Noah Levine

Once again my schedule in the Dental Lab Products newsroom prevented me from attending this year’s Consumer Electronics Show in Las Vegas, but like many followers of all things high tech I eagerly followed news breaking from the show’s expansive exhibit halls.

Coming just after New Years, CES is something of an annual weather vane for the technology sector. Most of the companies behind the smartphones, computers, TVs, cameras and other gadgets powering their lives are on hand to show off what they hope will be the next must-have device. Everything on display is trying to be noticed on its own merits, but when the show is looked at as one entity it provides a nice picture of what innovations and enhancements will take over the marketplace.

This year the show broke records for attendance and exhibitors, but bigger isn’t always better. In the past companies have used the show to launch new technologies such as 3D TVs, Android tablets and a range of gaming systems. Sometimes there’s even a singular item rather than a category that becomes the talk of the show. This year there was none.

Sure there were ranges of similar products to be found from companies big and small, and they can be lumped into neat little categories or given fancy new names. But just because they’re continuing to build (and rebuild) better, faster and stronger 3D TVs, tablet computers, laptops and smartphones, slapping a new name on them doesn’t change the fact that the newest generation of these devices are evolutionary steps rather than entirely new and exciting mutations.

Still a show this big had plenty to offer and technology fans still have plenty to get excited about. Devices of all sorts are going to be getting better, faster, stronger, more capable and more connected. The top-of-the-line gadgets on display interact like never before and bring more power, information and applications to bear in packages that get easier and easier to command. And, if there had to be a trend this year, it’s that they’re doing all of this in ever-slimmer packages.

If there was one buzzword surrounding this year’s event it was Ultrabook. Basically this is just the new term Intel trademarked for extra slim laptops. While the netbook craze of a few years ago presented the world with underpowered laptops in small packages, the latest laptop models are full-featured top-tier computers in paper-thin packaging.

Just about every computer manufacturer was in on the Ultrabook craze with thinner, lighter models that pack plenty of computing power and high quality screens. Of course, this form factor really isn’t all that new to the marketplace. Apple basically invented the Ultrabook category with the launch of the MacBook Air four years ago, so the gaggle of skinny laptops on display at CES were really the Windows based laptop makers playing a bit of catch up.

Laptops shedding inches and pounds follows the general trend of computing following Moore’s Law of things getting more power as they shrink in size. Processors, batteries, screens and hard drives are all at the point where they can be packaged in almost ethereal bodies. Lugging a heavy laptop around soon will be a thing of the past for most people who need to travel with a computer.

With both netbooks and tablets computing sacrifices are made. Netbooks sported small screens, underpowered processors and cramped keyboards. Tablets have no physical keyboard, and until the launch of Windows 8 later this year, they mostly run on scaled back mobile operating systems such as Android and iOS.

So while the Ultrabook invasion might not be groundbreaking, it’s certainly a welcome development in the computing world. There were even a few exciting innovations at the show such as Lenovo’s IdeaPad Yoga, which will be launched with Windows 8, a touchscreen and easy conversion from laptop to tablet via a custom hinge. It’s too big to be a tablet, but offers high quality laptop specs and could herald the merged future of these two form factors.
	
	

Laptops weren’t the only devices getting slim for the new year. TVs are really living up to the name flat panel, but it’s their other capabilities that are starting to make some headway. 3D sets were all the rage two years ago and while they haven’t made a huge commercial impact, glasses free screens continue to get better and ways to bring online content to the big screen are growing more abundant.

Whether it’s via the ever smaller Roku Streaming Stick, which is the size of a flash drive, or integrated connections, the Internet will be coming to TV screens of all sizes, and this will further blur the lines between broadcast, cable and streaming channels. This could mean more on demand viewing of all types of programming, if the networks creating the programming ever grasp that the public likes this model.

Controlling the TV is also getting easier, as more and more sets debuted with the ability for a smartphone or tablet to take the place of the remote control. A few sets were even designed to listen to voice commands. This could make looking for the remote control a thing of the past. Smartphone, tablet and voice command features also are coming to devices around the house and office. Technology on display showed off the ability to remotely control thermostats and other appliances. One standout appliance was Thermador’s Freedom, a full-surface cooktop that recognizes the shape of the pot and heats just the surface beneath the desired cooking vessel.

One technology area moving from commercial into consumer products that should be familiar to the dental lab industry is 3D design and production. MakerBot debuted is latest, the Replicator, a 3D printer for making plastic objects at home. It’s still a long way off, but 3D scanning and printing for the home is looking more likely than ever.

Of course even if there weren’t any game changing gadgets unveiled at CES 2012, that doesn’t mean this won’t be an exciting year for new technologies. Apple is always notably absent from the Las Vegas event, choosing to have the stage all to itself and debut its innovations at stand-alone events.

Other companies are following this model for the launch of flagship smartphones and tablets. Microsoft, of course, will launch the highly anticipated Windows 8, which is designed to be a single OS that bridges the gap between desktop PCs and the mobile world of tablets and smartphones.

The pace of technological development remains rapid and an event like CES is a great way to stop, take stock and then take a few minutes to let things sink in. The next big announcement is likely just a few days away.

Articles

Tech Smart: Lessons from CES 2012

	CAD/CAM production in a dental lab needs to be a round-trip operation. The patient-specific information required to produce a restoration can be easily digitized, but the designs based on that information need to be exported from the computer in a physical form, and for labs fully committed to a digital production model, investing in a stand-alone mill can be a great way to take complete control of the finalized physical production.

	Whether your lab is experienced in the scan and design sides of CAD/CAM and looking to bring the production in-house or completely new to the digital side of the industry but looking to remain self-sufficient, there are a wide range of mills currently available for milling different dental products. From tabletop-sized units to stand-alone systems, these open-architecture mills have a range of capabilities and can mill an array of materials, but the one thing they all bring to a lab is control.

	“If they bring their own milling system in, then they have full control of the products being released,” said Chuck Warren, CDT, who runs Tempus Dental Laboratory in Springville, Utah, is an advisor for 

 and produces restorations on the company’s Zenotec T1.

	Adding a mill allows a lab to reduce the time it takes to create a CAD/CAM restoration because nothing is being sent to an outsource partner, and in-house production can significantly reduce the cost per unit for the lab, said Steve Campbell, General Manager of 

. His company’s Origin line of mills range from a new tabletop-sized unit to the large scale Origin Pro Duo and are designed to provide a modular approach in terms of their capabilities.

	This approach allows a lab to invest in a mill that will handle the materials they currently work with and then add new material options when there’s demand from customers or the lab is ready to drive the demand through additional capabilities. This means a lab can start milling in wax, zirconia, lithium disilicate, and expand into in-house custom abutment milling, and soon implant bars. Campbell said a big advantage a lab gains by adopting an open mill such as the Origin line is the optimized use of material gained from milling discs rather than single-use blocks.

	“When considering a significant investment in a CAD/CAM system, astute lab owners calculate the production costs as well as the initial outlay,” he said. “In stark contrast to the blocks used in most of the existing desktop milling systems, the efficient disk utilization common to each of the Origin mills provides for some of the lowest expenses in the industry.”

	Similarly, Warren said the way the T1 works with discs of material is one of the features that sets that mill apart from the many other milling systems he’s used during his more than a decade milling dental restorations. He likes the way the T1 can have a range of discs loaded in a stack so it can be programmed to produce a range of restorations from different materials and then set to run all night or over the course of a weekend.

	The system is designed for easy loading of the materials, and Warren said this simple time savings adds up for his lab. While the T1 is strictly a dry mill so it won’t tackle titanium or lithium disilicate, which are both milled wet, he and his dentist clients are consistently impressed by what the 7-axis milling system can create from zirconia, PMMA, wax and a range of other materials. He keeps his mill loaded with an array of materials so it’s ready to go right away when his workflow calls for a new material to be milled.

	“The T1 is exceptionally more efficient than all of the other milling systems that I’ve had and been exposed to in the sense that you can stack discs in and do multiple millings at the same time,” Warren said. “There’s enough blanks in this thing, you can mill all weekend.”

	Both the Origin mills and Wieland’s milling solutions are open-architecture technologies, which means any CAD file that can be exported in STL format can be sent to the mill for production. Warren said the CAM software that controls his T1 is designed for both new and experienced users.

	It features presets for milling a range of restoration types from a range of materials. However, advanced users are able to customize those presets to maximize how material is used, speed up the milling process or do just about anything. The total control of the system even extends to when Warren isn’t in the lab, as the T1 can be controlled remotely so overnight or weekend milling runs can be monitored, and priorities can be changed via the Internet.

	As his lab grew more and more focused on CAD/CAM production, Warren said the workflow shifted to take advantage of the efficiencies available. Rather than wax up designs by hand, every case at his lab is computer designed, with the waxup milled on the T1. Even though he’s been using milling systems for years, Warren said he is constantly amazed at how the capabilities of both the software and the hardware continue to get easier to use while producing more accurate and better looking restorations.

	“It’s just a huge, huge time saver, and it doesn’t get tired,” he said. “It mills what I don’t think is capable of being milled.”
	Training on these systems is provided at the time of purchase and both Warren and Campbell said technicians familiar with CAD/CAM production can be confidently running their mill after just a few days of training. Campbell said it might be a few weeks for labs completely new to digital production, but the modular nature of the Origin systems allows a lab to take on one production change at a time, adding new features and options whenever ready for that next step.

	“A lab could start with dry milling of zirconia for both copings and full contour crowns. Then later they could add the wet metal milling module so that they could mill titanium copings and bridges and even full titanium abutments,” Campbell said. “The open architecture of the Origin CAD/CAM systems provides even more utilization, which helps to truly future proof a lab.”

	Knowing when a lab is ready to invest in a mill is important because while these systems bring major efficiencies and automate parts of the production process, they can represent a major investment for a lab. Campbell said labs with existing CAD/CAM business and large outsource expenses for production are good candidates for investing in a mill.
	However, this does not mean mills such as the Origin systems or Wieland’s Zenotec T1 are just designed for large labs. Warren’s lab isn’t a huge operation, but he firmly believes his lab’s digital production capabilities are what keep them successful and allow them to compete in an ever more global dental laboratory industry.

	“With a system like this one, you can compete worldwide,” he said. “The small lab, even up to the big lab is now all on a level playing field.”

	Campbell said small labs with a business model that focuses on digital production will find there is an Origin mill able to meet their needs. Origin mills are used in large labs, milling centers but also in 2-technician operations. Having an Origin mill with its modular design allows the labs to focus on one area of the business or expand to other areas when ready. Labs of any size with in-house milling capabilities are completely set up to take in work from other labs. In this way, a lab investing in a milling system could look at turning a monthly outsource bill into monthly revenue.

	Investing in a mill also is an investment in the lab as a business, Warren added. While technicians are valuable because of their knowledge and skills, those attributes aren’t easily passed on to new people, and this means the lab’s resale value is limited. However, a digital lab is something that can be sold and passed along to a new digital technician.

	“You can teach somebody much, much quicker to design and contour and color a full zirconia crown than you can teach somebody to layer one,” said Warren, who added that investing in CAD/CAM production has been a winning move for his lab, and working with the technology keeps him energized about what he does every day.

	“This is the best decision I’ve ever made in my entire dental career,” he said. “It’s exciting every time I sit down with it.”

 CAD/CAM production in a dental lab needs to be a round-trip operation. The patient-specific information required to produce a restoration can be easily digitized, but the designs based on that information need to be exported from the computer in a physical form, and for labs fully committed to a digital production model, investing in a stand-alone mill can be a great way to take complete control of the finalized physical production.

SCCAN: Carving a path to success

	Finding a product that purports to deliver a brighter, whiter smile is not in any way difficult. With whitening products on sale via late night television ads, Web sites and shopping mall kiosks, a dentist’s office or a pharmacy might be the last place consumers looking for whiter teeth begin their search.

	But with public safety in mind, the American Dental Association is hoping the U.S. Food and Drug Administration will enter this arena and enact some form of regulation on tooth whitening products. In November, based on a resolution from its House of Delegates and after receiving complaints from consumers and dental professionals, the ADA officially petitioned the FDA to take action.

	“The focus was primarily on some of the products that were being used in shopping malls and kiosks and were being advertised late night on television and on the Internet,” said Dr. Daniel Meyer, ADA Senior Vice President, Science/Professional Affairs. “Since these are unregulated products we don’t know what’s in those products. The position of the ADA is that any time you use these products, you should know what’s being put in your mouth. We were very concerned about the safety affects of these products.”

	While regulation can often be seen as a bad thing in the business world, this effort seems to be one that is being welcomed by both consumers of whitening products and manufacturers of dentist-administered products such as Discus Dental, maker of the Zoom! light and Dash in-office whitening system.

	“It’s our belief that tooth whitening materials should be administered by dentists. If left unregulated then what's next, do it yourself endo?” said Robert Cartagena, Chief Operating Officer for Discus Dental. “We are big supporters of the ADA’s push here. We think the ADA is being very responsible, and they’re being very proactive in ensuring that patient safety is being considered when these products are being used.”

	Cartagena said regulation would not impact legitimate manufacturers such as Discus who already comply with many FDA guidelines in their production and distribution. However, he believes federal oversight will help stem the flood of whitening-based credit card scams, as well as reign in the unsafe practices when whitening procedures are conducted in non-dental settings. In the end, that should be good for the business of companies making and selling legitimate whitening products and procedures.

	“These scams and these mall whiteners definitely have an affect on the patients that get duped into buying these products or enrolling in these systems. First, they don’t see the results that are expected and secondly, they end up getting a bad taste in their mouth about tooth whitening in general, and eventually become disinterested in the procedure,” he said. “I believe that there are a lot of consumers out there that are very interest in improving their smiles, but they end up buying one of these products on the Internet or get duped into having their teeth whitened in the middle of a shopping mall. After being disappointed they quite often believe that all teeth whitening products or procedures are the same. The simple fact is; they are not. There’s simply no comparison between these scams and the proven, effective and safe options offered by a dentist.”

	That’s a sentiment shared by Web developer Sasha Sienkiewicz who runs the Web site teethwhiteningreviews.com and has worked to expose companies selling fraudulent whitening systems. While his Web site tries to clear up some of the confusion present in the marketplace, he welcomes any FDA effort to make sure the public is not being fooled by potentially harmful products.

	“We currently have no way of knowing if whitening products being sold through the Internet and mobile kiosks are safe for the consumer,” Sienkiewicz said via e-mail. “I think the Internet is littered with ‘quick-buck’ businesses selling whitening products that have originated from China. If the FDA is willing to monitor Chinese produced toothpaste for ingredients like diethylene glycol (used in engine coolants), I think it is a good idea that the FDA takes some steps to regulate whitening products, even if it increases costs for the manufacturer and consumer.”

	The FDA has not yet officially responded to the ADA’s request, but Dr. Meyer said any potential regulation process would begin with a period of public comment. During that period the ADA would be sure to make sure the FDA understands that the efficacy and safety of whitening services can be impacted by a number of intraoral factors, making it important for consumers to receive some form of professional consultation prior to treatment.

	“The ADA does recommend that you consult with your dentist. Any time that you seek treatment you should know why you need the treatment,” he said.

	Cartagena agrees with that concept. There are many situations where whitening products can have a negative impact. Patients with composite fillings might whiten around the filling, making the restoration stand out against the surrounding teeth, or even more seriously, some whitening products can exacerbate serious oral health concerns.

	He thinks FDA regulation could have a huge impact on consumers in two ways. It would protect them from the plague of online whitening scams, and he hopes regulation also would force those providing whitening services outside of a dental setting to comply with infection control and other safety procedures.

	“We’re very interested in both buckets being addressed and the whitening being regulated by the FDA,” Cartagena said. “If this happens, then there won’t be any confusion in the marketplace and patient safety will be in the hands of the professionals that are trained to manage this.”

	While there is no strict timeframe for the FDA to act on new regulation requests, this one seems to enjoy widespread support.

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

 Finding a product that purports to deliver a brighter, whiter smile is not in any way difficult. With whitening products on sale via late night television ads, Web sites and shopping mall kiosks, a dentist’s office or a pharmacy might be the last place consumers looking for whiter teeth begin their search.

Federal whitening controls?

	It’s just a matter of time really. Eventually everything in your practice will come due for update or replacement. But, whether you’re a tech junkie who goes for the latest gadgets, or someone who prefers to stick with a trusted and well-used tool, the equipment and technology in your practice can still have a useful life after you have found its replacement.

	If you take care of the tools of craft and they are in good working order-whether they are relatively new or have been around a while-it is a good idea to pass them along so another member of your staff can continue to put them to use. Sometimes the item being handed down might be put to a slightly different use, but if it’s still functional, it’s likely still a valuable asset to your practice.

	"Whether we’re talking about computers, or high tech, or handpieces, or whatever, as long as it’s working and it’s functional, I don’t think it makes sense to get rid of it,” said Dr. Lorne Lavine, Founder and President of Dental Technology Consultants. “If the item is usable there’s no reason to think that it can’t go to another staff member or to a junior associate who comes into the office.”

	Whether you’re in the market for a new pair of loupes, the latest intraoral camera, a new caries detection technology, an ultrasonic unit or a new handpiece, Dr. Lavine said anything that still performs the task it was purchased for should be put to use somewhere in the practice.

	Still, it is important to remember that a practice functions as a system and the staff as well as the technology and equipment must be able to work together, said Nancy H. Dukes, BA, RDH, CBM, Director of Clinical Coaching at Jameson Management. If a staff member gets the job done with the tools he or she uses, forcing a hand-me-down replacement into his or her hands doesn’t always make sense.

	Efficiency should be the driver of all equipment changes, and if handing something down to another staff member will make that person a more valuable and efficient part of the team, then helping with the adjustment should be part of the hand-me-down process, Dukes said. Conversely if technology being replaced is so old it makes it difficult to work with other equipment in the practice, and handing it down to another team member would hurt efficiency, that move doesn’t make sense.

	“Sometimes we have to update because we need equipment that will be more user friendly with the equipment we have,” Dukes said.

	When it comes to making a hand-me-down decision, it is important to keep track of what you already have in your practice that might be put to other uses. Dr. Lavine said any equipment that is just sitting in a box should be put to use somewhere, even if a dentist has tried it and didn’t like the results. If  it’s workable, why not let another member of the team see if he or she likes putting it to use.

	“There’s a lot of money in those boxes. Often times for a typical practice there’s 10s of thousands of dollars in equipment that’s perfectly functional that the office just never got around to recycling or to having someone else use,” he said. “The fact that a dentist wasn’t able to adapt to a new technology or a new device doesn’t mean that someone else in the office won’t be able to use it. You’ve already got it, you’ve already paid for it, why not see if a staff member or a junior associate is going to be comfortable with it.”

	Sometimes a product’s new life might look very different than it’s previous one, especially when it comes to computers, Dr. Lavine said. He advises practices to place the newest, most powerful machines in the operatories where they are used for processor intensive imaging and other tasks.

	He said operatory computers should have a lifespan of about 3 years with those in other parts of the practice expected to last another year or two. When updating the operatory computers, the older ones can find new homes at the front desk, in a staff room, a consult room or for patient use in the reception area. Computers being retired from the practice completely can be given to staff to take home, or donated to schools, but Dr. Lavine said handing any computer down to a non-clinical use must be preceded by professional data wiping to make sure all patient data is completely and irretrievably erased.

	Typically, the dentist who owns and runs a practice is the one making the purchasing decisions and the person who gets the latest in technology and equipment. However, Dukes said it is critical to get the equipment to the place where it will be most valuable to the practice, and sometimes that means adding the newest purchase to the hygiene department and keeping or putting what the practice already has in the dentist’s hands.

	This can be particularly true for items such as intraoral cameras and caries detection systems that can be used during just about every hygiene appointment, but might not be used with every patient the dentist treats. Dukes said it is important to consider how the new addition or upgrade to the practice will benefit patient care.

	“If it’s of benefit to the patient, more than likely, that’s the place where it’s going to most likely pay for itself,” she said. “In some cases it would be better to upgrade and put the latest, greatest tool in the hands of the hygienist, the person who’s probably going to be using it most often.”

	When considered over the long term, handing equipment and technology down to other members of a team can be an important way for a practice to get the biggest return on investments. If everything is kept in good working order, someone should be able to put it to use, and when something reaches the end of its useful life, then it can be retired and replaced outright.

	“For the most part, if it’s usable and functional, then it’s probably a good idea to keep it,” Dr. Lavine said. “There’s nothing that comes to my mind that says this is something you should avoid handing down.”

 It’s just a matter of time really. Eventually everything in your practice will come due for update or replacement. But, whether you’re a tech junkie who goes for the latest gadgets, or someone who prefers to stick with a trusted and well-used tool, the equipment and technology in your practice can still have a useful life after you have found its replacement.

The "hand-me-down" cycle

	When it comes to achieving success in the dental industry, partnerships can be a huge factor. Whether it’s the collaborative relationship between a GP and an oral surgeon on a complex implant case, the cooperation between a dentist and a laboratory technician working on a smile design case, or a dental lab relying on accurate production from a trusted milling center, in every case both parts of the equation focus on their specialty in order to produce the best possible outcome.

	It’s this same spirit that brings dental manufacturers such as Nobel Biocare to form partnerships of their own. The Swiss company has built its global reputation as a leader in CAD/CAM processes and implant solutions, but rather than attempt to expand its expertise into in-house produced materials for finishing their industrially milled restorations, the company instead reached out to industry leaders with its Preferred Partner Program that has solidified close working relationships with VITA, Ivoclar Vivadent and Noritake.

	“There’s a lot of commonality and synergy between the companies in terms of philosophies based in science and education,” said NobelProcera Product Manager Peter Murphy.

	“We really try to drill it down to what’s in it for the end user. It’s all about making patients happy, making doctors successful and making laboratories successful as well,” added Nobel Biocare Senior Product Manager – Professional Marketing Robert Riggs. “We are the leader in what we do, and Ivoclar, VITA and Noritake are clearly the best at what they do as well. It’s nothing but a win for the end user.”

	While Nobel Biocare initiated the partnership programs, they made perfect sense to the other companies taking part. Andy Klein, Laboratory Marketing Manager for Vident, a VITA company, said it basically came down to the fact that while Nobel Biocare creates great frameworks and other products they don’t have their own porcelain to finish off the esthetic and functional restorations.

	“They realized it was not one of their core competencies, and certainly precision CAD/CAM processes is not a core competency of VITA. It’s really a classic case of two heads are better than one. It made perfect sense to become partners in materials.”

	Murphy pointed out that the partnership is about much more than two companies with products and reputations they stand behind. Rather for the two entities to work in concert they needed to have similar approaches to the industry and to the way in which their products are developed and brought to market.

	Of course, in the case of Nobel Biocare and VITA, Klein pointed out that geographical proximity didn’t hurt either. While in different countries, Nobel Biocare’s Zurich headquarters is just 40 minutes away from VITA’s headquarters in Bad Säckingen, Germany. Proximity is just one factor that allows Nobel Biocare and its partners to work closely on a wide range of projects and initiatives.

	“As far as R&D, engineering, product development and the creation of worldwide educational curricula, the opportunities are endless,” Klein said.

	The ties between Nobel Biocare and its Preferred Partners go deep into product development for each of them. Murphy said it is important for everyone to know that the frameworks, copings, abutments and other products that can be produced through NobelProcera will work seamlessly when paired with the porcelains, denture teeth and other products created by partner companies, so while products may be marketed under one company’s brand, they often are designed and tested in conjunction with a corresponding offering from the other side of the partnership.

	“They are connected at the very early stages. It’s not something that’s just folded in at the end. This partnership is something that extends far into the companies,” he said.

	Vident Technical Sales Director Jim McGuire said a very noticeable outcome of this partnership is on display in the precise shade matching available when using NobelProcera produced substructures with Vident’s porcelains. Because they’ve been tested together, labs can use the products from two sources with the same confidence in their continuity that they might have using one system.

	“There’s many combination cases that clinicians and labs do together, and it’s important that they can rely on predictable materials that are cost effective and fit together such as with VITA and NobelProcera,” McGuire said. “Our products are really the end point for Nobel Biocare’s end-to-end solutions.”

	The key to this working so well is that neither company is diverging much from their areas of expertise, Riggs said. VITA focuses on materials development and precise shade performance, while Nobel Biocare is able to focus on the precise medical device manufacturing processes they make available through NobelProcera.

	The collaborative relationship and shared expertise comes into play in more than just product development. Klein said Nobel Biocare will be the sponsor of a Vident panel discussion at the upcoming Lab Day meeting in Chicago in February. The event will bring together Nobel Biocare’s audio-visual expertise and experience running large-scale interactive multi-media with Vident’s hands-on education style to hopefully create a lively discussion.

	“We want to present the best opportunity for customers to ask questions and to get answers that are objective,” Klein said.

	While they continue to solidify their connections with regular meetings and collaborative efforts, neither company is tied completely to the other. While the products and services they develop may be optimized to work cohesively, the partnership is fluid and open, so each company is free to market and promote separately under their own brand and in their own way.

	The bottom line with the Preferred Partner Program is always the customer who will put the products from Nobel Biocare, VITA, Ivoclar Vivadent and Noritake to use in their lab or practice, Riggs said. Just as Nobel Biocare took its time in carefully selecting and solidifying its Preferred Partner relationships, the company is aware that dentists and labs will take a similar approach to choosing the manufacturers they will partner with to find success.

	Riggs said Nobel Biocare sought out the materials partners it felt were the best at what they do, and the most capable of enhancing what can be done through the NobelProcera system. He hopes dentists and labs make a similar consideration when looking for a manufacturing partner to enhance the high quality work they are already doing.

	“What we truly want to communicate is that the dentists and the technicians are choosing us as their CAD/CAM vendor not only because we have selected the very best materials partners, but because we are best-in-class when it comes to automated manufacturing and CAD/CAM processes,” he said.

	Dental Lab Products Senior Editor Noah Levine can be reached at 

 When it comes to achieving success in the dental industry, partnerships can be a huge factor. Whether it’s the collaborative relationship between a GP and an oral surgeon on a complex implant case, the cooperation between a dentist and a laboratory technician working on a smile design case, or a dental lab relying on accurate production from a trusted milling center, in every case both parts of the equation focus on their specialty in order to produce the best possible outcome.

Picking partners

If you were among the many dental laboratory professionals in Chicago late last month, it’s likely you were bouncing between meetings at different hotels across the river and across downtown from each other. When making those cross-meeting jaunts it helps to travel light, but it’s just as key to be in touch while on the road.

This means packing both light and smart. There’s no need to lug around anything electronic you won’t be using, but it’s just as important to have the technologies you will or even might need at your disposal. After visiting as many as four meetings a day and jumping in and out of countless cabs during the weekend of Midwinter madness, I got a very clear sense of which devices, cords and accessories were crucial and which were little more than dead weight in my bag.

The hero of any connected travels theses days is going to be a smartphone. It really doesn’t matter whether it’s Android, Apple or Windows, Samsung, HTC or Motorola, if it’s a smartphone that was considered state of the art in the last 18 months or so, it’s a multi-tasking wonder that can save plenty of space in your bag and possibly be used to make a phone call if needed.

Think of your smartphone like a Swiss Army knife that’s still allowed through airport security. It’s a phone, an e-mail hub, a web surfing device and an entertainment center. When outfitted with the right portfolio of apps it will handle the tasks of numerous gadgets an3d paper objects without putting an undue bulge in your pocket.

Your smartphone should make bringing along a point-and-shoot-camera, a GPS device, a camcorder, a voice recorder, a notebook, a guidebook, printed schedules, a calendar or a contact book redundant. Quite simply this should be the center of your electronic world while on the road, but it’s not quite a plug-and-play device.

Prior to leaving it’s a good idea to bookmark important web pages in your mobile browser, make sure contacts are up to date, save a note with important addresses, get your schedule into the calendar with reminders set and of course load in whatever music you might want to access on the road. With all that at the ready most of the information and access you need while on the road will never be farther away than your pocket.

As amazing and handy as a smartphone can be, it’s still not ready to take on all tasks. There are plenty of reasons to bring a laptop on the road, but if it’s possible to downsize to a tablet, that’s the way to go. Even with something as light and thin as a MacBook Air or an Ultrabook, anything in the laptop category is only necessary if you’ve got serious typing to be doing. If you’re working on an article or cranking away at a novel in your spare time, the laptop is nice to have, but unless it’s going to be critical for use at a meeting, if you must bring it, leave it back in the hotel.

Now a tablet on the other hand, this is a gadget that can be wonderful at a tradeshow. Light and thin, tablets are easy to fit into a bag, but the screen is large enough for sharing and once you get used to typing on a virtual keyboard, they can be great for taking notes during a lecture.

With a tablet, it’s easy to capture and share key points of a lecture, bookmark web pages mentioned by a speaker and while I’m not a fan of using a tablet as a camera, they can be great for snapping a pic of an interesting slide and then attaching it to your notes. Plus while a smartphone does a lot of things well, all but the biggest models make poor substitutes for an e-reader, but with a tablet you can leave the Kindle or nook on the bedside table at home.

The one other large gadget that might come in handy is a DSLR, but unless you plan to do some serious photography, a camera body and lenses is a lot of unnecessary bulk. If you’ve got some sightseeing on the agenda and taking pictures is a hobby, or you’ve got something you know you’ll want to shoot and print, it’s great to have a DSLR along. But if you’re only going to be grabbing casual shots of friends or even pics for online use, leave the bigger camera at home, your smartphone will be enough.

The gadget load might be light, but if there’s one thing not to forget, it’s all the cords that connect your devices to life-giving power and to one another. Your chargers should be the first cables on your must have list because you won’t get far if you’re trying to ration the battery to survive a weekend on one charge.

If you have a charger that can plug into USB ports as well as power outlets, that’s even better. The more ways and places you can add juice, the easier it is to stay charged. I always travel with an external battery that has USB in and out. That way I’m ready to charge any device a colleague or I may have, and I can recharge the battery itself from any wall plug or USB power source. While I carry an iPhone, I usually have an Android charger cord with me just in case a friend needs help.

Cords don’t take up much room or add much weight, so I’m a firm believer in bringing as many connection options as possible. It’s always a good idea to have a USB cable on hand, and while Ethernet cables are less critical these days if you are going to be giving a presentation, it makes sense to have any adapters and connectors your computer, tablet or smartphone might need to plug into a projector.

There are few other extras that can come in handy from time to time. If you have a Wi-Fi only tablet, then a Wi-Fi hotspot is not a bad addition to your gear. If you like playing music on something louder than a smartphone speaker, a nice set of headphones and an auxiliary audio cord can set you up to plug in personally and to a larger sound system. But those tend to be more in the optional, and less critical categories.

When traveling today, it is far easier than ever to keep things light. If you plan ahead your entire electronic world can be condensed to little more than a smartphone, a tablet, a battery pack and some nicely coiled cords. That means there will be plenty of room for your clothes and other necessities in a carry-on size bag, and more importantly, when bouncing around town, you’ve got everything you need while still hauling around just the bare necessities.

Tech Smart: Gear Necessities

pivots in its permanent Denture Cap for a genuine resilient connection of the prosthesis

 without any resulting loss of retention. The male remains in static contact with the female socket while the Denture Cap has a full range of rotational movement.
	
	The self-aligning feature of the LOCATOR Attachment 

allows patients to easily seat their overdentures

 without the need for accurate alignment, and without causing damage to the attachment components.

Designed to reduce the height of attachment and abutment on all brands of endosseous implants

, the LOCATOR Attachment has a total attachment height of only 3.17 mm (male plus 1 mm collar abutment) for an externally hexed implant, saving interocclusal space compared to other implant overdenture attachments.
	
	With twice the retention surface area of other attachments, the LOCATOR Attachment’s 

Dual Retention innovation provides inside and outside retention ensuring long-lasting performance

.
	
	Extended range males allow clinicians to 

restore a non-parallel implant with up to 20° of angulation

. This calculates to an extensive 40° of divergence between two implants.

 The LOCATOR Male pivots in its permanent Denture Cap for a genuine resilient connection of the prosthesis without any resulting loss of retention. The male remains in static contact with the female socket while the Denture Cap has a full range of rotational movement.  The self-aligning feature of the LOCATOR Attachment allows patients to easily seat their overdentures without the need for accurate alignment, and without causing damage to the attachment components.

One system, multiple benefits

Protects ears from the hazardous sounds in the dental practice with a 15 decibel flat attenuation response.
	
	15 decibel filter allows for clear, natural communication while you work so you can still hear speech.

Custom fit devices using temperature sensitive nitinol stents allows for comfortable fit without the need for messy, time consuming impressions of the ears.
	
	Comfortable enough to wear all day long so there’s no in and out between patients, which ensures you are always listening at safe decibel levels.
	
	Offered with a lifetime warranty there is “nothing to lose except your hearing.”

Protects ears from the hazardous sounds in the dental practice with a 15 decibel flat attenuation response.  15 decibel filter allows for clear, natural communication while you work so you can still hear speech.

Dental practice sound protection

	Having a focus for the practice doesn’t have to mean going all-in on a specialty such as endodontics or oral surgery. Nor does it mean playing up cosmetics or selling take-home products, but either of those are valid choices if they are the type of dentistry you believe in. General and family practices can really stand out by just embracing the reasons they’re involved with dentistry.
	Whether it’s using the latest technology, approaching cases with the idea of being minimally invasive or any other guiding principle, figure out what drives you and pursue it in your practice. Your patients will notice when there is passion behind the care they’re receiving.


	For Dr. Marvin Berlin and his practice,

, in McKinney, Texas, the drive to provide same day care as often as possible came after realizing how good it felt when he had to take his daughter to the doctor and she was seen and treated right away. He realized his patients rarely felt this way because if they came in for a hygiene appointment and needed further treatment, they’d leave with another appointment and maybe a prescription.

	“They would kind of slump their shoulders and say, ‘Is there any way you can do it today?’ and I’d say, ‘No, we have to reschedule you.’ Not really knowing why we were doing it that way other than that was how we were taught,” Dr. Berlin said.

	To change this, Dr. Berlin realized he’d need to hire at least one more assistant and get his staff on board with being flexible. But once those adjustments were made and everyone got the hang of simply working in extra treatments throughout the day, he discovered his patients were far happier.

	Patients no longer had to worry about getting another afternoon off work or finding another baby sitter, and whether it was a root canal or a crown, they went home with their dental issue addressed. Those patients told their families and friends, bringing in new referrals, and the practice promoted this same day care attitude everywhere it could, bringing in more patients.

	“It’s kind of what we call a ‘Yes’ philosophy, where we try to say ‘yes’ to whatever the patients want and make it happen today. That in itself has kind of set our practice apart,” Dr. Berlin said. “There’s really no more convenient time than right now. We don’t mind working through lunch or staying late if we have to. Then it’s taken care of, and that’s what it’s all about.”

	A different passion has guided the career of Dr. Mark Malterud, whose St. Paul, Minn., practice has honed its minimally invasive approach to care throughout the past 28 years. His drive to focus on minimal preps and save healthy tooth structure has been with him from the time he finished dental school.

	“It’s a philosophy of practice. You really have to look at things differently. Rather than just going in and cutting a prep here and cutting a prep there, and thinking about classic preps, you’re always thinking about what can I save,” he said.

	Before the term minimally invasive was a part of the dental conversation, Dr. Malterud was using pediatric-sized burs to create less aggressively designed preps than those he’d been taught in school. He adopted early generations of bonded composites, and today still sees patients with those restorations that have been functioning for 25 years. He has even greater confidence today thanks to the improved results from easier to use newer generations of these materials.

	Still, even the newest materials might eventually fail, and Dr. Malterud believes his approach to protecting the patient’s natural dentition will be beneficial in the future. This led him to focus his practice on prevention, detection and minimally invasive care, and he makes sure his patients understand why he is taking this approach.

	“My restoration isn’t going to be the last one that will be in there. It’s going to last a long time, but it’s going to have to be restored again down the road if something fails,” he said. “Five, 10, 15 years down the road we’re going to have better materials and better ways of dealing with tooth structure. The more that I leave, the better chance I’m going to have to restore effectively the next time.”


	Having a practice identity patients can understand and relate to can definitely help a practice stand out, which is important in the current economic climate, said practice consultant 

 who added that the industry is as competitive as she’s seen it during the 20 years she’s been involved. Anything that distinguishes a practice in a positive way can be helpful, she said while noting that just staying up to speed with the practice down the street can be an important baseline.

	“I think you’ve got to stay up to date and involved with these products and services or you will give the patient or potential patient that you’re practicing decades old dentistry,” she said.

	A practice needs to keep up to date on what is happening in terms of new technologies and treatment options, and at the very least a practice should be aware of options patients may find elsewhere, said dental technology consultant 

. Having a guiding philosophy of care also will drive technology and other product decisions for the practice.

	This was certainly true for Dr. Berlin’s practice, which found 

D4D Technologies’ E4D Dentist CAD/CAM system

 to be a natural fit when it came to providing immediate care. The ability to provide a definitive crown, inlay or onlay in one appointment was an exact match with the practice philosophy and added a capability competitors couldn’t match.

	“The practice has grown and I think a lot of that is because we’ve tried to separate ourselves,” Dr. Berlin said. “You can’t get better than a same day crown, in my opinion. There’s not anything out there that has changed the practice like the E4D has.”

	Dr. Berlin said adding CAD/CAM took the practice’s care to a new level. And because they have enough business to keep the system in use regularly, the costs per crown have shrunk while patient satisfaction has increased. The practice strives to use the technology as efficiently as possible. For endo cases, Dr. Berlin will prep the tooth and scan it prior to performing the root canal, so that the crown is ready to be seated when treatment is concluded so what once required four appointments is completed in one.

	The system is in use even for cases that aren’t completed in one day, and all of the assistants in the practice know how to use it. But while the scanner and the mill stay busy, the practice’s biggest return on its CAD/CAM investment is the ability to promote same day crowns. That concept has resonated with patients and it brings them in for all types of dental work.

	“I love it, it’s part of our day,” Dr. Berlin said. “We’re kind of known in the area now that if you need a crown today just give us a call. It’s kind of a cool reputation to have.”


	The purchase decisions at Dr. Malterud’s practice have followed a similar path, but for him the decisions to adopt a new product, technology or material is always based on whether that product will allow him to be less invasive with the care he provides. He said the philosophy of minimally invasive care really does require the use of certain technologies for patients to experience its benefits.

	At his practice he is always looking for new ways to improve the care he provides, while lessening its impact on healthy tissue. Core technologies for him include air abrasion, which he uses on every restoration he places; DIAGNOdent, which allows for early caries detection; and the bands, brackets and rings required to create contacts on his minimal preps. Still none of that has helped him provide the care he believes in as much as the 6X magnification loupes he wears to see every detail of the surfaces he works on.

	“That’s been a crucial part to my journey through minimally invasive dentistry,” he said.

	The development of restorative materials has been another part of his journey. Dr. Malterud said he tries to stay up to date on the latest materials because as their properties improve, it gets easier to provide care in a minimally invasive way. Today’s composites are far better than the first generation materials he started with, and he’s intrigued by the possibilities of the newest flowables.

	“That’s starting to actually pique my interest for the restorative aspects of dentistry, especially with minimally invasive preps,” he said.


	Having a staff with a true understanding of and commitment to a practice’s goals is an absolute necessity. The staff members interact with patients before the dentist ever meets them, and if a practice is going to live up to the philosophy it wants to present, team members need to embody that spirit during those interactions.

	Even in the Internet era where patients may discover a practice via its website, Limoli said the phone is still the primary way new patients make contact, and thus staff members answering the phone need to be prepared to present the practice in the way it wants to be seen. They need to be able to answer questions about what sets a practice apart without hesitation. If they can share personal experiences with the benefits of the care and products the practice provides, that’s even better, she added.

	Dr. Malterud said his staff has been a big part of his success as a minimally invasive practice. His hygienist has been with him for 24 years and has experienced the practice’s evolution from its early days as part of a production-focused practice following a practice management consultant, to its current status as an independent practice dedicated to minimally invasive care.

	“I always felt uncomfortable selling crowns, but she was great at selling crowns,” he said. “Now that she understands my philosophy, she’s great at selling minimally invasive dentistry.”

	Team buy-in is just as critical to the success at Dr. Berlin’s practice where he needs to know his hygienists, assistants and front office team will be ready to shift priorities as needed. His staff all know they are working hard to do the best they can for their patients, and he feels lucky to work with such a dedicated team.

	The practice is set up with an assistant assigned to every operatory, whether there is a patient seated or not. This way if there’s an open operatory for a patient, Dr. Berlin knows he’ll have a team member ready to help get treatment started right away. Having the facility and staff to handle the workload is important, but the dentists have to set the tone for everyone by hustling as much as the team members, if not more.
	
	“If you’re lazy then this probably isn’t going to work for you,” he said.


	Making sure the staff is properly trained on all aspects of the practice is important. While the administrative personnel won’t need to know every detail of the CAD/CAM software, Dr. Lavine said they need to know enough about the technology to help patients grasp what it can do for them.

	“If they’re not going to believe in that new technology, then they’re not going to be expressing that belief to your patients,” he said.

	Limoli agreed, and said a practice should regularly review questions it receives from patients to make sure staff are providing consistent responses that present the practice in the right light. It’s important for the team to be able to discuss the services a practice provides, but it can be just as important to know how to respond when patients ask about something the practice doesn’t offer.

	Patients have greater awareness of some dental products, such as Zoom! Whitening and Invisalign appliances, and if the practice doesn’t provide something, Limoli said the team should be ready to offer an alternative the practice can provide while explaining why the practice made that product decision.

	“Those are the conversations that you need to practice,” she said.

	Offering a viable alternative is precisely the route Dr. Malterud and his practice have taken when patients inquire about same day crowns. Even in a minimally invasive practice, there are plenty of cases where a crown is required, and while he doesn’t do enough crowns to support investing in a CAD/CAM system, Dr. Malterud said he understands the patient appeal and the clinical sense of being able to offer something definitive in one appointment.

	To accomplish this he places Natural 1 preformed composite resin crowns from 

, which can serve as a long term temporary that allows a patient to either save up for a definitive crown later, or replace the temporary with another sometime in the future.

	Operating with efficiency similar to a CAD/CAM system, Dr. Malterud has his assistant fabricate the Natural 1 crown while he is free to see another patient, and then he can return to seat the crown. It might not be a permanent solution for the patient, but Dr. Malterud is able to offer these crowns at a lower price, and they fit perfectly with his philosophy of helping his patients stay healthy until a more definitive option is available in the future.

	“It’s a transition, and during these economic times I think it’s positioned perfectly to take off,” he said.


	Once a practice has honed the business to follow a philosophy of care, successfully integrated the products and technologies that match that outlook and brought the staff on board with enthusiasm, it is important to make sure that message is reaching patients in a way they can understand.

	While putting the practice’s focus front and center is a good thing, Limoli said it is important for patients to see and understand the practice provides general dental care. Otherwise, if all they see is crown in a day or minimally invasive care, they might not be interested in coming in for a hygiene appointment. This is something that’s especially true for a minimally invasive practice, such as Dr. Malterud’s, because not every case can be treated that way.

	“Whether it’s dental caries, endodontics, restorative, implantology or periodontics, we focus on the minimally invasive aspect of all of those. But that being said, my foundation is strong enough that I have no problem jumping into full-mouth reconstructions and taking care of people who are severely broken down and you can’t perform minimally invasive dentistry on,” he said.

	However, once that focus is completely integrated into the fabric of the practice’s day-to-day operation, it is important to make sure your message about the care you provide is out there for patients to find. Limoli recommends putting the dentist front and center online via the practice website and beyond that via videos that can be posted to YouTube and even shown in the reception area.

	“We’ve got more technology at our disposal, not just in dentistry but in marketing, than we’ve ever had. Why not have the messenger be the doctor himself or herself? It connects them visually with that brand,” she said. “The doctor, whether they like it or not, is the rock star of the practice. The team is important, but the brand of the practice really winds up being, ‘Do I like the doctor?’”

	Marketing is a multi-faceted and wide-reaching effort for McKinneyDentist.com. Dr. Berlin’s practice takes out magazine ads, billboards, radio and online ads, and everything they put out encourages patients to “Ask us about same day crowns.”


	Once patients do arrive, they aren’t likely to leave Dr. Berlin’s practice without being introduced to the E4D system. The staff knows to make sure patients see the technology on the way to the operatory, especially if a crown is being designed or milled. When patients are in for a same day crown, Dr. Berlin said they are always in the room while it is designed because once they see the technology in action they want to talk about it.

	Both Limoli and Dr. Lavine said this should be the norm for any practice with CAD/CAM. Patients may not be familiar with the technology, but once they’ve seen it they can quickly grasp its cutting edge nature. With or without CAD/CAM, Limoli said it’s a good idea to note in a patient’s record if he or she has toured the practice. The tour should be repeated when there’s a new capability the practice wants to highlight.

	Once patients see the CAD/CAM at Dr. Berlin’s practice, or even better experience its benefits firsthand, they almost always become advocates for what his practice can offer. Making sure good patients leave with an understanding of his practice’s guiding principle of same day care can turn them into ambassadors for other good patients.

	“The best marketing for sure, 100% is word of mouth marketing. People tend to refer good people and good patients. You’re not going to get any better in my opinion,” Dr. Berlin said.

	This is something also experienced by Dr. Malterud’s practice. While he admits, minimally invasive dentistry can be a difficult concept for patients to understand, he and his team always explain how the concept of saving natural tooth structure and treating with as little impact as possible guides the clinical decisions. Then patients who feel the benefits personally are likely to tell their friends about their positive dental experience.


	Regardless of how many products a practice adopts to fit the philosophy behind the care it provides, if it doesn’t fit with the patient population around the practice, things probably won’t work.

	Dr. Lavine said a practice dedicated to same day crowns and immediate care will likely do well in an urban environment, but no matter how dedicated and ready, the same team may struggle in a slower-paced locale.  

	“If you’ve got a high number of busy professionals in the practice, then something like that may see more benefits than a practice that might be in a rural setting or have a lot of elderly patients,” he said.

	Another potential problem can come from moving too fast to turn the dentist’s philosophy into the basis of the care the practice provides. It starts prior to purchase with a plan for how any new technologies or products adopted will be integrated into the practice operations and how it will be promoted. Without such a plan, the investment might sit gathering dust, Dr. Lavine said.

	“The fact of the matter remains that with these technologies, they are not for every patient,” he said. “Practices can spend more time choosing the technology than answering the correct questions, which is can I use the technology.”

	The next step is knowing when to implement and promote new capabilities of the practice. Dr. Lavine said every practice will have a different comfort level and learning curve with new technologies and protocols. Attaining that comfort level is critical because a practice must be sure it can deliver on any promises made in marketing around the new systems, Limoli added.

	“I’d be sure you can prepare what’s on the menu before you start marketing it to the general public. Be prepared to deliver and be prepared to answer some questions,” she said.


	In the end, it will all come back to believing in the care you provide, because your patients will notice. Dr. Berlin said this has certainly been the case with his practice’s same-day care approach, and he expects the concept to catch on elsewhere.

	“I think you’re going to see more and more patients demand same day dentistry. I think the word is going to get out, or at least I’m going to try to get it out,” he said.

	Dr. Malterud also sees his approach to dentistry as one that could be successful for others. While it might be more difficult to pitch with an elevator speech, he believes minimally invasive care is something patients respond to once they’ve experienced it first hand, and just as importantly, it is something that strikes a chord with the reason many people got into dentistry in the first place.

 Having a focus for the practice doesn’t have to mean going all-in on a specialty such as endodontics or oral surgery. Nor does it mean playing up cosmetics or selling take-home products, but either of those are valid choices if they are the type of dentistry you believe in. General and family practices can really stand out by just embracing the reasons they’re involved with dentistry.