting or
talking in the dental chair is a breach
of etiquette.
“One young patient of mine had
to interrupt me when his phone was
buzzing in his pocket.” Dr. Boghosian
said she was also surprised when a
member of the clergy kept answering
his phone even though he admitted
the calls were not urgent. DT

DENTAL TRIBUNE
The World’s Dental Newspaper · US Edition

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

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

Published by Dental Tribune America
© 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] =>

SAFER.
STRONGER.
FASTER.
TF is twisted, not ground – unlike other nickel titanium
files – making it more durable. Most endodontic files are
made by grinding the flutes, weakening the metal’s molecular structure which can lead to separation. Not so with TF.
Our unique manufacturing process produces a file with
optimal sharpness and flexibility. TF allows you to work in
difficult situations faster, safer and with a stronger file.
Bottom line – TF helps you achieve your goals for saving
natural dentition, alleviating your patients pain and managing dental trauma.

Interested in improving your endodontic efficiency? Go to
our TF website for the details and the solutions.

WWW .TF WITH Rpha SE . COM
For more information on TF visit our website or call 800.346.ENDO. You can now shop online at store.sybronendo.com.
©2009 SybronEndo

[4] =>

[5] =>

Dental Tribune | September 2009

Practice Matters

Curbing cancellations and no-shows begins chairside
By Sally McKenzie, CMC

“Doctor, Mr. Jackson just cancelled his two-hour crown and bridge
appointment.” With one simple sentence, your production for the day
is swallowed up by a gaping hole in
your schedule.
Every dentist experiences the
seemingly endless frustrations associated with patient cancellations and
no-shows. Given the current recession, the number of holes in the
schedule has surged in many offices.
Compound that with lower treatment acceptance these days and you
have all the makings of an overhead
nightmare.
Even during robust economic
times, no-fshows and cancellations
are not uncommon. They add up to
huge revenue losses, on the order of
$40,000 to $60,000 every year. And
that doesn’t begin to count the thousands of dollars lost in production
that the dentist never has the opportunity to diagnose, much less deliver.
While dental offices typically
point the finger at the front desk
to maintain a full schedule, clinical
teams often overlook their indispensable role in urging patients to keep
appointments. In actuality, curbing
cancellations and no-shows begins
chairside.
It is essential that clinical teams
emphasize the value of the dental
care provided during even the most
regular dental visit, as well as clearly
explain to patients the importance of
keeping their appointments.
Ironically, dentists frequently
overlook the significant influence
that they have on the patient’s perception of routine dental care. In a
rush to return to their own patient,
they often unwittingly minimize the
value of the professional hygiene
appointment.

A hygiene scenario
Consider this common scenario: The
hygienist spends time explaining to
Mrs. Patient that she is now showing signs of periodontal disease and
may require more frequent hygiene
appointments. The patient is concerned and is prepared to schedule
these visits once every three to four
months.
Then the doctor walks in to check
Mrs. Patient. He greets her and marvels at the great job she is doing
with her oral health care. The dentist’s comment causes Mrs. Patient to
question the hygienist’s assessment
of her periodontal condition.
“The doctor said I’m doing a great
job. Why would I need another cleaning so soon?”
Even more troubling is the fact
that the dentist’s comments cause
the patient to question both the dentist’s and the hygienist’s diagnostic
abilities.

The solution
First, the clinical team has to be on
the same page. This situation is eas-

ily addressed if the hygienist takes
just a moment to explain to the dentist what has been found and subsequently discussed with that patient.
It is a simple solution, but it
underscores the significance of the
clinical team’s role in emphasizing
the value of ongoing dental care.
If your practice is not stressing
the importance of the next visit to
the patient while he or she is sitting in the chair, you probably have
many more broken appointments
and cancellations than you should.

Educate your patients
Oftentimes, patients have no comprehension of the turbulence that

their “little” cancellation or no show
can cause you and your team. In
fact, it has been estimated that more
than a quarter of your patients,
about 28 percent, routinely cancel
appointments because practices are
not actively educating them on the
importance of the next visit.
While cancellations and noshows may be a part of running a
practice, they do not have to be commonplace. In addition to emphasizing the value of every dental visit
with each patient, I recommend
that practices take specific, concrete
measures to reclaim control of their
schedules.
Appoint a staff member. The first

step is to establish accountability. Assign a specific person to be
responsible for ensuring that openings are filled promptly, appointments are confirmed 48 hours in
advance and daily production goals
are met.
Develop a policy. In addition,
develop a clearly articulated policy
regarding broken appointments. The
policy should be specific and appropriate in tone. It also should be periodically distributed to all patients,
especially new patients. Each time
an appointment is scheduled, the
policy should be politely reiterated
g DT page 6A
AD

[6] =>

Practice Matters

Dental Tribune | September 2009

f DT page 5A
to the patient.
When making appointments,
state the day, date, time and length
of the appointment.
For example, “Mrs. Smith,
your one-hour appointment is on
Wednesday, April 28 at 9:50 a.m. If
you are unable to keep this appointment, please call us at least 48 hours
in advance to allow another patient
the opportunity to see the doctor at
that time.”
Don’t overbook. In addition, avoid
the tendency to schedule all the
appointments for larger treatment
plans. Certainly, when presenting
higher dollar, multi-appointment
treatment plans there is a strong
desire to immediately schedule the
patient for all the necessary visits as
if that will guarantee he will keep
every appointment.
In reality, booking the entire treatment plan does nothing to insure
that the patient won’t change or cancel appointments. However, it does
cause the schedule to appear unnecessarily clogged and overwhelming.
Just avoiding the tendency to
overbook patients will help reduce
the number of cancellations and noshows the practice has to routinely
manage.
Be patient. Be patient with your
patients. They do not set out to create havoc or disruption in your day.
They too are very busy and, as is
often the case, when something has
to give in their demanding lives, it is
the dental appointment.
However, educating them on the
practice’s policies and expectations
for appointments is an essential step
every practice can take in controlling cancellations and no-shows.

Make it personal
Confirmation calls are a must for
every appointment scheduled. Yet,
don’t just rely on the telephone.
E-mail and text messaging are essential tools that every practice needs to
incorporate into their patient/practice communication protocol.
In fact, studies show that most
patients prefer that practices contact them via e-mail or text message. What’s more, your office is far
more likely to get a prompt response
from patients if you contact them via
e-mail and/or text message.
Patients should be contacted
48-hours in advance of their appointments. If you are not using text
messaging and e-mail to confirm
AD

Track down no-shows

Contact ‘no shows’ within 10 minutes
of their appointment time
appointments, adjust the scheduling
coordinator’s work hours somewhat
so that she can make the necessary
calls during times that patients are
most likely to be reached, such as in
the evenings.
The objective of the confirmation
call is to speak directly to the patient.
This requires far more effort than
just leaving a message on someone’s
machine or with another household
member.
If you are sincerely committed to
zeroing out the number of holes in
your schedule, you need to identify
what is the prime time for reaching
patients directly.
For example, if your practice
is located in what is considered
a “bedroom community” where
patients live but commute to work
during the day, evening is the time
in which you will experience the
greatest success with your confirmation calls.
When patients schedule their
appointments, tell them that you
will be calling two days in advance
to confirm the appointment. Request
the number where they can be
reached directly.
Use a positive and pleasant tone
when confirming appointments.
Keep notes in the patient’s personal
record regarding a particular area of
concern, and reinforce the need for
the treatment, based on the patient
information in the chart.
For example, “Mrs. Smith, I know
Dr. Jones wants to keep an eye on
that tooth on the upper left side.”
This will personalize the call for

patients, and it impresses upon
them both the need for the appointment as well as the fact that your
practice is truly attentive.
Be sure to remind patients about
any premedication needs and offer
to call the necessary prescription
into their pharmacy. In addition,
stress the specific amount of time
that has been reserved for that
patient.

Make it standard operating procedure to follow-up with every patient
who cancels, doesn’t show up or
doesn’t reschedule. Contact noshows within 10 minutes of their
appointment time, and express genuine concern for their absence.
For example, “Mr. Clemmons, this
is Ellen from Dr. Denny’s office.
We were expecting you for a 3 p.m.
appointment today and were concerned when you didn’t arrive. Is
everything okay?”
After two no-shows the patient’s
record should be tagged indicating
that he/she is unreliable. Politely
inform the patient that he/she will
be contacted when an opening is
available.
Cancellations and no-shows are
a reflection of our hurried and overextended culture. It is a problem
that affects those practices serving
patients with a lower dental IQ as
well as those serving the busy, welleducated executives.
Although they cannot be completely eliminated, by using a clear
and direct approach, cancellations
and no-shows can be minimized significantly in your practice. DT

About the author

Fill cancellations fast
A computerized scheduling system is
essential if the practice seeks to fill
cancellations quickly and efficiently,
as well as competently manage the
schedule as a whole. The computer
enables practices to maintain a list
of those patients interested in coming in sooner for their appointments.
When a patient cancels, the scheduling program retains the appointment
information and scans the available
patient database to fill unexpected
openings.
For example, two patients cancel
back-to-back appointments leaving
the schedule with a two-hour opening next Wednesday. This happens
to be the amount of time necessary
for a four-unit bridge. With a couple
of keystrokes, the scheduling coordinator tells the computer to scan
the patient data to find a patient that
would fit into that slot.
A phone call or two later, the
scheduling coordinator has rescheduled Mr. Jackson for his two-hour
crown and bridge appointment.
In addition to quickly accessing
patient data, most computer systems have incorporated the ability to
enter daily production goals within
the scheduling module. They also
commonly provide an instant daily
schedule for each treatment room
and a print out of information on
each patient.
Moreover, the scheduling coordinator has a reliable system to track
critical scheduling information and
necessary patient data. She/he is not
in the difficult and ineffective position of having to try to keep track of
the information in her head or on a
scrap piece of paper that is likely to
disappear.

Certified Management Consultant (CMC) Sally McKenzie
is a nationally known lecturer and author. She is CEO of
McKenzie Management, which
provides highly successful and
proven management services to
dentistry and has since 1980.
McKenzie Management offers a
full line of educational and management products, which are
available on its Web site, www.
mckenziemgmt.com.
In addition, the company
offers a vast array of practice
enrichment programs and team
training. McKenzie is also the
editor of an e-Management
newsletter and The Dentist’s
Network newsletter sent complimentary to practices nationwide. To subscribe, visit www.
mckenziemgmt.com and www.
thedentistsnetwork.net. She is
also the publisher of the New
Dentist™ magazine, www.thenewdentist.net.
McKenzie welcomes specific practice questions and can
be reached toll free at (877)
777-6151 or at sallymck@mcken
ziemgmt.com.

[7] =>

[8] =>

[9] =>

[10] =>

[11] =>

0A
Dental TRubric
ribune | September 2009

Dental Tribune
| Month11A
2009
Digital
Matters

Business
Headlinecontinuity and IT mangement
Part
1 of a two-part article on keeping your computer network running 24/7
Deck
By
By line
Lorne Lavine, DMD

As many dental offices know, no
matter
tk what you spend for IT support for your computers, it’s usually
nothing compared to what it costs if
your network goes down for two or
three days.
Business continuity involves two
steps: monitoring the network 24/7
and having a great backup protocol in place should something go
wrong.
Your computers are the machinery that runs your business. Every
minute of down time costs you
money. Just as dental offices do
preventative maintenance to keep
their patients’ oral health at a high
level, your computer network also
needs regular maintenance to keep
it running smoothly.
If you are not in the business
of IT support, then it makes no
sense for you to self-manage your
network.
Using on-call consultants for
basic maintenance has also become
a costly proposition for most offices.
Add to that the delays between the
time you notice a problem and it
actually getting fixed. All this extra
downtime is costing you money.

Electronic IT management
New monitoring systems provide
electronic management technology that has changed the way companies can maintain and manage
their IT systems.
No longer do you have to wait
for things to break before your
network gets attention. With these
systems watching over your network, many problems can be seen
and corrected before they impact
your staff.
Modern automation technology
alerts technicians whenever specified events occur on your network.
This allows us to directly focus on
areas that need attention. Without this automation, a technician
AD
would waste valuable time hunting around for possible problems.
These systems show us exactly
where to look.

Remote access
Thanks to secure remote-access
AD

What is
the total
cost to
your
practice
if your
network
goes
down
for two
or three
days?
capabilities, most problems can be
fixed remotely over the Internet.
For the dental practitioner, this
means problem resolution in minutes, not hours! In addition, your
network security is not compromised. This is an important factor for organizations in regulated
industries, such as dentistry, that
have HIPAA regulations.

Software updates
Patches and updates are released
regularly for your operating systems and key applications. These
fix problems with security and
make them run better.
Without these updates applied,
your software is vulnerable to
threats that can damage your systems, or worse, make them available to attackers.

Tracking installed software
Most of these software programs
contain a sophisticated asset
inventory system that tracks every
piece of software installed on
your computers. The software can
automatically identify those that
need updates.
Every week your management
node will download these updates

once and then apply them to all
the machines on your network
that need the updates.
This is far more efficient than
you downloading and updating
each workstation and server individually. In most cases, it makes
sense to schedule these updates
to run after hours so your staff is
not interrupted by the installation
process.

‘Reactive’ IT support
The old way of providing network
support relied upon you calling a
technician when something broke.
Then you wait for someone to
come find your problem. There
was no telling how long it would
take the technician to find and fix
the problem.
With this outdated “reactive”
support model, you pay when
things go wrong, so your IT consultant gets paid when things
break down. In short, there is no
incentive for your consultant to
make your network as reliable and
efficient as possible.
The cost of supporting computers is a common complaint among
dental offices. Something goes
wrong on your network and the
support bills start piling up.

AD
1/4 Page
9 1/4 x 3 3/8

‘Active’ IT support
How much will it cost this month?
Many dentists we’ve worked with
in the past commonly agree that
unknown support costs are one of
their most aggravating management issues.
Most of the new support systems
are a subscription-based service.
There is no hardware or software
to buy. No staff to hire. You pay a
monthly fee based upon the number of servers, workstations and
network devices. All monitoring,

notification, and remote support is
done for you.
The only extra charges you
might pay are for consulting,
implementation of new equipment
or software, or services that are
not part of maintaining your existing IT infrastructure. DT
Part 2 of this article will be published in the next edition of Dental
Tribune.

About the author

Dr. Lorne Lavine, founder
and president of Dental Technology Consultants (DTC), has
more than 20 years invested in
the dental and dental technology fields. A graduate of USC,
he earned his DMD from Boston
University and completed his
residency at the Eastman Dental Center in Rochester, N.Y.
He received his specialty
training at the University of
Washington and went into private practice in Vermont until
moving to California in 2002 to
establish DTC, a company that
focuses on the specialized technological needs of the dental
community.

[12] =>

12A Financial Matters

Dental Tribune | September 2009

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

tk
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/practice-management 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
have equipment placed in service

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

AD
AD

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.

Annual Internal Revenue Code Section 179 Example
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

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.

[13] =>

[14] =>

14A Events

Dental Tribune | September 2009

American Academy of Periodontology
to host 95th annual meeting in Boston
The American Academy of Periodontology (AAP) will host its 95th
Annual Meeting in Boston, from
Sept. 12–15 at the new Boston Convention & Exhibition Center.
Dental professionals from all specialties are encouraged to register to
learn about the latest advancements
in periodontology. More than 5,000
dental professionals and participating vendors are expected to attend.
The four-day meeting will include
a variety of educational and scientific sessions in seven distinct program
tracks, covering topics such as dental implants, periodontal-systemic
relationships, practice development
and management, and regeneration
and tissue engineering.
Traditional continuing education
courses, as well as hands-on workshops and clinical technique showcases, will be offered. In total, more
than 50 educational and scientific
sessions will be offered.
Of particular note is this year’s
Opening Ceremony, which will officially kick off the meeting on Sept.
12, with welcome remarks from
the 2009 AAP President, Dr. David
Cochran, DDS, PhD.

The academy is also pleased to
announce Paul M. Ridker, MD, as
the Opening Ceremony’s keynote
speaker.
Ridker is a leading researcher in
inflammation and cardiovascular
disease, and was an important contributor to the recent joint consensus
paper on cardiovascular disease and
periodontal disease published by The
American Journal of Cardiology and
the Journal of Periodontology.
Other events of interest this year

include:
• The Innovations in Periodontics sessions where the latest concepts, techniques or products in
periodontics will be showcased.
• The Dental Hygiene Symposium, which will discuss how periodontal care, continues to evolve
based on new research on the role
of inflammation in the progression
of periodontal disease.
• The popular Insurance Workshops, which will instruct attend-

ees how to submit appropriate
procedure codes to dental benefit
carriers, communicate with benefit carriers in adjudicating claims
and file claims with medical plans.
• The exhibit hall, which will
feature more than 150 dental products and services and will offer onfloor order placements and complimentary attendee lunches.
“This is an exciting time in periodontics, so I am thrilled to invite
the dental community to join us in
Boston,” Cochran said.
“It has become critical that all
dental professionals understand
the connection between periodontal disease and other chronic diseases of aging, such as cardiovascular disease, and especially the
role inflammation plays in this
connection.
“Our 2009 annual meeting offers
an exciting and informative forum
to learn about these important
advances in periodontology.”
For more information or to register for the annual meeting, visit
the AAP Web site or contact the
AAP meetings department at (312)
573-3216 or meetings@perio.org. DT

‘What you learn in Vegas, doesn’t have
to stay in Vegas!’
The American Association of
Dental Office Managers annual
conference is the premier educational and networking event in the
country for dental office managers, practice administrators, patient
coordinators, finance coordinators,
treatment coordinators, business
managers and dentists. Here are
the highlights of this two-day conference on Oct. 16 and 17:
• Great Communication = Great
Production, by Cathy Jameson
In these tough economic times,
now, more than ever, you and your
team need to use effective communication to increase your practice’s
bottom line.
Learn proven presentation and
communication skills to be used by
the entire team that will increase
your case acceptance to 90 to 95
percent.
• The Chartless Office and What It
Means to the Office Manager, by
Jana Berghoff
How does chartless look to
your patient? Take a walk, from a
patient’s perspective, through an
actual high-tech, chartless office
that will be simulated on site.
• How to Maximize Your Patient
Referral Program, by Kim McQueen,

Patterson Office Supplies
Learn how to use your most
effective marketing tool: your current patients! Did you know that
75 percent of all new patients that
come to a dental practice are referral-driven? Learn how to entice
your current patients to send referrals to you.
• Successful Techniques to Incorporate Implants into Your Practice, by
Lynn Mortilla and Teresa Duncan
Understanding
the
impact
implants have in patients’ lives
and how an office can benefit from
incorporating implants into treatment options will be discussed.
There will be a discussion of the
perceived challenges and realistic
implementation of strategies to create ideal patient experience.
• Purpose-driven HR for the Dental
Office Manager, by Robyn Adkins,
PHR
A course for those with human
resources/staff management questions. Join Adkins in discovering
your HR purpose, and reduce your
stress, focus your energy and simplify your decisions.
In this course you will learn how
to identify and manage your prime
risk areas, where to focus your efforts

for the
m o s t
return,
and how
to
plug
into
the
ample online
resources availDonTurn
able to you.
’t mis
s the
SPAC taskyour ad-hoc,
pre
E
IS HR
based and reactive
rou- mier e
LIM
duca
TE D
tiona
tine into
Offiac deliberate, Istrategic
!
F
l
o
r
eM
and proactive
part
aNaofgyour practice. more det and netw
orkyour
ails orincluding
rs •
ten
• Getting Results As AeManager,
by dental office
ing own
t
P
e
o
racti step image evaluation.
v
r
e
e
Linda Drevenstedt
nt fo
gister
ce d
r den
, visit ConManaging your dental staff is •aDental
MiNisPractice Management
tal a
w
w
w.de
tratDiscussion
complex and requires a variety of sultant Panel
Ors •
ntalm
an
Join some of the iN
top
skills. Getting results requires massurconsula
Nce &
tering seven critical management tants in dentistry for this one-hour
f
skills, which you’ll learn in this Q&A. Expert consultants repre- iNaNce
c
senting all fields of practice manpresentation.
• Professional Self Development for agement will take to the stage to
the Dental Office Manager, by Janice answer attendees’ questions.
• Roundtables by specialty
Hurley-Trailor
Bring your most pressing practice
This course will focus on understanding the impact your image has management questions with you for
on your professional success as a your peers to answer and bring your
dental professional, as well as how advice for them too. Tables divided
to project confidence and receive by practice specialty, which means
respect, improving self-esteem, networking at it’s best.
For more information about
effectively using body language in
patient communication, and learn- AADOM’s annual conference, please
ing life-changing makeovers in the visit www.dentalmanagers.com. DT

[15] =>

Industry 15A

Dental Tribune | September 2009

Vintage Halo
featured in seminar
Shofu’s Vintage Halo porcelain
was recently featured in a seminar
at the UCLA Master Dental Ceramist Program.
Taught by renowned dental technician Klaus Muterthies, the twoday seminar was an opportunity to
see the legendary master ceramist
at work.
The 15 technicians who participated in the program were taught
Muterthies’ famous four season
restorations using Shofu porcelain.
Muterthies, founder of the Art
Oral Design Group, cited Shofu’s
Vintage Halo porcelain’s easy handling abilities and the true opalescence properties of Shofu’s ceramic.
Participants used Vintage Halo
porcelain, which, in addition to its
natural esthetics, offers extremely
low shrinkage, precise color match,
high compressive strength and
excellent stability of margin edges.
A versatile material, Vintage
Halo is ideal for everything from
simple two- to three-powder build-

Dental Technician Klaus Muterthies
during the UCLA Master Dental
Ceramist Program that featured
Shofu’s Vintage Halo.
ups to complex multi-powder restorations. DT

New cameras from Nikon
and Canon
Canon and Nikon are introducing
new “upper entry level” digital SLR
cameras: the Nikon D5000 and the
Canon Rebel T1i.
The Nikon D5000 slots in between
the entry level D60 and the D90,
and splits the difference in features.
The D5000 matches the D90’s 12.3
megapixel resolution and includes
the same 720P HD video clip mode.
New to the Nikon D5000 is the
vari-angle LCD monitor that allows
you to shoot from various angles.
This is the first Nikon SLR model to
feature an adjustable LCD screen.
Even if you never use Live View,
the vari-angle screen allows you to
protect the LCD screen.
The LCD screen size is 2.7 inches
and, like the D60 (2.5 inches), has
230,000 pixels of screen resolution.
In comparison, the D90’s screen
does not move, but is 3 inches and
has 920,000 pixels.
Canon’s newest Rebel series
camera is called the T1i. The Rebel
T1i gains the 15 megapixel resolution and the higher resolution

screen from the Canon 50D while
also adding in 1080P HD video clip
capability (first seen in the 5D Mark
II).
The size and weight of the Rebel
T1i is identical to the Rebel XSi.
Visit the PhotoMed Web site
to view a chart that shows the
upgrades to the Rebel line over
time, as well as more information
about the Nikon D5000. DT
PhotoMed International
14141 Covello St., #7C
Van Nuys, Calif. 91405
Tel.: (800) 998-7765
Fax: (818-) 908-5370
Web: www.photomed.net
AD

[16] =>

16A Industry

Dental Tribune | September 2009

IPS e.max lithium
disilicate crowns

IPS e.max® from Keller is the
next generation of crown and bridge
material. It offers great strength,
esthetics and fit for a lower price.
IPS e.max lithium disilicate is a
monolithic glass ceramic.
This means it is fabricated from a
single block of material.
Unlike traditional PFMs and
many other ceramic restorations,
e.max does not have a coping with
a thin veneer of porcelain. It is
made entirely of pressed lithium
disilicate.
If it’s all-ceramic esthetics you’re
looking for, different ingot opacities
and characterization techniques
AD

make it possible to rival the esthetics of Empress.
e.max’s versatility of design can
deliver both bridges and crowns. It
is available for three-unit bridges to
the second premolar. e.max also is
available as an inlay/onlay.
IPS e.max is a good value in
an economy where every dollar
counts: crowns are $109 while
veneers are $129.
Keller is a market leader in providing solutions to the growing
demands in dentistry.
For more information on Keller
Laboratories, please call (800) 3253056 or visit www.kellerlab.com. DT

Triotray
by Triodent

The new Triotray by Triodent,
makers of the V3 Ring, is a rigid
and accurate posterior impression tray. Its sturdy metal construction and unique side tabs
produce consistently successful
impressions where other, more
flexible, dual-arch trays fail.
Triotray eliminates the frustration and embarrassment
caused by poorly fitting crowns
that are the result of distorted
impressions.
Triotray
removes
that
moment of doubt when you fit
a crown, and saves time and
money spent on adjustments and
extra appointments.
The Triotray comes in left and
right shapes, with the lingual
tabs more vertically oriented
than the others.
This prevents the tongue from
displacing impression material from the lingual margins of
mandibular crown preparations.
With the tongue in a passive
position beside the lingual arm,
it cannot push up on the tray, a
common cause of distortion.

Adjustable side tabs
All the side tabs are adjustable
using your fingers or pliers, so it
is easy to customize the tray to
fit a wide range of mouth shapes
and sizes, even if the patient has
a shallow palate, wide buccal
plate or mandibular tori.
The tray’s thinness and
strength in the retro-molar area
allows the patient to close easily and comfortably in centric
occlusion (maximum intercuspation position).

Using the tray is simple. Just
place the tray in the mouth and
ask the patient to close. Move
the tray slightly to make sure it
is free from any impingements
and adjust the tabs if necessary.

Tabs lock-in impression
material
Once the tray is tried-in and
adjusted, a generous amount of
impression material is applied
to the tray.
As the patient closes, the
material flows between the side
tabs, locking when it sets, thus
avoiding the need for adhesive
in all but a few putty and wash
cases.
If the tabs are fully trapped
within the impression material,
the impression cannot distort
and the lab can pour check dies
without worry.
An occasional reaction to the
Triotray side tabs is that they
look uncomfortable, but the tabs
are actually shorter than the
rims of conventional trays and,
because they are adjustable,
there is no reason for patient
discomfort, Triodent clinicians
say.
The Triotray, a single-use
product, is sold in packs of 24
—12 left and 12 right — retailing
at $62.
For more information, call
(800) 811-3949 or go to www.
triodent.com.
You can also learn more
about this product by watching
a First Impressions video product review, which is available at
www.DTStudy Club.com. DT

[17] =>

Industry 17A

Dental Tribune | September 2009

Pediatric advanced life support (PALS)
customized for dentists
By Heather Victorn

If you are a pediatric dentist, a
family practice dentist who treats
children or a dentist who performs
pediatric sedation, you should consider taking a pediatric advanced
life support (PALS) course.
Children are not simply small
adults. Their anatomy and physiology is vastly different. Even
practitioners who have attended
advanced cardiac life support
(ACLS) courses in the past should
still seek additional PALS certification.
Leading sedation dentistry and
emergency preparedness continuing education provider DOCS Education has expanded it curriculum
to offer a top-in-the-nation PALS
course customized for dentists.
Nearly every state requires dentists to have basic life support (BLS)
or CPR for health care providers
training. However, both courses
only teach basic skills for sustaining a patient’s life and do not teach
you how to use an automatic external defibrillator (AED) in the event
of a cardiac emergency.
Furthermore, they do not address
how to identify and treat the signs
and symptoms that can lead up to
a respiratory or cardiac emergency
in children, particularly in the dental setting.
Recognizing these signs and
symptoms can enable early intervention and prevent a small medical emergency from escalating into
a large one.
Changes in behavior, mood or
alertness can all be symptoms of
an allergic response. Often times
these first indicators of trouble are
misinterpreted as simply nervousness or agitation. When taught to
recognize the signs, the progression of respiratory and cardiac distress can often be resolved.
Because many of their allergies
and sensitivities haven’t manifested themselves yet, treating children presents unique challenges.
“Children are history in motion,”
says lead DOCS Education PALS
instructor John Bovia, Sr. “Their
history is developing moment by
moment as they go through their
formative years. They haven’t
been labeled with certain allergies
because they haven’t experienced
them yet.”
DOCS Education’s PALS course
teaches essential techniques for
pediatric assessment and recognition of systems in distress, including airway obstruction, allergic
reactions, respiratory insufficiency
and hypoxemia.
Dentists learn standard pediatric emergency protocols and how
to effectively run a MEGACODE
emergency using dental office

equipment.
The course also teaches participants how to use Broselow® Pediatric Tape, which provides precalculated emergency medication
dosages based on a child’s height
and weight.
Simulation is part of its foundation, and the course is designed to
be user-friendly with an emphasis on practice drills performed on
high-fidelity patient simulators.
These simulators provide realtime, real-world experience to max-

imize skill proficiency and preparation.
Training on how to use an AED
on pediatric patients experiencing
a cardiac emergency and understanding emergency drugs and their
administration via intraosseous and
other alternate routes of administration are covered in detail.
The next DOCS Education PALS
course will take place on Nov. 6 and
7 in San Francisco. To learn more or
register, visit DOCSeducation.org or
call (866) 592-9617. DT
AD

[18] =>

[19] =>

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

September 2009

www.dental-tribune.com

Vol. 2, No. 7

New approaches for patient
acceptance and appreciation
By Lorin Berland and Sarah Kong

This 51-year-old executive has
lived with the effects of tetracyclinestained teeth since she was a little
girl (Fig. 1a). All her life she wanted
to have a great smile, but she never
knew what her dental options were.
The general dentist she had seen
for many years told her there wasn’t
anything he could do to help her, so
he referred her to our office.
When the patient came for her
first visit, she had a number of dental
concerns she wanted to address. In
addition to the severe tetracycline
staining, she felt her teeth were worn
from years of grinding. She also had
old resin bonding on her lower front
teeth that was not only discolored, it
was mismatched from years of patching and re-patching every time something would break off.
After listening to her chief complaints and performing a thorough
exam and cleaning, we recommended she try deep bleaching and, after
evaluating the results of whitening,
a minimum of four minimal prep
Microveneers™ for her lower front
teeth and her upper seven teeth,
and a zirconium porcelain crown for
tooth No. 5 to achieve the smile she
was seeking.
Because her maxillary six anteriors had worn, flat incisal edges, it
was essential that we knew what the
patient hoped for in terms of shape
and length. We went over the Smile
Style Guide (www.digident.com) to
select a smile design (Fig. 2). With the
patient’s input, we determined that
P3 — pointed canines with square
centrals and round laterals — would
look the best for her (Fig. 3).
The length combination she liked
the most was L-2, laterals slightly
shorter than the centrals and canines
(Fig. 4). We submitted her pre-op
photo to SmilePix for a cosmetic
image (Fig. 5) and concluded with
PVS impressions (Splash, Discus Dental) and a bite registration (Vanilla
Bite, Discus Dental).
At her second consultation appointment, we confirmed the smile design
and length combination she had previously selected by showing her a
diagnostic wax-up of her upper and
lower teeth (Fig. 6). Matrices were
fabricated from the wax-ups before
this appointment and were used to
make an upper and lower Slip-On

Fig. 1a: Pre-op full face.
Smile right on the patient’s teeth.
We loaded the matrices with an
A-1 bisacryl temporary material —
such as Temphase (Kerr), Integrity
(DENTSPLY Caulk) or PERFECtemp
II (Discus Dental) — and seated them
in the mouth. After the material was
set, the matrix was removed and
what remained on her teeth was a
new smile.
We took a series of photographs
with the Slip-On Smiles in place and
the patient was ecstatic. She was able
to see and feel what her teeth could
look like before committing to any
dental work (Fig. 7). The patient was
truly amazed by this and wanted to
wear the smile home to show her
husband.
Though the patient had loved the
selected smile design and cosmetic
image, she was not quite sure about
pursuing this treatment. This is why
the Slip-On Smile was such an important part of her treatment presentation. She accepted the treatment as
soon as she could experience her
new smile firsthand.
We began her treatment with a
combination of in-office and takehome whitening. The incisals of the
canines and bicuspids, the part that
shows, had acceptable results.
We used this as a base shade,
planning to make the lower veneers
even lighter toward the front and the
upper veneers slightly lighter than
the lowers. As planned, teeth Nos.

Fig. 1b: Post-op full face.
6–12 were prepared for Microveneers
to preserve as much natural, healthy
tooth structure as possible.
Tooth No. 5 had an existing crown
that the patient wanted to replace
to match No. 12, so it was prepared
for a zirconium crown at the same
time. Digital photographs of the prep
shades were taken for our ceramic
artist (Fig. 8).
Once the preps were finished and
refined, it was time to provisionalize
the teeth. While an assistant loaded a
tray with alginate, hydrocolloid (Dux
Dental) was expressed over the pre-

pared teeth for an impression. Then
the alginate-filled tray was seated in
the mouth, directly onto the hydrocolloid. After a mere minute and a half,
the impression was removed with a
snap and handed off to an assistant
to pour.
In the lab, the impression was
disinfected and dried. Next, Mach-2
PVS (Parkell) was dispensed into the
impression to pour up the model on
a vibrator. A fast-setting bite registration material (SuperDent, Darby
g CT page 2D
AD

[20] =>

2D News

Cosmetic Tribune | September 2009

AACD unveils plans
for its 2010 meeting

COSMETIC TRIBUNE
The World’s Dental Newspaper · US Edition

The AACD
will meet
April 27
through
May 1 next
year at the
Gaylord
Texan in
Grapevine,
Texas.
By Fred Michmershuizen, Online Editor

The 26th Annual American Academy of Cosmetic Dentistry (AACD)
Scientific Session will take place in
Grapevine, Texas, April 27 through
May 1, 2010. According to the AACD,
the 2010 educational program offers
more learning platforms than ever
before, in-depth lectures and handson workshops, a mix of innovative
presenters and topics, and social
functions that foster legendary
AACD camaraderie.
Other highlights of the meeting
will include deeper learning during

lectures and hands-on workshops,
the debut of AACD Digital World, a
bigger team program, the exploration of international laboratory models and more.
More than 80 educators will present at the 26th Annual AACD Scientific Session. (A complete list of
those scheduled to speak is available at www.dental-tribune.com/
articles/content/scope/news/region/
usa/id/730 and at www.aacd.org.)
The AACD is the world’s largest
non-profit membership organization
dedicated to advancing excellence
in comprehensive oral care that

f CT page 1D

Fig. 3: P-3, pointed canines with
square centrals and round laterals.
Fig. 2: Smile Style Guide.
Dental) was then placed directly onto
the Mach-2 for a model base.
In less than two minutes, an accurate, instant silicone model was ready
on which to fabricate a provisional
— all of which was completed by an
assistant and outside the patient’s
mouth.
Using the matrices made from the
diagnostic wax-up and approved by
the patient in her Slip-On Smile, the
provisionals were fabricated.
First, the instant silicone model
was lubicated with a water-based
lubricant such as KY Jelly. Next, the
putty matrix was filled with bisacryl
and then placed onto the silicone
model. After a minute and a half, the

provisional was set up and ready to
be trimmed.
Because this method of temporization involves a quick way to make a
model of the prepped teeth, the provisional can be trimmed and polished
in the lab. Finishing provisionals in
this manner is much more accurate,
kinder and easier for the patient, and
especially for the gingiva and the
prepped and impressed teeth (Figs.
9a, b, 10a–c).
To prepare the gingiva for the
final impressions, Expasyl (Kerr) was
placed around the gumline. Final
impressions with a PVS material,
such as Take 1 Advanced (Kerr), or
Virtual (Ivoclar Vivadent), were then
taken in custom trays. A slow-setting

combines art and science to optimally improve dental health, esthetics and function.
Composed of more than 7,000
cosmetic dental professionals in 70
countries around the globe, the
AACD, based in Madison, Wis., fulfills its mission by offering superior
educational opportunities, promoting and supporting a respected
accreditation credential, serving as
a user-friendly and inviting forum
for the creative exchange of knowledge and ideas, and providing accurate and useful information to the
public and the profession. CT

material was used to record her bite
registration (SuperDent).
To cement the provisionals, the
same bisacryl was placed in the temporaries and seated in the mouth. The
excess was removed with a microbrush before the material set up. The
patient loved the way her provisionals
looked and fit (Fig. 11). There were
no surprises as she had chosen the
smile design she liked best before any
work was ever even started.
When she returned for the final
porcelain restorations, the patient was
concerned that they might not look as
good as her provisionals. Because the
minimal preparation was all in enamel, we could try the restorations with
no anesthetic and no discomfort. This
is important to the patient to really get
a “feel” for the teeth, especially when
we are increasing length.
We assured her that we would try
them in and get her approval before
they were seated permanently. Thus,
we invited her whole family to the
seat appointment to offer their opinions. As is often the case, it was especially important to please one family
member in particular, and this time it
was her daughter.
For the try-in, we used different
shade combinations of try-in pastes
g continued

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

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

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

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!

[21] =>

Clinical

Cosmetic Tribune | September 2009

f continued

Fig. 4: Length code L-2, laterals
slightly shorter than centrals and
cuspids.

Fig. 9b: Indirect provisionals on
instant silicone models.

Fig. 10a

Fig. 7: Slip-On Smile full face.

Fig. 10b

Figs. 10a–c
(above, left
and below):
Upper
and lower
indirect
provisionals
on instant
silicone
models.

Fig. 5: Cosmetic image.
Fig. 8: Upper preps and prep shade.

Fig. 10c

Fig. 6: Diagnostic wax-up and putty
matrices.

Fig. 9a: Indirect provisionals on
instant silicone models.

to see what looked the most natural.
I call this the “Mix to Match Method.”
This method is especially important when doing large cases with
multiple types of restorations and
porcelains.
In this case, feldspathic porcelain
was used to fabricate the veneers
while the crown was made with a
zirconium core.
When it comes to mixing cements,
we generally like to use the lightest shade for centrals and warmer
shades as we go distally. This Mix
to Match method helps to achieve a
natural-looking smile.
We ultimately decided, with the
patient’s input, to use a dual-cure
resin cement such as Maxcem (Kerr),
Multilink (Ivoclar Vivadent) or PermaCem Automix Dual (Foremost)
for the zirconium crown on No. 5;
Cosmedent Ludicrous for Nos. 8, 9,
24, 25; Bright for Nos. 6, 7, 10, 11, 12;
and Yellow-Red Universal for Nos. 23
and 26.
A fresh bottle of bonding agent,
such as Optibond Solo Plus (Kerr),
Excite (Ivoclar Vivadent) or Adper
Single Bond Plus (3M ESPE), was
selected. Using a fresh bottle ensured
that the bond would be at its strongest
potential.
The teeth were cured from all
angles with the FLASHlite Magna
(Discus Dental). Because it is a LED,
there is little danger of over-heating
the teeth.

Once the restorations were seated, the patient was ecstatic with the
results. She simply could not believe
how natural her teeth looked.
They were exactly the way she
had anticipated in shape and shade,
only better (Fig. 12). The once tetracycline-stained smile was the only
smile she had ever known.
Now, for the first time in her life,
she could look in the mirror and
smile with confidence knowing she
had a beautiful, natural smile.
In this case, a cosmetic image was
helpful in showing the patient a 2-D
photo of how her smile could look.
Yet, it was not until she saw her
personalized smile design in real life
with the Slip-On Smile that she could
really feel and sense what that new
smile would truly be like.
She was pleased with every step
of her smile transformation, with
her provisionals and ultimately with
her final results. Though the Mix to
Match Method is an extra step that
requires more chair-time, the end
results justify the means.
And for this patient, that meant
a beautiful new smile with minimal
tooth reduction to achieve the most
natural esthetics.
Each step of this process gained
more of the patient’s acceptance of
the proposed treatment, but it was the
extra steps that ultimately gained the
patient’s appreciation of the final
results. CT

Fig. 11: Provisional full face.

Fig. 12: Final full face.

About the authors
Dr. Lorin Berland, a fellow of the AACD, pioneered the
Dental Spa concept in his multi-doctor practice in the
Dallas Arts District. His unique approach to dentistry
has been featured on television (“20/20”) and in national
publications and major dental journals, including Time
magazine. In 2008, he was honored by the AACD for his
contributions to the art and science of cosmetic dentistry.
For more information on The Lorin Library Smile Style
Guide, www.denturewearers.com and Biomimetic Same
Day Inlay/Onlay 8 AGD Credits CD/ROM, call (214) 9990110 or visit www.berlanddentalarts.com.
Dr. Sarah Kong graduated from Baylor College of Dentistry, where she served as a professor in restorative dentistry. She focuses on preventive and restorative dentistry,
transitionals, anaesthesia and periodontal care. She is an
active member of numerous professional organizations,
including the American Dental Association, the Academy
of General Dentistry, the American Academy of Cosmetic
Dentistry, the Texas Dental Association and the Dallas
County Dental Society.

[22] =>

[23] =>

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

September 2009

www.dental-tribune.com

Vol. 2, No. 7

Oral cancer: Early detection saves lives
By Arlene Guagliano, RDH, MS

Cancer of the mouth or oral cavity is one of the most preventable
cancers in the United States today.
According to the Journal of the
National Cancer Institute, more than
35,000 Americans will be diagnosed
with oral or pharyngeal cancer this
year.
It will cause more than 8,000
deaths, killing roughly one person
per hour, 24 hours per day. Of those
35,000 newly diagnosed individuals,
only half will be alive in five years.
This is a number that has not significantly improved in decades.1
Although the overall incidence
of oral cancer has remained stable
with numbers only slightly increasing each year2, currently this is the
second year in a row in which there
has been an increase in the rate of
occurrence, about 11 percent over
last year.
The death rate for oral cancer is
higher than that of other cancers
that we hear about routinely, such
as cervical cancer, Hodgkin’s lymphoma, laryngeal cancer, cancer of
the testes and endocrine system cancers such as thyroid or skin cancer
(malignant melanoma).1
Oral squamous-cell carcinomas
(OSCCs) are the eighth most common cancer among men and the
14th most common among women
in the United States.3
It includes many parts of the
mouth: the lips, the buccal mucosa
of the lips and cheeks, the gingiva
and the area behind the wisdom
teeth, the floor of the mouth, the
hard palate, the soft palate and the
uvula, the tonsils and the tongue.4
The ratio of men to women diagnosed with oral cancer is 2:1 over a
lifetime, although the ratio comes
closer to 1:1 with advancing age.
Approximately 96 percent of oral
cancer is diagnosed in persons older
than 40, and the average age at the
time of diagnosis is 63 years.
However, recent evidence has
emerged indicating that oral cancers are occurring more frequently
in younger persons, those under 40
years old.2
Common symptoms of oral cancer include:
• A sore or lesion in the mouth
that does not heal within two weeks.
• A lump or thickening in the
cheek.
• A white or red patch on the gingiva, tongue, tonsil or lining of the
mouth.
• A sore throat or a feeling that
something is caught in the throat.

Fig. 1: The ViziLight Plus.

Fig. 3a: Normal
tongue in normal
light.

Fig. 2: The VELscope.
• Difficulty chewing or swallowing.
• Difficulty moving the jaw or
tongue.
• Numbness of the tongue or
other area of the mouth.
• Swelling of the jaw that causes
dentures to fit poorly.1
Oral cancer is caused by damage
to the DNA of cells in the mouth.
There are two distinct pathways
through which most people come
to have oral cancer. Many years
ago, the most prevalent pathway
was through the use of tobacco
and alcohol, but today the growing
pathway is through exposure to the
human papilloma virus (HPV), the
same one that is responsible for the
vast majority of cervical cancers in
women.
Whichever the pathway, damage
to the cells occurs and they malfunction, mutating into cancer cells. The
anatomical malignancy sites associated with each pathway appear to
also be different from each other.
In the broadest terms, they can
be differentiated into the following
areas: HPV-related appear to occur
on the tonsillar area, the base of the
tongue and the oropharynx while
non-HPV positive tumors tend to
involve the anterior tongue, floor of
the mouth, the mucosa that covers
the inside of the cheeks and alveolar
ridges.
It is now confirmed that HPV is
the most common virus group in the
world today, affecting the skin and
mucosal areas of the body. More

Fig. 3b:
Normal tongue
viewed
with the
VELscope.
than 100 different types/versions of
HPV have been identified. Different
types of the human papilloma virus
are known to infect different parts
of the body. There are certain forms
of HPV that are sexually transmitted
and are a serious problem.
Today, in the younger age group,
including those who have never
used tobacco products, there are
those who have oral cancer, which
is HPV-viral based.
Two types of genital tract HPV in
particular, HPV 16 and HPV 18, are
known to be linked to oral cancer
and have been conclusively implicated in the increasing incidence
of young, non-smoking, oral cancer
patients. The HPV group is the fastest growing segment of the oral cancer population to date.1
Oral cancer is among the most
debilitating and disfiguring disorders seen in today’s oral health
environment. Tumors affecting a
patient’s mouth, tongue and soft palate can prohibit proper swallowing
and speech.5
In addition, the cancer can spread
to other parts of the body, causing
disability and even death. The survival of patients and the quality of
life after treatment depend on early
diagnosis. Eighty-one percent of
patients with oral cancer survive at
least one year after diagnosis. Early
detection is the key.4

The best defense against oral cancer is early discovery. Early detection is complicated by the fact that
many lesions in their earlier stages
may be completely asymptomatic.
Historically, unaided visual examination, palpation and radiographs
were the only methods available
for oral cancer screening. In recent
years, screening technologies have
become available to supplement
the visual examination and help the
clinician identify suspicious lesions
that require further investigation.6

Adjunctive screening aids

ViziLight Plus. Technology such
as light-based detection systems
increases a clinician’s ability to see
tissue changes that the naked eye
might miss. One such technology is
ViziLite Plus, a simple screening tool
that helps visualize suspect tissues
in the oral cavity (Fig. 1).
Lesions that may have gone
unnoticed to the naked eye will be
more visible using Toluidine blue
(T-Blue) tissue dye and chemiluminescent light, which marks and
identifies oral lesions.
The patient rinses with a dilute
acetic acid solution, and abnormal
squamous epithelium tissue will
appear acetowhite when viewed
under ViziLite’s diffuse low-energy
g HT page 2E

[24] =>

Editor’s Letter

Hygiene Tribune | September 2009

Dear Reader,
Have you have taken me up on
my challenge to have written something by the time you receive this
edition?
I hope that some of you have
tried your hand at this project. If
you have, read on to learn what to
do now. If you haven’t, that’s OK
because you can still read about the
next step in the process.
Once you’ve written an article, it
is important to have others read it;
and in this case, the more pairs of
eyes that do this, the better it is for
you the writer.
You should ask readers to answer
the following questions: Is the main
idea of the article apparent? Is the
article concise and to the point?
Does the article teach readers something or give them something to
think about?
These three questions actually
summarize what are likely to be
the most common objectives of any
writing you undertake. If a reader
answered no to any one of them, ask

him or her to give you a bit more
feedback as to how things fell short
in that area.
Having more than one pair of
eyes read the article results in a
variety of feedback, some of which
may form a repeated refrain and
some of which may not.
Before you set about the next
step, which is doing a round of revisions, summarize the feedback you
received.
With the list of feedback nearby,
you can begin to revise. Reread the
article with this feedback in mind
in order to determine where in the
article you need to make changes.
The end goal is to have the three
basic questions answered with not
only a yes, but a resounding yes.
Once you feel you’ve achieved that,
the document is ready for the next
step in the process.
Work on your revisions for now.
In next month’s edition I will explain
the next step on the path to publication.

f HT page 1E

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

Publisher & Chairman
Torsten Oemus
t.oemus@dental-tribune.com
Vice President Global Sales
Peter Witteczek
p.witeczek@dental-tribune.com
Chief Operating Officer
Eric Seid
e.seid@dental-tribune.com
Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com
Editor in Chief Hygiene Tribune
Angie Stone RDH, BS
a.stone@dental-tribune.com
Managing Editor/Designer
Implant Tribunes & Endo Tribune
Sierra Rendon
s.rendon@dental-tribune.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com

Best Regards,

Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Product & Account Manager
Mark Eisen
m.eisen@dental-tribune.com

Angie Stone, RDH, BS
Editor in Chief

Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dental-tribune.com

biochemical information about the
cells at and just beneath the surface.
This gives clinicians the ability
to see early biochemical changes
before they present more obviously,
and therefore to detect lesions earlier in the disease process.7
Figue 3a is an image of a normal
tongue in normal light, and Figure
3b is an image of a normal tongue
with the use of the VELscope (images courtesy LED Dental).
Figure 4a shows a tongue with
an area that appears normal under
white light. However, Figure 4b
shows the area as seen under the
VELscope. The dark area is VELscope positive, which was confirmed
by biopsy as carcinoma in situ
(images courtesy of LED Dental).

Fig. 4a: Close-up of
the tongue in
normal light.

In-office tissue test

Fig. 4b:
Tongue
close-up
with the
VELscope
showing
in situ
carcinoma
that was
confirmed
by biopsy.
wavelength light.
Normal epithelium will absorb
the light and appear dark. ViziLite
can assist a dentist or hygienist in
identifying an abnormality in the
oral cavity that may need further
testing, such as a biopsy.
It has been difficult to determine
which tissues in the mouth are cause
for concern. It is with continued
research that technology has forged
forward and developed adjuncts for
the oral health care professional
to intervene when early signs are
unclear.

HYGIENE TRIBUNE

VELScope. The VELscope integrates four key elements: illumination, sophisticated filtering, natural
tissue fluorophores and the power of
human optical and neural physiology (Fig. 2).
Next to public awareness, which
is essential regarding the risk factors in oral cancer, the role of the
dental professional is the first line
of defense in early detection of the
disease.
The VELscope illuminates tissue
with specific wavelengths that interact with and provide metabolic and

OralCDx BrushTest. An essential
tool for early detection of oral cancer is the OralCDx BrushTest, or
oral brush biopsy (Fig. 5). This is the
only painless test for oral dysplasia
(pre-cancer) and cancer.
The BrushTest was found to be
at least as sensitive as a scalpel in
ruling out dysplasia and cancer in
every study in which the same tissue
was simultaneously tested by both
OralCDx and a scalpel biopsy.8,9
This procedure is simple and can
be done right in the dentist’s chair.
It results in very little or no pain or
bleeding, and requires no topical or
local anesthetic.
Firm pressure with a circular
brush is applied to the suspicious
area. The brush is then rotated five
to 10 times, causing some pinpoint
bleeding or light abrasion. The
cellular material picked up by the
brush is transferred to a glass slide,
g continued

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

Dental Tribune America, LLC
213 West 35th Street, Suite 801
New York, NY 10001
Tel.: (212) 244-7181
Fax: (212) 244-7185
Published by Dental Tribune America
© 2009 Dental Tribune America, LLC
All rights reserved.
Hygiene Tribune strives to maintain
utmost accuracy in its news and clinical
reports. If you find a factual error
or content that requires clarification,
please contact Group Editor Robin
Goodman, at r.goodman@dtamerica.
com. Hygiene Tribune cannot assume
responsibility for the validity of product
claims or for typographical errors.
The publisher also does not assume
responsibility for product names
or statements made by advertisers.
Opinions expressed by authors are
their own and may not reflect those of
Dental Tribune America.

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

[25] =>

Clinical

Hygiene Tribune | September 2009
f continued

Fig. 5:
The OralCDx
BrushTest.
6.
preserved and dried.
The slide is then mailed to a
laboratory along with written documentation about the patient and a
detailed description of the questionable area of the mouth. At the laboratory, the sample will be examined
for cells that show signs of change,
such as dysplasia or full malignancy.
A pathologist examines the cells
to determine the final diagnosis. A
lab report is then sent to the dentist, and experts from the pathology
department provide patient-specific
follow-up guidance by telephone for
every abnormal OralCDx report.

Oral Cancer Risk and Detection: The Importance of Screening Technology; Lynch, Denis
P. DDS Ph.D; www.ineedce.com/
pathology.html.
John C. Kois, DMD, MSD, and

P&F Ad-DTA

1/14/09

2:45 PM

Page 1

Edmond Truelove, DDS, MSD;
Detecting Oral Cancer: A New
Technique and Case Reports,
Dentistry Today, 2006, Oct;
25(10):94, 96–7.
“Oral
cytology
revisited”;
R. Mehrotra, M. Hullmann,
R. Smeets, T. E. Reichert, O.
Driemel; Journal of Oral Pathology & Medicine Volume 38,
Issue 2, Date: February 2009,
Pages: 161–166.
“Improving Detection of Precancerous and Cancerous Oral
Lesions:
Computer-Assisted
Analysis of the Oral Brush Biopsy”; James J. Sciubba, D.M.D.,
PH.D.; and for the U.S. Collaborative
OralCDx
Study
Group (JAMA) Journal of the
American Dental Association
1999;130:1445–1457.

About the author
Arlene Guagliano, RDH,
MS, is an associate professor
at Farmingdale State College
in the department of dental
hygiene and an assistant professor at Hostos Community
College in the dental hygiene
unit. Her professional experience includes 29 years in clinical practice specializing in geriatric dental care, oral cancer
screening for early detection,
dental hygiene education, caries management and periodontics. She can be reached at
arlene.guagliano@farmingdale.
edu, or via phone at (516) 6800231.
AD

™

A final word

The American Dental Association
states that 60 percent of the U.S.
population sees a dentist every year.
One only has to look at the impact
of the annual PAP smear for cervical
cancer, the mammogram to check
for breast cancer, or PSA and digital
rectal exam for prostate cancer to
see how effectively an aware and
involved public can contribute to
early detection, when coupled with a
motivated medical community.
The dental community needs to
incorporate adjunctive technology to
the screening process and assume
the same leadership role as the
medical community if oral cancer is
to be brought down in the future
from its undeserved high ranking as
a killer.1 HT

Contains no
Bisphenol A

References
1.
2.

The Oral Cancer Foundation
2007; www.oralcancerfounda
tion.org.
Inside Dentistry—The Forgotten Disease “Oral Cancer: Early
Detection and
Prevention”
Nelson L. Rhodus, DMD, MPH;
January 2007; Vol 3, No 1.
Chaturvedi, Anil K., Engels, Eric
A., Anderson, William F., Gillison, Maura L.; Incidence Trends
for Human Papillomavirus —
Related and Unrelated Oral
Squamous Cell Carcinomas in
the United States; Journal of
Clinical Oncology; February 1,
2008; Vol. 26, No. 4.
University of Texas Cancer Center; Oral Cancer M.D. Anderson
Cancer Center; www.mdander
son.org/diseases/oralcancer.
Baker, Gerry I.: Radiation Therapy to Head and Neck, Dental
Hygiene News, Fall 1991, Vol. 4
No. 4, p 1, 2.

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

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
■
✔ Easy to apply – only sealant that bonds in a moist field
■
✔ Margin-free seal
■
✔ Fast light cure
■
✔ Fluoride releasing
■
*Contact Pulpdent for study.

PULPDENT

Corporation

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

pulpdent@pulpdent.com • www.pulpdent.com

[26] =>

This interactive DVD
is written, directed,
and narrated
by Dr. Stanley
Malamed, dentistry’s
leading expert in
the management
of medical
emergencies.

Dr. Stanley Malamed
Dentist Anesthesiologist

“You don’t get a chance to save a life
you’ve lost. So get it right...the first time.”

Contains 14 different situations that can and do arise in the dental office
Including Cardiac Arrest, Seizure, Allergic Reaction and many others...
Dr. Malamed breaks down these scenarios using high definition 3D
animations and stunning dramatizations.
Great for in-office training sessions or individual training.
7 Continuing dental education credits available.

Visit us at the American Academy of Periodontology Annual
Meeting, booth no. 1144.

) [page_count] => 26 [pdf_ping_data] => Array ( [page_count] => 26 [format] => PDF [width] => 765 [height] => 1080 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => DT U.S. 2509

[toc] => Array ( [0] => Array ( [title] => ‘American dentistry at its best is remarkable’ [page] => 01 ) [1] => Array ( [title] => Curbing cancellations and no-shows begins chairside [page] => 05 ) [2] => Array ( [title] => Business continuity and IT mangement (Part 1 of 2) [page] => 11 ) [3] => Array ( [title] => Fiscally fit in 2009 [page] => 12 ) [4] => Array ( [title] => Events [page] => 14 ) [5] => Array ( [title] => Industry [page] => 15 ) [6] => Array ( [title] => Pediatric advanced life support (PALS) customized for dentists [page] => 17 ) [7] => Array ( [title] => Cosmetic Tribune 7/2009 [page] => Supplement1 ) [8] => Array ( [title] => Hygiene Tribune 7/2009 [page] => Supplement2 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

[cached] => true )