DT U.S. 3709

Same-day inlay/onlay technique (entree) / Florida periodontist launches online C.E. site / The oral body connection / Dental tissue engineering products in the U.S. market to double by 2015 / Making sense of digital radiography / Fiscally fit in 2009* / Is personality causing a ‘disorder’ in your practice? / Create more value through cosmetic dentistry / Same-day inlay/onlay technique / The utility of cone-beam computed tomography in endo / Dependent adults: The key is biofilm reduction / A moisture tolerant - resin-based pit and fissure sealant / DTSC Hygiene Webinar series / Have you been to our Web site lately? / Invisalign innovation: improved clinical results for a broader range of patients / Industry News / Cosmetic Tribune 10/2009 / Hygiene Tribune 10/2009

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Table of contents

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

December 2009

www.dental-tribune.com

Vol. 4, Nos. 37 & 38

CosmetiC tRiBUNe

HYGIENE TRIBUNE

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

Personality ‘disorder’?

Learn how personality types affect the office.

u page 10A

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

Implant-retained dentures

Several options offer functionality and esthetics.

Lasers in dental hygiene

u page 1B

Learn why this author won’t work without a laser.

upage 1C

Same-day inlay/onlay technique
Want to save teeth and time and improve your practice?
By Lorin Berland, DDS, FAACD

I’m always looking for ways to
help my patients get the dentistry they want and deserve. More
and more patients are demanding
esthetic, reliable alternatives for
their old, defective amalgams.
They still want to avoid crowns,
root canals and multiple visits.
This is why I’ve been providing
reliable, durable and much appreciated biomimetic same-day inlays
and onlays for years.

What is biomimetic dentistry?
Biomimetic dentistry is conser-

vative, preservative dentistry. We
treat weak, fractured and decayed
teeth in a way that conserves
tooth structure and helps preserve
strength.
This helps provide resistance
to bacterial invasion. It reduces
the need to drill down teeth for
crowns and will reduce postoperative discomfort, as well as the need
for two appointments, and possible
endodontic treatment.
In essence, it is utilizing the
latest in dental materials and technology to keep what we’ve got
for as long as we’ve got — just
as nature intended. Unlike other

Archived hygiene Webinars: Earn 3 C.E. credits!

parts of our bodies, our teeth do
not mend on their own.
It is, therefore, imperative to
conserve as much natural tooth
structure as possible. We strive
to do this with same-day inlays/
onlays.
This means no excessive tooth
removal, no cumbersome temporaries and no time-consuming and
uncomfortable second visits.

Biomimetic: to copy/mimic
nature
Nature is our ideal model. In order
g DT page 14A

Fig. 2: Immediate post-op, occlusal.

The oral body connection
By Fred Michmershuizen, Online Editor

What does oral health have to do
with heart health? Quite a bit if you
ask some of the leading experts in their
respective fields.
Evidence has long shown that those
with diseased mouths are at a higher
risk for heart attacks and strokes.
More recent findings indicate that
improving a person’s oral health
reduces the risk of atherosclerosis or
The DT Study Club Webinar series “Simple Advanced Treatment Modalities
for the Dependent Patient” with Hygiene Tribune Editor in Chief Angie Stone,
left, and Dental Tribune author Shirley Gutkowski is available online for
g See page 19A
viewing at a time that suits your schedule.

Fig. 1: Large, broken-down amalgam.

plaque in arteries. The evidence is so
strong that leading experts in periodontology and cardiology are teaming
up to encourage other dental and medical professionals to work together.
“The immense power we have as
dentists to impact not just our patients’
oral condition but their entire general
state of health is becoming clearer in
the science when it comes to reducing
g DT page 4A
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Dental Tribune America
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Suite #801
New York, NY 10001

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[2] =>

Interview

Dental Tribune | December 2009

Florida periodontist launches online C.E. site
Periodontist Dr. Bradley Engle discusses online continuing education and how it addresses the needs of dental professionals
In an interview with Dental Tribune, Dr. Bradley Engle, a periodontist in Naples, Fla., who founded
and runs an educational Web site,
www.dentaledu.tv, discusses online
continuing education and how it
addresses the needs of dental professionals.
Please tell our readers a bit about
your own personal dental background and how you became
interested in continuing education.
I went to Ohio State University and
gained early acceptance to dental
school. By age 24, I earned my dental degree from the Medical University of South Carolina. Over the next
36 months, I earned my periodontics
certificate as well as a master’s of
health science degree [MHS].
Soon after residency, I passed
both parts of the board exam to
become a board certified periodontist.
I became a clinical associate professional at the Medical University
of South Carolina in 2004. Due to the
travel distance between Charleston,
S.C., and Naples, Fla., it was clear
that I had to provide a more direct
link between the periodontal residents and me.
It was simply impossible to provide teaching there any more than
once every couple of months.
ADS

In 2006, I hired a professional
company to install a high-definition
surgical production studio at my
Naples location. It was kind of fun
recording surgical procedures and
making DVDs for the residents to
watch and archive for reference.
Since graduating from residency,
I have enjoyed providing lectures
around the world.
How long has www.dentaledu.tv
been around and what has been
the response to it so far?
Last November, my producer, Emanuel Boeck, and I stumbled upon a
rare format of video that allowed
streaming through the Internet at
a standard Internet speed. By February, we were able to develop a
functioning dental C.E. video distribution Web site. We hired a fulltime programmer to continually add
additional functionality to the Web
site.
It is a nice compliment that both
content providers as well as comarketing partners and sponsors
are contacting me daily for more
information and how to become
involved.
We recently started forming a
steadily growing momentum, especially since we completed the live
video broadcasting system with twoway chat system.
We are a recognized dental con-

tinuing education
provider by ADA
CERP, AGD
PACE and the
Florida Board
of Dentistry.
How many
courses do
you offer?
Over a period
of six months,
we
filmed
over 36 content providers with over
65
course
titles. All of
our content
providers are
recognized as key opinion leaders in
dentistry. In Addition, our user base
is expanding rapidly.
The site obviously offers tremendous convenience for dental professionals who can learn at home,
at their own pace. But are there
any disadvantages for those who
seek continuing education online?
Dentaledu.tv provides a very complete solution for online dental C.E.
Recently, I was told that we were the
“next generation Webinar.” There
are disadvantages to online C.E.,
which include the following: Some
health care providers coordinate
their vacations with taking CE.
Their tax deductable vacation
expenses are lost when there is no
longer a need to travel to receive
credits. Despite dentaledu.tv having
the ability to provide clean, fullscreen video streaming, the interaction with the instructor is lost online.
To help increase the interaction
with the provider, we developed a
two-way chat system to allow the
user to communicate directly with
the content provider during live
events.
Your Web site is very high-tech
and very professional. How complicated was it to set it up?
I spent day and night over the last
two years dreaming and implementing the development of this project.
Forming strategic relationships with
other professionals, I got lucky to get
as far as I have gotten.
Owning
100
percent
of
both the production company,
www.1mediaproduction, and DentalEdu, www.dentaledu.tv, has kept
the control and advancements of
this project solely with me.
Since we are a video Web site,
I have partnered with someone —
Emanuel Boeck, a major film producer and director from Europe —
who has made full-length films. He
can mobilize a film crew to produce
a one-hour course or can cast call a
DentalEdu commercial.
Emanuel helped perfect the use

of our video format and has been a
loyal friend throughout the last two
years.
Our full-time programmer has
incorporated patent pending technology that provides a lot of the
functionality of the site. He understands and has rewritten the Adobe
video players to function as we need
them to.
Since May 2009, he has perfected
all of the databases and has created
a completely automated Web site.
In your opinion, what do you
think the future holds for online
dental continuing education?
Due to providers’ crazy professional schedules, online education will
reduce or eliminate trade shows and
some of the smaller venues.
The larger venues will use a platform like dentaledu.tv to broadcast
high-definition, TV-quality videos to
providers that were unable to travel
to the meeting.
The next few years will be crucial. Our video systems can stream
video to the iPhone. Currently, all
of our videos are saved on our
server, ready to stream. The future
is video. DT

Contact information

Bradley J. Engle, DMD MHS
5659 Naples Blvd.
Naples, Fla. 34109
Tel.: (239) 593-2178
Cell: (239) 821-3388
E-mail: engle@dentaledu.tv

[3] =>

[4] =>

News

Dr. Neil Gottehrer, left, a periodontist, and Dr. Marvin Slepian, a
cardiologist, have written a resource
guide for dentists and doctors to use
in the evaluation and management
of inflammation — whether in the
mouth or in the cardiovascular system. (Photo/Fred Michmershuizen)
f DT page 1A
whole body inflammatory side effects
from dental conditions,” said Dr. Neil
Gottehrer, a periodontist who is considered a leading dental authority on
the oral-body inflammatory connection.
Gottehrer and Dr. Marvin Slepian,
a cardiologist, delivered an address
at the recent Academy of General
Dentistry meeting in Baltimore on the
subject and co-wrote a guide, Evaluation & Management of the Oral Body
Inflammatory Connection. The guide
AD

Dental Tribune | December 2009
was printed as a courtesy by Chase
HealthAdvance financing options.
“As more physicians and dentists
become fully aware of this and understand that there are treatment protocols shown to diminish or eliminate gum disease for the long term,
we’re going to start seeing many more
patients having healthier lives medically because of what happens in the
dentist’s office,” Gottehrer said. “We’re
probably entering one of the most
exciting phases that dentistry has ever
seen.”
Slepian told Dental Tribune that
many people who are at risk may not
be receiving any dental or medical
care at all. He said it is important when
such high-risk people do enter either a
dental or medical office, that they be
referred to the other specialty as well.
For example, he said, a person who
enters a dental office for treatment of
inflamed gums may be on the brink of
a “major event.”
On the other hand, Slepian said,
patients being treated for heart disease
can reduce their risk and improve
their overall health by improving their
oral health.
“Some diseases in the domain of
the dental world have an impact on
the medical world, and vice versa,”
Slepian said. “If you have a bad mouth,
you may be on your way to having a
bad heart.”
Gottehrer and Slepian are advo-

cates of a new system for dentists
to strengthen the referral relationship
between physicians and dentists for
reducing risks for systemic disease due
to dental disease. For dentists, simple
screening tools are available to use
with their patients.
“We have to be partners in general
health care,” Slepian said.
Two blood tests are available to
help reveal whether oral disease is
having effects beyond the mouth into
the circulatory system. Treatment by
the dentist and dental hygienist can
directly impact substances suspected
of contributing to whole body disease.
“Typically evident in most patients
with dental disease who were also
recorded as exhibiting the biological
markers on a blood test, require some
type of periodontal care and oftentimes tooth replacement with dental
implants or the use of Captek periodontal crowns if they have dental
crowns next to the gums,” Gottehrer
said.
Resources are available for dentists and doctors who are interested in
incorporating these philosophies into
their practices.
Big Case Marketing, a marketing
and case acceptance consulting firm
for dentists, has developed a referral
and marketing program for general
dentists, periodontists, oral surgeons
and prosthodontists that helps facilitate relationships with physicians.

“For some dental specialists, this
referral model will significantly
enhance their relationship with physicians and their referring dentists,” said
Dr. James McAnally, CEO of Big Case
Marketing.
The program from Big Case Marketing includes clinical protocol manuals,
administrative protocols, in-office clinical forms, physician referral forms,
and physician-dentist-patient referral
communication letters.
ChaseHealthAdvance financing
options, a division of Chase Card Services of JPMorgan Chase, is offering
a complimentary copy of the Evaluation & Management of the Oral Body
Inflammatory Connection guide upon
enrollment to both dentists and physicians.
“Our patient financing product
can help more patients accept the
treatments their health care providers prescribe to them by breaking up
treatment costs into more manageable
monthly payments,” said Barry Trexler, senior vice president of sales and
marketing for ChaseHealthAdvance.
“We give all approved patients a credit
line of at least $5,000.”
Information about the referral and
marketing system is available from
Big Case Marketing at www.BigCase
Marketing.com.
For ChaseHealthAdvance financing, call (888) 388-7633 or visit www.
advancewithchase.com/guide. DT

[5] =>

0A
Dental TRubric
ribune | December 2009

Dental Tribune
| Month 2009
5A
News

Headline
Dental
tissue engineering products
Deckthe U.S. market to double by 2015
in
By line

By Heather Paterson, BSc & Kamran
Zamanian, PhD

tk
Use of tissue engineering is a rapidly growing trend in dental offices
across the United States. Used in
dental bone graft procedures, tissueengineering products initiate osteogenesis and the selective regrowth
of supporting tissues.
Tissue engineering enhances
osteoinductivity to increase the rate
and volume of bone regeneration,
leading to increased success in dental bone grafting.
The U.S. market for tissue engineering is expected to reach nearly
$50 million by 2015.

New products drive adoption
In 2009, the market for dental tissue
engineering was composed of only
three products: GEM-21S, distributed by OsteoHealth; INFUSE, distributed by Medtronic; and Emdogain,
distributed by Straumann.
Emdogain was approved by the
FDA in 1999, while both GEM-21S
and INFUSE did not enter the market until after 2005. Tissue-engineering products are gaining more
acceptance from dentists and oral
surgeons, allowing them to be used
in a wider range of dental procedures.
The continued introduction of
new, competitive products will drive
the adoption of tissue engineering to improve the effectiveness of
bone grafting, especially in elderly
patients.

Expands patient base for dental
bone grafting
Bone regeneration is enhanced with
tissue-engineering products, allowing dental bone grafting procedures
to be performed on patients who
would otherwise not be able to
receive such treatment.
Tissue-engineering
products
encourage native bone cells, or
AD
osteoclasts, to grow into grafted bone
material, compensating for the very

low endogenous or natural level of
growth factors in older patients.

A lucrative market opportunity
Tissue engineering products for
dental applications are expected to
remain a niche market, but their
high price and associated procedure
fees represent a lucrative opportunity for dentists.
Procedures using tissue-engineering products do not require
much more time than conventional
bone grafting procedures while generating substantially larger billing
revenues.

Chart 1: Dental bone graft substitutes by material type, U.S., 2009.

Autografts account for large
proportion of dental bone grafts
In 2009, over one fifth of dental bone
graft materials used were autografts,
material taken from the patient’s
own body, as shown in Chart 1.
Other types of bone graft substitutes
include allografts, demineralized
bone matrix (DBM), xenografts and
synthetics.
Autografts are widely considered as an optimal material for
bone grafting due to their inherent
growth factors and natural scaffolding. While autografts have no commercial price, the time required to
harvest them is an opportunity cost
for dental professionals.
Autograft materials are generally
used immediately after the extraction of the problematic tooth and
often combined with another type of
bone graft substitute.
The volume of autografts used
is expected to grow at a compound
annual growth rate (CAGR) of 8.3
percent by 2015.

Strong recovery expected in dental
bone graft substitutes market
The U.S. market for dental bone
graft substitutes (BGS) experienced
a large decline in late 2008 through
2009 due to the economic recession, which resulted in a decreased
demand for dental implants and the
associated bone grafting procedures.

About the authors

Chart 2: Markets for dental implants and bone graft substitutes, annual
growth rate, U.S., 2005–2015.
Many consumers lost financial
confidence and limited their spending for dental implant procedures
and bone grafts.
With fewer patients, practitioners
were reluctant to purchase as many
implants and bone graft substitutes.
However, the dental bone graft
substitutes market closely follows

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

Heather Paterson, BSc is a research analyst at iData Research. Kamran Zamanian is the head of research at iData Research. iData Research
is an international market research and consulting group focused on
providing market intelligence for the medical device, dental and pharmaceutical industries.
The information contained in this article is taken from a detailed and
comprehensive global series on the “Markets for Bone Graft Substitutes
and Other Biomaterials 2009,” which is available for purchase from
iData Research and includes coverage on the United States, 17 countries
in Europe and three countries in Asia Pacific.
iData also offers global market intelligence reports on the dental
implant, dental prosthetic and dental CAD/CAM markets. For more
information about this and other reports on the dental industry, call
(866) 964-3282, e-mail dental@idataresearch.net or visit www.idata
research.net.

that of dental implants and is expected to show a strong recovery in 2010,
returning to double-digit growth
rates.
The bone graft substitute market
is expected to grow faster than the
dental implant market as long as
prices for BGS materials increase
faster than those for implants. DT
AD

[6] =>

Digital Matters

Dental Tribune | December 2009

Making sense of
digital radiography

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Singular Payments, LLC is a registered ISO/MSP of Wells Fargo Bank, N.A., Walnut Creek, CA

By Lorne Lavine, DMD

The look and feel of the modern dental practice has changed dramatically over the past 10
years. Systems that were once paper-based have
now moved into the digital realm. In many dental
advances over the past few years, there’s no doubt
that the technology has been the driving force in
this process. This is as true in other fields as it has
been in dentistry.
In the early 1990s, intraoral cameras were all
the rage. In the late ’90s, it was digital cameras. At
present, no other topic seems to generate greater
interest than digital radiography. While entire
books can be written on the subject, the goal for
this article is to focus on how digital radiography
can improve the profitability of the practice, particularly by improving case acceptance.
In Part II, which will be published in a few
weeks, we’ll take a closer look at the infrastructure that is required as this is often overlooked by
many practices.
Having worked with hundreds of offices that
have installed digital radiography, the biggest
hurdle to adopting this technology is financial.
While these initial costs are high, there is little
doubt that using digital radiography can definitely
help the bottom line of the practice by increasing patients’ willingness to come to the practice
and accept treatment. There are a number of key
areas where digital radiography makes sense.

Image size and quality matters
There is no doubt that in order to increase case
acceptance, we have to improve our ability to
diagnose disease, and the vast majority of dental
practices find digital radiography to be superior
to film.
In a recent survey, over 73 percent of the
respondents claimed that they found digital radiography to be more diagnostic than film. There
are a few reasons for this.
First, there’s a big difference between seeing
a life-size image that is around 1 inch compared
to an image magnified to fill up a typical 17- or
19-inch screen. Secondly, and just as important,
all digital radiography software gives us incredible tools to improve diagnostics. There are a few
programs that really simplify this process.
For example, XDR, a smaller company from
the Los Angeles area, offers a “caries” icon and
a “perio” icon. One click of the icons will apply
numerous filters and enhancements to bring out
the diagnostic features of the image with minimal
muss and fuss.
One thing to keep in mind, however, is that if
it’s necessary to enhance every image in order to
make it diagnostic, then there’s probably something wrong with the exposure times on the X-ray
head or other problems. It’s not an efficient use of
your time if you have to modify every raw image
that you take.

Timesaving
A practice that is efficient and saves time will be
very attractive to your patient base, many who are
busy and would prefer to minimize the time spent
in the office. The time saved with digital radiography is quite significant. However, it’s important
to understand that the time saved is limited to the
hard sensors.
While an excellent option for many offices,
phosphor plate systems do not provide any timesaving over traditional film. Many offices can
start and finish a full mouth series of radiographs
g DT page 10A

[7] =>

[8] =>

Financial Matters

Dental Tribune | December 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
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

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.

* This article appeared in our August
editions, but as the year is about to come
to a close, we felt it beared repeating.

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 much longer
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.

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

Don’t forget bonus depreciation
Your practice may generally claim

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

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 | December 2009

Headline
Is personality causing a

‘disorder’ in your practice?

Deck
By line

By Sally McKenzie, CMC

It is an unfortunate irony: survey a
group of dentists and many of them
will tell you that they chose this profession because they grew up enjoying
working with their hands.
Or perhaps they genuinely wanted to help people, and probably they
always loved science. Maybe they
knew they wanted a medical career,
but didn’t want the physician’s way
of life.
There are a number of very good
reasons why people choose to enter
dentistry. However, few would say they
entered the field because their No. 1
desire in life was to spend day after day
talking to people.
Even fewer would say they got into
the profession because they wanted
to be in charge of a dozen staff members or wanted to worry about making
money or selling cases or dealing with
an unhappy patient now and then.
The fact is that the art and science of
dentistry attracts certain types of individuals, and most entered the profession to simply “do the dentistry.” Yet,

f DT page 6A
in well under 10 minutes, allowing patients to get in and out of the
office quicker.
From the practice’s standpoint,
being able to see patients quicker means that additional patients
can be scheduled during the day,
improving the profitability of the
practice.

Reduced exposure time
Another key feature of digital radiography is the fact that you can
reduce the exposure time of the
radiographs. This can be a big selling point for current and future
patients.
One thing to be cautious of is that
many vendors still claim unrealistic
amounts of exposure reduction.
When digital radiography was
first introduced, film was much
slower and the claims of 80–90 per-

once there, they quickly discover there
is far more to succeeding in this profession than being an expert clinician.
There is considerably more to being
the leader of the team than being the
one who signs the checks. In addition,
when it comes to working with people,
it is far more difficult than anyone ever
imagines.
No one prepared you for the interpersonal tiffs that wear away your
energy or the battles that take on a life
of their own or the wars that cause you
to consider walking away from your
profession and never returning.
“Sure, everyone’s different, but
can’t we all just get along?” laments
one road-weary dentist after another,
exhausted from the stresses of trying to
guide a divisive team through to some
measure of success, day after day.
Yes, there is a lot more to being a
successful dentist than being a good
clinician. One factor in particular that
is seemingly elusive but profoundly
important is personality — that of the
dentist and everyone else on staff.
Years ago, personality clashes were
dismissed as minor and inconsequen-

cent reduction in exposure were
accurate. However, over the past 15
years, the speed of film has greatly
increased, and many offices are now
using E speed film.
While offices using digital radiography should still expect a reduction,
it’s closer to 30–50 percent over film.
What I always suggest for practices, which may seem counter intuitive to what most people expect,
is to take the X-rays at the highest
possible setting without overexposing them.
Not only do underexposed digital
X-rays appear grainy, you may end
up missing many problems because
there’s not enough radiation to pick
up on pathology.

tial.
However, over the years, studies
have shown those little “personality
conflicts” can metamorphose into allout wars leaving collateral damage
rivaling that of history’s major battles.

Personality: Plus or problem?
What exactly is this unwieldy thing
called personality? There are a variety
of traits and every person’s personality
is composed of a combination of 16
categories. While people are different

their trust of the practice and the
dentist to proceed with dental treatment.
In many cases, their dental conditions were not apparent to them and
did not have any associated pain, so
patients were completely unaware
of their dental problems.
While we often tried to show
patients the X-rays on a light box,
this is not ideal for most patients as
they have difficulty seeing the problems. Digital radiography changes
all of that.
Now, dental problems that show
up in a radiograph can be viewed
on a 17- or 19-inch screen and the
patients, for the first time, can see
exactly what we as dental profes-

due to their upbringing and life’s experiences, their basic personality will fit
into one of the 16 categories.
Introverted personality types, for
example, enjoy spending time alone.
They need to have quiet time for concentration and dislike being interrupted by the telephone.
They can work on one project for
a long time without any interruption
and can have trouble remembering
g continued

sionals can see. Once they see and
understand their condition, they will
be far more accepting of our treatment plans as there will be no doubt
in their mind about the status of
their condition.
There’s little doubt that digital
radiography is still a very hot topic
in dentistry. By my estimation,
around 40 percent of practices are
now digital and I expect that to
rise to 60 percent in the next two
to three years.
With the federal government
mandating an electronic health
record by the year 2014 and stimulus funds soon available, there’s
no time like the present to get
started. DT

Codiagnosis
Probably the biggest selling point of
digital radiography for case acceptance is the concept of co-diagnosis.
In the past, patients had to rely on

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.

[11] =>

0A
Dental TRubric
ribune | December 2009

Headline

f continued

names and faces. They prefer to work
alone and may prefer to communicate
in writing rather than talking.
Introverted dentists tend to be
exhausted when they go home at night.
By line
Depending on the degree of introversion, these doctors have to force themselves to be extroverted all day long,
which
tk drains their energy level. Introverted dentists also are not comfortable giving verbal feedback to employees, which is essential in addressing
performance issues and management
system shortfalls.
Moreover, introverted dentists can
also have low case acceptance rates
because they are unable to clearly
articulate patient needs. They don’t
naturally engage in conversation so
they are less likely to ask patients about
dental wants. This difficulty in communication takes its toll on the practice,
and there is often a struggle to reach
practice goals that can unwittingly
make staff members come across as
uncaring and aloof to patients.
Consider Dr. Goodfellow. He is an
excellent clinician who loves the profession of dentistry, but he absolutely
will not do anything else during a
hygiene check except a hygiene check.
Why? Because Dr. Goodfellow is an
introverted dentist and he really just
wants to get back to the patient he was
pulled away from.
The hygiene patient in the chair,
who’s been staring at her discolored
teeth for years and is tired of them,
wanted to ask about veneers but has
no opportunity. Dr. Goodfellow doesn’t
ask questions. He offers no suggestions, such as, “Ms. Sutherland, have
you ever considered whitening or
veneers?”
He doesn’t offer the slightest hint
that he has a moment more to spend
on this patient. He is on the “check
and charge” path: check the patient,
tell him/her all looks good and charge
right back out that door. Yet, Dr. Goodfellow doesn’t understand why new
patient numbers aren’t higher or why
production isn’t better.
Opposite of introverted personalities
are the extroverted. Extroverts love
talking to people and being with people. Extroverts like variety and action
in their jobs and are sometimes impaAD
tient with long, slow jobs. They enjoy
talking, sometimes too much, and generally would prefer to communicate
by talking rather than writing. It is not
uncommon for extroverted dentists to
run behind schedule.

Deck

Introvert vs. extrovert: Let the games
begin!
The
typical
misunderstandings
between extroverts and introverts can
be a source of ongoing conflict in dental practices. Introverts seem to understand that extroverts are boisterous.
Yet extroverts cannot seem to comprehend why their introverted colleagues don’t enjoy talking and being
around people to the extent that extroverts do. As a result, extroverts can fall
into the trap of looking at introverts as
if there is something wrong with them.
“What’s her problem?!”
Introverts can come across to

extroverts as being snobbish. Similarly, introverted clinicians often come
across as moody. They may be short in
their answers because they do not like
to engage in conversation longer than
is necessary and are not interested in
openly sharing the reasons why they
don’t feel good or are not happy.
Because of introverts’ desire not
to communicate outwardly, they have
a difficult time in dentistry overall.
Extroverts who work with them often
are trying to figure them out and
understand what’s going on. Extroverts may perceive the office as being
tense and feel as though they are walking on eggshells.
In some cases, the difficulties of
the clinician are further compounded
by the fact that these dentists have a
tendency to hire employees with similar personalities. Introverted dentists

Dental Tribune
| Month11A
2009
Practice
Matters
are more comfortable with introverted
staff members who, like themselves,
don’t care to talk all the time. Unfortunately, this general aversion to communication can spell trouble for the
practice.
The overall lack of communication
not only affects treatment acceptance,
it also has a powerful impact on team
dynamics and the ability of the office
to maximize the talents of the staff.
To achieve the level of success that
these dentists want and are capable of
requires that they learn some extroverted behaviors.

‘She doesn’t care’ vs. ‘he’s too
emotional’
Another dimension of personality are
the “thinking” and “feeling” types.
Other than the extroverts and introverts, this is the second greatest source

of conflict among dental teams. This
dimension relates to how people make
decisions.
The thinking type will make an
objective impersonal decision whereas
the feeling type will make an emotional decision. The thinking type is usually very analytical and considers all
the evidence before making a decision
about something even if that decision
is not pleasant.
On the other hand, feeling types
make a decision based on how they
feel about something. They are exactly
as the word describes, “feeling.” They
are usually very warm and compassionate, much different than the thinking types.
Thinking types are “bottom-line”
people and call things as they see it. As
g DT page 12A
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9 1/4 x 3 3/8

[12] =>

12A Practice Matters
f DT page 11A
a result, they can hurt a person’s feelings but are totally unaware they have
done so. Fairness is extremely important to thinking types. They are able to
step back from a situation, analyze it
for what it is and apply an impersonal
solution.
Thinking types can come across
as heartless, insensitive and uncaring because they naturally see all the
flaws in situations and are seemingly
very critical. Thinking types are usually motivated by a desire for achieving
goals and accomplishments. They also
feel it is more important to tell the truth
than be tactful.

Feeling types: harmony at any price
Feeling types like harmony and will
work very hard to make this happen. They will tend to be sympathetic
toward other co-workers, even if those
co-workers are not performing to practice expectations, and they need plenty
of feedback and praise from employers.
They consider it important to be
tactful. They dislike telling people
unpleasant things and have an inner
desire to please everybody. They can
come across to others as appearing
weak and emotional.
Thinking type dentists generally
have better managed dental practices
from the business standpoint. Their
AD

strengths lie in efficiently run systems
and analyzing a situation if it starts to
break down.
On the other hand, depending on
the types of employees they are working with, they can have poor relationships with the team, especially if many
staff members are feeling types.
Thinking types tend to voice only
their discontent because giving praise
does not typically come naturally for
them. They feel that doing so will
come across as fake to the employee. Yet, all employees need feedback,
direction and guidance regardless of
their personality type — even thinking
types.
However, for feeling type employees — and this temperament type
tends to be most attracted to dentistry
— they can be crushed by a thinkingtype dentist’s tendency to only find
fault and never give praise. Feeling
type employees need praise regularly
to help them achieve maximum performance.
Thinking type dentists can also turn
this firm and tough-minded attitude
toward patients too. “You know I’ve
been telling you for two years this
tooth was going to break. We could
have done a crown and saved it, now
I don’t know if that’s going to be possible.”
Conversely, the feeling type dentists
will be apologizing and agonizing over
the fact that their treatment plan is

Dental Tribune | December 2009
going to cost upwards of $3,000, so
they’ll present it then hurry up and
tell the patient that they can pay $50 a
month for the next five years. Feeling
type dentists usually have high patient
bases because of their strong warmth
and compassion.
However, case acceptance may be
low because they are uncomfortable
telling patients things that they feel are
unpleasant, and their accounts receivables are often high.
Dentistry requires certain parameters to be successful and every dentist
and dental team needs to know and
understand itself as well as others
in the practice. Explore personality
assessments such a the Keirsey Temperament Sorter in the book “Please
Understand Me”.
In doing so, you will gain a far better understanding of yourself and each
other. You’ll understand much more
clearly why you work the way you do
and how to maximize your personality
strengths and address the weaknesses.
Surround yourself with employees
whose temperament types complement yours but are not necessarily the
opposite.
Moreover, even though a dentist
or a staff member may not fit exactly
into a specific personality type that is
considered ideal for certain positions,
those willing to pursue additional
training and improve communication
skills can often make huge strides in

achieving their professional goals and
dreams.
For additional information on
personality types and how they
affect practices, visit www.mckenzie
mgmt.com. DT

About the author

Sally McKenzie is CEO of
McKenzie Management, which
provides success-proven management solutions to dental practitioners nationwide. She is also
editor of The Dentist’s Network
Newsletter at www.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 sallymck
@mckenziemgmt.com.

[13] =>

0A
Dental TRubric
ribune | December 2009

Dental Tribune
| Month13A
2009
Practice
Matters

Create
more value through cosmetic dentistry
Headline
Deck

By Roger P. Levin, DDS

People value a beautiful smile
By line
even in today’s economy. Many
patients will still accept cosmetic
service if you continue to promote
thetkvalue of your practice.
When a high level of enthusiasm
for a dazzling smile is conveyed
and communication between
patients and team members is
maintained, the value of cosmetic
services is linked to your practice.

Showcase the value of esthetic
treatment
Traditional dentistry is concerned
with the proper and healthy functioning of the oral cavity, while
cosmetic dentistry focuses on
improving the patient’s smile and
quality of life. Unlike need-based
dentistry, cosmetic procedures are
viewed as “extras” by patients.
A recent survey of Levin Group
clients revealed that the second
most difficult challenge to general
practices today is reduced cosmetic case acceptance — second only
to lower pracitioner compensation.
So how do you overcome that challenge?
The key to showing patients
the benefits of cosmetic dentistry begins with a case presentation that is both motivating and
exciting. Simply going through the
motions will not cut it.
Patients want to see themselves
transformed. Showing patients
before-and-after photographs of
successful cosmetic cases has been
proven extremely persuasive.
Begin a conversation about cosmetic dentistry by asking patients
questions such as:
• Have you ever thought about
whitening?
• Is there anything about your
smile you don’t like?
• Do you know you could have
a smile like this? (Use appropriate
visual aid here.)
These conversation starters are
a great way to get patients to think
about cosmetic dentistry.

er home-care is the best method
to preserve a new and improved
smile.
Exceeding patient expectations
is the heart of value creation.
Patients expect more from practices that provide cosmetic dentistry.
Look at your practice through
the eyes of patients. Could it be
perceived as basic or just OK? Be
honest.
Every practice has room for
improvement. Find those areas
and apply the principles of value
creation.
You’ll end up with a better team,
happier patients and a more successful cosmetic practice. DT

Dental Tribune readers are
entitled to receive a 50 percent
courtesy on a Levin Group Total
Success Practice Potential Analysis ™, an in-office analysis and
report of your unique situation
conducted by a Levin Group Senior

About the author
Dr. Roger P. Levin is founder and chief executive
officer of Levin Group. For more than 20 years, Levin
Group has helped thousands of general dentists and
specialists increase their satisfaction with practicing
dentistry. Levin Group may be reached at (888) 9730000 and customerservice@levingroup.com.

Extending the value beyond the
treatment
When a customer accepts cosmetic
services, schedule the appointment
right away. Create a spa-like atmosphere where patients are treated
like special guests of the practice.
Train team members to call
patients by name, provide refreshments and use encouraging,
enthusiastic comments before the
procedure.
Once treatment is performed,
the clinician should place a follow-up call that night to ensure
patients are doing well and are
satisfied with the results.
Levin Group recommends that
practices offer patients a Waterpik® dental water jet as an excellent way to maintain their investment in cosmetic dentistry. Prop-

Practice Analyst.
To schedule the next available
appointment, call (888) 973-0000
and mention “Dental Tribune” or
e-mail customerservice@levingroup.com with “Dental Tribune”
in the subject line.

AD
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9 1/4 x 3 3/8

[14] =>

14A Clinical

Dental Tribune | December 2009

Fig. 3: Immediate post-op, buccal.

Fig. 4: Broken, unhappy tooth No. 19.

Fig. 5: Amalgam and caries removed
showing dentinal floor fracture.

Fig. 7: Final prep.

Fig. 8: Onlay on model.

Fig. 9: Happy tooth, happy patient.

f DT page 1A
to mimic nature, we must understand what nature looks and feels
like.
We need to know how it moves
and functions. In other words, we
study nature’s properties so that
we can better replicate it. We want
stronger dental units — teeth and
restorations — not just stronger
crowns.
Now it is possible to rebuild
teeth with newer materials and
techniques that more closely simulate natural teeth and hold up
better to the hearty demands of
life.
Through advances in dental
adhesives, we strive to make the
compromised tooth whole, using
materials that best mimic dentin
and enamel.
Our patients can testify that biomimetic restorations look and feel
much better than traditional dental restorations.

Biomimetic dentistry is
conservative
Modern adhesives and bonding
techniques are the driving force of
biomimetic dentistry.
With
traditional
dentistry,
healthy tooth structure is destroyed
and/or removed in order to retain
a new restoration.
By using advanced adhesive
techniques and properly fashioned inlays and onlays, dentists
can help save their patients’ teeth,
time and money.

We could say that preservation
and conservation lie at the heart of
biomimetic dentistry. It is a winwin situation for everyone.
I think every dentist who sees
a lot of old amalgams should
consider offering these restorations. Most dentists probably have
almost everything they need to do
so, including the patients.
All that is most likely needed
is an indirect composite and curing system, a portable hydrocolloid impression method, silicone
injectables for die and model work
and disposable articulators. That’s
it.
In addition, once a dentist has
all that, in addition to same-day
inlays/onlays, the dentists will be
ready to provide patients with labquality transitionals and temporaries as well as custom trays on
an immediate, low-cost basis.
That means better dentistry.
Sound good?
We know it’s the right thing to
do. It’s what we would do for ourselves. Gordon Christensen says,
“The lack of use of tooth-colored
onlays is one of the most frustrating situations I see in current
restorative dentistry.”
People hate temporaries. The
worst aspect about temporizing
inlays and onlays is they always
come out when you don’t want
them to and sometimes won’t
come out when you do want them
to at the second, or “bond” visit.
Patients hate having to come
back to get numb for yet another

uncomfortable appointment.
Moreover, that second visit is
what keeps many people from
being proactive about replacing all
of their old amalgams. In addition,
it’s also what makes it so costly –
for your patients and for you.
That’s why if you incorporate
these restorations in your practice,
your overhead goes down and your
profits increase — all while taking
better care of your patients.
Same-day inlay/onlays will definitely benefit your patients and
your practice.
For a minimum investment in
new equipment and materials, and
a very short and easy learning
curve, you and your assistants can
quickly begin to replace defective
amalgam restorations and at the
same time conserve and reinforce
remaining tooth structure — and
so much more!
Your quadrant and full-mouth
dentistry will definitely increase
along with patient satisfaction,
referrals and profits.
Look at the benefits for you and
your patients:
• No temporaries means no “lost
temporary” emergencies between
appointments.
• No costly second appointments
means patients appreciate getting
it all done the same day.
• No lab bill means reduced
overhead costs.
If you’d like more information
on the Biomimetic Same Day Inlay/
Onlays 8-AGD credit CD-ROM that

Fig. 6: Self-etch primer.

Fig. 10: Same day inlay/onlay CD/
ROM cover.
outlines the materials, equipment
and techniques, please call (214)
999-0110 or e-mail ashley@dallasdentalspa.com. DT

About the author

Dr. Lorin Berland, a fellow of
the AACD, pioneered the Dental
Spa concept in his multi-doctor
practice in the Dallas Arts District. 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,
a
“Full-mouth Rehab in 2 Visits”
DVD and Biomimetic Same-day
Inlay/Onlay 8 AGD Credits CDROM, call (214) 999-0110 or visit
www.berlanddentalarts.com.

Fight oral cancer! Visit www.OralCancerSelfExam.com
D

id you know that dentists
are one of the most trusted professionals to give advice?
Thus, no other medical professionals are in a better position to
show patients that they are committed to detecting and treating
oral cancer.
Prove to your patients just how
committed you are to fighting
this disease by signing up to be

listed at www.oralcancerself exam.
com. This Web site was developed
for consumers in order to show
them how to do self-examinations
for oral cancer.
Self-examination can help your
patients to detect abnormalities
or incipient oral cancer lesions
early. Early detection in the fight
against cancer is crucial and a primary benefit in encouraging your

patients to engage in self-examinations. Secondly, as dental patients
become more familiar with their
oral cavity, it will stimulate them
to receive treatment much faster.
Conducting your own inspection
of patients’ oral cavities provides
the perfect opportunity to mention
that this is something they can easily do themselves as well.
You can explain the procedure

in brief and then let them know
about the Web site, www.oral
cancerselfexam.com, that can
provide them with all the details
they need.
If dental professionals do not
take the lead in the fight against
oral cancer, who will? And in the
eyes of our patients, they likely
would not expect anyone else to
do so — would you?

[15] =>

0A
Dental TRubric
ribune | December 2009

Dental Tribune
| Month15A
2009
Clinical

The
utility of cone-beam computed tomography in endo
Headline
Deck

By Dov M. Almog, DMD; Samuel Melcer,
DMD and Sergio Bueno, DMD
By line

Fig. 1: Based on clinical and radiographic diagnosis with a conventional two-dimensional periapical
radiograph, the root canal in tooth
No. 14 seems to be failing.
toward the sinus and into the tri-furcating area, and caused bone resorption extending up to the palatal gingival margin (Figs. 2, 3).
The patient was then referred back
to the referring dentist in order to
re-probe the mesio-lingual aspect of
tooth No. 14. During the initial examination, the periodontal probing depth
was only 5 mm. After the I-CAT was
reviewed, the patient was re-probed
in an attempt to find a communication
with the endo lesion.
The periodontal probe was inserted
from the lingual aspect in a buccal
direction to about 5 mm and then redirected to a palatal direction reaching
a depth of 11 mm.
This indicates that on routine periodontal probing, an endo-perio lesion
may not be diagnosed because the
osseous defect does not always occur
in a perfect matching path to the long
axis of the tooth. A pre-curved guttapercha point size 40 was then inserted
in the same direction and a new periapical radiograph confirmed the osseous endo-perio defect (Fig. 4).
Once the endo-perio communication was confirmed, it was concluded
that the advanced periodontal disease
occurred secondary to the endo lesion.
When the pulp becomes infected, the
lesion can progress beyond the apical foramen and cause periodontal
disease.
Once the endo-perio communication was confirmed, a referral to oral
surgery was generated for extraction
of No. 14 with bone grafting in preparation for a future dental implant.

Fig. 3: The CBCT study includes
cross-sectional slices of tooth No. 14
at 0.5 mm intervals, and revealed
endo-perio communication demonstrating that the periapical disease
extended toward the sinus into the
tri-furcation and buco-incisally.

Fig. 4: Conventional periapical radiograph with a gutta-percha point in the
mesio-palatal aspect of tooth No. 14
demonstrating an 11 mm endo-perio
communication. In this case, the periodontal disease is occurring secondary
to the endo lesion.

References
1.

Sukovic P. Cone Beam Computed Tomography in Dentomaxillofacial Imaging. 2004; AADMRT
Newsletter.
2. Fuhrmann RA, Bucker A, Diedrich PR. Furcation involvement:
About the authors
comparison of dental radiographs
and HR-CT slices in human
specimens. J Periodontal Res
• Dov M. Almog, DMD, chief of
1997;32(5):409–18.
the Dental Service, VA New Jersey
3. Low KMT, Dula K, Bürgin W, von
Health Care System (VANJHCS)
Arx T. Comparison of periapical
• Sergio Bueno, DMD, general
radiography and limited conedentist, VANJHCS
beam tomography in posterior
• Samuel Melcer, DMD, Assismaxillary teeth referred for apical
tant Chief of the Dental Service,
surgery. J Endod 2008;34(5):557–
VANJHCS
62.
4. Cotton TP, Geisler TM, Holden
Dov M. Almog, DMD
DT, Schwartz SA, Schindler WG.
VA New Jersey Health Care
Endodontic applications of coneSystem
beam volumetric tomography. J
385 Tremont Avenue
Endod. 2007;33(9):1121-32.
East Orange, N.J. 07018
5. Evered JC, Webb T. Cone beam
Tel.: (973)-676-1000, ext. 1234
computed tomography in EndFax: (973) 395-7019
odontics. Clinical Update. Naval
E-mail: dov.almog@va.gov
Anzeige METAL-BITE USA 2009/10:METAL-BITE 2009/10 01.11.2009 22:31 Uhr
Postgraduate Dental School,
Bethesda, Maryland. 2009; 31(9).
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dental

As was described in this case report,
some root canal treatment failures and
associated dento-alveolar pathologic
defects sometimes go unnoticed and/
or misdiagnosed.
Therefore, it is essential for us to
familiarize ourselves with the diagnostic capacity of CBCT as it pertains
to endodontic lesions diagnosis and
associated complications vs. the use
of conventional diagnostic periapical
radiographs.
This would certainly lead to better diagnosis and treatment planning.
This is besides the fact that CBCT
offers considerable scan-time and
radiation dose reduction compared to
a medical CT. DT

Following what seemed to be a root
canal failure in tooth No. 14 based
on tk
clinical and radiographic diagnosis
with a conventional two-dimensional periapical radiograph (Fig. 1), the
patient was considered for referral for
an endodontic consult.
At this stage, several treatment
options were contemplated: apicoectomy and retrograde filling; palatal
root amputation; and possible extraction. This diagnostic and treatment
planning protocol is fairly common in
dentistry.
However, although no clinical evidence was reached at this stage and
periodontal disease is frequently the
result of apical progression of periodontal disease, at times it is derived
from endodontic disease.
A perio-endo lesion can have a varied pathogenesis, that is, a periapical
lesion, root fractures and/or root canal
perforation. Although perio probing
surrounding tooth No. 14 was done in
this case, there was no evidence for
furcation or apical progression of periodontal disease.
As a matter of fact, already in 1997 it
was found that only one out of 14 furcation defects in the maxillary molars
was seen on periapical radiographs
because of overlapping roots, whereas
medical CT scans were able to identify
all furcation defects.2
Moreover, in 2008 it was found
that CBCT showed significantly more
lesions than periapical radiographs.3
Given the recent CBCT extended
diagnostic capacity as it pertains to
endodontics, the treating dentist made
a decision to take advantage of this
three-dimensional diagnostic modality and the patient was referred for a
CBCT.
As is described in this case report,
some root canal treatment failures
sometimes go unnoticed, and therefore it behooves us to familiarize ourselves with the diagnostic capacity of
CBCT as it pertains to endodontic complications vs. conventional periapical
AD
radiographs.
Dentists’ ability to assess the anatomic area of any tooth utilizing conventional periapical radiographs that
are known for superimposition of
anatomical structures is very limited, whereas their ability to assess the
anatomical area of interest utilizing
a three-dimensional CBCT is almost
unlimited.4,5
After performing a CBCT utilizing
an i-CAT™ 3-D CBCT (Imaging Sciences International, Hatfield, Pa.) to
evaluate tooth No. 14 and its surrounding anatomy, it was determined that
there was an endo-perio lesion on
the mesio-lingual aspect of the palatal
root.
The CBCT study included crosssectional slices of tooth No. 14 at 0.5
mm intervals, revealing endo-perio
communication and demonstrating
that the periapical disease extended

Fig. 2: By utilizing the i-CAT 3-D
CBCT (Imaging
Sciences International, Hatfield,
Pa.), an axial
view of tooth No.
14 was obtained
that demonstrated
a mesio-lingual
bony defect.

pattersondental.com

Seit

[16] =>

16A Clinical

Dental Tribune | December 2009

Dependent adults: The key is biofilm reduction
How can dental professionals decrease the complications of teeth in the dependent adult population without adding stress to caregivers?
By Shirley Gutkowski, RDH, BSDH, FACE

I think it’s safe to say that, in
general, the oral care of dependent
adults is bad. Perhaps the word horrible is more accurate, or abysmal,
shameful, poor, dreadful, terrible or
awful and possibly even “awe full!”
The teeth, broken, misaligned
and stained, are covered with a
thick coating of biofilm, once called
plaque. Caregivers think this is normal. They don’t make a connection
between nice teeth and their dependent charges.
There are a multitude of reasons
for this disconnect. The people who
study these types of things found a
couple of interesting insights. For
one, as the dental IQ of the caregiver
increases, the oral health of his or
her charges increases.
They also find that a dental health
care professional on-site increases
oral care incidence for the resident.
The third finding shows that oral
care in-service meetings (regardless
of the duration) increase oral care
over a short term, but the benefits
fade away quickly.
It’s time to shift our thinking.
The quickest and easiest thing to
do is remove all teeth. No teeth, no
biofilm, no dental problems. Many a
care provider has uttered this wish.
They don’t know what we know
about the decrease in the quality
of life these dependents undergo
once their teeth are removed. The
caregivers have a gut feeling that
teeth are a locus of infection and
removing them will surely help their
charges. They’re right.
Oral health care providers must
answer this question: How can dental professionals decrease the complications of teeth in the dependent
adult population without adding
stress to caregivers?
The answer is to shift the thinking down a notch from mechanical
means of biofilm reduction to biofilm disruption, period. It is possible
to do one without the other.
Recent research has given us a
list of ways to address biofilm without the use of caustic chemicals.
Many of the tools we’ve been trying
to use to address oral biofilm aren’t
really penetrating.
If they do, they penetrate a short
AD

distance into the film and never
affect the dormant or persistent
microbes deep inside. Most typical
rinses, pastes and creams affect the
free floating, planktonic bacteria.
However, the biofilm re-establishes
itself quickly after the danger is
past.
Many microbes contribute to the
film part of biofilm. For the most
part, they use sucrose and convert it,
not only to acids, but to the polysaccharide covering as well.
This covering makes it easy for
the biofilm to adhere to the tooth,
and protects the microbes from
attack. If the microbes are not sheltered by the polysaccharide, they
are easy to kill.
Science has found ways to interfere with the adhesion process of
oral pathogens. They are lactoferrin,
cranberry, licorice root extract and
xylitol. Including any of these into
the diet of those dependent adults
will decrease the microbes’ ability
to adhere to the hard or soft tissue.
Let’s see how swapping these
ingredients in a normal routine will
work.
Breakfast. Provide only cranberry
juice in place of the traditional rotation of juices (orange, apple and
cranberry); hot or cold cereal sweetened with xylitol.
Lunch. Applesauce sweetened
with xylitol to help swallow the daily
round of medication.
Snack. Finish with xylitol gum or
a mint.
Dinner. Finish with xylitol candy
or mint
Evening Snack. Licorice root
sucker.
Daily oral care routine. Xylitol
toothpaste, xylitol mouthwash, xylitol dry mouth spray. Lactoferrin is
not a viable product for this type of
use yet. Currently it is being used
in chronic wound care mixed with
xylitol.
The biofilm associated with dental disease is very sensitive to pH
changes. Using products to change
the pH will also shift the biofilm to a
more homeostatic one.
The shift can be accelerated by
using a bicarbonate rinse, but is
poorly tolerated. Mixing xylitol into
drinking water is a way to increase
oral pH and help hydrate the depen-

After six weeks of xylitol and
Recaldent use

After 12 weeks of xylitol and
Recaldent use.

dent adult.
Recaldent and NovaMin in pastes
have a great track record of increasing oral pH for hours after application. Arginine compound pastes
share that benefit as well.
Even if these pastes are put onto
the finger of the residents for them
to apply themselves, pH shift will
occur, stopping biofilm growth on
a dime.

We know that xylitol has residual effects for years after use. It’s
prudent for clinicians to advise all
patients approaching declining age
to start using xylitol products as a
preventive.
Use of these products, with an eye
toward biofilm reduction as opposed
to brush and floss education, may be
the answer everyone has been waiting for. DT

About the author
Shirley Gutkowski, RDH, BSDH,
FACE, is a clinical dental hygienist
from Sun Prairie, Wis. She is the 2008
recipient of the Leadership Award
from the World Congress of Minimally
Invasive Dentistry.
Dn award-winning author, she is
is co-author of the best seller, “The
Purple Guide: Developing Your Clinical Dental Hygiene Career.” Her new
book, “The Purple Guide: Caries Management for Difficult Case Presentations,” was published this summer.
Please visit www.rdhpurpleguide.com
for more information.
You may contact Gutkowski at
crosslink present@aol.com.

Watch Shirley Gutkowski’s Webinar series
and earn 3 C.E. credits!
Visit www.DTStudyClub.com
to access “Simple Advanced Treatment
Modalities for the Dependent Patient.”
Only $95 for three hours of C.E.
that suit your schedule.

[17] =>

0A
Dental TRubric
ribune | December 2009

Dental Tribune
| Month17A
2009
Industry
Clinical

Headline
A
moisture tolerant, resinbased pit and fissure sealant
Deck

By line

By Ira
tk Hoffman, DDS, BSc

Pit and fissure sealants have been
shown to be highly effective in preventing caries, and there is considerable research documenting sealant
success over extended periods.1–4
The primary measure of sealant
efficacy is retention. If the sealant
material stays bonded to the tooth
and provides a good seal, then it is
reasonable to expect that caries incidence can be decreased.
The practitioner must overcome
certain challenges to achieve the
desired high degree of success. The
decision to place sealant is based
on caries risk analysis. The first and
second permanent molars are at the
greatest risk of developing caries, and
the optimal time to seal them is during the early eruption.
Unfortunately, there are anatomical considerations that make the
placement of sealants less reliable at
that time.
During the eruption process, permanent molars break through the
gingival tissues leaving excess tissue,
an operculum, over the distal surfaces that can interfere with the success
of a sealant.
Furthermore, isolation is mandatory for traditional sealants, but is
extremely difficult, if not impossible,
with erupting teeth.
Because moisture contamination is
a contra-indication for traditional pit
and fissure sealants, which require
a clean, dry, etched enamel surface
for success, some clinicians prefer to
wait for the teeth to fully erupt so that
isolation can be achieved.
By this time, however, caries has
often invaded the at-risk pits and fissures and, as a result, a more invasive
treatment and restoration is required.
In recent years, we have seen the
development of new materials that
behave favorably in the moist oral
AD
environment, taking advantage of the
moisture that is ever-present in the
mouth.
An advanced, resin-based sealant technology has been developed
that incorporates a moisture-tolerant
resin chemistry that is placed on the
slightly moist tooth, allowing placement during early eruption (Embrace
WetBond Pit and Fissure Sealant,
Pulpdent Corporation, Watertown,
Mass.).
Traditional pit and fissure sealants
are hydrophobic. They repel water
and cannot be applied where there is
moisture. These materials are based
on bis-GMA and other monomers that
are primarily hydrophobic in nature
and require a dry field.
Many manufacturers recommend
their use with hydrophilic bonding
agents as a way to overcome the
dry field requirement; however, the

bonding agents add considerable
time and cost to the procedure, and
the procedure becomes more technique sensitive.
Embrace WetBond is based on a
unique chemistry that incorporates
di-, tri- and multi-functional acidic
acrylate monomers in a proprietary
formula with a carefully designed
hydrophilic-hydrophobic balance.
The result is a resin-based material
that is moisture tolerant and behaves
favorably in the moist oral environment.
In fact, Embrace is activated by
moisture. Embrace WetBond contains no bis-GMA and no bisphenol A,
and is unlike hydrophobic monomers
typically used in traditional sealants.
The moisture tolerant Embrace
sealant does not require a bonding
agent. Enamel is etched, rinsed and
lightly dried. The tooth is left slightly
moist and glossy but without any
drops or pooling of water. Embrace is
water miscible.
When placed on the tooth surface in the presence of moisture,
the sealant spreads over the enamel
surface and integrates with the tooth
in a unique way. It has been noted
that margins are smooth and virtually
undetectable with an explorer.5
This tooth-integrating phenomenon can be seen with scanning
electron microscopy, which shows
the intimate association between the
sealant and the tooth that provides an
exceptional seal against microleakage and protection against caries.
After light curing, however,
Embrace sealant has physical properties similar to other commercially
available sealants.6–8
A longitudinal clinical study using
Embrace WetBond Pit and Fissure
Sealant was begun in May 2002. The
study was conducted in a suburban
pediatric practice. There was no
prescreening of patients. Even difficult patients and children with poor
oral hygiene and dietary habits were
included in the study.
In this practice-based study, 334
sealed teeth were followed at recall
visits for four to six years and evaluated by a pediatric dentist. Of these,
299 sealants were intact and clinically acceptable. Of the remaining
teeth, 32 required resealing with no
evidence of occlusal caries, and only
three teeth, or less than 1 percent,
developed occlusal caries.9
As a basic concept, 5–10 percent
of sealant loss per year has been
seen when one reviews published
sealant data.10 This data reveals the
importance of periodic reevaluation
of sealed teeth and reapplication of
sealant if necessary. This reevaluation of sealants should be standard care. When a sealant needs to
be repaired or reapplied, the tooth

Fig. 1

Fig. 2

Fig. 3

Fig. 4

should be treated as if an initial sealant is being placed.11

Clinical technique
Embrace WetBond requires a small
change from the traditional clinical
protocol because the etched enamel surfaces of the teeth should be
slightly moist during sealant placement. Following these directions will
ensure clinical success.
1.

Examine and evaluate the occlusal surfaces, and isolate the teeth
to be sealed with rubber dam or
cotton rolls (Fig.1).
Clean the tooth surfaces using an
oil-free, water–pumice paste with
a disposable prophylaxis angle in
a slow-speed handpiece. Other
methods for cleaning teeth before
sealant placement include using
a non-fluoride, pumice prophylaxis paste and an air abrasion
device (Fig.2).
Rinse thoroughly with an airwater spray, removing all residual paste from pits and fissures,
and dry (Fig. 3).
Prepare questionable enamel
and small lesions in the usual
manner. Rinse and dry with oilfree compressed air.
Apply Pulpdent 35–40 percent
phosphoric acid etching gel to
the clean tooth surface for 15
seconds (Fig.4). Rinse well with
an air-water spray (Fig. 5). Do
not disturb this surface.
Lightly dry and remove excess
water with a cotton pellet or
clean compressed air (Fig. 6).
Leave tooth surfaces slightly
moist. Slightly moist tooth surfaces should appear shiny or glossy,
but there should be no visible
pooling or drops of water on the
tooth surfaces. With Embrace
WetBond, the typical dull, frosted

AD
1/4 Page
9 1/4 x 3 3/8
5.

appearance of the etched surface
is not desired. Embrace bonds
to surfaces slightly moist from
saliva; however, it is best to avoid
bacterial contamination.
Place an applicator tip on the
syringe and apply the Embrace
WetBond sealant to the occlusal
surface. After dispensing, use a
microbrush applicator to place
the sealant, covering all pits
and fissures and extending onto
the cusp ridges. The final sealant thickness upon application
should be at least 0.3 mm (Fig. 7).
After application, light-cure the
sealant holding the light-curing
probe at right angles and as
close as possible to the occlusal
surface. Embrace cures with all
lights (Fig. 8). Curing time for a
halogen light with a minimum of
300 mW/cm2 is 20 seconds. More
powerful lights will cure faster.
Evaluate the sealant for coverage, retention and occlusion (Fig.
9). The tooth is sealed and ready
for function (Fig. 10).

Although the most common practice is to apply the pit-and-fissure
sealant directly to the etched enamel,
various studies have evaluated the
efficacy of using a bonding agent
before sealant placement.
The use of a bonding agent has the
potential to increase sealant retention
with traditional sealants,12,13 but the
disadvantage is that it increases the
number of steps, is more technique
sensitive and adds cost in time and
materials.
With Embrace WetBond Pit and
Fissure Sealant, adhesive bonding
agents are not required and, although
saliva contamination should be avoided whenever possible, it does not
g DT page 18A

[18] =>

18A Industry Clinical
f DT page 17A
affect the bond of Embrace WetBond
sealant.

Discussion
Clinically, a moisture-tolerant
sealant makes sense. Unless a rubber dam is being used, the clinician is working in the oral cavity
with humidity near 100 percent. This
ensures that even the driest tooth surfaces contain some moisture.
In addition, because the permanent first molars are the teeth at
greatest risk, it is desirable to seal
them immediately upon eruption
when isolation is the most difficult.
Therefore, a moisture-tolerant resin
sealant is necessary to ensure the
optimal chance for successful retention.
Until now, the only moisture-tolerant sealants were glass ionomers.14
Their mechanism of adhesion is ionic
bonding, not micromechanical retention to an acid-etched enamel surface.
In studies with glass-ionomer sealants it has been reported that the
three-year retention rate is only 31
percent.15 Pardi and co-workers also
reported low sealant retention rates
with glass ionomers.16
The information currently available suggests that the optimal characteristics for a pit-and-fissure sealAD

ant are a resin-based material that
is moisture tolerant, light-cured and
lightly filled with color so that sealant
detection and evaluation at recall is
easily accomplished.14
The introduction of a moisture-tolerant, resin-based sealant (Embrace
WetBond) has eliminated the problems seen in the past with traditional,
hydrophobic resin-based sealants.
In a dental practice, pit-and-fissure
sealants are best applied by trained
auxiliaries using an etch-and-rinse,
moisture-tolerant sealant. Adherence
to the sealant technique described
above can lead to success in preventing pit and fissure caries. DT

Dental Tribune | December 2009

Fig. 5

Fig. 6

References
1.

3.
4.

5.
6.

Simonsen RJ. Retention and
effectiveness of a single application of white sealant after 10
years. J Am Dent Assoc. 115:31,
1987.
Simonsen RJ. Retention and
effectiveness of dental sealant
after 15 years. J Am Dent Assoc.
122: 34, 1991.
Simonsen RJ. Pit and fissure sealant: review of the literature. Pediatr Dent. 2002;24(5):393–414.
Strassler HE, Grebosky M, Porter J, et al. Success with pit and
fissure sealants. Dent Today.
2005;24(2):124–140.
Dental Advisor 2004;21(8)
Murnseer C, Rosentritt M, Behr

Fig. 7
Fig. 8

Fig. 9

Fig. 10

M, et al. Three-body wear of fissure sealants [abstract]. J Dent
Res. 2007;86(Spec Iss):417.
7. Antoniadou M, Kakaboura A, Eliades G. In vivo characterization
of resin-based sealants [abstract].
J Dent Res. 2006;85(Spec Iss
C):310.
8. Antoniadou M, Kakaboura A,
Rahiotis C, et al. Setting efficiency
of resin-based sealants [abstract].
J Dent Res. 1985;84(Spec Iss
B):212.
9. Strassler HE, O’Donnell JP. A
unique moisture-tolerant, resin-based pit and fissure sealant: clinical technique and
research results. Inside Dentistry
2008;4(9):108–110.
10. Feigal RJ. Sealants and preventive restorations: review of effectiveness and clinical changes for
improvement. Pediatric Dent.
20:85, 1998.
11. Srinivasan V, Deery C, Nugent Z.
In-vitro microleakage of repaired
fissure sealants: a randomized,
controlled trial. Int J Paediatr

Dent. 15:51, 2005.
12. Choi JW, Drummond JL, Dooley
R, et al. The efficacy of primer
on sealant shear bond strength.
Pediatr Dent. 1997;19(4):286–
288.
13. Levy MP, Feigel RJ. Intermediate
bonding agents increase clinical success on newly erupted
molars [abstract]. J Dent Res.
1996;75(Spec Iss):1296.
14. Strassler HE, Grebosky M, Porter J, Arroyo J. Success with pit
and fissure sealants. Dent Today.
2005; 24(2):124–140.
15. Taifour D, Frencken JE, van’t
Hof MA, et al. Effects of glass
ionomer sealants in newly erupted first molars at 5 years: a pilot
study. Community Dent Oral
Epidemiol. 2003;31(4):314–319.
16. Pardi V, Pereira AC, Mialhe
FL, et al. A 5-year evaluation
of two glass-ionomer cements
used as fissure sealants. Community Dent Oral Epidemiol.
2003;31(5):386–391.

About the author
Dr. Ira D. Hoffman maintains a
private practice in Montreal, Quebec. A graduate of McGill University, he is a faculty lecturer in the
Department of Restorative Dentistry. He is also a member of the
University Advisory Council of the
American Academy of Cosmetic
Dentistry, acting chairperson of
the University Co-ordinating Committee of the Canadian Academy of
Esthetic Dentistry and a fellow of
the Academy of Dentistry International and the International Academy of Dental Facial Esthetics.

[19] =>

0A
Dental TRubric
ribune | December 2009

DentalWebinars
Tribune | Month19A
2009

Headline
DTSC
Hygiene Webinar series
Deck
At www.DTStudyClub.com, you
will find the three-part Webinar
By line
series “Simple Advanced Treatment Modalities for the Dependent
Patient” with Hygiene Tribune Editortk
in Chief Angie Stone and Dental
Tribune author Shirley Gutkowski.
Part I: Who is taking care of the
dependent patient every day?
Are you sick and tired of nursing assistants avoiding their duty
to provide oral care to dependent
adults? Find out how much you
have in common with them.
Hygiene Tribune Editor in Chief
Angie Stone and Dental Tribune
author Shirley Gutkowski bring
their exciting tag-team program to
the Web in this first of three programs.
With their no-nonsense and
humorous approach, they show you
how to build the bridges between
“us and them.” Don’t miss this
informative, scientific and entertaining program.
Part I of this three-part series
will educate the attendees about
who is actually responsible for oral
care in nursing home facilities.
Attendees will learn what a typical
day is like in the life of a nursing
assistant, what education they are
provided and what their position is
regarding oral care.
Learning Objectives:
• Understand the true daily work
of the nursing assistant.
• Know what education the nursing assistant has.
• Understand who the nursing
assistant is.
Part II: The Dental Profession
Can Assist Primary Caregivers Help
Dependent Patients
Can’t get the nursing assistants
to brush and floss the dependent
adults they’re in charge of?
Never fear, Dental Tribune
author Shirley Gutkowski and
Hygiene Tribune Editor in Chief
Angie Stone show you how to make
an impression on caregivers that
AD
will stimulate change by shifting
your own thinking.
You won’t be disappointed in
quality and content of this important Web program.
Part II of this three-part series
will concentrate on what dental
professionals should be teaching
during the nursing home staff’s
required annual in-service training
session.
Think you should be teaching
brushing and flossing? Join us to
find out!
Learning Objectives:
• Gain knowledge on how to
develop an in-service training session.
• Know which simple advanced
treatment modalities improve the
oral health of nursing home residents.
• Understand the role xylitol

plays in oral health improvement.
Part III: How to Implement Your
Own Training Program Through
the Adopt-A-Nursing-Home Initiative
The alphabet soup of titles can
be daunting to the oral care provider trying to bring the message
of simple novel approaches to oral
care in a facility. Hygiene Tribune
Editor in Chief Angie Stone and
Dental Tribune author Shirley Gutkowski bring their hard-earned
knowledge and first-hand experience to this one-hour Web event.
This is the final part of the series

on oral care for the dependent adult
and it is just as entertaining as the
first two. It covers who is working
at the care facility, who to talk to,
and when to call. Don’t miss this
important information and round
out your new perspective on caregivers and dependent adults.
Part III of this three-part series
provides information on how to
find a home to adopt. Discussions
include:
• Who are the main players in
the nursing home environment that
need to be contacted?
• What should be said when contacting the facility?

In addition, complete information regarding AANH.
Learning Objectives:
• Know whom to contact at a
facility to adopt the nursing home.
• Understand what to say to the
facility administrators.
• Know what the mission and
goals are of AANH.
Take advantage of this opportunity to earn three C.E. credits by
logging onto www.DTStudyClub.
com, and from the Online Courses
menu choose the Dental Hygiene
option. All three Webinars are
offered for $95. DT
AD

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

[20] =>

20A www.dental-tribune.com

Dental Tribune | December 2009

Have you been to our Web site lately?
• General Dentistry
“Many orofacial injuries during
sports are preventable”
In 1998, Orlando Magic center
Adonal Foyle took an elbow from
Utah Jazz’s Quincy Lewis to teeth
Nos. 8 and 9, causing the teeth to
luxate back. In 2001, Dallas Mavericks’ Dirk Nowitzki was elbowed
by San Antonio Spur Terry Porter
and tooth No. 8 was knocked out.
In 2003, Mavericks’ ...
The list goes on and on, and
this is only the NBA. We don’t have
enough space to delineate all the
dental injuries hockey players have
endured.
www.dental-tribune.com/articles/content/scope/specialities/section/general_dentistry/id/1104
“Dentistry: It really is the new
medical specialty”
www.dental-tribune.com/articles/content/scope/specialities/section/general_dentistry/id/885
“Platinum is a patient’s best
friend”
www.dental-tribune.com/articles/content/scope/specialities/section/general_dentistry/id/810
• Implantology
“Avoiding the pitfalls of implants
AD

with 3-D imaging”
Once only a solution for the rich
and famous, dental implants have
become a popular option for people across all economic categories.
Along with the popularization
of this procedure, while implants
were usually delegated to specialists, technology such as in-office
cone-beam scans and digital imaging allow general practitioners to
offer this type of service while
also avoiding the pitfalls that result
from a lack of precise information.
www.dental-tribune.com/articles/content/scope/specialities/section/implantology/id/948
“Implants displaced into the
maxillary sinus”
www.dental-tribune.com/articles/content/scope/specialities/section/implantology/id/542
“Immediate implant placement
and immediate loading after a
complicated tooth extraction”
www.dental-tribune.com/articles/content/scope/specialities/section/implantology/id/125
• Endodontics
“Predictable apical microsurgery: Patient preparation (Part 1)”
Surgery will never replace solid

A snapshot of the www.Dental-Tribune.com home page as it looked a few
days before we went to press with this edition. The news is always changing,
and nowhere is that more true than in the field of dentistry. Are you keeping
up to date by logging onto our site?

endodontic principles and should
always be a last resort. Apical
microsurgery consists of nine basic
steps that must be completely performed in their proper order so we
can achieve the desired result for
our efforts.
www.dental-tribune.com/articles/content/scope/specialities/section/endodontics/id/929
“Linden explains canal anatomy”
www.dental-tribune.com/articles/content/scope/specialities/section/endodontics/id/1064
“Removal of warm carrier-based
products with the Twisted File”
www.dental-tribune.com/articles/content/scope/specialities/section/endodontics/id/928
• Cosmetic dentistry
“Aren’t you that guy on ‘Extreme
Makeover’?”
In an interview with Cosmetic
Tribune, Dr. William M. Dorfman,
the face of modern cosmetic dentistry, discusses his chosen career,
his business, his television show
— and his penchant for treating
all of his patients as if they were
celebrities.
www.dental-tribune.com/articles/content/scope/specialities/section/cosmetic_dentistry/id/543
“New smile, new life: Innovative
technologies and techniques can
transform a smile”
www.dental-tribune.com/articles/content/scope/specialities/section/cosmetic_dentistry/id/544
“Anatomic stratification technique for lifelike anterior composites”
www.dental-tribune.com/articles/content/scope/specialities/section/cosmetic_dentistry/id/1024

• Dental hygiene
“Pest control in gums gardening:
Locally applied antimicrobials as
adjuncts to nonsurgical periodontal
therapy”
The focused use of chemotherapeutics as antimicrobials can
enhance the outcomes of nonsurgical periodontal therapy, resulting in
healthier mouths for our patients.
www.dental-tribune.com/articles/
content/scope/specialities/section/
dental_hygiene/id/606
“Top 10 causes of tooth discoloration”
www.dental-tribune.com/articles/
content/scope/specialities/section/
dental_hygiene/id/578
• Practice management
“To retire or not to retire?”
I am a 1965 graduate of NYU College of Dentistry, and I practiced
until 2000. I was 58 at the time and
was somehow bent on retiring in
my late or middle 50s when most
people thought that way.
Social security was available at
age 62 then, and the average age
men lived to was 66. My dad died
at that age and so did most of my
friends’ fathers. Thus, I figured I
could have a good 10 years to live
the “really good life.” Boy has that
changed.
www.dental-tribune.com/articles/
content/scope/specialities/section/
practice_management/id/1072
“Good patient communication
can help eliminate no-shows”
www.dental-tribune.com/articles/
content/scope/specialities/section/
practice_management/id/905
“Curbing cancellations and noshows begins chairside”
www.dental-tribune.com/articles/
content/scope/specialities/section/
practice_management/id/816 DT

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0A
Dental TRubric
ribune | December 2009

Dental TIndustry
ribune | Month21A
2009

Invisalign
Headline innovation: improved clinical
results
for a broader range of patients
Deck
By line

In the 10 years since the commercial launch of the Invisalign® system,
Align
tk Technology has continuously
worked to improve Invisalign products to deliver the outcomes patients
desire and clinicians expect.
Today, with more than 1 million patients treated, the Invisalign
system enjoys broad acceptance as
an effective, in-demand treatment
option.
Yet despite the demonstrated
efficacy of Invisalign and numerous advances in treatment over the
years, the Invisalign system has
remained in many ways a first-generation product.
Until now.
This fall, Align introduced innovative new and improved features
in all Invisalign products, representing a significant leap forward in
Invisalign treatment. The product
improvements are based in part on
extensive Align customer research
that focused on why dentists do not
use Invisalign or why they limit
their use of Invisalign to certain
types of cases.
New aligner features, along with
improvements in Invisalign software
and clinical protocols, are designed
to overcome barriers to treatment
by both addressing clinical issues
that dentists have traditionally
perceived as challenging in Invisalign treatment, such as extrusions,
rotations and certain types of root
movements, and by implementing
improvements and best practices
identified and frequently requested
by Invisalign practitioners.
Invisalign’s Optimized Extrusion
Attachments, part of the next generation of Invisalign attachments,
are designed to optimize aligner
forces for upper and lower extrusion of anterior teeth. Using Align’s
patented 3-D modeling technology,
each attachment is custom designed
based on the width, long axis and
contour of each individual patient’s
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teeth.
The extrusion attachment features an active surface area that
helps control the extrusive aligner force delivered and enables the
aligner to engage the attachment
the same way each time for more
predictable performance.
The new Optimized Rotation
Attachments are designed to optimize aligner forces for rotations of
the upper and lower canines. The
shape and placement of each attachment is automatically designed to
deliver more optimal aligner forces
and moments for canine rotations.
As with the Optimized Extrusion
Attachments, advanced 3-D technology uses the patient’s unique tooth
anatomy to determine the attachment’s shape. As the aligner engages the attachment’s active surface
area, the aligner simultaneously

engages the lingual aspect of the
tooth. This results in a rotational
moment about the long axis of the
tooth.
Power Ridges™ are designed to
optimize aligner forces on upper
incisors to deliver lingual root
torque without having to bond
attachments. Power Ridges can be
used when uprighting retroclined
incisors, such as in Class II Division
2 cases.
This feature is designed to produce optimal moment-to-force
ratios to accomplish lingual root
torque. Previously available only
with Invisalign Teen, Power Ridges
are now available for all products,
making Invisalign applicable for
more cases.
Invisalign’s Velocity Optimization
provides more controlled movements of the entire tooth, including the root. Improved ClinCheck
setup protocols are designed to limit
the speed of crown and root movements, including rotations, to optimal ranges.
Using digital dental reference
points, ClinCheck setups are now
designed to factor in a combination
of root movement, crown movement
and rotational speed at every aligner
stage.
Previously, dentists had to identify movements that might require
velocity adjustments and request
those changes as part of the treatment planning process. While clinicians can still request velocity
adjustments if they wish, the velocity optimization improvements in
ClinCheck protocols will now be the
default in case setups.
Interproximal Reduction (IPR)
Protocol Improvements address a
frequent clinician request regarding timing of IPR during treatment.
Invisalign’s improved ClinCheck
protocols are designed for IPR to be
performed when the teeth are more
aligned.
In crowding cases, your prescribed IPR is now set up in later
stages of treatment so that tooth
contacts requiring IPR may be easier to access.
A new Invisalign Attachment Kit
and attachment material deliver
greater bond strength, wear resistance, accuracy and ease of use.*
Previously, attachment material
was left to the clinician’s personal preference, and Align research
determined that only 15 percent of
dentists were using top performing
materials for their attachments.
Clinicians can still use materials
of their own choosing, but Align
now offers these top performing
materials as part of a convenient kit.
“We believe that all of these product improvements, as well as our
commitment to constant innovation,
will give doctors greater confidence

in what they can achieve with Invisalign, and help deliver the outcomes
they expect in more clinical situations,” said Sheila Tan, Align’s vice
president and chief marketing officer.
Thus far, customer feedback supports Align’s belief.
“Learning about the improvements in anterior extrusion expanded the applicability of the Invisalign
appliance for me,” said Douglas D.
Boucher, DDS, a general dentist

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9 1/4 x 3 3/8

practicing in Menlo Park, Calif. “I
feel a lot more confident in clinical
outcomes moving forward.”
The new features are available
in Invisalign, Invisalign Teen, Invisalign Assist and Invisalign Express.
For more information on Invisalign products and the new and
improved features, please visit
www.aligntechinstitute.com/
Improvements. DT
* Data on file at Align Technology
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[22] =>

22A Industry

Dental Tribune | December 2009

PhotoMed cameras and mirrors

Anterior contacts mirror.
G11 digital dental camera
R2 dual-point flash bracket.

G11 digital dental camera
The PhotoMed G11 digital dental camera is specifically designed
to allow you to take all of the standard clinical views with “frame
and focus” simplicity.
The built-in color monitor
allows you to precisely frame
your subject, focus and shoot.
It’s that easy.
Proper exposure and balanced, even lighting are
assured. By using the camera’s
built-in flash, the amount of

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light necessary for a proper exposure is guaranteed.
In addition, PhotoMed’s custom
close-up lighting attachment redirects the light from the camera’s
flash to create a balanced, even
lighting across the field.

R2 dual-point flash bracket
PhotoMed’s new R2 dual-point
flash bracket is designed to give
you maximum flexibility in flash
positioning.

Bring the flash heads in toward
the lens for posterior views and
mirror shots.
Spread the flash heads out
to the side for anterior esthetic
images and natural looking smile
shots.
Each flash head can be repositioned “on the fly” with one hand.
The R2 bracket is available in
Nikon or Canon configurations
and will work with Nikon’s R1 and
R1C1 macro flashes and Canon’s
MT-24EX macro flash.

Anterior contacts mirror

The anterior contacts mirror
makes it easy to photograph the
overjet and anterior contact.
The inset curved end follows
the curve of the arch for comfortable placement. The mirror
can also be used for standard
occlusal arch views.
More information about each
of these produts is available
at www.photomed.net or call
(800) 998-7765. DT

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0A
Dental TRubric
ribune | December 2009

Dental Tribune
| Month23A
2009
Industry
News

Colgate
Sensitive Pro-Relief desensitizing paste
Headline
Colgate-Palmolive, considered a
Deck
world
leader in oral care, has introduced a major advance in the treatBy line
ment of dentin hypersensitivity with its
Colgate® Sensitive Pro-Relief™ desensitizing paste with Pro-Argin™ technology.
tk
Dentin hypersensitivity is a highly
prevalent condition, affecting up to 57
percent of people worldwide.1 Cold air,
a hot drink or a sweet dessert can trigger acute sensitivity pain.
Likewise, the touch of a dental
instrument can make routine dental
visits very uncomfortable. This discomfort may lead sensitivity sufferers
to avoid regular checkups — neglect
that can result in a progression of oral

care problems.
Colgate’s exclusive Pro-Argin technology is composed of an amino acid,
arginine, and an insoluble calcium
compound, calcium carbonate, to seal
open dentin tubules and help block
stimuli of pain receptors within teeth.
Recent research suggests the ProArgin technology binds to the negatively charged dentin surface and
helps attract a calcium-rich layer into
the dentin tubules to effectively plug
and seal them.
The Pro-Argin technology triggers
occlusion of the dentin tubules, an
occlusion that remains intact even
after exposure to acids, helping to
block pain-producing stimuli.

New Colgate Sensitive Pro-Relief
desensitizing paste with Pro-Argin
technology will offer patients comfort
and convenience without compromising treatment efficacy. Colgate Sensitive Pro-Relief desensitizing paste is
clinically proven to provide instant
sensitivity relief that lasts for four
weeks after a single application.2 It can
be used before or after dental procedures such as prophylaxis and scaling.
When applied prior to a professional dental cleaning, this desensitizing paste will provide a significant
reduction in dentin hypersensitivity
measured immediately following the
dental cleaning as compared to a control prophylaxis paste.3 DT

References
1. Addy M. Dentine hypersensitivity: new
perspectives on an old problem. Int Dent J.
2002;52 (Suppl 5):3367–3375.
2. Schiff T, Delgado E, Zhang YP, DeVizio
W, D Cummins, Mateo LR: A Clinical Investigation of the Efficacy of a Desensitizing
Paste Containing 8% Arginine and Calcium
Carbonate in Providing Instant and Lasting
In-Office Relief of Dentin Hypersensitivity. Am
J Dent, 2009.
3. Hamlin D, Phelan Williams K, Delgado E, Zhang YP, DeVizio W, Mateo LR.
A Clinical Investigation of the Efficacy of a
Desensitizing Paste Containing 8% Arginine
and Calcium Carbonate for the Reduction of
Dentin Hypersensitivity When Applied Prior
to Dental Prophylaxis. Am J Den. 2009.

PNDC
AD

Marvy
Masque by
Mydent

paciﬁc northwest dental conference · june 17-18, 2010

Mydent International is offering
Defend+Plus Marvy Masque cone
masks, which are designed for use
with pediatric patients.
The masks feature funny face
designs to entertain youngsters
and reduce dental anxiety.
They are molded, soft and manufactured with an easy breathing
material.
The masks also contain a nonAD
glare nosepiece and are made
without fiberglass or latex.
Defend+Plus Marvy Masque
cone masks are available in the
following designs: dog, clown,
rabbit and cat.
An assortment package contains
10 of each character. The masks
come 50 to a box and can be purchased from most dental dealers.
Mydent International, home to
Defend ® infection control products, disposables and impression material systems, provides
dependable solutions for defensive health care.
Mydent urges health-care professionals to: DEFEND. Be smart.
Be safe.
For more information on Mydent
International and its products, call
(800) 275-0020 or go to www.
defend.com. DT

SAVE THE DATES!
Join us for the 123rd

Paciﬁc Northwest Dental Conference
Seattle, Washington · Washington State Convention & Trade Center

Featuring:
• More than 90 educational lectures and workshops
• Continuing education tacks for the dental team
• More than 300 commercial exhibits
• Hands-On displays and demonstrations

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1/4 Page
EXHIBITORS:
9 1/4 x 3 3/8
Call today to reserve your booth and
For details on attending or exhibiting, please contact the
Washington State Dental Association at 800-448-3368 or
visit www.wsda.org.

secure sponsorship opportunities!