Terri Lively

	Jennifer Sanders, DDS, acted quickly in her private practice in Frenchtown, Mont., when the stay-at-home orders hit. As soon as the ADA came out with their recommendations, she began canceling appointments a week at a time. 

	“We are not sure how long this is going to last,” Dr. Sanders says. “Nobody is.”

	You don’t know either, but you are doing your part. You have closed your practice to all but the emergencies. With the “stay-at-home” directives moving from being counted in days to weeks and beyond, what else can you do?

	Plenty, according to our experts. Here are a few things dentists are doing during the shutdown.

	The first thing Jeff Lineberry, DDS, FAGD, did with his private practice in Mooresville, N.C., was cancel scheduled appointments. With a skeleton crew on hand to reschedule patients, process claims, and other business, he is treating emergencies only. 

	“I see our role during this pandemic is to keep patients out of the emergency room,” Dr. Lineberry says, adding he now pre-screens patients on the phone.

	Jason Goodchild, DMD, vice president of clinical affairs for Premier Dental Products Company, says at his Havertown, Penn. practice, they adopted the emergency-care-only protocol immediately after the CDC and state recommended it in mid-March. While he admits that everyone is handling the emergency care only order in their own way, he feels the CDC and ADA put out useful guidelines on what a dental emergency is. 

	 “We strictly adhere to that, and I think that’s the right thing to do,” Dr. Goodchild says. 

	The ADA’s guidance from March 18th defines emergencies as those conditions considered life-threatening, require treatment to stop bleeding, or alleviate severe pain or infection. Bleeding, cellulitis, soft tissue bacterial infections causing swelling that can compromise the airway, trauma for facial bones that can compromise the airway are all identified as emergencies. Additional situations that could require immediate dental care include pulpal inflammation, pericoronitis, suture removal, and denture repairs.

	It’s up to the dentist to determine if the situation warrants an in-person visit. However, the ADA published algorithms in their “Interim Guidance for Management of Emergency and Urgent Dental Care” to help. The algorithms can “assist dentists and dental offices in making informed decisions concerning patient triage, evaluation, and treatment during the COVID-19 crisis.”

Related article: In tough times, the dental industry bands together

	The ADA seeks to have the dentist help alleviate the need for these patients to go to the emergency room. However, the ADA urges dental professionals to treat them as minimally invasively as possible to avoid conditions that can spread the novel coronavirus that causes COVID-19. 

	Dr. Goodchild says it is incumbent upon dentists to be learning the facts about the pandemic on a day-to-day basis because it changes by the minute. He recommends monitoring the ADA, the CDC, and Clinician’s Report websites for the daily updates they publish. 

	“You have to learn what’s going on and do what you can to protect yourself, your team, your patients, and everybody else,” Dr. Goodchild says.

	Tera Poole, DDS, MS, is the clinical director for Uniform Teeth, a doctor-led orthodontic practice applying the latest technology, including telehealth, to orthodontic treatment. Once the stay-at-home order arrived, the practice increased communication with patients through its mobile app, email, and social media. 

	“We’ve had a steady stream of updates and progress messages for patients. We make sure that once we have information on our end, we continue to pass that along,” Dr. Poole says.

	Uniform Teeth is taking the same approach to communication with its entire team. They spent a lot of time researching the dental boards, the CDC, and the ADA recommendations, which they relay to the team. 

	“One of the core concerns for our business is to preserve our team’s benefits as much as possible during this challenging time. We’ve focused on doing everything we can to support our team during the clinic closure period. Ultimately, we believe we will come out stronger together.” Dr. Poole says. 

	Since February, Uniform Teeth has been proactively communicating about COVID-19 and its plans to its team, even on a weekly and at times daily basis. Since the shutdown, the communications are about what the company is working on during this time. From app updates to operational improvements, communication is critical for the Uniform Teeth team. 

	“We still have people reaching out from the customer service team to our patients. Our model is that patients do not have to come in as often, so we have a lot of patients mid-treatment and progressing. If there is a silver lining in this, it’s that patients can still check-in and progress through their trays by keeping that communication line open.”

Additional COVID-19 Coverage: Amidst a pandemic, teledentistry takes center stage

	At Dr. Goodchild’s practice they believe it is the dentist’s responsibility to make a plan and communicate it with the team and patients. Dr. Goodchild suggests updating the website, using social media, and leveraging practice management and patient communication technology to this effort. 

	“Over-communicate with patients to let them know that you’re available for emergencies and that when things normalize a bit, we’ll be ready for you again,” Dr. Goodchild says. 

	Sarah Jebreil, DDS, AAACD, has a private practice in Newport Beach, Calif. When she goes in to treat emergencies, there are a few different new protocols. For example, Dr. Jebreil ensures that there are only three people in the office, and patients wait in the car until they can enter the operatory. They also take temperatures of patients and staff to ensure no one is bringing COVID-19 to the practice. The team is also meticulous in their wipe-downs between patients. 

	During the shutdown, Dr. Jebreil has also been using Smile Snap, a website widget for virtual consultations. She likes Smile Snap because it allows her to do the consults when she has time, which is in short supply while she is working from home with children. 

One practice's recent experiences: Find out what Dr. Jeff Rohde has been up to during the shutdown

	“With the roles changing and not having a nanny or a housecleaner and not having the kids at school, I can’t do online consults on demand. So, Smile Snap is nice because I can do them when I have the time,” Dr. Jebreil explains. 

	Dr. Lineberry thinks dental offices should also take this opportunity to reset and take care of things they don’t have time for when patients are there. They can optimize staffing, clean up patient records, and organize by active and inactive patients. His team is also taking care of other essential to-dos, including training and reorganizing materials and equipment for efficiency.

	Dr. Lineberry thinks there will be changes in infection control best practices moving forward, so he is taking a proactive approach. They are replacing the cloth chairs in the waiting room with something easier to clean. Dr. Lineberry will also demonstrate more infection control management in the practice for patients. 

	 “You used to wash your hands and put hand sanitizer on, but you didn’t show the patients you were doing it. Now, we will. We will also do things like open the bags in front of the patients,” Dr. Lineberry says. “It’s a good idea to role-play what you do on a day-to-day basis.” 

	Dr. Goodchild recommends also managing cash flow. Most practice’s work on staggered cash-flow. For a few weeks, you have some receivables trickling in, but receivables will stop as the shutdown goes longer. Dr. Goodchild recommends applying for a small business loan, line of credit, or even talking to creditors to push payments out. 

	“The unknown of it is the worst,” Dr. Goodchild says. “If you told me that we need to batten down the hatches for 30 days, I could figure out how to make that work. But the unknown is upsetting because we don’t know how long it’s going be before we can get back to normal.”

	Jody Rodney, vice president of marketing and education for Planmeca, oversees education for customers and dealers. Usually, their continuing education would occur in their new, state-of-the-art education center just outside of Chicago. Moreover, they feel in-person instruction is the best way for dentists to understand how to use their technology. So, virtual learning has been a significant pivot for them, and one they had to do quickly.

	Planmeca hosted seven webinars by the first week in April with average attendees anywhere between 250 and 300. Many of these online webinars are like introductions to what they could expect to learn at an in-person training. Rodney says the topics garnering the most interest are those that provide value to the practice without having to make an immediate investment, such as how to incorporate dental sleep medicine into a practice. Also, Planmeca had over 500 attendees for a CBCT interpretation course, which Rodney explains helps dentists better utilize the technology that they already have. 

	“One of the doctors’ biggest concerns or fears when they adopt CBCT technology is that they are responsible for all of the information within the CBCT scan,” Rodney explains. “It’s not something that comes naturally to them or something that’s taught in dental school unless they’re at a progressive school that’s using 3D technology.”

	Rodney and her team are focusing on more user education webinars throughout April and the beginning of May. She and her team are brainstorming topics that they believe users want to know about and putting those online. 

	Rodney says dentists are likely to get bombarded with training and webinar opportunities. She thinks choosing topics that help them be more productive with what they have is the best use of the downtime.

	“Educating people on how to do their jobs better will probably be the most relevant,” Rodney says.  

	One topic they are working on is how to get up and running quickly after the shutdown. Rodney says it helps dentists create a game plan.

	 “Some of it is how to use technology to help them get more dental work because there’s more dentistry when you’re utilizing technology,” Rodney explains. “But also how they can position their staff and get them trained up during this downtime so that when they come out, they’re going to be more effective and ready to go.”

	Dr. Lineberry says dentists can’t control what’s going to happen, but you can control being ready when the practice reopens. From website and server updates, to working with staff on practice priorities, the stay-at-home order can be a productive time to work on practice management.

	“There are so many things that are within our control. It’s your choice to decide if you are going to do something with it,” Dr. Lineberry says.

	During the shutdown, Dr. Jebreil’s team is doing their regulatory compliance, which in California includes sexual harassment training. The CDA also has OSHA guidelines to review, although she suspects these will change. 

	“We are doing all of our stuff that you never have time to do, and you don’t always want to do,” Dr. Jebreil says. 

	Dr. Poole says Uniform Teeth is looking at all of their best practices across the organization and improving technology and processes, including virtual comfort consults with patients. She is also taking advantage of CE opportunities. Whether it’s professional or personal development, Dr. Poole feels it is vital to keep moving forward. 

	“In healthcare, we are always moving, moving, moving. When we aren’t moving, it’s scary at first. But if we embrace it, we can make sure we come out the other side a better version of ourselves,” Dr. Poole says.  

	“You can look at it as a crisis or an opportunity. If you look at it as an opportunity, as a reset for your practice, the hope is when you do come back, you can be more effective and efficient,” Dr. Lineberry says.

	“Personally, it’s a time to reflect and see, ‘Am I purposeful? Is this what I want to do with my practice and my team?’” Dr. Jebreil says. 

	For her part, Dr. Sanders finds being home with her son, she is getting a whole lot less done than she usually does-and that isn’t all bad. 

	“When I’m working, it always breaks my heart to drop him off at daycare, and I always wish I had more time with him,” Dr. Sanders says. “So, I’m focusing on gratitude.”

	Dr. Sanders heard someone say, “The best thing that could happen is that we look back at this and think that we overreacted.” Dr. Sanders hopes that is true. 

	“I sincerely hope we are overreacting,” Dr. Sanders says.    

	 1. Solana, Kimber. “ADA develops guidance on dental emergency, nonemergency care.” www.ada.org.

Articles

We spoke to dentists about what they are doing with themselves and their practices during the COVID-19 pandemic stay-at-home orders.

Making use of unexpected dental practice downtime

	Dentists have been using impression materials to capture the detail of patient's mouths for restorative work since the early 1700s. However, more than 200 years later, we still use impression materials for the same purpose, but not the same stuff. We spoke to experts to learn more about how these materials have changed over the years and why. 

	Peter Meyerhof, DDS, Ph.D., has a private practice in Sonoma, Calif., and is on the board of the American Academy of the History of Dentistry. He says the earliest known use of impression materials was in the mid-1700s in Prussia. One dentist, Dr. Philip Pfaff, who was the King of Prussia’s dentist, used sealing wax softened in hot water, which he then molded to the teeth and then poured in plaster to make a cast for a partial denture. 

	Some dentists claim that the use of wax goes back much earlier, but there is no remaining evidence for how they took impressions. For example archaeological evidence shows us that, as early as 600 BC, the Etruscans in making a fixed bridge would solder together bands around both abutments and pontics that were made of ox bone. This prosthesis would have required a model, Dr. Meyerhof explains. However, there is no surviving evidence of how the Etruscans did this. 

	Wax was commonly used for impressions, particularly beeswax. George Washington, who had several sets of dentures in his lifetime, would have had a dental impression made with beeswax. Dr. Meyerhof says President Washington's dentist, Dr. John Greenwood, used the same method; softening the wax, molding it to the teeth, and cooling it with water while it hardened a little before removing it. Then, Dr. Greenwood would have poured the cast with plaster of Paris. 

	Shirin Khoynezhad, DDS, a prosthodontist and the Director of Second-Year Pre-Clinical Dentistry at the University of Alabama, says another dentist advertising out of New York in the late 1700s also was taking impressions. The ad ran in 1787 in the New York Daily Advertiser and read, "persons at any distance may be supplied with artificial teeth by sending an impression, taken in wax, of the place where wanted…"

	"So, people could take a wax impression at home and send it to them, and then he would send a denture back to them," Dr. Khoynezhad says. 

	Dr. Khoynezhad teaches her students how to set teeth in wax. Wax changes dimensions in different room temperatures. She says the wax changes handling properties as the students work and raise the temperature in the room. She can only imagine the state of those impressions traveling in that mail during the 1700s with that much handling. However, it was revolutionary back then to have impressions taken and dentures made. 

	By the middle of the 1800s, dentists began using plaster as their impression material. The earliest techniques used a tray made of wax. However, Dr. Meyerhof explains, plaster sets up quickly, so the dentist would have to work quickly. Moreover, since plaster is not elastic, the dentist would tap it with a mallet to break it out and then reassemble outside the mouth. Dr. Meyerhof says this technique persisted until the early 1900s. 

	“That’s a pretty brutal method,” Dr. Meyerhof says. 


	At the turn of the twentieth century, dentists began using Impression Compound, which is wax with a talc filler and a lubricant that softens when heated. Impression Compound softens when heated to 150 degrees Fahrenheit and then the dentist would let it set up.

	“Once again, it will lock into undercuts, and would have to be broken and reassembled on the bench. But it could be used for dentures for people who have no teeth, for instance, quite well,” Dr. Meyerhof explains.

	Around 1930, dentists began using flexible impression materials. Hydrocolloid, which contains agar made from a special type of seaweed, is a reversible material that gels at 90 degrees Fahrenheit. Dr. Meyerhof says when it is hotter, hydrocolloid is a liquid, and you can put in trays to set up. Dentists commonly used hydrocolloids as impression materials until the 1940s. However, since the seaweed came from Japan, the Allied countries switched to using alginate during World War II. Unlike hydrocolloids, alginates set up irreversibly and are made from a common brown algae. Alginates were most popular until the 1950s, although they still have many uses today.  

	Dr. Meyerhof says the mid-twentieth century was a major turning point for dentistry in many ways, and this included new impression materials. In the mid-1950s, dentists began using Polysulfides, an elastic material made of synthetic rubber that is renowned for its bad smell and taste. Polysulfides had some great qualities, but they also had a long setting time and were not as accurate as some of the impression materials that came before it. Next, the dental industry introduced Polyether (PE), which was hydrophilic, making it easy to use when isolation was a problem. However, it was also stiff and tore easily. Moreover, the bad taste persisted with these early formulations, Dr. Meyerhof says. 

	By the 1980s, dentists began using Polyvinyl Siloxanes (PVS). These materials were more hydrophobic than PE materials. 

	“The first ones were very hydrophobic, meaning that moisture control was extremely important. If there was any liquid, they weren’t that good,” Dr. Meyerhof says. “They certainly evolved over time to become quite hydrophilic, which is important because even if you try to dry a tooth as much as you can, there's still this sulcular fluid that emerges adjacent to the tooth and often near the location of the margin of a preparation. It can certainly interfere with accuracy unless you have a hydrophilic impression material.”

	PVS is very accurate. It is also flexible, which means you can pull it out of the patient's mouth over bulging teeth. 

	“It has excellent resilience and tear strength

” Dr. Meyerhof says, “and for the last 20 years or so, it can be put into an auto-mix dispenser, so it’s extremely easy to use and very uniformly consistent.”

	PVS also has excellent dimensional stability. You can pour a cast from an impression long after you take it, which isn't true of many of the older impression materials. It can also be disinfected quickly because of its dimensional stability, which is essential in light of current infection control protocols. The dentist disinfects the impression and ships it to the lab, which then disinfects it again, often with CaviCide from Metrex. 

	"You can't disinfect a material like an alginate, because if you spray something on it, it will absorb it and distort," Dr. Meyerhof says. 

	In the 2000s, PEs persist, as well as alginates and alginate substitutes in some practices. However, PVS is the most commonly used material today. 

	“I think it’s the ideal material,” Dr. Meyerhof says. 

	Dr. Khoynezhad says silicone-based impression materials like PE and PVS became the gold standard. 

	"It's worth mentioning that how you handle impression material is done by impression trays," Dr. Khoynezhad says. "Trays changed a lot over these times, too, from the 1800s to now. Today we have a lot of good trays, thermoplastic trays dipped in hot water, and then put into the patient's mouth to mold. If you don't have an accurate impression tray, you can't get an accurate impression."

	Moreover, impression materials work best when manipulated in the best conditions, which includes the best tray fit, Dr. Khoynezhad says. For example, with alginate, you need to have room between the teeth and the tray so the material can be thick enough to capture the oral tissues. So, you use a looser tray with alginate than other materials. PVS materials, on the other hand, Dr. Khoynezhad explains, need less space because they are accurate in thinner layers. 

	Dr. Khoynezhad says that after the invention of PVS materials and toward the end of the twentieth century, all these advances in impression materials slowed down a lot. Synthetic elastomeric materials are what dentists use today, although the formulas have improved since their introduction. 

	"These synthetic materials were created because we needed dimensional stability," Dr. Khoynezhad says. "Alginate impressions are accurate if they are poured within 10 to 15 minutes of taking the impression. Alginates should not get dried out because their dimensional stability is very low, and they change. When you pour distorted material, you don't get an accurate cast."

	With today's synthetic impression materials, Dr. Khoynezhad explains, you can take an impression and pour it the next day, and it will be the exact position that it was when removed from the patient's mouth. Also, the tear strength improved with elastomeric materials. She prefers PVS over PE because it's easier to handle and has excellent dimensional stability. Moreover, she thinks it produces accurate prostheses. 


	Dr. Meyerhof sees dental offices turning to impressions using a digital scanner and computed tomography rather than impression material. However, there are some disadvantages to digital impressions which Dr. Meyerhof says are often overlooked in the rush to the latest technology. In particular, Dr. Meyerhof gives the example of subgingival margins. When trying to get a good impression of the margin so you can have a smooth emergence profile, he recommends PVS because it usually will be atraumatically pushed slightly below the prepared surface. The same is not true for digital impressions.

	"If you can't see it, it won't be captured in a scan," Dr. Meyerhof says of digital impression technology. 

	However, Dr. Khoynezhad prefers digital impressions and describes herself as a digital person. She also thinks the future of impressions is digital and that dentistry will no longer use impression materials in the upcoming decades. But, for now, she still uses both because a lot of cases still require impression materials to deliver the best treatment and care for a patient. 

	"A lot of time, the digital scan doesn't capture the prep, especially if it is subgingival. We have to go back to impression materials to capture the fine details to fabricate more accurate crowns,” Dr. Khoynezhad says. 

	"So, we still use them, and they are excellent materials."

			1. Glenner, DDS, Richard A. "How It Evolved: Dental Impressions." Chairside Magazine. May 7, 2014. Volume 9, Issue 1. Accessed via the web. 5 March 2020. <

https://glidewelldental.com/education/chairside-dental-magazine/volume-9-issue-1/how-it-evolved-dental-impressions/

As early as the 1700s, dental professionals have been taking impressions of patients' teeth. Over 200 years, many things have changed for the better. Here’s a brief history of how and why impression materials have changed over the last few centuries. 

How impression materials have changed over time

	Now, perhaps more than ever before, overhead costs are a significant concern to a dental practice. Getting the most out of your investment in materials is crucial to your bottom line. Impression materials are a staple of your inventory closet and your materials budget. So maximizing your ROI on impression materials can help optimize this crucial practice management area. Here are a few ways you can get the most out of your impression materials.

Don’t Waste Material with Bad Technique.


	When you take a bad impression and have to retake it, you have to throw out impression material. Improving your technique can make your inventory go further, and cost less per impression. More importantly, better impressions lead to better restorations. 

	Marc Geissberger, DDS, MA, has a private practice in Greenbrae, Calif., and is also a speaker with Catapult Education. His free continuing education webinar, “

Clinical Techniques to Master the Final Impression Using a Modern Impression Material

,” is available online at vivalearning.com (Sponsored by VOCO America). He shared that

 said that of 1,157 impressions evaluated, there was at least one error in 86 percent of them, and over half of them (55 percent) had critical errors related to the finish line.

	“That’s shocking,” Dr. Geissberger says in the video. “Because we know if we have an error around our finish line that the restoration is destined for early demise.”

	Investing in products that can prevent mistakes in your technique is another way to protect your bottom-line with impression material costs. One suggestion Dr. Geissberger said could help improve impressions is to use a product called DAMit Impression Tray Membrane from TinMan Dental. DAMit is a tape in a dispenser that prevents material from coming out of the back of your impression tray. Dr. Geissberger uses it on the distal aspect of the tray for his upper and lower impressions. 

	Tissue management and isolation is another crucial area for making a better impression, per Dr. Geissberger. The three primary strategies for tissue management include laser troughing, mechanical retraction and hemostasis (cord), and hydraulic retraction. Dr. Geissberger covers two techniques in the webinar, laser troughing and mechanical retraction. For lasers, he recommends using low wattage with a diode laser to trough the area to be exposed carefully. For mechanical retraction and hemostasis, Dr. Geissberger favors the two-cord technique. The first cord should be the smallest cord that goes in and fits below the margin. Then he places the second cord to allow for lateral distention for the tissue. He also uses a hemostatic agent, ViscoStat™, from Ultradent Products, Inc., which contains 20 percent ferric sulfate. Dr. Geissberger likes it because it is not only an effective hemostatic agent, but it also desiccates the tissue. 

	“Keep in mind that those minor salivary glands inside our gums constantly release fluid into the impression site,” Dr. Geissberger explains. “So, by leaching that out ahead of time, we get rid of a lot of the excess moisture.”

	Dr. Geissberger also says that with patients that don’t have as much bleeding and with thin gingival biotypes, retraction pastes are useful for tissue management. He uses 3M’s Astringent Retraction Paste for cases where minimal retraction is needed. It uses 15 percent aluminum chloride, a good hemostatic agent.

	He also offers additional advice for taking impressions, which he calls Geissberger’s Rules for Impressioning:

			After placing the cotton rolls, instruct patients not to swallow and remind them throughout. This strategy is more effective at keeping the tongue immobile then telling them not to move their tongue. 

			Concentrate on capturing the sulcus, not the finish line. 

Choose the Proper Tray in the Correct Size. 


	A good impression is the result of a technique that gives you the perfect negative impression of the teeth, the gums, and the sulcus. The tray you use is also essential. Using the proper tray helps you capture the detail without distortion and eliminates the need to retake the impression.

	Choosing the proper tray size is essential. Using an ill-fitting or low-quality tray leads to problems with conventional impressions. Per 

, the tray should be large enough to include all the teeth and should not touch the soft tissues.

 If your completed impression has show-throughs, the tray was likely too small (or improperly positioned).

 If the tray touches a tooth, hits a tori, or is too small or narrow, it adds variability to the impression. 

	Having an assortment of stock tray sizes on hand will help you avoid problems with your impressions due to tray size issues. However, when it comes to stock trays, the sizes can vary by brand. In other words, all “adult trays size small” are not the same size. To ensure you have the right size for your patient, stocking many different brand trays in each size can give you more options to make the right fit.

	Often, stock trays require modification.

Dentists can modify the tray using wax, tracing stick impression compound, or heavy-bodied silicone, but whichever material you choose, the modifications you make to the tray must be rigid.

Furthermore, if the patient has a high palatal vault, you can use tracing stick compound in the center of the maxillary tray to reduce the amount of material you need to use to get the details you need.

	Custom trays can help you avoid multiple retakes that use more impression material and lead to a poor patient experience. Custom trays help you exert the maximum pressure on the material to push it inside of the sulcus. Custom trays also have the advantage of providing uniform thickness for your impression materials.

The uniform thickness offers several benefits for your dental impressions, including curtailing distortion, reducing material waste, and providing a more comfortable patient experience. Custom trays are particularly useful when replacing multiple teeth, or if the arch does not conform to stock tray sizes.

 Furthermore, the time needed to take a preliminary impression and then customize the tray also gives the patient’s soft tissue time to heal, which, in turn, means the tissue won’t bleed as much when you take the final impression. 

	However, it is essential to use different types of materials for your preliminary impression and the final impression with the custom tray. The preliminary impression should be light-body so it can flow to the surface of the teeth and control the bubbles within the material. The final impression, by contrast, should be a heavy-body impression material that the customer tray can push into the sulcus and capture that detail. 

	Dual-arch impression trays are another way to optimize the use of your impression materials. First introduced in the 1980s, the closed-mouth technique allows you to capture the impression in a single-step that is faster and uses less material than other trays.

 Dual-arch impression trays come in a variety of sizes and types of material fabrication. Choosing which one depends on your clinical use and the restoration you want to place.


	Overhead costs are an area that nearly every dental practice would like to trim. Who hasn’t had to throw out material because you didn’t use it before the expiration date, and watched hundreds if not thousands of dollars of profit get thrown out with it?

	One way to avoid this waste of material and money is to have a systematic inventory management system in place in your practice. If you don’t know what you have, how do you know what you need? And, perhaps more importantly, how do you know if you already have it, but it’s just in the wrong place?

	Having a system of organization is an excellent way to get the most out of your impression material. Dental City, a dental supply distributor, offers the following 

. If someone owns it, then they can control what is coming in and out of the office. Moreover, it ensures that two people don’t order the same thing or that someone ordered new stuff when the old stuff was on a different shelf. One person in charge will help alleviate this well-intentioned but sometimes expensive activity. 

. Whether you have it on paper, or keep a digital file, have the ordering process spelled out. This way, if the person you put in charge of it is out of the office, their substitute can follow established ordering protocol. Dental City recommends getting granular with the details in this write-up to leave fewer variables up to chance. 

Doing a summary of what you have and need should be part of the practice management routine. This check will not only serve as an opportunity to restock, but it will also reveal what you use the most and how much. Ensure that this review occurs on a regular interval, so you have useful data to analyze when it comes time to adjust your order. 

Keep a list of everything you order and from where. 

Having a record to refer to when you need to order something, mainly if you don’t order it all the time, will save time and frustration. Over time, this list will also reveal any patterns for products, suppliers, seasonal needs, or opportunities for cost savings. 

Budgets are vital to keeping operating costs low. Also, when you are going over, it can be a red flag to help you spot pricing inconsistencies or opportunities to save on materials you stock regularly by buying in bulk. 

	Some dental suppliers have systems that help you manage your inventory for efficiency and cost savings.

 from Zirc assigns a color to a procedure.

	Then, every material, instrument, and tool you need for the treatment goes in the corresponding color-specific treatment tub. The idea is that you have everything you need for that patient's treatment in the color-coded container when you go into the treatment room. One of the significant benefits is that you no longer need to fill all your treatment rooms with the same materials. The procedure tub moves from room to room, and you can see at a glance what you have, which prevents over-ordering. 

	The American Dental Association (ADA) also has recommendations for inventory and supply management. Their book 

Basic Training III: For Dental and Administrative Personnel

, suggests using supplies in the order you bought them, using the oldest first or the “First in, first-out” method. The ADA also recommends a centralized storage system with similar items next to each other and the most frequently used items in easy-to-see locations. Another suggestion from the ADA is a “wish list” for the team to request materials so that when it is time to order, there is some guidance for whomever handles ordering.

	Also, new technology can help with managing inventory costs. 

 is an online marketplace where dental suppliers compete for dentists’ business. The idea is that dentists use the collective bargaining power to get the best possible price for supplies, including impression materials. 

 is another online marketplace where vendors compete for your business. The site aggregates vendor catalogs into their site. Dentists can then compare individual product pricing from all the vendors automatically. 

	Impression materials are a staple in your practice. Ensuring that you use them efficiently is an excellent way to optimize your overhead costs and improve your bottom line. By improving your technique, choosing the proper impression tray, and managing your inventory and procurement for optimal turnover and competitive pricing, you can get the most out of your impression material. 

	1.     Rau, Clayton T. et al. “The quality of fixed prosthodontic impressions.” 

The Journal of the American Dental Association

, Volume 148, Issue 9, 654 – 660. Accessed via web. 9 April 2020. <

https://jada.ada.org/action/showCitFormats?pii=S0002-8177%2817%2930406-3&doi=10.1016%2Fj.adaj.2017.04.038

	2.     Kurtzman, DDS, Gregori M., Strassler, DMD, Howard E. “Indentification and Correction of Common Impression Problems.” Glidewelldental.com. 17 April 2008. Web. 9 April 2020. < 

https://glidewelldental.com/education/chairside-dental-magazine/volume-3-issue-1/identification-and-correction-of-common-impression-problems/

	3.     Nandini, V Vidyashree et al. “Alginate impressions: A practical perspective.” 

 vol. 11,1 (2008): 37-41. doi:10.4103/0972-0707.43416. Accessed via web. 9 April 2020. <

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813082/

	4.     Punj, Amit & Bompolaki, Despoina & Garaicoa, Jorge. (2017). Dental Impression Materials and Techniques. Dental Clinics of North America. 61. 779-796. 10.1016/j.cden.2017.06.004. Accessed via web. 9 April 2020. < 

https://www.researchgate.net/publication/320046633_Dental_Impression_Materials_and_Techniques

	5.     “5 Tips for Effectively Managing Your Dental Practice Supply Inventory.” Blog.dentalcity.com. 3 November 2017. Web. 9 April 2020. < 

https://blog.dentalcity.com/5-tips-for-effectively-managing-your-dental-practice-supply-inventory/

. American Dental Association, 2003, p. 107. Accessed Via Web. 9 April 2020. <

https://books.google.com/books?id=NqjJyTjJ1WEC&pg=PA107&lpg=PA107&dq=Arranging+dental+materials+by+expiration+date&source=bl&ots=h9ICLLCz_O&sig=ACfU3U1wm0MLI8hjrg_aEqNA4HZwyLbtMw&hl=en&sa=X&ved=2ahUKEwjfy86bytzoAhULGTQIHeuuAL0Q6AEwDXoECA0QMQ#v=onepage&q=Arranging%20dental%20materials%20by%20expiration%20date&f=false

From technique improvements to tray selection options and inventory management and procurement tips and tricks, we take a look at how to optimize the use of your impression materials to get the most out of your investment.

Getting the most out of your impression materials

	Smart technology is everywhere, from smartphones and smartwatches, to smart TVs and refridgerators. Even thermostats and doorbells have smart technology built in.

	“SMART” began as an acronym for Self-Monitoring, Analysis and Reporting Technology. Today, most people think of smart technology as offering consumers interaction and control of things using the internet. One definition says smart technology provides “cognitive awareness” to inanimate objects through artificial intelligence (AI), machine learning, and big data analysis.
	
	“We live in such a smart world, that as consumers, we’re conditioned to work with technology to make our lives easier. It helped us be better performers. When it comes to the dental practice, we want to have the same thing at work,” says Jessica Wilson, MPH, business development manager for Instrument Management Systems, Hu-Friedy Group.
	
	Smart technology is used to automate mundane tasks in our everyday lives according to Masa Ogata, CEO of Tokuyama Dental America.
	
	“Smart technology is prevalent in every aspect of our private lives from smart lightbulbs to automatic pet feeders. It seems a natural progression for practitioners to want to improve their workplace as well. Smart technology will undoubtedly continue to evolve and simplify the centralization of the dental practice, helping to increase potential revenues while reducing overhead costs,” Ogata says.

	Jonathan Bass, content marketing manager for RevenueWell, also believes smart technology will become ubiquitous in the dental practice. He envisions a future where dentists can’t live without it.
	
	“As younger dentists come in and are more used to technology and the different systems, it will be folded into their muscle memory,” Bass says.

	“We believe that in the near future ‘smart’ is going to apply to any product that reduces time or effort-in terms of documentation, know-how, troubleshooting, and even worry, and this can be applied to the dental office now,” Heather Trombley, president of DentalEZ, says.

	Kyle Stanley, DDS, and chief clinical officer at Pearl says new technology will provide consistency and bring more dentists into the future. It will also take on mundane tasks dentists hate so they can focus on providing dentistry.

	“When you think about the stress, the burnout, and suicide rates, it is clear that we feel overwhelmed because we have too much on our plate. If you take the mundane tasks out of running a practice, we can do what we love-creating smiles and changing people’s lives,” Dr. Stanley says.
	
	Either way it’s defined and no matter how it’s used, smart technology has a variety of applications in the dental practice. From management to marketing and communication, the future of dentistry is smart.

	The benefits of smart technology in the practice

	Smart technology is already making an impact in numerous ways. With the automation and integration available today, smart technology and AI are already changing dentistry’s business-as-usual.

	Smart technology in the dental practice will mimic the enhancements of our personal lives where technology becomes a multiplier, says Tom McCleskey, general manager of A-dec’s Premium Core Equipment Team. Dentists will have more information in real-time that improve processes.

	“Smart technology is a pretty broad term, and it’s saying all of the different devices you’re interacting with can not only receive signals or change the state of different settings, but it also has some processing capability,” McCleskey explains.

	“Equipment with microprocessors that can interact inside of a particular system and then with other products in an ‘ecosystem’ is a big trend.”

	Teledentistry-which uses electronic information, imaging, and communication to provide diagnosis, consultation, and treatment-improves the patient experience during referrals and allows for efficient collaboration, making it more hands-on for the GP in real-time, according to Brant Herman, CEO of MouthWatch. He envisions live video conferencing with the specialist, patient, and treatment coordinators where the GP shares intraoral images and clinical data. Teledentistry also allows the GP more engagement with the patient during and after treatment, elevating the patient relationship.

	“So, it’s the provider that they have the relationship with helping guide and increase the case acceptance they’re proposing,” Herman says.

	Teledentistry can also facilitate public health dentistry for states that allow it, including community-centered practices, such as screenings at nursing homes and school-based varnish programs that lead patients into brick-and-mortar practices for follow-up care. Herman sees the potential to expand this idea beyond public health.

	“We’re seeing more of these programs now where practices are going onsite to an office building and setting up a portable operatory. Hygienists are providing preventive and cosmetic services, like whitening and taking images. Dentists then review the images taken remotely and share the treatment plan with the patient,” Herman says.

Intraoral Dental Camera from MouthWatch. 

Why it's smart: An affordable option that facilitates teledentistry.

MouthWatch’s turnkey teledentistry product TeleDent recently launched their patient portal with direct patient messaging designed to improve efficiency with delivering care. Also, the dentist can take snapshots during a live consult, which can be saved into a patient record. Plus, it allows for offline work when Internet service is a problem. Moreover, MouthWatch has end-to-end HIPAA compliance.

	Teledentistry needs cameras to work, and MouthWatch offers cameras for $299 with an additional discount when purchasing more than one. The company’s goal is to make it possible for every operatory to have a camera whether in traditional private practice, group practice settings, DSOs, and even public health settings.

	“We say that intraoral cameras are the starting point to teledentistry, because once practices have the cameras in place, teledentistry can begin. We’ve seen programs thrive by only sending out a hygienist with a laptop and a MouthWatch camera,” Herman says.

	Smart technology and increased communication

	The Internet of Things (IoT) is an often-used phrase that describes every device connected to the internet. But increasingly, IoT has come to specify objects that “talk” to each other. By combining these devices with automated systems, it’s possible to gather and analyze information and create an action based on that analysis. In layman’s terms, these devices are able to communicate with each other and automatically act on that communication.

			IoT impacts the dental practice with smart dental devices, according to John Flucke, DDS and Chief Technology editor for DPR. New software can connect devices in the operatory and collect data, including needed maintenance. This connectivity can create efficiencies in the practice.

			"Smart technology is prevalent in every aspect of our private lives. It seems a natural progression for practitioners to want to improve their workplace." 

-Masa Ogata, CEO, Takuyama Dental America

			“If someone can come in and fix a dental chair in the downtime over lunch, you never have downtime in that operatory. It allows us to take advantage of 100 percent of the time potential we have, which is pretty cool,” Dr. Flucke says.

			Take Denti.AI, for example-an unbiased cloud-based AI/Machine Learning clinical decision support tool used to identify non pathological and pathological findings on 2D dental radiographs and provides standardization, clarity, and calibration for the dental profession. Their smart chart technology is capable of automated charting for panoramic films. It also helps with communication between dentists, with patients and-in the U.S.-with insurers. Denti.AI offers both an enterprise model and a model for individual offices.

			“Our goal is to help great dentists provide great care,” Dr. Eric Pulver, chief dental officer for Denti.AI says.

			Jeremy Krell, DMD, MBA, head of marketing at Simplifeye, says technology will improve communication between software. He also predicts more consolidation through acquisition or design, and more multiple-function, one-stop shops improving user experiences for dentistry.

			“Everyone should be watching,” Dr. Krell says.

			Henry Schein One’s Dentrix Smart Image builds upon the philosophy that everything should to work together as one integrated system. Dentrix has a standardized API with over 250 partners that created integrated solutions. Smart Image is the end of 20 years of silo lockup, or how vendor-chosen relationships ruled dental technology integration, according to Michael Fillmore, Dentrix marketing manager, Henry Schein Practice Solutions.

			“The choice of what technology works best in your practice is up to the dentist,” he explains. “It’s our job to make sure that it integrates, that it speaks to each other, and it reduces complexity and extra work.”

			However, Fillmore says integration was only the first step. The next step is automation. Smart Image
			is the platform for all the imaging systems that exist from all different vendors to deliver them to the patient file automatically.

			For example, if a patient needs bitewings, premier vendors with Smart Image will get the imaging system ready to take them. Afterward, it will attach the bitewings to the patient file and automatically generate the CDT codes and post them to the ledger. The system will also note the bitewings in re-care.

			“If you’re using our electronic claims services, it automatically attached those correct images with correct codes to the correct claim for you to submit, which takes a lot of work off your plate from a financial and clinical perspective,” Fillmore explains. “All of that is about communicating, and it’s easier to have it all under one roof to make it all communicate together.”

				Automated communication technology can free up time to focus on developing personal relationships with patients in the office, according to Clint Berry, CTO of Weave. Smart technology also gives practices insights into business performance and improvement.

				“So, I see the impact soon being even more time savings to focus on the most important things in a dental practice and insights that tell dentists how to improve,” Berry says.

				DentalEZ understands connectivity and communication with their smart line of products. The Aeras

 product line is designed to make it simpler and more efficient to practice dentistry.

				“The oral health care professional can focus on what’s really important-great patient outcomes in
				an efficient care model,” Trombley says.

What does smart technology mean to your practice? We explore how smart technology can facilitate automation and clinical technique to bring more “smarts” to everything a practice does. 
