Modern Dentistry

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Technology n Practice Enhancement n Events n Restorations


• Hand-Layered Feldspathic Porcelain

• Minimal Preparation

• No Chair-side Shade Manipulation Required

• Dual-Cure Cementation Procedures


In This Issue... LETTER FROM THE EDITOR

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SECTION 1

TECHNOLOGY (2-8) DIGITAL IMPRESSIONS, MICHEAL PAQUETTE

2

SOCKET GRAFTING -VS- IMMEDIATE IMPLANT PLACEMENT, DR. AMAR KATRANJI 4 TRU RX DIGITAL DENTURE PERSCRIPTION, DENTSPLY

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SECTION 2

PRACTICE ENHANCEMENT (9-14)

TAKE AIM WITH YOUR WEBSITE, DANIEL BOBROW

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EVENTS AT SK DENTAL LAB 12

PUTTING CARE BACK IN YOUR PRACTICE, LORI BAUER 13

SECTION 3

RESTORATIONS (15-19) TECH TIPS, BORIS KAUFMAN 15

FEATURED RESTORATION “GOING ZIRCONIA”, DR. Butros 17


Contributing Professionals Dr. Amar Katranji Amar Katranji, D.D.S., M.S., is a specialist in periodontics with emphasis on dental implants and advanced grafting. Born and raised in Michigan, he is a graduate of the University of Michigan School of Dentistry in Ann Arbor where he was also a Clinical Instructor and Adjunct Clinical Lecturer in the Department of Periodontics and Oral Medicine. He now practices in Ann Arbor and Southfield, Michigan. Dr. Katranji is a Diplomate of the American Board of Periodontology and holds membership in the International Congress of Oral Implantologists, the American Academy of Periodontology, and the American and Michigan Dental Associations. Dedicated to research as well as to practice and education, his work has been published in prestigious professional journals; he is also the founder and director of a local implant study group. Dr. Katranji’s list of honors, awards, papers, and presentations include: Michigan College of Dentists Student Award 2003, Oral Surgery Award 2004, Lazzara Implant Fellowship Finalist 2007, Sigurd P. Ramfjord Award for Excellence 2007, and studies ranging from periodontal disease, esthetics for periodontics and implant therapy to socket augmentation, immediate implant placement, and 3-D imaging. He is currently working on the design of a new bone regeneration material in cooperation with a leading bone bank. 2004 University of Michigan: Doctor of Dental Surgery

Post-doctoral training in periodontics. Certified 2007.

2008-Present Private practice, limited to periodontics, dental implants, and advanced grafting, in Ann Arbor and Southfield, Michigan

Boris Kaufman

Boris Kaufman graduated form the University of Moscow Russia where he received a master dental technical degree in stomatology in 1967 and then received a second degree from the school of dentistry in 1970. He owned and operated two dental clinics in Moscow before moving to the United States in 1978. Boris is a specialist in full mouth rehabilitation implants and costmentic dentistry. In 1979 he started Shulman and Kaufman Dental Laboratories, now known as SK Dental Lab one of Michigan’s leading full service dental labs. SK Dental services more than 800 local dentists and has a staff of 60 employees.


Contributing Professionals Daniel A. Bobrow, MBA

Mr. Bobrow is a Certified mediator and arbitrator, and has worked pro bono for several agencies including; the Better Business Bureau, Youth Justice Institute, Center For Conflict Resolution, Illinois Department of Human Rights, the Circuit Court System of the City of Chicago, and Loyola University School of Law. Most recently, he chaired the website development committee of the Academy of Dental Management Consultants. He may be reached at : 1-800-723-6523 or www.AmericanDentalMarketing.com

Lori Bauer Lori Bauer graduated from Western Michigan University in 1981 with a BA in Industrial Marketing. She worked for IBM throughout college, and then moved to San Antonio, Texas to pursue a career with Xerox Corporation where she won numerous awards for outstanding performance. Those achievements paved way to her new position as New Rep Trainer for Xerox in 1983. A few years later, Lori moved into Medical Sales with US Surgical and was recruited to Hall Surgical two years later, covering a ten state region presenting the features and benefits of the Mandibular Staple. The division closed in November of 1989, but she was welcomed into Walter Lorenz Surgical Corporation where she remained until she was required to leave when her husband was transferred to Hamburg, Germany in 1999. Upon returning to the United States three years later, Lori continued her relationship with the University of Michigan as Clinical Coordinator for the Oral Surgery Department Cadaver Labs. It was there that she discovered Nobel Biocare and subsequently joined the company in 2003 as a Dental Solution Specialist focusing on dental implants and Procera. In 2006, Lori cofounded “Women in Dentistry Expo,� an annual symposium of professional women in the field of dentistry and after two years in Sales, she was promoted to Regional Manager. She held that responsibility until January of 2009 when she was promoted to Practice Development Consultant for the Great Lakes Region.


Publishing Company Acknowledgement

technicians who are with us, committed to providing exceptional aesthetics, personal care and effi cient services. Our commitment to excellence provides you with the best quality restorations at economical pricing.

Founded in 1978 by Boris Kaufman; SK Dental Among our offers and services Lab, Inc has always many are exclusive of SK been a change from the Dental; SKNY Veneers help ordinary. We have been your patients fi nd an effortless and will continue to serve natural smile. Our Magic Smile Southeast Michigan’s Triremovable options will give County Area with pride. many of your patients dealing Our top priority has always with the current economical been your patients’ needs; times an effective low cost we work with your specifi c guidelines and customize aesthetic transformation. Try our newest line of Implant our services to exceed your patients’ expectations. We Surgery mapping and planning software: Nobel Guide are a cut above your average production laboratory. from Nobel Biocare; combine it with a set of our Hybrid All of our restorations are made in our full service Implant Dentures and you’ll experience the SK Dental laboratory in Southfi eld, MI, by caring and professional change.

Contacting SK Dental

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Administration

Technical Support

Boris Kaufman 800.742.9685 Ext. 241 bkaufman@skdentallab.com

Jane Paisopoulos 800.742.9685 Ext. 223 janep@skdentallab.com

Customer Support

Vasiliky Thrushman 800.742.9685 Ext. 232 vash.thrushman@skdentallab.com

Sales

Human Resources

Alekos Alexopoulos 800.742.9685 Ext.231 alex.alexopoulos@skdentallab.com

800-742-9685 Ext. 228 sales@skdentallab.com


In This Section

Technology Digital Impressions - Benco Dental Lava C.O.S. Dr. Amar Katranji - Socket Grafting -vs- Immediate Implant Placement Newest Premium Denture Technology - Dentsply Tru Rx Software


technology has been around for

Digital Impressions

more than 20 years. However, the Lava C.O.S. is the only system on

Micheal Paquette

the market that has elevated the process from merely taking pictures to capturing video. With Lava C.O.S. 3D-in-Motion technology, doctors can capture and simultaneously view continuous 3D video images to create a digital impression on a touch screen monitor. The dental industry is the fi rst to benefi t from this amazing breakthrough in digital imaging ‌ the art of taking impressions in the dental offi ce will never be the same.

T

hroughout

the

world

wide range of benefi ts to doctors. Comfortable, Interactive Experience

more than 140 million impressions are taken each

Digital Impression System Helps

year. Even the most experienced

Strengthen Relationship With Your Lab

comfortable

practitioner, using the best materials,

The Lava™ Chairside Oral Scanner

experience that ultimately results in

can encounter diffi culties when

C.O.S. from 3M ESPE can increase

a beautiful restoration. Doctors will

taking an impression. Common

your productivity by reducing

appreciate an enhanced state-of-the-

problems

delamination,

seating times and remakes. Doctors

art image for their dental practice, a

facial-lingual pulls, tearing at the

can strengthen their relationship

high level of patient satisfaction and

margin, tray-tooth contact and stone

with their existing lab by utilizing

improved productivity. The Lava

model discrepancies.

powerful tools unique to digital

C.O.S. provides the foundation for

dentistry.

the dental practice of the future.

include

The Lava C.O.S. helps to solve the

and

interactive

challenges dentists experience with

The 3D-in-Motion Difference

Imagine turning an uncomfortable

traditional impressions and bring a

Traditional point-and-click digital

procedure into a remarkable, interactive

Contacting Benco Dental Micheal has over twenty years

Benco Dental

servicing dentists in south eastern

Micheal Paquette

Michigan. For a free in offi ce demonstration please feel free to contact Micheal Paquette.

2

Patients will benefi t from a

248-361-4607 mpaquette@benco.com


Digital Impressions (SLA) models

experience for patients and being able to confi dently review your work in •

Virtually mark margins and

spectacular detail. The Lava™ Chairside Oral Scanner

New Scan Review Process A faster, easier, more streamlined

ditch dies utilizing the exact

process

for

reviewing

scans

video images doctor captured in

eliminates time spent waiting for

the mouth

scans to process, helping reduce chair time.

C.O.S. is a digital impression • system that provides a powerful

Improved Speed, Ease of Use and

new connection and improved

Full Arch Capture

Wand Cursor Feature

productivity for a doctor and their The precise restorations created by Lava Software 2.0 allows you to the Lava C.O.S. can help boost your use arrows on the wand keypad to

dental lab.

productivity and attract new patients conveniently move through the on•

Benefits for Doctors:

to your practice. Lava™ Software screen selection areas.

Seating times of single unit

2.0 for Chairside Oral Scanner,

crowns decreased on average

which includes several signifi cant

by 41% when compared to

upgrades from the previous version, Need a reminder about how to use a

traditional impressions¹

further improves the productivity particular feature? Help text shows

Prescribe PFM or CAD/ CAM restorations

Assess

and simplicity of this revolutionary you how to navigate through the The Lava C.O.S. is available

and Completion Arrows

margins using powerful tools Lava

when the scan is complete, committed to partnering with

C.O.S. digital impression versus

improving your confi dence in the dentists, labs and distributors to help

a traditional impression

quality of the scan and helping transform the practice of dentistry.

Patients

prefer

a

ensure that inaccurate scans will not Benefits to Labs:

go undetected.

0.5% remake rate due to

marginal fit, 80% below industry

Alternate Starting Wand Orientations

average² •

Any lab can participate with a no-capital-investment option

Digital files enable timely and

effective

communication

between lab and doctor •

nationwide (US) as well as from

Lava Software 2.0 clearly indicates Benco Dental and 3M ESPE is

unique to digital dentistry

screens.

system.

preparations

Help Text

Eliminate

stone

The starting point for scans is no longer limited to the occlusal surface. More starting orientations make it easier to scan more challenging areas, such as anterior and full

model

arches.

production with highly accurate and durable stereolithography

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Socket Grafting -vsImmediate Implant Placement

O

ne of the complexities of dental implant therapy is determining the proper course of treatment that will minimize both time and morbidity for the patient. Historically, high success rates for implant therapy in the maxilla and the mandible utilized the protocol that Branemark popularized decades ago. In this protocol, a tooth is extracted and the socket is left to heal for approximately 6 – 12 months prior to implant placement. Osseointegration is established after 6 months, and the implant is loaded at this time. Typically, this mode of therapy can take up to a year before the patient is rehabilitated. In the late 1980’s and early 1990’s, Melcher’s guided tissue regeneration (GTR) concepts were applied to implant therapy by Schulte in Europe and Lazzara in North America. These early pioneers placed implants into extraction sites, used membranes to enhance regenera-

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Dr. Amar Katranji tion, and loaded the implants with highly successful outcomes. The concept of immediate implant placement has taken off since that time because it effectively cut therapy time in half. However, it is critical to accept the limitations of this treatment modality and understand the biology behind it. Healing of extraction sites The healing process of an extraction site has been identified in human histological studies by Amler. Five stages have been described that lead up to the resolution of the extraction site and is summarized in the table below. In stage I, an initial clot forms as a coagulum of red and white blood cells and is accompanied by the precipitation of fibrin. During stage II, granulation tissue replaces the clot over day 4 & 5 and the tissue is characterized by increased white blood cells, reticuloendothelial cells and cords of endothelial cells associated with the elaboration of capillaries. In the third

stage, connective tissue gradually replaces the granulation tissue over days 14-16. In the fourth stage, calcification of osteoid starting at the base and periphery of the socket is noted. Early osteoid is seen at the base and periphery as early as 7-10 days and trabecular bone fill of at least 2/3 of the socket is observed around day 38. Epithelium begins on the fourth day and complete epithelial closure of socket is achieved at 24-35 days, which marks the end of the fifth stage. It is important to note that substantial bone fill is seen between weeks 5-10 and by the 16th week bone fill is complete. In a delayed implant placement approach, these time points may be useful. Extraction Socket Changes Another key component of a healing extraction site is the deformation changes that will inevitably occur. Externally, the socket can lose considerable buccolingual ridge width and apicocoronal crestal height over a 6-12 months period. Most of this reduction occurs during the first 4-6 months of healing. It was found by Schropp and colleagues that the buccolingual width reduction is 50% over a 12 - month period in the premolar and molar area. The average ridge width reduced from 12mm to 5.9mm with 4mm of reduction occurring within the first 3 months after extraction. The molar areas tended to resorb more than the premolar sites and the mandible had greater reduction than the maxilla. In the apicocoronal dimension, a mean reduction of 0.8 mm was noted on the buccal side after 3 months. Socket Augmentation Although there are no established rules when deciding whether to augment a socket, leave the socket undisturbed, or immediately place an implant into the socket, there are guidelines that have been established based on predictability and success. It has been shown that ridge preservation with bone graft and


membrane will retain a signifi cantly greater portion of the host bone than extraction alone. A researcher named Nemcovsky placed non-resorbable HA into extraction sockets and found a mean vertical bone loss of 1.4mm and mean horizontal bone loss of 0.6 mm. Most of the shrinkage occurred during the fi rst month post extraction and almost no changes occurred after 6 months. This clearly indicated that socket grafting signifi cantly reduced the amount of bone loss that occurs over time. Several other studies compared grafting with extraction alone and implicate grafting as the treatment of choice for preserving a higher percentage of bone. These studies are summarized in the charts below. Comparison of Ridge Width between Preservation and Extraction: Group

Initial (SD)

Implant Change Placement (SD) (SD)

Ridge Preservation

9.2 mm 8.0 mm -1.2mm (1.2) (1.4) (.09)

Extraction Alone

9.1mm (1.0)

6.4mm (2.2)

-2.6mm (2.3)

Comparison of clinical factors between Socket Preservation and Extraction alone: Group Socket Preservation Extraction Amount “saved” with Socket Preservation Group

Socket

Extraction

Amount “Saved” with Socket Preservation

Alveolar Bone Height

-.38mm

-1.5mm

1.12mm

Horizontal Ridge Width

1.31mm

4.56mm

3.25mm

Internal Socket Fill

6.43mm

4.00mm

2.43mm

Preservation

Immediate Implant Placement The evolution of implant thera- Taken a step further, immediate loadpy has led to faster treatment outcomes ing of implants placed into fresh through the use of the body’s natural extraction sites is becoming more healing process. The concept of placing predictable. That is, delivering the implant, abutment, and temporary crown all at the same time is a reality for some cases. This is the ultimate treatment plan since it delivers a fi xed crown after surgery, which is of value to professionals who don’t want the embarrassment the implant immediately after extract- of a removable appliance. The patient ing the tooth has shown to be very suc- is required to maintain a soft food diet cessful in preserving the soft tissue and until the bone has healed around the maintaining esthetics. Therefore, it is implant and a fi nal crown is necessary the treatment of choice for the surgeon after about 3 months. With the use of and the patient if indicated. As a guide- 3D imaging, this treatment option is line, the minimum B-L bone needed at even more feasible since most of the an implant site is 6 mm for a standard preparation occurs prior to the sur4mm diameter implant, which takes gery. Many times, this can be done in into consideration the necessary 1 mm full mouth cases that would normally of buccal and lingual bone to surround require a temporary denture during the implant. A minimum of 3 mm of the 3 month healing period. bone apically is necessary to anchor the Dental implants are the treatment of implant in the socket. Anatomical land- choice for replacing missing teeth. marks like the sinus cavity or the inferi- Advancements in dental imaging, reor alveolar nerve can prevent immediate generative material, and the implants implant placement and should be stud- themselves have yielded more preied prior to surgery. As a reference, a dictable results in a shortened period typical surgery consists of the following of time. Realizing the changes that steps: occur after a tooth is extracted helps 1. Careful extraction of tooth and determine which treatment modalpreservation of socket walls. ity to choose. Immediate implant 2. Thorough degranulation. placement should be a consideration 3. Threaded implant placed in in patients that are candidates for this ideal restorative position. Primary procedure. stability is necessary. 4. Bone graft, membrane, and sutures if necessary. 5. Temporary restoration delivered

5


Healing of Extraction Site

Tooth #8 was extracted 9 months prior without grafting. Note the vertical loss of bone.

Socket Augmentation Patient had extraction due to tooth fracture.

A resorbable membrane covered particulate graft placed in the socket.

Immediate Implant Case

Patient presented with a fractured tooth that required extraction.

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This view shows the significant loss of bone in the horizontal dimension. This patient required a bone graft prior to implant placement.

A thin buccal plate necessitated grafting of the socket.

Socket fill at 3 months for placement of an implant.

The tooth was extracted with emphasis on soft tissue preservation.


An implant was immediately placed and achieved a high degree of stability.

The extracted tooth was used as the temporary.

Patient’s extracted tooth altered for use as temporary.

The patient left after surgery with the same tooth he came in with.

The patient at 3 months. Note the interproximinal soft tissue preservation.

Immediate Load Case (Full Arch) Patient presented with severe periodontal disease that necessitated full mouth extraction.

The patient had six implants placed immediately following extractions.

Four implants were immediately loaded on temporary denture. Patient was able to function more comfortably during the healing period.

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Newest Premium Denture Technology Dentsply TruRx™ Digital Denture Prescription

D

ENTSPLY Prosthetics announces the introduction of DENTSPLY TruRx™, The Intelligent Denture System. This proprietary (patent pending) software is the first of its kind and greatly simplifies the denture process. User tests show 80% of evaluating dentists prefer TruRx to conventional methods for the majority of their cases. The digital platform of TruRx helps to create a technology savvy, competitive advantage for dentist users, which potentially enables them to charge more for their consultative services.

The TruRx program requires use of calibration tools which are made of a soft, biocompatible, gray foam material. They include an Index square, which is placed on the patient’s forehead, and a Cosmetix™ mouthpiece. The color gray enables the program to adjust the patient’s image so that skin tones and tooth shades are color balanced. The size of the Index square is recognized by the program and allows the image to be snap fit to the correct size for measurement calculations. The Cosmetix™ mouthpiece provides a location for the likeness of the patient’s new smile to appear. When both the Index and Cosmetix™ are properly in place, a digital photograph of the patient is taken and imported into the program.

The standardized process allows delegation of the TruRx denture consultation to a dental team member, increasing office productivity and profitability. TruRx facilitates

The program uses key facial contours to calculate anterior mould form width and length. Once a shade system has been selected, TruRx provides the IPN® anterior maxillary and mandibular denture teeth mould form recommendations. In addition, the program offers selections for posterior denture teeth, occlusal schemes, and denture base materials (Lucitone 199® and Eclipse®). n

dental professional communications with both the patient and the laboratory. It also can be used to educate patients for increased understanding and acceptance of a premium treatment plan. The summary prescription can be sent to the laboratory via e-mail, fax or print out. TruRx removes the guesswork of an incomplete prescription, improving laboratory processing efficiencies and accuracy. The TruRx consultation begins with a digital photograph of the denture patient, which is imported into the program. It then guides the dental professional and the patient through the consultation process in a logical sequence, as they address key denture considerations. TruRx culminates in a detailed prescription that includes the patient’s post therapy image, complete with a likeness of their beautiful IPN® smile.

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Compartis ISUS Cad/Cam Innovation DENTSPLY Prosthetics is proud to introduce the newest Compartis member -Compartis ISUS Bars and Bridges. These

precision-milled

Implant

Supra Structures are available from Compartis

USA SmartSourcing™.

Now superstructures for implants can be CAD designed and CAM milled for the ultimate in precision fit. Both the bars and bridges are milled from one solid block of Titanium or Cobalt Chrome for a perfect, tensionfree fit. Either material is perfectly biocompatible, so it is safe for patients. ISUS bars and bridges can cover a range of two to eight implants; be screwed directly on the implant; and used on any implant system or multisystems within a case. These features offer dentist and patient benefits of a passive fit the first time. Compartis ISUS Bars and Bridges

Where To Get TruRx™ The TruRx Digital Denture Prescription Kit (PN 908400) is available through the SK Dental Lab, Inc. for $99 suggested retail. Reorders of the consumable calibration tools (PN 908402) are available, six sets (1 sheet) for $10 suggested retail.

eliminate

the

need

for

waxing,

casting, seating and finishing. This translates into laboratory fabrication cost savings. With Compartis ISUS, the cylindrical design eliminates the need for abutments. Therefore labs no longer need to inventory components.


Practice Enhancement In This Section

Take AIM With Your Website

Putting the care back in your practice

SK Dental Events


A simple way to attract people to your website is to place your website address (url) anywhere prospective patients will see it: on stationery, business cards, external signage, and all conventional marketing channels such as: direct mail, TV ads, radio ads, and billboards. Another way to get your website noticed is via on line search (discussed above). Online search is sub-classified into natural or organic (also termed search engine optimization or SEO) and paid (sometimes termed pay-per-click) search.

Take AIM With Your Website

Daniel A. Bobow, MBA

T

he Internet has changed the way people get information about the products and services they buy. Instead of receiving information about products through TV, radio, and Yellow Page ads, consumers are now, and with ever increasing frequency, using the Internet to make key decisions about where to stay, what airline to use, what movie to see, and, with increasing frequency, what dentist to visit. Online search is not new, but the reason dentists must pay heed or be left behind is the phenomenal growth of what is termed “local search.” Historically, consumers may have used the Yellow Pages to find a dentist. Today, they use the Internet. To win the Internet Marketing Game, your website must Take AIM, that is:

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Attract

Impress

and

Motivate

Website visitors to take any one of a number of desired actions. Attract the Visitor To encourage visitors to your website, it is imperative you position your website at or near the top of search engine listings so that, when people and businesses in your community are searching for dental care, it’s you they’ll find. A search engine is a service people use to find something on the Internet. As of this writing, the two market leaders are Google® and Bing® (when one uses Yahoo®’s search engine, the results delivered are those of Bing®).

The goal of both forms of online search is to get your website ranked high on search engine listings when website visitors enter words or phrases (called keywords and key phrases) that describe your office, location, and the services you wish to promote. Follow a few basic guidelines to increase the likelihood of getting your website (or pages within your website) ranked higher in search engine listings: • Mention the word “dentist” on your site often. Be sure it appears as text, not graphics, because search engines cannot read graphics. • Mention your city and zip code, as well as city names and zip codes surrounding your practice. • Get listed on Google’s Local Directory (the map often appearing between sponsored and organic results). This is a relatively new opportunity for getting local products and services listed.


• Start and maintain a blog. Search engines love to see unique and frequent updates to a website. It’s one of the ways they know the website is “alive and well.”

A.I.M Attract - Impress - Motivate

• Establish in bound links to your website. Inbound links are created when one website links to another. Note: if both websites link to the other (known as reciprocal linking) the benefit, from an SEO standpoint, at least, is negated. • Manage your Online Reputation by establishing and maintaining your presence on social networking sites e.g. Facebook and • Manage and Monitor online review sites (like Yelp). You can manage these sites by setting up an account with them, and encouraging your satisfied patients to submit favorable reviews of their experience with your practice. You can monitor what other people are writing by enabling notification settings. You can also monitor online references to you in general by setting up alerts through Google and other services, most of which are free. Used correctly, paid search can get your website ranking higher on the listings more quickly than relying solely on natural search. Search engines require time to notice your website, and since the search engines are the ones getting paid by pay-per-click advertising, these ads get noticed quickly. Be

you’ll visit us. Goodbye.” So what’s wrong with that? Nothing, if your sole concern is with only twenty percent of website visitors (the so-called “low hanging fruit”). Motivating the Visitor

careful, though, not to overbid. It is not critical to be first on the list. Also, be certain you only advertise locally: you don’t want to pay for a visitor who lives in, say, Saskatchewan if you don’t. Impress the Visitor So what happens when someone visits a website? That depends upon the website. Most sites can best be described as informational or static because, in essence, information is all they provide. They may be impressive and attractive, with lots of Flash (a program that permits websites to feature animation), and perhaps even audio. But take note: too many bells and whistles can be a distraction to the visitor, or the site may take too long to open (and web surfers are notorious for having a short attention span, as are the search engine robots that scour the web for relevant content). A website of the kind just described is great at saying “Hello, thank you for visiting our site. This is who we are, and this is what we do. We hope

This final step is where most dental websites fail to deliver. If all that visitors to your website get is a “thank you” for visiting, and information about who you are, and what you do, what you’ve got is basically an electronic brochure. As stated earlier, an informational website is fine, as far as it goes. But such a website lacks a mechanism for capturing visitor information and automatically communicating over time with that visitor. Why is this important? Consider that someone who visits your website will fall into one of three categories: • Not interested in joining your practice. The DNRs (for do not resuscitate). • Very motivated to join your practice. We call these the “butterflies.” • Those who are interested, but not ready to commit, “The caterpillars.” The ‘DNRs’ This group comprises approximately 20 percent of

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website visitors. Why they are not interested in you is, and most likely shall always remain, a mystery. If marketing teaches us anything it’s that we can’t be all things to all people.

The ‘Forgotten Sixty Percent’

The ‘Butterflies’ While we’d love all website visitors to fall into this category, they don’t. Yet, this is the only visitor segment most websites manage to convert to patients. In fact, studies suggest that only 20 percent or so take action during or immediately following their first visit. The others need time to ‘metamorphose,’ that is, to become aware, gather information, identify the need, sense urgency, and take action. That leaves 60 percent of website visitors. The ‘Forgotten Sixty Percent’ To convert this group, which comprises the majority of website visitors, you need to structure your site so it offers visitors a reason to willingly share their contact information with you, and automatically follows up with them. Why automatically? Because otherwise, who has time to do it? What To Do We suggest beginning your automated follow-up sequence with

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a special report that is created to appeal to the interests and needs of the visitor. Our clients’ websites include up to 12 special reports with such topics as “The 5 Things You Must Know Before Choosing a Dentist,” “How To Overcome Your Fear of the Dentist,” and “Are Implants Right for Me?” In addition, because people may require as long as a year to transition from a caterpillar to a butterfly, you’ll want to be sure you keep in front of the prospective patient for at least that long. We recommend a series of e-mail and direct mail cards. Some e-mails also offer an audio component, that is, a recording of the doctor

or staff member (usually the hygienist). The e-mails offer a series of Smile Tips containing brief but valuable information intended to simultaneously create the perception of the dentist as a credible expert, and to keep in front of the prospective patient so that, when it’s time to make an appointment, you’re most likely to be the one with whom they appoint. Also, by varying the medium, but not the message, we continually reinforce the dentist’s brand in the mind of the prospective patient.

Communications are scheduled with sufficient frequency so the prospective patient does not forget you, yet, not so frequently that the communications become an annoyance, resulting in a trip to the trash can, spam folder, or both.

Take AIM Now! Success with website marketing requires that your website Attract, Impress, and Motivate qualified patients. Being armed with the tools to capture visitor information and automatically communicate with visitors over time means that, when they are willing, you’ll be waiting. n



Putting Care Back In Your Practice Lori Bauer

T

oday, if you don’t take care of your patients, somebody is waiting, ready and willing to do it. Your competitive advantage in this Change Environment is not just the quality of your products and services. The real competitive edge you have is how you treat your patients. The only thing your competition can’t take away from you is the relationship your team has with your patients. Far too many clinicians are focused on products and themselves and not the patient experience. We need to replace our brain with our heart because that’s often how people make decisions. Studies have proven that the essential difference between emotion and reason is that emotion leads to action and reason leads to conclusions. What do you want for your practice? Do you want action or do you want people to think? The question you need to ask is “How am I making my patients feel?” “Am I making them compare or care about their treatment plan?” There is a big difference. Caring and feelings drive action…the other stuff is just a tool. The bottom line

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is that the really hard stuff is the soft stuff…It’s the feelings of your team and patients. That, in the end is your competitive advantage. Mac Anderson, founder of Simple

Practice Perks iConfiDent From Nobel Biocare PracticePerks™ is a comprehensive marketing and education portal that gives you access to a wide array of innovative marketing and education solutions. PracticePerks™ enables you to effectively communicate with your patients, improve team case acceptance skills, advertise on a local basis and much, much more. Best of all, your PracticePerks™ membership provides you with exclusive discounts for these tools that can save you thousands of dollars on your marketing, education and practice management budget.

How does it work? Truths & Success Stories, writes that Change is not easy. But it is Simple. Things will always change. We don’t have a choice about that, but we do have a choice on how we react to change; the choice really boils down to this…either we manage change, or it will manage us. Change is the key that unlocks the door to growth and excitement in any organization. A study published in December 2008 stated that a small number of Dental Practices were not feeling the adverse effects of our economy. This was because they were focusing on three areas intently: 1. Educating the Patient. 2. Educating the Team. And 3: Marketing Their Practice.

As a NobelSmile™ dental practice/ partner, you’re provided with a user name and password to the practiceperks.com website,where you can take advantage of all the free services and discounted special offers PracticePerks™ provides. iConfiDent gets dental implant professionals working together for optimal patient outcomes. iConfiDent is a secure, online, practicebuilding tool for shared communication and collaboration among clinicians, labs and manufacturers. It simplifies implant material selection, tracking and ordering. Patient case treatment planning and information are centralized and shared, easily accessible via the Internet to the team of professionals working together.


Putting Care Back In Your Practice Companies to make your job easier and more focused. For more information on Perks visit www. practiceperks.com.

You are so busy working in your practice and don’t have the time, or direction to work on your practice. Today there are 5 billion web pages (25 for every man, woman and child in this country) and six million going up every day. Patients are stressed out from information overload and conflicting information…more and more they are relying on their gut…and their feelings to make a

decision. We are zipping along on an information autobahn and the exits or solutions are a blur. Nobel Biocare recognized this two years ago and has invested millions of dollars researching Practice Growth Vehicles that will allow you to see those blurry exit signs clearer. We have partnered with a variety of outside Communication, Education, Advertising, and Web Services

Your Michigan Nobel Biocare Dental Solutions Specialists are:

Our feature Perk for this issue is a product called iConfident. iConfiDent is a secure, centralized, web-based program for shared communication and collaboration among clinicians, labs and manufacturers. It simplifies implant material selection, tracking and ordering. Patient case treatment planning and information are centralized and shared, easily accessible via the Internet to the team of professionals working together 24/7. Phone tag between office to coordinate patient planning and implant execution will be a thing of the past. The entire patient treatment plan will be available on a secure site where all individuals involved in the case will know precisely where the patient is in the treatment process including CT images, X-Rays, photos, and products utilized. For a free test drive of this Communication Tool, please contact Rob Lewis at (415) 867-9950 or rlewis@iconfident. com. n

Dennis Ayotte 248-941-5895 Jesse Velo

269-547-0685

Lori Bauer

517-980-6448

Murray Kamish 248-508-1669 Dan Kirkey

517-599-3472

Practice Development Consultant

16


Restorations In This Section Tech Tips - With Boris Kaufman Featured Restoration - Going Zirconia


Tech Tips With

Boris Kaufman

Realizing the Difference Between

more successful in the fi nal result

better fi t against the gum line but

Implant/Attachment Retained Appliances

when cured in place chairside.

aesthetically pleasing as well.

There are many instances where

By doing this we achieve more

a practioner will request that the

stability and better comfort for the

laboratory technician cure the

patient. If a technician has to cure

attachments in place using a stone

the attachments using the patient’s

model during the fabrication

hard model there will always be

process. The truth is that it is the

the presence of anterior/posterior

procedure will be accomplished

rocking when the appliance is

far more successfully if done

delivered to the patient. There

chairside; reason being is that

is no substitute for the patient’s

while chairside the appliance

unique tissue mobility which

will compress against the soft

is why it would be possible to

tissue while engaging the male

avoid rocking by performing the

attachment using self-cure acrylic

procedure chairside.

-vsImplant/Attachment Supported Appliances

In our experience we have found that

restorations

supporting

removable implant & attachments retained appliances are much

the fi nal result will not only be a

17



Realizing the Difference Between Flexible Partial Indications -vs(Traditional) Cast Metal/Acrylic Base Partial Indications All flexite and flexiplast flexible partial denture appliances are made from the same acetyl resin base. There are of course many contrasts between flexible and traditional

partial

fabrication;

the main being the chemical composition and reapplication capabilities. Flexible partials are made from a acetyl resin base that once chemically bound and cured is finite in its chemical composite. It cannot be added to; which means to the dentist and laboratory when a patient has periodontically involved teeth there would need to be a whole new appliance fabricated as the resin base is finite in its chemical structure. There are “mix and add� resins available for use to repair and add to these however our experience shows us that the bond is purely mechanical; there

is no chemical bonding which does not guarantee that the repair or

tooth

addition/replacement

will last as it is not bonded on a chemical level. The traditional partial is a polymethalacrylate (polymer/monomer

compound)

that is laid over a cast metal base and the material itself is much more versatile at accepting repairs

and

tooth

additions/

replacements; it can be applied and reapplied many times over. The flexible partial; in nature, is flexible which means the absence of occlusal resin in most cases; which makes the flexible partial not only unstable in placement but uncomfortable for the patient.

eats; the partial applies a tremendous amount of pressure to the residual soft tissue and bone which leads to the high absorption of residual tissue. Valplast Flexible (flexiplast) partial appliances are meant to improve the overall appearance and to be esthetically more pleasing than traditional partial appliances obviously because of the presence of metal framework, occlusal rests etc. Therefore Valplast quickly creates a special place in the restorative dental industry, however, there are too many disadvantages of the material itself as well as the patient’s comfort level in either flexible indication, to make a light decision.

For example; when the patient 18


Featured Restoration- Going Zirconia

Master Model of Maxillary Arch

Master Model of Mandibular Arch

Prepped Zirconia Substructure Maxillary Arch Before Crowns are Fabricated

Prepped Zirconia Substructure Mandibular Arch Before Crowns are Fabricated

Final Fabrication of Maxillary Arch Before Placement


Featured Restoration- Going Zirconia

Final Fabrication of Mandibular Arch Before Placement

Maxillary Substructure Orally Placed before Crown Placement

Mandibular Substructure Orally Placed before Crown Placement

View in Mouth of both arches Before Crowns are placed

View in Mouth after Crowns are in Place the Restoration is Complete

20


A recurring issue in our professional circles is the question whether solid, full-contour zirconia crowns are at all indicated in the view of aesthetics, abrasion characteristics, compatibility and strength.

Can we recommend them to our patients?

Prettau Zirconia

What is Zirconia?

• Zircon (ZrSiO4) is a mineral belonging to the mineral class of Silicates, discovered in 1789 by M.H. Klaproth. • Zirconium dioxide (ZrO2) is a compound of the element zirconium occurring in nature and has already been used for 10-15 years in prosthetic dentistry due mainly to it’s high bending strength.

Zirconium is one of the oldest and most abundant elements in the terrestrial crust and it is the basis for Zirconium oxide (yttrium stabilized Zirconium dioxide). This first-class performance material was successfully used for artificial limbs and joints in the medical field in the last decades and now it is also available to the dental industry. Due to its excellent biological characteristics, Zirconium is nowadays the preferred material for dental restorations. It’s use in the dental field is on the increase since the 1990s. It is assumed that 15,000 to 20,000 units are made in zirconium every day. Laboratory tests revealed that zirconium bridges and metal ceramic bridges on the basis of precious metal alloy show the same fracture resistance. Due to its excellent health-friendly characteristics, zirconia is nowadays the preferred material of modern dental restorations among dental ceramic materials available today.

Why Zirconia? l

Zirconia has a high resistance and is fully biocompatible.

l

It is increasingly used in dentistry (posts, crowns, bridges and implants).

l

The white basic color of Zirconia.

l

The possibility in dentin colors.

l

Its biotechnological characteristics enable the production of biocompatible, high-quality and esthetic dental and implant reconstructions.

l

Sintered Prettau Zirconia displays incredible density and smoothness. Therefore the material does not cause any wear on natural dentition. l By contrast veneer porcelain (or even metal) will cause wear on natural dentition due to its highly porous structure which acts like sandpaper.

SK Dental Lab, Inc. Commitment To Excellence


Especially in the field of implant dentistry, in cases of limited available space or restorations with tissue flanges, Prettau Zirconia comes into a world of its own. One of the many advantages is the complete elimination of posterior occlusal chipping because only the labial or buccal surfaces are porcelain veneered; all functional areas are maintained as solid Prettau zirconia.

Q: Will there be “extra load” on the mandible joints? A: The joints’ surfaces are “padded” by the disc which acts as a shock absorber. The hardness of a restoration bears no influence on the joints.

Q: How durable is the Prettau Zirconia?

A: The flexural strength of Prettau Zirconia lays 10% below regular zirconia but this shortfall is more than compensated for by the extra frame dimension (full contour!)

High translucency

No black margins

Absolutely metal-free

Excellent health compatibility

Extreme solidity

Longevity

Individual Abutments

Individual abutments offer the ease of quickly and effortlessly making repairs and adjustments without disassembling the restoration and completely removing the appliance from the patient. This technique is a leap ahead from the one-piece full-anatomical contour that has been standard for full arch implant restorations.

Milling

Prettau Zirconia can be full-anatomical contour milled using MAD/MAM technology. After checking the verification jig the prototype is prepped in individual abutments. We then scan each abutment to create individual zirconia copings and apply high quality porcelain. The copings are then ready for individual cementation to the substructure.

23225 Northwestern Hwy. n Southfield, MI 48075 800-742-9685 n 248-799-7070

www.skdentallab.com



Visit www.skdentallab.com for an Account & Passcode


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