THE #1 JOURNAL FOR NEW DENTISTS
Six Dentists Share their Experiences with
Practice Management Systems P LUS
Wait till You See This: Microscope-Enhanced Dentistry What’s In The New Dentist™ Practice Pack? FALL 2010
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© 2010 Henry Schein, Inc. All rights reserved. Easy Dental, easy to use, easy to own, Henry Schein, and the ‘S’ logo are registered trademarks of Henry Schein, Inc. Not responsible for typographical errors. A-EZDND-Q410
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FROM THE PUBLISHER’S DESK FA L L 2 0 1 0
Dear Readers,
PUBLISHER
Sally McKenzie Sally@thenewdentist.net
Welcome to the fall issue of The New Dentist™ magazine.
DESIGN AND PRODUCTION
I
t’s fair to say that on occasion I’ve been known to do things a little differently than many of my counterparts in the industry. I like to take chances, such as starting a magazine in a horrible economy, for example. I prefer candid conversations to politically correct exchanges. And I like to hear what people really think about an issue, a product, a concern, which is why in this issue, I wanted to find out what the actual users have to say about one of the most critical systems in the dental practice. We talked to six different dentists about the practice management systems they chose for their offices, their likes, dislikes, and what they would like to see improved. Find out what they told us on page 16. Also in this issue, Dr. Stacey Becker-Walker shares her experience with microscope enhanced dentistry. Not only has it saved her career as a dentist, it’s also saved patients from major dental problems. And after you have finished reading about Dr. Becker-Walker’s experience, check out the ad on page 11. With this issue, I’m kicking off a special offer just for new dentists – the opportunity to win nearly $18,000 in free services, including specialized practice management training, a website development package, continuing education, and much, much more. You’ve got to check this out. Don’t miss national speaker and recognized dental hygiene authority, Carol Tekavec’s five essential tips for ensuring that this department is productive. And be sure to check out page 26 and learn what 1-800-DENTIST has to offer your new dental practice. A note to dental students, mark your calendars for March 2-6, 2011, and plan to attend the American Student Dental Association’s (ASDA) 41st Annual Session, which will take place in Anaheim, California. This should be an excellent meeting with discussions on several key topics that are critical to the future of the dental profession. And finally, I encourage you to learn more about the many services available to new dentists at www.thenewdentist.net. You’ll discover a wealth of materials to guide you at every step throughout your dental career.
Fondly,
Sally McKenzie, Publisher
visit www.thenewdentist.net #1 Web-site for New Dentists 2 WWW.THENEWDENTIST.NET FA L L 2 0 1 0
?
See page 11
Picante Creative picantecreative.com MANAGING EDITOR
Tess Fyalka Tess@thenewdentist.net SALES AND MARKETING
For display advertising information contact ads@thenewdentist.net or visit our digital media book at www.thenewdentist.net/ mediabook.htm The New Dentist™ Magazine is published quarterly by The McKenzie Company (3252 Holiday Court, Suite 110, La Jolla, CA 92037) on a controlled/complimentary basis to dentists in the first 10 years of practice in the United States. Single copies may be purchased for $8 U.S., $12 international (prepaid US dollars only). Copyright ©2010 The McKenzie Company. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical without permission in writing from the publisher. Authorization to photocopy items for internal or personal use is granted by The McKenzie Company for libraries and other users registered with the Copyright Clearance Center. Disclaimer – The New Dentist™ does not verify any claims or other information appearing in any of the advertisements contained in the publication and cannot take responsibility for any losses or other damages incurred by readers’ reliance on such content. The New Dentist™ cannot be held responsible for the safekeeping or return of solicited or unsolicited articles, manuscripts, photographs, illustrations, or other materials. The opinions, beliefs and viewpoints expressed by the various authors and contributors in this magazine or on the companion website, www. thenewdentist.net, do not necessarily reflect the opinions, beliefs, and viewpoints of The New Dentist™ Magazine or The McKenzie Company. Contact Us – Questions, comments, and letters to the editor should be sent to Tess@thenewdentist.net. For advertising information contact ads@thenewdentist.net or visit our website at www.thenewdentist. net to download a media kit.
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TABLE OF CONTENTS
FALL 2010
10 FE AT U R ES
6 Physics Forceps Deliver
16
Quantum Leap
By Robert Fazio, DMD
8 Terror Aside, Time to Tackle Endo By Josh Austin, DDS
10 Magnification Takes
Dentistry to New Level
14 5 Steps to Keep Hygiene Productive
By Carol Tekavec, RDH
16 What Are You Really Getting
in that Practice Management System? Six Dentists Share Their Experiences By Tess Fyalka, Managing Editor
22 Periodontics and Dental
Implants: Implant Site Preparation – Extraction Socket Management By Marc L. Nevins, DMD, MMSc
26 What is 1-800-DENTIST Doing
DEPARTMENTS
for Today’s New Dentists?
2 Publisher’s Desk 24 Dental Students:
What’s on Your Mind?
32 Skinny on the Street 32 Index of Advertisers
32 4 WWW.THENEWDENTIST.NET FA L L 2 0 1 0
14
Scheduling DR (Digital Radiography)
Chart
iPhone Interface
iPad Interface
MacPractice DDS 3.7
EDR (Electronic Dental Record) Orthodontic / Endodontic Charting
Notes Attachments
Visit MacPractice.com for product information, events, screenshots and a demo.
Physics Forceps
I
BY ROBERT C. FAZIO, DMD
Deliver Quantum Leap
n my 34 years of dentistry, I have been privileged to witness an explosion of new ideas, new products, and a diversified armamentarium that allows us to deliver better dental care to our patients. Surgical techniques, growth factors, and bone grafting materials in periodontology have allowed us to retain healthy teeth that would previously have been sacrificed. In the setting of a lost tooth, the field of implantology has exploded with options to replace and restore a fixed dentition. The interface between these two massively expanding fields is conventional exodontia. Here, only subtle changes in forceps and elevator designs
“The constant, unrelenting
pressure to the PDL by the Physics Forceps is substantially more efficient at ‘releasing’ the tooth …
”
have appeared on the dental horizon in the last several decades. For most dentists, it represents one of our least favorite procedures and a procedure that can often be unpredictable in terms of time requirements. Even with subtle improvements in elevators and forceps, we are still faced with conventional techniques of torque, compression, rotation and the sometimes complication of broken teeth and the need to chase root tips. This all changed for me three years ago when I was introduced to the Physics Forceps from Golden|Misch. This is the revolutionary new concept in exodontia that materially changed the ease and predictability of extractions. The extractions using the Physics Forceps are more predictable in time commitment, faster procedures, and, most assuredly, less traumatic physically and psychologically to the patient. The key issue is the biomechanical design. The biomechanical rationale of the Physics Forceps is that the instrument acts like a simple first class 6 WWW.THENEWDENTIST.NET FA L L 2 0 1 0
lever. One force is applied with the beak of the forceps on the lingual aspect of the root. The second force is applied via a “bumper,” which is placed buccally in the vestibule as low as possible in the mandible and as high as possible in the maxilla. The handles of the Physics Forceps are not squeezed but just held with firm pressure. A gentle but steady rotational force is applied through a small amount of wrist movement only. (About 3-4 of rotational force) For the patient, it almost feels as if it is a passive motion. Time stands still for that brief period of time, but as the periodontal ligament disengages, the tooth will literally “pop.” After that releasing pop, the tooth is easily delivered with a conventional instrument. The constant, unrelenting pressure to the PDL by the Physics Forceps is substantially more efficient at “releasing” the tooth compared to the intermittent and alternating forces of conventional extraction technique. The simple first class lever multiplies the impact and speeds the process. This is what makes the Physics Forceps more efficient, faster, and less traumatic to the alveolar bone. While it seems to be a simple concept, the Physics Forceps have become my go-to instruments for atraumatically extracting teeth. I have met many dentists who are as delighted as I am with the ease of use, patient comfort, and superior outcome with the Physics Forceps. These instruments are a quantum leap forward in my exodontia armamentarium.
PHOTO COURTESY OF GOLDEN|MISCH
Dr. Fazio is currently Associate Clinical Professor of Surgery at Yale University School of Medicine. He is co-author of Oral Medicine Secrets and author of the textbook Principles and Practice of Oral Medicine. A 1971 graduate of Harvard College and a 1975 graduate of Harvard School of Dental Medicine, he also completed Clinical Fellowships in Periodontology and Oral Medicine at Harvard.
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FA L L 2 0 1 0
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7
Terror Aside, Time to Tackle Endo BY JOSH AUSTIN, DDS, CLINICAL ADVISOR FOR THE NEW DENTIST™
I
n the last issue of The New Dentist™ I wrote about five procedures every new dentist can perform to stay productive during the early years of practice. One of those procedures is endodontics. I firmly believe that competence in endodontics is a must for new dentists. Endodontic procedures are the highest grossing procedures dentists can perform without an associated lab fee. Becoming comfortable with endodontics can make you more productive and more profitable. As I write this article, I am sitting in a lecture given by Dr. Gordon Christensen. His take on endodontics is simple….”Any idiot with a ruler and a piece of rubber can do a root canal.” Obviously, it’s a tongue and cheek comment because most new dentists are terrified of endodontics. When talking about endodontics, it makes the most sense to break it down into three topics: access, instrumentation, and obturation. People always try to isolate one
us to fill them with gutta-percha. A plethora of instrument systems are on the market. Crown-down, step back, hybrid – take your pick. Choose the system that works in your hands and makes you comfortable. Take a course from the manufacturer to really learn it. Once you get comfortable with a system, stick with it. We know there is no way that we completely debride a canal with instruments. We must rely on irrigation to disinfect a canal. Sodium hypochlorite is the standard of care. We are seeing the emergence of auxiliary devices to help facilitate irrigation. Tulsa Dental has shown great success with the Endo Activator to agitate irrigant in the canals. Recently, several ultrasonic devices have been marketed to agitate bleach in the canals facilitating debridement. I think these devices are going to become much more ubiquitous in the near future as they are proving to be one of the few adjuncts we can use that will break up biofilm.
“I firmly believe that competence in endodontics is a must for new dentists.“ of these three as the most important. I disagree. An error at any one of these three stages can be catastrophic. Each of these builds on the other. Good access leads to good instrumentation preparation. Good instrumentation preparation leads to good obturation. Access preparations often cause much distress to new dentists. We learn access preparations on extracted teeth with little to no caries. We look for perfectly oval or triangular preps like we see in endo textbooks. In practice, endo preps just don’t look like this. There is a reason teeth need root canals. Huge caries and old restorations alter what we picture as the ideal access. The key is understanding chamber morphology and completely unroofing said chamber to allow light and instruments in. The use of a safe-ended access bur like the Endo-Z bur can help open up a chamber in order to provide adequate visualization. You can’t find canals you can’t see. Visualization and light are invaluable to the rest of the root canal procedure. Instrumentation is an extremely complex and diverse topic. We don’t have enough time or space to completely dive in, but I will touch on a few key points. The goal of instrumentation is twofold. First, we must eliminate the biofilm infection inside the canals. Second, we must open the canals by removing small amounts of dentin to allow 8 WWW.THENEWDENTIST.NET FA L L 2 0 1 0
After the chamber is accessed and the canals are disinfected, we must fill them with something. No matter what obturation method is used, if the canal isn’t clean there is an opportunity for failure. For many years, gutta-percha was the only option. Now we have other choices, such as resin. However, in my practice, gutta-percha is the only choice. With gutta-percha, there are two basic methods. Cold lateral condensation is the first, which we were all taught in dental school. It’s a great method; however, it is time consuming. For a single canal tooth lateral condensation is a great option. For a molar, lateral condensation can be too time consuming. The other option is a warm obturation. This can be something CONTINUED ON PAGE 29 >>
Dr. Josh Austin is a 2006 graduate of the University of Texas Health Science Center San Antonio Dental School. After working as an associate, Dr. Austin opened his own practice in 2009. He is a regular columnist for The New Dentist™ magazine and website. He can be reached at jaustindds@thenewdentist.net or www.thenewdentist.net/clinicalblog.php.
What has been your experience with endo? Tell Dr. Austin. Blog on at www.thenewdentist.net/clinicalblog.php.
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Wait till You See This!
Magnification
Takes Dentistry to New Level
D
r. Stacy Becker-Walker is passionate about microscope-enhanced dentistry and for good reason. This 2002 graduate of the University of Missouri Kansas City School of Dentistry says it has changed her clinical life. “Before I went to dental school, I worked as a hygienist, and early into practice as a dentist, I started to develop back problems. I thought, I’m a new dentist and I’m already having back problems, what am I going to do? I have debts to pay off and a long career in dentistry ahead of me.” Dr. Becker-Walker consulted with close friend Dr. Doxey Sheldon of St. Louis, MO. Dr. Sheldon has been performing microscope-enhanced dentistry for several years. “She was one of the first dentists in the country to incorporate it in the general practice. I took a course in her office, and that was it. I knew I wanted this in my practice.” The impact on both the ergonomics as well as the efficiency of practicing dentistry was profound. “I could look straight forward versus looking down over the patients. I sit upright in a neutral position. My arms and shoulders are rested. They are not up in the air like chicken wings. I can see the distal on number two and perform a crown prep looking straight ahead without moving my body, which is much more efficient. Using magnification, I can do a crown prep in 5-10 minutes. The entire procedure from start to finish is an hour. Some doctors take an hour-and-a-half, but I only need an hour.” But Dr. Becker-Walker emphasizes that the benefits of using magnification go well beyond the doctor’s posture and productivity. “What you find when you start using the microscope is what you didn’t see before. Teeth that looked great with your loops, you can see where you could improve things. You are picking up your handpiece more often and refining your old restorations a bit more.” Most importantly, the dentist has the ability to see minor problems long before they become major issues for the patient. “From the clinical standpoint with the superior light and the superior magnification, once you’ve worked with a microscope there’s just no going back.” 10 WWW.THENEWDENTIST.NET FA L L 2 0 1 0
PHOTO COURTESY OF DR. STACY BECKER-WALKER
She notes that fewer than 3% of all dentists use magnification, so patients are not accustomed to it. But the response has been overwhelmingly positive. “When I explain to patients that I can find problems earlier and save more tooth structure, they love it. I also had a patient who said he really liked it because I wasn’t ‘in his face.’ It’s true, we have to get into the patient’s personal space when we do dentistry, but with the microscope I am behind the patient.” In the current economy, Dr. Becker-Walker finds it is extremely important to educate patients about the importance of pursuing dental treatment because some people perceive treating a cavity or a cracked tooth as an elective procedure. She explains to the patient that it is better to address any disease early, whether it is tooth decay or cancer. When it comes to health, small problems are much easier to take care of than big problems. CONTINUED ON PAGE 12 >>
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Magnification continued from page 10 “The patient has to understand that there is a problem and a consequence to the problem. We have a solution and we can provide that solution when the problem gets bigger or we can deal with it when the problem is smaller and the solution is smaller. The bottom line is this cavity or this cracked tooth isn’t going to heal itself, so let’s be proactive. We know that decay is getting into small pits and fissures and it’s spreading out underneath the enamel. We want to address this when the procedure is minimally invasive and be proactive not reactive.” Explaining the microscope and how it is used is a standard part of the new patient protocols in Dr. Becker-Walker’s office. “Every patient understands why we use the microscope and that we are among a very small group of dentists in the nation that use magnification in their practices.” She believes that magnification is the wave of the future. “It’s the logical step forward in dentistry to improve the profession. Why wouldn’t we want superior light and superior magnification. Our medical colleagues have been using illuminations and magnification for years. Why should dentistry be
“What you find when you
start using the microscope is what you didn’t see before. Teeth that looked great with your loops, you can see where you could improve things…
‘‘
any different. If you can practice more effectively and enjoy a longer career, you’ll definitely see the return on the investment. Certainly, for me, it was well worth it.” If you would like to talk to Dr. Becker-Walker personally about her experience with the microscope-enhanced dentistry, she can be reached via email at stacyb7@yahoo.com. Dr. Becker-Walker uses the Global Surgical Microscope, the three step model: • Utilizing 10X eyepieces; 250mm objective lens; 160mm binocular • Magnification (x) 3.2 6.4 12.8 • Field of View (dia.-mm) 62 32 16* * Specifications courtesy of Global Surgical
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5 STEPS to Keep
HYGIENE Productive
Whether you employ one part-time or several full-time hygienists, keeping hygiene productive can be a key component to practice success. What can a dentist do to keep the hygiene department on track and as productive as possible? I recommend the following five steps. 1. Schedule new patients with the dentist first. When new patients call for an exam and “cleaning,” your business assistant gives them an appointment to meet you first, not the hygienist. Why does this make a difference? A common problem is the patient who does not have any conception of his/her periodontal condition. The patient may have become accustomed to a very cursory type of “cleaning” in the past and may think that is all they need. If a new patient is scheduled with the hygienist before seeing the dentist, and the hygienist discovers significant periodontal disease, there can be resistance from the patient in accepting this fact. The patient has no basis in trust with the hygienist yet and may decide that the office is just looking to charge as much as possible for dental treatment by scheduling perio treatments that the patient doesn’t think s/he really needs. Since the first encounter with the practice can set the tone for all subsequent visits, this is bad for everyone. Rather, meet the patient, talk with them in a private office before going to a treatment room, diagnose their conditions including any perio, and after explaining their needs and your recommendations, (with fees and insurance possibly covered by the business assistant), set up appointments accordingly. Ideally the hygienist would 14 WWW.THENEWDENTIST.NET FA L L 2 0 1 0
BY CAROL TEKAVEC, RDH
be scheduled on another day to begin whatever treatment the patient actually needs or see the patient after the dentist’s portion of the visit is complete. Patients are often more receptive to the hygienist after the dentist has made his/her diagnosis. They are more likely to believe that their treatment recommendations are based on their individual needs, not just part of a “new patient routine.” This scenario also reduces unproductive hygiene appointment time as the hygienist isn’t explaining and describing treatment the patient is not yet ready to pursue. After the dentist’s diagnosis, the hygienist can educate and reinforce the dentist’s recommendations while s/he is working, and, hopefully, guide patients to continued acceptance of the services they require. 2. Make sure that all patients receive a complete periodontal evaluation at least once annually. A complete
evaluation may include radiographs, periodontal charting and data collection, and the dentist’s and hygienist’s assessment. Initially it may be accomplished in its entirety by the dentist during the new patient exam, or with the dentist performing a “screening” with the complete data collection accomplished by the hygienist during her portion of the appointment time. Later the hygienist can incorporate the perio evaluation into the patient’s regular visits. Consistent evaluations provide the dentist with an accurate picture of a patient’s condition, and appropriate treatment can be planned. In addition, while dentists have long known about CONTINUED ON PAGE 20 >>
Carol Tekavec, RDH is a practicing clinical hygienist and a featured speaker at major dental meetings for over two decades. She is the Director of Hygiene for McKenzie Management, and is one of Dentistry Today’s Top Clinicians in Continuing Education. She was the columnist on insurance for Dental Economics magazine for 11 years. Carol can be reached at hygiene@mckenziemgmt.com.
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What Are You Really Getting in that
Practice Management System? • Six Dentists Share their Experiences • BY TESS FYALKA, MANAGING EDITOR
It can be both your crystal ball and your reality check. If you would like, you can slip it in your purse or pocket and take it with you wherever you go. It’s one of the most important investments you will make in your practice. The cost can run the gamut from a couple grand to several thousands of dollars. There are a multitude of options to choose from, and the effect of those choices is critical as they will have a direct impact on how you practice today and well into the future. This is your practice management software, otherwise known as the central nervous system of today’s dental office. Certainly, choosing a system requires significant time and consideration. Many factors come into play, including the total cost of the entire package, such as hardware, software, training, and ongoing support. How do you plan to use the system both today and in the future? Will it be used in the treatment rooms where it will need to interface with digital radiography, intraoral cameras, and other systems? Will you use it for digital charting, patient data collection, electronic treatment planning and the like? What are you looking for in terms of the business software? Most likely you’ll want the ability to manage all patient data and forms, run key reports to track production, collections, accounts receivables, insurance, and more.
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The New Dentist™ asked a few readers what they think of their software, why they chose it, to what extent they use it, and what they would like to change about it. Here’s what we learned.
MacPractice Dr. Angela Schweiger is a graduate of the University of
Kentucky College of Dentistry. She and her husband Andrew, the office manager, opened their Columbia, South Carolina practice in June 2009. From day one, the office has been using MacPractice. “We use iPhones, we have an iMac at home, we both have Mac laptops, and we even have one of those Apple TVs.” Although the couple certainly leans toward Apple
track production with dozens of different metrics – by month, by category, type of procedure, by provider. You can track patients by insurance provider. You can see outstanding preauthorization, which is very valuable. We can track our referral sources very easily, which is extremely helpful in marketing.” Mr. Schweiger would like to see one particular improvement in the future. “Currently, the software doesn’t support National Electronic Attachments. So, when an insurer requests an image of a crown or something like that, we do have to use third party software that runs on Windows to submit that attachment. However, I know that improvement is coming.”
Curve Dental Choosing the practice management system that is right for you takes time and research.
products, Mr. Schweiger says they were very familiar with both Dentrix and Eaglesoft and knew that they wanted to evaluate all three before making the decision to invest in a particular system. “We did an analysis of total hardware, software, and support costs among the systems. A lot of people are put off by Apple products because the hardware is expensive, and it is. However, MacPractice doesn’t require a dedicated server; you can use one of your work stations as the server. When we did the math, it was cheaper to go with MacPractice because of the server issue, and we didn’t need to purchase any additional IT support.” Mr. Schweiger says that he and the dental team really like the ease of using an Apple. “Everything you do on an Apple computer is intuitive.” He acknowledges that the software does have a bit of a learning curve, particularly for those that have never used a Mac. “But the ‘ah ha’ moment doesn’t take long. It’s usually a matter of a couple of days.” Perhaps most importantly, Mr. Schweiger says, the various systems are extremely easy to use. “For me as an office manager, it’s very good at managing patient insurance. It allows you to keep a database of insurance payments and reimbursement levels. Scheduling is very straightforward. Digital radiography is so easy you literally plug the sensor in and start snapping pictures.” Mr. Schweiger says that he and Dr. Schweiger like that it can interface with their iPhones allowing them to access patient records remotely. Additionally, the system allows for all patient documents to be completed electronically, and uses email and text message reminders. A self-proclaimed “data junky,” Mr. Schweiger says one of his favorite features is the ability to generate numerous financial reports. “You can track virtually everything, recall, collections, insurance, marketing, accounts receivables. You can
Dr. Craig Longenecker is a graduate of the University
of Maryland Dental School. He says he talked to several colleagues before making the decision to go with Curve Dental when he opened his practice in Monkton, MD last year. The software is web-based and that played a significant role in his decision. “I believe that being web-based provides a huge advantage in what the software is capable of doing. I see Curve delivering a dental management software system unlike any out there. Because they are web-based, it’s easier for them to create more effective patient relationship systems.” He notes that the system is very easy to use. “I’ve used another very popular system, and it was good but not easy to use. Today’s dental offices need to have everyone crosstrained, and that is just really easy with Curve. As we went through the process of purchasing Curve, I was in transition with my front desk. But everyone in the office was able to step in and take care of the front desk duties on their own. That was one of the reasons why I switched to Curve. When we did hire someone, within a week, she was completely comfortable. It’s a very intuitive system.” The team did participate in the training program, which Dr. Longenecker says is very comprehensive. “They don’t leave anything out and they make sure that everyone understands a feature before they move on to the next one.” Dr. Longenecker notes that he has been actively working to improve the business systems in his practice over the last couple of years. It was the flexibility with Curve’s reports that also influenced his decision to go with the web-based system. “It allows us to customize reports, which is very different from what other systems offer. “For example, overdue recare can be customized in multiple different ways and so can virtually every other report, so we can track data and information exactly the way we want to track it.” Additionally, he likes the patient email features in the system, which make it very easy to communicate with the CONTINUED ON PAGE 18 >>
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PMS continued from page 17 patient via email and text message, send documents and forms, newsletters, and patient education videos. “We are finding that the majority of our patients prefer email and text messaging.” Dr. Longenecker acknowledges that relying on a completely web-based system is something that he did have to think carefully about, but he hasn’t questioned his decision since. “In the year that we have been using the system, we’ve never had a problem. And the nice thing is that anytime there is an update to the software, we get it automatically. Every time they improve their system, our system is improved. Typically, with software programs, you have to wait for updates and upgrades to be sent.” Currently, the Curve system does not interface with mobile devices, such as Blackberry or iPhone. “One of the things that I really like about Curve is their customer service. I have been able to talk to them directly about their system and what users like me are looking for, and all of those things are going to happen. Because this is a web-based system, that’s a natural part of the growth of the company. I think web-based practice management systems are the wave of the future and other software companies are going to be playing catch-up.”
Henry Schein Dentrix Dr. Charles Smurthwaite of Rocklin, California is a 2000
graduate of the University of the Pacific School of Dentistry in San Francisco, CA. He chose the Dentrix system for his practice based on his own experience. He also considered EagleSoft and SOFTDENT. He spoke to several dentists about their experience with all three programs. He found Dentrix users to be consistently happy with their decision. Moreover, when prospective employees apply to work in the dental practice, typically about 60% of the applicants to his office know how to use Dentrix. Yet, it wasn’t just the voice of public opinion that influenced him; it was the treatment planning and the imaging systems that sealed the deal. “I could sit down and, literally, within five minutes, I could create a $25,000 treatment plan and hand it to the patient. I know the other programs offer a similar feature but with Dentrix the process is simpler and more intuitive. I also really like the smile design function. I
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do a lot of smile design, and I’ve trained my staff to do this as well. They can prepare a before and after picture for a patient before the patient ever pays anything. That has been really powerful.” He notes that he takes digital images routinely. “I take a picture of the patient’s decayed tooth and then a picture of their filling or their CEREC crown, and it’s instant justification for why they had to sit there with their mouth open for a while. It makes me look good, and they can walk around with that piece of paper as a walking advertisement.” Dr. Smurthwaite also actively uses the treatment management features in the system. “You can load the patient’s information, treatment plan, when they are scheduled, and you can use it like an Excel spreadsheet and sort the patients. We are using that to identify who has unused insurance benefits and then contact patients and let them know what they have left on their insurance coverage.” Recently, Dr. Smurthwaite began accessing his practice management system using his iPhone. “It’s pretty cool. Just last night my wife asked me if I could come home early the 8th, and I said just a second let me check. I have information right there if someone calls me at home with an emergency.” As for improvements, “When I first started using the G4 system, I wanted a simpler way to separate patient visits by number, so that I could insert extra visits in between as they came up. And they don’t allow you to do that now, but I did discover that I can have multiple treatment plans. I can just open a new file and highlight and drag what I want into a new one. That works out for me.”
KODAK SOFTDENT Dr. Dave Toppi is a 2005 graduate of Nova Southeastern
University College of Dental Medicine in Ft. Lauderdale, FL, This pediatric dentist opened his own practice in March 2010 in San Diego, CA, with an assistant and two other employees, including his Business Manager Jessica House. Dr. Toppi says he chose the software based on his own experience and his brother’s, who is also a pediatric dentist. Ms. House says that the system was very easy to learn and although the team did go through a training program conducted via phone and Internet, she was able to learn much of it on her own with the help of online tutorials. She finds the system is very user-friendly. “As an office manager, I like this system because you can make corrections and ensure accuracy. You can go back and check your employee’s work and make changes easily if necessary. With other programs, if you make corrections, it can clog up your system with a lot of extra data that isn’t necessary. I also really like the fact that you can access the CONTINUED ON PAGE 23 >>
STAy in touch WITH your PrAcTIce. AnyTIMe, AnyWHere.
InTroducIng denTrIx MobIle on-the-go access from the leader in practice management software dentrix Mobile gives you fast, secure access to current information about patients, appointments, medical alerts and prescriptions—anytime, anywhere. With support for blackberry®, iPhone™, iPad™, Palm Pre™ or Android™ smart phones, dentrix Mobile keeps you connected while you’re out of the office. And, dentrix Mobile is included with the latest version of dentrix g4.*
get dentrix Mobile and stay in touch with your practice.
To learn more call 1.800.Dentrix or visit www.Dentrix.com/Mobile
©2010 Henry Schein Inc. All rights reserved. Henry Schein, the ‘s’ logo and dentrix are all trademarks or registered trademarks of Henry Schein Inc. other products are trademarks or registered trademarks of their respective owners. not responsible for typographical errors. *dentrix Mobile is free with a dentrix customer Service Plan. A-dTx-denT-0710
Hygiene continued from page 14 the relationship between oral health and general health, more patients are aware of this too. They expect their dentist to diagnose and treat all their oral conditions. Identification and education of necessary periodontal treatment is a vital function of the office and the hygiene department. Moreover, it is important in keeping patients healthy and the hygiene department productive. 3. Encourage the hygienist to identify potential restorative needs of patients. At recall appointments, the
hygienist can identify potential problems, show them to the patient, and reveal these concerns to the dentist when s/he enters the treatment room for the exam. This sets the stage for patient acceptance of restorative treatment. The hygienist sees it, the dentist “confirms” it, and the patient feels comfortable going ahead with care because two dental professionals have identified the need for prompt attention. If the dentist decides that restorative treatment is not
of them to a three-month recall, the difference in revenue could be $7,500, plus the patient is receiving better care.) 5. Encourage fluoride treatments. It is now well known that fluoride is not “just for kids.” The ADA Report of the Council on Scientific Affairs, May 2006, set guidelines
We have seen that with the addition of a few appropriate adult fluoride treatments and more frequent prophys for those who require them, an additional $11,500 in office revenue might be generated. necessary, s/he can compliment the hygienist on her/his thoroughness and let the patient know that the area will be reevaluated at the next recall. The “concern” can be put on the patient’s recall notice giving them even more incentive to come back for their regular appointments. 4. Allow and encourage establishing recall intervals based on patient needs. The idea that everyone should
be on a six-month recall makes no sense. Encourage your hygienist to identify how often s/he thinks a patient should be coming back and explain this to the patient, and then set up the recall appointments based on individual conditions. While many patients expect the traditional six-month recall, (and most insurance plans only pay toward this) hygienists can help them understand why their individual issues may require more frequent treatment. Reasons for more frequent intervals include inadequate home care, systemic diseases, such as diabetes, heavy deposits of calculus, and others. Patients who have received perio treatment in the form of root planing and scaling or surgery will also need more frequent appointments for periodontal maintenance (again often only covered by insurance twice yearly). Your hygienist can explain, “Our job is to provide the treatment you need, your insurance carrier’s job is to keep their costs down.” (If an office with 250 active patients on a six-month prophy schedule, at a fee of $75 per visit, converts only 50 20 WWW.THENEWDENTIST.NET FA L L 2 0 1 0
for the appropriate use of fluorides for various age groups and risk factors. Among their recommendations: Fluoride is appropriate for persons with moderate caries risk, described as over age 6 with 1-2 incipient or cavitated carious lesions in the last three years, or other risk factors such as poor oral hygiene. The high caries risk category includes individuals with exposed root surfaces. These descriptions will likely fit many of your patients. Although most insurance carriers will only pay toward fluoride provided for persons age 14 and under, some will cover adults with past experience of cervical caries. Regardless of insurance coverage, your patients deserve your best, and current evidence suggests wider use of fluoride is appropriate. To start, ask your hygienist to identify and treat two adults per week whom s/he thinks could benefit from fluoride, and expand from there. (At an average fee of $40, even just two adult treatments per week could result in almost $4,000 annually for the office.) Simple steps can often yield big rewards when done consistently. We have seen that with the addition of a few appropriate adult fluoride treatments and more frequent prophys for those who require them, an additional $11,500 in office revenue might be generated. Ultimately, the entire office is more productive when the hygiene department is more productive.
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Frank A. Finazzo, DDS Fontana, California Offering CareCredit since 1992
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Already offer CareCredit and want more great ideas? CareCredit, the nation’s leading patient payment program, works with 85,000 dental teams who share with us great ideas and practical tools that work for them. And we’d like to share those ideas with you. Call 800-859-9975 to get connected to your Practice Development Team. Yet to add CareCredit as a payment option? Call 866-246-6401 to get started today. Just for calling, receive this FREE 26-page Guide full of proven ways to fix the leaks in your overhead and increase profitability by Sally McKenzie, CEO, McKenzie Management — courtesy of CareCredit. If you already offer CareCredit, visit carecredit.com/resource-center to access downloads of CareCredit’s full library of consultant educational white papers as well as this featured guide. Should you need assistance, call 800-859-9975.
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Periodontics
MARC L. NEVINS, DMD, MMSc
and Dental Implants
Implant site preparation — Extraction socket management
T
he focus of this article is on the benefits of proactive care to enhance the patients’ oral health through periodontal and dental implant therapy. Specifically, it will present the benefits of ridge preservation for establishing a healthy foundation for implant placement and ultimately esthetics.
These studies demonstrate the predictability of a preservation procedure at the time of extraction to provide adequate bone volume for dental implant placement. Without grafting there is significant reduction in ridge width occurring during the healing process, which compromises implant placement without additional bone grafting.
DENTAL IMPLANTS Dental Implant therapy continues to expand as it is the most desired method of tooth replacement by patients and dentists. Dental implant success is predicated upon a healthy foundation of bone and soft tissue. Implants placed in the esthetic zone have even greater need for the preservation of bone and soft tissue to preserve the natural esthetic contours and papillae form.
RIDGE PRESERVATION Procedures provided at the time of extraction combined with atraumatic extraction techniques will preserve ridge form. These procedures are generally less invasive than augmentation procedures provided after the ridge resorption has occurred. During the resorption process there is loss of 3-dimensional volume and scar tissue may form and this may make the future surgical procedures more challenging in regards to soft tissue management and primary closure. Multiple biomaterials including autogenous bone, bone allograft, xenograft, and synthetic biomaterials have been advocated for ridge preservation. Allogenic and xenogenic bone replacement grafts are favorable as they are osteoconductive and are obtained without the need for harvesting bone from the patient. Human growth factors generated through recombinant biotechnology such as rhBMP-2 and rhPDGF-BB are commercially available and have been reported to be successful in ridge preservation procedures. rhPDGF-BB is FDA approved for periodontal therapy, but there are preclinical and clinical reports focused on dental implant site development utilizing this growth factor for bone regeneration.
RIDGE RESORPTION The phenomenon of ridge resorption has been well documented with the process beginning early during the postextraction healing process. Once a tooth is extracted there is resorption of the unsupported bone or thin buccal plate which begins immediately and is evident clinically and radiographically as early as two-to-three months. The visible alterations in the soft tissue architecture are a sign of the underlying bony changes with resultant 3-dimensional shrinkage of the localized edentulous ridge form, which becomes a challenge in preservation of esthetic ridge contours for pontic site development or dental implant placement. Due to tooth angulation and anatomic contours there are often dehiscence defects present on the buccal surfaces of prominent maxillary anterior teeth. This results in the absence of buccal plate or very thin bone upon tooth extraction. Multiple randomized controlled clinical studies have demonstrated the benefits of ridge preservation procedures in preventing the subsequent resorption of these sites. Preservation procedures either with bone replacement graft materials or growth factors such as recombinant human bone morphogenic protein-2 (rhBMP-2) or recombinant human platelet-derived growth factor-BB (rhPDGF-BB) prevent the natural process of ridge resorption and establish a foundation with adequate bone volume for dental implant placement. 22 WWW.THENEWDENTIST.NET FA L L 2 0 1 0
DEBRIDEMENT It is important to thoroughly debride and degranulate an infected (acute or chronic) extraction site prior to placeCONTINUED ON PAGE 28 >>
Dr. Marc Nevins is in the private practice of Periodontics and Implant Dentistry in Boston, Massachusetts. He is Assistant Clinical Professor of Periodontology at the Harvard School of Dental Medicine and is a Diplomate of the American Board of Periodontology. Dr. Nevins is the Associate Editor of The International Journal of Periodontics and Restorative Dentistry. He can be reached via email at marc_nevins@hms.harvard.edu.
PMS continued from page 18 patient accounts easily.” Ms. House notes that customer support has been excellent. “I would rate it a 9 out of 10. I’ve had to call them about electronic claims, and they can jump in remotely, which is really helpful.” Although Dr. Toppi does not use the electronic charting options available, he notes that taking digital x-rays is somewhat challenging for offices that do not use the KODAK digital radiography system. He would like to see the process simplified in the future. “You have to punch in a key sequence to integrate the x-ray into SOFTDENT. I wish they had a quick tab where you could click on the patient name, click on x-rays and it would automatically bring up your x-ray system, but it doesn’t do that.” At this point the office is not using mobile peripherals offered by SOFTDENT, known as “Pearl.” “Perhaps if the price comes down we will consider it,” says Dr. Toppi. Ms. House emphasizes that the team is in the early stages of learning the software, having used it for just a few months. 7.375" x 4.875 “I think that once we have used it for a full year, we will have a better idea of everything it has to offer the practice.”
Patterson EagleSoft Dr. Kris Aadland is a 2006 graduate of Oregon Health
Science University. She opened her own general practice in September 2009 in Vancouver, WA. She says she chose EagleSoft after comparing it with Dentrix. “I had used it before, and I just felt more comfortable with it.” Dr. Aadland says the system is Windows based and her team had no trouble learning how to use it. “While we did go through formal training, we didn’t end up using all of it because it is so easy to use.” In the operatory, Dr. Aadland uses EagleSoft for electronic charting, including digital x-rays, intraoral cameras, perio charting, all patient data collection. “I also use CEREC and everything integrates.” The system’s patient education feature also is something that Dr. Aadland uses regularly. “It’s very easy to just click on a procedure, such as a crown, to educate the patient. It is imported into their electronic chart, so we know the patient has been educated on the procedure.” Dr. Aadland examines the business reports daily, including production and collections. “Everything is line CONTINUED ON PAGE 29 >>
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DENTAL STUDENTS: What’s on Your Mind? The New Dentist™ recently talked with University of Pittsburgh Dental Student Lance Grant about what attracted him to the profession and why he considers his dental school to be among the best. TND: Why did you choose to pursue dentistry? The practicality of dentistry is what drew me too it. I feel dentistry is more black and white than other health sciences. If there is decay, remove it. If the tooth can’t be saved, pull it. In addition, there is instant gratification when you improve someone’s smile. It’s not just their smile, it’s their whole life.
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TND: Upon graduation are you considering becoming an associate, opening your own practice, joining a nationwide group such as Aspen Dental, or pursuing a specialty degree? Why do you want to pursue that path at this time? Becoming an associate. I know my limitations as a dentist right now. I recognize the need for additional training. Personally, I feel I’ll get more valuable training through a mentorship, rather than an AGED or GPR. I believe the real-world experience is faster paced, more practical, and less hierarchy. TND: What do you feel sets your dental school apart from others? There are lots of opportunities to be involved. In addition to ASDA and
ADEA, Pitt offers many clubs and organizations that raise money, provide service, and have plain physical fun. It seems our faculty are very interested in helping us make the most of our time here. What is the single most important survival tip you have for dental students? I’d definitely say it’s to stay grounded. Being a senior means you might know more than all the other students, but stay focused on learning everything you can before you’re thrown out in the real world. Dental students, tell us what’s on your mind. Email Managing Editor Tess Fyalka at tess@thenewdentist.net. We want to hear from you.
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At Aspen Dental, our practice support model is based on the principle that strong relationships with doctors are the foundation of successful practices. We have consistently sought to differentiate our value proposition to dentists not only by providing best-in-class support services, but also by developing a unique approach that ensures the interests of the dentist and Aspen Dental are fully aligned. To learn more about our compelling proposition, call 1-866-748-4299 or visit us online.
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What is 1-800-DENTIST
Doing for Today’s New Dentists?
Editor’s note: 1-800-DENTIST Vice Chairman and co-founder Fred Joyal recently answered a few questions for The New Dentist™ to help our readers better understand some of the products and services offered by 1-800-DENTIST that are tailored specifically for them.
How does 1-800-DENTIST help new dentists build a patient base? One of the hardest things about starting out as a new dentist is finding new patients when you don’t have the extra time, budget, or expertise to create an effective marketing campaign. 1‑800‑DENTIST takes care of it. We advertise on major TV networks, radio, and the Internet to motivate consumers to call us to find a dentist. Because we’ve been in business since 1986, people are more likely to call or visit our website than respond to a single dentist’s ad — and over 5 million consumers contact us every year. For a new dentist, this is the easiest, fastest, and most cost-effective way to get the new patient leads they need. Newer practices also often want to treat a wider variety of patients than older offices, so 1‑800‑DENTIST lets them choose what kinds of leads they’d like to receive (fee-forservice, HMO, State Aid, etc.). They can change their preferences as their practice grows. We also provide tools to help convert more leads into loyal patients.
What do you offer for new dentists who are concerned with cost? We understand that new dentists need to be budget-conscious, especially in the first few years. Our Pay-Per-Lead program offers them a flexible way to get new patient leads at a pace that’s right for them. This plan lets dentists decide the maximum number of monthly leads they’d like — and pay only for the leads actually produced. Over time, they can increase this number as needed. 1-800-DENTIST also offers a production guarantee on most programs. It provides dentists a no-risk way to jumpstart their patient base without worrying about whether they’ll see a return on their investment. 26 WWW.THENEWDENTIST.NET FA L L 2 0 1 0
Do you have products to help new dentists create more patient loyalty and increase case acceptance? Yes, every 1-800-DENTIST member is offered our Patient Activator® software free of charge. This program helps keep patients coming back with text messages and emails sent automatically from the practice management software. It’s a great way for new dentists to foster long-term loyalty and motivate patients to accept treatment recommendations. Patient Activator also helps new dentists quickly develop an online presence. We send patient surveys to gather positive feedback, and post these reviews on a personalized microsite. This helps improve searchability so potential new patients can find the practice on the Web. The program also helps dentists take advantage of social media sites like Facebook and Twitter to manage their online reputation. Finally, Patient Activator makes it easy to send out newsletters, special offers, and birthday greetings (the kinds of communications most new dentists don’t have time to manage on their own). These messages help educate patients and make them more likely to return. It’s all fully automated and 100% free to 1-800-DENTIST members.
Are there other benefits for new dentists who join the 1-800-DENTIST program? 1-800-DENTIST also provides tools, tips, and training to make sure that new dentists are successful on our program. We have a dedicated Member Services team available to answer questions and offer advice. They can provide sample letters, patient scripting, tracking tools, and best practices to reduce no-shows and cancellations. We also have a suite of online Webinars with industry leaders, many that offer CE credit. This is an easy way for dentists and their staff to brush up on clinical, marketing, and practice management topics ranging from billing to assisted hygiene to effective case presentation. On top of that, 1‑800‑DENTIST members qualify for discounts at industry shows and seminars throughout the year. For more information, visit www.1800dentist.com/NewDentist.
Your patients need you. Your colleagues need you. Your family needs you.
Still think you’re in this for yourself? From dental school through retirement, ADA Insurance Plans protects you and those who count on you. All of our insurance plans feature a set of benefits and options that support the unique needs, challenges, and goals of dentists. Plus as a member, you’ll find comprehensive coverage at exceptionally low premiums. Our insurance experts work only with dentists and are ready to support you with objective guidance and information. For more information call 888-463-4545, email ada@gwl.com, or visit www.insurance.ada.org.
Benefits provided under respective Group Policy Nos. (104TLP Term Life, 1105GDH-IPP Disability Income Protection, 1108GDH-SDP Student Disability, 1106GDH OEP Office Overhead Expense Disability, 104GUL Universal Life, and 1107GH-MCP MedCASHSM) issued to the American Dental Association; underwritten and administered by Great-West Life & Annuity Insurance Company and filed in accordance with and governed by Illinois law. Coverage available to all eligible ADA members residing in any U.S. state or territory. Term Life, Universal Life and MedCASH premiums increase annually, Income Protection every 5 years and Office Overhead Expense every 10 years. Premium credit discount not guaranteed but reevaluated annually. ©2010 Great-West Life & Annuity Insurance Company. The inverse boomerang logo is a registered trademark of Great-West Life & Annuity Insurance Company. All Rights Reserved. This material is an outline only and not a contract. NDAD10-ND
Protecting the practice—and the life—you’ve built. Life • Disability • Business Overhead • Hospital & Critical Illness
ment of a bone replacement graft or growth factor enhanced matrix. It is imperative to transfer the diseased site to a healthy site for future implant treatment. Teeth that present with unresolved endodontic infections, vertical root fracture, non-restorable caries associated with endodontic infection, or advanced periodontal bone loss have inflamed or infected granulation tissue surrounding or apical to the extraction socket. These lesions must be completely debrided to optimize the osseous healing and prevent intraosseous areas of inflamed tissue, which would pose a risk for short-term infection or to the long-term healing and future implant placement. Failure to thoroughly debride may lead to compromised healing and possible infection and loss of the preservation graft.
PREDICTABLE ESTHETIC OUTCOMES Extraction socket grafting presents the dilemma as to whether to raise a flap or proceed with a flapless approach. Often there is the need for flap elevation to be able to thoroughly debride the defect. Alternative techniques such as a submarginal incision may preserve the gingival form and allow access to a periapical defect with the limitation of secondary healing at the coronal aspect of the socket. For sockets with a complete loss of the buccal plate flap advancement will provide primary closure and the best
Case example A 42-year-old female patient presents with an acute swelling at the mucogingival junction on the distal-buccal aspect of the maxillary left lateral incisor (Figure 1a, 1b). This root canal treated tooth has a crown restoration CONTINUED ON PAGE 30 >>
Figure 1b. Bone loss is present to the level of the post for this root canal treated maxillary lateral incisor.
Figure 1a. Swelling at the mucogingival junction on the distal-buccal aspect of the maxillary left lateral incisor.
Figure 2a. Flap elevation reveals an extensive dehiscence defect on the buccal surface.
Figure 2b. After extracting the lateral incisor a non-contained defect is present.
Figure 3a. The defect is grafted with a growth factor enhanced matrix combining freeze-dried bone allograft with rhPDGF-BB.
Figure 3b. The graft is protected by an absorbable collagen membrane.
Figure 3c. A connective tissue graft is placed to augment and preserve the ridge contour.
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PHOTOS COURTESY OF DR. MARC NEVINS
Periodontics
continued from page 22
protection of the bone graft. However this requires surgical skill and experience. The soft tissues must be managed to prevent a wound dehiscence, which can result in tissue volume shrinkage and loss of interdental papilla that can be difficult to recover in the future. The utilization of procedures combining hard and soft tissue grafting can result in optimal preservation of ridge form. The soft tissues are often supported by the root prominence, and there is the need for additional volume of tissue beyond that easily regenerated with the bone graft procedure. These combined procedures are performed for optimal esthetic preservation. In the case of flapless socket preservation, additional soft tissue thickness can be provided to enhance the tissue biotype either at the time of extraction with tunneling techniques or at the time of implant placement utilizing flap access. This will minimize the need for additional surgery after the implant has integrated by diagnosing and intercepting this so that the tissue thickness is augmented in combination with the implant placement procedure.
Endo
continued from page 8 like Thermafill or a warm vertical method. Thermafill gets a bad rap but can be a great obturation method if done well. The plastic carriers in use now make retreats easier if need be. I have and will continue to use this method in some endodontic cases in my practice. I am more excited about warm vertical obturation however. Warm vertical obturation is an excellent method that uses heat to essentially melt gutta-percha from main canals into lateral canals. It can be a fast method but is technique sensitive and equipment heavy. In warm vertical, a master cone is fitted in the canal with tug back very similar to lateral condensation. Then a heating element, like Sybron Endo’s System B, is applied to the cone a set distance from the apex. The heat allows the guttapercha to flow into the nooks and crannies of the canal system, sealing areas we could never seal before. Once the master cone is heated and seared off, we must perform the back fill to fill the middle and coronal thirds of the canal. This is done with heated gutta-percha expressed with pressure into the canal. There are many devices to do this. My favorite is Discus Dental’s Hot Shot. Its cordless, convenient, and safe.
This was an extremely cursory overview of endodontics, which is, obviously, a massive discipline with many areas requiring focus. I believe the key is exploration with endodontics. Take excellent continuing education courses. Find your limits and explore them. Save extracted teeth for trying out new things, and don’t ignore endo. Endodontics will be essential to growing your practice.
Dr. Aadland is looking forward to the next update of the software, which will allow her to access her practice management system electronically from her iPhone. “I am a huge Mac lover, that is one thing we have been promised. I’m looking forward to using my iPhone to access my practice system in the future.”
Henry Schein EasyDental Dr. Sean Phelan is a
PMS
continued from page 23 itemed, so I can see exactly what was collected, who paid and who didn’t. I can see what was written off, what was deleted, so there is a huge audit trail, which is a big deal in dentistry since embezzlement is so high. I can go back at any time to see what was adjusted or edited.” The software also enables practices to identify untapped revenue sources, trends, overdue recall patients, and short-notice cancellation fill list. The ability to breakdown production by code is another feature that Dr. Aadland finds particularly useful. “But my favorite feature right now is a section called ‘referrals.’ We can track if new patients find us through insurance, Internet, newspaper, website, or other patients, so we can see where our marketing is paying off.”
graduate of University of Missouri Kansas City School of Dentistry; he works in a large group practice in Albuquerque, New Mexico, which uses EasyDental. Dr. Phelan says the practice was sold on the affordability of the system, which is used primarily in the business area of the practice, not in the clinical operatories. “Everyone in the office is trained on the basics including how to make appointments.” Dr. Phelan has found the system is very user friendly. “If you can use a mouse, a Playstation, a word processing program, you can use EasyDental. It also has more advanced programs that enable you to access specific reports with graphics that breakdown information, such as production. We review information every day from the system. The front staff is trained to access reports with specific parameters
such as production by provider, collections, accounts receivables, and others. They can pull those reports in less than a minute.” Dr. Phelan also notes that the audit trail is very effective. In one particular case, money was being stolen from the practice. “We had a situation with an employee, and we were able to use the system to track down exactly when the theft occurred and exactly who was working on the computer at that time.” The aging report also has been very useful to the practice. It shows outstanding balances for the past 30, 60, and 90 days. Dr. Phelan says that he would like for the software to allow for easier integration of x-rays into the electronic claims process. “Many insurance companies are asking for the original x-rays and more and more documentation. We digitize our x-rays and then we put them into the computer, and it is very difficult to connect it to the patient’s insurance claim.” Easy Dental does not interface with mobile devices.
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that was recemented four years prior. There is a 7mm pocket associated with the lesion. The diagnosis is a root fracture and the treatment plan is to replace this tooth with a dental implant. This will be provided in a staged approach: • Extraction tooth #10 with a ridge preservation procedure • Dental implant placement after five months of healing Since there is anticipation of loss of the buccal plate the surgical plan is to access the site with a full thickness flap and plan to obtain primary closure over
Figure 3d. The flap is advanced to provide primary closure over the grafted site.
The implant is allowed to heal for an additional five months prior to healing abutment placement in preparation for the restorative phase of treatment. The restoration mimics the natural tooth with a porcelain fused to metal abutment and an all ceramic restoration (Figure 5a, 5b). LEGENDS Carlsson H, Thilander H, Hedgard B. Histologic changes in the upper alveolar process after extractions with or without insertion of immediate full denture. Acta Odontol Scand 1967;25:21-43. Araujo, MG, Lindhe J. Dimensional ridge alterations following tooth extraction. An experimental study in dogs. J Clin Periodontol 2003;30:809-818. Araújo M, Lindhe E, Wennstrom J, Lindhe J. The influence of Bio-Oss collagen on healing of an extraction socket: An experimental study in the dog. Int J Periodontics Restorative Dent 2008;28:123-135. Nevins M, Camelo M, DePaoli S, et al. A study of the fate of the buccal wall of extraction sockets of teeth with prominent roots. Int J Periodontics Restorative Dent 2006;26:19-29. Fiorellini J, Howell TH, Cochran D, et al. Randomized study evaluating recombinant human bone morphogenetic protein-2 for extraction socket augmentation. J Periodontol 2005;76:605-613. Nevins ML, Camelo M, Schupbach P et al. Human histologic evaluation of mineralized collagen bone substitute and recombinant platelet-derived growth factor-BB to create bone for implant placement in extraction socket defects at 4 and 6 Months: a case series. Int J Periodontics Restorative Dent 2009;29:129–139. Simion M, Rocchietta I, Kim D et al. Vertical ridge augmentation by means of deproteinized bovine bone block and recombinant human platelet-derived growth factor-BB: a histologic study in a dog model. Int J Periodontics Restorative Dent 2006;26:415-423.
Figure 4. Re-entry at five months demonstrates excellent osseous healing.
Simion M, Rocchietta I,Monforte M, Maschera E. Three-dimensional alveolar bone reconstruction with a combination of recombinant human platelet-derived growth factor BB and guided bone regeneration: a case report. Int J Periodontics Restorative Dent 2008;28:239-243.
Figure 5a. The clinical result meets the patient’s functional and esthetic goals.
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Figure 5b. the post-operative radiograph suggests an integrated implant with well maintained marginal bone levels.
visit www.thenewdentist.net #1 Web-site for New Dentists
PHOTOS COURTESY OF DR. MARC NEVINS
Periodontics
continued from page 28
graft. Flap elevation reveals an extensive dehiscence defect on the buccal surface (Figure 2a). After extracting the lateral incisor a non-contained defect is present (Figure 2b). It is evident that the root prominence was providing support for the soft tissues. In an effort to prevent tissue shrinkage a grafting procedure is utilized to provide maximum ridge volume preservation by combining hard and soft tissue grafting. A growth factor is utilized to stimulate osseous healing and facilitate the soft tissue healing for this extensive procedure. The graft is placed: • Growth factor enhanced matrix combining rhPDGF-BB (GEM 21s, Osteohealth Co.) with freeze-dried bone allograft (Regeneross, Biomet 3I). (Figure 3a) • Absorbable collagen membrane (Biogide, Osteohealth Co.). (Figure 3b) • Connective tissue graft harvested from the maxillary palate (Figure 3c) • Flap advancement for primary closure (Figure 3d) After five months of healing, the site is entered surgically to provide dental implant placement (Figure 4) and additional connective tissue grafting.
Culminating the journey we started three years ago, we are proud to announce:
Matsco is now Wells Fargo Practice Finance
While our name has changed, the value and service we’re known for has not. We remain committed to helping you achieve your practice goals, and are still the only practice lender endorsed by ADA Business ResourcesSM. Let’s talk about how we can support you. Contact your financing specialist at 888.937.2321 or visit us at wellsfargo.com/practicefinance.
© 2010 Wells Fargo Bank, N.A. All rights reserved. Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A. ADA® is a registered trademark of the American Dental Association. ADA Business ResourcesSM is a service mark of the American Dental Association. ADA Business Resources is a program brought to you by ADA Business Enterprises, Inc., a wholly owned subsidiary of the American Dental Association.
SKINNY
on the Street
The latest news on products and services for new dentists and their practices 2pro™ Total Access Disposable Prophy Angles Premier® Dental Products Company now offers 2pro™ Total Access Disposable Prophy Angles. The dual-action patented cup and tip design is said to be a great time saver. Premier reports that the cup is ideal for cleaning and polishing all tooth surfaces. Simply remove the cup and use the tip for greater access to gingival and proximal areas, veneer margins and around implants or orthodontic brackets. 2pro’s patented gearless design ensures that it will run smoothly and quietly with near-zero freeze-ups and less heat build-up. According to Premier, easy access to lingual areas is guaranteed due to its ergonomic 100˚ angle. 2pro is latex free and is available in four cup styles (soft/short, firm/short, soft/long, firm/long). For more information call 888-670-6100 or e-mail at dentalinfo@ premusa.com.
Toothflix™ Patient Education DVD Series The ADA’s Toothflix DVD Series delivers top-quality video clips that are simple to use…at an incredible value. Toothflix covers 23 topics, from flossing to implants, smile makeovers and insurance. Each DVD uses 3-D digital graphics to help patients visualize what you recommend. Toothflix DVDs are well suited for either dental practices or group presentations. For details about Toothflix products, pricing, run times, and free online demos, visit www.ada.org/goto/toothflix. Or call the ADA Catalog at 1-800-947-4746.
Midmark Corporation announces the availability of its newest chair for the dental office, the Elevance™ Dental Chair, with its unique Cantilever Forward™ design, advanced hydraulic system and the fully integrated heat and massage option. The Cantilever Forward design brings the patient to the clinician. Starting at a low seat height of 15 inches and extending to a seat height of 34 inches, the chair accommodates a broader range of operators and offers greater flexibility whether seated or standing. Since the dental chair is usually the most noticeable element in the dental office, aesthetics and presentation are integral. Midmark has expanded upholstery options to include limited seams. For more information call 1-800-MIDMARK or visit midmark.com/ elevance.
INDEX O F A D V E R T I S E R S Advertisers in this issue of The New Dentist™ have made it possible for you to receive this publication free of charge. Please support these companies. Contact information can be found below or visit www.thenewdentist.net Resource section to receive information from more than one company. American Dental Association......................IBC www.ada.org 800-947-4746
Northeast/South/West Regions Chyrisse Patterson 312-274-0308 x 320 cjpatterson@kosservices.com
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Keller Laboratories, Inc.......9 www.kellerlab.com 800-325-3056 Kodak SoftDent...................3 www.kodakdental.com/ makethemove 800.944.6365
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Matsco/Wells Fargo...........31 wellsfargo.com/practicefinance 888.937.2321
Triodent.............................13 Triodent.com 800-811-3949
visit www.thenewdentist.net FREE information from our Advertisers www.thenewdentist.net/resources.htm
PHOTOS COURTESY OF PREMIER DENTAL PRODUCTS, AMERICAN DENTAL ASSOCIATION, AND MIDMARK CORPORATION
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