Noah Levine

	When I recently came across a graphic clearly illustrating the rapid pace of computer technology’s twin progressions of increasing power and decreasing size, it sparked an image in my head of where all this could lead and ways the even more powerful and compact computers of the not-too-distant future computers might be put to use.

	This striking graphic simply placed the technical specs of the still almost brand new iPhone 4 side by side with the specs for the once state-of-the art iMac Bondi desktop computer from just 10 years back. In just about every category the pocket-sized iPhone blows away its desktop ancestor, with screen resolution the only stat category where the iMac can claim victory, and even with its huge advantage in terms of screen real estate, its resolution win is by a fairly slim margin.

	On the other hand, the iPhone boasts twice the processing power, four times the RAM and even more room for storing data. All of this is packed into a solid machine that easily fits into a pocket, and although some people might forget, can also be used to make phone calls. Oh yeah, it’s also available at about half the price as that iMac of yesteryear.

	What a long way computers have come in this century’s first decade.

	It’s an impressive display of computer power that the latest iPhone can boast of, but of course desktop and laptop computers of today are far more powerful than their smartphone kin. However, think back to computing just a few years back. That old iMac may look dated, but it could do amazing things back then and truth be told is still powerful enough for many computing tasks.

	Sure it’s fired up descendents can accomplish far more in less time, but those desk space monopolizing machines may not represent the future of mainstream, and even business computing. Whether it’s Apple’s flagship device, its Android competition or any of the other pocket-sized computing systems currently available, the populace clearly wants the mobile access to information and entertainment available via smartphone technology.

	Having a computer in your pocket with access to the entire Internet from almost anywhere is an incredibly convenient and powerful thing. Personal computers really took off alongside the growth of the Internet, and now everything they used to be counted on to do can be accomplished with a system that is easily held in one hand.

	Smartphones are now spawning slightly larger, but still conveniently portable relatives in the form of tablets such as the iPad and its growing number of competitors. These machines provide all of the power the smartphones offer but with a larger screen to play on. For many the added landscape makes them far more useful for business purposes, but that’s not to say smartphones will give way to tablets as computing’s future. If the computing power within smartphones can be connected to larger screens and other input and navigation devices it will create a once unbelievable combination of system power, portability and convenience.

	At Apple’s latest press event (and yes I know many people are tired of hearing about things from Apple and really dislike the company, but it’s impossible to overlook the company’s trendsetting ways in the computer landscape) the company announced the next generation of its desktop operating system. Rather than expand on the desktop systems people have been using for the last few decades, this new system will actually be incorporating elements from the operating system Apple developed for their smartphones and tablets. That says a lot about what the company thinks will be the future center of the computing world.

	The touchscreen navigation and app-based approach to accessing and working with information and content that are at the heart of mobile, smartphone computing are going to be integrated into the desktop and laptop environment. No, computer users will not be touching the screens of those machines, but rather they will be using touch-enabled mice and trackpads and multi-touch gestures to interact with their machines.

	The larger size of desktop and laptop systems enables them to be far more powerful than a smartphone, but a majority of computer users do not come anywhere close to pushing the limits of their state-of-the art computers with the tasks they put them to. Those machines have power to spare, and if the path illustrated by the previously mentioned graphic continues to be followed, it won’t be too long before some of that surplus computing power is even available in pocket-sized devices that may or may not continue to double as phones.

	With all this in hand, it’s not hard to imagine that we are only a handful of years away from a world where our main computers fit in our pockets and go everywhere we go. These devices could have the processing prowess of today’s desktops, plenty of on-board room for data and with cloud-based services easily accessible, virtually limitless (and constantly backed up) data storage.

	The computer you use to manage your business could be on hand at all times, and while working on a pocket-sized screen is less than ideal, it would be very simple to allow these systems to connect to larger screens, wireless keyboards, and because they are likely natively touchscreen in design, larger trackpads. This could mean one computer that manages business data, handles CAD/CAM design duties and provides limitless entertainment could be on hand at all times. Running a lab from anywhere would not only be possible, but possibly the norm.

	Powerful, portable, versatile, connectable and always ready, the future of computing may seem small, but at least to me, it seems very attractive.

Articles

 When I recently came across a graphic clearly illustrating the rapid pace of computer technology’s twin progressions of increasing power and decreasing size, it sparked an image in my head of where all this could lead and ways the even more powerful and compact computers of the not-too-distant future computers might be put to use.

Tech Smart: One device to run them all

Designed for use in full-contour situations, highly translucent Prettau® Zirconia can be used in conjunction with a specialized coloring system to create esthetic, implant-supported bridges.

The material is kind to opposing dentition and while its flexural strength is less than that of some other zirconias, when used in full-contour bridge cases it provides a stronger restoration when compared to a traditional bridge framework that must be covered with a veneering porcelain. Instead, Prettau® zirconia is designed and milled in full anatomical contour, and then prior to sintering, special Prettau® Liquids are applied with a technique similar to layering ceramic to add color and shade effects.

The color liquids are individually painted on the restoration using a small, metal-free brush. This step is similar to coloring a restoration before glaze firing. Final color intensity is defined by the number of brush strokes applied. While this technique does require a bit of practice, it makes the restorations highly customizable as the end result depends entirely on the way the brush is worked.

When the technique is mastered, it is possible to create highly esthetic full-contour, implant-retained bridges with optimal physical properties.

 Beginning with a model made from the impression with the four screw-retained abutments in place, a wax mock-up is created and tooth position is checked against the abutments 

 The gingiva is modeled precisely in wax with all denture teeth in place. If the final prosthesis is going to be copymilled, this full-arch model is then duplicated to create a silicone impression of the mock-up and this is processed for copymilling 

. If the case is going to be scanned and milled, the final wax-up is scanned.

 The full-arch restoration is then milled from a solid block of Prettau Zirconia. Note: for full-arch bridges, it must remain connected to the base until sintered 

 The milled restoration is given detailed shape with burs, stones and diamond rubbers to provide accurate anatomy

 A water-cooled handpiece is then used to slightly reinforce fissures 

, and a bur is used to reduce buccal surfaces if ceramic veneering is to be applied. The bur also is used to grind the connectors thinner without separating the restoration from the block 

 A non-metallic brush is used to apply Prettau Colour Liquids for shading the teeth, and violet color liquid is used to shade the gingiva 

 The connectors are thoroughly soaked and then the entire restoration is dried for at least 1 hour under an infrared drying lamp 

 The restoration is placed under the firing porter and sintered until it reaches approximately 30ºC (86ºF). It is now ready to be disconnected from the base 

 The bridge is now checked against the model and adjusted as necessary to fit before being cleaned with a sandblaster 

 An opaque layer of the ceramic dentin and tissue staining is applied and the restoration is wash-baked at 920ºC (1688°F) for 2 minutes

 The dentin layer is applied and baked for 2 minutes at 820ºC (1,508°F). Then the first gingiva layer is applied and baked for 2 minutes at 815ºC (1,499°F) 

 Stains are applied and the restoration is baked again for 1 minute at 700ºC (1,292ºF) 

 Glaze powder is applied and the restoration is given a final 1 minute firing at 780-800ºC (1,436ºF – 1,472ºF) 

 The final restoration ready for seating as seen from the palatal, buccal and full-arch views. 

One-piece wonder

	Whether talking about cell phones where something new and improved comes along every other day or cars where the next model comes out next year, the state-of-the-art in any category only remains so until something better comes along.

	The concept holds true in dental labs as well, as material options change, fabrication techniques advance and new solutions are discovered. If something was ideal in all cases it might never change, but even something as time-tested as the standard denture can be improved upon. As Preat Corp. founder and CEO Tom Bormes succinctly explained things, “If dentures worked we wouldn’t have implants.”

	Implants of course are nothing new, but the technology behind the implants themselves and the type of restorations they can support continues to improve, bringing more predictable treatments and improved outcomes to a growing number of patients.

	This is especially true for edentulous patients or those with failing teeth, because the ability to create reliable implant-retained overdentures provides them with a new esthetic set of teeth, and probably more importantly, the ability for those teeth to function at a high level. Bormes said this allows patients to eat better, improves their confidence and their appearance, changing “the entire quality of their life.”

	“There’s nothing like natural dentition, but once you have implants and secure a denture on top of those implants with a structure, such as a Compartis® ISUS bar, you’ve got the patient back to almost full function,” added Kristi Gregory, CDT, and technical specialist for DENTSPLY Prosthetics who oversees the Company’s Compartis® ISUS services.

	Greater predictability and more precise design and fabrication of every aspect of an implant-supported overdenture is bringing down the costs for what is still an expensive procedure for many patients. However, demand for these restorations continues to grow because the outcomes really change patients’ lives, said Chuck Genco, CDT. As General Manager of Van Hook Dental Studio in Tempe, Ariz., Genco specializes in cases where the implants are immediately loaded with a long term provisional, and is trained to be a part of the surgery so he can place the dentures at the appointment when the implants are placed. This is something he said he finds extremely rewarding.

	“It’s a phenomenal success for the patient,” he said. “When you talk to the cosmetic doctors, everybody will tell you that the greatest patient satisfaction is not in the final. It’s in the provisionals because that’s where all the changes occur.”

	Genco said his lab has seen an increase in immediate load implant-supported cases. While these dentures are a great option for many edentulous patients, the demand is even higher among patients with failing dentition because they now have an option to have their new teeth the same day their bad teeth are removed.

	At Collis Prosthodontic Laboratory in Rolling Meadows, Ill., there’s a department dedicated to just producing restorations for all-on-four implant cases, and owner Jim Collis, CDT, said business in this department has steadily increased during the past two years. He attributes this growth to increased patient awareness of their implant options thanks to advertising from dental chains such as ClearChoice and Implant Solutions and the easily accessible health care information on the Internet.

	“They’re advertising on TV, that’s bringing to the public information that they’ve never had before,” Collis said. “And because it’s more in the public eye, they can log onto the Internet and everything is at their fingertips now.”

	Amos Harting, CDT, owner of Harting Dental Arts Lab in St. Louis agreed that this is an area of growth labs can tap into. He said the CAD/CAM technology such as the NobelProcera system from Nobel Biocare his lab has used for more than 7 years to create restorations built on milled bars makes it easier than ever to offer patients a fixed prosthetic option, and when given the choice between traditional removables and fixed, patients are choosing fixed.

	This increasing demand is likely to gain momentum as the economy recovers from the recession that has hit dentists and labs hard during the past several years. Gregory said DENTSPLY is predicting a 15% to 18% growth in the market for milled implant bars this year, with the majority of them being for fixed cases.

	“It is a fast growing segment and a value added segment that labs can take advantage of as CAD/CAM technology advances,” she said.

	The growing demand for implant-retained overdentures is opening up new opportunities for dental labs to work with oral surgeons. Genco said some of his largest accounts are now oral surgeons who come to him for much more than just surgical guide fabrication.

	By becoming a part of the surgical procedure to deliver and place the immediate-load prosthesis, Genco said his lab has found a new pool of dentists to bring him cases. His lab is a part of the team restoring dentists get when they want to work with one of Genco’s surgical accounts. The surgeons are proving to be reliable accounts and as an added bonus they help bring the lab’s work to new general practitioners.

	“It’s been a great match for us because the surgeon tells the restorative doctor, ‘I do this procedure and I like to use this laboratory,’” Genco said. “On most cases we go in as a partner to the surgeon, rather than as a partner to the restorative doctor unless it was a doctor I was already working with.”

	Being trained to participate in surgical procedures may not be the best route for every denture technician looking to add immediate load denture cases to their product list. Genco said it requires training, time for the technician to be out of the lab as well as the investment in a mobile lab and an inventory of everything that might be needed during the surgery.

	Of course that isn’t a necessary investment for every lab looking to offer implant-retained overdentures. With a range of outsourcing services available, labs of any size and any specialization can find a partner to work with to get started right away. Preat’s President Chris Bormes said any lab can use a service such as his company’s Precision Implant Suprastructure Design and Milling Center and can be up and running without having to learn new skills or even add any software or hardware.

	Preat’s service requires the lab to send in an analogue model or cast with soft tissue, a verification jig and a wax set up, and they get back a complete design for a milled bar and restoration via e-mail. The design can be viewed in 3D, shared with the doctor and is only fabricated upon approval. Working with an outsource provider in this way gives labs access to both production capacity and knowledge of the nuances of these restorations.

	“The more that you outsource, the shorter the learning curve becomes. You’re benefitting from the additional expertise and experience of the design team. This can be invaluable when designing an implant supported or retained prosthesis,” Tom Bormes added.

	Gregory said working with DENTSPLY on these cases is also simple and rewarding. By providing the anatomical details and basic design of the case, a lab can have an ISUS bar produced in around 9 to 10 business days. The service includes a warranty to guarantee the bar will fit to the model, and she often consults with clients to go over the details of the case and the bar design prior to milling. The system is designed to make it easy for a removables or a crown and bridge lab to get into the business.

	“That’s the beauty of Compartis® ISUS. It’s a simple, hands-free process, start to finish,” she said. “You can pretty much just send us the model and we make it pain free.”

	Technological advancements are simplifying every aspect of implant-retained restoration design, production and placement. Through digital case design that includes both computer-driven surgical plans based on cone beam scans and CAD/CAM production of surgical guides and the dentures themselves, Tom Bormes said greater, patient-specific precision can be achieved.

	The digital components of this process have changed the way Collis approaches these cases, and he likes that they increase success, which means fewer expensive remakes. He insists the doctors he works with use guided surgery for the implant placement, and because he is able to convince them of this greater chance for success, few balk at this requirement.

	“I tell them exactly what we need to do to make this case successful on my end and I tell them why they need to give me these things, and most of the time they agree,” he said.

	Genco said the predictability of working with digital case planning software and CAD/CAM production allow his lab to charge a flat fee for his immediate load cases. With cone beam data used to plan implant placement and milled components used in the dentures, he has few cases that fail, and thus is confident the fee he charges will be profitable for the lab. Having a set lab fee also helps dentists price the procedure to make it attractive to patients.

	“I think by having predictable fees the doctors are more confident going in to the procedure,” Genco said.

	That predictability continues over to Genco’s material of choice for his substructures. He prefers a milled titanium bar for support because they are proving to be reliable over the long expected life of these restorations and provide this support without adding unnecessary weight to the restoration.

	Not only are these bars stronger and lighter, but because of the precision possible through digital designs and computer-driven milling, they are more accurate, Chris Bormes added. Designing and fabricating these bars is easier, especially when it comes to critical details such as placing the bar beneath the denture teeth for support and properly locating attachments. Also, the costs to produce them are less volatile when compared with what it takes to cast an implant bar.

	“Milling produces accurate, tension free, one-piece bars that just drop into place,” he said. “When you compare the cost of gold, implant components, and labor needed for casting a bar, milling provides a more economical, simpler, and better final product for the lab.”

	That cost savings is one of the reasons Harting likes using NobelProcera bars. It takes far less time for his lab to design a bar and send it off for production than it would to design and cast the bar, but the real cost savings come from the materials.

	When casting a bar for an implant-retained overdenture, castable abutments need to be purchased. Harting said the cost of a milled bar isn’t much more than just the cost of the four abutments needed for an all-on-four restoration, but casting the bar also includes cost of the metal being used, and with high alloy prices, that cost can be significant. Some labs might be making money doing these cases with cast bars, but Harting said they could be making even more money if they were using milled.

	“Just in materials alone, you’re saving money, that’s without any labor being involved,” he said. “That’s good business. That’s smart business.”

	Then of course there are those times when the casting process doesn’t work out. The abutments in the cast are often a victim of the mishap. Gregory said labs can save themselves the hassle of the sensitive casting process by choosing an outsourced milled bar service. This process means labs have predictable expenses for implant-retained cases, need to carry less on-hand inventory for casting bars, and most importantly, receive a more accurate appliance that provides a truly passive fit.

	“It’s difficult to get an accurate fit the first time with casting,” she said. “With milled bar options, the CAD software provides precision in design.”

	But long before a technician should be learning about what type of bar will provide the best results in specific situations, it is critical to understand the principles of designing dentures for these cases. Collis said continuing education in this area is a never ending process, and one that should be started long before the first case.

	The two main areas of knowledge a technician needs to complete an implant-retained overdenture are case design and how implants work. Learning the later is simple, but when it comes to case design there are many details for a technician to understand to create a restoration that will work for the case at hand.

	“Case design is a big thing. You need to know the dynamics behind the curtain. How is this case going to function in the mouth,” he said.

	Gregory added that there are too many implant options out there for a technician to be an expert on all of them. However, with systems like Compartis® ISUS, compatible with over 250 implant systems, the manufacturer assumes the responsibility of interacting with the platforms, making it possible for a technician to be comfortable working with just about any system.

	Another key to learn before tackling an implant-retained overdenture is the critical details the lab will need from the dentist. Tom Bormes said it is important to know not just what information is needed, but why it’s needed so the technician can explain this to the dentist when necessary.

	That communication and teamwork between the lab, the restoring dentist and the surgeon is critical to the success of these cases. Chris Bormes said having the case start at the removable lab with a diagnostic waxup prior to surgery can help get the process started and provide a guide to keep everyone involved on the same page.

	When implants are involved in the case, work at the lab can start months ahead of time, Collis said. He likes for his dentists to send him a PowerPoint featuring specific patient images and information so everyone can review the same documentation while planning the case.

	In many cases, the patient will transition from a traditional denture, to a provisional on the implants to the final restoration, and a lot can go wrong as the case transitions from one phase to the next if everyone involved isn’t on the same page along the way.

	“We all need to know what’s going on with this case from the very start. From the very start there’s an awful lot of communication,” Collis said.

	Harting values this communication because it gives everyone confidence in the outcome of the case, and Gregory said working as a part of the team, planning the case design from the beginning, puts the lab technician in an important position for success of the restoration and overall patient satisfaction.

	“It gives the entire team an opportunity to visualize the case and plan the restorative with the end in mind,” she said. “With better planning, laboratories aren’t just dealing with what they are given, but are now true partners in the restorative scheme.”

	Being a part of this communication is important to the success of these cases, but it also can be important to the future of dental technicians. Tom Bormes said lab technicians have the knowledge and skills to serve as valuable members of the dental team, and these communication and teamwork intensive implant-retained cases are a great way for a technician to show how important they can be to successful outcomes.

	“It’s an exciting time to be a dental technician. The dental technician’s knowledge and skills are an invaluable resource to the restorative team when fabricating removable prosthetics,” Chris Bormes added.

	That value can be especially apparent when working on an implant-retained overdenture case with a dentist who mostly does crown and bridge work. Because those clinicians are not used to working on designing smiles for edentulous patients, Genco said they rely even more heavily on the skills and advice of their technician.

	In fact when the restoring dentist will not be involved in the implant placement and not as experienced designing restorations for these types of cases, Genco said the technician and the surgeon are really driving the case.

	“The surgeon’s role is key and the laboratory’s role is key. The restorative doctor, their biggest role is working with the patients,” he said. “The restorative doctors rely heavily on every word that we say.”

	Collis said he experiences a similar sense that his role in these cases has been elevated. Still, that role is just as an advisor to provide input based on expertise in the nuances of these cases. The final decisions must always be left to the dentist, but the best outcomes are achieved when everyone involved is working together, and this is actually a big step up from the traditional dentist, lab technician hierarchy.

	“We decide together what type of restoration is best for this patient. More and more doctors are coming to the laboratory for advice,” Collis said. “We are no longer dental technologists. What we are or what we’re becoming are oral designers.”

 Whether talking about cell phones where something new and improved comes along every other day or cars where the next model comes out next year, the state-of-the-art in any category only remains so until something better comes along.

The force of fixed removables

	3D Systems recently introduced its new ProJet™ 6000 “crossover” 3D printer that combines SLA® part performance with 3D printer utility. The ProJet™ 6000 delivers production quantities of exceptionally detailed and accurate dental working models printed with VisiJet® e-Stone™, a new print material developed specifically to produce dental models. The material is available in a high contrast peach color to illustrate stunning dental anatomy. The printer and material are compatible with all “open system” intraoral and impression scanning solutions and produce accurate, durable models of individual teeth and arches with crisp, highly detailed resolution. 

 3D Systems recently introduced its new ProJet™ 6000 “crossover” 3D printer that combines SLA® part performance with 3D printer utility. The ProJet™ 6000 delivers production quantities of exceptionally detailed and accurate dental working models printed with VisiJet® e-Stone™, a new print material developed specifically to produce dental models. The material is available in a high contrast peach color to illustrate stunning dental anatomy.

Models of 3D printing success

Recommendations from friends are still a big part of how patients find a new dentist, but in a time when the whole world is much more closely connected through the Internet those “recommendations” and “friends” are available from a much wider array of sources, all of which are easily searchable.

Gone are the days when people would flip through a massive phone book to finds the pages of ads from dentists in their area. Those books still exist, but these days prospective patients are far more likely to conduct their search via a computer at home or at work, or even from the rapidly growing number of Internet-enabled cell phones.

They might start the search with the name of a specific dentist they heard about from a friend, or they might simply be searching for a dentist in a specific city, but either way they are likely to start at an Internet search engine such as Google, Yahoo or the newest to launch, Bing.

In the not too distant past, the results of such Web searches might turn up a practice’s Web site, or possibly a listing for the practice at an online “phone book” type site that lists contact information for different business categories. However, these days the search results are likely to include the practice Web site along with additional online outlets for the practice.

These can include practice controlled social media profiles on a site such as Facebook, a practice’s micro-blogging presence on a site such as Twitter, or content the practice does not control such as user reviews on a site such as Yelp!. Practices can either test the waters, or dive head first into the world of social media, depending on their comfort level and if they feel it’s a fit for their practice. But even those who are not yet up to setting up a blog should at least be up to date on what current and former patients are saying about them on the Web.

“Searches for a dentist that include the term ‘review’ are being conducted nearly as frequently as just the name and location of the dentist, so these review sites are clearly a force to be reckoned with,” said Daniel A. Bobrow, MBA, president of American Dental Marketing.

“These alerts, while not perfect, are a convenient way to keep up to date on what is being posted…”

Bobrow recommends that his clients set up Google Alerts, a free service that sends them an e-mail whenever keywords such as the practice’s or the doctor’s name appears in news articles or recently posted online reviews. “These alerts, while not perfect, are a convenient way to keep up to date on what is being posted, which is especially important if a patient posts a negative review,” he said.

Most review sites will not remove negative reviews, but they will allow the business to post a response. Bobrow recommends reaching out to the patient who posted the negative comments to address the concerns, and then posting the results of those efforts to accommodate the patient.

Rita Zamora, a consultant who blogs about relationship-focused dental marketing at dentalrelationshipmarketing.com agrees that dentists need to be actively policing their online reputation. Part of that is responding to negative comments, but another part of that effort can involve creating a more robust Web presence so positive information outranks a negative review when someone searches for your practice.

“When you’re actively participating in social marketing on the Web and have a lot of positive information out there, it will help to drown out some of those hopefully very sparse negative comments that exist out there,” she said.

The fastest way to spread a lot of positive information online is to create practice profiles on the social media networks. However, practices will only see the full benefit of those networks if they are putting in the time to actively participate in the online communities, Zamora said. Because of this, social media marketing will not be for everyone.

For those practices that are comfortable online and willing to dedicate the minimum of an hour or so a week to social media efforts, Zamora believes these efforts can pay off by creating stronger bonds with existing patients and showing an inviting presence to new patients. A practice can use a Facebook profile to post updates and specials that only fans of the profile can receive, and the page can also be used to show off small bits about the personalities of the practice’s staff.

“I think one of the most challenging situations that’s going to come up for dentists using Facebook is that there is a fine line between being too salesy and really socializing in a community,” she said. “They do want to have that traditional type of information available, but when they’re researching who is going to be the best dentist for them, they want to see a little bit about your personality and how it’s going to feel to interact with and relate to you when they come into your office.”

Maintaining a profile on Facebook gives a practice the opportunity to interact with patients on a number of levels. Engaged patients might be more likely to post a nice online thank you after an appointment, and Bobrow said dentists should be active in asking new patients to post a review about their positive experience. However, Zamora cautions about soliciting positive reviews, as she believes savvy Web users will be able to tell if a review is not genuine. Both agree that the best approach is to be sure search engine results feature far more positive than negative reviews.

While Facebook and similar sites can provide a terrific place for patients to get a sense of both the practice and the people behind the practice, micro-blogging site Twitter can provide practices with an easy way to provide current and prospective patients with practice-related news and announcements. The site lets practices post short notes that other users who’ve signed up to follow that practice’s Twitter feed can view online or receive as text messages on their phone.

A Twitter account can be useful to dentists who want to follow the latest news from media users such as Dental Products Report, or by following the feed from a manufacturer using Twitter, a practice can stay up to date on the most recent information on products and services. However, the site can also be very useful in helping a practice grow its online presence.

“It’s just a different avenue of marketing. It’s nice to be on it because if somebody happens to be reading a post we put on it, they can communicate with us right there on Twitter,” said Melinda Baugh, office manager at Brazos Family Dentistry in Waco, Texas. “We want to have an online presence where people can find us, and just having a Web site sometimes doesn’t get you there.”

Baugh said her practice started using Twitter as a promotional tool in March and the practice’s feed (twitter.com/WacoDentist) quickly amassed more than 400 followers. She manages the practice’s posts and includes everything from specials for their patients to links to interesting dental news stories.

Thus far Baugh has used the site to communicate with people from around the world, and thinks it is a useful tool for connecting with a range of people. Still the focus of her efforts will remain on providing information for people in her community because, “local followers equal potential patients,” she said.

Keeping up with the Twitter feed and the practice’s recently created Facebook page does take a bit of time, but Baugh said it really only adds up to 15 to 30 minutes a day. A self-described, “computer person” Baugh said it is not difficult to stay current and keeping the practice feed populated with fresh posts, but she does occasionally make her posts from home after the workday is over.

It is that genuine interaction and the dedication to making sure the practice is active with their social media efforts that are going be beneficial to the practice, Zamora said. While being on the sites everyday is not necessarily a requirement, she said spending about an hour a week to manage a practice’s social media presence is probably a good idea.

Bobrow and Zamora both agree that any practice jumping into social media to expand its online presence should have one staff member as the point person for the efforts. It doesn’t need to be the doctor, but should be someone who understands how to use the systems and has the good sense to keep things on a professional level.

Baugh ended up handling it for her practice because of her role managing the office and her comfort with computers. If a practice does not have someone comfortable with personal interaction via the Internet, social media marketing may not be a good fit, Zamora said. While every practice should stay aware of reviews-both positive and negative-efforts to expand a practice’s visibility through social networking should only be undertaken by those who can be dedicated to the efforts.

“Social media amplifies a dentist and a practice’s patient relation skills,” Zamora said. “Someone who has natural people skills may find social media marketing much more enjoyable and a lot easier than someone who doesn’t really appreciate the nuances of networking.”

Noah Levine is a senior editor for DPR. Contact him at nlevine@advanstar.com.

Do you Google yourself?

	Getting the most from your computer is about more than just having a super-charged machine to run the latest software at blazing speeds. Efficiencies come from knowing all the ins, outs, and shortcuts to the systems you use and finding the best way to issue commands for them to execute.

	The keyboard and the mouse are the most common tools we use to boss around our computers, but there are other ways for us to interface with our machines. Touchpads are now the standard for laptops as multi-touch controls are the cutting edge for smartphones. Wacom’s Bamboo Pen & Touch tablet brings the benefits of those technologies to the desktop, providing a new way of interacting with your PC or Mac.

	Simply put, the Bamboo is a peripheral navigation and input device that connects via USB and accepts both pen and multi-touch finger commands. Its 10” by 7” footprint is by no means small, but most of the real estate is active input area making it easy to command an entire widescreen display.

	Four assignable buttons sit alongside the active area, with a thin strip of light in the middle. The light glows brighter when a finger makes contact with the pad and shifts to orange when the pen is engaged. It’s a nice but almost unneeded visual cue, because once the controls are second nature, there’s no need to look down from the screen.

	At first touch, the various finger commands can seem a bit confusing, but they quickly grow familiar. Once mastered they can handle all of a mouse’s chores and then some. Clicking and dragging items is simple, and scrolling, panning, zooming, and rotating with one hand and no buttons is just as easy.

	A single finger touch moves the cursor, and tapping anywhere on the pad acts just like a mouse click. With two fingers in action more advanced commands come into play, speeding up routine tasks and providing more in-depth control of what’s on-screen.

	Multi-touch makes for fast navigation and powerful control, but picking up the Bamboo’s pen opens entirely new realms of computer/user interaction.

	Lightweight and comfortable to grip, the pen requires no batteries and features a pair of programmable buttons. When hovered about ¼-inch above the tablet it becomes active and is mapped to the screen for controlling the cursor. Its position over the pad is mirrored on-screen by the cursor. This makes navigating a large screen incredibly fast and eliminates the possibility of hitting the edge of the desk or mousepad.

	Tapping the pen makes mouse clicks, and with the buttons in use, all the finger controls can be accomplished with the pen. As the name implies, the pen allows on-screen writing and drawing, and an “eraser” on the back works in many programs to wipe out mistakes. Highly sensitive to small movements, the pen is all about precision control. With the latest versions of both Windows and Mac operating systems providing native support for handwriting recognition, the pen also can be used to jot notes on-screen or annotate documents.

	With just the USB cable plugged in and the software driver installed, the Bamboo is ready to make using any computer a truly hands-on experience, but the real power of the device comes in the myriad ways it can be customized. The device’s sensitivity and pen-to-screen mapping can be adjusted in numerous ways including for multi-screen use.

	The always-handy buttons give the tablet a major boost in functionality as each can be assigned to do just about any task the computer can handle with one click. Setting them to handle common tasks makes the things you do all the time as convenient as possible. As a user who bounces between software applications and likes to take content with me as I go, I have a button to toggle between applications and another to copy anything I select.

	Abandoning the controls I’ve been comfortable with for decades was not an easy decision, but after playing with the Bamboo for a while, a standard mouse just didn’t stand a chance. When it comes to controlling my computer, I can now have everything at the tips of my fingers.

 Getting the most from your computer is about more than just having a super-charged machine to run the latest software at blazing speeds. Efficiencies come from knowing all the ins, outs, and shortcuts to the systems you use and finding the best way to issue commands for them to execute.

Tech Smart: Let your fingers do the walking

	Keeping your feet on the ground and your head out of the clouds has long been sound business and general advice. However, these days there seems to be endless talk of the numerous benefits of sending things to the clouds.

	Cloud computing is a term with a lot of buzz right now, and while it’s not a brand new concept, there is certainly no shortage of companies creating and marketing their cloud services. Whether for work or play, there is a lot of promise in these services, but getting the most out of the clouds requires understanding how cloud computing really works, and both the advantages and drawbacks it brings.

	Put simply, a cloud is a remote, Internet-connected data storage system. Using a cloud means your data gets uploaded to the remote “cloud” servers from which you are able to access the information from anywhere you can connect to the Web via either an application or a simple Web browser.

	In a way, the entire Internet is a massive cloud, but it’s the smaller, more focused cloud entities that are making headway in the current computing climate. The spread of high-speed Internet connections, faster computers and the ever-decreasing cost of data storage are combining to make the cloud concept accessible on a mass scale. With that in mind, companies large and small are offering individuals and businesses remote data storage with universal access with a wide range of specific applications for the files being sent to their clouds.

	At it’s heart, cloud computing is about data backup and redundancy. All cloud services provide a way to keep a copy of your data in a location other than where the computer generating the data lives. This offers a measure of protection from not only local hardware failure, but also from physical damage that could impact both a computer and the external drive to which it’s routinely backed up. But when it comes to cloud computing, the storage of the data is almost a secondary benefit, because the real power of these systems is accessibility.

	On the entertainment side are the cloud media storage offerings from online giants Google, Amazon and Apple, all of which allow users to offload their personal music and digital media collections so every song or movie they own can be played from any device from which they can log into to access their cloud, which basically covers every computer and smartphone available.

	But the potential uses for a cloud go far beyond the power of having your entire music collection in your pocket. For a business, automatic remote back up of all data can be invaluable, and remote access to those back ups could provide the ability for a lab owner to answer an account’s emergency question, quickly and easily from anywhere.

	Data transfer is another powerful way to use a cloud service. Digital images can be huge files that clog e-mail inboxes if they even send at all. However, services such as 

 make it possible to upload massive files, or entire folders and then send someone a link to download it.

	Dropbox functions so seamlessly that it’s nothing more than a folder on your computer and anything you place in the folder is automatically uploaded. If you have multiple computers linked to the same Dropbox account those files are automatically available in the Dropbox folder on those computers, making interoffice file sharing simple, even if those offices are in different states. The service even allows folders to be shared between users with different accounts, so if a dentist also sets up a Dropbox you can have a private folder connecting your two computers for easy back and forth and simultaneous use of files of any size.

	Other cloud services reduce the reliance on local software, by providing Web access to the various applications normally used on a computer. Google Docs is that company’s suite of business applications that are accessible via the Internet to provide word processing, spreadsheets and other computer basics from anywhere and shared by multiple users. This type of service removes the need for local storage of both documents and the software to create and manage them. Working on remote documents makes it easy to share calendars, notes and other information.

	Cloud services can be extremely useful tools because most of them provide the advantage of universal access without requiring major changes in the way you already use your computer. These services work by making it easy to essentially store your files everywhere so you can access and interact with them from wherever you happen to be.

	There certainly are advantages to taking things to the cloud, but moving everything online does have some drawbacks as well. The biggest of these are the issues of trust and security. Moving your data to a cloud server means you are putting a lot of trust in the owner of that server. You are trusting that the business storing your data will manage its hardware to protect the integrity of your data and won’t simply disappear one day, taking all your files with it.

	Then there are the issues of data security. Pretty much every cloud service works with a password protection of some sort, but often a single login name and password is all that is needed to gain access to whatever is on that cloud. But creating, remembering and maintaining a secure password should be basic policy regardless of whether or not that password is protecting a single computer or a data cloud. However, there also is the matter of security during the transfer of the data.

	Working with cloud-based files means the data behind those files will be sent back and forth via the Internet more frequently than a locally stored file. Most of the services encrypt the data during transfer and some of them are even able to offer HIPAA compliant clouds, but knowing how your data is being transferred and how secure those transfers are grows in importance as the frequency of those transfers grow.

	With all these extra data transfers, cloud computing eats up a lot of bandwidth. This means for someone to really make the most of working in the cloud, they need to have a reliable Internet connection and broadband of some kind is a must. A smartphone’s 3G connection is good enough to access a cloud-based file once in a while, but a real pipe to the Web is a prerequisite to effectively getting those files up there in the first place.

	Cloud services are among the many Internet attractions requiring more bandwidth, and just as these services are finding their legs, many Internet service providers are adding caps to the amount of data their customers can use. The ISPs cite a number of reasons for this, with the most common being that they are trying to reduce congestion on their networks so everyone gets the speed they signed up for, but as you begin to send more data back and forth, it’s important to know if you have an Internet service plan with a data cap. As gaming consultant André Vrignaud discovered in his 

now well-publicized story of being cut off by Comcast

, running afoul of these limits when setting up a cloud service can have serious consequences.

	Cautions duly noted, cloud computing is here to stay and with the correct approach is ready for use today. The advantages of universal access and easier file sharing fit naturally into what dental labs do every day. Communication with a clinician can help avoid frustrations, and with the cloud in play, collaborating with outsource partners, dentists, surgeons and suppliers can be accomplished in a variety of simple ways.

 Keeping your feet on the ground and your head out of the clouds has long been sound business and general advice. However, these days there seems to be endless talk of the numerous benefits of sending things to the clouds.

Tech Smart: Clouds on the horizon

I can still remember the first time I came across a computer mouse when a childhood friend was showing me the brand new Apple Macintosh computer in the corner of his family’s kitchen.

Sure, I’d grown up in a house where there was always at least one machine, but our tan and brown Commodore 64 was text controlled, forcing me to quickly learn both rudimentary typing and the basic commands in order to use the computer on my own. So when I encountered that pixilated cursor and the new concept of pointing and clicking, I was completely blown away.

This marked a whole new way of interacting with a computer, a method so simple and straightforward that there was no new language to learn. All that was required to make that computer start a program or open a file was mastering the movement of the mouse in order to point it at what you want and a click to start the action.

Prior to the rise of the computer mouse computers were operated via text based interfaces that required the user and the computer to speak the same, often limited language. (Prior to that early computers were controlled via punchcards, which was an even more limited platform on which users and machines could interact.) But the mouse simplified things by shifting text to a secondary role and letting computer users take control via a Graphical User Interface (GUI, which is often pronounced as gooey).

The power of interacting with graphics is apparent from the first time a user comes across a computer. Folders containing files look like folders, the place for deleting files is a trashcan and applications, discs and other items can be represented by images of what they are. Finding things becomes easier than ever before, and navigating the computer can be taught in minutes.

The Macintosh marked the first commercial GUI, and personal computing has never looked back. Microsoft adapted this approach with its Windows operating system and quickly grew into a massive software powerhouse. The designs and capabilities of these interfaces have certainly advanced over the years with animated icons, better graphics and reimagined folder structures, but the GUI has withstood the test of time and probably will remain as the main way we communicate with our computing devices.

Beyond simplifying the commands required to control a computer, the GUI created opportunities for the development of a range of peripheral and integrated devices for navigating those graphical control landscapes. For more than 20 years the mouse remained the primary control device.

Computer mice could be found roaming the limited confines of mouse pads before lasers replaced the trackballs and the control devices were let loose on just about any flat surface. The number and placement of buttons changed, as did the size and shape of these devices, but for quite a while, the mouse was king of computer controls.

But that’s not to say other controller concepts haven’t made a run at the throne. Joysticks and jog-wheel equipped paddles were the preferred controllers for early video games. Whether for capturing handwritten notes or sketches, pen input and control schemes have also been around for quite a while.

The trackball was another concept that gained some traction in the industry. At first it was the way we controlled arcade games like Centipede and Crystal Castles, but trackballs have found use in a number of additional ways. At first they were basically inverted mice that didn’t have to be moved around the physical desktop to control a cursor within the virtual desktop. Then they became mobile controls with integration into some pre-smartphone cell phones such as the BlackBerry Pearl.

This concept was also evolved into the keyboard-embedded knobs found on some laptops. However, the knobs were never a popular controller scheme, and laptops quickly evolved around a touchpad for control of the cursor. The touchpads have grown in size and capability over the years with the addition of multi-touch commands. They’ve also led us to the current state-of-the-art in computer control, touchscreen.

While touchscreen controllers have been around for quite a while at gas station pumps, supermarket checkouts and other commerce kiosks, they were truly ushered into the world of popular computing devices with the 2007 introduction of Apple’s iPhone.

This shift in control technology seemed subtle at the time, but it actually required a major overhaul of how the operating system would be designed. Once optimized for touch, computer operating systems become even more intuitive to use and training is almost an afterthought.

Just touch what you want it to do and it does it. If you’ve never seen a baby with an iPhone, look for a video on YouTube, it’s amazing how quickly they understand how to make this strange device do something. It’s an immersive control set up that makes the user a part of the device he or she is using and it fits well with other innovations in computer control such as haptics which allow touch controls to provide physical feedback based on the commands given and motion control which uses cameras to capture the user’s movements to allow touchscreen like control simplicity without any actual touching taking place.

What started with smartphones just four years ago is now firmly established in the design of tablet computers and many newer PCs. The mouse will not disappear overnight, but touchable design aspects are being integrated into the latest versions of both Microsoft’s Windows and Apple’s OS X.

Both operating systems have borrowed aspects from their mobile OS cousins to make desktop computing the same type of immersive and intuitive experience. It’s an example of hardware innovation driving software design and it’s likely going to stay a trend in how computers continue to evolve. Drawing on a computer and fingerpainting are likely to be similar experiences going forward (although the former will remain the less messy of the two).

All this means computers will grow in their capabilities even as the learning curve for new users gets smaller. As touch becomes the mode of control, users no longer have to even bother learning the nuances of a mouse or another device. They just tap on what they want and there it is.

This concept is likely to be the next control paradigm, but it will probably quickly combine with the possibilities available via motion control systems. This could mean computers that are as easy to use as touchscreens, but without all the fingerprint smudges. Much like in the movie Minority Report, computer users may interact with projected graphics, shuffling them around in mid-air and tossing away the icons they no longer need.

The computer mouse may soon be a thing of the past, as trackpads take over for a brief transitional period until full-scale physical touch control moves into the majority and then quickly cedes way to virtual touch controls that offer the same level of interaction, without any of the actually touching.

Of course all the software design built to optimize touchable computers will need to be reimagined once technology allowing computers to be controlled via thought is perfected.

I can still remember the first time I came across a computer mouse when a childhood friend was showing me the brand new Apple Macintosh computer in the corner of his family’s kitchen. Sure, I’d grown up in a house where there was always at least one machine, but our tan and brown Commodore 64 was text controlled, forcing me to quickly learn both rudimentary typing and the basic commands in order to use the computer on my own. So when I encountered that pixilated cursor and the new concept of pointing and clicking, I was completely blown away.

Tech Smart: Input Adjustments

Some magicians have been known to amaze crowds with a trick where it appears they are catching bullets with their teeth. However, the tooth marks found on a 200-year-old musket ball on display at The Dr. Samuel D. Harris National Museum of Dentistry, on loan from Kathy Lee Erlandson, are more likely to have come from a wounded soldier than a showman from two centuries ago.

“Apparently there’s some credence to the ‘bite the bullet’ for pain kind of thing,” said Museum Curator Dr. Scott Swank.

The bullet on display at the museum was excavated from what is now the Northport section of Baltimore but is believed to have been a field hospital during the War of 1812. University of Maryland Dental School pathologist and  forensic odontologist Dr. Bernard Levy analyzed the musket ball and verified the impressions are from a human’s dentition.

This makes the musket ball a rare find because while many lead musket balls from the Civil War and prior conflicts have been found with teeth marks on them, Dr. Swank said the vast majority have been chewed on by feral hogs who rooted them from the ground. Spotting the difference between a bullet chewed by a hog and one a human chomped on to withstand a painful medical procedure takes some skill, but dental professionals are best equipped to notice.

“I’m not sure if an untrained eye would recognize them as tooth marks, but it’s definitely all chewed up,” Dr. swank said.

A well-scuffed bullet is a rare find, but it’s not the only item in the museum’s collection being showcased this year. Dr. swank said there will not be a special exhibit showing off all the items from 200 years ago, but the items from that area will be highlighted within their existing displays.

Just a handful of dental items have survived that long, and this is for several reasons, Dr. swank said. The biggest reason is that dentistry 200 years ago was very different than it is today. Only the very wealthy could afford anything that might resemble restorative treatment of today.

“A normal person was just having their teeth taken out when something broke or started hurting them, so the instruments that evolved around that time period are primarily geared toward extractions,” Dr. Swank said.

Those items in the museum’s collection include forceps, which have evolved in terms of anatomic and ergonomic design, but were basically the same tools 200 years ago as they are today. The other commonly used tool from that era was the extraction key, which Dr. Swank said is a little more difficult even for dental professionals to place without seeing an illustration showing how it was used.

“An extraction key, you’ve got to know what you’re looking at,” he said. “It just looks like a claw on the end of a steel bar with a handle. If you’ve never seen one before you’d think, ‘What is that?’”

Beyond the tools of extraction, a few sets of dentures from the era have also survived to become part of the museum collection. At that time most dentures were very expensive and either hand-carved or carefully swaged to fit a model.

The dental landscape of 200 years ago was far different than it is today, but to commemorate the 200

 anniversary of the War of 1812, and the significance the war played for its home of Baltimore, the Dental Museum is providing a peak at the surviving tools and relics from that era. For more information on the museum visit dentalmuseum.org.

Some magicians have been known to amaze crowds with a trick where it appears they are catching bullets with their teeth. However, the tooth marks found on a 200-year-old musket ball on display at The Dr. Samuel D. Harris National Museum of Dentistry, on loan from Kathy Lee Erlandson, are more likely to have come from a wounded soldier than a showman from two centuries ago. “Apparently there’s some credence to the ‘bite the bullet’ for pain kind of thing,” said Museum Curator Dr. Scott Swank.

Biting the bullet

	The search for a practice management software application that fits your practice’s needs can be a tricky endeavor. With a wide range of options ready to handle your scheduling, billing, patient records and more, it’s important to make the right choice because this will be the central hub for all of your practice’s information.

	While the task may seem daunting, the search is as much about your vision for your practice as it is about the software’s capabilities, said Laci Phillips, a practice management consultant with Banta Consulting Group. Phillips recently spoke with Dental Products Report to share some of the advice she provides practices seeking practice management software.
	
	

 What role is practice management software going to play in a practice being put together from square one?
	

 Other than the literal foundation of the practice, the practice management software is the foundation because that is going to basically run your practice. You make all of your appointments, you’re going to take all your patient information, insurance information, financials for your patients, all of your patients’ clinical information as well as running your reports to find out how your office is doing, by looking at the numbers and breaking everything down.
	
	

 The search for a practice management software application that fits your practice’s needs can be a tricky endeavor. With a wide range of options ready to handle your scheduling, billing, patient records and more, it’s important to make the right choice because this will be the central hub for all of your practice’s information.