January 2022 Texas Dental Journal by Texas Dental Association

January 2022

TEXAS DENTAL

INSIDE:

A Review of 3 Intraoral Scanning Systems and Conventional Modalities to Help Assess Clinical Significance and Superiority

www.tda.org | January 2022

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www.tda.org | January 2022

Contents January 2022 Established February 1883 n Vol 139, No. 1

FEATURES 18 | A Review of 3 Intraoral Scanning Systems and Conventional Modalities to Help Assess Clinical Significance and Superiority Roz Aghaaliandastjerdi Daymis Montalvo Carlos Perez Benjamin Shepperd Panagiotis Zoidis, DDS, MS, PhD Computer-aided design and computer aided manufacturing (CAD-CAM) has changed the practice of clinical dentistry and its usage within the field is only expanding.

DEPARTMENTS

31 | Calendar of Events

8 | President’s Message

32 | Oral and Maxillofacial

10 | Oral and Maxillofacial Pathology Case of the Month 14 | TDA Governance: Official Call to the 2022 Texas Dental Association House of Delegates

TDA members, use your smartphone to scan this QR Code and access the online Texas Dental Journal.

16 | TDA Governance: Notice of Grant Availability

Texas Dental Journal | Vol 139 | No. 1

Pathology Case of the Month Diagnosis and Management 38 | Value for Your Profession: Surcharging Credit Cards: Legal, Complicated, Risky 42 | Advertising Briefs 51 | Index to Advertisers

Editorial Staff Daniel L. Jones, DDS, PhD, Editor Paras B. Patel, DDS, Associate Editor Nicole Scott, Managing Editor Barbara Donovan, Art Director Lee Ann Johnson, CAE, Director of Member Services

Editorial Advisory Board Ronald C. Auvenshine, DDS, PhD Barry K. Bartee, DDS, MD Patricia L. Blanton, DDS, PhD William C. Bone, DDS Phillip M. Campbell, DDS, MSD Michaell A. Huber, DDS Arthur H. Jeske, DMD, PhD Larry D. Jones, DDS Paul A. Kennedy Jr, DDS, MS Scott R. Makins, DDS, MS Daniel Perez, DDS William F. Wathen, DMD Robert C. White, DDS Leighton A. Wier, DDS Douglas B. Willingham, DDS

The Texas Dental Journal is a peer-reviewed publication. Texas Dental Association 1946 S IH-35 Ste 400, Austin, TX 78704-3698 Phone: 512-443-3675 • FAX: 512-443-3031 Email: tda@tda.org • Website: www.tda.org Texas Dental Journal (ISSN 0040-4284) is published monthly (one issue will be a directory issue), by the Texas Dental Association, 1946 S IH-35, Austin, TX, 787043698, 512-443-3675. Periodicals Postage Paid at Austin, Texas and at additional mailing offices. POSTMASTER: Send address changes to TEXAS DENTAL JOURNAL, 1946 S IH 35, Austin, TX 78704. Copyright 2018 Texas Dental Association. All rights reserved. Annual subscriptions: Texas Dental Association members $17. In-state ADA Affiliated $49.50 + tax, Out-of-state ADA Affiliated $49.50. In-state Non-ADA Affiliated $82.50 + tax, Out-of-state Non-ADA Affiliated $82.50. Single issue price: $6 ADA Affiliated, $17 Non-ADA Affiliated, September issue $17 ADA Affiliated, $65 NonADA Affiliated. For in-state orders, add 8.25% sales tax. Contributions: Manuscripts and news items of interest to the membership of the society are solicited. Electronic submissions are required. Manuscripts should be typewritten, double spaced, and the original copy should be submitted. For more information, please refer to the Instructions for Contributors statement printed in the September Annual Membership Directory or on the TDA website: tda.org. All statements of opinion and of supposed facts are published on authority of the writer under whose name they appear and are not to be regarded as the views of the Texas Dental Association, unless such statements have been adopted by the Association. Articles are accepted with the understanding that they have not been published previously. Authors must disclose any financial or other interests they may have in products or services described in their articles. Advertisements: Publication of advertisements in this journal does not constitute a guarantee or endorsement by the Association of Association of the quality of value of Dental Editors and such product or of the claims made of Journalists. it by its manufacturer.

Board of Directors PRESIDENT Debrah J. Worsham, DDS 936-598-2626, worshamdds@sbcglobal.net PRESIDENT-ELECT Duc “Duke” M. Ho, DDS 281-395-2112, ducmho@sbcglobal.net PAST PRESIDENT Jacqueline M. Plemons, DDS, MS 214-369-8585, drplemons@yahoo.com VICE PRESIDENT, NORTHEAST Carmen P. Smith, DDS 214-503-6776, drprincele@gmail.com VICE PRESIDENT, SOUTHEAST Georganne P. McCandless, DDS 281-516-2700, gmccandl@yahoo.com VICE PRESIDENT, SOUTHWEST J. Ted Thompson, DDS 361-242-3151, tedito@aol.com 817-238-6450, pdalw@yahoo.com VICE PRESIDENT, NORTHWEST E. Dale Martin, DDS SENIOR DIRECTOR, NORTHEAST Elizabeth S. Goldman, DDS 214-585-0268, texasredbuddental@gmail.com SENIOR DIRECTOR, SOUTHEAST Glenda G. Owen, DDS 713-622-2248, dr.owen@owendds.com SENIOR DIRECTOR, SOUTHWEST Carlos Cruz, DDS 956-627-3556, ccruzdds@hotmail.com SENIOR DIRECTOR, NORTHWEST Teri B. Lovelace, DDS 325-695-1131, lovelace27@icloud.com DIRECTOR, NORTHEAST Jodi D. Danna, DDS 972-377-7800, jodidds1@gmail.com DIRECTOR, SOUTHEAST Shailee J. Gupta, DDS 512-879-6225, sgupta@stdavidsfoundation.org DIRECTOR, SOUTHWEST Richard M. Potter, DDS 210-673-9051, rnpotter@att.net DIRECTOR, NORTHWEST Summer Ketron Roark, DDS 806-793-3556, summerketron@gmail.com SECRETARY-TREASURER* Cody C. Graves, DDS 325-648-2251, drc@centex.net SPEAKER OF THE HOUSE* John W. Baucum III, DDS 361-855-3900, jbaucum3@gmail.com PARLIAMENTARIAN** Glen D. Hall, DDS 325-698-7560, abdent78@gmail.com EDITOR** Daniel L. Jones, DDS, PhD 214-828-8350, editor@tda.org LEGAL COUNSEL Carl R. Galant William H. Bingham, Advisor *Non-voting member **Non-voting attendee

www.tda.org | January 2022

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Texas Dental Journal | Vol 139 | No. 1

11 Presicci JAN Federico Dr.Felipe Clark Whitmire DEC Dr. Verde JAN Zirconia Bridge with Pink Ceramic levels 1Layering & 2: RECERTIFICATION COURSE 14-15 Natural Direct Composite Master Course and office preparation 6 -11 8 A review and update on drugs, techniques, emergencies, Dr. Aldo Sordelli, Dr. Giancarlo G. Romero HANDS-ON LEARNING AND LIVE PATIENT CARE! JAN 2022 COURSE CALENDAR CONTINUED EDUCATION! Federico Presicci JAN From CBCT to Surgical Guide Dr. Felipe Verde JAN Bridge with Pink Ceramic 28-29 Zirconia 14-15 Natural Layering Direct Composite Master Course 6 8 Dr. Aldo Sordelli, Dr. Giancarlo G. Romero MARCH Dr. AldoPreservation Sordelli, Dr. Giancarlo G. Romero JAN Ridge & Immediate Implant Placement Federico Presicci JAN 4-5 From CBCT to Surgical Guide 28-29 Zirconia Bridge with Pink Ceramic 14-15 Dr. Virgilio Gutierrez, Dr. Giancarlo G. Romero MARCH Dr. Aldo Sordelli, Dr. Giancarlo G. Romero MARCH Immersive Dental Clinical Photography Course Dr. Aldo Sordelli, Dr. Giancarlo G. Romero 11-12 JAN Ridge Preservation & Immediate Implant Placement 4-5 From CBCT to Surgical Guide 28-29 Spring IMPLANT FELLOWSHIP April Dr. VirgilioONE Gutierrez, Dr. Giancarlo G. Romero MARCH Session 22-23 Immersive DentalDr. Clinical Photography Dr. Aldo Sordelli, Giancarlo G. Romero Course MARCH 11-12 Ridgeimplant Preservation Spring fellowship& Immediate Implant Placement 4-5 MAY Spring IMPLANT FELLOWSHIP April session two 13-14 ONEGutierrez, Dr. Giancarlo G. Romero Dr. Virgilio 22-23 Session MARCH Dental Clinical AImmersive REFRESH AND UPDATE COURSE FOR: Photography Course implant fellowship June 11-12 MAY Spring Spring implant fellowship SIGN UP NOW THE LEVEL 1three AND LEVEL 2 DENTAL ANESTHESIA PRACTITIONER Session 17-18 two FELLOWSHIP 21 session 13-14 Spring IMPLANT April Session ONE 22-23 June Spring implant fellowship SIGN UP NOW Session three 17-18 MAY Spring implant fellowship session two 13-14 dr. felipe villa verde OCTober natural layering direct composite master course TDA10 for 10% Discount interactive 13,14,15 Spring implanttraining fellowship June live SIGN UP NOW Institute of Houston Dental Synergy Located at the Houston Dental Education Center 4548 Bissonnet St. Suite 210 Bellaire, TX 77401 Phone: 713.589.9603 Email: marketing@ihds-ce.com www.ihds-ce.com Houston Dental Education Center

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Chewon this B

ye, 2021! Can’t say you will be missed! You weren’t much better than your older sister, 2020!

Hello, 2022! Wonder what surprises you have in store for us? I’m sure we will adapt to whatever you throw our way, as we have been made to do these last couple years. After all, we Texans are a resilient bunch! Although I despise and refuse to make resolutions, a recent poll revealed these rank among the top 5: 1. Taking steps to improve physical health 2. Improve finances 3. Pursue a professional aspiration 4. Invest in relationships 5. Take care of mental health

and your team to grow professionally. By attending your local component society meeting, you are investing in relationships which are essential to your mental health and well-being. The camaraderie and networking opportunities available through this one avenue are priceless. Although 2021 wasn’t back up to pre-pandemic standards, your Texas Dental Association was still at work for you. The Texas Dental Association assisted 17 dentists with relief funds as a result of damage from winter storm Uri. TDA staff offered individualized help to more than 50 dentist offices facing third-party payor issues, and hundreds

of dentists were helped with personalized regulatory compliance assistance. The TDA Smiles Foundation provided 1,148 Texans with almost $1,000,000 in charitable dental care. Your TDA lobby team and staff, along with help from you, the TDA members, worked with legislators during the 87th legislative session to pass the teledentistry bill, while maintaining the current standard of care. This project was over 3 years in the works, and it required significant effort involving stakeholders, lawmakers, and legislative staff. This successful effort has now shifted from the legislative arena to the regulatory arena (rule-writing phase). Congratulations to all of us

All of these relate back to benefits available to you as a member of the Texas Dental Association. As 2020 and 2021 took their toll on us, the ADA launched a Health and Wellness series free to all members. TDA Perks offers multiple services to help with your finances and practice management issues. The TDA Meeting offers opportunities for you

TDA President Dr Debrah Worsham addresses the attendees at the Rio Grande Valley Society. The meeting was set up as a talk show called “Chew On This—A Talk Show With the TDA President.”

8 Texas TexasDental DentalJournal Journal | |Vol Vol 139 139| No. | No. 1 1

Pictured at the Rio Grande Valley Society meeting are TDA President Dr Debrah Worsham, Rio Grande Valley President Dr Melissa Uriegas, and TDA Past President Dr Joey Cazares.

on a well-deserved win! Insurance reform bills were introduced to help dentists and patients alike. HB 3459 prohibits certain state-regulated insurers from requiring dentists to obtain preauthorization if they meet specific criteria. SB 199, relating to purchase and maintenance of automatic external defibrillators, was amended to assure dentists remain able to purchase and maintain AEDs for their practices without unnecessary physician oversight and intrusion! These are just a few accomplishments which your TDA team fought for during this most recent and very abnormal legislative session. As we venture off into 2022, your Texas Dental Association staff and leaders will continue focusing on members’ needs, and the

TDA will adapt and change as necessary to meet them. Although there will be no TDA Meeting in San Antonio in 2022 due to the ADA meeting in Houston in October, the TDA Meeting Task Force is looking at ways to bring you continuing education in new and relevant formats. Stay tuned for these updates. Component leaders from across the state will assemble in Austin on February 4 and 5 for the 2022 TDA-hosted Leadership Conference. We will discuss common challenges and needs affecting components of varying sizes. It will be a great venue for exchange of ideas and networking opportunities with like minded folks. With focus group discussion on matters specific to your component group, the goal is to leave the conference with a greater understanding of

TDA President Debrah J. Worsham, DDS membership trends, TDA’s new Dental Concierge, TDA and ADA initiatives and priorities, TDA Perks program, TDA central office support available to members and component societies, and Advocacy and Regulatory Affairs. TDA staff will continue to provide quality service to each member of the Association, whether a new graduate or a seasoned member nearing retirement. TDA’s success is largely dependent on each member and their promotion of all the association has to offer. Let’s stay engaged, let’s stay informed, and let’s stay relevant!

The Rio Grande Valley Dental Society met in January in Corpus Christi. Local society meetings are great ways to meet peers and discover network opportunities.

www.tda.org | January 2022

ORAL

and maxillofacial pathology

Case History A 40-year-old former smoker, who is otherwise healthy, presented at the dental clinic due to poorly localized pain in the left maxilla. He also complained of an acute shooting pain in his left cheek, radiating to his eye and temple (ipsilateral), with associated sudden dental mobility in the upper left quadrant, of 2 months’ duration. Clinical findings were unremarkable. There was no palpable lymphadenopathy extraorally, and no obvious mass or ulceration was detected intraorally (Figures 1A and 1B). However, there was evidence of moderate periodontal disease and a CT scan revealed the presence of advanced bone loss of his left maxilla around teeth #12-#15, which was accompanied by pain and paresthesia. The osseous resorption was extensive, extending to involve the left anterior

case of the month

Figures 1A and 1B. Clinical pictures showing unremarkable oral cavity.

Texas Dental Journal | Vol 139 | No. 1

maxillary sinus wall (Figures 2A, B, C). A biopsy was performed (Figure 3) and a diffuse red/ white/yellow, soft tissue lesion, measuring approximately 22 mm x 20 mm x 15 mm in size, was obtained. Two teeth demonstrating severe

AUTHORS Ngozi Nwizu, BDS, MMSc, PhD Associate Professor, Board Certified Oral and Maxillofacial Pathologist, Department of Diagnostic and Biomedical Sciences, UTHealth at Houston School of Dentistry, Houston, Texas

Luis Diego Gonzalez, DDS Board Certified Oral and Maxillofacial Surgeon, Private practice, Houston, Texas

2A Figures 2A, B, C. Radiographic images showing extensive osseous resorption of the left maxilla and left anterior maxillary wall, in spite of negative clinical findings.

www.tda.org | January 2022

ORAL

and maxillofacial pathology, continued

Figure 3. Post-operative site.

Figure 4A. (Low magnification, x 40) showing a diffuse infiltrate of atypical, round, blue, mononuclear cells with scanty or ample cytoplasm.

Texas Dental Journal | Vol 139 | No. 1

Figure 4B. (High magnification, x 200) showing proliferation of atypical, round, blue, mononuclear cells with scanty or ample cytoplasm, interspersed with cells displaying hyperchromatic, angular nuclei and variation in nuclear size.

mobility were also extracted. The entire biopsy contents were submitted for microscopic analysis.

Figures 4C, 4D and 4D. CD45, CD3 and CD20 immunohistochemical stains.

Microscopic examination revealed the presence of fragments of dense fibrous tissue, some of which were partially covered by normal sinus mucosa. A prominent feature of the tissue specimen was the presence of a diffuse infiltrate of atypical, round, blue, mononuclear cells with scanty or ample cytoplasm (Figures 4a and 4b). These were interspersed with cells displaying hyperchromatic, angular nuclei and variation in nuclear size. Multiple mitotic figures, areas of crushing artifact and a number of apoptotic bodies were also observed. Other features of the tissue specimen include the presence of a fibro-vascular stroma enclosing multiple, irregular fragments of reactive bone trabeculae and small aggregates of chronic inflammatory cells.

What is the differential diagnosis? What is the final diagnosis? See page 32 for the answer and discussion.

www.tda.org | January 2022

OFFICIAL CALL TO THE 2022 TEXAS DENTAL ASSOCIATION HOUSE OF DELEGATES HOUSE OF DELEGATES:

REFERENCE COMMITTEE HEARINGS:

In accordance with Chapter IV, Section 70, paragraph

Reference Committee

A-1 of the Texas Dental

hearings will be facilitated

Association (TDA) Bylaws,

on Thursday, May 5, 2022

this is the official call for the

open to all members who

152nd Annual Session of

are present (any changes

the Texas Dental Association

to committee start times

House of Delegates. All

will be posted on the TDA

sessions of the House

website and announced

will be in the Lost Pines

at the first meeting of the

Ballroom of the Hyatt

House of Delegates):

Regency Lost Pines,

10:00 AM

Bastrop, Texas. The opening session of the House will convene at 8:00 a.m. on Thursday, May 5, 2022. The second meeting of the House will be at 1:30

REFERENCE COMMITTEES A & B (COMBINED) LOST PINES 1

p.m. on Friday, May 6, 2022. The third meeting of

COMMITTEE A:

the House will be at 8:00

Administration, Budget,

a.m. on Saturday, May 7,

Building, House of

2022, followed by the fourth

Delegates, Membership

meeting at 1:30 p.m. until

Processing

close of business. Component Societies are urged to certify an accurate list of Delegates and Alternates to fill each of their seats on the floor of the TDA House of

COMMITTEE B: President’s Address, Miscellaneous Matters, Component Societies, Subsidiaries, Strategic Planning, Annual Session

Delegates.

Texas Dental Journal | Vol 139 | No. 1

1:00 PM REFERENCE COMMITTEES C & D (COMBINED) LOST PINES 2 COMMITTEE C: Dental Education, Dental Economics, Health and Dental Care Programs COMMITTEE D: Legislative, Legal and Governmental Affairs

3:30 PM REFERENCE COMMITTEE E: Constitution, Bylaws, Ethics & Peer Review LOST PINES 3 The agendas for these committee meetings will be included in the Reference Committee section of the Delegate materials and sent to the Delegates and Alternate Delegates at least 30 days in advance of the meetings.

REFERENCE COMMITTEE REPORTS: Reference Committee Reports will be posted on the TDA website and

participation by candidates

electronically at least 30

for ADA elected offices, the

days prior to the Annual

Candidates Forum will not

Session. The supplements

be held.

to the House Documents,

DIVISIONAL CAUCUSES:

containing the agenda and subsequent reports, will be sent after the March 2022 TDA Board of Directors

emailed in PDF format to the members of the House

Divisional Caucuses

meeting. The minutes of the

of Delegates (reports may

(Northwest, Northeast,

TDA Board shall be posted

be downloaded from any

Southwest, Southeast)

on the members’ side of

location with Internet

will be facilitated entirely

the TDA website and made

access). Printed copies will

through electronic virtual

available to the general

not be provided.

means at 6:00 p.m. CDT as

TDA membership once the

follows:

minutes are approved by

FINANCIAL FORUM:

the TDA Board of Directors •

Monday, April 25, 2022

in accordance with Policy

Northeast Division

26-2018-H. Delegates and alternates will receive all

The TDA SecretaryTreasurer will facilitate a

•

one-hour questions and

Tuesday, April 26, 2022

House Documents in PDF

Southeast Division

format. Printed copies of the House Documents will not

answer financial forum open to all members who are

•

Wednesday, April 27, 2022

be provided.

Southwest Division

present at 9:30 a.m. on Thursday, May 5, 2022 in the same meeting room as Reference Committee A & B

•

Thursday, April 28, 2022

Wireless internet

Northwest Division

access will not be provided in the House

(Lost Pines 1). Registration is required

of Delegates meeting

CANDIDATES FORUM:

and open to all current

room—please download

The ADA and TDA

additional information.

Candidates Forums will be held in Lost Pines 1 and 2 of the hotel on Friday, May

members—please see the

all House materials on

TDA website for details and

a fully charged laptop

DELEGATE MATERIALS:

or device prior to attendance (charging stations will be centrally located in the meeting rooms).

6, 2022, from 10:30 a.m. to 12:00 p.m. In the event

In accordance with

there are no contested TDA

TDA Bylaws, the House

statewide elections and no

documents will be sent

www.tda.org | January 2022

TEXAS DENTAL ASSOCIATION NOTICE OF GRANT AVAILABILITY 501(C) (3) NON-PROFIT DENTAL ORGANIZATIONS

JKJ Pathology Oral Pathology Laboratory

John E Kacher, DDS • Available for consultation by phone or email • Color histology images on all reports • Expedited specimen shipping with tracking numbers • Reports available online through secure web interface

Professional, reliable service with hightechnology solutions so that you can better serve your patients.

Eligibility: Grantees must be 501(c)(3) nonprofit organizations affiliated with dentistry. Application: Letters of interest detailing the proposed project(s) and including a budget should be mailed to: TDA Board of Directors C/O Mr Terry Cornwell 1946 S IH 35, Ste 400 Austin, TX 78704 Deadline: Letters of Interest must be postmarked or emailed (tcornwell@tda.org) no later than January 31, 2022. Approval: All letters of Interest will be reviewed and considered by the TDA Board of Directors no later than its March 2022 meeting.

Call or email for free kits or consultation.

Notification: All recipients will be notified in writing on or before May 15, 2022.

jkjpathology.com 281-292-7954 (T) 281-292-7372 (F) johnkacher@jkjpathology.com

Previous Recipients: In 2021, grants totaling $7,842.44 were awarded to the following organizations in Texas for charitable patient care: Capital Area Dental Foundation (Austin), The Family Place (Dallas), Network of Community Ministries (Richardson), and San Jose Clinic (Houston).

Protecting your patients, limiting your liability

The Texas Dental Association (TDA) announces availability of financial assistance for qualifying 501(c)(3) non-profit organizations affiliated with dentistry. The monies are derived from TDA Relief Fund interest income earned over the 2021 fiscal year. Grantees will be determined by the TDA Board of Directors.

Texas Dental Journal | Vol 139 | No. 1

For more information, please contact Mr Terry Cornwell, TDA Governance Manager, 512-4433675, Ext. 146, or email tcornwell@tda.org.

CELEBRATING 30 YEARS

Experience Matters Since 1992, our firm has worked with hundreds of dentists to facilitate their practice sales and appraisals. We look forward to many more years of representing clients and providing smooth transitions for dental practices all over Texas.

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www.tda.org | January 2022

A Review of 3 Intraoral Scanning Systems and Conventional Modalities to help assess clinical significance and superiority

Texas Dental Journal | Vol 139 | No. 1

AUTHORS Roz Aghaaliandastjerdi

DMD Candidate, University of Florida College of Dentistry, Gainesville, FL

Daymis Montalvo

DMD Candidate, University of Florida College of Dentistry, Gainesville, FL

Carlos Perez

DMD Candidate, University of Florida College of Dentistry, Gainesville, FL

Benjamin Shepperd

DMD Candidate, University of Florida College of Dentistry, Gainesville, FL

Panagiotis Zoidis, DDS, MS, PhD

Associate Professor, Department of Restorative Dental Sciences, Division of Prosthodontics, University of Florida College of Dentistry, Gainesville, FL Corresponding author: Panagiotis Zoidis Email: pzoidis@dental.ufl.edu The authors do not have any financial interest in the companies whose materials are included in this article. www.tda.org | January 2022

Abstract PURPOSE: With digital dentistry becoming a large focus of interest by many clinicians, this paper aims to examine and assess differences in clinical significance and superiority in performance of 3 different intraoral scanner (IOS) systems as well in comparison to conventional techniques. METHODS: Information to answer the aims of the study were sought out from several in vitro studies that were obtained via electronic database searches of MEDLINE (via PubMed) for keywords such as “intraoral scanning”, “E4D”, “Cerec Omnicam”, “3M True Definition”, and “digital impressions”. RESULTS: The 3 IOSs studied varied in regards to method of image acquisition with Cerec Omnicam utilizing active triangulation with strip light projection, TrueDefinition using active wavefront sampling, and PlanScan using laser triangulation. TrueDefinition was not able to capture the entire crown margin with Cerec Omnicam performing the best overall. A shortcoming of the TrueDefinition could be the inability to capture high-resolution scans at a depth for single unit restorations. PlanScan performed the worst of the 3 scanners when assessing the finish line of single unit crown preparations with OmniCam and TrueDefinition being able to capture the finish line of single unit crown preparations with higher resolution. All systems performed more accurately when quadrants were scanned in comparison to full arches. When compared to conventional impressions, digital impressions most commonly present with overextension of the margin. When observing marginal gap volume associated with cemented restorations, conventional impression technique showed the largest discrepancy and the lowest being with the digital impression technique for lithium disilicate crowns. CONCLUSIONS: Digital impressions are faster than conventional impressions, taking only 41% of the treatment time. No significant variations present in accuracy of digital and conventional impressions in regard to single restorations with shortcomings present on both sides. CEREC Omnicam showed the highest accuracy, for single unit intracoronal restorations in comparison to other IOSs. Scanning accuracy declined when full arches were scanned compared to quadrants for all systems. Difference in data acquisition method could have effects on resolution of image captured.

Keywords

Cerec Omnicam,digital impressions, intraoral scanning, E4D, 3M True Definition

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INTRODUCTION

omputer-aided design and computer aided manufacturing

(CAD-CAM) has changed the practice of clinical dentistry and its usage within the field is only expanding. The clinical use of CAD-CAM began with the idea of inlay fabrication.1 The idea of chairside fabrication of an inlay made of composite and bonded with resinbased composite as a luting agent was hypothesized by Dr Werner H. Mörmann. Dr Mörmann consulted his friend Dr Marco Brandestini, an electrical engineer who pictured the idea that cavities could be captured using optoelectronic scanning.2 Dr Alain Ferru, a young software engineer, met with the two friends and learned about dental anatomy, and how to build an inlay in 3 domains: occlusion, proximal contacts, and the margins.3 Dr Brandestini, after several in vitro tests, concluded that 50 to 100µm fitting accuracy was possible to achieve.4,5 The invention of the computer controlled milling machine necessitated the use of an intraoral camera to capture instantaneous 3D images tooth preparations. The idea of integrating a way to scan the preparation with the camera and at the same time check what was being scanned became a necessity. Dr Mormann envisioned that the camera could be integrated to a device that would be held by the dentist like a hand piece, connected to a monitor displaying the image. The idea of using

ceramic instead of composite and that a block of ceramic could be turned into an inlay with little surface detailing, led to the introduction of CEREC 1 to the market by Dr Brandestini. The addition of 2D software to capture single crown preparations and of a diamond bur to facilitate the milling of partial and full crowns gave birth to CEREC 2.6 The integration of 3D software and a step bur to allow for greater precision resulted in the introduction of the CEREC 3 to the dental market in 2003. In 2006 the software was updated to perform automatic adjustment of the restoration to preparation, proximal contacts, and opposing teeth. CAD-CAM traditionally includes 2 features; an intra-oral scanner (IOS) which captures a digital impression in a succinct file and a milling machine to which the file is sent. To ensure their success and usage, intra-oral scanners (IOSs) must be able to capture digital impressions to the level of accuracy of conventional modalities in order to make their usage over conventional impressions advantageous. A number of IOSs are available to the clinician currently and their specifications and performance change by the day. A literature review was performed on some of the latest IOS systems in order to determine the best to use overall. The protocol of this literature review included electronic database searches of MEDLINE (via PubMed) for keywords such as “intraoral scanning”, “E4D”, “Cerec Omnicam”, “3M True Definition”, and “digital impressions”.

www.tda.org | January 2022

METHODS AND MATERIALS The aims of this study were to: a) understand the history of intraoral scanning technology, b) compare intraoral scanning to conventional impression techniques, c) compare modern intraoral scanning systems to assess successes and shortcomings with each system, and d) determine the clinical relevance of each scanning modality based upon differences in technology. The selection criteria for the devices in the study were influenced by availability in the U.S. market. The study compared 3 different intraoral scanners PlanScan (Planmeca Inc), CEREC Omnicam (Dentsply Sirona Inc), and True Definition (3M ESPE) to one another as well as to conventional techniques, in order to assess clinical significance and to determine superiority in performance. Systems varied in regards to technology acquisition, the need for a powder coating, file system, and color.7

PlanScan: Planmeca PlanScan is the byproduct of a newly founded partnership between Planmeca and E4D technologies. The digital workflow includes a powder-free image capture and blue laser technology which improves the ability to capture fine details on the screen, enabling the clinician to design and mill precise restorations. Planmeca’s Romexis is an open image management system that can be used with any system, enabling the clinician to import and export image files.8 (Disclaimer: This information relates to a more recent version of E4D than that utilized in some of the articles reviewed.)

Planmeca PlanScan

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CEREC Omnicam: Introduced in 2012, Omnicam is available in 2 versions: trolley (AC) and tabletop (AF). As a light scanner with a white light-emitting diode (LED), it works via optical triangulation, doesn’t require an intraoral powder coating, and produces colored images. Cerec Omnicam is a closed system, exporting digital impression as proprietary files that work on Sirona’s supporting CAD software and devices. However, recently, the system has partially opened and there’s a new possibility to transform the proprietary files into .STL files usable for any CAD system.9 CEREC Omnicam

TrueDefinition: As the second IOS fabricated by 3M Espe, TrueDefinition has been available since 2012, first as a touch-screen trolley model, and now a portable version with the scanner operating on a tablet (TrueDefinition Mobile). As a structural light scanner, it uses pulsating visible blue light and requires coating of the surface to be scanned with titanium oxide powders. Monochrome images are created and displayed as a video sequence. The scanner does not feature a cropping tool but rather a rewind function to return to a desired scan status. It is a semiclosed system, as the proprietary files formed can be exported to the .STL format with the payment of a monthly fee.9 Features examined will be method of image acquisition (videosequence vs. individual images) and performance (accuracy [trueness and precision], full arch vs. quadrant, etc.). TrueDefinition www.tda.org | January 2022

RESULTS Image Acquisition The method in which the IOS acquires the intraoral data was used to compare the technologies. The way image data is captured by each IOS is summarized in Table 1.

Table 1. Summary of the image acquisition technology used in each IOS.1 System Manufacturer

Scanner Technology

PlanScan

Laser Laser triangulation

Planmeca (formerly E4D Technologies)

Light Source

Acquisition Method Video Sequence

CEREC Dentsply Omnicam Sirona

Active Triangulation with strip light projection

Visible Light

Video Sequence

True 3M ESPE Definition

Active wavefront sampling

Visible Light

Video Sequence

The 3 IOSs studied varied with regard to the method of image acquisition; Cerec Omnicam utilizing active triangulation with strip light projection, TrueDefinition using active wavefront sampling, and PlanScan using laser triangulation.

Accuracy The accuracy of the different scanning systems is conventionally tested using in-vitro dental models. The scans are compared to a reference scanner that has been

tested and proven.3 Often, the reference scanner is a laboratory scanner. Depending upon the study, the digitized “gold-standard” model is compared to either digitized IOS data, or digitized data from conventional impression techniques that are performed using the reference scanner. The digital files are compared using the Geomagic inspection software, which is accepted in the literature.10,11 Accuracy is assessed by two variables,

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precision and trueness, according to ISO standard No. 5725-1:1994.12 One study showed that TrueDefinition was not able to capture the entire crown margin, with Omnicam performing the best overall. A shortcoming of the TrueDefinition system could be the inability to capture high-resolution scans at a depth for single unit restorations. PlanScan performed the worst of the three scanners when assessing

the finish line of single unit crown preparations, with OmniCam and TrueDefinition being able to capture the finish line of single unit crown preparations at a higher resolution. In regard to quadrant scans compared with entire arch digital impressions, all systems performed more accurately when quadrants were scanned in comparison to full arch scans.

Marginal Fit When observing marginal gap volume associated with cemented restorations, the conventional impression technique showed the largest discrepancy, the lowest being with the digital impression technique for lithium disilicate crowns. However, the digital impression technique most commonly presented with overextension of the margin. Another study showed that finish line distinctiveness and accuracy varied immensely amongst the IOSs and conventional impressions, with no sizeable differences between conventional and IOS impressions.13 With many new IOS systems available today, the field of digital dentistry

is very dynamic with new products emerging every year. Given this constant wave of new technology, clinicians are constantly searching for the best product available to incorporate into their practices.

DISCUSSION Comparing conventional and digital workflow The utilization of intraoral scanning techniques has greatly influenced the way clinicians operate in daily life, and the overall patient experience in the dental office. Clinical steps required in conventional

impression techniques are the following: tray selection, adhesive application, maxillary impression, mandibular impression, and bite registration. The digital impression workflow includes the following steps: patient information, laboratory prescription, maxillary scan, mandibular scan, and bite scan. While the steps hardly differ between the two protocols, the digital workflow reports a total treatment time that is roughly 41% the amount of time as the conventional system (248.48 seconds for digital system versus 605.38 seconds for the www.tda.org | January 2022

conventional system).14 Studies have shown 100% preference from patients for the intraoral scanners as opposed to having impressions taken.14 When conventional impressions were compared to IOS scans in terms of accuracy, the trueness and precision values for the conventional impression groups were consistently lower than those for the digital impression group.3 The literature shows no significant difference between the digital impression groups that were tested.3 One in vitro study evaluating accuracy and finish line distinctness between 7 IOSs and conventional impression techniques revealed that all IOSs except Planscan had comparable overall accuracy.15 Additionally, finish line distinctiveness and accuracy varied immensely amongst the IOSs and conventional impressions, showing no sizeable difference between conventional and IOS impressions. The marginal fit is the measurement of how well the restoration fabricated from a certain impression method adapts to the

margin of the restoration. Marginal fit is an important characteristic when assessing impression techniques, as it uses a clinically applicable criteria to evaluate the long-term success of the restoration.16 Marginal fit was assessed by investigation of marginal gaps, and marginal discrepancies (overextension and underextension). The marginal gap volume associated with cemented restorations was observed to be the greatest with the conventional impression technique, and lowest in the digital impression technique for lithium disilicate crowns.14,16 However, the most common marginal discrepancy observed was overextension of the margin, and this was observed most commonly in the digital impression technique.16 Underextension of the margin was seen most commonly in restorations fabricated with conventional impression techniques.16

Comparing Intraoral scanner systems The 3 scanning systems that were assessed in the study all work by capturing video. However, the light

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source used varies. The PlanScan has a laser light source, while the Omnicam and TrueDefinition systems both utilize visible light. From some of the previous studies, our review supports the contention that a visible light source performs a better scan for the partially edentulous maxilla and fully edentulous maxilla than the laser light source.15 The PlanScan performed the least well of the 3 scanners when assessing the finish line of single unit crown preparations.15 This was measured using the software associated with the IOS to determine the resolution of the scans. The OmniCam and TrueDefinition systems were able to capture the finish line of single unit crown preparations with a higher resolution.15 However, the TrueDefinition scanner struggled to capture the entire crown margin. A shortcoming of the TrueDefinition could be the inability to capture highresolution scans at a depth for single unit restorations. The Omnicam performed the best overall. This could be attributed to the scanner technology used, i.e., active triangulation with strip

light projection. However, there is no reference in the literature to support this. The ability of an IOS to capture a digital impression accurately is of the utmost importance and this information gathered from scanning must be converted to 3-dimensional data without distortion.1 The accuracy of a digital impression reflects upon the outcome of the final restoration and discrepancies between scanning and milling could yield poor adaptation of the prosthesis. Marginal discrepancies beyond the clinically acceptable standard of 120 μm could jeopardize the lifespan of restorations due to clinical complications such as secondary caries or periodontal inflammation from plaque accumulation.1,11 Accuracy is defined by trueness and precision. Trueness represents the mean deviation of a group of measurements from an original reference and precision is defined as the mean deviation between repeated measurements.3 Higher trueness and precision values correspond to lower numerical values of each variable.1,11,12

Clinical scenarios and the extent of the scanned area influence scanning accuracy. One study compared the accuracy of 4 IOSs using 2 different clinical scenarios: a partially edentulous maxilla (PEM) with three implants and a full edentulous maxilla (FEM) with 6 implants.17 The study revealed that in PEM scans, Omnicam had better trueness values than TrueDefinition, however the differences in these values were not deemed to be statistically significant. Alternatively, TrueDefinition had the best precision values in the FEM model, but with no statistically significant differences from the other systems tested. For both Omnicam and TrueDefinition, the

accuracy of PEM scans was significantly better than those collected in FEM scans.17 Digital system recommendations that depend on the clinical scenario could be proposed. The CEREC Omnicam exhibits the best overall depth of scanned field that results in the lowest values of trueness and precision, therefore the highest accuracy, for single unit intracoronal restorations.11 The CEREC Omnicam and 3M TrueDefinition showed comparable levels of accuracy when scanning full arches.1 Finally, although the use of powders can result in higher accuracy levels, reducing scanning time and patient inconvenience, www.tda.org | January 2022

remaining powder in the oral cavity may exert a harmful effect on the body.18,19

Aims for future studies Since most of the studies were of in vitro design, with only one presenting an in vivo method of conducting such a comparison, future studies should aim to conduct experiments to assess the performance of such IOSs in the intraoral environment to help better determine the superiority or ease of use for a given system.

full arches were scanned compared to quadrants for all systems. REFERENCES

8. 1.

CONCLUSIONS It appears that digital impressions are faster than conventional impressions, taking only 41% of the treatment time. There were no significant variations in the accuracy of digital and conventional impressions in regard to single restorations with shortcomings present on both sides. CEREC Omnicam showed the lowest values of trueness and precision, and therefore the highest accuracy, for single unit intracoronal restorations in comparison to other IOSs. Scanning accuracy declined when

Kim, RJ, Park J, Shim J. Accuracy of 9 Intraoral Scanners for CompleteArch Image Acquisition: A Qualitative and Quantitative Evaluation. J Prosthet Dent 2018;120:895–903. Mörmann WH. The origin of the CEREC method: a personal review of the first 5 years. Int J Comput Dent 2004;7:11-24. Mörmann WH, Brandestini M. The fundamental inventive principles of CEREC CAD/CAM. In: Mörmann WH, ed. State of the art of CAD/ CAM restorations: 20 years of CEREC. London: Quintessence; 2006:1-8. Mörmann WH, Krejci I. Computer-designed inlays after 5 years in situ: clinical performance and scanning electron microscopic evaluation. Quintessence Int 1992;23:109-15. Bindl A, Mörmann WH. Clinical and SEM evaluation of allceramic chair-side CAD/ CAM generated partial crowns. Eur J Oral Sci 2003;111:163-9. Mörmann, WH, Schug J. Grinding precision and accuracy of fit of CEREC 2 CAD-CAM inlays. JADA 1997;128:47-53.

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10.

11.

12.

13.

Mangano, F, Gandolfi A, Luongo G, Logozzo S. Intraoral scanners in dentistry: a review of the current literature. BMC Oral Health. 2017;17:149. “Planmeca Intraoral Scanners.” Planmeca Frontpage, https://www. planmeca.com/cadcam/ dental-scanning/intraoralscanners/. Imburgia M et al. Accuracy of Four Intraoral Scanners in Oral Implantology: a Comparative in Vitro Study. BMC Oral Health 2017;17:92. Jeong ID, Lee JJ, Jeon JH, Kim JH, Kim HY, Kim WC. Accuracy of complete-arch model using an intraoral video scanner: An in vitro study. J Prosthet Dent 2016;115:755-9. Park J, Kim RJ, Lee K. Comparative Reproducibility Analysis of 6 Intraoral Scanners Used on Complex Intracoronal Preparations. J Prosthet Dent 2020;123:113-120. Atieh M, Ritter A, Ko C, Duqum I. Accuracy Evaluation of Intraoral Optical Impressions: A Clinical Study Using a Reference Appliance. J Prosthet Dent 2017;118:400-405. Schmalz G, Federlin M, Reich E. Effect of dimension of luting space and luting composite on marginal adaptation of a Class II ceramic inlay. J Prosthet Dent 1995;73:392-9.

14. Yuzbasioglu E, Kurt H, Turunc R, Bilir H. Comparison of digital and conventional impression techniques: evaluation of patient’s perception, treatment comfort, effectiveness, and clinical outcomes. BMC Oral Health 2014;14:10. 15. Nedelcu R, Olsson P, Nyström I, Thor A. Finish Line Distinctness and Accuracy in 7 Intraoral Scanners versus Conventional Impression: an in vitro Descriptive Comparison. BMC Oral Health 2018;18:27.

16. Anadioti E. et al. 3D and 2D Marginal Fit of Pressed and CAD/CAM Lithium Disilicate Crowns Made from Digital and Conventional Impressions. J Prosthodont 2014;23:610-7. 17. Mostafa N. et al. Marginal Fit of Lithium Disilicate Crowns Fabricated Using Conventional and Digital Methodology: A Three-Dimensional Analysis. J Prosthodont 2018;27:145-152.

18. Nedelcu R, Persson A. Scanning accuracy and precision in 4 intraoral scanners: An in vitro comparison based on 3-dimensional analysis. J Prosthet Dent 2014; 112:1461-71. 19. Park J. Comparative analysis on reproducibility among 5 intraoral scanners: sectional analysis according to restoration type and preparation outline form. J Adv Prosthodont 2016;8:354-62.

www.tda.org | January 2022

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ORAL

and maxillofacial pathology diagnosis and management—from page 10

Non-Hodgkin Lymphoma Discussion This patient presented with no clinically obvious soft tissue mass or ulceration, although moderate periodontal disease was present. The main feature was observed radiographically, displaying evidence of advanced bone loss of his left maxilla, with extensive osseous resorption involving the left anterior maxillary sinus wall, which was accompanied by pain and paresthesia. Since the overlying mucosa appeared essentially intact, lesions arising primarily within the maxilla or secondarily involving the maxilla, would be top on the list of differential diagnoses. Also, lesions originating within the maxillary sinus that could extend to involve the maxilla, would be considered. Therefore, the differential diagnosis would include uncommon conditions such as lymphoma, multiple myeloma,

primary intraosseous squamous cell carcinoma, metastatic tumors to the jaws and primary malignancies of the sinus. Other disease conditions under consideration include chronic infection and inflammation involving the maxilla such as osteomyelitis, and similar conditions such as, medicationrelated osteonecrosis of the jaws (MRONJ) and osteoradionecrosis. Non-Hodgkin lymphoma is the 7th and 6th most common cancer diagnosed among adult males and females, respectively, in the United States. Non-Hodgkin lymphoma accounts for over 45,000 cancer cases among U.S. men, and 36,000 cancer cases in U.S. women.1 It is also the 9th leading cause of cancer deaths among adult men and women, responsible for a combined total of almost 22,000 deaths per year in the United States.1 Lymphoma

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is a cancer of the lymphatic system (lymph nodes, bone marrow, spleen and thymus gland), but can arise in virtually any organ of the body. It is a disease that mainly involves adults, although children are also known to be affected. Lymphomas are classified into 2 major groups, Hodgkin lymphoma and NonHodgkin lymphoma. NonHodgkin lymphoma is much more common of the two conditions and has many other subclassifications. Known risk factors include individuals with a compromised immune system, for example, organ transplant patients who take immunosuppressants. Other conditions such as Sjogren syndrome, HIV infection, lupus erythematosus, and EBV infection have also been implicated.1 Typically, patients suffering from lymphoma present with swollen lymph nodes involving the cervical, axillary, or inguinal region.

They may also experience fatigue, shortness of breath, chest pain, hepatosplenomegaly, night sweats, unintentional weight loss, itching and fever of unknown origin.1 When lymphomas arise in the oral cavity, they tend to be extranodal in presentation and are predominantly of the Non-Hodgkin lymphoma subtype.2 They often arise centrally within the jaws or as nontender, diffuse, erythematous or purplish soft tissue swellings with a boggy consistency (with or without ulceration). The most common intraoral location is the buccal vestibule, followed by the posterior hard palate or gingiva.3 When lymphomas involve bone, the symptoms are often nonspecific and may lead to a delay in diagnosis. Patients may complain of paresthesia or pain/ discomfort that is not well localized, or can sometimes present with tooth mobility and displacement, mimicking toothache and odontogenic infection. Radiographic findings may be subtle in early lesions, but usually present as a poorly defined radiolucency that may be accompanied by bony expansion and

cortical perforation, ultimately resulting in a soft tissue swelling that can be misdiagnosed as a dental abscess.3 Multiple myeloma is an uncommon malignant plasma cell neoplasm. It can present as cancerous growths involving multiple bones (commonest feature). Alternatively, it may affect a single bone, or present as a soft tissue swelling outside of the bone marrow (extramedullary presentation), referred to as a plasmacytoma. The clinical presentations of multiple myeloma include bone pain, pathological fractures, hypercalcemia, and renal insufficiency.4 Multiple myeloma presenting as an isolated lesion involving the jaw bones is a rare occurrence. Most cases involving the jaws usually demonstrate involvement of other skeletal bones as well. Involvement of the jaw bones may be the first indication of this disease and further work-up is usually recommended to exclude the presence of systemic involvement.5 In general, the skull bones are more commonly involved than the jaw bones and the mandible is more commonly

affected than the maxilla, particularly the posterior mandible and ascending ramus. Jaw involvement is usually accompanied by the presence of pain, numbness, bony expansion and teeth mobility.6 The radiographic features are often characteristic, presenting as multiple, punched out radiolucencies, although sometimes they may be accompanied by a diffuse, ill-defined, osteolytic radiolucency.6 Urine tests reveal the presence of M proteins produced by the abnormal plasma cells, normally referred to as Bence Jones proteins. Blood tests may also detect the presence of M proteins or beta2microglobulin. Primary intraosseous carcinoma (formerly called primary intraosseous squamous cell carcinoma), arises de novo centrally within bone without involvement of the overlying mucosa initially.7 The overlying oral mucosa must be intact, there must be no evidence of a remote primary tumor and microscopic analysis confirming the presence of a squamous cell carcinoma.7,8 Primary intraosseous carcinoma www.tda.org | January 2022

ORAL

and maxillofacial pathology, continued

usually develops from malignant transformation of the cystic lining of a residual, radicular, or dentigerous cyst, or less commonly from an odontogenic keratocyst.7 The lack of involvement of the overlying mucosa for primary intraosseous carcinoma is similar to the clinical findings observed in our patient. Pain is the most common clinical symptom. Jaw swelling and sensory alterations are also other common features.9 Radiographically, a majority of the lesions present as a diffuse, poorly defined radiolucency.10 Metastatic tumors to the jaws are rare and account for about 1% of oral malignancies.11 However, it is important to note that metastatic disease accounts for the most common malignancy occurring in the jaw bone, and might be the first sign of a previously undiagnosed malignancy at a remote site. Metastatic tumors to the oral cavity are most commonly found in the posterior jaw bones, especially the molar region

of the mandible, and the gingiva is the most commonly involved oral soft tissue.12 The origins of oral metastatic tumors are mainly from the lung, kidney, liver, prostate, breast, female genital organs and colorectum. Patients with metastatic tumors of the jaw bones most commonly present with swelling, pain and paresthesia.12 The radiographic findings of metastatic tumors may vary, depending on origin of the metastases. Metastases from certain anatomic sites, such as the prostate, tend to produce an osteoblastic response, resulting in a more radiopaque or mixed density appearance, while metastases from other organs such as the lung or breast often present with an ill-defined radiolucency.

display vague symptoms that may be clinically indistinguishable from sinusitis.13 Alternatively, the development of symptoms may occur rapidly including facial swelling, persistent unilateral stuffiness, discharge and epistaxis. Vision changes caused by eye displacement or protrusion may be present. Severe pain, paresthesia or numbness in the midface may mimic a toothache involving the maxillary teeth. There may also be intraoral manifestations including swelling and ulceration of the alveolar ridge and/or the palate, and affected teeth may become mobile. Radiographic findings may show cloudy sinuses and an ill-defined radiolucency with destruction of its bony walls.

Cancer of the maxillary sinus is also quite uncommon. Some cancers of the maxillary sinus arise within the lining of the maxillary sinus and can erode the maxillary floor extending to involve the maxilla. Patients may

Osteomyelitis is an infection and inflammation involving the bone. Patients with chronic suppurative osteomyelitis often present with localized pain, ulceration, swelling, foul smelling discharge and bone exposure. They may

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also present with constitutional signs of infection such as fever, and on rare occasions may show evidence of a pathological fracture. Other conditions such as medication-related osteonecrosis of the jaws (MRONJ) and osteoradionecrosis may also present similarly clinically. Medicationrelated osteonecrosis of the jaws (MRONJ), is a serious complication of the jaw bones, characterized by bone necrosis and exposure, with or without accompanying pain. It is often associated with patients who take bone sparing medications such as Bisphosphonates, for the treatment of advanced cancer or osteoporosis. Patients with osteoradionecrosis also develop bone necrosis and exposure, but as a complication of radiation therapy to the oral cavity. Since many diverse conditions can present with overlapping clinical and/or radiographic findings, it is important to perform a biopsy in order to arrive at a definitive diagnosis. Microscopically, our patient’s biopsy specimen showed a diffuse infiltrate of atypical, blue cells. Ancillary studies consisting of immunohistochemical stains for CD3, 20 and 45 markers, respectively, with appropriate controls, were performed to further narrow down the diagnosis. The cluster of differentiation (CD) system represents cell surface markers used in immunophenotyping different subpopulations of white blood cells. CD45 is used to identify lymphocytes as a broad group. Whereas CD3 is used to differentiate T lymphocytes

Figure 4C

Figure 4D

Figure 4E

www.tda.org | January 2022

ORAL

and maxillofacial pathology, continued

and CD20 to identify B lymphocytes. CD45 showed strong, diffuse positivity throughout the lesion. While CD3 showed diffuse nuclear and cytoplasmic positivity, CD20 revealed diffuse membranous positivity (Figures 4c, 4d and 4e). The patient was referred to a hematooncologist for additional workup and to further subclassify this neoplasm to determine the definitive treatment.

primarily originates from the oral cavity, or is a manifestation of more widespread disease.14 Other factors known to adversely affect prognosis and result in a lower overall survival rate, include the presence of advanced stage disease, greater extranodal involvement, and evidence of underlying infections such as HIV and EpsteinBarr virus infections.15

Whenever a patient presents with vague toothache, tooth mobility or an ill-defined radiolucency, lymphoma should be considered in the list of differential diagnoses.14 Additionally, the presence of a mass or ulceration at a site of previous extraction should raise a high index of clinical suspicion for malignancy, including lymphoma. Treatment of Non-Hodgkin lymphoma affecting the jaws usually involves a combination of chemotherapy and radiotherapy. In terms of prognosis, it is important to determine if the lymphoma

References

American Cancer Society. Cancer Facts & Figures 2021. Atlanta: American Cancer Society; 2021. Guevara-Canales JO, Morales-Vadillo R, de Faria PE, SacsaquispeContreras SJ, Leite FP, Chaves MG: Systematic review of lymphoma in oral cavity and maxillofacial region. Acta Odontol Latinoam 2011;24:245-250. Neville BW, Damm DD, Allen CA, Chi AC. Oral and Maxillofacial Pathology. 4th edition. In Hematologic Disorders Chapter 13,

Texas Dental Journal | Vol 139 | No. 1

555 – 558. An SY, An CH, Choi KS, Heo MS. Multiple myeloma presenting as plasmacytoma of the jaws showing prominent bone formation during chemotherapy. Dentomaxillofac Radiol. 2013;42(4):20110143. doi: 10.1259/ dmfr.20110143. PMID: 23520399; PMCID: PMC3667514. Owotade F, Ugboko V, Ajike S, Salawu L, Amusa Y, Omole M. Head and neck manifestations of myeloma in Nigerians. Int J Oral Maxillofac Surg. 2005 Oct;34(7):7615. doi: 10.1016/j. ijom.2005.02.007. PMID: 15979285. Bruce KW, Royer RQ. Multiple myeloma occurring in the jaws; a study of 17 cases. Oral Surg Oral Med Oral Pathol. 1953 Jun;6(6):729-44. doi: 10.1016/00304220(53)90199-6. PMID: 13063932. L. R. Eversole, C.

H. Siar, and I. van der Waal, “Primary intraosseous squamous cell carcinoma,” in World Health Organization Classification of Tumours. Pathology and Genetics, Head and Neck Tumours, L. Barnes, J. W. Everson, P. Reichart, and D. Sidransky, Eds., pp. 290-291, IARC Press, Lyon, France, 2005. E. W. Odell, C. M. Allen, and M. Richardson, “Primary intraosseous carcinoma, NOS,” in World Health Organization Classification of Head and Neck Tumours, A. K. El-Naggar, J. K. C. Chan, J. R. Grandis, T. Takata, and P. J. Slootweg, Eds., pp. 207–209, IARC Press, Lyon, France, 2017. Thomas G, Pandey M, Mathew A, Abraham EK, Francis A, Somanathan T, Iype M, Sebastian P, Nair MK. Primary intraosseous carcinoma of the jaw: pooled analysis of world literature and report of two new cases. Int J Oral Maxillofac Surg. 2001 Aug; 30(4):349-55.

10. Reichart PA, Philipsen HP. Odontogenic Tumors and Allied Lesions. London: Quintessence Publishing Co., Ltd; 2004. pp. 205–25. 11. Servato JP, de Paulo LF, de Faria PR, Cardoso SV, Loyola AM. Metastatic tumours to the head and neck: retrospective analysis from a Brazilian tertiary referral centre. Int J Oral Maxillofac Surg. 2013;42(11):1391– 1396. doi: 10.1016/j. ijom.2013.05.020. 12. Hirshberg A, Berger R, Allon I, Kaplan I. Metastatic tumors to the jaws and mouth. Head Neck Pathol. 2014 Dec;8(4):463-74. doi: 10.1007/s12105014-0591-z. Epub 2014 Nov 20. PMID: 25409855; PMCID: PMC4245411. 13. Neville BW, Damm DD, Allen CA, Chi AC. Oral and Maxillofacial Pathology. 4th edition. In Epithelial Pathology Chapter 10, 389 – 391. 14. Angiero F, Stefani M, Crippa R. Primary nonHodgkin’s lymphoma of the mandibular gingiva with maxillary gingival recurrence.

Oral Oncology Extra. 2006;42:123–8. 15. Guevara-Canales JO, Morales-Vadillo R, Sacsaquispe-Contreras SJ, BarrionuevoCornejo C, Montes-Gil J, Cava-Vergiú CE, Soares FA, ChavesNetto HD, Chaves MD. Malignant lymphoma of the oral cavity and the maxillofacial region: overall survival prognostic factors. Med Oral Patol Oral Cir Bucal. 2013 Jul 1;18(4):e61926. doi: 10.4317/ medoral.18903. PMID: 23722134; PMCID: PMC3731090.

www.tda.org | January 2022

VALUE

for your

Provided by:

profession

SURCHARGING CREDIT CARDS: LEGAL, COMPLICATED, RISKY By Phillip Nieto; President, Best Card

Texas Dental Journal | Vol 139 | No. 1

A dentist recently called our office asking if it was legal for a dental office to surcharge credit card processing costs to patients. An example of surcharging is charging a patient $104 on a bill that’s $100 because they paid with a credit card.

YOU MUST FOLLOW VISA, MASTERCARD, DISCOVER, AND AMERICAN EXPRESS REGULATIONS

Surcharging was illegal in Texas until 2018, but it’s now legal in all but two states: Massachusetts and Connecticut. Most credit card processors can offer a surcharging solution; and many aggressively promote them because they make the processors significantly higher profits than normal processing does. Processors often use the term “cash discount program” to describe their surcharge, claiming it will save their clients money.

If you decide to surcharge patients for credit card payments, the surcharge must abide by Visa, Mastercard, Discover, and American Express regulations. Here are those requirements:

Surcharging credit cards may be legal, but the question is whether doing so is a good idea. We’ll supply information that will help you decide.

•

• •

•

If you surcharge ANY credit cards, you must surcharge ALL credit cards. Once you begin surcharging card use, you can’t choose to NOT surcharge. You can’t surcharge debit cards. You’re not allowed to surcharge cards for cardholders from states where surcharging is illegal (Massachusetts or Connecticut). You must register with all 4 card brands a minimum of 30 days in

www.tda.org | January 2022

•

advance. If you don’t register, you’re not surcharging correctly. You must place notifications of surcharge at all payment stations and entrances to the business. If a fee is added to credit card transactions, it doesn’t matter if your processor calls it a “cash discount”—it’s a surcharge. You’re allowed to surcharge an amount equal to your average fees paid over the past quarter—up to 4%. To avoid recalculating these fees, many processors will set a steep flat rate of 4% on all cards.

CUSTOMERS HATE BEING SURCHARGED Recent studies show between 65%1 and 95%2 of customers who have been surcharged are less likely to patronize the business again.2 In dentistry, where customer loyalty is important to maintaining your patient base, these numbers should be a red flag. There’s a reason major stores haven’t decided to add a surcharge: it’s difficult for businesses to compete, and it’s only made more difficult if you’re angering customers.

IT’S A HUGE INCREASE IN COST Most surcharge programs have a flat monthly fee ($40 is common). And then the patient is charged a 3–4% surcharge that the processor keeps.

Texas Dental Journal | Vol 139 | No. 1

The average dental office using TDA Perks Program-endorsed credit card processor Best Card has an effective rate of around 2.18%. (You can calculate your effective rate by adding all the rates & fees you pay your processor and dividing it by the total amount run in sales.) If your processor is charging 4% to your patients, it’s making an additional 1.82% profit at your patients’ expense. All credit card processors have the same costs. Best Card makes a very small amount above the set cost all processors have. But a processor running cards at 4% would make a huge profit margin. Instead, you could raise your prices by 4% and keep the profit margin that would have been going to the processor.

USE EXTRA CAUTION WITH VIRTUAL CREDIT CARDS (VCC) Virtual credit cards issued by insurance companies will not allow a surcharge. These are issued with an exact balance— try to charge a penny more, and they will be declined. Since regulations require you to surcharge all credit cards if you surcharge any, you’d need to lower your fee so the payment— after the 4% surcharge is added—equals the VCC balance. That means you’d be paying the inflated surcharge rate out of your pocket!

In addition, the surcharge is reported to the card issuer; and you risk the insurance company noting the pre-surcharged amount (indicating you have a lower actual cost) and prompting an audit that could reduce the UCR (Usual, Customary, and Reasonable) reimbursement you receive for procedures. All told, adding a surcharge for credit card payments may seem like a cost-saving measure, but can end up costing your business. Best Card is the endorsed credit card processor of ADA Member Advantage and 40+ state dental associations or their affiliates, including TDA Perks Program. Best Card can provide surcharging

systems, but prefers to offer consistently low rates to ensure your monthly bill is as low as possible. This is one reason the average dental practice saves 24% in card processing fees with Best Card. Call 877739-3952 or visit BestCardTeam.com/ TX to learn about the many processing options available, including automatic payment posting into dental software. References 1. https://www.business.com/articles/ pros-and-cons-of-surcharging-creditcards/ 2. https://www.americanexpress.com/ us/small-business/openforum/articles/ charging-a-credit-surcharge-will-costyou-customers/

www.tda.org | January 2022

ADVERTISING BRIEFS PRACTICE OPPORTUNITIES ALL TEXAS LISTINGS FOR MCLERRAN & ASSOCIATES: To request more information on our listings, please register at www.dentaltransitions.com

or contact us at 512-900-7989 or info@ dentaltransitions.com. AUSTIN (ID #T521): This highly productive, implantfocused, general dentistry practice located in a growing community approximately 30 miles from the Austin metro area. Current annual revenue is 7 figures with

Opportunities Online at TDA.org and Printed in the

net cash flow in excess of 6 figures. The

Texas Dental Journal

and equipped with 6 operatories, CBCT,

ADVERTISING BRIEF INFORMATION DEADLINE Copy text is due the 20th of the month, 2 months prior to publication (ie, January issue has a due date of November 20.)

MONTHLY RATES PRINT: First 30 words—$60 for ADA/TDA members & $100 for non-members. $0.10 each additional word. ONLINE: $40 per month (no word limit). Online ads are circulated on the 1st business day of each month, however an ad can be placed within 24 business hours for an additional fee of $60.

SUBMISSION Ads must be submitted, and are only accepted, via www.tda.org/Member-Resources/TDAClassified-Ads-Terms. By official TDA resolution, ads may not quote specific incomes or revenues and must be stated in generic terms (ie “$315,000” should be “low-to-mid-6 figures”). Journal editors reserve the right to edit and/or deny copy.

Texas Dental Journal | Vol 139 | No. 1

modern facility is located in a retail space and paperless charts. The ideal buyer would be 1-2 high producing doctor(s) who are well versed in placing implants. NORTH OF AUSTIN (ID #T515): GD practice plus real estate. Excellent location situated in a rapidly growing community north of Austin. The practice is located in a free-standing building, contains 4 fully equipped operatories, digital X-ray units, and CBCT. This 100% fee-forservice practice boasts a strong hygiene recall program, which produces a third of practice revenue and a fantastic online reputation. HOUSTON (ID #H472): This established, boutique practice is located in a highly desirable area of central Houston. The practice provides

general, implant, and cosmetic dentistry

real estate is also available for purchase.

services to a 100% FFS patient base and

HOUSTON (ID #H482): Located in a

has an excellent reputation in the local

suburb of Houston in a spacious facility

community. The beautiful facility features

that boasts 10 operatories, CBCT, and

high-end finishes/décor, 3 fully equipped

digital radiography. The practice serves a

operatories, digital radiography, and a

FFS/PPO patient base and has historically

CBCT. HOUSTON, ORTHODONTICS

realized revenue of mid-to-high-6 figures.

(ID #H478): This recently built, 2,000+

HOUSTON (ID #H483): 100% FFS GD

square foot office is located in the upscale

practice plus real estate. Situated in a

Memorial area of Houston. There are 3

2,200 sq ft, free standing building with

fully equipped operatories with a large

5 fully equipped operatories. Hygiene

breakroom that is setup to facilitate CE

production is very healthy and the

courses. The breakroom can also be used

practice has seen 1,700+ active patients

to add an additional operatory. This is a

in the last 24 months with a steady new

great turn-key opportunity for a start-

patient flow. HOUSTON (ID #H486):

up or relocation. The seller is disabled

Located in a growing east Texas

and motivated to sell. HOUSTON,

community, this general practice caters

ORTHODONTICS (ID #H480): This

to a dedicated multi-generational active

productive, FFS orthodontic practice

patient base. The well-appointed 2,500

occupies an attractive free-standing

sq ft space contains 5 fully equipped

building situated on a high traffic

operatories, digital pano, plumbed

street in a desirable community in the

nitrous, and computers throughout.

heart of east Texas. The practice has

HOUSTON (ID #H487): 100% FFS

realized annual revenue of 7 figures

practice in The Woodlands/Spring area.

with exceptional profitability. The office

Modern facility with 4 equipped ops,

features a 4-chair ortho bay, 2 exam

digital x-ray sensors, an iTero, and

rooms, and digital Pan/Ceph unit. The

paperless charts. This practice checks

www.tda.org | January 2022

ADVERTISING BRIEFS all of the boxes—strong profitability, an

from the hygiene program and numerous

excellent hygiene program, and further

specialty procedures being referred out,

upside via numerous specialty procedures

there is immediate upside potential to

being referred out. HOUSTON (ID

be discovered. The office occupies 1,700

#H488): FFS/PPO practice and real

sq ft, has 3 equipped operatories with

estate, growing suburb 45 minutes

room for a 4th, digital radiography, and

NE of Houston. 1,800 total patients,

computers throughout. SAN ANTONIO—

steady flow of new patients, solid

WEST (ID #T454): GD Practice plus

hygiene recall, and consistent revenue

real estate, located in a rural community

of high six figures per year. The office

approximately 75 miles west of San

contains 6 fully equipped operatories,

Antonio. Serves a PPO/FFS patient base,

plumbed nitrous, digital X-rays, CBCT,

sees about 30+ new patients per month,

and computers throughout. HOUSTON

and offers consistent annual revenue

(ID #H489): This highly profitable,

with substantial upside potential through

general dentistry practice and real estate

expanding the procedures offered in-

is located in an east Texas town. The

house. The turn-key office features 3 fully

practice serves a large FFS/PPO patient

equipped operatories, digital sensors,

base and is on pace to exceed 7 figures

intra-oral cameras, and a digital pan.

in revenue in 2021 while maintaining a

SAN ANTONIO (ID #T501): Located

45%+ profit margin. The office has 3

in a highly sought-after area along

fully equipped operatories with possible

Loop 1604 in north San Antonio. The

room for expansion, digital radiography,

practice serves a large PPO/FFS patient

and computers throughout. HOUSTON

base and is located in a spacious office

(ID #H490): General/cosmetic practice

condo with 6 fully equipped operatories,

located West of Houston in the highly

digital pano, digital X-rays, and digital

desirable Memorial area. With roughly

sensors. SOUTH TEXAS (ID #T460):

40% of the production being generated

GD Practice and free-standing building,

Texas Dental Journal | Vol 139 | No. 1

ADVERTISING BRIEFS located in a charming south Texas town.

between entertainment and hi-tech

The office is located in a two story, free-

corridors (in the “Heart of Austin”). In

standing building and has a spacious

a single-story stand-alone building that

layout that includes 6 fully equipped

draws from mature upscale neighborhood

operatories (one additional plumbed for

and nearby schools. Practice produces

expansion, digital sensors, a digital pano,

seven figures, in 5 operatories, (3 dental

CBCT, and computers throughout. To

and 2 hygiene) within 2,000 sq ft.

request more information on our listings,

Immaculate equipment, all digital with

please register at www.dentaltransitions.

pano. Majority of patients 41 and older

com or contact us at 512-900-7989 or

with 98% collection ratio. NOTE: Practice

info@dentaltransitions.com.

recently acquired additional patient base that should boost production, new

AUSTIN, VICTORIA, SAN ANTONIO, AND DFW AREA (DDR DENTAL LISTINGS). (See also HOUSTON for other DDR Dental listings and visit www. DDRDental.com for full details. AUSTIN— GENERAL/PROSTHODONTIC practice provides comprehensive care but focuses on TMJ, occlusal rehabilitation and

McLerran & Associates is the largest dental practice brokerage firm in Texas. When it’s time to buy or sell a practice, we’ve got you covered. P RAC T I C E S AL E S DS O T RAN S ACT I O N S

P RAC T I C E AP P RAISA LS ASSOCIATE PLACEMENT

high-end cosmetic procedures. Must be prosthodontist or like training to apply. Owner prepared to remain and train in latest occlusal rehabilitation techniques. Located in highly sought-after affluent Austin area that is in very high demand

Austin

512-900-7989

DFW

214-960-4451

Houston

281-362-1707

San Antonio 210-737-0100 South Texas 361-221-1990 Emai l : t ex as@ den t al t r an si t i o n s.co m www.dentaltransitions.com

and closely proximate to downtown

www.tda.org | January 2022

ADVERTISING BRIEFS patients and collections. Contact Jim

2 operatories with 1 used for hygiene.

Dunn at 800-930-8017 or christopher@

The operatories are plumbed for nitrous.

ddrdental.com and reference “Austin

There is a good mix of patients ages,

Cosmetic or TX#560”. VICTORIA AREA—

with the largest percentage between

GENERAL Practice provides a wide range

30 to 65. The practice has been at its

of procedures for a small town near

current location for 35 years. The practice

Victoria. Gross collections in the high-6

is mostly fee for service, with some PPO

figures. The practice has a broad mix of

insurance accepted. The practice has a

patient ages. Most are middle- to high-

98% collection ratio. Contact Christopher

income households. Practice is 100%

Dunn at 800-930-8017 or christopher@

fee for service. In a single story stand-

ddrdental.com and reference “San

alone building. Only 2 other dental offices

Antonio or TX569”.

within 15 miles. 2,800 sq ft. Expanded in 2000. Located on a high visibility street.

AUSTIN: Associate to buy, planning on

Does have digital X-ray and pano. This

long transition. Prefer GP interested in

practice uses mainly word of mouth as its

orthodontics. Fee-for-service practice,

source of new patients. 99% collection

43 years same location, long standing

ratio. Contact Christopher Dunn at 800-

staff, beautiful view. Email Info@

930-8017 or christopher@ddrdental.

AustinSkylineDental.com.

com and reference “Victoria Area or TX#567”. SAN ANTONIO—GENERAL

DALLAS: Don’t waste time and money

practice provides comprehensive general

on buildouts when you can have a great

dentistry in a growing major Texas

practice today. Great opportunity to start

city. The practice is located in a highly

your dental practice without having to

trafficked area near a major highway.

pay a big loan and interest. Flexible lease

This practice is 1536 sq ft with the ability

options are available for well-qualified

to expand into the office next door. It has

dentists with no down payments and no

Texas Dental Journal | Vol 139 | No. 1

ADVERTISING BRIEFS interest for up to two years. Don’t waste

practices available for sale. Visit

time and money on buildouts when you

lonestarpracticesales.com or email

can have a great practice today. Turnkey

houstondentist2019@gmail.com.

dental offices for sale in the Dallas/Fort Worth metro and surrounding areas, the

HOUSTON, COLLEGE STATION, AND

offices are strategically located in areas

LUFKIN (DDR DENTAL LISTINGS).

for high production with ample parking.

(See also AUSTIN for other DDR Dental

Locations are ideal for emergency dental

listings and visit www.DDRDental.

services, Medicaid, Insurance and FFS.

com for full details. LUFKIN—GENERAL

Can be sold separately or as a package.

practice on a high visibility outer loop

Requirements Dentists need to have at

highway near mall, hospital and mature

least 2 years of experience in private

neighborhoods. Located within a beautiful

practice/corporate dentistry; credit and

single-story, free-standing building,

background check. For more information,

built in 1996 and is ALSO available

please email Txpracticesales@gmail.com

for purchase. Natural light from large

or call/text 214-995-0806.

windows within 2,300 sq ft with 4 operatories (2 hygiene and 2 dental).

FORT WORTH: Practice for sale in the

Includes a reception area, dentist office,

fast growing southwest area. Average

a sterilization area, lab area, and break

gross; 6 operatories; Excellent lease.

room. All operatories fully equipped. Does

Seller is relocating. Need to move quickly

not have a pano but does have digital

on this one. DFW 214-503-9696. WATS

x-ray. Production is 50% FFS and 50%

800-583-7765.

PPO (no Medicaid), with collection ratio above 95%. Providing general dental

HOUSTON AREA: Several acquisition

and cosmetic procedures, producing

opportunities in the greater

mid six figure gross collections. Contact

Houston area. General, ortho, pedo

Christopher Dunn at 800-930-8017

www.tda.org | January 2022

ADVERTISING BRIEFS or Christopher@DDRDental.com and

plumbed for 5 operatories. Digital pano

reference “Lufkin General or TX#540”.

and digital X-ray. Contact Christopher

HOUSTON—GENERAL (SHARPSTOWN).

Dunn at 800-930-8017 or christopher@

Well Established general dentist with

ddrdental.com and reference “Pearland

high six figure gross production.

General or TX#538”. HOUSTON—

Comprehensive general dentistry in

PEDIATRIC (NORTH HOUSTON). This

the southwest Houston area focused

practice is located in a highly sought-

on children (Medicaid). Very, very high

after upscale neighborhood. It is on a

profitability. 1,300 sq. ft., 4 operatories

major thoroughfare with high visibility

in single building. 95% collection

in a strip shopping center. The practice

ratio. Over 1,200 active patients. 20%

has three operatories for hygiene and

Medicaid, 45% PPO, and 35% fee-for-

two for dentistry. Nitrous is plumbed for

service. 30% of patients younger than

all operatories. The practice has digital

30. Office open 6 days a week and

X-rays and is fully computerized. The

accepts Medicaid. Contact Chrissy Dunn

practice was completely renovated in

at 800-930-8017 or chrissy@ddrdental.

2018. The practice is only open three

com and reference “Sharpstown General

and a half days per week. Contact

or TX#548”. HOUSTON— GENERAL

Christopher Dunn at 800-930-8017

(PEARLAND AREA). General Located in

or christopher@ddrdental.com and

southeast Houston near Beltway 8. It

reference “North Houston or TX#562”.

is in a freestanding building. Dentist

WEST HOUSTON—MOTIVATED SELLER.

has ownership in the building and

Medicaid practice with production over

would like to sell the ownership in the

6 figures. Three operatories in 1200 sq

building with the practice. One office

ft in a strip shopping center. Equipment

currently in use by seller. A 60 percent

is within 10 years of age. Has a pano

of patients age 31 to 80 and 20 % 80

and digital X-ray. Great location. If

and above. Four operatories in use,

interested contact chrissy@ddrdental.

Texas Dental Journal | Vol 139 | No. 1

ADVERTISING BRIEFS com. Reference “West Houston General

their patients and their community. Our

or TX#559”.

practice is an office supported by Pacific Dental Services (PDS), which means

KATY: Now is the time to join Grand

you won’t have to spend your career

Lakes Dental Group and Orthodontics.

navigating practice administration.

You will have opportunities to learn new

Instead, you’ll focus on your patients

skills from our team of experienced

and your well-being. Add on excellent

professionals. If you’re ready to take your

benefits, including malpractice insurance,

career to the next level and gain valuable

medical, dental and vision insurance,

experience, apply today! You’ve invested

retirement plans and much more and

the time to become a great dentist,

you’ll feel well taken care of throughout

now let us help you take your career

your career. The average full-time PDS-

further with more opportunity, excellent

supported associate dentist earns low-6

clinical leadership and one of the best

figures in their first year. The average

practice models in modern dentistry. In

income for a PDS-supported owner

working with our practice you will have

dentist, whose practice has been open

the autonomy to provide your patients

at least 2 years, is mid-6 figures. As

the care they deserve. In addition, you’ll

an associate dentist, you will receive

enjoy the opportunity to earn excellent

ongoing training to keep you informed

income and have great work-life balance

and utilizing the latest technologies and

without the worries of running a practice.

dentistry practices. If you are interested

You became a dentist to provide excellent

in a path to ownership, our proven

patient care and have a career that will

model will provide you with the training

serve you for a lifetime. With us, you

needed to become an owner of your own

will have a balanced lifestyle, fantastic

office. PDS is one of the fastest growing

income opportunities, and you’ll work for

companies in the US which means we

an office that cares about their people,

will need excellent dentists like you

www.tda.org | January 2022

ADVERTISING BRIEFS to continue to lead our growth in the

WESLACO: General dentist for

future. Apply now or contact a recruiter

pediatric practice in McAllen are.a

anytime. We’d love to chat, get to know

Great opportunity for a general dentist

you and share more about us. Pacific

interested in working in a pediatric dental

Dental Services is an equal opportunity

office. Opportunity available full or part

employer and does not discriminate

time. Our pediatric office sees patients

against any employee or applicant

6 months to 21 years of age. Our

for employment based on race, color,

philosophy is to treat our patients like

religion, national origin, age, gender, sex,

family. Weslaco Pediatric Dentistry is an

ancestry, citizenship status, mental or

established pediatric dental practice, our

physical disability, genetic information,

office is computerized, has digital X-rays,

sexual orientation, veteran status, or

and we have a wonderful staff. We offer

military status. Apply here:http://www.

a competitive daily base or a percentage

Click2Apply.net/gwy6pkn22knbzwzx

of adjusted production (whichever

PI106822492.

is higher). For full-time position (33 hours or more per week) we offer a

WATSON BROWN PRACTICES FOR

benefits package that includes health

SALE: Practices for sale in Texas and

insurance, 401K, malpractice insurance,

surrounding states, For more information

reimbursement for professional fees and

and current listings please visit our

continuing education courses. We can

website at www.adstexas.com or call us

sponsor an H-1B work visa if required.

at 469-222-3200 to speak with Frank or

Recent grads welcome. Spanish is helpful

Jeremy.

but not necessary. Interested dentists please email your CV or any questions to dfmego@gmail.com Please visit our website www.babyteethrgv.com We look forward to speaking with you soon!

Texas Dental Journal | Vol 139 | No. 1

YOUR PATIENTS TRUST YOU.

WHO CAN YOU TRUST?

ADVERTISERS AFTCO.................................................................... 31

Anesthesia Education & Safety Foundation.............. 6

DentalPost.............................................................. 29

E-VAC, Inc.............................................................. 31

If you or a dental colleague are experiencing impairment due to substance use or mental illness, The Professional Recovery Network is here

Institute of Houston Dental Society.......................... 7

JKJ Pathology......................................................... 16

McLerran & Associates.............................................45

to provide support and an opportunity for

MedPro.......................................................................3

confidential recovery. New Orleans Dental Conference and LDA Annual Session........................................... 31

Professional Recovery Network.............................. 51

Southwest Sedation Education............................... 30

TDA Perks..................................... Inside Front Cover

PRN Helpline (800) 727-5152

Visit us online www.txprn.com

Watson Brown Practice Sales & Appraisals............. 17

www.tda.org | January 2022

Texas Dental Journal | Vol 139 | No. 1

January 2022 Texas Dental Journal

Articles inside

TDA Governance

Advertising Briefs

Value for Your Profession: Surcharging Credit Cards: Legal, Complicated, Risky

Oral and Maxillofacial Pathology Case of the Month

President’s Message