Wisdom

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Spr ing 2 0 09 • Volume 6 • Number 1

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Bioceramic Technology Cadent iTero Digital Impressions

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Public ation of the New Jerse y Ac ademy of General Dentistr y

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NJAGD Officers President Navin Boggavarapu, DDS, MAGD

President-elect Jeffery C. Linfante, DMD, FAGD

Vice President Haniel C. Rosemond, DDS, FAGD

Spring 2009 • Vol. 6 • No. 1

In this issue 3 4 5 6

President’s message In my opinion Trustee’s corner Protect Your Practice Sue Locke, Director of Consulting, Coaching-Solution.com

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Bioceramic Technology Kenneth Koch, DMD

Secretary Evan G. Wasserman, DMD, FAGD

Treasurer Michael Conte, DMD, FAGD

Editor Evan Spivack, DDS, FAGD

Assistant Editor Mark D. Robinson, DMD, FAGD

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Cadent iTero Digital Impressions Dr. Virginia Plaisted

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My Mercury Memory Gene F. Napoliello, DDS

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The Diminishing Practice Value Shirley Feuerstein

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Student Chapter in Full Swing Clinical tips from your colleagues

How to Contact Us National Trustee, Region 4 Manuel A. Cordero, DDS,MAGD

Regional Director, Region 4 Elizabeth A. Clemente, DDS, FAGD

Publisher Ettore Palmeri, MBA, AGDM, B.Ed., BA

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NJAGD WISDOM One Dental Plaza, North Brunswick, NJ 08902 Tel: 866-GO-NJAGD Fax: 732-821-1082

WISDOM is published by Palmeri Publishing Inc. 35-145 Royal Crest Court, Markham, ON L3R 9Z4 Tel: 905-489-1970 Fax: 905-489-1971 Email: ettore@palmeripublishing.com Design & Layout: Lindsay Hermsen, B. Des. Hon.

w w w. N J AG D . o r g Wisdom is published and mailed quarterly by Palmeri Publishing and the New Jersey Academy of General Dentistry, a constituent of the Academy of General Dentistry. Known office of Publication, 1718 Broadway S, Schenectady, NY 12306. Application to mail at Periodicals Postage Rates is pending at Niagara Falls, N.Y. 14304 U.S. Postmaster send address correction to Palmeri Publishing, Box 1068 Niagara Falls, N.Y. 14304. No portion of Wisdom may be reproduced without prior written consent from the NJAGD and Palmeri Publishing, Inc. The opinions expressed in Wisdom do not necessarily represent the opinions of the NJAGD and are not endorsed by the AGD. Advertisements in Wisdom do not indicate endorsement of any product or service by the NJAGD or AGD unless specifically stated. The NJAGD is an AGD Pace Approved Sponsor for FAGD/MAGD credit.

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President’s message

Happy New Year!

Best wishes for a very successful and prosperous 2009

Navin Boggavarapu, DDS, MAGD NJAGD President

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am pleased to announce that we have a new executive person, Felicia Conte, who will be working with us on various issues such as membership, public information and continuing education. If you have any ideas on any services you would want NJAGD to provide for you, or any particular CE that you think might be of interest to our members, or ideas to improve our membership, please forward your ideas to contenjagd@yahoo.com or call 856.217.1580.

I am also happy to announce that we are launching a new website for NJAGD. It is more user friendly and will better help you take advantage of all NJAGD has to offer.

Several board members from NJAGD attended the Leadership Conference in Chicago in November and gained a great deal of information. It was very encouraging to see young members and recent graduates getting involved with the AGD. One of the items stressed was teamwork and leadership. I encourage you to attend our board meetings, held in North Brunswick, and urge you to come and join the leadership. If you have any questions, please contact me at gentledental@verizon.net.

Our student AGD chapter is strong and vibrant. If you have time to present a one hour lecture for our student track at UMDNJ, please let me know. You can receive CE credits for the presentation while at the same time helping our students with your knowledge and valuable advice about dentistry in everyday “real” life.

Last but not the least, we need help putting this journal together! Please send us articles with interesting cases you have treated, a useful technique you learned, etc. If you need more information regarding this, please contact our editor, Evan Spivack, at spivacev@umdnj.edu. To provide you all with updates, we would like you to take a moment to fill out the Contact Information Update form located on Page 22. You may submit it to contenjagd@yahoo.com or by fax to: 732-821-1082. You may also log onto the website www.njagd.org to update your information under the Members tab.

In this trying economy, we as dentists are very fortunate to be in a profession that is very viable. Stay abreast with our CE program and do more for your patients. For upcoming courses, please visit the website njagd.org . Again, have a wonderful 2009!!!

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Felicia Conte

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In my opinion

Evan Spivack, DDS, FAGD NJAGD Editor

The Good Old Days?!

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ecently, it has become impossible to pick up a newspaper, turn on the radio or television, or even have a conversation without reference to the current economic crisis. The economy has taken center stage in our consciousness, and was a major focus of the November elections. Across society, everyone has felt its impact: the future is uncertain, morale is low and even the “experts” are struggling to keep their balance as the situation becomes ever more dizzying.

There has already been a decrease in demand for elective dental procedures as wallets have become leaner, and some practices that focus heavily on those procedures are hurting. In many respects, however, those in our profession are fortunate. Despite tumbling stock values, people will always have teeth that require maintenance, repair and/or replacement.

Much of what we do on a daily basis in caring for our patients is not elective—deferment of needs will only result in pain, infection and a downwards spiral of oral and even systemic health. Dentists recognize this, and many of our patients do as well.

It seems just yesterday that we heralded the present as a golden age of dentistry. Are times still so lustrous? Or do we need to look back to “the good old days” with wistful eyes? Perhaps the answer is both. True, there has been an undeniable global economic setback, but perhaps there is opportunity here, as well…the opportunity to refocus on the medical, healing side of dentistry. In years past, dentists always held a position of trust in the public eye, and earned that trust daily. Today, the dentist is often seen as just one more “service provider”, with slick advertising targeting not needs, but desires. Our motivation is more frequently questioned and our plans second-guessed by a public that is indeed better educated, but also more attuned to style over substance.

Research has shown numerous links between oral and systemic health, and the literature in this field is expanding daily. We now understand how important periodontal health is not just as the foundation for a healthy smile, but as a key component of a healthy lifestyle. It is our responsibility to get this message out to our patients (and those who should become our patients), in a loud and clear manner. As the public assimilates this new paradigm, they will begin to see that dental care is not optional, but essential.

It is not hard to envision the coming of yet another “golden age” that harks back to the medical and need-based model of the past while utilizing a futuristic arsenal of technological and pharmacologic means. We have at our disposal lasers, computers, imaging systems, biomaterials, drugs, assays and—most importantly—the knowledge of how to best utilize them. Our patients should be made aware of what dentistry has to offer them, and why the not only want that care, they need it.

Although we do not know when, we can be assured that the economy will recover. When it does, our profession will be there as strong as it ever was. And perhaps, if we take advantage of the opportunities afforded to us in this time of crisis, we will emerge even stronger.

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Trustee’s corner

Manuel Cordero, DDS, MAGD National Trustee Region 4

We Have Fallen Upon Difficult Times...

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ntering 2009, we realize that we have fallen upon difficult times. For our profession, the spiraling economy and issues regarding access to care are just some of the problems that we must endure.

The Academy of General Dentistry has been facing similar challenges due to the effects of a dwindling economy and shrinking membership. It is now when our participation in organizations like the AGD proves to be most critical. The Academy has followed the selfless need of the dental profession by always acting in the best interest of our patients. We have provided the ultimate in CE to continue our relentless pursuit of eliminating the carious process as well as preventing pathologic conditions that affect the overall health of the community. Our global approach to dentistry has helped create an awareness of the link between oral health and overall health and well-being.

Within the last two years, we have confronted the periodontic referral guidelines and more importantly, the access to care issue. When the American Academy of Periodontology referral guidelines were published, we as general dentists were shocked. Many of the periodontists who have worked with us for many years were also surprised by the guidelines. As a member of the American Dental Association and a strong believer in the tripartite system, I expected the ADA to stand strong with their own set of guidelines on referrals, and prevent the AAP from publishing a dissenting guideline. Instead they remained silent and the AGD became involved. Shortly after, the issue was resolved through a mutual understanding between the AAP and the AGD. Not long after, dentistry was confronted with a JADA editorial on access to care and the ADA’s new approach to this problem. This became a defining moment for the AGD. The Academy came to realize itself as the only organization concerned about the future of the general dentist as well as the community that we treat. Access to dental care is highly problematic nationwide. The American Dental Association feels that a new tier of health care provider, similar to the nurse practitioner in medicine, would benefit the public. While the ADA feels that creating a new level of provider to deal with a perceived shortage of providers is the answer, the AGD perceives the problem more as a lack of awareness and funding.

The AGD published a white paper on access to care, which may be accessed through the AGD website

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(www.agd.org). This document takes a clear and defined stand against unqualified individuals providing dental care for poor Americans with the greatest needs.

In many cases the programs to provide needed dental care are already in position; often, however, they need more support and better delivery strategies to achieve success.

One of the most effective and innovative ways to deal with the access to care issue is the model in which dental schools are providing training to dental students in community- based centers. There, they can expand the dental experience of the students while taking care of the community’s oral health needs. UMDNJ-New Jersey Dental School participates in such a program in several sites throughout New Jersey.

On another front, at the AGD international level, we have reduced the time for CE recording while at the same time experiencing management changes and challenges. Our executive director, Christie Tarantino, resigned from our organization December 19, 2008 after four years on the job.

Unfortunately, we also lost some directors right around the time of her departure. This complicated matters to a certain extent, but also provided the Academy with an opportunity to refocus our energy and attention on the needs of our members. The Executive Committee has been diligently gathering information and looking at prospects for the executive director’s position.

The Academy has been working on making its website more user-friendly. The site is www.agd.org. We have launched our knowyourteeth.com, a new tool in our communication with the general public that helps to answer their dental questions and oral health concerns. Self instruction was also a great success after its introduction of eight exercises for the price of six, as was advertised in AGD Impact. I would also like to take this opportunity to remind you of the incredible library of downloadable marketing material available on the AGD website.

As a final note, I would like to welcome the new executive staff person for the NJAGD, Mrs. Felicia Conte. She has joined the NJAGD family to create the environment that we need to serve our members and strengthen our beloved profession. You may contact her by phone (856-217-1580) or through email (contenjagd@yahoo.com) As always you can contact me at dentalmac@gmail.com or 856-589-8533.

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Sue Locke, Director of Consulting, Coaching-Solution.com

Protect Your Practice with Strong Systems & Controls Let’s begin by saying the obvious, “An ounce of prevention really is worth a pound of cure!”

oaching Solutions believes strongly in each of our clients, and we do our best to support success on many levels. Cantilevered systems and controls in every aspect of your practice will help safeguard you and your practice.

While the subject of fraud and theft in the dental office is not a pleasant one to ponder, your awareness and involvement in the daily business aspects of your practice is critical in protecting you on every level. It must also be said that honest mistakes happen, and having good systems that you review will alert you to taking care of things in a timely manner. Evaluating your business and administrative areas, identifying weak areas and overhauling your internal control systems will go a long way in bringing security to your practice.

For example, bank reconciliations need to be done on a monthly basis. Your bank statement balance should tiein to the penny, with the cash balance your computer system has at month end. We have seen honest errors made, like a posting to QuickBooks for $3,000.00, when in fact a bank deposit was made for $30,000.00. This honest but undiscovered error, ultimately led to an under reporting of income to the IRS, and set off an audit.

We have also uncovered a dishonest employee who had control of payroll. She called in the hours worked to a payroll service, had direct deposits set up, and would intermittently give herself an “extra” week of vacation pay! The owner never questioned her or looked at his payroll reports.

Credit card processing must also be monitored. End of day receipts will show you every activity that has happened on your account that day. It should tie-in to your day sheets, showing you what was paid and by which patient. We have also found people who used the

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machine to give their accounts credits, as well as maneuver funds on your books to show accounts paid, and manage to keep money for themselves.

Alan M. Schiff, CPA, CFE, a founding member of the Academy of Dental CPA’s, (www.schiffcps.com), tells us that even with controls in place, the single largest deterrent to theft in the dental office is the belief that you will be caught and punished. Your team needs to know that you review your end of day sheets, look at accounts receivable, and keep abreast of your business details.

One of the best ways to avoid fraud and theft is to hire the right people. Most of you have chosen to implement a strong Human Resources manual, and, also use the guidelines we recommend in The Seven Steps to Successful Hiring Manual. (If you do not have this manual, please call Sandy Budinsky at 856-786-4814).

All potential employees should be interviewed several times and you MUST check references. Potential employees should be willing to take a drug test, have a criminal background and credit check, and be willing to take assessments for employment. Preventative measures are well worth the cost. Please call us if you need help in any of these areas.

Unfortunately, we have uncovered embezzlers in practices who were trusted employees, tireless workers, never took vacations and worked uncompensated overtime because they were “dedicated” to their jobs.

Even more unfortunate, the doctors/owners of the practice never really looked at their books or took time at the end of a busy day to make sure everything balanced out perfectly. The real responsibilities lie with you to make sure your employees know that you check and double check everything, and hold people responsible to have an accurate accounting of all transactions.

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Let’s do an inventory of Present Office Internal Controls 1. Does the person responsible for preparing checks have check signing ability?

2. Does the person paying the supplier invoices approve purchase orders?

3. Does the person who takes the daily deposit to the bank prepare the deposit?

4. Does the person who prepares and reviews the monthly patient statements also mail them?

5. Does only one person open the mail? Does that person have charge of Accounts Receivables?

6. Does the person who does payroll (or calls in payroll) distribute the checks?

7. Does the employee in charge of patient billing and accounts receivable have authority to write off errors?

8. Do patients complain about billing errors or bills they say are paid and show as open?

9. Do you use your end of day credit card transaction log receipt as part of your end of day tie-out process and match it to your patient appointment log? (Note: All patients, including those who cancelled that day, need to be accounted for.)

10. Do cash transactions get recorded and deposited the same day with a computer receipt for the patient and the office?

11. Do you review and audit your end of day reports daily?

If you answered “yes” to questions 1 through 8, you are at risk and controls should be put into place to protect everyone, including honest and hard working

employees. If you answered “no” to questions 8 through 11, you can begin to tighten your security now.

A “Daily Protocol Checklist” can be implemented to insure that the proper systems and procedures are being adhered to by your staff. Please call our office if you would like a copy of a “Daily Protocol Checklist”.

In summary, it is up to you, the owner of the practice, to gain clarity on what is happening in the business of your business.Remember, t he fact t hat you are a good clinician will not protect you from becoming a victim of loss or theft. Orchestration of complete and through systems and controls, along with daily follow-up, will set a new standard that will foster a strong foundation for your day to operations.

Coaching Solutions Dental Consulting offers experienced professionals who will customize a powerful in-office coaching program designed to help you achieve financial stability and develop your personal practice.

We offer a “PAY-AS-GO” program that will support your budget so you can get the help you deserve.

Call today: 856-786-4814 www.Coaching-Solution.com

About the author Sue Locke has been the Director of Consulting and Vice President of Coaching Solutions since 1999. Sue’s professional consulting experience is top notch. She develops consulting materials for Coaching Solutions and consults on leadership, DISC, communication skills, office policy and behavior, case presentation, personal life skills, and principles of success.

Sue integrates personal counseling and professional coaching to create transforming experiences for dentists and their staff.

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Bioceramic Technology -

Kenneth Koch, DMD

A Game Changer in Endodontic Obturation ecently, we have seen a great rush to condemn teeth and place implants among both general dentists and specialists. While t hese recommendations may be somewhat questionable, we want all clinicians not to forget the many benefits that well done endodontics can bring to their patients.

Furthermore, this desire to have dentists understand the benefits of good endodontics is critical to having the natural tooth remain a key component of restorative dentistry. Fortunately, over the past two decades, new techniques and technology have been developed which allow t he major ity of dentists to perfor m better endodontics. Significant among these changes is the introduction of advanced material science. However, it has only been recently t hat we have witnessed significant changes in endodontic material science. The good news is that the arena of endodontic material science is continuing to evolve and, in fact, the game has changed. The game changer is the increased use of bioceramic technology in endodontics; more specifically in endodontic obturation.

It has been a continuing goal of Real World Endo to develop products and techniques that will deliver excellent endodontic results in the most efficient manner. Furthermore, it has been an additional goal to design these techniques in such a manner that the greatest majority of practitioners will be able to perform these procedures successfully and in a predictable manner.1 The basic EndoSequence file system has given all clinicians the ability to machine predictable shapes that ultimately lead to synchronicity between the preparation and the master cone fit. Embracing this concept of synchronicity, and taking it to a more sophisticated level in obturation are sealer based obturation systems such as the Activ GP Obturation System and EndoSequence BC Sealer (Brasseler USA, Savannah, Georgia).

Activ GP is a system which utilizes improved glass ionomer technology (both as a sealer and as a special glass ionomer coated gutta percha cone) to create a true single cone obturation. This is very significant because a true single cone technique will allow us, for the first time, to create a hermetic seal (or as close to a hermetic seal as possible) within the root canal space.

A hermetic seal has been a goal of endodontics for

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more than fifty years. Furthermore, a true single cone technique is a method that is now clinically achievable a s a r e s u l t o f i mp r ove d m a t e r i a l s c i e n c e . M o st impor tantly, such a technique (when perfor med properly) will give the greatest percentage of clinicians (due to the ease of technique) the ability to produce superior obturation results.2 In fact, in a study published in t he Jour nal of Endodontics in 2008, Fransen et. al. at Baylor University compared the sealing ability of single cone Activ GP wit h glass ionomer sealer to t he war m ver tical compaction of gutta percha with AH Plus sealer and to the warm vertical compaction of Resilon with Epiphany sealer. Their conclusion was, “In summary, there were no statistically significant differences for any of the parameters tested between the three obturation systems tested. Based on these results, the single cone Activ GP /GI sealer system has potential as an obturation system to provide a seal comparable to that achieved with other popular obturation systems.”3 Also Russell and his colleagues at Fort Bragg (US Army) conducted “a study utilizing a fluid filtration method which showed no statistically significant difference in leakage between the Activ GP Obturation system and gutta-percha (and AH Plus sealer) using a warm vertical continuous wave of condensation technique.”4 These two non sponsored studies are offered as evidence that a single cone obturation technique can be very effective if performed properly and with the correct materials. However, gaining acceptance for a true single cone technique has taken a number of years and has had its challenges.

In the original pursuit of achieving a hermetic seal in endodontics, glass ionomer (Ketac Endo) was selected because of its superior biocompatibility and its physical properties. However, a problem historically with the early generations of glass ionomer, and resin sealers, was t hat neit her met hod was able to develop a tr ue monobloc. Although there were advocates on both sides of the argument, research showed that both the glass ionomer and resins sealers each had some advantages and some limitations. However, one thing that both the resin and glass ionomer advocates could agree on was that obturation was headed in the direction of sealer based techniques rather than the mechanical packing

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and melting of gutta percha. This made sense from both the technical and science sides.

It is also very interesting to see how the two materials differed. The resins were shown to have a good seal between the sealer and the gutta percha cone but their seal to the canal wall was questionable. The glass ionomer cements, on the other hand, displayed an excellent seal to the canal wall but their seal to the gutta perha was less than ideal. So as the 20th Century came to a close, we still found ourselves searching for a technique t hat could consistently deliver a tr ue monobloc obturation.2 Activ GP obturation is, in fact, a single cone technique that requires a minimal amount of sealer, rather than the excess that is utilized in other methods. This is because the system is precision based. As previously mentioned, precision-based endodontics requires accuracy between the file and the master cone. Similar to the regular EndoSequence gutta percha, all Activ GP points are laser verified (and calibrated) to precisely match the preparations made by the .04 or .06 tapered EndoSequence file system. The precision matching of the primar y cone to the preparation (endodontic synchronicity) is very important with any single cone technique because the accuracy of the cone fit to the preparation minimizes the amount of sealer and any dimensional change. Although dimensional change can occur with all sealers, glass ionomer is very stable and does not shrink. Furthermore, due to the predictability of shape associated with constant tapers, it may be stated t hat a tr ue single cone technique should be accomplished with a constant tapered preparation such as a .04 or .06. A variable taper technique is not recommended because its lack of shaping predictability (and its corresponding lack of reproducibility) will lead to a less than ideal cone fit. This lack of endodontic synchronicity is why all variable taper preparations are associated with thermoplastic techniques.

While glass ionomer has been a huge help in establishing a true single cone filling technique, there has always been those practitioners who question the handling character istics of glass ionomer. While respecting t hose questions about handling characteristics, the obturation equation has further changed wit h t he introduction of a new mater ial…..bioceramics. This new bioceramic technology is the basis of EndoSequence BC Sealer. But, before we discuss how this specific sealer is changing obturation, we need to address some of the merits associated with bioceramics.

The first question we need to ask ourselves is, “What are bioceramics?” Bioceramics are ceramic materials specifically designed for use in medicine and dentistry.

They include alumina and zirconia, bioactive glass, glass ceramics, coatings and composites, hydroxyapatite and resorbable calcium phosphates, and radiotherapy glasses.5,6,7 There are numerous bioceramics currently in use in both dentistry and medicine, although more so in

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medicine. Alumina and zirconia are among the bioinert ceramics used for prosthetic devices. Bioactive glasses and glass ceramics are available for use in dentistry under various trade names . Additionally, porous ceramics such as calcium phosphate based materials have been used for filling bone defects. Even some basic calcium silicates such as ProRoot MTA (Dentsply) have been used in dentistry as root repair materials and for apical retrofills.

However, we must ask ourselves again, “What are the advantages of bioceramics in dental applications?”

Clearly the first answer is related to physical properties.

Bioceramics are exceedingly biocompatible, non – toxic, do not shrink, and are chemically stable within the biological environment. Secondly (and this is very important in endodontics) bioceramics will not result in a significant inflammatory response if an over fill occurs during the obturation process or in a root repair. A further advantage of the material itself is its ability (during the setting process) to form hydroxyapatite and ultimately a bond between dentin and filling materials.

While the properties associated with bioceramics make them very attractive to dentistry, in general, what would be their advantage if used as an endodontic sealer? From my perspective as an endodontist, some of t he advantages are: enhanced biocompatibility, possible increased strength of the root following obturation, high pH (12.9) during the setting process which is strongly anti-bacterial, sealing ability, and ease of use.8 The introduction of EndoSequence BC Sealer allows us, for the first time, to take advantage of all the benefits associated with bioceramics but to not limit its use to merely root repairs and apical retrofills. This is possible because of recent nanotechnology developments (the particle size of BC Sealer is so fine, it can actually be used with a capillary tip). When viewed in the overall context of obturation techniques, EndoSequence BC Sealer is a game changer.

Furthermore, this material has been designed as a non-toxic calcium silicate cement that is easy to use as an endodontic sealer. In addition to its excellent physical properties, the purpose of BC Sealer is to improve the convenience and delivery method of an excellent root canal sealer while simultaneously taking advantage of its bioactive characteristics (it utilizes the water inherent in the dentinal tubules to drive the hydration reaction of the material, thereby shortening the setting time). Dentin is composed of approximately 20 % (by volume) water 9 and it is this water which initiates the setting of the material and ultimately results in the formation of hydroxyapatite.

For clinical purposes, the advantages of a premixed endodontic cement (sealer) should be obvious. In addition to a significant saving of time and convenience, one of the major issues associated with the mixing of any cement, or sealer, is an insufficient and non homogenous mix. Such a mix may ultimately compromise the benefits associated with the material.

Keeping this in mind, BC Sealer has been designed as a

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premixed bioceramic sealer that hardens only when exposed to a moist environment (such as that produced by the dentinal tubules).

The technique with this material is straightforward.

Simply remove the syringe cap from the EndoSequence BC Sealer syringe. Then attach an Intra Canal Tip of your choice to the hub of the syringe. The Intra Canal Tip is flexible and can be bent to facilitate access to the root canal. Also, because the particle size has been milled to such a fine size, a capillary tip (such as a .014) can be used to place the sealer.

Following this procedure, insert the tip of the syringe into the canal no deeper than the coronal one third (1/3). Gently and smoothly dispense a small amount (1-2 calibration markings) of EndoSequence BC Sealer into the root canal by compressing the plunger of the syringe. Using a #15 hand file or something comparable (such as the master cone), lightly coat the canal walls with the existing sealer in the canal. Then coat the master gutta percha cone with a thin layer of sealer and very slowly insert it into the canal. The synchronized master gutta percha cone will carry sufficient material to seal the apex.

The precise fit of the EndoSequence gutta percha master cone (in combination with a constant taper preparation) creates excellent hydraulics and, for that reason, it is recommended that the practitioner use only a small amount of sealer. Furthermore, as with all obturation techniques, it is important to insert the master cone slowly to its final working length. Finally, here’s more good news. The glass components in the bioceramic sealer bond to the Activ GP glass ionomer coated cones. So in essence what we have is a bond to the canal wall as a result of the hydroxyapatite that is created during the setting reaction and we also have a bond between the ceramic particles in the sealer to the ceramic particles in the glass ionomer coated cone (Activ GP). In a sense, the bioceramic cement, with its ease of use, can replace the glass ionomer sealer.

The following five cases evidence the importance of maintaining endodontic synchronicity, particularly when doing a single cone technique. Also, please notice the radiopacity of BC Sealer. It’s excellent.

Case I

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4 canal mandibular molar (courtesy of Dr. Ali Nasseh)

Case II 3 rooted maxillary premolar (courtesy of Dr. Ali Nasseh)

Case III mandibular molar with a large mesial curvature (courtesy of Dr. Ali Nasseh)

Case IV

retreatment of BC Sealer case. Yes, BC Sealer is readily retreated. (courtesy of Dr. Ali Nasseh)

Case V maxillary molar with obturated palatal delta demonstrating how BC Sealer can fill three dimensionally (courtesy of Dr. Alex Fleury)

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EndoSequence BC Sealer in combination with Activ GP cones creates an excellent single cone obturation technique. But, when we talk about a true single cone technique let’s think about what this really means. The easiest way to comprehend this is to compare a single cone technique to carrier based methods. Recently, many in the endodontic community have come to the conclusion that excessive coronal enlargement (of the radicular dentin) can adversely affect the long term prognosis of a tooth. While various thermoplastic techniques have contributed to the problem of over enlargement of the radicular dentin (and subsequent weakening of the tooth), the recent use of carrier based obturation (both gutta percha and Resilon) has also resulted in wider than ideal orifice enlargement. The rationale behind this is again quite simple. The larger the hole at the top of the canal, the less likely it is to strip (denude) the carrier of gutta percha (or Resilon). This has been one of the challenges associated with carrier based obturation (stripping the carrier at the orifice during insertion).2 Certainly, one can get good obturation results with carrier based techniques (as with other methods) if done properly, but this issue of stripping a carrier remains a significant one in endodontics. In these techniques, you heat the obturator and then insert it into the tooth, delivering it to a point just shy of the working length.

Basically, you are using a hard plastic carrier to deliver heated gutta percha, or resin, into the root canal system.

In addition to the concern of stripping (or denuding) the carrier of gutta percha (or resin) when inserted, is the lack of apical control that is the result of using heated gutta percha or resin. This concern about stripping the carrier at the orifice is often addressed by simply making the hole larger at the top of the canal. This will not work long term. However, the concept of filling a root canal with a device that you can “feel” is attractive. It is essentially the same with an Activ GP cone and BC Sealer, but with a few differences. Again think what you are doing. You are, in essence, using a stiff carrier (but one that is actually a stiffer gutta percha cone, not a plastic carrier) to deliver a non shrinking bioceramic sealer into the root canal system. So while you get the “feel” of a carrier based technique, you have the advantage of using gutta percha as a carrier to deliver sealer. After all, it is the sealer that creates the seal in obturation, not heated gutta percha (which shrinks significantly when cooled).

Additionally, post preparation will be a lot easier because you are now removing gutta percha not cutting plastic. It just makes sense!

In this article, we have introduced a new bioceramic sealer (EndoSequence BC Sealer ) that when combined with Activ GP cones offers an exciting new obturation technique. The excitement is a result of the physical properties associated with bioceramic technology as well as the incredible ease of use. We now have a true, three dimensional single cone technique that will allow a much greater percentage of dentists to get outstanding obturation results. EndoSequence BC Sealer is a game changer!

NJAGD wisdom

References 1. Realworldendo.com 2. Koch K, Brave D. A New Endodontic Obturation Technique Dentistry Today May 2006 Vol 25 No.5 pg.102-107 3. Fransen J.N., He J., Glickman G. et al. Comparative Assessment of Activ GP /Glass Ionomer Sealer, Resilon/Epiphany, and Gutta —Percha/AH Plus Obturation: A Bacterial Study J Endo June 2008 Vol. 34, No.6 pg.725-727 4. Russell G.S., Mineo P., et al. A Fluid Filtration Comparison of Gutta- Percha Versus Activ GP, A New Root Canal Obturation System J Endo March 2007 Vol. 33 No. 3 pg.355 5. Best S.M., Porter A.E., Thian E.S., Huang J., Bioceramics: Past, Present and for the Future, Journal of the European Ceramic Society 28 (2008) 1319-13 6. Dubok V.A., Bioceramics Yesterday, Today Tomorrow, Powder Metallurgy and Metal Ceramics, Vol.39, Nos.7-8 (2000) 7. Hench L., Bioceramics: From Concept to Clinic, Journal Amer. Ceram. Soc., 74(7) 1487-1510 (1991) 8. Hichman K., Bioceramics, April 1990 http://www.csa.com/doscoveryguides/archives/bceramics.php#editor 9. Koch, K., Brave D., A New Day has Dawned: The Increased Use of Bioceramics in Endodontics Dentaltown, March 2009 10. Pashley D. H., Dynamics of the Pulp Dentin Complex, Crit Rev Oral Biol Med 7(2):104-133 (1996)

About the author Dr. Ken Koch received both his D.M.D. and Certificate in Endodontics from the University of Pennsylvania School of Dental Medicine. He is the founder and past Director of the New Program in Postdoctoral Endodontics at the Harvard School of Dental Medicine. Prior to his Endodontic career, Dr. Koch spent ten years in the Air Force and held, among various positions, that of Chief of Prosthodontics at Osan AFB and Cheif of Prosthodontics at McGuire AFB. In addition to having maintained a private practice, limited to Endodontics, Dr. Koch has lectured extensively in both the United States and abroad. He is also the author of numerous articles on Endodontics. Dr. Koch is a co-founder of Real World Endo.

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Dr. Virginia Plaisted

Cadent iTero Digital Impressions – The newest tool for everyday use in the dental practice here was a time when the fastest high-speed handpiece only went 3,0 0 0 r pm’s. The air turbine handpiece was introduced to dentistry i n t h e 19 5 0 ’ s , w h i c h s p e d u p t h e h i g h - s p e e d handpiece to 400,000 rpm’s. I’m sure dentists were thrilled with the change. Now, we can’t even imagine practicing dentistry without high-speed handpieces.

Fo r d e n t a l l a b o r a t o r i e s , t h e l a st 10 ye a r s h ave revolutionized the standard PFM into highly esthetic, p r e c i s e f i t t i n g C a d / C a m r e st o r a t i o n s . D e n t a l professionals, both dentists and dental laboratory technicians are embracing change in nearly every part of their practices.

In my practice, taking predictable, accurate impressions and bite registrations has always been one of the more difficult procedures to perform consistently.

Did the patient hold still while the impression and bite were setting? Did I miss any tears, voids or pulls when reading the impression? Will the lab be able to read the margins? Even as advances in impression materials have improved, the patient variables continue to offer daily challenges in most practices. As technology advanced from improved dental impression materials to digital impression systems I’ve been able to once again take the quality, accuracy and esthetics of my crown and bridge practice to the next level.

Since the day the Cadent iTero Digital Impression System was installed in my office, it has been used numerous times every day. My partner and I use the iTero for all of our crown and bridge, veneers, inlays and onlays. We can’t imagine going back to the trays, goopy impressions, bite registration material, and let’s not forget the clean-up of these materials. In addition, the lab work that is returned for insertion is so accurate that these appointments are consistently much shorter.

There is nothing like the feeling of inserting a crown with a perfect fit. Just recently, I was able to complete ten crowns (six Zirconia and four PFM) in two visits. All of these crowns had perfect margins and interproximal contacts. (fig 1, 2, 3)

T

12

Integrating iTero Into The Practice Integrating digital impressions into my practice was as easy as the first day I wore loop magnification to complete my preparations. Having Cadent trainers well versed in the total office team concept made the learning curve for this new technology extremely fast for everyone.

Although the crown preparation appointment has changed in my practice, with iTero the new procedure is simple to learn. The handheld scanner of the iTero used to obtain the digital images is guided by voice, written word, and visual prompts. The scanner acquires the images needed to create the precision milled models for the lab within 2-5 minutes. (Fig 4) With iTero there is no powder required in any clinical situation, resulting in a faster and highly accurate digital impression process. I can deter mine if I have captured what I need immediately and can add scans of any image if needed. iTero also visually indicates whether there has been enough occlusal reduction. My patients greatly prefer t his to t he uncomfor table, goopy, bad-tasting impressions of the past. For my patients with a highly sensitive gag reflex the ability to easily start and stop at any times reduces their anxiety and improves my ability to take a quality impression. The auxiliaries enjoy the decreased clean up in the room, ease of infection control, and decreased time in the lab. In addition, it is always a joy for everyone in the office when the crowns seat quickly, easily, with usually no adjustments.

The clinical and practice management advantages of iTero digital impressions include: • The iTero does not require powdering the teeth • There are no limitations on the type of crown and bridge materials that can be used.

• Sub-gingival impressions can be taken digitally when using a double cord technique for tissue retraction. If you can see the margin, the scanner can digitally capture it.

• The real-time images are magnified, so problems with the impression or preparation are immediately apparent, such as moisture, blood, or tissue covering a margin.

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• The impression procedure can be stopped and started at any time for the comfort of the patient or to achieve moisture control. • Adequate occlusal reduction is clearly indicated • The models are milled from polyurethane and are much more accurate and durable than stone models • The chair time for the seating appointment is usually dramatically reduced • The final prosthesis has a consistently improved fit • The cost of the iTero is reasonable and will more than pay for itself by decreasing time and material expenses.

Technology is closing the gap between the art and science of dental impression taking. As scientists, we are always seeking the knowledge and skills to improve our dentistry.

Leaping into the science of digital impression taking has brought a new level of clinical results, patient satisfaction, and excitement to my practice each and every day.

Fig 2: Precision milled models allow for the fabrication of restorations with highly accurate margin integrity and nearly perfect interproximal and occlusal contacts.

About the author After receiving her Doctorate of Dental Surgery, Dr. Plaisted relocated to Albany where she hase been practicing dentistry for over 20 years. She is an active member in the ADA, AGD, AACD and the local Dental Society.

Fig 1: Pre-operative view of the mandibular arch.

Fig 3: Post-operative restorations provide the foundation for the treatment plan.

Fig 4: Scanning With iTero. The wireless foot pedal allows the clinician to operate the system utilizing only one hand for the scanner wand.

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13

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Gene F. Napoliello, DDS

My Mercury Memory Our AGD members are about more than dentistry. Do you have an interesting story to tell?

Or do you know a colleague who does? If so, please contact the editor at spivacev@umdnj.edu

I

it as a parts car for another ‘51 Mercury convertible I’m restoring.” I visited Sam and offered him my AACA Preservation Merc in exchange for his two cars. We settled on the good car for cash, and I kept my Merc as a back up parts source for the 1951 Mercury convertibleextreme make over-restoration.

Over the next five years, I filled my spare hours searching for parts and patiently assembled my dream car at my dental office garage in Bloomfield, New Jersey.

Fellow AACA member, Al Smeraldo, with help from my godson, Mark Szep, supervised the restoration process.

My dental laboratory also assisted by fabricating a custom vent window hinge using chrome cobalt steel.

Some of my patients, for whom I was providing somewhat different restorations, kept my spirits up by cheerfully inquiring, “Hey Doc, when are we going for a ride in the Merc?”

Parts and expertise was provided by many others over the course of the restoration process. It was a pleasure and learning experience watching each step move the car closer to its original glory. In the end, this team of exper ts and I had created an aut hentic factor y restoration by using original Mercury parts, manuals, and literature. But the total cost was twice my original estimate, so to acquire the needed funds, my wife, office manager, long time mentor, Lucille, and I taught dental assisting skills to high school students on my day off.

14

NJAGD wisdom

n 1975, my son David brought home a plastic1950 Mercury model car. This flashed me back to 1968 when I was a student in dental school. I had owned a 1950 Merc coupe which I sold to my brother-in-law Tony for $75, just before enlisting in the Air Force. Now, I wanted more than David’s model. I wanted that car that I had let go and wished I could get back. Knowing nothing of the Antique Automobile Club of America, I searched locally and found a four-door 1951 Mercury sedan. Close enough, I thought, as I started the fantasy trip which led a quar ter centur y later to a Grand National winner.

Slowly, over a ten year period, I restored the sedan.

After three attempts, the car won AACA awards: a junior in 1986, a senior in 1987, and later a preservation award.

While I received many compliments, I also heard the proverbial “but it’s not a convertible.” What car owner hasn’t heard this or deep down yearned for the dream rag top? I committed to the challenge and started a search at the Hershey, PA car show, Mercury parts dealers nationwide, and in every junk yard I passed.

Fast forward seven years to 1993 and to a tempting Hemmings Motor News ‘51 Mercury advertisement. I called, but was told “I just sold the car to a fellow in Massachusetts.” By the time I tracked down that Bay Stater, Sam Gagliano, I figured he would have lost interest. “Yes, I have the car,” he replied, “but I’m using

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Figure 3: After Restoration

Figure 1 & 2: Before Restoration

In 1998 and 1999 the car won both Junior and Senior AACA awards at the annual Hershey fall car show and in 2000 an AACA Grand National Award at Montoursville, PA. At the awards dinner, Al Smeraldo and I dined with Judy and Earl D. Beauchamp, Jr., vice president for senior car awards. We discussed the idea of starting an AACA region in Vermont where I now owned a second home.

With Earl’s guidance and two dozen of Ethan Allen’s automobilists, t he Green Mountain Region was chartered in February 2003.

Under the continuing tutelage of Ron Westwood, I joined the Early Ford V/8 Club of America. My ‘51 Mercury convertible received this club’s Dearborn Award at the Vernon Downs car show in July 2002. The car also won two “Best of Show” awards from the Vermont Automobile Enthusiasts car club’s Stowe 2000 and Shelburne 2001 car shows.

Thank you, Antique Automobile Club of America, Early Ford V/8 Club, Vermont Automobile Enthusiasts Club, restoration participants, and family for the past quarter century journey that led to a “Green Mountain Top Experience” for me.

NJAGD wisdom

www.paragon.us.com

866.898.1867

Sujithra Rajagopalan, D.D.S. has acquired the practice of

Shreedevi Thulasidas, D.D.S. Milltown, New Jersey We are proud to have represented both Dr. Rajagopalan and Dr. Thulasidas in this practice transition.

Shirley Feuerstein 908.868.9330 (cell) 908.222.0199 (office) shirley@paragon.us.com

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NJAGD Continuing Education Courses

Registration Application Name____________________________________________________________________________________________________________________ (Last)

(First)

(Middle Initial)

(Degrees)

Mailing Address ____________________________________________________________________________________________________________ (Street Address)

(P.O. Box, if applicable)

________________________________________________________________________________________________________________________ (City)

(State)

(Zip)

(Country)

________________________________________________________________________________________________________________________ (Phone: Area Code and Number)

(Fax: Area Code and Number)

Friday Saturday, April 24 26, 2009

Members

Non Members

Masters TrackCourse in Endodontics $1050.00 $1400.00 Presentation by Dr. Ken Koch Location: Echo Lake Country Club/Westfield NJ Registration: 8:00am Course: 8:30am 4:30pm (Fri/Sat) / 8:30am 12:30pm (Sun)

Wednesday, May 13, 2009

(Email)

AIM “Light” $475.00

Members

Non Members

AIM “Light”

$195.00

$225.00

$99.00

Restorative Science / NJAGD Annual Meeting Presentation by Dr. Dan Nathanson Location: The Pines Manor, 2085 Rt 27, Edison, NJ 08817 Registration: 8:00am Course: 8:30am 4:30pm

Total

Total

Total # of Tickets

Return this registration form to: Academy of General Dentistry 211 East Chicago Avenue, Suite 900, Chicago, IL 60611 1999 Make checks payable to: Academy of General Dentistry (US $ Only)

•

Total Enclosed (or to be billed by credit card):

If you wish to pay by credit card, please complete the following information (Please print):

Name On Card:_________________________________________________________________________________ ____________________________ (Last)

Card Type:

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Amex Card Number ____________________________________________Expiration Date: ______________

Signature:____________________________________________________________Date:_________________________________________________

To register, visit www.NJAGD.org, call toll free 1 866 GO NJAGD, or fax registration form to 312.440.0559

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Code:

2009 GENERAL MEMBERSHIP APPLICATION

Referral Information If you were referred to the AGD by a current member, please note information below:

For more information: Call us toll-free: (888) AGD-DENT • (888) 243-3368 Or join online: www.NJAGD.org

Member’s Name City, State/Province, or Federal Services Branch

Member Information

____________________________________________________________________________________________ First Name

MI

Type of Membership: (Check one)

Last Name

Active General Dentist Associate

Informal Name (if applicable)

Active General Dentist (Recent graduate in last four years)

Resident

Do you currently hold a valid U.S./Canadian dental license?

Designation (i.e. DDS, DMD, BDS)

Dental Student Yes

No

/

/

Date of Birth (mm/dd/yyyy)

Affiliate

Required for access to the members only AGD Website

____________________________________________________________________________________________ License Number

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Date Received (mm/yyyy)

If you are not in general practice, please indicate your specialty: __________________________________________________________________________________________ Current practice environment: (Check one)

Solo

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Faculty __________________________________________________

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If you are a member of the Canadian Forces Dental Service, please indicate your preferred constituent:

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PREFERRED METHOD OF CONTACT:

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Your AGD constituent is determined by your business address, unless one is not available.

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___________________________________________________________________________________________________________________________ Phone

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ARE YOU A GRADUATE OF AN ACCREDITED* U.S./CANADIAN DENTAL SCHOOL?

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/

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Dues Information

Refer to back side for membership and constituent dues rates.

1 2 3

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+ ____________

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For information on qualifying for the residency dues discount, please refer to the description on the back.

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to __________________________________________________________________________________________________________________________________________ Post-doctoral Institution Begin Date (mm/dd/yyyy) End Date (mm/dd/yyyy)

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Return this application with your payment to: Academy of General Dentistry 211 East Chicago Avenue, Suite 900 Chicago, IL 60611-1999 For credit card payments, fax to: 312.335.3443 Dues rates effective until 10/01/09. Contact the AGD or visit www.agd.org for updated rates.

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______________________________________________________________________ Signature

Date

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The Diminishing

Practice Value F

ive years ago we were solidly entrenched in a seller’s market, but today we are fast slipping into a buyer’s market. The potential future selling price of your dental practice is dropping and there is really nothing you can do about it! What is expected to happen in the dental market place over the next few years is completely out of your control. Basic supply and demand trends are actually flip-flopping from where we were just a couple of years ago.

In fact, prior to the past couple of years, the dental industry had experienced an unprecedented trend of significantly rising practice market values since 1983. This “seller’s market” condition had been even more prevalent since 1988. In 1988 it was quite common for metro area dental practices to sell in the 50% to 60% of annual gross revenues range. In 1998 the majority of these same practices would have sold in the 80% to 90% of gross revenues range. Likewise in 1998, most experienced and knowledgeable practice consultants predicted that market values would escalate into the 125% to 150% range by 2010. Unfortunately, this is simply no longer a valid prediction.

We feel that the following factors and/or trends can and will impact the sale of dental practices for the next decade and beyond.

1. Demographic projections show that retirees will outnumber dental graduates by the year 2008.

2. In 1995, 23.4 percent of professionally active dentists were 55 years of age or older. A recent study indicates that this percentage is projected to reach 33 percent by 2005 and 40 percent by 2010.

3. Graduating dentists have decreased from about 5,800 in 1983 to approximately 4,000 in 1999. It is anticipated that this trend will likely continue.

4. 75 percent of all dental practices are solo owned. The percentage is even higher with general dentists.

5. Less than 5 percent of all dental practices have a formal transition plan or their "heir apparent" in place.

6. Stress levels and burnout symptoms are increasing because of business; management; growth; and various government agency demands of practices.

7. The “baby boomers” are selling younger, to both retire earlier and pursue second careers, placing added pressure on the market place with more and larger practice opportunities becoming available.

8. The average human life expectancy is increasing annually and is now in the mid-70s for both men and women. Those who plan to retire at age 60 need to prepare for as much as 25-plus years of retirement.

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Shirley Feuerstein

WHAT DOES THIS REALLY MEAN TO YOU? Well, with a market place that is sure to see more sellers than buyers within the next few years, today’s practice owners are sailing directly into a “buyer’s market”. And the characteristics of such a market are quite straightforward. If you wait too long to sell your practice, you are virtually assured of suffering a major financial blow! In fact, the real possibility of not selling at all is a fact that must be considered. Under current trends, the longer you wait, the less likely a purchaser will be found. It is really that simple!

To respond to today’s market trend, all dental practice owners should create and implement a well-planned practice transition strategy immediately.

Does that mean you should sell immediately? Maybe… maybe not. But keep in mind that selling does not necessarily mean retiring. Many doctors are selling while still in their 40’s and 50’s and continuing to work for the buyer. The most important thing you should do immediately is to have a formal analysis of your practice’s growth potential and market value prepared. Discover the realistic expectations for YOUR practice – and not from an emotional perspective, but rather from an unbiased professional perspective. This is the only way to discover and place a pragmatic value on your future options. Your personal needs and goals must be weighed against YOUR options to arrive at the maximum course of action. Often that action is continuing to “stay the course”, but sometimes, a change is imperative.

This is sort of like riding the value of a stock investment down because you are certain the losing trend will turn around. One day you finally wake up and realize that you could have had so much more money if you had just sold the stock sooner. Your practice value is diminishing now, BUT what you will do about it remains to be seen!

You have valuable transition and/or career options that should be thoroughly investigated 15 to 20 years before retirement. Explore your alternatives… you will be very glad you did!

About the author Shirley Feuerstein, a transition consultant for PARAGON, INC., has vast experience with practice sales, mergers, presales, progressive ownership programs, partnerships and practice valuations. Ms. Feuerstein has over 30 years experience in the dental profession and understands the goals of dentists and can provide information about the transition process. She can be reached at her office (908) 222-0199 or cell (908) 868-9330 or email shirley@paragon.us.com.

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Student Chapter

in Full Swing

T

he New Jersey Dental School Student Chapter of the Academy of General Dentistry is an organization that brings third and fourth year students together to learn more about the profession of dentistry. Every other month, local AGD members volunteer their time to speak about dentistry during a lunch and learn seminar.

We have all newly elected officers this year; as a result, many new ideas are being put into effect. Furthermore, we are developing a Fellow Track Program, the objective of

which is to encourage life-long learning and to help students earn credits for their fellowship. Our goal this year is to have our senior dental students prepare and take the fellowship exam shortly after graduation.

The Student Chapter of the AGD seeks to participate in community service projects around the area. The students are eager to help make this a reality. Some of our ideas include Oral Cancer Screenings, Special Olympics, and Oral Hygiene Instruction to the underserved communities.

We would like to set up a network between the dental students and AGD members in the local community. This would provide an opportunity both for local dentists to find associates from our dental school and for our students to find a future job. Such a network would also allow students to shadow local dentists and really get a feel for what dentistry is like in the real world.

This is a big year for the AGD Student Chapter and we are all excited for the new additions to the program. With the help of the chapter president Brett Druger, the three officers Doris Lam, Christopher Armento, and Roshani Patel, and Associate Dean of Clinical Affairs and faculty advisor Dr. Michael Conte, this program is making a positive impact on the school. If you have any questions or would like to participate in the program, please contact Brett Druger or Dr. Michael Conte at contemi@umdnj.edu.

Spreading the word...

The AGD has launched a new consumer website where patients can locate an AGD dentist. They also have an opportunity to learn basic facts and have common questions answered. The site is KnowYourTeeth.com‌ Check it out!

Dr. Wes Blakelee of Manasquan, NJ has been selected to do a monthly podcast interview series of notable dentists and educators in the field.

Dr. Melvin Pierson appeared on CN8 (Comcast Network) "Your Mornings" with Connie Colla and Greg Coy on October 28, 2008. The segment was titled Healthy Halloween. This segment has been selected to be placed on the AGD's new web portal‌ Check the website to see our local stars in action!

Haniel Rosemond, DMD, MAGD Public Information Officer

NJAGD wisdom

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Clinically Speaking

Clinical tips from your colleagues Please submit your clinical tips to the editor via email at spivacev@umdnj.edu. We want your ideas, and can help with the write-up where necessary. If you have accompanying photos, please feel free to submit those as well.

And now on to this issue’s clinical tips…

Get better marks!

That’s so dam easy!

submitted by Joseph Sandberg, DMD, MAGD

submitted by David Paulussen, DMD, MAGD

Are you getting good marks? It can be difficult and often frustrating to get good marks when checking occlusal contacts. If you don’t like the false positive smudges you get with thick blue articulating paper, try Parkell’s double sided (black/red) AccuFilm II. This film, at 20 microns, is half the thickness of paper and doesn’t tear as readily. It is great stuff except one small detail: it often does not leave marks, resulting in the problem of false negatives. What to do? Here’s the key! Use a thin film of Vaseline smeared onto the surface of the Accufilm once you have placed it in the forceps. This only takes a few seconds and dramatically improves the ability of the film to mark the occlusal surfaces of enamel, composite, porcelain, and even polished gold. The Vaseline also makes the marks much easier to remove with a cotton pellet or cotton roll once you’re finished. Don’t forget to dry the teeth before trying to mark them… I still haven’t found anything that marks teeth swimming in saliva!

This tip is from my gold study club. A wellplaced dental dam can be the dentist's best friend: the patient is happier with saliva and debris wellmanaged, the assistant has better access for suctioning, visibility is tremendously improved and the operative field remains dr y—imperative when working with gold, composites and other materials.

Placing the rubber dam can sometimes be a challenge. I have found that using brushless shaving cream makes placement easier. I squeeze some of the shaving cream into a Sultan disposable impression syringe and gently wipe a thin film on the underside of the perforated rubber dam.

With this lubricant and my assistant’s help, the dam can usually be placed in less than a minute.

The band plays on submitted by Gary Vander Vliet, DMD, MAGD I have found a method to create a matrix for core build-ups that is much easier to use than the traditional Toffelmire approach.

When dealing with a tooth that has fractured to the gingival and requires a post and core or a core build-up, a copper band can provide an excellent matrix to support the core material.

Select an appropriate sized copper band, then simply cut the band to mimic the gingival contour. After placement, secure the band with wedges and use your preferred bonding system and core material. Once the core has set, a single groove cut into the band will allow for easy removal of the matrix, leaving the core intact for finishing.

VELscope submitted by Barry Polansky Diagnosing oral cancer is one of the fundamental responsibilities of dentists. Too often, oropharyngeal cancers are diagnosed only in the later stages, when

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treatment is more difficult and the prognosis poorer. I know that every case of oral cancer that I have diagnosed came at the late stages. My personal experience with a squamous cell carcinoma on my lower leg that “just appeared” made me think of how helpful it would have been to know that below my skin, cells were being corrupted while I slept.

The VELscope, an award-winning product from LED Dental, Inc. is a diagnostic tool cleared by the FDA for helping to discover cancerous and precancerous tissue in the oral cavity not other wise apparent. It uses a technology called Fluorescence Visualization to discover aberrant cells in an exam that can be completed in less than five minutes. The hand-held unit is easily portable between operatories, and offers dentists yet another tool in the fight against oral cancer.

Figure 2: Fill voids in the tooth to prevent binding in undercuts

Figure 3: Place the button in warm water, remove when it turns clear

VELSCOPE VANTAGE EXCLUSIVE FOR NJAGD MEMBERS

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Figure 4: Place matrix material, extending beyond the prepared tooth

www.dentadepot.com Use Promotional Code 16NJ678GT

Permanently reduce temporary pain submitted by Shari Hyder, DMD, FAGD Temporaries for crowns and multiple units are a common source of frustration in the busy dental office. Fortunately, however, there are several products on the market that can permanently remove temporary pain.

Temporary crown matrix buttons (Advantage Dental Products, 800-388-6319) have simplified the process of fabricating temporaries. Among their advantages: Figure 1: The matrix button

• Can light cure through the matrix • Can be saved in patient’s chart in case of a lost or broken temp • Density of plastic drives your temporary material into the margins extremely well • Buttons can melted together to create a three or four unit bridge • Buttons can form a barrier around non-anesthetized sensitive teeth to insulate them from air and water during preparation of other teeth.

NJAGD wisdom

Figure 5: Matrix material is opaque when set

Figure 6: Temporary material in matrix, ready to place on the tooth

Figure 7: Buttons combined for a temporary bridge matrix

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CONTACT INFORMATION UPDATE For more information: Call us toll-free: (888) AGD-DENT • (888) 243-3368 Or join online: www.NJAGD.org

Contact Information __________________________________________________________________________________________________________________________________________ First Name Last Name

___________________________________________________________________________________________________________________________ Address __________________________________________________________________________________________________________________________________________ City State/Province Zip/Postal Code

___________________________________________________________________________________________________________________________ Office Fax

Office Phone

___________________________________________________________________________________________________________________________ Cell Phone

Home Phone (optional)

___________________________________________________________________________________________________________________________ Email What is you preferred method of contact:

Office Phone

Office Fax

Cell Phone

Email

If you have provided us with your email address, you will automatically be notified of upcoming CE/NJAGD events.

______________________________________________________________________ Signature

Date

To update your information, please fill out this form and email to: contenjagd@yahoo.com or fax to: 732.821.1082 Attn: Lorraine Sedor.

April 23

24-26

May Thursday

Wednesday

AIM 12: Critique

Dr. Dan Nathanson

8:00am Registration 8:30am-4:30pm Course

Restorative Science Course

Friday - Sunday Dr. Ken Koch

AIM 13: Master Track Course in Endodontics 8:00am Registration 8:30am-4:30pm (Fri/Sat) 8:30am-12:30pm (Sun)

30

13

Winner!

8:00am Registration 8:30am-4:30pm Course

NJAGD Annual Meeting

Congratulations to Dr. Joseph Perno, of Voorhees, NJ, winner of the NJAGD Free CE Raffle March 18, 2009

Thursday

NJAGD Board Meeting

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NJAGD Continuing Education Courses For information or to register, visit the website at www.NJAGD.org or call toll-free 1-866-GO-NJAGD

AIM 12 Critique

AIM 13: Masters Track Course in Endodontics

Restorative Science

Thursday, April 23, 2009

Fri-Sun, April 24-26, 2009

Wednesday, May 13, 2009

Presentation by

Presentation by

Dr. Ken Koch

Dr. Dan Nathanson

Location: Echo Lake Country Club Westfield, NJ

Location: The Pines Manor, 2085 Route 27 Edison, NJ 08817

Location: Echo Lake Country Club Westfield, NJ Registration: 8:00am Course: 8:30am – 4:30pm

Critique open to those who attended and completed AIM 12 For information or to register, visit the website at www.NJAGD.org

NJAGD wisdom

Registration: 8:00am (Fri-Sun) Course: 8:30am – 4:30pm (Fri/Sat) 8:30am – 12:30pm (Sun)

NJAGD Annual Session

52 CE credit hours

7 CE credit hours

For information or to register, visit the website at www.NJAGD.org

For information or to register, visit the website at www.NJAGD.org

Registration: 8:00am Course: 8:30am – 4:30pm

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Power your dental

practice

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; Case presentation skills that always work

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