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

Renee Knight

Orville Sadler, CDT, is the head technician at Bastrop Denture and Implant Center in Bastrop, Texas. His two-person lab fabricates dentures for one doctor. The lab portion of the clinic does 15 to 20 dentures a day. Sadler has been at the clinic for 6 years and a lab technician for 41 years.

Synca Direct’s Fiber Force™ is a system of resin pre-impregnated E-glass fibers that are used to repair and reinforce dental appliances as well as for direct and indirect perio and ortho splinting. The fibers come pre-impregnated in a light-cured urethane dimethacrylate resin that reportedly allows appliances to be significantly strengthened without added weight or thickness while maintaining esthetics.

About six months ago, Sadler saw the product release for Synca’s Fiber Force in the pages of Dental Lab Products, and knew he had to give it a try in his lab. Today, Sadler couldn’t be happier with that decision.

Sadler does a lot of metal frameworks in his lab, he said, and before he started using Fiber Force he had to send those frameworks out. That meant waiting three weeks to get them back. Fiber Force is something he can do himself, in his own lab.

So far, Sadler has completed more than 60 cases with Fiber Force and hasn’t had problems with any of them. This re-enforcement system is stronger than metal, he said, and while it’s flexible enough to give when the patient bites, it doesn’t break.

“It saves me time and money big time,” Sadler said. “And I feel like they’re stronger. I’ve not had a single one come back that’s cracked or broke or anything, and I’ve had that problem with metal frames. They’re too rigid and won’t keep from breaking. I haven’t had one of these break yet.”

Not only are they stronger than metal frameworks, they’re also more affordable, Sadler said, and he’s seen a pretty significant return on investment since he began using Fiber Force. Before, he spent $55 a piece for frames. Now he buys Fiber Force in bulk, and that cost comes to $39 per frame.

Fiber Force also saves Sadler, and his doctor and patients, a lot of time. It only takes about 15 to 20 minutes for him to make a Fiber Force reinforcement, and that means same-day dentistry for the clinic’s patients. What the clinic starts in the morning they can finish in the afternoon, and that’s a huge benefit to everyone involved. Patients no longer have to wait three weeks for their dentures to come in, or worry about scheduling another appointment to get them. Additionally, Sadler can get more done in his lab in a shorter amount of time, and that of course lead to more money coming into the lab.

The esthetics Fiber Force provides are another huge benefit that patients appreciate, Sadler said. The pink acrylic color gives it a more natural appearance that patients really seem to like.

“Yes, every one of my clients (patients) love it,” Sadler said. “You can’t even tell they’re in there because of the color. With metal frames you can. And it’s lighter. So patients are much happier with them. I have some patients who I’ve replaced metal frames with these. They just look better and are more comfortable. They’re not as bulky or as heavy as metal so the denture doesn’t end up being bulky and heavy.”

The esthetics are so much better that you can’t even really tell the patient is wearing a denture, Sadler said, and that of course is a great benefit to the clinic’s patients.

“The fiber, it’s pink colored like acrylic so it blends right in instead of being silver like a cast partial is,” Sadler said. “You have to hold it up to the light to see that it’s in there. They don’t have gray spots. When people smile with metal you can see gray around their teeth because of the metal frameworks. With these you don’t have that problem.”

While he’s only been using Fiber Force for about five months, he’s impressed with what the product has done for his lab, his dentist and his patients and said he would encourage other labs to give it a try.

“It’s just a great product. It really is,” Sadler said. “It just saves me a lot of time and money and they’re so easy to make. It’s easy to do; any lab can do it.”

Articles

The Lab Orville Sadler, CDT, is the head technician at Bastrop Denture and Implant Center in Bastrop, Texas. His two-person lab fabricates dentures for one doctor. The lab portion of the clinic does 15 to 20 dentures a day. Sadler has been at the clinic for 6 years and a lab technician for 41 years. The Product

Real Time ROI: Synca Direct’s Fiber Force®

Sexual harassment isn’t a topic most people like to talk about, especially in the workplace. But just because you’re not talking about it doesn’t mean it can’t happen in your operatory.

Ignoring the fact that sexual harassment can and does happen in dental offices only leaves you and your employees vulnerable to potential problems. Instead of pretending it isn’t an issue, there are ways you can protect yourself and your team members. Investing in training, developing a policy and simply knowing what to do if an allegation is made are all ways to help you avoid ever needing to deal with such a claim, but will prepare you for the worst if you ever have to.


	Sexual harassment is “unwelcome verbal, visual or physical conduct of a sexual nature that is severe or pervasive and affects working conditions or creates a hostile work environment,” according to the Equal Rights Advocate Web site. The problem is, every person’s view of unwelcome is different. Some of your team members may not think twice about a seemingly innocent pat on the back, while it may make others uncomfortable. And intent doesn’t matter. If your actions make someone uncomfortable it can be considered sexual harassment, even if you didn’t mean it that way.

Never be alone with a patient. Always make sure a hygienist or a dental assistant is with you, Penny Reed Limoli said. That way if a patient falsely accuses you, you have someone who can back you up.

“It can be anything you say, even it’s just ‘oh look at this picture’ and the person is offended by the picture. Or it can be physical conduct as far as rubbing somebody’s back or shoulder or even hugging,” said Penny Reed Limoli, owner of the Reed Limoli Group. “I can remember a doctor I knew years ago who had morning huddles and everybody would get a hug afterward. Allegations were filed against him for those hugs. You have to remember all of us are not the same. What I might think is welcome to someone else might be very unwelcome.”


	Bringing a professional in for training is a good way to get everyone on the same page when it comes to what sexual harassment is and what won’t be tolerated in your practice. These training sessions usually only take a few hours out of your work day, and are well worth the time, said Mitchell Karp, founder and lead consultant at Karp Consulting Group Inc. And if you’re worried about the stigma of calling it sexual harassment training, label it something else. Call it training on how to build better working relationships, or how to create a better working environment.

“How it’s communicated and how it’s positioned is important,” Karp said. “A dentist who positions this as we need to be mindful of how we interact with our patients and how we interact with each other and the more knowledge we have the more skilled we’ll be, that dentist is ahead of the curve.”

Before you schedule the group training, you may want to think about going to training on your own first, Limoli said. Chances are sexual harassment training wasn’t covered in dental school, but it’s still something you as a small business owner should take seriously. Attend a more in-depth training first that’s geared to HR professionals or small business owners, and then schedule a lighter version for your team.

Unfortunately, with more employee training comes an increased number of fraudulent claims being filed, said Anika Ball, Executive Director of the American Society for Dental Ethics. Patients and team members see you as someone who has large financial assets and may be looking for ways to take advantage of that. It’s just something you have to be aware of.

“With more education comes the possibility of it being abused,” Ball said. “So now we have some disgruntled employees who use it as a weapon.”


	Putting a policy in place and making sure your employees are aware of it also is key to avoiding problems, Ball said. Include it with the employee manual and maybe even post it somewhere employees can see it. Go over the policy every time you hire someone new. Make it clear what type of behavior is expected, and make sure your employees know where they can go if they ever feel like they’ve been a victim of sexual harassment. Offer a list of organizations they can turn to, such as the Equal Employment Opportunity Commission and the state dental board.

Being proactive helps build trust, and lets your team members know they can come to you if they ever have a problem with another employee or a patient. But no matter how much you want your employees to come to you with their work-related problems and concerns, they’re probably not going to feel comfortable talking to you if you’re the one who has said or done something they feel is inappropriate, Karp said. As the dentist, you’re the one with the power-even if that’s not how you see it. You control their wages, their vacation time. You simply aren’t the right person to talk with in this situation. Consider making an arrangement with a third party, like a lawyer or an outside consultant, who employees can turn to if needed. Make sure they know how to contact that person.

If you don’t want to go this route, let your team members know they can always talk to a trusted office manager or another dentist in the practice, Limoli said. But if they’re truly planning to make such a serious accusation, they’re going to need an attorney.


	
	In 2000, 540 randomly selected dental hygienists in Virginia were sent a questionnaire about their experiences with sexual harassment. Here’s what the researchers found:
	54% of the responding dental hygienists experienced sexual harassment, and of these, 50% experienced it four or more years ago, 23% one to three years ago and 28% within the last year
	The people being accused of sexual harassment were either male dentists (73%) or male clients (45%).

While 70% of the sexually harassed respondents indicated that filing formal complaints was an effective strategy to manage sexual harassment, less than 1% actually did so.
	Source: Sexual harassment in dentistry: experiences of Virginia dental hygienists, found on pubmed.gov.


	Remember sexual harassment isn’t just an issue that can come up within your team. Something your hygienist says or does may make a patient uncomfortable, or vice versa. You can’t control your patients’ actions, but you can take steps to ensure your staff members aren’t the ones doing the offending.

Make it a policy to “keep it a family show,” Limoli said. Your staff members should act professional at all times, even when they’re not in the same room as a patient. Most practices aren’t that big, and patients often can hear you when you’re talking in the hallways or at the front desk.

“You have to conduct yourself in a professional manner, almost as if you were on camera. You are on stage,” Limoli said. “When you are in that practice and patients are there, you need to conduct yourself differently than you would if you were out with personal acquaintances enjoying adult leisure.”


	No matter how many precautions you take, a team member or a patient still may make an allegation against you-even if it’s not true.

If someone accuses you of sexual harassment, the first thing you need to do is contact a lawyer, Ball said. Find out what documentation you need and start gathering it. But whatever you do, don’t confront your accuser and don’t talk with other people in your office about what you should do or how ridiculous the claim is. Talk to your lawyer and determine what steps you need to take from there.

“When issues of inappropriate behavior or allegations of biased or harassment come up, many human beings feel like someone is throwing a finger in their face and saying they’re a bad person,” Karp said. “Often people react to those allegations by engaging in behavior that leads to a second claim of retaliation. They think, ‘How dare you treat me like this.’ You have to manage the emotional reaction of being accused with your professional obligation to not retaliate in any way.”


	If one of your employees comes to you with an allegation about another employee or even a patient, you can’t take it lightly. If you dismiss the claim, you open yourself up to a lawsuit down the road. And the same is true if it’s a patient.

“Your patients and employees have a trust in you as a professional,” Ball said. “And if you aren’t following through with seeking their best interest then they may feel abandoned, unheard or disrespected.”

When a staff member comes to you, ask that employee to put the allegation in writing and then call an attorney for advice, Limoli said. Have the staff member outline what happened and what he or she felt the intent of the conversation or action was.

After you’ve gotten some guidance from an attorney, it’s time to confront the employee who’s been accused of sexual harassment. Sometimes the act is so inappropriate there’s no second chances, Karp said, but if you’re planning to keep this person on board you have to be clear about what is appropriate and what isn’t.

“Let the person know you’re putting something in their file, and give them a warning,” Karp said. “You’re going for zero tolerance because it undermines morale and productivity. Make it clear you want to focus on providing outstanding dental service to your patients.”

If it’s a patient causing the problem, you need to have a similar conversation, Karp said. This can be difficult because you don’t want to lose a revenue source, but you can’t let your team members work in an environment that makes them uncomfortable. Talk to this patient like he or she is your best friend; getting nasty won’t help. Let this person know you and your team take your work seriously, and his or her comment or action was inappropriate. Don’t worry about losing the patient. In fact, depending on the situation, that may not be a bad outcome.


	No matter who has been accused of inappropriate behavior, your team members will find out about it and they will gossip. Staff morale may become low and productivity will drop. Some staff members may even quit because they just don’t feel safe in your practice any more.

“An allegation significantly affects morale and productivity because they’ll (team members) have that sense of loss of trust or violation,” Ball said. “If it’s within the staff dynamic it could be a difficult situation, especially if it’s not addressed quickly. It has a huge affect on the cohesiveness of that working group.”

You might be tempted to call an emergency staff meeting to ease some of your staff members’ concerns, but that really isn’t a good idea, Limoli said. This could be very uncomfortable, especially if the accuser and the person being accused are in the room. Don’t call a meeting or even talk to individual team members about what they saw or what they know until you’ve talked to an attorney.


	It might seem like common sense, but simple things like asking patients if they’re married or single may give the impression that you’re hitting on them. Keep conversations with your patients strictly professional to ensure nobody takes anything the wrong way.

Training, a written policy and just having a plan in place in case an allegation is made are all key to handling what can be an awkward, messy situation. If you make sure you and your employees know exactly what sexual harassment is and that it is not tolerated in your practice, you’re less likely to have to deal with problems that stem from inappropriate behavior.

“Sometimes these things are indicators of break downs in communication, break downs in trust, reluctance to give feedback,” Karp said. “It’s really about how people work well together in an office setting and how people learn to manage boundaries and identify what is appropriate and inappropriate behavior and how to handle it.”

 Sexual harassment isn’t a topic most people like to talk about, especially in the workplace. But just because you’re not talking about it doesn’t mean it can’t happen in your operatory.

Dealing with sexual harassment in the operatory

	The people who come to Dr. Kevin Boehm’s practice all have one thing in common: they want their dental care done naturally.

	They’re not interested in what antibiotic can cure what ails them. These patients are looking for a more holistic approach to health care, and would much rather turn to something like acupuncture, homeopathy or a diet change to get their dental health back on track. Through Traditional Chinese Medicine, Dr. Boehm offers them just that.

	Before you can know if Traditional Chinese Medicine will work for your practice, you need to know what it is. It’s based on having a balanced qi, or energy flow, throughout the body. This philosophy says qi regulates a person’s physical balance and is influenced by opposing forces of yin (negative energy) and yang (positive energy). These energy channels course throughout the body and must remain in balance. If the yin-yang connection is thrown out of balance, it can set off a chain reaction that stimulates health problems. Each energy channel, or meridian, has a specific pathway it travels, zigzagging through the body to seemingly unrelated places.

	The Meridian Tooth Chart is how this all ties into dentistry, and is one element of Traditional Chinese Medicine that has become part of Dr. Boehm’s practice, which is listed on ChicagoHealers.com. The chart shows the relationship between teeth and various organs, tissues and glands in the body. Each tooth is related to an acupuncture meridian. Using this chart, dentists can evaluate a patient’s overall health and wellness by assessing their teeth’s current condition. If there is a problem with an internal organ, the associated meridian tooth may be the source of the problem.

	The chart is on every office computer in Dr. Boehm’s practice, and he said it’s amazing what correlations you can find. He doesn’t show it to every patient, but there are some patients who even ask him about it and what it might show about an ulcer or some other health problem they’re dealing with.

	“It goes back a few thousand years. Traditional Chinese Medicine says if you have a certain ailment, you likely have problems with a certain tooth,” Dr. Boehm said. “Whether that’s true 100 percent of the time or not I don’t know, but if you look hard enough you’ll find a lot of things that could be tied in there.”

	The tooth chart is just one aspect of Traditional Chinese Medicine that can be beneficial to your patients. Dr. Boehm also offers homeopathy, acupuncture and cranial work, which is similar to chiropractic treatment but gentler. Cranial therapy is most beneficial to his orthodontic patients, he said, because it helps sutures in the skull relax themselves so they can be moved around with great ease and flexibility. When he has time he may do a little cranial work on patients who come to him for orthodontics but he also has trained acupuncture and cranial therapists in his practice, as well as a network of 50 to 60 specialists he can refer patients to if necessary.

	He also uses changes in nutrition and homeopathy rather than antibiotics to help patients get perio problems under control. Adding Vitamin C, for example, to a patient’s diet won’t hurt a patient suffering from periodontal disease, so why not try it and see if it works before going to an antibiotic?

	If this sounds like something you’d like to add to your practice, there are plenty of places you can check out to learn more. The Holistic Dental Association, the International Academy of Oral and Maxillofacial Toxicology, and the International Academy of Biological Dentistry and Medicine all offer classes and put together meetings designed to help dentists get started down a more holistic path. Going to meetings and talking with dentists who have an expertise in certain areas can help you decide which elements are right for you and your patients.

	And these groups continue to grow as more and more dentists decide a more holistic approach to care is beneficial for their patients and their practice. There’s a wealth of knowledge out there about a variety of treatments and disciplines to help you get your feet wet and decide what to incorporate into your practice. It might just be a different approach to using certain things in your periodontal disease control program, Dr.  Boehm said, but there are a lot of interesting things you can pick up along the way that will do a lot of good for your patients.

	“You’ll probably find certain dentists who have one or two things they like to do. Maybe it’s homeopathy and acupuncture in one office, or maybe an office only does one thing,” Dr. Boehm  said. “But that number is growing slowly. There’s an awful lot you can do for folks that doesn’t involve drugs and many patients appreciate that. Some will be eccentric about it, but it usually comes from a desire to try to do things as naturally as possible.”

	People go to Dr.  Boehm’s practice because he is a holistic dentist and that’s how they want to be treated. This approach to care is becoming more and more attractive to patients, he said, and is probably why the number of holistic dentists seems to be growing. These patients are well read on the subject and are likely already using acupuncture or some other form of Traditional Chinese Medicine.

	Dr.  Boehm has offered holistic care in his practice for about seven years, and said the biggest difference between his patients when he practiced then versus now is their level of health. And most of the time, they can avoid using pharmaceuticals to get their dental health where it should be.

	“There will certainly be occasions when you need antibiotics because you have an infection that is boiling out of control,” Dr.  Boehm said. “But more often than not you can beat the body at its own game. It already knows how to heal itself. Sometimes you need to jump start it.”

 The people who come to Dr. Kevin Boehm’s practice all have one thing in common: they want their dental care done naturally.  They’re not interested in what antibiotic can cure what ails them. These patients are looking for a more holistic approach to health care, and would much rather turn to something like acupuncture, homeopathy or a diet change to get their dental health back on track. Through Traditional Chinese Medicine, Dr. Boehm offers them just that.  What it is

How does Chinese care compare?

		G-ænial Universal Flo combines the best properties of a composite and a flowable composite.

		Finding the right nano particle was key to giving this material the strength and esthetics needed to create high-quality restorations.

	After Dr. Patrick Broome finishes a restoration with GC America’s new G-ænial Universal Flo flowable composite, his patients are left trying to figure out which tooth he worked on.

	Dr. Broome has been using G-ænial Universal Flo for a few weeks now, and said his patients have been “ecstatic” with the results.

	“They see it right away. It literally is seamless and invisible,” Dr. Broome said. “I had a patient this week with carious Class V lesions on No. 8 and No. 9, and when we finished he could not tell where the composite ended and the tooth began.”

	Dr. Broome is one of about 100 clinicians who evaluated this nano-hybrid composite, which is set to launch this month. But before G-ænial Universal Flo was ready for dentists like Dr. Broome to try clinically, the company put in a lot of time and research to create a material that is meant to take the flowable composite category to the next level.

	It all started in 2003, when GC America launched its first composite, GRADIA® DIRECT to the U.S. market. Since then, GC has introduced various composite resin products under the GRADIA Family name. With G-ænial Universal Flo, GC focused on further improving the company’s second generation of composite resin.

	The G-ænial family, which also includes G-ænial Flo and G-ænial Bond, took four years to get to market. The research took place at the company’s R&D facility in Japan, where chemists and researchers work toward one common goal: improving dental materials.

	“Very few, if any, dental companies have as many people as GC focused on research and development,” Product Manager Kelley Reinfelds said. “The composite group is working on developing products continuously. GC really has some R&D prowess.”

	With G-ænial Universal Flo, the researchers focused on optimizing the composite’s handling and improving the physical properties, said Mizuki Nakayama, Chief Researcher in Polymer-based material section. Even though it features a consistency that is similar to that of a flowable composite, its 200 nm glass fillers give it a smooth surface void of bubbles or any other common problems associated with flowables. The strontium glass particles are silanated using a new proprietary technology and have a low refractive index for beautiful final restorations.

	Finding the right nano-filler technology was key for developing this product, Nakayama said. According to advanced filler technology, nano-sized filler can be dispersed homogeneously, which means the polished surface can maintain a high gloss, even after the patient leaves your office and gets back to his or her normal brushing routine, Research Chemist/Liaison Kyosuke Hirano said. The pure 200 nm strontium glass powder enabled researchers to achieve that.

	This nano-filler uses advanced technology, Reinfelds said, and really gives patients the glossy smile they’re after while providing clinicians with the material strength and durability they need for a successful restoration. The 69 percent filled flowable features gloss retention that is comparable to a microfill, Reinfelds said, and features increased flexural strength and is easy for the clinician to handle, all features that have been lacking in flowable composites.

	“We’ve taken a product category that has been around for 15 or 20 years, and we’ve really improved the physical properties,” VP of Sales and Marketing John O’Neill said. “In the past, it was a compromise. This product category had a high level of shrinkage and they weren’t strong. We’ve taken a product category and raised the bar extremely high. Dentists can do a nice restoration and look the patient in the eye and say ‘I don’t have to worry about this product.’”

	When GC develops a product, clinician feedback is a key part of getting it ready for the everyday dentist’s practice. Field evaluators work with the product in their practices and then report back about what went well and what could be improved.

	Dr. Broome’s local GC sales rep encouraged him to evaluate the product. He does a lot of cosmetics in his practice, uses other GC products and even does some speaking and training, so he was excited to get his hands on the company’s latest development.

	“It’s tremendously rewarding to be able to work with a dental manufacturer almost like a team,” Dr. Broome said. “We can give them feedback. You can do certain things in a lab or certain things on a model and think you have a great product, but the question is does it work clinically. These manufacturers need feedback from clinicians using the product on patients. It’s fun to contribute to what’s going on in the industry and help them market a better product to help dental professionals and their patients.”

	Many of the doctors who evaluated G-ænial Universal Flo liked the polishability and the polish retention, but did have some difficulty realizing it can be used as a regular restorative material and not just as a flowable, Nakayama said, but once they used the sample they saw it was easier to manipulate than a regular composite.

	“One of the things we found in pre-market evaluation was that, despite all the data, clinicians are still hesitant. It’s a leap of faith to use a flowable differently,” Reinfelds said. “It won’t replace universal composites, but it’s better than other flowables when it comes to esthetics, handling and physical properties.”

	Dr. Hal Stewart, who has evaluated products for GC in the past, was impressed with how the material handles. It stays where you put it, he said, and you can manipulate it very easily-something you can’t really do with other flowable composites. Dr. Stewart has been using G-ænial Universal Flo for a few months now and said it seems to become hard and enamel-like once it’s cured and polished. Not only that, the colors match (it comes in 15 shades), something he’s been very pleased with.

	When Dr. Broome talked with his sales rep and Reinfelds about the product, he had similar feedback. The product’s properties create a “unique opportunity” because the material is thicker than a flowable yet thinner than other types of composites you sculpt with an artist brush, he said. It will require a technique to control the material, but that’s apparent once you start using it clinically. Multiple color layering on the facial aspect of teeth has an excellent color match, and he described the gloss he could obtain and the ability to blend as outstanding. There’s no graininess or pitting visible under high magnification.

	The new syringe features longer, flexible tips, which makes the material easier to place in tight spots, Reinfelds said. Not only that, flowables simply are easier to use, and that means patients are in and out of your office faster and back to their busy lives.
	But saved time isn’t the only benefit. The material allows for a minimally invasive approach, and any time you can conserve natural tooth structure that is a good thing, Dr. Stewart said.

	“It will give dentists another tool for more conservative preps,” Dr. Stewart said. “In my case, I’m able to offer them another option restoratively rather than doing crowns everywhere. If we can just build the anatomy up with the technique I use, it allows patients to enjoy being rehabilitated without having to spend the money for major prosthetics. I can rebuild anatomy with the material and give patients a few more years before they have to start doing crowns. It opens up a whole new avenue for patients who can’t afford crowns. They can afford this.”

	And the restoration feels and looks like enamel, Dr. Stewart said. Too many people know what a composite that doesn’t polish well feels like once it’s in their mouth, and it doesn’t feel natural. That is something GC wanted to address with this material, and from Dr. Stewart’s experiences, it looks like they’ve done that successfully.

	And, of course, when it’s all done, the patient will walk away with a beautiful smile.
	“Esthetics is so important in dentistry nowadays, and this will hold its gloss better than other flowables,” Reinfelds said. “It’s so quick and easy to place. The restoration will retain its beauty, and the patient will like having a glossy smile.”

	A product launch like this involves a variety of departments working closely together, from R&D to Professional Relations, to Sales to Customer Service to Quality Assurance. Everything has to be in place before the product is ready for your practice. But once it is, marketing plays a key role in making sure you know about a product and what it can do for you and your patients. GC is officially launching the G-ænial family of products at this month’s Yankee Dental Congress in Boston. Show activities will be scheduled around the launch. Key Opinion Leaders who have been using G-ænial in their practices also will be lecturing about their experiences at Yankee and upcoming meetings.

	National ads, direct mail pieces, Web banners and e-blasts also are part of the marketing plan, as is featuring all the information you need to know about G-ænial on the company website (

	To encourage dentists to try the new product, GC also will include one free syringe of G-ænial Universal Flo with the G-ænial Bond, Reinfelds said. That puts the material in the hands of dentists who may be hesitant to try it. Sales reps also will be talking the product up, and later this year results from the field evaluations will be published.

	In the U.S., GC America is best known as an expert in glass ionomers, but with this product, the company plans to increase its strength in the composite area as well, Reinfelds said. G-ænial Universal Flo follows GRADIA and KALORE and brings yet another brand to GC’s composite family, adding to a presence in the industry that will continue to grow.

	“In America, people don’t realize to what extent we have an extremely strong foundation of R&D capability in dentistry,” O’Neill said, noting that the research is focused on material science. “When they see new product innovation after new product innovation they’ll realize we are serious about raising the bar in all main categories in dentistry. Our goal is to improve oral health care throughout the world. We are a large dental company and have one mission: improving dental oral care.”
	This product is a big departure from what’s already available, O’Neill said, and the first time clinicians will be able to use a flowable as a universal restorative.

	For Dr. Broome and Dr. Stewart the reasons you should try it go on and on. It provides excellent esthetics and wear resistance. It’s minimally invasive. It’s easy to handle. It’s a combination between a nano-hybrid composite and a flowable composite, giving you options you never really had before. It may be a little different from what you’re used to, but that gives you all the more reason to try it.

	And, above all else, it will make your patients happy when they leave with a restoration that didn’t take a lot of time to complete, that was placed conservatively and that gave them the beautiful smile they’re after.

	“It’s going to help clinicians provide more esthetic restorations, especially in challenging areas like Class Vs,” Dr. Broome said. “We have a lot of products we can use that give nice results, but to  have a product that has some adaptability to cavity preps or has the characteristics where you can drag and pull and sculpt it in an easier manner is going to allow clinicians to be more artistic. It’s really another tool in the tool box we’re going to have as clinicians, or artists per say, in creating really beautiful restorations.”

Special Report: A new take on flowables

	This meeting is not only about learning and advancing your skills, it’s also about creating a community.

 18th Annual Conference is a place for dentists-whether you’re new to laser dentistry or incorporated it into your practice years ago-to come together to learn about the latest in the field and to talk with other practitioners who share their same passion for laser dentistry and what it can do for their practice and their patients.

 is March 3 to 5 at the LOEWS Coronado Bay Resort in San Diego.

	“There aren’t any other meetings in 2011 dedicated to lasers in dentistry to the extent that this one is,” said Gail S. Siminovsky, Executive Director of the Academy of Laser Dentistry. “This is it. Everyone can choose what CE events they will attend and there are quite a few choices, but in terms of lasers in dentistry ALD’s annual meeting is the one place where we foster camaraderie and education around this technology based upon sound clinical and scientific knowledge.” 


	With 42 presenters, clinicians and team members will have the chance to hear from a variety of voices on a variety of topics involving laser dentistry, from laser basics for pediatric dentistry and orthodontics to a demonstration of the operating microscope and laser dentistry.

	Dr. Samuel B. Low, President of the American Academy of Periodontology, will kick the meeting off Friday morning with the keynote address, “The Role of Lasers in Periodontics.” Other highlights include hands-on programs on Thursday that will enable attendees to try out different lasers, and on Friday ALD corporate members will sponsor presentations focused on how clinicians can use their lasers in daily practice. This gives attendees the opportunity to hear from a variety of different laser manufacturers about what they have to offer from an education and training perspective rather than a sales perspective, and why it might be something they want to incorporate into their practice.

	“This is an opportunity for dentists who use a variety of different lasers to attend our meeting because all lasers will be discussed in detail,” Siminovsky said. “It doesn’t matter what laser you use, we’re working with all the different companies so this meeting will be educationally relevant.”

	The meeting continues on Saturday with a presentation from dental consultant Sally McKenzie, who will speak about “Practice Management for Today’s Dentistry,” and courses geared for your team members to learn and get excited about laser dentistry.

	Outside of the classroom, the exhibit floor will feature 30 vendors to make it easy for attendees to browse and compare the different laser devices and many other dental products and services. And even though the days are jam packed with presentations and hands-on learning opportunities, there is plenty of time for networking and socializing with colleagues, including the welcome reception, lunches and the President’s Reception and Awards Ceremony.


	Pre-registration is available until Friday on the ALD’s website (link to site here), and onsite registration also is an option. Special packaging is available that includes the meeting and a one-year membership to the ALD. Interested in learning more about the education? 

 This meeting is not only about learning and advancing your skills, it’s also about creating a community.  The Academy of Laser Dentistry’s 18th Annual Conference is a place for dentists-whether you’re new to laser dentistry or incorporated it into your practice years ago-to come together to learn about the latest in the field and to talk with other practitioners who share their same passion for laser dentistry and what it can do for their practice and their patients.

For the love of lasers

	In 20 minutes, Dr. David Grayson was able to help a 7-year-old girl to stop habitually sucking her thumb. He’s helped patients quit smoking, and he’s performed dental procedures without using a drop of anesthetic. He’s eased his patients’ fears and enabled them to get treatment they may otherwise have opted not to receive.

	Dr. Grayson has practiced clinical hypnosis in his Parsippany, New Jersey office for about 5 years and is still amazed by what it can do. He’s able to work with patients to help them achieve things they didn’t necessarily know they could achieve. He connects with them on a deeper level, and what he can do for them at chairside really does have a positive effect on their daily lives. Helping that 7-year-old girl break her thumb sucking habit is one example that sticks with Dr. Grayson.

	“Here’s a little girl who would have had problems with kids teasing her and making her life hell. In 20 minutes I solved that problem,” Dr. Grayson said. “How could you not love doing that?”

	If you’ve never taken a course or haven’t done any research on your own, forget what you think you know. It’s nothing like what you see on stage or in the movies, Dr. Grayson said. The goal isn’t to have power over your patients or to make them act silly.  

	Clinical hypnosis is an extension of the doctor/patient relationship and fosters connectivity between the doctor and the patient, said Dr. Timothy Crowe, who also uses clinical hypnosis in his Chicago practice. Dr. Crowe said every day he practices, he learns more because of this mindset. It facilitates acceptance and commitment to treatment. But it’s important to note that all hypnosis is self hypnosis; patients can’t be hypnotized if they don’t want to be.

	So how do they do it? Clinical hypnosis involves the induction of a trance that has been characterized by Dr. Crowe as "mental absorption of an impassioned vision of a desired reality.”

	Trance induction is different for every patient, but providing a suggestion of relaxation is a good place to start in most instances. Dr. Crowe asks patients to slowly comfort and settle themselves by looking for and experiencing the soothing stillness that occurs in between their breaths. Other relaxation suggestions include progressive muscle relaxation and the eye roll technique. As the patient manifests the physical and emotional signs of trance, he provides additional deepening suggestions of safety, comfort and control.

	Click here for an in-depth look from Dr. Timothy Crowe at how clinical hypnosis works.

	After the procedure is completed, Dr. Crowe re-alerts the patient. This includes post-hypnotic suggestion that entails comfort and ease of healing. The patient is acknowledged for cooperating and helping make the procedure successful. Patients often lose track of time, which is known as time distortion, and may not remember or realize treatment has been completed. 

	Clinical hypnosis is a great option for patients who have dental phobias, Dr. Grayson said. If they’re open to it, clinical hypnosis can help them get past their fears, and without the use of medication. It’s also an option for patients who prefer to have treatment without any anesthetic. Drs. Grayson and Crowe both have used hypnosis to perform procedures without anesthetic, and both told stories of others who have done the same.

	Clinical hypnosis also makes patients more accepting of treatment, Dr. Crowe said, and thus more compliant. They take responsibility for their oral health and can achieve better outcomes. Patients and the doctor participate in what Dr. Crowe calls “the therapeutic alliance of trust,” which makes them more likely to believe in the process and to follow through with what they need to do to reach their desired result.

	"This relieves the doctor of the burden of enabling the noncompliant patient," Dr. Crowe said. "This minimizes the doctor's risk for burnout and lack of job satisfaction while fostering enjoyment for the work and patient contact." 

	Dr. Grayson loves the fact that he can help his patients get past their fears. That by itself, he said, is “tremendously rewarding.” But there are other benefits. Inducing trances also can be relaxing for the clinician.

	“If nothing else, it’s emotionally rewarding. My attitude, my outlook on things and the way I react to things have changed,” Dr. Grayson said. “I am in general more calm in my life than I was before.”

	Training in behavioral science isn’t something clinicians get in dental school, so they’re left to their own devices when they go into practice, Dr. Crowe said. Clinical hypnosis effectively deals with the behavioral aspects of a dental practice by "mitigating the stress and emotional conflict that occurs within and between the clinician and patient during the rendering of care.”

	The clinical hypnosis mindset causes dentists to listen better to their patients, Dr. Crowe said, which causes them to better recognize their needs. This is especially true for patients with dental phobias. 

	“Initially I got into this because of the stress I would experience when administering an anesthetic injection,” Dr. Crowe said. “I’d have to ho hum it and overlook what the patient was experiencing. I didn’t appreciate it when myself or patients would white knuckle their way through the procedure. Today I understand clinical hypnosis has a vast array of clinical applications beyond that of rendering a stress- and pain- free local anesthetic injection.”

	At first, patients can be skeptical and maybe even a little frightened of the thought of clinical hypnosis.

	“Once patients know what hypnosis is about, that it’s not harmful, that I’m not making them do anything against their will and that they’re fully in control and basically running the show, I’m just enabling them to do it, I get very little resistance,” Dr. Grayson said. “But some people just don’t want to. And like anything else some people are better at it than others.”

	There’s a Hypnosis Induction Profile (HIP) that tells you if a patient is open to hypnosis, Dr. Crowe said. Clinicians should never pressure patients who aren’t a good fit. This may embarrass them and make them even more uncomfortable in the chair. But when a patient is open to it, it's an effective way to get patients more of what they want and less of what they don't want.  

	Clinical hypnosis isn’t something you can just do; you have to be trained. You have to learn about this dynamic process first hand. Both Drs. Crowe and Grayson are certified with The American Society of Clinical Hypnosis.

	"ASCH training is a great cross disciplinarian collegial experience," Dr. Crowe said. "Through this organization, the allied healthcare professions-dentists, clinical psychologists, MDs and RNs- jointly learn clinical hypnosis and its application relative to the care of the mind and body needs of the patient." 

	Drs. Grayson and Crowe also teach courses themselves. Dr.  Grayson said while there is in interest, this way of working with patients isn’t for everyone. You really have to want to do it and be committed to the doctor/patient relationship for it to work.

	Remember you have to be trained before you can add clinical hypnosis to your practice, and that means this isn’t something your hygienist or dental assistant can do in your place, That said, your team should be knowledgeable about clinical hypnosis and be able to answer any patient questions that may come up, Dr. Grayson said.

	If you don’t make sure all your team members are in line with this mind set, they may say something to a patient that goes against what you’re trying to do.

	“At chairside during a surgical procedure I had to pull an assistant aside to say ‘why are you asking the patient if they’re OK? Why aren’t you telling the patient everything is OK, things are going smoothly, isn’t this a wonderful result that’s occurring, as opposed to asking are you OK? Are you alright?,” Dr. Crowe said. “So you want to ratify a positive trance, not a negative one. You want to get the patients on the right track and keep them there.”

	Having trouble getting past what you thought you know about hypnosis? Remember, stage hypnosis is about entertainment; clinical hypnosis is about helping.

	Stage hypnotists can look in an audience and quickly determine who is susceptible to suggestion, Dr. Grayson said. Looking around for volunteers and asking a few questions of those volunteers can help them determine who will be willing to cluck like a chicken or bark like a dog. 

	But clinical hypnosis isn’t about  entertainment, Dr. Grayson said. It’s serious work that the doctors who perform it are passionate about, and its something that can be so beneficial to your patients.

	“We’re not trying to make people look foolish or do amusing things,” Dr. Grayson said. “We’re trying to help people, enable them to get past dental fear or not smoke any more. That’s the difference. We’re about helping people.”

	Renee Knight is a senior editor for DPR. Contact her at 

 In 20 minutes, Dr. David Grayson was able to help a 7-year-old girl to stop habitually sucking her thumb. He’s helped patients quit smoking, and he’s performed dental procedures without using a drop of anesthetic. He’s eased his patients’ fears and enabled them to get treatment they may otherwise have opted not to receive.  And he’s done it all through clinical hypnosis.

Should you be hypnotizing your patients?

	You’ve noticed a change in one of your most dependable employees. She’s been missing a lot of work lately, and when she does come into the office she’s usually late. Her productivity is slipping and you know her behavior change is affecting the rest of the team.
	
	You suspect this employee might be struggling with a mental health disorder. About one in five working-aged Americans experience symptoms of a mental health disorder in any given month, according to the February issue of the Harvard Mental Health Letter, and is certainly something that can happen in your practice. When it does, you have to be very careful about how you handle the situation. You can’t confront the employee about the mental illness you suspect she has, or try to play counselor. You have to get outside help. If you try to handle it on your own, you’re opening yourself up for legal trouble down the road.
	
	

	If you think a mental health issue is negatively affecting an employee’s performance, you need to talk to an outside professional before you sit down with that employee, said Dr. John Jameson of Jameson Management. Talk to an HR professional in your area and a labor law attorney to get some advice before you have that conversation.
	
	No matter what your suspicions are-or if you know for a fact the employee has been diagnosed with depression or anxiety-this shouldn't be the focus of any conversation you have with the employee, said Tim Twigg, owner and president of Bent Ericksen and Associates. You should focus on performance issues, not what might be causing the issues. Use the job description to talk about where the employee is falling short. Don’t go down the path of assuming, accusing or labeling the employee as someone with a mental illness.
	
	You also can turn to the office policy manual, said Penny Reed Limoli, owner of the Reed Limoli Group. While the manual shouldn’t specifically address mental illness, employee expectations should be clearly spelled out-from coming to work on time to treating other employees with respect. If the employee is struggling with these or any other job requirements, you have to address the problem. Even though this can be a difficult situation that must be handled carefully, it isn’t something you can ignore and hope will go away. Talk to the employee as his or her boss, not a friend or counselor. Remember everything you talk about should be based on performance and how not meeting expectations affects the staff, the practice and the patients.
	
	“You have to treat mental illness like any other illness,” Limoli said. “If someone is getting strep throat and missing work, as a business owner you want the employee to be healthy, but at the same time dental offices are small. If the same person is missing work over and over it hurts the practice.”
	
	Document everything that is said during the conversation, Limoli said. Make sure you talk to an attorney about your concerns and solicit his or her advice onhow to move forward to carefully resolve the situation. 
	
	“In this day and age, you have to get an attorney involved beforehand, prior to deciding how to handle the situation,” Limoli said. “It’s a balance. You want to take care of your employees but you can’t be at their mercy if they can’t be there.”
	
	

	You may find yourself in a situation where an employee tells you about a recent mental health diagnosis, Dr. Jameson said. This employee might bring in a doctor’s note that indicates some restrictions, meaning he or she may not be able to perform some job duties. This could mean you need to modify the employee’s current job or re-assign the employee to another position in the practice. If this happens, remember the employee is likely to be covered under state and federal disability laws. You have to try to make accommodations, unless you want a lawsuit on your hands. But, if undue hardship to the practice is shown, you may be able to end the employment relationship if that’s what you believe is best for the practice and the rest of the staff. But don’t think that’s the end of your worries. This decision can be challenged in court, and isn’t something you can take lightly.
	
	Just like with the other scenario, you have to document everything that is said throughout the process and you have to get a lawyer involved, Dr. Jameson said. Document based on behavior and activity, not based on the illness.
	
	

	While offering assistance is a nice gesture, both Dr. Jameson and Twigg agree that you should proceed cautiously when offering  mental health resources to any employees you have concerns about, even if they come to you. Americans with Disabilities Act guidelines are strict, but state laws often are more strict and constantly changing. Dr. Jameson suggests contacting Twigg’s team members at Bent Ericksen and Associations because they keep up-to-date on state laws and can guide you through these types of challenges.
	
	“Bottom line, this is not a win/win situation for dentists if they mess up,” Dr. Jameson said. “That can be from communication with the employee or how they handle it from the beginning. Any misstep can be lots of trouble for the dentist.”
	
	Dr. Alan Axelson, a member psychiatrist with the American Psychiatric Foundations’ Partnership for Workplace Mental Health, said it’s a good idea for bigger offices to have an employee assistance program on retainer, whether it’s something through your state dental association or a program you find on your own. These programs offer people your employees can talk to, and they look at whatever the problem is from both the employer’s and the employee’s point of view-which is good for you if the employee blames his job for his problems.
	
	“You can get into legal difficulty if you say, ‘Look you haven’t been showing up so I’m going to fire you,” Axelson said. “This is saying ‘I’m concerned about your performance and your personal welfare.’ To refer someone to an employee assistance program, you’re doing something all sorts of employers do.”
	
	Axelson and Limoli support providing assistance, as long as you do it the right way. Don’t tell them they have to call or visit a counselor, or that you even recommend that they do so. Give them the resources, maybe it’s just a phone number for a crisis hot line, and they can decide where to go from there. This is an option for smaller practices that may not want to pay the fee for having an assistance program on retainer, but is not something you have to do if it makes you uncomfortable.
	
	

	If one employee is struggling with a mental health disorder, it will effect the rest of your staff, Axelson said. As a small staff, it’s difficult not to get involved when a co-worker starts talking about personal problems. They spend time talking it out, and that can become a distraction that leads to decreased efficiency and productivity.
	
	Beyond that, co-workers will notice when someone repeatedly comes in late or calls in sick at the last minute, and they won’t like it. No one wants to feel like they have to pick up someone else’s slack at work. Dealing with this day after day will lower your staff’s morale, Limoli said, again resulting in efficiency and productivity problems for the practice. No matter how much the rest of the staff loves that team member, resentment will grow if one employee continues to miss work. In a small dental team, everyone has an important role, and if someone isn’t there every day or is always late, it makes it more difficult for the rest of the team members to do their jobs and meet goals.
	
	And when the employee does show up, he’ll likely be distracted and won’t perform at his best, Axelson said.
	
	“Precision is very important and things have to be right,” Axelson said. “If someone is depressed or anxious and having trouble concentrating, that person may not get things correct, so you’ll have mistakes that impact productivity and efficiency in the office.”
	
	

	As dental providers you and your staff members are involved with your patients’ total health care. You’ve likely treated a patient with a mental health disorder at some point in your career. Teaching your staff to be sensitive to these issues that may come up with patients can make it easier to deal with the same issues that a staff member may deal with later.
	
	“If a hygienist is working on a patient and that patient says my husband left and I’m depressed, the hygienist should tune into that,” Axelson said. “Staff members should know what to do with patients in distress. That sets them up to deal with employees who may have these problems.”
	
	Making your practice one that’s sensitive to mental health disorders is key to making your employees feel like they can come to you if they are having a problem, Axelson said. If you or other staff members make jokes about anxious Mrs. Jones or that whiney patient who is going through a divorcee, staff members who are struggling with problems won’t feel comfortable telling you about what they’re experiencing. While you don’t want to play counselor, the sooner you know about a problem the sooner you can take steps toward fixing it.  
	
	

	It’s natural for you to be concerned about your employees, especially if you think they’re struggling with a mental health disorder. But you can’t get too involved, or you open yourself up for a world of trouble. You also can’t just fire someone who’s suddenly become depressed. Discrimination laws protect these employees, and you will have to fight a lawsuit if you take drastic action without taking the proper steps.
	
	Anything you say or do can be misinterpreted and later used against you, Twigg said. That’s why it’s so important to document everything and show that, if you do have to let the employee go, you gave him or her every chance to rectify the situation. Remember if you do end up in court, the burden of proof is on the employer to prove the action took was not discriminatory or retaliatory.
	
	Ultimately, it comes down to this: You have to protect yourself, your practice and your patients.
	
	“It’s all about trying to be as fair as possible, but if it’s really beginning to affect the practice, you can very quickly, with the best of intentions, get yourself in a not-so-great place,” Limoli said. “I love my dental teams but we have to protect these doctors, or there’s no place for the employees to work.”

 You’ve noticed a change in one of your most dependable employees. She’s been missing a lot of work lately, and when she does come into the office she’s usually late. Her productivity is slipping and you know her behavior change is affecting the rest of the team.

Dealing with mental illness in the operatory

	With a focus on increasing everyday efficiency, Eaglesoft 16 Practice Management Software was created based on customer feedback and is designed to be intuitive and easy to use, giving each member of the dental team the power to do more in less time. Patterson Dental’s latest version of its integrated dental software comes with a new look, greater functionality and enhanced adaptability.

	Line-item accounting: Easily see where the account and patient balance is coming from, and which individual services have been paid in full.

	It’s Customizable: With customizable windows and dockable panels, users can choose how much information to display on the Account, Appointment and OnSchedule windows to fit individual user preferences.

	Date-based reporting: Run financial reports for any range of dates-practices no longer have to choose a range of “End of Days.”

	Family walkout processing: Process all family members on the same walkout with just one receipt for the entire family.

	Added plus: Eaglesoft 16 offers timesaving electronic capabilities to capture and store original patient signatures and documents, transmit claims and statements, and verify patient benefit information. Patterson Dental provides unrivaled support and customer service for all users. 

 Information provided by Patterson  With a focus on increasing everyday efficiency, Eaglesoft 16 Practice Management Software was created based on customer feedback and is designed to be intuitive and easy to use, giving each member of the dental team the power to do more in less time. Patterson Dental’s latest version of its integrated dental software comes with a new look, greater functionality and enhanced adaptability.

Applying Eaglesoft .16 in your practice

	When it comes to selecting a handpiece for your practice, there certainly isn’t a shortage of options to choose from. There are a variety of handpieces available with similar features and designs to make handpiece use seamless and comfortable.  

	So with all these options, how do you choose the handpiece that’s the best fit for you and your practice?

	We recently spoke with Betty Garabedian, president of 

, a company that ensures quality certification as part of an integrated group of dental technology companies offering dentists a variety of products and services to solve their handpiece-related issues. The company’s 165-plus dealers in North America offer both mobile on-site and mail-in-services. Handpiece Experts repairs more than 800 handpieces each day. Garabedian outlines what dentists should know when buying a new handpiece for their practice, from what questions you should ask your sales reps about the handpiece warranty to what a dentist truly needs to know about handpiece maintenance.
	
	

Q: What should dentists think about when buying a handpiece?

It depends on the type of procedures the doctor does in his practice and if it’s a specialty practice and what type of handpiece is the best fit. And beyond that it’s a matter of taste. In Europe, 80 percent of doctors use an electric handpiece. In the United States it’s 30 percent. We thought electric was going to be the thing and that everybody would upgrade to an electric handpiece. I don’t know if the economy slowed that down, but many doctors decided they wanted to wait to make the switch. It’s a big change for them.
	
	

 Q: What should dentists be asking their sales reps about the handpieces they’re interested in?

They really need to find out about the warranty-how long the warranty lasts, who will repair the handpiece and how much will it cost if they have to replace the turbine after the warranty runs out. A sales person will do everything to sell the product and will even sell at cost, but don’t forget they will try to make money after the sale on service costs. It’s important to find out how much it will cost to repair the handpiece after the warranty is up. Sometimes it can cost $1,000 to repair a handpiece.

	You need to ask how long it will take to repair a handpiece if you send it out for service. Sometimes it can take as long as two months. Many doctors don’t have a spare handpiece they can use while it’s gone, so it’s essential to find out exactly how long you can expect it to be out.

	You also need to ask if you can try the handpiece. Ask the sales rep to leave a demo of the handpiece that you can use in your practice. This is a tool you’re going to use for the next 10 years. You want to make sure it’s a good weight, that the angle is comfortable and that it runs as smoothly as what you’re using now.
	
	

Q: What should dentists know about handpiece maintenance?  

Dentists don’t know much about maintenance because they usually have somebody in the office who takes care of it. But it’s something they should be worried about because first of all they can spend a lot of money on repairs. They should be worried about where their handpieces are being sent and if they could get a better price if they sent them somewhere else. A lot of times everything is sent to a large distributor and the dentist doesn’t know who’s fixing the handpiece. It could be a student fixing the handpiece yet charging a lot of money. I deal with independent guys, where you get a better price and you know who’s fixing the handpiece. It’s like taking your car to a dealership to fix it or taking it to the garage guy you know. The repair portion and maintenance portion of how they’re spending their money should be something dentists are looking into.

 When it comes to selecting a handpiece for your practice, there certainly isn’t a shortage of options to choose from. There are a variety of handpieces available with similar features and designs to make handpiece use seamless and comfortable.  

Finding the right handpiece

	Photo: RubberBall Productions/Getty Images

	Just about every day, a dentist asks Steve Killian, CDT, to use a material he knows won’t work for the cosmetic case in front of him. Maybe the dentist didn’t provide him with all the information he needs to use that particular all-ceramic material, or maybe the dentist’s material of choice just isn’t strong enough for the type of restoration he’s creating. Regardless of the problem, he has to explain to the dentist why it won’t work and why another material is better.

	“If I’m asked to use something and I disagree then I’ll explain why. We usually end up doing it my way. They (dentists) trust my technical ability,” said Killian, who owns Killian Dental Ceramics. “Nobody wants to risk it not turning out. They want to make sure I’m successful for them.”

	Your dentist clients depend on you to choose the best material for their cases. It’s often left to the technician to educate the clinician about those materials, and the number of options just keeps growing, with many of them combining both strength and esthetics to help you create more natural-looking, more functional cosmetic restorations. That’s why it’s so important for you-and everyone at your lab-to really know your stuff, to keep up-to-date on what’s available and to attend the latest CE courses. You need to be able to decide when to use what material and then explain your decision to your clients. That’s a huge part of creating successful cosmetic restorations.

	As more options have become available in the last five years or so, many doctors have become confused about what should be used when, said Daxton Grubb, President of R-dent Dental Laboratory, and it falls to the lab to lead them in the right direction.

	All too often, they expect you to use a certain material but don’t give you the information you need to make it work, Grubb said. If they don’t give you the proper prep design and stump shade, you either have to go back to them to get the information you need or tell them what you can successfully do with what you’ve been given.

	When a case is underprepared, Killian said he’ll call and ask the doctor if he wants him to adjust the prep or provide another restoration. It may be a slight compromise over what the doctor asked for originally, but it saves time and money. The doctor still can get a high-quality restoration without bringing the patient back in. Not only that, there will be a much greater chance for success than if you went forward without making that call.

	“We’re getting more involved. The pressure is getting put more on labs to learn the products. It gives us more credibility,” Grubb said. “We can give options. It’s saying I can’t do an e.max but I can do another all-ceramic that will look beautiful. Here are the options. It boils down to giving doctors more options and not just telling them yes or no.”

	When you first get a case in, there’s a lot to think about before you decide what type of material to use, including if the restoration is going in the anterior or posterior and how strong it needs to be. But regardless of what else is involved, it all comes down to doing what’s best for the patient.

	“The first thing we all need to think about is using the most conservative material that will satisfy esthetics and durability,” said Dr. Ed McLaren, Director of the UCLA Center for Esthetic Dentistry. “It doesn’t matter how good it looks if it breaks, but it also doesn’t serve the patient if you could have used a conservative veneer and the dentist did crowns everywhere. I’m going to use the most conservative material I can.”

	Porcelain is the most conservative material for anterior restorations, Dr. McLaren said, and is his first choice for veneers when there is 50 percent of enamel or more remaining on the tooth and a thickness of 0.8 mm or less. If that’s not what you’re working with, Dr. McLaren recommends the second most conservative choice: glass ceramics, which include the leucite-based IPS Empress from Ivoclar Vivadent and Jensen Dental’s Authentic. Both are esthetic, conservative choices for veneers and crowns.

	Of course, there will be times when you’re working in a higher-stress environment where you’re more worried about fracture or bruxing. This is when you might want to think about IPS e.max lithium disilicate, Dr. McLaren said. This works better than pure porcelain if you have to bond to dentin, which is more flexible than enamel and requires something stronger when bonding to it. Empress also is a good choice in this situation, but you do get more strength from e.max and less chance of fracture.

	At Grubb’s lab, the three most common materials used are Ivoclar’s e.max, Lava Zirconia from 3M ESPE and his own R-brux in-house brand, which are all great choices for single-unit posteriors. He typically uses e.max for veneers and Lava Zirconia for bridges. Those are his materials of choice, but it’s important to remember that every lab is different and has different strengths. Communicate that to your clients, and don’t try to sell them on a certain material because you like to use it; focus on what’s best for the patient.

	Dentists don’t have a lot of spare time, and some of them may not be willing to return your calls or e-mails to discuss a case. But you can’t miss out on the opportunity to educate those who do. If they wanted you to use Lava or e.max but didn’t provide you with enough information, let them know what you need next time.

	Labs should have a technical team that focuses on quality control, Grubb said. Have people on staff who are capable of talking to doctors about preps and making suggestions for improvements. But you have to be consistent. If you call about a case today but miss one tomorrow, it sends a mixed message to the dentist.

	Grubb also sends prep models to doctors to give them something they can actually see. His lab even sends doctors the burs he’d like them to prep with, introducing them to a product they may otherwise never have used. This helps get you and your doctors on the same page, and it is a way to build that all-important technician/doctor relationship.

	“Labs are inventorying certain things from the clinical side, which is something they didn’t do before. Ten years ago it was paper,” Grubb said. “When you send the same sheet of paper versus putting that instrument or that model in their hand, generally speaking people pick up faster that way. It’s more personal,too. You touch the customer then.”

	Even though labs tend to know more about the materials they’re using, the doctor still should be involved in the decision, said Gary Hult, Professional Relations Manager at 3M ESPE. The dentist and lab technician should come to a collaborative decision about what restoration is best for the patient.

	“Unfortunately, dentists too often delegate that to the lab and just tell them what shade they want. They don’t get into a discussion about the benefits and limitations of different restorations in terms of what they’re trying to clinically accomplish,” Hult said. “Labs and dentists should understand enough based on the patient’s situation and overall clinical needs to determine what would be the optimal choice for the patient.”

	The dentist knows the patient the best, 3M ESPE Marketing Manager Angie Hadrits said. They’re going to know individual patient circumstances and any special health concerns. They can provide you with relevant information as well as photos to help the lab create a restoration that the lab, the dentist and the patients are happy with-and an open dialogue is key to making that happen.

	“Ultimately, a great ceramist can make an average dentist look great. A bad ceramist can make a great dentist look bad. The ceramist is an important part of the team,” Dr. McLaren said. “There needs to be a close dialogue between the two. It’s not 100 percent the dentist prescribing to the technician.”

	And as patients become more and more informed about their options, they may have an opinion about what’s going in their mouth, too, Dr. McLaren said. For instance, many patients don’t want metal restorations, and zirconia is a strong, esthetic option that can meet that need.

   Photo: RubberBall Productions/Getty Images