New Dentist Fall 2011

THE #1 JOURNAL FOR NEW DENTISTS

PURCHASING A DENTAL PRACTICE?

CLINICAL

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Large Group Practices FALL 2011

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FROM THE PUBLISHER’S DESK F A L L 2 0 11

Dear Readers,

PUBLISHER

Sally McKenzie Sally@thenewdentist.net

Welcome to the fall issue of The New Dentist™ magazine.

DESIGN AND PRODUCTION

C

ertainly, one of the biggest decisions a new dentist will ever make is the decision to purchase a practice. You want to make a sound investment.

You want to ensure that the practice holds real potential for the future. But how do you know?

What factors should you base this major decision on? In this issue, Dr. Tom Snyder offers practical advice for new dentists considering purchasing a dental practice.

Also in this edition, Dr. Rod Kurthy, founder of Evolve Dental Technologies and creator of the KöR® Whitening Deep Bleaching™ system urges new dentists to quit sabotaging the new patient experience. You won’t want to miss what he recommends to ensure that your next new patient becomes a patient for life.

Additionally, find out what four clinicians from around the country have to say about their intraoral camera. Turn to page 16 and read about why these new dentists chose the cameras they did. And don’t miss New Dentist™ columnist Dr. Josh Austin’s take on flowable resins. He explores whether these products actually deliver what they promise.

Finally, we are in the closing weeks of registration for The New Dentist™ Practice Pack giveaway. Over $16,000 in fabulous prizes will be awarded to the lucky NEW DENTIST winner, including equipment, training, and website development. Register at www.thenewdentist.net, and while you’re there, discover a wealth of FREE information and 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 1

Picante Creative picantecreative.com MANAGING EDITOR

Tess Fyalka Tess@thenewdentist.net SALES AND MARKETING

For display advertising information contact ads@thenewdentist.net or 877.777.6151. 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 ©2011 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 877.777.6151. Visit our website at www. thenewdentist.net to download a media kit.

Filling That Cavity

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After years of having nowhere to turn, finally, you have a friendly alternative in the banking world. At Live Oak Bank, we’re not afraid to do the mega-deals most banks would find mouth-numbing. Not only will we provide unique, big business loans to entrepreneurial dentists like yourself, we can also help you expand, remodel, refinance or acquire an existing dental practice. Finally, a bank that doesn’t act like a bank.

Connect with one of our Senior Loan Officers for more information: Keith Merklin (877) 790-1678 or Mike Stanton (866) 954-8362 liveoakbank.com

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TABLE OF CONTENTS

FALL 2011

10

FE AT U R ES

6 Purchasing a Dental Practice?

What’s the Real Value?

Thomas L. Snyder, DMD, MBA

10 One Dentist’s Journey: My Experience with Large Group Practice Chedly Schatzie Vincent, DMD

14 Been There, Done That:

Guru Knows How to Make the Most of New Patients

16 What Makes This Intraoral Camera ‘The Best’?

Four Doctors Weigh In Tess Fyalka, Managing Editor

20 Flowable Resins: Can They

Deliver What They Promise?

Josh Austin, DDS

14

DEPARTMENTS 2 Publisher’s Desk 26 Dental Students:

What’s on Your Mind?

32 Skinny on the Street 32 Index of Advertisers

4 WWW.THENEWDENTIST.NET FA L L 2 0 1 1

32

26

{After KรถR}

Before KรถR

This is a real case; photos are not retouched or altered in any way.

To see additional KรถR Whitening cases, please visit www.korchallenge.com.

Case by Dr. Victor Burdick, Littleton, CO

RATING

PRODUCTS 2011

4.8 OUT OF 5

Purchasing a Dental Practice?

What’s the Real Value?

A

s many of you may be considering purchasing a practice over the next several years, the first question that comes to mind is: How much is the practice worth? Some transition firms offer “Free Practice Valuations,” but be wary of how they value a dental practice especially if they use a simplified approach to determining the practice’s value.

One of the common techniques that some firms use to value dental practices is applying a gross multiplier method.

This method either uses last year’s gross revenue or takes an average of the past several years to arrive at a value by multiplying these numbers by a revenue multiplier factor (percentage). So if you plan to purchase a practice and this is the only method utilized you will be making a big mistake! Since this method does not consider the practice’s profit potential, you could potentially overpay for a practice that may be valued at a lower number, had other methods been applied.

6 WWW.THENEWDENTIST.NET FA L L 2 0 1 1

BY THOMAS L. SNYDER, DMD, MBA DIRECTOR TRANSITION SERVICES THE SNYDER GROUP/DIVISION OF HENRY SCHEIN

A Gross Revenue Multiplier Method is based on multiplying the prior year’s gross receipts or an arithmetic average or a weighted average of the last three to five years by a percentage whose value is “mysteriously” determined. Some may argue that if a transition consultant or broker resides in an area, they “know” what the market dental practices may CONTINUED ON PAGE 8 >>

Dr. Thomas L. Snyder is Director of Practice Transitions for The Snyder Group/Henry Schein Professional Practice Transitions, a nationwide practice transition services consulting firm. They provide a full range of transition services ranging from new dentists considering purchasing a practice, practice valuation services, associate/partnership agreement templates, and practice sales. He can be reached directly at 1-800-988-5674 or tom.snyder@henryschein.com: www.snydergroup.net

IMAGE QUALITY

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Elite in Technology A brand new, advanced CMOS APS imager, Schick 's unique replaceable cable technology and innovative on board diagnostics provide the ultimate intraoral imaging device.

Elite in Patient Comfort CDR Elite’s curved corners and cable interface location enhance patient comfort, while the sensor’s new color scheme aids in precise and gentle positioning.

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Purchasing a Practice continued from page 6

Which Practice Would You Prefer to Purchase?

Practice A

Practice A

Practice A

Gross Receipts $600,000 Overhead -330,000 (55%) Profit $270,000

Gross Receipts $600,000 x 60% = $360,000 Value

Practice B

Gross Receipts $800,00 x 60% = $480,000 Value Comparing Net Profit (after Debt Service)

Gross Receipts $600,000 Practice Value $360,000 Pre-Debt Net Income $270,000 Post-Debt Net Income $206,197

Gross Receipts $800,000 Overhead -530,000 (66.3%) Profit $270,000 Gross Revenue Value Calculation

Practice B

sell for based on their prior experience.

Let’s review and see how this method applies.

Let’s assume we have two dental practices, one grossing $600,000 and one grossing $800,000. Practice A has overhead of 55%. The adjusted profit in this case would be $270,000. The second practice, grossing $800,000 has an adjusted overhead of 66.3%. The adjusted profit in this case would be identical at $270,000. Let’s assume the valuator states that both practices are worth 60% of last year’s gross receipts. Practice A would be $360,000 and the value of Practice B would be $480,000. Comparing these values would mean a purchaser may pay $120,000 more for a practice netting the same as Practice A! So what’s wrong with this picture? Well, the simple reason is that a purchaser will be paying more money for the same net revenue. We’ve provided you an illustration to prove our point. We assumed a seven year loan with an interest rate of 6.5%. So the bottom line in using a Gross Revenue Multiplier Method is that it is only useful for comparing the ratio of historical sales price to practice 8 WWW.THENEWDENTIST.NET FA L L 2 0 1 1

Practice B Gross Receipts $800,000 Practice Value $480,000 Pre-Debt New Income $270,000 Post-Debt Net Income $184,928

gross receipts when the overhead ratios are comparable. In cases when they are not, clearly, this is not the way to go.

Practice A would provide an additional $148,882 in income (without adjustments) over the loan period.

The worst thing about buying Practice B is that you’d be working 33% harder to get the same net, which is not too appealing.

So, if Gross Revenue Multipliers don’t work, what’s the next best solution? In our opinion, the tried and true method of valuing a dental practice is based on the practice’s net profit plus the fair market value of the Tangible Assets (equipment, leaseholds, supplies, etc.). The bottom line is that when you are buying a dental business you are buying someone else’s income stream. So, valuation methodologies using practice cash flow, net profit and value of Tangible Assets indicate the opportunity you have and more accurately reflect the true worth of a practice.

Ultimately, if you want to trust your future on a “simple” valuation you may be disappointed with the outcome.

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.

This material is an outline only and not a contract. 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; insured 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. ©2011 Great-West Life & Annuity Insurance Company. The inverse boomerang logo is a registered trademark of Great-West Life & Annuity Insurance Company.

All Rights Reserved.

NDAD11-ND

Protecting the practice—and the life—you’ve built. Life • Disability • Business Overhead • Hospital & Critical Illness

ONE DENTIST’S JOURNEY:

BY CHEDLY SCHATZIE VINCENT, DMD

L

ike many recent graduates, when I finished dental school I was unsure about how I was going to practice. I remember asking myself, where do I want to live? How will I pay my student debt? How much do I want to earn? Should I open my own practice and, if so, how will I pay for it?

As I started exploring my options – going into the military, working as an associate at a private practice, or starting my own practice – I also began to research large group practices. I had heard the stereotypes – that my schedule would be overwhelming, that group practices were driven by profits, and that clinical decision-making would be out of my hands. But when I started asking questions, it quickly became clear those stereotypes didn’t hold true.

The benefits of large group practice, such as career opportunities, marketing and business support, and chances to network with my peers, seemed to far outweigh the one disadvantage I could think of – not owning my own practice. Then I discovered Aspen Dental and their Practice 10 WWW.THENEWDENTIST.NET FA L L 2 0 1 1

Ownership Program. This unique program provided me the opportunity to own my own practice and still have all the advantages of being part of a group practice. For me, it was the perfect fit.

Clear path to ownership In 2006, I started with Aspen Dental as a Managing Clinical Director; I didn’t own a practice right away. During this time, I was able to develop my clinical skills quickly in a busy practice with support from a more experienced practice owner. I learned through hands-on experience in clinical diagnosing and treatment planning, along with great professional training and business development programs.

Over time, I felt confident in my abilities and knew I was ready to own a practice. Because I had worked at Aspen for years, I knew the business model made sense. I saw my classmates from dental school in private practices struggling with the management aspect of the business, and hurting financially. It’s not a surprise – we had trained to become dentists and deliver patient care, not run a business.

My experience would be different – I had the support and guidance from the team and didn’t have the financial risk of attempting to go at it alone.

CONTINUED ON PAGE 12 >>

Dr. Chedly Schatzie Vincent received her DMD from the College of Dental Medicine at Nova Southeastern University. Today she owns two Aspen Dental offices in Fairfield and Norwalk, Connecticut. She can be reached at drcvincent@aspendental.com

TYLER OLSON/SHUTTERSTOCK.COM

My Experience with Large Group Practice

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Large Group Practice continued from page 10

Business support The marketing and business support that comes along with joining a group practice has really made a difference in my success. I have access to a wonderful group of people at our practice support center who handle the administrative burdens that would distract me from patient care, things like payroll, benefits, and insurance processing.

Also, my practice has an established brand name backed by a strong marketing and advertising team that keeps a steady flow of new patients coming to my practice.

Being part of a large group practice, both of my offices benefit from the purchasing power that comes with being part of a larger network – from equipment and supplies to advertising buys. Aspen also supports the negotiation of insurance contracts and, being part of a large group, I am able to get better reimbursements from insurance carriers.

For me, it’s the best of both worlds – I’m able to run my practice, manage my team, and develop my people, but without some of the headaches that come along with running a successful business. Today, I own two Aspen

12 WWW.THENEWDENTIST.NET FA L L 2 0 1 1

Dental offices, in Fairfield and Norwalk, CT, and couldn’t be prouder of what I have accomplished.

Peer-to-peer interaction There is a sense of pride among all dentists in the network.

The camaraderie that comes along with being a part of a bigger network is something I didn’t expect. My peers and fellow practice owners offer a wealth of experience that I’ve been able to tap into and learn from.

Many of my peers were in private practice for decades before joining the team, so they have a unique understanding of our industry from both sides of the coin. As practice owners, we frequently get together to talk about trends in our practices and the industry as a whole, and to share ideas on how to grow our individual businesses and build stronger teams.

My advice for new dentists I would encourage all new dentists to really explore their options. Put stereotypes aside and look at the choices in front of you with an open mind. Group practice won’t be the choice for everyone, but it was the path that worked for me.

BEEN THERE, Done That

Dr. Rod Kurthy in his practice in Mission Viejo, CA. Photo courtesy of Dr. Kurthy.

Guru Knows How to Make the Most of New Patients Spend a few minutes with Dr. Rod Kurthy and it doesn’t take long before his passion and infectious enthusiasm for the profession of dentistry become plainly evident. This general practitioner’s knowledge and understanding of what it takes to enjoy profound success stem from seemingly simple strategies that virtually any practitioner could pursue. The difference, however, is that only some are willing to make the effort.

T

he New Dentist™ recently had the opportunity to talk to Dr. Kurthy, founder of Evolve Dental Technologies and creator of the KöR® Whitening Deep Bleaching™ system about his career and his advice for new dentists.

Throughout Dr. Kurthy’s 30+ years in dentistry he has had one primary goal: “fun,” which, in Dr. Kurthy’s mind, means improving the profession as well as the tools and techniques used. This dentist/entrepreneur is known across dentistry for his many successes. In addition to starting his own company and developing KöR® Whitening Deep Bleaching™, he is one of the founding members of

enough, so Fridays became my research day. All dentists frequently say, ‘Somebody should come up with a better way to do that.’ So just for my own fun and on my own dime, over the past 32 years I would develop new treatment techniques and work with dental manufacturers on the development of new products.” Many of the techniques and products used in the dental marketplace today were brought about originally by Dr. Kurthy.

Since 1976, Dr. Kurthy has been involved in research and development of techniques and products in the fields of: whitening, bone regeneration, impression systems, cos-

“If you can say in your marketing that you can straighten adults’ teeth in just six months, you can’t believe how many will flock to you.”

DentalTown, author of six books, a key source on dental topics for the national news media, and a widely respected dental researcher.

Ironically, it all began out of boredom. After finishing his residency program at Newark Beth Israel Medical Center, which Dr. Kurthy describes as a “battleground where we dealt with continuous trauma, massive dental infections and all manner of excitement, sometimes for up to 34 hours straight, with no breaks and no sleep,” he entered private practice.

After the thrill of his general practice residency, he found that day-to-day life in the dental office was boring.

“Although I love treating patients, I just wasn’t challenged

14 WWW.THENEWDENTIST.NET FA L L 2 0 1 1

metic porcelain systems, surgical endodontic treatment, root resorption repair, direct composite technique, dentin/enamel bonding systems, surface microabrasion, tooth desensitization, crack diagnosis and treatment, composite polishing materials and techniques, single-unit delivery systems of bonding agents, enamel re-mineralization technique, techniques for interim treatment of failing implants, bone regeneration around failing implants, laser periodontal treatment and bone regeneration, among others.

While Dr. Kurthy has enjoyed significant success in many areas of dental technique and product research and development, treating patients remains a primary passion.

CONTINUED ON PAGE 22 >>

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What Makes This

Intraoral Camera ‘The Best’?

BY TESS FYALKA, MANAGING EDITOR

Four Doctors Weigh In

D

r. Peter Chen wanted an intraoral camera for patient education and treatment presentation. He was looking for something basic – a means to show patients the true condition of their oral health, but he didn’t want to break the bank. “I wanted a camera that was low cost, would give me the ability to take images and save them for insurance purposes. I wanted to use it to talk about procedures and show patients before and after photos. If you do a filling and the patient looks in the mirror, it doesn’t look like you have done anything unless you are able to show the before and after pictures. Then they can see the work you put into it.”

This 2006 graduate of New York University Dental School invested about $800 in his Cammy USB intraoral camera two years ago. The price and features were just what he was looking for. “I didn’t want to spend a fortune on a high-end intraoral camera. I characterize the Cammy as something that does the job. This camera integrates well with my software. You can zoom in and zoom out. It’s no bigger than a toothbrush, so it can easily go from one treatment room to the next, and it plugs into the laptop with a USB. It’s pretty heavy-duty, as long as you’re not dropping it, it should last.”

For new dentists considering purchasing an intraoral camera, Dr. Chen recommends getting a hands-on demonstration of the cameras you are considering. In addition, he urges doctors to carefully consider what they really need in an intraoral camera, and he says he wouldn’t hesitate to purchase another Cammy.

Dr. Steven Zdep, a general practitioner in Syracuse, NY, uses the Schick USB Cam2. He purchased two of the cameras about six months ago. The Schick cameras replace a different model the practice used for several years. Dr. Zdep said he considered three cameras before choosing the Schick, which interfaces seamlessly with his practice 16 WWW.THENEWDENTIST.NET FA L L 2 0 1 1

management software system and his digital x-ray system, also from Schick.

This clinician says he learned right away that the camera is a huge asset. “When you show the patient a picture of what is happening in their mouth and you are able to draw on the screen to show them exactly what areas you are recommending treatment for and why, they are the ones asking the questions rather than me having to explain what is going on. It’s the patients asking, ‘Why is that brown?’ ‘Why is that cracked there?’ Then they want to know how quickly they can get in to get it fixed. Everyone should have one. It gives people confidence in your work.”

Dr. Zdep, a 2003 graduate of the University of Buffalo School of Dental Medicine, also notes that the Schick model he uses saves the images so that the doctor and the patient can closely monitor changes in the condition of a tooth.

“You definitely want the ability to archive images, especially if you want to watch an area, or if a patient doesn’t accept treatment. You can bring up the images on the computer and monitor changes to the tooth structure.”

He says he chose this model, which costs around $3,000 and has a USB interface, for several reasons. “It has a good range of focus. You can move it around and the picture stays clear. With an eight-LED light source, the lighting is very good and the color is pretty true. It also allows you to highlight a specific area on a tooth to show a patient what is happening there.” Dr. Zdep also notes that the camera received positive reviews in the Gordon J. Christensen Clinicians Report.

The Schick USB Cam2 is used at least three or four times a day and on every new patient in the practice that he shares with his father. Dr. Zdep notes that, given the level of use in the practice, his only concern is how the device will hold up over time. The LED batteries are expected to last for the lifetime of the camera. Aside from routine sterilization, it

requires no special care or maintenance.

Dr. Zdep urges new dentists considering an intraoral camera to look at their current practice management system and make sure it is compatible. The camera should be very easy to use and require little training. The images should have good clear resolution and the camera should have the ability

Cammy™ USB Intraoral Camera Directly connects to a computer via the USB port.

• • • • • • • • •

Designed with a freeze button to capture images and a joystick to control digital zoom.

Self-sufficient, CCD technology, digital image processing.

Four white LED lamp illumination to provide maximum realistic color reproduction.

Built-in lens protector designed to prevent dust and scratches to optical components.

Mini-head design allows for easy access to the third molar.

Lightweight (only 92 grams), ergonomically designed handpiece.

User-friendly software, Easy to use and integrate into patient management software.

Digital images can be easily stored, retrieved and transmitted electronically.

Disposable sleeves included to prevent cross contamination.

Schick USBCam2™ • • • • •

PHOTO COURTESY OF SCHICK

• • •

Lightweight, portable and transfers easily between operatories.

Universal fixed focal range delivers clear, crisp images.

Provides images from extreme close-up to full arch without focal adjustment.

Eight high quality LEDs provide superb image clarity and color.

Advanced noise-free electronics and increased imager sensitivity contribute to better image quality.

Capture button located on the rear of the camera for ease of use.

Connects directly to any computer through high speed USB 2.0.

Multiple mounting options allow flexible installation in any operatory.

to print images. “It is good to be able to send patients home with a picture of the area that needs treatment and it’s helpful in submitting insurance claims as well.”

Dr. Nikki Chauhan of Sacramento, CA, says the Digital Doc Iris has been an excellent choice in her group practice. In fact, she and the other two doctors as well as the rest of the clinical team are so impressed with the ease of use and the quality of the images that they have 12 cameras – one in each operatory.

“We use them all the time. It is very simple, the pictures are excellent, and it interfaces well with our Dentrix system. The focus is good and it will maintain a clear picture even if there is motion. It also has options that allow you to focus on an arch, individual tooth, or multiple teeth, which is a nice feature.”

From Dr. Chauhan’s standpoint, Schick a digital camera is well worth the USBCam2TM money. “It is an excellent return on investment. Many people are visual learners. When the patient sees the picture it becomes real to them.

It’s tangible. It is so much easier to explain the diagnosis and the recommended treatment. It doesn’t just go in one ear and out the other.”

Dr. Chauhan says she and her team have found that using the intraoral camera with children and sending them home with pictures of the condition of their mouths is particularly helpful in encouraging children and parents to improve homecare procedures.

What’s more, says Dr. Chauhan, when the business team is on the phone with a patient, they can pull up the images and see exactly why the appointment is needed.

“The entire team can reinforce the need for treatment any time they talk to the patients.”

Dr. Feras Al Rezk of Visalia, CA, says he considered a few specific factors before choosing the Owandy Digital Camera USB 2.0. “We’ve been using it for about four years now and have been very happy with it. It takes very good CONTINUED ON PAGE 24 >>

FA L L 2 0 1 1

WWW.THENEWDENTIST.NET

17

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Flowable Resins: A CAN THEY DELIVER WHAT THEY PROMISE?

BY JOSH AUSTIN, DDS

s we all know, technology is a major driving force in the dental industry today. One of the major benefactors of technological advancement is biomaterials. Dentin bonding has transformed biomaterials, vastly increasing the number of restorative products available to dentists. Over the past few years, flowable resins have become indispensable in the dental office. As the materials have advanced, their applications have expanded. Today, many companies are recommending flowable resins as the lone restorative material for moderately sized restorations.

Originally, flowable resins were introduced to allow dentists to line preparations and fill hard to reach corners.

They were very light on filler and really did not stand up to any type of intraoral exposure. Contained under more highly filled resins, they served their purpose well. Over time, manufacturers have increased the filler content while maintaining the flowable properties, which has led to the transformation of flowable resin.

For a flowable resin to be successful, it must be thixotropic. That is, it must stay in place or flow as needed.

The decrease in viscosity can usually be triggered by mild agitation. In my hands, this is done with an explorer. The flowable is loaded and when I am ready for it to flow into the areas needed, I run my explorer through it, dragging it to the desired places. Some practitioners may use an applicator brush or any number of powered instruments that use vibration to decrease the viscosity of the resin.

In recent years, dental manufacturers have begun to expand the applications of flowable composites by improving their properties and marketing them for other CONTINUED ON PAGE 28 >>

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/clinicalBuzz/.

What is your experience with flowable resins? Tell Dr. Austin.

Blog on at www.thenewdentist.net/clinicalblog.php.

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New Patients continued from page 14 Having built a highly successful practice in Mission Viejo, CA, Dr. Kurthy has a few suggestions for new dentists seeking to create successful practices, starting with marketing.

“Dentists like to talk about ‘modern dentistry’ in their marketing. But this simply markets ‘dentistry.’ What they should do is tell the public what they can offer, not dentistry in general. If all you are offering is a coupon or financial offer, good luck. That’s not enough to impress “good” patients. You have to make them want to come to only you. You have to appeal to patients who want to have a good dentist because these are the people who will follow through on treatment recommendations. They will stay with you over the years.

They will recommend their friends and family. Those are the good patients.”

And how should new dentists go about attracting the “good patients”? “Talk about things you can provide that will cause excitement,” urges Dr. Kurthy. “Talk about how you use lasers for various things, and anything else that will excite them.” Short-term orthodontics is another area that Dr. Kurthy says generates significant interest for new patients. “There are so many adults who want straight teeth.

If you can say in your marketing that you can straighten adults’ teeth in just six months, you can’t believe how many will flock to you. Oral Conscious Sedation (OCS) is another option that patients get excited about. To be able to say that you can sedate a patient with a pill is another plus because many people don’t like needles and wouldn’t want IV sedation.”

Dr. Kurthy, formerly the official dentist for the USA Men’s World Cup Soccer Team, also recommends providing free sports mouthguards for young athletes. “This can be done to promote a practice, but, more importantly, it’s a great way to give back to the community. Over the years, I’ve received numerous emotional calls from parents telling me how our mouthguards have saved their children’s teeth. That not only feels great, but it creates a wonderful reputation in your community.”

Dr. Kurthy emphasizes, “When a practice offers a free exam or other special offer such as whitening, it is the opportunity for doctor and team to win over this new patient. Most dentists short-cut any ‘free’ treatment because they believe they can’t afford to spend much time or money providing the free offer. The truth is that they short-cut the free exams or free whitenings, and the new patients are not impressed, and the dentists have just proven to those valuable new patients that they are not good dentists, so the patients do not return

22 WWW.THENEWDENTIST.NET FA L L 2 0 1 1

or refer others. That’s just the stupidest thing in the world!

This mistake is precisely why most dentists say that marketing doesn’t bring in the good patients.

“That new patient potentially represents the lifetime value of that patient, the lifetime value of their family members and lifetime value of patients they will refer over the years. I don’t care if the exam or whitening is free or not – take this opportunity to WOW that patient. Spend TIME with that new patient exam. Impress them. Use a great whitening system to totally blow them away. Immediately they will talk about you, saying, ‘Dr So-and-So is the best dentist I’ve ever been to,’ long after the first visit!”

One of the easiest yet most effective means of establishing an excellent relationship with the new patient is for the dentist to personally call them before that first appointment.

“I know that dentists will not want to spend the average two minutes to call these patients, but it is vital that they do so. And it’s not a bad idea for the front desk to let the new patient know that the doctor might be calling to talk to them for a couple minutes.”

Dr. Kurthy explains that the dentist should be given any information that was collected about the new patient when the appointment was scheduled. “All the dentist has to do is say ‘Hi, we’re looking forward to meeting you,’ and either ask more questions about the concern that the patient stated when they booked the appointment, or ask if they have any particular concerns about their teeth or smile.”

When that new patient walks in and meets the dentist, it’s a whole different experience because they’re shaking hands with a dentist who’s already impressed them. “This goes a long way toward establishing this person as a longterm patient, raving fan, and referral missionary – not to mention there is a much greater chance they will accept suggested treatment,” he adds.

In addition, Dr. Kurthy urges new dentists to curb referrals and learn to do more treatment themselves. “New dentists should invest in specific training courses in areas such as endo, perio, oral surgery, TMJ, orthodontics, etc. Short-Term Orthodontics (STO) is a must. When considering courses, don’t decide based on the cost of the course – look at your return over your career.” He recommends Dr. Ryan Swain’s Six Month Smiles® course and Dr. Rick DePaul’s Powerprox Six Month Braces®.

“And get some great books. But don’t just buy the books, read them.” Specifically, he recommends Unlimited New Patients V3 by Howie Horrocks and Dr. Mike Barr’s book The Complete Website Owners’ Manual for Dentists.

For more information about Dr. Kurthy and his company visit www.evolvedental.com or contact Dr. Kurthy directly at RKurthy@ EvolveDental.com.

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continued from page 17 pictures, which I can save, and is compatible with my practice management software. I can also take video.”

Dr. Feras says he will frequently “go live” during a procedure to show the patient what is happening especially

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Digital Doc® IRIS USB 2.0 INTRAORAL DENTAL CAMERA

if the treatment required becomes more extensive than he originally told the patient. “If I have to change the materials and the procedure becomes more involved, the patients appreciate being told and being able to see why the change is necessary.”

For new patients, it helps to provide a foundation of trust in the doctor, his diagnosis, and treatment.

“A new patient comes in and they’ve never had cavities and then you find oral disease, they may become suspicious, until they see the images. But when a new or existing patient takes part in the diagnosis they take greater responsibility in their oral health care.”

He says that the Owandy model is small and very light making it easy to use in each of the treatment rooms.

It plugs into the computer through a USB port and is ready to go. The only improvement Dr. Feras says he would recommend the company make would be custom covers to protect the head of the camera.

For new dentists that want to be able to show patients intraoral pictures but are not interested in a typical intraoral camera, DrQuickLook™ enables clinical teams to provide patients with clear visual images to help them understand the diagnosis and recommended treatment. For example, they can visibly see calculus deposits, caries, fractures, and fillings. DrQuickLook™ allows the doctor to survey the area as well as zoom and freeze an image. After treatment, the dentist can show the patient the final result. However, unlike traditional intraoral cameras, it is not designed to store or print images. It is a standalone viewer that simply allows the patient to see the area of concern on a 3.5 inch LCD screen.

No staff training is required and the device does not use a computer or require USB cables. At $895 it offers an affordable option for new dentists to consider.

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DENTAL STUDENTS: What’s on Your Mind?

Mission-Minded Dental Student Organizes Care in Orphanage UCLA School of Dentistry students provide care to children in China.

Photo courtesy of Junyi Xie.

J

unyi Xie is a dental student on a mission, both literally and figuratively. After two years of careful planning and philanthropic support from six key dental supply companies*, Ms. Xie has organized two, two-week mission trips to China. The first took place in the summer of 2010 and the second is scheduled for Aug. 27-Sept. 5.

This third-year dental student at UCLA School of Dentistry began

“I have integrated this trip with the Chinese Dental Student Association (CDSA) of UCLA, and I am getting some help from a planning committee that consists of participants from the trip,” said Ms. Xie. Her goal: Bring dental care to an orphanage that relies solely on volunteers to provide health care for the children living there. In addition, the trips are providing much needed oral health care for those in the local

“Oral health in China is definitely not emphasized, and there is just a general lack of care when it comes to the teeth. So the patients are very grateful. I was surprised to learn that some people have never been to the dentist in their life, and there is a lack of dental hygiene education in China.” planning the mission trips to Yanjin, which is located in northern China on the border of North Korea and China, during her first year in dental school.

26 WWW.THENEWDENTIST.NET FA L L 2 0 1 1

community, which is severely underserved. “The orphanage really depends on volunteers from other countries to provide for the 80+ kids because it

is run by one mother and one father and receives very limited funding from the Chinese government. In addition, the community where the orphanage is located also lacks in dental care because it is not a developed city, and so I knew they really needed access to dental services.”

Ten volunteers will participate in the upcoming mission trip, one dentist and nine dental students. The focus is restorative work, including composites, scaling and root planing, sealants, prophys, extractions, and oral hygiene instruction. Ms. Xie notes that the need for oral health care is significant throughout the country.

“Oral health in China is definitely not emphasized, and there is just a general lack of care when it comes to the teeth.

So the patients are very grateful. I was surprised to learn that some people have never been to the dentist in their life, and there is a lack of dental hygiene education in China.” *The following companies have been instrumental in enabling Ms. Xie and her team to provide much needed care to those most in need in Yanjin, China: • Colgate-Palmolive • Coltène/Whaledent Inc. • Crosstex® • Henry Schein Dental® • Patterson Dental • Ultradent For more information on how you can become involved, contact Ms. Xie at jxie87@gmail.com.

Dental students, tell us what’s on your mind. Email Managing Editor Tess Fyalka at tess@thenewdentist.net. We want to hear from you.

Flowable Resins continued from page 20

uses. In recent months, we have seen the emergence of flowable resins marketed to be more than just liners or deep fissure sealants. Some products, like Dentsply’s Surefil SDR Flow, have increased the maximum increment thickness to four millimeters. Their flowable system allows the dentist to bulk fill a preparation with their flowable composite, stopping 1-2 mm short of the margins. This bulk increment is cured then the dentist’s favorite traditional resin is layered on top for maximum esthetics and resistance. Dentsply’s clinical trial on this material was done by Dr. John Burgess

the last increment, filling the final portion of the preparation. It does flow much less than the Low Flow component; however, it does flow more than a regular non-flowable composite would.

I used the Beautifil Flow Plus system to restore several teeth over the past few weeks, so I have zero long-term anecdotal data. It does handle almost exactly as it describes.

The Zero Flow will flow slightly if provoked; more so than a regular composite resin would. I used the system for small to moderate sized restorations and took care to not load larger than two millimeter increments. I felt the Zero Flow component worked the best in class V preparations on its own. I had a difficult time adding any anatomy to the Zero Flow pre-cure. I had to cure first and then carve

“I FEEL THAT FLOWABLE COMPOSITES DEFINITELY HAVE A PLACE IN RESTORATIVE DENTISTRY.” and spanned 24 months. It showed good results; however, I would like to see a more longitudinal study, especially on gingival marginal integrity.

The idea of bulk filling a preparation with a large C factor, like an occlusal or small class two, still troubles me.

Polymerization shrinkage in high C factor situations can lead to long-term sensitivity, pulpitis, and pulpal necrosis.

The less filler in a resin composite, the higher the polymerization shrinkage will be. I will be interested in observing how some of these new flowables perform when used in these situations.

Another company that is advancing the use of flowable composite is Shofu. Their Beautifil Flow Plus system utilizes two syringes of flowable composite, each with different handling properties. Using both syringes, Shofu recommends using Beautifil Flow Plus on any class of restoration. Using S-PRG (a treated glass filler) in the composite, Shofu claims Beautifil Flow Plus releases fluoride as it is recharged intraorally.

One of the components of the system is called Low Flow. This is recommended as a base liner and provides “effortless adaptation.” This would be the component of the system that would be initially placed in a preparation after etching and bonding. The next component placed would be the Zero Flow component. Billed as “non-slumping” and for “precision stacking,” Zero Flow would be applied as

visit www.thenewdentist.net

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anatomy with a finishing bur. Partly, this could be user error as Shofu recommends small incremental stacking and curing for anatomy.

Shofu heavily presents their “GIOMER technology” as a major benefit of this material. Previous iterations of compomers have done poorly in clinical tests; however, Beautifil Flow Plus could be the next evolution as it is not technically a compomer. Compomers of the past tended to hold the worst characteristics of both resins and glass ionomers, providing restorations that neither held up to occlusal wear nor released enough fluoride to prevent recurrent decay. Shofu cites an eight-year clinical study on S-PRG; however, they fail to succinctly explain that the study was not done on their material. The results showed an increase in mineral induction with no secondary caries. This particular formulation of glass ionomer particles infused into resin composite may be the cariostatic breakthrough we have been waiting for, but more long-term research needs to be done. In my practice, I would continue to use Beautifil Flow Plus for smaller class I and class V restorations.

I feel that flowable composites definitely have a place in restorative dentistry. There was a time when regular resin composite would never be used in some of the applications we use it in today. That may be true in the future for flowable composites. More research needs to be done on these more advanced flowable systems and their long-term success. For now, I will continue to use flowable composite for preventive resin restorations and now class V restorations with Beautifil Flow Plus. One thing that the clinician needs to keep in mind is that per volume, flowable composites are one of the most expensive dental materials we use.

This must be considered when using flowable composite for large restorations.

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Mesa-Solid hygiene, Dentrix, Digital X-ray #12120 Tuscon-4 Ops, Immaculate, Established, GR $700K #12122 Tuscon Area-4 Ops, 2300 SF, Modern equipment #12112 Tuscon-5 Ops, 1850 SF, Successful, Real estate avail. #12121

CALIFORNIA

Barstow-4 Ops, 3 Days hygiene, GR $393K, Adj Net $193K #14357 Big Bear City-3 Ops, New lease, GR $428K #14345 Folsom-GR $1.5M+, 09 Adj Net $550K #14336 Fresno-Merger opportunity-IV Sedation practice, GR $933K #14250 Grass Valley-3 Ops, GR $307K, Adj Net $105K #14337 Grass Valley-3 Ops-4 Avail., Bldg Avail., GR $89K #14362 Greater Chico-4 Ops, 1200 SF, GR $584K, Adj Net $152K #14359 Greater Fair Oaks/Sunrise Area-2400 SF, 6 Days hygiene, GR $1.1M+ #14343 Irvine & Costa Mesa-Combined practices, GR $781K, Adj Net $369K #14355 Laguna Niguel-4 Ops, 1500 SF, Pan, EZ Dental #14352 Lakeport-8 Ops, GR $904K, Adj Net $302K #14338 Lindsay-2 Ops (3 Avail.), Practice/Building for Sale, GR $330K #14363 Los Angeles-4 Ops, 1200 SF, GR $274K, Adj Net $89K #14348 Newport Beach-4 Ops, 1450 SF, 3 Days hygiene #14354 Pleasanton-5 Ops, Excellent location, Must see! #14364 Plumas County-3 Ops-4 Avail., 1245 SF, GR $475K #14318 Redding-5 Ops, 2200 SF, GR $1M #14293 Sacramento/Roseville-Highly successful GP practice #14334 San Diego-3 Ops, 950 SF, Dentrix, Pan, GR $414K #14356 San Diego-6 Ops, 2300 SF, GR $1.4M+ #14331 San Diego-3 Chair office, Pan, Intra Oral Camera #14321 San Diego/City Heights-3 Chair office, Pan #14321 San Luis Obispo-8 Ops, Great location, GR $1.5M+, Adj Net $691K #14353 Santa Cruz-4 Ops-Room for 1 more, 1855 SF, 6 Days hygiene #14361 Santa Cruz-3 Ops, Digital, Pano, Dentrix, GR $300K #14358 Tracy-Equipment, furnishings, leaseholds only #14335 Torrance-3 Ops, 2 Equipped, 1080 SF, GR $434K #14320

DELAWARE

New Castle-4 Ops, 1600 SF, GR $535K #172701

GEORGIA

Atlanta-Looking to expand, GR $942K #19138 Atlanta Suburb-3 Ops, 2 Hygiene, GR $863K #19125 Atlanta Suburb-1 Op, Pedo, GR $426K #19134 Dublin-GR $1M+, Asking $825K #19107 Macon-3 Ops, 1625 SF, State-of-the-Art equipment #19103 Newnan-Growing opportunity, GR $420K #19141 N Atlanta Suburb-Small office w/potential, GR $484K #19142 W Georgia-Modern, Great opportunity #19140 W Georgia-Wonderful opportunity, FFS, GR $690K #19143

HAWAII

Maui-4 Ops, 1198 SF, Pano, Laser, GR $636K #20101

ILLINOIS

Chicago-4 Ops, GR $709K, Asking $461K #22126 NW Suburb Chicago (20 mins downtown)-GR $500K #22131 Northwest-Growth potential, GR $550K #22137 W Suburbs Chicago-Qualified Buyer to buy or merge #22135 1 Hr SW of Chicago-5 Ops, $500K production #22123

Mishawaka-4 Ops, Established, Potential #23113 West Central-Ideal location, Fully digital, GR $1.6M #24101

KENTUCKY

Louisville-Great starter practice or merger #26104

MARYLAND

Penobscot County-3 Ops, Pan, Intraoral Camera, GR $203K #28114 Somerset County-3 Ops, Cerec, Biolase Laser, GR $305K #28113

MASSACHUSETTS

Boston-3 Ops, Well-established, Digital, Cerec, Intraoral #30146 Middle Cape Cod-Modern, State-of-the-Art #30124 N Western-Beautiful location, Real estate for sale, GR $440K #30144

MICHIGAN

Clinton Township-5 Ops, Remodeled, Bldg available #31114 Dearborn-1500 SF, Great location, Bldg for sale #31113 Detroit-3000 SF, Close to suburbs #31112 Sturgis-Good area close to IN border, Bldg for sale #31111 Suburban Detroit-2 Ops, 1 Hygiene, GR $213K #31105 West-5 Ops, 2000 SF, Established pediatric practice, GR $520K #313501

MINNESOTA

Suburban St. Paul-Established, Excellent location #32111

NEW HAMPSHIRE

Southern-Oral Surgery practice, Condo for sale, GR $1.3M #38106

NEW JERSEY

Atlantic County/Egg Harbor Township-Established, Great area #392139 Burlington County-Large Ops, Historic downtown, FFS #392138 Central Jersey-Established pediatric practice, GR $945K #392145 Hudson County-4 Renovated Ops, Digital #392136 Marlboro-Associate positions available #39102 Monmouth County-Hi-Tech 7 Ops, State-of-the-Art, Digital #392140 Salem County-3 Ops, RE avail., GR $600K #392134 South Jersey-Established, Great area, GR $2.7M #392135 South Jersey-4 Chairs, 1600 SF, New facility #392143

NEW YORK

OHIO

Centerville-4 Ops, 8 Days hygiene, GR $680K #44163 Clark County-4 Ops, 3000 SF, Turnkey, GR $900K #44155 Clark County-2.5-3 Day/week, Bldg avail. #44167 Dayton-Established, Avail. immediately, GR $475K #44165 Dayton-Established, 3.5 Day/week, FFS, Avail. immediately #44156 Greene County-Well managed, Low overhead, Large prof. bldg #44160 Medina-Associate to buy 1/3, Rest of practice in future #44150 N Cincinnati-Excellent net profit 4 days/week, Immediate sale #44172 Scioto County-35 Year+ established, 3.5 Day/week #44171

OREGON

Salem-6 Ops, Established, 1500 Active patients, Dentrix #46101

PENNSYLVANIA

Bradford County-4 Ops, 2700 SF, Borders NYS, Digital, Pan #472094 Bucks County-Hi-End specialty practice, GR $1M+ #47149 Carbon-Established, Digital, Laser, Pan #472088 Chester County-2 Ops plumbed for 3, Established #472085 Cumberland-4 Ops, GR $527K #472069 Dauphin County-6 Ops-Opportunity for 9, Dentrix #47133 Lebanon County-14 Ops, Equipment 5 years old #47147 Lehigh County-5 Ops, Pedo, FFS, Open concept #47150 Luzerne County-4 Ops, 1000 SF, Real Estate avail. #47151 Northhampton County-4 Ops, Well-established, Pan #472092 North Hampton-4 Ops, Paperless, GR $1.2M #472082 North Hampton-3 Ops, Room to expand, GR $1M #472086 NW PA/College Town-5 Ops, GR $542K #472076 Snyder County-Established, 4 Days/week #72087 Wayne County-9 Ops, Dentrix, Pan, Real Estate Avail. #472093

SOUTH CAROLINA

Columbia-7 Ops, 2200 SF, GR $678K #49102

TENNESSEE

Chattanooga-Paperless office, Modern #51118 Clarkesville-Excellent opportunity, GR $800K #51116 Maryville-Great practice, Growing community, GR $739K #51109 Nashville-Great area, GR $300K #51117 Nashville-Growing location, Stand alone #51120 Tri Cities-TMJ practice, GR $290K #51119

TEXAS

Dallas-3 Ops, Great potential #52106

VERMONT

Central-FFS, Real Estate for sale, GR $683K #54105

Bronx County-5 Ops, 2100 SF, Digital #412328 Geneseo-5 Ops, Turnkey #41119 Onondaga County-4 Ops, 1800 SF, GR $700K+ #41107 Suburb of Syracuse-Great practice, GR $462K #41117 Tioga County-1400 SF, Pan, Real Estate avail. #412334

Loudon County-8 Ops, Great area, Space avail. for sale #552405/552406

NORTH CAROLINA

WASHINGTON

Cabarrus County-Established, Excellent location, Digital #42179 Charlotte-2 Ops, Beautiful space #423105 Charlotte-4 Ops, 1470 SF, Digital, Laser #423106 Denton-Established, Near Lake Denton, Bldg avail. #42167 Lenoir County-Office bldg & equipment avail. #423107 Northwest-Seasoned practice, Bldg avail. #42178 Raleigh-1300 SF, Established #42172 Raleigh, Cary, Durham-Doctor looking to purchase #42127 New Hanover County-Practice on coast, Growing area #42145

NORTH DAKOTA

S Central-Productive rural practice, GR $696K #43102

© 2011 Henry Schein, Inc. No copying without permission. Not responsible for typographical errors.

VIRGINIA

Burien-5 Ops, Annual production $1.2M+ #57101

WISCONSIN

NW WI-4 Ops w/building for sale #58120

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