Terri Lively

	Juan Yepes, DDS, MD, is a pediatric dentist in Indianapolis concerned about limiting his patients’ radiation exposure. As an associate professor at Indiana University School of Dentistry, he seeks to inform his students about higher levels of patient care and minimize radiation exposure. Dr. Yepes also researches and is a frequent lecturer on “Radiation Safety in Pediatric Dentistry” at major dental shows in the U.S. and around the world. His experience with the digital radiography line at Air Techniques aligns with his philosophy of dental care and helps him put it to work in his private practice.

	“I lecture all over the country and internationally about how we can’t expose children to too much radiation. I don’t want to say to everyone, “Be careful!” and then, in my office, have to retake 50 percent of the radiographs that we take,” Dr. Yepes says. “When I say something, that’s what I practice in my office.”

	Dr. Yepes explains that out of all the patients who can walk into a dental office, children are the most radio-sensitive. Children are also not the easiest to work with, and it isn’t unusual to need retakes on radiographs. Dr. Yepes wants to not only optimize the number of radiographs in which children participate but also to educate parents about radiation exposure.

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	“It is a critical issue. Parents these days are motivated to learn about all these things. And I am a dad,” Dr. Yepes says. “When I take my kids to the dentist, as their dad, I want the dentist to minimize the exposure to radiation.”

 for many years. He began using a system with sensors. However, when working with children, Dr. Yepes realized how challenging it could be to place the sensor or film inside the mouth of small patients. After trying different sensors and developing a lot of frustrations, he decided to look into phosphor storage plates (PSPs).

	PSPs are indirect radiology. Similar to what’s used when taking a traditional film, PSPs are thin and easy to place in children’s mouths, even those as young as three years old.

	After implementing indirect radiology with PSP technology, his patient compliance increased and his retakes decreased. Dr. Yepes researched his equipment options and chose Air Techniques ScanX Swift for his practice.

	Earlier this year, he upgraded to the top-of-the-line 

 The transition to PSPs was natural for Dr. Yepes and his staff. He thinks the ScanX Swift View also had an easy learning curve, which is good news for clinicians who have yet to transition away from traditional film. One tip Dr. Yepes has for taking the best possible image with ScanX Swift View is to use a positioning film device with PSPs to minimize the contacts.

	“You can use a film holder with sensors, but it’s difficult because sensors are not all the same size. With the PSPs, it’s easy to use the holders - and we have been using them in dentistry for the past 85 years,” he says. “For someone who is just joining the amazing world of digital radiology, phosphor storage plates are an easy transition.”

	Dr. Yepes also likes that the ScanX Swift View is Wi-Fi enabled. “You don’t have to be next to the radiology equipment or your main computer; you can place it anywhere in the office you need to improve workflow,” he says.

	Another feature Dr. Yepes appreciates is the top panel with a touchscreen that requires no more than two steps. “You select the size of the film you are using, push it and that’s it,” he says.

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	Dr. Yepes also enjoys the resolution ScanX Swift View produces. In his pediatric dentistry practice, Dr. Yepes often has concerns about small caries between his patients’ teeth. Sometimes the resolution of the image makes a difference between treating the decay or just observing it.

	With technology, there are always early-adopters and others who wait. As a self-described middle adopter of technology, Dr. Yepes says the ScanX Swift View is enough like traditional radiography that it can make the transition to digital radiography easier.

	“For those that have been waiting, it is a good time to use this new technology and not be disappointed,” Dr. Yepes says.

Articles

How the ScanX Swift View has helped one educator practice what he preaches to his patients. 

Making the switch to digital radiography

	Silver diamine fluoride (SDF) has been used all over the world for decades. The FDA approved its use in the U.S. in 2014 to treat hypersensitivity. However, it’s also well-known for its off-label use for dental caries management. It’s not yet in widespread use stateside; however, dental professionals are learning that with all the benefits it presents with few downsides, SDF could provide a significant new solution for conservative treatment of carries in specific patient populations.

	“It’s something you can do at a school, in a nursing home, you could do it in a doctor’s office. You could use it on a mission trip in the middle of some rural area,” says Dr. Nathaniel Lawson, DMD, Ph.D., division director of division of biomaterials at the 

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	While officially an off-label use, SDF handles dental decay with a more conservative approach. Per the 

fact sheet by the California Dental Association

, silver’s antibacterial properties combined with fluoride’s ability to remineralize tooth enamel slows or stops dental decay.

American Academy of Pediatric Dentistry (AAPD) published a guideline

 in October 2017 that recommended the use of 38% SDF to treat caries. It’s ideal for patients who can’t get the dental treatment they need for various reasons (e.g., too young, too old, too sick, too remote without regular access to dental care, etc.).

	Dr. Lawson works in an HIV clinic once a month. Sometimes his patients have been in the hospital and haven’t been able to take care of their teeth. Some of them could have as many as 25 cavities when he sees them. SDF buys the patients some time.

	“I’ll stop all the cavities from getting any bigger, and I will see them every other week until all their fillings are done,” Dr. Lawson explains. 

	Dr. Lawson also says it’s easy to use if a child can’t sit still long enough for treatment. In these cases, the dentist applies SDF to all of the child’s cavities. Then, the child has time to mature or build rapport with the dentist without the cavities worsening. It can also help when the child is on a wait list for surgical procedures that require general anesthesia, which can be a lengthy wait, particularly for Medicaid patients.

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SDF also helps geriatric patients who could have cavities that are difficult to treat (e.g., on the root of the tooth or under other dental appliances). The dental professional can apply SDF and, in some cases, never fix the cavities. Dr. Lawson emphasizes that follow-up application is needed every six months to maintain the effects.

, a dental hygienist in Colorado, explains that SDF is also ideal for 

when you don’t have time to do all the restorative care that’s needed.

	“If the patient in a remote area has 10 fillings, and you don’t know when the next dentist is going to be there to finish the case, SDF is a great way to get people out of pain and stop the disease from progressing as well as help with sensitivity in the meantime,” she says.

	State law dictates who can use SDF on patients

	Aberle works for a community health center as a school-based dental hygienist. She would like to use SDF with her students, but she can’t. The state of Colorado where Aberle practices has yet to sign into law that SDF falls under a dental hygienist’s Scope of Practice.

	Aberle, who is also the executive administrator for the 

 that will change that. After a significant process, it has passed the state’s senate and house and, on March 22, 2018, was signed into law by the governor. A Rulemaking hearing through the dental board will finalize the specifics of its use, which will happen within 90 days.

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	Colorado is unusual in this instance, Aberle explains. Most states treat SDF like the other fluoride varnishes and rinses that dental hygienists administer. However, hygienists should always check state law before using SDF.

	A new product representing a new approach

	SDF represents a new way of approaching caries management. Dr. Jason Goodchild, DMD, director of clinical affairs for Premier Dental Products Company, remembers a time when the only way to manage caries was removal and restoration. As an associate clinical professor at Creighton University School of Dentistry and also an adjunct assistant professor at Rutgers School of Dental Medicine, Dr. Goodchild likes the options that SDF provides tomorrow’s clinicians.

	“When I was in dental school 20 years ago, it was an instant failure on your board exam if you left caries in the preparation. There was no gray area there. It was removal 100 percent, and that’s it. Now, we see things a little bit differently, meaning tooth preservation, preventative measures and earlier caries detections are all very important. That’s where SDF comes in. It opens up options of partial or no caries removal as a way to treat decay for certain situations,” Dr. Goodchild says.

	However, Dr. Goodchild warns that it’s not a “magic bullet.” Despite its numerous advantages, success rates with SDF are not 100 percent. In fact, there’s some discussion about how much of the bacteria SDF kills and how long it lasts. All proponents of SDF recommend follow-up applications at least twice a year. Dr. Goodchild’s practice follows the first application with a second application after three weeks, and then every six months after that. He also recommends covering up the lesion right away with fluoride varnish to optimize the substantivity of SDF.

	More studies are needed to determine standardized guidelines and protocols. The 

 presents a systematic review for SDF, a clinical protocol and a consent procedure. The UCSF study finds the every-six-months protocol “outperformed all minimally invasive options” for decay restoration and was less expensive. SDF has preventive properties for other teeth that was only outperformed by dental sealants. However, sealants were much more expensive than SDF. In the UCSF study’s conclusion, the team describes SDF as “a powerful new tool in the fight against dental caries, particularly suited for those who suffer most from this disease.”

	Application of SDF is simple. The liquid comes in a small bottle, and dental professionals use a couple of drops in a small disposable container and apply with a brush. The UCSF study advises dental professionals to use a “cautious approach” and isolate the area with cotton or gauze and dry the lesion before application. It also supports giving the solution one to three minutes to soak into the tooth. However, if that time frame is beyond the limits of compliance that a patient can muster (as it may be in very young children), a few seconds also seems to be sufficient for arresting carries.

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. Dr. Jeremy Horst, DDS, Ph.D, the lead author of the UCSF study, demonstrates how to apply SDF using the cautious approach.

	SDF’s on-label use is as a tooth desensitizer. Aberle explained that this benefit gets overlooked. However, people with sensitivity have a hard time keeping up with proper nutrition, focusing and sleeping.

	“To get people out of pain and reduce that sensitivity is a huge benefit. We always talk about stopping the cavity, which is great, but getting people out of pain quickly is also important,” she says.

	SDF is also cost-effective. A bottle costs around $150; individual packets can run $120 for 30 packets.

	“That brings it to $4 a patient, and you can get three to four teeth out of that. For public health applications, it’s pretty good,” Dr. Lawson explains.

	SDF stains decay black a couple of days after application. Although the staining is a disadvantage, it’s also a benefit, acting like a caries detection solution. However, the staining can make patients or their parents less enthusiastic about the treatment.

	“Some parents will see that balance between trying to treat a child versus having a black tooth and say, ‘No big deal. I’d rather see black on the tooth than having them sit through the dental work at a young age or even having to go to the operating room or go under general anesthesia to get this work done.’ For others, it’s a no-go,” Dr. Goodchild says. 

	Dr. Goodchild uses the SMART (Silver Modified Atraumatic Restorative Treatment) technique with his patients, which can cover up the staining.

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	“If you want to do the SMART technique with traditional glass ionomer (not light cured), then spoon out the caries or drill at a slow speed to get rid of the easily removable caries, which can be done without local anesthesia. Apply SDF, then you restore with traditional glass ionomer, which not only fills in the hole but also can help cover up the black color,” Dr. Goodchild explains.

	Aberle feels that dental professionals put a lot more importance on the staining than patients do. Elderly patients and parents of young children want to stop the disease and relieve the pain or forgo the operating room.

	“We have to try not to let the staining scare us away from the benefits of it,” Aberle says.

	Another disadvantage is that treating a cavity with SDF doesn’t restore teeth back to their healthy state.

	“It’s not a final solution,” Dr. Lawson says. “It’s an interim solution to stop the cavity.”

	SDF has also been known to stain inflamed gum tissue. It shouldn’t be applied where there is broken or ulcerated tissue as the staining could be permanent.

	The use of SDF is new in the U.S., which can be challenging when billing. Its off-label use could also pose a problem when trying to code the treatment. Dr. Lawson has seen the following four codes used:

			D-1208: Topical Application of Fluoride

			D-1999: Unspecified Preventative Procedure

	Dr. Lawson cautions clinicians to be sure to cover all the essential details in the pretreatment interview. SDF isn’t right for patients with a silver allergy, nor is it good for those averse to fluoride treatments.

	“Drinking water has one part per million of fluoride. Toothpaste has 1,000 parts per million. SDF has 44, 000 parts per million of fluoride, making it 44,000 times more fluoride than water and 44 times more than toothpaste,” Dr. Lawson says. “So, it does have a high concentration of fluoride.”

	“Some people are more conservative with how much fluoride they apply to their teeth. So that’s always something to include in the conversation,” Aberle agrees.

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	The American Dental Association’s (ADA) 

November 2017 issue of Professional Product Review

 analyzed some of the properties of SDF for treating or preventing caries in two articles. First, it featured a study on silver diamine fluoride by researchers from the ADA Science Institute and the University of Michigan. In the second article, a team of dentists covers clinical indications for SDF, clears up some questions about it and addresses some clinicians’ concerns.

	At the time of publication, only one SDF product was on the market, 

 by Elevate Oral Care, LLC. However, as the use of the product grows in popularity, new products are sure to hit the market, including two-step systems currently used in Australia that address the esthetic concerns of SDF. In these systems, potassium iodide (KI) is applied to counteract the silver properties that cause the staining.

	“It’s not an option in the U.S., but it could be one day,” Dr. Lawson says.

	Awareness and use of SDF continue to grow, giving dental professionals another option for caries management and, for some patients, the best possible option.

	“It is very straightforward and a quick procedure. It’s something that can be done in non-traditional settings. It can be done on children that can’t sit still very long. It can be done on elderly who aren’t able to sit in a dental chair or wheelchair-bound patients,” Aberle says. “It’s very simple to apply. It’s very quick and can be used for a lot of people who might not be able to seek traditional dental care.”

Exploring the advantages and disadvantages of using SDF for specific patient populations. 

Using silver diamine fluoride as a new caries management solution

	Dr. John Weston, DDS, FAACD, has been practicing for nearly three decades and for a little more than half of that time, he has been using RelyX™ Unicem 2 Self-Adhesive Resin Cement from 3M. As an early adopter, he recalls when it came in a capsule that you mixed in an amalgamator. While the delivery system has changed over the years, Dr. Weston says the need for an adhesive to hold full-coverage crowns and work in areas with short vertical height of preparations hasn’t.

, in my experience, you had to use adhesive techniques, usually etching and then placing adhesives by treating the surfaces of both the crown and the tooth. What Unicem 2 did was eliminate the need for those steps and give you the adhesive qualities with just a single step,” he says.

	Unicem 2’s elimination of surface preparations and multiple steps streamlined and simplified the process for Dr. Weston. It also created a more predictable outcome. Dr. Weston says he likes how using Unicem 2 helps to avoid mistakes.

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	“There are fewer chances of doing something wrong, missing a step or not doing a step exactly right. This is important for the assistants and doctors as well,” he says.

	One of the reasons dentists utilize adhesive dentistry is to properly seal the tooth and avoid sensitivity for patients. Dr. Weston explains that Unicem 2 is an adhesive cement with good sealing properties, which leads to excellent patient response.

	“I don’t think the patient cares what kind of cement you use; they just want it to be easy, comfortable and have no sensitivity in their tooth,” Dr. Weston says.

	Dr. Weston knows a common problem with cements is that they can be difficult and time-consuming to clean up. Early on, his practice experienced challenges cleaning up Unicem 2. Now, he uses the Elipar™ Curing Light’s one-second tack feature to initiate the cure on the excess cement on buccal and lingual, enabling him to “pop it right off.” However, he recommends curing for no longer than one second.

“Don’t over cure it. If you spot tack longer and accidentally cure for five or 10 seconds, it’s going to be very difficult to remove,” he explains. “Also, if using a self-cure technique, don’t start cleaning it before it’s starting to set because that can be messy. I hear about people blowing air through the proximal contacts and then it sprays everywhere. It can be a real mess.”

	Once you have removed the excess, Dr. Weston says to cure for another 20 seconds on buccal and lingual for the final cure or, if time allows, let it completely self-cure for five minutes.

	Another common concern about self-adhesive cements is that they are not as strong as fourth- or fifth-generation bonding agents with multi-step systems. While that is true, Dr. Weston says that isn’t a fair comparison. No self-adhesive resin cement will have the same bond strength as those products by the nature of their one-step procedure. However, when comparing Unicem 2 to a traditional cement or to a resin-modified glass ionomer cement for full-coverage crowns or in areas where you have a short vertical height for preparations, Unicem 2 has superior advantages.

	“That’s why people get confused and say, ‘It doesn’t have great adhesion.’ Well, it does compared to other one-step cements. You have to qualify what you are comparing it to,” he says. “The bond strengths are plenty reliable to the situations we are using it for, which is typically full-coverage crowns. We would not use this cement for ceramic veneers however.”

	Dr. Weston also addresses the discussion regarding Unicem 2’s lack of fluoride release, a feature found in resin-modified glass ionomer cements. He asserts that a well-fitting restoration with a proper seal doesn’t need to rely on fluoride release. Moreover, research shows that resin-modified glass ionomer cements release very little fluoride at the margin. As a result, Dr. Weston believes the benefits of working with Unicem 2 outweigh any advantages resulting from fluoride release, especially in cases where you have short vertical height preparations.

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	“If you have a crown that has a short vertical height, you likely would not use a resin-modified glass ionomer because it’s not strong enough. Now, you find yourself using a different cement that the doctor and assistant are not as familiar with,” he explains. “Unicem 2 allows you to use one cement for everything and have the adhesion you need for the very short vertical height preparations that traditional cements don’t offer.”

	Dr. Weston appreciates the fact that using Unicem 2 for all full-coverage restorations, whether they are metal, pressed-ceramics or zirconia, means they only need to order one material. They don’t have multiple materials in the drawer, resulting in a streamlined chairside process for the dental staff.

	“They know what to put out when we have the full-coverage crowns,” he says. “We can deliver crowns efficiently, fast and predictably. And we have reliability. You don’t have to worry about things coming off or failures. It solves a lot of problems for us.”

Why one clinician prefers using this self-adhesive resin cement over others. 

How RelyX Unicem 2 creates predictable results for full-coverage crowns

	Dr. Sam Halabo, DMD, who has a private dental practice just 10 minutes south of downtown San Diego, started using TheraCem

 from BISCO in January 2017. He says he was drawn to this self-adhesive resin cement because of its bioactivity. Dr. Halabo shares his experience with using TheraCem and how this resin cement has reduced sensitivity for his patients and increased efficiency for his practice.

What do you like best about the product? How does it compare to others on the market?

	TheraCem has many great features, including calcium release and promoting apatite formation. There was an IADR study done, showing it allows for dentin formation and bioactivity. It means it can help the tooth to heal itself. It can help with sensitivity and inhibit bacterial growth. It can help with many different aspects of the tooth.

	The majority of products on the market in this category -self-adhesive resin cements - do not have these features. Therefore, this cement does give us a great advantage when using it over others.

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	What have been the results or patient responses?

	The results have been excellent. I have had a decrease in sensitivity when cementing crowns and I have had zero patient responses because the only time you hear from patients is if there is pain or sensitivity. The best patient response is no response at all, which means that everything is working.

	What benefits to your practice have you seen since using TheraCem?

	One of the great benefits has been the reduced amount of sensitivity. It is an incredibly simple cement to use in that it eliminates many of the steps that can cause sensitivity, such as etching, using an adhesive, etc. In addition, this cement is extremely easy to clean up, which is a benefit that every dentist seeks.

	Why would you recommend this product to your colleagues?

	Many of my colleagues probably use self-adhesive resin cements in their repertoire. This cement would be great for them to use in that it would reduce sensitivity, increase efficiency and provide high bond strength. Also, it would give them a very easy cement to clean up that is working for them in terms of bioactivity (apatite formation and calcium release) after the restoration has been cemented.

How one dentist uses this cement to reduce patient sensitivity and increase office efficiency.


The benefits of TheraCem from BISCO

	Many factors contribute to the accuracy of impressions, and impression materials can often make or break a restoration. In order to take perfect impressions and create great fitting restorations, Dr. Michael A. Miyasaki, owner of Miyasaki Dental in Sacramento, California, prefers to use Thermo Clone

 VPS impression material from Ultradent Products. By using the material, Miyasaki is able to deliver excellent impressions at a lower cost without compromising on quality.

	When did you start to use Thermo Clone and why?

	We started using it this year. A good impression - in material or digitally captured - is key to everything we do with indirect restorations. If you don’t have a good impression, nothing else matters, so we are always trying new things and 

 came across my radar. I tried it and liked it. We haven’t had any problems using it, and it has performed well.

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	What do you like best about Thermo Clone VPS? How does it compare to other materials?

	Because it is hydrophilic, we can make great impressions the first time. We have used it with large full-arch cases and in fields where there was some bleeding and fluids. We still got a good impression and great-fitting restorations.

	It also smells good, which translates into a better taste for the patients. The patients like it because of that. It comes in a variety of set times and viscosities to match the preference of the clinician, and I find the colors are easy to read.

	Two properties - tear strength and elastic recovery - work very well with Thermo Clone. Around the thin areas or the sulcus where we are trying to capture detail, some impression material - if it’s not strong enough - will tear when we remove it from the mouth. So, even though we had the details we needed in the impression material while it was still in the mouth, we lost that detail when we removed it. Thermo Clone, I have found, has great tear strength. And the elastic recovery is just great. When you pull it out of the mouth, Thermo Clone can pull over the contours of the teeth and go back to its original shape.

	Thermo Clone features thermal-accelerated setting, which means outside the mouth it isn’t setting fast. But once you put it in the mouth and it is in that warm environment, the heat of the mouth accelerates the set. It’s also thixotropic, meaning it flows well under pressure, but then once you stop pushing it, it holds its shape. We can load our tray and place it in the mouth and the material will flow. In the oral cavity, the warmth activates the thermal acceleration feature helping it set quickly, and the properties of Thermo Clone mentioned above help us get accurate impressions.

	What have been the results and/or patient responses?

	We don’t want to compromise on an impression material because that could affect the final fit of the restoration. I haven’t experienced anything but good-fitting restorations using Thermo Clone. The patient response has been excellent as well. As I said earlier, patients like it because it doesn’t have that bad taste. Patients just hate having to redo the “goopy stuff.” When we are able to make the impression the first time with Thermo Clone we have a happier patient, and I’m happier, too.

	What benefits to your practice have you seen since using Thermo Clone?

	Time savings when you get the impression the first time. An accurate impression also saves us time during the delivery of the dental work. If it’s accurate, then we have fewer remakes, saving us time. That’s fantastic because it drives the practice crazy when we have to send something back because it doesn’t fit, which is wasted time.

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	Also, cost-wise, we are always looking for things that are a good value. Today, with the constraints of insurance reimbursement, it is difficult to raise our fees even as the cost of doing business rises. Thermo Clone, compared with some of the other materials out there, is about 30 percent less, which is nice. Using Thermo Clone I can keep my supply costs down and increase my efficiency, which is good for my practice and our patients. Controlling the cost without compromising quality with Thermo Clone - that’s a big win.

	Because of everything I mentioned: the cost, the ease of use and the accuracy that we have observed using it. We need to provide good impressions to the lab. The Clinician’s Report in March 2015 said dental laboratories reported that up to 90 percent of impressions don’t have ideal characteristics. The bottom line is it is important for us to use good impression material like Thermo Clone so we don’t compromise what is right for our patients

Why one clinician prefers to use this material to take great impressions the first time.

Using Thermo Clone from Ultradent to create perfect impressions

	Clinicians have no shortage of options for types of cement. When it comes to choosing a product, bond strength to both tooth and restoration is a crucial feature in their decision process - but not the only one. Dentists often find that some of the additional features in a product can prove as vital as the strong bond.

, PA, and his dental assistant, Tara Bishop, CDA, about their experience with GC America’s G-CEM LinkForce™ universal dual-cure adhesive resin cement and what features of the product they appreciate most.

	Dr. Kleive graduated from dental school in 1997, making this past summer his 20th year practicing dentistry. For five years, Tara Bishop, CDA has been a dental assistant in Dr. Kleive’s practice. Between them, they share a quarter of a century of experience practicing adhesive dentistry.

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	With a private practice in Black Mountain, North Carolina, Dr. Kleive and Bishop have been using G-CEM LinkForce for some time on all their direct and indirect restorations, including 

 workflows. They are enthusiastic about their results, both for esthetic outcomes and material properties.

	What Dr. Mark Kleive, DDS, says about GC America’s G-CEM LinkForce

	The thing that attracted me to G-CEM LinkForce is that it is a very nice, all-in-one system you can bond anything with, whether it be a metal crown and bridge, all-ceramic crown and bridge, or hybrid-ceramic crown and bridge. I use it for cementations of all types of ceramics, resins, metals, for partial restorations or whole restorations, inlays, onlays, and crowns and bridges. It really is a one-size-fits-all type of scenario.

	In dentistry, it is common for dental practices to have multiple materials they are using for different indications. You end up having all kinds of inventory.  Efficiency to me is that I don’t have to go hunting for different materials in the office. I like to keep things as simple as possible. I appreciate having an all-in-one kit because it’s easier for me. The workflow is simpler when you are not thinking about, ‘What bonding agent or what adhesive system are we going to use for this?’ Maybe it’s just because I am getting older, but simplicity is such an improvement.

	It is more color stable than other products I have used before, and there are more shades of cement, so you have a little bit more room to alter the colors of the final restoration. Also, the shades of cement are included in try-in paste. A lot of companies don’t do that. With G-CEM LinkForce Try-In Paste™, you can see if the shade of cement you are using is the right color because cement will show through in some of your restorations. So, in other words, you can try different shades of cement without the adhesive present to ensure you match as much as possible to achieve the proper esthetics of a restoration.

	When it comes to the consistency of the materials, some materials are really sticky before they are cured. The handling properties of this material are less sticky, and I like that better than other materials I have used before.
	I do lots of CAD/CAM dentistry in my office. I have found G-CEM LinkForce is an ideal cement for virtually every material. For every milling block that CAD/CAM dentists have in their office, for all the milling blocks that are out there, it works for all of it.

	What Tara Bishop, CDA, says about GC America’s G-CEM LinkForce

	I like that the adhesive can be used for multiple purposes. It simplifies the process because I do not have to find out which adhesive to use. I automatically know I can use G-CEM LinkForce for cementing my veneers and crowns. It’s just a smoother process between me, as the assistant, and the doctor.

	I place orders for the practice, too, so instead of ordering multiple adhesives and cements, I can just order the G-CEM LinkForce kit. It simplifies ordering tremendously.

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	I also like the fact that there are more try-in shades and more cement shades, which include the option of opaque or translucent, because every patient is different.  If we have those options, we can get the best cosmetic outcome, and even more so in the anterior.

	With G-CEM LinkForce Try-In Paste, we can make sure the shade looks good. We know exactly what it’s going to look like using that shade of the cement. And if we don’t like the way it looks, we can choose a different shade. The system we were using before just had one tube of try-in paste.

	When we cement the crown with G-CEM LinkForce, the excess cement is so much easier to clean off than a different type of cement, so you are actually saving time. Overall, it simplifies many things.

How this universal adhesive from GC America streamlines adhesive dentistry in a busy practice.

I Use That: G-CEM LinkForce

	Unless you live "off the grid," you know that technology is an excellent tool. In a dental practice, technology has eliminated many daily manual tasks for everyone from the front office to the clinical team, particularly when you consider the features of practice management software. 

	Many practice management software products employ features that improve efficiency and productivity. They can systematize time-consuming administrative tasks for your front-office staff, freeing your staff up for tasks that can add value to the practice. 

 practice management software is integrated with their open platform 

software, allowing information to be compiled into one, easy-to-navigate patient record. Best of all, these features function automatically and are hassle-free.

Trending article: Why practice management systems are crucial for dental practices

	Brittney Weinholtz is the office manager at Fulmer Dentistry. With 13 years in the dental industry and managing two locations in Wisconsin, Weinholtz knows what it means to manage the moving parts of a practice-and how practice management software that integrates well with other technology can help. “Ideally for any practice, having as much in your dental software program as you can makes it easier for the whole office,” Weinholtz says. 

	Weinholtz speaks from experience. Dr. Fulmer’s practice-where she works-evolved from one location in Paddock Lake to a second location in Kenosha a few years later. The computer systems and imaging systems at each location were different and incompatible, resulting in the staff flip-flopping between the systems. 

	“When you have to click out of something in order to access something else, that’s just more time,” Weinholtz explains. “You also have to enter those patients into each practice management software that you have, meaning they would be on my software for the schedule, but if my imaging is something completely separate, not only am I having to enter a new patient in our scheduling system, but also in the imaging system. And that’s super time-consuming and frankly just a waste of time.”

Trending article: How to take charge of software implementation in the dental practice

	Another pain point for Weinholtz was the old system’s backup exercise. Using physical backup disks, she captured the system’s data at the end of the day and took the disks home every night in case there was a catastrophic event at the practice. “And that information can sometimes take a long time to back up, especially if we’ve had a long day,” she says. 

	Weinholtz also spent a lot of time verifying patient insurance benefits, distributing bulk insurance payments to various patient accounts, and manually entering processed credit card payments from the separate credit processing software. All of these tasks added up to a lot of time-consuming detail work.

	“And, you know, mistakes can easily be made if you process a credit card and the phone rings and you forget to go ahead and put that payment on the patient’s ledger,” Weinholtz explains.

Next: the power of technology integration

	Dr. Craig Rosenthal, DDS, practices in Garwood, New Jersey. After 40 years of practicing dentistry, he understands it is essential that your 

 works with your practice flow. He decided about five years ago that he wasn’t happy with his existing systems, so he decided to integrate 

 and open platform imaging software with his existing practice management software.

	“The integration and the support was great. We had very few problems, if any,” he says.

	The DentiMax imaging and practice management software paired with the DentiMax Dream Sensors is an example of integration and interoperability. All of the patient’s images are captured and stored in the imaging software. Integration between the systems allows clinicians to see all of the images in the patient’s chart in the practice management software. With one click, they can view them during treatment planning. 

Trending article: How DentiMax Dream Sensora made a big impact in one practice

	Because Weinholtz uses DentiMax imaging software and Dream Sensors in combination with DentiMax’s practice management software, it streamlines the process of accessing patient data.

	“Before we had to flip-flop back and forth between scheduling and imaging software and now we don’t have to do that anymore. Now, we’re already in the patient’s chart, and we just click on the icon in order to take the X-rays. Everything is right there,” Weinholtz says.

	Not only is the system integrated, but Weinholtz worked with DentiMax’s head of imaging, Jim Ramey, to dial in the settings for all the X-ray machines the clinical team uses. “I don’t think in the 13 years I’ve been in dentistry that I have seen a digital X-ray that has come out as clear and perfect as with this center that we have. And also that’s because Jim helped us dial those numbers in,” she says. 

	Weinholtz also appreciates all the ways her cloud-based system solves some of her past headaches. Her back-ups happen automatically and are stored safely in the cloud. It also has a built-in insurance verification feature and credit card processing that automatically deducts payments from the patient’s ledger balance. She can also view the schedule for both offices in one system, meaning no more flip-flopping between two systems. Bulk payments from the insurance company for multiple patients are easy to process with her DentiMax practice management software.

	“In a lot of the systems, you have to go into each specific account and enter that patient’s portion of the bulk payment,” Weinholtz says. “Through DentiMax, I can enter that number in as a whole and then start clicking on patients.”

Trending article: 5 EHR tips that could save your dental practice

	Dr. Rosenthal thinks that one important consideration for a practice combining different systems for integration is the quality of the supplier’s support team. He had few issues using the Dream Sensors with his existing practice management software, but when he did, Dr. Rosenthal appreciated the immediate and personal support he received.

	“When you call, you always get somebody on the phone who is very knowledgeable and helps you out right away,” he says.

	Weinholtz agrees that a real connection with the company you work with is crucial. For her part, she feels that she has formed genuine friendships with the people on the other end of the phone. “I know that I can rely on them and that’s super important to us,” she says. “It’s super important to the future of this practice, knowing that if I have an issue, I can call them and they’re right there to help me fix whatever mistake I’ve made or walk me through something that maybe I haven’t learned about the system.”

	Few technologies impact your practice in a day-to-day way more than your practice management software. Perhaps most importantly, practice management software allows you and your staff to get away from mundane and time-consuming tasks. The integration between DentiMax practice management software, DentiMax Dream Sensors and DentiMax imaging software frees up the team to focus on the most important aspect-patient care

How practice management software can streamline your day-to-day through integration and interoperability for excellent patient care.

How to simplify practice management with DentiMax

	It was 1996. The music was grungy, and the rumor was a dot-com economy would make us all millionaires. Technology was still just beginning to transform our analog world, even in the dental practice. In Northern California, Dr. Michael Miyasaki, DDS, was working with his first laser in the dental practice, a medical laser brought over to use in dentistry.  

	“They were big, overpowered and way too much for what we needed, but they were lasers, so we were excited,” Dr. Miyasaki says. “But we didn’t understand how best to use them.”

	Fast-forward to 2017: Many clinicians now understand how best to use lasers. In fact, today’s lasers have a much simpler user interface than before and are designed for dental professionals to deliver a predictable and effective patient outcome.

Related: 5 reasons to revisit lasers in your practice

	But despite the evolution of laser dentistry over nearly 30 years, the dental community has its fair share of skeptics about its use. Some argue that it’s a gimmick or a marketing ploy to disguise a dentist’s lack of clinical skill. Others say the cost of entry is just too high-and that the ROI on lasers just isn’t there once the initial investment is there. However, early adopters say that is not true, laser dentistry is here to stay, and that it is great news for a dental practice’s bottom line. We spoke with several industry experts to learn how laser dentistry has improved revenue for clinicians. Here’s what they had to say.

1. Laser dentistry condenses procedure timelines by avoiding injectable anesthetic and reducing the need to manage bleeding.

	In the past, two alternatives existed for things like soft tissue re-contouring and ablation, a blade or an electrosurgery, Dr. Miyasaki explains. Both require an injectable anesthetic. Using a scalpel also requires managing the patient’s bleeding. Lasers get away from the injectable anesthetic and prompt minimal bleeding, making same-day surgery and prep feasible. 

	“I had a patient in today for some gingival contouring, and I didn’t give him an injection; I just put some topical on the tissue. When we did the gingivectomy, he was fine with it,” Dr. Miyasaki says. “It’s a kinder, gentler way of doing dentistry.”

	Dr. Jeff Rohde, MS, DDS, practices in California and uses lasers for his soft tissue surgeries also, which he describes as anesthesia-free and blood-free. “So, let’s say a 6-year-old comes in and has this flap of tissue over an erupting molar,” he says. “I just laser that little thing off. I don’t have to numb her up. There’s no bleeding, and she’s out the door. I would never have tried that before.”

	Dr. Sam Low, DDS, MS, MEd, agrees that laser dentistry is a less traumatic way to do dentistry, especially for young patients. While local anesthesia is very safe, it can cause soreness. He sees laser dentistry as a way for parents to spare their children negative emotional experiences. “As a parent, do you want your child to undergo the local anesthesia aspect-the stress, the crying, the anxiety-versus seeing a practitioner who can do restorative dentistry without local anesthesia?” Dr. Low asks.

	Dr. Low, who is also the chief dental officer and vice president of clinical and dental affairs for BIOLASE, says that some practitioners who have fully embraced laser dentistry use the laser almost on every single patient. “Part of that is the ability to do restorative dentistry, especially with children, with minimal local anesthesia,” he says.

2. Laser dentistry adds production for routine procedures to regular hygiene visits.

	A regular hygiene appointment with an exam, bitewings and prophylaxis typically bills around $200. Many times, the dental team identifies issues like decay. 

	Dr. David Stinchfield, DDS, describes his private practice in Washougal, Washington, as technology-driven. He began using lasers 10 years ago with a laser and now uses the 

Dental lasers have fully come into their own-but many dentists continue to balk at lasers. Here’s why bringing laser technology into your office can pay off-and help your patients.