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w w w. o r a l h e a lt h g r o u p. c o m
LABS
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SURVIVING IN THE DIGITAL WORLD
FALL 2015
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The power of this
Packed into this
Because we’re not born with robotic arms MADE EASY FOR YOU To make dental scanning easy, we could have built the world’s first automatic, clearance controlled high-speed bionic appendage. Instead we packed it all into our new CS 3600 to make acquiring digital impressions easier for you. Explore more at carestreamdental.com/CS3600 or by calling 855.762.2291
© Carestream Health, Inc. 2016. 13744 CAN CS 3600 0315
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contents
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Editorial Survival Of The Fittest
What Business Are You In?
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News Smile of the Year Contest Sirona’s 7th inLab Summit
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Foundation for Effective Collaboration
Photographic Communication Between Dentist and Dental Technician
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The Screwmentable
CASE STUDY
Multidisciplinary Digital Dentistry
Advantages of Digital Smile Design
EDITORIAL DIRECTOR
Catherine Wilson (416) 510-6785 cwilson@oralhealthgroup.com EDITORIAL ASSISTANT
Jillian Cecchini (416) 442-5600, ext. 3207 jcecchini@oralhealthgroup.com ART DIRECTOR
Carolyn Brimer
PRODUCTION MANAGER
DENTAL GROUP ASSISTANT
Karen Samuels (416) 510-5190 karens@newcom.ca
Kahaliah Richards (416) 510-6777 krichards@oralhealthgroup.com
CIRCULATION
SENIOR SALES MANAGER
MANAGING DIRECTOR
Melissa Summerfield (416) 510-6781 msummerfield@oralhealth group.com
Mary Garufi (416) 442-5600 ext. 3546 mary@newcom.ca
Tony Burgaretta (416) 510-6852 tburgaretta@oralhealthgroup.com
VICE PRESIDENT
DENTAL MARKETPLACE – CLASSIFIED
ASSOCIATE PUBLISHER
Jim Glionna
Karen Shaw (416) 510-6770 kshaw@oralhealthgroup.com
Joe Glionna PRESIDENT
Hasina Ahmed (416) 510-6765 hahmed@oralhealthgroup.com
ORAL HEALTH LABS IS A SUPPLEMENT TO ORAL HEALTH
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editorial
SURVIVAL OF THE FITTEST As Bob Dylan wrote, “The times they are a-changin’”. This often quoted lyric holds true to dentistry and dental laboratories today. We as dentists have seen many changes over the years to materials and techniques, none in my humble opinion as dramatic as the advent of the digital age of dentistry. More and more dentists are embracing digital technologies and employing them in their offices. Yes the use of digital radiography is probably most prevalent, but how about the use of digital impressioning systems? There are multiple companies at every major dental convention on the trade show floor wanting us to buy their digital impression scanners whether it is Trios, iTero, Planmeca, Cerec, E4D and so on. More and more dental offices are embracing these systems as times goes by as the gold standard for dental impressions. These scanners truly are amazing in that they now are bringing dentistry to the patients quicker (if one chooses to use in office milling such as Cerec or E4D) and much quicker via the internet delivery of our impressions to our labs. Within seconds the labs can start working on our cases, or can they? Do they possess the ability to utilize this technology in their facilities or do they have to “farm out” our impressions elsewhere to be able to work on our cases? Do they wish to go through the painstaking process and monetary commitment to keep up with the ever-changing advancements in dentistry? These are the kinds of issues that we as the dental profession are encountering on a daily basis. We all have choices to make within our own practices. Is there anything wrong with maintaining our course using the tried and true methods that have been very successful in dentistry since the age of the dinosaur? We have used amalgam as a very successful material forever, but recognize that there are safer and better ways to restore teeth. Our patients too have had a large say in what THEY wanted inside their mouths due to the information that was made available in public places like magazines, newspapers, and the Internet. So we as dentists evolved our materials to suit the public’s wants and desires. Dental labs have been able to help dentists restore teeth for decades by fabricating restorations of either metal or ceramics. Dental materials for indirect restorations are evolving daily. There are so many new materials available that not only rival the old PFM restoration, but actually far exceed them in terms of durability, strength and esthetics. Most of these materials involve some sort of digital technology. With all these new materials and technologies available, the question is, will your lab be equipped to evolve with the times that are definitely changing? In my mind, survival of the fittest is the best way to define this. Dental laboratories that are willing to evolve with our new technologies will survive, but ones that maintain the tried and true, unfortunately will become extinct like the dinosaur.
Les Rykiss, DMD
Dr. Rykiss maintains his private practice in Winnipeg, MB. He is a graduate of the University of Manitoba as well as a graduate and Mentor at the Nash Institute for Dental Learning in Charlotte, N.C. He has his Fellowship with the International Academy for Dental Facial Esthetics,
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an associate Fellowship from the World Clinical Laser Institute, and is a member of the ASDA and CAED. He teaches, lectures, and writes articles on restorative, cosmetic dentistry, and hard and soft tissue laser use.
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news
Tetra Dynamics Dental Laboratory Presents Smile of the Year Contest Tetra Dynamics, a MircoDental Dental Laboratory, introduced their Smile of the Year contest. The lab believes smiles matter and are constantly witnessing how great dentistry is able to transform people’s lives. Tetra Dynamics Smile of the Year celebrates the positive impact that cosmetic dentistry has on patients around the world. To be eligible for the contest, a doctor must have a patient that has benefitted from a Tetra Dynamics smile makeover (already restored). Restorations include all-ceramic, implants, partial and complete dentures. Doctors must complete and submit the required entry form and photographs by June 30th, 2016. The winning doctor and his/her patient will be part of a professional photo shoot in San Franciso. Airfare, transportation, meals, up to four-nights hotel and a $500 gift card for both the patient and the doctor will be included. This is a wonderful opportunity to experience a photo shoot production with a professional team of stylists, makeup artists and photographer. All prizes are awarded in exchange of image usage rights. The prizewinner may be featureE in a variety of marketing projects including videos, ad campaigns, and on the company website. Winning doctors will also receive digital copies of selected photo shoot images. The winner will be selected on August 1st, 2016. For more information about Tetra Dynamics’ Smile of the Year contest, visit www.teradynamics. com/tetra-dynamics-smile-of-the-year.
Sirona’s 7th inLab® Summit Dentsply Sirona, The Dental Solutions Company, announced its 7th inLab Summit. The inLab Summit will take place at Harrah’s New Orleans Hotel on April 15th and 16th, 2016. The twoday summit includes powerful educational sessions and hands-on courses presented by laboratory professionals that translate directly to your lab. Hundreds of lab technicians are expected to attend this year’s inLab Summit in order to learn about the most current industry topics centered on all aspects of inLab CAD/CAM technology in a powerful educational environment among like-minded colleagues and professionals. With a non-stop schedule containing an outstanding roster of educational opportunities, the inLab Summit is set to provide the
most beneficial CAD/CAM training along with the richest networking opportunities available. Over 30 breakout sessions and hands-on workshops are scheduled throughout the summit where attendees will have multiple opportunities to work alongside expert inLab users on a multitude of specific applications and techniques relevant to everyday restorative requests, as well as unique laboratory situations. All courses and workshops are designed to provide participants with increased knowledge and skills in order to maximize their own production, efficiency, and financial benefits using the inLab system. All attendees will be provided up to nine CE credits for attending the inLab Summit. For more information and to register for the inLab Summit in New Orleans, please visit www.inLabevents.com.
SPRING 2016
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WHAT BUSINESS ARE YOU IN? By George Cowburn
As an established dental lab, you are proud of your workmanship and expertise. Over the years, you have built a reputation for quality and service, and you have a solid, long-term relationship with key local professionals. But the flood of new technology is worrying –
“How can I ever keep up with it all?”
George Cowburn, D.D., began researching digital dental solutions in 2003 while studying denturist technology at the Northern Alberta Institute for Technology. He went on to cofound one of the largest denture clinics in Western Canada. For the last five years, Cowburn has
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been dedicated to researching and developing digital treatment workflows. This passion for digital solutions was fully realized with the launch of Perfit Dental Solutions, a company dedicated to facilitating the adoption of digital technology in the dental industry.
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I
n our last article in Oral Health Labs’ Fall 2015 edition, we looked at how digital dentistry is slowly crossing the adoption cycle chasm. Digital dentistry has been slow in coming, largely because the learning curve for new methods and tools is steep indeed. Given their professional responsibility for patient care, dentists have every reason to be measured and thoughtful in adopting new methods; “Sorry, that didn’t work” is not what patients are willing to hear. A lab can test ideas and procedures on models to refine and perfect their methods before bringing them to market, but dentists are not afforded this opportunity. Until digital workflows are quick, easy and reliable, digital dentistry will continue to be a gently flowing stream of gradual change. Dental labs in contrast already have digital tools and workflows, which are quick, reasonably straightforward and highly reliable. The change is and will be an overwhelming tsunami flooding the entire landscape. Labs are being forced to decide to head for higher ground or retire. A recent survey showed by 2020, over one-third of labs plan to sell off their equipment or sell their business to a competitor or lab group. RIDERS ON THE STORM Dental labs are responsible for producing whatever the dentist requires. The dentist needs results, and is less concerned with how those results are achieved. Three-dimensional printing versus milling a model is irrelevant to most dentists; they just want the restoration to fit. There is therefore, no limit on the pace of technology adoption in dental labs — new ideas can be very rapidly adopted. How can smaller labs deal with this situation? Historically, full service labs did it all but with the heavy equipment investments in newer workflows, labs are forced to outsource, and often with a twinge of regret. “We really should be able to do that.” Unless you are a very large lab with deep pockets, most labs simply can’t continue to provide every service in house. As the waters of change rise, labs can’t stay moored to the old dock. The only way to survive is to cut loose and become a rider on the storm. SERVICING THE DENTIST BEST As a lab, you have an intimate relationship and understanding of what your doctors want. With a bit of training, that design skill can be transferred from physical design to software driven design. CAD can become your core area of expertise. Large milling operations have the benefit of economies of scale. They can buy many machines and have extra capacity available when inevitable breakdowns occur. They can invest in researching efficiencies in manufacturing and optimize it over hundreds and thousands of cases. Missteps are surviv-
able as they bring in and test out new machines and procedures and recover from their failure without going under. As the technology matures, it may make sense to bring milling in house. Milling centres recognize and support this evolution. They leverage their knowledge and expertise to empower smaller labs to enter the milling business. What they stand to lose in market share, they regain in providing support services, affordable materials and, most importantly, they can step in to fill orders if the local mill has an issue. This allows smaller labs to gain experience with digital workflows without significant capital outlay and risk while providing reliable products of exceptional quality for reasonable costs. These milling companies are also riders on the storm, intelligently navigating a sea of change. SO WHAT BUSINESS ARE YOU IN? The dental lab industry is now becoming a computer technology industry. Google is one of the most successful computer technology companies in the world. Eric Schmidt, Google’s former CEO, summed it up well: “Be a damn good router.” From a dentist’s perspective, what matters is quality, timeliness and cost. So let’s walk through the digital production process. First and foremost, you have to support dental staff in learning what data they need to provide you with in order for you to achieve mutual success. A recent survey of labs showed one in four of impressions received from dental offices are unacceptable. Working with poor inputs makes high quality products impossible to achieve. Then the practice has to learn how to send you digital image files, along with clear and precise instructions. This too is a new skill, and you want to be a supportive part of the learning process, to train the office to efficiently route information to you. Then you want to manage and monitor every step of the production process. The dentist’s instructions should be interpreted by a design expert, preferably one with knowledge of the subtle preferences of the specific client. In an ideal world, the proposed design would be reviewed and approved by the doctor, or patient, before proceeding to manufacturing. In the event the client isn’t satisfied, redesigning a virtual case is far easier and less costly than remaking physical work. The manufacturing process may have several steps, depending on the product required. At every step, progress is logged and tracked, so that you, and your client, know precisely what stage the work is at. Expectation is the mother of disappointment; allowing transparency is a highly effective way of managing expectations. At a minimum, you must be a damn good router. SPRING 2016
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IS IT ENOUGH TO BE A DAMN GOOD ROUTER? It is entirely possible for a modern lab to be nothing more than a router. After building and renovating several clinics, we see similarities between the dental lab industry and the construction industry. Any homeowners can choose to be their own general contractor, and manage the whole process. But a homeowner who does that ends up spending an enormous amount of time chasing after contractors and managing the project schedule. “The drywaller didn’t show up again, now I have to rebook the painters and figure out how to get the project back on schedule so it doesn’t affect the move-in date.” With dental labs, the situation is far more complex, because there is an ever-changing suite of technologies to choose between. Dentists are seldom interested in assessing emerging technologies – they just want the restoration to consistently fit, look good and be affordable; how it came into existence is of far less concern. It becomes your responsibility to pick the right solution to provide a product of good value and uncompromising quality – as their general contractor. The more change and upheaval there is in the dental industry, the more value a router will have. New solutions and efficiencies are being discovered every day and good routers are always on top of the latest developments, and know when to adopt them. FORGING THE GOLDEN HANDCUFFS Traditional dental labs employ people in departments and simpler tasks are done by regular technicians, who become experts in a relatively limited set of tasks. But the success of a lab commonly relies on a few highly skilled ‘star performers’, who have a deeper understanding of the overall picture. In a digital workflow environment, these ‘star performers’ will have a different set of skills which are not yet part of any school program and cannot be hired ‘off the street.’ Persons with the interest and ability to become experts in dental lab workflow management and automated production will be few and far between. You absolutely must retain these key employees. Forging “golden handcuffs” is essential: create an environment where employees have it so good that they could never consider leaving. Part of the solution may be financial; some labs offer high
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wages, bonuses, profit sharing, shares in the company, or additional benefits and holidays. Research continually shows that the most effective incentives are not financial. The key to success is developing a culture that people want to be a part of, and one that fits the new business model. If your people are happy, processes will flow smoothly, dentists will be pleased, and patients will be well cared for. THE RIGHT DESIGN Computer Assisted Design (CAD) is a function that likely fits well with your current lab’s skill set. This is the most critical component of the digital process in the lab’s control, so quality is key. Many five axis mills produce great results, but the product is only as good as the design. Mistakes in the virtual world aren’t significant issues until they’re milled and become real problems. In CAD design, a culture of quality is critical. A new technology is always suspected, and the results will have to be even better than the conventional state of the art to convince skeptics. Once you have talented CAD experts in-house, utilize them to train others. This skill set will be ever more valuable, and it is essential that you manage your dependency on the star performers that your competitors will be seeking to lure away. Many of our best technicians are retiring, so we must mentor a new generation. Companies are now specializing exclusively in CAD and work closely with milling companies to deliver integrated solutions. If you have weaknesses in CAD, try sending a couple test cases to outsourced CAD companies and evaluate the results. THE BRAINS OF YOUR BUSINESS Irrespective of your labs position in the industry, you need to have a solid process management system in place. Implementing a new software system is always challenging, but offers efficiencies. The sooner these efficiencies are realized the more significant impact they can have on your business. Being digital-ready sooner means that by the time the digital market really opens up, you’re more than ready for it. Digital data transfer rules are reasonably new. We’ve had
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cars for a hundred years and every driver is familiar with the rules of the road. The new information highway is not as well understood by the people who navigate its lanes. To communicate with dental professionals, you should utilize a system, which is PIPPA/HIPPA compliant. The software you choose will literally become the brains of your business. You either need integration with your lab management software or an all-in-one solution. Here are some things to consider:
Is there a client portal where they can quickly log in and see all communication and files sent? This will save you phone calls to see where cases are. Web based cloud-data solutions are generally preferable to those in which the software and data are stored on your own machine – which must then be backed up and secured. Is there invoicing and integration to accounting programs such as quickbooks? This will save you time and money. Your bookkeeper and accountants will thank you. Can it streamline and sort information more efficiently? Software solutions, such as CAPzilla and LabStar, have the ability to acquire information, such as the patient’s name, directly from the 3Shape files, reducing the time and error inherent in double entry. Does my software meet my current and long term needs? This is perhaps the most important question, as switching systems is always challenging. Make sure you choose a software vendor that has a long-term vision and the ability to adapt with the industry. These are stormy seas of change – but if you cut free and ride on the storm, these will be the winds of opportunity!
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dental photography
Foundation for effective collaboration Photographic communication between dentist and dental technician Prof. Dr Daniel Edelhoff, Munich/Germany
In addition to a bite registration, facebow transfer and impressions, intraoral and extraoral photos form the most important key in the communication between dentist and dental technician. Adequate photographic equipment is an indispensable tool for the teamwork between dentist andtechnician
T
he importance of photographic communication is particularly significant if the dentist and dental technician collaborate with each other from distant locations and have to fulfil demanding esthetic and functional requirements. Photos are not only used for the initial transfer of information to conduct an esthetic and functional analysis on the basis of a wax-up, but they also play a significant part in many other steps of the restorative process, such as in the clinical evaluation of the proposed restoration (mock-up) and in the shade selection of the toothand preparation. Scope of photographic documentation To be able to obtain a detailed impression of the clinical situation at hand, dental technicians should receive a comprehensive photographic portfolio comprising the following shots: 1. Portrait photo of the patient with the facebow (Fig. 1). 2. Portrait photos showing the patient with relaxed lips, with a light smile and with a full smile (Fig. 2).
Fig. 1 A portrait photo of the patient with the facebow in place gives the dental technician valuable information on the position of the bipupillary line in relation to the occlusal plane. Fig. 2 A portrait photo showing the patient with a full smile is used for analysing basic esthetic parameters: 1. centre line, 2. bipupillary line, 3. occlusal plane. The patient presented in this case shows asymmetries in the area of the facial midline (4.), gingival contours and the occlusal plane/buccal corridor.
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3.
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Fig. 3 Frontal view of the upper anterior teeth. An autoclavable black contrastor was used to obtain a more detailed picture of the morphological structures (Flexipalette, www.smileline.ch).
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Fig. 4 Frontal view of the upper anterior teeth. To facilitate the analysis of the internal structures, it may be useful to take an additional picture using a cross-polarization filter to eliminate all reflections (polar_eyes, www.finest-dental.de).
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2
Fig. 5 Shade selection with a gingival mask including a white balance and Fig. 6 For fine tuning the intensity of the tooth’s fluorescent level, additional pictures using a UV light source may be useful and may be referenced with grey card (modified according to MDT Otto Prandtner). The shade tabs of shade tabs (fluor_eyes, www.finest-dental.de). the A-D shade guide may be fitted in the gingival mask and photographed Fig. 5 Shade selection with atooth gingival maskatincluding a white and Fig. 6 For fine tuning the intensity of the tooth’s fluorescent level, additional together with the relevant regions the beginning ofbalance the treatment pictures using a UV light source may be useful and may be referenced with grey card Shofu, (modified (Gumy, Art.according PN 7040).to MDT Otto Prandtner). The shade tabs of shade tabs (fluor_eyes, www.finest-dental.de). the A-D shade guide may be fitted in the gingival mask and photographed together with the relevant tooth regions at the beginning of the treatment Fig. 5 Shofu, Shade selection with a gingival mask including a white balance and Fig. 6 For fine tuning the intensity of the tooth’s fluorescent level, additional (Gumy, Art. PN 7040). pictures using a UV light source may be useful and may be referenced with grey card (modified according to MDT Otto Prandtner). The shade tabs of shade tabsfine (fluor_eyes, the A-D shade guide may in the gingival mask and photographed Fig. 5 Shade withbea fitted gingival mask including a white balance and Fig. 6 For tuning thewww.finest-dental.de). intensity of the tooth’s fluorescent level, additional Scope of selection photographic documentation together with the relevant tooth regions at the beginning ofshade the treatment pictures using a UV light source may be useful and may be referenced with grey card (modified according to MDT Otto Prandtner). The tabs of To be able to obtain a detailed impression of the clinical situashade tabs (fluor_eyes, www.finest-dental.de). (Gumy, Art. PNmay 7040). the A-D Shofu, shade guide be fitted in the gingival mask and photographed tion atof hand, should receiveofathe comprehenScope photographic together with the dental relevant technicians tooth documentation regions at the beginning treatment (Gumy, Shofu, PN 7040). sive photographic portfolio following shots: To be able toArt. obtain a detailedcomprising impressionthe of the clinical situa-
1. at Portrait the patient with receive the facebow (Fig. 1) tion hand, photo dental of technicians should a comprehenof photographic 2.Intraoral Portrait photos showing the patient relaxed lips, sive photographic portfolio comprising thewith following shots: 3.Scope photos from thedocumentation anterior front, lateral left and bewith able to obtain a detailed impression of the clinical situaa light smile and with a full smile (Fig. 2) 1.Tolateral Portrait photo of the patient with the facebow (Fig. 1) right in static and dynamic occlusion with special Scope of photographic documentation tion at hand, dental technicians should receive a comprehenIntraoral anterior lateral 2.3.focus Portrait thetreatment patient front, with relaxed lips, on photos thephotos areashowing infrom needthe of (Figs. 3 andleft 4). and To be able to obtain a detailed impression of the clinical situasive photographic comprising the(Fig. following shots: lateral right in portfolio static and dynamic occlusion special with a light smile andthe with a full smile 2)with 4. Intraoral photos from occlusal showing the complete tion at hand, dental technicians should receive a comprehenPortrait photo of the patient the facebow (Fig.and 1) focus on the area in the need ofwith treatment (Figs 3left and 4) 3.1.upper Intraoral photos from anterior front, lateral and lower jaw. sive photographic portfolio comprising the following shots: 2. Portrait photos showing the patient with relaxed lips, 4.lateral Intraoral photos from occlusal showing the complete right in static andthe dynamic occlusion with special 1. Portrait photo of the patient with the facebow (Fig. 1) with a light smile and with full smile (Figs (Fig. 2) upper and jaw focus on thelower area in need ofatreatment 3 and 4) Shade selection 2. Portrait photos showing the patient with relaxed lips, 3. Intraoral photos from the anterior front, lateral left and 4. Intraoral photos from the occlusal showing the complete Before thea teeth are prepared, should with light smile and withshade a fullselection smile (Fig. 2) be perlateral right in static and dynamic occlusion with special Shade selection upper and lower jaw formed (e.g. with an from A-D shade guide) front, (Figs. lateral 5 and left 6). It is 3. Intraoral photos the anterior and focusthe on teeth the area need of treatment (Figs 3 and 4) be Before areinprepared, selection should essential clearly define anddynamic agreeshade with the patient the lateraltoright in static and occlusion with on special 4. Intraoral photos from occlusal the complete performed (e.g. with anthe A-D shade showing guide) (Figs 5 and 6). Shade selection finalfocus toothonshade. If any toothofwhitening the area in need treatmentprocedures (Figs 3 andhave 4) lower jaw It isupper essential to are clearly define shade and agree with should the patient Before the and teeth prepared, selection be been carried photos out, they should be completed bythe thiscomplete stage. 4. Intraoral from the occlusal showing on the final tooth shade. If any toothguide) whitening performed (e.g. with an A-D shade (Figs procedures 5 and 6). Generally, the brightness upper and lower jaw value has a more decisive effect selection have been carried out,define they should be completed by this ItShade is essential to clearly and agree with the patient than thethe tooth shade proper on theshade final outcome. Ifshould the pa-be Before teeth shade. are selection stage. Generally, the prepared, brightness value has a more decisive on the final tooth If any tooth whitening procedures Shade selection tient cannot clearly decide between two brightness values, performed (e.g. with A-Dshould shadebe guide) andthis 6). effect than the tooth shade proper oncompleted the (Figs final 5outcome. have been carried out,an they by Before the teeth areversion prepared, shade selection should selecting the brighter of the two is advisable. In casebe ItIf isthe essential clearly define and agree patient patient to cannot clearly decide between twothe brightness stage. Generally, the brightness value has awith more decisive performed (e.g. with an A-D shade guide) (Figs 5 andthe 6). of doubt, thethe dental technician will beon able tofinal decrease on thethan final tooth shade. If any tooth whitening procedures values, selecting the brighter version of two is advisaeffect tooth shade proper thethe outcome. It is essential to clearly define and agree with the patient value on, ifthe need be. Conversely, if the brighthave been carried out, they should be completed by able this ble. In case oflater doubt, dental technician will be Ifbrightness the patient cannot clearly decide between two brightness on the final tooth shade. Iftoo anylow, tooth whitening procedures ness value turns out to be it is virtually impossible stage. Generally, thebrighter brightness value more decisive to decrease the the brightness value later on, need Con values, selecting version ofhas theifatwo is be. advisahave beenitcarried out, they should be completed by this to increase atbrightness adoubt, later stage by using stains. It be is will essential toit is effect than the tooth shade proper on final outcome. verse if the turns outthe to too low, ble. Inly,case of thevalue dental technician be able stage. Generally, theclosest brightness value has a more shade) decisive take a picture of the shade sample (reference Ifvirtually the patient cannot clearly decide between two brightness impossible to increase it at aon, later stage byCon using to decrease the brightness value later if need be. effect than the shade proper on the final outcome. together thetooth remaining dentition. If of translucent restoravalues, the brighter version is advisastains. Itwith is essential to value take aturns picture of the closest shade verse ly, ifselecting the brightness out tothe be two too low, it is If theare patient cannot clearly decide between two brightness tions created, it is important include awill die shade ble. In case of doubt, the dental able sample (reference shade) together with thestage remaining denvirtually impossible toalso increase it attechnician atolater bybe using values, selecting the brighter version of the two is advisaguide (IPS DietoMaterial) to enable the technito decrease the brightness laterof on, ifdental need be. Con stains. It isNatural essential take value a picture the closest shade ble. In case of doubt, the dental technician will be able verseto ly,(reference if the brightness value turns outthe be too low, it is cian manufacture laboratory dies in a to matching colour sample shade) together with remaining dento decrease the brightness value later on, if need be. Con virtually impossible to increase it at a later stage by using (Figs. 7 and 8). versely, if the brightness value turns out to be too low, it is stains. It is essential to take a picture of the closest shade virtually impossible to increase it at a later stage by using sample (reference shade) together with the remaining denstains. It is essential to take a picture of the closest shade sample (reference shade) together with the remaining den-
Fig. 9 Professor Edelhoff during intraoral photography Fig. 9 Professor Edelhoff during intraoral photography
Fig. 7 Various shade samples of the IPS Natural Die Material shade guide Fig. 7 Various shade samples of the IPS Natural Die Material shade guide Fig. 8 Selecting the shade of the severely disFig. 7 Various shade samples of the IPS Natural Die Material guideinciFig. 8 shade coloured central Selecting shade sor afterthe preparation offor thea severely dis Fig. 7 Various shade samples of the IPS Natural Die Material shade guide full wrap veneer coloured central inciFig.after 8 preparation sor Selecting the shade for a full wrap veneer of the Fig. 8 severely discoloured the central inciSelecting shade sorthe after preparation of severely disfor a full central wrap veneer coloured incisor after preparation tition. If translucent restorations are created, it is also imporfor a full wrap veneer tant to include a die shade guide (IPS Natural Die Material)
to enable the dental technician manufacture laboratory tition. If translucent restorations aretocreated, it is also impordiestoininclude a matching andNatural 8). tant a die colour shade (Figs guide7(IPS Die Material) to enable the dental technician to manufacture laboratory Conclusion tition. translucentcolour restorations it is also imporConclusion dies in aIf matching (Figs 7 are andcreated, 8). High-quality photographic (Fig. 9) an tant to include a die shadedocumentation guide (IPS Natural Dieprovides High-quality photographic documentation (Fig. 9)Material) provides tition. If translucent restorations are created, it is alsobetween imporindispensable fortechnician the collaboration to the basis dental to manufacture laboratory anenable indispensable basis for successful the successful collaboration beConclusion tant to include a die shade guide (IPS Natural Die Material) the members of thecolour restorative team and8). provides high levela dies in athe matching (Figs 7 and tween members of the restorative team and High-quality photographic documentation (Fig. 9)aprovides provides to enable the dental technician to manufacture laboratory of predictability with regard to the clinical result. level of predictability with regard tocollaboration the clinical result. anhigh indispensable basis for the successful bedies in a matching colour (Figs 7 and 8). Conclusion tween the members of the restorative team and provides a High-quality photographicwith documentation 9) provides Acknowledgement high level of predictability regard to the(Fig. clinical result. Acknowledgement Conclusion an indispensable basisOliver for the successful collaboration be like Brix forfor providing the the dental lab II would would like to tothank thank Oliver Brix providing dental High-quality photographic documentation (Fig. 9) provides tween the members of the restorative team and provides a pictures. Acknowledgement lab pictures. an indispensable basis for the successful collaboration belevel regard to thethe clinical result. I high would likeof topredictability thank Oliver with Brix for providing dental lab tween the members of the restorative team and provides a pictures. Reprinted with permission.with Reflect, 2/14. high level of predictability regard to the clinical result. Acknowledgement Contact details: I would like to thank Oliver Brix for providing the dental lab Acknowledgement pictures. Prof. Dr Daniel Edelhoff details: I would like to thankContact Oliver Brix for providing the dental lab Chief Senior Surgeon, Deputy Chair pictures. Policlinic for Dental Prosthetics
Prof. Dr Daniel Edelhoff Ludwig Maximilian University Chief Senior Surgeon, Deputy Chair Contact details:70 Goethestrasse Policlinic for Dental Prosthetics 80336 Munich Ludwig Maximilian University Contact Prof. Dr details: Daniel Edelhoff Germany Goethestrasse 70 Chief Senior Surgeon, Deputy Chair daniel.edelhoff@med.uni-muenchen.de 80336 Munich Prof. Dr Daniel Edelhoff Policlinic for Dental Prosthetics Germany Chief Senior Surgeon, Deputy Chair Ludwig Maximilian University daniel.edelhoff@med.uni-muenchen.de Policlinic for Dental Prosthetics Goethestrasse 70 SPRING 2016 • oralhealthLABS Ludwig Maximilian University 80336 Munich www.oralhealthgroup.com Goethestrasse 70 Germany 80336 Munich daniel.edelhoff@med.uni-muenchen.de Germany daniel.edelhoff@med.uni-muenchen.de 16-03-28
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Fig. 9 Professor Edelhoff during intraoral photography Fig. 9 Professor Edelhoff during intraoral photography OHLabs Spring16.indd 11
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THE
Screwmentable Mike Callaghan, RDT; Peter McKeon, RDT
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n an industry that offers so many options and emerging products restoratively, many of us have never heard of one of the new and extremely useful phenomenons: the Screwmentable. What is a Screwmentable? It’s a restoration consisting of an abutment, a crown and a screw. To many, that doesn’t sound any different from a screw-retained restoration, and it shouldn’t. But here’s where it differs. With a Screwmentable, we at the Lab pre-cement the crown to the abutment creating a one-piece restoration. All that is left to be done is to screw the abutment (through the access hole in the crown) down and then place composite over the screw access hole to hide the area. Voila, we have the Screwmentable! Here’s why this solution should be considered. First of all, it is very cost effective as it not only allows the use of stock or Ti base abutments, but it saves chair time as it arrives to the practice already cemented into one piece, leaving a clean and smooth surface that will be sub gingival. The Screwmentable also alleviates the worry about cement entrapment as the lab
pieces the crown and the abutment together, and as such, a spinoff is that it therefore helps prevent peri implantitis that excess cement may cause. Finally, moving forward, there is the ease of future access and retreiveability should the screw become loose or the cement erode. In both cases, unlike with a cement-retained restoration, there is no need to try and find the mesostructure of the abutment below because the screw access hole is available. All that would need to be done is one of two options. Drill out the composite cover and either tighten the screw, or remove the Screwmentable and re-cement chairside, or in more complicated situations, return to the lab for cementation. Screwmentables can be used for a wide variety of restorations including Full Contour and Layered Zirconia, PFM’s and e.Max. Of note, as with all implant procedures, we would recommend that the master model be saved at the practice in case of potential micro movements or any unforeseen complications arising down the line. Should you have any question, concerns or comments please feel free to call or email us at Shaw Laboratories. 416-977-0700 / info-toronto@shawlab group.com.
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case study
MULTIDISCIPLINARY DIGITAL DENTISTRY ADVANTAGES OF DIGITAL SMILE DESIGN: A CASE STUDY
By: Amarjit Rihal, DMD, FICD, FPFA; Tim Dumore DMD, BSc, MSc, FRCD(C), DipABO, FICD, FPFA; Les Rykiss DMD, FIADFE
Amarjit Rihal obtained his DMD degree from the University of Manitoba, Faculty of Dentistry, in 1995. His professional interest has involved all aspects of implant and CAD/CAM dentistry. He has additional training in both hard and soft tissue grafting as well as placing and restoring implants. In addition to implantology, Dr. Rihal has acquired expertise in CAD/CAM
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he prevalence of impacted cuspids is approximately one to two percent of the population. For those individuals with impacted cuspids who seek orthodontic treatment, they can expect more complicated mechanics and increased treatment time. There is a similar prevalence of cases with peg lateral incisors. These situations also present challenges for the orthodontist and the restorative dentist alike. One solution for peg laterals with poor prognosis can be substitution of the cuspids into the lateral incisor position. With proper management, a very acceptable result is often possible. Of course, CL II management in non-growing patients presents challenges in treatment as well, with a need to consider upper bicuspid extraction or surgical correction of a skeletal discrepancy to achieve an acceptable result. This case report presents an interesting patient presentation that combines all of these considerations.
based prosthetic dentistry, involving numerous CAD systems and materials. Utilizing his CEREC ac and InLab system he has designed over 2000 restorations. He presently is a partner in a large group practice in Winnipeg, MB and serves on the boards of the Manitoba Dental Association and the National Dental Examination Board. He has newly be elected to the Com-
mission on Dental Accreditation of Canada. He was also a part time clinical instructor at the University of Manitoba Faculty of Dentistry and is a fellow of the Pierre Fauchard Academy and International College of Dentist. Tim Dumore has practiced orthodontics in Winnipeg since graduating from the orthodontic residency at
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Case Study
This patient presented in January 2010 to the orthodontist with a chief concern that the "cuspids need to be brought down" and that he wanted to address his front teeth that had been traumatized in a hockey accident three years prior. Diagnostic records were obtained in March; five days prior to the records, he fell and traumatized 22. Figures 1 and 2 shows patient’s full smile and retracted anterior view. Upon initial examination, our findings showed an increased vertical jaw relationship. This was due to the posterior rotation of the mandible and contributed to the open bite tendency and a class II malocclusion. His open bite was compounded by factor of his central incisors as seen in Figure 3. Figure 3 shows impacted cuspids 13, 23, pegged lateral incisors, supernumerary tooth between 22-24 as well as severe maxillary crowding and moderate mandibular arch crowding.
Fig. 1
Fig. 2
Fig. 3
University of California, San Francisco in 1998. He has a special interest in interdisciplinary treatment and is codirector of the Winnipeg Progressive Dental Study Club, a chapter of the Seattle Study Club. His practice places a significant focus on technology, with early adoption of digital radiographs and CBCT, intra-oral scanning, and 3D printing. He has been a part-
time clinical instructor at the University of Manitoba Faculty of Dentistry Graduate Orthodontic program for sixteen years. In 2013, he was invited to be a member in the Schulman Study Group. Les Rykiss maintains his private practice in Winnipeg, MB. He is a graduate of the University of Manitoba as well as
a graduate and Mentor at the Nash Institute for Dental Learning in Charlotte, N.C. He has his Fellowship with the International Academy for Dental Facial Esthetics, an associate Fellowship from the World Clinical Laser Institute, and is a member of the ASDA and CAED. He teaches, lectures, and writes articles on restorative, cosmetic dentistry, and hard and soft tissue laser use.
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sponsored case study
Fig. 4
Restorative Phase
The cuspids and peg lateral incisors were prepared for CAD all ceramic crowns with the supra gingival margins on enamel. Figure 6 shows prepared teeth and uneven proximal spacing. After the preparations were complete, it was necessary to take a normal digital photograph of the patient smiling to be imported to our Sirona Inlab design software. Note that the patient’s facial midline was not coincident with his mandibular dental midline as seen in Figure 7. A digital impression using Sirona’s Omni cam was taken. As you can see a colour digital 3D rendering of the patient’s prepared maxilla, mandible and bite was captured into the software. Figures 8 and 9 show occlusal and anterior scanned images from CEREC’s OmniCAM. Figure 8 shows preparations from the occlusal view as well as occlusal contact points. As seen in Figure 9, an approximated final incisal and maxillary midline position
Fig. 5
Treatment Plan
Due to the complexity and challenges dentally presented with this case, there are a number of treatment options that could have been considered. The reality of this case was that after orthodontics was completed, the case was presented, and the patient would only be available for three days. The treatment would need to be completed by then. This really simplified our restorative treatment plan options. It was decided that our only choice, given time constraints, was using Sirona InLab Smile Design software in combination with CEREC (Sirona) CAD/CAM design and in-house milling. The orthodontist had already decided that restoring 11 and 21 was not feasible due to the poor restorative prognosis and were planned for extraction. As the impacted cuspids were approaching the central incisors, the cuspids were erupted in the position of the central incisors post extraction. The pegged lateral incisors were maintained to assist with orthodontic anchorage. Figures 4 and 5 show the final orthodontic position with 13, 23 in the position of (formerly extracted) 11 and 21. As you can see, there were tremendous restorative challenges due to asymmetrical proximal spacing, tooth size discrepancies, and asymmetrical anterior dental midlines. Due to severe time limitations, we didn't have the ability to do any pre-preparation wax-ups or diagnostic aesthetic evaluations.
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Fig. 7
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was roughly drawn with pencil and captured by the Omni cam on the facial surfaces of 31 and 41. This was to help confirm our smile design is accurate. Next, preparation margins were identified easily with CEREC’s auto margination feature as shown in Figure 10. The next step in our lab component with CEREC software is to upload the full face smile photo that we took after preparation of the teeth, and transfer the intercanthi width (far corner of eye to corner of other eye in mm) to calibrate the photo to the digital impression as shown in Figures 11 and 12. The full integration of the digital facial photo and digital impression is shown in Figure 13. The digital impression is guided into correct position by utilizing the software tools as seen in Figure 13. Once the integration was completed, the next step is an initial proposal by the CEREC software for four anterior crowns, 12 to 22.
Fig. 10
Fig. 8
Fig. 11
Fig. 9
Fig. 12
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Fig. 13
Fig. 15
There are many design tools that are used to adjust the shape, size, length and anatomic form of the restorations. These tools are very intuitive and as one becomes more experienced with design, their actions become second nature. Figure 14 shows the final design of the crowns to be superimposed and manipulated on the full facial smile design photo of the patient (Fig. 14). This photo can be grabbed and rotated three dimensionally in any direction to illustrate to the patient chairside (and the dentist) exactly what the 3D crown proposal setup is (Figs. 15 and 16). Each restoration can then be altered so that the midlines are straight and coincident to the facial midlines and the incisal length positioning can follow the lower lip line. Being
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Fig. 16
able to visualize the final proposal in his own smile was invaluable to the patient experience. Once the patient viewed this proposal, it was accepted and the crowns were milled. Figures 17 and 18 show the transparent restorations over the preparations. As one can see, the orthodontic asymmetries of tooth positioning was corrected in our CEREC crown design. This would not have been possible without the Smile Design software. The CAD/CAM ceramic block of choice was Vita’s Tri-Lux Forte. This block contains four layers of feldspathic porcelain built into the block. This mimics the labour intensive layering techniques that the lab artists (technicians) do for ultimate aesthetics. Figure 19 shows the stratified layers of
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Fig. 17
Fig. 18
Fig. 20
Fig. 19
g. 16
the block, which can be raised or lowered to alter the opacity and translucency of the milled crown. Figure 20 shows the untreated freshly milled crowns. Also visible is the natural chroma progression from gingival to incisal that is built into this block. Some incisal variations and texture characterizations were cut into the porcelain using a finishing diamond bur. The patient verified the shade and contours (this time intraorally) and the crowns were treated with surface glaze, fired in the VITA PM oven and polished for insertion. Figure 21 shows the completed restorations after cementation (with Ivoclar’s Multi-link and a self-etch technique using a yellow shaded cement, which warmed the overall value of the restorations), and final polishing of the margins.
Fig. 21
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Conta
Fig. 22
Fig. 23
Digital Timeline
As you can recall, the patient presented for the first time from the orthodontist. At that time, we took facial photos, prepped, and designed the crowns in a matter of two hours. The crowns were milled the next day for try-in, finalization, and insertion. This took a total of three hours. The grand total for this improbable task was completed start to finish in five hours, which included combined chair and lab time. This was an incredible result for our patient and an incredibly rewarding experience for the dentist. The true value as a restorative dentist was shown by our patient’s emotional reaction when seeing his new smile. This is the true power and versatility of digital dentistry.
Fig. 24
Conclusion
Final post-operative check of the restorations were done several months later when the patient returned to town for a visit , as shown in Figures 22, 23 and 24. Tissue response and healing were uneventful. This case was only possible given our timeline with the use of CAD/CAM dentistry and is a tremendous adjunct to our restorative practice.
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Dental Marketplace
Contact: Karen Shaw • tel: 416-510-6770 • fax: 416-510-5140 • e-mail: kshaw@oralhealthgroup.com Toll free: CDA 1-800-268-7742 ext 6770 • Toll free: USA 1-800-387-0273 ext. 6770
Practices & Offices SOUTHERN MANITOBA — ORTHODONTIC PRACTICE
WEST KOOTENAYS, BC
Well established practice with solid referral base. Spacious, modern office in free-standing building. 6+2 ops. Newer leaseholds. Ample parking with easy access. For more information, please contact ruth@heapsanddoyle.com ph: 604-220-4830 www.HEAPSandDOYLE.com
VANCOUVER, BC
Successful Prosthodontic practice. Vendor willing to stay on for longer term transition. Beautiful office with great views. 2+1ops. Strata unit available for purchase. Contact Ruth at 604-220-4830 or ruth@heapsanddoyle.com www.HEAPSandDOYLE.com
Successful practice in smaller Southern BC community. Associate buy in available. Spacious office with 5 ops. Nicely decorated with dedicated staff. 1600 active patients. Currently on a four day week. Great lifestyle! Call Ruth at 604-220-4830 ruth@heapsanddoyle.com www.HEAPSandDOYLE.com
TORONTO N.E.
Part time general practice and condo for sale. Owner retiring. 2 ops located in professional and commercial building. Toronto N. East. Contact Mrs. Nguyen 647-999-0475 Email: thuylilyng@gmail.com
COBOURG, ON
OSHAWA, ON
Busy dental office looking for a full or part time associate. No evenings or weekends and new graduates are welcome. Associate must be competent in root canal therapy. For more information please call: 905-372-6251 or e-mail: dentalv@bellnet.ca
SOUTHWESTERN ONTARIO Chaudhry Corporation is looking for dental associates for multiple practices in their southwestern Ontario offices. Part time and full time available depending on location. Please send resume to heatherconsorti@hotmail.com or you can call Heather at 519-732-0920
OSHAWA, ON Looking for a part time associate asap in an Oshawa office. Shifts are Tuesdays 1-9, selected Wednesdays 9-1, every other Friday and every other Saturday. We prefer an associate with minimum 2 years experience. We are a large office with the potential of more working hours in the future. E-dental: ocdental@rogers.com
TORONTO, ON
Busy and expanding downtown family clinic is looking for a general dentist, periodontist, implant specialist and a part time orthodontist. Please fax your resumes to 416-538-8422 or email to davidkourosh@hotmail.com
Associateships EXCELLENT ASSOCIATE OPPORTUNITY
Associateships
Progressive growing family practice in Oshawa is looking for an energetic, friendly, ambitious, caring individual for a part time associate position. For Thursday, Friday and alternating Saturdays starting in April. Please forward your resume to dentaloshawa@yahoo.ca
BRADFORD, ON Part-time associate needed for our Holland Square Dental Clinic, Monday’s, Thursday’s and Friday’s weekly. The clinic is 8 years old and has a wonderful staff that care about the community as a whole. We prefer a minimum of 2 years experience. Please send your resume to strouddental@rogers.com Attn: Denise.
EDMONTON, AB Great opportunity for a motivated associate with some experience. $80,000-$100,000 per month, in a beautiful office with new equipment and a great team. Current associate is moving to another province. Potential of earning up to 45% and longterm buy-in for the right candidate. Experience is an asset but not required. Please email: EdmontonDentalCareer@gmail.com
THOMPSON, MB
Westwood dental clinic in Thompson, MB team looking for experienced dentist full time or part time. Decent income plus accommodation . E-mail: westwooddental@hotmail.com
NEWMARKET, ON
Seeking Part-time associate for Monday and Wednesdays for our busy practice in Newmarket. Please email resume to: drcroppooffice@rogers.com
GRANDE PRAIRIE, AB
Full time associate dentist required for busy family practice. Looking for highly motivated associate. Our practice includes the latest in technology (IOC camera, digital x-rays, paperless etc.). Large existing patient base. Current associate moving, team in place to help. Please send resume to pmdcgp@telus.net 780-538-2992. MULTIPLE LOCATIONS IN ONTARIO Exciting full and part time associate opportunities available for Barrie, Mississauga, Stoney Creek, Etobicoke and Scarborough. We are also looking for an orthodontist. E-mail: yourdentaldream@gmail.com
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Associateships MULTIDISCIPLINARY DENTAL CLINIC IN BURLINGTON REQUIRES: Oral & Maxillofacial Surgeon 1 – 2 days per month to start. Orthodontist P/T This is an excellent opportunity in a well established, dynamic, privately owned practice, maintaining Type A facility permit, with 9 ops, 5 hygienists & 2 f/t dentists. Please email CV to guelphlinedental.andrea@gmail.com
SOUTHWESTERN ONTARIO We are a family dental office looking for a periodontist available to work once or twice a month. Please reply to: a.dascalu.ca@gmail.com
TORONTO, ON
Full time dental associate needed immediately for busy group practice in downtown Toronto. Seeking dentist who is comfortable with a fast paced environment. Excellent earning potential. Please forward your resume to: dentistrywithcare15@gmail.com
OTTAWA, ON
Modern Ottawa area 5 op. clinic with growth potential in need of an associate. We are well established and use the latest tech. The ideal candidate must be dynamic, passionate and enthusiastic. Reply: everythingdental613@gmail.com
Great opportunity of mentorship & partnership. Beautiful new office. We offer IV, GA, nitrous & conscious sedation. Ideal opportunity for someone seeking a balanced lifestyle. Email: vpdc@outlook.com
WHITBY, ON
GTA/HAMILTON/GUELPH, ON
Part time associate position for friendly office in Whitby. Experience a must. Great staff and relaxed environment. Please send resume to dentaljobs1801@gmail.com
PT/FT associates required. Family practices looking for family dentists to grow with our teams. Minimum 2 years experience required. Please send your resume to guelph@nortondental.ca
Large group practice(s) seeking self motivated dentists who enjoy above average remuneration. Positions available in great established locations in Calgary, Medicine Hat, Regina and surrounding communities that are all within driving distance to airports. Progressive and established clinics with strong patient base and excellent support structure. Shifts available for minimum 4 days on, 4 days off allow the right individual an opportunity to enjoy life and be very productive. Remuneration to be greater of guaranteed income, or percent collections. Experience with kids, surgery, endo and sedation an asset. Mentorship and buy-in opportunities available to right candidates. Email resume in confidence to: airdriedentist@yahoo.ca
CORNWALL, ON Part-Time position available in sophisticated office with excellent staff and team environment. Must be compassionate and maintain the highest quality standard of care for all patients. Hours: 2 days per week with growth opportunities. E-mail: dralma@dentistryatcornwall.ca
STONY PLAIN, AB Our progressive, paperless & high tech clinic is looking for an Endodontist and Periodontist. You will have an eager team to maintain your schedule, referrals & keep you linked to the region. We are 20 minutes from Edmonton. The ideal candidate will be a seasoned dentist who focuses on clinical excellence, patient rapport that is caring and informative, while still being production motivated. Position is available for September 2016. Will assist with relocation. Please email your CV to dentalspecialist8g@gmail.com
OWEN SOUND, ON
GTA – TORONTO, ON
Applications to be forwarded to drtimpringle@bell.net
We are seeking a Pediatric Dental associate for a well-established G.T.A practice. We provide a full scope of services, including oral sedation, general anesthetic, and emergent care for a large patient demographic. We provide a warm, and family oriented work environment, taking a team approach to eliminating anxiety for our patients and their families. Associates will enjoy excellent compensation, and opportunity for income growth. If you are committed to the comfort and quality care of each child like we are, please email: topediatricdent@gmail.com
Full time associate required for multi practitioner, progressive family practice. All facets of dentistry provided to all ages including E4D, implants, sedation, invisalign, crown and bridge, digital charting and radiography. Pleasant, supportive and well trained staff in a modern, welcoming environment . Applicant must be a positive, engaged professional looking for a permanent position. Enjoy above average earnings, and a professionally fulfilling career while enjoying an enviable relaxed year round lifestyle on Georgian Bay. Applicants are required to include references and CV. Those applicants selected for further consideration will be required for a working interview. Confidentiality is expected and assured.
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Full time associate required for Grande Cache Dental Care, located in the beautiful Rocky Mountains of Alberta. The successful applicant will be fully booked from day one. Must be comfortable with all aspects of general dentistry with special emphasis on diagnostics, restorative, oral surgery and endodontics. Strong communication skills are essential. No weekends or evenings required. High gross/net office. Associate can expect above average remuneration. Please email to: grande.cache.dental.care@gmail.com
VICTORIA, BC PAEDIATRIC DENTIST
SEEKING FULL TIME GENERAL DENTISTS AND AN ORTHODONTIST – AB and SK
GRANDE CACHE, AB
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Associateships
OKANAGAN, BC
CALLANDER BAY, ON
Fantastic 5 op state of the art practice with billings 1.3-1.5M. A beautiful office with natural daylight throughout. Use only the best equipment while enjoying fantastic views and a low cost of living. Superbly managed: fully digital/paperless, very profitable, excellent staff, efficient bookings & collections. Room for an associate with tremendous growth potential.
Associate required for busy established practice in Callander Bay. Multi-disciplinary, supportive, caring team. Clinic offers advanced dentistry complemented by specialist services. We are located 3.5 hours north of Toronto. Located on the shores of Lake Nipissing, this community offers a great lifestyle. Year round outdoor activities including boating, fishing, snowmobiling, skiing and camping. Great place to raise a family or to appreciate the outdoors. To discuss this opportunity contact Samantha Simpkin. Email resumes to nearnorthassociate@gmail.com
Contact Ron at mackenz@telus.net or (604) 685-9227.
AJAX, ON
Full Time/Part Time Associate wanted for a busy practice in Ajax. Must be experienced. Great Opportunity. Must be a graduate of an accredited North American University. Please email in confidence to hdentalresume@gmail.com
GTA Expanding group of dental offices in the GTA looking for experienced dental associates to join for PT position. Mail CV to careers@SabharwalDentalGroup.com
MILTON, ON
Associate Required Part-time Tuesday, Wednesday and Saturdays (9-2) with potential to go to full time. The right doctor will possess experience and ability in General dentistry. We are a high energy, fun office. The office is fully equipped with modern technology (Cone-beam, Planscan (crowns while you wait) etc…) Please email resumes to hawthornedental1@gmail.com
20 MINUTES WEST OF HAMILTON, ON Associate needed, 3-5 days a week to replace relocating associate dentist. Send resumes to brantford.dental@gmail.com
SASKATOON, SK DOWNTOWN DENTAL requires a fulltime or part-time Associate for our well established clinic in downtown Saskatoon. This is an excellent opportunity to work in a newly renovated, modern dental office with an established patient base and a great staff. The current position involves no weekends or evenings.The ideal start date would be fall 2016 – January 2017. Check us out at www.downtowndentalsaskatoon.ca Contact donna@downtowndentalsaskatoon.ca or 306-664-3555.
Bilingual Dental Associate – Full Time – 3-5 Days per week Dr. Nicole Brien – Children’s Dentistry Moncton, NB www.childrensdentistrynb.ca
A MONCTON DENTIST – SPECIALIZED FOR CHILDREN’S HEALTH Having been a trusted children’s dentist in Moncton for a number of years, we are set up to offer on-site hospital procedures so children can receive the most advanced care in an atmosphere they already know and are comfortable in. Our staff are friendly and our dental experts will work together to ensure that a child’s experience with us is positive, fun and educational. In our modern office, we offer a variety of amenities and age-appropriate sedation techniques for the more nervous children. Dr. Nicole Brien – Children’s Dentistry is seeking a General Dentist to join our fastgrowing well-established pediatric practice as a full time associate. The ideal candidate will provide services to children and medically compromised adults from all over New Brunswick. Mentoring with our Pediatric Dentist and with potential for future opportunities to work in an OR setting. The successful candidate must have excellent communication skills and warm personality and sense of humor a plus. New graduates welcome to apply. Possible prospect of buying into the practice. Benefits include: Hours: Mon – Thurs 8:00 am – 4:00 pm & Fri 8:00 am – 12:00 pm Remuneration – 45% pending
Please forward resume or direct inquiries to Kathy Kirkby 902-489-5514 or email kathy@healthqueststaffing.com
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