Catalyst Q2 2018 by Burkhart Dental Supply

Spring/Summer | 2018

INCREASED PRODUCTION BY 48%

GOING DIGITAL IS A BEAUTIFUL THING DR. ALEX TOUCHSTONE TALKS ABOUT HIS DIGITAL JOURNEY

TAKING ROUTINE CASES AND MAKING THEM QUICKER AND EASIER DEVICES TO TAKE YOUR PRACTICE TO THE NEXT LEVEL

THE DIGITAL DENTISTRY DIVIDE THE TIME TO CROSS OVER IS NOW

An innovation so big it fits in your hands. Introducing the 3M™ Mobile True Definition Scanner. The first mobile intraoral scanner that operates solely on a tablet.

3M™ True Definition Scanner Now available in mobile or cart editions. Choose the digital scanner that fits your practice.

3M.com/TrueDef

For more information, please contact your Burkhart Account Manager or call Customer Service at 800.562.8176.

NEW!

A LITTLE GIVE

GOES

A LONG WAY A New Standard in Patient Comfort Introducing the DEXIS FS Ergo by KaVo—the latest innovation to redefine comfort. By pairing the newly developed flexible sensor technology with a soft housing, FS Ergo can “give” as X-rays are being captured. Imagine a digital sensor that gently cushions your patient’s sensitive anatomy—a new standard in patient comfort.

Feel the difference yourself: dexis.com/fs-ergo

1-888-883-3947 www.dexis.com

The DEXIS FS Ergo is designed to adapt and reduce pressure on contact points in the oral cavity to provide a very comfortable experience for your patient. This happens automatically when the sensor is positioned into a patient’s mouth. Bending outside of clinical use can reduce the life of the sensor. KV00246_RevA

Accomplish more with complete implant workflow using one software

The easiest path from 3D imaging to implants - Planmeca Romexis® Your workflow just got easier with Planmeca Romexis® software. Create your implant guide with a few simple clicks. Place with confidence.

Get all the info at

www.planmeca.com/na/Software PLANMECA USA, Inc. | 100 N. Gary Ave, Roselle, IL 60172 | (630) 529-2300 | www.planmecausa.com

FEATURE

TABLE OF CONTENTS

INCREASED PRODUCTION BY 48%: GOING DIGITAL IS A BEAUTIFUL THING DR. ALEX TOUCHSTONE IN HATTIESBURG, MISSISSIPPI

BY CARRIE DAVIS, PHOTOS BY JOHN LESTRADA

Investing In Your Practice: Tips from our experts

The Dentistry Divide: Traditional vs. Digital

DR. ALEX TOUCHSTONE

BY CARRIE DAVIS, PHOTOS BY JOHN LESTRADA

THE DIGITAL DENTISTRY DIVIDE BY DOUG FETTIG, CPA, MBA OF ALDRICH CPAS + ADVISORS

ARE YOU READY TO SAVE?

BY TIFFANY INGRAM, VIP SMILES OFFICE MANAGER

TAKING ROUTINE CASES AND MAKING THEM QUICKER AND EASIER

BY MICHAEL KELLIHER, DMD

INVESTING IN YOUR PRACTICE: TIPS FROM OUR EXPERTS BY SAM MARTIN, MBA (TAX), CFPÂ®, CPA

ADVERTISERS:

BURKHART BELIEVES IN GIVING BACK BY DELENE LOSCH

3M................................. INSIDE FRONT

DEXIS........................................... 1, 34

ACCUTRON....................................... 31

I-CAT................................... BACK COVER

ACTEON.......................................... 11

KAVO.................................................... 26

A-DEC........................................ 20-21

NSK................................................. 12

AIR TECHNIQUES............................ 17

PLANMECA............................................ 2

ALDRICH ADVISORS..........................17

PREXION............................................... 27

BURKHART........................................13

SCICAN.............................................. 3

DENTAL GROUP LLC......................... 31

VATECH.............................INSIDE BACK

DIGITAL DOC.................................... 30 CATALYST MAGAZINE // SPRING/SUMMER, 2018 // 3

SERVING THE DENTAL PROFESSION SINCE 1888

FROM THE

President

urkhart is passionate about providing exceptional service for our clients. We aim to identify each clientâ&#x20AC;&#x2122;s unique needs along with their personal and professional goals. We strive to provide helpful information, skilled service, and specific products. We earnestly work in the best interest of others because at the end of the day, thatâ&#x20AC;&#x2122;s what makes our work most satisfying. Passion is not a virtue developed overnight. Since 1888, Burkhart has worked to make sure every service we provide, in some way, improves the career or life of our clients. Many of the services we provide help free up our clients from smaller day-to-day tasks and allow them to focus on their top priorities. Some of those services include managing inventory, controlling supply costs, and making sure digital equipment and software work well together. We focus on one central goal, providing the best client experiences. Staying focused is what makes us efficient, knowledgeable, and current in the marketplace.

Lori Burkhart Isbell President

4 // BURKHART DENTAL SUPPLY

At Burkhart we realize our clients are both dental professionals and business owners. It is our goal to help them be successful at both. Catalyst is fully dedicated to that success. The articles in this publication vary from product use and selection to business management topics and provide information and guidance that can lead to a more successful practice. Throughout the publication are stories of Burkhart clients who have succeeded in the areas highlighted. We hope you enjoy!

If you have a request for a topic you would like for us to cover in Catalyst, please contact Sara Wisely at: swisely@burkhartdental.com Catalyst Magazine is published by:

BURKHART DENTAL SUPPLY 2502 South 78 th Street Tacoma, WA 98409 p) 253.474.7761 f) 253.472.4773

DESIGNER Sara Wisely

ADVERTISING

Melissa Gill mgill@burkhartdental.com 253.212.4874 All rights reserved. Reproduction of any part of this publication without written permission from the Publisher is strictly forbidden. Images are not necessarily to scale.

Customer Service:

800.562.8176

My WiFi is connected. My water is good. My cassette is not pushed all the way in. Just sayin’ :-)

Fast, Gentle, Reliable. And Now Smart. STATIM G4 Cassette Autoclaves. STATIM® is the world’s fastest cassette autoclave from start to sterile™, gentle on your instruments due to its patented steam process and relied upon by the busiest of practices. G4 Technology, now WiFi enabled, automatically records, monitors and helps troubleshoot every cycle 24/7 so you can operate with the utmost efficiency. It detects human or mechanical error before it costs you time and money.

The future of sterilization is at www.scican.com/STATIMG4 Sends data to any device. scican.com

STATIM is a registered trademark and from start to sterile and Your Infection Control Specialist are trademarks of SciCan Ltd.

SciCa

INCREASED PRODUCTION BY DIGITAL IS % GOING A BEAUTIFUL THING

An Interview with Dr. Alex Touchstone, D.D.S.

BY CARRIE DAVIS | PHOTOS BY JOHN LESTRADA

Helping you Weigh the Benefits of Going Digital

s an early adopter of Computer Aided Design (CAD/CAM), Dr. Alex Touchstone has been instrumental in the development and use of dental technology and holds several patents for advances he has made in the production of replacement teeth.

6 // BURKHART DENTAL SUPPLY

Dr. Touchstone shares how adding a Cone Beam (CBCT) to his practice increased production numbers by 48%. Now thatâ&#x20AC;&#x2122;s impressive! Clearly, he made strategic decisions to experience that magnitude of growth. Learn how incorporating digital dentistry can help grow your practice too.

Q: We understand you’ve had great success integrating CBCT into your practice; what other technology has been key for your growth and success? A: Six months out of dental school, I invested in CAD/CAM technology for my newly formed practice. It was ambitious at the time, but it was one of the best decisions I made—and I’ve never looked back. I can’t imagine having to work without this and other emerging technology that have radically streamlined my practice, workflow, and business processes.

Q: Where should one start if they are considering investing in digital technology for their practice? A: In the beginning, there’s a “decision tree” driven by a series of questions and answers:

• • •

What procedures am I doing today?

•

How many restorations am I currently doing; would I like this to increase?

•

Would I like to increase the number of other high-value inoffice procedures?

•

What other procedures would I like to add in my practice (implants, sleep, etc.)?

• • •

How many “return” treatment visits do I have each month?

SO WHAT ARE MY OPTIONS? Applying Dr. Touchstone’s “decision tree” approach should reveal areas worthy of investment. There are many ways to improve your current patients’ level of care while attracting patients in search of higher-value procedures. Here are a few investments to consider:

1 2 3

Am I looking to increase my patient base? What areas would l like to be more efficient; can chairside time be reduced?

How much is my current lab bill?

4 5 6

INTRAORAL CAMERA—digital, handheld camera that allows patients a detailed view of their oral condition HANDHELD X-RAY—lightweight, wireless, portable handheld x-ray unit with radiation shield INTRAORAL SENSORS—chairside, industryleading images allowing customization for operatory adaptability INTRAORAL SCANNER—provides a fast detailed color 3D digital impression, making it easier to communicate with both your patient and lab CAD/CAM—same day, fully-integrated, in-office restoration that extends longevity and is highly accurate CONE BEAM—3D imaging offering a clear view of the patient’s teeth, soft-tissues, nerve pathways and bone

What should I invest in?

CATALYST MAGAZINE // SPRING/SUMMER, 2018 // 7

Planmeca ProMax Mid Unit

Q: How much of a role does training play in adding new technology? A: It’s critical. First, you must have an in-office technology leader. A team member that is excited to lead the way and is comfortable being trained—and extending that knowledge to the rest of the team. It’s common for it to take roughly six months for the entire team to feel fully confident in newly added technology.

Learning can be intimidating, especially if staff does not feel tech savvy. With the right training in place—and these key considerations—any office can make a healthy transition. • Choosing the best equipment for the desired feature set • Quality of brand/manufacturer • Availability of product, training and service maintenance • Relationship with your dental supplier

In addition to manufacturer or dealer training, there are some exciting online training resources readily available. There are extremely effective closed Facebook groups where dentists can get immediate responses from experts all over the world. 8 // BURKHART DENTAL SUPPLY

CONE BEAM BENEFITS Just so it’s front-of-mind, let’s go over a few things a Cone Beam specifically has to offer.

1 2 3 4 5 6

IMPLANT DENTISTRY—allows an undistorted view of crucial structures ENDODONTICS—provides an incredibly accurate and precise view of endodontic pathology PERIODONTICS—reveals three-dimensional views of bone levels ORTHODONTICS—allows the creation of cephalometric reconstructions ORAL SURGERY—removes the guesswork, revealing the inferior alveolar nerve AIRWAY—offers insight to diagnose sleep and other airway conditions

MAKING TRAINING EASY At Burkhart, we fully agree with Dr. Touchstone and pride ourselves in connecting clients with valuable training resources. Dr. Touchstone offers extensive and practical insight at LearnDigitalDentistry.com

Planmeca Sovereign Classic CATALYST MAGAZINE // SPRING/SUMMER, 2018 // 9

Q: Does marketing play a part in transitioning a practice to digital technology? A: Absolutely, it must be woven into your value proposition. Patients need to understand the value you place on their care and the investment you’re making to ensure they have the best outcome. It’s not about marketing the technology as much as it is marketing the benefit to the patient. Key areas to focus on are same-day dentistry, quick and painless procedures, preventative measures and full-transparency— where the patient is able to make an educated decision about their treatment plan.

Q: At the end of the day, is transitioning to digital technology really worth the investment of time and money? A: It’s not a matter of if you need it, it’s a matter of when you need it. Investing in digital dentistry is always a good thing, and if you utilize the filters provided in this article, you should be confident about which areas need to be addressed now and which ones can come later. As stated earlier, simply adding and promoting CBCT to my practice increased productivity by 48%. Digital dentistry offers: • A high-level, more accurate diagnosis • Higher treatment acceptance

DR. ALEX TOUCHSTONE

• Increased production

Dr. Alex Touchstone has been a dentist for over 20 years, operating a private practice serving Hattiesburg, Mississippi, developing a reputation as one of the world’s leading experts on advanced computer-enabled digital dental technology.

• Streamlined workflow • Time savings and efficiencies • More complex treatment offerings • High-quality, long-lasting treatments • Greatly reduced lab costs • Predictable scheduling • Patient trust

There’s nothing better than hearing your patients say, “You mean, I don’t have to come back?” Trust is key. Every day I’m challenged to become better and watch how my investment in technology helps my patients while creating an environment where my staff and I are constantly learning and growing. I can’t imagine ever running out of things to learn… and that’s a beautiful thing!”

Contact your Burkhart Account Manager to weigh your digital options today! 10 // BURKHART DENTAL SUPPLY

As an early adopter of Computer Aided Design (CAD/ CAM), he has been instrumental in the development and use of dental technology and holds several patents for advances he has made in the production of replacement teeth. Teaching other dentists has resulted in Dr. Touchstone being recognized as one of the world’s foremost educators in digital dentistry. Today, he teaches hundreds of dentists every year how they can use this technology to improve their patients’ lives. He is the author and administrator of LearnDigitalDentistry.com, an interactive web portal and forum for the dental community.

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1.800.562.8176 | www.BurkhartDental.com

The Dentistry Divide

TRADITIONAL vs.

DIGITAL Now is the Time to Invest BY DOUG FETTIG, CPA, MB, DENTAL BUSINESS CONSULTANT, ALDRICH CPAS + ADVISORS

“Your life does not get better by chance, it gets better by change.” – Jim Rohn Spoiler alert…Substitute “dental practice” in place of “life” in the quote above, and the theme of this article has just conveniently summarized.

Are you practicing dentistry using the same techniques you did ten to twenty years ago?

Just as technology continues to change every aspect of the world around us, it has, and will continue to revolutionize the dental world and improve dental care. The first step to crossing the digital dentistry divide is to embrace this non-negotiable fact. Before we discuss the benefits of taking the leap to digital, let’s make sure we are working from the same definition.

WHAT IS DIGITAL DENTISTRY?

Do you expect to be practicing dentistry in an identical manner ten to twenty years in the future?

Any dental technology or device that incorporates digital or computer-controlled components, for both restorative and diagnostic purposes in contrast to utilizing mechanical or electrical components alone.

ADVANTAGE OF DIGITAL DENTISTRY EFFICIENT

A more streamlined process while increasing the efficient use of resources in terms of time and cost.

14 // BURKHART DENTAL SUPPLY

ACCURATE

More precise diagnoses and treatment; removes expensive rework, saving time and money.

VALUE / PATIENT EXPERIENCE

Improved outcomes requiring fewer patient visits which enhances the patient’s perception of care.

HOW DENTISTRY HAS GONE DIGITAL

WHY GO DIGITAL Becoming the accepted (and eventually legal standard of care

CAD/CAM and intraoral imaging, both laboratory and clinician-controlled Photogrammetry-based intraoral scanning (software-driven) caries diagnosis

Ease of use procedures with increased efficiency and accuracy

Computer-aided implant dentistry, including design and fabrication of surgical guides

Offers measurable ROI (return on investment)

Digital radiography, intraoral/extraoral, along with cone beam computed tomography (CBCT)

Adds an element of excitement, creating new drive and refreshed happiness in a practice

Electric and surgical implant handpieces

Provides higher quality of care for patients

Occlusion and TMJ analysis and diagnosis

If embraced and relevant, the value of the practice is positively impacted when time to sell

Photography, extraoral/intraoral Soft and hard tissue lasers Practice and patient record management, including digital patient education Shade matching

YOU CAN’T COST CUT YOUR WAY TO PROSPERITY I often talk to dentists who focus on overhead percentages and expenses when looking to increase profitability. While these things are important, remember, you can’t cost cut your way to prosperity!

QUESTIONS TO ASK…

The best way to control/lower overhead percentages is to significantly increase production. Increasing top line numbers without corresponding increases in overhead and expenses translates to financial benefits. Digital dentistry accomplishes this goal for you.

Will my team embrace and utilize it?

Are we willing to dedicate the necessary time and effort needed to learn new technology and continue advancing?

If now is not the right time for me to embrace digital dentistry… then when?

“Change is inevitable. Progress is optional.” – Tony Robbins

MORE PROCEDURES IN THE SAME AMOUNT OF TIME

GREATER PRODUCTION PER HOUR

INCREASING PRODUCTION AND DOING LESS REWORK

HIGHER PROFITABILITY

SAVING YOUR PATIENT TIME, REDUCING INCONVENIENCES

INCREASED PERCEPTION OF VALUE AND CASE ACCEPTANCE

CATALYST MAGAZINE // SPRING/SUMMER, 2018 // 15

THE MOST COMMON MISTAKES WHEN GOING DIGITAL FAILURE to excite the dental team about new technology FAILURE to provide robust training A lack of quality training leads to frustration on how to operate the technology, increasing failure rates, lowering usage rates and slowing overall adoption by your team.

ADOPT A GROWTH MENTALITY If the goal is to maximize practice profitability, here’s how you can crunch the numbers…

INCOME NUMBER OF PATIENTS

INCOME PER PATIENT

EXPENSES

If you focus on income growth drivers and increase the number of patients, procedures per patient and fee for procedure, you can significantly increase your profitability. Digital dentistry accomplishes this, allowing you to offer higher value dentistry in less time. Since time is not a commodity you can create, your only option is to increase production per hour. This significantly increases the relation between expenses and overhead and places you on your path to longterm growth and prosperity.

VARIABLE

FIXED

NET PROFIT INCOME

EXPENSES

I want to give you a few examples of potential increases in collections and net income that can be achieved. The charts below show the results from several practices we work with, before and after two years as a result of their conversion to digital—including CAD/CAM and cone beam (CBCT) technology. You can’t dip your toe into the digital dentistry pool, you must dive in head first!

BEFORE & AFTER DIGITAL DENTISTRY NET COLLECTION

A dentist will often say to me, “I can’t go digital, my CPA said it’s not in the budget.” How can growing your business and becoming more profitable not be in the budget? This leads me to think your CPA may not be a dental specialist. A specialized dental CPA will assess the cost of equipment, the payment terms, the expected increase in production, and cash flow—as well as the overall impact on profitability when making a recommendation.

Practice A

Before Purchase $1,295,000

After Purchase

% Increase

$1,633,000

28%

$982,000

$1,885,000

92%

$1,999,000

$2,593,000

30%

BEFORE & AFTER DIGITAL DENTISTRY NET INCOME Practice A

Before Purchase $476,000

After Purchase

% Increase

$850,000

79%

$266,000

$465,000

75%

$598,000

$908,000

52%

D o ug Fe t t ig , C PA , M B A Dental Business Consultant, Aldrich CPAs + Advisors Doug has over two decades of experience as a CPA and a finance professional, providing him the unique ability to understand dentists’ needs and help them grow efficient and profitable practices. His insight allows him to effectively collaborate and communicate business concepts to dental practices while strategically addressing tax, investment and retirement planning needs. “Here’s a little tip to impress your friends at the next cocktail party; the “Godfather” of digital dentistry is French Professor Francois Duret. He invented the CAD/CAM in 1973! So for those considering going digital, they’ve had 45 years to work out the kinks.” – Doug Fettig

16 // BURKHART DENTAL SUPPLY

“If your dreams do not scare you, they are not big enough.” —Ellen Johnson Sirleaf (first elected female Head of State in Africa)

WHO WINS WITH DIGITAL? At the end of the day, dentistry will be digital. It’s just a matter of time. The wonderful thing is, this shift produces two sets of “winners”: your patients and your practice!

Own Your Practice, Own Your Future Tax Planning + Advisory Services Cost Segregation Practice Purchase + Transitions Strategic Business Planning Retirement Planning Wealth Management

www.aldrichadvisors.com

SEE THINGS IN A DIFFERENT LIGHT Cam -

Intra, Extraoral & Macro Images in Real HD Quality

Spectra -

Reliably Detect Caries & Plaque

For more information, to schedule a demo, or to place an order, contact your local Burkhart Dental representative. To learn more, visit www.airtechniques.com

Proxi -

Reliably Detect Interproximal Caries

SUPPLY SAVINGS GUARANTEE:

ARE YOU READY TO SAVE

Quality Care Paired with Cost Savings allows a Dental Practice to Flourish through The Supply Savings Guarantee Program BY TIFFANY INGRAM OFFICE MANAGER, VIP SMILES

We consider Ann a valuable member of our team and are so grateful for her tireless work on our behalf; she is always there for us.

iffany Ingram, VIP Smiles’ Office Manager shares: “After communication issues with our previous supplier, we decided to work with Burkhart Dental Supply. Dr. Shad Ingram met Ann Arrington, our Burkhart Account Manger, through an outside connection. He was impressed with her and the Supply Savings Guarantee (SSG) program Burkhart offers, and asked her to come by our office to explore them further. She presented opportunities successful with other clients while allowing us to maintain our preferences in areas we believed remained the best fit for our office.

A few areas where she brings real value are:

The combination of working with Ann and getting comparable or lower prices with guaranteed savings was very risk-free and appealing, so we decided to give it a shot.

We are happy to say, since partnering with Burkhart—and with Ann’s help— our supplies have become very organized, which has relived Dental Assistant "hording." She set up a new tagging system and updates tags with every order which has helped us successfully reduce our supply costs.

THE IMPACT OF A GREAT ACCOUNT MANAGER We really appreciate the quarterly updates Ann provides which allows us to track our costs and savings. It’s great we don’t have to ask for it, wait for six months to finally get it, or even have to think about it in the first place. We always know where we stand with our supply costs through the SSG program, which is extremely comforting. Working with Ann is AMAZING! We have worked with several reps in the past and experienced all the extremes that come with it; she was definitely a key factor when we decided to switch to Burkhart.

18 // BURKHART DENTAL SUPPLY

• Helping keep our costs low— not overstocking or understocking • Keeping us aware of new products that also help with costs, efficiency and time • Following up on requests, even informally or in passing • Sharing endless research on topics we just don't have time for • Informing us about CE that could be beneficial to our office efficiency and production

An Account Manager… No—a GREAT Account Manager—must be a team player, it’s essential. They should be able to make strong recommendations to ensure your office is up-to-date with digital technology equipment while helping prevent things slipping through the cracks. It’s also important they kindly allow you the freedom to discuss challenges or concerns. Ann is the definition of a GREAT Account Manager, and we appreciate her support in areas outside of managing our

supplies. For example, she brought in implant trainers to help us expand our patient services, an offering we wanted to add to our practice. She has also scheduled maintenance training for our team to help reduce costs. We consider Ann a valuable member of our team and are so grateful for her tireless work on our behalf; she is always there for us.

LEFT TO RIGHT: Tiffany Ingram, Dr. Rick Ingram, Dr. Shad Ingram, Ann Arrington

We can't express our appreciation enough. We had a bad experience with a previous rep from another supplier. So much of our time was dedicated to managing another company’s employee. It didn't seem right, and we are grateful we were able to find someone who’s as committed to doing a great job for her clients as we strive to do for our patients.

VIP SMILES, BURKHART SUPPLY SAVINGS GUARANTEE CLIENT

I also need to give a shout out to Scott Orris, our Burkhart Service Technician. Equipment maintenance costs can be paralyzing to a dental office. He is so helpful and we appreciate that he allows us to do what we can—and if things are above and beyond our current means, he is ready and willing when we’re ready. He is kind and easy to talk to, never getting frustrated with our many questions.”

A MESSAGE FROM ANN ARRINGTON

Dr. Clive Ingram opened his third practice, VIP Smiles in 2000 with the hope his sons would join him. This came to pass as brothers, Shad and Richard Ingram both opted to begin their careers at VIP Smiles upon graduation in 2005 and 2006. Dr. Clive has since retired and about five years ago Dr. Shad Ingram and Dr. Richard Ingram became co-owners of the practice.

Burkhart Account Manager, Salt Lake City, Utah Branch Thank you Tiffany for your kind words. I’m grateful you’re able to experience the value I and my Burkhart team strive to bring to your practice. Tiffany, VIP Smiles’ Office Manager, really keeps the practice running smoothly. Each week as I visit their office, I’m impressed with both her leadership and organizational skills. She is always eager to learn and open to new ideas. She and I get along famously because she’s a great communicator. It’s a team effort and I love being a part of their team!

CATALYST MAGAZINE // SPRING/SUMMER, 2018 // 19

WHEN YOUR EQUIPMENT WORKS TOGETHER EFFICIENTLY, SO DOES YOUR TEAM. Dental equipment is the core of the operatory. And with that, it’s important to consider how comfort, aesthetics, and efficiency come into play. Everything about your operatory setup affects the workflow, physical comfort and mood of you and your team, which in the end, impacts productivity. One solution does not fit all. Your operatory should reflect the way you work, and the processes you follow. So, as you design your treatment rooms, keep these three important attributes in mind. And remember, a few small adjustments in the vital areas of ergonomics, environment and workflow, can impact your bottom line—and make for a happy staff.

WORKFLOW Purposeful. Intuitive. Efficient. With integrated equipment and task-based furniture design, your team can move intuitively and seamlessly between procedures.

ERGONOMICS

ENVIRONMENT

Moveable. Adjustable. Comfortable. When everything is easy to position and within reach, you can minimize the toll on your body, and maximize your time out of the office.

Inviting. Modern. Calm. An aesthetically pleasing office that reflects your level of professionalism and care instills confidence in patients, and keeps dental staff productive. That’s practice perfected.

Learn how the dental equipment you choose makes all the difference. Download your “What to Look For When Buying Dental Equipment” guide at a-dec.com/confidence.

your

by A-dec

TAKING ROUTINE CASES AND MAKING THEM

QUICKER AND EASIER BY MICHAEL KELLIHER, DMD

hen evaluating new technology for our office, I’ll look at several factors to decide if it’s something I will invest in. Will this technology help me do things I do now better or faster? Can this technology allow me to do any additional procedures? And how will this technology improve the patient experience? We have incorporated two significant advances to our office recently that help in all three regards: the Planmeca Emerald scanner and Planmeca PlanCAD Easy version 5.9 (Planmeca). The Planmeca Emerald is the nextgeneration intraoral scanner that features a much faster scan time, native color through the use of a 3 laser acquisition and is a very light, ergonomic device (Fig. 1). The improved scan speed has allowed us to much more easily scan routine restorative cases, which have helped us complete cases in a more efficient manner. Also because of the fast scan speed, we have found that scanning full arches is extremely practical, so we are now using the Planmeca

Fig. 1: The Planmeca Emerald intraoral scanner. (Photo/ Provided by Planmeca)

22 // BURKHART DENTAL SUPPLY

Emerald to scan for things such as night guards rather than taking a physical impression, which is a nice benefit for our patients (Figs. 2, 3). Crucial to any scanner is, of course, software. Version 5.9 has many useful features, two of which we have been finding extremely helpful. First, the buccal bite has been revamped for this version, allowing the user to scan two bite registrations to more accurately align the models. This combined with the ability to refine the bite automatically has made accurate articulation of full-arch models simple and predictable (Figs. 4, 5). A second addition to version 5.9 that we are finding very useful is the ability to see what the clearance between prep and opposing is. One of the things I see users struggle with is design when they don’t have proper reduction. When the clearance is tight, design becomes a bigger challenge because you need to balance material thickness and proper occlusion, which can be time consuming. This feature makes it very easy

Fig. 3

Fig. 2

to see if there are clearance issues, allowing the user to make a prep modification prior to proceeding to the restoration (Fig. 6). Routine restorative is what the vast majority of dentists primarily use in office CAD/CAM systems. The combination of the Planmeca Emerald scanner and the updates in version 5.9 have made our bread-and-butter cases easier, faster, and more predictable. Here is a recent case completed in our office. A patient presented with a chief complaint of a fractured tooth on the lower left. Exam revealed a cusp fracture of tooth #18 with a large existing resin filling. Treatment of choice was to crown the tooth (Fig. 7).

Fig. 4

Fig. 5

Fig. 6

Fig. 7

After local anesthesia (Septocaine, Septodont), a rubber dam was placed. I find use of a rubber dam for the initial preparation is very helpful, especially on lower molars, allowing me to more easily and quickly complete the bulk of the prep (Fig. 8). Once the majority of the prep is completed, the dam is removed and first size 0 retraction cord is placed (Ultradent). Preparation is refined and a second size 2 retraction cord is placed. Cord is left in place for at least five minutes to allow for adequate tissue retraction.

Figs. 2, 3: Full-arch models. (Photos/Provided by Dr. Kelliher) Fig. 4: Bite refinement. Fig. 5: Properly aligned models. Fig. 6: Clearance indicator. Fig. 7: Initial presentation.

The opposing arch is scanned while the cord is in place to help expedite the workflow. After five minutes, the size 2 cord is removed and the prep CATALYST MAGAZINE // SPRING/SUMMER, 2018 // 23

Fig. 8

Fig. 9

Fig. 10

Fig. 11

Fig. 8: Initial prep. Fig. 9: Planmeca Emerald scan and prep. Fig. 10: Heat map of bite. Fig. 11: Plan with bite in place.

side arch is scanned with the Planmeca Emerald scanner (Fig. 9). We will leave the size 0 cord in place until the crown is cemented. This helps to keep the fluid from seeping from the sulcus during cementation as well as preventing any cement from being pushed deep subgingival. Next the buccal bite is scanned. In version 5.9, you begin by scanning the upper arch and scanning until the upper model pops onto the bite. Normally for the upper you will only need to scan the upper molar. We proceed to the lower scanning units until the lower arch pops, which does require scanning several teeth. As always, we will confirm the models have articulated correctly by opening the bite window and examining the articulation. We now have a heat map bite representation that allows the user to easily see if the articulation is accurate (Fig. 10). If it appears the bite is over closed, refinement of the bite can be accomplished by going to the buccal bite scan and clicking the bite refinement button, which will fine-tune the articulation of the models. Itâ&#x20AC;&#x2122;s a good idea also to check the clearance at this point. If the software detects close clearance, you will see a colored indicator in the area where the software is detecting potential issue. Moving the cursor around inside the prep will give a measurement of the clearance. This can be very helpful, and if there is a tight spot on the prep, the user will see exactly where the concern is and may

24 // BURKHART DENTAL SUPPLY

then go back and adjust the prep if needed. The model is oriented and margins are marked in the usual manner. The color model produced by the Planmeca Emerald is helpful in identifying the margins. Utilizing the Plan Tab, the proposal is resized, rotated and placed on the model (Fig. 11). This helps autogenesis provide a more accurate initial restoration design. My goal is to minimize the amount of time spent on design. Basic idea: The less you have to modify the library tooth, the better. If the plan step is done well normally, we find you will not need to use the incremental change tools at all and can make any needed modification with the freeform change tools (Fig. 12). When I design a case, I will first use rubber tooth to fill out any contours on the facial and lingual, adjust the bite and marginal ridges and broaden the proximal contacts as needed. Last step in design is to check the proximal contacts and adjust as needed using the smoother or dropper tool. Minimizing the tool set I use helps me to complete a design quickly and efficiently (Fig. 13). The design was sent to the Planmeca PlanMill 40 (Planmeca), and an IPS e.max MT block shade A2 (Ivoclar) was milled. The restoration was tried in after milling and found to need no adjustments to the occlusion or contact. I like to try the restoration in prior to crystallization for two

Fig. 12

Fig. 14

Fig. 12: Initial design proposal. Fig. 13: Completed design. Fig. 14: The final restoration. Fig. 13 reasons. First, it is easier to adjust the material if needed in the purple stage, and second, there will be no need to republish the restoration if the final contacts are perfected prior to crystallization. Stain was placed on the buccal and occlusal surfaces and a spray glaze was applied (InSync Jensen Dental). The restoration was crystalized on the speed crystal cycle using a Programat CS oven (Ivoclar). Once the restoration was cooled, the internal aspects of the ceramic were etched with 5 percent hydrofluoric acid for 20 seconds, and monobond (Ivoclar) was applied for one minute prior to air drying. The tooth was isolated and oil and debris cleaned from the prep using Clean and Boost (Apex Dental Materials). Tooth was rinsed and dried prior to application of all three components of Surpass dental adhesive (Apex Dental Materials) per manufacturerâ&#x20AC;&#x2122;s directions. The restoration was loaded with Variolink Esthetic neutral and seated. The restoration was exposed at each corner for one second with a Valo light (Ultradent) to gel the excess. Variolink esthetic has a very nice gel set stage, which makes cleaning up the excess very easy. Excess resin was removed with an explorer and floss. The restoration was then cured for a total of 30 seconds using the Valo light on high power setting. The initial retraction cord was then removed and the restoration checked for any

remaining cement. A final check on the occlusion was done and the patient was dismissed (Fig. 14). This case presented some unique challenges because of the edentulous space immediately anterior to the restoration as well as the presence of a rotated #17. Being able to scan quickly made it very simple to scan additional teeth anterior to the edentulous area as well as acquire more of the upper quadrant to allow the software to align the bite. This was more time consuming in the past. In cases like these, the Plan Tab is also a very helpful feature, allowing the user to easily resize and place the library tooth in the proper orientation, which yielded an initial proposal that required very little modification. Prior to the introduction of the Plan Tab being available, a restoration like this tended to take quite a bit of time to design. The combination of the Planmeca Emerald and Planmeca PlanCAD easy version 5.9 have helped our office do the routine cases more quickly and easily. We also are now able to routinely scan full arches, which have allowed us to do more and more procedures with digital impressions. In the future, we are looking forward to pairing the abilities of the Planmeca Emerald scanner with 3-D printing to allow us to print models and a variety of appliances in the office. Digital dentistry is no longer the futureâ&#x20AC;&#x201D;it is the present!

D r. M i c h a e l K e l l i h e r Dr. Michael Kelliher is a 1993 graduate of Tufts University School of Dental Medicine. He operates a general dental practice in Longmeadow, Mass., with an emphasis on CAD/CAM restorative dentistry.

CATALYST MAGAZINE // SPRING/SUMMER, 2018 // 25

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INVESTING IN YOUR PRACTICE

TIPS FROM OUR EXPERTS BY SAM MARTIN, MBA (TAX), CFP ®, CPA

s a wealth manager to dentists, I never forget the most valuable income-generating asset is your practice. It is the primary engine driving your long-term success, allowing you and your family to achieve both professional and personal financial goals. Investing in your practice is the absolute best decision you can make. For the past twenty-seven years, I’ve worked at a dental CPA firm where I’ve been able to observe, first-hand, the increase in productivity and profitability following a key investment in a practice. The most profound is an investment in technology. This includes CAD/CAM production and 3D imaging among many other new and developing technologies. CAD/CAM dentistry has come a long way over the past decade or so. I remember the first time I was exposed to a print-out from a 2D imaging machine and walked away shaking my head. I couldn’t “get” how you could visualize teeth, margins and other anatomical factors that allow the milling of a 3D restoration. It may be true I flunked the spatial intelligence portion of the SAT exam; perhaps because of this, the printout

just looked like a squiggly line to me. I recently observed high definition 3D technology at a dental show; and in its current state of precision and ease-of-use, it almost seemed a Dental Financial Planner, like myself, could design a crown—maybe not well—but yes, it could be done! Same-day restorations provide one of the greatest improvements in patient service. When embraced and managed correctly, this technology is a significant, long-term and profitable opportunity. Greatly reduced lab fees help finance the cost of equipment and with effective delegation, the doctor’s time is reduced and seat appointments are eliminated. When researching our clients’ ROI, we found they had new, growing anterior cosmetic procedure demands after investing in this type of technology. Like CAD/CAM, 3D imaging can be a tremendous benefit to a practice, it supports many procedures, such as implant placement, root canal diagnosis and difficult extractions; it is also used in sleep dentistry, TMJ and other diagnostics and procedures.

For the past twenty-seven years, I’ve worked at a dental CPA firm where I’ve been able to observe, first-hand, the increase in productivity and profitability following a key investment in a practice.

The most profound is an investment in technology. 28 // BURKHART DENTAL SUPPLY

OPTIMIZE THE VALUE— PLANNING, TRAINING AND DELEGATION 1. INVESTING IN EQUIPMENT AND TECHNOLOGY HAS A HUGE TAX BENEFIT The government provides you with an outstanding opportunity to invest in your practice with significant (tax) subsidies. Dentists can generally expense up to one million dollars in qualifying fixed asset purchases per year. Alternatively, mixing expensing elections with first year bonus depreciation as well as regular front-loaded tax depreciation gives you the ability to target tax deductions to your highest bracket (or two), maximizing long-term tax savings.

2. PLANNING AND TRAINING We find, to achieve success, taking time to plan out the execution of your investment is key. Ensuring you and your staff are well-trained is critical to making a technology investment effective, profitable and fun (vs. stressful). Failure to plan and train can lead to your new CAD/CAM equipment gathering dust in the corner (like the elliptical you use as a laundry rack). The cost of appropriate training is worth every penny; it positions you and your staff to hit the ground running - and begins immediately paying for your investment. Utilize your Burkhart Account Manager, Equipment Specialist and Dental CPA/Tax Advisor to assist as you develop a plan and carryout the project.

CONCLUSION Investing in your practice is powerful. Taking steps to plan, train and delegate help you optimize the value of your investment on day-one—and avoids the abandonment of technology you never figured out. It can: • Provide a significant one-time source of long-term investment funding • Offer ongoing profits fueled by higher funding of your portfolio • Help you reach your personal long-term goals and objectives • Make a new process rewarding vs. stressful • Improve your quality of life A strategic investment in your practice begets a current and ongoing increase in the investment into the future for you and your family.

3. DELEGATION The primary benefit of investing is to reduce time needed for procedures. Technology is one of the greatest returns on investment, saving the doctor time better used elsewhere. Consequently, this is the reason adequately cross-training your staff is important. Once you are confident your staff is equipped, delegate within ethical and legal boundaries.

4. REINVEST TAX SAVINGS Take the windfall in tax savings from your investment and maximize your 401(k) plan, add your spouse to the plan, fund a back-door Roth IRA or augment your after-tax portfolio. The long-term payoff can be remarkable. Work with your Dental Financial Planner on how to best deploy these savings within your comprehensive long-term financial plan.

S a m M a r t i n i s D i re c t o r o f We a l t h M an agement S e r v i c e s a n d A d v a n c e d Ta x Planning for the Dental Group, LLC / M a r t i n B o yl e PL L C / D e n t a l We a l t h Advisors, LLC , a CPA, practice advisory, financial planning and wealth management services group exclusively serving dentists a n d t he i r p ra c ti c e s . S a m i s a C e r tif i ed P u bl i c A c c o u n t a n t ( C PA ), a C e r t i f i e d F i n a n c i a l Pl a n n e r ( C F P), a n d ho l d s a master’s degree in federal income taxation. L oc ated in Kirkl an d , Wa shing ton , S am c an be reached at 425. 216 .1612 or Sam@cpa4dds.com.

CATALYST MAGAZINE // SPRING/SUMMER, 2018 // 29

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BURKHART BELIEVES IN

GIVING BACK

Burkhart shares a culture of giving back. With our ten branch locations spanning as far east as Oklahoma and West to our Washington State headquarters, we enjoy the opportunity to support communities in which we live and work.

Watch for our Burkhart Believes in Giving Back report-out in the next edition of Catalyst. We’ll share the impact these and other organizations have made throughout 2018 in the communities in which we live and work!

Burkhart’s Charitable Giving Board was formed by President Lori Burkhart Isbell in 2010. The Board is charged with reviewing opportunities in each of our geographic locations to support efforts in fighting world poverty through the support of small business and dental industry foundation work. We have had the pleasure of being involved with several organizations that support initiatives to create a greater good. Join us in learning more:

UNIVERSITY OF WASHINGTON DENTAL SCHOOL

Lori Burkhart-Isbell (Burkhart President), Jerry Ritsema (Burkhart Regional Sales Manager) and University of Washington scholarship recipients

The University of Washington School Of Dentistry educates a diverse student body through a challenging learning environment. As part of a public university, their vision is to educate a progressive oral health workforce, develop community collaborations, and bring advances in science to address the pressing oral health needs of Washington State, the nation and the world. In order to accomplish their vision, they promote diversity in thinking and human resources, support creative breakthroughs, and commit to ethical and responsible leadership in patient care, scholarship and research. dental.washington.edu/about-us/about-the-school/vision-and-mission

ORAL HEALTH AMERICA Oral Health America’s mission is to change lives by connecting communities with resources to drive access to care, increase health literacy and advocate for policies that improve overall health through better oral health for all Americans, especially those most vulnerable. ACCESS: OHA supports the prevention of oral disease and promotes oral health for Americans of all ages through their funding, professional education opportunities, donated dental products, and by facilitating public-private partnerships. EDUCATION: OHA’s message centers around self care, regular dental visits, tobacco avoidance and cessation, and healthy food choices, for all Americans of all ages. ADVOCACY: OHA encourages policies that create oral health equity for the 300 million Americans, including the 100 million+ individuals without dental insurance and those unable to obtain dental care. oralhealthamerica.org 32 // BURKHART DENTAL SUPPLY

NEW REALITY INTERNATIONAL New Reality International was founded in 2007 as a 501c3 public charity in the United States. They have been able to directly serve an estimated 22,000 people suffering from extreme poverty around the world with health education, medical care, dental care and surgical care. In 2012, NRI began the development of the first Children's Village for orphaned, abandoned and trafficked children in Northern Haiti through Project 7. The goal of Project 7 is to work with the local Haitian leaders to provide a self-sustaining safe haven for these rescued children to grow and thrive. Globally, their work has reached some of the most vulnerable populations suffering from extreme poverty in Guatemala, Guyana, Haiti, Mexico, Myanmar/Burma and Nigeria. www.newrealityinternational.org/about_us

DENTAL LIFELINE NETWORK DLN is a national charitable organization whose mission is to improve the oral health of people with disabilities or who are elderly or medically fragile and have no other way to get help. DLN accomplishes its mission by developing and coordinating collaborative relationships that provide essential resources for direct-service programs, especially charitable care. dentallifeline.org

PIERCE COUNTY DENTAL FOUNDATION ENDOWMENT The Pierce County Dental Foundation is a non-profit, charitable organization formed in 2003. The Foundation was started to raise and disperse funds for charitable, educational and scientific purposes. PCDF has a goal of raising $1,000,000 for its endowment fund. The proceeds will be used to support community programs that support access to care, building oral health awareness, and supporting the education of dental health professionals. To reach this goal, they will be holding an annual event: "A Day for Smiles" where dentists donate a day of dentistry to the endowment fund. September 17-21, 2018 is the week to donate a day of dentistry. www.pcdentists.org

DENTISTRY FROM THE HEART (DFTH) DFTH is a worldwide nonprofit organization dedicated to providing free dental care to those in need. Every year, thousands of individual dentists, hygienists, volunteers, and hundreds of practices across the world donate their time and resources to host their own DFTH events. Dr. Vincent J. Monticciolo founded Dentistry From The Heart over 16 years ago, with the goal of giving back to those who cannot afford dental care. Those in the dental industry who have participated in this event have shown a giving and generous spirit in their communities. Each year hundreds of events take place where thousands of patients are helped and giving millions of dollars in free dental care. www.dentistryfromtheheart.org CATALYST MAGAZINE // SPRING/SUMMER, 2018 // 33

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