John Gammichia, DMD, FAGD, graduated from the University of Florida College of Dentistry in 1995. He is and has always been passionate about teeth and conservative dentistry. He has been in private practice in Apopka, Florida, for over 28 years. As a dentist he always works under the premise “person first, then teeth.” He feels like “knowing your patient” is often overlooked in his field. He is an active member of the Academy of General Dentistry and belongs to the Academy of Operative Dentistry and the Academy of Biomimetic Dentistry. He is a courtesy faculty member at the University of Florida College of Dentistry. He is married to his college sweetheart, has 4 children, and is very active in his church.

How to Restore “Unrestorable” Teeth | Image Credit: © John Gammichia, DMD, FAGD

Information provided by Kuraray America, Inc.

Restoring severely decayed and damaged teeth is a challenging task in dentistry, so challenging that a significant number of dentists choose not to do it, often opting for an extraction and an implant. However, with the advancement in adhesive systems and composite materials, it is now possible to successfully restore teeth that were previously deemed unrestorable.

This article presents a case study highlighting the successful restoration of a badly broken tooth using a comprehensive treatment approach and superior dental materials. The aim is to shed light on the potential of complex composite restorations and encourage dental professionals to consider this conservative and cost-effective alternative to more invasive treatments.

The patient, a 33-year-old woman, presented with a broken tooth (#30) as her chief complaint (

). Prior to treatment, she had excellent oral health with no decay, operative needs, or periodontal issues. The patient had a class I occlusion and was concerned about the broken tooth.

To assess the patient’s oral health, a comprehensive evaluation was conducted, including a full series of x-rays, oral cancer screening, occlusion assessment, and periodontal health evaluation. Considering the patient’s virgin adjacent teeth, I proposed an extraction and bone graft and an immediate placed implant.

Kuraray Noritake’s composites are called Majesty and are formulated to reign supreme and deliver dignity and beauty. The line includes CLEARFIL MAJESTY ES-2 Universal, CLEARFIL MAJESTY ES-2 Classic, and CLEARFIL MAJESTY ES-2 Premium. All 3 systems offer a chameleon effect and LD (light-diffusion) Technology.

But this treatment, although ideal, did not fit into her present budget. She desired an implant but was going to have to save up the money. The goal, then, was to restore the broken tooth with the anticipation of future implant placement while preserving the interdental space.

First, the dentin floor was roughened using a diamond bur to aid in composite retention and create a pulp access point of approximately 2 to 3 mm for additional retention. A matrix (Getz Tofflemire from Waterpik) was placed around the tooth, using wedges for adaptation and stability. The exposed enamel was then etched (Etch from BISCO) prior to the application of an adhesive system (CLEARFIL SE Protect by Kuraray America).

Next, CLEARFIL MAJESTY Flow (Kuraray America) was used at the margins in an increment of less than 1 mm. Then CLEARFIL MAJESTY ES-2 Classic (Kuraray America) nano-hybrid composite was applied. Each layer of composite was cured prior to application of the next layer with a VALO Grand Cordless curing light (Ultradent Products, Inc) until final restorative tooth height was achieved. The restoration anatomy was started with an explorer before the final increment was cured. Then the anatomy was fine-tuned using finishing burs (a football bur from Two Striper and a veneer finishing diamond), and the esthetics were enhanced by applying stain (Kolor + Plus composite color from Kerr Dental) to match adjacent teeth (

Restoring a severely damaged tooth presented several challenges. The size of the restoration pushed the limits of the matrix systems, making adaptation difficult, often requiring the operator to hold the matrix down with their finger. Achieving proper contacts also posed a challenge.

To overcome these hurdles, I utilized various techniques such as restoring buccal and lingual margins first, then using the Contact Pro 2 instrument (Practicon, Inc) for tight contacts and implementing meticulous curing methods.

The success of the treatment was attributed to the use of specific Kuraray products, including CARIES DETECTOR for thorough decay assessment, CLEARFIL SE Protect adhesive system for superior bond strength, and MAJESTY ES-2 Classic composite for layered restoration. These technologies and techniques contributed to the long-lasting success of the restoration.

The patient’s satisfaction was addressed by an explanation of the treatment plan and expectations. The final results of the treatment exceeded expectations, with the restoration still intact even years after its placement (

). The patient expressed delight in avoiding the previously planned implant and appreciated the preservation of her natural tooth (

During the patient’s recall appointments, her oral health remained stable, and the restoration was consistently evaluated for longevity. At year 7, the restoration was still functional, showcasing the exceptional longevity of the restoration.

This case highlights the successful restoration of an “unrestorable” tooth, challenging the notion that severely broken teeth are beyond repair. By employing advanced adhesive systems, meticulous techniques, and composite materials, dental professionals can provide conservative, esthetic, and cost-effective alternatives to more invasive treatments.

This case contributes to the field of dentistry by showcasing the potential for long-lasting complex composite restorations. The primary ethical consideration was the uncertainty regarding the longevity of the restoration. My commitment to patient satisfaction and long-term oral health led to a mutual agreement with the patient. If the restoration failed within an unreasonable time, alternative solutions, such as a retainer, would have been provided free of charge.

The successful restoration of severely broken teeth using composite materials and advanced adhesive system presents a conservative and durable treatment alternative. This case study highlights the importance of comprehensive treatment planning, meticulous techniques, and the selection of optimal dental materials. By adopting these approaches, dental professionals can provide patients with long-lasting, functional, and esthetically pleasing restorations while preserving natural teeth and reducing the need for more invasive interventions.

Articles

A case study in complex composite restorations that utilizes superior dental materials including a variety from the CLEARFIL line of products. 

How to Restore “Unrestorable” Teeth 

Dental Products Report Chief Clinical Editor and Technology Editor John Flucke, DDS, explains why he and his time were so impressed.

Video Test Drive Primescan Connect from Dentsply Sirona

Read more about Dr Flucke's experiences using the Primescan Connect intraoral scanning solution from Dentsply Sirona 

Primescan Connect offers dental professionals a fast and efficient intraoral scanning experience without requiring a bulky desktop. Primescan Connect has a specific laptop so that clinicians can use the intraoral scanner for restorative, implant, orthodontic, and more modalities. Primescan Connect is validated for all major lab software and is said to be a good starting point for clinicians starting out with digital dentistry. It is designed to integrate easily into the dental practice.

Hi, I'm Dr John Flucke. I'm Technology Editor and Chief Dental Editor here at Dental Products Report. And today, I would like to tell you about a test drive that I've recently completed on a really phenomenal digital product.

I think all of us in dentistry are familiar with the word CEREC. And to many of us CEREC means intraoral scanning, but it also means in-office milling. What if you don't want to do in-office milling, and maybe that's a possibility of where you are right now. Or maybe you're thinking about it, but at this point in time, you don't want to, or financially, maybe that's a little bit more expensive than you want to go. And the really smart people at Dentsply Sirona they had a great idea recently where they said, you know, what if we just made an intraoral scanner, and behold the result Primescan Connect.

So you have the camera, and the scanner system here. It has a cradle that it sits in on your countertop, and then this all connects to a laptop, via USB. So when you want to scan a patient, all you need to do is move the laptop and move the scanner camera to wherever you are, and you are good to go. This is affordable, and it's portable. And the really cool part to me is that even though it's affordable and portable, you don't sacrifice anything as far as the scanning.

This scanner slash camera process is 1.5 million 3D data points each second. Think about that for a minute now. 1.5 million 3D data points every second. This thing has incredible accuracy. It is easy to use, it is well weighted, it scans like a dream. It's also smart.

One of the things that I do when I test a scanner is I sit down and I just try it right out of the gate with no training just to see how intuitive is it. And I can tell you that, it sits in this cradle, the moment you pick it up, if it's plugged in, it kicks on and wakes up and you are good to go to start scanning. If you get to a point in your process where maybe you think oh, I need to touch up that prep, or maybe the patient needs to breathe or shift or swallow or whatever, and you have to stop for a second. Put this back in there. The system immediately goes to sleep, you pick it back up, it wakes back up, and it knows right where you are, and can you can then commence scanning right from that point forward. This sucker is smart.

The camera also has a 20 mm depth of focus. And basically, what that means is from the edge of the lens to 20 mm away is in focus with this dynamic lens. Everything you scan is clean and crisp. You can use this for anything that you would normally take an impression for whether it's occlusal guards, night guards, sleep apnea appliances, crowns, bridges, implants, removables, all of that can be done with this system.

It is quick and easy. You can scan—once you get a little experience under your belt, and it doesn't take long—you can scan an entire mouth, maxillary arch, mandibular arch, and buccul bite in about 60 seconds. You can't do that with impression material, and you can't do it with the accuracy that this system has.

If you're a doctor on a budget, or you're a young graduate and you've got some student loans you'd like to pay down before you really bite off a large expense for your practice, this is the 3D intraoral scanner to look at. It's called Primescan Connect and it's available now.

Videos

Dental Products Report Chief Clinical Editor and Technology Editor John Flucke, DDS, explains why he and his time were so impressed after using this portable intraoral scanning solution in their practice.

Video Test Drive: Primescan Connect from Dentsply Sirona

Sticking With Dental Adhesives

[SPONSORED] In a recent survey conducted by Dental Values, dentists from throughout the US were asked about their preferences and their habits when it comes to dental adhesive materials. See the key finding in this infographic sponsored by BISCO Dental Products.

Infographic: Sticking With Dental Adhesives

Ankur Gupta, DDS, after completing a 1-year GPR in Cleveland, Ohio, started a practice from scratch in 2005. Armed with what he considered adequate knowledge, hand skills, and a personable demeanor, he watched as his practice floundered, finances became unpredictable, and his lower back and spirit toward life became worrisome. Rather than continue the trend, he made a guinea pig out of his office, family, and self, attempting any and all personal and professional “experiments” in self-improvement. More than a decade later, he enjoys enviable new patient numbers and case acceptance, a solution- oriented dental team, and, most importantly, a meaningful and positive identity. He happily shares the failures and successes with dental and community groups throughout the country, always ending his presentations with practical, implementable, step-by-step ways to be better.

Shade matching has always been difficult for me. Crowns and large fillings require so much nuance, because the surrounding tooth structure always possesses variability in shade, hue, chroma, opacity, etc. This small inconvenience becomes much larger to me as an educator, because I have a tendency to take close-up photos of random before and after cases, and it is always painful when that blown-up digital image looks a little off.

Numerous high-level and reputable dental manufacturers continue to introduce better, easy-to-handle, adaptable, and chemically superior options, which is great. However, until recently, there haven’t been many options in the arena of predictable shade matching. As clinicians, we regularly spend several minutes at the beginning of most direct composite procedures determining the proper shade and then keep our fingers crossed.

Kettenbach has long enjoyed a reputation in the industry for its incredibly high-rated and affordable impression materials. The company has also 

Kettenbach Dental has created an expansion of its Visalys® family of composites with new Visalys Fill and Visalys Flow light-curing, radiopaque nano-hybrid filling materials. These materials are indicated for class I to VI fillings. There is a Flex Shade System within Fill and Flow that is said to offer enhanced esthetics through its VITA A1-D4 shade matching. It also offers a bleach shade and OA2 opaque shade for even more shade flexibility. Visalys Fill is designed with easy handling and modeling in mind, whereas Visalys Flow contains a low viscosity that allows for good wetting and adaptation to cavity walls. It is also suitable for anterior and posterior restorations. Both Fill and Flow are comprised of high inorganic filler content, which is said to result in high flexural strength. Combining these mechanical properties with its Flex Shade System, Kettenbach aims to offer a highly durable and esthetic filling material.

become an industry leader in certain restorative products, including dual-cure resin cements, core buildup material, temporary material, etc.

Most recently, Kettenbach has introduced a composite restorative material intended to be used as a daily material of choice for direct resin applications. The feature that makes it unique is the convenience it claims to provide in terms of shade matching.

The Kettenbach Visalys Flow and Fill composite restoration materials are both nano-hybrid filling materials and therefore possess the microscopic criteria needed to compete with the current highest-rated composites on the market. What allegedly sets them apart, however, is their Flex Shade System, which allows these composites to match the 16 traditional composite shades with only 5 available shades.

Members of the Catapult Education product review board were asked to rate this composite in terms of the following characteristics:

No respondents (there were 17 evaluators in total) gave the Kettenbach Visalys Flow and Visalys Fill a response of “not satisfied” for even 1 of the 

above categories. The 2 evaluative criteria with the lowest scores were surface gloss and translucency. These criteria, however, still possessed an average overall evaluation score higher than 4 on a scale of 1 to 5 (with 5 being the highest score). Survey respondents were most impressed with the adherence to instrument, perception of shrinkage, radiopacity, and delivery system.

Some of the comments included the following:

“An excellent composite. In a new generation of composites, this is one of the best!”

“Matching color was better in posterior; if tooth was thin in the anterior it was a little too translucent.”

The flowable material was also evaluated based on the preceding criteria.

Again, no survey respondents marked “not satisfied” with any of the preceding criteria. The criterion with the lowest score was resistance to slumping, which also received an average score above 4. One evaluator, an endodontist, responded, “Visalys Flow encompasses everything I would desire in a composite restoration to restore endodontic accesses. It handles well, is capable [of] reconstructing occlusal anatomy, is sufficiently opaque, and blends with the shade of the existing crown better than any other composite I have used in the past.”

Although most survey respondents reported high overall satisfaction marks in describing their experience with Visalys Fill and Visalys Flow, the majority indicated that their experience with both products was neither better nor worse than their current composite restorative material of choice.

What set these products apart from others was the shade-simplifying feature, called the Flex Shade System, which claims to blend harmoniously with the cavity because of the chameleon effect for all 16 VITA shades with just 5 shades. Seventy-one percentof respondents reported a good to excellent impression with the shade matching.

In order to attain the Catapult Vote of Confidence, standard criteria must be met. These criteria require that more than 90% of survey respondents must: have very good/excellent experience using the product. Every survey respondent reported that they would recommend Visalys Fill to a colleague.

Catapult evaluates 15 to 20 dental products and materials every year. It is very rare for a product to achieve a 100% rating from every participant when asked whether they would recommend a product. I have been pleased with my experience with other Kettenbach Visalys products, and it is with no doubt that I intend to continue using this innovative restorative option in my practice.

Kettenbach’s Visalys Flow and Visalys Fill composite restoration materials earn the Catapult Vote of Confidence.

These New Composite Systems Deliver Shade Simplification

Renee Knight is a freelance writer and editor who's been covering the dental industry for 15 years. 

Create Beautiful Temporaries That Last With This Natural-Looking Material | Image Credit: © Jennifer Derse, DDS

Jennifer Derse, DDS, the chief clinical director at Espire Dental, prides herself on creating beautiful temporaries for her patients. Even though theywear them only for a short time, patients still must go about their daily lives, and shouldn’t be self-conscious about esthetics.

“I think one of the worst things you can do for your patients is make a bad temporary,” she says, noting she’s even had some patients ask if they could keep their temps on permanently. “I lecture, and if I were wearing temps, I wouldn’t want anyone to know.”

Patients also shouldn’t have to worry about their temporaries breaking before it’s time for their permanent replacements. No one wants to come back to the dentist for a repair, Dr Derse says. Not only is it time-consuming for the patient, but these appointments cost the provider time and money rather than bringing it in.

To provide patients with esthetic and strong temporary restorations, you have to start with the right material. Dr Derse relied on VOCO’s Structur 2 SC as a workhorse for a long time, but switched to Structur 3 for most cases a few years ago. The enhanced temporary crown and bridge material is stronger and offers improved esthetics, allowing her to create even better temporaries for her patients. The material saves her time in the operatory and gives patients the results they’re after, making it a no-brainer for her group of 30 practices.

The material comes with a long list of benefits you simply can’t find in other products. For example, Dr Derse performs a lot of cosmeticdentistry and full-mouth rehabs, and because of the material’s Wipe&Go technology, she doesn’t have to spend nearly as much time polishing. She also appreciates the material’s fast set time, high compressive strength, and natural esthetics. Then there’s the 1:1 bisphenol A-glycidyl methacrylate to acrylic ratio, which reduces shrinkage and decreases waste—a distinctive advantage Structur 3 has over other materials.

Patient 1

“It’s just a really great material,” she says. “It would be really hard for you to get me to change, and I like trying new things.”

Saves Time, Leads to Better Profitability

Dr Derse uses Structur 3 for anterior full-mouth rehab cases, and says the Wipe&Go technology reduces her polishing time and her chairside time, while still providing her patients with beautiful results.

“You can take an alcohol gauze and wipe off the temporary, removing the oxygen inhibiting layer,” she says. “So you don’t have as much polishing and shining or the need to buff things out. You don’t have to use a gloss; with Structur 3, you wipe it and you’re good to go other than maybe doing a little trimming here and there around the margin.”

The material’s 45-second set time is fast, which is key, Dr Derse says.

“Every minute counts when patients are under your care,” she says. “Their time is as valuable as yours. They want you to be accurate, but they also want you to be efficient.”

Wipe&Go technology reduces and even eliminates the need to polish

Small mixing tips that reduce bleeding before changing mixing tips, which yields at least 20 more units per cartridge compared with 10:1 and 4:1 products

High fracture resistance and compressive strength

Well suited for long-span bridges and long-term provisionals

Dr Derse has seen doctors pull a temporary matrix off too soon when using other materials with a longer set time, leading to a globby mess and, even worse, the need to start over. The faster set time makes this less likely to happen, decreasing the number of temps you have to remake in your practice.

The Structur 3 materials saves at least 15 minutes per patient, and that’s huge when you think about the number of patients seen each day at Espire’s multiple practice locations.

“I think of dentistry in terms of how much I am doing by the hour and I break that down into 15-minute marks,” she says. “If a product can save me 15 minutes, I’m in.”

The material’s high fracture resistance and compressive strength means your temporary restorations will last, whether patients need them for 3 weeks or 3 months. You won’t see any chipping or breaking. In fact, Dr Derse has never had a temporary posterior restoration break with this material.

Structur 3 also features a natural gloss and tooth like fluorescence and is color stable for those longer, more complex cases. And because you don’t have to polish as much to get that shine, you’re able to preserve surface anatomy.

The nanofill technology in the material, which VOCO is known for with its composites as well, creates the beautiful esthetics patients want, even in their temporaries.

“Structur 3 has a more natural gloss because of the nanofill technology,” Dr Derse says. “It gives you a life-like temporary. You don’t get that with most other temporary materials.”

The Wipe&Go technology also contributes to that gloss, quickly bringing teeth to a beautiful shine. And because teeth require less polishing they’re much smoother, making it harder for plaque to attach.

Structur 3 offers a 1:1 mixing ratio of bis-GMA to acrylic, Dr Derse says, while most other temporary materials feature a 4:1 or 10:1 mixing ratio.

“Other temporaries have higher acrylic in them so they shrink more,” she says. “If they shrink more, the mixing ratio is less forgiving and you have to dilute the product more to make sure the mixture is accurate. So you end up using more material, which increases your costs.”

Patient 2

If you’re taking impressions, you can use the same gun for Structur 3 because the cartridge sizes are the same, Dr Derse says. This may seem small, but it eliminates any time you might waste looking for the specific gun required for 4:1 or 10:1 products, and that means there’s 1 less item you need to keep in the operatory.

“That mixing ratio is what really makes this material different,” Dr Derse says. “I remember helping a young doctor in one of my practices who had his gun out for his impression material but couldn’t find the correct gun for the temporary material. He wasted so much time, and the patient was watching all of this go on.”

The small mixing tips also make a huge difference. There’s no more bleeding before changing mixing tips, and that yields at least 20 more units per cartridge compared with 10:1 and 4:1 products—and that’s a huge cost savings.

There are also patients who are allergic to acrylic, so using a material that has less of it lowers the likelihood of an allergic responses, Dr Derse says.

“The material gives you a prettier temporary and because of the lower amount of acrylic it doesn’t smell and it produces less heat,” she says. “That’s also a benefit for our patients. It requires a lower curing temperature and that means less sensitivity, and that all has to do with acrylic.”

While Structur 2 SC is still a great option for back teeth and single unit cases, Structur 3 improves upon that product with the nanofilled esthetics, the Wipe&Go technology, higher compressive strength and low surface roughness—making it ideal for Dr Derse’s cosmetic and full-mouth rehab cases.

Two case studies are highlighted in the photos within this article. Patient 1 (

) showcases restorations completed by Nelson Rego, CDT. While the second case, Patient 2, features work completed by Quint Whipple, CDT (

“We have a lot of volume because of our size, so this material really impacts our profitability,” Dr Derse says. “I don’t want my temps to break. I want them to look good and I want my patients to be happy with them. And it decreases my chair time by 15 minutes. When you multiply that by 30 locations, it starts to add up. It’s a benefit for me as a business owner and also for my patients. They don’t want to have to come back in and deal with a broken temporary. I don’t have to worry about that with this material.”

VOCO’s Structur 3 strong, natural-looking temporary material features technology that creates a natural gloss with less or no polishing, and a 1:1 bis-GMA to acrylic mixing ratio that provides a host of advantages over other options. 

Create Beautiful Temporaries That Last With This Natural-Looking Material

Stan Goff is a Managing Editor with MJH Life Sciences, which includes Dental Products Report, Dental Practice Management, Dental Lab Products, Modern Hygienist, and Dentist's Money Digest. He has covered the dental industry since 1999 and can be reached at sgoff@mjhlifesciences.com.  

DentiMax Sensors, Practice Management Software Cover All the Bases | Image Credit: © DentiMax

Arizona dentist Kent Stapley, DMD, talks frequently with fellow dentists, some of whom work out of the same building in Mesa, Arizona, where he has practiced for over 25 years. When sharing stories and comparing notes with his colleagues, he glows with joy when talking about the results he gets in his practice from using DentiMax practice management software as well as the company’s digital x-ray sensors.

Dr Stapley switched from another prominent practice management software solution years ago and loves the ease of use and the features he gets from DentiMax, all the while knowing that he’s paying significantly less for his current software.

When it comes to his sensors, it’s more of the same. He loves the detail and the capabilities he has with his DentiMax Dream Sensor, which again is more affordable than other leading brands in the dental industry, he says.

When his hygienist requested her own sensor, he added the Open Sensor from DentiMax to his practice, and this even less expensive option also gets the job done quite well.

“I started with DentiMax back around 2008, and I began with the Dream Sensor,” Dr Stapley explains. “More recently I added another sensor for my hygienist because she wanted to have a sensor all the time. It is a less expensive sensor that was kind of new and we helped them beta test it, the Open Sensor. It’s worked great for us.”

Not only is the Open Sensor ideal for his hygienist, but the images are also such high quality that most staff members are hard-pressed to notice any differences from the Dream Sensor’s diagnostics.

“In our practice we have the Dream Sensor and the Open Sensor, and for us, it’s kind of hard to tell the difference. I can tell the difference, but the staff isn’t really keyed one way or the other. The difference is minuscule enough that I’m OK with using it,” he adds.

It’s one thing for Dr Stapley to be satisfied with the images he regularly gets from his Dream Sensor, but when compared to what some of his colleagues are producing, he knows he made the right choice to work with DentiMax.

His staff at Mesa Dental Health receives x-rays from other offices and, in many cases, the imaging just isn’t as good as what they’re getting with their DentiMax sensors. In addition to this, a dentist who practices in the same building as Dr Stapley uses a competitor’s sensors and, according to Dr Stapley, the results can’t compare.

“I don’t know how he works with the images he takes. He’s seen mine, and I’ve seen his,” he says. “He’s invested so much in his that he doesn’t want to change, but he’s kind of defensive of his [choice] because he’s spent a lot.

“We’re glad that we have what we have. It’s very diagnostic, and we’ve never really run into issues at all. In the past when we’ve changed computers, they’ve had to adjust filters to help us get our images right where we want them, and DentiMax provided the support. They were able to help us right then.”

One feature Dr Stapley loves with his sensors is the contrast function. It may not be needed by every clinician, but he surely experiences the benefits.

“There’s another dentist on my side of the office who uses these sensors as well, and he doesn’t ever go in and adjust the contrast. He just takes the image that kicks out. He’s happy with it and diagnoses from it,” he says. “I like going in there and using the tool that allows me to adjust the contrast. I feel like I can see a lot of the more subtle conditions coming on if I get in there and adjust the contrast. It’s a neat little tool, and I use that constantly.”

The ability to blow up images to full screen without losing much resolution is also a plus. This helps him see images from across the operatory and helps with patient communication and, thus, treatment acceptance.

“I use the contrast feature, and I’m able to pick out little things and show it to the patient,” Dr Stapley says. “I have the monitor in front of the patient. It’s right there in black and white, with shades of gray, literally [for the patient]. A regular x-ray shows pretty much everything that’s going on and it creates some urgency with the patient, who realizes, ‘Yeah, I’d better get after that.’”

Just like the sensors, the DentiMax practice management software delivers optimal results at a lower cost. Dr Stapley is happy with the efficiency of the software, the confidence he gets from its security, and the ability to store images easily both locally and in the cloud. DentiMax allows the staff to create their own reports, and a key feature for Dr Stapley is a screen that shows all of his practice’s production by provider.

“It’s a pretty powerful little feature that I use on a regular basis,” he says. “I can quickly check on what I’m doing up front and what I’m doing in back. It’s just a schedule production tab, and you can also look at payments that were applied that day—at a glance. You don’t have to have a report. You can just glance at any point in the day and see payments that are posted that day. It is a really easy screen, pretty much updated in real time. As soon as it’s done up front, you can see it. I’m often looking at production in the back, but I can also peek at my front office and look into collections and whatnot. Without looking at a lot of reports, I am able to pull up information that I need just from that feature. You don’t have to wait for reports to print or for it to tabulate. It’s just quick. That’s my favorite feature.”

Again, he’s glad he found something that works well for his practice and doesn’t come with sticker shock. “The software doesn’t really find us wanting for anything else. We haven’t felt like we need to go shopping for practice management software because we know everyone else is going to cost more,” Dr Stapley says. “The support is inexpensive for us. With our previous software, it cut into my overhead quite a bit with all the payment plans and different modules. Now my software costs overall are minuscule compared to what they were before.”

All in all, he says, “we’re really clean. We’ve got our bases covered.”

[SPONSORED] This Arizona dentist likes the results he sees from his digital x-rays and his software, and knows he’s also getting a bargain.

DentiMax Sensors, Practice Management Software Cover All the Bases

Dr. Lou Shuman is the CEO of Cellerant Consulting Group, dentistry’s leading corporate incubator and accelerator; a venturer-in-residence at Harvard’s i-Lab; the chairman of the technology advisory board at WEO Media; a long-time contributor to Dental Products Report; and the founder and creator of the Cellerant Best of Class Technology Awards.

Figure 1. With Bright Referral, your dashboard is populated with different types of trend data, and over time the growing list of referral names will be organized by year, month, or day, and can even be sorted by referral source. | Image Credit: © Bright Referral

When you write a referral on a referral pad, what happens next? Does the patient even keep it, or does it become a crumpled ball in the bottom of a purse, never to see the light of day again? Bright Referral is a new way of taking the guesswork out of referrals for clinicians and patients.

Geoff Sudit, DDS, and Liz Sudit cofounded Bright Referral and have created a modern, user-friendly approach to maintaining referral information. I talked to Liz Sudit about Bright Referral and how a simple tap on your phone from a colorful card can increase referrals.

Lou Shuman (LS): How did you get the idea for Bright Referral?

 Geoff, a renowned orthodontist, was on a retreat and wanted to keep in touch with someone who used a near-field communication (NFC)-enabled bracelet to share his contact information. Like tapping a credit card when buying groceries, it was quick and easy. A few months later, Geoff was at lunch with a dentist who told him that she had referred 10 patients in the past month and was wondering how things were going. He knew 2 of the patients came in but had no idea what happened to the other 8. Frustratingly, the dentist wouldn’t know what happened until their follow-up visit in 6 months.

That whole scenario represented a glaring problem in patient care and practice development. Recognizing the issues, Geoff and I decided to find a solution. My background is in marketing and advertising, so in my world, everything is digitized and tracked, sometimes whether the consumer knows it or not. We decided to create a technology that provides control over the referral process and makes relationships with referring dentists easier.

We knew that a paper referral was ineffective. Then, we remembered the value of that NFC experience to new connections. We started with NFC and then built our custom software to be exactly right for the referral flow—from the specialist to the referring dentist and, ultimately, to the patient. Because it is digital, all referral information can be organized, analyzed, and displayed on a color-coded, easy-to-read dashboard.

 Dental specialists create an account. The simple profile setup takes about 5 minutes to enter the practice name, website, phone number, social accounts, or any other information desired. The specialist then enters their referral sources and specifies what information they want the patient from that source to be able to see. Then, they are ready to order their Bright Cards, which is the way that the patients will access that information. The Bright Card is customized—with the specialist’s logo on the front and an NFC symbol and a QR code on the back. The cards are connected, and the specialist hands them out to the dentist.

Each referral source is individually templated. Only the information from your profile that you specify will be seen by the patient. Do you want this dentist’s patients to see all of your locations or just the closest ones? All of your social media or just certain ones? It is interesting that some users have created unique referral sources like their mom or the restaurant that they often eat at because the servers like to recommend them. It’s really fun to see.

 The referring dentist asks the patient to unlock their phone and taps the card to the patient’s phone. The patient receives a little alert and then sees everything about the referring doctor. It’s like a digital bridge. They can click to schedule online, learn about insurance or pricing, call or text the office, or see all locations (

). There is even a little checkbox that says, “Follow up with my doctor” that alerts the office to reach out for more information. Everything is customizable. You can add a blurb about why the referring dentist refers to you. The process feels very high touch and valuable because it’s coming from the doctor whom the patient already trusts, instead of a name on a piece of paper that has no meaning. It’s fast and efficient.

What practice management data can Bright Referral provide?

 Your dashboard is populated with different types of trend data (

). Over time, the growing list of referral names will be organized by year, month, or day and can even be sorted by referral source. You can start to see and analyze trends. Do referrals rise in a certain season or after a lunch? Was someone referring often and then trending down? Maybe it’s time to reach out?

Figure 2. Bright Referral allows you to capture referrals in real time, with real data. | Image Credit: © Bright Referral 

The pie charts can become a fun way to compare who refers the most and have a bit of a contest to see who wins for the most referrals in a specific month. Are some dentists referring but the patients are not scheduling? Maybe that dentist needs some tips on how to warm up those leads. Even if a patient does not share contact information, you still see if they visited your website and if they took any action. Patient referral data is time stamped so you can respond in an appropriate time frame. This is all about patient care—patients cannot fall through the cracks. The data [can be viewed] at a glance—every color has a meaning.

 We’re always looking to the future, adding ways to update and process the data. We are now working through data integrations with 3 different practice management softwares that will create even more value. Geoff has been using Bright Referral himself for 6 months, and with just existing referral sources, he’s seen a 30% increase in his referrals. Bright Referral pays for itself quickly. The cards can be kept by treatment chairs and at the front desk to be ready for patients to tap into this dynamic resource.

Easy, friendly system can help maintain referral information and increase the number of referrals to your practice.

Tapping Into New  Referrals With Bright Referral

Lorne Lavine, DMD, founder and president of The Digital Dentist, has more than 30 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 TDD, a company that focuses on the specialized technological and HIPAA needs of the dental community. He can be reached at drlavine@thedigitaldentists.com or 866-204-3398.

As some of you may know, I have a presence on many dental social media sites where I am happy to answer questions that are posed to me. One of the most frequent questions I get is about whether dentists should switch to a cloud or web-based practice management software, or continue with the more traditional model, which is called client-server. It’s never a bad idea to revisit such a popular question that practices have.

In a nutshell, in most cases, I do not recommend switching to a cloud-based practice management software for most dental practices. There are some situations, like multilocation practices and dental service organizations (DSOs), where it makes perfect sense, but for solo or small group offices, it usually is difficult to justify. There are a few reasons why this is my best recommendation:

Cost savings, or better, lack thereof. Many cloud vendors will claim that offices can save a lot by moving to a web-based solution, but in my experience, this is almost never true. Most cloud-based dental software averages around $500 to $700 a month by the time you add in the subscription, extra modules, support, etc. Compare that with the average client-server software, which is typically around $100 to $150 per month for support. In a given year, you’d spend $5000 to $6000 more for cloud software, and that repeats itself every year. The assumed hardware savings don’t exist.

Speaking of hardware, this is one of my pet peeves with cloud software companies—their claims that since your data is in the cloud, you don’t need a server, backup, antivirus software, firewalls, or any Health Insurance Portability and Accountability Act (HIPAA) compliance. Nonsense. While it’s true that a lot of your patient data would reside in the cloud, in almost all cases, not all of it does. Consider images, emails, Word documents, spreadsheets, Invisalign, QuickBooks…you get the idea. All that data is electronic protected health information, meaning you need to log access, back it up, encrypt it…all of which requires a server. And if you have digital x-ray sensors, then you can’t get by with cheap dumb terminals for computers. To work efficiently, you need pretty much the same specs you’d need if you were using a client-server configuration.

While cloud vendors often talk about their software as some sort of complicated, fancy system that mere mortals can’t possibly understand, that’s not the case. Here’s another definition of the cloud: “somebody else’s server.” That’s really all it is; you’re just hosting your data on another company’s server and accessing that data through a web browser. And, that’s the next issue for many practices: What happens if that connection goes down? We all dream of 100% internet uptime, but the reality is that most dental offices suffer regular outages lasting minutes or hours. And, you guessed it, if your internet is down, then so are you: no access to your schedule, treatment plans, past treatment; you’re dead in the water. I always recommend that practices using a cloud software system have a backup internet provider.

As I mentioned, the cloud is usually a better option for larger practices with multiple locations; remote access software and virtual private networks (VPNs) are challenging to set up and maintain. But, for the majority of solo and small group practices, there are not, in my opinion, enough compelling reasons to switch to the cloud for most dentists.

Cloud-based practice management software often makes more sense for DSOs and multilocation practices than it does for solo practitioners and small groups.

Looking to the Cloud Is Not the Best for All Practices

It would be nice if patients took their clinician’s word for it every time regarding diagnosis and treatment planning. Luckily, technology can help you show them while you tell them what’s going on with their oral health, which can help improve patient engagement and adherence.

The Agency for Healthcare Research and Quality says that health care is most effective when patients are knowledgeable about their conditions and what choices are available to them. This understanding makes them actively engaged in their care.

Plus, they don’t always take the clinician’s word for it. Brandon Thorpe, DMD, a private-practice dentist at Spring Dental of Lumio Dental in Tulsa, Oklahoma, says there’s been a clear shift in patient education preferences.

“Today, patients want to see the problem related to the recommended treatment plan, and they want confirmation and validation from technology,” Dr Thorpe says.

Managing patient expectations is an essential part of patient education. The Foundation for Oral Rehabilitation (FOR) suggests discussing patients’ oral health goals for a specific treatment. These patient goals should drive the patient education conversation.

These conversations might also reveal the patient’s overarching goals for oral health. For example, some patients may want to invest only in treatments that alleviate pain, while others may want to maintain or improve esthetics.

FOR offers the following areas to discuss with patients regarding their goals for an upcoming restorative treatment plan and delivery:

Evaluating patient expectations in 4 areas: comfort, esthetics, function, and quality of life. 

Determine the primary problem, whether they care about what looks best, whether they need to improve their speech or mastication, and whether their self-esteem is affected by the current state of their oral health.

Discovering how far patients want to go with it. 

For example, do they want full-mouth rehabilitation or wish to concentrate only on the esthetic zone? Is surgery on or off the table?

Determine their professional or personal obligations.

 These areas might drive their decision-making and affect how they approach the provisional phases of treatment.

Then, once these factors have been discussed, the clinician should address the following areas in patient education to ensure the best possible outcome with regard to the patient’s expectations:

What is possible with the proposed treatment and, perhaps more importantly, what isn’t

The treatment times and timelines, as well as the expected recall appointments

What it will cost, and what insurance might cover or reimburse

The patient’s role in long-term success regarding adherence, time, and effort, and, perhaps more importantly, what happens if they do not take that role seriously

The behavioral adaptations required during and after treatment, including smoking cessation, special diets, and pain management

The risks to the patient that are associated with the treatment

Follow Up Expectations Management With Visuals

John Flucke, DDS, chief dental and technology editor for 

, says humans are visual creatures. Dr Flucke, who has a bachelor’s degree in psychology, says one of the fascinating things he learned as an undergraduate was that about 87% of what human beings perceive about their environment comes from what they see.

“There’s the adage, ‘I hear, I forget. I see, I remember,’ ” Dr Flucke says. “That comes into play with this. We saw that in dentistry with the advent of digital x-rays.”

He remembers showing patients their dental x-rays through the view box, showing them the decay, and watching them nod in agreement. However, once he showed them digital x-rays of the decay on the monitor, he was astounded by the difference in patient reaction. He jokes that it was obvious that they were lying before when viewing the old x-rays; their new response was so much more engaged with the image of their teeth and gums.

“When you can show it to people on a monitor, it changes things,” Dr Flucke says.

International speaker and mentor Ankur Gupta, DDS, says patients know more about health and dentistry than ever before, which is both a good and bad thing. The problem with being more knowledgeable is that a great degree of skepticism can occur. However, he says clinicians can consistently circumvent suspicion by using high-level photography.

In the past, the problem was that high-level photography came with high costs, both in time and money. Dr Gupta says that when he opened his Ohio practice in 2004, the TV was $2000, the intraoral camera was another $1200, and the SLR cameras were $1000 each. So, high-level photography already cost over $4000.

The higher costs also came in productivity. Since the earlier cameras were not as intuitive as today’s, Dr Gupta was the only one who took the photos, which was inefficient. The actual dollars and the lost productivity due to inefficiency made demonstrating to patients what he saw in their mouths cost prohibitive. Those barriers to entry have gone away, he says.

“Now, you get a TV for $99 on Amazon and mount it in your operatory. Every single operatory can have a TV. You can get an intraoral camera for $300, and an extraoral camera that is so incredibly easy to use and autofocus that anybody, including the least tech-savvy person in your office, can still grab it, point it, and take some nice photos,” Dr Gupta says.

He appreciates how the imagery changes the conversation. Every patient can see what the clinician sees, such as an open or failing margin or teeth that are tipped.

“For me, nothing has ever been as valuable as allowing patients to look at their oral situation closely with a screen in front of them,” he says.

The Oclean X Pro Digital Smart Sonic Toothbrush uses a gyroscope sensor to track 8 areas in real-time brushing behaviors and identify any missed areas to improve user oral health. | Image Credit: © Oclean

However, patient education is not just for treatment plans and restorative cases. Patient education is also a critical component of preventive care.

Dental hygiene educator and international speaker Katrina Sanders, RDH, BSDH, M.Ed, RF, says dentistry used to have a one-size-fits-all approach to preventive care back in the 1950s. Everyone used the same toothbrush, paste, and floss.

The many options available today make it harder to choose what’s best. Sanders says hygienists should help patients sort through all the information and products available to create a customized care plan.

For example, patients who have experienced bone loss might have more significant embrasures to clean. Therefore, the hygienist should recommend a specialized tool to address their needs. The same concept applies to patients who lack dexterity or have implants or implant-supported dentures. They need different tools, such as electronic toothbrush heads or water flossers, wooden wedges, or picks, to adapt to the restorations’ surrounding areas.

A Sneak Peek at Where Patient Education May Be Headed

As digital technology continues to evolve, the future of patient education has begun to take shape. Our trio of experts—John Flucke, DDS, Ankur Gupta, DDS, and Katrina Sanders, RDH, BSDH, M.Ed, RF—share more thoughts on how this shift involves digital technology that can help with diagnosis, interpretation, and presentation.

Dr Flucke predicts a future where AI provides treatment planning, but also shows patients just what their smile will look like after the treatment. These applications will also play a role in orthodontic simulations. Not only will this system show patients what they can expect from the treatment, but it can also increase the predictability of the case because the workflow is digital.

“You can print those models that are perfect, and then you can tell the person, ‘This is what we’re going to use to build all of this,’” Dr Flucke says. “So, this isn’t kind of what you’re going to look like; this is exactly what you are going to look like.’”

Looking ahead, Sanders thinks the future of patient education on the preventive side is using salivary diagnostic tests in the dental operatory. Gathering the practical data revealed the test is common practice in medical and even veterinary spaces but not in dentistry. Sanders sees that changing for preventive care, putting salivary diagnostics as a standard part of the dental appointment, alongside x-rays and observations by periodontal probing and the naked eye.

Moreover, having salivary diagnostics alongside the other assessments subject to clinical subjectivity might help clarify the best path forward for the patient’s oral health and identify critical signs of other systemic diseases.

Here’s a look at why patient education is essential, what technology can help, and where the future of patient education is going.