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.

Lou Shuman, DMD, CAGS

Dental Innovation Alliance: Venture Capital Reimagined | Image Credit: © Dental Innovation Alliance

Dental Innovation Alliance (DIA) is a unique investment firm built by more than 40 individuals and organizations dedicated to ushering in the next generation of dental innovation. Working to create positive change through technology, DIA has connected innovators and investors across the industry to improve practice performance and patient outcomes through competitive research and innovation. I spoke with cofounders and managing partners Doug Brown and Thomas Sharpe to explore the goals of this dynamic group and learn about its impact to date.

Can you share some of your backgrounds in dentistry?

I started my career in finance. After that, I led and grew 2 national dental support organizations for more than 20 years, most recently as CEO and vice chairman of Affordable Care, d/b/a Affordable Dentures & Implants. In the late ’90s, I brought together several prominent dental industry leaders into a small study group, which over time grew and eventually led to the formation of the Association of Dental Support Organizations (ADSO). I have been both president and chairman of the Government Affairs Committee of ADSO, and currently serve on ADSO’s Executive Committee.

I met Thomas when we were chosen as co–vice chairmen for Affordable Care. We both saw a huge opportunity to invest in early-stage dental technology companies and began to lead the process to invest alongside several of our trusted industry colleagues. We then decided to take it to the next level by launching DIA in October of 2022, so that we could bring more investors in to scale this important work. We now have 11 professionals on the DIA team, and 34 industry investors, who collectively bring their diverse expertise and backgrounds to make DIA so successful.

Separate from DIA, in 2021, Thomas and I launched a successful nonprofit clinic and learning center, Local Start Dental, in Durham, North Carolina, which works closely with faculty and students from the nearby UNC Adams School of Dentistry, where I’m on the Dean’s Advisory Board. It serves underserved populations but is also a hands-on learning center for GPs [general practitioners] who wish to advance their clinical skillset into implants, surgery, digital workflows, and advanced prosthodontics. Local Start often has the first look at new concepts brought to DIA, which provides us with real-world feedback in the early stages of a company going to market.

I have a business background and an MBA from Vanderbilt University and a law degree from the University of Oklahoma. I currently serve on the Innovation Investment Committee at Vanderbilt, which helps augment my work at DIA. After graduating from law school, I helped form a DSO [dental service organization] concept called DDS, which we successfully grew from eastern Oklahoma to 10 states in width and 52 units in size. We subsequently joined forces with Affordable Care, where Doug and I met. When the company was sold to a private equity firm in August 2021, we turned our knowledge, wisdom, connections, and financial resources to DIA.

Doug and I come from decades of operational roles and have an investor’s passion but with the scar tissue of veteran operators. We know the pain points and dynamics of dental offices and what it takes to operate complex companies, both DSOs and product and service companies that support them.

 DIA is a uniquely designed venture capital firm made up of a diverse group of investors—industry veterans, business leaders, dental clinicians, some of the largest global dental OEMs and distributors, a large DSO, and even the Florida Dental Association. This sets us apart from other venture funds that don’t have the scope of industry knowledge and connections that we do,and increases the chances of success for new ventures.

 I like to describe DIA as a rising tide that lifts all stakeholder boats. These stakeholders include the following: innovators, investors, end users of the innovation, patients who benefit from the innovation, and the dental industry overall. Through its network, DIA is leveraging its collective power to benefit all of them. Our pipeline is robust, with more than 1000 companies in our database, which is growing at between 30 to 45 new companies per month. This tells us it’s a good time for dental technology growth. It’s exciting!

LS: What does this mean for dentists? What’s in it for them?

 For dentists, it’s very difficult to keep up with all the innovations that are developing so quickly and so broadly. Dentists are—and should be—focused on patient care. It can be overwhelming for even larger DSOs with internal business teams to keep up with technology development at the current rate of new concepts coming to market. So, we view DIA as being a hub for information of all things relating to innovation. We have divided the dental technology industry into 40 vectors, and we have a mix of current and pending portfolio companies that fit into those vectors. We also conduct deep analysis into how potential competitors overlap and differentiate themselves. As we make investment decisions, we compare the advantages of certain companies over others, analyze which are competitively best positioned to succeed, and which have the best technology and approach to going to market. When provided to forward-thinking dentists, this research can help guide them and their teams to the services and products that can best improve practice efficiencies and patient outcomes. Many dental practices and group practices are highly leveraged. So, if we can help provide the information and guide dentists and group practices in making smart decisions about their technology choices, then we feel like we’ve elevated the profession.

LS: How are you different from other venture capital firms?

 DIA is pursuing a business model of venture capital [VC] reimagined. We are more deliberate in our investments than many other VC firms; specifically, we invest in a relatively small number of companies so we can use our resources to support each one more deeply.

 Simply stated, our strategy of being narrow and deep with our investments means fewer investments, more support, and larger checks. We also reserve significant investment dollars for critical second and third rounds of capital for our growing companies as they scale.

 The world is taking notice of artificial intelligence [AI], and Pearl was DIA’s first AI investment. We’re happy to report that Pearl recently had a tremendous round—$58 million raised at a $400 million premoney valuation in a Series B funding in July 2024. The company noted that this funding marks the largest investment ever in dental AI. We’re very excited about its future.

 Another company that we are engaged with, Perceptive, has developed 2 ground-breaking technologies: 1. a new scanner and imaging system that uses optical coherence tomography [OCT], giving it the ability to capture 3D volumes of data — including below the gum line, through fluids, and under the tooth surface without exposing patients to ionizing radiation; 2. coupled with the OCT imaging, the company also has developed a robot that can complete crown and filling preps fast (targeting 5 minutes), safely and accurately. We are eager to see how this combination of advanced imaging, AI, and robotics evolves over time.

 Also important are developments in revenue cycle management [RCM] products, software that manages items from payment options and processing to dental plans to insurance verification and processing. Beyond the ever-present staffing concerns, one of the biggest pain points reported by dentists includes RCM.

RCM technology is currently very siloed, and many dental practices are paying multiple subscription fees to several platforms, which involves considerable effort by staff members to learn and operate through this complexity and clunkiness. We see DIA constructing a conduit to ideally combine these technologies so they can work together as one de facto system, one integrated product, one subscription fee that ties into the practice management software systems. This will take some time, but with our knowledge and access to most of the SaaS dental products, we are in a unique position to help make this happen.

We want large group practices and individual dentists alike to view us as the world’s most innovative investment firm for supporting early-stage dental and health technology companies. We want to be at the center of the ecosystem for improving practice efficiencies, expanding care, and achieving better clinical results in dentistry.

 We are now developing DIA’s InnoCircle, a virtual community where members of the dental industry can share best practices and knowledge of the top emerging technologies. The InnoCircle will provide unmatched research on the most important innovative tech trends impacting the future of dentistry and be the connective tissue for dental professionals. This initiative is a key part of DIA’s strategy to position itself as a hub for innovation, fostering collaboration, and driving the future of the industry.

What is the best way for practitioners and companies to get more information?

 Contact Tori Cockman at tori@dialliance.com to get in touch with us about DIA and how you can plug in. You can also follow DIA on LinkedIn, sign up for our monthly Dental Innovation Insights newsletter, and listen to our Bright iDIAs podcast.

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This alliance is built by dental experts for dental experts.

Dental Innovation Alliance: Venture Capital Reimagined

The DWX-53D is suitable for a variety of cases, including prosthodontics and more.

Laboratories and dental professionals alike are very familiar with the Roland DGA name and reputation. For over a decade, the company has expertly manufactured DGSHAPE DWX open-architecture CAD/CAM milling solutions for dental laboratories and has recently expanded their offering to specialty and general dentistry offices. As of October 1, 2024, DGSHAPE launched an upgrade to their flagship single-puck dry mill, the new DWX-53D milling solution. The upgrades to their best-selling flagship product makes the DWX-53D the ideal dry milling solution for general dentists, prosthodontists, oral surgeons, dental service organizations (DSOs), and in-house labs. Roland DGA dental marketing manager Lisa Aguirre explained how the enhanced dry milling solution can increase production dollars per hour while creating a better chairside patient experience.

Lou Shuman (LS): What is the difference between the DWX-42W Plus and the DWX-53D milling solutions?

Lisa Aguirre (LA): The DWX-42W Plus is anything but the traditional chairside milling solution as its true open-architecture ecosystem platform allows users the freedom in choice of intraoral scanner, CAD software, and restorative materials. Clinicians can produce same-day restorations from commonly used materials like traditional precrystallized lithium disilicate and pre-sintered chairside zirconia. The DWX-42W Plus is commonly utilized in clinical dental offices for everyday bread-and-butter restorative procedures such as posterior single crowns.

Whereas the new DWX-53D milling solution is the ideal single-puck dry mill for the in-office production of advanced applications such as All-On-X cases, traditional and implant supported dentures, and other removable and fixed prosthetics. We consider these to be advanced applications as these services are traditionally being provided by prosthodontists, oral surgeons, and general dentists who are performing full-mouth reconstruction cases.

LS: What kind of software is needed with DGSHAPE DWX milling solutions?

 DGSHAPE prides themselves with their truly open-architecture ecosystem platform. That means it doesn’t tie users to any specific software, subscription/maintenance fees, or proprietary control source. Clinicians are free to choose their preferred CAD/CAM software, scanners, and restorative materials.

LS: Can I replace my dental laboratory with the DWX-53D?

 Roland DGA continues to emphasize the importance of maintaining the clinician’s relationship and collaboration with their trusted dental laboratory partner. Same-day dentistry can be productive and beneficial, but when the restorative application becomes more complicated—for example, a subgingival restoration or even a highly esthetic anterior case—the clinician should consider collaborating with their trusted laboratory in order to achieve an optimal clinical outcome.

In-office milling can easily add value to a practice by being able to produce certain applications in-office, when appropriate, and creating a better overall experience for the patient.

LS: What excites you about the new improvements to the DWX-53D?

 Essentially, the best just got better. We like to say that the innovation was “built from the outside in” with the DWX-53D. First, the spindle has been upgraded, now with 1.5 times more gripping power than the previous DWX-52D Plus model. This allows for even more precise milling of materials like PMMA [polymethyl methacrylate] and other very rigid plastics along with faster milling times.

The frame structure has also been redesigned and reinforced, creating more stability when milling and helping to minimize routine maintenance procedures. The included open-edge adapter accessory allows for advanced 90-degree-plus milling capabilities to reproduce 100% of the case design. This is perfect for milling of large full-arch and/or highly esthetic cases.

One exciting and useful aspect of the innovation is the addition of a built-in web camera so the practitioner can monitor inside the actual milling chamber of the machine.

LS: Can my dental office really benefit from having a DWX-53D in-office?

 The return on investment for bringing milling in-office can quickly become apparent. In-house milling can make everyday and complex restorative cases more profitable by increasing production dollars per hour and in-office efficiency. For the patient, this translates to a better overall chairside experience, reduced time between visits, and fewer visits overall. For those who are ready to take control and do more advanced applications in-office, you can upgrade your practice with the DWX-53D for just under $30,000.

LS: How can practitioners learn more about the updated dry mill and contact you?

 For any questions, clinicians can email dental@rolanddga.com. For availability and purchase, contact www.rolanddga.com/dealers, or for more specific information on the mill, visit www.rolanddga.com/DWX-53D.

The company has launched an upgrade to its flagship single-puck dry mill, the new DWX-53D milling solution.

Take Control of Your Production Dollars With Roland DGA’s New DGSHAPE Dry Milling Solution

The Eyes Have It | Image Credit: © OCU-GUARD

My perspective on shielding patients during x-rays changed when I met Steve Maiman, founder and CEO of OCU-GUARD, and was introduced to his novel, cost-effective, intricately designed eye shield tailored for both adults and children. Although I previously hadn’t considered eye protection for radiation exposure, Maiman showed me a wealth of compelling scientific evidence underscoring the imperative of safeguarding the eyes against even minimal doses of radiation.

Coincidentally, during a recent dental visit where I underwent a comprehensive series of images, I took careful note of the proximity of the x-ray unit to my eyes, particularly during anterior imaging. Although opinions about radiation protection during dental radiographs have recently been modified, the eyes were not addressed by the American Dental Association.

Lou Shuman (LS): Why did you create OCU-GUARD?

 I was getting dental x-rays at a routine appointment, and the assistant put a protective lead apron on [me] that covered my body and my neck. After the x-rays, I asked my dentist if they ever considered covering the eyes. He said no but did not have a definitive answer on why not. I decided to pursue the question further and asked my brother, a practicing radiologist, whether ionizing x-rays are harmful to the eye, particularly the lens tissue. This led me to both further research and to the creation of OCU-GUARD.

LS: Can x-rays harm lens tissue of the eyes?

 The lens tissue of the human eye is very sensitive. And the sensitivity is exponentially increased in children because they are still developing physically and their cells are multiplying quickly. They are far more sensitive than adults to radiation. Even more importantly, radiation is cumulative—once irradiated, the damage stays with you. When kids start their early dentistry and orthodontic treatment and they keep getting x-rays, radiation exposure keeps adding up, from youth to old age.

LS: So why does that matter, if modern x-rays emit lower amounts of radiation?

 As we get older, we [are] more susceptible to cataracts regardless of whether we’ve gone to the dentist or not. But having x-rays to the eyes over a lifetime can contribute to an early onset of cataracts. So that can be part of the problem.

LS: Is there any research to back up the need for this product?

There are now [findings from] over 30 published studies demonstrating that x-rays cause tissue changes and damage to the lens tissue. The unique cells of the eyes are extremely radiosensitive, and unlike most cells in the human body, once irradiated, [they] will not regenerate.

At a session of the FDI General Assembly called “Radiation Safety in Dentistry,” the speaker said, “Exposure to ionizing radiation carries the risk of harm. The effect on the eye may be caused by lower doses than previously considered. All reasonable means should be used to reduce radiation exposure, without compromising diagnosis, when radiographs are taken.”2

Roy Rubinfeld, MD, MA, agrees, saying, “As a clinical professor of ophthalmology and practicing eye surgeon, [I can say] it is known that dental x-rays, even in low dosages, can increase the risk of earlier cataract development, especially in younger people. To help safeguard against this, eye shields should be an integral part of every dentist’s safety protocol.”

LS: What can dentists do to help prevent this potential problem?

 The solution is an eye shield. The flexible OCU-GUARD is composed of finely divided, specially graded, pure lead particles, fully encapsulated within a durable vinyl matrix. The lead content offers radiation attenuation greater than 93%. It is contained within the vinyl structure to prevent absorption from the product to the skin.

It is extremely durable [and] comfortable and can be cleaned with standard disinfectant wipes. Each shield is guaranteed to last a minimum of 500 complete examinations, making the cost per examination under 10 cents. The OCU-GUARD core leaded material passes the 3 most universally recognized testing procedures for radiation products: ASTM [American Society for Testing and Materials], [the] US standard; IEC [International Electrotechnical Commission] 61331-1, widely used throughout the world; and DIN [Deutsches Institut für Normung (German Institute for Standardization)] 6857-1, [the] German standard and considered to be the strictest in the world.

 Whether you are a parent or a patient yourself, once you realize that ionizing radiation is harmful to the eyes, you will be relieved to know that your dentist is doing something to prevent possible damage. Also, every practice has patients who refuse x-rays or who are very reluctant to allow x-rays to be taken because they are radiation averse. This is very helpful to show those types of patients that you’re taking every step you can, including protecting the eyes.

LS: Why should dentists add an eye shield to their protocols?

Dentists know they have always done their best with ALARA [as low as reasonably achievable] radiation initiatives. But now that we know a bit more than we used to, there is a need to be more protective, especially with children. We need to do what is best for the patient, even if it is not mandated, because it is the right thing to do. For more information, visit 

1. Benavides E, Krecioch JR, Connolly RT, et al. Optimizing radiation safety in dentistry: clinical recommendations and regulatory considerations. 

. 2024;155(4):280-293.e4. doi:10.1016/j.adaj.2023.12.002

2. FDI World Dental Federation. FDI policy statement on radiation safety in dentistry: adopted by the FDI General Assembly: 13 September 2014, New Delhi, India. 

. 2014;64(6):289-290. doi:10.1111/idj.12148

Radiation sensitivity shows a need for eye shielding during dental x-rays.

The Eyes Have It

Biomarker Reader Helps Catch Oral Cancers Earlier |

Head and Neck Cancer Awareness Month occurred in April, and the facts show that oral cancers cannot be ignored. The American Society of Clinical Oncology estimated that in 2023 in the US, 39,290 men and 15,250 women received a diagnosis of oral or oropharyngeal cancer. The 5-year relative survival rate in the US is 68%, but if diagnosed at an early stage, the 5-year relative survival rate jumps to 86%.

Vigilant Biosciences® has developed an accurate method of detecting oral cancers by identifying biomarkers chairside in the dental office. The BeVigilant™ OraFusion™ System has been granted FDA breakthrough device designation and is expected to receive FDA approval in the coming months. I spoke with Bill Brodie, CEO of Vigilant Biosciences, to find out more.

How did you get involved with Vigilant Biosciences?

 I’ve been in the dental medical space for 34 years and ran my own dental supply equipment company that was subsequently bought by Benco Dental, which was a small regional company at the time. As vice president of sales, I helped grow the Southeast region for 7 years. After that, I shifted to the medical area, working with cutting-edge artificial intelligence (AI)–driven technologies. The Vigilant Biosciences board saw me as uniquely qualified because of my experience in both medical and dental areas. I’ve been with the company for 5 years.

What is the company trying to accomplish?

 The company was originally founded by an attorney whose parents both died of oral cancer. He connected with a biomarker researcher, and they began exploring how salivary biomarkers can predict oral cancer. The first 6 years were spent researching and improving biomarker accuracy. In the past 4 years, after studying thousands of biomarkers, specific biomarkers that focused on the goal of early detection were chosen. In all our studies and trials, at least 50% of the cohort was early stage or precancer stage 0.

 We believe the most benefit is achieved if the dentist can move the decision of whether the patient needs a specialist to when that patient is still sitting in the dental chair. A good example is lichen planus. There is a less than 4% chance of lichen planus turning cancerous. But if it does, it is very aggressive, and the patient can be dead in 18 months.

 The lateral flow cassette looks similar to home COVID-19 tests. The dentist or hygienist puts 4 drops of saliva on each side. The cassette is then put in the little drawer of the reader, and the software produces a result and gives you a report. The reader has an onboard battery so it can be moved among operatories.

It takes about 10 minutes to get a result. The reader measures the exact concentration of 2 proteomic biomarkers and a control. These proteins become elevated as tissue becomes cancerous.

The control measures the amount of the saliva and the viability of the sample.

The first biomarker, a transmembrane biomarker, detects rapid reproduction of the cells, a hallmark of cancer. This biomarker is shed by the cell membrane as the cells reproduce.

The second biomarker becomes overexpressed as the body attempts to suppress that cellular activity. The relationship between these 2 biomarkers provides information that produces the accuracy.

Combine that with clinical risk factors, such as sex, age, and tobacco and alcohol use, in intelligent machine-learning software, and the ultimate result indicates whether the patient needs to be referred to a specialist. The report can then be emailed.	

 Testing is recommended if a dentist or hygienist sees some abnormality in the patient’s mouth—it could be leukoplakia, lichen planus, red spots, white spots, or anything out of the ordinary. Knowing whether to wait and monitor or refer to a specialist is very hard in the early stage. About 25% to 30% of patients have an oral abnormality. The report shows the relative concentration of the biomarkers, signifying whether the abnormality in the mouth is starting to exhibit cancerous behavior.

 Suggested retail for the machine is around $1000 and each cassette is $60 to $70 individually, but they are sold in packs of 12. We are working with reimbursement experts who have suggested an insurance code that is used by light-based devices—CDT 0431 (assessment of oral abnormality). When dentists start using the product in the US after final FDA approval, they can use this code.

In March 2023, we were awarded FDA breakthrough device designation, a program by the FDA that designates the product as truly unique under the current standard. As we speak, there is legislation pending that all breakthrough products will get reimbursed. We hope for this legislation to come to fruition and also to have FDA approval in the US by summer 2024. When we receive approval, Henry Schein and Benco are ready to be distributors.

The ability to improve is the beauty of a machine-learning algorithm. We hope to develop a future iteration that indicates how far along the cancer is on a scale.Interested clinicians go to vigilantbiosciences.com to learn more and be notified when available.

It’s a shame that basically about 73% of oral cancers get diagnosed late stage. And with those, there is a less than 50% 5-year survival rate.

 The signs should not be ignored until [the disease is] obvious. Vigilant Biosciences has given dentists the opportunity to save patients’ lives with early detection of oral cancer and make a big difference in healthcare.

to learn more and be notified when available.

1. American Society of Clinical Oncology. Oral and oropharyngeal cancer: statistics. Cancer.net. February 2023. Accessed April 8, 2024. 

https://www.cancer.net/cancer-types/oral-and-oropharyngeal-cancer/statistics

2. Saka-Herrán C, Jané-Salas E, Mari-Roig A, Estrugo-Devesa A, López-López J. Time-to-treatment in oral cancer: causes and implications for survival. 

. 2021;13(6):1321. doi:10.3390/cancers13061321

Vigilant Biosciences has developed a method to help dental clinicians accurately detect oral cancers chairside, with the goal of early cancer diagnosis and better survival rates. 

Biomarker Reader Helps Catch Oral Cancers Earlier

For this column, I wanted to share the history and science of orthodontic retention, so I knew I needed to contact Brian Gray, DDS, for my conversation. He is a fellow in 3 academies and a master in the Academy of General Dentistry (AGD). At AGD, he was awarded the Lifelong Leadership and Service Recognition Award—fewer than 1% of dentists have received this award since its inception. Dr Gray is chief dental officer at Candid, and when he took on this role, one of his goals was to evolve a next generation of retainers. Candid is a dental company that provides CandidPro clear aligner solutions. Our discussion on the science of retention leads to understanding why the right materials and protocols are needed for lasting orthodontic results.

Why did you start looking at a next-generation retention solution as an important part of the whole orthodontic process?

In the past, when patients finished orthodontic treatment, they got their retainer and returned to their general practitioner [GP] for their regular dental checkups. If the patient didn’t adhere and noticed that a tooth was starting to relapse, the GP would usually send them back to the orthodontist. That extra appointment was just another hassle in their day, so often they would let it slide, and the teeth would shift even more. Retention must be for life. But it must be based in science to produce lasting results. GPs now represent such a significant part of aligner treatment that understanding retention has become an integral part of long-term patient care.

 We want a retainer to act as a gentle reminder for the teeth to stay in the final position after treatment. The true standard of care for removable retention has been the Hawley retainer—it has a long life span unless it gets lost or the dog eats it—and it can be adjusted in the case of simple relapse. A Hawley maintains tooth position because the scalloping of the acrylic on the lingual surface locks teeth in place. But the problem is, when you wear that type of retainer, it is like going back to high school. After patients have had their teeth straightened with a clear aligner system, they don’t like to wear a Hawley because it looks and feels strange.

LS: So, from a scientific point of view, what makes a good retainer?

 An ideal retention appliance has 2 important components: It needs to fit very well and maintain its shape. In other words, a clear plastic retainer needs to be precise and know where to stay. In the past, some doctors would use the final aligner as a retainer. The plastic would fatigue very easily, and then the teeth would start to shift a bit in the retainer. If the plastic is not holding the teeth in position, they tend to move in a transverse direction, sideways. But the proper retainer material changes the game.

Studies showed that certain first-generation aligner and retainer plastics would start to fatigue in as little as 1 week after being worn for 8-hour days. Based on that information, Candid started searching for a new, more reliable material. We saw improvement but still observed too much fatigue with second-generation materials. For efficient retention, patients had to update their aligners about every 6 months. So we continued analyzing the data to deliver the best retention plastic available. And we nailed it. We chose the latest clear, stain-resistant Zendura FLX material because of how well it resists cracking and deformation.

Candid performed rigorous stress analysis tests on plastic materials to see which one was going to have the best memory and last the longest. We ran fatigue tests for strength, memory, and rigidity. We then ran a double-blinded clinical trial to verify the best trim and thickness that patients found to be most comfortable.

LS: Why not use an aligner as a retainer?

There is a big difference between clear aligners and retainers. Clear aligners are designed to move teeth. Retainers are designed to keep teeth from moving—to maintain a specific position. The fit needs to be highly intimate with the teeth, so they have less of an opportunity to start movement under the plastic. A poorly made retainer will allow the teeth to drift or shift, but a well-made retainer will hug the teeth and hold them in place.

Also keep in mind that a retainer will wear out more quickly if the patient is a heavy grinder or bruxer. This causes the plastic to flex and not hold on to the sides of the teeth as well.

It is important to know that a precise-fitting retainer relies on 2 components of accuracy for success. First is the veracity of the impression or scan. Second is the validity of the model used to thermoform the clear retainer. The scan, which gives us data on tooth position, is turned into a solid lithograph model. When the models are fabricated, they must be made with a highly accurate printer. We found that Carbon printers were the best in this regard. Super-precise models allow our thermoforming units to deliver the fidelity we were looking for when we started this mission.

The most important part is the type of plastic used to form over the model. The material needs to be able to [reach] into the interproximal spaces to help hold the teeth. Without that, the teeth will be allowed to shift. When Candid came up with the design of our next-generation retainer, we looked for these key things: the proper material, being able to obtain the best data from the scan, and the highest accuracy of printing.

The next generation of retainers Candid just launched does not rest on the gingiva, and this is very important. It is designed to be supragingival, so it does not impinge at all on the soft tissue. But because it is extended lower, the retainer can now leverage physics to grab on to more teeth and lock into the interproximals between the teeth to keep them from moving. And this helps to prevent that transverse movement.

 Teeth actually relapse by wanting to return to their previous position. This has a lot to do with the periodontal ligament. Without getting too deep, there are 3 leading theories on strain-based bone remodeling in orthodontic movement. They all pretty much correlate on relapse rotation, which may occur because round circular fibers act like a rubber band. [Before orthodontic treatment], the tooth is out of position, but the circular fibers are passive. Now we move the tooth, and even though it is in an ideal position, those circular fibers are stretched and want to return to their original passive pre-rotated position. The longer the aligned tooth is held in its ideal position, the fibers start to relax and become passive in their new position. This change occurs over a lengthy period, which is why adherence and the best retentive device are so critical. It is also why Candid spent so much research and development time to create a retainer to allow the dentition to remain ideally positioned.

 The exciting part of working at Candid is their state-of-the-art [research and development team]. The company is quick, agile, and has a ton of game-changing innovations in progress. The next 18 months will see much disruption and change in our incredible profession. Candid already has a retainer update coming in July, adding some extra features. You do have to be a CandidPro provider to purchase retainers through the CandidPro website.But patients don’t have to have gone through CandidPro aligner treatment to get PermaForm retainers.

The research and science that went into the creation of this next generation of retainers from CandidPro provide significant upgrades in fit, comfort, and longevity. Patients spend much time and money on straightening their teeth, and Dr Gray and Candid are determined to keep those teeth in place.

The launch of Candid’s next-generation retainer is backed by its research of the best materials and protocols.

The Science Behind Orthodontic Retention

A Mouth Rinse to Tackle More Than Just a Single Job. Image credit: © OraCare

In the dental office, especially in the hygiene department, you will find many products that do 1 job. Maybe we don’t like that product but keep using it anyway because we don’t have a good alternative. Chlorhexidine is that kind of product. It is a staple in the dental office, but in my many years in clinical practice working with clinicians and hygienists, no one is satisfied with it. We continue to look for alternative products that do many jobs well. I am thrilled to say that there is a better alternative: OraCare. I know that because I use it myself. I sat down with Kristin Goodfellow, RDH, chief clinical officer of OraCare and practicing registered dental hygienist, to find out the details on this award-winning product.

 Chlorhexidine is a staple in dentistry and hygiene. What’s wrong with a product that has been used for so many years?

 Chlorhexidine is for short-term use only, but many of our patients have long-term issues. It does kill bacteria, but it also causes staining and additional calculus buildup. Chlorhexidine [affects] the cells in the mouth that help rebuild tissue, causing complications with healing.

 Tell me how and why OraCare was created.

 OraCare was developed by 3 dentists, Dr Robert Martino, Dr Richard Downs, and Dr Berdj Kiladjian, who shared other dentists’ frustrations [about] the negative effects of chlorhexidine. Dr Downs recognized how effective and compatible chlorine dioxide, the active ingredient in OraCare, is for use in the mouth. Now thousands of dental professionals use and trust OraCare as an alternative to chlorhexidine. Even better, it can be used for many more applications, from simple issues [such as] bad breath to more complex problems [such as] periodontal disease, cancer care, [postoperative] healing, mouth sores, dry mouth, fungal infections, braces, bleeding gums, and general home care. It has so much function and applicability for day-to-day use.

 OraCare uses a 2-bottle system to create activated chlorine dioxide, a unique gas that is the active ingredient. Chlorine dioxide is versatile; able to kill bacteria, viruses, [and] fungi; break up biofilm; and reduce volatile sulfur compounds. Compare that with chlorhexidine, [which] just kills bacteria. And although killing bacteria is important in dentistry, it’s not the only pathogen that we need to be concerned about. For example, we know that viruses play a role in issues [such as] implant failure and the progression of periodontal disease. OraCare has the ability to do more, something which is much needed in 2023.

Tell me more about the science. Have there been any studies related to the use of OraCare?

 OraCare has many studies, and we are always working toward participating in more. The active ingredient in OraCare, chlorine dioxide, is a powerful yet versatile compound that has gained significant attention in the dental industry. Its study and application have long been applied in other disciplines, including chemistry, water treatment, and health care. This is one of many reasons it has become so popular with dental professionals. It is fantastic at breaking up biofilm but also kills bacteria, viruses, [and] fungi and reduces volatile sulfur compounds. The fact that it has all these qualities makes it ideal for use in the oral cavity when trying to find something to help a plethora of issues from everyday care to periodontal disease.

How does OraCare handle the destruction of bacteria in the mouth differently from chlorhexidine?

 The chlorine dioxide in OraCare is a very selective antimicrobial. It doesn’t destroy the cells that rebuild tissue. There have been [findings from] many studies on chlorhexidine that show that it inhibits a particular type of cell called fibroblasts, which are key to rebuilding connective tissue. In the [management] of periodontal disease, when the doctor’s definition of success may be 1 mm of reattachment, you don’t want to have the patient use a product that completely contradicts your goal of rebuilding the tissue.

 You mentioned that chlorhexidine has a limited life span as far as usage. Can you give us more information on why that matters?

 One of the biggest challenges of chlorhexidine is that we often start using it when our patients really need help. Chlorhexidine can only be used for 2 weeks, and most dental issues can’t be resolved in that time. For example, after an extraction, it takes about a month for the tissue to heal, so the patient needs a product that they can use for at least that healing time to help keep the area clean and not cause any additional issues.

Also, if you want the patient to be [adherent] for a longer period, it has to be easy to use and taste good. Many patients complain about the taste of chlorhexidine, and some won’t use it after trying it. OraCare tastes good, doesn’t cause any stinging or discomfort, and leaves the mouth feeling super clean. Patients can feel a difference.

 I hear that OraCare has gotten involved in humanitarian efforts with patients [with] cancer. Tell me more about that aspect.

 We are incredibly proud of our humanitarian efforts. The OraCare Cares program, offered to offices that carry OraCare, donates a set of OraCare to a patient [with] cancer from that office. All the office has to do is go to our website and fill out the form for their patient. When we get the notification, we’ll send the patient the OraCare with a card that has a personalized message that the patient is receiving a gift from the office.

We had not at first realized how beneficial OraCare was to patients [with] cancer until a hygienist started offering our product to patients [with] cancer [experiencing] fungal infections and dry mouth. OraCare also helps with the mouth sores and burning mouth syndrome that often occur as a result of certain cancer [therapies]. We started getting testimonials from patients [with] cancer that OraCare helped them with their mouth sores from chemotherapy and radiation. Patients compared their first round of treatment when they were not using OraCare with their second round of treatment when they were using OraCare and found that their oral [adverse] effects were significantly reduced. Ultimately, we’re proud because we can provide some relief to patients during an uncomfortable time. We are so pleased that they are able to eat and drink more comfortably and keep their oral cavity healthy.

Dental professionals have an advantage in that they typically see a patient [with] cancer about a month before they start treatment, so they start on this product even before they start treatment to prevent problems [and] not deal with them as they pop up during treatment. They should start cancer [management] with the healthiest mouth possible and no active infection in the oral cavity.

 As a dedicated OraCare user, I have felt the amazing effects firsthand. From perio [and] dry mouth to cancer care [and] everyday maintenance, integrating OraCare into a patient’s hygiene routine can make a remarkable difference in oral health.

OraCare offers practitioners a healthy and versatile alternative to the controversial chlorhexidine. Learn more about it from OraCare Chief Clinical Officer Kristin Goodfellow, RDH.

A Mouth Rinse to Tackle More Than Just a Single Job

Wilson Martino Dental is the Practice That Keeps on Giving. Image credit: © Wilson Martino Dental

Robert Martino, DDS, CEO of Wilson Martino Dental, is always looking for ways to help others. From local events to corporate sponsors to national recognition, his enthusiasm and energy have grown his outreach many times over. The old adage “Practice what you preach,” just may be Dr Martino’s motto. His humanitarian efforts blend perfectly into every aspect of his work and family life.

You could say that Dr Martino’s practice, which is headquartered in Bridgeport, West Virginia, is going to the dogs. But that wouldn’t be totally true. Cats also reap the benefits of his practice’s philanthropy. His generosity is evident in the Humane Society of Harrison County’s newly renovated building, which has been dedicated as The Martino Home for Cats & Dogs (

Figure 1. With renovations funded by Dr Martino and his family, the Humane Society of Harrison County named their shelter in their honor.

Dr Martino and his family donated more than $100,000 toward paying the Humane Society’s mortgage, funding renovations, and saving countless animals’ lives.

During a previous fundraiser, patients were able to drop off money and pet supplies with the practice matching the monetary donations. To sweeten the pot, anyone who donated was entered into a drawing for a free Zoom whitening. In a recent interview, Dr Martino said, “Right now we’re in the middle of trying to save 100 dogs. We pay the adoption fee. We’ve saved about 93 dogs so far.” The 7 offices of Wilson Martino Dental hosted the annual “Wilson Martino Dental Adopt A Pet Month,” which saved more than 700 dogs and cats from being euthanized at animal shelters throughout West Virginia, he noted.

Dr Martino has 6 dogs, and he has owned as many as a dozen at a time. He says, “I’m a big dog lover. It’s really great that we’re doing this because I personally know what joy dogs give. Not only are we saving their lives, but we’re making all of the new owners happy.”

Dr Martino and his aeronautic business partner, Edward Waske Jr, also bring smiles to children’s faces in nondental ways. After investing in EASW, an international airplane maintenance company, he and Waske took their good deeds to new heights by sponsoring an air show for children. Each year, hundreds of kids flock to the hangar to see different types of flying machines in action. They take home model planes along with education and a newfound love for flying.

During the holiday season, Dr Martino and his team turn their attention to children who are not as fortunate. The Angel Tree shopping project has been funded by the office, team members, and dental associates for the past 15 years. Money is distributed so that every team member from all of Dr Martino’s businesses can fulfill the wishes found on a child’s paper angel from the Salvation Army, local churches, or schools during Christmas.

“We choose one day, usually around the first of December, and about 100 of us all go to Walmart together to shop for our ‘angels’,” says Wendy Boyce, Wilson Martino Dental’s vice president of customer relations. “Dr Martino and Dr Wilson started this long ago when we had just 1 office. And now we have 7 offices, plus the company headquarters, OraCare, a call center, and a specialty practice. So when everybody gets together to shop, we are quite a spectacle.”

The good tidings extend to adults as well. Eleven years ago, as a nod to West Virginia’s sizable veteran population, Dr Martino founded Freedom Day USA, an appreciation event for past and present members of the military and their families (

Figure 2. The Wilson Martino Dental team on Freedom Day USA, an event founded by Dr Martino to honor veterans in West Virginia.

Boyce recalls, “It started out as a day of free services. Our motto is ‘a day of free for our lifetime of freedom.’ And it started growing as Dr Martino’s colleagues wanted to participate, too, and it spread all over the nation. At one point, we had participants in every state, with almost $1 million in services being donated on that day.”

The day has expanded in scope and flexibility. Any business, not just dentists, can donate products or services, and if they cannot participate on a certain day, they can hold their event at a more convenient time. There is no specified amount to donate, and it doesn’t have to involve a certain number of military members or even a whole day of services. To learn more or participate in Freedom Day, visit freedomdayusa.org.

“Whatever you can give is a ‘thank you’ that supports our mission, even if it is providing something to 1 military member of their family,” Boyce says.

Each summer, the offices host a West Virginia Healthy Kids Drive event, which so far has helped more than 4000 children. The day provides free dental care for children in the community 12 years and younger, providing cleanings, exams, x-rays, fluoride treatments, and any necessary dental treatment that can be completed that day, such as fillings, micros, extractions, crowns, and more.

The practice’s kindness warms hearts in other ways as well. More than 10,000 coats were donated to local shelters for those in need. After Halloween, the practice’s candy “buy back” drive resulted in more than 3000 pounds of candy shipped to troops. Office staff are out in the community for career days, health fairs, and school presentations.

“Some of our hygienists go into the community on their morning or day off or host an evening program for a local youth group or church,” Boyce says. “The program has expanded greatly because we’re all doing it together.”

Sometimes a new program arises by pure serendipity. When Dr Martino helped found OraCare, which makes a mouth rinse that’s replacing chlorhexidine in practices as well as in patients’ homes, he knew that it would be a better alternative for bleeding gums, bad breath, periodontal disease, and dry mouth. But he didn’t know it would become popular with cancer patients. He quickly realized that OraCare also increases oral comfort for patients undergoing cancer treatment by easing the fungal infections, dry mouth, burning mouth, and mouth sores associated with chemotherapy and radiation.

When testimonials started coming in from cancer patients, Dr Martino was moved to action. In November 2020 the OraCare Cares Program was launched. OraCare providers can fill out a form for a patient who has cancer, and OraCare will send a kit directly to that patient on behalf of their practice at no cost to the practice or the patient. The package arrives at the patient’s house along with a personalized note from the office. The program already has reached more than 2000 patients from all 50 US states.

With all of these fun and philanthropic events, it’s a wonder that the staff have time for dentistry. Dr Martino credits his team with helping him to accomplish all of his goals.

“I could not do any of this stuff without my team. I’ve been very blessed, and if you are blessed, it’s your responsibility to make life better for others,” he says. “We may not change people’s lives totally, but at least they know that there are people out there who care about them.”

From coat drives to Freedom Day USA, this West Virginia practice cares for the community in numerous ways beyond traditional dentistry.

Wilson Martino Dental Is the Practice That Keeps On Giving

When important equipment breaks, the last thing you need during your busy day is to have to help an assistant look for the product information, rifle through business cards to find who fixes that particular device, schedule the technician, and then keep track of when they’re coming and whether they actually show up, and know where to file the information about the repair for next time. It’s exhausting just thinking about it.

You and your staff should not have to be equipment or inventory experts. But keeping all your devices in working order is key to providing the best care to your patients and getting your best return on investment. I spoke with CEO and cofounder of UptimeHealth, Jinesh Patel, to find out about his strategy to simplifying and predicting dental equipment service, purchase, and compliance.

How did you get the idea for UptimeHealth?

Jinesh Patel (JP):I have a master’s degree in biomedical engineering and an MBA, so I enjoy working on device design as well as equipment management and processes. Early on, I got a job as a clinical engineering manager for the largest health system in Austin, Texas. This involved taking care of the equipment inside our huge health care system, developing a strategic maintenance plan, keeping track of vendors, monitoring cost-effectiveness, and working with the departments to inform their purchase decisions. I came to understand what compliance means for the environment of care in the medical world and how a broken device impacts the day-to-day operations.

In 2013, when our health system started acquiring urgent care outpatient locations, I was tasked with evaluating their equipment management policies and compliance. When I started interviewing them, I realized they had no solutions; some could not even show me a device list or management plan for their equipment. These are items required by regulatory bodies in the medical world.

I was surprised that in most of these cases, there was no equipment expert in the building. Yet every medical procedure requires some kind of medical instrument. That was my inspiration to create UptimeHealth. I was serendipitous enough to meet cofounder Bill Olsen, a software expert who formerly was chief technology officer of Accruent, the premier equipment and asset management platform for health care systems. He saw the same problems I was seeing. At first, we were hyper-focused on the urgent care and surgical markets,but in March 2020, during the COVID-19 crisis, we started to look at other markets that could be helped by UptimeHealth and decided to serve the niche of over 120,000 dental offices in the US.

First we help dental offices manage their equipment efficiently by creating a roster of what they actually own, a comprehensive list—category, model, serial number, location in the building, who is managing the device at that building, the date of purchase, and purchase price. We make all these data points searchable. So there is, for example, a list of all the autoclaves in the office, all the chairs, everything. Based on that roster, we indicate any upkeep or maintenance that is needed for that equipment—on a daily, weekly, monthly, quarterly, annual basis, and whether it’s compliance related.

A good example is testing sterilizers or clean-outs for chairs that need either to be maintained or comply with applicable laws. A task management engine flags the tasks that need to be done and then stores the maintenance record for each device in a digital binder. Also, we keep a record of your service technician so in case of an issue, you’re not searching for business cards or emails for your contact. With UptimeHealth, you can click a button and send a message to that technician telling them about your problem, along with all the pertinent information on that device, and an office contact for more information. We then track their service progress. You can look across the systems and see if the service call is scheduled, if parts are on order, and when it’s complete. Anyone in the office can log in to the product and see the status of a piece of equipment.

Lastly, we analyze data about your equipment—how often it’s failing and how much it costs to service and support those devices. We can produce depreciation reports and suggest when it may make sense to replace instead of repair equipment.

In addition to our original services, customers have requested other applications, like facilities management. We already have a concept of your space because we assigned the devices to their places in the building. So just like you open up a service ticket on a device, you can open up a service ticket on an area, such as an operatory where a ceiling tile has fallen or a plumbing issue.

 We are in the process of developing a sophisticated version of the equipment roster to store documents for your office, and in the future we are envisioning that eventually our product will communicate with the equipment, like a machine will send a message when it may be overheating, and that will create a task or a service ticket.

UptimeHealth helps dental practices manage equipment and analyze efficiency and maintenance to ensure everything runs smoothly.

Simplifying Equipment Service, Purchase, and Compliance

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

Temporomandibular disorder (TMD) is painful and frustrating, and patients are seeking relief. According to the National Institute of Dental and Craniofacial Research, approximately 11 to 12 million adults in the United States report pain in the region of the temporomandibular joint. TMD is twice as common in women as in men.

 There are a lot of methods to treat TMD, but unfortunately, many are not backed by science.

That means patients often spend a lot of time and money and still end up hurting. I spoke with Anthony P. Urbanek, DDS, MD, MS, who has dedicated his life to exploring and researching effective treatment for patients with TMD. He reports incredibly positive results with his Urbanek TMJ Device, which is designed to relieve the inflammation that causes TMD.

Lou Shuman (LS): Tell us about your background and experience.

The Urbanek TMJ Device is designed to relieve the inflammation that causes temporomandibular disorder, and the results have been promising.