Академический Документы
Профессиональный Документы
Культура Документы
August 2015
August 2015
Retirement
Planning
Are the Top
1 Percent Safe?
p. 52
Debt-Repayment
Basics for Dentists
p. 58
p. 42
p. 48
p. 76
AA Division
Division of
of Farran
Farran Media,
Media, LLC
LLC
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Dentrix.com/Solved
BRAIN POWER
contents
august 2015
In This
Issue
08
On Dentaltown.com
16
Continuing
Education Update
28
Poll
82
Product Prole: Uncomplicate Business
92
Practice Solutions:
Ivoclar Vivadent
97
Ad Index
108
Industry News
110
Product Prole:
LocalMed
112
Dentally Incorrect
34 | PEDIATRIC
DENTISTRY
Pediatric Dentistry, Parents,
and Spoiled Kids
Dr. Jeanette MacLean has
experienced the tyrant-intraining patients that are every
dentists worst nightmare.
Heres how she copes with
themand their parents.
88 | GENERAL
PRACTICE
Yoga for Dentists
Dr. David Hennington shares
how yogas physical, mental
and emotional benets can
have a gentle but profound
effect on the unique health
challenges of dentists and
dental teams.
10 | HOWARD SPEAKS
38 | HYGIENE
14 | PROFESSIONAL COURTESY
48 | PROSTHODONTICS
30 | PRACTICE MANAGEMENT
This image-rich resource list provided by Dentaltown Clinical Director Dr. Betty Fleming shows
the options available in implants and abutments.
52 | FINANCE
BOTTOM LINE
DENTALTOWN.COM
42 | RADIOLOGY
Need more Dentaltown? Dont miss the opportunity to have the most
clinical and business-savvy information at the touch of your ngertips.
contents
august 2015
58 | FINANCE
84 | PRACTICE MANAGEMENT
Financial expert Konstantin Litovsky provides an indepth look at how dentists should manage money, and
offers debt-management advice.
62 | FINANCE
A Creative Approach to Retirement Funding
Authors Paul Homoly, Kenneth H. Mathys and Rob Ziliak
share a unique approach for funding retirement savings.
66 | ORTHODONTICS
Diode Use in Orthodontic-Related Procedures
Dr. Ron Kaminer explains how diode lasers help him
more easily perform various orthodontic procedures.
76 | CONTINUING EDUCATION
Stick With It: A Systematic Approach for Bonding
CAD/CAM Restorations
98 | PRACTICE MANAGEMENT
Why Dentists Need to Be Mobile-Ready
Rachel Taylor explains why phones and tablets are
the medium of choice for effective and timely patient
communicationand how you can be ready.
102 | RADIOLOGY
Rehabilitation Case with CAD/CAM Design and
Excellent Results
Dr. Abraham Stein and master ceramist Luke Kahng
describe a case in which a patients serious oral problems
were effectively treated with implants and crowns.
In this CE, Dr. Adamo Notarantonio demonstrates a stepby-step approach to bonding CAD/CAM restorations and
highlights their importance.
MESSAGE
BOARDS
22
70
PROSTHODONTICS
The Chasolen Effect
An in-depth look at how a Townie
treated a patient using implants
and a xed restoration after
attending the Chasolen study club.
PROSTHODONTICS
Thin Implants
Do you splint thin, short implants?
Check out this online discussion.
Dentaltown (ISSN 1555-404X) is published monthly on a controlled/complimentary basis by Farran Media, LLC,
9633 S. 48th St., Ste. 200, Phoenix, AZ 85044. Tel. (480) 598-0001. Fax (480) 598-3450. USPS# 023-324 Periodical Postage Paid in Phoenix, Arizona and additional mailing offices. POSTMASTER: Send address changes to:
Dentaltown.com, LLC, 9633 S. 48th St., Ste. 200, Phoenix, AZ 85044
2015 Dentaltown.com, LLC, a division of Farran Media, LLC. All rights reserved. Printed in the USA.
dentaltown
staff
on
.com
So you read the magazine, but did you know we also have an active online community?
The magazine is just a small part of what we do at Dentaltown. Visit Dentaltown.com for an ongoing conversation about
everything from tough cases to staff issues to whos going to win the World Series this year. Join the discussion!
Message Boards
Looking for Ideas for the Latter Half of 2015
Docs share tips and advice for increasing production during the second half
Inherited Case
of the year..
2nd Half
Case Presentation
Inherited Case
A great case from an oral surgeon involving a
70-year-old woman with a broken implant bridge.
Can Retire
Online CE
Plotino
Grande
Gambarini
ReciprocationAn Optimal
New Paradigm in Root-Canal Preparation By Gianluca Plotino, DDS, PhD;
Connect With Us
Nicola Maria Grande, DDS, PhD; Prof Gianluca Gambarini, MD, DDS
The reciprocating motion has been recently applied to specifically designed
dental
town
kind of movement.
howard speaks
column
10
howard speaks
column
Continued from p. 10
Remember when you dreamed of going into
dentistry? Being in dentistry is what you wanted.
You may have wanted it as badly as you now want
to retire. What can you change so that you love dentistry again? Its possible to love the profession into
old age.
For instance: Kenny.
Kenny was my neighbor growing up and he is
the reason I wanted to become a dentist. Kenny
recently celebrated his 50th year in dentistry; this
guy is still practicing! I used to watch him take
X-rays and do root canals and I thought it was
awesome. I had to become a dentist, even though it
broke my dads heart when I didnt follow his footsteps and continue in the family business. I wanted
to be a dentist, and I still want to be a dentist. Every
year I get better and faster.
Dentists much older than I am say that every year
they get so much better, so much faster. Theyve had
thousands of people walk through their doors, they
have a client list a dozen feet longthey get better
each step of the way. Maybe around 55 they say their
goal is to work one hour less a day and make $100 a
day more, and they can.
Howard Live
Howard Farran, DDS, MBA, is an international speaker
who has written books and dozens of articles. To schedule Howard to speak at your next national, state or local
dental meeting, email rebecca@farranmedia.com.
2015
12-19
AUG
12
RESTORATION
LA CARTE
SCAN
DESIGN
MILL
professional courtesy
column
Product Perfection
is Not Guaranteed
As we all know, the perfect dental product does
not exist. There are hundreds of new products introduced to the dental market each year and while some
are terrific, others are duds. As frustrating as this is,
trial and error is necessary for the advancement of
our profession. However, trial and error is also one
of the job gripes that dentists complain about the
most. We dont want to perform clinical tests on our
patients and we dont want to find out that a product
does not perform to its expectations after weve used
it hundreds of times. As an aside, this situation is not
always the fault of an inventor or manufacturer; one
of the most common reasons that a product does not
perform to expectations is failure to follow directions.
I believe first and foremost, every new product
comes to market with good intentions from the person or people who made it. They want the product
to be great, they want it to be successful and they
want to make your life as a dentist better. There is no
money to be made in a bad product. In fact, with the
cost of bringing a product to market, companies large
and small are on the hook to recover big development
costs before they can realize a dollar of profit. In
addition, the population of potential customers is relatively small so it is critical to get enough customers
to sustain the product in the long term. Occasionally,
youll see a product you like disappear from the market because there are not enough people using it.
Why do we unknowingly use some products
when they are not ready for primetime? In short, this
is the price of progress. Major manufacturers perform
extensive testing prior to bringing
a product to market, but if every
new product went through five to
10 years of rigorous clinical testing
before making it to market, we
would probably pay five to 10 times
the cost and we would currently
14
THANK YOU FOR MAKING ISOLITE TOWNIES CHOICE FOR TEN STRAIGHT YEARS
IN THE CATEGORY OF RESTORATIVE DENTISTRY: NON-RUBBER DAM ISOLATION.
Vote Early this year for the Chance to Win Prizes: www.Dentaltown.com/tca
FREE FACTS, circle 41 on card
continuing education
update
16
continuing education
update
Continued from p. 16
18
easy-graft CLASSIC
alloplastic bone grafting system
Register on the New GUIDOR.com to receive 15% Off your first online purchase.
To purchase or learn more, visit GUIDOR.com/easy-graft/ or call 1-877-484-3671.
Instructions for Use (IFU), including indications, contraindications, precautions and
potential adverse effects, are available at GUIDOR.com/IFU/.
2015 Sunstar Americas, Inc. All rights reserved. GDR15040 07012015v1
GUIDOR is a registered trademark of Sunstar Suisse, SA. easy-graft is a registered trademark of Degradable Solutions AG.
continuing education
update
Continued from p. 18
20
prosthodontics
message board
JasonL
Member Since: 04/13/00
Posts: 1-8 & 15 of 58
Introduction:
I brought this case to the Chasolen Study Club in 2007 (was it that long ago?). This gentleman
has been struggling with an upper partial for many years. In addition, his remaining teeth have
gradually been failing, requiring extraction, additions to his partial, and more despair for him.
We discussed a full denture, implants, and everything in between a few years ago and he didnt
feel he should spend that kind of money on himself.
I was also a little unsure about how to phase him through any treatment since we were
getting awfully close to not having anything stable to hold onto. I went to the Chasolen Study
Club with the photos and ideas. The case discussion ended up being longer than I anticipated,
with treatment options ranging from telescopes on teeth to locators, bars, fi xed on implants and
sinus surgery. I came home, reviewed everything and presented it all to the patient with his wife.
They finally decided to move forward with extractions, implants, and a fi xed restoration. Here
is that story.
Fig. 1
Fig. 2
Smile (Fig. 1)
Fig. 4
22
Continued on p. 24
prosthodontics
message board
Continued from p. 22
I waited four months and went back into the area of 8 and 9 and placed an implant in each,
buried them and waited. Eight weeks later I uncovered them and incorporated them into a new
provisional.
Fig. 7
Fig. 8
A model of the PEEK abutments for
reference (Fig. 7).
The new provisional when 8 and 9
were incorporated (Figs. 8 11).
Fig. 9
Fig. 10
Fig. 11
So, cost was an issue here and I tried to work as much as possible to get a nice final result
and keep costs in check. One way to do that was by utilizing the abutment that comes with the
implants (called a 3-in-1) and have the lab prep it. I also used a few custom abutments in order
to get ideal contours in the anterior.
Fig. 12
Fig. 13
The framework was fabricated with
bite tabs at the vertical we had determined
in the provisionals.
The abutments were inserted and the
pontic spaces contoured (Fig 12 & 13).
The framework was then tried in
Fig. 14
over this (it fit great) and a pickup impression was done. At this time all of the porcelain directions
were sent to the lab along with some of the original photos.
The patient wanted things to look as natural as possible; he was
against white teeth.
Fig. 15
We fi nished this morning. Two cemented restorations. The fit
was terrific.
Minor adjustment on the occlusion. Plan on him wearing this
for three weeks and then I will tweak the occlusion and insert the
mouthguard. Many thanks to Howard Chasolen and the crew at the
study club. And more thanks to Arrowhead Dental Lab. Tech Jacob
Bryan did a fantastic job.
The lab bill was in the neighborhood of $2,300. Implant parts were $3,000 roughly. ($379
per implant, three custom abutments, impression parts, PEEK abutments).
Fig. 16
Fig. 17
Fig. 18
JUN 25 2009
sunburstlespaul
Member Since: 07/04/07
Post: 16 of 58
Beauty of a case Jason! I thought you said the CT showed the need for sinus lifts for
implants. Was it done? Or did you just stay anterior to the sinus?
JUN 25 2009
24
Continued on p. 26
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prosthodontics
message board
Continued from p. 24
JasonL
Member Since: 04/13/00
Posts: 17, 20, 24, 29 & 33 of 58
Exactly. If the bone were there I would have extended further on the right side since he does
have 30 and 31. We discussed the procedure, cost, etc. and he decided he could survive with
premolar occlusion. Ill post the radiographs shortly.
One of the big things that stands out in this case is the tissue. Look at the pre-op photos and
then the final. The tissue is dramatically improved. Inflammation down, bleeding decreased ...
overall a much healthier situation.
The whole story: The case came back and there was no characterization. I sent it back and
had them re-read the lab Rx. Then it came back like this. Much better.
Initially, the PEEK abutments determined the contour. I just prepped them equi-gingivally.
The lab then did a soft tissue model when I sent the abutment impressions in to them. Utilizing
the photos and descriptions they prepared 8, 9, and 11 as custom abutments with ideal
emergence and margins just sub-gingival.
The other teeth just utilized a prepped 3-in-1 abutment to the tissue level with minimal
contouring. When I did the try-in of the framework I
prepared the pontic spaces with a diamond round bur
and the Periolase MVP-7 on diode setting.
They poured the framework pickup impression with
Duralay and pink tissue and stone. Does that answer your
questions/requests?
I was a little concerned because, even after deprogramming, I had a hard time when I would just tell him
to bite. So, when I was ready to take the bite, I sat him
up and had him tap, tap, tap and I observed what he
did. Then I instructed him to tap and hold. I then
visually confi rmed that he was centered.
On the framework you can see the tabs for the bite.
When he was supine it was way off and he was biting all
over the place. As soon as I sat him up he closed right into
the tabs ... I was surprised somewhat.
The one fear I had, though, was that he would be
hitting hard on the posteriors while sleeping. So, I took
a bite with the framework in and him supine. The lab
could then see this position that he could get to while
sleeping (in theory). I wanted to make sure they knew
this range and built to it accordingly. I think they did a
great job.
JUN 26 2009
www.dentaltown.com
Chasolen Effect
FREE FACTS, circle 34 on card
26
dentaltown
poll
pediatric dentistry
Isnt it helpful to know what other practices are doing? With our monthly poll you can see how other practices operate, what
works, what doesnt and how dentistry is evolving. The information we gather each month helps us measure trends in the
profession. This pediatric dentistry poll on was conducted on Dentaltown.com from July 1, 2015 to July 17, 2015.
When you restore primary teeth, what percentage of the time do you use
a glass-ionomer-based restoration?
4 7 %
2 2 %
1 4 %
1 7 %
Less than 5%
6-25%
26-50%
77%
Yes
23%
10%
No
Yes
90%
80%
No
Yes
20%
No
80%
77%
57%
75%
80% No
16% Yes
4% Im a pediatric dentist
77% Yes
23% No
57% No
19% Yes, routinely
24% Yes, sometimes
75% Zero
19% 1-5
1% 6-10
5% 16+
28
2 4 %
2 1 %
1 3 %
0 5 %
0 9 %
0 9 %
1 9 %
Implant placement
Endodontics
Occlusion
Implant restoration
Oral surgery
Pediatric dentistry
Esthetic procedures
practice management
feature
Setting a clear
referral goal for
your office
Make your
office referable
Strategies for
Maximizing
New-Patient
Referrals
Hold a staff
contest
by Jay Geier
Send out
Patient
newsletter
30
Communicate
that you want
referrals
practice management
feature
31
practice management
feature
Author Bio
Jay Geier is the founder and president of the Scheduling Institute and creator of the world-renowned Five Star New Patient Generation Training Program that has revolutionized the way dentists attract new patients to their practices. He is revealing his secret for record-setting results (600+ new
patients in ONE week) in a FREE CD available now at www.SchedulingInstistute.com/dentaltown.
32
14.4 LP/mm
8.4 LP/mm
8.4 LP/mm
10 LP/mm
10 LP/mm
12 LP/mm
14.4 LP/mm
DEXIS Platinum
12 LP/mm
Schick 33
Examine
the Evidence
Yourself!
Go to
dexis.com/
best
1-888-883-3947 | www.dexis.com
*Data sources: DEXIS Sensor Competitive Performance Study and DEXIS Sensor Clinical Evaluation Report. Visit www.dexis.com/about-evidence-document for
study details. For DEXIS Platinum Sensor Indications for Use, visit www.dexis.com/ifu.
2015 DEXIS, LLC DX53060115REV0.5530
FREE FACTS, circle 50 on card
pediatric dentistry
feature
Pediatric Dentistry,
ids
34
pediatric dentistry
feature
The overindulger
Nowadays you dont have to be
wealthy to have an overindulged child.
In many ways, our overscheduled lives
and complicated family dynamics have
bred a culture of guilt-ridden parents.
Contributing factors for parents who
overindulge their little ones may include
common stressors such as divorce, grandparents who serve as primary caregivers, or
both parents working full-time jobs.
As a working mom of two young children, I am guilty of this parenting pitfall.
Too many treats, too many toyswhy do
we do it? While I cannot speak for everyone, I know that I feel guilt from the long
hours I put in at the practice.
After a long, hard day managing
other peoples children at my office, the
last thing I feel like doing is wrestling my
3-year-old to get her to brush her teeth. I
just want to come home and relaxI want
my kids to be happyI dont want conflict. But having seen the perils of the tiny
dictators at my office, I quickly snap out of
it, put on my mommy pants and lay down
the law. The problem is the ever-growing
number of parents and guardians who fail
to be the parent and find it far easier to be
their childs friend. Because there is very
little discipline for bad behavior, often the
child is left with a sense of entitlement.
Another cultural phenomenon that
contributes to the overindulged child is
the new normal of parents striving for
Pinterest perfection. In an ongoing
attempt to not just keep up with the
Joneses, but rather one-up the Joneses,
every little life event is celebrated, documented and chronicled online for all the
world to see. There is a ribbon, a trophy,
or certificate of participation for all of
lifes precious moments. Even my 5-yearold son, who was more interested in his
soccer leagues postgame snack and never
scored a goal the entire season, still got
a trophy from his team. The trouble is,
when we try to get these little darlings to
cooperate for dental treatment, theyre no
longer impressed by a 25-cent prize from
our treasure tower.
35
pediatric dentistry
feature
Author Bio
Dr. Jeanette MacLean is a private-practice pediatric dentist and owner at Affiliated Childrens Dental Specialists in Glendale, Arizona. She is a
diplomate of the American Board of Pediatric Dentistry and her clinical research has been published in Pediatric Dentistry, the official publication of the American Academy of Pediatric Dentistry. Visit Kidsteethandbraces.com for more information.
36
GENERAL DENTISTRY
ENDODONTIC
PERIODONTIC
RESTORATIVE
Specialty presets allow you to see and save images based on diagnostic need.
Exclusive
Distributor
0% SHARPENING
50% SHARPENING
100% SHARPENING
Dynamic Image Enhancement allows you to maximize Schick 33s true diagnostic potential.
GLOBAL
NUMBER
hygiene
feature
FINDING
THE
HIDDEN TREASURE
TREASURE:
Prevention =
Treatment +
Motivation +
Compliance
by Barbara Vugteveen, RDH
38
A rich haul
Why is this so important and why
do your patients need to get their dental
swag on? Patients need motivation
through instructionto make all your
efforts in the office work over the longterm. They need the right tools for the job
to make this happen, and more important, they love the individual, case-specific
oral-hygiene instruction you give them.
When a hygienist gives a patient a proxy
brush, end tuft, Stim-U-Dent or any tool
that targets a specific problem area, the
patient loves the hygienist for it and will
often stay with the practice for life.
We all know periodontal disease isnt
cured; its maintained. We also know that
proper treatmenta prophy, a debridement with reevaluation for scaling, or
quadrants of scaling and root planing
wont be successful without the patients
compliance with home-care and daily
plaque-removal instructions. Educate
your patient about the disease process and
how critical it is that he or she participates
hygiene
feature
39
hygiene
feature
Author Bio
Barbara Vugteveen is a registered dental hygienist. She has 20 years of experience in
private practice and currently works in Tucson, Arizona. Vugteveen believes making a
personal connection and motivating her patients to be active participants in their overall health is just as important as restoring and maintaining periodontal health.
40
202K
495%
RETURN ON INVESTMENT
Guaranteed
CALL 855-391-1044
FREE FACTS, circle 37 on card
080115_DT_FLPG_IRMM
radiology
feature
The Three
Dimensions
of Endodontic CBCT:
42
radiology
feature
Fig. 1
Fig. 2
Using a
CBCT image
can greatly
simplify
Fig. 3
what may
otherwise
sound like a
Fig. 4
Fig. 5
very complex
treatment
plan.
Using 3D imaging to educate our
patients and referring dentists
Fig. 6
43
radiology
feature
Fig. 7
Fig. 8
Fig. 9
Fig. 11
Fig. 12
44
radiology
feature
Continued from p. 44
Fig. 13
Fig. 14
Fig. 15
patient arrived for her subsequent appointment with a high degree of trepidation.
She asked many questions about what
might happen if we were not able to locate
the canal. While I truthfully advised that
apical surgery or extraction may be an
option, I very confidently advised her that,
armed with my 3D scan and my microscope, I should be able to readily locate the
canal and complete the case.
Indeed, 15 minutes after placing
the rubber dam and removing the
temporary fi lling, I was able to direct
my ultrasonic instrument 0.5mm in
the distobuccal direction and locate
the canal. Once the canal was located,
the root-canal treatment and bonded
composite core buildup were completed
uneventfully (Fig. 16).
The patient was extremely grateful
to have saved her tooth without any
additional procedures. In looking back at
this case, there is no telling how it would
have turned out without the benefit of the
CBCT. There is a much higher likelihood
that the tooth would have been weakened
or even perforated in looking for the canal.
When I reviewed the images with
her dentist, who had initially proposed
performing the root canal himself, he
was surprised by the degree of difficulty
of this case and was very relieved not to
have attempted it. This kind of interaction between the specialist and
referring dentist is a great way to
build bridges and increase future
referrals.
46
radiology
feature
rather than the cursory overview of sharing only the resulting findings.
As a professional, I find it is critical to
be comfortable with modern technologies
as they emerge. In endodontics, the emergence of cone-beam CT has dramatically
enhanced our ability to diagnose, treatment-plan and execute procedures with
greater confidence than ever before.
Author Bio
Dr. Rowshan Ahani is a graduate of the UCLA School of Dentistry. He earned his certificate of endodoctics and MS in oral sciences from the SUNY
Buffalo. Dr. Ahani is a diplomate of the American Board of Endodontics and maintains a private endodontic practice, Bayside Endodontics, in
Daly City, California.
47
prosthodontics
feature
Implant Drivers
and Driver Tips
for Single-Torque Wrenches
Elizabeth J. Fleming, DDS,
Clinical Director, Dentaltown Magazine
48
prosthodontics
feature
For NobelBiocare, 31
TG Driver
49
prosthodontics
feature
If you place implants on your patients, likely you work with a few different implant systems and are familiar with the components.
For those of us who are just restorative dentists, remembering which driver and the corresponding torque value needed to restore the
various implant systems can be a challenge. To help, here is a comprehensive torque value chart from Genieoss.
Torque N-cm
15
20
24
25
30
Driver
35
45
Titanium Screw
Gold Screw
Atlantis titanium and zirconia abutments utilize the same torque and driver setting as the original implant manufacturer
Astra 3.0
Astra 3.5-4.0
Astra 4.5-5.0
Biomet 3i Certain *
0.048" hex
0.048" hex
BlueSkyBio Trilobe
0.050" hex
0.050" hex
BlueSkyBio Max
0.048" hex
BlueSkyBio Quatro
0.048" hex
Unigrip
1.28mm hex
0.048" hex
1mm hex
1.2mm hex
Imtec 3M Endure
1.2mm hex
X
Implant Direct
0.050"-1.25mm hex
Square
Keystone/Lifecore Renova
0.048" hex
0.048" hex
Keystone/Lifecore Restore
Mega'Gen EZ Plus
Mega'Gen Rescue
Mega'Gen ExFeel internal (3.5)
0.048" hex
X
0.048" hex
1.2mm hex
X
X
1.2mm hex
1.2mm hex
1.2mm hex
0.050"-1.25mm hex
Neoss
50
Square
Square
Unigrip
Square
prosthodontics
feature
Manufacturer
Torque N-cm
15
NobelActive 3.0
20
24
25
30
Driver
35
45
Titanium Screw
Unigrip
OCO Biomedical
0.050"-1.25mm hex
32
0.048" hex
32
Unigrip
32
Star/Torx
Star/Torx
Square &
Unigrip
1.7mm hex
Four lobe
Gold Screw
Four lobe
Four lobe
X
* Biomet 3i Certain screws are gold plated only. Keystone Genesis and Prima abutment screws are made of titanium and have a titanium
nitride coating.
51
cover story
feature
Retirement
Planning
Are the top 1 percent
safe? Take steps to
create a secure future.
52
cover story
feature
Mismanagement and
poor execution
Several years ago, I was hired to
research a potential investment in a new
massively multiplayer online (MMO)
Continued on p. 55
dentaltown.com \\ AUGUST 2015
53
cover story
Continued from p. 53
video game. Stargate Worlds, in association with Metro-Goldwyn-Mayer, promised to be an exciting competitor to the
popular World of Warcraft MMO series.
The video-game community was buzzing
with excitement, and investors committed
millions of dollars of capital to Cheyenne
Mountain Entertainment (CME) to help
build what was then one of the most
anticipated games in MMO history.
I visited CME headquarters in Mesa,
Arizona to do some onsite research. After
interviewing some of the staff and management, I recommended that my clients
withhold investing, because I identified
some red flags that turned me completely
off the venture. During my visit, I saw
an overly ambitious executive developing
multiple games at the same time, not just
Stargate Worlds. He felt these were good
opportunities. But any competent analyst
would have seen them as I didthey
were distractions.
To make a long story short, CME
went bankrupt and millions of dollars
worth of code never even made it to
market. The game wasnt developed in
time to meet contractual deadlines. The
investment opportunity was wasted, and
investors lifestyles were jeopardized.
My clients had the foresight to ask for a
second opinion before committing large
amounts of capital to this particular
venture, and Im sure they will continue
to exercise the same caution in the future.
Remember, no good idea can overcome
poor management and poor execution on
someone elses part. Exercise extreme prejudice when investing directly into another
business. If not, you may end up hanging
yourself out to dry.
Fraud
I grew up in a small town in Idaho,
where one of the largest Ponzi schemes
in U.S. history took a heavy toll. James
Paul Lewis of Financial Advisory
Consultants met with individuals in
my small community, and promised a
consistent, high return through various
small-business investments.
feature
55
cover story
feature
uncertainty that follows. This is especially true when the company in which
youve invested is producing financial
or accounting records. You never know
when you could be dealing with a
self-serving sociopath.
Concentration risk
My no-brainer guidelines
Author Bio
Reese Harper is the founder and CEO of Aquire Advisors. His firm helps dentists make smart financial decisions and plan for a secure retire-
ment. He lives in Salt Lake City with his wife and four kids. Learn more at www.dentistadvisors.com.
56
cover story
feature
DEBT-Repayment
Basics for DENTISTS
by Konstantin Litovsky
f you started practicing dentistry sometime in the last decade, you know that
being in debt is a fact of life no dentist
can avoid.
An education at a private dental school
can cost well over $400,000, and purchasing a practice in some states on either coast
can set you back anywhere from $500,000
to $1 million. In the past 15 years, the
average graduating dentists loan debt has
risen to $240,000,1 yet this number hides
the fact that a small (but increasingly
growing) number of dentists who specialize will have a student-debt level that can
be more than two times that amount,
putting tremendous pressure on new graduates and limiting their career choices.
In addition to student and practice
debt, most dentists will also have a mortgage and will also be responsible for their
childrens higher-education expenses.
Carrying a large amount of debt into
retirement can be a huge problem for
those who do not have adequate retirement savings.
For one thing, student debt is impossible to discharge in bankruptcy.2 Debt
repayment should be a key component of
every dentists financial plan, and there
is excellent and extensive advice on debt
management offered by financial gurus
like Douglas Carlsen.3 Lets concentrate
on the basics of loan repayment and
58
Prepay or invest?
Whether you have student loans,
practice loans or a mortgage, one of the
most common questions is whether it
makes sense to pay off your loans early
or invest your money in stocks, instead.
Do your loan interest rate and principal
amount matter when deciding whether
to repay your loan quickly? What rate of
return do you need from your investment
to justify investing, rather than prepaying
the loan?
Lets take a 25-year, $500,000 student loan with 6.8 percent interest and a
monthly payment of $3,470 ($41,640 per
Principal
Regular
Payments
$500,000
Prepayment
Scenario #1
$500,000
Prepayment
Scenario #2
$500,000
Interest
6.8 percent
6.8 percent
6.8 percent
$3,470
$3,470
$3,470
$0
$1,000
$6,000
25.00
14.82
5.24
$541,108
$294,749
$95,812
$1,041,108
$794,749
$595,812
$0
$246,359
$445,296
Monthly payment
Extra monthly payment
Repayment period (years)
Total interest payment
Total payment
Interest savings
cover story
feature
Prepayment Scenario #1
Prepayment Scenario #2
Repayment period:
14.82 years
Repayment period:
5.24 years
Rate of return
Remaining
principal
Compounded
payments
Remaining
principal
Compounded
payments
5 percent
$305,432
$262,632
$452,010
$430,559
6.8 percent
$305,432
$305,432
$452,010
$452,010
8 percent
$305,432
$338,781
$452,010
$467,070
Table 2. Extra monthly payment invested at different rates of return over the repayment period of
each loan
Types of debt
While credit-card debt can be a problem for some people, depending on where
you live a practice loan is probably the
biggest debt youll have, followed by your
mortgage and student loans.
1. Practice loans. The interest for
practice loans is tax deductible, and
these loans are usually paid out over the
period of 10 years. A typical loan has an
interest rate of around 5.5 percent, so the
effective interest rate for someone in the
33-percent federal and 5-percent state
tax bracket is 5.5 percent x (1 - 0.38), or
3.4 percent. You can continue taking out
practice loans if this will help your practice make more money.
2. Student loans. In the case of the
student loan in Table 1, prepaying the loan
would effectively produce a 6.8-percent
return on investment, given that for most
dentists the interest is not tax deductible.
While a typical graduate student loan will
have an interest rate ranging from 6.8 percent to 7.9 percent, the good news is that a
growing number of banks are letting dentists consolidate their student loans into a
fixed-rate loan with an interest as low as
5 percent. This loan should be paid out as
quickly as possible.
3. Mortgage. For most dentists, the
interest on their mortgage will be tax
deductible. If you are in the 33-percent
federal and 5-percent state tax bracket and
your 30-year mortgage interest rate is 4.5
percent, your effective interest rate would
be 4.5 percent x (1 0.38), or 2.8 percent.
If your AGI is too high and your itemized
deductions (including the mortgage interest deduction) are phased out, you might
want to consider refinancing into a 15-year
loan. If you happen to live in a state where
an average house costs $1 million, refinancing into a 15-year loan may also be a
good idea.
Loan
amount
30-year loan
@ 4.5 percent,
interest paid
15-year loan
@ 3.5 percent,
interest paid
Total interest
saved
$200,000
$164,814.00
$57,357.00
$107,457.00
$1,000,000
$824,068.00
$286,788.00
$537,280.00
59
cover story
feature
While very few dentists are totally debt-free, the quicker you
shed most of your bad and unessential debt, the sooner you will
be able build up your savings.
return was 0.4 percent annualized over
10 years, a CD or a money-market fund
seemed like a great investment choice.
Most consequential stock market returns
(both positive and negative) happen in
short periods of time, and one or two
good years can easily skew the annualized
return numbers. A decade of bad returns
can be transformed by a quick rally, or a
decade of good returns can be destroyed
by an even quicker crash.
Extrapolating a historical return into
the future can create a false sense of security and may lead us to assume (unrealistically) that all we have to do is wait long
enough to get a 10-percent return from
the market.
Market statistics (and research) do
not support the hypothesis that historic
average returns can be expected in the
future. There may be scenarios under
which a portfolio can get a return higher
than 10 percent, but it can also experience negative returns and long periods of
drawdowns, so it is not advisable to count
on the stock market to outperform your
your student loans, you should do so, provided you take the following steps first:
1. Establish an emergency fund that
will cover between six months and 1
year of your expenses.
2. Contribute to Roth IRA. Use
a backdoor contribution via a
non-deductible Traditional IRA if
you are phased out.
3. If you are an associate, contribute
to a retirement plan, at least enough
to get the employers matching
contribution.
If a retirement plan is not available
to you, invest after tax until you can
buy your own practice. If you are paid
as an independent contractor, you may
be eligible to open your own solo
401(k) plan.6 As a practice owner,
you can start with a basic retirement
plan, such as SIMPLE IR A or a Safe
Harbor 401(k). After you pay out your
student loans, you can always catch
up on retirement savings by using a
custom-designed 401(k) plan and/or a
Cash Balance plan.7
Summary
Whether you prefer to repay your debt
quickly or take your time and invest your
money instead, simple rules can help you
develop an optimal approach to managing
your debt. For any type of loan, if you
want to invest rather than prepay the loan,
your ROI (after taxes) has to be greater
than the interest rate on your loan. It
would be a good idea to prepay your loans
carrying highest interest (such as student
loans) as quickly as possible, because such
prepayment generates a return that equals
the interest rate on your loan (less tax
deduction, if any).
Even if you can get an investment to
generate a higher ROI than your mortgage
interest, it is still a good idea to repay your
mortgage more quickly (ideally by refinancing into a 15-year mortgage), because
the cost of your mortgage is proportional
to the mortgage amount, so the higher the
original mortgage, the larger your mortgage cost will be. While very few dentists
are totally debt-free, the quicker you shed
most of your bad and unessential debt,
the sooner you will be able build up your
savings. Whether you want to retire early
or continue practicing dentistry, being
financially independent will give you more
control over your future plans.
References
1. http://www.asdanet.org/debt.aspx
2. http://www.nolo.com/legal-encyclopedia/student-loan-debtbankruptcy.html
3. http://www.dentaltown.com/dentaltown/article.
aspx?i=273&aid=3696
4. http://www.wsj.com/articles/dont-buy-a-home-as-aninvestment-1419728902
5. http://retirementresearcher.com/greatest-hits-part-2-thebond-market/
6. http://quantiamd.com/player/ygvmhdmbm?cid=1467
7. http://litovskymanagement.com/2013/04/retirement-plansbusiness/
Author Bio
Konstantin Litovsky is the founder of Litovsky Asset Management, a wealth-management firm that offers flat-fee, comprehensive financial
planning and retirement plan advisory services to doctors and dentists. Litovsky specializes in setting up and managing retirement plans for
small practices, including 401(k) and defined benefit/cash balance. He can be reached at konstantin@litovskymanagement.com.
60
iPad
iPad
iPad
practice solutions
Practice Solutions explores how specific products and services can be of use clinically or in practice management.
A Fresh Approach
to Retirement Funding
by Paul Homoly,
Kenneth H. Mathys,
and Rob Ziliak
Paul Homoly, CSP, is president of
Homoly Communications Institute,
a resource for developing practicebuilding skills and leadership for
dentists. He provides seminars,
workshops, and consultations on the
topics of the new-patient experience,
dental practice development and
management, and communication with
patients. Visit Paulhomoly.com or call
(800) 294-9370 for more information.
Kenneth H. Mathys, CPA, is founder
and CEO of Dental Practice Advisors,
LLC (DPA). The company supports
dentists who express the need
for quality, accessible practicemanagement support and for a much
deeper professional relationship
with their advisers. DPA provides
a wide array of services, including
practice management, business
planning, leadership, human
resources, transition support
and financial accounting. Visit
Dentalpracticeadvisors.com or call
(920) 593-7250 for more information.
Rob Ziliak, MPAS, CFP, is a wealth
advisor and office director at
Buckingham, a comprehensive wealthmanagement firm with a niche practice
area that focuses on financial solutions
for dentists and their families. Ziliak
also participates as an advisor in
the Dental Practice Area of the BAM
ALLIANCE, a community of more than
140 independent firms across the
United States. To learn more about the
BAM ALLIANCE and to find an advisor
near you, visit Thebamalliance.com or
call (888) 470-3064.
62
Dentists need a process that makes retirement savings a part of their everyday practice
experiences. Too often the pressure and complexity of delivering clinical care diverts the energy
and attention needed to implement retirement
strategies. Consequently, many dentists face
retirement challenges that are unsolvable without
drastic, unwelcome changes to their lifestyles.
There are hundreds of retirement articles
out there; however, very few of them take into
account the unique financial circumstances
that dentists are faced with at the time of
retirement. Fortunately, there is a new way for
dentists to fund retirement savings that also fits
into their clinical culture, a way that is often
overlooked by mainstream finance experts
whose target audience often excludes clinicians.
By offering interest-bearing patient
financing administered through a third party,
dentists can earmark the principal and interest
payments received from patients to a segregated retirement savings account.
This strategy allows dentists to avoid taxation on principal and interest payments and
allows those payments to grow in a tax-deferred
environment.
By offering a modest number of patients
these financing solutions, dentists can:
Fill empty chair times in the schedule
Treat patients who normally would not
have accepted care without financing
solutions
Enjoy referrals from these grateful
patients
Secure their retirement savings goals.
Dentists mindsets
Although many dentists have modest
business skills, their mindsets are more often
aligned with production, collection, case
acceptance, and scheduling. More specifically,
when patients do not accept treatment recommendations, time and money are lost in the
process, resulting in the dentists suffering.
To make treatment acceptance easier, dentists can offer patients financing options supported by financial institutions. This provides
the opportunity to link retirement funding
into dentists mindsets.
Dentists can make patient-financing solutions available through a company that shares
the financing interest paid by the patient.
The process:
1. Patients are offered financing solutions.
These solutions include a choice in which
they make modest down payments for
their dental care.
2. Dentists complete patients care and
patients make interest-bearing monthly
payments to the finance company. The
finance company earns a small percentage
of these payments and sends the remaining payment balance, with interest, to the
dentists.
3. Dentists take these interest-bearing
payments earned from patients and
deposit them into a segregated account
earmarked for retirement savings. Once
deposited into a retirement savings
account, the interest-bearing payments
practice solutions
Practice Solutions explores how specific products and services can be of use clinically or in practice management.
A closer look
Lets look at an example of how this could
work in a dental practice. Dr. Stephanie Kotter
began offering interest-bearing financing for her
patients two and a half years ago. She started
by offering it to her recall patients who needed
additional care but delayed treatment until it fit
within their budgets.
She discovered that of her 1,500 active patients,
close to one-third needed additional care, and,
when offered patient financing, 25 percent of those
additional-care patients chose to go ahead with
5
$15,000
$8,800
26
months
78
patients
$5,000
1
12
months
24
months
36
months
Authors note: Information from sources deemed reliable, but its accuracy cannot be guaranteed.
Performance is historical and does not guarantee future results.
63
practice solutions
Practice Solutions explores how specific products and services can be of use clinically or in practice management.
interest payments, she enjoyed increased patient referrals from patients who were grateful to her for making it easier for them to receive care. These results
gave her the confidence to offer financing solutions to
all of her new patients.
Now after two and a half years, Dr. Kotters
patient financing loan portfolio is worth $113,000,
yielding $8,800 a month in principal and interest
payments. Heres a chart of Dr. Kotters patient
financing progress. (See p. 63.)
Notice how, after 26 months of offering patient
financing, Dr. Kotter averages three loans a month,
totaling $8,640, and she is receiving $8,800 a month
in principal and interest payments. In other words,
she has reached a point where there is no cash-flow
risk. Plus, she gains in referrals from patients who
normally may not have accepted care without the
benefit of patient financing.
Dr. Kotter is in her late 40s, married, and has
two sons, both of whom are in private schools. Up
until now, Dr. Kotter has been paying down debt,
financing large purchases for her practice, compensating her staff well, paying tuition and enjoying a
reasonably nice lifestyle. Unfortunately, like many
dentists, Dr. Kotter has not been sufficiently saving
toward retirement.
Emergency Scenarios
SEDATIONREADY.COM
64
Practice Solutions explores how specific products and services can be of use clinically or in practice management.
The solution
Dr. Kotters new-patient financing loan portfolio
can fund her retirement savings and enable her to
pay less in taxes. For example, by funding a customdesigned retirement plan arrangement, inclusive of
both a defined contribution (401(k) profit sharing)
and defined benefit (cash balance) plan, Dr. Kotter
can defer all $8,800 of increased earnings per month,
while also having the assets grow tax-deferred until
withdrawn during retirement. When all $8,800 per
practice solutions
Conclusion
Dentists clinically-oriented mindsets often do
not coincide with good financial planning and follow-through. Too many dentists are forced to retire to
a less-than-ideal lifestyle. However, if retirement-fund
savings were connected to their everyday clinical
mindset, then creating abundant retirement savings
could be a predictable outcome. Interest-bearing
patient financing managed by an outside third party
can be the stress-free solution for dentists to save for
retirement and retire on their own terms.
To find out more about how to create a portfolio of interest-bearing patient financing, contact
Comprehensive Finance at (866) 964-4727 or visit
Comprehensivefinance.com.
Editors note: This article is an excerpt from the
white paper An Innovative Solution to Retirement Plan
Funding for Dentists. To download the entire white
paper, go to Comprehensivefinance.com/dt.
65
orthodontics
feature
Diode Use in
Orthodontic-Related
Procedures
by Ron Kaminer, DDS
Lasers emergence
Fig. 1
Fig. 2
Fig. 3
Fig. 4
66
orthodontics
feature
Fig. 5
Fig. 6
67
orthodontics
feature
Fig. 7
Fig. 13
Fig. 8
Fig. 14
Fig. 9
Fig. 15
Fig. 10
Fig. 16
Fig. 11
Fig. 17
Fig. 12
Fig. 18
68
orthodontics
feature
A common
issue we see
among our
ortho patients
is overgrowth
of tissue due
to poor oral
hygiene.
The stent is then tried in the mouth
before anesthetizing the patient to make
sure there is positive seat (Fig 15).
After confirming the fit of the stent
and anesthetizing the patient, the diode is
used to follow the outline of the stent to
create pleasing gingival contours. In this
particular case, the patient disliked the
knife-edge appearance of the gingival tissue around tooth #7 (Fig. 16). The tissue
was recontoured (Fig. 17) and typically,
Conclusion
As evidenced by a few of the highlighted procedures, using the Picasso diode
laser can enhance orthodontic-related
procedures. Other ortho procedures for
which a diode can be used include uncovering of soft-tissue impactions, removing
soft tissue for easy bracket placement, and
supracrestal fiberotomies.
Since the Picasso diode is relatively
inexpensive, the return on investment
is tremendous for the doctor. If a doctor performs only three cases a year of
overgrown tissue around orthodontic
brackets, he or she will be able to pay
for the laser, even at reduced reimbursement from insurance companies. Add
in a number of frenectomies, soft-tissue
smile-recontouring procedures, and the
plethora of other procedures that can
be performed with a diode in operative
dentistry and crown and bridge, and
the doctor will fi nd that the Picasso
diode is a sound investment in any
practice. Because complete training is
included, the learning curve is short
and the doctor can start using the diode
almost immediately.
Lasers have had a huge impact on
my practice over the last 20 years. While
change can be difficult, I assure you that
if you take the leap into laser dentistry,
it will change your practice forever in a
positive way.
Author Bio
Dr. Ron Kaminer is a 1990 graduate from SUNY Buffalo School of Dental Medicine. He maintains two practices in Hewlett and Oceanside, New York dedicated to minimally invasive and
laser dentistry. He consults for many dental manufacturers and lectures nationally and internationally on topics ranging from minimally invasive and laser dentistry to new materials
and technology. He is the founder of the Masters of Laser training course and facility in New
York, and has trained thousands of dentists on the use of a variety of dental lasers. He is currently the medical director of AMD lasers and is passionate about spreading the word on laser dentistry. He lives in Hewlett,
New York with his wife and three children.
69
prosthodontics
message board
billschaeffer
Member Since: 10/22/03
Post: 1 of 71
Implant CaseVariations
on a Theme
Variations On
Introduction:
Lovely lady came in today for another implant in the lower jaw so it gave me the opportunity
to review some upper implants I placed in 2013. I pretty much never (and thats a word I rarely
use) splint adjacent units. My screws just dont
Fig. 1
Fig. 2
come loose and its never caused me a problem
doing them without splints.
Missing upper left molar and premolar
(Fig. 1)
Thin ridge (Fig. 2)
I did place a bit of particulate over the fenestration (Fig. 3).
Fig. 3
Fig. 4
Another view (Fig. 4)
Another view (Fig. 5)
Squeezed them in somehow in October
2013. These are both Ankylos implants that
are 3.5mm wide and 6.6mm long. Both
placed one-stage. Surely these small implants
Fig. 5
Fig. 6
will have to be splinted together to cope with
the forces of occlusion (Fig. 6)!
At check of integration in February 2014
(Fig. 7).
Unsplinted crowns fitted in March 2014
(Fig. 8).
And here they are today on May 6, 2015,
Fig. 7
Fig. 8
more than one year after loading.
Hows that overloaded bone looking
(Fig. 9)?
Clinical photo taken, as always, after
probing (no probing less than 1mm and no
BOP)(Fig. 10).
Fig. 9
Fig. 10
Conclusion:
I just dont see the problems that others
report when I dont splint my implants, even
implants as short and thin as these.
MAY 6 2015
70
Continued on p. 72
prosthodontics
message board
Continued from p. 70
MatthewE
Member Since: 04/16/08
Post: 8 of 71
billschaeffer
72
prosthodontics
message board
Anecdotally, crestal loss is much more common in implants that have the coronal microthread design. I would speculate that as a primary reason most manufacturers have abandoned
this feature.
mattcosta
Member Since: 07/02/09
Post: 11 of 71
MAY 6 2015
markmcdds
Especially when the microthreads are not completely buried in bone at placement.
MAY 6 2015
Bill, about the Trisi study, the author says it could depend on the implant design.
One implant manufacturer swore to me that implant design could indeed cause bone loss
because of too high torque at the crestal level during insertion, and that it had already been
burned by it (having to redo the design for another brand he was working for).
choixpeau
Member Since: 02/02/06
Post: 13 of 71
MAY 6 2015
73
prosthodontics
message board
raykwon2
Member Since: 02/15/12
Post: 16 of 71
Not so sure about this. What about Astra, BioHorizons, Zimmer, Dentium all have
microthreads at the top and did from the start. In fact, due to the increased surface area provided
by the microthreads, its more likely that less crestal bone loss should occur on these implants
since the biologic width of ~1.5mm is formed over a shorter distance vertically.
Its more about the connection, platform switching, surgical technique and initial depth of
implant placement.
MAY 6 2015
billschaeffer
Member Since: 10/22/03
Post: 21 of 71
Every implant system has its pros and cons. As you know, we place quite a lot of Ankylos
implants (1,677 in 2014) so we get to see what works and what doesnt with this system.
You will also know that we do some fairly silly things with our implants, like cantilevering
off single implants and restoring short skinny implants with unsplinted molar crowns (some of
the stuff we do with these implants makes even me nervous...!).
Do we see abutments fracturing? Yes, but very, very rarely.
We do not use zirconia abutments that have a ceramic connection inside the implants. That never
seemed like a good idea to me and I think that most people prefer to have a titanium-titanium I-A
interface these days. Why? Because those all-zirconia abutments broke on many different implant
systems and Ankylos was no different.
Honestly, I have zero financial interest in Ankylos other than that I place their implants, and
abutment fractures in our hands (45 percent of our implants are restored by the referring dentists
so they are not all expert hands) are incredibly rare.
MAY 7 2015
dentsim
Member Since: 05/12/07
Post: 28 of 71
billschaeffer
Member Since: 10/22/03
Post: 32 of 71
We see the patient one month after the implant has been restored. Then six months after the
implant has been restored. Then yearly after the implant has been restored until I feel its stable,
and then Ill see the patient every two years.
During each appointment, I will examine the restoration and the gum, and ask, is it loose?
Is the gum discolored? Is there a draining sinus? Is there recession, etc.?
I will massage the gum and look for any pus from the gingival margin.
I will probe around the restoration. Does it bleed? Is there a deep pocket (pocket depth
itself is not as important as around a tooth, but its one more indicator of health or disease)?
Is there pus?
I will take a periapical X-ray. I will sometimes take photos, sometimes not. I will always
take photos at the fit appointment, and if there are any changes. If I take photos, they are always
taken after probing.
(Posted May 10, 2015)
Almost everything we do uses stock TiBase abutments*. We very rarely use Atlantis abutments. About the only thing we use them for is delayed loaded Syncone cases.
*Not all products are available in North America.
MAY 10 2015
74
continuing education
feature
A Systematic Approach
for Bonding CAD/CAM Restorations
by Adamo E. Notarantonio, DDS, FICOI, AAACD
Abstract
This article will demonstrate a step-by-step approach
to bonding CAD/CAM restorations. The article will
demonstrate proper technique, as well as explain all
materials used and why they were selected.
AGD
Code:
615
76
This print or PDF course is a written self-instructional article with adjunct images and is
designated for 1.5 hours of CE credit by Farran Media. Participants will receive verification
shortly after Farran Media receives the completed post-test. See instructions on page 81.
continuing education
feature
Objectives
Case presentation
Fig. 1
Fig. 2
77
continuing education
feature
Fig. 3
Fig. 4
Fig. 5
Fig. 6
78
CAD/CAM
manufactured inlays
and onlays require
adhesive bonding as
it increases retention
and improves
marginal seal, as well
as strengthens the
restoration and the
supporting tooth.
All-Bond Universal is an ethanol/
water-based dental adhesive that bonds
to dentin and to cut and uncut enamel.
It bonds to all indirect substrates, and
is compatible with all composite and
resin-based cements without an additional activator. The solvent was evaporated with a tooth dryer for 30 seconds
(Fig. 8) until there was no visible movement of the material and the surface had
a uniform glossy appearance.
The surface was then light-cured for
10 seconds. Duo-Link Universal was
applied directly into the matrix band (Fig.
9) enclosed preparation. The restoration
continuing education
feature
Fig. 7
Fig. 10
Fig. 8
Fig. 11
Fig. 9
Author Bio
Dr. Adamo Notarantonio is a graduate of the State University of New York at Stony Brook School of Dental Medicine (2002), where he received
honors in both removable and fixed prosthodontics. He completed his residency in the advanced education in general dentistry program at
Stony Brook in 2003, and was chosen by faculty to complete a second year as chief resident.
Notarantonio is one of approximately 400 dental professionals internationally to achieve accreditation status in the American Academy
of Cosmetic Dentistry, and has been elected to serve on the American Board of Cosmetic Dentistry. He also volunteers for the AACDs Give Back
A Smile (GBAS) program, golfs often and is fluent in Italian.
79
continuing education
feature
P O S T-T E S T
Answer the test in the Continuing Education Answer Sheet and submit it by mail or fax with a processing fee of $36. You can also answer the post-test questions online at www.dentaltown.com/onlinece.
We invite you to view all of our CE courses online by going to www.dentaltown.com/onlinece and clicking
the View All Courses button. Please note: If you are not already registered on www.dentaltown.com, you
will be prompted to do so. Registration is fast, easy and of course, free.
1.
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Legal Disclaimer: The CE provider uses reasonable care in selecting and providing content that is accurate. The CE provider, however, does not independently verify the content or materials. The CE
provider does not represent that the instructional materials are error-free or that the content or materials are comprehensive. Any opinions expressed in the materials are those of the author of the
materials and not the CE provider. Completing one or more continuing education courses does not provide sufficient information to qualify participant as an expert in the field related to the course
topic or in any specific technique or procedure. The instructional materials are intended to supplement, but are not a substitute for, the knowledge, expertise, skill and judgment of a trained healthcare professional. You may be contacted by the sponsor of this course.
Licensure: Continuing education credits issued for completion of online CE courses may not apply toward license renewal in all licensing jurisdictions. It is the responsibility of each registrant to verify
the CE requirements of his/her licensing or regulatory agency.
80
continuing education
feature
CONTINUING
EDUCATION
ANSWER
SHEET
Instructions: To receive credit, complete the answer sheet and mail it, along with a check or credit card payment
of $36 to: Dentaltown.com, Inc., 9633 S. 48th Street, Suite 200, Phoenix, AZ 85044. You may also fax this form
to 480-598-3450 or answer the post-test questions online at www.dentaltown.com/onlinece. This written selfinstructional program is designated for 1.5 hours of CE credit by Farran Media. You will need a minimum score
of 70 percent to receive your credits. Participants only pay if they wish to receive CE credits, thus no refunds are
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81
product profile
feature
Uncomplicate Business:
All it Takes is People,
Time, and Money
I wrote Uncomplicate Business: All it Takes is People, Time, and Money because
anted to help fello business o ners gro and thri e elo you ll nd an
exclusive sneak peek of the book. I encourage you to explore the material whether
youre a new entrepreneur or are looking to improve your existing business.
Dr. Howard Farran, DDS, MBA, Publisher, Dentaltown Magazine
Excerpt from Uncomplicate Business: All it Takes is People, Time and Money.
As weve discussed, running a business doesnt have to be complicated if
you focus on three things: people, time, and money. Heres an example of a
business that missed the mark on the third item.
A new restaurant opened up near my home in Phoenix, Arizona. They had
been marketing in my area pretty stronglybillboards, advertisements in
the local shopper, and direct-mail cards with free dessert coupons. Almost
everywhere you turned, something displayed this restaurants name. Im a
creature of habit, so despite all the advertising, I hadnt really considered
going until a close friend of mine recommended it.
I took my family on a Thursday night. It was a pretty place with a pleasant
atmosphere, and the food was pretty decent. And the place was bustling.
The friendly and helpful staff hurried from table to table, waiting on diners
as quickly as possible so they could seat the people who had been waiting up
front for an hour. It really seemed as though this place would take off.
The manager came around to my table and asked me how I liked my meal
and if I was enjoying myself. I told her everything was great, but that I was curious to know how many new customers her restaurant was getting each month.
She appeared dumbfounded at first, but then she finally said: I dont
know. Probably around fifty? The woman had no idea.
I just let it go and decided Id wait and see how things were going with this
restaurant in a few months.
My favorite restaurant happens to be located across the street from this
place. It is one of four restaurants in my ZIP code that has stayed in business
for all 25 years I have lived there. I know the managers of all four, and they
know me.
So one night when I was dining at my favorite restaurant, I asked the
manager how many new customers he attracts in a month. He said, On average, about forty, but last month we had forty-two.
When I asked where his new customers came from, he said, Well, fi ve
came from our website, 10 came from a Google ad, 20 were word-of-mouth
referrals . . . He went on down the list.
This guy didnt even have to check his data. He knew it cold. He even knew
how many dollars per head his new customers cost him in advertising on his
website, direct mail, Facebook, and in the newspaper. Why? Because he wanted to invest his money where he was getting the most bang for his buck. He
was measuring his return on investment. A classic entrepreneur.
82
practice management
feature
Establishing an Accounts
Receivable System
by Sandy Pardue
Financial policy
Your practice should establish a firm financial policy. It
should be in writing and include payment options (see the section
below). Post it on your website and give it to new patients and
existing patients making financial arrangements.
Payment options
All of the payment options you offer should be listed on a
professional financial arrangements form so patients can choose
84
practice management
feature
Insurance system
To improve collections from patients with insurance, verify
benefits in advance and, when available, use online or phone predeterminations. This allows you to have more information about
their benefits. You can use effective verbal skills such as, Your
insurance company says you will owe $50.
Utilize electronic claims to speed up reimbursements. Make
sure you have included the full details that the insurance company will need for the claim, such as X-rays, narratives, etc. Send
X-rays on crowns, implants, root canals (before and after) and
SRPs. You will also need to include a perio chart for SRPs.
Generate an insurance aging report and track outstanding
claims each week. Name a set day and put it on the insurance
coordinators checklist. Pay attention to the clearinghouse status
report. Look for verbiage like zero payment, rejected, holding claim or unprocessed. Many practices wait to receive the
EOB (explanation of benefits) from the insurance company, and
that will delay payment 30 days or longer.
Consider using direct deposit for insurance payments. This
single action will help you get your money fasteryou can have
dentaltown.com \\ AUGUST 2015
85
practice management
feature
SAMPLE POLICY TO
SHARE WITH PATIENTS
Regarding Insurance Benefits:
We will file your insurance claims as a courtesy for you
and will accept assignment of benefits on your behalf.
Regardless of what we may calculate your insurance company
to pay, it is only an estimate. The financial obligation for dental
treatment is between you and this office, and is not between
this office and your insurance company.
We will do all we can to get the maximum benefits reimbursed for you. Please be aware that some of the services
provided may not be covered or may be considered above the
usual and customary. You are responsible for payment of
your account, regardless of any insurance companys arbitrary
determination of usual and customary fees.
Collection
The financial coordinator should be working past-due
accounts on the aging report each month. Collect amounts due
as rapidly as possible and give discounts and incentives for early
payments. Use a plain envelope with a handwritten address for a
collection notice so that the patient will be curious and open it.
I recommend sending three notices before sending an
account to collection. If you are threatening collection on a pastdue account, always follow through.
Become familiar with Fair Debt Collection Practices Act.
State laws will vary. You can learn more about your state guidelines at your state attorney generals office. People there will help
than it is.
We know that patients who are current on their accounts like
your dentistry, but patients who are late tend to be more critical
of the services they received. Having a plan for controlling this
area of your practice can provide not only huge dividends, but
also happier patients. Better control with good systems is a fast
way to boost profitability and help ensure the long-term success
of your practice.
Author Bio
Sandy Pardue is an internationally recognized lecturer, author and practice-management consultant. She has more than 25 years of experience
in helping doctors with practice expansion and staff development. Pardue is known for her comprehensive and interesting approach to dental
office systems, and offers a refreshing point of view on how to make a practice more efficient and productive.
86
general practice
column
Yoga for
Dentists
88
general practice
column
Physical benefits
As a regular yoga practitioner for
more than 15 years, I have experienced
firsthand yogas many physical benefits.
Yoga can be used therapeutically to alleviate existing ailments and can also be
employed preventatively. Modern medical
research continues to verify the validity of
yoga as therapy to improve overall health.
Given the wear and tear our bodies experience over time as we practice dentistry,
yoga is especially beneficial for the dental
professional.
One of the obvious benefits of yoga is
improved flexibility, but the postures also
build muscle strength. That additional
muscle strength, particularly of the critical core musculature, is balanced by the
increased flexibility to help improve posture, both when sitting and when moving
through space. This, in turn, reduces strain
on the back, neck, shoulders, and other
muscles and joints, which decreases the
practitioners chance of developing future
degenerative musculoskeletal conditions.
Yoga improves blood flow by increasing your heart rate and delivering more
oxygen to your cells, which then function
better. While some styles of yoga can get
you into an aerobic target range, studies
have shown that even those that dont can
improve your cardiovascular conditioning.
Other studies have shown yogas
positive impact on a wide variety of physiologic functions, including strengthening
bones and reducing osteoporosis, lowering
89
general practice
column
ranging from chronic anger, fear, and frustration, to addictions such as smoking.
Once we have done so, we are more likely
to experience more positive emotions, such
as gratitude, empathy, forgiveness, and
increased self-esteem.
Having practiced dentistry for more
than 25 years and yoga for more than
15, I am very familiar with not only the
physical, mental, and emotional challenges
each one of us faces daily, but also the
effectiveness of yoga in dealing with them.
Through my yoga practice, I have experienced changes in body and mind that I
never thought possible. If you are curious
about yoga, I strongly encourage you to
explore what it has to offer. You could try
public classes, private instruction, videos,
or online instruction.
I suggest trying different styles and
teachers until you find a style and teacher
that works for you. You may not like yoga
at first; it can feel uncomfortable at times.
I encourage you to try at least a few classes,
though. As your body starts to open, you
are likely to enjoy the classes more.
You can even practice yoga at work,
such as by concentrating on your breath.
You could take a break of a minute or two
just to bend forward (head toward your
feet). Let your arms hang. Let your head
and neck hang. Bend the knees slightly.
Relax and release. Dont pull. Dont strain.
Dont worry about how far you can bend.
Breathe in and out at the same rate. When
you start to feel relaxed, youve probably
gotten what you need from the break.
I hope youll experience many benefits
from yoga, and that youll also see quiet
yet positive changes in your practice, your
relationships, and your world.
Have a yoga experience to share or want to know more? Ask questions at Dentaltown.com/magazine.aspx.
Author Bio
David Hennington, DDS, has been a solo practitioner in Georgetown, Texas, since 1991. He has practiced various styles of yoga for more than
15 years and in 2012 was certified as a yoga teacher through Yoga Alliance (RYT-200). He recently participated in a podcast with Dentaltowns
founder, Howard Farran, discussing the benefits of yoga for dentists.
90
practice solutions
Practice Solutions explores how specific products and services can be of use clinically or in practice management.
by Jason Olitsky,
DMD, AAACD
Dr. Jason Olitsky is the past
president of the Florida
Academy of Cosmetic Dentistry
and an accredited member
of the American Academy of
Cosmetic Dentistry. He is also
an accredited Digital Smile
Design Master and director
of esthetics and photography
with the Clinical Mastery
Series. Olitsky teaches portrait
and clinical photography and
over-the-shoulder anterior
esthetics courses with The
Clinical Mastery Series. He is
clinical adjunct faculty with
Arizona School of Dentistry
and Oral Health and a clinical
consultant with Dental Advisor.
Olitsky also owns WallSmiles.
com, a photography business
that sells clinical before and
after images, and portrait wall
art for dentists.
92
Case presentation
A 34-year-old woman in good health but
with high caries risk presented with an occlusal
cavity in tooth #17, recurrent caries under existing amalgam restorations on teeth #18 and #19,
and a defective amalgam restoration on tooth
#20 (Fig. 1). Treatment options (e.g., direct or
indirect restorations) and associated risks were
discussed with the patient, and the decision was
made to restore teeth #17 and #20 using a nanohybrid bulk fill composite (Tetric EvoCeram
Fig. 1
Practice Solutions explores how specific products and services can be of use clinically or in practice management.
practice solutions
Fig. 2
Tetric EvoCeram Bulk Fill restorative was placed in one increment throughout the entire quadrant, sculpted, cured, and
polished.
Fig. 5
93
practice solutions
Practice Solutions explores how specific products and services can be of use clinically or in practice management.
Fig. 6
contributes to the
materials exceptional
shade stability.
The necessary air thinning and evaporation of the dental adhesive solvent was completed using an Adec air drier to ensure
moisture and oil free air.
Fig. 9
Continued on p. 96
94
practice solutions
Continued from p. 94
Fig.10
Conclusion
When placing IPS e.max lithium disilicate restorations on
composite core buildups that are also adjacent to natural teeth
and direct composite restorations, Variolink Esthetic can be used
to facilitate seamless shade matching, exceptional shade stability,
fast and reliable curing, and easy cleanup of excess cement. The
cements ideal flow and handling characteristics, as well as its durable and long-lasting bond strength, contribute to simplicity and
predictability when providing a combination of restorations in the
posterior region.
96
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97
practice management
feature
WH
YD
EN
TIS
TS
MO
BIL NEED
E-R TO B
EAD E
Y
by
Da
nL
in d
q ui
st
In
todays digital age, the way people recommend medical professionals to each other
has changed drastically. Word-of-mouth
still carries weight, but the way those words travel has
evolved. Businesses need to be mobile-ready.
According to Search Engine Watch, the landscape
in which businesses operate changed forever in early
2014, when app usage on mobile devices exceeded
Internet use on PCs for the first time.
98
practice management
feature
99
practice management
feature
100
practice management
feature
feedback. And without requiring the patients to log in, they can
leave a review that is automatically syndicated to sites such as
Bing, Citysearch and Facebook.
Ultimately, making your practice mobile-ready will allow
you to always put your best foot forward, which enables you
to improve your patients overall experience every time they
walk through your door. After all, youve dedicated your life to
improving your patients smiles, so give them something to smile
about by placing your practice in the palm of their hands.
References
1. http://www.mobify.com/blog/13-stats-to-convince-your-boss-to-invest-in-mobile-in-2013/
Author Bio
Dan Lindquist has a decade of tech-industry experience between Yahoo! and Demandforce, where he currently manages the digital communi-
cations platform. He holds an MBA from the Kellogg School of Management and has also worked as a consultant at Deloitte Consulting, where
he advised companies on their product-development and technology strategies.
101
radiology
feature
Rehabilitation Case
with CAD/CAM Design and
Excellent
Results
Introduction
102
radiology
feature
Fig. 1
Case study
A preoperative photograph illustrates
the above outlined areas of concern (Fig.
1), most noticeably the old composites
and discoloration on the centrals 8 and 9.
Teeth #7, 11 and 13 had been extracted
and NobelActive implants placed with
healing abutments. Once healing had
been completed postsurgery, the dentist
took an impression and ordered a wax-up
as a guide for treatment to repair the
occlusion and aesthetics.
Once that had been accomplished
during the preparation visit, crowns on #4
and 5 were sectioned off, and teeth #4-10
were prepared for all-ceramic crowns.
The dentist photographed a retracted
Fig. 2
Preoperative
Fig. 3
Post-preparation, retracted
Occlusion view
104
radiology
feature
Fig. 4
Fig. 5
Post-milling, copings
Fig. 6
Fig. 7
Fig. 8
105
radiology
feature
Fig. 9
106
radiology
feature
Fig. 10
Fig. 13
Seated
Fig. 11
Retracted
Fig. 14
Conclusion
From the authors viewpoint, we
must evaluate and improve the patients
smile pre-operatively during the planning
stage. That is where the knowledge and
expertise combined between the dentist
and the technician will work together
to deliver the best possible results to the
patient. We can consider the color, size
and shape of teeth by checking our frame
design for full support and building it
with porcelain in a way that will enhance
the patients appearance. Our knowledge
of occlusion will help us create a bright
smile to rehabilitate the patients overall
function and appearance. When we work
together in this way, the dentist, patient
and technician can all be happy with the
results we achieve.
Rest position
Author Bio
Luke S. Kahng, CDT, is a world-renowned master ceramist, as well as owner and operating director of LSK121 Oral Prosthetics. He lectures
nationally up to 10 times per year, and has published more than 100 educational articles in professional dental journals, written six hardcover
books, and created approximately 55 instructional YouTube videos involving dental cases. He serves as a board member for Spectrum Dialogue,
Teamwork, Inside Dental Technology and Dental Lab Products.
Dr. Abraham E. Stein received his dental degree from Southern Illinois University School of Dental Medicine. He went on to complete his prosthodontic residency training at The Ohio State University. He has a passion for dentistry and delivering the highest-quality care to all of his
patients. Dr. Stein is a prosthodontist, one of the nine specialties recognized by the American Dental Association. He has special training in
restorative, implant, and esthetic dentistry. He was the recipient of the American Academy of Esthetic Dentistry and the American College of
Prosthodontist awards. He lectures nationally and is published in the International Journal of Oral and Maxillofacial Implants.
dentaltown.com \\ AUGUST 2015
107
industry
news
Industry News
The Industry News section helps keep you informed and up to date about whats happening in the dental profession. If
there is information you would like to share in this section, please email your news releases to arselia@farranmedia.com.
All material is subject to editing and space availability.
www.dentaltown.com
108
industry
news
109
product profile
feature
LocalMed
Can your patients schedule when it is
convenient for them, or only when you are
able to answer the phone? Are potential
patients choosing other ofces because you
are not making it easy? Do you want to make
scheduling easy for your patients, and ll up
more of your chair time? LocalMed can help.
What is LocalMed?
LocalMed is the first online scheduling platform that allows patients to
view accurate, real-time availabilities and book confirmed appointments,
24/7. In the same way you currently schedule, our system offers different
time slots based on appointment types. You select which appointment types
and chairs you want to make available; we take care of the rest.
110
dentally incorrect
feature
the previous thousand. Maybe. That sounds about right right? Its
hard to argue when you take into account marvels like the pop-up
chance for the city to show its rebound after the disastrous 1906
the city.
But to truly appreciate where we are today, you must first look
Now
back and see how much has changed in the last hundred years.
Now
Now
There are more than five million people per second complaining
cellphones.
Apply Composite
Adapt Fibers
Finished Splint
Single-Visit Bridges
Before
Ribbond Framework
Exceptional durability
Superior ease of use
Virtually no memory
Completed Bridge
Now
Pluto, your neighbors chow chow, is photographed 50 times a day,
and the images are distributed over Facebook and subsequently
onto your news feed so often youve come to despise your
neighbor and that fluffy, unphotogenic mutt. Pluto is no longer
Sold directly by
Ribbond, Inc.
Ref. - 3/15
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112
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