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

Renee Knight

Dr. Michael R. Sesemann and his team can’t imagine going back. For more than 20 years, they’ve used the incremental placement technique for direct posterior composites in an effort to minimize polymerization stress, and that meant using three different composites to finish a restoration. This is a very labor intensive process, Dr. Sesemann said, and isn’t fool proof. Even though he took these steps to minimize shrinkage, he often still ended up with a white line here or there from the material shrinking.

Recently, Dr. Sesemann has been looking for an easier protocol, one that would give him the quality esthetics he’s after along with the metrics that are so important to a posterior composite-durability, minimal shrinkage, good marginal adaptation and easy placement. A few months ago, he found it in Ivoclar Vivadent’s new 

“It was an answer to our prayers because all of a sudden here we are still taking the same rubber dam isolation approach, still bonding like we always did but all of a sudden we’re treating the tooth surface with a bonding material of our choice, then placing this material and in some cases filling it from top to bottom and curing it,” he said. “It’s almost like we haven’t done enough to justify our time and fee, it’s so much easier. It’s been surreal for my staff and I in doing this. And a good surreal I should say.”

Ivoclar Vivadent launched what Dr. Sesemann describes as a “revolutionary advancement in posterior dentistry” at the Greater New York Dental Meeting in November. This material was developed to streamline the posterior composite placement procedure, to offer an option that is faster and easier to apply but that also maintains the integrity of the composite restoration.


	The team at Ivoclar Vivadent first started talking about the concept of a one-material bulk fill technique about six years ago. Over the years, the company has received requests from dentists asking for a composite filling material that’s easier to use, or an easier overall process, VP of Marketing Dr. Michael Gaglio said, and those requests were the motivation behind Tetric EvoCeram Bulk Fill. The team at Ivoclar Vivadent wanted to create something that was easier to incorporate into routine treatments such as Class II posterior restorations, while maintaining or even increasing reliability.  

At the beginning of the development process, they wanted the research to go beyond just what they were hearing from dentists who were contacting the company directly. They wanted to focus in on exactly what dentists wanted in a posterior composite, and they wanted to hear from a variety of voices. To get there, they held focus groups, and the research team talked with many different types of dentists, from general practitioners to specialists to academic researchers, said Chet Spivey, Director of Marketing for Clinical Products. They wanted to get a balanced perspective about what was most important, and no matter what type of dentist they talked with, they all pretty much wanted the same thing.

“A lot of dentists out there don’t like doing composite restorations because they have to layer the material,” Spivey said. “It’s time consuming and eats away at chair time. They said they wanted to make the technique faster, but they layer for a reason, and that’s to maintain integrity. They wanted a way to bulk fill the restorations and still have integrity.”

After years of research and development, the team came up with a material featuring managed working times and a new light initiator that allows it to fill cavity preparations up to 4 mm in one layer applications, and be sculpted and cured without the need for a capping layer, Dr. Gaglio said. The material is comprised of layered silicates that produce a smooth and adaptable consistency, and that means there isn’t a need for a flowable liner. The new Polymerization Booster ensures the complete curing of 4 mm thick increments in 10 seconds, Dr.  Gaglio said, and the material’s Shrinkage Stress Reliever decreases overall shrinkage volume experienced during polymerization. That means clinicians like Dr. Sesemann reduce the chance of a white line at the margin that could compromise esthetics, or shrinkage that might lead to cracks, gaps, leakage or post-operative sensitivity.

Bulk fill composites represent a newer category of filling materials, Spivey said, and while there are some very good products out in the market, they all involve some sort of compromise, whether that means ending up with a gray restoration because the composite had to stay translucent for curing, adding an extra step to the technique to put a top capping layer on for improved esthetics and wear, or buying a separate device designed to change the consistency of the material so it can fill floor to ceiling and is easy to manipulate and sculpt. The team at Ivoclar Vivadent wanted to eliminate all of these challenges with this Tetric EvoCeram Bulk Fill.

“We’re marketing this as no compromise,” Spivey said.”You don’t need the handpiece. We have stress relievers that absorb stress. We have patented initiators that allow us to cure floor to ceiling without effecting the working time or esthetics. It’s a true one material bulk fill composite. And while this category includes very good materials, this is the first time a dentist isn’t really compromising. We’re very rarely first on to the market in any category, and the reason for that is we’re always looking to provide unique features so dentists don’t have to compromise.”


	For Dr. Sesemann and his staff, the biggest benefits Tetric EvoCeram Bulk Fill has brought to his restorations are reduced shrinkage and adaptability. It adapts well, resulting in very good margins. It has consistency so in some cases Dr. Sesemann can fill up a restoration, sculpt the material and cure it without any further preparations.

With the old technique, he needed to use a 4th generation bonding material to create a strong hybrid layer to avoid post-op sensitivity, but with Tetric EvoCeram Bulk Fill he can use 5th (total etch) or 7th (selective etch) generation bonding agents, giving him more flexibility and saving him time. It also takes less time to cure and place the composite. When you take everything into account this material saves him 25% to 30% of the time it used to take him to complete a direct posterior composite, Dr. Sesemann said.

“That’s a big deal for the average dentists out there who have found they cannot implement a difficult protocol for posterior composite placement in their practice because they can’t allot that much time or charge their patients that much to make it work in their business model,” Dr. Sesemann said. “But with this material they have something they can serve their population with and create an excellent filling with an easier protocol and less financial outlay that keeps their fees perhaps too high for their patients’ liking. And they can deliver exceptional work.”

Dr. Sesemann’s patients really haven’t said much about the new material, but he said their silence is a good sign. He’s placed about 30 restorations in eight different cases with the material, and not one patient has come back with a complaint about post-op sensitivity.

“For so many years we in the dental field felt we had to master the bonding technique to reduce post-op patient sensitivity, when in reality we weren’t accurately taking into consideration polymerization shrinkage and its effect,” Dr. Sesemann said. “So now that we have polymerization shrinkage somewhat under control, my patients haven’t said a word. That means the fillings are feeling great, which makes us happy.”


	No matter what the product is, developing a new dental product is a complex process that typically requires several years, said Dr. George Tysowsky, VP of Technology. The process includes idea conceptualization, focus groups, creating prototypes, the upscaling process and validation studies. And the people behind each step are vital to ensuring a successful outcome, from the chemists to the engineers to the in-house and independent researchers to the marketing department. Tetric EvoCeram Bulk Fill went through each of these steps, steps that Dr. Tysowsky said are important to validate the efficacy of the final product as well as influence a project’s timeline, outcome and likelihood that it will meet customer and patient expectations.

New product innovation is critical to Ivoclar Vivadent, and they continually invest into research and development.

“We believe in the value of R&D in both the short and long term. We understand the needs of our customers and closely follow a clear vision based on these needs. As a result, we can define areas of opportunities for providing our customers with value, but without limitations,” Dr. Tysowsky said.

“Our capacity for innovation in dental materials is excellent, and we emphasize innovation that creates opportunities for our customers. Our people are passionate about their responsibilities, which gives them a commitment that our customers recognize. In summary, throughout our development process we focus on excelling beyond customer expectations.”

Tetric EvoCeram Bulk Fill is currently being tested at a number of U.S. dental research centers, Spivey said. Each study is testing a different parameter, including polymerization shrinkage and shrinkage stress, to validate what Spivey said Ivoclar already has proven with in-house evaluations.

Restorative materials are at the heart of what Ivoclar Vivadent does, and the company is known as a leader in the composite resin category. They listen to their customers’ needs, and Tetric EvoCeram Bulk Fill is a great example of a product driven by customer demand.

“If dentists are asking for it and patients can benefit from treatments that incorporate Tetric EvoCeram Bulk Fill-either financially or clinically-then the market demands that we provide this material,” Dr. Gaglio said. “The launch of Tetric EvoCeram Bulk Fill composite is just another example of Ivoclar Vivadent’s commitment to delivering what the market demands.”

Tetric EvoCeram Bulk Fill is a product that everyone in the company is excited about, Spivey said, because whether you’re talking to the CEO, one of the researchers who was part of this product’s development or anyone of the Ivoclar Vivadent employees around the world, everyone knows this product is going to change the way dentists practice.  

“We’re extremely excited about this product because it is truly unique,” Spivey said. “There’s no other product on the market with this new initiator system, shrinkage stress relievers and extended working time. It’s truly something we’re proud of. This material is really going to allow dentists to enjoy doing a direct composite posterior restoration because it’s going to be faster, more efficient and less traumatic for the patient. We’re saving steps but not sacrificing any physical properties or performance. Dentists can still expect the same longevity of a layered restoration, and that’s the main motivation behind this product.”


	Dentists have been layering these restorations for years, it’s how they were taught in dental school, and many of them don’t see any reason to change now. So getting them to realize that change can be good, and layering is no longer necessary with this material may be a challenge, Spivey said, but one the marketing team at Ivoclar Vivadent is up for. It comes down to getting the product in the hands of the dentists and giving them the opportunity to try it out. Their sampling initiative is a key product launch element they plan to focus on at the dental trade shows throughout 2012.

“Now we have to get dentists to believe in the fact they can do it,” Spivey said. “We’ve done a lot of market surveys and a lot of dentists are still layering even with these new materials. It’s hard to accept these materials can perform because it’s been ingrained in the way that they do dentistry.”
	Spivey and his team have to find a way to help dentists become confident that they can use this new material without layering. How are they planning to do that? Beyond their push at the trade shows, they’re also using traditional marketing avenues to tell dentists about Tetric EvoCeram Bulk Fill and what it can do for their practice. They’re also putting together webinars, videos and technique articles to show dentists the product in use. KOLs are talking about Tetric EvoCeram Bulk Fill and its benefits at lectures and through these technique articles and videos, giving the material even more credibility. Testimonials from these trusted dentists are key to breaking down the barrier and getting dentists excited about trying this new material in their practice, Spivey said.

Another important element of marketing a new product like this is getting it in the dental schools, Spivey said. If dentists learn how to use the material from the beginning, they’ll be more likely to incorporate it into their practice.

“Our phrase is bulk, sculpt and cure. Everything you see will say that,” Spivey said. “This is a product we didn’t just develop and then put on the market. This was derived from customer feedback from dentists around the world of what they need and what they want.”


	The team at Ivoclar Vivadent  has already received some initial feedback from clinicians who have used Tetric EvoCeram Bulk Fill, Spivey said, and he’s been overwhelmed by how positive the comments have been. They put the product in the hands of top cosmetic dentists, such as Dr. Sesemann, and many of them are saying it has exceeded their expectations. They’re happy with the esthetics, the marginal integrity, how easy it is to use and how well it blends.

“I’m pretty particular,” Dr. Sesemann said. “I have a higher end cosmetic practice so my patients are pretty particular with the products that we deliver to them. So the fact that this gives us such a nice end result is also a win/win situation for myself and the patient.”

Dentists who have been using Tetric EvoCeram Bulk Fill the last few months also have given the team at Ivoclar Vivadent suggestions on how they can enhance the product even more in its next generation, which is another important part of the product development process. Following up with dentists who are using the product is key to ensuring the product is meeting customer needs, Dr. Tysowsky said.
	 

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Dr. Michael R. Sesemann and his team can’t imagine going back. For more than 20 years, they’ve used the incremental placement technique for direct posterior composites in an effort to minimize polymerization stress, and that meant using three different composites to finish a restoration. This is a very labor intensive process, Dr.

A new way to think about posterior composites

	Reminding patients to come to their scheduled appointments can be costly. Buying recall cards, paying for postage and staff hours spent mailing the cards all take time and money. And after all that, chances are those reminders will go straight from your patients’ mailboxes to their recycle bins.

	These days, many of your patients do their communicating online or via text messaging. They don’t want to call your office during business hours; they’d rather do their confirming or any other business with your practice online, when it’s convenient for them.

	Communicating with your patients this way is an economical, efficient way to keep track of what’s going on in your practice. Intimidated? There are solutions out there from Smile Reminder, Sesame Communications and Demandforce that can help.

	These solutions integrate with your practice management system and electronically remind patients about scheduled appointments-and with no extra work for your staff. With Demandforce’s solution (

), patients receive a text message and an e-mail; all they have to do is click to confirm. This way, staff members can easily see what their day looks like, Senior Marketing Manager Jordan MacAvoy said. They can tell who has or hasn’t confirmed, so they know who they need to reach out to.

	Not only does e-communication save money, it can add revenue to your practice, said Mark Olson, VP of Marketing for Smile Reminder (

). If you have unscheduled patients who are overdue for hygiene appointments, they’ll receive an e-mail reminder that makes it easy to request an appointment.

	And last-minute cancellations don’t have to mean lost chairtime, Olson said. Features like Smile Reminder’s ASAP find patients who asked to move their appointments up. Those patients get a text message, and within minutes someone has filled the time slot.

	These solutions make it easy to track just how much money they’re bringing into the practice.

	“Each month, we literally show the office the patients we brought in,” said Marc Watenwaker, Demandforce’s National Sales Manager, Dental. “The most important thing the doctor wants to see is ROI. We show him the exact revenue the patient spent with the office. It’s a very powerful tool.”


	While it’s important to keep your Web site updated, a complete strategy for patient connections that includes access to treatment plans, online payment, reviews and feedback mechanisms and a variety of other services is extremely important. And you can’t ignore social media’s potential to attract patients, Sesame Communications (

) CEO Frith Maier said. She recommends an online strategy that incorporates a top patient-rated Web site, social media, blogs and YouTube content. Think of Twitter as a modern chamber of commerce, she said; other businesses can serve as an active referral source for you. Use Facebook and YouTube to promote new services, something these solution providers can help with.

	And don’t forget about the power of patient referrals, Maier said. Patient reviews generated from solutions like Sesame’s also can be posted on your Facebook page for potential patients to see.


	E-communications have a longer life and further reach than a piece of mail or a phone message, Olson said. If you send a newsletter about implants to patients through the mail, they’ll likely throw it away if it doesn’t apply to them. But if it comes via e-mail and they know someone who’s interested in implants, they’re more likely to forward it on. You also can post it on Twitter or Facebook, where there’s a chance others will re-post it for their networks to see.

	“That gives you an indication of the power of the electronic message,” Olson said. “You’re actually doing more for less.”


	Not only does e-communication save you money, it’s what many of your patients want, Watenwaker said. If you’re not online, potential patients are likely to pass you by, and in the end, that will only cost you money.

	“If you’re not online, you’re not visible to patients in the first place,” Maier said. And if you’re not using the tools that make their life easier, they’re going to feel like any dentist could be as good as you. It’s a major differentiator.”

    Reminding patients to come to their scheduled appointments can be costly. Buying recall cards, paying for postage and staff hours spent mailing the cards all take time and money. And after all that, chances are those reminders will go straight from your patients’ mailboxes to their recycle bins.

Talk should be cheap

	You’ve likely noticed a change in your patients. The patients who come through your practice are more selective these days. the economy has made that a necessity for most americans, whether you’re talking about the type of dentistry they choose to go forward with or the type of car they opt to buy. Americans, in general, don’t have the discretionary income they once did, and that means expensive treatment plans aren’t in the budget.

	They’ve changed their thinking about what is elective versus necessary dentistry, and they don’t want to pay a big dental bill out of pocket or add it to their credit card debt if they don’t have to. They’re more cautious about what they’re spending their money on, and that means you and your team have to work a little harder to ensure your patients receive the dental care they need.

	To thrive in this environment, your practice has to adapt to this new patient-a patient who wants to spend less and save more. You have to change the way you communicate with your patients about treatment, you have to offer more flexible payment options for patients who continue to struggle financially and you have to look at more economical alteratives when it comes to the materials and techniques you use.

	The recession may have officially ended in 2009, but many of your patients are still out of work, or worried they will be soon. Many don’t have insurance, and if they do their plan doesn’t cover as much as it once did. They have economic pressures and concerns they didn’t have before the recession hit in 2007, a reality that likely will continue for awhile and may even become the norm. This may make your job more challenging, but it’s also an opportunity for you to take a step back, look at the systems you have in place and make positive changes that will not only help your patients, but also your practice. This is the time to focus on getting back to the basics, and doing your part to educate patients about what’s best for their dental health.

	“It’s all about building the relationship with patients and communicating with them,” cosmetic dentist Dr. Marty Zase said. “Sometimes dentists have a tendency to be standoffish. If we remember doctor means teacher and teach patients what they need to know, they have an understanding of why treatment is important.”


	When money gets tight, consumers have to make changes to survive, and studies show that is happening, from Americans buying less expensive brands to making a commitment to save more money (see “What’s happening to the consumer,” below). The health care industry has seen the effects of that, with U.S. health care spending only growing 4 percent in 2009 to $2.5 trillion, the lowest growth rate in 50 years, according to the latest annual National Health Expenditure Accounts (NHEA).

	What does that mean for dentistry? Spending for dental services declined 0.1 percent in 2009 to $102.2 billion compared with 5.1 percent growth in 2008. Out of pocket spending for dental services, which accounts for more than 40 percent of dental spending, declined to 5.5 percent in 2009.

	These numbers and this new consumer mentality is exactly why you have to up your game. If you don’t, you’re going to get left behind.

	“Every recession people pull back and these spending practices become new habits,” consultant Dr. Dean Mersky said. “We also have the threat of a new norm in our national economy. It’s very possible unemployment will have a new higher normal. It’s possible that as companies scale back on benefits, fewer dental benefits will be a new normal.”


	A majority of today’s patients are driven by what they need rather than what they want, cosmetic dentist Dr. John Weston said, so if you present treatment plans as purely cosmetic they’ll most likely say no, or maybe later. If their insurance doesn’t cover it, in their mind, that means it isn’t a need-even if you know it is. But if you educate patients about what will happen if they don’t do anything and provide real evidence of “need,” they are more likely to accept treatment. It also helps them see why the treatment you’re recommending is necessary. Times like this can help get you back to the nuts and bolts dentistry you likely weren’t doing as much of when the economy was thriving.

	“It’s just about education,” Dr. Weston said. “We’ve always approached it that way, but we’re taking it to a higher level now, and it’s been great for my practice. Now we’re doing more of what we probably should have been doing. We’re doing more smaller cases now and fewer larger cases (compared with before the recession).”

	Many patients are looking for practices that offer third party financing, and CareCredit has been one of the most popular options for nearly 25 years. Here, we talk with Bete Johnson, Director, Business Development, on what CareCredit can offer your patients and your practice.
	
	DPR: How would you say the recession has changed the dental patient as far as what they’re willing to pay for out of pocket?
	
	Johnson: The recession has impacted patients in several different ways, which has changed the way they view and pay for their dental care needs. Though the S&P is the highest it’s been in 3 years, consumer confidence is now at only 63%* (90% is considered a healthy level*).

	First, as employee health care and dental benefits have been reduced, more patients are paying out of pocket for their care to bridge the gap between their insurance coverage and the cost of the care. Second, many people have adjusted their financial priorities and spending behavior because of job changes or budget requirements. As a result, patients remain hesitant to tap into their savings or use any remaining available credit on their consumer cards and may not have access to previous lines of credit (i.e., Home Equity credit lines). Instead, patients are prioritizing their spending on more fundamental needs and saving more ‘just in case.’

	In this ’new normal’ environment, patients are coming into the practice knowing what they are willing to spend-and what their non-cash resources are- before they even know the dentist’s recommendations based on a clinical examination. They’re taking more time in between hygiene visits; and elective, cosmetic dentistry is not being readily considered, if at all.
	
	DPR: With more patients struggling financially, how can dentists help them get the care they need?
	
	Johnson: Offering a dedicated line of credit for health care expenses through a program such as CareCredit is truly an extension of the level of service a doctor can provide. As part of the broader conversation before the clinical examination, including a discussion about what to expect during the visit and verifying patient information, communicating with patients about financial options enables them to focus on the dentist’s recommended care and not on how they are going to pay for it.

	During the financial conversation, it’s helpful to discuss the cost of care in terms of both total treatment fee and estimated monthly payment, giving patients as many choices and as much information as possible to determine what best fits their individual financial situation. It also is important for the dental team to clearly communicate the value of the dentistry needed and the consequences of delaying or declining care.
	
	DPR: Can you tell me a little about CareCredit and how it works?
	
	Johnson: CareCredit is a health care credit card for every member of the family, including pets, and has provided health care payment options for nearly 25 years and for more than 20 million consumers.

	Patients complete a short credit application and credit decisions are provided in seconds. Patients can immediately use CareCredit for their elective treatment needs. CareCredit is a revolving line of credit that can be used at any of the nearly 150,000 health care practices that offer the program, including dentistry. Patients have a set credit limit and, as they pay down their balance, they can use the line of credit again for additional care for themselves or their entire family, at any of the health care practices that offer our program. CareCredit offers two basic payment plans to meet a patient’s financial needs.**
	
	DPR: What are the benefits of using CareCredit for patients? How does having a revolving line of credit benefit the entire family?
	
	Johnson: The biggest benefit for patients is the ability to get the care they need without delay and conveniently pay over time with monthly payments. The most popular patient choice is a No Interest plan that charges no interest when account holders make their required minimum monthly payment and pay the entire balance in full within the promotional period. CareCredit enables patients to retain their savings for emergencies and their other credit cards for day-to-day expenses. And the revolving line of credit I described earlier helps the entire family access care with no need to reapply.
	
	DPR: What are the benefits for dentists?
	
	Johnson: For dentists and their teams, CareCredit makes financial conversations easier by providing another payment option. When patients have multiple payment options to choose from, it helps them access the care they need.

	The provider’s ultimate responsibility is to the patient. CareCredit helps providers focus on the important job of diagnosing and delivering care, and making sure the patient understands the recommendation, by lessening the financing and administrative tasks that come with managing their own payment plans. Another benefit is the financial relationship is now between the patient and CareCredit, reducing team stress and the likelihood of patients delaying care or hygiene because they have an outstanding balance with the practice.
	
	DPR: Has there been an increase in the number of patients using CareCredit and offices offering it in recent years?
	


	Johnson: Founded in 1987, CareCredit was initially offered to doctors to help their patients pay for new dental implant technology. Continued advancements in technology, and procedures that are often not covered or fully covered by insurance, have created new choices for care, increasing the demand for financing options. The number of practices offering CareCredit grows steadily every year.Today, CareCredit is offered by 86,000 dental practices, nearly 7 out of 10.

	Two of the primary reasons doctors add CareCredit include: patients request CareCredit by name, which is a strong indicator of increasing patient preference to use CareCredit; and at the recommendation of one of their colleagues, which indicates high satisfaction with the program.
	
	DPR: Is there anything else you’d like to add?
	
	Johnson: One of the most unique aspects of our program is our Practice Development Team. These dedicated professionals educate dental teams on how to integrate financial options into the practice and provide valuable, customized reporting, including benchmark data. Many practices tell us they value the training, best practices and growth ideas their representative provides, based on their experience meeting with other dental teams on a daily basis.

	In addition, our dedicated CareCredit Practice Support Center is available 24/7 to answer questions and support practices with practice enhancing resources. We also have a dedicated Healthcare Customer Service team that treats patients as the practice would, with respect. As a result, our cardholder satisfaction ratings are very high, with more than 96% indicating they would recommend CareCredit to a friend or family member.***

	Most importantly, we are partners with our practices that offer our program, working together to help more patients access care and providing a variety of payment options patients need and appreciate.
	Your readers are invited to call 800-300-3046 to speak with one of our professionals for more information about our program.
	
	 * The Conference Board Consumer Confidence Index, March 2011
	** No Interest Plans for 6, 12, 18 and 24 months that charge no interest when account holders make their required minimum monthly payment and pay the entire balance in full within the promotional period.
	-- Extended Payment Plans for 24, 36, 48 or 60 months. These plans carry an interest rate that is more competitive than most bankcards and feature a fixed, equal monthly payment and a longer term.
	*** Bi-annual Cardholder Satisfaction Survey, October 2010


	The patient sitting in your chair may need thousands of dollars worth of dental work, but that doesn’t mean you should overwhelm that patient with a dollar amount he or she likely can’t afford. That’s the fastest way to get a patient to say “No, not now.”

	It’s your job to help patients prioritize treatment, Dr. Zase said. Make it OK for them to postpone some of the needed treatment, as long as they’re not being neglectful. Listen to your patients about their financial concerns, and let them know you understand and will do what you can to make treatment manageable. Talk to them about what really needs to happen now and what can maybe wait six months or a year. Give them all their options and help them see the value in what you’re offering. Remind them that if they don’t do anything, they may end up spending more to fix serious problems you’re giving them the chance to prevent.

	When presenting a treatment plan you need to be realistic, said Tom Limoli of Limoli and Associates (limoli.com). Don’t diagnose the patient based on the number of crowns he needs and expect that patient to accept treatment. Slow down and make it digestible for your patients. Focus on building relationships and trust, not just your bottom line.

	“The basic treatment planning dentists learned in college has always been you remove first, then you repair, then you replace. That can’t happen until you stabilize the patient. Once you stabilize the patient, and it’s not getting worse, then you begin to repair, then you move to replace,” Limoli said. “Patients are looking for a partner in health, and unfortunately they’re not getting it from a lot of dentists. A patient walks in the door, sits in the chair and the doctor says you need a crown here a crown here and that will be $4,000. The patient may need those crowns, but that patient has been to three other dentists who told him the same thing. Patients are looking for somebody who will treat their overall health but who will treat it in a way they can make work for their budget.”


	When you deliver the treatment plan in phases, Lois Banta, of 

, said the first phase always should involve attaining life-long oral health and comfort. Discuss with your patients how they can keep their teeth over a lifetime, and again, spend time listening.

	“When talking about phased dentistry, you have to listen to what your patients want so you can tell them what they need to do to get there,” Banta said. “If you tell them what they need before they’re ready to listen, they’ll come back to how it’s too expensive.”

	Once it’s your turn to do the talking, it’s important to know the right thing to say, Banta said. Often, if you say something just a little differently, you’ll get the message across and get patients thinking about why they should get treatment, not focusing on why they shouldn’t.

	Be sure to use benefit statements when talking with patients about treatment options. Explain to patients who aren’t sure if they really need that crown what the health and financial consequences may be for delaying care. But don’t leave it at that. Let them know you want to make sure they have the least amount of out of pocket cost possible. Help your patients see the long-term benefits of receiving the care now versus waiting until the problem gets worse.

	When patients leave you with a maybe because of financial concerns or because they want to talk out their options with their spouse, you or your treatment coordinator should get them out of “maybe” and actually get them to “no,” said Amy Morgan, CEO of 

. The patient will feel better but not stalked, and while you’re getting “no” for now, you have the opportunity to find out what the real obstacles are that need to be transcended to ultimately get to the “yes.”

	“If a patient says ‘I want to do cosmetic dentistry but I’m not certain about insurance or keeping my spouse in his or her job,’ look at that patient and say ‘What I hear you say is it’s no for now. What are the criteria that we need to help you get to yes?,’” Morgan said. “Even if yes isn’t for two years down the line, having an agreement that the treatment plan is essential and that the practice is going to work with the patient to get to yes opens up the opportunity for positive discussion and flexible options to get the practice and the patient where they want to be.”


	Not a lot of patients have dental insurance these days, and even if they do, that insurance isn’t going to cover much for patients who are in need of pricey cosmetic work. Phasing treatment by doing what’s most important first helps make the cost more manageable for the patient, but that alone often isn’t enough. Many patients need some sort of third party financing option, Periodontics Clinical 360 team member Dr. Richard Huot said, whether that’s CareCredit (see “What third party financing can offer,” p. 63) or the ability to use a credit card.

	Many doctors are afraid to talk about money with their patients, Dr. Zase said, but these days you simply must have that conversation. Dentistry is expensive, but there are many organizations willing to help finance dentistry, many of them interest-free if the patient pays the amount in a certain period of time.

	Dr. Weston offers outside financing in his practice, something he said his patients use every day. He looked for a lender with more lenient conditions to make it easier for his patients to qualify for a health care loan, enabling patients who don’t have the best credit to still get the treatment they need.

	“The nice thing about outside financing is the dentist office gets paid upfront and the finance company collects the fee from the patient. You get the money up front like a cash paying patient,” Dr. Weston said. “The company charges a small fee for their services, but it allows you to treat those patients who were going to walk out your front door, so that’s a pretty big value.”

	But for some patients, even these financing options aren’t enough. They’re just not able to get a loan, no matter how flexible the conditions. That’s where internal financing becomes an option, though it’s not a popular one with many dentists. But with more offices moving to e-communications and online bill pay, there’s a great opportunity to create dynamic, customized financial solutions to help patients afford care, Morgan said.

	How can you make this work in your practice? You have to create systems for financial arrangements and collections that are modern and that actually satisfy the patients you’re delivering the dentistry to, Morgan said. You have to understand your existing system’s strengths and challenges and look at what’s working and what isn’t. It also means clearing out any old debt.

Many doctors are hesitant to offer internal options, Morgan said, but if you have the systems in place it’s not as risky as many think. If you can help patients set up automatic payments online, the risk of them not paying each month decreases significantly. And you don’t have to worry about draining practice resources to prepare bills and spending money to stamp envelopes to snail mail them. Today, it all can be done with an automatic system that you monitor through e-blasts and texts.

	The economy may be down, but that doesn’t mean you can’t invest in your practice. Keeping up-to-date on the most current technologies will not only attract patients to your practice, it will wow them while they’re there, Dr. Marty Zase said. Cutting-edge technology, like lasers, is a way to generate patient interest and position yourself as an innovative practice focused on patient care. Featured on the right is the Odyssey Navigator Diode Laser from Ivoclar Vivadent.

	“Learning effective skills to create strong financial systems to allow patients to get dentistry and get the practice paid is an art form,” Morgan said. “It does require training, re-invention of processes and thinking differently, but strong financial options are very often going to be the make/break for success.”

	Still not convinced this is a viable option for your practice? Banta suggests having patients who don’t qualify for third party financing make payments before their procedure rather than after it. These patients pay a small monthly fee, which ensures you get paid and helps them get their confidence and their credit life back, not to mention the dental work they need to stay in good health.
	Even for patients who are out of work and struggling financially, there are options you can offer to help them get the care they need. It just takes a little creativity and flexibility.

	“There’s a way around every obstacle, you just have to look for the way around it,” Banta said. “You have two choices, look for a way around it or you can wallow in it. I choose the latter. It’s a lot more fun.”


	Offering high quality service isn’t enough these days, Limoli said. It’s expected. Patients have high expectations and will not spend their dollars at your practice if they don’t feel valued. Now’s the time to give that little bit extra to let your patients know they’re in the right place, to help them feel more confident when they do make the financial commitment to a treatment plan.

	There are simple gestures you can make to take your practice above and beyond, Banta said. Have a new patient coming in this week? Give him a call the night before to let him know you’re looking forward to meeting him. Take him on a tour of the office when he arrives the next day. Keep patients of record informed of the latest advancements offered at your practice and services you’ve added for a more personal touch. Give patients a call after a procedure just to see how they’re doing, and be sure to send the same patients home with a TLC kit filled with Hershey Kisses, Tylenol and chicken soup. 

	Banta calls this focus on customer service a secret weapon that will keep patients loyal to your practice, no matter their financial situation. Decay and cracked teeth aren’t going away because the economy is bad; patients are stressed and likely have more dental problems than they did when times were good. Upping your customer service, which includes offering flexible financing and searching for more affordable alternatives, will make patients want to spend they’re money with you, even if that isn’t today.

	“Many behavioral psychologists and researchers have indicated people make decisions based on emotion,” Dr. Mersky said. “The behavioral economists believe there is no rational thought to what drives the economy, it’s mostly emotion and that’s what creates bubbles and swings. This type of thinking has weaved it’s way into marketing and advertising and underscores the importance of the customer experience in the decisions they make…We all know patients aren’t checking margins and don’t understand contours and bonding and all the things we do, but they do understand how they feel about the experience.”


	Sure this is a stressful time for your patients, but it’s also a stressful time for you. You and your team members are working extra hard to get patients to accept treatment plans, and you’re worried about how the struggling economy is affecting your practice.

	Patients base your level of expertise on how well you treat them when they walk though the door, Banta said. If you’re stressed about the economy, or anything at all, you can’t let your patients see that. It only creates a negative scenario for the patient, who will be less likely to accept needed treatment from you and more likely to visit the practice down the street. Remember patients aren’t just more selective about the dental treatment they’ll accept; they’re also more selective about who they’ll let do it.

	“It’s a constant work in progress. Have team meetings often on addressing issues early, and strategies in place for helping patients get what they need. If you don’t have a positive attitude it will eat you alive as well,” Banta said. “You have to get more creative with how you handle stresses that come along with that. Like increasing customer service, building relationships, changing your body language and increasing verbal skills to help patients have a very positive experience in your office.”

	Offering patients more economical alternatives is a great way to get them on board with a treatment plan. They’ll like the fact that you’re working with them so they can get the care they need, and if the bill feels more manageable, they’ll be more willing to take it on. It also goes a long way toward gaining their trust.

	Through skills he’s learned as a member of the 

, Dr. Weston offers direct bonded cosmetic treatments, a great alternative for patients who are looking to save money but still want high-quality results.

	“I’ve done more of this in the last three years of practice than in the last 10 years,” he said. “Patients are looking for affordable alternatives and I have developed the skill to do it. Pursuing training that expands your skills in the area of direct bonded restorations for anterior teeth is huge. For about half the price of porcelain I can do a direct bonded restoration that will look great. It’s durable and a nice long-term transitional option that’s affordable. Patients come to my practice and I offer them a direct bonded option and they go for it. We can treat a patient who was forced to say no everywhere else because the doctors only offered a lab restoration option.”

	There are also lower-cost options and procedures for posterior teeth, including doing more direct bonded filings instead of porcelain inlays. Using direct materials allows you to do more quadrant dentistry, and done well, may even last as long as porcelain.

	There also are ways to help make implants more affordable, Dr. Weston said. These days, he’s doing more stock abutments than custom abutments, and instead of doing an implant per tooth he’s placing implant bridges. He’s also using his patients’ transitional partial dentures  as surgical guides when he can, and he’s slowing down the treatment time. More patients are opting to extend their healing time to five or six months and then maybe start the crown the following year.

	Dr. Huot also has noticed that if patients need an implant, they’re putting off the final restoration as long as possible. Patients are getting the prep work, and then they’re waiting.

	“The advantage we have is we can have an implant placed and it can stay like that for an indefinite amount of time. It’s important for dentists to work as a team with their patients. Let’s at least get the first part done and revisit it later,” Dr. Huot said. “But I don’t think there’s a real clear alternative to implants like dentures. That would be drastic. People might go with bridges, fixed bridges where they’re just replacing one tooth. The insurance company may not pay for an implant but will pay for a three-unit bridge for a patient who lost a tooth. You can make that an alternative choice even though the implant is the better treatment. It’s almost like a fall back option.”

	It comes down to looking for ways to make treatment more affordable, whether it’s by changing the procedures you’re doing or by talking with your lab about using more economical materials so you can pass that savings on to your patients. It may take a little research, talking with colleagues and taking extra classes to be able to offer your patients these options, but the extra work will be worth itwhen you turn an, “I’m not sure I can afford this” to a, “Yes, when can we get started?

Discounts can help clear debt                                                                  

	Before you set up a new financial system, you need to collect any outstanding debt, Pride Institute CEO Amy Morgan said. Send an amnesty letter to patients explaining you’re very sensitive to the fact that many patients have been struggling with financial concerns for quite some time, and you never want patients to compromise their care because of lack of affordability. Let them know to create new options, you’re looking at old accounts and offering a 10% adjustment. Announce that you’re becoming more flexible financially and explain what options you have available. This not only gives them a bit of a discount on their current bill, but lets them know you’re willing to work with them on any future bills.  


	Just because a patient isn’t willing to take on a pricey cosmetic case doesn’t mean he might not be willing to consider low-cost elective continuing care or restorative options that will help him care for and preserve his health, Morgan said. The continuing care department that offers whitening, sealants, fluoride treatment, clear aligners, lasers, sleep therapy and anti-microbials is providing low-cost solutions that will help patients remain invested in their dental care.

	“There are many, many options and if patients feel like the options you provide are customized to their needs from a financial and treatment point of view, the more likely they are to commit,” Morgan said.

	A strong recall program also is important, Dr. Weston said, because prevention is key not only to keeping patients healthy, but to keeping costs down as well. Having a healthy patient base means when patients are ready for cosmetic dentistry, there aren’t many, if any, problems holding them back. It’s important to help people protect their dental investments, and to make sure you catch problems while they’re still small.

 You’ve likely noticed a change in your patients. The patients who come through your practice are more selective these days. the economy has made that a necessity for most americans, whether you’re talking about the type of dentistry they choose to go forward with or the type of car they opt to buy. Americans, in general, don’t have the discretionary income they once did, and that means expensive treatment plans aren’t in the budget.

Recession-ERA Recalls

	No matter how big or small your lab is, you’re not in this alone.

	And if you feel like you have been, it’s time to make a change. As a lab owner or manager, you have a large network you should be tapping into on a regular basis, whether you’re looking for advice about a new technology you’re thinking of incorporating into your lab or you’re looking for a new technician to add to your team. Creating strong relationships with each piece of your network will help you stay up-to-date on the latest industry happenings and product development, and that will lead to higher quality work coming out of your lab as well as new dentists becoming part of your client list. But to reap the benefits a large network provides, you have to make an effort to build new relationships and further strengthen the ones you’ve already developed.

	When thinking about who’s in your network, think about who you regularly interact with, or who you know you should be regularly interacting with even if you’re not. Dentists and their staff members, specialists, vendors, outsource providers, fellow lab owners, state and national association members and leadership, your employees, study club members and the folks in your community all should be considered part of your network. These people are your partners in dentistry, and working closely with them will not only help you grow, but also the industry as a whole.

	“Laboratory owners and technicians are operating in a global market,” National Association of Dental Laboratories Chief Staff Executive Bennett Napier said. “It’s extremely important that individuals and organizations are linked in with all allied interest groups and professional peers to share information, ideas and be a part of affecting change as a collective body. The interdependent relationship between laboratories, dentists and manufacturers is paramount to positive growth for the domestic market.”

	But knowing who’s in your network is only a small part of this. Now, you have to start building those relationships. Yes, that can be overwhelming, especially if the mere thought of networking makes you more than a little uncomfortable. But there are ways to get there; you just have to be willing to make the trip.

	Building strong relationships with your clients is key to ensuring you’re producing high-quality work, work that you, your dentists and, most importantly, the patients can get excited about. Effective communication between labs and dentists can be challenging to achieve, but if you take the time to reach out to your clients it will become easier and eventually it will be part of your routine. You can’t expect them to come to you; make a habit of calling or e-mailing them to check in. They’ll appreciate your efforts and will be more likely to come back to you with another case.

	DLP Benchtop Editor and Matrix Dental Laboratory owner Tom Zaleske typically follows up on every case a week or two after it’s been delivered. It’s important to him to let the doctors know he cares about the end product, and wants to resolve any issues that may have come up or concerns the dentist may have. He also uses this time to get to know the doctors, and may spend a few minutes chatting about plans for the upcoming weekend or getting an update on the client’s daughter who just started college. But he also uses the time to talk business. If his clients are telling him their business is starting to slow down, that indicates to him it might be time to start actively looking for more clients.

	But regardless of what they talk about beyond the case, these check-in calls are vital for establishing that relationship, to let your clients know you’re available and that you’re happy to resolve any problems that may have come up throughout the process. It shows you’re someone who takes action, and it also gives them a chance to tell you about problems you wouldn’t have known about otherwise.

	“In the early years, I thought no news is good news, but that’s not really the case any more,” Zaleske said. “You can’t let your accounts just cruise along without checking with them and calling them. Now no news isn’t good news. No news now means maybe they’ve moved on to somebody else and are using another lab. In this competitive time you can’t just think things are status quo. You have to stay up front and make sure everything is good.”

	It’s also important to keep the dentist involved while you’re still working on a case, said Mark Jackson, RDT, Vice President/GM for Precision Ceramics Dental Laboratory. When a case comes into Jackson’s lab, it’s logged into a computer and an order confirmation with a case number is e-mailed to the dentist. The confirmation e-mail includes a link that enables the doctor to check the status of a case until it’s delivered. While Jackson said many doctors still call with questions, this is a great way to keep busy doctors in the loop with a single e-mail.

	Much of the communication between Jackson’s lab and his clients is done via e-mail, he said, because it’s the best way to document. But if there’s a problem with a case, the communication has to go beyond that. He’ll take a picture of a case and shoot the doctor an e-mail if he has a question, and if that isn’t enough he’ll set up a GoToMeeting or a Skype call. He has it set up so the doctor can actually watch what he’s doing in real time, and the two of them can talk about any problems or concerns live as he works on the case. That makes the doctor even more involved in the process and further strengthens that all important dentist/lab technician relationship.

	Not only do these types of communications keep your doctors happy and in the loop, it may even inspire them to refer a friend or two your way, Zaleske said. If dentists are happy with your work, they’re happy to refer-but you have to ask. Just let them know you’d love to work with more clients like them and chances are they’ll know of someone looking for a new lab. The best part? Most of these referrals will end up being great clients who pay their bills on time. They don’t want the embarrassment of a friend or trusted colleague finding out they’re not paying their bills, so they’re extra motivated to get you that payment on time.

	Yes, building that relationship with the dentist is key, but that’s not where your interaction with the dental team ends. The hygienists, the assistants, the front office and the specialists are all part of your network, said Lonni Thompson, CDT, owner of Image Gallery in Dublin, Ohio. Everyone at her lab knows every doctor’s staff, and who they should call with problems or questions. Her office manager connects with each office daily, but that doesn’t necessarily mean talking with every dentist every day. The team members are trained, knowledgeable dental professionals and can help answer your teams’ questions so the doctor doesn’t have to, which is something a busy doctor is likely to appreciate.

	“Those communications are extremely important to be competitive. They help keep your remake issues down and keep the dentists happy as well,” Thompson said. “We’re a high-end boutique lab so to compete we have to provide services they need that will help make everybody’s lives easier.”

	Thompson’s lab also does a lot of implant work, so that means she needs to have strong relationships with oral surgeons and periodontists. She also works closely with orthodontists on some cases, providing consults for all three specialities when necessary. Making sure everyone on the team is on the same page is key to ensuring the patient receives the best results, with minimal problems along the way. That can’t happen if you don’t find a way to connect with them and communicate.

	Specialists outside of dentistry also can be part of your network, Jackson said. He has a cone beam CT scanner in his lab, and sends every scan to a radiologist for review. He sends the radiology report DICOM file to the radiologist via an ftp transfer. The radiologist then sends back a report, which may show problems the patient is having that aren’t related to dentistry.

	“My own son was having braces done and the orthodontist ordered ceph tracing. They did a CT scan on my son and found a 5 mm mass on his brain,” Jackson said. “It ended up not being a problem, but the fact that we can have experts look at scans and screen for pathology means they can potentially intercept a life threatening condition. They can find obtrusions, tumors, cysts, all types of things we’d never even consider at the point of treatment planning.”

	If it’s an implant case, Jackson also sends the DICOM file to a prosthodontist for review before he sends the scan to the doctor. He’s developed a website, 

, to make communication for everyone involved in the process that much easier. Doctors anywhere in the world can upload DICOM files to the site and Jackson’s lab can complete the implant case. The website features a dialogue box where doctor, lab tech and specialists can talk back and forth about the case. They can pull up these conversations and the CT file at any time, which is a great way to keep everyone on the same page and constantly communicating.

	“I see a need for more accurate implant placement. I think the technology is out there but it’s really expensive for the average doctor,” Jackson said. “We wanted to make that service available to doctors. A CT scan can be done at any scanning center in the world. They upload the file and we get it back to them quickly and have it reviewed by a prosthodontist and a radiologist. We have a team of people working on the case, and they can be anywhere in the world.”

	Working closely with specialists not only may lead to referrals from their office and improved patient outcomes, but that type of team involvement is a great value add to your clients. The constant communication and feedback gives them confidence that the lab will deliver a high-quality product, and also makes their lives easier.

	The vendors you work with are out in the marketplace and likely are pretty up-to-date on what’s going on in the industry. They are a great resource for you to find out what’s happening in your area, said Kevin Hudi, General Manager of DSG Clearwater. Without giving away any secrets, they can share what’s working in other labs and what’s not. They also can help you steer clear of areas where people are in a price war. They have a wealth of information, you just have to take the time to have a conversation.

	“They also give you extremely valuable information about how their products and services work, too,” Hudi said. “Dental labs and technicians seem to think they’re experts on everything, but we should rely on the experts that developed the products and materials to tell us how to use them best.”

	Keeping in touch with vendors is vital to the quality and consistency of the products you produce, Hudi said. They keep you updated on any changes to instructions and how to use the product properly, and they also can keep you in the know about new developments, features and benefits of the products you use every day.

	This is so important when you’re talking about big investment products, Jackson said. You can take the information you get from your vendor regarding new studies or findings about the material and share it with current and potential customers. This keeps the product hot and in front of your customer, rather than letting it get stagnant. It also ensures you’re getting the most out of your investment.

	For Jackson, it’s important for him to stay on top of the latest technologies. His lab thrives on new product development, he said, and he’s constantly introducing new technologies and materials to his customers. Having a good relationship with his vendors is a big part of making that happen. Not only can he tell his clients about the products he’s thinking of bringing in to his lab, he also lets some of his dentists test them out, which is just another element of how he builds that lab/dentist relationship.

	“I have a group of doctors who are really sort of on the cutting edge. What I’ll do is float these things past them first to see what their interest is and get them involved in testing these materials before I introduce them to the rest of my clients,” he said. “Once something gets some traction, we’ll do e-mail blasts to customers. We update our website, send out press releases, send out direct mail and post on Facebook. We use every channel we can to stay in front of our clients.”

	Chances are, no matter how big your lab is, you’re going to need to outsource. Regardless of what services you might need, an outsource provider such as Dale Dental can make it possible to offer restorations and services to your clients that you otherwise couldn’t.

	Dale Dental only works with labs, not dentists, and that means they’re not your competition, said Dave Lesh, founder of Dale Dental. That is one of the big advantages of adding an outsource provider such as Dale Dental to your network.

	“It’s important for you to have friends in your network who are genuinely part of your lab’s success and who consider you the most important customer,” Lesh said. “You’re not the most important if you’re sending cases to a lab that also works with dentists.”

	Dale is a great option for both bigger and smaller labs, Lesh said, because even if you have invested in your own equipment, there are too many options to offer your clients everything they want. Dale does have the equipment, so if you include this outsourcing lab in your network, you can provide what your dentists are looking for, regardless of what it is, rather than risking them sending the case to another lab.

	“Don’t be afraid to offer your doctors everything we have available,” Lesh said. “(When I worked in a lab) Doctors would call and say ‘hey do you make whatever product,’ and I’d say ‘No, doc, but great news we make this other one, which is just as good.’ The doctor would say ‘great I’ll send it to you when I get the case.’ Then guess what? You never get the case because the doctor called around and found someone who could make the product he wanted. Everybody gets calls like that all the time and the doctor never sends the case. Don’t try to steer customer decisions.”

	But a service like this isn’t just about providing restorations your lab can’t offer. Some labs use Dale Dental when they’re busy and need the extra help, or if they’re thinking about trying a new product and want to give it a try before they make the investment in the equipment. But no matter why you’re using this outsourcing service, every case you send them will come back to you for your final touches before it goes out to the doctor, Lesh said, so your lab can finish it for fit, function and esthetics exactly to your dentists’ preferences. Lesh’s job is to empower you to make the case for your doctor, not turn you into a broker.

	Having Dale Dental in your network will only improve your relationship with your clients, as you’re able to offer them more and more services, making you their go-to lab when they’re looking to try something a little different.

	When thinking about who you need to build relationships with to strengthen your networks, you have to include other lab owners and technicians. Not only are they great people to bounce ideas off and learn from, they may even send you referrals.

	Zaleske has set up a network of cross referrals, he said. He doesn’t fabricate partial dentures. He will set the teeth on them, but making the casting is a separate specialty his lab doesn’t do. Early on in his career he found someone who does do that and formed a relationship. But he had to make sure it was someone he could trust; it had to be someone who provided the same quality of work as his lab, and it had to be someone who wouldn’t be competing with him for business.

	“A doctor calls and says I need a partial frame made. I send it on to that lab to fabricate the frame and he sends it back to me and bills the doctor separately for his work. The beauty is the lab gets the full fee he would charge the doctor and he doesn’t have to discount me,” Zaleske said. “I refer my doctors to send the work to him and in return he does the same for me. It’s almost like we’re marketing for each other. We cross refer back and forth doctors because we’re doing different things…that works ideally with labs that do only removable and only do fixed.”

	This takes a lot of trust, as does working with another lab that does your milling. Again, you have to be sure the lab you’re working with has the same quality standards as you do, Thompson said. Remember whatever comes out of that lab will have your name on it. Use your network to help you find the right fit. Take the time to go out to these labs and talk with them before you decide which one fits best with your lab and your niche, and keep the communication going once you make your choice.

	It’s also great to have other lab owners to talk to about the latest material developments, to turn to for advice about a case and to share ideas with. Take the time to build a camaraderie with your colleagues. Make friends in the industry who you can turn to with questions and ideas.

	“One of the things that is a huge benefit to me and a lot of other people is communication with our peers, having other lab owners to bounce things off, to trade and share ideas and to help solve technical problems,” Jackson said. “So many small labs or one man labs working out of home are virtual shut ins. They don’t go to dental meetings or get CE so their world stays very small. Expanding your horizons and opening up to other technicians around the world gives you a better feel for the landscape and lets you predict trends, where the business is headed and where technology is headed.”

	Labs, wherever possible, need to participate at the local, state or national level with allied organizations, Napier said. These associations, including the NADL, offer great opportunities for networking and learning, but are outlets not nearly enough labs are using.

	“There is strength in numbers and by participating as a member or volunteer leader with an association, great things can happen,” Napier said. “The strength of groups like the ADA has come from the fact that nearly 70% of licensed dentists belong to the ADA, where technicians, at the state level or national, participate in associations at between a 10-40% market penetration rate. This means that more than half of all technicians and laboratories are sitting on the sidelines and not necessarily tapped into what is truly happening in the marketplace.”

	Beyond the fact that you need to be more involved with your industry, if you’re someone who works in a small lab and doesn’t have a huge network of colleagues, these meetings are a great place to start, Hudi said. Go to a state association meeting and make an effort to meet people. Exchange business cards and then start with light interactions when you’re back in your lab. Maybe ask a few questions via phone or e-mail to start building a rapport.

	Thompson agrees that attending meetings and being involved with associations is important to network building, and also suggests looking at local dental study clubs. She was invited to join two study clubs in her area, and even though there is a fee for membership, she jumped at the opportunity. She’s the only lab that is part of these study clubs and said she has gained a lot of respect and clients because of her involvement. 

	“When we get involved things happen, but we need to work together,” Thompson said of the importance of getting involved with associations and study clubs. “I love this industry. I’ve been in it for 38 years and I’m more excited about it today than I was when I first started. But it’s difficult. We work long hours and we work hard at it. But I think if we work together we can change the industry for the better for all of us.”

	The people working in your lab to provide your clients with a high quality product are another important part of your network, and you have to communicate with them constantly, Hudi said. 

	“It’s important that information gets cascaded throughout the organization. Your employees need to feel like they understand what their contribution is and that’s measured in sales dollars and customer retention,” Hudi said. “And if we don’t find ways to give them that information, they don’t understand what they’re doing and how they fit into the overall scheme. If they don’t understand that they can’t be as effective as they can potentially be.”

	So what are some ways to communicate with your employees? Hudi recommends using a white board in the lab. As important information comes in, he posts it there to make sure everyone sees it, including stats that show how the lab is measuring on key metrics. Not everyone in the company has e-mail, so this is a great way to get important messages out to his employees. He also holds meetings a few times a week to address important topics. He keeps them up to date as much as possible, and that helps them understand their role, which leads to a better product for your clients.

	Yes, your work keeps you busy. Yes, you want to spend time with family and friends and doing the activities you enjoy outside of work. But you have to find the time to be involved with your industry, to network with the different people who make it work. It not only helps you grow your lab, it helps unite the industry and gives its developing technology a higher profile, Napier said.

	Not only that, networking with others in your industry will help rejuvenate you and renew your passion for what you do. Thompson recently took a trip to Florida with 11 other lab technicians for an association event, and described what she learned during that trip as invaluable. She now has a new network of people she can call and ask questions, or turn to for advice when she’s hiring a new employee, something she recently did.

	These friendships and connections are what keep the industry strong, and they’re also what keep you and your lab strong. You just have to make the effort to strengthen each piece of your network and become an active part of your industry. If you don’t, you, your clients and their patients are missing out on so much.

	“When we’re stuck in our labs all the time, we get wrapped up in our heads,” Thompson said. “We need other people to bounce our ideas off. It makes for a better life and for better communication.”

 No matter how big or small your lab is, you’re not in this alone.

Navigating your networks

Master Ceramist Bob Passaro has been in the lab industry nearly 50 years and founded the Center for Ceramics in Charlotte, N.C. about seven years ago. The lab’s nine employees produce 70 to 80 units a day. This medium- to high-end, family-owned dental laboratory specializes in fixed dental restorations, and Passaro prides himself on staying up-to-date on the latest technology to provide his clients with high-quality, esthetic restorations.  

VITA VMK Master Porcelain, distributed through Vident, A VITA Company in North America, offers exceptional physical properties and handling characteristics. Because of its fine structure, the porcelain features clinical wear characteristics that mimic natural tooth enamel. Its optimum firing temperature as well as chemical and physical properties make it suitable for veneering nearly all types of dental alloys, including non-precious. Other benefits include improved modeling characteristics, minimal shrinkage and accurate, esthetic results.

After nearly 50 years in the lab industry, Bob Passaro is having more fun than ever.

Not only that, the work he’s producing is the best it’s ever been. He’s excited about what he does again, and after three attempts, he has no plans to try to retire again any time soon. And he said he owes a lot of that renewed enthusiasm to VITA VMK Master Porcelain.

After using the material for five months, he said production at his lab has increased by about 25 percent, mostly because this material is so easy to use and doesn’t shrink. His lab makes 40 to 45 units a day with the material, and he couldn’t be happier with the results.

“I’m having a ball with it. I really am,” Passaro said. “Its ability to block out underlying colors is second to none. There isn’t anything better.”

So what are some of the material’s main benefits? The minimal shrinkage is huge-Passaro said shrinkage is about 10 percent, if that much. It doesn’t shrink on the third or fourth firing like other materials he’s used in the past, and the color stability and accuracy couldn’t be better. It can be stacked in as many colors as you want, and you end up with restorations that compete with what’s coming out of high-end labs, domestic or overseas, no matter what size lab you have.

“I can’t see any lab whether it be a boutique or commercial lab not use this material,” he said. “It’s just foolproof. I took one of my people who’s a waxer and within three weeks he was stacking porcelain. It’s amazing because of the ease of working with it. There’s no technique sensitivity whatsoever.”

Not only does he love the product, he loves the company that makes it. Center for Ceramics is a VITA lab, Passaro said, and over the years he’s been impressed with Vident’s level of customer service. When his lab first began using VMK, Vident sent master technicians to his lab twice to train and re-train his employees, making sure they’re all using the material correctly and achieving the best results. 

“They’ve taken their time with this product,” he said. “They spent a lot of time re-inventing this material. It is absolutely foolproof. There’s no way to make a mistake.”

And Passaro is all about telling other labs about VMK and encouraging them to give it a try. He’s talked the material up to his brothers who work in New York, and now they’re hooked as well.

And back at his lab, Passaro said this material has taken the stress out of his work. He no longer has to worry about the production or the material. There’s no more concerns about technique sensitivity. The system truly is a complete master system.

“It just put us over the top,” Passaro said. “It’s made my life easier, and I’ve been around a long time. This material makes me as excited as the first time I baked porcelain and metal, and 1962 was  the year I did that. I’m at the bench full time. I’ve retired but will never do it again. I’m telling you I was ready to give up again, but with this material I’m having more fun than I’ve ever had and I think my work is probably better now than it ever was. The stress over the production and material and technique sensitivity is gone. Just gone. Disappears. Doesn’t exist.”

Real Time ROI: VITA VMK Master Porcelain

	Ivoclar Vivadent Inc.
	Multilink Automix
	Multilink Automix ensures a strong bond in all cementation cases and is recommended for the cementation of all IPS e.max® and IPS Empress® restorations in addition to all other restorative materials. This self-curing luting composite with light-curing option is suitable for the adhesive cementation of indirect restorations. Features include high immediate bond strengths to all restorative materials; universal application; fast, easy clean-up; and reduction in post-op sensitivity. It is available in transparent, yellow and opaque shades.

Dr. G. Franklin Shull
	Lexington, South Carolina
	General Dentist, practicing since 1994

	Variolink II was the first resin cement I trusted to bond my ceramic restorations when I started my career. Multilink Automix caught my attention as a product born from the very successful Variolink system and the self-etch chemistry ofAdheSE. There are many universal, all-in-one, resin cements out there, and they are not created equal.

	What would you say are its best qualities?

	This system uses a primer that increases bond strengths and reliably seals the dentin. The primer incorporates the smear layer and doesn’t expose dentin tubules so that sensitivity is not an issue. The real advantage is that it will bond to any material!

	How does Multilink Automix compare to earlier versions of resin cements and its competitors?

	Some of the other products on the market that are in the same category have very low bond strengths to dentin and especially enamel. Lower bond strengths can lead to microleakage and restoration failure. Another issue with earlier resin cements was clean-up after curing. We have all had to spend too much time chiseling away excess cured resin after seating a restoration. With Multilink Automix Easy Clean-Up, you can spot cure each quarter of the tooth for 1-2 seconds, and the resin cement sets to a gel that is easily peeled away from the tooth and restoration.

	Would you recommend this product to other clinicians? If so, why?

	Yes, this is a product that has had a great track record and now is even better with its Easy Clean-Up  version. With its versatility, it could be used for the cementation of 90 percent of the restorations in the office. Everyone needs a resin cement that is this good!

 Ivoclar Vivadent Inc. Multilink Automix Multilink Automix ensures a strong bond in all cementation cases and is recommended for the cementation of all IPS e.max® and IPS Empress® restorations in addition to all other restorative materials. This self-curing luting composite with light-curing option is suitable for the adhesive cementation of indirect restorations. Features include high immediate bond strengths to all restorative materials; universal application; fast, easy clean-up; and reduction in post-op sensitivity. It is available in transparent, yellow and opaque shades.