Dr. Lisa Knowles has a unique ability to see the whole picture in dentistry as well as the whole patient. In addition to practicing, she is a public speaker, writer, and dental consultant. She shares her knowledge with colleagues looking for more peace and a bigger piece of the pie. Dr. Knowles is a social butterfly: Follow her blog at beyond32teeth.com. Tweet or Instagram with her @beyond32teeth. Facebook or LinkedIn with her at Lisa Lynn Knowles. For more fun and peace of mind, find her website at IntentionalDental.com

Dr Lisa Knowles

Eliminate the paper hassle when doing referrals by choosing digital workflows.

End Referral Frustrations by Going Digital

Many patients can benefit from a hybrid teledentistry workflow.

It’s Time to Embrace Teledentistry’s Hybrid Workflow

There are effective ways to be less invasive when helping pediatric patients in the dental chair. 

Treat PRR, Small Class I Pediatric Cases With a Bioactive Restorative

Choosing an open architecture workflow for your digital dentistry can boost efficiency. 

Choose an Open Architecture Workflow for Digital Dentistry

Artificial intelligence can be a powerful tool when it comes to diagnosing in the dental practice. 

Use Artificial Intelligence to Enhance Diagnostic Precision and Practice Efficiency

Help patients get a better image of the procedure by showing them intraoral scans. 

Erase Skepticism With Your Intraoral Camera

Safe and effective cleaning agents should be used prior to cementation to best results. 

Limit Contamination During Bonding with a Nonacidic Cleaner

Dry field isolation is crucial when trying to obtain a smooth restoration. 

Obtaining Dry Field Isolation in Class V or Cervical Defect Case

Reconsider Your Endodontic Referrals 

Essix Retainer Technique

Essix Retainer Technique is Designed With Healing Abutment in Mind

Using a desensitizer like Hemaseal & Cide can reduce instances of sensitivity.

Prevent Postoperative Sensitivity With Antimicrobial Desensitizer

Thermoplastics are a great alternative to other, more costly products.

How to Use Thermoplastics for Provisional Crown, Bridge Fabrication

MatrixTemp has provided a unique technique for temporary crowns.

A Simple, Economical Workflow for Fixed Prosthetics

Digital scanning and Carbon 3D printing have changed my attitude—and my patients’ attitudes—about dentures. 

Going Digital Makes a Big Difference

Robin the Robot Alleviates Pediatric Patients' Anxiety 

Many patients aren't aware that they clench and grind their teeth. This simple device can alleviate the tension.

A Simple Device Can Offer Grinding Relief

Thank you, Leonardo DaVinci

Simplifeye lets you work smarter, not harder when it comes to getting paid.

Increase Cash Flow by Making It Easier for Patients to Pay

SmartMirror is 21st Century Technology for 21st Century Challenges

By offering telehealth services, dental providers can bridge the access-to-care gap.

Telehealth Takes Your Practice to the Next Level

The Occlusinator® PRO Composite Finishing System allows me to create beautiful anatomic carvings in seconds.

This Should Be in Everyone's Toolbox

Sunbit's Buy Now, Pay-Over-Time solution has been a game-changer for this practice's patients and staff. 

Eliminate Cost as a Barrier to Treatment

Stationary intraoral tomosynthesis (sIOT) delivers the quality and resolution of 2D radiography without most of the metal artifacts seen in CBCT.

Take Advantage of a New 3D Imaging System For Intraoral Imaging

Tip: this technique can be used every day to make doing some restorative procedures efficient, productive, and enjoyable: Class I, V, and incisal edges are a slam-dunk combo.

A Slam Dunk for Class I, V Restorations

vTail provides easy connection to the products and the reps clinicians need, giving them time for quality dental care and a more relaxed quality of life outside the office

Connect With Dental Manufacturers on Your Time

Technique Touch-Ups 2022

Tokuyama made a big splash in our industry a few years ago with the introduction of OMNICHROMA. It was a unique product in an otherwise well established, and somewhat boring, space. The company itself has been around for a while and this by far is not its first innovation. When I first used their hard REBASE material for denture relining, it was as good as anything I got back from the lab. Accurate, chairside, no lab fee. It was a push against the norm with a simple but elegant solution. For me, OMNICHROMA was equally innovative, as well as impressive.

The whole idea of “one shade for every tooth” was obviously a compelling story. I am always looking for a way to simplify our armamentarium and streamline our product supply. OMNICHROMA’s success stems from a basic optical property of the composite. Most composites are shaded by having a particular color of the filler. A1 shaded composite has particles that are A1, for example. A light source hits the surface of the composite and reflects light to your eye for your brain to perceive color. In the case of OMNICHROMA products, the filler actually regenerates light from the surrounding tooth against the filler particles. This essentially creates the illusion that the composite itself is the same color as the structure around it. If you could isolate that composite, you would see it hasn’t actually changed color at all.

One technicality of using the product is that you do need actual structure to reflect that color. If you have an incisal extension that extends out, it would have less to reflect back and potentially look a bit too translucent or gray. In this case, Tokuyama recommends using their OMNICHROMA BLOCKER or OMNICHROMA BLOCKER Flow. It has similar regenerative properties but also creates a base layer of color to avoid that grayed-out look. Because of its ability to block color, it is only recommended to use a 0.5 mm layer of OMNICHROMA BLOCKER Flow. I find this is also useful when I have a darker base shade, such as a tooth with amalgam staining or a dark root surface. The opaque layer nicely blocks out the undesirable shades for a more esthetic color match in the final result.

The introduction of OMNICHROMA Flow BULK further redefines this category with simplicity and greater efficiency. Like other bulk composites, you don’t have to place the material in small incremental layers. The reason we used to place composites small layer by small layer is because large layers would exhibit greater shrinkage affecting marginal integrity and deeper layers could remain uncured if light could not get to the material in the deepest parts of the prep for proper curing. In the case of OMNICHROMA Flow BULK, this is no longer an issue. Its flowability and self-leveling help to not only layer evenly but the supra-nano fillers allow reflection of red to yellow structural color. It also enables the material to have a high level of polishability. Considering extensive studies that show great compressive strength, flexural strength, and lack of polymerization shrinkage, the company has definitely backed their claims with good science. 

When I first got a chance to use OMNICHROMA Flow BULK, I was most surprised by the simplicity of the packaging. A syringe and some tips were all that was in there, again reinforcing the value of OMNICHROMA products when it comes to helping declutter our storage. According to their recommendations, I can use the material on any posterior or anterior application. The instruction card had just a few steps that basically consisted of apply your bond of choice, fill it up, cure, and polish. The viscosity of the material is noticeable and flowed well into crevices, especially the floor of a Class II prep. I used the OMNICHROMA BLOCKER Flow in all cases of amalgam stain and it definitely helps keep the restoration at the brighter shade of the surrounding teeth. I did not have a single case that developed that “little white line” from poor bonding. If anything, it feathered well across any bevel.

Simplicity Goes Even Deeper with OMNICHROMA Flow BULK case images by Jeff Rohde, DDS

The only tricky part for me was for Class V applications. Due to the viscosity of the material, if I overfilled the preparation at all it would pool across onto the gingiva and make finishing a little more laborious. In this case, I found that it was best to initially wet the preparation right up to the margins, but not totally filled. After an initial cure, I would then layer the regular OMNICHROMA material over that due to its thicker handling. Sandwiching like this gave a great optical result, I still got a good seal, and simplified finishing. If this were a Class IV fracture, I would only use the original OMNICHROMA to ensure you can build out that body of the material to the intended incisal edge. One nice thing about OMNICHROMA Flow BULK is you don’t have to have that topper layer to protect it. In the Class V case switching materials to cap the restoration with the original OMNICHROMA viscosity was to be able to shape and sculpt the material.

Because of the viscosity of OMNICHROMA Flow BULK, I would recommend confirming you have nice four wall preparation to get the best results with the material. This would include a Class I, a Class II with a matrix band, a Class III with a matrix band, etc. You can also very easily adapt this for use with the Bioclear technique, especially in the posterior.

In a Class II situation, the material flowed nicely in the bevel areas of the buccal and lingual walls. Once placed in those areas, I filled the bulk of the rest with no issues. I still did another round of curing after I removed the matrix band but that was more out of habit than necessity. For anterior restorations with Bioclear matrix bands, I would place OMNICHROMA BLOCKER Flow into the deeper areas of the black triangle to block off the dark background and then fill with the regular OMNICHROMA Flow BULK material over the top of that.

OMNICHROMA Flow BULK definitely delivers on the simplicity of the system, as well as its broad range of use. It’s an excellent addition to Tokuyama’s line-up and continues to push the boundaries of what can be accomplished when solid science and research are applied to developing innovative and effective dental materials.

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Experts from across the industry share their favorite tips, tricks, and solutions to make dental care better for patients and easier for you.

Dental Products Report's Technique Touch-Ups 2022

	Need a check up? Most of us do. But, do we get one? Everything seems all right, and there has been no pain. Yes, believe me, after being in practice for almost twenty years, I have heard many excuses. Some are logical excuses and many make no sense.

	Before you suffer with physical or emotional pain, here are a few 

 tips I have acquired over the years to help quell the pain for my patients, clients and, quite often, for myself.

Related: What happens when your practice runs on autopilot

	Before jumping to conclusions, investigate the situation. I can be the queen of accusers. My mouth opens and accusations tumble out about how or why something did not happen. I watch patients do this. I watch teammates do this. I watch bosses do this. It’s human nature to blame someone else for a problem. When a problem does arise, take a deep breath, fight the desire to blame someone else for the error or problem, and ask a few questions, with a level tone, instead of placing immediate blame on someone else or something else.

	This will help with the blame game problem from above, too. When there are clear lists, 

assigned to people, it’s easier to know where the problems start. Checklists help ensure completion of mundane tasks that can get overlooked, and they can help us ensure a high quality of work is completed for patient safety and satisfaction. Little things seemingly routine to us mean a lot to our patients. And, they mean a lot to the overall operation of a business.

	It’s OK to not know everything. It’s not OK. to think we do. We all have blind spots in our personal and professional lives. We strive to be perfect, but we are human, and it’s impossible to know how we are perceived. We need back up. We need an honest friend. We need people to keep us in check. And, most importantly, we need to listen to these people-even when our egos are bruised and when we feel as righteous as ever.

Must read: 6 ways to improve your practice in 2017

, maybe with your healthcare professional, or perhaps with your business acquaintances, I urge you to take the time, and get it done. By utilizing the tips I provided for daily usage, I hope the annual reviews will go more smoothly. Prevention is the best medicine. 

Dr. Lisa Knowles explores three ways practice leaders can effectively manage their teams.

3 "check ups" every practice leader should do

Strategic use of an intraoral camera is essential. New cameras can be pretty exciting, and the urge to take pictures of everything is tempting. When we got new cameras, I found the hygienists to be a bit unclear about their usage and even unclear about what to show me and not to show me during the periodic oral exam. With good intentions, consultants, salespeople, and doctors say, “I would like to see five pictures (or six, or 10, or whatever magic number desired) of the mouth on every patient.”

In our office, the hygienists started snapping pictures left and right, and literally had five to 10 photos ready to review upon exam time. Perfect, right? Not so fast. After looking at the 15th picture of disclosed teeth and cleaned off teeth, it became apparent we did not know why we were taking pictures. The hygienists thought it would be good to show me the pictures of EVERYTHING 

 time. In reality, the doctors do not need to see the educational hygiene photos utilized so nicely with the patient - unless the hygienist truly wants the doctor to reinforce this issue for dramatic effect or influence. Typically, though, these pictures are for the patient’s benefit. A quick recap of what was done and why it was done from an oral hygiene standpoint is suffice and can shorten the doctor exam time.

So what should be photographed and what should be reviewed with the doctor? To help your team know why your office is using an intraoral camera, here is a devised acronym (PEPPP) to share with your office to help everyone remember what, and more importantly, 

something should be photographed and discussed.  

 something - A baseline tour of the mouth should be on file for each current and new patient. It’s the safety net in any legal dispute. This can be used to verify what was and was not done prior to a certain date. It also provides a “before” shot to any “after” shot that may be needed later on.

- This usage is vital for helping a patient own his or her disease. If patients are missing an area while brushing or want to know what a perio pocket looks like, you can show them up close and personal right in their own mouth. Also, if case acceptance is low, it may mean the patient does not believe you. Educating a patient with pictures can help convince a patient there is a problem. Providers may also want a picture of something so they can use it later to educate others in a lecture or classroom setting.

- Any pathological condition that is diagnosed or looks suspicious in the mouth should be photographed.

 treatment - Any treatment that is needed should be photographed: a crown that has loosened, a diastema that a patient may want to close, or a broken cusp. Interproximal cavities, in my opinion, can be reviewed on X-rays and do not need to be photographed unless visible in the mouth. 

 never seen before (anomaly) - If there is a dental anomaly so interesting and never seen before, this would be a good reason to snap a picture.

Early in the doctor’s exam, while both hygienist and doctor are looking at the computer screen - with the patient looking on as well - the hygienist should start off with an intraoral camera summary script like this: “I took five baseline photos today of Jasmine. I took two photos of her with disclosing solution on her teeth - one before and one after we removed the plaque. I took two photos of that crown we talked about doing last time and the diastema between her teeth that she does not like. I also took a picture of a suspicious area on her tongue.” The doctor needs to listen to the first two parts and

 the last two parts (the possible treatment areas and the suspicious area on the tongue).

The other items may warrant further review upon request, but since time is of the essence during the exam, the hygienist and doctor must work together to transfer the knowledge from what the hygienist observed and heard from the patient to what the doctor is going to dial in on for his or her 5-10 minute exam. The patient is given the opportunity to confirm or add in information at this point. Then, the doctor can sit down, affirm intraorally what he or she has discussed with the hygienist, and listen further to the recommendations the hygienist has already discussed with the patient.

With these tips, I imagine your team will have more PEPPP when using the intraoral camera because they will know WHY they are using it and they will know what to use it for.

Editor's Note: To learn more about the Academy of Dental Management Consultants, 