	Marketing is always changing, and dental practices are always looking for new patients. Now is the best time to regroup and upgrade your marketing plans and efforts. But how do you turn your office into a dental marketing machine?

There are many things you can do. First, you need to understand what works. For example, did you know that around 79 percent of people who are looking for a new dentist will book their appointments over the phone? That means that if your staff has poor phone skills, you may lose out on a lot of business. There is no point to increase your marketing efforts if your practice isn’t equipped to properly handle phone calls.

Second, you need to thoroughly measure your marketing efforts. You should always test to see what works best for you and your practice. Then you can put your money wherever it brings you the most clients. You should also ask yourself what message you’re trying to send to your audience. You need to do everything you can to make your practice stand out. Are you trying to be the most affordable or the most comfortable practice? You should convey that through your marketing messages.

You also need to stay visible by having proper signage. This is a no-brainer and can be costly to your practice. Make sure you have clean and easy to read signage and marketing materials, especially if your practice is hard to find.

Finally, you should download our e-book, “The definitive guide to marketing your dental offices," to receive dozens of proven tips and strategies.

Thanks to our sponsor, Patient Pursuit, you can have everything you need to know about marketing your dental office in one easy guide. 

Articles

 Marketing is always changing, and dental practices are always looking for new patients. Now is the best time to regroup and upgrade your marketing plans and efforts. But how do you turn your office into a dental marketing machine?

How to turn your dental office into a marketing machine

 President Tom Stratton to discuss the company’s offerings, emerging products and plans for the future.  

Give our readers a brief history of Implant Direct. 

The foundation of Implant Direct was started in 1982 when Core-Vent Bio-Engineering was formed. Core-Vent later became Paragon Dental Implant Company. In 2004, Implant Direct LLC was formed and, in 2010, Danaher, the parent company of the 

, acquired 75 percent interest in the company. We are built from a history of innovation, which includes the creation of the internal hex connection that is the cornerstone of the 

. It was the first internal connection with a lead-in (or conical) bevel and was widely licensed to other implant manufacturers, including 

Dental implant emerging research: Antidepressant drug linked to dental implant failure

What was the focus of Implant Direct when it was introduced into the dental community? 

 Implant Direct created the value segment in implant dentistry by introducing USA-made compatible products with enhanced features in a groundbreaking All-in-1 Packaging vial at a quality and price that truly rivaled the premium-priced implant companies. To accomplish this, and continue to revolutionize the implant industry, Implant Direct invests in sophisticated manufacturing technology to produce products of exceptional quality while achieving cost efficiencies we can pass directly on to the dental practice. This is not something that any other major implant companies are able to offer at this time. Instead, some are looking to cut costs by outsourcing their manufacturing to low-cost regions.

Related reading: Q&A: Dr. Joseph Gian-Grasso on trends and advances in dental implants

How is Implant Direct dealing with the growth of general practitioners placing more implants?

The general practitioner has been critical to the future of implant dentistry for decades; especially in non-referral countries that have limited surgical specialist bases. It’s important to allow general dentists to effectively deliver the type of procedures that they are trained to provide. At Implant Direct, we believe strongly in our obligation to serve the dental community. In our leadership role with the innovation of new products, education and customer support platforms, our focus is to give dentists-no matter their specialty-a reason to rank the surgical placement of dental implants as the No. 1 growth procedure in their practice. 

We do this through our portfolio of Simply Smarter products and significant investments in education through our ID University, which includes the Las Vegas training center, as well as satellite locations throughout the world. Our recent introduction of the ID Education Passport, which offers two years of unlimited dental implant education, truly trains dentists to deliver safe and predictable implant dentistry to their patients. This mission has made implant dentistry accessible to more patients, not just by helping to make treatment more affordable, but by also helping the general practitioner to develop his/her implantology skills. The range of expertise may vary, but it certainly begins with the ability to diagnose, treatment plan and educate the patient in the chair. 

More on dental implants: How technology can simplify the placement of dental implants

How has Implant Direct’s success changed the landscape of implant dentistry?

 It’s incredible to see the changes that have taken place since the introduction of Implant Direct. Premium-priced implant companies first reacted by spreading false and misleading rumors about the quality of our products, then these same companies were forced to negotiate discount prices in an attempt to recapture lost customers, have started to buy/invest in discount implant companies and now even tried to clone our All-in-1 Packaging. While competitors may attempt one-off imitations, they struggle to replicate the complete simplified experience that Implant Direct has created. We have executed our strategy, one that is now being cloned by many of the premium-priced implant companies, by holding to our foundation of delivering true value to our customers–and their patients. Time will tell if others will be successful in executing their strategies. 

Editor's Note: Learn more about Implant Direct in our exclusive interview with Stratton below...

 Tell us about your Swish line of dental implants and why you are focused on Straumann.

, we are bringing a compatible solution with our unique brand of simplicity to a market segment that has been asked to believe in a convoluted product portfolio and corporate message. Some of the product enhancements in the Swish System are surgical simplicity and greater precision in prosthetic placement at the bone level. Unlike Straumann, we have remained consistent with our corporate message. For years, Straumann touted the importance of product research through the 

, yet now is investing in discount dental companies like Neodent and MegaGen without that same clinical evidence criterion. 

Even while making such investments, Straumann has continued to publicly criticize lower-priced implants and some doctors that buy them, as stated by Straumann CEO Marco Gadola in a press release on March 31, 2014, that, “some dentists are willing to pay for lower standards than those offered by premium brands.” This message coincided with a letter from Gino DeSimone, senior vice president, dental division, Straumann North America, to its customer base that, “Neodent is not Straumann.” In addition to pursuing this two-tiered price strategy, 

Straumann is also attempting to capitalize on the growing general practitioner-placing-implants market, albeit without training, selling or supporting them directly. This can be seen in its recently announced bundled implant packaging (a clone of our original All-in-1 Packaging concept) to be sold through a distribution partner. Implant Direct’s position is that dentists don’t want education or sales activities in the closet, but, rather, they wish to partner directly with implant manufacturers. This is a stark contrast to Implant Direct’s DIRECT to ALL dentists model.

Related reading: New SwishActive joins Swish Implant System

 How do you believe the surgical specialist, in particular, and the overall dental community perceives Implant Direct?

Many doctors in the surgical specialist community have embraced our products. They appreciate our honesty, history of innovation, current product designs, breadth of product offerings, support and the overall value we deliver. They recognize our fundamental belief in the referral model when a general practitioner is ready to refer a patient to them. In the case of implant dentistry, this is still often. The overall dental community has shown us they believe we offer superior products, service, support and education by making us the fastest-growing major dental implant manufacturer. We have also seen this through third-party surveys of dentists that rate us at the top of the categories that mean the most to dentists. They choose us because we deliver on our promise to provide the best products at the best value. We created this segment, and no matter what the premium-priced companies clone from us, it will not deliver like the original…Implant Direct. 

More on Implant Direct: Implant Direct announces expansion

What does the future hold for Implant Direct?

We will continue to push the envelope on our technological research to enhance our manufacturing processes to deliver the highest-quality products for the greatest value. We are actively gathering clinical input about the surgical and restorative challenges implant clinicians face and then designing creative solutions to overcome each of these challenges. Our robust customer support platform will continue to evolve and include expanded support through mobile applications and the global expansion of our ID Education Passport program. 

 Dental Products Report sat down with Implant Direct President Tom Stratton to discuss the company’s offerings, emerging products and plans for the future.  

How the general practitioner has been critical to the future of implant dentistry

	Dentists, expanded function dental auxillaries (EFDAs) and dental assistants traditionally harbor conflicting thoughts about fabricating anterior provisionals.

Although created and placed with the knowledge that they are not intended to be permanent, anterior provisionals still, in truth, reflect the skill of the clinician, and well-constructed provisionals are important for maintaining healthy soft tissues, acclimating the patient to the new tooth form and protecting underlying tooth structure.

Proper protocol and appropriate materials and instruments are the keys to fabricating anterior provisionals that, in addition to functioning well, make patients smile long before the final restorations are complete.


	The proper pre-operative steps set the tone for ideal temporization and superior finished restorations. During the treatment-planning phase, diagnostic casts should be made for all cases, even single-tooth procedures. For anterior cases, pre-waxing is essential, providing the patient with an idea of the desired outcome; it also allows the patient to participate in treatment planning and work toward the final result. In addition, lab technicians must receive ample information detailing the patient’s preferences, further underscoring the importance of maintaining the proper channels of communication, to efficiently wax up anterior restorative cases. Ultimately, the diagnostic wax up is an invaluable, three-dimensional communication tool for all members of the treatment team, and it serves as a guide for preparation and provisional design.


	For all cases, photographs are imperative to the communication process among the clinician, the lab and the patient, and they provide a valuable addition to the practice’s record. Because the laboratory technicians must fully understand the proper shapes, sizes, and planes of anterior preparations to ensure the crowns or veneers suit the patient’s arch form and occlusion, it is important for the doctor to communicate this information in the most effective manner possible.


	A range of materials is available for fabricating temporaries, and most clinicians have their favorites. Some prefer acrylic, which is generally stronger and longer-lasting for cases in which extended provisional time is required. Others favor bis acrylics, which offer enhanced, more-natural-looking esthetics. 

 (Ribbond, Seattle, Wash.) bondable reinforcement ribbon can be considered with either material if extra strength is required. For improved esthetics, shades can be layered to create a natural color gradient between the gingival and incisal aspects of the teeth.

Check out the following video to view the step-by-step case:


	Choices for bonding provisionals vary, depending on the case. For full-coverage restorations, non-eugenol cement is ideal. For added strength, a carboxylate luting cement can be used with a coating of chlorhexadine on the teeth prior to placement. For veneer temporaries, spot-bonding techniques work very well. Materials should be placed as they are for composite restorations, using a preferred etchant, bonding resin and flowable composite.
	The following case outlines some simple steps to ensure restorative success by maintaining optimal communication among all members of the dental team.


	Following completion of orthodontic therapy, the patient requested esthetic restorative treatment to address a range of concerns, including discolorations, unesthetic contours and poor length-to-width ratio due to congenitally missing laterals.

 Following impressions, a diagnostic wax up was created and approved by all members of the restorative team.

 The wax up was duplicated and used to create a vacuum-formed stent with a rigid, .080 material.

 834.FG.016 depth-marker diamond and the Komet® 5862.FG.012 feather-edge diamond. Photographs were taken to check the occlusal clearance at chairside and to allow the lab technician to view the dentin shade.

An alginate impression was taken of the finished preps, and a quick-setting stone was poured. This enabled the model to be viewed from several different angles and planes so corrections could be made prior to taking or scanning the final impression.

 The stent was placed over the prepped teeth to gauge how much thickness and length would be gained in the provisionals and final restorations. 

Note: While gaining beautiful esthetic results with shape and shade is relatively simple, the case can easily fail if soft tissues are not considered during tooth preparations. Ideally, margins should be supra gingival. Although, for a variety of reasons, this is not always possible, respect must be given to biological width and the human body’s response to foreign materials in the mouth.

To prepare the stent for use of bis acrylic material, the Komet® 5862.FG.012 bur was used to create small holes in the incisal portion of each tooth in the stent.

The stent was filled with the bis acrylic and placed in the mouth. After the material set, the stent was removed and set aside.

 An impression was taken while the bis acrylic completely hardened inside the stent. 

Note: Trimming is simplest when the material is at its most rigid.

 Bulk trimming was accomplished with the Komet® H79EF.HP.040 fluted acrylic lab bur, and the Komet® FS6 and FS9 fluted finishers were used to adjust margins.

 So the provisionals would look as natural as possible, the incisal embrasures were opened using the Komet® 943.HP.100 diamond disc.

 The same disc was used to open gingival embrasures, allowing tissues to breathe as foreign material was introduced into the oral cavity.

Occlusal reduction of the anterior bis acrylic material was completed with a fluted football-shaped bur.

 To further enhance esthetics, the provisional was polished with the Komet® AR9464 goat-hair wheel. Note: An array of materials and techniques is available for polishing, and the proper choice for any case depends on the fragility of the temporaries. If they are very fragile, they can be bonded into place and then polished with Komet USA’s composite polishing kit 4477A. For full-coverage crowns or very thick veneer provisionals, a fine- to medium-grit pumice can be used on a new saturated rag wheel. This technique buffs out any imperfections that may have occurred during trimming.

 A baby-pea-size amount of etchant was placed in the center of each tooth and then rinsed.

 Bonding agent was applied, air-thinned, and flowable composite placed. Provisionals were then seated.

 Excess flowable composite was brushed away, and the provisionals were light cured. 

Note: Always double check facial and lingual margins for excess cement or bonding resins, as leftover particles can inflame tissue and compromise outcome.


	Although patients typically don’t comprehend the rationale or procedures behind providing them with the best-possible temporary restorations, the dental team understands that esthetic, well-functioning provisionals are the first step toward a successful restorative case. By using these techniques and maintaining open lines of communication, the entire restorative team and the patient can work together to achieve an ideal final result, starting with a comfortable and esthetic set of provisionals.

 Dentists, expanded function dental auxillaries (EFDAs) and dental assistants traditionally harbor conflicting thoughts about fabricating anterior provisionals.

How to fabricate anterior provisionals

There are products at different price levels that doctors should have in their practices, and there are also words of wisdom to guide judicious spending, not only for making smart equipment purchases but also for ensuring the practice engenders the growth it needs to be successful.

We spoke to dentists, consultants and suppliers, each with different perspectives on what doctors should invest their money in and how.


For purchases up to $500, spending is small enough that it’s usually earmarked for supplies and items the doctor needs, but there are also useful-to-have items for the practice.

For example, doctors can benefit from monthly subscriptions to different professional services benefiting the practice.

“For $59 a month, a doctor can get CAESY Cloud,” says Jana Berghoff, technology marketing manager at Patterson Dental in St. Paul, Minn.

The CAESY system began as an $8,000 computer that delivered educational videos to workstations in the office. With the proliferation of cloud computing, that product evolved into a cloud-based service.

"They are one- to three-minute videos that explain to the patient what a treatment is going to be and why they need it,” Berghoff explains. “For $59 a month, they have access to over 300 different videos and animations to explain to their patients why they need different services and what the procedure is going to be like.”

Dr. John Flucke, DDS, technology editor for Dental Products Report, recommends investing in a Microlux flashlight from AdDent in Connecticut. The Microlux is a high intensity flashlight with interchangeable tips.

“It’s a really nice transilluminator,” Dr. Flucke says. “You basically shine it on the tooth. You put that flat tip against the surface of the tooth and it makes it look like it’s glowing. You can see all kinds of things, like cracks.”

The Microlux’s interchangeable tips include some with mirrors and perioprobes, as well as tips that help find tooth roots.

Dave Steck, vice president and general manager of Henry Schein, recommends electric handpieces.

“Those have been on the market for years, and they keep getting better and cheaper – which is good,” Steck says. “Electric handpieces allow doctors to do a variety of procedures that they can do in the office. A third of the dental offices have electrical handpieces. Two thirds do not, but the ones that don’t, once they get them, they tend to be very pleased with them.”

Looking at overall improvements to the practice, Dr. Roger Levin, DDS, CEO and chairman of the Levin Group, a dental practice consulting firm in Owings Mills, Md., recommends using those dollars for educational opportunities.

“I would recommend either taking a course, focused on increasing practice production, or buying a series of books,” Dr. Levin notes. “It’s best to buy dental-specific books. General business books are helpful, but they don’t help the dental practice very much.”


Around $1,000, Dr. Flucke recommends the VALO, a curing light from Ultradent Products.

“It is very bright and very efficient, so it saves you a lot of time,” Dr. Flucke says. “It’ll set white filling material in five seconds. The VALO has multiple LEDs in it that produce different wavelengths of light, so it will set every white filling material on the market.”

Another benefit of the VALO, notes Dr. Flucke, is its durability.

“In dentistry, despite our best efforts, we drop things,” he says. “I’ve knocked two different things on the floor this week. So when you buy something, you buy it in the back of the mind knowing that thing will hit the floor eventually. There are different types of aluminum, and the VALO is made out of the best aluminum out there –  it’s made out of aerospace-grade aluminum, and you can literally drop this thing up to 300 times before it breaks.”

On the practice management side, Dr. Levin recommends spending $1,000 on staff training.

"Today, any worker in America who is not retrained every few years becomes obsolete in the job, and as the industry changes, we have to work very hard to keep your staff current and up-to-date,” Dr. Levin says. “The doctor can learn whatever the doctor wants to learn but will have trouble implementing that information into the practice without a well-trained staff.”

No one likes to think tragedy could strike, but if it does, a product like DDS Rescue is invaluable. Costing around $2,000 (depending on its configuration) and a monthly subscription fee, DDS Rescue can help keep your practice safe from catastrophe or theft.

“Dental offices have all this data on their patients,” Berghoff says. “They’re required to keep it secure and protected. But what many dental offices do is back up that data on an external hard drive and take it home in their car or leave it in the office. That’s putting patient data at risk.”

Whether kept in the office or transported to an off-site location, that physical backup is still susceptible to theft or damage. DDS Rescue is both a physical and a virtual solution to information backups.

"It sends that data up into the cloud, so if is wiped out completely, the doctor can go online and view their patient information, ensuring continuity of service to those patients,” Berghoff says.

DDS Rescue isn’t the sexiest purchase for the dental practice, but if it’s needed even once, doctors will likely be grateful they made the investment.

"This isn’t something that is necessarily going to give you an immediate return on investment in your practice,” Berghoff adds. “It’s not something that’s necessarily the fun thing to buy. It’s not a new toy that you get to play with; it’s not something that’s going to bring additional revenue into your practice. But for those doctors who have gone through catastrophe or a hardware malfunction, they would pay any amount of dollars to get that information back. This is an unbelievably important thing that absolutely every doctor needs to have.”

Steck recommends a diagnostic intraoral camera.

“Not only do they work as intraoral cameras that you can show a picture to the patient,” Steck says, “they also are good at finding dentistry, almost like an X-ray. So if you don’t want to take an X-ray – some people don’t like radiation – you can use that, and it’ll give you maybe not as good a picture as an X-ray but good enough so that you can actually find dentistry. So, it will show you that too in a different kind of view and actually show you decay. It’s not as good as an X-ray but it is a good in-between step, and, in many cases, it works really well, and they pay for themselves if the doctor uses them a lot.”

Dr. Flucke endorses a caries detection system, though a specific make and model is really dependent on the doctor’s needs.

“They all work well,” Dr. Flucke observes. “They all have their pluses and their minuses. It just depends on what bells and whistles you want.”

On the practice management side, Dr. Levin advises having a comprehensive practice analysis performed by a certified practice analyst.

“The practice analysis is a detailed review of the current state of the practice,” Dr. Levin says. “Too many dentists start making changes before they really understand the current state of the practice. Many dentists never think about analyzing their situation, but if you think about it, if you go to a physician, they’re going to diagnose you first. If you go to a personal fitness trainer, they’re going to analyze your current physical condition. If you go to a cardiologist, they’re going to check your heart before they do anything, and we run our practices day after day without really diagnosing our current situation.”


With $10,000, Dr. Levin recommends bolstering the practice’s online presence. Since the Internet is so omnipresent, it is important the practice be well represented online. And if the doctor is going to spend that amount of money on online presence, he or she should make sure the money is spent wisely.

“So many dentists are really buying a bill of goods from people who tell them going to do all these things, and they really don’t,” Dr. Levin says. “So many practices are just not even in the digital world at all. Patients can’t find them; they don’t come up well in search engines; they’re not managing the reputation on the directories.”

For $10,000, Dr. Flucke recommends a diode laser, which allows cutting in a bloodless environment.

“With a laser, I can go in and just basically make a cut and get the same results that you would with the blade, but it coagulates as it cuts, and I’m still going to get the drainage like I wanted,” Dr. Flucke says. “Post-operatively it will not hurt.”


	For $25,000, Dr. Levin recommends getting comprehensive practice consulting.

"You can get consulting cheaper by getting a one- or two-day consultation, which I don’t find to be the best approach, and that’s why I use the word ‘comprehensive,’” Dr. Levin says. “For $25,000, you can hire a consulting firm that will transform the practice. They should still start with an analysis, but they can transform the practice into what we call a ‘real-world business.’ In the business world, businesses must copy the best models out there. There’s a reason why smaller fast food chains copy Wendy’s, Burger King and McDonald’s. It’s called ‘industry standards.’ In dentistry, we don’t do that.”

In terms of hardware, Dr. Flucke and Steck both recommend a digital impression system.

“At Schein, we believe that is the hottest category, and it will be for the next five or six years,” Steck says. “For years, dentists have used impression materials. They don’t really need to do that anymore. The digital scanners are actually more accurate than the impression materials now. They obviously allow you to send a digital file to your lab.”

Utilizing a digital impression system is far more convenient than sending off a physical impression to the lab.

“You don’t have to pour it up as a model and send it out, which is a very labor-intensive, archaic process,” Steck says. “But until the last two or three years, the quality of the digital impression scanning was not nearly as good, and it’s made a quantum leap.”
	Steck expects there to be more digital impression scanners on the market this spring.

“We think there are going to be 10 or 15 new scanners on the market in March,” he says. “It’s an exciting part of the business that we feel should be the first thing to buy.


	In tandem with digital impression systems are milling units, which come in around the $50,000 mark.

"The other nice thing about the digital impression systems is that they allow the doctor to take these images and use their own CAD/CAM milling system to create the crown in the dental office while the patient waits,” Dr. Flucke says. “Companies are creating milling units that interface with these digital impression systems, and it is allowing the doctor to come in and do this whole CAD/CAM thing and create crowns in-house using digital impression systems that they purchased thinking, ‘Oh, I just won’t have to use impression material anymore,’ and some doctors are seeing the benefit a milling unit that will interface with this, so I can have this whole in-house system that I didn’t even realize existed before.”

Dr. Levin advises adding an extra treatment room to the practice.

“First, if you put in an extra treatment room and you manage and market your practice properly, you’re going to grow, and you’re going to need the space,” Dr. Levin says. “Second, it creates terrific scheduling flexibility. So many practices are jammed up because they have to see higher volumes due to the decrease in insurance reimbursements so that an extra room takes a huge amount of stress off the practice. Third, if the practice does grow successfully, it will want to have an associate at some point, and this helps add room to bring the associate into the practice.”


	It can’t be disputed that additional education and skills help the doctor expand his or her offerings, making for a more successful practice. Education can be another wise investment opportunity.

Dr. Attila Nagy, DDS, of Bucyrus, Ohio, gained additional education via a master’s degree and training through Progressive Orthodontic Seminars and the McGann Postgraduate School of Dentistry, adding orthodonture to his family practice. During the course of three years, he spent about $120,000 on education and equipment. The investment, he says, was quickly recouped. But for Dr. Nagy, money hasn’t been the most important part of his continuing education – there are intangibles that have come with the new work.

“The biggest thing in adding orthodontics to a general dental practice is that it is a more positive experience,” Dr. Nagy says. “It’s one of the few things that patients actually want from a dentist. Patients don’t really want a filling, but they have to have it, and cleanings – very few patients want to have cleanings. I think that braces are the most life-changing. I don’t think the money part is the most important. Yes, it brings in income to the dental practice, but the biggest thing is that it’s a lot more rewarding. It makes a practice a lot more positive and that’s something that patients like.”


	There are thousands of products at any price point a doctor can purchase, but it’s important for a doctor to know what he or she should spend money on and when to keep that wallet in its holster.

“We have something we call the ‘coat rack syndrome,’” says Amy Morgan, CEO of the Pride Institute, a practice management consulting firm in San Francisco. “Even if the technology is the best of the best of the best, and it’s been stamped by Gordon Christensen, the Best of Class awards or whatever, we have seen so many expensive pieces of innovative technology serve only as coat racks. If you’re not doing it for the right reasons, there’s a good chance you’re not going to implement that effectively and not going to get a return on investment.”

Knowing your practice and its mission is critical in avoiding over-purchasing.

AMD Lasers provide clinicians with quality products designed to fit your budget.

“Most of these guys shoot from the hip, and they don’t have a clearly defined vision of what their practice is, what their practice offers, the target profile patient that they are offered to and a strategy on what their systems and their outcomes need to look like to achieve that vision,” Morgan says. “As a result, they very often go into some of the more expensive purchases looking for a silver bullet solution. For example, I notice my new patient flow is down, so I’m going to go and buy a cone beam scanner, which is a higher price point piece of equipment. The truth of the matter is that the cone beam scanner by itself will never compel a new patient to pick up the phone and call; however, how you’re utilizing the cone beam scanner, how you’re pricing the cone beam scanner, the fees around the scanner, how you’re marketing the cone beam scanner to referring practices and how your team utilizes that is that make/break point for success.”

Be careful about purchases. Knee-jerk reactions and spending without really thinking through what you need can cause expensive mistakes.

“Dentists are not necessarily looking at enhancing their practice and making additional purchases of technology,” Morgan says. “Very often they buy based on the tummy ache, and a running joke is 80 percent of the population of dentists usually walk through a convention floor with a sign on their back that says ‘Talk to me. I’ll buy anything that’s shiny and new,. And then they get cynical when they get older. They get the dead carcasses of the initiatives that they tried to make lying in their way. They tend to get cynical and shut down to the technology and purchases that they should be making. The higher a doctor goes on a new piece of equipment or a purchase, the more planning and investigating are involved.”


	“Eighty percent of doctors don’t take a salary,” Dr. Levin observes. “They just look in the checkbook to see what’s left. If you don’t take a salary of any sort, then you don’t have any kind of budget. So when they look in there and they see an extra $5,000, they’re focused on the most immediate thought: ‘Take this course,’ ‘take a vacation’ or ‘buy the newest gadget.’ A lot of the technologies are very helpful and important, but some of them don’t help grow the practice so it’s very important to have a plan for each year.”

Another factor to consider when making a purchase is what will the return on investment be.

“ROI isn’t just money. It can be increased efficiency, decreased stress, increased market profile,” Morgan notes. “It can even be an increased staff morale. But if you don’t define what your return-on-investment desire is, it makes it harder for you to decide what pieces of technology may support that. If my return on investment is that I want excellent clinical results with minimal redos or I want a more efficient way to be able to serve our patients’ restorative needs in the least amount of time, then you might be looking at CAD/CAM because it is known for reducing the amount of visits that need to be done.”

Ultimately, purchasing requires solid information and decision-making on the doctor’s part, which can be difficult in this day and age, Morgan observes.

It is important that dentists and their teams feel safe in their education,” she says. “We are so inundated by so many messages, whether it’s dental messages or the pop-up ads that come up on your email every day, that the consumer is becoming more and more cynical – not about the companies that are trying to sell them but by their own ability to make the appropriate decisions. What tends to happen is analysis paralysis: ‘I don’t trust my ability to make decisions, therefore I do nothing.’ Being in a safe environment to educate themselves how to approach technology and a safe environment where they can understand the merits of the technology without feeling like they’re being sold is an absolutely essential element for the dental profession to keep the lake moving forward.”

Take advantage of technology: Products like the ACTEON North America SoproCARE offer comprehensive oral exams in one device.

Spending must be done conscientiously and with consideration for the overall good of the practice.

“We really are in a new normal,” Dr. Levin says. “Dentistry is never going back to the way it was seven or eight years ago, and if we don’t invest in the business side of the practice, there’s a real danger of hitting a plateau and a decline in production.”

Ultimately, when buying new equipment, the doctor must consider how it will benefit his or her patients.

“When making a technology decision, I look at it from the point of view of my first and most important responsibility is to take care my patients,” Dr. Flucke says. “If I can make it fun and techy and ‘gee-whiz isn’t it wonderful,’ that’s great. But, at the end of the day, if it doesn’t benefit the patient, if I can’t look them in the eye and say, ‘This is good for you,’ I’m not going to do it.”

 Money tends not to grow on trees, and given the current state of the economy – not to mention issues specific to the dental industry – buying new equipment is rarely a frivolous endeavor. Doctors have to weigh the pros and cons of their needs and wants against their available funds before making purchases – no matter the size.

The best dental products for your bucks

	The growth of multiple options to serve patients’ esthetic and functional needs and desires requires mastery of disciplines that usually necessitate a coordinated and collaborative team approach with multiple specialties.

Often, the information is in the form of the traditional database of radiographs, photos, models and diagnostic wax ups, as well as new 3D digital technologies such as cone beam (DICOM files) and impressions (STL files). More importantly, creating a shared vision of the final esthetic communicates infinite details of the patient’s hopes and dreams and presents higher accountabilities between the restorative, orthodontic and surgical partners (aka the three Rs: relocate, replace and restore).

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Fortunately, with this high level of expectations, there are innovative, conservative and dynamic methods that keep everyone on the same page and satisfy a patient’s emotional appearance needs during interdisciplinary care that may take several months or years.
	This article will demonstrate how the general dentist can “quarterback” and design success as an architect and an artist.

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	A 35-year-old female patient with a history of unsuccessful surgical exposure/orthodontics eruption and subsequent extraction and bridge reported to our office with a misplaced implant at tooth position No. 11. Because of the compromised bone volume caused by the rotated first bicuspid, the surgeon in South America was unable to access a proper location for the implant three dimensionally, which compromised the trajectory toward the labial, as well as the attached gingiva. With the situation creating an unacceptable esthetic, biologic and functional risk, the patient accepted a long-range treatment plan of orthodontic and surgical site development prior to placing an implant. This would be followed by restorative care with an implant-supported crown using custom zirconia abutment for No. 11 and porcelain restoration on adjacent teeth to create an ideal smile enhancement.

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Continue reading about the procedure on Page 2 ...

To be able to communicate our future goals and parameters to the orthodontist and periodontist, records were gathered and shared, including 

 to road map the journey. The sequencing of care was “brainstormed” in the following phases:

		Full orthodontic realignment of the teeth, in addition to creating adequate space for increased bone volume and implant placement. The pre-existing transitional bridge was to be split to allow for distal rotation of tooth No. 12 to create more optimal intradental space.

		Esthetic verification of the ideal placement of tooth No. 11 with an updated provisional restoration, as well as CBCT analysis for surgical planning.

		Soft tissue and block osseous grafting prior to a tapered implant placement with a surgical guide.

		Restoration as listed above and occlusal maintenance with a retainer and protective appliance.

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 Following two years of orthodontic therapy, a space was created between Nos. 10 and 12, necessitating a more ideal wax up to plan a provisional that diagrammed pink/white balance and position of the missing canine.

A lined silicon matrix was created to help duplicate this intraorally (

). The patient was given the opportunity to home whiten using her 

 retainers. Also the gingival shades were assessed prior to anesthesia of the tissues, which would affect blood flow and color in the area of treatment.

 After local anesthesia, the length of tooth No. 10 was enhanced using an all-tissue 

 with soft tissue settings of 2 watts/20% water/20% air.

Bisacryl Luxatemp Ultra B1 material (DMG America)

 with an embedded custom cut and resin-coated strip of 3 mm wide 

 that added structural reinforcement to prevent cracks from propagating.

After full curing of the restoration, it was shaped and equilibrated. Some excess material was cut back facially to allow for layering of 

GRADIA® gum shades composite material (GC America)

Using GRADIA Pink instructions from the manufacturer,3 we roughened the resin surface by sandblasting with 27 micron aluminum oxide using a 

 After full curing of the restoration, it was shaped and equilibrated. Some excess material was cut back facially to allow for layering of GRADIA® gum shades composite material (GC America).

 was placed on the roughened surface to wet the Bisacryl and promote adhesion and was light cured for one minute. Finally, two colors were layered anatomically and separately onto the surface. The initial application (shade G23) was placed more apically and corresponds to a darker, unattached gingival tissue. The final layer (shade G21) was blended into the G23 and sculpted to match adjacent attached gingiva.

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 Unfilled resin helped the application of this material. This was smoothed and shaped to mirror the corresponding anatomy including the papillae.

 The tooth portion of the restoration was tinted with a thin layer of ochre shade to blend with enamel on tooth No. 9 using 

 The provisional was completely sealed with

 to enhance physical and optical durability. Afterward, it was carefully cemented using 

, which contains fluoride, potassium nitrate and chlorhexidine for pulpal protection.

 Following this procedure, the incisal edges, which had been worn down from excessive function, were enhanced to promote better esthetics. Given that this was an additive technique, light beveling of the enamel surface was followed by Prepstart microabrasion (rinsed by 

) and 37 percent phosphoric acid (washed thoroughly away by water and lightly dried to allow some moisture with no desiccation of the surface). Placement of a multipurpose resin and curing for a minimum of 30 seconds will help prime the surface for the restorative material.

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Using a compule delivery system, small amounts of shade BW 

 were applied and sculpted to add a more youthful look to the central incisors and help the incisal plane coincide better with lips and face.

 After polishing with multifluted carbide finishing burs, as well as abrasive discs and aluminum oxide paste, the patient was very pleased with her rejuvenated appearance.

 After taking a CBCT of the area, it was easy for the periodontist to visualize the “triangle of bone” and collaborate with us and our patient on the implant position relative to the ideally placed pontic on the provisional bridge and the need for osseous/soft tissue augmentation.4
	Phases three and four have yet to be completed. This may take another 12 months due the necessity of optimized healing from grafting and implant surgery before the restorative phase can begin. Fortunately, the patient will be able to feel comfortable with her appearance.


	Careful treatment planning of complex cases requires a collaborative approach that allows the interdisciplinary team to share information and create optimized results by not only sharing information to blueprint plans for excellence but also to allow the patient to participate in his or her care. When there are esthetic considerations, having input from specialists, lab technicians and the patient will allow the team to move forward in tandem so everyone is on the same page. Using transitional bonding offers a modality to conservatively communicate esthetic goals, test drive the blueprint and give the patient a chance to enjoy a nicer appearance during multiple phases of care that often take many months to complete. Fortunately, we have a wide palette of colors to customize and balance pink and white considerations.
	 

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 since 1994 and became accredited in 1997. He was president of the Atlanta Chapter of the AACD (1996-1998) and founded the 

 in 2007. Dr. Flax served for two years as cochair of the Conference Advisory Committee for 2003 AACD Scientific Session in Orlando. He has been the chairman of the AACD Private Education Advisory Council, the 2008 AACD Meeting and the 2010 AACD European Meeting. He was a member of the AACD Board of Directors for more than eight years. Outside of the AACD, Dr. Flax is a member of the 

 and a fellow of both the International Academy of Dentofacial Therapeutics and ICOI. Dr. Flax practices full time in Atlanta, focusing on functional appearance-related conditions and advanced laser dentistry, as well as writing and lecturing on helping others do the same for their own practices. In 2003, he was 

’s expert on cosmetic dentistry and also appeared on 

. He has been the expert dentist on the “Meet the Products” television show and 

. Lastly, he and his practice have been featured in many women’s magazines.

 The growth of multiple options to serve patients’ esthetic and functional needs and desires requires mastery of disciplines that usually necessitate a coordinated and collaborative team approach with multiple specialties.

How to use transitional bonding for interdisciplinary care

	I can’t help but speculate that the aversion to performing a feasibility study is as much emotional as it is financial. Clearly, there is a cost factor that may dissuade the fiscally faint of heart-despite its proven worth.

However, my perception is that a feasibility study evokes the emotional equivalent to that of having a colonoscopy. Interestingly, they both produce valuable insight to preventable conditions. So I will temporarily deem the invaluable “feasibility” service to be a “projectoscopy” in an effort to make a point.

To date, the preponderance of my perseveration regarding “projectoscopies” has concentrated on the costs and savings associated with construction, site development and purchase/lease agreements. However, the emphasis of this article is function and usable space.

Survey: What you said matters most when it comes to dental office design

We were asked to design a satellite office for an OB/GYN* practice for which we had designed three other offices. The history is noteworthy because we had gained the confidence of the practitioners to act on their behalf and perform the necessary preplanning due diligence – or “projectoscopy.” Previous projects with this client heightened their awareness regarding the value of this exercise. Their faith in our ability to ferret out mitigating factors was particularly significant because the project was for a suite in a new, yet-to-be-built building-and they had already committed to lease the space. Under similar circumstances, the requisite response former clients have expressed could be paraphrased as, “I don’t need no stinkin’ feasibility study.” “It’s a brand new building. What could go wrong?” The fact is, much!

Logically, by all expectations, there shouldn’t be any issues with a new building. But, as it turns out, there were many. For the sake of focus, I will limit the review to the physical plant and the available space.

The architectural firm that designed the building provided the plans of the subject suite to us. Upon review, we noted that, in addition to the “horseshoe” configuration imposed by the stairwells, lobby and elevator hoistway at the front and rear entrances, the center core of the suite was profoundly encumbered by structural columns, two separate HVAC supply/return ducts and a roof-access ladder.

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The collective impositions created two factors:                                                                                                      
	1. The usable space, which is calculated by perimeter measurement, did not account for the losses associated with the noted internal obstructions. Additionally, it was determined the advertised square footage of the suite referred to “leasable” space, not “usable” space.  Although this is standard practice, in accordance with 

BOMA (Building Owners and Managers Association)

 I can’t help but speculate that the aversion to performing a feasibility study is as much emotional as it is financial. Clearly, there is a cost factor that may dissuade the fiscally faint of heart-despite its proven worth.

Dental Products Report-2015-03-01

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How to use transitional bonding for interdisciplinary care

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