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From new software to updated materials, here's why dental professionals should look forward to advancements in dentures this year.

3 Reasons to be excited about dentures in 2019

	Dentures are rarely an exciting part of dentistry for clinicians. And patients typically aren’t that excited when you tell them they need dentures either.

However, that could change in the next 12 months, and that’s a good thing because dentures aren’t going away anytime soon.

	“As patients continue to live longer, there are still going to be huge portions of the population that are going to need traditional dentures with no implants,” says Dr. John Huebner, a private practice general dentist from Lee’s Summit, Missouri. “Whatever we can do to make the process easier and get the best product outcome for the dentists or the patients is going to be a huge benefit.”

	This year could be the year we start seeing these huge benefits, according to our experts. From new software to new materials to new techniques, there are many reasons to be excited about dentures in 2019. 

	Dr. Tae Hyung Kim is chair of removable prosthodontics in the division of restorative science at the Herman Ostrow School of Dentistry of the University of Southern California and has dedicated his research to making 3D partial and complete dentures. He invented a denture system, DENTCA, which uses computer-aided design and computer-aided manufacturing (CAD/CAM) with 3D printing technology to produce dentures.

	Dr. Kim and his students at USC worked with many of their patients for multiple decades. He says many of his long-time patients who are familiar with how conventional dentures fit tell him how excited they are about 3D printed  dentures.

	“This is a huge benefit from the patient view,” Dr. Kim says. 

	One of the specific ways it helps patients is if they need a replacement. Dr. Kim says it’s common for his elderly or special needs patients to misplace their dentures. When that happened in the past, the dental team had to develop the dentures from scratch again. With digital dentures, however, clinicians don’t have to start at the beginning for a replacement set.

	“Everything is digitally recorded, so it’s all there,” Dr. Kim explains. “You just push the button.”

	3D printing for crowns and bridges is becoming commonplace and to varying amounts of success, depending on a number of factors. However, some of the challenges aren’t the same for dentures. Dr. Kim says 3D printing is better for removables than fixed restorations because dentures need less accuracy and strength than crowns and bridges.

	“For denture teeth, the required physical properties are a lot lower than what we require for crowns,” Dr. Kim explains.

	3D printed dentures are faster to produce than conventional dentures. The old school of thought taught that it took five appointments to fabricate a denture. Many practitioners have modified that process to four appointments and some even down to three, a move Dr. that Kim doesn’t recommend.

	“Then you start sacrificing quality if you start pushing to three visits with conventional dentures,” Dr. Kim says.
	With a digital denture, you deliver the same or better quality removables in three visits. In certain cases, Dr. Kim says you can push it to two visits, but that isn’t what he recommends.

	“We teach three visits. At this moment, I don’t want to sacrifice any steps that we include so that it is properly done,” Dr. Kim says.

	In the traditional technique, most practitioners have the patients come in for a try-in appointment with a wax denture to ensure it looks fine. However, they can’t test the denture at the try-in appointment because the teeth aren’t secured enough on the wax.

	3D printed dentures make a testing denture instead of the teeth set in wax that you see with a conventional denture process. That means you can test the fit and the function too.

	“We tell the patients, ‘Bring the food that you like - a sandwich, fruit, whatever you enjoy eating.’ We are actually testing before making the final removable,” Dr. Kim says.

	In addition to the numerous benefits to the patient, there are benefits to the practice too. Reducing the number of visits to produce a denture benefits the practice’s bottom line. Also, they can be less expensive to produce, depending on who prints it.

	“Some practitioners have a printer in their office that could save a lot of costs, not only time-wise, but manufacturing costs could be a lot different,” Dr. Kim says.

	Regenerating the same denture for a replacement set with the push of a button relieves stress for the clinician. To make a second set, they just print it and deliver when the patient comes back. There’s no stress for the long-term maintenance and care for the patient.

	“That’s completely different than what we had in the past. Nobody kept the master cast. Nobody kept the impression. That means if anything happens to the denture, you have to do the whole thing all over again,” Dr. Kim says.

	Dr. Kim says 3D printed dentures dramatically progress how you manufacture removables and improve what you can deliver the patient, especially when compared to what has been available for the past few decades. 

	“The only reason I am excited about it is that we provide a better service to the patient,” Dr. Kim says. “If you are not changing the way you make dentures, you are not delivering the best dentures out there to your patient.”

	New removable partial dentures materials

	Dental materials are always improving, and denture materials are no exception. A new polymer could make removable partial dentures (RPD) much more comfortable for your patients to wear but without the drawbacks of previous polymer frame materials.

	Dr. Huebner says he does more partials than full dentures with his patient population. Some patients aren’t good candidates for implants. However, he still needs to replace one or multiple teeth.

	“A partial is really the only option,” Dr. Huebner says. “When you are trying to reach the goal of restoring function, but doing it in the most esthetic way possible, a partial really helps fill a void.”

	For decades, removable partial dentures have been comprised of a pink plastic base, manufactured replacement teeth and a metal framework, usually made of a chrome-cobalt alloy or stainless steel. Sometimes clasps were used to connect them to the surrounding natural teeth. Other times precision attachments, sometimes secured by crowns on the natural teeth, were used.

	However, there were drawbacks. RPDs could be difficult to insert and remove. Sometimes the clasps didn’t look great. Some patients felt like the appliances were bulky or awkward, or they needed adjusting to relieve sore spots. Also, cleaning could be time-consuming and detail-oriented.

	Dr. Huebner says new polymer materials are hitting the market that could replace the metal portion of the RPD. He has been looking into the Ultaire™ AKP. AKP stands for aryl ketone polymer, and Ultaire AKP was designed to be an alternative for the metal RPDs, which patients have complained can be too stiff.

	In addition to being metal-free, Ultaire doesn’t use metal clasps like traditional RPDs. It also addresses the strength issues that other flexible polymers had.

	“Some of the flexible partial materials were slightly more esthetic than metals, but you didn’t quite get that same function that you do with the traditional metal framework. There is a gap there that is now starting to get filled with a nice alternative,” Dr. Huebner says. 

	Digital impressions make a significant impact on the process with partial and full dentures.

	With a conventional denture fabrication, there’s a primary and secondary impression taken. Then those impressions are shipped to the lab.

	Once the lab has the impression material, they make a physical model and flow the wax in the model. The denturist then creates a denture base and attaches the teeth with wax and ships it back to the doctor. Each step takes time and has a possibility of the proportions to shift around a little bit, rotate, or change the occlusion, among other problems.

	Both our experts are fans of incorporating the digital workflow into full and partial dentures. Not only does it streamline the process from the two-impression conventional workflow, but it also prevents some of the distortion and adjustments necessary that occur with a traditional workflow.

	“The nice thing about a digital impression, depending on how far away you are shipping your impressions or anything, you never have to worry about digital impressions distorting like some impression materials may do. You can rely on data,” Dr. Huebner says.

	Another benefit of digital impressions for dentures and removable partial dentures is improved predictability. The lab gets the scan via email, where the technician can view it and request a new scan if anything is missing that the lab needs. Also, it gives both the technician and the doctor a chance to see the denture before fabricating it.

	Libraries of teeth are available online to scroll through with every size, shade and shape of the tooth. Also, the scan allows the lab and dentist to make significant changes to the denture easily and to collaborate with the patients to improve the esthetics and minimize adjustments. Moreover, all of this occurs via email, which improves efficiency.

	Dr. Huebner has only begun incorporating the digital workflow with partial dentures. He says, for now, he still makes traditional impressions with polyvinyl siloxane. The patient experience between the two types of impressions improves with digital scanning. He says patients like scanning over traditional impressions, especially those with a sensitive gag reflex.

	“In the past, you said, ‘Let’s try and power through and get this done.’ Now, being able to do it digitally makes it so much easier for all parties involved. The patient goes through it easier, and you don’t have to worry about having a trash can close by,” Dr. Huebner says. “It makes the assistant’s and the dentist’s job a lot easier too.

	Dr. Kim agrees that digital impressions make a significant difference in patient experience. Also, it produces a predictable outcome for the impression success.

	“Once you learn how to make digital impressions, it’s a lot more consistent,” Dr. Kim says.

	With 3D printed dentures improving the accuracy and speed of manufacturing, new materials providing options for RPDs making them more comfortable, and streamlining and progressing the outcomes of digital scanning, there are many reasons to be excited about dentures in 2019.

	“Anything that can improve that process and make it easier for the dentist and the lab is going to help,” Dr. Huebner says. “And if it helps keep costs down, that’s a huge benefit too.”

From new software to updated materials, here's why dental professionals should look forward to advancements in dentures this year. 

3 reasons to be excited about dentures in 2019

	Dentures that don’t fit correctly are a significant patient complaint. Even worse, poorly fitting dentures can also lead to health problems down the road.

Dr. John Huebner, a general dentist in private practice in Lee’s Summit, Missouri, works with the denture patients at the practice. He says that getting an excellent fit is crucial and the methods for achieving a good fit is an area that hasn’t changed much over the past few decades.

Read more: How to use multifunctional teeth to create new dentures

	Let’s look at the best practices for creating dentures that are comfortable for patients to wear.

	Click through the slides to find out four tips for creating well-fitted dentures.

	“It all starts with good impressions and good materials for the impression,” Dr. Huebner says.  “You still need a good custom tray or a well-adapted, pre-fabricated tray of some type to get the best impression, so you can capture all the anatomy that you need to get the best fit.”

	Dr. Huebner notes that advances in the digital workflow will improve planning stages for some cases, particularly partials and implant-retained overdentures. However, the traditional complete denture still favors a custom tray or a customizable pre-fabricated tray and the two-impression system.

	You can substitute for the custom tray a different tray made with a thermoplastic material, which can be cooled and heated several times without compromising its chemistry. If you’re trying to avoid a primary and a secondary impression, then you can also trim the tray if needed to make it work. However, Dr. Huebner thinks this method is still not as popular as taking a primary and a secondary impression with a custom tray.

More from the author: 3 major challenges when creating dentures

	“A lot of people are not quite ready to get rid of their traditional two-impression system,” Dr. Huebner says.

	Common mistakes clinicians make in their denture impressions are allowing slight inaccuracies or taking an insufficient final impression, where they capture most but not all of the anatomy. Dr. Huebner says to get the best fit, retention and stability, you have to get the final impression all the way to the borders.

	“A lot of it goes back to your final impression, your border molding and traditional techniques for a complete denture,” Dr. Huebner says. You hate to have a case where you think you captured an adequate impression, and then you deliver it to the patient and it just doesn’t fit the way you want. You have to come back and reline it later. You think to yourself, ‘Shoot, if I would have retaken that final impression once, I could have saved myself headaches down the road.’"

	For partials, and especially for patients who have many undercuts, Dr. Huebner recommends taking a digital impression instead of a traditional impression that might tear upon removal. The digital impression might help to avoid problems later.

	Most of all, Dr. Huebner says to trust your instincts. Many times, when he’s unsure his impression was entirely adequate but moves forward with the denture in spite of it, he has problems with the fit. “Those are usually the ones that later on I say, ‘Oh! I was right in the first place,’” he says.

	In addition to taking excellent impressions, Dr. Huebner encourages clinicians to maintain communication with the lab. He works with a few labs for his removable restorations. They do a lot of work behind the scenes, so communication is vital for a good fit.

	“Being able to tell the lab when you think something is not quite right and vice versa is very important,” Dr. Huebner says.

	2. Know what anatomy you can’t afford to miss

	Dr. Tae Hyung Kim, chair of removable prosthodontics in the division of restorative science at the Herman Ostrow School of Dentistry of the University of Southern California, agrees that the impression is crucial to an excellent denture fit. However, he believes that many clinicians don’t know all the critical areas of the anatomy they need to capture.

	“The primary reason they miss it is because they are not looking to capture it, they are not looking for it,” Dr. Kim says. “Quite amazingly, some practitioners do not even know if they missed it or not.”

	Capturing two anatomical features in the maxillary impression is imperative for the denture to fit. The first is the Hamular Notch. The second is the distal buccal corner. Dr. Kim says students make fabulous dentures in the student clinic if they capture these parts of the patient’s anatomy, even if they haven’t made dentures before.

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	Dr. Kim says if the impression captures the Hamular Notch, then the maxillary denture is almost guaranteed to fit.

	“Any problem denture that we observe in the clinic, it’s highly likely this one is missing from the impression,” Dr. Kim says of the Hamular Notch.

	The distal buccal corner is adjacent to the Hamular Notch, around the distal border. Dr. Kim says if you capture it in your impression, then the denture has no problem with retention. “If you don’t, or it’s shallow or there is leakage, you are looking for trouble,” he says.

	Two critical areas of the anatomy affect the lower denture fit, Dr. Kim says. The first is the mid-lingual side, where the tongue is. Dr. Kim says if that area has a good seal, then the denture will function.

	“If there is any leakage or air goes underneath that site, don’t expect any retention of the lower denture,” Dr. Kim explains.

	The second critical area to capture for an excellent lower denture fit is the distal buccal corner, which used to be called the M-plane. Dr. Kim says it was called that because it’s the location of the master muscle and where the anatomy has proximity to the denture border.

	“If that part is overextended, the denture will not stay, and it will move too much,” Dr. Kim explains. “If it is properly extended, the dentures stay in - and you can eat steak.”  

	3. Manage your patients’ great expectations

	Per Dr. Huebner, another vital part of providing a great fit is managing patient expectations. Some patients don’t have a ton of surface area to work with, which affects how the denture feels.

	Early and consistent communication about what to expect with a denture can alleviate some of the perceived problems after receiving it.

Related reading: How to create well-fitted, esthetic dentures using a simple digital workflow

	“It drives you crazy sometimes. You have a patient come in, and they have had the same poor-fitting denture for 30 years, and they are happy with it and see no problems with it. Then, in another case, I’ll think I make the perfect denture. It fits, and it has great suction, and the person thinks they are going to be able to chew through a chain link fence,” Dr. Huebner says, “So, you have to manage the patient at the same time.”

	Dr. Kim says one of the problems with fit is the skill level of the clinician. Because the conventional way of manufacturing dentures is complicated, it’s too technically sensitive in the short term. The fit will depend on your skill level. “The quality of the denture will vary dramatically based on it,” Dr. Kim says.

	Dr. Kim has dedicated his research to creating 3D removables, including partials and complete dentures. The dental students at USC have a curriculum on 3D printing for partial and full dentures - the first dental school to introduce it.

	Removables produced with 3D technology are more accurate than traditionally produced dentures. The production itself is also more efficient than the conventional method; the doctor can deliver the dentures in only three visits versus five appointments the traditional way. They’re also more comfortable for the patient than conventional dentures.

More from the author: Digital impressions: Ready for their close-up? 

	“When it is made digitally, it means that technically, there is a lot less skill level sensitivity that will affect fit,” Dr. Kim says.

	However, while the 3D technique is less technically demanding than the conventional method, there’s still a learning curve. The digital method is a new process with new habits.  Dr. Kim compares it to riding a bike, and then an e-bike.

	“When you are used to a bicycle, you know how to ride it. But if you have an e-bike, there is a learning curve. You think, ‘Oh, this is electrically motored. There is a slight difference,’” Dr. Kim explains. “Same thing on digital dentures. Digital impressions are different from traditional impressions. Once you learn how to make digital impressions, it’s a lot more consistent.”

Follow these best practices for creating dentures that are comfortable for patients to wear. 

4 tips for creating well-fitted dentures

Follow these best practices for creating dentures that are comfortable for patients to wear.

4 Tips for Creating Well-fitted Dentures

	Bulk fills aren’t like other composites. In fact, a literature review published in 2017 in The Journal of Adhesive Dentistry said the most significant difference from conventional composites was their increased depth of cure, mostly because they're more translucent than other composites.

	However, other differences exist too, such as in handling, placement, technique and shade matching, to name a few. Moreover, the differences aren’t just between bulk fills and other composites; some of the bulk fills have significant differences too.

	We researched bulk fills and spoke to an expert about them to find out more about these materials and how to get the best possible outcomes with them. Here are the top three tips we discovered for using bulk fills in your practice.

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	In the past, bulk fills were primarily intended for posterior restorations. However, as the materials have improved in the areas of durability, esthetics and handling, you can use them in different areas and in varying ways.

	As bulk fills improve, they have different physical properties. Understanding what type is best for each restoration is critical with the various formulations of bulk fills. Researchers have been working to clarify this area with scientific evidence.

 published a literature review in 2017 that showed different viscosities were better for different preparations. The researchers determined, after reviewing all the literature on bulk fill composites up to 2016, that narrow cavities with a depth greater than four millimeters should have a flowable base bulk fill whereas wider ones needed a full-body or thicker bulk fill. Also, the researchers suggest that thicker bulk fills create improved contact points as well as provide better durability and strength than other composites.

	The Journal of Conservative Dentistry published a study last year that determined bulk fill composites and other composites that require more layers had similar results as far as marginal gap widths. However, they also found that the bulk fills had “similar dentin adaptability when compared with the control group.” The researchers concluded that the thickness of the bulk fills did affect the marginal interface as well as how the materials adapted in the dentin.

	However, despite what these studies say, what kind of bulk fill you reach for in the operatory usually comes down to what type of bulk fill composite you like to work with and the preparation you’re treating. When it comes to what composite should go where, it’s vital that you feel comfortable working with the product - and then go with the flow.

	Tip #2: Know your product because not all bulk fills are alike

	Dr. Jeff Lineberry, a private practice general and cosmetic dentist in Mooresville, North Carolina, and a professional educator for continuing education, says knowing your bulk fill product is vital because they’re designed to do different things.

	For example, some bulk fills were designed to be liners alone and will fill up part of the cavity preparation. However, they’re not intended to be in occlusion because they lack strength and durability.

	“They are more designed to fill in part of the hole, so to speak, up to five millimeters, and then you put a final regular layer of composite or resin on top of it,” Dr. Lineberry explains.

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	Other composites are designed to fill a preparation all the way into occlusion. These bulk fills are strong and durable. Still others are intended to be liners. Some materials are more translucent than other formulations.

	Most conventional composite will cure between two and three millimeters, layered in for the restoration. However, as you work with regular composite, you increase the chances of incorporating voids into it, Dr. Lineberry says.

	One of the most significant reasons dental professionals use bulk fills is that you can lay in a thicker layer, making them faster and more predictable to use. With fewer layers in bulk fills, you also have less chance of integrating air pockets in the materials by accident, as long as you mind your technique.

	“As you are injecting, make sure that you keep the tip in the material. Otherwise, if you are coming in and out of the materials, you can introduce air pockets and voids,” Dr. Lineberry explains.

	Another benefit of knowing your product is the predictability of the esthetics. The materials often have varying levels of translucency that allow them to cure at four millimeters, which changes how they look. When more light transitions through them, you want them in the posterior restorations instead of anterior ones.

	“You definitely want to put those in areas that are less esthetically driven, such as in back teeth,” Dr. Lineberry says. “You don’t want to put them in the areas where you can see them more clearly, so to speak.”

	Dr. Lineberry says it’s crucial to know the limitations of the material. Some of these materials are thicker and more packable, while some are much more fluid. Knowing your product and understanding the differences between the two will help you to choose the proper composite for the preparation you want to fill.

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	“The last piece of it would be is that it is not an end-all-be-all product,” Dr. Lineberry explains. “It’s just another tool in your belt. You are not going to buy bulk fill and throw everything else away. It has a place where it works well.”

	Composite materials are evolving and improving all the time. Dr. Lineberry says one of the issues with bulk fills is the polymerization shrinkage that can occur during light curing. Shrinkage can cause stress and microgaps around the materials. However, newer materials have addressed that issue.

	“There are some of the newer materials that were developed to have stress breakers incorporated into the material to alleviate that,” he says. “Definitely stay abreast with what’s going on as far as the material because the dental manufacturers are working on trying to improve it.”

	Getting a sufficient cure of the bulk fill is crucial to its performance. Doctors cure composites one of two ways, either with a light only or as a combination of the chemical reaction and light. Light-cured composites require a high-intensity light to activate the chemical processes in the composite material.

	Curing lights have different outputs depending on the type of light used. The two most common in today’s operatories are the Light Emitting Diode (LED) and Quartz Tungsten Halogen (QTH) curing lights.

	No matter which type of curing light you use, the light intensity decreases when it passes through composite materials, a significant consideration since bulk fills are often layered at  four millimeters. Dr. John Flucke, technology editor for Dental Products Repor,t says curing lights for bulk fill composites should produce between 800 and 1000 mW per cm squared.

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	However, not every doctor knows how strong his or her light is. As an example, a study published in the Journal of Dentistry in March 2017 said that 78.3 percent of dentists in the Norwegian Public Dental Service were unaware of the irradiance value of their curing lights as new, and 17 percent said they didn’t check them regularly. Moreover,  14.5 percent said they didn’t have a routine for regular maintenance.

	To determine the strength of your curing light, you need a radiometer. The irradiance is measured by determining how many milliwatts (mW) reach a surface area of the curing light guide. Per the Oral Health Group, you need to get a baseline reading on your curing light when it’s new and then test it every week thereafter. Furthermore, you should send the light to the manufacturer for service every 24 months or after five bulb changes with a QTH light.

	Bulk fill composites are an excellent tool for your practice. Once you understand how you want to use them, choosing the right body type of the composite can help you to achieve a better outcome. Moreover, knowing how the composite you work with responds to different situations puts you in a better position to manage the result of your restoration. Finally, by ensuring that your curing light is emitting enough intensity to cure the bulk fill properly, you’ll have the best possible performance from this versatile and efficient restorative material.

	1. Van Ende, Annelies & De Munck, Jan & Lise, Diogo & Meerbeek, Bart. (2017). Bulk-Fill Composites: A Review of the Current Literature. The journal of adhesive dentistry. 19. 10.3290/j.jad.a38141. <https://www.researchgate.net/publication/316524305_Bulk-Fill_Composites_A_Review_of_the_Current_Literature>.

	4. Agarwal, Rolly Shrivastav et al. “Evaluation of cervical marginal and internal adaptation using newer bulk fill composites: An in vitro study” Journal of conservative dentistry: JCD vol. 18,1 (2015): 56-61. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313481/>.

	5. Elsenpeter, Robert. “6 ways bulk fills are changing restorative dentistry.” Dentalproductsreport.com. 2 May 2018. Web. 4 January 2019. <http://www.dentalproductsreport.com/dental/article/6-ways-bulk-fills-are-changing-restorative-dentistry?page=0,3>.

	6. Kopperud S.E., Rukke, H.V., et al. “Light curing procedures - performance, knowledge level and safety awareness among dentists.” Journal of Dentistry. (2017) Vol. 58:67-73. From Web: sciencedirect.com. <https://www.sciencedirect.com/science/article/pii/S0300571217300301>.

	7. Miller, DDS, Michael B. “Curing Lights: What you should know before buying one.” Oralhealthgroup.com. 1 December 2009. Web. 4 January 2019. < https://www.oralhealthgroup.com/features/curing-lights-what-you-should-know-before-buying-one/>.

Follow these tips and tricks to get the best possible outcomes when using bulk fills in your dental office.

Top 3 tips for using bulk fills

	How a practice manages its materials inventory affects its bottom line. No dentist wants to waste money, at least not if he or she is going to stay in practice.

	However, wasting money isn’t the only challenge presented by materials inventory mismanagement. Poor materials inventory management can have implications for your patient experience, staff morale and productivity too.

	Here are four reasons you should reconsider how you manage your materials inventory at your practice.

	Reason #1: Minding the bottom line requires tight materials inventory management

	The practice overhead should be as low as possible to be profitable. One of the sources of overhead in a dental office, per 

, a dental financial planning firm, is inefficiencies in ordering.

	Inefficiencies in ordering can lead to several problems. First, you can over or undersupply the practice. When you oversupply, you tie up money and space in the office; undersupply creates patient experience problems, staff stress and higher costs, to name a few challenges.

	Also, as Four Quadrants points out, if you order from several suppliers, you’re an average account to many companies rather than a large account to one. In other words, you can’t leverage all your ordering with one vendor to earn a higher discount.

	Over a decade ago, Dr. Roger Levin wrote about “Just in Time” inventory management for the Journal of the American Dental Association (JADA, 2004). Originating in Japan, Just in Time inventory management means you order things as you need them (i.e., at the last minute) rather than having much inventory on site. The system helps businesses avoid tying up capital in materials that sit in storage. Dr. Levin advocated for practices to modify this concept and maintain in inventory a 30-day supply of necessary materials.

Related reading: 6 ways bulk fills are changing restorative dentistry

	The practice enjoys several benefits of the modified Just in Time inventory, according to Dr. Levin:
	
	1. It frees up cash flow that would otherwise be tied up in materials for other investment opportunities or to enhance the bottom line of the practice.

	2. It maximizes the space in a practice by optimizing storage.

	3. It allows the dentist to make changes to what he or she uses day to day without wasting the materials he or she already purchased of a previous product.

	4. It illuminates for the practice what materials it uses the most and which ones it doesn’t.

	5. It creates a system for the staff to follow and promotes organization for inventory management.

	“The overhead should be as low as possible if you want to be profitable,” says Dr. Sheri Doniger, an international speaker and the author of “

Practical Practice Solutions in Dentistry: Building Your Successful Future

	Dr. Doniger has a private practice in Lincolnwood, Illinois, just outside Chicago, and says her practice keeps a tight inventory because her practice is small. “We don’t have much space, so when I am ordering something like an anesthetic, I order just what I need.”

She also recommends exercising caution about what you bulk order on a deal. For example, if the deal is, “Buy seven, get one free,” you need to think about if you need seven and where to store them. Dr. Doniger also advises practices to consider what happens when the team members use the product you now have eight of and who don’t like it. 

	However, Dr. Doniger acknowledges that the deal could be appealing, depending on the product.

	“I could see buying seven autoclave bag orders and trying to find a place to tuck those in because you use those constantly,” Dr. Doniger says. “However, for most things, you have to watch what you are ordering in bulk.”

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	Dr. Jeff Lineberry, a general and cosmetic dentist who practices in Mooresville, North Carolina, and a lecturer, recommends reviewing your materials in inventory on an annual basis to see what you use a lot of and what’s sitting there expiring on the shelf. A yearly review not only ensures you don’t waste money but also shows which materials to pre-purchase at year end to offset taxes for the upcoming year.

	“If you want to spend tax dollars and you see you use a ton of a particular material, then you might want to buy some at the end of the year,” Dr. Lineberry explains. “But only if you go through it really fast.”

	Reason #2: Having what you need when you need it is essential to productivity

	Productivity is critical to practice management and leads to more revenue for the practice. The more work you do, the more patients you help. Increasing patient care also increases your billing. 

	Productivity is critical for staff. Staff are part of your overhead costs as well. Not only does more production from your team provide a better experience for the patients, but you also have a better return on investment for your labor cost expenses.

	Productivity is also crucial for patients. Reduced chair time and elimination of multiple visits are excellent improvements to the patient experience. Furthermore, the happier the patient is, the more likely he or she is to return, leave better reviews online, and refer his or her friends and family.

	Dr. Doniger believes productivity is essential to practice management. Recently, she discovered that she didn’t have the dental stone for an impression she had to pour up. Her solution was to borrow some from the dentist downstairs. “It was like borrowing a cup of sugar from the neighbor,” Dr. Doniger says.

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	Dr. Doniger shares that story because it demonstrates that there are some products that you don’t often use that can slip through the cracks. There are also essentials that you need to run a practice every day and some that you need to have once in a while.

	“The last thing you want to do is turn down production,” Dr. Doniger says. “You don’t want to tell a patient, ‘I’m sorry. I can’t do that treatment for you because I don’t have the materials on hand to do it today.’"

	Delegation is critical to the doctor’s productivity as well. Managing inventory is an excellent task to give to a member of the team.

	Dr. Lineberry has his long-time assistant manage the materials for his practice. However, he says you can assign it to anyone on the team. “The person who opens the boxes and puts things away would be a good person to order material and manage it,” Dr. Lineberry says.

	Dr. Doniger agrees but emphasizes that one person should do the ordering for organizational purposes. “You need to have a point person to do inventory control, especially if it’s a big office because there are so many different sites now,” she says.

	Dr. Doniger compares inventory control to grocery shopping; you either like doing it or you hate it. However, with all the requirements for OSHA, infection control and regular patient care essentials, you should have a point person who takes time to assess the space to see what you have and what you need.

	She also recommends taking time out of the daily huddle to discuss what the different team members need. You don’t want to be out of inventory on a basic dental material when a patient is in the chair.

	“The last thing the assistant wants to do is look up at the doc and say, ‘I’m sorry, I don’t have any shade A2 composite today,’ or ‘I’m sorry ,I don’t have any more short-gauged needles.’ There are workarounds of course, but you don’t want to be in that situation,” Dr. Doniger says.

	Reason #3: New tools and systems are available to reinvent how you manage inventory

	Inventory control is a term that describes managing all the supplies in the practice as well as maintaining storage and facilitating accessibility. The concept promotes the idea that you should have an adequate amount of given materials but not too much or too little supply.

	Having a system is crucial to maintaining inventory control. The Wisconsin Dental Association (WDA) addresses the components of a materials inventory management system that will help you to avoid both oversupplying or undersupplying the practice:

	1. Determine which materials need more oversight or control.

	2. Keep a list/log and build in accountability for the staff.

	3. Learn how much of a material you use and what event should trigger an order.

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	Let’s say composite resins are a material you use a lot of and you want to control the inventory on it. First, make a list of all your composite resins and have team members check it out on the log with their initials, so you know who is using what, how often and how much. Then, create triggers for ordering more product. For example, if you need to have at least one full composite while you wait for your next order to arrive, then the WDA suggests putting an ordering card right before the last composite on the shelf to remind you to place the order.

	As the WDA says, the system can be analog or digital, but either way it’s imperative to let you know what you have and when you need to get more.

	Dr. Doniger uses a spreadsheet that includes pertinent information for inventory management. She covers all the details of the product, manufacturer, where they order it, what the minimum order is, and how much they need to have on hand for a week or month. Then, everyone has a reference if the point person is out of the office for some reason.

	“A lot of people don’t like paper in the office, but I think this is the perfect thing for paper. You can see it easily. You can access it easily if you can’t get to a computer and it’s something you can keep in the lab,” Dr. Doniger says. 

	For paperless offices, new practice management software features functionality that can help you manage your materials inventory. Many have cloud-based services that allow you to access the inventory control and distribution from wherever you are.

	The materials change also. From zirconia to porcelain, adhesives to composites, materials are always evolving and improving, which can change how and what you take into inventory. 

	Reason #4: Expiration dates can cause shortages even when you have plenty of the material

	Expired product is a cost of doing business at many practices. Some experts estimate that hundreds of thousands of dollars’ worth of inventory get thrown out because the product expires in the stock room.

	Maintaining awareness of and managing expiration dates are crucial parts of any materials management system. Dr. Lineberry suggests having an honest look at your materials’ shelf lives periodically. Do all of the materials have a similar expiration date in any given category? If not, which ones expire the fastest and which ones last the longest?

	Another question Dr. Lineberry encourages practices to ask on a regular basis is whether your supplier always gives you the freshest supply. Dr. Lineberry says all suppliers aren’t the same.

	“If I order from Henry Schein or Patterson, you would hope the shelf life on it is two years,” Dr. Lineberry says. “If you order it from mom-and-pop places, sometimes the expiration date might be 2019. It might not be the latest lot, so to speak.”

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	Dr. Lineberry has had a couple of incidents in which the materials expiration date was six months out or less. If he uses a lot of the material, then the date isn’t a concern. However, if he doesn’t use it often, then he could be paying for materials he might not have time to use.

	“It’s like picking up a loaf of bread at the grocery store. You want to get the freshest loaf because you want it to last the longest,” Dr. Lineberry says.

	Dr. Doniger says expiration dates could be a problem if you don’t maintain tight inventory control. If you have a comprehensive inventory control system, then you won’t be throwing away product that expired.

	“You are going to be using all the bonding agent and you will have the new one when the present one is halfway finished. Plus, you know that there is another one coming,” she says. “But something like a local anesthetic with no epinephrine that you may not be using a lot of, you have to watch the expiration dates on that and then throw it away when it is past the date.”

	An excellent relationship with your supplier is another critical element for managing materials expiration dates, Dr. Doniger says. The practice can’t control the expiration date on the product it receives from a supplier, but it can control from whom it orders future product. Dr. Doniger uses a mix of suppliers she knows well, from Patterson to smaller suppliers like Net32 and Dental City.

	“I have not had a problem with getting close to expiration date product in a long time,” Dr. Doniger says.

	1. Levin, DDS. MBA, Roger. “A Better Practice: Inventory Management.” Journal of the American Dental Association. Vol. 135, June 2004, 786-787. Web: https://jada.ada.org/article/S0002-8177(14)61322-2/fulltext.
	
	2. Ibid.
	 

Poor materials inventory management can have implications for your patient experience, staff morale and productivity.

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