Richard Palmer

	Applying New Technologies: Cercon brain expert

	The Cercon brain expert highspeed CAD/CAM milling machine is engineered to shape discs of pre-sintered zirconia and resin cast materials with maximum precision. The Cercon brain expert enhances productivity and throughput due to its contact free linear drive motor for highspeed milling. The 4-axis milling design, high-quality milling spindle, and direct measuring system deliver consistent, precise results and make automatic adjustments to ensure accuracy and marginal integrity of the milled coping. The unit houses up to nine burs and offers automatic tool exchange for constant milling without manual intervention. The Cercon CAD software maximizes design efficiency for optimal use of materials and reduced remakes.

		Linear drive motor provides highspeed milling for increased productivity and work throughput

		4-axis milling provides optimal consistency and precision

		Direct measuring system offers permanent positioning control

		Unit houses up to nine burs and offers automatic tool exchange for constant, unattended milling

		Milling discs can nest an average of 30 units per disc, including 16-unit bridge frameworks

		Closed system includes Cercon eye scanner, updated Cercon art Version 3.0.3 software, and Cercon heat and Cercon heat plus sintering ovens

Articles

 Applying New Technologies: Cercon brain expert  The Cercon brain expert highspeed CAD/CAM milling machine is engineered to shape discs of pre-sintered zirconia and resin cast materials with maximum precision. The Cercon brain expert enhances productivity and throughput due to its contact free linear drive motor for highspeed milling. The 4-axis milling design, high-quality milling spindle, and direct measuring system deliver consistent, precise results and make automatic adjustments to ensure accuracy and marginal integrity of the milled coping.

Great expertations

	Designed to improve case acceptance, DDS GP is the first member of the Dental Demo Suite package (orthodontic, oral/maxillofacial surgery and endodontic specialty apps will be added early in 2011, as well as a general package download). The interactive app for iPad, iPhone or iPod Touch features more than 200 demonstrations of diagnoses and procedures, in 6 languages, designed to help with patient understanding. Users can add to, delete from and sequence the plan from the app then e-mail customized treatment plans with pictures and video to remind patients what they saw and encourage case acceptance. Users soon will be able to add digital pictures directly to the app without any other interface, and an intraoral camera function also will be integrated into the app. Built on the Apple platform, the app provides free, automatic updates every 2 to 3 weeks.

Lares Research
	Lares Laser Video Library

	Lares Research has added an extensive library of more than 30 live-patient clinical laser videos to its website for viewing by prospective laser owners. The videos feature both hard- and soft-tissue laser treatments, including cavity preparation, root canal therapy using PIPS™ (Photon Induced Photoacoustic Streaming™), and periodontal disease therapy using WPT™ (Wavelength-optimized Periodontal Therapy™). Both Er:YAG and Nd:YAG laser wavelengths available in the Lares PowerLase® AT laser are included in the videos. The videos were created by experienced laser clinicians from the providers of PowerLase AT user training-the Masters of Laser Dentistry, The Montana Center for Laser Dentistry, and the Arizona Center for Laser Dentistry.

	Compatible with iPhone/iPad/iPod Touch, Android, BlackBerry, Palm OS and Windows Mobile platforms, the Lexi-DENTAL COMPLETE comprehensive dental application includes Lexi-Comp’s full dental library, plus complementary resources. The apps feature the color images, charts and appendices from Lexi-Comp’s print titles, all the clinical information you need for fast diagnosis and treatment conveniently at your fingertips. Lexi-DENTAL COMPLETE is continually updated, providing the timeliest information available with a comprehensive dental pharmacology database; color images, charts, and appendices from Lexi-Comp’s print titles; more than 160 high-quality radiographs, 1,000 full-color photographs and images and 5,000 full-color medication images; diagnostic and patient education resources; and complementary licensed content. A variety of subscription packages are available.

	Designed to allow dental practices to attract new patients more effectively, retain existing patients, reduce no shows and measure patient satisfaction, the Web-based Demandforce D3 application offers enhanced functionality and features, including: two-way text message capabilities for patients to receive and confirm appointment reminders; intelligent newsletters that enable practices to segment and target the patient list based on demographic data; and a digital consultant that automatically displays critical practice health metrics against aggregate data across the Demandforce network, highlighting areas for improvement. The system integrates with all major practice management software to determine which communications have been sent to patients. A data integration agreement with Google allows active patients to submit Web reviews to populate the practice’s Google Places profile with the reviews. The mobile component allows practices to access their Demandforce portal from a smartphone to view read-only patient information, contact information, and online reviews.

The TryKaVo.com test-drive program is designed to allow practices to use select KaVo air-driven, electric and hygiene handpieces in the operatory with no obligations. They simply go online, select the handpiece to try, use it free for 5 days, and return it in the pre-paid shipping package if they decide not to purchase. Clinicians can choose from GENTLEsilence LUX 6500BR, GENTLEmini 4500BR, SUPERtorque 659BR or Mira LUX 3 635BR air-driven handpieces; the electric ET-TLC Package with ELECTROtorque controller and GENTLEpower attachments or the COMFORTdrive 200XDR model; and the PROPHYflex 3 air polisher, the DIAGNOdent caries detection aid or the PROPHYwiz hygiene handpiece.

Top online and mobile apps

	Even as more and more intraoral digital impression capture systems come onto the marketplace, for labs working with dentists who prefer to follow the traditional tray-based route of impression capture yet want to eliminate models from there workflow procedures, there is an increasing number of options for scanning the tray impression from the dentist directly into a CAD system using a benchtop scanner. Depending on the system, a number are designed for the clinician to scan the tray impression in the practice and send the digital data to the lab.

	To accommodate conventional porcelain buildup procedures, scanner suppliers are looking to partner with manufacturers of CAM milling or stereolithographic 3D printing equipment for the fabrication of models generated from the scan data. To date, only 3Shape, DentalWings, and 3dO have announced working relationships that would provide trimmed and sectioned models to labs from scanned tray impression data, which is an integral component of most chairside digital impression capture systems. Undoubtedly, more scanner manufacturers will include model-generation through partnerships or internal equipment development.


	Developed by Solutionix Corp. the open-architecture Rexscan DS2 high-precision 3D scanner features twin high-resolution cameras with a 15° triangulation angle combined with a dual LED white-light source and a 2-axis rotary stage movement to ensure secure line of sight for complicated models and impressions. It can scan tray impressions in silicone, alginate, alginate alternative, PVS, and polyether as well as wax, gypsum, and epoxy models.
	877-482-7904
	


	The D700 digital scanner uses a laser and dual cameras with a reduced angle as well as three axes of movement to capture data from deep inside impressions as well as stone models. It also has an upgraded camera throttle and bi-directional scanning to minimize overall scan times of dies, bridges, single-unit waxups, antagonist bites, double scans, and impressions. The scanner’s proprietary Adaptive Scanning Technology automatically rescans any missing or incomplete areas. Using the same application, the operator/user trims, sections and builds a virtual 3D model that can then subsequently be rapid prototyped either by means of a 3D printer or a milling machine having model milling capability. Having created the digital model, the user can proceed into DentalDesigner software to design the restoration using the scanned preparation and antagonist for automatic approximation and control of occlusal design. Scan files are output in open STL and DCM formats
	908-219-4642
	


	Working as a comprehensive system with the Mill200 CAM unit, the Scan200 high-precision scanning unit scans single dies to full arches at 60 to 90 seconds per element up to 16 units per batch, while the CAD software provides simple-to-use graphic user interface for simplified, automatic design of copings and bridges. It combines white light technology, dual cameras, and an ultra-precise drive mechanism for precision and clarity with no holes or dead zones.
	800-433-2436 

	D4D  Technologies
	(distr. by Zahn Dental)
	


	Using a handheld laser scanner, E4D Labworks has the ability to scan models or impressions without the need for contrast agents. Once scanning is complete, the System’s proprietary DentaLogic™ software creates a true 3-D virtual model and restoration proposal using intuitive design tools along with the System’s Autogenesis™ design process. Finalize the design and send the data to the E4D milling unit for fabrication of inlays, onlays, veneers, and full-coverage restorations, including IPS e.max CAD thin veneers (@150 microns).
	972-234-3880
	

	D4D Technologies
	(distr. by Zahn Dental)
	


	Available in Q3 of 2010, the E4D Flash benchtop scanner incorporates a multiple line laser and 5 axes of rotation (140° vertical, 360° horizontal) to scan a range of impression materials as well as wax, gypsum, epoxy, and metal. It outputs data in proprietary a selectively open formats to in-house CAD/CAM equipment or to an outsource provider via the E4D Sky Network (also available Q3). 


	The open-architecture Imetric IScan D101 white-light scanner requires only 2 axes due to a large field of view, thus reducing inaccuracy due to error stack up. In addition to impression scanning, the Swiss-made system provides high-accuracy scanning for copings, partials, orthodontics, custom abutments as well as implant position determination for dental bars and superstructures. It offers unique rapid calibration within a minute.
	877-DELCAM-1
	


	Providing robust Germany craftsmanship for small-to-medium-sized labs, the OpenLaser Scanner Model OL100 5-Axis 3D laser scanner provides the users the ability to scan solid unsectioned full-arch models as well as cut and trimmed working models, impression trays and bite registrations, single dies, and implant and trajectories to create surgical drilling guides. It features 5 axes of movement and a 3D laser line for detecting and saves files to open STL/STA file formats.
	866-328-5011
	


	The NobelProcera optical scanner uses proprietary conoscopic holography technology for fast, precise data acquisition of impressions, models, and single dies. The unit’s co-linear scanning technology allows measurements of steep angles up to 85° as well as deep cavities such as those found in dental impressions. It features an open-air design for ease of access and setup, an intuitive holder design for batch scanning of single copings, and a high-speed, stable platform for fast and accurate scanning.
	800-993-8100
	


	The 5-axis DW-IS Dental Wings impression scanner with an embedded Quadcore computer is fully dedicated to scanning impressions in the dental office or dental laboratory. The scanned impressions are electronically transmitted with minimum human intervention, eliminating expansion of physical properties, saving time, and eliminating shipping costs. Accessories include an impression holder, an axis finder holder for scanning models and opposing using Vertex-like articulators, and a multi-die plate for the simultaneous scanning of up to 16 single dies
	800-496-9500
	

 Even as more and more intraoral digital impression capture systems come onto the marketplace, for labs working with dentists who prefer to follow the traditional tray-based route of impression capture yet want to eliminate models from there workflow procedures, there is an increasing number of options for scanning the tray impression from the dentist directly into a CAD system using a benchtop scanner.

Scanner manufacturers develop model-generation options

	The 6-instrument kit is specifically designed for the quick, simple, sequential and systematic retrieval of a fractured rotary nickel-titanium instrument within the canal.

	The use of the high-speed (100,000 rpm) H269GK.315.016 tungsten-carbide endo bur with non-cutting tip reshapes and enlarges the pulp cavity to provide access and improve vision into the canal.

	The lower-speed (800 rpm) G180A.204.110 and G180A.204.090 burs straighten the coronal curvature and create access directly to the fragment.
	
	The slow-speed (300 rpm) RKP.204.090 and RKT.204.090 provide exposure of the fractured surface and subsequent seizure of the fragment for removal.
	
	The kit also comes with the 150.155.000 manual screw for those practitioners who would rather not use a handpiece.

	You can find these @
	products.dentalproductsreport.com.

 Information available at komet-usa.com  The 6-instrument kit is specifically designed for the quick, simple, sequential and systematic retrieval of a fractured rotary nickel-titanium instrument within the canal.

Coming to the rescue

effective, easy-to-use and more affordable option

 in clear aligner therapy. Provides patients with an easy, cosmetically appealing alternative to traditional braces.

	Phase-based delivery system makes it easy to 

, which leads to successful treatments and happier patients.

 to help you through the entire treatment. A service representative is available to answer any questions you may have.

	No mid-course correction, refinement or retainer fees are added during treatment, which 

 for every step are provided for affordable, in-house replacement aligners. 

 Provides dentists with an effective, easy-to-use and more affordable option in clear aligner therapy. Provides patients with an easy, cosmetically appealing alternative to traditional braces.  Phase-based delivery system makes it easy to track movements and make corrections, which leads to successful treatments and happier patients.

The choice is clear

	Whip Mix now offers verification gages for Denar®, Hanau™ and Whip Mix® articulators. These gages, the Denar Mark 300 Series verification gage system, the Denar/Hanau verification gage system and the Whip Mix verification gage system, offer a quick way to verify articulators are in calibration, making it easy to transfer just the casts between compatible articulators. With articulators in calibration, technicians and clinicians may transfer just the casts between compatible articulators with confidence. By simply sliding a stainless steel pin through the device the user can quickly verify the accuracy of the articulator.

Tech Brief: Verification Gages

	Dentistry used to be an ergonomic standing profession. Once practitioners took a seat, it became a pain in the neck…and back…and arms…and eyes…

	The general public often stereotypes a visit to the dentist as an uncomfortable experience. But patients don’t realize their dental practitioners all too often experience musculoskeletal pain that surpasses their discomfort during an oral exam. Worse yet, many professionals believe head, neck, shoulder and back pain are all part of the job.

	“It’s been widely accepted among dentists that pain is an intrinsic part of dentistry, and it doesn’t have to be” said Bethany Valachi, PT, MS, CEAS, a physical therapist, lecturer and author who specializes in dental ergonomics and consults with dental professionals on all aspects of ergonomics.

	An online survey conducted by DPR shows dentists want to practice ergonomically, and they are willing to make the necessary adjustments to ensure their health and that of their staff.

	Three-quarters of those participating in the survey indicated that practicing dentistry in an ergonomically sound way is something they value as a dental professional, and another 20% said it is somewhat important. When asked for their reasons, many indicated they had either experienced first-hand the debilitating effects of incorrect ergonomics or have seen it in colleagues.

	Obviously, dental professionals want to practice in the most comfortable working position possible, but unfortunately many resort to working in the most practical position because they have never been trained properly about tools (chairs, loupes and lights) to achieve ergonomic postures.

	“There’s going to be something that you can do faster if you go into a compromised posture, and as a result, dentists teach themselves how to do damage to their health,” said Dr. David J. Ahearn, founder of Design/Ergonomics, which consults with dentists to design healthy, efficient and productive offices and operatory setups.

	The key is to start in an ergonomically proper position that will be comfortable for long stretches of time. Once that is set, the other factors involved in ergonomics should relate back to the posture without altering it.

	Although dentists and hygienists spend the majority of their day in a seated position as in traditional office settings, their seating requirements are quite different. Working on an office computer, the work usually is straight ahead, which warrants an upright posture and straight neck. But Alan Hedge, PhD, CPE, Director of Human Factors & Ergonomic Factors at Cornell University, said this does not translate well to dentistry because the focus of your attention-the patient’s oral cavity-is below a horizontal line-of-sight plane. Therefore sitting requires a different set of guidelines.

	It is from an ergonomic starting position that you make your chair selection, not the other way around.

	“Your operator stool is arguably your most important tool,” Dr. Ahearn said. “It should be the first thing you buy, and it’s usually the last, often an afterthought thrown in with the purchase.”

	Just like dentistry presents unique requirements for sitting position, so does the seat.

	“We work in a proclined position, so we need a seat with a steep waterfall or a saddle-type seat to support that,” Dr. Ahearn said.

	Valachi suggests an operator stool with a tilting seat pan, but cautions operators should tilt it forward only between 5° and 10°.

	“If you over-tilt it, you can cause hyperlordosis of your lumbar curve, which is too much low back curve,” she warned.

	In addition, she said if the seat pan tilts too far forward, there’s a danger of sliding on the washable surface. She points out that retrofit kits or angle seat cushions are available to angle non-tilting seats for proper seating. Hedge recommends sitting on a height-adjustable split-saddle seat or on an ergonomic stool such as the swopper.

	In conjunction with the seat pan, the backrest should have a forward adjustment as well.

	“The lumbar support on an ergonomically designed backrest is slightly convex to naturally fit your low back curve when sitting upright,” Valachi said. “Unfortunately, most dental stools do not have this.”

	The backrest does not need to be more than 8-to-10-inches tall to provide adequate lumbar support. In fact, large backrests that extend above the lower edge of the shoulder blade can inhibit movement in the operatory, she added.

	Also, stools for both dentists and hygienists should have compact yet stable, multipoint caster bases for mobility and to allow a close proximity to the patient chair with easy-to-access chair adjustment controls.

	Even if the majority of dental treatment calls for a seated position, variety in overall position can help prevent fatigue and stress.

	“Stand up and move around whenever possible,” Dr. Hedge suggested.

	Most patient chairs adjust high enough to allow dentists to perform treatment procedures while standing, if desired, Valachi pointed out.

	“Dentists can stand for injections, extractions, impressions, consultations, examinations,” she said. “Alternate between sitting and standing. That’s a huge benefit right there.”

	The delivery system used in the operatory is another point sometimes overlooked or treated as an afterthought.

	“Certain delivery systems have pros and cons,” Valachi said. “You need to choose a delivery that best fits your body size, your operatory layout, and each team member.”

	According to the survey, more than two-thirds of doctors (70%) promote proper ergonomics for themselves and their staff through specific equipment and seating purchases. Another 11% indicated they made specific purchases for their dental hygienists, and 9% for their dental assistants.

	Valachi said a rear delivery system works well when true 4-handed dentistry is practiced. A side delivery setup is less effective because the assistant cannot reach instruments and handpieces.

	“Over-the-patient is one of the best from an ergonomic standpoint,” she said. “But if the user has a very short torso, they’re going to be reaching repeatedly upward, and that movement biomechanically leads to shoulder pain.”

	“You can’t use what you can’t reach,” Dr. Ahearn said. “Create an environment for delivery that’s efficient and ergonomic. If you’ve got the doctor in the ideal position and then you have to get out of that posture to get what you need, then we just threw it all away.”

	Tim Caruso, PT, MBA, MS, Cert. MDT, CEAS, put it another way, “Sometimes, habits overrule ergonomics.” Even when dentists want to practice ergonomically, they may have trouble changing established posture and that shifting into a proper ergonomic sitting position may cause discomfort so they slide back into unhealthy sitting profiles, he added.

	When designing the ideal delivery system, Dr. Ahearn worked with a NASA ergonomist as well as MIT engineers for input on working interfaces and how the patient’s sense of space fits in with the dental delivery setup. The result was an over-the-head system that allowed the doctor and assistant to access instruments without undue reach and without impeding on the patient’s personal space.

	It allows for a smaller yet more spacious and efficient treatment environment,” he said. “This reduces costs and increases productivity.”

	Arguably, properly selected and adjusted magnification loupes can provide numerous benefits to users in terms of reduced strain on eyes, neck, shoulders and back. However, they need to be used properly, or you will suffer the consequences.

	“Many people think loupes solve ergonomic problems, but loupes can create ergonomic problems,” said B.J. Chang, PhD, President and Chief Scientist of SurgiTel/General Scientific Corp. “If they’re using the wrong kind of loupes, then they are forced to use excessive head tilt. Then they develop chronic neck pains, eventually neck surgery and early retirement. The key is to find loupes that meet their ergonomic requirements.”

	“Loupes sit differently on every face, depending on the height of the nose bridge, the depth of the eyes, and other facial features,” Valachi said, emphasizing the need for loupes to be custom-fit to the individual user.

	Some of the key factors to consider when selecting dental loupes include lens styles such as front-lens-mount (FLM) with flip-up option or through-the-lens (TTL) options, interpupilary distance, depth of field and working distance as well as convergence angle, viewing angle and declination angle.

	Valachi said poor declination angle of loupes is the No. 1 magnification problem in dental operatories. The declination refers to the downward tilt angle of the loupe lens, which added to the neck tilt forward adds to the total viewing angle.

	FLMs are almost always going to allow the best declination because the scope is not built into the glass and adjustable,” she said. “TTL models with a pantascopic tilt feature will generally provide the best declination for TTL users. The tilt feature means the bottom part of the glasses are angled back toward the cheek. The lenses of sports frames angle slightly backward as well, which allows better declination.”

	The optimum declination angle will vary according to physical features of users or procedures. Too small or too large declination angles will foster poor postures. Certain FLM models feature such adjustment options as double hinges and vertical positioning mechanisms that allow users to fine-tune their declination angles to achieve the maximum comfort. Chang said the convergence angle (the inward tilt of the lenses toward the object) should be custom set and fixed to provide for the optimal working distance and depth of field, which can help offset poorer vision due to age.

	He suggests a 2.5X magnification for beginning loupe users, with more powerful levels up to 3X or 3.5X for taller wearers because the longer working distance requires more magnification power to achieve the same visual acuity with the shorter working distance. Magnification powers are available up to 8X.

	eight also can be a factor in loupe selection, but should not supersede affecting the vision. Valachi said FLMs, which allow the best head posture, have been less popular because they have traditionally been heavier. However, several flip-up models on the market today are ultra-lightweight with ideal declination angle to allow for optimal head posture.

	A TTL model that offers good declination angle to one user may not be able to offer good declination angle to another user, Chang said.

	Now that you’ve got yourself into the proper, ergonomic posture, it’s time to add the patient into the equation.

	“How you position the patient really should be balanced in favor of the doctor,” Dr. Ahearn said. “You need to be comfortable. The patient needs to be okay.”

	Valachi said proper patient positioning complements doctor positioning. To get the patient’s head into this ideal position, use a chair with a double-articulating headrest that angles up into the patient’s occipital and angles downward, or add a contoured ergonomic dental cushion under the patient’s head.

	“When treating the maxillary arch, the occlusal plane of the upper arch needs to be angled backward up to 25° in relation to the vertical plane,” she said. “Usually, what I see in the operatory is the upper arch more vertically angled, and then the doctor is forced to crank their head forward.”

	Aggie Pennington, Senior Equipment Product Manager for DentalEZ Group, offered additional factors to consider in selecting a treatment chair for doctor and patient ergonomics.

	“What you need is a very thin chair back so you can come down as low as possible onto the dentist’s legs,” she said. “The thicker that back is, the more your arms have to be up higher because the patient’s head is up higher. The more you have to raise your shoulders and arms, that’s when you start to have health issues.”

	The chair back should be narrow across, and the base of the chair should be cut in to allow close access to the patient, she added.

	Another feature to consider, offered in DentalEZ’s J/V-Generation J-Chair models, is an independent tilt that helps maintain proper spinal alignment to reduce stress on the discs and soft tissue around the patient’s spine. The “lounge-chair” feel allows the patient to recline farther into a supine position.

	Ergonomics is one aspect of dentistry where dentists, dental assistants and dental hygienists often are left to find answers on their own. Hedge said he doesn’t know of any dental schools that offer training in ergonomics, and a search of dental school curricula backs his assessment.

	In addition, there are no professional societies in the United States dedicated to the study and promotion of dental ergonomics, though the European Society of Dental Ergonomics does offer information for members and holds an annual meeting (June 4-5 in France).

	Consultant agencies such as Valachi’s Posturedontics Inc. and Dr. Ahearn’s Design/Ergonomics provide doctors, hygienists and assistants with research-based education on establishing proper ergonomic working conditions and unbiased reviews of dental ergonomic products, as well as instruction on reversing some of the negative cumulative effects of improper ergonomics, before it’s too late. 

	Hedge also provides general ergonomic information online at ergo.human.cornell.edu.

	“You want to pay attention before you feel pain,” he said. “You want to pay attention to discomfort. If you are getting any signs like headaches, neck aches, back aches, sore arms, sore wrists, those kinds of signs are telling you that something is not right with how you are working.”

The February 2010 DPR Ergonomics Survey was sent via e-mail to 9,266 general practitioners in the United States. The link to the survey was also promoted on Facebook, where we currently have 4,304 followers. The survey was completed by 103 respondents.

 Dentistry used to be an ergonomic standing profession. Once practitioners took a seat, it became a pain in the neck…and back…and arms…and eyes…  The general public often stereotypes a visit to the dentist as an uncomfortable experience. But patients don’t realize their dental practitioners all too often experience musculoskeletal pain that surpasses their discomfort during an oral exam. Worse yet, many professionals believe head, neck, shoulder and back pain are all part of the job.

No pain all gain

	While the massive healthcare reform bill recently signed into law by President Obama will affect all Americans in one way or another, it contains a provision that will have a direct impact on dental laboratories in their role as manufacturers of medical devices.

	Analysis by Reed Smith LLP and the NADL Executive Staff of the amended 

Health Care and Education Reconciliation Act of 2010

 indicates the law will impose a 2.3% tax on the sale of finished medical devices, including final dental prosthetics, to be remitted by the "manufacturer, producer, or importer" of the device. The excise tax provisions apply regardless of the classification of the device, but do not apply to over-the-counter devices such as eyeglasses, contact lenses, or hearing aids.

 Co-Executive Director, "Any dental lab is subject to the tax. It's got uniform applicability, regardless of the size of the laboratory. If you sell $1 of medical devices, you've got a 2.3% tax on the $1." He points out that a previous version of the law was tiered so that labs with less that $5M annual sales would not be subject to the excise tax, but that was repealed in the reconciled version. "A small lab is just as subject to the tax as everybody."

	Napier emphasizes that the 2.3% is not a sales tax per se (as levied by individual states) but a federal excise tax. "Each state regulates [sales taxes] differently, and that's going to confuse a lot of people," he says. "In some states, they look at the finished device as tax exempt from a sales tax perspective because the end-user is a patient."

	“Laboratory owners will need to decide for themselves from a business perspective how to handle this new added cost of the restoration. This is a new expense in making a restoration. Some dental laboratories may absorb the new cost and others may pass it on. That is a business decision for each individual dental laboratory to make,” says Napier.

	He adds that it will be at the dentist's discretion how or if the increased cost of the final restoration is applied to the cost to patient.

	The excise tax is on the finished medical devices only and not on any individual components used to make the final product. For example, the tax would not be applied to a milled zirconia framework or remitted by an outsource lab providing the substructure, but it would be applied to a finished bridge, and the lab supplying it to the dentist would be responsible for the 2.3% tax on the cost to the dentist.

	If a dentist were to send casework directly to an offshore laboratory and receive the final restoration from that foreign entity, then the dentist as the importer of the final product would remit the tax.

	"If there is a broker taking possession of finished devices for multiple clients, lab or dentists, effectively it's likely they would be the one to remit the tax on the finished device," adds Napier.

	Though lab owners need to be aware of the excise tax and how it will affect their business, the tax itself does not go into effect until 2013. In addition, the collection requirements have not been established either, which adds to the confusion and frustration. "The biggest unanswered question, because nobody has the answer, is how will the IRS implement this. What's the frequency of remitting the excise tax. They haven't even started to speculate how that will be done," says Napier.

	In the meantime, Napier says that he and the NADL, as well as other trade organizations such as the Dental Trade Alliance, are lobbying on having the tax on finished medical devices repealed or amended by Congress.

	But Napier is not optimistic about the law being changed before it goes into effect. "I'd say this particular element probably would not be subject to repeal, unless you see a large change with the Congressional elections in the fall. If the interim elections don't change the party makeup significantly, most of these prevailing elements of the law will stand."

	The National Association of Dental Laboratories is the unified voice of the dental laboratory industry supporting dentistry and serving the public interest by promoting high standards. NADL accomplishes this by providing programs, services and networking opportunities to meet the evolving technical, educational, professional and business needs of dental laboratories. For more information, please contact the NADL office at 800-950-1150, or visit www.nadl.org.

 While the massive healthcare reform bill recently signed into law by President Obama will affect all Americans in one way or another, it contains a provision that will have a direct impact on dental laboratories in their role as manufacturers of medical devices.

Medical device taxation and the dental lab

	When it comes to advice, it is far easier to give than to receive. Most people have opinions on just about everything and are more than happy to share with anyone willing (or unwilling) to listen. For an independent small-business owner, such as a dental laboratory operator, the search for dependable sources of useful information often results in too many conflicting points of view from too many sources with hidden or blatant agendas. The key is to assess where the guidance originated and take everything with a grain of salt.

	When Chris Brown helped build Apex Dental Milling from the ground up in 2007, he was in an unenviable position faced by many new lab owners, as well as those just trying to keep up to date: where to turn for reliable information on the myriad choices for equipment, supplies and materials.

	“I didn’t know where I could go to get information,” said Brown, Business Manager for the milling center located in Ann Arbor, Mich. “Unfortunately, I had to do what I think a lot of lab owners do, and that’s just go through a trial by fire, trying this and that.” He adds that this hit-or-miss approach can work for smaller supplies like burs; “It’s something else when it’s a $1,000 handpiece or a $100,000 milling system.”

	To help with his task to equip a high-tech milling center with everything from brushes and burs to CAD software and CAM hardware, Brown sought out input from others who had the same day-to-day and long-term concerns that he faced.

	“I found for me talking with other labs really was my best source for information,” Brown said.

	Fellow lab owners and managers very often are beneficial go-to resources for seeking and sharing information on topics including purchasing decisions, business and employee management, financial planning, and material usage techniques. Being part of a fairly small industry-compared to other health care fields-dental laboratory owners see the collegiality rather than the competitiveness of their profession when it comes to sharing information and knowledge with peers.

	According to the November 2010 DLP Purchasing Survey more than two-thirds of lab owners (70.8 percent) rely on colleague recommendations when making purchasing decisions. The same percentage said that they do research on the Internet, and 58.3 percent replied that they do research by attending dental technology trade shows.

	Alan Barnes, facilitator of The Barnes Group, a think tank and technical consortium of independently owned dental laboratories from across the U.S. and Canada, agrees with Brown on the need for intra-lab communication.

	“Linking with other labs and being able to talk with your colleagues is important,” he said.

	The Barnes Group members (currently 11 lab owners) meet via conference call twice a week and then a third time every other week to discuss subjects directly related to the profitable operation of a dental laboratory, including partnering with manufacturers and suppliers to establish fair pricing and service, as well as sharing information and ideas on topics such as sales and marketing strategies and the evaluation of new technologies.

	“We have labs of all different sizes that make significant contributions,” Barnes said. “We feel that it’s important not to focus on just one size of lab. All of us have pretty much the same needs.”

	The sharing of information among lab owners does not need to be in the format of an organized members-based buying group but could instead be an informal gathering of peers through Web-based outlets such as social media and e-mail forums. Barnes also recommends collaborating with colleagues at state or local dental association meetings.
	“You can listen to the lectures and hear the panel discussions, and then go out on the exhibit floor and test the equipment or find out more information,” he said.

	As valuable a resource other lab owners can be for helping gather and discern information before making buying decisions, there’s another set of peers even more convenient and familiar with your particular needs.

	“Employee involvement is paramount,” Barnes said. “One of the things that can backfire is when a lab owner decides, ‘This is what we’re going to buy,’ and then they buy it and bring it in. Employees should be involved on all different levels of leading the lab, and making decisions and purchasing should be part of that.”

	However, results from our Purchasing Survey show that less than 5 percent of responding lab owners involve their employees before making a purchase.

	Barnes added that the size of the lab is irrelevant to employee inclusion in decision-making, primarily because they are the ones who are going to be using the equipment after the purchase and therefore are directly related to your return on investment.

	“Owners who spend more time in preparing their group and their teams/departments on what they’re going to bring in have a better chance of implementing it properly,” Barnes said.

	In addition to your own staff, use external non-industry consultants such as accountants and business advisors to obtain an impartial view.

	While getting input from other lab owners and managers as well as your own staff provides real-world experience for making purchasing decisions, Dean Mersky, DDS, VP of Sales & Marketing for Dentalle Inc., cautioned that colleagues should not be the only source lab owners use for buying information.

	“When lab owners need help or they have a question about how to manage a material, they turn to each other. They don’t ask the manufacturers,” Dr. Mersky said.

	Obviously, the manufacturer will have data on performance and reliability, but as Brown puts it, “You take that with a grain of salt.”

	Brown said that when he talks with vendors about their high-tech equipment, he doesn’t just ask about the features and benefits but also the problems involved with the item in question. He even finds two layers of satisfaction with their responses.

	“I love to watch a manufacturer squirm when I ask them, ‘What’s wrong with your system?’ or ‘Where does it not excel?’ To me, that’s what I want to know,” he said. “I want to know where your system isn’t great, and is that important to me or not.”

	By asking these types of questions, he feels that he gets a more complete answer than a simple, “Why should I buy your product?”

	He added, “If somebody is willing to say somebody else does a better job but this is where we excel, that says an awful lot about the credibility of the manufacturer. You’ll see how honest the manufacturer is, and it helps you as a buyer make an informed decision.”

	In addition to pointing out their own flaws, Brown said manufacturers should offer information as to steps they are taking to correct or upgrade possible deficits.
	Dr. Mersky agrees that it can be challenging to get “a straight story” from manufacturer sales reps, which may be a reason dental lab owners and clinicians turn to one another for advice.

	“There’s inherent questions that can’t be answered even from the manufacturer in concrete form, such as service,” he said.

	Some of the points that may be best answered by users involve breakdown rates, service issues, warranty follow-through and unforeseen costs of use, Dr. Mersky said. Barnes recommends approaching vendors as allies rather than adversaries.

	“You have to have a good working relationship with them. You want to have a partnership relationship where you’re in it together,” he said. “But it helps to have it all in writing. Intentions are one thing, but performance is another.”

	With such a partnership in place, Barnes said buyers have the opportunity to ask vendors for add-ons like facility tours or trial test-drives on certain equipment. KaVo recently introduced a program (trykavo.com) that allows dental practices to try its electric, air-drive, hygiene and ­diagnostic handpieces for a 5-day risk-free trial in the dental operatory on actual patients.

	Once all the information and opinions from employees, colleagues and manufacturers has been gathered and analyzed, it’s up to the lab owner to sort through all the data to make the final decision. In doing so, certain patterns will emerge, which Brown refers to as the “common thread of truth.”

	“Talk to enough people, and you’ll eventually be able to filter out personal preferences from actual fact and ­dependable information,” he said.

	Dr. Mersky cautions about taking the extreme viewpoints, treating ­phenomenally positive or notably negative as anomalies rather than the model.

	“In trying to get a real-world estimate of a value, ask more than one user or purchaser as they could have an exceptional judgment,” he said.

	Ultimately, however, the responsibility for making purchasing decisions lies in the hands and the mind of the ­business owner.

	“Sometimes, you’re going to have to make a calculated risk,” Barnes said. But by gathering information from knowledgeable sources and then using your experience and judgment to guide your buying determinations, you can minimize the overall risk involved.

 When it comes to advice, it is far easier to give than to receive. Most people have opinions on just about everything and are more than happy to share with anyone willing (or unwilling) to listen. For an independent small-business owner, such as a dental laboratory operator, the search for dependable sources of useful information often results in too many conflicting points of view from too many sources with hidden or blatant agendas. The key is to assess where the guidance originated and take everything with a grain of salt.

Buyer's resource

	Customizable personal settings let users change banner appearance and behavior, so each computer can have its 

 sets a unique tone identifier for each user.
	
	Automated Web Forms promote the 

, saving valuable time and money. Patients can fill-in information online and submit it. The “Immediate recognition” system notifies staff when a new patient form is submitted. At the first visit, patients can digitally sign the forms using the V.Com Clipboard software.
	
	V.Com intra-office communication system is 

quick, efficient and easy-to-install on your own

. It works seamlessly with the current computer system and network, with no new equipment, hard wiring, construction costs or business interruption. Three levels are available, including the basic free level.
	
	Multiple messages can be sent to 

…simultaneously. The V.Com communication banner does not interfere with programs running on the desktop.

		Ceiling-mounted monitor: Ergodontic LLC’s Pendulum Mount

		Durable portable computer: Careworx’s GammaTech MT10