New Dentist Spring 2011 by The New Dentist

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FROM THE PUBLISHER’S DESK S P R I N G 2 0 11

Dear Readers,

PUBLISHER

Sally McKenzie Sally@thenewdentist.net

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

DESIGN AND PRODUCTION

’d like you to close your eyes for a moment and picture yourself as a successful dentist. What do you see? A beautiful office? A nice car? Student loans paid in full? A busy schedule with lots of patients? For many new practitioners, success means one thing: busy, busy treating patient after patient after patient. However, few realize that being “busy” doesn’t necessarily translate into successful. I urge you to consider a factor far more important than merely being busy. Turn to page 14 and discover what that all important element is. Also in this issue, we talked to three different dentists about the digital radiography systems they chose for their offices, why they selected the system they did and the impact it has had on their practice. Find out what they told us on page 16. And don’t miss our interview with my good friend Dr. Howard Farran. This widely respected dental guru earned his stripes as a general practitioner; you won’t want to miss his recommendations for every new dentist. Additionally, we have been honored to have the editorial contributions of Dr. Marc Nevins, Assistant Clinical Professor of Periodontology at Harvard School of Dental Medicine, in the past two editions of The New Dentist™. In this issue, he discusses recent advances in periodontal regeneration, specifically with regard to oral plastic surgery. And finally, I encourage you to register 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 S P R I N G 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.

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TABLE OF CONTENTS

SPRING 2011

6 F E AT U R ES

6 Oral Plastic Surgery

By Marc L. Nevins, DMD, MMSc

8 Put Your Practice on Guard By Josh Austin, DDS

10 Been There, Done That:

Guru Dr. Howard Farran Offers Advice for General Practitioners

14 When ‘Busy’ Isn’t Good Enough

By Sally McKenzie, CEO, McKenzie Management

16 The 21st Century Standard of Care: Digital Radiography By Tess Fyalka, Managing Editor

20 Search Engine Marketing for Dental Practices

By Lance McCollough, CEO ProSites, Inc.

23 Smile with Confidence By Ryan B. Swain, DMD

26 What is the National Health Service Corps Doing for Today’s New Dentists?

31 Top 10 for 2011

DEPARTMENTS 2 Publisher’s Desk 25 Dental Students:

What’s on Your Mind?

32 Skinny on the Street 33 Index of Advertisers

14 4 WWW.THENEWDENTIST.NET

ZERO IN ON PATIENT POSITION

Introducing the world’s first Intelligent Positioning System The new Kodak RVG 6500 system is another first from the company who invented digital radiography. The ground-breaking Intelligent Positioning System (IPS) lets you visually align the sensor placement with an intuitive, real-time display. The wireless sensor lets you share sensors between examination rooms and keep your operatories cable–free. This all with the same film-quality images you’ve come to expect from the RVG family. To get the right shot, you need the right sensor.

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ORAL PLASTIC

SURGERY

ecent advances in regenerative therapies, such as periodontal regeneration, root coverage procedures with soft tissue grafting, and procedures combined with dental extractions or postextraction for implant site development, have significantly improved the ability to restore damaged periodontal tissues. Early diagnosis is critical to periodontal disease management and offers a patient the best chance of preserving their natural tooth dentition. Over the past 20 years, it has become accepted in much of the dental community to provide a staged approach to periodontal therapy. This article focuses on how thorough dental diagnoses and evaluation of prognoses can best determine the appropriate treatment options for periodontal patients in need of mucogingival periodontal therapy otherwise known as oral plastic surgery.

Gingival Recession - Diagnosis and Treatment Planning One of the challenges of diagnosing gingival recession is determining the appropriate timing of intervention with corrective periodontal plastic surgical procedures. The clinician must determine the key anatomic factors that influence the evaluation of the need for therapeutic intervention versus the option of monitoring and providing ongoing periodontal health maintenance. Critical decision factors for surgical intervention include: • Extent of gingival recession • Absence of keratinized gingiva • Less than 2mm attached gingiva • Evidence of progressive recession • Compromised access for oral hygiene due to aberrant frenum position or decreased vestibular depth • Need for full coverage restoration • Site of dental implant planned treatment Options for therapy continue to increase as new technologies advance in the marketplace. It is important to assess the evidence of newer therapies in comparison to well-documented procedures such as the free gingival graft1,2 for gingival augmentation, and the connective tissue graft3 for root coverage. Alternative therapies today include allogeneic donor graft biomaterials4 biologic amelogenin-like proteins5 and growth factors6 combined with coronally positioned flaps, biomaterial membranes to scaffold new tissue formation7 and cell therapies.8 6 WWW.THENEWDENTIST.NET S P R I N G 2 0 1 1

Marc L. Nevins, DMD, MMSc

The Gold Standard - Connective Tissue Graft Langer and Langer introduced the connective tissue graft for root coverage procedures in 1985.2 When the treatment goal for gingival recession is a combination of providing root coverage and augmenting the zone of attached gingiva, the connective tissue graft is the gold standard procedure. The added vascular supply available utilizing a connective tissue graft allows for successful, predictable root coverage procedures, as it is a layered procedure with the primary flap advanced coronally over the graft to achieve partial or complete primary closure. In comparison to connective tissue graft, a free gingival graft has only a periosteal blood supply and is therefore more limited in achieving root coverage. Connective tissue grafts can be harvested from either the maxillary palate or the maxillary tuberosity. A variety of successful incision designs have been developed over the years that, depending on the tissue thickness of the palate, are indicated to allow adequate graft thickness and potential primary closure of the donor site wound. In general, connective tissue graft donor sites heal uneventfully with limited discomfort compared to a free gingival graft donor site from the surface tissue of the palate. Larger volume connective tissue grafts may risk temporary or permanent neurosensory disturbance. This most often presents as numbness of the surface tissue on the palatal surface of the maxillary bicuspids. Advanced surgical techniques such as modified double pedicle techniques can allow for optimal healing by: • Repairing clefting of the marginal gingival tissues • Increasing the width of keratinized gingival at site of cleft • Strengthening the marginal gingival tissue • Improving surface tissue contours associated with coronally advanced flap CONTINUED ON PAGE 12 >>

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 E-Mail: marc_nevins@hms.harvard.edu

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Put Your Practice BY Josh Austin, DDS

ust like any other red-blooded American, I love sports. For me, football trumps all with baseball running a close second. There is nothing like a Saturday evening in the fall at Darrell K. Royal Texas Memorial Stadium in Austin. Usually this means watching my University of Texas Longhorns rout the competition. Much to my disappointment, this season has been drastically different as the Longhorns have struggled. Much like my beloved Horns, many dental practices have been struggling as well with a jobless soft economic recovery and fear of tax hikes. One niche in dentistry that might be able to increase a dental practiceâ&#x20AC;&#x2122;s patient base is sports dentistry. All of us practice sports dentistry to an extent, though we might not realize it. The largest sector of sports dentistry, just like general dentistry, is prevention. This comes in the form of mouthguards. Virtually all dentists offer this service to patients, even though it may not be prominent in our in-office marketing. Sports mouthguards can be made quickly and easily, and patients greatly appreciate the

8 WWW.THENEWDENTIST.NET S P R I N G 2 0 1 1

on Guard

service. In fact, sports mouthguards can be an excellent way to build a patient base through community outreach. From a clinical viewpoint, sports mouthguards are quite simple compared to many of our other appliances. The first step is getting an accurate impression with your impression material of choice. I find that, if handled correctly, alginate is accurate enough for this purpose and inexpensive. Certainly, any other type of impression material could be used. After accurate casts are obtained, we must make some decisions regarding the materials to be used. Several factors will influence this decision. First and foremost is which sport the patient is playing. High impact sports like football, hockey, boxing, martial arts (including mixed martial arts), and lacrosse will require thick mouthguards. Great Lakes Orthodontic Laboratory recommends a 5mm thick mouthguard for these sports. Other sports, such as baseball and basketball, may require 3 or 4mm thick mouthguards. In my opinion, a 5mm mouthguard will not be noticeably thicker than a 3 or 4mm mouthguard to the patient, so I only fabricate 5mm mouthguards for my patients. There are several different types of laboratory equipment that can be used to fabricate sports mouthguards. In my opinion, the best method uses a positive pressure thermal forming machine like the BioStar or MiniStar from Great Lakes Orthodontics. These machines yield mouthguards with better fit and adaptation, which provide more support and protection. In addition to a better fitting mouthguard, these positive pressure thermal forming machines give the operator the ability to use multiple layers of EVA material. This allows me to do many different things with the mouthguards I make. I use a 3mm sheet of colored EVA material as the first layer. After this is formed, cooled, and trimmed, I add a name and team logo if desired. On top of this, I add a second layer of CONTINUED ON PAGE 18 >>

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 Dentistâ&#x201E;˘ magazine and website. He can be reached at jaustindds@thenewdentist.net or www.thenewdentist.net/clinicalblog.php.

What are you doing to build your practice? Tell Dr. Austin. Blog on at www.thenewdentist.net/clinicalblog.php.

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BEEN THERE, Done That

Internationally Known Guru Dr. Howard Farran Offers Advice for New General Practitioners

f general dentistry is your passion, Dr. Howard Farran urges you to understand that there is a lot more to building a highly successful general practice than merely fillings and crowns. Chances are good that you’ve heard of Dr. Farran both as a leading international speaker and media mogul as publisher of Dentaltown and Orthotown magazines and founder of dentaltown.com. If you are not familiar with Dr. Farran, you’ll want to get to know this high energy expert who, in his first month in private practice, brought in 88 new patients and collected more than $40,000. He built Today’s Dental, based in Phoenix, AZ, into an eight operatory practice with collections upwards of $2 million a year. He is an internationally known expert on practice management, the author of “The Business of Dentistry,” and CEO of Farran Media, LLC. The New Dentist™ magazine recently caught up with Dr. Farran and asked him to share his insights and expertise as a dentist who has “been there, done that” in the world of general practice dentistry.

root canals, fillings, crowns, composites, veneers, to practice management topics like how to hire employees, scheduling, recall, establishing fee schedules, and others. Take advantage of free online courses such as these. It’s all approved for ADA (American Dental Association) and AGD (Academy of General Dentistry) continuing education credits. You’re going to need those CE hours, so take as much as you can. Start looking at the big money generators in dentistry that insurance pays 80% for, like endo. A lot of dentists get out of school and they don’t have a lot of experience doing root canals. They don’t feel good about doing them, and they refer all of them out to endodontists. When patients are in pain you don’t need a smooth treatment plan presentation. There’s no selling. The patient is in pain, and they want the

“I THINK YOUNG DENTISTS NEED TO CHALLENGE THEMSELVES TO LEARN AS MUCH AS THEY CAN.“ TND: What are the most important steps new dentists can take to ensure success of their general practices? Dr. Farran: Continuing education is extremely important. It’s fairly common that dentists are undertrained when they get out of school. It takes years and years to learn dentistry. Dentists think they know it all when they get out of school. It takes three-to-five years for the dentistry they did when they first got out of school to start failing and for them to realize they don’t know all they think they know. The biggest mistake new dentists make is waiting five years before they take any continuing education. If you take those courses right out of school, you get a huge return on your investment. I think I took about 500 hours of continuing education every year for the first decade that I was in practice. I know that new dentists don’t have a lot of extra money, so that’s why we’ve posted 126 free-to-view courses on Dentaltown.com (with a nominal fee to obtain the credits). We have courses covering everything from clinical topics like

10 WWW.THENEWDENTIST.NET S P R I N G 2 0 1 1

problem taken care of. The typical charge for a root canal is about $1,000, and insurance pays $800. TND: Are there other services that general dentists should consider providing? Dr. Farran: I think young dentists need to challenge themselves to learn as much as they can. Quit throwing in the towel and referring out dentistry. If you limit yourself to fillings and crowns, you’ll be referring out hundreds of thousands of dollars in dentistry every year, and you won’t be challenged. Pay attention to what’s in demand and take those courses. CONTINUED ON PAGE 29 >>

Howard Farran DDS, MBA, MAGD, is a noted international speaker on practice management. He is a graduate of the University of MissouriKansas City School of Dentistry. He earned his MAGD in 1998 and MBA from Arizona State University in 1999.

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Periodontics

continued from page 6

Biologic Agent in Longevity of Therapeutic Result To promote longevity of the therapeutic result recent breakthroughs in combining the application of biologic agents such as Enamel Matrix Derivative or recombinant human platelet-derived growth factor (rh-PDGF-BB) to stimulate healing with advanced surgical techniques have been shown to improve early wound healing. These biologic agents have been documented to provide regeneration of the periodontal attachment apparatus with human histologic case studies.4, 9 These biologic agents tip the healing process toward regeneration with new connective tissue attachment, rather than reliance only upon repair with long junctional epithelial seal. Cervical Restorations Root coverage procedures are not recommended over composite or porcelain restorations. Treating the site of a planed root coverage procedure first with surgical therapy is recommended with the understanding that if there is incomplete root coverage and a restoration is needed for caries control or esthetic reasons this can be provided after the healing is complete. Where class V restorations are present, they can be removed at the time of surgical intervention and replaced after the healing is complete, adjusting to the new level of the marginal gingival as needed. If a crown margin extends onto the receded root surface, this can also be altered prior to surgery to allow for esthetic correction. If a cavity preparation is shallow, it can be root planed or smoothed with high speed instrumentation, but a deeper preparation may pose a challenge for a root coverage procedure. Treating Multiple Teeth Multiple adjacent teeth can be treated with a single surgical procedure to alleviate the need for multiple surgeries. The palate donor sites available and the thickness of the palatal tissue will limit the extent of therapy at one time. Although some clinicians prefer the use of alternative techniques for multiple teeth such as allogeneic acellular dermal matrix10 the predictability of root coverage should not be compromised and in most cases adequate donor tissue can be harvested atraumatically. Case example A 25-year-old patient presented with the esthetic and functional concerns of progressive gingival recession present for the maxillary left quadrant extending from tooth #9-12 (fig 1a). 12 WWW.THENEWDENTIST.NET S P R I N G 2 0 1 1

Fig 1a. A 25-year-old patient presented with the esthetic and functional concerns of progressive gingival recession present for the maxillary left quadrant extending from tooth #9-12

Fig 1b. The buccal flap was designed maintaining the papillary form with mesial and distal releasing incisions extending from tooth #s 9-12

Fig 1c. The clefting of the gingival tissues has been repaired with modified double pedicle sutures and the connective tissue graft has been stabilized with continuous sling absorbable sutures.

The surgical treatment plan was to proceed with a combined procedure of modified double pedicle technique, connective tissue graft, Enamel Matrix Derivative application (Emdogain, Straumann), and coronally advanced flap. With local anesthetic, a buccal flap was designed maintaining the papillary form with mesial and distal releasing incisions extending from tooth #9-12 (Fig 1b). Once the flap was elevated, root preparation was provided with chemical treatment and hand instrumentation. Tetracycline paste was applied for approximately two minutes prior to root planing with curettes. Once a hard, smooth root surface was achieved, a second chemical treatment was applied with neutral pH EDTA (Prefgel, Straumann). The next step was to repair the clefting of the gingival tissues. This was accomplished with double interrupted sutures placed at the site of clefting with non-absorbable 7-0 polypropylene sutures (fig 1c). (For sites with deeper clefts more than one suture may be necessary.) A connective tissue graft was then harvested from the maxillary left palate and the donor site sutures with a continuous suture for primary closure. The buccal surfaces of the interdental papillae were deepithelialized prior to graft placement. The graft was then sutured CONTINUED ON PAGE 30 >>

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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

When ‘Busy’ Isn’t Good Enough By SALLY MCKENZIE, CEO

It’s a familiar mantra among new dentists… “I just want to be busy.” Understandably, when you are beginning as a practitioner, you simply want patients in the chair. There’s little concern for how your day is structured. You aren’t thinking about “ideal day,” or “scheduling for production”; all you want is to be busy. Honestly, early in practice for the first couple of years, “busy” is a logical goal to pursue. However, over time, as you mature and grow in your profession, the concept of “I just want to be busy” can eventually become a pattern for poor production and a source of frustration for you and your entire team.

hat’s wrong with wanting to be busy? The concept of “busy” typically translates into unorganized, unproductive, and ineffective. There’s no focus or structure to the doctor’s day. If the scheduling coordinator has the doctor running from room to room, s/he believes s/he is meeting the doctor’s expectations, after all the doctor is “busy.” Yet, there are no goals tied to the schedule. Consequently, it becomes a hodgepodge of space and time strung together in hopes that the doctor will be busy enough to pay the bills, pay the team, pay him/herself, and build a financially successful practice. In reality, busy isn’t the goal; rather, productive is the goal. How do you get there? As your patient base grows, take a few straightforward steps to ensure that your schedule is structured so that you are achieving financial objectives, start with a specific goal. Let’s say yours is to break the half-a-million dollar mark by your fifth year in practice. Keep in mind that the hygiene department should be expected to generate 33% of practice revenues. Taking 33% out for hygiene leaves the doctor with a $335,000 annual production goal. This calculates to about $7,290 per week (taking two weeks out for vacation). Working 32 hours per week means the doctor will need to be scheduled to produce about $227 per hour. A crown charged out at $950, which takes two appointments for a total of two hours, exceeds the per hour production goal by $496. This excess could be applied to any shortfall caused by smaller ticket procedures.

14 WWW.THENEWDENTIST.NET S P R I N G 2 0 1 1

Unfortunately, you are probably not doing crowns every hour on the hour. Regardless of your personal goal, following the formula below will enable you to determine the rate of hourly production. From there, you can establish your own personal production objectives. 1 The assistant logs the amount of time it takes to perform specific procedures. If the procedure takes the doctor three appointments, s/he should record the time needed for all three appointments. CONTINUED ON PAGE 22 >>

Sally McKenzie is CEO of McKenzie Management and Publisher of The New Dentist™ magazine, www.thenewdentist. net. Ms. McKenzie welcomes specific practice questions and can be reached toll free at 877-777-6151 or at sallymck@ mckenziemgmt.com.

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The 21st Century Standard of Care

DIGITAL RADIOGRAPHY Digital radiography has become the standard in diagnostic imaging. As the technology has steadily improved, reliability and versatility as well as the image sharing capabilities have made digital x-ray a “must have” technology for today’s dental practice. The New Dentist™ magazine recently spoke to three new dentists using three different digital radiography systems. There is no shortage of quality systems available, and each of the doctors we spoke with is extremely satisfied with his choice.

DEXIS Dr. John Vargas is a solo practitioner at Chappaqua Smiles in

Chappaqua, New York. After graduating from the University of Maryland Dental School in 2004, Dr. Vargas gained experience in Washington, DC and in Boston offices that used traditional film radiography. He notes several differences. “Now that I am restoring implants, the time element is very obvious. Digital images are instantly on the screen. I can verify if an implant abutment or impression is seated with digital. With film, after each x-ray, we would have to wait several minutes for the film to develop. Even retakes can be done immediately without removing the sensor from the patient’s mouth.” Moreover, patients appreciate the fact that digital x-rays expose them to less radiation, are instant, and are just as, if not more, comfortable than conventional film. Since implementing it in June 2010, Dr. Vargas finds that patient education is one of the main benefits of digital 16 WWW.THENEWDENTIST.NET S P R I N G 2 0 1 1

Courtesy of Schick

technology. He notes that his technology is considerate of the patients’ time constraints as well as dentists’ need to inform. “I feel that an educated patient is an informed patient, and an informed patient is more willing to accept treatment recommendations.” he says. “The patient better understands why I may recommend treatment when they can actually see the problem tooth on the monitor. Sometimes, I don’t even have to say anything. Their reaction to the image on the monitor is, ‘Wow, I have never known so much about my teeth. I didn’t know that filling was so big, so maybe we should do something about it.’” Communicating visually and verbally also helps in developing patient loyalty. As a new dentist taking over for a dentist who has treated them for 30 years, the visual image shows that I am not lying about my diagnosis. The image quality with my DEXIS® Platinum sensor is clear, and because of the digital format, I can zoom in or change the resolution, making it easier to see conditions that would not have been seen on conventional film. The staff was trained quickly and easily. Dr. Vargas used conventional radiography during his year-long GPR residency in a Baltimore, VA hospital, where he focused on prosthetics, implant-retained prostheses, implants, and full mouth rehabilitations. In the new office, the dentist, assistant, and two hygienists worked with a DEXIS instructor for a day, and “after a week of using it, we felt like experts.” He chose DEXIS

mainly because of brand loyalty. “I had used it at another practice. I liked both the image quality and customer service.” Dr. Vargas hopes to transition to a chartless office. He now uses the Easy Dental® practice management system to track patient information, insurance, emails, treatment plans, and act as a link for the images. Charts and progress notes are still on paper; however, the digital x-rays are easily shared with colleagues electronically. “Digital radiography is one of the best returns on investment a new dentist can make,” says Dr. Vargas. “In this age of networking and high-speed connections, patients expect cutting-edge technology.” He adds, “Many new patients complain that their former dentist was not up-to-date. Even though he may have been good, their perception is that technology means better care. Adding digital technology definitely contributed to my practice’s growth.”

Schick Dr. Joshua Solomon, or “Dr. Josh” as he is known to his

patients, is a second-generation pediatric dentist, and the owner of a large practice in Livermore, CA, which he took over from his father about two years ago. Dr. Solomon earned his DDS from the University of the Pacific Dugoni School of Dentistry. Following dental school, he completed an additional two-year specialty residency in pediatrics at the University of Texas Dental Branch, Houston. With three doctors on staff, including an orthodontist, as well as seven additional members of his clinical team and three business employees, the practice sees 40-65 patients per day in eight chairs. Efficiency is critical in this completely paperless office. “About a year ago, we transitioned to paperless, transferring about 4,000 active patients from paper charts to electronic records. We made the transition over time, but the first thing we did was start using the first-generation Schick digital x-ray system. Shortly after that we moved to a new 3,000-square-foot office and went completely paperless. We scanned all of our old paper charts and adopted Schick’s new CDR Elite Sensors. We were among the first of the early adopters,” noted Dr. Solomon. He finds that his digital x-ray system works seamlessly with the Patterson EagleSoft practice management software. Dr. Solomon says choosing this particular technology was done with careful consideration. He did extensive research before deciding to invest in the Schick digital x-ray system. “I spent a lot of time reading literature on the different systems and viewing images. I chose the Schick Elite because the quality of the image is far better than the other systems I looked at. In pediatrics, it’s often difficult to diagnose because the enamel and dentin are very dense and it’s easy to miss caries without a high resolution image. The other reason was

the ease of use and placement of the sensor. We see children from age 1 to 18. I looked at a flood of companies with rounded edged sensors, but they would cut off up to 20% of the image. The shape of the Schick sensor allows us to get a full-mouth series on 3-year-olds with no problem.” The Schick sensors are available in three sizes, 0, 1, 2 and can be used with cable lengths that are 3’, 6’, 9’. Sensor life is typically more than 400,000 doses. Another of the system’s key features, notes Dr. Solomon, is that the cable is “field replaceable,” meaning, “If the cable is damaged, you can just unscrew it and change it out in about three minutes without shutting down the system. The cable is very strong, but I have on occasion had a special needs child bite down and while they didn’t bite through the cable, if they bite through the plastic I would worry that it would fray. So I can just change it right away and not be down a sensor.” In terms of staff training requirements, Dr. Solomon found that making the transition from film to digital requires training and practice to ensure that the staff is comfortable using the system. “It takes time to get used to sensor placement. We had both Patterson and Schick come out and train the staff. Within a week or two, they had no problems. It’s rare that we have a child now who we can’t get an image on, and there are very few instances when an image needs to be retaken.” While the system allows for easy adjustment of the contrast of the image to lighten or darken it, Dr. Solomon says he rarely has to use that feature. “I will do measurements with the pulp or looking at space lost if there’s an orthodontic issue. Those features are built in and very easy to use.” Not only does Dr. Solomon appreciate that his digital x-rays not only provide an instantaneous image, but “they are so sensitive that they use up to 85% less radiation than the traditional film x-rays. The computerized images also allowed us to do away with the use of chemicals to develop the film, decreasing our impact on the environment.”

KODAK Dr. German Trujillo is an oral and maxillofacial surgeon in

San Diego, CA. He earned his DDS degree from the Health Sciences Institute CES in Medellin, Colombia and his specialty degree from the University of Illinois College of Dentistry at Chicago in July 2009. After spending five years in Seattle as an associate oral surgeon, he opened his first practice about 18 months ago. It was then that Dr. Trujillo began using digital radiography, the KODAK 9000 system, specifically. Prior to that, Dr. Trujillo had used film based x-rays. “Transitioning to digital was no problem. You can instantly see the benefits, so too can your patients. The CONTINUED ON PAGE 30 >>

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Mouthguards continued from page 8 2mm clear EVA material. This yields the desired 5mm guard that has the cool details patients love, such as names, logos, and team colors. For a new dentist, making sports mouthguards can be a good way to increase exposure and patient flow. There is most definitely a high school, college, or sports club near every practice that might need mouthguards for one or more of their teams. Compared to some external marketing, fabricating mouthguards for a local football team is inexpensive and can yield high results. Over the past year, we have seen the emergence of branded mouth guards for sports. Under Armour® has been very aggressive with their marketing of these “performance enhancers” to the general public. With a subscription fee through Patterson Dental, they will issue the marketing materials to be used in the office. Their proprietary data shows use of their mouthwear decreases cortisol production and through improved oxygen exchange, decreases lactate levels thereby increasing strength and performance. They offer two different models of performance mouth-

wear, and selection depends on the sport being participated in. While I feel that any dentist can make a comparable guard in their office, Under Armour® offers a brand that patients are familiar with and desire. Seeing their favorite athletes smile during competition revealing the patented Under Armour® logo probably generates more interest in mouth guards from patients than any amount of chair-side education. Trauma education for local schools and organizations can also be a great way to reach out to the community, all the while promoting your practice. Put together a dental trauma kit for local school nurses or Scout troops with information on what to do after a student suffers dental trauma. Make sure your practice logo and information are plastered all over the documentation. Affix a sticker with your info on containers of balanced salt solution that can be used to store avulsed teeth. School nurses appreciate help with issues that are outside their realm of comfort. No dentist will be limiting his/her practice to sports dentistry any time soon. It is such a small niche in dentistry; however, it can be a vehicle to allow a new dentist to reach out to the community and help build his/her practice.

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Search Engine Marketing FOR DENTAL PRACTICES

BY Lance McCollough, CEO, ProSites, Inc.

f you’ve ever wondered about making Internet marketing an important part of your practice development strategy, consider this: Americans search the Internet over 10 billion times each month (that’s billion with a “b”). One national study found that over 100 million Americans search the Internet for health related information, and 70% said the information they found online influenced their treatment decisions. This represents a huge opportunity for doctors who capitalize on search engine marketing. So, how can you capture a share of all those prospective patients conducting searches in your local area? The answer is search engine marketing. Search engine marketing (SEM) is a form of Internet marketing that seeks to promote websites by increasing their visibility and ranking within the search engine results pages. This is typically done using search engine optimization (SEO) techniques, pay per click (PPC) campaigns, and other methods. Pay per click (PPC), is a quick and easy way to target prospective patients at the precise moment they are searching for the services you provide. Unlike search engine optimization (SEO), which can take months of hard work without any guarantee of success, PPC is immediately effective in driving targeted visitors to your website, typically within a matter of just minutes. All of the top search engines have PPC programs available. Google AdWords, Yahoo Search Marketing, and Bing AdCenter are the majors (Microsoft’s Bing AdCenter and Yahoo Search Marketing have recently created an alliance). With PPC, you are essentially bidding an amount you are willing to pay for each visitor who clicks your “sponsored link.” Bids can be as low as one cent (.01) per click. Your sponsored link only appears when a prospect does a search using your chosen keywords, so you have the advantage of targeting prospective patients who are seeking out high value services like cosmetic dentistry, dental implants, or any other services you wish to focus on. You’ll need to have a good website before you start a PPC campaign. Your website is where the prospects will end

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up when they click your sponsored link. You’ll want to have a website that not only looks great, but also has good content related to what the prospects are searching for. I’ll assume you already have a great website.

Where to Start I recommend starting with Google AdWords, since Google has the lion’s share of all Internet searches. You can setup your Google AdWords account on your own for just $5, or you can hire a professional to do everything for you. For those who are computer savvy, Google’s help screens should provide enough information to enable you to get set up properly. Choose your keywords You want to narrow your focus to specific services and choose a bunch of keywords that relate to those services. Be certain to break out each service into its own group. For example, don’t lump keywords for “teeth whitening” with keywords for “dentures.” Prospects that search for one type of service will be focused on that service and not necessarily on any other service. Google AdWords allows you to segment your keywords into multiple AdGroups. This is important because you’ll also be creating short ad text that will be shown with your sponsored link. If your ad text matches the keywords that triggered your sponsored link, you’ll get a higher number of visitors (and avoid wasting your money on bad clicks). In most cases, a handful of well-targeted keywords will deliver the majority of your relevant clicks, so there’s no reason to come up with hundreds or thousands of keywords. Create your ad text When a person does a search using one of your keywords, your ad text (with a link to your website) may appear on the CONTINUED ON PAGE 28 >>

Lance McCollough is the CEO and founder of ProSites, Inc., a website design and Internet marketing company specializing in dental practice marketing. For more information, call (888) 932-3644 or visit www. prosites.com.

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Scheduling for Success continued from page 14 2 Record the total fee for the procedure. 3 Determine the procedure value per hourly goal. Take the cost of the procedure, for example $215; divide it by the total time to perform the procedure 50 minutes. Production per minute value - $4.30. Multiply that by 60 minutes - $258/hour. 4 The amount must equal or exceed the identified goal. Now you can identify tasks that can be delegated and opportunities for training that will maximize the assistant’s functions. You also should be able to see more clearly how set up and tasks can be made more efficient. Additionally, it is essential that your scheduling coordinator be trained and fully understand the concept of scheduling to ensure that specific production goals are met. Next curb the no shows and cancellations. Every dentist, new or experienced, must cope with the frustrations associated with patient cancellations and no shows. And with the recession, the number of holes in the schedule has surged in many offices. Compound that with lower treat-

often unwittingly minimize the value of the professional hygiene appointment. Consider this common scenario that is played out over and over again by both new and experienced dentists: The hygienist spends time explaining to Mrs. Patient that she is now showing signs of periodontal disease and may require more frequent hygiene appointments. The patient is con-

Every dentist, new or experienced, must cope with the frustrations associated with patient cancellations and no-shows. ment acceptance these days and you have all the makings of a serious scheduling challenge. Too often clinical teams point fingers at the business staff to maintain a full schedule. In reality, it’s a partnership. Clinical teams have an indispensable role in educating patients to keep appointments, and scheduling success begins chairside. It is essential that clinical teams emphasize the value of the dental care provided during even the most routine dental visit as well as clearly explain to patients the importance of keeping their appointments. Ironically, dentists frequently overlook the significant influence that they have on the patient’s perception of routine dental care. In a rush to return to their own patient, they

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cerned and is prepared to schedule these visits once every three to four months. Then the doctor walks in to check Mrs. Patient. The doctor greets her and marvels at the great job she is doing with her oral health care, unintentionally causing Mrs. Patient to question the hygienist’s assessment of her periodontal condition. “The doctor said I’m doing a great job; why would I need another cleaning so soon.” Even more troubling is the fact that the doctor’s comments cause the patient to question both the doctor’s and the hygienist’s diagnostic abilities. First and foremost, the clinical team has to be on the same page. This situation is easily addressed if the hygienist takes just a moment to explain to the doctor what has been found and subsequently discussed with that patient. It is a simple solution, but it underscores the significance of the clinical team’s role in emphasizing the value of ongoing dental care. Over the next few weeks, pay attention to the subtle or not-so-subtle cues you give your patients regarding care and treatment. And take a good close look at how your days are scheduled, are you truly productive or merely busy?

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Six Month Smiles

Patients Smile With Confidence Ryan B. Swain, DMD

f you’re like me, you graduated from dental school without much practical orthodontic knowledge. In fact, you probably think that fixed orthodontics is complicated and mysterious. I’d like to set the record straight-it’s not! Most of us leave school with a strong desire to expand our abilities and to venture into new areas such as: implants, perio, oral surgery, and molar endo, but ortho seems to be something that most of us are reluctant to tackle. Traditional comprehensive orthodontics can be time-intensive to learn and cumbersome to implement in a general practice. However, Six Month Smiles is a cosmetically focused orthodontic approach that is both patient and dentist friendly and can be implemented with great success in a general practice. A short-term orthodontic system provides adult patients with the ability to have straight teeth in an average of just six months. The system involves use of a focused treatment approach that utilizes clear brackets and small tooth-colored wires to create dental symmetry and to solve the patients’ chief cosmetic complaints. Very light

forces are used to provide the desired cosmetic tooth movement. The short treatment times are mostly due to the fact that the goal of treatment is to give patients an esthetic and harmonious smile while not significantly altering the posterior occlusion. Certain aspects of the occlusal scheme can be improved, such as deep bites and minor crossbites, which is a nice added benefit of this cosmetically focused treatment. Compared to other cosmetic options like porcelain veneers, short-term orthodontic treatment is a downto-earth and minimally invasive option for adults with crooked teeth. Adding short-term ortho to a general practice is essentially turn-key as a dentist can become a provider through attending a two-day, handson seminar. Regardless of previous ortho experience, the seminar provides dentists with a strong ability to select and treat cases successfully. Good case selection and patient communication are essential, as not all patients are candidates for treatment. Generally, if a patient’s chief cosmetic complaints can be corrected in 4-9 months, the patient would be a candidate for treatment. Contrary to what many initially think, dramatic SPRING 201 1

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A DV E RTO R I A L

“Personally, I have had more satisfaction while providing this service than anything else I do.” changes to tooth position can be made safely and predictably during this short time period. Six Month Smiles is also easy to implement in terms of marketing. Patients can easily find Six Month Smiles providers in their area on the www.SixMonthSmiles.com website. Additionally, a wide array of high quality and results-producing marketing materials are available for providers including: brochures, posters, patient educational videos, web content, photo books, and much more. The systematic approach allows dentists to make orthodontics a robust part of their practice. Much of the process can be delegated, and the results are life-changing for patients. Personally, I have had more satisfaction while providing this service than anything else I do. My patients are happy to be in the office and incredibly thankful at the completion of treatment. I usually finish the cases with some minor composite bonding and teeth whitening (Kor whiteningEvolve Technologies). I love providing dramatic cosmetic results in a manner that is conservative and cost-effective for my patients. I am no longer stuck when adult patients refuse traditional braces. This is incredibly freeing for my patients and my practice. Surprisingly, the orthodontists that I work with are also benefitting. I market Six Month Smiles heavily and generate a lot of patient interest, but some of the patients that I see

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for consultations are not candidates for short-term treatment. Also, my eye is now better trained to recognize the orthodontic needs of adolescent patients. Between these two groups of patients, I refer a significant amount of patients to orthodontists in my area. In fact, I operate with the mindset that comprehensive orthodontics should always be the first recommendation for patients with crooked teeth. Years of traditional braces provide for the possibility of creating the most esthetic final result. However, when adult patients aren’t interested in the traditional route, I feel good about offering them a more attractive and time-sensitive option with the Six Month Smiles system. With this tested, safe and reasonable approach, I can give hope to many adult patients who had previously lost hope for their smiles. I don’t think that patients should be stuck with crooked teeth if they aren’t candidates for porcelain veneers or willing to undergo comprehensive orthodontics. I believe everyone should be able to smile with confidence…and I know I can help.

DENTAL STUDENTS: What’s on Your Mind? The New Dentist™ recently talked with UCLA School of Dentistry student Andrew Read-Fuller about what attracted him to the profession and what he appreciates most about his dental school experience. TND: Why did you choose dentistry? I chose dentistry after working in my childhood dentist’s office as a summer intern. I love building relationships with patients and watching them grow. It is rewarding to treat patients and make a positive impact on their lives, and dentistry offers practitioners the chance to get more involved as leaders in their communities. TND: What has been the best aspect of attending UCLA School of Dentistry? My favorite part about dental school is that I have had the opportunity to work with some of the brightest students and faculty in the country. Every day, my classmates and instructors challenge me to be the best clinician I can be, and I am constantly amazed by their hard work and dedication. I am also very happy that UCLA has given me tremendous support for my efforts to get involved in organized dentistry. TND: What, in your opinion, is the greatest challenge facing the dental profession today?

Almost every major challenge in dentistry today is tied in some way to access to care. It is important that dentists and dental students advocate for their patients and their profession. We must all work hard to make sure that the public understands what is involved in our training, so that they understand why only dentists should perform dental surgery. We must also convince legislators to fund Medicaid programs so we can better deliver care to patients who need it the most. TND: Any advice or words of wisdom you have to offer other dental students?

I hope that all students take the time to learn about some of the issues confronting dentistry. Students need to realize that dentistry is facing some major changes in the future, which will inevitably affect the way we practice. Dentistry will be stronger ultimately if students and dentists stay aware of these changes and respond to challenges when necessary. 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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What is the National Health Service Corps

Doing for Today’s New Dentists?

Editor’s note: Representatives from the National Health Service Corps recently answered a few questions for The New Dentist™ to help our readers learn more about the $290 million in new funding available to help dentists and dental hygienists repay student loans while serving communities.

What is the National Health Service Corps (NHSC)? Since 1972, the NHSC has connected over 37,000 primary health care practitioners to communities with limited access to primary care. Currently, more than 7,500 doctors, dentists, nurse practitioners, physician assistants, behavioral health specialists, and other health practitioners are treating more than seven million people in the United States, regardless of their ability to pay. To support their service, the NHSC offers financial, networking, and educational resources to support qualified health care practitioners, including dentists, who want to bring their skills to areas where they are needed most.

How exactly does the NHSC loan repayment program work? The NHSC offers primary care medical, nursing, dental, and mental health clinicians student loan repayment in exchange for two years of service at health care facilities in medically underserved areas, known as HPSAs. Practitioners must first apply for, and accept, a position at a NHSC-approved site, and then apply to the NHSC for loan repayment. Once accepted to the National Health Service Corps, the NHSC offers fully-trained and licensed health care practitioners up to $170,000 in loan repayment for completing a fiveyear service commitment, in addition to their regular salary. The program starts with an initial, tax-free loan repayment award of $60,000 for two years of service.

What is a Health Professional Shortage Area (HPSA)? Communities with limited access to care are designated as Health Professional Shortage Areas (HPSAs). HPSAs are defined regionally, by population group, or medical need. They can be urban or rural and are classified by a lack of primary care practitioners, dentists, and mental health specialists. All NHSC-approved sites are located in HPSAs, and

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currently, there are more than 10,000 sites. About one in five people in the U.S. (21%) lives in a primary care shortage area, which means they go without essential health services, or they have to travel long distances to see primary health care practitioners, including dentists.

What does this mean for dentists? There are currently 4,455 dental HPSAs with an underserved population of 32,780,286. This means that 6,971 dentists are needed to remove the HPSA designation.

How do communities located in HPSAs benefit from the NHSC? The NHSC translates into greater access to health care for those who might otherwise go without. As of December 2010 there are more than 950 National Health Service Corps dentists and dental hygienists serving in more than 750 sites across the country. More than 75% of NHSC members report they plan to stay at the site where they are currently working after their obligation is fulfilled.

What types of service options are available to new dentists? The Affordable Care Act provides more flexibility in how the Corps administers the loan repayment program. In addition to monetary awards that are higher than previous years, the Corps will give members the option of working half-time to fulfill their service obligation and provide credit for some teaching hours.

What is new about the 2011 online application? For the first time, clinicians may apply to the NHSC loan repayment program online where they will find tutorials and additional information to assist in the application process.

Is the Corps expanding? New funding of $290 million from the Affordable Care Act (ACA) builds on a $300 million investment in the NHSC in the American Recovery and Reinvestment Act (ARRA). Approximately 10,500 clinicians will be caring for more than 11 million people by 2011, more than tripling the NHSC since 2008.

Where do dentists go for more information? To learn more about the NHSC and the dedicated public health care practitioners who provide service in all 50 states and territories, visit NHSC.hrsa.gov.

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Search Engine Marketing continued from page 20 top or right-hand side of the search engine results page. Ideally, you want to create ad text that is related to the keywords that triggered your ads. For example, create ad text like “Brighten your smile today!” for your keywords related to “teeth whitening.” For “denture” related keywords your ad text might say something like “Get stable, secure, and natural looking dentures.” When you segment your ad text and keywords into focused AdGroups, you’ll increase the number of clicks you get and convert more prospects into new patients.

Set your budget Your monthly budget will limit the amount of clicks you get each month and the amount you’ll spend on traffic to your website. Pay per click means just that (you pay a fee for each click). You bid on each keyword, and that determines the order in which your ad appears. The higher your bid, the greater likelihood your ad appears at the top of the search results. You’re essentially bidding against other dentists for the same keywords. Google charges a click fee up to your maximum bid. For example, if you bid $1 for the keyword phrase “teeth whitening” and the only other bidder was willing to pay just 25 cents, then Google would charge you 26 cents a click and place your ad above the other dentist. If the other dentist bids more than you, say $1.10, your ad would appear below the other dentist’s ad and cost you up to your $1 maximum bid. Remember though, you only pay when someone clicks on your ad and visits your website (it doesn’t cost you anything to have your ad appear hundreds or thousands of times). Google will only run your ads until you’ve received enough clicks to use up your budgeted amount for the month, then your ads stop running (until the start of the next month). Use Geo targeting Google AdWords allows you to target your ads so they only appear to users located in your local area. Without getting too technical, it does this by identifying the IP address of the person doing the search. It’s critical that you use Geo targeting in order to prevent your ads from appearing to users who are outside your local area; otherwise you could end up paying for clicks from visitors located far away or in other states. Use landing pages So, you’ve carefully chosen your keywords and have written some pretty compelling ad text. Your ads are being seen by hundreds of prospective patients and being clicked numerous times each day. Great! But where do they land on 28 WWW.THENEWDENTIST.NET S P R I N G 2 0 1 1

your website when they click your sponsored link? If you’re smart, you won’t just drop them off on your home page. Instead, you’ll want to send them to the specific page on your website that relates to what they were searching for. If they are searching for “teeth whitening” you’ll want them to land on the “Teeth Whitening” page of your website. If your sponsored link sends them to your home page, the visitor will have to navigate through your website to find what they were looking for. More often than not, they simply hit the “back button” and leave your website. On the Internet, people have the attention span of a fly. For this reason, you want to take them to the information they were looking for. This is also one of the greatest benefits of PPC; you direct what page they land on and get to spoon feed them the exact info they were searching for. Proper use of landing pages will dramatically increase your number of “conversions” (that is, the number of prospects who contact you to schedule an appointment).

Track your results Google AdWords keeps a record of all of your account activity. You can view reports showing the number of times your ad was seen (impressions), the number of clicks you’ve received, the percentage of times your ads were clicked compared to the number of impressions (click through rate), your average cost per click (CPC), conversions and more. You can setup reports that are automatically generated and emailed to you each month. If you have a Google Analytics account (a free service) you can automatically integrate your AdWords activity in your site statistics from Google Analytics. The main thing is you want to track your performance and determine your return on investment (ROI) so you know your precious marketing dollars are being well spent. Start today! Each day we hear more news about the economy slowing down and that we’re in a recession. When times get tight, you might be tempted to cut your marketing budget. Don’t do it! It has been well documented that increasing advertising during a recession, when competitors are cutting back, is a great way to grow your business and get a better return on your investment than during good economic times. It’s time to be astute about where you focus your marketing dollars and view them as an investment, not an expense. A pay per click (PPC) campaign can be an effective way to target high value patients seeking your most profitable services. Pay per click (PPC) is just one form of search engine marketing (SEM). Other forms of SEM include search engine optimization (SEO) which utilizes techniques to increase your website’s visibility within the natural or “organic” listings (i.e.,

the free listings). Ideally, you’ll want to implement both strategies to attract new patients and target high value services that will keep your practice thriving, in any economy.

Been There, Done That continued from page 10 TND: What should new dentists look for in associateship opportunities? Dr. Farran: Before signing on to an associateship, pay attention to how long staff have been with the doctor. If he or she can’t retain quality staff, something is wrong. And if the doctor can’t keep staff, chances are they are not keeping patients either. Look for an office where employees have been on staff for several years. That is what you want to create in your own office. You want to hire the best team. When I staffed my office, I interviewed for several weeks and looked at 30-to-40 applications. I graduated May 11, 1987,and started my own practice from scratch on Septem7.375" ber 27.xI4.875 spent those four months picking over the players for my team because staff is everything.

TND: What are the best tools to use in marketing a new dental practice? Dr. Farran: Having a practice website and a strong presence on search engines, such as Google, is essential. But don’t overlook visibility on the street. Locate your practice in a place where people will see it. I didn’t go into some medical-dental building where my practice would be hidden on the fourth floor. Yes, these places are cheaper because they have no value. I went into a strip mall with a Safeway, Walgreens, Chase Bank, Pizza Hut, and a dry-cleaner. There were 40,000 cars in and out of the parking lot each month. If just 2% of the people who went through there decided to come to my practice, that’s nearly a full-time practice. We were busy on day one, and if we had an hour of down time, my assistant would put flyers on the windshields of the cars in the lot. We did a million dollars that first year, and that was 1987 dollars. We were highly visible. The office was nice, and all the equipment was new. You have to remember that when you get out of dental school, you create your own luck. Run your dental office like a business, and continually improve or expand what you have to offer. Marketing is essential. At least 2% of your collections should go toward marketing your practice.

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Periodontics continued from page 12 firmly in place to the level of CEJ, or desired root coverage with absorbable 6-0 chromic gut suture utilizing continuous sling suture with the knot on the palatal surface and engaging the interdental tissues at each interproximal pass to add to the graft stability (fig 1c). Once the graft was secured, the primary flap, which was repaired with the double pedicle sutures, was advanced with a periosteal releasing incision and sutured tension-free in a coronal position to provide primary closure (Fig 1d). The post-operative result demonstrates excellent root coverage combined with the maintenance of esthetic gingival contours and a natural appearance with limited evidence of surgical intervention without the comparative pre-operative information (fig 1e). Fig 1d. the repaired buccal flap has been coronally advanced for primary closure over the connective tissue graft.

Fig 1e. The post-operative result demonstrates excellent root coverage combined with the maintenance of esthetic gingival contours and a natural appearance with limited evidence of surgical intervention without the comparative pre-operative information.

Post-Operative Information The need for flap elevation and advancement for primary closure may be associated with post-operative edema or ecchymosis. Patients may expect this to peak at 24-48 hours and should accommodate their schedule with limited activity for the first 48 hours. Pain control is generally achieved with non-narcotic medicine (ibuprophen or acetaminophen) with a mild narcotic available if needed. 1 Sullivan HC, Atkins JH. Free autogenous gingival grafts. I. Principles of successful grafting. Periodontics 1968; 6:121-129. 2 Edel, A. Clinical evaluation of free connective tissue grafts used to increase the width of keratinised gingiva. Journal of Clinical Periodontology 1974; 1:185–196. 3 Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol. 1985; 56:715-20. 4 Harris RJ. A comparative study of root coverage obtained with an acellular dermal matrix versus a connective tissue graft. Results of 107 recession defects in 50 consecutively treated patients. Int J Periodontics Restorative Dent 2000; 20:51-59.

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5 McGuire MK, Cochran DL. Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 2: Histological evaluation. J Periodontol. 2003; 74:1126-35. 6 McGuire MK, Scheyer ET, Schupbach P. Growth factor-mediated treatment of recession defects: a randomized controlled trial and histologic and microcomputed tomography examination. J Periodontol. 2009;80:550-64. 7 Nevins M, Nevins ML, Camelo M, Camelo JMB, Schupbach P, Kim DM. The clinical efficacy of DynaMatrix extracellular membrane in augmenting keratinized tissue. Int J Periodontics Restorative Dent 2010;30:151-161. 8 McGuire MK, Scheyer ET, Nunn ME, Lavin PT. A pilot study to evaluate a tissue-engineered bilayered cell therapy as an alternative to tissue from the palate. J Periodontol. 2008; 79:1847-56 9 McGuire MK, Scheyer T, Nevins M, Schupbach P. Evaluation of human recession defects treated with coronally advanced flaps and either purified recombinant human platelet-derived growth factor-BB with beta tricalcium phosphate or connective tissue: a histologic and microcomputed tomographic examination. Int J Periodontics Restorative Dent. 2009;29:7-21 10 Mahn DH. Use of the tunnel technique and an acellular dermal matrix in the treatment of multiple adjacent teeth with gingival recession in the esthetic zone. Int J Periodontics Restorative Dent. 2010; 30:593-599.

Digital Radiography continued from page 17 quality of the KODAK imaging software is superior, and the integration with my practice management software was satisfactory. But from a maintenance and support standpoint, it is a one-stop-shop. KODAK provides very good maintenance and support for all their products. I use the KODAK 9000 3D System as well. They are always available, which is one of the major benefits of this system. If there is any problem, they can log into our system remotely, so the issue is addressed quickly and efficiently.” For patients, the benefits are obvious, emphasizes Dr. Trujillo. “First, there is much less exposure to radiation. The 9000 system focuses only on the area in need of diagnosis; therefore, the amount of radiation exposure is significantly reduced. Patients do not have to sit in the chair and waste time while we process the images. The pictures are very clear, much better than traditional film x-rays. I can provide a diagnosis, take measurements, and the patient can have a treatment plan in a matter of minutes.” He notes that in choosing the KODAK system he wanted to work with one company that could do it all. “If there are problems integrating different aspects of the system and you are working with different companies, it’s too easy for one to point the finger at the other.” For new dentists considering an investment in digital radiography, Dr. Trujillo offers some advice. “It’s much more efficient to do the research and determine which company will best meet your imaging needs and go with them for the entire system. Look at what the companies have to offer. Consider how the system will integrate with your existing technology, and pay attention to how long the company has been in the digital radiography market. KODAK has a long history in the marketplace.”

TOP

FOR

2011

The best thing about a New Year is the host of new opportunities it offers. There is no better time to ask yourself: What are you going to do to make 2011 a perfect 10? Here are a few suggestions in this Top 10 countdown to making this your most successful year in dentistry yet.

10 If you can see it, you can create it. Where do you want to be one year from now? Involve your staff in developing a plan to ensure that everyone is focused on the same goal, namely total practice success. Over the coming weeks and months, you and your team work through various aspects, including: • Improving communication skills and establishing dialogue. • Clearly defining jobs and responsibilities. • Assessing the effectiveness of specific systems, such as scheduling, new patient procedures, treatment acceptance, etc. Schedule a two-hour team meeting each month to identify the vision, goals, and the strategy for advancing practice success in the coming year.

9 Take the broad goals and objectives and translate them into specific priorities that are individualized for each person. Spell out how each person’s responsibilities and objectives help to achieve those priorities and how they fit into the larger practice goals.

8 Open the lines of communication. Group problem solving and trouble-shooting all involve ongoing constructive communication. Encourage staff to offer input and insights aimed at moving the practice forward.

7 Set the example for your team. Pay close attention to your own actions, behaviors, and decisions daily to ensure they are consistent with practice values and priorities. Do not expect your team to follow you if you are not willing to live by the same principles and uphold the same standards that you expect of others.

6 Cut the deadwood and enjoy smooth sailing. Deal with the problem performers on your team. There are few things more demoralizing to top-flight employees than a boss who

looks the other way when one or more staff consistently disregard office policies, bring poor attitudes to work, generate conflict, and make excuses for poor performance. Next, take a close look at practice numbers, starting with establishing a realistic financial goal for your practice.

5 Create a clear plan of action for production. • •

• • • • •

Establish daily production goals. Make certain that your scheduling coordinator fully understands exactly how much time is needed for each procedure. Prescribe a treatment plan that includes everything that needs to be done. Designate a treatment coordinator who is expected to secure at least 85% case acceptance. Implement an interceptive periodontal therapy program. Provide superior customer service. Each month run the year-to-date Practice Analysis Report and compare it to the same period last year.

Now consider what needs to happen in the treatment room, which brings me to #4.

4 Continue to diagnose patient needs and wants according to your practice philosophy, not on what you perceive they can afford. Emphasizing the importance of oral health and its impact on overall health has never been more important. 3 Regularly review key reports including the Accounts Receivables and Outstanding Insurance Claims reports to monitor exactly how much money is owed your practice. In addition, watch the details of your production, new patient flow, and patient retention using the production report.

2 Watch overhead carefully. The industry standard for overhead is 55% of collections. If you are currently at 60-65%, you are comfortably within reach. If yours is higher, take action. The first step in controlling overhead is to establish the following budget targets: Dental supplies - 5%, Office supplies - 2%, Rent - 5%, Laboratory - 10%, Payroll - 20% Payroll taxes and benefits - 3%, Miscellaneous - 10%

1 Make this your best year yet. Invest in your success. Consider working with a management consultant. Do your homework and pick one with a proven track record. SPRING 201 1

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SKINNY

on the Street

The latest news on products and services for new dentists and their practices OptiBond™ XTR

Procenter Specialty Cabinet Mounted Delivery System Midmark Corporation introduces the Procenter Specialty Cabinet Mounted Delivery System. The Procenter Specialty Cabinet Mounted Delivery System is available in four different models and has been specifically designed to be a standard delivery offering for Midmark’s Artizan™ Pedo Benches and Ortho Cabinets/Carts, in addition to custom applications. Some of the features include a cabinet mounted control tray configured to offer both a right-hand and left-hand option, a cabinet mounted water bottle system, an optional handpiece illumination system, and Midmark’s patented Kink Valve technology, which provides an independent control system for each handpiece. For more information visit www.midmark.com

Kerr Corporation announces a powerhouse addition to its renowned OptiBond™ family of adhesives: OptiBond™ XTR. This extraordinary self-etch, light-cure universal adhesive system—built on proven OptiBond technology—stands apart as the only bonding agent to embody both the power and durability of a total-etch adhesive and the simplified protocol of a self-etch technique. Universal compatibility enables use for any type of restoration, direct or indirect. For more information about OptiBond XTR or to learn about the Kerr portfolio of products, visit www.kerrdental.com, contact your local Kerr representative or call 800. KERR.123. To find out more about continuing education online and free CE credit, visit Kerr University at www.kerrdental. com/education for upcoming live webcasts, on-demand video, and the latest CE articles. For new product updates, special offers and the latest news from Kerr, sign up at www. kerrdental.com/email.

Cone Beam/3D Dose Reduction Of 30 - 40% J. Morita has announced a major reduction in X-ray dosage of its cone beam (or 3D) X-ray units. Morita’s 3D product lines now come automatically equipped with a Dose Reduction Feature that lowers dosage from 30% to 40% on all three-dimensional fields of view. Additionally, the Dose Reduction Feature does not diminish clarity of image, and, in fact, enhances the display of soft tissue. It is rooted in how the machines acquire information. Through advanced engineering, the intensity of the X-rays has been optimized, which decreases the overall level of emissions and dosage. Maximizing the efficiency of the machines has also resulted in sharper images of soft tissue with fewer artifacts. The Dose Reduction Feature is 100% automatic. This feature comes standard on every 3D unit Morita sells which includes the Accuitomo and Veraviewepocs product lines with no retail price increase. Additionally, Morita 3D units that are already in the field can be upgraded with minimal, if any, part replacement. Learn more by contacting J. Morita USA, at 877-JMORITA (566-7482) or online at www.morita.com/usa.

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Four New Ways to Fight Cavities Xylishield Gum, Mints, Mouth Rinse, and Toothpaste. Ultradent Products, Inc. recently launched Xylishield, the ultimate defense against cavities. Xylishield is the perfect addition to the take-home hygiene routine for patients. The Xylishield line consists of gum, mints, mouth rinse, and toothpaste, each containing high levels of Xylitol, an allnatural sweetener that helps to “shield” teeth from cavity causing bacteria. Studies demonstrate that consuming 6-10 grams of xylitol per day may reduce the risk of tooth decay. By helping patients establish a daily Xylishield routine, they’ll be equipped with an easy, effective, and enjoyable way to improve their oral health and reduce the risk of tooth decay. Xylishield gum is available in a fresh spearmint or cinnamon flavor. The complete line of Xylishield products are also available in a convenient “dental care kit.” For more information visit www.ultradent.com.

INDEX O F A D V E R T I S E R S Advertisers in this issue of The New Dentistâ&#x201E;˘ 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. 3M ESPE..............................1 800-634-2249 www.3MESPE.com/KetacNano

Mac Practice.......................19 www.Macpractice.com 646-305-9008

American Dental Association Insurance Plans.................13 www.insurance.ada.org 866-607-5330

McKenzie Management...............21, BC www.mckenziemgmt.com 877-777-6151

ASPEN Dental...................21 www.aspendentaljobs.com 866-748-4299

Practice Pack......................15 www.thenewdentist.net 877.777.6151

Bank of America................18 www.bankofamerica.com/ practicesolutions 877-541-3535

NAPB..................................29 www.napb1.com 888-817-4010

CareCredit...........................3 www.carecredit.com 800-300-3046 x4519 Dental Dreams . ................25 www.dentaldreams.org 312-274-0308 x324 Easy Dental..........................7 Henry Schein Practice Solutions www.easydental.com 800-768-6464

Insurance for Dentists and Dental Practices

American Dental Association Insurance Plans....................13 Job Opportunities

Aspen Dental........................21 Dental Dreams......................25 Legal Assistance

Wood & Delgado.................11 Practice Financing

Bank of America...................18 Practice Management Consulting

New Dentist Bookstore.....27 www.thenewdentist.net

McKenzie Management..................21, BC

Six Month Smiles............IFC www.6monthsmiles.com 866-957-7645

Practice Management Products

Wood & Delgado...............11 www.dentalattorneys.com 800-499-1474

New Dentist Bookstore.........27 Practice Management Software

Easy Dental.............................7 Mac Practice.........................19 Practice Purchases and Sales

PRODUCT INDEX

Keller Laboratories, Inc.......9 www.kellerlab.com 800-325-3056

Continuing Education

Kodak Dental Systems........5 Carestream Dental www.carestreamdental.com 800.944.6365

NAPB....................................29 Restorative Products

Six Month Smiles...............IFC

3M ESPE.................................1

Dental Appliances

Treatment Financing

Keller Laboratories, Inc..........9

CareCredit..............................3

Digital Radiography

Kodak Dental Systems Carestream Dental..................5

visit www.thenewdentist.net FREE information from our Advertisers www.thenewdentist.net/resources.htm

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